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Is Health Insurance Even Worth It Anymore?

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Re: Is Health Insurance Even Worth It Anymore?

#141

Post by nullocator »

lotsofpulp wrote: post #70
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?

>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…

Uh huh, and for them to have inserted themselves between me and my doctor, what exactly did they contribute to the transaction and how much should I want to pay for such a privilege since apparently $30k a year isn't enough? A measly 2-3% for adding no value and creating friction, egregious, we must get the profits higher!

Re: Is Health Insurance Even Worth It Anymore?

#142

Post by lotsofpulp »

nullocator wrote: post #141
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…

Uh huh, and for them to have inserted themselves between me and my doctor, what exactly did they contribute to the transaction and how much should I want to pay for such a privilege since apparently $30k a year isn't enough? A measly 2-3% for adding no value and creating friction, egregious, we must get the profits higher!

First of all, some or much of your premium is a wealth transfer (from young and healthy to old and sick). So consider that portion a tax (it literally is, just not collected by the government directly):

https://news.ycombinator.com/item?id=45800973

https://www.cms.gov/marketplace/private-health-insurance/mar...

https://www.healthcare.gov/how-plans-set-your-premiums/

>what exactly did they contribute to the transaction

Obviously this varies based on personal experience, but the biggest benefit is usually covering the big expenses beyond the out of pocket maximum, such as premature babies, bypass surgeries, cancer treatments, hemophilia treatments, etc stuff that costs hundreds of thousands and millions of dollars.

Second would be negotiated pricing with healthcare providers. If you think you can do a better job negotiating, you are welcome to not pay the health insurance company (better referred to as managed care organizations), and see what kind of deals you can get.

Third would be services as an agent that knows something about healthcare to be able to discern necessary and unnecessary care, since most buyers are unable to discern that information. This is, of course, highly subjective based on personal experience and the lack of government audits here leaves much to be desired.

>how much should I want to pay

When you have 7 publicly listed managed care organizations along with numerous non profits such as the various BCBS and Providence and Kaiser Permanente all selling insurance at roughly the same price, it's sufficient to conclude prices are about as low as they can get in this business environment.

>A measly 2-3% for adding no value and creating friction, egregious, we must get the profits higher!

This sentiment really doesn't make sense, unless the goal is to just be outraged for the sake of being outraged, because it has been clearly shown that there aren't much profits to be had in the first place. It's such a shitty business that one will end up with more money by investing in SP500.

Re: Is Health Insurance Even Worth It Anymore?

#143

Post by tvchurch »

notfried wrote: post #9

The article mentions early a "cancer diagnosis" but puts that aside and moves on, when this is pretty much the crux of the issue. Prostate and Breast cancers are a 1 in 8 chance. The risk of no insurance at 25 is very different than 50, and than 75. And everyone at all ages is paying for those expensive treatments. The system is broken, but going without insurance is you basically toying with the odds of life.

Author here. I'm definitely not advocating going without health insurance. Just running simple numbers to get some perspective.

I'd like to see health insurance act like insurance again though. Right now it covers absolutely everything, meaning it's more like pre-payment for routine care + insurance.

Insurance isn't for routine, predictable, or low-cost expenses. But we've mandated that our health insurance cover all of those things.

The comparison to car insurance is overused, but it's a good one. Catastrophic coverage + dedicated savings with lower premiums looks more attractive to a lot more people.

Re: Is Health Insurance Even Worth It Anymore?

#144

Post by tvchurch »

infecto wrote: post #12

It is worth it imo but it could be better. This is my back of napkin mental model but I have convinced myself that most of our troubles are because health insurance morphed from truly emergencies to every day care. Routine care (both primary and specialist) have to hire deep staff to handle insurance claims with the different payers. It’s a constant game. For myself I always pick the high deductible plan. It’s the ne…

Author here.

DPC is terrific if you have an option near you! Paired with catastrophic insurance, it's a great bet for relatively healthy people.

The DPC Alliance map is well worth a visit: https://mapper.dpcfrontier.com/

And I wrote about DPC a while back: https://church.substack.com/p/direct-primary-care

Re: Is Health Insurance Even Worth It Anymore?

#145

Post by rayiner »

dh2022 wrote: post #118
rayiner wrote: post #63

Earlier quoted context omitted.

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).

I only go to the doctor for the kids. So checkups, vaccines, ear infections, minor injuries, etc.

Re: Is Health Insurance Even Worth It Anymore?

#146

Post by Workaccount2 »

righthand wrote: post #135
Workaccount2 wrote: post #134

Earlier quoted context omitted.

I didn't say they were innocent, I said they were/are awful capital extractors. Like, they do a really bad job at making money. If you are following the money, it absolutely does not lead to health insurers. It passes right through them. But people need to do more than watch tiktoks to learn that. So it's lost.

Can you be a bit more clear as to something someone could reference to start following the money? Perhaps the awareness of the issue would spread faster if the advice wasn’t so inactionable. Follow what money? My insurance payment? How? Are you alluding to political payments? Lead me to water or we’re all doomed. Being coy helps nothing only misunderstanding. As demonstrated by my previous response to your comment. I…

These are public companies, their financials are open and readily available.

You can see for yourself how bad they are at making money.

Re: Is Health Insurance Even Worth It Anymore?

#147

Post by jabroni_salad »

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?

I still have a HDHP for intensive visits and if I go to local out of network Urgent Care for the narrow range of things Urgent Care is good for, it's like $50 tops.

Re: Is Health Insurance Even Worth It Anymore?

#148

Post by nullocator »

lotsofpulp wrote: post #142
nullocator wrote: post #141

Earlier quoted context omitted.

Uh huh, and for them to have inserted themselves between me and my doctor, what exactly did they contribute to the transaction and how much should I want to pay for such a privilege since apparently $30k a year isn't enough? A measly 2-3% for adding no value and creating friction, egregious, we must get the profits higher!

First of all, some or much of your premium is a wealth transfer (from young and healthy to old and sick). So consider that portion a tax (it literally is, just not collected by the government directly): https://news.ycombinator.com/item?id=45800973 https://www.cms.gov/marketplace/private-health-insurance/mar... https://www.healthcare.gov/how-plans-set-your-premiums/ >what exactly did they contribute to the transactio…

I think my sentiment is that with single-payer we could go from arguing about how expensive health care is and how much money should middle-men be able to extract from the system, to mostly just arguing about how expensive health care is.

Re: Is Health Insurance Even Worth It Anymore?

#149

Post by exabrial »

sunshowers wrote: post #42
exabrial wrote: post #6

Earlier quoted context omitted.

Correct, instead it made them unaffordable and disappeared them out of existence. Previously to ACA, I paid $280/month for a direct (non-employer sponsored) plan that had a $5k deductible. The plan was discontinued as the base fell out. There is so much wrong with ACA and the hardliners are not capable of self-reflection, and cannot admit that overregulation has done nothing but make things incredibly expensive.

do you have anything to say about the fact that before Obamacare, pre-existing conditions were generally not covered? to me that is the main purpose of Obamacare. I think not covering pre-existing conditions is a moral atrocity.

Why does everyone thing that the "one thing" Obamacare did was pre-existing conditions? That is a footnote in the grand scheme of paperwork in unloaded on health insurers. It's one tiny straw in a hayfield of regulations.

Re: Is Health Insurance Even Worth It Anymore?

#150

Post by danielmarkbruce »

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…

Agree. As a society we probably need to accept that saving someones life when they are 80 maybe isn't worth $5 million or whatever. We have to map back to person hours and realize that it just doesn't add up in many cases.
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