4 ms·

For my kids, health insurance premium would have been almost $2k per month. In a typical year we spend about $1,200 total on medical stuff just paying out of p

For my kids, health insurance premium would have been almost $2k per month. In a typical year we spend about $1,200 total on medical stuff just paying out of pocket. Also keep in mind that premiums are not all you pay - there's also deductible and co-pays on top of that! It's not hard to math that up and see how insane doing the health insurance would be. Yes there's the catastrophic risk of a bad accident or ER visit or something, and that's worth some cost, but even saving half the premiums in a money market account not only provides a good cushion for that, but if we don't use the money we actually get to keep it!

dboreham 11mo ago
And this is why you can't have a system where people can opt out of paying for healthcare.
- hnuser123456 11mo ago
  And how many zeros does that justify tacking onto realistic fair-market pricing on meds and procedures to force people to "opt in"?
  - ocschwar 11mo ago
    The value you get from the health care system isn't just from the services they provide when/if you need them. It's from the system existing and being ready to help you. We're not talking about widgets, onions, haircuts, or pork bellies here. You can't opt out of the system existing. And you can't opt out of the horrific consequences if the system doesn't exist. So it's a bit silly to talk about health care like it's something that has a free market.
    - hnuser123456 11mo ago
      I work at a hospital, so should I get better rates than everyone who doesn't, since I'm helping keep that system ready?
      - ocschwar 11mo ago
        Whatever it takes to keep you from leaving your post.
- freedomben 11mo ago
  > And this is why you can't have a system where people can opt out of paying for healthcare. We do pay for our healthcare. We don't pay for health insurance. I get the general point you're making and I'm not trying to be pedantic, but I do think it's important to distinguish between the two in order to have a productive exchange.
  - senordevnyc 11mo ago
    But you wouldn't pay for your healthcare if you had a major event that cost $500k+. The rest of us would be left holding the bag. I don't think you're doing anything wrong, but I do think we need a system everyone is a part of paying for, via health insurance mandate, single payer, etc. Or we let people opt out completely, to where a family like yours just wouldn't receive care if you can't pay for it, but I don't think this is the world we want to live in.
- Timshel 11mo ago
  You can if not every actor in your system is trying to gouge the others ...
  - koolba 11mo ago
    The ACA has specific language that limits insurance company profits to a percentage of gross costs of care. It’s in their interests to have the provider costs be as high as possible as it directly limits their own profits. To put it another way, when the private equity that bought your local doctor’s office raises their prices, your insurance company wins.
- msandford 11mo ago
  I suspect that the parent does in fact pay for any healthcare that they need or that their kids need. They just aren't buying insurance because the price of the insurance far outweighs their normal spending. This is the real problem with health insurance is that it covers relatively routine and non emergency healthcare services where you can ship around and have market forces encourage people to find efficiency. I understand the "if I'm dying from a car crash I can't shop around" argument and I agree. But that's very different than shopping for a family doc you like for the half dozen times a year you or your family will need to see someone for a strep test and maybe antibiotics.
ashleyn 11mo ago
It would be nice if health insurance were, well, insurance, and not some bastard mix of cost sharing and collective bargaining. The closest you get to "catastrophic only" insurance is an obamacare bronze and/or a high deductible plan with an HSA. Same service, same networks, but you pay less premiums and thus keep what you don't spend. Health catastrophes are more likely than you may think, so I would suggest a HDHP+HSA at the very least. It's very difficult to self insure against a cancer diagnosis that may blow a million dollars in a year. I'm a fairly high net worth individual with a high deductible plan. Setting aside the deductible amount in savings (often, tax free with the HSA) and keeping it every year you have good health is OP.
- patja 11mo ago
  HDHP is good advice but doesn't save anything from the prices cited above. My HDHP Bronze plan is over 2k/month for 3 people.
  - giantg2 11mo ago
    Not to mention, this paradigm completely fails for almost anyone with an income that isn't above the 50th percentile.
    - JumpCrisscross 11mo ago
      > this paradigm completely fails for almost anyone with an income that isn't above the 50th percentile I'm in Wyoming, and our threshold is under 200% the poverty line. That's $53,300 for a family of 3 [1]. Median household income–nationally–is $84k [2]. In Wyoming, it's $75k [3]. That's a gap. But it's a workable one. [1] https://health.wyo.gov/healthcarefin/chip/doesmychildqualify/ https://health.wyo.gov/healthcarefin/chip/doesmychildqualify... [2] https://fred.stlouisfed.org/series/MEHOINUSA672N https://fred.stlouisfed.org/series/MEHOINUSA672N [3] https://usafacts.org/answers/what-is-the-income-of-a-us-household/state/wyoming/ https://usafacts.org/answers/what-is-the-income-of-a-us-hous...
      - deleted 11mo ago
guywithahat 11mo ago
There are programs in the US to give poor people healthcare for free; I was unemployed for a while and on one. Surprisingly simple and easy to set up. The issue highlighted in this article seems to largely be due to illegal immigration, not due to a lack of support. If we curbed illegal immigration the problem would likely fix itself, although this article isn't very clear on who is or isn't a citizen in their numbers which makes it hard to use for anything useful
- deleted 11mo ago
  [deleted]
- toomuchtodo 11mo ago
  https://usafacts.org/answers/how-many-people-are-on-medicaid-in-the-us/country/united-states/ https://usafacts.org/answers/how-many-people-are-on-medicaid... https://usafacts.org/just-the-facts/do-you-qualify/health/ https://usafacts.org/just-the-facts/do-you-qualify/health/ https://usafacts.org/articles/how-will-the-obbb-impact-medicaid/ https://usafacts.org/articles/how-will-the-obbb-impact-medic... https://www.congress.gov/crs-product/IF11912 https://www.congress.gov/crs-product/IF11912 https://www.kff.org/racial-equity-and-health-policy/5-key-facts-about-immigrants-and-medicaid/ https://www.kff.org/racial-equity-and-health-policy/5-key-fa... https://www.americanimmigrationcouncil.org/blog/undocumented-immigrants-snap-medicaid-benefits/ https://www.americanimmigrationcouncil.org/blog/undocumented... > Do undocumented immigrants qualify for federal healthcare benefits? No. Undocumented immigrants do not have access to federally funded healthcare coverage, including Medicaid, Medicare, or the Children’s Health Insurance Program (CHIP). They are also unable to purchase health insurance coverage from the Affordable Care Act (ACA) Marketplace.
  - guywithahat 11mo ago
    Right, they shouldn't have access to ACA, nor should a citizen of Denmark or India. They are foreign nationals and including them in the 4 million uninsured children in the US statistic makes the statistic worthless. My issue with this article is it suggests there's some massive child uninsured problem in the US, but to get that number they're including foreign citizens. If we included all of south america I'm sure we could find tens of millions of uninsured people. If we included the rest of the world it might be closer to hundreds of millions. That doesn't mean there's a problem with the ACA. There could be a problem with it, but this 4 million number doesn't get us closer to an answer.
anubistheta 11mo ago
That's why I liked catastrophic health care plans. Insurance works best when it covers rare, expensive events. Otherwise, it interferes with the process. My car insurance doesn't cover oil changes or new tires, but if I get I crash and injure someone, it kicks in. Homeowners insurance doesn't cover a routine roof replacement, but it will if there's storm damage. That's how health insurance should work. A catastrophic health care plan has low premiums and high deductibles. You also get access to a tax advantaged savings account to save up for future events. So you can take the money you saved on premiums and pay for medical expenses tax free. Or let the money accumulate to cover future medical expenses or even retirement!
- giantg2 11mo ago
  "A catastrophic health care plan has low premiums and high deductibles." Except they don't really exist anymore. You can get really high deductibles, but the premiums are still ridiculous. The plans have to cover many non-catastrophic events now by law. The other problem is that the cost and frequency of things like auto accidents or home damage is generally much lower than for health events, and generally include much lower caps on how much they will payout.
  - bombcar 11mo ago
    This was the intent of the insurance agencies, they sold catastrophic plans but didn't really make a ton on them, so they negotiated basically not being able to sell them anymore. Self-insurance is the final catastrophic plan and the numbers keep looking better every day.
- patja 11mo ago
  I would like to get a catastrophic plan that doesn't cover things I would categorize as consequences of bad choices. I get that covering these things is less costly for society than just letting things run their course, but it does drive costs onto everyone else's premium. Catastrophic plans are still quite costly because they aren't really a pure insurance product. Mine is over 2k/month for 3 people on an ACA Bronze plan with HSA.
giantg2 11mo ago
"but even saving half the premiums in a money market account not only provides a good cushion for that, but if we don't use the money we actually get to keep it!" Until they require a $50k life flight or $100k brain, heart, etc surgery. The problem is that insurance was intended to cover the large, infrequent costs - house fires, totaled cars, etc. The deductibles are intended to influence people to pay out of pocket for the smaller expenses. The problem with health insurance is that the deductibles, premiums, and cost of care are out of control. The laws mandate significant amounts of coverage for a plan. The costs can be as high as a house fire, but happen much more frequently within the population. You can't get a plan that just covers expenses over $10k-20k per year. You can get kind of close with the super high deductibles but it still has to cover some things before the limit. Even if you could get to that, you're still looking at high costs when you consider the odds of something like 1 out of 100 people might need a $100k procedure in a year (made up numbers).
- Escapado 11mo ago
  Genuine question: How does it happen that a heart surgery costs 100k? 2 surgeons (200$/h) + 6 nurses(100$/h) for 10 hours would be 10k. Where do the other 100k come from? Is it the equipment cost? Consumables? After care? Or are the margins just ridiculous?
  - dec0dedab0de 11mo ago
    In the breakdown it's usually the anesthesia that costs the most. I think a big chunk of that goes to malpractice insurance.
    - ben_w 11mo ago
      Malpractice insurance? One insurance premium is high in order to pay for the cost of another insurance premium? This seems… suboptimal. I'm in Germany, I don't know what we spend money on here because I'm still integrating myself and have not mastered the German language to the level of having opinions about the Krankenversicherungsbeitragsentlastungsgesetz, but I do know we spend about 2/3rds per capita as the USA for better outcomes: https://ourworldindata.org/grapher/life-expectancy-vs-health-expenditure https://ourworldindata.org/grapher/life-expectancy-vs-health...

dboreham 11mo ago

And this is why you can't have a system where people can opt out of paying for healthcare.

hnuser123456 11mo ago
And how many zeros does that justify tacking onto realistic fair-market pricing on meds and procedures to force people to "opt in"?
- ocschwar 11mo ago
  The value you get from the health care system isn't just from the services they provide when/if you need them. It's from the system existing and being ready to help you. We're not talking about widgets, onions, haircuts, or pork bellies here. You can't opt out of the system existing. And you can't opt out of the horrific consequences if the system doesn't exist. So it's a bit silly to talk about health care like it's something that has a free market.
  - hnuser123456 11mo ago
    I work at a hospital, so should I get better rates than everyone who doesn't, since I'm helping keep that system ready?
    - ocschwar 11mo ago
      Whatever it takes to keep you from leaving your post.
freedomben 11mo ago
> And this is why you can't have a system where people can opt out of paying for healthcare. We do pay for our healthcare. We don't pay for health insurance. I get the general point you're making and I'm not trying to be pedantic, but I do think it's important to distinguish between the two in order to have a productive exchange.
- senordevnyc 11mo ago
  But you wouldn't pay for your healthcare if you had a major event that cost $500k+. The rest of us would be left holding the bag. I don't think you're doing anything wrong, but I do think we need a system everyone is a part of paying for, via health insurance mandate, single payer, etc. Or we let people opt out completely, to where a family like yours just wouldn't receive care if you can't pay for it, but I don't think this is the world we want to live in.
Timshel 11mo ago
You can if not every actor in your system is trying to gouge the others ...
- koolba 11mo ago
  The ACA has specific language that limits insurance company profits to a percentage of gross costs of care. It’s in their interests to have the provider costs be as high as possible as it directly limits their own profits. To put it another way, when the private equity that bought your local doctor’s office raises their prices, your insurance company wins.
msandford 11mo ago
I suspect that the parent does in fact pay for any healthcare that they need or that their kids need. They just aren't buying insurance because the price of the insurance far outweighs their normal spending. This is the real problem with health insurance is that it covers relatively routine and non emergency healthcare services where you can ship around and have market forces encourage people to find efficiency. I understand the "if I'm dying from a car crash I can't shop around" argument and I agree. But that's very different than shopping for a family doc you like for the half dozen times a year you or your family will need to see someone for a strep test and maybe antibiotics.

ashleyn 11mo ago

It would be nice if health insurance were, well, insurance, and not some bastard mix of cost sharing and collective bargaining. The closest you get to "catastrophic only" insurance is an obamacare bronze and/or a high deductible plan with an HSA. Same service, same networks, but you pay less premiums and thus keep what you don't spend. Health catastrophes are more likely than you may think, so I would suggest a HDHP+HSA at the very least. It's very difficult to self insure against a cancer diagnosis that may blow a million dollars in a year. I'm a fairly high net worth individual with a high deductible plan. Setting aside the deductible amount in savings (often, tax free with the HSA) and keeping it every year you have good health is OP.

patja 11mo ago
HDHP is good advice but doesn't save anything from the prices cited above. My HDHP Bronze plan is over 2k/month for 3 people.
- giantg2 11mo ago
  Not to mention, this paradigm completely fails for almost anyone with an income that isn't above the 50th percentile.
  - JumpCrisscross 11mo ago
    > this paradigm completely fails for almost anyone with an income that isn't above the 50th percentile I'm in Wyoming, and our threshold is under 200% the poverty line. That's $53,300 for a family of 3 [1]. Median household income–nationally–is $84k [2]. In Wyoming, it's $75k [3]. That's a gap. But it's a workable one. [1] https://health.wyo.gov/healthcarefin/chip/doesmychildqualify/ https://health.wyo.gov/healthcarefin/chip/doesmychildqualify... [2] https://fred.stlouisfed.org/series/MEHOINUSA672N https://fred.stlouisfed.org/series/MEHOINUSA672N [3] https://usafacts.org/answers/what-is-the-income-of-a-us-household/state/wyoming/ https://usafacts.org/answers/what-is-the-income-of-a-us-hous...
    - deleted 11mo ago

guywithahat 11mo ago

There are programs in the US to give poor people healthcare for free; I was unemployed for a while and on one. Surprisingly simple and easy to set up. The issue highlighted in this article seems to largely be due to illegal immigration, not due to a lack of support. If we curbed illegal immigration the problem would likely fix itself, although this article isn't very clear on who is or isn't a citizen in their numbers which makes it hard to use for anything useful

deleted 11mo ago
[deleted]
toomuchtodo 11mo ago
https://usafacts.org/answers/how-many-people-are-on-medicaid-in-the-us/country/united-states/ https://usafacts.org/answers/how-many-people-are-on-medicaid... https://usafacts.org/just-the-facts/do-you-qualify/health/ https://usafacts.org/just-the-facts/do-you-qualify/health/ https://usafacts.org/articles/how-will-the-obbb-impact-medicaid/ https://usafacts.org/articles/how-will-the-obbb-impact-medic... https://www.congress.gov/crs-product/IF11912 https://www.congress.gov/crs-product/IF11912 https://www.kff.org/racial-equity-and-health-policy/5-key-facts-about-immigrants-and-medicaid/ https://www.kff.org/racial-equity-and-health-policy/5-key-fa... https://www.americanimmigrationcouncil.org/blog/undocumented-immigrants-snap-medicaid-benefits/ https://www.americanimmigrationcouncil.org/blog/undocumented... > Do undocumented immigrants qualify for federal healthcare benefits? No. Undocumented immigrants do not have access to federally funded healthcare coverage, including Medicaid, Medicare, or the Children’s Health Insurance Program (CHIP). They are also unable to purchase health insurance coverage from the Affordable Care Act (ACA) Marketplace.
- guywithahat 11mo ago
  Right, they shouldn't have access to ACA, nor should a citizen of Denmark or India. They are foreign nationals and including them in the 4 million uninsured children in the US statistic makes the statistic worthless. My issue with this article is it suggests there's some massive child uninsured problem in the US, but to get that number they're including foreign citizens. If we included all of south america I'm sure we could find tens of millions of uninsured people. If we included the rest of the world it might be closer to hundreds of millions. That doesn't mean there's a problem with the ACA. There could be a problem with it, but this 4 million number doesn't get us closer to an answer.

anubistheta 11mo ago

That's why I liked catastrophic health care plans. Insurance works best when it covers rare, expensive events. Otherwise, it interferes with the process. My car insurance doesn't cover oil changes or new tires, but if I get I crash and injure someone, it kicks in. Homeowners insurance doesn't cover a routine roof replacement, but it will if there's storm damage. That's how health insurance should work. A catastrophic health care plan has low premiums and high deductibles. You also get access to a tax advantaged savings account to save up for future events. So you can take the money you saved on premiums and pay for medical expenses tax free. Or let the money accumulate to cover future medical expenses or even retirement!

giantg2 11mo ago
"A catastrophic health care plan has low premiums and high deductibles." Except they don't really exist anymore. You can get really high deductibles, but the premiums are still ridiculous. The plans have to cover many non-catastrophic events now by law. The other problem is that the cost and frequency of things like auto accidents or home damage is generally much lower than for health events, and generally include much lower caps on how much they will payout.
- bombcar 11mo ago
  This was the intent of the insurance agencies, they sold catastrophic plans but didn't really make a ton on them, so they negotiated basically not being able to sell them anymore. Self-insurance is the final catastrophic plan and the numbers keep looking better every day.
patja 11mo ago
I would like to get a catastrophic plan that doesn't cover things I would categorize as consequences of bad choices. I get that covering these things is less costly for society than just letting things run their course, but it does drive costs onto everyone else's premium. Catastrophic plans are still quite costly because they aren't really a pure insurance product. Mine is over 2k/month for 3 people on an ACA Bronze plan with HSA.

giantg2 11mo ago

"but even saving half the premiums in a money market account not only provides a good cushion for that, but if we don't use the money we actually get to keep it!" Until they require a $50k life flight or $100k brain, heart, etc surgery. The problem is that insurance was intended to cover the large, infrequent costs - house fires, totaled cars, etc. The deductibles are intended to influence people to pay out of pocket for the smaller expenses. The problem with health insurance is that the deductibles, premiums, and cost of care are out of control. The laws mandate significant amounts of coverage for a plan. The costs can be as high as a house fire, but happen much more frequently within the population. You can't get a plan that just covers expenses over $10k-20k per year. You can get kind of close with the super high deductibles but it still has to cover some things before the limit. Even if you could get to that, you're still looking at high costs when you consider the odds of something like 1 out of 100 people might need a $100k procedure in a year (made up numbers).

Escapado 11mo ago
Genuine question: How does it happen that a heart surgery costs 100k? 2 surgeons (200$/h) + 6 nurses(100$/h) for 10 hours would be 10k. Where do the other 100k come from? Is it the equipment cost? Consumables? After care? Or are the margins just ridiculous?
- dec0dedab0de 11mo ago
  In the breakdown it's usually the anesthesia that costs the most. I think a big chunk of that goes to malpractice insurance.
  - ben_w 11mo ago
    Malpractice insurance? One insurance premium is high in order to pay for the cost of another insurance premium? This seems… suboptimal. I'm in Germany, I don't know what we spend money on here because I'm still integrating myself and have not mastered the German language to the level of having opinions about the Krankenversicherungsbeitragsentlastungsgesetz, but I do know we spend about 2/3rds per capita as the USA for better outcomes: https://ourworldindata.org/grapher/life-expectancy-vs-health-expenditure https://ourworldindata.org/grapher/life-expectancy-vs-health...