As someone who has helped all sizes and types of employers set up benefits for their employees for more than 12 years now, I get asked at every meeting why their rates are so expensive. I see employees struggling to include their spouse and children on their plan with them. I see children getting dropped from CHIP due to income, but the parent still can’t afford the additional $600 / month to add them to their company’s group plan. I see employers contributing to tax-favored H.S.A.’s less often now due to the cost of ever-increasing premiums. Employers often want to know the specifics about their group’s claims history (in a compliant, HIPAA approved way, of course) and for good reason; after all, isn’t it the company’s claims experience that drives the bulk of their increases? Not so fast.
Most employers under 50 employees have zero control over their health premiums. ACA (Healthcare Reform) created guarantee-issue, community rates for groups in the 2-50 realm, and those rates are strictly determined by employee ages, zip codes, and in some states, tobacco usage. Employers over the 50 employee mark may have their claim experience creating more of an impact on their health premiums, but there are many other factors contributing to those costs beyond claims alone; well beyond what a single employer can affect.
The Hard Truths
America spends trillions on healthcare each year, yet we rank 37th in the world in terms of efficacy. I’ve always had a little twitch when calling it “healthcare” since the primary purpose of medical insurance is to help us cover the expenses when we get sick or hurt. For example, when your car needs an oil change, you don’t call your car insurance company, you go to a trusted mechanic or you change out the oil yourself; however, when you get in a car accident, you’re surely going to rely on your insurance to pay for those costly repairs. Same as medical insurance. Sure, there are some preventive measures they must cover now (thanks to ACA), but millions of Americans don’t go in for their annual checkup and wait until they’re sick to see a doctor. Even when we do go in for preventive visits, most of us wait weeks sometimes for an appointment and hours in the waiting room. We don’t leave with our own blood work results or a clear understanding of how to prevent future illnesses from occuring. Preventive care is still very important for catching many illnesses before they’re untreatable or costly to treat, and I encourage all our clients to educate their population on the FREE preventive visits they should use each year and how to go in better educated on the questions to ask their doctor.
This quick video from CNN gives us the top 5 reasons our system costs so much, and I’ve added one of my own at the bottom because it’s the truth!
- Drug prices are set by the companies who make them and there’s zero negotiation on cost.
- Admin costs due to billing systems; coding, submission, timelines, appeals, peer to peer reviews, etc.
- Patients with PPO networks often choose a specialist doctor over primary care docs for same basic care needs.
- Newer, more expensive treatments come out all the time when older treatments are known to work well.
- Defensive medicine: Ordering a litany of tests beyond what’s needed to diagnose a patient mostly for legal reasons so that doctors & facilities cover their liabilities.
- We’ve engineered movement & consistent nutrition out of our lives; most Americans don’t eat properly and move enough daily. We sit at desk jobs or in our cars for hours upon hours, we eat poorly, don’t drink enough water, don’t practice stress prevention, and when something does go wrong with our bodies, we expect our doctors to fix it with a prescription or another treatment after paying our $40 copay, circling back to numbers 1-5 above…
Better healthcare begins with us. -CNN
Sorry, I don’t have a nice wrap-up message to make this all better for us! A real change is going to take time; nothing this massive happens overnight. It’s not up to Washington to fix this with an executive order or even editing ACA rules. I do see people slowly starting to wake up to this reality. There’s education everywhere, although it’s not distributed evenly among all Americans, and education alone isn’t cutting it. This cultural shift will take all of us–our communities, local governments, the hospitals, the surgeons, the nurses, the employer, the employee, the family, the individual, the insurance provider, the pharmacist, the drug companies, the lobbyists–taking accountability and responsibility for our role in this very important part of this country’s ability to care for our people.
We’re all in this together and I believe it starts with the individual. Of course I do! Take responsibility for your holistic, long-term wellness practice. I say holistic, because wellness touches every aspect of our lives and goes much deeper than movement and nutrition; our finances, our mental well-being, our physical, spiritual, and emotional. Start in your home and spread the message of long-term wellness by living your best life and putting wellness at the forefront. Find your deeper why and move from there. We’re all in this together and we can’t afford NOT to put wellness first.