United States Healthcare Reform

[Brettmcd]

It is possible that you can keep the same coverage from the same company, though you’ll have to take that up with the Insurance company, not your employer, and they’ll probably expect you to pay the full freight with no group discount.

Well its not the promise Obama made when he was trying to get Obamacare passed.

[Brettmcd]

If you’re getting health insurance through work, what guarantee do you ever have that they won’t change health care providers or change plans with the same provider?

I’ve had my employer change my insurance plan numerous times. I think with a government plan you have a better chance of finding a provider you like and actually getting to stay with that provider.

Doubtful. The government will find a way to screw it up, as it always does.

[Scuzz]

I see employers canceling insurance but I also see insurance companies offering the coverage to existing policy holders, but at a higher rate or perhaps some type of group coverage not currently used. (credit union members, etc).

But be prepared to be amazed at how expensive the coverage will be. Be prepared to go to a higher deductible.

What my company pays for 4 families currently is obscene. Most my employees are union so we don’t handle them but I know from the benefit package payments and from their info that even they are suffering under the weight of health insurance payments.

[Dawn_Falcon]

Well its not the promise Obama made when he was trying to get Obamacare passed.

What, that he’d mind-control companies into not changing the healthcare plan they’d offer? Heh.

[mouselock]

I see employers canceling insurance but I also see insurance companies offering the coverage to existing policy holders, but at a higher rate or perhaps some type of group coverage not currently used. (credit union members, etc).

Are there provisions that if an employer previously offered health care and they decide to dump it that they have to offer the remainder of the benefits they’re no longer providing via health care to the employee?

The real problem here seems to me to be the fact that employers can use this as an excuse to not muck with salaries but screw with benefits under the guise of “All these changes, we can’t afford them!” in order to cut net costs, with no compensatory obligation to the employees who, before the passing of this bill, effectively had the value of the benefits priced into their salary.

[Scuzz]

Are there provisions that if an employer previously offered health care and they decide to dump it that they have to offer the remainder of the benefits they’re no longer providing via health care to the employee?

The real problem here seems to me to be the fact that employers can use this as an excuse to not muck with salaries but screw with benefits under the guise of “All these changes, we can’t afford them!” in order to cut net costs, with no compensatory obligation to the employees who, before the passing of this bill, effectively had the value of the benefits priced into their salary.

This was in the original link…

The surveys, which involved more than 1,200 companies, suggest that some businesses feel they will be better off dropping health insurance coverage once the exchanges start, even though they could face fines and tax headaches. The percentage of companies that are already saying they expect to do this surprised some experts, and if they follow through, it could start a trend that chips away at employer-sponsored health coverage, a long-standing pillar of the nation’s health system.

In my companies instance we would save $60,000+ a year dropping health care. I somehow doubt the government fines would be that much and as an S corp the tax write-off is minimal. However, as we are a family firm (3 of 4 families) we would have no logical reason to drop the insurance coverage.

[Mr_Popov]

Actually a large shake-up like this might be a good thing in the long run. I really don’t think a company should be in charge of what their employees’ options are for health insurance coverage. They aren’t when I choose homeowner’s, auto, and other types of insurance.

Instead let the companies focus on making their products and services and get the bloated HR departments out of the picture. (Off topic, but I have never had a good relationship with HR representatives at the jobs I have held.)

[Dawn_Falcon]

(Off topic, but I have never had a good relationship with HR representatives at the jobs I have held.)

I have, but she was both singular and cute.

Anyway;

One way of solving that is to specify what the base package should contain, again like .nl. You can then upsell all sorts of things to it (and some, like dental, are commonly taken), but the base package for a base price is near-identical from all the .nl health insurance companies.

[Jonathan_Crane]

There’s a nice perspective piece on the Dutch healthcare system from the NEJM. (I’ve snipped the highlights below - more details in the article itself)

“Managed Competition for Medicare? Sobering Lessons from the Netherlands”

Four key points emerge from the Dutch experience. First, competition has not sharply slowed the rate of growth in health care spending.

Second, some Dutch people remain uninsured, and there has been a substantial increase in the number of insured persons failing to pay their insurance premiums.

Third, the expansion of consumer choice has not worked as envisioned.

Fourth, notwithstanding the rhetoric of competition, the Netherlands still relies heavily on regulation.

The myth that competition has been key to cost containment in the Netherlands has obscured a crucial reality. Health care systems in Europe, Canada, Japan, and beyond, all of which spend much less than the United States on medical services, rely on regulation of prices, coordinated payment, budgets, and in some cases limits on selected expensive medical technologies, to contain health care spending. System wide regulation of spending, rather than competition among insurers, is the key to controlling health care costs. The Netherlands, after all, spent much less on medical care than the United States with virtually universal insurance coverage long before it began experimenting with managed competition in 2006.

The Dutch experience provides a cautionary tale about the place of private insurance competition in health care reform. The Dutch reforms have fallen far short of expectations — a reminder that policy intentions should not be confused with outcomes and that managed competition is hardly a panacea. The idea that the Dutch reforms provide a successful model for U.S. Medicare to emulate is bizarre. The Dutch case in fact underscores the pitfalls of the casual use (and misuse) of international experience in U.S. health care reform debates. Before we learn from other countries’ experiences with medical care, we first need to learn about them.

[Mark_Asher]

Doubtful. The government will find a way to screw it up, as it always does.

Maybe. I take it you acknowledge that as an employee you don’t really get much choice in your health care. Instead of the government giving you selected choices, your employer does.

[Dawn_Falcon]

There’s a nice perspective piece on the Dutch healthcare system from the NEJM. (I’ve snipped the highlights below - more details in the article itself)

Without going into tedious detail - no, the system hasn’t been perfect (and has been adjusted several times), but cost inflation is something all systems have seen, and the .nl system remains the best insurance-based scheme at avoiding adverse selection, encouraging preventative care and delivering as much as possible via private doctors (which I don’t care about, but know makes a difference to many Americans).

[Brettmcd]

Maybe. I take it you acknowledge that as an employee you don’t really get much choice in your health care. Instead of the government giving you selected choices, your employer does.

I understand that, I had choices of 7 different levels of coverage from my employer this year. I decided on a high deductible health savings account plan that I doubt I would have the option to do with the federal government.

[unbongwah]

Doubtful. The government will find a way to screw it up, as it always does.

I’m not surprised you’re so cynical about the gov’t - I am too!

I’m just surprised you think you’ll be less screwed if you’re left solely at the mercies and discretion of businesses - both your employer and the health-care industry.

[Brettmcd]

I’m not surprised you’re so cynical about the gov’t - I am too!

I’m just surprised you think you’ll be less screwed if you’re left solely at the mercies and discretion of businesses - both your employer and the health-care industry.

I have yet to have any problems with any of my employer based health insurance, and that is with preexisiting conditions and other health problems. Never been declined or turned down for any medical issues I have had taken care of by insurance. I know others have had problems, and I dont deny they exist, but I can only speak from personal experience I have never had them.

[JeffL]

The hope is that businesses will continue to offer good health care options for the same reasons they do today - to be competitive with other companies in attracting and keeping good employees. Health care is a HUGE expense for companies today, but there is no law that forces them to offer that benefit. The ones who do provide it do so primarily because they know that if they don’t and a competing company does, the competing company will get the better employees. I’m not sure I see how that dynamic changes with the new insurance reform law changes.

[Mark_Asher]

The hope is that businesses will continue to offer good health care options for the same reasons they do today - to be competitive with other companies in attracting and keeping good employees. Health care is a HUGE expense for companies today, but there is no law that forces them to offer that benefit. The ones who do provide it do so primarily because they know that if they don’t and a competing company does, the competing company will get the better employees. I’m not sure I see how that dynamic changes with the new insurance reform law changes.

And it’s worth noting that the percentage of uninsured is higher than the percentage of employed, so relying on business to provide health care insurance is a bit sketchy.

[JeffL]

And it’s worth noting that the percentage of uninsured is higher than the percentage of employed, so relying on business to provide health care insurance is a bit sketchy.

Yep. It does always circle back to the skyrocketing health care costs. I’ve seen the numbers on the cost of the health care plan to a multinational as well as smaller companies, and in all cases a huge amount of revenues ends up going back into the company health care plan. For some companies it is becoming close to unsustainable. And while some parts of the insurance reform bill are really good for people, such as the requirement that companies cover your “children” even up to age 26 (and I’m taking advantage of that starting 9/1, as my daughter who graduated college is still looking for a job,) they just add to the cost that companies have to bear. Ultimately much of the insurance reform bill increases the costs to the insurance companies, and since they are driven by profit lines, they are not going to eat those costs but rather just pass them on.

[jason]

So I sat down and read through my wife’s entire insurance plan, cover to cover. And I have absolutely no idea what it covers. It makes clear that regular doctor’s visits equals “$20 copay”, but everything beyond that I cannot fathom.

The reason for my journey into insanity is due to my wife having had to have emergency surgery a month ago. At the time, the hospital didn’t collect her insurance info, so we got all the bills with nothing applied. We’ve since given them all the insurance–

sidebar… the way hospitals work is down right silly. Everything is contracted out, so rather than get a single consolidated bill for the entire visit from the hospital, we got one bill from the hospital entirely for the rooms and materials used, we got another bill from the surgeon, another from the anesthesiologist, another from the nursing company, another from the ultrasound operator, one from the company that reads the ultrasound, one from the company that did the blood tests, and more…

– so we gave them all the insurance info, and I’ve finally gotten back the bills with the new adjusted amounts. Insurance has agreed to pay (or negotiated down the rates of) 66% of the surgeon’s fees. And that’s it. Of the $20k this trip to the hospital cost, our insurance has agreed to pay about $1,400. We pay them way more than that per year in premiums. In fact, if we’d been putting that money into an HSA instead of paying it in premiums, we probably could have covered nearly the whole cost of this.

Aetna. Highway fucking robbery. I think I’m done with insurance for good now.

[JeffL]

Aetna. Highway fucking robbery. I think I’m done with insurance for good now.

Dude - that would be against the law.

[Scuzz]

So I sat down and read through my wife’s entire insurance plan, cover to cover. And I have absolutely no idea what it covers. It makes clear that regular doctor’s visits equals “$20 copay”, but everything beyond that I cannot fathom.

The reason for my journey into insanity is due to my wife having had to have emergency surgery a month ago. At the time, the hospital didn’t collect her insurance info, so we got all the bills with nothing applied. We’ve since given them all the insurance–

sidebar… the way hospitals work is down right silly. Everything is contracted out, so rather than get a single consolidated bill for the entire visit from the hospital, we got one bill from the hospital entirely for the rooms and materials used, we got another bill from the surgeon, another from the anesthesiologist, another from the nursing company, another from the ultrasound operator, one from the company that reads the ultrasound, one from the company that did the blood tests, and more…

– so we gave them all the insurance info, and I’ve finally gotten back the bills with the new adjusted amounts. Insurance has agreed to pay (or negotiated down the rates of) 66% of the surgeon’s fees. And that’s it. Of the $20k this trip to the hospital cost, our insurance has agreed to pay about $1,400. We pay them way more than that per year in premiums. In fact, if we’d been putting that money into an HSA instead of paying it in premiums, we probably could have covered nearly the whole cost of this.

Aetna. Highway fucking robbery. I think I’m done with insurance for good now.

If you are thinking the hospital would have given you those reduced rates you are probably wrong…especially in a case of emergency treatment. While some doctors, hospitals etc will negotiate prices they always want to do it in advance.

This is a game the insurers, the hospitals, doctors etc play, not the insured. Even the government (medicare) plays the game.