16 ms·

Money Won’t Buy You Health Insurance

596 points by epall 16y ago

zmmmmm 16y ago
The cost of healthcare and college basically scared me away from migrating to the US. It's a definite trade off but here in Australia, having paid off my house, I can live almost free of overheads. It is incredibly liberating to get up in the morning and know I can go to work on my own business without worrying that some freak accident or illness will destroy me financially. On the other hand, I do think that the lack of these other costs is one reason that we have some of the highest house prices in the world. When you take away these other costs people just devote their disposable income elsewhere. Even so, I think it's better used that way than paying executives in health insurance companies.
mrkurt 16y ago
> The difference is significant: my recent M.R.I. cost $1,300 at the “retail” rate, while the rate negotiated by the insurance company was $700. The shocking thing is, if you get an MRI at a cash only diagnostics facility it can cost as little as $300.
- mikebike 16y ago
  I've never understood the meaning of the "retail" rates. How many people are there who can afford to pay these rates and also don't have health insurance?
  - pessimizer 16y ago
    I had a bad asthma attack while uninsured and got hit with a bill that took me 7 years to pay off.
    - mikebike 16y ago
      Yipe! Were you able to negotiate the bill down at all when working out a payment plan, or did the hospital end up charging you the full amount?
      - pessimizer 16y ago
        Didn't negotiate a thing. I was pretty naive about that sort of thing at the time (really was still until the last few years, and I'm 35 now) and didn't know that bargaining was an option. I was just unemployed, broke and 22 and had a giant bill that I didn't know what to do with. I thought a bill was a bill and a debt was a debt, and had never even had a credit card in my life. Soon after that, I got a $9 an hour job at a factory and started making payments...
    - wmeredith 16y ago
      7 years and a bankruptcy drops off your credit rating...
  - cookiecaper 16y ago
    Zero, obviously. People either let them lapse where possible, declare bankruptcy to get Constables off their backs, or spend years paying $50-$100/mo. Things like this happen even to insured people. Due to a communications snafu between the doctor and the insurance company, my mom, who has "good" insurance from BigCo, is paying for her annual mammogram $50/mo now, and will be doing this for the better part of two years. My parents paid on an ER visit I made in my late teens until I was 21 or 22 because of another such insurance oversight. These happen all the time because that's how insurers make money. The insurance model is based explicitly on not paying out. For something that's universally utilized like health insurance, that generally means you have to deny a lot of claims to keep acceptable margins. Homeowner's insurance works fine because most people aren't burglarized often and most peoples' homes don't burn down, so people make modest monthly payments and one claim in a lifetime more than pays for itself. Likewise, car insurance is not used too often by its patrons. Health insurance, however, is used (at least) several times a year by almost every individual. As such, insurance is a terrible model for health care, since the entire concept behind insurance is that more people are paying for the coverage than are using it. The continued feasibility of medical insurance depends on people not getting medicine.
ck2 16y ago
I just wish her report include some mention of WHAT the new legislation will in reality do for her? Because I suspect it will do little for serious health problems. IF they can pay for it, all it will do is prevent the insurance companies dropping her when she gets sick someday or stop paying out when they hit a limit like on cancer. I say that's not a lot because they ARE allowed to raise the premiums so high that the patient has to drop the insurance on their own because there's no way to for it. So the legislation is useless for the serious stuff.
ashbrahma 16y ago
Countries like India, Malaysia are starting to see a boom in Medical Tourism. It costs approximately $4500 for a open heart surgery at the best hospitals compared to $15-$20K in the US. http://en.wikipedia.org/wiki/Medical_tourism http://en.wikipedia.org/wiki/Medical_tourism
- Ras_ 16y ago
  Going to a dentist on your holiday would be a casual example.
  - twistedanimator 16y ago
    That's exactly what I did when I went to El Salvador last year. It cost me $30 for a routine cleaning as opposed to $150 in the US.
hartror 16y ago
I might be living in a socialist paradise (Australia) or some thing but my last visit to the doctor (broken toe) was free. I am truly horrified by the state of the US health system, sure Australia's might be a bit messed up at times but it is so much better than what Americans have to deal with. Move your startup to Australia! Seriously, cheap/free heathcare for minor->medium problems (the bad stuff is still going to throw up some major bills but not bankruptcy worthy). As a plus we have a superior economy right now, better living standards and hot women. Not sure the state of the laws regarding Americans access to our healthcare but worth a look.
- rdouble 16y ago
  There's no visa that will let you do this. Australia has a points based immigration system. If you're younger than 25 and have an engineering degree you just barely have enough points to get a self-sponsored work visa. If you're older than 25 it's impossible to get enough points and you have to work for someone else (or marry an Australian). I'd love to be wrong about this, corrections are welcome.
  - hartror 16y ago
    That is sad, given our current prosperity it would be great if we could leverage it to bring super talented entrepreneurs here to start more great businesses.
- yaix 16y ago
  Good to know, thanks. I am actually considering moving to AUS, however not because of health care, being from Europe. Good to know its "socialist" in Australia too ;D
ajays 16y ago
The irony is: the same Congresscritters who vote against universal health insurance get top-notch health insurance paid for by taxpayers: http://www.suite101.com/content/health-care-for-the-us-congress-a72870 http://www.suite101.com/content/health-care-for-the-us-congr... After 5 years of service, they get lifetime health insurance, the same as all federal employees and retirees:http://www.opm.gov/insure/retirees/index.asp?MainQuestionId=6 http://www.opm.gov/insure/retirees/index.asp?MainQuestionId=...
- klenwell 16y ago
  A few tea partiers turned down the insurance this year on principle. One was interviewed on NPR, where he acknowledged that the insurance rates he found on the open marker were a bit of a shock: http://www.npr.org/2011/02/09/133629806/16-Freshmen-GOP-Decline-Federal-Health-Coverage http://www.npr.org/2011/02/09/133629806/16-Freshmen-GOP-Decl... Still, he rationalizes away the benefits of the new Health Care law: "But I think that if we had true health care reform that I wouldn't be paying $1,300 a month for this health care. If we had true tort reform, if we had true health care reform where physicians weren't ordering unnecessary, you know, procedures just to protect their backside, I'd think that a lot of us would see a reduction in what we pay in any health care, whether it's, you know, employee - helped, subsidized, or, you know, employer-subsidized." In case you miss his weasel words: tort reform makes virtually no difference and hasn't had a noticeable impact in states where it has passed. Otherwise, the new law is about the most realistic first step you're going to get passed in this country toward controlling costs. Meanwhile, the one area where the law is halfway decent is in extending more affordable health insurance coverage to more people.
  - ajays 16y ago
    IMHO, Obama and company got carried away. They saw this opportunity to enact something comparable to Social Security and Medicare, and wanted to go down in the history books as having achieved something similar. Unfortunately, like any big project in Washington, this one was laden with loopholes, sweeteners, etc. In other words, a total mess. It would have been far better to pass a series of smaller laws. Start with: it's illegal to discriminate based on pre-existing conditions. Then, create cross-state markets and let insurance companies compete across state boundaries. Then, let families buy into the Federal government's health insurance program (if our elected reps can do it, why can't we?). And so on.
ChristianMarks 16y ago
I couldn't get surgery approved on my employer's health insurance. I eventually decided not to let that stop me from changing jobs and doing what I wanted to do, despite not being able to afford surgery out of pocket and despite an inferior choice of health insurance plans. I suppose I could emigrate to England if all else fails. I can do this as my mother was a British citizen otherwise than by descent, though it is an involved process. The present system is designed to impose a huge negative externality on would-be entrepreneurs and others who might have left their jobs to pursue other opportunities. And you are subsidizing the profits of the industries that benefit from the relative immobility of labor. That negative externality you pay is someone else's subsidy. If it were up to me, I'd rather pay into a universal health care system than pay the negative externality to stay tied to an employer on account of health care coverage. Another negative externality is the administrative burden imposed on companies to handle employee health care.
deleted 16y ago
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jasongullickson 16y ago
Sounds like an industry ripe with opportunity for the right hacker.
- danssig 16y ago
  Except for all the barriers that the established players have put in place to keep said hacker out.
hnl2sea2nrt 16y ago
I've had some luck with hacking my family's healthcare expenses in the last couple of years. I am a healthy 26 y/o with a wife and son. We were living in Seattle and healthcare was the most expensive when I was employed full-time and my wife was pregnant. Luckily, the company nearly tanked and let me go along with my entire department. I've been a self-employed consultant since then (almost 3 years) and went without insurance for about a year just so I could afford to pay for my wife and kid. Then I figured out some hacks. I found a startup health practice called Qliance in Seattle which Michael Dell, Jeff Bezos and Drew Carey have funded (nice article about it here: http://www.techflash.com/seattle/2010/04/jeff_bezos_michael_dell_drew_carey_and_others_back_health_care_startup.html http://www.techflash.com/seattle/2010/04/jeff_bezos_michael_...). For about $50/month each for my wife and I and $40 for my kid (total of ~$140) were able to see a doctor any time we wanted for non-emergencies without co-pays. I can't tell you how much weight this was off my back. Staff was friendly, service was great, modern offices, experienced doctors. Couldn't have asked for more. We got a high deductible family plan along with it which added about $200 to the costs. If you are in the Seattle area and are self-employed, this is probably your best option. The second hack was that we moved to Japan about a year ago. As others have mentioned, they have a very consumer-friendly system over here. I had a big health scare when we first moved which required lots of medication and several doctor visits, but it didn't set us back more than a couple hundred bucks. I'm really worried about moving back to the US now. I hope things get better before we move back in a couple of years.
tapp 16y ago
> "If members of Congress feel so strongly about undoing this important legislation, perhaps we should stop providing them with health insurance. Let’s credit their pay for the amount that has been paid by the taxpayers, and let them try to buy health insurance in the individual market...Health insurance reform might suddenly not seem to them like such a bad idea." Hell yes. While we're at it, lawmakers should be required to do their own taxes at least once every few years as well. In terms of systemic change, I think requiring our legislators to eat their own dogfood would do much more for our country than all of our disjointed attempts at campaign finance reform and the like.
GFischer 16y ago
So, people in the U.S. are billed an astronomical sum for a MRI, even with insurance? The most expensive MRI bill for someone in the "mutualism" system here in Uruguay is U$ 100. I tried to explain the Uruguayan "mutualist" socialist health system here: http://news.ycombinator.com/item?id=1627862 http://news.ycombinator.com/item?id=1627862 "Mutual organisations do not have external shareholders - they are controlled by their members. Members may be users of the mutual, employees, other stakeholders or a combination of these Mutual organisations are either owned by and run in the interests of existing members, as is the case in building societies, cooperatives and friendly societies, or, as in many public services, owned on behalf of the wider community and run in the interests of the wider community" A HN member compared them to credit unions, I think it's a valid analogy. The mutualist system is always near bankruptcy and is perfectible (and the government is always meddling), but it doesn't bankrupt it's users and it kind of works (life expectancy here in Uruguay is the same as in the U.S.). Edit - funnily, it seems it's very similar to the Japanese case (and MRI's cost U$ 98 there too): http://news.ycombinator.com/item?id=2247969 http://news.ycombinator.com/item?id=2247969
- SapphireSun 16y ago
  We have vaguely similar, but smaller versions, of the system you are talking about in the US. They are called "self insured entities" and are typically companies that bankroll their employees directly. They typically hire a professional insurance company as a "Third Party Administrator" to handle administering claims. I am unsure as to their efficacy, although scale certainly affects their performance.
ylem 16y ago
I was in France not too long ago and had to go to the emergency room for stitches. The wait was not much longer than in the US--we started talking about payment (I didn't have my insurance card on me...doh!. Finally, I asked them what the bill was--around 20 Euro. I paid cash...I talked to a doctor on the bus ride back and part of it is a combination of low malpractice suits (I think a minor part) , taxes, and the fact that doctor salaries are much lower than they are here in the US... I agree that the system is broke here.
scottshapiro 16y ago
It's simple. The US needs to stop subsidizing the bad calories (i.e. sweetners and hydrogenated oils) and enabling the treatments (i.e. dialysis, statins) that treat resulting diseases of civilization (i.e. diabetes, heart disease).
jjcc 16y ago
I used to be a long-time believer of free market. But for health care and Education system things are quite different. All the participants taking care of their own interest doesn't mean the interest of the whole society will be maximized. Some poor countries might be better than the States. Believe or not, check the healthcare of Cuba!
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acabal 16y ago
This really highlights how utterly insane our system is. I'm living off of my own business, which means that I don't have an employer to cover me under group insurance. But I really only make enough to live frugally and save a tiny amount each month--to me, an affordable health insurance plan would be between $50-$100 a month. Fat chance of that happening. And if it did, the deductible would be so high as to make the plan worthless for anything short of a car-crash-emergency-type-situation. But not only would it not happen at that price, but as the article says, it wouldn't happen period--even though I'm a healthy, nonsmoking, active 26-year-old male, I've had cubital tunnel problems in the past (typing) and surgery on my wrist (badly broken in an accident). If I applied, I would surely be denied--and again, as the article states, if you're denied once, your chances of being accepted in the future just dropped by a big percentage. It literally makes more financial sense for me to pay minor expenses out of pocket and declare bankruptcy in the chance of crippling bills than to be insured. Healthcare in America is utterly, utterly broken; it's damaging poor, middle-class, and rich people alike, and stifling innovation. I have the ability to innovate with my company because I'm young, single, and healthy; but many smart people have existing medical problems, families, or other factors that make them indentured servants to the company that pays their healthcare. As a nation we're under the thumb of the insurance companies, and instead of doing anything serious about it, we've done almost the worst possible option: require every one of us to be a customer of these monstrous companies, with little regulation on cost or other government oversight. I'm the first person to back health insurance reform, but we've reformed it in the name of shoveling more money into the pockets of industry instead of for regular people needing real care. It's crap like this that's compelling me to make my current expat lifestyle permanent. America might still get the tax dollars my business generates (the only country to still tax you if you live abroad) but it won't get my brain or my talent within its borders.
- WalterBright 16y ago
  "For fun, let’s imagine confiscating all the profits of all the famously greedy health-insurance companies. That would pay for four days of health care for all Americans." http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/7617/3/ http://www.theatlantic.com/magazine/archive/2009/09/how-amer... Insurance company profits are not the problem.
deleted 16y ago
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- krschultz 16y ago
  <sarcasm>But it's written by someone involved in the tech world, that makes it hacker news</sarcasm>
  - acabal 16y ago
    I think it's hacker news because hackers struggling to become ramen-profitable (or even just thinking about it!) are directly affected by the cost and availability of health insurance. It's a big factor for many people in deciding whether they want to quit their cube jobs that keep them insured to strike out on their own.
    - krschultz 16y ago
      I'm well aware of this, in fact I made the exact same point higher up in this discussion, but as much as I love politics (and thats not sarcasm, I'm probably even more into politics than technology, I've actively campaigned, gone on TV & radio for interviews about politics etc) this is not a site I come to for politics.
    - DanielBMarkham 16y ago
      It's a big factor for many people in deciding whether they want to quit their cube jobs that keep them insured to strike out on their own. And I think that's total bullshit and people who don't want to strike out won't and will find lots of reasons not to, while people who want to strike out will, and figure out how to make it work. Kind of takes us to a rhetorical dead end, since we're both wildly speculating about what some imaginary people we dream up might or might not do. All we're really doing is inventing examples to support opinions that we've already decided to hold. Look -- I think health insurance needs fixing. I also think the current solution is so bad we should fire every Congressman who voted for it and run them out of town on a rail. I further believe that if two reasonable people sat down, they'd find that most of us really aren't that far apart on the issues. But this looks like picking a fight. For no reason.
_delirium 16y ago
Does anyone have any experience with small-business health-care pools as an alternative to buying individual insurance? They've been talked about for a long time, and some states supposedly have programs for them, but I haven't heard much about how or if they work. Can you join one and get insurance at any sort of vaguely group-negotiated price with fewer of these kinds of problems?
- coffeedrinker 16y ago
  I've talked to an agent about that. In Washington State, she said a group plan v. individual would not make much difference. At least not enough to warrant they additional paperwork and/or insurance company switch.
coffeedrinker 16y ago
I have my family on a $10,000 deductible per person ($30,000 for family). That still costs over $500/month. Unless you have cancer, heart surgery, or some other major thing, and are in good health you'll save far more over buying a lower deductible plan. We used to have reasonable insurance, but the annual increases have been enormous, without any claims. More people will drop insurance, leaving the companies with only the sick, if they keep pushing younger, healthier people out of the system.
krschultz 16y ago
The subtle but crazy part about this is at the bottom when it details the author: "Donna Dubinsky, a co-founder of Palm Computer and Handspring, is the chief executive of a computer software company." I'm going to go out on a limb and say money is not an issue for Donna, yet she still can't even buy insurance if she wants to. I've always thought healthcare access was a bigger hurdle for entrepreneurs than tax rates. If I make a lot of money with my startup, great, I really could care less if I pay 15% or 40% of that to the gov't, because it will be a whole lot more than I make now. But not having health care insurance (or worse, having crappy insurance that denies you all the time like most individual plans do) is so damn risky it makes me afraid to step out on my own.
- ajays 16y ago
  +1 If the Republicans are serious about an economic recovery and want startups to flourish, then universal healthcare is a cornerstone of such an effort. I know of other people too who are afraid of leaving their (big-company) positions because they have a wife + young kids, and lack of health insurance terrifies them.
  - Vivtek 16y ago
    What could possibly have given you the idea that the Republicans want an economic recovery?
    - angelbob 16y ago
      Well, eventually. Just not under Obama. Maybe if they wait a few years?
- JabavuAdams 16y ago
  Well, once her current software company (Numenta) deploys AI maybe she won't need coverage. /joking
- sammcd 16y ago
  I think she could buy insurance if she really wanted. I've thought about this a lot because I could easily be in this situation. If I did anything on my own I would need a group plan quickly. You only need 2 people to create a group. So you can buy insurance its expensive, here is how you do it. 1) Start a company. 2) Hire another employee (this costs a lot) 3) Make a group health insurance policy for the company. There you bought insurance. I know this is stupid, but I'm just the kind of person that when someone says "You can't do XXX" I automatically have to see if I can do it.
theoj 16y ago
Link without registration: <removed> Edit: Apparently you need to go through Google for this to work. See comment below.
- bluishgreen 16y ago
  dint work, but click thru from google works http://www.google.com/search?sourceid=chrome&ie=UTF-8&q=money+cant+bye+health+insurance#hl=en&sugexp=elsfph&xhr=t&q=Money+Wont+Buy+You+Health+Insurance+-+NYTimes.com&cp=50&qe=TW9uZXkgV29uJ3QgQnV5IFlvdSBIZWFsdGggSW5zdXJhbmNlIC0gTllUaW1lcy5jb20&qesig=rcbfvWvet2J5DX7wG0xMAA&pkc=AFgZ2tl1CKSYKfo9K59o-qj2w1_c09EpC_W1_oFlB_OK3jWc2mzq1ajNC-M68aCWMIvhIRnSHQrSI46jrNwVbe4ukokwW_3cRw&pf=p&sclient=psy&aq=f&aqi=&aql=&oq=Money+Wont+Buy+You+Health+Insurance+-+NYTimes.com&pbx=1&bav=on.1,or.&fp=681127d0c6f645aa http://www.google.com/search?sourceid=chrome&ie=UTF-8&#3...
nhangen 16y ago
I left the Army where I had free healthcare for me and my family - I got spoiled. I really can't afford it now that I'm out and not with a big company. I've thought of going into the Reserves just to have the option to buy it again. Healthcare really does suck.
- tonfa 16y ago
  If you are inclined to move somewhere else, there are lots of countries with affordable healthcare (most of Europe, and I guess Canada for example).
  - shiny 16y ago
    How easy are these countries to get into (and become a working member of their society)? I know Switzerland and New Zealand are particularly tough.
    - raganwald 16y ago
      Canada has more opportunities than people, which is why getting in is particularly easy.
    - jasonlotito 16y ago
      Did you miss the Montreal open-source thread here yesterday? =) Canada is great for tech people looking for work. We need people up here. Sure, it gets cold in the winter, but it's really not that bad.
  - nhangen 16y ago
    I am, the problem is that my wife isn't...yet. I'm working on it for sure.
sabat 16y ago
I'm an example -- I have private health insurance out of necessity. It was an arduous process, and I'm lucky to have managed to get it -- even though I'm healthy. If I had so much as one serious problem, I'm convinced I would have been turned down. It is broken. Seriously broken.
- lolno 16y ago
  I paid for cancer treatment, end to end, out of pocket because this country is a third world shithole in disguise. It's broken and the competition on price is non-existent even if dishonest pieces of shit like tptacek claim otherwise.
herf 16y ago
"Group of 2" in California can be husband and wife. (We did this, because the plans are better, the rates are better, and they can't limit you based on pre-existing conditions.) Just make a partnership and pay the state taxes annually (ugh).
SandB0x 16y ago
I would have died at the age of 19 if it weren't for the help of the UK's National Health Service. My parents and I didn't have to worry about hospital bills, future insurance issues, being tied to a job, any of that crap. Just get some rest, get better, go out there and be productive again. The American system looks like a horrible joke from over here. I just can't understand any of it.
- ahpeeyem 16y ago
  I would have lost my sight and probably then died slowly and painfully from a tumour some time in my teens if not for Australia's national Medicare system that's been treating my condition since I was 12 years old. Instead I've only had to pay a nominal fee every time I need medication. Surgery, over a dozen MRI scans and visits to specialists over the years plus other tests and whatever else have all been paid for at no cost to me. It scares the crap out of me to think what would have happened to me if I was in the USA. To be able to see specialists or have expensive tests at times when I've been lucky to have $5 to my name is something I feel enormous gratitude for. I can't imagine the hardship having to pay for all this out of pocket would cause.
- DanI-S 16y ago
  I moved to the US from the UK over a year ago and I can't find words to describe the feeling of not having the NHS to rely on. This whole new world of potential disaster has opened up. It's something you've never had to think about before that is now at the forefront of your consciousness. You can be young, fit and healthy, but get hit by a car and your life is over. Once you're bankrupted by medical fees, you'll never have good credit again - and in the US, this is like the mark of the beast. It's no wonder that American streets are filled by the homeless and disabled. This is a great country, with wonderful people, but in some ways it's medieval.
  - RK 16y ago
    Just out of curiosity, does your NHS insurance cover you while you're in the US?
ryanwaggoner 16y ago
I'm no expert, but isn't this one of the major issues that the health care reform bill of 2010 is going to fix? Granted, it doesn't go into effect (for adults) until Jan 1, 2014, but I thought that insurance companies will be prohibited from denying coverage or charging higher rates based on pre-existing medical conditions. Am I mistaken? http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act#Provisions http://en.wikipedia.org/wiki/Patient_Protection_and_Affordab...
- nostrademons 16y ago
  If it's not repealed first. I believe that's what this article's addressing - she's trying to educate people enough that they will not support a repeal of Obamacare.
- marshray 16y ago
  I'll believe it when I see it.
Dramatize 16y ago
I'm glad we don't have these issues in Australia. The American healthcare system would be one of the only reasons not to move there to start a business.
- jacques_chester 16y ago
  Australia has a hybrid public/private system. You can rely on the public system for pretty much everything, but only catastrophic medical services are well-funded (and even then ...). Otherwise you will need to get used to waiting in a queue. Private health insurance then allows you to get the frills and to do so without waiting. If you have private cover and need surgery to treat a non life-threatening issue, then you can usually get it done almost immediately. If you don't have private cover, you may be waiting for years. Still, in US terms, our private cover is very cheap. I'm a single, non-smoking, exercising male, 30 years old. I pay about $1200 a year with a $500 gap. But I also pay $20,000 in taxes, a goodly portion of which make their way into the public health system (and far too much of which goes into middle class welfare, but that's by the by).
  - deleted 16y ago
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andrewpbrett1 16y ago
Shameless plug: I'm working on a startup that, while it won't be able to directly fix people being denied coverage, will hopefully help people to understand their coverage a bit better. http://cakehealth.com http://cakehealth.com. Not yet open to all but you can sign up if that sounds interesting to you. We <3 beta users. And on a related note, I have noprocrast enabled so apologies for the n00b-looking account, real uid = andrewpbrett. Someone alerted me that this was being discussed.
mrshoe 16y ago
Can someone please explain to me why five thousand self employed people can't form a corporation together and get group insurance? Do shell corporations like that already exist?
- elwin 16y ago
  I believe organizations like local Chambers of Commerce do this.
- zdw 16y ago
  They do. Usually they handle not only health insurance, but most of the other benefits and paperwork regarding employement (payroll, etc.).
- noisebleed 16y ago
  I mentioned it above, but the closest I've seen to this idea is Freelancers Union / Insurance ( freelancersinsuranceco.com )
- joeshaw 16y ago
  For types of employment which are often for-hire or hourly (think plumbers, electricians, etc.), unions typically offer group insurance for their members. It would be nice if there were a similar union for tech entrepreneurs and startup employees... although maybe companies would become worried that such a union would start trying to negotiate for concessions from employers.
- SkyMarshal 16y ago
  Freelancersunion.com I believe does something similar with their health plan.
health-anon 16y ago
I'm an entrepreneur with a wife and son. I'm 23. We pay $360/mo for individual insurance and it is pretty crappy. The deductible is high and there are several "up-front" visits, which means the first X times we go to the doctor the insurance pays nothing and deducts one of our up-front visits. Each of us have X of these, so the first X times wife goes in, and then the same for me, they are not taken from the same pool. This accumulates to several hundred dollars of visits before insurance pays for anything, and then we still have the deductible to churn through, and they've applied regular visits to that as well. We're struggling to make ends meet here; our clients are good and we're trying to build a steadier base, but the pay is irregular and sometimes we have trouble meeting monthly obligations. They make it such a hassle to do anything and they rip us off so hard (providers and insurers alike) that we usually just don't pay our medical bills except what we have to pay up-front. It's too much crap to deal with, the insurance always makes up a reason not to cover things, and it's absurdly expensive. Every time we have tried to pay the people have come back saying we'd owe literally 10x more than they we were originally told we would owe. It's just not worth the headache or the hassle, much easier to silence unrecognized numbers from bill collectors and let their corrupt and evil system rot in on itself. We don't really have the option of not getting health care and dying, we don't go to the doctor for fun, we only go when we have to.
harold 16y ago
My wife and I are healthy. But we've seen our rates more than double in the last year. I've heard many stories like the one referenced in the article where healthy people are having hard time even finding insurance. A friend (a plumber) told me the other day that he was really struggling to afford insurance for his family because his premiums had more than doubled as well. He said he had incurred 3 rate increases in 3 months. I'm just curious how many people have seen any benefit yet from health care reform? I know most of it doesn't go into effect until 2014. But something is seriously out of whack here.
- cschneid 16y ago
  My early-twenties girlfriend is able to stay on her dad's health insurance. Which is good because she has a chronic condition that would cancel any chance of purchasing individual insurance. So yes, people have seen benefits.
tom_b 16y ago
In the past three years, I have made significant career decisions based on the insurance costs and coverage of the employer. In one case, I turned down what was clearly a great hacking gig with a hacker whose work I really respected. The root issue there was that not only was the position a lot less in salary than I was previously making (this was fine and known when I started looking into the job), but the huge cost of obtaining a private policy for myself and my family blew me away. I was quite naive and assume I would be paying a small multiple more (2x or 3x) but the numbers looked to be at least double that. So, the cost of health insurance prevented me from taking a pay cut to do more interesting work. Of course, the employer was pretty strapped, if they had higher money to offer, I would have been all over it. The private health policy costs just took me by surprise.
sportsTAKES 16y ago
I find it absolutely impossible to believe that her coverage was denied for the reasons she described - I have been approved for and paid for my own insurance for years (including my family's insurance) with medical issues far more serious than those. I concede that the system is totally messed up and the new health care bill makes it even worse. Employers shouldn't be required to provide health benefits - eliminate the necessity of group plans. Open up the state lines, allow insurance companies to compete for your business and watch prices drop dramatically. I'm certainly in favor of some basic oversight but not the egregiously burdensome regulation of the current system. Anecdotally speaking, I have several friends, colleagues and family from various backgrounds that are doctors and nurses in different states and I have yet to find one of them that agrees the new health care bill is a good idea. They all think it dramatically complicate how they treat patients and ultimately marginalize the overall quality of care they will be able to provide. (Again, this is anecdotal but has definitely influenced my opinion. I have been shocked to find out that not one of these people I know actually support the new bill. Having said that, I know there are those that agree with the new bill.)
- helmut_hed 16y ago
  Your success in getting private health insurance may be due to the fact that you have "been approved for and paid for my own insurance for years". Bear in mind that the OP had group health insurance through her employer, and then tried to get private health insurance. I had much the same experience with minor things from the time I had group insurance being considered "pre-existing conditions" and justifying a denial of coverage. After many long hours of paperwork and going through the appeal process (including getting letters from doctors certifying that my minor ailments were unlikely to require expensive surgery) I now have private health insurance. I never would have imagined it would be this hard.
  - sportsTAKES 16y ago
    To clarify, I have been approved for private insurance at different times (three times actually) over roughly twelve years with intermittent times of receiving benefits from employers - I have worked off and on as an independent contractor during that time.
Uhhrrr 16y ago
The article does not mention that money _can_ buy you health _care_. Given this, there should be market opportunity for a company which courts the supposed legions of people denied for picayune reasons.
- marshray 16y ago
  Not in any fair-market sort of way. The price of prescription meds, tests, and procedures is "negotiated" between pharmacies, providers, and insurance companies. The Dr. bills "X" and the insurance company comes back with "X/2". The Dr. may try to collect the difference from you, but they usually don't. If you aren't paying with insurance, you have to pay many times higher prices than an insurance company would for the same treatment. Last I heard 80% of the market did have some type of coverage. Of the remaining 20%, many of them simply can't pay their emergency room bills. So if you have a decent income and don't have insurance, you are a very small minority with no bargaining power. In other words, no, you are not able to purchase health care in any sort of functioning market.
  - Uhhrrr 16y ago
    Which is to say, you can indeed purchase health care. You might not get the volume discount that Blue Cross et al do, but you can buy it. And, in practice, if you tell the provider that you can only pay X, it is quite possible that they will prefer getting X to getting 0.
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georgieporgie 16y ago
I'm 35, single, and paying something like $120 per month for Blue Cross coverage that I found on ehealthinsurance. I've used them each time I've not been actively employed, and I've always found an acceptable deal. Mind you, I took the high deductible route since I'm only concerned with catastrophic illness at right now. Also, the moment anything serious comes up, they can cleverly drop me, since they have ludicrous things on their forms like, "have you EVER received ANY medical treatment not listed on this form." It would be essentially impossible to answer that question unless writing about a newborn. By the way, Blue Cross tried to ratchet up my rates last year. I went back to ehealthinsurance and found a plan for about 25% less than the exact same plan directly through Blue Cross. There is no loyalty incentive whatsoever.
- dgabriel 16y ago
  What's the point of catastrophic insurance if they can drop you when you need it? It seems like you're paying for nothing.
  - georgieporgie 16y ago
    It's a gamble. I imagine that the risk of being dropped is directly proportional to the amount of attention I garner. Break a leg? Probably not a big deal. Get cancer? Better look out.
    - potatolicious 16y ago
      > "Break a leg? Probably not a big deal. Get cancer? Better look out." This is a horrifying, inhumane, uncivilized concept. Why the American public simply accepts this is mind-boggling.
      - georgieporgie 16y ago
        I don't accept it. But choosing no insurance leaves me in a worse situation. And to be fair, as another pointed out, they can't really boot me anymore for not listing every single bit of medical care I've ever gotten, which is the best single thing to happen in Obama's presidency, IMO.
SoftwareMaven 16y ago
Health insurance is broken because the people who pay the bills (the insurance companies) are not the people receiving the services (patients). If patients were actually paying the bills, they would be much more price-conscious and you would see price competition on that stupid-expensive MRI (for evidence, look at how much cheaper LASIK surgery has become and how much better it has become, yet insurance does not cover it). Doctors, on the other hand, are far more concerned about making sure the people paying the bills are taken care of. The proof that you aren't the customer is the 90 minute wait that is expected when you see a doctor. What other industry would force their customer to wait that long after making an appointment? But, since you are not the customer, that's OK, isn't it. Having had a gastric bypass, I will never be able to get insurance outside of a group plan. My wife can't get coverage for other reasons. One of my four kids can't get coverage, either. I'm 9 months into my COBRA for the start-up I'm working on. If we don't have a group plan in the next 6 months, I will have to bail on the company. And our government can't even bother to have a real dialog on the subject. Pisses me off.
- cookiecaper 16y ago
  Heh, I paid almost $1000/mo for COBRA coverage for six months last year. I think that the only plausible thing to do in that situation is to flee to Canada, or figure out how to consistently receive medical care without paying for it. Unless you're bringing in the cash hand over fist, it's just not a feasible proposition for an entrepreneurially-minded patriarch with multiple uninsurable family members to stay in the US. Your options are basically to totally ruin your credit constantly and eventually be banned from all nearby medical facilities or pay $15k+ each year for medicine. It's plausible (though not very likely with four kids) that there may be a couple of relatively quiet years medically, and then you can only hope that you don't end up paying more than $10k in bills that year. With every X-ray, mammogram, MRI, or other routine imaging procedure costing $500+, and a fifteen minute appointment costing $100-$200, it really adds up. For a multi-millionaire it's doable, but pretty difficult for anyone else.
gersh 16y ago
The US government spends $793B on medicare & medicaid, and give $215B in tax deductions for health insurance. This total $1.008 trillion/yr on healthcare costs, which totals $3272/per capita/yr. Japan spends $2249/per capita on healthcare. The UK spends $2317/per capita on healthcare. Sweden spends $2745/per capita/yr on healtchare. You get the idea. You are already paying the government for healthcare. You pay higher taxes to offset the loses for the health insurance deduction. The IRS collects medicare along with the Social Security. However, you don't get the healthcare you pay for. Instead, you have to pay again to actually get healthcare. In some countries, they call this a bribe. However, America has institutionalized it.
rms 16y ago
When I am back in the USA next month, I am planning on cancelling my virtually worthless health insurance ($90/month) and signing up for cryonics ($30/month).
danbmil99 16y ago
Can anyone shed some light on the oft-repeated "let them compete across state lines" conservative argument? Is there any chance that less regulation could actually foster some healthy competition?
- danssig 16y ago
  No, health care is an inelastic market. A free market is not the best way to handle health care (which is why no other first world country even tries to).
yaix 16y ago
It is broken ...and expensive. My health insurance (not from US) has worldwide 100% coverage, except for the US. To get a US coverage, I would have to double what I am paying now. The US health system is twice as expensive as any other health system in the world.
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quattrofan 16y ago
I went down this path myself, the company I was with in California went under and I had ended up consulting, COBRA runs out after 6 mos so I decided to buy some health insurance and I got denied. The reason being that years previously I had "asked" a consultant about a procedure that I never actually went ahead with and that was in my records which they dug up. I moved back to the UK and now enjoy the wonders of the NHS and this was one of the biggest reasons I left since I really didn't want to lose my house to pay medical bills if I got seriously ill.
jacoblyles 16y ago
Ug, this kind of article brings out the worst in Hacker News. Less like this, please. I can get this on reddit.
thinkingeric 16y ago
Something to add to the discussion: She says "my recent M.R.I. cost $1,300 at the “retail” rate, while the rate negotiated by the insurance company was $700." I have insurance and the insurance company (BCBS) will only pay what it thinks is appropriate for a service, not some negotiated rate. That is, if the doctor, hospital, or lab says that it costs $1,300, but the insurance company wants to pay $700, I'm stuck for the other $600. The result is that in order to meet the high deductible (at which point I no longer have to pay out of pocket like this), I pay way beyond the amount of the deductible since only the approved rates are applied. In practice, I end up paying out 175% or more of the deductible amount. I suspect that our experience will soon become the norm, if its not already.
- thinkingeric 16y ago
  Also, this is of course over and above what my company pays in premiums. Altogether it is a significant amount of money for a family of four that has no major medical problems. For a small business, the overall burden is problematic.
imechura 16y ago
the problem in this country is that not enough people are paying for their own health care or insurance. Some people are getting medicare others are getting medicaid, others have benefits from the VA or a government job. Others get it from unions or employers. Only the people who are responsible for paying their own bills truly understand the state of our health care industry. Because of that it is always someone else's problem and no one really minds paying 48k for 2 nights of saline drip in the hospital when the only cost to them is the 500.00 deductible. The hospital collecting the 48k certainly does not want that to change neither do any of the other predators in that food chain. Put a high tax on employer sponsored insurance plans so that all employers stop offering it as a benefit. Then we will see real reform.
hparra 16y ago
If you want to revolutionize medicine, you need to revolutionize how everyone in medicine is paid. The revolutionary technology already exists: telemedicine (TM) through live video conferencing, store & forward of image data for dermatology, radiology, or ophthalmology, home health monitoring, wearable monitoring systems, online health management systems, personal health records, genome sequencing, its all here! So what's the problem? Doctors can't get paid for any of this. Despite common belief, doctors don't get paid that much, particularly doctors that work in the public setting and must deal with Medicare (and in California, MediCal) patients. If a neurologist in San Francisco sees a Medicare patient in Los Angeles through video conferencing they can't bill Medicare because LA is not a non-Metropolitan Statistical Area. No doctor wants to deal with dismal MediCal rates. There are little to no codes to bill for home-based monitoring, and if even those exist, there is no code for a specialist to diagnose remotely. We have 30 years of academic literature praising TM. So who's holding everything up? We need a new insurance company that focuses on TM and monitoring technologies from the start to usher in what everyone and their mom has been describing as "preventive" healthcare. Sure, we'll still need traditional methods for surgeries and catastrophic events, but I'd pay out of pocket to be able to forward an image of a rash to a dermatologist or the back of my throat to my physician any day. Fast, instant, convenient. Someone in the comments mentioned Qliance, which looks promising. I'm surprised someone in SV hasn't taken advantage of something similar there. Geeks love to be on the cutting edge, why not be the cutting edge medical patient?

596 points by epall 16y ago

The cost of healthcare and college basically scared me away from migrating to the US. It's a definite trade off but here in Australia, having paid off my house, I can live almost free of overheads. It is incredibly liberating to get up in the morning and know I can go to work on my own business without worrying that some freak accident or illness will destroy me financially. On the other hand, I do think that the lack of these other costs is one reason that we have some of the highest house prices in the world. When you take away these other costs people just devote their disposable income elsewhere. Even so, I think it's better used that way than paying executives in health insurance companies.

mrkurt 16y ago

> The difference is significant: my recent M.R.I. cost $1,300 at the “retail” rate, while the rate negotiated by the insurance company was $700. The shocking thing is, if you get an MRI at a cash only diagnostics facility it can cost as little as $300.

mikebike 16y ago
I've never understood the meaning of the "retail" rates. How many people are there who can afford to pay these rates and also don't have health insurance?
- pessimizer 16y ago
  I had a bad asthma attack while uninsured and got hit with a bill that took me 7 years to pay off.
  - mikebike 16y ago
    Yipe! Were you able to negotiate the bill down at all when working out a payment plan, or did the hospital end up charging you the full amount?
    - pessimizer 16y ago
      Didn't negotiate a thing. I was pretty naive about that sort of thing at the time (really was still until the last few years, and I'm 35 now) and didn't know that bargaining was an option. I was just unemployed, broke and 22 and had a giant bill that I didn't know what to do with. I thought a bill was a bill and a debt was a debt, and had never even had a credit card in my life. Soon after that, I got a $9 an hour job at a factory and started making payments...
  - wmeredith 16y ago
    7 years and a bankruptcy drops off your credit rating...
- cookiecaper 16y ago
  Zero, obviously. People either let them lapse where possible, declare bankruptcy to get Constables off their backs, or spend years paying $50-$100/mo. Things like this happen even to insured people. Due to a communications snafu between the doctor and the insurance company, my mom, who has "good" insurance from BigCo, is paying for her annual mammogram $50/mo now, and will be doing this for the better part of two years. My parents paid on an ER visit I made in my late teens until I was 21 or 22 because of another such insurance oversight. These happen all the time because that's how insurers make money. The insurance model is based explicitly on not paying out. For something that's universally utilized like health insurance, that generally means you have to deny a lot of claims to keep acceptable margins. Homeowner's insurance works fine because most people aren't burglarized often and most peoples' homes don't burn down, so people make modest monthly payments and one claim in a lifetime more than pays for itself. Likewise, car insurance is not used too often by its patrons. Health insurance, however, is used (at least) several times a year by almost every individual. As such, insurance is a terrible model for health care, since the entire concept behind insurance is that more people are paying for the coverage than are using it. The continued feasibility of medical insurance depends on people not getting medicine.

ck2 16y ago

I just wish her report include some mention of WHAT the new legislation will in reality do for her? Because I suspect it will do little for serious health problems. IF they can pay for it, all it will do is prevent the insurance companies dropping her when she gets sick someday or stop paying out when they hit a limit like on cancer. I say that's not a lot because they ARE allowed to raise the premiums so high that the patient has to drop the insurance on their own because there's no way to for it. So the legislation is useless for the serious stuff.

ashbrahma 16y ago

Countries like India, Malaysia are starting to see a boom in Medical Tourism. It costs approximately $4500 for a open heart surgery at the best hospitals compared to $15-$20K in the US. http://en.wikipedia.org/wiki/Medical_tourism http://en.wikipedia.org/wiki/Medical_tourism

Ras_ 16y ago
Going to a dentist on your holiday would be a casual example.
- twistedanimator 16y ago
  That's exactly what I did when I went to El Salvador last year. It cost me $30 for a routine cleaning as opposed to $150 in the US.

hartror 16y ago

I might be living in a socialist paradise (Australia) or some thing but my last visit to the doctor (broken toe) was free. I am truly horrified by the state of the US health system, sure Australia's might be a bit messed up at times but it is so much better than what Americans have to deal with. Move your startup to Australia! Seriously, cheap/free heathcare for minor->medium problems (the bad stuff is still going to throw up some major bills but not bankruptcy worthy). As a plus we have a superior economy right now, better living standards and hot women. Not sure the state of the laws regarding Americans access to our healthcare but worth a look.

rdouble 16y ago
There's no visa that will let you do this. Australia has a points based immigration system. If you're younger than 25 and have an engineering degree you just barely have enough points to get a self-sponsored work visa. If you're older than 25 it's impossible to get enough points and you have to work for someone else (or marry an Australian). I'd love to be wrong about this, corrections are welcome.
- hartror 16y ago
  That is sad, given our current prosperity it would be great if we could leverage it to bring super talented entrepreneurs here to start more great businesses.
yaix 16y ago
Good to know, thanks. I am actually considering moving to AUS, however not because of health care, being from Europe. Good to know its "socialist" in Australia too ;D

ajays 16y ago

The irony is: the same Congresscritters who vote against universal health insurance get top-notch health insurance paid for by taxpayers: http://www.suite101.com/content/health-care-for-the-us-congress-a72870 http://www.suite101.com/content/health-care-for-the-us-congr... After 5 years of service, they get lifetime health insurance, the same as all federal employees and retirees:http://www.opm.gov/insure/retirees/index.asp?MainQuestionId=6 http://www.opm.gov/insure/retirees/index.asp?MainQuestionId=...

klenwell 16y ago
A few tea partiers turned down the insurance this year on principle. One was interviewed on NPR, where he acknowledged that the insurance rates he found on the open marker were a bit of a shock: http://www.npr.org/2011/02/09/133629806/16-Freshmen-GOP-Decline-Federal-Health-Coverage http://www.npr.org/2011/02/09/133629806/16-Freshmen-GOP-Decl... Still, he rationalizes away the benefits of the new Health Care law: "But I think that if we had true health care reform that I wouldn't be paying $1,300 a month for this health care. If we had true tort reform, if we had true health care reform where physicians weren't ordering unnecessary, you know, procedures just to protect their backside, I'd think that a lot of us would see a reduction in what we pay in any health care, whether it's, you know, employee - helped, subsidized, or, you know, employer-subsidized." In case you miss his weasel words: tort reform makes virtually no difference and hasn't had a noticeable impact in states where it has passed. Otherwise, the new law is about the most realistic first step you're going to get passed in this country toward controlling costs. Meanwhile, the one area where the law is halfway decent is in extending more affordable health insurance coverage to more people.
- ajays 16y ago
  IMHO, Obama and company got carried away. They saw this opportunity to enact something comparable to Social Security and Medicare, and wanted to go down in the history books as having achieved something similar. Unfortunately, like any big project in Washington, this one was laden with loopholes, sweeteners, etc. In other words, a total mess. It would have been far better to pass a series of smaller laws. Start with: it's illegal to discriminate based on pre-existing conditions. Then, create cross-state markets and let insurance companies compete across state boundaries. Then, let families buy into the Federal government's health insurance program (if our elected reps can do it, why can't we?). And so on.

ChristianMarks 16y ago

I couldn't get surgery approved on my employer's health insurance. I eventually decided not to let that stop me from changing jobs and doing what I wanted to do, despite not being able to afford surgery out of pocket and despite an inferior choice of health insurance plans. I suppose I could emigrate to England if all else fails. I can do this as my mother was a British citizen otherwise than by descent, though it is an involved process. The present system is designed to impose a huge negative externality on would-be entrepreneurs and others who might have left their jobs to pursue other opportunities. And you are subsidizing the profits of the industries that benefit from the relative immobility of labor. That negative externality you pay is someone else's subsidy. If it were up to me, I'd rather pay into a universal health care system than pay the negative externality to stay tied to an employer on account of health care coverage. Another negative externality is the administrative burden imposed on companies to handle employee health care.

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jasongullickson 16y ago

Sounds like an industry ripe with opportunity for the right hacker.

danssig 16y ago
Except for all the barriers that the established players have put in place to keep said hacker out.

hnl2sea2nrt 16y ago

I've had some luck with hacking my family's healthcare expenses in the last couple of years. I am a healthy 26 y/o with a wife and son. We were living in Seattle and healthcare was the most expensive when I was employed full-time and my wife was pregnant. Luckily, the company nearly tanked and let me go along with my entire department. I've been a self-employed consultant since then (almost 3 years) and went without insurance for about a year just so I could afford to pay for my wife and kid. Then I figured out some hacks. I found a startup health practice called Qliance in Seattle which Michael Dell, Jeff Bezos and Drew Carey have funded (nice article about it here: http://www.techflash.com/seattle/2010/04/jeff_bezos_michael_dell_drew_carey_and_others_back_health_care_startup.html http://www.techflash.com/seattle/2010/04/jeff_bezos_michael_...). For about $50/month each for my wife and I and $40 for my kid (total of ~$140) were able to see a doctor any time we wanted for non-emergencies without co-pays. I can't tell you how much weight this was off my back. Staff was friendly, service was great, modern offices, experienced doctors. Couldn't have asked for more. We got a high deductible family plan along with it which added about $200 to the costs. If you are in the Seattle area and are self-employed, this is probably your best option. The second hack was that we moved to Japan about a year ago. As others have mentioned, they have a very consumer-friendly system over here. I had a big health scare when we first moved which required lots of medication and several doctor visits, but it didn't set us back more than a couple hundred bucks. I'm really worried about moving back to the US now. I hope things get better before we move back in a couple of years.

tapp 16y ago

> "If members of Congress feel so strongly about undoing this important legislation, perhaps we should stop providing them with health insurance. Let’s credit their pay for the amount that has been paid by the taxpayers, and let them try to buy health insurance in the individual market...Health insurance reform might suddenly not seem to them like such a bad idea." Hell yes. While we're at it, lawmakers should be required to do their own taxes at least once every few years as well. In terms of systemic change, I think requiring our legislators to eat their own dogfood would do much more for our country than all of our disjointed attempts at campaign finance reform and the like.

GFischer 16y ago

So, people in the U.S. are billed an astronomical sum for a MRI, even with insurance? The most expensive MRI bill for someone in the "mutualism" system here in Uruguay is U$ 100. I tried to explain the Uruguayan "mutualist" socialist health system here: http://news.ycombinator.com/item?id=1627862 http://news.ycombinator.com/item?id=1627862 "Mutual organisations do not have external shareholders - they are controlled by their members. Members may be users of the mutual, employees, other stakeholders or a combination of these Mutual organisations are either owned by and run in the interests of existing members, as is the case in building societies, cooperatives and friendly societies, or, as in many public services, owned on behalf of the wider community and run in the interests of the wider community" A HN member compared them to credit unions, I think it's a valid analogy. The mutualist system is always near bankruptcy and is perfectible (and the government is always meddling), but it doesn't bankrupt it's users and it kind of works (life expectancy here in Uruguay is the same as in the U.S.). Edit - funnily, it seems it's very similar to the Japanese case (and MRI's cost U$ 98 there too): http://news.ycombinator.com/item?id=2247969 http://news.ycombinator.com/item?id=2247969

SapphireSun 16y ago
We have vaguely similar, but smaller versions, of the system you are talking about in the US. They are called "self insured entities" and are typically companies that bankroll their employees directly. They typically hire a professional insurance company as a "Third Party Administrator" to handle administering claims. I am unsure as to their efficacy, although scale certainly affects their performance.

ylem 16y ago

I was in France not too long ago and had to go to the emergency room for stitches. The wait was not much longer than in the US--we started talking about payment (I didn't have my insurance card on me...doh!. Finally, I asked them what the bill was--around 20 Euro. I paid cash...I talked to a doctor on the bus ride back and part of it is a combination of low malpractice suits (I think a minor part) , taxes, and the fact that doctor salaries are much lower than they are here in the US... I agree that the system is broke here.

scottshapiro 16y ago

It's simple. The US needs to stop subsidizing the bad calories (i.e. sweetners and hydrogenated oils) and enabling the treatments (i.e. dialysis, statins) that treat resulting diseases of civilization (i.e. diabetes, heart disease).

jjcc 16y ago

I used to be a long-time believer of free market. But for health care and Education system things are quite different. All the participants taking care of their own interest doesn't mean the interest of the whole society will be maximized. Some poor countries might be better than the States. Believe or not, check the healthcare of Cuba!

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acabal 16y ago

This really highlights how utterly insane our system is. I'm living off of my own business, which means that I don't have an employer to cover me under group insurance. But I really only make enough to live frugally and save a tiny amount each month--to me, an affordable health insurance plan would be between $50-$100 a month. Fat chance of that happening. And if it did, the deductible would be so high as to make the plan worthless for anything short of a car-crash-emergency-type-situation. But not only would it not happen at that price, but as the article says, it wouldn't happen period--even though I'm a healthy, nonsmoking, active 26-year-old male, I've had cubital tunnel problems in the past (typing) and surgery on my wrist (badly broken in an accident). If I applied, I would surely be denied--and again, as the article states, if you're denied once, your chances of being accepted in the future just dropped by a big percentage. It literally makes more financial sense for me to pay minor expenses out of pocket and declare bankruptcy in the chance of crippling bills than to be insured. Healthcare in America is utterly, utterly broken; it's damaging poor, middle-class, and rich people alike, and stifling innovation. I have the ability to innovate with my company because I'm young, single, and healthy; but many smart people have existing medical problems, families, or other factors that make them indentured servants to the company that pays their healthcare. As a nation we're under the thumb of the insurance companies, and instead of doing anything serious about it, we've done almost the worst possible option: require every one of us to be a customer of these monstrous companies, with little regulation on cost or other government oversight. I'm the first person to back health insurance reform, but we've reformed it in the name of shoveling more money into the pockets of industry instead of for regular people needing real care. It's crap like this that's compelling me to make my current expat lifestyle permanent. America might still get the tax dollars my business generates (the only country to still tax you if you live abroad) but it won't get my brain or my talent within its borders.

WalterBright 16y ago
"For fun, let’s imagine confiscating all the profits of all the famously greedy health-insurance companies. That would pay for four days of health care for all Americans." http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/7617/3/ http://www.theatlantic.com/magazine/archive/2009/09/how-amer... Insurance company profits are not the problem.

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krschultz 16y ago
<sarcasm>But it's written by someone involved in the tech world, that makes it hacker news</sarcasm>
- acabal 16y ago
  I think it's hacker news because hackers struggling to become ramen-profitable (or even just thinking about it!) are directly affected by the cost and availability of health insurance. It's a big factor for many people in deciding whether they want to quit their cube jobs that keep them insured to strike out on their own.
  - krschultz 16y ago
    I'm well aware of this, in fact I made the exact same point higher up in this discussion, but as much as I love politics (and thats not sarcasm, I'm probably even more into politics than technology, I've actively campaigned, gone on TV & radio for interviews about politics etc) this is not a site I come to for politics.
  - DanielBMarkham 16y ago
    It's a big factor for many people in deciding whether they want to quit their cube jobs that keep them insured to strike out on their own. And I think that's total bullshit and people who don't want to strike out won't and will find lots of reasons not to, while people who want to strike out will, and figure out how to make it work. Kind of takes us to a rhetorical dead end, since we're both wildly speculating about what some imaginary people we dream up might or might not do. All we're really doing is inventing examples to support opinions that we've already decided to hold. Look -- I think health insurance needs fixing. I also think the current solution is so bad we should fire every Congressman who voted for it and run them out of town on a rail. I further believe that if two reasonable people sat down, they'd find that most of us really aren't that far apart on the issues. But this looks like picking a fight. For no reason.

_delirium 16y ago

Does anyone have any experience with small-business health-care pools as an alternative to buying individual insurance? They've been talked about for a long time, and some states supposedly have programs for them, but I haven't heard much about how or if they work. Can you join one and get insurance at any sort of vaguely group-negotiated price with fewer of these kinds of problems?

coffeedrinker 16y ago
I've talked to an agent about that. In Washington State, she said a group plan v. individual would not make much difference. At least not enough to warrant they additional paperwork and/or insurance company switch.

coffeedrinker 16y ago

I have my family on a $10,000 deductible per person ($30,000 for family). That still costs over $500/month. Unless you have cancer, heart surgery, or some other major thing, and are in good health you'll save far more over buying a lower deductible plan. We used to have reasonable insurance, but the annual increases have been enormous, without any claims. More people will drop insurance, leaving the companies with only the sick, if they keep pushing younger, healthier people out of the system.

krschultz 16y ago

The subtle but crazy part about this is at the bottom when it details the author: "Donna Dubinsky, a co-founder of Palm Computer and Handspring, is the chief executive of a computer software company." I'm going to go out on a limb and say money is not an issue for Donna, yet she still can't even buy insurance if she wants to. I've always thought healthcare access was a bigger hurdle for entrepreneurs than tax rates. If I make a lot of money with my startup, great, I really could care less if I pay 15% or 40% of that to the gov't, because it will be a whole lot more than I make now. But not having health care insurance (or worse, having crappy insurance that denies you all the time like most individual plans do) is so damn risky it makes me afraid to step out on my own.

ajays 16y ago
+1 If the Republicans are serious about an economic recovery and want startups to flourish, then universal healthcare is a cornerstone of such an effort. I know of other people too who are afraid of leaving their (big-company) positions because they have a wife + young kids, and lack of health insurance terrifies them.
- Vivtek 16y ago
  What could possibly have given you the idea that the Republicans want an economic recovery?
  - angelbob 16y ago
    Well, eventually. Just not under Obama. Maybe if they wait a few years?
JabavuAdams 16y ago
Well, once her current software company (Numenta) deploys AI maybe she won't need coverage. /joking
sammcd 16y ago
I think she could buy insurance if she really wanted. I've thought about this a lot because I could easily be in this situation. If I did anything on my own I would need a group plan quickly. You only need 2 people to create a group. So you can buy insurance its expensive, here is how you do it. 1) Start a company. 2) Hire another employee (this costs a lot) 3) Make a group health insurance policy for the company. There you bought insurance. I know this is stupid, but I'm just the kind of person that when someone says "You can't do XXX" I automatically have to see if I can do it.

theoj 16y ago

Link without registration: <removed> Edit: Apparently you need to go through Google for this to work. See comment below.

bluishgreen 16y ago
dint work, but click thru from google works http://www.google.com/search?sourceid=chrome&ie=UTF-8&q=money+cant+bye+health+insurance#hl=en&sugexp=elsfph&xhr=t&q=Money+Wont+Buy+You+Health+Insurance+-+NYTimes.com&cp=50&qe=TW9uZXkgV29uJ3QgQnV5IFlvdSBIZWFsdGggSW5zdXJhbmNlIC0gTllUaW1lcy5jb20&qesig=rcbfvWvet2J5DX7wG0xMAA&pkc=AFgZ2tl1CKSYKfo9K59o-qj2w1_c09EpC_W1_oFlB_OK3jWc2mzq1ajNC-M68aCWMIvhIRnSHQrSI46jrNwVbe4ukokwW_3cRw&pf=p&sclient=psy&aq=f&aqi=&aql=&oq=Money+Wont+Buy+You+Health+Insurance+-+NYTimes.com&pbx=1&bav=on.1,or.&fp=681127d0c6f645aa http://www.google.com/search?sourceid=chrome&ie=UTF-8&#3...

nhangen 16y ago

I left the Army where I had free healthcare for me and my family - I got spoiled. I really can't afford it now that I'm out and not with a big company. I've thought of going into the Reserves just to have the option to buy it again. Healthcare really does suck.

tonfa 16y ago
If you are inclined to move somewhere else, there are lots of countries with affordable healthcare (most of Europe, and I guess Canada for example).
- shiny 16y ago
  How easy are these countries to get into (and become a working member of their society)? I know Switzerland and New Zealand are particularly tough.
  - raganwald 16y ago
    Canada has more opportunities than people, which is why getting in is particularly easy.
  - jasonlotito 16y ago
    Did you miss the Montreal open-source thread here yesterday? =) Canada is great for tech people looking for work. We need people up here. Sure, it gets cold in the winter, but it's really not that bad.
- nhangen 16y ago
  I am, the problem is that my wife isn't...yet. I'm working on it for sure.

sabat 16y ago

I'm an example -- I have private health insurance out of necessity. It was an arduous process, and I'm lucky to have managed to get it -- even though I'm healthy. If I had so much as one serious problem, I'm convinced I would have been turned down. It is broken. Seriously broken.

lolno 16y ago
I paid for cancer treatment, end to end, out of pocket because this country is a third world shithole in disguise. It's broken and the competition on price is non-existent even if dishonest pieces of shit like tptacek claim otherwise.

herf 16y ago

"Group of 2" in California can be husband and wife. (We did this, because the plans are better, the rates are better, and they can't limit you based on pre-existing conditions.) Just make a partnership and pay the state taxes annually (ugh).

SandB0x 16y ago

I would have died at the age of 19 if it weren't for the help of the UK's National Health Service. My parents and I didn't have to worry about hospital bills, future insurance issues, being tied to a job, any of that crap. Just get some rest, get better, go out there and be productive again. The American system looks like a horrible joke from over here. I just can't understand any of it.

ahpeeyem 16y ago
I would have lost my sight and probably then died slowly and painfully from a tumour some time in my teens if not for Australia's national Medicare system that's been treating my condition since I was 12 years old. Instead I've only had to pay a nominal fee every time I need medication. Surgery, over a dozen MRI scans and visits to specialists over the years plus other tests and whatever else have all been paid for at no cost to me. It scares the crap out of me to think what would have happened to me if I was in the USA. To be able to see specialists or have expensive tests at times when I've been lucky to have $5 to my name is something I feel enormous gratitude for. I can't imagine the hardship having to pay for all this out of pocket would cause.
DanI-S 16y ago
I moved to the US from the UK over a year ago and I can't find words to describe the feeling of not having the NHS to rely on. This whole new world of potential disaster has opened up. It's something you've never had to think about before that is now at the forefront of your consciousness. You can be young, fit and healthy, but get hit by a car and your life is over. Once you're bankrupted by medical fees, you'll never have good credit again - and in the US, this is like the mark of the beast. It's no wonder that American streets are filled by the homeless and disabled. This is a great country, with wonderful people, but in some ways it's medieval.
- RK 16y ago
  Just out of curiosity, does your NHS insurance cover you while you're in the US?

ryanwaggoner 16y ago

I'm no expert, but isn't this one of the major issues that the health care reform bill of 2010 is going to fix? Granted, it doesn't go into effect (for adults) until Jan 1, 2014, but I thought that insurance companies will be prohibited from denying coverage or charging higher rates based on pre-existing medical conditions. Am I mistaken? http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act#Provisions http://en.wikipedia.org/wiki/Patient_Protection_and_Affordab...

nostrademons 16y ago
If it's not repealed first. I believe that's what this article's addressing - she's trying to educate people enough that they will not support a repeal of Obamacare.
marshray 16y ago
I'll believe it when I see it.

Dramatize 16y ago

I'm glad we don't have these issues in Australia. The American healthcare system would be one of the only reasons not to move there to start a business.

jacques_chester 16y ago
Australia has a hybrid public/private system. You can rely on the public system for pretty much everything, but only catastrophic medical services are well-funded (and even then ...). Otherwise you will need to get used to waiting in a queue. Private health insurance then allows you to get the frills and to do so without waiting. If you have private cover and need surgery to treat a non life-threatening issue, then you can usually get it done almost immediately. If you don't have private cover, you may be waiting for years. Still, in US terms, our private cover is very cheap. I'm a single, non-smoking, exercising male, 30 years old. I pay about $1200 a year with a $500 gap. But I also pay $20,000 in taxes, a goodly portion of which make their way into the public health system (and far too much of which goes into middle class welfare, but that's by the by).
- deleted 16y ago
  [deleted]

andrewpbrett1 16y ago

Shameless plug: I'm working on a startup that, while it won't be able to directly fix people being denied coverage, will hopefully help people to understand their coverage a bit better. http://cakehealth.com http://cakehealth.com. Not yet open to all but you can sign up if that sounds interesting to you. We <3 beta users. And on a related note, I have noprocrast enabled so apologies for the n00b-looking account, real uid = andrewpbrett. Someone alerted me that this was being discussed.

mrshoe 16y ago

Can someone please explain to me why five thousand self employed people can't form a corporation together and get group insurance? Do shell corporations like that already exist?

elwin 16y ago
I believe organizations like local Chambers of Commerce do this.
zdw 16y ago
They do. Usually they handle not only health insurance, but most of the other benefits and paperwork regarding employement (payroll, etc.).
noisebleed 16y ago
I mentioned it above, but the closest I've seen to this idea is Freelancers Union / Insurance ( freelancersinsuranceco.com )
joeshaw 16y ago
For types of employment which are often for-hire or hourly (think plumbers, electricians, etc.), unions typically offer group insurance for their members. It would be nice if there were a similar union for tech entrepreneurs and startup employees... although maybe companies would become worried that such a union would start trying to negotiate for concessions from employers.
SkyMarshal 16y ago
Freelancersunion.com I believe does something similar with their health plan.

health-anon 16y ago

I'm an entrepreneur with a wife and son. I'm 23. We pay $360/mo for individual insurance and it is pretty crappy. The deductible is high and there are several "up-front" visits, which means the first X times we go to the doctor the insurance pays nothing and deducts one of our up-front visits. Each of us have X of these, so the first X times wife goes in, and then the same for me, they are not taken from the same pool. This accumulates to several hundred dollars of visits before insurance pays for anything, and then we still have the deductible to churn through, and they've applied regular visits to that as well. We're struggling to make ends meet here; our clients are good and we're trying to build a steadier base, but the pay is irregular and sometimes we have trouble meeting monthly obligations. They make it such a hassle to do anything and they rip us off so hard (providers and insurers alike) that we usually just don't pay our medical bills except what we have to pay up-front. It's too much crap to deal with, the insurance always makes up a reason not to cover things, and it's absurdly expensive. Every time we have tried to pay the people have come back saying we'd owe literally 10x more than they we were originally told we would owe. It's just not worth the headache or the hassle, much easier to silence unrecognized numbers from bill collectors and let their corrupt and evil system rot in on itself. We don't really have the option of not getting health care and dying, we don't go to the doctor for fun, we only go when we have to.

harold 16y ago

My wife and I are healthy. But we've seen our rates more than double in the last year. I've heard many stories like the one referenced in the article where healthy people are having hard time even finding insurance. A friend (a plumber) told me the other day that he was really struggling to afford insurance for his family because his premiums had more than doubled as well. He said he had incurred 3 rate increases in 3 months. I'm just curious how many people have seen any benefit yet from health care reform? I know most of it doesn't go into effect until 2014. But something is seriously out of whack here.

cschneid 16y ago
My early-twenties girlfriend is able to stay on her dad's health insurance. Which is good because she has a chronic condition that would cancel any chance of purchasing individual insurance. So yes, people have seen benefits.

tom_b 16y ago

In the past three years, I have made significant career decisions based on the insurance costs and coverage of the employer. In one case, I turned down what was clearly a great hacking gig with a hacker whose work I really respected. The root issue there was that not only was the position a lot less in salary than I was previously making (this was fine and known when I started looking into the job), but the huge cost of obtaining a private policy for myself and my family blew me away. I was quite naive and assume I would be paying a small multiple more (2x or 3x) but the numbers looked to be at least double that. So, the cost of health insurance prevented me from taking a pay cut to do more interesting work. Of course, the employer was pretty strapped, if they had higher money to offer, I would have been all over it. The private health policy costs just took me by surprise.

sportsTAKES 16y ago

I find it absolutely impossible to believe that her coverage was denied for the reasons she described - I have been approved for and paid for my own insurance for years (including my family's insurance) with medical issues far more serious than those. I concede that the system is totally messed up and the new health care bill makes it even worse. Employers shouldn't be required to provide health benefits - eliminate the necessity of group plans. Open up the state lines, allow insurance companies to compete for your business and watch prices drop dramatically. I'm certainly in favor of some basic oversight but not the egregiously burdensome regulation of the current system. Anecdotally speaking, I have several friends, colleagues and family from various backgrounds that are doctors and nurses in different states and I have yet to find one of them that agrees the new health care bill is a good idea. They all think it dramatically complicate how they treat patients and ultimately marginalize the overall quality of care they will be able to provide. (Again, this is anecdotal but has definitely influenced my opinion. I have been shocked to find out that not one of these people I know actually support the new bill. Having said that, I know there are those that agree with the new bill.)

helmut_hed 16y ago
Your success in getting private health insurance may be due to the fact that you have "been approved for and paid for my own insurance for years". Bear in mind that the OP had group health insurance through her employer, and then tried to get private health insurance. I had much the same experience with minor things from the time I had group insurance being considered "pre-existing conditions" and justifying a denial of coverage. After many long hours of paperwork and going through the appeal process (including getting letters from doctors certifying that my minor ailments were unlikely to require expensive surgery) I now have private health insurance. I never would have imagined it would be this hard.
- sportsTAKES 16y ago
  To clarify, I have been approved for private insurance at different times (three times actually) over roughly twelve years with intermittent times of receiving benefits from employers - I have worked off and on as an independent contractor during that time.

Uhhrrr 16y ago

The article does not mention that money _can_ buy you health _care_. Given this, there should be market opportunity for a company which courts the supposed legions of people denied for picayune reasons.

marshray 16y ago
Not in any fair-market sort of way. The price of prescription meds, tests, and procedures is "negotiated" between pharmacies, providers, and insurance companies. The Dr. bills "X" and the insurance company comes back with "X/2". The Dr. may try to collect the difference from you, but they usually don't. If you aren't paying with insurance, you have to pay many times higher prices than an insurance company would for the same treatment. Last I heard 80% of the market did have some type of coverage. Of the remaining 20%, many of them simply can't pay their emergency room bills. So if you have a decent income and don't have insurance, you are a very small minority with no bargaining power. In other words, no, you are not able to purchase health care in any sort of functioning market.
- Uhhrrr 16y ago
  Which is to say, you can indeed purchase health care. You might not get the volume discount that Blue Cross et al do, but you can buy it. And, in practice, if you tell the provider that you can only pay X, it is quite possible that they will prefer getting X to getting 0.

deleted 16y ago

[deleted]

georgieporgie 16y ago

I'm 35, single, and paying something like $120 per month for Blue Cross coverage that I found on ehealthinsurance. I've used them each time I've not been actively employed, and I've always found an acceptable deal. Mind you, I took the high deductible route since I'm only concerned with catastrophic illness at right now. Also, the moment anything serious comes up, they can cleverly drop me, since they have ludicrous things on their forms like, "have you EVER received ANY medical treatment not listed on this form." It would be essentially impossible to answer that question unless writing about a newborn. By the way, Blue Cross tried to ratchet up my rates last year. I went back to ehealthinsurance and found a plan for about 25% less than the exact same plan directly through Blue Cross. There is no loyalty incentive whatsoever.

dgabriel 16y ago
What's the point of catastrophic insurance if they can drop you when you need it? It seems like you're paying for nothing.
- georgieporgie 16y ago
  It's a gamble. I imagine that the risk of being dropped is directly proportional to the amount of attention I garner. Break a leg? Probably not a big deal. Get cancer? Better look out.
  - potatolicious 16y ago
    > "Break a leg? Probably not a big deal. Get cancer? Better look out." This is a horrifying, inhumane, uncivilized concept. Why the American public simply accepts this is mind-boggling.
    - georgieporgie 16y ago
      I don't accept it. But choosing no insurance leaves me in a worse situation. And to be fair, as another pointed out, they can't really boot me anymore for not listing every single bit of medical care I've ever gotten, which is the best single thing to happen in Obama's presidency, IMO.

SoftwareMaven 16y ago

Health insurance is broken because the people who pay the bills (the insurance companies) are not the people receiving the services (patients). If patients were actually paying the bills, they would be much more price-conscious and you would see price competition on that stupid-expensive MRI (for evidence, look at how much cheaper LASIK surgery has become and how much better it has become, yet insurance does not cover it). Doctors, on the other hand, are far more concerned about making sure the people paying the bills are taken care of. The proof that you aren't the customer is the 90 minute wait that is expected when you see a doctor. What other industry would force their customer to wait that long after making an appointment? But, since you are not the customer, that's OK, isn't it. Having had a gastric bypass, I will never be able to get insurance outside of a group plan. My wife can't get coverage for other reasons. One of my four kids can't get coverage, either. I'm 9 months into my COBRA for the start-up I'm working on. If we don't have a group plan in the next 6 months, I will have to bail on the company. And our government can't even bother to have a real dialog on the subject. Pisses me off.

cookiecaper 16y ago
Heh, I paid almost $1000/mo for COBRA coverage for six months last year. I think that the only plausible thing to do in that situation is to flee to Canada, or figure out how to consistently receive medical care without paying for it. Unless you're bringing in the cash hand over fist, it's just not a feasible proposition for an entrepreneurially-minded patriarch with multiple uninsurable family members to stay in the US. Your options are basically to totally ruin your credit constantly and eventually be banned from all nearby medical facilities or pay $15k+ each year for medicine. It's plausible (though not very likely with four kids) that there may be a couple of relatively quiet years medically, and then you can only hope that you don't end up paying more than $10k in bills that year. With every X-ray, mammogram, MRI, or other routine imaging procedure costing $500+, and a fifteen minute appointment costing $100-$200, it really adds up. For a multi-millionaire it's doable, but pretty difficult for anyone else.

gersh 16y ago

The US government spends $793B on medicare & medicaid, and give $215B in tax deductions for health insurance. This total $1.008 trillion/yr on healthcare costs, which totals $3272/per capita/yr. Japan spends $2249/per capita on healthcare. The UK spends $2317/per capita on healthcare. Sweden spends $2745/per capita/yr on healtchare. You get the idea. You are already paying the government for healthcare. You pay higher taxes to offset the loses for the health insurance deduction. The IRS collects medicare along with the Social Security. However, you don't get the healthcare you pay for. Instead, you have to pay again to actually get healthcare. In some countries, they call this a bribe. However, America has institutionalized it.

rms 16y ago

When I am back in the USA next month, I am planning on cancelling my virtually worthless health insurance ($90/month) and signing up for cryonics ($30/month).

danbmil99 16y ago

Can anyone shed some light on the oft-repeated "let them compete across state lines" conservative argument? Is there any chance that less regulation could actually foster some healthy competition?

danssig 16y ago
No, health care is an inelastic market. A free market is not the best way to handle health care (which is why no other first world country even tries to).

yaix 16y ago

It is broken ...and expensive. My health insurance (not from US) has worldwide 100% coverage, except for the US. To get a US coverage, I would have to double what I am paying now. The US health system is twice as expensive as any other health system in the world.

deleted 16y ago

[deleted]

quattrofan 16y ago

I went down this path myself, the company I was with in California went under and I had ended up consulting, COBRA runs out after 6 mos so I decided to buy some health insurance and I got denied. The reason being that years previously I had "asked" a consultant about a procedure that I never actually went ahead with and that was in my records which they dug up. I moved back to the UK and now enjoy the wonders of the NHS and this was one of the biggest reasons I left since I really didn't want to lose my house to pay medical bills if I got seriously ill.

jacoblyles 16y ago

Ug, this kind of article brings out the worst in Hacker News. Less like this, please. I can get this on reddit.

thinkingeric 16y ago

Something to add to the discussion: She says "my recent M.R.I. cost $1,300 at the “retail” rate, while the rate negotiated by the insurance company was $700." I have insurance and the insurance company (BCBS) will only pay what it thinks is appropriate for a service, not some negotiated rate. That is, if the doctor, hospital, or lab says that it costs $1,300, but the insurance company wants to pay $700, I'm stuck for the other $600. The result is that in order to meet the high deductible (at which point I no longer have to pay out of pocket like this), I pay way beyond the amount of the deductible since only the approved rates are applied. In practice, I end up paying out 175% or more of the deductible amount. I suspect that our experience will soon become the norm, if its not already.

thinkingeric 16y ago
Also, this is of course over and above what my company pays in premiums. Altogether it is a significant amount of money for a family of four that has no major medical problems. For a small business, the overall burden is problematic.

imechura 16y ago

the problem in this country is that not enough people are paying for their own health care or insurance. Some people are getting medicare others are getting medicaid, others have benefits from the VA or a government job. Others get it from unions or employers. Only the people who are responsible for paying their own bills truly understand the state of our health care industry. Because of that it is always someone else's problem and no one really minds paying 48k for 2 nights of saline drip in the hospital when the only cost to them is the 500.00 deductible. The hospital collecting the 48k certainly does not want that to change neither do any of the other predators in that food chain. Put a high tax on employer sponsored insurance plans so that all employers stop offering it as a benefit. Then we will see real reform.

hparra 16y ago

If you want to revolutionize medicine, you need to revolutionize how everyone in medicine is paid. The revolutionary technology already exists: telemedicine (TM) through live video conferencing, store & forward of image data for dermatology, radiology, or ophthalmology, home health monitoring, wearable monitoring systems, online health management systems, personal health records, genome sequencing, its all here! So what's the problem? Doctors can't get paid for any of this. Despite common belief, doctors don't get paid that much, particularly doctors that work in the public setting and must deal with Medicare (and in California, MediCal) patients. If a neurologist in San Francisco sees a Medicare patient in Los Angeles through video conferencing they can't bill Medicare because LA is not a non-Metropolitan Statistical Area. No doctor wants to deal with dismal MediCal rates. There are little to no codes to bill for home-based monitoring, and if even those exist, there is no code for a specialist to diagnose remotely. We have 30 years of academic literature praising TM. So who's holding everything up? We need a new insurance company that focuses on TM and monitoring technologies from the start to usher in what everyone and their mom has been describing as "preventive" healthcare. Sure, we'll still need traditional methods for surgeries and catastrophic events, but I'd pay out of pocket to be able to forward an image of a rash to a dermatologist or the back of my throat to my physician any day. Fast, instant, convenient. Someone in the comments mentioned Qliance, which looks promising. I'm surprised someone in SV hasn't taken advantage of something similar there. Geeks love to be on the cutting edge, why not be the cutting edge medical patient?