Re: Biden trying to bring NHS style health care to America!!

I love discussing this topic. From everything I have studied, the above post is absolutely correct. The exchange is just a place were different insurance companies sell polices. There are different levels, or there were 8 years ago, that provide different levels of care. From what I remember most companies plans mirrored the middle option “Gold Type”. So care, is roughly the same.

8 years ago I was working for a small business (less than 100 employees). I had the opportunity to join a company with greater than 10,000 employees. One of the many reasons I joined the larger company was benefits. My Health Insurance cost dropped by $6 thousand dollars. Health Coverage (stuff covered) was the same. It was still a high deductible HSA policy. Only change was the price of the dependent coverage ( family). That alone was a $5k raise.

From talking with friends that work in HR type jobs that deal with this topic, Larger companies are able to negotiate a better policy price because of the volume of policies they bring to the table. In essence buying in bulk.

My hope for the exchanges were that if they were being managed correctly/ and hit a critical mass, they could be used to negotiate a better policy price. From what I can see that has not happened. The price is still higher than even a typically priced small business offered plan. And that is why most people who have insurance are still getting it through there employer. I think self employed, independent contractor positions are taking advantage of the exchange. But there rates account for this.

There was a post above that mentioned that insurance through your employer was a uniquely American weirdness. I would love to see this change. I think small business would do better if this element was removed from the employer / employee relationship. I personally would be willing to pay 1~$2k more if the cost was the same across the board. Why should your health coverage cost be different if you are a self employed architect or a nurse at a hospital.

Another point, People keep mentioning wait times. This is not a direct result of insurance/ coverage. The variables are number of patients and number of providers. We are seeing shortages. I scheduled a visit with a specialist this week. They were 15+ weeks out. I opted to see the PA in the office that was 6 weeks out. Never once was the question do you have/ or what is your insurance asked. Another example, my child has some dental issues. We had to schedule that surgery out in May (14+ weeks). With the “Boomer” generation retiring, we don’t have the number of employees to back fill the existing openings plus more to provide for growth and competition.

Now maybe insurances is indirectly making it more costly for doctors, And that is driving down people joining the profession. But from what I hear healthcare is paying well and folks are going to school for those jobs. So, I don’t think that is necessarily true.

Would love to see more discussion on this topic. After my house payment, it’s the next biggest line item on my family’s budget. I have to believe that is a common theme for families that are not paying a current college tuition payment.

Go Tigers!
LNT

fchrisgrimm®

Associate AD [828]

TigerPulse: 94%

Posts: 3982

Joined: 4/14/09

Feb 5, 2023, 11:53 AM [ in reply to Re: Biden trying to bring NHS style health care to America!! ]

MiuraTiger®
Thanks for the question. Answering the best that I can. I'm going to preface that I am a reasonably healthy guy, which makes all things better.

I am not Medicare eligible.

1. I have a "Silver" Plan via a Connecticut company (that I got through the Connecticut exchange).
2. Just me. My significant other has her own plan through a company from which she took early retirement.
3. I'm paying a little over $200/month.
4. $20 for the GP, $40 for specialists - and I don't have to be referred to in-network specialists.
5. Yes (though, once again, I'm a comparatively healthy guy - 59)
6. While (relating to being healthy) I generally only need appointments, I would say that I have had two "urgent" situations in the last five years. One relating to a kidney stone that acted differently from others. The other relating a sciatica, caused by a disk that I compressed without knowing it. I had no problem getting fast service.

In the first situation, I thought I was going to figuratively die. Excruciating pain (not like other stones I'd passed fairly easily. Pardon the TMI). The pain hit out of the blue at 3am, I tried to deal with it until office hours, and called them at 8am. They took me... surely before 10. Doc didn't think it was stones from symptoms but sent me for bloodwork (which they do in the same building) and by the time they had my blood he had me scheduled for an MRI. My partner drove me directly to the radiologist and I was scanned within an hour - most of the wait was to drink the awful stuff before the scan. Doc called me by the end of the day with the results. I can not complain about that. Now there is a funny aspect - the pain was getting worse and worse, but when I got home (before the doc called) around 1 or 2, I got myself into the house, sat on the john to ####, stood up, and... the pain's gone, I'd pee'd the stone out.

With the back problem... I made a next-day appointment with my GP who I like, but he couldn't get me an MRI. So I scheduled with an orthopedist (which I should have done in the first place). I think I got in to see him within a day or two (I forget exactly, but it wasn't difficult). It was a few days or a week to get the MRI appointment and I had to drive to a location that wasn't as close to me, but it wasn't a big deal. If it had been more of an emergency, it would have seemed like a bigger deal.

So these relate to both 5 and 6. Outcomes were great (the back is the one that needed treatment - scheduled PT, all good). But wait times (in my case, appointment scheduling) was not a problem in the slightest.

When I tested positive for COVID, I was able to set up a same-day call with my doctor and my prescription for Paxlovid was at the pharmacy the next morning.

7. IIRC, I get sent a bill from the lab at the insurance company negotiated rate, which has always been fairly low. If it seemed exorbitant, I'd remember. I feel like whenever I get bloodwork for anything, it costs me $125 (except for my annual, when it's free). But the charge for the most recent MRI was very low - not $300 and maybe less than $200. I said before, while my annual deductible is $5,000, the negotiated rates are really good.
8. I'm sure I do, but I don't really talk health coverage so much with people. But I can't say that people I know sit around complaining about it. See, and I mean this in the nicest possible way, asking "are people pleased with ACA plans" is like asking someone "do you like food?" or "do you like cars?" Plans are extremely varied - dirt cheap high-deductible plans, expensive low-deductible plans. I'm sure you can get a bad plan if you don't want to pay for a good one. But I don't hear people (who I know who must be purchasing through the exchange (gig workers), complaining.
9. Yes. I don't often need to fill them (and I'm not on any daily prescription medication) but I don't usually pay more than $20 for a prescription, usually less. I always take the generic option if it's available.
10. Same as the answer to #8. I will say, I did have a conversation with a colleague who is pretty much as happy with her plan. Another colleague had opted out, broke their arm, and was complaining about money. We were not sympathetic. We were like, "well, it is so cheap, it's your own fault."
11. Absolutely covers pre-existing conditions, although that was not an issue for me.
12. You aren't going to like this answer one bit. Misinformation about ACA. States that have not made it easy to sign up. Look at a table showing the percentage of uninsured. The redder the state, the higher the percentage uninsured, for the most part. But here in deep blue Connecticut, only 5.1% are uninsured. New York, 5.2%. California, 7%. (There is a lot of public outreach encouraging people to sign up around here - subway ads, PSA's on local television - there is a genuinely effort to encourage people to get health insurance. I suspect that is not the same in redder states.) But rates in those redder states... 18.1% uninsured in Texas, 10.1% in Tennessee, 10.4% in North Carolina, 11% in Wyoming. 12.1% in Florida. 11.9% in Mississippi. Those likely include states that refused to implement Medicaid expansion, too.
13. I fear having a bureaucracy running the complete insurance market a little bit, but I 100% support a public option (which Joe Lieberman killed). Competition from a government insurance company would keep for-profit insurers more honest. And I make a clear distinction between doctors (who save lives) making a good living and insurance companies, who just move money around based on actuarial tables. (I think that has been part of a misleading narrative over ACA - or was when it was passed - it wasn't about government "taking over" healthcare, but about insurance.) OTOH, all that money that the insurance industry spends on television commercials could be spent on more valuable services - or, if we want to keep the media happy, on PSA's with good health advice. People will complain about government bean-counters, but I don't think private bean-counters would be any better. The USA's employer-based health insurance system is uniquely convoluted.

flag link

military_tech

thumb_down

thumb_up

Biden trying to bring NHS style health care to America!!