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Higher deductibles affecting healthcare
More companies push higher-deductible plans
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More from County NewsAs employers' profits nose-dive with the economy, health insurance deductibles, co-pays and premiums for workers all rise.
Experts and healthcare providers say the seesaw is influencing the way patients use doctors and hospitals and turning some decisions on which insurance plan to choose for 2009 into a cross-your-fingers proposition.
"People can't afford full-priced insurance, so they're opting for the high deductible, and then they're praying they don't get sick," said Dr. Serena Friedman, a general practice doctor in Simi Valley, noting the problems begin when the prayers go unanswered. "They put paying the doctor at the bottom of the list of the bills they're going to pay. It's getting worse month by month and year by year."
Data on health plan choices people are making for 2009 isn't available, but a study by Families USA said the average cost of premiums in California rose five times faster than the median income from 2000 to 2007.
Nationwide, premiums have more than doubled over the past decade, according to the Kaiser Family Foundation healthcare research group.
The rising cost and slumping profits cause employers to seek policies that have more affordable premiums but require people to pay more for care before treatment is covered.
Just less than one of five workers with insurance this year nationwide had plans with deductibles of at least $1,000, according to a Kaiser Family survey released in September. In small companies, more than one of three people had deductibles of $1,000 or more.
"Employees look at it as a takeaway," said Donald Jones, a Thousand Oaks insurance agent and president of the California Association of Health Underwriters. "They say, ‘I had a $500 deductible and now I have a $2,500 deductible.'"
'What's the point?'
The highest deductibles are often accompanied by health spending accounts that are exempt from federal taxes. Employers and employees make contributions to the accounts that can be used for any kind of care. Money not used within one calendar year rolls over.
Advocates say the plans allow people to stockpile money for future health needs while paying less in premiums. The plans typically cover preventive care and offer 100 percent coverage after deductibles are met, providing protection against huge bills.
Insurance providers said there's a gradual increase in the companies that are pushing high-deductible savings account plans, but the Kaiser Family survey shows only 8 percent of the nation's workers were covered by the plans this year.
Some observers cite reluctance from employers. Others point to workers scared of deductibles that can range from $1,150 to $5,800 for individuals.
"People wonder what's the point of getting health insurance if I have to spend a thousand or a couple of thousand of dollars to get benefits," said Anthony Wright of the Health Access California advocacy group. "There might be a good answer to that, but it's a hard sell to make."
Jones said that in Southern California more companies are sticking with traditional HMO insurance plans because the prices are still competitive. But many of the companies offering managed care are pushing more of their costs onto workers through higher co-pays and deductibles.
The rise in deductibles means some people will have to bring more than their insurance cards when they visit the doctor's office. They'll need money in order to get care.
"We'll treat them like a cash-pay patient," said Dr. Lewis Kanter, an allergy and immune disease specialist in Camarillo.
Cash can mean flexibility
Kanter said when people with high deductibles pay up front, doctors have more flexibility in offering discounts on prices contracted with insurance providers.
"I might give them 20 to 25 percent off on services if they give cash," he said. "We'll frequently play ‘Let's Make A Deal.' I'd rather give it to them at a discounted price instead of having them say I just can't afford it and not get it."
Some doctors in Ventura County expect to refer more patients to county programs for people who can't afford healthcare. They talk about handing out pricing lists that show where people can get the least expensive medicine.
Friedman said many doctors perceive the increase in deductibles and co-pays as more proof of a healthcare system that rewards insurance company executives at the expense of doctors and patients.
"Your plumber gets paid more than your doctor, and the doctor has your life at stake," she said, noting insurance companies might pay her $65 or less for a fairly complicated office visit. "Your hairdresser gets paid more."
High deductibles mean doctors who aren't paid up front have to collect from patients who can't afford to pay. That's one of the economic pressures forcing primary care doctors out of business, Friedman said.
"The frustration with the economics of healthcare has made me lean in a different direction. I now have a second profession," said the doctor, who makes wine in the Paso Robles area.
Tests, surgery postponed
Higher insurance deductibles may be one reason Los Robles Hospital & Medical Center in Thousand Oaks is busier at the end of the year and relatively quiet in January and February, said President Jim Sherman. People may put off elective procedures until they've paid off their deductible.
Doctors throughout the county tell stories of patients who postpone MRI scans and tests for cancer because their insurance won't cover the cost.
At Los Robles, patients with high deductibles are asked to pay before being admitted for most scheduled surgeries. But federal law mandates hospitals provide care to people who come to the emergency room.
Sherman said higher deductibles and co-pays may contribute to the costs of uncompensated care at the hospital.
"It's been rising about 5 percent a year," he said.
Insurance providers said high deductible plans are designed to get people to rely more on the preventive care that's often fully covered. They said the goal is to get people to shop for healthcare procedures like they do any other expenditure.
"They'll be acting more and more like consumers," said John Nelson, co-chief executive officer of Warner Pacific Insurance in Westlake Village. "They'll ask more and more questions of doctors and hospitals of what things cost or what are the alternatives. We know what it costs to fix a car, but we can't figure out what it costs to have a baby born?"
Gary Claxton, vice president of the Kaiser Family Foundation, predicted many doctors and insurers will resist revealing costs because they want to be able to charge their current rates.
The trend of consumers shouldering more insurance costs could be altered in the healthcare reform proposed by President-elect Barack Obama, Claxton said. But without that type of restructuring, he doesn't see change coming.
"As the economy just went to hell, this is not a time where employees are going to be able to negotiate for better benefits," he said.
Posted by joncmac1 on November 30, 2008 at 2:51 a.m. (Suggest removal)
There are many ways for people to get help and save on medical bills and prescriptions. Consumers need to be sure the medical provider is billing them correctly, they can negotiate down bills (Consumer Reports says 90% success rate), medical advocates can save money, and compare prices. I found this site had some ways that I saved on my medical bills.
http://www.needhelppayingbills.com/ht...
Posted by handyhood on November 30, 2008 at 6 a.m. (Suggest removal)
This all of course if your lucky enough to even have health insurance! A lot of people don't!
Posted by cassandra2 on November 30, 2008 at 8:19 a.m. (Suggest removal)
This is screwed. We need national health. We need to kick the predatory insurance corps. out of the mix and bargain collectively with the pharmaceuticals.
The ideologues so afraid of "socialized medicine" should stuff it. All the major industrial nations manage this is some way; only rightwing propaganda keeps us from doing the same.
Posted by NightLight on November 30, 2008 at 9:10 a.m. (Suggest removal)
Cassandra, I couldn't agree with you more. Some people treat socialism like a dirty word but I'm all for anything that can get affordable health care to the majority of people, what could be more important to a civilized society than that?
Insurance companies and executives are criticized for trying to maximize income and profits, but that is the system we have set up. Something has to change, the current system and situation can't go on.
Posted by carlyrose on November 30, 2008 at 9:20 a.m. (Suggest removal)
Health care costs are not as easy to estimate as a car costs. Its not an exact science. Mr Claxton VP of Kaiser foundation seems to think there should be one price for having a baby. He needs to get real. Working on the clinical end i know you can't put one price on a medical procedure. complications do happen.
to cassandra2- all the other nations manage to have national health because they have everyone paying into it. the United States doesn't have enough people paying taxes into the system to cover national health. Its a good idea however EVERYONE will have to contribute.
Posted by THX1138 on November 30, 2008 at 9:46 a.m. (Suggest removal)
"patients who postpone MRI scans and tests for cancer because their insurance won't cover the cost."
This is just unacceptable. Something is really wrong when folks put-off treatment there-by risking their lives.
If national healthcare isn't the answer we should at least impose hardcore regulation. Insurance companies should forced to show a little compassion and reduce treatment limitations. We should limit annual increases and force providers to treat those with existing conditions.
It's truly sad when an advanced country like ours cares so little for the citizens...
Posted by horsespinner on November 30, 2008 at 11:37 a.m. (Suggest removal)
I want my health care run by the guys in Sacramento, or D.C. They have done an excellent job of not funding now, I just cant wait for these guys to cover me.
Posted by yellowdvr on November 30, 2008 at 1:04 p.m.
(This thread was removed by the site staff.)
Posted by NightLight on November 30, 2008 at 1:41 p.m. (Suggest removal)
Yellowdvr, there's no need for name calling here. I personally am fortunate enough to have a job with good medical coverage but that doesn't keep me from seeing there is a major problem with health care costs in this country. Some of us are able to look beyond our personal situations and sympathize with those who are less fortunate. A lot of the people who are affected, including children and the elderly, don't have the option of just getting a job that offers reasonable medical coverage.
Posted by gramagracie on November 30, 2008 at 2:09 p.m. (Suggest removal)
Universal Health care is here, alive and well. It is called Medical, Medicaid, Access, whatever depending where you live. There is no way that the government will give us Universal Health Care, for those of us who can "afford" it, remember spread the wealth. The government can't afford it. I have a few friends who live in Mexico and Canada. They tell me that the country decides the needs of the many, it's kinda like Bakin Robbins "pick a number".
My dedutible is $3,000 yearly, Max of $2 million, this does not include the co-pay for doctors or meds. I am willing to pay my fair share. I would like there to be a choice, like we have with car insurance, I don't need fertility care, pregnancy or child care...give me a reduction and I will be okay. The young should pay for these needs, not us who no longer need it. By the way my husband and I pay $1,020.00 monthly. We have been pretty healthy, do we get a reduction because we have good heatlth...no...there is another thought..a payback from the insurance companies for those of us who don't meet our deductible.
Posted by gramagracie on November 30, 2008 at 2:13 p.m. (Suggest removal)
PS...We are retired which means our employer no longer has to meet his portion....we are responsible for all of it. Which in my opinon is okay. I don't believe an employer should pay from cradle to grave.
Posted by yellowdvr on November 30, 2008 at 3:04 p.m. (Suggest removal)
Night light I to understand how fortunate i am to have good health coverage. I still believe it is up to the private citizen to get health coverage if we need it.
Posted by yellowdvr on November 30, 2008 at 3:13 p.m. (Suggest removal)
And gramagracie I also agree with you that the employer should not be obligated to cover someone from cradle to grave. I also agree that if you been healthy you should get a portion of you premiun back. I work for a company that pays one-hundred percent of my benifits and my wife does also so we are very fortunate. I would have no problem paying for my benifits if the company asked me to.
Posted by xrl650 on November 30, 2008 at 3:55 p.m. (Suggest removal)
I am told "we have the best health care system in the world", if you can afford it.
Posted by Andrew_Smolik on November 30, 2008 at 5:05 p.m. (Suggest removal)
I just don't want some nanny-state government taking away my vitamins and herbs, ramming prescription meds down my throat, forcing me to get certain medical treatments or checkups that I don't want, using such results to discriminate against me due to some “fascistatistics” considering me to be unhealthy or “at risk” of being unhealthy, and then charging me for all of the above through taxes.
In reciprocation, I also have no personal agenda for a nanny-state government to force all of the above upon *others*. Even worse would be if *I* am also charged for it through taxes.
Medical insurance companies, employers, and other countries' nationalized healthcare systems already are doing or have done these types of things to people. At least when it's insurance companies or employers, consumer or employment choices do exist. However, when it's government, the only choice is comply with the law, or else... be punished... with tax penalties and/or “criminal” charges.
Any sound, agreeable medical system reform must be based around giving people more — not less — choices.
Posted by ironwoman on November 30, 2008 at 7:44 p.m. (Suggest removal)
Just go to prison and all of your medical will be paid for.
Posted by Freedom1 on December 1, 2008 at 4:28 a.m. (Suggest removal)
"gramagracie - Universal Health care is here, alive and well. It is called Medical, Medicaid, Access, whatever depending where you live."
You're absolutely right gramagracie. These government agencies were put into place for those without insurance, when the majority of us received insurance through our employers. Unfortunately the number of the uninsured has increased dramatically when businesses began to reduce or eliminate coverage for their employees/retirees. Not to mention that more and more sophisticated procedures have been developed to prolong life or improve the quality of it for seriously injured or ill patients. It doesn't help that "cheap labor" in the form of illegal immigrants puts an additional drain on the system to which they contribute little or nothing. It all comes at a tremendous cost - which the vast majority of us pay for in the form of taxes. If we think our taxes are high now, just wait until socialized medicine becomes a reality and it's just a matter of time before it happens.
Posted by NightLight on December 1, 2008 at 1:14 p.m. (Suggest removal)
Unfortunately the old American dream that if you studied hard and went to college then everything would be fine is no longer true for a lot of people. Every day you read about businesses closing and/or moving out of state or out of the country. A lot of people have the attitude of, "Oh well, if a business can't be competitive they are going to fall by the wayside, that's how the system works." Unfortunately how does a business maximize its profits? Cutting back employee salaries and benefits, for one.
As noted in the above story, even companies who provide benefits are having to offer less attractive packages in the name of cutting costs. So unfortunately, the health care crisis in our country is due in large part to our capitalistic, competitive, dog-eat-dog mentality.
And regarding those low paying jobs that offer no benefits, you can't just think it's their own fault for not getting an education or working harder, and that it doesn't affect you. It does. When they can't afford to take their kids to the doctor, their sick kids are sitting in class next to yours. When they can't afford to buy their medicine, they are in line behind you at the grocery store, coughing and sneezing. The inability for a segment of the population to have access to adequate health care affects everyone.
You may think socialism is a nasty word but something has to change because the current system is failing too many people.
Posted by Andrew_Smolik on December 1, 2008 at 7:53 p.m. (Suggest removal)
Re: “When they can't afford to take their kids to the doctor, their sick kids are sitting in class next to yours. When they can't afford to buy their medicine, they are in line behind you at the grocery store, coughing and sneezing.”
Doctors and prescription antibiotics can't do a whole lot for common colds, 24-hour “stomach flu” illnesses, flus, or flu-like infections, since they are caused by *viruses*, yet antibiotics are effective only against *bacterial* infections. About the only effective “cure” for the above illnesses is simple: time, sleep, and rest. Over-the-counter medications aid only the symptoms, not the infection itself. With no more than the typical symptoms, a general-practice doctor would be unlikely to be willing to do lab tests for more serious infections or illnesses anyway.
Basic medical illiteracy of the general population, and instead trying to rely on doctors and medications for curing even the most common ailments, are part of the problem of escalating medical costs.
Posted by Andrew_Smolik on December 1, 2008 at 8:01 p.m. (Suggest removal)
The “cure” of time, sleep, and rest is not only simple, but it is also costs absolutely nothing per se.
Posted by Freedom1 on December 2, 2008 at 4:02 a.m. (Suggest removal)
"Andrew_Smolik - Basic medical illiteracy of the general population, and instead trying to rely on doctors and medications for curing even the most common ailments, are part of the problem of escalating medical costs."
What a great post and I couldn't agree more! I have several friends who run their kids to the doctor the minute their temperature rises one degree or their noses start to run and then complain about the cost of their insurance! Not only are they expecting far too much from whatever medicine that is being distributed, they are impeding their children's immune systems from building up resistence to common viruses.
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