Going without health insurance

[CivicFan]

OK

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# Medicare spending grew 7.9% to $502.3 billion in 2009, or 20 percent of total NHE.

As the economy tanked and unemployment grew, the private coverage became scarce. The doctors had to shift their focus to the elderly to maintain their lifestyles.

The life expectancy continues to grow. Every additional day is more expensive to treat.

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# Medicaid spending grew 9.0% to $373.9 billion in 2009, or 15 percent of total NHE.

As unemployment grew and people became poorer, more people were eligible for Medicaid coverage.

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# Private health insurance spending grew 1.3% to $801.2 billion in 2009, or 32 percent of total NHE.

There was a net reduction in private coverage as the health care cost inflation was around 4%.

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# Out of pocket spending grew 0.4% to $299.3 billion in 2009, or 12 percent of total NHE.

Smaller growth than one might expect given the popularity of high deductible plans. But see the point for Medicaid - Medicaid patients cannot pay out-of-pocket fees.

 

[PandaBear]

Originally Posted By: Tempest

If there were no government distortion (and it is massive) and people could purchase their own insurance (without tax laws distorting the market), it would send pricing signals to the health care sector. It would also send pricing signals to consumers because insurance would cost them and looking for the best deal on a provider would matter.


1) We were there, are there, and how is our cost compare to other developed nation for the past record? Also how is insurance reducing cost (denying care in some cases) and how consumer counter that (by hiring lawyers). How care provider counter that (by merging into monopolies that equal in size to insurance company, like sutter health).

2) Market economy only works if the variation in price alter spending and production habits. Reducing from 4x unaffordable price to 2x unaffordable price is still unaffordable, and would do not a lot. It acts as a monopoly that the only way to lower cost is to deny care, some unnecessary while other necessary, depends on how much is the write off value of individual life, like auto insurance policies.

Your hypothesis doesn't make any sense at all on the extremely high cost procedures / treatment. What you recommended already exist today as high deductible health savings account plan.

 

[eljefino]

Originally Posted By: Tempest

Now, there are no such signals getting to end user. If someone else is paying the bill, resources will always be over utilized.



Yes there are: When you pull up your insurance website and find out which doctors are in network and which are not.

OP is trying to choose between a couple of pricey plans and or doing without. So he is getting the "signal". If he chooses without, he'll probably skip preventative care and if lucky limp along until he's 65 then check in for a whole bunch of expensive stuff on Medicare.

 

[Tempest]

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The doctors had to shift their focus to the elderly to maintain their lifestyles.

Then why are doctors dropping medicare patients?

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There was a net reduction in private coverage as the health care cost inflation was around 4%.

Then as I said, government spending in health care is driving prices up.

Also:
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CMS estimates that $48 billion of estimated Medicare outlays of $509 billion in fiscal 2010 went to improper payments, including fraudulent ones. “However, this improper payment estimate did not include all of the program’s risk since it did not include improper payments in its Part D prescription drug benefit, for which the agency has not yet estimated a total amount,” said Kathleen King, director of GAO’s health care team.

http://www.politico.com/news/stories/0311/50543.html#ixzz1Juak9BRf
At least 10% waste.

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Medicaid patients cannot pay out-of-pocket fees.

Price signals not getting to the consumer. Exactly as I stated.

 

[Tempest]

Notice the trend toward government spending and lower out of pocket expenditure while costs increase?

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Yes there are: When you pull up your insurance website and find out which doctors are in network and which are not.

Did "you" pay for your health insurance or someone else? Most people don't pay for their own insurance due to tax reasons.

 

[PandaBear]

Originally Posted By: Tempest
Then why are doctors dropping medicare patients?


My doctor friend told me that many got laid off or their employer cut down / eliminated health insurance, so they end up having to take more medicare patients because the more lucrative cases dried up.

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There was a net reduction in private coverage as the health care cost inflation was around 4%.

Then as I said, government spending in health care is driving prices up.

I think you got it backward, as it was the cost inflation reduces private coverage demand, not increases in gov demand increases prices.

Quote:

http://www.politico.com/news/stories/0311/50543.html#ixzz1Juak9BRf
At least 10% waste.

And the waste in private insurance? the care provider dealing with private insurance, the lawyers who live on lawsuits, etc? You got any number proving that it is lower than 10%?


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Medicaid patients cannot pay out-of-pocket fees.
Price signals not getting to the consumer. Exactly as I stated.

The entrance into Medicaid is not easy, you cannot just "decide" to enter like you want. Not personally on medicaid but if anything similar to my wife's worker's comp, they would ask doctors to do evaluation on whether it is the responsibility of the work condition, then every 6 treatments need additional approval, many levels of double check to make sure it is not abused to the point that care provided aren't as easily obtainable as health insurance. Many of my wife's coworker decide not to file cases due to the fear that it would put them in a "pre existing condition" that give private insurances weapon to deny claims in the future.

Health care is not something that is "market driven" because you don't automatically get more sick and need more doctors visit when you make more money, then suddenly you get better and never get sick because you are broke. If anything it is a reverse because when you are in financial problem your stress level deteriorate your health, and you live better when you are financially better off and improve your health.

How do you factor that into your market driven economy for health care?

 

[eljefino]

Originally Posted By: Tempest


Quote:
Yes there are: When you pull up your insurance website and find out which doctors are in network and which are not.

Did "you" pay for your health insurance or someone else? Most people don't pay for their own insurance due to tax reasons.


It's part of my job compensation, so darn right I'm paying for it. I'd get more money as a contractor. I don't care who signs the check or gets tax breaks- it's semantics and you know it.

But even if I bought a personal health insurance policy I bet there'd be in network cheap doctors and out-of-network expensive ones.

There's also an opportunity cost, as I have a reasonable idea for my own business, which I'm not acting on, as I'm the health insurance breadwinner for my family. "The man", large employers who can get group insurance, love implicitly threatening the health of those who could form upstarts and nibble at his heels.

 

[tonycarguy]

Health insurance is part of the problem and needs to change.

Think about the effect of supply and demand:

Imagine if auto insurance not only fixes damage from collisions but also pays for oil changes, new brakes, and all maintenance, and UOA's. First thing that'd happen is your rates would go way up. Secondly, there is now increased demand for mechanics. Now imagine if auto mechanics had to be licensed like docs and it's hard to get a license; so there's now an intense shortage of mechanics. Suddenly, your shop's $90/hr rate jumps to $250/hr because there are too many customers. Now your insurance rates go up even higher.

That's the problem with health insurance now. It covers too much, patients come in for every little thing. One time I was waiting at the doctor's office and some woman brought her kid in because he had a scraped knee (for crying out loud!). If she didn't have insurance would she have come in? I doubt it

Insurance needs to cover less. People need to pay for insurance themselves. And there needs to be more doctors.

 

[Spector]

There was a special on TV a while ago where the reporter visited 5 countries with national health care, Japan, Germany, Taiwan, Switzerland (with the home of huge drug companies) and one other. Japan was incredible, their citizens see the doctor twice as often as Americans, their administrative cost is less then 10%, ours double that. Taiwan is totally paperless, debit card carries all info etc. All five were loved by citizens and all 5 had two things in common, national health care either via a Gov program or private carrriers but ALL PROIVATE CARRIES HAD TO BE NON PROFIT and of course all had fixed pricing for services.,

I am a proponent of free markets and capitalism but some things do not belong in the for profit sector, one is health care. The bottom line becomes the driving force, seen it in VA when the legislature sold out to Blue Cross years ago and let them go for profit. The Executives had a plan, once for profit obtained they continued to record record profits every quarter, premiums increased, benefits decreased and stock value went up, they then sold out to Anthem and all of them had golden parachutes and became millionaires overnight. The legislature was bought out with cash payments to the state coffers but the citizens have paid ever since.

 

[kb01]

Originally Posted By: tonycarguy


Imagine if auto insurance not only fixes damage from collisions but also pays for oil changes, new brakes, and all maintenance, and UOA's. First thing that'd happen is your rates would go way up. Secondly, there is now increased demand for mechanics. Now imagine if auto mechanics had to be licensed like docs and it's hard to get a license; so there's now an intense shortage of mechanics. Suddenly, your shop's $90/hr rate jumps to $250/hr because there are too many customers. Now your insurance rates go up even higher.

That's the problem with health insurance now. It covers too much, patients come in for every little thing. One time I was waiting at the doctor's office and some woman brought her kid in because he had a scraped knee (for crying out loud!). If she didn't have insurance would she have come in? I doubt it

Insurance needs to cover less. People need to pay for insurance themselves. And there needs to be more doctors.


In my situation, your analogy doesn't make any sense. I have a $5,000 deductible HDHP/HSA plan. It doesn't cover any of those little things. I have to spend 100% of that out-of-pocket before it kicks in. There are no co pays, co insurance, etc. If I or a member of my family goes to the doctor or gets a prescription for anything, I pay out-of-pocket from my HSA.

For insurance to cover anything, it would require a hospitalization for a few days.

 

[kb01]

Originally Posted By: eljefino


Yes there are: When you pull up your insurance website and find out which doctors are in network and which are not.

OP is trying to choose between a couple of pricey plans and or doing without. So he is getting the "signal". If he chooses without, he'll probably skip preventative care and if lucky limp along until he's 65 then check in for a whole bunch of expensive stuff on Medicare.


It doesn't really work like that in my situation. Going without insurance and paying for preventative care and the occasional doctor's visit would still be cheaper than continuing coverage at $1,000 month and still paying out-of-pocket until I reach my deductible. My deductible is high enough that it really only protects against hospitalization.

Due to the recent legislation, a very limited amount of preventative care is paid for via insurance w/no cost sharing but my premiums went up a commensurate amount to make up for this discrepancy.

If I get a colonoscopy, insurance would (probably) pay for it with no cost sharing. If anything was identified that needed to be removed and follow up visits were required, I'd pay for it out-of-pocket until my deductible was hit.

 

[Billy_D]

Originally Posted By: kb01
...Due to the recent legislation, a very limited amount of preventative care is paid for via insurance w/no cost sharing but my premiums went up a commensurate amount to make up for this discrepancy.


All the preventive well-care visits for my children are 100 per cent covered by the ins. There is no copay. My wife and I also get an annual physical as part of the preventive care all covered by the ins with no copay. Look for a different employer if you can. It might be beneficial for your family and yourself to find a job even if the employer pays less to get into a better health plan.

 

[kb01]

Originally Posted By: Billy007


All the preventive well-care visits for my children are 100 per cent covered by the ins. There is no copay. My wife and I also get an annual physical as part of the preventive care all covered by the ins with no copay. Look for a different employer if you can. It might be beneficial for your family and yourself to find a job even if the employer pays less to get into a better health plan.


Trust me, I'm trying to get a better job and have run the numbers countless times.

I'm really hoping to a job with the government (Army Corps), so I can get government benefits. I have interviewed for a few jobs but it appears that most small businesses only cover a very small segment of the premium -- Back in November, I turned down a job that paid better but my portion of an individual policy would have been $500/month and a family policy (IRC) about $1,500/month. Insurance is insanely expensive in West Virginia, especially for those at small businesses.

Preventative care is covered 100% but that's only a portion of a visit. We just took our daughter to her 2 months baby well visit. The total bill was about $600 but it was broken up into 6 or 7 separate billing codes, with two of them being covered 100% as preventative care.

 

[CivicFan]

The reason for the higher premiums in small businesses is simple. The risk pool is too small and a large expenditure within that group will be catastrophic for the plan.

For example, if the insurance group is made up of 10 people, if someone goes and has a $10,000 procedure, the expense will be a very large proportion of the pool. The same $10,000 expense in a group plan with 100 participants will be a much smaller portion of the available pool of money.

That's the reason why the health care reform was proposing to have a federal plan (a very large pool with low risk) or another proposal was to have state coop plans (smaller but still low risk pools) as part of individual mandates. But that did not happen so we are stuck with the same P.O.S. insurance companies.

 

[kb01]

Originally Posted By: CivicFan
The reason for the higher premiums in small businesses is simple. The risk pool is too small and a large expenditure within that group will be catastrophic for the plan.

For example, if the insurance group is made up of 10 people, if someone goes and has a $10,000 procedure, the expense will be a very large proportion of the pool. The same $10,000 expense in a group plan with 100 participants will be a much smaller portion of the available pool of money.



That's exactly why our current rates are so bad. We're a small business (~12 people in our office). Those under the age of 30 have dumped their policies due to rising premiums, leaving the rest of us to subsidize the two very unhealthy people on our plan (cancer survivors).

I never felt this way before and I really do feel like a heartless [censored], but at this point I'm starting to feel that small businesses should have the right to dump unhealthy employees. It doesn't seem right that my coworkers have to go without, or give up huge portions of our paychecks, so a few individuals can get more than they pay in premiums, consistently, year-after-year. If two people were laid off results in everyone else being able to afford insurance, is that a bad thing? Yes, it's heartless, mean, etc. but I don't know of any alternatives under our system's current framework.

 

[PandaBear]

Originally Posted By: kb01
That's exactly why our current rates are so bad. We're a small business (~12 people in our office). Those under the age of 30 have dumped their policies due to rising premiums, leaving the rest of us to subsidize the two very unhealthy people on our plan (cancer survivors).

I never felt this way before and I really do feel like a heartless [censored], but at this point I'm starting to feel that small businesses should have the right to dump unhealthy employees. It doesn't seem right that my coworkers have to go without, or give up huge portions of our paychecks, so a few individuals can get more than they pay in premiums, consistently, year-after-year. If two people were laid off results in everyone else being able to afford insurance, is that a bad thing? Yes, it's heartless, mean, etc. but I don't know of any alternatives under our system's current framework.


If companies are allowed to dump employees just because their health care cost is high, that would create a problem that someone has to pay for them (government, social service, service writer or debt holder via bankruptcy, etc), or put them aside and let them die. So the least painful solution is either socialized health care or forcing insurance not to drop it (Cobra, regulation, etc). But once you are out...

The other side of the problem if you look, is what use would insurance be if they only collect money from you when you don't need it, and kick you to the curb when you need it. I certainly wouldn't buy it and it wouldn't offer much protection for anything. Letting people join on a volunteer basis have this problem because they think rolling their dice may be a better choice if they only need catastrophic coverage and have nothing to loss in a bankruptcy. WIthout going to a mandatory policy of a minimum pool size or socialized care system, this would still be kicked around.

 

[greenjp]

Originally Posted By: kb01
That's exactly why our current rates are so bad. We're a small business (~12 people in our office). Those under the ge of 30 have dumped their policies due to rising premiums, leaving the rest of us to subsidize the two very unhealthy people on our plan (cancer survivors)...

Sorta gets to the heart of the absurdity of having health insurance linked to employment. It's a historical accident (unintended consequence of gov't intrusion) that's screwing things up to this day. How silly would it be for us to expect car insurance from our employers?

jeff

 

[kb01]

I'm not saying that its a good system but the fact that one or two people can dramatically increase the rates for everyone else isn't a good system either. All the bad things you mention can happen to those who don't have insurance because of cost (due to the costly employees). None of the younger technicians buy in, so the rates just go up even more. I can't imagine the government forcing anyone to buy a plan from an employer like some coal camp's company store.

My wife's employer dumped insurance entirely due to cost (she's a secretary at a tiny office). Her rates were insanely high and it's my understanding that the office is simply uninsurable. The plan they previously offered were incredibly expensive and had a high deductible, so very few bought into it anyways.

 

[kb01]

Originally Posted By: greenjp

Sorta gets to the heart of the absurdity of having health insurance linked to employment. It's a historical accident (unintended consequence of gov't intrusion) that's screwing things up to this day. How silly would it be for us to expect car insurance from our employers?

jeff


The real absurdity comes out when you try to explain how things work to family and friends who live overseas. My wife and I were pleading with our obstetrician to induce labor on December 30th to help save us at least $5,000. I tried to explain this to my family in Poland and they simply could not wrap their heads around the concept. From my understanding, this is something that just isn't done outside of the USA.

I can only imagine what life would be like if other types of insurance were handled like health insurance. If a coworker gets into a wreck or a DUI, then my rates go up or I get dropped.

 

[Tempest]

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It's part of my job compensation, so darn right I'm paying for it.

You did not pay for it as it didn't come out of your wallet and you didn't sign the contract. What you have is a third party payer.

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There's also an opportunity cost, as I have a reasonable idea for my own business, which I'm not acting on, as I'm the health insurance breadwinner for my family.

We have an employer based system in this country because the tax law creates incentives for employers to pay for health insurance rather than individuals. Companies can expense their health care costs and individuals can't.