Health Insurance 44

[tbonebanjo]

I was just wondering how many companies still have good insurance and how many have gone the way of Obamacare. I am in a small MEP firm in Maryland. Our health insurance just changed, our premiums went up and our coverage went way down. I have maximum out of pocket expenses of $12,500 per year, $4000 deductable per person, tnen start the copay schedules. Should I start looking for other employment or are all companies being affected this way?

 

[ScottyUK]

A question to those in the US: could the apparently high per-capita spend and apparently below-average life expectancy in the US be a result of the wealth divide, where the relatively small numbers who have the ability to pay for a first-class service are likely to achieve a relatively long lifespan, but the far greater numbers who have limited access to premier quality health care drag your average lifespan right down?

It's interesting that the nations with equal-for-all systems - France, UK, Canada, Australia and the rest - are all in a cluster achieving similar results for similar expenditures, and out-performing the US system in both lifespan achieved and in per-capita cost.

 

[hokie66]

ScottyUK,
Australia is not really an equal-for-all system, although it does have a publicly paid hospital system running in conjunction with a private or insurance based system. It's complicated, as most health systems are.

I think the high per capita spend and low life expectancy issues in the US are due more to lifestyle choices than anything else...too many fat people.

 

[IRstuff]

Perversely, fat-inducing, high-carb, food is made and sold more cheaply that healthy food; so, yes, there is some factor of income disparity that drives poorer people into less healthy food, coupled with the fact that most of the poor are uninsured, so they can't take are of their health problems as well as they should.

TTFN
faq731-376

Need help writing a question or understanding a reply? forum1529

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

 

[ScottyUK]

Hokie - my misunderstanding, thanks for the clarification.

FWIW, the British system is equal-for-all, except those with deep pockets (or a generous bennies package) can get private cover which allows them to jump the sometimes long waiting times for the routine stuff. I don't have a problem with that, except when the private work ties up resources and manpower in an NHS hospital which tends to happen more often than you might imagine. Unsurprisingly the insurers don't tend to cough up for the really big expensive emergency jobs like the operation which kept me out of a wheelchair four years ago; they still get picked up by the state. My family and I are all immensely grateful to the NHS for what they did for me, and even though I have good private cover through work I am a massive supporter of the state system.

 

[glass99]

beej67: One option is to make purchasing healthcare no different from purchasing real estate or automobiles, and make it completely deregulated individual market. It would be by far the best way of weeding out the "song and dance" inefficiencies you speak of. The problem with it is that human beings take sympathy on other human beings who are sick, and there is a tendency to call is a "right" not a "privilege". Its actually incredibly difficult to see someone with cancer and not want to help them.

 

[IRstuff]

"make it completely deregulated individual market. It would be by far the best way of weeding out the "song and dance" inefficiencies you speak of. The problem with it is that human beings take sympathy on other human beings who are sick"

It's not a question of sympathy, but sharing risk. Individuals will never get anywhere near the premiums that a group can get, precisely because of the lack of shared risk. For an individual policy, the premiums have to have a high probability of covering the risks, and will therefore be higher than for a group policy for the same individual, since the probability of everyone in the group getting the same diseases is lower. To make it deregulated simply adds to the cost, since the insurers would have no incentive to keep their profits down.

TTFN
faq731-376

Need help writing a question or understanding a reply? forum1529

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

 

[glass99]

IRStuff: If deregulated and totally individual, why would health insurance be any less efficient than car or home insurance? You have no expectation of single payer car insurance. Sharing risks creates a moral hazard - it does not provide incentive to find ways of reducing cost.

 

[IRstuff]

I don't think that car and house insurance are that similar to health insurance, other than the shared risk. Houses and cars don't get strokes, or necrotizing faciitis or MRSAs. Car and house claims are generally from external forces or agents, while sizable chunks of the panoply of diseases are inherent in the body. At some point, well before complete system fail, a car or house is declared a complete loss, and the value of the policy is paid out. Cars and houses, in general, are not put on life support, racking up $20k/day in costs.

TTFN
faq731-376

Need help writing a question or understanding a reply? forum1529

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

 

[CELinOttawa]

Health and Transport are a cliché apples and oranges comparison. No one wants their child to need serious and or long term treatment, but it is rarely a choice you can make.

Any form of single payer system is, fundamentally, a far more noble, just, and democratic way to deliver health care. People who believe otherwise are heartless, brainless, souless, greed filled, or otherwise evil. It is nearly impossible to be naïve once you've had any opportunity to read about healthcare.

Not that I have an opinion...

 

[hokie66]

CEL,
You are entitled to your opinion, but do you have to be so harsh about it? Some of those adjectives are over the top, and just wrong.

 

[glass99]

CEL + IRStuff: I'm not advocating for highly individual health insurance necessarily, just pointing out that at present its a pretty arthritic system, and a deregulated market would have the flexibilty to adapt itself to the contours of the market. Part of the problem with the current US system is that it is neither here nor there. Its not a proper free market solution because there are so many restrictions and subsidies, and its not a proper single payer system. Totally agree that there is a "moral" dimension to health insurance that doesn't exist with car insurance.

 

[ScottyUK]

CELinOttawa,

Our system over here is far from perfect. It wastes money on a barely imaginable scale because of bureaucracy and inefficiency, and the layers of expensive underloaded management which have invented themselves over the past few of decades are a disgrace, yet it is so very good at the difficult things like fixing broken people and looking after those with long-term and chronic conditions without question or judgement. There is much to admire about our state-funded system, but many non-clinical aspects of the operation need to be run more like a commercial organisation where value for money is an important factor, except any savings aren't shareholder dividend but additional funds to spend on a better service.

 

[hokie66]

I'm certainly no expert on health or health funding, but have come to the conclusion that the Australian system of mixed public/private works well, even if it is too complex. As to hospitals, the mix is about 2/3 public and 1/3 private. The public hospitals are without cost to admitted patients, but there are sometimes long waiting lists involved. The waits can sometimes be shortened by electing to be treated as private patient in a public hospital, in which case private insurance or personal contribution kicks in. I think that in those cases, you can have a say in who your doctor(s) are, which public patients don't. Employed people are encouraged to have private insurance, as tax penalties apply if you don't, depending on income. There are two types of private insurance, one for just hospital coverage, one for "extras" like dental, physiotherapy, etc.

The public hospitals are the large teaching hospitals and the place you want to be with something bad wrong. For instance, all organ transplants are done in the public hospitals.

For visits to doctors, not hospitalisation, we get government rebates, about half the cost of the visit, unless your doctor "bulk bills" or there are government concessions involved. Referrals are required for specialists, but if you have a continuing issue, the referral can be made continuing.

Every country has its variation, and it may be just good luck when a system works well.

 

[beej67]

"I sprain my knee in Denmark. I go to the doctor, he sends me home with some pills and an ACE bandage. I sprain my knee in the USA, I go to the doctor, he sends me to a specialist, who sends me to an MRI, which must be read by a specially trained/paid MRI Reading Person, who tells the specialist, who tells the generalist, that I should go home with some pills and a highly specialized proprietary knee brace that does the same thing as an ACE bandage."

Most HMO plans already clamp down on that, because they ca deny referrals, but the "Cadillac" plans actually have gone the other way, with "self-referrals."

Yes, but how much money does it take for the insurance company to "clamp down" on that? They end up spending a bunch of money on claims management to cut costs, but the claims management itself is a cost.

In Denmark, they just do what they're supposed to do.

Just like we used to do here when we paid for our sprained knees out of pocket, before the days of MRIs and Specialists and fancy MRI Reading People.

I don't think that car and house insurance are that similar to health insurance, other than the shared risk.

See my post above from 21 Sep 14 20:47. The reason they're not comparable is that health insurance isn't insurance at all, in the USA. It's a "Health Plan" that covers lots of things other than emergency care. If all health insurance covered was emergency care, it would work pretty much like car insurance does.



Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East -

http://www.campbellcivil.com

 

[glass99]

beej: what's the secret sauce that makes it work in Denmark? I assume its something cultural, not the fact that they have a single payer system.

 

[beej67]

1) Their country is full of Danes.
1.a) Their government still works.
1.a.1) Their corporations aren't using the force of government to funnel money to themselves.
1.a.2) Their votes mean something.

http://en.wikipedia.org/wiki/List_of_freedom_indices

(sort by democracy index)

2) Their country is small enough that corruption within the system has very little place to hide.

http://en.wikipedia.org/wiki/Corruption_Perceptions_Index#2013

3) They don't sit around all day eating cheetos watching Maury Povich.

(sorry, don't have a link for world rankings of cheeto delivery / Maury reruns)

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East -

http://www.campbellcivil.com

 

[IRstuff]

"Yes, but how much money does it take for the insurance company to "clamp down" on that? "

not so much that they are both doing it right now, and making a profit. It's just a simple rationing system.

TTFN
faq731-376

Need help writing a question or understanding a reply? forum1529

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

 

[cranky108]

Some how I think there is a point that is being missed. The goverment created this health care problem by requiring doctors and hospitals to take care of everyone no matter there ability to pay.
And by making limiting collections methods used by bill collectors. This makes the healthcare system left with setting a high price for everything so they can offset the cost of those who can't pay.

If you had a members only hospital the cost would be much lower because those who can't pay woulden't be allowed.

So fix the free loader problem. Single payer dosen't do that, because the free loaders also don't usually pay taxes.

Now I am not saying we should let the poor die, but we need to put the problem into perspective in order to solve it.

I also agree that we are putting things as medical costs, that should not be. Electric wheel chairs, or power chairs are good examples. I have to move about under my own power, why not everyone else.
Lets face it, I can't count my allergy medicine as a medical expence, so why should someone be able to count sex drugs, or appritis as a medical expence?

There is a load of fat called medical need that really isn't needed at all.

 

[TenPenny]

That all boils down to what we, as a society, think we should do for other people.

That's the fundamental difference between the US and Canada; Canada decided that, as a society, it was better to use sales taxes to cover essential medical costs so that nobody had to worry about their healthcare costs. The US has a different belief on this.

It's a basic philosophical difference, that has led to a lot of misunderstanding, and fuelled many talk show performers who know nothing but how to spew the party line.

 

[beej67]

Some how I think there is a point that is being missed. The goverment created this health care problem by requiring doctors and hospitals to take care of everyone no matter there ability to pay.

And by making limiting collections methods used by bill collectors. This makes the healthcare system left with setting a high price for everything so they can offset the cost of those who can't pay.

That's a problem, but it's only one of a dozen problems. But each of the problems are a result of people being encouraged, and often even required by law or regulation, to go through an expensive process that's not necessary or won't do any good.

When we all used to pay for our own stuff, we had incentive to tell a doctor "no, I really don't need that MRI for five thousand dollars if it's not going to change your recommendation anyway." When we pay into a shared pool, we have every incentive in the world to go get the free MRI that we don't really need, because why not? We've already paid for it. And the doctor has every incentive in the world to recommend the MRI, since we're not going to say no, and he makes more money when we say yes, and in fact he could get sued if he doesn't recommend it.

That's it. That's the deal. The U.S. system is a feedback loop of cost pressures. And flipping the switch between private cost sharing and public cost sharing will do nothing to fix that feedback loop. In fact, feeding the beast with tax money instead of premiums will just make it worse. The only thing more wicked than doing that would be forcing everyone at gunpoint to buy a private plan, and then forcing the private plan to cover things we don't want it to cover.

..sound familiar?

It should, because that's what Obamacare is.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East -

http://www.campbellcivil.com