geojanes

so when you buy insurance, most everyone loses money, and that is an investment that repulses me.

The people you "make money" have been stricken with some major medical problem... So, considering the alternative ... maybe you shouldn't be repulsed?

Your paying about $13,800 in premiums and still have to pay the first $12000 in charges, as deductibles. Is that right?
My provincial and federal tax rate together is around 37% For that my wife and i are pretty fully insured. When you add the insurance costs with your taxes, whats your effective tax rate?

(A fair way to compare a single payer tax funded system with the US system, no?)

rickyp wrote:geojanes

so when you buy insurance, most everyone loses money, and that is an investment that repulses me.

The people you "make money" have been stricken with some major medical problem... So, considering the alternative ... maybe you shouldn't be repulsed?

Your paying about $13,800 in premiums and still have to pay the first $12000 in charges, as deductibles. Is that right?
My provincial and federal tax rate together is around 37% For that my wife and i are pretty fully insured. When you add the insurance costs with your taxes, whats your effective tax rate?

(A fair way to compare a single payer tax funded system with the US system, no?)

In terms of cost, that's about right. I've thrown in the required pediatric dentistry insurance, which we won't use because there is no dentist we'd go to that participates (drives me crazy, there is no option just to go to a dentist and pay, you have to pay for insurance that most dentists won't take, and then still pay for your dentist!) All well-visits are covered 100% (annual check-up, vaccinations) but that's true for all NYS plans. This new plan also comes with two sick visits 100% covered per year, which is a change from our current plan. There is also some coverage of drugs, but if you're hospitalized and you're really sick, you've got to spend 12k in provider costs before it covers anything.

As far as effective tax rate including insurance, first, I'm hoping to never come anywhere near that deductible, (knock wood), and if you spend a lot of money (is it 7.5% of income? Or 10%? I forget) on health care it is deductible on your federal taxes, so I'm not sure how easy it is to calculate.

And I stand by the statement I made: insurance is like a lottery ticket with consequences that you hope you don't win, but the concept is the same, as a whole, the players lose, which makes it a terrible investment. The only sure winners are the house, but you still have to do it because of the potential for catastrophic costs. It's just simple math.

Oh, I agree that insurance, especially where it's privately run, is going to cost more in the aggregate. Of course the flipside to it should be (and the co-pay thing on health insurance seems to undermine this greatly), that pooling risk means that if you are unlucky and need to claim, it is not the potential financial disaster that it would be if uninsured.

Similarly for home insurance, car insurance, life insurance...

The ACA is definitely a fudge, more of a set of sticking plasters and reforms to a stinking system than a true reform. But I don't see what reforms that would make a serious positive difference are also politically possible. The healthcare industry and the insurance industry are clearly resistant to any dents to their financial power.

What would be interesting to know is what premiums had been doing over the last 5-10 years on your plans.

geojanes wrote:The whole process and value was pretty bad. The plan we ended up with is clearly a worse value than the plan we had previously. The premium is actually slightly lower than what we currently pay, but it essentially doesn't cover much of anything. Previously, my insurance cost $1,200 a month for my family with a $1,200 deductible and completely covered a bunch of standard things. My new plan will be about $1,150 a month with a $12,000 deductible. To get a similar deductible as my current plan, the monthly premium was in the $1,600-$1700 range.

While others want to blow by this paragraph, I want to highlight it.

1. A bad value. A bad web experience.
2. A slight savings on the policy. $600 a year.
3. An increase of . . . 900% on the deductibles! Roll them bones!

Geojanes also discusses useless yet mandatory coverage (dental). He also mentioned having to pay higher prices for the same insurance available via groups. I thought the ACA was supposed to get those group rates?

In any event, if Geojane's experience is remotely typical, that law is not going to gain in popularity, nor is anyone going to cry if it gets overhauled.

Geojanes:

As far as effective tax rate including insurance, first, I'm hoping to never come anywhere near that deductible, (knock wood), and if you spend a lot of money (is it 7.5% of income? Or 10%? I forget) on health care it is deductible on your federal taxes, so I'm not sure how easy it is to calculate.

If you are self employed you should look into taking your health insurance premiums as a tax adjustment on the 1st page of Form 1040.

This does not represent tax advice as I do not know your personal tax situation and have not researched your situation. You should consult with your own tax advisor.

Well, as I read it George had to purchase an individual plan where before he was able to get covered under a group plan. If the parties could cooperate we could fix such things...but we know that is not going to happen.

freeman3 wrote:Well, as I read it George had to purchase an individual plan where before he was able to get covered under a group plan. If the parties could cooperate we could fix such things...but we know that is not going to happen.

But, wasn't this one of the things the ACA was supposed to address?

I am not sure what the intent was in not allowing George's plan to qualify as a group plan. Maybe they simply came with a definition of what constituted a group that unintentionally excluded George 's plan. If they did it because of size of the company, I guess it would be intentional but perhaps something could be done to ameliorate people harmed because they now do not qualify for a group plan, anymore. They could certainly make an exception if the exclusion was unintended and perhaps provide a subsidy for a period of time if no exception can be made. Maybe the provision of the ACA causing George not to qualify as a group plan was put in at the behest of insurance companies so they could make more money.
I don't know that the ACA was designed to address this issue. It's a 900 page document which could use a little tweaking (to fix unintended or harsh consequences) but for political reasons that is not possible.

freeman3 wrote:I am not sure what the intent was in not allowing George's plan to qualify as a group plan. Maybe they simply came with a definition of what constituted a group that unintentionally excluded George 's plan.

Oh, I know. For the past couple of years the only people my company has employed as official employees and not contractors, has been me and my wife. Any company with two or more employees has always been able to qualify for a group plan in NY. The ACA specifically excluded companies that employed two people who were spouses from qualifying for group coverage. My understanding is that this was a purposeful decision to to force people who got group insurance onto the exchange as a way of increasing the number of people who would use the exchange, and making the risk pool better. My insurance broker tells me that a lot of people did this as a way of getting attractive rates without having official employees outside their own family.

Ironically, considering all the fuss about the ACA hurting employment, I nearly hired a contractor who works with me as an employee as a way around this. We've worked together for many years, and he used to be an employee, but he's just a contractor now. Under the old state-arranged plan for small businesses--which I could have continued if I hired him--I had to offer him health insurance, and then pay at least half of his premium if he wanted it. Since he could have had a family plan too, that was an additional 600 a month, so I passed on that and went onto the exchange. We'll see how it works out.

Doctor Fate wrote:

freeman3 wrote:Well, as I read it George had to purchase an individual plan where before he was able to get covered under a group plan. If the parties could cooperate we could fix such things...but we know that is not going to happen.

But, wasn't this one of the things the ACA was supposed to address?

The rates are determined by insurance companies. The risk pools, apparently, are different, so they charge different rates. (I expect the administrative costs are also much different.) Was the ACA supposed to address this? I think a single payer system might have, but not when private insurance companies are setting their own rates.

Thanks for the info. I guess the question is do you think it was fair or not for the ACA to do that.

geojanes

The rates are determined by insurance companies. The risk pools, apparently, are different, so they charge different rates. (I expect the administrative costs are also much different.) Was the ACA supposed to address this

The continuation of the private insurance business was a goal of the ACA. Because of the pressure from the insurance companies...
That the private insurance business is proven to be much less efficient than any single payer system (including Medicare in the US) the ACA did nothing to change the basic problem.

freeman3 wrote:Thanks for the info. I guess the question is do you think it was fair or not for the ACA to do that.

Fair is not the right word. When it comes to policy issues like this I think we should talk about dumb. The policy-people were faced with the problem of two insurance pools: one in group plans and others in individual plans, and the individual pool were a much higher risk than the group pool. So I'm sure they were thinking, "how do we shrink that difference?" And someone said, "well, how about these people who are kinda like individuals, we can make rule to force them onto the exchange and improve the risk of the pool for all individuals," at least marginally. In my opinion, it was not a dumb decision given the context.

But I also think that when you make policy there are often winners and losers, and my family falls squarely into the loser camp, and it is useful to examine who wins and who loses in any policy. As I've mentioned a while ago, we have an old family friend who has had a troubled life, has Hepatitis C and no health insurance until the ACA. He has it now because my brother helped him sign up for it and because he's poor, he gets something like a 90% subsidy. He's the winner in this policy game. If we take the two of us as examples, the consequence of my losing this game will likely be some money, which while it will pain me to spend it, will not materially impact my life if I'm being honest. The consequences to our friend, however, may be that he lives a much longer and healthier life. If every winner and loser were like us, then I would have no problem with the policy, but I also know that a lot of the small employers are living on the edge already and extra costs may be a real hardship, but hopefully that's where subsidy kicks in.

There are dumb parts: the requirement for pediatric dental insurance (which may just be a NYS requirement, I'm not sure) where most dentists just don't take it and so we'll never use it. We don't have the option of showing proof of service and forgoing the insurance. We just have to pay for the insurance and then pay for the care. It seems to me that if you require patients to buy it, you should require licensed professionals to take it, that would make a lot of sense, but it would also upset a very powerful lobby.

Geo:

There are dumb parts: the requirement for pediatric dental insurance (which may just be a NYS requirement, I'm not sure) where most dentists just don't take it and so we'll never use it. We don't have the option of showing proof of service and forgoing the insurance. We just have to pay for the insurance and then pay for the care. It seems to me that if you require patients to buy it, you should require licensed professionals to take it, that would make a lot of sense, but it would also upset a very powerful lobby.

It's also required in MA ... although we have been able to find providers who take it ... there are all sorts of dental insurance plans, so perhaps if you dig harder you can fine one that your dentist accepts?

The pediatric dental insurance is an example of really bad policy. The purpose of insurance is to cover catastrophic risk. Other than that, there's no value added, in theory. However, for pediatric dentistry, there is no real financial risk.

So, the government has conflated two distinct concepts: 1. the need for children to go to the dentist and 2. the need to cover the risk that some people will have catastrophic health expense. With dentistry you don't have to require insurance. You just have to cover the cost for people who cannot afford the pediatric dental care (not insurance).

Ray Jay wrote:The pediatric dental insurance is an example of really bad policy. The purpose of insurance is to cover catastrophic risk. Other than that, there's no value added, in theory. However, for pediatric dentistry, there is no real financial risk.

So, the government has conflated two distinct concepts: 1. the need for children to go to the dentist and 2. the need to cover the risk that some people will have catastrophic health expense. With dentistry you don't have to require insurance. You just have to cover the cost for people who cannot afford the pediatric dental care (not insurance).

Well said.

My own chapter on this story has not yet been written, as my wife contacted our new provider to arrange payment for the first premium since we'll out of town at the end of the year, and they have no record that we signed up at the exchange five days earlier. The exchange says give it more time, but the month is going to start running out of days soon.