5 ms·

I really like the idea of high deductible plans. The idea for me is that insurance shouldn't cover regular costs that most people pay every year. Insurance shou

by rb808 7y ago

I really like the idea of high deductible plans. The idea for me is that insurance shouldn't cover regular costs that most people pay every year. Insurance should just be for unusual events, like car insurance is only used if you have an accident. So now I got a $2k bill from ER for something that wasn't really an emergency. It makes me think carefully about next time this happens where before the cost didn't really affect me. Changing people's behavior is important part of reducing costs of the health care industry. EDIT: Yes I'm not happy with how expensive prices are now. That is the problem that HD plans have.

conorh 7y ago
I like it too, except that my (bronze level in the marketplace) high deductible plan is ~$1300 a month for my family, that is not sustainable. A recent ER visit with 1 night stay cost us about 8k out of pocket, the family deductible for the plan is $13k a year.
- symfoniq 7y ago
  Sounds like we are on the same plan.
- FireBeyond 7y ago
  Be glad that "recent" wasn't in December, prior to the deductible reset. Fun fact - my company (who sells Health Benefits Management software) added functionality so an insurer could do a "rolling window" for deductible / out of pocket management, i.e. "In any given 12 month period, your costs will not exceed $x" (where given unfortunate timing, your out of pocket could actually be 2x). Except it was less profitable to the insurers, so no-one was interested. But spun as "will be too complicated for consumers".
duxup 7y ago
> It makes me think carefully about next time this happens where before the cost didn't really affect me. I don't think that necessarily leads to logical behavior as people are, not logical, not able to make these types of decisions knowledgeably. Also let's be clear the situations we hear about with large ER bills and large volumes of non emergencies there are people who can't pay anyway. I don't doubt the system works for you and you're a good participant, but i don't know if it works for a society as a whole.
AdmiralAsshat 7y ago
I'd like to know if there's any empiric data on how many people go to the ER for something that "wasn't really an emergency." Then I'd like to know how many people have died because they didn't go to the ER for something that really was an emergency. My guess would be that the latter greatly outweighs the former. And I'd follow up that guess with a wager that a large percentage of those people failed to go to the ER because they were worried about the cost. If that's the kind of decision that high-deductible health care encourages, I don't think it's worth it.
- FireBeyond 7y ago
  Encouraged in part by a system where finding "Urgent Care" outside of 9-5 Monday to Friday can be very difficult to impossible in many locations. Only thing worse is dentistry. Following a bad toothache, I walked through the directory. Not a single dentist in my entire County (quarter of a million people) was open on a Friday, let alone the weekend.
NikkiA 7y ago
Except that early diagnosis has been shown consistently to improve outcomes and reduce costs.
ip26 7y ago
The fundamental problem is when you cover emergency care but not preventative care, you get more emergency care. Because emergency care is more expensive, this is worse for everybody in the long run, except for profitable hospitals and insurance companies who enjoy the increased revenues.
- bhupy 7y ago
  This is only a problem if preventative care is expensive to begin with... In India, a visit to the doctor for a general checkup can cost anywhere between Rs. 100-1000 out of pocket, with no insurance whatsoever. For reference, this is basically the price of a movie ticket. What if preventative care cost $15-30 a pop out of pocket?
pastor_elm 7y ago
Ok, but what if your doctor says you need an MR enterography because there is something really suspicious going on in your stomach? The problem is many people just say, "that's all out of my deductible. I'll take my chances."
xenospn 7y ago
Whenever people ask me what's the biggest difference about living in the US vs. where I'm from, I always say the same thing: "People have to think twice before going to the doctor". It's just so damn weird. I think it's the equivalent of being a woman in Saudi Arabia and having to ask your husband's permission before going outside. Both scenarios can result in your life being completely ruined.
chadash 7y ago
In theory, I think it's true that healthcare costs are high because most people aren't paying them, their insurance companies are. And then the insurance companies just turn around and charge more, so they aren't really (enough) incentivized to lower costs either. In practice, the current system screws a lot of people at the bottom. We live in a world where by-and-large, the people with the most clout are also the most likely to have better insurance with lower deductibles. If you work at Google, McKinsey or JP Morgan, you probably have the option to get a low-deductible plan with 80%-100% of premiums covered. Work at Walmart? Your lowest deductible for a family is $3,500 with an annual out-of-pocket maximum of $13,700 [0]. And Walmart actually has better insurance than many low-paying companies, presumably because they are a behemoth with a lot of negotiating leverage. > So now I got a $2k bill from ER for something that wasn't really an emergency. It makes me think carefully about next time this happens where before the cost didn't really affect me. Changing people's behavior is important part of reducing costs of the health care industry. Yeah, but there are two big issues here: 1) Sure, it prevents some people from going in when something isn't really an emergency. But it also prevents people from going in when something really is an emergency. I recently heard a story of a poor family whose toddler accidentally drank something poisonous. They knew that they couldn't afford to go to the ER, so they drove to it and waited outside to monitor the kid and see if she started having seizures or other side effects from the poison. She luckily ended up being okay, but that's a horrible decision to have to make. I'm personally very lucky to be in a financial situation where a few thousand dollars is significant to me, but not significant enough to take chances with my child's health. 2) Why is that bill $2K in the first place? I once had some chest pain and went to the ER. They took an EKG, everything was fine and they discharged me. Bill was a few thousand bucks. EKG machines are ubiquitous, not very costly to purchase (given how much they are used) and the test takes less than 10 minutes to administer and look at. In almost any other developing country, they'd be able to do exactly the same set of tests for a few hundred dollars, insurance or not. [0] https://smartguide.walmartone.com/smartpages/Media/Default/LeadershipGuide/Decision-Guide-eComm-English-2018.pdf https://smartguide.walmartone.com/smartpages/Media/Default/L...
- WrtCdEvrydy 7y ago
  It's because there's nothing to gain by lowering costs. If you get a bill from a ER for $36 dollars, you'd be less likely to buy a $200 insurance plan, so we have to make ERs as expensive as possible so we can guarantee customers for the poor insurance companies. They won't pay that full 2K anyways.
fzeroracer 7y ago
Funny story about that. This was prior to the ACA but the issue remains particularly salient. When my mother had her stroke, there were major concerns about the cost of going to the ER. We at the time didn't know she was having a stroke and so my parents put it off. If you're at all familiar with how strokes work this is the worst thing you can do. The sooner you get the victim to a hospital, the better chances of recovery. She was lucky to survive because we did eventually go to the ER, but she suffered from partial paralysis of her body as well as massive brain damage. She's struggled a lot with mood disorders and has trouble doing some mental tasks. So put yourself in this situation. Are you prepared for potentially permanent mental and physical impairment because you were afraid of going to the hospital? My family ended up bankrupt anyways because this was prior to the ACA, but if we had gone sooner things would've been vastly different.
godshatter 7y ago
I seem to be the only one that thinks this way, but I view health insurance as a plan to cover catastrophic events. I view it kind of like auto insurance. I don't use auto insurance to get my oil changed or to replace the wipers or to add a rack to the roof. So the high deductible plan I get at work is perfect for me because it has a high deductible, yes, but it has a lower overall ceiling. Meaning that if I get in an accident or I come down with a disease I won't go bankrupt because after a certain value things are covered 100%. I do use the HSA, since my employer basically puts money in my savings account if I agree to put so much into it. So it's both an incentive to save and free money at the same time. I do use it on tests and appointments occasionally, but I often go a year or more without touching it. Of course, I have the luxury of doing this because I don't have a chronic disease and don't have dependents to worry about. I understand that.
- rb808 7y ago
  Agreed, the main wrinkle is that buying auto parts is a simple transaction. With my HD plan the provider still bills insurance first who negotiates a rate then sends me the bill which is hugely inefficient.

by rb808 7y ago

conorh 7y ago

I like it too, except that my (bronze level in the marketplace) high deductible plan is ~$1300 a month for my family, that is not sustainable. A recent ER visit with 1 night stay cost us about 8k out of pocket, the family deductible for the plan is $13k a year.

symfoniq 7y ago
Sounds like we are on the same plan.
FireBeyond 7y ago
Be glad that "recent" wasn't in December, prior to the deductible reset. Fun fact - my company (who sells Health Benefits Management software) added functionality so an insurer could do a "rolling window" for deductible / out of pocket management, i.e. "In any given 12 month period, your costs will not exceed $x" (where given unfortunate timing, your out of pocket could actually be 2x). Except it was less profitable to the insurers, so no-one was interested. But spun as "will be too complicated for consumers".

duxup 7y ago

> It makes me think carefully about next time this happens where before the cost didn't really affect me. I don't think that necessarily leads to logical behavior as people are, not logical, not able to make these types of decisions knowledgeably. Also let's be clear the situations we hear about with large ER bills and large volumes of non emergencies there are people who can't pay anyway. I don't doubt the system works for you and you're a good participant, but i don't know if it works for a society as a whole.

AdmiralAsshat 7y ago

I'd like to know if there's any empiric data on how many people go to the ER for something that "wasn't really an emergency." Then I'd like to know how many people have died because they didn't go to the ER for something that really was an emergency. My guess would be that the latter greatly outweighs the former. And I'd follow up that guess with a wager that a large percentage of those people failed to go to the ER because they were worried about the cost. If that's the kind of decision that high-deductible health care encourages, I don't think it's worth it.

FireBeyond 7y ago
Encouraged in part by a system where finding "Urgent Care" outside of 9-5 Monday to Friday can be very difficult to impossible in many locations. Only thing worse is dentistry. Following a bad toothache, I walked through the directory. Not a single dentist in my entire County (quarter of a million people) was open on a Friday, let alone the weekend.

NikkiA 7y ago

Except that early diagnosis has been shown consistently to improve outcomes and reduce costs.

ip26 7y ago

The fundamental problem is when you cover emergency care but not preventative care, you get more emergency care. Because emergency care is more expensive, this is worse for everybody in the long run, except for profitable hospitals and insurance companies who enjoy the increased revenues.

bhupy 7y ago
This is only a problem if preventative care is expensive to begin with... In India, a visit to the doctor for a general checkup can cost anywhere between Rs. 100-1000 out of pocket, with no insurance whatsoever. For reference, this is basically the price of a movie ticket. What if preventative care cost $15-30 a pop out of pocket?

pastor_elm 7y ago

Ok, but what if your doctor says you need an MR enterography because there is something really suspicious going on in your stomach? The problem is many people just say, "that's all out of my deductible. I'll take my chances."

xenospn 7y ago

Whenever people ask me what's the biggest difference about living in the US vs. where I'm from, I always say the same thing: "People have to think twice before going to the doctor". It's just so damn weird. I think it's the equivalent of being a woman in Saudi Arabia and having to ask your husband's permission before going outside. Both scenarios can result in your life being completely ruined.

chadash 7y ago

In theory, I think it's true that healthcare costs are high because most people aren't paying them, their insurance companies are. And then the insurance companies just turn around and charge more, so they aren't really (enough) incentivized to lower costs either. In practice, the current system screws a lot of people at the bottom. We live in a world where by-and-large, the people with the most clout are also the most likely to have better insurance with lower deductibles. If you work at Google, McKinsey or JP Morgan, you probably have the option to get a low-deductible plan with 80%-100% of premiums covered. Work at Walmart? Your lowest deductible for a family is $3,500 with an annual out-of-pocket maximum of $13,700 [0]. And Walmart actually has better insurance than many low-paying companies, presumably because they are a behemoth with a lot of negotiating leverage. > So now I got a $2k bill from ER for something that wasn't really an emergency. It makes me think carefully about next time this happens where before the cost didn't really affect me. Changing people's behavior is important part of reducing costs of the health care industry. Yeah, but there are two big issues here: 1) Sure, it prevents some people from going in when something isn't really an emergency. But it also prevents people from going in when something really is an emergency. I recently heard a story of a poor family whose toddler accidentally drank something poisonous. They knew that they couldn't afford to go to the ER, so they drove to it and waited outside to monitor the kid and see if she started having seizures or other side effects from the poison. She luckily ended up being okay, but that's a horrible decision to have to make. I'm personally very lucky to be in a financial situation where a few thousand dollars is significant to me, but not significant enough to take chances with my child's health. 2) Why is that bill $2K in the first place? I once had some chest pain and went to the ER. They took an EKG, everything was fine and they discharged me. Bill was a few thousand bucks. EKG machines are ubiquitous, not very costly to purchase (given how much they are used) and the test takes less than 10 minutes to administer and look at. In almost any other developing country, they'd be able to do exactly the same set of tests for a few hundred dollars, insurance or not. [0] https://smartguide.walmartone.com/smartpages/Media/Default/LeadershipGuide/Decision-Guide-eComm-English-2018.pdf https://smartguide.walmartone.com/smartpages/Media/Default/L...

WrtCdEvrydy 7y ago
It's because there's nothing to gain by lowering costs. If you get a bill from a ER for $36 dollars, you'd be less likely to buy a $200 insurance plan, so we have to make ERs as expensive as possible so we can guarantee customers for the poor insurance companies. They won't pay that full 2K anyways.

fzeroracer 7y ago

Funny story about that. This was prior to the ACA but the issue remains particularly salient. When my mother had her stroke, there were major concerns about the cost of going to the ER. We at the time didn't know she was having a stroke and so my parents put it off. If you're at all familiar with how strokes work this is the worst thing you can do. The sooner you get the victim to a hospital, the better chances of recovery. She was lucky to survive because we did eventually go to the ER, but she suffered from partial paralysis of her body as well as massive brain damage. She's struggled a lot with mood disorders and has trouble doing some mental tasks. So put yourself in this situation. Are you prepared for potentially permanent mental and physical impairment because you were afraid of going to the hospital? My family ended up bankrupt anyways because this was prior to the ACA, but if we had gone sooner things would've been vastly different.

godshatter 7y ago

I seem to be the only one that thinks this way, but I view health insurance as a plan to cover catastrophic events. I view it kind of like auto insurance. I don't use auto insurance to get my oil changed or to replace the wipers or to add a rack to the roof. So the high deductible plan I get at work is perfect for me because it has a high deductible, yes, but it has a lower overall ceiling. Meaning that if I get in an accident or I come down with a disease I won't go bankrupt because after a certain value things are covered 100%. I do use the HSA, since my employer basically puts money in my savings account if I agree to put so much into it. So it's both an incentive to save and free money at the same time. I do use it on tests and appointments occasionally, but I often go a year or more without touching it. Of course, I have the luxury of doing this because I don't have a chronic disease and don't have dependents to worry about. I understand that.

rb808 7y ago
Agreed, the main wrinkle is that buying auto parts is a simple transaction. With my HD plan the provider still bills insurance first who negotiates a rate then sends me the bill which is hugely inefficient.