Whew, I have health insurance for 2014 !!!!

[JHZR2]

Originally Posted By: simple_gifts
Some really good observations in this thread. Whether ACA gets us there, it is in everyone's best interest to have healthy Americans and have them have the ability to recognize illness early, so more costly procedures or diability benefits are not needed. x million people without coverage doesn't make their healthcare needs disappear, it aggravates the situation, moving cost onto those who do have coverage (fairness anyone?)

For those who don't like subsidizing others care, kindly remove your children from public school; I don't have kids and dislike subsidizing the raising of kids I did not choose to have, and apparently you can't afford to educate.... j/k, sort of. Point is society benefits from having healthy (and educated) people.


And your comments are really great too. Some people took offense to some of the things that I said, and certainly they are entitled to their opinion. But I see it exactly as you do. The cost to society don't just go away because we choose to ignore them. That's just mathematics. Blend a little bit of a compassionate heart into the mix, which would obviate why I joked about the euthanization metrics before, and one can rationalize but nobody wants to see anybody deaden the gutter, yet nobody necessarily want to pay out of their own pocket for themselves let alone anybody else.

And the reality is that we have an unhealthy population, not even top 20 in the world for lifetime, and we're slipping to every Asian country when it comes to education, and so we have issues. Throwing money at any problem isn't necessarily the best solution. But to gripe about the true actuarial cost of insuring the population, is just funny to me. These people either disappear or they die. That's just natural fact. Past history as indicated that we certainly don't have a population that is proactive about their health, Nora population but is willing to pay the bills for their own treatment. Nobody has the like the laws and situation as it currently exists, certainly anything needs to be innervated a good number of times before it's perfection. But what annoys me is the desire to play ostrich to so many things that in the end all do indeed cost us. The more unfortunate thing is that so many intend to Paula to size this stuff instead of calling a spade a spade and actually having a reasonable discussion based upon the mathematics and physics of reality.

 

[Turk]

This is all nice, but what happens when people cannot afford to pay the much higher expense??

 

[volk06]

Originally Posted By: TrevorS
Originally Posted By: volk06
I am paritally involved in benefits, I know all about this. The company is paying the same percentage. The premiums for the PPO plan and the HDHP are basically the same due to the fact that the HDHP has a lower deductible and the PPO has about double the deductible.

You younger single people are seeing the most increase due to the insurance companies having to make up for only being able to charge elderly people 3x the amount instead of the 5x the amount of a single young person, it use to be. So the younger people are getting hit harder to help fill the gap. I believe it is 3x and was 5x, iirc, I'm going off the top of my head.


Does that rule apply to your contribution within a company plan? My company seems to have a flat rate for the employee contribution.


You lost me here what are you talking about exactly? Our company pays a certain % of the health care plan, that % has stayed the same but the premiums have gone up that much. Our company pays a certain % of the premium, the rest is what the employee has to pay for the premium, this way it is "fair" all the way across the workforce, obviously a family plan will be more expensive so the company pays more than a single worker.

Are you asking about me paying my premium portion as my contribution or are you talking about my contributions into a HSA?

 

[sciphi]

For giggles I downloaded the NY exchange's Excel spreadsheet cost estimator. I have employer-based coverage that is about equivalent to a silver-level plan (at least through December 31st, we'll see what happens on January 1, 2014). For a silver-level plan for me and family, it's the same price on the exchange as the total cost of my employer-based coverage. Due to income we'd not be eligible for any tax credits.

NY's estimator also had something that stated the most I'd pay out of pocket per month for a plan would be 10% of income. I'm not sure if that's the case, or if I'd still be liable for the full cost of the insurance. Remember, I'm just window-shopping, so I'm not sure what the real answer is on whether I'd be paying sticker price, or have it be income-based.

Cujet, did you call into the NY exchange with your particular situation, or just window-shop? Your situation may warrant a call or spending an hour making an account on the NY exchange to figure out your exact costs.

 

[eljefino]

Originally Posted By: OVERKILL
Originally Posted By: JHZR2


Why doctors and insurance companies have to "negotiate" prices is beyond me. How many times have they billed insurance company x or some service? And how much do they get? The same amount every time? Why this isnt posted as a retail price everywhere is beyond me. People can buy based upon their means and the prices charged.


That's basically how it works for providers in Ontario. If somebody goes to their doctor, the doctor bills OHIP/submits to OHIP for that visit and the type of visit has a code associated with it that carries a set price. There is no negotiation. If the doctor then sends the patient down to a private clinic for an X-ray or ultrasound, each procedure has a specific billing code associated with it that the clinic then submits to OHIP and are paid for those procedures. The rates are standardized as OHIP is the single payer and dictates the rates.

What this also means is that if somebody who doesn't have coverage in Canada were to need to visit a clinic for something, they would just be out of pocket the OHIP rate for the procedure, which is quite reasonable.


This sounds heavenly from a user perspective. How do they incentivize providers though?

Seems the US system is deliberately a cat and mouse game. The insurance company wins if they are somehow more cunning than all the other insurance companies and can get a healthier pool... without being caught breaking any laws of course. Doctors win if they get mostly insured customers from insurance companies paying well that year, and if they're up to date on the billing codes and loopholes they have to jump through. Customers win if they're actually covered and stumble into a half competent hospital.

 

[eljefino]

Originally Posted By: Turk
This is all nice, but what happens when people cannot afford to pay the much higher expense??



Ideally we would have waded into this mess slowly. But if everyone is "trapped" into paying insurance premiums (or penalties) they'll buy more modest homes. If a society has less money for rent, rents drop. This benefits those playing it "straight" and covering themselves all along. Those who make things for our lives know how much money we have and design appropriately.

18% of the GDP was spent on healthcare before ACA. We'll see how much gets spent as this progresses. There are other drains on GDP, like energy prices. At least doctors are educated so kids see a career path. (Engineering is a bust with NASA wandering aimlessly for example.) Even insurance money that gets blundered and wasted gets wasted on our shores instead of the Middle East.

 

[OVERKILL]

Originally Posted By: eljefino

This sounds heavenly from a user perspective. How do they incentivize providers though?


They don't really. You play by OHIP's rules and you make some decent money. There are programs in place from the government that allow for rebates/funding for new equipment if you run a clinic (they like you to keep things up-to-date and modern) and if you have some decent turnover because you have good gear, you'll usually make more money than a clinic that doesn't. Also the physicians are paid separately from the business. Some clinics are owned and operated by a physician or group of physicians, so they make their money and then usually invest some of the profit that the business makes back into the business for equipment, maintenance....etc. That's of course after they pay staff and the like. Other physicians choose to work for a clinic owned by somebody else who looks after the business and equipment and they make their money from their professional fees.

Because the pay structure is fixed, I think it allows us to avoid a lot of (all of?) the financial crazy inherent in the American system.

3rd party health insurance in Canada (which I have through work) is more for dental coverage, medication (which isn't usually all that expensive anyway) and stuff like that. And again, I believe the rates are for the most part standardized.

 

[Cujet]

Because of my known health issues, I purchase the very best plan available to me. Period. I know that I need it.

In my case, I'm fairly sure my health expenses have been less than my premiums every year. But, as I age, that may change. I am not willing to risk substandard coverage under any situation.

I was initially told that our company could not source reasonable insurance and was placing us at the mercy of the NY health care exchanges. I was not happy about even more expense and worse coverage.

I am happy now, with the best coverage the company offers.

And, yes, I earn enough money to afford a good plan.

 

[Cujet]

Originally Posted By: sciphi


Cujet, did you call into the NY exchange with your particular situation, or just window-shop? Your situation may warrant a call or spending an hour making an account on the NY exchange to figure out your exact costs.


I was provided an exchange price list by my company. I did not call. I would never choose silver or bronze. To match what I need and want, I'd go Platinum. Remember, I've gone from the high end of insurance plans to a PPO. I don't want to go lower.

 

[JHZR2]

Originally Posted By: Turk
This is all nice, but what happens when people cannot afford to pay the much higher expense??



I think the accounting still isn't complete on that one... In other threads, folks on here have mentioned savings. As was mentioned just above, we were already spending 18% of GDP on this, it wasn't a small expense before...

We couldn't afford it as it stood. It was just less obvious. If there is any difference, it is the "retail" side of medical care, where in the interest of a profit, high costs and constant duplicative paying off of the same equipment over and over again is practiced (after tax depreciation has also taken it to nothing). The people who get helped for "free" are paid for by your and my insurance premiums and the charges for seeing providers. Thing is that before the costs were "snuck" in, and now they will be paid at full retail. In the end this will mean massive profits for providers, IMO.

No system is perfect at the start. The key is that were discussing all this and how we can deal with the excessive costs that are real, because the people are real and human and will need care whether we ignore them or not. Iterating can be expensive, but in this situation, not iterating was already bankrupting us. IMO the system could be better with some of the regulations that to me are sensible for protecting the population from insurance tricks that put them in a bind (which have been enacted), and also by freeing up the ability to shop and group risk better (which was IMO the intent of the exchanges, but has been a complete failure judging by the prices compared to the fully unsubsidized costs to large employers with big pools).

 

[ottotheclown]

without So without

calling you figured less coverage at more money??

 

[Brule]

Originally Posted By: JHZR2
Originally Posted By: Brule
Here's another way to look at the situation.

This all comes down to basic liberty. I don't want to be forced into a national insurance plan with all of the misshapen, morbidly-obese, sugar and grease-eating, sit-on-their-butts all day dregs. And I don't want to force these life's-losers to change their lives because of their right to personal liberty as well. They live that way; let them suffer the consequences without my subsidy.

I exercise, lift, and eat healthily because I want to and it makes me feel good. Not to entitle others to succumb ultimately to diabetic amputation and clogged arteries due to their lifestyle. I don't want to pay for the laziness and sloth of so many others.


This is beyond laughable. Guess what? You already do!

You pay for it at the worst possible time (end of life) via medicare, and you pay for it when these folks go in and use the ER or go see a doctor and then stiff them for the bill. You think the doctor or health system eats it out of the goodness of their own hearts? Nope. They pass it into your bill. Congratulations for being blind to the reality of things.


It's you who are missing the point, son. You are so blinded by the way things are that you can't see a better way. [And I guess by your angry tone you feel the "Affordable Act" IS a better way]. The idea of individual liberty has become foreign to you now, and apparently to a lot of other Americans who just let this debacle happen while Ted Cruz, a modern-day patriot was ridiculed.

We must all group together and look out for each other for the common good, just like good commies, right?

 

[uc50ic4more]

Originally Posted By: Brule
We must all group together and look out for each other for the common good, just like good commies, right?


Don't knock it 'til you try it!

 

[Tones]

Agree Brule, the ACA was sold as a way of reducing costs. Everyone wanted that. But of course that's not what it does. It is just another hand out. There were lots of things we could have done but didn't. In fact, it will cost us much more, employing thousands of people just to manage it.

Eventually we will run out of people wiling to work while every one else gets a free ride. The country has already piled up a debt that we will likely never get out from under and yet people clamor for more. Our country is circling the drain. I fear for my children's future.

 

[JHZR2]

Originally Posted By: Brule
Originally Posted By: JHZR2
Originally Posted By: Brule
Here's another way to look at the situation.

This all comes down to basic liberty. I don't want to be forced into a national insurance plan with all of the misshapen, morbidly-obese, sugar and grease-eating, sit-on-their-butts all day dregs. And I don't want to force these life's-losers to change their lives because of their right to personal liberty as well. They live that way; let them suffer the consequences without my subsidy.

I exercise, lift, and eat healthily because I want to and it makes me feel good. Not to entitle others to succumb ultimately to diabetic amputation and clogged arteries due to their lifestyle. I don't want to pay for the laziness and sloth of so many others.


This is beyond laughable. Guess what? You already do!

You pay for it at the worst possible time (end of life) via medicare, and you pay for it when these folks go in and use the ER or go see a doctor and then stiff them for the bill. You think the doctor or health system eats it out of the goodness of their own hearts? Nope. They pass it into your bill. Congratulations for being blind to the reality of things.


It's you who are missing the point, son. You are so blinded by the way things are that you can't see a better way. [And I guess by your angry tone you feel the "Affordable Act" IS a better way]. The idea of individual liberty has become foreign to you now, and apparently to a lot of other Americans who just let this debacle happen while Ted Cruz, a modern-day patriot was ridiculed.

We must all group together and look out for each other for the common good, just like good commies, right?


Blinded? Your claims are silly. There may well be a better way, and Im sure that ACA isn't it. But the fact that you think that the millions who do indeed still use the system and incur costs to the system aren't somehow paid for by us who are insured is just funny.

I get your liberty claims. Good for you to feel that way, I feel mostly the same. But I also see the practical reality that the medical system currently isn't something that when it must be used can be paid for through "self insurance" for the vast bulk of the population, myself included. So health insurance is a way of life. Maybe you're mega-rich and can self insure. If so, great for you. If not, good luck when you get a cancer or major illness (though I hope and pray you never do). Tons of horrible stories out there about the financial ruin. Medical is the #1 cause of bankruptcy. That's a problem, no?

So the bulk of us responsible, regular, productive and working Americans NEED health insurance as part of our financial planning. Its not a liberty thing, its an affordability and financial planning thing. And we need it. So the fact that others currently pay NOTHING, yet get treatment, and it is part of the bills that I (since I have an HDHP) and my insurer pay makes it my business and something I care to have fixed. I don't want to pay for obesity or stupid decisions either, but again, we already are, no matter what... Unless you TOTALLY boycott the medical system COMPLETELY, no matter what happens. Good luck with that. While were not even in the top 20 nations when it comes to longevity, there's a reason why we live past 42 these days...

 

[Vikas]

That 18% number has always bothered me. A family making $100K, is it using $18K worth of medical care?

 

[JHZR2]

Well cujet is saying his insurance is $30k. I know ours is around $12k/yr. The average family income is around $50k...

But remember that GDP is a summation of all kinds of earnings, profits, sales, and other non black market economic activity.

 

[TrevorS]

Don't forget to add in Medicaid deductions and any state contributions.

Then don't forget that some of your federal, state and sales taxes go to government who employ people who get health insurance and themselves pay premiums and Medicaid.

And no doubt there are lots of funds and charities out there paying for / providing healthcare.

 

[eljefino]

Originally Posted By: Brule

We must all group together and look out for each other for the common good, just like good commies, right?


So what's your plan, aside from dissing someone else's plan?

I'm getting sick of freeloaders "getting religion" when they're sick and suddenly deciding they should have had insurance all this time.

 

[SteveSRT8]

This whole thing is ridiculously expensive and there are MORE uninsured! Where's the improvement? Plus the whole back end is undeveloped, the insurance companies don't even know you registered yet. You may waltz in January 1 and no one will know who you are or whether you're even insured.

With over 2000 companies locked up by regulations into state lines all we needed to do was REMOVE THE RESTRICTIONS and allow any company to sell into any state. The competition would have been excellent, and rates would have dropped dramatically.

The insurance companies wanted those restrictions, they lobbied for them. They are still driving this bus...