- If my health insurance lists a benefit value of $1500/mo for PrEP, and has a sticker price of $500/mo in other countries (and out-of-pocket might be $15-$60), is the "value" of the care I receive 3x greater than that received by a similar person in Belgium? Is it 25x the value of the same care received by someone in Ireland?
- If the healthcare I receive includes GP visits needed to get a referral to a specialist to satisfy my insurance co, or extra tests to convince them that a procedure is necessary, is that "value" that I received?
- If 20-30% of healthcare costs are billing and administration, is that "value"?
Our employers aren't just stealing this money from us, but for-profit healthcare providers and health insurance companies and pharmacy benefit manager companies creating inefficiency to their benefit and to the harm of patients.
https://www.thebody.com/article/what-does-prep-cost-outside-...
Do you? Regardless of the price in other countries or what processes are currently “required”, there’s the price you have to pay. If you are going to buy a car, you either “value” it at or above the price you pay, or you don’t buy it. Why is healthcare different?
As someone part of a family that has recently consumed a lot of healthcare (myself included), I am not ignoring them at all, pretending they don’t exist, or arguing that we don’t need significant reform (I think we do). But they currently do exist and they currently are part of the cost and therefore currently dictate the value.
Your beholden to your employment to keep it and if you work for a smaller company they usually have shittier plans leading to worse bargaining power. Also if that company is looking to cut costs they may choose even worse plans which you have ZERO control over.
Just because that's the way it is doesn't mean things couldn't improve.
If you are going to buy drinkable water, you either "value" it at or above the price you pay, or you don't buy it. Why is healthcare different?
Americans don't "value" their health 2x more than people in other developed countries. But Americans pay more for worse outcomes. It's silly to say that our worse-performing, often racist, hostile-to-the-poor healthcare system is providing "more value" just because corporate interests have aligned to price it higher.
If I live in a company town where my employer owns the water supply, and tells me that the 'cost' of that water has increased by some enormous multiple, and now they'll pay me a 'water benefit' in lieu of compensation increases, it would be absurd to say if I'm doing the same work, consuming the same amount of water, and getting the same pay, that my company is suddenly providing me "more value" just because it has declared that the cost of the same amount of water is higher.
That’s not to say I’m happy with it or would like to pay those inflated rates. Or that I don’t wish it were cheaper for me and for everyone else. But when it comes down to it, the value I have placed on it is higher.
If fact, other countries may value their health more than average Americans, given relative activity levels and rates of obesity and other diseases such as type 2 diabetes, despite their cost of healthcare services being cheaper.
Suppose we built a Byzantine system around food like we do for prescription drugs. Food can be powerful medicine after all ... so imagine if you needed a nutritionist to prescribe specific foods in specific quantities. When you go to the grocery store, you're not allowed to just pick whatever, and you don't find out the cost of anything until weeks later. Grocery billing specialists send endless documents back and forth. Everyone in this society spends twice as large a portion of their income on food as their peers in other countries, but the food is worse. Food becomes so expensive and costs are so unpredictable that employers provide grocery insurance benefits that pull down the salaries they can pay. But when you're hungry, you need to eat so of course you "value the food you've received recently more than the price you paid for it". Does the fact that a hungry person with no options will pay a lot to not continue being hungry really imply that the high prices in this system match high value being delivered? Or can we perhaps recognize that the value being provided (food to be eaten) is similar to the food-value provided at much lower cost in other systems, and therefore the high prices in this system do not imply that its services are especially valuable?
I find it really hard to understand how people will continually go against their own self interests to align with their beliefs, without question.
Things can be different, things do change and we're not always right.
Data has shown we could all be spending considerably less on Healthcare with single player [1] and not be at the mercy of our employment for it... But it's still shunned because it's socialism or some other reason.
1. https://www.ucsf.edu/news/2020/01/416416/single-payer-system...
Do you think all of those tests are irrelevant? Who sent you to the specialist, if not your primary care provider?
What do you think health care value actually is? It appears you don’t think it includes actual care or diagnosis.
Who should I trust more with my health? My doctor, or my insurance?
In October of 2019 I needed a hip replacement. I had bone grinding into bone. You could literally hear it if you walked beside me. Imaging showed it clearly. My doctor, being a doctor, knew that the best course of treatment was to replace it with a prosthetic ball and socket, despite the risks (I will need two more in my life, if I live to average age).
My insurance refused to pay for it, saying my age alone disqualified me (too young).
It's 2024. I'm still fighting that insurance company. I'm totally healed, feel no pain, and can actually run as a hobby. My health as a result has drastically improved.
Do you believe that health insurance companies provide value?
And GPs and other medical professionals have complained to me in the past that some test is not actually necessary, that they are confident in a diagnosis, but some additional test is necessary purely to convince the insurance company that they do in fact know what they know.
I value diagnosis by the appropriate trusted medical professional. I do not value the opinion of my insurance company.
It has a high cost, I'll grant. But value isn't the same as cost, especially in a captive market.
Over my career, I am upside-down on my healthcare costs to the tune of six figures - and that's after kidney stone surgery some years back...) I think I'll pass on succumbing to cancer to try to recover a bit more, though...
You’ve just described insurance. If everyone took more than they used, it wouldn’t work.
It's not pre-paid care. It's not a discount plan. Really, it's a gamble.
Health insurance is ridiculously expensive because health care can become ridiculously expensive. Sure, you're healthy and accident-free, but the costs of a traumatic accident or long-term illness could easily reach 6, possibly even 7 figures in the long term. That's what your insurance is paying for.
For any type of insurance to work, you need people that aren't making claims to fund the people that are making claims. If you take the attitude of "Why should my premiums pay for someone else's care?", then really there's no reason to even get insurance. Your insurance is costing $25K/year, because statistically, the average family has at least $20K in healthcare costs per year (Assuming the insurance company is satisfying the ACA requirement of 80% of premiums must go to paying for care).
Your $25K/year in premiums is a bet that you won't need some $Y to pay for healthcare, where $Y >>> $25K. Most of the time, you're losing that bet, and the insurer is making $25K off of you. But if you ever find yourself in a world of hurt (quite literally), you'll be glad you made the bet.
Imagine an alternative world where health insurance acts more like a mortgage with an amortization schedule. when youre young (and have low savings) your premiums act like they do now - simple insurance. But as you age, your payments are split gradually between pure premium and an HSA. The amount you’re personally liable for increases as you age, but so does your ability to pay out of pocket. For high earners this scheme makes a lot more sense (because youll have a few hundred thousand in health savings by retirement).
Most people actually do the above but clumsily and also in the opposite order - HDHP plans are more broadly useful when youre young and healthy because you probably wont have high medical costs so you just save on premiums.
This world could be disastrous.
Imagine your entire savings wiped out by a single incident. Though this already happens in the current world.
Also, that world would simply not work for low earners.
My health insurance is not free (it is taxed as a separate social tax) but it is way, way less than this.
There is still one important disclaimer to add. Because very good niche doctors who can perform very specific rare procedures can charge a lot more in US then it can happen that these doctors will emigrate to US from EU and it is possible but not necessarily true that this kind of very expensive insurance could cover such procedures and make them more available for US insurers than for EU insurers (e.g. tax payers).
Or, alternately, look up the word “insurance” and realize what its purpose is.
Where’s that story?
It doesn't explain how Gen X won't be able to retire, or how 80% of Americans can't afford new cars, or how the average person can't afford a home in 99% of America. And, it sure as hell doesn't explain what's going on at the grocery store, or in the used car market, or in the rental market. (All of which has been previously / recently discussed on here, BTW.)
And, it for damn sure doesn't pay my bills. That story and $3 doesn't even get you a latte at a chain coffee shop anymore.
No, it's just some made up BS to either gaslight us into thinking everything is fine, or make wealthy people feel okay about all the exploitation it takes to turn the crank that makes them a dollar.
That’s what I expected. The annual food stamp benefit appears to be less than the employer covered plans for health care at companies commonly employing people on this site. But I’m open to reading GP’s articles.
It's not like it's a free market because you can't just kick them to the curb a month later like you can with car or homeowner's insurance.
Workers look at the total compensation package, not just wages alone.
So much 'value' that millions of Americans still end up in medical debt, with many having to resort to medical bankruptcy even as 'insured' individuals.
Too many exclusions, too many ways to deny coverage. The private health care system of the US is broken.