[Discussion] Health Care System Catch-all

This article didn't fit into quackery but other threads I searched were from years ago so I thought I would make a catch all.

Health Care Costs Are Eating Us Alive, A New Survey Shows

The American health care system is complicated, and so are proposals to change it. The 2020 Democratic presidential primary campaign has focused a lot of attention on whether to preserve the private, job-based insurance system that covers 153 million people or replace it with a single-payer “Medicare for All” program that covers everyone.

The latest data from the Henry J. Kaiser Family Foundation’s annual survey of employers underscores why this debate is so important.

In the past 10 years, the average premium for job-based health insurance that covers a family has risen 54%, to $20,756. Moreover, the amount of that premium workers pay for family coverage has increased 71%, to $6,015.

During that same decade, the share of workers whose health plans carry deductibles requiring them to pay hundreds or thousands of dollars in out-of-pocket costs before their insurance coverage kicks in has increased from 63% to 82%. The size of the average deductible has grown from $826 to $1,655.

At the same time, income hasn’t kept pace. From 2009 to 2019, earnings have gone up just 26%.

Given that employment is the single-largest source of health coverage in the United States, the increases go a long way toward explaining why Americans are so fed up with the current health care system.

U.S. workers and their families with employer-based insurance are paying more and more each year for their health coverage and for out-of-pocket costs, which is consuming a bigger share of their income.

These trends date back even further than the past 10 years, and costs have been rising steadily and outpacing workers’ incomes for decades, previous Kaiser Family Foundation surveys have found.

This year, the average family coverage plan employers offered cost 5% more than in 2018, compared to a 3.4% increase in workers’ earnings. That year-over-year change may appear less troublesome than the longer-term findings, but these relatively small increases in premiums for job-based health insurance have added up over time and have increasingly burdened workers.

Our coverage costs me $1500/mo in premiums. With a type 1 diabetic daughter there's really no choice but to pay that. My job wouldn't pay for her care without insurance, let alone what the rest of my family needs. Without insulin, she dies.

Even when the system IS working, it has drawbacks.

To whit – I’m lucky enough to have excellent health insurance through my employer (largely because it’s a union-represented job). Which is particularly lucky becuase my wife has a chronic condition that requires ongoing lifelong care.

Which means that I essentially have a pair of golden handcuffs. I’m not going to quit this corporate job and go be an entrepreneur and start my own business, because I can’t afford to lose that healthcare.

Which is great for my employer (as they don’t have to re-train someone when I leave), but bad for the economy.

Jonman wrote:

Which means that I essentially have a pair of golden handcuffs. I’m not going to quit this corporate job and go be an entrepreneur and start my own business, because I can’t afford to lose that healthcare.

My wife often says we are not "wage slaves" but "insurance whores"

farley3k wrote:
Jonman wrote:

Which means that I essentially have a pair of golden handcuffs. I’m not going to quit this corporate job and go be an entrepreneur and start my own business, because I can’t afford to lose that healthcare.

My wife often says we are not "wage slaves" but "insurance whores"

Yeah, it's such a perverse incentive - the better your job is, the better your healthcare is, the less able you are to walk away from it.

Same here. My cancer treatment ain't cheap (current oral chemo meds are $16000 a month if I didn't have insurance. IV chemo was like 50-80k per month if I'm reading my bills correctly). Healthcare for the wife and kid ain't cheap. I've had recruiters contact me a few times over the last few months. I'd honestly love to move on from this job since they've made it clear there's no more room for promotion. No way I can unless I suddenly go into remission.

Implement a single payer system providing a basic level of care, and allow 'Cadillac' plans provided by employers if they still want to use premium health insurance to attract employees. Let them have their little class stratification if it means everyone gets the care they need without being chained down to one job.

Amazon just started offering this... Light on details though we know the cost is $10 for a video visit and $25 for an in home visit.

bighoppa wrote:

Same here. My cancer treatment ain't cheap (current oral chemo meds are $16000 a month if I didn't have insurance. IV chemo was like 50-80k per month if I'm reading my bills correctly). Healthcare for the wife and kid ain't cheap. I've had recruiters contact me a few times over the last few months. I'd honestly love to move on from this job since they've made it clear there's no more room for promotion. No way I can unless I suddenly go into remission.

Implement a single payer system providing a basic level of care, and allow 'Cadillac' plans provided by employers if they still want to use premium health insurance to attract employees. Let them have their little class stratification if it means everyone gets the care they need without being chained down to one job.

Serious question - why aren't the big corporate players and the Chamber of Commerce all for single payer? I imagine bighoppa's employer would be super-happy not to have to pay his five figure monthly bills, as I imagine my employer would prefer not to pay for my wife's ongoing treatment, particularly as they self-insure, so literally are paying for every cent of it.

Jonman wrote:

Serious question - why aren't the big corporate players and the Chamber of Commerce all for single payer?

A mix between the fact healthcare is a crazy big business--like almost 20% of our GDP--and as much as companies would love to dump the expense of healthcare they are loath to turn their back on market ideology because they fear that if the government successfully replaces private health insurance then the same might happen in other industries, possibly theirs.

That and the first corporation that seriously pushes for nationalized healthcare on its own will have the entirety of the healthcare industry's lobbying and PR power turned against them.

Chairman_Mao wrote:

Amazon just started offering this... Light on details though we know the cost is $10 for a video visit and $25 for an in home visit.

My company has a similar service. The video visits are mostly useless. Without checking your vitals (your numbers aren't good enough), they can't prescribe much, not even antibiotics, so they basically amount to a call to evaluate whether or not you should come in for an in-person visit.

OG_slinger wrote:
Jonman wrote:

Serious question - why aren't the big corporate players and the Chamber of Commerce all for single payer?

A mix between the fact healthcare is a crazy big business--like almost 20% of our GDP--and as much as companies would love to dump the expense of healthcare they are loath to turn their back on market ideology because they fear that if the government successfully replaces private health insurance then the same might happen in other industries, possibly theirs.

I was going to say that being 20% of GDP means that most business, and/or business owners are invested in healthcare. They will lose money if there is a shift.

I have a few ideas of varying quality:
* Straight-up Republicanism. Regulations BAD. Government BAD.
* Change is risky and companies don't want that. When companies have to stop paying for health care, and lose that tax deduction, and employees simultaneously are asking for a raise to cover *their* taxes and to keep their compensation at the same effective level, what happens?
* It locks employees in so that leaving is risky (as stated above)
** Corollary: Like we're seeing in the UAW/GM strike, losing health care is a hell of a threat to hang over unions
** Corollary 2: Relatedly, it's something that management can use as a bargaining chip instead of actually giving up control in the employment relationship
* They foresee a day they can fire people with "excessive" health care costs and would rather put up with costs for a while until that "blessed" day.
* They think their health care offering is a selling point for employees; some of them might even be right. My last job absolutely was; they covered everything 100% and funded a HRA with $4000/family so we paid *zero* out of pocket ever. I left because the total comp package at the new place was better, but let me tell you the peace of mind of just not having to worry about any of this crap was pretty damn nice.

I bet it also costs them less in the long run. They pay out X in healthcare but if they didn't offer it they would have to pay employees X+1 if they cut that benefit. That "+1" is a cost they don't want to pay.

farley3k wrote:
OG_slinger wrote:
Jonman wrote:

Serious question - why aren't the big corporate players and the Chamber of Commerce all for single payer?

A mix between the fact healthcare is a crazy big business--like almost 20% of our GDP--and as much as companies would love to dump the expense of healthcare they are loath to turn their back on market ideology because they fear that if the government successfully replaces private health insurance then the same might happen in other industries, possibly theirs.

I was going to say that being 20% of GDP means that most business, and/or business owners are invested in healthcare. They will lose money if there is a shift.

I don't know that that's true though. A lot of businesses are very domain-specific (e.g. my employer, Boeing, have 6-figure number of employees, but their only involvement in healthcare if paying the bills of those employees. I would have though that they'd jump at the chance not to carry the risk of their employees' cancer drugs on their ledger.

qaraq wrote:

** Corollary: Like we're seeing in the UAW/GM strike, losing health care is a hell of a threat to hang over unions
** Corollary 2: Relatedly, it's something that management can use as a bargaining chip instead of actually giving up control in the employment relationship

A major driver of the GM strike is that GM wants workers to cover 15% of their healthcare costs vs. the 3-4% they currently pay (the national average is 28%).

And GM announced today that it's going to cover the healthcare costs of striking workers because it's pretty damaging to their brand when stories pop about the kids of striking workers missing their chemo treatments while GM rakes in billions of dollars in profits.

And GM--and every other auto manufacturer--would love to get out of the healthcare game. Back in 2012 GM said that healthcare costs accounted for between $1,500 and $2,000 of the sticker price of every vehicle (healthcare costs have increased just shy of 7% a year each and every year since 2012). They would absolutely love to get rid of that expense as well as benefit from the increased sales (or increased profitability) that would happen if their cars were thousands of dollars cheaper to make.

Let's just say that working in our nation's health care system has not improved my opinion of it.

OG_slinger wrote:

And GM--and every other auto manufacturer--would love to get out of the healthcare game. Back in 2012 GM said that healthcare costs accounted for between $1,500 and $2,000 of the sticker price of every vehicle (healthcare costs have increased just shy of 7% a year each and every year since 2012). They would absolutely love to get rid of that expense as well as benefit from the increased sales (or increased profitability) that would happen if their cars were thousands of dollars cheaper to make.

Above you said

OG_slinger wrote:

A mix between the fact healthcare is a crazy big business--like almost 20% of our GDP--and as much as companies would love to dump the expense of healthcare they are loath to turn their back on market ideology because they fear that if the government successfully replaces private health insurance then the same might happen in other industries, possibly theirs.

So you really believe that they want very much to get out of healthcare but they don't because of their belief in ideology? GM is worried that if private health care works the government might want to get into their industry - i.e. government made cars?

It feels like a stretch.

farley3k wrote:

So you really believe that they want very much to get out of healthcare but they don't because of their belief in ideology? GM is worried that if private health care works the government might want to get into their industry - i.e. government made cars?

It feels like a stretch.

Businesses very much believe in market ideology, that the invisible hand of the market is all that's needed to get the optimal outcome.

Having the government literally step in and dismantle a multi-trillion dollar market, causing quite a few companies to loss significant chunks of their revenue streams and market value, if not put them out of business altogether, would very much give businesses in other industries pause. If the government can do that for one industry--one that's represents a fifth of all economic activity in the country--then they can do that to any industry.

Within the auto industry things like seat belts, air bags, catalytic converters and unleaded gas, and greater fuel efficiency literally had to be forced on them via regulation. The invisible hand didn't call for them even though consumer safety and the environment did. Every time auto manufacturers fought back claiming that the regulation was unneeded or that it would cost them--and ultimately consumers--too much.

GM might not fear that Uncle Sam will make cars, but they don't like the idea of more and tighter government regulation.

Sorry OG, that really reads like a BS slippery slope argument.

There's NO indication that the US government wants to get into the business of making cars. Why would they? There's no good reason to do that.

Now, if cars had been getting more expensive by 15% annually for the last decade? Of if the leading cause of bankruptcy in the country was car ownership? Then maybe there'd be a case.

Regulation is the mechanism by which the government ensures that industry isn't doing a disservice to the public. THAT'S why the healthcare industry is looking down this barrel. The auto industry isn't close to in the same situation in a macro sense, and in a micro sense, that's exactly the rationale for the regulation they ARE currently under e.g. safety standards, fuel economy etc.

Jonman wrote:

Sorry OG, that really reads like a BS slippery slope argument.

There's NO indication that the US government wants to get into the business of making cars. Why would they? There's no good reason to do that.

Now, if cars had been getting more expensive by 15% annually for the last decade? Of if the leading cause of bankruptcy in the country was car ownership? Then maybe there'd be a case.

Regulation is the mechanism by which the government ensures that industry isn't doing a disservice to the public. THAT'S why the healthcare industry is looking down this barrel. The auto industry isn't close to in the same situation in a macro sense, and in a micro sense, that's exactly the rationale for the regulation they ARE currently under e.g. safety standards, fuel economy etc.

You asked why businesses and pro-market trade groups like the Chamber of Commerce haven't eagerly embraced single payer healthcare. I said it had a lot to do with their devotion to market ideology.

I agree with you that it's a BS slippery slope argument. But we're dealing with people who honestly think the optimal world is one where the government barely exists or it is small enough that it can't meddle with the all powerful and always correct invisible hand of the market.

Businesses and pro-market groups are going to be against any attempts by the government to regulate their actions. Businesses will funnel money to their trade or industry groups and those groups will lobby the government or weigh in on lawsuits to prevent or minimize those regulations. You'll even have unrelated trade groups weigh in because they don't want that government interference crossing over to their neck of the woods.

Which is why we end up with businesses who would really love to dump all the costs and administration headaches of providing healthcare, but who don't. And how you end up with trade groups, like the Chamber of Commerce, who stick with the myth that healthcare costs would drop and more people would have access if only the government would back off and let the market's invisible hand do it's thing.

OG_slinger wrote:

And how you end up with trade groups, like the Chamber of Commerce, who stick with the myth that healthcare costs would drop and more people would have access if only the government would back off and let the market's invisible hand do it's thing.

They forget that sometimes the invisible hand only has a middle finger.

I saw this comment on a blog I read regularly. Context is Arkansas' implementation of work requirements for Medicaid recipients:

Arkansas public librarian here. The Arkansas Works program required that Medicaid recipients report their work hours online ONLY - no phone, no mail, no in person reports allowed. Since almost all poor Arkansans rely on the public library for internet access - IF they can get it there; Arkansas still has about a quarter of the state without any internet access at all, and another quarter still dependent on dial up - we were prepared for a huge demand for our help navigating the reporting portal. Not that we were happy about it; the portal was a nightmare to use, and wasn't optimized for mobile access at all.

But we actually got very few requests! Discreet inquiries with patrons I knew were receiving Medicaid revealed that most didn't even know about the reporting requests; or thought that since it was for their children, or that they were "on disability", the rules "didn't apply" to them.
Until they tried to go to the doctor.

ETA They don't blame Trump or the Republican state legislature who put these rules into effect. Every single one griped about "the government" - nebulous faceless bureaucrats - who were behind their misery, and were glad that the people they voted for were going to "shake them up" and "stick it to 'em."

The fact that they were making this complaints to someone who was herself a "government bureaucrat" doing her damndest to help them, entered their minds not at all.

So the plan screws people who need help, then makes it hard to get unscrewed, and shunts all of the blame to the people who are trying to actually help (read: 'Democrats').

ETA: The site shut down at 9pm daily, because apparently the computer gnomes only work one shift. But this was all blocked by a federal judge in March; the administration is appealing of course (and has approved 8 more states' work requirement programs).