3 ms·

I think most Americans over-index on the cost of healthcare and the availability of insurance because it’s constant in our news and our system absolutely sucks.

I think most Americans over-index on the cost of healthcare and the availability of insurance because it’s constant in our news and our system absolutely sucks. Most people don’t need regular medical care because most people are healthy (until they start getting older). It’s expensive, sure, but most people in the middle-class have employer sponsored healthcare, and retirees have government sponsored healthcare, and many low-income people have government sponsored healthcare. The difference in out-of-pocket costs is easily accounted for within significantly higher salaries. Of course, the issue is not the actual availability of insurance, it is that there is a patchwork of laws and protections and it’s not universal to be covered at any point in your life. But many states have well above a 90% insurance rate. California, the most populous state, has 93%. Massachusetts is sitting at 98%. Even Texas, the worst state for health insurance, is at 85% of the population covered.

fastasucan 2y ago
>The difference in out-of-pocket costs is easily accounted for within significantly higher salaries. Any sources for this?
- vineyardmike 2y ago
  Salary Info (25k USD salary difference, before tax) https://en.wikipedia.org/wiki/List_of_countries_by_average_wage https://en.wikipedia.org/wiki/List_of_countries_by_average_w... Cost of healthcare: There are a bunch of numbers that are trivially accessible via Google, including government sources, but I couldn’t find any that match perfectly with the time range of the wage data. Here is one quote, from a few years earlier… > Median annual out-of-pocket spending on medical care ranged from $360 (Hawaii) to $1,500 (Nebraska). In four states, households in the top 10 percent of out-of-pocket expenses spent $7,000 or more on these items. https://www.commonwealthfund.org/publications/issue-briefs/2019/may/how-much-us-households-employer-insurance-spend-premiums-out-of-pocket https://www.commonwealthfund.org/publications/issue-briefs/2... See also: https://meps.ahrq.gov/data_files/publications/st441/stat441.shtml https://meps.ahrq.gov/data_files/publications/st441/stat441....
SnorkelTan 2y ago
I quit my job as a dev to care for my father who has dementia. Using COBRA and paying for the identical health insurance I had from my employer is $1,000/mo. I have no dependents. California minimum wage annual income is ~$32k. Almost half the income of someone who works a shit job. I'd say that almost 50% of minimum wage just for the privilege of going to a doctor when I have a problem is rightfully a pretty big deal.
- nradov 2y ago
  No, that's not how it works. Poor people who lose coverage from employer-sponsored health plans don't pay COBRA premiums out of pocket. They spend much less to either buy a subsidized health plan on the state exchange or go on Medicaid. The system is a mess but let's not exaggerate the problems.
  - SnorkelTan 2y ago
    I can’t imagine getting Medicaid to cover the biologic that I take that costs $5,000 a month without a prescription to be anything other than a nightmare.
- vineyardmike 2y ago
  This is the issue with American healthcare - it’s super confusing and people don’t even understand that they have better options. And of course, living with a super pricy COBRA plan while being unemployed is not the normal experience for people, and also not the actual “optimal” way to get healthcare in that situation. COBRA isn’t meant to be a full healthcare insurance, it’s meant to be a “bridge” care for people in between jobs (that’s why it’s tied to your prior employers plans). You also don’t even need to pay the COBRA premiums unless you actually use it, so you can save that $1K/mo while being implicitly insured (helpful in case you only really want to be insured against catastrophic accidents). If you were not working because you were caring for a dependent (like a sick adult), or if you’re a minimum wage worker, you wouldn’t use an employer sponsored plan through COBRA, you’d use Medi-Cal (California’s expanded Medicaid) or the ACA marketplace, and could be “free” or ultra low (premiums). Medi-Cal is free, and the ACA plan for a 45yo male in SF making Cali minimum wage (34k/yr) would pay $18/mo. Healthcare is absolutely a “pretty big deal” and absolutely the system is terrible. But if you actually made 34k/yr, it probably makes sense to spend 1hr googling for the actual programs that exist so you’d discover that you can get it for much cheaper.

fastasucan 2y ago

>The difference in out-of-pocket costs is easily accounted for within significantly higher salaries. Any sources for this?

vineyardmike 2y ago
Salary Info (25k USD salary difference, before tax) https://en.wikipedia.org/wiki/List_of_countries_by_average_wage https://en.wikipedia.org/wiki/List_of_countries_by_average_w... Cost of healthcare: There are a bunch of numbers that are trivially accessible via Google, including government sources, but I couldn’t find any that match perfectly with the time range of the wage data. Here is one quote, from a few years earlier… > Median annual out-of-pocket spending on medical care ranged from $360 (Hawaii) to $1,500 (Nebraska). In four states, households in the top 10 percent of out-of-pocket expenses spent $7,000 or more on these items. https://www.commonwealthfund.org/publications/issue-briefs/2019/may/how-much-us-households-employer-insurance-spend-premiums-out-of-pocket https://www.commonwealthfund.org/publications/issue-briefs/2... See also: https://meps.ahrq.gov/data_files/publications/st441/stat441.shtml https://meps.ahrq.gov/data_files/publications/st441/stat441....

SnorkelTan 2y ago

I quit my job as a dev to care for my father who has dementia. Using COBRA and paying for the identical health insurance I had from my employer is $1,000/mo. I have no dependents. California minimum wage annual income is ~$32k. Almost half the income of someone who works a shit job. I'd say that almost 50% of minimum wage just for the privilege of going to a doctor when I have a problem is rightfully a pretty big deal.

nradov 2y ago
No, that's not how it works. Poor people who lose coverage from employer-sponsored health plans don't pay COBRA premiums out of pocket. They spend much less to either buy a subsidized health plan on the state exchange or go on Medicaid. The system is a mess but let's not exaggerate the problems.
- SnorkelTan 2y ago
  I can’t imagine getting Medicaid to cover the biologic that I take that costs $5,000 a month without a prescription to be anything other than a nightmare.
vineyardmike 2y ago
This is the issue with American healthcare - it’s super confusing and people don’t even understand that they have better options. And of course, living with a super pricy COBRA plan while being unemployed is not the normal experience for people, and also not the actual “optimal” way to get healthcare in that situation. COBRA isn’t meant to be a full healthcare insurance, it’s meant to be a “bridge” care for people in between jobs (that’s why it’s tied to your prior employers plans). You also don’t even need to pay the COBRA premiums unless you actually use it, so you can save that $1K/mo while being implicitly insured (helpful in case you only really want to be insured against catastrophic accidents). If you were not working because you were caring for a dependent (like a sick adult), or if you’re a minimum wage worker, you wouldn’t use an employer sponsored plan through COBRA, you’d use Medi-Cal (California’s expanded Medicaid) or the ACA marketplace, and could be “free” or ultra low (premiums). Medi-Cal is free, and the ACA plan for a 45yo male in SF making Cali minimum wage (34k/yr) would pay $18/mo. Healthcare is absolutely a “pretty big deal” and absolutely the system is terrible. But if you actually made 34k/yr, it probably makes sense to spend 1hr googling for the actual programs that exist so you’d discover that you can get it for much cheaper.