under pressure

[shaynabelle]

I am obsessed with the health care reform vote today. Can't stop loading cnn.com, this HC twitter list and Ezra Klein. Might something really happen?

It's going to be a cold but beautiful Sunday and we have few plans. This is rare, and will be enjoyed.

Comments

[summernot]

"Reality" might've been a little better term than "Fact" on a few of her points. ;) But she did base her figures on the CBO report, so it's not exactly an opinion.

wrt pre-existing conditions, Texas already has an exchange/pool in place for those who have pre-existing conditions. What is being proposed is no different. 31 or 32 states already have these pools. It is still quite expensive. There's no getting around that, unfortunately, whether insurance is obtained through the existing program or through what is being proposed.

At least until the bill goes into effect, you might price out some plans through ehealthinsurance.com that are low premium/high deductible plans and couple that with an HSA. Put about $50 per month for each of you in the HSA, then pair it with a plan with a high deductible but one that is comprehensive once you hit that deductible (i.e. pays 100% after the deductible). You might be able to save a little bit going this route -- and if/when you have a healthy month, you get to keep the HSA $$ and let it build up, instead of handing it over to the insurance companies. The HSA fund rolls over year-to-year and over time builds up. It is funded with pre-tax income, so you save whatever % your tax bracket is on medical expenses, plus whatever cash discount your doctor offers for not filing a claim (usually about 10%).

This is essentially the plan Whole Foods offers to its employees, and most people love it. Our insurance premium is $70 monthly per individual (paid by the employer in full for employees), and the deductible is like $1800. WF gives each employee money in a flexible spending account to defray the deductible, and then employees can sock away in an HSA on top of that. The longer you've been at the company the more they give you. I think I get like $1500 annually now, and it rolls over and builds up year-to-year. When I leave at the end of this week, COBRA coverage will cost me $140 monthly for Tony and me. Compared to the $500 monthly for just me when I paid for COBRA at Apple, this is phenomenal.

Two countries have particularly interesting systems that I find to be much more palatable than what just passed:

- Singapore, where the only thing compulsory is paying into a personal healthcare savings account deducted from each paycheck. Each person is in full control over the funds in their account.

- The Netherlands, where everyone receives a subsidy towards private medical insurance. Insurance companies cannot drop consumers, and there are no pre-existing condition restrictions on consumers. This preserves competition while making sure everyone is covered.

I think The Netherlands model is a plan that would have the best chance of working here.

[shaynabelle]

My company actually does HRA for us, and due to the high deductible we'd be screwed without it! But overall I feel like our plan is lame. :(

I will check that site, thank you! I like info. :)

[summernot]

Not all plans are created equal, that's for sure. It's harder for a small business, too. There are fewer options.

Here's a Youtube of what they do in The Netherlands...

http://www.youtube.com/watch?v=YkLxk335cHs

They often are recognized as providing the best quality of care among developed countries. (Of course, that's such a difficult thing to measure...)