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The top earning 50% of Americans with a stable w2 job (union + white collar jobs) get very "good" insurance where their job pays most of, while they pay a modes

The top earning 50% of Americans with a stable w2 job (union + white collar jobs) get very "good" insurance where their job pays most of, while they pay a modest copay. The bottom earning 25% of Americans have 0 assets and 0 money, so health care is effectively free. Go to a hospital, they must treat you, you can't pay the bill, so it gets written off. The 26-49th percentile of people who have some money but no insurance are the people screwed by the current system. So the reason why American's tolerate it.. is it works decently for 75% of the population. And it is hard for 25% of the population to really change anything. And of those, many are young and healthy so they don't really care. So maybe we are talking about 12.5% of the population being actively screwed by the system at any given time...

foldr 5y ago
> Go to a hospital, they must treat you For emergency care, sure, but they don’t have to offer you expensive treatments for whatever health conditions you might have. It’s wishful thinking to think that poor Americans are getting adequate health care.
- brianwawok 5y ago
  Right. It's not perfect, but it's pretty workable in a pinch. In no means am I saying the current system is good or the right way, but simply offering reasons why there aren't enough people up in arms about the status quo.
  - foldr 5y ago
    Err, no. Using emergency care as your only source of care is not “workable in a pinch”. It represents a vastly lower standard of care than that available to poor people in most first world countries. Face it: if someone you loved had no money and no health insurance, you wouldn’t feel reassured that they’d be able to access the care that they needed.
    - brianwawok 5y ago
      Great. Convince more voters that this is true, and put pressure on the government to change it.
      - foldr 5y ago
        The first step to convincing more voters that it’s true is to stop repeating the untruth that poor Americans somehow receive adequate healthcare in spite of not being insured. But I’m not American, so it’s not really my job.
        brianwawok 5y ago
        Not many people outside the top 5% by net worth of Americans are on hacker news, so step would be to find another venue...
    - kcplate 5y ago
      The question isn’t “no money”. It’s “no income”. Lots of people and even some with high incomes have no money. If you have “no income” there are options available to you for government healthcare coverage.
  - pasquinelli 5y ago
    there were enough people up in arms about it to elect obama, who ran on healthcare reform.
    - brianwawok 5y ago
      The 2008 election top issue was based on the economy and energy (gas price). Health care and education were #3 and #4, where they often tend to live (per my OP for reasons why) https://www.pewresearch.org/politics/2008/08/21/section-3-issues-and-the-2008-election/ https://www.pewresearch.org/politics/2008/08/21/section-3-is...
throwawaymanbot 5y ago
75% accepting rate still does not mean its a good deal. This percentage also does not imply that they wouldn't prefer a better system like Canada/UK has.
chrisseaton 5y ago
My understanding was the 'modest' copay can be thousands of dollars. Is that not right? Can you buy insurance to pay the copay?
- brianwawok 5y ago
  Per year? I think as an employee the most I ever paid for a year of insurance for myself and my family was maybe $2k? On a salary of over 100k, it was pretty tiny. Insurance to pay the copay makes no sense, insurance is not free money. It's a risk pool to allow you to be able to afford the million dollar surgery only 1/100 people need. (I now own a business so am on the other side of the coin. I want nothing to do with health care. Why do I have to be involved? It's real dumb).
  - chrisseaton 5y ago
    > Insurance to pay the copay makes no sense Why not I can pay a small sum to eliminate any potential copay on my car insurance? Guaranteed to pay a small amount vs possibly going to have to pay a larger amount - that's the whole idea of insurance.
    - brianwawok 5y ago
      Sorry I am blending terms. Copay as your % of the insurance premium that your work buys you. Example: Plan cost $2,000 per month. You have a $400 a month copay. In retrospect, that is a bad term to use here, because copay means something totally different in insurance plans. There is also a copay for treatmeat, but not what I was talking about.
  - foldr 5y ago
    I’m not completely sure, but you seem to be confusing copay with the insurance premiums? Copay is the residual part of the cost of any given treatment that you have to pay after your insurance has (hopefully) paid for most of it. As the sibling says, there is nothing inherently nonsensical about insuring against copay.
m_ke 5y ago
Unless you lose your job or are self employed...
deleted 5y ago
[deleted]
runako 5y ago
> The top earning 50% of Americans with a stable w2 job (union + white collar jobs) get very "good" insurance where their job pays most of, while they pay a modest copay. These folks are getting squeezed too, though. Copays keep increasing, employee contribution to premium increases, and healthcare increases have eaten compensation increases for 25 years.
- taylodl 5y ago
  Yeah, my "good" insurance is costing me $500 per month. And I'm considered one of the lucky ones! For anyone curious that's for a family, but still!
  - runako 5y ago
    I would expect the total costs to be $1,500 or more, meaning the employer is also paying > $1,000/mo for this plan. That's $18,000 annually that didn't go to each employee.
    - taylodl 5y ago
      You are correct! And it's amazing how many Americans never take this into account when discussing single payer options. I'm not saying single payer or universal healthcare options are better, but at least when evaluating the different options and their costs we should be putting all the facts on the table.
wedowhatwedo 5y ago
The bottom 25% of Americans don't have free health care. They won't be treated for anything that is not an emergency. There is a huge difference. Some die because diseases aren't detected until it is too late.
- brianwawok 5y ago
  Right. Some people would use it. Other's, typically rural Americans, have a deep distrust of the medical profession. They aren't going to go in for a yearly checkup, free or not free. It's very complicated.
  - chrisseaton 5y ago
    Something that's a stark difference between US-style healthcare and British socialised-style healthcare is I don't get a yearly checkup in the UK - it's just not a service they offer. When I ask about this some people say it's not needed any way... not sure if that's right or not.
    - nradov 5y ago
      Routine annual checkups aren't medically justified for most healthy adults. https://time.com/5095920/annual-physical-exam/ https://time.com/5095920/annual-physical-exam/
- nradov 5y ago
  A large fraction of Americans in the bottom income quartile are on government Medicare and/or Medicaid plans. They can access regular treatment and preventative care, although the provider networks are limited in some areas.
- s1artibartfast 5y ago
  it is even worse than the parent post. 28% of US population is low-income(<200% federal poverty level) and 21% are covered by Medicaid/CHIP. This leaves 6 percent who are low income and uncovered. https://files.kff.org/attachment/fact-sheet-medicaid-state-US https://files.kff.org/attachment/fact-sheet-medicaid-state-U...
paulpauper 5y ago
A major problem I read is insurance companies trying to find excuses to not pay or condition not being covered.
MisterTea 5y ago
> The 26-49th percentile of people who have some money but no insurance are the people screwed by the current system. Or they have insurance through their employer who continually changes plans every year in a never ending game of pay the lowest rates possible. The alleged insurance company then provides you with one of two shitty bronze or silver plans. The silver plan is so costly that low paid employees cant afford it so they opt for the bronze thinking it covers just enough to help in an emergency (And the dipshit selling you the plan will tell you it will). Now when your cheapskate employer dumps one plan for another, the new plan might not be accepted by your current doctor so you have to find a new doctor. Then when you have an actual emergency you find your shit plan doesn't cover things like ambulance rides (those are like fucking $1500+), your medication because it's a tier 1 medication and not a generic, or some other stupid edge case. Finally, you spend the following months sifting through one unpaid bill after another as the insurance company does everything it can to not pay. To add insult to injury, your doctors now mark you as having shit insurance. So when you go back for follow up visits you have to sit and wait while your doctor's assistant asks your lords and masters of health and wellness at DontPay Ins Co if they will pay for a test or procedure turning an hour visit into a half day affair. Fuck the USA health insurance system. I want everyone involved in keeping it this way, DEAD.
- kasey_junk 5y ago
  This doesn’t contradict your post (and perhaps even reinforces it) but it’s important to note, ambulance rides are required to be covered as in-network by your insurance, though billing you that way isn’t! That is a single ambulance ride should top out your out of pocket coverage on any legal insurance plan. If your bills or insurance say otherwise they are likely paying fast and loose with the rules. As far as your other points, I agree. Carry on.
- kcplate 5y ago
  > Fuck the USA health insurance system. I want everyone involved in keeping it this way, DEAD. That’s approximately 700k people. That seems a bit like an extreme reaction, TBH.
  - 5y ago
deleted 5y ago
[deleted]
kcplate 5y ago
I wouldn’t say all of the 26-49 are screwed. A portion of those folks might be choosing not to pay for healthcare. They may be screwed if they get sick, but in general, if you opt out of paying intentionally and don’t get sick…you kind of “win”. My biggest issue with the ACA was that it really didn’t fix the 26-49% and in many ways by mandating people buy insurance, especially young families making less than around $75k a year. made things worse.

foldr 5y ago

> Go to a hospital, they must treat you For emergency care, sure, but they don’t have to offer you expensive treatments for whatever health conditions you might have. It’s wishful thinking to think that poor Americans are getting adequate health care.

brianwawok 5y ago
Right. It's not perfect, but it's pretty workable in a pinch. In no means am I saying the current system is good or the right way, but simply offering reasons why there aren't enough people up in arms about the status quo.
- foldr 5y ago
  Err, no. Using emergency care as your only source of care is not “workable in a pinch”. It represents a vastly lower standard of care than that available to poor people in most first world countries. Face it: if someone you loved had no money and no health insurance, you wouldn’t feel reassured that they’d be able to access the care that they needed.
  - brianwawok 5y ago
    Great. Convince more voters that this is true, and put pressure on the government to change it.
    - foldr 5y ago
      The first step to convincing more voters that it’s true is to stop repeating the untruth that poor Americans somehow receive adequate healthcare in spite of not being insured. But I’m not American, so it’s not really my job.
      - brianwawok 5y ago
        Not many people outside the top 5% by net worth of Americans are on hacker news, so step would be to find another venue...
  - kcplate 5y ago
    The question isn’t “no money”. It’s “no income”. Lots of people and even some with high incomes have no money. If you have “no income” there are options available to you for government healthcare coverage.
- pasquinelli 5y ago
  there were enough people up in arms about it to elect obama, who ran on healthcare reform.
  - brianwawok 5y ago
    The 2008 election top issue was based on the economy and energy (gas price). Health care and education were #3 and #4, where they often tend to live (per my OP for reasons why) https://www.pewresearch.org/politics/2008/08/21/section-3-issues-and-the-2008-election/ https://www.pewresearch.org/politics/2008/08/21/section-3-is...

throwawaymanbot 5y ago

75% accepting rate still does not mean its a good deal. This percentage also does not imply that they wouldn't prefer a better system like Canada/UK has.

chrisseaton 5y ago

My understanding was the 'modest' copay can be thousands of dollars. Is that not right? Can you buy insurance to pay the copay?

brianwawok 5y ago
Per year? I think as an employee the most I ever paid for a year of insurance for myself and my family was maybe $2k? On a salary of over 100k, it was pretty tiny. Insurance to pay the copay makes no sense, insurance is not free money. It's a risk pool to allow you to be able to afford the million dollar surgery only 1/100 people need. (I now own a business so am on the other side of the coin. I want nothing to do with health care. Why do I have to be involved? It's real dumb).
- chrisseaton 5y ago
  > Insurance to pay the copay makes no sense Why not I can pay a small sum to eliminate any potential copay on my car insurance? Guaranteed to pay a small amount vs possibly going to have to pay a larger amount - that's the whole idea of insurance.
  - brianwawok 5y ago
    Sorry I am blending terms. Copay as your % of the insurance premium that your work buys you. Example: Plan cost $2,000 per month. You have a $400 a month copay. In retrospect, that is a bad term to use here, because copay means something totally different in insurance plans. There is also a copay for treatmeat, but not what I was talking about.
- foldr 5y ago
  I’m not completely sure, but you seem to be confusing copay with the insurance premiums? Copay is the residual part of the cost of any given treatment that you have to pay after your insurance has (hopefully) paid for most of it. As the sibling says, there is nothing inherently nonsensical about insuring against copay.

m_ke 5y ago

Unless you lose your job or are self employed...

deleted 5y ago

[deleted]

runako 5y ago

> The top earning 50% of Americans with a stable w2 job (union + white collar jobs) get very "good" insurance where their job pays most of, while they pay a modest copay. These folks are getting squeezed too, though. Copays keep increasing, employee contribution to premium increases, and healthcare increases have eaten compensation increases for 25 years.

taylodl 5y ago
Yeah, my "good" insurance is costing me $500 per month. And I'm considered one of the lucky ones! For anyone curious that's for a family, but still!
- runako 5y ago
  I would expect the total costs to be $1,500 or more, meaning the employer is also paying > $1,000/mo for this plan. That's $18,000 annually that didn't go to each employee.
  - taylodl 5y ago
    You are correct! And it's amazing how many Americans never take this into account when discussing single payer options. I'm not saying single payer or universal healthcare options are better, but at least when evaluating the different options and their costs we should be putting all the facts on the table.

wedowhatwedo 5y ago

The bottom 25% of Americans don't have free health care. They won't be treated for anything that is not an emergency. There is a huge difference. Some die because diseases aren't detected until it is too late.

brianwawok 5y ago
Right. Some people would use it. Other's, typically rural Americans, have a deep distrust of the medical profession. They aren't going to go in for a yearly checkup, free or not free. It's very complicated.
- chrisseaton 5y ago
  Something that's a stark difference between US-style healthcare and British socialised-style healthcare is I don't get a yearly checkup in the UK - it's just not a service they offer. When I ask about this some people say it's not needed any way... not sure if that's right or not.
  - nradov 5y ago
    Routine annual checkups aren't medically justified for most healthy adults. https://time.com/5095920/annual-physical-exam/ https://time.com/5095920/annual-physical-exam/
nradov 5y ago
A large fraction of Americans in the bottom income quartile are on government Medicare and/or Medicaid plans. They can access regular treatment and preventative care, although the provider networks are limited in some areas.
s1artibartfast 5y ago
it is even worse than the parent post. 28% of US population is low-income(<200% federal poverty level) and 21% are covered by Medicaid/CHIP. This leaves 6 percent who are low income and uncovered. https://files.kff.org/attachment/fact-sheet-medicaid-state-US https://files.kff.org/attachment/fact-sheet-medicaid-state-U...

paulpauper 5y ago

A major problem I read is insurance companies trying to find excuses to not pay or condition not being covered.

MisterTea 5y ago

> The 26-49th percentile of people who have some money but no insurance are the people screwed by the current system. Or they have insurance through their employer who continually changes plans every year in a never ending game of pay the lowest rates possible. The alleged insurance company then provides you with one of two shitty bronze or silver plans. The silver plan is so costly that low paid employees cant afford it so they opt for the bronze thinking it covers just enough to help in an emergency (And the dipshit selling you the plan will tell you it will). Now when your cheapskate employer dumps one plan for another, the new plan might not be accepted by your current doctor so you have to find a new doctor. Then when you have an actual emergency you find your shit plan doesn't cover things like ambulance rides (those are like fucking $1500+), your medication because it's a tier 1 medication and not a generic, or some other stupid edge case. Finally, you spend the following months sifting through one unpaid bill after another as the insurance company does everything it can to not pay. To add insult to injury, your doctors now mark you as having shit insurance. So when you go back for follow up visits you have to sit and wait while your doctor's assistant asks your lords and masters of health and wellness at DontPay Ins Co if they will pay for a test or procedure turning an hour visit into a half day affair. Fuck the USA health insurance system. I want everyone involved in keeping it this way, DEAD.

kasey_junk 5y ago
This doesn’t contradict your post (and perhaps even reinforces it) but it’s important to note, ambulance rides are required to be covered as in-network by your insurance, though billing you that way isn’t! That is a single ambulance ride should top out your out of pocket coverage on any legal insurance plan. If your bills or insurance say otherwise they are likely paying fast and loose with the rules. As far as your other points, I agree. Carry on.
kcplate 5y ago
> Fuck the USA health insurance system. I want everyone involved in keeping it this way, DEAD. That’s approximately 700k people. That seems a bit like an extreme reaction, TBH.
- 5y ago

deleted 5y ago

[deleted]

kcplate 5y ago

I wouldn’t say all of the 26-49 are screwed. A portion of those folks might be choosing not to pay for healthcare. They may be screwed if they get sick, but in general, if you opt out of paying intentionally and don’t get sick…you kind of “win”. My biggest issue with the ACA was that it really didn’t fix the 26-49% and in many ways by mandating people buy insurance, especially young families making less than around $75k a year. made things worse.