Healthcare premiums to rise about 20%

[Guest]

AFA my own family coverage is concerned, my strategy is that I am looking for a hole in the sand, into which I can place my head and make believe I didn't notice.

[poppy]

I just heard some startling numbers on NPR. It will "save" $7 billion, but cost $200 billion. The tax credits aren't going away, just the cost-sharing piece. The premium increases will be passed on to the federal government for the 85% of people on the exchange who receive the tax credits. 

 

Just want to be super clear about this, this is going to make the cost to government increase and make the cost to consumers increase.  This is a lose-lose by any measure except for one: the  "any change is good, kill  the status quo no matter what the cost" thinking.

[2squared]

But, although they're super expensive, the coverage is mandated to be good. Here are our BCBS VT plans for next year. Dental is about $300/month on top of it. The plan we have this year is the gold standard. Next year, it's about $1850 +$300 for dental = $2150. 

 

http://www.bcbsvt.com/wps/wcm/connect/0d29ba0a-f166-458d-a375-ad2ef4484942/2018-bcbsvt-qhps-quick-compare-group.pdf?MOD=AJPERES

 

I can't image dental insurance is cost-effective at $300/month unless your family has a ton of dental needs every year.  I price our dental costs with and without insurance every year, and a $300 premium wouldn't be worthwhile, even for my family of seven.

[EMS83]

"Oh yeah? Hold my beer." -- Congress

 

:lol:  :lol:  :lol:

[Lanny]

I scanned, very quickly, a lot of the responses.  One of them had a list of things that would help. That list included Lawyers. A lot (about 25% ?) of what doctors and hospitals do is so they can CYA against Malpractice Attorneys.  That's another group that donates a huge amount of $ to people on both sides of the aisle and has a lot of Lobbyists. 

 

I read this tonight, which refers to the subsidies to the private health insurance companies: "The funds initially had been authorized under former President Barack Obama after Congress would not appropriate them."

[Barb_]

9. Life sucks and then you die. Get rid of the perception that healthcare is the road to happiness. It should not be considered a way to be totally pain free, stress free, emotion free, and glamorous appearing. These perceptions have created a bunch of addicts, very expensive procedures, and even more expensive drugs.

I deleted most of your quote because I'm assuming it wasn't meant to be taken seriously, lol. I can hardly wait to go party with my cardiologist, because my ekg and blood draws are the highlight of my year. If I wasn't worried about totally giving myself over to hedonism, I might make an appointment with the gyno-spa for a Pap smear but I don't know if I could handle all of the glamour and happiness. I'll have to content myself with feeding my addiction to blood pressure meds.

 

Lord, have mercy.

Edited October 14, 2017 by Barb_

[Guest]

[\quote]

 

9. Life sucks and then you die. Get rid of the perception that healthcare is the road to happiness. It should not be considered a way to be totally pain free, stress free, emotion free, and glamorous appearing. These perceptions have created a bunch of addicts, very expensive procedures, and even more expensive drugs.

It is not a perception, its reality. Ask anyone who escaped early death because of healthcare. A diabetic perhaps, if you don't know a cancer patient. I would have been dead in my 40s with your plan...but because I have paid into health insurance my entire adult life, I was able to get life saving treatment when I needed it. The total cost was less than the premiums I paid. If I hadn't paid premiums, I would have self insured, and then would have to have been lucky it didn't appear too early. Insurance should be there for the catastrophic genetic issues, its the human thing to do.

 

Additionally, research needs to be funded. I am still alive because of genetic research and chemistry that became reality because of engineering projects I personally contributed to. I have no desire to live in your stone age, but if you want to opt out its great with me as long as you live with your consequences instead of showing up wanting to freeload when Death is breathing down your neck.

Edited October 13, 2017 by Heigh Ho

[Barb_]

I scanned, very quickly, a lot of the responses. One of them had a list of things that would help. That list included Lawyers. A lot (about 25% ?) of what doctors and hospitals do is so they can CYA against Malpractice Attorneys. That's another group that donates a huge amount of $ to people on both sides of the aisle and has a lot of Lobbyists.

 

I read this tonight, which refers to the subsidies to the private health insurance companies: "The funds initially had been authorized under former President Barack Obama after Congress would not appropriate them."

Lanny, you and others have mentioned more than once that a federal judge ruled subsidies to be unconstitutional, and while that is true his wasn't the final word on the case. That's why the subsidies were continuing--the case is in appeal and hasn't been settled yet. Otherwise 15 states wouldn't be suing to continue subsidies:

 

http://thehill.com/policy/healthcare/355360-15-states-sue-over-trump-halted-obamacare-payments

[OrganicJen]

I'm not sure I get the "get rid of lawyers" comment.  Johns Hopkins ranked medical errors as the 3rd leading cause of death in the US.  The misperception that lawyers or lawsuits cause insurance rates to rise is one that the insurance companies perpetuate because when their client loses a malpractice case they have to pay some of the money they have been collecting to the person injured or killed by their client's malpractice, so they want people to think that lawsuits are all bad.  They want people to believe most malpractice cases are shams but the reality is that the lawyers who take those cases spend on average several years and $50,000-$100,000 of their own money to fund the case up to and through trial and don't get a penny back or any a fee for their time if they lose, so the majority of them certainly wouldn't want to take a case that wasn't legitimate.  And as for the injured patients, the 3 year battle that it takes from filing a malpractice lawsuit until they can finally get to trial is not a pleasant experience and the insurance companies who pay for the doctor's attorneys spend as much money as they need to make the injured person or their family suffer as much as possible during their lawsuit.  Although we often hear of the rare large verdicts in the news, the truth is the amount that most injured people or their families receive is much smaller than most people realize.   And honestly, I personally think that if someone is injured or killed by a healthcare provider, they have some amount of a duty to try to keep it from happening to others.  For instance, if someone goes to the optometrist to get a new prescription for contacts and the doctor permanently blinds them, then I would hope that person would take steps to see that the optometrist is held accountable and that the person is compensated in some way to at least make up for no longer being able to work and make money,  so that maybe the optometrist will be more careful with their next patient who could be me or a loved one of mine.    

[Barb_]

No, it’s still a winner by constitutionality, even if you grant every other premise on cost (which I don’t).

 

From HHS:

And I wouldn’t call singer payer the solution either, since NHS keeps producing exactly the results one might expect. A recent tidbit:

https://www.independent.co.uk/news/uk/politics/nhs-winter-crisis-latest-waiting-times-british-medical-association-sleepwalking-nine-year-high-a7997461.html

 

 

I’m no big fan of the great orange wonder, but given the behavior of congress in not acting to fix this after we were saddled with this mess in the previous administration, I wouldn’t say malice is the driving motivation.

Not malice toward Americans--just indifference. The real deep-seated hatred is reserved for his predecessor.

[Carol in Cal.]

I have a friend who lives in a non-major but still metropolitan area.  I've been working toward moving there someday.  She thinks I shouldn't.

 

The local hospital is so bad that it refers a ton of patients to places that are a two hour ambulance or helicopter ride away.  Patients like a guy who falls down the stairs and breaks his neck in two places and probably will never regain the use of his legs.  Really?  You can't stabilize and treat someone like that, and you call yourself a hospital?  Was it the fall or the two hour trip to the other hospital that really trashed this man?

 

None of the local doctors will accept a new patient.  None.  Doesn't matter what insurance they do or don't have; they can't get a doctor.

 

There is one nursing home.  It's marginal.  And not cheap.  There are no home care agencies.

 

Availability of care is a real issue whether you have insurance or not.  Calling what we have a 'system' is laughable.   

 

 

[Sandwalker]

I get the frustration. I have it too. My question is that I don't understand how people have worse insurance? All ACA plans are required to cover preventative care and no yearly or lifetime caps. They're required to cover mental health benefits, dental and vision for kids and a bunch of stuff I'm forgetting.

 

The price is killing us, as a family. Because we buy from the exchange, we have to use our post-tax income on premiums. BCBS is going up 12% next year, which means for a family plan with dental, we're looking at about $2200/month in premiums. We have a deductible on top of that. So, it sucks and DH and I are seriously considering going without insurance for a year and just covering DS.

 

We make just a hair over the limit for receiving tax premium assistance, so we will end up having to pay about 1/3 of our income towards health insurance next year. WHICH IS RIDICULOUS. It's more than my entire take-home paycheck. So I don't know what we are going to do.

 

But, although they're super expensive, the coverage is mandated to be good. Here are our BCBS VT plans for next year. Dental is about $300/month on top of it. The plan we have this year is the gold standard. Next year, it's about $1850 +$300 for dental = $2150.

 

http://www.bcbsvt.com/wps/wcm/connect/0d29ba0a-f166-458d-a375-ad2ef4484942/2018-bcbsvt-qhps-quick-compare-group.pdf?MOD=AJPERES

Paying 1/3 of your income for health insurance is ridiculous! I would choose a cheaper plan and put some of the money saved on premiums in a tax free hsa to help with the deductible.

[EMS83]

Health insurance =/= healthcare, plain and simple.  No one will ever convince me there's not enough money in the collective medical industry to fund actual healthcare for all of us, it's just in the wrong places and pockets.  I don't know if adding bureaucracy is helpful.  Like education, I think the $$ belongs in the pockets of the people actually rendering the service.  How to get it there??  No clue.   :confused1:  

 

 

ETA

 

RE: lawyers...I don't think they're the problem so much that I think malpractice should be a criminal issue.  If you kill someone or blind them or debilitate them through...whatever, being sued and sent back to the trenches just shouldn't cut it.  Money should be involved in such cases insofar as there are real costs incurred.  No emotional trauma suits.  Just no.  Doctors pay malpractice insurance premiums, which bumps list prices up, as does insurance company negotiated rates.  Both need to go.  Then we can address actual overhead and actual profit and the actual needs of the low income and those with expensive conditions.  That's the part I'm not sure how to handle efficiently.  Something like a regional Go Fund Me managed by...someone.

While we're at it, ax advertising for pharmaceutical industries.  Just make your product right and understand how many people are actually in the targeted demographic and don't overproduce like a dummy.

 

Ugh whatever.  I'm probably just talking out of my rear; I have no idea how any of this works.

Edited October 14, 2017 by CES2005

[mom2scouts]

"Oh yeah? Hold my beer." -- Congress

 

I really want to laugh at this, but it's too true to be funny.

[Spryte]

Paying 1/3 of your income for health insurance is ridiculous! I would choose a cheaper plan and put some of the money saved on premiums in a tax free hsa to help with the deductible.

I have refrained from responding, but I kind of had to laugh at the tax free HSA. Even if a family can afford to fund their HSA, it's still limited. I would know. Our crappy insurance plan this year meant that even after we met our high deductible and OOP costs, and still funneled the max allowed amount into the HSA (we are not allowed to make any more contributions this year, that tax free ship has sailed - it is not unlimited), we still can't pay our portion of the medical bills. Nope. It's simply more than we can float. We've paid $40K + in medical this year, and the bucket is dry. I honestly don't know what to do next. Or how to pay the next month's Rxs which are undercovered under our plan and leave us with $1K + in co-pays. Monthly. That's on top of bills for two hospitalizations for anaphylaxis, a cardiac event and the subsequent followup, and a broken limb. The point to all that rambling is that the tax free HSA is a nice tool for the people who can afford it, but even then it's a drop in the bucket when it comes to major medical expenses.

[scholastica]

I have refrained from responding, but I kind of had to laugh at the tax free HSA. Even if a family can afford to fund their HSA, it's still limited. I would know. Our crappy insurance plan this year meant that even after we met our high deductible and OOP costs, and still funneled the max allowed amount into the HSA (we are not allowed to make any more contributions this year, that tax free ship has sailed - it is not unlimited), we still can't pay our portion of the medical bills. Nope. It's simply more than we can float. We've paid $40K + in medical this year, and the bucket is dry. I honestly don't know what to do next. Or how to pay the next month's Rxs which are undercovered under our plan and leave us with $1K + in co-pays. Monthly. That's on top of bills for two hospitalizations for anaphylaxis, a cardiac event and the subsequent followup, and a broken limb. The point to all that rambling is that the tax free HSA is a nice tool for the people who can afford it, but even then it's a drop in the bucket when it comes to major medical expenses.

You can't even put enough in per year to cover the oop maximum for a family. Which is a joke number anyway

[Barb_]

I have refrained from responding, but I kind of had to laugh at the tax free HSA. Even if a family can afford to fund their HSA, it's still limited. I would know. Our crappy insurance plan this year meant that even after we met our high deductible and OOP costs, and still funneled the max allowed amount into the HSA (we are not allowed to make any more contributions this year, that tax free ship has sailed - it is not unlimited), we still can't pay our portion of the medical bills. Nope. It's simply more than we can float. We've paid $40K + in medical this year, and the bucket is dry. I honestly don't know what to do next. Or how to pay the next month's Rxs which are undercovered under our plan and leave us with $1K + in co-pays. Monthly. That's on top of bills for two hospitalizations for anaphylaxis, a cardiac event and the subsequent followup, and a broken limb. The point to all that rambling is that the tax free HSA is a nice tool for the people who can afford it, but even then it's a drop in the bucket when it comes to major medical expenses.

No joke. We set aside the max HSA this year even with decent insurance and garden variety healthcare needs. That's before braces. Just copays and deductibles for contacts, fillings, psych meds and appointments for one kid, my yearly cardiology thing, physicals, booster shots, and a couple of weird, unexplained illnesses that eventually cleared up on their own. $2600 gone.

[AmandaVT]

I can't image dental insurance is cost-effective at $300/month unless your family has a ton of dental needs every year.  I price our dental costs with and without insurance every year, and a $300 premium wouldn't be worthwhile, even for my family of seven.

 

Unfortunately, we're big dental users in this house.  :sad:

 

So far this year, we've each had 2 cleanings, 1 set of xrays. $200/cleaning, $75/xrays = $1425

 

DS had to have a second appointment with the dentist and another set of xrays to take a closer look at a few cavities. $275

 

DH had 2 cavities, a root canal and a crown - lots of $$. $1500 for the root canal, $260 for each filling and $1300 for the crown

 

I needed to get a filling replaced - which required another set of xrays $260

 

Insurance covers cleanings and the first set of xrays and 80% of everything else (50% of crowns). So, I think it's worth it. It also covers 50% of orthodontics, which DS will need in the next year or so. 

[Sandwalker]

I'm sorry you have these terrible medical bills. The health problems are enough to worry about :(

[AmandaVT]

Paying 1/3 of your income for health insurance is ridiculous! I would choose a cheaper plan and put some of the money saved on premiums in a tax free hsa to help with the deductible.

 

I've been looking at all of our options. The cheapest, bronze plan, is about $500 less per month. But, the deductible is huge and we'd have to pay everything out of pocket until we meet it. Currently, DS's therapist is $100/week and we all have prescriptions that would cost out of pocket, instead of the $15 copay we pay for Dr's visits. Most of our prescriptions are less than $5 on our current plan. We'd have at least 2 over $100/month if I went to the lowest plan, which still costs a TON.

 

So, I'd save about $500/month on premiums but would have to pay $400/month for the therapist and at least $200/month on medication. And, if anyone needed a Dr's appointment during the year, we'd be paying out of pocket instead of $15. The deductible on the bronze plan is $10,000 for the family. Our current plan has a $15 or $30 copay for everything except inpatient hospitalization. 

 

Also, HSA's max out at about $3,000 per year. That wouldn't make much of a difference. 

 

I've looked into our business getting on the small business plan through the exchange and having us pay with pre-tax money for premiums. BUT, the problem with that is that if the business offers a plan to employees, no employee of the business will be eligible for the tax credits. We have a few employees that get them, so offering insurance would mess that up.

[Bootsie]

1. Failure to cite sources

2. Cherry picking data (for example, Walmart has averaged 10%-11% this year)

3. Are you saying insurance companies are hurting because they aren't making the kind of profits Costco makes? I don't even know where to begin there because I reject your premise

 

 

Health insurance companies are NOT hurting because of the ACA, which is the reason they gave for the large bump. The fact that retail companies are more profitable is completely irrelevant to the converstaon.

 

Here is the source/

 

https://www.axios.com/profits-are-booming-at-health-insurance-companies-2418194773.html

 

Edited to remove crappy example

These numbers are from Securities and Exchange filings and are available at www.marketwatch.com.

 

Wamart's ROE for the past year is 17.23%--http://www.marketwatch.com/investing/stock/wmt/profile

 

I am not saying that insurance companies are hurting, and I am especially not tying any of that to ACA; I am simply taking issue with the suggestion that health insurance companies have profits that are spiralling.  Whether are not as a society we want for profit companies involved in health care is one issue.  Given that we do have for profit companies at this point, I think it is unreasonable to expect their ROE to be substantially less than in other industries.  

[Barb_]

These numbers are from Securities and Exchange filings and are available at www.marketwatch.com.

 

Wamart's ROE for the past year is 17.23%--http://www.marketwatch.com/investing/stock/wmt/profile

 

I am not saying that insurance companies are hurting, and I am especially not tying any of that to ACA; I am simply taking issue with the suggestion that health insurance companies have profits that are spiralling. Whether are not as a society we want for profit companies involved in health care is one issue. Given that we do have for profit companies at this point, I think it is unreasonable to expect their ROE to be substantially less than in other industries.

Disagree. Health care doesn't respond to typical market forces and can't be compared to retail.

 

Walmart over the past year:

 

https://csimarket.com/stocks/WMT-Return-on-Investment-ROI.html

 

When I said profits were "spiraling" that was in comparison to the justification for their rate hikes. At the time they were supposedly needed to cover the extra burden from the ACA because they were going to lose money.

Edited October 14, 2017 by Barb_

[ChocolateReignRemix]

I could fix healthcare, easy.

 

1. Ninety percent of healthcare dollars are spent in the last 5 years of life. Eliminate those last five years by focusing on hospice care rather than prolonging life. Ouch. This is like killing grandma.

 

2. Also, eliminate risky procedures. Did I see the UK is thinking of postponing some surgeries for the obese until there is weight loss? (I hope this was a Facebook fake news) Obesity is just one risk factor for surgical complications. I would guess it should be OK to eliminate surgeries for anyone who has any type of risk factor.

 

3. Get rid of lawyers.

 

4. Get rid of unnecessary tests. Do not allow patients to request expensive testing.

 

5. Get rid of insurance covering expected expenses. Go back to Major Medical. We all know we will have to buy birth control pills, a couple of doctor visits a year for colds and sore throats. This regular, routine stuff should not be insured. We all know we will get hungry after church on Sundays. There is no reason to purchase insurance, which would add to the costs, of Sunday dinner.

 

6. Get rid of government mandated medical practices. It is not the recommendations that are bad. Most are based on decent evidence. But, the government requires more administrators to prove healthcare is in compliance. Administrators now outnumber those actually taking care of the patients. I am sick of seeing hospitals continually cutting staff in patient care areas just to add more administrative positions.

 

7. Get rid of all the middlemen. Healthcare should be between the patient and the doctor. No one else should get a vote, certainly not some foreigner sitting in a basement office deciding what tests will be allowed. The back and forth crap between healthcare providers and payers has gotten beyond ridiculous.

 

8. Get rid of malpractice lawsuits. While surprisingly, this doesn’t add a ton of cost to Medicine directly, indirectly it does. The amount of over-prescribing and over-testing is beyond out of control.

 

9. Life sucks and then you die. Get rid of the perception that healthcare is the road to happiness. It should not be considered a way to be totally pain free, stress free, emotion free, and glamorous appearing. These perceptions have created a bunch of addicts, very expensive procedures, and even more expensive drugs.

 

1.) Source?

 

2.) Have fun defining risky.

 

3.) Nonsensical.

 

4.) There is some room for change here but ever allowing a patient to push for a test when a need is not being addressed seems absurd.

 

5.) I am not sure the data supports this as a cost cutting move.  Insurance companies initially pushed this as a cost-saving move through catching issues early.

 

6.) Do you want to get rid of preventative care, patients being allowed to request tests, malpractice and standards of care?  Sounds like you may have a found a path to cheap yet ineffective care. 

 

7.) Overhead is an issue but I see no way you can mandate this.

 

8.) So in theory a doctor could be negligent and it would be just bad luck for the person who is damaged?  lol no.

 

9.)  Wow.

 

[ktgrok]

No, it’s still a winner by constitutionality, even if you grant every other premise on cost (which I don’t).

 

From HHS:

And I wouldn’t call singer payer the solution either, since NHS keeps producing exactly the results one might expect. A recent tidbit:

https://www.independent.co.uk/news/uk/politics/nhs-winter-crisis-latest-waiting-times-british-medical-association-sleepwalking-nine-year-high-a7997461.html

 

 

I’m no big fan of the great orange wonder, but given the behavior of congress in not acting to fix this after we were saddled with this mess in the previous administration, I wouldn’t say malice is the driving motivation.

 

The rest is too far outside the TOS.

Huh, so there people might have to wait a year for a non urgent operation, and here you just have to do without indefinitely because you can't afford it. 

 

There, 20 percent of people had to wait more than 4 hours at an ER...here it is probably just as many but you get to pay thousands of dollars for the privilege. 

 

Nothing about that article scared me. Not when so many here go without care entirely. 

[ChocolateReignRemix]

Huh, so there people might have to wait a year for a non urgent operation, and here you just have to do without indefinitely because you can't afford it. 

 

There, 20 percent of people had to wait more than 4 hours at an ER...here it is probably just as many but you get to pay thousands of dollars for the privilege. 

 

Nothing about that article scared me. Not when so many here go without care entirely. 

 

Not to mention those waits were a 10-year high.  And for non-urgent care.  Not bad considering some here have been swearing for decades that the entire healthcare system in the U.K. and elsewhere is on the verge of collapse.

 

Meanwhile in this country people have to beg hospitals/charities for financial assistance to help cover bills of babies who need extensive neonatal care or other treatments.

[Frances]

No, it’s still a winner by constitutionality, even if you grant every other premise on cost (which I don’t).

 

From HHS:

And I wouldn’t call singer payer the solution either, since NHS keeps producing exactly the results one might expect. A recent tidbit:

https://www.independent.co.uk/news/uk/politics/nhs-winter-crisis-latest-waiting-times-british-medical-association-sleepwalking-nine-year-high-a7997461.html

 

 

I’m no big fan of the great orange wonder, but given the behavior of congress in not acting to fix this after we were saddled with this mess in the previous administration, I wouldn’t say malice is the driving motivation.

 

The rest is too far outside the TOS.

But the current NHS problems are mainly due to underfunding. If we put what we spend in the US on healthcare into a similar system, we could have much shorter wait times. Also, neither the US nor the U.K. produces enough doctors for their populations, which is absolutely ridiculous given the excellent higher education systems in both countries. Thousands of qualified US students are turned away from medical school every year due to a lack of training spots.

 

My son is currently living in the U.K., and so far has chosen to skip the NHS wait times and uses private care which is partially reimbursed by our insurance. But likely because everyone has free care available to them as an option, the prices for private care are drastically lower than in the US and the quality has been absolutely top notch. A chronic knee problem that he's seen multiple doctors (including specialists) and physical therapists for during the last two years in the US and Germany has been almost completely resolved by four appointments with a private U.K. physical therapist.

[Bootsie]

Disagree. Health care doesn't respond to typical market forces and can't be compared to retail.

 

Walmart over the past year:

 

https://csimarket.com/stocks/WMT-Return-on-Investment-ROI.html

 

When I said profits were "spiraling" that was in comparison to the justification for their rate hikes. At the time they were supposedly needed to cover the extra burden from the ACA because they were going to lose money.

Although health care may not respond to typical market forces, investors do respond to typical market forces (whether they are investing in retail, health care, energy, or anything else).  Therefore, to have investors, any industry will have to offer investors a return comparable to the risk in the industry and what the investor can earn elsewhere.  Many would argue that health care is a RISKIER industry than retail, given the uncertainty of changing laws.

 

The provided link is for ROI not for ROE; mathematically ROI will be lower than ROE; it is not as broad of a measure of return to the owners of the business as ROE (which is what I was comparing) is.  (If you do want to use ROI as the measure, Aetna, for example, has had an ROI under 3.5% last quarter).

 

In the past the health insurers said that they would need to raise rates because of the burden of ACA.  Now, they have a positive ROE (which they would not remain in business very long if they didn't).  I don't see how you conclude, therefore, that they would not have had a loss had they not raised their rates.  I can't conclude they would or would not without some number crunching.  But, the presence of profits now does not negate the argument that they would have had losses without the rate increases.  

[Barb_]

Although health care may not respond to typical market forces, investors do respond to typical market forces (whether they are investing in retail, health care, energy, or anything else). Therefore, to have investors, any industry will have to offer investors a return comparable to the risk in the industry and what the investor can earn elsewhere. Many would argue that health care is a RISKIER industry than retail, given the uncertainty of changing laws.

 

The provided link is for ROI not for ROE; mathematically ROI will be lower than ROE; it is not as broad of a measure of return to the owners of the business as ROE (which is what I was comparing) is. (If you do want to use ROI as the measure, Aetna, for example, has had an ROI under 3.5% last quarter).

 

In the past the health insurers said that they would need to raise rates because of the burden of ACA. Now, they have a positive ROE (which they would not remain in business very long if they didn't). I don't see how you conclude, therefore, that they would not have had a loss had they not raised their rates. I can't conclude they would or would not without some number crunching. But, the presence of profits now does not negate the argument that they would have had losses without the rate increases.

I see your point now that I follow your line of thinking. Profits are like French fries--a little addicting and you keep grabbing at them long after you've had enough. Why then do we need continual rate increases as profits continue to chug along? Which brings me to my original assertion. Health care has no business being a for-profit or investor-supported industry and this conversation really reinforces that. Edited October 14, 2017 by Barb_

[Barb_]

Huh, so there people might have to wait a year for a non urgent operation, and here you just have to do without indefinitely because you can't afford it.

 

There, 20 percent of people had to wait more than 4 hours at an ER...here it is probably just as many but you get to pay thousands of dollars for the privilege.

 

Nothing about that article scared me. Not when so many here go without care entirely.

I'm glad you addressed that. I read it and had the same reaction but had trouble articulating why.

[2squared]

Unfortunately, we're big dental users in this house.  :sad:

 

So far this year, we've each had 2 cleanings, 1 set of xrays. $200/cleaning, $75/xrays = $1425

 

DS had to have a second appointment with the dentist and another set of xrays to take a closer look at a few cavities. $275

 

DH had 2 cavities, a root canal and a crown - lots of $$. $1500 for the root canal, $260 for each filling and $1300 for the crown

 

I needed to get a filling replaced - which required another set of xrays $260

 

Insurance covers cleanings and the first set of xrays and 80% of everything else (50% of crowns). So, I think it's worth it. It also covers 50% of orthodontics, which DS will need in the next year or so. 

 

My only comment is that your dentist is much more expensive than mine (like more than twice as expensive), and he/she takes way more xrays than mine does. We only pay for one set of xrays every other year. He does not charge more to examine cavities. I wonder if your dentist has typical rates for your area?

[Laura Corin]

From HHS:

And I wouldn’t call singer payer the solution either, since NHS keeps producing exactly the results one might expect. A recent tidbit:

[url=https://www.independent.co.uk/news/uk/politics/nhs-winter-crisis-latest-waiting-times-british-medical-association-sleepwalking-nine-year-high-a7997461.html]https://www.independent.co.uk/news/uk/politics/nhs-winter-crisis-latest-waiting-times-british-medical-association-sleepwalking-nine-year-high-a7997461.html

That's not due to single payer, just funding. If the US spent less than it spends now but on a simple single payer system, it could have amazing health-care for everyone. The UK needs to spend more and I support higher contributions to make that happen. The population is aging and more is needed.

 

ETA: I see that with my mother.  For someone of 93, she's amazingly healthy.  But she has seen the doctor at least monthly for the last eighteen months, sometimes weekly, and has seen specialists over that time too (physio, chiropody, gastro), has had one minor surgical procedure and is due another.  These are not excessive end-of-life procedures, just things to make her comfortable.  She has been to the NHS walk-in clinic after a fall too.  In her earlier life, I'd be surprised if she went to the doctor once a year.  I think she had surgery twice in seventy years - once after a car accident, once for hysterectomy.

Edited October 14, 2017 by Laura Corin

[DawnM]

I am waiting to see what DH's insurance will do.  Mine has already gone up.  I am paying more than double for my individual insurance.  

 

DH just got his yearly "raise" and it was the lowest raise he has ever gotten.  2% total.  Since he had planned to up his retirement fund 2%, we don't see it in our bank account for spending.  I am ok with that, but if expenses keep going up, that will be a problem.

[brehon]

Spending more, as though money is some endless pool and taking it from one part of the economy (spending by the public on goods and housing) and moving it increasingly to services, has no ramifications or unintended consequences? You can’t just endlessly shift more and more tax dollars to cover funding issues. And *some* consumers pay more commensurate with the quality or quantity of the healthcare they want to receive, but this is not monolithic across the population and many many people were paying far less before the ACA precisely because their costs were lower. Taking more from them to cover a higher risk population and decreasing the costs for that risk pool isn’t just benign and fair and helps everyone. It really doesn’t. It’s the least efficient and one of the more economically damaging ways to deal with the problem of sick people and associated expenses.

 

Money from the public to cover healthcare is not an endless pool in either country. And there are precious few times where looking money with a government body makes things less expensive or increases quality and performance.

 

Blah blah blah, you (general you) are all going to argue and disagree and claim how I’m wrong on this. Like I was wrong on Obamacare (except I wasn’t, because these fiscal issues are *predicable*). Or better yet, argue that ever increasing costs for taxes to help people is an unreservedly good thing and *you’re* willing to make the trade offs, so why isn’t your neighbor?

 

Yeah, we’ve been down this road ten times before. I don’t know why I even bother except to put up the token protest that silence doesn’t mean you’ve actually convinced everyone you’re right.

 

You realize that you use this rhetorical device a lot, don’t you? Make an argument for/against whatever issue is being discussed, present your argument as the only correct one, then state you don’t know why you bother because no one ever listens to you even though you’ve been proven right; so tootles, I’m out, or another variation on the theme.

 

To be sure, I’m not addressing your argument itself or saying you should or shouldn’t participate as you want, of course; I just wonder why you employ this type of device. It actually detracts from the points you're trying to make.

[Sandwalker]

But the current NHS problems are mainly due to underfunding. If we put what we spend in the US on healthcare into a similar system, we could have much shorter wait times. Also, neither the US nor the U.K. produces enough doctors for their populations, which is absolutely ridiculous given the excellent higher education systems in both countries. Thousands of qualified US students are turned away from medical school every year due to a lack of training spots.

 

My son is currently living in the U.K., and so far has chosen to skip the NHS wait times and uses private care which is partially reimbursed by our insurance. But likely because everyone has free care available to them as an option, the prices for private care are drastically lower than in the US and the quality has been absolutely top notch. A chronic knee problem that he's seen multiple doctors (including specialists) and physical therapists for during the last two years in the US and Germany has been almost completely resolved by four appointments with a private U.K. physical therapist.

Your example proves that single payer in most places is a two tier system, with the top tier only for those who can afford it. Why is that great physical therapist working for private insurance in the UK rather than helping the masses on the NHS?

[Barb_]

Your example proves that single payer in most places is a two tier system, with the top tier only for those who can afford it. Why is that great physical therapist working for private insurance in the UK rather than helping the masses on the NHS?

You say that like it isn't an improvement. The two tier system we have here is that you pay a high percentage of your income for healthcare if you can manage it, or you do without. Why disparage a system that works so much better than ours just because it doesn't live up to the ideal.

[Twolittleboys]

No, it’s still a winner by constitutionality, even if you grant every other premise on cost (which I don’t).

 

From HHS:

And I wouldn’t call singer payer the solution either, since NHS keeps producing exactly the results one might expect. A recent tidbit:

https://www.independent.co.uk/news/uk/politics/nhs-winter-crisis-latest-waiting-times-british-medical-association-sleepwalking-nine-year-high-a7997461.html

 

 

I’m no big fan of the great orange wonder, but given the behavior of congress in not acting to fix this after we were saddled with this mess in the previous administration, I wouldn’t say malice is the driving motivation.

 

The rest is too far outside the TOS.

 

I am not saying any system is perfect but I can tell you that living in a country with universal health care I have NEVER met anyone who wasn't able to see a doctor (maybe after a bit of a wait), went bankrupt, couldn't afford medicine for kids etc. NEVER! Both my parents needed quite a bit of medical intervention before their deaths (4+ weeks in hospital, special beds/equipment at home, weeks of rehab, etc.) and I / they maybe had to pay a couple of hundred in total. 

 

My son had an infection on his finger when we were on vacation in the UK. We visited the doctor three times (urgent care). We maybe had to wait one to two hours to be seen. Got a prescription for antibiotics. Absolutely no cost to us.

 

It may not be perfect but it is so much better than what I hear from the US (full disclosure: when I lived in the US I had great, inexpensive health care). And the US could learn from other countries and come up with a great plan that maximizes the overall benefit (but of course will not be an improvement for everyone as that is not possible). So from an individual perspective I can see people not wanting a change but for someone entrusted with the good of the nation, it should be easy to make choices for the public good that benefit the most.

[Twolittleboys]

Your example proves that single payer in most places is a two tier system, with the top tier only for those who can afford it. Why is that great physical therapist working for private insurance in the UK rather than helping the masses on the NHS?

 

I have never needed to see a private practitioner. The public options are just fine. It's like saying a country in which everyone has enough to eat is not a better place to live than a country in which many are starving because in the first country only the rich eat caviar. So what? Sometimes good enough is good enough (again, not saying that health care in other countries could not also be improved).

[Barb_]

Spending more, as though money is some endless pool and taking it from one part of the economy (spending by the public on goods and housing) and moving it increasingly to services, has no ramifications or unintended consequences? You can’t just endlessly shift more and more tax dollars to cover funding issues.

 

And *some* consumers pay more commensurate with the quality or quantity of the healthcare they want to receive, but this is not monolithic across the population and many many people were paying far less before the ACA precisely because their costs were lower. .

I want to address these two points separately. Firstly, Laura didn't say the US needed to spend more on healthcare, she said the UK isn't spending enough on healthcare. While I agree that endlessly throwing money at something isn't in anyone's interests, sometimes you do have to reallocate funds in order to get the most for your money. That seems to be where the U.K. Is right now, but I can't imagine either of us is more qualified than Laura to give an opinion on that's.

 

What Laura actually said was that if her country spent anywhere near the percentage of the GDP the US already spends on healthcare, they would have a world class system.

 

To your second point, the fact that some people were spending lesson healthcare before the ACA is largely irrelevant. Most people were spending more of less care or had no insurance at all. Or were spending large amounts only to have it capped or treatments denied. Government's responsibility is to follow the utilitarian rule--make policies that provide the greatest good for the greatest number of people. I agree that doesn't always happen, but that is the point of good government. That's those policies don't work for a small percentage of people is a consequence of society.

 

Last point. Insurance costs were already increasing and believing the ACA is at solely at fault for rising costs is confusing correlation with causality. There is no way to go back and take out the ACA and check--well maybe there is since it looks to be unraveling--but health insurance costs were already out of control. Those low costs plans were already on the rise, unless of course they were minimal plans that covered next to nothing for largely healthy people and then that carries its own inherent cost eventually.

 

:grouphug: You sound fragile and exhausted. I hope everything is okay.

[Sandwalker]

You say that like it isn't an improvement. The two tier system we have here is that you pay a high percentage of your income for healthcare if you can manage it, or you do without. Why disparage a system that works so much better than ours just because it doesn't live up to the ideal.

I am not convinced that the NHS does work better than our system, even in ours' current state of crisis.

 

I'd like to address the lawyer point mentioned above. The real cost of lawyers is the adaptations that hospitals, physicians, and the entire health care system must make in order to stave off huge lawsuits that would threaten their practice/institution. Patient care is #2.

 

The charting on patients done by nurses like me has ballooned to ridiculous mountains of unnecessary, time-wasting, cover-your-butt information input into slow and repetitive programs. The real reason is to make it difficult for lawyers to go through and find pertinent information in the hundreds of pages of garbage spewed out as 'medical records' these days. As a hospital RN, I am required by law to do continuing ed every year; the large teaching hospital I work for requires yearly training on what things not to write in the chart. There is also a special computer program on reporting "incidents" (mistakes or accidents) directly to our hospital lawyers before charting anything about it. The lawyers also draft all of the consents that patients are required to sign for care, procedures, surgeries, privacy documents, etc.

 

I'll be 60 years old this year, and have seen patient care in the hospital worsen unbelievably since the ACA doled out hundreds of millions to the health care community to get them on board with electronic medical records. So now when you are hospitalized, your nurse is likely looking at the computer more than she is at you, the patient--even when she is in your hospital room. And at the physician's office--are they looking at you more than in a cursory fashion? Or are they filling in boxes on the (likely non user friendly) medical record while you tell them your symptoms?

 

In addition, most hospitals and doctor's offices I am aware of are still using Windows 7 for their operating systems. Yes, insecure 7. And Win10 is not considered secure for electronic medical records--so what happens when Windows support for 7 ends next year? Our large urban public hospital had to switch from XP(!) a year or two ago when Microsoft stopped supporting it.

 

Recently I had a short hospitalization, my first since my childbirths. Although I was there for cardiac issues, not one nurse touched a stethoscope to my body the entire time. The nurse would come in the room, shielded by her huge wheeled computer on wheels, and each one spoke to me from behind the computer, so I was not even assessed by the eyes of a nurse, her most important tool. Not one nurse touched me in any way, although I know they were all charting full head to toe pretend assessments every four hours. The PCT did vital signs, and the EKG tech did EKGs every four hours. The RNs? Came in and asked questions while typing and then left.

 

Before the forced switch to the EMR, nurses had time to assess patients properly, even fluff a pillow or two, sit with a scared pediatric patient for a few minutes, reassure a worried spouse. Nurses are the front line; if we don't see changes in condition, the doctor will not know, as he only sees the patient once a day for a couple minutes. These days? Nearly all the time for both RNs and physicians is used on charting. And most charting is for the lawyers.

Edited October 14, 2017 by Sandwalker

[Barb_]

I am not convinced that the NHS does work better than our system, even in ours' current state of crisis.

 

 

No, no no. Wait a minute. Back up a sec. That is the bulk of your rebuttal?

 

"I see your statistics, I hear your logic, I know there are testimonials and first hand accounts right here on this thread, but I reject it all. Still not convinced." So there.

[Guest]

 

 

To your second point, the fact that some people were spending lesson healthcare before the ACA is largely irrelevant. Most people were spending more of less care or had no insurance at all. Or were spending large amounts only to have it capped or treatments denied. Government's responsibility is to follow the utilitarian rule--make policies that provide the greatest good for the greatest number of people.

Its not irrelevant, its a deal breaker. Remember Bill Clinton's remarks of oct 3, 2016? He was spot on. People overnight had their premiums doubled, covereage halved, and had to choose between food or coverage when the ACA plans arrived. Its great that people with no coverage now have coverage, but it cost the working middle class families by giving them plans they can't afford to use. Look at their death rates now by age. What we need is one big pool, or a high cost conditions medicare plan like those kidney dialysis patients have. Government is responsible for ALL the people, not just certain groups.

[Barb_]

Its not irrelevant, its a deal breaker. Remember Bill Clinton's remarks of oct 3, 2016? He was spot on. People overnight had their premiums doubled, covereage halved, and had to choose between food or coverage when the ACA plans arrived. Its great that people with no coverage now have coverage, but it cost the working middle class families by giving them plans they can't afford to use. Look at their death rates now by age. What we need is one big pool, or a high cost conditions medicare plan like those kidney dialysis patients have. Government is responsible for ALL the people, not just certain groups.

No, you're right. I'm not defending the ACA as it is. I am objecting to the idea that the only way to fix it is to scrap the whole damned thing. Every plan is going to be better for some people and less good for others. The trick is to work something out that offers the greatest benefit for the most people. What we have now is far from perfect but is better *for most peole* than the free market was. We need to keep going and regulate healthcare, not toss it out altogether.

[Carrie12345]

I'm not sure I get the "get rid of lawyers" comment.  Johns Hopkins ranked medical errors as the 3rd leading cause of death in the US.  The misperception that lawyers or lawsuits cause insurance rates to rise is one that the insurance companies perpetuate because when their client loses a malpractice case they have to pay some of the money they have been collecting to the person injured or killed by their client's malpractice, so they want people to think that lawsuits are all bad.  They want people to believe most malpractice cases are shams but the reality is that the lawyers who take those cases spend on average several years and $50,000-$100,000 of their own money to fund the case up to and through trial and don't get a penny back or any a fee for their time if they lose, so the majority of them certainly wouldn't want to take a case that wasn't legitimate.  And as for the injured patients, the 3 year battle that it takes from filing a malpractice lawsuit until they can finally get to trial is not a pleasant experience and the insurance companies who pay for the doctor's attorneys spend as much money as they need to make the injured person or their family suffer as much as possible during their lawsuit.  Although we often hear of the rare large verdicts in the news, the truth is the amount that most injured people or their families receive is much smaller than most people realize.   And honestly, I personally think that if someone is injured or killed by a healthcare provider, they have some amount of a duty to try to keep it from happening to others.  For instance, if someone goes to the optometrist to get a new prescription for contacts and the doctor permanently blinds them, then I would hope that person would take steps to see that the optometrist is held accountable and that the person is compensated in some way to at least make up for no longer being able to work and make money,  so that maybe the optometrist will be more careful with their next patient who could be me or a loved one of mine.    

 

Indeed.

We were preparing to lose my stepfather after his surgery.  He was in and out of consciousness, hallucinating when "awake", and no antibiotics were helping his infection.  Then they realized that a surgical towel was left inside of him. I had flown down to say goodbye, but wound up (thankfully) staying to help him through the first few weeks of an incredibly difficult recovery. It took him a year to get as back to normal as he did.

Because of the limitations on lawsuits in their state, the cost of the lawsuit, the lack of experts willing to testify against anyone associated with that hospital, and the cost of the medical bills they received, including for the second surgery, they were cornered into settling for very little more than covering those bills.  

 

It is a fact that similar cases in other states have won enormous payouts.  But, in my research, the majority turn out like my parents'.

[Sandwalker]

No, no no. Wait a minute. Back up a sec. That is the bulk of your rebuttal?

 

"I see your statistics, I hear your logic, I know there are testimonials and first hand accounts right here on this thread, but I reject it all. Still not convinced." So there.

Ok, here http://www.bbc.com/news/health-38926697

[Sandwalker]

 

 

No, you're right. I'm not defending the ACA as it is. I am objecting to the idea that the only way to fix it is to scrap the whole damned thing. Every plan is going to be better for some people and less good for others. The trick is to work something out that offers the greatest benefit for the most people. What we have now is far from perfect but is better *for most peole* than the free market was. We need to keep going and regulate healthcare, not toss it out altogether.

You have statistics for this? That the majority's health care is now better post-ACA?

[Barb_]

Ok, here http://www.bbc.com/news/health-38926697

I'm not disagreeing they are struggling. Healthcare systems across the developed world are struggling as populations age due to the post war baby boom and the reduction in population growth in the younger generations. But this article is written by people who take their good healthcare largely for granted. They view it as a right and are understandably frustrated when it isn't working the way it always has. They are still stunned and appalled to hear what we go through here. One cannot support the statement that our system is better, even in crisis, than the NHS

[Barb_]

You have statistics for this? That the majority's health care is now better post-ACA?

Preventative care is covered, birth control is covered, preexisting conditions are covered, lifetime and yearly caps are abolished, high school and college graduates who used to fall between the cracks between dependency and full time work are covered, and uninsured rates have fallen to record lows

https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201702.pdf

[Guinevere]

Preventative care is covered, birth control is covered, preexisting conditions are covered, lifetime and yearly caps are abolished, high school and college graduates who used to fall between the cracks between dependency and full time work are covered, and uninsured rates have fallen to record lows

https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201702.pdf

But isn't it true that so many people don't use their insurance because they can't afford the deductibles? I'm not sure that more people being insured is proof that health care has improved. Of course more people are insured, because now it's law that they have to be!

[Barb_]

Health insurance is expensive because healthcare is a for profit operation. Publically traded companies are required to turn a profit for their shareholders. We are trying to provide a something that is a basic right for survival in a civilized society on a capitalist model that prioitizes profits above care. That is our problem. It willl continue to be our problem even if we toss out the ACA because we haven't changed our model of provision.

[Barb_]

But isn't it true that so many people don't use their insurance because they can't afford the deductibles? I'm not sure that more people being insured is proof that health care has improved. Of course more people are insured, because now it's law that they have to be!

That's a fair point. I don't know the answer to that.