Here's a statement of the obvious: The opinions expressed here are those of the participants, not those of the Mutual Fund Observer. We cannot vouch for the accuracy or appropriateness of any of it, though we do encourage civility and good humor.
No, all good, thanks; sometimes I know when I have nothing further to add. I thought that op ed would be of interest to many, not political and not to do w/ ACA. Glad to see you and Mona are still able to steer it back around to politics and broken promises / broken hearts and the evil BO (though you yourself do this with some wit); still very surprised, or maybe not, to see Mean Girl Mona resume her nasty gender-slur campaign against me, or whatever it is, just sooo strange.
Hey, Dave -- Glad to hear you're okay! I'm still sick with a bad cold, so no golf for me today. It's causing me a lot of anxiety, too, because there's only one month left in the year and Obama is waaayyy ahead of me in rounds played!
Anyways, I have enjoyed sparring with you over the last few days...you are an admirable opponent...and fun, too! I never post on these forums and the only reason I did this time was because someone insinuated that Mona needed the mental health mandate of the ACA...not funny at all, in my opinion. By joining in the fray, I was hoping to lighten up the situation and maybe draw some of the missiles being fired at her. I may be a conservative, but I am smart enough to know that no one is going to feel sorry for me and my paltry 30% increase in premiums...I will yell, scream and cause drama, but in the end, I'll pay it, because I accept personal responsibility...and I can easily afford it....worst case scenario would be to not golf as much and cede the crown to the King! I just wanted to point out, though, that there are people who were blindsided by these increases and who have to make some difficult decisions. That's why I asked you, with some effrontery (big word for a conservative yahoo...I had to look it up! ) who paid your premiums...I wanted to get my facts straight before I amped things up further. Well, you know the rest. Without getting personal, Mona has some difficult decisions to make. She thanked me in a pm for coming to the rescue and shared her story with me. To add insult to injury, she voted and worked for BO twice, but the good news is, I have a new friend and the Republican Party has a new member!!
I did, however, drag my sorry, germ-ridden carcass down to my local Blue Cross office yesterday to talk to my friendly agent. She said they can only ask questions about smoking now, not obesity, not alcoholism, not drug abuse. If I were a smoker, my premiums would be $950/month...not to mention all the taxes on the cigs themselves, so I am getting a deal after all. I was happy to hear, however, that obesity and alcohol are okay...goodbye, treadmill; hello, Haagen Dazs and Corona! Meanwhile, back at the ranch, bf was in a chat room with former employer, asking about adding yours truly to his policy. Things have changed...we would have had to get married before he retired for me to be included. Which brings up an interesting question...I wonder if the same applies to same-sex couples? But I'm not changing genders...I've got too many cute clothes...I'm gonna ask him to switch when he gets back from golf.
Anyways, Dave, I've got one more question before I go and I know you'll LOVE this one...That New York Times article you posted? Was that a legit article or one of the ones where they make stuff up?
Your favorite red state Conservative and sparring partner,
@l5b, if you mean the NYT article by the small businessman (woodworker, IIRC) about his own family healthcare costs and his keen concerns about his employees, I can't imagine what point could have been being made if it were fictitious, as his advocacies were not much political, were they.
Agree the fork in this discussion is past quivering and starting to slump toward the table. Does not mean it cannot get interesting again somehow, but I would be surprised.
I'm done...read above post. I really like davidrmoran, though, and Dave, if you want to keep going, we can meet in the back alley...aka pm. so we don't continue to bore people.
Some politicians would have us believe that the so-called "death tax" is a new concept, by, of course, "the other guys". Not so. The concept was alive and well going back to at least the fifteenth century. Nothing new here....
Everyone knows the half-serious / half-idiotic / half-'what can be done about it?' glib insight 'perception is reality.'
This thoughtful analysis made me depressingly reevalute the profound problem --- it's all media-flamed perception now, little to do with data --- in recent terms:
For the past week, I have been in Panama, where I am a pensionado and spend part of my year, looking into various health insurance plans. I am only in the beginning of the investigative stage, but I am excited, as there appears to be a number of very cost effective BCBS plans. Some cover only services in Panama and others will cover Panama and the US.
I would appreciate if you would take a look at a few of the plans that cover Panama and the US and give me your thoughts.
Mona, Don't speak Spanish, don't know enough anyway, don't know your situation (other than the strange, constant resentment you cannot help presenting), but the video makes it clear yours isn't a serious request anyway (again). I do hope you get what you need, at least in terms of healthcare, and if not, then, you know, mental health services.
Mona explicitly mentioned US coverage (some international plans exclude the US). So it appears this is shopping for coverage in lieu of ACA coverage (though having previously commented that this would result in having to pay a penalty). Singling out BC/BS from the other insurers available there - again suggests intended use as a replacement US policy.
I've seen an assertion (I haven't verified as reliable yet) that international coverage is available only if one spends nearly all one's time in Panama, which is not the way Mona described her situation.
So it's not clear what the point of the exercise is. Health care is cheap enough in Panama that many people self insure, especially if they are in fine health, as Mona is. Thus the value would appear to be for catastrophic insurance. Here, the Panama BC/BS policies fall short. Their out of pocket max is thousands of dollars above the cap allowed under ACA. Just read the policies.
---
The plan summaries (and in some cases, premiums) are available in English. Even I can muddle my way through these cognates and crossword answers : In the middle of the page is Planes de Salud (salud as in a toast to your health), and below that, Plan Médico Internacional. That latter link takes you to a page where the Opciónes (options) drop down menu offers you the plan benefits in English. The caps are quite literally the bottom lines.
---
P.S. to John - Maybe China follows its own preferences? Not sure what you're getting at here.
@msf, that was in response to the language comment above mine.
@mona, msf does bring up a point regarding self insuring. If the healthcare is cheap enough that might be the way to go. In my situation I have paid for all of our healthcare for the past several years. Even with a surgery and hospitalization it was far less expensive than paying premiums. Of course you do take a chance on the possibility of your being in a serious condition.
I do find it interesting that there is no option on the website to change the language, considering their target audience.
Edit: Was that a promise also? If you have a language already you can keep your language
John,
I too would have thought the same (please don't tell drm), but I did not look for it.
The promise was by Jimmy Carter to promote the metric system. I think the only road in the US that has sign posts in kilometers is a stretch on Interstate 19 from Nogales to Tucson.
So now we have two Democratic Presidents who broke their promise.
re metric: We really tried here in CA- had miles/km for quite a long time on a number of highways. It wasn't Carter: it absolutely was the presidents and congresses that followed Carter, much to my disgust.
If we're going to engage in pointless exercises counting presidents who "broke their promises", why don't we start with Washington, Jefferson, and various Indian tribes?
re metric: We really tried here in CA- had miles/km for quite a long time on a number of highways. It wasn't Carter: it absolutely was the presidents and congresses that followed Carter, much to my disgust.
"The markers from Nogales to Tucson are a relic of a failed Carter administration pilot program that aimed to convince Americans to adopt the system of measure in use across much of the rest of the world"
We just drive into Canada for the "kilo" experience. But, the gasoline thing was always confusing; although we always filled the gas tank with "x" liters. 'Course, sometimes I set the speedo to the kilo speed mode; but that is show and tell for the young ones. They are then tested, about the speed or distance conversions; as we motor down the highway. Now, for the modern mechanics; well, more fun. I recall the conversion to metric for some portions/parts of some machinery that was needed for international regs. So, now more tool types; as one never knew which bolts, nuts, screws/part would be metric for the regs. Hell, I have enough fun keeping up to speed with investment matters. This, plus I know I can't know everything and have to exclude items from the input list; as my brain cells won't tolerate the condition. Lastly, if one is making a list of political fails; many companies should be included, too. It is a wonder with some company functions, with which I am familiar; that much of a profit exists at all from the many feeble attempts at management. Too many MBA's many times who only have had "book learn'in" and no street experience. They're gonna fix the world! Ya, okay. Catch
Except if we close it we lose msf's astute and learned corrections of misinformation and misstatement.
drm,
Nope, no misinformation and if there was a misstatement, you might want to keep in mind that English was my third language.
And unlike msf, I do not make assumption after assumption ("So it appears", "suggests intended use", "Thus the value would appear") and then come to incorrect conclusions regarding health plans on a website in a language that I do not understand ("Even I can muddle my way through these cognates").
But I am glad that you continue to feel that msf is "de man" and have someone to pay homage to a posting board.
Heavens, seems I'm wasting my time signalling differences between inferences and deductions.
Lots of claims about erroneous inferences I make. Rarely see corrections substantiating those claims, though. Even an assertion that I was wrong about what plan descriptions written in English say (because I must not speak the language!)
Unfortunately, this thread has degenerated into petty remarks, devoid of useful information. So I'm inclined to agree with others - I'm pretty much through with this thread.
I do have a couple of very long final posts - observations about the "lay of the land" regarding ACA plans that vary from state to state, and how I reacted to my own plan being cancelled and the less than satisfying alternatives I had to deal with.
You can always ignore the posts. You can also complain about them, but without adding useful (or at least interesting) information, what's the point?
I not only lost my insurance due to ACA, but my entire insurance company was killed! The next post will describe what I did to replace it. This post is about how the situation varies state by state.
As noted in the NYTimes recently, ACA gave states a lot of flexibility. That's why my plan continued through 2014 - the state had the flexibility to keep it going for awhile. But the state (not the ACA directly) said "enough".
A couple of states like Vermont (that Kaiser listed has being one of the ten most expensive ACA markets in the country) prohibit rates based on age. And Vermont has a second difficulty - lack of competition (only two insurers). Despite that, all their bronze plans (HDHP, standard, and variants) cost under $400/person. So if your rates are 50% higher, hold your state insurance commissioner accountable.
States have flexibility in the features of their plans (so long as they include the 10 essential benefits, give or take pediatric dental). They must designate a "standard" plan at each level (with virtually identical terms, making comparison shopping basically a matter of three factors only - price, provider network, and formulary).
But they can also allow variants on a case by case basis, which can work to your advantage if you expect to use one type of service more (or less) than others. For example, if you expect to be scheduled for surgery, you might be better off with a plan that has lower deductibles, even if it imposes those deductibles on all doctor visits (rather than allowing a simple co-pay without the deductible).
One way that states can hold down costs (and encourage more insurers to compete) is to put tight constraints on what the insurers can offer, and include requirements that whatever is available off-exchange is available on-exchange. One plus is that this makes shopping easier (you can find everything in one place). A downside is that you could wind up with no PPOs and narrow networks. That's what I'm facing, and I'll discuss in the other post. There's always a tradeoff - flexibility comes with a cost. From what I've read, while people chafe at restrictions, on balance they prefer lower costs.
Before going out of business, my insurance company looked at offering a PPO. What it found was that this would add so much to the cost as to be impractical. The state reached much the same conclusion, rejecting requests to mandate insurance companies provide a PPO option - it would have the effect of driving up rates not only for the new PPOs, but for the other plans in the marketplace.
There are a myriad of factors that affect the system. States are trying out different combinations, serving their federal role as laboratories (a concept that originates in a Brandeis dissent - this link is an interesting commentary on the concept). More insurers are entering markets. We can gripe or we can deal with it.
My ACA search process, aka what I did on my Thanksgiving vacation.
The only plans available to me are in-network only (HMO, EPO type plans). That's the elephant in the room - it's why so many people that were on my old plan are complaining about the cancellation - not losing the plan per se, but losing the PPO feature.
But those network limitations are a reason why the Affordable Care Act plans are somewhat "affordable" here.
I've been able to eliminate matching existing doctors to networks as a concern - any doctor I've been working with is either on all plans or no plans (so choice of network doesn't affect them), or I've just started with the doctor and can change easily. For other people looking to keep multiple doctors, the restricted networks can be a real problem.
Next issue - which network and why.
I found a paper written by Kaiser people forty years ago. Very interesting on a variety of fronts - how integrated health system can work (and why hospital-formed systems often don't), the limits of single payer systems including Medicare in driving down costs (they address price, not the underlying delivery system), etc. One of the points it makes (and I agree with), is that flexibility in choice of doctors is overrated. You get a doctor out of the yellow pages, so what?
Still, I have concern over how the insurer puts together the network. These are all narrow networks. For example, BC/BS has created a "Pathways X Enhanced" network in many states that includes only local doctors (no BC/BS network) and limits the choice of local doctors as well. The inclusion of providers seems to be on the basis of cost (naturally enough).
There is a different approach. Integrated health systems (or provider-owned plans - I'm still trying to figure out the difference) like Kaiser start with the idea that they already have facilities and doctors on staff (not only in hospitals, but with affiliated medical groups). They can offer not the cheapest doctors, but the in-house doctors (both good and bad). That can be more restrictive (and a smaller network), but still offer a wide variety of specialties (albeit in lower numbers).
In the 90s, lots of providers tried to go this route, and failed miserably. It seems that they were trying to make a buck (cut out the middleman) without focusing on, well, integrated care. (And yet look at UPMC, also launched in the 90s.) I'm hopeful that this time the plans that are being created by existing provider networks are more focused on care as opposed to revenue. The plan that I'll use, though new, is offered by one of the larger provider networks in the country with fine hospitals (several US News rated) I've known since childhood, and is nonprofit.
(Would you rather buy a Vanguard fund or one from Janus? Now I'm going to hear from all the Gross enthusiasts - that's the point, one of these companies is out for a buck)
As to level of plan - I'm expecting some contracting income next year, so I'll be able to write off the premiums. That argues for paying up for a higher level plan, rather than taking a smaller writieoff on a lower cost plan and paying more for expenses with post-tax dollars. (HSA is not a viable option here.) Also, this provides insurance against an unexpected illness. If my expenses should be higher than planned, I won't be paying much more, as I would with a lower-priced plan.
The calculations would be very different if I couldn't write off premiums. This is not fair to most people. Employers get to pay with pre-tax dollars; contractors get to pay with pre-tax dollars. Everyone else pays full freight. (Subsidies can help tremendously, but that's addressing a different target population.)
Obviously for different people it's different factors that matter. Could be geography (I'm willing to travel for this care), could be particular drugs, could be 24 hour phone support. I've just tried to give you a sense of my own reasoning here, FWIW.
I've included a few more links on integrated (or provider-owned) health systems. I figure that if all you've got are narrow networks, embrace them - find a system designed to make them work well. Much more constructive than griping about what's not available.
Comments
Anyways, I have enjoyed sparring with you over the last few days...you are an admirable opponent...and fun, too! I never post on these forums and the only reason I did this time was because someone insinuated that Mona needed the mental health mandate of the ACA...not funny at all, in my opinion. By joining in the fray, I was hoping to lighten up the situation and maybe draw some of the missiles being fired at her. I may be a conservative, but I am smart enough to know that no one is going to feel sorry for me and my paltry 30% increase in premiums...I will yell, scream and cause drama, but in the end, I'll pay it, because I accept personal responsibility...and I can easily afford it....worst case scenario would be to not golf as much and cede the crown to the King! I just wanted to point out, though, that there are people who were blindsided by these increases and who have to make some difficult decisions. That's why I asked you, with some effrontery (big word for a conservative yahoo...I had to look it up!
I did, however, drag my sorry, germ-ridden carcass down to my local Blue Cross office yesterday to talk to my friendly agent. She said they can only ask questions about smoking now, not obesity, not alcoholism, not drug abuse. If I were a smoker, my premiums would be $950/month...not to mention all the taxes on the cigs themselves, so I am getting a deal after all. I was happy to hear, however, that obesity and alcohol are okay...goodbye, treadmill; hello, Haagen Dazs and Corona!
Anyways, Dave, I've got one more question before I go and I know you'll LOVE this one...That New York Times article you posted? Was that a legit article or one of the ones where they make stuff up?
Your favorite red state Conservative and sparring partner,
l5b
Agree the fork in this discussion is past quivering and starting to slump toward the table. Does not mean it cannot get interesting again somehow, but I would be surprised.
I agree...it's become a forum of two people.
Now the thread can close.
This thoughtful analysis made me depressingly reevalute the profound problem --- it's all media-flamed perception now, little to do with data --- in recent terms:
http://www.nytimes.com/2014/12/03/opinion/is-obamacare-destroying-the-democratic-party.html
And whew, thank God for Hiltzik:
http://www.latimes.com/business/hiltzik/la-fi-mh-sen-schumer-20141126-column.html
For the past week, I have been in Panama, where I am a pensionado and spend part of my year, looking into various health insurance plans. I am only in the beginning of the investigative stage, but I am excited, as there appears to be a number of very cost effective BCBS plans. Some cover only services in Panama and others will cover Panama and the US.
I would appreciate if you would take a look at a few of the plans that cover Panama and the US and give me your thoughts.
http://isweb.iseguros.com/bcbs/
Mona
Don't speak Spanish, don't know enough anyway, don't know your situation (other than the strange, constant resentment you cannot help presenting), but the video makes it clear yours isn't a serious request anyway (again). I do hope you get what you need, at least in terms of healthcare, and if not, then, you know, mental health services.
Lo siento (I'm sorry). I can appreciate language challenges. For me, English came after French and Spanish, so I understand.
Mona
That was good!
While I can understand a few more than I can speak, Chinese is not one of them
Mona
Edit: Was that a promise also? If you have a language already you can keep your language
I've seen an assertion (I haven't verified as reliable yet) that international coverage is available only if one spends nearly all one's time in Panama, which is not the way Mona described her situation.
So it's not clear what the point of the exercise is. Health care is cheap enough in Panama that many people self insure, especially if they are in fine health, as Mona is. Thus the value would appear to be for catastrophic insurance. Here, the Panama BC/BS policies fall short. Their out of pocket max is thousands of dollars above the cap allowed under ACA. Just read the policies.
---
The plan summaries (and in some cases, premiums) are available in English. Even I can muddle my way through these cognates and crossword answers : In the middle of the page is Planes de Salud (salud as in a toast to your health), and below that, Plan Médico Internacional. That latter link takes you to a page where the Opciónes (options) drop down menu offers you the plan benefits in English. The caps are quite literally the bottom lines.
---
P.S. to John - Maybe China follows its own preferences? Not sure what you're getting at here.
@mona, msf does bring up a point regarding self insuring. If the healthcare is cheap enough that might be the way to go. In my situation I have paid for all of our healthcare for the past several years. Even with a surgery and hospitalization it was far less expensive than paying premiums. Of course you do take a chance on the possibility of your being in a serious condition.
John,
I too would have thought the same (please don't tell drm), but I did not look for it.
The promise was by Jimmy Carter to promote the metric system. I think the only road in the US that has sign posts in kilometers is a stretch on Interstate 19 from Nogales to Tucson.
So now we have two Democratic Presidents who broke their promise.
Mona
If we're going to engage in pointless exercises counting presidents who "broke their promises", why don't we start with Washington, Jefferson, and various Indian tribes?
http://www.azcentral.com/story/news/local/arizona/2014/10/04/arizona-highway-signs-in-metric-units-may-change/16724615/
Now, for the modern mechanics; well, more fun. I recall the conversion to metric for some portions/parts of some machinery that was needed for international regs. So, now more tool types; as one never knew which bolts, nuts, screws/part would be metric for the regs.
Hell, I have enough fun keeping up to speed with investment matters. This, plus I know I can't know everything and have to exclude items from the input list; as my brain cells won't tolerate the condition.
Lastly, if one is making a list of political fails; many companies should be included, too.
It is a wonder with some company functions, with which I am familiar; that much of a profit exists at all from the many feeble attempts at management. Too many MBA's many times who only have had "book learn'in" and no street experience. They're gonna fix the world! Ya, okay.
Catch
I suggest this.
http://congressforkids.net/Constitution_threebranches.htm
maybe @Ted would be kind enough to suggest this thread be closed.
I believe that you most likely meant to say "maybe @Ted would be kind enough to order this thread be closed."
Catch
Nope, no misinformation and if there was a misstatement, you might want to keep in mind that English was my third language.
And unlike msf, I do not make assumption after assumption ("So it appears", "suggests intended use", "Thus the value would appear") and then come to incorrect conclusions regarding health plans on a website in a language that I do not understand ("Even I can muddle my way through these cognates").
But I am glad that you continue to feel that msf is "de man" and have someone to pay homage to a posting board.
Mona
Lots of claims about erroneous inferences I make. Rarely see corrections substantiating those claims, though. Even an assertion that I was wrong about what plan descriptions written in English say (because I must not speak the language!)
Unfortunately, this thread has degenerated into petty remarks, devoid of useful information. So I'm inclined to agree with others - I'm pretty much through with this thread.
I do have a couple of very long final posts - observations about the "lay of the land" regarding ACA plans that vary from state to state, and how I reacted to my own plan being cancelled and the less than satisfying alternatives I had to deal with.
You can always ignore the posts. You can also complain about them, but without adding useful (or at least interesting) information, what's the point?
As noted in the NYTimes recently, ACA gave states a lot of flexibility. That's why my plan continued through 2014 - the state had the flexibility to keep it going for awhile. But the state (not the ACA directly) said "enough".
A couple of states like Vermont (that Kaiser listed has being one of the ten most expensive ACA markets in the country) prohibit rates based on age. And Vermont has a second difficulty - lack of competition (only two insurers). Despite that, all their bronze plans (HDHP, standard, and variants) cost under $400/person. So if your rates are 50% higher, hold your state insurance commissioner accountable.
States have flexibility in the features of their plans (so long as they include the 10 essential benefits, give or take pediatric dental). They must designate a "standard" plan at each level (with virtually identical terms, making comparison shopping basically a matter of three factors only - price, provider network, and formulary).
But they can also allow variants on a case by case basis, which can work to your advantage if you expect to use one type of service more (or less) than others. For example, if you expect to be scheduled for surgery, you might be better off with a plan that has lower deductibles, even if it imposes those deductibles on all doctor visits (rather than allowing a simple co-pay without the deductible).
One way that states can hold down costs (and encourage more insurers to compete) is to put tight constraints on what the insurers can offer, and include requirements that whatever is available off-exchange is available on-exchange. One plus is that this makes shopping easier (you can find everything in one place). A downside is that you could wind up with no PPOs and narrow networks. That's what I'm facing, and I'll discuss in the other post. There's always a tradeoff - flexibility comes with a cost. From what I've read, while people chafe at restrictions, on balance they prefer lower costs.
Before going out of business, my insurance company looked at offering a PPO. What it found was that this would add so much to the cost as to be impractical. The state reached much the same conclusion, rejecting requests to mandate insurance companies provide a PPO option - it would have the effect of driving up rates not only for the new PPOs, but for the other plans in the marketplace.
There are a myriad of factors that affect the system. States are trying out different combinations, serving their federal role as laboratories (a concept that originates in a Brandeis dissent - this link is an interesting commentary on the concept). More insurers are entering markets. We can gripe or we can deal with it.
The only plans available to me are in-network only (HMO, EPO type plans). That's the elephant in the room - it's why so many people that were on my old plan are complaining about the cancellation - not losing the plan per se, but losing the PPO feature.
But those network limitations are a reason why the Affordable Care Act plans are somewhat "affordable" here.
I've been able to eliminate matching existing doctors to networks as a concern - any doctor I've been working with is either on all plans or no plans (so choice of network doesn't affect them), or I've just started with the doctor and can change easily. For other people looking to keep multiple doctors, the restricted networks can be a real problem.
Next issue - which network and why.
I found a paper written by Kaiser people forty years ago. Very interesting on a variety of fronts - how integrated health system can work (and why hospital-formed systems often don't), the limits of single payer systems including Medicare in driving down costs (they address price, not the underlying delivery system), etc. One of the points it makes (and I agree with), is that flexibility in choice of doctors is overrated. You get a doctor out of the yellow pages, so what?
Still, I have concern over how the insurer puts together the network. These are all narrow networks. For example, BC/BS has created a "Pathways X Enhanced" network in many states that includes only local doctors (no BC/BS network) and limits the choice of local doctors as well. The inclusion of providers seems to be on the basis of cost (naturally enough).
There is a different approach. Integrated health systems (or provider-owned plans - I'm still trying to figure out the difference) like Kaiser start with the idea that they already have facilities and doctors on staff (not only in hospitals, but with affiliated medical groups). They can offer not the cheapest doctors, but the in-house doctors (both good and bad). That can be more restrictive (and a smaller network), but still offer a wide variety of specialties (albeit in lower numbers).
In the 90s, lots of providers tried to go this route, and failed miserably. It seems that they were trying to make a buck (cut out the middleman) without focusing on, well, integrated care. (And yet look at UPMC, also launched in the 90s.) I'm hopeful that this time the plans that are being created by existing provider networks are more focused on care as opposed to revenue. The plan that I'll use, though new, is offered by one of the larger provider networks in the country with fine hospitals (several US News rated) I've known since childhood, and is nonprofit.
(Would you rather buy a Vanguard fund or one from Janus? Now I'm going to hear from all the Gross enthusiasts
As to level of plan - I'm expecting some contracting income next year, so I'll be able to write off the premiums. That argues for paying up for a higher level plan, rather than taking a smaller writieoff on a lower cost plan and paying more for expenses with post-tax dollars. (HSA is not a viable option here.) Also, this provides insurance against an unexpected illness. If my expenses should be higher than planned, I won't be paying much more, as I would with a lower-priced plan.
The calculations would be very different if I couldn't write off premiums. This is not fair to most people. Employers get to pay with pre-tax dollars; contractors get to pay with pre-tax dollars. Everyone else pays full freight. (Subsidies can help tremendously, but that's addressing a different target population.)
Obviously for different people it's different factors that matter. Could be geography (I'm willing to travel for this care), could be particular drugs, could be 24 hour phone support. I've just tried to give you a sense of my own reasoning here, FWIW.
I've included a few more links on integrated (or provider-owned) health systems. I figure that if all you've got are narrow networks, embrace them - find a system designed to make them work well. Much more constructive than griping about what's not available.
Systems in Minnesota, Salt Lake City, Hawaii managing costs through integrated health systems (and insurer competition, narrow networks driving down costs as well)
NYTimes - Room for Debate - Kaiser model of integrated health delivery
Provider plans entering the ACA market (what they may do better this time than in the 90s)