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Comment by throwaway84742 | Hacker News Reader

People tend to be irrational about things and this is a good illustration. As broken and expensive as US healthcare is, you’re making 3x the money here, and out of pocket maximums do kick in eventually. And the US is not the top country by far, even among developed ones, in number of mass murder victims per 100000 population. You’re vastly more likely to drown in your backyard pool than be a victim of a mass shooting in the US. Majority of firearm deaths are suicides. Majority of homicides are concentrated in crime / gang activity hubs like Detroit, Chicago, and a few others. Firearm homicide has been trending downward for decades, even if you take the crime hubs into account. IOW if you don’t live in one of the well known “bad” places, your chance of dying from a firearm wound is very low indeed.

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Out of pocket maximums kick in eventually, unless you accidentally go to an out-of network provider, unless you lose your job and therefore your insurance, unless your insurance decides that a drug you need isn't covered, etc., etc., etc.

You don’t lose your insurance anymore if you lose your job. You are required by law to have insurance whether you have a job or not.

Your formulation makes it sound like the government will make sure you have insurance.

This is not the case. You have to make sure you have insurance or the government will fine you. But if you were unable to get insurance for whatever reason, you still don't have insurance.

And Obamacare premiums are not small and the insurance is not very good.

What's your criteria for "good"?

The worst conforming ACA plans are essentially the catastrophic insurance that people think they are clamoring for; they are expensive because health care costs in the US are spiraling out of control. It could be that people actually want plans with a bunch of complicated limitations and limits, but I doubt it.

> The worst conforming ACA plans are essentially the catastrophic insurance that people think they are clamoring for

Just an anecdote, but I have not found this to be the case at all, and I'd figure I'd offer an example of one such "clamorer who thinks he wants catastrophic plans" to balance the discussion.

Prior to ACA I was on a "catastrophic" plan (despite being able to afford something much more comprehensive). I think the "catastrophic" term is kind of dumb, and I'd instead call it "actually-insurance, not a prepaid health subscription".

The premium was around $95/month and I spent maybe another ~$1k/year on medications and office visits. I was totally satisfied with this health coverage and never felt I had to limit my access to health care because of my plan.

As soon as ACA rolled around I tried to find the most similar plan I could (mine was discontinued despite promises to the contrary).

1) I couldn't get as high a deductible, so I was forced to pay for risk-reduction I didn't want. In an absolutely life-threatening 1%-of-insurees catastrophe, my family can absorb say $25k/year out of pocket so I see no reason to insure against that financial risk.

2) The first year my premium was $180, then $220, then $260. I did not save any money on medications or office visits (if anything it got more expensive, but that may also just be a general trend in US health costs).

So post-ACA my insurance premium cost has nearly tripled, and the product I considered satisfactory before is simply not available on the market.

In summary: people can rationally prefer pre-ACA catastrophic plans, and post-ACA such options are not available.

I think that's a fair counterpoint. It would be interesting to see some statistics about how many people are informed about the trade offs between deductibles and premiums and such.

To follow up on this, you will be fined by the IRS for every month of the year in which you have no insurance...

Not anymore though, the 2017 tax bill repealed that part of the law.

My experience with a silver level ppo plan through the exchanges is that it is exceptionally good. But yes, I'm sure if you choose the absolute bare minimum coverages it won't be great.

Yes. So rather than putting a gun to my head to make me pay for your insurance they put the gun to the head of the purportedly responsible adult who should be paying, and provide steep discounts if you can’t afford it.

Government can merely redistribute its tax earnings, often in extremely corrupt and wasteful ways. It does not create wealth on its own.

COBRA is a good option to retain your insurance for many months after leaving an employer, during which time you can (for now) pick a new lower-priced provider from your state’s Obamacare exchange.

COBRA is time-limited, and expensive. You're now paying for both the employer and the employee parts of the insurance cost.

Been there, done that.

> As broken and expensive as US healthcare is, you’re making 3x the money here

It's not a matter of the expected values, it's a matter of their distribution. The fact that you're making 3x as much doesn't change the fact that if you're unlucky for whatever reason you'll be in debt for the rest of your life.

No you won't. Bankruptcy is a thing. You have a put option to pay for medical care at the price of "all your non-creditor-protected assets". If you're in a reasonable place like Texas and you're maxing out IRA/401k and paying down your mortgage on your primary residence, you're going to be fine financially as long as you can either work or have good disability insurance.

Oh, so you just go bankrupt. That's a good system then.

And the US is not the top country by far, even among developed ones, in number of mass murder victims per 100000 population.

Snopes describes the report you're probably talking about as "extremely misleading": https://www.snopes.com/fact-check/united-states-lower-death-...

Sure, he is making 3x now, but there are a lot of people in the U.S who do not have healthcare or fall into real debt financing it.

On a side note, the NHS crisis worries me a lot, but I’m thinking it must be better than no public health care at all, right?

You make three times.. until you don't.a big accident,six months out of job?

Never heard working out in America.

In Germany no problem...

You make it sound like Germany doesn’t have poor people. That is most certainly not the case. In fact if you consider percentages, more Germans than Americans live below poverty level.

The state pop ups your income to 800€.

Which allows you to live in a small Appartement outside the city and still have like 400€.

If you are not an alcoholic or smoke you can live a good live. And. Have free and good health insurance.

Source: my mom is in exactly that situation. Pension is only 600, state ups it to 800. She needs to move to a smaller appointment to live now. But she is now some without kids and stuff. No need for a big two or three room apartment.

I know it is sad for old people to move. ( I see it with my mom)

But in live you grow and later you shrink ( home size, income etc etc) it's normal circle of life.

I bet I will be sad when I need to move out of my three room Appartement.

You have own-occupation disability insurance for that. These downside risks are rather easily hedge-able. I don't quite have things set up yet, but my long-term plan involves moving to Texas, storing most of my wealth in IRAs/401(k) plans and my primary residence, and taking out own-occupation disability insurance for the time I'm still dependent on my income to make ends meet.

If something happens, my medical insurance pays for most, and then past that I spend down my emergency fund from taxable employment income and start drawing un-garnishable private disability insurance.

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