7 ms·

Maps like this give a sobering view of the Healthcare debate. Insurance for a family is now > $20K a year. Look at how many counties this would be half or mor

Maps like this give a sobering view of the Healthcare debate. Insurance for a family is now > $20K a year. Look at how many counties this would be half or more of the median pay. The whole situation seems like a melt-down ready to happen.

hnaccy 8y ago
>The whole situation seems like a melt-down ready to happen. How will it melt down, won't they just become infirm or die?
- drspacemonkey 8y ago
  My guess is that it would be more like "get sick, don't seek healthcare until it's an emergency, go to emergency room, rack up many thousands of dollars in medical debt, be unable to pay it back, linger for a while, then die".
- deleted 8y ago
  [deleted]
- smileysteve 8y ago
  Skyrocketing bankruptcy rates and losses of generational wealth. Potentially causing the next recession. Or, we modify the system, the whole health insurance industry and hospital industry causes a recession.
  - deleted 8y ago
    [deleted]
  - dragonwriter 8y ago
    > Skyrocketing bankruptcy rates and losses of generational wealth. The people who can't afford insurance aren't the people that have substantial generational wealth to lose, generally.
    - deleted 8y ago
      [deleted]
  - mlindner 8y ago
    You know we didn't have this problem back in the early 1900s. It would be helpful if regulation didn't completely eliminate the ability of unions to pool together funds and create their own mini-insurance collectives. Regulation killed that by forcing all doctors to be licensed, a very expensive process that limits the supply of doctors and nurses.
    - mcguire 8y ago
      https://en.wikipedia.org/wiki/John_R._Brinkley?wprov=sfla1 https://en.wikipedia.org/wiki/John_R._Brinkley?wprov=sfla1
    - smileysteve 8y ago
      > You know we didn't have this problem back in the early 1900s. 1900s... so, the X-Ray machine had just been invented. Antibiotics, Radiation, Chemotherapy, laparoscopy, endoscopy, the mri, titanium, stainless steel. Medicine was in a relative infancy and outcomes were much, much worse.
- vertexFarm 8y ago
  That has a very bad impact on the economy. When lots of people (it's a systemic problem, it's going to be LOTS of people) who are a part of this society start to become infirm, die out prematurely, leave the workforce, undergo radical drops in productivity, or merely become financially crippled from dealing with normal healthcare costs--that will send ripples through the economy. Our style of healthcare is a ludicrous expense for us all. It's a lot bigger than just the sticker price. It's not just their own problem. They won't simply die and get out of the way of the more fortunate.
- michaelkschmidt 8y ago
  At a certain price point (% of income), people stop buying insurance. You can buy a lot of healthcare services for $20K a year. To your point, the meltdown is more on the insurance side. The normal, every day providers will just charge patients directly. The issue is the people who get "left behind"--ones who have large numbers of issues. All our insurance money right now goes to provide for them. If insurance collapses, what happens to them?
  - ryandrake 8y ago
    > You can buy a lot of healthcare services for $20K a year. You must be joking. In the US, that $20k would barely cover a pregnancy. I’m about to blow $10k on a few dental bridges. It’s insanity.
    - souprock 8y ago
      It's about $2000 to $4000 for a non-hospital midwife with an assistant, toward the higher end of that range for at-home and toward the lower end for the midwife's office.
      - ryandrake 8y ago
        ...if you have great insurance or live in a very, very cheap area. Our family was out of pocket over $10k with “standard mediocre” tech company health insurance. A UCSF study found that California women giving birth were charged from $3,296 to $37,227 for an uncomplicated vaginal delivery, depending on which hospital they visited. For a C-section, women were billed between $8,312 and nearly $71,000. 1: https://www.ucsf.edu/news/2014/01/111071/how-much-does-it-cost-have-baby-hospital https://www.ucsf.edu/news/2014/01/111071/how-much-does-it-co...
        souprock 8y ago
        No, that is the bare price. Insurance drops it more. For a recent baby, my price went from about $3500 down to about $1000 due to insurance, though we had to prepay more and we're still trying to get back some of the difference. Back when I had better insurance and lived in an expensive location, the full cost was covered by insurance. I've never heard of it being over $5000. I can imagine that an at-home birth in San Francisco might be that bad or worse, since the midwife needs to deal with the cost of living. The problem here is "depending on which hospital they visited". There is no need to involve a hospital (full of exotic infections) for a normal bodily function. That is why your cost is so high.
dragonwriter 8y ago
> Insurance for a family is now > $20K a year [citation needed] > Look at how many counties this would be half or more of the median pay. Even if your $20K is a correct national average figure for family insurance costs, you can't do that and get meaningful results; insurance costs vary widely between states and localities (e.g., of ACA exchange plans, the statewide as average second lowest cost silver plan costs for states using the federal marketplace range from $459 in ND to $1,185 in WY—and the range of local rates, and/or including the states that don't use the federal exchanges, is even wider.) So you'd need to map local income against local costs to get anything meaningful. http://www.ncsl.org/research/health/health-insurance-premiums.aspx#2018_premiums http://www.ncsl.org/research/health/health-insurance-premium...
- michaelkschmidt 8y ago
  > [citation needed] Your link shows $20k / Family too :-) Look at the chart with the caption "Recent from HHS/CMS" (The costs are you quoting are the monthly costs for a single individual) The costs do vary, but they do not drop off the way median income does in rural areas.
  - dragonwriter 8y ago
    > Your link shows $20k / Family too :-) No, it shows < $20K, not > $20K as you claimed. But, the accuracy of the national average figure is mostly a side issue. > The costs do vary, but they do not drop off the way median income does in rural areas. The costs vary enough locally that you can't make anything like a reasonable point by comparing the national cost to local incomes (and, also, you need to consider the effect of subsidies, which are based on income in relation to FPL.) I suspect the reality, before subsidies, may be even worse than what your naive comparison would suggest, but I don't have a lot of confidence in that because I haven't seen, or had time to analyze, national locality data. The bits and pieces I've seen, though, seem to suggest that, while there isn't a simple relationship, local health insurance costs may overall be weakly inversely correlated with local income. But, then you still have to consider subsidy availability—and Medicaid eligibility—to get the real picture.
GuB-42 8y ago
The median pay in the US is also half or more of the median pay in countries with much more generous healthcare. I live in France, which is known for its good health coverage. However, I know a few people who worked both in France and in the US, and they made more there in terms of purchasing power, even after paying all the insurance required to get at least the same level of protection we get "for free" in France. I suppose that the situation can be different depending on your occupation. But what I am saying is that it is just a different system. Healthcare is expensive by nature: highly trained personnel, state of the art research, unforgiving safety requirements, etc... and has to be paid for in some way, be it by taxes or by private insurance companies.
- mindslight 8y ago
  The taxes in France presumably pay for everybody, while the US premiums only pay for similar healthy working people. Healthcare is expensive. The US government started providing healthcare to old people, rather than letting them die on the street outside the hospital. But rather than the government paying the full cost of this program (ala food subsidies), the government dictated that providers give them special lower prices. The hospitals want to make up for that money some how, and so attempt to pass on extra costs to others. The next target (private health "insurance") doesn't want to subsidize that cost either, so they negotiate lower rates. The hospitals are still optimistic that they can still fool someone, and so attempt to take it out of helpless patients. The entire system is essentially musical chairs. This is why after you receive medical services, the hospital will send you a fraudulent bill with a fictitious inflated price list rather than waiting for your "insurance" to cover their part first - they're hoping to luck into a sucker who will mindlessly pay the sticker price rather than the back room reduced rates. I can foresee a trend of people setting up trust funds for themselves, to reduce the chance of losing their assets to the healthcare reverse lottery. That's really the point we're at - the last attempt at healthcare reform was basically jiujitsued by the health "insurance" industry into making patronizing their cartel mandatory!
  - sjg007 8y ago
    Many hospitals survive solely on Medicare revenue.
jonas21 8y ago
That's ignoring ACA subsidies, which you're eligible for if you make less than 4x the federal poverty level. For a family of 4, if you make under $98K per year, you're eligible for a subsidy so that you will not pay more than 9.5% of your income in premiums. That can still be a large burden, but it's a far cry from half or more. EDIT: I re-read your comment, and yes, in the context of the healthcare debate, where the subsidies could potentially go away, this is quite concerning.
sheepmullet 8y ago
> Insurance for a family is now > $20K a year. The real question is why is it so expensive? When I was growing up in my town with about 1000 kids we had 1 kid who was diabetic, 1 attempted suicide, and 2 serious car accidents. We had plenty of minor problems like broken bones but you didn’t need insurance to cover these. So it was maybe 800-1000 working adults covering a handful of serious cases over a 14-16 year time period.
- zanny 8y ago
  There is tremendous waste in US healthcare. For every doctor there are a dozen accountants, marketers, insurance reps, sales reps, etc. Tons of bureaucracy trying to get a slice of that grotesque money pie. The model you describe, a town subsidizing a few, is why the optimal state of healthcare affairs is the whole of a nation (through taxes) providing healthcare to everyone. It maximizes your healthy pool to offset the costs of the sick.
  - dilap 8y ago
    Another factor is we're just really unhealthy. Diabetes is exploding, obesity is exploding, Alzheimers is going up, cancer is going up...
    - zanny 8y ago
      Turns out another part of keeping healthcare costs down is curing the sick as early as possible. In the US, even if you have insurance, you still often have deductibles and copays that strongly disincentivize you going to the doctor. So you don't, until that cold turns into pneumonia or you tear your trachea from a bad cough. Theres a completely different mindset in the first world compared to how people in the US behave - if there is anything unusual "its better safe than sorry" in any European country. You still go to the doctor even with a "routine" illness because there is often no expense to you to do so. But that is the right behavior. You want that at the societal level. Because for every false alarm there is someone developing a crippling or lethal ailment that will dramatically reduce their productivity and cost you substantially more than 15 minutes of consultation and 30 pills would have had they seen a doctor right away. The US is killing its own citizens to line the pockets of the money hungry just by having its healthcare system be insurance based at all, regardless of if people are insured or not.
deleted 8y ago
[deleted]
ransom1538 8y ago
In fact, medical debt is the No. 1 source of personal bankruptcy filings in the U.S., and in 2014, an estimated 40% of Americans racked up debt resulting from a medical issue. https://www.fool.com/retirement/2017/05/01/this-is-the-no-1-reason-americans-file-for-bankrup.aspx https://www.fool.com/retirement/2017/05/01/this-is-the-no-1-...
deleted 8y ago
[deleted]
stupidbird 8y ago
I am angry about this every fucking goddamned day.
deleted 8y ago
[deleted]
shard972 8y ago
It's ok, we can just import new debt slaves to take over.

hnaccy 8y ago

>The whole situation seems like a melt-down ready to happen. How will it melt down, won't they just become infirm or die?

drspacemonkey 8y ago
My guess is that it would be more like "get sick, don't seek healthcare until it's an emergency, go to emergency room, rack up many thousands of dollars in medical debt, be unable to pay it back, linger for a while, then die".
deleted 8y ago
[deleted]
smileysteve 8y ago
Skyrocketing bankruptcy rates and losses of generational wealth. Potentially causing the next recession. Or, we modify the system, the whole health insurance industry and hospital industry causes a recession.
- deleted 8y ago
  [deleted]
- dragonwriter 8y ago
  > Skyrocketing bankruptcy rates and losses of generational wealth. The people who can't afford insurance aren't the people that have substantial generational wealth to lose, generally.
  - deleted 8y ago
    [deleted]
- mlindner 8y ago
  You know we didn't have this problem back in the early 1900s. It would be helpful if regulation didn't completely eliminate the ability of unions to pool together funds and create their own mini-insurance collectives. Regulation killed that by forcing all doctors to be licensed, a very expensive process that limits the supply of doctors and nurses.
  - mcguire 8y ago
    https://en.wikipedia.org/wiki/John_R._Brinkley?wprov=sfla1 https://en.wikipedia.org/wiki/John_R._Brinkley?wprov=sfla1
  - smileysteve 8y ago
    > You know we didn't have this problem back in the early 1900s. 1900s... so, the X-Ray machine had just been invented. Antibiotics, Radiation, Chemotherapy, laparoscopy, endoscopy, the mri, titanium, stainless steel. Medicine was in a relative infancy and outcomes were much, much worse.
vertexFarm 8y ago
That has a very bad impact on the economy. When lots of people (it's a systemic problem, it's going to be LOTS of people) who are a part of this society start to become infirm, die out prematurely, leave the workforce, undergo radical drops in productivity, or merely become financially crippled from dealing with normal healthcare costs--that will send ripples through the economy. Our style of healthcare is a ludicrous expense for us all. It's a lot bigger than just the sticker price. It's not just their own problem. They won't simply die and get out of the way of the more fortunate.
michaelkschmidt 8y ago
At a certain price point (% of income), people stop buying insurance. You can buy a lot of healthcare services for $20K a year. To your point, the meltdown is more on the insurance side. The normal, every day providers will just charge patients directly. The issue is the people who get "left behind"--ones who have large numbers of issues. All our insurance money right now goes to provide for them. If insurance collapses, what happens to them?
- ryandrake 8y ago
  > You can buy a lot of healthcare services for $20K a year. You must be joking. In the US, that $20k would barely cover a pregnancy. I’m about to blow $10k on a few dental bridges. It’s insanity.
  - souprock 8y ago
    It's about $2000 to $4000 for a non-hospital midwife with an assistant, toward the higher end of that range for at-home and toward the lower end for the midwife's office.
    - ryandrake 8y ago
      ...if you have great insurance or live in a very, very cheap area. Our family was out of pocket over $10k with “standard mediocre” tech company health insurance. A UCSF study found that California women giving birth were charged from $3,296 to $37,227 for an uncomplicated vaginal delivery, depending on which hospital they visited. For a C-section, women were billed between $8,312 and nearly $71,000. 1: https://www.ucsf.edu/news/2014/01/111071/how-much-does-it-cost-have-baby-hospital https://www.ucsf.edu/news/2014/01/111071/how-much-does-it-co...
      - souprock 8y ago
        No, that is the bare price. Insurance drops it more. For a recent baby, my price went from about $3500 down to about $1000 due to insurance, though we had to prepay more and we're still trying to get back some of the difference. Back when I had better insurance and lived in an expensive location, the full cost was covered by insurance. I've never heard of it being over $5000. I can imagine that an at-home birth in San Francisco might be that bad or worse, since the midwife needs to deal with the cost of living. The problem here is "depending on which hospital they visited". There is no need to involve a hospital (full of exotic infections) for a normal bodily function. That is why your cost is so high.

dragonwriter 8y ago

> Insurance for a family is now > $20K a year [citation needed] > Look at how many counties this would be half or more of the median pay. Even if your $20K is a correct national average figure for family insurance costs, you can't do that and get meaningful results; insurance costs vary widely between states and localities (e.g., of ACA exchange plans, the statewide as average second lowest cost silver plan costs for states using the federal marketplace range from $459 in ND to $1,185 in WY—and the range of local rates, and/or including the states that don't use the federal exchanges, is even wider.) So you'd need to map local income against local costs to get anything meaningful. http://www.ncsl.org/research/health/health-insurance-premiums.aspx#2018_premiums http://www.ncsl.org/research/health/health-insurance-premium...

michaelkschmidt 8y ago
> [citation needed] Your link shows $20k / Family too :-) Look at the chart with the caption "Recent from HHS/CMS" (The costs are you quoting are the monthly costs for a single individual) The costs do vary, but they do not drop off the way median income does in rural areas.
- dragonwriter 8y ago
  > Your link shows $20k / Family too :-) No, it shows < $20K, not > $20K as you claimed. But, the accuracy of the national average figure is mostly a side issue. > The costs do vary, but they do not drop off the way median income does in rural areas. The costs vary enough locally that you can't make anything like a reasonable point by comparing the national cost to local incomes (and, also, you need to consider the effect of subsidies, which are based on income in relation to FPL.) I suspect the reality, before subsidies, may be even worse than what your naive comparison would suggest, but I don't have a lot of confidence in that because I haven't seen, or had time to analyze, national locality data. The bits and pieces I've seen, though, seem to suggest that, while there isn't a simple relationship, local health insurance costs may overall be weakly inversely correlated with local income. But, then you still have to consider subsidy availability—and Medicaid eligibility—to get the real picture.

GuB-42 8y ago

The median pay in the US is also half or more of the median pay in countries with much more generous healthcare. I live in France, which is known for its good health coverage. However, I know a few people who worked both in France and in the US, and they made more there in terms of purchasing power, even after paying all the insurance required to get at least the same level of protection we get "for free" in France. I suppose that the situation can be different depending on your occupation. But what I am saying is that it is just a different system. Healthcare is expensive by nature: highly trained personnel, state of the art research, unforgiving safety requirements, etc... and has to be paid for in some way, be it by taxes or by private insurance companies.

mindslight 8y ago
The taxes in France presumably pay for everybody, while the US premiums only pay for similar healthy working people. Healthcare is expensive. The US government started providing healthcare to old people, rather than letting them die on the street outside the hospital. But rather than the government paying the full cost of this program (ala food subsidies), the government dictated that providers give them special lower prices. The hospitals want to make up for that money some how, and so attempt to pass on extra costs to others. The next target (private health "insurance") doesn't want to subsidize that cost either, so they negotiate lower rates. The hospitals are still optimistic that they can still fool someone, and so attempt to take it out of helpless patients. The entire system is essentially musical chairs. This is why after you receive medical services, the hospital will send you a fraudulent bill with a fictitious inflated price list rather than waiting for your "insurance" to cover their part first - they're hoping to luck into a sucker who will mindlessly pay the sticker price rather than the back room reduced rates. I can foresee a trend of people setting up trust funds for themselves, to reduce the chance of losing their assets to the healthcare reverse lottery. That's really the point we're at - the last attempt at healthcare reform was basically jiujitsued by the health "insurance" industry into making patronizing their cartel mandatory!
- sjg007 8y ago
  Many hospitals survive solely on Medicare revenue.

jonas21 8y ago

That's ignoring ACA subsidies, which you're eligible for if you make less than 4x the federal poverty level. For a family of 4, if you make under $98K per year, you're eligible for a subsidy so that you will not pay more than 9.5% of your income in premiums. That can still be a large burden, but it's a far cry from half or more. EDIT: I re-read your comment, and yes, in the context of the healthcare debate, where the subsidies could potentially go away, this is quite concerning.

sheepmullet 8y ago

> Insurance for a family is now > $20K a year. The real question is why is it so expensive? When I was growing up in my town with about 1000 kids we had 1 kid who was diabetic, 1 attempted suicide, and 2 serious car accidents. We had plenty of minor problems like broken bones but you didn’t need insurance to cover these. So it was maybe 800-1000 working adults covering a handful of serious cases over a 14-16 year time period.

zanny 8y ago
There is tremendous waste in US healthcare. For every doctor there are a dozen accountants, marketers, insurance reps, sales reps, etc. Tons of bureaucracy trying to get a slice of that grotesque money pie. The model you describe, a town subsidizing a few, is why the optimal state of healthcare affairs is the whole of a nation (through taxes) providing healthcare to everyone. It maximizes your healthy pool to offset the costs of the sick.
- dilap 8y ago
  Another factor is we're just really unhealthy. Diabetes is exploding, obesity is exploding, Alzheimers is going up, cancer is going up...
  - zanny 8y ago
    Turns out another part of keeping healthcare costs down is curing the sick as early as possible. In the US, even if you have insurance, you still often have deductibles and copays that strongly disincentivize you going to the doctor. So you don't, until that cold turns into pneumonia or you tear your trachea from a bad cough. Theres a completely different mindset in the first world compared to how people in the US behave - if there is anything unusual "its better safe than sorry" in any European country. You still go to the doctor even with a "routine" illness because there is often no expense to you to do so. But that is the right behavior. You want that at the societal level. Because for every false alarm there is someone developing a crippling or lethal ailment that will dramatically reduce their productivity and cost you substantially more than 15 minutes of consultation and 30 pills would have had they seen a doctor right away. The US is killing its own citizens to line the pockets of the money hungry just by having its healthcare system be insurance based at all, regardless of if people are insured or not.

deleted 8y ago

[deleted]

ransom1538 8y ago

In fact, medical debt is the No. 1 source of personal bankruptcy filings in the U.S., and in 2014, an estimated 40% of Americans racked up debt resulting from a medical issue. https://www.fool.com/retirement/2017/05/01/this-is-the-no-1-reason-americans-file-for-bankrup.aspx https://www.fool.com/retirement/2017/05/01/this-is-the-no-1-...

deleted 8y ago

[deleted]

stupidbird 8y ago

I am angry about this every fucking goddamned day.

deleted 8y ago

[deleted]

shard972 8y ago

It's ok, we can just import new debt slaves to take over.