patrick.net

Holy shit!

That's amazing. And this is the "very healthy person" rate, I'm almost certain.

Yes, it seems to be the rate they charge everyone the age of my wife and myself with kids. We jog, eat mostly vegetarian, and don't smoke.

For a while I thought it was because we did need to use the insurance last year, but that's not it. They even sent me their chart to show that my premium is the same as everyone else in my age and family category.

They're just screwing everyone equally.

Blue Shield screws over the doctors in their system as well. They suddenly decide to withhold 60-80k in payments and dare the doctors to sue them. They have an army of lawyers ready to bankrupt any doctor that tries. I've seen them do it to 3 physicians in the past year.

Yep, healthcare is so royally fucked in this country. The insurance companies cry and weep publicly, and then work nonstop to screw us on the back end. The solution is to do away with them, whether that's a free market system, or a single player system, or mixed like Singapore. American health insurers are just holding us all hostage, even the retards who think the current system is a free market are affected.

Yes, I agree. Insurance companies should not even exist, except for small optional treatments.

For life-or-death catastrophic coverage, there never was a free market and never will be. You risk bankrupcy or death for your family members if you don't pay whatever they say. That's no market. It's extortion.

Even more than national defense, the first priority of government should be protection of the lives and assets of its citizens from this kind of extortion. This means the insurance companies must get out of the way.

Every other industrialized country pays half as much per person as the US, for better care, because they have a government option or a single-payer system.

The only explanation for our f'd up system is legalized corruption, also called lobbying and campaign donations. Well, that and "the retards who think the current system is a free market" referred to so accurately by Blue-collar in the comment above.

I'm far from the only person upset about this. Here's a blog with some good comments about Blue Shield:

http://iainsuranceca.wordpress.com/2010/11/15/wellmark-blue-cross-blue-shield-of-iowa/

Say, doesn't California have a Commissioner of Insurance who is supposed to hold a hearing prior to making a decision on the requested rate increase? How could they possibly approve such huge increases?

On a related note - I thought this was rather interesting, in case anyone missed it:

http://www.youtube.com/watch?v=6xlpcDnr7eM

Move to Australia like me.

One drastic way is to not to have insurance and just go to ER when thing hits.
Last year, I took my son to ER for real emergency. There are several other patients and their family, who do not seem so urgent but more like having a tour in ER room, before my turn. You will guess who are those people. When my turn is up, then the nurse asked for many paperwork while my son was in great pain before they will take a look at him.
Even with employer insurance, the copay has doubled. Who knows when it will double again.

Yes, I agree. Insurance companies should not even exist, except for small optional treatments.
For life-or-death catastrophic coverage, there never was a free market and never will be. You risk likely bankrupcy or death for your family members if you don’t pay whatever they say. That’s no market. It’s extortion.
Even more than national defense, the first priority of government should be protection of the lives and assets of its citizens from this kind of extortion. This means the insurance companies must get out of the way.
Every other industrialized country pays half as much per person as the US, for better care, because they have a government option or a single-payer system.
The only explanation for our f’d up system is legalized corruption, also called lobbying and campaign donations. Well, that and “the retards who think the current system is a free market” referred to so accurately by Blue-collar in the comment above.

From what I can tell, the US system is a bad combination of the following:

1. Some groups of people get very good, free healthcare (low to zero deductibles). These groups often visit the doctor a lot, get unnecessary tests, and run up the bill since it's no cost to them. Medicare advantage groups, gov employees, employees with 'cadillac' coverage,etc. Since there's no cost to them to go to the doctor for every minor thing, some go ahead and do. I know a few people personally like this...

Doctors bill by the procedure, plus all those tests cost a lot of money, so these costs run up. These costs result in higher health insurance costs for everyone since the HI companies pass these onto us. Also, the increased 'demand' on the system results in higher prices, just like if everyone started eating a ton of tacos, corn prices go up.

In Europe, everyone sorta falls into this group of free access to healthcare. However, Europe has rationing. Since it's all through the state and the state is fundamentally broke, it just won't pay much, so people just wait in line. The waiting in line dissuades people from getting healthcare unless they actually need it, so it inadvertently takes care of the incentive to visit the doctor a lot.

2. Health insurance companies pretty much add zero value- just bureaucracy. I'm a small government/fiscal Republican type, but I can fundamentally see why having the government run health insurance would be more efficient than the current program (I wouldn't call the current program 'free market' since it's a unholy combo of gov programs like Medicare/gov insurance and 'free market.') From what I can tell, HI companies just haggle with people over prices and coverage.

3. America is a nation of fatasses. The diabetes epidemic jacks up everything since it's an expensive disease to treat, especially if the patient lets it continue to develop.

4. There is fundamentally no cost-benefit analysis with new technologies. Some new gadget is like 5% better but it costs 50% more? They'll still use it since it's better. Most of the time, the cost isn't borne on the patient, it's borne on the insurer, so the doctors use it since it's the 'better' tech. Who ends up paying is the taxpayer and everyone else since it's more cost in the system.

So yeah, that's why we have $700 HI plans for catastrophic coverage. It's not the people with catastrophic coverage that runup the system. In fact, I think if everyone had catastrophic coverage and had to pay like 20% of the entire bill after the deductible (to say $20k a year), then health insurance prices would plummet since people wouldn't abuse the system (and that $700 plan is now $70/month, which seems more fair for catastrophic coverage).

It's the people that have 0 deductibles, are overweight, the insurance bureaucracy, you name it- there's pretty much very little in the current system that keeps the cost down and those groups combined result in these higher costs.

In Europe, they're just like 'fuck it, hospital you get $XYZ dollars, do your best' and well, looks like it's better than us at least from a cost standpoint. Of course, if you have good or even catastrophic coverage and something really bad or rare did happen, I'd still probably rather get US care.

But for basic coverage and I break a leg, gimme Europe.

Blue Cross also systematically raises rates as well. There has to be a point where the cost of the insurance ( aka the price of getting insurance company rates for medical care b/c with a $8000 deductible, the insurance company is not paying anything out with you ) is simply not worth the risk of financial ruin by a possible medical event. If you reach that point, people have cancel and stop donating to the company or find a job that will provide the coverage. Risk based adjustment is nonsense unless your previous rates were teasers.

The challenge is to calculate that magic number where the insurance cost is riskier to your financial situation than the actual cost of the emergeny room visit.

The ER cannot refuse to see anyone... EMTALA

I believe Patrick also just hit the age bump that's responsible for a lot of the jump.

I'm still in the cheaper rates, but rates did in fact jump significantly on me starting next month for some reason.

They say they're getting rid of the lifetime cap ($5M), not charging different rates based on gender, allowing those 25yos to stay on their parent's plan, etc.

I don't really fall into any of those categories. I already upped the annual deductible from 1700 to 4500, but now I'm paying more for 4,500 than I was for 1700 when I started this in 2008. Bah. Need to get my ass out of this country again. Canada is attractive, too bad it's latitudinally challenged.

don't think Blue Shield is the problem here though.

Wellpoint had $14.6B in revenue and $2B in overhead leaving $1.2B in profits.

This is a 78% MLR, so even if WellPoint had no overhead and no profit rates would still be ~80% what they are now, at least in the naive analysis.

Kaiser is harder to analyze since they can pay themselves more for care, which fuzzes the MLR benchmark.

The core problem is the sheer amount of rent-seeking going on in the medical care sector. All that money they're making has to come from somewhere.

I think the best way to deal with this is to not own a home! If you are not old enough for Medicare and you don't have a fancy job with great benefits, you are screwed if you have assets that are vulnerable.

Patrick is smart. The best insurance really is to eat organic healthy food, live a sane life, exercise and take care of yourself. And pray you don't get in an accident or become ill anyway.

Of course I’m shopping for other insurance via http://www.healthcare.gov/ but so far none of the others seem to be much cheaper.

Another reason for this is the antitrust exemption the insurance industry enjoys. The House passed a bill to eliminate it, but whether you'll hear anything more about it is doubtful.

The USA has a higher concentration of experts, no doubt, but as the US is a nation in decline that will not last forever. I've been treated in the USA, Japan, Singapore, and also the bastardized free market system in Japan (doctors that work outside of national health). I would take any of those systems over our system from a cost/quality of care perspective. If you need something special, and your financially well off, your always going to be able to get what you need. Unfortunately, most of the so called American middle earners do not fit this bill and are limited to the narrow choices that insurers will allow us to have (doctors don't decide treatments, insurance companies do). It's just like a single player system, except the deck is even more financially stacked against you.

US ER care is deplorable, and I feel for any poor people who have to use it for non emergency care. It's definitely inappropriate and a very poor substitute for general care. ER docs are not trained to be general practitioners, and therefor are not good at it.

It's politically impossible to do away social security, Medicare/Medicaid, so I don't see the USA ever being able to create a free market system. The US government's administrative pricing model used by new doctors to figure out what medical fields will pay the most (yes that's right, the government sets the scale for our current "free market.") This is also known as price fixing.

Thinking about it is terribly sad, but the reality is that my 90 year old grandmother does not have any more of a right to life than I do, yet she is afforded that right, and I am not.

This is insane and unsustainable. Eventually all of these people will price themselves out of the market. It is also imhumane and unthinkable!

Patrick ... when you go to a doctor, do you use your insurance (deductible) or pay out of pocket. I see why you would need the insurance for catastrophic situations, but you might save some $ when you go for checkups if you pay out of pocket (rather than pay via deductible) ... rates usually drop dramatically. I have a friend who was without insurance and their pediatrician only charged a $20 copay for a visit ... next time you go to a doctor, just ask if the rate would be different ... worth a try.

My better half works for a non profit business in the city. The CEO of the business was a huge supporter of HC reform. Their HC insurance provider is also a non profit, so all cost increases have to be passed on as they are NOT allowed to make a profit.

During the last renewal phase for their HC bennies the CEO and a rep from the insurance company (now remember both these businesses are NON PROFIT) told all the employees the cost of their coverage was going to double. Needless to say the employees were all quite upset. The CEO and insurance rep explained that this was due to the new HC regulations and the cost increases were unavoidable. During this meeting the formerly supportive HC reform CEO was as upset as the employees about what the new HC legislation was doing to costs and coverage.

Both my wife and I work in the HC field as nurses, my wife for 15 years and myself for 5 years. We were both dead set against this legislation for we knew what would happen. Unfortunately it passed anyway and now we will get to see the damage first hand.

What a boondoggle.