^haha. But but......

11/29/2011 9:49:17 PM

I just caught this from Lumex,

Quote :

"They do it because they want to save lives. No one becomes a surgeon because their first priority is making money. "

I guess you also believe Bret Farve just did it for the love of the game, too...

Regardless, I don't really see how you don't think making transactions between a doctor and patient would force prices down. You do realize there are entire offices at hospitals that are employed to do nothing but run insurance claims, right? That's one of the reason so many hospitals enter into these "networks" with other hospitals: so they can consolidate their overhead which is largely (a) legal offices (and that gets into the a whole different facet of medical inflation) and (b) insurance/accounts offices. I don't see how you don't think the elimination of all that overhead in addition to patients being more cognicent of the price of their care wouldn't drive prices down.

FYI, If I need a root canal at my dentist and can't pay, they offer their own internal payment schedules where I can straighten up my debts. Why couldn't I do the same thing at Duke Medical if I needed a bypass?

[Edited on November 30, 2011 at 8:27 AM. Reason : .]

11/30/2011 8:20:42 AM

Quote :

"They do it because they want to save lives. No one becomes a surgeon because their first priority is making money."

Then when their patients demand to pay less because it is their money and patients are greedy, the doctors will accept it.

But I refuse to accept that surgeons are not greedy.

11/30/2011 10:38:39 AM

Quote :

"Regardless, I don't really see how you don't think making transactions between a doctor and patient would force prices down. You do realize there are entire offices at hospitals that are employed to do nothing but run insurance claims, right"

I never said that. Of course overhead will come down, and I think that cost savings will be transmitted to customers, especially in the realm of basic care.

That said, getting rid of insurance is not going to get rid of accounts payable and accounts receivable departments in a hospital. It's also not going to have a significant effect on the price of high-level procedures like transplants and invasive surgery. Insurance overhead accounts for only a small portion of those costs. They're not going to come down enough to where the average person can save enough money to get a lung if they need one. Even if the lung is donated, and the doctor does the procedure for free, the cost of hospital operations and consummables alone is still incredibly high.

My entire point is that having people save their own money for medical expenses is going to make high-level care unaffordable for most Americans, even if you take out the cost of insurance overhead, medicaid, social security, etc. I'm not an advocate of insurance, I think it IS wasteful. I just think the alternative that is being presented here is poorly thought out, and I've seen no hard data to support the assumptions you guys are making.

Quote :

"Then when their patients demand to pay less because it is their money and patients are greedy, the doctors will accept it. But I refuse to accept that surgeons are not greedy."

What about the actual things that surgeons put into you? Do those somehow become cheaper when people talk directly to their surgeons? Do you have any idea how the cost of high-level medicine breaks down?

[Edited on November 30, 2011 at 12:00 PM. Reason : .]

11/30/2011 11:58:58 AM

Quote :

"Neither are hunger expenses. Should we have a single payer food distribution program administered by the state? If not, why not?"

You can grow your own food, and you have complete freedom to choose what to eat. There is already a state-administered program to provide free food to those who can't afford it, as well as many private ones.

Can you do your own diagnosis? Can you do your own surgery? Can you choose which organs need to be replaced? How many community churches offer a free coronary-bypass and hospital stay every holiday season?

11/30/2011 12:07:32 PM

Quote :

"My entire point is that having people save their own money for medical expenses is going to make high-level care unaffordable for most Americans, even if you take out the cost of insurance overhead, medicaid, social security, etc. "

And you are basing this off what data? I can tell you that I'm basing my assumption that healthcare will become more affordable based on what happens when anyone attempts to visit the doctor and pay cash: significantly lower costs. As was already pointed out, is lasik surgery cheaper because it's less involved, or because most people pay for lasik out of pocket, eliminating the need for unneeded costs? You are assuming that the efficiencies gained from eliminating insurance would not significantly decrease costs.

Here is just one link: <http://www.jacksoncoker.com/newsletter/Long_10282008.aspx>
One highlight: 24% of every healthcare cost goes to the insurance companies' overhead. That's just their overhead, not their profits or operating expenses. That means at least 24% of your bill would disappear without using insurance or with using some form of insurance that was more computerized/automated. What's funny is that this article is a guy advocating a single-payer government "trust" for healthcare. I don't agree with what he's advocating, but his statistics are correct.

By the time you eliminate not just the overhead, but the entire insurance company's role, allow people to shop around for better prices (encouraging free market competition between medical providers), and introduce a patient-pays-the-way system where patients may be more apt to practice preventative medicine (taking better care of yourself, getting year check-ups rather than waiting for something serious to occur, etc), it's pretty easy to see how something like this could work, even for that person who needs that costly heart operation. Don't forget that people can still work out payment plans if the bill is more than their savings.

So... I'd be interested to see what data you have to support your claim that healthcare costs would still be more than a consumer could bear if you eliminated insurance companies.

11/30/2011 12:43:39 PM

Quote :

"You can grow your own food, and you have complete freedom to choose what to eat. "

You can also choose to study medicine. Knock yourself out and then work for free for all I care.

11/30/2011 1:12:11 PM

Quote :

"You can grow your own food, and you have complete freedom to choose what to eat. There is already a state-administered program to provide free food to those who can't afford it, as well as many private ones."

Can I grow my own food? I don't know the first thing about horticulture. It would take months to successfully grow crops, and I have no idea if they would fail or not. Obviously, that won't help me in the short-term, since I need food soon to live in the coming weeks.

Why isn't there a state-administered program to provide free food to everyone? The whole premise of single payer is that, by having everyone pay into the system and pool resources, it makes it cheaper/better for everyone. Why is this model only applicable to one type of service?

Quote :

"Can you do your own diagnosis? Can you do your own surgery? Can you choose which organs need to be replaced? How many community churches offer a free coronary-bypass and hospital stay every holiday season?"

I already hit on this, but I don't know how to grow my own food either. Should we have a system where a 110 year old smoker is put through chemo and kept on life support indefinitely? How can the state effectively provision health care?

There should not be long waits in the emergency room. There is no other area, other than medical care (where government intervention has been heavy handed for many, many years), where there are shortages of service like this. It's truly absurd. We have to allow the market to work, which means repealing a shit ton of laws.

[Edited on November 30, 2011 at 1:18 PM. Reason : ]

11/30/2011 1:13:15 PM

Just because there are programs to give food to the poor (just like free medical care) doesnt mean that we magically have free food and health care. THe people providing those services get paid.

The reason that healthcare costs (and education) are rising so fast is that when the individual is paying little to nothing for the goods or services they consume they will consume more thus rising the costs to whoever is paying the bill. Ever wonder why medicaid is the fastest growing and biggest exp in most states (soon to be all)?

(an aside, it is sad how a program that is meant to provide basic needs to the poor now provides for such luxuries that people who actually pay taxes towards those programs AND buy their own insurances dont cover. Braces, Viagra, Contacts, etc etc.) How that shit grows and spreads.

11/30/2011 1:27:31 PM

Quote :

"And you are basing this off what data? I can tell you that I'm basing my assumption that healthcare will become more affordable based on what happens when anyone attempts to visit the doctor and pay cash: significantly lower costs. As was already pointed out, is lasik surgery cheaper because it's less involved, or because most people pay for lasik out of pocket, eliminating the need for unneeded costs? You are assuming that the efficiencies gained from eliminating insurance would not significantly decrease costs."

Lets be clear. You are advocating the removal of medical insurance, and FSAs for everyone. I am saying that under that scenario, there will still be expensive procedures that the vast majority of people cannot afford; expensive procedures that are quite common, like a coronary bypass. Why do I say this? Because your assertion lacks evidence and because I've seen the balance sheets of many medical procedures.

You have not provided anything to indicate the cost of something like a coronary bypass would drop enough for average people to afford it out-of-pocket.

Also, I don't see where your link states that 24% of every healthcare cost goes to the insurance company's overhead. Even if I accepted that, a 24% drop in health-care cost would not be nearly enough to make high-level procedures affordable. Even if I accepted all your other reasoning without actual evidence, I don't think it would be enough. Whats your best-case scenario? If it's a 80% drop, then I can get behind it. Keep in mind, here are some of the common procedures I am referring to:

Organ transplants: $250-1,000K
Open heart surgery/pacemaker: $180-300k
Invasive abdominal surgery (e.g. bowel resection, colostomy): $110-180k
In-patient psychiatric care: $12-20k/week
These include post-op care and medication, but not diagnostics (e.g. ultrasounds, radiology, biopsies)

[Edited on November 30, 2011 at 4:03 PM. Reason : .]

11/30/2011 4:00:00 PM

^I think you really need to read up on what a HSA is and does. People would still get those expensive procedures and they wouldnt have to pay the full amount, that isnt what a HSA is at all.

http://en.wikipedia.org/wiki/Health_savings_account

11/30/2011 5:32:54 PM

Quote :

"There is already a state-administered program to provide free food to those who can't afford it, as well as many private ones."

And there is also a state-administered program to provide free healthcare to those who can't afford it, as well as many private ones.

11/30/2011 5:54:23 PM

^^Thanks. BTW, I keep saying FSA... an FSA is the federal employee equivalent to an HSA. Same thing, different name.

Another thing: for those with employment and health insurance benefits, if your company no longer has to pay that extra couple hundred dollars a month for your health benefits, there is always contribution matching. Many employers already offer such a service for retirement saving (i.e., you put in $1, and we'll put in $1). Right now my health insurance is something like $600-ish/month for my wife and I (employer pays for a portion of that). They also match my retirement contributions up to a certain percentage. Whats to say if we using nothing but HSAs that your employer couldn't match your contributions in lieu of paying for a portion of an insurance premium?

I still can't get over the benefit of (a) not being limited to a "network" and (b) being able to shop around for doctors who are competing for patients and therefore competitively pricing their services. I'm not sure there is an accurate way to predict what those cost savings would be, but when cost becomes a factor, efficiencies are always introduced that drive costs down.

12/1/2011 10:49:57 AM

^sadly the notion as creeped into our culture that if you need something someone should give it to you. The idea that you contribute/pay for the goods/services you NEED has become so foreign to many.

HSAs will put the individual back in charge of their habits, while giving them high deductible insurance. Businesses will have to focus on competition and will also save a ton bc most people will now be paying cash for your services.

I have been seeing patients for about 9 years now. I have never ONCE had someone show up for an office visit for dry eyes that was paying cash. Of course not. These people at least try a 5 dollar bottle of artificial tears before paying a doctor. I get several a week on medicaid/medicare though who dont even try a OTC drop first. Im not blaming them, it is just human nature. Same thing with people after they meet their deductible.. "Ive met my deductilbe for the year, so I want to get everything I can done since I dont have to pay for it."

12/1/2011 11:11:28 AM

$600 a month? Damn!

I pay $60.

However, I rarely ever get sick.

12/1/2011 11:15:36 AM

MattJMM2, trust me, I don't pay that much, but that's the total premium. I end up shelling out around $225/mo but that covers everything under the sun (almost covered everything I needed during an ER visit). The problem is that the health insurance packages I had to choose from were either for individual (which were more like what you're talking about) or family. I needed to cover my wife and I so.... here I am. Can't wait till she gets a job with benefits.

12/1/2011 11:31:34 AM

That's understandable. And my package is pretty barebones, really only for catastrophic injury or disease.

And, since I am self employed I am a stingy mofo.

[Edited on December 1, 2011 at 11:33 AM. Reason : stingy]

12/1/2011 11:33:32 AM

In most circumstances, the employer pays way, way more than the employee. Where I work, it's a 90/10 split. That could be money in my pocket.

It's obvious that we need to divorce health insurance from employment. I have no idea why people are still pushing to keep this model in place. It's definitely driving up prices. One, because people don't shop around for insurance and/or doctors. Two, because it's a flat premium for all group members, which makes no sense. I should not be paying the same premium as some old guy that has been smoking his entire life.

12/1/2011 1:56:01 PM

I guess different employers do it different. We have a dozen or so packages from different companies to chose from so there is some ability to shop around. You can also opt out of the employer insurance and just buy your own.

I'm not against employers offering some sort of health incentive, but in a "we'll match what you put into a saving account" model, it encourages much better fiscal responsibility.

12/1/2011 1:58:39 PM

Quote :

"I should not be paying the same premium as some old guy that has been smoking his entire life. "

OH but you have to. To have him pay more because he is more risky (despite the fact that is EXACTLY how insurance works) is premium DISCRIMINATION. (per democrats in the obamacare debates) Unreal.

12/1/2011 1:58:41 PM

cooperatives are the way to go.

I thoroughly support free market capitalism, but with the cards stacked so heavily in favor of insurance companies, as long as they are so dominant with their current for profit model, you could change almost any other aspect of the system and things wouldn't really change all that much.

they are smarter than the lawmakers, enact a law, and they're gonna adjust accordingly somewhere else...Rinse and repeat.

12/1/2011 2:30:49 PM

Quote :

"I thoroughly support free market capitalism, but with the cards stacked so heavily in favor of insurance companies, as long as they are so dominant with their current for profit model, you could change almost any other aspect of the system and things wouldn't really change all that much."

Not true. Change the tax code, and don't allow employers to provide health insurance to their employees on a tax-free basis. Allow individuals to purchase private plans on a tax-free basis. We'd see a big shift in the way that consumers are getting insurance and health care.

12/1/2011 2:39:00 PM

then there'd have to be gov mandated guiedlines on what premiums you could charge who etc, etc.

not to mention that would entrench large ins companies even more since they'd still be able to offer the lowest premiums and most options in most cases.

Just moving the shells around.

Tax code needs to be changed to promote not for profit insurance companies/cooperatives.

12/1/2011 2:51:45 PM

Quote :

"then there'd have to be gov mandated guiedlines on what premiums you could charge who etc, etc."

Why?

Quote :

"not to mention that would entrench large ins companies even more since they'd still be able to offer the lowest premiums and most options in most cases."

Not necessarily. Insurance isn't like a normal good or service. Their expenses depend on how well they calculate risk. It's possible that a smaller start up could actually calculate risk better, but with a lot less overhead.

Quote :

"Tax code needs to be changed to promote not for profit insurance companies/cooperatives."

Why in the world would you start an insurance company to lose money?

Our problem is that insurance has been made necessary for everything, including something as simple as a physical. A lot of these services should just be paid for with cash. If the majority of people actually had to shop around, there's no doubt that they'd often opt for catastrophic insurance plans. With this complex in place where employers provide health care, most people don't shop around, and that's a huge problem if you want to see lower (rather than increasingly higher) prices.

12/1/2011 2:59:31 PM

Quote :

""Tax code needs to be changed to promote not for profit insurance companies/cooperatives.""

actually the profit margins for health insurance companies are pretty low. And some of the biggest insurance companies are in fact not for profit. I believe BC/BS of NC is one.

Until you allow hospitals to turn away people that dont have true emergencies then the problem will always exist. Why pay for something you can get for free?

12/1/2011 3:21:52 PM

Quote :

"It's obvious that we need to divorce health insurance from employment. I have no idea why people are still pushing to keep this model in place."

Tax avoidance purposes. Employers would stop offering employees healthcare once the tax loophole is closed and the IRS forces employers to estimate and report all non-salary benefits as individual taxable income.

12/1/2011 3:28:57 PM

Quote :

"^I think you really need to read up on what a HSA is and does. People would still get those expensive procedures and they wouldnt have to pay the full amount, that isnt what a HSA is at all. ...HSAs will put the individual back in charge of their habits, while giving them high deductible insurance. "

Apparently you're the one who doesn't know what a HSA is, even though you cited wikipedia. A HSA is something you can have in addition to your high deductible insurance plan. There is no compensation beyond what you put into the account, if you just have the HSA and no insurance.

We were talking about a scenario where there is no insurance.

12/1/2011 7:04:40 PM

If you were to shop for a HSA it INCLUDES a high deductible insurance plan. In fact you HAVE to have it in order to have a HSA. (tax advantage). You save because it is a higher deductible so you are basically using your own money, tax free, for your routine care while covered against the big stuff by your insurance plan. I believe you were talking about 90k dollar procedures correct? If that is the case in person would be responsible for the deductible...which is usually between 3-10k.

The benefit is that you build up your HSA, with tax free money, in years when you are healthy to use in years when you arent.

As someone else mentioned, bc of the cheaper RATE that some employers are paying they are even passing on some of that and MATCHING the employees contributions.

I prefer a true HSA that carries over year to year vs a flex account that must be spent by the end of the year.. THose encourage waste. imo

http://www.health--savings--accounts.com/

Price out a plan and compare for yourself.

Also try www. ehealthinsurance.com

[Edited on December 1, 2011 at 7:35 PM. Reason : .]

12/1/2011 7:33:20 PM

Are you reading my posts?

We were talking about a scenario where there is no insurance

12/1/2011 11:19:50 PM

and a HSA is a low cost way to be covered for the big stuff.

Want to have real health care reform that works? Allow hospitals to turn away non emergent care or dont let medical debt be bankruptable. People will buy insurance then. Until then a lot of people have the attitude why pay for insurance when I can get medical care for free at the hospital.

12/1/2011 11:34:21 PM

How does a HSA cover the big stuff when there's no insurance?

12/2/2011 3:17:11 AM

^

Try to follow my math for a second. [WARNING: Words. But it's completely worth it. This HSA/FSA thing makes so much sense, it's stupid.]

CHEAPER FOR ME OUT OF POCKET AND CHEAPER FOR MY EMPLOYER
I currently pay a premium of $150 biweekly for my three health insurance policies (health - dental - vision). My employer matches $400 biweekly. During the course of a year, that would mean that my premiums total $3900 and my employer's premiums total $10400.

After working for one year, I had to go to the ER for a back injury. The doctor saw me and I had to receive medicine there in the ER. The flat-rate cost was somewhere around $3000 for just the visit and getting a fucking pill (there wasn't anyone else in the ER, so it's not like I was adding to the workload either). Lets assume that prices would not drop one bit if you eliminated health insurance. Under this scenario, if I deposited my premium into an HSA or FSA, I would have $900 left over for that first year which more than covered the flat-rate costs of dental visits for myself and my wife and "her other appointment" as well as prescriptions.

So while as with my current health insurance company, I have needed to pay $25 co-pays for my wife and I to get two dental check-ups a year ($100 total) and something like $200/year in contacts (as well as my $70 hospital bill and $400 ER physician bill), I could have paid nothing in an HSA/FSA only system assuming that the cost of care remained the same and I had a lower employer contribution to my HSA/FSA than they current contribute to my insurance premium.

YOUR $200K OPERATION COULD BE COMPLETELY COVERED BY AN HSA/FSA... WHAT HEALTH INSURANCE COMPANY DOES THAT?
Let's say you're still not convinced and still looking at that $200K operation down the road. In that case, consider my TSP (retirement). I deposit $130 and my employer matches $105 on a biweekly basis into my account that is netting around or better than 4% each year. If you assume that my employer follows a similar model and matches my $150 biweekly deposit into an HSA or FSA, my $3900/year turns into $6630. Keep in mind that this is actually saving my employer money because he wouldn't need to invest a $400 biweekly premium. Suddenly my ER visit leaves me with $3630 left for the year. We're also assuming the money is just sitting around and not accruing interest like any other savings account.

So, for your example of the heart surgery, let's assuming I have $3630 in my account every year and at the age of 45 I need a bypass (apparently at the age of 45 I've become morbidly obese). From the age of 23 to the age of 45, that means you would have accrued a little less than $130K for your $200K operation leaving you with $70K to work out with the hospital via payment plan or whatever has to be done.



Assuming you're still reading this, Lumex and are still not convinced that this system is better than the current one, I want you to note what assumptions were made:
1) I would theoretically deposit $6630/year with my $150 biweekly contribution and my employer's $105 matching, but I am assuming that I will incur at least $3000 of medical expenses every year. I would suggest that between two dentist check-ups for my wife and I, our yearly optometrist visits, and her girly-appointment, we won't be using even close to $3000 until we start thinking about having kids. I don't think it's unreasonable to say that this number is high meaning I would put in much more than $3630/year into my HSA or FSA. Between other major medical expenses, $3000/year might actually be reasonable, but it's certainly not low.

2) I'm assuming my contributions will never increase. Right now, I'm earning about 70% of what I think I am almost certain to be netting in several years, and currently I'm paid below industry average. Increase that $3630 by 30% and that $70K gap shrinks to closer to $45K.

3) We're assuming a 4% interest rate. That's if you are playing it safe (i.e., sticking more to investing your HSA/FSA in note and bonds). The long-term average for larger indexed funds is better than 4%.

4) The biggest assumption is that healthcare rates will not drop at all. From my previous source (I noticed the link is not working, but I can dig it up again if it's really that big of a deal for you), rates would drop 24% if you eliminate the insurance company's overhead. That brings $200K down to $152000. If you look at the results of assumption 2 and put it together with this one, it's possible that your ENTIRE $200K operation could be paid-in-full by your FSA/HSA savings if there was no insurance company.

So, [user]Lumax[/user], I'm going to make one more assumption and assume you read that whole thing. If you did, hopefully you see how an HSA/FSA ONLY system could actually be better than the existing construct. I wonder what insurance policy would pay off a $200K operation in full...

(PS: There was another assumption in there, too, that further proved my point, but I have too many other things on my mind at the moment... it'll come to me later.)

This 'Fuck You' was presented by NCStatePride and I approve of this message.

12/2/2011 9:41:16 AM

Right, but there is really no need for that. If you ever need to big operation, just put your assets in your wife's name and get medicaid.

12/2/2011 10:19:31 AM

So at age 24, your putting away $150 bi-weekly?

If you're the average 24 year old worker, that's going to be roughly half your income.

12/2/2011 12:06:30 PM

If I'm the average aerospace engineer with a couple year's experience, that's very little of my income.

Poverty for the US is considered under $22K (plus some change), so just for shits and giggles lets say that they get to take home (after taxes, etc) $16K. That gives someone just at poverty line $615 every two weeks. Assuming that welfare programs still exist that compensate for food and housing (which is a whole different argument), that makes $100 biweekly 16% of their income. 16% of your income to look after your health doesn't seem unreasonable for me.

And before you say "you just don't understand what that's like", understand that (a) I didn't have mommy and daddy giving me money in college so I DID live like that and (b) I work with people in my local community every Tuesday in particularly this situation who can't afford insurance due to the prices and they effectively do a form of "health savings". Hell, some of them pay for their own medical care AND still find a way to tithe for their churches (10%).

That's just assuming poverty line, which is 15.1% of our population. Those individuals are covered by other welfare programs that I'm not interested in discussing at this time. For the other 84.1% of us, it should be easier.

------------------------

BTW, if you're 24 and $150 is roughly half of your income ($150*26 biweekly pay periods*2=annual income), then you have bigger economic/aspiration goals that what insurance plan is best for you. I'm curious what percentage of your claimed "average 24 year olds" are still living with their parents.

[Edited on December 2, 2011 at 12:27 PM. Reason : BTW...]

12/2/2011 12:17:31 PM

Actually I was wrong about that percentage, because I said "worker". I really don't know the average wage is for a 24 year old, excluding the unemployed and full-time students.

In any case, your scenario still seems incredibly rosy. We do know the average american worker earns roughly $41,000. If we assume 40 years of employment and a constant annual wage increase, then the average person should reach $41,000 around age 40-45. Can you show me how the average worker will save enough over 20 years to get a coronary bypass?

BTW, a FSA and HSA are not the same thing. FSAs do not typically get bi-weekly employer contributions, or earn interest. You can make this about a HSA if you want, but I wanted to point that out.

12/2/2011 12:47:01 PM

Quote :

"BTW, a FSA and HSA are not the same thing. FSAs do not typically get bi-weekly employer contributions, or earn interest. You can make this about a HSA if you want, but I wanted to point that out."

(After this response, I sincerely feel that you simply have no idea what any of this is about and that is actually why you can't get your mind around what's going on. The "employer" for an FSA is the US government, dipshit. An FSA is to HSA as TSP is to 401K. Besides...)

You still don't get the hypothetical scenario here, and I'm not exactly sure how to dumb it down any more than we already have. The idea is that pretend, hypothetically, that *poof*, there is no more insurance company. They all disappeared. Period. Now people are relying on their own savings to pay out of pocket. They instead start relying on the construct of an HSA or an FSA which both allow you to save your own money out of your paycheck for later medical expenses.

The fucking thing you keep missing is that I'm trying to give you multiple scenarios to prove that any way you look at it, it's a good system. The first scenario is that my employer gives me no matching. So in other words, I'm already changing the modern application of an HSA or FSA. Stop thinking it's the same thing because we just deleted the whole fucking insurance industry. The second scenario is where I deposit money into my HSA or FSA and my employer deposits money in. Again, it's a hypothetical so the traditional purpose of an HSA or FSA isn't even a part of the discussion... it's just a vehicle for saying "some account that saves money for medical expenses". I could call it a fucking banana and the point would be the same. The third scenario is where I deposit money into my account, my employer matches it, and I accrue some amount of interest. That's how you get the plot I gave you.

You didn't specifically ask it, but your response indicates you either chose not to read it or you don't understand simple fucking math. If you are poverty line in the US, you can still afford to put in $150 into a medical account. That's poverty line which is half of the +$40K amount you mentioned in your last post. If I proved to you in my last post that $150 biweekly is possible for someone poverty line, I want you to put your big boy shoes on and your thinking cap to determine what my response is going to be to you about someone backing above poverty line.

Christ, it's like talking to a 4 year old. I mean, I hate to just resort to being a dick but damnit, I explain how it's feasible for someone poverty line to invest in it and explain in painful detail the math of how it works out. How fucking simple do you need it to be?

12/2/2011 1:18:38 PM

You know, just to show I'm not a complete asshole and that I actually am trying to dumb this down to a level that you're understanding it. I'll answer your hypothetical. Bear in mind that I already fucking explained that someone poverty line can save $150 every two weeks, yet you're still confused how someone making twice that much can have enough money for major medical expenses.

Quote :

"If we assume 40 years of employment and a constant annual wage increase, then the average person should reach $41,000 around age 40-45. Can you show me how the average worker will save enough over 20 years to get a coronary bypass? "

Over the last 2-3 years, my medical expenses have been closer to $1K, and that's with the ER bill in there. I'll go ahead and assume that your average American is going to the ER every 2-3 years just to give you the benefit of the doubt. At $150 every two weeks for 26 weeks a year, that comes out to $3900. The number I got for my 2-3 year medical expenses was actually closer to $1125 (and keep in mind that's for two adults), so that leaves this average person with $2775 to be left in their HSA or FSA.



Leaves you with $120K-ish. From there, look back at my assumptions section a few posts back and you'll see that leaves the outstanding debt to $30K which, similar to how many dentists and optometrists work today, you can work out via loan or payment plan. Note that this number doesn't require any kind of employer contribution... it's a straight $150 from the patient every two weeks.

EDIT: The reason this number is so close to the last number is because in my last brief analysis I tried to assume out of the problem as many things that would make the picture rosey as possible. That's one reason why when you said my last scenario seemed rosey I couldn't take it seriously.

[Edited on December 2, 2011 at 1:35 PM. Reason : .]

12/2/2011 1:32:16 PM

Do you have any kind of chronic conditions? Diabetes, asthma, any kind of medications or prescriptions? This model works fine for a mostly-healthy person who doesn't suffer anything that requires more than a a doctor's visit or possibly a stay in the ER. Pretty much any health plan works well for somebody like that.

[Edited on December 2, 2011 at 3:38 PM. Reason : .]

12/2/2011 3:37:03 PM

Quote :

"Bear in mind that I already fucking explained that someone poverty line can save $150 every two weeks."

Here is where our communication is disconnected. I completely disagree that someone at the poverty level can afford to put 20% or more of their income away in addition to their current living expenses. I don't think that's a reasonable expectation of anyone up to the mean income. Isn't the point of this to reduce the cost of medicine?

Also, there are no savings accounts that exist that offer guaranteed 4% annual return. If this is a completely hypothetical savings account, then OK. Where does it come from, the government?

I completely understand your scenario. Its your assumptions I disagree with. Chill out.

12/2/2011 7:32:45 PM

No y'see back in the day the doctor would amputate a gangrenous finger for only 6 cents + alcohol costs if you didn't BYOB. There's no reason we can't use the same model today for MRI's and chemo, just gotta restore that patient-doctor relationship!

12/5/2011 4:01:32 PM

Quote :

"The "employer" for an FSA is the US government, dipshit. An FSA is to HSA as TSP is to 401K. Besides..."

This is not entirely correct. FSAs are available to many people working in the corporate world.



Just to clear up a few things:

FSAs and HSAs are not interchangeable although they do operate in similar ways. However, they are best used for different expenses.


A Flexible Spending Account allows employees to put pre-tax dollars aside for medical care, and they are generally on a 'normal' health insurance plan. I actually don't know if FSAs are available for someone on a high-deductible plan. BIG DISADVANTAGE: Any money left in the Flex Spending Account at the end of the plan year is forfeited. Therefore if you overestimate how much you are going to spend on medical care in a particular year by $XYZ, you suddenly either lose $XYZ at the end of the year, or you go on a spending-spree to buy a bunch of medical crap so you don't lose your money and you can at least show something for it. FSAs are generally very helpful for people who have known, fixed medical costs on a regular basis so they can pay for these costs with pre-tax dollars and lower their yearly income tax basis.

A Health Savings Account is a tax-advantaged account specifically for qualified medical expenses as defined in IRS Publication 969, and only available for people enrolled in a High-Deductible Health Plan (being defined as $1,200 deductible for single, $2,400 for family, and no more than $5,950 out of pocket for single and $11,900 out of pocket for family). You can contribute money pre-tax, and frequently, employers will contribute or match your contributions (again, pre-tax). There is a yearly maximum contribution limit. Contributions from your paycheck lower your annual tax basis. However, money in this account rolls over each year and you can earn interest on it. In some instances, this money can actually be invested and can grow tax-free within certain restrictions. Note: using money in an HSA for things that are not qualified medical expenses involves a tax hit of 20% on the cost of the item purchased, so save your receipts.

Also, if you switch from a high-deductible health plan back to a 'normal' health plan, you still have access to the money in your HSA and it still operates in the same way as before (only qualified medical expenses) but you are not allowed to contribute anything to it.

One potential disadvantage of HSAs are the companies who administrate them (usually banks). When my previous employer was looking for someone to hold their HSAs, all the banks they looked at either had card-swipe fees or access fees or monthly account maintenance fees. I nudged them towards Coastal Federal Credit Union -- their HSA earned 2% at the time and did not have any type of fees.

[Edited on December 5, 2011 at 6:25 PM. Reason : ]

12/5/2011 6:22:52 PM

^^ Is it really so hard to understand that middle men always increase the costs? Sometimes that increased cost is worth it, other times it isn't. For most routine medical care, it isn't. Would a service plan from the car dealer that covered your routine oil changes save you money? Why would health insurance that covers routine care be any different?

12/5/2011 7:00:13 PM

in reference to first post. here's everything though. just to put it all in perspective.

12/5/2011 7:36:41 PM

Quote :

"Is it really so hard to understand that middle men always increase the costs? Sometimes that increased cost is worth it, other times it isn't. "

Cheaper/Saving Money does not equally affordable. It doesn't matter if you share a bunk bed with your doctor, even a minor chemo regimen will drain the pockets of any working stiff, no matter how long they've saved.

Yes, in the old days you didn't need insurance because just about all medical treatment could be administered from a toolbox and a bottle. In the old days the average lifespan was also around 30-40.

However, today, the implements of medicine are more costly, so folks enter insurance groups. That doesn't mean a middle man is necessary, there are alternatives to middle men. Single payer, universal healthcare is one option, another might be non-profit health insurance co-ops. And of course there's always private charity (bahaha).

Quote :

"For most routine medical care, it isn't. Would a service plan from the car dealer that covered your routine oil changes save you money? Why would health insurance that covers routine care be any different?"

This is certainly correct, and a great argument for universal healthcare. When some jackass with no insurance goes into the emergency room for a preventable illness, every person with insurance pays for it when the hospital recoups losses. Just like a car, it's cheaper to get the regular checkups than to wait and pay up once it breaks down on the highway.

[Edited on December 6, 2011 at 1:53 PM. Reason : .]

12/6/2011 1:49:45 PM

Quote :

"This is certainly correct, and a great argument for universal healthcare."

This is a great argument for HSAs. If everyone were on universal healthcare, hospitals and ERs would be even more clogged than they are now because everyone who doesn't pay would be in there every day for each little bump and scrape.

For the HSA program I was on earlier this year -- preventative care was 100% covered (I'm guessing insurance companies think is cheaper to find things when they're small problems before they turn into big problems). My deductible (and out of pocket maximum) was $2,500 per year, so anything other than preventative care was 100% covered by me unless it was something catastrophic...which is what insurance is supposed to be.

One of the (many) reasons that healthcare is so expensive these days is the attitude that "insurance will pay for it", so it doesn't matter how much the procedure or visit "actually costs"...consumers only care about the co-pay and deductible.

[Edited on December 6, 2011 at 3:50 PM. Reason : ]

12/6/2011 3:50:01 PM

Quote :

"even a minor chemo regimen will drain the pockets of any working stiff, no matter how long they've saved."

And yet I could get it for my dog for $2,000

http://www.cbsnews.com/stories/2007/01/24/earlyshow/contributors/debbyeturner/main2393732.shtml

Of course, humans will need more of the drug, so there are some increases to the cost, but why should the difference be so much? And why can't I get a quote for the treatment from a hospital, but I can get a quote from my vet?

Quote :

"This is certainly correct, and a great argument for universal healthcare. When some jackass with no insurance goes into the emergency room for a preventable illness, every person with insurance pays for it when the hospital recoups losses. "

Question: If something is free, will you use more of it or less of it?
Question: If you don't have to pay for your poor choices (such as lack of general hygine) are you likely to change your choices?

12/6/2011 4:01:40 PM

Quote :

"If everyone were on universal healthcare, hospitals and ERs would be even more clogged than they are now because everyone who doesn't pay would be in there every day for each little bump and scrape."

Treating bumps and scrapes is a lot more cost-effective than treating the infections that come a week later from not treating them. I have healthcare through my employer, and my copays are less than $20 for just about anything, but don't go to the hospital for every bump and scrape. Hmm perhaps your analysis is a little oversimplified.

Quote :

"Question: If something is free, will you use more of it or less of it?"

Depends. If cancer screenings are free, I'll use more of them. As a result, I'll likely use fewer Chemo treatments in the future when I can nip it in the bud instead of having it in 3 organs at once.

Maybe the car analogy makes more sense. What do you think costs more overall, giving people free service tune-ups, or free repairs when their car breaks down or is totaled? Remember: in this analogy the "emergency room" of mechanic shops are free, and they recoup the losses by shifting the cost to paying customers.

Quote :

"Question: If you don't have to pay for your poor choices (such as lack of general hygine) are you likely to change your choices?"

Just because a dentist will drill out a cavity doesn't mean I'm going to gleefully invite the pain that goes along with the cavity, the procedure, and the recovery.

Jesus Christ you people act like there's no inherent benefits to having good health, as though people are going to go out and break their legs just to get free casts.

[Edited on December 7, 2011 at 10:40 AM. Reason : .]

12/7/2011 10:38:32 AM

What's that, little Jimmy? You want to go pay in traffic? Yeah go ahead, we have universal healthcare so whatever happens we'll just get you patched up. Make sure to play extra dangerously so we can score as much treatment for your injuries as possible!

12/7/2011 10:41:17 AM

Quote :

"Treating bumps and scrapes is a lot more cost-effective than treating the infections that come a week later from not treating them. I have healthcare through my employer, and my copays are less than $20 for just about anything, but don't go to the hospital for every bump and scrape. Hmm perhaps your analysis is a little oversimplified."

That's because you don't appear to be part of the Entitlement Class / Free Shit Army. Medicaid patients are clogging ERs and hospitals for all kinds of free treatment. Why? Because it's free, and they don't have anything better to do.

12/7/2011 10:43:26 AM