Newspaper articles suggest that Clinton's medical plan would have the
following costs:

Individual:  individual pays $360, employer pays $1800, total $2160
Family:  family pays $840, employer pays $4200, total $5040

Given that newspaper articles suggest that these plans would limit the
choice of physicians unless the person is willing to pay extra, the
plans would seem to be comparable to PPO or HMO plans.

But these costs ($2160 per year for an individual, $5040 per year for a
family) seem to be quite high.  Around here, group rates for HMO and
PPO plans seem to be about $1500 or less per individual (larger groups /
employers tend to be able to negotiate better deals).  Even when
tacking on an added 20% to subsidize those who are currently uninsured
(about 1/6 of all Americans) an HMO plan would cost $1800 per year for
an individual (and that's not accounting for the fact that the
government can probably get a better deal than this when negotiating
with an HMO or insurance company), which is less than the $2160 for the
individual under the Clinton plan.

So why the discrepency?  Or have I just been running into unusually
inexpensive examples of group medical plans?

--
------------------------------------------------------------------------

No warranty of any kind is provided with this message.

: (about 1/6 of all Americans) an HMO plan would cost $1800 per year for
: an individual (and that's not accounting for the fact that the
: government can probably get a better deal than this when negotiating
: with an HMO or insurance company), which is less than the $2160 for the
: individual under the Clinton plan.

: So why the discrepency?  Or have I just been running into unusually
: inexpensive examples of group medical plans?

I don't know what community you're in...costs vary considerably from area to
area.  My impression is that the costs are comparable to HMO/PPO plans here in
Los Angeles.  Also remember that insurance companies practice 'cherry picking':
Anyone with any pre-existing illness is excluded.  In areas where this is
not allowed, the costs are considerably higher.

I believe that Clinton's plan does not discriminate against the already ill.

|: (about 1/6 of all Americans) an HMO plan would cost $1800 per year for
|: an individual (and that's not accounting for the fact that the
|: government can probably get a better deal than this when negotiating
|: with an HMO or insurance company), which is less than the $2160 for the
|: individual under the Clinton plan.
|
|: So why the discrepency?  Or have I just been running into unusually
|: inexpensive examples of group medical plans?
|
|I don't know what community you're in...costs vary considerably from area to
|area.

Northern California.

|       My impression is that the costs are comparable to HMO/PPO plans here in
|Los Angeles.  Also remember that insurance companies practice 'cherry picking':
|Anyone with any pre-existing illness is excluded.  In areas where this is
|not allowed, the costs are considerably higher.
|
|I believe that Clinton's plan does not discriminate against the already ill.

The costs that I noted in the previous article are for HMO group plans
at employers.  These plans take anyone who becomes employed without
restrictions based on pre-existing conditions.

--
------------------------------------------------------------------------

No warranty of any kind is provided with this message.

This is not a universal situation - many, if not most plans that employers
subscribe to will NOT provide coverage to employees with pre-existing illness!
This is particularly true when an employer CHANGES HMO/PPO plans to reduce
benefit expenses and obtains a plan that usually gives considerably less
for the lower price they pay.  Employees who were previously covered under
prior plans as well as new employees can find they no longer will be able
to obtain treatment under the NEW plan that had been available under the
old - this can be financially devistating to an OLD employee with an existing
or chronic medical condition!
--
   The opinions expressed are not necessarily those of the University of
     North Carolina at Chapel Hill, the Campus Office for Information
        Technology, or the Experimental Bulletin Board Service.
           internet:  laUNChpad.unc.edu or 152.2.22.80

|>The costs that I noted in the previous article are for HMO group plans
|>at employers.  These plans take anyone who becomes employed without
|>restrictions based on pre-existing conditions.
|>
|This is not a universal situation - many, if not most plans that employers
|subscribe to will NOT provide coverage to employees with pre-existing illness!
|This is particularly true when an employer CHANGES HMO/PPO plans to reduce
|benefit expenses and obtains a plan that usually gives considerably less
|for the lower price they pay.  Employees who were previously covered under
|prior plans as well as new employees can find they no longer will be able
|to obtain treatment under the NEW plan that had been available under the
|old - this can be financially devistating to an OLD employee with an existing
|or chronic medical condition!

My original question was why Clinton's plan seemed to be much more
expensive that similar existing group medical plans, which do _not_
exclude people for pre-existing conditions (the existence of plans
which do exclude people for pre-existing conditions is not relevant
to this cost comparison).  The Clinton proposal is still significantly
more expensive even if 20% were tacked on to the price of the existing
group plans to subsidize those currently uninsured.

The question is "why?".  Shouldn't the government, with its size and
negotiating power, be able to get at least as good a deal as a small
or large employer?  Or have the plans that I have seen been unusually
inexpensive for the services that they provide?

--
------------------------------------------------------------------------

No warranty of any kind is provided with this message.

Current HMOs recruit young, healthy, working people.  The first thing
someone usually does when they develop a chronic, expensive, disease
is to switch to Blue Cross from the HMO at the first open enrollment
period.  That way they can see the specialist they want when they
want.  HMOs are great for young healthy people who want well baby
care for the kids included, etc.  HMOs know that and are marketed
to attract such clients.  When was the last time you saw an ad
trying to get diabetics, people with renal disease on dialysis,
or the elderly into your friendly local HMO?  Once these people
are factored in, HMOs will become much more expensive and those
who have been used to the low rates will be shocked at the hit
they are about to take.

--
------------------------------------------------------------------------------
Gordon Banks  N3JXP      |"I can eat more fat meat than you can cook in a week

------------------------------------------------------------------------------

To add to this, I have a vague recollection of a number of pioneer HMOs
in the northeeast, where I was living at the time being the hotest thing
going for economical medical services - until their expansion incorporated
a number of VERY large employers who offered the HMO as an option to their
employees - the new members comprised a cross section of the normal
population for the most part, but was skewed slightly to a more senior
element because of the almost 'a job for the rest of your life' philosophy
of the employers of the new participants.  In a short time costs exceeded
income and the HMO's were on the ground belly up. One of the Blues came along
and bailed them out, but not before completely restructuring the how and
who of the services provided, and realigned the staff to fit in with the
their previous experience and employed only those physicians and other
professionals who for what ever reason, were willing to accept the lower
than market place payment schedules they enforced.  The previous
reputation that they had for excellent low cost medical care was left
behind and replaced by adequate but marginal care at a higher price to who
ever was paying the membership fees, employee, employer, or both! Caases
that previously were referred to specialists outside the HMO no longer
were referred as frequently and patient selection of physician was limited
by the decrease in the number of physicians associated with the HMO after
the restructuring that folowed its bankruptcy!  
--
   The opinions expressed are not necessarily those of the University of
     North Carolina at Chapel Hill, the Campus Office for Information
        Technology, or the Experimental Bulletin Board Service.
           internet:  laUNChpad.unc.edu or 152.2.22.80

: |
: |I believe that Clinton's plan does not discriminate against the already ill.

: The costs that I noted in the previous article are for HMO group plans
: at employers.  These plans take anyone who becomes employed without
: restrictions based on pre-existing conditions.

Wanna bet?  That may be the theory, but the practice is that people with
serious medical problems are still having a very hard time getting
insurance even through employers.  I speak from bitter experience, believe
me.  Very large employers still offer it.  A lot of smaller ones find some
way to keep you off the health insurance so their rates won't go up.  

A lot of small employers don't get the same deal the big ones do.  At
a number of places that I worked that offered 'health benefits', you applied
directly to the company for coverage and would be evaluated and turned
down just like an individual applying on their own.

I think California just finally passed a law last year covering that situation
for 5 people or more.  But I bet they'll find a way around it.

:write

Perhaps I should rephrase my question:

Are the costs suggested in Clinton's plan reasonable?

The costs suggested in Clinton's plan are:

Individual:  $360 + $1800 = $2160 per year
Family:  $840 + $4200 = $5040 per year

The description of the type of plan it would buy appears to be similar
to an HMO or PPO (extensive coverage, but limits on choices of physicians
unless one is willing to pay higher deductibles and fees).

--
------------------------------------------------------------------------

No warranty of any kind is provided with this message.

                        .........................

Adequate by whose definition?
--
Herman Rubin, Dept. of Statistics, Purdue Univ., West Lafayette IN47907-1399
Phone: (317)494-6054

{purdue,pur-ee}!snap.stat!hrubin(UUCP)

The participants in the HMO who have commented on the care they received
and also based on the services provided by the organization that took over
management of the defunct HMO - many participants used the HMO for
"routine" medical treatment but, if they could afford other sources for
treatment in other than routine (pre-school physicals, colds, bunps and
bruises, etc.,) situations or if they where unable to get referral to
specialists they did not hesitate to go elsewhere.  The organization
operating it had been in the business since the early 1950 or late 1940's
and was originally set up to provide health care to a very large group of
municipal employees who had no other option but to accept the plan that
was offered to them.  
--
   The opinions expressed are not necessarily those of the University of
     North Carolina at Chapel Hill, the Campus Office for Information
        Technology, or the Experimental Bulletin Board Service.
           internet:  laUNChpad.unc.edu or 152.2.22.80

says:

See my other post.  yes, they are right in line with the average national
cost of HMOs.

says:

Average HMO group staff rates in 1990 were $1,476 for an individual.  Trend

roughly) and you get $2161

Looks like it.