Quote:A health savings account is not health insurance. What you are doing is self-insuring at least a portion of the costs that are not covered by your regular health insurance policy. So you really can't equate what you call the "premium" on your HSA with the premium on your health insurance policy. They are not the same thing.
Yes, I know. My "Premium" is $160 a month for my HDHP HSA. My old "Premium" was around $500 a month, so I still pretend like I am paying my old premium by putting the difference in my HSA versus just keeping the cash for a larger paycheck.
The actual health insurance plan is crap. Simply there to get those mysterious "negotiated discounts" off of your doctor bills that magically reduce them by 75% still leaving you with a ridiculous bill.
Quote:A health savings account is not health insurance. What you are doing is self-insuring at least a portion of the costs that are not covered by your regular health insurance policy. So you really can't equate what you call the "premium" on your HSA with the premium on your health insurance policy. They are not the same thing.
You are kind of right, but there is a difference. Health insurance should not cover or pay for routine health care which is the reason for a HSA. Health insurance should cover catastrophic and/or unexpected injury or illness.
A HSA allows a person to put money aside tax-free for routine medical expenses. One of the many benefits of it is it can be passed on to family members in the event of your death. It can be used not only to pay for routine doctor visits (physical, dental checkup, eye exam, etc.), but also medications both prescription and over-the-counter. Insurance shouldn't pay for such things.
If your "insurance" is paying for those things, then it really isn't "insurance". Would you rather pay a higher premium for your "health care plan", or save the money tax free yourself and be able to leave it to your loved ones?
Quote:You are kind of right, but there is a difference. Health insurance should not cover or pay for routine health care which is the reason for a HSA. Health insurance should cover catastrophic and/or unexpected injury or illness.
A HSA allows a person to put money aside tax-free for routine medical expenses. One of the many benefits of it is it can be passed on to family members in the event of your death. It can be used not only to pay for routine doctor visits (physical, dental checkup, eye exam, etc.), but also medications both prescription and over-the-counter. Insurance shouldn't pay for such things.
If your "insurance" is paying for those things, then it really isn't "insurance". Would you rather pay a higher premium for your "health care plan", or save the money tax free yourself and be able to leave it to your loved ones?
This is your opinion. I think routine should be covered.
Routine and prevention is the key to driving costs down. Otherwise folks stop going for check ups until that catastrophe.
Quote:This is your opinion. I think routine should be covered.
Routine and prevention is the key to driving costs down. Otherwise folks stop going for check ups until that catastrophe.
That last line goes right over his head. He brings this point up every time and is dead wrong.
Regular doctors visits: physicals; vision, dental, hearing exams, mammograms, prostate checks, vaccinations, diet checks, blood work, stress tests, are good for everybody and can help prevent more serious health outcomes.
But that is just one part of the healthcare issue. We need to develop a new American culture of sound diets and exercise. Food providers need to provide safer and more nutritious food products. We need to get away from the junk food and drinks. I'm not suggesting a ban but a change in the way we think about what we put in our bodies.
Quote:When your deductible with a "regular" health insurance policy is upwards of $2500, which is the case for most policies since the ACA was passed, then it is the same thing. The "regular" plan is just more expensive and interferes with the free market.
$2500 is a catastrophic plan. The average silver plan with dental and vision is like $500-$700.
Quote:$2500 is a catastrophic plan. The average silver plan with dental and vision is like $500-$700.
Yeah thats not correct, 10k is a catastrophic. $2500 is considered a decent option for an 20/80 plan (i.e. a silver). And its what several of my jobs offered (thus disqualifying me from being able to pick my own on the exchange). Health insurance is a bad deal for most folks post Obamacare, it did not get cheaper.
Need to clarify I was talking about an Out of Pocket. My deductible was about a 1000, then 2500 limit for 'in network.' 5k for level B, and 10k for out of network.
Quote:
<blockquote class="ipsBlockquote" data-author="jj82284" data-cid="971117" data-time="1488330402">
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1.) I never stated that the Swiss system was perfect.
No system is perfect. But the others are
significantly better.
2.) As we have stated above, Medicare already acts as a defacto government benchmark for fee schedules. We still have the same challenges.
Medicare in no way limits charges made by our private health systems.
3.) We've already talked about the importance of cost transparency and consumer choice.
So you agree all of this talk of competition is pretty pointless if we can't know what everyone is charging? If not, how do you solve the problem and guarantee competition?
4.) Just as an aside, we currently have more than 150% of the entire population of Switzerland living in the country as undocumented aliens.
Yes, and they are a bit of a drag due to emergency care. If emergency care is 2% of spending, and undocmented aliens are 3% of the population, it matters, but ins nowhere near the bulk of the costs.
5.) The Labor force participation rate in Switzerland is over 80% here its just over 60%, They have conversations about how best to deliver care within their communal values and not as much about half the country trying to piggy back the other half.
Yeah, or maybe it is the fact that all of the other countries use the government to actually do something useful like get decent rates on procedures and medicine.
</div>
</blockquote>
Just gonna point out again that you are equating better to cheaper. I don't think most people in healthcare see it that way. There Labor Force Participation rate is a huge deal that you can't ignore. If 80% where working instead of 60% we might not even have a deficit. They don't have a massive retirement age population that is far larger than the generation below them. Their healthcare 'payer mix' is much better.
Quote:1.)Significantly is a relative term. As the Forbes article stated, we are essentially the world Leader in speed getting people to Treatment. My wife for instance has had a routine check up at 10:00 and been in for a diagnostic referral before the close of business. That creates value vs. a system that would make her wait 6 months for government approval. Also, you have to make adjustments for other economic conditions. Per Capita GDP in Britain is 38k and per Capita GDP in the US is nearly 60k then there is a built in difference in how that correlates to wages and thus the cost of delivering health care.
There are certain features that other countries have tried that may add value to our overall health care market and I think it makes sense to consider adopting some of them.
2.) Medicare Might not make statutory requirements of health care providers, but generally costs and reimbursements are based on the direction Medicare Takes.
3.) Agree, I am the one who bought it up. When you walk into the average Doctors office, even if you ask what a procedure will cost they can't give you an answer. More over, we bundle our catastrophic risk, preventative prepayment, incidental care risk, collective purchasing power, etc. all in the same financial instrument (current health insurance). We should be looking at ways to take preventative and incidental care away from major insurance and have risk pools managed by care providers. Also, we should be able to create groups to allow banding and collective purchasing that are a.) not tied to employment, b.) able to allow each individual policy owner to own their own policy.
4.) You missed it. at current about 71% of undocumented immigrants are on some form of government assistance. The vast majority will not be covered or be receiving their care through some form of a government program. That means that we are already subsidizing a population greater than that of most of the ALTERNATIVES That most people point to. This is a contributing factor to why Switzerland actually spends about 1/3rd the money we do as a percentage of GDP on Healthcare expenses.
5.) Why do you keep pointing to other countries that have longer wait times and less choice as better options? more over, why don't you point to the VA as the system that you want to participate in? Why don't you tout the actuarial solvency of Social Security as the Gold standard in Modern government run insurance? Why don't you tout the transparency of the Obama Care deliberations, and the promises made to the American people as the clear winner over Public Insurance companies and their requirements to tell the Truth?
Instead we just get the standard answer of "all other industrialized Democracies" When we point out that our current employer based system is the byproduct of failed price controls what's your response?
As FL pointed out, the basic principle of economics is Scarcity. That Scarcity will manifest itself in some way, be it through price or lack of supply. We could pass a law that says every laptop only costs 5 dollars. Guess how many laptops will get produced? Allow people to see their own costs, make their decisions and hold providers accountable to provide more options to the public to do things more efficiently while getting barriers out of their way!
Quote:Exactly. Companies don't invest time or money in the individual market (10% of the population) because the money is in the group markets (85% of the population) IT's a bigger piece of the pie, the persistency of premium payments is going to be exponentially higher because you are dealing with corporate officers and not just random people. Moreover, people are only going to be employed there for 3-5 years on average. That creates and ARTIFICIAL TERM in the actuarial calculations that means that there is theoretically less risk insuring that pool.
IF we truly had a free market where there wasn't a double blind between patients and Doctors (their employer and the insurance companies) then we would have much better options as consumers.
Excellent posts, agreed 100%.
Quote:That last line goes right over his head. He brings this point up every time and is dead wrong.
Regular doctors visits: physicals; vision, dental, hearing exams, mammograms, prostate checks, vaccinations, diet checks, blood work, stress tests, are good for everybody and can help prevent more serious health outcomes.
But that is just one part of the healthcare issue. We need to develop a new American culture of sound diets and exercise. Food providers need to provide safer and more nutritious food products. We need to get away from the junk food and drinks. I'm not suggesting a ban but a change in the way we think about what we put in our bodies.
This is true, and insurance companies should provide those on their own (because they benefit the insurance just as much). But as JJ mentioned in his post, by tying themselves (insurance) to employers they create artificial terms which dis-incentivizes them to do this. Which kind of lead to ACA in the first place.
Agree on the second point as well. Take away the corn subsidies.
Quote:This is true, and insurance companies should provide those on their own (because they benefit the insurance just as much). But as JJ mentioned in his post, by tying themselves (insurance) to employers they create artificial terms which dis-incentivizes them to do this. Which kind of lead to ACA in the first place.
Agree on the second point as well. Take away the corn subsidies.
We wouldn't need an employer mandate if we had singlepayer.
Also I was wrong about the insurance deductibles. Maybe it's different in Florida but where I am you can get a good silver plan with vision and dental where you pay around $750 a year. The deductible is $550. Doctors visits are $5, Specialist are $1, Behavioral Health includes unlimited visits for $1. I think that's a good deal...much better than the crappy graduate student insurance that you're forced to opt in for $150 a month or any employer insurance I have had. The only negative is that some in-network drs are a little farther away than typical. But how iften are you going to see a dentist anyway?
Quote:This is your opinion. I think routine should be covered.
Routine and prevention is the key to driving costs down. Otherwise folks stop going for check ups until that catastrophe.
Ford some it makes sense to pool preventative risk with catastrophic coverage. For some it doesn't.
The better question is are there more efficient self contained risk management strategies for routine/preventative that cut out the middle man. If you have hsa paying for concierge care and couple that with major medical then that might be the most efficient formula.
Quote:$2500 is a catastrophic plan. The average silver plan with dental and vision is like $500-$700.
Where are you getting these numbers? That's not what i saw?
Quote:We wouldn't need an employer mandate if we had singlepayer.
Also I was wrong about the insurance deductibles. Maybe it's different in Florida but where I am you can get a good silver plan with vision and dental where you pay around $750 a year. The deductible is $550. Doctors visits are $5, Specialist are $1, Behavioral Health includes unlimited visits for $1. I think that's a good deal...much better than the crappy graduate student insurance that you're forced to opt in for $150 a month or any employer insurance I have had. The only negative is that some in-network drs are a little farther away than typical. But how iften are you going to see a dentist anyway?
Deductible is not the important one, OOP expenses are. Even one hosp admission and the deductible is shot easily. And that's for an in-network hospital.
Quote:Deductible is not the important one, OOP expenses are. Even one hosp admission and the deductible is shot easily. And that's for an in-network hospital.
So far my OOP expenses have been reasonable usually nothing more than a $200 bucks a year. I recently had a hospital visit whenI came back home to Jacksonville and it was covered fully. I think it really depends on the details of the plan.
Quote:I'm sorry, I didn't realize we were arguing. I can't and don't defend our system as you seem to want, and have no real interest in doing so. I hopefully gave you some information about how prices are set that you can use or not, I don't really care if you're disappointed. The facts is simply that we have a choice between more government control and less government control of the healthcare sector and I will always favor less. If you are incapable of recognizing that your thoughts are much more complex than a comparison of prices among unlike environments then you should expand your thinking.
You are absolutely correct that my disappointment is my problem. I am working some doubles, so will have to get into more detail later, but you seem to be in favor of competition and free market solutions, which is good, and I think you (and jj) are in favor of price transparency (which in my opinion is absolutely essential). We also agree that diet and individual responsibility is important. But just to be clear, I am not sure I have ever gotten an opinion on how procedure and drug costs are more expensive for private insurance here versus other countries, even those with private insurance. Did I miss that somewhere?
Quote:Regarding #2, how many contracts have you negotiated with an insurance company, what conversion factor did you use to set your fee schedule, and how did you assign credit to the physicians to compensate them for their labor while insuring adequate margin for non-production overhead?
None. I was referring to any formal limits, it sounds like you are stating that it serves as some sort of starting point in negotiations, a believe. Far earlier in the thread I believe I referred to some studies that indicated that there was a pretty large discrepancy in many fields from the medicare rates. But it sounds like you have been involved in such negotiations perhaps?
Quote:1.)Significantly is a relative term. As the Forbes article stated, we are essentially the world Leader in speed getting people to Treatment. My wife for instance has had a routine check up at 10:00 and been in for a diagnostic referral before the close of business. That creates value vs. a system that would make her wait 6 months for government approval. Also, you have to make adjustments for other economic conditions. Per Capita GDP in Britain is 38k and per Capita GDP in the US is nearly 60k then there is a built in difference in how that correlates to wages and thus the cost of delivering health care.
There are certain features that other countries have tried that may add value to our overall health care market and I think it makes sense to consider adopting some of them.
2.) Medicare Might not make statutory requirements of health care providers, but generally costs and reimbursements are based on the direction Medicare Takes.
3.) Agree, I am the one who bought it up. When you walk into the average Doctors office, even if you ask what a procedure will cost they can't give you an answer. More over, we bundle our catastrophic risk, preventative prepayment, incidental care risk, collective purchasing power, etc. all in the same financial instrument (current health insurance). We should be looking at ways to take preventative and incidental care away from major insurance and have risk pools managed by care providers. Also, we should be able to create groups to allow banding and collective purchasing that are a.) not tied to employment, b.) able to allow each individual policy owner to own their own policy.
4.) You missed it. at current about 71% of undocumented immigrants are on some form of government assistance. The vast majority will not be covered or be receiving their care through some form of a government program. That means that we are already subsidizing a population greater than that of most of the ALTERNATIVES That most people point to. This is a contributing factor to why Switzerland actually spends about 1/3rd the money we do as a percentage of GDP on Healthcare expenses.
5.) Why do you keep pointing to other countries that have longer wait times and less choice as better options? more over, why don't you point to the VA as the system that you want to participate in? Why don't you tout the actuarial solvency of Social Security as the Gold standard in Modern government run insurance? Why don't you tout the transparency of the Obama Care deliberations, and the promises made to the American people as the clear winner over Public Insurance companies and their requirements to tell the Truth?
Instead we just get the standard answer of "all other industrialized Democracies" When we point out that our current employer based system is the byproduct of failed price controls what's your response?
As FL pointed out, the basic principle of economics is Scarcity. That Scarcity will manifest itself in some way, be it through price or lack of supply. We could pass a law that says every laptop only costs 5 dollars. Guess how many laptops will get produced? Allow people to see their own costs, make their decisions and hold providers accountable to provide more options to the public to do things more efficiently while getting barriers out of their way!
Will provide more detail later when I get more time, but thanks for your reply.
1) I am not aware of these 6 month waits for a general checkup, but maybe you have some info. When I say significantly, I refer to things like the deaths due to lack of insurance, the huge numbers of bankruptcies, and other admittedly less specific info like satisfaction with care and life expectancy.
2) If by based you mean it servers as a starting off point, maybe, but I think there is very large variance in the specifics.
3) Good, we agree on the price transparency and the removal of links to employment. That at least provides a bit of groundwork for me to wrap my head around a private system with no governmental involvement, which I think is your preference, or am I off on that?
4) Yeah, I did miss it and still am. I am not seeing the impact you are giving to undocumented impact. Got any facts for this?
5) No, i point to other countries that have far more choice, and have seen nothing from anyone on the wait times that indicates that the other countries like Switzerland or France are worse. And I have no idea what you are talking about with Obamacare. Other than the preexisting conditions stuff, I am not a big fan.And referring to the origin of a bad system being a bastardization of some 1940's dodge seems pretty irrelevant compared to real-time comparisons with those 'other countries'.
Finally, what does scarcity have to do with the costs of a shoulder replacement procedure being less in France or Germany than the U.S.?
So BiffSkippy what's your opinion on CheetoCare?