You Don't Need Health Insurance
prigoose.substack.com
prigoose.substack.com
I've done the no health insurance thing, and I've done the catastrophic-only health insurance thing. That resulted in a bankruptcy from $90k in medical costs, and that's after the various bits of charity care, neogtiation, and whatnot.
It works great, until it suddenly doesn't. These days, I pay the $3,063/month insurance bill... not happily, but I absolutely pay it.
But until that happens, you've got to deal with the world as it is, not how you wish it would be.
* For the ~50% that isn't already on government managed medical care
# The constituent states of the EU each do something different.as I understand it, but they don't send gobs of money out of their State so that gormless bureaucrats can take their massive vigorish before sending it back
It's already disastrous enough that private health insurance doesn't adjust premiums for smokers and the obese, like life insurance does.
See here for a list of premiums in a state like NJ:
https://www.nj.gov/dobi/division_insurance/ihcseh/ihcrates20...
$427 per month would be the cost for a 21 to 24 year old for “BCBS Omnia Silver HSA” (a good representative health insurance), and you can figure out the premiums for other ages using the age rating factors on bottom left (max is $1,287 per month for a 64 year old).
Page 6 here shows the deductible and oop max ($2,300 and $7,500).
https://www.ehealthinsurance.com/ehealthinsurance/benefits/2...
The blogger in question is pregnant and planning to do a home birth, so they may find themselves in that category surprisingly rapidly.
Precisely: https://jakeseliger.com/2023/07/22/i-am-dying-of-squamous-ce.... The best ENT surgeons in Arizona for creating a "flap" that replace part or all of one's tongue after surgery were (and are) at the Mayo Clinic. And I needed radiation after the first surgery. And then another surgery a few months later.
I too like the "just don't get seriously sick" strategy, but if it doesn't work, then you have a huge problem.
That $90k ran up much faster than that, even with shitty insurance paying at least some of it, and medical needs continued to accelerate for a while afterwards. Savings wouldn't have done a bit of good; it was rapidly exhausted. (That's not part of the $90k, either! It's on top!)
https://www.dfs.ny.gov/consumers/health_insurance/surprise_m...
If the hospital is in-network, you're good.
Similarly, if something went wrong then I couldn't go back and insure that risk afterwards! You can't insure unpredictable events as and when you need them, and there's no point in my organising insurance from the wreckage of my car, house or health.
Our existing insurance model is basically a giant racketeering scam. The lack of access to affordable healthcare increases crime, stifles innovation, decreases longevity and quality of life, and has created a breeding ground for lot of the crazier shit we are seeing in America.
I think we see Medicare For All sometime in the next 10-15 years. The first major party nominee for President who embraces it is going to get elected.
And Republicans will use every ability in their power to prevent it from happening, through the filibuster and Supreme Court most likely. Fighting that sort of socialism is their entire reason for existence. That and upper-income tax cuts obviously.
Now if that's a good policy to cut taxes and spend as much as they do (Trump especially), that is another question.
This has been the dynamic long enough that I can remember an SNL skit from 20 years ago about how bad the Democrat's messaging was on the subject. Something like the Democratic leadership of the time cutting ads about how the rich could use their tax cut for a full-service holiday at a brothel, while all the middle class could get from their cut was a lousy handjob. Obviously it was amusing enough to stick with me.
1. No hospital will leave you (because of decency and federal law) to die if you can't pay. This right here obliterates any justification for private health insurance unless said insurance is mandatory like it is in a country such as Switzerland. When someone like the OP inevitably gets injured and has a $370,000 bill or something they go bankrupt and then society has to pay for it. If OP and others were willing to let themselves and others die on the street outside of a hospital I would be at least a little more sympathetic toward their decision to have or not have health insurance.
2. Health insurance is basically a jobs program in the United States. Health insurers do not provide value or innovate. What they do is became defect state agencies with private profits attached, and then when they decide they aren't paying for something we still end up with the bill anyway (both personally and as a society). My main gripe here is that because of the way we've structured our society, we're basically bankrolling a private industry and protecting its profits for no added value. At least the defense industry actually builds things for us. We could eliminate these insurance companies, their profits, and those jobs, and overnight our healthcare costs would go down and everyone would be insured and the economy would be better off too.
Yes, they will. The legal requirement (under EMTALA) is to provide emergency screening and care until stabilized. https://en.wikipedia.org/wiki/Death_of_Nataline_Sarkisyan
"UCLA declined two livers while waiting for insurance approval from Cigna. Sarkisyan's family was also informed that they could proceed with the transplant if they could make a down-payment of $75,000."
I've provided a very concrete example of how this plays out.
Also once you reach the point that you are describing that is typically when state resources kick in. If you become sick enough (for example with cancer) you go on Medicaid and disability. I recently went through this exact process with my mom. It wasn't fun and boy do the spam and scam calls really add to the experience. Why we tolerate this crap in America is absolutely bewildering.
EDIT: I doubt OP is reading this but I would highly recommend they get insurance before giving birth...sure, they won't cover your at home birth, but they will cover your hospital stay if you end up having potentially fatal complications
Health insurance can also be free for low income folks, so it is incredibly dumb not to have it.
My dad just went through this (cancer). He was on a co-op plan (snake oil if you ask me), had to pay out of pocket then fight to get reimbursed. The co-op said they wouldn't pay the outstanding bills if he left the plan and also refused some of the treatments doctors suggested. In the end he was able to get real insurance (not during open enrollment) through some loophole since the co-op was refusing to pay for something. I'm not sure if he died due to not getting treatment earlier or if earlier treatment would have resulted in the same but this advice is not just stupid, it's dangerous.
I'm billed $1M annually for my health care (Stage IV Cancer), and yes, I likely could get that dollar amount lowered through different tactics, but for a measly $9k a year (premiums + deductible), I don't have to deal with any of that nonsense. $9k for $1M in health care is a deal.
edit: sorry not currently. It starts 21th January.
You can probably negotiate the bill down to what the insurance pays, but not beyond that. Plus, hospitals don’t think highly of folks that don’t carry insurance. They may refuse to bargain with you at all.
Do you think that 3 million dollar hospital bill will just go to collections? No they are going to sue you and get a judgement on you.
This is how I know not to consider anything this person says.
no drugs either - although my partner had studied various breathing techniques
we also mitigated the risks as well with scans and monitoring, and the worse case stuff - we also knew with research what the approx risks where (I really can't rememeber those now) but I do remember that hospitals typically massively over react - which causes harm in itself
That's because you didn't fully understand the risks.
My wife is an ER doc (https://bessstillman.substack.com/), and her and many of her colleagues have seen the results of home births gone sideways.
Choosing a home birth to save money is a whole other thing. If she gets preeclampsia or has to go for an emergency c section she can count on a 6 figure bill.
It increases risk of death from 3.27/10000 to 13.66/10000. And that’s before confounding factors like high risk births are more likely to choose hospitals this pushing up the apparent risk of hospital births.
I agree, my wife totally intended on a minimal medical intervention based birth. Still went to the hospital, just in case, as we had planned. Turns out that after hours of contractions, the birth was not going to happen (sparing the details) and a section was necessary after all. You simply can’t plan for this ahead of time.
Isn't it incredibly hard to find insurance if this is the case? Quite curious how it works in the US. I think this all changed under the Affordable Care Act??
Here in the UK it's hard to find insurance that would accept you with a chronic illness unless it's quite low-risk. The only way I was able to "lock-in" a policy was by contuining a medical-history-agnostic one I had under an employer. To get it as a private citizen would have been impossible due to my medical history. So basically I'm now never letting that policy go. TBF the main reason to get private health insurance in the UK is for a shorter waiting list and better aftercare or rehab, but it can also provide hugely life-changing medical intervention if you can carry the policy into old age, AFAIK.
But yeh.. I'm privately uninsurable. I cannot purchase life insurance anywhere ... trust me I've tried. Which is funny because I thought the whole point of insurance was to equitably balance out the risk amongst a collective. Ultimately, for me, the whole point with insurance is that it can cover you if something super-super-awful happens. It protects from financial ruin in the case that e.g. you need life-saving emergency surgery. It's there for the unpredictable.. not routine dental appointments lol.
It is, but if you are higher risk, adding you is inequitable to the pool of already insured lower risk people.
You have to buy insurance before the need for it to be equitable to the others in the pool.
I would compare this to my first dog vs my next dogs. The first dog I took him to the low cost clinic to get shots and did minimal cheap health care for him. But as he got older, it became clear that when you start having complications you need to see the same person and you can’t just skate by with different vendors and there is a lot of value to being seen repeatedly by the really highly qualified person as you get older or know where to go if you have an emergency.
It’s totally true that you can negotiate and find cheaper prices on things, but like the best veterinarians, the best doctors generally accept the top quality healthcare usually BCBS and aren’t going to discuss or negotiate price with you. They didn’t spend a decade in medical school to deliver transparent billing.
I’m all for transparent billing and think it should exist, but my health is too important to try to fight some philosophical price battle and I want the best.
If you are uninsured, for instance, you stand almost no chance of getting an organ transplant. There are not enough organs for too many people, the operation is very expensive, and lifetime support medication is also expensive.
In my experience, transplant centers won't even start the evaluation without proof of insurance.
While it might be possible to get insurance after diagnosis for people like the OP who choose not to have insurance, that isn't always feasible. Sudden organ failure, while rare, certainly happens. And should it happen, it is hardly the best time to be scrambling to find insurance.
Yes, the system is screwed up. But it is the system (in the US).
So yes, insurance is never worth it... unless it is... and then often it really was worth it all along.
Basically, insurers make most of their money by investing the float, so their incentive is to have a bigger float by offering competitive rates to bring in more customers. They don’t really care if they pay out every dollar they take in, because they made money by holding onto the premium in the time in between when you paid it and when a claim was made.
So for things like car insurance, it actually is a pretty good deal. Many companies expect to pay out as much as their clients put in, with the added benefit that you can take out more than you put in if you have a claim immediately after getting insured.
Buy the cheapest plan with an HSA. You essentially get an above-the-line deduction of all medical expenses even OTC things, you cap your expenses, and you get insurance-negotiated rates.
I personally wasn't aware I can buy contact lens from the UK - will be giving that a try.
Once it gets bad enough you may get Medicare/Medicaid for disability/income reasons, but that's... a suboptimal approach.
But it's not like cancer moves fast or anything right? You can just wait, nothing bad will happen... /s
I'm a bit salty, I lost my dad to cancer last year and he was on a bullshit co-op plan that delayed treatment and made the whole experience even worse than it already was. Would insurance have saved his life? I can't answer that but the delays (before he got real insurance) couldn't have helped.
If you have assets, carry insurance to protect those assets. Maybe you get lucky with no insurance and come out ahead in the casket, but if you lose, you can lose big.
I have exceptional insurance through work now, but when I didn't, I carried high-deductible insurance with an out-of-network max-out-of-pocket. They might get me for 12 grand, but they had to weasel a lot harder to get me to pay more.
Also, I've been blessed with pretty good health. But my total hospital bill for life is probably about $250,000 due to a ruptured appendix. (The work was in a socialist hospital so I didn't get a bill--that's just my estimate.)
> Insurers can’t refuse to cover you or charge you more due to a "pre-existing condition."
This is absolutely true, however one does not simply buy insurance outside of open enrollment; you'd best hope you only get sick or injured in that particular month.
We are both self-employed, so we get our health insurance on HealthCare.gov, so if we let payments laps on our health insurance, we are barred from getting new health insurance for the remainder of the year. Health insurance is not just insuring our health, it is also insuring our ability to be insured.
But beyond any of that, our health insurance is a positive return on investment. Our $900/mo = $2500/mo in benefits.
So maybe it is true that you don't NEED health insurance... until you do, and then it is too late.
What does "being responsible" for that look like? Should they enter the world a million dollars in debt already?
As the old saying goes, it's ten times easier to fool somebody, than convincing them that they've been fooled. So I don't have any hopes. But complicated medical procedures and births are done everywhere in the world, and they don't cost millions or hundreds of thousands.
No amount of "personal responsibility" is going to stop you from being born a micropreemie, or autism, or any number of other expensive, long-term medical issues... and quite a few of these sorts of things tend to hit you on the other side as a bonus, in income/earning potential.
Healthcare's like national defense; it's simply not the sort of thing you can tackle individually very effectively on a 300 million people scale.
Finally someone else who gets it, every time I say this I get strange looks.
Could you pause to think why healthcare providers let insurance "negotiate" down the hospital bills of their patients? Why in the world would this be possible? If the hospital is actually charging anywhere close to what it costs for them to provide the services with some profits, there would be little room for negotiation. Especially considering that each patient is unique. So why would it be cheaper for an insurance company than for the actual patient? Medical care is not a whole-sale order. The only explanation is because it's a scam.
The only real medical insurance is healthy eating and regular exercise. A medical insurance that you pay for is more an insurance against getting scammed.
How should I take the comments about "the agony of being responsible for your own health" in their/my context?
> Could you pause to think why healthcare providers let insurance "negotiate" down the hospital bills of their patients? Why in the world would this be possible?
The insurer brings patients in bulk, and by coming to a blanket agreement to pay $x for procedure y, gets to cut out all the individual negotiation and collections mayhem that one-on-one payment arrangements bring. I get similar discounts if I order LEDs off AliExpress in quantity.
> The only real medical insurance is healthy eating and regular exercise.
Ooof.
Yes, healthy eating and regular exercise are pretty much the only real insurance for your health. Anything else is treatment after you've had a problem. Just like driving carefully is the best auto insurance.