Do you recognize that the nature of employment has changed?

[charrison]

Originally posted by: senseamp

Originally posted by: charrison

Originally posted by: Vic

Originally posted by: charrison

Originally posted by: Vic

Originally posted by: charrison
But paying for $89/month for a plan with 5-10K deductable is not bad at all. You just have to ask yourself how much risk you want to bear. For most people in most situations that would save them $110/month. And a 10K deductible is not going to send many people into bankruptcy either.

Yeah, but it's $89/mo for nothing more than disaster/bankruptcy insurance. Calling it health insurance is kind of a stretch.

That is exactly what insurance is. What is sold today for the most part is health care plans, not health insurance. Insurance is for the unexpected and expensive, not the inexpensive and expected.

When you get a middle man(insurance/goverment) involved in the ordinary stuff, you get a health system like we have today. Consumers dont know or care of the cost as their copay is the same and health providers have responded by making things more expensive.

To fix our health care mess, consumers have to bear more risk.

Consumers presently have all the risk they can bear.

The only risk a consumer bears right now is a copay and that is often quite inexpensive. They dont care what doctor they see or where they buy their drugs, the copay is the same. Thie consumer is blind to the actual costs of services and this has let prices rise.

Ask yourself, why is a procedure like lasik, which requires expensive equipment growing in cost at a rate less than inflation. Thats right, it is typically not covered by insurance.

Completely false comparison.
Lasik is an elective procedure most consumers can understand. I mean if Lasik gets too expensive, people will just keep wearing glasses or contacts.

It is not a false comparison at all. THe consumer knows the cost will be and it will be far more than a copay.

If doctor orders an EKG, CAT scan, or an MRI, or a blood test, patient has no way to assess the value of that procedure without getting a medical education, and thus market forces are not likely to work properly.

And under the current system, the consumer will pay they copay and go on. The consumer will not even ask if they are really needed or if there is alternative.

If a doctor says, you need a CAT scan, and that will be $3K, what do you expect the patient to say? Nah, I don't really need one, my life isn't worth $3K? The patient is also likely to be under considerable physical and emotional duress, with real danger to his life or health, essentially being made an offer he can't refuse. This so called "free" market idea of healthcare is a delusion, and a dangerous one that needs to be dissolved.

IF the patient is under duress, they are probably at a hospital and running a tab up already and that is where the high deducible kicks in.

Otherewise the patient can ask questions and find out if the cat scan is really needed or is something else is worth trying first. OR they can shop arround and get it done for much less. THere are MRI labs that operate on a cash basis and do scans for a few hundred dollars. OF course they bill insurance companies much more as the consumer is only responsible for the copay.

 

[senseamp]

Originally posted by: charrison

Originally posted by: senseamp

Originally posted by: charrison

Originally posted by: Vic

Originally posted by: charrison

Originally posted by: Vic

Originally posted by: charrison
But paying for $89/month for a plan with 5-10K deductable is not bad at all. You just have to ask yourself how much risk you want to bear. For most people in most situations that would save them $110/month. And a 10K deductible is not going to send many people into bankruptcy either.

Yeah, but it's $89/mo for nothing more than disaster/bankruptcy insurance. Calling it health insurance is kind of a stretch.

That is exactly what insurance is. What is sold today for the most part is health care plans, not health insurance. Insurance is for the unexpected and expensive, not the inexpensive and expected.

When you get a middle man(insurance/goverment) involved in the ordinary stuff, you get a health system like we have today. Consumers dont know or care of the cost as their copay is the same and health providers have responded by making things more expensive.

To fix our health care mess, consumers have to bear more risk.

Consumers presently have all the risk they can bear.

The only risk a consumer bears right now is a copay and that is often quite inexpensive. They dont care what doctor they see or where they buy their drugs, the copay is the same. Thie consumer is blind to the actual costs of services and this has let prices rise.

Ask yourself, why is a procedure like lasik, which requires expensive equipment growing in cost at a rate less than inflation. Thats right, it is typically not covered by insurance.

Completely false comparison.
Lasik is an elective procedure most consumers can understand. I mean if Lasik gets too expensive, people will just keep wearing glasses or contacts.

It is not a false comparison at all. THe consumer knows the cost will be and it will be far more than a copay.

Elective procedure, do you not get the difference, or you willfully ignore it?

If doctor orders an EKG, CAT scan, or an MRI, or a blood test, patient has no way to assess the value of that procedure without getting a medical education, and thus market forces are not likely to work properly.

And under the current system, the consumer will pay they copay and go on. The consumer will not even ask if they are really needed or if there is alternative.

OK, let's say I ask the doctor, and he says it is necessary, then what? I mean what am I supposed to do with that bit of information?
Decide if a procedure my doctor says is medically necessary for my health is worth the money? Based on what, rolling dice?

If a doctor says, you need a CAT scan, and that will be $3K, what do you expect the patient to say? Nah, I don't really need one, my life isn't worth $3K? The patient is also likely to be under considerable physical and emotional duress, with real danger to his life or health, essentially being made an offer he can't refuse. This so called "free" market idea of healthcare is a delusion, and a dangerous one that needs to be dissolved.

IF the patient is under duress, they are probably at a hospital and running a tab up already and that is where the high deducible kicks in.
Otherewise the patient can ask questions and find out if the cat scan is really needed or is something else is worth trying first.

Ah yes, patient can decide if cat scan is really needed or not. Maybe simple X-ray will catch a cancer, or maybe not. I am sure patient can get an education in radiology and make an informed decision on cost effectiveness of a procedure. Heck, while we are at it, let's just self medicate and self prescribe, since we know best what's good for us.

OR they can shop arround and get it done for much less. THere are MRI labs that operate on a cash basis and do scans for a few hundred dollars. OF course they bill insurance companies much more as the consumer is only responsible for the copay.

So you are saying insurance companies would rather pay thousands than hundreds of dollars? If not, why don't they shop around, and direct patients to these MRI labs? This whole shop around stuff is complete BS, these are not shoes, it's health care. The balance of power and information is not conducive to properly functioning free market.

 

[Patranus]

Heh, I find it funny how everyone here is talking as if the evil health care companies are bilking consumers out of money with "high costs". Do you know how much an MRI machine costs? Do you know how much it costs to operate an MRI machine? Do you know how much an MRI machine operator earns? You guys are acting like MRI machines grow on trees.

MRI machines cost $2,000,000 to 4,000,000 million dollars to buy and install and on top of that $800,000 per year to operate.

 

[Special K]

Originally posted by: Infohawk
Pensions/retirement-funding should not be employer-provided. Instead it should follow the individual. (Again, I'll leave it up to you to decide if the government should set aside a portion of your paycheck or if we should all have our own accounts.)

I agree that pensions don't really make sense in this day and age where there is no loyalty by either employees or employers. 401k plans do follow you around, however. After you leave one job, you can typically leave the money where it is if you like the investment options, or you can roll the 401k money over into a new 401k accout or an IRA at the brokerage institution of your choice.

Also contributing to 401k's has always been optional, although studies have shown that more workers participate when they are enrolled in the plans by default and have to specifically opt out of them, as opposed to not being enrolled in the plans by default and having to opt in.

Originally posted by: Infohawk
We need to have some parity for government employees. They should not have rock-solid job security and benefits that are no longer what the average American can expect. Do you disagree?

I'm not sure what your issue with government employees' job security is. The reason they have job security is because the government isn't a business in the traditional sense of the word - it's goal is not to simply turn a profit, and it can't go bankrupt in the same way that a corporation can, or at least not nearly as easily. Therefore, it doesn't need to constantly cycle its workforce.

IIRC they may have better benefits, but their base salary is probably lower than what the same or a similar job would be paid in private industry. It sounds like a tradeoff to me. For some it would be worth it, for others it wouldn't.

 

[rchiu]

Originally posted by: spidey07
I prefer freedom. One can always get your own health insurance, you don't need to participate in your employer's program. It is a benefit that you can elect to not receive and in turn get more compensation. Choice and freedom are what we need and what we have today.

This is what is wrong, people are too stupid to know that they can get their own health insurance and not through employers group coverage. It's not like that with home, auto or life but people magically thing health insurance is different.

-edit-
What you propose already exists today. Go get your own health insurance and it will follow you. Nothing is stopping you from getting your own health insurance.

Well try to get your own insurance when you have some kind of pre-existing condition. Not every is lucky like you to have perfectly clean bill of heath you know.

For example, I have diabetes. With employee based program, I get health insurance easy, no question ask, no health check, no difference in preminum. I looked into getting my own health insuranance. I'd have to pay through the nose and go through so many procedure to get my own insurance it is not even funny.

 

[WhipperSnapper]

Originally posted by: Infohawk
The modern service economy means people are changing jobs a lot more often than they used to. People also need to change the type of work they do more often. They can't rely on the exact same skill set for the rest of their lives. Employers need to hire and lay people off more frequently and cannot rely on having a static number of employees year after year. The downside is that there is more job instability. The upside is that we have a more efficient, dynamic economy that can respond to supply and demand more easily. Do you disagree?

Unfortunately, few of these services are anything that we can export to other countries that people in the other countries cannot do themselves at lower costs. Since we won't have any money that can be used to purchase manufactured goods from other countries and since we aren't going to produce our own manufactured goods wealth here, we really won't have much need for our "service economy".

Note that the vast majority of "service economy" jobs are not high-value-added knowledge-based college-education-requiring jobs, but rather low-paying, low-value-added jobs such as waitressing and cashiering.

 

[WhipperSnapper]

Originally posted by: spidey07
I prefer freedom. One can always get your own health insurance, you don't need to participate in your employer's program. It is a benefit that you can elect to not receive and in turn get more compensation. Choice and freedom are what we need and what we have today.

That's working really well, isn't it. Also works great in Somalia. The barely functional Somali government might not tell businesses what to do (or at least it doesn't have the power to enforce anything) nor does it regulate health care as far as I know, but so what? Advocating "freedom" is a wonderful, touchy-feely thing. Who wouldn't want freedom and individual rights? Sadly, real-world economics and human behavior are much more complicated than establishing an Atlas Shrugged-like capitalist Atlantis.

This is what is wrong, people are too stupid to know that they can get their own health insurance and not through employers group coverage. It's not like that with home, auto or life but people magically thing health insurance is different.

They're afraid they won't be able to afford it. Perhaps if all employers would pay all of their employees what they spend on them for health insurance in addition to their current compensation it would work.

What you propose already exists today. Go get your own health insurance and it will follow you. Nothing is stopping you from getting your own health insurance.

Except, <cough> <cough>, money. (Duh.)

Note that a great many news reports have come out about insurance companies bending over backwards to drop people's coverage once they are diagnosed with serious conditions. Also, some people just cannot afford insurance or have medical conditions that make it unaffordable. Should those people die under your system?

 

[charrison]

Originally posted by: senseamp

Elective procedure, do you not get the difference, or you willfully ignore it?

Are you willfully ignorant or do you think 100% of all procedures are done under duress where is there hope of taking a closer look at things.

OK, let's say I ask the doctor, and he says it is necessary, then what? I mean what am I supposed to do with that bit of information?
Decide if a procedure my doctor says is medically necessary for my health is worth the money? Based on what, rolling dice?

The doc may say it is needed, he may also say he is doing it be sure or practicing defensive medicine. I had ct scan on my annkle done before I had surgery on it. I am pretty sure this was just defensive medicine and not medically needed. It was no big deal, just $20 copay to have it done. For all I know he was getting a kickback from the imaging off down the hall. Same with my wife when she had to have an mri(and she did need those), but it was not an emergency situation either. We went to were was recommended as the copay was the same no matter where we went.

Ah yes, patient can decide if cat scan is really needed or not. Maybe simple X-ray will catch a cancer, or maybe not. I am sure patient can get an education in radiology and make an informed decision on cost effectiveness of a procedure. Heck, while we are at it, let's just self medicate and self prescribe, since we know best what's good for us.

A simple xray caught my ankle problem. 2 Doctors agreed on the issue I was having. The orthopedic doctor ordered the CT scan to be sure. I really dont think it was needed, but it was done. This is not about patients self diagnose, but making sure patients know if something is really needed or not. As stated in that article you posted, the most expensive peiced of medical equipment is a doctors pen.

So you are saying insurance companies would rather pay thousands than hundreds of dollars? If not, why don't they shop around, and direct patients to these MRI labs? This whole shop around stuff is complete BS, these are not shoes, it's health care. The balance of power and information is not conducive to properly functioning free market.

I am saying it does happen and there is alot of fraud because of insurance in the middle and consumers complete lack of pricing information. It has distorted the market a great deal. I am not saying this is a cureall, but consumers must be informed of pricing, if we want to bring health care under control

 

[Genx87]

Originally posted by: Gonad the Barbarian
I absolutely agree that one's health coverage should not be tied to their employer. It kind of baffles me how most folks are just blindly accepting of how this is. I think cheap labor politicians (you know who you "R") love the fact that one has to risk their health to change jobs.

Probably because it has been like this for quite some time and there are tax benefits from doing it. If I decline my employers health plan and run out and buy my own. I have to do with with aftertax dollars. If I opt into my employers plan it is tax free.

So we have two options to help remedy this situation.

1. Grant the cost of health insurance as a tax deduction for people who buy outside their employer.
2. Tax the benefit when purchased through an employer.

Which one do you think the dimwits in DC will choose?

 

[Genx87]

And yes the cost disconnect is a major issue in tackling the costs of healthcare. People see a dinky 15-30 dollar copay on thousands of dollars worth of procedures. Until the end user see's more of the costs the prices will continue to rise. It is a broken market.

Imagine purchasing car insurance that covered everything for a 15 dollar copay. Oil changes, spark plugs, window wiper blades, tires, lights ect ect. The cost would climb through the roof as people constantly use the system with little regard for cost.

 

[smashp]

Originally posted by: Patranus

Originally posted by: TruePaige
I can't afford 2k a month for health insurance on myself.

A middle of the road plan from Kaiser Permente with prescription drug coverage is $89.00 per month.

Make a CHOICE: Internet or Health Coverage

You CHOOSE to not be able to afford health coverage.

Kp.com

For a 30 year old male a

Plan 20 Copay is 228.34 a month

Plan 1500/3000 DED is 100.47 a month

For a 40 year old male

Plan 20 Copay is 320.40 a month

Plan 1500/3000 DED is 143.91 a month

For a 50 year old male

Plan 20 Copay is 461.70 a month

Plan 1500/3000 DED is 207.52 a month

For a 60 year old male

Plan 20 Copay is 730.63 a month

Plan 1500/3000 DED is 328.60 a month

the fine print on the quoting engine

"The system calculates the estimated rates based on the information you have provided. Actual rates may vary based on which family members are approved for coverage and on your selection of optional benefits.

The quote is not a binding contract between you and Kaiser Permanente. Rates are subject to change. "

 

[0marTheZealot]

Originally posted by: Genx87

Imagine purchasing car insurance that covered everything for a 15 dollar copay. Oil changes, spark plugs, window wiper blades, tires, lights ect ect. The cost would climb through the roof as people constantly use the system with little regard for cost.

If the consumer had to pay a fraction of what is owed for these tests, the consumer would quickly go bankrupt. The whole problem is that the health condition may not always be found on the first test. This isn't a car where most of the problems are pretty obvious. Your proposal might make sense if doctors were limited to a set number of tests, the costs were brought down considerably and the percentage paid was reasonable. However, it's just not feasible.

 

[StageLeft]

It is strange to tie it to employment.

I'd have to worry about a lapse in coverage turning some condition I don't even know about into "pre-existing."

Immaterial unless looking for your own insurance; most employers will take you on regardless of any "pre-existing" condition.

I can't afford 2k a month for health insurance on myself.

Where the hell did you pull that number from? I can insure my entire family with awesome deductibles for well under $1k. There are much cheaper plans with higher deductibles.

Healthcare costs are high, but we as a society are not looking at some harder choices including:

1) Stop being a fat smoking drunk lazy bastard. Ever heard of a treadmill? Salad? 2/3 of the population is overweight and half of them obese. Pathetic and downright shameful. Most people put in no effort _at all_ to live in a healthy way.
2) I've heard 80% of a person's lifetime healthcare costs occur in the last year. Is this really money well spent? For those who say money is no object to extend life, what if it was 90%? What if it was 99%? It's increasingly silly to throw money at somebody who's about to die soon anyway. Money is simply resources and they are finite.

 

[StageLeft]

Let's not pretend that a great many uninsured are uninsured by choice. You can bet your sweet ass that many of the 50 million "uninsured" manage to find money to go to restaurants and buy new cars and other crap. They'd just rather have a new car for $500/month than a used one and $500/month to medicine. This is a risk they take. Then they get sick and cry foul. And of those 50 million, I'd be willing to bed at 40 million of them or more do very little in the way of preventative care (read: stop eating like a stray dog at a knocked over garbage bin and exercise). I ask: is there anything sadder than a morbidly obese person suffering from a catastrophic illness complaining about how they can't afford healthcare? They didn't have a problem affording the food.

Feel it. Feel the love! :heart:

 

[RyanPaulShaffer]

Originally posted by: Skoorb
Let's not pretend that a great many uninsured are uninsured by choice. You can bet your sweet ass that many of the 50 million "uninsured" manage to find money to go to restaurants and buy new cars and other crap. They'd just rather have a new car for $500/month than a used one and $500/month to medicine. This is a risk they take. Then they get sick and cry foul. And of those 50 million, I'd be willing to bed at 40 million of them or more do very little in the way of preventative care (read: stop eating like a stray dog at a knocked over garbage bin and exercise). I ask: is there anything sadder than a morbidly obese person suffering from a catastrophic illness complaining about how they can't afford healthcare? They didn't have a problem affording the food.

Feel it. Feel the love! :heart:

This.

The fact that is largely (perhaps willingly) ignored by those screaming for universal health care is the fact that there are tons of health insurance plans out there, many of which are extremely affordable. A single guy in their 20s, for example, can get coverage for like $40 a month. Now, it won't contain all the frilly crap like $20 co-pay office visits, chiropractors, rehab, etc., but if you are in an accident and/or need to go to the hospital for something serious, you would be covered.

There are two problems I see with the current health care system. One is the fact that your coverage is tied to your employment. Another is the whole "pre-existing condition" thing. Other than that, the only other thing I could see is that insurance companies drop all the fluffy crap from most of their basic plans (while still retaining the option to get them if you wanted), and you'll see premiums come way down.

A private market solution without spending tons of tax-payer dollars and creating more government bureaucracy! :Q

 

[Uhtrinity]

Originally posted by: DaveSimmons
Health insurance would be my biggest worry in changing jobs. I keep enough in savings that I could, and would like to, take a vacation in between but I'd have to worry about a lapse in coverage turning some condition I don't even know about into "pre-existing."

I also approve of the 401k model, but I think it should be harder to get your hands on the money when changing jobs -- something like: a minimum of 50% must go into a brokerage account that you can't withdraw funds from until age 59.

The last year has shown that the 401k model doesn't work. In one year speculators get greedy and someone loses 40% of their retirement savings after being told it is safe to go long. retirement shouldn't be a gamble. It is also wrong that you practically have to have a degree in economics to make 401ks / stock market profitable.

The point the OP makes is good, and is another reason for going to a single payer health care system. I myself have had 3 major employers in the last 10 years which means I had 3 different health plans with gaps in coverage between jobs. Two out of those three jobs didn't even have coverage the first year of employment.

 

[Uhtrinity]

Originally posted by: Patranus

Originally posted by: TruePaige
I can't afford 2k a month for health insurance on myself.

A middle of the road plan from Kaiser Permente with prescription drug coverage is $89.00 per month.

Make a CHOICE: Internet or Health Coverage

You CHOOSE to not be able to afford health coverage.

At what, a $6k deductible, and their coverage area seems limited? Most likely if you are working a job that has no benefits it is doubtful you would be able to meet the deductible if anything happens. I know first hand how bad it can be. I've gone from no insurance with major bills, to crappy insurance with major bills, and great insurance. There is a huge difference. A low wage earner with crappy insurance will end up in collections just as fast as someone with no insurance.

 

[TheSkinsFan]

Originally posted by: Infohawk
We need to have some parity for government employees. They should not have rock-solid job security and benefits that are no longer what the average American can expect. Do you disagree?

I disagree completely. What the heck is wrong with someone having rock-solid job security and benefits?! Why would you want to take those away?

 

[StageLeft]

Two out of those three jobs didn't even have coverage the first year of employment.

Wow, that sucks!

BTW Cobra should hook you up between jobs for a while, and you only need to pay it IF you need it, which is an interesting and surprising bonus.

The last year has shown that the 401k model doesn't work. In one year speculators get greedy and someone loses 40% of their retirement savings after being told it is safe to go long.

The only people who lost 40% were either stupid or are not retiring for so long that it shouldn't really matter that much. I was one of them and in the latter category. If you put money into an index fund and a decent mix of bonds, that's really all anybody is being told to do and it doesn't require a degree.

A low wage earner with crappy insurance will end up in collections just as fast as someone with no insurance.

In many cases this can be true. In the end, the only way for good, solid coverage to be extended to even the lower classes is for the middle and upper to pay more taxes to spread the wealth south. There's no other way around it.

 

[Vic]

Good read on this subject

Your employer-provided tax-exempt govt-subsidized benefits are a result of the WWII war effort. There's nothing free market about them.

 

[BoomerD]

Originally posted by: Patranus

Originally posted by: TruePaige
I can't afford 2k a month for health insurance on myself.

A middle of the road plan from Kaiser Permente with prescription drug coverage is $89.00 per month.

Make a CHOICE: Internet or Health Coverage

You CHOOSE to not be able to afford health coverage.

Maybe for you kids...My wife & I are in our 50's and Kaiser is about $800/mo.

A decent Blue Cross policy is almost $1000/mo, and a good policy is over $1200/mo.

When my union insurance ran out in 2004, the COBRA cost was almost $1400/mo...:shocked:

 

[Gonad the Barbarian]

I'll be the first to agree that people in general have horrible consumption priorities, but unless you are buying to what amounts to an extra car every year health insurance isn't something you can budget in by just cutting other expenses here and there.

 

[evident]

Originally posted by: spidey07

Originally posted by: JKing106

Originally posted by: spidey07
This is what is wrong, average, blue collar people are too poor to afford their own heatlth insurance, rent/mortgage, food, and utilities not through employers group coverage.

Fixed

Bullshit. They can afford all those an more but choose to live beyond their means.

i dont know how you can make very informative and smart posts in other forums but be very shortsighted and borderline troll in P&N. have you looked up rates to get health insurance by yourself without getting help from an employer? a COBRA alone is about $700 a month for a healthy 24 yr old like me. imagine someone older w/ health probs? that $700 is rent in some areas imagine if they had a car payment, mortgage/rent and other shit they got to pay for

 

[Special K]

Originally posted by: Uhtrinity
The last year has shown that the 401k model doesn't work. In one year speculators get greedy and someone loses 40% of their retirement savings after being told it is safe to go long. retirement shouldn't be a gamble. It is also wrong that you practically have to have a degree in economics to make 401ks / stock market profitable.

This is incorrect. If someone was close to retirement last year, they shouldn't have had their money invested 100% in stocks. The stock market is volatile in the short term - as you move closer to retirement, you are supposed to shift assets from stocks and into bonds/cash to help prevent these market events from devastating your portfolio.

You certainly don't need a degree in economics to use a 401k. Try reading The Boglehead's Guide to Investing, Mutual Funds For Dummies, and/or The Only Guide to A Winning Investment Strategy You Will Ever Need. It outlines a solid investing strategy that anyone with the time to read the book can understand.

My biggest complaint about 401k plans is the crappy choices and high expenses present in most of them. Some plans have fees that aren't visible to the plan participants, but eat away at returns.

 

[SammyJr]

Originally posted by: Patranus

Originally posted by: TruePaige
I can't afford 2k a month for health insurance on myself.

A middle of the road plan from Kaiser Permente with prescription drug coverage is $89.00 per month.

Make a CHOICE: Internet or Health Coverage

You CHOOSE to not be able to afford health coverage.

What's the deductible? What preexisting conditions are allowed? How long until they are covered? What's the prescription copay? What's the coinsurance? What's the max out-of-pocket? How many people does that cover?

Somehow for $90/month, I think it covers one young person in excellent health with a $5000 deductible, $50 drug copays, and no office visits. In other words, a very small percentage of the population can actually use this kind of plan.