No Politics, HC big issue for FIRE

[scrabbler1]

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Originally Posted by GTFan And that solid majority is getting heavily-subsidized, employer-provided insurance which buries the real cost of care. So why do they want change? Good summation of the problems and fixes btw.

What's just as bad is how the subsidies in the employer-based health care work. There are two of them (maybe more). The first is the subsidy based on family type and size. Those employees who are single subsidize those who are married because the employer subsidy is worth more for the latter than for the former. Those employees who have no kids subsidize those who have kids in the same way. So, if you are single AND childfree, you get hurt both ways.

The next way is that the employer subsidy rewards those more who have higher incomes at the expense of those with lower incomes because the tax benefit is greater. Similarly, the employee share of their premiums is paid using pretax dollars, so employees with higher incomes benefit more.

The way to undo these inequities is to (a) tax the employer subsidy as ordinary wage income, and (b) allow those in individual plans to deduct their premiums even if they don't itemize, like with tIRA deductions. I'm not holding my breath on either one of these happening any time soon.

[ivinsfan]

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Originally Posted by CaptTom I question the use of the word "heavily." Every MegaCorp I know has been on a years-long program of reducing the percentage of the health insurance that they pay. The end goal is to pay nothing, but simply offer some sort of group-purchasing power (if anything) to their employees. The companies I know are approaching that goal at a pretty good clip. Many would see this as a good thing. When everyone pays their own way, maybe there will be some motivation (and political pressure) to do something about the costs. The whole idea of putting the responsibility for health care on employers seems out of whack.

+ 10000 we had group BCBS for our small business for over 25 years..Finally couldn't afford to pay for it and switched over to an ACA policy from a company that I consider to be inferior in all ways to BCBS...we're a family owned C corp and can control our personal income so it hits ACA subsidy level.

Our insurance agent who is a relative, lost her commission and the multi-city agency she works for has started charging them more and more for her share of HI..They said they just can't afford the expense any more. Even the selling agencies are finding the cost too high.

[ivinsfan]

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Originally Posted by scrabbler1 What's just as bad is how the subsidies in the employer-based health care work. There are two of them (maybe more). The first is the subsidy based on family type and size. Those employees who are single subsidize those who are married because the employer subsidy is worth more for the latter than for the former. Those employees who have no kids subsidize those who have kids in the same way. So, if you are single AND childfree, you get hurt both ways. The next way is that the employer subsidy rewards those more who have higher incomes at the expense of those with lower incomes because the tax benefit is greater. Similarly, the employee share of their premiums is paid using pretax dollars, so employees with higher incomes benefit more. The way to undo these inequities is to (a) tax the employer subsidy as ordinary wage income, and (b) allow those in individual plans to deduct their premiums even if they don't itemize, like with tIRA deductions. I'm not holding my breath on either one of these happening any time soon.

You have this backwards, the more you earn the less the subsidy from the company is, they figure you have more money to give the insurance company. You are correct on the pre/ post tax..

[scrabbler1]

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Originally Posted by ivinsfan You have this backwards, the more you earn the less the subsidy from the company is, they figure you have more money to give the insurance company. You are correct on the pre/ post tax..

Backwards? Not at my old company. They paid 75% of our HI premiums for full-time employees and it didn't matter what your income was or what our family size/status was. For single/childfree employees (like me), I'd get a $3k or $4k subsidy. Married/childed employees would get at least twice that, regardless of salary.

[Mr._Graybeard]

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Originally Posted by BeachOrCity -- Tort controls

This often comes up, and I think it's an issue that has largely been dealt with on the state level. Thirty-three states have imposed caps on damage awards for medical malpractice, including most of the biggest ones.

In my state, the "pain and suffering" cap was $750,000. That limit was recently set aside in the case of a woman who lost all four of her limbs because doctors let a strep infection go untreated. The jury awarded her $25 million. Was that excessive? She's going to need round-the-clock care for the rest of her life, and as we know, that kind of care is expensive.

[ivinsfan]

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Originally Posted by scrabbler1 Backwards? Not at my old company. They paid 75% of our HI premiums for full-time employees and it didn't matter what your income was or what our family size/status was. For single/childfree employees (like me), I'd get a $3k or $4k subsidy. Married/childed employees would get at least twice that, regardless of salary.

It's the new reality, my SIL works for WF....its been that way for at least 5 years..

[karen1972]

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Originally Posted by ivinsfan You have this backward, the more you earn the less the subsidy from the company is, they figure you have more money to give the insurance company. You are correct on the pre/ post tax..

I don't think one has anything to do with the other. How much a company pays is based on industry competition and company policy. HR sees the "competition" lower it to 60% premium co-pay that's what you're going to get. Our industry benefited from some foreign buy-outs which paid 90%, so all of a "sudden" our company was like, we love you guys and want to do the very best as the costs are so expensive we will up our contributions... which is the exact opposite comment they made the year before. Its a game of HR balancing out pay and benefits to get the optimum employees.

[ivinsfan]

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Originally Posted by karen1972 I don't think one has anything to do with the other. How much a company pays is based on industry competition and company policy. HR sees the "competition" lower it to 60% premium co-pay that's what you're going to get. Our industry benefited from some foreign buy-outs which paid 90%, so all of a "sudden" our company was like, we love you guys and want to do the very best as the costs are so expensive we will up our contributions... which is the exact opposite comment they made the year before. Its a game of HR balancing out pay and benefits to get the optimum employees.

You would know more about the motives then I would....but in this case higher earning employees get less subsidy money period...

[hesperus]

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Originally Posted by Chuckanut IMHO, we are all fussing over insurance costs, when we should be questioning the cost of medical care itself and why it is so much higher here than in other countries with similar lifespans.

+1 Absolutely correct

Read:
Bitter Pill: Why Medical Bills Are Killing Us
How outrageous pricing and egregious profits are destroying our health care


Bitter Pill: Why Medical Bills Are Killing Us - TIME

[Pilot2013]

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Originally Posted by scrabbler1 Backwards? Not at my old company. They paid 75% of our HI premiums for full-time employees and it didn't matter what your income was or what our family size/status was. For single/childfree employees (like me), I'd get a $3k or $4k subsidy. Married/childed employees would get at least twice that, regardless of salary.

Not sure how long you have been RE, but the past 15 years (2 companies) that I have worked for is exactly opposite of what you are talking about.

Also, a LOT of companies are self insured, and pay for administration of the HC program. I love how some lambast that employees have company sponsored HC, but work as hard as possible to game the ACA system.

[Senator]

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Originally Posted by ivinsfan No... people will just stop training to be doctors if the pay is not acceptable...doctors are smart people, they can do many things besides train to practice medicine. Careful what you wish for, all the good doctors will move on to other things and quantity doesn't equal quality.

Some will, many people will still go into the profession. Especially if the training was free, and we could offer living in the USA as a bonus. Medical professionals will still be paid more than most people, just not as much as now. I suppose the US could even draft doctors, and pay them the equivalent in military wages if we really needed them.

Outsourcing and H1Bs worked to worked to lower IT wages, and we still have plenty of IT workers.

I work with a lot of smart people. Whether a person is in medical school for 8 years, or working as a plumber for 8 years is no difference. It's still 8 years. Pilots put in a lot more time training, have a greater responsibility, and get paid a lot less.

Giving up the salary for 8 years is the major sacrifice, not the 8 years. Paying people while they are in medical school would solve that. A salary of $30K while in school, and a guaranteed $75K once you got out would still bring in many people to be a doctor. Once you remove the malpractice issue, it's easily do-able.

There is nothing special about doctors, any more than IT people, teachers, pilots, bankers, or even mechanics. All categories of people are smart enough to be Doctors. There are even people that went into business for themselves that would/could have been a doctor, but decided against it because of the limited availability of medical school.

Open up medical school to many more people, forgive student loans to those that commit to working for the government or government pricing, and providing disincentives to doctors that do not want to work with the payment plans.

[ShokWaveRider]

I disagree with some of these comments. It IS an insurance problem, or at least a funding problem. Non profit, large client base.... Medicare, VA, Medicaid and the Individual market WILL control costs, or at least what the providers will charge the Single Payer.

Employers will still get gouged as usual.

[Chuckanut]

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Originally Posted by Teacher Terry I know someone with ACA insurance that needs a dangerous surgery that no one in their state can perform. It is a situation of life/death to not have the surgery. The ACA will not pay a dime for this out of network. That's how people go bankrupt.

Interesting and sad. I thought this was the kind of thing ACA was supposed to put an end to.

[Rianne]

I feel fortunate my ACA offered plans that were POS (point of service) so if we go out of state or to out of network doctors they cover 50%. We have a high deductible with HSA. I'm kind of scared to go to Florida this month, but my HI said go to ER if you have any issues. They are really nice at customer service. ER is covered no matter where you go in U.S.

ShokWaveRider, I agree with you. We are a wealthy country. Canada and Europe, Japan and other places are not as wealthy and give citizens the right to healthcare.

[Rianne]

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Originally Posted by Pilot2013 Not sure how long you have been RE, but the past 15 years (2 companies) that I have worked for is exactly opposite of what you are talking about. Also, a LOT of companies are self insured, and pay for administration of the HC program. I love how some lambast that employees have company sponsored HC, but work as hard as possible to game the ACA system.

Are you talking about Megacorp? Of course they are self insured. Not all companies can afford to do that. Really? One heart attack would put many smaller companies out of business.

Sorry, the super wealthy game the system in so many ways, I cannot even begin to talk about it. Research the true gamers, they have advisors and CPA's that would knock our socks off.

[ivinsfan]

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Originally Posted by Senator Some will, many people will still go into the profession. Especially if the training was free, and we could offer living in the USA as a bonus. Medical professionals will still be paid more than most people, just not as much as now. I suppose the US could even draft doctors, and pay them the equivalent in military wages if we really needed them. Outsourcing and H1Bs worked to worked to lower IT wages, and we still have plenty of IT workers. I work with a lot of smart people. Whether a person is in medical school for 8 years, or working as a plumber for 8 years is no difference. It's still 8 years. Pilots put in a lot more time training, have a greater responsibility, and get paid a lot less. Giving up the salary for 8 years is the major sacrifice, not the 8 years. Paying people while they are in medical school would solve that. A salary of $30K while in school, and a guaranteed $75K once you got out would still bring in many people to be a doctor. Once you remove the malpractice issue, it's easily do-able. There is nothing special about doctors, any more than IT people, teachers, pilots, bankers, or even mechanics. All categories of people are smart enough to be Doctors. There are even people that went into business for themselves that would/could have been a doctor, but decided against it because of the limited availability of medical school. Open up medical school to many more people, forgive student loans to those that commit to working for the government or government pricing, and providing disincentives to doctors that do not want to work with the payment plans.

I can see you have put a lot of thought into some of these ideas,so have you ever seen in the print the actual % of medical spending that goes to doctors?
And this would be a seismic shift in medical care, in fact if a DR makes 75K, what do your propose an RN would make? How about all the lab techs and other medical professionals?

[Senator]

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Originally Posted by Rianne ShokWaveRider, I agree with you. We are a wealthy country. Canada and Europe, Japan and other places are not as wealthy and give citizens the right to healthcare.

I would be curious to what level the healthcare salaries are in those countries compared to the USA.

Do Doctors get paid just as much in Canada as the USA?

[Rianne]

My knowledge of Italy, they do not. But Drs. and veterinarians go into those fields for different reasons. My niece is a veterinarian in Italy. Her passion for animals is incredible. I think she would do it for free. They make a nice salary but don't do it to become rich. How much do you need to be happy or comfortable?

[Meadbh]

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Originally Posted by Senator I would be curious to what level the healthcare salaries are in those countries compared to the USA. Do Doctors get paid just as much in Canada as the USA?

No, they don’t.

Canadian doctors still make dramatically less than U.S. counterparts: study | National Post

https://globalnews.ca/news/2898641/h...ian-workforce/

[ShokWaveRider]

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Originally Posted by Meadbh No, they don’t. Canadian doctors still make dramatically less than U.S. counterparts: study | National Post https://globalnews.ca/news/2898641/h...ian-workforce/

However the services they provide are just as good.