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Buried midway down, they mention that the commercial health plans available to people without conventional employers (Obamacare) can (and routinely do) set dedu

by alwa 3y ago

Buried midway down, they mention that the commercial health plans available to people without conventional employers (Obamacare) can (and routinely do) set deductibles as high as $9,450. And that’s in addition to the premium-which, in New York City for example, starts at $618/month for the very worst plan for an individual. Sure, that’s subsidized for lower-income households — but who among those has a spare $10K lying around to spend out of pocket before they actually benefit from the insurance? When you’ve budgeted the $7,400 to pay for premiums whether or not you use healthcare, and the insurance doesn’t even kick in until you’ve spent a total of $16,800 on medical care in a given year, it doesn’t come as a huge surprise to me that people feel like they’ve already paid enough, and that the payers and providers should sort it out amongst themselves. There’s economic, contractual, and policy reality; but then, even among people who might be able to afford it, there’s the gut feeling of “I’ve already paid way too much for this 5-minute checkup, I’m not paying more.”

slfnflctd 3y ago
We should've gotten single payer. The insurance lobby is just too strong, I guess. In several recent years, I would've been better off not having insurance and paying out of pocket because I never (or just barely) hit the deductible. Even when my deductible was lower, if you added up my premiums against what was covered I still probably overpaid most years. So all I've been doing is subsidizing someone else's bills while paying my own on top of it. Yes, I know this is how insurance works, but it doesn't feel great to keep paying out so much money while getting nothing for it but vague promises they likely won't have to keep which expire every year.
- paxys 3y ago
  Insurance companies are very much to blame, sure, but that doesn't change the fact that >50% of the country rejects these systems because "socialism". If we can't get over that hurdle first then nothing will ever change.
  - nojvek 3y ago
    Socialism is such a stupid argument because we pool our taxes for common things such as Transportation infrastructure, defense, port immigration, and other social benefits. Australia charges 2% for medicare (I'm sure other countries have something similar). Because the money is pooled, they can negotiate prices for common procedures and medicine down. I'd rather pay 2% extra tax for not having to deal with getting new insurance when I switch jobs. An x-ray shouldn't cost in $1000s. Australia still has private insurance and special surgeons. The deal is that the 2% covers most common basic heathcare related things. Imagine if we had to pay separate tax for going on each highway. Middlemen sitting and ripping off based on demand and supply. Getting billed for each highway use and having those bills come months later. Because it is so expensive to travel, we'd need highway and flight insurance. That's the absurdity of US healthcare. Play stupid games, win stupid prizes.
- Aloisius 3y ago
  Single payer was killed by the healthcare provider lobbies, not the insurance lobby. Doctors have waged a war against single payer anytime it has been suggested for over a century. The power the doctor and the hospital lobbies wield to sway opinion utterly dwarfs that of the health insurance industry.
  - slfnflctd 3y ago
    There are multiple reasons I can imagine why that might be, but I would love to see some citations for this so I have solid data I can confidently adjust my world view with. My opinion is that insurance companies are middlemen who too frequently rob patients & providers alike, and I would expect any reasonable legislation to include provisions to ensure that being a doctor is still financially attractive. Coming around full circle, the cost of malpractice insurance is now so high that it's become a significant barrier to entry for anyone trying to start a new medical office, and I think that should be addressed as well.
    - Aloisius 3y ago
      Ultimately, it's about pay. This covers some of the history: https://www.kqed.org/news/11902591/why-do-so-many-doctors-oppose-single-payer-health-care https://www.kqed.org/news/11902591/why-do-so-many-doctors-op... That people believe healthcare providers, where the vast majority of the $4.5 trillion in healthcare spending ultimately goes, are just barely getting by and that they're being robbed by insurance companies (~5% of spending) should be ample evidence of how powerful they are. Never mind that private insurance reimbursement rates are higher than Medicare's and even Medicare's rates are double that of every other advanced developed country.
- fn-mote 3y ago
  In my case, not hitting the deductible is the wrong metric. You are still benefitting from the insurer's negotiation of lower rates for all procedures. For example, your insurer may have negotiated $0 for standard bloodwork. The parent's acknowledgement that "this is how insurance works" doesn't change the fact: that IS how insurance works. Coverage of a risk has a value, even if that risk does not materialize. (This is easier to understand from the point of view of the finance markets, but it's the same everywhere.)
paxys 3y ago
Obamacare was essentially gutted when the individual mandate was deemed unconstitutional and removed. If young, healthy people aren't signing up and paying into the system then of course the sick ones will bear the brunt of it. That's just how insurance works.
plants 3y ago
I’m unemployed in NYC right now - so, zero consistent income. I’m one of those people with the very worst marketplace health plans. Here’s what I get for $640/mo (with a $120 tax credit, oh boy!): - Visits to my general practitioner (but not so fast! no diagnostic tests or ANYTHING else - those are 100% out of pocket until my $9,000 deductible is met) - Pregnancy care (it’s currently a biological impossibility for me to give birth) Everything else is entirely out of pocket until my $9,000 deductible is met. My coverage is basically a $6,000 guarantee that I won’t be completely bankrupted if I get run over by a garbage truck and live to tell the tale. Otherwise, it’s completely useless. Something’s gotta give.
BenjiWiebe 3y ago
Interesting. I am using an obamacare plan (in Kansas). It's in no way an amazing plan, but I only pay single digit (or was it $10, idr) premiums per month, and my deductible is $1200. I've been pretty pleased with obamacare for the three years I've had a plan with it.

by alwa 3y ago

slfnflctd 3y ago

We should've gotten single payer. The insurance lobby is just too strong, I guess. In several recent years, I would've been better off not having insurance and paying out of pocket because I never (or just barely) hit the deductible. Even when my deductible was lower, if you added up my premiums against what was covered I still probably overpaid most years. So all I've been doing is subsidizing someone else's bills while paying my own on top of it. Yes, I know this is how insurance works, but it doesn't feel great to keep paying out so much money while getting nothing for it but vague promises they likely won't have to keep which expire every year.

paxys 3y ago
Insurance companies are very much to blame, sure, but that doesn't change the fact that >50% of the country rejects these systems because "socialism". If we can't get over that hurdle first then nothing will ever change.
- nojvek 3y ago
  Socialism is such a stupid argument because we pool our taxes for common things such as Transportation infrastructure, defense, port immigration, and other social benefits. Australia charges 2% for medicare (I'm sure other countries have something similar). Because the money is pooled, they can negotiate prices for common procedures and medicine down. I'd rather pay 2% extra tax for not having to deal with getting new insurance when I switch jobs. An x-ray shouldn't cost in $1000s. Australia still has private insurance and special surgeons. The deal is that the 2% covers most common basic heathcare related things. Imagine if we had to pay separate tax for going on each highway. Middlemen sitting and ripping off based on demand and supply. Getting billed for each highway use and having those bills come months later. Because it is so expensive to travel, we'd need highway and flight insurance. That's the absurdity of US healthcare. Play stupid games, win stupid prizes.
Aloisius 3y ago
Single payer was killed by the healthcare provider lobbies, not the insurance lobby. Doctors have waged a war against single payer anytime it has been suggested for over a century. The power the doctor and the hospital lobbies wield to sway opinion utterly dwarfs that of the health insurance industry.
- slfnflctd 3y ago
  There are multiple reasons I can imagine why that might be, but I would love to see some citations for this so I have solid data I can confidently adjust my world view with. My opinion is that insurance companies are middlemen who too frequently rob patients & providers alike, and I would expect any reasonable legislation to include provisions to ensure that being a doctor is still financially attractive. Coming around full circle, the cost of malpractice insurance is now so high that it's become a significant barrier to entry for anyone trying to start a new medical office, and I think that should be addressed as well.
  - Aloisius 3y ago
    Ultimately, it's about pay. This covers some of the history: https://www.kqed.org/news/11902591/why-do-so-many-doctors-oppose-single-payer-health-care https://www.kqed.org/news/11902591/why-do-so-many-doctors-op... That people believe healthcare providers, where the vast majority of the $4.5 trillion in healthcare spending ultimately goes, are just barely getting by and that they're being robbed by insurance companies (~5% of spending) should be ample evidence of how powerful they are. Never mind that private insurance reimbursement rates are higher than Medicare's and even Medicare's rates are double that of every other advanced developed country.
fn-mote 3y ago
In my case, not hitting the deductible is the wrong metric. You are still benefitting from the insurer's negotiation of lower rates for all procedures. For example, your insurer may have negotiated $0 for standard bloodwork. The parent's acknowledgement that "this is how insurance works" doesn't change the fact: that IS how insurance works. Coverage of a risk has a value, even if that risk does not materialize. (This is easier to understand from the point of view of the finance markets, but it's the same everywhere.)

paxys 3y ago

Obamacare was essentially gutted when the individual mandate was deemed unconstitutional and removed. If young, healthy people aren't signing up and paying into the system then of course the sick ones will bear the brunt of it. That's just how insurance works.

plants 3y ago

I’m unemployed in NYC right now - so, zero consistent income. I’m one of those people with the very worst marketplace health plans. Here’s what I get for $640/mo (with a $120 tax credit, oh boy!): - Visits to my general practitioner (but not so fast! no diagnostic tests or ANYTHING else - those are 100% out of pocket until my $9,000 deductible is met) - Pregnancy care (it’s currently a biological impossibility for me to give birth) Everything else is entirely out of pocket until my $9,000 deductible is met. My coverage is basically a $6,000 guarantee that I won’t be completely bankrupted if I get run over by a garbage truck and live to tell the tale. Otherwise, it’s completely useless. Something’s gotta give.

BenjiWiebe 3y ago

Interesting. I am using an obamacare plan (in Kansas). It's in no way an amazing plan, but I only pay single digit (or was it $10, idr) premiums per month, and my deductible is $1200. I've been pretty pleased with obamacare for the three years I've had a plan with it.