3 ms·

I'm pretty sure I have to have full insurance or I'm going to get a nice big tax penalty at the end of year.

Mz 10y ago
http://micheleincalifornia.blogspot.com/2015/12/how-to-fix-americas-financial.html http://micheleincalifornia.blogspot.com/2015/12/how-to-fix-a...
- nodesocket 10y ago
  What happens when you need urgent medical care like the hospital using direct care?
  - Mz 10y ago
    That is what the high deductible insurance or health savings account is for.
    - mgkimsal 10y ago
      i can't contribute to an HSA without subscribing to a high deductible plan. " basically a membership in a clinic where you pay a monthly fee in order to get cheap access to your doctor... The monthly fee is substantially less than typical health insurance premiums." But... I still need a high-deductible plan to contribute to an HSA to deal with catastrophic issues anyway. high deductible plans are putting colleagues of mine in to $1000/month premiums already - saying "spend even more $ each month on a membership plan" isn't going to cut it for most people I know. 5 year ago a 'high deductible' plan cost my family <$300/month. Today it's close to triple what I paid just a few years back.
      - Mz 10y ago
        Well, you are only giving me partial info here. I am not sure if you merely want to shoot down what I am saying or just what. I have found this if you actually want info: https://directprimarycarejournal.com/2014/06/08/how-does-direct-primary-care-work-with-high-deductible-health-plans-hdhp-and-health-savings-accounts-hsas/ https://directprimarycarejournal.com/2014/06/08/how-does-dir...
        mgkimsal 10y ago
        How am I giving you only partial info? "High deductible" plans, on their own, are very unaffordable relative to only a few years ago. Your link illustrates this even more. HSA funds can't be used for DPC monthly fees - those are out of pocket costs. You can pay service fees (for services over and above what's provided by regular DPC services) with HSA. However, you can't get money IN TO an HSA without also having a high-deductible insurance plan. You can say the HD plan is for catastrophic situations, with DPC being day to day, but for most folks I know, especially with families, the HD plan on its own has extremely high costs, and saying "let's also subscribe to a DPC service to keep our costs down!" makes 0 sense for almost all of them. DPC alone won't deal with "crap, I just got cancer and need $180k of treatment". "regular" insurance can deal with that, but it's still extremely expensive. Maybe I'm missing something in what you're trying to say.
        Mz 10y ago
        Okay, that's valid. Here is the thing: Catastrophic health events are not determined by some random number generator that says "Tag! You're it! We decided to fuck with you today!" Study after study after study shows that diet, lifestyle and preventive care (or lack thereof) correlate strongly with whether or not someone winds up with a catastrophic health event. This includes cancer. One of the ways DPC lowers costs is by helping patients stay on top of health maintenance so health problems do not escalate. For example, patients with well managed diabetes can live long, healthy lives with few complications. Patients with poorly managed diabetes see high rates of blindess, foot amputations and other horrifying, expense, life altering health complications due to diabetes. Does that make any more sense?
        JoeAltmaier 10y ago
        Only about 40% of cancer can be controlled by our behavior. The rest are indeed random and unpredictable. Its healthy to see ourselves in control of our lives. But at some point it becomes unrealistic, or victim-blaming, or just denial.
        10y ago
- uiri 10y ago
  > My understanding is that health insurance originated in this country as a means to plump up employee compensation in a situation where paying more wages was not desirable. You could not entice good employees by offering them a pay raise because it bumped them up into another tax bracket and it just wasn't worth it to them. But the way health insurance got handled, if you offered them a benefits package, it increased their quality of life without the punishing extra taxes. You could not entice good employees by offering them a pay raise because it was illegal [0] This passage also reflects a possible misunderstanding of how marginal income tax brackets work. In no situation does bumping someone into a higher tax bracket result in lower net pay. [0] https://en.wikipedia.org/wiki/Stabilization_Act_of_1942 https://en.wikipedia.org/wiki/Stabilization_Act_of_1942
  - Mz 10y ago
    Thanks. I am considering doing a new piece because I get a lot of flack over details like that while people generally seem to miss the point relevant to our lives today that DPC is a legal alternative under the ACA and a genuinely better solution. I am frustrated and not sure what I need to do differently to get that across effectively. Edit: Feel free to nitpick this version: http://micheleincalifornia.blogspot.com/2017/01/direct-primary-care-real-alternative.html http://micheleincalifornia.blogspot.com/2017/01/direct-prima... Maybe I shall eventually get it right (just in time for the law to change under Trump). Thank you.
    - uiri 10y ago
      Sorry, I didn't mean for my comment to be taken as a criticism of the overall piece but rather a nitpick of that particular paragraph. I agree that separating disaster/catastrophic coverage (ie: insurance ) from routine things like doctor visits (ie: health care ) is a good thing. I was aware of HDHP and HSA for the former but I did not know about DPC until you brought it to my attention with this comment thread. Thank you.
      - Mz 10y ago
        It was written somewhat off the cuff and I did frame it as "as I understand it." I was just trying to give some general historical background for why the US has gotten to where it is currently, even though what we currently do is incredibly broken. I don't know why I seem to inspire this kind of reaction in people, and maybe it isn't "me" per se, but I seem to get this a lot. And I am genuinely interested in figuring out if it is really something I do that I can somehow change. Thank you for engaging me in meaty discussion. Best.
- Mz 10y ago
  FYI: Attempt #3 to explain why people should look into DPC: http://micheleincalifornia.blogspot.com/2017/01/direct-primary-care.html http://micheleincalifornia.blogspot.com/2017/01/direct-prima... Also submitted: https://news.ycombinator.com/item?id=13354383 https://news.ycombinator.com/item?id=13354383 I assume it will get no traction. Best of luck in resolving your problem.

Mz 10y ago

http://micheleincalifornia.blogspot.com/2015/12/how-to-fix-americas-financial.html http://micheleincalifornia.blogspot.com/2015/12/how-to-fix-a...

nodesocket 10y ago
What happens when you need urgent medical care like the hospital using direct care?
- Mz 10y ago
  That is what the high deductible insurance or health savings account is for.
  - mgkimsal 10y ago
    i can't contribute to an HSA without subscribing to a high deductible plan. " basically a membership in a clinic where you pay a monthly fee in order to get cheap access to your doctor... The monthly fee is substantially less than typical health insurance premiums." But... I still need a high-deductible plan to contribute to an HSA to deal with catastrophic issues anyway. high deductible plans are putting colleagues of mine in to $1000/month premiums already - saying "spend even more $ each month on a membership plan" isn't going to cut it for most people I know. 5 year ago a 'high deductible' plan cost my family <$300/month. Today it's close to triple what I paid just a few years back.
    - Mz 10y ago
      Well, you are only giving me partial info here. I am not sure if you merely want to shoot down what I am saying or just what. I have found this if you actually want info: https://directprimarycarejournal.com/2014/06/08/how-does-direct-primary-care-work-with-high-deductible-health-plans-hdhp-and-health-savings-accounts-hsas/ https://directprimarycarejournal.com/2014/06/08/how-does-dir...
      - mgkimsal 10y ago
        How am I giving you only partial info? "High deductible" plans, on their own, are very unaffordable relative to only a few years ago. Your link illustrates this even more. HSA funds can't be used for DPC monthly fees - those are out of pocket costs. You can pay service fees (for services over and above what's provided by regular DPC services) with HSA. However, you can't get money IN TO an HSA without also having a high-deductible insurance plan. You can say the HD plan is for catastrophic situations, with DPC being day to day, but for most folks I know, especially with families, the HD plan on its own has extremely high costs, and saying "let's also subscribe to a DPC service to keep our costs down!" makes 0 sense for almost all of them. DPC alone won't deal with "crap, I just got cancer and need $180k of treatment". "regular" insurance can deal with that, but it's still extremely expensive. Maybe I'm missing something in what you're trying to say.
        Mz 10y ago
        Okay, that's valid. Here is the thing: Catastrophic health events are not determined by some random number generator that says "Tag! You're it! We decided to fuck with you today!" Study after study after study shows that diet, lifestyle and preventive care (or lack thereof) correlate strongly with whether or not someone winds up with a catastrophic health event. This includes cancer. One of the ways DPC lowers costs is by helping patients stay on top of health maintenance so health problems do not escalate. For example, patients with well managed diabetes can live long, healthy lives with few complications. Patients with poorly managed diabetes see high rates of blindess, foot amputations and other horrifying, expense, life altering health complications due to diabetes. Does that make any more sense?
        JoeAltmaier 10y ago
        Only about 40% of cancer can be controlled by our behavior. The rest are indeed random and unpredictable. Its healthy to see ourselves in control of our lives. But at some point it becomes unrealistic, or victim-blaming, or just denial.
        10y ago
uiri 10y ago
> My understanding is that health insurance originated in this country as a means to plump up employee compensation in a situation where paying more wages was not desirable. You could not entice good employees by offering them a pay raise because it bumped them up into another tax bracket and it just wasn't worth it to them. But the way health insurance got handled, if you offered them a benefits package, it increased their quality of life without the punishing extra taxes. You could not entice good employees by offering them a pay raise because it was illegal [0] This passage also reflects a possible misunderstanding of how marginal income tax brackets work. In no situation does bumping someone into a higher tax bracket result in lower net pay. [0] https://en.wikipedia.org/wiki/Stabilization_Act_of_1942 https://en.wikipedia.org/wiki/Stabilization_Act_of_1942
- Mz 10y ago
  Thanks. I am considering doing a new piece because I get a lot of flack over details like that while people generally seem to miss the point relevant to our lives today that DPC is a legal alternative under the ACA and a genuinely better solution. I am frustrated and not sure what I need to do differently to get that across effectively. Edit: Feel free to nitpick this version: http://micheleincalifornia.blogspot.com/2017/01/direct-primary-care-real-alternative.html http://micheleincalifornia.blogspot.com/2017/01/direct-prima... Maybe I shall eventually get it right (just in time for the law to change under Trump). Thank you.
  - uiri 10y ago
    Sorry, I didn't mean for my comment to be taken as a criticism of the overall piece but rather a nitpick of that particular paragraph. I agree that separating disaster/catastrophic coverage (ie: insurance ) from routine things like doctor visits (ie: health care ) is a good thing. I was aware of HDHP and HSA for the former but I did not know about DPC until you brought it to my attention with this comment thread. Thank you.
    - Mz 10y ago
      It was written somewhat off the cuff and I did frame it as "as I understand it." I was just trying to give some general historical background for why the US has gotten to where it is currently, even though what we currently do is incredibly broken. I don't know why I seem to inspire this kind of reaction in people, and maybe it isn't "me" per se, but I seem to get this a lot. And I am genuinely interested in figuring out if it is really something I do that I can somehow change. Thank you for engaging me in meaty discussion. Best.
Mz 10y ago
FYI: Attempt #3 to explain why people should look into DPC: http://micheleincalifornia.blogspot.com/2017/01/direct-primary-care.html http://micheleincalifornia.blogspot.com/2017/01/direct-prima... Also submitted: https://news.ycombinator.com/item?id=13354383 https://news.ycombinator.com/item?id=13354383 I assume it will get no traction. Best of luck in resolving your problem.