Rant (healthcare costs)

I have the good fortune of retiring very young. Went to the affordable healthcare act marketplace to shop coverage. My family of 4 will cost $20k per year in premiums and $15k addition out of pocket if we have claims. No way the average family of 4 could afford that.
Pretty close to my plan with an HSA, and I'm a family of 3. I pay 100% up to $14K. My annual premium is over $15K . The perils of being in a small business. :(
 
Its really hard to tell the Republicans from the Democrats on this thread. ;)

I have not seen the Republicans (serving in government) bring any solutions forward. Maybe I missed it. Tired of politicians bashing something they offer no alternative for.
 
I have not seen the Republicans (serving in government) bring any solutions forward. Maybe I missed it. Tired of politicians bashing something they offer no alternative for.

Reasonable people can argue about the efficacy of the solutions brought forward, but to say they have not brought any forward, is just plain wrong. Here is a starter list;

H.R. 30, H.R. 596, H.R. 1191, H.R. 2, H.R. 45, H.R. 2009, H.R. 2575, H.R. 2667, H.R. 2668, H.R. 2775, H.R. 3350, H.R. 3811, H.R. 3979, H.R. 4118

Some of these, but not all, do attempt to dismantle parts of the ACA (IMO for good reason). Other proposals which have not made it into formality, include, the ability for insurers to cross state lines, tort reform, increased competition for prescription drugs, penalties against birth-tourism, legal residency status requirements, means testing to curtail subsidy abuse, etc.
 
Just an aside, depending on what kind of medical user you are you should run numbers on the HSA plans. I have found it's basically pay now (in premiums) vs. pay later (in deductible). Net/net its a wash. So if your a light user and a smart user, you can actually save some money in your HSA (especially with no kids).
My main cost is Dr visits and prescriptions. Probably 3 visits a year. No idea how much the prescriptions are at full price but don't think they are too costly. Even so, if I figure conservatively about $20 each/month that is about $80/month between the 2 of us. Dr visits might be about $100 each? So figure about $1200-1500/year that I would have to pay out of pocket under the 2 HSA's we were offered. The HSA's were $840/month for the $3000 deductible and $660/month for the $5000 deductible. Under each of these I would have to pay out of pocket for almost everything until my deductible is met. The price difference between what I went with and the $3000 HSA is only about $250/month ($3000/year) but I would also have to pay the first $3000 out of pocket so if I used my deductible it's a wash. We have never used up our deductibles but I am probably going to have hernia surgery this year so it is worth it at least for this year. I may drop it down next year when we re-up. But anyway, so at a minimum I would be spending $9200 with the cheapest plan and my deductibles for Dr visits and prescriptions. Under the plan I went with I will spend at least $13200/year in premiums plus my co-pays on Dr and prescriptions, which is only going to be about $200/year. So probably a $4000/year savings if we do not use our insurance at all going with the cheaper plan but 1 broken bone or surgery and we will be further ahead with the better plan. The HSA's covered $0 of anything until deductibles were met. And the price difference between the $3000 HSA and the plan I went with was only about $2000/year. After paying for our minimal stuff we would be almost even anyway. But yeah, you are right, if we hardly use it the HSA might be better and I may switch to that next year after I have the surgery.
 
I pay about $8,000 per year for premium, deductible and co-pays (single guy). But a lot of services are 80/20, they cover 80% and I pay 20%. However getting a CT scan twice a year completely uses up my deductible and copay so things are covered 100% for a good portion of the year. I also have money taken out of my check for my HSA (which the company also donates $1K) and that takes care of the deductibles/co-pays on a tax free basis.
In 2017 I was on a similar plan and had $500,000 of medical treatments. Only paid the deductibles and co-pays and everything else was covered. The last 6 months I was on Cobra and my last treatment was 2 weeks before my Cobra expired.
 
What if we restructured the business model of Health Care providers? Not focus on the insurance companies.

Go back 50 years, 75 years, you had a grocery store, shoe repair, hardware store, and a doctor all operating under the same business model.

Now in that world, if you could not afford to get your shoes repaired, you didn't.

Same with going to the doctor.

Our society has evolved, we don't want anyone to go hungry because they cannot afford to go the grocery store. So we provide a subsidy.

[ for sake of brevity, only discussing people who are working, not retired or unemployed, but applies in the end ]

As health care advanced, became more successful in helping people, the costs climbed. First evolution was insurance, people who had jobs, their employer said I will pay into a fund every month that will cover those more expensive services. How many people in 1950 had health insurance?

Costs kept climbing. Employers started passing an increasing portion to employees. Then our society said - everyone should have access to healthcare even if they cannot afford insurance, so lets subsidize their insurance payment.

Why not take a look at why healthcare costs as much as it does.

What % of revenue does a healthcare provider pay in Insurance costs on their work?
What % of revenue goes to redundant or extra testing to make sure the action is defensible?
What % of revenue goes to dealing with the administrative costs of getting paid?

My views have changed over the past few years. 10 years ago I stood in the group that said healthcare is not part of our constitution, so therefore it is not a right.

Couple of years ago I had early cataracts (runs in my family) which resulted in surgery in both eyes. My insurance paid the base, I paid extra for the lens I wanted.

When I think about the impact that had on my life. When I see where doctors have gone to under developed areas and are able to impact 100's if not 1,000's of people with something as straightforward as cataract surgery it started me thinking.

Healthcare today has so much life improvement, life sustaining, and truly life impacting technology -- How can we ethically, morally as a people withhold that treatment from fellow humans.

We want to make sure they have food and housing - yet its ok if we let them go blind because they don't have insurance?

I do not believe the Government can successfully operate a train line, a postal service, or a healthcare provider. That's proven. I do not support the government providing a solution. I do believe the government can be an agent of change facilitating a new model.

Doctors and Nurses are special people. Not everyone can be a doctor or nurse. They should be compensated at a level that commensurate with the investment they have made.

Not particularly worried if insurance companies are a piece of the next model or not, an insurance company has never healed a sick person or enabled a person to see better.

Doctors (and supporting staff) should be focused on people who need their help.

How do we handle when a Medical provider makes mistakes? Is that an oversight function or peer review function with licensing implications?

I feel pretty strongly that the current approach of letting the courts decide on dollar based penalties that are subsequently paid by malpractice insurance companies, based on the persuasive arguments of lawyers is not working very well.

Think about this. I am paying health insurance so I can go to a doctor. The doctor is paying malpractice insurance before they treat me. Should something go wrong, my only recourse is to hire a lawyer who fights with the lawyer representing the doctors insurance company. Then a sympathetic jury awards a huge settlement. This drives up the entire category of doctors in that practice area. They pay more, which means they want more from my health insurance company, who then raises my rates.

Way too many people making money in health care that have nothing to do with a person's life being extended or improved.

Wild idea, what if Doctors did not pay tax on their income and were relieved of Professional Insurance costs? Would we just make a lot of rich doctors? Or could we build a fence around it - so that it provided a premium wage commensurate with their education, yet force delivery of services cost down. Wild idea that probably would not work - but maybe it spurs a different approach.

I use the term Doctor - but that could be hospital, Lab, etc.

I believe the only way we can address the need to share the technology we have today across our society is to lower the cost of the service. We can never afford to have the government provide or subsidize insurance to get there.

Before you pick apart my poorly written scenario - think about what I am trying to say.

I am not proposing the specific steps above - I am proposing that very smart knowledgeable people need to come up with new models, new approaches...

My ideas are not that great, I see a lot of problems with them. But the only two approaches I am seeing talked about is either change the insurance model -- or just turn it over to the government. There has to be another model out there.

And by the way - If you have to assign a label - I am a (small government favoring ) Conservative with a soft heart that believes we do have responsibilities as humans.
 
@FootballFan. I think you touched on the exact problem with all of the healthcare legislation that has been passed to date. The Affordable Care Act is not at all about health care. It is about insurance. A large portion of our populace, and certainly our legislators fail to understand the difference.
 
Went to the Doctor today. Found out I have a sinus infection. Got a script for an antibiotic. Went to pick it up. On my “new” insurance plan the company went to (with Express Scripts)... $112.60. I told them hang on I was going to see if the Doctor could sub for something less expensive. Couldn’t get in touch with the Doctor. On my phone found a coupon thru “GoodRX”... $62.66.

Done. I will turn the receipt in for credit against my deductible.
 
Went to the Doctor today. Found out I have a sinus infection. Got a script for an antibiotic. Went to pick it up. On my “new” insurance plan the company went to (with Express Scripts)... $112.60. I told them hang on I was going to see if the Doctor could sub for something less expensive. Couldn’t get in touch with the Doctor. On my phone found a coupon thru “GoodRX”... $62.66.

Done. I will turn the receipt in for credit against my deductible.
Nice! Will check into that. I get all mine from the local Rite Aid
 
The ACA is not about insurance either. It was intended to usher in universal coverage aka Medicare for all. The ACA was targeted to a small population approximately 15-20 million. It was a tax. It set a precedent that the government can compel its citizens to purchase a product in this case health insurance. Or pay a penalty on your taxes.

Most people and of the comments I read here, don’t understand healthcare nor the economics of it.

I’ve been in healthcare for 37 years. I’ve been throughout Canada, LATAM, EU, including UK and Nordics. I’ve been in hospitals in all these places.

The US has the best healthcare in the world. The problem is when useful idiots conflate privilege and rights.

The bleeding hearts want healthcare for all. Sounds great. But it simply can’t be done. Especially in a country w 350M population.

The UK contracts the private sector and off loads over 15% of their government volume back to private doctors.

In Canada they use a wait list. You wait for months sometimes over a year for your appointment for your procedure. I know this because I sold the identity technology they use to the Health Ministry.

People complain about the cost of care while they wait 20 minutes at the McDonald’s drive thru for their super sized meal.

Anyone can receive care in this country. It’s called the ER. Illegals go there for flu and colds and they all get free shit.

I have direct insight into what’s wrong w healthcare and what drives costs up. It’s the Fed.

See college tuitions skyrocketing in last 20 years. Why? The Fed.
Same w healthcare.
 
Some of the single young people that work with my wife who were no longer covered by their parents chose to pay the penalty for not having coverage under Obamacare when that was a thing.
Their reasoning was that the high deductibles under the least expensive options weren’t worth it so they decided to roll the dice.
While they could take care of most things out of pocket at urgent care or minute clinics, the logic falls apart if something serious were to happen.
If something serious happened they would have to go to the ER which would probably mean the taxpayers would be on the hook for the bill.
 
The ones that get free healthcare are the ones that go to the ER for a hang nail. I mean literally, due to her career my wife is in contact with quite a few that get 'free' healthcare and some of the reasons they go to the ER are ridiculous. One was for a stomach ache. One for a bad cough. Last time I was at the ER was when I got a sliver of metal in my eye about 15 years ago. In the 26 years me and my wife have been together I think I was there twice (sliver in my eye and a cut on my arm that required about 7 stiches). I think my wife has been there once in that time and that was for a dislocated elbow after a fall. I know a few people she talks to on free healthcare that go to the ER at least once a month. I agree with above, if you can't afford healthcare then work harder to get yourself out of that situation. There are some exceptions but the majority are perfectly able to work, just too lazy to.
 
@boatman37 - That's the problem with making anything "free"...You have to have skin in the game...

That said, Emergency room or not, a cough, nor a stomach ache shouldn't be expensive no matter where people go.
I had something in my ear that was bothering me for a couple of weeks. Finally went to Med Express and they found a dog hair wedged in there that was rubbing my eardrum. I was literally in there for 5 minutes with the Dr/nurse and that includes the time the nurse spent with me taking my BP. Dr got a pair of tweezers and pulled it out. Bill was a little over $500. I called Med Express and complained that they were billing me about $10,000/hour. They did reduce it to about $250 but it was still ridiculous. I will never go to Med Express again. And the shocker, I had to pay that $250 out of my pocket. But a 'freeloader' would have not paid a dime.

There are deeper reasons I feel the way I do but those are a little too personal for a public forum but the jist of it was I had nothing growing up and worked harder than 90% of the population to get to where I m today. I could have easily taken the easy way out and got everything for free but I refused and busted my butt
 
Boatman37. I feel your pain. Took my daughter to a Med Express when she had stomach pain. Turned out she had a bladder infection... she peed in a cup and they dipped a strip for $1,700. What a rip off.
 
What's nice is my doctor does an early am walk in clinic. Like 7:30-10:30 am. Just walk in, patient or not. They'll check you out. Only costs a regular doctor visit, not inflated walk in/ER charges.
 
What's nice is my doctor does an early am walk in clinic. Like 7:30-10:30 am. Just walk in, patient or not. They'll check you out. Only costs a regular doctor visit, not inflated walk in/ER charges.

That’s fantastic!
 

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