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The weirdest thing about health insurance in the US is how tied it is to employment, Obamacare helped a little with this. The second weirdest thing is that ins

The weirdest thing about health insurance in the US is how tied it is to employment, Obamacare helped a little with this. The second weirdest thing is that insurance companies can't offer more tightly defined plans for, say, young people who never go to the doctor except for critical/emergency care vs me who goes a couple times a year for various things. Obamacare did not help with this, at all.

Retric 2y ago
Age impacts health insurance costs, but health insurance is specifically excluded for considering existing conditions because people can’t get long term coverage. If someone gets a chronic condition while covered the company isn’t paying out a lifetime benefit, so they soon need to renegotiate rates while sick even though they had insurance while they got sick.
ceejayoz 2y ago
> The second weirdest thing is that insurance companies can't offer more tightly defined plans for, say, young people who never go to the doctor except for critical/emergency care vs me who goes a couple times a year for various things. That's not weird; it's essential for the system to work, because you can rapidly move from "never go to the doctor" into "seven figures of healthcare spend" without much warning. We used to have "high risk pools"; it was horrific. https://www.kff.org/affordable-care-act/issue-brief/high-risk-pools-for-uninsurable-individuals/ https://www.kff.org/affordable-care-act/issue-brief/high-ris...
SkyPuncher 2y ago
One the second point, they essentially offer this with high deductible plans. Essentially, these plans really only make sense if you only expect to have emergency care (like young people).
- HarryHirsch 2y ago
  These things don't make sense even for young people because at a young age people tend not to have savings, and a medical emergency can totally wipe out your finances. Remember what they told you about burial insurance: it's a scam, except for young people who don't have savings
mindslight 2y ago
Well the entire public policy point of insurance is to have the people who pay in but don't really use it subsidize the people who end up needing it. This dynamic is why the ACA had an individual mandate, which addressed the incentive of young healthy people to not want to pay in. It would be sensible if we were talking about one society-wide pool (ie single payer), since those younger people would end up being subsidized as they developed health conditions. But as it stands having many pools run by independent companies is fraught with perverse incentives, since an "insurance" company is quite happy to have you as a customer when you're paying in, but much less happy when they're paying out.
jabroni_salad 2y ago
There is actually a decent way to do that. You get a high deductible catastrophe plan, and bolt on a Direct Primary Care provider for simple things. The DPC is a doctor who you pay a small retainer (My guy is $70/mo) and the main reason that the cost is so low is that he does not need to staff a billing department due to simply not integrating with insurance at all. I keep $10K in an HSA to cover my deductible if I need to. DPC doctors also keep a much smaller patient roster so it is pretty easy to book time with him and he isn't being pressured by some middle manager to keep every interaction at 10 minutes or less. Once you see how this all works it's easy to become singlepayer-pilled because wow the whole medical scene could pay providers better, offer higher quality services, and have competitive pricing if we could just get around to deleting the billing department and insurance company.
- abecedarius 2y ago
  Unfortunately the high-deductible catastrophic care plans are a lot less attractive ever since Obamacare. I agree about your advice as the least bad choice (afaik) when you don't have coverage you like through work.
- matwood 2y ago
  If you're making income you should max your HSA. It's triple tax advantaged. https://www.investopedia.com/articles/personal-finance/120715/why-hsas-appeal-more-highincome-earners.asp https://www.investopedia.com/articles/personal-finance/12071...
snarf21 2y ago
This was a consequence of WW II labor shortages and the government froze wages. So companies used benefits like health care instead. It should have been outlawed after the war. It is very anti-worker and many people won't change jobs for no reason other than healthcare. It has also created an issue where the health "insurance" companies don't have to compete like they do in car insurance, etc.
Brian_K_White 2y ago
It is entirely correct that the young have to pay for the old. It's not robbing from the young who "don't need" it. It's the young paying for their own selves who absolutely will need it. Setting aside the reality of the system which will happily collect premiums for 40 years and then use any slightest technicality to avoid paying in the end, ie like changing jobs or providers and it's like you were born on the day of that switch and haven't been paying in your whole life. That is a seperate issue from the simple concept that the young somehow "don't need" to be contributing to the health care pool because they "don't need" to dip from it. In this, there are no individuals and it's not some elective luxury like how much you want to blow on toys. Merely in the US, we have been treating it like it was, except even worse, because when I buy a fancy over the top steak, I know the price ahead of time and get no surprises after the fact either. I don't just get hit with $500 steak bills with no warning or choice or recourse and thank god my boss takes $12k out of my salary so that I only have to pay a $50 deductible and fill out 3 forms correctly for that $500 steak I didn't ask for...

Retric 2y ago

Age impacts health insurance costs, but health insurance is specifically excluded for considering existing conditions because people can’t get long term coverage. If someone gets a chronic condition while covered the company isn’t paying out a lifetime benefit, so they soon need to renegotiate rates while sick even though they had insurance while they got sick.

ceejayoz 2y ago

> The second weirdest thing is that insurance companies can't offer more tightly defined plans for, say, young people who never go to the doctor except for critical/emergency care vs me who goes a couple times a year for various things. That's not weird; it's essential for the system to work, because you can rapidly move from "never go to the doctor" into "seven figures of healthcare spend" without much warning. We used to have "high risk pools"; it was horrific. https://www.kff.org/affordable-care-act/issue-brief/high-risk-pools-for-uninsurable-individuals/ https://www.kff.org/affordable-care-act/issue-brief/high-ris...

SkyPuncher 2y ago

One the second point, they essentially offer this with high deductible plans. Essentially, these plans really only make sense if you only expect to have emergency care (like young people).

HarryHirsch 2y ago
These things don't make sense even for young people because at a young age people tend not to have savings, and a medical emergency can totally wipe out your finances. Remember what they told you about burial insurance: it's a scam, except for young people who don't have savings

mindslight 2y ago

Well the entire public policy point of insurance is to have the people who pay in but don't really use it subsidize the people who end up needing it. This dynamic is why the ACA had an individual mandate, which addressed the incentive of young healthy people to not want to pay in. It would be sensible if we were talking about one society-wide pool (ie single payer), since those younger people would end up being subsidized as they developed health conditions. But as it stands having many pools run by independent companies is fraught with perverse incentives, since an "insurance" company is quite happy to have you as a customer when you're paying in, but much less happy when they're paying out.

jabroni_salad 2y ago

There is actually a decent way to do that. You get a high deductible catastrophe plan, and bolt on a Direct Primary Care provider for simple things. The DPC is a doctor who you pay a small retainer (My guy is $70/mo) and the main reason that the cost is so low is that he does not need to staff a billing department due to simply not integrating with insurance at all. I keep $10K in an HSA to cover my deductible if I need to. DPC doctors also keep a much smaller patient roster so it is pretty easy to book time with him and he isn't being pressured by some middle manager to keep every interaction at 10 minutes or less. Once you see how this all works it's easy to become singlepayer-pilled because wow the whole medical scene could pay providers better, offer higher quality services, and have competitive pricing if we could just get around to deleting the billing department and insurance company.

abecedarius 2y ago
Unfortunately the high-deductible catastrophic care plans are a lot less attractive ever since Obamacare. I agree about your advice as the least bad choice (afaik) when you don't have coverage you like through work.
matwood 2y ago
If you're making income you should max your HSA. It's triple tax advantaged. https://www.investopedia.com/articles/personal-finance/120715/why-hsas-appeal-more-highincome-earners.asp https://www.investopedia.com/articles/personal-finance/12071...

snarf21 2y ago

This was a consequence of WW II labor shortages and the government froze wages. So companies used benefits like health care instead. It should have been outlawed after the war. It is very anti-worker and many people won't change jobs for no reason other than healthcare. It has also created an issue where the health "insurance" companies don't have to compete like they do in car insurance, etc.

Brian_K_White 2y ago

It is entirely correct that the young have to pay for the old. It's not robbing from the young who "don't need" it. It's the young paying for their own selves who absolutely will need it. Setting aside the reality of the system which will happily collect premiums for 40 years and then use any slightest technicality to avoid paying in the end, ie like changing jobs or providers and it's like you were born on the day of that switch and haven't been paying in your whole life. That is a seperate issue from the simple concept that the young somehow "don't need" to be contributing to the health care pool because they "don't need" to dip from it. In this, there are no individuals and it's not some elective luxury like how much you want to blow on toys. Merely in the US, we have been treating it like it was, except even worse, because when I buy a fancy over the top steak, I know the price ahead of time and get no surprises after the fact either. I don't just get hit with $500 steak bills with no warning or choice or recourse and thank god my boss takes $12k out of my salary so that I only have to pay a $50 deductible and fill out 3 forms correctly for that $500 steak I didn't ask for...