What IS The Cost Of US Health Insurance ?


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Terror Australis
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Message 1183454 - Posted: 7 Jan 2012, 9:11:19 UTC
Last modified: 7 Jan 2012, 9:47:57 UTC

In overseas countries we read so much about the cost of health care/health insurance in the US but nothing about what it costs in dollar terms.

I'd like to know just what the cost really is.

As a comparison, on top of the universal health care I'm entitled to I have backup private health insurance which costs me $A150/month at the Family rate. This has certain minor advantages over the public system such as semi-private ward accomodation. It also gives coverage for optical and dental plus other stuff I don't use like hearing aids, "alternative" medicine and health club membership.

What would the cost per month be in the US for similar medium level cover plus extras be in the US?

T.A.

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Message 1183458 - Posted: 7 Jan 2012, 9:56:37 UTC - in response to Message 1183454.

For a family of four working in industry it would probably be $15000 per year. Probably the employer would pay half. In the past industry provided most all of this coverage. Some teachers and gov't workers pay only 1500 to 2000 dollars per year.

For a retiree who has paid in 2.5% of his salary into MEDICARE up to age 66 it would still cost him $300 per month for himself--frankly that is all it's worth. greed, fraud, inefficiency, government, HMO's, insurance companies, pharmacies, hospitals, equipment suppliers all have their hand in our pockets and there is no restraint other than bankruptcy or death.

Medical care is one of our major National Disgraces as far as cost and wild profiteering is concerned.


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Message 1183472 - Posted: 7 Jan 2012, 12:33:08 UTC
Last modified: 21 Mar 2014, 1:59:18 UTC

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Terror Australis
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Message 1183475 - Posted: 7 Jan 2012, 13:01:05 UTC - in response to Message 1183472.
Last modified: 7 Jan 2012, 13:03:45 UTC

The real cost of health care is the most a consumer is willing to pay for it and the least a doctor is willing to accept to perform that service.

The problem is, the consumer does not have to worry about cost. Taking that out of the equation, demand is functionally infinite, and the supply is finite. This shifts the supply/demand curve *way* out of a natural equilibrium.....

I think it is only fair that you answer my question as reasonably as I answered yours in the other thread.

If you need clarification, what insurance premium would a family of 4 have to pay in the US in order to get the same degree of medical care for illness, accident, pregnancy etc. plus dental and optical, to the same degree as what I get ?

The problem is, the consumer does not have to worry about cost.

From what I read on these pages and elsewhere that statement is blatantly false. Whether it is the actual cost of medical treatment or the cost of health insurance, from William's post above, it appears the "consumer" (patient ?) does indeed have something to worry about.

T.A.

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Message 1183530 - Posted: 7 Jan 2012, 17:59:20 UTC

OK -- for my wife and I -- we are covered by insurance which we pay for -- no corporate funding.

We are in our early 60's (pre-Medicare insurance coverage) and our annual insurance cost is just under *18,000*. Note, this is a high deductible (HSA) plan which means that the first $3K of medical (and medicine) expenses for us is not covered, ie out of pocket. So before the insurance kicks in, we are out of pocket $24,000. Then above the $3K number the coverage is 80/20 for the next $3K (ie another $600 for us). That means if we have a significant medical emergency (6 years ago I had colon cancer, surgery and chemo -- I am now clear of this and have been for 5 years or more), our total medical costs would run to over $25K -- for two people. That also assumes all medical care is done 'in network' and per the insurance companies rules.

Two years ago, my wife needed cataract surgery -- because in her case it required specialized care (complications due to very high myopia and extremely high astigmatism) we were out of pocket entirely for that -- something like $6K in addition to still paying insurance.

We manage to afford this cost, but there are plenty who can't -- and for them, they need to pretty pray nothing happens.

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Message 1183533 - Posted: 7 Jan 2012, 18:15:47 UTC

There are some plans which take the cost issue out of the hands of the consumer entirely -- but increasingly they are going away. Insurance companies tend to be very 'aggressive' regarding claim denials for various reasons -- in a for profit industry, it is very much in their interest to 'just say no'.

Where the insurance system appears most flawed (and excess cost inducing):

1) End of life care -- there is way too much heroic intervention, keeping people alive for days or weeks but either not alert or in severe pain at very high expense. Many would be better served in hospice care at end of life at much lower costs to all.

2) Procedure based compensation -- this becomes a scavenger hunt for labs and physicians to find codes which get higher compensation but don't appreciably improve care. It is an area where specialists can do VERY well and primary care (those with direct patient contact as their primary activity) are not all that well compensated (my wife's Psychiatrist -- for a one hour visit, the going insurance rate is between $100 and $120 of which the insurance company pays 80% - whenever they get around to paying it. That is the total compensation -- no additional compensation for insurance company follow up time, or any staff she might have. That's a do the math sort of question. Internists and Pediatricians (among other primary care) are in the same boat.

On the other hand, if you are in a specialty and know how to 'work the codes' a 15 minute patient contact (of which you might have 6 in an hour -- funny math that) get's you $75 to $100.

So folks in the medical profession are discouraged from primary care (where they are most needed) and encouraged to specialties which pay much better.

3) Duplicate testing and procedures -- these get paid for due to lack of coordination or simply because they can generate payment. Waste for sure.

4) People, lacking regular physician contact using hospital ER's for their primary care -- highly inefficient and expensive use of resources.

5) Costs of over testing and multiple visits to protect against malpractice suits.

6) Some proportion of patients who abuse the system and run up medical costs because it isn't theirs to pay for. (I suspect this is not as big a factor as some make of it - it is simply used as a rational for cutting health care support for those who can least afford cuts in health care.

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Message 1183679 - Posted: 8 Jan 2012, 5:17:47 UTC - in response to Message 1183533.

There are some plans which take the cost issue out of the hands of the consumer entirely -- but increasingly they are going away. Insurance companies tend to be very 'aggressive' regarding claim denials for various reasons -- in a for profit industry, it is very much in their interest to 'just say no'.

Where the insurance system appears most flawed (and excess cost inducing):

1) End of life care -- there is way too much heroic intervention, keeping people alive for days or weeks but either not alert or in severe pain at very high expense. Many would be better served in hospice care at end of life at much lower costs to all.

2) Procedure based compensation -- this becomes a scavenger hunt for labs and physicians to find codes which get higher compensation but don't appreciably improve care. It is an area where specialists can do VERY well and primary care (those with direct patient contact as their primary activity) are not all that well compensated (my wife's Psychiatrist -- for a one hour visit, the going insurance rate is between $100 and $120 of which the insurance company pays 80% - whenever they get around to paying it. That is the total compensation -- no additional compensation for insurance company follow up time, or any staff she might have. That's a do the math sort of question. Internists and Pediatricians (among other primary care) are in the same boat.

On the other hand, if you are in a specialty and know how to 'work the codes' a 15 minute patient contact (of which you might have 6 in an hour -- funny math that) get's you $75 to $100.

So folks in the medical profession are discouraged from primary care (where they are most needed) and encouraged to specialties which pay much better.

3) Duplicate testing and procedures -- these get paid for due to lack of coordination or simply because they can generate payment. Waste for sure.

4) People, lacking regular physician contact using hospital ER's for their primary care -- highly inefficient and expensive use of resources.

5) Costs of over testing and multiple visits to protect against malpractice suits.

6) Some proportion of patients who abuse the system and run up medical costs because it isn't theirs to pay for. (I suspect this is not as big a factor as some make of it - it is simply used as a rational for cutting health care support for those who can least afford cuts in health care.



BarryAZ,

Well, I happen to agree with most of your list of problems, but likely totally disagree with the 'what to do about it'.

1. End of life care. Yeah, this is a problem, but the decision should be totally between the physician and (depending on the patient's condition and previously recorded desires on the subject) either the patient or their next of kin. You can dump ever increasing piles of money on a problem and after a point it stops mattering much (law of diminishing returns). It should be up to the doctor and the patient (or next-of-kin) ONLY to determine when the point is reached when to do more does not make much sense.

2. The 'procedure codes' game... I remember when these hit, first with Medicare, then with private insurance (which adapts itself to the Medicare system like a faithful little lap dog). Not good. These codes took the decision of how much to charge a particular patient out of the hands of the physician and put it into the hands of a bureaucrat somewhere. Of course physicians and hospitals try to game the system. A lot of private practice physicians are getting close to bankruptcy because many of the more widely used codes are not keeping pace with ever rising costs. They have to code-shop just to cover their expenses.

But the codes game (with its increased payoff for specialists) is far from the only reason why many new doctors choose specialties instead of general practice, and none of the reasons are good.

3. Poor paperwork and recordkeeping. Yep, its a waste.

4. ER as the 'primary care physician of last resort'. Well, it is the fault of the law. Here in Texas, the ER at most (maybe all) hospitals is *REQUIRED BY LAW* to provide medical treatment, regardless of the ability to pay. Physicians do not have the same legal requirement on them at their offices, and the realities of Medicare/Medicaid/private insurance discourage many of them from taking new patients of any sort, much less those that can't pay.

A bit over a year ago, I had to rush my wife to the hospital ER. She was having chest pains of the heart attack sort. Even then, we got stuck 'in line' behind a bunch of women whose kids had the sniffles (until, that is, I had had enough and went into full arsehole mode, found some staff (a doctor and a couple nurses) taking a break, and demanded they take care of my wife ASAP). Well, that got results, and they wheeled her back and started tests. For the next 10 hours, I never left her side except during X-rays, and I have never seen such gross incompetence in a hospital before. They weren't that way back around 30 years ago when I worked in one (pathology lab tech). Thankfully it wasn't her heart, but it was something that if left untreated likely would have killed her.

5. Heh... Defensive medicine. Bloody bloodsucking lawyers and a sue-happy populace. Arrgh. A number of years ago, my wife's little sister died in the hospital. She became ill, was rushed to a doctor, then rushed to a hospital and admitted. It was heroic measure time, total life support. My wife visited her the first day, then I took my wife back the second to find her sister in a coma in the critical care ward. I looked at her sister, and what was being done. I looked at her chart. I then went and found her dad and talked with her doctor. It was a terrible thing, my sister-in-law was only 18 and had just graduated high school a few months earlier. I talked with my wife and her parents, told them it didn't look good. They thought that 'where there is life, there is hope', and on a patient that young maybe... just maybe she might recover... About 4 days later she stroked out again and passed away when they pulled the plug.

A couple of weeks later, I got ahold of a copy of the autopsy report. It pretty much confirmed the doctor's diagnosis (and my own thoughts). The 'feeling sick' was not due to the illness itself, but instead due to severe organ damage caused by the illness. By the time she 'felt sick' and got taken to the doctor, it was really too late to save her.

I know... it seems like this fits more on point 1 than point 5, but I am getting to it.

You wouldn't believe the number of lawyers calling my in-laws wanting them to sue the doctor and the hospital. Heck, I even had a few call my wife and I wanting us to 'work on' her parents. There was blood in the water and it was a feeding frenzy, promising huge jack-pot payouts on a malpractice lawsuit... When nothing could be further from the truth.

6. Tell me about it. A lot of doctors nowadays will prescribe useless medication (usually antibiotics for a viral illness) just to shut up the patient (or more usually, the patient's mommy). So, we get increased prevalence of MRSA and its kin. So the antibiotics don't work as well on the people that actually NEED them, forcing the doctor to resort to ever more expensive, designer cocktail antibiotics (and even those are failing now). Not to mention all those patients who will demand some expensive drug from their physicians just because *they saw it advertised on TV*. Bahhh...

Now for what we are likely to disagree on... The solution. There are huge problems with health care nowadays due to insurance/medicaid/medicare. Before these things, we didn't have a problem.

The obvious solution? Get rid of private insurance, medicare, and medicaid. Let the free market regulate health care prices, as it did before.
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Message 1183684 - Posted: 8 Jan 2012, 5:36:19 UTC - in response to Message 1183679.


Now for what we are likely to disagree on... The solution. There are huge problems with health care nowadays due to insurance/medicaid/medicare. Before these things, we didn't have a problem.

Well lets look at why things cost more. Insurance wants to make a profit. Medicare and medicaid don't they actually keep costs down.

I work with a Physicians that consistently doesn't code her patient visits and diagnosis' correctly. this costs the business plenty because we have to have a full staff that constantly needs to review charts. If the Dr. doesn't get her codes correct and in on time, <24 hours after service, then there is a delay in payment. which again we need a host of people to keep up with this nonsense. Coding works when its used correctly. This wonderful Dr. runs vitamin B12's on every person she see's her nurse makes up ICD-9 coding to make it pass muster. We know its a lie and its just a matter of time before Medicare audits her charts and fines the company. Usually the fines start at $10,000 for each error found. That could lead to millions of $$$ being taken out of the corporate pockets.

BTW my nice private national Corporation was bought recently by McKesson Group. The Overlords are now looking at ways that we can save money. What I've seen is their asking for cuts to customer service.
The whole process is a means to recoup the money spent in the buyout in as short a time as possible. I do have an Idea. Cut his and all executives salaries by 90% across the board. That would be a massive cost savings for not only me but for the company that he's sucking dry

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Message 1183688 - Posted: 8 Jan 2012, 6:21:50 UTC - in response to Message 1183679.

1. End of life care. Yeah, this is a problem, but the decision should be totally between the physician and (depending on the patient's condition and previously recorded desires on the subject) either the patient or their next of kin. You can dump ever increasing piles of money on a problem and after a point it stops mattering much (law of diminishing returns). It should be up to the doctor and the patient (or next-of-kin) ONLY to determine when the point is reached when to do more does not make much sense.

Scared of death panels I see. Then get your butt to the lawyer and get a durable power of attorney for health care and make sure the person you appoint knows you want to be resuscitated no matter what or how expensive. Then pray they have tons of cash because at some point the insurance and your estate will run out and they will have to pay for it.


The Dr. has a profit motive to keep sucking the insurance dry. Any lawyer would tell you that is a conflict of interest that is impossible to overcome and he would be right.

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Message 1183694 - Posted: 8 Jan 2012, 6:52:27 UTC - in response to Message 1183679.

Right, like I said before, you are proposing a budget balancing approach -- eliminate the duty of care (that Texas law for example which you lament) as well.

That way those that can't afford care won't get it --- and they will die off faster. Helps with Social Security budget as well -- dropping life expectancy by 5 to 10 years is a solution there. Oh, make sure that you eliminate corporate paid health insurance as well -- the companies need the profit.

After all, that sort of approach worked well in the 70's (1870's) and so little has changed since then.

Nope, that is not an obvious solution -- or rather it is a pretty bad approach unless you are VERY wealthy.

I'm thinking that there are countries where health care isn't approaching 20% of GDP -- perhaps those models actually make more sense.



The obvious solution? Get rid of private insurance, medicare, and medicaid. Let the free market regulate health care prices, as it did before.

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Message 1183695 - Posted: 8 Jan 2012, 6:55:00 UTC - in response to Message 1183688.

We agree here -- durable power of attorney approach is reasonable (we each have one here). But it does not specify 'always resuscitate'. I've read that something like 15% of all medical expenses for an individual these days happen during the last 60 days.


Scared of death panels I see. Then get your butt to the lawyer and get a durable power of attorney for health care and make sure the person you appoint knows you want to be resuscitated no matter what or how expensive. Then pray they have tons of cash because at some point the insurance and your estate will run out and they will have to pay for it.


The Dr. has a profit motive to keep sucking the insurance dry. Any lawyer would tell you that is a conflict of interest that is impossible to overcome and he would be right.


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Message 1183754 - Posted: 8 Jan 2012, 12:05:32 UTC - in response to Message 1183475.
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