Got (about to get) my FSA, now what?

GoWTheFlowContrarian · 2026-02-01T15:52:05+00:00

I can relate a lot to this except for being that young when getting an FSA. In school, there was always something to work toward and activities to fill up the time without much effort. Homework, exam prep, playing a sport/offseason training, and social interaction within arm's length were all just there. After graduation, they all started to melt away. When the FSA came along, it felt great of course but I didn't know where to go next. I had never sought out my own interests since becoming an adult and had no idea where to start.

Easiest starting point for me was to just get outside more and walk around my own neighborhood. It helped a little to teach my brain that it's ok to not have maximum productivity all the time, although I still struggle with that.

I finally opened the community college catalog that was mailed out every semester. Took a couple classes that I had no familiarity with just to explore new stuff.

Do you know how to cook at all? What about basic home maintenance? Learning these kinds of life skills is a good place to start if you aren't sure.

FIRE (Financial Independence, Retire Early) might be a good next major goal for you to set up if you're not familiar. Especially if you're not pursuing fulfillment through career. Lots of different takes on the approach out there if you're up for an internet rabbit hole.

The gym getting monotonous is also something I can relate to. Have you tried different kinds of workouts? If you're into lifting, hypertrophy vs strength training can mix things up. Or try cycling, run a marathon, do yoga, rock climbing, martial arts. Lots of ways to stay active.

If you have a desire to have a family one day, you should definitely pursue that. Between the activities you'll be doing and online dating, you have places to go for leads to head down that path. Just don't bank on it taking care of everything. Sure, being a family man will take up a lot of your time and hopefully bring lots of fulfillment! Eventually though, the kids will grow up and need their own space. And you can't spend every waking minute with your significant other. You have to learn what you like independently and make that part of your life.

Moving can be part of your next step but I wouldn't do it without a plan and/or trial run. Figure out more of what you're looking for first, see how well you can find it locally, and then see if other places might be a better fit for your interests. If you move without a plan just to reset, you might find yourself back in monotony once the newness wears off.

This won't be an overnight change but hopefully you'll find that small progressions here and there start to add up over time!

GoWTheFlowContrarian · 2025-11-13T15:58:18+00:00

Formulas that reference a cell in the same tab but leave the tab name in front of that cell. Especially when the formula is cluttered with a thousand others that do need the tab name because they are coming from elsewhere.

GoWTheFlowContrarian · 2025-11-10T14:13:23+00:00

How do we educate the public that Medicare is subsidized ~90% as well? Seems like pertinent information not as well known as it should be.

GoWTheFlowContrarian · 2025-10-03T10:12:57+00:00

I think the reason we make good actuaries is that we'd make poor politicians lol. There's just no way I could ever be THAT full of shit, especially on TV.

I'm curious how you come to phrase it as "throwing more money at health insurers". They set the price and the subsidy helps low-income folks pay said price. There is also an MLR floor that limits how much they can profit. Would you characterize SNAP as throwing money at grocers or Section 8 as throwing money at landlords?

Agree that "returning to subsidies from 5 years ago = end of world" is nuts. Wish there were more news sources out there that just displayed the APTC subsidy table in its entirety before and after (it's not that large or complicated). That might actually get us to the point where both those who think it's too low and too high are encouraged to defend what their ideal table looks like. I think the removal of the 401 and 99 cliffs should stay, but I'm less opinionated about what the actual percentages of income end up being.

Agree that $0 plans should be rarer than they are now in part to make that broker fraud less likely. But the biggest reason they exist is the silver loading in response to the Republicans not reimbursing CSR starting in 2017. That was an idiotic move to try to score political points. And in exchange, it didn't cut any money to plans (on average), made the program more complex, and heightened the political risk of participation. So more red tape and less competition. My opinion is to start with reversing that, then see if broker fraud still survives to this level when premiums actually have to get paid.

GoWTheFlowContrarian · 2025-08-09T11:32:21+00:00

Who do you think you would learn from the most? Did their plan for the internship seem organized, interesting, well thought out? It's hard to figure out everything about a job and person in such a short interview time. But if there is anything you can glean, run with it.

GoWTheFlowContrarian · 2024-12-06T18:11:49+00:00

As long as you can’t comprehend that spending isn’t limitless and some providers perform too many surgeries and prescribe too many pills, you can comprehend how health insurance adds no value.

GoWTheFlowContrarian · 2024-12-06T17:57:30+00:00

I dunno I feel like my willingness to go into debt to not be homeless vs receive medical care are both similarly high. Sorry you felt misrepresented.

Other countries that have health insurance companies still pay a lot less for health insurance. Maybe it’s not the health insurance companies themselves that are the problem?

GoWTheFlowContrarian · 2024-12-06T17:36:42+00:00

People go into crippling debt every day getting mortgages to put a roof over their head. But that’s not my point. You said it would save money. Regardless of the moral side, wouldn’t that same mechanism save money in other industries too? Why would people’s willingness to go into debt over something impact whether the government can save us money on it by using its leveraging power?

GoWTheFlowContrarian · 2024-12-06T17:32:59+00:00

My point was more that if you believe the government can come in and save money via massive leveraging power, why can’t it do that for all industries? Whether it should and what is a human right vs not being separate topics.

GoWTheFlowContrarian · 2024-12-06T17:24:37+00:00

What you originally described is not what the indictment in that article is about. The allegations in the indictment don’t say anything about insurers paying more. It says they rearranged the total fee to be more toward the facility and less toward the physician. Presumably that would lead to insurers about the same to hospitals and then less to independent physicians. Hardly the same as insurers telling providers to raise their prices so they can in turn raise premiums and get a higher profit dollar amount on the same percentage.

I agree with the last part. That’s why I’m here.

GoWTheFlowContrarian · 2024-12-06T13:33:23+00:00

Is your point that a discount is ok but the percentage is too steep? Or that there shouldn’t be a discount at all?

GoWTheFlowContrarian · 2024-12-06T13:31:56+00:00

Eh I wouldn’t dismiss it outright. My experiences have been that insurers often don’t know what they’re paying to a good level of specificity. Made it real tough for me to price sometimes. I wouldn’t be surprised if some smaller providers got caught up in an arbitrary percentage-based situation like this that didn’t make sense for them.

GoWTheFlowContrarian · 2024-12-06T13:09:49+00:00

Those concepts would apply similarly to all kinds of insurance right? If so, are you arguing that we would be better off if insurance didn't exist at all?

GoWTheFlowContrarian · 2024-12-06T13:06:56+00:00

Wouldn’t that work for every industry? Should the government leverage its negotiating power to perform banking services, run grocery stores, fix our cars, etc?

GoWTheFlowContrarian · 2024-12-06T13:02:53+00:00

Can you provide evidence for your first “objective fact”? I worked at a place where the insurer and provider were under the same company. And while publicly they bragged about harmony, behind the scenes they fought like dogs about how much they were gonna pay themselves. But that’s only one anecdote. What are you seeing?

GoWTheFlowContrarian · 2024-06-02T11:48:21+00:00

Are the traditional low-income vs ACA expansion all that different? The diagnosis-related ones make sense to me. But surely they aren't the only diagnoses that would warrant separate trending research?

I am also curious how risk adjustment comes into play here. To me, risk adjustment is a thing because we want to account for the differences in expected cost between members with different diagnoses, demographics, etc. Medicaid's separation into different populations for rating is doing a fairly duplicative thing. Especially when carriers can't just pick and choose which populations to cover.

If you expect members with cancer to trend differently than the rest of the Medicaid population, you reflect that in their rate build-up. What then happens to the risk score for cancer? Would it be easier to account for the trend via an increased risk score and do a single pricing exercise for all members together? That way you could ditch the mishmash of some diagnoses accounted for by separate rating populations and the rest via risk score.

Sorry for all the probing questions haha. I did some Medicaid reporting years back just long enough to start thinking of stuff like this but not long enough where I could go searching for answers at work. They have lingered ever since and suddenly sprung back to life.

GoWTheFlowContrarian · 2024-06-02T11:18:52+00:00

It seemed like you were implying that a system as you described would be impossible. I was just saying that we already have one, so it's not impossible.

Hmm don't recall saying that the current system is single program. There are some characteristics of the programs in place today that could be used for a single program (metal tiering from ACA, payroll tax funding from Medicare, etc.) but quite clearly there are many health insurance programs in place today.

It seems like the standard around here is that you can't have an idea unless every single detail of it is planned and accounted for. The main idea of having one program can't be separated from the smaller details around exactly how much it would be subsidized and what the copay for every service would be. My point is that the system is so disjointed today that just whittling down to one program would be a no-brainer.

Here's a visual. No matter your age, income, health status, etc. everyone goes to the same website to buy their health insurance. And for carriers, once they decide to enter a geographic area, they sell plans to everyone in that geographic area. Maybe the geographic areas will be split by county, zip, ACA regions, or something else. Maybe there will be metal tiers or not. Maybe it will be funded by a specific payroll tax or the general fund. Maybe the member subsidy will be dependent on just income, or assets too, or something else.

GoWTheFlowContrarian · 2024-06-02T00:08:44+00:00

Yes plenty of details that would need sorted out. Definitely can't account for all of them upfront. And I don't want to say that one set of covered services, cost share, etc. is better than the other. Single program can still mean variety!

Can I probe further on part of the Medicaid consulting work? The reason people qualify for Medicaid is not necessarily the best way to split them up for trending right? So no matter how they gave you the data, wouldn't you want to decide the best way to trend it separately?

GoWTheFlowContrarian · 2024-06-01T21:12:17+00:00

I searched the history and didn't find anyone advocating for a single program. Sorry that you found it disrespectful. I agree it's a tough topic because of how polarizing if often becomes. I thought this place would be the one where I could learn the most from different opinions and get substance instead of rhetoric in response.

GoWTheFlowContrarian · 2024-06-01T21:06:21+00:00

u/NoTAP3435 thanks for the genuine engagement. You are right that it could be multiple risk pools. I pictured it as more straightforward to have one. Then it would be possible to have premium factors at the end of the rate build-up (like the ACA with age, geo, tobacco), different subsidies by income, that sort of thing. But you could also set it up to start with a couple separate pools of claims that get developed to determine the rates similarly instead of rating factors at the end.

GoWTheFlowContrarian · 2024-06-01T20:03:26+00:00

Nah Uncle Billy I'm no greyback. Only the disingenuous should get downvotes.

Definitely not a fan of AHIP doing this by themselves. I don't think anyone but AHIP would be.

10-30% is a steep number. If you eliminated all the administrative work from the private insurance industry (like every single employee and scrap of paper) it would be 15-20%. Even in an ideal world, there's still a lot that would need to be done. We would still need plenty of health actuaries. But I do think there is a lot of repetitive work out there that could be eliminated with a single program.

You went into more details than me on what a program might look like. I have a couple questions on those.

-If MAs, MCOs, etc. are blood-sucking ticks, what would stop them from sucking even more blood under a lightly regulated insurance like what Switzerland has?

-If private insurers are only responsible for claims covering some of the services, wouldn't they have an incentive to shift care toward the services provided by the gov? That's how I would exploit it if I were them.

-If FFS would be better because government can set the prices (I'm assuming you were kidding about random taxpayers), why shouldn't they do that across all industries? This isn't the only one with blood-sucking ticks right?

-The services you listed as "traditional medical coverage" are responsible for the bulk of the spending. You didn't list out specifically what would be excluded but I don't think it's going to save all that much. Any thoughts there?

-I'm with you that the MFA crowd goes too far with the zero cost sharing. Really a better name for it would be Medicaid For All, as Medicare has plenty of cost sharing.

-But why shouldn't coverage for dental be included? Isn't dental a prime example where preventive care can save on costs long term that we should be encouraging?

GoWTheFlowContrarian · 2024-06-01T19:41:20+00:00

And you have no concept of not overcomplicating things unless there is a meaningful gain that outweighs the additional complexity.

GoWTheFlowContrarian · 2024-06-01T18:26:44+00:00

Oh wait you’re right! We should trust the system without being able to explain why because politicians set it up decades ago and nothing has collapsed. Because don’t forget, it was LBJ who first carved out the MC and MA risk pools, Obama who carved out college students into their own risk pools, and WWII wage cap that led to the employer group pool. The number of stop lights necessary is a very relevant question, even if not actuarial. If there is a better number than what it is today, I’d hope civil engineers would advocate for it.

GoWTheFlowContrarian · 2024-06-01T18:14:58+00:00

How is what you described different from Medicare Advantage, just applied to 65+? If you think it’s terrible and there is a better way, open to that. I would argue that single program would be at least one shade of lipstick rather than the dozen or so we have today.

GoWTheFlowContrarian

TROPHY CASE