Open Enrollment

[LogGrad98]

At this wonderful time of year, open enrollment time, when we find out how our new insurance plan is suckier and more expensive than ever, let's open a new thread to bitch about the broken American health care system.

At our open enrollment our insurance cost in premiums rose by 12% overall, but at the same time they changed from total coverage plans to high-deductible plans. So cost went up and quality of coverage went down significantly. The lowest cost plan last year had a $6k deductible for a family, this year it is $12k, and it covers fewer preventable drugs and costs 10% more than last year. The plan with the best coverage last year, and highest cost, had a $2k deductible with co-pays for dr visits and such, which was decent. This year the co-pay part was dropped and the deductible was raised to $4k, with 80% coinsurance after deductible, where last year it was 85%, and the cost went up a whopping 16%. This is now, with this update, the same for prescriptions as they are all under the same plan. And our list of low-cost preventative prescriptions, like blood pressure meds and such, has shrunk so much our out of pocket for prescriptions will nearly double. On that front it is worth it for us to buy a supplemental plan for prescriptions.

I am looking at a bi-weekly premium of nearly $500 for a middle of the road plan. That is almost enough to make looking for a plan in the marketplace viable. However I am in that wonderful middle level of earners making too much for any support on the premiums, but nowhere near enough to be able to just not worry about it. I am going to be paying out the equivalent of 2 car payments a month, and still won't have true coverage until I shell out another $6k on top of it in deductibles, then I will still be responsible for 20% of every bill as coinsurance. Based on our family's past medical history (and using the cost estimating tool our company provides) this means my total cost of health care this year stands to be between approx $28k and $40k, considering my wife needs surgery for her hip dysplasia which will be approx 25k, if we are lucky, and I need a procedure done on my spinal fusion which should cost around 15k. This includes all premiums, estimated prescription costs, deductibles, and co-insurance at 20% for the surgeries. This does not count diagnostics, where both my wife and I will need multiple CT and MRI scans, so this could very well be more than $10k low. So we are looking at paying out right around 25% of my salary just for health care.

For anyone who cares to keep track, that is nearly 10% higher than we paid in Germany, all costs included, including "higher" premiums for the single-payer system (about 15% of my total salary went to health care costs). And I made quite a bit less in Germany than I do now.


So let's get into it!

Here is a short but decent article:

Is our healthcare system broken? - Harvard Health

The US healthcare system is expensive, complicated, dysfunctional — and broken. The system needs a major overhaul, and the arguments for this fall into a few broad categories: high cos...

www.health.harvard.edu

Here is another nice depressing piece, with a selected quote:

Health Insurance & Medicare

WebMD provides coverage of health care reform, Medicare, Medicaid, health insurance, and the Affordable Care Act, including benefits, costs, coverage, financial assistance, and much more.

www.webmd.com

Aug. 4, 2021 -- The U.S. health care system ranked last overall among 11 high-income countries in an analysis by the nonprofit Commonwealth Fund, according to a report released this week.

The report is the seventh international comparison of countries' health systems by the Commonwealth Fund since 2004, and the United States has ranked last in every edition, David Blumenthal, MD, president of the Commonwealth Fund, told reporters during a press briefing.

Researchers analyzed survey answers from tens of thousands of patients and doctors in 11 countries. They analyzed performance on 71 measures across five categories — access to care, care process, administrative efficiency, equity, and health care outcomes. Administrative data were gathered from the Organization for Economic Co-operation and Development (OECD) and the World Health Organization (WHO).

Among contributors to the poor showing by the U.S. is that half (50%) of lower-income adults and 27% of higher-income adults say costs keep them from getting needed health care.

"In no other country does income inequality so profoundly limit access to care," Blumenthal said.

In the United Kingdom, only 12% with lower incomes and 7% with higher incomes said costs kept them from care.

In a stark comparison, the researchers found that "a high-income person in the U.S. was more likely to report financial barriers than a low-income person in nearly all the other countries surveyed: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the U.K.."

Norway, the Netherlands, and Australia were ranked at the top overall in that order. Rounding out the 11 in overall ranking were (4) the United Kingdom, (5) Germany, (6) New Zealand, (7) Sweden, (8) France, (9) Switzerland, (10) Canada, and (11) US.

Vomit if you must first, then discuss. But don't expect any kind of help from your doctor if you are vomiting, unless you want to pay $300 toward your $12,000 deductible.

 

[Al-O-Meter]

Our healthcare system is broken, but the solution isn’t socialized healthcare. Obamacare was written by the healthcare industry and American "socialized healthcare" would be Obamacare on steroids.

The laws are written in such a way that only a certain type of provider can provide the service. That limits supply which increases cost. The most obvious demonstration of how it works is in the number of abortion providers in super pro-life states. All the legislatures in those states had to do was classify abortion providers as healthcare providers and nearly all of them in those states went out of business.

Like so many things, government isn’t the solution to the problem. Government *IS* the problem.

 

[RandyForRubio]

Our insurance system is objectively awful.

I use a Christian health share plan, as my family is still fairly young, and we don’t go to the hospital often. So this might not work for everybody.

I pay a little over $500/month for my family of 6. With an add on that’s an additional $75 every quarter, I get coverage that is considered unlimited. There are some bills that wouldn’t be covered, a vasectomy for example. But my wife’s most recent pregnancy, everything was covered. A $15,000 bill covered, no problem. So every medical incident that’s over $500 is covered. Anything under that, you pay yourself.

I have saved an incredible amount of money doing this, and had little to no problems. Now as I get into my 50’s and 60’s, I might switch back to a more traditional insurance, but for now, this is as easy and cheap as can be.

 

[One Brow]

Our healthcare system is broken, but the solution isn’t socialized healthcare. Obamacare was written by the healthcare industry and American "socialized healthcare" would be Obamacare on steroids.

Obamacare is designed to support private, corporate profits. Socialized healthcare would remove the profit motive. Other features might be worse or better, but this would mean a significant difference.

The laws are written in such a way that only a certain type of provider can provide the service.

Are you referring to the existence of medical specialties? Which laws, for example, prevent a GP from performing surgery of giving an allergy test? If not this, what do you mean?

That limits supply which increases cost. The most obvious demonstration of how it works is in the number of abortion providers in super pro-life states. All the legislatures in those states had to do was classify abortion providers as healthcare providers and nearly all of them in those states went out of business.

Abortion was classified as a medical procedure because it is a medical procedure, one that can cause great harm if not performed by knowledgeable people.

Like so many things, government isn’t the solution to the problem. Government *IS* the problem.

Because health care is so much better in countries that don't have government-provided healthcare?

 

[One Brow]

Our insurance system is objectively awful.

I use a Christian health share plan, as my family is still fairly young, and we don’t go to the hospital often. So this might not work for everybody.

I pay a little over $500/month for my family of 6. With an add on that’s an additional $75 every quarter, I get coverage that is considered unlimited. There are some bills that wouldn’t be covered, a vasectomy for example. But my wife’s most recent pregnancy, everything was covered. A $15,000 bill covered, no problem. So every medical incident that’s over $500 is covered. Anything under that, you pay yourself.

I have saved an incredible amount of money doing this, and had little to no problems. Now as I get into my 50’s and 60’s, I might switch back to a more traditional insurance, but for now, this is as easy and cheap as can be.

You may have already seen this, and if your plan is working for you, I'm certainly not telling you to change. Still, I thought it should be offered.

 

[fishonjazz]

Damn log. Our healthcare does suck but yours is extra sucky. Thats was too high of premiums. My heathcare plan went up a little compared to last year. I pay about 400 bucks per month plus i put about 100 into my hsa each month. Family deductible is 3000 dollars of which i pay 100% up to that point and then insurance pays 80% after that. I think my max out of pocket is 6000. My company puts 700 into my hsa at the beginning of each year which is nice.

I try to avoid going to the doctor no matter what.


Sent from my iPad using JazzFanz mobile app

 

[Al-O-Meter]

Socialized healthcare would remove the profit motive.

Not a chance. Any American socialized healthcare will still have drug companies developing the drugs and corporate owned hospitals doing hospital things. Whatever law is made to socialize healthcare in America would be written in a way to please the massive political donors who finance election campaigns. The profit motive will go nowhere. There is no way Home Depot could sell an $800 toilet seat to consumers, but the government has purchased a lot of $800 toilet seats. Passing socialized medicine will allow providers to jack their prices far higher by making the government the purchaser than they ever could if they had to sell to consumers. That is the goal. Everything about making healthcare available to the poor is the happy story they're peddling to get the public to agree to making the government the purchaser.

Are you referring to the existence of medical specialties? Which laws, for example, prevent a GP from performing surgery of giving an allergy test? If not this, what do you mean?

The laws are far more insidious. For example, one that has been used to put a lot of abortion providers out of business is the minimum hallway width laws. The hallways in medical facilities have to be a certain width supposedly to allow gurneys to get through when other gurneys are along the wall. There are hundreds of laws like this that hinder small shops from opening in regular commercial spaces.

Because health care is so much better in countries that don't have government-provided healthcare?

The idea of government built hospitals directly employing doctors who use government medical equipment and dispense government drugs in America isn't reality.

 

[RandyForRubio]

You may have already seen this, and if your plan is working for you, I'm certainly not telling you to change. Still, I thought it should be offered.

I made it about 10 minutes. There is a ton of misinformation, and I mean, it’s John Oliver, that’s not surprising. He’s being intentionally biased because he disagrees with it, and that’s fine.

So for some examples, I’ll use my healthcare company because I’m familiar with it. They’re very upfront that it’s not insurance, that there are certain things that are not eligible for cost sharing, and they spell it all out pretty well. There really aren’t any surprises. I don’t know why Oliver is shocked that a company named Christian Healthcare Ministries (CHM) would have certain Christian moral requirements for its use, I mean, that’s the entire idea of it. It’s a sort of an insurance alternative for a specific group of people. I had a pre-existing issue before I signed up for it, let them know, and I haven’t had any issues getting my things covered. As far as amount of coverage, that depends on how much you want to pay per month. I have unlimited coverage. It’s also a misconception that you have to send a check to families in need to pay for their bills. I have never done that, nor have I ever received one. And in one part he mentioned how a family was eligible for $250k of help. That is per case, and you can get more coverage if you pay more per month.

It’s certainly not something that is for everybody. It doesn’t claim to be. There’s an application process that lines out the conditions of it all. Nothing is a surprise. It for the most part fits my moral standards, it’s cheaper, easier, and I haven’t had any problems with it. But like I said, it’s really only for a certain group that agrees with their standards. They never claim otherwise.

Oliver makes it sound fairly bad, but his piece isn’t very accurate imo. He intentionally leaves out that this isn’t marketed towards everybody. That’s the whole point of it. Anyways, that’s my experience.

 

[Gameface]

I fear that insurance companies in particular will be able to defeat anything that makes a significant positive change. In an ideal system they wouldn't exist at all. As it stands they are a $31 Billion industry as per a quick google search.

I don't have any hope that we'll ever have a good system. I think as some point public sentiment will become overwhelming and out federal government will do "something" about the problem but it will be a stupid half-assed solution that will hardly move the needle, it'll just reshuffle the **** piles.

 

[One Brow]

Not a chance. Any American socialized healthcare will still have drug companies developing the drugs and corporate owned hospitals doing hospital things.

Then it's not really socialized, right? Unless you have a definition for "socialized" that does not involve some sort of government take-over.

Whatever law is made to socialize healthcare in America would be written in a way to please the massive political donors who finance election campaigns.

I agree here. It's why we have Obamacare as opposed to other sorts of methods.

The profit motive will go nowhere. There is no way Home Depot could sell an $800 toilet seat to consumers, but the government has purchased a lot of $800 toilet seats.

While I agree that there is a surfeit of military over-spending, I also understand that you can't take some cheap, home-use toilet seat from Home Depot and expect it to perform adequately in a military capacity.

Passing socialized medicine will allow providers to jack their prices far higher by making the government the purchaser than they ever could if they had to sell to consumers. That is the goal.

Please list some other countries where this has been the result of socialized medicine.

The laws are far more insidious. For example, one that has been used to put a lot of abortion providers out of business is the minimum hallway width laws. The hallways in medical facilities have to be a certain width supposedly to allow gurneys to get through when other gurneys are along the wall. There are hundreds of laws like this that hinder small shops from opening in regular commercial spaces.

Then I agree. These are laws specifically aimed at abortion providers, and are often not applied to other sorts of healthcare providers.

The idea of government built hospitals directly employing doctors who use government medical equipment and dispense government drugs in America isn't reality.

I also agree here.

 

[LogGrad98]

I fear that insurance companies in particular will be able to defeat anything that makes a significant positive change. In an ideal system they wouldn't exist at all. As it stands they are a $31 Billion industry as per a quick google search.

I don't have any hope that we'll ever have a good system. I think as some point public sentiment will become overwhelming and out federal government will do "something" about the problem but it will be a stupid half-assed solution that will hardly move the needle, it'll just reshuffle the **** piles.

As soon as we commoditized a person's health we severely limited the ability to provide healthcare for everyone. It is a purely profit-driven enterprise now and the highest profits come from charging the most they can and paying out the least they can. This means charging whatever the market will bear, which is enough to drive many people to bankruptcy, and then paying out as little as they can, which means constraining care and deciding who gets what and what they will pay for. This is the worst possible economic model for the goal of a healthcare system, which should be to provide the best care possible to the vast majority of the population. Instead, we in essence have healthcare for the highest bidder. And that is morally wrong, imo.

 

[Al-O-Meter]

These are laws specifically aimed at abortion providers, and are often not applied to other sorts of healthcare providers.

Not true. The term 'TRAP law' is lawyer's marketing speak to help win lawsuits. If it were true the laws would be struck down immediately for failing the arbitrary-or-capricious test. The so-called TRAP laws that include the minimum hallway width laws have withstood legal challenge precisely because they are applied to other sorts of healthcare providers too. All the legislators did was take these ridiculous restrictions designed to keep low cost competitors out of the market and reclassify the abortion providers so that they were subject to them.

To lower cost, increase supply. Increasing government has never been the solution to lowering cost.

 

[One Brow]

Not true. The term 'TRAP law' is lawyer's marketing speak to help win lawsuits. If it were true the laws would be struck down immediately for failing the arbitrary-or-capricious test.

They have occasionally been struck down when applied to abortion centers.

The so-called TRAP laws that include the minimum hallway width laws have withstood legal challenge precisely because they are applied to other sorts of healthcare providers too.

They are applied mostly to ambulatory surgical centers, which actually feature cutting people open the various side issues that arise therefrom.

BTW, you've been misinformed on the meaning of TRAP.

Evidence You Can Use

www.guttmacher.org

All the legislators did was take these ridiculous restrictions designed to keep low cost competitors out of the market and reclassify the abortion providers so that they were subject to them.

There are valid reasons to make sure that surgeries are conducted in safe locations.

To lower cost, increase supply. Increasing government has never been the solution to lowering cost.

So, now you'll offer an example of a country whose medical spending drastically increased after moving to socialized medicine?