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It more and more feels like the difference between not having insurance, and having insurance when something bad actually happens is "do I get a massive bill th

It more and more feels like the difference between not having insurance, and having insurance when something bad actually happens is "do I get a massive bill that I can't afford now, or do I get a massive bill that I can't afford later?". The only real benefit of having "insurance" in the US is having reasonable access to basic preventative care. Don't get me wrong, it is a massive advantage to have default access to basic preventative care (without it being a cost-benefit tradeoff each time), but that is in no way/shape/form "insurance" in the typical meaning of the term.

majormajor 5y ago
Most of the time the system works for people who have good coverage. The tragedy is that "having good coverage" is a hard-to-control combination of luck in employer and/or wealth. It's terrible that these things happen at all, and we CERTAINLY need to improve the US healthcare system, but exaggerations like "the only benefit of insurance in the US is access to preventative care" doesn't help. If people were regularly getting fucked like that the system wouldn't have the entrenched support it does from the "but I want to keep my insurance" camp, and so speaking in generalities like that just makes you appear uninformed to the millions who regularly see doctors, get treatment, have surgery, etc, without these problems. It also cheapens the inequality problem: the gap isn't just "has access to preventive care" vs "doesn't have that access." The gap is "has hundreds of thousands of dollars, or even millions, of bills turn into nothing" vs "bankrupt if they seek treatment for any serious problem."
- NationalPark 5y ago
  I've had "good" coverage for my 15 year career and it does not work most of the time, or even half of the time. I've paid bills out of pocket because I didn't have time to untangle payer/insurance situations. I was taken to the ER unconscious once after a freak accident and ended up paying thousands for the ambulance. I've had to do provider paperwork myself and submit it to insurers myself because they refused to help me help them get paid. The system is simply not functional for people who don't have huge amounts of free time, patience, and money.
  - pkaye 5y ago
    That is why I like the Kaiser HMO system. Most of the rates are pre-negotiated since the hospital and insurance are under the same company. Its typically $20/40 copay for a doctor visit. Even for me with my kidney failure and health issues, the OOP is minimal.
- pavlov 5y ago
  > “If people were regularly getting fucked like that the system wouldn't have the entrenched support it does from the "but I want to keep my insurance" camp” I don’t see how that follows. The “I’ve got mine” camp doesn’t care that it happens to those other people, and also doesn’t understand that it could happen to them in their old age (or simply after bad luck) because they’ve only made short visits into the system.
- ohazi 5y ago
  > Most of the time the system works for people who have good coverage. I'm sorry, but I just can't see how this is true. Do you only go to the doctor for a yearly checkup, or something? I've had "good" coverage (paid for by big employers with cushy all inclusive packages), and I've also had the cheapest option on CA’s exchange, and the only difference was whether I had to pay the receptionist $25 or $150. The "we won't cover this" and the "surprise, this costs 50x what you were told!" billing nightmare comes six months later. This has happened with every insurer I've ever had.
  - rootusrootus 5y ago
    It really does vary by individual. My mom is going through cancer treatment right now. 35K/month in medication and she pays $250. I don't expect surprise bills later. She had surgery 8 years ago for the same cancer and that was also $250, for a week-long hospital stay. In my experience it does help to have an HMO. My mom uses Kaiser. So there's none of this in- vs out-of-network. One billing system, one insurance, etc. She has nothing but positive things to say about them. My dad had a similar experience towards the end of his life. He loved 'em. And nobody was left destitute as the result of his medical care.
    - hef19898 5y ago
      That shouldn't be the exception, that should be the rule.
    - nrmitchi 5y ago
      One of the problems with the how the US medical system works is that "35K/month in medication" is only "35k/month" because of some expectation that insurance is going to pay whatever the negotiated rate it (and I seriously doubt that it's 35k/month). Lets look at it this way: If that was the true price, what percentage of the US population do you think has the funds to actually pay $420k/year in for medication?
      - rootusrootus 5y ago
        In this case the insurance is paying $25K/month for the medication, so they definitely did negotiate it down somewhat. > what percentage of the US population do you think has the funds to actually pay $420k/year in for medication? Zero, plus or minus. That's why the manufacturers basically give it away to people who can't afford it. Because they can, and it helps them somewhat mitigate the bad PR.
- nrmitchi 5y ago
  > If people were regularly getting fucked like that I'm not sure what point you're trying to make, but it sounds like you're making the claim that people in the US don't regularly end up with massive surprise medical bills? This entire conversation is about action the government is taking because it happens so often. > "has hundreds of thousands of dollars, or even millions, of bills turn into nothing" That's not really how that works. It's not like your insurance company is actually paying "millions of dollars", they're paying some level of reasonable negotiated rate. If they actually had to pay "millions of dollars", that's when they claim something is not covered and you get stuck with a bill anyways. Edit: First quote was just wrong from a bad copy/paste
- treyfitty 5y ago
  After serving 3 large employers and reading through all the fine print attached to each health insurance policy, I can wholeheartedly say most companies do not offer "good coverage." After experiencing the fallout from my father's heart attack, I scoured through every health document I received afterwards, including but not limited to health insurance policies. Of my different health insurance policies, the longest duration in an ICU that was covered by any of those insurance policies was 60 days. My father was "lucky" in that he was on a subsidized Obamacare policy that "only" charged $350 per month (which was cheaper than my employer's policy) but was FAR superior to any of my employers' health insurance in every aspect.
usefulcat 5y ago
> The only real benefit of having "insurance" in the US is having reasonable access to basic preventative care What insurance do you have where the cost of the annual premium is less than what the out of pocket costs would be for annual checkups for the covered individuals? I have the cheapest insurance I can get. Yes, it pays for basic preventative care (basically a checkup per person per year), and it also costs more than my mortgage.
ryandrake 5y ago
When you have insurance, a claim should become purely a discussion between your insurance company and the health providers. It seems the current system needlessly inserts the patient into the middle, for the purpose of torturing him/her with paperwork, threats, bills, threats of bills, and the need to learn the intricacies of in-network, deductibles and co-pays, lifetime maximums, covered vs. uncovered procedures, etc. Instead of the insurance and health companies privately fighting it out between each other, they stick you in the middle, fighting through you as the proxy/punchingbag. Wouldn't it be better if you went to the hospital, gave them your insurance information, and that's the last you ever were involved with anything regarding payment? Isn't that one of the reasons we have insurance?

majormajor 5y ago

Most of the time the system works for people who have good coverage. The tragedy is that "having good coverage" is a hard-to-control combination of luck in employer and/or wealth. It's terrible that these things happen at all, and we CERTAINLY need to improve the US healthcare system, but exaggerations like "the only benefit of insurance in the US is access to preventative care" doesn't help. If people were regularly getting fucked like that the system wouldn't have the entrenched support it does from the "but I want to keep my insurance" camp, and so speaking in generalities like that just makes you appear uninformed to the millions who regularly see doctors, get treatment, have surgery, etc, without these problems. It also cheapens the inequality problem: the gap isn't just "has access to preventive care" vs "doesn't have that access." The gap is "has hundreds of thousands of dollars, or even millions, of bills turn into nothing" vs "bankrupt if they seek treatment for any serious problem."

NationalPark 5y ago
I've had "good" coverage for my 15 year career and it does not work most of the time, or even half of the time. I've paid bills out of pocket because I didn't have time to untangle payer/insurance situations. I was taken to the ER unconscious once after a freak accident and ended up paying thousands for the ambulance. I've had to do provider paperwork myself and submit it to insurers myself because they refused to help me help them get paid. The system is simply not functional for people who don't have huge amounts of free time, patience, and money.
- pkaye 5y ago
  That is why I like the Kaiser HMO system. Most of the rates are pre-negotiated since the hospital and insurance are under the same company. Its typically $20/40 copay for a doctor visit. Even for me with my kidney failure and health issues, the OOP is minimal.
pavlov 5y ago
> “If people were regularly getting fucked like that the system wouldn't have the entrenched support it does from the "but I want to keep my insurance" camp” I don’t see how that follows. The “I’ve got mine” camp doesn’t care that it happens to those other people, and also doesn’t understand that it could happen to them in their old age (or simply after bad luck) because they’ve only made short visits into the system.
ohazi 5y ago
> Most of the time the system works for people who have good coverage. I'm sorry, but I just can't see how this is true. Do you only go to the doctor for a yearly checkup, or something? I've had "good" coverage (paid for by big employers with cushy all inclusive packages), and I've also had the cheapest option on CA’s exchange, and the only difference was whether I had to pay the receptionist $25 or $150. The "we won't cover this" and the "surprise, this costs 50x what you were told!" billing nightmare comes six months later. This has happened with every insurer I've ever had.
- rootusrootus 5y ago
  It really does vary by individual. My mom is going through cancer treatment right now. 35K/month in medication and she pays $250. I don't expect surprise bills later. She had surgery 8 years ago for the same cancer and that was also $250, for a week-long hospital stay. In my experience it does help to have an HMO. My mom uses Kaiser. So there's none of this in- vs out-of-network. One billing system, one insurance, etc. She has nothing but positive things to say about them. My dad had a similar experience towards the end of his life. He loved 'em. And nobody was left destitute as the result of his medical care.
  - hef19898 5y ago
    That shouldn't be the exception, that should be the rule.
  - nrmitchi 5y ago
    One of the problems with the how the US medical system works is that "35K/month in medication" is only "35k/month" because of some expectation that insurance is going to pay whatever the negotiated rate it (and I seriously doubt that it's 35k/month). Lets look at it this way: If that was the true price, what percentage of the US population do you think has the funds to actually pay $420k/year in for medication?
    - rootusrootus 5y ago
      In this case the insurance is paying $25K/month for the medication, so they definitely did negotiate it down somewhat. > what percentage of the US population do you think has the funds to actually pay $420k/year in for medication? Zero, plus or minus. That's why the manufacturers basically give it away to people who can't afford it. Because they can, and it helps them somewhat mitigate the bad PR.
nrmitchi 5y ago
> If people were regularly getting fucked like that I'm not sure what point you're trying to make, but it sounds like you're making the claim that people in the US don't regularly end up with massive surprise medical bills? This entire conversation is about action the government is taking because it happens so often. > "has hundreds of thousands of dollars, or even millions, of bills turn into nothing" That's not really how that works. It's not like your insurance company is actually paying "millions of dollars", they're paying some level of reasonable negotiated rate. If they actually had to pay "millions of dollars", that's when they claim something is not covered and you get stuck with a bill anyways. Edit: First quote was just wrong from a bad copy/paste
treyfitty 5y ago
After serving 3 large employers and reading through all the fine print attached to each health insurance policy, I can wholeheartedly say most companies do not offer "good coverage." After experiencing the fallout from my father's heart attack, I scoured through every health document I received afterwards, including but not limited to health insurance policies. Of my different health insurance policies, the longest duration in an ICU that was covered by any of those insurance policies was 60 days. My father was "lucky" in that he was on a subsidized Obamacare policy that "only" charged $350 per month (which was cheaper than my employer's policy) but was FAR superior to any of my employers' health insurance in every aspect.

usefulcat 5y ago

> The only real benefit of having "insurance" in the US is having reasonable access to basic preventative care What insurance do you have where the cost of the annual premium is less than what the out of pocket costs would be for annual checkups for the covered individuals? I have the cheapest insurance I can get. Yes, it pays for basic preventative care (basically a checkup per person per year), and it also costs more than my mortgage.

ryandrake 5y ago

When you have insurance, a claim should become purely a discussion between your insurance company and the health providers. It seems the current system needlessly inserts the patient into the middle, for the purpose of torturing him/her with paperwork, threats, bills, threats of bills, and the need to learn the intricacies of in-network, deductibles and co-pays, lifetime maximums, covered vs. uncovered procedures, etc. Instead of the insurance and health companies privately fighting it out between each other, they stick you in the middle, fighting through you as the proxy/punchingbag. Wouldn't it be better if you went to the hospital, gave them your insurance information, and that's the last you ever were involved with anything regarding payment? Isn't that one of the reasons we have insurance?