The healthcare market is taxing reproduction out of existence • Hacker News Board

Re: The healthcare market is taxing reproduction out of existence

#251

Post by potato3732842 » Tue, Dec 02, 2025, 1:20 AM UTC

autoexec wrote: post #113

godsinhisheaven wrote: post #76

A lot of this is an issue of insurance no longer being "insurance" in the classical sense. Insurance covers all sorts of things, my HSA pays for all sorts of things that I never would have even considered, and while that sounds great, it helps to drive up costs. It's somewhat counter-intuitive, but if you dropped all government funding of healthcare tomorrow, healthcare plans would get cheaper. It'd also be total cha…

> but if you dropped all government funding of healthcare tomorrow, healthcare plans would get cheaper. I doubt it. Hospitals charge $15 for a single pill of Tylenol because they know insurance will pay for it, and that includes private insurance. The best thing we could do is ditch the private healthcare industry to the extent that the rest of the first world has and cover everyone with government plans. Those plans…

You don't need the insurance industry sticking their dick in most of the business they do. Insurance is for the foreseeable but unforecastable, not for routine things.

The additional overhead is substantial and adds huge marginal cost for routine things and say nothing of the principal-agent problem

Re: The healthcare market is taxing reproduction out of existence

#252

Post by dh2022 » Tue, Dec 02, 2025, 1:21 AM UTC

toast0 wrote: post #79

mhb wrote: post #44

Earlier quoted context omitted.

Also not a big impact on the message, but $200/mo for a phone is a bit disingenuous.

Claiming $200/month for a phone makes one wonder which numbers are valid. I'm not saying everyone needs to make a $100 phone last 5 years and use a $15/month plan, but I'm not even sure how I would get to $200/month in phone bill, even including financing an iPhone 17 Pro Max.

$200 seems valid - it comes from the linked article [0] and it includes home internet (I pay $110 / month Comcast just for home internet in Bellevue. In Seattle I paid $130 / month). Maybe Aaron could have phrased it better. (I also recommend to read the linked article as it is a phenomenally well done financial analysis.)

[0] https://www.yesigiveafig.com/p/part-1-my-life-is-a-lie

Re: The healthcare market is taxing reproduction out of existence

#253

Post by Aaronontheweb » Tue, Dec 02, 2025, 1:22 AM UTC

evanelias wrote: post #215

Aaronontheweb wrote: post #168

Earlier quoted context omitted.

Did you try reading the lengthy section of the article where I answered your question?

I skimmed your 2400-word article a second time just now, and I still don't understand why your math is allocating 100% of your family's health insurance premiums to childbirth. And now I additionally don't understand your abrasive tone in answering this fairly straightforward question. Multiple commenters are raising this point, so perhaps you should consider that you aren't conveying this information well?

1. I mentioned, in multiple places, that this is the cheapest PPO offered to me through a limited selection of potential brokers / marketplaces - and that's important because it covers our current health care providers AND child birth as a benefit.

2. If we weren't trying to have kids, our options for purchasing health insurance expand drastically. Individual marketplace plans become a viable, for instance, since the "not covering childbirth" issue goes away. I mention the short-comings of the individual health insurance marketplace at least twice in this regard, including a big pull quote explaining the ACA work-around with child birth coverage.

Re: The healthcare market is taxing reproduction out of existence

#254

Post by Aaronontheweb » Tue, Dec 02, 2025, 1:23 AM UTC

codingdave wrote: post #248

Aaronontheweb wrote: post #174

Earlier quoted context omitted.

> Given he has 3 children, 400% of FPL in 2026 is $150,600 so he's easily eligible for ACA subsidies I am absolutely not eligible. I earn more than $150k. And "manipulating your income" is not really feasible with a pass-through entity. > The premiums have nothing to do with the plans. Every single plan on the marketplace has to cover child-birth, that's sort of the point of the ACA. As I mention in the piece, I chec…

ACA plans absolutely cover childbirth ( https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-ge... ). But it might not matter because you aren't on a marketplace plan according to the screenshots in your post. You are on this plan: https://www.trinetaetna.com/pdfs/Aetna_PPO_7150.pdf Which does cover childbirth according to page 3. And has a 7150 deductible per person - the $14300 is the family out of pocket max,…

> the $14300 is the family out of pocket max

You know they charge you, separately, for both the mother's care AND the infant's during a delivery right? Those count as two people. I am, with 100% certainty, going to hit the out of pocket max - I have every time.

Like I've paid for three kids all on the same plan, including one born in January so my deductible got spread over two different billing years.

I have to ask - why are you defending this?

Re: The healthcare market is taxing reproduction out of existence

#255

Post by AnthonyMouse » Tue, Dec 02, 2025, 1:24 AM UTC

forgetfreeman wrote: post #226

godsinhisheaven wrote: post #76

A lot of this is an issue of insurance no longer being "insurance" in the classical sense. Insurance covers all sorts of things, my HSA pays for all sorts of things that I never would have even considered, and while that sounds great, it helps to drive up costs. It's somewhat counter-intuitive, but if you dropped all government funding of healthcare tomorrow, healthcare plans would get cheaper. It'd also be total cha…

"There's not a single silver bullet that will fix everything" idk, it seems like eliminating the profit motive from healthcare would resolve all kinds of problems.

Suppose you want to remove the profit motive from healthcare.

If doctors would still get paid above-median wages, you would still have a profit motive. Their lobbyists would want to limit the supply of doctors or simply lobby to have the government pay them high wages, to require that things be done by a doctor instead of a nurse, etc. Likewise the drug companies would lobby for the government to pay them more for their drugs, and when the government is captured then that's what happens. The same problems we have now; you haven't solved anything.

If doctors would get paid a lower wage but still have to attend 8 years of medical school, there wouldn't be a profit motive, but then there would be a shortage of people willing to become doctors, patients would have to wait a long time to get an appointment as they do in places like France, etc.

The profit motive isn't the problem, that's the thing that causes anyone to want to (and be able to) provide healthcare. The problem is the corruption. You have to stop limiting the number of medical residency slots and allowing drug companies to patent trivial changes to preexisting things etc.

Re: The healthcare market is taxing reproduction out of existence

#256

Post by [deleted] » Tue, Dec 02, 2025, 1:28 AM UTC

thatfrenchguy wrote: post #172

losvedir wrote: post #29

Hmm, counting the insurance premiums 100% towards the birth of the child is a bit misleading. Presumably, you'd be paying those even if you didn't have the child. That said, the cost of health insurance for a family is pretty outrageous. My premiums are along the same lines as the ones here (although less noticeable since they're paid by my employer).

I think OP here is just keeping a completely dominated plan (and his health insurance company knows it). He has less than 50 employees, he is not required to offer health insurance to his employees and he should go on the ACA market. Given he has 3 children, 400% of FPL in 2026 is $150,600 so he's easily eligible for ACA subsidies (which, by the way, in 2021-2026, were available to everyone) by tweaking his income (e…

[deleted]

Re: The healthcare market is taxing reproduction out of existence

#257

Post by Aaronontheweb » Tue, Dec 02, 2025, 1:30 AM UTC

codingdave wrote: post #248

Aaronontheweb wrote: post #174

Earlier quoted context omitted.

> Given he has 3 children, 400% of FPL in 2026 is $150,600 so he's easily eligible for ACA subsidies I am absolutely not eligible. I earn more than $150k. And "manipulating your income" is not really feasible with a pass-through entity. > The premiums have nothing to do with the plans. Every single plan on the marketplace has to cover child-birth, that's sort of the point of the ACA. As I mention in the piece, I chec…

ACA plans absolutely cover childbirth ( https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-ge... ). But it might not matter because you aren't on a marketplace plan according to the screenshots in your post. You are on this plan: https://www.trinetaetna.com/pdfs/Aetna_PPO_7150.pdf Which does cover childbirth according to page 3. And has a 7150 deductible per person - the $14300 is the family out of pocket max,…

> ACA plans absolutely cover childbirth (https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-ge...)

that link doesn't even say what you says it does - it said you can apply for coverage, not that there are plans that cover child birth. Have you never done this before?

Re: The healthcare market is taxing reproduction out of existence

#258

Post by deathanatos » Tue, Dec 02, 2025, 1:31 AM UTC

hn_acc1 wrote: post #198

AstroBen wrote: post #117

Earlier quoted context omitted.

Mint or US Mobile are ~$15-20 a month. You're massively overpaying

Do they come with free mid-tier phones? What if you need 4-5 lines? What if, as a CEO, he needs a better plan than "basic prepaid, lowest-priority-subject-to-throttling"?

Okay, so on the non-budget side, I pay ~$64/mo for T-mobile's "unlimited[1]" plan and a Google Pixel phone. ($57/mo for the service, and I've amortized the phone price to ~$7/mo based on my lifetime average phone lifetime. Even if you amortize the phone over only its ridiculously short warranted lifetime, that's $42/mo for the phone, or $99/mo, but that implies purchasing a new phone yearly, which most people do not do (the average phone lifespan is just under 3y).)

[1]: (n.b., the plan is not truly unlimited.)

Re: The healthcare market is taxing reproduction out of existence

#259

Post by vel0city » Tue, Dec 02, 2025, 1:34 AM UTC

throwaway150 wrote: post #104

estimator7292 wrote: post #72

Earlier quoted context omitted.

How come other countries have better healthcare at lower real costs? Basically every developed nation has better healthcare outcomes than the US. All other nations have cheaper healthcare. America is not special, we've just brainwashed our less-observant citizens into believing that solutions the entire rest of the world uses will never and can never work here. There's nothing special about our population or economy…

As someone who has lived in several countries, I do not believe every developed nation achieves better healthcare outcomes than the United States. Many European countries, as well as Canada, offer some form of universal coverage with free general treatment but waiting times for appointments and procedures can vary widely. That said, I still think universal healthcare is preferable, as these systems tend to prioritize…

> waiting times for appointments and procedures can vary widely

Waiting times for appointments and procedures can very widely in the US. Approvals to get needed treatments can also be denied for seemingly flimsy reasons in the US as well.

Re: The healthcare market is taxing reproduction out of existence

#260

Post by codingdave » Tue, Dec 02, 2025, 1:34 AM UTC

Aaronontheweb wrote: post #254

codingdave wrote: post #248

Earlier quoted context omitted.

ACA plans absolutely cover childbirth ( https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-ge... ). But it might not matter because you aren't on a marketplace plan according to the screenshots in your post. You are on this plan: https://www.trinetaetna.com/pdfs/Aetna_PPO_7150.pdf Which does cover childbirth according to page 3. And has a 7150 deductible per person - the $14300 is the family out of pocket max,…

> the $14300 is the family out of pocket max You know they charge you, separately, for both the mother's care AND the infant's during a delivery right? Those count as two people. I am, with 100% certainty, going to hit the out of pocket max - I have every time. Like I've paid for three kids all on the same plan, including one born in January so my deductible got spread over two different billing years. I have to ask…

I'm not defending it. I'm correcting your misinformation. You are claiming that ACA plans do not cover childbirth. They do. You are claiming that this event alone costs 40K, which is not accurate. It hits your out of pocket max, exactly as designed.

It sounds like you have never looked at an ACA silver plan, which is the lower deductible/out of pocket max option. I also have a family of 5, and have a $1800 per year out of pocket max from an ACA plan. You would still have the same level of premiums as you do now for silver plans, but you would save 13K a year. You are picking bad plans, dude.

Our system has problems, but when you make enough to not be subsidized, yet still pick a crappy 40K per year plan, that is beyond the systemic problems. It is a bad choice. There are insurance consultants who work with people, especially high income people, to find good plans for their family. You should be calling them.