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Comment by BeetleB | Hacker News Reader

> Hmm, counting the insurance premiums 100% towards the birth of the child is a bit misleading.

I see your point, but do you not think that if you're a family of 4, having to pay $40K before insurance kicks in is ridiculously expensive, and out of reach for most Americans?

I'd wager that most self employed folks in the US almost never benefit from insurance (except for things covered by Obamacare which come nowhere near justifying the premiums). The deductibles can be so high that you're pretty much always paying out of pocket.

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> I'd wager that most self employed folks in the US almost never benefit from insurance (except for things covered by Obamacare which come nowhere near justifying the premiums).

Self-employed here. My wife and I paid $470/month last year, $618/month next year, for a gold insurance plan than has a $3400 deductible with typically a $20 co-pay. It covers 3 prescriptions, therapy sessions for each of us, various older age diagnostic checks, and almost all office visits. In addition, if either of us develops cancer or is hit by a truck, we will not be rendered bankrupt.

So I'd say ... nah.

i'm 36, self-employed. silver plans in my state are ~800/month next year, with 8k deductible, no out of network coverage at all, with no in-network providers out of my state, so god forbid I get injured while traveling to visit my in-laws. the marketplace is a joke and health insurance in this country is pointless.

Too expensive? check

Deductibles too high? check

Stupid coverage limitations? check

Pointless? nope

> no out of network coverage at all

I thought they'll all cover ER visits out of network. Is that not required by law?

As usual, they find ways to limit that.

https://www.emergencyphysicians.org/press-releases/2017/10-1...

> In a controversial decision, health insurance giant Anthem Blue Cross Blue Shield is warning policy holders—in Georgia, Kentucky and Missouri—that they may have to pay for their trips to the ER. The company has developed a secret list of diagnoses that they will not pay for, such as "chest pain on breathing" and blood in the urine, even if the patient thought it was a medical emergency.

> My wife and I paid $470/month last year, $618/month next year, for a gold insurance plan than has a $3400 deductible

That's really nice - are there state/government subsidies involved?

I work for a top tier company and my premiums are not that much lower than yours.

When I checked the public market's insurance options, getting a $3000 or so deductible was a lot more expensive than yours if one is not low income (i.e. not subsidized).

Yes, those are numbers with

(a) for 2025, federal premium subsidies in effect ($19k/year of subsidy) ! (b) for 2026, NM temporary subsidies

A reminder that until the end of this year almost everyone gets subsidies. Nobody in the US, no matter their income level, should be paying more than 8.3% of their AGI for health insurance. That all changes come Jan 1st 2026, thanks to the current Congress. Our premiums would be $2531/month had NM not stepped in to use some of those sweet, sweet fossil fuel extraction taxes to help us out.

Oh yeah, deductible in 2025 was actually $2800. At our age (early 60s) and general health (good), gold plans make much more sense (if you can afford them).

The problem is the healthcare cost is insane. You will go through $40k after a good injury that may need a major surgery or few smaller surgeries. Average cost for hip replacement is $40k.

I've had a sports hernia and the bill was about $30k.

> I've had a sports hernia and the bill was about $30k.

And what the OP is pointing out is that if your injury is $30K, insurance covers nothing, because the premium + deductible is $40K.

> And what the OP is pointing out is that if your injury is $30K, insurance covers nothing, because the premium + deductible is $40K.

The point of insurance is to mitigate risk. If you think you have enough money to cover your risk, there's no reason to buy insurance.

The sleight of hand here is first complaining that you did not incur enough hazards to offset the risk premium and then citing this as a reason the risk premiums should not exist. Where is the story of the family being weighed down by bills? Or of not getting physical therapy after an injury and having permanent, income-reducing disabilities?

> The point of insurance is to mitigate risk.

Agreed - both to you and to society.

What's under debate is "how much risk." For most people in the US, they'll need help before they hit $40K. They can't afford paying $40K every year for medical and medical related expenses.

Risk is not the only factor. Premium cost is probably the more important one for most. If someone can afford the $40k deductible option, but not the $5k option, you’ll just have to accept the risk. Increasing earnings significantly right now is harder than hoping medical bankruptcy won’t matter in the long run.

30% of US households make less than $50k. That’s more than 100,000,000 people in homes with less than $3.6k/mo for all living expenses. The stories you ask for are simply inevitable

In my country people are already complaining about a 300 euro deductible (my mom has a chronic illness so she hits that every year)...

I surmise that either Americans are all rich and have 40k in savings that they can lose with no sweat or

America is hell for anyone not rich

It's the latter.

^ That.

OP was talking about a family for $30k.

Imagine 2 people get injured in a year, you are now at $60k. Plus, $150 a visit for primary and $300+ for specialist.

My 5 year old has been to the hospital 3 times, stitches once. US healthcare will ruin you if you don't have insurance. A cancer treatment can bankrupt a millionaire.

That's crazy, I looked it up and the average cost for a hip replacement here in the private system in Australia is about $24k (US$16k).

You can get it for basically nothing in the public system but you might have to wait a year or so if it's considered elective (emergency surgery is immediate of course), but most people with private health insurance can get the procedure done within in a few weeks and would only have to pay about $1000 (US$650) out of pocket with a $500 excess (which is pretty common), because the anaesthetist and surgery are usually invoiced separately. Some plans do have lower excesses (like $350) though if you pay higher premiums.

I am a male breast cancer survivor. I had a mammogram the other week. $620.

No, nobody benefits from insurance in America. Well, nobody ill.

You had health insurance but it did not cover that?

Oh, the bill was 12.3k

So this was sarcasm? Or a remark on the co-pay/deductible being too high?

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