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Comment by BrianEatWorld | Hacker News Reader

Seems like either a poor headline or the wrong metric.

I am insured now, but as someone who was rationally uninsured, I don't think I am better off. While I am only one person, the assumption that insurance necessarily makes someone better off seems a bit spurious.

Are there any metrics on whether the cost of insuring the same person has gone down? Wasn't that meant to be one of the benefits?

Edit: Did some digging and it looks like a more comprehensive review of the stats can be found here: www.nytimes.com/interactive/2014/10/27/us/is-the-affordable-care-act-working.html

As for my own question, it does look like the majority of the markets will see prices increases.

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Did you have $20,000 socked away to cover appendicitis? (If you've already had appendicitis, insert any of 100 other relatively common highly tractable medical emergencies you haven't had yet). If not: your policy of rationally forgoing insurance was being financed by everyone else in the market.

(The $20,000 figure comes from my friend, whose teenager had appendicitis a couple years back).

About five years ago my brother had appendicitis and, since he'd decided not to buy insurance (which he could have easily afforded), the $17K came out of his hide. So your $ number is about right. Fortunately he was wealthy enough to afford to pay up, but I have no idea what someone for whom $17K was a year's after-tax income would have done.

Indigent care. Please note, "indigent care" only applies to people who truly can't afford the care they need. If you could afford the care you need by moving into a tiny apartment and eating nothing but Ramen noodles for a decade, then you would be expected to do that.

Rationally uninsured? Care to explain your circumstances?

I don't think it was meant to reduce the cost of insuring someone but to reduce the rate of the increases. Remember how fast health insurance premiums were going up in the late Bush and early Obama years?

To answer the headline of the article I did not read... The health insurance companies?

I have catastrophic insurance to cover unexpected circumstances and enough money in an account to handle normal, day-to-day healthcare. In setting up my finances in this way, I am able to cover myself and not have to fork over a premium every month. This has saved me thousands of dollars over the years, if I compare the current premium I am obligated to pay with my previous strategy of putting money into an account.

True insurance is a hedge against risk, I looked at my risks and made the rational decision that covering myself was the better decision.

Its not for everyone and so I don't want to generalize. I just offer it as anecdotal evidence that while increasing the percentage of the population that is insured, may be a nice easy metric to measure and affect, it is not necessarily an indication of improving situations for all Americans.

This has been my approach as well, but effective December 31 my insurance provider will be prohibited from offering a catastrophic-only policy, so I'll likely be completely uninsured come the end of the year. The Affordable Care Act will have priced me out of the market.

Just the other day I price-compared a catastrophic plan with Bronze plans, and the difference was about $20/mo.

That's just an anecdote, a more important point is that if you buy through the exchange, you get subsidized if you're really too poor to pay the premiums on your own.

The people really getting screwed are the people in the Medicaid gap, in states where Republicans refused the Medicaid expansion.

> As for my own question, it does look like the majority of the markets will see prices increases.

Health spending was growing at an average of 7.2% / year from 1990-2008, vs an estimated 3.6% in 2013. Certainly the slowdown is the result of more than just the ACA, but this is the relevant metric one should use when measuring its success at cost containment, not the fact that almost everything gets more expensive from one year to the next.

http://content.healthaffairs.org/content/early/2014/08/27/hl...

>but as someone who was rationally uninsured

It's not rational for anyone to be uninsured. Any healthy person could get in an accident.

And we should all play the lottery because we might win? If the expected value https://en.wikipedia.org/wiki/Expected_value is lower than the cost, then you rationally shouldn't buy it.

The utility of money is non-linear though. It can be worthwhile to pay a small amount of money in order to prevent a non-zero probability of losing a large amount of money, even if the expected value in terms of dollars is negative.

The expected value of insurance is always lower than the cost, that's why someone sells it. The reason you buy insurance is to protect against catastrophic events, which are impossible to predict on an individual basis.

No...

Hey, if you don't want to buy health insurance fine but... Don't show up at a hospital when you are sick or hurt to drive up the cost for everyone else. Deal?

Personally, I am single payer type person. Cut the middle man insurance companies right out of the equation.

EDIT: Why is my comment being downvoted?

Single payer probably looks good on paper, but I would never trust someone with that much money and power.

The US spends more, not only per capita but as a share of GDP, public funds on healthcare than some OECD countries that have single payer with generally similar outcomes.

So you (in the general sense) are already trusting the government with (or at least, not preventing the government from spending, whether you trust them or not) the money to provide single payer -- you are just doing it in a system which requires an even greater amount in private expenditures on top of those public expenditures to provide a similar overall quality of care.

>Single payer probably looks good on paper

And in the many first world countries that have used it for decades. It's a proven model.

>I would never trust someone with that much money and power.

That's how they're able to negotiate better rates.

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