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

#231

Post by peckrob » Tue, Jan 05, 2016, 4:38 AM UTC

Camillo wrote: post #135

davidw wrote: post #19

Earlier quoted context omitted.

> perhaps slightly better than what the USA has at the moment? Pretty much anything would be. Health care in Italy was better than in the US, and that's saying something - Italy is a nice place, but not always run that well. A more market-based system might be better too as at least for some things there might be some downward pressure on prices. The current system (including pre-Obamacare in that as well) just sucks…

When the WHO ranked the world's health care systems in 2000, Italy was actually the second best in the world: https://en.wikipedia.org/wiki/World_Health_Organization_rank... That was 16 years ago, yes, but the country wasn't run any better than it is now.

Random personal anecdote. When I was a teenager, my family took a trip to Europe. This was summer of 1999, IIRC. Anyways, near the end of the trip, when we were in Italy, my dad came down with a cough and sore throat. Rather than try to gut it out for another week and then have to fly back to the US sick, we decided to try to find a doctor.

After consulting with the front desk at our hotel, we were directed to a small clinic a few blocks away. Being that it was evening, we were surprised they were open and even more surprised to be seen reasonably quickly (it was less than an hour, less than I usually wait at a clinic here in the US).

We were seen by a doctor who conducted the very typical medical exam. We mimed our way through it, and a prescription for an antibiotic was doled out. When we went to pay, we were waved away. "No money" they said, in broken English. They also gave us simple directions to a nearby pharmacy where we could get the prescription filled.

We walked over to the pharmacy, presented the pharmacist with the prescription. After waiting a few minutes, he came back with the pills. There was a cost for this, but I remember it being very cheap. Like a couple euro.

The whole thing, from start to finish, was less than 3 hours and only cost us whatever the antibiotics cost. Frankly, our biggest problem with the whole experience was the language barrier. Dad knew some French and I knew extremely basic Spanish and could puzzle out most things given enough time, but nowhere near close enough for a complex interaction such as seeing a doctor in Italian.

Fast forward 17 years (this happened to me last week). I'm visiting family in Tennessee and come down with the same sore throat and cough.

First, I have to find a clinic that accepts my out-of-state insurance. Then, I have to get there when they open because experience with these things has taught me that if I'm not there when they open I'm waiting a few hours. Fill out the 5 pages of forms. Pay a $30 co-pay before I even go back to see a doctor. And then STILL wait 2 hours to be seen. After the same cursory exam, the same prescription for antibiotics is doled out.

Walk down the road to the pharmacy and get it filled, waiting 45 minutes. Another $10. The whole thing from start to finish was probably 4 hours and cost me $40 out of pocket. No idea how much they billed my insurance yet.

The experience we had in Italy made a big impression on me. Even as a 17 year old, I walked away from that experience wondering why our system in the US is so broken. Surely we can do better.

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

#232

Post by Frondo » Tue, Jan 05, 2016, 4:40 AM UTC

dmitriy_ko wrote: post #134

MCRed wrote: post #109

Earlier quoted context omitted.

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…

> government programs with benefits- like welfare- blow %75 of their budget on overhead and only pay out %25 That's hard to believe. Source?

It is hard to believe because it isn't true. In the U.S., the government-run health care systems are the most efficient systems, far better than the private insurers.

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

#233

Post by geomark » Tue, Jan 05, 2016, 4:41 AM UTC

brandonmenc wrote: post #179

The real problem is that no one knows how much anything costs - including doctors. Ever ask them "how much is this going to cost?" They'll either tell you they have no idea, or give you a useless range like, "between $1k-$10k."

This drives me crazy. I walk in and want to pay cash, but they won't treat me because I have to show proof of insurance because they have no idea what they will charge when the bill is generated.

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

#234

Post by abawany » Tue, Jan 05, 2016, 4:43 AM UTC

clamprecht wrote: post #223

abawany wrote: post #200

Earlier quoted context omitted.

I am in Cedar Park and was offered the Scott & White PPO when I was on healthcare.gov. I didn't go with it due to the state limitation.

I researched Scott & White, and it looked like you had to go to their doctors, which for me defeated the purpose of getting an PPO over an HMO (i.e., I can choose where I go, I don't need a primary care physician). Scott & White's offices weren't close to me, and their clinics got bad reviews.

I have been to S&W and you are right to be concerned - I have had care and billing issues. That's why BCBS with HMO to me was preferable to S&W PPO even though I hadn't read through their "PPO" plan to the level of detail that you did.

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

#235

Post by sitharus » Tue, Jan 05, 2016, 4:47 AM UTC

MCRed wrote: post #103

jhulla wrote: post #4

Personal experience with ACA: As of 2016, we're onto our 3rd insurer. Each prior one has dropped our local doctors, physicians groups and hospital. With each insurance change, our deductible has gone up, our premium has increased and our co-pay, co-insurance has increased. In effect, our ACA plan has become an extremely expensive catastrophic insurance plan.

Comparing to my "free market" insurance before the ACA was passed, I had much more coverage (it was real insurance: eg: pay in advance against a risk, rather than covering pre-existing conditions which violates the definition of insurance, since you're not pooling money against risk, but paying for current liabilities.) ..... and not only did I have more coverage, but my deductibles were 1/5th what they are now and t…

'New Zealand where if you're "old" you're just not covered and you have to leave the country for basic things like dialysis, even though there are dialysis machines in the country'

Source for this? I know more than a few old people here on dialysis. The system will even pay to have a dialysis machine in your house if it's long term so you don't have to keep travelling to the hospital.

Care is universal, the only reason someone could be rejected is if they're not a New Zealand resident.

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

#236

Post by Laaw » Tue, Jan 05, 2016, 4:49 AM UTC

facetube wrote: post #171

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…

Don't you contribute your own money to the HSA? I know there are some tax advantages, but it seems a little disingenuous to call that $0.

My employer does that "for me", though I suppose you could in a way consider that to be my money (they'd pay it to me if they didn't have to put it in my HSA). It is tax-free, though.

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

#237

Post by Laaw » Tue, Jan 05, 2016, 4:53 AM UTC

brandon272 wrote: post #208

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…

> 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. That's the case in most modern countries. As far as data is concerned, the U.S. performs poorly in many metrics. The risk to individuals in the system compared to other nations is atrocious. The per-capita cost is atrocious. And the actual health outcomes are not spectacular.…

If the difference between Canada and the US were merely their healthcare systems, I'd be utterly indignant and demand change from my government.

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

#238

Post by sliverstorm » Tue, Jan 05, 2016, 4:56 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…

"Not for routine costs" and "high deductible" are hardly the same thing. You can conceivably have a $0 deductible for treatment and no coverage for routine prevention. Thus, you pay nothing when you break your arm- it was unlikely and unexpected- and you pay full cost for checkups.

(Of course, that creates a bit of a perverse incentive, nudging you to skip preventative care and lean on treatment)

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

#239

Post by cname » Tue, Jan 05, 2016, 4:57 AM UTC

pbreit wrote: post #212

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.

In the US we ascribe much higher value to freedom of choice & markets, etc. We have elected to take the good (driving a disproportionate share of medical progress) with the bad (twice the cost for worse outcomes).

As a counterpoint, I'm from the US and I completely disagree with this. I never ascribed any such value to the "free market", especially when it comes to health care.

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

#240

Post by HillRat » Tue, Jan 05, 2016, 4:58 AM UTC

mgkimsal wrote: post #189

rconti wrote: post #81

Earlier quoted context omitted.

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.

I've been buying insurance for a more than a decade, in multiple states. (direct, not via employers). I can't say I've seen annual rate increases of 20% year in year out for 2 decades. That's simply not sustainable. By way of example, my $100/month policy would be $3800/month after 2 decades of 20% year on year growth.

I believe 8% annual inflation has been the normal rate for many years -- slightly decreased following ACA enactment, but rates then increased by a few points due to less-healthy enrollees, so it's a bit of a wash (not counting all the people who now have health insurance, to be sure). Premiums also only cover part of the cost increase; higher deductibles and reduced coverage are also used to defray costs, and aren't as obvious to the end consumers. Finally, plans that don't conform to ACA minimum coverage requirements have been killed off, so some individuals are seeing their rates increase commensurate with their improvement in coverage.