1) My example was just the one I received yesterday, not the only one. I was not going to scour my inbox for this discussion.

2) You seem to believe that medical debt is going to take care of itself, as long as you can self finance your receivables. Good for you, but the bankruptcy attorneys likely disagree with you.

3) I said earlier “He who has the gold, rules. And that’s the corporations and they are already establishing their own co-op managed care companies. Get ready for corporate medicine, Anonymous, you won’t have another choice in five years.”

You seem unconcerned about where the system is heading. Good for you.

And in response to your earlier comment, I know that Medicare and Medicaid have caps, but the privates often reimburse up to quadruple those fees. So I’m guessing that you do alright, and if not, you can simply over-order to drive up income.

That said, however, most physicians are pretty fair with their billing, and according to one Minnesota survey 64% prefer a single-payer system.

Since I now have savings that exceed deductible, I would not even have the cash flow problem of Example Three.

The medical issues aside, the financial issues were non-problems.

I see, though. The “horror story” was not yours, but you had to go out and solicit “horror stories”, if I understand you now. “Already the horror stories are emerging” you said, but you didn’t really have any. Sorta like the “99%” statistic of employers not funding HSA’s. You just make things up as you go along.

So you go out and look for some examples of problems, and the best you can find is people who put off inexpensive health care because they would not pay anything out of pocket. Your worst example is a high-risk pregnancy, where the person will go on a payment plan so the HSA can get funded.

Looks like I’ll be waiting a long time for you to come up with some facts to go with your mouth.

The docs here in the group. You have a patient where they face a big procedure and there’s a cash flow problem. The patient says he’s getting HSA contributions of three hundred dollars a month that he’ll sign over. Would you say no?

I get patients making twenty dollar payments, I don’t think many docs would turn away a payment plan of hundreds of dollars a month.

Is that the best you can do?

- coworker injured his ankle, but decided not to seek medical attention because it would cost a minimum of $500 for the doc, xrays, etc. and he didn’t want to spend that much for “just a sprain”

That person showed up at my office, or the urgent care where I work part-time, the total cost, with X-rays, would be about two hundred. That’s assuming I even ordered X-rays based on clinical findings. Otherwise, it’s an office visit charge and a splint.

Of course, that part of the idea behind HSA’s. To encourage people to be more prudent with medical services.

- coworker cut the back of his head open in a bicycle accident and had a friend stitch it up to avoid the ER expense

About a hundred fifty bucks at my urgent care. Less in my office. Bet he spent more on beer or cigarettes or restaurants that month.

- coworker, recently hired, has a pregnant wife and not enough time to fund the HSA before his wife delivers. The annual deductible is now higher than the IRS will allow in annual HSA contributions and the max out-of-pocket is over $4000 higher than can be contributed. His first child was premature and spent time in the NICU, so they are at higher risk anyway. He is planning on paying several thousands of dollars on a credit card to cover the birth of this next child.

If deductible is higher than annual allowable contribution it does not sound like a qualified high-deductible plan and your story already sounds suspect. Legislation is in place to allow acceleration of contributions to HSA’s for the reason you allude to. We’ll see if the current Democratic Congress lets it through. So, what you get is medical costs that will be higher than deductible.

So, what do we see in regards to payment for services. Insurance pays some. Doc lets patient pay deductible at rate currently allowed. I can’t think of any doc I have met who would have a problem with a payment plan. Certainly I get patients with payment plans all the time.

If you choose the socialized system, you can find the government taking away your money in taxes AND denying you care. Here’s just one example. I could cite dozens.

http://nhsblogdoc.blogspot.com/2007/03/tale-of-two-cancers.html

Let’s see. Not getting X-ray for a sprain when indication is questionable in the first place (see Ottawa ankle rules), not willing to spend a hundred bucks for boo-boo on head, having to make a payment plan for high-risk pregnancy…….versus denied treatment for cancer.

Oh, yeah, you’ve convinced me.

Your profile says you’re retired. You got a lot of coworkers for a retired guy.

————-
My personal story is disturbing, though not necessarily for its impact on our family.

Because of our high claims, my employer was forced into a HDHP/HSA plan for 2005. Had we stayed with the PPO plan, it would have seriously hurt my employer financially.

I remember the option well. It was November 2004. We were offered a choice between two options:
1) Stay with our PPO. Total premiums would increase 36% and employee contribution would jump from $2200 to $4810/year.
2) Switch to HDDP. Total premium + max HSA contribution would still be 34% increase over previous year’s premiums, but at least $4,000 of that would be going pretax into an HSA.

Since we had to deal with massive cost shifting in either case, everyone chose what seemed like the lesser of two evils at the time and went with the HSA.

Personally, it has served our family fairly well. We’ve been able to find 3rd-party financial assistance in covering part of our deductibles and other out-of-pocket expenses when we hit our maximum every January, which lets us keep some money in our HSA. Then we can actually use some of that money for other things that are never covered by insurance — such as travel to/from medical conferences.

It has pretty much screwed everyone else, though. There are some that couldn’t afford the extra $4,000 of cost-shifting that first year (almost $6,00/year now), and have decided to roll the dice. Here are a few anecdotes picked up in water cooler conversation since the switch to the HDHP:

– coworker injured his ankle, but decided not to seek medical attention because it would cost a minimum of $500 for the doc, xrays, etc. and he didn’t want to spend that much for “just a sprain”
– coworker cut the back of his head open in a bicycle accident and had a friend stitch it up to avoid the ER expense
– coworker, recently hired, has a pregnant wife and not enough time to fund the HSA before his wife delivers. The annual deductible is now higher than the IRS will allow in annual HSA contributions and the max out-of-pocket is over $4000 higher than can be contributed. His first child was premature and spent time in the NICU, so they are at higher risk anyway. He is planning on paying several thousands of dollars on a credit card to cover the birth of this next child.

HDHP/HSAs are simply a nasty form of cost shifting that hits the people in the middle the hardest, resulting in delayed or substandard treatment and more financial problems for consumers. I worry that more businesses will be attracted to them simply because of the significant reduction in their outlay for premiums.

Subsequently, we changed to another insurance plan. Think of a color. Since this is not like, say, Kaiser or similar player, the insurance allows fairly unlimited choice of docs. I get patients all the time who say they had to change docs because of insurance. We don’t have that problem. Most docs sign with these insurances if they sign with anything at all.

Setting aside the scurrilous remark about how I charge patients, saving money is saving money. It’s cheaper. I put the money in their hands and not the insurance company’s hands.

If they leave employment, any money saved is theirs to keep. Even at our age, with kids, we find we do not always spend the entire deductible every year. So there is usually savings over time. If they choose, they can pay premium with savings via COBRA provisions, so they can retain insurance between jobs.

Will HSA’s disappear in the future? Who knows? The alternative? People who start them in their 20′s could well find they have enough saved by their 50′s, that they could fund the annual deductible off of interest from savings. So instead of insurance companies holding onto your money and investing it, the individual gets to hold onto the money and invest it.

I don’t feel sorry for the insurance companies. They will make money off HDHP’s that are used less often, as they don’t have to pay for an office visit for someone who rarely needs a doctor. Plus they are realizing that someone has to play bank and investment firm for the HSA funds saved, check processing, extra funds put into mutuals, etc.

How do you know my patient charges are “obviously high”? Have you seen my fee schedule? My “obviously high” patient charges are set by Medicare, Medicaid, and the insurance companies.

I’m sorry you think that’s arrogant, but that’s how it is.

Oh, and still waiting to hear about the “horror stories” associated with HSA’s.

Get over yourself.

A typical Lohman quote: “That’s BS, Anonymous. You simply don’t know what you are talking about.”

I remain anonymous because there are a lot of ignorant, nasty, bitter old men with time on their hands, who like to harass people if given the opportunity.