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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

#531

Post by aaomidi »

zanny wrote: post #330
aaomidi wrote: post #260

Earlier quoted context omitted.

You're forgetting that medicare for all also comes with a lot of promises about free education. The artificial barriers for education will be slowly removed and the supply will quickly match up the demand. The solution isn't going to fix everything immediately, but it IS required for a full solution.

Nothing about removing tuition costs to universities changes the AMA artificially restricting the number of medical doctorates issued every year.

Except now starting a training program does guarantee you'll have students that don't need a ton of money to pay off their loans. It becomes less risky.

Re: Employer health plans are getting pricier and skimpier

#532

Post by sokoloff »

kelnos wrote: post #528
sokoloff wrote: post #491

Earlier quoted context omitted.

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.

In practice, most people do not actually understand how the boxes on W-4 translate into withholding amounts. There'd be a lot of trial and error involved if done manually. Regardless, there's a reason why I marked that issue as "not a big deal" -- because it isn't -- the other issues I mention are the meat of it.

The issue you appear to have marked as not a big deal is calculating the gross-up that would be required to keep employees whole not the per-paycheck withholding cash flow issue, which you labeled a “real burden” for some (unless I’m misreading your post). I agree both are manageable and would be automated if things switched models.

Re: Employer health plans are getting pricier and skimpier

#533

Post by dredmorbius »

kmjg88nvf8 wrote: post #511
tomp wrote: post #501

Earlier quoted context omitted.

I don't think the size of the pool is that relevant. The pool from the perspective of insurance company is all insured people, so it doesn't matter whether it's a company of 5 or 5 individuals joining, it's still a huge pool. Adverse selection is the big reason. An individual signing up for insurance can be used as a signal that means "individual is sick" or "individual is likely to need insurance soon". If a company…

I think people who are already sick should be covered by a kind of charity (or social services). It doesn't make sense to ask insurance companies to insure people who are already sick.

An alternative is to have random-lot assignments, at least so long as you care to preserve a private, for-profit, insurance sector. That is, members of a given population is assigned, at random, to a set of insurance providers, who have minimum performance and obligation standards.

Otherwise, the socialised version already exists, in most industrialised countries, in some form or another. Within the US, Medicare for the elderly, Medicaid for the poor and children, and in many states, "high risk pools" which are state managed.

More generally, a problem is that the bulk of health benefits do _not_ accrue from direct or acute medical treatment, but from public health and preventive measures, _especially_ well-mother, well-baby, early childhood, municipal sanitation and environmental measures, and general (workplace and elsewhere) safety provisions. Insurance companies of and by themselves don't address much of this.

Re: Employer health plans are getting pricier and skimpier

#534

Post by tails4e »

nine_k wrote: post #512
tails4e wrote: post #463

Earlier quoted context omitted.

I think you are mis- characterizing the European systems. I say systems as each country is different - some better than others for sure, but from what I've seen from both the US and European systems, I prefer the ones where my family going bankrupt does not depend on one of us getting seriously sick or not. The cost of healthcare per capita is way higher in the US, and outcomes generally poorer (see infant mortality…

I agree that the "cost disease" is bad enough. It's strange to hear about not getting an insurance if staying at home. That's exactly what my wife did when our child was small. She had the same insurance as me, because I was able to add her to my employer-sponsored insurance policy. What really sucks is to be a small-scale entrepreneur, a garage-stage startup founder. You're cash-constrained, and there's no employer…

In this case she is a teacher in CT with very good benefits, but her husband, while on a decent salary has pretty terrible benefits, so she could not switch to his insurance is she stayed at home. Crazy situation when you think about it

Re: Employer health plans are getting pricier and skimpier

#535

Post by webninja »

kmjg88nvf8 wrote: post #462
comnetxr wrote: post #360

Imagine if grocery stores forced us to choose one of a few dozen grocery "insurance" memberships to buy groceries, and negotiated directly with the insurers. No prices are labeled in store, they just detect whatever you take and send you a bill at the end of the month. (Differing brands of the same food product are not available in store of course.) Individuals are charged 3-100x more per product than negotiated rate…

Can you explain to a Non-American what forces this system of employer insurance onto the US? Why don't independent insurance companies emerge that offer other models of insurance?

Tax laws. When healthcare is paid out from payroll, it is FICA exempt which means you don’t have to pay Social Security or Medicare taxes on it.

Re: Employer health plans are getting pricier and skimpier

#536

Post by ceejayoz »

nine_k wrote: post #417
doctorpangloss wrote: post #404

Earlier quoted context omitted.

This isn’t a very good analogy. In a just world, nobody would go hungry, nor would anyone die prematurely or suffer needlessly due to lack of care. We can obviously afford both, in this country, just like they can everywhere else in Europe or Canada. So this entire argument about insurance is a straw man. It’s not the doctors who set up this world. It’s people who want to pay less taxes, but blame doctors.

Regarding Europe, which I happen to have friends all over: it's not exactly as rosy. European countries do have more doctors per capita, which is good. They don't have nearly as much resources in the system, though. Come to a doctor with a bad cough, get a prescription for Paracetamol. You got to have a pretty bad infection to get a prescription for an antibiotic. Endure a long discussion with a doctor to renew an an…

> Come to a doctor with a bad cough, get a prescription for Paracetamol.

Good. Most coughs are viral, and that's the appropriate treatment.

Re: Employer health plans are getting pricier and skimpier

#537

Post by cma »

ergothus wrote: post #181
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…

> Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous I appreciate your reasonable breakdown, but I don't understand this one. I've seen many reports talking about how the costs of basic supplies and procedures are dramatically higher in the US (and vary wildly within the US). Things like X-Rays, MRIs, etc, being off by an order of magnitude or m…

He's comparing the higher per-person costs of elderly care to lower per-person costs of whole-population care.

Re: Employer health plans are getting pricier and skimpier

#538

Post by notadoc »

hcknwscommenter wrote: post #370
notadoc wrote: post #245

Earlier quoted context omitted.

You think the government should cap the price of suffering? What do you think should happen with malpractice or medical errors? For example, take this recent news story and pretend this was in the USA, where a woman goes in for a routine procedure and ends up with an abortion. https://nypost.com/2019/09/24/doctor-performed-abortion-on-w... How would you like to strictly regulate damages for that? What do you think is…

People like to point to malpractice and lawyers and blame it all on that. Every actual study I've read totals the cost of tort liability (insurance, law suits, damages, etc.) at about 5% of total health care spending. Significant to be sure, but not the bogey man people like to make it out to be.

It sounds like an industry argument that would be introduced by insurers to benefit insurers, since it would obviously benefit them.

I see no benefit to the patient to limiting medical error liability, but I'd be interested to hear the arguments in favor.

Re: Employer health plans are getting pricier and skimpier

#539

Post by spiznnx »

geggam wrote: post #187
dnadler wrote: post #175

Earlier quoted context omitted.

That would kill a lot of people as the market adjusts...

Yep, solve global warming crisis, food crisis, insurance crisis Life is harsh and the system we have setup will require this or war to change. You pick how the death happens. The fact death has to happen for change is inevitable ( channeling thanos here )

Thanos was the bad guy you know.
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