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Comment by e40 | Hacker News Reader

Kaiser is no longer a low-cost provider. They actually are quite expensive. We go through a very large group to get a better rate but it's still much higher than many of the other options that we have in our plan.

When you look at how Kaiser is structured, they should be cheaper. I think they're just pocketing the difference between the market rate and what their costs are.

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I'm downvoting you because you stated this as if it is a fact for everyone. We're in a small group plan and paying about the same for Kaiser as we are for Blue Shield, not "much higher". So, I think here's it's more "your mileage may vary."

To be fair, Blue Cross/Blue Shield are usually highway robbery for terrible plans, so...

The whole thing is broken. A friend of mine is switching jobs and is going to forking over a third of her paycheck for COBRA until the new job enrolls her in their plan. Almost certainly, nothing will happen in that short time period, and she'll have wasted thousands of dollars. But if something did happen, and she didn't pay the extortion, sorry COBRA, she'd be up shit creek without a paddle and ruined.

She can wait until an incident happens and then activate cobra. You don't have to pay for it upfront.

This was really good to know, had no idea.

This is not true of all COBRA plans. To be safe, she can delay premium payments a maximum of 45 days and still have coverage for claims that occur before the initial premium payment.

https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/...

I think you can retroactively pay for COBRA, yeah?

You can enroll after an event and it'll be as though you had insurance the whole time. You'll have to pay for the retroactive coverage, but it's a pretty smooth way (assuming nothing happens) to avoid paying for COBRA while still technically "having coverage".

Though I think there's a time-limit on it.

>I think they're just pocketing the difference between the market rate and what their costs are.

This is baseless and not really possible.

Insurers must spend 80% of premiums (85% for large group plans) on providing care for their insured.

An allowance 15-20% overhead for health insurance seems like pretty low bar for the industry...

And yet, it was groundbreaking when it was signed into law. People received refund checks after it went into effect.

And immediately after, administration costs shot up to ooh, 15-20%...

Yes, I suspect it ends up as something of a perverse disincentive to control costs

They were already above that. Especially the not-for-profits (e.g. Blues) had to scramble to get under the cap.

There was a huge amount of waste in the system. 15-20% is a marked improvement.

> "There is no such thing as a legitimate price for anything in health care,” says George Halvorson, former chairman of Kaiser Permanente, the giant health maintenance organization based in California. “Prices are made up depending on who the payer is."

When you can game the pricing you can always just slice 80% from an ever increasing pie.

That's not really how it works. The "ever increasing" pie would have to come directly from increasing subscriber premiums, not from cutting costs and pocketing the difference the OP indicated.

It doesn't matter how much they play with pricing on the back end, the company can't make more than 20% profit from subscriber premiums.

There is a whole lot of backscratching with the profiteers taking their cut of the 80%. That is why we get $30 Tylenol pills under the guise of "care".

Hospitals aren't charging insurance companies $30 for Tylenol and then paying insurance companies under the table if that's what you're alleging.

That's completely illegal and it's just too noticeable for them to do it large scale.

The OP was making a baseless claim because they didn't know what they were talking about, and you're now grasping at straws supporting their claim for some reason.

None of the stakeholders in American for-profit healthcare have any incentive to reduce costs so everything just keeps ratcheting up. Growth can't be achieved by increasing the population of sick people so the only other option is to raise prices. The insurance companies do benefit from this. They agree to cover the inflated pricing so that their 20% cut can be bigger. If ACA permitted rational price controls this whole problem would have been reigned in.

How does this have anything to do with

>I think they're just pocketing the difference between the market rate and what their costs are.

The OP had made a very specific claim about Kaiser. That Kaiser is reducing their costs but pocketing the savings and not passing them on to consumers.

I pointed out that there is no legal way for them to do that. You've made 3 posts and so far nothing you've said in anyway refutes that.

Cancer care at Kaiser was outstanding. They may be spending the money on extra staffing and facilities, not just pocketing it.

The only place where I believe Kaiser falls short and gives the impression of pinching pennies is mental health care.

Is there any private non-university health chain in the country that does mental health well? Every contact I've seen with any acute mental health care system --- except at the University of Michigan --- has been a catastrophe.

Go Blue!

(Hope you’re feeling better)

My employer has a very good kaiser plan, basically I pay $15 for any office visit, and nothing for lab tests, etc. The total unsubsidized price is $1450/month for two people.

I don't know if $725/per person is good or not, but when I've looked around at other plan, I've found plans with far worse benefits (high out of pocket costs) for more money.

It's been a while since I've worked for a company that had Kaiser as an option, but my recollection was that it was more expensive too. The quality of care in a given service region might be higher, but there's a reason that they haven't completely taken over their market.

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