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Is Health Insurance Even Worth It Anymore?

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Re: Is Health Insurance Even Worth It Anymore?

#111

Post by lotsofpulp »

rayiner wrote: post #102
lotsofpulp wrote: post #94

Earlier quoted context omitted.

Effective tax rates are not that easy to compare. In fact, the portion of a US health insurance premiums IS a tax, based on your age! Not to mention the myriad ways tax policy (including the age rating factors that cause young people to pay a tax via their health insurance premium) vary among not only the 50 states, but the smaller jurisdictions within the states. https://news.ycombinator.com/item?id=45800973 https:/…

Sure. But if you make the calculation that granular, you also need to include employer-paid health insurance on the compensation side of the ledger. More than half of Americans have employer-paid health insurance, and employers contribute on average $17,000 per employee: https://www.business.com/articles/health-insurance-costs-thi...

Of course, that is why US employees should be able to have access to benefit costs in terms of dollars to be able to compare total compensation. Currently, that is usually only available after the end of a calendar year on form W-2 (box 12 code DD for health insurance premiums).

Technically, you have to get even more granular. If your employer subsidizes health insurance premiums, then you pay for health insurance with pre tax income. If your employer does not, then you have to buy with post tax income. The difference is thousands of dollars per year.

You even avoid FICA if you can max out your HSA via payroll withholdings, a decision solely made by your employer.

It’s actually amazing how many ways the US governments has come up with to screw young people and small businesses.

Re: Is Health Insurance Even Worth It Anymore?

#112

Post by ceejayoz »

jsbisviewtiful wrote: post #101

Anecdotal - A friend of mine decided to go without health insurance this year and then tore her ACL. So guess who is walking around with a torn ACL until next year because she simply can't afford the surgery... The US healthcare system is rotten to the core but the populous refuses to educate themselves and keeps voting for losers that won't do anything to fix the system - so we all suffer. Republicans have been prom…

> So guess who is walking around with a torn ACL until next year because she simply can't afford the surgery…

And if the pre-ACA preexisting condition thing comes back, she might be waiting much, much longer.

Re: Is Health Insurance Even Worth It Anymore?

#113

Post by JohnFen »

angmarsbane wrote: post #100
JohnFen wrote: post #74

Earlier quoted context omitted.

If you get a very serious and expensive problem, insurance may not help nearly as much as you'd think. My mother had great insurance, but when she got cancer, the insurance didn't stop her from getting absolutely destroyed by the medical bills (not to mention having to constantly fight with the insurance company while being extremely ill). It drove her to bankruptcy anyway. In hindsight, she commented that had she kn…

I feel the constant fighting with insurance isn't spoken to enough. I don't want insurance because I don't want to be both a billing department and a sick person. We went through the same mess when both of my parents were sick. We were already taking in an enormous amount of new information about their illnesses and then we were also having to try and learn how their insurance worked, what was covered, what wasn't, t…

Absolutely.

A comment about this, though:

> I'd rather have 0 insurance and just negotiate each bill as it came in with one single entity, the hospital.

That's not how it works, insurance or not. You won't get just one bill from a single entity, you'll get many bills from many different entities and will have to negotiate with each separately.

Re: Is Health Insurance Even Worth It Anymore?

#114

Post by lotsofpulp »

Taikonerd wrote: post #105
lotsofpulp wrote: post #70

Earlier quoted context omitted.

>How can I start an insurance company? One requirement is to be willing to earn returns less than SP500. Look up profit margins and annual returns for UNH, Elevance, CVS, Cigna, Humana, Centene, and Molina. You have a billion laws to follow, you’re used as a punching bag by politicians and customers, have to get the price of your service approved by a government employee, and for all of that, you earn a 2% to 3% prof…

> for all of that, you earn a 2% to 3% profit margin. Yeah -- it seems like a paradox that the insurance companies charge so many people so much money, yet struggle to make a profit. I've heard that they spend a lot of money handling their "internal friction" -- reviewing claims, handling appeals, etc.

Health insurance premium revenue = medical loss ratio + operating costs + profit margin

Medical loss ratio is the money paid to healthcare providers. Operating costs end up being ~10%, across multiple publicly listed companies. This fact, plus 2% to 3% profit margins means any more cost reductions have to come from legislation, reduction in healthcare prices, or advances in automation.

https://www.oliverwyman.com/our-expertise/insights/2023/mar/...

https://www.kff.org/private-insurance/medical-loss-ratio-reb...

Re: Is Health Insurance Even Worth It Anymore?

#115

Post by exabrial »

jakemcgraw wrote: post #26
exabrial wrote: post #2

Repeal Obamacare, go back to HSAs. Nobody should be taxed on health expenses, which was the whole point of HSAs in the first place. We literally had a budding system that was working and affordable, and it was "fixed".

If we repeal ACA, we'll need to force insurers to take on patients with preexisting conditions. We can't ice out 38% of Americans[0] from coverage. [0]: https://www.commonwealthfund.org/publications/issue-briefs/2...

As other commenters have said, pre-existing conditions could and should have been handled separately in a single issue bill, separate from existing insurance. Instead, the truckload of regulations that was brought in around Obamacare has buried health insurance in the US in depths of inefficiency.

Its absurd to drive multi-ton flaming trash truck when all we originally needed was a scooter.

Re: Is Health Insurance Even Worth It Anymore?

#116

Post by actionfromafar »

rayiner wrote: post #88
danielmarkbruce wrote: post #69

Earlier quoted context omitted.

The actual cost to treat "cancer or whatever" is extremely high in many cases. 15k a year to know you have that covered for a family isn't so bad given the true underlying cost. A family member has a rare disease and I've gone through the details of the various treatments, how many people are involved in ongoing care and treatment etc. It's a lot of very well trained people spending a lot of time. A concrete treatmen…

> but there will always be a desire to save people's lives even if the cost is very high. Also, Americans place extraordinarily high value on life. My wife's grandmother had cancer in her 60s and had a quarter of her lung removed. She then had a stroke in her late 80s. She was in rural Oregon, and they evacuated her via helicopter to Portland. They wanted to give her an aggressive treatment, but she refused, and pass…

+1

The whole system is setup to maximise the "care" whenever possible. IMHO it would be better with a universal healthcare that asked itself some tough questions. Start from a pile of money and calculate maximum impact backwards from there. But maybe that's impossible for the US. (It's satanic and/or communist or something.)

Re: Is Health Insurance Even Worth It Anymore?

#117

Post by xboxnolifes »

fabiofzero wrote: post #32

Looking from outside your system is scary. I don't get how anyone could defend it in earnest.

What I think you will find is usually defended is not the healthcare system itself, but the idea of not "paying for the bad decisions of others".

Re: Is Health Insurance Even Worth It Anymore?

#118

Post by dh2022 »

rayiner wrote: post #63
whatever1 wrote: post #40

Earlier quoted context omitted.

So you have to pay like $30k out of pocket in a year before the insurance chips in a single dollar? And if you ever ask for a dollar, I can also reject your coverage. How can I start an insurance company?

You don't pay the deductible for many typical services if you're in-network. We have a mid-tier United Healthcare plan, and we only ever pay a $25 copay per doctor visit. United Healthcare's net profit margin is about half that of Chipotle in a good year: https://www.macrotrends.net/stocks/charts/UNH/unitedhealth-g... ; https://www.macrotrends.net/stocks/charts/CMG/chipotle-mexic...

What is a typical service that you only pay $25? This year I had two shoulder injuries. I paid for every single thing (doctor visits, X-Ray, MRI, Physical Therapy).

Re: Is Health Insurance Even Worth It Anymore?

#119

Post by electric_mayhem »

Taikonerd wrote: post #64
electric_mayhem wrote: post #10

Direct primary care was a completely game-changing improvement in healthcare for me. $95/mo to basically subscribe to a local doctor. Covers most things other than tests or surgery or limb setting. But tests are often very discounted relative to what insurance charges for them (with my previous dpc provider an entire battery of tests cost less through them than just the copay for two of them added up to). It’s remark…

My big question about DPC is: what about people who just don't think about primary care until they have something wrong? How long is the wait list at that point? Or can they go see a doctor for $X as a one-off, without a subscription?

If someone was hung up on only paying when they need care, the business model needs to support that would probably look a lot like an emergency room or urgent care facility.

For me, I consider it an astonishingly good value paying $1200 a year even when probably nine months out of the year I don’t even talk to them. Being a healthy dude I get proactive tests done twice a year to keep tabs on a couple dozen different metrics ($150 each round, all in) and inform any needed course corrections over time (early insight- vitamin d was low (previous insurance-based provider refused to order test). Later insight- eating trash and five drinks a day for 7 days at a vacation resort made basically every metric go to absolute shit; subsequently did an early test after a month of clean diet and regular exercise showed tremendous improvement across the board). And then when something random comes up I know they’re there for me.

If it sounds like the sort of thing, you might be into find a couple local providers and just have a conversation with them. I’ve yet to speak to a DPC provider that isn’t excited about the model and delighted to communicate its value to prospective customers.

It’s as close to concierge healthcare as I’ll ever able to afford and I absolutely adore that it removes the parasitic insurance from my primary care loop.

Re: Is Health Insurance Even Worth It Anymore?

#120

Post by antisthenes »

rayiner wrote: post #63
whatever1 wrote: post #40

Earlier quoted context omitted.

So you have to pay like $30k out of pocket in a year before the insurance chips in a single dollar? And if you ever ask for a dollar, I can also reject your coverage. How can I start an insurance company?

You don't pay the deductible for many typical services if you're in-network. We have a mid-tier United Healthcare plan, and we only ever pay a $25 copay per doctor visit. United Healthcare's net profit margin is about half that of Chipotle in a good year: https://www.macrotrends.net/stocks/charts/UNH/unitedhealth-g... ; https://www.macrotrends.net/stocks/charts/CMG/chipotle-mexic...

Profit margins are irrelevant if you inflate your costs to reduce them.
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