T Nation

Healthcare Tumult

Have any of you had your healthcare affected recently?

The company I work for recently had a meeting on healthcare. It’s a small business, and the costs have become prohibitive enough that we had to significantly reduce our network. At least the benefits are the same though.

We also work with a very large number of small to midsize companies. A lot of them are not able to keep up with the costs and have had to drop their employees’ coverage all together. Some of them, especially the ones with around a few hundred employees, are talking about retiring and selling the business, or just shutting down completely once the whole of the healthcare reform goes into effect.

Pretty much everyone is being extremely tentative about hiring anyone new until they know for sure what will happen and how much control they’ll have. The gentleman we work with for our healthcare has been to no small number of conferences on Obamacare and described it as “a complete mess”. They don’t even know all the regulations they’re going to pass yet. Except whatever they are, they’re already effective.

And the absolute worst part of it is I’m wondering if they’re going to remove FSA’s/HSA’s all together. The best part of my “healthcare” is a generous contribution from my ER into an FSA. As a young healthy man, this covers my healthcare costs completely. If FSA’s and HSA’s get tanked then my healthcare costs will technically have risen by like infinity.

Can someone remind me what the upside of this was?

[quote]csulli wrote:
Have any of you had your healthcare affected recently?

The company I work for recently had a meeting on healthcare. It’s a small business, and the costs have become prohibitive enough that we had to significantly reduce our network. At least the benefits are the same though.

We also work with a very large number of small to midsize companies. A lot of them are not able to keep up with the costs and have had to drop their employees’ coverage all together. Some of them, especially the ones with around a few hundred employees, are talking about retiring and selling the business, or just shutting down completely once the whole of the healthcare reform goes into effect.

Pretty much everyone is being extremely tentative about hiring anyone new until they know for sure what will happen and how much control they’ll have. The gentleman we work with for our healthcare has been to no small number of conferences on Obamacare and described it as “a complete mess”. They don’t even know all the regulations they’re going to pass yet. Except whatever they are, they’re already effective.

And the absolute worst part of it is I’m wondering if they’re going to remove FSA’s/HSA’s all together. The best part of my “healthcare” is a generous contribution from my ER into an FSA. As a young healthy man, this covers my healthcare costs completely. If FSA’s and HSA’s get tanked then my healthcare costs will technically have risen by like infinity.

Can someone remind me what the upside of this was?[/quote]

Remember that Obamacare is not the problem. Not really. Rising health care costs are.

Health care costs have been going up 13% per year on average for the last decade. It is expected to be worse for the next decade as well (Obamacare or not). Even if Obamacare increases costs by 25% it just puts us 2 years closer to ruin.

The truth is Americans are unhealthy. 36% of us are obese! If you include the overweight as well it gets closer to 70%. 60% of Americans are sleep deprived. We simply, as a country, don’t give a damn about our health.

It is honestly to the point where people don’t even see being overweight or constantly sleep deprived as the blight on our country that it is.

My premiums have gone up, and trying to model Europe is foolish when their obesity rate is 8% and thinking we will have the same outcome is beyond foolish.

…“Remember that Obamacare is not the problem. Not really. Rising health care costs are…”

phatheon:

Can you write this about 10 more times?

Actually; health-care cost have never really stopped rising since Third-Party Payers became a significant part of the mix…and no…third-party payers are not even the reason for rising cost.

As you pointed out…we are unhealthy…AND OVERUSERS of Healthcare with unreasonable expectations.

Going to ER’s for colds…expecting the most High Tech and experimental treatments to be paid for…litigation…waste…fraud.

The list goes ON and ON and ON…

Mufasa

[quote]Mufasa wrote:
…“Remember that Obamacare is not the problem. Not really. Rising health care costs are…”

phatheon:

Can you write this about 10 more times?

Actually; health-care cost have never really stopped rising since Third-Party Payers became a significant part of the mix…and no…third-party payers are not even the reason for rising cost.

As you pointed out…we are unhealthy…AND OVERUSERS of Healthcare with unreasonable expectations.

Going to ER’s for colds…expecting the most High Tech and experimental treatments to be paid for…litigation…waste…fraud.

The list goes ON and ON and ON…

Mufasa[/quote]

Fair points, but HSA’s are actually cheaper for companies to use…you will see much more of them in the future.

Also, you will see companies paying the fine and not offer insurance as it will be cheaper for them to do so.

[quote]phaethon wrote:
Remember that Obamacare is not the problem. Not really. Rising health care costs are.[/quote]

That’s true. I didn’t mean to make it sound like it was all Obamacare’s fault. Healthcare costs were definitely spiraling out of control regardless. Do you believe Obamacare is helping or is going to help though? I mean it seems to have exacerbated the problem from my perspective.

The U.S, public spends twice as much as any other industrialized country yet we are ranked 34 by the World Health Organization. France, Germany and Japan are in the top ten and pay half of what we do. So why does the public stand for this ineptitude? Because we are not informed of this injustice.

Unfortunately Big Pharma has a lot to do with this. They keep off potentially life changing treatments off the market if they can’t patent it and make money. So everyone else has to suffer because they can’t make obscene profits. There is a special place in hell for these bastard demons.

I think an important point to make regarding the ACA is that there are very few people who have read and understand the law in its particulars (I consider this to be a failure on its authors’ part).

[quote]smh23 wrote:
I think an important point to make regarding the ACA is that there are very few people who have read and understand the law in its particulars (I consider this to be a failure on its authors’ part).[/quote]

I bet its a hideous mess. Ever read through ERISA? Its awful. I used to run into lawyers who specialize in ERISA litigation who I swear had never even skimmed it. And what’s worse is for every one page of statute, there’s 20-50 pages of regulations interpreting the statute. I’m sure the ACA will be even worse.

[quote]jjackkrash wrote:
I bet its a hideous mess. Ever read through ERISA? Its awful. I used to run into lawyers who specialize in ERISA litigation who I swear had never even skimmed it. And what’s worse is for every one page of statute, there’s 20-50 pages of regulations interpreting the statute. I’m sure the ACA will be even worse. [/quote]

Wow I can’t believe you mentioned this. I am a retirement plan administrator. I eat, sleep, breathe, and drink ERISA. The only people that are deeper in than I am are ERISA attorneys (they’re supposed to be at least). I always say it takes a very “special” kind of person to be an ERISA attorney. And I bet you are completely right about ACA. Most people haven’t the slightest idea as to how complicated and convoluted the government has made retirement plans. In fact that’s how I have a job lol. It’s so complex that there is an entire market of people who are willing to pay someone else to worry about all of it for them, because they’re trying to run their business, and they don’t have time to learn and follow the mountain of rules. I can only imagine what healthcare looks like.

[quote]csulli wrote:

[quote]jjackkrash wrote:
I bet its a hideous mess. Ever read through ERISA? Its awful. I used to run into lawyers who specialize in ERISA litigation who I swear had never even skimmed it. And what’s worse is for every one page of statute, there’s 20-50 pages of regulations interpreting the statute. I’m sure the ACA will be even worse. [/quote]

Wow I can’t believe you mentioned this. I am a retirement plan administrator. I eat, sleep, breathe, and drink ERISA. The only people that are deeper in than I am are ERISA attorneys (they’re supposed to be at least). I always say it takes a very “special” kind of person to be an ERISA attorney. And I bet you are completely right about ACA. Most people haven’t the slightest idea as to how complicated and convoluted the government has made retirement plans. In fact that’s how I have a job lol. It’s so complex that there is an entire market of people who are willing to pay someone else to worry about all of it for them, because they’re trying to run their business, and they don’t have time to learn and follow the mountain of rules. I can only imagine what healthcare looks like.[/quote]

Which was PRECISELY why it was a crappy idea in the first place. Costs rising are the problem–BUT Obamacare does nothing to reduce costs. In fact it has accelerated rising costs for many. THAT is why Obamacare is a problem.

You had a problem that could have been at least partially handled by single issue bills, maybe 30-60 pages long: reform crappy lawsuits, cap lawsuit $ so malpractice insurance doesn’t cost an arm and a leg, allow interstate insurance competition to free up a market rather than leave it in semi-monopoly with companies who don’t compete against each other at all… etc etc etc. Any individual issue could have been the basis of a bill and would have been much more manageable to pass bi-partisan. Not to mention they would have had a MUCH more direct and much more measureable impact on the healthcare system, which would have thus provided more data for future bills aimed at problems more specifically.

Instead you have a mountainous pile of SHIT that doesn’t even address the root problem in the first place. I mean hell, if you’d approached each issue individually you could have been able to see what torte reform did, what caps did, what inter-state insurance competition did–which would have reaaaally helped costs lower…and THEN you could have designed a well considered plan to fill the gaps for people who were still uncovered and which would not have cost us 1.6 Trillion fucking dollars during a recession. As an another Plus, this kind of “fill in the gaps” national plan probably would not have been nearly as aggressively opposed by people because it would have made more sense, been more targeted, and been better written with less pork less rules and less surprises. This alone probably would have made Obama a hero. It most certainly would have stifled most of the critics to see him do something sensible.

As an added benefit the small bite sized legislation probably would have helped the economy keep going and/or acclimate to new standards without nearly the same discomfort and sluggishness we are seeing now as companies everywhere freak out about the increased costs under the new rules…let alone figuring out what all the new rules are in the first place.

But noooooooo! partisans had to go steamroll a piece of shit through that nobody even understands. Law of Unintended Consequences fail.

[quote]Aragorn wrote:

You had a problem that could have been at least partially handled by single issue bills, maybe 30-60 pages long: reform crappy lawsuits, cap lawsuit $ so malpractice insurance doesn’t cost an arm and a leg, allow interstate insurance competition to free up a market rather than leave it in semi-monopoly with companies who don’t compete against each other at all… etc etc etc. [/quote]

Respectfully, I don’t agree with these points at all. Med.-mal cases pretty much dried up in Texas due to tort reform but this didn’t do dick to rain in Texas health-care costs. Also, I don’t believe that the cost of insurance would be affected all that much by more competition–not that more competition would be a bad thing–because they are basically insuring against the cost of the underlying health care. The underlying care is what is expensive. In other words, the cost of the underlying care is what needs to somehow get rained in, which drives the cost of insuring for the care.

[quote]jjackkrash wrote:

[quote]Aragorn wrote:

You had a problem that could have been at least partially handled by single issue bills, maybe 30-60 pages long: reform crappy lawsuits, cap lawsuit $ so malpractice insurance doesn’t cost an arm and a leg, allow interstate insurance competition to free up a market rather than leave it in semi-monopoly with companies who don’t compete against each other at all… etc etc etc. [/quote]

Respectfully, I don’t agree with these points at all. Med.-mal cases pretty much dried up in Texas due to tort reform but this didn’t do dick to rain in Texas health-care costs. Also, I don’t believe that the cost of insurance would be affected all that much by more competition–not that more competition would be a bad thing–because they are basically insuring against the cost of the underlying health care. The underlying care is what is expensive. In other words, the cost of the underlying care is what needs to somehow get rained in, which drives the cost of insuring for the care. [/quote]

Could you unpack that a little more?

Also, if what you say is true, Obamacare still doesn’t attack the reason that care is expensive. In other words, it’s still not doing what we need and still creating problems.

You’re usually respectful, I’m just in a Lewis Black style ranting mood today

[quote]Aragorn wrote:

[quote]jjackkrash wrote:

[quote]Aragorn wrote:

You had a problem that could have been at least partially handled by single issue bills, maybe 30-60 pages long: reform crappy lawsuits, cap lawsuit $ so malpractice insurance doesn’t cost an arm and a leg, allow interstate insurance competition to free up a market rather than leave it in semi-monopoly with companies who don’t compete against each other at all… etc etc etc. [/quote]

Respectfully, I don’t agree with these points at all. Med.-mal cases pretty much dried up in Texas due to tort reform but this didn’t do dick to rain in Texas health-care costs. Also, I don’t believe that the cost of insurance would be affected all that much by more competition–not that more competition would be a bad thing–because they are basically insuring against the cost of the underlying health care. The underlying care is what is expensive. In other words, the cost of the underlying care is what needs to somehow get rained in, which drives the cost of insuring for the care. [/quote]

Could you unpack that a little more?

Also, if what you say is true, Obamacare still doesn’t attack the reason that care is expensive. In other words, it’s still not doing what we need and still creating problems.

You’re usually respectful, I’m just in a Lewis Black style ranting mood today[/quote]

I don’t really disagree with what you are saying, except the two specific points you raised that I see repeated often.

With respect to tort reform, Texas is on the vanguard of aggressive med-mal. tort reform and has been since 2003 to the point where its almost impossible to find a lawyer there to take a case regardless of merit. Not impossible, but there’s only a few firms left who will take a case and there is a very stringent screening process and only for certain types of cases. Health-care costs in Texas and health insurance in particular is still very expensive and on par with, for example, WA state, where there is still a robust med. mal. practice and very little by way of tort reform. So I just don’t believe that tort reform or the lack thereof is driving healthcare costs.

My only point with regard to opening up cross-state insurance is that I don’t see how that decreases the underlying cost of the care, which is the real driver of premium costs. I’m not against more competition, I just don’t think it matters that much.

I don’t really have any issue with the rest of your post.

Edit: And I hope I didn’t come off as attacking you, I was just trying to make points relevant to the discussion.

Obamacare was just an attempt to fix an already broken system. From what I’ve seen and read I don’t see it doing that.

Lol last time I was at the doctor my nurse was “surprised” at me having health care as she said most everyone she sees doesn’t have it.