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

Re: Employer health plans are getting pricier and skimpier

#521

Post by AlphaSite » Thu, Sep 26, 2019, 4:29 PM UTC

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…

This is how the NHS functions and it has far better rates.

Re: Employer health plans are getting pricier and skimpier

#522

Post by madengr » Thu, Sep 26, 2019, 4:43 PM UTC

pravda wrote: post #396

madengr wrote: post #296

Earlier quoted context omitted.

My employer dropped dental insurance a few years ago. They never gave me a pay bump to compensate. Now I spend $1,600/year on cleanings for a family of 4. At least it is out of my HSA, so pre-tax.

$400 for a cleaning?! You gotta negotiate better! That is an outrageous price!

It’s $200 per person (4x people, 2x a year), that sometimes has x-rays and sealant.

Re: Employer health plans are getting pricier and skimpier

#523

Post by GordonS » Thu, Sep 26, 2019, 5:13 PM UTC

d1zzy wrote: post #340

I would love if everyone that seems to be in support of a single player system would make a mental note right now that they were in support of it, and then years later after the US moves to such a system (seems pretty likely?) they review how much it helped. I grew up in a single payer system and I'm theoretically in support of it for the many reasons people already listed in the comments (larger negotiation position…

I'm in the UK, and have unfortunately had all too much experience of the health care system here.

My view is that it's optimised for the majority, and for the "easy" things. For example, all the NHS endocrinologists I've seen have only really known about diabetes, the dieticians I've seen only really know about weight loss, the pain specialists I've seen have a narrow and fixed list of mess they prescribe, and the neurologists I've seen only really knew about... well, not much TBH. I can only guess it's because they're over-stretched and simply don't have time, but it's also been my experience that consultant's knowledge is way behind the times; almost like they haven't read a paper since they left medical school. Oh, and waiting list times are often ridiculous.

The NHS fails many, but I know helps far more than it fails, and if you have the money you have the option of private medical insurance or self-funding private medical care.

I'd still take our "sort of works for most people" system over that of the USA any day.

Re: Employer health plans are getting pricier and skimpier

#524

Post by romwell » Thu, Sep 26, 2019, 5:30 PM UTC

ytNumbers wrote: post #517

romwell wrote: post #343

Earlier quoted context omitted.

>In my opinion, the best yardstick for a health care system is how long you have to wait to be treated for cancer. To quote a famous movie: well, you know, that's just like uh, your opinion. Why would the wait time (and not treatment outcome, or rate of occurrence) for one group of diseases be a good metric for evaluating the overall performance of a healthcare system? In my opinion, it's a horrible metric. To give a…

Rather than pull up the specific data regarding US/UK/Canada, I'll just reply with a link to a general overview of how free (but rationed) government provided health care compares to what exists in the USA: https://www.forbes.com/sites/johngoodman/2019/03/05/what-soc...

I'd expect more from someone with "numbers" in the username.

Your source is wonderful. Here's my favorite part:

> In Canada, when patients see a doctor the visit is free. In the U.S., the visit is almost free

If someone can tell me how to move to that US, I'll be packing my bag right away!

Re: Employer health plans are getting pricier and skimpier

#525

Post by cullenking » Thu, Sep 26, 2019, 6:06 PM UTC

opportune wrote: post #120

cullenking wrote: post #109

Earlier quoted context omitted.

I manage a health plan for our smallish business of 19 employees. We offer "pretty good" health insurance, meaning, we pay around $600 per employee per month for health and dental. It gets worse every year. I am considering moving toward a HSA based plan, because upon analysis, it's actually probably better for everyone involved. The max out of pocket per year is the same, but instead of a $1000 deductible you have a…

From my perspective, I am unlikely to hit the out of pocket maximum but quite likely to spend more than $1k/year. All the high deductible does is discourage you from seeking care for things before they become serious. Not sure how it worked from the employer’s end, but $5k/year will get taxed at roughly 50% before I see it so it’s not clear whether that will be greater than my out of pocket costs

Late to reply, sorry. Yes there are ups and downs, but you can setup automatic deductions from paychecks straight into an HSA. I haven't done the full analysis and asked everyone at work, but if the trend continues for the next few years it's going to be really hard for a high deductible HSA plan to not come out ahead. Whether or not we eat the extra cost to keep the convenience will be a decision to be made then.

My comment was only to serve as counterpoint that companies aren't all looking at an HSA because they want to screw people over. Many are looking at an HSA based health plan because they are increasingly becoming more attractive as benefits shrink while becoming more expensive. Again, I am friends with my coworkers, my family is on the same health plan, and I have everyone's best interest in mind, and I wouldn't approach the decision lightly. Obviously there are shitty people out there managing employer plans, I don't speak for them!

Re: Employer health plans are getting pricier and skimpier

#526

Post by maxerickson » Thu, Sep 26, 2019, 6:13 PM UTC

jacobush wrote: post #476

maxerickson wrote: post #318

Earlier quoted context omitted.

Medicaid mandates drug prices at a fixed percentage of what private buyers pay.

So just raise prices.

Private buyers won't just automatically pay more, so they can't "just raise prices".

Of course prices will still be raised, but the point is that Medicaid drug spending is rather directly linked to negotiated prices for drugs, not just based on whatever the manufacturer asks.

Re: Employer health plans are getting pricier and skimpier

#527

Post by kelnos » Thu, Sep 26, 2019, 7:31 PM UTC

throwaway66920 wrote: post #130

erichocean wrote: post #114

Earlier quoted context omitted.

> Getting insurance as an individual is expensive because you’re not part of a group plan. I see people say this constantly. Insurance by definition is literally always a "group plan"—everyone who buys insurance is in the same group. That's literally the point of insurance. It's why it exists. That's what it is . That is fundamentally how insurance works . All insurance, in every category, of every type. There are no…

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)…

I don't think I understand this. Take two scenarios. In both cases, I'm 22 years old, just exiting college, and starting my first job.

In scenario 1, I start working at a 1000 person company that offers insurance benefits. I sign up for their plan, and my employer pays for nearly all of it.

In scenario 2, I start working at a tiny company that doesn't offer insurance benefits. I find an individual plan (coincidentally from the same insurance company used in scenario 1) that suits me, and sign up for it, paying out of pocket.

The total amount paid to the insurance company in scenario 1 is, as is typical, lower than in scenario 2.

In both of these scenarios, the insurance company doesn't know anything about me. For scenario 1, sure, they might know the mean and variance of expected health costs of the 1000 people already at the company, but that does not extend to me. They cannot assume I will conform to the rest of the group. I am new, and an unknown, and they do not know how I will affect those statistics. For scenario 2, I'm just another independent signup. I might have health care costs in line with the average of all of their beneficiaries, or I might be an outlier (on either end), or something in between. But that's the same as scenario 1.

This feels like it has nothing to do with risk assessment; this is just a reflection of the company in scenario 1 having greater negotiation power because they're representing 1000 people, versus you just representing yourself.

Re: Employer health plans are getting pricier and skimpier

#528

Post by kelnos » Thu, Sep 26, 2019, 7:33 PM UTC

sokoloff wrote: post #491

kelnos wrote: post #484

Earlier quoted context omitted.

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.

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.

Re: Employer health plans are getting pricier and skimpier

#529

Post by kelnos » Thu, Sep 26, 2019, 7:36 PM UTC

mattkrause wrote: post #505

kelnos wrote: post #486

Earlier quoted context omitted.

I don't think that's a great analogy. There are plenty of medical conditions where there are several options for how to manage it. With insurance, people usually choose based on risk of failure or complications, recovery time, etc. Without insurance, someone might choose primarily based on price, and a poor person might go for the cheapest option. For some non-life-threatening issues, a poor person might refuse treat…

Have you ever actually tried to do this? It is hard. A family friend, a smart guy with excellent insurance, was recently diagnosed with Parkinson’s Disease. Since I’m a neuroscience researcher, he asked me for advice. Despite working in an immediately adjacent field, at a Parkinson’s Centre of Excellence, with access to experts and tons of relevant training and literature, I found it very difficult to make a recommen…

No one said it was easy. Regardless, I'm not sure this particular example is relevant: you cherry-picked something that actually _is_ hard to decide about.

Re: Employer health plans are getting pricier and skimpier

#530

Post by oarabbus_ » Thu, Sep 26, 2019, 8:57 PM UTC

kelnos wrote: post #500

oarabbus_ wrote: post #328

Earlier quoted context omitted.

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 l…

With more doctors (and consequently lower salaries) the cost of preventative care drops, no? And perhaps just as importantly, the EASE and time-delay of getting an appointment drops.

Blue collar workers tend to wait, as you said, until an illness becomes critical - because they have to work 9-5, the same hours doctors work. With an additional 25 or 50% of MD workforce, we can easily begin offering preventative care services outside of 8-5, allowing low-income people to get the preventative care they deserve without affecting their livelihood.

We should strive for primary care visits to be available 7am-7pm (at least), 7 days a week, in every hospital/clinic in the nation. And specialist visits should be bookable in ~2-3 weeks max, not the 6+ week timeline many individuals requiring a specialist face.

I agree with all your points, and definitely the administration costs I hope will drop as we get better ML/AI technology. I don't personally see a realistic way to get rid of the insurance companies, but they can be quite harmful. Finally I also would like to double down that the "cartel" aspect is the single largest contributing factor.