Family health coverage passes $20K this year

[MTAtech]

Huh ? It was their last " workable policy " ( the ACA ) that created this mess.

The ACA forced everyone into the same State based risk pool. Both healthy and sick and subsidised plans and unsubsidized plans
Those who qualify for subsidizes typically have higher healthcare cost than people who don't qualify, but since their get subsidies they're insulated from premium and deductable hikes

Now, every State pool is disproportionately weighted with subsidized plans, because premiums have risen to the point where millions of people have been priced out of the market.

The risk pools set the premium price for each State, and are one of the big reasons where seeing these stratospheric cost for health insurance.

What a disaster that law is, and people actually want the same party thats responsible for it to take total control of our healthcare system. Unreal !

It’s not the same poll. That’s what community ratings is part of the ACA.

 

[ludin]

Ten years of health premiums is enough to pay cash for a house in much of the country! Some employers charge the whole $20K to their employees.

2019 Employer Health Benefits Survey | The Henry J. Kaiser Family Foundation

wait i thought obamacare was to lower healthcare costs? guess no then again it never was there to lower healthcare costs.

 

[ludin]

Universal coverage works everywhere else. No country having universal coverage has ever gone back to private insurance.

other countries have private insurance and people buy it so that they can see doctors that their free "lol" healthcare won't cover.
in france you still have to buy private insurance.
same in most countries.

even in the US people that are on medicare have to buy private insurance to cover the things that medicare doesn't.
those run about 350 a month for 1 person.

So no it doesn't work every where. recently england just kicked 2k some people out of the hospital. they were denied needed surgeries
or operations.

no thanks. the government has proven itself 100% inept at handling healthcare and the prove it every day.

don't believe me look at the VA and walter reid.
that is the kind of healthcare that you will receive if the government is in charge.

you are not going to get the healthcare that Warren gets. that is where the lie is.
which is why support for this drops to below 20% when told the truth about it.

 

[ludin]

Huh ? It was their last " workable policy " ( the ACA ) that created this mess.

The ACA forced everyone into the same State based risk pool. Both healthy and sick and subsidised plans and unsubsidized plans
Those who qualify for subsidizes typically have higher healthcare cost than people who don't qualify, but since their get subsidies they're insulated from premium and deductable hikes

Now, every State pool is disproportionately weighted with subsidized plans, because premiums have risen to the point where millions of people have been priced out of the market.

The risk pools set the premium price for each State, and are one of the big reasons where seeing these stratospheric cost for health insurance.

What a disaster that law is, and people actually want the same party thats responsible for it to take total control of our healthcare system. Unreal !

I know everyone else knows it as well, but they simply won't admit it.

 

[jaeger19]

That all depends. There are countless medical needs that are far more expensive than what you or I can sock away. A heart bipass can cost $50,000 to $100,000, which means most people can’t save enough to prefund their medical costs with HSAs. That’s why we need insurance.

WTF? Who said we "don't need insurance?"...cuz it sure wasn't me. Everyone needs insurance. We need a mandate that everyone must obtain insurance.

The point being however, that not everyone.. needs to have a real low deductible. For many its better to pay less to the insurance company and save more. I am not talking 15000 deductibles.. but a 6000 or 7000? that's in the realm of most middle class or higher people. .

 

[ALiberalModerate]

Average premiums that high suggest overly generous coverage (i.e., not enough bronze/HDHP enrollment). People are handing over too much money to insurance companies on the front end and then expecting them to pay for everything. More people should be putting that money into their own HSAs rather than expecting insurance is supposed to pay for everything.

While I agree it may we be due to overly generous benefits, primary care, which is what you pay for out of an HSA, is only 7% of overall healthcare spending. Chronic and catastrophic care account for the vast majority of healthcare spending and they are the primary drivers of higher premiums.

 

[ALiberalModerate]

Different car insurance companies also pay different amounts for various repairs. Property insurance companies pay different amounts for rebuilding. Yet autobody shops and roofers will still provide you with a firm price.



Every business on the planet charges as high as possible. The difference is US hospitals are screwing over sick and dying people.




We have an average amount of hospital beds:

View attachment 67266271




Sorry, that doesn't justify the prices. Heart bypass surgery in the US costs between 100 and 200k. In Singapore it's 25k max. In Israel it's 30k. In Germany it's 50k max, which was the most expensive one I could find. None of these countries have waiting lines.

So where's all the money going in US hospitals?

I agree with much of this, but you cannot compare other types of insurance to health coverage. If health insurance worked like every other form of insurance, you would be insured up to your economic value, and as you were older, and thus had a lower economic value, the amount of money an insurer would pay out for your care would drop proportionately before you were considered a total loss. For example, an insurer might pay out a couple of million dollars for a 35 year old senior IT professional because of their potential lifetime wages / economic value, but a 78 year old retired man with a cancer history may only get 20k in total coverage before the insurer would consider him a total loss. Point being, health insurance doesn't work like any other form of insurance, and we would not want it to.

Example a new roof if damaged would qualify for a home insurance policy to pay 100% of replacement, minus deductible for wind and hail damage. A 20 year old roof often only qualifies for 30% or so of replacement costs to be paid for by the insurer. In contrast, the typical health insurer will be out exponentially more money paying for healthcare for a 80 year than they will a 30 year old.

 

[MTAtech]

WTF? Who said we "don't need insurance?"...cuz it sure wasn't me. Everyone needs insurance. We need a mandate that everyone must obtain insurance.

The point being however, that not everyone.. needs to have a real low deductible. For many its better to pay less to the insurance company and save more. I am not talking 15000 deductibles.. but a 6000 or 7000? that's in the realm of most middle class or higher people. .

I interpreted your statement to mean that instead of having insurance with $6K deductibles, Health Savings Accts were the alternative. If I got it wrong, sorry.

 

[MTAtech]

While I agree it may we be due to overly generous benefits, primary care, which is what you pay for out of an HSA, is only 7% of overall healthcare spending. Chronic and catastrophic care account for the vast majority of healthcare spending and they are the primary drivers of higher premiums.

Correct.

There are two strongly distinctive aspects of health care. One is that you don’t know when or whether you’ll need care -- but if you do, the care can be extremely expensive. The big bucks are in triple coronary bypass surgery, not routine visits to the doctor’s office; and very, very few people can afford to pay major medical costs out of pocket.

This tells you right away that health care can’t be sold like bread and it cannot be saved through HSAs. It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy. Consumer choice is nonsense when it comes to health care. And you can’t just trust insurance companies either -- they’re not in business for their health, or yours.

The issue then shifts to what kind of health insurance system works the best. There are all kinds of models throughout the world. If one was designing a system from scratch, you'd have Medicare for all system that has no insurance company middlemen that covers everyone in the country, with the cost paid via taxes. But we aren't designing it from scratch, which means we need to fact in political considerations, like insurance companies are donors to campaigns. Therefore, any change will be difficult to cut out the insurance companies entirely. That's why a big public option is the most sensible choice -- one can go to private insurance companies or buy into a government plan.

 

[ALiberalModerate]

Correct.

There are two strongly distinctive aspects of health care. One is that you don’t know when or whether you’ll need care -- but if you do, the care can be extremely expensive. The big bucks are in triple coronary bypass surgery, not routine visits to the doctor’s office; and very, very few people can afford to pay major medical costs out of pocket.

This tells you right away that health care can’t be sold like bread and it cannot be saved through HSAs. It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy. Consumer choice is nonsense when it comes to health care. And you can’t just trust insurance companies either -- they’re not in business for their health, or yours.

The issue then shifts to what kind of health insurance system works the best. There are all kinds of models throughout the world. If one was designing a system from scratch, you'd have Medicare for all system that has no insurance company middlemen that covers everyone in the country, with the cost paid via taxes. But we aren't designing it from scratch, which means we need to fact in political considerations, like insurance companies are donors to campaigns. Therefore, any change will be difficult to cut out the insurance companies entirely. That's why a big public option is the most sensible choice -- one can go to private insurance companies or buy into a government plan.

There are efficient multi-payer systems. Take Germany for example. What all other systems have in common is they are much, much more heavily regulated than ours is. We talk about insurers, but providers actually outspend them on lobbying. If you took a 15k a year family premium and took every ounce of profit out of it, the premium might go from 15k to 14.2k or so a year. Pharma isn't the problem either. Prescription drugs only account for 10% of overall health spending. We just notice it more because more of it is out of pocket. The fact is, there is a massive amount of rent seeking behavior on the part of some health systems. Obfuscated billing to the point where we would call it fraud if it was anything other than healthcare, "facilities fees" for outpatient surgery centers that make outpatient surgery more expensive than inpatient (it would be like your mechanic charging you for use of the lift in addition to parts and labor), oncologists slowing down the rates of chemo infusions to increase billing, hospitals charging 400 dollars for a 20 dollar metabolic panel by billing for each result separately... The list goes on and on.

You are right, for the most expensive types of healthcare, there is no shopping it. For example, you could be in an accident and spend more in a few hours in critical care before you are conscious, than you would in several lifetimes of routine care.

 

[bluesmoke]

Average premiums that high suggest overly generous coverage (i.e., not enough bronze/HDHP enrollment). People are handing over too much money to insurance companies on the front end and then expecting them to pay for everything. More people should be putting that money into their own HSAs rather than expecting insurance is supposed to pay for everything.

"More people should be putting that money into their own HSAs rather than expecting insurance is supposed to pay for everything."

Instances of $1 put into an HSA averaging a better outcome than $1 put into insurance premiums are rare. HSA has always been a suspect plan. Bad advice.

 

[jaeger19]

I interpreted your statement to mean that instead of having insurance with $6K deductibles, Health Savings Accts were the alternative. If I got it wrong, sorry.

No worries.

The answer though is HSA's. Currently.. we do it backward. You can only have a HSA.. if you have a high deductible. Well that's stupid. It makes sense to have an HSA.. and then when you have enough built into the HSA to have a high deductible.. THEN you go get a high deductible plan.

AND it makes sense to make is so employers can contribute unlimited amounts to your HSA.. in order for you to go out and buy your own private insurance. So that private insurance follows you wherever you go. Your employer can still pay for it.. or most ofit… but they are not buying YOUR policy. You are.

This allows smaller employers.. which don't have enough employees to get a competitive rate for insurance.. to still help their employees get health insurance. And health insurance that makes sense for them.

 

[jaeger19]

"More people should be putting that money into their own HSAs rather than expecting insurance is supposed to pay for everything."

Instances of $1 put into an HSA averaging a better outcome than $1 put into insurance premiums are rare. HSA has always been a suspect plan. Bad advice.

that makes no sense.

For what you say to be the case.. it would mean that insurance companies typically end up paying way more in healthcare.. than they collect in premiums. Basically you would be claiming that insurance companies run at a massive loss..

 

[ALiberalModerate]

No worries.

The answer though is HSA's. Currently.. we do it backward. You can only have a HSA.. if you have a high deductible. Well that's stupid. It makes sense to have an HSA.. and then when you have enough built into the HSA to have a high deductible.. THEN you go get a high deductible plan.

AND it makes sense to make is so employers can contribute unlimited amounts to your HSA.. in order for you to go out and buy your own private insurance. So that private insurance follows you wherever you go. Your employer can still pay for it.. or most ofit… but they are not buying YOUR policy. You are.

This allows smaller employers.. which don't have enough employees to get a competitive rate for insurance.. to still help their employees get health insurance. And health insurance that makes sense for them.

You currently cannot use an HSA to purchase health insurance though.

 

[Fenton]

It’s not the same poll. That’s what community ratings is part of the ACA.

Risk pools are State based, and set the price for premiums in that State. So one pool per State

 

[jaeger19]

You currently cannot use an HSA to purchase health insurance though.

Bingo. And as I said.. we do it backward.

WE could do this.. institute that ever person/family has an HSA that their employer.. or they.. can put into tax free (tax free to them and their employer). If they have Medicaid.. great.. if their employer has some that they can put into the plan (but not enough to purchase a whole plan)..then that person has an HSA to help bolster things that Medicaid doesn't pay for.. OR they end up building enough up over the years.. so that they can purchase a high deductible policy (like a 6000 policy).. so that when they do make too much money for Medicaid.. they aren't suddenly dropped off and have nothing saved to purchase on their own etc.

In other words.. it removes the employer incentive to keep salaries low.. so that people will still qualify for Medicaid. Its a way that a person can make more money.. and save enough to get insurance if their employer isn't willing to foot the total bill or buy a employer plan.

It would help with portability. Instead of having to pay for an employee healthcare policy... which costs me a lot.. and overcharges really.. because I pay insurance based on everyone being primary.. but many of my employees have spouses that get healthcare from another employer.. so I pay as if they COULD be on the insurance as primary.. but they aren't. Basically there employer and me pay more for their healthcare.. than either will use because they are double covered. Instead.. my employee could have an HSA that I pay into to cover what they wish to purchases. If its more than my cost now.. well they have to come up with more.. if its less.. then they can get it or choose to get more in salary.

The HSA solves the portability problem. The insurance follows the person.. not the job. AND the person can tailor their insurance to what they need.. not what the employer wants.

And with millions more people buying insurance.. companies will have to be more competitive. They cannot rely on a couple of larger companies.. basically giving them most of their customers.

 

[ALiberalModerate]

Bingo. And as I said.. we do it backward.

WE could do this.. institute that ever person/family has an HSA that their employer.. or they.. can put into tax free (tax free to them and their employer). If they have Medicaid.. great.. if their employer has some that they can put into the plan (but not enough to purchase a whole plan)..then that person has an HSA to help bolster things that Medicaid doesn't pay for.. OR they end up building enough up over the years.. so that they can purchase a high deductible policy (like a 6000 policy).. so that when they do make too much money for Medicaid.. they aren't suddenly dropped off and have nothing saved to purchase on their own etc.

In other words.. it removes the employer incentive to keep salaries low.. so that people will still qualify for Medicaid. Its a way that a person can make more money.. and save enough to get insurance if their employer isn't willing to foot the total bill or buy a employer plan.

It would help with portability. Instead of having to pay for an employee healthcare policy... which costs me a lot.. and overcharges really.. because I pay insurance based on everyone being primary.. but many of my employees have spouses that get healthcare from another employer.. so I pay as if they COULD be on the insurance as primary.. but they aren't. Basically there employer and me pay more for their healthcare.. than either will use because they are double covered. Instead.. my employee could have an HSA that I pay into to cover what they wish to purchases. If its more than my cost now.. well they have to come up with more.. if its less.. then they can get it or choose to get more in salary.

The HSA solves the portability problem. The insurance follows the person.. not the job. AND the person can tailor their insurance to what they need.. not what the employer wants.

And with millions more people buying insurance.. companies will have to be more competitive. They cannot rely on a couple of larger companies.. basically giving them most of their customers.

What about all the companies that are self insured though? For example, where I work they are self insured. I go with the HSA compatible plan, but ultimately, they just use BCBS for the provider network and BCBS bills the company for every claim.

Personally, I think the best way to make insurance cheaper is to get the most expensive people off of it. For example, you could drop the Medicare eligibility age down to 55. The vast majority of people under 50 pose very little risk to an insurer and insurers are for the most part only paying for their routine care (and not even all that). That is only 7% of overall healthcare spending (and even that, is mostly people over 50). It's the heart attacks, cancers, knee replacements and so on that are the drivers of healthcare costs, and higher insurance premiums.

For example, in August 2016, I was out riding my road bike over lunch and while I was at a stop light, a lady in a minivan drove right through me at 45 mph because she was looking at her phone. I was, and am, in extremely good shape, very strong and fit, so despite waking up in critical care a few hours later with a subdural hematoma, several broken ribs, a shattered scapula, a spinal fracture, and my skull exposed requiring over 100 stitches, I was out of the hospital in just 3 days, back at work in under 2 weeks, running again in 3 weeks, and starting to strength train again in about 8 weeks. No surgeries and no physical therapy needed. Total healthcare costs to my self insured employer, just under 40k. Had I been in the kind of shape and health that a typical American man is in by his late 50s and suffered a the same accident and injuries, it very well could have been hundreds of thousands in medical bills before it was all said and done.

Point being, even when you take into account the tax increases needed to extend Medicare down to 55 year olds, by getting them out of the private insurance system, most likely, premiums would be cut in half for everyone else.

 

[Allan]

other countries have private insurance and people buy it so that they can see doctors that their free "lol" healthcare won't cover.
in france you still have to buy private insurance.
same in most countries.

I live in a country with universal healthcare. What you've said there is simply not true.

 

[bluesmoke]

that makes no sense.

For what you say to be the case.. it would mean that insurance companies typically end up paying way more in healthcare.. than they collect in premiums. Basically you would be claiming that insurance companies run at a massive loss..

One is a health insurance coverage plan, the other one is a tax-free bank account that can only be used for medical costs (until over age 65) without heavy penalty. Anyway, you can contribute up to $3,500 for a single plan or $7,000 for a family plan per yr. Avg. fam. Premium is nearly $19K per yr. Or, just go for the least expensive plan with the lowest deductibles (HSA doesn’t apply to ded. or copay and there are other ins and outs) but has the least coverage and gamble that the $ you can afford to put into the HSA will pay for whatever happens. Maybe you can beat Vegas. Because that’s exactly what you’d have to do. One has greater guarantee than the other. That’s the whole idea of insurance. Assurance. You have absolutely no assurance that an HSA will act like some kind of layaway for a catastrophic situation.

 

[washunut]

Ten years of health premiums is enough to pay cash for a house in much of the country! Some employers charge the whole $20K to their employees.

2019 Employer Health Benefits Survey | The Henry J. Kaiser Family Foundation

Which large company charges the total cost of health insurance to its employees? Not legal under ACA so turn them in.

 

[Neomalthusian]

Instances of $1 put into an HSA averaging a better outcome than $1 put into insurance premiums are rare. HSA has always been a suspect plan. Bad advice.

This doesn’t even make coherent sense.

 

[jaeger19]

What about all the companies that are self insured though? For example, where I work they are self insured. I go with the HSA compatible plan, but ultimately, they just use BCBS for the provider network and BCBS bills the company for every claim.

Personally, I think the best way to make insurance cheaper is to get the most expensive people off of it. For example, you could drop the Medicare eligibility age down to 55. The vast majority of people under 50 pose very little risk to an insurer and insurers are for the most part only paying for their routine care (and not even all that). That is only 7% of overall healthcare spending (and even that, is mostly people over 50). It's the heart attacks, cancers, knee replacements and so on that are the drivers of healthcare costs, and higher insurance premiums.

For example, in August 2016, I was out riding my road bike over lunch and while I was at a stop light, a lady in a minivan drove right through me at 45 mph because she was looking at her phone. I was, and am, in extremely good shape, very strong and fit, so despite waking up in critical care a few hours later with a subdural hematoma, several broken ribs, a shattered scapula, a spinal fracture, and my skull exposed requiring over 100 stitches, I was out of the hospital in just 3 days, back at work in under 2 weeks, running again in 3 weeks, and starting to strength train again in about 8 weeks. No surgeries and no physical therapy needed. Total healthcare costs to my self insured employer, just under 40k. Had I been in the kind of shape and health that a typical American man is in by his late 50s and suffered a the same accident and injuries, it very well could have been hundreds of thousands in medical bills before it was all said and done.

Point being, even when you take into account the tax increases needed to extend Medicare down to 55 year olds, by getting them out of the private insurance system, most likely, premiums would be cut in half for everyone else.

Well first.. the HSA would not mean that employers would have to get rid of their insurance if they did not want to. IF they and their employees.. wished to continue to self insure.. that's fine. If the employees would rather have the self insured plan.. they could do it. and any contributions they made to it would still be tax free and they could use the HSA for things that aren't covered by the self insured plan or for any copays.

As far as your suggestion to lower the medicare age. All you are doing is robbing peter to pay paul. So now you have the taxpayer.. which includes you.. having to pick up the bill for those 55 to 65. Medicare only barely works fiscally now.. by people paying in there working lives and then taking out much later. And it hasn't been bringing in more money than it sends out. Nor equal...so basically you are adding a host of high cost people..who haven't paid in all the way yet.

 

[jaeger19]

One is a health insurance coverage plan, the other one is a tax-free bank account that can only be used for medical costs (until over age 65) without heavy penalty. Anyway, you can contribute up to $3,500 for a single plan or $7,000 for a family plan per yr. Avg. fam. Premium is nearly $19K per yr. Or, just go for the least expensive plan with the lowest deductibles (HSA doesn’t apply to ded. or copay and there are other ins and outs) but has the least coverage and gamble that the $ you can afford to put into the HSA will pay for whatever happens. Maybe you can beat Vegas. Because that’s exactly what you’d have to do. One has greater guarantee than the other. That’s the whole idea of insurance. Assurance. You have absolutely no assurance that an HSA will act like some kind of layaway for a catastrophic situation.

OR.. you make the law so that you can put any amount into an HSA.. so that the employer can contribute tax free into that account.

But either way.. its not like you give up your insurance now when you have an HSA.

And its not beating vegas. I and my employees KNOW that we can put away enough to cover our deductible. So whats better then? Paying the insurance company more every month.. year after years..
Or putting that same amount in an HSA? And then once the deductible and out of pocket is met.. not having to pay?

 

[ALiberalModerate]

Well first.. the HSA would not mean that employers would have to get rid of their insurance if they did not want to. IF they and their employees.. wished to continue to self insure.. that's fine. If the employees would rather have the self insured plan.. they could do it. and any contributions they made to it would still be tax free and they could use the HSA for things that aren't covered by the self insured plan or for any copays.

As far as your suggestion to lower the medicare age. All you are doing is robbing peter to pay paul. So now you have the taxpayer.. which includes you.. having to pick up the bill for those 55 to 65. Medicare only barely works fiscally now.. by people paying in there working lives and then taking out much later. And it hasn't been bringing in more money than it sends out. Nor equal...so basically you are adding a host of high cost people..who haven't paid in all the way yet.

With Medicare, you would obviously have to increase the tax rates to pay for it, which will probably have to be done anyway. Medicare's fiscal woes largely stem from people living longer. Allowing younger people to buy into it if anything would improve its fiscal picture (assuming Medicare taxes were increased sufficiently). Those 55 - 65 are the highest risk individuals on the private insurance market. For Medicare, they would be the lowest risk individuals in the program.

Also, individuals in companies do not self insure, its the company that self insurers. Many medium to large sized companies find it cheaper to self insure, and purchase reinsurance.

 

[UtahBill]

I am retired military so this isn't much concern to me, but.....

I was investing in 401K funds from the start. All went well until Wall Street saw a huge amount of "assets under management" that they could use/abuse at the expense of the public. Add a small fee or increase an existing fee and it adds up very quickly if you have enough accounts to milk. Why should we think HSA funds will escape this ripoff?

And when you turn over some of your hard earned cash to some insurance company acting as an investment company, you have no guarantee it will grow in value.
Just like 401K and other similar plans supposedly operating for your benefit. There is no protection against high fees, exorbitant salaries for agents, brokers, etc.
Am I wrong? Can the public trust Wall Street to act as true fiduciaries?
I think I smell a Ponzi scheme.