6193

We have some sort of thing they show us called “Total Compensation” which includes, among other things, what they pay for our healthcare premiums. So you can see the figure, but it’s not right in front of us.

6194

My pay stubs used to have a similar section. I’m not seeing it anymore, though. We moved to a different portal for that stuff and it’s changed a lot. I may just not be looking in the right place. I can see that my contribution has been over 7k so far this year.

6195

I think that’s very difficult without the negotiating power of being the primary game in town. Essentially the public option has to be a massive collective bargaining organization - if you allow a well-established industry with tons of customers to act as scabs (providing coverage at providers that don’t want to deal with the public option bargain), it greatly reduces their power to bargain.

If you mandated that any provider that accepts private insurance also accept the public option, you might be able to get the bargaining power you need, though it isn’t clear how effectively you would drive down costs. For example, if the private insurance still looks like a better deal because it obfuscates the risk, is aggressive in rejecting claims, and severely limits where and how much coverage you have, then many will still choose the private insurance that seems cheaper, which will in turn pay the providers more (because it isn’t really cheaper when adjusted for risk), so the providers will be able to accept the public option at a loss in exchange for getting the private dollars at a higher rate and people will continue to go bankrupt when they get really sick.

6196

My paystub has a section that breaks out my employer’s contribution to healthcare and 401k. It’s pretty significant.

6197

There is definitely a line on my paystub for it. I’m going to pay roughly $3,500 in premiums this year for a family plan (HSA / $3K deductibile / $6K OOP max), and my employer is going to pay about $10K on top of that. They definitely want to make sure we’re aware of the cost, if only because it helps their argument when they’re adding a buck or two a week into the employee piece each year.

6198

My last company did not, probably because it was shit. I paid more for myself on an HSA than i do at my current company for my family on a PPO.

My current company I do not, but thats because paychecks are managed by a third party, it is international, and they are a large company so have arrangements more directly. I could probably get the info if I was so inclined. However it is generally not something immediately accessible.

6199

It is kind of a mixed bag. On the one hand they want to tell employees how much value they are getting. On the other, if the information is transparent, over time employees can see that often most of the increase in annual premiums is being dumped on the employee portion.

6200

Well the employees covering all premium increases and hiding that fact was absolutely a thing at my last employer.

6201

You are not alone!

6202

I just checked my paycheck (which is virtual, so I normally never see it) and found out my employer is paying around $950/month for my healthcare (for this plan I pay nothing). That’s for a plan with $2700 per person deductible, $5k max out of pocket and $25/visit co-pays/low prescription copays (they vary but between $5 and $30). … what I consider to be a pretty good plan. But still too expensive in general!

6203

Oh, this should absolutely be the case. Current Medicare does this, as far as I know. There’s not really anyone who serves 65+ folks that won’t take Medicare.

Then it’s not really better, is it? I grant you that it’ll be necessary for there to be public education on the subject. Regulations about transparency, better than what we have today, are a good idea no matter what system we end up with.

Just to be clear, I’m not saying that I prefer a public option to single payer. I just think it’s much more likely from a political perspective, and that it is possible to improve the current situation. It’ll probably take multiple iterations to get right. I see it as an iteration from the ACA…what we had before 2010 was downright terrible, the current ACA landscape is awful, a first attempt at public option would be merely bad, a mature public option might cross into mediocre territory, eventually we might get to a place with decent single payer (like Japan’s system, perhaps) that would actually work well.

Amen. One of the worst parts of the American healthcare system, locking people into jobs because their options are so much worse if they leave.

6204

I don’t care if the public option wins out or not, and I don’t understand why everyone seems to insist that’s the only way.

I hope we all can agree on the objectives

  1. Ensure that every American, regardless of means, has access to healthcare.
  2. Lower the total cost of healthcare for the country
  3. Disconnect your healthcare from your employer

Notice, I use the word healthcare and not health insurance for a reason. Insurance is just a means to end; healthcare is the service we want to provide.

I think rebranding the “public option” as Medicare for All is smart. Medicare has a generally positive image, but as discussed, it is not without its many problems.

We do need to take some steps to accelerate the disconnect between employers and healthcare. First, I’d treat health insurance as compensation and tax it, but not subject it to payroll tax. Since high-income people tend to have better coverage than low income and by definition are in higher tax brackets, this would progressively raise a lot of money. Money that could be used to help provide healthcare for poor people
Hell, you could even argue (somewhat disingenuously) we didn’t raise taxes. I’d also require employers to allow employees to take the money they now spend on health insurance and buy insurance on the exchanges.

My expectation is the Medicare for All who want its option would be the least expensive insurance because Medicare has already negotiated the lowest rates, and they have outsourced the collection process to the IRS. I’ld also expect Medicare to be worse insurance, it would cover the least number of new procedures, it would a laggard in deploying technology, and probably have the worst customer service. But who knows Medicare could surprise us. I’d expect private insurance to be more expensive but better.

The problem with Medicare For All is that it locks us into the current system and our ridiculous prices. In theory, Medicare should be able to negotiate great prices because of their size. In practice, it virtually never happens that the government gets the best prices. The DOD doesn’t get the prices for airplanes, or boots. NASA doesn’t get the best prices for rocket launches,. Your local government doesn’t get the best price for office space, nor for paving parking lots or fixing potholes.

What terrifies me is that Medicare for All eliminates the possible cost reductions we MAY see from things like collaboration between Amazon, Berkshire Hathaway, and JP Morgan on healthcare.

6205

It is also not designed to service the young and working class populace. Medicare would have to change, quite a bit, and estimates are going to be way off. People who still want children, who want to climb Mt. Everest, who want to manage a lifetime of diseases and not just the last 20-30 years… it’s not the same insurance people think it is. It’s just not that great… for old people. It sure is heck isn’t going to get top marks for the younger groups, but of course it’s still better than no access at all.

6206

I really don’t get this at all. There are no Medicare doctors or Medicare hospitals or Medicare clinics. What there are are doctors, hospitals, clinics who service customers, and those customers pay for that service in different ways, one of which happens to be Medicare. There isn’t any hospital saying wait, that guy is on Medicare, use the old machines on him.

6207

Are you suggesting that providers don’t know which insurance patients are using because they certainly do, and if the insurance won’t pay for that machine, they’re generally not going to use that machine on that patient…

6208

Or if they do, they are going to catch hell from the patient who founds out they have to pay for it out of pocket.

I do think Nesrie makes a good point Medicare isn’t really designed to service young people. If there is some new experimental and costly treatment, the doctor may not even tell the 85 year-old that it exists, especially if Medicare doesn’t cover it. If the treatment is going to be painful, the 85-year old may decide “I’ve had a good life, I don’t want to send the rest of my life at the doctors office and battling Medicare to get it paid for”.

The parents of 15-years old, aren’t going to take no for an answer and even if the doctor doesn’t tell them about the treatment, Dr Google and WebMD are going to let them know it exist. How is Medicare going to handle that?

6209

Yep and infertility, forget it, that goes for Medicaid, Medicare and, I think, many of the exchange plans. Sure, we can argue about whether or not that’s moral or really needed vs elective, and keep in mind, those arguments occur around contraceptives too which is why some employer plans forbid covering them, made the news even… which can be solved by not having insurance through employers but not really if you just hand the decision over to the government we have now…

6210

TriCare covers surgical and horomonal treatments for infertility. It does not cover IVF. TriCare also covers contraceptives: IUDs, pharmaceutical contraceptives, contraceptive diaphragms, surgical sterilization, and Plan B.

6211

TriCare expects and does cover people in the prime and youth of their lives.

TriCare is around 9 million people.

Medicare is 44 million

Medicaid is around 74

yes there is some overlap.

6212

Right. I think that TriCare for All would be a better indicator of type of program being considered. But more people are familiar with Medicare, so that’s the slogan. But the U.S. federal government is currently running a single-payer health care program for middle-class working families. Seems like that’s a better model for talking about it.