8 ms·

I'm not a twentysomething kid so I have to buy insurance — and at this point I'm now spending about $10k a year. I realize that doesn't sound like a ton of mone

I'm not a twentysomething kid so I have to buy insurance — and at this point I'm now spending about $10k a year. I realize that doesn't sound like a ton of money, but if you're trying to self fund your own projects while living off the income of client projects and while paying office rent in NYC it's pretty damn painful. Ten years ago I was spending at least half that amount, and what kills me is that I'm a single guy — if I was paying for a spouse or a family plan it would be about double the cost. And the sad thing is that my coverage from ten years ago actually gave me more coverage. I'm happy to pay for coverage and be responsible, but the insurance companies at this point are pretty much on the level of racketeering mobsters. I had hopes for healthcare reform: But without a public option or killing the insurance companies I don't see much changing any time soon. I really hope that more pressure builds and people demand a real change.

greeneggs 14y ago
One big problem is that laws often restrict the ratio that insurance companies charge older people to younger people to at most 5 to 1. Starting in 2014, Obamacare lowers this to 3 to 1, so younger people with insurance are heavily subsidizing their elders (yet again). You'll be paying significantly more, with no direct benefit. [0] http://www.buzzfeed.com/bensmith/obama-healthcare-young-people http://www.buzzfeed.com/bensmith/obama-healthcare-young-peop...
- seanmcdirmid 14y ago
  This is how it works in Switzerland except...the insurers aren't allowed to discriminate at all. So ya, the young kids heavily subsidize the elders...the misery of that! (Also, everyone buys insurance themselves, poor people get help, your employer doesn't buy your insurance) And what is wrong with this exactly? We all get old eventually, so this subsidy is actually fair. > You'll be paying significantly more, with no direct benefit. Only true if you don't plan on getting old.
  - dfxm12 14y ago
    Or if there are more old people now, when you're young, than there will be young people when you are old. :P
rayiner 14y ago
It doesn't really have anything to do with the insurance companies. Their margins on paper aren't that great, and even if those margins are bigger than they look, it's probably not a big difference one way or the other. The major costs here are two-fold: 1) old people 2) doctors and hospitals (those huge, beautiful new buildings aren't free: http://www.feinberg.northwestern.edu/gfx/news/2012-year-review/lurie-400.jpg http://www.feinberg.northwestern.edu/gfx/news/2012-year-revi...)
- ori_b 14y ago
  Other countries also have old people, and I don't have any reason to think that doctors and hospitals are more expensive in the USA than they are elsewhere.
  - rayiner 14y ago
    > I don't have any reason to think that doctors and hospitals are more expensive in the USA than they are elsewhere They definitely are. Doctors in the U.S. make more money. Drugs are more expensive, partially because the U.S. subsidizes R&D for everyone else. Hospital construction in the U.S. is insane in the major systems. They're "spare no expense" affairs, very different from the utilitarian facilities you used to find in the U.S. in say the 1970's and which you still find in the U.S. today.
    - yardie 14y ago
      Doctors in the U.S. make more money. No, not really. My american, pediatrician drove a beat up Subaru. Doctors is a pretty big field that covers GPs (PCPs in the US), surgeons, anaesthesiologist, etc. Surgeons make a lot of money in the US and everywhere, but your typical GP is not ballin'. I'd even say doctors in other western countries make more because no student loans and no malpractice insurance means their take home pay is higher. Drugs are more expensive, partially because the U.S. subsidizes R&D for everyone else. This list http://en.wikipedia.org/wiki/List_of_pharmaceutical_companies http://en.wikipedia.org/wiki/List_of_pharmaceutical_companie... has the top 2 drug companies being in the US and 3rd, 4th, and 5th are european. The US does subsidize the worlds R&D in erectile dysfunction research ;-). There are plenty of drugs that have been approved elsewhere that haven't been seen in the US.
philwelch 14y ago
> and at this point I'm now spending about $10k a year. I realize that doesn't sound like a ton of money That's more than a third of the median US individual income.
- lostlogin 14y ago
  If that was put in a savings account and used for health expenses, is there anyway it wouldn't be a better option? By the time something bad happens, statistically, there should be a fair bit of cash there. It's worth noting that I'm not in the US, and while I know care is expensive in the US, I may be under estimating it.
  - nicksergeant 14y ago
    Unfortunately things are insanely expensive via self-pay. My wife's first pregnancy was in the realm of $25-30,000 if we didn't have insurance. And that was just a routine pregnancy with no complications...
    - lostlogin 14y ago
      That's unbelievable - my wife had our child at no financial cost other than taxes and had a terrible experience. If we had used an obstetrician that we paid for out our pocket and she had a Caesarian (I only we had taken that option) it would have cost US$2500 - that's all inclusive with pre birth and post delivery visit and checks. New Zealand.
  - koeselitz 14y ago
    A friend of mine that had insurance cut off his thumb a few years ago; all told the bill to him ended up being around $80,000. It is unfortunate, but you can't really just save and hope that a tragic thing like that won't happen - it is possible.
ck2 14y ago
I'm pretty far from 20something myself and I live on less than 10k a year (in the usa). If I needed 10k for a medical problem I'd be completely screwed. It's not like they will treat cancer in the emergency room.
- jandrewrogers 14y ago
  Actually, yes, they treat people with no insurance with cancer or other serious injuries all the time. I was literally sitting in an emergency room at Stanford when they flew in a poor illegal immigrant from Fresno and did the micro-surgical reattachment of a finger. I was there for someone with no insurance who had stage 4 liver cancer who was undergoing treatment (they survived). I grew up very poor, there was nothing unusual about this. The idea that poor people do not get top notch medical care in the US is largely a myth. It might not be quite as nice but it is often nearly as effective. A large part of the reason medical care is so expensive for average people is that they are subsidizing the healthcare of poor people. This is why the average survival rates for most cancers are higher in the US than anywhere else in the world; people that cannot afford it still get treated with the state of the art and the cost is passed on to people with insurance. A poor person with cancer in the US with cancer has a much higher survival rate than the average person in the UK. Poor people may not have official insurance but that does not imply lack of healthcare in practice.
  - robbiep 14y ago
    This is the second time I have seen this claim (re cancer survival) posted to HN, both times it has been unsupported by any references- Do you have any references? I have been able to find this Global Cancer Statistics, 2002 DOI 10.3322/canjclin.55.2.74 That shows essentially the same survival between the US and western Europe. (Link to table http://i.imgur.com/UWPxDEx.png http://i.imgur.com/UWPxDEx.png ) Which contradicts the claim
    - Someone 14y ago
      I think they refer to http://www.thelancet.com/journals/lancet/article/PIIS1470-2045(08)70179-7/abstract http://www.thelancet.com/journals/lancet/article/PIIS1470-20... (I think http://healthcare.procon.org/sourcefiles/CONCORDCancerSurvivalStudy.pdf http://healthcare.procon.org/sourcefiles/CONCORDCancerSurviv... is a freely available copy). It shows th USA consistently in the top 5, but not always the top. I think they worked hard on getting comparable data, but I find the discussion on where they come from somewhat lacking. There is some discussion on inconsistencies between diagnoses (when is something Cancer X?), but I could not find a discussion on QALy's (http://en.wikipedia.org/wiki/Quality-adjusted_life_year http://en.wikipedia.org/wiki/Quality-adjusted_life_year). I expect that can make a decent difference in 5 year survival rates (if you give patients the choice between 6 months in bed in hospital and 3 months at home, the last on bedridden, quite a few would choose the 3 months)
pkulak 14y ago
You're missing the whole point. It's not the insurance companies. At least not to any great extent. Their margins are usually under 2% (though their marketing and administrative budgets can be quite large). Hospitals' margins are ten times that. I see the bills that my insurance company pays and they are usually an order of magnitude higher than the Medicare rates. As an aside, what you need to look up Medicare rates are the HCPCPS codes (call them "hick pick" codes on the phone so you sound like you know what you're doing). Just call your hospital and ask for them. They'll give them to you; they just mail you a new form separate from your actual bill. Then, just plug those codes in here: http://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx http://www.cms.gov/apps/physician-fee-schedule/search/search... (use a "specific locality" to get the rates in your area). Then you're ready to negotiate! But... good luck with that...
- rogerbinns 14y ago
  > It's not the insurance companies. At least not to any great extent. Their margins are usually under 2% I'm with Anthem Blue Cross in California. In 2011 they spent 79.9% of premiums on actual medical expenses and due to law changes had to issue a refund for 0.1% This year they raised premiums by 22%. Various administrative expenses are hidden all over the place. eg the cost of an appendectomy also includes the cost of recovering the money charged. The problem with the US healthcare system isn't any one part. Every single part is broken in some way, with the interoperations between them compounding to make the problem worse.
  - yen223 14y ago
    I suspect that the main reason the single-payer healthcare system is so efficient is simply that there are less players involved.
    - GFischer 14y ago
      I work for a non-health insurance company. I believe that removing insurance companies from the equation would definitely make things more efficient - at the very least my company doesn't have the motivation to really cut down on expenses, most managers are more worried about internal power struggles, I've seen so much waste I'd start my own company in a heartbeat if only it wasn't so capital-intensive to start, and a papework and political minefield (which of course lets the old boys get by with a lot of leeway in terms of actual efficiency improvements).
stcredzero 14y ago
> Ten years ago I was spending at least half that amount The same thing happened to me. Over a span of 10 years, I went from having HMO $30 copay and no deductible to $5000 deductible plus another $7500 out of my pocket for co-insurance and the monthly payment being 2X as high.
Xylakant 14y ago
Actually, I'm in the "state" insurance system in germany and I pay 10 grand per year as well. That might or might not be comparable to what you pay since our incomes might or might not be comparable, but the figure itself seems fine. Given that any major injury can cost quite a bit more than 10k to treat, I'm totally fine with that.
- wybo 14y ago
  Really? In the Netherlands health-insurance is around a hundred euros per month (1250 Euros per year). The annual copay is 350 Euros (total). And if you make less than about 20k Euros a year, you get most of your insurance covered by the government. Looks like we've got things sorted over here. (and in the UK, where I live now, things are even easier...)
rwmj 14y ago
I'm in the UK, and the total cost of the NHS is around £130 billion. With a population of approx. 60 million, that means everyone pays on average £2200. Call it $3500. Of course, that's an average covering every man, woman, child, pensioner etc. People in paid employment are paying at least double that (in tax). It's not far from your $10000 figure. Of course, on the up side the NHS is hassle-free. I don't have to worry about co-pays, or money at all. I just go when I need it. Source for budget: http://en.wikipedia.org/wiki/National_Health_Service#Funding http://en.wikipedia.org/wiki/National_Health_Service#Funding Source for population: https://www.cia.gov/library/publications/the-world-factbook/fields/2119.html#uk https://www.cia.gov/library/publications/the-world-factbook/...
- nemesisj 14y ago
  I'm an American living and working in the UK. I think it's telling that I pay less in NHS contributions than I did for Medicare & Medicaid in the USA, and I can use the NHS now.
- specialist 14y ago
  Of course, that's an average covering every man, woman, child, pensioner etc. People in paid employment are paying at least double that (in tax). That $10,000/yr is just the monthly insurance premium. The patient still has to pay for things out of pocket. Because his premium is so high, I'm guessing GP has a very high deductible, eg $5,000, which is paid out of pocket. Then there's the copays, scripts, and misc fees. I currently have awesome coverage (by USA standards) and still have to pay ~20% of visit out of pocket. Actually, that last part I'm guessing. Because of the back and forth game played between insurers and providers, I get confused, and haven't expended the effort to figure out the actual monies exchanged.
  - rwmj 14y ago
    One thing I didn't understand about your reply (sorry, I'm not an American!) is this: You say Because his premium is so high, I'm guessing GP has a very high deductible, eg $5,000 Surely if his premium is high, he would pay less for each visit to the doctor?
katbyte 14y ago
> $10k a year. I realize that doesn't sound like a ton of money Sounds like quite a lot to me considering i would pay (here in Canada) ~66$ a month, ~$800 a year (0 co-pay i think its called), if my employer didn't pay my insurance fee for me. And prescription drugs are also mostly covered... 10K really sucks :(
antihero 14y ago
> I realize that doesn't sound like a ton of money That's a fucking shitload of money.
- michaelpinto 14y ago
  thank you antihero — you're my hero!

greeneggs 14y ago

One big problem is that laws often restrict the ratio that insurance companies charge older people to younger people to at most 5 to 1. Starting in 2014, Obamacare lowers this to 3 to 1, so younger people with insurance are heavily subsidizing their elders (yet again). You'll be paying significantly more, with no direct benefit. [0] http://www.buzzfeed.com/bensmith/obama-healthcare-young-people http://www.buzzfeed.com/bensmith/obama-healthcare-young-peop...

seanmcdirmid 14y ago
This is how it works in Switzerland except...the insurers aren't allowed to discriminate at all. So ya, the young kids heavily subsidize the elders...the misery of that! (Also, everyone buys insurance themselves, poor people get help, your employer doesn't buy your insurance) And what is wrong with this exactly? We all get old eventually, so this subsidy is actually fair. > You'll be paying significantly more, with no direct benefit. Only true if you don't plan on getting old.
- dfxm12 14y ago
  Or if there are more old people now, when you're young, than there will be young people when you are old. :P

rayiner 14y ago

It doesn't really have anything to do with the insurance companies. Their margins on paper aren't that great, and even if those margins are bigger than they look, it's probably not a big difference one way or the other. The major costs here are two-fold: 1) old people 2) doctors and hospitals (those huge, beautiful new buildings aren't free: http://www.feinberg.northwestern.edu/gfx/news/2012-year-review/lurie-400.jpg http://www.feinberg.northwestern.edu/gfx/news/2012-year-revi...)

ori_b 14y ago
Other countries also have old people, and I don't have any reason to think that doctors and hospitals are more expensive in the USA than they are elsewhere.
- rayiner 14y ago
  > I don't have any reason to think that doctors and hospitals are more expensive in the USA than they are elsewhere They definitely are. Doctors in the U.S. make more money. Drugs are more expensive, partially because the U.S. subsidizes R&D for everyone else. Hospital construction in the U.S. is insane in the major systems. They're "spare no expense" affairs, very different from the utilitarian facilities you used to find in the U.S. in say the 1970's and which you still find in the U.S. today.
  - yardie 14y ago
    Doctors in the U.S. make more money. No, not really. My american, pediatrician drove a beat up Subaru. Doctors is a pretty big field that covers GPs (PCPs in the US), surgeons, anaesthesiologist, etc. Surgeons make a lot of money in the US and everywhere, but your typical GP is not ballin'. I'd even say doctors in other western countries make more because no student loans and no malpractice insurance means their take home pay is higher. Drugs are more expensive, partially because the U.S. subsidizes R&D for everyone else. This list http://en.wikipedia.org/wiki/List_of_pharmaceutical_companies http://en.wikipedia.org/wiki/List_of_pharmaceutical_companie... has the top 2 drug companies being in the US and 3rd, 4th, and 5th are european. The US does subsidize the worlds R&D in erectile dysfunction research ;-). There are plenty of drugs that have been approved elsewhere that haven't been seen in the US.

philwelch 14y ago

> and at this point I'm now spending about $10k a year. I realize that doesn't sound like a ton of money That's more than a third of the median US individual income.

lostlogin 14y ago
If that was put in a savings account and used for health expenses, is there anyway it wouldn't be a better option? By the time something bad happens, statistically, there should be a fair bit of cash there. It's worth noting that I'm not in the US, and while I know care is expensive in the US, I may be under estimating it.
- nicksergeant 14y ago
  Unfortunately things are insanely expensive via self-pay. My wife's first pregnancy was in the realm of $25-30,000 if we didn't have insurance. And that was just a routine pregnancy with no complications...
  - lostlogin 14y ago
    That's unbelievable - my wife had our child at no financial cost other than taxes and had a terrible experience. If we had used an obstetrician that we paid for out our pocket and she had a Caesarian (I only we had taken that option) it would have cost US$2500 - that's all inclusive with pre birth and post delivery visit and checks. New Zealand.
- koeselitz 14y ago
  A friend of mine that had insurance cut off his thumb a few years ago; all told the bill to him ended up being around $80,000. It is unfortunate, but you can't really just save and hope that a tragic thing like that won't happen - it is possible.

ck2 14y ago

I'm pretty far from 20something myself and I live on less than 10k a year (in the usa). If I needed 10k for a medical problem I'd be completely screwed. It's not like they will treat cancer in the emergency room.

jandrewrogers 14y ago
Actually, yes, they treat people with no insurance with cancer or other serious injuries all the time. I was literally sitting in an emergency room at Stanford when they flew in a poor illegal immigrant from Fresno and did the micro-surgical reattachment of a finger. I was there for someone with no insurance who had stage 4 liver cancer who was undergoing treatment (they survived). I grew up very poor, there was nothing unusual about this. The idea that poor people do not get top notch medical care in the US is largely a myth. It might not be quite as nice but it is often nearly as effective. A large part of the reason medical care is so expensive for average people is that they are subsidizing the healthcare of poor people. This is why the average survival rates for most cancers are higher in the US than anywhere else in the world; people that cannot afford it still get treated with the state of the art and the cost is passed on to people with insurance. A poor person with cancer in the US with cancer has a much higher survival rate than the average person in the UK. Poor people may not have official insurance but that does not imply lack of healthcare in practice.
- robbiep 14y ago
  This is the second time I have seen this claim (re cancer survival) posted to HN, both times it has been unsupported by any references- Do you have any references? I have been able to find this Global Cancer Statistics, 2002 DOI 10.3322/canjclin.55.2.74 That shows essentially the same survival between the US and western Europe. (Link to table http://i.imgur.com/UWPxDEx.png http://i.imgur.com/UWPxDEx.png ) Which contradicts the claim
  - Someone 14y ago
    I think they refer to http://www.thelancet.com/journals/lancet/article/PIIS1470-2045(08)70179-7/abstract http://www.thelancet.com/journals/lancet/article/PIIS1470-20... (I think http://healthcare.procon.org/sourcefiles/CONCORDCancerSurvivalStudy.pdf http://healthcare.procon.org/sourcefiles/CONCORDCancerSurviv... is a freely available copy). It shows th USA consistently in the top 5, but not always the top. I think they worked hard on getting comparable data, but I find the discussion on where they come from somewhat lacking. There is some discussion on inconsistencies between diagnoses (when is something Cancer X?), but I could not find a discussion on QALy's (http://en.wikipedia.org/wiki/Quality-adjusted_life_year http://en.wikipedia.org/wiki/Quality-adjusted_life_year). I expect that can make a decent difference in 5 year survival rates (if you give patients the choice between 6 months in bed in hospital and 3 months at home, the last on bedridden, quite a few would choose the 3 months)

pkulak 14y ago

You're missing the whole point. It's not the insurance companies. At least not to any great extent. Their margins are usually under 2% (though their marketing and administrative budgets can be quite large). Hospitals' margins are ten times that. I see the bills that my insurance company pays and they are usually an order of magnitude higher than the Medicare rates. As an aside, what you need to look up Medicare rates are the HCPCPS codes (call them "hick pick" codes on the phone so you sound like you know what you're doing). Just call your hospital and ask for them. They'll give them to you; they just mail you a new form separate from your actual bill. Then, just plug those codes in here: http://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx http://www.cms.gov/apps/physician-fee-schedule/search/search... (use a "specific locality" to get the rates in your area). Then you're ready to negotiate! But... good luck with that...

rogerbinns 14y ago
> It's not the insurance companies. At least not to any great extent. Their margins are usually under 2% I'm with Anthem Blue Cross in California. In 2011 they spent 79.9% of premiums on actual medical expenses and due to law changes had to issue a refund for 0.1% This year they raised premiums by 22%. Various administrative expenses are hidden all over the place. eg the cost of an appendectomy also includes the cost of recovering the money charged. The problem with the US healthcare system isn't any one part. Every single part is broken in some way, with the interoperations between them compounding to make the problem worse.
- yen223 14y ago
  I suspect that the main reason the single-payer healthcare system is so efficient is simply that there are less players involved.
  - GFischer 14y ago
    I work for a non-health insurance company. I believe that removing insurance companies from the equation would definitely make things more efficient - at the very least my company doesn't have the motivation to really cut down on expenses, most managers are more worried about internal power struggles, I've seen so much waste I'd start my own company in a heartbeat if only it wasn't so capital-intensive to start, and a papework and political minefield (which of course lets the old boys get by with a lot of leeway in terms of actual efficiency improvements).

stcredzero 14y ago

> Ten years ago I was spending at least half that amount The same thing happened to me. Over a span of 10 years, I went from having HMO $30 copay and no deductible to $5000 deductible plus another $7500 out of my pocket for co-insurance and the monthly payment being 2X as high.

Xylakant 14y ago

Actually, I'm in the "state" insurance system in germany and I pay 10 grand per year as well. That might or might not be comparable to what you pay since our incomes might or might not be comparable, but the figure itself seems fine. Given that any major injury can cost quite a bit more than 10k to treat, I'm totally fine with that.

wybo 14y ago
Really? In the Netherlands health-insurance is around a hundred euros per month (1250 Euros per year). The annual copay is 350 Euros (total). And if you make less than about 20k Euros a year, you get most of your insurance covered by the government. Looks like we've got things sorted over here. (and in the UK, where I live now, things are even easier...)

rwmj 14y ago

I'm in the UK, and the total cost of the NHS is around £130 billion. With a population of approx. 60 million, that means everyone pays on average £2200. Call it $3500. Of course, that's an average covering every man, woman, child, pensioner etc. People in paid employment are paying at least double that (in tax). It's not far from your $10000 figure. Of course, on the up side the NHS is hassle-free. I don't have to worry about co-pays, or money at all. I just go when I need it. Source for budget: http://en.wikipedia.org/wiki/National_Health_Service#Funding http://en.wikipedia.org/wiki/National_Health_Service#Funding Source for population: https://www.cia.gov/library/publications/the-world-factbook/fields/2119.html#uk https://www.cia.gov/library/publications/the-world-factbook/...

nemesisj 14y ago
I'm an American living and working in the UK. I think it's telling that I pay less in NHS contributions than I did for Medicare & Medicaid in the USA, and I can use the NHS now.
specialist 14y ago
Of course, that's an average covering every man, woman, child, pensioner etc. People in paid employment are paying at least double that (in tax). That $10,000/yr is just the monthly insurance premium. The patient still has to pay for things out of pocket. Because his premium is so high, I'm guessing GP has a very high deductible, eg $5,000, which is paid out of pocket. Then there's the copays, scripts, and misc fees. I currently have awesome coverage (by USA standards) and still have to pay ~20% of visit out of pocket. Actually, that last part I'm guessing. Because of the back and forth game played between insurers and providers, I get confused, and haven't expended the effort to figure out the actual monies exchanged.
- rwmj 14y ago
  One thing I didn't understand about your reply (sorry, I'm not an American!) is this: You say Because his premium is so high, I'm guessing GP has a very high deductible, eg $5,000 Surely if his premium is high, he would pay less for each visit to the doctor?

katbyte 14y ago

> $10k a year. I realize that doesn't sound like a ton of money Sounds like quite a lot to me considering i would pay (here in Canada) ~66$ a month, ~$800 a year (0 co-pay i think its called), if my employer didn't pay my insurance fee for me. And prescription drugs are also mostly covered... 10K really sucks :(

antihero 14y ago

> I realize that doesn't sound like a ton of money That's a fucking shitload of money.

michaelpinto 14y ago
thank you antihero — you're my hero!