COMMENTARY: How's Your Health... Insurance?

Having health insurance seems more like a privilege, but what's your insurance temperature?

I noticed this story on the Milwaukee Journal Sentinel about health insurance premiums going up, but I was curious to find out your experience with health insurance.

America's Health Insurance Plans issued a press release with the following talking points. Here are a few of the takeaways:

  • Prices for medical services continue to rise 
    • Recent data from the S&P Healthcare Economic Composite found that “healthcare costs covered by commercial insurance increased by 7.73% over the year ending July 2011.” 
    • The annual Milliman Medical Index (MMI) found that “between 2010 and 2011, the MMI increased by $1,319 or 7.3%.”  Moreover, the report noted that “even though hospital spending is only 48% of total healthcare spending, increases in facility spending (inpatient and outpatient combined) account for over 60% of this year’s total increase in cost of healthcare.”
    • PricewaterhouseCoopers (PwC) Health Research Institute’s “Behind the Numbers: Medical Cost Trends for 2012”, which examines the medical cost trends for employers in 2012, found that “medical cost trend is expected to increase from 8% in 2011 to 8.5% in 2012.”
    • Medco’s Drug Trend Report, an annual look at prescription drug price and utilization trends, found that “overall drug inflation climbed 5.4%”,  “record inflation of branded drugs at 9.4% exceeded generic inflation by a wide margin”, and “specialty drug trend was 17.4% in 2010, fueled by unit cost growth of 11.5%.”
    • According to National Health Expenditure Data released by CMS, the growth in health insurance premiums has tracked directly with the growth in benefits. 
  • Health plan administrative costs and profits are not driving up the cost of coverage
    • According to the latest Yahoo!Finance data, the health plan sector has an average profit margin of 4.5 percent.  
    • In 2010, health plan profits accounted for less than 1 percent of total health care spending in the U.S.

But I want to hear from you. Did your premiums go up? Did your employer cost share with you or did the increase get passed on directly to you?

Also, I wondered how the level of coverage has changed? Do you go to the doctor? How is your health?

CowDung September 27, 2011 at 09:35 PM
Interesting--During the Obamacare debates, it seems that everyone on the left was blaming health plan 'administrative costs and profits' for the high cost of our healthcare. I guess we really would not be saving a ton of money by going to a single payer system...
Denise Lockwood September 27, 2011 at 11:30 PM
Not answering my questions? You are breakin' my heart man...
Heather Rayne Geyer September 28, 2011 at 12:53 AM
We have always had great insurance and still do. I am grateful. That being said, costs most certainly went up. We went from paying modest copays to now having a deductible and yearly out of pocket limit. Medications I do believe are pretty close to what they were. I do go to the Dr and aside from a heart condition for which I have tests every few years - I am pretty healthy. (knocking on wood) I do believe these costs were set to go up even prior to the passing of Obamacare. I believe that until we have a national healthcare, costs will continue to rise for everyone, less people will be able to pay and it will be a never ending cycle. I for one am willing to pay more so that everyone can have affordable healthcare. Its the moral thing and economically smartest choice.
CowDung September 28, 2011 at 01:34 PM
I haven't noticed any rate increases, and my payment split with my employer has not changed. My level of coverage, deductables and copay have not changed. I go to the doctor as needed, but am generally healthy.
CowDung September 28, 2011 at 01:35 PM
How will national healthcare keep the costs from going up?
Heather Asiyanbi (Editor) September 28, 2011 at 02:07 PM
To answer your questions: Did your premiums go up? Yes, under the insurance with Mr. Heather, our premiums went up every year and most drastically in 2010 when the company switched to an HSA plan. Did your employer cost share with you or did the increase get passed on directly to you? The employer did a cost share, but with a new, large family deductible and increased co-pays for medications and some expenses we hadn't experienced before, we were in a bit of sticker shock. The level of coverage changed only in that we weren't really going to the doctor much except for yearly visits (we have amazingly strong immune systems) but then those unexpected situations came up and we had some fairly large out-of-pocket costs. As for going to the doctor - family and friends tease that we have teflon immune systems and that is mostly true. Except for some allergies, we don't really get sick and we really don't take any medicine. For those with chronic conditions, I feel for them ... and I feel extremely blessed that we're as healthy as we are!
Mark Maley September 28, 2011 at 02:08 PM
What I can never figure out is how the overall rate of inflation only goes up by 2% or 3% annually, yet health insurance costs are typically double or triple that rate... No matter what happens with inflation overall, health care always goes up significantly more than that.
Denise Lockwood September 28, 2011 at 05:11 PM
@Cow... wow, that's good. So you are pretty happy with the coverage? @Mark, when I worked for the Kenosha News I did a series on Medicaid moms because they were having access issues. One doc helped birth 700 babies a year, which was a substantial percentage of the total moms on Medicaid. I remember asking the president of United Hospital Systems what was up with that and he told me 2/3 of his patients coming into the ER weren't paying their bill. And then he asked me if I thought health care was a right or a privilege? That started an interesting discussion.
Heather Rayne Geyer September 28, 2011 at 05:15 PM
And when those bills aren't paid - costs increase to make up the difference. This is why universal healthcare is necessary. Well, one of the reasons. (to answer question from above)
Heather Asiyanbi (Editor) September 28, 2011 at 05:25 PM
I participated in a discussion centered on the right/privilege question ... bascially, we agreed that access to quality health care is a right, but health insurance is a responsibility. That is where we diverged and had to agree to disagree about where the responsibility falls and how to make sure everyone had access to affordable insurance.
CowDung September 28, 2011 at 05:53 PM
Having national healthcare isn't necessarily going to get the bills paid. Currently, Medicaid pays healthcare providers at rates below the cost of care provided (I read something along the lines of 88 cents for every dollar of care provided). If that trend continues under a universal system (and there's no reason to think things will change), the system is doomed to failure and we will be in deep trouble...
CowDung September 28, 2011 at 05:54 PM
It's just not sustainable when your 'single payer' doesn't like to pay the full amount...
Heather Asiyanbi (Editor) September 28, 2011 at 07:33 PM
@Cow - no insurance company pays the full amount, really, so until that system changes, we're doomed to trouble no matter what. What I think we need is transparency in pricing and the ability to have individuals negotiate prices on their own behalf. I should be able to call one hospital and get the price of an MRI and call another hospital and get the price there, then choose where I want to have my MRI. I realize health services aren't fast food, but the same principles of posted prices/truth in advertising/whatever you want to call it could still apply.
Denise Lockwood September 28, 2011 at 07:36 PM
Here's where I see the conflict...whether or not you agree or disagree with current health care insurance policy requirements, any discussion about this topic needs to acknowledge how the system currently works. Under current law, if you walk into the emergency room with a traumatic injury, the hospital has no obligation to cure you or fix you. They have an obligation to stabilize you and once stabilized, move you to a hospital where charity care is accepted. When I was unemployed and on Badgercare, I was personally patient dumped after a visit to Wheaton's ER department and sent to an Aurora doctor. Fortunately for that Aurora doctor I got this job and he was paid in full, and a happy man. Cow is right. Those who show up to get care and don't have insurance, Medicaid pays only about 50 percent of the cost. The rest is shifted to those of us who do pay. To say we aren't paying for everyone else right now, is a major flaw in a lot of the conversations we have around health care. So the question is -- how do we make this system sustainable?
CowDung September 28, 2011 at 08:26 PM
The difference is that with the insurance system, healthcare providers can choose to not accept patients with insurance that doesn't pay enough. It is in the insurance company's best interest to pay healthcare providers a fair amount, if not the full amount. If they aren't paying enough for the doc to make any money, the doc can just take them off the list of 'accepted insurance providers'...
Denise Lockwood September 28, 2011 at 08:47 PM
So if the system is not sustainable given that Medicaid doesn't pay enough, how do we make the system sustainable? Do we limit care? Do we deny care? Do we expand Medicaid? Do we make the system responsible for the care it provides and demand a different level of care? Void of politics, these are valid questions.
Heather Rayne Geyer September 28, 2011 at 09:08 PM
No insurance pays full price. And Drs are basically forced to take all major plans otherwise they would not get patients. Usually it is more of whether or not the insurance covers a particular Dr or facility. They are the ones who are choosier. Dr. apply to become accredited with providers. (I used to do a lot of boring insurance work at All Saints and Eye Center) I had a Dr who was in private practice. He is now working with people on the Indian reservations because he just couldnt keep his practice open in Racine anymore (and his wife was the DA for Door Co so it wasnt worth the time away). The insurance companies dictated how long he could spend with each patient, the determined how much he would get paid and he simply couldnt keep afloat any longer while doing the job he felt strongly about doing right (ie spending more time with patients). We spoke about it before he left and he said that national healthcare is the only way our system can be saved. He said contrary to what everyone thinks - Medicare was the most efficient provider to work with. He actually said that he wished everyone was on Medicare. Obviously I couldnt go into it too much, but I can say that he was and is one of the smartest people I have ever met. His intelligence, intuition and integrity were out of this world.
Heather Rayne Geyer September 28, 2011 at 09:13 PM
The right/privelage thing is all semantics to me. I mean, its all relative. Poor kids dont necessarily have a legal RIGHT to get help with school supplies or lunch - but they still should have it. Maybe I just believe that there are something which we consider privilege which should be given just out of the sake of being a compassionate human being. So whether it is a right or not doesnt matter to me. There are all different types of "rights" anyway. Human rights, civil rights, legal rights, marital rights....
CowDung September 28, 2011 at 09:39 PM
Another valid question would be: 'What is wrong with the current insurance based system, and can the wrongs be corrected?' I think the biggest problems with the current system is coverage for pre-existing conditions, benefit limits and people not having insurance. It should be pretty easy to address those issues through government subsidies for those who cannot afford insurance, and subsidies to cover insurance benefit payouts that exceed a certain level.
Heather Asiyanbi (Editor) September 28, 2011 at 10:39 PM
Our family doctor left the Racine practice for a private practice in Kenosha. It took us 2 years to finally follow her, but she was like your doc, Heather. She scheduled physicals for a full 1/2 hour and 20 minutes for sick appointments. But like most private practices, they were getting priced out or whatever and had to join Aurora, which keeps stats on the docs for patients, labs, tests, etc. She hasn't totally bent to them, but she said she feels the pressure. She says that as long as she squeaks in at the line, she's good. Still, she thought about quitting medicine for this kind of regimented care model. @Cow & @Denise - I don't have the answers, but I feel access to quality health care with or without insurance needs to be a priority for every American to make sure every other American has because the current way we do things is costing us all much too dearly.
Brian Dey September 29, 2011 at 12:36 PM
Denise- The one thing that nobody takes into consideration is the cost of lawsuits and the high cost of malpractice insurance. Until you get some kind of TORT reform and lawsuit caps, the prices will continue to rise, with or without national healthcare. Also, limiting interstate commerce whereas you may only purchase insurance in your state, has driven up costs. If you could have national insurance providers, like in auto and home, you could see prices drop dramatically. The problem with government provided insurance is that we see with medicare, services are limited and no doctors become the strongest lobbying group. The more government control of anything, the better chance of pandering. The insurance companies and lawyers are biggest problem with the current system.
Denise Lockwood September 29, 2011 at 01:01 PM
@Brian: yeah, you raise some good points. What I find interesting though is that you parallel health care insurance with auto insurance, which we're mandated to have. Perhaps we should take a page out of their book and offer good body discounts. I think we've got a disconnect between our thinking about the relationship between costs and our responsibility to care for ourselves/and others. There's value in making sure prenatal vitamins and prenatal care are funded, especially when the lack of prenatal care is so integral to preventing birth defects. I don't think government has all the answers on this one, but I do think our discussions need to focus on the question of how can we be more responsible for ourselves and to one another? The business of caring and prevention seems almost lost in these conversations.
Denise Lockwood September 29, 2011 at 01:03 PM
BTW... in that same light, I am extremely intrigued by our local food movement here. It's very refreshing to see the focus on the basics and being a farm girl, it's kinda cool to see gardening become cool. Now if I can only manage to grow mine....
Denise Lockwood September 29, 2011 at 01:10 PM
What did you guys think of this? The annual Milliman Medical Index (MMI) found that “between 2010 and 2011, the MMI increased by $1,319 or 7.3%.” Moreover, the report noted that “even though hospital spending is only 48% of total healthcare spending, increases in facility spending (inpatient and outpatient combined) account for over 60% of this year’s total increase in cost of healthcare.”
Jay Sykes September 30, 2011 at 01:24 AM
Interstate health insurance purchases are restricted by the .McCarran–Ferguson Act;it passed congress in 1945. Further federal laws limit the total allowed discount for healthy behavior to 20% of total. So, if you are a non-smoker, and we know that smokers cost 25% more and your BMI<30, and we know BMI>30 costs 35% more, you don't get the 25+35=55% discount, you legally can only get a maximum 20% discount. We have legislated that people making healthy choices help pay for those that do not.
Brian Dey September 30, 2011 at 01:39 AM
Jay- That seems to be the theme in Washington. The healthy pay for the non-healthy and the rich pay for the poor. Really takes away the motive to be healthy or rich.
Jay Sykes September 30, 2011 at 04:19 PM
@Denise... Does 'facility spending' mean just general patient charges(over night rate) for using the building and basic staff or line items(MRI, x-ray, meds,Dr, PT) or the total from a hospital visit?


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