Hacker News Reader

Comment by usaphp | Hacker News Reader

Imagine a regular sized family of 4, you have to shell out more than $20K/year for the most basic health insurance for your family if you are self employed, $20,000! and you still have to pay for EVERY doctor visit for your kids and regular checkups, and your family deductible is around $10-12K. And every year they send you a new increased quote by 10-15%. There should be some kind of a discount for families, like when you have multiple cars under your insurance your rate barely goes up when you add another one.

View on HN

In my expensive area of CA, a gold insurance plan for a family of 4 costs $20,400 per year. That’s an insurance plan with a $0 deductible and $30 co-pay per doctor visit. That is far from the most basic health plan. A plan with a $12k deductible is $13,500 per year.

Even so, a $20k a year is peanuts compared to the out-of-pocket expenses of a serious medical emergency. Don’t fall into the trap of thinking insurance is not with it just because you haven’t had to use it yet.

In my area (Seattle) such plans aren't even available. So don't blindly assume that they're available outside CA. The deductible ranges between "high" and "crazy". Dental that you can buy through health exchange doesn't cover anything at all. I'm seriously at a loss as to why anyone would pay for it, if you can buy a better plan from the same company outside the exchange. And this year, Kaiser Permanente just nonchalantly raised the premium by a little under 20%. It'll probably do the same thing next year, too, because hell, why not. We need to seriously look into opening up (and stimulating) competition between health insurance companies, hospitals, and so on, to upend this blood sucker of an industry.

> And this year, Kaiser Permanente just nonchalantly raised the premium by a little under 20%.

I wonder how much of this is due to the repeal of the individual mandate, which Wikipedia says takes effect this year.

Don't see why KP would be affected by that directly. KP doesn't eat the cost of the uninsured.

But the uninsured are more likely to be poor (and use the error for basic care because they can't afford it, raising the cost for everyone) or healthy (adding less to the cost more than they share of it). Thise two ideas are the heart and trade-off of the individual mandate: insurers must cover anyone without giant markups and in exchange everyone was forced to buy insurance to help cover those costs.

> $20k a year is peanuts compared to the out-of-pocket expenses of a serious medical emergency.

And that’s the most annoying part. The fact that $20,000 is considered peanuts in a medical condition is already outrageous. My friend’s wife had a c-section child delivery and was billed $38,000...for a 3 days stay at the hospital. No complications just a planned c-section. I understand that’s the reason why the insurance is so high

> No complications just a planned c-section

There was a lot of effort, planning, and training that goes into making sure that there aren't any complications. Not to mention the fact that even routine procedures can have unexpected complications that have to be planned for and addressed. I think that $38k for a surgical procedure with post-operative care for the mother and child isn't necessarily that outrageous. Just imagine the people, training, facilities, etc...

EDIT: Now that I'm thinking about it -- was the $38k bill with or without insurance? Meaning, was this their out of pocket costs with insurance? If so, that does seem rather unreasonable. If that was the billed rate for the insurance company and your friend's out of pocket costs were lower, that would make more sense.

I have 3 kids delivered by c-section. Total paid - €0. Performed by trained professionals in a nice hospital, not by villagers in a shed.

Given that you are quoting the price in Euros, I suspect the funding mechanism for your hospital is very different than the hospital costs the parent was talking about.

I know nothing about how the financial side of European hospitals work though... but I assume they still have internal costs that are tracked and tallied. Your kids' deliveries may not have cost you, but there was a total cost somewhere in the system. It probably wasn't anywhere near $38k, but even that isn't a fair comparison due to the substantial differences between the medical systems and the way indirect costs could be covered.

(I'm not trying to defend one system or the other, just pointing out that the systems are different so direct comparisons like $38k vs €0 aren't that straightforward. It gets even less straightforward when you factor in the US medical insurance system.)

In France a 1 day stand in hospital is billed around 1000€, of course it is almost entirely covered by insurance. You have to pay a fee of 17€ a day if you have some standard insurance package. If you 'stay' at the hospital then all costs are bundled in this price, if you only follow exams they can actually get more expensive in total (usually they offer you to stay the night if you have exams that would cost more than a "full-pension")

This was a few years ago so the prices may have changed.

Thanks for the insight into how things work in France. Like I said -- I don't know much about how non-US healthcare systems are funded.

But, I think the main question I was trying to get at is -- how much are the French (or Japanese from a different thread) hospitals subsidized by the government. I expect for there to be indirect costs that might have to be covered by direct billing in one country, but not another. For example, electricity bills (or the cost of the building, etc)... is this covered by the 1000€ bill, or is is paid for by some other means? I recognize that US hospitals also get some level of subsidy, but there are hidden costs that aren't always apparent.

This is what I was trying to get at... that direct comparisons of costs aren't always that straightforward when comparing different systems. A 2000€ or $2000 bill might represent only a fraction of the actual cost of treatment. And given the opaque nature of heathcare billing, it's very hard to know.

> Like I said -- I don't know much about how non-US healthcare systems are funded.

Then shouldn't you read up on that before expounding upon how a 38k price tag for a scheduled routine procedure is reasonable? Healthcare billing isn't that shocking when you travel outside of the states.

I agree completely.

I simply believe that not becoming broke by a scheduled or unscheduled medical procedure is a human right and it's realistic to achieve. I'm not saying it should be free - I pay quite a bit of medical insurance to the state, but it's mostly transparent as it's included in the income tax deductions.

Another data point: Japan is a first-world country with one of the lowest infant mortality rates in the world. Births are not covered by insurance. We paid US$5,500 out of pocket, for a birth in a private clinic that ended in an unplanned C-section and 10 days in hospital (in a premium upcharge private room). $3,500 was later refunded in a birth stipend from the city.

Eh, with cars you can only be driving one at a time so it doesn't make sense for insurance to double or triple just because you now have two or three cars.

With family members, they are all absolutely living in parallel and at the same time.

I've owned 5 cars at one point, and dropping or adding cars never changed the amount of the premium attributed to the other cars. (That is to say adding car 5 was an increase similar to adding car 4, for example.) I never understood why, seeing as how I can only drive one at a time, but I've always just assumed this is customary.

Maybe I’m daft but it seems like the premium is for cases of theft or damage not caused by driving. Seems pretty clear to me.

Reply on news.ycombinator.com