Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Many See I.R.S. Penalties as More Affordable Than Health Insurance

nytimes.com

Post reply on HN
Print view View original

81–90 of 383 posts

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#81

Post by rconti »

mgkimsal wrote: post #40
mecameron wrote: post #18

Earlier quoted context omitted.

Personal experience with nearly all health care insurance plans since the 90's: Each year the premiums go up, the out of pocket costs increase, and benefits decrease (beyond more than general inflation).

I understand premiums going up annually. I don't understand 30-50% increases year on year.

I believe 18-20% was the norm for the past decade or two. Nationwide, I think the growth has supposedly slowed very slightly.

That doesn't make it any easier if you're one of the people who are getting screwed, though.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#82

Post by tomohawk »

millstone wrote: post #69
tomohawk wrote: post #32

Inevitable result of thinking that adding even more government intervention would result in better, cheaper plans. If they were really interested in making better, cheaper plans, they would roll back most of the ACA, eliminate the restrictions on buying across state lines (actually allow competition), and transfer the tax incentives for getting insurance from employers to employees. Basically, all they had to do to m…

The experience with credit card deregulation should put the lie to the idea that selling across state lines results in meaningful competition and better products. After the Supreme Court ruled that credit cards could be issued across state lines, the issuers migrated to states with the weakest consumer protections. As expected, this was followed by a series of abuses: credit card issuers would raise rates without war…

The Federal plan banned those things long ago and yet still created a functional market that helped contain costs and boost quality. It still does today. Only, just for Federal employees and Congresscritters.

The real issue is the ACA is a solution from 60 years ago that doesn't meet the problems we have today and has actually made a bad situation worse.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#83

Post by clamprecht »

parfe wrote: post #77
clamprecht wrote: post #7

Earlier quoted context omitted.

You're not alone. In Texas, they cancelled almost all (or maybe all) individual PPO plans (affecting about 367k people), leaving us to choose HMO or EPO plans (the lesser of two evils). And about a 20% increase (per year) in insurance cost for the last 3 years. I at least hope some folks are benefiting from the ACA, I'm certainly not.

What'd you have before the ACA?

I had an individual PPO plan. Also, my current plan isn't an ACA "marketplace" plan, it's a non-marketplace HMO plan.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#84

Post by lotsofpulp »

ploxiln wrote: post #50
djrogers wrote: post #37

Earlier quoted context omitted.

likely because the incredibly high base deductibles (6k per person for example) on most exchange plans mean that most people will never actually utilize any insurance.

Well, that's not traditionally how health insurance works in the US, but it's how all types of "insurance" should work - it should not be for routine costs. Insurance, generally, should be for unlikely unexpected costs. Otherwise, it's just involving an extra middle-man in payment, and that middle-man is going to make a profit. It's unfortunate that in the US, even for completely routine medical costs, you can't skip…

Yes, it's funny to me how so many educated adults are in this conversation, when the problem is mostly political.

On one hand, you have a population that believes that no one should be left to die if they show up at a hospital (probably due to their religion and whatnot).

A significant portion of the same population also believes that everyone should stand on their own two legs and that offering healthcare to all via increased taxes is socialism.

Conclusion: We end up with a system where all costs are distorted and people are given this illusion that they buy access to subsidized health care (aka health insurance), but they get to satisfy their egos by pretending to deserve the health insurance they have and they get the satisfaction of knowing that their neighbors aren't getting free handouts from their taxpayer money.

Side benefit for employers: You get a trump card over an employees' mobility because the best value for health plans is via health insurance plans tailored for employers, ideally white collar due to the type of work.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#85

Post by graeme »

djeikyb wrote: post #71
graeme wrote: post #54

I'm a Canadian. I'm curious to know what it would cost to match my level of coverage in the US. 1. Public medical care. Good care, normally easy to see a doctor. Excellent quality. Can use this as much as you need. 2. Occasional use of the parallel private billing system. Costs less than $300 Canadian to see a specialist. 3. Private coverage for paramedical claims (Physio, massage, drug plan, dental, vision, etc.). P…

I live in Arizona. My employer only offers high deductible health plans with a pre-tax health savings account. So, I pay ~350 USD per month for the plan to cover my wife and I. Then I also contribute to this health savings account, my employer kicks nothing in. For this, we get basic vision and dental completely covered. That is, routine checkups, cleanings, basic prescription eyewear. Everything is else is subject t…

Should I take that to mean that there is no option to get equivalent insurance to what we have in Canada?

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#87

Post by pmorici »

mecameron wrote: post #16
pmorici wrote: post #10

Earlier quoted context omitted.

My current plan has an has an HSA component but the company that administrates the account, BenefitWallet, has some fine print in the account agreement that they charge an account fee for balances less than several thousand dollars. Realistically I only spend several hundred dollars per year on healthcare stuff so I don't think it is to my advantage to lock up that much money in a non-interest bearing account or pay…

You are not required to use the HSA provider that your insurer/employer is tied to. You can pick and contribute to your own HSA account elsewhere, with one caveat. Your contributions are deductible from federal and most state taxes, but are only deductible from payroll taxes (social security/medicare) if the HSA contribution is deducted from your paycheck by your employer (and thus deposited in their preferred HSA pr…

Yeah, in my case it isn't though my employer either so there is another reason to avoid it.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#88

Post by lotsofpulp »

mikeash wrote: post #66
eplanit wrote: post #62

Earlier quoted context omitted.

> "I'll pay almost anything to ensure that a sudden medical event doesn't bankrupt me." Exactly, and reflects the mafia-esque choice imposed on the consumer when rates are increased: pay the absurd rate or face absolute ruin if (when) a sudden medical event occurs.

It's mildly terrifying. If you're unlucky enough to break a major bone or get cancer or something like that, you could literally be on the hook for millions of dollars. I lived overseas for a couple of years, and when I got back to the US one of the first things I did was obtain health insurance because of this.

Might be a better option to just declare bankruptcy.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#89

Post by chimeracoder »

douche wrote: post #38
dibujante wrote: post #25

Earlier quoted context omitted.

As a Canadian, I am astonished at how expensive even the cheapest of these plans are. My monthly healthcare cost amounts to $178, once you factor in the taxes I pay that go to healthcare. That's cheaper than any of the plans in this article. How do people find these prices bearable?

I had an emergency appendectomy done in a little rinky-dink Quebec hospital. I was driven in an ambulance 150 miles, had general anesthesia, scope surgery, and an overnight stay in the hospital. Had to pay out-of-pocket for the procedure in cash. It was, all told, less expensive than the half-hour echocardiogram I had a couple years ago. Similar surgeries in the States have cost my insurance north of twenty grand. It…

> Similar surgeries in the States have cost my insurance north of twenty grand.

I'm assuming you're referring to the amount your insurance company had to pay, not the amount that you had to pay. If so, keep in mind that the prices insurance companies pay for procedures are not designed to make sense on an individual level[0].

I've explained this in more detail on previous comments, but basically, hospitals lose money on publicly-insured patients (Medicare/Medicaid), and so they have to make up the difference by overcharging private insurers. This is why the sticker price for procedures is so heavily inflated - they're intended to be the starting point for negotiation, and the insurers then negotiate standard rates (still inflated, but less so) for in-network providers.

In other words, the amount that your insurer had to pay for your ECG includes an amortization of the amount of excess cost that your insurer bears in order to (effectively) subsidize the patients on public insurance.

In theory, this should not affect your out-of-pocket costs (though of course, in the end, it all does come out of patients fixed monthly premiums, so you still are paying for it in some way).

Yes, this is unnecessarily complicated, but that's the way billing works.

[0] That is not to say that the amount that the insured patients pay for procedures shouldn't make sense on an individual level - just the amount that the insurer pays on top.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#90

Post by simoncion »

ploxiln wrote: post #50
djrogers wrote: post #37

Earlier quoted context omitted.

likely because the incredibly high base deductibles (6k per person for example) on most exchange plans mean that most people will never actually utilize any insurance.

Well, that's not traditionally how health insurance works in the US, but it's how all types of "insurance" should work - it should not be for routine costs. Insurance, generally, should be for unlikely unexpected costs. Otherwise, it's just involving an extra middle-man in payment, and that middle-man is going to make a profit. It's unfortunate that in the US, even for completely routine medical costs, you can't skip…

> I think the fixation on "everyone should have good health insurance" is making this dysfunctional situation permanently unfixable.

Nah. Every citizen should have good health insurance that requires no out-of-pocket expenditures.

There should be one plan, available to every citizen. There should be one payer, the Federal Government.

Anything else is a recipe for price-gouging and ballooning costs.

Post reply on HN