Talk:Health insurance in the United States
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[edit] Employer/group health insurance is almost always less expensive
The IP 146.145.79.247 has been reverting the edits of my removal of the following: "Average premiums are somewhat lower than those for employer-sponsored coverage, but vary by age." The premiums are not lower for identical coverage, which is what is implied by the statement that was removed. The questionable health insurance industry site that is cited for this quote admits in a disguising manner that the coverage is different. There are many reputable organizations and publications, some within the health insurance industry itself, that will state what is common knowledge, that employer/group health insurance is almost always less expensive than individual insurance. --Historian 1000 (talk) 15:47, 28 January 2008 (UTC)
- Historian, I disagree with you on your evaluation of the research. Take a look at the sample size of the AHIP survey - it's larger than anything else out there. They've done this survey several times now, and the results have been consistent. Yes, it's done by a trade association, but they have the contacts with insurance companies to get the data. Beyond that, the KFF has published a very similar, albeit smaller survey. They are hardly in the pocket of the insurance industry.
- We've had some back and forth edits on the relationship of average premiums in the individual health insurance market to those in the employer-sponsored market. They are in fact lower on average. There are a number of likely reasons for this. They include the average age and health of people with individual coverage (though if you look at the data, the average age isn't all that much lower), and perhaps most significantly, the benefits tend to be a good bit less generous. In particular, deductibles, co-payments and out-of-pocket limits are higher. In many cases people choose to buy policies that don't cover maternity, which makes a big difference for younger women.
- The reasons stated for taking this out of the article include that individual market premiums aren't lower for identical coverage, that it isn't relevant unless you are comparing identical coverage, and it's the net employee contribution that's the real issue anyway. I strongly believe the difference in average premiums is a relevant fact. First, it's a result that's been found by multiple surveys, but is so counter intuitive that people's immediate reaction is say "that's wrong" without even thinking about it. That's exactly the kind of fact that forces us to think through and really understand an issue. Second, it's not true that premiums will always be lower in the group market when the benefits are identical. Look at the age curve in the individual market surveys. It's not unusual to see premium differences of five to one based on age. A healthy young adult may very well be able to find identical coverage at a lower premium than is available to an employer, where the average age may be 40. Third, the benefit differences are relevant in and of themselves - part of the reason group coverage is so expensive is the level of benefits provided. I'm personally agnostic on the whole "consumer driven healthcare" movement, but the possibility that someone can get a lower premium in the individual market - despite all the inefficiencies there - by buying something different is relevant. Fourth, the text already states that the consumer has to pay the entire premium without employer help, so it's not misleading people there (though this is not always true - sometimes small employers will help pay for individual coverage rather than sponsor a group plan). I'd be glad to add some statistics on the average level of employer contributions - that might well help round out the context (though it might make more sense to put it under the section on employer coverage). Fifth, the current policy debate in the U.S. has a number of proponents of moving towards a more individual system, and the relationship between the gross premiums in the two markets is directly relevant to that issue. Sixth, the relationship is directly relevant today for small employers, many of whom have the choice between buying individual coverage for themselves, or establishing a small group plan for their firm. That decision is often made based on price.
- If I could find a study that compared premiums for identical benefit packages, I'd include it - but I haven't seen one. I'm not sure how a survey could be done on this, and still have an adequate sample size. It would be extremely hard to match up an adequate number of policies with identical benefit provisions. Researchers have attempted to study differences in benefit levels using actuarial models, but there are limitations there - you have to trust the actuarial equivalence calculations, which can be more art than science (and on a technical level, the results of an actuarial equivalence calculation are dependent on the health cost distribution of the population involved - which will presumably differ between the two markets). If you want to include some of that research, that's fine. I believe that there have been a couple of studies done by ARC that have been published in Health Affairs (I forget who sponsored them - KFF or Commonwealth, perhaps?). I would note, though, that KFF and Commonwealth have their own point of view as well.
- Bottom line, I'm convinced that this is a relevant (albeit perhaps inconvenient) research result. It's a result that's well known and understood among researchers studying the individual health insurance market, but is almost completely unknown by anyone else (and, in fact, the opposite is almost universally assumed to be true). That's exactly the kind of thing we should be helping people find. If we exclude it, we're biasing the article by omission. If we think more context and explanation is necessary to help the reader properly understand what it means, I'll be glad to help round out the discussion (look at my last set of edits - I made a good faith effort to bring in the considerations that had been raised, modeled on the discussion in the KFF report). But I strongly object to deleting it simply because we don't like the result, think the fact is somehow misleading, or are afraid the average reader isn't sophisticated enough to draw the correct conclusion (whatever we think that conclusion may be). Let's be as careful as we can to characterize the research correctly, let's add all of the relevant considerations and other factors that bear on the question, but let's not censor stuff out because we don't like it.
- What I would like to suggest is that we include this research, along with all the caveats and commentary - and that you add whatever additional research findings you believe are relevant to set the appropriate context and help people understand what it all means. But what I've added is well cited, is not inflammatory, and given our last round of edits is surrounded by a good faith attempt to highlight the concerns and considerations you've been talking about. I'm not trying to POV push, but I don't think it's either correct or reasonable to implicitly say that "we all know that individual health insurance is more expensive" and leave it at that - reality is much more complicated and nuanced. 146.145.79.247 (talk) 16:15, 28 January 2008 (UTC)146.145.79.247 (talk) 17:39, 28 January 2008 (UTC)
