Just been dealing with the pharmacy and our health insurance

[xiphias]

Can anyone give me an example of ANY problem that we'd have with socialized medicine that we don't have right now with our current health care system?

I mean, if I'm going to have to go through byzantine, bizzare, arbitrary bureaucracy and have to bang my head against walls and argue with people to have simple, commonsense health care taken care of, I'd like to at least know that it was available to everyone.

Comments

[cheshyre]

HSAs were first devised by people who thought the problem with healthcare costs was that Americans were overinsured. This is neither hyperbole nor exaggeration, and that faulty premise makes me distrustful of any solutions based off of it.

The notion appears to be if individuals are paying out-of-pocket they'll economize and that individual consumers can negotiate better prices than collective groups. [This cartoon is one of the more cynical criticisms I've seen...]

Group insurance balances out costs among a large patient pool. In the last several years, for-profit insurance has been trying to cherry-pick their clientele, to only attract the healthiest so they can avoid paying for the people who truly need the health insurance. My gut reaction is that this kind of plan appeals most to the young and healthy, who anticipate few health expenses. [What *does* happen if something major happens and the account gets overdrawn? SOL? Or will there be a safety net? Too cruel without the safety net, and if there is an adequate safety net, why do we need the HSAs?]


Ian, if you want to do more reading on this, I've got a mess of links for you, though I haven't sifted them for quality or authority, but we've got some further reading if you're interested.

[bimmer1200.livejournal.com]

This is only a part of the notion. It also provides for flexibility. In Ian's case, he'd have almost 4K (or more if he and Liz opted to put more money into the account)to spend on whatever mental healthcare provider he'd like, as well as medicine that's prescribed. To give an example, I'll use my own life path. I'm going to use some estimates, so take the numbers with a small grain of salt:



My first job with medical insurance came when I was 24. Now, I don't think it would meet the average I sited above so I'm going to assume it was only paying 2k a year in ins. premiums. I was on that job for a year, but I didn't go to the doctor except for a routine check up. The cost billed to the insurance company was 60.00 + my 15.00 co-pay. That's 75.00. There's also the premium for catastrophic health insurance. Let's say around 400.00 a year.





So let's say I had an HSA. I'd have had 2000.00 in the bank because I was young and didn't contribute. I had to take out 75.00 (we're going to assume no price drop due to HSAs) and that left me with 1925.00. I went to the dentist twice at 60.00 per visit. So that's another 120.00 deducted. That leaves me with 1805.00. Take out the catastrophic and we're down to 1405 At this point, I could take the money out and pay normal income tax on it. Or just leave there. I'm going to leave it there.



The next year, I changed jobs. Now, it took 3 mo. for my ins. to kick in. But with an HSA, I'd have been able to keep that 1405.00 and use it if something happened. Nothing did, and at my new job my healthcare contribution was probably higher than average. But I'm going to use the average number of 4K a year. Now, I only got 9 mo. of coverage that year, so that's 75%. That means 3k. My HSA now has 4405.00 in it. Less the same 195.00 for physical and teeth cleanings. That leaves us with 3810.00 after the catastrophic.



I stay in the same position for another year. I get the full 4K and I haven't used any of that money again that year, save for the same check up and teeth cleanings. So I'm at 8005.00. Then, disaster strikes. I lose my job. Fortunately, that 8005.00 is mine. I start doing contract work, so my real dollar income is up, even if my benefits are down. I don't add more to it, reasoning I don't know if this contract thing is going to work out and I need to pay my bills. I forego one teeth cleaning and the checkup, so I'm still at 7910.00. Maybe not too smart, but I'm 27 and healthy and in reasonably good shape so I take the gamble.

(More coming in an additional reply)

[bimmer1200.livejournal.com]

I find a new job with UPS. Benefits are better than average so I'm going to say 5K a year on this one, and that they pay the catastrophic for me. Benefits also start after three months though. And oh, shit. I got a kidney stone and have to go to the ER to take care of it. I racked up like 4500.00 in bills. Now, i've got a choice. I can pay my catastrophic premium of 1000.00 and let the catastrophic cover the rest. Or I can pay all 4500.00 out of my HSA. I decide to do that. the Catastrophic has a lifetime limit of 1 million and I want to make sure if I get cancer or gangrene or something fucked up I don't have to work. So that leaves me with 3410.00. I have no more health problems during the year though, and I'm back to my regular check-up and teeth cleanings of 195.00 a year. So I'm down to 3215.00. UPS kicks in though, and I get my 3750.00 from them which brings me up to 6965.00.



My next year at UPS, I go to the doctor once for a sore throat. So that's an extra 80.00 visit added to my normal 195.00. So I'm down to 6690.00. Add in my annual 5k and I'm up to 11,690.00. That's a pretty good little hedge.



I change jobs again. My insurance is about the same as UPS and kicks in after 30 days. That was almost a year ago so I'm going to assume the year is finished for purposes of this example (and because this is getting long). This year I've been to the doc. twice besides a checkup. That's 375.00. I spent another 300.00 on a chiropractor. So that's 675.00. I only get 4583.00 this year due to losing a month. That leaves me with 15,990.00 sitting in HSA.



Now, I've not bothered figuring interest. Or taking out costs of meds as I didn't really spend that much on meds. I think, once since I started working 7 years ago I got a prescription medication, so I'm going to call that even. Regardless, I'd be sitting with almost 16K in an account and should I start having medical problems I can use that, and if it gets near the bottom, I can use my catastrophic insurance, say if I get cancer or have a heart attack or something like that. This ignores my wife's income and insurance. My point though is this: if people have it, they have their 20s which are typically low health-care expenditures to build up a cushion so that as later in life problems get more serious/expensive/likely, they are better prepared to handle it.

Now, I don't know Ian's finances or medical expenses. But his major complaint seems to be choice. And HSA would undeniably give him more choice than he currently has, at no additional expense to himself or to anyone else. It's just removing some of the blocks on money that's already there, freeing it up to go where it is treated best, as defined by Ian instead of a pencil-pusher in the gov't or at some insurance company.

[xiphias.livejournal.com]

You're making a number of assumptions here.

First is that "young equals healthy."

There has never been a year of my life in which I've consumed less than a thousand dollars of health care. And most years have been significantly more. My medications are over $200/month alone. And have been for most of my life.

In addition, I've never earned more than $10,000 in a single year.

Under your plan, I'd be dead.

Now, this may or may not be a downside of your plan from your point of view, but I assure you that, from my point of view, it is. I'm afraid that I cannot support any plan under which I'm dead.

Another assumption that you are making is that I have the ability to make better decisions about my own health care than a pencil pusher in the government or at some insurance agency.

Why? Actual assignment of health care risk is a significantly complex technical specialty. Why would I be better at it than someone trained in it?

[bimmer1200.livejournal.com]

I'd say you being dead is a downside, yes.

Why would you be better at it than a pencil pusher? Precisely because it would be your life on the line. I think you're perfectly capable of picking a doctor or other health care provider that will meet your needs.

I did make a presumption though, that if someone has insurance of some kind from their work, they'd be able to use that money for an HSA. Or to choose their own healthcare instead of having to go with what their employer provides.

Another point I didn't make is that if someone with an HSA takes money out for non-medical purposes, they'd have to pay an income tax on it. As benefits of this kind are currently taxed, that additional revenue could be channeled into helping people who are having trouble. You well know I'm not fond of taxes, but I'd find that tolerable as a) the subsidy is self-selecting b) the self-selectors are people taking risks of their own choosing.

I'd also presume that necessary medical treatment would be provided as it is now. The problem with socializing systems like this is that it doesn't bring the people at the 'bottom' up, it just drags the people in the middle down and makes it even worse for the people at the 'bottom' and I don't think that helps anyone.