Part of the problem is that ACA made catastrophic insurance illegal, because all insurance had to have lots of minimum coverage. I don't want insurance to provide one free checkup per year, I want to pay for normal stuff normally, and not have to pay the insurance company's expenses + profit margin on normal stuff just to have the unlikely stuff covered.
Is Health Insurance Even Worth It Anymore?
191–198 of 198 posts
Re: Is Health Insurance Even Worth It Anymore?
#192Earlier quoted context omitted.
Switzerland does have mandated universal health care, so essentially the same result as "Medicare for All". It's just implemented in a different form: mandatory basic insurance + supplemental insurance, instead of a single-payer system. A number of other European countries have something similar.
Yes, but that was what the ACA attempted, and there wasn’t just one simple model that America could have adopted to fix all its healthcare problems.
Agreed. The ACA was a compromise solution meant to move the US closer to a single-payer system, but was later stripped of many of its clauses, making it of much less value (though not rescinded altogether -- thank you, McCain!)
Re: Is Health Insurance Even Worth It Anymore?
#193I have been struggling to find the breakeven point for me and my family. On one side, it keeps getting more and more expensive even though we are young and healthy. On the other, if one of us needs an expensive operation or months of treatment, no amount of HSA savings will be enough. I don't know if there is a 3rd option that would be more reasonable.
The third option that becomes more tantalizing every year in the US is to not have insurance, pay OOP for routine matters, and when something catastrophic happens let the medical debt go to collections and settle for pennies on the dollar. It doesn't feel right, but it's the direction the medical-pharmaceutical-insurance cartel is pushing us.
Only works if you're young and healthy.
Re: Is Health Insurance Even Worth It Anymore?
#194I don't like the US healthcare/insurance system, but my objection to the article is that it fundamentally misunderstands the point of insurance. Insurance is fundamentally a transfer of wealth from those who do not experience misfortune (in this case, poor health) to those who do experience misfortune (so they can pay for it). In the case of healthcare, old people are much more likely to experience misfortune than the young, which means that health insurance -- no matter how you structure it -- is essentially a transfer of wealth from the young and healthy to the old and sick.
The only way insurance works is if enough people pay into it, ideally everyone. European countries work with mandated insurance (either through taxes, or a legal requirement) to fund the system sufficiently.
Catastrophic-only insurance is a nice idea and is truer to the idea of insurance as a protective measure, but healthcare costs are so high in the US compared with other countries, and the frequency at which non-routine care is necessary is also very high -- partly because Americans lead such unhealthy lives, particularly in terms of diet (and here we have a separate food industry problem) -- that the costs for the "catastrophic-only" insurance have to be quite high. We see this in the "Bronze" level plans. And if people are paying that much per month, it starts to make sense to pay a bit more and get some of the more routine care covered rather than pay so much for nothing really (unless there's a catastrophe).
Bear in mind that "catastrophe" is not just cancer. It's almost any non-routine care. I had surgery this year for a hernia -- the bill was $30,000. I was insured so that's not what I paid. But my point is, an unexpected $30K can easily put a household in a serious financial bind given that Americans don't have much in the way of savings.
Re: Is Health Insurance Even Worth It Anymore?
#195Direct 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…
It's a good option for primary care. It's also a form of insurance, since the reason why it's low is that enough people will subscribe but not use it, just like the gym :)
The issue is that primary care is not generally expensive, and also not generally needed if you're healthy. I've gone to a PCP less than half-dozen times in my 56 years. So the $100/mo is a waste in my case -- I save much more by just paying out of pocket if every I need to go.
But medical expenses for unexpected conditions -- surgeries, specialized tests, visits with specialized doctors, non-routine medications -- those are all what cost a lot. And that's not covered by $100/month.
So DPC is a nice idea, but it doesn't really replace health insurance -- I look at it more as an "extra" for regular health monitoring and preventative care, which is important in itself (and in most cases worth the $100/month).
Re: Is Health Insurance Even Worth It Anymore?
#196Earlier quoted context omitted.
It's not like someone would forbid Warren Buffet from doing so. The government already set up a system that is all but in name compulsory. So, let's take a pile of the same size as the current system uses, but let it go through a single arbiter, with combined purchase power.
We have a system like that for student loans—where the federal government itself originates and owns 90% of student debt—and it has led to massive cost inflation. What makes you think we’d implement a healthcare system better?
The federal government hasn't even lifted a finger to control undergrad education costs. In British Columbia, Canada where I'm from, the government sets limits on student loan coverage (seems to be CA$520/week right now) and universities don't get anything more from student loans. When my student loan disbursement occured, the form explicitly had $5000 of "unmet need" that I would need to scrounge up somehow.
If a universal healthcare system really wanted to, it could keep costs under control in a similar manner by telling hospitals to accept X amount for Y procedure or get bent. That the government doesn't swing its big dick on colleges in the US is entirely the fault of the government and a populace that always votes for "candy for dinner" vs. "eating vegetables".
Re: Is Health Insurance Even Worth It Anymore?
#197[dead]
Re: Is Health Insurance Even Worth It Anymore?
#198Earlier quoted context omitted.
That seems... fine? That's $14,000 annually. For an income in the $75k-$100k range, Maryland health connection shows me a premium of $700/month for two parents/two kids. Judging by your premium and assuming 2 adults/2 kids, your income is probably over $200k. With that income in Canada, you'd be paying over $20,000 in taxes attributable to healthcare: https://www.fraserinstitute.org/sites/default/files/price-of... .…
Right I think a lot of upper income Americans don't understand how it compares globally. Seeing what my UK colleagues deal with, a $200K income would land you solidly in the 40% marginal tax bracket over there, vs (if married) .. 22% here. US federal effective tax rate (before getting into deductions) would be like 17% on that 200k, for a $166k take home.. versus equivalent UK take-home would be as low as $123k (agai…
How are you getting $166k take home for a $200 salary? If I use one of those online tax calculator things for New York, I get a take home of $135,000 from $200k. Ok, so let’s try a lower tax state that still has a lot of economic opportunity. For Texas I get $150,000 take home. Once you start adding on the costs associated in the US with having a serious medical condition, it’s far from clear that you’re going to be saving a lot of money from lower taxes. You’ll save a bit if you stay healthy and pay a lot more if you don’t.