Health Insurance That Doesn’t Cover the Bills Has Flooded the Market

Torn down by whom? There is a whole system of laws and companies and staff that would object to such a dictatorial move.

We agree that it’s fucked. We likely disagree on where it needs to go, and possibly on how it needs to get there.

Actionable steps to improve are what is needed, especially now that stance on healthcare regulation has become a point of political identity in the USA.

I think it will probably get worse before it gets better.

FWIW, I agree totally on the lack of information part. The current system is the worst possible setup.

> [US healthcare] needs to be torn down and rebuilt from scratch...

Here are some numbers, just to provide perspective: [1]

The worst recession in recent history (2008-09) featured a drop of US GDP by -2.5%. The US healthcare spending per capita is about twice as high than EU average. US healthcare spending is about 17% of GDP. Which means if we somehow manage to fix it and bring it to average European levels, that would represent a drop of -8.5% GDP We haven't seen GDP drops like this since WW2.

So... I seriously doubt "rebuild from scratch" will work. We need a gradual, systematic cost cutting program spread over 10-15 years. And why aim at EU average? Let's make it the world's most efficient, while we're at it.

[1] quoting from memory, feel free to google & correct me

Honestly, a free market might even be better than what we have (though something like single-payer would be ideal). As usual, we have the weird half-assed worst of both works policy solution that comes from neither self-consistent solution being palatable to the electorate.

Not true. Even the bronze plans cover doctor visits with just copays, no deductible to be met. Copays count towards deductibles.

Now when you need hospital services, surgery, emergency, yes the deductible is formidable. After that they cover at some amount, 80% typically.

So the notion you have to pay $12k first is a blatant lie.

The bronze plans are akin to what low end employers used to/still offer. It’s better than nothing, for example in the scenarios listed in the article, max out of pocket would be their total liability, probably about $12k as you noted.

None of this is good, but it’s better than plans literally designed to scam people. That’s what the “short term healthcare” being proffered is. Scams.

IDK, the last "progressive" action on insurance more than doubled my rates and I had a distinct feeling of some kind of corruption like insurance companies were cashing in.

I'm a proponent of universal healthcare, but pointing to "insurance industry greed" is a dishonest narrative. Health insurers are having a banner year, and that means their profit margins are approaching 6%. (By contrast, Facebook is regularly over 40%.) For the year ending Q3 2018, health insurer profits amounted to $25 billion, industry wide, which is about the same as Google alone makes in a year.

If running a business that makes 6% profit margins is "greedy" then the word literally means nothing. The only reason health insurer profits are even part of the discussion is because Democrats reflexively lean to anti-corporatism to explain any societal problem. But it's like republicans blaming everything on the decline of two-parent households. It's rah-rah narrative that has no basis in reality.

If Democrats in California can't muster the votes to outlaw something as uniformly hated as balance billing while they have the Governor's office and a supermajority in both houses, I'm afraid I don't have much faith in their ability to fix any of this at the federal level.

Everybody likes a simplistic explanation of the high cost of health care like "blame the insurance industry" but the reality is more complicated. Yes they are middlemen and need to make profits which adds cost. But look at doctor salaries, particularly specialists, many of whom make over $1m/yr. Look at testing costs, often run by private companies (sometimes owned by the doctors who order the tests) that also need to make a profit. Look at the costs of hospital and hospital systems whose administrative and facilities costs rival that of higher education. And not to mention the whole pharmaceutical-industrial complex. Reducing healthcare costs is going to have to happen at the input side of the industry, not just by taking out payer inefficiencies.

"Apparently EU citizens (and visa holders?) get a healthcare card that's portable across EU. Is this true? "

I don't think so. The systems are very different. But if you get sick in another country they won't rip you off like they doing in the US. My sister from Germany was charged $1200 when her daughter had a fever in NYC. She talked to a doctor for 5 minutes and got an antibiotic.

There is no wisdom to impart. There are 2 countries in the world who do not have public healthcare: the US and Liberia.

The US does not have public healthcare because of a lack of wisdom, it’s because of greed. Literally anything other than what you’re doing now is better. Roll the fucking dice on public health policy and it will be better than what you have now. It’s not a lack of wisdom, you aren’t even listening to the wisdom that surrounds you, it’s a complete lack of empathy for the sake of greed!

Correct, and they share data across countries and offices. https://en.wikipedia.org/wiki/European_Health_Insurance_Card

You can get a cheap (like $10) EU-wide health insurance with wide coverage, or get a refund from your country after getting healthcare in another member country but it's quite the bureaucracy. (That's where the insurance company helps.)

Now even if paying from out of pocket, the cost is unlikely to bankrupt you. The expensive things are experimental biological therapies (e.g. new antibodies) and some cancer treatments.

As for quality, it depends, e.g. Poland has the healthcare starved for money and qualified people. That's because it's way too small bit of GDP. (I think around 5%.) That mostly makes specialist care much slower, not the general care, and hospital workers overloaded. Cost cutting is visible everywhere. (Only Romania and Bulgaria are more starved.)

It's still much better than US situation.

As a number, it is around 700 Euro per year per capita. And the money is supposed to increase to some 6% gradually.

I just DDG’d this because it sounds like a great idea but I wouldn’t sign those “five core statements of belief, freedom, and ethics” even if it meant I’d get free healthcare. One thing I know for certain: our health insurance system needs less religious involvement if we want to fix it, not more.

> we should return to an open market place.

What should happen when an uninsured child ends up in the emergency room?

Is the ACA responsible for the rise? Personally, my health insurance rates (for a family plan offered through my employer of ~1,000 people) were increasing by 5-10% per year before the ACA and have been more stable since (3-5% increases per year).

Its currently at a total of $22,000/year (between employer and employee contributions) - that's equivalent to $35,000 dollars in my country of birth (New Zealand), or 700% of what the total tax on the median income is. Somehow, kiwis get all of the functions of government for 14% of what health insurance costs in America. It's insane and reminds me every enrolment season of how poor the ROI on healthcare dollars is in the US.

Before ACA you couldn't get insurance if you had preconditions and they would often drop you if actually got sick. ACA needs improvement but things sucked long before.

> What I know is that before ACA, my health insurance was about $150 a month. Now it’s $650 a month

The health insurance industry is a middle man that provides no services and only acts to raise prices. The whole industry needs to die, yesterday.

You're not paying for that through premiums, taxes are. Your increase is due to the cost of care increasing, blame your doctors and their MBA-run hospitals charging $500 for a 10-minute office visit.

There has been no spike in insurance premiums after the ACA. They've been rising at the same rate for a long time. http://healthaffairs.imgus11.com/public//332ce71d3968fad1b21...