Great article. There's a huge issue with how people choose their health insurance, and the process seems designed to confuse the consumer. KFF found that 84% of Americans can't figure out what something will cost because they don't understand plan structures (deductibles, copays, allowed amounts, etc.).
Choosing the wrong employer-sponsored health plan can cost an individual thousands more in premiums and out-of-pocket costs. Across all our users, the wrong plan typically costs $4,339 more per year. And employers have an incentive to get everyone on the lowest-cost plan, whether or not it's right for the individual. Billions have been raised in recent years by companies that help steer employees toward the plans that cost employers the least (e.g., Nayya) or push them toward benefit programs unrelated to core insurance (e.g., Thatch).
We're building PlanStan (theplanstan.com), the first employee-aligned analysis tool, to solve this problem. It analyzes your options to find the one that actually costs you and your family the least. It uses hundreds of thousands of billing records to estimate usage and cost scenarios, then runs them through the real math and tax implications of each plan.
Next up for us is bringing more transparency to billing and pricing so people can be better consumers of healthcare.
We need to kill Employer Sponsored Insurance (ESI). Anything else is just rearranging deck chairs. Medicare For All (M4A) is a good slogan - but we already know that Medicare pricing won't work - so the slogan is just that. A slogan.
Obviously with 70% of us OBESE and 90% have CKM we will have to pay for medicine etc. But only 15% of the 70% take a GLP-1 and the Wellness Bitches want to get rid of these drugs so they can revel in "healthy." The latest: Chris TSAKALAKIS ECO of Eli Lilly Direct didn't know the obesity stats. In emails with him it appears he is unhappy to find that the market is almost twice as big as the FDA says. It's not 40% and he seems to wish it was! That's how sick we are.
The problem is the whole system, not one element, like healthcare.
Healthcare costs are rising exponentially because of other industries; one of the biggest is the food industry. When the government went after the tobacco industry, the unintended consequence was that the tobacco companies bought up a large number of food companies; these food companies were bad enough as intense food-manipulation criminals. Now the tobacco companies could employ their scientists to create even more dangerous processed foods. All of the so-called food created, every single piece is poisonous, and so begins our journey into the health industry.
The whole system, from political to financial, is criminal; it's corrupt beyond imagination. The whole system needs to be trashed and started over. Not holding my breath.
Well written, as always. I so much appreciate Scott's level-headedness and common sense approach.
As a Canadian, I rarely read about America's healthcare situation, but once in a while it's good to remind myself that what we have here may not be perfect, but it's pretty damned good, and we should be grateful.
My wife and I live in a rural area of Ontario, having moved out after retirement. Our local town (pop c 5000) has a small regional hospital which is twinned with the other similar hospital in the county and which is about fifteen minutes away. Between them they enjoy pretty decent tech, including labs and MRI. In the eight years we've been here, we've gone to the emergency maybe twenty times, a few being genuine "emergencies", the rest being more or less outpatient clinic things such as tick bites. Average wait times are about an hour, and treatment is always courteous and competent. We're more than satisfied. On the few occasions that "all hell had broken loose" on the health front, admission was quick and care was superb.
Is our little hospital unique? Not at all. We've been treated in city hospitals and in other smaller community hospitals across this country, always with courtesy, kindness, and professionalism. For a number of years, I sat on the board of a city hospital fundraising foundation and got to see the inner workings of the business of running a world-class institution, including its research arm. And I'm damned proud of our achievements.
To be sure, after we moved into the community, we were on a wait list for nearly a year to get a new doctor, and in the meantime used walk-in clinics where the wait time was often over an hour, but the care was good. Finally we were assigned to a nurse practioner led clinic where we have received exceptional care. In addition to our visits on request, we have three regular visits each per year where the NP reviews blood work, presenting symptoms if any, medications, and whatever else is on our minds health-wise. If need be, she refers us to a specialist such as an ortho, gyno, or urologist. Wait times for these are typically six months, unless the matter is considered urgent. These follow ups are universally thorough and excellent. The NP clinic is so impressive that I served on the board for three years where I learned how well these professionals make every penny of government funding count. The NPs are pros, and so are the admins.
In the last two or three years, most provinces have given increasing authority to pharmacists to assess and prescribe for all kinds of minor conditions from pinkeye, tick bites, UTIs, and various skin complaints, basically walk-in, free (tax supported), and so far, so good. This alone takes a significant burden off the frontline family physicians.
I think the real key to Canadian health care is its emphasis on preventive medicine, keeping the patient healthy first and foremost, pushing the patient interface down the professional chain to the level best suited for the presenting complaint, and dealing with symptoms sooner than later. Having run my own business for four decades (private practice lawyer), it seems to me a no-brainer that any system or business is going to produce better results at lower cost by getting ahead of reactivity.
One last comment. Our area is cottage country, with a significant number of Americans who come up to enjoy time at their cottage on the lake. These folks use our hospitals as well, and it's not uncommon to meet them in the waiting room. I have yet to hear anything but good words for the treatment they've received. Yes, they have to pay for it, but generally speaking, the rates are more modest, and it's then up to them to look to their insurer for compensation.
When we talk with our American friends and relatives, we just don't "get it". You don't pay for police protection, fire services, or primary and secondary education. By and large, you drive on roads and bridges that are publicly funded. So, you have to pay if you get sick? Face bankruptcy if you get really sick? Sorry, we just don't get it.
All in all, Canadian healthcare works and works well. Perfect? No, but we're working on that.
Thank you for the excellent article. Insurers are making money but so are healthcare providers. There is a reason why all these universities are starting healthcare systems. For example, I just received a 10 minutes physical from a UCLA primary care doctor that cost $623. This is 3 times more than my prior solo practice doctor charged last year. Aetna just pays the money to UCLA Health and passes the costs along to my employer who passes the increased premiums to their employees. Big fat profits all around on the backs of employees with no incentive to bring costs down. Expansion of medicare is a practical step in the right direction.
Thank you for shining a light on this. As a small business, we've always prided ourselves on offering 100% of our health insurance coverage covered (which I'm especially proud of given that the majority of my team are women, some of whom are working mothers). I think many other small businesses have a similar approach--take care of your employees who help take care of the business. Given how America's healthcare system operates, this was also a benefit that was morally important to me.
I was incensed to find out this week that the cost of our insurance is skyrocketing this year (double digit percentages--above the norm you stated), largely because my team used their insurance in the past year. AKA, the reason they have insurance. Like you all, we pay to be in a PEO and have our rates negotiated as if we were a bigger company. I really wish I had a solution here, or even an alternative--but unfortunately given the way that our healthcare system operates in the richest country in the world, employees and small businesses (who employ nearly half of all of the American private workforce), are left holding the bill.
I love the same reimbursement for procedure proposal and lowering age incrementally for Medicare. Unfortunately the only way this will happen is by reversing the seriously flawed Citizens United ruling. We need to also create more awareness of which hospitals are PE owned so people can actively boycott them due to higher risk of adverse outcome for patients at those locations. I just did a ChatGPT query for my county and am getting okay results that are at least better than nothing.
Great article. There's a huge issue with how people choose their health insurance, and the process seems designed to confuse the consumer. KFF found that 84% of Americans can't figure out what something will cost because they don't understand plan structures (deductibles, copays, allowed amounts, etc.).
Choosing the wrong employer-sponsored health plan can cost an individual thousands more in premiums and out-of-pocket costs. Across all our users, the wrong plan typically costs $4,339 more per year. And employers have an incentive to get everyone on the lowest-cost plan, whether or not it's right for the individual. Billions have been raised in recent years by companies that help steer employees toward the plans that cost employers the least (e.g., Nayya) or push them toward benefit programs unrelated to core insurance (e.g., Thatch).
We're building PlanStan (theplanstan.com), the first employee-aligned analysis tool, to solve this problem. It analyzes your options to find the one that actually costs you and your family the least. It uses hundreds of thousands of billing records to estimate usage and cost scenarios, then runs them through the real math and tax implications of each plan.
Next up for us is bringing more transparency to billing and pricing so people can be better consumers of healthcare.
Growing up, I remember my father saying "the insurance business is a license to steal." That was 50+ years ago. Plus ca change...
We need to kill Employer Sponsored Insurance (ESI). Anything else is just rearranging deck chairs. Medicare For All (M4A) is a good slogan - but we already know that Medicare pricing won't work - so the slogan is just that. A slogan.
https://danmunro.substack.com/p/why-we-need-to-end-employer-sponsored?utm_source=share&utm_medium=android&r=8d11k
Obviously with 70% of us OBESE and 90% have CKM we will have to pay for medicine etc. But only 15% of the 70% take a GLP-1 and the Wellness Bitches want to get rid of these drugs so they can revel in "healthy." The latest: Chris TSAKALAKIS ECO of Eli Lilly Direct didn't know the obesity stats. In emails with him it appears he is unhappy to find that the market is almost twice as big as the FDA says. It's not 40% and he seems to wish it was! That's how sick we are.
The problem is the whole system, not one element, like healthcare.
Healthcare costs are rising exponentially because of other industries; one of the biggest is the food industry. When the government went after the tobacco industry, the unintended consequence was that the tobacco companies bought up a large number of food companies; these food companies were bad enough as intense food-manipulation criminals. Now the tobacco companies could employ their scientists to create even more dangerous processed foods. All of the so-called food created, every single piece is poisonous, and so begins our journey into the health industry.
The whole system, from political to financial, is criminal; it's corrupt beyond imagination. The whole system needs to be trashed and started over. Not holding my breath.
Well written, as always. I so much appreciate Scott's level-headedness and common sense approach.
As a Canadian, I rarely read about America's healthcare situation, but once in a while it's good to remind myself that what we have here may not be perfect, but it's pretty damned good, and we should be grateful.
My wife and I live in a rural area of Ontario, having moved out after retirement. Our local town (pop c 5000) has a small regional hospital which is twinned with the other similar hospital in the county and which is about fifteen minutes away. Between them they enjoy pretty decent tech, including labs and MRI. In the eight years we've been here, we've gone to the emergency maybe twenty times, a few being genuine "emergencies", the rest being more or less outpatient clinic things such as tick bites. Average wait times are about an hour, and treatment is always courteous and competent. We're more than satisfied. On the few occasions that "all hell had broken loose" on the health front, admission was quick and care was superb.
Is our little hospital unique? Not at all. We've been treated in city hospitals and in other smaller community hospitals across this country, always with courtesy, kindness, and professionalism. For a number of years, I sat on the board of a city hospital fundraising foundation and got to see the inner workings of the business of running a world-class institution, including its research arm. And I'm damned proud of our achievements.
To be sure, after we moved into the community, we were on a wait list for nearly a year to get a new doctor, and in the meantime used walk-in clinics where the wait time was often over an hour, but the care was good. Finally we were assigned to a nurse practioner led clinic where we have received exceptional care. In addition to our visits on request, we have three regular visits each per year where the NP reviews blood work, presenting symptoms if any, medications, and whatever else is on our minds health-wise. If need be, she refers us to a specialist such as an ortho, gyno, or urologist. Wait times for these are typically six months, unless the matter is considered urgent. These follow ups are universally thorough and excellent. The NP clinic is so impressive that I served on the board for three years where I learned how well these professionals make every penny of government funding count. The NPs are pros, and so are the admins.
In the last two or three years, most provinces have given increasing authority to pharmacists to assess and prescribe for all kinds of minor conditions from pinkeye, tick bites, UTIs, and various skin complaints, basically walk-in, free (tax supported), and so far, so good. This alone takes a significant burden off the frontline family physicians.
I think the real key to Canadian health care is its emphasis on preventive medicine, keeping the patient healthy first and foremost, pushing the patient interface down the professional chain to the level best suited for the presenting complaint, and dealing with symptoms sooner than later. Having run my own business for four decades (private practice lawyer), it seems to me a no-brainer that any system or business is going to produce better results at lower cost by getting ahead of reactivity.
One last comment. Our area is cottage country, with a significant number of Americans who come up to enjoy time at their cottage on the lake. These folks use our hospitals as well, and it's not uncommon to meet them in the waiting room. I have yet to hear anything but good words for the treatment they've received. Yes, they have to pay for it, but generally speaking, the rates are more modest, and it's then up to them to look to their insurer for compensation.
When we talk with our American friends and relatives, we just don't "get it". You don't pay for police protection, fire services, or primary and secondary education. By and large, you drive on roads and bridges that are publicly funded. So, you have to pay if you get sick? Face bankruptcy if you get really sick? Sorry, we just don't get it.
All in all, Canadian healthcare works and works well. Perfect? No, but we're working on that.
Thank you for the excellent article. Insurers are making money but so are healthcare providers. There is a reason why all these universities are starting healthcare systems. For example, I just received a 10 minutes physical from a UCLA primary care doctor that cost $623. This is 3 times more than my prior solo practice doctor charged last year. Aetna just pays the money to UCLA Health and passes the costs along to my employer who passes the increased premiums to their employees. Big fat profits all around on the backs of employees with no incentive to bring costs down. Expansion of medicare is a practical step in the right direction.
Thank you for shining a light on this. As a small business, we've always prided ourselves on offering 100% of our health insurance coverage covered (which I'm especially proud of given that the majority of my team are women, some of whom are working mothers). I think many other small businesses have a similar approach--take care of your employees who help take care of the business. Given how America's healthcare system operates, this was also a benefit that was morally important to me.
I was incensed to find out this week that the cost of our insurance is skyrocketing this year (double digit percentages--above the norm you stated), largely because my team used their insurance in the past year. AKA, the reason they have insurance. Like you all, we pay to be in a PEO and have our rates negotiated as if we were a bigger company. I really wish I had a solution here, or even an alternative--but unfortunately given the way that our healthcare system operates in the richest country in the world, employees and small businesses (who employ nearly half of all of the American private workforce), are left holding the bill.
I love the same reimbursement for procedure proposal and lowering age incrementally for Medicare. Unfortunately the only way this will happen is by reversing the seriously flawed Citizens United ruling. We need to also create more awareness of which hospitals are PE owned so people can actively boycott them due to higher risk of adverse outcome for patients at those locations. I just did a ChatGPT query for my county and am getting okay results that are at least better than nothing.