Happy New Year again! Let’s look at the new prices for the new year in our inflation-free economy or, at worst, our 2 percent inflation economy.
We have a United Healthcare policy for our family (two adults, two kids). The deductible/out-of-pocket limit for the family is $6,500/year, which means it would have been a skimpy policy back in the 1980s but now qualifies as luxurious. The premium is $48,312 per year, up 10 percent compared to 2024. Unlike Luigi Mangione, who wasn’t a customer of United Healthcare, we are grateful to have this small business policy because it is impossible to get Obamacare insurance that includes visits to the better providers here in Florida (e.g., Mayo, Cleveland Clinic, Tampa General, UHealth Miami). Every bill and “explanation of benefits” makes us yet more grateful for the United Healthcare policy because the document always starts with the provider trying to cheat us by charging 10-20X the fair price for a service (where “fair” = what United Healthcare has purportedly “negotiated” and what we often end up paying out of pocket because the $6,500/year limit (see above) hasn’t been hit).
Home health care aides in our corner of Palm Beach County? A 12-hour shift is now $264 ($22/hr), up 10 percent compared to 2024.
To be featured in a future blog post… a new USPS stamp thanking health care workers:
When will the USPS release a stamp honoring health insurers?
Related:
- Shopping for health insurance on healthcare.gov (there is no price at which coverage can be obtained that includes going to the better quality institutions)
Cheating us by charging 10-20x is not an exaggeration. I once got a bill for $53,000 that was negotiated down to $3,000, and the bill said that they would accept $2,000 if I paid withing 24 hours.
Thanks, Roger. In what other industry would this be legal? If I could wrest the dictatorship from Donald Trump my first edict would that each health care provider must set a single price for its services and charge everyone, including insurance companies, the same price. Any system more complex than that and Americans will game it.
Phil – a mildly similar idea that perhaps could be enacted would be something like – “if a health care provider charges all who pay within 90 days the same price for all services, then they can deduct/count as charity 10x that charge for any unpaid bill” .
Would still be gamed – “please don’t pay this but donate an equivalent amount to our foundation and we won’t bug you about it” but at least that wouldn’t be stress inducing.
I’m grappling with my own healthcare diagnosis, and it is striking how the system is penny wise and pound foolish. Insurance won’t authorize the correct dosage pill, because a larger dosage is $1 cheaper and I’m expected to precisely cut them in half. I also can’t order my own $100 test even on a self-pay cash basis; I must find a prescriber who is willing to authorize the test, but that means convincing them it is important yet overlooked by primary care.
The same system that is willing to do this is also willing to pay a quarter million to treat blood pressure inside the ICU. I asked Claude.AI what would happen if undiagnosed primary aldosteronism is treated in the ICU via an IV drip using labetalol or hydralazine.
Here was the answer: A: Treating undiagnosed primary aldosteronism with standard hypertensive crisis protocols can be dangerous. The body may respond poorly to beta blockers and vasodilators, potentially leading to worsening BP, electrolyte imbalances, and organ damage. The key is recognizing when initial treatments fail and urgently investigating underlying causes like hyperaldosteronism rather than just increasing doses of ineffective medications.
Part of the problem is the system is memoryless. Every new provider wants to repeat the mistakes of the previous provider, especially if they are mistakes with expensive billing codes. But the inexpensive tests are deemed either medically unnecessary, or over the annual limit.
Steve: Yes, the dream of readily accessible lifetime medical records might not prove to be worth anything because doctors aren’t interested in medical records!
That premium is insane by international standards. Here in Australia we have a decent single-payer public healthcare system, however most adults also have private health insurance. The government issues a ~1.5% levy for taxpayers over 30 without it. I’m not sure off-hand how much of my taxes go to Medicare, but my family’s private insurance premiums are only around $3000 a year. Australia’s healthcare system isn’t bad either by international standards. At those prices, are you sure the American system is really worth defending?
Actual: the only part of the US system worth defending is that the crazy high wages ($500,000+/year for a specialist is easily within reach) attract a lot of the best and brightest people into medicine (applicants for med school and residency are first sorted by skin color, gender ID, and 2SLGBTQQIA+ status so I guess it would be fair to say “best and brightest on a per-category basis”). But everything else is a disaster. The $100 charge for a service that 99% of patients end up paying $5 for (“negotiated rate”) and then the inevitable paper bill in the mail for the $5. The 6-month waiting time to see a specialist because the border is open to low-skill migrants (“patients”) but closed to people with First World MDs (if one ends up here by mistake or via marriage or whatever, he/she/ze/they can’t practice because of the lack of an American residency and the American residencies are closed to already-trained doctors aged 40+).
I wonder about this “best and brightest” argument.
My perception is that medicine draws in idealistic young people who want to save lives… but they quickly learn from the business managers that they need to prescribe SSRIs and GLP1s and treat chronic hypertension in the ICU in order to keep the lights on and sustain the high paychecks.
Is it really different from tech or finance where brilliant people start out with mantras like “Don’t be evil” and then learn from incentives to do the opposite?
I suppose this is a philosophical discussion about the nature of money, culture and incentives. How to reward excellence without rewarding excess?
They are raising all the prices because they are involved in a very expensive CEO search.
“Home health care aides in our corner of Palm Beach County?”
I thought the never-ending non-high skilled immigration was supposed to provide sufficient, reasonably-priced labor to fill jobs such as Home Health Care Aid. Or, maybe, the US just hasn’t had enough non-high skilled immigration and needs…more, a lot more?
And also, are all the Home Health Care Aids in Palm Beach County recent Haitian immigrants? That was the case as I remember it from 30 years ago.
DP: Indeed, most of my mom’s aides have been Haitian, though many seem to have been here for at least 15-20 years. At least one is a Trump voter.
“Shopping for health insurance on healthcare.gov”
Planning on retiring within a couple of years and hoping my employer doesn’t drop the retiree health insurance benefit (employer pays 50% of a decent United Health Care HMO for an individual plan for the retiree only). So the other day I priced out an individual plan on healthcare.gov. The lowest cost individual HMO plan was a “bronze” plan at $500/mo with a $7500 deductible and $8000 max out of pocket.
The main reason I continue working is that I cannot figure out, after spending substantial research time, whether Medicare coverage would be good enough in comparison to my current employer sponsored Aetna PPO with respect to providing access to better providers (Mayo, etc). Also, currently I have an ability to access providers in multiple states (which I never used, but who knows in future).
Another reason is to delay Alzheimer onset while not caring a whit about corporate politics.
Imagine an American health care system where people pay for their own services without “insurance” being involved.