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Just curious how much a good health insurance policy in the US actually costs? I imagine it varies depending upon personal circumstances.
According to a new app released today on how the government spends our taxes, just over £100 a month comes out of my wages each month for "health". Direct income taxation only accounts for about a quarter of expenditure though so I imagine its £400 a month I'm responsible for.
A vast majority of Americans get their health insurance through their employers, who get discounts from the insurance companies for insuring all their workers. This distorts the prices of individual health insurance premiums.
The price can vary quite a bit, for both good and bad reasons. The "good" reason is that health insurance companies can charge different rates based on their actuarial sense of what a person's risk premium should be. And, as Loki mentioned, groups of people can get group discounts. Though I don't think this is a bad thing.
But the "bad" reason is pretty overwhelmingly bad, and that is because our health insurance market is massively distorted in a few key ways-
1) Employer based tax distortions- As Loki mentioned, most people get health insurance through their employer. This is a relic from WWII, when price controls and labor shortages clashed. To be competitive, firms began coupling health plans with their compensation. This was fairly novel and stuck around after WWII.
The distortion comes along because the government allows employers to provide health insurance without counting the cost of that insurance as income. The corporations can also deduct those costs from their books. But if you buy health insurance on your own, you can only partially deduct those expenses. This effectively subsidizes employer-based health insurance and penalizes individually-purchased health insurance.
2) Lack of interstate portability- Each state regulates its health insurance market. This means that moving to a different part of the country requires getting new insurance, especially if your insurance company doesn't have a branch in the state you're moving to. The net result is a separate insurance market for every state and territory. Considering that, before the recession, 50% of Americans moved every 5 years, this segmentation basically breaks the market competition into smaller chunks.
3) Tangle of overlapping regulations- Because of above-mentioned state-level regulation, there is no uniformity. Plus the federal government regulates health plans. This leads to 50+ different sets of health insurance regulations across Amerikkka coupled with an overlapping layer of federal laws.
This is an invitation for state legislators (and federal regulators) to slowly insert their own pet issues into the health insurance codes. EG, Obama's Dept. of Health and Human services just dictated that health insurance companies who insure Catholic organizations must provide birth control/abortion to insureds but not charge for it. IE, the government mandated that something must be free.
I don't bring this up to make a point about Obama's decision specifically, but to point out how silly things can get when the government starts making political decisions.
***
This is obviously a summary, but the net result is an insurance market with no subsidies weighing against individual insurance, no inter-state portability and a massive tangle of laws. This is why health insurance companies have really low profit margins (about 2% on average) and have even stopped doing business in some states. When I was a healthy student and my parents were unemployed with no insurance to give me, I was quoted $2000/year for insurance.
Just click on the Get A Quote button.
http://healthinsurance.aetna.com/sta...en-access-1750
As one of the few on this forum who actually buys individual health insurance on the "Freee Market" :rolleyes: without an employer subsidy....Quote:
Originally Posted by RandBlade
Mine is a basic 80/20 catastrophic policy, with a modified PPO network "discount", a $5,000 deductible, and monthly premiums of just under $400.
Translation: Only in-patient care is covered. I'd have to be hospitalized for any of the "insurance" to kick in. Then, after I pay the first $5k out-of-pocket, the policy will cover 80% of the charges (so long as the facility and physicians participate in their regional networks). I'm responsible for the remaining 20% of total charges.
The policy has no lifetime maximum cap, but the $5k deductible applies for each calendar year. It doesn't cover any doctor office/clinic visits, outpatient procedures, prescription medications, therapies, or durable medical home devices. It doesn't cover vision or dental, or anything "cosmetic".
It has a specific exclusion for any breast cancer in-patient treatment, including chemotherapy, mastectomy or reconstructive surgery (due to some benign masses in my history, and a family history of breast cancer).
I did a lot of homework for all of this, and it wasn't easy. I found policies that would cover office visits, out-patient screenings (mammograms, colonoscopies, blood work, etc.), out-patient surgeries and therapies, prescriptions, vision and dental....even rehab (nursing home) or home care. With varying co-pays and deductibles. But the premiums were more than $1,000/month. :sour:
My auto-insurance covers things like ambulance and ER treatment, and some amount of hospital/physician charges. But that only applies if I'm not at fault for a car accident-with-injuries. My homeowner's insurance has medical coverage for others injured on my property, but that's a liability clause. When my kids were younger, I also had an umbrella policy to cover any accidental injuries on the property.
I keep meaning to look into prices for Disability Insurance, to augment my crappy 80/20 catastrophic policy. Thanks for the reminder. :mad:
Oh yeah, and if I have a "medical psychiatric condition" requiring inpatient care, there's a lifetime limit. ie, the lifetime of the policy. I'd have to check, but it's either 60 days or 6 months. Fairly sure that any type of dementia or Alzheimer's...possibly any cognitive or behavioral change after a head injury, stroke or CVA...would be categorized and coded under that shortest possible timeframe. :(
Your characterization of the PPACA, and the "compromise" made by religious-affiliated institutions is patently false. You're conflating birth control with abortion. In case you forgot, the Hyde Amendment precludes any federal funding of abortion services. That includes university health clinics (whether it's Notre Dame, Georgetown, or Ohio State) or Planned Parenthood.Quote:
Originally Posted by Dreadnaught
The mandate was aimed at employers who subsidize the health insurance premiums of ALL employees, while enjoying their governmental Tax Breaks in exchange. Half of the work force is female, and sorry to break the news to you....but womens' health is linked to reproductive care, and that includes Birth Control.
Maybe you got confused by the political terminology of "Free"? The PPACA aimed to turn ALL preventative care 'co-pay free', by incorporating those costs into everyone's premium costs. The theory is that it's more cost-effective in the long-term to encourage (or even subsidize) prevention and proaction, than it is to pay the higher costs of illness, unintended pregnancies, or being reactive.
The stupid silliness began when we coupled health care with employment, and employers were in cahoots with insurers and legislators. If the health insurance companies are so strapped with their "really low profit margins", they could stop spending multiple Billions in advertisements, CEO and executive pay packages, bureaucratic middle-men, and DC lobbyists. :bored:Quote:
I don't bring this up to make a point about Obama's decision specifically, but to point out how silly things can get when the government starts making political decisions.
This is obviously a summary, but the net result is an insurance market with no subsidies weighing against individual insurance, no inter-state portability and a massive tangle of laws. This is why health insurance companies have really low profit margins (about 2% on average) and have even stopped doing business in some states. When I was a healthy student and my parents were unemployed with no insurance to give me, I was quoted $2000/year for insurance.
$0... for uh.... some.
I'm using much the same thing *though mine has an annual cap of ~ $60k* but my premiums are only about 1/4 of what you pay.Quote:
Originally Posted by GGT
Who'd think that a person who's ~20 years older and has many more preexisting conditions would be required to pay more for health insurance. :noob:
Many more pre-existing conditions? If you assume that because I'm older, you might be be wrong. Besides, my premiums do NOT include pricing for any breast cancer diagnostics or treatment. :bored:
Rand, maybe you should be asking what US health insurance doesn't cover. That's more illuminating than what people pay in premiums.
http://well.blogs.nytimes.com/2012/0...me&ref=general
No, my characterization is spot-on. It also has nothing to do with the Hyde Amendment. :weird:Quote:
Originally Posted by GGT
But this is important, so I will re-emphasize: The Obama administration has said that people who receive a specific benefit from their health insurance specifically cannot be charged for that benefit. Short of outright communism, this is pretty much the biggest market distortion you can get.
Yes, there are "reasons" for it. But they are ultimately political reasons, because the insurance companies aren't doing their own math to arrive at the conclusion that everyone should contribute to birth control. The government is saying men and menopausal women should explicitly pay for birth control for younger women, instead of letting the incentive become self-evident.
It may be a good idea, it may not. I think the idea of insurance-paid birth control as preventative care is probably good, but not when it's a government mandate that distorts pricing.
Communism? :rolleyes: Yes, it's a market distortion....but so is for-profit insurance controlling our health and sickness care.Quote:
Originally Posted by Dreadnaught
The proposal was to make birth control co-pay free for the user, and the costs would be rolled into everyone's premiums....just like it's done for those policies with a $5 or $10 Rx co-pay. Insurers shift prices around all the time that way. You didn't think insurers just absorb the losses, did you?
First of all, "birth control" is also used by older women as hormonal therapy, not just to prevent pregnancy. Secondly, every woman taking BC to prevent pregnancy involves a man. Also, women also pay for men's vasectomies, erectile dysfunction, infertility, testicular and prostate cancers. That's how group insurance works.Quote:
Yes, there are "reasons" for it. But they are ultimately political reasons, because the insurance companies aren't doing their own math to arrive at the conclusion that everyone should contribute to birth control. The government is saying men and menopausal women should explicitly pay for birth control for younger women, instead of letting the incentive become self-evident.
I was never a fan of this plan, without a public option or some option like Medicare for All, because it gave too much control to insurance companies instead of providers. Any co-pay-free preventative care is likely a good idea, and something insurers coulda shoulda done on their own as an overall cost-saving measure. It's not just a 'distorting prices' problem, no matter who's doing it (employers, insurers, teh gummint)....it also reflects what our society and culture values.Quote:
It may be a good idea, it may not. I think the idea of insurance-paid birth control as preventative care is probably good, but not when it's a government mandate that distorts pricing.
The "group insurance" you're speaking of sounds a lot like single payer socialized health care. Which is fine, but it's not what I'm talking about here. You just descended into some talking points to explain what you want, which wasn't really what Rand was asking.
He asked what a "good" health insurance plan would cost in the US, as compared to what's taken from his wages or taxed in the UK. The two systems can't really be compared very well, it's apples and oranges. You're the one who brought political motivations and what's "bad", excuse me for following suit. :bored:Quote:
Originally Posted by Dreadnaught
BTW, Dread, how much do you pay for your health insurance, and how much is subsidized by your employer? Any exclusions, annual or lifetime caps? Do you have co-pays, deductibles, a prescription discount, network requirements? Would you know how to value/compare your policy on an exchange, without the group bargaining powers and discounts from employer-insurance? Are you (or HR) billed for costs denied by the carrier?
Rand might be trying to figure if his NHS is a "good deal", compared to what he'd have to buy in the US? I'm explaining the many costs involved than just buying a policy, or basing prices on premiums.
My health insurance is heavily subsidized by my employer and the American taxpayer, as with most people. See post #3 for more details about why that is. :confused:
Looks like Rand didn't click on my link. Sad, the answers are there. If you are put off by Aetna, I have several more from diiferent suppliers.Quote:
Originally Posted by Being
I don't see where you shared specific dollar amounts, as Rand did. We may not be able to compare our systems, but we can probably compare what comes out of our wages and/or taxes, and make contrasts from there.Quote:
Originally Posted by Dreadnaught
Most likely, Rand has never been billed for healthcare costs denied by private insurance. He's probably never had to figure out what's "in network" or "out of network" prior to accessing care. And he'll definitely never have to declare medical bankruptcy, which dings his credit-score, and limits his future employment opportunities.
I did share a specific dollar amount ($2000) that I was quoted for a personal out-of-pocket policy when I was a student. So far you haven't gone into any specifics of what our distorted market has quoted for you.
First question on Get a Quote is "Zip Code", can't exactly enter one can I?Quote:
Originally Posted by Being
Long since outdated, with no mention of student health services that might have been part of your tuition at the time. Now that you're post-grad and gainfully employed (by "the government"?) with employer subsidies, your premiums and coverage would be totally different.Quote:
Originally Posted by Dreadnaught
:confused: Post #5 wasn't "specific" enough? All I can add is that my premiums have doubled since 2003, even after I raised the deductible and agreed to use a PPO network for 'discount' premiums. I've never filed a claim, or been diagnosed with a new condition/disease. That reflects rising medical costs in general, and not changes in my age or health status. At least that's what their notification of premium change letters say.Quote:
So far you haven't gone into any specifics of what our distorted market has quoted for you.
I have no idea what my health insurance costs my employer. Because our system is broken, I don't see that data and I only pay a token amount each month. That's the point I've been making.
Suggestion: pay closer attention during your next enrollment period, and ask HR to delineate the employer subsidy. Or ask the question during the annual employee/management hob nob.Quote:
Originally Posted by Dreadnaught
I'm surprised you haven't done that already....in order to figure out what you're not getting in wages/salary, because it's being used to fund every employees' health insurance, with their "token" monthly deductions. No offense, but one reason why our system is broken is because of people like you, who don't pay much attention to what's going on behind the green curtain.
If all you care to know is whether you have a crappy-decent-great insurance plan provided through your employer, and how much is taken from your wages/salary....it's hard to take you seriously about the fundamental flaws in our "system". You want to opt-out of SS or Medicare, so long as you get to keep those employer subsidies, but you don't even know what they are? :confused:
They do tell us during annual enrollment period. And I calculate out about how much it is because I'm naturally curious. But the number is also meaningless because it's a semi-imaginary number within a group-insurance deal purchased in our broken system. Given the perversities of our system, my employer has no reason to give me that money in cash and cut off my insurance.
So I don't bother asking to get cash instead and I eventually forget the top-line number until the next year, which we both know indicates a policy that costs several thousand dollars a year.
I'm not the problem because I'm willing to nuke my entitlements for the greater good. I want to opt-out SS and Medicare, but I explicitly don't want to keep the other elements of the broken system, EG the employer subsidy. Please don't fabricate a position on this that I plainly don't espouse.
Translation: you have no incentive to ask for that "semi-imaginary" number to be added to your salary, and have them cut off your insurance --- because you know damn well you couldn't buy the same coverage without their perverse group-discount. Plus, your employer likes the corporate tax deductions they get from subsidizing employee health insurance.Quote:
Originally Posted by Dreadnaught
In the meantime, you're the beneficiary of employer-subsidized healthcare. You can say you don't want to keep your employer subsidy, or benefit from their reduced-price collective bargaining, but that's just lip service. If you really want to "nuke entitlements" for the greater good, you'd be pushing to end the employer subsidy long before any SS or Medicare opt-out.Quote:
So I don't bother asking to get cash instead and I eventually forget the top-line number until the next year, which we both know indicates a policy that costs several thousand dollars a year.
I'm not the problem because I'm willing to nuke my entitlements for the greater good. I want to opt-out SS and Medicare, but I explicitly don't want to keep the other elements of the broken system, EG the employer subsidy. Please don't fabricate a position on this that I plainly don't espouse.
Now I'm confused.
A group discount via the employer is perverse?
And what does wanting to opt out of SS/Medicare have to do with wanting to keep your insurance via your employer?
:weird:Quote:
Originally Posted by GGT
First of all, there's nothing "perverse" about group discounts. Bulk pricing is not a distortion. The distortion comes from my employer getting substantial tax benefits and being allowed to give me insurance as tax-free compensation. This is policy, it's not an entitlement like Medicare or SS.
But why should be willingly pay 10x what I pay now just to prove a point that no one will hear? My whole point is the government has rigged the system in a way that makes private health insurance unaffordable for me. I make my views known in the ballot box, as the government has forcibly prevented me from voting with my feet/wallet.
95621Quote:
Originally Posted by RandBlade
Yeah, how's that Freee Market theory working out? :rolleyes: Employer group discounts are distortions. Just think about all y/our state and federal employees getting those preferred government discounts, subsidized by the tax payers. It doesn't matter if it's a gov't, a union, or a large private employer....it distorts the prices for anyone outside the network, without the same valuable collective bargaining abilities.Quote:
Originally Posted by Veldan Rath
There's "perversion" and "distortion" when certain groups get deeper discounts than others. Companies with more employees will get bulk premium discounts that small fry can't get...unless they join an association (with fees), or allow their workers to join a union (with fees). All employers get substantial tax credits, but not all employees benefit in the same way.Quote:
Originally Posted by Dreadnaught
Medicare and SS are also "policy". Employer-matched 401-K plans, or defined-contribution pension plans are also "entitlements"....if they go bust, the PBGC picks them up. Ask candidate Romney how that works. :donkey:
It's a rigged system, alright. But the Insurance and Pharmaceutical industries practically own our legislators on healthcare, so it's no wonder that "government has rigged the system" in favor of those lobbyists and campaign donors. One-person one-vote only matters AFTER a few billionaire funders or super PACs have already decided what they want.Quote:
But why should be willingly pay 10x what I pay now just to prove a point that no one will hear? My whole point is the government has rigged the system in a way that makes private health insurance unaffordable for me. I make my views known in the ballot box, as the government has forcibly prevented me from voting with my feet/wallet.
How well can our views be expressed at the ballot box, if the "choices" have already been bought?
No, bulk pricing is not a distortion. And it's good and rational that certain groups get charged differently than others. A company insurance plan for coal miners should charge the employer more than a company insurance plan for office workers.Quote:
Originally Posted by GGT
My point is that these kinds of rational decisions have been effectively removed from the health insurance market. I would argue that Obamacare tries to even further negate this kind of rational insurance decision-making.