I'm not sure why the post highlights dental/vision care; these aren't covered by health insurance anyways.
I've done the no health insurance thing, and I've done the catastrophic-only health insurance thing. That resulted in a bankruptcy from $90k in medical costs, and that's after the various bits of charity care, neogtiation, and whatnot.
It works great, until it suddenly doesn't. These days, I pay the $3,063/month insurance bill... not happily, but I absolutely pay it.
It will be never be free.
And in any event, I will believe the US should enact government paid medical care* as soon as the EU does#.
* For the ~50% that isn't already on government managed medical care
# The constituent states of the EU each do something different.as I understand it, but they don't send gobs of money out of their State so that gormless bureaucrats can take their massive vigorish before sending it back
The only way I could ever be ok with universal health care is if the average BMI of this country drops precipitously. I am 100% fine with helping the guy who gets some random cancer, but I will die on the hill of not supporting the myriad chronic diseases of people who refuse to put the fork down.
It's already disastrous enough that private health insurance doesn't adjust premiums for smokers and the obese, like life insurance does.
$3k per month health insurance in the US must be for a family of 4, and must have a very low deductible/oop max (indicating regular use of healthcare).
See here for a list of premiums in a state like NJ:
$427 per month would be the cost for a 21 to 24 year old for “BCBS Omnia Silver HSA” (a good representative health insurance), and you can figure out the premiums for other ages using the age rating factors on bottom left (max is $1,287 per month for a 64 year old).
Page 6 here shows the deductible and oop max ($2,300 and $7,500).
There's copays and uncovered costs like dental/vision on top of that, too. We reported $49k in medical expenses (which include these premiums, to be clear) to the IRS last year.
We aimed our two kids’ births to be April/May so that we could take advantage of hitting the annual out of pocket maximum and getting all physical therapy for recovery from birth and anything else that might happen fully covered. And to avoid new resident doctors coming starting in June.
Someone has to think of the poor executives in the military industrial complex. The taxes must go to the billions of dollars of infrastructure that is spent annually to support policies like shooting $40M missiles at Iranian drones that cost $100k at most.
And it's not dependent on my employer, and is far lower due to state negotiating power, and I don't have the prospect of out-of-coverage treatments or co-pays bankrupting me.
Precisely: https://jakeseliger.com/2023/07/22/i-am-dying-of-squamous-ce.... The best ENT surgeons in Arizona for creating a "flap" that replace part or all of one's tongue after surgery were (and are) at the Mayo Clinic. And I needed radiation after the first surgery. And then another surgery a few months later.
I too like the "just don't get seriously sick" strategy, but if it doesn't work, then you have a huge problem.
I guess if 90k was the max you could pay, it might not make sense. After all, you are paying more than 90k over 3 years. You could just save the money and have savings if you didn't get ill. I bet it could be a lot higher than that though.
> After all, you are paying more than 90k over 3 years.
That $90k ran up much faster than that, even with shitty insurance paying at least some of it, and medical needs continued to accelerate for a while afterwards. Savings wouldn't have done a bit of good; it was rapidly exhausted. (That's not part of the $90k, either! It's on top!)
Be careful because there are two many out of pocket amounts. One for in network and one for our of network. Most ACA plans that I can get in my state do not have an out of network max. That's a huge risk because most hospitals have out of network contractors. That means if you stay in a hospital that is in network, you'll still get billed separately for out of network care. And half the hospital staff might be out of network. So you can still go bankrupt in an in network hospital. The ACA really didn't do much to protect people from bankruptcy.
This is a pretty good way to go bankrupt when you have a real health emergency
EDIT: I doubt OP is reading this but I would highly recommend they get insurance before giving birth...sure, they won't cover your at home birth, but they will cover your hospital stay if you end up having potentially fatal complications
why?
(from the UK) my partner gave birth at home - twice in a big blow up swimming pool thing - we did have local maternity nurses here, although they was extremely helpful and useful, we could have got by without them.
no drugs either - although my partner had studied various breathing techniques
that was my biggest concern, but we had gone through various scenarios and we fully accepted the risks
we also mitigated the risks as well with scans and monitoring, and the worse case stuff - we also knew with research what the approx risks where (I really can't rememeber those now) but I do remember that hospitals typically massively over react - which causes harm in itself
Choosing a home birth knowing that if something goes wrong you have the entire NHS to save your life is one thing.
Choosing a home birth to save money is a whole other thing. If she gets preeclampsia or has to go for an emergency c section she can count on a 6 figure bill.
It increases risk of death from 3.27/10000 to 13.66/10000. And that’s before confounding factors like high risk births are more likely to choose hospitals this pushing up the apparent risk of hospital births.
You should have kept reading because she then reveals that she used the life event (of becoming pregnant) to enroll in an insurance plan.
I agree, my wife totally intended on a minimal medical intervention based birth. Still went to the hospital, just in case, as we had planned. Turns out that after hours of contractions, the birth was not going to happen (sparing the details) and a section was necessary after all. You simply can’t plan for this ahead of time.
This is mad (especially from a UK perspective!) and it doesn't cover the key point of insurance: you insure risks that you couldn't afford if they went wrong.
I insure my house, my life and my car because it'd be financial ruin for me and my partner if the worst case scenario happened to any of those. Sure, I could avoid going through insurance for small things and negotiate with 3rd parties to get bills down, but that wouldn't make a difference to a £500k house rebuilding cost, car crash settlement, or medical bill.
Similarly, if something went wrong then I couldn't go back and insure that risk afterwards! You can't insure unpredictable events as and when you need them, and there's no point in my organising insurance from the wreckage of my car, house or health.
America would benefit tremendously from adopting any of the universal healthcare models successfully implemented by many other countries.
Our existing insurance model is basically a giant racketeering scam. The lack of access to affordable healthcare increases crime, stifles innovation, decreases longevity and quality of life, and has created a breeding ground for lot of the crazier shit we are seeing in America.
I think we see Medicare For All sometime in the next 10-15 years. The first major party nominee for President who embraces it is going to get elected.
> The first major party nominee for President who embraces it is going to get elected.
And Republicans will use every ability in their power to prevent it from happening, through the filibuster and Supreme Court most likely. Fighting that sort of socialism is their entire reason for existence. That and upper-income tax cuts obviously.
That "tax cuts for the rich" line buds me so much. Republicans do not simply cut taxes for the rich. I've looked at income tax tables going back to the mid 70's. It's clear that Republicans cut taxes for all, not just the rich. Regan , G.W. Bush, and Trump cut taxes for the poorest, Middle class and the wealthy. I don't know of any case in the past 50 years when Democrats have cut taxes for the poor, though Obama did continue the Bush tax cuts.
Now if that's a good policy to cut taxes and spend as much as they do (Trump especially), that is another question.
They do throw a couple bucks to the poor and middle class so they can say that, you've got me there, but you should be able to see in your explorations of the historical tax tables who is getting the biggest benefit.
This has been the dynamic long enough that I can remember an SNL skit from 20 years ago about how bad the Democrat's messaging was on the subject. Something like the Democratic leadership of the time cutting ads about how the rich could use their tax cut for a full-service holiday at a brothel, while all the middle class could get from their cut was a lousy handjob. Obviously it was amusing enough to stick with me.
That throwaway line is a bit suspicious to me. Maybe they were lucky enough to be diagnosed right around annual enrollment time; someone diagnosed in February might be in a lot of trouble.
There are a couple of things I think are important to point out that does make this not just mad but annoying too.
1. No hospital will leave you (because of decency and federal law) to die if you can't pay. This right here obliterates any justification for private health insurance unless said insurance is mandatory like it is in a country such as Switzerland. When someone like the OP inevitably gets injured and has a $370,000 bill or something they go bankrupt and then society has to pay for it. If OP and others were willing to let themselves and others die on the street outside of a hospital I would be at least a little more sympathetic toward their decision to have or not have health insurance.
2. Health insurance is basically a jobs program in the United States. Health insurers do not provide value or innovate. What they do is became defect state agencies with private profits attached, and then when they decide they aren't paying for something we still end up with the bill anyway (both personally and as a society). My main gripe here is that because of the way we've structured our society, we're basically bankrolling a private industry and protecting its profits for no added value. At least the defense industry actually builds things for us. We could eliminate these insurance companies, their profits, and those jobs, and overnight our healthcare costs would go down and everyone would be insured and the economy would be better off too.
"UCLA declined two livers while waiting for insurance approval from Cigna. Sarkisyan's family was also informed that they could proceed with the transplant if they could make a down-payment of $75,000."
They won't give you months worth of chemo, or a liver transplant. You will die without them, but the hospital has no legal obligation to prevent that in these cases. You can keep coming back to the ER, getting progressively sicker and sicker, and they'll give you fluids, pain meds, treat acute symptoms, and then refer you to an oncologist or surgeon, who won't treat you further without knowing it's gonna be paid for.
I've provided a very concrete example of how this plays out.
Yes but the concrete example of how this plays out doesn't contradict what I said. If you wanted to contradict what I said you would find an example where someone showed up to the ER and the hospital said sorry we're not treating you because you can't pay, and then they died outside of the hospital or in the waiting room. And even then you'd have to find a number of examples to establish a pattern.
Also once you reach the point that you are describing that is typically when state resources kick in. If you become sick enough (for example with cancer) you go on Medicaid and disability. I recently went through this exact process with my mom. It wasn't fun and boy do the spam and scam calls really add to the experience. Why we tolerate this crap in America is absolutely bewildering.
The greatest desire of almost every person alive is to put the responsibility for their life and decisions in the hands of others. That's what we've been bred for. So health insurance is an absolute must, whether it's private or through the government. It doesn't even matter if the hospitals, doctors and pharmacies were actively hurting their patients, people would still need health insurance. Because the agony of being responsible for your own health would be too much for people to bear.
The desire is so strong that you're even arguing in defence of scammers. There is no medical procedure that actually costs millions or hundreds of thousands of dollars, those bills are simply scams – unless they're surgically switching heads between people or bringing back the dead and buried to life.
As the old saying goes, it's ten times easier to fool somebody, than convincing them that they've been fooled. So I don't have any hopes. But complicated medical procedures and births are done everywhere in the world, and they don't cost millions or hundreds of thousands.
No matter how you slice it, two months in a neonatal ICU is gonna cost. I've no doubt insurance negotiates that initial inflated bill down quite a bit, but under no circumstances is it ever going to be cheap.
No amount of "personal responsibility" is going to stop you from being born a micropreemie, or autism, or any number of other expensive, long-term medical issues... and quite a few of these sorts of things tend to hit you on the other side as a bonus, in income/earning potential.
Healthcare's like national defense; it's simply not the sort of thing you can tackle individually very effectively on a 300 million people scale.
Sigh. I'm not asking for personal responsibility from the unborn. I don't know what you gain from twisting things that way. And I'm not particularly inclined to discuss your private medical matters. Those are yours. But the fact remains that there is an entire world outside of your circumstances, where people undergo complicated birth and medical procedures, without going into lifelong debt. Your circumstances are the outlier, because you have to seek care within a scam system.
Could you pause to think why healthcare providers let insurance "negotiate" down the hospital bills of their patients? Why in the world would this be possible? If the hospital is actually charging anywhere close to what it costs for them to provide the services with some profits, there would be little room for negotiation. Especially considering that each patient is unique. So why would it be cheaper for an insurance company than for the actual patient? Medical care is not a whole-sale order. The only explanation is because it's a scam.
The only real medical insurance is healthy eating and regular exercise. A medical insurance that you pay for is more an insurance against getting scammed.
> I'm not asking for personal responsibility from the unborn.
How should I take the comments about "the agony of being responsible for your own health" in their/my context?
> Could you pause to think why healthcare providers let insurance "negotiate" down the hospital bills of their patients? Why in the world would this be possible?
The insurer brings patients in bulk, and by coming to a blanket agreement to pay $x for procedure y, gets to cut out all the individual negotiation and collections mayhem that one-on-one payment arrangements bring. I get similar discounts if I order LEDs off AliExpress in quantity.
> The only real medical insurance is healthy eating and regular exercise.
If you deliberately misinterpret, then there is no reason for us to have a conversation.
Yes, healthy eating and regular exercise are pretty much the only real insurance for your health. Anything else is treatment after you've had a problem. Just like driving carefully is the best auto insurance.
Funny that most of the stuff mentioned is low enough that it doesn't even meet my deductible. I'm not paying for insurance to cover a $250 bill, or even a $2,500 bill. I'm paying for insurance to cover an unexpected $250,000 bill.
Small numbers. My hospital bill was almost 8 figures before insurance. Insurance contract rates down to high six figures. That is basically instant bankruptcy for most folks.
Health insurance can also be free for low income folks, so it is incredibly dumb not to have it.
I wouldn't recommend foregoing health insurance but there are some good takeaways here. Negotiating bills is something a lot of people aren't aware of.
I personally wasn't aware I can buy contact lens from the UK - will be giving that a try.
The idea of getting a dental exam through Groupon is absolutely hilarious. And by hilarious, I mean shocking, bewildering, and absurd. Negotiating ER appointments, even more so. This reads like an article from the Amish telling us "You Don't Need Electricity".
Yes, because when you find out you have cancer is the best time to go and try sign up for insurance it's not like you are under any other stressors... And I hope you like waiting for open enrollment, cancer can wait right? This is terrible advice and I'll be flagging this article which I don't do often at all.
My dad just went through this (cancer). He was on a co-op plan (snake oil if you ask me), had to pay out of pocket then fight to get reimbursed. The co-op said they wouldn't pay the outstanding bills if he left the plan and also refused some of the treatments doctors suggested. In the end he was able to get real insurance (not during open enrollment) through some loophole since the co-op was refusing to pay for something. I'm not sure if he died due to not getting treatment earlier or if earlier treatment would have resulted in the same but this advice is not just stupid, it's dangerous.
> If you are diagnosed with a chronic illness, explore your insurance options.
Isn't it incredibly hard to find insurance if this is the case? Quite curious how it works in the US. I think this all changed under the Affordable Care Act??
Here in the UK it's hard to find insurance that would accept you with a chronic illness unless it's quite low-risk. The only way I was able to "lock-in" a policy was by contuining a medical-history-agnostic one I had under an employer. To get it as a private citizen would have been impossible due to my medical history. So basically I'm now never letting that policy go. TBF the main reason to get private health insurance in the UK is for a shorter waiting list and better aftercare or rehab, but it can also provide hugely life-changing medical intervention if you can carry the policy into old age, AFAIK.
But yeh.. I'm privately uninsurable. I cannot purchase life insurance anywhere ... trust me I've tried. Which is funny because I thought the whole point of insurance was to equitably balance out the risk amongst a collective. Ultimately, for me, the whole point with insurance is that it can cover you if something super-super-awful happens. It protects from financial ruin in the case that e.g. you need life-saving emergency surgery. It's there for the unpredictable.. not routine dental appointments lol.
> I cannot purchase life insurance anywhere ... trust me I've tried. Which is funny because I thought the whole point of insurance was to equitably balance out the risk amongst a collective.
It is, but if you are higher risk, adding you is inequitable to the pool of already insured lower risk people.
You have to buy insurance before the need for it to be equitable to the others in the pool.
Insurance is never a good deal. They are betting you’ll never use more then you pay and you are hedging that the day you really do need it, it’ll be worth it. Anything an insurance company covers out of pocket is purely them hedging that those services will save them money in the long run or they have factored it into the price you pay up front.
So yes, insurance is never worth it... unless it is... and then often it really was worth it all along.
I doubt this is true for health insurance, but for many competitive insurance industries insurers will frequently break even or even take a loss on premiums. Warren buffet explains it well in his letters to investors.
Basically, insurers make most of their money by investing the float, so their incentive is to have a bigger float by offering competitive rates to bring in more customers. They don’t really care if they pay out every dollar they take in, because they made money by holding onto the premium in the time in between when you paid it and when a claim was made.
So for things like car insurance, it actually is a pretty good deal. Many companies expect to pay out as much as their clients put in, with the added benefit that you can take out more than you put in if you have a claim immediately after getting insured.
TL;DR: You don't need medical insurance as long as you have no major medical incidents. Just like you don't need an umbrella as long as it doesn't downpour. What a bad article.
This is a reckless opinion piece and it's going to leave some unfortunate soul with a bill that absolutely wrecks their financial situation.
I'm billed $1M annually for my health care (Stage IV Cancer), and yes, I likely could get that dollar amount lowered through different tactics, but for a measly $9k a year (premiums + deductible), I don't have to deal with any of that nonsense. $9k for $1M in health care is a deal.
Without insurance, my wife and my medicines would be close to $2000/mo (using services like GoodRX). That is not even considering the every 3 month lab work both my wife and I have to get done for managing our chronic disorders, the 1-2 times a year we get actually sick and need a doctor visit, the vaccines we take yearly due since we both have compromise immune systems, the various flare ups of immune disorders.
We are both self-employed, so we get our health insurance on HealthCare.gov, so if we let payments laps on our health insurance, we are barred from getting new health insurance for the remainder of the year. Health insurance is not just insuring our health, it is also insuring our ability to be insured.
But beyond any of that, our health insurance is a positive return on investment. Our $900/mo = $2500/mo in benefits.
So maybe it is true that you don't NEED health insurance... until you do, and then it is too late.
Beyond the risk of medical bankruptcy in the US, lack of health insurance can prevent you from getting some lifesaving treatments.
If you are uninsured, for instance, you stand almost no chance of getting an organ transplant. There are not enough organs for too many people, the operation is very expensive, and lifetime support medication is also expensive.
In my experience, transplant centers won't even start the evaluation without proof of insurance.
While it might be possible to get insurance after diagnosis for people like the OP who choose not to have insurance, that isn't always feasible. Sudden organ failure, while rare, certainly happens. And should it happen, it is hardly the best time to be scrambling to find insurance.
Yes, the system is screwed up. But it is the system (in the US).
You can really buy insurance after being diagnosed with cancer? That’s the polar opposite of anecdotes I have heard, and my understanding of how most insurance works.
You can, via the ACA exchanges (ACA compliant plans can't deny coverage for pre-existing conditions), but only at the end of each year. You wouldn't want to get a diagnosis in Feb.
Once it gets bad enough you may get Medicare/Medicaid for disability/income reasons, but that's... a suboptimal approach.
Since the ACA you can. As long as it's a Marketplace plan, they can't deny you or charge you more for preexisting conditions, and I've never met someone with a private plan nowadays. The catch is that you can only change plans for the next calendar year unless you move or lose your job or something.
I can tell you from personal experience that you cannot, unless you want to wait till the next year (and sign up during open enrollment).
But it's not like cancer moves fast or anything right? You can just wait, nothing bad will happen... /s
I'm a bit salty, I lost my dad to cancer last year and he was on a bullshit co-op plan that delayed treatment and made the whole experience even worse than it already was. Would insurance have saved his life? I can't answer that but the delays (before he got real insurance) couldn't have helped.
You should never go completely without insurance, but the article does have some good points. I have health insurance, but they still find ways to not cover unforeseen expenses. Most recently an ambulance bill for my daughter at a school sporting event. So even with insurance I don't feel safe. The best advice is similar to that of the court system, try to avoid the system completely.
This is called gambling. Health insurance isn't so expensive for no reason. You save a modest amount until you fall off a ladder and lose your house.
Buy the cheapest plan with an HSA. You essentially get an above-the-line deduction of all medical expenses even OTC things, you cap your expenses, and you get insurance-negotiated rates.
Yes you do. Negotiation will still leave you hundreds of thousands in debt if you are hospitalized. I know from experience.
You can probably negotiate the bill down to what the insurance pays, but not beyond that. Plus, hospitals don’t think highly of folks that don’t carry insurance. They may refuse to bargain with you at all.
Do you think that 3 million dollar hospital bill will just go to collections? No they are going to sue you and get a judgement on you.
Wow--so if I get smashed up on my bicycle by a hit-and-run, I can talk them down to $250? Amazing!
If you have assets, carry insurance to protect those assets. Maybe you get lucky with no insurance and come out ahead in the casket, but if you lose, you can lose big.
I have exceptional insurance through work now, but when I didn't, I carried high-deductible insurance with an out-of-network max-out-of-pocket. They might get me for 12 grand, but they had to weasel a lot harder to get me to pay more.
Also, I've been blessed with pretty good health. But my total hospital bill for life is probably about $250,000 due to a ruptured appendix. (The work was in a socialist hospital so I didn't get a bill--that's just my estimate.)
> Insurers can’t refuse to cover you or charge you more due to a "pre-existing condition."
This is absolutely true, however one does not simply buy insurance outside of open enrollment; you'd best hope you only get sick or injured in that particular month.
Clickbait and sensationalism. The author knows they're wrong, but that people will read it, because it's backwards. Commenters will be baited into engagement. The Americans bankrupted every year by simply lacking health insurance won't be acknowledged in the article, even indirectly.
I feel this really underplays the proper way to purchase health care, the importance of relationships and the quality of having great providers.
I would compare this to my first dog vs my next dogs. The first dog I took him to the low cost clinic to get shots and did minimal cheap health care for him. But as he got older, it became clear that when you start having complications you need to see the same person and you can’t just skate by with different vendors and there is a lot of value to being seen repeatedly by the really highly qualified person as you get older or know where to go if you have an emergency.
It’s totally true that you can negotiate and find cheaper prices on things, but like the best veterinarians, the best doctors generally accept the top quality healthcare usually BCBS and aren’t going to discuss or negotiate price with you. They didn’t spend a decade in medical school to deliver transparent billing.
I’m all for transparent billing and think it should exist, but my health is too important to try to fight some philosophical price battle and I want the best.
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