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The fact that excluding health insurance actually lowers the price makes me wonder what the point of health insurance is anymore.
by jimt1234 3y ago
The fact that excluding health insurance actually lowers the price makes me wonder what the point of health insurance is anymore.
- lotsofpulp 3y agoIt is for the six and seven figure heart surgery/NICU baby/cancer treatment. Edit: My question is, is Sesame paying the doctors less, or are you actually paying $29 for a Nurse Practicioner/Physician's Assistant?
- ethbr1 3y agoAnd technically, that's what health insurance always should have been for. Allowing insurers to step in the middle of smaller, everyday health transactions by empowering them to negotiate price fundamentally screwed up the system. There's no reason insurance should be involved in non-catastrophic or routine pharmaceutical purchasing.
- lotsofpulp 3y agoThe US government does offer a massive carrot for people to choose high deductible health plans, in the form of the most tax advantaged account you can have, a Health Savings Account. The root problem is most Americans are too poor to afford healthcare at the current prices of doctors/medicines/medical equipment/liability protection/etc, period.
- creato 3y agoUsing an HSA can be a pain in the ass. On multiple occasions I’ve had to go back and forth with the provider and HSA to get an acceptable receipt. I ended up just giving up in one case because it was a small amount and not worth fighting phone reps and automated systems.
- mcny 3y agoI thought the whole point of an HSA was to be used as a tax shelter. I didn't get one because it seemed way too complicated and also I don't make nearly enough money to set aside money in an HSA but that's what I remember when looking up on it a little. I think you're not supposed to use it actually for healthcare, at least not in your young age.
- lotsofpulp 3y agoI do not know why that would be difficult, I have never had an issue getting a receipt with patient name, charges, and the amount on it. Also, the ideal way to use an HSA is to not use it. Every year, transfer the HSA funds to Fidelity, invest in VOO or whatever, and let it ride as long as you can. PDF all the receipts, and then pay yourself with tax free income when you finally need to.
- mighmi 3y ago> pay yourself with tax free income when you finally need to My understanding's that direct withdraws are possible after 65, taxed as income. Does your "when you finally need to" mean only withdrawing for healthcare reasons or is there a way to transfer or withdraw without a tax hit, besides for health costs?
- lotsofpulp 3y agoYes, worst case scenario, it performs as an IRA/401k. But pretty much everyone will incur healthcare costs as they get older, so you should be able to withdraw tax free for those. And all healthcare costs incurred by your family during your lifetime while you had an HSA are eligible for reimbursement. Quite frankly, I do not know how auditable a 40 year old medical receipt is. Is the IRS' plan to just take everyone's word for it?
- smsm42 3y agoProbably yes, until they audit you. I don't think many people who want to defraud IRS do it by faking 40 year old medical receipts.
- MiddleEndian 3y agoFor these kinds of relatively low-cost interactions, the HSA is even more of the same problem as health insurance: It's for people who find paperwork to be a fun hobby. Just tell me how much money I owe you and let me pay. When I find myself at a clinic, I tell them I don't want to use health insurance to pay. They just give me a bill and I give them money.
- wokkel 3y agoThe ultimate root of the problem is thinking healthcare works like a bakery: if the bread is too expensive i'll go shopping elsewhere or even choose something else besides bread. This last option is basically off the table in healthcare: you either get healthcare or die. Which in the usa seems to be the options indeed.
- monero-xmr 3y agoThe solution is to have universal catastrophic insurance for all citizens automatically, say $100k or some number. Combine that with tax-deductible health savings accounts and a competitive retail healthcare market, you find a sweet spot between universal and for-profit. Anyone who thinks the universal model standard in Canada and the UK is actually working has a hole in their head. The solution is a combo.
- lotsofpulp 3y agoIt is not as easy as that because supply is heavily constrained. You need a lot more people able and willing to become doctors, nurses, people who change bedpans and clean hospital rooms, so on and so forth. Add in aging populations with fewer proportionate working age people, and the equation does not balance. That is not something any policy change can fix until far in the future. In the short term, all that is possible is deciding who gets allocated the available healthcare.
- monero-xmr 3y agoNurse practitioners have been allowed by states to handle more and more services. Telehealth primary care has enabled more scaling - I know because I use such a service for my whole family. I’m much, much more confident in the US to handle an influx of immigrants and aging retirees than Canada or the UK with their rigid services.
- lotsofpulp 3y agoYes, one of the ways that the limited resource of doctor time will be allocated is to simply have increasing portions of the population see people less qualified than doctors (perhaps not bad from a systems point of view if it is diagnosing conjunctivitis, but from an individual point of view, you can see where this is going.). You pay more, you get people who have met a higher standard of education/experience, e.g. concierge care and direct primary care practices.
- 3y ago
- jimt1234 3y agoWould those procedures cost "six and seven figures" if it wasn't for health insurance? To put another way, would the costs be so high if it wasn't for the current health insurance system, where the "consumers" are actually the health insurance companies themselves and patients like you and I have basically no power to choose, well, anything.
- huytersd 3y agoThe prices have got to be up there. It’s taking up dozens of hours from multiple highly skilled workers at the very least. That with the use of very expensive medication and some very complicated machines adds up.
- Projectiboga 3y agoI don't know if it is insurance or the administration on both the provider and insurer sides. I have a horrible respiratory infection in western Europe, here I'd have likely died or been so overcharged I'd wish I had died. There 17 days in ICU on a ventilator and a few weeks or normal hospital recovery the total bill in 2001 was under $20K, the Euro and Dollar were almost even then so the conversion isn't important. Now if a local had needed that bed more I might have not been as lucky. This is what a well organized society can do, keep everyone under some level of free care so there is less chaos in their ER departments and that they'd have time to treat a foreigner well. If we switched to single payer the estimates are that we'd save money as a nation the first year, even with all the backlog of needed care and any transition costs. The savings would compound as preventive care started preventing more serious outcomes and things like car insurance and liability insurance would come down in cost too.
- huytersd 3y ago[dead]
- gdcbe 3y agoHuyterds, they don’t cost that much in Belgium though, US medical prices are out of the roof.
- deleted 3y ago[deleted]
- TylerE 3y agoI imagine your appts/per hour go WAY up when it's a 5 minute voice chat versus occuyping a room in a physical building for an hour, having a nurse take vitals, all that ancillary stuff.
- smsm42 3y agoProbably the latter, buf this would frequently be the case now in other providers too. Unless you want to wait for 2 months.
- Ekaros 3y agoNICU baby feels so weird. Why isn't that covered by Medicare or something else? Like why isn't basic health-care for children under whatever age 18 or 16 fully covered by government? At least to certain level.
- lotsofpulp 3y agoBecause babies and kids do not vote. Why is Medicaid a separate thing than Medicare? Because poorer people are less likely to vote than older people. The US is composed of very fractured tribes, that people move in and out of throughout their lives. And US politicians are tasked with keeping taxes extremely low, and services very high, and the various tribes do all they can to give disproportionately little relative to how much they benefit.
- tbalsam 3y agoOh, it's a vast field of corruption. Don't look around or into if you want to keep your blood pressure low. Cause, y'know. It'll cost an arm and a leg to take care of that. With your insurance.
- SOLAR_FIELDS 3y agoThe long form Time article “Bitter Pill” from over a decade ago does a good job of explaining the how and why of the clusterfuck of American healthcare. Sadly and unsurprisingly, not much has changed since then besides slightly more price transparency that hospitals have fought tooth and nail against and hasn’t really moved the needle much in terms of improvement. The only other somewhat significant improvement that I can think of in recent years is the enactment of the surprise billing bill on Jan 1 2022 but I’m not even sure that has done anything meaningful or not since it went into force.
- lotsofpulp 3y agoInstead of signing a blank check for my doctor visits, I now get a paper that tells me how much my visit might cost, and that I am only liable for up to $400 more than that. That is progress. Also, if my wife has a baby at an in network hospital, and the anesthesiologist or whoever is out of network, I know that the healthcare is still going to be considered in network, and so we are still only on the hook for the out of pocket maximum. Also progress. And if you are away from home, and happen to get into an emergency where you are taken to an out of network facility, you are still only liable for your in network out of pocket maximum, which is progress too.
- astrange 3y agoYou're leaving out Medicaid expansion, probably because you earn too much to need to use it.
- SOLAR_FIELDS 3y agoGood point, but I left out Medicaid expansion in my case because I live in a state who turned it down for political grandstanding purposes. But it is worthwhile to mention because most states did not
- deleted 3y ago[deleted]
- donatj 3y agoI've told this story here before. My girlfriend at the time, now wife and I both had pneumonia. Identical symptoms. We saw the same doctor the same day, back to back. Got prescribed the same antibiotics. I had "good" health insurance, she had none. My bill AFTER insurance was higher than her bill without insurance. I'm really not sure the moral but it was frustrating as heck.
- SV_BubbleTime 3y agoI like that only 13 years later after a decade of ranting about it - people are finally understanding on their own why the “Affordable Care Act” was such a bullshit scam entirely supported by insurance providers. It was even sold in a ridiculous way. “We all know health care is broken, so if we just force everyone to sign up, and give them more guaranteed income streams then it will fix itself!!”. I don’t want to hear about how Obama actually wanted single payer or X. He knew exactly what it was the whole time. “Medical billing” is an industry probably larger than medical care. I fully support Costco here, insurance is a scam.
- somewhat_drunk 3y agoPlease describe how the Affordable Care Act led to the situation you're responding to.
- kromem 3y agoIt would have been better had the provider constraints not been struck down by the supreme court. The entire idea was using the threat of losing access to Medicare $$$ to force acceptance of all ACA plans by providers in order to drive down cost negotiations for individual payers. Large companies get to leverage large group sizes, and the idea of the ACA was to effectively turn all government aligned plans including Medicare into a single giant "all or nothing" group. But when the courts struck that down, instead it became the exact opposite, allowing for even more division and sub-grouping across ACA plans, which drives up the end payee costs because there's little to no consequences for providers telling ACA plans to get bent. The ACA as designed was effectively a compromise, and then the courts reversing the key compromise meant the overall result was a hot pile of crap outside of finally ditching preexisting condition lock-in (which was still a win overall, but a much more minor one).
- huytersd 3y agoCostco virtual healthcare is not going to cover your cancer treatment, angioplasty or terminal care. We have to all pay a lot of insurance because a small minority of people (along with the very old) consume a vast majority of our health care spend.
- SOLAR_FIELDS 3y agoVery true. But for someone in their 20’s-40’s who lives a reasonably healthy lifestyle this is an option for preventative care that they did not have before. We can all lament about why this is an option vs an actual functioning healthcare system but for the people who are alive in this dumpster fire today that don’t otherwise have insurance it’s good that something is available. And even for people who have insurance it’s probably actually financially smarter to purchase cheap “catastrophic death level bazillion dollar cost cancer insurance” and just go here for preventative care on their own dime
- huytersd 3y agoIt is but the problem is life is unexpected and you’re going to need the insurance if something happens. Personally being in my 30s, I wouldn’t be comfortable having no insurance in America. If I needed surgery for a fall on my hike, without insurance it would bankrupt me. So if I have insurance anyway, I might as well see my primary care physician for a similar copay then go this route. For poor people they are covered through Medicare anyways so they wouldn’t really use this either. This market is for specific one off lab tests and to get referrals.
- alaskamiller 3y agoHealth insurance is a coupon code you subscribe and pay for every month.
- 8n4vidtmkvmk 3y agoExcept coupons actually lower your bill.
- Mistletoe 3y agoI wonder the same thing when some weird GoodRx card is always lower prices on my prescriptions than my insurance.
- SOLAR_FIELDS 3y agoAt my local grocer the pharm techs always seem somewhat baffled when I tell them to remove the insurance and they see my medication price is 50% cheaper. I usually raise my eyebrows as if to say “Really? You don’t see this kind of bullshit on a daily basis?”
- arwineap 3y agoDo you try this blindly, to test the cost, or do you somehow know which will be cheaper?
- SOLAR_FIELDS 3y agoGoodRX app lets you look online for which pharmacies in your area offer discounts with them. So you already know going in that Randalls will charge X with GoodRX and Y with your insurance, Kroger will charge A and B, Walgreens C and D. So yeah you can discover the discrepancy online before you even walk into the store. You simply type your drug and dosage into GoodRx app with your location to get the list and prices. The real hack to get the best prices is to look at larger amounts. I have saved 50% or more on drugs by buying them in 90 day increments instead of 30 day increments (this of course only works with non controlled substances that can be purchased in more than 30 day increments at a time, but that is the vast majority of drugs). There is also no correlation to dosage and prices from what I’ve seen. I was taking 100mg of one drug for awhile, for instance, then I tried to fill 80mg of the same drug at the same place and it was inexplicably double the price Once in the store you open the GoodRx app and in there is a discount code that the pharm tech at the counter will enter into their billing system that will give you the listed price in the app. Oftentimes I have discovered that the pharmacies keep a list of these types of codes (GoodRx is not the only one, just the one people know about the most due to advertising) and once I show them the app they will try a couple of other codes off their list and sometimes I will get a price that is even marginally cheaper (perhaps 5%) than the GoodRx price I showed them. There’s also huge variation between places. My local grocery chain’s GoodRX price is usually less than half of what Walgreens’ price is and usually at least 25% cheaper than Walmart and Kroger As to why I have to ask them to remove it, two reasons: 1: most people just assume insurance is always best, when it isn’t. 2: because lol USA healthcare, of course it only makes sense to do this with some of the meds I take and not others. My cholesterol meds are so cheap it doesn’t even matter whether they are insured, and some of my other meds are evergreened to hell and using insurance actually does help by a significant factor, like saving 75% or more. It’s this third class of Expensive But With Actual Competition where this GoodRX stuff comes into play. So half my meds insurance pays for and the other half I pay out of pocket. lol USA healthcare
- MichaelDickens 3y agoThat's how you'd expect it to work, right? Not to say healthcare is a functional market (it's not), but in general, if something is less risky, then it should be more expensive. Insurance companies are less exposed to risk, so they're willing to pay more for healthcare than individuals.
- jksflkjl3jk3 3y agoFirst, I think he meant that the out-of-pocket cost (not including the insurance premiums that are already being paid) were higher than the no-insurance cost. But even if he meant the total cost, the way insurance reduces risk through diversification is analogous to investment in a less risky index fund vs a more risky single company: beyond some minimal operational overhead, the risk reduction should be free.
- monksy 3y agoSo. Getting a CPAP. DME charges 1.2k$. That's the one that the doctor set me up with. Goes through insurance. I end up having to pay $800 in insurance. Now it requires 1 month of monitoring. Also, $16 for 2 generic filters. DME is pretty shit about getting back in touch with you unless you force them to via the doctors office. Dropped them for Cpap.com with a script from the doctor. What do they charge out of pocket? $800, do the insurance reimbursement yourself. Secondly, they'll call you up 15 minutes after you order and in 2 days later the machine will be on your door step. Filters here are $8 for 6. (Delhi, India was about $5 for 2 in a store with a label stamped from chicago)
- taftster 3y agoIt's insurance. Just like car insurance, home insurance, travel insurance, etc. It's not supposed to pay for everything for everyone at all times. It's supposed to pay for the outlier events, the super events where an accident occurs or a tragic health diagnosis. Health insurance is not health care. That being said, I'm not arguing whether everyone should be entitled to free/reduced health care - but I am making the point that insurance is just insurance; it's a hedge against an unlikely but costly event.
- ttt3ts 3y agoThinking of insurance in healthcare like normal insurance is not accurate. They are activly involved in setting coding practices and therefore prices. They are entwined and in many ways ARE health care as far as billing is concerned. (Currently studying for my CPC exam)
- barsonme 3y agoThe parent comment is lamenting this fact.
- lsmeducation 3y agoOne could argue that they are in complete control simply because the average patient can never pay the amount the provider bills. So the provider HAS to play ball with the insurer, because good luck getting joe blo American to foot the bill (it's impossible in most cases).
- ttt3ts 3y agoThis isn't quite true. Discounted cash price is often LESS than a given insurance pays. You can see this your self if you download price transparency data for your hospital (assuming they bothered to actually comply)
- TylerE 3y agoLike any insurance, the reason you have it is for when something happens that one cannot reasonably anticipate. It's not the $500 infection that gets you. It's the $60k knee reconstruction or the multi-million dollar cancer treatment.
- DoreenMichele 3y agoThe existence of multimillion-dollar treatments offends me. It seems like medical profit motive has driven medical development too long and we could come up with cheaper, more effective treatments if medical research wasn't driven so much by profit motive. (/someone with a very expensive condition, so don't @ me)
- deleted 3y ago[deleted]
- tptacek 3y agoClinic visits, including those for acute but straightforwardly treatable illness, just aren't where all the cost is in the system. You insure against chronic illness and major surgery. This is the logic of HDHP plans: it often really is a better deal just to pay cash for routine care, especially when you're (relatively) young and that care is likely to be cheap. You can see echoes of this in other insurance products. Homeowners insurance, for instance: you insure against your house burning down, but you're probably better off not making a claim for non-catastrophic events, because you'll probably pay more than you would out of pocket, in the long run, when your rates go up. Obviously, what makes health insurance especially annoying is that there isn't a transparent market for services the way there is for home repairs. Insurers work out special rate sheets with providers and quote bizarro numbers back to you. That sucks! But the underlying logic of insurance not reducing the cost of a pneumonia visit is still sound.
- MagicMoonlight 3y agoYou don’t have insurance in america, you just have corruption. It’s a shakedown tax like when gunmen stop cars in africa. Nowhere else would you have “insurance” which bankrupts you. How is that insurance? The point is it’s supposed to cover the whole cost for you.
- smsm42 3y agoCatastrophic bills. Insurance doesn't make sense for colds, routine checkuos and other cheap and frequent things. It makes sense where you get a rare disease whose medication costs 50k/yr or more. Unfortunately US system is an unhealthy (no pun) mix of both.
- gnicholas 3y agoI used to go to a chiropractor, at a time when I had a high-deductible health plan. It was definitely cheaper to tell them I had no insurance. Basically, people without insurance tend to be less wealthy than people with insurance, so providers use this as a way to "price discriminate" and get the most out of both parties. Of course, the fact that insurance probably covers a good chunk of the total cost makes this system even more profitable.
- peteradio 3y agoYou should be able to turn around and submit a claim yourself to your insurance.
- gnicholas 3y agoThat's true. I don't know about the legality of telling a provider you don't have insurance if you do, though.
- peteradio 3y agoIt shouldn't matter one bit to the provider. This shouldn't be a triangular relationship at all. Provider should be providing a service for a known price. I should be able to claim to my insurance I've received said service and then they reimburse the thing. Having them negotiate in such a way that I have to pay both for insurance and then pay more for the fucking service after their deduction is some kind of insanity.
- gnicholas 3y agoI realize it "should" not matter, but in reality this is what I've encountered. And I don't know if it is impermissible to say you do not have insurance in order to get the no-insurance pricing. I simply said that I had a HDHP and they let me pay the cash price.
- dikaio 3y agoI’ve invested the money I would have spent on health insurance over the past 4 years in stocks. This might not be ideal for older people but if you’re relatively young or healthy it’s an alternative to dealing with the headache of health insurance. Also, touching on what someone mentioned above, the costs are almost always cheaper.
- flandish 3y agoSame as it ever was. Profit.
- lost_tourist 3y agoI think it's mostly for saving you from bankruptcy. A cardiac event would destroy most American's savings and potentially cost them their house, without insurace to cover the majority/argue with the hospital
- Grimblewald 3y agoThe real question is how anyone was ever convinced inserting a parasitic middle man into healthcare would not harm either cost or outcome.