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Comment by lotsofpulp | Hacker News Reader

Because your 1993 health insurance covered far less.

There was no out of pocket maximum, you were denied for pre existing health conditions, and a surprise bill could show up anytime.

Now, you can buy health insurance even if you know your anemic kid will need $1.5M of treatment in the year, and it will only cost you ~$10k to ~$15k per year.

To be clear, today’s health insurance premiums are not premiums either, they are taxes, due to the legal ban on underwriting health risks and caps on premium price ratios between various ages. For example, my kid is going to use up more healthcare than he will probably ever earn in his life, before he even turns 7. Your premiums are what is paying for that, aka wealth redistribution via “premiums”.

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All fine. The only part that I have trouble with in your message is the 1.5M number. Why should something like anemia cost 1.5M a year of treament? And out of that 1.5M a year to the hospital, how much goes to:

a) administration b) health care claims administration (a huge %age of the gap) c) private equity profit numbers

Do we even know? Is it ruly worth 1.5M?

I ask because an MRI costs thousands in the U.S. And if I go oversees and pay out of pocket it costs something like $300 out of pocket - and I'm talking the U.K. here, not Turkey or Mexico. How do you explain that?

> Do we even know? Is it truly worth 1.5M?

I don’t know what worth means, but the price is the price. I can see all the bills that the insurance company pays the hospital, and the hospital collects $80k per dose of medicines like

https://www.asparlas.com/

And $100k+ for

https://www.blincyto.com/

And $10k to $15k for other infusions (can happen two times per week).

The hospital is owned by the government.

In general, pharmaceutical companies have huge profit margins and profits, and doctors earn a decent amount of money in the US, especially specialists. Also, liability is huge in the healthcare space, with awards in the millions and tens of millions.

>How do you explain that?

Bottom line is a lot of people earn a lot less money in other countries.

We use an insurance model. Get upset how insurance works. Then complain it’s broken. Either it’s insurance or it’s wealth redistribution.

In the US, it is explicitly wealth redistribution, from the young and healthy to the old and sick. It is still called an insurance premium because it is more politically palatable.

Unless you don’t intend to age, you too will become old and sick. As will, hopefully, almost everyone else.

How is it wealth redistribution when most people will start as recipients, then move to being the donors and will then become the recipients again?

Because there is no guarantee that the donors now will receive the same benefits when they are older. It's almost the opposite, given demographic trends. For example, 20 to 30 years ago, getting consultation by a doctor was easier, but now you often have to get consultation from a physician assistant, if you're lucky, or more likely a nurse practitioner, who are far less qualified than doctors.

Also, ACA started in 2010, so all the people receiving the most healthcare now (age 50 to 65) had a good chunk of working years where they never paid into the system, but they received a lot of benefits. Also, there is no mandate to pay the premiums in the US, so many people don't pay into it at all, until they need the healthcare.

Unless your (kid's) care is denied because it's a pre-existing condition. Or for some other pretext.

In 1993, it would have been. In 2026, he cannot be denied coverage due to Affordable Care Act passed in 2010.

However, because more people are getting more healthcare, like my son, premiums are higher. Which, as I explained, are not premiums, but rather taxes. So OldSchool is comparing a $300 per month premium with benefit maximums to $3,000 per month taxes, which are not comparable.

And it’s not the insurance companies that cause the $3,000 premiums, it’s the medicine manufacturers and hospitals and doctors. My son is on medication that costs $80k per dose, and each infusion visit is $10k at least. And, of course, the legal liability each step of the way.

To be fair, I suspect lots of the increase in premiums comes from the removal of the individual mandate. If not everyone contributes, then any insurance system works much less well.

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