Rationing of Health Care: Lower Health Insurance Premiums Come With Fewer Choices

@Walter Hinteler,

I'm glad to hear you've fixed that. You used to choose between public and private plans, with only the private plans allowing a choice of doctors. Is/was there a difference in premiums between the two, by the way.

1 Reply

@roger,

Ehm. No. There was nothing to fix.
Their is a difference between private insurance and the mandatory insurance, mainly, however, in hospitals (like one person room, treatment by the head physician).

When I a go a doctor, family doctor or specialist or dentist or for any other medical treatment (psychologist, sports therapy, rehabilitation in a hospital or ambulant ....) I have the free choice.

When I want to get my operation in Berlin or Munich, I can do so as well. However, in the mandatory insurance, most certainly not all the costs for the ambulance would be paid then. (I've no idea, how this would work in the private insurance.)

Private insurers offer a basic tariff which is slightly above the fees for the mandatory insurance. But with that, you get less.
You can pay what you want to get in the private insurance - no limit.

1 Reply

@Walter Hinteler,

Walter Hinteler wrote:

Ehm. No.

I have to clarify that: we can only choose such physicians and dentists who are accredited to the statutory health insurance scheme (99% of dentists, 95% of all other doctors)

As far as I could find out, we have the right to choose any doctor and hospital at least since the Federal Republic exists.

1 Reply

@Walter Hinteler,

compare that with America where our very first conversation with the receptionist is an interrogation as to the relationship between that doctor and our insurance issuer......when military insurance changed companies my dentist of 8 years no longer had a contract with my company, they called to schedule telling me that the exam would cost only $5 now instead of nothing. what they did not say till I asked was that because they have no contract with the new company my new insurance would only pay 50% of any needed further work rather than the old 80%, and that the charge would be the dentists standard rates not the old insurance contract capped rates. In actual fact any work would cost me 4-7 times as much as it would have before the before my dentist became non contracted . needless to say I switched dentists.

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@hawkeye10,

Though I can get new teeth (80% paid), I have to pay new glasses full ... but could get for new hearing aids a subsidy of more than $1,000 (though only the missus says, I need them) ... it's all not fair ...

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Whaddayaknow! There ain't no more cookies in the cookie jar. In my opinion, serves everyone right that voted for a party that promulgates the myth that the cookie jar is on automatic refill. Or, at least cookies can be taken from a filled cooke jar nearby.

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one of the dirty little secrets of American capitalism is that we often have too much choice in the market place, thus shopping is exhausting and people often make irrational and/or not thought out choices in part because shopping with knowledge drains and deadens us. I lobe Costco in part because I have no choice, the company has picked a good product at a good price and I have once size of one ketchup to choose, not 7 brands in 5 sizes.

lack of choice is not a major knock on ObamaCare, that it makes the major flaw of our health system worse (cost of operations) is the top one. this bit about choice is spun by the insurance companies who want to exploit too much choice in the marketplace for profits, because they know that many people will make buying decisions that are not good for them. even better is that the one making the bad choice gets his purchase paid all or some by uncle sam, no questions asked. how cool is that!

1 Reply

@hawkeye10,

I actually have to agree with you here Hawkeye.

As with everything, there are just too many things to choose from, and it either leads people to make emotional choices, make the wrong one because there's just too many variable to think about, or it literally just wears you out and makes you brain dead.

Me? I looked at the info for about half and hour, made up my mind, and that's it. In a month or so, I'll sign up, if I'm not working somewhere with benefits, and that's that. Prior to this, I maybe looked at the whole thing for an hour, just so I could educate myself on what Obamacare is.
Not like I'm being stubborn, but I haven't heard anyone here, or elsewhere say anything that makes me think I've missed something.

Paralysis by analysis.

What if this, what if that. Jesus.
Take the most likely course and go with it.
If it doesn't suit your needs, change it at next open enrollment, just like you do at your job.

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@chai2,

it is very difficult to get missions done efficiently and with good result when so many people firmly believe that max number of choices leads to best quality of life. this is a nice window into how massively mis educated the American people are, and this flaw is of course exploited for profit.

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@Miller,

Miller wrote:

Please remember, that physicians and hospitals are continually dropping out of plans. So, you might enroll in a plan that serves you well in Jan, and then in March find that the services/physicians are no longer being offered.
Nothing lasts forever.

I believe they are only allowed to change during the enrollment period, when people are also free to change plans.

Simply bothering to check what is up during the yearly enrollment period should protect against such a move (definitely a good idea to do that).

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@Walter Hinteler,

Walter Hinteler wrote:

But as of now resp before Obamacare, everyone with an health insurance can go to any doctor and in any hospital in the USA, like we do it with our mandatory insurance in Germany. Correct?

It depends on the insurance plan. Cheap plans (HMOs) give you no choice. Expensive plans (Traditional) offer unlimited choice. Moderate plans (PPOs) have a moderate amount of choice.

1 Reply

@chai2,

chai2 wrote:

Not like I'm being stubborn, but I haven't heard anyone here, or elsewhere say anything that makes me think I've missed something.

One further thing you might consider:

The bronze plans and the cheaper silver plans can be linked to a "health savings account".

I am not terribly familiar with health savings accounts, but I think they are a tax free account that can be used to pay for service while you are making your way through your deductible.

If you are willing to bother with the added complexity, attaching a health savings account to your bronze plan might improve your coverage by making the deductible more manageable.

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@oralloy,

Thank you.
All Americans, I know, didn't have traditional plans then: although they paid (what I think) quite a lot of money, they had to look for doctors/hospitals in their state ... which were accepted by their insurance company.

1 Reply

@Walter Hinteler,

Walter Hinteler wrote:

Thank you.
All Americans, I know, didn't have traditional plans then: although they paid (what I think) quite a lot of money, they had to look for doctors/hospitals in their state ... which were accepted by their insurance company.

PPOs are a kind of hybrid between HMOs and traditional insurance. You have to go within your insurance network in order to get full coverage. But the insurance company will pay for half of the bill for service outside the network.

I presume that "out of network" coverage would cover service outside a state (but I don't know for sure).

1 Reply

@oralloy,

oralloy wrote:

chai2 wrote:
Not like I'm being stubborn, but I haven't heard anyone here, or elsewhere say anything that makes me think I've missed something.

One further thing you might consider:

The bronze plans and the cheaper silver plans can be linked to a "health savings account".

I am not terribly familiar with health savings accounts, but I think they are a tax free account that can be used to pay for service while you are making your way through your deductible.

If you are willing to bother with the added complexity, attaching a health savings account to your bronze plan might improve your coverage by making the deductible more manageable.

What complexity? You fund an account and pay for your services with a debit card.

HSA, PPO's, HMO's, these are all old news, been around for years and years.

It's like some are trying to present this as some impossible maze.

Honestly, it was no more complex than looking through your yearly elections via your place of employment. The only additional time was studying it a bit to ascertain there are largely no differences, as far a concepts.

It's less complicated buying an iphone and downloading apps in my opinion.

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@oralloy,

oralloy wrote:

I am not terribly familiar with health savings accounts, but I think they are a tax free account that can be used to pay for service while you are making your way through your deductible.

Health savings accounts are usually cafeteria plans (clickity-click), and, so long as they are managed according to IRS rules, the money is excluded from gross income when filing one's taxes. We used such a plan when i was working as a business manager for my last employer. The employer offered a basically minimal 80-20 insurance plan, with very high deductibles--but he also paid 100% of the premiums on the insurance. The employees were very satisfied in that he did pay all of the premiums, but at an employee meeting, they did say they were concerned about the high deductibles. I suggested a cafeteria plan, and it was implemented. Predictably, single employees opted for the cash payment in lieu of the health savings account--grasshoppers and ants.

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@oralloy,

I've used the Health saver plans in the past. In general they are pretty simple to use. The difficult part is estimating accurately how much you want to put in the account and also to be aware of what it actually covers and does not cover.

At one time these accounts more flexible you could use them to buy stuff like bandaids and OTC medication like pain relievers. No more. So make sure you are fully aware of what it covers.

You also want to estimate accurately. Say you simply estimate - I pay about $500 year in medical bills. And then next year you end up only having $100. You lose the other $400. You have to determine during your signup period of insurance how much you want in this HSA for the following year. So if you overestimate, you lose money. It is good for things like - you know your kid needs braces next year - get an estimate from the dentist on what you spend out of pocket. If your medical bills vary alot from year to year, you could be out of luck.

Another thing if you end up leaving a company, you lose what you have accumulated in the HSA unless you keep paying the monthly amount - but then it will be after taxes. This happened to me - I was leaving a company and had a HSA for my daughter's braces. If I didn't use it I would lose it - so I called the dentist and paid ahead of time - which is legit as long as the work is in the same calendar year.

It sounds simple on the surface as you do use it like a credit/debit card, but it can get complicated (or expensive) if you overestimate what you will need or if you leave your place of employment.

1 Reply

@Linkat,

complicated=inefficient and prown to error. that we have health saver plans and that they have been encouraged by our leaders goes to show how broken american healthcare is.

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@oralloy,

oralloy wrote:

I presume that "out of network" coverage would cover service outside a state (but I don't know for sure).

In Mass, with BC/BS, PPO coverage for "out of network" services, means out of network, but in the same State as the "network".

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@Walter Hinteler,

Walter Hinteler wrote:

Though I can get new teeth (80% paid)...

Bu new teeth, I assume you mean dental implants, which in the US cost in the ballpark of $6500/tooth +.

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Rationing of Health Care: Lower Health Insurance Premiums Come With Fewer Choices

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