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Comment by giantg2 | Hacker News Reader

There are some good points in here. However, it feels disingenuous with the author being a former surgeon general.

"the onus of the entire amount still fell on me due to my high-deductible health plan (HDHP)."

I mean, yeah, that's how HDHP works. Anyone in healthcare should understand that.

Meanwhile, it's entirely possible to be out of 3000 dollars after an animal bite with a regular insurance plan. Nothing more than an x-ray and a couple stitches, and the out-of-pocket cost was 3000 dollars. One wonders where the premium goes.

The premiums go to subsidize other people's even more expensive care, like $80k helicopter rides, or $100k heart surgeries.

It's not really a subsidy though (it's a set of actuarial models and contractual agreements).

Helicopter rides are pretty much never covered.

> The average cost of life flight within the U.S. ranges between $12,000 and $25,000, according to NAIC (National Association of Insurance Commissioners). This is based on a 52-mile trip, which is also the average distance. This figure represents an out-of-pocket cost when not covered by insurance or calculated before an insurance company steps in. International flights can easily cost 3 to 5 times that amount. … In December 2020, Sean Deines was diagnosed with acute lymphoblastic leukemia (a fast-growing blood cancer) and took an air ambulance from Colorado to North Carolina, which also included ground transportation between hospitals and airports. His total bill was $489,000.

https://www.emergencyassistanceplus.com/resources/what-is-th...

I wouldn't say never covered. The stuff in that article doesn't give any data on how often they're covered. But I'm sure they play the same games as regular ground ambulances.

The one I have experience with involved transportation between hospitals and it was covered. I've had experiences where other ground ambulance services were not covered.

A physician of mine has said that he thinks HDHPs are predatory and (in his opinion) should be illegal. They sound attractive until the moment you actually need to get medical care.

I like my HDHP. It's honestly not that much different than the other plans my employer offers. They all have large deductibles in my opinion. It's great because my premiums are lower and I contribute to an HSA. The deductible is only about $2k higher than the other plans. And yes, I have used it. I've hit my maximum out of pocket cap multiple years with it. I would have hit that cap under the other plans as well.

Now, that might change as I get older and I need care for chronic conditions that wouldn't hit the out of pocket max but would be above the deductible. And they aren't right for everyone - you need to be making enough to max out your HSA. Companies pushing low wage earners into them are probably predatory.

HDHPs are awesome if the deductible and OOP max is low-ish (less than $2000/$4000) AND you either don't see doctors very often or you see them all of the time AND your employer contributes. That is the only combination with which I'd ever recommend a HDHP. Just about everyone is better off with a PPO.

I had a HDHP for a few years. $1500 deductible/$2500 OOP max; employer contributed $750/year. I loved the concept and contributed myself, but basically any doctors appointment I'd have would wipe out my contributions. I saw many doctors in 2021 due to random stomach issues that were ultimately GERD. I landed up paying out of pocket before hitting the deductible. I now have a PPO.

The issue is that they are often the cheapest plan to get (because of the HD part) and many HDHPs have crazy high deductibles and astronomical OOP maxes (with out of network deductibles and OOP maxes that are of this solar system), so that + people (understandably) not understanding medical insurance = a very bad time

Yeah, and he does. But as he is arguing, the cost is exhorbitant, and if he had known what the cost would be, he would have chosen to do it himself at home. Even if you have an HDHP (especially if you have an HDHP) this is how it should be.

It didn't read that way to me. It read more like he's upset he had to pay for the whole bill on an HDHP. I got the other parts about cost.

Highly educated anesthesiologist, former state and federal public health professional, and current employee of Purdue University since 2021, selects HDHP for his insurance plan and then gets upset when he actually has to pay the high deductible for the plan that he himself selected. News at 11:00. And, don't get met started on his assertion that having to pay that deductible prevented him from contributing to his HSA that year. This person is a shining example of what's wrong with US healthcare, not a beacon of light for fixing it.

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