The Money Mustache Community

General Discussion => Post-FIRE => Topic started by: Hikester on June 12, 2018, 07:07:32 PM

Title: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Hikester on June 12, 2018, 07:07:32 PM
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
Title: Re: Mustachians Deserve Group Health Insurance Outside Work
Post by: smoghat 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!
Title: Re: Mustachians Deserve Group Health Insurance Outside Work
Post by: BTDretire 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?
Title: Re: Mustachians Deserve Group Health Insurance Outside Work
Post by: Hikester 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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Work
Post by: FIRE@50 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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Hikester on June 13, 2018, 10:05:09 AM
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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Work
Post by: Mr. Green 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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: seattlecyclone on June 13, 2018, 11:10:52 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.

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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Work
Post by: Threshkin 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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Work
Post by: Mr. Green 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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Work
Post by: Threshkin 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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Hikester on June 13, 2018, 08:35:32 PM
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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: DreamFIRE on June 13, 2018, 09:06:48 PM

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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: ChpBstrd on June 13, 2018, 09:34:23 PM
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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Hikester on June 14, 2018, 07:39:29 PM
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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Paul der Krake on June 14, 2018, 08:31:03 PM
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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Acastus on June 15, 2018, 08:35:15 AM

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."
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: TheWifeHalf on June 15, 2018, 08:40:03 AM
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
Title: Re: Mustachians Deserve Group Health Insurance Outside Work
Post by: Jrr85 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. 
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: MrThatsDifferent on June 15, 2018, 09:36:57 AM
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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Work
Post by: Threshkin 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)
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Hikester on June 19, 2018, 07:06:11 AM
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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Jrr85 on June 19, 2018, 08:10:20 AM
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. 
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Hikester on June 19, 2018, 05:53:41 PM
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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: ChpBstrd on June 20, 2018, 08:23:22 AM
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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Paul der Krake on June 20, 2018, 08:37:03 AM
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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Jrr85 on June 20, 2018, 09:41:01 AM
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.

Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Hikester on June 20, 2018, 11:45:22 AM
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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Acastus on June 20, 2018, 02:25:33 PM
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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Work
Post by: smoghat 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?
Title: Re: Mustachians Deserve Group Health Insurance Outside Work
Post by: ChpBstrd 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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Paul der Krake on June 20, 2018, 09:08:42 PM
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?
Title: Re: Mustachians Deserve Group Health Insurance Outside Work
Post by: ChpBstrd on June 21, 2018, 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.
Title: Re: Mustachians Deserve Group Health Insurance Outside Work
Post by: Jrr85 on June 21, 2018, 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. 

Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: smoghat on June 22, 2018, 07:50:48 AM
The negotiation thing isnít answer though, itís still completely mad (systemically, not you guys, although me ... perhaps). First off, Iím not sure about you, but the doctors I go to are largely incapable of negotiating (physical therapists being the one exception since it is so rarely covered enough) and their staff are barely conscious and have high turnover. Second, although I used chemotherapy as an example, what about the ER? I just read a story about a guy looking up the hospital while lying in the ambulance to make sure it was covered. Actually, the last time I went to the ER, I got balance billed for the paramedic.

As I said, Iím just looking for the same fair shake that someone who isnít FIREíd is. Now I have a relative who has worked very little all his life. Claims ADHD, bad luck, whatever. He wasnít covered by insurance until just now when he finally started paying the money to be attached to his wifeís policy (or rather she did). Heís got all sorts of serious health problems from a lifetime of binge drinking, so should he pay the same as I do? I have had insurance my entire life. I wouldnít say I gladly paid it, but I paid it. I may have missed a month here or there due to coverage between jobs, but Iíve paid into the system the entire time. Now that Iím 50 and things start to show up though, Iím screwed, and even then Iíve looked at the bills, insurance is still making money off me.

Hereís the rub: if someone without insurance goes to the ER, we are still all paying for them even after they have declared bankruptcy. Some kind of mandatory system needs to be put in place. Why itís costing this country so much is beyond me.

Another thought: if someone had early retired with over $3 million, they probably have pretty decent health. I booze a little too much (nothing like my relative who also smokes), but I exercise hard at least an hour a day, donít smoke, reduce my stress, etc. Iím probably a pretty good bet for someone who wanted to make money in health insurance. Surprised there isnít a health insurance company for us.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: FIRE@50 on June 22, 2018, 08:05:11 AM
The purpose of insurance, any insurance, is to protect you from catastrophic loss. Health insurance (along with many other forms of insurance) has been corrupted such that people use it for minor things like the sniffles and sprained ankles. On top of that, insurance is a for profit business and they will therefore always try to screw you out of coverage. If we are talking about covering the paint job on your dented fender, that isn't a big deal. If we are talking about covering your lifesaving medication, that is a different story.

All of this is why we need free public healthcare.

Lastly, Mustachians don't deserve anything more than anyone else. You saved a higher percentage of your income than the average American. Good for you. However, if you think there is a profitable business model to be developed from selling insurance to Mustachians, go for it.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Jrr85 on June 22, 2018, 08:23:23 AM
The negotiation thing isnít answer though, itís still completely mad (systemically, not you guys, although me ... perhaps). First off, Iím not sure about you, but the doctors I go to are largely incapable of negotiating (physical therapists being the one exception since it is so rarely covered enough) and their staff are barely conscious and have high turnover. Second, although I used chemotherapy as an example, what about the ER? I just read a story about a guy looking up the hospital while lying in the ambulance to make sure it was covered. Actually, the last time I went to the ER, I got balance billed for the paramedic.

As I said, Iím just looking for the same fair shake that someone who isnít FIREíd is. Now I have a relative who has worked very little all his life. Claims ADHD, bad luck, whatever. He wasnít covered by insurance until just now when he finally started paying the money to be attached to his wifeís policy (or rather she did). Heís got all sorts of serious health problems from a lifetime of binge drinking, so should he pay the same as I do? I have had insurance my entire life. I wouldnít say I gladly paid it, but I paid it. I may have missed a month here or there due to coverage between jobs, but Iíve paid into the system the entire time. Now that Iím 50 and things start to show up though, Iím screwed, and even then Iíve looked at the bills, insurance is still making money off me.
 

And that is the one real problem with insurance that we should have tried to fix through statute.  It's actually sort of hard to keep people from getting re-risk rated in a way that doesn't screw up the market.  It's easy to say that once a company is insuring you, they can't re-risk rate you.  But then if you start getting expensive, they have an incentive to provide you poor service because they would be happy for you to leave, but you can't leave unless other companies are prohibited from risk rating you. 

If you prevent other companies from re-risk rating you, then every company has an incentive to provide policies that are undesirable for people with health issues.  Also, to the extent companies continue to provide good service, you have to do something to prevent customers from gaming the system.
 You can't let people just pay for barebones policies while they are healthy and then allow them to move to much more generous coverage when they are not healthy and not allow companies to risk rate them. 
 


Hereís the rub: if someone without insurance goes to the ER, we are still all paying for them even after they have declared bankruptcy. Some kind of mandatory system needs to be put in place. Why itís costing this country so much is beyond me.

Another thought: if someone had early retired with over $3 million, they probably have pretty decent health. I booze a little too much (nothing like my relative who also smokes), but I exercise hard at least an hour a day, donít smoke, reduce my stress, etc. Iím probably a pretty good bet for someone who wanted to make money in health insurance. Surprised there isnít a health insurance company for us.
There is not an insurance company that can cater to you because it's been made illegal to cater to healthy people.  To the extent an insurance company is competing for you business, it will be by trying to offer products and service that is undesirable to unhealthy people, and there's just a limit to how much that can accomplish. 
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Acastus on June 22, 2018, 08:37:55 AM
Not to go all political, but how about America deserves health insurance decoupled from employment?
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Rcc on June 23, 2018, 11:38:16 AM
Not to go all political, but how about America deserves health insurance decoupled from employment?

A simple goal, stated clearly. It does not have to be political at all.

Amongst the few people Iím willing to discuss this topic with, I have a simple sentence to reframe the question:

In the US, war and combat operations are single payer. Why not health insurance.

I have other thoughts, but am not interested in hijacking the thread. I think the only way to make this happen is for us to vote in Congress critters who will back single payer....

Wishful thinking I know.



Title: Re: Mustachians Deserve Group Health Insurance Outside Work
Post by: Telecaster on June 23, 2018, 01:03:06 PM

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.


I see that statement a lot, however it isn't true.  About 1/3 of the entire bill was cost control measures, mostly for Medicare.   For example, incentives to improve outcomes, paying for treatments instead of procedures, etc.  The idea was that

Obviously, nothing is going to change over night, but the result was that Medicare costs grew far slower than was projected back in 2010, while outcomes improved.   Medical inflation itself is at the lowest level in decades.   Might not be a home run, but it was at least a triple. 
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Roadrunner53 on June 23, 2018, 03:19:51 PM
The Hub and I bought:
Part B Medicare $134 per month
Plan D Prescriptions $78 a month
Plan F Medigap $241.50 a month

This is the cost for each of us so $907 per month total for two people.

Yes, we could take a cheaper Medigap plan or a cheaper prescription plan but you get what you pay for. With plan F, there are no deductibles and all bills are paid for as long as Medicare approves the charges.

So, Medicare is not cheap either! If you don't pay for a medigap plan or a prescription plan, you will be paying out of your pocket. Drugs are expensive if not under some kind of a plan.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: DreamFIRE on June 23, 2018, 04:44:58 PM
The Hub and I bought:
Part B Medicare $134 per month
Plan D Prescriptions $78 a month
Plan F Medigap $241.50 a month

This is the cost for each of us so $907 per month total for two people.

Yes, we could take a cheaper Medigap plan or a cheaper prescription plan but you get what you pay for. With plan F, there are no deductibles and all bills are paid for as long as Medicare approves the charges.

So, Medicare is not cheap either! If you don't pay for a medigap plan or a prescription plan, you will be paying out of your pocket. Drugs are expensive if not under some kind of a plan.

Yes, I recall seeing those high Medicare costs in the ACA thread.  It's probably safer to assume it will cost $1000/mo.   I know it varies some with different states.   But it's certainly no where close to being FREE.   I wouldn't mind paying higher payroll taxes to help shore up SS and Medicare and reduce the burden on senior citizens instead of so much of my tax money going to subsidize young families.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Roadrunner53 on June 23, 2018, 05:14:29 PM
The Hub and I bought:
Part B Medicare $134 per month
Plan D Prescriptions $78 a month
Plan F Medigap $241.50 a month

This is the cost for each of us so $907 per month total for two people.

Yes, we could take a cheaper Medigap plan or a cheaper prescription plan but you get what you pay for. With plan F, there are no deductibles and all bills are paid for as long as Medicare approves the charges.

So, Medicare is not cheap either! If you don't pay for a medigap plan or a prescription plan, you will be paying out of your pocket. Drugs are expensive if not under some kind of a plan.

I live in wonderful CT an other than Part B everything is expensive. I checked out other states and Plan F and Plan D are less expensive almost everywhere.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: PBandJelli on June 23, 2018, 08:23:11 PM
Health insurance is tied to employment (more or less) in the United States because that is how it started in this country: as a benefit of employment.  Our institutional system is set up in that way, and it presents a peculiar challenge for people like us.

That said: I wonder if we could get enough of us together willing to pay into a pool to collectively bargain for insurance?  I'd actually be willing to do the research to see if this is possible, should enough people be willing.

Lots of details to work out, but as a community we might be able to solve this for ourselves, especially as the costs of ACA coverage increase or become more limited.

Of course, I hold out hope for single payer.  And it's what I vote for.... :-)  Vote in November and tell your Congressmen/women and Senators that this issue matters to you.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: pecunia on June 23, 2018, 10:42:34 PM
PBandJelley:
Quote
That said: I wonder if we could get enough of us together willing to pay into a pool to collectively bargain for insurance?  I'd actually be willing to do the research to see if this is possible, should enough people be willing.

Sounds like a really good idea, a sort of health cooperative.

Now the ACA has been out for a while.  The people who run insurance companies are probably much more knowledgeable than any of use who read and write these posts.  Those people are the CEOs and they get paid a lot to solve problems.  American companies have been known for innovation in the past.  In fact I believe Kaiser Permanente was one such solution started by Henry J. Kaiser when the Hoover dam was being constructed.  You just know that good solutions are coming for health care.  How do you know?  Well, I've seen advertisements for these health care providers and from the ads you can see that things are just great.  You can also see it from the politicians.  They too want to solve these health care problems.  For example, before the failed repeal of Obamacare, I saw President Trump saying that Obamacare was going to be replaced by something terrific.  You just know these guys are going to do good because they are so dissatisfied with Obamacare.  I guess it really bothered them that there were still millions of people left out and they want something better.

As far as the cost, I don't know the details but they must have something coming down the pipeline in that arena as well.  Why do I think this?  Well - the last tax bill took out the requirement for people to buy insurance.  This removed a lot of money from Obamacare.  Many of these same politicians have gone on at great lengths in the past about being able to pay for all Federal programs.  So - the politicians must have figured a way to cut the health care costs.  They wouldn't want deficits.  It will be very interesting to see what innovative financial moves they will do to help maintain the health of Americans and thus promote the general welfare.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Telecaster on June 24, 2018, 10:01:57 AM
Health insurance is tied to employment (more or less) in the United States because that is how it started in this country: as a benefit of employment.  Our institutional system is set up in that way, and it presents a peculiar challenge for people like us.

That said: I wonder if we could get enough of us together willing to pay into a pool to collectively bargain for insurance?  I'd actually be willing to do the research to see if this is possible, should enough people be willing.

Lots of details to work out, but as a community we might be able to solve this for ourselves, especially as the costs of ACA coverage increase or become more limited.

Of course, I hold out hope for single payer.  And it's what I vote for.... :-)  Vote in November and tell your Congressmen/women and Senators that this issue matters to you.

It is an intriguing idea.  One potential pitfall that does in groups like this one is that someone gets really sick with an expensive condition.  That causes premiums to spike and the healthy people bail, which causes the pool to collapse. 

Another potential problem is that every state has its own insurance regulations.   But still an intriguing idea.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Paul der Krake on June 24, 2018, 10:16:15 AM
Amazon/Berkshire/JPMorgan self-insure their employee health expenses, which means that they only pay the insurance company for administrative benefits, not for taking on financial risk. Despite that and having a combined 1 million employee, the cost savings are currently marginal. Do you seriously think a group of early retirees can get cost savings that multinational corporations can't?
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: pecunia on June 24, 2018, 10:25:27 AM
Paul der Krake:

Quote
Do you seriously think a group of early retirees can get cost savings that multinational corporations can't?

Yes
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Linea_Norway on June 25, 2018, 05:36:53 AM
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.

https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

As you see on this list, USA has by far the higher cost per capita. Many other western countries spend only half the money per capita. My travel insurance covers medical care all around the world, except for the USA, which required an additional insurance.

Norway is also quite high on the list, although a lot lower than the USA. In Norway everybody is automatically insured by the government when living legally in the country, not connected to work. We all have to pay our own share for any kind of treatment, but up to a maximum of approx $350 per year. This includes medicine. But in our system dental treatment and glasses are not covered. We need to pay for everything dental, with the exception of a very few dental operations, like removing wisdom teeth.
The Norwegian government negotiates with medicine companies for prices. If a price is too insanely high, they won't buy the medicine and the few people who need if have a problem. For other medicines, the pharmacy has to give you the cheapest option when the government if (partly) paying the bill. Any customer who prefers the more expensive option, has to pay the difference himself.
We have long queues in the public hospitals. Therefore there have risen private hospitals. Companies often buy a health insurance for their employees that give you access to those private hospitals. I think the government is still paying the the procedure, but the insurance make sure you get treated with 2 weeks or so, compared to a public hospital that can let you wait for 45 weeks just for the investigation.

In the Netherlands there is a public health care insurance for people under a certain income and private health insurance for people with a higher income. The insurance companies pay the bills. I have understood that those health insurance companies negotiate heavily with the hospitals and medicine companies to get the prices down. And from what I have understood, while living abroad, is that health care prices have gone down because of the negotiations.
I also know that in the past, my FIL couldn't get his private health insurance to cover anything to do with his back, because he had a very specific precondition. So this system was not fair for everyone.  I don't know how that is currently. Lots of people, like my FIL and my mother, buy a basic insurance that doesn't cover dental. Probably because the next step higher costs a lot and doesn't cover so much more that it is worth it. But I'm sure it covers hospital treatment.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: ender on June 25, 2018, 06:20:01 AM
Paul der Krake:

Quote
Do you seriously think a group of early retirees can get cost savings that multinational corporations can't?

Yes

Anytime you insure only healthy people, you can decrease costs. Presumably Amazon/Berkshire/JPMorgan don't have policies where they only hire healthy people.

If you made your Mustachian early retiree group out of a large group of people who were all healthy, I suspect you could lower costs.

But to keep them low, you probably would have to do things like avoid people with preexisting conditions, kick people who get cancer out, keep the average age low, etc, or otherwise keep the actuarial cost of the group lower such that you could have meaningful bargaining position with an insurance company.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Hikester on June 25, 2018, 01:48:32 PM
Whether we are talking about the Mustachian community or ABC employer, someone in that pool of people will get drastically sick, that is the definition of insurance, to spread risk. No pool will be perfectly healthy and accident free. But that is not the point. The point is for different groups, other than employers, to unite to negotiate for better rates. This could be state or city based, private groups etc. We still have the issue that employers contribute to the cost of healthcare while these other groups presumably wouldnít. Other countries get help from their government, but Americans are very opposed to this. We might end up with a two tier system in the future where some states help their citizens and others donít. Like in different countries but different states. This discussion has been great in producing lots of angles to this issue and been quite enlightening. We are all going to need healthcare sometime in our lives, so we will see what the future holds. Like Mahatma Gandhi said: Be the change you wish to see in the world.Ē
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Telecaster on June 25, 2018, 02:48:23 PM
Amazon/Berkshire/JPMorgan self-insure their employee health expenses, which means that they only pay the insurance company for administrative benefits, not for taking on financial risk. Despite that and having a combined 1 million employee, the cost savings are currently marginal. Do you seriously think a group of early retirees can get cost savings that multinational corporations can't?

No, but they still might be able to get some savings.  Here's how:  Presumably, many in the MMM community are retired and therefore buy individual insurance plans (as opposed to employer-sponsored).   But a group plan likely would be cheaper than an individual plan. 

The trick would be making sure the risk pool is large enough. 
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Paul der Krake on June 25, 2018, 03:34:00 PM
Thatís still going to be a subset of the pool of the individual market. What pricing leverage do you think a group of early retirees has?
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Hikester on June 26, 2018, 08:54:05 AM
Well AARP has a lot of leverage but they are much larger. The FIRE community is still too small.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: ChpBstrd on June 26, 2018, 07:17:59 PM
We might end up with a two tier system in the future where some states help their citizens and others donít. Like in different countries but different states.

Welcome to the future: https://www.kff.org/medicaid/issue-brief/medicaid-expansion-health-coverage-and-spending-an-update-for-the-21-states-that-have-not-expanded-eligibility/ (https://www.kff.org/medicaid/issue-brief/medicaid-expansion-health-coverage-and-spending-an-update-for-the-21-states-that-have-not-expanded-eligibility/)

The U.S. is so crazed by ideology that people can't even make decisions to enact pragmatic solutions to benefit themselves. Rejecting funds from the ACA is exhibit A. It's not that the problem isn't severe enough to force the ideologues into a compromise, it's that we can't even think beyond zero-sum games anymore.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: pecunia on June 26, 2018, 08:02:32 PM
ChpBstrd:
Quote
It's not that the problem isn't severe enough to force the ideologues into a compromise, it's that we can't even think beyond zero-sum games anymore.

Absolutely right - Here there is literally an issue of life and death for citizens of this country and they get caught up in some bizarre abstractions instead of trying to fix the problem.

Of course some of them have simply sold out to big money interests and had no morals or principles to begin with.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Paul der Krake on June 26, 2018, 08:12:50 PM
Well AARP has a lot of leverage but they are much larger. The FIRE community is still too small.
Does AARP actually have any leverage in the health insurance market? If that were true, why isn't every single senior a member?
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Jrr85 on June 27, 2018, 07:50:52 AM
Amazon/Berkshire/JPMorgan self-insure their employee health expenses, which means that they only pay the insurance company for administrative benefits, not for taking on financial risk. Despite that and having a combined 1 million employee, the cost savings are currently marginal. Do you seriously think a group of early retirees can get cost savings that multinational corporations can't?

No, but they still might be able to get some savings.  Here's how:  Presumably, many in the MMM community are retired and therefore buy individual insurance plans (as opposed to employer-sponsored).   But a group plan likely would be cheaper than an individual plan. 

The trick would be making sure the risk pool is large enough.

Having a large enough group to get pricing power is better than the alternative, but that doesn't really change things much.  Healthcare is expensive because we throttle the supply for a necessary service.  We compound that error by having 90% of the costs paid by third parties, with costs only indirectly flowed through to consumers. 

We can't fix it because politically we are focused on making sure other people pay for healthcare and pretending that regulation of a financial instrument is going to significantly change the costs. 
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: austin944 on June 27, 2018, 08:35:51 AM

Absolutely right - Here there is literally an issue of life and death for citizens of this country and they get caught up in some bizarre abstractions instead of trying to fix the problem.


Fixing the problem is going to require addressing the obesity epidemic in this country.  The USA has the highest obesity rate in the world, and it is expected to get worse in the future.

Why should I have to pay for somebody's health insurance when they refuse to maintain a healthy weight, exercise, or quit smoking?  If you are going to demand that people work together on lowering the cost of health care, then why can't I tell people to quit destroying their health with their bad habits?  It's a two-way street.  Don't reach into my wallet and expect me to demand nothing in return.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Threshkin on June 27, 2018, 09:09:04 AM

Absolutely right - Here there is literally an issue of life and death for citizens of this country and they get caught up in some bizarre abstractions instead of trying to fix the problem.


Fixing the problem is going to require addressing the obesity epidemic in this country.  The USA has the highest obesity rate in the world, and it is expected to get worse in the future.


Why should I have to pay for somebody's health insurance when they refuse to maintain a healthy weight, exercise, or quit smoking?  If you are going to demand that people work together on lowering the cost of health care, then why can't I tell people to quit destroying their health with their bad habits?  It's a two-way street.  Don't reach into my wallet and expect me to demand nothing in return.

Incorrect.  The US does not have he highest obesity rate in the world.  In fact it ranks 12th as of Feb 2018.

https://www.worldatlas.com/articles/29-most-obese-countries-in-the-world.html (https://www.worldatlas.com/articles/29-most-obese-countries-in-the-world.html)
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: austin944 on June 27, 2018, 09:50:22 AM

Incorrect.  The US does not have he highest obesity rate in the world.  In fact it ranks 12th as of Feb 2018.

https://www.worldatlas.com/articles/29-most-obese-countries-in-the-world.html (https://www.worldatlas.com/articles/29-most-obese-countries-in-the-world.html)

The USA has the highest obesity rate among OECD countries, as of 5/2017:
https://www.marketwatch.com/story/the-us-is-the-most-obese-nation-in-the-world-just-ahead-of-mexico-2017-05-19

The top country in your list (Nauru) receives "significant" support from Australia for its health services:
https://www.homeaffairs.gov.au/about/corporate/information/fact-sheets/health-services-nauru

And the second receives aid as well (Cook Islands, receiving aid from NZ):
https://www.mfat.govt.nz/en/aid-and-development/our-work-in-the-pacific/cook-islands/
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: ChpBstrd on June 27, 2018, 10:54:02 AM

Absolutely right - Here there is literally an issue of life and death for citizens of this country and they get caught up in some bizarre abstractions instead of trying to fix the problem.


Fixing the problem is going to require addressing the obesity epidemic in this country.  The USA has the highest obesity rate in the world, and it is expected to get worse in the future.

Why should I have to pay for somebody's health insurance when they refuse to maintain a healthy weight, exercise, or quit smoking?  If you are going to demand that people work together on lowering the cost of health care, then why can't I tell people to quit destroying their health with their bad habits?  It's a two-way street.  Don't reach into my wallet and expect me to demand nothing in return.
Why should I have to pay for the costs of motorcycle accidents when I don't ride?

Why should I have to pay for the costs of eye injuries to welders, when I am not a welder?

Why should I have to pay for the costs of silicosis when I am not a miner?

Why should I have to pay for the costs of people with type 1 diabetes when I am not genetically succeptable?

Why should I have to pay the costs of premature babies when I'm not having any more kids?

Why should I have to pay for the earthquake injuries of people in California when I chose to live in a geologically stable region?

Why should I have to pay for the many, many national parks I will never get to visit?

Why should I have to pay for the higher healthcare costs of the elderly when I am not (yet) elderly?

It is satisfying to set up one mental account for oneself and another for everybody else. It's reassuring to imagine a world where one's own virtues and healthy habits mean nothing could go wrong, and one's insurance premiums are simply charity to the undeserving. But one day we will all need the assistance of other people. Maybe you break a hip in 20 years, or develop an autoimmune disorder, or slip a disc? I know very few people who've never had a bout with some health problem - that's what insurance is for.

Now, if you're talking about huge taxes on tobacco and sugar, I think that makes sense. Candy bars and soft drinks should cost 10x as much as they do. Tobbacco should be taxed until it almost makes sense for the drug dealers to sell.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: pecunia on June 27, 2018, 11:00:23 AM
Austin-944:
Quote
Fixing the problem is going to require addressing the obesity epidemic in this country.  The USA has the highest obesity rate in the world, and it is expected to get worse in the future.

I think so too.  In fact I think fixing it will require a new outlook from the medical industry.  More emphasis should be on prevention and tools should be provided to make it easier for people to maintain their health.  Then it will infiltrate our culture and we will all be better off.

Here's a simple example.  I work away from home and sometimes like to take a good walk.  I'm sort of amazed as to how many places are "boxed in."  You literally cannot take a good walk.  To get from point A to point B, you need a vehicle.  Wouldn't the simple act of people walking go a long way to helping them?

I guess there is a lot less money to be made from healthy people.

Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Threshkin on June 27, 2018, 03:07:05 PM

Absolutely right - Here there is literally an issue of life and death for citizens of this country and they get caught up in some bizarre abstractions instead of trying to fix the problem.


Fixing the problem is going to require addressing the obesity epidemic in this country.  The USA has the highest obesity rate in the world, and it is expected to get worse in the future.

Why should I have to pay for somebody's health insurance when they refuse to maintain a healthy weight, exercise, or quit smoking?  If you are going to demand that people work together on lowering the cost of health care, then why can't I tell people to quit destroying their health with their bad habits?  It's a two-way street.  Don't reach into my wallet and expect me to demand nothing in return.
Why should I have to pay for the costs of motorcycle accidents when I don't ride?

Why should I have to pay for the costs of eye injuries to welders, when I am not a welder?

Why should I have to pay for the costs of silicosis when I am not a miner?

Why should I have to pay for the costs of people with type 1 diabetes when I am not genetically succeptable?

Why should I have to pay the costs of premature babies when I'm not having any more kids?

Why should I have to pay for the earthquake injuries of people in California when I chose to live in a geologically stable region?

Why should I have to pay for the many, many national parks I will never get to visit?

Why should I have to pay for the higher healthcare costs of the elderly when I am not (yet) elderly?

It is satisfying to set up one mental account for oneself and another for everybody else. It's reassuring to imagine a world where one's own virtues and healthy habits mean nothing could go wrong, and one's insurance premiums are simply charity to the undeserving. But one day we will all need the assistance of other people. Maybe you break a hip in 20 years, or develop an autoimmune disorder, or slip a disc? I know very few people who've never had a bout with some health problem - that's what insurance is for.

Now, if you're talking about huge taxes on tobacco and sugar, I think that makes sense. Candy bars and soft drinks should cost 10x as much as they do. Tobacco should be taxed until it almost makes sense for the drug dealers to sell.

Very good points above.  Risk pooling groups people with high and low risk for many factors together.  It is really the only way insurance can work.  Statistical predictions hold up much better in large populations.  In small groups the beta is just too high.  This is a good argument for nation-wide mandatory single payer insurance because it creates an extremely large risk pool.

Funny thing abut your last point, In some US jurisdictions, Tobacco is already taxed to the point where it is profitable to sell it illegally.  Do a quick search on Illegal Cigarette Sales and you will find a lot of news reports.  NYC in particular seems to have a big problem with this but it is not the only place.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: austin944 on June 27, 2018, 04:15:53 PM
Very good points above.  Risk pooling groups people with high and low risk for many factors together.  It is really the only way insurance can work.

You can have different pools with different levels of risk in each pool.  Auto insurance works that way, and Obamacare allows insurers to force smokers to pay higher premiums.   These risk factors can be based on an individual's behavior.  If you choose to drive through red lights or choose to begin smoking, you get charged a higher insurance premium.

But if you choose not to maintain a healthy weight, you're charged the same health care premiums as everybody else.  That provides no incentive for people to make healthy choices, and it will never address the growing obesity epidemic in this country and its associated health care costs.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Threshkin on June 27, 2018, 04:44:14 PM
Very good points above.  Risk pooling groups people with high and low risk for many factors together.  It is really the only way insurance can work.

You can have different pools with different levels of risk in each pool.  Auto insurance works that way, and Obamacare allows insurers to force smokers to pay higher premiums.   These risk factors can be based on an individual's behavior.  If you choose to drive through red lights or choose to begin smoking, you get charged a higher insurance premium.

But if you choose not to maintain a healthy weight, you're charged the same health care premiums as everybody else.  That provides no incentive for people to make healthy choices, and it will never address the growing obesity epidemic in this country and its associated health care costs.

Sure, risk pools can be and are broken up by different criteria.  My point is purely statistical.  The larger the pool, the easier and more accurate the overall risk predictions can be.  That is independent of the actual risk rates. 

Insurers would like to keep high-risk people (smokers, preexisting conditions, family history, etc.) out of the pool because that reduces their aggregate risk which improves profitability for the insurer and (hopefully) costs for the insured.

If you create a risk pool that only includes people   The desirable traits you by definition exclude people who don't meet the criteria.  This is good for the people in the pool and bad for the people who are not.  One of ACA's goals was to reduce this injustice by forcing insurers to include more people in the risk pool.  The logical outcome of adding higher risk individuals is to increase the overall risk of the pool which increases costs for both the insurer and the insured. The individual mandate was intended to decrease that risk by forcing low-risk individuals to also join the pool.  Unfortunately for many the tax penalty imposed for not buying insurance was too small to force compliance.  Now, with the mandate gone the situation is even more acute.

The subsidy program in ACA attempted to mask the true cost of insurance by transferring part of the costs from the individual to the taxpayers but the actual cost was still there.  The limitations on insurer profits were also intended to reduce costs but they did not address the pass-through costs from the service providers.  The profit controls made it less desirable for insurers to participate in ACA resulting in limited coverage options.  It also was a significant factor in the demise of many exchanges.

The revisions to medicare and medicaid were some of the best parts of ACA because they did attempt to control service provider costs.  Unfortunately those cost controls did not extend beyond those programs.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Concojones on June 28, 2018, 02:59:55 PM
In response to this whole thread:

Healthcare options have always been available, even outside of your employer. The problem is the often prohibitive cost. So what we need is reasonable healthcare costs rather than a mustachian group policy. How do we do that?

According to Harvard (https://www.hsph.harvard.edu/news/press-releases/labor-pharmaceuticals-administrative-costs-health-costs/):

- US healthcare costs twice what it costs in other rich countries
- the difference is due to inflated prices across the board (salaries, drugs, ADMINISTRATION). I put ADMINISTRATION in CAPS because if you read the article carefully, this item alone explains the cost difference between the US and other countries. I'm disappointed that they didn't care to specify what exactly they mean by 'administration'.
- Obamacare doesn't address the root problem (cost!)

Looks like we have 2 options:
1. Get rid of layers of administration and design a new system, which could be great (in theory) or (if Obamacare is any guide) subpar for the foreseeable future.
2. Simply copy the socialized healthcare system of just about any other country. It won't be perfect, but it's better than what we have now, and it's immediate relief.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: pecunia on June 29, 2018, 07:52:37 AM
ChronicJones:
Quote
Looks like we have 2 options:
1. Get rid of layers of administration and design a new system, which could be great (in theory) or (if Obamacare is any guide) subpar for the foreseeable future.
2. Simply copy the socialized healthcare system of just about any other country. It won't be perfect, but it's better than what we have now, and it's immediate relief.

OK - You can go for option 1 which is undefined or go for option 2 which works elsewhere.  Hmmmm.  Try something vague and undefined or something that is shown to work. 

How about an option 3 where we ease our way over to option 2?  It will be a hard sell to get the politicians to abandon their supporters, i.e. the health care industry.  You may be able to chip away at the system by improving Obamacare and maybe opening some Federal clinics staffed by medical personnel who have been given scholarships for say 7 years of supporting said clinics.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: DreamFIRE on June 29, 2018, 06:37:03 PM

Yeah, improve Obamacare, and improve Medicare.  Seniors shouldn't have to pay so much out of pocket.

If we can't get those existing systems stabilized and affordable, I can't see anything more global ever working out successfully.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: pecunia on June 29, 2018, 07:32:43 PM
Dreamfire:
Quote
If we can't get those existing systems stabilized and affordable, I can't see anything more global ever working out successfully.

Have you ever considered that the people in charge do not want to fix these programs?  These are the same people that almost eliminated the healthcare for millions.  These are the same people that talk about "reforming" Social Security.  These folks love the profit motive and believe market forces can solve all problems.

Have you seen one piece of healthcare legislation come out of these guys that will promote the common welfare?
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: beekayworld on August 18, 2018, 07:22:14 PM

Now, if you're talking about huge taxes on tobacco and sugar, I think that makes sense. Candy bars and soft drinks should cost 10x as much as they do. Tobbacco should be taxed until it almost makes sense for the drug dealers to sell.

Good points! And if the government would stop subsidizing corn crops,  corn sugar would not be so cheap that it gets added to almost all foods (e.g. ham, bread, canned soups).  Corn syrup is a carb. The old food pyramid with grains as the base needs to be turned upside down.
Title: Re: Mustachians Deserve Group Health Insurance Outside Work
Post by: BTDretire on August 18, 2018, 08:00:37 PM
Mustachians pay taxes too. All I am saying is that tying insurance to employment does not make sense.

 I agree, I have not had an employer subsidized health insurance policy since the 80s.
 I had a very happy day back in 2009 when I raised the deductible on my insurance and opened an HSA.
I was paying $4,512 for my family of 4. and getting a deduction on my HSA. Things looked great.
 Then in 2012 Obamacare regulations kicked in and now I'm paying $12,144 for the same family of 4.
When those regs started I had some whoping 18%, 19% and 24% increases in my premium.
  Note: I got those increases when the government started helping.

 
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: pecunia on August 18, 2018, 10:36:26 PM
Is there anywhere where a purely market based health care program actually works today?  People complain about government causing costs to rise.  No argument there.  Was the wrong fix applied?
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: BTDretire on August 19, 2018, 08:43:46 AM
Is there anywhere where a purely market based health care program actually works today?  People complain about government causing costs to rise.  No argument there.  Was the wrong fix applied?

 I don't know, but in 2017 the percentage of the population that used Obamacare was 3.5%.
 All that trouble to cover just 3.5% of the population.
 The obvious solution is to cut medical expenses.
Then the argument is, "your letting people die!" Or, your killing people.
 So we spend billions to keep people alive another six months.
Here's an article the tells the tradeoffs that I think should be made, but...
https://www.theatlantic.com/health/archive/2017/06/how-we-spend-3400000000000/530355/
It also says the 5% of the population spend 50% of the healthcare money.
EDIT to add,
 This seems helpful.
https://www.theatlantic.com/health/archive/2017/06/fixing-the-5-percent/532077/
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: DreamFIRE on August 19, 2018, 11:51:43 AM
Dreamfire:
Quote
If we can't get those existing systems stabilized and affordable, I can't see anything more global ever working out successfully.

Have you ever considered that the people in charge do not want to fix these programs?  These are the same people that almost eliminated the healthcare for millions.  These are the same people that talk about "reforming" Social Security.  These folks love the profit motive and believe market forces can solve all problems.

Have you seen one piece of healthcare legislation come out of these guys that will promote the common welfare?

I consider it a fact that those with the most power don't want to fix it.  My point was that if they won't fix what we have, and continue to attempt to repeal or dismantle it, what are the chances they come up with something globally better?

If the Republican healthcare bill would have passed, the CBO estimated that over 20 million Americans would have lost health insurance.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: pecunia on August 19, 2018, 12:49:14 PM

- SNIP -

 I don't know, but in 2017 the percentage of the population that used Obamacare was 3.5%.
 All that trouble to cover just 3.5% of the population.
 The obvious solution is to cut medical expenses.
Then the argument is, "your letting people die!" Or, your killing people.
 So we spend billions to keep people alive another six months.
Here's an article the tells the tradeoffs that I think should be made, but...
https://www.theatlantic.com/health/archive/2017/06/how-we-spend-3400000000000/530355/
It also says the 5% of the population spend 50% of the healthcare money.
EDIT to add,
 This seems helpful.
https://www.theatlantic.com/health/archive/2017/06/fixing-the-5-percent/532077/

.035 X 325,000,000 = 11,375,000  people - Just 3.5 percent of the population.  I guess I'm not one of those collateral damage types of guys.  I don't think they are all going to die in another six months.  Most are probably not sick at all.  They just need affordable health care.  Might be a better idea to spend billions keeping folks alive rather than the:

WASHINGTONóU.S. wars in Afghanistan, Iraq, Syria and Pakistan have cost American taxpayers $5.6 trillion since they began in 2001, according to a new study, a figure more than three times that of the Pentagon's own estimates.Nov 8, 2017

You know if they had some sort of Federal program, they could competitively bid on things like drugs and medical services.  I really don't think the medical companies have a lot of incentive otherwise to lower prices.  The Federal program could possibly eliminate a lot of middle men and this could drive down prices.

"So we spend billions to keep people alive another six months."

Yes - We've all heard stories of people being in a coma kept alive by a machine.  I don't think I'd want that.


- SNIP -

I consider it a fact that those with the most power don't want to fix it.  My point was that if they won't fix what we have, and continue to attempt to repeal or dismantle it, what are the chances they come up with something globally better?

If the Republican healthcare bill would have passed, the CBO estimated that over 20 million Americans would have lost health insurance.

I'm kind of thinking a lot of the present politicians are digging a big hole for themselves.  I figure there will be some new heads in November.  New heads may bring new ideas.  Of course, you don't always hear how bad these guys are because Trump takes all the headlines and this acts as a smokescreen.  Maybe one of the new ideas will be a new kind of group health insurance outside the traditional employment.  People are quite mobile these days and this could solve many problems.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Telecaster on August 19, 2018, 01:20:16 PM
I'm kind of thinking a lot of the present politicians are digging a big hole for themselves.  I figure there will be some new heads in November.  New heads may bring new ideas.  Of course, you don't always hear how bad these guys are because Trump takes all the headlines and this acts as a smokescreen.  Maybe one of the new ideas will be a new kind of group health insurance outside the traditional employment.  People are quite mobile these days and this could solve many problems.

The problem with that approach is that the group has to be really, really big otherwise a few sick people will drive up premiums and collapse the pool.   One limiting step is that insurance is regulated by the individual states, so everyone in the group also has to be in the same state.

The ACA does allow states to form regional insurance bodies, but no states have done so.   An early version of the ACA allowed for federal regulation, which would have allowed insurance companies to issue polices across state lines, but that was stripped out of the final version. 
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: beltim on August 19, 2018, 03:49:03 PM
It also says the 5% of the population spend 50% of the healthcare money.

In any one year.  It's not the same 5% every year.

This is how insurance works.  There's a similar ratio for every kind of insurance - auto, flood, fire - a few claims are responsible for the vast majority of costs.  That's the whole point of insurance.

As an extreme example, consider life insurance - most people never collect it, but no one ever makes two claims on the same policy.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: v8rx7guy on August 19, 2018, 07:00:35 PM
This is similar to how a health share ministry works and they have seemingly incredibly low "premiums".  They are able to take in only members who live a reduced risk lifestyle.  For instance, no smoking, no excessive drinking, no sex outside of marriage, etc. 
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: flyingaway on August 19, 2018, 09:17:27 PM
In any one year.  It's not the same 5% every year.

This is how insurance works.  There's a similar ratio for every kind of insurance - auto, flood, fire - a few claims are responsible for the vast majority of costs.  That's the whole point of insurance.

As an extreme example, consider life insurance - most people never collect it, but no one ever makes two claims on the same policy.

Why is this the case? The insured may not collect his/her own benefit, but his/her beneficiaries do.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: Paul der Krake on August 19, 2018, 09:24:27 PM
In any one year.  It's not the same 5% every year.

This is how insurance works.  There's a similar ratio for every kind of insurance - auto, flood, fire - a few claims are responsible for the vast majority of costs.  That's the whole point of insurance.

As an extreme example, consider life insurance - most people never collect it, but no one ever makes two claims on the same policy.

Why is this the case? The insured may not collect his/her own benefit, but his/her beneficiaries do.
Most beneficiaries never collect it... this is why you can buy 1 million for $20 a month or whatever.
Title: Re: Mustachians Deserve Group Health Insurance Outside Traditional Employment Option
Post by: seattlecyclone on August 20, 2018, 10:32:22 AM
In any one year.  It's not the same 5% every year.

This is how insurance works.  There's a similar ratio for every kind of insurance - auto, flood, fire - a few claims are responsible for the vast majority of costs.  That's the whole point of insurance.

As an extreme example, consider life insurance - most people never collect it, but no one ever makes two claims on the same policy.

Why is this the case? The insured may not collect his/her own benefit, but his/her beneficiaries do.
Most beneficiaries never collect it... this is why you can buy 1 million for $20 a month or whatever.

Right. Life insurance is mostly purchased by younger people, with lower savings, kids to provide for, etc. As you age, premiums go up and the need for life insurance goes down, so not all that many people actually still have life insurance by the time they pass away.