2014 Health Insurance Premiums - Ouch!

[Smith1942]

My brother is in the military and I have to say, I would have been a lot happier if the exchange plans were TriCare...I truly believe that socialized medicine is a far superior alternative and think that the Affordable Care Act should have provided a federal single payer system. The current plan is like the worst of both worlds...

Have you looked through the coverage?

I am pregnant and due in Feb, thankfully I think that my job is going to continue to offer insurance that covers l&d with a $500 deductible and reasonable copay.

My husband currently does not have insurance b/c we can't afford the premiums for him and we are considering paying the "penalty" for 2014 as there is no way for us to afford the monthly premium for him until the fall when he hopefully will resume working (he is currently in school full-time).

Just in case my job dramatically changes their plan/coverage/premiums, I checked the exchange and ...Here is the maternity coverage on the exchange (I live in NYC).

Bronze: $6000 family deductible, $12,700 family out of pocket max, 50% coinsurance AFTER deductible for in-patient hospital delivery AND 50% coinsurance (after deductible) for delivering physician. Premiums for this are about $14,500/year for a family of 4 with no subsidies and children covered under ChildHealth Plus.

Silver: $4,000 family deductible, $11,000 family out of pocket max, $1,500 per admission AFTER deductible AND $100 copay for delivering physician (after deductible). Premiums for this are about $16,500/year for a family of 4 with no subsidies and children covered under ChildHealh Plus.

Gold: $1,200 family deductible, $8,000 family out of pocket max, $1,000 per admission AFTER deductible AND $100 copay for delivering physician (after deductible). Premiums for this are about $18,000/year for a family of 4 with no subsidies and children covered under ChildHealh Plus.

Platinum: $0 family deductible, $4,000 family out of pocket max, $500 per admission (no deductible involved) AND $100 copay for delivering physician (no deductible involved). Premiums for this are about $20,000/year for a family of 4 with no subsidies and children covered under ChildHealh Plus.

AND, HERE IS THE KICKER...ALL OF THESE PLANS STILL REQUIRE "PARTICIPATING PROVIDERS" SO YOU HAVE TO DEAL WITH THE HASSLE OF MAKING SURE THAT ANY PROVIDER YOU SEE (FROM THE DR TO THE ANESTHESIOLOGIST TO THE PATHOLOGIST TO THE LAB, ETC. IS A "PARTICIPATING PROVIDER" or you'll need to pay in full for the services.

Billed amounts for standard vaginal deliveries with no complications in NYC are about $30,000 and insurance companies usually pay about $10,000. If insurance coverage continues to work the way it currently does...in the Bronze plan, you would pay the $6,000 deductible AND 50% of $30,000...SO A TOTAL OF $21,000...then the insurance company would pay whatever it pays of the remainder, based on my recent insurance bills that would be about $1500 b/c on all my bills from the past few years, insurance companies have paid about 10% of the charged amount.

Whoop-dee-doo...I'll get a "free" breast pump too. In my mind that is one h*ll of an expensive breast pump!

And that is why, if you are planning a family, you don't buy the Bronze plan! We live in Mass which already has RomneyCare, and when we both went self-employed, we could choose our plan. Our premiums are $1,100 per month for us both but all prenatal and postnatal visits are free and a vaginal birth costs 1k to the insured (not sure about billed amounts but it's top-notch hosp, Mass General in Boston) including anaesthesia, radiology, delivery, lab tests, and hospital for mother and baby. And free breast pump too.

Other plans didn't cover diabetic care. You've just gotta read all the small print when buying and relate it to your own healthcare situation.

ETA: Considering we pay over 13k per year for us two, that Gold plan sounds OK. $18k per year for FOUR people? Not so bad. Very low deductible and that $1,200 is per family, not per person. I've heard much worse, considering that private health insurance in the US means fast and accessible tests and results. I had a breast lump; in the same day at MGH Breast Center, despite being only 36. That would never have happened on the NHS. I had reason to believe that my husband has brittle bones; I won't bore you with the symptoms. He goes to see his PCP and he gets a DEXA scan two days later. The NHS is liable to tell you it's very unlikely at his age (45) and tell you to come back for a scan at 65.

If you are truly in trouble on the NHS, you will get your leg saved or your heart replaced and it won't cost you a penny. But tests and results can be very problematic, and so can be getting taken seriously. At 25 I went to my GP and told her I thought I had a particular fertility-threatening disease. She just laughed, told me there's no way I would have it, and refused to examine me or test me. Fortunately for me, I went to a different NHS facility where they did take me seriously, and I did have that disease.

I'm just trying to say that you do, in many healthcare scenarios, get what you pay for. In the UK you get excellent urgent care and no one is bankrupted or loses their house; but you don't get the in-depth GP appointments (NHS target is 10 mins per patient I believe unless you book a double appointment) and you don't get the easy access to tests and speedy results that you get here, no siree. So, there is a benefit to paying those premiums, over the universal healthcare model.

But then, you have to pay the premiums, which you don't in the UK! It's kind of a pick-your-poison scenario.

 

[Beacon]

That may be so, but let's be real......for a lot of people it's not about picking the bronze or silver or whatever. These costs are absolutely huge and many cannot pay them in any way. And many who cannot pay them will not qualify for "assistance" because they make over the limits. It would kinda be ok if they had no other costs like, rent or food or car or student loan, but they DO.

 

[Smith1942]

Well, in the UK people may not have to worry about healthcare premiums. However, the burden of affording accommodation is one of the highest in the world. For many people, servicing their mortgage costs half or 60% of their take-home pay, after the high taxes.

That's the missing piece of the jigsaw puzzle about how people live and afford to live in the UK. The real financial monkey on everyone's backs in the UK is the cost of housing.

So, in a way, we have a terrible financial burden too, it's just in housing. And you might never get sick but you need a house to live in every day.

Here is an example. This small 2-bedroom bungalow is in a low-cost, non-prestigious area. It's got two small bedrooms, a living room and a kitchen. That's IT. Not even built-in closets. In this area, there are not many professional jobs unless you work in retail or you are a doctor, police officer, nurse, teacher - a "key" worker. You could commute to London, but it's difficult. Three hours each way, depending if the trains are running that day. Could be more, could be 20 mins less but no less than that. This house costs 250,000 pounds. That's $400k. And, the annual train fare is five thousand pounds, which is eight thousand dollars, post-tax.

http://www.rightmove.co.uk/property-for-sale/property-28077174.html

We have a HUGE problem with housing, due to so many people crammed onto a small island. Then there are the taxes, and yes people have student loans etc. But somehow, many people get by. Like in the US people make cutbacks, use coupons, etc. At least with healthcare you can take a sort of gamble, but you'll always need a house.

 

[Bella_mezzo]

There is no way that we could afford the Bronze plan at all which is ironic as it is supposed to be the "most affordable"...my point is that that plan as a whole is basically designed to screw the consumer and should have no place in the ACA offering (even without maternity coverage, it's an expensive, tricky mess). Given the cost of premiums and the lack of coverage, these plans are not affordable and will be inaccessible to many/most of those currently uninsured, as well as a large number of those who are currently insured.

If you are a responsible "middle class" person who goes on the exchange, buys what seems to be the most affordable plan, spends a huge chunk of your income on premiums, and then has very thin coverage with coinsurance that you will likely not be able to pay...how is that better than just not being insured in the first place? You'd be better off paying the penalty, saving what you would have paid in premiums, and negotiating with the provider as an uninsured person...

Smith-I used to live in MA and found the insurance options there to be far better than other states where I have lived (PA, LA, IL, NY...). Also, one of the years I lived in MA I made very little money (well under $20k) and was covered by "free care" at Brigham and Women's hospital. That was the best and most clear cut medical care I have ever had in my life!

For the vast majority of the country, there is nothing "affordable" about the ACA plans, plus they don't address the underlying issues of complex billing/registration or plans and treatment, "preferred provider" networks that result in insured people still having to pay astronomical bills, and the seemingly intentional lack of transparency regarding who controls coverage/treatment/makes a profit. The money stream is so convoluted, the paperwork so complex, and the options so designed to trick the consumer and benefit everyone else (insurance companies, drug companies, hospitals, etc.), that American healthcare is truly a time- and money-sucking maze for its citizens.

Regarding an earlier comment in the thread. I have no issue with people making money and with income disparity, BUT America has become very skewed towards supporting corporations/institutions over individual citizens. Because of this, the income disparity has grown unchecked to an extreme position that is untenable and detrimental to the majority of American citizens. Free market capitalism can certainly be a viable economic model for a country, but for it to function remotely effectively you have to be willing to take the downside risk as well. America has chosen to protect its corporations/institutions from downside risk at the expense of exposing its individual citizens. I do not support that!

Back to the topic...

Smith-My GP in NYC rarely sees me for more than 5-10 minutes when I go in (which is very rarely), so no loss there if I was on NHS

We are a family of 3, soon to be 4, living in NYC (b/c this is where my job is and my DH's school is so we can't move at the moment). We are already just making it in NYC given the cost of living which keeps going up. We make just a few dollars more than the subsidy cut-off for the affordable care act. In general I would say that I make a very good salary (especially for the non-profit sector in which I work) and we have worked hard to make our budget work for our family.

DH got laid off this past year very unexpectedly and since he was in the middle of a career change it was better for him to just accelerate his schooling and go full-time.

My student loans come due in Jan and will need to be deferred until DH is working. We don't have extras in our budget (no cable, no landline, basic internet which DH needs for school, boost mobile cell phones, public school for our son, thrift store/ebay clothes, grocery shopping at Aldi and through a CSA, a very used Prius which DH needs to commute to his school and we street park in NYC which takes hours a day but we can't afford a garage, we're selling my bling to make my final MBA tuition payment, etc.) We bought our small 2 bedroom coop when we were both working so we don't have the flexibility to move, but when you factor in principal payments and interest deductions, we pay less per month than we would to rent in our middle class neighborhood.

Despite all these constraints, I still recognize that our family is "upper middle class" and is tremendously financially advantaged compared to many New Yorkers, and certainly to most of the rest of the world. I am very grateful to what we have and believe that we have a lot! But, when you are squeezed from all sides with federal taxes, healthcare premiums, state AND local taxes, student loan payments, and some of the most expensive housing in the US...the current "affordable care" options are untenable.

The only way we could pay for DH's ACA premiums would be to take out student loans to pay them...at that point it seems more prudent to just take the risk of having him uninsured for one more year...it is a hard decision...and many, many families/individuals will have even more untenable situations than my family.

 

[Smith1942]

That is all very interesting, Bella. Wow, NYC, that is one expensive city! Yes, healthwise we are lucky to live in Mass. I'm sure you could still get screwed here though, if you had a combination of bad luck with your health plus the wrong plan.

I don't know what the answer is about the non-affordable premiums. As in my message above, and in the sample house, in the UK we have non-affordable housing on top of the high taxes and non-affordable commute fares too (eight thousand dollars before tax in the sample above). Also, salaries are generally quite a bit lower in the UK, and 40% tax kicks in at $57,000 equivalent, plus the non-affordable housing.Oh yes....and 20% sales tax. But somehow, people of ordinary means do buy houses and do have holidays and scrape by. Lots of credit card debt.

Just trying to think of things the British might not spend their money on that Americans do, and vice versa. I don't actually know how people afford to live in the UK, given the scenario I described above and in my last message. Well, our houses are much, much smaller, and the radiator heating is less efficient than the baseboard. I was cold a lot more of the winter in the UK than I am in the US, and I live in Boston! But I think people eat out in the UK as much as in Boston, and people in the UK have cable, cellphones, everyone has a car and people go on foreign holidays. This is all ordinary families I'm talking about, which a joint income of perhaps $70k equivalent, maximum. I have been in American houses and they have far, far more "stuff" than most UK houses, generalising wildly. When I looked at 40 places in the pursuit of our condo, I simply could not believe the amount of stuff crammed into those houses. I have never seen so much stuff in my life. Of course, things are much cheaper in the US, without 20% tax.

That's the only difference I can see in spending habits between the US and UK. Less shopping. Oh, and people move less, too, I think. Moving house costs a hell of a lot of money, and many British people stay put for decades. There are fewer work centres in a much smaller country, of course.

I have absolutely no idea how we afford our houses in the UK, with their price and the lower salaries and the higher taxes and the 20% VAT. Somehow, we just do.

ETA: OK, according to the Office of National Satistics (ONS) the average salary in the UK is 23,244 pounds. The average house price is 171,000 pounds.

That's an average salary of $37,190 and an average house price of $273,600.

The average US house price is $152,000 according to Zillow (the US Census website is not running due to the shutdown) and the average US salary is $52,100 according to the New York Times last month.

So, 37k average salary and 274k average house for the UK.
52k average salary and 152k average house for the US.

Factoring in the UK's high taxes and the 20% VAT, on paper the US looks like the more affordable place to live. If the UK ever did away with the NHS, the majority of people wouldn't be able to pay any premiums at all. They're too busy paying the huge mortgage for a tiny house with what they've got left after the taxes!

 

[Bella_mezzo]

Bella - that is just - I cannot imagine

Are they out of their minds! No one can pay that!

the math looks like you would pay the 21K PLUS the huge premium for the healthcare itself. Over 30K out of pocket. Come on - it would be better for MANY people to just go unemployed and make the government pick up that whole tab.

I know, it's crazy! Yes, the $21k would be on top of the premiums (and you'd still have to pay 50% for any other medical services you needed in the course of the year). Though in fairness there is an "out of pocket max" so provided everything is in network, etc. there should be a $12,700 cap...but premiums are separate from this.

One of my biggest issues with US health insurance is that providers, especially hospitals, will bill patients huge amounts and then accept pennies on the dollar from the insurer. So, the family has to pay $15k of the delivery bill and the insurers "50%" is more like $1500. At a minimum, it would be more reasonable for the family to have to pay what the insurance company pays as its "50%".

But yes, these plans are totally unaffordable in terms of premiums and in terms of coverage. I just don't see people being able to pay for premiums, let alone coverage...

 

[Bella_mezzo]

Smith-UK housing and commuting is crazy, I really don't understand it. What kinds of financing are possible for a house? $400k house on $70k income is very tight! When I bought my place it cost less than that and I made a little less than that, but the only way for me to make the $ work was to rent out he second bedroom...(and my then employer paid my full healthcare premium for a platinum BlueCross plan so I didn't have much at all in the way of healthcare costs at the time

 

[Smith1942]

Bella, the house financing is bad, too. When I found out that there was such a thing as a thirty-year fixed mortgage in the US, I nearly fainted. Never had I heard of such a beautiful, wonderful thing. In the UK, mortgages are generally fixed for two years, period. Then they go up and down like whores' drawers, according to the vagaries of the interest rates, but generally up. There are some deals for five years fixed, but generally the good deals are for the two-years. We have never heard of mortgages fixed for thirty years in the UK. You can't accurately predict what you will pay over the mortgage term. Another financial worry.

I understand that many families are poor and can't afford the healthcare premiums. It's the same in the UK - families who can't afford housing, heat, etc. Of course, we have a much more generous welfare state, paid for through the higher taxes.

I guess what I'm wondering is, since the US has these higher salaries, lower taxes, and significantly lower housing costs, plus much lower sales tax, in theory the premiums should be more affordable for ordinary families than they would be, say, if the same scenario were to hit the UK. Because looking at those comparative house and salary averages I posted above, it's much cheaper to live in the US.

ETA: on top of all the things I've mentioned, the weather is famously cold, grey and damp in the UK, and when I go home I notice how old, dirty and broken everything is. I tried to use four payphones - all broken. I tried to buy a train ticket at the station - 75% of the machines, broken. The buildings are old and dirty - the place just looks really shabby compared to gleaming Boston. There has been decades of under-investment so the train system breaks down ALL the time - the most common excuse is leaves on the line - and there are no roller rinks, ice rinks or outdoor swimming pools like there were in the Fifties through the Seventies. Even the municipal indoor pools in my hometown are looking seriously rundown and tired, now.

The healthcare premiums are a real bugger, I know, when you're not used to paying them each month. But on balance I think things are probably worse in the Old Country, overall - in terms of daily living and trying to make all the sums add up.

 

[Beacon]

Smith, isn't is true that outside of London the costs for housing are better? My sister lives in the UK, in Berkshire and also owns a property in Oxford she rents out. They are not cheap properties but far more affordable by comparison than what you can buy were I live (silicon valley, California).

I know London is INSANE, but it is so many foreign people buying there, paying all cash. London is so prosperous, but the countryside, isn't that much different?

 

[Smith1942]

No, houses way outside London are very expensive too. Did you see the house sample I posted in the link above? It's tiny and nowhere near London, it's right on the south coast in an area with not much work available. Houses are a bit cheaper up north, but the salaries are significantly lower. Have a further look on that website if you want to - you'll see what I mean.

London is like a different country all on its own. The average house price in London is now 500 thousand pounds - $800k.

Average Uk salary is $37k equivalent, average house price is $274k.
Average US salary is $52k, average US house price is $152k according to Zillow.


ETA: Just read your message more carefully. The work distribution is different in the UK. There are far fewer centres of work, and in fact most of the well-paid jobs are in London. So, to carry out the same function in the UK as you do in Silicon Valley, you'd have to be either in London or somewhere expensive and leafy on the south coast, like Farnham (I think Sun Microsystems is in Farnham) or somewhere in the commuter belt where some tech companies are, which is also super-expensive as everyone who works in London wants to live in the commuter belt!

What I'm saying is, you wouldn't be able to get your current salary equivalent in Oxford or Berks. Berks is commuter belt and also very expensive.

Here you go. A modest, small 3-bed row house in Newbury, a typical Berks town, is 400k in pounds, so $640k. That's about 1 hour 30 mins from London. And nicer, single-family 3-bed homes in the area are about 650k in pounds, so over a million dollars.

http://www.rightmove.co.uk/property-for-sale/property-40484767.html

We seem to have gone a bit off-topic! I'm just saying I come from a country that has such impossible economics that the healthcare prems don't seem quite so bad from my perspective. If I didn't live here I'd be paying out just as much in crazy mortgages, taxes, sales taxes, earning less etc, all while living in a dolls' house!

At least you can have a nicer house here to sit in while you fret, and the baseboard heating to keep your feet warm while you worry!

 

[Beacon]

I took a look at that website at Berkshire, which is where my sister lives.

Sadly, it is cheaper than my area. Most everything is, and so is Berkshire. I was looking at places for 800 pds. Much better than what we can get here for that. But I agree, UK stuff is all falling apart and the standard of living is definitely lower than here in the US.

 

[Smith1942]

Right, Berks is cheaper than Silicon Valley, but my point is that you wouldn't be able to get your current salary in Berks - it would be much lower there as it's not a tech centre. You'd have to be in London, probably. (Sorry, I'm just assuming you work in the tech industry and that salaries in the Valley area echo the high house prices - but perhaps that is not the case.) Silicon Valley is so expensive because there's so much high-quality work available, partly.

Also, I chose an ugly house with not much going for it. The nicer houses will be much, much more. Probably not as much as the Valley though - but salaries are much lower too, and you'd be paying 50% tax!

Yeah, the UK's been falling apart for decades. DH and I both think that, all things considered, it's quite a depressing place to live these days.

 

[Beacon]

That is sad Smith. Sad and true, I guess. When I've been in London, it feels like that - falling apart. Even the places that are supposed to be nice. I hope the US doesn't go like that. England was once the world's power. But no more.

I fear we will meet the same fate here. I feel bad for my sister living there - I couldn't take it myself. She's been there so long I think she doesn't notice the difference much. US is good at present. Hong Kong is killer good. There are places. We'll see.

 

[ksinger]

Bella - that is just - I cannot imagine

Are they out of their minds! No one can pay that!

the math looks like you would pay the 21K PLUS the huge premium for the healthcare itself. Over 30K out of pocket. Come on - it would be better for MANY people to just go unemployed and make the government pick up that whole tab.

I know, it's crazy! Yes, the $21k would be on top of the premiums (and you'd still have to pay 50% for any other medical services you needed in the course of the year). Though in fairness there is an "out of pocket max" so provided everything is in network, etc. there should be a $12,700 cap...but premiums are separate from this.

One of my biggest issues with US health insurance is that providers, especially hospitals, will bill patients huge amounts and then accept pennies on the dollar from the insurer. So, the family has to pay $15k of the delivery bill and the insurers "50%" is more like $1500. At a minimum, it would be more reasonable for the family to have to pay what the insurance company pays as its "50%".

But yes, these plans are totally unaffordable in terms of premiums and in terms of coverage. I just don't see people being able to pay for premiums, let alone coverage...

I'm obviously not privy to your personal experiences, but mine have been exactly as you say they should be, and for many years across many different insurers and with a range of procedures and tests.

The best example I could come up with would be a surgery on my hand several years ago. I had a long-time small yet very painful tumor deep between my 2nd and 3rd fingers on my right hand, that I banged up all the time and was slowly enlarging, and so I decided enough was enough. I had it removed. It was outpatient, about a 3 hour stint in an operating facility. The doctor charged $2900 for his services, and the facility charged $17,000. So we're talking getting charged $20,000 for 3 hrs outpatient. While I'm certainly not disparaging the importance of the skill needed to be sure that my hand functioned at the end of the surgery, or the quality of the surgical team, I'm sure most here would have about the same reaction I did - $20,000??? For THAT???

At the end of it all though, I seem to recall that the allowable charge for the doctor's services was around $1100, and the allowable for the facility was about $3000, both of which I paid a portion (deductible plus 20%). So yeah, the hospital did charge huge amounts, but just as you said, I did not pay MY portion on the billed 20,000, but paid my percentage just as the insurer did - on what the insurance had negotiated as the "allowable" price for that particular service.

While there is much to work out with the ACA, one really good thing is that it is ripping the veil of obfuscation away from how this particular sausage has long been made. Those premiums quoted sound high, but if you've ever been on COBRA, you have a better idea of how much your insurance actually costs even under a group plan, and you become aware of just how much your own insurance has been "subsidized" by an employer. Almost no one has been seeing or paying the full bill for their insurance. Now we might get a slightly clearer picture. (Of course, trying to make this stuff so arcane that even a bright person can't tell up from down, is an insurance strategy I'm convinced.) I'm also pleased to note that the deductibles, coinsurance, and copays all apply toward the yearly out of pocket. Many plans currently out there apparently have a deductible that must be met that does NOT apply to the out of pocket. Now THAT is a true rip off right there, and that's going on as we speak. The ACA does not allow that practice, so there is one thing cleaned up a bit. And having stared down the barrel of a pre-existing at one point I can say that it is great that that problem - which affects so many - has been put to rest.

And while the vast majority of us here - who have jobs that supply insurance, or enough to buy individual policies - grouse about the high cost, in Republican states like mine that opted out of the Medicare expansion, there are hundreds of thousands of the working poor - the very ones this law was supposed to help the most - who are finding they can neither qualify for Medicare OR subsidized premiums with the ACA. Talk about a kick in the teeth for those poor folks.

http://www.nytimes.com/2013/10/03/health/millions-of-poor-are-left-uncovered-by-health-law.html?hp&_r=0

 

[Bella_mezzo]

ksinger-that is great that you were able to pay the fraction of what was billed. I have never been able to settle for that low, even when I negotiate. My best negotiating outcomes with providers have been when no insurance is involved (e.g. something is totally uncovered or the patient has no insurance). The bigger issue is why the extremely inflated amount was billed to anyone in the first place. That is a large part of the problem with our healthcare system.

I have been on Cobra, have purchased insurance on my own, and have had to pay the full unsubsidized rate for health insurance for myself and my family so I am well aware of the full costs without employer subsidy.

I know that many, many people are worse off than my family and especially feel for the working poor who fall through the cracks. I only posted my example as one case study of who can fall through the cracks/be squeezed by this system. There are so many more, and many are more heartwrenching than my family...

Again, I think the only way this system works and becomes remotely affordable/helpful is a federal singlepayer system.

 

[ksinger]

ksinger-that is great that you were able to pay the fraction of what was billed. I have never been able to settle for that low, even when I negotiate. My best negotiating outcomes with providers have been when no insurance is involved (e.g. something is totally uncovered or the patient has no insurance). The bigger issue is why the extremely inflated amount was billed to anyone in the first place. That is a large part of the problem with our healthcare system.

Absolutely agreed. The amounts charged are just insane. And have you ever tried to get an ITEMIZED bill so you can see what they're charging for what? OMG. And just setting FOOT in an ER around here - you know, if your problem goes away before they have to lift a finger - will rack up an $1800 bill. I bet you the amount I had to shell out each time (about $500 a pop) that they billed me for the X-ray that they didn't do. Each time, someone rolled the X-ray machine to the door, and the nurse would say to the guy, "No, the Dr said she doesn't need that." What do you bet they billed me part of that insane amount for it anyway, because they seemed to roll that sucker up as a matter of course.

I have been on Cobra, have purchased insurance on my own, and have had to pay the full unsubsidized rate for health insurance for myself and my family so I am well aware of the full costs without employer subsidy.
It sounds like you have spent most of your time on individual polices, while I have spent most of my time on various employer-sponsored plans. I'm sure that's where the negotiated price comes in, although you would think that if the insurance companies can negotiate with the provider for a reduced fee, they could also do so on behalf of their policyholders, Insurance companies are evil.

I know that many, many people are worse off than my family and especially feel for the working poor who fall through the cracks. I only posted my example as one case study of who can fall through the cracks/be squeezed by this system. There are so many more, and many are more heartwrenching than my family...

Yeah, I tend to be most grateful that I can bitch about the price, rather than worry every day that my life is being shortened by lack of adequate care.

Again, I think the only way this system works and becomes remotely affordable/helpful is a federal singlepayer system.

110% agree on this. And I think we'll see the country move that way over time. It's the only way we're going to get the costs down from the riduclous 17-18% of GDP that is chewed up by healthcare.

Edited multiple times for readability. I think.

 

[rosetta]

Right, Berks is cheaper than Silicon Valley, but my point is that you wouldn't be able to get your current salary in Berks - it would be much lower there as it's not a tech centre. You'd have to be in London, probably. (Sorry, I'm just assuming you work in the tech industry and that salaries in the Valley area echo the high house prices - but perhaps that is not the case.) Silicon Valley is so expensive because there's so much high-quality work available, partly.

Also, I chose an ugly house with not much going for it. The nicer houses will be much, much more. Probably not as much as the Valley though - but salaries are much lower too, and you'd be paying 50% tax!

Yeah, the UK's been falling apart for decades. DH and I both think that, all things considered, it's quite a depressing place to live these days.

Ok off topic but here goes.

London is almost impossible to live in for all but the very rich. I have no idea how people on average incomes manage it. I love London and our salary is so much more than the average, that we are far off the scale here:

http://www.ifs.org.uk/wheredoyoufitin/

And yet, we cannot afford a decent 4 bed detached house in a nice area of London, without making big sacrifices. Nothing fancy, just a normal house that we are willing to do up ourselves. If we get a big enough house, we can't afford to have the kids to put in it! Now, affordability is relative. We enjoy a good quality of life, with regular holidays and some luxuries. If we lived on beans on toast, we could get a nice-ish house and maybe have a single child. And then I'd have to get my tubes tied. I don't have strong urges to have kids, and I'm grateful for that.

I expect London to be shabby, frankly the city is ancient and it looks it. Not very long ago, the smog was legendary. It has layers of history that a new city can't even begin to rival. And I love that about it. I think it's infrastructure is actually fairly sound considering how many people live here. New York is way shabbier, but that's unsurprising too, given how densely populated it is. Big cities will have grotty bits. Fact. I can leave my house and find something new to do in London every day for the rest of my life. I'll take that over living in a beautiful house in the middle of nowhere any damn day.

We have foreign investment driving house prices up, which the govt now is propping up themselves (help to buy scheme anyone?) because a crash would be a disaster. Average families just can't afford to buy a house here, and will just have to rent for the rest of their lives, or leave London. There are other areas that are way more affordable, but the catch is getting a job there. I didn't grow up in London, but I feel sorry for those who have lived here for generations, and now can no longer afford to stay.

 

[Bella_mezzo]

Yes, the itemized bills are insane! I am currently disputing a $300 flu shot given as part of an annual physical from 2010 which my whack insurance at the time apparently decided not to pay b/c "adult immunizations are not covered" even though I called in advance and they specifically said that flu shots were covered...and they didn't send me any notification about the bill, so it's in collections now so the provider can't negotiate with me. We'll see how that ends up...

I have had several employer-sponsored healthcare plans in addition to my forays into individual plans. One was great and you could include your family $12/month (pity I was a single lady at the time, one was awful and I had to pay $800/month just to add my 2 year old son to the plan--which it turned out covered almost nothing, the network was tiny and labs were almost never covered (this is the plan I had at the time of the "flu shot" ), and the one I have now is decent coverage, decent network, and I am pretty happy with it. My employer pays my individual premium which is great and I have to pay the difference in premium to add children or family which is about $500/month to add 1-2 children or $1100/month for a family plan.

I am very grateful to have the current insurance I have. Although we can't afford to add my husband right now, I think that it is a reasonable plan compared to what else is available and much, MUCH better than what is available on the exchanges; however, I don't think that these premiums are "affordable" for families for many middle class and working poor families, even with the subsidies, and think that the coverage/network issues that the NY exchange plans offer will result in much higher out of pocket costs for the majority of participants (even for those who were previously uninsured).

 

[Smith1942]

Ksinger - so basically, hospitals can charge these wild amounts, but there are caps in place - i.e. allowable amounts - which means that saying, "Oh, the bill is 20k for day surgery on your hand" is basically meaningless? At least, in your state, maybe. Bella seems to have had a different experience in NYC. I am getting the impression that that city is not very healthcare-friendly!

A British friend did fall sick on vacation in Florida a few years ago. She had severe ovarian pain, I think it turned out to be a cyst. She was not admitted; I think she went to the ER and had an ultrasound. Anyway, I think she said the hospital asked her for a thousand, but I can't remember if she meant dollars or pounds. She said no way am I paying that, and they cut the bill in half. Seems like hospitals just throw these wild sums around, thinking that sometimes they'll stick. i.e. - sometimes people will pay.

Agree that if you've been on COBRA, you see the full cost of the insurance. When we were on it, we saw that our insurance cost the employer $1,350 and they mistakenly had us on a family plan even though we had no children. My husband paid $230 of that, and in his company people who earned more subsidised those who earned less. So, a secretary would not be paying the same portion that my husband did.

Rosetta - I actually think London is pretty snazzy, with its lovely centre and gorgeous stucco areas like Pimlico, Mayfair, Kensington, Notting Hill, etc. I lived in London for five years and loved it, although I felt like such a pauper all the time! If I won the lottery I would buy a lovely place in Pimlico, which is where I lived for 2.5 years. Of course, places like Woolwich are a different matter. In the above, I was talking about my hometown, Brighton. Although it's very trendy now with some lovely areas like the Lanes, the main shopping street is just awful these days - used to have beautiful old department stores and now it's just discount store after discount store, and cheap takeaways, and there is no good shopping. The nicest store is a crap Debenhams! The lower end of town where the Lanes are has the high-end boutiques and cobbled streets and chi-chi restaurants, but the rest is looking very down-at-heel and all the buildings are dusty and dirty. Never noticed that until I moved away and then went back on visits.

With all the stuff I've posted here about UK house prices and taxes and commutes etc etc - I won't bore anyone by repeating it all - I'm just trying to say that finances are just as hard in the Old Country. In fact, looking at the averages I posted, they're quite a bit harder than in the States. So even with the unwelcome new premiums, you could be in worse places!

 

[ksinger]

Ksinger - so basically, hospitals can charge these wild amounts, but there are caps in place - i.e. allowable amounts - which means that saying, "Oh, the bill is 20k for day surgery on your hand" is basically meaningless? At least, in your state, maybe. Bella seems to have had a different experience in NYC. I am getting the impression that that city is not very healthcare-friendly!

A British friend did fall sick on vacation in Florida a few years ago. She had severe ovarian pain, I think it turned out to be a cyst. She was not admitted; I think she went to the ER and had an ultrasound. Anyway, I think she said the hospital asked her for a thousand, but I can't remember if she meant dollars or pounds. She said no way am I paying that, and they cut the bill in half. Seems like hospitals just throw these wild sums around, thinking that sometimes they'll stick. i.e. - sometimes people will pay.

Agree that if you've been on COBRA, you see the full cost of the insurance. When we were on it, we saw that our insurance cost the employer $1,350 and they mistakenly had us on a family plan even though we had no children. My husband paid $230 of that, and in his company people who earned more subsidised those who earned less. So, a secretary would not be paying the same portion that my husband did.

Rosetta - I actually think London is pretty snazzy, with its lovely centre and gorgeous stucco areas like Pimlico, Mayfair, Kensington, Notting Hill, etc. I lived in London for five years and loved it, although I felt like such a pauper all the time! If I won the lottery I would buy a lovely place in Pimlico, which is where I lived for 2.5 years. Of course, places like Woolwich are a different matter. In the above, I was talking about my hometown, Brighton. Although it's very trendy now with some lovely areas like the Lanes, the main shopping street is just awful these days - used to have beautiful old department stores and now it's just discount store after discount store, and cheap takeaways, and there is no good shopping. The nicest store is a crap Debenhams! The lower end of town where the Lanes are has the high-end boutiques and cobbled streets and chi-chi restaurants, but the rest is looking very down-at-heel and all the buildings are dusty and dirty. Never noticed that until I moved away and then went back on visits.

With all the stuff I've posted here about UK house prices and taxes and commutes etc etc - I won't bore anyone by repeating it all - I'm just trying to say that finances are just as hard in the Old Country. In fact, looking at the averages I posted, they're quite a bit harder than in the States. So even with the unwelcome new premiums, you could be in worse places!

Smith, basically, yes they can. And do. There is no agreed upon anything anywhere. There are only caps IF the insurer and the healthcare provider have a working arrangement - we will make you in-network and funnel you business, and you agree to take what is "reasonable and customary" for this area. Of course that never stops them from printing those outrageous bills that make people think they're going to stroke out. And this is something that MUST be brought under control if we're going to get healthcare under control. It's a pretty pitiful situation. This article is pretty good for giving you an idea.

http://www.huffingtonpost.com/2013/05/08/hospital-prices-cost-differences_n_3232678.html

I'm curious - did all the employees at your husband's company have access to the same plans? What was going on there - the subsidy - would seem to be illegal, although I'm not sure if it is. How did that work?

I've worked at a company that tried some pretty shady dealing with a few of its employees - this was pre-HIPAA - where the employer was informed by the insurance company exactly WHO was running up the costs, and then tried to cull those two off from the herd (so to speak) and get them out of the group, and pressure them into taking much more expensive and restrictive individual policies, which was big-time illegal even back then. I will give myself a rare public pat on the back for getting so pissed off when I heard of it that I funneled both of those employees (who were clueless and stressed, poor things) so much information that, well let's just say that the employer's nefarious plan didn't work and it was a good ending for both of the employees. But man was I lyin' LOW. There were some highly annoyed execs who (via the grapevine) were trying to find out WHO had given them that info and foiled their plan, dammit.

 

[Smith1942]

Well done, Ksinger, for helping the employees!

As far as I'm aware, there was no choice of plans at my husband's company - you just had what you were given. And I just remember that he said he paid higher premiums than someone in the company who earned very little.

Thanks for the Huff article. I read it all the way through.

 

[Dancing Fire]

My daughter must figure out what to do before the 19th of March .... .. can a student go on welfare?..