Hacker News Reader

Comment by dv_dt | Hacker News Reader

Plus one carries a huge high side uncertainty in costs from healthcare in the US.

This is true for people in the middle to the bottom of the pay spectrum in the US. From experience where insurance paid ~1 million for a significant healthcare expense and my out of pocket was $4k -- when you are in a field with such a low unemployment rate and generally good benefits, it's a non issue. The month premium we pay is a non-issue. The maximum out of pocket is a non-issue.

That being said, the way healthcare is paid for in the US is complete garbage for basically everyone that doesn't have that same (more or less) guarantee of employment (with benefits) and is a huge problem. It just isn't for upper middle income (and above) workers.

Same with college. In my experience most SW engineers in the US make enough money to drop money in some kind of investment account for their children monthly so that college isn't so burdensome unless their children go to the absolutely most expensive places or they have a ton of kids.

Again, it's the people in the middle and bottom that are getting screwed. The top 20% of earners in the US come out ahead i think.

EDIT: I'm not advocating this as a positive thing or anything, just noting that I think SW engineers in the US have a pretty good gig compared to many other people both globally and at home.

I think if you read the fine print, it is quite possible to get hit by high out of pocket costs in surprising circumstances, but also if you have an extended illness. You may very well have had great coverage, but it's all to easy to end up in a uncovered circumstance. Most medical bankruptcies are people who have health insurance.

Also as the average age of many high tech companies increases, expect more cost limiting changes from offered benefits.

Only if you're uninsured. Any halfway decent health insurance plan has out of pocket maxes that a software engineer can easily cover.

I'm general, QOL is going to be better in Europe if youre in a low income bracket because you get so much as a public service. But if you make real money, you're going to be better off in America.

I have never seen a health-care plan in the US with real out-of-pocket maxes. The fine-print is crazy on those clauses. We got burned by going to an ER while traveling, and while the ER bill was covered under out-of-pocket maxes, both doctors who saw our son in the ER were not employees of the ER, and so counted as neither in-network nor emergency room care. Basically 90% of the bill was not subject to the out-of-pocket maximum on our plan.

I have always had an option for a plan that has an explicit out of pocket max for out of network costs. Maybe that's not very common.

We have that option to, and I looked at switching to it, but the list of exceptions to the out-of-network costs was still fairly long and contained words that I wasn't sure what they meant in the context of a legal document. Considering we'd be paying about $20k more out-of-pocket with that plan in a typical year, I wasn't sure if "getting a smaller list of exceptions" was worth it.

Washington state passed a law making this sort of balance billing illegal, effective Jan 1 2020.

It's a huge problem nationwide, though, and ultimately needs to get addressed at the federal level. It's absolutely insane and fraudulent that an in-network hospital has out-of-network providers within it.

One chilling exception I found with a previous employer was in the small print with "premium" cancer treatment medications. I kept thinking cancer is a primary case where I really do not want to worry about if my chemo drugs are on the premium list or not to avoid out of pocket costs.

Reply on news.ycombinator.com