I’m sure there are other ways, but a scummy method just came to light. Now this is not for me, but I see it’s effect on 4 people who are long time workers, always carried medical insurance, and who have developed serious and expensive medical issues and are expected to need care for years to come.
The method takes about 3 years to implement it it’s full ugliness. And the insurance representative actually used the word ‘gross offenders’ to describe those 4 people. It seems clear that they ‘encouraged’ management to do this. It basically goes like this, year one premiums jump up for that plan, and a second ‘slightly lesser coverage’ plan comes about at a much lower price point and incentives to jump plans, but will not do those 4 people much good - or at least it is better for them to stay with their current plan…
Year 2, due to the large number of workers who went with the cheaper plan and with the 4 gross offenders staying on the more expensive plan to get the coverage they need, the expensive plan gets a huge rate increase due to the cost of those 4 being diluted by less people on that plan. Now they also offer incentives to leave that expensive plan to a high deductible plan. More people leave.
Year 3 By the end of year 3 the price of the most expensive plan is astronomical forcing all but the most dire cases to stay on it, but at that point the price is prohibitive.
I guess it’s actually the opposite. I am impressed and somewhat in awe in a weird way at the way they went about this. So personally cruel and heartless but also so detached cold and calculated at the same time.
In some ways it’s a form of shunning, excluding someone from a group and forcing them outside, which seems to live on in many different forms. I guess that’s what I am bitching about.
Why don’t the insurance companies simply hire someone to hunt down and quietly kill those people that are making claims? Seems that this would accomplish the same goal, and be more efficient.
I’ve never figured out why the risk pool for health insurance is limited to a particular group or employer. For car insurance, my risk is shared across all the policy holders for that insurance company. That’s the whole point of insurance. So why does one sick person at a company impact just that company’s premiums? Surely the insurer has thousands (hundreds of thousands?) of other healthy people under their coverage. That a few get sick is expected, no matter which company they’re employed by.
I used to get my insurance through a small business I did contract work for. In one year, one high level employee had kidney cancer AND TWO serious bicycle accidents. Another one had gastric bypass surgery, then later that year she was hospitalized for 8 weeks with pneumonia that would not respond to anything, then she got lung abscesses then finally they cleared it all up surgically. But can you imagine the hospital bill for an 8 week stay? The place only had 8 full time employees, and the other employees had their fair share of medical issues, although not on that scale.
Now I was reimbursing this company for the full cost of my insurance, which kept getting more and more expensive. Many insurers just flat out refused to cover them. The ACA saved me, because it allowed me to find a somewhat reasonable individual policy. Still expensive, $600 a month or so, but pre-ACA i was getting quotes of around 2K a month for an individual policy for a single person.
Not being in the US this is all alien to me, but I was always under the impression that the whole point of a group plan is that all members of the group had the same rates and coverages. Ah, but I begin to see how this works! Through the wonderful free-market feature of “choice”, the victims are being offered a “choice” of different plans where, by sad coincidence, only one of the plans is any good to the four sick people, and it’s exorbitantly expensive. It should also serve as a warning to anyone else who dares to get seriously ill, because they’ll be in the same boat.
It reminds me of another lovely industry inspired by free market capitalism, protection racketeering, as practiced by Capone-era mobsters. Insurance works somewhat well for things like car insurance, where a number of at-fault accidents quite reasonably define you as a bad driver and your rates go up. You might even decide to stop driving for a while. Do these insurance companies expect these sick people to stop living? Why, yes, in fact, although they would never explicitly say it, but “fuck off and die” is precisely their wish for them on this holiday season.
Let me say that I’m a great fan of capitalism as a fantastic engine of commerce that has brought us much of the wealth and standard of living that we have today. The mistake that conservatives make on this issue is that like the metaphorical craftsman who possesses only a hammer, everything to him looks like a nail. As illustrated in the OP, there are certain things that capitalism is very, very bad at, and human health insurance is one of the most egregious examples. When someone is seriously ill, the absolute last question that should be on anyone’s mind is “how can we exploit this to maximize shareholder profit?” (or in the case of insurance, to minimize “medical loss ratios”). Because any answer to that question runs squarely against all medical ethics and human decency.
Don’t count on it. In Colorado we tried and thanks to the millions the insurance companies put into the campaign, 70% of my state felt the current system was just fine.
Everyone who has a car has to have car insurance (liability insurance at least, comprehensive if you have a loan out) so there’s no negative selection. That’s no longer the case with health insurance, so there’s negative selection – the people who need health coverage are much more likely to pay for it, and healthy young people are more likely to skip it. That’s true even at the group level.
Many companies are self-insured, where the insurance company is just the administrator. I don’t know how small of a company can do this though. And, I don’t know enough about the ins and outs of group insurance to comment on group sizes.
America’s health insurance system is dysfunctional. In other news, Generalissimo Franco is still dead.
I’ve mentioned the story of my friend John’s car insurance before. He was a week late paying the premium, but the insurance company cashed the check. Life went on. Many months later, after an accident, John filed a claim. It was refused because the payment months earlier was late. “But you cashed my check!” Oh! We’ll mail you a refund.
I think many insurance executives should be in prison, but the trillion-dollar justice system is too busy killing blacks who sell loosies, or who break into their own homes. Make America Great Again!
I understand that, but once I have made the decision to buy insurance, who cares what company I work for.
Suppose I could find out what company provides health insurance to the employees of Amazon. I should be able to go them, as an individual, and say “I’ll take the same coverage you’re selling to Amazon.” I’ll have to pay the whole cost of it myself, of course. I am no more, or less, likely to get sick than an Amazon employee is. If the insurance company can sell coverage to x Amazon employees and turn a profit, they should be able to sell to x + 1 and profit even more.
Actually, the assumption on the part of the insurance empire is that if you are seeking insurance on your own it’s because you ARE more likely to become sick/injured than average. You’re anticipating needing it, rather than being a clueless Joe who assumes he will never get sick or injured.
I get insurance through a group called TRS, which provides insurance for most public educators in Texas. Our rates are TERRIBLE. I’ve been rold this is because we have a higher % of women, so total costs are higher, so we all pay more. If we cpuld all get into a lower risk pool, we would . . But it wouldn’t be lower risk.
My employer used to have 3 levels of coverage with 3 different deductible and premium levels. Then I guess they couldn’t afford that anymore so last year went down to two levels. You could have no premium and something like a $4000 deductible or you could have a premium of about $80 a month and a $2000 deductible. Whoopie! And if you wanted to have your spouse or children on it, your premiums would be pretty much unaffordable for most people working there.
This year the two plans are basically the same but the deductible has gone up $1000 for each, the premium for the “better” plan has gone up to $100 a month from $80, and the family premiums are totally unaffordable. I have opted for the no premium plan this year because being on the “better” plan for the past couple of years hasn’t done much for me as far as I can tell. I’m not going to be able to afford the high deductible either way so I may as well pay no premium anymore. It worries me because I am a potential “gross offender” who hasn’t had anything major while on this plan yet but could, considering my medical history.
My employer has had a terrible time finding insurance for us, apparently. This is the best they can do, they claim.
They have added some programs this year that they hope will help us with costs. There’s a program to talk to a doctor online for $10 a pop for small issues like a cold or a UTI (but I can’t figure out how they help you over the Internet with a urinary problem). There’s a program that helps you find a lower price if you have an upcoming surgery, but it only works for certain types of surgeries - no surgery for brain or cancer. There will also be a program to give you someone to go over your medications with you and see if there’s anything cheaper or redundant in your medication list.
This overall situation cannot continue, but most of the populace keeps obliviously dancing into the fire and taking the rest of us with them by voting for politicians who tell them that the free market solves everything.