2016 Health Care costs, surprises...

[LtSwtCrude]

My wife and daughter have their own individual family plan, I have a separate policy.
I figured starting in 2012 that their premiums would move up not too much each year for a while, then comes the kicker.
And so it has. For 2016. My premiums have increased very modestly. Between 5 and 10% per year, on a not-too-high premium.

Base year 2011 we started that individual family plan (not supported by an employer; I'm self-employed).

2012 -- premium increased 10.84 % over 2011
2013 -- 14.98% over 2012, and 27.44% over base year 2011
2014 -- 19.17% over 2013, and 51.86% over base year 2011
2015 -- 9.16% over 2014, and 65.78% over base year 2011
2016 -- 28.15% over 2015, and 112.44% over base year 2011

Three years into Obamacare and our family plan premiums just went up almost 30% from prior year.
Base on 2011 premiums, more than doubled. With benefits the same.

I had figured all along the incremental changes were being staged to hold off sticker shock for a few years... then Wham!! Staged, perhaps, also to hold back any Republican-controlled House from damn-sure repealing Obamacare, hence ruining the windfall bloodsucking from the insurance companies.

My premiums plus their policy combined ... our health care premiums in 2016 will be almost half our mortgage.

Ironically, our family is into preventative health care by our life style choices and don't even need the damn coverage other than for catastrophic matters, as with auto insurance.

This country's health care system, I surmise, is rigged for the insurance companies and hospitals (as opposed to private clinics). Looks like I'm shopping around in November.

 

[zork]

I'm guessing your data would indicate a nasty inflection point up going forward. It will likely get much worse before it gets any better with some type of counter measures or allowances for High Deductible plans for anyone instead of the BS regs now.

It is still being implemented with even the spoon feeding mechinisms to hide the increases/pain not helping to fool anyone who doesn't want to be fooled or the small percentage who didn't have any coverage before.

Where do we go from here with Hillary, Trump, Sanders, or Biden?

 

[Crockett]

My impression is the Democrats look the other way when the insurance/medical/industrial complex screws over the consumer. Republicans actively assist.

Surely somebody somewhere wants to implement market mechanisms to reward LtSwtCrude for good health choices and practtiooners that enable the well to stay well and pretty much out of hospitals, MRI, the offices of specialists and the pharmacies. My company, self insured, pretty much does that with fitness centers, nurseline, free flu shots, welllness screenings, etc and good in network costs for our high deductible plan that helps me stretch the $1,500 health savings plan to cover all my medical costs. As pretty healthy 56 year old with no serious health issues except an arthritic knee, I pretty much use my deductible each year, and the insurance company pays for my annual physical, a colonoscopy every couple of years and helps cover some physical therapy for injuries I seem to incur in clumsy pursuit of fitness. That must be typical, because my insurance premiums did not go up for 2016 after a slight rise in 2015. When it's time for my knee replacement (older brother and parents have 5 artificial knees among them) then I will hit them with a pretty good bill after paying the $3k out of pocket max.

 

[zork]

Crockett, do you know if your company took care of most of the increase so your share only appeared to go up a little or are you buying off the exchange? You can find out, perhaps, by figuring out how much your cobra would be for your current insurance should you ever be separated from the company for whatever reason.

 

[Crockett]

My company pays United Health Care to administer our company-specific plan. Employees pay 25 percent of premium and fund their own health savings account, though the company does kick in $400 to the HSA if we achieve easily achievable wellness incentives. I hate to even imagine COBRA costs.

 

[Mr. Deez]

My impression is the Democrats look the other way when the insurance/medical/industrial complex screws over the consumer. Republicans actively assist.

Yep, pretty much. Obama and the Dems learned their lesson from the HillaryCare debacle. If the insurance industry hates your bill, it can kill it regardless of which party is in charge. They can count on about 40 percent of Democrats and about 95 percent of Republicans to unreservedly carry water for them. With that kind of clout, it matters little which party is in charge. Why do you think Obama dropped the public option (the only part of his original plan that might have actually done something about costs)? Because the insurers didn't want it.

Personally, I don't see any real solution to the healthcare issue. People want security when they get sick, and that means they're not going to want a true free market approach to healthcare. They're always going to want a third-party payer who will cover the bills - certainly the big bills. We could adopt a single payer system (or something similar to one), but for that to work, the government would have to actually care about holding down costs. Unfortunately, when we've given the government that kind of power, they've never shown the ability to do that or even make it a serious priority.

 

[zork]

Personally, I don't see any real solution to the healthcare issue. People want security when they get sick, and that means they're not going to want a true free market approach to healthcare. They're always going to want a third-party payer who will cover the bills - certainly the big bills. We could adopt a single payer system (or something similar to one), but for that to work, the government would have to actually care about holding down costs. Unfortunately, when we've given the government that kind of power, they've never shown the ability to do that or even make it a serious priority.

want? I want a lot of things but deserve what I can pay for is what I want society to do for me and my family. Why should I want someone else to pay my way for anything?

Having the government get more and more involved is helping a few and driving up costs for the many. College, healthcare, cash, for clunkers, mortgages(90's/2000's), etc, I'm sure I am leaving out a bunch have all inflated the costs of things. People in the know get on the various gravy trains and make lots of money. But the competition isn't as it should be.

(this was a rushed post)

 

[theiioftx]

For the last time, this is not a "healthcare" issue. It is an insurance issue. Obamacare has done very little to improve the quality of care. It simply is starting to penalize hospitals who fail to meet its standards which are already being manipulated. Yes, premiums for most are increasing and deductibles have also increased substantially across the board. Much of what Obamacare has accomplished could have more easily been done simply by expanding Medicaid.

 

[theiioftx]

Well here is a few more specifics. Maybe some of the dems can tell us about how they calculate "savings."


"Experts are predicting rates will escalate faster next year than in the two years prior, as insurers take a close look at who is enrolling in Obamacare plans to get a good sense of the overall picture.

While plans and rates vary by state, a look at rate increases published Monday on healthcare.gov shows many hovering around 10 to 30 percent in many states.

But there's also a sprinkling of even bigger hikes. Blue Cross wants to raise its most expensive "platinum" plan in Alabama by 71 percent next year. Aetna wants to charge 59 percent more for one of its small group plans in Virginia. Time Insurance Co. is proposing a 64 percent hike for an individual plan in Georgia."


http://www.washingtonexaminer.com/obamacare-2016-sticker-shock/article/2565411

 

[Crockett]

Obamacare was all about getting as many people insured without causing too much disruption to the existing structures for health care delivery and reimbursement. Health Care reform is much needed. There is little price transparency. I'm sure there is a rhyme and reason to how stuff is priced, but it is not orderly. I've been billed $120 for blood tests. Then when I had insurance and a health savings plan it cost $12, even prior to exhausting my deductible, which by the way takes some doing. By contrast, services my physician billed insurance $180 for, she would do for $60 cash (out of kindness I suppose.)

I guess I "have" to have an insurance company looking out for me or the medical/industrial complex will screw me over. But I don't think the government cares and I can't find enough information to look after myself.

I have a friend who worked in a physicians office. The practice made the mistake of billing at the reimbursement rate. It cost thousands of dollars before they fixed it. If you charge a lot more than the "reimbursement" rate you get the full reimbursement. If you charge less, you get a much smaller percentage of the "full" reimbursement rate.

I'm sure there is a rhyme and reason for all the bizarre pricing and reimbursement crap that happens. Unfortunately, it seems to follow no orderly pattern. It's more like psychology than science and math. Why can't we have transparent prices we can ask and get before a procedure? Am I a conspiracy theorist to guess it's because windfalls are accruing to a politically potent class ?

Why do physician's need sophisticated computer programs to bill to get optimal reimbursement? There's a lot of wasted effort and expense in the system that doesn't have a damn thing to do with helping people be healthier.

 

[theiioftx]

True and Obamacare does nothing to improve your situation. As I have said before, it is not healthcare reform. It is insurance re-distribution.

 

[Phil Elliott]

Am I right that insurance carriers are prevented from offering more cost-effective plans because there are minimum coverages that are required by Obamacare for all plans? For example - my plan must cover birth control and drug recovery, even tho I have never needed either of those in my 54 years and would opt-out if allowed? So no such a thing as a "cafeteria" plan anymore?

 

[theiioftx]

I am fairly certain cafeteria plans are still available. ACA does require you to pay for insurance you do not need though.

 

[Seattle Husker]

Am I right that insurance carriers are prevented from offering more cost-effective plans because there are minimum coverages that are required by Obamacare for all plans? For example - my plan must cover birth control and drug recovery, even tho I have never needed either of those in my 54 years and would opt-out if allowed? So no such a thing as a "cafeteria" plan anymore?

I thought those minimum coverages applied only to the exchanges but I could be wrong. Can't we agree that a standard set of coverage should be the floor? If so, let's argue over that standard not whether one should exist.

 

[theiioftx]

Actually, no we cannot agree on a standard set of coverage. Why should anyone be forced to buy something they do not want?

 

[NJlonghorn]

Personally, I don't see any real solution to the healthcare issue. People want security when they get sick, and that means they're not going to want a true free market approach to healthcare. They're always going to want a third-party payer who will cover the bills - certainly the big bills. We could adopt a single payer system (or something similar to one), but for that to work, the government would have to actually care about holding down costs. Unfortunately, when we've given the government that kind of power, they've never shown the ability to do that or even make it a serious priority.

Yep. The crux of the problem can be seen in the uproar over "death panels". Unless you go to one extreme (government provides full coverage for every service imaginable) or the other (government provides no coverage for anything), someone has to decide what gets covered and what does not. If we can't come to grips with this grim reality, we are screwed.

We could easily afford a system where basic coverage is provided to everyone free of charge, but where expensive services are available only for those who can afford them. We draw similar lines in connection with government assistance for non-luxury food, clothing, and shelter. We need to do the same for non-luxury healthcare. Unfortunately, we can't afford to give away cutting-edge care for free, so we shouldn't do so.

Of course, nobody wants to tell some poor teenager "Sorry, you can't have that million-dollar brain surgery unless you pay cash up front." Hell, nobody even wants to say that to an elderly person who is going to die within a few years even with the surgery.

 

[Crockett]

Why should anyone be forced to buy something they do not want?

Well, with car insurance is so there is a responsible party ready to pay when the unexpected happens (unless it is something really bad, then the responsible party is responsible only up to the point they have assets worth suing for)

 

[theiioftx]

Nobody is forced to buy a car. And if someone wants to get fat, smoke and handle snakes, nobody should be forced to provide them healthcare for free.

 

[Crockett]

Yep, but if they show up at the emergency room of a public hospital with a cancerous tumor, injuries from bull riding or a gunshot, our solution is to provide care. An uninsured person with no assets is going to get treatment and somebody is going to pay for it.

 

[Seattle Husker]

Actually, no we cannot agree on a standard set of coverage. Why should anyone be forced to buy something they do not want?

We buy or contract for complex things all the time that we may or may not need. Simply, some things are too complex to not have a set of standards.

Do you think an automobile should have a minimum set of standards before being sold or should the buyer be an expert enough in automobiles to say "it must have a muffler?"

How about purchasing financial securities? Should there be a minimum standard?

Healthcare is anything but transparent as stated by Crockett above. Having a minimum set of services offered is a must due to it's complexity or the public can and does get taken advantage of. We should be arguing over the what is in that standard? For example, is birth control in or out?

 

[theiioftx]

Yep, but if they show up at the emergency room of a public hospital with a cancerous tumor, injuries from bull riding or a gunshot, our solution is to provide care. An uninsured person with no assets is going to get treatment and somebody is going to pay for it.

True, but it is a federal law. We have safety net insurance programs called Medicaid and Medicare. If someone chooses to not enroll in those programs if qualified or buy insurance if they do not, why should someone else pay for their decisions?

 

[theiioftx]

We buy or contract for complex things all the time that we may or may not need. Simply, some things are too complex to not have a set of standards.

Do you think an automobile should have a minimum set of standards before being sold or should the buyer be an expert enough in automobiles to say "it must have a muffler?"

How about purchasing financial securities? Should there be a minimum standard?

Healthcare is anything but transparent as stated by Crockett above. Having a minimum set of services offered is a must due to it's complexity or the public can and does get taken advantage of. We should be arguing over the what is in that standard? For example, is birth control in or out?

Standards are different than options. Insurance, cars and financial securities already have standards. I should not have to buy a four wheel drive SUV if I just want a compact car. And once again, HEALTHCARE is very transparent. Just ask your doctor about your treatment and he/she will tell you everything they know about it. Conversely, how it is paid for (health insurance) is not. The healthcare provider has no idea what insurance will pay them or when they will pay them. Obamacare only made that worse. And under such free programs, their is no incentive for the patient to use it wisely and this causes everyone to pay more.

 

[Crockett]

True, but it is a federal law.

In effect, people are "insured" in that they will get care if desperately needed. I don't think our right-to- lifers are going to want folks expiring in the waiting room or even get moved out of $3,000 a day ICUs to hospice care by what Sarah Palin would call a death panel. Assuming it's politically impossible to remove the safety net, what sort of fair mechanisms can we use to pay for that safety net?

 

[theiioftx]

What do "right to lifers" have to do with this?

We already have a safety net. If someone decides not to get health insurance, they are taking a risk. The risk is you do not get treated if you show up at the hospital without insurance or a cash payment.

I know their are attorneys here. What say you if we require you to accept every client that walks into your office regardless of ability to pay? Who is in?

 

[Crockett]

http://www.redstate.com/2015/12/07/texas-death-panel-fights-remove-coherent-patient-life-support/

There is pressure/legal requirement for hospitals to provide uncompensated care, and it doesn't just come from Democrats. The risk iof being uninsured sn't that you will be untreated so much as it is you might receive suboptimal treatment or be hounded into bankruptcy.

 

[Mr. Deez]

We already have a safety net. If someone decides not to get health insurance, they are taking a risk. The risk is you do not get treated if you show up at the hospital without insurance or a cash payment.

But you don't really take this risk, and this is where the personal freedom argument falls apart on the health insurance issue. If you show up at the hospital without insurance or a cash payment, the hospital is going to provide care, because of the federal Emergency Medical Treatment and Labor Act (EMTALA), which requires all hospitals that accept Medicare (which is pretty much all hospitals) to stabilize and treat all patients who show up seeking emergency care regardless of ability to pay. They aren't going to give you whatever care you want, but what they will provide is very substantial, and paying patients and/or the government will ultimately bear the costs.

For example, I had a client who fell through a hole on a construction site and had an open fracture in his leg (nasty). His employer was uninsured and insolvent, so no workers compensation. He was rushed to Brackenridge Hospital in Austin, and performed two surgeries on his leg - one to set his leg and install external hardware and another he had to return for to remove the hardware. Brack put out $100K worth of care with no expectation of ever getting paid, and they do that every day.

I know their are attorneys here. What say you if we require you to accept every client that walks into your office regardless of ability to pay? Who is in?

In matters of life and death, most of us wouldn't mind, as most hospitals and doctors are OK with providing emergency care regardless of ability to pay. Even before EMTALA was law, most hospitals and doctors weren't heartless and didn't just let people die in the waiting room or out in the street.

 

[theiioftx]

Yes federal law requires hospitals to treat or stabilize you when you show up. However, you are sadly mistaken if you think Brackenridge had no expectation of ever getting paid. They are heavily subsidized by tax payer money and these cases are exactly why taxes get increased so often.

Just curious, were you to be paid for your services? Not everyone who comes into the hospital is a life and death situation. In fact, most are not in a life and death situation.

As long as we are sharing client stories, one of my clients treated an uninsured patient who came into the ER with a snake bite. Apparently, he tried to pick up the snake after watching Animal Planet. The anti venom, other medications and other services exceeded $25,000. Luckily, they were not "heartless" and saved the patient. Three days later he re-entered the ER with another snake bite after once again trying to pick up a snake in his backyard. Why should anyone but this idiot pay for his actions?

I am all for health insurance or health care provided to those who truly cannot afford it. However, I am not for subsidizing or providing insurance to those who can afford it, but choose to spend their money elsewhere. Just don't ask me to provide free services.

 

[Mr. Deez]

Yes federal law requires hospitals to treat or stabilize you when you show up. However, you are sadly mistaken if you think Brackenridge had no expectation of ever getting paid. They are heavily subsidized by tax payer money and these cases are exactly why taxes get increased so often.

Yes, they do get taxpayer money, but they weren't going to get taxpayer money on that specific bill. Also, your taxes are getting increased in spite of cases like the one I mentioned. If the case hadn't been brought, Brack would have written off the bill. (In fact, they did write it off before I even took the case.) By bringing the case, I was able to get them paid about double what a health insurer would have paid them. It took a while, but they did quite well in the end.

Just curious, were you to be paid for your services? Not everyone who comes into the hospital is a life and death situation. In fact, most are not in a life and death situation.

Yes, I did get paid. What's your point?

As long as we are sharing client stories, one of my clients treated an uninsured patient who came into the ER with a snake bite. Apparently, he tried to pick up the snake after watching Animal Planet. The anti venom, other medications and other services exceeded $25,000. Luckily, they were not "heartless" and saved the patient. Three days later he re-entered the ER with another snake bite after once again trying to pick up a snake in his backyard. Why should anyone but this idiot pay for his actions?

He should have to pay, but two things complicate the situation. First, you can't suck blood out of a turnip. If he doesn't have the money, then there's little you can do to force him to pay. You can sue him and force him into bankruptcy court, but most creditors aren't willing to go to that degree of trouble and expense to ultimately collect pennies on the dollar. Second, our society has decided that it's not going to let people die because of lack of resources if we can avoid it, even if the person is dying due to stupid conduct. Hell, we try to save people who intentionally try to kill themselves.

Those two facts force us into a position in which doctors are going to treat first and ask questions later. However, there are things that could be done to give the hospitals a chance to get at least some money back. For example, we could allow hospitals to collect against the patient's tax refund or some forms of public assistance.

 

[theiioftx]

My point is that lots of people outside of healthcare think it is perfectly fine for patients to get free healthcare. However, few seem to want their industry providing large quantities of uncompensated services. Also, people are quick to throw out how expensive a Tylenol is without regard to the fact they are largely paying for someone else's Tylenol as well.

County hospitals are constantly lobbying for new revenue from taxpayers due to uncompensated care. Smaller county hospitals across the country are closing their doors due to uncompensated care and reimbursement from Medicare and Medicaid which do not cover their costs. I am glad you were able to recover for everyone and got paid as well. Our revenue rates for legal cases are much higher than that received from Medicare and Medicaid or even third party insurance.

And your final point is correct. However, if people like the Crocodile Hunter above are not held accountable, the healthcare system will continue to collapse financially. Don't even get me started on new drug development or medical devices if the government removes or limits the return on investment.

 

[Crockett]

As long as we are sharing client stories, one of my clients treated an uninsured patient who came into the ER with a snake bite. Apparently, he tried to pick up the snake after watching Animal Planet. The anti venom, other medications and other services exceeded $25,000. Luckily, they were not "heartless" and saved the patient. Three days later he re-entered the ER with another snake bite after once again trying to pick up a snake in his backyard. Why should anyone but this idiot pay for his actions?

I feel your pain theii. Hell, at least your client and the ER should get the story rights.