4 ms·

That's not how insurance works, expensive insurance has a lower max out of pocket. What you are talking about is that rich people don't need insurance at all.

That's not how insurance works, expensive insurance has a lower max out of pocket. What you are talking about is that rich people don't need insurance at all. They just pay out of pocket.

robocat 6y ago
That is how health insurance works in New Zealand. If you want private health insurance for say $50 a month[1], then insurance gives access to procedures more quickly and the rooms are much nicer than the public health care system. It may give access to rare but expensive procedures. If you don’t want insurance, then the default is the public healthcare system, which is paid for by taxes. You will usually be in a ward with other patients. You pay small amounts on use (to prevent abuse, and even those amounts are reduced to nearly free if you are poor). The level of care is reasonable, but can be slow for non-urgent elective surgery, and extremely expensive procedures are not available. The public healthcare system handles ongoing chronic conditions much better than a private system could. [1] You can see a quote from https://www.southerncross.co.nz/ https://www.southerncross.co.nz/ if you give your age, gender and tick whether you smoke. Note that Southern Cross is a nonprofit co-op, most premiums get returned to members (on average, less an approx 10% administrative overhead).
- karmicthreat 6y ago
  That system looks terrible for handling cancer and pre-existing conditions.
  - kevin_thibedeau 6y ago
    As opposed to one where everyone avoids medical care at all costs to avoid extortionate bills?
    - missedthecue 6y ago
      I don't think there is any system like that in first world countries. The US isn't like that if that's what you're insinuating
      - grecy 6y ago
        Please look around you a little more. My buddy separated his shoulder snowboarding in Tahoe. He had a full time (40 hours a week) job at the time, but it didn't provide healthcare. He couldn't afford to go to hospital, so never did. I was visiting from Australia at the time and was utterly horrified, having no idea the US worked like that. Now years later his shoulder is still screwed. Of course people in the US avoid going if at all possible, it's horrendously expensive, and medical bills are the number one cause for bankruptcy in the US [1] In a stack of OECD countries (all the other ones?) nobody has ever gone bankrupt from medical bills, because that's impossible. [1] https://www.thebalance.com/medical-bankruptcy-statistics-4154729 https://www.thebalance.com/medical-bankruptcy-statistics-415...
        hateMyIdeas 6y ago
        Person doesn't have insurance and injured themselves doing a risky activity, and can't afford treatment. If it's really bad, why not use bankruptcy, I can't imagine this person has anything valuable given the history you described. Or use physical therapy, it's cheap.
        WaylonKenning 6y ago
        What is insurance for? To cover risk of something bad happening. The bigger the pool paying for it, the less impact to any one person to cover all the risk. Now imagine that was scaled up to a whole country. That's New Zealand. Check out the Accident Compensation Corporation. All medical costs related to accidents are automatically covered! But who pays the costs! Everyone, via levies. How much? $2000 on a $150K IT income. But how do you control costs? Who is entitled? Who is at fault? Surprise! It's a no-fault accident insurance system that covers all accidents. In exchange for that, we gave up our right to sue in accidents for medical damages. Why pay a lawyer when they're not required?
  - flukus 6y ago
    Cancer is not an elective surgery and gets treated with urgency. Across the Tasman Sea with a very similar system my father had bowel cancer removed the day after diagnosis in the public system and spent most of the recovery in no state to miss a private room.
  - robocat 6y ago
    All NZers get treated for cancer or pre-existing conditions, within the funding limits of the health system. Severe health problems don’t bankrupt NZers, and you are not locked into a job just to (a) keep your insurance, or (b) keep your insurance benefits. How many recently unemployed in the US have lost cover for their pre-existing conditions? I expect you can find the benefits list document for Southern Cross, if you wished to check out the details of cover for cancer or pre-existing conditions.
- cadlin 6y ago
  The most expensive plan for my family (2 parents and a young child) is $367 a month. Equivalent coverage in the US would be thousands of dollars.
  - goodcanadian 6y ago
    I do not know the New Zealand system, but I suspect the base level of care is still covered by public funding and the insurance is only covering optional extras (like private rooms).
- int_19h 6y ago
  They still pay taxes, though. Germany allows people to opt out entirely, although there are a bunch of conditions and limitations. Most people don't, so the public system can still pay for itself.
  - zaarn 6y ago
    Sadly in germany it's rather difficult to switch between public and private or no insurance. Or rather, it's very difficult to get back on a public insurance once you're private or self-insured. The best you can hope for is pulling it off once, maybe twice.
    - AndrewDucker 6y ago
      That doesn't seem unreasonable. If you're avoiding paying into a system because you don't want to claim from it then letting you hop back on whenever you need it would destroy the system very quickly.
      - zaarn 6y ago
        It's not that easy, luckily, if you're self-insured and have to take the service of a doctor, you can't switch just like that. It takes about a year of paper exchange with everyone involved to switch cleanly. Even then, any costs you started paying for from before will still have to be paid unless you're below a certain income bracket (or declare bankruptcy). So if you were self-insured and broke a leg, then decided to switch back to insurance, you'd still be on the hook for the costs of the ongoing physiotherapy until it is healed back up. The insurance doesn't have to actually pay anything that happened before a switch (switching from public to public insurance or private to private doesn't have this limit, private to public and the other way round but you don't pay, your old insurance pays).
    - josinalvo 6y ago
      I'd wager that is by design, and one of the ways they keep people from avoiding insurance when young and healthy, and then getting it when old

That's not how insurance works, expensive insurance has a lower max out of pocket. What you are talking about is that rich people don't need insurance at all. They just pay out of pocket.

robocat 6y ago

That is how health insurance works in New Zealand. If you want private health insurance for say $50 a month[1], then insurance gives access to procedures more quickly and the rooms are much nicer than the public health care system. It may give access to rare but expensive procedures. If you don’t want insurance, then the default is the public healthcare system, which is paid for by taxes. You will usually be in a ward with other patients. You pay small amounts on use (to prevent abuse, and even those amounts are reduced to nearly free if you are poor). The level of care is reasonable, but can be slow for non-urgent elective surgery, and extremely expensive procedures are not available. The public healthcare system handles ongoing chronic conditions much better than a private system could. [1] You can see a quote from https://www.southerncross.co.nz/ https://www.southerncross.co.nz/ if you give your age, gender and tick whether you smoke. Note that Southern Cross is a nonprofit co-op, most premiums get returned to members (on average, less an approx 10% administrative overhead).

karmicthreat 6y ago
That system looks terrible for handling cancer and pre-existing conditions.
- kevin_thibedeau 6y ago
  As opposed to one where everyone avoids medical care at all costs to avoid extortionate bills?
  - missedthecue 6y ago
    I don't think there is any system like that in first world countries. The US isn't like that if that's what you're insinuating
    - grecy 6y ago
      Please look around you a little more. My buddy separated his shoulder snowboarding in Tahoe. He had a full time (40 hours a week) job at the time, but it didn't provide healthcare. He couldn't afford to go to hospital, so never did. I was visiting from Australia at the time and was utterly horrified, having no idea the US worked like that. Now years later his shoulder is still screwed. Of course people in the US avoid going if at all possible, it's horrendously expensive, and medical bills are the number one cause for bankruptcy in the US [1] In a stack of OECD countries (all the other ones?) nobody has ever gone bankrupt from medical bills, because that's impossible. [1] https://www.thebalance.com/medical-bankruptcy-statistics-4154729 https://www.thebalance.com/medical-bankruptcy-statistics-415...
      - hateMyIdeas 6y ago
        Person doesn't have insurance and injured themselves doing a risky activity, and can't afford treatment. If it's really bad, why not use bankruptcy, I can't imagine this person has anything valuable given the history you described. Or use physical therapy, it's cheap.
        WaylonKenning 6y ago
        What is insurance for? To cover risk of something bad happening. The bigger the pool paying for it, the less impact to any one person to cover all the risk. Now imagine that was scaled up to a whole country. That's New Zealand. Check out the Accident Compensation Corporation. All medical costs related to accidents are automatically covered! But who pays the costs! Everyone, via levies. How much? $2000 on a $150K IT income. But how do you control costs? Who is entitled? Who is at fault? Surprise! It's a no-fault accident insurance system that covers all accidents. In exchange for that, we gave up our right to sue in accidents for medical damages. Why pay a lawyer when they're not required?
- flukus 6y ago
  Cancer is not an elective surgery and gets treated with urgency. Across the Tasman Sea with a very similar system my father had bowel cancer removed the day after diagnosis in the public system and spent most of the recovery in no state to miss a private room.
- robocat 6y ago
  All NZers get treated for cancer or pre-existing conditions, within the funding limits of the health system. Severe health problems don’t bankrupt NZers, and you are not locked into a job just to (a) keep your insurance, or (b) keep your insurance benefits. How many recently unemployed in the US have lost cover for their pre-existing conditions? I expect you can find the benefits list document for Southern Cross, if you wished to check out the details of cover for cancer or pre-existing conditions.
cadlin 6y ago
The most expensive plan for my family (2 parents and a young child) is $367 a month. Equivalent coverage in the US would be thousands of dollars.
- goodcanadian 6y ago
  I do not know the New Zealand system, but I suspect the base level of care is still covered by public funding and the insurance is only covering optional extras (like private rooms).
int_19h 6y ago
They still pay taxes, though. Germany allows people to opt out entirely, although there are a bunch of conditions and limitations. Most people don't, so the public system can still pay for itself.
- zaarn 6y ago
  Sadly in germany it's rather difficult to switch between public and private or no insurance. Or rather, it's very difficult to get back on a public insurance once you're private or self-insured. The best you can hope for is pulling it off once, maybe twice.
  - AndrewDucker 6y ago
    That doesn't seem unreasonable. If you're avoiding paying into a system because you don't want to claim from it then letting you hop back on whenever you need it would destroy the system very quickly.
    - zaarn 6y ago
      It's not that easy, luckily, if you're self-insured and have to take the service of a doctor, you can't switch just like that. It takes about a year of paper exchange with everyone involved to switch cleanly. Even then, any costs you started paying for from before will still have to be paid unless you're below a certain income bracket (or declare bankruptcy). So if you were self-insured and broke a leg, then decided to switch back to insurance, you'd still be on the hook for the costs of the ongoing physiotherapy until it is healed back up. The insurance doesn't have to actually pay anything that happened before a switch (switching from public to public insurance or private to private doesn't have this limit, private to public and the other way round but you don't pay, your old insurance pays).
  - josinalvo 6y ago
    I'd wager that is by design, and one of the ways they keep people from avoiding insurance when young and healthy, and then getting it when old