Companies are dropping health coverage for spouses to cut costs

Parent Cafe
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<p>Do you actually envision a world where, through the wonders of the free market, every American would be able to pay for a triple bypass? Or a round of chemo? Or a couple of days in ICU? It’s inconceivable that these and many other medical services will ever be affordable for most people, no matter how active the Invisible Hand is. And no other country in the developed world thinks they should be affordable. Every other country gets it – the key is to make insurance affordable. </p>

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<p>Well, that’s the whole point of ACA, isn’t it? You’re right, we currently have 50 million free riders – people who have access to medical care without paying in a penny. Under ACA, they will be forced to begin taking some responsibility for helping to pay for their health care, either by buying insurance or paying the penalty. So yes, ACA changes that.</p>

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<p>Take a close look at your next EOB. Then google the CPT code and find the Medicare reimbursement rate for that same code in your area. Your EOB charger rate will be many multiples higher than the medicare reimbursement schedule. The negotiated rate a provider has with an insurance company (an hence the insured) is structured so that the provider can continue to exist given the minimal income Medicare patients provide. Add to that the losses medical providers incur because of non-payment and the costs incurred due to mandatory treatment (ER’s) and guess what…again that cost gets shifted to the insurance contract. THIS is where the high rates are coming from. Insurance companies actually have a rather puny profit margin compared to say - high tech companies. Medicare on the other hand was designed from the get go to rely on cost shifting from the ‘private’ sector.</p>

<p>As for those who ‘can not afford’ insurance - the ACA is taking care of this - right? Now, those already paying very high premiums will have the opportunity to pay even higher ones.</p>

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<p>dietz, yes, Medicare for seniors is subsidized, and I wouldn’t expect that non-seniors would be subsidized in the same way. If we had single-payer, my premiums would be higher than my elderly parents’. But they would be lower than the rates which Blue Cross charges me, because built into my Blue Cross premium is the cost of sales and marketing, profit margins, obscene executive compensation, underwriting and recision, judgments and settlements, and other free-market costs. None of those costs would have to come out of my Medicare-for-all premiums. </p>

<p>BTW, why do you suppose it is that every other developed country on the face of the earth manages to provide access to health care for all of their citizens? And how do they do it at less than half the cost we pay? Do you believe we’re the one country who simply cannot solve this problem which everyone else has solved?</p>

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<p>Medical care should, quite simply, cost less to provide. There are many ways to reduce waste in the system.</p>

<p>For example, the federal government is currently prohibited from negotiating Medicare prescription drug prices with pharmaceutical corporations - because the Republicans specifically wrote Medicare Part D as a giant giveaway to drug companies. Fix that problem and taxpayers would save billions of dollars every year.</p>

<p>Also, doctors in the United States are, frankly, overpaid. We have the highest-paid GPs and the second-highest paid specialists in the entire world. And they’re less efficient than their less-well-paid counterparts overseas.</p>

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<p>The counterpoint would be that medical education is absurdly expensive in the United States - but the solution to that should be reducing the cost of medical education, not increasing the cost of doctors.</p>

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<p>The well-known “free rider” problem. Under a universal, tax-supported health care system, the “free rider” problem is essentially eliminated, because everyone pays taxes. You just made one of the most important arguments for switching to single-payer.</p>

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<p>LasMa,
You keep arguing with me as though I have been claiming that a free market health care system will work for us. I never said that. All I did was refute your claim that “the free market is what got us into this mess.” We never had a free market health care system and never will.</p>

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<p>Exactly, polarscribe. And let’s not forget that most free-rider services are provided in ERs. When an uninsured person gets treated for an ear infection at the ER, we all pay an astronomical price. It would be a lot better for all of us – patients and payers alike – if that person could get their ear treated in a doctor’s office.</p>

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<p>Lasma,
People do get billed for ear infections treated in the ER. I’m just pointing that out.</p>

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<p>Bay, I won’t disagree with you that we don’t have a free market in health care (or health insurance), and we never can, by its very nature.</p>

<p>The free market does a beautiful job of distributing tennis shoes and cars, because the market is transparent. The consumer knows what she wants to buy and what options are available, she can compare features, she can consult friends and experts and online resources, she can weigh price versus quality, she can change her mind as she ponders the choices, and ultimately, she has the choice not to buy at all. And – most important – her life and health do not hang in the balance as she goes about gathering data to make an informed decision.</p>

<p>For lower-cost medical services, some of these free-market features apply. For example, we can decide whether we’d like to get our prescriptions filled at Pharmacy A or Pharmacy B, based on cost, distance, or convenience. More expensive, but still affordable for most CCers, we might even be able to decide where we’d like to get our routine mammograms done by calling around to compare prices.</p>

<p>But the really expensive stuff – the heart attack which lands us in CCU for a week, the emergency appendectomy, the brain aneurysm, the broken leg, the aggressive cancer – these things which would ruin most of us financially – are precisely the things which do NOT lend themselves to rational-consumer behavior. You are in pain or unconscious or terrified. It’s the middle of the night, or you are bleeding out. Seconds matter. You are most assuredly not going to get on the phone and start calling around to talk to hospital billing departments. You are not going to go online to compare outcomes of this doctor versus that doctor, or check user reviews of this type of chemo drug versus that kind of chemo drug. In other words, you are not going to behave as you would if you were buying tennis shoes. </p>

<p>In these situations, you are not a consumer. You are a patient. As you are being rushed to the hospital or beginning chemo for your Stage 4 cancer, your goal is NOT to get value for your money. Your goal is to get life-saving treatment. And that’s why health care services, especially the expensive ones for which we really need insurance, are not subject to the same rational-consumer market forces as tennis shoes.</p>

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<p>Bay, true, people do get billed for ER services if they don’t have insurance. But if they don’t pay, they still got the treatment, and we’re stuck with the bill. If I’m going to pay for someone’s ear infection treatment, I’d rather pay doctor office rates than ER rates. And under ACA, that person will at least have contributed something to the cost of their care. That’s not true of our current system.</p>

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<p>I was under the impression that low income people were exempt from ACA fees. Is that not correct?</p>

<p>Also, I was under the impression that everyone today receives a bill for services received. I don’t know how much each ends up paying, but I imagine most do pay something towards their care.</p>

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You posted that if people could get affordable care they wouldn’t <em>need</em> insurance. Hypothetical or no, everyone needs insurance, except Bill Gates and Warren Buffet. Even a minor event can result in ginormous medical bills. That’s why the idea that people would oppose the “mandate” that everyone is covered because some people don’t feel like they “need” insurance is ridiculous on it’s face. </p>

<p>People who take that position should have to sign treatment waivers, so we could in good conscience escort them to the curb when they show up needing something they can’t pay for out of their current or future earnings.</p>

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<p>They’re not exempt, but the premiums are subsidized based on income. The goal is to get everyone into the insurance pool, regardless of income. The more people in the pool, the more widely the cost is spread.</p>

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<p>It depends entirely on what your insurance covers. For those lucky enough or wealthy enough to have good insurance, there may be a small co-pay or none at all. Those who aren’t fortunate enough to have insurance will get a bill for the whole thing. So for example, I – well above median income with very good employer-paid insurance – have a co-pay of $100. That’s all I will ever have to pay for ER services, no matter what care is provided. OTOH, someone living below the poverty line without insurance will get a bill for $1000, $5000, whatever it is. That’s one of the many injustices of our system.</p>

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<p>Sylvan,
I meant they wouldn’t need insurance to cover those affordable services, because they could afford to pay for them on their own. I was not referring to catastrophic coverage, which as I said early on, is all that most people really need. We’ve morphed medical care into an insurance monster, but now I’m repeating myself, as always seems to happen with these ACA threads.</p>

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<p>Agree that if you have good insurance, there is already a pretty good cap on your expenses. The most I will have to pay for myself (other than Rx copayments) in a calendar year should be about $2500, with virtually no cap on the cost my care may be. This is MUCH, MUCH lower than the many folks followed in the Bitter Pill article. It’s all because H’s employer provides good insurance. My co-pay per office visit with any MD is $15. Not sure what my co-pay for ER services is, as we have never used them, fortunately.</p>

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<p>Bay, “affordable” is relative. There are millions of Americans who could never pay for prescriptions out of pocket, much less annual screenings.</p>

<p>sylvan, I love your idea of anyone who opts out of insurance having to agree that they will not call upon the rest of us to pay for their medical care. I bet THAT would bring lots of people into the system!</p>

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<p>Rx costs can be VERY high, especially if you end up with cancer and/or chronic illness. Some conditions can require medications that can cost 5 or 6 figures EVERY MONTH! Without insurance, it can easily wipe out most families.</p>

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<p>Good point, HImom. I was thinking of my own Rxs, which might run me $500 a month if I didn’t have insurance. Not fun, but not a game-changer. But as I said, I’m fortunate. For many Americans, $500 a month might as well be a million. We need universal insurance.</p>

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<p>I was speaking in hypothetical terms: if we could bring down the cost of routine care with free-market type pressure - more transperancy, more competition, and especially more personal responsibility for one’s health, then we wouldn’t need to have insurance companies controlling our medical care lives, other than catastrophes. It’s a futile pipe dream at this point, we’re already way past exploring that idea, it was just something to ponder and discuss.</p>

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<p>Actually, the emergency or urgent care situation is somewhat different from the other situation. In for emergency or urgent care situation, you have no time to shop around from the back of the ambulance (and you didn’t get to choose which ambulance picked you up either). In the “you have cancer [or other dangerous condition]” situation, you do theoretically have the opportunity to shop around, because it won’t kill you today. However, shopping around is often difficult because there is often little transparency in either quality or price for medical services, plus the fact that different physicians may have different opinions about what treatment options are better for your situation (so you may have to consider both different treatment options as well as different physicians for each – a difficult task for the non-expert).</p>