Employer sponsored insurance is better than ObamaCare’s gold plans. This is very unfortunate for those who do not qualify for insurance for their company.
The silver standard is a joke. That or bronze is what most people will have if they sign up for coverage. They may feel secure having it, but if something happens and the realities set in, they will not like it.
It can be clearly stated that Obamacare did everything except making the healthcare affordable. With historically high premiums and almost impossible to meet deductibles, Americans will spend more on healthcare to receive worse treatment.
Thanks Obama for making healthcare more expensive and making coverage mediocre. Thanks to the administration that is meddling in the people’s business, when no one asked them to. Thanks for decreasing the quality of an already poor system. Thank you for making us worse off.
Hey now. It’s Obama that is trying to help everyone get insurance. Blame the doctors for not taking every patient. They are the ones making you worse off. Evil Doctors.
Everything is great until the people start getting sick and realizes that having insurance is not worth it. If deductibles are $6,000 and premiums are high, people would prefer pay the fine and take their chances than paying for an insurance that is useless.
Zero deductible insurance can be 60-80 percent less expensive than Exchange Plans or even employer sponsored coverage
It requires self insured employers if 200 or more employees to look beyond the current year
With appropriate claims history we can provide significant guarantees over 3-5 years
Brokers who advise in this market are encouraged to contact donaldlevit@aol.com
Don Levit ,CLU,ChFC
Principal of National a Prosperity Life and Health
I’d be more concerned about the breadth of the network and the max out-of-pocket.
But it’s ironic that the people who are touting this as a success are the same ones who used to claim HSA’s were unacceptable because the associated policies usually came with $2000 or $2500 deductibles.
By the time the ACA has worked its “magic” in the small group insurance market, employer plan deductibles may be much higher on average than they are today.
Low deductible plans cost a lot of money. The corporations and unions that have such plans usually pay huge amounts for coverage, i.e. $18,000+ a year for family coverage. Medicare has low deductibles and it is very expensive per-person.
I think that the Obama administration knew right away that their law could not contain subsidies that large.
I do not think that this problem is solvable by private insurance alone. I would support the use of Medicare Part A by anyone, at any age, for catastrophic coverage. People could then buy low-deductible ‘mini-med’ plans with their own dollars for the first $5K-$10K of exposure.
“Medicare has low deductibles and it is very expensive per person.”
Really, Bob?
You compare the cost of coverage for a working population with the cost of a senior, retired population?
Besides, the Medicare cost-sharing is a lot more than you suggest .
You are correct however that the cost problem cannot be solved by private insurance alone. In fact, because “the problem” is the cost of medical care, it cannot be “solved” by insurance at all – whether private, public, or some combination.
Using any insurance mechanism to pour ever more oceans of money into a system that has clearly been unable to control its costs is certain to make the problem worse. As Nipsy Russell would say, that’s running through Hell in gasoline pants!
Obamacare is an insurance mechanism that does virtually nothing to address high medical cost. I’m talking about factors that make the delivery of medical care more expensive in the US than anywhere else on earth. And that is the fundamental reason Obamacare is failing to fulfill the promises made for it.
John, let make a “modest proposal.” You are an intelligent observer and I would enjoy your response.
My proposal is this:
The cost of medical care is determined by what we pay for it.
(as opposed to the cost of oil or wheat or similar commodities)
If like Japan we had a national fee schedule which mandated payments of $98 for an MRI, would not the “cost’ of an MRI head down to $98?
If we had a national fee schedule that called for hospitals to receive $1500 a day,
the adjustment would be very painful but would not the cost of hospital care head down to $1500?
I am aware that my assertion is not standard economics by any means. I am not accounting in the traditional way for land, labor, and raw materials.
But I have studied labor economics. And in that field, the cost of a worker really is what the employer is willing to pay.
I was going in a little different direction, John. I was thinking as follows:
– if you look at senior airline pilots, you would assume that a skilled pilot had an intrinsic cost of $200,000 a year.
– but every day the airlines find skilled pilots and pay them $40,000 a year (sometimes even less).
I was just hinting that the same thing could happen in medicine. Certainly in drugs and some procedures.
Fixing the SGR is just Congress trying to keep 90% of doctors in the Medicare system. Doctors are big campaign contributors so this makes political sense.
“Fixing the SGR is just Congress trying to keep 90% of doctors in the Medicare system.”
Exactly.
And yet you still assert that the cost of medical care can be dictated by what the buyer wishes to pay?
Does the cost of your medical care become zero if you cannot find a physician willing to treat you at your price?
I think it’s very clear the supplier of the service always has a say, including the possibility of saying No.
In a free economy, the price is determined by a willing buyer and a willing seller. The willingness is crucial. It seems to me you imagine a less-free economy in which the buyer can force the seller to accept the buyer’s price. But in that less-free economy, the supplier always has the option to supply less, or not to supply at all.
Your pilot example leaves out a whole lotta important stuff. I’m sure you know that, having studied labor economics in college. Anyway, you can hint all you like that physicians would willingly supply the same amount of their labor for significantly less money than they earn today. I doubt it because there are so many costs imposed on physicians that that their practices must cover, and there are so many other things physicians could choose to do instead.
One more thing. A $40,000 pilot rides in the same aircraft as the passengers. A $40,000 surgeon (if you can find one) never gets on an operating table. Who do you think bears the greater risk from an underpaid supplier – the passenger or the patient?
Vast sections of agriculture and the restaurant industry and the retail store industry
are able to hold wages down, and even reduce them, and still attract employees.
Of course they have an enormous ‘reserve army of the unemployed” to draw from, plus immigrants both legal and illegal. If some workers demand more, the industry keeps finding cheaper substitutes.
But enough of my analogies. This is a health care blog, let’s talk about doctors.
There is a collision between fee for service insurance and the need for insurers to try and stay within a budget. This happens in every rich country, Canada and Germany as well as the USA. Other countries have some version of the SGR struggle every year also.
In our case, the best long term answer might be that Medicare quit covering office visits altogether. Seniors could get an annual voucher and either pay cash for visits, or buy a mini-med policy. The government could control its costs, which is a worthwhile goal, and doctors could charge what they want.
The massive 40,000-item fee schedule for physicians could be tossed into the wastebasket, where it probably belongs.
“agriculture and the restaurant industry and the retail store industry”
Well, I think doctoring is quite unlike those industries and I think the physician labor supply is not at all comparably elastic.
But perhaps, as you suggest, there is presently some “reserve army” of unemployed physicians who would be willing to practice their profession for significantly less money than the existing federal reimbursement rates. That seems to be your supposition. I have no information that would support such a supposition; have you ?
“I suspect there is a huge reserve army of physicians in Mexico, Korea, China, et al”
Really, Bob?
I have no information that would support your statement; have you? It’s my understanding those countries haven’t enough physicians to treat their own populations (at least in part because many come here where they can make a lot more money).
You suggest that reducing the incomes of physicians and hospitals will surely if mysteriously reduce their costs and thus their charges. But if true, that tells me medical costs are secondary to a much bigger item that your suggestion could also address. Yet you seem satisfied to talk about second best. Why?
Why not fundamentally alter the cost of our entire economy by reducing government revenues? In other words, why are you not advocating sweeping, across the board reductions in taxes? (I mean real cuts, not reductions to growth rates.) If your cost-reducing idea is valid, reduced government revenues will lead directly if mysteriously to reduced government costs and, thereby, a reduced cost of living for all Americans.
That’s what I call a big item Bob; why not go for it?
I am not an expert in England’s health care, but I have read that the Brits hire many foreign doctors in part to contain costs.
I have never had a problem with doctor’s incomes. The $39 billion or so that doctors get from Medicare is not a budget buster, and the SGR debates are a massive waste of time.
I do think that hospitals are vastly over paid, at least on cardiac and cancer cases.
The hospitals will tell us that this enables them to provide maternity care and uncompensated emergency care.
OK, Bob, I get it. I’ve been thinking about your comments and responding to them as you asked me to do but, rather than reciprocate, you run on ahead with more fresh hypotheses, guesses, suspicions, and other unsubstantiated ramblings. That may make for amusing bar conversation when everyone is half-lit anyway. But I gotta tell ya, I just left the bar. Good luck with your idea that you can reduce medical cost by paying your doctor less than she thinks she’s worth.
I’m a bit biased (long-time owner of HSA) but higher deductibles make financial sense, assuming you rarely, if ever meet them. (We discuss this on a regular basis at http://www.majormedicalhealth.com )
But a hidden gem for many consumers is the cost-sharing feature of “Silver” Metal plans. Depending on your FPL income, deductibles can dramatically reduce, and of course, coupled with the subsidy, it’s a great option.
The only thing that is catastrophic is the size of those deductibles.
Maybe next year they will make deductible insurance to pay your deductible.
Well to make it more affordable, its either this or higher premiums. I’m sure more people would opt for higher deductibles than premiums.
Employer sponsored insurance is better than ObamaCare’s gold plans. This is very unfortunate for those who do not qualify for insurance for their company.
The silver standard is a joke. That or bronze is what most people will have if they sign up for coverage. They may feel secure having it, but if something happens and the realities set in, they will not like it.
The Bronze is about 4 times as high as employer insurance. I thank my lucks stars I have my family covered through our employer.
But Obamacare’s successful, they’re signed up for something!
Probably the same people who thank the Obama Administration for giving them ObamaCare, but blame the doctors for getting rejected from 95 offices.
I wonder if this includes family plans through ObamaCare or if it is individual coverage only.
It can be clearly stated that Obamacare did everything except making the healthcare affordable. With historically high premiums and almost impossible to meet deductibles, Americans will spend more on healthcare to receive worse treatment.
There is no meaning for health insurance while deductibles are that high.
Sure there is. It’s so you can say, “I’m Covered!”
Sarcasm.
Thanks Obama for making healthcare more expensive and making coverage mediocre. Thanks to the administration that is meddling in the people’s business, when no one asked them to. Thanks for decreasing the quality of an already poor system. Thank you for making us worse off.
Hey now. It’s Obama that is trying to help everyone get insurance. Blame the doctors for not taking every patient. They are the ones making you worse off. Evil Doctors.
Everything is great until the people start getting sick and realizes that having insurance is not worth it. If deductibles are $6,000 and premiums are high, people would prefer pay the fine and take their chances than paying for an insurance that is useless.
Zero deductible insurance can be 60-80 percent less expensive than Exchange Plans or even employer sponsored coverage
It requires self insured employers if 200 or more employees to look beyond the current year
With appropriate claims history we can provide significant guarantees over 3-5 years
Brokers who advise in this market are encouraged to contact donaldlevit@aol.com
Don Levit ,CLU,ChFC
Principal of National a Prosperity Life and Health
I’d be more concerned about the breadth of the network and the max out-of-pocket.
But it’s ironic that the people who are touting this as a success are the same ones who used to claim HSA’s were unacceptable because the associated policies usually came with $2000 or $2500 deductibles.
By the time the ACA has worked its “magic” in the small group insurance market, employer plan deductibles may be much higher on average than they are today.
Low deductible plans cost a lot of money. The corporations and unions that have such plans usually pay huge amounts for coverage, i.e. $18,000+ a year for family coverage. Medicare has low deductibles and it is very expensive per-person.
I think that the Obama administration knew right away that their law could not contain subsidies that large.
I do not think that this problem is solvable by private insurance alone. I would support the use of Medicare Part A by anyone, at any age, for catastrophic coverage. People could then buy low-deductible ‘mini-med’ plans with their own dollars for the first $5K-$10K of exposure.
“Medicare has low deductibles and it is very expensive per person.”
Really, Bob?
You compare the cost of coverage for a working population with the cost of a senior, retired population?
Besides, the Medicare cost-sharing is a lot more than you suggest .
You are correct however that the cost problem cannot be solved by private insurance alone. In fact, because “the problem” is the cost of medical care, it cannot be “solved” by insurance at all – whether private, public, or some combination.
Using any insurance mechanism to pour ever more oceans of money into a system that has clearly been unable to control its costs is certain to make the problem worse. As Nipsy Russell would say, that’s running through Hell in gasoline pants!
Obamacare is an insurance mechanism that does virtually nothing to address high medical cost. I’m talking about factors that make the delivery of medical care more expensive in the US than anywhere else on earth. And that is the fundamental reason Obamacare is failing to fulfill the promises made for it.
John, let make a “modest proposal.” You are an intelligent observer and I would enjoy your response.
My proposal is this:
The cost of medical care is determined by what we pay for it.
(as opposed to the cost of oil or wheat or similar commodities)
If like Japan we had a national fee schedule which mandated payments of $98 for an MRI, would not the “cost’ of an MRI head down to $98?
If we had a national fee schedule that called for hospitals to receive $1500 a day,
the adjustment would be very painful but would not the cost of hospital care head down to $1500?
I am aware that my assertion is not standard economics by any means. I am not accounting in the traditional way for land, labor, and raw materials.
But I have studied labor economics. And in that field, the cost of a worker really is what the employer is willing to pay.
“I have studied labor economics. And in that field, the cost of a worker really is what the employer is willing to pay.”
Really, Bob?
Then explain why Congress “fixes” SGR every year.
I was going in a little different direction, John. I was thinking as follows:
– if you look at senior airline pilots, you would assume that a skilled pilot had an intrinsic cost of $200,000 a year.
– but every day the airlines find skilled pilots and pay them $40,000 a year (sometimes even less).
I was just hinting that the same thing could happen in medicine. Certainly in drugs and some procedures.
Fixing the SGR is just Congress trying to keep 90% of doctors in the Medicare system. Doctors are big campaign contributors so this makes political sense.
“Fixing the SGR is just Congress trying to keep 90% of doctors in the Medicare system.”
Exactly.
And yet you still assert that the cost of medical care can be dictated by what the buyer wishes to pay?
Does the cost of your medical care become zero if you cannot find a physician willing to treat you at your price?
I think it’s very clear the supplier of the service always has a say, including the possibility of saying No.
In a free economy, the price is determined by a willing buyer and a willing seller. The willingness is crucial. It seems to me you imagine a less-free economy in which the buyer can force the seller to accept the buyer’s price. But in that less-free economy, the supplier always has the option to supply less, or not to supply at all.
Your pilot example leaves out a whole lotta important stuff. I’m sure you know that, having studied labor economics in college. Anyway, you can hint all you like that physicians would willingly supply the same amount of their labor for significantly less money than they earn today. I doubt it because there are so many costs imposed on physicians that that their practices must cover, and there are so many other things physicians could choose to do instead.
One more thing. A $40,000 pilot rides in the same aircraft as the passengers. A $40,000 surgeon (if you can find one) never gets on an operating table. Who do you think bears the greater risk from an underpaid supplier – the passenger or the patient?
Vast sections of agriculture and the restaurant industry and the retail store industry
are able to hold wages down, and even reduce them, and still attract employees.
Of course they have an enormous ‘reserve army of the unemployed” to draw from, plus immigrants both legal and illegal. If some workers demand more, the industry keeps finding cheaper substitutes.
But enough of my analogies. This is a health care blog, let’s talk about doctors.
There is a collision between fee for service insurance and the need for insurers to try and stay within a budget. This happens in every rich country, Canada and Germany as well as the USA. Other countries have some version of the SGR struggle every year also.
In our case, the best long term answer might be that Medicare quit covering office visits altogether. Seniors could get an annual voucher and either pay cash for visits, or buy a mini-med policy. The government could control its costs, which is a worthwhile goal, and doctors could charge what they want.
The massive 40,000-item fee schedule for physicians could be tossed into the wastebasket, where it probably belongs.
“agriculture and the restaurant industry and the retail store industry”
Well, I think doctoring is quite unlike those industries and I think the physician labor supply is not at all comparably elastic.
But perhaps, as you suggest, there is presently some “reserve army” of unemployed physicians who would be willing to practice their profession for significantly less money than the existing federal reimbursement rates. That seems to be your supposition. I have no information that would support such a supposition; have you ?
I suspect there is a huge reserve army of physicians in Mexico, Korea, China, et al.
Not that persons on Medicare want to travel to see them, or maybe even see them in the USA.
Why has the price of clothing and shoes fallen in the USA, while the prices of health care have gone up and up?
Because in clothing and shoes, we Americans accept cheap foreign substitutes.
in health care we do not, by and large.
This is a big item, John, let’s stay on it if you wish.
“I suspect there is a huge reserve army of physicians in Mexico, Korea, China, et al”
Really, Bob?
I have no information that would support your statement; have you? It’s my understanding those countries haven’t enough physicians to treat their own populations (at least in part because many come here where they can make a lot more money).
You suggest that reducing the incomes of physicians and hospitals will surely if mysteriously reduce their costs and thus their charges. But if true, that tells me medical costs are secondary to a much bigger item that your suggestion could also address. Yet you seem satisfied to talk about second best. Why?
Why not fundamentally alter the cost of our entire economy by reducing government revenues? In other words, why are you not advocating sweeping, across the board reductions in taxes? (I mean real cuts, not reductions to growth rates.) If your cost-reducing idea is valid, reduced government revenues will lead directly if mysteriously to reduced government costs and, thereby, a reduced cost of living for all Americans.
That’s what I call a big item Bob; why not go for it?
I am not an expert in England’s health care, but I have read that the Brits hire many foreign doctors in part to contain costs.
I have never had a problem with doctor’s incomes. The $39 billion or so that doctors get from Medicare is not a budget buster, and the SGR debates are a massive waste of time.
I do think that hospitals are vastly over paid, at least on cardiac and cancer cases.
The hospitals will tell us that this enables them to provide maternity care and uncompensated emergency care.
OK, Bob, I get it. I’ve been thinking about your comments and responding to them as you asked me to do but, rather than reciprocate, you run on ahead with more fresh hypotheses, guesses, suspicions, and other unsubstantiated ramblings. That may make for amusing bar conversation when everyone is half-lit anyway. But I gotta tell ya, I just left the bar. Good luck with your idea that you can reduce medical cost by paying your doctor less than she thinks she’s worth.
I for one think that higher deductibles are a good thing. I would like to see them much higher.
I’m a bit biased (long-time owner of HSA) but higher deductibles make financial sense, assuming you rarely, if ever meet them. (We discuss this on a regular basis at http://www.majormedicalhealth.com )
But a hidden gem for many consumers is the cost-sharing feature of “Silver” Metal plans. Depending on your FPL income, deductibles can dramatically reduce, and of course, coupled with the subsidy, it’s a great option.