Health Insurance

[tomz]

It looks like folks with employer-provided insurance would rather buy a PPO/HMO policies rather than the HSA/high deductibles, which are still not that widespread.

http://news.yahoo.com/s/ap/20061201/...r_health_plans

[Martha]

I think it is mostly a question of cost as well as a perception of risk. The high deductibles make it more expensive for many people unless someone subsidizes part of that deductible, or they are really healthy and end up not using the deductible.

[justin]

A lot of folks are just plain broke. They don't want to face the possibility of paying $1000-2000+ out of pocket if they or someone in their family gets sick. Even middle class folks operate like this. They have an inability to save any significant amount of money for a rainy day. They'd rather pay the extra $100 or $200 every month in higher premiums for the full insurance plan than to save it and spend it when needed.

[Rich_in_Tampa]

PPOs are a contrivance, an artificial structure designed to facilitate discounts, lower payments, and exert leverage over the stakeholders. Sometimes they work, sometimes they don't. No provider ever feels that they "work for "or have allegiance to a PPO. They join because it is in their best interest to do so (preservation of patient volume at the cost of lower revenue per patient, mostly).

HMOs are another issue (staff-model, that is, with employed providers). At their worst, they are cost-reduction machines with everyone too busy, underpaid, and so on. At best they are efficient providers of protocol-based care, transparently exposing themselves to quality measures, adherence to national guidelines when applicable, and a culture of safety and value care.

Historically, many in the profession equate HMOs with socialized medicine, but that is not a supportable view IMHO. I regret that the country did not tilt that way in the 70s and 80s since I believe it was our best shot at an affordable, accessible, high quality health care system within a competitive economic system. They can be overseen using accepted outcome measures, can compete with one another, can offer fluffy optional services at a fee (house-calls which are not strictly medically necessary, wellness clubs, in-house pharmacy and retail, etc.). Cherry-picking of the healthiest patients can be legislatively monitored away. Kind of like a big department store: some like Penneys, some like Nieman Marcus and are willing to pay. But everybody can buy pants somewhere.

Reasons? Lobbying from the insurance industry, AMA (which at the time was a small private practice advocacy lobby unlike now where it is largely irrelevant), and confused congress, among others.

If I were 30 years old and interested in a nonacademic primary care career, I would seek a high quality HMO with colleagues of a similar mindset. If there are any left.

[grumpy]

As if I didn't already know how critical good health insurance is to a secure retirement my recent experience sure brought it home again. Last month needed to have both an MRI and CT scan. I just got the explanation of benefits form from Blue Cross for the MRI. The provider billed BC $4,631. BC paid the provider $2,218 (preferred provider writes off the difference). My co-pay is $221. I haven't received the statement on the CT scan yet but I expect the numbers will be similar. Without insurance I would have been out of pocket close to $10,000!!! My health insurance premiums run about $3500 per year and I have had additional out-of-pocket expenses of about $3000 per year in recent years. It certainly helps me sleep better at night knowing that any medical expenses I might incur I can handle with little or no strain. What do people without insurance and significant health issues do?

Grumpy

[Martha]

Quote:

Originally Posted by grumpy What do people without insurance and significant health issues do?

They are more likely to die sooner.
www.iom.edu/File.aspx?ID=17748

[windsurf]

i vote for socialized medicine. If one can argue that the only legitimate concern of government is national defense, I contend that an equally plausible argument can be made that the preeminent concern should be the health of the citizenry. If President's pay tops the beauratic food chain, then pay docs a shitload more than librarians. I think there are talented individuals who would work just as hard to perform a surgery with perfection if they were making 200k even if they weren't making 800k (or more). They just might not be the same indivduals.

[bamsphd]

Quote:

Originally Posted by tomz It looks like folks with employer-provided insurance would rather buy a PPO/HMO policies rather than the HSA/high deductibles, which are still not that widespread. http://news.yahoo.com/s/ap/20061201/...r_health_plans

My employer still does not offer an HSA option.

My wife fall's into the mis-priced camp. I expected to recommend she go with the
HSA option, since she is very healthy, and we are getting close to FIRE. However,
once I looked at the prices there was no way. I don't remember the exact numbers,
but I calculated that we would only save a trivial amount of money assuming she
used NO medical services. Add a multiple thousand dollar deductible, and an
associated savings account with high fees and poor investment choices. No thanks.
Only the mathematically challenged would be suckered by that offer. The PPO
alternative with an out-of-pocket maxiumum close to the HSA deductible looked
like a much better deal.

[Rich_in_Tampa]

Quote:

Originally Posted by bamsphd My employer still does not offer an HSA option.

HSA seems to be best for those with time to build the account over at least 5-10 years, and enough cash on hand to cover potentially high out of pocket expenses for a few years if necessary. That's a relatively small number.

When I looked at it, it didn't make sense for us. What we would gain via HSA we lost by eliminating our flex account (medical reimbursement with employer contribution). Even if I maxed out the HSA contributions we wouldn't have enough accumulated to make it worthwhile. Would have been nice after 10 years of contributions, though.

[FinanceDude]

I think the HSA thing is just getting going.

I foresee a time when folks negotiate how much the employer will fund their HSA coming in as much as how much vacation time, etc.

HSA's work pretty well over time, particularly if you are healthy and don't overuse the benefits in the group plan.

How many times have large increases been inflicted on the group with the explanation that "you have a sick group"