Many See I.R.S. Penalties as More Affordable Than Health Insurance • Hacker News Board

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

#151

Post by ritchiea » Tue, Jan 05, 2016, 2:48 AM UTC

Laaw wrote: post #118

mschuster91 wrote: post #110

Every time I see one of these articles (or anything related to US healthcare) and read the comments, I can't help but ask myself how rotten a country can be. In this case, as a German, I dare say "rotten to the core". It apparently is impossible to move the US healthcare system to a system where every person in the US is eligible to even the most expensive emergency healthcare without having to fear bankruptcy afterw…

Yeah, the vast majority of us have healthcare, aren't really sick, and occasionally when we do get really sick, our insurance pays the bills. I had an emergency root canal earlier last year in the US, cost me zero dollars, and I've got one of those high-deductible plans (it's the HSA that covered that). I'm actually a little surprised you (or anyone on HN) are so eager to jump at the "worst case" stories and presume…

I have health care through the exchange and it drives me crazy that I pay $300+ monthly and if I have to see a doctor I still have to cover the expense myself because I have to spend several thousand dollars out of pocket before my insurance begins to cover anything. It seems to me that ~$4,000 annually is a lot to pay for what is effectively disaster insurance. But if I don't pay it not only do I pay a fee but I run the risk that if anything truly horrible happened I would be bankrupt.

Health care in the US remains a disaster if you are not covered by your employer (I'm a contractor and thus not covered by any employer).

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

#152

Post by rdtsc » Tue, Jan 05, 2016, 2:50 AM UTC

This is turning out to be a failure for some. It was for me personally. Was at a smaller company. Insurance premiums had been increased by a huge amount (probably 40% or so) in the 2 years _before_ Obamacare went into effect.

Representatives would come and would tell us a sad story about how all this legal environment is punishing them, and there is a lot of risk and uncertainty so they have not choice but to raise premiums.

So 3 years later premiums are way up, coverage is ... different. No lifetime maximums, that's nice, some free preventice checks and labs (unless the find something, then it becomes a paying lab or doctors' visit). Otherwise it is a about the same or worse coverage as before.

So far as far as the pocket is concerned, as far as the story I am told by employer, and by insurance representatives is that Obamacare is not a good thing. I want to believe, but I can't.

I knew it was going to be a so or so or failure when they striped the single payer option away early on. It wasn't agressive enough that's the problem. Without cost controls it is like plugging holes in hunk of swiss cheese. "Oh law wants to expand coverage for more people? Ok, everyone's premiums are higher now by 20%...."

I'll grant it that it might not be just the insurance companies to blame. Doctors, hospitals, pharma companies -- anyone in the money pipeline is guilty of abusing and taking advantage as much as they can.

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

#153

Post by fpgeek » Tue, Jan 05, 2016, 2:50 AM UTC

lotsofpulp wrote: post #84

ploxiln wrote: post #50

Earlier quoted context omitted.

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…

> 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).

Or out of simple self-interest. Having health insurance doesn't guarantee you'll always show up at an ER capable of demonstrating to the hospital's satisfaction that you are insured, with the necessary documentation (e.g. after a car accident or a mugging).

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

#154

Post by transfire » Tue, Jan 05, 2016, 2:50 AM UTC

Evey once in a while I have to go to the emergency room for a serious migraine. All I need is a few drop of morphine. But I also get a bill for over $3,000. Of course, it goes in the trashcan.

The real problem with the medical system is its total contrivance to prevent people from treating themselves and having access to treatments at their actual cost -- the inflated pricing for the non-insured is the racket of the health insurance "mafia".

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

#155

Post by stvswn » Tue, Jan 05, 2016, 2:51 AM UTC

methodover wrote: post #17

> But plenty of healthy holdouts remain, and their resistance helps explain why insurers are worried about the financial viability of the exchanges over time. They say they sorely need more healthy customers to balance out the costs of covering the sicker, older people who have flocked to exchange plans. Ah, the tragedy of the commons at work. Healthy people don't buy insurance because it's too expensive. Insurance i…

"If only the plan worked as intended! We were close!" -- the same refrain after every single failed socialist endeavor.

But in this case we had the smartest people study the problem! Economists from the top universities designed the incentives! How could it fail?

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

#156

Post by Laaw » Tue, Jan 05, 2016, 2:52 AM UTC

ritchiea wrote: post #151

Laaw wrote: post #118

Earlier quoted context omitted.

Yeah, the vast majority of us have healthcare, aren't really sick, and occasionally when we do get really sick, our insurance pays the bills. I had an emergency root canal earlier last year in the US, cost me zero dollars, and I've got one of those high-deductible plans (it's the HSA that covered that). I'm actually a little surprised you (or anyone on HN) are so eager to jump at the "worst case" stories and presume…

I have health care through the exchange and it drives me crazy that I pay $300+ monthly and if I have to see a doctor I still have to cover the expense myself because I have to spend several thousand dollars out of pocket before my insurance begins to cover anything. It seems to me that ~$4,000 annually is a lot to pay for what is effectively disaster insurance. But if I don't pay it not only do I pay a fee but I run…

My employer is a big group of people and has the power to bargain with the health insurance companies. I think there are groups you can join that provide the same advantage.

But what you might not understand (and I'm about to sound like a big jerk) is the idea that maybe the system that works best for the country might not work the best for you specifically. That doesn't make the entire system a disaster.

There's perspective here that might not make you healthy, but it would at least provide a modicum of understanding.

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

#157

Post by fredliu » Tue, Jan 05, 2016, 2:53 AM UTC

FWIW, reading the comments reminds me of Hilary Clinton's answer to "Is Obamacare helping or hurting the average U.S. citizen?" on Quora (https://www.quora.com/Is-Obamacare-helping-or-hurting-the-av...) The comments on Hilary's response seem resonate the comments here...

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

#158

Post by graeme » Tue, Jan 05, 2016, 2:53 AM UTC

stvswn wrote: post #143

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…

What I want to know is, how much does it cost to provide that service to you? Not how much do you pay, but how much does it cost? If it's greater than $100 a month (how could it be less?), then someone is paying. What portion of Canada's budget is spent on the health system? Are you paying for your healthcare indirectly via taxes (in which case you're just unaware of the true cost) or is someone else paying (in which…

For cost, it varies by province, because health care is a provincial responsability.

Overall though, Canada's entire public medical system costs less per capita than America's public system (medicare + medicaid + whatever else they're including).

http://www.slate.com/blogs/moneybox/2013/01/23/chart_us_gove...

I checked the stats for my province, Quebec. In 2013, costs were a bit under $4000 per capita for the public sector. So that's about $333 per month.

Per province breakdown stats: https://secure.cihi.ca/free_products/4.0_TotalHealthExpendit...

As for replicating it....I'd wager that it couldn't be done nationally. It could possibly be done in a small state. It probably could have been done back in the 1950s, but there's been so much drift in the two systems since then that it would be difficult to imagine implementing it.

Because there'd be pretty wholesale change: no private health insurers. Also the fact that medicare + medicaid cost more than Canada spends already doesn't bode well.

But that could just be status quo pessimism.

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

#159

Post by vidarh » Tue, Jan 05, 2016, 2:53 AM UTC

MCRed wrote: post #109

simoncion wrote: post #90

Earlier quoted context omitted.

> 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.

And what will happen is you will not get much health care. Certainly much less than you got in 2005, for much more than you paid in 2005. Insurers routinely pay out over %100 of premiums in claims. Meanwhile government programs with benefits- like welfare- blow %75 of their budget on overhead and only pay out %25. Economics is like physics. You can wish it wasn't so. You can look at optical illusions, but the reality…

How much healthcare do you get in the US for $2928/year? That's how much the UK National Health Service cost the UK government per person in the 2013/2014 reporting period, for a comprehensive universal healthcare system with no deductibles, no co-pays other than a minor prescription charge (7 pounds, unless you're exempt due to low income), and which is consistently ranked higher than US healthcare by the WHO.

If we can cut that by 75% since government programs are apparently so wasteful, I'm assuming US insurers should be able to offer some insanely great programs in the ~$3000/year bracke, since the UK apparently ought to be able to get away with providing this level of service for $750/year.

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

#160

Post by mschuster91 » Tue, Jan 05, 2016, 2:56 AM UTC

Laaw wrote: post #142

mschuster91 wrote: post #120

Earlier quoted context omitted.

> I'm actually a little surprised you (or anyone on HN) is so eager to jump at the "worst case" stories and presume they're normal. These "worst case" stories should not happen at all in any civilized country! One of them is one too much.

Every country has people who fall through the cracks. It's noble and true to say this shouldn't happen, but it does, and in every country. Germany, too.

> Germany, too.

Yes, it's mostly either illegal immigrants or self-employed one man companies, and I don't like that either... but even if you're not insured, you'll be taken care of in a hospital in emergency cases and not be stuck with a 500k+ bill...