22 ms·

Many See I.R.S. Penalties as More Affordable Than Health Insurance

• 0xcde4c3db 11y ago
  At least in retrospect, this doesn't surprise me. If Kafka had been a 21st-century American, he probably would have written a novel about medical billing instead of The Trial. An incomprehensible cost structure represents, in some sense, infinite risk. Why wouldn't people be hesitant to engage?
• gscott 11y ago
  I work with someone who has health insurance from the California exchange. His assigned doctor is about a 2 hour drive away. Maybe he has picked the cheapest plan but such a situation shouldn't really happen if this was well run.
  • methodover 11y ago
    _Assigned_ doctor? Did he get put in an HMO? If he got a PPO plan, there shouldn't be a doctor assignment, right? It could be that the only doctor he was able to find that could take his PPO plan is 2 hours away.
    • gscott 11y ago
      He had to choose a doctor, so I believe it is an HMO. He picked the closest one in Newport Beach but he lives in San Diego.
  • marincounty 11y ago
    There's problems. We need health care for people though. Obama original plan was fine. The republicans started in with the death squads, and the scare tatics. We ended up with a system that Insurance companies exploited. I am waiting for someone to fix it, or offer a better solution. I have heard of nothing. Nothing feasible. See--if I get sick I go to a doctor's office, or hospital. It might be the only industry that isn't required to offer a bill in advance? Doctors, and insurance companies can charge whatever they like, or at least that's been my experience. I gave given this a lot of thought. I don't have an answer. My only plan would be to make medical bills bankruptable--for any amount, and at any time. There would be no ten year waiting. It's not feasible because it would clog up federal courts, unless we stream line the process. Made a medical related bankruptcy so easy you could send it in on a post card. I don't want to lose my shack because I get sick. Even now, people are losing their homes in municipal court because they got sick, and didn't have the ability to pay the outrageous bill. Hospital lawyers try to keep it quiet, but they sue. A friend's wife is recovering from stage three cancer. I don't know the type, or wanted to ask. They were in Switzerland, and she got very sick. When they got hone they were expecting a huge bill--the insurance company would balk at. It was completely covered by the Swiss government. What a country? We need a reform. We don't need a Blowhard in office who will make things worse?
  • magicalist 11y ago
    FWIW as of 2015 California requires there be "primary care network providers with sufficient capacity to accept covered persons within 30 minutes or 15 miles of each covered person's residence or workplace", specialists within 60 minutes or 30 miles, and that there be sufficient capacity for doctors within those limits to accept new patients[1]. Getting that enforced isn't easy, but that situation not only shouldn't happen but should also be grounds for regulatory action against the insurer. [1] http://www.insurance.ca.gov/0400-news/0100-press-releases/2015/upload/nr012-NetworkAdequacyApproval.pdf http://www.insurance.ca.gov/0400-news/0100-press-releases/20...
    • DrScump 11y ago
      Getting that enforced isn't easy How is that even possible? How does the state mandate that some random provider step in and subsidize higher payments to providers in order to encourage them to take on more new patients?
      • YokoZar 11y ago
        By preventing them from selling their insurance on the state-run exchange if they don't meet the standards.
        • DrScump 11y ago
          OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients. There is a good article on this problem (many doctors not accepting new patients, leaving regions without care except for ERs) on the front page of the 5/18/15 San Jose Mercury News.
          • magicalist 11y ago
            > OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients It has nothing to do with coercing doctors. Why would it? If a insurance network can't meet its obligations it will be fined or shut down. If an insurer has to pay more money to a doctor in some area to meet its obligations it will then have to (though undoubtedly that will be eventually passed on to its customers). Meanwhile it's an agonizingly slow process to get justice for the people that need it, but insurance companies forced to refund money for not meeting their network coverage requirements is in the news right now, specifically because "more than 25% of physicians listed by Anthem and Blue Shield weren't taking patients in the Covered California health exchange or were no longer at the location listed by the companies, according to the state's investigation." http://www.latimes.com/business/healthcare/la-fi-obamacare-network-probe-20151103-story.html http://www.latimes.com/business/healthcare/la-fi-obamacare-n...
• tunesmith 11y ago
  Kind of a contentless article - of course there will always be people who choose the penalty instead of coverage. Some will be rational choices, some will be short-sighted. It looks like the overall forces, though, are good for the ACA - the penalty is going up, more healthy people are signing up for coverage, the risk profiles are stabilizing, etc. All of this should theoretically help create more choice in the exchange over time.
  • CrowFly 11y ago
    I don't know. I think the stories from people who are actually trying to use the ACA should bear a lot of weight.
    • Analemma_ 11y ago
      No, they shouldn't. "The plural of anecdote is not data": of course you can go around cherry-picking people who are unhappy with the ACA; health care is extremely complicated, no solution was ever going to be perfect, and this law in particular attracts people with an axe to grind. But I can find just as many anecdotes of people who are a lot better off under the ACA. Stories are pointless; the only effective measurement is the bird's-eye view of the numbers as a whole: how many uninsured are there now, what is happening to the mean/median premiums, etc.
      • deleted 11y ago
        [deleted]
    • pdabbadabba 11y ago
      It seems to me this depends on how those people are selected, and the purpose to which one is trying to put the article. An article about just a handful of people who choose to pay the penalty (rationally or not) is not a very enlightening way of evaluating the program overall, standing alone. I don't think this was the purpose of the piece, but it is naturally the way the piece will be used by opponents of the program. This is generally the role played by anecdotes in any policy discussion. (See the top of this thread for more examples.) For this information to be truly valuable for this purpose, it would be joined with a representative collection of stories about other people's experiences so one can form an accurate impression of how the program is actually working. (It could, of course, be debated whether the New York Times has provided this broader context in a meaningful way through its other ACA coverage.) The article does provide some interesting human detail, and illustrate the depth of some people's convictions about (i.e., opposition to) the ACA, however, which seems valuable and enlightening in its own right. But this angle doesn't well serve anyone's political agenda.
• jhulla 11y ago
  Personal experience with ACA: As of 2016, we're onto our 3rd insurer. Each prior one has dropped our local doctors, physicians groups and hospital. With each insurance change, our deductible has gone up, our premium has increased and our co-pay, co-insurance has increased. In effect, our ACA plan has become an extremely expensive catastrophic insurance plan.
  • clamprecht 11y ago
    You're not alone. In Texas, they cancelled almost all (or maybe all) individual PPO plans (affecting about 367k people), leaving us to choose HMO or EPO plans (the lesser of two evils). And about a 20% increase (per year) in insurance cost for the last 3 years. I at least hope some folks are benefiting from the ACA, I'm certainly not.
    • vonmoltke 11y ago
      > In Texas, they cancelled almost all (or maybe all) individual PPO plans (affecting about 367k people), leaving us to choose HMO or EPO plans (the lesser of two evils). I know Scott and White[1] is still offering PPOs, but apparently they only service 77 counties in Texas. A quick check of healthcare.gov tells me that none of the big insurers are offering PPOs, though. I don't know if there are other small-ism nonprofits like SWHP serving other parts of the state and providing PPOs. [1] https://swhp.org/en-us/ https://swhp.org/en-us/
    • parfe 11y ago
      What'd you have before the ACA?
      • clamprecht 11y ago
        I had an individual PPO plan. Also, my current plan isn't an ACA "marketplace" plan, it's a non-marketplace HMO plan.
    • azinman2 11y ago
      In CA, that's not the case. Our insurance went up maybe $50/person, but we got mental health care, acupuncture, and various other benefits we didn't have before. Oh and we have pre-existing conditions that would prevent us from being insured if we didn't have employer-based. And this is all PPO.
• dpweb 11y ago
  I'm against Obamacare, but if I was for it, I would peg the penalties at 2x the avg basic exchange coverage price. Also, people with high deductibles should make sure you take advantage of tax benefits, HSA for instance. The $6000 deductible may really only be a $4800 deductible once you figure in the tax deduction. If you're talking Obamacare coverage being 20% higher than the penality (I'm assuming the penalty is not tax deductible) that may end up being a wash and you're better off with the coverage. Now consider the guy paying the $1800 penalty instead of the $2900 coverage. The coverage being effectively $2175 (considering a 25% tax break). He pays $1800 for nothing instead of $2175. Passing up $375 coverage. Again, Obamacare - pretty much a debacle as far as costs - but that guy maybe not be the wisest choice.
  • pmorici 11y ago
    My current plan has an has an HSA component but the company that administrates the account, BenefitWallet, has some fine print in the account agreement that they charge an account fee for balances less than several thousand dollars. Realistically I only spend several hundred dollars per year on healthcare stuff so I don't think it is to my advantage to lock up that much money in a non-interest bearing account or pay the bank 120 bucks per year.
    • mecameron 11y ago
      You are not required to use the HSA provider that your insurer/employer is tied to. You can pick and contribute to your own HSA account elsewhere, with one caveat. Your contributions are deductible from federal and most state taxes, but are only deductible from payroll taxes (social security/medicare) if the HSA contribution is deducted from your paycheck by your employer (and thus deposited in their preferred HSA provider).
      • pmorici 11y ago
        Yeah, in my case it isn't though my employer either so there is another reason to avoid it.
    • 11y ago
• pbreit 11y ago
  Why would it not be more affordable? You're not getting anything.
  • swagv 11y ago
    You can pay and get something or pay and get nothing.
    • bdcravens 11y ago
      If you don't go to the doctor and don't need medicine, the "something" isn't valuable especially if it's more expensive than the "nothing". (I say that as someone with a preexisting condition who is happy to pay my premiums and get the medicine I need; I also grew up in a family where we didn't have insurance but somehow always had cigarettes and cable TV, so I know multiple perspectives)
      • Killswitch 11y ago
        I'm 30 years old and haven't been to a doctor in about 10 years outside of simple things that I paid out of my own pocket. Nothing that a year of healthcare would cover, and considerably lower than it'd cost. I'd have paid in tens of thousands of dollars over the course of that time, and for what? What ifs?
        • DanBC 11y ago
          When you're 60 years old you're going to want doctors and nurses who know what they're doing. That means someone needs to pay now to train them and their replacements.
          • Killswitch 11y ago
            So what you're saying is if I don't go to the doctor for 10 years, but pay $350/mo over the course of that 10 years for an insurance plan, the insurance company uses the money to fund college education for nurses and doctors? Doubt it.
• daurnimator 11y ago
  In Australia the penalty is 1% of your income (or more) https://www.ato.gov.au/Individuals/Medicare-levy/Medicare-levy-surcharge/Income-for-Medicare-levy-surcharge,-thresholds-and-rates/ https://www.ato.gov.au/Individuals/Medicare-levy/Medicare-le... This makes it a no-brainer for anyone earning over ~$90k to get health insurance (as it's cheaper than not having it). Yet it doesn't force low income earners into having private health insurance: they fall through to the safety net of the public healthcare system. It's not a perfect solution; but it's perhaps slightly better than what the USA has at the moment?
  • ploxiln 11y ago
    from TFA: > For 2016 and beyond, the penalty will be $695 per adult or 2.5 percent of household income, up from $325 per adult or 2 percent of household income last year. The difference is that health care costs in the US are nonsensical. So high that it's really hard for the penalty to be less than the cost of insurance, until you have a six-figure income. If you make low-six-figures, you very likely get good health insurance through your employer (which ends up being priced much more reasonably because the group includes mostly healthy people).
    • daurnimator 11y ago
      Ah, I missed that bit. I guess the difference is in the cost of healthcare then. Also we don't have health insurance via employers.
  • davidw 11y ago
    > perhaps slightly better than what the USA has at the moment? Pretty much anything would be. Health care in Italy was better than in the US, and that's saying something - Italy is a nice place, but not always run that well. A more market-based system might be better too as at least for some things there might be some downward pressure on prices. The current system (including pre-Obamacare in that as well) just sucks.
    • Camillo 11y ago
• methodover 11y ago
  > But plenty of healthy holdouts remain, and their resistance helps explain why insurers are worried about the financial viability of the exchanges over time. They say they sorely need more healthy customers to balance out the costs of covering the sicker, older people who have flocked to exchange plans. Ah, the tragedy of the commons at work. Healthy people don't buy insurance because it's too expensive. Insurance is more expensive because there are too many expensive sick people and not enough healthy people paying into it. It's a terrible feedback loop, one which the IRS penalties were designed to solve.
  • dibujante 11y ago
    As a Canadian, I am astonished at how expensive even the cheapest of these plans are. My monthly healthcare cost amounts to $178, once you factor in the taxes I pay that go to healthcare. That's cheaper than any of the plans in this article. How do people find these prices bearable?
    • mikeash 11y ago
      They're cheaper than getting sick and not having insurance. I'll pay almost anything to ensure that a sudden medical event doesn't bankrupt me.
      • eplanit 11y ago
        > "I'll pay almost anything to ensure that a sudden medical event doesn't bankrupt me." Exactly, and reflects the mafia-esque choice imposed on the consumer when rates are increased: pay the absurd rate or face absolute ruin if (when) a sudden medical event occurs.
        • mikeash 11y ago
          It's mildly terrifying. If you're unlucky enough to break a major bone or get cancer or something like that, you could literally be on the hook for millions of dollars. I lived overseas for a couple of years, and when I got back to the US one of the first things I did was obtain health insurance because of this.
• dguaraglia 11y ago
  I'm glad someone changed the original title to "health insurance" rather than "health care". Using the two terms interchangeably has to be one of the biggest reasons why we get the shitty system we get for the amount we pay per year.
• tomohawk 11y ago
  Inevitable result of thinking that adding even more government intervention would result in better, cheaper plans. If they were really interested in making better, cheaper plans, they would roll back most of the ACA, eliminate the restrictions on buying across state lines (actually allow competition), and transfer the tax incentives for getting insurance from employers to employees. Basically, all they had to do to make healthcare more affordable was to open up the Federal employees plan to everyone and transfer the tax incentives to employees. This was actually proposed by both major parties prior. It would have been about a 10 page bill.
  • millstone 11y ago
    The experience with credit card deregulation should put the lie to the idea that selling across state lines results in meaningful competition and better products. After the Supreme Court ruled that credit cards could be issued across state lines, the issuers migrated to states with the weakest consumer protections. As expected, this was followed by a series of abuses: credit card issuers would raise rates without warning, hiked late and overlimit fees, and buried key information in fine print to obscure the true cost. It fell to the federal government to impose stronger consumer protections, via the CARD Act. Much of the ACA was concerned with strengthening consumer protections by ending policies like rescission, lifetime limits, or denial for pre-existing conditions. If we were to repeal the ACA and allow selling across state lines, we should expect the re-introduction of these policies and worse.
    • tomohawk 11y ago
      The Federal plan banned those things long ago and yet still created a functional market that helped contain costs and boost quality. It still does today. Only, just for Federal employees and Congresscritters. The real issue is the ACA is a solution from 60 years ago that doesn't meet the problems we have today and has actually made a bad situation worse.
  • epistasis 11y ago
    >Inevitable result of thinking that adding even more government intervention would result in better, cheaper plans. and >open up the Federal employees plan to everyone and transfer the tax incentives to employees. Seem somewhat in contradiction. I'd go with the first being the incorrect part.
• ars 11y ago
  The plans have been a disaster. They got rid of the only plan that makes sense for young people: Catastrophic insurance (deductible of over $10,000). The plans that remain have high enough deductibles to be worthless, but low enough to be expensive. The plans helps almost nobody. The only people who gain value from the exchanges are those who get a subsidy. To make things worse insurance companies are pulling out in droves, and prices are expected to go up 40% year to year. Things are not looking good.
  • privong 11y ago
    > The plans have been a disaster. They got rid of the only plan that makes sense for young people: Catastrophic insurance (deductible of over $10,000). Don't forget, that was by design. The law needs young, healthy people to put money into the system to support the expenses insurance companies would encounter due to the increased coverage for less healthy people.
    • clamprecht 11y ago
      I am okay with paying more to cover others who can't afford it. What I'm not okay with is losing my plan, my doctor, and my benefits, all while paying more.
      • iofj 11y ago
        When you think about it, the two are really the same thing. A lot of people (some 15 million) got coverage, and they're not paying for it, you are.
        • deleted 11y ago
          [deleted]
  • sehugg 11y ago
    They didn't get rid of catastrophic plans, they just made them completely unusable. You need a hardship exemption and be < 30 to qualify for one, but they aren't eligible for subsidies.
• abawany 11y ago
  This is unfortunate. Health problems are unpredictable and very expensive, in my experience. I was grateful for ACA (unsubsidized) in 2015 in spite of being on a bronze plan with a high deductible. Why? Because even though I was generally paying for care out of pocket due to my high deductible, the insurance company had negotiated much lower rates for this care than what the providers wanted to charge me. I guess I could have dealt with the 10+ providers and negotiated lower cash prices myself but I have a day job. In my estimation, the negotiated rates saved me $3k compared to the billed rates. People I know minimized the dent to their financial health as a result of it of ACA as well. Life and health is unpredictable and one can be hale and hearty one day and hospitalized in the ER the next. The thought of being without health insurance and allowing one's meager savings to be wiped out as a result is an outcome that sends chills down my spine. I hope I don't come across as shilling but I am grateful for the ACA. It is not perfect but just like democracy, it is the best that this country has been able to scrape up after 200+ years of SOL-care.
• graeme 11y ago
  I'm a Canadian. I'm curious to know what it would cost to match my level of coverage in the US. 1. Public medical care. Good care, normally easy to see a doctor. Excellent quality. Can use this as much as you need. 2. Occasional use of the parallel private billing system. Costs less than $300 Canadian to see a specialist. 3. Private coverage for paramedical claims (Physio, massage, drug plan, dental, vision, etc.). Pretty comprehensive. Costs about $100 Canadian a month. I work for myself. Is it even possible to replicate such a plan without employer coverage? What would it cost?
  • djeikyb 11y ago
    I live in Arizona. My employer only offers high deductible health plans with a pre-tax health savings account. So, I pay ~350 USD per month for the plan to cover my wife and I. Then I also contribute to this health savings account, my employer kicks nothing in. For this, we get basic vision and dental completely covered. That is, routine checkups, cleanings, basic prescription eyewear. Everything is else is subject to a high deductible, ~10,000 USD. The insurance covers something like 20% of certain kinds of expenses until we hit the deductible, then it covers 80-100%, per year. A few weeks ago I had an asthma attack and went to see a doctor. The office refused to tell me in advance what I would be charged, or even what my insurance would be charged. I ended up being charged $200 after insurance, and then an additional $100 for prescriptions. Because I had not previously selected a primary care physician, it was difficult to see a doctor in a reasonable amount of time. The doctor I did find gave wrong instructions for one of the prescriptions, and forgot to call or even write down the other.
    • graeme 11y ago
      Should I take that to mean that there is no option to get equivalent insurance to what we have in Canada?
      • djeikyb 11y ago
        I think it depends on the state. We don't have a national healthcare system (disregarding a couple programs for the old or very poor). Obamacare laid down only the barest of national standards.
• imh 11y ago
  Some people don't get insurance because the high deductibles mean they probably won't get any benefit. I think an even scarier effect is that I personally don't go to the doctor unless I really, really need to because of those same high deductibles (and the high cost of time off of work). Preventative care is expensive!
• pg_is_a_butt 11y ago
  penalized for not buying a non-tangible good from a private corporation. FUCK THIS COUNTRY.
• exabrial 11y ago
  Obama said no one is losing their coverage. He didn't lie.
  • white-flame 11y ago
    That is the one flag-waving thing they can say about this, that more people are eligible or covered (but that ≠ "no one lost their coverage"). Obama will wave that raw number flag hard to try to tout his legacy. Literally everything else in all aspects of the American health care & health insurance industries is worse off because of it.
• mschuster91 11y ago
  Every time I see one of these articles (or anything related to US healthcare) and read the comments, I can't help but ask myself how rotten a country can be. In this case, as a German, I dare say "rotten to the core". It apparently is impossible to move the US healthcare system to a system where every person in the US is eligible to even the most expensive emergency healthcare without having to fear bankruptcy afterwards, and that's shocking.
  • Laaw 11y ago
    Yeah, the vast majority of us have healthcare, aren't really sick, and occasionally when we do get really sick, our insurance pays the bills. I had an emergency root canal earlier last year in the US, cost me zero dollars, and I've got one of those high-deductible plans (it's the HSA that covered that). I'm actually a little surprised you (or anyone on HN) are so eager to jump at the "worst case" stories and presume they're normal. This is a data problem, not a "let's tell our horror stories" kind of problem. Every system has people who fall through the cracks, these half-baked "I'd just do X" without any research is exactly the kind of thinking that causes problems.
    • mschuster91 11y ago
      > I'm actually a little surprised you (or anyone on HN) is so eager to jump at the "worst case" stories and presume they're normal. These "worst case" stories should not happen at all in any civilized country! One of them is one too much.
      • alextgordon 11y ago
        I suspect "worst case" may be a euphemism for "poor people".
      • Laaw 11y ago
        Every country has people who fall through the cracks. It's noble and true to say this shouldn't happen, but it does, and in every country. Germany, too.
• tvanantwerp 11y ago
  My wife is from Hong Kong, and we're both seriously considering moving back there because of the cost of health care in the US. It's been a constant strain on our finances--any little thing can set us back by hundreds or thousands, even while insured! We never had problems like this back in Hong Kong. I really wanted to make our lives work in the US, but I don't see how we'll ever get ahead when raises and bonuses get eaten away by health care.
  • geomark 11y ago
    Can you summarize the healthcare system in Hong Kong? I'm particularly interested in options for non-citizens. Can you just walk into a private hospital and get treatment for cash? Or is it like so many places in the US where they don't want to talk to you unless you have proof of insurance?
• beatpanda 11y ago
  >"If something catastrophic happens," she said, “I feel like it’s better just to die.” This is the richest country in the world in 2016, no other country has this problem, and this is the best our politics can do. Sit with that thought for a little while.
• rdtsc 11y ago
  This is turning out to be a failure for some. It was for me personally. Was at a smaller company. Insurance premiums had been increased by a huge amount (probably 40% or so) in the 2 years _before_ Obamacare went into effect. Representatives would come and would tell us a sad story about how all this legal environment is punishing them, and there is a lot of risk and uncertainty so they have not choice but to raise premiums. So 3 years later premiums are way up, coverage is ... different. No lifetime maximums, that's nice, some free preventice checks and labs (unless the find something, then it becomes a paying lab or doctors' visit). Otherwise it is a about the same or worse coverage as before. So far as far as the pocket is concerned, as far as the story I am told by employer, and by insurance representatives is that Obamacare is not a good thing. I want to believe, but I can't. I knew it was going to be a so or so or failure when they striped the single payer option away early on. It wasn't agressive enough that's the problem. Without cost controls it is like plugging holes in hunk of swiss cheese. "Oh law wants to expand coverage for more people? Ok, everyone's premiums are higher now by 20%...." I'll grant it that it might not be just the insurance companies to blame. Doctors, hospitals, pharma companies -- anyone in the money pipeline is guilty of abusing and taking advantage as much as they can.
• transfire 11y ago
  Evey once in a while I have to go to the emergency room for a serious migraine. All I need is a few drop of morphine. But I also get a bill for over $3,000. Of course, it goes in the trashcan. The real problem with the medical system is its total contrivance to prevent people from treating themselves and having access to treatments at their actual cost -- the inflated pricing for the non-insured is the racket of the health insurance "mafia".
  • tshtf 11y ago
    Morphine? Why not get a prescription for Imitrex?
    • stordoff 11y ago
      Sumatriptan isn't a cure-all for migraines. I suffer from near-constant migraine-like headaches (sometimes diagnosed as migraines, some not - depends on the consultant), and they are actually worsened by sumatripan. Morphine seems a little strong, but having tried every offered non-opiate medication (amitriptalyne, sodium valproate, gabapentin, propranolol, topiramate etc.) and only had any success with opiates (tramadol and codeine), it doesn't seem that unlikely.
      • tshtf 11y ago
        Thanks, fair enough. I shouldn't have assumed the first-line approaches for migraine would work for everyone.
• fredliu 11y ago
  FWIW, reading the comments reminds me of Hilary Clinton's answer to "Is Obamacare helping or hurting the average U.S. citizen?" on Quora (https://www.quora.com/Is-Obamacare-helping-or-hurting-the-average-U-S-citizen https://www.quora.com/Is-Obamacare-helping-or-hurting-the-av...) The comments on Hilary's response seem resonate the comments here...
• brandonmenc 11y ago
  The real problem is that no one knows how much anything costs - including doctors. Ever ask them "how much is this going to cost?" They'll either tell you they have no idea, or give you a useless range like, "between $1k-$10k."
  • geomark 11y ago
    This drives me crazy. I walk in and want to pay cash, but they won't treat me because I have to show proof of insurance because they have no idea what they will charge when the bill is generated.
• deleted 11y ago
  [deleted]
• mrslave 11y ago
  Another Peter-Schiff-was-right moment.
• pinaceae 11y ago
  As an European living in the US, the US health system is so utterly broken and asinine, it's not even funny. You take a non-free market (I get sick, I need help - no choice involved) and apply seemingly free market logic to it. The result is a disaster, tada. Single payer, all the way, everyday. Add private, optional insurance on top to allow well-off people to get private rooms, etc. But no one should worry about going bankrupt over medical bills, ever. And yes, Austria is living proof that such a system can exist, with awesome results. Including electronic health records, the e-card etc. - all sci-fi ideas that US super genius companies like Google, MS, a myriad of startups cannot create.
  • novalis78 11y ago
    It's not a free market system. I wish it was. It's amazing how people vote for government protected cartels. It took the press (Time magazine article two years back) an incredibly long time to start digging into fraudulent healthcare pricing - since then some things have started moving (legislation in some states to force hospitals to show prices, at least to bring in some semblance of a market and allow market forces to start operating). In a true free market environment such abuse by an incumbent/system would lead to innovation and new ideas that would quickly obliterate the monopoly, in this case the monopoly has the guns (i.e. regulation/government protected insurance and health care industry). Disclaimer: I lived in Austria/Germany for decades and their system is worse because it's totally closed to any potential market innovation while taxing the living daylights out of the middle class.
• DougN7 11y ago
  My individual/family plan has gone up by about $1000/year for the past two years. AND our deductible has increased as well! Not too thrilled with the ACA - it's becoming less and less affordable as time goes on.
• cmurf 11y ago
  Insurance I had as self-employed for 12 years gave up in 2015 and would not renew. Crap bronze plan with highest possible deductible is almost 4x what I was paying. The part I particularly don't like is that this is compulsory. I'd rather see private insurance destroyed than expanded under penalty threats. Or better, go back to barter.
• novalis78 11y ago
  Before ACA we could barely afford health insurance for our family. After ACA it became evident that we can't afford to participate in this mafia racket if we truly want some money left over to pay for necessary medical expenditure. We were ready to face the tax penalty, but then my accountant found a loop hole. It's time for a repeal and replace -with some introduction of market competition. This unholy alliance of hospital-insurance-government mafia cartel needs to be broken.
• rdl 11y ago
  I've always been a fan of HSAs + HDHP w/ extremely good coverage (no lifetime limits, etc.) beyond the self-insured amount. (Keep preventive care, birth control, etc. in the exempt amount, too, and especially public health stuff like vaccinations, since it reduces overall cost.) I currently have an HRA (essentially a non-accruable form of HSA) through employer; it gets the incentives wrong so there's every incentive to use as much care as possible (slightly more convenient providers who charge 5x as much to the plan; as much care as possible). I still have some hope ACA 2.0 could include: 0) Transparent pricing and mandate that anyone prepaying cash gets the medicare price. Maybe medicare prices have to rise. 1) Catastrophic/HDHP being encouraged for everyone. Potentially, subsidized for some income levels (i.e. money goes directly into your HSA, and HDHP premiums can be reduced.) I'd prefer if those premiums be market-based and then explicitly subsidized. 2) End employer deductibility for health insurance (over, say, 5-10y window); make it deductible, if at all, for individuals only. Employers for many many reasons should have nothing to do with health care -- privacy, portability, etc. 3) Pressure to reduce actual costs of health care delivery. End the AMA cartel's reign on care -- there is a LOT of care where 5% of the cost could produce a 90% as good solution, and people should be free to choose that if there are no negative externalities. Really, only antibiotics and contagious disease should have enforced minimum standards which can't be deviated from even w/ informed consent. This is especially meaningful for terminal or end of life care. 4) Any subsidies come from general tax and not from adjusting the underwriting (which is essentially a tax on people buying certain classes of health plan only, to cover others) 5) All government plans, except deployed active-duty military ONLY (i.e. care in war zones), go via this plan; end the VA and tricare. Provide superior care to gov/mil people by making this overall plan better, and for everyone. The President can have a personal doctor for COG reasons, but all other senior government people go through the plan, too. 6) Potentially fold medicare/medicaid into this as well. 7) Explore single-payer 8) Relatively unlimited access to medication (certainly imports from overseas), outside of antibiotics. If there is patent protection, shorten term. Reduce trials costs (safety must be shown, but not efficacy) -- efficacy and superiority can be decided by informed consumers, who may not be individuals, but could be insurers or other groups.
• tyingq 11y ago
  Interesting to see the anecdotal evidence in the comments that the ACA has been very good to some, and very bad to others. It's been particularly bad for us. The covered employees are largely older (40+), with families, and it's a fairly high-end policy with a low deductible and a high percentage of covered inpatient costs. We pay 100% of the premiums for employees. The cost, for one employee with a family, is now over $1800/month. It is a high end policy, but...WOW.
• dawnbreez 11y ago
  This is actually further than I expected this to go. I'd figured companies would charge up to the penalty, not more than it, as charging more would drive customers away, and charging just a little less would net them the most money.
• rphlx 11y ago
  I've heard that, based on how the ACA was written, the penalty is only weakly enforceable; if you refuse to pay it, the IRS cannot garnish your wages or seize assets for it, etc. They can subtract it from a tax refund if you are owed one, but that's about it. So I imagine more and more people will find ways to not have insurance and also not pay the penalty, as both continue to become more expensive over time.