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

#161

Post by facetube » Tue, Jan 05, 2016, 2:57 AM UTC

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…

Our employer-sponsored plan is roughly equivalent to this, and it costs the employer about $1,950 per month.

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

#162

Post by ploxiln » Tue, Jan 05, 2016, 2:58 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…

Your 100% vs 25% is for completely different metrics.

Insurers will pay out over 100% of premiums for some small percentage of people, but will pay out less than 100% of what they take in premiums overall, or else they go out of business.

Insurers seem to make enough money to pay a huge staff and process a lot of paperwork, but you also have to consider the higher costs of health care due to the health providers also needing more staff to do "coding" (looking up codes which precisely classify medical services administered, there are many thousands) and other paperwork (and IT systems etc) needed to get paid by insurance companies.

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

#163

Post by graeme » Tue, Jan 05, 2016, 2:58 AM UTC

geomark wrote: post #127

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'm genuinely curious about this, particularly the "easy to see a doctor" part, because I know that quite a few Canadians travel to Thailand for non-emergency medical care mostly due to long wait times. That's according to a few statistics published by some of the private hospitals in Thailand. I've seen few outbound studies published by Canadian researchers, although here's one from last year [1]. From what I unders…

I think it varies a lot by jurisdiction, proximity to foreign centers, and type of procedure.

For instance, I live in Quebec. On the chart in the article, Quebec only had 6284 travelers, despite having a large population. Quebec's private medical system is more extensive than average, and I think you can buy more here than you can in some other provinces.

BC also has easier travel options to Asia. It would be quite a trip from Quebec, and possibly easier to buy locally.

Across the board, wait times tend to be long only for elective issues. I've generally had no trouble with them for and neither has my family.

Though some specialties seem worse off. For instance, if I needed a gastroenterologist in Montreal, I believe I'd have great difficulty finding one.

Also, in Montreal, much depends on your local hospital. Some have longer wait times than others, even within the same city. If someone doesn't know how to navigate that system, going abroad may seem simpler.

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

#164

Post by jellicle » Tue, Jan 05, 2016, 2:59 AM UTC

Spoom wrote: post #47

x5n1 wrote: post #41

Earlier quoted context omitted.

And so it goes, National Healthcare like Britain or Canada is what America needs and what the medical establishment does not want. But somehow I think America would screw that up as well.

For what it's worth, I have talked to doctors who want single payer just as much as some of us.

It is vastly less hassle for doctors to have to deal with a single entity for all reimbursements. No hiring collection agencies to hassle patients, no mysterious nonpayments, no switching networks, one set of rules to learn and that is it.

They'll also probably end up paid a bit less under such a system.

The tradeoff is worth it.

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

#165

Post by ars » Tue, Jan 05, 2016, 3:03 AM UTC

vidarh wrote: post #138

ars wrote: post #33

The plans have been a disaster. They got rid of the only plan that makes sense for young people: Catastrophic insurance (deductible of over $10,000). The plans that remain have high enough deductibles to be worthless, but low enough to be expensive. The plans helps almost nobody. The only people who gain value from the exchanges are those who get a subsidy. To make things worse insurance companies are pulling out in…

To me as someone living in the UK, this is bizarre. Why would you need an deductables at all for it not to be expensive? This in itself indicates that your entire healthcare sector is entirely dysfunctional. In 2013/2014, the UK National Health Service spent $2928/year per person. This is the average, and includes everything from the costs of births to the costs of expensive heart transplants or cancer treatments. Ge…

People have written about this before, but basically the US subsidizes medical expenses for the entire world.

That was able to happen because, unlike virtually anywhere else in the world, medical insurance in the US is private.

If the US changes that (which will never happen) I would expect medical costs to go up everywhere else to compensate, either that or research slows down.

One thing that might, might, help is forbidding medical companies from advertising at all, that might save some money. But the law of unintended consequences tells me it would have other effects that might not be so great.

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

#166

Post by MaysonL » Tue, Jan 05, 2016, 3:04 AM UTC

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…

See direct primary care (not available everywhere) for a partial solution.

https://en.wikipedia.org/wiki/Direct_primary_care

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

#167

Post by vidarh » Tue, Jan 05, 2016, 3:04 AM UTC

narrator wrote: post #56

x5n1 wrote: post #41

Earlier quoted context omitted.

And so it goes, National Healthcare like Britain or Canada is what America needs and what the medical establishment does not want. But somehow I think America would screw that up as well.

I think it would bankrupt the government if they did single payer without price caps on drugs. We already spend about double, as a percent of GDP, on health care compared to other countries. Getting the costs under control is the only way to approach reforming health care that's going to work.

With single payer, the government suddenly holds a lot of cards even without explicitly making laws. Most drugs have alternatives. Facing the threat of having all drugs that have sufficiently good alternatives disappear off the approved prescription lists makes most pharmaceutical companies quite reasonable to negotiate with even for players like the UK government that "only" represents 60 million people.

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

#168

Post by spiralpolitik » Tue, Jan 05, 2016, 3:05 AM UTC

pmorici wrote: post #10

dpweb wrote: post #5

I'm against Obamacare, but if I was for it, I would peg the penalties at 2x the avg basic exchange coverage price. Also, people with high deductibles should make sure you take advantage of tax benefits, HSA for instance. The $6000 deductible may really only be a $4800 deductible once you figure in the tax deduction. If you're talking Obamacare coverage being 20% higher than the penality (I'm assuming the penalty is n…

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…

Look for a HSA that is backed by a money market account. If you are young and healthy then a HSA based plan makes sense as you can put money away until you needed it. Better than paying premiums you never use. If you start paying it at 20 then you are looking at decent amount later in life assuming the stock market delivers.

If you have ongoing healthcare costs then the math becomes a wash and usually sticking with a PPO type plan is the way to go.

Looking longer term I can see the HSA becoming the norm and employers will pay into that rather than offering insurance plans. At this point the exchanges should become competitive enough to drive costs down if everything happens through the exchange.

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

#169

Post by jimmyswimmy » Tue, Jan 05, 2016, 3:07 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…

I would be quite interested to see your data. A quick google search indicated to me that the vast majority of insurers pay out less than the ACA-required 80-85% of premiums and therefore were required to pay a rebate to their customers under the new law. Certainly 80% It would also be interesting to see your data on government payout ratios as well. Government employment is at the same time notoriously stingy but also forgiving. It's well known that civil servants are difficult to fire even when they aren't performing their duties. I could believe that the remora effect of underperforming laggards could push overhead costs up somewhat but the statistics you suggest seem quite excessive.

I can't vouch for this website's data or slant [1], which suggests that Medicare's administrative costs are around 3% of premiums, while private insurance administrative costs approach 17%. Medicare is reported to be a good example of a system with excessive MLR which apparently leads to high rates of fraud. Sort of like not giving the IRS enough money to audit people, reducing the impetus to pay legally-owed taxes. In these cases it is better to marginally increase overhead.

[1] http://www.ahipcoverage.com/2014/01/03/myth-vs-fact-administ...

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

#170

Post by humanrebar » Tue, Jan 05, 2016, 3:07 AM UTC

stvswn wrote: post #133

mgkimsal wrote: post #40

Earlier quoted context omitted.

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

It's was pretty easy to predict: allowing enrollment after a diagnosis was politically popular but a terrible economic disincentive to not buy insurance (because at that point, it isn't insurance -- it's a subscription plan for your treatments). The young and healthy needed to enroll for the economics to work, but the individual mandate was delayed for years -- because coercion isn't popular politically, and there wa…

> This would be politically disastrous -- "we know the plans are expensive, but it will be even more expensive to not get one!" isn't a great selling point.

IANAL but it's my understanding that the individual mandate only passed Constitutional muster because it was not punitive. If it were a penalty or crime instead of a tax, the legal interpretation might change. Then again, the Supreme Court had been all over the place lately.