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Since a year or two before the individual mandate ended (it was worth the fee), I dropped health insurance and self-pay for self and family; I pay now in a year

by kldg 1y ago

Since a year or two before the individual mandate ended (it was worth the fee), I dropped health insurance and self-pay for self and family; I pay now in a year for actual service what I paid in a month in premiums, mostly to dentist, without feeling any restrictions on seeking healthcare. I don't often need referrals, can self-order procedures directly, and the amount insurance says they "negotiated" is pretty misleading, often comparable to what I pay in cash without insurance. Since ACA was implemented, prior to covid, life expectancy in the US stopped increasing; not to say ACA is directly responsible (without more data), but whatever its net benefits may be are clearly losing out to other signals. That said, our ... fascinating ... experiences ... in trying to get the government to fix our health systems is certainly no outsider's fault. Europeans and others can feel at ease continuing to mock us.

ChrisMarshallNY 1y ago
Ooohh... Wait until you have a really nasty health emergency. I'm 63, and my wife is near my age. We take this stuff seriously. I have known many people that have been completely devastated by medical crises. Even with insurance, some types of illness can be catastrophic, financially. I also have known quite a number of folks that have done an amazing job of taking care of themselves, yet still had medical crises.
- kldg 1y ago
  It's a lottery either way, I think. I can pay $20k/year for health insurance and limit to $20k/year in expenses (or w/e current annual limit is), or I can save the $20k/year and put it into an unencumbered investment account. The insurance company charges so much that I feel much better about getting out of insurance in my 20s so that I have a pretty decent pile now in my 30s, and going forward, the pile accumulates as my risks do. -but if I get a terminal, especially long-term illness, it's a wipeout either way; if I'm out $20k/year to the healthcare providers and $20k/year to the insurance company, and can't work -- draining $40k/year in health costs just isn't going to work out for very long, unless I can make it another decade or two. Edit: I should say, too, I give money directly to my daughter (that is, well before [ideally] I'm ill), specifically so I can declare bankruptcy with less family wealth loss if I should have to, and to help fend off Medicaid clawback.
  - ChrisMarshallNY 1y ago
    About 30 years ago, I had a brain tumor that damn near killed me. Put me in Hospital for 17 days. A week of that, was ICU (lots of machines that go “beep”). I had an HMO, at the time, and it was a pain, dealing with them, but it ended up costing me almost nothing. I think it would have been almost a million dollars, if out of pocket.
    - kldg 1y ago
      Yes, that very likely would be a run-ender for me, and make me dependent on family and gov't assistance (which is fine; which is something I've planned and plan for; but obviously it'd be nice to not be bankrupt and mooching of my family). I'm glad you got through it; my uncle had a brain tumor found while simultaneously having Alzheimer's (despite only being in his late 50s and a clean and pretty mentally active fellow) -- it didn't work out well. edit: remainder of original reply removed.
      - ChrisMarshallNY 1y ago
        Long time ago. I could probably scare up the paperwork. They didn't really do digital, in those days. I think my MRIs were film-only.
      - fragmede 1y ago
        > it uses hashed non-reversible IP address as credentials; I don't store IP addresses I'm sorry but by my math, there aren't that many publicly routable IP addresses (like 2.5 billion?). Generating and storing rainbow tables for all 2.5 billion publicly routable IP addresses wouldn't take an exorbitant amount of time, making that part semi-reversible.
        kldg 1y ago
        Your IP address is hashed when you connect and then a large part of it is lopped off. The part that isn't lopped off is used for ID. There is collision risk; definitely use alternatives if not comfortable with that -- it was made for a small handful of friends in Discord to share >10MB attachments and definitely not for storing folks' medical information. Edit: On reconsideration, though, given that, I went ahead and removed the link, email address, and solicitation generally. I'm confident nothing would go wrong in the context of the 1000 or so people I imagine would ever see that link before the service is removed/renamed in some years, but I can appreciate the high-value liability of being wrong on that. Thanks.
dekhn 1y ago
Your approach would work fine until you have a bigger emergency than you can afford. The entire original point of insurance was to amortize the costs of the extreme events by spreading the costs across many people. Are you paying rack rates for pharmaceuticals instead of the PBM rates? That gets expensive really fast.
- kldg 1y ago
  Nobody pays rack rates. Most pharmacies keep their own PBM access cards (like GoodRx) to scan at the counter if customer doesn't bring their own. Some examples of self-pay prices: Insulin Lispro 10ml of 100 units/ml (1 vial) - $27.49 Amoxicillin 500mg (21 capsules) - $9.09 Lisinopril/HCTZ 20mg/12.5mg (90 tablets) - $12.15 This isn't very relevant to us though given none of us have any long-term issues (what actually got me to switch off health insurance was getting the EoB paperwork [every week, because the bills never seemed to stop for a long while after I stopped going to the burn clinic] for severely burning my hand in a grease fire; I would've been better off uninsured and shopping around). After a decade at the $20k/year assumption for family of 3's health insurance, we wind up with ~$200k saved up BEFORE investment gains (which, while I'll grant can be negative, we do have a pretty powerful, accessible, and long-term consistent engine in the US). Once I'm in my 40s, I should be able to afford having brain cancer; and if I don't get brain cancer, well, the biggest positive there is not having brain cancer.

by kldg 1y ago

ChrisMarshallNY 1y ago

Ooohh... Wait until you have a really nasty health emergency. I'm 63, and my wife is near my age. We take this stuff seriously. I have known many people that have been completely devastated by medical crises. Even with insurance, some types of illness can be catastrophic, financially. I also have known quite a number of folks that have done an amazing job of taking care of themselves, yet still had medical crises.

kldg 1y ago
It's a lottery either way, I think. I can pay $20k/year for health insurance and limit to $20k/year in expenses (or w/e current annual limit is), or I can save the $20k/year and put it into an unencumbered investment account. The insurance company charges so much that I feel much better about getting out of insurance in my 20s so that I have a pretty decent pile now in my 30s, and going forward, the pile accumulates as my risks do. -but if I get a terminal, especially long-term illness, it's a wipeout either way; if I'm out $20k/year to the healthcare providers and $20k/year to the insurance company, and can't work -- draining $40k/year in health costs just isn't going to work out for very long, unless I can make it another decade or two. Edit: I should say, too, I give money directly to my daughter (that is, well before [ideally] I'm ill), specifically so I can declare bankruptcy with less family wealth loss if I should have to, and to help fend off Medicaid clawback.
- ChrisMarshallNY 1y ago
  About 30 years ago, I had a brain tumor that damn near killed me. Put me in Hospital for 17 days. A week of that, was ICU (lots of machines that go “beep”). I had an HMO, at the time, and it was a pain, dealing with them, but it ended up costing me almost nothing. I think it would have been almost a million dollars, if out of pocket.
  - kldg 1y ago
    Yes, that very likely would be a run-ender for me, and make me dependent on family and gov't assistance (which is fine; which is something I've planned and plan for; but obviously it'd be nice to not be bankrupt and mooching of my family). I'm glad you got through it; my uncle had a brain tumor found while simultaneously having Alzheimer's (despite only being in his late 50s and a clean and pretty mentally active fellow) -- it didn't work out well. edit: remainder of original reply removed.
    - ChrisMarshallNY 1y ago
      Long time ago. I could probably scare up the paperwork. They didn't really do digital, in those days. I think my MRIs were film-only.
    - fragmede 1y ago
      > it uses hashed non-reversible IP address as credentials; I don't store IP addresses I'm sorry but by my math, there aren't that many publicly routable IP addresses (like 2.5 billion?). Generating and storing rainbow tables for all 2.5 billion publicly routable IP addresses wouldn't take an exorbitant amount of time, making that part semi-reversible.
      - kldg 1y ago
        Your IP address is hashed when you connect and then a large part of it is lopped off. The part that isn't lopped off is used for ID. There is collision risk; definitely use alternatives if not comfortable with that -- it was made for a small handful of friends in Discord to share >10MB attachments and definitely not for storing folks' medical information. Edit: On reconsideration, though, given that, I went ahead and removed the link, email address, and solicitation generally. I'm confident nothing would go wrong in the context of the 1000 or so people I imagine would ever see that link before the service is removed/renamed in some years, but I can appreciate the high-value liability of being wrong on that. Thanks.

dekhn 1y ago

Your approach would work fine until you have a bigger emergency than you can afford. The entire original point of insurance was to amortize the costs of the extreme events by spreading the costs across many people. Are you paying rack rates for pharmaceuticals instead of the PBM rates? That gets expensive really fast.

kldg 1y ago
Nobody pays rack rates. Most pharmacies keep their own PBM access cards (like GoodRx) to scan at the counter if customer doesn't bring their own. Some examples of self-pay prices: Insulin Lispro 10ml of 100 units/ml (1 vial) - $27.49 Amoxicillin 500mg (21 capsules) - $9.09 Lisinopril/HCTZ 20mg/12.5mg (90 tablets) - $12.15 This isn't very relevant to us though given none of us have any long-term issues (what actually got me to switch off health insurance was getting the EoB paperwork [every week, because the bills never seemed to stop for a long while after I stopped going to the burn clinic] for severely burning my hand in a grease fire; I would've been better off uninsured and shopping around). After a decade at the $20k/year assumption for family of 3's health insurance, we wind up with ~$200k saved up BEFORE investment gains (which, while I'll grant can be negative, we do have a pretty powerful, accessible, and long-term consistent engine in the US). Once I'm in my 40s, I should be able to afford having brain cancer; and if I don't get brain cancer, well, the biggest positive there is not having brain cancer.