<p>Also, the law against denying coverage for pre-existing, or cancelling for illness has to stay, even if this means it costs those of us who are healthy more. That’s just the humane fundamental cost of living in a civilized society where we also make sure everyone has clean water to drink.</p>
<p>But, decoupling insurance from employment is the best thing that could happen. It’s just this silly complication which helps nobody. Honestly, if everyone is in the market then that brings prices down and there can be like three levels or four (only catastrophic) coverage.</p>
<p>I mean, if I need to have my car fixed, I don’t call the insurance company. If I need an oil change I pay. I’m not calling the insurance company when I need a new roof or need to get the pool resurfaced. So… health care is a strange paradigm already and it requires a more collective view, as in: we’re all in this market as people, not as working for this, that or the other company.</p>
<p>I have a concierge doctor for specific clinic that I go to, this is not my primary care provider. My PCP scoffs at this sort of medicine. Regardless, the concierge doc is very conscious of the fact that people pay cash, and may or may not get something reimbursed by insurance. She is careful to only order blood tests that she really thinks I need, in specific intervals, and considers whether the expensive ones are really necessary. I don’t think their lab gouges people on the tests, either.</p>
<p>As well, it would be one less cost for companies, which could bring down the cost of goods and services–a whole lot of the cost of a car, for instance, goes toward the workers’ health insurance.</p>
<p>Dstark–good point that it would eliminate insurance jobs, but on the other hand it would lead to small business creation, more self-employed workers (my H and I, for sure), and possibly job creation as companies didn’t need to cover that cost.</p>
<p>For sure dietz that will be the next issue. I was in the emergency room of the local hospital a few weeks ago with an injured kid. They were training physicians assistant like crazy. Five came to see her. This is northwestern medical school. Fwiw</p>
<p>We had PPO coverage until our COBRA ran out a few years ago. Our primary care doctor went to an all Concierge plan. We decided to leave her practice, since we couldn’t afford the $1500 per person payment, in addition to our healthcare premiums. </p>
<p>6 months later, she was working for the local hospital clinic. She went out of business. </p>
<p>Is this a successful model for most doctors? I would guess it would have to do with what the clientele demographic is and how often they use the services.</p>
<p>There was an interesting article today about the delays in getting web based exchanges online in time for the October rollout of ACA, and how this is impacting costs for individuals.</p>
<p>Not sure what the policies of linking articles is nowadays here - so here is the title of the article for your Google enjoyment. </p>
<p>“Obamacare’s key goal threatened by delayed Web marketplaces”</p>
<p>Decoupling insurance from jobs would IMHO help the job market for the older worker. Consider my yearly cost for a family of four costs $18,000 (male worker over 50) vs. $2160 for a single 27 year old male. Do the math.</p>
<p>The hospital sends a bill to the insurance company for 3000. The insurance company negotiates the 3000 down to 350. You have to pay
100 percent of the negotiated rate until your deductible is reached. In your case 350.</p>
<p>That is what it sounds like to me. Ask your agent again. </p>
<p>
</p>
<p>This is correct. And do note the part about the agreement between the insurance company and the hospital. (This also happens with doctors. But in saying so I also wish to note that there are doctors who choose to provide pro bono care or reduce their rates selectively. Doctors will also accept payment plans.) The uninsured are billed a hugely inflated amount–the original bill in the above example–because there is no insurance co agreement in place. If the uninsured person is savvy, s/he can appeal/protest this bill, and the provider will reduce the amount, although not necessarily all to way to what an insured person pays (the famous “usual and customary” charge).</p>
<p>"6 months later, she was working for the local hospital clinic. She went out of business.</p>
<p>Is this a successful model for most doctors? I would guess it would have to do with what the clientele demographic is and how often they use the services."</p>
<p>I sure wouldn’t pay concierge costs for my PCP. Nice lady, but I could probably get similar service at a walk in clinic. I only pay additional costs to the other clinic because that’s how I get bio-identical hormones, and it’s worth it to feel so much better. I would think that concierge medicine would be successful in areas where it is hard to actually get a great doctor, or perhaps in places where people are retired or wealthier, and feel that it’s worth it to pay the cost. Sounds like your doc made a bad choice.</p>
<p>With our HSA, we pay up to the negotiated cost, but are not responsible for costs above that amount – if lab tests are billed at $1,000, but the negotiated cost is $250, we’re responsible for paying only $250, at least until we’ve met our deductible. After that, we pay 10% of negotiated costs until we reach the max out-of-pocket, which isn’t too much larger than our deductible. Then insurance picks up 100%.</p>
<p>We found the high deductible plan to be cheaper for us overall than the previous PPO plan.</p>
<p>Many of the mid-size employers in our area have dropped PPO plans because they became too costly.</p>
<p>The quotations got messed up in my earlier post and I couldn’t fix them in time. That’s the way ours works too, arabrab. </p>
<p>I get tired of hearing about how the healthy “subsidize” everyone else. It’s shared risk, people. That’s the whole idea. (I also wonder about how many of the well-insured <em>I</em> subsidized with my $40K that the insurance company collected, safe in the likelihood that they would never have to pay for a dime of care for us.)</p>
<p>I would like to see health coverage uncoupled from employment. I am in favor of universal coverage, single payer. Put everyone on Medicare: the system that does it best, delivering coverage for significantly lower overhead cost than any private company. Pay for it with taxes, instead of premiums. Take the insurance companies out of the picture entirely, unless they want to offer some kind of supplemental luxury policy that enough people want to buy.</p>
<p>Someone commented that we are moving towards a have/have not system. That is EXACTLY what we have now–I’ve been on the have not end of it–except that we are paying a higher proportion of GDP for health care than other western societies and geting poorer results by all public health measuring sticks.</p>
<p>Well… My daughter is right next to me. The larger the group, the better the rate. The more claims your group has… The higher the rates in the future.</p>
<p>So the only way to get the best rate for everyone is for everyone to be in the same plan or to put all the healthy people in one plan, kick them out once they get sick and just let the group they end up with to fend for themselves. As long as you never put in a claim you can be join the low cost group.</p>
<p>But don’t force everyone to be on the same system, if they aren’t interested. I am always leery of the concept of telling people what they must do. I’m no fan of health insurers, but who has the right to tell them they must go out of business? I would support a national health care system that everyone has access to, paid for by taxpayers. But if individuals and businesses want to purchase separate insurance, who has the right to say they are not allowed to? Just don’t offer tax breaks for it, and the environment will change.</p>
<p>Fair enuff bus driver. Take the employer out of it and the system might have a chance of working. Right now it is slowing hiring and forcing people to work two jobs. Why the employer thing?</p>