huge topic:Americans keep getting fatter

[CA renter]

Captcha,

Thanks for posting about your experience overseas. It’s always instructive to know how things work in different circumstances.

Based on your experience and knowledge, which system do you think functions better? Highly regulated or publicly owned for basic needs, with some capitalism for the “wants”…OR our sytem (which seems somewhat similar, but with a bit more privatization)?

[ocrenter]

[quote=bearishgurl]
First of all, the monthly premiums for low-deductible PPO’s (=<$500) are 30-50% HIGHER than HMO premiums. Second of all, nearly half of "PPO policyholders" have (more-affordable) high-deductible health plans (HDHP's) which have a $3000 - $8000 annual deductible (avg $5000). How much do you think an HDHP is going to pay out-of-pocket for your "chest-pain odyssey??" Do you actually think a person with a deductible of say, $5000, is going to check into an emergency room complaining of "phantom" chest-pain?? No, they may pay a $50 co-pay to see a cardiologist. But the party stops at that first “specialist-office call,” ocrenter!!
[/quote]

you don’t even know the half of it.

reality is every PPO patient that walks into a physician’s door is viewed as a cash cow. like it or not, this is the reality. this is especially true in regard to the low deductible plans, which one will immediately switch to if there’s ever a chronic disease diagnosed. as for the high deductible plans, yes it does prevent someone from going in to seek care, and this may also cause a real chest pain guy to wait until a heart attack, forcing a 911 call to the ER.

The young and healthy are going to pick the HDHP. That much is true. But their utilization under the HMO system is not high either.

The real juice comes with the population with chronic conditions. Those will not be picking the HDHP. So if 50% of PPO are HDHP, I guarantee you the other 50% picking are chronic disease folks picking low deductible plans.

Let’s take a PPO guy with diabetes, cholesterol problems, and hypertension. This guy is going to be given Lipitor at $140/mo, Januvia at $220/mo, and Benicar/HTZ at $110/mo. True cost for this guy is $470/mo, or $1410/3mo. His copay for the drugs will be $150. So it doesn’t even begin to cover for the meds. His guy will have a cardiologist for his blood pressure, an endocrinologist for his diabetes and cholesterol. Both of which will charge specialist billing to the health plan. (btw, the cardiologist and the endocrinologist will be routinely visited by their prospective double D enhanced drug rep couple of times a week to re-enforce the need to prescribe these meds.)

In the meantime, the same guy at a HMO will get a metformin at $18/mo, a lisinopril/HCTZ at $22/mo, and simvastatin at $28/mo. He will see a HMO internist who will manage all of his medications. $204/3 mo is the total cost of meds, of which this guy pays $90 on his copay, about half of the drugs’ cost. His HMO internist will not be visited by the double D enhanced drug rep at all because he simply will not go to those medications until he tried all other available medications.

The cost spillover from the PPO guy will be adsorbed by everyone else on the PPO plan, and that is why everyone pays.

[ocrenter]

[quote=bearishgurl]
First of all, the monthly premiums for low-deductible PPO’s (=<$500) are 30-50% HIGHER than HMO premiums. Second of all, nearly half of "PPO policyholders" have (more-affordable) high-deductible health plans (HDHP's) which have a $3000 - $8000 annual deductible (avg $5000). How much do you think an HDHP is going to pay out-of-pocket for your "chest-pain odyssey??" Do you actually think a person with a deductible of say, $5000, is going to check into an emergency room complaining of "phantom" chest-pain?? No, they may pay a $50 co-pay to see a cardiologist. But the party stops at that first “specialist-office call,” ocrenter!!
[/quote]

you don’t even know the half of it.

reality is every PPO patient that walks into a physician’s door is viewed as a cash cow. like it or not, this is the reality. this is especially true in regard to the low deductible plans, which one will immediately switch to if there’s ever a chronic disease diagnosed. as for the high deductible plans, yes it does prevent someone from going in to seek care, and this may also cause a real chest pain guy to wait until a heart attack, forcing a 911 call to the ER.

The young and healthy are going to pick the HDHP. That much is true. But their utilization under the HMO system is not high either.

The real juice comes with the population with chronic conditions. Those will not be picking the HDHP. So if 50% of PPO are HDHP, I guarantee you the other 50% picking are chronic disease folks picking low deductible plans.

Let’s take a PPO guy with diabetes, cholesterol problems, and hypertension. This guy is going to be given Lipitor at $140/mo, Januvia at $220/mo, and Benicar/HTZ at $110/mo. True cost for this guy is $470/mo, or $1410/3mo. His copay for the drugs will be $150. So it doesn’t even begin to cover for the meds. His guy will have a cardiologist for his blood pressure, an endocrinologist for his diabetes and cholesterol. Both of which will charge specialist billing to the health plan. (btw, the cardiologist and the endocrinologist will be routinely visited by their prospective double D enhanced drug rep couple of times a week to re-enforce the need to prescribe these meds.)

In the meantime, the same guy at a HMO will get a metformin at $18/mo, a lisinopril/HCTZ at $22/mo, and simvastatin at $28/mo. He will see a HMO internist who will manage all of his medications. $204/3 mo is the total cost of meds, of which this guy pays $90 on his copay, about half of the drugs’ cost. His HMO internist will not be visited by the double D enhanced drug rep at all because he simply will not go to those medications until he tried all other available medications.

The cost spillover from the PPO guy will be adsorbed by everyone else on the PPO plan, and that is why everyone pays.

[ocrenter]

[quote=bearishgurl]
First of all, the monthly premiums for low-deductible PPO’s (=<$500) are 30-50% HIGHER than HMO premiums. Second of all, nearly half of "PPO policyholders" have (more-affordable) high-deductible health plans (HDHP's) which have a $3000 - $8000 annual deductible (avg $5000). How much do you think an HDHP is going to pay out-of-pocket for your "chest-pain odyssey??" Do you actually think a person with a deductible of say, $5000, is going to check into an emergency room complaining of "phantom" chest-pain?? No, they may pay a $50 co-pay to see a cardiologist. But the party stops at that first “specialist-office call,” ocrenter!!
[/quote]

you don’t even know the half of it.

reality is every PPO patient that walks into a physician’s door is viewed as a cash cow. like it or not, this is the reality. this is especially true in regard to the low deductible plans, which one will immediately switch to if there’s ever a chronic disease diagnosed. as for the high deductible plans, yes it does prevent someone from going in to seek care, and this may also cause a real chest pain guy to wait until a heart attack, forcing a 911 call to the ER.

The young and healthy are going to pick the HDHP. That much is true. But their utilization under the HMO system is not high either.

The real juice comes with the population with chronic conditions. Those will not be picking the HDHP. So if 50% of PPO are HDHP, I guarantee you the other 50% picking are chronic disease folks picking low deductible plans.

Let’s take a PPO guy with diabetes, cholesterol problems, and hypertension. This guy is going to be given Lipitor at $140/mo, Januvia at $220/mo, and Benicar/HTZ at $110/mo. True cost for this guy is $470/mo, or $1410/3mo. His copay for the drugs will be $150. So it doesn’t even begin to cover for the meds. His guy will have a cardiologist for his blood pressure, an endocrinologist for his diabetes and cholesterol. Both of which will charge specialist billing to the health plan. (btw, the cardiologist and the endocrinologist will be routinely visited by their prospective double D enhanced drug rep couple of times a week to re-enforce the need to prescribe these meds.)

In the meantime, the same guy at a HMO will get a metformin at $18/mo, a lisinopril/HCTZ at $22/mo, and simvastatin at $28/mo. He will see a HMO internist who will manage all of his medications. $204/3 mo is the total cost of meds, of which this guy pays $90 on his copay, about half of the drugs’ cost. His HMO internist will not be visited by the double D enhanced drug rep at all because he simply will not go to those medications until he tried all other available medications.

The cost spillover from the PPO guy will be adsorbed by everyone else on the PPO plan, and that is why everyone pays.

[ocrenter]

[quote=bearishgurl]
First of all, the monthly premiums for low-deductible PPO’s (=<$500) are 30-50% HIGHER than HMO premiums. Second of all, nearly half of "PPO policyholders" have (more-affordable) high-deductible health plans (HDHP's) which have a $3000 - $8000 annual deductible (avg $5000). How much do you think an HDHP is going to pay out-of-pocket for your "chest-pain odyssey??" Do you actually think a person with a deductible of say, $5000, is going to check into an emergency room complaining of "phantom" chest-pain?? No, they may pay a $50 co-pay to see a cardiologist. But the party stops at that first “specialist-office call,” ocrenter!!
[/quote]

you don’t even know the half of it.

reality is every PPO patient that walks into a physician’s door is viewed as a cash cow. like it or not, this is the reality. this is especially true in regard to the low deductible plans, which one will immediately switch to if there’s ever a chronic disease diagnosed. as for the high deductible plans, yes it does prevent someone from going in to seek care, and this may also cause a real chest pain guy to wait until a heart attack, forcing a 911 call to the ER.

The young and healthy are going to pick the HDHP. That much is true. But their utilization under the HMO system is not high either.

The real juice comes with the population with chronic conditions. Those will not be picking the HDHP. So if 50% of PPO are HDHP, I guarantee you the other 50% picking are chronic disease folks picking low deductible plans.

Let’s take a PPO guy with diabetes, cholesterol problems, and hypertension. This guy is going to be given Lipitor at $140/mo, Januvia at $220/mo, and Benicar/HTZ at $110/mo. True cost for this guy is $470/mo, or $1410/3mo. His copay for the drugs will be $150. So it doesn’t even begin to cover for the meds. His guy will have a cardiologist for his blood pressure, an endocrinologist for his diabetes and cholesterol. Both of which will charge specialist billing to the health plan. (btw, the cardiologist and the endocrinologist will be routinely visited by their prospective double D enhanced drug rep couple of times a week to re-enforce the need to prescribe these meds.)

In the meantime, the same guy at a HMO will get a metformin at $18/mo, a lisinopril/HCTZ at $22/mo, and simvastatin at $28/mo. He will see a HMO internist who will manage all of his medications. $204/3 mo is the total cost of meds, of which this guy pays $90 on his copay, about half of the drugs’ cost. His HMO internist will not be visited by the double D enhanced drug rep at all because he simply will not go to those medications until he tried all other available medications.

The cost spillover from the PPO guy will be adsorbed by everyone else on the PPO plan, and that is why everyone pays.

[ocrenter]

[quote=bearishgurl]
First of all, the monthly premiums for low-deductible PPO’s (=<$500) are 30-50% HIGHER than HMO premiums. Second of all, nearly half of "PPO policyholders" have (more-affordable) high-deductible health plans (HDHP's) which have a $3000 - $8000 annual deductible (avg $5000). How much do you think an HDHP is going to pay out-of-pocket for your "chest-pain odyssey??" Do you actually think a person with a deductible of say, $5000, is going to check into an emergency room complaining of "phantom" chest-pain?? No, they may pay a $50 co-pay to see a cardiologist. But the party stops at that first “specialist-office call,” ocrenter!!
[/quote]

you don’t even know the half of it.

reality is every PPO patient that walks into a physician’s door is viewed as a cash cow. like it or not, this is the reality. this is especially true in regard to the low deductible plans, which one will immediately switch to if there’s ever a chronic disease diagnosed. as for the high deductible plans, yes it does prevent someone from going in to seek care, and this may also cause a real chest pain guy to wait until a heart attack, forcing a 911 call to the ER.

The young and healthy are going to pick the HDHP. That much is true. But their utilization under the HMO system is not high either.

The real juice comes with the population with chronic conditions. Those will not be picking the HDHP. So if 50% of PPO are HDHP, I guarantee you the other 50% picking are chronic disease folks picking low deductible plans.

Let’s take a PPO guy with diabetes, cholesterol problems, and hypertension. This guy is going to be given Lipitor at $140/mo, Januvia at $220/mo, and Benicar/HTZ at $110/mo. True cost for this guy is $470/mo, or $1410/3mo. His copay for the drugs will be $150. So it doesn’t even begin to cover for the meds. His guy will have a cardiologist for his blood pressure, an endocrinologist for his diabetes and cholesterol. Both of which will charge specialist billing to the health plan. (btw, the cardiologist and the endocrinologist will be routinely visited by their prospective double D enhanced drug rep couple of times a week to re-enforce the need to prescribe these meds.)

In the meantime, the same guy at a HMO will get a metformin at $18/mo, a lisinopril/HCTZ at $22/mo, and simvastatin at $28/mo. He will see a HMO internist who will manage all of his medications. $204/3 mo is the total cost of meds, of which this guy pays $90 on his copay, about half of the drugs’ cost. His HMO internist will not be visited by the double D enhanced drug rep at all because he simply will not go to those medications until he tried all other available medications.

The cost spillover from the PPO guy will be adsorbed by everyone else on the PPO plan, and that is why everyone pays.

[bearishgurl]

[quote=ocrenter] . . . reality is every PPO patient that walks into a physician’s door is viewed as a cash cow. like it or not, this is the reality. this is especially true in regard to the low deductible plans, which one will immediately switch to if there’s ever a chronic disease diagnosed. as for the high deductible plans, yes it does prevent someone from going in to seek care, and this may also cause a real chest pain guy to wait until a heart attack, forcing a 911 call to the ER.

The young and healthy are going to pick the HDHP. That much is true. But their utilization under the HMO system is not high either.

The real juice comes with the population with chronic conditions. Those will not be picking the HDHP. So if 50% of PPO are HDHP, I guarantee you the other 50% picking are chronic disease folks picking low deductible plans.

-snip-

The cost spillover from the PPO guy will be adsorbed by everyone else on the PPO plan, and that is why everyone pays.[/quote]

ocrenter, I agree about the “cost spillover” from those with chronic conditions. That’s why individual and small-business plans are priced according to age. This is done so the healthy in a particular age-group can subsidize the ills of their unluckier (or more often, those who made bad choices in life) contemporaries. This “cost” spillover in premiums applies to both PPOs and HMOs alike.

Your “PPO guy” (above) is likely paying a far higher monthly premium than your “HMO guy” is, either themselves or in conjunction with an employer. Many, many persons that would experience the problems you recounted above are at an age where they have been downsized, involuntarily retired or laid off and thus have to pay their OWN health premiums.

You touched above on the “choices” people make between low and high deductible plans as though they were pastries displayed in a bakery case. More often, people who choose HDHPs can’t afford the premiums for lower-deductible plans. Even HMO premiums are higher than HDHPs. Many small businesses can only afford to offer HDHPs or the barest bones HMO to their workers/

For instance, for a new insured in my “age group,” monthly premiums are (approximately) as follows:

Kaiser HMO: $540 mo
Pacificare HMO: $530 mo
Indemnity Plan ($10,000 ded): $830 mo
Aetna PPO with $250 ded: $870 mo (Group only [not sure if still avail])
Aetna PPO with $500 ded: $790 mo (Group only)

Until 2014, these (individual, best-case scenario) HDHP premiums are currently subject to state of health):

Aetna PPO with $1750 ded: $523 mo
Aetna PPO with $2750 ded: $497 mo
Aetna PPO with $3500 ded: $421 mo
Aetna PPO with $5000 ded: $372 mo

Catastrophic coverage only:

Aetna PPO with $2500 ded: $281 mo
Aetna PPO with $5000 ded: $206 mo
Aetna PPO with $8000 ded: $173 mo

ocrenter, your two typical sample “guys” (with health issues) paid different premiums to have their coverage. Are you forgetting that your two sample “guys” paid substantial premiums to their carriers (perhaps $540 to $870 mo)?

Aetna reduces their payments to providers down to their “allowable charge” just like Tricare or Medicare. Not sure why you are stating that providers consider PPO patients “cash-cows.”

ocrenter, are you employed in the healthcare field? Just wondering.

[bearishgurl]

[quote=ocrenter] . . . reality is every PPO patient that walks into a physician’s door is viewed as a cash cow. like it or not, this is the reality. this is especially true in regard to the low deductible plans, which one will immediately switch to if there’s ever a chronic disease diagnosed. as for the high deductible plans, yes it does prevent someone from going in to seek care, and this may also cause a real chest pain guy to wait until a heart attack, forcing a 911 call to the ER.

The young and healthy are going to pick the HDHP. That much is true. But their utilization under the HMO system is not high either.

The real juice comes with the population with chronic conditions. Those will not be picking the HDHP. So if 50% of PPO are HDHP, I guarantee you the other 50% picking are chronic disease folks picking low deductible plans.

-snip-

The cost spillover from the PPO guy will be adsorbed by everyone else on the PPO plan, and that is why everyone pays.[/quote]

ocrenter, I agree about the “cost spillover” from those with chronic conditions. That’s why individual and small-business plans are priced according to age. This is done so the healthy in a particular age-group can subsidize the ills of their unluckier (or more often, those who made bad choices in life) contemporaries. This “cost” spillover in premiums applies to both PPOs and HMOs alike.

Your “PPO guy” (above) is likely paying a far higher monthly premium than your “HMO guy” is, either themselves or in conjunction with an employer. Many, many persons that would experience the problems you recounted above are at an age where they have been downsized, involuntarily retired or laid off and thus have to pay their OWN health premiums.

You touched above on the “choices” people make between low and high deductible plans as though they were pastries displayed in a bakery case. More often, people who choose HDHPs can’t afford the premiums for lower-deductible plans. Even HMO premiums are higher than HDHPs. Many small businesses can only afford to offer HDHPs or the barest bones HMO to their workers/

For instance, for a new insured in my “age group,” monthly premiums are (approximately) as follows:

Kaiser HMO: $540 mo
Pacificare HMO: $530 mo
Indemnity Plan ($10,000 ded): $830 mo
Aetna PPO with $250 ded: $870 mo (Group only [not sure if still avail])
Aetna PPO with $500 ded: $790 mo (Group only)

Until 2014, these (individual, best-case scenario) HDHP premiums are currently subject to state of health):

Aetna PPO with $1750 ded: $523 mo
Aetna PPO with $2750 ded: $497 mo
Aetna PPO with $3500 ded: $421 mo
Aetna PPO with $5000 ded: $372 mo

Catastrophic coverage only:

Aetna PPO with $2500 ded: $281 mo
Aetna PPO with $5000 ded: $206 mo
Aetna PPO with $8000 ded: $173 mo

ocrenter, your two typical sample “guys” (with health issues) paid different premiums to have their coverage. Are you forgetting that your two sample “guys” paid substantial premiums to their carriers (perhaps $540 to $870 mo)?

Aetna reduces their payments to providers down to their “allowable charge” just like Tricare or Medicare. Not sure why you are stating that providers consider PPO patients “cash-cows.”

ocrenter, are you employed in the healthcare field? Just wondering.

[bearishgurl]

[quote=ocrenter] . . . reality is every PPO patient that walks into a physician’s door is viewed as a cash cow. like it or not, this is the reality. this is especially true in regard to the low deductible plans, which one will immediately switch to if there’s ever a chronic disease diagnosed. as for the high deductible plans, yes it does prevent someone from going in to seek care, and this may also cause a real chest pain guy to wait until a heart attack, forcing a 911 call to the ER.

The young and healthy are going to pick the HDHP. That much is true. But their utilization under the HMO system is not high either.

The real juice comes with the population with chronic conditions. Those will not be picking the HDHP. So if 50% of PPO are HDHP, I guarantee you the other 50% picking are chronic disease folks picking low deductible plans.

-snip-

The cost spillover from the PPO guy will be adsorbed by everyone else on the PPO plan, and that is why everyone pays.[/quote]

ocrenter, I agree about the “cost spillover” from those with chronic conditions. That’s why individual and small-business plans are priced according to age. This is done so the healthy in a particular age-group can subsidize the ills of their unluckier (or more often, those who made bad choices in life) contemporaries. This “cost” spillover in premiums applies to both PPOs and HMOs alike.

Your “PPO guy” (above) is likely paying a far higher monthly premium than your “HMO guy” is, either themselves or in conjunction with an employer. Many, many persons that would experience the problems you recounted above are at an age where they have been downsized, involuntarily retired or laid off and thus have to pay their OWN health premiums.

You touched above on the “choices” people make between low and high deductible plans as though they were pastries displayed in a bakery case. More often, people who choose HDHPs can’t afford the premiums for lower-deductible plans. Even HMO premiums are higher than HDHPs. Many small businesses can only afford to offer HDHPs or the barest bones HMO to their workers/

For instance, for a new insured in my “age group,” monthly premiums are (approximately) as follows:

Kaiser HMO: $540 mo
Pacificare HMO: $530 mo
Indemnity Plan ($10,000 ded): $830 mo
Aetna PPO with $250 ded: $870 mo (Group only [not sure if still avail])
Aetna PPO with $500 ded: $790 mo (Group only)

Until 2014, these (individual, best-case scenario) HDHP premiums are currently subject to state of health):

Aetna PPO with $1750 ded: $523 mo
Aetna PPO with $2750 ded: $497 mo
Aetna PPO with $3500 ded: $421 mo
Aetna PPO with $5000 ded: $372 mo

Catastrophic coverage only:

Aetna PPO with $2500 ded: $281 mo
Aetna PPO with $5000 ded: $206 mo
Aetna PPO with $8000 ded: $173 mo

ocrenter, your two typical sample “guys” (with health issues) paid different premiums to have their coverage. Are you forgetting that your two sample “guys” paid substantial premiums to their carriers (perhaps $540 to $870 mo)?

Aetna reduces their payments to providers down to their “allowable charge” just like Tricare or Medicare. Not sure why you are stating that providers consider PPO patients “cash-cows.”

ocrenter, are you employed in the healthcare field? Just wondering.

[bearishgurl]

[quote=ocrenter] . . . reality is every PPO patient that walks into a physician’s door is viewed as a cash cow. like it or not, this is the reality. this is especially true in regard to the low deductible plans, which one will immediately switch to if there’s ever a chronic disease diagnosed. as for the high deductible plans, yes it does prevent someone from going in to seek care, and this may also cause a real chest pain guy to wait until a heart attack, forcing a 911 call to the ER.

The young and healthy are going to pick the HDHP. That much is true. But their utilization under the HMO system is not high either.

The real juice comes with the population with chronic conditions. Those will not be picking the HDHP. So if 50% of PPO are HDHP, I guarantee you the other 50% picking are chronic disease folks picking low deductible plans.

-snip-

The cost spillover from the PPO guy will be adsorbed by everyone else on the PPO plan, and that is why everyone pays.[/quote]

ocrenter, I agree about the “cost spillover” from those with chronic conditions. That’s why individual and small-business plans are priced according to age. This is done so the healthy in a particular age-group can subsidize the ills of their unluckier (or more often, those who made bad choices in life) contemporaries. This “cost” spillover in premiums applies to both PPOs and HMOs alike.

Your “PPO guy” (above) is likely paying a far higher monthly premium than your “HMO guy” is, either themselves or in conjunction with an employer. Many, many persons that would experience the problems you recounted above are at an age where they have been downsized, involuntarily retired or laid off and thus have to pay their OWN health premiums.

You touched above on the “choices” people make between low and high deductible plans as though they were pastries displayed in a bakery case. More often, people who choose HDHPs can’t afford the premiums for lower-deductible plans. Even HMO premiums are higher than HDHPs. Many small businesses can only afford to offer HDHPs or the barest bones HMO to their workers/

For instance, for a new insured in my “age group,” monthly premiums are (approximately) as follows:

Kaiser HMO: $540 mo
Pacificare HMO: $530 mo
Indemnity Plan ($10,000 ded): $830 mo
Aetna PPO with $250 ded: $870 mo (Group only [not sure if still avail])
Aetna PPO with $500 ded: $790 mo (Group only)

Until 2014, these (individual, best-case scenario) HDHP premiums are currently subject to state of health):

Aetna PPO with $1750 ded: $523 mo
Aetna PPO with $2750 ded: $497 mo
Aetna PPO with $3500 ded: $421 mo
Aetna PPO with $5000 ded: $372 mo

Catastrophic coverage only:

Aetna PPO with $2500 ded: $281 mo
Aetna PPO with $5000 ded: $206 mo
Aetna PPO with $8000 ded: $173 mo

ocrenter, your two typical sample “guys” (with health issues) paid different premiums to have their coverage. Are you forgetting that your two sample “guys” paid substantial premiums to their carriers (perhaps $540 to $870 mo)?

Aetna reduces their payments to providers down to their “allowable charge” just like Tricare or Medicare. Not sure why you are stating that providers consider PPO patients “cash-cows.”

ocrenter, are you employed in the healthcare field? Just wondering.

[bearishgurl]

[quote=ocrenter] . . . reality is every PPO patient that walks into a physician’s door is viewed as a cash cow. like it or not, this is the reality. this is especially true in regard to the low deductible plans, which one will immediately switch to if there’s ever a chronic disease diagnosed. as for the high deductible plans, yes it does prevent someone from going in to seek care, and this may also cause a real chest pain guy to wait until a heart attack, forcing a 911 call to the ER.

The young and healthy are going to pick the HDHP. That much is true. But their utilization under the HMO system is not high either.

The real juice comes with the population with chronic conditions. Those will not be picking the HDHP. So if 50% of PPO are HDHP, I guarantee you the other 50% picking are chronic disease folks picking low deductible plans.

-snip-

The cost spillover from the PPO guy will be adsorbed by everyone else on the PPO plan, and that is why everyone pays.[/quote]

ocrenter, I agree about the “cost spillover” from those with chronic conditions. That’s why individual and small-business plans are priced according to age. This is done so the healthy in a particular age-group can subsidize the ills of their unluckier (or more often, those who made bad choices in life) contemporaries. This “cost” spillover in premiums applies to both PPOs and HMOs alike.

Your “PPO guy” (above) is likely paying a far higher monthly premium than your “HMO guy” is, either themselves or in conjunction with an employer. Many, many persons that would experience the problems you recounted above are at an age where they have been downsized, involuntarily retired or laid off and thus have to pay their OWN health premiums.

You touched above on the “choices” people make between low and high deductible plans as though they were pastries displayed in a bakery case. More often, people who choose HDHPs can’t afford the premiums for lower-deductible plans. Even HMO premiums are higher than HDHPs. Many small businesses can only afford to offer HDHPs or the barest bones HMO to their workers/

For instance, for a new insured in my “age group,” monthly premiums are (approximately) as follows:

Kaiser HMO: $540 mo
Pacificare HMO: $530 mo
Indemnity Plan ($10,000 ded): $830 mo
Aetna PPO with $250 ded: $870 mo (Group only [not sure if still avail])
Aetna PPO with $500 ded: $790 mo (Group only)

Until 2014, these (individual, best-case scenario) HDHP premiums are currently subject to state of health):

Aetna PPO with $1750 ded: $523 mo
Aetna PPO with $2750 ded: $497 mo
Aetna PPO with $3500 ded: $421 mo
Aetna PPO with $5000 ded: $372 mo

Catastrophic coverage only:

Aetna PPO with $2500 ded: $281 mo
Aetna PPO with $5000 ded: $206 mo
Aetna PPO with $8000 ded: $173 mo

ocrenter, your two typical sample “guys” (with health issues) paid different premiums to have their coverage. Are you forgetting that your two sample “guys” paid substantial premiums to their carriers (perhaps $540 to $870 mo)?

Aetna reduces their payments to providers down to their “allowable charge” just like Tricare or Medicare. Not sure why you are stating that providers consider PPO patients “cash-cows.”

ocrenter, are you employed in the healthcare field? Just wondering.

[NotCranky]

Starbuck has their pastries labeled for calorie content. OMG!Short Starbucks.

[NotCranky]

Starbuck has their pastries labeled for calorie content. OMG!Short Starbucks.

[NotCranky]

Starbuck has their pastries labeled for calorie content. OMG!Short Starbucks.

[NotCranky]

Starbuck has their pastries labeled for calorie content. OMG!Short Starbucks.

[Author]

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