[NA] Health Insurance. US vs. Elsewhere

[SixPapaCharlie]

I know this thread will be locked in a matter of minutes but here goes.

I just filled out my open enrollment paperwork for my company and the plan for me and my family is $1720 per month. My employer pays half so $860 per month for me for premiums.

This means to use zero medical services, my medical premiums add up to $20,640 per year.
That is the cost if I never use it. My deductible is $7500 so $28,140 annually. My share is $17,820.

I assume most of that money goes to the insurer's pockets but have no way of knowing for sure.
(Feels like it should be illegal)

I also stress that these are the prices irrespective of income. There are people at my company that make $20k / year. We have an option of a cheaper plan that is about 50% less but 15,000 deductible. For them that still seems impossible.

To those that don't live in the U.S. your medical is added into your annual taxes correct?
Does anyone know what that comes out to for an individual? Is it more or less than what I described above?

Are there alternatives here or is this the sandwich we have no choice but to eat?

I have been reading through the paperwork and it feels like the system is designed to be very expensive and try not to offer very much in the way of actually helping people.

I get. If I get cancer and have million dollar bills, it counts then but not much else.
If I paid my normal visits and preventative care out of pocket it sure wouldn't add up to 20k a year.

Ok, Lock the thread.

 

[tawood]

Fortunately for me (and my insurance company) up until recently, my family and I have never had a major medical emergency. Then, my son's appendix burst. Surgery, then sepsis, then 5 days in the hospital. As a rough estimate, the insurance company didn't break even with me yet, and I worked at the same job for 26 years....that's just how much his hospital bill was. So even though the high insurance bills $uck, the high hospital bills $uck more, in my opinion.

 

[idahoflier]

Health insurance can be a complex problem - or not. My opinion is that there should be one price for services and that's it. In any case, I get your thinking and I felt the same. Without getting into details, one of my family members required medical care outside of the regular PCP ailments this year. Without my health insurance plan my out of pocket would have been $100K+. With my plan our out of pocket ~$6K. Just for kicks I compared what the cost would have been under a "Gold" Obamacare plan and it came to ~$46K. So fo me the insurance plan really came through and more than covered my premiums over the years. I will admit I have an outstanding medical plan, but I'm also earning way less than market so maybe it evens out?

 

[Jim K]

It's worse if you're self employed.

We went to Samaritan Ministries about 5 years ago. $375/mo, there's a sizeable deductible, but it gets waived if you negotiate discounts with the provider. They don't pay (actually "share")anything for day to day stuff, so we pay $150/mo to a concierge doctor who takes care of illnesses and physical & the like.

Samaritans is not insurance, they assign shares of your bill to other members. There no legal obligation there, so you have to accept there's a risk there. I believe they are the largest, oldest, and most overtly Christian. There are others. They exist essentially through a loophole in the ACA allowing faith- based organizations.

We have been very satisfied. We are a young, healthy family, so we rarely have claims. We did have a baby since we've been with them and although negotiating with the hospital and uploading bills is a pain, it beats the $2000/mo we were previously paying for care we don't use. I don't recall what we wound up paying out of pocket, but it was only a couple hundred. Mostly straggler bills that I just paid and didn't bother to upload.

Time will tell of course, but at this point we've saved so much money that we could pay a pretty sizeable bill and still be ahead. YMMV.

 

[SixPapaCharlie]

I have been on a cheaper indemnity plan up until now but if injured in a plane crash, all coverage is denied so I switched back to the employer plan.

Anyone know ballpark what % of premiums go to peoples' medical bills versus profits? Is this regulated?

 

[TCABM]

…
Does anyone know what that comes out to for an individual? Is it more or less than what I described above?

Having lived overseas for 3 years, the answer is that it’s very country and scheme specific.

… Are there alternatives here or is this the sandwich we have no choice but to eat?

There are healthcare cost sharing plans available that may or may not be cost competitive assuming your employer will allow you to decline coverage.

 

[Velocity173]

Man, and I complain about paying $25.25 a month for Tricare.

 

[SoonerAviator]

Well, unfortunately in the US, what we call "health insurance" is sort of a hybrid of insurance as well as socialized medicine. Most of the money you are paying goes to cover other people's medical bills just like any other type of insurance. Sure, the insurance companies make a profit, but it's not "most" of the money from your premiums. You are paying for that guy on the other side of the country fighting cancer or the lady having her first child, or the prescription drugs for your father. The other portion that US healthcare covers is the normal doctor's visits (yes, most still have a co-pay) and other lab work/etc. I dislike that portion of US healthcare insurance that deals with regular doctor's visits and broken arms and such, as that would be like using your car insurance to pay for oil changes or new tires. Those expenses should be paid fully out-of-pocket by the patient. I would prefer that US healthcare be more akin to catastrophic insurance where it comes into play in a car accident or cancer/kidney/major medical issue.

The higher-deductible plans are usually a consumer-driven healthcare plan which is typically better for those rarely go to see a doctor. In my adult lifetime, I have been to the doctor twice for less than 30 minutes each. I have paid for 20 years of health insurance premiums in that time. I probably could have saved a boat load if I had used a higher-deductible plan, but it's hard to accept that additional risk for the deductible.

As for national healthcare plans in foreign countries, to me understanding it's not typically a separate tax bill or line item added, it's just built into their country's taxes which get applied to everyone. It obviously varies in implementation by country, so there's not hard and fast rule to how the taxes are applied. I seriously doubt it's any cheaper in other countries, except that the burden would be have some income-based proration. The total cost of the "system" is just as expensive, because it includes more participants rather than just those who want to carry insurance.

 

[PPC1052]

I have been on a cheaper indemnity plan up until now but if injured in a plane crash, all coverage is denied so I switched back to the employer plan.

Anyone know ballpark what % of premiums go to peoples' medical bills versus profits? Is this regulated?

I don’t know for medical insurance. But for casualty, it’s not on common that claims and administrative costs to be greater than premiums. The profits came from holding the funds and investing them.

 

[Seanaldinho]

Man, and I complain about pay $25.25 a month for Tricare.

When I came off my family's Tricare and joined the work insurance program it was quite eye opening. As a kid who broke a lot of bones, I am glad I don't break them much as an adult.

For the OP, assuming you have a family of 4, my premiums are slightly higher but with a lower deductible so it may not be totally out of line.

Another part of insurance is the negotiation they do on your behalf. I received a medical bill for close to 10k, but after they negotiated the discounts/said what they would pay the total came down to 3-4k and then I had to pay a smaller portion of that for coinsurance.

 

[sarangan]

I know this thread will be locked in a matter of minutes but here goes.

I just filled out my open enrollment paperwork for my company and the plan for me and my family is $1720 per month. My employer pays half so $860 per month for me for premiums.

This means to use zero medical services, my medical premiums add up to $20,640 per year.
That is the cost if I never use it. My deductible is $7500 so $28,140 annually. My share is $17,820.

I assume most of that money goes to the insurer's pockets but have no way of knowing for sure.
(Feels like it should be illegal)

I also stress that these are the prices irrespective of income. There are people at my company that make $20k / year. We have an option of a cheaper plan that is about 50% less but 15,000 deductible. For them that still seems impossible.

To those that don't live in the U.S. your medical is added into your annual taxes correct?
Does anyone know what that comes out to for an individual? Is it more or less than what I described above?

Are there alternatives here or is this the sandwich we have no choice but to eat?

I have been reading through the paperwork and it feels like the system is designed to be very expensive and try not to offer very much in the way of actually helping people.

I get. If I get cancer and have million dollar bills, it counts then but not much else.
If I paid my normal visits and preventative care out of pocket it sure wouldn't add up to 20k a year.

Ok, Lock the thread.

I find the term "insurance" a bit odd. We buy insurance for things we expect won't happen, such as accidents, fire and property loss. With health insurance, we expect to use it every year for routine medical visits in addition to unexpected events. It's like filing an insurance claim for your oil change and routine repairs in your car.

 

[DFH65]

When they added a whole bunch of people to the system for free and with pre-existing conditions you didn't think that was going to be free did you?

Between my employer and I we pay about $17,000 into the system before the insurance company pays a dime.

 

[aterry1067]

I know this thread will be locked in a matter of minutes but here goes.

I just filled out my open enrollment paperwork for my company and the plan for me and my family is $1720 per month. My employer pays half so $860 per month for me for premiums.

This means to use zero medical services, my medical premiums add up to $20,640 per year.
That is the cost if I never use it. My deductible is $7500 so $28,140 annually. My share is $17,820.

I assume most of that money goes to the insurer's pockets but have no way of knowing for sure.
(Feels like it should be illegal)

I also stress that these are the prices irrespective of income. There are people at my company that make $20k / year. We have an option of a cheaper plan that is about 50% less but 15,000 deductible. For them that still seems impossible.

To those that don't live in the U.S. your medical is added into your annual taxes correct?
Does anyone know what that comes out to for an individual? Is it more or less than what I described above?

Are there alternatives here or is this the sandwich we have no choice but to eat?

I have been reading through the paperwork and it feels like the system is designed to be very expensive and try not to offer very much in the way of actually helping people.

I get. If I get cancer and have million dollar bills, it counts then but not much else.
If I paid my normal visits and preventative care out of pocket it sure wouldn't add up to 20k a year.

Ok, Lock the thread.

Check out board officer compensation of all those insurance companies and it becomes clear why health insurance costs so much. They charge that much because they can.


I lived overseas for several years as well. Most other civilized and prosperous places have much better systems for the average citizen. Our health care payment system is broken for the consumer, but works great for the supplier.

 

[Jeff Oslick]

The total cost of the "system" is just as expensive, because it includes more participants rather than just those who want to carry insurance.

I don't believe this is at all accurate. The per-capita cost in the US is substantially higher than other countries. A portion of that is insurance company administration and profits, but that is nominally capped under the ACA, and not the major contributor. The largest contributors to the higher cost in the US are defensive medicine - 1) where the doc is afraid to get sued for missing something, so they order a few thousand in scans/lab tests for something that is relatively unlikely to be serious, 2) prescription medicines costs (both in per-capita prescriptions and higher costs for the same thing than in other countries), and 2) blatant conflict-of-interest cost inflation, where both necessary and unnecessary testing is done by a facility that is in whole or part owned by the same provider that ordered the testing, and directs the patient to that testing facility. The last one "could" be avoided in some cases if the patient is informed enough to shop pricing for the same tests from other providers, but the patient/consumer typically lacks the knowledge to know how or where to seek alternatives, or the alternatives may not be geographically feasible for the consumer.

This is about all I can type without getting political.

 

[skier]

My opinion is that there should be one price for services and that's it.

But not all doctors are the same. Some are better than others. Some are more up to date on research and using the latest techniques. Others are using procedures that went out of style in the 90s. Just because 2 people get the same procedure it doesn’t mean they’re really getting the same procedure. The differences are striking when you know multiple people who have had the same procedures for the same conditions.

Location and cost of living also ties into compensation packages for the doctors.

 

[Sac Arrow]

I've been to third world countries that have a better handle on health care coverage than the United States. And that is not an exaggeration.

 

[hindsight2020]

oof, you found my tell at the poker table. Too emotional a topic for me, as it is my red line in this life. My expanded/open comments would get this thing insta-locked. So I'll just say the following and walk away:

My entire reason for remaining in the indentured service of the US military under the AVF at this point, singularly hinges on the attainment of lifetime healthcare promise to me and my dependents upon retirement in my 40s, and all the way to a Medicare age transfer. In the absence of that social contract, we did in fact consider expatriation to Canada, and my subsequent resignation of my US officer commission.

I don't take the topic of pledging allegiance to another flag lightly, but that's how much the topic of healthcare is a red line in my house. My family's definition of Honor doesn't require oak leafs on my shoulders.

Our system is a dumpster fire. And I'm out. *white knuckles away from the keyboard*

 

[skier]

You can also look at the types of care we get here vs. elsewhere. We have many more options available to us for treatment than in places with state run care. even with something as routine as a pregnancy we in the US have access to more up to date diagnostics and methods than our friends across the pond.

 

[Zeldman]

It's worse if you're self employed.

We went to Samaritan Ministries about 5 years ago. $375/mo, there's a sizeable deductible, but it gets waived if you negotiate discounts with the provider. They don't pay (actually "share")anything for day to day stuff, so we pay $150/mo to a concierge doctor who takes care of illnesses and physical & the like.

Samaritans is not insurance, they assign shares of your bill to other members. There no legal obligation there, so you have to accept there's a risk there. I believe they are the largest, oldest, and most overtly Christian. There are others. They exist essentially through a loophole in the ACA allowing faith- based organizations.

We have been very satisfied. We are a young, healthy family, so we rarely have claims. We did have a baby since we've been with them and although negotiating with the hospital and uploading bills is a pain, it beats the $2000/mo we were previously paying for care we don't use. I don't recall what we wound up paying out of pocket, but it was only a couple hundred. Mostly straggler bills that I just paid and didn't bother to upload.

Time will tell of course, but at this point we've saved so much money that we could pay a pretty sizeable bill and still be ahead. YMMV.

I use Christian Health Care Ministries bill sharing for my wife and me. $346/mth for the both of us. It doesn't pay day to day stuff like doctor appointments and prescriptions, but with Rx discount cards all over the place who needs Rx insurance?

Yeah, I have to negotiate the price with the health providers, but that is a game I enjoy playing. And insurance is a game. The hospital was really happy when I told them I had Christian Healthcare Ministries. Just the hospital bill alone for when I had the heart attack was something over $69,000. The negotiated price came down to a little over $19,000. I was sent a check for $19,000+, went to the hospital and paid it. My out of pocket expense was 500 bucks. I was happy and the hospital was very happy.

Thank goodness the government came in and made health insurance affordable..

Oh, IBTL

 

[SoonerAviator]

The health "insurance" part of all this is part of a much larger discussion of the healthcare industry. That includes pharmaceutical companies, hospitals, and providers across the nation. Each group wants their "cut" of the pie, and since the healthcare insurance game includes everything, those costs get distributed among all of the paying customers. You get to pay for the landscaping at the local hospital, which if it's anything like our premier hospital in Tulsa, has landscapers out there 24/7/365. I bet their landscaping budget is over $1MM annually. Same goes for all of the build-outs and cosmetic upgrades. Uber-expensive machines. Pharmaceutical reps schmoozing every doctor/provider they can get an appointment with. My wife's OB/GYN practice gets lunch catered in by a pharmaceutical rep at least once a week, sometimes more. Those meals get paid for by everyone in the healthcare system. I'm not for nationalized healthcare, personally, at least in the way it's usually presented. I'm also for a free-market, so that companies can charge whatever they want and let consumers decide what they're willing to pay. It shouldn't cost $10K to anyone (health insurance or the insured) to set a simple fractured arm. However, with regard to more severe injuries and mortal danger there isn't much opportunity to "shop around" when having a heart attack. I'd rather have something of a nationalized catastrophic health care system so that people don't go bankrupt when fighting cancer. I also think that all employers should be completely out of the insurance game, leave it all to the open market and just pay the employees via wages the portion of the healthcare premiums they were previously paying. However, you break you arm or need stitches you should have to pay for it all yourself with your local doctor.

Hard to know where to draw the line on what gets included in "catastrophic" though. Complex fractures? Multi-day hospital stays?

 

[weilke]

In germany you pay 10-12% of your gross pre-tax income. The difference between individual and family is small. The premium is not age indexed so the 25 year old who has zero expenses subsidizes the retired folk. It's designed that way under the 'social contract' concept, similar to how the US handles medicare.
The premium caps out at a level where you are considered 'rich' (at about 65k euro) and given the option to buy cheaper private health insurance.

 

[Tantalum]

I get. If I get cancer and have million dollar bills, it counts then but not much else.
If I paid my normal visits and preventative care out of pocket it sure wouldn't add up to 20k a year.

man I get it. It's awful

Every year during open enrollment I tell HR I'm dropping it and they scare me with the whole "what if you get cancer?!" or "what if you break your leg in a car accident?!" - but honestly, I'm starting to think I'd be happy to take that risk

The system is a shameful joke.

In the meantime CEOs make millions https://www.blueshieldca.com/bsca/b...me=BSCA_2019_ExecutiveCompensationSummary.pdf

/rant over

 

[Scrabo]

The UK NHS system gets a bad rap as an example of how not to do socialize medicine.

My younger brother had a heart attack a few years ago, he was in the OR within 90 mins and a stent put in. Home 3 days later with more drugs than I can remember, give him a gym membership for 2 years etc..

No deductibles, no co-pays no direct out of pocket.

FIL passed away recently after a long battle with cancer - drugs, home care etc... again no deductibles, no co-pays no direct out of pocket.

Sure if it's a non emergency situation like a hip replacement you would have to wait, but then there is private insurance as well, same hospitals, same doctors , better hospital room...

 

[MooneyDriver78]

Anyone know ballpark what % of premiums go to peoples' medical bills versus profits? Is this regulated?

IIRC, 85-90%
If your employer is a large corporation there’s a good chance they self insure. That means they pay the actual medical cost and just use the insurance company to handle all the paperwork and get them the preferred insurance rate.

 

[Ted]

Bryan, it sounds like your company has pretty rotten insurance. I have had three employers in my post-college time. All three of them have had a healthcare option with $0 premiums, including for family. My max out of pocket has always been something in the 4-figure range, and usually they're contributing something to an HSA if you go with that $0 option and the high deductible health plan. Then again they've all been larger companies and I think they may all self-insure, using the insurance company for admin more than anything. So maybe looking for another employer with better benefits would be worthwhile in your situation if that is a big enough issue for you.

A few months ago I had hernia surgery, and the bills (which were significant on paper) were quite manageable now that I'm done and all the paperwork people have sorted out who pays what. And now I'm past my deductible so I'm done paying medical bills for the year. Quick, time to take up more dangerous hobbies!

My wife's job doesn't have as good of insurance coverage and it would cost more, but they still aren't bad. Honestly what you just described is the worst I've heard of in a long time, especially for someone with a skilled and good-paying job.

I think a quick Google search would answer how much more you would pay in other countries vs. here. Looking at Canada, it seems that in total you're generally looking at maybe an extra 10-15% of your household income per year. Then do the math to see how that would work out for you. We have a lot of friends in Canada and while there are horror stories about waiting a long time for treatment, none of them have ever experienced that personally. My godfather (who was Belgian) in his elderly years certainly had much better government-provided care than my grandmother (US) had that we paid for in the nursing home.

 

[IK04]

I though this gubmint run scam was determined to be unconstitutional?

We won't have much left at this rate....

 

[SoonerAviator]

I don't believe this is at all accurate. The per-capita cost in the US is substantially higher than other countries. A portion of that is insurance company administration and profits, but that is nominally capped under the ACA, and not the major contributor. The largest contributors to the higher cost in the US are defensive medicine - 1) where the doc is afraid to get sued for missing something, so they order a few thousand in scans/lab tests for something that is relatively unlikely to be serious, 2) prescription medicines costs (both in per-capita prescriptions and higher costs for the same thing than in other countries), and 2) blatant conflict-of-interest cost inflation, where both necessary and unnecessary testing is done by a facility that is in whole or part owned by the same provider that ordered the testing, and directs the patient to that testing facility. The last one "could" be avoided in some cases if the patient is informed enough to shop pricing for the same tests from other providers, but the patient/consumer typically lacks the knowledge to know how or where to seek alternatives, or the alternatives may not be geographically feasible for the consumer.

This is about all I can type without getting political.

I don't doubt that the "defensive medicine" is part of the expense, but that doesn't go away with socialized health insurance unless we re-write US law to absolve providers of a lot of the liability or cap lawsuit payouts. The US is still where the leading edge medicine is being done, and where the newest drugs are being trialed. The cost of all of that is generally passed on to the US market, where the rest of the world typically gets to benefit from that. As far as interest cost inflation, the consumer/patient being too ignorant or lazy to search out a cheaper alternative isn't really the fault of the US healthcare system, in my opinion, it's just free market. You can choose to use expensive auto repair shops as well if you don't want to search around, no one is holding a gun to your head over it. The effect of the US technology/pharmaceutical industry costs largely being absorbed by the American populace is partially why it is cheaper to provide healthcare in those other countries. I'd also pose that I believe the average US citizen is likely less healthy than many of our other developed countries, so that doesn't help any with regard to per capita healthcare costs.

 

[Archer Jack]

You can also look at the types of care we get here vs. elsewhere. We have many more options available to us for treatment than in places with state run care. even with something as routine as a pregnancy we in the US have access to more up to date diagnostics and methods than our friends across the pond.

We talk about how much better our system is with its availability of the most up to date technology, best trained physicians, more treatment options etc. compared to countries with nationalized health care. Did you ever notice that the people in most of those countries are generally much healthier than we are? Also did you ever notice the United States of America is the only country on the planet where hospitals advertise on TV to get your business. We are also the only country which allows prescription drugs to be advertised to the public rather than just to the physicians who prescribe them. I'm seeing a pattern here.

 

[Velocity173]

oof, you found my tell at the poker table. Too emotional a topic for me, as it is my red line in this life. My expanded/open comments would get this thing insta-locked. So I'll just say the following and walk away:

My entire reason for remaining in the indentured service of the US military under the AVF at this point, singularly hinges on the attainment of lifetime healthcare promise to me and my dependents upon retirement in my 40s, and all the way to a Medicare age transfer. In the absence of that social contract, we did in fact consider expatriation to Canada, and my subsequent resignation of my US officer commission.

I don't take the topic of pledging allegiance to another flag lightly, but that's how much the topic of healthcare is a red line in my house. My family's definition of Honor doesn't require oak leafs on my shoulders.

Our system is a dumpster fire. And I'm out. *white knuckles away from the keyboard*

Yeah but that attainment of lifetime healthcare is provided by physicians that graduated Summa Bottom Class Laude in med school.

You’ll also find out when you retire that using VA and and Tricare is like dealing with the DMV. Horrible website, can rarely get someone on the phone and you wait in line forever.

I will say this though, they’ve paid for normal doctor visits / immunizations. Very little out of pocket costs so far. I just hope down the road with looming high end medical issues they’ll be there when I need them because I’ve got a sneaky suspicion that Tricare is one big Ponzi Scheme.

 

[luvflyin]

We talk about how much better our system is with its availability of the most up to date technology, best trained physicians, more treatment options etc. compared to countries with nationalized health care. Did you ever notice that the people in most of those countries are generally much healthier than we are? Also did you ever notice the United States of America is the only country on the planet where hospitals advertise on TV to get your business. We are also the only country which allows prescription drugs to be advertised to the public rather than just to the physicians who prescribe them. I'm seeing a pattern here.

Yeah

 

[bluesky74656]

I just checked my benefits. Full disclosure: I work for a health insurer, but the deal we give ourselves is not as good as the deals we work out with other employers.

For medical, dental and vision for a family of 5 I pay about $500/month. Out of Pocket max is $3,700 individual and $7,400 for a family, although the deductible is lower and above the deductible a coinsurance applies. I have no copays for normal visits. This is in Ohio, and it’s the most expensive plan we offer to employees. There are two cheaper options that have lower deductibles in exchange for a narrower network.

So it sounds like either healthcare is more expensive in Texas, or your employer is offering you a raw deal. For me that’s a huge argument in favor of a real government option: being able to choose the health benefits that you need without needing to change your job to do it.

 

[wsuffa]

It's more of a "service contract" or "service plan" than it is "insurance". (like getting a call about an extended warranty for your body instead of your car). It used to be closer to true insurance, which is for the unforeseen, but over they years it's become something else. And prices have gone up accordingly.

It's worse if you're self employed or (at least where I am, on an ACA/exchange plan).

Oh, and IBTL

 

[Initial Fix]

IIRC, 85-90%
If your employer is a large corporation there’s a good chance they self insure. That means they pay the actual medical cost and just use the insurance company to handle all the paperwork and get them the preferred insurance rate.

exactly. “Larger” seems to be around 500 people if I remember correctly.

My company has some tiered options with high deductible and lower/no deductible options. The latter cost much more. It will be interesting to see what changes this year during open enrollment.

when my gallbladder decided it wanted to come out a few months ago, the ER and hospital bill was eye watering. My out of pocket was about a grand.

 

[FORANE]

I though this gubmint run scam was determined to be unconstitutional?

We won't have much left at this rate....

So was the eviction ban yet somehow we still have it.

 

[wsuffa]

I just checked my benefits. Full disclosure: I work for a health insurer, but the deal we give ourselves is not as good as the deals we work out with other employers.

For medical, dental and vision for a family of 5 I pay about $500/month. Out of Pocket max is $3,700 individual and $7,400 for a family, although the deductible is lower and above the deductible a coinsurance applies. I have no copays for normal visits. This is in Ohio, and it’s the most expensive plan we offer to employees. There are two cheaper options that have lower deductibles in exchange for a narrower network.

So it sounds like either healthcare is more expensive in Texas, or your employer is offering you a raw deal. For me that’s a huge argument in favor of a real government option: being able to choose the health benefits that you need without needing to change your job to do it.

Is that total cost before the employer subsidy? Or your cost after the subsidy?

I know someone that worked for a large law firm who's client was an insurance company. They had a decent subsidized rate (maybe $150/month), but when they retired they ended up paying full-boat of about $1200 per month. Ouch. Very good subsidy by the employer.

 

[Salty]

Who do you think is paying for that cancer patient's care?

 

[wsuffa]

exactly. “Larger” seems to be around 500 people if I remember correctly.

My company has some tiered options with high deductible and lower/no deductible options. The latter cost much more. It will be interesting to see what changes this year during open enrollment.

when my gallbladder decided it wanted to come out a few months ago, the ER and hospital bill was eye watering. My out of pocket was about a grand.

Yep, and those that self-insure usually contract with one of the big insurance companies to administer the plan. It also allows them to tweak the pricing for different plans.

For example, one past employer of mine was pushing the high-deductible/HSA plans and not only offered decent pricing on them, the company kicked in a pretty sizable additional deposit to your HSA each year - calculating it out for different scenarios, pretty much every normal medical scenario for me pointed to the high-deductible/HSA plan as being better.

 

[Morgan3820]

My wife is an RN for 30+ years. When I asked , she said her estimate is that fully 50% of her patients are listed as non-pay. Being that the hospital receives county tax dollars, They get the same care, same treatment as the payers. There is a sign in the lobby stating that they cannot turn away patients. but you can’t get blood out of a stone. Often also the non-payers at the lower economic spectrum are the neediest, most costly patients. So a good portion of it is that you’re paying for the others who don’t or can’t pay.

Obamacare ‘tried’ to fix it but people still didn’t pay for it. In the hospital still excepted patients without Obamacare. No matter how affordable you make it, there are people who still won’t pay for their own health care. Until you turn away the ones who can’t pay there’s no incentive to find a way to get insurance. In the final analysis somebody has to pay. Either the Government through taxpayers or the individual.

 

[Steve Costello]

For me that’s a huge argument in favor of a real government option: being able to choose the health benefits that you need without needing to change your job to do it.

Having your health care/quality of care intrinsically tied to your employment is just freaking awful.

 

[danhagan]

Anyone know ballpark what % of premiums go to peoples' medical bills versus profits? Is this regulated?

I've been in the medical field for over 3 decades (medical imaging). Our reimbursements that we are paid as non-hospital schedule B providers has decreased 10 fold.

I used to be able to insure our employees prior to Obamacare at $1200 per YEAR ($500 deductible 100 percent of pharmacy covered). Now coverage is nearing $12,000 per person ... my employees pay about 15% with the company I own covering the rest ... we can no longer provide that kind of coverage starting this year. Current deductible is 3500 and a ton of prescriptions that aren't covered. My family insurance will run over 30k a year with BCBS, only employees are paid, dependents are not ...