re: Health Insurance Costs Are Out Of Control

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$2400 per month is on the expensive side for sure. But not by much.

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It’s over $2500 for an employee with a spouse and children at my company. The company pays for 100% of it, but it’s definitely over $2400 per family

Thanks HoBama

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$150,000 between the two of us

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I’m dumbfounded. We make the same but teacher insurance is $200/month for a family of 4. I couldn’t even tell you the deductible because it’s never mattered.

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The situation is complicated. Federal law requires hospitals to stabilize anyone in an emergency—citizens and non-citizens alike. The actual cost of emergency care for undocumented immigrants is less than 1% of Medicaid spending

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bullshite!

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Hypothetically, if you make 75k and your work offers insurance, it’s a disservice to you.

You’re better off with an employer offering no insurance and getting it free from marketplace.

Almost to the point where you’re better off working part time and getting free healthcare rather than pony up 30k/year for it.

Job making 55k with no insurance + marketplace insurance nets you more than making 75k and being offered dogshit insurance that costs a family 25k in premiums.

Just work part time and get free healthcare….or better yet, find a job that doesn’t offer any health insurance at all.

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You could peel back the onion even further.

Why work a 76K a year job when you can drop to a part time position making less than 25K a year and be eligible for Medicaid for you and your children. Receive a Section 8 Voucher, Receive a healthy amount of food stamps depending on the number of children, qualify for free child care, school lunch program, and no telling how much other free programs available to you.

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And I don't think "deporting them all" dents healthcare costs significantly.

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Then you are a frigging imbecile.

Where do you suppose hospitals get the funds to cover "uninsured expenses"?

Since this is apparently a challenging concept, let's make it a multiple choice.

Do hospitals get the funds to cover "uninsured expenses" from:
A) Tinkerbell?
B) Santa Claus?
C) The Easter Bunny?
D) The Tooth Fairy?
E) Medicaid Funding!

At least 5% of the population is comprised of illegals. >10% by some assessments.
You've just elaborated on the lack of insurance in that population.

Adding insult to injury, illegals are extraordinarily aware of US health entitlements. They can't make normal MD appointments sans insurance, or spot payment. So instead, they advantage of EMTALA. With EMTALA they typically seek care in far and away the most expensive US healthcare entry portals ... ERs ... at 10x or more the cost of a normal care pathway.

Why?
Because EMTALA is a federal law requiring hospitals with emergency departments which receive Medicare/Medicaid funds to provide a medical screening examination to any patient who comes to the ER and requests one, regardless of a person's ability to pay or their insurance status.

That dramatically increases their per capita costs.
Think man!
Think!

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A lot of local governments self-insure.

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Government self insurance works something like this. Each worker is assigned a premium cost for single, spousal, and family coverage with typical deductibles and copays through a health care network PPO. The individual's responsiblity for premiums are put into a smaller pool and each employee has an annual exposure limit where reinsurance pays out more for critical or expensive procedures. The government's portion of premium is paid based on the number of claims up to the exposure limit per employee and administrative fees and reinsurance. The total cost of this is typically less than traditional insurance for the government or large business.

Only down side is that depending on who the government picks as their PPO will determine if it is worth it. Some times the PPO networks are small and some hospitals don't deal with them. Some could be large and come from Blue Cross or United Health Care.

For example, about 8 years ago a local parish did this and the workers were critical of the switch because they were complacent with Blue Cross. The parish wanted to save money by going the self insured route. Initially, the employees relented because they may have to change doctors or their doctor wasn't on their PPO network yet as it was a new network coming to the area and would only start accepting new facilities and doctors after the insurance was written in that area..

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Because it was still a hybridized structure, and the worst kind - a compulsory one.

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No, because it was designed to be a wealth redistribution scheme from the outset. Otherwise, they would have simply bought every citizen below a certain income level a basic BC/BS policy for $375 a month (yeah, that's what they were going for for average people back then, $650 a month for the whole family) and anyone who was declared uninsurable due to being too expensive would simply have been absorbed into Medicaid or Medicare.

That would have kept the private system intact while covering everyone. They didn't do that because that wasn't the goal. It wasn't the only goal, anyway.

I believe that you are fixating on the form rather than the intention and blaming the wrong factor. Until you substantiate why a "hybrid" system "can't" work instead of just stating it as though it's a self-evident fact, I'm going to keep believing that. There are probably dozens of hybrid systems that could work. This is a game of pick your poison.

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I'm not sure why people get up in arms over the semantics of this.

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Then you haven't thought about it very deeply.

If health INSURANCE is the same thing as health CARE, then all I have to do as a politician is make sure you have health INSURANCE and I can claim that I have given you access to health CARE. But if your health INSURANCE has a deductible of $12,000—you have insurance—but who is paying for your actual health CARE?

You are.

And if you have a health CARE need that costs $15,000 and don't have $12,000 to pay the deductible, then what?

The point being, just because you have one doesn't mean you have access to the other. I can declare that I am going to bestow upon every citizen of the US my own private health INSURANCE plan, free of cost. In fact, I will do so right now. Anybody who wants to sign up, just email me. Now, the deductible for the plan is a billion dollars. And it doesn't actually cover anything. But you'll have health INSURANCE for free!

This also works in reverse. Just because you don't have health INSURANCE doesn't mean you don't have access to health CARE. I'm receiving treatment for something right now and the clinic doesn't file insurance. So I might as well have none in this scenario. But i walk in and pay them myself and viola! I get health CARE even though health INSURANCE had nothing to do with it.

If you still don't understand why this is important, let's keep going.

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That is basically what we are comparing when we are comparing the current model to a single payer.

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Nope. That's not the important factor. The important factor is that we still have a model in which one party gets the service, one party provides it, and a third party pays for it. Only NOW, that third party is the government, and it's now the only game in town. There is no alternative.

So when the government budget office gets a call in February after having reviewed last year's numbers and someone on the other end says, "It's getting too expensive, cut the budget by 20%," then they just make the "medical" decision to cut reimbursement and/or deny services to fit the budget.

Now what you may not know—but I do, as I used to own a medical clinic—is that government reimbursement is kind of all over the map. Because it doesn't respond to medical evidence or logic or supply and demand, and that especially goes for government reimbursement when there are no competitors (single payer).

Some Medicare/Medicaid reimbursement is quite good—better than most private reimbursement. Some of it, you couldn't sustain a clinic on it if that's all you were getting. In those situations those patients are just "light bulb" patients, meaning that we can afford to take in a minority of them to help keep the lights on, but we can only handle so many before it's not worth it.

With a single payer and no alternatives, they can reimburse however little they want, whenever they want, for whatever reason they want. And under pressure to lower costs, that's exactly what they will do.

So your knee replacement surgery gets denied. Come back in three years and we'll re-evaluate your need.

Reimbursement drops so low that the best and brightest stop going into medicine and find something else to do. So your doctor tomorrow isn't the quality of your doctor today. Clinton admitted this 25 years ago, only she arrogantly declared that doctors would simply have to get used to making less money. No, the hell they won't. With the nonsense they have to put up with there isn't much room at all to cut doctor's salaries before the landscape changes drastically.

Speaking of doctors, you want to see the doctor instead of the Nurse Practitioner? O.k., we'll put you on the waiting list. It usually takes around nine months to get you in. Once.

Equipment that would normally be kept current and in good working order becomes outdated and old, but the clinics/hospitals don't have the revenue to replace it.

And because of that, companies that used to develop and sell innovative equipment to clinics and hospitals downsize or go out of business altogether. So the technological progress of the industry slows to a crawl.

Conclusion: it is absolutely NOT a given that it would be "better" to go to a single payer model with "fewer problems."

Also, I trust that by now you see why not equating health INSURANCE and health CARE is important. Having "single payer insurance" doesn't mean it will pay for the care you want/need, and it also doesn't mean it will pay the doctors what they need/want to stay in the profession, or pay enough for clinics and hosptials to stay current on equipment, etc., etc.

What do you mean, go to marketplace? I go through an agent and it has gotten crazy expensive.