I have private insurance through my employer. It costs quite a bit, but there is no deductible and a wide network. It covers my family as well. Without going into much detail, we have gone through some fairly serious health problems with no difficulty from our insurance company.
I have pretty good coverage from my husband’s employer’s plan but I abhor our current system of health insurance. I have an issue that requires an ongoing medication, one of the expensive biologic medicines. All of the insurance plans hate how expensive it is, and I don’t blame them but I hate the way they deal with it. For example:
Years ago insurance plans implemented copays on the theory that if patients had “skin in the game” they would be more likely to shop around for lower priced care/medications. Then more recently they implemented pharmacy benefit managers, ostensibly to help them, again, manage costs. So what do the PBM’s immediately do with expensive drugs like biologics? Mandate that you can only ONLY fill them at their chosen specialty pharmacy. No, you may not shop around or use Goodrx.com.
And they implemented a tiered coverage system so if your drug is on their Tier 2 list the copay is X+Y, and if it’s on their Tier 3 list then the copay is X+Y+Z. Remember the concept of copays was to encourage us to shop around, but since they won’t let me, now it’s just punitive.
Even worse, the insurance plans often require a pre-authorization for these meds which means additional bureaucracy between the PBM, the doctor’s office and the insurance plan which causes weeks or even months of delay. I’ve given accounts in other threads on the SDMB of my situations of having to go 6-7 weeks without taking my meds because of this very issue.
I haven’t even had a catastrophic illness (yet), but they make dealing with them so much trouble that I kind of hate our insurance. And over the last 10-15 years, between job changes and employers changing plans, I’ve used nearly all of the major insurance providers. And every one of them are nearly the same, just varying degrees of aggravation.
I think its because as Americans we have been conditioned to realize our health care could be a lot worse, and we consider ourselves lucky if we have insurance that actually pays the bills.
So it would be more like if tons and tons of people were driving around on shitty tires that always go flat, but yours work. Yeah you’d be grateful, but there are countries where everyones tires are always inflated and in good condition too.
Its a testament to how fucked up our system is, that a small % of Americans who are currently in a good position are deeply grateful for something that people in other nations take for granted and consider a birthright. I’m sure in Africa, there are minorities of people who are deeply grateful for clean drinking water since so many people around them don’t have clean water and they realize they could lose their own clean water at any time. In most other nations we just take clean water for granted as a sign that you live in a civilized nation.
I have insurance through the Marketplace, since the company I work for is small and doesn’t have insurance you can get through them (there is an option you can use, though I forget what it’s called. It works similar to insurance, but it’s run through a faith-based organization, and I didn’t want to risk not being able to get bc or something like that). They’re looking into getting some, but in the meantime I’m okay with the insurance I have. My job does give me $100 a month to put toward health expenses, so I opted for a plan I pay less than that for every month. So far all my bc has been free, and any additional drugs have been $10 or under. I don’t have any gripes about them that I wouldn’t have toward any other insurance option, or the one I had prior (which was through work).
Is your plan subsidized because of your income? If it is, I think that’s really relevant.
I’m curious if those under a universal healthcare system get similar notifications of how much their healthcare cost themselves and fellow taxpayers. I’m not really for or against either systems - just curious.
I get $400 from the government due to my income, and my plan cost me about $458 (just me, no spouse or dependents). Originally, anyway - it supposedly went down to about $38 when the new year started, but I only started the insurance in October, so my monthly bills have kind of been all over the place.
It is a little cheaper than I got through my previous employer, which cost be about $80 a month. That also included super cheap dental and vision, which I no longer have.
If I didn’t get that money from Marketplace, I’d have to go with as cheap a plan as possible. Or do the odd faith-based insurance my job currently offers. I’ve been on catastrophic insurance before and it’s far from fun. Fortunately, I’m generally a healthy person.
Thats not universally true. My employer can not legally change health care on us whenever they want because it’s part of our contract.
Our plan is very good with no deductible, a small co-pay and not cheap but reasonable premiums.
We have employer provided insurance and it’s ok. The best insurance we had was a Gold level Obamacare plan a couple of years ago, it was wonderful the current plan is a little more expensive and doesn’t cover quite as much (we only get glasses or contacts every other year). My parents are on Medicare and their insurance is much worse then ours. It takes them longer to get stuff done and it costs them more money out of pocket. I’d be grumpy if my current plan was removed and I ended up with longer lines and spending more money.
That being said I’m generally a fan of a single payer system and realise that the societal benefits are greater than my personal costs.
As US health insurance goes, mine is ok to good. I pay about $600 a month with a 1500 individual/3000 family deductible, so it’s not terribly expensive as such things go. It’s through a major insurer, so the negotiated rates are pretty good and the network is pretty large.
What I don’t like is the general pain in the ass actions required to navigate the system and get the best outcomes. It’s not unique to my insurance- it’s the way all of them are. They may require a certain test to be run before they’ll ok a different one, even if your doctor has an educated hunch that it’s your gallbladder and not your colon. Or your doctor may want to prescribe you one hypertension medication, but they require them to prescribe some first-line drug off their specific formulary and prove that it doesn’t work before they’ll pay for the second one that your doctor actually wants. Or you may end up in the ER needing emergency surgery and later get a bill finding out that the guy who the hospital assigned to you isn’t actually in-network, despite the hospital itself being in-network. And having to argue that point with them that you had no choice in the matter- it’s not like you could go home and research and come back a week later for the emergency surgery. Or having a test done in an in-network facility for an in-network doctor, and getting a $200 bill, because the price of the test was $750, the negotiated rate was $225, and the insurance portion is $25, leaving you on the hook for the other $200 because your deductible hasn’t been met.
It’s all that crap that drives people insane.
What people fear about single payer health care is that it will cost more, reduce choice, and depersonalize the process. Proponents need to gin up a bunch of examples, or maybe a website that would explain how it would be cheaper for your average middle-class family of four making about $70-80k a year, and how it won’t prevent them from seeing the doctors they like, when they like, etc… Nobody’s quite stupid enough to think it’ll be absolutely free for anyone, except maybe the indigent, but proponents do need to show that whatever tax increases will be necessary will offset the aggregate premiums, copays and deductible payments for most people.
Well, the first thing to point out is that the notion of large tax increases derives from the fact that what employers currently pay is not classified as a payroll tax - which, in effect, it is. Your middle class family making $70-80k a year is really making $100-110k a year with $30k deducted by their employer that goes to pay for their current private insurance. Their breakeven point is that this $30k is now simply reclassified as a tax and goes to the single-payer public insurance pool rather than a private insurance company.
Other than my annual tax bill, you mean? 
But the non-facetious answer is that I’ve lived in three different provinces in Canada and have never got a statement of what my health care has cost that year. That’s because we don’t think of it as insurance. It’s a government service.
I don’t get a statement showing how much the police services in my town cost me each year, or the cost of the roads, or the cost of fire services, or the cost for the Cub’s public schooling. Those are all government services, paid for from our taxes.
Health care is just one more example of a government service paid for by our tax dollars.
Why couldn’t I have been made Canadian?
It’s a poll. The question was how do I feel about MY private insurance plan. NOT what do I think is best for the “big picture.” That’s how polls work.
As someone who grew up in the U.K., I concur.
However, there’s a real sense in which, unlike most other government services, it is much more like insurance. People’s individual requirements for healthcare vary much more than (say) their use of roads or the benefit they derive from defense spending. And I think framing it as public insurance gives insight into why private insurance is a terrible approach to healthcare.
The benefit of all private enterprise is efficiency gains motivated by competition. In the insurance business, a company with better a model for risk estimation can out-compete a company with a worse model. And risk estimation requires looking carefully at your historical behavior as an individual. In auto or home insurance, the contract usually only lasts for a year, then your risk is reassessed. If you’re a driver with a good safety record, an auto insurance company that can accurately place you in a low risk pool can profitably sell you cheaper auto insurance. And our society generally doesn’t have any ethical problem with the idea of dangerous drivers being forced to pay more for auto insurance, or if they can’t afford it to take the bus. Because there’s a feedback effect, it’s under your control - the risk of higher insurance premiums encourages you to be a safe driver.
The equivalent kind of risk analysis for health insurance requires analysis of your likely future requirement for healthcare. Private companies obviously want to insure only healthy people! Since we find that ethically unacceptable, U.S. private insurers are generally not allowed to terminate their contracts with people who get sick (although they will jump at the just if they have a legal justification), and they are not allowed to consider pre-existing conditions. So we’re letting private insurance companies exist, but banning them from competing with one another in assessing individual risk. They just sit there, not competing because we don’t want them to compete, gathering money and taking a big cut.
The correct ethical model for healthcare insurance is that the customer and the insurance company both commit to a contract for an entire lifetime, and unlike auto or home insurance your risk is not reassessed every year. You commit to it with a Rawlsian veil of ignorance about whether your individual lifetime healthcare needs will be higher or lower than the average person. In other words it’s a part of the social contract.
And if this is the correct model for healthcare insurance, private competition has no place in it. It should be a single obligatory insurance pool that everyone must contribute to. And the simplest and cheapest way to administer such an insurance pool is to fund it through general taxation. This is what “single payer” means.
Every nation on earth except the United States understands this.
And as others has emphasized, this relates solely to the funding of healthcare, it has nothing to do with the provision of healthcare. Private enterprise and the benefits of free market competition are absolutely part of the efficient provision of healthcare.
«Many are called, but few are chosen.»
I voted “love”, although I’m not sure that’s an accurate description. My employer covers the full cost, which is great. The insurance seems to be good? The only major medical expense I’ve had in the past decade was several days in the hospital for which I paid $100 out of pocket for the emergency room visit.
There is occasional wrangling with the insurance over not paying something, but they’ve always eventually either paid it or provided an acceptable reason (to me) for why it’s not covered. It is disturbing to me that this process seems to be as arbitrary as it is, though.
Example: When our second baby was born, our insurance didn’t pay for CA’s newborn genetic testing, which is required by the state. I asked about why, and the insurance person said it’s not covered. I pointed out that they had paid for it for my first child, and they said, maybe you had different insurance. I pointed out that I had the same insurance, and also inquired about how it could be that the state required this, but the state insurance commissioner didn’t make sure that insurance covered it? I escalated this to HR and now I had HR, and the insurance company, and our insurance broker telling me that it was common that insurance didn’t cover this, but no one could provide any documentation of that. I submitted the bill again and the insurance paid it.
The whole thing is bullshit. If this is really not covered, then it should be really easy to point to a document that says so, and they shouldn’t pay it. And if it is covered, they should pay it. At no point in the process should I have to send 20 emails and make 4 phone calls to get them to cover an event that happens 400,000 times a year in California. It’s not like the state-mandated testing of a newborn was this weird unlikely event that no one had run into before!
I didn’t read the OP post before I answered the poll.
I am benefiting from a Medicare Advantage plan funded through my (wife’s) employer.
So most of the cost is covered by Medicare, but the Advantage part is covered mostly by the retiree health plan. The cost is spread out among 3 entities: Medicare, Employer retirement system, our individual premiums and copays.
Given the spread, no one entity is paying a huge amount for the benefits we receive. And while our cost is not high compared to most people, if you add up all the different payments we make, it is a noticable amount.
I used to have excellent company-provided health care. Low cost, low deductibles, and it was a very nice thing.
Then, Seven (?) years ago, Obamacare came up, and our lovely healthcare had to be gutted to meet the standards. It went to a high cost, high deductible. My prescriptions went from a $20 copay to nearly $200 each. I lost access to my longtime doctor - I chose to pay his fees rather than being forced to switch doctors.
Our plan is merely OK now. $3k deductible is the lowest plan, 80/20 split.
I wish they’d left our company healthcare alone.
I’m reasonably happy with my employer-provided Kaiser plan. My primary care doctor is great, the urgent care center is convenient, and the premiums and co-pays are reasonable. I recognize that there are gaps in coverage, especially when it comes to mental health care, but those issues haven’t affected me personally. My favorite thing is never getting a surprise bill for thousands of dollars for a test or procedure my doctor insisted on but my insurance decided not to cover, as happened several times when I had a PPO. Incidentally, my husband is currently unemployed and purchased a nearly identical Kaiser plan through Covered California for much less than it would have cost to add him to my plan, so that’s been working pretty well for us. But it was still a hassle for him to have to change providers. I’m very much in favor of universal healthcare, and would be happy to pay twice as much out of my paycheck for a system that would always be there for me, even if it was otherwise exactly like the plan I have now.