Employer health plans are getting pricier and skimpier • Hacker News Board

Re: Employer health plans are getting pricier and skimpier

#321

Post by throwaway66920 » Wed, Sep 25, 2019, 10:17 PM UTC

kylebyproxy wrote: post #255

throwaway66920 wrote: post #130

Earlier quoted context omitted.

You see it constantly because it is true. A group plan is a thing. Yes you’re still in a “group” when you register as an individual, but it is an “individual plan” and semantics doesn’t really help you out. The difference is that if I know the mean and variance of expected health costs for the group, I can offer a lower premium to every individual member because the variance of total actual cost goes down by n^(-1/2)…

That's all fine in theory, but do some shopping-around and you'll see it's simply untrue. Personal anecdata: 2018, my employer didn't offer insurance. I signed up for a "silver" tier individual plan ($1250 deductible, good coverage) on the ACA marketplace and paid $170-something/mo. (after receiving ~$250/mo. in tax credit). 2019, my employer starts offering insurance, so I'm no longer eligible for the ACA tax credit…

Huh I didn’t know about the tax credit. That sounds like another layer of backwards thinking and another reason to get rid of the whole practice. I’m sorry for your situation.

Re: Employer health plans are getting pricier and skimpier

#322

Post by shkkmo » Wed, Sep 25, 2019, 10:18 PM UTC

throwaway_law wrote: post #266

js2 wrote: post #226

Earlier quoted context omitted.

I am a U.S. citizen. Yes, cost is a huge issue. We would not have to rip out private insurance, but we would probably have to regulate pricing, which is how it works in Germany. Folks should be welcome to buy supplemental insurance as they do with Medicare. There's basically four models[1] for providing health care, and the US has all of them: The Bismarck model like Germany with multiple payers, but they are non-pro…

Sorry, I figured you were German. As long as people are covered it would be a good start (I won't bother engaging further on the single payer/private insurance/hybrid systems, not enough room and not the right forum)...it just scares me to hear the game plan to get there is political pressure after a critical mass of people are uninsured . I know that is not attributable to you, and you seem optimistic we get there a…

> it just scares me to hear the game plan to get there is political pressure after a critical mass of people are uninsured

And who are you attributing this to? This seems like either a strawman or a misunderstaning to me.

Re: Employer health plans are getting pricier and skimpier

#323

Post by maxerickson » Wed, Sep 25, 2019, 10:18 PM UTC

ambernightcruse wrote: post #196

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…

Part of the problem is that Medicare/Medicaid pays market prices. Its a pricetaker not a pricesetter, because of poor regulation, in spite of its larger position. If you pay market prices, expect inflation every year on top.

No they do not.

Re: Employer health plans are getting pricier and skimpier

#324

Post by throwaway5752 » Wed, Sep 25, 2019, 10:20 PM UTC

oarabbus_ wrote: post #299

throwaway5752 wrote: post #288

Earlier quoted context omitted.

You just proved my point, you know that right? It's the healthcare delivery and the markups along the way. If you paid doctors $0 tomorrow, healthcare costs would go down by 20%, at best, and probably less. Your analogy is perfect, actually. The problem in sandwich cost is rent, utilities, administrative expenses, marketing, an acceptable return on investment to the owners, etc, etc. The actual good being sold, a san…

On the contrary, you proved mine. I worked in medical devices and hospitals for a significant portion of my career, and I really don't care that you aren't impressed by the term "cartel", that's your prerogative to turn a blind eye to the facts. It's a combination of inflated salaries plus numerical shortage of doctors (the two are related) causing the root issues here. You claim to be familiar with other health syst…

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.

Re: Employer health plans are getting pricier and skimpier

#325

Post by anarchodev » Wed, Sep 25, 2019, 10:20 PM UTC

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…

> One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people.

One of the myriad reasons healthcare in the US expensive is the middlemen who stand to profit from taking as big a cut of your premiums as possible, while paying for as little care as possible. Without this fundamental force driving healthcare prices it doesn't seem clear to me at all that prices would stay the same. Your dismissal of single-payer plans like M4A glosses over the largest proposed change to the structure of medical billing.

Re: Employer health plans are getting pricier and skimpier

#326

Post by zanny » Wed, Sep 25, 2019, 10:21 PM UTC

baq wrote: post #188

geddy wrote: post #180

Earlier quoted context omitted.

> Doctor's are paid too much... why? You can also branch off here: because malpractice insurance is insanely expensive. Why? Because people sue over absolutely everything. Why? Because lawyers in this country are vultures. If anything is overly expensive, you can usually track it back to insurance costs somewhere, which can typically be tracked back to the fact that we live in a litigious society.

they sue and get awarded insane damages, which is probably something that could be regulated more strictly, but then what do i know.

At the same time doctors are given immense authority and depending on circumstance very limited oversight in their administration of care. People will go to three different practices and get radically different diagnosis and prescriptions. There are substantive and documented biases amongst medical practitioners as well, including how women are substantially less likely to be treated for a heart attack because many doctors don't believe their reported symptoms.

Medicine is also a precipitously massive field of study and in the same way a programmer isn't expected to know every language and technology - hell, most are not expected to understand even the full breadth of the standard library or code base they are presently working in - few doctors are actually as informed as they like to act. A lot of it is cultural, doctors are supposed to be authoritative, but the US has a very problematic medical culture of assumed authority that has people putting blind faith in doctors who "trust their instincts" and end up being completely wrong and hurting people for it.

Remember that medical malpractice lawsuits are still overseen by a judge. If there is a settlement, there often was a mistake made. The solution to malpractice costs is not have doctors make mistakes but to reduce how often mistakes happen.

A lot of those remedies require a reform of culture though, and that is one of the hardest challenges to approach. And don't think I'm just "blaming" practicing doctors here, its structural to the industry and is why MDs are being put on 18 hour highly stressful shifts where its unbelievable they make as few mistakes as they do in such unreasonable working environments.

Re: Employer health plans are getting pricier and skimpier

#327

Post by comnetxr » Wed, Sep 25, 2019, 10:21 PM UTC

hristov wrote: post #306

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…

If you do not want to hear one thing about negotiating power then you are missing the main reason why medical costs are skyrocketing. Medicare/medicaid does not negotiate drug costs down because it is prohibited by law from doing so. This is because of a law signed by the Bush administration ( https://en.m.wikipedia.org/wiki/Medicare_Prescription_Drug,_... ).

In a sense, wasn't the choice to not negotiate drug costs itself the result of a negotiation? I believe the way it works is that health insurers and providers threaten to fund fear-mongering attack ads against politicians who support laws that don't like. The politicians cave and carve out rules for the industry.

So it's not that the Medicare drug care costs aren't negotiated, its that the chance for lower costs was traded away by Congresspeople of the past (many of whom aren't in office anymore) in exchange for campaign funds. Not literally a campaign fund check, of course, but countering an attack ad costs campaign money that they could be spending otherwise.

Re: Employer health plans are getting pricier and skimpier

#328

Post by oarabbus_ » Wed, Sep 25, 2019, 10:23 PM UTC

throwaway5752 wrote: post #324

oarabbus_ wrote: post #299

Earlier quoted context omitted.

On the contrary, you proved mine. I worked in medical devices and hospitals for a significant portion of my career, and I really don't care that you aren't impressed by the term "cartel", that's your prerogative to turn a blind eye to the facts. It's a combination of inflated salaries plus numerical shortage of doctors (the two are related) causing the root issues here. You claim to be familiar with other health syst…

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 considerably.

As a consequence of the overwhelmingly positive benefit of lifting the artificial supply of MD (or DO), doctor salaries will naturally drop, as necessitated by economics.

Re: Employer health plans are getting pricier and skimpier

#329

Post by zanny » Wed, Sep 25, 2019, 10:28 PM UTC

MuffinFlavored wrote: post #228

eric_b wrote: post #164

Earlier quoted context omitted.

In many cases US doctors make 2x (or more if you're a specialist) than their European counterparts. The outcomes are not materially better in most cases. (Also, I'm just picking on one small reason for healthcare costs, the point is that is just one of many)

> In many cases US doctors make 2x (or more if you're a specialist) than their European counterparts. That sounds outrageous but isn't the same for software engineers as well? Senior level software engineers in (not San Francisco/New York/Los Angeles) can easily make $80k - $160k.

The salaries given relate back to expenses paid. Doctors in Europe broadly don't pay anything for medical school and thus don't have a mcmansion of debt to recoup after graduating.

Developers throughout Europe find their salaries regularly pegged to cost of living wherever they are. In the US salaries are distorted for 2 reasons - most major global tech companies are here and thus there is higher demand for developers here than elsewhere - and two that those tech companes congregate in the most expensive cost of living places on Earth due to NIMBYism and Americas broken city planning culture.

In general almost everyone in the US is paid, comparatively, more than their European counterparts because their raw income has to afford to cover potential medical expenses that nobody else abroad has to contend with. Americans also get much reduced food, utilities, and housing benefits compared to the broader first world.

Re: Employer health plans are getting pricier and skimpier

#330

Post by zanny » Wed, Sep 25, 2019, 10:28 PM UTC

aaomidi wrote: post #260

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…

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.