3921

Agreed. Being “first” in medicine is a rather empty celebration, at the moment.

3922

More on how consumers are “gaming the ACA”. Whatever your perspective is on the ACA, it’s an important topic b/c it shows how people will abuse good intentions in an insurance system. It’s also a pretty good look at how people are rational in maximizing their $$$. Paying 9 months of premiums for benefits seems like a big problem and not sure how you fix.

A best case scenario with Kaiser pushing back on insurers. (Although, it’s telling that when the insurers shared their data and experiences with CMS, CMS announced that they’r going to try to limit special enrollments)

A more cynical perspective on ACA’s fate from Megan Mccardle http://www.bloombergview.com/articles/2016-01-14/gaming-of-obamacare-poses-a-fatal-threat

3923

Market forces are one thing, but we cannot continue to treat medical care like it’s a toaster oven. It’s not a commodity and when I need medical care, I don’t have a whole lot of choice in the matter. If I have a heart attack I don’t have the luxury of weighing if I want the Cadillac of treatments or if maybe I should save for another year or two before getting a Ford Focus.

I think our system is terrible all around. I have no idea why my employer needs to be saddled with the burden of providing healthcare to myself and my coworkers. What does that have to do with making software?!. I have no idea why employees should be reliant on an employer to get medical treatment that just maybe won’t bankrupt them. And by adding multiple layers of obfuscation on the actual costs of said care, it just makes it easy for profiteering to take place every step of the way.

Example: My family opposes any sort of government-provided healthcare because it means taxes will go up, and taxes are bad. I have no idea what makes a tax deduction any different than the premium that gets siphoned out of every paycheck I receive. But that premium is only part of the story, in many cases people don’t see how much it is costing their employers to provide said care. In a perfect world, that is money that could be going towards their wages instead. But because they don’t see it, it’s out of sight and out of mind.

Example: I have pretty miserable spring allergies, which I just take an OTC Allegra a day for. When I was hospitalized, I was not allowed to take my own medication, I had to take the hospital-provided Allegra pills. Of course instead of taking one pill every 24 hours, the dosage is three pills that I take once a day. The cost of each pill, when I looked at my itemized bill? $15. Nice, I was paying $45 a day for Allegra, which is what I pay for a couple months. It’s an OTC medication, why is the hospital charging me $15 a day?!? Because they can. Because people aren’t having to pull out their wallet to buy $15 dollars worth of allergy medications a day. It just goes onto their bill, which goes on to their insurance, which then turns around and makes the money back by raising premiums on everyone.

The screws that my friend’s company makes that are used for back surgery cost under a dollar to make. They sell them to doctors/hospitals for over $100 a piece, and the hospital then turns around and charges $1000 for each. Even accounting for the real costs involved in R&D, FDA approval, and the facilities needed to manufacture them, it’s insane! But because a surgeon doesn’t say “Hey buddy, I need to use 8 screws for this surgery. That will be $8000, please” it just sails on by. But fuck yeah, America, we didn’t raise taxes! Wooo!

Anyway, the ACA is shit too. I realize a lot of the political reasons of why it’s shit, but I would love some real healthcare reform. I know healthcare isn’t cheap and isn’t easy, but there are absolutely better ways of dealing with it than we do.

3924

The strength of getting insurance through work is the whole “power of volume” thing. Your employer can negotiate a better deal for its 6000 employees than those 6000 employees could negotiate for themselves. That was supposed to be what the clearing houses were for too; so that individuals could get the same volume discounts as folks who get insurance through an employer.

My employer is very up front with what they pay for us. When we sign up for our annual insurance…thing… we get a $225 per check credit and a list of plans we can choose from. My wife is on some very specific medications that it turns out only Aetna covers, so we’re locked in to using the Aetna Silver plan, which runs at close to $600 per check, of which I pay $375-ish of. Since I’m paid every 2 weeks, that comes to close to $10k a year that I pay for insurance. But we’re stuck with this plan because, without it, the out of pocket for the medication would be more than that, annually, plus the cost of any doctor visits or whatever else comes out.

Sigh… depressing just talking about it

3925

Yep. I bet 320 million people can negotiate better rates than those 6,000 ever could!

3926

No kidding. The cost of medical devices is bananas. I use CPAP equipment for my apnea, and use the “nasal pillows” style mask that is a formed bit of silicon with nozzles that fit into your nostrils. Here’s a link with a picture: http://www.cpap-supply.com/Nuance-Gel-Nasal-Pillows-Cushion-p/110517x.htm

Now on that page it states that the list price is 31 bucks for that, and implies that they’ll sell it to you for less. However, Kaiser Permanente of Oregon/Washington (my insurance through work) pays roughly twice that as its negotiated price with the vendor (per the “explanation of benefits” statement), and lists the “list price” as something in the low 80s. I end up paying $13.something as my 20% of the negotiated price. What the actual f**k. I’m in the wrong business. These companies are operating on a different plane where prices bear no relation to reality.

3927

It’s not just strength in numbers, I believe the employers get a good tax break for having part of your salary be these benefits. It’s a fascinating study, if i recall correctly, about how a freeze in salaries led to a lot of benefits we see today. It’s not by accident employers got into this game.

3928

Have you tried looking for your own insurance separately, through the exchange?

3929

It’s a tax right off but it is also a great way to attract or keep employees. But it is also very expensive. As an example, my small business has union carpenters and has 4 non-union employees. The union insures the carpenters and we insured the non-union employees. What used to cost $5k +/- 20 years ago now costs nearly $40k +/-. Imagine that jump with 100-200-500 employees. That’s a lot of widgets.

As for the union employees, we pay $11.05 per hour to the union into their health and welfare fund.

3930

Sure, but what I am pointing out is our current system of having insurance through employment can be somewhat tied to a period of time when there were wage freezes but you could still compete for employees by providing benefits. In practical purposes, benefits are wages, it’s just a lot people don’t value them properly and they’re not as easily compared.

3931

It was either during or after WW2. One of the most commonsense and therefore least likely health care reforms would be to either tax employer health benefits, or exempt individual spending on health care, but it is not to be.

I’m pro-no-employer-health-care, myself. One of the reasons why the individual market sucks so badly is that it’s biased toward people who couldn’t get employer health benefits in the past for health reasons.

3932

Yeah, it sucks that people who need healthcare are benefitting from it so much. I am so jealous that I don’t have so terrible long standing disease or disability, because I would total benefit more from that!

3933

I would say you’re better than partisan sniping like that, but inside P&R, you really aren’t. Consider how it goes:

  1. Those with ill health have improved access to health care, at a cheaper cost than the old high-risk pools. Yay! This is a good thing, because I’m not a monster, and you’re kind of a dick for thinking I am!
  2. They’re over-represented in the individual market, because the healthy generally have easy access to health care through their employers, and most employers didn’t change anything. Hmm.
  3. Since the individual market has more net health care consumers than employer plans, the individual market gets more expensive. Hmm.
  4. The young, healthy people without employer health care, like me, who are a net input into the individual market, look for alternatives, because the individual market is more expensive. (I pay about $190 a month for a health care sharing plan for me and my wife that requires that we cover the first $3500 of medical expenses of any sort in a year; the plan covers 100% of every expense above that. The cheapest exchange plan I can get would be about $250 a month for a ~$12,500 deductible.)
  5. The sick people in the individual market aren’t much better off than they were at the beginning.

If, on the other hand, employers couldn’t go to insurers and buy health plans for their employees tax-free, or if employees could buy their own individual-market health plans tax-free (either way works; just don’t tax-advantage the employer situation), employees are no longer nearly as tied to their employers. If you don’t like the plans your employer is offering, take the money instead of the benefit, and go buy your own plan in the individual market. People take that option, the individual market fills up with a broader array of people nearer the national average health, and plans get cheaper for everyone. So, I turn your implied dumb, insulting question back on you: why do you hate the sick?

3934

Don’t the sick people in the individual market (as long as they’re not poor enough to fall into expanded Medicaid–or in Republican Hell-states that didn’t take part in the expansion, are totally SOL) get subsidies toward their insurance premiums? And get their conditions covered under their plans, whereas before the ACA, they often couldn’t buy insurance at all? I don’t know how you can make the claim that “The sick people in the individual market aren’t much better off than they were at the beginning.”

3935

A subsidy doesn’t do anything to prevent the price rise/healthy exit spiral, especially for people above the subsidy line. If enough of them exit, the plan falls apart. Expanding the individual market (preferably, making it the exclusive market) fixes the cost issue forcing healthy people out of the individual market, and reduces the need for subsidies in the first place by driving rates down, because there would be more healthy people per sick person in the individual market.

And get their conditions covered under their plans, whereas before the ACA, they often couldn’t buy insurance at all? I don’t know how you can make the claim that “The sick people in the individual market aren’t much better off than they were at the beginning.”

The sick people who had access to insurance before will not end up much better off than they were in state high-risk pools and other similar programs. Is that clearer?

Edit: and leaving that aside, it’s obvious that pushing people who currently get employer health benefits onto the individual market and tax-exempting spending on health insurance is even or better than even for all parties involved. The healthy get better control over their health spending, and have the same sorts of options. The sick get a huge infusion of healthy people into a market where they are currently a disproportionate number of sick people, driving prices down. The ACA may be better for chronically ill people, but why not make it better still?

3936

We’ve done some looking through the exchanges, yeah. Haven’t been able to find anything that makes up for the loss of the $450/month supplement that my company offers. Anything that would save money ends up not covering my wife’s medication. That is likely to change in the coming year or so when it moves in to the “standard treatment” category. Right now most insurance companies don’t cover it because there are cheaper alternatives that are said to do the same thing…but, as an outside observer, I can tell you that what she’s on now is leaps and bounds better, for her, than the “cheaper alternatives” that she was on originally. It’s not like the doctors swapped her on a whim; the did it specifically because what she was taking wasn’t working.

3937

I haven’t looked at the individual market since ACA. The one time i had couldn’t get insurance from my employer, made too much for Medicaid, all I could get from the private insurance was what they called an emergency temporary plan which I was scared to take. I was scared to use it because I kept thinking they’re going to diagnosis me with something then for the rest of my life I’m going to have this pre-existing condition on file that will be a problem for me every time I switch insurances. In addition, it had no preventative benefits, extremely high ED co-insurance, and I could take that insurance and go without a dozen other things because it was so expensive.

I went without for about a year until I was hired into a job that offered it. I also went without my medication for that year too because the cost was too high. The plan I was offered also had no drug coverage. This was my early twenties.

3938

I’ve always had to get my insurance privately due to my employer not providing healthcare at all, but a stipend to pay for it. (It’s how our contracts work- the stipend comes out to around $3/hr which is a supplemental part of our income- capped at 2080 hours)

Due to this, I ended up getting a waiver from having to get ACA insurance, so my insurance falls under the old rules, with some added protections.

The difference in plans for myself and an ACA plan with the same benefits is now around 100 or 40% per month, and I’m in my late thirties. $250 vs $350. I would have to make below $25k/yr for it to make sense for me to go with the ACA.

I’d take Sanders Medicare for all in a heartbeat, even if it meant it cost me $300/mo more in taxes. At this point I say let it death spiral if it means it gets solved in the long-term.

3939

I was wondering…is employer offered health insurance considered taxable income? Is an employer stipend for health insurance considered taxable income? Is government assistance towards health insurance considered taxable income?

In this day and age of unemployment being taxable I was just curious. As part owner of an S-Corp my insurance is not taxable.

3940

Now, I work in the 401(k) industry as a third party administrator, but I believe, like Employer Retirement contributions, if it meets the qualifications, than insurance offered to the employees is not considered taxable income. The company can use that against their taxes.