Ucodegan, it appears you’re arguing against having insurance, that it’s cheaper just to pay discounted rates for care instead. In some cases I’m sure that’s correct. The whole idea of insurance (any kind of insurance) is to cover otherwise unaffordable losses.
Yes and no. I am arguing that paying direct for most of the regularly occurring ‘stuff’ and insuring for catastrophic. I am also trying to state that for most people, self-pay is actually cheaper.
What I am paying per month has nothing to with whether or not insurance companies pay full charges, which is what I believe you originally said.
True, but they can also ‘game’ the numbers they present to you so that it looks like you are saving. “Here at Scripts, this is what it would cost, but since you are with a Scripts plan, this is what we(our insurance/HMO arm) really paid us(our medical arm).” I do notice that you are with Aetna, not Scripts.. What you are paying every month does have real implications as to the cost to people. Part of the problem is comparing the cost of self-pay vs HMO/PPO insurance. I know what my numbers would be, and self-pay is better. Even when I was quite ill and jaundiced(when I had the MRI and crap load of blood tests), it was better for self-pay. I don’t know everyone else’s numbers though. You stated that your employer pays $450/month, do you have a monthly insurance fee? So far:
pay-in = $450/month – employer premium
$50/month – prescription co-pay
total = $6000 – for year
Determining the real payout by the insurance co is the problem as well as determining what would have been paid out if it was cash pay. Your listed total was $3884. You mentioned that this did not include prescription charges..? What it would have been as cash-pay, I don’t know.
Which is why, if I lost my employer sponsored insurance, I would probably be uninsurable due to pre-existing conditions (all very controllable, but require regular maintenance. It’s a bitch getting old.)
I was laid of by my employer at the start of this downturn (shortly after I got ill than recovered). This is why I am very sensitive to the ‘company plan’ issue. Instead of spending the diff between what I would have paid on health insurance, I invested it. If I had paid into their plan, I would not be covered and would not have the money as well. I just wish that I could have invested the money in a pre-tax form. I also agree with its a bitch getting old(er).
Your final statement about the loss ratio is not even an argument I’ve ever seen made in the reform debate. Nor does it make any sense. Too much premium dollar goes to insurance company bottom line.
And the loss ratio is one way to see how much money is going to the insurance bottom line (combined with overhead and bad investment decisions) as a percentage of paid in. I do agree with the need for competition.
