7 ms·

Here's my anecdote: Before ACA, as a full-time worker at decent companies I paid maybe $50 a month for my insurance, my employer picked up the rest. When I wen

Here's my anecdote: Before ACA, as a full-time worker at decent companies I paid maybe $50 a month for my insurance, my employer picked up the rest. When I went to the doctor, filled a prescription, or anything else routine, it was $10-$20 max. In the one year where I had a lot of care (broken wrist), I think I paid my out-of-pocket max of about $750 and that was it. After ACA: Catastrophic plan at pretty much every company I work for now (same for many of my friends in non government jobs). Minimum deductible of $1500-$2000 as a single guy. Probably 5x that for someone with a child and wife. When I go to the doctor, I pay for everything out of pocket at full price: $300 for a prescription (in the US they push up the drug prices to astronomical levels - we cannot buy from foreign sources), $200 for a simple doctor's visit. I have never hit my deductible which would then pay 80% of my costs. Oh and I can't actually just go and get things like a hearing test or sleep study - I first need a referral from my primary physician at $200 / visit. In exchange, I get to put $100 away each month tax-free into a 'FSA' account. It is mostly use-it-or-lost-it by the end of the year, and will go back to my employer (i.e. a perk for them, not for me). At the end of this year, it basically turned into a $200 gift from me to my employer.

vpeters25 10y ago
I think you hit the nail on the actual issue with health care in the USA. The problem is not as much insurance companies but medical providers' price-gouging. Edit: sometimes it's a good idea to call ahead and ask for "uninsured quote", you would be surprised your $200/visit physician might only charge $50 to someone without insurance.
- nodamage 10y ago
  It's an unfortunate feedback cycle. Medical providers charge high numbers because they know insurance companies will only pay out a percentage of the billed amount.
- cmiles74 10y ago
  Hospitals and insurance companies are co-dependent. In my experience, hospitals price everything high so that they have more room when they negotiate with the various insurance companies. No one is meant to pay these prices. Hospital billing is also pretty awful. I've seen them place every possible reimbursable item on every bill, full well knowing that some insurance companies would cover some items and others different things. This resulted in inflated bills that were never paid in full regardless of a person's insurance coverage. Many hospitals will negotiate with the uninsured but it's rare for them to make this easy to do. This article is pretty weak, but the best I could find on this relatively arcane subject: http://truecostofhealthcare.net/hospitalization/ http://truecostofhealthcare.net/hospitalization/
  - sbov 10y ago
    There have been plenty of reports showing something even worse - that pricing usually has no basis in reality, and you can have a 1,000% price difference by going to a hospital across the city. Most hospitals can't even quote you a price. We were researching a procedure our insurance doesn't cover. One non hospital place quoted $750 cash price within 20 minutes on the phone. We called a nearby hospital and after over 10 hours on the phone spread over a week, and claiming that we don't have insurance (because their policy is you MUST use insurance even if they don't cover it), they quoted us $350 cash price. We chose the hospital, and when we got there they said that price didn't actually include everything. WTF? It's a frigging mess.
    - cmiles74 10y ago
      It's true, I can't argue with you. There are people at the hospital (or their parent organization) that know actual dollar amounts and then argue them with insurance companies. Outside of that person it's pretty hard to get any numbers, let alone numbers you should feel confident about. I am a software developer, I worked for a mid-sized community hospital. "It's a frigging mess" is a reasonable summary and also heart-breakingly accurate. This is one area in which the ACA is making progress: providing an incentive to the hospital to know what a particular procedure actually costs. Your example, while disappointing and frustrating, was extremely rare in the 90's. High deductible insurance has given every customer a reason to shop for the hospital with the most reasonable rates. I can't say if that incentive is strong enough, but I believe it is progress.
vpeters25 10y ago
Forgot to mention FSA. Employers love them because unused money deducted from your paycheck (i.e. YOUR MONEY) goes back to them. I suggest you look into HSA accounts instead.
- ceejayoz 10y ago
  FSAs are also risky for employers, though, because you can get your entire FSA balance on Jan 1, use it Jan 2, and resign Jan 3. They can't make you pay it back.
hibikir 10y ago
I'll trade your anecdote for mine: I have been working for Decent Companies for 15 years. Every year my payments went up, the company's prices went up, my copayments went up, and my coverage went down. The real nadir for coverage was in the end of the Bush years: I worked at Home Depot as a developer. That means that the plan covers a lot of badly paid people, and a lot of old people. I was paying hundreds a month, my doctor visits were $75, 20% coinsurance in hospital visits up to 10K, and a maximum lifetime benefit of 1 million: So if something really bad happened, like a stroke, they'd stop covering before it was all said and done! Since, my payments kept going up at similar rates, but at least things like maximum lifetime coverage has gone away. The one and only time things have dropped in price was last year, now that I work at a place where the average employee's age is 26. The company still pays $1600/mo for their side of the coverage, but since it's mostly developers, they can afford it. No company in their right mind will pay that when the employees are making $15/hr Healthcare has been less and less affordable since the Clinton years, it's just that it started very affordable. the ACA didn't make things noticeably different for the good plans overall: It's all still very expensive, and picking an employer that either has a young, healthy workforce, or has so much money they can pay for expensive plans, is the big difference between having good health coverage or not. So I guess that what I am trying to say is that if you had the insurance you claim to have had in the bush years, you were incredibly fortunate, and your situation was not common.
Glyptodon 10y ago
So what gets me is that people seem to think healthcare should cost less than $1000/person/year and I just can't see how that's reasonable. If anything remotely serious happens it will cost hundreds of thousands if not millions, and I just can't see how it's possible to cover that kind of situation when we know from our own lives that things like Diabetes, Cancer, Stroke, Heart Attack, and even Car Accidents and such are common enough. I had childhood cancer and at the time it'd have costs millions without insurance. While the healthcare market is hopeless opaque and corrupt and no doubt that does drive costs somewhat (or a lot), and probably there are things to do about it, but I think fundamentally the success of complex and expensive treatments is also driving costs - things that you'd have gotten painkillers and left to die even in '50s and '60s now can be cured/improved/fixed, it's just ridiculously expensive compared to popping some pills and expiring. Or look at prosthetics. There was a time you might have made do with crutches or a peg leg and now there are specially designed, fitted, and crafted prosthetics for various activities... that don't come cheap. Not to mention improvements to the standard of care or the sheer man-power requirements of health-care. A normal doctor's visit requires interaction with 3+ employees, across ~45 minutes, all of whom are presumably being payed more than $10 an hour, and possibly a lot more. It may actually be reasonable that budgeting $5k/person/year for healthcare is sane in terms of both risk and what you get, but just far more than people are used to thinking about or seems intuitively reasonable.
- smacktoward 10y ago
  > I had childhood cancer and at the time it'd have costs millions without insurance. This is the entire theoretical reason for insurance: to spread costs out across a large group, so that by having everyone pay a little nobody has to pay a lot. It's also why the logic of modern healthcare makes single-payer systems the ones that work the best; they spread the costs across the widest possible "risk pool." And why the ACA had to include a (deeply unpopular) mandate that everybody buy some form of health insurance -- as long as your system is based on private insurance, such a mandate is the only way to get the young and healthy into that pool. > It may actually be reasonable that budgeting $5k/person/year for healthcare is sane in terms of both risk and what you get, but just far more than people are used to thinking about or seems intuitively reasonable. Remember that most Americans' income has been stagnant in real terms for nearly 40 years now, while health care costs have done nothing but increase and seem set to keep on doing so. So, barring some major change in how the economy works, whatever figure you set for "a reasonable amount to save for health care" is only going to seem less and less reasonable as it grows to consume a greater and greater share of those stagnant incomes. In other words, if peoples' wages increased by $5K a year at the same time as they were expected to bear $5K a year of health care costs, it'd feel a lot less painful than just expecting them to pull that $5K out of the couch cushions.
ceejayoz 10y ago
Sounds like your employer used ACA as an excuse to switch to cheaper plans and cover less of the costs. Are you sure you're laying blame on the right culprit here?
tkahnoski 10y ago
What I think your actually complaining about is High Deductible Health Plans and HSAs which came into law in 2003. It's just taken time for them proliferate. The reason they are becoming popular is that they are intended to incentivize the consumer to pick and choose their providers since they have to bear the brunt of the initial cost. (And cheaper for employers to fund over non high deductible plans). I recommend reading up on the history here: https://en.wikipedia.org/wiki/Health_savings_account https://en.wikipedia.org/wiki/Health_savings_account
specialist 10y ago
So... What are you saying? For profit corporations will always find a way to game the system? Just like the whackamole with tax cheats? That trying to regulate a broken marketplace doesn't work very well? Perverse incentives lead to perverse behavior?

vpeters25 10y ago

I think you hit the nail on the actual issue with health care in the USA. The problem is not as much insurance companies but medical providers' price-gouging. Edit: sometimes it's a good idea to call ahead and ask for "uninsured quote", you would be surprised your $200/visit physician might only charge $50 to someone without insurance.

nodamage 10y ago
It's an unfortunate feedback cycle. Medical providers charge high numbers because they know insurance companies will only pay out a percentage of the billed amount.
cmiles74 10y ago
Hospitals and insurance companies are co-dependent. In my experience, hospitals price everything high so that they have more room when they negotiate with the various insurance companies. No one is meant to pay these prices. Hospital billing is also pretty awful. I've seen them place every possible reimbursable item on every bill, full well knowing that some insurance companies would cover some items and others different things. This resulted in inflated bills that were never paid in full regardless of a person's insurance coverage. Many hospitals will negotiate with the uninsured but it's rare for them to make this easy to do. This article is pretty weak, but the best I could find on this relatively arcane subject: http://truecostofhealthcare.net/hospitalization/ http://truecostofhealthcare.net/hospitalization/
- sbov 10y ago
  There have been plenty of reports showing something even worse - that pricing usually has no basis in reality, and you can have a 1,000% price difference by going to a hospital across the city. Most hospitals can't even quote you a price. We were researching a procedure our insurance doesn't cover. One non hospital place quoted $750 cash price within 20 minutes on the phone. We called a nearby hospital and after over 10 hours on the phone spread over a week, and claiming that we don't have insurance (because their policy is you MUST use insurance even if they don't cover it), they quoted us $350 cash price. We chose the hospital, and when we got there they said that price didn't actually include everything. WTF? It's a frigging mess.
  - cmiles74 10y ago
    It's true, I can't argue with you. There are people at the hospital (or their parent organization) that know actual dollar amounts and then argue them with insurance companies. Outside of that person it's pretty hard to get any numbers, let alone numbers you should feel confident about. I am a software developer, I worked for a mid-sized community hospital. "It's a frigging mess" is a reasonable summary and also heart-breakingly accurate. This is one area in which the ACA is making progress: providing an incentive to the hospital to know what a particular procedure actually costs. Your example, while disappointing and frustrating, was extremely rare in the 90's. High deductible insurance has given every customer a reason to shop for the hospital with the most reasonable rates. I can't say if that incentive is strong enough, but I believe it is progress.

vpeters25 10y ago

Forgot to mention FSA. Employers love them because unused money deducted from your paycheck (i.e. YOUR MONEY) goes back to them. I suggest you look into HSA accounts instead.

ceejayoz 10y ago
FSAs are also risky for employers, though, because you can get your entire FSA balance on Jan 1, use it Jan 2, and resign Jan 3. They can't make you pay it back.

hibikir 10y ago

I'll trade your anecdote for mine: I have been working for Decent Companies for 15 years. Every year my payments went up, the company's prices went up, my copayments went up, and my coverage went down. The real nadir for coverage was in the end of the Bush years: I worked at Home Depot as a developer. That means that the plan covers a lot of badly paid people, and a lot of old people. I was paying hundreds a month, my doctor visits were $75, 20% coinsurance in hospital visits up to 10K, and a maximum lifetime benefit of 1 million: So if something really bad happened, like a stroke, they'd stop covering before it was all said and done! Since, my payments kept going up at similar rates, but at least things like maximum lifetime coverage has gone away. The one and only time things have dropped in price was last year, now that I work at a place where the average employee's age is 26. The company still pays $1600/mo for their side of the coverage, but since it's mostly developers, they can afford it. No company in their right mind will pay that when the employees are making $15/hr Healthcare has been less and less affordable since the Clinton years, it's just that it started very affordable. the ACA didn't make things noticeably different for the good plans overall: It's all still very expensive, and picking an employer that either has a young, healthy workforce, or has so much money they can pay for expensive plans, is the big difference between having good health coverage or not. So I guess that what I am trying to say is that if you had the insurance you claim to have had in the bush years, you were incredibly fortunate, and your situation was not common.

Glyptodon 10y ago

So what gets me is that people seem to think healthcare should cost less than $1000/person/year and I just can't see how that's reasonable. If anything remotely serious happens it will cost hundreds of thousands if not millions, and I just can't see how it's possible to cover that kind of situation when we know from our own lives that things like Diabetes, Cancer, Stroke, Heart Attack, and even Car Accidents and such are common enough. I had childhood cancer and at the time it'd have costs millions without insurance. While the healthcare market is hopeless opaque and corrupt and no doubt that does drive costs somewhat (or a lot), and probably there are things to do about it, but I think fundamentally the success of complex and expensive treatments is also driving costs - things that you'd have gotten painkillers and left to die even in '50s and '60s now can be cured/improved/fixed, it's just ridiculously expensive compared to popping some pills and expiring. Or look at prosthetics. There was a time you might have made do with crutches or a peg leg and now there are specially designed, fitted, and crafted prosthetics for various activities... that don't come cheap. Not to mention improvements to the standard of care or the sheer man-power requirements of health-care. A normal doctor's visit requires interaction with 3+ employees, across ~45 minutes, all of whom are presumably being payed more than $10 an hour, and possibly a lot more. It may actually be reasonable that budgeting $5k/person/year for healthcare is sane in terms of both risk and what you get, but just far more than people are used to thinking about or seems intuitively reasonable.

smacktoward 10y ago
> I had childhood cancer and at the time it'd have costs millions without insurance. This is the entire theoretical reason for insurance: to spread costs out across a large group, so that by having everyone pay a little nobody has to pay a lot. It's also why the logic of modern healthcare makes single-payer systems the ones that work the best; they spread the costs across the widest possible "risk pool." And why the ACA had to include a (deeply unpopular) mandate that everybody buy some form of health insurance -- as long as your system is based on private insurance, such a mandate is the only way to get the young and healthy into that pool. > It may actually be reasonable that budgeting $5k/person/year for healthcare is sane in terms of both risk and what you get, but just far more than people are used to thinking about or seems intuitively reasonable. Remember that most Americans' income has been stagnant in real terms for nearly 40 years now, while health care costs have done nothing but increase and seem set to keep on doing so. So, barring some major change in how the economy works, whatever figure you set for "a reasonable amount to save for health care" is only going to seem less and less reasonable as it grows to consume a greater and greater share of those stagnant incomes. In other words, if peoples' wages increased by $5K a year at the same time as they were expected to bear $5K a year of health care costs, it'd feel a lot less painful than just expecting them to pull that $5K out of the couch cushions.

ceejayoz 10y ago

Sounds like your employer used ACA as an excuse to switch to cheaper plans and cover less of the costs. Are you sure you're laying blame on the right culprit here?

tkahnoski 10y ago

What I think your actually complaining about is High Deductible Health Plans and HSAs which came into law in 2003. It's just taken time for them proliferate. The reason they are becoming popular is that they are intended to incentivize the consumer to pick and choose their providers since they have to bear the brunt of the initial cost. (And cheaper for employers to fund over non high deductible plans). I recommend reading up on the history here: https://en.wikipedia.org/wiki/Health_savings_account https://en.wikipedia.org/wiki/Health_savings_account

specialist 10y ago

So... What are you saying? For profit corporations will always find a way to game the system? Just like the whackamole with tax cheats? That trying to regulate a broken marketplace doesn't work very well? Perverse incentives lead to perverse behavior?