Employees Start to Feel the Squeeze of High-Deductible Health Plans • Hacker News Board

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#141

Post by fzeroracer » Fri, May 03, 2019, 6:45 PM UTC

rb808 wrote: post #39

I really like the idea of high deductible plans. The idea for me is that insurance shouldn't cover regular costs that most people pay every year. Insurance should just be for unusual events, like car insurance is only used if you have an accident. So now I got a $2k bill from ER for something that wasn't really an emergency. It makes me think carefully about next time this happens where before the cost didn't really…

Funny story about that. This was prior to the ACA but the issue remains particularly salient.

When my mother had her stroke, there were major concerns about the cost of going to the ER. We at the time didn't know she was having a stroke and so my parents put it off.

If you're at all familiar with how strokes work this is the worst thing you can do. The sooner you get the victim to a hospital, the better chances of recovery. She was lucky to survive because we did eventually go to the ER, but she suffered from partial paralysis of her body as well as massive brain damage. She's struggled a lot with mood disorders and has trouble doing some mental tasks.

So put yourself in this situation. Are you prepared for potentially permanent mental and physical impairment because you were afraid of going to the hospital? My family ended up bankrupt anyways because this was prior to the ACA, but if we had gone sooner things would've been vastly different.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#142

Post by WalterSear » Fri, May 03, 2019, 6:47 PM UTC

mrosett wrote: post #133

Someone1234 wrote: post #89

Earlier quoted context omitted.

I know someone who pre-ACA had employer insurance who was dropped by that insurance after they got skin cancer. The official reason was lying during the application process (10+ years earlier). They forgot to list childhood Asthma on their application form ten years earlier.

Would the ACA prevent that kind of scam? I genuinely don't know.

The incentive is gone, since preexisting conditions are no longer a disqualification.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#143

Post by basetop » Fri, May 03, 2019, 6:48 PM UTC

mrosett wrote: post #2

You can argue that the ACA improved the healthcare system overall. But it's been tough for people who were already covered by employer insurance. I think people fail to appreciate that prior to the ACA, when the healthcare system worked, it actually worked really well. I got very sick at the age of 20 while I was still on my parents very modest insurance (pre-ACA). Within 48 hours I had an appointment at the best onc…

I agree. The pre-ACA healthcare system worked well ( maybe not great but well ) for 80% of the population and not so well for 20% of the population. We paid less premium for far less co-pay, deductible, etc overall. Feels like the ACA made things worse for the 80% in order to make things better for the 20%.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#144

Post by WalterSear » Fri, May 03, 2019, 6:49 PM UTC

mrosett wrote: post #51

WalterSear wrote: post #37

Earlier quoted context omitted.

It's more extreme than your example. The parent is ignoring the fact his great healthcare experience is predicated on them being able to drop him the moment they could, when his illness became too expensive. Ending pre-existing conditions was the game changer in the AMA. Treating people is obviously more expensive than not treating them.

That's just not how it worked with employer insurance. Perhaps they could drop your whole company, but the insurer couldn't unilaterally cancel a single employee's plan.

There were plenty of cases where they would raise an employer's premiums and let them know why, and sick people lost their jobs and their insurance.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#145

Post by tfandango » Fri, May 03, 2019, 6:52 PM UTC

jandrewrogers wrote: post #54

duxup wrote: post #3

Earlier quoted context omitted.

How so? The choice of covering crappy plans is the employer's choice... and crappy plans are what have been pushed AFTER the ACA was passed. Largely by the GoP... Is that what the ACA was, or what someone(s) who want it to fail want? There's a weird narrative where any event is tied to the ACA while they ignore what the healthcare system is in the US overall.

The cost to employers of very good plans massively increased after ACA went into effect. When this changeover happened, I was running a company where we paid 100% for one of the best healthcare plans available in the state for both the employees and their families -- people really appreciated this benefit. This was the polar opposite of a "crappy plan", and it wasn't inexpensive to begin with. After the ACA, this pla…

This happened to me. I had what is considered a "Cadillac plan" which my employer offered generously as a benefit. After ACA, the government began to tax that plan and our public company could not justify that while other companies in our market were offering much lower quality plans. Thus my medical spending rose by thousands of dollars per year (also thanks to an unfortunate @$3000 hospital stay but that would have cost me $250 on my old plan). The old plan did of course come with a lifetime max but obviously was not a factor at my age yet.

I think the ACA does good things for people who needed it. And generally I've been against repealing it, but only because there has not been an adequate replacement as part of the repeal, only "trust us, we'll do something great".

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#146

Post by llamataboot » Fri, May 03, 2019, 6:52 PM UTC

mrosett wrote: post #2

You can argue that the ACA improved the healthcare system overall. But it's been tough for people who were already covered by employer insurance. I think people fail to appreciate that prior to the ACA, when the healthcare system worked, it actually worked really well. I got very sick at the age of 20 while I was still on my parents very modest insurance (pre-ACA). Within 48 hours I had an appointment at the best onc…

All of us with pre-existing conditions that couldn't buy insurance no matter the cost feel different of course, but you acknowledge that.

I'm interested in why you think ACA itself has made anything worse. Surely premiums have gotten worse, but it's not clear to me how it is nec linked to the ACA. (And it should be said that the insurance industry basically wrote large portions of the ACA, and arguably its weakest parts or because of that!)

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#147

Post by URSpider94 » Fri, May 03, 2019, 6:52 PM UTC

civility wrote: post #137

bliblah wrote: post #67

Earlier quoted context omitted.

>> just needs to be actually thought through, It's impossible because you both political parties want exclusively mutual results You can't have cheap insurance without making it mandatory since only the sick will get it You can't have easily accessible insurance without forcing healthcare companies to comply with new regulations forcing them to increase costs You can't have good insurance if you aren't willing to pay…

> You cant lower costs in the US without having a more aggressive regulatory body which 50% of political bodies strongly oppose alongside lobbying efforts Here is the fundamental problem from my point of view. Compare human medical costs to veterinary costs. Yes, people expect a slightly higher standard for themselves than they do their animals, but you can get a major knee surgery for your dog for a small fraction o…

You don't even have to go all the way to veterinary medicine. This is an old article, but compare the $100,000 cost for a joint replacement in the USA vs. $13,000 for that same procedure in Belgium. https://www.nytimes.com/2013/08/04/health/for-medical-touris...

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#148

Post by jdoliner » Fri, May 03, 2019, 6:53 PM UTC

LarryDarrell wrote: post #92

jdoliner wrote: post #55

I've been trying for a while to figure out what would be a good metric to judge the ACA by. Most of the time it's success is talked about in terms of number of people insured, but that doesn't really capture how well insured they are. Life expectancy seems to be the only well known (at least to me) stat that begins to capture the health of the nation. We've now had 3 straight years of declining life expectancy in the…

I hate on the ACA as much as the next guy, but the article you linked blames drug overdoses and suicides. For that I would blame the for-profit health care system pushing opioids and the (Great Recession + inadequacy of our mental health care system). To blame that on a law that sought to eliminate preexisting conditions and to establish a baseline as to what a health insurance plan ought to provide seems like a stre…

I was just linking that as a reference for the declining life expectancy. I don't think they even come close to establishing opioid and suicide deaths as the cause, that's just journalistic conjecture. If you look at the number of opioid and suicide related deaths it's very small compared to the total population of the US, so the math just doesn't seem to work out for me. I remember an HN comment a while ago that worked out how many deaths you'd need from those causes to lower the life expectancy as much as we're seeing and it was a lot higher than what we're seeing now. Unfortunately I can't seem to unearth the comment.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#149

Post by rb808 » Fri, May 03, 2019, 6:54 PM UTC

lotsofpulp wrote: post #140

trynewideas wrote: post #105

Earlier quoted context omitted.

An HSA with no employer contribution, or even administrative assistance, is like throwing money into a trash can, except at least if you throw money into a trash can, you can wheel it down to any hospital and they'll probably accept it.

What? It takes 5 minutes to open a free HSA account at Fidelity and transfer funds to it.

I didn't know they were available. I thought it could be open to everyone, but employer ones do have advantages.

https://www.fidelity.com/go/hsa/why-hsa > You could also use it in place of an employer HSA. If you do this, you may miss out on opportunities like pre-tax payroll or employer contributions, so check with your employer to see what they offer.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#150

Post by [deleted] » Fri, May 03, 2019, 7:00 PM UTC

WrtCdEvrydy wrote: post #117

LarryDarrell wrote: post #60

If you were designing a society starting from scratch today and said, "I think we should make having health insurance largely dependent on having an employer.", you would be laughed out of the room. I think we are running along some tracks that were laid long ago, and rather than all jumping off, some people in comfy Pullman cars are content with letting the train run off a cliff.

Individualism in America is the main cause... if you just got taxed and didn't have to worry about healthcare, people wouldn't care, but they all think that it could never happen to them.

[deleted]