6 ms·

> Still worth it for 'free' education and 'free' healthcare? No brainer, absolutely worth it. Even making good money in Silicon Valley I'm perpetually afraid

by jjav 6y ago

> Still worth it for 'free' education and 'free' healthcare? No brainer, absolutely worth it. Even making good money in Silicon Valley I'm perpetually afraid of medical bankruptcy if something were to happen. And the cost of education here takes another 15% off my salary for schools far lower quality than in Finland.

TheGrim-888 6y ago
If you're afraid of an unexpected large financial burden, I have news for you, there's a product you can buy that limits the unexpected burden in return for small regular payments, it's called insurance! If you're afraid of your vehicle being unexpectedly totaled, you can insure it! Similarly, you can buy health insurance to insure you against the scenario you're so worried about. It's an unheard of idea, I know. And even better, the extra 30+% of your paycheck that you don't have to pay in tax, you can use that to pay for your health insurance.
ciarannolan 6y ago
You're "making good money in Silicon Valley" and don't have health insurance? Are you freelancing and choosing not to purchase insurance?
- bleepblorp 6y ago
  The overwhelming majority of Americans who experience medical bankruptcy have health insurance.
- misterpigs 6y ago
  You're assuming that whatever you're stricken with leaves you in good enough health to continue working.
  - refurb 6y ago
    But that’s true in Canada as well. The medical expenses might not bankrupt you, but not being able to work will. https://bankruptcy-canada.com/bankruptcy/causes-of-bankruptcy/ https://bankruptcy-canada.com/bankruptcy/causes-of-bankruptc...
- purerandomness 6y ago
  You're obviously not from the US. In the US, they have this concept of a "pre-existing condition", and depending on your situation, a health insurance might cover it, or not, as far as I understand. Even making good money in SV, you can still end up with a medical bankruptcy (or your family, for that matter).
  - sgerenser 6y ago
    Since the ACA became law in the US (10 years ago) all health insurance has to cover preexisting conditions.
  - deleted 6y ago
    [deleted]
  - ciarannolan 6y ago
    You're about a decade late with this comment. Just like I won't expound on German healthcare policy, maybe you should reserve judgement on US healthcare policy until you actually know what you're talking about.
ryandrake 6y ago
Barring the few lucky people with those platinum-plated insurance policies, American workers with normal insurance are one random cancer diagnosis away from total bankruptcy. You can have a great salary, do everything right, be frugal, save in your 401k invest well——it all goes poof when you get sick. Honestly, I’d trade half my salary to not have to avoid the doctor because his diagnosis might ruin me.
- jlmorton 6y ago
  There's an $8,500 annual maximum out-of-pocket per individual under ACA. That's a lot over several years, but it's not going to be retirement-destroying for most SV workers.
  - geofft 6y ago
    This is only true of Marketplace plans (which are, increasingly, very bad deals is you're not actively using your insurance - even back in 2015 when I was looking for Marketplace plans for myself, I could easily spend close to that amount on the premiums of plans that had high deductibles/coinsurance/etc. and it's not like the Marketplace has gotten more competitive since then), and I think it's only true of expenses that the insurance company is willing to cover - if you get treatment out of network, or if you get treatment beyond what's insured (e.g. you get "elective" surgery on the medical advice of your doctor to avoid a bigger problem later), I don't believe those are covered by the out-of-pocket max.
    - jlmorton 6y ago
      The out of pocket maximum also applies to non-grandfathered group insurance plans. There were some plans allowed to be grandfathered, so the plans wouldn't terminate as non-compliant, but in practice the vast majority of plans terminate every year, and essentially everyone with health insurance now has an $8,500 per individual annual out of pocket maximum. I'm sure if you look at your own insurance, you'll find $8,500 or less. It's true this cap only applies to in-network, approved care. But that's the same under any health plan, whether universal, or not. For instance, Sovaldi and Harvoni are curative for hepatitis C, but it costs $50,000 for a 12-week course of treatment in the UK. There are 210,000 people with hepatitis in the UK, but the NHS only furnishes 10,000 courses of treatment per year. If you're not approved, you can't get it from the NHS, but you're free to buy it yourself, of course.
reader_mode 6y ago
>Even making good money in Silicon Valley I'm perpetually afraid of medical bankruptcy if something were to happen. Let me get this straight - you are covered by medical insurance (assuming on "making good money"), and you're "perpetually afraid" that you will be forced in to bankruptcy after being treated for life threatening condition ? Not the fact that you'll first need to have a life threatening condition that requires a huge amount of money to treat, which you will need to overcome to get to the bankruptcy part, but the fact that you'll need to go through bankruptcy afterwards ? I mean there are ways to hedge against that scenario if you have the money and are really afraid of it - maybe start treating family better and share your money so you have a support network to fall back to if you get in to such situations, or work on building it - going through those scenarios alone is going to suck without it - ignoring social safety net and economic factors. You people make it seem like bankruptcy is worse than death.
- geofft 6y ago
  This is an entirely reasonable concern and I agree with it. If you're not in the US (or you're young / otherwise don't know people with horror stories) it may not make sense to you, and yes, it's awful that it's realistic, but it's still realistic. 1. Coverage by medical insurance, in the US, does not generally translate to 100% coverage. For a variety of reasons, including coinsurance, copays, out-of-network coverage (especially common if there's some sort of emergency), in-network coverage beyond what's covered (e.g., the doctor says "this is medically necessary" and some bureaucrat at the insurance company says "I disagree"), and so forth, you can have a medical insurance plan and still be on the hook for large amounts of money. (I don't think you implied this, but just to clarify, "making good money" is typically not strongly correlated with having good insurance. Because of how byzantine medical insurance is, it's hard for a potential employee to figure out what their offered benefits will actually cover, so it's generally not a factor in negotiations at all, unlike actual salary, and in turn higher-paying employers don't have a particularly strong reason to offer better insurance plans.) 2. You can have a "life-threatening condition" that is easily manageable via modern medicine. Take diabetes, for instance - life-threatening if unmanaged, but very well-understood in how to manage it. I have a friend with a chronic condition that requires taking an (expensive, only partially covered by high-tech-employee insurance plans) injection once a month. As long as they take that injection they're fine; their body becomes effectively unusable without it. I know multiple people who have beaten cancer; I don't think any of them would say that the actual process of beating it was easy (or cheap). The whole reason you care about medical care is so that "life-threatening conditions" stop being life-threatening. Also, we have this pandemic going around which absolutely can be life-threatening, but even among the people who get very sick with it, many of them come out of it fine provided they have immediate high-quality medical care. 3. Beyond the assumption that the person you're replying to is treating family poorly... the amounts of money in question are generally larger than can even be pooled across many family members and large support networks, even if they all have substantial savings on their own. And even if technically I can manage to pay off a medical bill by exhausting my life savings and those of my extended family, what happens when someone else in the family gets sick?
PopeDotNinja 6y ago
I had a six figure income in San Francisco & insurance, and still ended up medically bankrupt. Bike accident, head trauma, unable to work, work tied to job... employer sponsored healthcare sucks if your ability to work is compromised.
- pkaye 6y ago
  Your employer didn't provide short/long term disability insurance?
  - soul_grafitti 6y ago
    Do you live and work in America?
    - pkaye 6y ago
      Yes I do. If you have a six figure salary (or even a bit less), an employer will certainly buy a short/long term disability plan for their employees. Its a perk even small startups can afford. Also California is unique among the states in that it runs a mandatory short term disability plan through payroll deductions but employers are able to buy enhanced plans which cover higher income thresholds.
      - PopeDotNinja 6y ago
        Even if they did, I was massively depressed with two broken arms and a head injury. I wasn’t thinking clearly about my options. Trying to navigate the healthcare system when you can't wipe your own ass is not a fun situation to be in.
  - jjav 6y ago
    Disability insurance provides a percentage of your salary while disabled. It does not provide medical insurance and often you'll get dropped by the company insurance because you're not working.
refurb 6y ago
You work in Silicon Valley, have good insurance and you’re worried about medical bankruptcy? I was in the same shoes as you and had zero concerns about it (yes I realized that a very lucky position to be in). Even if I had something horrible happen my max out of pocket was like $4k for the year with no limit to coverage. If I lost my job, had zero income and no insurance I’d qualify for Medi-cal.
- tclancy 6y ago
  How did it go when you had a really serious medical situation? My eye opener was my first programming job when one of the owners had twins with really serious health problems at birth. Turned out a million dollars was the cap the insurance was willing to cough up for them.
  - klipt 6y ago
    I think lifetime caps are now illegal thanks to Obamacare?
  - refurb 6y ago
    No more lifetime caps.

by jjav 6y ago

TheGrim-888 6y ago

If you're afraid of an unexpected large financial burden, I have news for you, there's a product you can buy that limits the unexpected burden in return for small regular payments, it's called insurance! If you're afraid of your vehicle being unexpectedly totaled, you can insure it! Similarly, you can buy health insurance to insure you against the scenario you're so worried about. It's an unheard of idea, I know. And even better, the extra 30+% of your paycheck that you don't have to pay in tax, you can use that to pay for your health insurance.

ciarannolan 6y ago

You're "making good money in Silicon Valley" and don't have health insurance? Are you freelancing and choosing not to purchase insurance?

bleepblorp 6y ago
The overwhelming majority of Americans who experience medical bankruptcy have health insurance.
misterpigs 6y ago
You're assuming that whatever you're stricken with leaves you in good enough health to continue working.
- refurb 6y ago
  But that’s true in Canada as well. The medical expenses might not bankrupt you, but not being able to work will. https://bankruptcy-canada.com/bankruptcy/causes-of-bankruptcy/ https://bankruptcy-canada.com/bankruptcy/causes-of-bankruptc...
purerandomness 6y ago
You're obviously not from the US. In the US, they have this concept of a "pre-existing condition", and depending on your situation, a health insurance might cover it, or not, as far as I understand. Even making good money in SV, you can still end up with a medical bankruptcy (or your family, for that matter).
- sgerenser 6y ago
  Since the ACA became law in the US (10 years ago) all health insurance has to cover preexisting conditions.
- deleted 6y ago
  [deleted]
- ciarannolan 6y ago
  You're about a decade late with this comment. Just like I won't expound on German healthcare policy, maybe you should reserve judgement on US healthcare policy until you actually know what you're talking about.

ryandrake 6y ago

Barring the few lucky people with those platinum-plated insurance policies, American workers with normal insurance are one random cancer diagnosis away from total bankruptcy. You can have a great salary, do everything right, be frugal, save in your 401k invest well——it all goes poof when you get sick. Honestly, I’d trade half my salary to not have to avoid the doctor because his diagnosis might ruin me.

jlmorton 6y ago
There's an $8,500 annual maximum out-of-pocket per individual under ACA. That's a lot over several years, but it's not going to be retirement-destroying for most SV workers.
- geofft 6y ago
  This is only true of Marketplace plans (which are, increasingly, very bad deals is you're not actively using your insurance - even back in 2015 when I was looking for Marketplace plans for myself, I could easily spend close to that amount on the premiums of plans that had high deductibles/coinsurance/etc. and it's not like the Marketplace has gotten more competitive since then), and I think it's only true of expenses that the insurance company is willing to cover - if you get treatment out of network, or if you get treatment beyond what's insured (e.g. you get "elective" surgery on the medical advice of your doctor to avoid a bigger problem later), I don't believe those are covered by the out-of-pocket max.
  - jlmorton 6y ago
    The out of pocket maximum also applies to non-grandfathered group insurance plans. There were some plans allowed to be grandfathered, so the plans wouldn't terminate as non-compliant, but in practice the vast majority of plans terminate every year, and essentially everyone with health insurance now has an $8,500 per individual annual out of pocket maximum. I'm sure if you look at your own insurance, you'll find $8,500 or less. It's true this cap only applies to in-network, approved care. But that's the same under any health plan, whether universal, or not. For instance, Sovaldi and Harvoni are curative for hepatitis C, but it costs $50,000 for a 12-week course of treatment in the UK. There are 210,000 people with hepatitis in the UK, but the NHS only furnishes 10,000 courses of treatment per year. If you're not approved, you can't get it from the NHS, but you're free to buy it yourself, of course.

reader_mode 6y ago

>Even making good money in Silicon Valley I'm perpetually afraid of medical bankruptcy if something were to happen. Let me get this straight - you are covered by medical insurance (assuming on "making good money"), and you're "perpetually afraid" that you will be forced in to bankruptcy after being treated for life threatening condition ? Not the fact that you'll first need to have a life threatening condition that requires a huge amount of money to treat, which you will need to overcome to get to the bankruptcy part, but the fact that you'll need to go through bankruptcy afterwards ? I mean there are ways to hedge against that scenario if you have the money and are really afraid of it - maybe start treating family better and share your money so you have a support network to fall back to if you get in to such situations, or work on building it - going through those scenarios alone is going to suck without it - ignoring social safety net and economic factors. You people make it seem like bankruptcy is worse than death.

geofft 6y ago
This is an entirely reasonable concern and I agree with it. If you're not in the US (or you're young / otherwise don't know people with horror stories) it may not make sense to you, and yes, it's awful that it's realistic, but it's still realistic. 1. Coverage by medical insurance, in the US, does not generally translate to 100% coverage. For a variety of reasons, including coinsurance, copays, out-of-network coverage (especially common if there's some sort of emergency), in-network coverage beyond what's covered (e.g., the doctor says "this is medically necessary" and some bureaucrat at the insurance company says "I disagree"), and so forth, you can have a medical insurance plan and still be on the hook for large amounts of money. (I don't think you implied this, but just to clarify, "making good money" is typically not strongly correlated with having good insurance. Because of how byzantine medical insurance is, it's hard for a potential employee to figure out what their offered benefits will actually cover, so it's generally not a factor in negotiations at all, unlike actual salary, and in turn higher-paying employers don't have a particularly strong reason to offer better insurance plans.) 2. You can have a "life-threatening condition" that is easily manageable via modern medicine. Take diabetes, for instance - life-threatening if unmanaged, but very well-understood in how to manage it. I have a friend with a chronic condition that requires taking an (expensive, only partially covered by high-tech-employee insurance plans) injection once a month. As long as they take that injection they're fine; their body becomes effectively unusable without it. I know multiple people who have beaten cancer; I don't think any of them would say that the actual process of beating it was easy (or cheap). The whole reason you care about medical care is so that "life-threatening conditions" stop being life-threatening. Also, we have this pandemic going around which absolutely can be life-threatening, but even among the people who get very sick with it, many of them come out of it fine provided they have immediate high-quality medical care. 3. Beyond the assumption that the person you're replying to is treating family poorly... the amounts of money in question are generally larger than can even be pooled across many family members and large support networks, even if they all have substantial savings on their own. And even if technically I can manage to pay off a medical bill by exhausting my life savings and those of my extended family, what happens when someone else in the family gets sick?

PopeDotNinja 6y ago

I had a six figure income in San Francisco & insurance, and still ended up medically bankrupt. Bike accident, head trauma, unable to work, work tied to job... employer sponsored healthcare sucks if your ability to work is compromised.

pkaye 6y ago
Your employer didn't provide short/long term disability insurance?
- soul_grafitti 6y ago
  Do you live and work in America?
  - pkaye 6y ago
    Yes I do. If you have a six figure salary (or even a bit less), an employer will certainly buy a short/long term disability plan for their employees. Its a perk even small startups can afford. Also California is unique among the states in that it runs a mandatory short term disability plan through payroll deductions but employers are able to buy enhanced plans which cover higher income thresholds.
    - PopeDotNinja 6y ago
      Even if they did, I was massively depressed with two broken arms and a head injury. I wasn’t thinking clearly about my options. Trying to navigate the healthcare system when you can't wipe your own ass is not a fun situation to be in.
- jjav 6y ago
  Disability insurance provides a percentage of your salary while disabled. It does not provide medical insurance and often you'll get dropped by the company insurance because you're not working.

refurb 6y ago

You work in Silicon Valley, have good insurance and you’re worried about medical bankruptcy? I was in the same shoes as you and had zero concerns about it (yes I realized that a very lucky position to be in). Even if I had something horrible happen my max out of pocket was like $4k for the year with no limit to coverage. If I lost my job, had zero income and no insurance I’d qualify for Medi-cal.

tclancy 6y ago
How did it go when you had a really serious medical situation? My eye opener was my first programming job when one of the owners had twins with really serious health problems at birth. Turned out a million dollars was the cap the insurance was willing to cough up for them.
- klipt 6y ago
  I think lifetime caps are now illegal thanks to Obamacare?
- refurb 6y ago
  No more lifetime caps.