Comment by ambiate | Hacker News Reader

Comment by ambiate | Hacker News Reader

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After visiting the ER with a 108F temp due to pneumonia, I can attest to the fact that ER visits are a rip off. 3 unique doctor visits to the room + 1 IV + phlegm sample + 1 $60 pill + 1 prescription = $4200 for 50 minutes of office and 120 minutes of wait. Afterwards, I explained I did not have insurance. $60 pill was wrote off instantly. $4200 turned into $1200. Govt reimbursed 3/4ths of the bill instantly to the hospital. $1200 got wrote off after 3 months because it was not worth collecting...

Edit: The interesting thing was each doctor had an individual bill of $600 sent to me. These are still in collections. The phlegm sample cost $120 and come from a separate clinical laboratories bill.

My wife's birth control has a package value of $130/mo. Health insurance ($600 for wife, and kid), had a copay of $40 for this medication. I called the same clinic, requested generic and expressed my need to pay in cash. Instantly brought the price down to $8/mo.

I did not sign up for health insurance this year. It is a complete waste. I usually pay more than just asking for generic and paying with cash. The 'poor' clinics here have a higher quality of care and staff, and are more affordable than my co-pays.

ERs are expensive for two reasons:

1. You are paying for a standing army. 1 hour of scheduled doctor time is much different than 1 hour of doctor time ready to deploy in an instant.

2. The ERs need to cover all the non-paying clients.

These two items probably feed on each other.

Emergency departments are about 1% of total health care costs. They can be a good indicator of other symptoms that are wrong (medical billing is a maze, on purpose[1]), but fixing it won't really address health care costs.

[1] http://www.thedailybeast.com/articles/2013/02/22/how-hospita...

I'm in the same boat. My insurance premium changed this year to $950 a month. We have 3 younger kids and are all healthy. I would be paying almost $12,000k a year for the privilege of being able to pay "less" after the deductible is met. Paying around ~$120 for an office visit is so much less than premium + copay, and like you said a lot of services prices change once they know you don't have insurance.

I wish health insurance were more like car insurance (accidental coverage, not maintenance) and I think we wouldn't have the same convoluted pricing we have now.

Not having health care works if you don't have a catastrophic injury, and/or you are willing to let the hospital write off services and pass the bills on the the rest of us.

This isn't really a sustainable plan for the nation.

There's a hidden truth in 'writing off'.

Insurance companies wager paying the bill too. They say "We'll pay 60% of that $8000 ER visit."

Guess who covers 25% of that leftover 40%? In a majority of cases, the government.

(Source: My aunt has worked for a hospital performing these write-offs the majority of her 45 year life.)

> My wife's birth control has a package value of $130/mo.

Wow. My girlfriend's birth control is $9/month, without health insurance (Target's generic Ortho Tri-Cyclen).

I suppose you are prepared to starting paying the tax penalty for not having insurance under the PPACA?

If necessary, I will pay the penalty. I assume the credit for health care costs and taxes charged on health care should make up for any penalties incurred by the PPACA. If I read correctly, my penalty should only be $950-1300. Inevitably, with my insurance rates, I would spend that on 2 months of health coverage for my small family.

Just to break down costs: $600/mo health for wife/kid. $7200/yr. vs ~200/mo + 1000 penalty. $3400/yr.

We're not exactly getting Xrays and CT scans on a daily basis in my household! If my wife was to get pregnant, I know most hospitals offer a specialized bundle plan for dealing with the pregnancy for a set flat rate. All check ups, ultrasounds, single doctor, etc, for $6000.

You don't need to have traditional "insurance" to be exempt from penalty under PPACA.

There are exemptions for members of certain groups (IIRC, Native American tribes and religious groups that are opposed to the concept of insurance, like the Amish). There are also exemptions for participants in "health cost sharing ministries" [0]. My family pays $135/month for what, practically, functions like a high-deductible plan [1] -- a little more expensive than just paying the penalty, but it's worth it to mitigate the cost risk associated with catastrophic illness.

[0] http://en.wikipedia.org/wiki/Health_care_sharing_ministry . There's a list of Christian health-sharing ministries at http://www.healthcaresharing.org/ ; I don't know what other religions or non-religions might have similar programs.

[1] the friend who referred me to this signed up for a no deductible option. He was diagnosed with cancer a month later, and they covered everything.

I'm not in the USA, but 'only $950-1300'? That's more or less what I pay for a whole year of health insurance in the NL. How much does insurance cost in the USA?

Unless you have low income, you pay more than that in the Netherlands.

Payment for health care is composed of two parts:

You pay about EUR 867 to 1,140 directly to an insurance company PER ADULT depending on how much you want to pay yourself in case of required care.

Then there's the socialized income dependent part of the insurance that's either payed via your employer or by yourself, which, in the latter case, is 5,65% over up to EUR ~51 K.

A family of two, each with an income > 51K then pays between EUR 7,480 to 8,026 (atm USD ~10K) each year for health insurance, subsidizing insurance for lower income groups.

Here is an example rate sheet for where I live (Northern NJ):

http://www.horizon-bcbsnj.com/SiteGen/Uploads/Public/horizon...

$200/mo per kid. $350/mo for wife. $600 for wife and unlimited kids.

And for the record: that's what qualifies as "incredibly inexpensive" in the US. Many people pay well over $1000/mo for family care, not counting what their employer contributes.

These costs are roughly what I'm faced with as well. I have insurance on myself but my kid is uninsured because I can't bring myself to pay so much per month when my child is only at the doctor 2-3 times a year and the cost is probably around $180 for a whole year, or less than the cost of a single month of insurance which I'd still be paying a copay on.

when I left my last job, I had the option to continue the health insurance the company was paying for, for up to a year (this rule is called "COBRA"). It costs me about $1100 per month, to cover two people.

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