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Is Health Insurance Even Worth It Anymore?

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Re: Is Health Insurance Even Worth It Anymore?

#51
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...

Americans do not care about Americans, and there is no way to design a working system if Americans don't want it because it benefits Americans.

Re: Is Health Insurance Even Worth It Anymore?

#52
Any good explanations as to why insurance companies haven't merged? Each provide roughly the same service. Instead of one staff (and one highly paid exec team and management hierarchy), our healthcare spending has to support a dozen or so, and for what gain to the consumer?

Re: Is Health Insurance Even Worth It Anymore?

#53
I think to address the problem we should first address the language.

It is not largely health insurance, it is medical treatment payment insurance, so I usually just call it medical insurance.

We are not paying so much money for promotion of or preservation of health, or even early detection of disease. We are paying so much for late medical treatment of disease

Re: Is Health Insurance Even Worth It Anymore?

#54
When I was child, our dog got hit by a car. The dog had two broken legs and was bleeding from the nose. My dad said, "Come with me son, I will show you what to do." So we went into the woods behind the house and dug a hole. I put the dog in the hole and my dad shot the dog in the head. After we filled in the hole my dad said. "Now you know what to do with me when I get old."

So my health insurance is healthy living, CrossFit, rapamycin etc. When that fails, I have a 9mm pistol I keep in the safe. I do worry about if I am somehow too incapacitated to use the pistol but not enough to die naturally. Infirmity scares me a lot more then death does.

Re: Is Health Insurance Even Worth It Anymore?

#55

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

Honestly, I don't think anyone would defend the healthcare system itself in the US.

What they would defend is the premise of returning value to shareholders. And of course, that's what most for-profit healthcare and insurance companies are set up to do. The largest shareholders are typically retirement and pension funds.

That can be applied to almost anything, of course, but if you look at the "enshittification" of most markets in the United States, you'll notice that the process began in earnest around the time that the Baby Boomers began to retire. The Boomers, mathematically speaking, did not have enough children to sustain increasing returns on investments through market expansion. When you have fewer people to extract wealth from, you have to extract more from the average person in order to keep up the numbers, and that's ultimately what we see here and across many sectors of the US economy. You have a generation that was told they would have as good of a retirement as their parents' generation, while also being told that they didn't need to produce the human capital in order for that retirement to happen with the same margins as before.

The effect is a generation that gets their basic healthcare met by the taxpayer through Medicare, while getting their retirement checks paid for by their children being squeezed on everything from real estate to healthcare to transportation costs. It's the tyranny of the gerontocracy.

Re: Is Health Insurance Even Worth It Anymore?

#56

I just looked at the local marketplace plans. The absolute dirt-cheapest I could do for my family is ~$1,225/month premium with a deductible of $13,400 and out-of-pocket max of $21,200. Most of the structure is some form of "zero help until the deductible, then I pay 20%-40% of everything up until the OOP max". In other words, I'm being asked to buy a product, and the cheapest form of it is to basically pay almost $1…

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....

Now you have to account for taxes you pay in the U.S. for medicare, and a risk-adjusted share of the deductible payments, but overall it doesn't seem that crazy.

Re: Is Health Insurance Even Worth It Anymore?

#57

I just looked at the local marketplace plans. The absolute dirt-cheapest I could do for my family is ~$1,225/month premium with a deductible of $13,400 and out-of-pocket max of $21,200. Most of the structure is some form of "zero help until the deductible, then I pay 20%-40% of everything up until the OOP max". In other words, I'm being asked to buy a product, and the cheapest form of it is to basically pay almost $1…

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?

Broadly speaking yes, though to be fair I should note that if your household size is a certain number and your income is a certain number, that can come down. They cap the amount you pay in premiums to a certain percent of your income.

EDIT: https://www.healthreformbeyondthebasics.org/wp-content/uploa...

Re: Is Health Insurance Even Worth It Anymore?

#58

I just looked at the local marketplace plans. The absolute dirt-cheapest I could do for my family is ~$1,225/month premium with a deductible of $13,400 and out-of-pocket max of $21,200. Most of the structure is some form of "zero help until the deductible, then I pay 20%-40% of everything up until the OOP max". In other words, I'm being asked to buy a product, and the cheapest form of it is to basically pay almost $1…

> In other words, I'm being asked to buy a product, and the cheapest form of it is to basically pay almost $15k in a year to hedge against someone getting cancer or whatever, and actively incentivizes me to not use it[0]

You are not paying $15k to hedge against someone in your family getting cancer in a calendar year.

You are paying $15k to pay for old and sick people’s routine healthcare, due to the ACA’s requirement that the highest premium to be at most 3x the lowest premium, and the requirement that premiums be only a function of age and tobacco use (i.e. no underwriting for health risks by factoring in pre existing conditions).

So an ACA compliant health plan’s premiums are far more comparable to a tax than an insurance premium since they are explicitly a wealth transfer mechanism from young and healthy to old and sick.

New York state takes this wealth transfer even further and mandates that age not be used at all to price premiums. I think Massachusetts only allows an age rating factor of 2.

Re: Is Health Insurance Even Worth It Anymore?

#59
post #15
post #4

I 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.

Third option is pay what you can reasonably pay and file for bankruptcy. Which sucks, but is an option. Try to get assets into bankruptcy protected holdings when possible (401k, house, etc, depending on state of residence), so you have more flexibility post bankruptcy.

Another option for the U.S., fly to Mexico and take advantage of the "medical tourism" that is gaining in popularity.

Re: Is Health Insurance Even Worth It Anymore?

#60

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

Easy - they will say providing it for everyone is communism and by default bad. Despite spending more on healthcare than every other developed nation and having a robust and well funded by the taxpayer healthcare system for the selected few. But suddenly it's not communism if you're treating veterans and old people not just all of your citizens.
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