Hacker News Reader

Comment by geerlingguy | Hacker News Reader

I was paying around $1200/month last year (a little under that with subsidy).

This year I'm paying $2100/month for a family of five, on a roughly equivalent plan. Except, none of the options in my state allow me to visit the PCP I switched to this year (since none of the plans last year covered my PCP from the year before).

So I guess I'm on a primary care physician merry go round :D

I am at least able to have my main specialty doctor and the drug I take to keep me in remission from Crohn's disease, and my kids' pediatrician is covered.

But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :(

View on HN

> But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :(

These increases are specifically a lapse in subsidies for high earners -- those with a "decent income." People under 400% of Federal Poverty Level still qualify for the subsidies. And it's a relatively recent policy change to roll back; we didn't have this subsidy from 2010-2020.

This is not specifically just a lapse in subsidies for high earners, this is for everyone which is telling how little people actually understand what will happen when the subsidies expire.

The enhanced subsidizes made it so people earning more than 400% FPL were also eligible for subsidies, but also more importantly increased the cap on how much income insurance could cost. In reality, most people would see their insurance costs double if the subsidys expired [1].

[1] https://www.kff.org/affordable-care-act/aca-marketplace-prem...

I'm so, so sorry to hear this. Can you share which state you're in?

My man, this is the Raspberry Pi guy, Jeff Greeling. He lives in St. Louis, MO.

He is a god, and we mere mortals.

For those like me, who also had no idea:

https://www.jeffgeerling.com/about

He is impressive.

You go without coverage of course. Unfortunately.

(It's getting late, Jeff. I'm heading to bed myself.)

I take Remicade for UC on a monthly cadence. From $500 to now $1300/m for 2 in TX, and an added bonus of a 10% lab coPay + All kinds of fees.

I am Blessed running a good startup but I've always felt this deeply.... "But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :("

my premium actually went down because my carrier left aca, but there are no longer any carriers with a decent network in the exchange.

the networks in the illinois aca suck if you live in the chicago area.

> This year I'm paying $2100/month for a family of five,

blink

Top cover in Australia for a family is about USD$400 per month.

Excuse me, but how in the world were you able to afford 1200/month, you know that's like cheap rent right?

If you're getting health insurance through your employer, that's a pretty standard price (counting both your contribution and your employer's together).

I'm probably going to be self employed for 2026 and a cheap-ish (not the cheapest, but probably below the average) plan for my family is going to be a little under $1500 / month.

It's pre-tax money, which helps a wee bit, but it is definitely expensive. If I made less money, I'd qualify for subsidies, but I don't, so that's just something that needs to be paid in full unfortunately.

My Employer sponsored supposedly nice insurance (I say supposedly because they keep being a pain in the ass for pretty much everything) is $200+ per paycheck for me and my spouse, i.e. ~$450/month. That is after my employer covers most of the cost. This stuff is ridiculous.

That’s absolutely not an exception.

I’m in Germany, and for a family of four, the public healthcare system, covering my wife and my two kids costs us around 2,200€ per month. The company pays half.

A switch to a private insurance would lower the costs around half.

I was under the impression that German healthcare was essentially free (government funded) at the point of delivery, with additional top-insurance carried by most people similar to how it is in here in France.

Here I am self-employed and pay about 100 euros a month in top-up insurance (mutuelle) for myself and a couple of kids. Of course, the healthcare costs more, that’s why my taxes are high; but the insurance cost is about €1200 a year, not €2200 a month.

That will be hard to explain in English but you can find what you're paying to French healthcare system by looking at your paycheck (the document you receive every month that detail your paycheck rather). It basically either 7% or 13% of your paycheck (and .5% of non-work income via the CSG), and you have a hard cap on total contributions (4k/month, and healthcare if a bit more than half of that, so a bit more than 2k/month). It cover universal healthcare of course , but also maternity/paternity leave and invalidity benefits.

Paternity/maternity also cover the pension parents get (half a year of contribution to the pension system per child if you take care of them til they are 13, plus half a month for giving birth) (that's so awkward explaining this in English, sorry)

Thanks for this. I work independently (no CDI or CDD) so I don’t get the paycheck/payslip. I imagine it is broken down somewhere in the different taxes I pay, but unfortunately I don’t get the monthly reminder.

My understanding (British citizen living in Berlin) is that the German system looks and acts like a tax, but is actually mandatory payments to one of a handful of almost-but-not-quite-identical private insurance companies, with care being free-at-point-of-use.

It's possible to opt out if you're rich enough, but if you change your mind later it's very hard to return to the normal system.

I'm currently not working*, my monthly insurance cost is €257,78.

* thanks to my very cheap lifestyle, my passive income of only about €1k/month means I don't strictly speaking need to work ever again.

Nevertheless, I am treating this time as a learning opportunity with a view to being able to change career path, given that I think LLMs make the "write the code" skill I've been leaning on for the last two decades redundant in favour of, at a minimum, all the other aspects of "engineering", "product management", and "QA", and possibly quite a bit more than that.

Plus, y'know, get that B1 certificate so I can get dual citizenship.

Free at point of delivery does not mean free at all. Netflix is also free when delivering you movies, but it costs a monthly fee.

I think it’s time that we all stop with the nonsense that government funded healthcare is free. Because who ends up funding the government are us, the citizens, and that costs lots of money.

Some governments, like the German one, still make the costs transparent to the citizen, something you can even see in your payslip. Other governments, after failed policies and extreme inefficiencies, hide that and just budget healthcare costs out of the rest of the taxes.

In your case you believe your cost is only 1200€ a year, because your government has not made at all clear to you how much you’re paying from your other taxes into the healthcare system. When governments hide that type of information is because they actually do have something they don’t want the normal citizen to see. And that’s worrying and not democratic at all.

>> In your case you believe your cost is only 1200€ a year, because your government has not made at all clear to you how much you’re paying from your other taxes into the healthcare system.

I absolutely do not believe my healthcare costs only €1200 a year. As I wrote, my top-up insurance costs about €1200 a year, and the healthcare costs more and that is why my taxes are so high.

Ok, then I misinterpreted you.

However it’s still unclear how much you’re paying, as the problem with socialized services like healthcare is that you never know exactly how much you’re paying and if you’re overpaying or underpaying as there’s no free competition whatsoever.

There are of course also negative second order consequences. In socialized health care systems, where doctors and hospitals are payed the same no matter their performance, the economical incentives to provide modern treatments or provide better services do not exist, so best professionals need to leave the public systems if they believe they are being underpayed according to their value.

I’ve seen that happening in Germany and Spain a lot. Best doctors I had left their public healthcare position to open their own private business as that was the only way to be compensated economically according to the level of service they were providing.

Hot take - the private doctors tell you they are great but the public doctors can often be spectacular because their motives are not primarily economic.

For example, the absolute best diagnosticians in Houston are at the public hospital primarily serving Medicaid and Harris Health patients. Super evidence based, order tests for differential diagnosis not to make $$. Passionate about what they do. In a unexplained emergency my doctor friends would go there to be diagnosed and then the fancy privates to be treated.

Bro, try going to the doctor in America's not socialized services. You have zero idea how much that specific visit is going to cost, on top of the tens of thousands in insurance premiums paid on your behalf yearly.

> as the problem with socialized services like healthcare is that you never know exactly how much you’re paying and if you’re overpaying or underpaying as there’s no free competition whatsoever.

Also true in America, in which there is no socialized healthcare. (In any standard use of the term)

Hell, even Medicare ended up partially privatized. (At huge extra cost)

The worst thing about government-run monopoly services is there's little bottom-up incentive to optimize.

The worst thing about private-run services is there's little incentive for anything other than profit.

Given the fundamental realities of must-deliver services (e.g. healthcare, prison, etc.), I'd rather have them government-delivered than some bastardized free market without competition.

At least the former has a path to excellence. The latter just inevitably turns into a hostile hellscape for the end consumer.

You must be mistaken…

The maximum personal contribution to public health insurance (GKV) is capped at around 400/m for healthcare (and an additional 200 towards long-term/elderly care). Spouse and children are free if they are unemployed.

https://www.tk.de/resource/blob/2189790/9321e565c304a9cc33bb...

If you are paying more than that then you are already paying for private health insurance (PKV) or private supplementation on top of GKV for some premium coverage.

I am not mistaken. I know how to read my own payslip.

Both me and my wife are employed. We have GKV both and we’re basically paying the maximum rate. That’s around €1100/month each, pre-tax. Half of it comes from my official bruto salary and the other half comes from my unofficial bruto salary. Which is how governments hide the costs of public healthcare. Ultimately is part of my salary deductions for the finances of my employer.

Kids are not free: kids doctors don’t work for free. They need to be payed, and they’re paid from the contributions me and other employed fellow citizens pay every month.

You're still allowed to visit the same PCP although it might not be covered, or covered out-of-network with a higher patient responsibility.

Reply on news.ycombinator.com