Author Topic: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option  (Read 1762 times)

Hikester

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As Mustachians and the FIRE community, you could argue that those that leave work to retire early due to saving and sacrificing and smart financial decision making deserve coverage too and should not have to rely on employer for coverage. We should not be penalized for having financial discipline. I found it interesting the part about the woman and the Christmas gifts. Itís a bit of ďif I canít have it, nobody else should eitherĒ as she was not happy to see the other kids have gifts, sad all around but the uglier side of human behavior nonetheless. It is this selfish thinking which is partially responsible for this debate not moving forward. Instead of Americans helping Americans as we all move toward a goal that benefits the whole regardless of income, we are too caught up in the ďif I canít have it..........thinking,Ē Itís time to move on!

https://www.vox.com/policy-and-politics/2018/6/11/17441858/obamacare-repeal-debate-lawsuit
« Last Edit: June 13, 2018, 09:55:50 AM by Hikester »
Two roads diverged in a wood, and I,
I took the one less traveled by,
And that has made all the difference.

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smoghat

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Re: Mustachians Deserve Group Health Insurance Outside Work
« Reply #1 on: June 13, 2018, 05:42:35 AM »
Yes, itís so evil. I donít get Republicans. You would think the right to self determine oneís life would be important to them, but no. The constant rise in health care premiums is the single biggest issue in my retirement. I can see why Moustachians who get subsidies would annoy others, but we donít pay subsidies and our insurance is GOING THROUGH THE ROOF. I am spending at least $1,000 on a Democratic candidate for the house to help us get back affordable health care. Oh and the right to live wherever I want! No more double taxation on real estate.

Iíll be working the poor black neighborhoods of Philip in 2020 too. I am an old Cold Warrior, I hate the Russian secret police and am so angry that our President works with them!

BTDretire

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Re: Mustachians Deserve Group Health Insurance Outside Work
« Reply #2 on: June 13, 2018, 09:31:02 AM »
Yes, itís so evil. I donít get Republicans. You would think the right to self determine oneís life would be important to them, but no. The constant rise in health care premiums is the single biggest issue in my retirement. I can see why Moustachians who get subsidies would annoy others, but we donít pay subsidies and our insurance is GOING THROUGH THE ROOF. I am spending at least $1,000 on a Democratic candidate for the house to help us get back affordable health care. Oh and the right to live wherever I want! No more double taxation on real estate.

Iíll be working the poor black neighborhoods of Philip in 2020 too. I am an old Cold Warrior, I hate the Russian secret police and am so angry that our President works with them!
It sounds like you think making others pay for your health insurance is somehow going to lower the cost of health insurance. That's not how it works, when the government (the 50% of workers that pay taxes) pays for things,
the cost goes up. As a provider government money is to easy to take, and as a citizen, look how many are just thrilled to get there government insurance subsidy!
  There are government regs that can help lower the cost of health insurance, but throwing taxpayer money at it, does not lower cost.
"but we donít pay subsidies and our insurance is GOING THROUGH THE ROOF."
 Maybe I don't understand what you mean in the above statement.
Who doesn't pay subsidies? And if you say nobody, where does the money come from?

Hikester

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Re: Mustachians Deserve Group Health Insurance Outside Work
« Reply #3 on: June 13, 2018, 09:40:15 AM »
Mustachians pay taxes too. All I am saying is that tying insurance to employment does not make sense. In todayís world people donít work with one employer like before. They change jobs frequently, move for various life situations, marry, divorce, stay single, retire early, go to school etc. So this model of tying healthcare to employment is outdated. The world is much more dynamic than before. And people that donít neatly fit in the box get penalized with higher rates.
Two roads diverged in a wood, and I,
I took the one less traveled by,
And that has made all the difference.

Robert Frost

FIRE@50

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Re: Mustachians Deserve Group Health Insurance Outside Work
« Reply #4 on: June 13, 2018, 09:44:09 AM »
Mustachians pay taxes too. All I am saying is that tying insurance to employment does not make sense. In todayís world people donít work with one employer like before. They change jobs frequently, move for various life situations, marry, divorce, stay single, retire early, go to school etc. So this model of tying healthcare to employment is outdated. The world is much more dynamic than before. And people that donít neatly fit in the box get penalized with higher rates.

The government didn't tie health insurance to employment. Health insurance is a benefit of employment for many people. Benefits are not problems.

The rising cost of healthcare is the problem.

Hikester

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Iíd like to add that work is not the issue. Many people work for themselves or for companies too small to offer the benefit of healthcare. A big part of the cost of healthcare going up is all the uninsured going to the emergency room for minor issues. Itís a catch 22. Canít afford insurance so use expensive ER option which in turn increases costs for everyone else. And the cycle continues. Healthcare should not be partisan. Everyone will need it at some point. The young get in accidents and have sports injuries, the old get sick. Everyone in between is a combo of that. We all agree we need communal firefighting and donít mind that your neighbors house is covered right? We pay for it and go about our lives.
Two roads diverged in a wood, and I,
I took the one less traveled by,
And that has made all the difference.

Robert Frost

Mr. Green

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Re: Mustachians Deserve Group Health Insurance Outside Work
« Reply #6 on: June 13, 2018, 10:29:40 AM »
Mustachians pay taxes too. All I am saying is that tying insurance to employment does not make sense. In todayís world people donít work with one employer like before. They change jobs frequently, move for various life situations, marry, divorce, stay single, retire early, go to school etc. So this model of tying healthcare to employment is outdated. The world is much more dynamic than before. And people that donít neatly fit in the box get penalized with higher rates.

The government didn't tie health insurance to employment. Health insurance is a benefit of employment for many people. Benefits are not problems.

The rising cost of healthcare is the problem.
While the government hasn't tied health insurance to employment, it has become tied to employment for the most part. Consider the fact that if offered insurance through an employer an insurer cannot refuse you, vs. prior to the ACA there was no guarantee you could get health insurance on your own. And as the DOJ is now currently trying to achieve, a reversion back to the way it was before the ACA when getting insurance could be like rolling dice.

The cost of healthcare is absolutely a problem, and the root cause of the rising cost of insurance.  Just creating something like the ACA without addressing the root cause is like trying to fight a fire while only pointing the water at the top of the flame.
RE in June 2016. Wife is joining me at the end of June!

seattlecyclone

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Mustachians pay taxes too. All I am saying is that tying insurance to employment does not make sense. In todayís world people donít work with one employer like before. They change jobs frequently, move for various life situations, marry, divorce, stay single, retire early, go to school etc. So this model of tying healthcare to employment is outdated. The world is much more dynamic than before. And people that donít neatly fit in the box get penalized with higher rates.

The government didn't tie health insurance to employment. Health insurance is a benefit of employment for many people. Benefits are not problems.

The rising cost of healthcare is the problem.

Government policy definitely influences the prevalence of employer-provided health insurance. This benefit has long been untaxed to the employee, which means that an employee is generally better off receiving $10k worth of health insurance than $11k in salary, and the employer saves $1k this way too. Obamacare took this incentive a step farther, by taxing employers who don't offer insurance for their employees.

Get rid of these incentives and I predict that many employers would stop offering insurance. Coordinating health insurance for employees is an administrative cost and hassle that employers would rather not deal with if the tax benefits for doing so went away. Furthermore, looking at our W-2s from last year the combined employer and employee cost for our three-person family's health insurance was over $20k. It's a pretty nice insurance plan, but we'd be perfectly happy with a bronze plan from the exchange that costs less than half as much even before subsidies.
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Threshkin

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Re: Mustachians Deserve Group Health Insurance Outside Work
« Reply #8 on: June 13, 2018, 12:50:12 PM »
Mustachians pay taxes too. All I am saying is that tying insurance to employment does not make sense. In todayís world people donít work with one employer like before. They change jobs frequently, move for various life situations, marry, divorce, stay single, retire early, go to school etc. So this model of tying healthcare to employment is outdated. The world is much more dynamic than before. And people that donít neatly fit in the box get penalized with higher rates.

The government didn't tie health insurance to employment. Health insurance is a benefit of employment for many people. Benefits are not problems.

The rising cost of healthcare is the problem.
While the government hasn't tied health insurance to employment, it has become tied to employment for the most part. Consider the fact that if offered insurance through an employer an insurer cannot refuse you, vs. prior to the ACA there was no guarantee you could get health insurance on your own. And as the DOJ is now currently trying to achieve, a reversion back to the way it was before the ACA when getting insurance could be like rolling dice.

The cost of healthcare is absolutely a problem, and the root cause of the rising cost of insurance.  Just creating something like the ACA without addressing the root cause is like trying to fight a fire while only pointing the water at the top of the flame.

Mr. Green, I agree with you completely on your second point.  That was one of my biggest concerns about ACA, it didn't address the costs of health care.

BUT, the root problem is not the rising cost of health insurance.  Insurance cost is just the symptom that the consumer sees.  ACA severely limited the profit insurance companies could make on ACA compliant policies.  Limited to the point where many carriers dropped out of the program because it was not profitable.  If insurance company profits are limited, why are costs going up so fast?  The insurance costs go up because the covered medical services and drug costs keep going up.  Insurers are allowed to pass on those cost increases to the consumer.  Otherwise they would go out of business.

Why are health care costs increasing?  That is a much more complex question, something ACA did little if anything to address.

If we want to truly control health care costs, we need to control what service providers and drug companies can charge.  Of course that is likely to limit service availability and drug development, not necessarily what people want.

Mr. Green

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Re: Mustachians Deserve Group Health Insurance Outside Work
« Reply #9 on: June 13, 2018, 02:00:03 PM »
The cost of healthcare is absolutely a problem, and the root cause of the rising cost of insurance.
Mr. Green, I agree with you completely on your second point.  That was one of my biggest concerns about ACA, it didn't address the costs of health care.

BUT, the root problem is not the rising cost of health insurance.  Insurance cost is just the symptom that the consumer sees.  ACA severely limited the profit insurance companies could make on ACA compliant policies.  Limited to the point where many carriers dropped out of the program because it was not profitable.  If insurance company profits are limited, why are costs going up so fast?  The insurance costs go up because the covered medical services and drug costs keep going up.  Insurers are allowed to pass on those cost increases to the consumer.  Otherwise they would go out of business.

Why are health care costs increasing?  That is a much more complex question, something ACA did little if anything to address.

If we want to truly control health care costs, we need to control what service providers and drug companies can charge.  Of course that is likely to limit service availability and drug development, not necessarily what people want.
I probably worded that sentence poorly. I meant to say that the outrageous cost of healthcare is the root cause of rising insurance costs. It sounds like we're in agreement there.
RE in June 2016. Wife is joining me at the end of June!

Threshkin

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Re: Mustachians Deserve Group Health Insurance Outside Work
« Reply #10 on: June 13, 2018, 02:34:09 PM »
The cost of healthcare is absolutely a problem, and the root cause of the rising cost of insurance.
Mr. Green, I agree with you completely on your second point.  That was one of my biggest concerns about ACA, it didn't address the costs of health care.

BUT, the root problem is not the rising cost of health insurance.  Insurance cost is just the symptom that the consumer sees.  ACA severely limited the profit insurance companies could make on ACA compliant policies.  Limited to the point where many carriers dropped out of the program because it was not profitable.  If insurance company profits are limited, why are costs going up so fast?  The insurance costs go up because the covered medical services and drug costs keep going up.  Insurers are allowed to pass on those cost increases to the consumer.  Otherwise they would go out of business.

Why are health care costs increasing?  That is a much more complex question, something ACA did little if anything to address.

If we want to truly control health care costs, we need to control what service providers and drug companies can charge.  Of course that is likely to limit service availability and drug development, not necessarily what people want.
I probably worded that sentence poorly. I meant to say that the outrageous cost of healthcare is the root cause of rising insurance costs. It sounds like we're in agreement there.

Yup.

Hikester

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Iíd also like to know how other developed countries control their costs. You donít usually hear Canadians, Australians and Europeans wishing they had the American healthcare system in their countries. It would be interesting to hear from Mustachians abroad how we could fix or at least mitigate this issue. We could learn from their perspectives. Do they think the ACA was a step in the right direction? They might have ideas we never even thought of.
Two roads diverged in a wood, and I,
I took the one less traveled by,
And that has made all the difference.

Robert Frost

DreamFIRE

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I personally like the employer subsidized model of health care insurance.  It was not that high at my previous employer, and I'm currently paying less than $60/mo in premiums (for myself only) and have a $100 deductible (although co-pays apply, like $25 office visit.)

I'll soak ACA for a PCT and maybe a little CSR if possible by regulating my MAGI when I FIRE.

ChpBstrd

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Iíd also like to know how other developed countries control their costs. You donít usually hear Canadians, Australians and Europeans wishing they had the American healthcare system in their countries. It would be interesting to hear from Mustachians abroad how we could fix or at least mitigate this issue. We could learn from their perspectives. Do they think the ACA was a step in the right direction? They might have ideas we never even thought of.

1) Less patent protection for name-brand prescription drugs.
2) Less litigation.
3) Insurers have negotiating power. In the U.S. the government is actually banned from negotiating lower prices and required to pay whatever the drug companies are bold enough to ask. Lobbyists pay for political ads in return for this favor and Americans vote based on what these ads tell them, perpetuating the system. This blank check increases prices for all consumers.
4) More support for the education systems that produce medical professionals. When doctors don't have a half-million in student loan debt to pay off, they can charge less.
5) Fewer subsidies for activities that harm population health, such as roads/driving, sprawl/fast food joints, sugar/meat subsidies, etc.
6) More subsidies for activities that improve population health, such as bike paths, investments in urban density and walkability, better education, poverty reduction, etc.
7) Less care provided in the last few weeks of life. Less emergency heart bypass surgeries for 90 year olds and more hospice care.
8) Less administrative overhead coordinating payments, insurance records, etc. There is a single payer.
9) Resolution of the incentive problem, where providers get paid for whatever they can sell the patient, who is not the end payer and doesn't care about the net value.
10) Less spent advertising drugs and treatments.
11) Fewer violence-related injuries. The U.S. is an outlier among developed nations in terms of violence.
12) In some developed countries, lower rates of addiction to illicit drugs and alcohol.

The #1 thing they do is treat healthcare as a challenge to be solved pragmatically instead of making it a big ideological fight. Americans think of electricity distribution, firefighting, or other logistical issues pragmatically, but when it comes to healthcare we bicker over ideological abstractions (socialism! death panels! greedy corporations!) without ever solving a problem (or should I say, insisting our leaders solve the problem and then getting rid of them if they fail).


I personally like the employer subsidized model of health care insurance.  It was not that high at my previous employer, and I'm currently paying less than $60/mo in premiums (for myself only) and have a $100 deductible (although co-pays apply, like $25 office visit.)

I'll soak ACA for a PCT and maybe a little CSR if possible by regulating my MAGI when I FIRE.

My employer also pays ~90% of the cost for my family. However, I am under no illusions this is "free money" any more than I think of my income tax refund as a gift. The reason middle class wages in the U.S. have stagnated for three decades is because the cost of employer-sponsored health care has eaten up the gains. Had the cost of healthcare risen at the rate of regular inflation, you would be earning thousands of dollars more right now. Instead, your employer takes a bit of your raise each year and uses it to offset the rising cost of your health insurance.

Hikester

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Right on Chp Bstrd. The issue needs to be attacked from so many different angles. You are so right. And a strong will to solve this age old problem apparently not really there. Our so called land of innovation cannot solve what other nations have long already done.
Two roads diverged in a wood, and I,
I took the one less traveled by,
And that has made all the difference.

Robert Frost

Paul der Krake

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Right on Chp Bstrd. The issue needs to be attacked from so many different angles. You are so right. And a strong will to solve this age old problem apparently not really there. Our so called land of innovation cannot solve what other nations have long already done.
The US is great at innovating in the sense of creating brand new markets, and sucks at getting things to evolve over time. Something to do with the huge diverse population, landmass, a common law judicial system, and the cultural expectation that you shouldn't break existing setups, no matter how clunky or outdated.

Acastus

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I personally like the employer subsidized model of health care insurance.  It was not that high at my previous employer, and I'm currently paying less than $60/mo in premiums (for myself only) and have a $100 deductible (although co-pays apply, like $25 office visit.)

I'll soak ACA for a PCT and maybe a little CSR if possible by regulating my MAGI when I FIRE.

The employer model stinks. It means the company chooses whether you have good coverage or terrible coverage. You get essentially no say. My company, one of the Dow components, chose only high deductible options. For $175/mo, I get a $7250 deductible. There is no coverage of any kind until I hit the deductible. That means a routine checkup with lab work costs about $300. Urgent care for a sprained ankle or other simple acute problem is $60-90.

I am looking forward to FIRE next month. I got an ACA plan, with dental, for under $400/mo after subsidies. Now I will get $35 copays while I chip away at the $3500 deductible. That is a middle of the road silver plan with a broad network of doctors.

It really shows my company health plan is the pits. The ACA plan with the same deductible is called "Catastrophic Coverage - do not offer to anyone over 30 years old."

TheWifeHalf

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Iíd also like to know how other developed countries control their costs. You donít usually hear Canadians, Australians and Europeans wishing they had the American healthcare system in their countries. It would be interesting to hear from Mustachians abroad how we could fix or at least mitigate this issue. We could learn from their perspectives. Do they think the ACA was a step in the right direction? They might have ideas we never even thought of.

1) Less patent protection for name-brand prescription drugs.
2) Less litigation.
3) Insurers have negotiating power. In the U.S. the government is actually banned from negotiating lower prices and required to pay whatever the drug companies are bold enough to ask. Lobbyists pay for political ads in return for this favor and Americans vote based on what these ads tell them, perpetuating the system. This blank check increases prices for all consumers.
4) More support for the education systems that produce medical professionals. When doctors don't have a half-million in student loan debt to pay off, they can charge less.
5) Fewer subsidies for activities that harm population health, such as roads/driving, sprawl/fast food joints, sugar/meat subsidies, etc.
6) More subsidies for activities that improve population health, such as bike paths, investments in urban density and walkability, better education, poverty reduction, etc.
7) Less care provided in the last few weeks of life. Less emergency heart bypass surgeries for 90 year olds and more hospice care.
8) Less administrative overhead coordinating payments, insurance records, etc. There is a single payer.
9) Resolution of the incentive problem, where providers get paid for whatever they can sell the patient, who is not the end payer and doesn't care about the net value.
10) Less spent advertising drugs and treatments.
11) Fewer violence-related injuries. The U.S. is an outlier among developed nations in terms of violence.
12) In some developed countries, lower rates of addiction to illicit drugs and alcohol.

The #1 thing they do is treat healthcare as a challenge to be solved pragmatically instead of making it a big ideological fight. Americans think of electricity distribution, firefighting, or other logistical issues pragmatically, but when it comes to healthcare we bicker over ideological abstractions (socialism! death panels! greedy corporations!) without ever solving a problem (or should I say, insisting our leaders solve the problem and then getting rid of them if they fail).

I used to show dogs a lot in the part of Canada accessible by the Great Lakes area. I knew a Canadian who said her husband died (recently) because the doctor left a sponge in him. By law, all she got was $10.000. This was 12- 15 years ago.
I have no reason to doubt her

Jrr85

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Re: Mustachians Deserve Group Health Insurance Outside Work
« Reply #18 on: June 15, 2018, 09:00:28 AM »
Mustachians pay taxes too. All I am saying is that tying insurance to employment does not make sense. In todayís world people donít work with one employer like before. They change jobs frequently, move for various life situations, marry, divorce, stay single, retire early, go to school etc. So this model of tying healthcare to employment is outdated. The world is much more dynamic than before. And people that donít neatly fit in the box get penalized with higher rates.

The government didn't tie health insurance to employment. Health insurance is a benefit of employment for many people. Benefits are not problems.

The rising cost of healthcare is the problem.
While the government hasn't tied health insurance to employment, it has become tied to employment for the most part. Consider the fact that if offered insurance through an employer an insurer cannot refuse you, vs. prior to the ACA there was no guarantee you could get health insurance on your own. And as the DOJ is now currently trying to achieve, a reversion back to the way it was before the ACA when getting insurance could be like rolling dice.

The cost of healthcare is absolutely a problem, and the root cause of the rising cost of insurance.  Just creating something like the ACA without addressing the root cause is like trying to fight a fire while only pointing the water at the top of the flame.

Mr. Green, I agree with you completely on your second point.  That was one of my biggest concerns about ACA, it didn't address the costs of health care.

BUT, the root problem is not the rising cost of health insurance.  Insurance cost is just the symptom that the consumer sees.  ACA severely limited the profit insurance companies could make on ACA compliant policies.  Limited to the point where many carriers dropped out of the program because it was not profitable.  If insurance company profits are limited, why are costs going up so fast?  The insurance costs go up because the covered medical services and drug costs keep going up.  Insurers are allowed to pass on those cost increases to the consumer.  Otherwise they would go out of business.

Why are health care costs increasing?  That is a much more complex question, something ACA did little if anything to address.

If we want to truly control health care costs, we need to control what service providers and drug companies can charge.  Of course that is likely to limit service availability and drug development, not necessarily what people want.

Insurance profits are not limited.  There is a percentage of revenue cap.  So Obamacare actually incentivized insurance companies to not care as much about putting downward pressure on costs.  If their plan is more expensive, then maybe they lose customers, but they also get more profit per customer.  That's a good example of why technocrats and politicians shouldn't be trying to micromanage the insurance market.  It's one thing to look at it and weigh the tradeoffs of how the different incentives go, but the vast majority of the people designing and voting for Obamacare didn't even know enough to realize the perverse incentive they were creating. 

MrThatsDifferent

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Iíd also like to know how other developed countries control their costs. You donít usually hear Canadians, Australians and Europeans wishing they had the American healthcare system in their countries. It would be interesting to hear from Mustachians abroad how we could fix or at least mitigate this issue. We could learn from their perspectives. Do they think the ACA was a step in the right direction? They might have ideas we never even thought of.

Australia here. Everyone has healthcare coverage. It follows the individual. The more you make, the you pay for it, generally around $1200 for the whole year. If you make more youíre encouraged to get private health care. Youíll pay the same or a little more than the national system. There are still co-pays for things. Health insurance definitely isnít a concern regarding FIRE.

Threshkin

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Re: Mustachians Deserve Group Health Insurance Outside Work
« Reply #20 on: June 15, 2018, 11:11:03 AM »
Mustachians pay taxes too. All I am saying is that tying insurance to employment does not make sense. In todayís world people donít work with one employer like before. They change jobs frequently, move for various life situations, marry, divorce, stay single, retire early, go to school etc. So this model of tying healthcare to employment is outdated. The world is much more dynamic than before. And people that donít neatly fit in the box get penalized with higher rates.

The government didn't tie health insurance to employment. Health insurance is a benefit of employment for many people. Benefits are not problems.

The rising cost of healthcare is the problem.
While the government hasn't tied health insurance to employment, it has become tied to employment for the most part. Consider the fact that if offered insurance through an employer an insurer cannot refuse you, vs. prior to the ACA there was no guarantee you could get health insurance on your own. And as the DOJ is now currently trying to achieve, a reversion back to the way it was before the ACA when getting insurance could be like rolling dice.

The cost of healthcare is absolutely a problem, and the root cause of the rising cost of insurance.  Just creating something like the ACA without addressing the root cause is like trying to fight a fire while only pointing the water at the top of the flame.

Mr. Green, I agree with you completely on your second point.  That was one of my biggest concerns about ACA, it didn't address the costs of health care.

BUT, the root problem is not the rising cost of health insurance.  Insurance cost is just the symptom that the consumer sees.  ACA severely limited the profit insurance companies could make on ACA compliant policies.  Limited to the point where many carriers dropped out of the program because it was not profitable.  If insurance company profits are limited, why are costs going up so fast?  The insurance costs go up because the covered medical services and drug costs keep going up.  Insurers are allowed to pass on those cost increases to the consumer.  Otherwise they would go out of business.

Why are health care costs increasing?  That is a much more complex question, something ACA did little if anything to address.

If we want to truly control health care costs, we need to control what service providers and drug companies can charge.  Of course that is likely to limit service availability and drug development, not necessarily what people want.

Insurance profits are not limited.  There is a percentage of revenue cap.  So Obamacare actually incentivized insurance companies to not care as much about putting downward pressure on costs.  If their plan is more expensive, then maybe they lose customers, but they also get more profit per customer.  That's a good example of why technocrats and politicians shouldn't be trying to micromanage the insurance market.  It's one thing to look at it and weigh the tradeoffs of how the different incentives go, but the vast majority of the people designing and voting for Obamacare didn't even know enough to realize the perverse incentive they were creating.

You are correct.  I could have been clearer.  Insurance company profits on ACA plans are limited to a percentage of revenue, a very small profit percentage in general business terms.

I also agree with your comment on technocrats and politicians micromanaging health care insurance. 

Remember this?

Quote
ďThe other thing weíve done is to say, what are the critical needs of small business? A lot of time, one of the biggest challenges is to make sure that you, as a sole proprietor, that you can get health insurance for you and your family.  So when you hear about the Affordable Care Act ó Obamacare ó and I donít mind the name because I really do care.  Thatís why we passed it. You should know that once we have fully implemented, youíre going to be able to buy insurance through a pool so that you can get the same good rates as a group that if youíre an employee at a big company you can get right now ó which means your premiums will go down

ó President Obama, campaign speech in Cincinnati, July 16, 2012

(Highlighting is mine)
« Last Edit: June 15, 2018, 11:13:11 AM by Threshkin »

Hikester

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Australians are very happy with their system. Why is it Americans always quote development of new drugs to justify the unreasonable costs? Other countries develop new drugs AND have a reasonable system too. Is the US the only developer of new drugs? We know the answer is no.
Two roads diverged in a wood, and I,
I took the one less traveled by,
And that has made all the difference.

Robert Frost

Jrr85

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Australians are very happy with their system. Why is it Americans always quote development of new drugs to justify the unreasonable costs? Other countries develop new drugs AND have a reasonable system too. Is the US the only developer of new drugs? We know the answer is no.
You are not understanding the argument.  It's not that the US develops new drugs, it's that the US pays for new drugs. 

Other countries, particularly those with single payer that use their monopsony power to drive down drug prices, are free riding off the U.S. paying much higher drug prices. 

The US does not allow Medicare (nor Medicaid I think) to use its market power to negotiate better drug prices.  Then they also outlaw importing drugs from other countries so that people don't just purchase drugs from countries that do use market power (or monopsony power for those countries with single payer) to drive costs below the average cost of production (which is almost entirely the R&D costs, as the production costs are usually pretty minimal). 

In theory, this results in more drugs being developed by making the rewards for a successful drug much larger, and since drug development is a high risk, high reward business with many expensive failures for each drug that makes it through the regulatory process and is marketable, that's important to keep people plowiong money into R&D. 

I'm not sure the theory works in practice for people in the U.S., but no doubt it's a fantastic deal for the rest of the world, who get the benefits without bearing any of the cost. 

Ideally, Medicare would be allowed to cap their payments for drugs at no more than the average of the net price given to other developed countries, or maybe 110% or 125% of the average if you think the U.S. should bear more of a burden as a richer country. 

Hikester

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Thanks Jrr55,, sounds like the US got the short end of the stick not once but twice and not enough willpower to change it. And in the meantime our average citizens suffer. Medicare should be allowed to negotiate. We also have a huge under 65 population. There is negotiating power in numbers.
Two roads diverged in a wood, and I,
I took the one less traveled by,
And that has made all the difference.

Robert Frost

ChpBstrd

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Australians are very happy with their system. Why is it Americans always quote development of new drugs to justify the unreasonable costs? Other countries develop new drugs AND have a reasonable system too. Is the US the only developer of new drugs? We know the answer is no.
You are not understanding the argument.  It's not that the US develops new drugs, it's that the US pays for new drugs. 

Other countries, particularly those with single payer that use their monopsony power to drive down drug prices, are free riding off the U.S. paying much higher drug prices. 

The US does not allow Medicare (nor Medicaid I think) to use its market power to negotiate better drug prices.  Then they also outlaw importing drugs from other countries so that people don't just purchase drugs from countries that do use market power (or monopsony power for those countries with single payer) to drive costs below the average cost of production (which is almost entirely the R&D costs, as the production costs are usually pretty minimal). 

In theory, this results in more drugs being developed by making the rewards for a successful drug much larger, and since drug development is a high risk, high reward business with many expensive failures for each drug that makes it through the regulatory process and is marketable, that's important to keep people plowiong money into R&D. 

I'm not sure the theory works in practice for people in the U.S., but no doubt it's a fantastic deal for the rest of the world, who get the benefits without bearing any of the cost. 

Ideally, Medicare would be allowed to cap their payments for drugs at no more than the average of the net price given to other developed countries, or maybe 110% or 125% of the average if you think the U.S. should bear more of a burden as a richer country.
I suppose it depends on the outcome we are seeking. The current system is essentially a subsidy for R&D at the expense of patients, but it is also a subsidy for prescription drug ads on TV aimed at seniors, pharmaceutical reps schmoozing/bribing doctors, mergers and acquisitions, dividends and executive salaries, and lobbying. Much of the difference between what U.S. residents pay and what residents of other countries pay goes to these outcomes.

It's easy to say we would pick a different outcome to pursue, i.e. patient well-being. However, such a change would involve essentially ending a whole range of industries, putting millions of people out of work, and decimating everyone's stock portfolios as healthcare margins revert to utility levels (and care becomes affordable). To the extent these changes are politically unthinkable in the modern U.S, we will continue to see layers of tinkering around the edges as political initiatives and compromises come and go. Of course, each new piece of legislation adds regulation, red tape, and cost.

It is unclear how this cycle of compromise and rising costs ends without some sort of radical revolution. The U.S. is trapped by its own ideology about how politics and healthcare are supposed to work.

Paul der Krake

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It's easy to say we would pick a different outcome to pursue, i.e. patient well-being. However, such a change would involve essentially ending a whole range of industries, putting millions of people out of work, and decimating everyone's stock portfolios as healthcare margins revert to utility levels (and care becomes affordable). To the extent these changes are politically unthinkable in the modern U.S, we will continue to see layers of tinkering around the edges as political initiatives and compromises come and go. Of course, each new piece of legislation adds regulation, red tape, and cost.
We put people out of work and drive companies into the ground all the time. Something something creative destruction. What's different here?

The billing department of an average hospital should be a team of 10-50 humans monitoring computers and handling edge cases, not the cubicle farms of 1000+ workers they are today.

Jrr85

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Australians are very happy with their system. Why is it Americans always quote development of new drugs to justify the unreasonable costs? Other countries develop new drugs AND have a reasonable system too. Is the US the only developer of new drugs? We know the answer is no.
You are not understanding the argument.  It's not that the US develops new drugs, it's that the US pays for new drugs. 

Other countries, particularly those with single payer that use their monopsony power to drive down drug prices, are free riding off the U.S. paying much higher drug prices. 

The US does not allow Medicare (nor Medicaid I think) to use its market power to negotiate better drug prices.  Then they also outlaw importing drugs from other countries so that people don't just purchase drugs from countries that do use market power (or monopsony power for those countries with single payer) to drive costs below the average cost of production (which is almost entirely the R&D costs, as the production costs are usually pretty minimal). 

In theory, this results in more drugs being developed by making the rewards for a successful drug much larger, and since drug development is a high risk, high reward business with many expensive failures for each drug that makes it through the regulatory process and is marketable, that's important to keep people plowiong money into R&D. 

I'm not sure the theory works in practice for people in the U.S., but no doubt it's a fantastic deal for the rest of the world, who get the benefits without bearing any of the cost. 

Ideally, Medicare would be allowed to cap their payments for drugs at no more than the average of the net price given to other developed countries, or maybe 110% or 125% of the average if you think the U.S. should bear more of a burden as a richer country.
I suppose it depends on the outcome we are seeking. The current system is essentially a subsidy for R&D at the expense of patients, but it is also a subsidy for prescription drug ads on TV aimed at seniors, pharmaceutical reps schmoozing/bribing doctors, mergers and acquisitions, dividends and executive salaries, and lobbying. Much of the difference between what U.S. residents pay and what residents of other countries pay goes to these outcomes.

Not quite.  First, it's not really a subsidy for current R&D.  It's an incentive for current R&D by increasing the reward for past R&D (which is sort of an implicit promise that current R&D will also be richly rewarded in the event it results in a marketable drug).  Of course that also increases the incentive for things that increase current sales, like marketing.  I don't know that there is a reliable way to tell how much of each activity it incentivizes.  Presumably the incentive for increasing current sales is greater, since that payoff is certain whereas R&D is still uncertain, not only in that drug development is uncertain but that politics could change before a drug is brought to market and they might start getting the same payments from MEdicare and Medicaid that they get from other governments. 

Second, it's not clear that it's at the expense of patients.  It's at the expense of taxpayers who pay for medicaid and medicare, and maybe at the expense of medicare patients using drugs, to the extent they have a copay that is higher than it otherwise would be.  But it's arguably a benefit to non-medicare/medicaid patients in the U.S., because to the extent you believe in cost shifting, it reduces the amount of fixed costs that have to be recovered from US consumers (I suspect that they get the max they can out of private insurance companies regardless of what amount is coming from Medicare/Medicaid) and it also in theory has resulted in more drugs being available to those customers, although you of course could never identify how many drugs wouldn't have been developed nor which ones they would be. 


It's easy to say we would pick a different outcome to pursue, i.e. patient well-being. However, such a change would involve essentially ending a whole range of industries, putting millions of people out of work, and decimating everyone's stock portfolios as healthcare margins revert to utility levels (and care becomes affordable). To the extent these changes are politically unthinkable in the modern U.S, we will continue to see layers of tinkering around the edges as political initiatives and compromises come and go. Of course, each new piece of legislation adds regulation, red tape, and cost. 

It is unclear how this cycle of compromise and rising costs ends without some sort of radical revolution. The U.S. is trapped by its own ideology about how politics and healthcare are supposed to work.


Hikester

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Well all that R&D is not exactly producing the longest lived, healthiest people on the planet either. And itís very true that we decimate entire industries all the time. Complete decimation is not necessary, but definitely serious reforms. Health care professionals will always be in great demand as our population is not getting any younger. So if US subsidizes drug development for so many other countries, and those citizens enjoy lower prices, maybe US citizens should get good deals abroad. Trapped is a good word in this dilemma.
Two roads diverged in a wood, and I,
I took the one less traveled by,
And that has made all the difference.

Robert Frost

Acastus

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It's easy to say we would pick a different outcome to pursue, i.e. patient well-being. However, such a change would involve essentially ending a whole range of industries, putting millions of people out of work, and decimating everyone's stock portfolios as healthcare margins revert to utility levels (and care becomes affordable). To the extent these changes are politically unthinkable in the modern U.S, we will continue to see layers of tinkering around the edges as political initiatives and compromises come and go. Of course, each new piece of legislation adds regulation, red tape, and cost.
We put people out of work and drive companies into the ground all the time. Something something creative destruction. What's different here?

The billing department of an average hospital should be a team of 10-50 humans monitoring computers and handling edge cases, not the cubicle farms of 1000+ workers they are today.

Yes, I would like to see a lot of people lose their jobs. I am sure that will include a host of people. A lot of other people will either take a pay cut or not get a raise for 10 years. We need to squeeze at least $1 trillion dollars out of the US health industry. We spent over $3 trillion in 2017. We should try to eliminate half of that.  Our whole industry charges too much, and no one can tell them no. I also think other countries will be forced to pick up some of the research and development costs when we finally say enough.

smoghat

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Re: Mustachians Deserve Group Health Insurance Outside Work
« Reply #29 on: June 20, 2018, 06:31:51 PM »
It sounds like you think making others pay for your health insurance is somehow going to lower the cost of health insurance. That's not how it works, when the government (the 50% of workers that pay taxes) pays for things,
the cost goes up. As a provider government money is to easy to take, and as a citizen, look how many are just thrilled to get there government insurance subsidy!
  There are government regs that can help lower the cost of health insurance, but throwing taxpayer money at it, does not lower cost.
"but we don’t pay subsidies and our insurance is GOING THROUGH THE ROOF."
 Maybe I don't understand what you mean in the above statement.
Who doesn't pay subsidies? And if you say nobody, where does the money come from?

I guess I wasn’t clear enough:

I want to buy medical health insurance for my family and myself.
I’ve got plenty of millions, I don’t want to work for a living, but rather for my own desire.
Obamacare allowed me to have ok health insurance at an ok price. But Trumpcare is as dumb as Trump. I am already paying way more than least year and we a deductible so high, I can’t use the insurance.

All I’m asking is I have the same fair shake that drones working for a corporation get when they pay health insurance. I have high blood pressure, wife has migraines, son is allergic to cars, daughter has acne. Pre-existing conditions that under the Donald’s regime will invalidate any healthcare we hope to receive even though we are paying over $2000 a month. I know how much unsubsidized COBRA is, so why can’t I receive that? I have looked over a decade of our medical records and for that decade (and probably forever) insurance agencies have made money off my sorry ass.

Look, I’d even be willing to pay for my own cancer treatment or whatever, if I ever needed it, but the rates I would pay would be much higher than what an insurance agency pays. So that won’t work.

What’s so hard to understand about that?
« Last Edit: June 20, 2018, 06:37:02 PM by smoghat »

ChpBstrd

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Re: Mustachians Deserve Group Health Insurance Outside Work
« Reply #30 on: June 20, 2018, 08:55:19 PM »
It sounds like you think making others pay for your health insurance is somehow going to lower the cost of health insurance. That's not how it works, when the government (the 50% of workers that pay taxes) pays for things,
the cost goes up. As a provider government money is to easy to take, and as a citizen, look how many are just thrilled to get there government insurance subsidy!
  There are government regs that can help lower the cost of health insurance, but throwing taxpayer money at it, does not lower cost.
"but we donít pay subsidies and our insurance is GOING THROUGH THE ROOF."
 Maybe I don't understand what you mean in the above statement.
Who doesn't pay subsidies? And if you say nobody, where does the money come from?

I guess I wasnít clear enough:

I want to buy medical health insurance for my family and myself.
Iíve got plenty of millions, I donít want to work for a living, but rather for my own desire.
Obamacare allowed me to have ok health insurance at an ok price. But Trumpcare is as dumb as Trump. I am already paying way more than least year and we a deductible so high, I canít use the insurance.

All Iím asking is I have the same fair shake that drones working for a corporation get when they pay health insurance. I have high blood pressure, wife has migraines, son is allergic to cars, daughter has acne. Pre-existing conditions that under the Donaldís regime will invalidate any healthcare we hope to receive even though we are paying over $2000 a month. I know how much unsubsidized COBRA is, so why canít I receive that? I have looked over a decade of our medical records and for that decade (and probably forever) insurance agencies have made money off my sorry ass.

Look, Iíd even be willing to pay for my own cancer treatment or whatever, if I ever needed it, but the rates I would pay would be much higher than what an insurance agency pays. So that wonít work.

Whatís so hard to understand about that?
The reason the insurance companies charge you so much is because of the selection problem: sick people are the ones most likely to want to buy insurance and healthy people tend to skimp on it. Insurance prices rise due to attracting sick people, so even more semi-healthy people take a gamble and go uninsured, so the pool of buyers tends to be even sicker, costs rise faster, and the premium rises more, disincentivizing even more people again. It's a natural upward spiral. In a "free market" for insurance, this is the natural outcome.

The hated pre-existing conditions limitations were one attempt to control this selection problem. The ACA eliminated the pre-existing condition limitation by replacing it with a fine/tax for going uninsured. Republicans have repealed the ACA tax but if pre-existing conditions also must remain covered, as they are now, expect the costs to spiral to absurdity and healthcare systems to collapse under the weight of uncollectable bills. The closure of dozens of rural hospitals is just the start.

The high likelihood of a bill being uncollectable is why healthcare providers charge you more than they'd charge an insurance company.

I bet the price of healthcare services could drop dramatically with negotiations involving pre-payment. I also wonder if a millionaire could negotiate prepayment of 3-5 years worth of insurance premiums to keep the costs down.

Paul der Krake

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The prepayment thing is difficult to crack too because as soon as money changes hands all the consumer's leverage is lost. So you'd need something that's large enough to get you in the door, and hope that all parties play nice during reconciliation.

Say I walk into a doctor's office thinking I need procedure A, and state so at the reception. Reception knows that procedure is billed at $500, my insurance knows that the negotiated price is really just $300, and I know nothing. What does the receptionist require for me to get in line?

If the prepayment is $500, I may balk, and it would be hard to get my $200 back (because the insurance company has no interest in spending time and money and me).
If the prepayment is $50, that's not enough to protect the facility from risk of non-payment if it turns out I'm not covered for procedure A.

Now imagine that after a quick examination, I am advised to submit to procedure B, which happens to be much more expensive. Do I get shuttled back to the reception where another prepayment is required? What if I could afford prepaying A but not B? What about Joe Schmoe who can't float any money for 3 weeks until the claim is settled?

ChpBstrd

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Re: Mustachians Deserve Group Health Insurance Outside Work
« Reply #32 on: Today at 08:21:03 AM »
It sounds like you think making others pay for your health insurance is somehow going to lower the cost of health insurance. That's not how it works, when the government (the 50% of workers that pay taxes) pays for things,
the cost goes up. As a provider government money is to easy to take, and as a citizen, look how many are just thrilled to get there government insurance subsidy!
  There are government regs that can help lower the cost of health insurance, but throwing taxpayer money at it, does not lower cost.
"but we donít pay subsidies and our insurance is GOING THROUGH THE ROOF."
 Maybe I don't understand what you mean in the above statement.
Who doesn't pay subsidies? And if you say nobody, where does the money come from?

I guess I wasnít clear enough:

I want to buy medical health insurance for my family and myself.
Iíve got plenty of millions, I donít want to work for a living, but rather for my own desire.
Obamacare allowed me to have ok health insurance at an ok price. But Trumpcare is as dumb as Trump. I am already paying way more than least year and we a deductible so high, I canít use the insurance.

All Iím asking is I have the same fair shake that drones working for a corporation get when they pay health insurance. I have high blood pressure, wife has migraines, son is allergic to cars, daughter has acne. Pre-existing conditions that under the Donaldís regime will invalidate any healthcare we hope to receive even though we are paying over $2000 a month. I know how much unsubsidized COBRA is, so why canít I receive that? I have looked over a decade of our medical records and for that decade (and probably forever) insurance agencies have made money off my sorry ass.

Look, Iíd even be willing to pay for my own cancer treatment or whatever, if I ever needed it, but the rates I would pay would be much higher than what an insurance agency pays. So that wonít work.

Whatís so hard to understand about that?
The reason the insurance companies charge you so much is because of the selection problem: sick people are the ones most likely to want to buy insurance and healthy people tend to skimp on it. Insurance prices rise due to attracting sick people, so even more semi-healthy people take a gamble and go uninsured, so the pool of buyers tends to be even sicker, costs rise faster, and the premium rises more, disincentivizing even more people again. It's a natural upward spiral. In a "free market" for insurance, this is the natural outcome.

The hated pre-existing conditions limitations were one attempt to control this selection problem. The ACA eliminated the pre-existing condition limitation by replacing it with a fine/tax for going uninsured. Republicans have repealed the ACA tax but if pre-existing conditions also must remain covered, as they are now, expect the costs to spiral to absurdity and healthcare systems to collapse under the weight of uncollectable bills. The closure of dozens of rural hospitals is just the start.

The high likelihood of a bill being uncollectable is why healthcare providers charge you more than they'd charge an insurance company.

I bet the price of healthcare services could drop dramatically with negotiations involving pre-payment. I also wonder if a millionaire could negotiate prepayment of 3-5 years worth of insurance premiums to keep the costs down.

Jrr85

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Re: Mustachians Deserve Group Health Insurance Outside Work
« Reply #33 on: Today at 08:44:12 AM »
It sounds like you think making others pay for your health insurance is somehow going to lower the cost of health insurance. That's not how it works, when the government (the 50% of workers that pay taxes) pays for things,
the cost goes up. As a provider government money is to easy to take, and as a citizen, look how many are just thrilled to get there government insurance subsidy!
  There are government regs that can help lower the cost of health insurance, but throwing taxpayer money at it, does not lower cost.
"but we donít pay subsidies and our insurance is GOING THROUGH THE ROOF."
 Maybe I don't understand what you mean in the above statement.
Who doesn't pay subsidies? And if you say nobody, where does the money come from?

I guess I wasnít clear enough:

I want to buy medical health insurance for my family and myself.
Iíve got plenty of millions, I donít want to work for a living, but rather for my own desire.
Obamacare allowed me to have ok health insurance at an ok price. But Trumpcare is as dumb as Trump. I am already paying way more than least year and we a deductible so high, I canít use the insurance.

All Iím asking is I have the same fair shake that drones working for a corporation get when they pay health insurance. I have high blood pressure, wife has migraines, son is allergic to cars, daughter has acne. Pre-existing conditions that under the Donaldís regime will invalidate any healthcare we hope to receive even though we are paying over $2000 a month. I know how much unsubsidized COBRA is, so why canít I receive that? I have looked over a decade of our medical records and for that decade (and probably forever) insurance agencies have made money off my sorry ass.

Look, Iíd even be willing to pay for my own cancer treatment or whatever, if I ever needed it, but the rates I would pay would be much higher than what an insurance agency pays. So that wonít work.

Whatís so hard to understand about that?

It may be different where you are, but I am guessing you are generally incorrect about that.  If you go get care and don't get a price up front, they will charge you astronomical rates that are way higher than what anybody actually pays.  But if you negotiate ahead of time and pay up front, you will get either comparable prices or better prices because they don't have to deal with insurance.  The exception might be for chemotherapy drugs.  Not sure how those are priced to the medical profession and whether not being on insurance would lock you out of bulk rates.  Also, some doctors offices, particularly those that are employees of a hospital and have outsourced all their billing and collections to them might not give you a cash price.  So definitely not a good solution, but something to keep in mind if you are using a high deductible policy. 

I have gotten a cheaper price than my out of pocket when going to an out of network primary care physician.  They are going to charge the insurance company something like $225 for a visit, of which I would have ended up paying everything.  Asked how much it would be if I paid right there, and it was $90.  I suspect I could get a cheaper overall price from my physician in network too, but not cheaper than my co-pay, and I'm not sure how it would work if I paid cash and then submitted for reimbursement myself.