15 ms·

I've done my own thing since high school with the exception of two years in offices (one as W2 and one as part time 1099). I'm now 35 and experiencing health is

I've done my own thing since high school with the exception of two years in offices (one as W2 and one as part time 1099). I'm now 35 and experiencing health issues and discovering that unless you earn "f$&! you money" group health insurance in the US is worth at least $75k a year in income. At least. If you aren't in a country with proper healthcare and are not earning AT LEAST $300k USD a year (consistently), understand that all your years of work can be destroyed by one diagnosis. And plan accordingly. I love my life. I've had a charmed existence moving to wonderful locales and doing what I wanted when I wanted; but the genetic lottery cannot be outwitted. You can be healthy one day and in debt the next. Plan accordingly. Don't let youth and good health lull you into complacency. It's completely possible and attainable for software developers to be independent anywhere on the globe, but understand the potential financial implications and limitations of the social safety nets of your country of citizenship/residence. Plan accordingly.

patryn20 9y ago
This comment sharing more of my life than I'm strictly comfortable with and coming off as patronizingly preachy is my highest point earner. Go figure.
- ironic_ali 9y ago
  Maybe(?) the comment is preachy, but the sentiment is borne of goodwill and of course, reality. It's a wake up and I personally need to get on to this.
  - patryn20 9y ago
    What I really want to get across is that young entrepreneurs need to plan for aging/medical emergencies. The reality of where you live and the potential for unexpected medical expenses can devastatingly impact your life and business if you don't properly plan for those outliers. I'd recommend you determine your acceptable level of financial exposure to disaster and get competent legal and financial advice to protect yourself and fully understand the potential ramifications of your self employment and/or startup decisions.
- youdontknowtho 9y ago
  It was a great point. Once I realized that the writer was from emea, health care and social safety net were the first thing that popped into my mind. Your experience is valuable. Thank you for sharing it. As I was reading ops post, I personally latched on to the writer having what sounded like a family that actively cared what happened to him. That's not something that everyone has. Going to bed hungry and not knowing where your next meal might come from will alter your level of comfort with employment risk.
- mtbcoder 9y ago
  I thought it was salient and not at all preachy. I came to similar conclusions several years ago. The lack of social safety nets in the US is a heavy burden in the long run for independent contractors and eventually the burden becomes too heavy. I think every independent contractor needs to re-evaluate their business every six months or so and be realistic with their long-term outlooks.
- return0 9y ago
  welcome to show business. (your comment was fine, really)
- lr4444lr 9y ago
  You kept it real. HN appreciates keepin' it real.
fpgaminer 9y ago
> group health insurance in the US is worth at least $75k a year in income. At least. Would you be able to expand on this? The math isn't adding up on my end. At 35 in California, you'd be paying $350/mo for a Silver plan, with an OOP max of $6800/yr. So the max health costs for a year would be $11k. Plus you get a ~30% discount on premiums from tax deductions under your own company.
- patryn20 9y ago
  Out of pocket only refers to covered billing codes (originally said expenses). And that varies state to state by insurer. But in the case of blue cross blue shield Texas the SPEC test was "covered" but the injectible radioisotope was not. Nor was the injection itself. Or the IV catheter insertions. Or the related ECG. Etc etc. Out of pocket only applies to covered benefits. Which in many cases are selectively chosen by the insurers.
  - patryn20 9y ago
    Also understand the tax and benefits implications of various corporate structures. Being a C-corp vs S-corp in the US can have major tax implications in the event of a major healthcare expense or even routine premium payments. Talk to an accountant and attorney for advice relevant to your situation/jurisdiction.
  - maxerickson 9y ago
    Is it really such a safe assumption that a group insurance plan would provide better coverage than an ACA marketplace plan? Because that is what you are implying, that group plans are all better than the individual plans people are talking about.
    - kesselvon 9y ago
      Group plans are subsidized by your employer, which makes it cheaper than the ACA plans at certain incomes. Also the group plan I have has lower deductibles than the ACA does. The ACA did do a great thing in controlling what insurers have to cover, which prevents insurers from being super selective on coverage.
geomark 9y ago
I would expatriate to a country that has good healthcare at much lower prices so you can pay out of pocket without being ruined. I did precisely that - for other reasons, not for the healthcare advantages. But now this is one of the big reasons I would never go back to the U.S., because of how easily I could be ruined by an unfortunate health event.
- patryn20 9y ago
  In my case hindsight is 20/20. If you don't mind me asking what country did you expatriate to? I've found that several countries I would want to relocate to do not allow permanent residency for people with existing medical conditions in order to avoid undue strain on their subsidized medical systems.
  - technics256 9y ago
    At least in Europe, I have never seen anyone ask for pre existing medical conditions unless getting specialized private insurance. I have never heard of any residency permit being based on medical history in Europe. I would imagine it to be illegal? I'm currently in Italy myself, and my father was visiting me and got a nasty case of pneumonia on the way over. Here in italy care is (mostly) free,as is his hospital stay here in genova. While it may be not to the full American standard, his care has been great, and the staff wonderful. I'm glad to be in a system here where Healthcare is good, and affordable, and that with this episode my father is not bankrupted or in considerable debt because of it, especially as an elderly patient. La dolce vita.
    - patryn20 9y ago
      British commonwealth countries seem to have health assessment/medical history checks. Germany requires immigrants to have private health insurance until they are granted permanent residence/citizenship. That insurance can have restrictions on pre-existing conditions and/or be prohibitively expensive. If you are already an EU citizen the rules can often be quite different than as a US passport holder. I am not a global expert in immigration law though and I'm now going to research Italy. ;-) Thank you!
sandGorgon 9y ago
India - probably the hottest startup culture outside the US. World class healthcare at 1/10 the cost - medical tourism already exists. A large part of the economy is already built around software services.
- ishi 9y ago
  Some would argue that Israel has "the hottest startup culture outside the US". There are 96 Israeli companies listed in NASDAQ, and only 12 Indian ones. http://www.nasdaq.com/screening/companies-by-region.aspx?region=Middle+East&country=Israel http://www.nasdaq.com/screening/companies-by-region.aspx?reg... http://www.nasdaq.com/screening/companies-by-region.aspx?region=Asia&country=India http://www.nasdaq.com/screening/companies-by-region.aspx?reg...
  - sandGorgon 9y ago
    That's because India's domestic markets are large enough. In fact, the hottest startup culture is actually China - but those are closed markets. When you build startups in India, you build for the fastest growing economy in the world. Yes - startups still do list on international markets, but that is a combination of Nasdaq, Singapore and BSE. For example, the largest "unicorn" in India - Flipkart - is listed in Singapore.
    - sah2ed 9y ago
      I had to google that BSE is the Indian exchange, Bombay Stock Exchange.
    - cmadan 9y ago
      Flipkart is registered in Singapore but not listed on the SGX (Singapore's stock exchange).
      - sandGorgon 9y ago
        not yet - but that is the reason it is registered. Same for Ola IMHO. Its was the most regulatory friendly arrangement to allow for an international IPO while still operate things like wallets and multi-brand retail in India.
anothercomment 9y ago
A bit OT, but this post made me think: how do countries provide good health care? does it always have to be government sponsored, otherwise it would be not affordable? And how does the government pay for it, given that the money has to come from taxpayers? Because otherwise I don't understand why the market can't provide good health insurance in the US? Isn't that a classic insurance problem, take a group of people and spread out the risk? What is going on? Is medicine too expensive because of state subsidies, so private insurers can't compete? Or are there regulations preventing private insurers from entering the market?
- anewhnaccount2 9y ago
  I mean isn't one factor that healthcare simply costs more in the USA in the first place?
  - hellofunk 9y ago
    This is the main problem. American health industry (doctors, pharmaceuticals, etc) cost a vast amount more than in other countries, thus insurance is also high to compensate for this. I've heard that a big part of this cost is due to the highly litigious culture in America that requires doctors to carry very high malpractice insurance, which they must then pass on in their patient costs. Americans love to sue, and this drives prices up. I don't know if this is true, but its the one argument I've heard over the years that makes the most sense to me. I once had a worldwide health insurance plan while living in Asia, and it covered all countries EXCEPT the USA, because of the absurd costs there.
    - patryn20 9y ago
      Strangely enough my primary income is writing software for the healthcare industry. A significant portion of my firm's income goes to insurance and lawyers to ensure compliance/protection in the event of a lawsuit.
  - anothercomment 9y ago
    But why does it cost more, and how are employers able to provide health insurance anyway?
NicoJuicy 9y ago
The author is from Holland. It's safe to say that we ( I'm from Belgium) are much better off in terms of healthcare
- gt2 9y ago
  Why is that?
  - sangnoir 9y ago
    Their healthcare is - to American sensibilities - a bit "socialistic".
  - pg314 9y ago
    Belgium has high-quality care that is accessible to all. Everybody contributes to social security proportionally to their working income (which in my opinion is not fair since e.g. capital gains are untaxed). In return, everybody enjoys complete health care coverage (and other protections, such as unemployment benefits, maternity leave, ...). There is a copay for doctors visits (e.g. 6 EUR for your GP, 1.5 EUR for people with low income) and medical procedures, but there is also a maximum amount a person can be charged for health care in a year (459 EUR for low incomes). Bankruptcy due to medical bills is pretty much unheard off. According to [1], health spending accounted for 10.9% of GDP in Belgium in 2012, which is much lower than in the United States (which spent 16.9% of its GDP on health). Meanwhile infant and maternal mortality rates in Belgium are about half what they are in the US: 3.6 vs 6.1 per 1000 live births [2] and 7 vs 14 deaths per 100,000 live births [3], respectively. Anybody who argues that the free markets lead to better health outcomes than 'socialized' medicine, is ignoring the data. By the way, dental care is included in medical care. So we don't have third world country situations like [4] in the US. [1] http://webcache.googleusercontent.com/search?q=cache:2VeNWmBzMy0J:www.oecd.org/belgium/Briefing-Note-BELGIUM-2014.pdf+&cd=1&hl=en&ct=clnk&gl=be http://webcache.googleusercontent.com/search?q=cache:2VeNWmB... [2] http://data.worldbank.org/indicator/SH.STA.MMRT http://data.worldbank.org/indicator/SH.STA.MMRT [3] https://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_05.pdf https://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_05.pdf [4] http://www.washingtonpost.com/sf/national/2017/05/13/the-painful-truth-about-teeth/?utm_term=.32cb1afec6e8 http://www.washingtonpost.com/sf/national/2017/05/13/the-pai...
malloryerik 9y ago
This is why healthcare should be decoupled from employment. Your work and your doctor should have nothing to do with each other. It distorts the market and limits innovation.
- grecy 9y ago
  It also makes people slaves
  - eeZah7Ux 9y ago
    In countries with at-will employment an old person with a long-term life threatening condition (e.g. cancer) is pretty much company property.
    - nickpsecurity 9y ago
      There's quite a few in my company that are only there for the health insurance. It's cheap but their meds aren't.
    - raarts 9y ago
      >countries You'd be hard-pressed to find a country that as at-will employment besides the US.
      - kgwgk 9y ago
        In Switzerland the contract can be terminated at will by both the employer or the employee, with the same notice period (in general one, two or three months depending on how long the contract has been in force).
        omnimus 9y ago
        But health care although not free is heavily regulated and mandatory. Switzerland does have social help. And there is much less poverty. And most of the people living in poverty are not poor homeless poor. They just dont qualify because the avrage income is so big. You cant compare it.
zrail 9y ago
Obamacare/ACA changes this a bit. Your premiums usually won't exceed 10% of your income so you just have to have enough saved for your out of pocket max. That said I would strongly recommend everyone who goes independent look into long term disability insurance while they're healthy. Freelancers Union has a decent group policy available to anyone for pretty good rates.
- patryn20 9y ago
  Please understand what "out of pocket maximum" actually means. It only applies to "covered" procedures. If that experimental surgery isn't covered your OOP maximum doesn't apply. Also please understand that insurance companies like to consider thirty year old tests/procedures/treatments as experimental/unproven and will consistently use that as an excuse to deny coverage and not apply them to your OOP maximum. Hope you can afford an attorney if that happens. Will this likely happen to you? Not at all. Can it happen to you? Absolutely.
  - ceejayoz 9y ago
    All of these things apply to group insurance, as well. Pre-ACA many plans didn't have an out-of-pocket maximum even for covered stuff, and most had lifetime limits on coverage as well.
- patryn20 9y ago
  I strongly second the long term disability insurance. Once you need it the opportunity to reasonably purchase it has passed.
baby 9y ago
Why not moving to another country?
majani 9y ago
I'm curious, were you living a healthy lifestyle before, or was it a condition that came about from bad lifestyle choices?
deleted 9y ago
[deleted]
builtinbuffalo 9y ago
You know you can buy health insurance, right? When you start a business, you will have costs. Health insurance, part of benefits, is one of them. You need to factor this into what you charge customers and clients. It shows poor business acumen to assume that what you charge is what you make. You may be able to get away with that when you're doing side gigs, but if you start a business, you must plan for costs. One of them is heathcare. If you can't afford it, maybe you shouldn't have gone out on your own in the first place.
- wwweston 9y ago
  > You know you can buy health insurance, right? Assuming we're talking about the US market, this is currently true-ish with some caveats, the biggest of which is that there's a major political party currently holding all the power at the federal level working hard to take us back to a time when some people -- even some people with wealth -- could not buy insurance (natural consequence when insurers have every incentive to be selective about who goes in the risk pool), and even some workplace groups faced limiting choices.
  - jermaustin1 9y ago
    My first full time job (in 2006) was with a relatively small company, but with hundreds of full time employees, and thousands of part-timers. I started right before a group policy was to be established, so every full-timer (including myself) was given a medical survey and a doctor was scheduled to come into our main campus for physicals. Needless to say, we were denied a policy that any of us could afford. The average age at that company was over 50. Thankfully, being young, I could stay on my parents insurance for one more year before having to get my own personal insurance. I pretty much had to switch insurance every couple of years to higher and higher deductibles so that my monthly expense didn't grow. This was during the housing debacle, and no jobs and my current salary wasn't getting higher. I kept my shitty insurance which wasn't ACA compliant until it was illegal to do so, and then I went without paying the fee the first year, then getting insurance through my wife's school the next year. If the US goes back even 10 years, rates might be lower, but real care is almost non-existent. I didn't get to have a stomach bug covered without months of fighting back and forth and medical collections calls until the ACA's pre-existing conditions clause went into effect, as I had a lot of stomach issues as a child.
hackerboos 9y ago
Even in countries with 'universal' healthcare like Ontario, you still have to cover drug costs and dental yourself. Which can be really expensive. This has even made me think about relocating back to the UK or Ireland before trying to start a business.
duckingtest 9y ago
>understand that all your years of work can be destroyed by one diagnosis. And plan accordingly. Outside of emergency, you can travel to cheaper countries for treatment.
rasmafazi 9y ago
That is mostly a problem in the USA. You could get your healthcare in places like the Philippines and save 95% of the bill.
nathan_f77 9y ago
> If you aren't in a country with proper healthcare One thing that surprised me is that healthcare in Thailand is exceptionally good. There are world-class hospitals and doctors, and people come here for medical tourism. The dentists are also very good, and very affordable. I think I've actually had better treatment in Chiang Mai than in San Francisco. I have health insurance, but I've never had to use it, and I just pay cash for everything. I once went to the ER in San Francisco and ended up paying $2,000 for an x-ray and some medicine (that was after insurance, I think the total bill was something like $5,000.) We've had a few x-rays and medicine in Chiang Mai, and we just paid $40 in cash (USD). So I think it's definitely a good idea to live in a country with universal healthcare, or one where healthcare is very affordable. Of course, unless you have "f&*@ you" money, then it doesn't really matter.

patryn20 9y ago

This comment sharing more of my life than I'm strictly comfortable with and coming off as patronizingly preachy is my highest point earner. Go figure.

ironic_ali 9y ago
Maybe(?) the comment is preachy, but the sentiment is borne of goodwill and of course, reality. It's a wake up and I personally need to get on to this.
- patryn20 9y ago
  What I really want to get across is that young entrepreneurs need to plan for aging/medical emergencies. The reality of where you live and the potential for unexpected medical expenses can devastatingly impact your life and business if you don't properly plan for those outliers. I'd recommend you determine your acceptable level of financial exposure to disaster and get competent legal and financial advice to protect yourself and fully understand the potential ramifications of your self employment and/or startup decisions.
youdontknowtho 9y ago
It was a great point. Once I realized that the writer was from emea, health care and social safety net were the first thing that popped into my mind. Your experience is valuable. Thank you for sharing it. As I was reading ops post, I personally latched on to the writer having what sounded like a family that actively cared what happened to him. That's not something that everyone has. Going to bed hungry and not knowing where your next meal might come from will alter your level of comfort with employment risk.
mtbcoder 9y ago
I thought it was salient and not at all preachy. I came to similar conclusions several years ago. The lack of social safety nets in the US is a heavy burden in the long run for independent contractors and eventually the burden becomes too heavy. I think every independent contractor needs to re-evaluate their business every six months or so and be realistic with their long-term outlooks.
return0 9y ago
welcome to show business. (your comment was fine, really)
lr4444lr 9y ago
You kept it real. HN appreciates keepin' it real.

fpgaminer 9y ago

> group health insurance in the US is worth at least $75k a year in income. At least. Would you be able to expand on this? The math isn't adding up on my end. At 35 in California, you'd be paying $350/mo for a Silver plan, with an OOP max of $6800/yr. So the max health costs for a year would be $11k. Plus you get a ~30% discount on premiums from tax deductions under your own company.

patryn20 9y ago
Out of pocket only refers to covered billing codes (originally said expenses). And that varies state to state by insurer. But in the case of blue cross blue shield Texas the SPEC test was "covered" but the injectible radioisotope was not. Nor was the injection itself. Or the IV catheter insertions. Or the related ECG. Etc etc. Out of pocket only applies to covered benefits. Which in many cases are selectively chosen by the insurers.
- patryn20 9y ago
  Also understand the tax and benefits implications of various corporate structures. Being a C-corp vs S-corp in the US can have major tax implications in the event of a major healthcare expense or even routine premium payments. Talk to an accountant and attorney for advice relevant to your situation/jurisdiction.
- maxerickson 9y ago
  Is it really such a safe assumption that a group insurance plan would provide better coverage than an ACA marketplace plan? Because that is what you are implying, that group plans are all better than the individual plans people are talking about.
  - kesselvon 9y ago
    Group plans are subsidized by your employer, which makes it cheaper than the ACA plans at certain incomes. Also the group plan I have has lower deductibles than the ACA does. The ACA did do a great thing in controlling what insurers have to cover, which prevents insurers from being super selective on coverage.

geomark 9y ago

I would expatriate to a country that has good healthcare at much lower prices so you can pay out of pocket without being ruined. I did precisely that - for other reasons, not for the healthcare advantages. But now this is one of the big reasons I would never go back to the U.S., because of how easily I could be ruined by an unfortunate health event.

patryn20 9y ago
In my case hindsight is 20/20. If you don't mind me asking what country did you expatriate to? I've found that several countries I would want to relocate to do not allow permanent residency for people with existing medical conditions in order to avoid undue strain on their subsidized medical systems.
- technics256 9y ago
  At least in Europe, I have never seen anyone ask for pre existing medical conditions unless getting specialized private insurance. I have never heard of any residency permit being based on medical history in Europe. I would imagine it to be illegal? I'm currently in Italy myself, and my father was visiting me and got a nasty case of pneumonia on the way over. Here in italy care is (mostly) free,as is his hospital stay here in genova. While it may be not to the full American standard, his care has been great, and the staff wonderful. I'm glad to be in a system here where Healthcare is good, and affordable, and that with this episode my father is not bankrupted or in considerable debt because of it, especially as an elderly patient. La dolce vita.
  - patryn20 9y ago
    British commonwealth countries seem to have health assessment/medical history checks. Germany requires immigrants to have private health insurance until they are granted permanent residence/citizenship. That insurance can have restrictions on pre-existing conditions and/or be prohibitively expensive. If you are already an EU citizen the rules can often be quite different than as a US passport holder. I am not a global expert in immigration law though and I'm now going to research Italy. ;-) Thank you!

sandGorgon 9y ago

India - probably the hottest startup culture outside the US. World class healthcare at 1/10 the cost - medical tourism already exists. A large part of the economy is already built around software services.

ishi 9y ago
Some would argue that Israel has "the hottest startup culture outside the US". There are 96 Israeli companies listed in NASDAQ, and only 12 Indian ones. http://www.nasdaq.com/screening/companies-by-region.aspx?region=Middle+East&country=Israel http://www.nasdaq.com/screening/companies-by-region.aspx?reg... http://www.nasdaq.com/screening/companies-by-region.aspx?region=Asia&country=India http://www.nasdaq.com/screening/companies-by-region.aspx?reg...
- sandGorgon 9y ago
  That's because India's domestic markets are large enough. In fact, the hottest startup culture is actually China - but those are closed markets. When you build startups in India, you build for the fastest growing economy in the world. Yes - startups still do list on international markets, but that is a combination of Nasdaq, Singapore and BSE. For example, the largest "unicorn" in India - Flipkart - is listed in Singapore.
  - sah2ed 9y ago
    I had to google that BSE is the Indian exchange, Bombay Stock Exchange.
  - cmadan 9y ago
    Flipkart is registered in Singapore but not listed on the SGX (Singapore's stock exchange).
    - sandGorgon 9y ago
      not yet - but that is the reason it is registered. Same for Ola IMHO. Its was the most regulatory friendly arrangement to allow for an international IPO while still operate things like wallets and multi-brand retail in India.

anothercomment 9y ago

A bit OT, but this post made me think: how do countries provide good health care? does it always have to be government sponsored, otherwise it would be not affordable? And how does the government pay for it, given that the money has to come from taxpayers? Because otherwise I don't understand why the market can't provide good health insurance in the US? Isn't that a classic insurance problem, take a group of people and spread out the risk? What is going on? Is medicine too expensive because of state subsidies, so private insurers can't compete? Or are there regulations preventing private insurers from entering the market?

anewhnaccount2 9y ago
I mean isn't one factor that healthcare simply costs more in the USA in the first place?
- hellofunk 9y ago
  This is the main problem. American health industry (doctors, pharmaceuticals, etc) cost a vast amount more than in other countries, thus insurance is also high to compensate for this. I've heard that a big part of this cost is due to the highly litigious culture in America that requires doctors to carry very high malpractice insurance, which they must then pass on in their patient costs. Americans love to sue, and this drives prices up. I don't know if this is true, but its the one argument I've heard over the years that makes the most sense to me. I once had a worldwide health insurance plan while living in Asia, and it covered all countries EXCEPT the USA, because of the absurd costs there.
  - patryn20 9y ago
    Strangely enough my primary income is writing software for the healthcare industry. A significant portion of my firm's income goes to insurance and lawyers to ensure compliance/protection in the event of a lawsuit.
- anothercomment 9y ago
  But why does it cost more, and how are employers able to provide health insurance anyway?

NicoJuicy 9y ago

The author is from Holland. It's safe to say that we ( I'm from Belgium) are much better off in terms of healthcare

gt2 9y ago
Why is that?
- sangnoir 9y ago
  Their healthcare is - to American sensibilities - a bit "socialistic".
- pg314 9y ago
  Belgium has high-quality care that is accessible to all. Everybody contributes to social security proportionally to their working income (which in my opinion is not fair since e.g. capital gains are untaxed). In return, everybody enjoys complete health care coverage (and other protections, such as unemployment benefits, maternity leave, ...). There is a copay for doctors visits (e.g. 6 EUR for your GP, 1.5 EUR for people with low income) and medical procedures, but there is also a maximum amount a person can be charged for health care in a year (459 EUR for low incomes). Bankruptcy due to medical bills is pretty much unheard off. According to [1], health spending accounted for 10.9% of GDP in Belgium in 2012, which is much lower than in the United States (which spent 16.9% of its GDP on health). Meanwhile infant and maternal mortality rates in Belgium are about half what they are in the US: 3.6 vs 6.1 per 1000 live births [2] and 7 vs 14 deaths per 100,000 live births [3], respectively. Anybody who argues that the free markets lead to better health outcomes than 'socialized' medicine, is ignoring the data. By the way, dental care is included in medical care. So we don't have third world country situations like [4] in the US. [1] http://webcache.googleusercontent.com/search?q=cache:2VeNWmBzMy0J:www.oecd.org/belgium/Briefing-Note-BELGIUM-2014.pdf+&cd=1&hl=en&ct=clnk&gl=be http://webcache.googleusercontent.com/search?q=cache:2VeNWmB... [2] http://data.worldbank.org/indicator/SH.STA.MMRT http://data.worldbank.org/indicator/SH.STA.MMRT [3] https://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_05.pdf https://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_05.pdf [4] http://www.washingtonpost.com/sf/national/2017/05/13/the-painful-truth-about-teeth/?utm_term=.32cb1afec6e8 http://www.washingtonpost.com/sf/national/2017/05/13/the-pai...

malloryerik 9y ago

This is why healthcare should be decoupled from employment. Your work and your doctor should have nothing to do with each other. It distorts the market and limits innovation.

grecy 9y ago
It also makes people slaves
- eeZah7Ux 9y ago
  In countries with at-will employment an old person with a long-term life threatening condition (e.g. cancer) is pretty much company property.
  - nickpsecurity 9y ago
    There's quite a few in my company that are only there for the health insurance. It's cheap but their meds aren't.
  - raarts 9y ago
    >countries You'd be hard-pressed to find a country that as at-will employment besides the US.
    - kgwgk 9y ago
      In Switzerland the contract can be terminated at will by both the employer or the employee, with the same notice period (in general one, two or three months depending on how long the contract has been in force).
      - omnimus 9y ago
        But health care although not free is heavily regulated and mandatory. Switzerland does have social help. And there is much less poverty. And most of the people living in poverty are not poor homeless poor. They just dont qualify because the avrage income is so big. You cant compare it.

zrail 9y ago

Obamacare/ACA changes this a bit. Your premiums usually won't exceed 10% of your income so you just have to have enough saved for your out of pocket max. That said I would strongly recommend everyone who goes independent look into long term disability insurance while they're healthy. Freelancers Union has a decent group policy available to anyone for pretty good rates.

patryn20 9y ago
Please understand what "out of pocket maximum" actually means. It only applies to "covered" procedures. If that experimental surgery isn't covered your OOP maximum doesn't apply. Also please understand that insurance companies like to consider thirty year old tests/procedures/treatments as experimental/unproven and will consistently use that as an excuse to deny coverage and not apply them to your OOP maximum. Hope you can afford an attorney if that happens. Will this likely happen to you? Not at all. Can it happen to you? Absolutely.
- ceejayoz 9y ago
  All of these things apply to group insurance, as well. Pre-ACA many plans didn't have an out-of-pocket maximum even for covered stuff, and most had lifetime limits on coverage as well.
patryn20 9y ago
I strongly second the long term disability insurance. Once you need it the opportunity to reasonably purchase it has passed.

baby 9y ago

Why not moving to another country?

majani 9y ago

I'm curious, were you living a healthy lifestyle before, or was it a condition that came about from bad lifestyle choices?

deleted 9y ago

[deleted]

builtinbuffalo 9y ago

You know you can buy health insurance, right? When you start a business, you will have costs. Health insurance, part of benefits, is one of them. You need to factor this into what you charge customers and clients. It shows poor business acumen to assume that what you charge is what you make. You may be able to get away with that when you're doing side gigs, but if you start a business, you must plan for costs. One of them is heathcare. If you can't afford it, maybe you shouldn't have gone out on your own in the first place.

wwweston 9y ago
> You know you can buy health insurance, right? Assuming we're talking about the US market, this is currently true-ish with some caveats, the biggest of which is that there's a major political party currently holding all the power at the federal level working hard to take us back to a time when some people -- even some people with wealth -- could not buy insurance (natural consequence when insurers have every incentive to be selective about who goes in the risk pool), and even some workplace groups faced limiting choices.
- jermaustin1 9y ago
  My first full time job (in 2006) was with a relatively small company, but with hundreds of full time employees, and thousands of part-timers. I started right before a group policy was to be established, so every full-timer (including myself) was given a medical survey and a doctor was scheduled to come into our main campus for physicals. Needless to say, we were denied a policy that any of us could afford. The average age at that company was over 50. Thankfully, being young, I could stay on my parents insurance for one more year before having to get my own personal insurance. I pretty much had to switch insurance every couple of years to higher and higher deductibles so that my monthly expense didn't grow. This was during the housing debacle, and no jobs and my current salary wasn't getting higher. I kept my shitty insurance which wasn't ACA compliant until it was illegal to do so, and then I went without paying the fee the first year, then getting insurance through my wife's school the next year. If the US goes back even 10 years, rates might be lower, but real care is almost non-existent. I didn't get to have a stomach bug covered without months of fighting back and forth and medical collections calls until the ACA's pre-existing conditions clause went into effect, as I had a lot of stomach issues as a child.

hackerboos 9y ago

Even in countries with 'universal' healthcare like Ontario, you still have to cover drug costs and dental yourself. Which can be really expensive. This has even made me think about relocating back to the UK or Ireland before trying to start a business.

duckingtest 9y ago

>understand that all your years of work can be destroyed by one diagnosis. And plan accordingly. Outside of emergency, you can travel to cheaper countries for treatment.

rasmafazi 9y ago

That is mostly a problem in the USA. You could get your healthcare in places like the Philippines and save 95% of the bill.

nathan_f77 9y ago

> If you aren't in a country with proper healthcare One thing that surprised me is that healthcare in Thailand is exceptionally good. There are world-class hospitals and doctors, and people come here for medical tourism. The dentists are also very good, and very affordable. I think I've actually had better treatment in Chiang Mai than in San Francisco. I have health insurance, but I've never had to use it, and I just pay cash for everything. I once went to the ER in San Francisco and ended up paying $2,000 for an x-ray and some medicine (that was after insurance, I think the total bill was something like $5,000.) We've had a few x-rays and medicine in Chiang Mai, and we just paid $40 in cash (USD). So I think it's definitely a good idea to live in a country with universal healthcare, or one where healthcare is very affordable. Of course, unless you have "f&*@ you" money, then it doesn't really matter.