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> And I have good health insurance

I think your example illustrates how low people's expectation can be when it comes to calling health insurance "good" in the U.S.

If I were asked to pay $3400 for urgent care or $250 for an ophthalmologist I would not consider the health insurance "good" for its intended purpose of insuring against medical expenses. (It might be good for other purposes like enabling you to invest without taxes.) My health plan simply asks me to pay $35 for urgent care and $25 for a specialist like an ophthalmologist. That I consider good. Your insurance isn't.

Yeah, I wouldn't consider any HDHP (High-Deductable Healthcare Plan) to be "good insurance".

Why not? Do you expect to not pay any part of your normal, expected annual heath care costs?

Insurance is for unexpected expenses that (a) you cannot foresee and (b) would be catastrophic to your finances. Thinks like major storm or fire damage to your house. A car accident that results in a total loss or worse, liability for someone's injuries.

Your annual physical, eye exam, and dental hygiene vists, and other routine medical expenses are as predictable as your utilites or grocery expenses. You can plan and save for those in an HSA, and your HDHP can cover anything catastrophic.

Insurance is for unexpected expenses that (a) you cannot foresee and (b) would be catastrophic to your finances

I do not agree with that view, and I'm not sure that is how it is used in the US at least. In the US, for many people, health insurance is the only realistic means to obtain any healthcare, not just catastrophic care.

I get injured at least annually due to mostly-outdoor physical activities, and have a chronic health issue or two, so the prospect of paying thousands of dollars out of pocket before my insurance even kicks in, doesn't sound great (and wasn't, when I had HDHPs for years).

I think the issue is that pretty much everything which isn't preventative care is considered "catastrophic" under this logic (because it requires paying hundreds or thousands out of pocket), even non-major issues, so "catastrophic" happens a lot.

I guess the idea is that you put a deductible amount of money into the account annually, and the tax-advantaged investment makes up for any difference between the deductible and the savings you get on premiums for having a HDHP (I.E. HDHP premiums + deductible - tax savings ≈ normal premiums + deductible).

It's an insane way to run health insurance, and it just goes to show that expected value and mathematical benefit isn't the end-all be-all, but it's supposedly mathematically coherent.

It's mathematically coherent, but it's value relies upon the assumption that we are already spending thousands out of pocket (but it's not taxed).

I prefer the option of don't spend thousands out of pocket, pay taxes on the unspent income. If I'm paying 100% of my healthcare costs, what good is the health insurance?

Here I think it boils down to whether one thinks it's okay for everybody to spend tens of thousands of dollars per year on medical care, as long as they (probably) aren't bankrupted.

If so, then they are probably more likely to view "don't bankrupt me bro" as the use case for health insurance, rather than "I need affordable medical care".

It's not that people don't expect to pay. It's that plans like HDHP do not have predictability. An average person getting an average number of injuries cannot reasonably work out how much it will cost them to treat these injuries and whether the HSA is enough. The fact that there is the distinction between in-network and out-of-network means the deductible isn't a constant.

Your idea that insurance is only for things that are catastrophic to your finances is wrong. Health insurance is mandatory for the common good, even if your net worth is in the millions. You can't forgo health insurance just because you are rich enough. There have been long debates about ACA that led to mandatory health insurance that I will not rehash. And auto insurance is another example: you are still required to buy it even if covering liability for accidents and covering the loss of your car would be completely affordable for yourself.

What we have in the US is the opposite of insurance; the insurance companies tend to pay for normal health-care and then suddenly find a reason to not pay when something catastrophic happens.

It is when you take into account the tax advantages of an HSA.

If you're like me and can shake off a few grand medical expense out of pocket, suddenly it's the best plan.

I have a HDHP and paid less than $10k all year for my family's medical expenses and we had a freaking baby lol.

Right, but it's also nuts that a lot of people are on a health insurance plan that encourages avoiding medical care because it offers tax-advantaged investing. You get how that's nuts, right?

It doesn't seem nuts to me? I have a good emergency fund and a stable job and no big debts (cuz I'm good with money generally), so I can choose to use my health insurance to make a little more money.

That's only fair given all the pre-work I did to set it up for myself.

Of course it's fair, my criticism isn't with your outcome but with designing an insurance plan to work this way.

It's weird to tie your little extra money to your health insurance plan.

That's why it's not the only option. It's a benefit not a restriction. The powers that be saw an opportunity for insurers to cover less and insurees to leverage that into a different benefit. It's all just about shifting risk around and taking a little off the top.

It's a nice incremental addition to the existing system. Way more feasible than changing the system.

But the additional benefit is a tax benefit, also known as "all the other taxpayers subsidize this behavior"

They're (slightly) subsidizing the fact that I am covering more of my medical expenses out of pocket. Remember it's only tax free if I eventually spend it on health care.

Feels like the equivalent of other things we give tax benefits for. Various things for your and your dependents' well being.

Exactly. I also think conflating health insurance and investment is a terrible idea. It should just be a simple credit system for accumulating unused deductible.

> tax advantages of an HSA

The minuscule tax advantage here is that 1. you're paying for your health care costs with pre-tax dollars, but you can generally still deduct these even without an HSA, so +0 advantage there, and 2. you are allowed to invest the savings, and gains are not taxed at the federal level (but may be taxed at the state level), so the advantage here is your savings account size x your effective tax rate. The premiums for a HDHP also tend to be slightly less than PPO or other plans.

For most of us that tax advantage is tiny. I would rather have an insurance plan that actually covered my costs minus a copay, even better one without a copay, even better Medicare For All where I don't even have to worry about an insurance company or pay insurance premiums. HDHP + HSA is pretty much the worst of the bunch.

> for most of us

yeah so for most of you, don't do it?

I like that I can stuff away $7k+ I'd be stuffing away anyways tax free. And all I have to do is keep a responsible emergency fund.

So, in other words, the typical American "Hope and pray that my health costs don't outrun my savings/investment rate" philosophy. Different strokes for different folks, hope it works out for you.

My health care costs have a pretty clear soft upper bound given how HDHPs (and most plans) are structured. Deductible and out of pocket max makes it easy to be responsible and budget into an emergency fund.

In terms of non-exceptional costs, I'd say I spend about as much on medical bills every year as I do keeping my cars in good shape. Less than my house and less than I spend on hobby stuff, my cats' vet, or jewelry haha.

It's pretty good when your employer funds a good chunk of the high-deductable.

Au contraire, that is much closer to the definition of insurance. We don't want people to get bankrupt with an unforseen medical issue like cancer. Insurance should cover that.

Routine care, including shit that's a little unlucky should be paid for out of pocket.

In the US, health care and health insurance have become synonymous such that all the good bits of insurance are out the door and all the bad ones have stayed. And polluted the true cost of getting simple, routine care.

In that vain health insurance is never insurance.

Getting a kid is not an accident for most modern people, and should never be seen as an event that could bankrupt anybody.

Hence, deferring to the definition of insurance is futile.

Then again - the US is the only country I know of that insists that health is something you insure.

You need to broaden your horizons then - look at the medical plans that are on offer in India. Or the travel medical insurance that every EU country requires you to carry. They are classic insurance.

Having a kid without complications should not cost $50K. It should be a few grand at the most. If the kid now needs NICU, then yes, that's what insurance is for.

So, I exanped my horizon Besides the states there is south Africa who treat having a kid as some catastrophic event that might bankrupt you.

In EU countries the spirit of health insurance is socializing the cost / solidarity which we explicitly do not consider in the thread - please read the parents of that was not clear.

>>- look at the medical plans that are on offer in India.

The one's that companies offer are quite good, actually.

I'd have depleted my life savings, and gone bankrupt several times around COVID years with my parents health, if I didn't have company health insurance.

Good for me, because I knew people in hospital sitting in the waiting lobby literally crying because they were done financially. Like finished for life.

Having said, this in India the market for this things is still building up, and given how big India is it will take years before it reaches the US stage of profit seeking.

3k out-of-pocket for a random mishap could easily get many people bankrupt.

I did scratch an eyeball recently. The cost turned out to be €50 for drops which ain’t covered by single-payer insurance. 3k out of pocket would be pretty bad even naming nice salary. And could cause big issues to a massive portion of people.

I would demand an itemized bill from that urgent care and play hard ball with that provider. That's absurd, even by US standards. I've had ER visits that total less than that. My son had a cast that fell off while on travel in Florida, and we stopped by an ER (only place that was open and could fit a new cast). Total cost out the door _at the ER_ was less than $500, which while expensive, is nowhere near what you're talking about.

Your country is crazy. I wouldn't want to end jobless there, that's a potential death call.

Just got my bill for a recent 20 minute doctor visit (with one of the best HC insurance coverages in my state: $1,600 cost, $1,400 adjustment, $200 out-of-pocket given my $3,000 OOP limit was not reacehd). Absurd. The USA will likely never get to an efficient govt. single pay system (unlike every other industrialized company). Given this, the option I hope for is that the FedGov passes a law that requires all Master Charge prices to be based on "Acitivty Based Accounting". ABC would provide insights for greater operational efficiency, and the 1600>1400>200 magic hand-waving would disappear. There would be a great loss of employees for health insurance portfolio analysts, but most of them could move into cost accounting roles for hospitals. Please GOP/DEM consider this.

>> The USA will likely never get to an efficient govt. single pay system (unlike every other industrialized company).

Not really efficient.

Due to low pay there is a huge shortage of medical workers.

Also for non life treating conditions there are waiting lists for the next few years.

Had a light knee injury during football game? Your surgery is scheduled for 2027. Real story of my friend from Poland.

And you pay 9% of your income for this "care".

> persistent irritation > went to Urgent care

You waited until it became a problem, then went to an expensive option instead of contacting your GP and getting a recommendation for an in-network care? And were surprised that it was expensive? This is healthcare 101 in the US. You could have gotten the same care for a reasonable price had you done 1 hour of due diligence.

We do not need to remake the system--which will result in far greater inconveniences than the 1 hour of dd you found to be unreasonable, not only for you, but for people who are perfectly capable of navigating the current system--to save you from yourself.

...in what world does it make sense to charge the cost of a motorcycle for a few minutes of a doctor/NP's time and $15 worth of drugs? Jumping through bureaucratic hoops to avoid this is a waste of everybody's time.

Urgent care is pretty widely known to be a scam that preys on those too impatient to "jump through buerocratic hoops (make an appointment in the future with a highly-paid professional instead of paying the premium for the surplus staffing it takes to always have someone available for walk-ins)"

That's interesting because my co-pay at urgent care is the same as with my GP. Maybe there are regional differences? (ER on the other hand I know I won't walk away without many thousands of dollars in bills, on top of a much larger copay, because even though the ER is "in network" none of the contractors working there are)

"make an appointment for several months for now or get treatment this week" is maybe a better explanation.

your GP is good if you have a long term medical issue you want to ask about, less so if you think you've just gotten injured or sick in some way.

It takes about 6 months for me to get an appointment with my GP, and then it takes up to a month for their referral to a specialist to be approved, and only then can I make an appointment with my specialist, which is usually booking a few months out, making it about 9 months before I can see someone.

Or I can go into urgent care, and get a referral submited that day, and see someone in only 3 months.

My father in law has a tumor, and was able to start radiation therapy almost 18 months after he first went into a doctor for his symptoms. The specialist scolded him for how long it took saying "there's permanent damage if you don't start treatment within 6 months, you should have come in much sooner" He nearly punched the guy.

> It takes about 6 months for me to get an appointment with my GP, and then it takes up to a month for their referral to a specialist to be approved, and only then can I make an appointment with my specialist, which is usually booking a few months out, making it about 9 months before I can see someone.

That is radically below par. The nice thing about the American system is that if your GP sucks (as yours clearly does), you can go out and get yourself a new GP! I'm able to get an appointment within a month for a checkup, a couple of days for pressing issues, and have gotten an in-network (non-specialist) referral for a same-day appointment the one time I needed urgent attention. The one time I got a specific referral whose office had a months-long waitlist, I found an in-network alternative, got an updated referral from my GP, and saw someone the following day. My wife regularly gets appointments with her GP or an in-network alternative within a day when she's sick and needs attention. It's worth noting that altering our system wouldn't improve your access to match mine, but would rather would diminish mine to match yours! Surely it's better for both of us if you just find a new GP?

> My father in law has a tumor, and was able to start radiation therapy almost 18 months after he first went into a doctor for his symptoms. The specialist scolded him for how long it took saying "there's permanent damage if you don't start treatment within 6 months, you should have come in much sooner" He nearly punched the guy.

What took so long?

> in-network (non-specialist) referral for a same-day appointment

My HMO takes 5-10 business days to approve a non-emergency referral; 3-days for an emergency one doesn't matter what my GP does. Though it's partly moot by the fact that I would have to drive hours to find a specialist that isn't booking many weeks out, it's exacerbated by the fact that no specialists let one schedule an appointment prior to the referral being approved.

> Surely it's better for both of us if you just find a new GP?

Or I can just go to urgent care if I have an urgent issue?

I thought by adding the bit about "navigating the complexities" it would prevent comment like yours. You're blaming the victim here.

"it is YOUR FAULT for not reading the fine print"... yeah I know. I am stupid regular guy who would rather NOT have to understand the fine print and have things just work better like the rest of the developed world.

You're an adult. You paid dearly for the convenience of an urgent care, and you clearly learned your lesson. You were not a victim, you were a sucker. In America, we do not reorganize entire industries to soothe the bruised egos of suckers. We just encourage them to do a quick Google search next time.