From the article:

State employees enrolled in the consumer-driven plan will save more than $8 million in 2010 compared to their coworkers in the old-fashioned preferred provider organization (PPO) alternative. In the second straight year in which we've been forced to skip salary increases, workers switching to the HSA are adding thousands of dollars to their take-home pay. (Even if an employee had health issues and incurred the maximum out-of-pocket expenses, he would still be hundreds of dollars ahead.) HSA customers seem highly satisfied; only 3% have opted to switch back to the PPO.

The state is saving, too. In a time of severe budgetary stress, Indiana will save at least $20 million in 2010 because of our high HSA enrollment. Mercer calculates the state's total costs are being reduced by 11% solely due to the HSA option.

Most important, we are seeing significant changes in behavior, and consequently lower total costs. In 2009, for example, state workers with the HSA visited emergency rooms and physicians 67% less frequently than co-workers with traditional health care. They were much more likely to use generic drugs than those enrolled in the conventional plan, resulting in an average lower cost per prescription of $18. They were admitted to hospitals less than half as frequently as their colleagues. Differences in health status between the groups account for part of this disparity, but consumer decision-making is, we've found, also a major factor.

Overall, participants in our new plan ran up only $65 in cost for every $100 incurred by their associates under the old coverage. Are HSA participants denying themselves needed care in order to save money? The answer, as far as the state of Indiana and Mercer Consulting can find, is no...

It turns out that, when someone is spending his own money alone for routine expenses, he is far more likely to ask the questions he would ask if purchasing any other good or service: "Is there a generic version of that drug?" "Didn't I take that same test just recently?" "Where can I get the colonoscopy at the best price?"

By contrast, the prevalent model of health plans in this country in effect signals individuals they can buy health care on someone else's credit card.

I have been making the exact same arguments in favor of HSA's for over 3 years now (and these arguments have ALWAYS fallen on deaf ears when it came to liberals). Let's just say that I am not at all surprised by Indiana's success with this program.

In other states, HSA's have been thoroughly looted by those managing the HSA's. And, from what I'm able to tell, Glen Beck likes looters.

I don't ever want to be in a situation where I couldn't get my meds because my HSA ran out of money.

In other states, HSA's have been thoroughly looted by those managing the HSA's. And, from what I'm able to tell, Glen Beck likes looters.

#2 | Posted by Zed

What states are you talking about?

I have an HSA through a private employer and am very happy with it. My company puts a certain amount each month into the account and I put the difference between the cost of the PPO and the HDHP/HSA into the account. The interest rate isn't great (1.0%) but once you hit a certain threshold it can be invested in mutual funds and eventually rolled into your IRA.

How exactly would the employer loot the account? In my plan, it's like any other bank account, where payments are direct deposited from my employer.

How exactly would the employer loot the account?

Your employer actually maintains the HSA account?

Here's one example:

participants will become more cost-conscious and careful about overpayment or overutilization.

Code for waiting to see a doctor until they are really really really sick.

Katie,

Not to mention - If you spend less on health services than monies allocated, you can increase your catastrophic deductible over time thus further decreasing your health insurance costs.

HSA's make a ton of sense. As much as I distrust a single-payer system, I think some of its inherent problems could be avoided if it was set up in the mold of an HSA.

Code for waiting to see a doctor until they are really really really sick.

#6 | Posted by 726

Except that in Indiana they haven't found that to be the case.

HSA's only work if you have money to cover the high deductible if you don't have enough money in your HSA. If you live paycheck to paycheck you are fucked.

Good article Yav.

Of course, this is just the free market working things out, no regulation is needed, those people who lost their money will likely not do business again with those crooks, so the system works.

Except that in Indiana they haven't found that to be the case.

#8 | Posted by JeffJ

Where does it say anything about that?

I disagree, HSA's are good ways for the healthy to participate with 'oh crap insurance' having the highest deductible plan but also having so much money put into the HSA preparing for a certain disaster.

It is like a bank account, its nice to have. I can go to the pharmacy and buy my OTC medicines with it instead of paying out of pocket, and I can use it to pay for visits not covered by insurance, etc.

I think HSA's are really good way of FORCING people to plan for medical problems. Seriously. That's the problem right with our society right? We want the best bang for our buck but we don't want to pay for it. People would rather stay sick than pay with their own money for it... that says something.

If you live paycheck to paycheck you are fucked.

So stop buying groceries and utilities for a few months until you can fund your HSA.

Sincerely,

The Wing Ding Right.

Read the article, JA. It's in there.

So stop buying groceries and utilities for a few months until you can fund your HSA.

That comment belies such a fundamental lack of understanding as to how HSA's actually work - I don't even know where to begin.

Jackass - give me a minute and I will provide you the quote you are looking for.

"They were admitted to hospitals less than half as frequently as their colleagues. Differences in health status between the groups account for part of this disparity, but consumer decision-making is, we've found, also a major factor."

I'm sure many people don't go to the hospital even though they should because they can't afford the deductible. My union insurance is 1000 better than a shitty HSA. Mgmt tried to offer this and our union told them hell no.

Jackass,

Here you go:

Are HSA participants denying themselves needed care in order to save money? The answer, as far as the state of Indiana and Mercer Consulting can find, is no. There is no evidence HSA members are any less likely to defer needed care or common-sense preventive measures such as routine physicals or mammograms.

Personally, I think this comment nails it squarely on the head:

The Indiana experience confirms what common sense already tells us: A system built on "cost-plus" reimbursement (i.e., the more a physician does, the more he or she gets paid) coupled with "free" to the purchaser consumption, is a machine perfectly designed to overconsume and overspend. It will never be controlled by top-down balloon-squeezing by insurance companies or the government. There will be no meaningful cost control until we are all cost controllers in our own right.

Americans can make sound, thrifty decisions about their own health. If national policy trusted and encouraged them to do so, our skyrocketing health-care costs would decelerate.

Jeff, I have a 0 deductible on inpatient stays. I pay 10 dollars an office visit and generics are 4 dollars with my insurance and it costs me about 90 bucks a month. How is a HSA better for me again?

I'm sure many people don't go to the hospital even though they should because they can't afford the deductible.

Do you realize that the amount of the deductible is up to the individual?

Can't afford a $5000 deductible? Opt for a lower deductible, but in the process receive less in terms of money that you 'own' in the process.

"There is no evidence HSA members are any less likely to defer needed care or common-sense preventive measures such as routine physicals or mammograms."

Jeff try seeing if it changes if everybody goes to this method of insurance. I guarantee people will delay going to the ER and office visits if they can't afford the high deductible. Not everyone has 5K laying around if they break a leg. This method of insurance sucks for the working poor.

Jeff while I agree it is good for the young and healthy it isn't good for everybody.

How is a HSA better for me again?

How much does your employer pay for all of those goodies?

How much of all of that extravagent covereage do you never use?

When you see a physician do you just blindly say "OK" to their costs, their tests, their prescriptions, etc? Would you be THAT cavalier if the money to pay for all of this was STILL part of your compensation as an employee, but you had the ability to personally use that money in other capacities if you were more frugal?

When you buy a car, do you walk into a Ford dealership knowing that a moderately-equipped Focus will meet all of your needs and then let the salesman talk you into spending $28K more on a fairly-well loaded Taurus SHO?

Lastly, did you read the article?

We want the best bang for our buck but we don't want to pay for it. People would rather stay sick than pay with their own money for it... that says something.
Posted by greeneyedguy

Okay, I think advocates here are talking about the best case scenario with respect to HSA's. I think the most important conversation would be to discuss the ramifications of when HSA's go wrong.

Jeff, I have a 0 deductible on inpatient stays. I pay 10 dollars an office visit and generics are 4 dollars with my insurance and it costs me about 90 bucks a month. How is a HSA better for me again?

#17 | Posted by jackass

You have very good insurance. If your employer pays the preponderance of your premium, there would be no reason to switch to an HSA/HDHP plan. If you pay the bulk of the premium and are healthy, it may make sense to switch.

I read it 3X and I think it may be a good fit for somebody that is healthy and has a good state job like the people in the article. For me an HSA would be severely hurt me until the deductible kicked in. I go to counseling 2X a week and take several anti-psychotics that have no generic yet. I come out far better with a PPO. Like I said our union met heard the facts and we rejected it.

Your employer actually maintains the HSA account?

Here's one example:

www.kaiserhealthnews.org

#5 | Posted by YAV

That's interesting. It appears what happened in the article was illegal and I suspect essentially the same thing could happen to an employer sponsored PPO.

My HSA is through Mellon Bank and the non-invested portion of it is FDIC insured.

Jeff while I agree it is good for the young and healthy it isn't good for everybody.

#20 | Posted by jackass

You are correct - The elderly springs immediately to mind.

However, I don't take a Utopian-view of anything. ALL measures result in winners and losers. What I like best about the HSA model is:

1. It removes the 3rd-party pay structure of our current-sytsemt as well as the socialist systems of Europe and Canada with a system that is FAR more 1-on-1 patient-to-provider. Yes, this means that individuals have to be more responsible and efficient and certainly poor decisions will result in losers - however, considering how many people file bankruptcy in THIS country due to healthcare expenditures, this system would most likely lower that number. Also, this would be a net-reduction in healthcare costs overall; as evidenced by Indiana's success with this.

2. Individuals would be exposed to less rationing and to a reduced degradation of the overall quality of care relative to more socialist models.

Again, it isn't perfect and possibly some tweaking would be in order, but it seems to me to be far superior to anything the Dems are offering up.

JeffI never want to be in a doctors office and be told I need certain tests but can't afford them so I skip them and have a heart attack because of it. I prefer to be safe than sorry.

"There is no evidence HSA members are any less likely to defer needed care or common-sense preventive measures such as routine physicals or mammograms."

I can only speak for my plan (through BC/BS) -- Preventative care is covered 100% by the insurer, regardless of the deductible. This actually works in our favor, as those on the PPO buy up plan through work, have to pay their co-pays and a percentage of lab work & testing out-of-pocket until they hit their deductible and out-of-pocket maximum.

My husband and I just had our annual physicals and all the associated "growing old" bloodwork and exams and our out-of-pocket cost was $0.

Jackass,

If you'll notice from the article, Indiana's HSA plan isn't compulsory. It's an option. Yet, they had an enrollment conversion of 70% with less than 5% moving back to the PPO program.

Again, I am not trying to sell snake-oil - I know this system, like all systems, has its flaws. I am simply pointing out the merits of such a system on a fairly large-scale. If we are trying to make healthcare access more affordable, this system has proven remarkably successful.

Good point, Katie.

A number of HSA plans cover 1-2 annual well-visits either 100% or with a VERY nominal deductible.

Jeff I know what you are saying and I think High deductibles are great for 18-30 year olds that can't afford expensive premiums. At least this way they aren't ruined if a catastrophe occurred. It may even be good if that is all you can afford but somebody like myself it wouldn't work that well.

I guess I don't understand the hostility towards HSA/HDHP plans. There are a lot of PPO's out there that have very similar deductibles but cost significantly more and none of the tax advantages.

I'd much rather have a HSA plan through BC/BS with a $2,500 deductible for $100/month than a PPO through Aetna with a $750 deductible for $450/month. The Aetna plan might have $10 copays to see a doctor or $5 drugs but I don't think it's worth the extra money to insure myself against $80 doctor visits and $15 prescriptions.

We all make risk assessments -- I like having this option available to me. It's kind of like car insurance; the cost of a policy for state minimum coverage and a $100 deductible isn't a whole lot different than a half million in coverage and a $1000 deductible.

HSA's only work if you have money to cover the high deductible if you don't have enough money in your HSA. If you live paycheck to paycheck you are fucked.

#9 | Posted by jackass

Sounds like you don't have any experience with HSA's or even know anyone that is happy with them.

All they are is a vehicle to pay for your health costs pre-tax. Nothing more nothing less.

Jackass,

Like I said - it's not Utopia.

It would have to be coupled with a form of high-risk pool - a pool that would likely have to be subsidized by tax-payer dollars.

I guess my overall point is that I think the proven success that Indiana has had with this, particularly when compared with a system that the Dems favor in Mass.; I think ANY reform measure would do well to implement this model to its fullest - it won't work accross-the-board, but when coupled with a couple of other measures I believe it will really bend the cost-curve down.

Jackass,

What isn't talked about is the reduction in cost for providers. It's very expensive to process forms, employ people to collect from 3rd parties and then wait 90-180 days for services already rendered. If standard operating procedure was to have services paid on-the-spot without all of the aforementioned overhead, providers could afford to offer their services at a reduced cost.

We need to full-on attack costs first, in every conceivable manner. If we succeed at that, all of the other objectives become far-more attainable.

I like having this option available to me.

Choice, options and competition are what make the world go around.

A number of HSA plans cover 1-2 annual well-visits either 100% or with a VERY nominal deductible.

#30 | Posted by JeffJ

At my workplace, a few people have used AFLAC policies to supplement their HSA plans. They added sickness/injury plans, which would cover the majority of their deductibles, as well as provide other financial assistance (AFLAC also pays a bonus for well visits). Even with these extra coverages, the cost was still lower than with the straight PPO buy up plan offered.

One of my biggest concerns with the current health care legislation is that the federal government is going to set a floor for what is considered minimum acceptable insurance, without a mandate for employers to pay more towards these upgraded policies. For those who work at small businesses and are middle class (who wont be subsidized by the government), being forced to upgrade from an HSA to PPO will come entirely out of our paychecks.

There were several articles posted here last year about the Massachusetts model and this is exactly what happened. People elected to keep their HSA plans and pay the state fine for not having acceptable insurance, and they still came out ahead.

HSA vary in benefit. They're useful for some, completely useless to others, and they'd never exist if we'd actually address the issues in our health care system.

If we had universal health care they wouldn't even be discussed.

Katie,

One of my dad's best friends owns a small bankruptcy company in Florida.

He only has about a dozen employees but about 5 years ago he modified his benefits package to include the HSA model and all-but-one of his employees went for it.

*I know this is anecdotal*

One of the many things I like about it is that it tends to reward those who are responsible and those who make health-conscious decisions. Again, plenty of examples exist where the chronically-ill can't subsist under such a plan it was the only thing available. Also, risk-pools are just that - pools. The more healthy individuals are removed from high-benefit plans the more those within said plans have to pay in premiums in order to make said plans solvent - this is a major problem for the HSA-model.

If we had universal health care they wouldn't even be discussed.
#39 | Posted by jackass

These are the discussions we have to keep from talking about universal single payer.

this is a major problem for the HSA-model.
#40 | Posted by JeffJ

That's the problem for all currently proposed initiatives.

These are the discussions we have to keep from talking about universal single payer.

HSA's keep you locked into a job, they aren't portable, and for them to be of any use, you better have a job and have a taxable ceiling that makes HSA useful.

In ours, any money that's not spent at the end of the year is lost. There's no investing or carry over. That means folks are running around buying all kinds of stupid things just so they don't lose what they've put aside in their HSA accounts.

they'd never exist if we'd actually address the issues in our health care system.

#38 | Posted by YAV

I disagree completely.

They introduce the frugalness and efficiencies of a market-based system where they haven't existed for a long-time.

These are the discussions we have to keep from talking about universal single payer.

Your comment is dripping with the presumption that a universal single-pay system is optimal. Personally, I think the negative tradeoffs of such a system more-than outweigh the benefits. Tweaking our existing system; allowing for more choice AND, yes, even throwing a few extra tax-dollars this way makes more sense than single-pay or the watered-down version that the Dems are trying to pass as as stepping-stone toward their ultimate goal of a single-pay system.

I love my HSA, and will never go back to the days of low-deductible, high-premiums.

Of course, the libbies hate them, because it leaves all the decision-making power in the hands of individuals, instead of the government.

In ours, any money that's not spent at the end of the year is lost. There's no investing or carry over. That means folks are running around buying all kinds of stupid things just so they don't lose what they've put aside in their HSA accounts.

#43 | Posted by YAV
* * * * *

That's not an HSA. That's a Flexible Spending Account.

Rightiswrong you have money so obviously you prefer an HSA. You probably don't even need insurance you could just pay out of pocket for everything.

That's not an HSA. That's a Flexible Spending Account.

You are correct.

#43 | Posted by YAV

I think you are, to an extent, confusing HSA's with FSA's. I only have access to an FSA and any tax-free monies set aside are lost if they aren't spent within the same calendar-year. HSA's allow un-spent monies to grow in an account - very much like rollover minutes.

Again, I am not suggesting the system is perfect nor that it can't be improved; but it is STILL a far-cry from what is coming from the left-side-of-the-aisle IMO.

Do the math, and an HSA is a superior plan for almost everyone who isn't chronically ill.

Of course, asking a libbie to "do the math" is already asking too much. Easier to let Pelosi and Reid figure out that stuff for you.

What isn't talked about is the reduction in cost for providers. It's very expensive to process forms, employ people to collect from 3rd parties and then wait 90-180 days for services already rendered. If standard operating procedure was to have services paid on-the-spot without all of the aforementioned overhead, providers could afford to offer their services at a reduced cost.

#35 | Posted by JeffJ

I think one of the biggest flaws of the HSA/HDHP model is that this never really materialized.

If you have an HSA, the same paperwork is required as with a PPO. You go the doctor, doctor bills the insurance company, who responds with an EOB that states the negotiated rate. Then the doctor bills the insured for negotiated rate, who then cuts a check out of the HSA for this amount.

It would be nice if there was an easier way to work outside this model and develop our own "negotiated rates" by paying cash upfront and filing our own insurance paperwork. My dentist gives a 20% discount for cash if we do this, I don't see why the medical fields wouldn't do the same. The problem is, even my doctor seems to have no idea what the negotiated rate, as determined by my insurance company, will be.

To an extent, I do this with my plan... When I had a PPO, if I needed any lab testing, I would go to my doctor who sent my blood to the county hospital. I didn't realize there were other, significantly cheaper options for blood work. All it takes is for her to enter a different code into the computer and I can save $200.

We also do the same thing with ER visits. We used to go to the ER for things like X-Rays and stitches because of the low deductible with the PPO; if you have kids, these sorts of visits are fairly common. For these types of non-emergencies, we now just go to our family doctor or our local university's walk in clinic. I guess I was just incredibly naive but I always thought you had to go to the ER this type of care. The cost savings alone is immense for ER vs. walk in clinic. It also frees up the ER for actual emergencies.

Of course, asking a libbie to "do the math" is already asking too much. Easier to let Pelosi and Reid figure out that stuff for you.

You need to get laid.

Do the math, and an HSA is a superior plan for almost everyone who isn't chronically ill.

#50 | Posted by rightisright

So you admit that an HSA is a poor choice for me. Good we finally are on the same page. If I couldn't get my meds I'd be locked up already.

An FSA and an HSA are mutually exclusive. An FSA is used to cover deductibles and out-of-pocket expenses on a traditional plan; an HSA is a completely different plan type. So don't register your complaints with your FSA as a reason to reject HSA's.

I think you are, to an extent, confusing HSA's with FSA's. I only have access to an FSA and any tax-free monies set aside are lost if they aren't spent within the same calendar-year. HSA's allow un-spent monies to grow in an account - very much like rollover minutes.

I think a lot of people confuse these. At my employer, if you have a PPO you can also get a Health Spending Account (aka "Cafeteria Plan") which can be used on predictable health expenses, as well as child care. If the funds for this plan aren't used at the end of the year, they are forfeited. They're very good for parents who know how much they plan on spending for things like dentist visits, glasses, and child care over the course of the year.

You also can't legally have a Health Spending Account and a Health Savings Account at the same time according to the IRS.

That's a Flexible Spending Account.

I suppose that's what I was thinking about.

You also can't legally have a Health Spending Account and a Health Savings Account at the same time according to the IRS.
#55 | Posted by katieberry

Probably because they are both funded with pre-tax dollars?

Probably because they are both funded with pre-tax dollars?

Yes -- It's nice not having to forfeit unused funds or go on a spree of dentist & optometrist visits in December with the spending account. But I do miss the child care provisions that I don't have with the savings accounts.

"Yes -- It's nice not having to forfeit unused funds or go on a spree of dentist & optometrist visits in December with the spending account."

I got my teeth whitened in December with what was left on my FSA. Got a professional courtesy discount too. Was that wrong?

I've always said that the plans which drove the decisionmaking to the individual and nowhere else is preferable. Indiana has saved a fortune--savings that will only grow over time--and there is a staggeringly high degree of satisfaction: only 3% have decided to go back to the PPO plan.

Anything that replicates this nationally will be a big success. Until then, I have no desire whatsoever to subsidize people who want to take their stuffy-nosed kids to the ER, or who are smokers, or who are heavy drinkers, or who live unhealthy lifestyles--with my money.

It's always about greed with RIR. Hopefully the govt raises his taxes sky high so he just leaves America because we would be better off without him.

You're the one who wants me to pay for your anti-psychotic medications, just so you can spend your money instead on gay porn.

It's not my fault you're insane. Why should I pay for it.

Why should I pay for it.

#62 | Posted by rightisright at 2010-03-01 10:06 AM

For the well being of your fellow citizens that is why.

I got my teeth whitened in December with what was left on my FSA. Got a professional courtesy discount too. Was that wrong?

#59 | Posted by Hagbard_Celine

Why would that be wrong?

It's always about greed with RIR.

you are the one is against this because it might cause YOU to pay a little more Jackass.

You are so blind you can't even see that you are the greediest fucker here.

"Why would that be wrong?"

I guess I misunderstood you when you said:

"It's nice not having to forfeit unused funds or go on a spree of dentist & optometrist visits in December with the spending account."

You are so blind you can't even see that you are the greediest fucker here.

#65 | Posted by eberly at 2010-03-01 10:13 AM

It'll cost everyone with Chronic illnesses a whole lot more.

For the well being of your fellow citizens that is why.

Oh, if we are going to talk about the well being of our fellow citizens then I should remind you that most psychos and criminals are locked up for the well being of our fellow citizens.

It's only a matter of time Jackass.

This is a pretty good discussion and most reasonable liberals can't argue with this common sense approach to reforming health care.

you aren't one of them

It'll cost everyone with Chronic illnesses a whole lot more.

they are the ones who are utilizing the care more.
Is it wrong to charge them more? we have to be reasonable though. We have to continue to cover them and the health insurance company has to spread out the cost of including you and your chronic illness to everybody on the plan. If you have to pay more to meet your out of pocket expenses??? not the end of the world.

everybody else is already covering your problems already.

quit bitching.

I guess I misunderstood you when you said:

"It's nice not having to forfeit unused funds or go on a spree of dentist & optometrist visits in December with the spending account."

#66 | Posted by Hagbard_Celine

I was just noting that it is a considerable inconvenience to have to burn through cafeteria plan funds in December due to my own procrastination. Everyone else in the world is doing essentially the same thing (either because of deductibles, fear of forfeiting funds, or using up unused sick time for appointments) at a time providers are taking their vacations. It's often a mad rush to get in anywhere before December 31st.

"For the well being of your fellow citizens"

That was the same rationale used to provide universal coverage in the UK and in Canada, and is now being used to deny them the coverage. Fatties in England don't get surgeries, along with smokers.

Be very careful what you're asking for. When every American is paying higher taxes to take care of HIV/AIDS sufferers, it'll only be a matter of time before gay men are kicked out of the public plans. When we're paying higher taxes to keep lung cancer victims around who still can't keep from smoking two packs a day, we'll have prohibitions for that too. Ditto for alcoholics, extreme sports enthusiasts, people who don't fasten seat belts: universal health care means a nanny state, and in a country where more than half of the voters are conservatives, it'll fall on gays and drunks first.

Just wait.

Ebs,

To be fair - I thought Jackass did a pretty good job of arguing his position; at least with his interactions with me on this thread.

everybody else is already covering your problems already.

quit bitching.

#69 | Posted by eberly at 2010-03-01 10:19 AM

With Single payer the cost gets spread out even more. This way nobody feels the burden. It is the fairest approach rather than creating a risk pool of sick people. Most will have to drop out of the pool because of high costs. That will lead to a bunch of sick people that can't afford their meds. We need to help each other it's the right thing to do. This only reinforces the need for socialism in our country.

"It's often a mad rush to get in anywhere before December 31st."

I had a hard time getting my appointment. That was another professional courtesy I got to take advantage of.

With Single payer the cost gets spread out even more.

bullshit. we have huge groups in this country that aren't "healthy". spreading out only works to a point.

This way nobody feels the burden.

actually, EVERYBODY feels the burden.

It is the fairest approach rather than creating a risk pool of sick people.

your definition of fair = "give me more, you have it and I want it".

You do understand that your healthy co-workers and employer are sharing the burden of YOUR health problems now don't you?

an HSA is not "creating a pool of sick people". WTF are you talking about?

My dentist is in a rundown seedy strip mall. Not surprisingly I get in very easily.

With Single payer the cost gets spread out even more....

...by force...without any kind of choice or alternatives...all subservient to state-power.

Get the feds out of this.

Handle it at a state level.

If a citizen wants to enjoy the fruits of meaningful tort reform in action, they can move to Texas. If a government employee wants better overall compensation (pay + benies) they can try to move to Indiana. If one wants the leftist Utopia of draconian price controls, fleeing providers and excessive costs they can retreat to that Utopia known as Mass.

To be fair - I thought Jackass did a pretty good job of arguing his position; at least with his interactions with me on this thread.

It's a good as he can do Jeff. But in the end, it's all the same "I can't afford it otherwise and anybody who doesn't agree with me is mean and greedy".

oh, and I forgot "we need socialism".

LOL

WTF are you talking about?

#75 | Posted by eberly at 2010-03-01 10:30 AM

The republicans want to push people like me into a risk pool while creating HSA's for the healthy. If we have one health plan for everybody the cost gets spread out. So instead of you paying 100 a month while I pay 500 we each pay 300 a month. That sounds fair to me.

The republicans want to push people like me into a risk pool while creating HSA's for the healthy. If we have one health plan for everybody the cost gets spread out. So instead of you paying 100 a month while I pay 500 we each pay 300 a month. That sounds fair to me.

#79 | Posted by jackass

LOL! I bet your laughing your ass off when you post shit like this.

The republicans want to push people like me into a risk pool while creating HSA's for the healthy. If we have one health plan for everybody the cost gets spread out. So instead of you paying 100 a month while I pay 500 we each pay 300 a month. That sounds fair to me.

Jackass, nobody is going to treat you any differently under an HSA. you are still under the same plan as your co-workers and the employer will be billed the same.

If we have one health plan for everybody the cost gets spread out. So instead of you paying 100 a month while I pay 500 we each pay 300 a month. That sounds fair to me.

groups can be only be so large to spread out stuff. you need to understand that. one group won't accomplish what you are wishing for.

Also, you are continuing to ignore the success of this plan. It isn't some bill being presented and discussed by douchebags in DC who don't know shit. It is a real live success story we can analyze and discuss. And all you are doing is going back to theory and rhetoric that you have no substantial proof that will work at all.

I pay 90 bucks a month for insurance. Even with an HSA I don't see it being much cheaper. Only thing different is that I would have a deductible. If they made it cost me 0 a month and I had a 1000 deductible I would consider because my employer contribution would be higher than the deductible so I would make money off of it.

I pay 90 bucks a month for insurance. Even with an HSA I don't see it being much cheaper. Only thing different is that I would have a deductible. If they made it cost me 0 a month and I had a 1000 deductible I would consider because my employer contribution would be higher than the deductible so I would make money off of it.

any reform we would ever pass in the form of a single payer system will cost you MORE than you pay now.

The benefit of what you are discussing is that folks like you will pay more than folks who don't utilize their plan. It's not oppressive.

what would be the most fair is a tiered system based on income. Those who make the most would subsidize the costs of those on the bottom of the economic ladder. So If I make 30K and you make 90K you would pay 3X as much as I do for insurance.

I pay 90 bucks a month for insurance. Even with an HSA I don't see it being much cheaper. Only thing different is that I would have a deductible. If they made it cost me 0 a month and I had a 1000 deductible I would consider because my employer contribution would be higher than the deductible so I would make money off of it.

#82 | Posted by jackass

I think you already established that you have an excellent plan and it wouldn't make sense to trade it in for anything else, so long as your employer pays the preponderance of your premium.

But there are a lot of us out there who have to decide between expensive PPO's and HSA plans. When you look at it, dollar for dollar, and take into account both employer and employee expenditures on aggregate, there are significant advantages of HSA plans for many of us.

PPO's make a lot of sense for large group plans where the employer pays the majority of premium. For those who are in small plans, where the employer pays ~ 50% of the premium, there can be significant advantages to higher deductibles coupled tax free accounts.

what would be the most fair is a tiered system based on income. Those who make the most would subsidize the costs of those on the bottom of the economic ladder. So If I make 30K and you make 90K you would pay 3X as much as I do for insurance.

what an original idea!!

I'm shocked a liberal would suggest something like this.

LOL

If we have one health plan for everybody the cost gets spread out.

yes. and that would likely INCREASE the cost as a result.....in terms of direct care.

I'm shocked a liberal would suggest something like this.

LOL

#86 | Posted by eberly

FF!!

If we have one health plan for everybody the cost gets spread out.

yes. and that would likely INCREASE the cost as a result.....in terms of direct care.

www.nationmaster.com

#87 | Posted by eberly at 2010-03-01 10:59 AM

With my system of wealth redistribution those higher costs would mostly be absorbed by the wealthy so individuals with less would barely notice any increases at all. If properly distributed many could enjoy a reduction in costs.

Well, that's true of anything. We could get the wealthy to pay for your housing, your furniture, your gasoline, and your internet service too.

With single payer, your out-of-pocket will more than quintuple--because your employer won't be bothering with it anymore. Besides that act of poetic justice, I can't think of a good reason to do it.

With my system of wealth redistribution those higher costs would mostly be absorbed by the wealthy so individuals with less would barely notice any increases at all. If properly distributed many could enjoy a reduction in costs.

#89 | Posted by jackass

I'm not necessarily opposed to a single payer system; however...

For those like yourself, who have excellent PPO coverage through your employers, wouldn't your out-of-pocket costs increase if the burden of paying premiums was shifted from the employer to employee tax withholdings?

Like I said not if the costs were tiered so that the wealthy would absorb most of the costs. The rich can afford to pay the brunt of it. While I may have a slight increase I would be ok with it.

We could get the wealthy to pay for your housing, your furniture, your gasoline, and your internet service too.

#90 | Posted by rightisright

I'm not greedy so just the housing would be ok.

Better get to work. Can't slack all day I guess.

Within our current healthcare system, HSA's are a fair choice for sole proprietors and small businesses that can use the tax advantages, and who have no pre-existing conditions. They may also be a way for large corps to save money by lowering premiums through higher deductibles. It will likely be at a higher expense for employees of large corps if they were already provided insurance anyway. If you're going to try to get an HSA, I would certainly recommend you seek an HSA through a reputable provider. I believe that through many banks HSA's may be accounts that are counted with the rest of your total bank deposits (for FDIC type reasons).

HSA's are far from the end-all answer to the healthcare problems that this country faces. HSA's may help lower premiums, as people have HSA's are likely to have higher deductibles. HSA's may NOT lower premiums for any extended period because Ins. co's will eventually simply increase premiums to make up for the lost revenue, as demonstrated by the 20%+ increases many have seen this year.

I don't believe that HSA's will significantly lower HC costs. The best shot at HC cost reduction at the consumer level is to reduce waste in practice, and inefficiencies in billing. The industry has little motivation to do either, as both may be a least partially intentional.

Mitch has taken the Hoosier state from rack to ruin, his skills in budgets and management are severely questionable. But, listen if you like... Personally though I'd pick a "champion" with a bit better record...

HSAs are pretax dollars - of course the current govt would love to get rid of them so they can collect more taxes - as well as have more control over your life.

Ref my comment above: ALWAYS remember and NEVER forget - liberals are control freaks.

I don't ever want to be in a situation where I couldn't get my meds because my HSA ran out of money.

#3 | Posted by jackass

HSA's only work if you have money to cover the high deductible if you don't have enough money in your HSA. If you live paycheck to paycheck you are fucked

soooo, there is no expectation for you to have any responsibility to pay for your own healthcare at all? so your employer pays you a salary, pays workers comp to cover you, pays taxes upon taxes and he/she must pay all of your healthcare?

I don't believe that HSA's will significantly lower HC costs. The best shot at HC cost reduction at the consumer level is to reduce waste in practice, and inefficiencies in billing. The industry has little motivation to do either, as both may be a least partially intentional.

waste in practice, like excessive tests to cover their ass against lawsuit happy america? yeah well i guess you can count that out since tort reform is evil.

"I pay 90 bucks a month for insurance. Even with an HSA I don't see it being much cheaper."

Then I imagine your employer is chipping in at least 50%.
And Eberly is wrong, Medicare could be supplied to everyone for less than we pay for health insurance and at the same time we could make it solvent for the future.

And Eberly is wrong, Medicare could be supplied to everyone for less than we pay for health insurance and at the same time we could make it solvent for the future.

where did you get your PhD in Actuarial Science?

the only evidence you can supply to justify that are the numbers from other countries who have implemented a single pay system.

but none of them are THIS country.

"the only evidence you can supply to justify that are the numbers from other countries who have implemented a single pay system."

That is good evidence but you can also use common sense that when you take out insurance company administrative costs (much higher than Medicare), advertising, executive pay, profit, etc. you are going to save money. By insuring everyone you are going to save money because you won't have the uninsured showing up at the ER. There are plenty of reasons that single payer would be cheaper, I never heard anyone try to pretend differently before.
It's laughable to pretend that.

mitch daniels has done good things for healthcare here in IN. it didnt use to be like this here. i know about the HIP program or Healthy Indiana Plan. i couldnt get the medicine that i needed for 30 yrs. and couldnt get medicaid because i always had a job, but now i get the medicine i need to keep me from suffering like i had to for a long time. im a democrat but i voted for mitch daniels and hope i get another chance to do so. this country needs to take a look at IN and take some notes because its working for me. i dont know of any other republican that actually cares about healthcare.

There are plenty of reasons that single payer would be cheaper,

Danni, keep in mind that I was referring to Jackass and his situation. not everyone.

But it is naive to just accept 100% that it will be cheaper.

you are driven by such ideological hatred that you can't admit that you don't know. all you can say for sure is that you "hope". nothing more.

In any case, this is pointless to discuss because single payer isn't on the table and won't be for some time if ever.

But it is hilarious watching liberals discuss single pay when their own heros can't get a public option (which has public support) in a bill with the majorities and control they have.

we might as well discuss a national sales tax replacing our federal income tax system or how we are going to ship 15 million illegals back to mexico or how we are going to criminalize abortion on demand.

good God, stop being sheep.

like excessive tests to cover their ass against lawsuit happy america? yeah well i guess you can count that out since tort reform is evil.

#100 | Posted by scooter

I never said that I was completely against tort reform. Although, I doubt that my definition of reasonable tort reform would match a corporate pubbies.

In fact, I'm not happy that it's currently not in the reform packages. But, as I said about HSA's, tort reform is hardly the "end-all answer to the healthcare problems that this country faces". Tort reform really doesn't even rank high on the list of effective solutions when it only represents a small percentage of the problem.

The whole point here is that the the EMPLOYER puts a big chunk of money in the account for the EMPLOYEE. If you have any health problems or have to pay out of pocket this plan is very expensive. If you are an individual with this plan (not tied to an employer) it is very expensive.

I had this two years ago and ended up paying close to 14k out of pocket for premiums and due to the deductible and the difference between the amount in the account and the deductible. Add the premium and it was very expensive.

I'm not one to abuse or use unless absolutely necessary.

With Single payer the cost gets spread out even more....
...by force...without any kind of choice or alternatives...all subservient to state-power.
Get the feds out of this.
Handle it at a state level.
If a citizen wants to enjoy the fruits of meaningful tort reform in action, they can move to Texas. If a government employee wants better overall compensation (pay + benies) they can try to move to Indiana. If one wants the leftist Utopia of draconian price controls, fleeing providers and excessive costs they can retreat to that Utopia known as Mass.

#77 | POSTED BY JEFFJ

Its clear its a state versus individual rights with you.

This whole the state versus individual rights became moot when the federal government started paying for over 1/2 of the healthcare in this country.

The fear card regarding MASS is moot if the whole country is on single payer. I say fuck the providers if they are in it solely for the coin. Why is it every other country that is a so called socialist nirvana like France can provide healthcare, control costs so it doesn't become more than 10% of your GDP and provide SUPERIOR service to what we are currently receiving here?

Greed on every level.

This problem needs to be solved or you can kiss our economy goodbye.

#100 | Posted by scooter

If your employer pays the preponderance of your premium, there would be no reason to switch to an HSA/HDHP plan

Depending on his state of health, this statement may/may not be true.

In the employer sponsored plans that I have heard about, the employer contributes $X dollars to the HSA account to cover the high deductible.

If the insured is not healthy, there is no difference between a HSA + high deductible medical insurance plan UNLESS the insured spends the money in the HSA. People with HSAs MUST have the discipline not to spend the money in the HSA unless it is for legitimate medical purchases.

If the insured is healthy, the company's contributions accumulate in the HSA and, over time, a large sum will result; all on the company's dime. All of the money in the HSA belongs to the insured. If/When the insured leaves the company, the HSA goes with them.

Developing a healthcare plan around HSAs and catastrophic healthcare would be the most responsible methodology from a cost basis, maintaining quality of care, and protecting the physician/patient relationship. You could then bring on the uninsured and fill in the gaps.

The system is broken guys..nibbling at the fringe will not solve the crisis. Wishing the evil libs would go away will not change the problem. The republican mantra is kick the can down the road, don't change what we got because I have mine.

Being conservative doesn't mean you have to be stupid for stupid sake. Fix the problem.

The problem, as illustrated by a lot of the "rightie" posters here is that capitalism, by it's very nature creates winners and losers. The problem comes in where the winners say "fuck the losers". The losers will always be in the majority. As a result, they will always have more voting power than the winners (unless, of course you accept that money = speech). Therefore any representative form of government will have tension between the "winners" who have all the money and the "losers" who have all the voting numbers. The Republican strategy has been to con the losers into thinking that the winners are their friends. As the posts on this forum illustrate, nothing could be farther from the truth. The backup plan is to subvert democratic (small "d") governance, because they can't rule as a majority.

It goes back to what Grayson said on the House floor: The republican health plan is "don't get sick" and if you do get sick, "hurry up and die". You people have no humanity, and if the Christian constituency on your side is right, and there is a heaven, good luck justifying yourself when you meet St. Peter!

Whatever moves the spending decisions from bureacracies to the point of consumption will drop costs....people don't waste their own money if they can help it....make it like car insurance, and watch the costs drop....no need for Big Brother