I just scratch my head over some of the figures thrown around regarding healthcare costs. 13% of your income, 5-10,000 out of pocket, what planet are these people on? Who other than insurance companies are they talking to? Jump and I will tell you how when I read HR 676 I knew they had done their homework the right way.
I work for a large diverse company with 40,000 employees nationwide. About 8 years ago they saw the handwriting on the wall and chose to self insure. They hired an insurance company to administer the plan, pay the bills when they came in and stopped giving us the choice between their plan and an HMO. BTW, we got insurance the day we were hired, no waiting.
This year on average the company spent $3300 per employee and their families. My coverage is $3157, of that I pay less than $6 a month. Among other things while we do pay a portion of the cost, it is paid pretax dollars and is on a sliding scale, the more you make the greater the part you pay. The company credits you back, again on a sliding scale a small amount each month to cover the basic plan so those people who are at the lowest pay grade or are covered by additional insurance pay nothing. Out of the credit you choose the level of insurance you want, not just health insurance but long term disability and life insurance beyond what is provided free of charge.
The basic plan is $600 a year deductible for a single person before 80/20 activate, after $2500 the plan starts paying at 100%. Families pay $750 deductible and after $5000 the plan pays 100%.
We have the option, at a slightly higher cost to us, to choose $300 deductible for a single and $500 for families. I took the $300 deductible and it costs me an addition $5.50 a month. there is also a $20 co-pay for doctors visits and $25 for a specialist. When the plan started it was $5 regardless of doctor.
All our drugs are covered, the only bad part of the pharmacy service is you only get a 20% discount at the local drug store. Drugs that are taken regularly can be done via mail, $20 or less for a 90 supply of a generic and $40 for name brand. They even cover Chantix and birth control pills.
We have the choice between two dental plans, the basic pays on a schedule with a yearly cap of $1000 per person and if you shop it is the best deal, I think. The other pays a percentage with a cap of $1500 a year in services. The both cover virtually everything including dentures, braces and implants. The former plan costs a little extra every month.
We have eye as well, $200 a year covered per person and eye exams free. They pay $500 per eye for Lasik surgery.
No such thing as not covering pre-existing. Among the people I know they have covered multiple very expensive eye surgeries, for a pre-existing eye injury. Covered experimental breast cancer drugs when it was the only chance a young mother had for survival. They cover TWO liver transplants for the hard living husband of a co-worker, they also paid for three months in the hospital waiting for a THIRD liver that never came. They paid for a kidney tranplant of another co-worker. They have paid for the testing and surgery for epilepsy, which worked by the way. They paid for expensive ($80,000) cutting edge laser back surgery for another co-worker, her disability will cover 100% of her salary for 6 months and it cost her nothing. She will have some left to pay from the procedure, but no more than $2500. They allow $500 a year for your annual check up and have always paid for mammograms etc.
They will pay for fertility screening but not the procedures. They pay fro drug and alcohol treatment and anti-smoking treatment. They have wellness fairs and reward one for losing weight and getting healthy with cash and gift certificates. They get killer deals with gyms and fitness centers, each office has their own work out room and mini gym available 24 hours a day.
When you retire you keep your insurance, mine will cost me $3 a month ( based on years of service ). I have the same drug plan, eye and dental plan. The medical pays everything not covered by Medicare.
This is not the best healthcare I have ever had, but these days it doesn't get much better than this. How did they do it? By making their own deals with doctors and hospitals. Based on results 40,000 people is apparently a lot of negotiating power. But think about 40,000 verses 4 million or 40 million. Obviously my employer plan is not for profit, but they also have the overhead of paying someone to administer the program. The government is in a much better position to negotiate with providers and drug companies for the very best prices. HR 676 believes this care could be provided for about $2200 a year per person. (100 billion dollars for 47 million people)
Seems pretty clear to me it is time for this country to self insure!