People Lose Their Employer-Sponsored Insurance Constantly(peoplespolicyproject.org)
peoplespolicyproject.org
People Lose Their Employer-Sponsored Insurance Constantly
https://www.peoplespolicyproject.org/2019/04/04/people-lose-their-employer-sponsored-insurance-constantly/
245 comments
We have a high-deductible health plan and live in Reno. When my gf recently had the need for a CAT scan, the first choice was here in Reno, and it was priced at over $800. She cancelled her appointment, called over in Carson City (20 minutes south of Reno), and got one done, by someone in our network, for $400. The doctor's office who referred her said, "$800? Really!?"
The Reno specialist made her a follow-up appointment in June. The Carson City specialist saw her in 4 days.
Etc, etc.
We're our own LLC, and we got our own group health plan, as a function of being self-employed and having experienced the employment-related gaps in health insurance coverage.
None of this is interesting, but it's stupid and risky. This system has to be changed.
The Reno specialist made her a follow-up appointment in June. The Carson City specialist saw her in 4 days.
Etc, etc.
We're our own LLC, and we got our own group health plan, as a function of being self-employed and having experienced the employment-related gaps in health insurance coverage.
None of this is interesting, but it's stupid and risky. This system has to be changed.
That actually sounds like the high deductible plan is functioning as it should though. Causing consumers to price-shop and avoid price-gouging providers.
I'll be sure to let the ambulance driver know after a car accident they should shop around :\ Maybe an Ayn Rand medicalert bracelet would help. Allergy: Socialism.
That's why the out of pocket maximum exists. (I think?)
The out of pocket maximum can be a lie, too. I have an 'out of pocket maximum' on my ACA insurance plan, but there are medical services that are exempt.
Last year, I paid $4000 more than my $6500 out of pocket maximum, because I had a heart procedure and the heart rehab following the procedure was an exception to the out of pocket maximum, a fact I discovered only after incurring the costs. You see, if you clearly follow the asterisk and the footnote references in the policy, then it's very clear that these expenses would not have been covered.
Last year, I paid $4000 more than my $6500 out of pocket maximum, because I had a heart procedure and the heart rehab following the procedure was an exception to the out of pocket maximum, a fact I discovered only after incurring the costs. You see, if you clearly follow the asterisk and the footnote references in the policy, then it's very clear that these expenses would not have been covered.
if I understand correctly, the out of pocket maximum might only apply to in network providers. I think if you end up getting a non-covered procedure or get service from an out of network provider, you can be on the hook for way more than the out of pocket maximum. if so, it would be hard to ensure that this doesn't happen in an emergency.
That was fixed long ago by ACA. Emergency services are treated as in-network regardless of whether they were actually in-network.
Well yes, but you make it sound so easy. You'll have to go multiple rounds with the insurance and aca reps in many cases to get it approved after the fact.
Yes, and that is the biggest issue. Hospitals and insurance companies playing hot potato with each other while the hospital tries to pin whatever the insurance company doesn't pay for on the consumer. We need more punitive regulatory action for such situations.
In our area, its becoming popular for the hospital (the only one in our area) to be in network, but the doctors who work in that hospital are NOT in our network.
#BAM!
Funny! Pointed too.
Getting the best dealz runs in basic conflict with needing to stay alive.
This is why markets do not work well for primary care. They can work well higher up the chain where life basics are not really in play.
Funny! Pointed too.
Getting the best dealz runs in basic conflict with needing to stay alive.
This is why markets do not work well for primary care. They can work well higher up the chain where life basics are not really in play.
Sure, in the case of a scan that isn't urgent. If you were in a car accident and have a piece of metal embedded in your kidney are you in a level, clear-minded state to price shop about which emergency room won't gouge you?
Health care is an inelastic good, we need it. So this is a market (much like having a military) that really benefits from the government stepping in and making things sane.
Health care is an inelastic good, we need it. So this is a market (much like having a military) that really benefits from the government stepping in and making things sane.
Not that I disagree, but the majority of health care expenses are not time-critical emergencies. I saw a statistic somewhere where it's around 15%?
IMO the biggest problem is that you're not really qualified to judge medical practitioners. How am I supposed to know if what they're recommending is actually necessary? The market price of an MRI? How do I know they're not skipping care I should have to offer a lower price? Or if they're offering unnecessary procedures?
The reality is you need an M.D. to make a reasonable evaluation. This is why at an HMO we have primary care physicians. Or in any other country, GPs. They decide if you need specialized care. However, how am I supposed to pick one of them? It's Russian nesting doctors.
It's probably the most complicated thing we have to deal with in our non-professional lives.
The reality is you need an M.D. to make a reasonable evaluation. This is why at an HMO we have primary care physicians. Or in any other country, GPs. They decide if you need specialized care. However, how am I supposed to pick one of them? It's Russian nesting doctors.
It's probably the most complicated thing we have to deal with in our non-professional lives.
Same way you evaluate developers. Say you are a manager at a company who needs to hire somebody to develop an application for you. You aren't technical. You have no idea if you need the thing the consultant is saying you need. So you check completed works, existing client testimonials, educational history, recommendations from coworkers or friends, etc.
Just wait until you get a reference request on your last colonoscopy :P
Seriously though in general managers have worked in and around technical people before, and their role in the process is to evaluate qualitatively. Are they a good communicator? Do they seem like awful people? They use feedback from the engineers to estimate if they're good engineers. I don't have a deep bench of M.D.s to lean on to figure this stuff out.
Seriously though in general managers have worked in and around technical people before, and their role in the process is to evaluate qualitatively. Are they a good communicator? Do they seem like awful people? They use feedback from the engineers to estimate if they're good engineers. I don't have a deep bench of M.D.s to lean on to figure this stuff out.
Actually that raises an additional interesting point... if the market price is varying from doctor to doctor it could be for many factors - how am I supposed to judge the relative quality of an MRI that would be read by two different specialists. If the quality is different then how can I be informed as to the efficacy and truth of that difference?
With a bank, Bank of America has terrible service - so I just don't use them, with a doctor though... what if I'm paying a premium price but receiving substandard care, given how complex human bodies are most illnesses compound over time and only in very select circumstances could you get a doctor to come in post defacto look at an X-Ray and say "This doctor was terrible, that's totally a tumor" maybe the real issue is that a tingling in your finger tips when you sit down that you asked your doctor about went unnoticed and twelve years later your heart gave out over totally preventable causes.
With a bank, Bank of America has terrible service - so I just don't use them, with a doctor though... what if I'm paying a premium price but receiving substandard care, given how complex human bodies are most illnesses compound over time and only in very select circumstances could you get a doctor to come in post defacto look at an X-Ray and say "This doctor was terrible, that's totally a tumor" maybe the real issue is that a tingling in your finger tips when you sit down that you asked your doctor about went unnoticed and twelve years later your heart gave out over totally preventable causes.
> Or in any other country, GPs. They decide if you need specialized care. However, how am I supposed to pick one of them? It's Russian nesting doctors.
Same way you would pick anything else? I shopped around for my GP and changed several.
Some factors were: years of experience, user feedback, spoken languages, any red flags for the whole practice, how they respond to my concerns and questions in conversation, etc.
Same way you would pick anything else? I shopped around for my GP and changed several.
Some factors were: years of experience, user feedback, spoken languages, any red flags for the whole practice, how they respond to my concerns and questions in conversation, etc.
The majority in terms of cost or volume? Also is this figure including oncology treatments - those drugs can run 1k/pill and while some are potentially cures many more are just pushing eventual death a bit further off. These drugs would quite possibly skew any statistic that isn't designed precisely to account for them.
Also I think it's not really fair to take full lifetime costs into consideration at once. As you get older you'll be looking at those much more expensive treatments and covered by expensive insurance but the insurance tends to be of a higher quality when it comes to reducing sudden costs - I am more concerned about younger people who generally have terrible insurance and may get hit with 4 months of 20k physio due to a sudden injury but generally have low "normal" costs.
Also I think it's not really fair to take full lifetime costs into consideration at once. As you get older you'll be looking at those much more expensive treatments and covered by expensive insurance but the insurance tends to be of a higher quality when it comes to reducing sudden costs - I am more concerned about younger people who generally have terrible insurance and may get hit with 4 months of 20k physio due to a sudden injury but generally have low "normal" costs.
That’s what an advanced directive is for. We just need to extend it beyond CPR/no CPR and heroic measures vs no heroic measures, etc. Kinda how like insurance companies negotiate prices for everything in advance of you showing up.
Let users watch a series of videos and choose what kind of risk and benefit they tolerate/want and how much they’re willing to spend.
It’s morbid, but we do such assessments constantly. Do I come to a complete stop and waste a few seconds and ml of gas, or roll through it and be really careful about it?
Let users watch a series of videos and choose what kind of risk and benefit they tolerate/want and how much they’re willing to spend.
It’s morbid, but we do such assessments constantly. Do I come to a complete stop and waste a few seconds and ml of gas, or roll through it and be really careful about it?
Seriously?
The difference in your "every day" scenarios is recoverability. Your actual health put at risk means you die, unrecoverably.
Then there is always people not being able to spend. So they just die?
A poll on that policy would be instructive.
The difference in your "every day" scenarios is recoverability. Your actual health put at risk means you die, unrecoverably.
Then there is always people not being able to spend. So they just die?
A poll on that policy would be instructive.
The every day scenarios can result in permanent effects. Not everyone going through a stop sign is in a protective cage.
Obviously the advanced directive solution is largely irrelevant in a 100% coverage/public system. The insurer then makes those decisions for you. But for as long as you have a system with uninsured, there’s value in having decisions made in advance as a “just in case”.
Obviously the advanced directive solution is largely irrelevant in a 100% coverage/public system. The insurer then makes those decisions for you. But for as long as you have a system with uninsured, there’s value in having decisions made in advance as a “just in case”.
Real value is health care as human right. That we do not do it, and worse, can't even get a basic like water right is an embarrassment at the least, and rock solid cause for reform all day long.
In simpler times, a city able to provide clean water was a city of note. Worthy destination. This has been true for ages.
Flint fucked for how long now?
Our national priorities are insane! Bat shit wrong and health care, food, water, housing are all right at the top of reform agendas for damn good reason.
We can do better, and we need to.
The uninsured are uninsured because they are unable to spend. Put whatever the fuck anyone wants on that paper and it does not matter one lick.
Might as well write, "yeah, let me die, k?"
Frankly, there is zero value in the idea, and a lot of harm potential in the norms being changed for the worse: "but they consented..."
Anyone who wants to make a directive can do so today. Expecting people to do it because our system is fucked makes zero sense.
It is long past time we get our priorities in order so conversations like this are laughable, not morbid.
In simpler times, a city able to provide clean water was a city of note. Worthy destination. This has been true for ages.
Flint fucked for how long now?
Our national priorities are insane! Bat shit wrong and health care, food, water, housing are all right at the top of reform agendas for damn good reason.
We can do better, and we need to.
The uninsured are uninsured because they are unable to spend. Put whatever the fuck anyone wants on that paper and it does not matter one lick.
Might as well write, "yeah, let me die, k?"
Frankly, there is zero value in the idea, and a lot of harm potential in the norms being changed for the worse: "but they consented..."
Anyone who wants to make a directive can do so today. Expecting people to do it because our system is fucked makes zero sense.
It is long past time we get our priorities in order so conversations like this are laughable, not morbid.
So now not only do I have to spend several days on the phone each year with my insurance company, on top of figuring out which plan I want every new job, but I also need to watch a bunch of videos about kidney-replacement options for when I get in a car accident? And what heart attack care is available? And how many $1000 Ti screws they should put in my leg when I shatter it rock climbing? And somehow the collective time-wasting is going to be somehow cheaper for all of us?
I always wonder if you libertarians are doing a bit, because it sure seems like it.
I always wonder if you libertarians are doing a bit, because it sure seems like it.
You get some agent to do the heavy lifting in agreement with your parameters.
It’s a solution to the problem of “I continued to choose to live in an environment without health insurance, how do I handle the situation of not being in a position to negotiate?”
It’s a solution to the problem of “I continued to choose to live in an environment without health insurance, how do I handle the situation of not being in a position to negotiate?”
The agent I choose it the government, which I am proposing becomes the common agent of all Americans and advocates for all of us - since the expertise to act as a rational agent in this setting is unavailable to most citizens.
This extreme libretarianism stuff is pure BS, health care services in an emergency cannot exist as a free market.
This extreme libretarianism stuff is pure BS, health care services in an emergency cannot exist as a free market.
Oh, I agree. But most Americans actively vote against that system.
As for those uninsured that just broke their ____ and are not in a position to start calling around, having pre-negotiated rates for the best pricing against all hospitals within a reasonable time’s transport would save a pile of cash. There’s no shortage of hospitals or excess capacity in the US.
As for those uninsured that just broke their ____ and are not in a position to start calling around, having pre-negotiated rates for the best pricing against all hospitals within a reasonable time’s transport would save a pile of cash. There’s no shortage of hospitals or excess capacity in the US.
What if the cheaper place is cheaper cause it's not as capable? How am I supposed to know? In what other scenario are we similarly encouraged to act on price alone? Price transparency is meaningless with quality transparency.
Price is the best mechanism for organically assessing quality at scale.
And quality transparency isn't that much help either - if you have cancer are you really going to shop around if chemo treatment drug group A is more effective then drug group B? A patient cant even begin to be able to shop around for something like that.
... and assessing quality in this space is way outside of what a normal consumer is capable of anyway.
The UK has periodically had a back and forth on whether the outcome ratio numbers which are collected for internal statistical measures should be published.
ie should we make it easy to get a number that says 4.6 for Mr Able, 5.2 for Ms Awesome and 3.8 for Mr Good?
At one extreme the reality may be that Mr Good isn't good and his numbers are low because he's a bad surgeon, he makes a lot of mistakes, his technique is not what it should be, he's using an approach that's outdated... that's a real problem, and maybe "patient choice" is a fix where colleagues may be reluctant to say "Fire Mr Good" because he's a good guy, he's not _terrible_ at his job, but yeah they would not themselves choose to be treated by him.
At the other extreme the reality may be that Mr Good is the only guy who'll take patients that Ms Awesome thinks are too high risk. She thinks it's better to say "No", he thinks if they seek medicine he should do his part. Maybe they're obese, or they won't stop smoking, or they won't stop doing the sport that's wrecking their body. And Ms Awesome is right that Mr Good's patients are higher risk, but that's not because he's doing a bad job, he's playing what was dealt.
The UK has periodically had a back and forth on whether the outcome ratio numbers which are collected for internal statistical measures should be published.
ie should we make it easy to get a number that says 4.6 for Mr Able, 5.2 for Ms Awesome and 3.8 for Mr Good?
At one extreme the reality may be that Mr Good isn't good and his numbers are low because he's a bad surgeon, he makes a lot of mistakes, his technique is not what it should be, he's using an approach that's outdated... that's a real problem, and maybe "patient choice" is a fix where colleagues may be reluctant to say "Fire Mr Good" because he's a good guy, he's not _terrible_ at his job, but yeah they would not themselves choose to be treated by him.
At the other extreme the reality may be that Mr Good is the only guy who'll take patients that Ms Awesome thinks are too high risk. She thinks it's better to say "No", he thinks if they seek medicine he should do his part. Maybe they're obese, or they won't stop smoking, or they won't stop doing the sport that's wrecking their body. And Ms Awesome is right that Mr Good's patients are higher risk, but that's not because he's doing a bad job, he's playing what was dealt.
Also don't forget that Mr. Good might have tougher customers because he's Mr. Good and his prices are low or because he's willing to take on the hardest jobs that are unlikely to leave customers satisfied no matter how good they turn out. If you're the guy that everyone goes to because nobody else is willing to try and fix what you will your success/failure ratio will by abysmal.
Measuring quality is also incredibly difficult, patient input is practically worthless.
Every time patients are asked to rate the quality of the care, they consistently rate simple feel-good care like massages, chiropractice, or just therapy as very good, but saved-your-lfe-operations get rated very badly, because the experience and recovery is often miserable. You live, but you don't feel good, so you rate the quality of the care after how you feel, even though you ought to rate it Five-star, A++++, would transplant a failed heart again!
So the rational person abandons subjective ratings and look at objective ratings, what's the medical outcome for a provider? Sure, that's better, but the quality of the outcome is incredibly dependent on the quality of the patients! It's a well-known fact that a positive attitude helps immensely with recovery, how do you measure that? How do you integrate that with an outcome measurement?
Every time patients are asked to rate the quality of the care, they consistently rate simple feel-good care like massages, chiropractice, or just therapy as very good, but saved-your-lfe-operations get rated very badly, because the experience and recovery is often miserable. You live, but you don't feel good, so you rate the quality of the care after how you feel, even though you ought to rate it Five-star, A++++, would transplant a failed heart again!
So the rational person abandons subjective ratings and look at objective ratings, what's the medical outcome for a provider? Sure, that's better, but the quality of the outcome is incredibly dependent on the quality of the patients! It's a well-known fact that a positive attitude helps immensely with recovery, how do you measure that? How do you integrate that with an outcome measurement?
People in poor health are not consumers and getting medical help is not shopping.
That's not the purpose of deductibles though... it's to put people's skin in the game - if you use insurance, you also pay for it, so it's not free for you.
On the other hand, if a provider is charging too much, they shouldn't be included in the plan in the first place, as they're simply a bad option.
On the other hand, if a provider is charging too much, they shouldn't be included in the plan in the first place, as they're simply a bad option.
No... the grandparent had it right. "Skin in the game" is just a colloquial restatement of the earlier point. The purpose isn't to make people needlessly suffer more by having to pay!
The principle idea is that because they have to pay some, they'll be more sensitive to pricing and more willing to shop for an affordable provider, which is exactly the efficiency argument.
And in this particular case I agree, even. Though the fact that this has to be done by individuals (who are sick!) sort of makes a hash of the moral notions of "the market" being the solution here. We're buying efficiency at the cost of individual grief, and that has value too.
The principle idea is that because they have to pay some, they'll be more sensitive to pricing and more willing to shop for an affordable provider, which is exactly the efficiency argument.
And in this particular case I agree, even. Though the fact that this has to be done by individuals (who are sick!) sort of makes a hash of the moral notions of "the market" being the solution here. We're buying efficiency at the cost of individual grief, and that has value too.
If private insurance is going to work, then every healthcare provider has to accept payment from every insurance. This clusterfuck we have where you have in-network providers with one price and out-of-network providers with a different price just has to stop.
Oh you went to an in-network hospital, but this one doctor walked into the room for five minutes and she was out-of-network, so now your bill is 10x higher than it otherwise would be, etc. etc. It's ridiculous.
Oh you went to an in-network hospital, but this one doctor walked into the room for five minutes and she was out-of-network, so now your bill is 10x higher than it otherwise would be, etc. etc. It's ridiculous.
I've always wanted to add a clause to those consent forms stating that my consent is conditional to the provider being in-network for the insurance information I provided the hospital. It is their responsibility to make that determination before they start treatment. If they provide treatment and find that they're not in network, then they forgo the right to bill for that service.
A great alternative strategy is to structure your finances so that it's impossible for creditors to seize your assets - that way, your practical liability is limited to the up-front costs. Which, by being up-front, you can actually reason about and make informed decisions on.
This is less difficult than it sounds. Move to Texas, and keep all your assets in retirement accounts, home equity in your primary residence, and possibly annuities if you've made too much money for that all to hold everything. Note that this should be done before possibly incurring debts.
This is less difficult than it sounds. Move to Texas, and keep all your assets in retirement accounts, home equity in your primary residence, and possibly annuities if you've made too much money for that all to hold everything. Note that this should be done before possibly incurring debts.
> A great alternative strategy is to structure your finances so that it's impossible for creditors to seize your assets
It is absolute insanity that this is even a thing to consider.
The funniest thing about it is that if you do this, you are effectively socializing your personal losses and letting everyone else insured through your provider bear the cost for your healthcare. If that's not an argument for actually socializing healthcare costs for everyone, I don't know what is.
It is absolute insanity that this is even a thing to consider.
The funniest thing about it is that if you do this, you are effectively socializing your personal losses and letting everyone else insured through your provider bear the cost for your healthcare. If that's not an argument for actually socializing healthcare costs for everyone, I don't know what is.
If I could cap my downside risk from medical events through insurance, I would do that instead. And this is not a replacement for insurance, since many medical providers will refuse to provide non-emergency care if they didn't expect that they could bill my insurance for services rendered.
But, unfortunately, it's currently impossible to set a maximum price you could wind up owing due to receiving medical care. Any provider you go to could end up incurring out-of-network charges and wind up balance billing you. The only fix is to cap the actual damage of creditor judgements in general.
But, unfortunately, it's currently impossible to set a maximum price you could wind up owing due to receiving medical care. Any provider you go to could end up incurring out-of-network charges and wind up balance billing you. The only fix is to cap the actual damage of creditor judgements in general.
> But, unfortunately, it's currently impossible to set a maximum price you could wind up owing due to receiving medical care.
Of course, because demand for healthcare is infinite, so you could wind up costing the insurance company an infinite amount of money. And if their expenses are uncapped, they're not going to cap how much you can pay them.
And if they cap their expenses on your behalf, it's not really insurance, it's just a shitty payment plan.
Of course, because demand for healthcare is infinite, so you could wind up costing the insurance company an infinite amount of money. And if their expenses are uncapped, they're not going to cap how much you can pay them.
And if they cap their expenses on your behalf, it's not really insurance, it's just a shitty payment plan.
I misspoke a little: it's impossible to set a maximum price that the 95th percentile household can afford. A single medical event can bankrupt households but not the state of California.
I wouldn't describe that strategy as great. Having a desired effect, sure, but the tradeoffs are pretty nasty. And doesn't it create potential situations where you require a lawyer? And what if the laws in Texas change, what then?
Wouldn't it be easier instead for healthcare billing not to contain so many gotchas?
Wouldn't it be easier instead for healthcare billing not to contain so many gotchas?
>And doesn't it create potential situations where you require a lawyer?
Sure, but improving your BATNA helps your negotiations even if you don't need to exercise it. The bill gets handled with opening a dispute and sending a "give me documentation for an implied regulatory complaint" letter. If things devolve into a lawsuit or threat thereof, I tell them my financial situation and what they can expect from a lawsuit and offer to settle for a nominal amount.
>Wouldn't it be easier instead for healthcare billing not to contain so many gotchas?
Well yeah, but I can't change the healthcare billing system, while I can change how my finances are structured.
Sure, but improving your BATNA helps your negotiations even if you don't need to exercise it. The bill gets handled with opening a dispute and sending a "give me documentation for an implied regulatory complaint" letter. If things devolve into a lawsuit or threat thereof, I tell them my financial situation and what they can expect from a lawsuit and offer to settle for a nominal amount.
>Wouldn't it be easier instead for healthcare billing not to contain so many gotchas?
Well yeah, but I can't change the healthcare billing system, while I can change how my finances are structured.
What’s special about Texas? And how can you put everything in retirement account?? 401k is 19k/year and IRA is 5k? What do you do with the rest of your money? Do you setup and LLC or trust? Can you elaborate?
>What’s special about Texas?
Debt collection follows a combination of state and federal law, and Texas state law is unusually favorable to debtors. Specific important pieces:
1. Your primary residence is protected from forced sale to satisfy general creditors, up to 10 acres (urban) or 100 acres (rural).
2. Garnishment of wages is limited to certain special circumstances, such as nonpayment of taxes or child support.
3. IRAs have unlimited protection from creditors (other states have a cap).
>And how can you put everything in retirement account?? 401k is 19k/year and IRA is 5k? What do you do with the rest of your money?
Home equity is a very significant part of this. If you borrow $300k to buy a $400k home, the $100k you have tied up in your house is protected from creditors. If you have an extra $50k you want to save, you pay down your mortgage more aggressively and creditors can no longer come after it.
Oh, also, from reading into things, it looks like if you buy a 2 to 4 unit house, then even the non-owner-occupied units remain protected. So you can extend things somewhat that way by having a more expensive home that cashflows.
>Do you setup and LLC or trust?
LLCs are more for business-related liabilities, and trusts are weird and expensive enough that I haven't looked into them. Besides which, there's a perfectly reasonable alternative to a trust - annuity and insurance products. Both their value and payments to you are exempt from attachment and seizure in Texas, again with the exception of child support payments and "fraudulent transfers" made after incurring the debt. So essentially, if an insurance company is holding your money and giving it back to you in a structured way, creditors have a really hard time getting at it.
Debt collection follows a combination of state and federal law, and Texas state law is unusually favorable to debtors. Specific important pieces:
1. Your primary residence is protected from forced sale to satisfy general creditors, up to 10 acres (urban) or 100 acres (rural).
2. Garnishment of wages is limited to certain special circumstances, such as nonpayment of taxes or child support.
3. IRAs have unlimited protection from creditors (other states have a cap).
>And how can you put everything in retirement account?? 401k is 19k/year and IRA is 5k? What do you do with the rest of your money?
Home equity is a very significant part of this. If you borrow $300k to buy a $400k home, the $100k you have tied up in your house is protected from creditors. If you have an extra $50k you want to save, you pay down your mortgage more aggressively and creditors can no longer come after it.
Oh, also, from reading into things, it looks like if you buy a 2 to 4 unit house, then even the non-owner-occupied units remain protected. So you can extend things somewhat that way by having a more expensive home that cashflows.
>Do you setup and LLC or trust?
LLCs are more for business-related liabilities, and trusts are weird and expensive enough that I haven't looked into them. Besides which, there's a perfectly reasonable alternative to a trust - annuity and insurance products. Both their value and payments to you are exempt from attachment and seizure in Texas, again with the exception of child support payments and "fraudulent transfers" made after incurring the debt. So essentially, if an insurance company is holding your money and giving it back to you in a structured way, creditors have a really hard time getting at it.
I see. What if you want to FIRE? You can’t have all your $ tied up in a house.
You can likely actually swing it between accessing IRA funds, having a paid-off duplex/triplex/quadplex, and purchasing an annuity or the like. Wouldn't lose all that much efficiency, depending on things.
They won't let you have the procedure if you attempt to alter the agreement. I've tried!
When you go to the hospital, you just need to wear a Darth Vader mask and rasp "pray I don't alter it any further."
Only that insurance takes 3 weeks to process the claim. Delaying care 3 weeks for that guarantee would have caustic medical implications.
imgabe just said in network not that the claim gets accepted. There's been a couple cases where not everyone administering as part of the procedure was in network so there's a surprise bill for one part [0]. You can do all the right homework to make sure the principal people involved are in network and still get screwed!
[0] https://www.cbsnews.com/news/out-of-network-anesthesiologist...
[0] https://www.cbsnews.com/news/out-of-network-anesthesiologist...
If the procedure is not covered it doesn't matter if its in-network. You will face the same issue: the provider doesn't know if he will get paid from insurance until at least 3 weeks later.
I agree, however this is the unfortunate reality of the private healthcare system maximizing for profit. Consumers rarely have proper choice in shopping around or choosing doctors and insurance providers take advantage of this by inventing as many different systems as they can to avoid paying out.
That's why I think full free market healthcare simply won't work. It's far too much at odds with people that need medical care, made worse if you need timely medical care.
That's why I think full free market healthcare simply won't work. It's far too much at odds with people that need medical care, made worse if you need timely medical care.
> unfortunate reality of the private healthcare system maximizing for profit
> Consumers rarely have proper choice in shopping around
If you have a M4A, you have less choices not more.
> That's why I think full free market healthcare simply won't work
The last thing I would call healthcare in the us is free market.
If you have a M4A, you have less choices not more.
> That's why I think full free market healthcare simply won't work
The last thing I would call healthcare in the us is free market.
The reason this doesn't work is because not all doctors are equal.
Insurance companies want to contract with the healthcare providers with the highest quality outcomes that don't have overprescription, relapses, and readmissions.
Search terms: "narrow networks"
Insurance companies want to contract with the healthcare providers with the highest quality outcomes that don't have overprescription, relapses, and readmissions.
Search terms: "narrow networks"
1) Pass law providers require to support all insurances
2) Make insurance company that reimburses 1$ per visit
3) Profit
2) Make insurance company that reimburses 1$ per visit
3) Profit
> which should in theory make it more efficient for the sake of maximizing profit
There are multiple reasons why this doesn't work for healthcare even in theory.
- Emergency care can't be substituted without massive cost. Providers compete on distance not on price.
- Emergency care can't be denied (or at least we don't want this) on the basis of price.
- Health is not insurable like cars, etc. You can't predict in advance when you are going to get in a car wreck so you better buy insurance when you get the car. If you could, the price of the insurance would be the price of the car, and therefore worthless. But you could just wait until you feel sick to get health insurance. This is why the ACA has to be paired with the individual mandate to work properly.
There are multiple reasons why this doesn't work for healthcare even in theory.
- Emergency care can't be substituted without massive cost. Providers compete on distance not on price.
- Emergency care can't be denied (or at least we don't want this) on the basis of price.
- Health is not insurable like cars, etc. You can't predict in advance when you are going to get in a car wreck so you better buy insurance when you get the car. If you could, the price of the insurance would be the price of the car, and therefore worthless. But you could just wait until you feel sick to get health insurance. This is why the ACA has to be paired with the individual mandate to work properly.
Emergency care being expensive is not a problem of insurance. Public hospitals are also expensive. Its related to other things.
It's not the expense that's the problem the expense is a symptom and the problem is the attempt to treat healthcare like a market when consumers a) have very little ability to discover the price, b) have little option in substitution (if my appendix is ruptured my substitution to getting surgery is dying!) and c) many purchases are made under emergency situation with no time to price shop (or often the ability, no one can comparison shop unconscious in the back of an ambulance).
> to treat healthcare like a market when consumers a) have very little ability to discover the price
There is HUGE price discoverability capacity in healthcare. But the US is not a free market: every single player has some sort of regulatory capture to mess it up, including workers, that get tax benefits and are blind to price through employer provided insurance.
Price sensitivity does work for high deductible plans, pointing to the basic economic principal-agency problem of the current system: if you have low copays and you cant choose insurances because your employer pays for it, you are a price insensitive patient.
My favorite example is OneMedical: one of the biggest complains patients have is "why do I have to pay 150 a year", while their healthcare plan is thousands A MONTH and a single doctor visit costs 300 U$S!
> have little option in substitution (if my appendix is ruptured my substitution to getting surgery is dying!)
Emergency healthcare is a small fraction of overall healthcare spending, and it is NOT expensive because of insurance, its expensive because hospitals are expensive. It doesn't make sense to complain to an auto-insurance company that fixing cars is expensive, its completley out of their hands, and they actually work in your favor to reduce costs if they can.
And medicine has PLENTY of substitutes. From cheaper drugs, to less accessible and lower quality healthcare. It's called the Iron Triangle of Healthcare: cost-quality-access. You can find your place in the triangle.
There is HUGE price discoverability capacity in healthcare. But the US is not a free market: every single player has some sort of regulatory capture to mess it up, including workers, that get tax benefits and are blind to price through employer provided insurance.
Price sensitivity does work for high deductible plans, pointing to the basic economic principal-agency problem of the current system: if you have low copays and you cant choose insurances because your employer pays for it, you are a price insensitive patient.
My favorite example is OneMedical: one of the biggest complains patients have is "why do I have to pay 150 a year", while their healthcare plan is thousands A MONTH and a single doctor visit costs 300 U$S!
> have little option in substitution (if my appendix is ruptured my substitution to getting surgery is dying!)
Emergency healthcare is a small fraction of overall healthcare spending, and it is NOT expensive because of insurance, its expensive because hospitals are expensive. It doesn't make sense to complain to an auto-insurance company that fixing cars is expensive, its completley out of their hands, and they actually work in your favor to reduce costs if they can.
And medicine has PLENTY of substitutes. From cheaper drugs, to less accessible and lower quality healthcare. It's called the Iron Triangle of Healthcare: cost-quality-access. You can find your place in the triangle.
Churning health insurance with a high deductible plan + HSA is an even bigger timesuck.
Just yesterday I sent in the paperwork to roll over my HSA from one bank to another-- the punchline is, my insurance provider didn't change and my insurance login was the same (Premera ConnectYourCare), but it looked like the 15k in my HSA account inexplicably disappeared. Needless to say, this was concerning.
A few phone calls later, and I come to find out that my 15k with Bank_0 was available on the backend, but since Bank_1 was preferred by my new employer, Premera shows Bank_1 on the frontend. Keep in mind, all interactions with your HSA bank account are abstracted away from you. So you must track down your Bank_0 and Bank_1 account numbers (I used my tax paperwork) and mail in honest to god physical signed forms authorizing the rollover.
Then I come to find out that I should have done this anyway-- HSA accounts are laden with monthly account fees, paper billing fees and investment fees that my previous employer wasn't paying anymore, and these aren't covered by my current employer. HSA bank accounts are one hell of a moneymaking venture for the big banks-- 0 risk because employers send yearly contributions into the account; high likelihood that people will forget to roll it over and the account will drain via fees.
HSAs have the hugely hidden cost of managing this separate account+tax entity, and I did not know this when I signed up for one. I'm not even sure that my hours of labor on it are worth the tax savings.
Just yesterday I sent in the paperwork to roll over my HSA from one bank to another-- the punchline is, my insurance provider didn't change and my insurance login was the same (Premera ConnectYourCare), but it looked like the 15k in my HSA account inexplicably disappeared. Needless to say, this was concerning.
A few phone calls later, and I come to find out that my 15k with Bank_0 was available on the backend, but since Bank_1 was preferred by my new employer, Premera shows Bank_1 on the frontend. Keep in mind, all interactions with your HSA bank account are abstracted away from you. So you must track down your Bank_0 and Bank_1 account numbers (I used my tax paperwork) and mail in honest to god physical signed forms authorizing the rollover.
Then I come to find out that I should have done this anyway-- HSA accounts are laden with monthly account fees, paper billing fees and investment fees that my previous employer wasn't paying anymore, and these aren't covered by my current employer. HSA bank accounts are one hell of a moneymaking venture for the big banks-- 0 risk because employers send yearly contributions into the account; high likelihood that people will forget to roll it over and the account will drain via fees.
HSAs have the hugely hidden cost of managing this separate account+tax entity, and I did not know this when I signed up for one. I'm not even sure that my hours of labor on it are worth the tax savings.
It's painful. After going through something similar (with UMB and ConnectYourCare/UMB), I ended up over at Lively. No fees, and you can invest with TD Ameritrade for free. I hear Fidelity is a good option as well.
Isn't it pretty cost-effective and efficient to keep you on the phone for three hours in the hopes that you just give up and don't undergo a medical procedure?
This is exactly what I was thinking during the whole read. It's what Comcast did in the early 2000s when they were scamming people by adding random charges. Just keep them sandbagged long enough to give up, and it's basically free income.
I think your phenomena might be due to startups? Obviously this is a startup focused board so I am not saying this to mean go one way or another, but I ditched the startup, job hopping life a little while ago, and had to deal with "insurance bs" roughly two times in 7 years.
I am either the luckiest person alive, or maybe there is additional benefits not obviously well represented here to working for a stable, revenue producing organization, but I don't seem to encounter what seems to be the well-represented insurance pains documented here (probably a little bit of both, in my guess).
I am either the luckiest person alive, or maybe there is additional benefits not obviously well represented here to working for a stable, revenue producing organization, but I don't seem to encounter what seems to be the well-represented insurance pains documented here (probably a little bit of both, in my guess).
My partner has been employed with the same large international company for 8 years. She had an elected procedure done that is required by law to be fully covered by insurance. She had 3 calls leading up to the procedure with her health insurance company each time asking them if they were certain it would be covered 100%. I thought that this was overkill but she was worried to the point of being paranoid about it. They assured her each time she would not have to pay any money at all for anything.
The procedure was in December. After the procedure she received a 6-figure bill, which she then had to follow up with hours of phone calls back and forth to the insurance company, hospital, and doctor's office. They sent her a revised bill for somewhere around $8,000, and then another revised bill for around $4,000.
The insurance company says it's because the doctor coded the procedure incorrectly. The doctor says the hospital coded it incorrectly. She has had to file an appeal with the insurance company, and the only reason it looks like it will work out is because the insurance company records all phone calls and was able to get records of her original calls before the procedure asking if it would be fully covered. She has still been told to expect that they will deny her first appeal and she'll have to appeal a second time in order to get it covered. This has been causing her immense stress for the past 4 months as she does not have enough money to pay even the $4,000 bill out of pocket.
My experience is that your experience actually is extremely uncommon in America today. Most people who have to interact with the health care system beyond annual checkups have to deal with something like this.
The procedure was in December. After the procedure she received a 6-figure bill, which she then had to follow up with hours of phone calls back and forth to the insurance company, hospital, and doctor's office. They sent her a revised bill for somewhere around $8,000, and then another revised bill for around $4,000.
The insurance company says it's because the doctor coded the procedure incorrectly. The doctor says the hospital coded it incorrectly. She has had to file an appeal with the insurance company, and the only reason it looks like it will work out is because the insurance company records all phone calls and was able to get records of her original calls before the procedure asking if it would be fully covered. She has still been told to expect that they will deny her first appeal and she'll have to appeal a second time in order to get it covered. This has been causing her immense stress for the past 4 months as she does not have enough money to pay even the $4,000 bill out of pocket.
My experience is that your experience actually is extremely uncommon in America today. Most people who have to interact with the health care system beyond annual checkups have to deal with something like this.
She is lucky she is getting that even partially covered if she only got a verbal agreement. My insurance policy has a clause that anything they say over the phone is not a promise to pay. You have to call AND get something in writing to even be eligible for a dispute later.
I am fortunate to have had the experience of growing up with a rabid Greek mother who would get to the bottom of any shenanigans with any sort of insurance agency, bill collector or anything. I now have my own experience. Yes the first time was stressful, but reading your story, trying to put myself in your partner's shoes this would not have ended up causing me any stress, especially if I knew the law is on my side. I certainly wouldn't paid any bill until it was all sorted out. I also have experience where a medical charge that was suppose to be covered as a legitimate procedure was not and charged off onto my credit (because again, I refused to pay). I was easily able to negotiate with the credit reporting agency to remove this negative mark on my credit. (Negative marks due to medical bills affect your credit much less than say missing a credit card payment, IIRC, I was still able to obtain credit cards, get loans, and generally had decent overall credit).
My father currently undergoing treatment for lung cancer. He has medicare and supplemental coverage through Humana. Bills are still in excess of 150,000, so I definitely understand the other side of it.
My father currently undergoing treatment for lung cancer. He has medicare and supplemental coverage through Humana. Bills are still in excess of 150,000, so I definitely understand the other side of it.
My previous employer had my insurance totally wrong. According to everything I signed at open enrollment, I had a $6k deductible and $6.6k Out-of-pocket max. This was for the family, no individual deductible.
When I go to the insurance site, it lists me with a $2k individual & $4k family deductible. It says my OOPM is $7.5k. Of course I hit my deductible this year, so I'm getting billed an extra thousand.
My employer and insurance company both swear it's the other one's fault and even filing a complaint with the state insurance commission doesn't seem to have helped. :(
When I go to the insurance site, it lists me with a $2k individual & $4k family deductible. It says my OOPM is $7.5k. Of course I hit my deductible this year, so I'm getting billed an extra thousand.
My employer and insurance company both swear it's the other one's fault and even filing a complaint with the state insurance commission doesn't seem to have helped. :(
In the future the way to avoid this is for the hospital/doctor to submit a prior auth request. Then you have it in writing.
I'm not at a startup and have better than average insurance, however it's still a clown show.
For example, I recently got prescribed a medical device, but was then told that if I didn't have a follow up appointment between certain dates I'd be billed out of pocket for the device.
The prescribing physician, of course, has no open appointments until a couple months after the given follow up interval, despite knowing the potential issue and prescheduling the followup.
And of course the device provider, the physician, and the insurance company all tell me completely different things about the situation.
The current "solution" is "just see your primary care instead," not sure how it'll go.
For example, I recently got prescribed a medical device, but was then told that if I didn't have a follow up appointment between certain dates I'd be billed out of pocket for the device.
The prescribing physician, of course, has no open appointments until a couple months after the given follow up interval, despite knowing the potential issue and prescheduling the followup.
And of course the device provider, the physician, and the insurance company all tell me completely different things about the situation.
The current "solution" is "just see your primary care instead," not sure how it'll go.
Not due to startups necessarily so much as changing insurance a lot. I'm on my 6th insurance plan in 4 years (Job 1, not a startup, lasted 9 months. Job 2, a startup, changed insurance 2 months after I started then again the next year for a total of 3 plans over 2.5~ years on the job. Job 3, a startup, had better than average insurance (with a weird/awesome reimbursement plan so I pay 0 deductible and 0 premium and get to cover my wife for free too!). Then one month after I started we got acquired and so in 2019 I now have a normal (still good) corporate insurance policy.
On top of that insurance frustrates my wife so before we were married when she was on PhD student insurance I generally managed that too, plus her transition to my insurance after marriage.
So I'm definitely out-of-norm on this. If anything I like to think that means I'm more qualified to call out how bullshit the world of insurance is, atleast in terms of end-user UX, but obviously that's just my opinion.
On top of that insurance frustrates my wife so before we were married when she was on PhD student insurance I generally managed that too, plus her transition to my insurance after marriage.
So I'm definitely out-of-norm on this. If anything I like to think that means I'm more qualified to call out how bullshit the world of insurance is, atleast in terms of end-user UX, but obviously that's just my opinion.
I think it depends on your state's insurance market as well as the priorities of your employer. If your state has a plethora of plans available, your employer is tempted to shop around more often. In that case, it depends on the priorities of your employer, weighing the cost savings versus the cost (financial, employee morale, time) were they to switch to a cheaper plan.
I've worked for employers of varied sizes and profitability (self-employed, small nonprofit, very large health system [including its own insurance plans], midsize for-profit), and I haven't noticed a consistent pattern that would differentiate them in terms of health plan stability. In all cases, the goal is to minimize cost while providing an acceptable level of coverage.
Of course, job hopping and employer-provided coverage are a painful combination. My family had to reach our deductible twice last year, which wasn't fun (the increased salary and other benefits of the new job made it worth it).
I'd love to see health coverage detached from employment. If traditional Medicare-for-all isn't feasible, then let's go with Medicare-Advantage-for-all instead.
I've worked for employers of varied sizes and profitability (self-employed, small nonprofit, very large health system [including its own insurance plans], midsize for-profit), and I haven't noticed a consistent pattern that would differentiate them in terms of health plan stability. In all cases, the goal is to minimize cost while providing an acceptable level of coverage.
Of course, job hopping and employer-provided coverage are a painful combination. My family had to reach our deductible twice last year, which wasn't fun (the increased salary and other benefits of the new job made it worth it).
I'd love to see health coverage detached from employment. If traditional Medicare-for-all isn't feasible, then let's go with Medicare-Advantage-for-all instead.
The phenomena is linked to how often someone switches jobs in the United States irrespective of the type of company or employment (full-time, part-time, self-employes etc).
No matter what an individual’s stance is with respect to another individual’s professional history in terms of frequent changes or gaps, I don’t think that has to correspond to level of healthcare that the latter individual is able to obtain.
No matter what an individual’s stance is with respect to another individual’s professional history in terms of frequent changes or gaps, I don’t think that has to correspond to level of healthcare that the latter individual is able to obtain.
>This can be done via taxes but insurance is a private market solution which should in theory make it more efficient for the sake of maximizing profit.
Imagine there's a single, private, insurance company, A.
Wouldn't the natural interest of A be to maximize health costs (i.e. make paying for health coverage expensive, as thus their insurance more desirable and more expensive in return)?
And if there were more smaller insurance companies competing with A, wouldn't it make sense for A to just eat them up to eliminate competition (so, having us end up with an even larger company)?
And if there were several equally large insurance companies aside A (say, B, C, D), wouldn't it make sense for them to collude and keep prices and profits high?
And since A (a single large) or A+B+C+D (several large) companies surely have considerable clout (money gives you that) isn't it their natural interest to spend on buying politicians, media, etc, to make sure things get even more in their favor?
All those seem inevitable (and profitable) in a market economy. How would insurance being a private market make it "make it more efficient for the sake of maximizing profit"?
Imagine there's a single, private, insurance company, A.
Wouldn't the natural interest of A be to maximize health costs (i.e. make paying for health coverage expensive, as thus their insurance more desirable and more expensive in return)?
And if there were more smaller insurance companies competing with A, wouldn't it make sense for A to just eat them up to eliminate competition (so, having us end up with an even larger company)?
And if there were several equally large insurance companies aside A (say, B, C, D), wouldn't it make sense for them to collude and keep prices and profits high?
And since A (a single large) or A+B+C+D (several large) companies surely have considerable clout (money gives you that) isn't it their natural interest to spend on buying politicians, media, etc, to make sure things get even more in their favor?
All those seem inevitable (and profitable) in a market economy. How would insurance being a private market make it "make it more efficient for the sake of maximizing profit"?
> Wouldn't the natural interest of A be to maximize health costs
A, an insurance company, is the one fighting to get the cost down from B, the healthcare provider.
> And if there were more smaller insurance companies competing with A, wouldn't it make sense for A to just eat them up to eliminate competition
Monopolization is more dangerous from the healthcare provider side, though it happens both ways. Basically, insurances compete against each other at state levels, while hospitals only fight the nearest hospital, maybe.
> And if there were several equally large insurance companies aside A (say, B, C, D), wouldn't it make sense for them to collude and keep prices and profits high?
You can see that health insurnace companies are not really profitable. They have lower margins than auto-insurance.
> And since A (a single large) or A+B+C+D (several large) companies surely have considerable clout (money gives you that) isn't it their natural interest to spend on buying politicians, media, etc, to make sure things get even more in their favor?
Noone has more interest than to implement national health insurnace than politicans. It's the biggest political boon plus almost unlimited spending they could get. If something like M4A passed, the state would grow in the order of 10% of GDP.
> ow would insurance being a private market make it "make it more efficient for the sake of maximizing profit"?
By keeping at bay provision costs vs quality. In Healthcare there is something called the Iron Triangle: Access vs Quality vs Cost. If you unleash access, you need to lower quality or increase cost.
A, an insurance company, is the one fighting to get the cost down from B, the healthcare provider.
> And if there were more smaller insurance companies competing with A, wouldn't it make sense for A to just eat them up to eliminate competition
Monopolization is more dangerous from the healthcare provider side, though it happens both ways. Basically, insurances compete against each other at state levels, while hospitals only fight the nearest hospital, maybe.
> And if there were several equally large insurance companies aside A (say, B, C, D), wouldn't it make sense for them to collude and keep prices and profits high?
You can see that health insurnace companies are not really profitable. They have lower margins than auto-insurance.
> And since A (a single large) or A+B+C+D (several large) companies surely have considerable clout (money gives you that) isn't it their natural interest to spend on buying politicians, media, etc, to make sure things get even more in their favor?
Noone has more interest than to implement national health insurnace than politicans. It's the biggest political boon plus almost unlimited spending they could get. If something like M4A passed, the state would grow in the order of 10% of GDP.
> ow would insurance being a private market make it "make it more efficient for the sake of maximizing profit"?
By keeping at bay provision costs vs quality. In Healthcare there is something called the Iron Triangle: Access vs Quality vs Cost. If you unleash access, you need to lower quality or increase cost.
>A, an insurance company, is the one fighting to get the cost down from B, the healthcare provider.
If the healthcare cost is zero or negligible the need for insurance is also zero. You just pay it out of pockets.
The insurance company might want to lower their bills (when they do pay for your treatment), but they have a counter-incentive to health costs being lowered too much, and a positive incentive to get health costs higher for the uninsured.
If the healthcare cost is zero or negligible the need for insurance is also zero. You just pay it out of pockets.
The insurance company might want to lower their bills (when they do pay for your treatment), but they have a counter-incentive to health costs being lowered too much, and a positive incentive to get health costs higher for the uninsured.
> If the healthcare cost is zero or negligible the need for insurance is also zero. You just pay it out of pockets.
Tautologic, of course, the service insurance gives is precisely the individually unforeseeable cost of disease.
> The insurance company might want to lower their bills (when they do pay for your treatment), but they have a counter-incentive to health costs being lowered too much, and a positive incentive to get health costs higher for the uninsured.
The great enemy of insurance companies is direct-to-provider pay (and insurance one of the historically great political enemies of doctors as well). It's been unfortunately regulated from its inception, but its an intuitive proposition to say that insurance companies win by how efficiently they apply the actuarial model, and how they control the risks and the payouts. Insurance companies that pay more to providers and restrict less coverage of their patients will soon be out of business.
Tautologic, of course, the service insurance gives is precisely the individually unforeseeable cost of disease.
> The insurance company might want to lower their bills (when they do pay for your treatment), but they have a counter-incentive to health costs being lowered too much, and a positive incentive to get health costs higher for the uninsured.
The great enemy of insurance companies is direct-to-provider pay (and insurance one of the historically great political enemies of doctors as well). It's been unfortunately regulated from its inception, but its an intuitive proposition to say that insurance companies win by how efficiently they apply the actuarial model, and how they control the risks and the payouts. Insurance companies that pay more to providers and restrict less coverage of their patients will soon be out of business.
> Imagine there's a single, private, insurance company, A. ... Wouldn't the natural interest of A be to maximize health costs ... ?
Sure, but as an insurer they don't have any control over health care costs. They could bid prices up, I suppose, but that eats into their profits; such a strategy would cost them more than they could possibly gain.
> And if there were more smaller insurance companies competing with A, wouldn't it make sense for A to just eat them up to eliminate competition ... ?
The smaller companies would have to agree to that. Some of them could be co-ops or other organizations structured to represent their members and not interested in being bought out by a company which doesn't share the same principles.
> ... wouldn't it make sense for them to collude and keep prices and profits high?
Cartels are notoriously unstable. Every member has an incentive to cheat on the cartel to gain market share. And then you have the aforementioned co-ops and others who wouldn't be interested in joining the cartel.
> ... isn't it their natural interest to spend on buying politicians ... ?
And here we come to the real issue. Not that companies are interested in buying politicians—that's only to be expected, under the circumstances—but rather that (a) there exist politicians with the power to forcibly interfere in the market without being branded as criminals, and that (b) these politicians are willing to be bought and to support laws actively harmful to their nominal constituents.
In order to have a private market for either health care or health insurance you must first get the politicians out of the market.
Sure, but as an insurer they don't have any control over health care costs. They could bid prices up, I suppose, but that eats into their profits; such a strategy would cost them more than they could possibly gain.
> And if there were more smaller insurance companies competing with A, wouldn't it make sense for A to just eat them up to eliminate competition ... ?
The smaller companies would have to agree to that. Some of them could be co-ops or other organizations structured to represent their members and not interested in being bought out by a company which doesn't share the same principles.
> ... wouldn't it make sense for them to collude and keep prices and profits high?
Cartels are notoriously unstable. Every member has an incentive to cheat on the cartel to gain market share. And then you have the aforementioned co-ops and others who wouldn't be interested in joining the cartel.
> ... isn't it their natural interest to spend on buying politicians ... ?
And here we come to the real issue. Not that companies are interested in buying politicians—that's only to be expected, under the circumstances—but rather that (a) there exist politicians with the power to forcibly interfere in the market without being branded as criminals, and that (b) these politicians are willing to be bought and to support laws actively harmful to their nominal constituents.
In order to have a private market for either health care or health insurance you must first get the politicians out of the market.
>So then if it's supposedly more efficient, why do I waste multiple hours dealing with insurance bullshit literally every few months?
It's friction costs for splitting up the decision-making process into multiple entities. For any bill, the insurance company pays $X, the patient pays $Y, and the provider has $Z in costs. The $X that the insurance company pays is what they optimize for, not $Y and certainly not $Z. This has the side effect of somewhat optimizing $Z, since $Y is limited by how much money people have and if $Z is consistently bigger than $X + $Y, the healthcare provider loses money and goes out of business.
Honestly, the way to go is to treat the entire process as interaction with hostile bureaucracy. Document everything, and look like you'll generate a regulatory incident if you don't get what you're legally entitled to. Otherwise the insurance company will happily reduce their costs by offloading it onto you or the healthcare provider through pulling bullshit stunts.
It's friction costs for splitting up the decision-making process into multiple entities. For any bill, the insurance company pays $X, the patient pays $Y, and the provider has $Z in costs. The $X that the insurance company pays is what they optimize for, not $Y and certainly not $Z. This has the side effect of somewhat optimizing $Z, since $Y is limited by how much money people have and if $Z is consistently bigger than $X + $Y, the healthcare provider loses money and goes out of business.
Honestly, the way to go is to treat the entire process as interaction with hostile bureaucracy. Document everything, and look like you'll generate a regulatory incident if you don't get what you're legally entitled to. Otherwise the insurance company will happily reduce their costs by offloading it onto you or the healthcare provider through pulling bullshit stunts.
So you think if we paid more in taxes and turned all of it over to the government, the current level of beurocracy would decrease?
I’m about to graduate college and I just last week had to take an hour to learn insurance vocabulary to decide if I should go to a doctor for something. It’s disgusting how complicated it is now compared to how simple the concept of insurance initially was when it was created.
The insurance companies profit massively from the confusion they have created.
The insurance companies profit massively from the confusion they have created.
Ironically, indirect government interference.
The market is doing its job perfectly well maximizing the value defined by government constraints and influence (since govt is the largest payor).
The market is doing its job perfectly well maximizing the value defined by government constraints and influence (since govt is the largest payor).
The problem isn't the insurance, but the fact that your insurance is tied to your employer. There's reason health insurance should be treated like car, life, and home insurance. You shop for what you want and switch whenever you find something better. Unfortunately the current system is so ridiculous that most people think private insurance itself is the problem.
You can fund private insurance via taxes as well. That's not a limit to private market insurances.
But I tell you one thing that really affects why insurance sucks: that you get sweet tax exemptions if you get it through an employer, and to be an insurance that works through an employer you need to overcome massive regulatory hurdles.
Welcome to the world of regulatory capture.
But I tell you one thing that really affects why insurance sucks: that you get sweet tax exemptions if you get it through an employer, and to be an insurance that works through an employer you need to overcome massive regulatory hurdles.
Welcome to the world of regulatory capture.
I wonder if the increases in the gig economy (ride sharing, charging, food delivery) will lead to more people eligible to file these incomes as sole proprietorships, allowing them to deduct health insurance.
Even M4A includes removing the tax exemption. But it will not be popular when workers get a Marginal tax rate jump on their entire income.
That subsidy should die and healthcare should be finally decoupled from the employer. That would unleash massive market forces.
That subsidy should die and healthcare should be finally decoupled from the employer. That would unleash massive market forces.
Ask your employer to pay your benefits amount in salary. That way you don’t need to change insurance when changing jobs.
I've always heard that your benefits amount at a large organization is almost certainly not enough to pay for the same benefits as an individual, because companies get group rates that you can't get.
It’s also not taxed as a medical benefit. Also, companies have to maintain certain enrollment proportions to avoid non discrimination testing, and so allowing people to take cash in lieu wouldn’t work out for employer.
> If I could choose to just pay more in taxes
One of the fallacies in play is buying insurance is put in one category. Whereas paying taxes for insurance is another. The first is 'good' because it's 'free market' and the second is 'bad' because it's the government taking your money's.
One of the fallacies in play is buying insurance is put in one category. Whereas paying taxes for insurance is another. The first is 'good' because it's 'free market' and the second is 'bad' because it's the government taking your money's.
>One of the fallacies in play is buying insurance is put in one category. Whereas paying taxes for insurance is another. The first is 'good' because it's 'free market' and the second is 'bad' because it's the government taking your money's.
Well, I'm in favor of socialized healthcare and generally receptive to increased taxation, so that's definitely not the implication I was going for. But it is true that there doesn't need to be a categorical consideration at all. A more sound statement would be "I as a consumer am willing to pay dollars equal to twice my current premiums to get healthcare coverage while avoiding hassles while receiving routine healthcare"
In truth I'm not making a blanket argument for any government-run healthcare system because alleviating my pain points necessarily depends on said system being efficient and well implemented. But I KNOW that the free market isn't suddenly going to start improving on these pain points without introduction of regulations to manage issues like competing doctor networks, confusing healthcare coding and opaque pricing, etc, and I have no trust that the free market types in congress have any interest in regulations of any kind, so I personally err on the side of socialized healthcare on this one.
Well, I'm in favor of socialized healthcare and generally receptive to increased taxation, so that's definitely not the implication I was going for. But it is true that there doesn't need to be a categorical consideration at all. A more sound statement would be "I as a consumer am willing to pay dollars equal to twice my current premiums to get healthcare coverage while avoiding hassles while receiving routine healthcare"
In truth I'm not making a blanket argument for any government-run healthcare system because alleviating my pain points necessarily depends on said system being efficient and well implemented. But I KNOW that the free market isn't suddenly going to start improving on these pain points without introduction of regulations to manage issues like competing doctor networks, confusing healthcare coding and opaque pricing, etc, and I have no trust that the free market types in congress have any interest in regulations of any kind, so I personally err on the side of socialized healthcare on this one.
> A more sound statement would be "I as a consumer am willing to pay dollars equal to twice my current premiums to get healthcare coverage while avoiding hassles while receiving routine healthcare"
Ah, but are you willing to force everyone else pay twice as much so that you can get the health care you want? That's the real question. You said you were in favor of socialized healthcare, so I would guess the answer to that question is "yes", but let's at least be honest here—the private vs. public debate is never about how much you are willing to pay. Under a private system you're free to buy as much healthcare as you can afford. The point of socializing healthcare is making other people pay.
Ah, but are you willing to force everyone else pay twice as much so that you can get the health care you want? That's the real question. You said you were in favor of socialized healthcare, so I would guess the answer to that question is "yes", but let's at least be honest here—the private vs. public debate is never about how much you are willing to pay. Under a private system you're free to buy as much healthcare as you can afford. The point of socializing healthcare is making other people pay.
> generally receptive to increased taxation
Yes, that's the "making other people pay" part.
Right I guess you were being rhetorical then, I'm saying I'm okay with it
> are you willing to force everyone else pay twice as much
Comparisons to other (first-world) countries with socialized healthcare systems suggest that it shouldn't be necessary for everyone to pay twice as much. If everyone paid exactly the same amount as they currently do (in tax + insurance premiums) there should be plenty to fund a first-world-standard national health system.
> you're free to buy as much healthcare as you can afford
It's difficult to know what you can afford when you can't find out even an approximate price until it's over and the bill arrives.
Comparisons to other (first-world) countries with socialized healthcare systems suggest that it shouldn't be necessary for everyone to pay twice as much. If everyone paid exactly the same amount as they currently do (in tax + insurance premiums) there should be plenty to fund a first-world-standard national health system.
> you're free to buy as much healthcare as you can afford
It's difficult to know what you can afford when you can't find out even an approximate price until it's over and the bill arrives.
> If everyone paid exactly the same amount as they currently do (in tax + insurance premiums) there should be plenty to fund a first-world-standard national health system.
Right. Regardless of whether health care is paid for privately or via taxes, it's obvious that the problem isn't that we're not spending enough money.
> It's difficult to know what you can afford when you can't find out even an approximate price until it's over and the bill arrives.
I agree that prices and billing should be more transparent. It's crazy that they expect you to agree to pay whatever they might choose to bill, months or years after the fact, without even the courtesy of a binding estimate. I think a good argument could be made that these are not valid contracts and you should be able to walk away from them without penalty; they only get away with this sort of borderline-fraudulent behavior because the law grants health care providers special status. This situation is not improved by changing things so that health care providers don't even need your formal consent, or any interaction at all for that matter, to bill you via the IRS, with no contractual obligation on their part to provide any services whatsoever in return.
Right. Regardless of whether health care is paid for privately or via taxes, it's obvious that the problem isn't that we're not spending enough money.
> It's difficult to know what you can afford when you can't find out even an approximate price until it's over and the bill arrives.
I agree that prices and billing should be more transparent. It's crazy that they expect you to agree to pay whatever they might choose to bill, months or years after the fact, without even the courtesy of a binding estimate. I think a good argument could be made that these are not valid contracts and you should be able to walk away from them without penalty; they only get away with this sort of borderline-fraudulent behavior because the law grants health care providers special status. This situation is not improved by changing things so that health care providers don't even need your formal consent, or any interaction at all for that matter, to bill you via the IRS, with no contractual obligation on their part to provide any services whatsoever in return.
> The point of socializing healthcare is making other people pay.
Yes. Especially you personally. Honestly, I don't even care about socialized healthcare as long as your tax rate is > 90%. Think of it as a "stupid libertarian tax".
I think most people will be in support of this measure, as hopefully it will force you to work so hard you don't have time to make inane internet comments.
Yes. Especially you personally. Honestly, I don't even care about socialized healthcare as long as your tax rate is > 90%. Think of it as a "stupid libertarian tax".
I think most people will be in support of this measure, as hopefully it will force you to work so hard you don't have time to make inane internet comments.
What I don't get is why do you think paying 2k to a private insurance is any worse than 2k to the state.
Because the private insurance company is incentivized to optimize for profits and the state is incentivized to optimize for a healthy population.
> the state is incentivized to optimize for a healthy population.
The state is incentivized to be a political boon for politicians, not to give "healthy outcomes".
The state is incentivized to be a political boon for politicians, not to give "healthy outcomes".
> Etc cetera. There's no end to the nuisance. If I could choose to just pay more in taxes (hell I'll pay way more than my current premiums) and never deal with insurance again, I would do it in a heartbeat.
If you have a high deductible, you already chose to pay less. Revealed preferences and all that.
If you have a high deductible, you already chose to pay less. Revealed preferences and all that.
I'm not sure I follow your logic.
You can choose to have less insurance hassle by choosing a more expensive insurance plan where you don't haggle for the deductible.
Sorry what do you mean haggle? This is just one of the 3 plans offered by my employer where the deductible is much bigger and the premium is lower. I did need to open a savings account but I figured that would make things easier to pay, idk haven't used it. Otherwise my behavior as a consumer has been identical. maybe I'm missing something
If your employer has a low deductible plan with a higher premium your insurance coverage issues will be a lot lower (as you could eat the copay cost instead of negotiating).
what negotiation are you talking about?
Capitalism as it exists today in the US (and other parts of the world) is a paperclip optimizer. The pressure is for those with power to leverage that power toward their maximum short term financial benefit. One consequence of this is that health care has essentially been parasitized by profit seekers who extract money from the system as if it were a strip mine. You can easily see the impact of this in the gross statistics in the form of the extremely high spending on health care in the US vs. comparatively poor return on that spending in terms of overall health outcomes. This is a corrupt system which today produces health care only as a side effect of its main purpose of wealth extraction. That is a natural consequence of our culture, economic incentives, etc. combined with the vast power imbalances between health care "providers" (hospitals, drug makers, device makers, etc.), insurance companies, employers, and individuals. There's no such thing as a patients or insurance holder union, the imbalance is enormous and there's very very little to tip it back from being dominated by the interests of the powerful.
>>> This can be done via taxes but insurance is a private market solution which should in theory make it more efficient for the sake of maximizing profit.
In reality, it's less efficient.
In reality, it's less efficient.
Efficient? For who and what purpose? Its efficient for insurance companies, and for the purpose of making money. What do you expect? Any consumer friendliness comes from regulation.
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When I quit my job in SF in November 2017, I had $1200 on my FSA. When I switched to COBRA, my FSA account kept its balance, but my VISA card associated with it immediately and unexpectedly stopped working. I was seeing a psychologist at the time and it was awkward when I didn’t pay him right away because I thought it would be fine to try and fix my card and pay him the next day (which I did). It felt awkward enough to me that I stopped my therapy sessions with him, because I felt like it had become strained. Anyway, the company stopping my card from working was intentional. It was the same company and the same account but my card didn’t work anymore and I had to go through the trouble to submit a claim, and they acted like this was by design that my FSA card would stop working when I quit and switched to COBRA.
Now I’m working remotely and am in a new state (Florida) and not sure I’ll stay here long enough to switch everything to this state. I needed to get a fever checked out and ended up paying out of pocket because I was told over the phone that they accepted my out of state insurance, but when I got there in person, they didn’t.
What a mess.
Now I’m working remotely and am in a new state (Florida) and not sure I’ll stay here long enough to switch everything to this state. I needed to get a fever checked out and ended up paying out of pocket because I was told over the phone that they accepted my out of state insurance, but when I got there in person, they didn’t.
What a mess.
Health insurance in the United States is a shit show. The Medicare for all that Bernie is proposing is a reaction to the inability of Congress to meaningfully fix the issue.
I personally would prefer a market based approach to fixing the issues with obtaining medical care, but Congress can't do anything because there's just too much money and influence involved.
I personally would prefer a market based approach to fixing the issues with obtaining medical care, but Congress can't do anything because there's just too much money and influence involved.
Italy has a thriving market based private health care industry. You can call in and get prices and everything.
Just that it's in addition to the single payer system, which means the private one is cheap because the competition is 'free'.
As a % of GDP, Italy spends a lot less than the US in health care, and people live long and productive lives.
I mention Italy because 1) I lived there and 2) it's not some perfectly run place where everything works. It's not, and yet the health care is still better, overall, than in the US.
Just that it's in addition to the single payer system, which means the private one is cheap because the competition is 'free'.
As a % of GDP, Italy spends a lot less than the US in health care, and people live long and productive lives.
I mention Italy because 1) I lived there and 2) it's not some perfectly run place where everything works. It's not, and yet the health care is still better, overall, than in the US.
All other first world nations pay less. On average they pay less than half what the US pays. The fully socialized systems, like the UK, seem to trend lower in cost, as low as one third the cost of the US. But really, the takeaway should be you need universal healthcare with significant government cost controls on drugs and procedures, after that almost any arrangement of public/private administration works (but the caveat that it looks like the more private companies are in the healthcare mix, the higher the costs seem to run).
> the more private companies are in the healthcare mix, the higher the costs seem to run
One worrying thing about single-payer healthcare in America is that we can look at other countries with a _rich history_ of single-payer healthcare from before the modern era [0] and see that they have developed efficient public healthcare systems, but it does not follow that our system, with its similarly rich history of for-profit entities developing methods to thrive in the weird world of American health insurance, can be immediately brought to a level of cost efficiency that is comparable. Consider, for instance, how much ownership of the healthcare space is held by private equity firms in the U.S. I'd love to see a great transition plan towards single payer, but it would need to be one that takes into account that the operators have no inherent incentive to reduce costs.
[0] http://www.euro.who.int/__data/assets/pdf_file/0020/96410/E7...
One worrying thing about single-payer healthcare in America is that we can look at other countries with a _rich history_ of single-payer healthcare from before the modern era [0] and see that they have developed efficient public healthcare systems, but it does not follow that our system, with its similarly rich history of for-profit entities developing methods to thrive in the weird world of American health insurance, can be immediately brought to a level of cost efficiency that is comparable. Consider, for instance, how much ownership of the healthcare space is held by private equity firms in the U.S. I'd love to see a great transition plan towards single payer, but it would need to be one that takes into account that the operators have no inherent incentive to reduce costs.
[0] http://www.euro.who.int/__data/assets/pdf_file/0020/96410/E7...
Medicare for all plans a two year transition. There are already mechanisms to expand to set payment costs for procedures in Medicare. We would have to extend those to cover a system of setting fairer prices for drugs - as medicare is legally prohibited from negotiating drug prices currently. That's a legal precedent, not a cultural one.
But basically, future history begins today. I don't see why because we historically have an ineffective system, we shouldn't strive to build a working system.
But basically, future history begins today. I don't see why because we historically have an ineffective system, we shouldn't strive to build a working system.
It might be hard to find... unless you take a gander up north, Canadian public health care is a recent thing and the transition was flow and began with regional efforts. This[1] is a nice little rough timeline of things that happened. And, to be honest, it's not done yet, Canada lacks national pharma coverage (most places having provincial coverage of a sort) and entirely lacks dental & vision coverage, the later is a bit arguable but poor dental care has been strongly linked to heart disease.
[1] https://www.healthcoalition.ca/tools-and-resources/history-o...
[1] https://www.healthcoalition.ca/tools-and-resources/history-o...
The Economist did a nice comparison of different systems a few years back:
https://www.economist.com/united-states/2017/08/10/the-fix-f...
https://www.economist.com/united-states/2017/08/10/the-fix-f...
Similarly, a Frontline episode:
https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
An excellent book on the subject ("The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care"):
https://www.amazon.com/Healing-America-Global-Better-Cheaper...
And a comparison by The Commonwealth Fund:
http://international.commonwealthfund.org/
And just a reminder how long the U.S. has been having this argument:
https://en.wikipedia.org/wiki/Clinton_health_care_plan_of_19...
And a quote from that page:
The long-term political effects of a successful... health care bill will be even worse—much worse.... It will revive the reputation of... Democrats as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.
— William Kristol, "Defeating President Clinton's Healthcare Proposal", December 1993
https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
An excellent book on the subject ("The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care"):
https://www.amazon.com/Healing-America-Global-Better-Cheaper...
And a comparison by The Commonwealth Fund:
http://international.commonwealthfund.org/
And just a reminder how long the U.S. has been having this argument:
https://en.wikipedia.org/wiki/Clinton_health_care_plan_of_19...
And a quote from that page:
The long-term political effects of a successful... health care bill will be even worse—much worse.... It will revive the reputation of... Democrats as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.
— William Kristol, "Defeating President Clinton's Healthcare Proposal", December 1993
Without the U.S. subsidizing the drug research R&D, who pays for it?
You could fill notebooks with worthy, approachable hypotheses for any number of diseases that could show promise if given the funding.
But if everyone makes it law to cap prices - fewer scientists, labs, studies are performed.
The money has to come from somewhere.
I think countries take for granted the progress we've made. No progress is made without incredible intellectual efforts and monetary backings.
You could fill notebooks with worthy, approachable hypotheses for any number of diseases that could show promise if given the funding.
But if everyone makes it law to cap prices - fewer scientists, labs, studies are performed.
The money has to come from somewhere.
I think countries take for granted the progress we've made. No progress is made without incredible intellectual efforts and monetary backings.
This paper gives pretty interesting breakdown of how private companies are increasingly bad at paying for it.
https://www.ucl.ac.uk/bartlett/public-purpose/sites/public-p...
One quote from the paper: In the last ten years, Pizer has spent US$139 billion on share buybacks and dividends compared to US$82 billion on R&D.
Edit: It shouldn't require massive profit margins to make the drug industry work for a basic human need like healthcare. Other sectors for human basics like the grocery industry, run on margins of 1-5%.
https://www.ucl.ac.uk/bartlett/public-purpose/sites/public-p...
One quote from the paper: In the last ten years, Pizer has spent US$139 billion on share buybacks and dividends compared to US$82 billion on R&D.
Edit: It shouldn't require massive profit margins to make the drug industry work for a basic human need like healthcare. Other sectors for human basics like the grocery industry, run on margins of 1-5%.
Food production is predictable. Finding a safe, effective treatment for Alzheimer’s is not.
If you want thin margins, maybe government research wing can take its findings from idea to market (imagine waiting on a cure and that’s your only hope?)
But you can’t force a private company to operate on low margins by way of capping prices, you’ll kill them. You can’t taje away their ability to control their risks (cash flow). Drug R&D already has a huge failure rate and now the company can only take a 5% profit on the slight chance they’ve found something effective?
If you want thin margins, maybe government research wing can take its findings from idea to market (imagine waiting on a cure and that’s your only hope?)
But you can’t force a private company to operate on low margins by way of capping prices, you’ll kill them. You can’t taje away their ability to control their risks (cash flow). Drug R&D already has a huge failure rate and now the company can only take a 5% profit on the slight chance they’ve found something effective?
If you look at the paper, private drug discovery is creating drugs at a declining rate. I would suggest this is because those private efforts are much less research than development, and it's actually the public system that drives much fundamental research. And the drugs to market rate is in serious decline because of a the widespread application of increasingly austure public funding budgets for medical research causing an early pipeline bottleneck.
When you dump a link to a 60 page pdf and you’re going to reference it, please list the page number and/graph you’re referring to. I don’t want to guess.
Sorry, Fig 1, page 15 is the data on drugs discovered per billion. Table 1, pg 18 shows some sample breakdowns of drug investments broken down between basic research and commercial development.
I don't necessarily subscribe to everything in that report, but I do think that modeling drug development in terms of a simple risk-reward model for the private drug industry needs further thought.
I don't necessarily subscribe to everything in that report, but I do think that modeling drug development in terms of a simple risk-reward model for the private drug industry needs further thought.
Does the "huge margins of the healthcare industry" include all the money spent on failed pharma startups? If you spend $1bn on a drug then make $1bn profit but the other 9 drugs failed (after someone having spent $1bn for each) the margin isn't 100%, it's 10%.
Ha!
This is a silly talking point that lots of companies bounce around - you know how insulin costs money because it was so expensive to develop... Except no, it was invented in Canada and the researchers released the formula for free[1] as a "benefit to humanity" thing... then a few US companies acquired rights to produce it and proceeded to establish market control in the US - the fact that insulin isn't being sold at cost is just pure greed.
And this happens a lot, very often drugs are innovated using public funds and then sold to private companies to produce which milk the consumers for profit - this whole "it pays for R&D" is a pharmaceutical PR line, just like when McDonalds buried their hot coffee lawsuit under "well, if people weren't such klutzes". The US isn't the great innovator here to save us all and a huge proportion of your drug prices cycles back into marketing to sell more of the drug.
[1] Technically, they sold it for a dollar to the University of Toronto
This is a silly talking point that lots of companies bounce around - you know how insulin costs money because it was so expensive to develop... Except no, it was invented in Canada and the researchers released the formula for free[1] as a "benefit to humanity" thing... then a few US companies acquired rights to produce it and proceeded to establish market control in the US - the fact that insulin isn't being sold at cost is just pure greed.
And this happens a lot, very often drugs are innovated using public funds and then sold to private companies to produce which milk the consumers for profit - this whole "it pays for R&D" is a pharmaceutical PR line, just like when McDonalds buried their hot coffee lawsuit under "well, if people weren't such klutzes". The US isn't the great innovator here to save us all and a huge proportion of your drug prices cycles back into marketing to sell more of the drug.
[1] Technically, they sold it for a dollar to the University of Toronto
Of course it does. Because people don’t buy and use the drug if they don’t know about it..?
Money matters. Marketing to recoup costs matters. Piles of cash to get every dollar of return on an investment matters. That allows the company to turn around and invest in future promising drugs, trials, other companies, marketing to bring awareness to the solution and hopefully get people to buy and use it.
Money matters. Marketing to recoup costs matters. Piles of cash to get every dollar of return on an investment matters. That allows the company to turn around and invest in future promising drugs, trials, other companies, marketing to bring awareness to the solution and hopefully get people to buy and use it.
Making sure doctors are well informed about treatment options are one thing... egging patients on to request a possibly mismatched medication and taking doctors out to lunch to encourage the prescription of a possibly mismatched medication is entirely different.
The ideal case for drugs is that no one actually needs them so no one takes them - this is a large contributor as to why this market should be heavily nationalized.
The ideal case for drugs is that no one actually needs them so no one takes them - this is a large contributor as to why this market should be heavily nationalized.
The patient can egg on all they want - it’s still the doctor’s (expert) decision whether to prescribe.
And as an informed patient, I want to know my options. My doctor and I will discuss trade offs, he’ll sign off if he thinks it’s appropriate.
And as an informed patient, I want to know my options. My doctor and I will discuss trade offs, he’ll sign off if he thinks it’s appropriate.
Unless someone has a medical degree they're not an informed patient - they're someone who has been fed information through pharma PR campaigns to believe they're informed about a topic while only knowing information that would contribute to a private corporation's profit.
It is amazingly difficult to find good balanced information on prescriptions in the US - even doctors have issues.
It is amazingly difficult to find good balanced information on prescriptions in the US - even doctors have issues.
Please do not protect me from myself.
Especially in the case of if/when my life is on the line, I want to know about my options. I'd much rather have information overload, than be blind.
And between my doctor and I, we will discern what is a real option, what is BS, and what tradeoffs I am willing to make in an effort to extend my life.
Stop being The Great Protector.
Especially in the case of if/when my life is on the line, I want to know about my options. I'd much rather have information overload, than be blind.
And between my doctor and I, we will discern what is a real option, what is BS, and what tradeoffs I am willing to make in an effort to extend my life.
Stop being The Great Protector.
Using that argument millions of Americans have refused to let their children be vaccinated because they know more about medicine - even themselves. If your medical decision will endanger others it is a matter for The Great Protector, and, it's my opinion, that the great American habit of second guessing experts is what has let groups that oppose vaccinations, a round earth and the dangers of CO2 infiltrate modern society at such a large level.
Considering cancer, heart disease, or dementia aren't contagious, my individual treatment decision does not threaten those surrounding me.
I want to know as much as possible about treatments, their side effects, and tradeoffs. And if I partially learn about those items from a commercial, who cares? I want more time with my friends and family. I don't care about the source of a potential solution.
And the doctor can still elect to not provide the medication. The treatment decision is expertly gated, regardless of my wishes or insistence that "I know better".
I want to know as much as possible about treatments, their side effects, and tradeoffs. And if I partially learn about those items from a commercial, who cares? I want more time with my friends and family. I don't care about the source of a potential solution.
And the doctor can still elect to not provide the medication. The treatment decision is expertly gated, regardless of my wishes or insistence that "I know better".
I'll admit I have no evidence advertising to patients increases drug sales. But, considering how often I see drug commercials on television explicitly targeting patients, it seems the drug companies have evidence it works.
Isn't the R&D money for scientists and labs coming from the US government?
business drug R&D follows the "which drug patents can we buy and Jack the prices up for extra profit?"
business drug R&D follows the "which drug patents can we buy and Jack the prices up for extra profit?"
> Without the U.S. subsidizing the drug research R&D, who pays for it?
I wish we could stop using this tired trope once and for all in debates about medical care.
Most medical care is routine and does not require cutting edge drugs. Things like insulin, epinephrine, anesthetics, antibiotics, antihistamines, vaccines, most of those things have been developed in the 1st half of the 20th century.
How much do the cutting age drugs account for in the scope of the total health care costs in the US? Even if it was higher than 1% (I'm willing to bet money that it isn't), the marketing budgets for drug companies far exceed their R&D spending.
I wish we could stop using this tired trope once and for all in debates about medical care.
Most medical care is routine and does not require cutting edge drugs. Things like insulin, epinephrine, anesthetics, antibiotics, antihistamines, vaccines, most of those things have been developed in the 1st half of the 20th century.
How much do the cutting age drugs account for in the scope of the total health care costs in the US? Even if it was higher than 1% (I'm willing to bet money that it isn't), the marketing budgets for drug companies far exceed their R&D spending.
i'm keen on the idea that such a model of a government entity (or two) in competition with an open market would provide the most favorable outcome, because a truly free and fair market (one where competition leads to efficiency and low prices) seems mythically distant at this point.
government entities can get subsumed by politics and bureaucracy, while private markets can get distorted by poor regulations and anti-competitive practices. if bureaucrats can get thrown out for not being competitive with the private companies, and private companies can go out of business for not being efficient and serving customers well, we might get decent service-oriented entities in the market.
many goods that don't fit the simple paradigm of commerce (e.g., housing) can benefit from such a model.
government entities can get subsumed by politics and bureaucracy, while private markets can get distorted by poor regulations and anti-competitive practices. if bureaucrats can get thrown out for not being competitive with the private companies, and private companies can go out of business for not being efficient and serving customers well, we might get decent service-oriented entities in the market.
many goods that don't fit the simple paradigm of commerce (e.g., housing) can benefit from such a model.
> a government entity (or two) in competition with an open market
Meaningful competition cannot exist between tax-funded and voluntarily-funded service providers. Anyone who chooses the private provider ends up paying for both. The only way to ensure a level playing field is for the "government" entity to be limited to essentially a co-op, receiving no government funding or special influence and adhering to all the same rules which apply to private providers, in which case it might as well not be a government entity in the first place. Even then there is an obvious conflict of interest since the organization that makes and enforces the rules is also backing one of the competitors.
Meaningful competition cannot exist between tax-funded and voluntarily-funded service providers. Anyone who chooses the private provider ends up paying for both. The only way to ensure a level playing field is for the "government" entity to be limited to essentially a co-op, receiving no government funding or special influence and adhering to all the same rules which apply to private providers, in which case it might as well not be a government entity in the first place. Even then there is an obvious conflict of interest since the organization that makes and enforces the rules is also backing one of the competitors.
> politics and bureaucracy
Health care was way less bureaucratic in Italy. Every time you go to the doctor in the US, you fill out forms. And then hand them to the person in the office who spends their days doing insurance stuff.
In Italy - you just go to the doctor.
Health care was way less bureaucratic in Italy. Every time you go to the doctor in the US, you fill out forms. And then hand them to the person in the office who spends their days doing insurance stuff.
In Italy - you just go to the doctor.
> Just that it's in addition to the single payer system, which means the private one is cheap because the competition is 'free'
Eek. This is also called crowding out. It means expensive but efficient health services can't survive. It might be a decent compromise but I would call it a success.
Eek. This is also called crowding out. It means expensive but efficient health services can't survive. It might be a decent compromise but I would call it a success.
There's no market based approach that can "fix" healthcare. Market self regulates around substitute goods, but healthcare is in the business of health and there's no substitute for that. Very few humans will say "all considered, the ROI/statistical likelhood of this procedure is not positive so I will pick death instead", it just doesn't happen. Single payer is the only way to go.
Even with single payer, there's a large thriving market. Vendors, suppliers, manufacturers, contractors, auditors, etc. Bandages need to be made, hospitals need to be cleaned, nurses need to be trained, etc.
You can make things and get paid in a non-market economy like the one connected to single payer healthcare. What you don't get is maximization of profits.
> but healthcare is in the business of health and there's no substitute for that
There's plenty of substitutes, and there are plenty of things that have little to no substitutes and don't have these issues (food, clothing..housing does have some of the same issues).
Healthcare is a mess because it is the most regulated market there is.
There's plenty of substitutes, and there are plenty of things that have little to no substitutes and don't have these issues (food, clothing..housing does have some of the same issues).
Healthcare is a mess because it is the most regulated market there is.
I don't think you understand what I said.
Correct me if I'm wrong:
luckydata: there is no substitute to healthcare services, so whatever you need in healthcare, whoever provides service has absolute leverage to charge whatever they want.
response: there are plenty of substitute effects in healthcare as you can deny getting treatment, or choose cheaper treatments. Moreover, even if you had no substitute effect possible, there are also other examples of markets with "no substitute effects" like food or clothing, but there is no gouging. It is a characteristic of the market but on itself is does not guarantee gouging unless other conditions are met, most typically mononopolies, and most typically gov. granted ones.
luckydata: there is no substitute to healthcare services, so whatever you need in healthcare, whoever provides service has absolute leverage to charge whatever they want.
response: there are plenty of substitute effects in healthcare as you can deny getting treatment, or choose cheaper treatments. Moreover, even if you had no substitute effect possible, there are also other examples of markets with "no substitute effects" like food or clothing, but there is no gouging. It is a characteristic of the market but on itself is does not guarantee gouging unless other conditions are met, most typically mononopolies, and most typically gov. granted ones.
The insurance companies have had years (decades?) to come up with one.
Instead they've invested in lobbying to keep the status quo.
Instead they've invested in lobbying to keep the status quo.
All the inefficiencies are either profit or jobs for them. US health insurance companies are the worst bureaucracies I have ever seen. They have power over people's lives and almost zero accountability. They can do pretty much whatever they want and you are helpless if you can't afford the time and money to constantly call them or hire lawyers.
It mostly benefits big businesses to have employer based insurance.
He who pays the piper calls the tune [0].
[0] https://www.merriam-webster.com/dictionary/he%20who%20pays%2...
[0] https://www.merriam-webster.com/dictionary/he%20who%20pays%2...
I'm not too sure about that. It has signficant costs for business to run these programs. And when companies get large enough they self-insure.
One honest question: if you believe the system as it is, is broken because of lobbying, why would a socialized medicine system be immune to lobbying?
> The Medicare for all that Bernie is proposing is a reaction to the inability of Congress to meaningfully fix the issue.
Wouldn't expanding Medicare to all also require an act of Congress? Bernie will have the influence of the White House, which is important, but it doesn't change the fact that Congress is still the body that would need to fix this.
I've always felt like the Affordable Care Act was a bandaid almost designed to point out the breaking points in the existing system, and force something like Medicare for All, to come along and "fix" the situation permanently.
Wouldn't expanding Medicare to all also require an act of Congress? Bernie will have the influence of the White House, which is important, but it doesn't change the fact that Congress is still the body that would need to fix this.
I've always felt like the Affordable Care Act was a bandaid almost designed to point out the breaking points in the existing system, and force something like Medicare for All, to come along and "fix" the situation permanently.
> ... inability of Congress to meaningfully fix the issue.
They'll never fix it. As long as there is a mentality that the poor are poor because they make bad life choices and thus should receive as little support as possible as a punishment, nothing will change because any change that would give everyone basic healthcare would also mean helping the poor.
They'll never fix it. As long as there is a mentality that the poor are poor because they make bad life choices and thus should receive as little support as possible as a punishment, nothing will change because any change that would give everyone basic healthcare would also mean helping the poor.
If Bernie wins running with it as his primary issue, it’s a lot easier to get Congress on board.
Its definitely a boon for the cause, but I would be surprised if it passed the senate.
OTOH I dont even get how it could be in the table to bankrupt an entire market without compensation. Can the state really just outlaw all private insurances?
OTOH I dont even get how it could be in the table to bankrupt an entire market without compensation. Can the state really just outlaw all private insurances?
After Obama ran on hope and change and won, one thing he did was shut down his very capable campaign organization without transitioning it to something else. It was maybe one tactical reason that later midterms became a mess for Democrats.
It's pretty clear the Bernie's organization, as well as the loose independent collective of progressive organizations around similar national and local causes who have also sprung up, will continue full bore to change congress as well as keep pressure on congress to make, well, progress.
It's pretty clear the Bernie's organization, as well as the loose independent collective of progressive organizations around similar national and local causes who have also sprung up, will continue full bore to change congress as well as keep pressure on congress to make, well, progress.
> as well as the loose independent collective of progressive organizations around similar national and local causes who have also sprung up,
The problem being that none of their candidates won competitive seats. Now, some like Kara Eastman came close..but candidates closer to the Obama/Hillary mold, veterans, and pro-gun control candidates in suburbs made up the bulk of the wins in the midterms.
The problem being that none of their candidates won competitive seats. Now, some like Kara Eastman came close..but candidates closer to the Obama/Hillary mold, veterans, and pro-gun control candidates in suburbs made up the bulk of the wins in the midterms.
I doubt your data. Just one counter example, in Orange County CA, Katie Porter, a democrat, won a competitive seat in a district that has been Republican for a long time (maybe 30+ years?).
From what I understand, she wasn't endorsed by Our Revolution (I'm strictly talking about the Bernie-aligned groups). She was endorsed by lots of other progressive groups that are more effective at this sort of thing.
On the other hand, people like Kendra Horn flipped deep-red Oklahoma 5th with help of Bloomberg's Independence PAC, and Sharice Davids beat Bernie-backed Brent Welder in the primary to win the general by 10 points in a swing district.
On the other hand, people like Kendra Horn flipped deep-red Oklahoma 5th with help of Bloomberg's Independence PAC, and Sharice Davids beat Bernie-backed Brent Welder in the primary to win the general by 10 points in a swing district.
Does it matter if it's a Bernie aligned group? In CA-25, Our revolution endorsed one candidate, Justice Democrats another candidate, and a third Democratic candidate actually won yet another historically Republican district. They were helped (but not endorsed) by also progressive, but not as closely aligned to Bernie, Indivisible, by loose Bernie inspired independents, etc. I think it's a mistake to only look at strict boundaries of support by candidate name. I would consider CA-25s win with Katie Hill another progressive win in an contentious district.
"After Obama ran on hope and change and won,"
My theory is that presidents should try to make big changes only in their second term when they understand how the system works. Obama in his first term was a complete pushover with the banks after 2008 and also during the Obamacare debate. I think he would have done much better in his second term.
My theory is that presidents should try to make big changes only in their second term when they understand how the system works. Obama in his first term was a complete pushover with the banks after 2008 and also during the Obamacare debate. I think he would have done much better in his second term.
I don't mean this to be snarky, but if what you are saying is true (Congress can't do anything), why do you think the governmental disfunction will not carry over to an expanded medicare-for-all program? Medicare is not without issue and is wrought with fraud that needs decisive congressional action to help fix, yet they have shown inability there as well.
using the word 'inability' is obfuscating the issue. they are actively working against it.
One of the fundamental reasons why I haven't really bothered doing startups or running a small business myself is the radical uncertainty over health insurance for myself and my family. It's not just plain $$$ and career risk, it's the "suppose you will go bankrupt and your family has permanent medical issues now" risk. That game is for the wealthy or healthy single people
In addition, each insurance plan has slightly different doctors that sign on, so when there are changes, you might wind up needing to use different doctors or worse, health systems.
It'd be much better for me, personally, to require providers to all accept some US Public Single Payer plan (or whatever you call it) as part of opening a practice and seeing patients.
(I don't speak in any sense for my employer, who is in the health care space: this is just an engineer's personal musings)
In addition, each insurance plan has slightly different doctors that sign on, so when there are changes, you might wind up needing to use different doctors or worse, health systems.
It'd be much better for me, personally, to require providers to all accept some US Public Single Payer plan (or whatever you call it) as part of opening a practice and seeing patients.
(I don't speak in any sense for my employer, who is in the health care space: this is just an engineer's personal musings)
> One of the fundamental reasons why I haven't really bothered doing startups or running a small business myself is the radical uncertainty over health insurance for myself and my family.
I joined a startup once, but it was in Europe, so these issues weren't even on my radar or the company's radar. With government healthcare and government unemployment insurance, it's a no-brainer. The only risk is to your lifetime earning potential. Stay at a solid job with a solid salary, or take a shot at the startup lottery. Your health or your family or your home are just never on the line by taking that risk.
The amount of time and worry you have to spend on healthcare for yourself and your family in the US is absolutely off the charts, and this cost is completely hidden! Time that companies have to spend on acquiring healthcare insurance for their employees is wasted time. Time that employees have to spend on researching the insurance options their company is offering them is wasted time. Time that you spend dealing with healthcare providers to ensure that you're covered by your insurance is wasted time.
In Europe the time spent on this is, for the most part, 0. Companies don't spend time on this. Employees don't spend time on this. But noone in the US seems to regard this waste, this cost, as something fixable. Noone seems to think of the competitive edge this gives EU companies, or want to have the same competitive edge. Why? Why are US companies and US employees just completely resigned to the thought that healthcare just is a massive necessary headache for everyone?
I joined a startup once, but it was in Europe, so these issues weren't even on my radar or the company's radar. With government healthcare and government unemployment insurance, it's a no-brainer. The only risk is to your lifetime earning potential. Stay at a solid job with a solid salary, or take a shot at the startup lottery. Your health or your family or your home are just never on the line by taking that risk.
The amount of time and worry you have to spend on healthcare for yourself and your family in the US is absolutely off the charts, and this cost is completely hidden! Time that companies have to spend on acquiring healthcare insurance for their employees is wasted time. Time that employees have to spend on researching the insurance options their company is offering them is wasted time. Time that you spend dealing with healthcare providers to ensure that you're covered by your insurance is wasted time.
In Europe the time spent on this is, for the most part, 0. Companies don't spend time on this. Employees don't spend time on this. But noone in the US seems to regard this waste, this cost, as something fixable. Noone seems to think of the competitive edge this gives EU companies, or want to have the same competitive edge. Why? Why are US companies and US employees just completely resigned to the thought that healthcare just is a massive necessary headache for everyone?
And yet the US is still way more entrepreneurial.
This is also the reason why I've never looked seriously into starting a company. I wonder how many jobs would almost instantly be created in the US if this factor of uncertainty was lifted.
I think you'd see a bump upwards, followed by a slow fall downwards as people realize that there's a hell of a lot more to running a small business than just healthcare costs.
There's no shortage of morons staring businesses doomed to fail in our current system. This would just put self employment in reach for millions.
When I worked for a startup, they were affiliated with a "professional employer organization", which allowed access to major PPO and HMO insurance plans, and also handled some of the payroll obligations.
When I was young, my dad started a small business around the same time my mom stopped being a stay at home mom and finished her education at the local community college to pursue a nursing career. I learned later one of the main motivations for her career was that it allowed my parents to have a good healthcare plan for the family under her employer.
Employer sponsored health insurance is an outpost of neofeudalism. Swear your fealty to a lord or go without.
Employee sponsored health insurance is a result of "centrally planned" economics - https://www.nytimes.com/2017/09/05/upshot/the-real-reason-th... ... it has nothing to do with feudalism or even what employers wanted, but has a lot more to do with government officials who thought they could design an economy.
The reasons things start, and the reasons they persist, are often quite different.
The US doesn't seem to have subscribed to strongly-cenralised economic policy for nearly 70 years. And yet the employer-feudal healthcare system continues.
Preponderance of evidence suggests that dominant economic, financial, and power structures prefer it that way.
The origin story is an interesting footnote, no more.
The US doesn't seem to have subscribed to strongly-cenralised economic policy for nearly 70 years. And yet the employer-feudal healthcare system continues.
Preponderance of evidence suggests that dominant economic, financial, and power structures prefer it that way.
The origin story is an interesting footnote, no more.
While it's true the reason things start and persist are different, many would disagree about the level of central planning in the US, with healthcare being an example odd where there is a good deal of government control (everything from pricing of procedures, drug approval, and licensing to name a few). Whether that's a good thing is another question, but I think it's oversimplifying to conclude that the problem is all due to corporate feudal overlords and not at all due to government policy. Further, there is a lesson to be learned concerning unanticipated co sequences in the origin of the current system that we're in danger of repeating by having further government control of healthcare.
Yes. And it was made even worse by the ACA which effectively required employers to be feudal lords, whether they wanted to or not.
Before, the possibility of sane choose-my-health-insurance-like-I-choose-my-car-insurance was at least on the table.
Before, the possibility of sane choose-my-health-insurance-like-I-choose-my-car-insurance was at least on the table.
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The fundamental problem is no body knows the cost of anything beforehand. Neither insurance company not doctors tell the cost of the care. Its really frustrating ! The first step to fix the problem is getting the cost of the care transparently. Without this i am not sure how any of the scheme works whether it is done by govt or private insurance companies !
This also translates to the cost for labor. How much your company is paying for insurance seems to have little correlation to how good your insurance is, so Company A could be paying an extra $5k per employee because they don't have a good HR department.
It also means that every job offer has to be examined not only for salary and culture, which are usually pretty easy to see; but also benefits cost. I've had offers that were an over 20% raise which would have all been eaten by insurance costs. I've looked at my "benefits cost breakdown" at similar companies only to see that one is paying $90k for me and one is only paying $70k, on similar salaries of around $60k.
These insurance costs are not something usually shared outside the company, and they are hard to get until the last stages of your job offer.
It also means that every job offer has to be examined not only for salary and culture, which are usually pretty easy to see; but also benefits cost. I've had offers that were an over 20% raise which would have all been eaten by insurance costs. I've looked at my "benefits cost breakdown" at similar companies only to see that one is paying $90k for me and one is only paying $70k, on similar salaries of around $60k.
These insurance costs are not something usually shared outside the company, and they are hard to get until the last stages of your job offer.
I think the problem is that hospitals can use the price of procedures as a bargaining chip. They can jack up the price for the uninsured (on paper) then lower it if they're actually going to bill a person. Then they take the jacked up number and use it to negotiate with insurance companies, and insurance companies can likewise point to the number and say "look what will become if you if you don't stick with us!"
The first step should be disallowing this negotiation. That should massively lower the on-paper prices, or let insurance companies at least make the tough decisions about what procedures are actually worth it, which is supposed to be one of their functions anyway. If that isn't their function, I'm not sure what their function is.
The first step should be disallowing this negotiation. That should massively lower the on-paper prices, or let insurance companies at least make the tough decisions about what procedures are actually worth it, which is supposed to be one of their functions anyway. If that isn't their function, I'm not sure what their function is.
There is no single cost. It depends entirely on who asks, which is why you cannot get an answer beforehand.
it's a shit show. I had "great benefits" at my last job accept when i needed them
1. when something happened and i needed physical therapy it turned out my copay was like 6k so i just DIY my own therapy..
2. when changing jobs i had a month gap, so i bought COBRA and 3 things went wrong.
1. when something happened and i needed physical therapy it turned out my copay was like 6k so i just DIY my own therapy..
2. when changing jobs i had a month gap, so i bought COBRA and 3 things went wrong.
a. it cost $1300 for a month of coverage (even with a 2k deductible)
b. since my last day was before a weekend, they actually covered my only until that same day next month, so i still had a gap of coverage (might be my employer but still sucks people have to be faced with this bs)
c. when i did go to a routine physical healthcare provider still denied the claim and i was sent a full bill. after hours of calling it turned out they initially rejected it, but then accepted months later and i was left with _*some*_ expenses ?!
I don’t understand why the article uses labor turnover or health plan churn. Why would that be relevant to the original bolded premise that people like their better coverage sponsored by employers?
If I leave a job or get laid off, usually I’ll get a similar job that has similar insurance. Now maybe you could argue that there’s a big risk of an insurance gap or that something like COBRA is unfairly priced, etc., but that would have more to do with unemployment insurance and virtually nothing to do with the basic structure of health insurance.
When I “churn” in the insurance market, it is almost always going to be a super short-term switch from Insurance A to Insurance B (both via employers) where A and B are incredibly similar.
That seems perfectly consistent with saying that people love employer-provided insurance quality. The employers have to offer the same high quality insurance everywhere, or else people won’t switch. As a result, they do provide the same high quality insurance everywhere, to ensure insurance is not a sticking point that creates job movement friction.
Of course there are outliers offering bad insurance and classes of labor like Wal-Mart retail staff that get screwed by deliberately bad corporate actors, and I’m sure anybody reading this with a personalized anecdote will angrily try to refute me.
But in the aggregate, these are exceptions, and most people like their insurance for the most part and find that almost all possible employers (for them) offer such a nearly fungible set of insurance plans that they can churn jobs without significantly worrying that the insurance they like will be very different at company A vs company B.
There could be many arguments for nationalized healthcare, but this article seems pretty much wrong from its main thesis. People “keep” the private insurance they like all the time, because “churning” the coverage is not at all similar to giving up the coverage or making concessions or compromises for the next plan of insurance you accept from an employer.
If I leave a job or get laid off, usually I’ll get a similar job that has similar insurance. Now maybe you could argue that there’s a big risk of an insurance gap or that something like COBRA is unfairly priced, etc., but that would have more to do with unemployment insurance and virtually nothing to do with the basic structure of health insurance.
When I “churn” in the insurance market, it is almost always going to be a super short-term switch from Insurance A to Insurance B (both via employers) where A and B are incredibly similar.
That seems perfectly consistent with saying that people love employer-provided insurance quality. The employers have to offer the same high quality insurance everywhere, or else people won’t switch. As a result, they do provide the same high quality insurance everywhere, to ensure insurance is not a sticking point that creates job movement friction.
Of course there are outliers offering bad insurance and classes of labor like Wal-Mart retail staff that get screwed by deliberately bad corporate actors, and I’m sure anybody reading this with a personalized anecdote will angrily try to refute me.
But in the aggregate, these are exceptions, and most people like their insurance for the most part and find that almost all possible employers (for them) offer such a nearly fungible set of insurance plans that they can churn jobs without significantly worrying that the insurance they like will be very different at company A vs company B.
There could be many arguments for nationalized healthcare, but this article seems pretty much wrong from its main thesis. People “keep” the private insurance they like all the time, because “churning” the coverage is not at all similar to giving up the coverage or making concessions or compromises for the next plan of insurance you accept from an employer.
These numbers are super misleading. 72% were continuously enrolled, but 16% switched to a different employer plan! We don't know how many of those were the same employer or if the spouse just had access a better deal that year or what. Either way, 88% were covered by their employer plan. 12% is entirely different from 28%. We all have to do open enrollment, but that's entirely different from losing coverage and finding something new!
I'm totally on board with Medicare-for-All but we don't need smoke and mirrors and misleading statistics.
I'm totally on board with Medicare-for-All but we don't need smoke and mirrors and misleading statistics.
This is still important. I changed insurance with no gap, but it reset my fully paid deductible.
Healthcare finance is a mess in the US.
Pelosi is a moron who doesn't even know how the current insurance system works. Of course people lose their insurance. And ACA insurance often doesn't cover the same things as the employer-based insurance. If people need to get on Medicaid, they need to wait months before it starts, months without coverage. Everyone needs healthcare and few people can afford to pay the exorbitant costs of it in this country. And of course, if you get injured on the job, you have to fight a whole different system that shouldn't exist either. Of course Pelosi has her own insurance and plenty of money so like so many rich assholes in congress and elsewhere doesn't care and doesn't want to improve healthcare coverage for the rest of us. Let us get sick and die. Even with insurance this is often the case. Pelosi's a moron on this issue and many others. She's almost as clueless as the Republicans who get off on kicking people off of Medicaid and watching them get sick and die. How can the US even be considered a developed country anymore when we let our own people get sick and die so a few rich assholes can get richer?
Am I correct in understanding that Medicare for All plans to abolish private insurance? I prefer there be a system where you can get private insurance if you want, but if you go without you are automatically on Medicare.
One thing this article doesn't discuss: at least some of the times where I "lost" my employer-sponsored insurance (either because I switched jobs or because my start-up decided to switch providers), it went to something better than what I had before, and most of the time it was a change that was a matter of indifference (from one major plan provider to another where everything was pretty similar). In most universal health care proposals I've seen, "leaving," isn't really an option, you're just stuck with The Healthcare Option.
Whatever the merits of the more general arguments for or against, it seems like we should at least not put a finger on the scale.
Whatever the merits of the more general arguments for or against, it seems like we should at least not put a finger on the scale.
It is highly unlikely that you will be left with no options. Under most universal health care systems, private insurance plays a complementary role[1]. Also, if we go the public option route, it would compete against, rather than replace, the private insurance market.
[1] https://www.vox.com/health-care/2019/2/12/18215430/single-pa...
[1] https://www.vox.com/health-care/2019/2/12/18215430/single-pa...
People [in the US] … ;)
As much as your comment might be taken in the wrong way, it is important to point out first world countries have this sorted. I simply don't get it. When did patriotism become about military might and waving flags instead of making sure your fellow countrymen don't live in agony, fear, and poverty?
I'd say about 1946, or whenever the cold war is said to have officially begun. Or maybe even earlier during WW2.
That being said the sentiment was never a good one, and we do need to move on from it.
That being said the sentiment was never a good one, and we do need to move on from it.
Medicare-for-All is some sort of "far left" fantasy in the United States, but single-payer healthcare is center-right dogma in every other developed country. I have no idea why this is so hard for the American right to grasp: single-payer healthcare is a social program, but it's not the same as socialism. We aren't trying to steal the means of production from you in some sort of revolution, we just don't want people to die from preventable things. It is entirely possible to have a single-payer healthcare system alongside a thriving capitalist economy. This sort of foundational public service actually makes economies better, not worse. It's not a burden on the market to have healthy workers.
> We aren't trying to steal the means of production from you
I mean, workers created them in the first place, so I'm all for "stealing" them back.
But I also wouldn't mind single-payer healthcare in the meantime.
I mean, workers created them in the first place, so I'm all for "stealing" them back.
But I also wouldn't mind single-payer healthcare in the meantime.
"single-payer healthcare is a social program, but it's not the same as socialism"
American politics is geared towards appealing to the extremes. Social programs are "socialist" and get connected to the Soviet Union, cuba and Venezuela. If you say something that's even slight politically incorrect you are immediately labeled as a "racist" that should be removed from your job and all public discussion. There is no interest in discussing problems and finding solutions. It's all about anger.
American politics is geared towards appealing to the extremes. Social programs are "socialist" and get connected to the Soviet Union, cuba and Venezuela. If you say something that's even slight politically incorrect you are immediately labeled as a "racist" that should be removed from your job and all public discussion. There is no interest in discussing problems and finding solutions. It's all about anger.
Couldn't agree more.
Doesn't really help that M4A is pushed by someone that calls himself a socialist and outspokenly disapproves of capitalism.
Yes, people do lose their insurance constantly when they switch jobs...and then immediately sign onto their new plan. Is the argument that switching insurance plans is stressful? What's stressful is remaining uncovered. Switching plans is hardly comparable to the transition to a Medicare-for-all program.
> and then immediately sign onto their new plan
Nope. Employer-provided insurance plans often have blackout dates.
If you quit your job on June 2, and start your new job on June 3, your new job's health insurance might not actually take effect for up to 30, 60, or even 90 days after your start date.
To cover that gap period, you either have to switch to a new plan with your old employer (commonly called COBRA) at ridiculous high rates nobody can afford, or you have to get temporary blackout insurance coverage (which cover nothing at all, and are almost identical to having no insurance).
This need is so common, that most insurance companies have special advertising just for it (like https://www.priorityhealth.com/individual-family-health-insu... for example).
In America, to switch jobs once, requires three concurrent interactions with three different health insurance plans, simultaneously. (Your old employer plan, your intermediate temporary plan/COBRA, and your new employer's plan). For obvious reasons, this is incredibly error prone, risky, and fraught with stress.
> Is the argument that switching insurance plans is stressful?
Yes! Literally every single interaction with every single health insurance provider is painful and stressful and complicated and intentionally obfuscated, for absolutely no valid reason whatsoever.
Nope. Employer-provided insurance plans often have blackout dates.
If you quit your job on June 2, and start your new job on June 3, your new job's health insurance might not actually take effect for up to 30, 60, or even 90 days after your start date.
To cover that gap period, you either have to switch to a new plan with your old employer (commonly called COBRA) at ridiculous high rates nobody can afford, or you have to get temporary blackout insurance coverage (which cover nothing at all, and are almost identical to having no insurance).
This need is so common, that most insurance companies have special advertising just for it (like https://www.priorityhealth.com/individual-family-health-insu... for example).
In America, to switch jobs once, requires three concurrent interactions with three different health insurance plans, simultaneously. (Your old employer plan, your intermediate temporary plan/COBRA, and your new employer's plan). For obvious reasons, this is incredibly error prone, risky, and fraught with stress.
> Is the argument that switching insurance plans is stressful?
Yes! Literally every single interaction with every single health insurance provider is painful and stressful and complicated and intentionally obfuscated, for absolutely no valid reason whatsoever.
As I painfully found out, transitioning between jobs also requires competent HR people on both ends. Our insurance was accidentally terminated a week early so our claim was denied and we got a massive bill. Not only do you have to then deal with the insurance company but you have to deal with your previous employer to fix the situation.
That's the worst because most likely you are already locked out of most systems so you can't even communicate.
>This need is so common, that most insurance companies have special advertising just for it (like https://www.priorityhealth.com/individual-family-health-insu.... for example).
This doesn’t even cover pre-existing conditions. So, if you are on medication for high blood pressure, or have diabetes, or are just one of the 55 percent of Americans who take prescription drugs... you are out of luck.
That these plans are even legal is a monumental failure of the American system.
This doesn’t even cover pre-existing conditions. So, if you are on medication for high blood pressure, or have diabetes, or are just one of the 55 percent of Americans who take prescription drugs... you are out of luck.
That these plans are even legal is a monumental failure of the American system.
> Yes, people do lose their insurance constantly when they switch jobs...and then immediately sign onto their new plan.
Lets say you payed for insurance, but were healthy for the 90s. So ~10-years of paying insurance. Around 2005, you are diagnosed with Diabetes, so your insurance pays for your care.
Around 2007, the recession happens and you lose your job. You immediately find a new job, but you need to get new insurance. Diabetes is now a "pre-existing condition", so your insurance no longer covers your condition.
Its important to recognize that changing health-plans is a regular event, that shouldn't punish people with chronic conditions. Diabetes is lifelong, once you get it, you live with it for the rest of your life. Insurance companies don't want to pay for that kind of issue. With all talk about "Repeal and Replace", its important to recognize the tradeoff.
As long as "pre-existing conditions" are banned in the USA, I don't think its a big deal to lose employer sponsored health care (at least, compared to pre-Obamacare). We should build a world where it is easy to lose (and regain) health coverage... compared to the pre-Obamacare world where it was a big risk to lose coverage. Hopefully laws of the future make it easier to switch health care plans without problems.
Lets say you payed for insurance, but were healthy for the 90s. So ~10-years of paying insurance. Around 2005, you are diagnosed with Diabetes, so your insurance pays for your care.
Around 2007, the recession happens and you lose your job. You immediately find a new job, but you need to get new insurance. Diabetes is now a "pre-existing condition", so your insurance no longer covers your condition.
Its important to recognize that changing health-plans is a regular event, that shouldn't punish people with chronic conditions. Diabetes is lifelong, once you get it, you live with it for the rest of your life. Insurance companies don't want to pay for that kind of issue. With all talk about "Repeal and Replace", its important to recognize the tradeoff.
As long as "pre-existing conditions" are banned in the USA, I don't think its a big deal to lose employer sponsored health care (at least, compared to pre-Obamacare). We should build a world where it is easy to lose (and regain) health coverage... compared to the pre-Obamacare world where it was a big risk to lose coverage. Hopefully laws of the future make it easier to switch health care plans without problems.
If you find a new job and you’re eligible under group insurance, the insurance company can’t deny a claim under pre-existing conditions. This was true before the ACA. What the ACA changed was that insurance companies couldn’t exclude treatment based on preexisting conditions if you go on the open market.
Pre-ACA group plans could deny preexisting conditions for a time period equal to the time that you were uninsured.
When I switched job I would get a letter from previous insurance company stating the dates that I was insured. Once I actually had to provide that to the new company.
When I switched job I would get a letter from previous insurance company stating the dates that I was insured. Once I actually had to provide that to the new company.
It seems like we are both partially correct. They could deny you for up to a year for a pre-existing condition prior to the ACA.
https://twocents.lifehacker.com/you-could-be-denied-pre-exis...
https://twocents.lifehacker.com/you-could-be-denied-pre-exis...
That’s been ameliorated somewhat by ACA and is the only reason I think it’s an improvement even though my premiums have gone up. There’s all sorts of pre-existing conditions, and healthcare with the threat of retroactive recision if they feel your application was incomplete ought to feel insecure to just about anyone.
Somewhat, but people with insurance are still the largest group of people with medical bankruptcies.
I don't mean that it's affordable, I just mean that the reason isn't a pre-existing condition exclusion. For insurance for myself I'm paying $484.71 a month and there's a $5850 deductible, after which it probably only covers some percentage of it, until a maximum out of pocket is reached (this information isn't viewable in my account online and is probably in some mail that I've thrown out). Certainly not affordable.
A pre-existing condition exclusion means that you're on your own for expenses arising from your pre-existing condition, or if you didn't report it when you applied for your health insurance, that you could have your health insurance retroactively cancelled, and have to pay back any money you received. It's really bad, but since some healthcare expenses seem to have more than tripled in the last 10 years, it's often worse today. I'd much rather pay 100% of $800 than 50% of $3000.
A pre-existing condition exclusion means that you're on your own for expenses arising from your pre-existing condition, or if you didn't report it when you applied for your health insurance, that you could have your health insurance retroactively cancelled, and have to pay back any money you received. It's really bad, but since some healthcare expenses seem to have more than tripled in the last 10 years, it's often worse today. I'd much rather pay 100% of $800 than 50% of $3000.
Insurance is expensive in this country because medical care is expensive.
Medical care is expensive for a variety of reasons: nurse shortage, high-cost of training doctors, poor market conditions (opaque pricing that almost no layperson understands), cultural emphasis on fighting to the end rather than dying with dignity.
The cultural part probably won't change, we just have to accept that USA's culture (aka: "Full Code") is going to naturally result in more expensive health care. Its far more expensive to try to live than to accept death. Maybe someone out there will fight the cultural battle, but I don't see any political advantage in doing so.
Other issues can be worked on. Doctors aren't necessary for all care: nurses are sufficient for most cases. Lowering the cost of becoming a doctor likely would help too: if doctors had less medical bills, they might charge less for their services. (They HAVE to charge a lot to pay off those $200k+ to $300k+ student loans).
Medicine / Drugs is getting political... because changes to drug laws necessarily becomes a patent dispute. Should we allow drugs from India to become FDA-tested and imported? Or should we keep them banned for patent-law issues?
There's research issues: FDA is purely a placebo test. There's almost no comparative research going on at the federal level (Obamacare started up a comparative research group, but that group needs more funding and probably should also research on the PRICE of medical solutions. For whatever reason, research of prices is illegal). FDA is a very, very rigorous placebo test, but that's all it is. If a new drug comes out that's better than a placebo (but worse than standard treatment), it will pass the FDA. This means that doctors still have to research which drugs are most effective for their patients on their own.
Doctors can't trust insurance companies when they pay for research: insurance companies are looking for the cheapest solution. Drug companies are obviously biased, and may not conduct fair comparative trials. And unfortunately, those are the two major groups which sponsors research in the USA.
Medical care is expensive for a variety of reasons: nurse shortage, high-cost of training doctors, poor market conditions (opaque pricing that almost no layperson understands), cultural emphasis on fighting to the end rather than dying with dignity.
The cultural part probably won't change, we just have to accept that USA's culture (aka: "Full Code") is going to naturally result in more expensive health care. Its far more expensive to try to live than to accept death. Maybe someone out there will fight the cultural battle, but I don't see any political advantage in doing so.
Other issues can be worked on. Doctors aren't necessary for all care: nurses are sufficient for most cases. Lowering the cost of becoming a doctor likely would help too: if doctors had less medical bills, they might charge less for their services. (They HAVE to charge a lot to pay off those $200k+ to $300k+ student loans).
Medicine / Drugs is getting political... because changes to drug laws necessarily becomes a patent dispute. Should we allow drugs from India to become FDA-tested and imported? Or should we keep them banned for patent-law issues?
There's research issues: FDA is purely a placebo test. There's almost no comparative research going on at the federal level (Obamacare started up a comparative research group, but that group needs more funding and probably should also research on the PRICE of medical solutions. For whatever reason, research of prices is illegal). FDA is a very, very rigorous placebo test, but that's all it is. If a new drug comes out that's better than a placebo (but worse than standard treatment), it will pass the FDA. This means that doctors still have to research which drugs are most effective for their patients on their own.
Doctors can't trust insurance companies when they pay for research: insurance companies are looking for the cheapest solution. Drug companies are obviously biased, and may not conduct fair comparative trials. And unfortunately, those are the two major groups which sponsors research in the USA.
The problem with covering pre-existing conditions at all times is that you need to make insurance mandatory, due to the adver selection problem.
If insurance is optional, then only people that know they are sick or will get sick will dominate the insurance, making it more expensive, and pushing the healthy-low risk out.
Its a well known economics problem that has no silver bullet.
What is crazy to me is that insurance is involved in paying primary care doctors. That is a terrible application of health insurance, and have full faith on high deductible plans bringing sanity back into this.
If insurance is optional, then only people that know they are sick or will get sick will dominate the insurance, making it more expensive, and pushing the healthy-low risk out.
Its a well known economics problem that has no silver bullet.
What is crazy to me is that insurance is involved in paying primary care doctors. That is a terrible application of health insurance, and have full faith on high deductible plans bringing sanity back into this.
If you switch to another insurance provider, you might have to change doctors, pharmacies and other service providers, because your previous service provider is no longer in-network or too costly.
Also your coverage may completely change for better or worse. The worst case scenario is just as disastrous as losing insurance entirely.
This is particularly bad for people with chronic/ongoing medical needs.
Also your coverage may completely change for better or worse. The worst case scenario is just as disastrous as losing insurance entirely.
This is particularly bad for people with chronic/ongoing medical needs.
>Yes, people do lose their insurance constantly when they switch jobs...and then immediately sign onto their new plan.
Unless they lose their jobs. Or change to a job that doesn't offer coverage/start a new business. Or have their hours cut to be <40 hrs/wk and are no longer eligible. . .
>Switching plans is hardly comparable to the transition to a Medicare-for-all program.
Why? It would be a one-time switch. Switching costs would be exactly the same as the switching costs you pay every time you change jobs, except you only pay it one time in your life and you don't have to shop around in some silly healthcare exchange or open enrollment process where you get to weigh which absurdly high premium you want to pay despite deductibles being so high that barely any of your routine health costs will be compensated.
And then there is the joy of making sure all your care providers are covered by your new plan. AND hoping your providers don't drop your plan because of insurance company negotiations.
Unless they lose their jobs. Or change to a job that doesn't offer coverage/start a new business. Or have their hours cut to be <40 hrs/wk and are no longer eligible. . .
>Switching plans is hardly comparable to the transition to a Medicare-for-all program.
Why? It would be a one-time switch. Switching costs would be exactly the same as the switching costs you pay every time you change jobs, except you only pay it one time in your life and you don't have to shop around in some silly healthcare exchange or open enrollment process where you get to weigh which absurdly high premium you want to pay despite deductibles being so high that barely any of your routine health costs will be compensated.
And then there is the joy of making sure all your care providers are covered by your new plan. AND hoping your providers don't drop your plan because of insurance company negotiations.
It’s not just when you change jobs. My wife handles large employer groups and the insurance companies ask for a 15% rate increase every year so the employers have to threaten to switch every year to negotiate down then actually switch every other year. It’s a wasteful, useless game. Even if you stay at same employer, your insurer and networks will regularly change.
They lose their insurance for other reasons, too. Their employer changes plans; they get dropped from full time to part time; they lose their job and don't immediately get another.
And switching insurance plans at almost any time can be very costly, even if you go straight to a new one, as all your deductibles and out-of-pocket limits get reset. And then you have to hit them again when the plan year starts again, almost certainly sooner than a year later.
And switching insurance plans at almost any time can be very costly, even if you go straight to a new one, as all your deductibles and out-of-pocket limits get reset. And then you have to hit them again when the plan year starts again, almost certainly sooner than a year later.
My employer switched health insurers 3 years in a row. First because we became a new company (understandable), second because they thought they could get a better deal at another place (okay...), and thirdly reverting the 2nd change except some of the numbers and coverage is different now.
I really am considering leaving if they switch a 4th time.
I really am considering leaving if they switch a 4th time.
> Switching plans is hardly comparable to the transition to a Medicare-for-all program
The big stressor is having to pay two deductibles in one year. That said, from an individual perspective I don't see what would be different. Before you had an (Aetna|Cigna|BCBS|UHC) card, now you have a M4A card.
The big stressor is having to pay two deductibles in one year. That said, from an individual perspective I don't see what would be different. Before you had an (Aetna|Cigna|BCBS|UHC) card, now you have a M4A card.
>Is the argument that switching insurance plans is stressful?
I think it’s clear the article is promoting universal coverage, and simply highlight how ridiculous it is that healthcare is a benefit of employment by highlighting nearly 1/3 of employment based plans are discontinued within 12 months.
I’m not sure how you can conclude switching private insurance plans is hardly comparable to a transition to Medicare-for-all, when millions of people make the jump from private insurance to Medicare every year and you don’t hear much complaining from that group. Not to mention a 1 time transition compared to nearly 33% of the workforce going through this annually.
I think it’s clear the article is promoting universal coverage, and simply highlight how ridiculous it is that healthcare is a benefit of employment by highlighting nearly 1/3 of employment based plans are discontinued within 12 months.
I’m not sure how you can conclude switching private insurance plans is hardly comparable to a transition to Medicare-for-all, when millions of people make the jump from private insurance to Medicare every year and you don’t hear much complaining from that group. Not to mention a 1 time transition compared to nearly 33% of the workforce going through this annually.
> Is the argument that switching insurance plans is stressful?
It absolutely is stressful, because every single time you have to carefuly inspect the documentation to figure out what conditions and care (if any) you're "allowed" to have without going bankrupt.
It absolutely is stressful, because every single time you have to carefuly inspect the documentation to figure out what conditions and care (if any) you're "allowed" to have without going bankrupt.
I don't understand why you're downvoted. It's an important observation.
In my case, my employer was bought and sold 3 times. All three cases involved a sudden and abrupt termination of my insurance.
It was "okay" when I was single, but once I carried my wife, and then my entire family, it became a huge problem.
Throughout my tenure at my job, I had major surgery and two children. Sudden insurance changes immediately before or during any of those events would be a huge problem. (Fortunately, the timing worked out.)
In my case, my employer was bought and sold 3 times. All three cases involved a sudden and abrupt termination of my insurance.
It was "okay" when I was single, but once I carried my wife, and then my entire family, it became a huge problem.
Throughout my tenure at my job, I had major surgery and two children. Sudden insurance changes immediately before or during any of those events would be a huge problem. (Fortunately, the timing worked out.)
Europe also has a broader fix for this, called Transfer of Undertakings rules, the UK version is "TUPE" the "Transfer of Undertakings (Protection of Employment) Regulations".
The broad overview of TUPE is that employees whose actual job doesn't change shouldn't have to put up with any negative consequences at all for the fact that at some higher level their employer changed. e.g. the office building switches from Ace Cleaning Corp. to Best Cleaning Limited, but it's still Jenny and Achmed actually doing the cleaning, just in blue overalls instead of yellow now. It makes no sense to be allowed to tell Jenny now she's only getting minimum wage because Best Cleaning Limited doesn't pay as much as Ace Cleaning Corp, she's doing the same job so she should continue to get the same pay.
But I don't mean just obvious stuff like they can't cut your pay, it's everything - your seniority is preserved, shift priorities, rules for how much paid leave you get, or how pensions are paid - if it was part of the job, then it moves with the job. If employment-based health insurance was a big thing here, that would undoubtedly be covered.
The broad overview of TUPE is that employees whose actual job doesn't change shouldn't have to put up with any negative consequences at all for the fact that at some higher level their employer changed. e.g. the office building switches from Ace Cleaning Corp. to Best Cleaning Limited, but it's still Jenny and Achmed actually doing the cleaning, just in blue overalls instead of yellow now. It makes no sense to be allowed to tell Jenny now she's only getting minimum wage because Best Cleaning Limited doesn't pay as much as Ace Cleaning Corp, she's doing the same job so she should continue to get the same pay.
But I don't mean just obvious stuff like they can't cut your pay, it's everything - your seniority is preserved, shift priorities, rules for how much paid leave you get, or how pensions are paid - if it was part of the job, then it moves with the job. If employment-based health insurance was a big thing here, that would undoubtedly be covered.
With the current love for High deductible plans, it can get much riskier. I just walked away from a plan where I had paid the full Out of pocket max for the year (around $7k), in January. That hurt, but the other offer was good enough.
None of that money translates to the new plan, I'm back to paying deductibles for everything.
None of that money translates to the new plan, I'm back to paying deductibles for everything.
When I started my current job I wasn't eligible for benefits for 90 days. This is not uncommon.
My wife recently worked for a startup and had them change the company policy to start benefits on day 1 simply by asking. No one really knew why the benefits started after N days and no one cared enough to change it previously.
One time I switched jobs the company I left was so small (I think ~ 15 to 18 people) it turned out that COBRA wasn't available and new job benefits didn't kick in for 90 days. This was between when the ACA was passed and took effect so getting private insurance for the gap was scary. (Going without coverage was not an option, I have serious medical history.)
How about having to switch doctors, or having to go a couple weeks without an insurance card, but hey, you still have insurance and you can pay up front and get reimbursed later? Big fucking deal, right?
So then if it's supposedly more efficient, why do I waste multiple hours dealing with insurance bullshit literally every few months?
Start a new job at a startup, need to go to trainings to understand the health care options and choose one, get new cards and website logins, update my info at every provider
New dentist is having difficulty getting my routine care billed to insurance and calls me every week asking for my insurance information again.
Wifes doctor didn't do something correctly when I updated insurance so now I need to call and deal with this big medical bill that I shouldn't have gotten.
Startup got acquired so I get another training for the new insurance options. And get new cards and logins and update with all providers again
Planning to get a surgical operation but nobody can tell me how much it will cost, doctor says "probably whatever your deductible is" except I have a high deductible plan so is it really going to cost me $2500?
Etc cetera. There's no end to the nuisance. If I could choose to just pay more in taxes (hell I'll pay way more than my current premiums) and never deal with insurance again, I would do it in a heartbeat.