Health Care - Business Perspective ( not political)

[tomASS]

Ok - we get our health care insurance through my wife's employer. She works for the school district in special ed. (yeah, yeah. yeah she's had plenty of practice )

District put the insurance contract out for bid. Current Supplier, Blue Cross came in with a big increase. Health Partners came in barely under that and Medica was out of the running completely.

We will pay an additional $300 dollars a month to bring our grand total for health insurance premiums up to $1200 a month for a currently health family of 5.

Not only do we pay more for the coverage itself, we will pay more for co-pay office visit $25 to $50, we will pay more co-pay for prescriptions $20 to $30.

Now we could go with a huge deductible and lower our payments dramatically since our health care visits have been nominal the past 3 years, but you know how one major incident can impact the budget and the rainy day account. But maybe that is the way to go. Or maybe we just purchase our own and see what we can get.

How is it when we manage our family's health care costs in an extremely responsible and cost effective manner. We are then penalized for our good health because of the overall rising cost of health care? Why should I share in the cost of others poor health and the cost associated while profits in these organizations are extremely healthy. I should probably take the big deductible and invest in the Health Care stocks.... I would come out a head I think.


This managed health care system is out of whack. They have to be squeezing the doctors on their end too. These outfits are rolling in profits in a system that they manipulate and control. I'm not in support of any form of a nationalized social medicine plan that is government funded or operated, But where is the free market in the health care system right now? It's not managed care it is manipulated care.

I'm done ranting ....for now

[elliott70]

Medical insuranced right into the hospital because of the stress.

I have good coverage but I pay for it, big time.

[EREmpireStrikesBack]

Coming from a college kid's perspective, what else is there besides what your employer offers? Or is that the only option or decent option?

I plan on working in a government entity of some sort, so hopefully they provide good insurance and I don't have to worry about it, but just curious what else is out there.

[Knowlzee]

What if health insurance was more like our auto insurance,.....where the insurance takes care of the large accidents, but we take care of maintenance and small repair costs. We would be insured for the large costs of such things as a car accident, a heart attack, a fall, etc. (i.e. hospital stays), but.......we would be responsible for colds, cuts, broken bones, the flu, etc. (i.e. clinic visits).

Wouldn't this greatly reduce unnecessary visits, if people knew they would pay for the sniffles, themselves? This should also reduce paperwork, and mutilpe small checks and payments of co-pays. Not to mention, the lessening of the doctors' workload. Furthermore, if people were expected to pay for their sniffles, maybe they would also take better care of themselves, also,....maybe join the health club, wash hands more, wear warmer clothes, etc.

Back to car insurance, imagine if our insurance company paid for oil changes, we would be doing it every week. If the door rattled, we would have it replaced. Everthing we didn't like about the car would be fixed. If everthing was fixed without out of pocket payment, would we take very good care of the car? Would we do any maintenance ourselves, or just bring it in and have it done, at the cost of the insurance company?

Isn't this at least part of our health insurance problem?

[Can't Never Tried]

Well Knowlzee, I think it use to work well in the age of a tougher America.
The only time you went to the doctor was an emergency.

We have become such a soft society that we can't stand being uncomfortable with a cold, or headache, etc. for a couple days, and it's off to the doc, and for what? They say the same thing your Mom said, rest, take some Tylenol (Back then they had asprin) and let your body do it's thing.

No, we need instant cure..
and in most cases it takes the same amount of time to get well anyway.

But to address tomAss on the cost, I have always thought the premium cost should be directly tied to your usage. But in essence those that take care of themselves and don't abuse it, are paying for the rest that don't take care of themselves or do abuse it. Also administrative costs are way over the top as well.

[kickshot]

You can get quotes on-line. Google Health Insurance and have away. I searched about 3 years ago and found a plan with BlueCrossClueShield, still with same plan. You can look at all different levels of participation....set deductibles; 100% coverage or 80/20, etc. I believe you can also set different copays, office visits amounts, and prescription amounts. Good Luck.

[tomASS]

But to address tomAss on the cost, I have always thought the premium cost should be directly tied to your usage. But in essence those that take care of themselves and don't abuse it, are paying for the rest that don't take care of themselves or do abuse it. Also administrative costs are way over the top as well.

Does over $10 million in art and sculptures fall under the administrative expense line (United Health Care lobby and hallways)

But I am old school and rarely visit the doctor for anything .....that small heart attack? Couple Bayer and I was back up on my feet.

I do agree the public does go in for every little ache and pain now days

[who_b_dat]

The name "fringe benefit" came to be when medical insurance was a blip on a company's balance sheet. It was literally pennies per employee. Nowadays, medical insurance and other fringes can equate to almost half of the average worker's pay.

You wont like this Tom but an employee cost of $1,200 per month is very high. Most companies and public sector employers are picking up betwen 70 and 80% of the premium cost. Assuming your wife's employer was only picking up 70%, that puts the full cost of your family's premium at $4,000 per month. That's off the charts! You are either 1) in with a group of very high users that are driving up your group's experiance rating; 2) are in some high cost unlimited plan that allows you to go anywhere and not be limited to a specified network of providers or 3) they are balancing their cost of retiree medical (if applicable) on your back through these premiums.

The $50 office visit and $30 Rx copay (assuming generic, formulary) are on the high side but not way out of whack. $25 office and $18 Rx (generic - formulary) were the norm when I did some survey work last year of major companies in the midwest.

Didn't want to further rain on your rant parade Tom but I couldn't sit by and not comment on that HIGH premium cost.

ps- Knowlzee hit the bullseye and should of also noted that we'd do a better job of price shopping if we paid the full cost ourselves. It's amazing the variation that can occur between docs for the same service.

[ChrisK]

I don't like the car analogy. When your car breaks down you buy a new one, you don't have that option with your health.

Knowlzee, I think you're being pennywise and pound foolish when you start charging the full cost for routine visits. Many serious illnesses start out with minor symptoms but if they're caught at that point they can be treated. If you have to pay $100 to see the doctor you may put it off until it's too late.

[Knowlzee]

Auto insurance is no analogy, it is they way it is covered, and it works pretty well. If a similar system was used in health insurance it would be much more efficient.

Sure there would be cases of tragedy for someone not going to the doctor because of $100 dollars, but.......it happens now, and always will. Some people just don't go to the doctor. That is hardly a reason to promote the continuation of a terribly inefficient system,.....and continue to whine about it's rising costs.

As Packerboy states you have to "pay to play".

[tomASS]

I don't like the car analogy. When your car breaks down you buy a new one, you don't have that option with your health.

Knowlzee, I think you're being pennywise and pound foolish when you start charging the full cost for routine visits. Many serious illnesses start out with minor symptoms but if they're caught at that point they can be treated. If you have to pay $100 to see the doctor you may put it off until it's too late.

Not if you net another $500 dollars per month because of reduced insurance cost. If you could put that into private managed account without it being taxed - I would be great with that

[UpNorthStars]

$1200 a month! wow that is high. I was disappointed when my coverage went over $100/month this year. That is for me, my wife, and my two kids. Sorry to hear your situation, but that sure makes me feel better.