Comment by gargravarr | Hacker News Reader

Comment by gargravarr | Hacker News Reader

The out-of-network stuff is the most insane part of the American health system. No question, it's deliberately set up to trip up those who need urgent care. There are plenty of stories of people who go out of their way to find an in-network hospital to have surgery with an in-network surgeon, only to be billed for the anaesthesiologist who is out of network - something they cannot object to because they're being put under. Even if they could ask, what choice do they have - take the surgery while awake? So beautifully set up to screw over the patient.

It's often said that health is a highly profitable business in America. And yet it is astonishing how feverishly the average Joe will fight against free healthcare because those who make the profits have convinced them it's bad for them. Look at any country with nationalised healthcare; none of us in the UK have a bad word to say about paying for the NHS through National Insurance if it means we can walk into any GP's surgery or hospital and never need to worry about money or insurance.

In the best possible way I hope the system breaks completely and it has to be rebuilt from the ground up. Maybe then some semblance of fairness can creep in.

In America, it is virtually impossible to safely retire early knowing that you will have enough money to cover unexpected medical expenses for you and your loved ones. Without insurance, you may be on the hook for millions of dollar of liabilities.

Your 401(k) is bankruptcy-exempt nationwide, IRA balances are exempt up to state statutory limits (some states are unlimited here), Social Security payments are fully bankruptcy-exempt, and some states will even exempt your primary residence (eg, Texas).

Insurance is only really necessary to avoid large up-front cash payments - the healthcare provider will treat you with the expectation that they'll negotiate some amount of payment from your insurance provider. Past that, it's fully legal and completely possible to set up your retirement finances so that healthcare providers have to make you pay in advance to get any money out of you whatsoever.

For example: move to Texas to get your IRA 100% exempt. Buy a duplex that's also 100% exempt, live in half, and rent out the other half for cash or physical checks. Whenever you get money from your tenant, immediately convert it to cash and use the money to pay off credit card bills - if you're spending via debt, they can't seize the cash accounts you're using to make purchases.

More generally, there are plenty of ways to acquire bankruptcy-exempt assets with your non-exempt retirement savings. Delaying social security is the easiest of these.

It is depressing that our system is so broken that this kind of strategic planning is needed to avoid destitution in your elder years. For everyone who isn't familiar with bankruptcy law or hasn't been casually informed - how do they survive retirement. If you've shifted your 401(k) money into private investments for a better return or already burned through your IRA - if you're retired in a state that isn't protective of your primary residence (and lots of people have retired to places that aren't Texas) then what? Is it just "sucks to be you, you didn't understand all these complicated rules well enough?" and what if your mind is deteriorating, then it's on your inattentive descendants to make sure all of this is running as it should be? Or are you constantly losing money paying a firm to manage your affairs - essentially the "please don't let health insurance bankrupt me" tax.

>For everyone who isn't familiar with bankruptcy law or hasn't been casually informed - how do they survive retirement

That's a big thing that breaks my heart to see happen. People have a giant pile of medical bills, and a large 401(k), and decide to raid their retirement funds to pay off the bills when there's neither a legal nor moral obligation to do so.

>if you're retired in a state that isn't protective of your primary residence (and lots of people have retired to places that aren't Texas) then what?

My standard advice is to limit your home equity via a mortgage or line-of-credit. Losing a $300k house to creditors sucks, losing the $60k in home equity on a $300k house sucks a lot less.

>and what if your mind is deteriorating, then it's on your inattentive descendants to make sure all of this is running as it should be?

You should have a well-documented financial plan anyhow, especially if you want to make it easy for your heirs to deal with your financial assets.

Many people will develop chronic, expensive health problems that will persist beyond bankruptcy. Someone I work with has a chronic blood disorder with medication costing $10k per month. That does raise a good point, though. Would a health insurance provider have to take you once you've gone through bankruptcy? This is the type of question that convinces me the US medical system is incredibly broken.

It’s not really that astonishing that Americans are divided on healthcare when you look at the fact that neither primary political party truly supports universal healthcare. Only the progressive left does, very much against the wishes of the base of the Democratic Party.

We can’t act like Americans not wanting universal healthcare is such a head-scratcher when the vast majority of those in power are fighting to prevent it.

Part of the problem is that many people don't realize how bad it can get until they actually experience problems. These problems don't happen often, but even 5% is too much. If most people understood the edge cases and fall-thru there would be far more support for a national solution.

In my family's case, it was a difficult pregnancy and delivery, and pretty soon you were getting bills from 20 odd providers with different names, many out of network, who happened to participate in some capacity or another.

I regularly heard comments like "I dont want to change things, I have great insurance!" and I think to myself...yeah just hope you don't experience the reality of it.

Much of that is explicitly shaped by our political discourse. Tons of data exists that shows the ACA saved lives by expanding access to coverage. That didn’t stop political opponents from working to undermine and destroy it.

Apathy is baked into our individualistic political ideologies. It’s a feature, not a bug.

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