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You’re totally right, and I love those charts. But let’s be clear about what they’re telling us: what we are buying for our employees. It provides no informatio
by entee 6y ago
You’re totally right, and I love those charts. But let’s be clear about what they’re telling us: what we are buying for our employees. It provides no information about how those costs will increase or any “gotcha” features of the plan. While it provides information about a copay and percentage an employee pays and a deductible, I have no clue if plan 1 has negotiated 25% lower prices from the local hospital system vs its competitor. Likely, all the major plans have more or less the same negotiated rates with providers, but that opacity makes it even harder for anyone to drive efficiency.
Kaiser is a very interesting example actually. Because they own both sides of the business (provider AND payer) they have a big incentive to be efficient. They do pretty well! There’s a few issues: 1.) they are still part of a larger market, so they have to pay for doctors, which means they can’t be TOO far below market salaries. Many doctors are paid on both salary and based on how many and what procedures they do i.e. how much revenue they bring to the hospital. Your doctor in many cases is paid on commission. Kaiser doesn’t do this, which some docs like, but others don’t. 2.) they are regionally limited. You can’t get Kaiser in a lot of places in the US. I’m not sure why it hasn’t scaled nationally, I’d really love to know.
Oddly, I’m told by a friend who works there that Kaiser is run internally as two halves, the insurer and the provider, they then negotiate somewhat independently and keep each other accountable.
Anyway, my pet project is something like what you suggest, decoupling insurance for employment. As an employer (and by extension an employee) I pay no taxes on a health plan I buy. I pay with pre-tax $$. As an individual if I buy insurance I pay with post tax $$ unless it makes up a certain percentage of my income and that falls above some threshold and... I lost track it’s too complicated. It shouldn’t be, there should be a way to properly decouple employment and healthcare.
- lotsofpulp 6y ago>But let’s be clear about what they’re telling us: what we are buying for our employees. It provides no information about how those costs will increase or any “gotcha” features of the plan. You're definitely right about this, but in my experience, they're all the same negotiated pricing. And the insurance companies will conveniently group different doctors/healthcare facilities based on their costs into different tiers. You can also be sure prices will keep going up, and I like to assume that I am liable for my out of pocket maximum since healthcare providers just bill willy nilly anyway, so I know I need to keep enough cash for 2 years worth of out of pocket expenses (in case something happens in Nov/Dec of one year and carries into next year). Hint: plan to have babies in April/May, so any complications all get stuffed into one plan year, and you hit out of pocket maximum sooner. Plus you avoid the new inexperienced resident doctors coming in during June. >It shouldn’t be, there should be a way to properly decouple employment and healthcare. It's really simple, remove the tax benefit from employers purchasing health insurance, and give it only to individuals purchasing on healthcare.gov. Ideally no one would have a tax benefit period, and everyone would be forced to go to healthcare.gov and employer plans and whatnot would be outlawed. Politically, big business will fight that though since price transparency helps people compare job offers properly and makes it easier for people to change jobs.
- thomasfedb 6y ago> Hint: plan to have babies in April/May, so any complications all get stuffed into one plan year, and you hit out of pocket maximum sooner. As an Australian medical student I'm horrified to think that this would be a genuine "hint" that would be relevant in a first-world country.
- biztos 6y agoThere's lots like that in the US, and to a much lesser extent in Europe as well. In the US I had a family member whose husband kept a not-great job because its insurance paid for her cancer treatment, whereas if he'd tried to switch jobs the other insurance might not have. Even in Germany my (private) deductible is 3000 EUR so if I thought I might need "something done" I'd try to do it early in the year: if I spend 2999 in December the counter resets on January 1st. And I'm told I have a pretty sweet deal compared to America.
- lotsofpulp 6y agoIn the US, the first scenario is not a problem anymore since the Affordable Care Act requires coverage of pre existing conditions.
- biztos 6y agoTrue, but I wouldn't place any bets on the longevity of the ACA until at least, say, mid-January.
- treis 6y agoIt's actually a poor hint. You want to choose to be pregnant just before you elect your coverage for the following year. Then you can buy the gold plated care with a tiny out of pocket maximum. Then you can go back to a lower quality plan until you're ready for baby #2
- lotsofpulp 6y ago
- jjt-yn_t 6y ago"entree..." With regards to only the 1st 3 paragraphs, if only there were some hundred distinguised persons somewhere seeing your slideshow for an hour and then deflating, intelligently, one of the principal worries of the vast majority of mothers and fathers... and by extension of course, their children.