Americans With Government Health Plans Most Satisfied

[GandK]

Per Gallup, this morning:

Americans With Government Health Plans Most Satisfied

My first cynical thought before reading it was, "Of course they are. These are the people who don't have to pay at the counter v/s those who do. The former will naturally be happier."

Yep. That was it.

[IlliniDave]

This is slightly off-topic.

I got a letter from my employer about our healthcare plan options for 2016 last month. I had been enrolled in a traditional, non-HDHP-type plan since my first day at the company amlost 29 years ago. Over time, due to costs, the plan has eroded to the point where it's something like ~70% as good as it was back in the late 80s, with me paying a much greater fraction of the cost (about 5-6% to over 30% now).

The letter said the plan exceeded the "cadillac" threshold ($10,600) defined in ACA and that the company had until 2018 to rectify that. My understanding was that I would have to pay an imputed income tax on amounts paid by the company that exceeded the threshold, which seems reasonable although I don't like it. But apparently along with that the company has to pay a 40% "excise" tax on any amount the value of my benefit exceeds the threshold. So the company was presented with the option of depositing the extra money in the corporate coffers and paying a 35% tax out of it, or giving it to me and paying a 40% tax on top of it. Guess which one they chose? They've basically made the traditional plan stupidly worse/more costly than the HSA options to essentially force everyone into those. Presumably by 2018 they'll close the traditional plan for lack of participation or something.

The HSA plans aren't really a bad deal for me, and I probably should have switched over a couple years ago. My gripe is with the gov't and ACA and why they felt it necessary to actively punish a company for offering a healthcare benefit that is "too good". Like I said, I can see capping the tax advantage to the employee at some point, but the rest is just bizarre.

I wonder where the government plans fall w.r.t the "cadillac" threshold or if that threshold even applies.

[enigmaT120]

I wonder where federal employees fall on that scale. We have to pay more for our share of the premiums than military, I think... except postal employees, they pay very little.

Next year my share of the premiums for Kaiser P. will be $150/2 weeks for self + 1 coverage, so there's $3900/year out of my pay check, and they contribute around twice that. So Kaiser is getting about 11,700 per year for two people. At least what I pay is pre-tax money.

[Spartan_Warrior]

I find it amusing that any American would say they're "satisfied" with our notoriously broken health care system.

That said, I am a civilian federal employee and I can vouch for the comparative cushiness of the plans*. But that's like picking out the least-dead tree in a dying forest and saying, "Hey, it's got a few more leaves than its neighbors, I'm satisfied!" While comparatively lush and vibrant forests grow just across the pond...

*Mostly because the agency contributes to the HSA a little each month, offsetting the cost of the insurance to a sizable degree.

(I would not say I'm satisfied with the system, if that wasn't clear. )

[jacob]

My first cynical thought before reading it was, "Of course they are. These are the people who don't have to pay at the counter v/s those who do. The former will naturally be happier."

That's certainly a factor; similar to how employee taxes are invisibly deducted monthly BEFORE the payout lest there be a howl of outrage at 4/15 were they expected to pony up for the annual tax bill.

I think there's more to than that though. In my opinion, the most evil parts of the US system is that market efficiency simply doesn't work that well for products where the customer has no idea about the actual cost of a service while simultaneously being pressed for time. Consequentially, US health care is one of the most inefficient pricing systems imaginable. It's so bad that if you knew the ins and outs of it, you could make a fortune.

Buying a car or a computer, one can shop around doing comparative pricing etc and pick the best offer. When hiring professionals to do home repairs, e.g. electricians, it's not uncommon to get 3 independent estimates.

However, suppose you're at your doctor with your facial expression resembling #8 on the pain scale and the doctor says that he's referring you to the ER because he doesn't have the equipment to properly diagnose you but he can tell that it's very likely quite serious, so please make a decision within the next hour or so, eh? Now, are you going to call the nearest three hospitals for an estimate. What do you tell them? This being in a country where doctors will rather give you options than tell you what to do. "Uhh.. it might be this or that .. do you want to take an X-ray?" ... "Fuck if I know?! Aren't you the expert here. Whatever, sure take the x-ray. I'll pay!". So practically speaking with your smiley pain-face being a lot closer to #10 than #1, you just sign whatever waivers and pick whatever is handed to you. Or at least I do ... because I'm not exactly a rational value-optimizing agent when I'm doubled over in pain.

And yet the US system somehow expects this of people.

Which brings me to my second point ... namely, that this allows doctors and institutions to charge basically whatever they effing want. Because the cost is spread out as long as you have insurance. If you can't pay, they'll reduce the bill by 90% thus demonstrating that actual price and cost are completely and utterly out of whack.

Here's a recent example of how the US health care system works when it comes to price efficiency...
http://www.nytimes.com/2015/09/21/busin ... .html?_r=0

(I'm pleased to report that the free market actually fixed this one. Somebody decided that it would be a smart move to buy the only company that manufactured a certain pill (cost of production $1/pill, patent long expired) and hike the price from around $15 to $750. Hell, yeah, Bro! After all, insurance will pay, right? Right! It was only after the media storm that another company did the humane/responsible thing, stepped in, and started offering the pill for ... $1/pill. If it hadn't gotten media attention, it probably wouldn't have happened. So... in many cases, it probably has not happened.)

I completely agree with SW ... Most Americans just don't know what they're missing when it comes to the administration of first-world health care.

Imagine moving to a new city. You have a problem. You call the nearest doctor. They bring you in. You fill out NO FORMs of paper. They see you. If they think there's a problem. They tell you where to go. You go there. They fix you. Once they fixed you, you go on your way. That's it.

It's not just that one escapes the paperwork and the fact that insurance companies as a profit maximizing strategy are likely to automatically try to reject the first claim (yes, been there, done that ... even of so-called pre-approved procedures); but just as much the liability/customer mentality in which doctors don't really want to tell you [the sick person who quite likely is in a rather vulnerable position] what you should do but leave it up to you to decide every step.

Well, in terms of ALL OTHER developed countries and many developing countries, this just doesn't happen.

I think the only possible reason that Americans can be happy with the current employer-subsidized, insurance company racket, tort-reform-deficit medicine is that they've never experienced the alternative. The disparity in functionally simply overrides any kind of political ideology.

Even complaints about socialism, etc. don't hold water here. The US health care system cost TWICE as much as the second-most expensive country in the world (hence the inefficiency => fortune comment above)... and US health in itself is actually worse, which just further goes to show that even if you pay twice as much, you actually get a worse product at the end of the day. One doesn't even need to be a management consultant to see that if there's that much of a mismatch, it's about time to scrap the entire system and start over.

Unfortunately, there are too many entrenched special interests. ObamaCare just added another layer on top of a crappy system: "Hey, why don't we force everybody to buy into the current system. That'll surely solve the problem." No it won't do, duh! Compounding a dysfunctional system won't change it. Guess who lobbied in favor of OCare? That's right. Insurance companies.

So yes ... I can totally understand why the Medi* and the Military people are the most satisfied people. Because they basically enjoys the kind of health care that every developed country in the world except the US also enjoys.

PS: I really like the US and living in the US but if I had to give any reason not to go and live here, the broken health care system is #1 on my list by far. Oh yeah ... the crazy paranoia of taking off my shoes at the airport for idiosyncratic/historic reasons is #2 ... an extremely distant #2!

PPS: Sorry about the explicatives, but this issue drives me up the wall.

[peerifloori]

I think there's more to than that though. In my opinion, the most evil parts of the US system is that market efficiency simply doesn't work that well for products where the customer has no idea about the actual cost of a service while simultaneously being pressed for time. Consequentially, US health care is one of the most inefficient pricing systems imaginable. It's so bad that if you knew the ins and outs of it, you could make a fortune.

Buying a car or a computer, one can shop around doing comparative pricing etc and pick the best offer. When hiring professionals to do home repairs, e.g. electricians, it's not uncommon to get 3 independent estimates.

However, suppose you're at your doctor with your facial expression resembling #8 on the pain scale and the doctor says that he's referring you to the ER because he doesn't have the equipment to properly diagnose you but he can tell that it's very likely quite serious, so please make a decision within the next hour or so, eh? Now, are you going to call the nearest three hospitals for an estimate. What do you tell them? This being in a country where doctors will rather give you options than tell you what to do. "Uhh.. it might be this or that .. do you want to take an X-ray?" ... "Fuck if I know?! Aren't you the expert here. Whatever, sure take the x-ray. I'll pay!". So practically speaking with your smiley pain-face being a lot closer to #10 than #1, you just sign whatever waivers and pick whatever is handed to you. Or at least I do ... because I'm not exactly a rational value-optimizing agent when I'm doubled over in pain.

And yet the US system somehow expects this of people.

Actually, it's quite impossible to comparison shop for (acute) health care needs. Most places can't give you an estimate, and even if they do, chances are that it will be off by a huge factor. This is in part because care needs may change and it's difficult to anticipate all the care that will be required. Then there's the fact that services/goods are charged different rates based on what insurance you use vs. self-pay. And most care professionals have no idea what things will cost to a patient.

I work in a hospital and I have no idea how much most of the things I give/use/do cost. I did see someone's itemized hospital bill once though (from the hospital where I work). $7 for a damn ibuprofen! The whole system is so so so so so so SO SO SO broken. It's beyond frustrating.

[IlliniDave]

My satisfaction has varied. I really have no complaints about access to care or quality of care. I've been with the same employer and used their insurance my whole independent life, but have lived/worked in 3 states with 3 different plan administrators. The billing end of it was bumpy until networks were smoothed out, and I have heard stories from reliable people about having to change physicians because of networks, but it's not happened to me. I've never considered shopping around for the cheapest price because the way the insurance worked is that my cost was predetermined based on the nature of the service. Now that I'm in the HDHP world I may become more cost-conscious. For more significant non-urgent things like minor surgeries I have taken the time to get references for the choices within the network, but more from the perspective of quality.

So as a consumer of healthcare whose always had insurance coverage, I don't have a lot of complaints, the caveat being I have not experienced the other systems in the world some view as vastly superior.

I do notice some ridiculous differences in what the providers bill to the insurance company and what the insurance company (or I) pay once the prices are adjusted to the negotiated network rate. That's something ACA might be able to smooth out in time as people concentrate into fewer networks with larger patient populations.