Money Won’t Buy You Health Insurance

Right now my current location is Monterrey, Mexico, so again, doctor visits are cheaper to simply pay out of pocket. As an example, my uninsured girlfriend had to visit a doctor last week--a walk in appointment at the major Monterrey hospital plus lab test, technician, and prescription medication: 800 pesos, or about $66. And this is in a modern hospital in the most expensive city in Mexico.

You can see these plans for yourself by checking our Blue Cross or Humana in Florida, among others.

http://www.healthcare.gov/law/provisions/preexisting/states/...

Anyway, this isn't the place to get in a discussion about how to fix the system. But as it stands now, it's just a fact that my bank account is better served by not being insured, having minor procedures done in another country, and declaring bankruptcy in the event of a cataclysm. That's not what the system in the richest and most powerful country in the world should look like.

How many surgeries per decade do you think typical healthy nonsmoking twenty-somethings are having?

Health care might have cost thirty years ago but not the same degree.

Further, Health care is approaching twenty percent of GDP where once is was less than five. Wouldn't that be large factor in costs? And doesn't that seem a tad less than necessary?

http://en.wikipedia.org/wiki/File:International_Comparison_-...

So as a matter of priority versus other spending outlays, we're way out of line.

Here's per capita GDP: http://www.wolframalpha.com/input/?i=per+capita+GDP

Spitballing from these numbers, it looks like we spend about as much in absolute terms as Switzerland, with everyone else way, way far behind.

Here's another interesting graph, since I seem to be on a roll here:

http://krugman.blogs.nytimes.com/2011/02/16/medicare-and-med...

The degree to which our government is in the red is in no small part a result of the degree to which we're invested in the health care money pit.

The amount of money that is going to health care should blow your mind. People go bankrupt every day due to health care expenses, and even if you don't go bankrupt your tax dollars are supporting this nonsense.

I was talking to a gentleman the other day who works for a medical hardware company. He said they had a radiation treatment device that costs one hundred million dollars. A tenth of a billion dollars for one machine! "Jeez," I said, "How long does it take to pay off such a thing?"

About a year.

There is, of course, a debate on how to fix health care. Is there really a debate on whether it's broken?

I got a $800 bill for 10 minutes doctor visit (swollen toe). Not exaggerating a tiny bit. No insurance company involved. "Must exist" is not an argument. Something is broken in the system where a doctor charges you $4,800 per hour. Insurance companies, obesity, poor lifestyle choices (all usual BS reasons I hear on TV) do not explain why this particular ####le charged me $4,800 per hour.

This saddens me hearing that most discussions about healthcare are circling around the question of "how?" instead of asking ourselves "why so much?".

And, if you want to talk care and outcomes, let's pick the most grim of diagnostics: Cancer. Japan's 5-year survival rates are among the highest in the world, and the highest in particular cancers such as colon and rectal cancer. And, FYI, the US isn't #1 in survival rates for all cancers. It's spread evenly through the G8.

And, the most free of supposed free markets and tax-friendly wonderlands, Singapore, also puts price controls on procedures, with similarly successful outcomes. So it isn't a cultural or "economic" thing, it's a government thing. It always will be. An adult just needs to come in, put their foot down similar to what Tommy Douglas did in Canada, and declare either we all buy in to a government-run healthcare system, or we buy in to the government completely regulating the market much like it does the stock market or agricultural industry. States will have no say, no quarter, or feedback. They can choose to secede from the union to opt-out of the program.

And, while I love me some comment karma, I know that my position is tantamount to heresy on this board, so, get your dismissive hand cocked and ready to wave me away :D

Invisible cost: Medicare/medicaid. You pay into it regardless of whether or not you use it - how much medicare/medicaid withholdings are in your paycheck?

Add that onto your actual private monthly premiums to get the real cost of health care.

I don't know about you, but mine works out to be considerably more expensive than $325 a month. And in the Canadian case I can be a bit happier knowing that everyone is covered.

Still, $324 is a pretty nice average, when you weigh in the mix of young and elderly, and of course if it comes out of taxes, presumably someone who is only able to afford $100 a month is going to have a lower tax burden as well.

Drug companies will charge US customers more, because health insurers will pay. Good luck importing drugs from ebay - it's not legal!

Doctors, and hospital managers charge more, because health insurers pay. Good luck getting an unqualified doctor to prescribe penicillin - it's not legal!

If the government was paying for more of it, they would train more doctors, and force drug companies to lower prices (as they do in most countries). Removing the profit motive in public hospitals makes them focus on better care, not more expensive care. Then the private sector has some real competition (Australia and Canada both have private health ... it's better than the US for most people).

  At $50-100/month, they would have to sap you for nearly a 
  decade to make up a single surgery.

That's why Germany has a social system where people pay in a fixed percentage (15,5%) of their income. That way, everybody pays the same percentage and everybody gets the same service.

If I wasn't self-employed, my employer would have to pay 50% of these costs, so it would be about 8% of my income.

The nice thing: this gets automatically deducted from an employees pay, so if he gets a raise or a cut, the percentage always stays the same.

The downside of it: I make decent money at the moment and have to pay 600-700 euros/month for healthcare.

If you make over a certain amount of money or are self-employed, you can opt-out of this system and move to a cheaper and better private one.

I won't work for long because of demographic change, but it's an ok starting point

£12k (grad student, trainee) - £62 per month £24k (young professional) - £114 per month £60k (moderately wealthy) - £318 per month

The average price is probably near your lower bound but the fact that it scales with income means that you aren't a slave to your workplace. You can quit your job and start a business without fear of crippling medical costs.

(Source is http://wheredoesmymoneygo.org/)

Which brings up one of the biggest red herrings in this whole debate - the notion that the U.S. has a "market-based" system. The next time you go to the doctor, ask someone what it's going to cost. Guess what? No one outside the two people working in the basement billing office have the slightest clue, because it's all paid for by the insurance fairies. There's nothing even remotely resembling an efficient market for healthcare in the U.S., but the insurance companies like to spout otherwise, because it's entirely to their advantage.

All that space for a fallacious argument.

1) Do you really think only sick people want health insurance? 2) Not everyone has to buy car insurance. Only people who drive. High rates will force people not to drive. There's nothing people can do against high mandatory health insurance premiums. 3) We've tried incentivizing people to be healthier seven ways from Sunday but somehow they getting sick. So, like Bullwinkle said to Rocky, "this time fur-sure".

-- The beatings will continue until morale improves.

Also, if you have a group of 2,5,10 or 20, the insurance company has an easier time denying you because if you get pissed and drop them, its not a big loss for them. In contrast, if you deny the right person at a 10,000 person company, they lose a big account.

My auto insurance company also runs a savings bank for its members and offers loans at markedly better rates than retail banks.

Consumer cooperatives would seem the simplest way to alleviate this issue--no need for additional legislation. To confirm, I live in the US.

The vast majority of costs borne by and in the US healthcare system are the results of overeating, oversmoking, and underexercising. Period. Heart disease, many forms of cancer, diabetes, most forms of pancreatic, gallbladder, and adrenal conditions, are largely the result of personal choice.

Setting aside for a moment the fact that congenital defects, hereditary disorders, infections, and accidents are no fault of the victim/patient, it should be important to note that a system that REQUIRES those who take care of their health by eating and exercising properly to subsidize the consequences of the choices of those who do not, is taken by many Americans to be fundamentally unfair.

If legislative initiative were taken to find a way to exclude universal coverage of lifestyle diseases, while still permitting universal coverage of non-lifestyle conditions, many people would not have such a viscerally negative reaction to the notion of universal health care.

In my opinion, the "very minor reforms" you mentioned will probably accelerate health cost inflation by subsidizing more consumption of health care goods and offering no incentive for offsetting conservation. They may ease the symptoms for a time, but they will exacerbate the underlying illness.

It's the Republican Party. They serve a certain set of masters. This set of masters is not the everyday Joe. This should be old news. Unfortunately it is not. And yes some folks vote for them that probably should not, but we have a sort of Bell Curve of intelligence and education out there -- though everyone's vote counts exactly the same -- combined with a variety of different levels of empathy for others, combined with a propaganda-rich media environment. This is what happens under those conditions. Ideally, we want to change these underlying conditions.

As a relatively well-paid (when I wasn't working for myself) Canadian, it just never occurred to me that I might need to stick with a job just for the benefits. I had the freedom to move.

A six or twelve month wait is also unusual on switching jobs. Generally it will take ~60 days from hire for the new insurance to kick in, but rarely more than 90.

Of course, that presupposes you don't need to pay out-of-pocket for major medical care more than once every 5-10 years.

I've been self-employed since 2003 and I've never paid a cent in health insurance, I just pay the Medicare levy like everyone else. I didn't pay any money at all for this stay or surgery, and also received free pain medication (endone, oxycontin etc.) upon release.

The surgery was successful and although I still have some pain sometimes, I can walk, run, play sport and do anything else I like.

If only the U.S healthcare system were my broken calcaneus :)

I saw 3 different doctors, including seeking multiple opinions from 2 different knee specialists. I decided not to have surgery right away, and got a brace.

A few years later, my preferred leisure activities changed, so I decided to have surgery done. It took 11 weeks to get an appointment (as it was elective surgery at that point). The surgery was done by an experienced surgeon (a few hundred ACLs under his belt), and he met with me 4 times himself during the following year to follow up on my recovery progress.

Total out of pocket cost was ~$300 for a couple optional recovery devices (icing machine, etc.).

Physiotherapy appointments were, however, covered by my employer's extended medical at the time. That was about $1-2k that I would have had to pay had I been completely uninsured. I probably would have elected for less and cheaper physio care in that case though.

Short version: after reading this article/thread, I'd honestly be scared to join YC in SV, especially now that I have a daughter.

(Side note, I tore my ACL in Ontario and had an initial appt there, but ended up getting treatment in BC. It seems a lot of posts here talk about which state you have coverage in? Is the paid-for insurance not country-wide either??)

The MRI was on the order of $1200, and another appointment later (this time with a knee specialist), it turned out that I did, in fact, have a torn ACL. By now, however, it had happened nearly a month prior, and the doctor recommended waiting at least two more months for the swelling to fully subside.

Reluctant to make such a big investment and being fearful of such a major surgery, I waited about 9 more months before I finally had the surgery. Since I didn't go to a hospital, the costs were actually reasonably low: ~$2500 each for the facilities, the anesthesiologist, and the surgeon. From diagnosis through final checkup, the cost was about $10K, and I was fortunate enough to have my doctor advise me on personal rehabilitation (I didn't go to a single session of rehab).

So I was lucky to get into a good facility with a good doctor and get reasonably-priced care, and now I'm stuck in a job I don't like with high credit card bills in order to pay off a large cost for a fluke basketball accident. Call me crazy, but I'd be interested in taking my chances in Canada or the UK. I've only just now (a year later) paid off the anesthesia, and I'm halfway done paying off the surgeon.

It would have been far better to pass a series of smaller laws. Start with: it's illegal to discriminate based on pre-existing conditions. Then, create cross-state markets and let insurance companies compete across state boundaries. Then, let families buy into the Federal government's health insurance program (if our elected reps can do it, why can't we?). And so on.

That said, one family member in particular is a nurse practicioner at a major trauma center. Her primary concern is not the billing disputes as much as the actual quality of care. She feels that her hospital is already inundated with somewhat reckless medicaid requests. She believes that 60% of medicaid patients at her hospital seek medical care that they don't need (e.g., person has a basic headache that some rest or an aspirin would surely cure but instead they actually seek professional medical attention). If that visit were to come at a slightly greater cost, there is no way that person would go to an emergency room for a headache.

It sounds like a dramatic example but she says crazy incidents like this happens every single day, w/o fail. So much so that they track and keep a monthly log that helps them measure their performance. As such, the hospital's resources are strained and their ability to treat seriously ill or injured patients is somewhat compromised. So I think the concern on her part is that the new health care bill actually exacerbates this problem.

I understand that selling across state lines could violate states rights. At the same time, it's too bad that many (myself included) wouldn't trust the fed to be in charge of interstate oversight. In reality, it might be better to have one consolidated standard of mandates but I just can't imagine fed efficiently and accurately providing that type of oversight.

Things like this happen even to insured people. Due to a communications snafu between the doctor and the insurance company, my mom, who has "good" insurance from BigCo, is paying for her annual mammogram $50/mo now, and will be doing this for the better part of two years.

My parents paid on an ER visit I made in my late teens until I was 21 or 22 because of another such insurance oversight.

These happen all the time because that's how insurers make money. The insurance model is based explicitly on not paying out. For something that's universally utilized like health insurance, that generally means you have to deny a lot of claims to keep acceptable margins.

Homeowner's insurance works fine because most people aren't burglarized often and most peoples' homes don't burn down, so people make modest monthly payments and one claim in a lifetime more than pays for itself. Likewise, car insurance is not used too often by its patrons.

Health insurance, however, is used (at least) several times a year by almost every individual. As such, insurance is a terrible model for health care, since the entire concept behind insurance is that more people are paying for the coverage than are using it. The continued feasibility of medical insurance depends on people not getting medicine.

And, in practice, if you tell the provider that you can only pay X, it is quite possible that they will prefer getting X to getting 0.

You're basically paying for the privilege, in the event of a large medical expense, to say, "Don't blame me, I paid for the insurance."

It will make no practical difference, as some of the follow-up comments have already suggested. You're just spared the indignity of those ignorant of the realities of the American health care market (or, worse, fully conscious of them), asking: "Why didn't you buy insurance? There's this website/company I see advertised on cable news all the time where you could have gotten a really reasonable deal. So you've got no one to blame but yourself."

I know that in Canada, if I am sick, I will be looked after. I won't go bankrupt trying to pay for my treatment or trying to pay for the legal bills in a court battle, trying to get my insurance company to pay out.

The American system is so truly and completely fucked, I can't understand why anyone would defend it. Better hope you've got good genetics, good luck and a good lawyer. If any of those things isn't in your favor, one quick illness and your financial life is over.

Do not go through United trying to get them to pay this. Prepare for a day spent on the phone with the hospital until you find the person in the billing or services department who can really get to the bottom of it. They will figure out for you which technicality the insurance company is trying to use and what the correct one is. I had something similar happen and, after a day on the phone, was able to get the incorrect code that was used, how much they were supposed to pay, and what to say to them (this needs to be reprocessed according to X agreement).

From there you need to write a letter to United saying you want the case appealed. Send it certified mail and be prepared for the first response acknowledging your letter and the second one, about 30 days later, with the result of your appeal.

PS: I would have emailed this to you but couldn't find any contact information in your profile.