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Comment by mumblemumble | Hacker News Reader

I'm having a hard time interpreting that because I don't know enough about the Affordable Care Act. Is this making an apples-to-apples comparison? Are Silver ACA plans roughly comparable in terms of quality of coverage?

One anecdotal experience in this area for me is that my employer recently switched health insurance companies on us. On paper, the new plan is equivalent to the old plan, but appreciably less expensive. In reality, I would gladly pay even more than the old plan cost, just to go back to it. And probably save money (certainly be able to hold onto my hair color a bit longer) in the process.

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Yes, the same metal level plans are comparable since the coverage all health insurance has to provide is the same in the US (excluding the weird church plan loophole but they are not actually insurance and no one uses them)

https://www.healthcare.gov/choose-a-plan/plans-categories/

What will change is the network of healthcare providers that are in network for you. This is how I think price discrimination will work in healthcare in the US going forward.

A more expensive silver health insurance will have more doctors in network since it will reimburse at a higher price (from your or your employer’s higher premiums). A less expensive silver health insurance will have fewer doctors in network, since fewer doctors will accept that price. Or it will have overworked doctors, or you will have to see nurse practitioners or physician’s assistance instead of MDs.

If you find your employer’s in network doctors worse, then it is basically a stealth pay cut from one perspective.

Can you qualify why specifically you would prefer the old plan even though it is 'on paper' the same?

Not OP, but switching providers could mean one actually provides coverage and the other regularly denies it. I have upgraded health plans in the past, only to discover I spent more time fighting my insurance company because they just refused to honor the coverage. I actually had to get a lawyer involved at my own expense.

I find it bizarre how many people just trust that insurance companies will actually honor their contracts. In my experience, they likely won't. This is just my anecdote.

As a non-American, that sounds pretty fucked.

It is not as bad as it sounds. There is an appeals process:

https://www.healthcare.gov/appeal-insurance-company-decision...

And in general, anything the insurance company might not want to pay for required a “prior authorization”, which usually happens if the insurance company’s doctors think there is another option for treatment or the proposed option does not have sufficient evidence.

I imagine there is similar processes in taxpayer funded healthcare systems too to properly allocate resources. Although, I am sure there are many cases of problems caused by insurance companies in the US, due to the bureaucracy.

It really is as bad as it sounds.

>I imagine there is similar processes in taxpayer funded healthcare systems too to properly allocate resources.

What the doctor orders is what you get. You can typically choose your doctor, as well as get a second opinion. The doctors are generally paid the same.

These are some pharmacists talking about prior authorizations for medicine, and they seem to exist in Canada, UK, AUS, and NZ.

https://www.reddit.com/r/pharmacy/comments/oekhrp/curious_ab...

I would be surprised if any country gave doctors blank checks for everything since no one has unlimited resources. There most likely is a system for figuring out where waste is happening and avoiding it.

I can't speak for all of Canada since health care is handled at he provincial level, but I think most provinces don't cover prescriptions except for the young and elderly, and even then prices are capped anyway.

Yes, but it's generally done on a national level. The waste in the American system is the requirement for an extra 73 rounds of paperwork for every interaction with the medical system.

The American healthcare system is quite fucked. Proponents are typically profiting from it directly, have no idea what things are like in other places, or suffering Stockholm syndrome (and lack access to medical care to treat it).

What lotsofpulp and Judgmentality describe pretty much covers it.

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