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

#351

Post by DanBC » Tue, Jan 05, 2016, 4:03 PM 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…

> I know liberals are going to argue "that's why you need to take the market out of it and have single payer." It's a consistent argument only if you believe that you'd be better off with single payer. Some people would be; I know I wouldn't be. I'd end up paying even more for everyone else who isn't paying.

US government currently pays more per capita than eg UK NHS, and you still get stuck with insurance, co-pay, and bills for your very expensive health care.

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

#352

Post by hospes » Tue, Jan 05, 2016, 4:04 PM UTC

jakobegger wrote: post #333

douche wrote: post #104

Earlier quoted context omitted.

I still had to pay my $2500 deductible on the $2600 ECG, so the insurance company didn't worry about haggling them too much. If you're young, relatively healthy, non-clumsy, male, and childless, chances are you might not go to the doctor once in a year, so it'd be a gamble, but you might very well statistically be better off pocketing the insurance premiums. Better yet, put on a furry suit, bark convincingly, and go…

$2600 for an ECG is a ridiculous sum. Out of curiosity, I checked how much my insurance pays a doctor for an ECG (I live in Austria). My insurance (SVAGW) pays 36€ for an ECG. Of course, the total bill would be a bit more since the doctor would likely also charge for consultation (33€), draw blood, order lab diagnostics (6€) etc. The total would probably be well under 200€.

You are lucky that you are in Austria and can check prices somewhere. In US It is really hard to get prices for any medical services (including serious and expensive surgeries) before they are scheduled or you already received them.

My friend had a C-section during the delivery, hospital billed insurance 40K. She paid her deductible. C-section just like many other procedures are not planned and doctors are making decision on-fly during the delivery and obviously you do not have enough time to discuss pricing or negotiate them. So normally in this kind of cases you see the price 1st time in the bill, when you get it in your mail in couple weeks after the fact.

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

#353

Post by DanBC » Tue, Jan 05, 2016, 4:08 PM UTC

Killswitch wrote: post #124

bdcravens wrote: post #111

Earlier quoted context omitted.

If you don't go to the doctor and don't need medicine, the "something" isn't valuable especially if it's more expensive than the "nothing". (I say that as someone with a preexisting condition who is happy to pay my premiums and get the medicine I need; I also grew up in a family where we didn't have insurance but somehow always had cigarettes and cable TV, so I know multiple perspectives)

I'm 30 years old and haven't been to a doctor in about 10 years outside of simple things that I paid out of my own pocket. Nothing that a year of healthcare would cover, and considerably lower than it'd cost. I'd have paid in tens of thousands of dollars over the course of that time, and for what? What ifs?

When you're 60 years old you're going to want doctors and nurses who know what they're doing. That means someone needs to pay now to train them and their replacements.

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

#354

Post by Killswitch » Tue, Jan 05, 2016, 4:24 PM UTC

DanBC wrote: post #353

Killswitch wrote: post #124

Earlier quoted context omitted.

I'm 30 years old and haven't been to a doctor in about 10 years outside of simple things that I paid out of my own pocket. Nothing that a year of healthcare would cover, and considerably lower than it'd cost. I'd have paid in tens of thousands of dollars over the course of that time, and for what? What ifs?

When you're 60 years old you're going to want doctors and nurses who know what they're doing. That means someone needs to pay now to train them and their replacements.

So what you're saying is if I don't go to the doctor for 10 years, but pay $350/mo over the course of that 10 years for an insurance plan, the insurance company uses the money to fund college education for nurses and doctors?

Doubt it.

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

#355

Post by SwellJoe » Tue, Jan 05, 2016, 4:31 PM UTC

dragonwriter wrote: post #331

SwellJoe wrote: post #279

Earlier quoted context omitted.

It isn't ACA that has caused me problems, or at least the law itself. The description given matched my experience with insurers before ACA. My problem with ACA is Healthcare.gov (still). It is possible to go through the entire application process, make one mistake or fail to provide the right detail, and end up disqualified from buying insurance through Healthcare.gov (in my case, I used a mail forwarding service add…

The federal exchanges (for which healthcare.gov is the portal) were never intended to be a good choice (or even to have to exist at all), they were in the law as a minimal fallback to be applied for states that failed to implement their own exchangees.

Yes, my "home" state is Texas, which has been extraordinarily regressive on ACA. It might be time for me to consider making another state "home".

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

#356

Post by tracker1 » Tue, Jan 05, 2016, 4:55 PM UTC

briandear wrote: post #305

tracker1 wrote: post #277

Earlier quoted context omitted.

I'm paying less out of pocket now than my share at my last job, with netter coverage... though this year I'm paying as much for a plan with $1k more for deductible... it's pretty sad... I keep it because I'm on a few medications that would be far more out of pocket. Something needs to happen with USPTO, especially medicine at this point.

Something needs to happen with tort reform and the cost of FDA approvals. The FDA process is hugely expensive and inefficient. Contrast the FDA with Switzerland. The patent system is essential for medicines. I know many people don't like that reality but who will invest in pharma companies if their investment could quickly be nullified due to the loss of intellectual property? Would you invest in a company when the c…

Pharmaceutical companies still make generic medications that are no longer covered by patents as well as over the counter medications. As for approval costs, the biggest cost for these companies is marketing, plain and simple. The actual people doing the research, I'm guessing are not solely guided by their pay or patents for that matter. I would presume that many people just want to make society better.

I am not suggesting that patents go away entirely, but their scope should definitely be reduced... extension patents in particular should not receive the same 20 years that original patents receive. The patent system has resulted in generations of gaming the system to the point where it no longer works.

I'm unconvinced that patents serve the public good in this day and age. I am convinced, however, that the vast majority of patents granted should not have been.

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

#357

Post by sparkzilla » Tue, Jan 05, 2016, 5:05 PM UTC

DanBC wrote: post #347

sparkzilla wrote: post #346

Earlier quoted context omitted.

My mother's second husband's stomach trouble was misdiagnosed. Because of the long waiting times to see a specialist, the cancer was too far gone by the time they found out what it was, and he died when he was 50. My wife's sister was taken to hospital with a gallbladder infection. Despite being extremely weak, the staff let her walk and she fell. She broke her pelvis, but they missed it. Despite being in severe pain…

> but no compensation for their mistakes. You sue to get compensation.

You can sue them but it is a long process and you won't get U.S.-style amounts for payouts. That's if you can get that far. The staff cover for each other and use processes like the Ombudsman to delay and obfuscate. Also, the UK is not a litigious culture and my mother and other family members simply didn't want to go through more trouble.

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

#358

Post by jonlucc » Tue, Jan 05, 2016, 5:36 PM UTC

Cyberdog wrote: post #244

jonlucc wrote: post #214

Earlier quoted context omitted.

How high is your deductible? I think the highest I've seen is $5k, which is nothing to sneeze at, but also not really in the realm of bankrupting most families.

The plan I have currently has a $6k deductible for my family, for in-network care - $10k outside of network. This would not bankrupt us currently, no, but it would have as recently as a few months ago, and almost all other times in my life.

I thought that the vast majority of healthcare providers are amenable to payment plans and other forms of assistance.

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

#359

Post by dragonwriter » Tue, Jan 05, 2016, 5:51 PM UTC

benjamcal wrote: post #226

jljljl wrote: post #193

Earlier quoted context omitted.

Doesn't the federal government continue to cover 90% of the costs beyond 2020? That's still a pretty huge increase in funding.

To clarify, yes. After 2020, the federal government continues to cover 90% of the cost (compared with 60% normally) of the expansion indefinitely. So, for a state government, it is likely the cheapest way to ensure a large number of low income people are insured.

60% is not the normal federal share; the normal federal share varies by State, depends on state economic performance relative to other states, and is a minimum of 50% for certain populations, 65% for other populations.

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

#360

Post by unprepare » Tue, Jan 05, 2016, 6:09 PM UTC

orangecat wrote: post #211

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.

There should be one plan, available to every citizen. There should be one payer, the Federal Government. Should this also be the case for food, housing, and cell phones? If not, why?

The very obvious difference is negotiation.

If you had a gunshot wound that needed treating, and you arrive at the hospital to find today only they are charging 1 million dollars for bullet removal (what a coincidence), but the hospital one state over was doing bullet removals for only 100,000$ - are you in a position to negotiate? Is there any reason at all that this hospital would lower its price to match its competition? (as would happen in a competitive market)

Now flip it and say instead of a gunshot you broke your cellphone. You arrive at best buy and they say today only the iphone costs 1 million dollars, but a store one state over has it for 600 - are you in a position to negotiate? Is there any reason at all best buy would lower its price to match the competition? In fact, this happens every day at most every major retailer.