6 ms·

At first I was wondering how people do this when surprise medical bills can easily bankrupt someone with 25x their yearly spending saved up, as mentioned in the

At first I was wondering how people do this when surprise medical bills can easily bankrupt someone with 25x their yearly spending saved up, as mentioned in the article. Then I realized that this was The Guardian reporting non-US news.

ap3 7y ago
Can’t people get their own insurance or ACA in the US? Surprise medical bills can hit anyone regardless of their financial situation
- PopeDotNinja 7y ago
  You can get screwed even with insurance. I had a bike accident in 2006, breaking both of my arms required me to get a bi lateral radial head replacement. It turned out the hospital to which I was sent was out of my insurance network, and I ended up getting an out of network bill for $50,000 USD.
  - crispyporkbites 7y ago
    Head replacement? For $50k that sounds like a bargain!
    - PopeDotNinja 7y ago
      Ha! Joking aside, I needed 2 implants of to replace these these => https://en.wikipedia.org/wiki/Head_of_radius https://en.wikipedia.org/wiki/Head_of_radius
  - jacquesm 7y ago
    Man that sucks. The whole 'out of network' thing sounds like a perfect excuse. As though patients have a whole lot of control over which parties the insurance companies sign up with.
    - PopeDotNinja 7y ago
      And you can't avoid it really. I asked the hospital if they took my insurance as I was being rolled into the ER. They said yes. That means that they are happy to bill the insurance, not that that are in the insurance network. Check out this story: https://www.google.com/amp/s/www.vox.com/platform/amp/policy-and-politics/2019/1/7/18137967/er-bills-zuckerberg-san-francisco-general-hospital https://www.google.com/amp/s/www.vox.com/platform/amp/policy...
      - jacquesm 7y ago
        For contrast: I also had a biking accident, broke my right leg in six places, pretty complex breaks too. Seven hours of operations and a lot of effort to get back to normal which more or less worked. Total cost: $500 or so in deductibles, not a cent more. I still have half an Ikea in my right leg on account of this little trip for my health, still debating whether to have it removed or not, which will be free because it is related to the original accident. That story is disgusting, what I find really shocking is that apparently if you get the media interested suddenly your bill evaporates.
  - arethuza 7y ago
    My wife had a bad climbing accident in Glencoe a few years back and was rescued by the local mountain rescue team working in conjunction with an RAF helicopter and taken to Fort William hospital. The only thing we were left with was the suggestion from the (awesome) nurse to "Come back to Fort William, but don't come back here!"...
- kerkeslager 7y ago
  That doesn't solve the problem. More than half of bankruptcies caused by medical expenses in the US are people who have medical insurance. Further, medical insurance makes it impossible to live cheaply in the US. I make do with very few possessions, humble housing, and little spending. Health insurance accounts for about half my expenses, more than the next three largest expenses (rent, food, car insurance) combined. I'm probably going to move into a van at some point in the next year, at which point health insurance will be around 2/3 of my expenses. If health insurance is 2/3 of your expenses, that means that you can be retired for 1/3 as long. And that's health insurance if I never get sick--healthcare costs a lot more if you do get sick. Granted, I would eventually qualify for medicare at which point that expense would come down.
  - jacquesm 7y ago
    You could move.
  - ac29 7y ago
    Health insurance subsidies kick in at when insurance costs over 9.5% of income, unless you make over ~$50k/year. I'm not entirely sure how insurance could be 1/2 to 2/3 of your expenses, unless you are saving 90% of your income.
    - kerkeslager 7y ago
      I'm really not sure where you're getting your math. I think you're conflating net (post-tax) income with gross (pre-tax) income, but the numbers you're saying don't add up even with that assumption, so I'm really not sure what mistake you've made or how to correct it. My monthly breakdown is (VERY) roughly: 45% taxes, 15% health insurance, 10% rent, 5% other required stuff (food/utilities/other insurances). The remaining 25% mostly goes to savings/retirement, but sometimes not, depending on variances in expenses and if I decide to buy some big ticket item. When I do spend money it's usually on experiences (trips/concerts mostly) rather than buying things. I make more than $50K/year. If you make enough money to pay the full cost of health insurance, and you live frugally on your other expenses, it would be quite easy for health insurance to be half your expenses.
paulpauper 7y ago
health insurance. yeah, it can be costly, but that is how it is done.
- criddell 7y ago
  I'm almost 50 and when I look at the retirement saving calculator from my employer (through ADP), they tell me to expect to pay $15k / month for healthcare expenses when I'm 85. That can't be possible, can it?
  - tempotemporary 7y ago
    Man, $15k/mo sounds crushing. What if you have a wife? $360k/y for a couple, this is crazy.
jandrewrogers 7y ago
Most FIRE practitioners in the US buy their own health insurance. It is modeled into their expenses the same as mortgage payments and property taxes.
- abootstrapper 7y ago
  Besides the $1k monthly premiums. Don’t forget to save up for the $10k deductible in case you actually get sick!
  - jandrewrogers 7y ago
    A standard part of the financial model is an emergency fund that exists for purposes like this. I believe the advice is at least 6 months worth of expenses in the emergency fund, which should be enough to cover deductibles in the vast majority of cases. Generally, people who FIRE sensibly build quite a bit of slack into their financial models to make allowances for unexpected large costs.
  - echelon 7y ago
    My understanding is that monthly premiums should be on the order of $600/mo for an excellent plan with a low deductable and copay. It's more if you have a family, of course.
  - jldugger 7y ago
    Well, that's what the HSA is intended for =)
hogFeast 7y ago
You still pay for it. The costs don't disappear into the ether (although it is definitely true that your exposure to extreme financial risk is substantially reduced). However, there are downsides. If you have something very wrong with you, and it is somewhat rare (i.e. the medicine is expensive) or not well understood...you are done. The NHS provides universal care but not universal treatment. You go to the doctor, they go shrug can't help you. That is it and there is no "second opinion" (unless you go privately but that doesn't work either in many cases...you are usually seeing the exact same doctor, just paying for it upfront). It is important to recognise that there are trade-offs in every situation. The UK system is, despite the cult-like following, not particularly effective. In terms of outcomes, it is below average by most measurements. It is very cost-effective...but that isn't the only thing that matters.
- arethuza 7y ago
  I think that's a bit harsh on the NHS - a more reasonable view would perhaps be: “Compared to the other 18 countries the UK has middling funding and middling performance overall. We can be proud of the fact that the UK is a standout nation where people are not put off from seeking care due to cost, and the NHS is cheap to run. But austerity has bitten hard, and the lag of investment shows. If we want to hold our head up high next to our European neighbours we can and must do better.” https://www.nuffieldtrust.org.uk/news-item/nhs-receives-mixed-scorecard-in-major-analysis-of-international-health-systems https://www.nuffieldtrust.org.uk/news-item/nhs-receives-mixe... I don't think anyone thinks that the NHS provides the best healthcare, that's unlikely given the amount we pay for it, but as a country I guess we do have "cult-like" obsession with making sure everyone has access to healthcare.
  - hogFeast 7y ago
    I don't think that conclusion is one that follows naturally from the data. And what the report misses out is that in many other countries patients are not put off from seeking care due to cost either...and they achieve better outcomes. They do this through a mix of private and public healthcare which is naturally intolerable to the NHS. Btw, this should be plainly obvious if you actually look at what the data is...it is based on a population sample. If someone sick does not have access to care then that shows in the data. It is a great trick to change the question and say it is about access, it is not one that follows from the data. As a lot of the Nuffield Trust get their staff from the NHS, I am not surprised that they self-importantly included that their work has led to the UK being a "standout nation". The stuff about austerity is utter bullshit. Health spending per person has been growing after inflation at ~2%/year, and as a percentage of GDP health spending is up two points since 2010. Yes, attempts at cuts were made in 2017 (the rate of growth in spending was only ~1%) but that is because the govt had cut literally every other department to the bone first. A reasonable person would question whether that was worthwhile given that it involved large % cuts for the income of vulnerable people (in other departments, and in care budgets) rather than asking doctors to just accept an unchanged or small % drop in salary. Wasn't the recent negotiation for junior doctors a double-digit increase (which they wouldn't even accept and striked multiple times)? The willingness of Brits to not think rationally on this topic (and not realise how much lobbying goes into the maintenance of these views) is baffling.

ap3 7y ago

Can’t people get their own insurance or ACA in the US? Surprise medical bills can hit anyone regardless of their financial situation

PopeDotNinja 7y ago
You can get screwed even with insurance. I had a bike accident in 2006, breaking both of my arms required me to get a bi lateral radial head replacement. It turned out the hospital to which I was sent was out of my insurance network, and I ended up getting an out of network bill for $50,000 USD.
- crispyporkbites 7y ago
  Head replacement? For $50k that sounds like a bargain!
  - PopeDotNinja 7y ago
    Ha! Joking aside, I needed 2 implants of to replace these these => https://en.wikipedia.org/wiki/Head_of_radius https://en.wikipedia.org/wiki/Head_of_radius
- jacquesm 7y ago
  Man that sucks. The whole 'out of network' thing sounds like a perfect excuse. As though patients have a whole lot of control over which parties the insurance companies sign up with.
  - PopeDotNinja 7y ago
    And you can't avoid it really. I asked the hospital if they took my insurance as I was being rolled into the ER. They said yes. That means that they are happy to bill the insurance, not that that are in the insurance network. Check out this story: https://www.google.com/amp/s/www.vox.com/platform/amp/policy-and-politics/2019/1/7/18137967/er-bills-zuckerberg-san-francisco-general-hospital https://www.google.com/amp/s/www.vox.com/platform/amp/policy...
    - jacquesm 7y ago
      For contrast: I also had a biking accident, broke my right leg in six places, pretty complex breaks too. Seven hours of operations and a lot of effort to get back to normal which more or less worked. Total cost: $500 or so in deductibles, not a cent more. I still have half an Ikea in my right leg on account of this little trip for my health, still debating whether to have it removed or not, which will be free because it is related to the original accident. That story is disgusting, what I find really shocking is that apparently if you get the media interested suddenly your bill evaporates.
- arethuza 7y ago
  My wife had a bad climbing accident in Glencoe a few years back and was rescued by the local mountain rescue team working in conjunction with an RAF helicopter and taken to Fort William hospital. The only thing we were left with was the suggestion from the (awesome) nurse to "Come back to Fort William, but don't come back here!"...
kerkeslager 7y ago
That doesn't solve the problem. More than half of bankruptcies caused by medical expenses in the US are people who have medical insurance. Further, medical insurance makes it impossible to live cheaply in the US. I make do with very few possessions, humble housing, and little spending. Health insurance accounts for about half my expenses, more than the next three largest expenses (rent, food, car insurance) combined. I'm probably going to move into a van at some point in the next year, at which point health insurance will be around 2/3 of my expenses. If health insurance is 2/3 of your expenses, that means that you can be retired for 1/3 as long. And that's health insurance if I never get sick--healthcare costs a lot more if you do get sick. Granted, I would eventually qualify for medicare at which point that expense would come down.
- jacquesm 7y ago
  You could move.
- ac29 7y ago
  Health insurance subsidies kick in at when insurance costs over 9.5% of income, unless you make over ~$50k/year. I'm not entirely sure how insurance could be 1/2 to 2/3 of your expenses, unless you are saving 90% of your income.
  - kerkeslager 7y ago
    I'm really not sure where you're getting your math. I think you're conflating net (post-tax) income with gross (pre-tax) income, but the numbers you're saying don't add up even with that assumption, so I'm really not sure what mistake you've made or how to correct it. My monthly breakdown is (VERY) roughly: 45% taxes, 15% health insurance, 10% rent, 5% other required stuff (food/utilities/other insurances). The remaining 25% mostly goes to savings/retirement, but sometimes not, depending on variances in expenses and if I decide to buy some big ticket item. When I do spend money it's usually on experiences (trips/concerts mostly) rather than buying things. I make more than $50K/year. If you make enough money to pay the full cost of health insurance, and you live frugally on your other expenses, it would be quite easy for health insurance to be half your expenses.

paulpauper 7y ago

health insurance. yeah, it can be costly, but that is how it is done.

criddell 7y ago
I'm almost 50 and when I look at the retirement saving calculator from my employer (through ADP), they tell me to expect to pay $15k / month for healthcare expenses when I'm 85. That can't be possible, can it?
- tempotemporary 7y ago
  Man, $15k/mo sounds crushing. What if you have a wife? $360k/y for a couple, this is crazy.

jandrewrogers 7y ago

Most FIRE practitioners in the US buy their own health insurance. It is modeled into their expenses the same as mortgage payments and property taxes.

abootstrapper 7y ago
Besides the $1k monthly premiums. Don’t forget to save up for the $10k deductible in case you actually get sick!
- jandrewrogers 7y ago
  A standard part of the financial model is an emergency fund that exists for purposes like this. I believe the advice is at least 6 months worth of expenses in the emergency fund, which should be enough to cover deductibles in the vast majority of cases. Generally, people who FIRE sensibly build quite a bit of slack into their financial models to make allowances for unexpected large costs.
- echelon 7y ago
  My understanding is that monthly premiums should be on the order of $600/mo for an excellent plan with a low deductable and copay. It's more if you have a family, of course.
- jldugger 7y ago
  Well, that's what the HSA is intended for =)

hogFeast 7y ago

You still pay for it. The costs don't disappear into the ether (although it is definitely true that your exposure to extreme financial risk is substantially reduced). However, there are downsides. If you have something very wrong with you, and it is somewhat rare (i.e. the medicine is expensive) or not well understood...you are done. The NHS provides universal care but not universal treatment. You go to the doctor, they go shrug can't help you. That is it and there is no "second opinion" (unless you go privately but that doesn't work either in many cases...you are usually seeing the exact same doctor, just paying for it upfront). It is important to recognise that there are trade-offs in every situation. The UK system is, despite the cult-like following, not particularly effective. In terms of outcomes, it is below average by most measurements. It is very cost-effective...but that isn't the only thing that matters.

arethuza 7y ago
I think that's a bit harsh on the NHS - a more reasonable view would perhaps be: “Compared to the other 18 countries the UK has middling funding and middling performance overall. We can be proud of the fact that the UK is a standout nation where people are not put off from seeking care due to cost, and the NHS is cheap to run. But austerity has bitten hard, and the lag of investment shows. If we want to hold our head up high next to our European neighbours we can and must do better.” https://www.nuffieldtrust.org.uk/news-item/nhs-receives-mixed-scorecard-in-major-analysis-of-international-health-systems https://www.nuffieldtrust.org.uk/news-item/nhs-receives-mixe... I don't think anyone thinks that the NHS provides the best healthcare, that's unlikely given the amount we pay for it, but as a country I guess we do have "cult-like" obsession with making sure everyone has access to healthcare.
- hogFeast 7y ago
  I don't think that conclusion is one that follows naturally from the data. And what the report misses out is that in many other countries patients are not put off from seeking care due to cost either...and they achieve better outcomes. They do this through a mix of private and public healthcare which is naturally intolerable to the NHS. Btw, this should be plainly obvious if you actually look at what the data is...it is based on a population sample. If someone sick does not have access to care then that shows in the data. It is a great trick to change the question and say it is about access, it is not one that follows from the data. As a lot of the Nuffield Trust get their staff from the NHS, I am not surprised that they self-importantly included that their work has led to the UK being a "standout nation". The stuff about austerity is utter bullshit. Health spending per person has been growing after inflation at ~2%/year, and as a percentage of GDP health spending is up two points since 2010. Yes, attempts at cuts were made in 2017 (the rate of growth in spending was only ~1%) but that is because the govt had cut literally every other department to the bone first. A reasonable person would question whether that was worthwhile given that it involved large % cuts for the income of vulnerable people (in other departments, and in care budgets) rather than asking doctors to just accept an unchanged or small % drop in salary. Wasn't the recent negotiation for junior doctors a double-digit increase (which they wouldn't even accept and striked multiple times)? The willingness of Brits to not think rationally on this topic (and not realise how much lobbying goes into the maintenance of these views) is baffling.