Insurers used to be able to save money by denying service or cancelling coverage. They can’t do that anymore, so higher premiums.
They can’t?
I know I’ve said it many times before but I’m going to say it again. Health insurance companies are engaged in a fundamentally useless and immoral business whose only real utility is to themselves. It’s closely akin to Mafia racketeering. They are parasites on the health care system. There is nothing they do – absolutely nothing – that could not be done at less than half the cost by a public single-payer system. The only thing standing between the health insurers and a sensible single-payer system is the health insurance lobby and the several million gullible idiots who believe their self-serving propaganda. One of many good books on the subject is Deadly Spin by Wendell Potter, a former Cigna PR executive whose conscience overpowered his greed. The last straw was when a young teenage girl died because Cigna refused to pay for her treatment.
They absolutely can, and it’s absolutely intrinsic to how they operate. What they can’t do any more AFAIK is deny coverage based on the finding of a “pre-existing condition”.
But its not a sustainable system. if health care costs go up 2-3% a year but insurance costs go up 20-30% a year, its not going to last more than another decade.
My understanding is it is more due to the death spiral. Young healthy people choose to go uninsured while the sick buy insurance. Then prices go up, and repeat. Soon only the sickest people are insured and are paying 2k a month for insurance while everyone else goes without insurance.
I at least partially blame the Trump Administration for getting rid of the mandate. What is sad is that I am a doctor and my staff cannot afford insurance. Even if I pay 70% of the costs, it would be over $600 a month for each of them which I know they cannot afford. Meanwhile, I would have to pay $4400 a month to cover us. Sure I could go with one of Trump’s low cost group plans but they have so many exemptions (for things like pregnancy and cancer-and one of my staff is a cancer survivor) that they are worthless. I talk to other practices that “cover” insurance for employees and find that the employees are responsible for 50-100% of the costs but my employees tell me that none of their friends who work there can afford to pay for it. Virginia did finally expand Medicaid through the ACA but my employees make too much to qualify and even with ACA subsidies they cannot afford personal insurance. Meanwhile, I have trouble treating patients since even those with insurance have high deductibles so I am forced to forego necessary testing and treatments. (Also, to make it clear to those in countries with UHC, $1000-2500 is not considered a high deductible here. High deductible plans range from about $6000 individual to $15,000 family to start).
I know I keep replying, but take medicare expenditures.
https://kaiserfamilyfoundation.files.wordpress.com/2015/01/8623-exhibit-1-3.png
This is from 2011, but evenso medicare was spending about 15k per year per beneficiary on someone who was 90 years old.
How in gods name can a deductible plan for a woman who is probably in her 40s or 50s cost more than medicare for a 90 year old? Hell the spending for a 65 year old is barely $5000 a year. Why would insurance cost 20k a year for someone who is probably in their 40s or 50s when medicare only needs 5k a year (plus premiums and medigap, which probably add another 3k a year) to cover a 65 year old?
Medicaid only spends $6000 per enrollee and medicaid covers a lot of elderly.
Jesus fucking christ. I hope the democrats, if they don’t pass single payer, pass some kind of medicare or medicaid buy in. This is bullshit.
EDIT: $2500 used to be considered a high deductible though.
I’ve had to turn away several patients with $10,000 deductibles EACH for in-network and out of network services. They couldn’t afford to pay me out of pocket, and I can’t afford to lower my rate too much for too many people.
Well, at least they had out of network coverage. A lot of plans don’t offer that anymore.
I think it’s near impossible to get from where y’all are now, to single payer. History is littered with, ‘right choice at the right time’ imperatives. Once you have profit in health care, it’s like money in politics. Everyone knows it’s awful but that’s a hard train to turn back once you’ve set it in motion.
I think the best hope may be in philanthropy. You need a few Oprah, Gates, etc to create a healthcare cooperative. Creating one extra large, ever increasing group. And it probably won’t work if you cover all the poor people to begin. You need to start on better footing, maybe aim at a narrow, lower middle class, and expand from there.
They’d need experienced people to handle forms, protocols, big pharma negotiating, etc.
They’d need to be ready to scale up fast, and probably anticipate Dr, Hospital, payment scales/issues etc. Thing is Drs would always get paid, every time. I think they’d get on board.
You need something so well prepaired it can absorb millions, even if they have to pace enrolment to a manageable amount over time.
Just one idea, of course!
Here are some potential reforms I’d like to see.
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Single payer on the state level. Probably won’t happen because our health care system is so wildly overpriced that democrats just like to talk about this idea, not actually do it. It sucks. Democrats talk a good game about single payer, but when push comes to shove it is all talk.
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On the federal level, expand medicare and medicaid. One plan was to auto-enroll people in these programs if they are uninsured. Another plan was to lower the medicare age to 50 or 55. Another was to put medicare and medicaid on the exchanges as an alternative to private health insurance (medicare for the OP would probably barely cost 3-4k a year). All are good ideas.
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On the private company level, let a company like walmart enter healthcare (on a hospital and outpatient level, not a doc in a box level). Healthcare is very bloated and has no real market forces. Letting an efficient private company like walmart enter would probably do quite a bit to lower prices assuming that the laws also changed to mandate competition. There are probably a lot of efficiencies that could be had if the laws were changed to encourage competition.
In Spain one of the many starting points was the unions; another was large companies offering healthcare managed by the company. These started creating exchanges with each other, then associating… some of them were eventually taken up by the UHC system the government had created, while others remain as our system of Mutuas, which offer preventive healthcare services specifically linked to work issues and manage some aspects of long-term medical leave. The system officially became “universal” (that is, covering even people who had never contributed and who were not the legal dependents of people who contributed) within my lifetime; I want to say in the 1980s but can’t swear on it and not sure how to search.
Trump and the GOP have been flip-flopping on that issue. No, not “flip-flopping” in the sense of changing their minds, “flip-flopping” in the sense of flipping to one set of lies when talking to voters, but flopping back when they file anti-ACA court cases.
It appears that what they’ve fixed on — probably a good compromise for them since American voters are VERY stupid — is to require that insurance be offered to people with pre-existing conditions, but the insurance policy may exclude those pre-existing conditions from its coverage.
Insurance companies surely play a role in the pain a lot of people have in the system, but they are not the only causes for high costs.
High drug prices, the excessive use of imaging and surgery, and excessive administrative burdens are the bulk of this country’s healthcare overspending, says healthcare policy expert Ezekiel J. Emanuel, MD.In an essay this week in JAMA, Emanuel, chair of the department of Medical Ethics and Health Policy at the Perelman School of Medicine at the University of Pennsylvania, says Americans average $9,403 per person in annual health care spending. By comparison, Germans and Dutch, average $5,182 and $5,202 respectively.
Costs for insurance policies reflect the escalating costs of the services they are providing, not to mention the profit motive for every single thing along the way.
I agree. Right now there’s a lot of incomplete information out there if you’re a consumer- they make it harder than necessary to find out what’s covered, how it’s covered, etc… and whether everyone involved is in-network, etc…
I think that if people always have a reasonably priced alternative then that’ll drive costs down- we see it with some commonplace generic medications already- places like Wal-Mart selling them for $4/month has driven the cost down for everyone on those drugs. Having the same kind of thing for x-rays, ultrasounds, surgical procedures, etc… would have the same kind of effect, I suspect.
One thing that I’d like to see would be a law saying that if you go to facility X that’s in-network for your carrier, that EVERYTHING associated with your procedure, visit, stay, etc… is also considered in-network.
None of this bullshit where you need knee surgery and come to find out that the hospital is in-network, but the anesthesiologist and surgeon are out of network, but the radiologist and lab are in-network, or that your insurance only covers orthopedic suture brand A, but not brand B. Doubly so if you’re not doing it as a planned surgery.
And that profit motive plus the inherently adversarial nature of so many things in the US combine to explain the overuses.
This year I’ve had inpatient eye surgery, 6 x specialist outpatient ophthalmologic appointments, 8 x GP visits (mainly for script renewals but also a couple for urgent back care/drugs). I’ve had 1 x MRI and two physiotherapy visits.
Out of pocket for me? Zero, nada, zilch. I haven’t paid a cent for those individual events.
Taxpayers here in (Aus) are charged a Medicare Levy, roughly 2% of gross annual income. As I don’t earn a shitload, that works out at around $600 per annum for me. That’s per annum folks, not per month!
I honestly don’t know how anyone can afford health care in the US. Sheer madness.
We envy you, we really do. But sadly we are stuck in this country and our brutal, overpriced system. Politicians of both parties refuse to fix it because neither side wants to anger the rich and powerful (who benefit from our overpriced system).
Basically we are trapped. Personally I’m hoping to save enough money to retire in my early 50s, and I’ll probably leave the country at that point. I’m not losing my life savings over health issues. I’d rather live in latin america where I can get good health insurance for $100 a month.
On an unrelated note, at a job I used to work they listed the price of health insurance. A PPO plan with a $500 in network deductible and a $1500 out of network deductible was about $500/month total. Of which the employer paid about $300, the employee paid $200.
So how can they offer a plan like that so ‘cheaply’ when on the individual market there is nothing that cheap? I tried pricing plans as a single person in my late 30s, and it was about $400 for a 7k deductible and no out of network coverage. So how did this company offer a plan with a low deductible and out of network coverage for only $500?
Their profits weren’t due to the ACA. I would suggest repurposing the brain cells you use for writing factually inaccurate sarcasm into doing some relevant basic research on the subject.
Things like previous claims and age distribution at your old job were doubtless very different from the group of people buying individual policies (who were probably buying because they had health problems). Depending on your state, the premiums might have been ‘community rated’ - meaning all ages pay the same.
An employer-based health plan, especially a large employer, gets a decent rate from the insurer. It has to do with risk pools - the larger the pool, the less risk that one expensive person drains the whole pool. When you are an individual, the risk is high that you will drain away the portion you added to the pool, so the rate is high. When you are one of many, all contributing to the pool, when you get sick, the pool is large so it can cover your cost more easily. Health insurers employ teams of actuaries to help understand the risks of selling policies to certain employers, and price accordingly.
For those not in the US - this is how employer-based health coverage works. Most people in the US have employer-based coverage, and it is not horrible. The pain points being expressed here are mainly for the individual market (I think), so the rules of engagement are different, and costs are higher and benefits lesser. In the individual market, the risks to the pool are less predictable as well. Only when you get into government programs like Medicare are prices set for the individual.