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Comment by raw_anon_1111 | Hacker News Reader

It’s almost impossible for an upper middle class couple to retire in the US before their 65 unless they have some type of government provided or private company provided health insurance like teachers, police officers, military etc.

It’s about $25K a year for a decent plan which is doable. But you have to hope that Republicans - and yes this is a political issue - don’t successfully kill the ACA and make it impossible to get insurance at any cost if you have a pre-existing condition. If you are old - you will develop a pre-existing condition.

My parents are 83 and 81 and retired at 57/55. But my mom was a teacher who still gets benefits through the government and my dad gets benefits from the one factory that didn’t shut down in our hometown.

I’m 51 and even if I could retire early financially, I wouldn’t do it and stay in the US. Play the smallest fiddle for us. I “retired my wife” at 44 in 2020 8 years into our marriage when I did a slight transition to an industry where remote work with travel is the norm (cloud consulting + app dev) and we have traveled a lot including doing stints as “digital nomads”.

We are staying in one of the countries that we might retire to as a Plan B for six weeks starting next week.

Even now that we moved to state tax free Florida and my wife hasn’t had to work in six years, she keeps a current CDL because she can get a job as a school bus driver easily for the benefits and someone will pay me for independent consulting if I lose my job.

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The FIRE community and my own personal situation prove you very, very wrong. It's absolutely possible for a upper middle class family to retire in their 50s, even in their 40s, if they live frugally.

"Live frugally" , "FIRE" , "work in tech"

All incompatible with 99% of the upper class, neither do they want to eat ramen to retire early.

You're also one medical disaster away from being "very very wrong"

FIRE doesn't depend on having a tech job. Its all about income to expense ratio. Planning for medical events is something that gets talked to death in these communities.

How do you plan for a potential quarter million dollar medical bills over a couple of years?

Good insurance is one aspect including long term disability coverage if you haven’t retired.

That’s the thing medical expenses when young are unlikely enough insurance is a viable strategy. Long term it’s worthwhile to move to a country with a less expensive medical system. You can move basically anywhere in retirement and be better off.

Again like I have been saying, good insurance is predicated on the open market and ACA being around and not being killed by Republicans. Even if they don’t outright kill it, they are trying to put in a “death spiral” where only sick people use it and insurance companies don’t want to participate.

LTC not discriminating against pre-existing conditions is also post ACA.

In a hypothetical universe with different laws people would make different decisions, like abandoning the US. But you’re asking about medical conditions which rarely apply and laws that don’t exist. That’s not a failing of FIRE for the vast majority of people.

Further FIRE doesn’t mean crap if you get something serious and die at 23, that’s just the reality of human existence.

People didn’t abandoned the US before the ACA was the law in 2011-2012. And if there were an influx of US citizens to foreign countries, I can guarantee you other countries wouldn’t be as welcoming.

There are plenty of conditions where the difference between life and death is being able to get health care

Some did. The US expat community has been quite large for decades.

Most people didn’t do FIRE style early retirement while dealing with pre existing medical conditions. There however was plenty of expats pre ACA who very much left the country for early retirement.

US healthcare is ruinously expensive but on average it’s not particularly good if you’re in the income bracket where 1/4 million over a few years is a serious issue.

There is absolutely no significant number of Americans who left without ties to other countries. I find it rich that Americans who leave the US call themselves “ex-pats” instead of “immigrants”

There’s over 1/2 million former Americans living in Canada or the UK which doesn’t require learning a foreign language. You really can’t make those kinds of sweeping statements about populations that large. Many Americans without any prior connections fled to Canada to avoid the Vietnam war for example and then made a home there.

Brit’s will also call themselves expats. https://britishexpats.com/forum/ ditto Canadians https://www.expatden.com/global/canadians-living-abroad/ Also, the US imposes taxes on Americans who leave until they renounce their citizenship on the upside they still get to vote. It’s an unusual relationship to your former country.

There's a difference in intention between ex-pat and immigrant. Ex-pat's tend to think of themselves as being wherever they are temporarily, but intending to return to their home country. Immigrants desire is to make wherever they are their new home country.

If you're saying that people who have permanently left the US call themselves ex-pats, that is news to me, and I can understand the confusion.

They very much do. People retiring to other countries specifically

The same way that an employed person would plan for this. Catastrophic insurance plans put a cap on how much your medical bills can be.

An employed person since the ACA hasn’t had to worry about lifetime caps…

Oh and catastrophic insurance plans only have to cover pre-existing conditions since the ACA - which one party is actively trying to kill.

A lot of people are often surprised at how non-frugal their lifestyles are. I'm not suggesting that people living on $50k/year aren't already frugal, but yeah, there's definitely people who take out car loans, take out mortgages for the full amount they were approved for, and all sorts of random things like buying chicken parts instead of whole chickens, buying small grocery store containers instead of bulk pricing for shelf-stable items, keeping your speed down to save gas, etc.

You really just need to build an innate understanding that the hedonic treadmill doesn't make you happier long-term and develop a resolution to get your expenses down and stay disciplined about it.

But also you see people asking why can’t someone making the median wage - $75K a year - max out there 401K at $23500 and their HSA at $8300, etc

There are three things you can do with your money - save it (e.g. investments), give it away (e.g. charity), or spend it (e.g. housing, vacations). Whether or not somebody's investment strategy (i.e. saving) is optimal for their income level has nothing to do with the frugality of their lifestyle (i.e. spending).

So you are saying when I first graduated from college in 1996 I should have been able to max out my 401K - then it was $10K I believe. I was making $22K.

If the median income is $70k a year, after taxes they should be able to save $23500 a year and have an HSA compatible healthcare plan and max out their HSA?

I have no idea how you got that from my comment. How much you make, how much you save, how much you spend, and how much you give away are all independent, and neither is it a zero-sum pie (for example, sometimes investments go down in value, and sometimes the line between giving away and spending is blurry).

To answer your question directly, $70k income is independent of the cost of living in high cost of living cities (like NYC or SF) vs. low cost of living areas. If you make $70k/year in NYC, no you don't have the spare income to max out 401k/HSA. If you make $70k/year working for Walmart in Bentonville, Arkansas, then yeah, I expect that you ought to be able to max them out.

I know several people with normie jobs (not tech related or government) and normie lifestyles that saved up enough money to never need to work again by 50 while still maintaining their lifestyle. Most still work because they have no idea what to do with their time even though they don’t need to work anymore.

You can easily derive that this is possible from the median household finance statistics published by BLS, never mind the upper class. It isn’t that hard if you care to do it.

No one is doubting that it is possible to save enough to retire by the time you’re 50 - as long as the ACA and the open market is viable.

Just leave the US, problem solved.

I said in another reply, that’s actually a real Plan B. We are going to stay in Costa Rica for 5 weeks starting next week and my wife and I are both learning Spanish now. I’m at around an A2 CEFR level.

I’ve already researched the residency requirements for both there and Panama

There are definite costs to this in terms of continued US taxation as an expat, especially if there isn't a tax treaty in place.

Costa Rica doesn’t tax foreign income. But logically it only makes sense to establish residence there if I am not working. CAJA - their healthcare system would be about the same price as my employer provided healthcare.

I already don’t pay state tax living in Florida and I would pay federal tax either way.

90%+ chance the person you are replying to has health insurance that will cover them in case of medical disaster.

I absolutely have health insurance, the most expensive available on my state. That doesn't protect me 100%, but what health insurance (including the ones available at most companies) does?

People who have poor money management skills believe that FIRE=Ramen and no health insurance... In fact, it's about getting a 30K car (the one I bought new 3 years ago) instead a 70K car despite having the money.

And what happens when the Republican Party gut the ACA and you have a pre-existing condition. Do you know what life was like trying to get insurance with a pre-existing condition before 2012?

Then they can just skip insurance. Most people don't need it, especially if they already have a lot of money (which is what FIRE means)

Obviously said by someone who is young and never had or knew anyone that had an expensive medical procedure like a friend who is 45 who I have known since 2003 and is a cancer survivor and now has to have open heart surgery

I don't believe your friend is most people. I have quite a few who haven't been to a doctor in decades.

So, in your 30s? My parents both had cancer in their late 50s/early 60s (including surgery / chemo) - and paid like $15 for some pain meds in Canada.

Even on a pretty good Kaiser plan, we're paying $200+ per day in the hospital, etc. On a high-deductible, more. They say they have a $1M annual limit, but that they've never enforced it. I hope we never have to find out.

Yes, I would get insurance once I have kids and that would cover the 50s+ when people usually start needing it.

But do you want to take the chance that you will never have major medical expenses between the time you retire early and you are 65 and eligible for Medicare? How many of your friends are over 50?

Very few, I am just saying that you can sign up when you think the risk hits your threshold. I'm mid 30s and wish I hadn't had to pay the last 10yrs. Honestly, until you have ids it's unlikely you'll use it and even less likely that you can't sign up for it before a major operation.

Yes you should try to time a major medical issue or accident during the open enrollment window. You should also not have car insurance until you think you might have an accident

That plan works until it suddenly doesn't. When it doesn't it's catastrophic for your finances and your health.

If you have an extra couple million dollars above and beyond your regular retirement fund you could self-insure your medical costs. But then you could just buy the health insurance.

Medical expenses are less expensive when you don't have insurance. Insurance is just for catastrophic events, if you do some regular risk analysis you can come to a balance that works for you. If you know a major medical expense is imminent then get the insurance. Most procedures don't happen immediately anyway.

That’s not how insurance works even with the ACA. You have open enrollment is the only time you can get insurance on the open market. Good luck if you find you have a major medical issue right after open enrollment ends - which the Republican administration has shortened and you have to wait 9-10 months.

99% of people have poor money management skills? It's statements like this that makes FIRE a fringe scene.

you're saying 99% of people think FIRE = ramen? I doubt that many even have heard of it

i think you can get a pretty decent prius from 5k to 10k and a fantastic nearly brand new tesla model 3 for 17K. That's what i did. it was 8 years old, practically brand new, FSD prepaid included! it drives me to work and i only paid 17K for it!

you don't need to eat ramen. there are many cost effective options out there: oatmeal, beans, rice, you could grow your own fruits and vegetables, etc.

and as for the medical disaster: heart attack and stroke are actually preventable with a plant based diet (keep your LDL under 80 and you'll vastly decrease your chance of a heart attack). i know a lot of people will hate on that, but those are the facts and any evidence based nutritionist can tell you this.

How do you prevent random accidents, cancer, etc?

And health insurance as soon as the ACA is gutted and you have a pre existing condition? Sure I could retire to Costa Rica or Panama. One of those are a plan B and we will be in CR for six weeks and we are both learning Spanish - I am. decent at it.

I bet you also your idea of upper middle class is not statistically valid.

https://dqydj.com/household-income-percentile-calculator/

Costa Rica is on my retirement shortlist. I really like it there and have taken the family for vacation a couple times. I've driven the whole country pretty much North to South. Puerto Jimenez is one of my favorite places but it's very rural. There's some nice areas an hour or two North of San Jose as well. I've met a handful of US families that, when the pandemic hit, just sold everything they owned and moved to Costa Rica. As far as central america goes Costa Rica is a bright spot of stability and like a functioning government. I live in Dallas so pretty much have to know a little Spanish but there isn't much of a language barrier at all. You could do a lot worse than Costa Rica.

I didn't get where I am by taking random bets, but I'll say you'd lose your money here.

Were you around and trying to get health insurance before 2012? I was. The startup I worked for shut down and while I had a well paying contract lined up literally the next week, I couldn’t get health insurance at any price because of a pre-existing condition even though at the time, I was a part time fitness instructor and I had just gotten through running my first (and last) two half marathons.

If you are betting on the stability of the US health care system outside of employer funded health care, that is a monumentally stupid bet with one party actively trying to kill the ACA.

So what did you do? Clearly you didn't die. Did you just have no insurance for the week before the new job started, or what?

This also happened to you while you were working and slightly between jobs. So it's not really a FIRE concern if the concern is the US messing up the health care system even more in that it would effect everyone whether working or not. Generally speaking, an answer to mitigating a lot of types of risk with a FIRE model is: you just go back to work for a while. This is easier the younger you are.

Edit: Also I thought COBRA would have been a more recent thing but it was Regan era. So did you not have employer-sponsored coverage with the startup?

No, my then fiance/now wife and I canceled our wedding we had planned, and went to the courthouse and got married six months earlier so I could get on her insurance.

Also, just so happen I did end up in the hospital three weeks later because something happened that affected my breathing for an entire year.

And how do you “go back to work” if the entire reason you need to go back to work is that you have a health condition?

If you haven’t checked, jobs aren’t that easy to come by quickly in 2026 in tech like they use to be. Sure I could find someone to give me a contract if not hire me full time - but we are still back to not having insurance .

The US messing up insurance on the open market is the concern and it being back like it was pre ACA. That only affects the unemployed under 65.

As far as being between jobs - usually you can get COBRA for a limited amount of time - not an option for FIRE.

Oh yeah, that brings up another point, I did pay for COBRA for two months back then. The contract I had paid more than enough to afford it. Then the acquiring company shut down their insurance plan and COBRA wasn’t even an option

You do know you can have a wedding even if you're already on-paper married? The ceremony really has nothing to do with the legal act.

So wouldn’t it go against everything that FIRE stood for to spend money on a wedding after you lost your job?

Nope, it's just mindful capital allocation. There are plenty of ways to spend money wisely on a wedding. It's just a big party, and maybe a traditional ceremony. It's whatever you want it to be.

I retired on my 40th birthday, and it is AWESOME.

The thing is... no one has anything that I want to buy. I don't mean this in an elitist way, but more of a monk way. Like, I don't understand status and keeping up with people.

This is the way.

Like good meals, but I don't really understand the allure of owning a bunch of things.

The ego, when left to it's own devices, is a hell of a drug.

Ego is truly wild. I had one last bastion of ego that echoes a bit. It was my ability to code the machine. Im that guy that really loves to code. It fills me with joy in ways that I cant describe. It was the only status I really had... until AI.

AI has freed me.

I am free to fully enjoy life as a nut case. Its fantastic as im living a second childhood right now.

Beautiful man, love it. Enjoy :)

Yeah, I have a pet theory that I give about a 0.01% chance of coming to fruition... Next couple decades, AI, etc is going to force humanity to confront it's sense of self and priorities and wake up. A man can dream lol.

I think it will come sooner than that especially if AI doubles in capability every 4-5 months.

Statistics! Can a person below the median income afford to retire early? The answer is a resounding no. Can a person the top 10th percentile (upper middle class) afford to retire early? Yes.

https://dqydj.com/household-income-percentile-calculator/

So the top 10% is a household income of $250K and most of those couples didn’t reach that until their 40s. They aren’t making $225K as an L5 at 25 years old like a former intern/new grad I mentored when I was at BigTech

Most software developers won’t even see above $160K inflation adjusted during their career. Most work in second tier cities in the “enterprise”z.

This guy did it: https://www.mrmoneymustache.com/ on like $65K IIRC

The problem is, at core, fear. Fear of taking responsibility for your life.

So exactly how do you “take care” of your insurance if the ACA goes kaput? “Thoughts and Prayers” until you are 65?

I pay cash for everything right now since ACA plans are terrible... BUT, I am also one of those nut jobs that only eats meat and it is amazing. But, most people can't even begin to imagine giving up carbs as they are junkies.

Are you willing to bet that nothing catastrophic will happen to your health before you are 65?

Yes. I will not let fear rule my life.

That’s monumentally not a good idea

https://www.cdc.gov/chronic-disease/about/index.html

90% of adults will have a chronic condition by the time they are 65.

https://www.aarp.org/health/conditions-treatments/most-commo...

That data alone invalidates any idea of insurance being sustainable, it's a sinking ship.

I, on the other hand, only eat beef, butter, bacon, and eggs and everything is getting better. BUT, I may be in a cult, but this cult has benefits.

No insurance is viable because the risk pool includes people of all ages.

No, insurance is not viable until we fix metabolic health in the masses.

Again, I'm a nut job that has a HbA1C of 4.7 because I only eat beef, butter, bacon, and eggs.

Why even use pools? Ask your actuary about risks.

there are still tribes in the amazon that have very little money, like the hazda. they may not call it retirement but they don't need to go to the office everyday.

Serious question, what makes us so addicted and dependent to money that we can't imagine any way of life without a lot of it?

People play dumb status games.

Here is the crazy thing, I went carnivore after I retired because one thread that worried me about shitty insurance is the risk. Now, I'm pretty sure if I only eat meat and work-out, then I might not even need insurance. Like, my labs are phenomenal.

By taking away the fear and the addiction, I've got a level of calm and control of my life that makes me realize the "modern world" is deeply sick.

So you think healthy living will prevent you from needing medical care until you are 65?

For the chronic stuff, yes.

For acute accidents, who knows!

With carnivore: I'm off almost all meds, my mobility and flexibility are amazing these days (I am sitting on the floor right now with crossed legs).

That’s not how life works…

Dude, cancer is an RNG roll away for anyone.

Doesn't matter how well you take care of yourself if a random cell decides to divide in just the wrong way.

Cancer happens all the time and your immune system deals with it. Look into the recent evidence of how keto deals with cancer. I'm telling you, I live in a world without fear and it is awesome.

I'm well aware of keto and cancer. I spent 5 years in ketosis, I trained semi professionally as an athlete (4 hours a day at a professional MMA gym), I spent years helping people get into keto and lose tons of weight and improve their health.

Keto helps with some cancers that are powered by glucose.

It does nothing to help with any other forms of cancer, of which there are plenty.

Are you willing going to “happy thoughts” your way into never having a serious illness?

Yes, 100%, all the way, full send.

edit: to add clarity, I'm going to leverage full placebo and happiness to my advantage: https://pubmed.ncbi.nlm.nih.gov/12883117/

I'm refute any negative emotions as they are counter-productive. I reject fear of the unknown, and I instead believe happy thoughts.

The Hazda live in Tanzania, not the Amazon. And they grow up learning to live the way they do. They'd be as lost in our world as we'd be in theirs.

And what’s their life expectancy?

Hate to be that guy, but the Hazda live in Tanzania.

Thanks for living frugally. Since you now have some spare money, I decided it's time for a rent increase. And a tax increase.

Without digging into this too far, I do think it’s possible but it does require starting early and sticking to the plan. I’m not one of those people, but I know people who are.

The mean household income for the 4th quintile is 115k a year. The mean of the middle quintile is 70k. There’s a theoretical 45k a year spread if you earn like the 4th quintile and spend like the 3rd (evidently possible since a lot of people live in the 3rd quintile).

Even ignoring compound interest, if you can hit that 4th quintile at 30 and you lose half the spread to taxes, by 55 you have 25 years of saving 22.5k/year for 562.5k in savings.

It’s probably not the most fun thing, but I do think it’s doable.

Here are the numbers for context:

https://dqydj.com/household-income-percentiles/

The median household income doesn’t earn the median wage every year from when they started working. That’s just a snapshot and it’s highly correlated with age. I’m 51, I damn sure couldn’t afford to max out my 401K. That means I was 25 in 1999. I definitely could afford to max out my 401K - which was then $10K a year - when I was making $35K a year.

Especially when new grads are coming out now with student loan debt.

https://mrmoneymustache.com/blog/ Read this story and more in the fire community, it's not impossible

Does that answer the question about what happens when the ACA is gutted and you can’t get insurance at any price with a pre-existing condition?

That happened to me right before the ACA went into affect. I was engaged to my now wife and we moved our marriage up early so I could get on her insurance.

https://mrmoneymustache.com/2020/11/09/direct-primary-care/

https://mrmoneymustache.com/2017/11/05/when-your-shitty-heal... Regarding ACA >My family’s monthly health insurance premium, which had already more than doubled in the last few years to $674 per month, was going up a further 44% for the coming year. For no good reason, other than perhaps the the current government’s attempts to kill off the Affordable Care Act. (By cutting various parts of the structure, the insurance market becomes less stable and predictable, and thus more expensive).

Also besides that there is also the solution of barista fire that's working part time just to get insurance. https://www.reddit.com/r/baristafire/

How do you "work part time" when you need medical care to GET WELL ENOUGH to be able to work again? I.e. if you are in a serious car accident with a broken leg and broken arm, ain't no one hiring you just to let you sit around and get free health care.

And what part time jobs offer health insurance?

While I can drag myself out of bed most of the time as long as I have my right hand that I can type with [1] and walk over to my office most of the time if I am not feeling well, that’s big an option for most people.

[1] about that whole pre-existing condition thing. I have cerebral palsy that mostly affects my left hand and slightly my left foot. Even though I hadn’t been to a hospital since 1995 at the time for foot surgery - my only CP complication, had been a part time fitness instructor and could easily run a sub 10 minute mile up to a 15K at the time in 2012 - I couldn’t get private insurance. Now at 51, I’m still a gym rat with no CP related complications.

And again, you’re assuming that insurance companies won’t just flee the exchange when it’s not profitable because only sick people sign up because of prices. It’s called the “death spiral”. Originally that was suppose to be prevented by subsidies that Republicans killed.

So Texas also doesn’t have income tax but my siblings house (assessed at a lower value than mine) is assessed property tax almost triple wha mine is, dwarfing my state income tax plus property tax. Not sure about Florida - YMMV.

My property taxes are $3000 a year. They were around $7K a year before we moved. We also downsized to a two bedroom condo -1200 square feet - from a 3500 square foot house in the most expensive county in GA (Forsyth) after my step son graduated in 2020 and after Covid. We sold our house for twice what we had it built for 8 years earlier and bought our condo for the same price as we paid for our house in 2016.

Florida - especially when you live in the same county as DisneyWorld - is heavily subsidized by tourism

Is it possible to get insurance as an expat living in a foreign country, yet spend time in the states? Would that be a good coverage for retirees that want to split time between US and other countries?

For curiosity's sake, what exactly do you think Republicans will do to "kill the ACA"? I doubt they're going to introduce a bill that revokes the ACA in its entirety. They killed the mandate almost a decade ago and the marketplace healthcare plans have continued to limp along, depending on the state. What's next?

It’s simple. One of the original tenants of the ACA was to provide subsidies for most people earning up to what would be the upper middle class between this and the insurance mandates, it would prevent the death spiral where only the sick would sign up for it, making the cost go up until it was almost unaffordable to anyone and unprofitable for the insurance companies making them leave the exchange.

The first blow was when the Supreme Court killed the mandates. The second blow just happened when they killed the subsidies last year.

The expanded subsidies, which were a Covid-era enhancement some 10+ years after ACA was enacted.

If you could have FIRE'd before the COVID era subsidies you can do it now

Not if the ACA continues its current “death spiral” where only the sick sign up making the premiums go up to the point where insurance companies just leave the plan.

https://www.theguardian.com/us-news/2025/dec/14/aca-obamacar...

With health marketplace you can get insurance, or you can get a PPA service, or save money into a HSA, like there is multiple ways to do it.

Until the Republican Party finally succeeds at gutting the ACA or make it so bad that insurers wing cover it.

Let’s say you maxed out your HSA for 20 years and have $200K - that can be wiped out with one uncovered major medical incident the HSA max is relatively low.

The other way to avoid a pre-existing condition is to just avoid medical care entirely.

Ah yes, the 4chan retirement plan. Die of a preventable cause at age 42 while waiting for your captcha.

If you accept that cancer is a death sentence, it’s not absurd to “self fund” your insurance with a nest egg.

You can shop around quite a bit for non urgent care, and get good cash discount.

If you accept cancer as a death sentence, you're an idiot. I had cancer at age 41. If I left it untreated, sure I'd be dead, probably by age 43. But I'm not an idiot, I had good health insurance, I was treated, and now that health event is over twenty years in the past.

Had I self-funded with a (non-existent) nest egg, I would still be in debt over $600k. Instead, my insurance had to deal with that...

600k once in 40 years is cheap compared to the total cost of insurance, especially when you consider the compound interest you could have made on premiums not paid, plus with the freedom to get cancer care cheaper someplace privately outside the US.

Your insurance company got the last laugh by a long shot. A typical family on insurance would pay $600,000 (between their take-home and the reduced wages paid by employers to cover insurance) in just 25 years, and that's before considering the opportunity cost of lost investments/yield.

Are you really suggesting that a family should not have insurance at all and save the money?

I have been working for 30 years and have never once paid more than $10K a year for insurance across 10 jobs 15 of those years were a family plan.

Hell one of those jobs was with Amazon - the company with the shittiest benefit package in all of BigTech and even then I only $12K with a family plan. Right now we pay around $10K - my wife myself and my adult but under 26 (step)son

You've likely paid at least $18k if not more like $25k for that insurance in the form of wage income moved to benefit income. The government's tax and regulatory environment post WWII just ensures that unless you choose to take it as 1099 income, your potential 1099 income gets reflected in reduced W2 wages that are paid out in benefits.

You might claim that if your employer didn't offer that benefit they'd just pay nothing, but required health benefits function much as payroll taxes which economists have showed are largely reflected in the form of reduced incomes. That is, you are paying it ~all one way or another.

We know exactly how much your employer pays for their share of your health benefits. That was also part of the ACA to disclose it to employees.

You’re not wrong - I think it’s around 2/3rds so for me it would be around $36K a year all in if I had to do COBRA.

My annual premium for insurance was roughly $2400/year. Since then, it's gone to about $6k per annum. Even compounded at whatever the S&P500 returns for a 40 year interval, I'm pretty sure I'm ahead of the game. If you think I've lost $600K by having work provided insurance, we're not dealing with the same level of reality.

While I won’t argue insurance wasn’t overall beneficial in your case…

There is no way that $600,000 is the cash price for cancer treatment (especially 20 years ago, but also today).

The average cost of cancer treatment is $150k [1], and lower with cash price + shopping.

[1] https://treatcancer.com/blog/cost-of-cancer/

I stopped cataloging the invoices after it hit $1.6M. Granted that's what the providers would bill my insurance, and we all know those are funny numbers, and while I'm sure that a concentrated effort to negotiate cheaper cash prices might have been productive, there's still the fact that I would have had to have $600k or so readily available. HYSA yields were pretty low for most of this time period, and if I had kept that kind of money in a stock portfolio, taxes would have killed me.

And it's beside the point. 99% of Americans can't afford to build a $600k nest egg just to cover medical expenses. THAT'S WHAT INSURANCE IS FOR!

Also, I wonder if this is skewed by more affordable treatments for things like basal cell carcinoma or prostate cancer that doesn't require surgical intervention. In my case, I had full on chemo, rad treatment, surgery, and more chemo. Wouldn't wish it on my worst enemy, but I'm sure as hell glad I had good insurance. Dealing with the medical side was traumatic enough, I don't think I or anyone in my family had the bandwidth to deal with negotiating cash deals with multiple providers.

How much of a nest egg do you think would let you afford a major operation like heart surgery or cancer care?

Read the qualifier.

And heart surgery is ~$60k. [1]

That's <36 months of insurance premiums according to the earlier poster.

[1] https://cost.sidecarhealth.com/ts/heart-bypass-surgery-cost-...

It cost $30k for a loved one just to go to the hospital when their heart "felt weird" but absolutely nothing turned out to be wrong and all they did was run a couple quick scans and tests. I do agree with the overall idea of what you're saying that usually the premiums are way more than what you could get care for if you just saved the money, but the numbers on the website seem very wrong. I realize it's a total anecdote but from loved one's bills it is $20-30k just to get in the door and that is if actually nothing is wrong and there is no heart attack yet they're quoting $30k for an actual heart attack care.

That's the pricing when you have insurance. It is cheaper if you don't.

This is one of the most insane things that I have realized... I have terrible insurance (in case), but I generally don't present it as it is much cheaper and faster to pay cash...

I think we can all agree that the current system is just... ridiculous

I used to be fearful of health concerns, but now I'm a carnivore and just feel great.

I have never in my 30 year career paid more than $10K a year for health care across 10 jobs and that’s including working at Amazon with their shitty benefit package

In my 15 year career, I have never paid less than $10k per year for just me and my wife for health insurance. And I basically try to pick the most sensible and affordable option, not luxury plans.

In the last 15 years I’ve worked for: General Electric when it was still a F10 company and more recently Amazon along with a 60 person startup where the family plan was $150 a month. (2018-2020) and two mid size companies in between and now I work for a mid size 1000+ person consulting company

And if you want data instead of anecdotes

https://www.business.com/articles/health-insurance-costs-thi...

Makes sense, I have never worked for a company with more than 200 employees or so. NYC area.

Even a minor one.

What are you smoking? My parents are in their 80s, both 15+ and 20+ years cancer free. At least in my mom's case (colon), not having surgery + chemo probably WOULD have been a death sentence. In Canada, their total out-of-pocket costs (other than transportation to/from the hospital) was like $15 for some painkillers.

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