Why are we so paranoid about having choices?

[travelover]

Quote:

Originally Posted by Gatordoc50 .......I'm not saying you aren't getting ripped off, just that you're ripping someone else off even better. Well played.

Huh?

[samclem]

Quote:

Originally Posted by travelover The part I have a problem with is that we (all Americans) have a societal contract to pay for any medical care that the patient can't afford themselves. So, if you can afford a policy with no caps, but choose to buy an inexpensive capped policy, you are in effect pushing the risk off on the rest of society - the hospital and the other patients that must pay higher premiums to cover the uncompensated care.

That's all true. When the ACA (or whatever replaces it) is in place, with guaranteed issue of insurance, subsidies or other mechanisms to help people with low incomes afford health insurance, etc, we might need to consider this "contract" fulfilled. If, after all the sacrifice that people are making for the sake of the chronically sick and the poor, these same people can't be bothered to even sign up for the free/cheap insurance, I think we need to ask ourselves just who should be responsible picking up the pieces. Obviously, there will be cases of mental incapacity, etc, but at that point the recipient and his/her situation deserves examination, by the legal system, that goes well beyond provision of health care.

[47]

Quote:

Originally Posted by samclem If, after all the sacrifice that people are making for the sake of the chronically sick and the poor, these same people can't be bothered to even sign up for the free/cheap insurance, I think we need to ask ourselves just who should be responsible picking up the pieces.

I can understand signing up for the cheap insurance.

But we have to ask ourselves what exactly does it even mean that someone *should* sign-up for the "free" insurance.

We are going through all this contortions and knotting ourselves into a pretzel because as a country because we have trouble accepting that in some cases collectively spending for some common good can be a good thing. Labeling something as socialism of course makes it difficult to digest in a society so conditioned to think of it as the evil personified.

But unfortunately there are somethings that just need a comprehensive solution. We did it for fighting fires, and the water supply. To some extent even electricity.

The only way to eliminate polio or chicken pox is to vaccinate pretty much the entire population. Some epidemic such the SARS episode of the 2003 kind can traverse the country in a few weeks and we may all be glad that our neighbors and others we may interact with would be covered.

What would have been a cleaner solution would have been something similar to the Medicare Part D, with a donut hole. Preventative and Primary care, as well as catastrophic coverage is automatically covered for all residents. Everyone buys optional coverage for everything in between same as before, including for all elective and nice-to-have coverage such as viagra, restless leg syndrome, thin eye lashes, etc.

[clifp]

Quote:

Originally Posted by 47Percent I am not arguing your premise that to each their own in terms of health care cost. But I think your $3,500 figure is missing a zero at the end. Here is a more representative link. http://transform.childbirthconnectio...omparison1.pdf Note that these graphs DO NOT include anesthesia charges and newborn care charges as per the footnote. Ouch!! Just cut her up and pull it out, then pack it up all to go! These are 2010 figures, and you may have to add 30-40% to those numbers now. I have had various women go through pregnancies in my family over past few decades and I don't know what a "birth center" is. The birth center costs seem quite tempting and are somewhat in line with your $3,500 number. Maybe they just have one midwife with some vaseline.. not sure how it works. But hospital deliveries in Metro areas are definitely in the five figures. Prenatal care is not included in these figures.

Ah no not all.

News flash:

Quote:

Having a baby is expensive. It's the most costly health event families are likely to experience during their childbearing years. On average, U.S. hospital deliveries cost $3,500 per stay, according to the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project.

from WebMD.

Quote:

Hospital Expenses The cost of having a baby can really add up at the hospital. You should make sure you are well-prepared financially for this part of pregnancy, especially if you don't have health insurance. The costs of childbirth can be steep. The charge for an uncomplicated cesarean section was about $15,800 in 2008. An uncomplicated vaginal birth cost about $9,600, government data show. Women who have individual health insurance policies often find that maternity care coverage is completely excluded, says Carol Sakala, PhD, director of programs at the nonprofit Childbirth Connection. Medicaid or group private insurance plans, however, cover almost all pregnancy-related health care costs. "It's important to be aware that these numbers reflect the amount a hospital will charge for these services, rather than the actual cost," says Anne Elixhauser, PhD, senior research scientist at the Agency for Healthcare Research and Quality. "The actual amount of what it costs the hospital to perform the service is about 30% of what's charged." For someone facing out-of-pocket costs, this is an important negotiating tool. "Ask and negotiate with a hospital to pay a discounted rate," Sakala says. "Since what is being charged is significantly higher than the actual cost, you have some room to potentially save."

So 30% of 9,600-$15,800 is ~$3,000-$5,000.
Which gets back to a point I've made in other threads. There is such a huge difference between what the hospital bills and what the hospital actually collect that it completely distorts discussion.

In fact the chart you posted states "average hospital birth.... CHARGES".

Really the main reason to get insurance (except for the rare, horrible life threatening incidents) is to get access to the discounts insurance companies get from hospitals and doctors.

Given that you have at least 6 months to prepare. Maternity expense is something that can be easily shopped around. When people pay for things with their own money, cost drop. A classic example is Lasik and Plastic surgeries.

I think asking parents to pay $3,000-$5,000 isn't unreasonable asking them to fork over $10,000-15,000 is.

[sengsational]

A quick one about the original topic: I think it's about shelf space. If company B has 20 plans, and company C has 3 plans, even though B really has 4 plans with 5 variants, how many will they sell having 20 versus the true 4 they really have? Its probably a loophole in the marketplace rules. I predict that there will need to be a rule to clamp down on frivolous differences.

[NW-Bound]

Quote:

Originally Posted by Gumby When faced with myriad choices, whether it be clothes shopping, insurance shopping or anything else, I try to keep in mind the old adage that "perfect is the enemy of good enough". The young wife does not agree -- that's why she spends an hour looking for a new shirt at the department store and I spend five minutes.

+1

Quote:

Originally Posted by davef Reading a good book now, The Paradox of Choice by Barry Schwartz. He discusses the problems with the range of choice we have today, no matter what it is. Sorry, not quite on topic but might be helpful in understanding why people look at choice differently.

+1. The author makes the point that we spend too much time trying to be sure to make the optimal choice when it often does not matter. Then once we have made the purchase, we still second-guess ourselves and are miserable over it.

In the case of health plan policies, we tend to have an idea of our immediate care needs, so can make some educated choices. However, the number of plans as described below does not make sense.

Quote:

Originally Posted by ziggy29 We have 17 choices in my county (all BCBS TX). I don't see a need for 17 plans, especially from the same insurer with the same provider network, though I certainly see room for a couple at each metallic level. (That 17 includes only bronze, silver and gold plans here.)

I am sure you would rather see more providers than just BCBS. There are 10 providers in my area according to healthcare.gov, but I have not created an account to see the real prices and the difference between them.

Quote:

Originally Posted by sengsational A quick one about the original topic: I think it's about shelf space. If company B has 20 plans, and company C has 3 plans, even though B really has 4 plans with 5 variants, how many will they sell having 20 versus the true 4 they really have? Its probably a loophole in the marketplace rules. I predict that there will need to be a rule to clamp down on frivolous differences.

Good point about shelf space. However, I wonder if the complexity can backfire when a smaller list of policies actually helps an insurer with a opposite tact.

[clifp]

Quote:

Originally Posted by sengsational A quick one about the original topic: I think it's about shelf space. If company B has 20 plans, and company C has 3 plans, even though B really has 4 plans with 5 variants, how many will they sell having 20 versus the true 4 they really have? Its probably a loophole in the marketplace rules. I predict that there will need to be a rule to clamp down on frivolous differences.

Shelf space has less relevance in ecommerce, what matters is ranking based on search criteria. I am guessing Amazon sells at least 100,000 different products and possibly as many as 1 million. Yet most of the time I don't feel overwhelmed because they have such good tools to narrow down what you want based on your personal criteria. Same thing with looking at Netflix despite having many many thousands of movies and TV shows

I've only used Hawaii's and California web site, but there does seem to minimal filtering ability. Perhaps healthcare.gov is better now. Still I am not sure I've seen anything more useful than ehealth.com yet.
Ideally should be able to search, on price, copays, quality rating, network coverage, and benefits covered.


In age where mass customization is possible for product like clothes that cost $10s of dollars, it seems silly that health insurance which costs $1,000s of dollars a year can't be more customizable.

[47]

Quote:

Originally Posted by clifp In age where mass customization is possible for product like clothes that cost $10s of dollars, it seems silly that health insurance which costs $1,000s of dollars a year can't be more customizable.

Heck.. I can't quite understand why we can't construct the policy exactly the way we want..I want the deductible to be X, co-pay for primary care to be Y, and out of pocket max to be Z and so on. The insurance companies know exactly how these variables affect the MLR profile, and they are capable of crunching the numbers and coming up with a bid for your rates.. at least the big ones are.

I understand, 90% of the people may not want that much flexibility -- but I can see a lot of people wanting to tweak just one or two parameters from a fixed set of choices.

Now that the underwriting is completely taken out, this should be rather simple.

I would love to have a gold plated bronze which will qualify for HSA right now!

[2B]

Quote:

Originally Posted by audreyh1 On the other hand - I discarded Silver really quick when I realized I could save big on premiums and apply the savings toward the deductible instead - if needed. Silver is like the plans we used to have, with high premiums because we had low doctor visit copays and low prescription copyays. I never had the bronze option before, and it's better for DH and me.

I have avoided commenting because I find this thread to have become very political. I've been warned for making what I have thought the most innocent statements but somehow this thread continues. I feel like this is worth commenting on and hope no one considers it to be political.

+1

I've seen the same thing. I tried playing with the silver and gold equivalents of what I thought was the best bronze plan and saw where the only advantage was if I was horribly sick or disease ridden. Then, any plan would propel me to the max OP. There wouldn't be much difference in total cost once this happened. It seemed like the higher premiums were just budgeted payments for the inevitable OP maximum. If I wasn't a big medical consumer, I lost the higher premiums.

[Gatordoc50]

Quote:

Originally Posted by 2B I have avoided commenting because I find this thread to have become very political. I've been warned for making what I have thought the most innocent statements but somehow this thread continues. I feel like this is worth commenting on and hope no one considers it to be political. +1 I've seen the same thing. I tried playing with the silver and gold equivalents of what I thought was the best bronze plan and saw where the only advantage was if I was horribly sick or disease ridden. Then, any plan would propel me to the max OP. There wouldn't be much difference in total cost once this happened. It seemed like the higher premiums were just budgeted payments for the inevitable OP maximum. If I wasn't a big medical consumer, I lost the higher premiums.

That's a good point. With the exception of a few barbs thrown around, I don't think this thread is political. I think we are all in agreement that our goal as a society should be universal coverage. We tend to disagree on how that will be payed for while keeping quality high and costs down as much as possible.

[2B]

Quote:

Originally Posted by Gatordoc50 That's a good point. With the exception of a few barbs thrown around, I don't think this thread is political. I think we are all in agreement that our goal as a society should be universal coverage. We tend to disagree on how that will be payed for while keeping quality high and costs down as much as possible.

That's the point. You are assuming that "everyone" agrees with one point of view. They don't. We don't have any real say over it anyway. It also has no bearing on retirement except in the form of baseless conjecture. We can discuss options based on current law no matter how much we (unspoken) agree or disagree with it until we're all arthritic in our fingers. Stray beyond that and we're outside the forums rules/guidelines.

[Hamlet]

Since the deductibles for most of these policies are in the 6k range, I think the ACA is giving you pretty much exactly what you are asking for.

Quote:

Originally Posted by clifp I think asking parents to pay $3,000-$5,000 isn't unreasonable asking them to fork over $10,000-15,000 is.

[Gatordoc50]

Quote:

Originally Posted by 2B That's the point. You are assuming that "everyone" agrees with one point of view. They don't. We don't have any real say over it anyway. It also has no bearing on retirement except in the form of baseless conjecture. We can discuss options based on current law no matter how much we (unspoken) agree or disagree with it until we're all arthritic in our fingers. Stray beyond that and we're outside the forums rules/guidelines.

I stand corrected. Those that think we shouldn't have a system that provides for universal access to healthcare are free to speak up as you have. No blood, no foul.

[Mulligan]

Quote:

Originally Posted by Hamlet Since the deductibles for most of these policies are in the 6k range, I think the ACA is giving you pretty much exactly what you are asking for.

This is part I am struggling to understand. I assume many people who are uninsured are being brought under the tent with subsidies. But how in the world is this going to help them when they have a 6k deductible. Many of these people probably don't even have $500 to their name.

[NW-Bound]

There's a subsidy for the premium, then there's another subsidy for the OOP part to help with the deductible. This 2nd one is not as well-known as the 1st. The following Web page is a calculator to help one figure out both subsidies: http://kff.org/interactive/subsidy-calculator/.

As an example, I entered in the following info to see for myself: family of 2 married adults of age 60, non-tobacco users, no dependents, my ZIP code.

Income of 25K: premium for silver plan of $10,028 subsidized down to $1,129, OOP max of $4,500.

Income of 100K: premium for silver plan of $10,028 no subsidy, OOP max of $12,700.

So, yes, the low income people still have to pay quite a bit. Note that the OOP does not include the premium, so the total medical cost for a major illness will be up to $5,629 for the low-income couple, vs $22,228 for the high-income pair.

[haha]

Quote:

Originally Posted by Gatordoc50 I stand corrected. Those that think we shouldn't have a system that provides for universal access to healthcare are free to speak up as you have. No blood, no foul.

That isn't the point. Whenever you say everyone thinks, or does, or even says anything you will be wrong, unless you are talking about basic metabolic processes. Sometimes there will not even be a clear majority thinking one way or another, about anything.

[Mulligan]

Quote:

Originally Posted by NW-Bound There's a subsidy for the premium, then there's another subsidy for the OOP part to help with the deductible. This 2nd one is not as well-known as the 1st.

That makes sense. But wow, this subsidy thing could get pretty expensive if a lot of people get it.

[47]

Quote:

Originally Posted by Mulligan This is part I am struggling to understand. I assume many people who are uninsured are being brought under the tent with subsidies. But how in the world is this going to help them when they have a 6k deductible. Many of these people probably don't even have $500 to their name.

There is a HUGE, I mean really HUGE.. difference between being in debt for $6,000 and being in debt for $220,000.

When your spouse or your only child needs some critical care to survive $6,000 debt is definitely manageable even for someone who is destitute. A church bake sale, some relatives and friends pitching in, or even panhandling near costco may be able to cover it. But $220,000 is certain death. Also when you seek care you would be on equal footing with everyone else. If you don't have insurance you can't even get a normal appointment with a doctor -- ER is your only hope.

Of course, for people who are slightly better off, that will mean not going bankrupt.
=====

Also one of the most important things about having an insurance and not is the access to negotiated rates. See the discussion regarding child birth cost vs. charges. If you don't have insurance (self pay) you will be looking at a bill of $35,000; With insurance you would pay a fraction of that.

[NW-Bound]

Quote:

Originally Posted by 47Percent There is a HUGE, I mean really HUGE.. difference between being in debt for $6,000 and being in debt for $220,000.

Yes.

The late Sir John Templeton who was a philanthropist once said that he believed that the healthcare recipient must be made to contribute something, and that a all-you-can-eat system can never work.

Of course none of the other countries' single-payer systems is all-you-can-eat. There's always a gatekeeper, and there has to be one. The deductible and the copay serve to encourage the healthcare recipient to take better care of him/herself.

[Mulligan]

Quote:

Originally Posted by 47Percent There is a HUGE, I mean really HUGE.. difference between being in debt for $6,000 and being in debt for $220,000. When your spouse or your only child needs some critical care to survive $6,000 debt is definitely manageable even for someone who is destitute. A church bake sale, some relatives and friends pitching in, or even panhandling near costco may be able to cover it. But $220,000 is certain death. Also when you seek care you would be on equal footing with everyone else. If you don't have insurance you can't even get a normal appointment with a doctor -- ER is your only hope. Of course, for people who are slightly better off, that will mean not going bankrupt.

That is certainly true, and I definitely agree with you. I guess I was thinking more of the mundane issues, of breaking a arm, or needing ongoing prescription expenses. If they are running 2-5k in yearly expenses, they will never have the money for that. But maybe it isn't a problem for them as NW mentioned they would get subsidies on the deductible, too.