3 ms·

The answer is: don't get sick in the U.S. Breaking Bad is accurate in terms of what happens when you're sick in this country. (I don't know of any who became m

The answer is: don't get sick in the U.S. Breaking Bad is accurate in terms of what happens when you're sick in this country. (I don't know of any who became meth kingpins, but people doing stupid stuff due to medical-cost desperation is common.) Health insurance won't cover everything. It won't cover most things it's supposed to cover. Its purpose is to collect premiums when you are young and healthy but when you are sick or old it has no interest in serving you. You're just a problem customer in their portfolio. Also, if you get seriously ill in the U.S., the payment/insurance aspect of it (and all the compromises you have to make to avoid unreasonable costs) will often add PTSD into the recovery process. I know people who have been essentially broken by the financial fallout (and the emotional drama around abandonment or, if they landed in debt, being pursued) of a serious illness. This is common, but few talk about it.

plaguuuuuu 12y ago
It's comparable to living in a third-world country. In the eyes of someone from a country with universal healthcare it beggars belief that people actually want to live in the US. It just looks like you're all boiling like frogs with no real understanding that your situation is abnormal even by the standards of many developing countries.
dllthomas 12y ago
"[W]hen you are sick or old it has no interest in serving you. You're just a problem customer in their portfolio." Right, with two caveats. A big problem with relying on competition to get good behaviour out of health insurers is that for health care in particular the common pattern is that expenses are low, and then for some expenses get high and stay high. As you say, this means that as soon as you need to actually use your insurance, you're a "problem customer" and - basic incentives wise - they'd rather not have you as a customer any more. If they frustrate you sufficiently that you say, "Screw this, I'm going to your competitor!" they win - they keep all the money you paid in, and it's their competitor that needs to pay out now. The caveats. First: employer based health care, as weird as it is, serves a role as collective bargaining. Losing the sick person is good. Losing the sick person and a couple thousand healthy people is bad (or at least less good). The other caveat is the cap on the medical loss ratio in the ACA. If a company is operating near the cap (and why wouldn't they be?) then the pool of money available for executives and shareholders can depend more on total revenues than on revenues minus medical costs. When that's true, losing any customer hurts - even one that nets negative. I don't think either of these is doing enough (the second might, long term, but I'm not sure the industry has internalized it yet), but they help some.
- kyllo 12y ago
  First: employer based health care, as weird as it is, serves a role as collective bargaining. Losing the sick person is good. Losing the sick person and a couple thousand healthy people is bad (or at least less good). Except that many large employers are self-insured anyway, they only have an insurance company contracted to administer claims, but the employer pays. So, unfortunately the company then has an incentive not to employ sick people and old people.
  - dllthomas 12y ago
    "Except that many large employers are self-insured anyway" Many; it's not all, I'm not sure it's most, and the dynamic I spoke of is still present in smaller employers. "So, unfortunately the company then has an incentive not to employ sick people and old people." I never claimed employer based coverage was a panacea. I explicitly called it weird, and I specifically said that it doesn't entirely fix the issue.

plaguuuuuu 12y ago

It's comparable to living in a third-world country. In the eyes of someone from a country with universal healthcare it beggars belief that people actually want to live in the US. It just looks like you're all boiling like frogs with no real understanding that your situation is abnormal even by the standards of many developing countries.

dllthomas 12y ago

"[W]hen you are sick or old it has no interest in serving you. You're just a problem customer in their portfolio." Right, with two caveats. A big problem with relying on competition to get good behaviour out of health insurers is that for health care in particular the common pattern is that expenses are low, and then for some expenses get high and stay high. As you say, this means that as soon as you need to actually use your insurance, you're a "problem customer" and - basic incentives wise - they'd rather not have you as a customer any more. If they frustrate you sufficiently that you say, "Screw this, I'm going to your competitor!" they win - they keep all the money you paid in, and it's their competitor that needs to pay out now. The caveats. First: employer based health care, as weird as it is, serves a role as collective bargaining. Losing the sick person is good. Losing the sick person and a couple thousand healthy people is bad (or at least less good). The other caveat is the cap on the medical loss ratio in the ACA. If a company is operating near the cap (and why wouldn't they be?) then the pool of money available for executives and shareholders can depend more on total revenues than on revenues minus medical costs. When that's true, losing any customer hurts - even one that nets negative. I don't think either of these is doing enough (the second might, long term, but I'm not sure the industry has internalized it yet), but they help some.

kyllo 12y ago
First: employer based health care, as weird as it is, serves a role as collective bargaining. Losing the sick person is good. Losing the sick person and a couple thousand healthy people is bad (or at least less good). Except that many large employers are self-insured anyway, they only have an insurance company contracted to administer claims, but the employer pays. So, unfortunately the company then has an incentive not to employ sick people and old people.
- dllthomas 12y ago
  "Except that many large employers are self-insured anyway" Many; it's not all, I'm not sure it's most, and the dynamic I spoke of is still present in smaller employers. "So, unfortunately the company then has an incentive not to employ sick people and old people." I never claimed employer based coverage was a panacea. I explicitly called it weird, and I specifically said that it doesn't entirely fix the issue.