What a field day for the heat
A thousand people in the street
Singing songs and carrying signs
Mostly saying, "hooray for our side"

Monday, January 18, 2010

More on why I think we need an even larger overhaul of the healthcare industry

Okay, this post I've been working on for the past week in the moments when I didn't feel like ripping my arm off, ala the Black Knight in Monty Python and the Holy Grail, to end the pain. And now that I'm referred to an orthopedist for my pain and the first appointment I can get is on the 28th (or a week and a half away for those reading this later). I have one percocet left. I don't think it's going to make it. I'm taking enough tylenol on top of it that I'm concerned about the side effects (I already have the loose stool, next up, hole in stomach and possible heart attack!). And I can't see somebody for another week and a half? Tell me again how we have the best system in the world. Oh yeah, don't forget that at this point I'm down a few hundred and if we go through the whole MRI scenario, that will increase exponentially.

And then I'll have another pre-existing condition to boot.

The other night I had to play the alternate liaison to a local small government agency (actually, an NGO, but we have weird rules here in the US). And, as it is elsewhere, it was time for the health insurance renewal.

They run on an HSA (Healthcare Savings Account) that is set up this way. The first $250/500 a year is the patient's responsibility. After that they are reimbursed. Up to $2500/5000 is the responsibility of the "Savings" part of the deal (which the entity coughs up, pays through the insurance broker for an extra fee, I don't know if the employees contribute to that amount or not, but it doesn't matter for this example). And then anything over $2750/5500 the insurance covers at 100% (in network, our of network is a cost sharing, 60/40 if memory serves).

Okay, so we all have got that. Let's bring it down to just the individual and leave the spouse and family out of the numbers from now on. So, for the first $2750 the individual spends on healthcare that money comes from either the individual's own pocket or from the organization's saving plan set up in the name of the individual. Now, anything over that amount, that's when the insurance actually starts kicking in (not a cent beforehand, though).

We had all the data on the individuals, there's 8 of them, and what they spent (but not what on). One person spent nothing (or less than $250), one person met the $2750 out of pocket (but there was no figure for how much over they went), but overall each person averaged about $1200 still in their account (including the person who spent zero and the person who spent all of it). We're clear here, only one person would have received any moneys directly from the insurance policy.

For the eight employees the insurance cost per month was roughly $4500 (or $54,000 a year). Now, there are two spouses included and one family, so that brings the cost a little higher. And let me say here, that's not bad. Of course, that's a "high deductible" plan and the cost for the employer is higher as they're covering the $2500 per person savings plan (I'm pretty sure, but again, not fully sure it's not shared between the employer and employee).

How much do you think their insurance increased? Again, remember, only one person ended up using it (and while we didn't have any numbers on how much they used, there was no table talk of "well, they had some problems this year").

Did you guess 24%? Okay, well, since they increased the deductible to $3500, only 23.75%. So now they'll be over $5580 (lowest increase) per month for the insurance premiums (depending on the options, the could save as much at $4200 a year or least than one months premium, and that's by increasing their exposure by 150%).

So I asked for what's called "the experience." That's the number of how much was paid into the plan versus how much was paid out. The answer we got back from the broker was, "Normally they don't provide such numbers for a group as small as yours."

WTF. It's not like they have to wake up an accountant who dusts off their green shade and cracks the books with a pencil. Hey, how about we're your frickin' customer and we're demanding an account review. Are you telling me they didn't have this number ready when they decided to up the premium by 24%? If they didn't, I'm willing to call shenanigans. And if they did, hey, it's a frickin' copy paste function. They have keyboard shortcuts to help out with that.

Tell me again why this industry doesn't need an enema. Because, frankly, it needs flushed. Or at least that's what it smells like to me.

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