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Employer health plans are getting pricier and skimpier

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Re: Employer health plans are getting pricier and skimpier

#491

Post by sokoloff »

kelnos wrote: post #484
kmjg88nvf8 wrote: post #477

Earlier quoted context omitted.

How can "big business" prevent alternative insurance companies?

Lobbying for preferred tax treatment. If insurance costs $500/mo, either your company can pay the premium for you directly, with no taxable event for you; or, they can give you $500 more as a part of your salary, but the government will take $150 of that (or whatever, depending on your tax bracket), and then you have $350 to cover a $500 expense. Individuals can deduct medical/insurance payments on their taxes every…

You can adjust your withholding amounts by filing form W-4 with payroll, so that in-year cashflow issue is largely a red herring. (It’s solvable now and would become standardized/automated if the overall system changed.)

Other (more concerning) items you itemize are the real blockers.

Re: Employer health plans are getting pricier and skimpier

#492

Post by kelnos »

desas wrote: post #468
deepaksurti wrote: post #438

Earlier quoted context omitted.

>> In Japan I have had mixed experiences: Replace ‘Japan’ with ‘metro cities in India’ and its almost the same. I can’t still fathom why there would be no walk in facilities for ailments like cold. I still remember my shock when in US I realised from a colleague that for my cold I need to wait because I can’t walk in and need to take an appointment.

What does a doctor do for a cold? In the UK and I wouldn't dream of going to the doctor's for a cold. You just wait it out don't you?

I don't get this either. If I have a cold, I just take acetaminophen a couple times a day to suppress the symptoms until it goes away. Sure, if you're elderly or have an autoimmune deficiency, you may want to see a doc for everything, but that's not that common.

(Amusingly, I was in London a few years ago and came down with a cold. One of my local colleagues told me about this amazing thing called paracetamol that was just magic and would make me feel better. I was astounded that we didn't have it back home in the US... until I looked it up and realized it's just acetaminophen under a different name.)

Re: Employer health plans are getting pricier and skimpier

#494

Post by kelnos »

kuzimoto wrote: post #454
fzeroracer wrote: post #335

Earlier quoted context omitted.

The 'quality of care' you receive in the US is entirely dependent on your wealth and it's only the upper class that actually benefit from it. You know what quality care I got as a poor person? Nothing, because my family couldn't afford it. I was given the privilege of going through highschool and college with teeth quite literally broken down to the gumlines and abscessed because it was either that or not being able…

Did something happen to your teeth that basic maintenance like brushing and flossing wouldn't have prevented? What you're describing doesn't sound very normal, even if you never went to the dentist in your life.

Genetics and diet seem to be large factors in dental health.

Poor people tend to not be able to afford healthy foods and will often eat foods high in sugars, which are terrible for your teeth. Perhaps their parents couldn't afford toothpaste regularly, or floss at all, or could only replace their toothbrushes once a year or two. Perhaps the parents work all the time, and don't have as much time or energy to instill strong daily tooth hygiene habits in their kids or police their brushing.

As an anecdotal data point, a friend of mine always goes for regular dental checkups, and brushes and flosses daily, but still has tartar buildup and gum issues. He had to get a deep-clean, and was in pain and bleeding for several days afterward. I (foolishly) avoided going to a dentist for many, many years, and in that time did a mediocre (at best) job of daily maintenance. When I finally started seeing a dentist again, I got away with two minor fillings (my first ones, and they didn't even numb me at all for the drilling) and a deep cleaning, where I had no bleeding issues and the pain was gone within a few hours (aside from tenderness around the anesthetic injection sites). My gums aren't in great shape, but are better off than my friend's. Unknown as to why the outcomes are so different. I can't imagine what my friend's teeth would be like if he didn't go to the dentist and didn't have good hygiene habits.

Re: Employer health plans are getting pricier and skimpier

#495

Post by DocTomoe »

Hm, 7100 USD for a single person seems pretty affordable. Sounds to me like the US healthcare system is a lot more affordable than they made us believe.

In Germany, with my income level, I pay about 17000 EUR (roughly 18600 USD) per year (of which my employer pays 50%).

Re: Employer health plans are getting pricier and skimpier

#496

Post by broknbottle »

deepaksurti wrote: post #438
greggman2 wrote: post #424

Earlier quoted context omitted.

In the USA, at least in my experience. If I have a cold I still had to make an appointment which would be 2 to 3 days later. I got around this by joining a doctor in a clinic and they'd let me see any doctor if my doctor wasn't avaiable but i'd have to sit in the waiting room for 1 - 2 hrs. In Japan I have had mixed experiences: Good: * It's relatively cheap. Apprently the government sets prices. The government offer…

>> In Japan I have had mixed experiences: Replace ‘Japan’ with ‘metro cities in India’ and its almost the same. I can’t still fathom why there would be no walk in facilities for ailments like cold. I still remember my shock when in US I realised from a colleague that for my cold I need to wait because I can’t walk in and need to take an appointment.

There's no reason to visit a doctor for the common cold. Stay home and get some rest.. Do you take your car to the dealer or local mechanic to put air and washer fluid in your car?

Re: Employer health plans are getting pricier and skimpier

#497

Post by kelnos »

JMTQp8lwXL wrote: post #179
eric_b wrote: post #148

The problem is that there is not a single reason that healthcare is so expensive. Even if you list the top 15 reasons, you still have to apply the "5 whys" to each of them to find root causes and possible solutions. - Doctor's are paid too much... why? - Well they need to be paid a lot because medical school debt is 250k or more... why? - Medical schools/the AMA are artificially limiting the number of students and re…

Software Engineers in the US often make 2x as much as our European counterparts, yet we don't have any artificial limits on the number of people able to study Software Engineering. I'm not disagreeing with you the point on the AMA, but even if they removed their limits -- would many more people want to enter the field? It seems extremely intensive, not only during your education and residency, but on the job too. 12+…

Software engineers are in such high demand in the US that we can't train supply fast enough. In addition, most tech companies tend to be clustered in areas with the highest cost of living in the country. Those two things combined are what serves to push salaries up.

If there were more doctors, they wouldn't have to work 12+ hour days. They are overworked and have to pack patients in because of the limited supply of doctors.

Re: Employer health plans are getting pricier and skimpier

#498

Post by kelnos »

nemothekid wrote: post #189
eric_b wrote: post #148

The problem is that there is not a single reason that healthcare is so expensive. Even if you list the top 15 reasons, you still have to apply the "5 whys" to each of them to find root causes and possible solutions. - Doctor's are paid too much... why? - Well they need to be paid a lot because medical school debt is 250k or more... why? - Medical schools/the AMA are artificially limiting the number of students and re…

>- Doctor's are paid too much... why? Haven't doctor's historically had high salaries? Becoming a doctor requires years of training which leads to a low supply of doctors for a field that has always had high demand. Likewise, Doctors seem to be overworked so I'm not sure I can say they are being overpaid. I don't think all the money that is being spent on healthcare is actually being funneled into doctors pockets. Yo…

No, the low supply of doctors is caused by the AMA, which keeps the number of accredited medical schools low. In the 90s, they were instrumental in getting Congress to pass laws that cap the number of residencies permitted per year. Medicare pays much of residents' salaries, and the law stipulates a maximum number it will pay for, a number that was fixed in 1997, and only changed once, in 1999 (and then only for teaching hospitals in rural areas).

The US population has grown by around 25% since then, but we're still getting the same number of new practicing doctors per year that we got over 20 years ago. Doctors are overworked because we have a shortage, not for any reason inherent to their profession.

Re: Employer health plans are getting pricier and skimpier

#499

Post by paulcole »

simonsarris wrote: post #239
mullen wrote: post #218

Earlier quoted context omitted.

> One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. Now, you can argue it's the morally correct course of action, or those people who will be forced to foot the bill (upper middle class taxpayers) are more capable of doing so, but you cannot credibly claim with a straight face that it will make anything cheaper. In fact, the opposite will oc…

> Having every person under the same plan that has the negotiating power of 327.2 million people will definitely drive costs down. Why do you think this would be true? Why do you think the bargaining power would work the way you think it would? If you were correct, then cop cars must be fairly cheap compared to normal cars. Is this the case? What about other goods? Laptops? Cruise missiles? etc. Actually is it true f…

Wait, how much are you paying for cruise missiles? I always feel like my cruise missile guy is ripping me off.

Re: Employer health plans are getting pricier and skimpier

#500

Post by kelnos »

oarabbus_ wrote: post #328
throwaway5752 wrote: post #324

Earlier quoted context omitted.

For the record I want to say that the second link you pasted - http://www.jparksmd.com/blog/a-massively-overpaid-cartel -actually argues against even more effectively than I was able to.

I'm very glad you pointed that out; I mean, jparks makes the same claim you make - that salaries aren't the problem - and doesn't address the artificial restriction of doctors at all. In other words, he fails to refute the "AMA isn't a cartel" claim. If you prevent the AMA from artificially restricting doctor supply, the overall cost of health care drops significantly, and the health of the population increases consi…

I think you're focusing a bit too hard on this. If we broke the AMA cartel, prices would not magically fall to be in line with other developed nations. The AMA cartel is certainly a factor, and not small one, but it's not the only factor.

We also need to fix the high administrator-to-doctor ratio that adds costs.

Insurance companies provide little value and just extract money from people. They need to go away.

Many low-income people skip out on preventative visits because they can't afford them. This leads to high-cost illnesses later down the road that could have been prevented or mitigated with proper care.

So yes, doctor salaries are inflated, there is a shortage of doctors, and the AMA is a cartel that limits supply. But there's more to it than that.

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