Fat chance of that happening. And if it did, the deductible would be so high as to make the plan worthless for anything short of a car-crash-emergency-type-situation.
But not only would it not happen at that price, but as the article says, it wouldn't happen period--even though I'm a healthy, nonsmoking, active 26-year-old male, I've had cubital tunnel problems in the past (typing) and surgery on my wrist (badly broken in an accident). If I applied, I would surely be denied--and again, as the article states, if you're denied once, your chances of being accepted in the future just dropped by a big percentage.
It literally makes more financial sense for me to pay minor expenses out of pocket and declare bankruptcy in the chance of crippling bills than to be insured.
Healthcare in America is utterly, utterly broken; it's damaging poor, middle-class, and rich people alike, and stifling innovation. I have the ability to innovate with my company because I'm young, single, and healthy; but many smart people have existing medical problems, families, or other factors that make them indentured servants to the company that pays their healthcare. As a nation we're under the thumb of the insurance companies, and instead of doing anything serious about it, we've done almost the worst possible option: require every one of us to be a customer of these monstrous companies, with little regulation on cost or other government oversight. I'm the first person to back health insurance reform, but we've reformed it in the name of shoveling more money into the pockets of industry instead of for regular people needing real care.
It's crap like this that's compelling me to make my current expat lifestyle permanent. America might still get the tax dollars my business generates (the only country to still tax you if you live abroad) but it won't get my brain or my talent within its borders.
A close read of your first three grafs --- the only ones that respond to the article --- suggests that you wish you could get something better than "car-crash-emergency" insurance for 50-100. Well. Let's unpack what you're missing here.
(1) The author of this article, like my own family, can't get "car-crash-emergency" insurance for 50, 100, or 500 dollars a month. Never mind the deductable. If your records include a shred of evidence of 150+ seemingly-random conditions†, you're an automatic decline. That's the problem the article is bringing up.
(2) A system in which only "car-crash-emergency" care was automatically covered would be workable; a vast improvement over what we have today! Outside of car crashes and appendicitis††, you in fact don't spend $1200/year on health care. We're a family of four, and we don't spend $1200/year on health care, let alone $4800/year or (gak) the significantly greater amount we really spend on the low-deductable group coverage we set up for Matasano.
A $5k deductable would suit us just fine; we'd save, significantly, simply by plowing the money we would have spent on crazy bullshit low-deductable insurance into an interest-bearing vehicle and shelling out from it when we actually needed care, all the while secure in the knowledge that when someone ends up in the ICU, our liability is capped. Not for nothing, but this is a scheme that both Dems and Republicans buy into.
Health care in America is broken. But it's not "utterly, utterly" broken. Whatever the number of random medical bk's we have in the US, it's too high. But we don't need to transform our health insurance system into the National Health or the French system. We are epsilon away from a Swiss-style system of mandatory and guaranteed-issue private insurance.
† http://www.thecasongroup.com/forms/enrollment/Humana/H1%20Un... .
†† Many tens of thousands of dollars. Happened to a friend.
"$499 for a 50 year old subscriber in San Francisco"
Looking at other states, there are premiums as low as $172/month.
It would surely be much cheaper for you as a 26-year-old. Not quite the $50-100 you're looking for but I'd bet you could afford it.
Things are bad but maybe not as bad for you as you think.
Right now my current location is Monterrey, Mexico, so again, doctor visits are cheaper to simply pay out of pocket. As an example, my uninsured girlfriend had to visit a doctor last week--a walk in appointment at the major Monterrey hospital plus lab test, technician, and prescription medication: 800 pesos, or about $66. And this is in a modern hospital in the most expensive city in Mexico.
You can see these plans for yourself by checking our Blue Cross or Humana in Florida, among others.
http://www.healthcare.gov/law/provisions/preexisting/states/...
Fat chance of that happening. And if it did, the deductible would be so high as to make the plan worthless for anything short of a car-crash-emergency-type-situation.
Actually, that's exactly the policy you want as a healthy 26 year old: $5,000 deductible catastrophic coverage, and nothing more. It'll cost you $86 per month from Blue Shield.
Health insurance, in the sense that you see it in group policies from your employer, is not worth the cost if you're buying it yourself. It will be 15 years before you get to the point where a $50 copay and low deductible make sense. Think about it. How often are you at the doctor? Once a year? Once every 3 years? And it costs you a hundred bucks or so. That's not something you need to be insuring yourself against.
The key is to keep a bit of insurance just in case you get in that car crash and need new hip joints, or if you suddenly develop bone cancer and are looking at $10k/month health care bills. Those things are crazy rare, and the policy that protects you against them is priced accordingly.
Fat chance of that happening. And if it did, the deductible would be so high as to make the plan worthless for anything short of a car-crash-emergency-type-situation.
This fits a fair number of cost complaints I hear over healthcare. Who wouldn't like to pay $50-100/month to have something better than emergency healthcare support? But think about the costs of such a system, regardless of inefficiencies / the problems of the current system that make things cost hundreds of thousands:
Doctors and nurses and supporting staff must exist. So must hospitals. They are highly trained, and will be expensive - period. They also have to keep learning, so they can't be busy making money all the time. And they must have such people available all the time, or people die.
Given that, and the equipment and check-up and hospital time, how much should a minor surgery cost? Not in cost to you, in cost. If the cost to you is mitigated in any way, it's extracted another way (taxes). I'd have trouble seeing it cost less than a few thousand dollars in the best, highly-used system. That's a lot of training and a lot of supporting necessities for any random surgery.
At $50-100/month, they would have to sap you for nearly a decade to make up a single surgery. It might even out for the insurance company if that was it - but certainly not when you get older, and not with any kind of routine, preventative care. Scale that up to emergency situations where major surgery and years of rehab for even 0.1% of the people they're covering - how many hundreds of years does that cost everyone on the plan?
Cataclysmic health insurance is cheap because it only covers cataclysms. Because one in a hundred lives cost an utterly enormous amount more than a single person generates.
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None of this is to say that I think the healthcare system is efficient by any means, nor not full of corruption, waste, frivolous lawsuits, or damaging dogma. Merely that there is simply a bottom limit that the prices that people want to pay will never be able to support, unless all cataclysmic protection is dropped. And would you rather die from a car crash, or be rehab'd for a couple years and continue your life for another 60 years? So people choose the cataclysmic protection, and prices jump.
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edit: because this seems it will come up often, some evidence for my claim based on Canada's setup, copied from another comment I made below: http://en.wikipedia.org/wiki/Health_care_in_Canada
>In 2009, the government funded about 70% of Canadians' health care costs.
>Per capita expenditure in 2009: 3,895
$227 per month, per person, comes from the government, which means it comes from taxes. And an additional $100 per person is spent per month on average ($324.58 per month). Far in excess of $50-$100.
And, if you want to talk care and outcomes, let's pick the most grim of diagnostics: Cancer. Japan's 5-year survival rates are among the highest in the world, and the highest in particular cancers such as colon and rectal cancer. And, FYI, the US isn't #1 in survival rates for all cancers. It's spread evenly through the G8.
And, the most free of supposed free markets and tax-friendly wonderlands, Singapore, also puts price controls on procedures, with similarly successful outcomes. So it isn't a cultural or "economic" thing, it's a government thing. It always will be. An adult just needs to come in, put their foot down similar to what Tommy Douglas did in Canada, and declare either we all buy in to a government-run healthcare system, or we buy in to the government completely regulating the market much like it does the stock market or agricultural industry. States will have no say, no quarter, or feedback. They can choose to secede from the union to opt-out of the program.
And, while I love me some comment karma, I know that my position is tantamount to heresy on this board, so, get your dismissive hand cocked and ready to wave me away :D
http://en.wikipedia.org/wiki/File:International_Comparison_-...
So as a matter of priority versus other spending outlays, we're way out of line.
Here's per capita GDP: http://www.wolframalpha.com/input/?i=per+capita+GDP
Spitballing from these numbers, it looks like we spend about as much in absolute terms as Switzerland, with everyone else way, way far behind.
Here's another interesting graph, since I seem to be on a roll here:
http://krugman.blogs.nytimes.com/2011/02/16/medicare-and-med...
The degree to which our government is in the red is in no small part a result of the degree to which we're invested in the health care money pit.
The amount of money that is going to health care should blow your mind. People go bankrupt every day due to health care expenses, and even if you don't go bankrupt your tax dollars are supporting this nonsense.
I was talking to a gentleman the other day who works for a medical hardware company. He said they had a radiation treatment device that costs one hundred million dollars. A tenth of a billion dollars for one machine! "Jeez," I said, "How long does it take to pay off such a thing?"
About a year.
There is, of course, a debate on how to fix health care. Is there really a debate on whether it's broken?
I got a $800 bill for 10 minutes doctor visit (swollen toe). Not exaggerating a tiny bit. No insurance company involved. "Must exist" is not an argument. Something is broken in the system where a doctor charges you $4,800 per hour. Insurance companies, obesity, poor lifestyle choices (all usual BS reasons I hear on TV) do not explain why this particular ####le charged me $4,800 per hour.
This saddens me hearing that most discussions about healthcare are circling around the question of "how?" instead of asking ourselves "why so much?".
Anyway, this isn't the place to get in a discussion about how to fix the system. But as it stands now, it's just a fact that my bank account is better served by not being insured, having minor procedures done in another country, and declaring bankruptcy in the event of a cataclysm. That's not what the system in the richest and most powerful country in the world should look like.
How many surgeries per decade do you think typical healthy nonsmoking twenty-somethings are having?
£12k (grad student, trainee) - £62 per month £24k (young professional) - £114 per month £60k (moderately wealthy) - £318 per month
The average price is probably near your lower bound but the fact that it scales with income means that you aren't a slave to your workplace. You can quit your job and start a business without fear of crippling medical costs.
(Source is http://wheredoesmymoneygo.org/)
At $50-100/month, they would have to sap you for nearly a
decade to make up a single surgery.
Which brings up one of the biggest red herrings in this whole debate - the notion that the U.S. has a "market-based" system. The next time you go to the doctor, ask someone what it's going to cost. Guess what? No one outside the two people working in the basement billing office have the slightest clue, because it's all paid for by the insurance fairies. There's nothing even remotely resembling an efficient market for healthcare in the U.S., but the insurance companies like to spout otherwise, because it's entirely to their advantage.
Drug companies will charge US customers more, because health insurers will pay. Good luck importing drugs from ebay - it's not legal!
Doctors, and hospital managers charge more, because health insurers pay. Good luck getting an unqualified doctor to prescribe penicillin - it's not legal!
If the government was paying for more of it, they would train more doctors, and force drug companies to lower prices (as they do in most countries). Removing the profit motive in public hospitals makes them focus on better care, not more expensive care. Then the private sector has some real competition (Australia and Canada both have private health ... it's better than the US for most people).
Invisible cost: Medicare/medicaid. You pay into it regardless of whether or not you use it - how much medicare/medicaid withholdings are in your paycheck?
Add that onto your actual private monthly premiums to get the real cost of health care.
I don't know about you, but mine works out to be considerably more expensive than $325 a month. And in the Canadian case I can be a bit happier knowing that everyone is covered.
Still, $324 is a pretty nice average, when you weigh in the mix of young and elderly, and of course if it comes out of taxes, presumably someone who is only able to afford $100 a month is going to have a lower tax burden as well.
That's why Germany has a social system where people pay in a fixed percentage (15,5%) of their income. That way, everybody pays the same percentage and everybody gets the same service.
If I wasn't self-employed, my employer would have to pay 50% of these costs, so it would be about 8% of my income.
The nice thing: this gets automatically deducted from an employees pay, so if he gets a raise or a cut, the percentage always stays the same.
The downside of it: I make decent money at the moment and have to pay 600-700 euros/month for healthcare.
If you make over a certain amount of money or are self-employed, you can opt-out of this system and move to a cheaper and better private one.
I won't work for long because of demographic change, but it's an ok starting point
Health care might have cost thirty years ago but not the same degree.
Further, Health care is approaching twenty percent of GDP where once is was less than five. Wouldn't that be large factor in costs? And doesn't that seem a tad less than necessary?
http://www.theatlantic.com/magazine/archive/2009/09/how-amer...
Not that it has anything to do with the main subject, but that is not true. Other countries tax their expat citizens.
http://www.theatlantic.com/magazine/archive/2009/09/how-amer...
Insurance company profits are not the problem.
http://www.health.gov.bc.ca/msp/infoben/premium.html
The West Coast, by the way, is beautiful. Vancouver BC and Seattle WA are practically sibling cities.
Apply for citizenship. We'd love to have you!
Over-regulation, high cost, and impossible to get without an employer or some other kind of large group.
The American system benefits only one group: insurance companies.
This is a common misunderstanding of the economics of this situation. The principle involved here is "Adverse Selection".
To illustrate, let's look at automobile liability insurance. The reason this insurance is so affordable for most americans is that 1) everyone with a car must pay it and 2) there is price competition among insurers.
Imagine for a moment that automobile liability insurance was optional. Who would benefit the most from having this insurance? Accident-prone drivers or non-accident-prone drivers?
That's right - the accident-prone drivers.
And since accident-prone drivers have the most incentive to have liability insurance, you would see the customer pool of the insurance start skewing heavily towards these high-risk drivers.
Then, since it's mostly the high-risk drivers in the customer pool, the number of claim payouts would go dramatically up along with the average payout per claim.
In order for the insurance company to remain in business they would be forced to raise their rates OR to be super strict about not insuring customers that seem risky.
Naturally, the insurance business only works if you have more money coming in than going out. And in order for the insurance to be "affordable" to most people, then the risk needs to be spread amongst most people (not just the more risky ones).
So, while I understand and share your frustration at the current state of health care in the U.S. - it's important to point out "why" everyone needs to be insured in order for the rates to be "affordable".
Of course there are other important variables affecting health insurance premium rates (rising health care costs is a major one), but the "Adverse Selection" issue is probably the most important.
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Another point to consider is that the current big health insurance companies have focused their skill on just a couple things:
1. Avoiding risky customers (by denying them or offering only super-high premiums)
2. Paying out as little as possible (by reducing health care costs and denying claims)
The dynamics of the health insurance market are about to be dramatically changed. #1 will no longer be nearly as important and there will be a huge jump in the size of the market. This will be a huge opportunity for disruption in the industry.
The old health care companies are extremely slow, bloated, and resistant to change. It's easy to see that new entrants will be able to grab significant market share from them and initiate some real price competition.
It's frustrating to have to wait the few years until this happens, but I'm very optimistic about the future (assuming the recent health care reforms won't be diluted before they can be enacted).
All that space for a fallacious argument.
1) Do you really think only sick people want health insurance? 2) Not everyone has to buy car insurance. Only people who drive. High rates will force people not to drive. There's nothing people can do against high mandatory health insurance premiums. 3) We've tried incentivizing people to be healthier seven ways from Sunday but somehow they getting sick. So, like Bullwinkle said to Rocky, "this time fur-sure".
-- The beatings will continue until morale improves.
You can be young, fit and healthy, but get hit by a car and your life is over. Once you're bankrupted by medical fees, you'll never have good credit again - and in the US, this is like the mark of the beast.
It's no wonder that American streets are filled by the homeless and disabled. This is a great country, with wonderful people, but in some ways it's medieval.
Of course, that presupposes you don't need to pay out-of-pocket for major medical care more than once every 5-10 years.
Neither can those of us who live here.
I mean, I can kind of understand the series of historical accidents of how we got here. What I can't understand are the politicians promising to fight tooth and nail to roll back the very minor reforms just enacted, and all of the people who enthusiastically just voted them into office last election, based on that platform.
In my opinion, the "very minor reforms" you mentioned will probably accelerate health cost inflation by subsidizing more consumption of health care goods and offering no incentive for offsetting conservation. They may ease the symptoms for a time, but they will exacerbate the underlying illness.
It's the Republican Party. They serve a certain set of masters. This set of masters is not the everyday Joe. This should be old news. Unfortunately it is not. And yes some folks vote for them that probably should not, but we have a sort of Bell Curve of intelligence and education out there -- though everyone's vote counts exactly the same -- combined with a variety of different levels of empathy for others, combined with a propaganda-rich media environment. This is what happens under those conditions. Ideally, we want to change these underlying conditions.
The vast majority of costs borne by and in the US healthcare system are the results of overeating, oversmoking, and underexercising. Period. Heart disease, many forms of cancer, diabetes, most forms of pancreatic, gallbladder, and adrenal conditions, are largely the result of personal choice.
Setting aside for a moment the fact that congenital defects, hereditary disorders, infections, and accidents are no fault of the victim/patient, it should be important to note that a system that REQUIRES those who take care of their health by eating and exercising properly to subsidize the consequences of the choices of those who do not, is taken by many Americans to be fundamentally unfair.
If legislative initiative were taken to find a way to exclude universal coverage of lifestyle diseases, while still permitting universal coverage of non-lifestyle conditions, many people would not have such a viscerally negative reaction to the notion of universal health care.
In the US you can't leave your job to start your own business because your children might get sick and die. Even leaving for another employer is tricky because there is often a 6-12month gap before the new health coverage kicks in and anything you had treated in the past (like a broken leg in a childhood cycling accident) becomes a pre-existing condition and the new place denies you coverage.
This very effectively reduces wage costs since the whole 'importing people from africa' thing was banned.
As a relatively well-paid (when I wasn't working for myself) Canadian, it just never occurred to me that I might need to stick with a job just for the benefits. I had the freedom to move.
A six or twelve month wait is also unusual on switching jobs. Generally it will take ~60 days from hire for the new insurance to kick in, but rarely more than 90.
Instead I've only had to pay a nominal fee every time I need medication. Surgery, over a dozen MRI scans and visits to specialists over the years plus other tests and whatever else have all been paid for at no cost to me.
It scares the crap out of me to think what would have happened to me if I was in the USA.
To be able to see specialists or have expensive tests at times when I've been lucky to have $5 to my name is something I feel enormous gratitude for. I can't imagine the hardship having to pay for all this out of pocket would cause.
The problem is the government is broke and the health care bill was so bad that many supporters already have exemptions (including a few unions that backed the bill). Worse it really didn't address the big problem of why health care costs so much. It also had unwarranted optimism on cost savings.
At some point, I hope that the government will address: tort reform, drug trial costs, cost of medical training, bulk drug purchasing, "catastrophic" government backed insurance, and better medical savings accounts. I really expect more talking heads yelling at each other first.
"In 2006, 70% of health care spending in Canada was financed by government, versus 46% in the United States."
http://en.wikipedia.org/wiki/Comparison_of_the_health_care_s...
I saw 3 different doctors, including seeking multiple opinions from 2 different knee specialists. I decided not to have surgery right away, and got a brace.
A few years later, my preferred leisure activities changed, so I decided to have surgery done. It took 11 weeks to get an appointment (as it was elective surgery at that point). The surgery was done by an experienced surgeon (a few hundred ACLs under his belt), and he met with me 4 times himself during the following year to follow up on my recovery progress.
Total out of pocket cost was ~$300 for a couple optional recovery devices (icing machine, etc.).
Physiotherapy appointments were, however, covered by my employer's extended medical at the time. That was about $1-2k that I would have had to pay had I been completely uninsured. I probably would have elected for less and cheaper physio care in that case though.
Short version: after reading this article/thread, I'd honestly be scared to join YC in SV, especially now that I have a daughter.
(Side note, I tore my ACL in Ontario and had an initial appt there, but ended up getting treatment in BC. It seems a lot of posts here talk about which state you have coverage in? Is the paid-for insurance not country-wide either??)
I've been self-employed since 2003 and I've never paid a cent in health insurance, I just pay the Medicare levy like everyone else. I didn't pay any money at all for this stay or surgery, and also received free pain medication (endone, oxycontin etc.) upon release.
The surgery was successful and although I still have some pain sometimes, I can walk, run, play sport and do anything else I like.
If only the U.S healthcare system were my broken calcaneus :)
The MRI was on the order of $1200, and another appointment later (this time with a knee specialist), it turned out that I did, in fact, have a torn ACL. By now, however, it had happened nearly a month prior, and the doctor recommended waiting at least two more months for the swelling to fully subside.
Reluctant to make such a big investment and being fearful of such a major surgery, I waited about 9 more months before I finally had the surgery. Since I didn't go to a hospital, the costs were actually reasonably low: ~$2500 each for the facilities, the anesthesiologist, and the surgeon. From diagnosis through final checkup, the cost was about $10K, and I was fortunate enough to have my doctor advise me on personal rehabilitation (I didn't go to a single session of rehab).
So I was lucky to get into a good facility with a good doctor and get reasonably-priced care, and now I'm stuck in a job I don't like with high credit card bills in order to pay off a large cost for a fluke basketball accident. Call me crazy, but I'd be interested in taking my chances in Canada or the UK. I've only just now (a year later) paid off the anesthesia, and I'm halfway done paying off the surgeon.
I'm going to go out on a limb and say money is not an issue for Donna, yet she still can't even buy insurance if she wants to. I've always thought healthcare access was a bigger hurdle for entrepreneurs than tax rates. If I make a lot of money with my startup, great, I really could care less if I pay 15% or 40% of that to the gov't, because it will be a whole lot more than I make now. But not having health care insurance (or worse, having crappy insurance that denies you all the time like most individual plans do) is so damn risky it makes me afraid to step out on my own.
I've thought about this a lot because I could easily be in this situation. If I did anything on my own I would need a group plan quickly. You only need 2 people to create a group.
So you can buy insurance its expensive, here is how you do it.
1) Start a company.
2) Hire another employee (this costs a lot)
3) Make a group health insurance policy for the company.
There you bought insurance.
I know this is stupid, but I'm just the kind of person that when someone says "You can't do XXX" I automatically have to see if I can do it.
Also, if you have a group of 2,5,10 or 20, the insurance company has an easier time denying you because if you get pissed and drop them, its not a big loss for them. In contrast, if you deny the right person at a 10,000 person company, they lose a big account.
My auto insurance company also runs a savings bank for its members and offers loans at markedly better rates than retail banks.
Consumer cooperatives would seem the simplest way to alleviate this issue--no need for additional legislation. To confirm, I live in the US.
If the Republicans are serious about an economic recovery and want startups to flourish, then universal healthcare is a cornerstone of such an effort. I know of other people too who are afraid of leaving their (big-company) positions because they have a wife + young kids, and lack of health insurance terrifies them.
In California you need at least 2 employees to qualify for group coverage. So you start an actual company, perform business (presumably turning in some money to cover your costs), and also get coverage for your dependents. There's one caveat that the coverage does not start until your company has been around for 6 months (unrelated to the pre-existing 6 months figure above.)
Or was the author's post related to (presumably) retiring earlier and specifically not wanting to start a company again?
Mind you, I took the high deductible route since I'm only concerned with catastrophic illness at right now. Also, the moment anything serious comes up, they can cleverly drop me, since they have ludicrous things on their forms like, "have you EVER received ANY medical treatment not listed on this form." It would be essentially impossible to answer that question unless writing about a newborn.
By the way, Blue Cross tried to ratchet up my rates last year. I went back to ehealthinsurance and found a plan for about 25% less than the exact same plan directly through Blue Cross. There is no loyalty incentive whatsoever.
I know that in Canada, if I am sick, I will be looked after. I won't go bankrupt trying to pay for my treatment or trying to pay for the legal bills in a court battle, trying to get my insurance company to pay out.
The American system is so truly and completely fucked, I can't understand why anyone would defend it. Better hope you've got good genetics, good luck and a good lawyer. If any of those things isn't in your favor, one quick illness and your financial life is over.
Do not go through United trying to get them to pay this. Prepare for a day spent on the phone with the hospital until you find the person in the billing or services department who can really get to the bottom of it. They will figure out for you which technicality the insurance company is trying to use and what the correct one is. I had something similar happen and, after a day on the phone, was able to get the incorrect code that was used, how much they were supposed to pay, and what to say to them (this needs to be reprocessed according to X agreement).
From there you need to write a letter to United saying you want the case appealed. Send it certified mail and be prepared for the first response acknowledging your letter and the second one, about 30 days later, with the result of your appeal.
PS: I would have emailed this to you but couldn't find any contact information in your profile.
Actually they can't any more, as the "no rescission" part of the health care law came into effect in September of 2010: http://www.healthcare.gov/law/timeline/index.html
They now have to prove you intentionally misled them about your condition.
EDIT - More detailed link: http://www.healthcare.gov/law/provisions/Curbing%20Insurance...
You're basically paying for the privilege, in the event of a large medical expense, to say, "Don't blame me, I paid for the insurance."
It will make no practical difference, as some of the follow-up comments have already suggested. You're just spared the indignity of those ignorant of the realities of the American health care market (or, worse, fully conscious of them), asking: "Why didn't you buy insurance? There's this website/company I see advertised on cable news all the time where you could have gotten a really reasonable deal. So you've got no one to blame but yourself."
So, you are saying that you are paying expecting to never receive anything back?
It would be nice if there were a similar union for tech entrepreneurs and startup employees... although maybe companies would become worried that such a union would start trying to negotiate for concessions from employers.
I concede that the system is totally messed up and the new health care bill makes it even worse.
Employers shouldn't be required to provide health benefits - eliminate the necessity of group plans.
Open up the state lines, allow insurance companies to compete for your business and watch prices drop dramatically. I'm certainly in favor of some basic oversight but not the egregiously burdensome regulation of the current system.
Anecdotally speaking, I have several friends, colleagues and family from various backgrounds that are doctors and nurses in different states and I have yet to find one of them that agrees the new health care bill is a good idea. They all think it dramatically complicate how they treat patients and ultimately marginalize the overall quality of care they will be able to provide. (Again, this is anecdotal but has definitely influenced my opinion. I have been shocked to find out that not one of these people I know actually support the new bill. Having said that, I know there are those that agree with the new bill.)
After many long hours of paperwork and going through the appeal process (including getting letters from doctors certifying that my minor ailments were unlikely to require expensive surgery) I now have private health insurance. I never would have imagined it would be this hard.
You know what they love most about the bill? It would prevent insurers from dropping coverage. Insurer-instigated billing disputes are the biggest obstacles to health service provider getting paid.
Also, allowing insurance companies to sell across state lines without adhering to the laws of the states in which they are selling coverage violates states rights to control insurance coverage within the state. Insurers can already sell across state lines; the only impediment is that they adhere to the laws of each state.
That said, one family member in particular is a nurse practicioner at a major trauma center. Her primary concern is not the billing disputes as much as the actual quality of care. She feels that her hospital is already inundated with somewhat reckless medicaid requests. She believes that 60% of medicaid patients at her hospital seek medical care that they don't need (e.g., person has a basic headache that some rest or an aspirin would surely cure but instead they actually seek professional medical attention). If that visit were to come at a slightly greater cost, there is no way that person would go to an emergency room for a headache.
It sounds like a dramatic example but she says crazy incidents like this happens every single day, w/o fail. So much so that they track and keep a monthly log that helps them measure their performance. As such, the hospital's resources are strained and their ability to treat seriously ill or injured patients is somewhat compromised. So I think the concern on her part is that the new health care bill actually exacerbates this problem.
I understand that selling across state lines could violate states rights. At the same time, it's too bad that many (myself included) wouldn't trust the fed to be in charge of interstate oversight. In reality, it might be better to have one consolidated standard of mandates but I just can't imagine fed efficiently and accurately providing that type of oversight.
Healthcare really does suck.
After 5 years of service, they get lifetime health insurance, the same as all federal employees and retirees:http://www.opm.gov/insure/retirees/index.asp?MainQuestionId=...
http://www.npr.org/2011/02/09/133629806/16-Freshmen-GOP-Decl...
Still, he rationalizes away the benefits of the new Health Care law:
"But I think that if we had true health care reform that I wouldn't be paying $1,300 a month for this health care. If we had true tort reform, if we had true health care reform where physicians weren't ordering unnecessary, you know, procedures just to protect their backside, I'd think that a lot of us would see a reduction in what we pay in any health care, whether it's, you know, employee - helped, subsidized, or, you know, employer-subsidized."
In case you miss his weasel words: tort reform makes virtually no difference and hasn't had a noticeable impact in states where it has passed. Otherwise, the new law is about the most realistic first step you're going to get passed in this country toward controlling costs. Meanwhile, the one area where the law is halfway decent is in extending more affordable health insurance coverage to more people.
It would have been far better to pass a series of smaller laws. Start with: it's illegal to discriminate based on pre-existing conditions. Then, create cross-state markets and let insurance companies compete across state boundaries. Then, let families buy into the Federal government's health insurance program (if our elected reps can do it, why can't we?). And so on.
The shocking thing is, if you get an MRI at a cash only diagnostics facility it can cost as little as $300.
Things like this happen even to insured people. Due to a communications snafu between the doctor and the insurance company, my mom, who has "good" insurance from BigCo, is paying for her annual mammogram $50/mo now, and will be doing this for the better part of two years.
My parents paid on an ER visit I made in my late teens until I was 21 or 22 because of another such insurance oversight.
These happen all the time because that's how insurers make money. The insurance model is based explicitly on not paying out. For something that's universally utilized like health insurance, that generally means you have to deny a lot of claims to keep acceptable margins.
Homeowner's insurance works fine because most people aren't burglarized often and most peoples' homes don't burn down, so people make modest monthly payments and one claim in a lifetime more than pays for itself. Likewise, car insurance is not used too often by its patrons.
Health insurance, however, is used (at least) several times a year by almost every individual. As such, insurance is a terrible model for health care, since the entire concept behind insurance is that more people are paying for the coverage than are using it. The continued feasibility of medical insurance depends on people not getting medicine.
I am truly horrified by the state of the US health system, sure Australia's might be a bit messed up at times but it is so much better than what Americans have to deal with.
Move your startup to Australia! Seriously, cheap/free heathcare for minor->medium problems (the bad stuff is still going to throw up some major bills but not bankruptcy worthy). As a plus we have a superior economy right now, better living standards and hot women.
Not sure the state of the laws regarding Americans access to our healthcare but worth a look.
Australia has a points based immigration system. If you're younger than 25 and have an engineering degree you just barely have enough points to get a self-sponsored work visa. If you're older than 25 it's impossible to get enough points and you have to work for someone else (or marry an Australian). I'd love to be wrong about this, corrections are welcome.
http://en.wikipedia.org/wiki/Patient_Protection_and_Affordab...
The price of prescription meds, tests, and procedures is "negotiated" between pharmacies, providers, and insurance companies. The Dr. bills "X" and the insurance company comes back with "X/2". The Dr. may try to collect the difference from you, but they usually don't.
If you aren't paying with insurance, you have to pay many times higher prices than an insurance company would for the same treatment.
Last I heard 80% of the market did have some type of coverage. Of the remaining 20%, many of them simply can't pay their emergency room bills. So if you have a decent income and don't have insurance, you are a very small minority with no bargaining power.
In other words, no, you are not able to purchase health care in any sort of functioning market.
And, in practice, if you tell the provider that you can only pay X, it is quite possible that they will prefer getting X to getting 0.
If patients were actually paying the bills, they would be much more price-conscious and you would see price competition on that stupid-expensive MRI (for evidence, look at how much cheaper LASIK surgery has become and how much better it has become, yet insurance does not cover it).
Doctors, on the other hand, are far more concerned about making sure the people paying the bills are taken care of. The proof that you aren't the customer is the 90 minute wait that is expected when you see a doctor. What other industry would force their customer to wait that long after making an appointment? But, since you are not the customer, that's OK, isn't it.
Having had a gastric bypass, I will never be able to get insurance outside of a group plan. My wife can't get coverage for other reasons. One of my four kids can't get coverage, either. I'm 9 months into my COBRA for the start-up I'm working on. If we don't have a group plan in the next 6 months, I will have to bail on the company.
And our government can't even bother to have a real dialog on the subject. Pisses me off.
Unless you're bringing in the cash hand over fist, it's just not a feasible proposition for an entrepreneurially-minded patriarch with multiple uninsurable family members to stay in the US. Your options are basically to totally ruin your credit constantly and eventually be banned from all nearby medical facilities or pay $15k+ each year for medicine. It's plausible (though not very likely with four kids) that there may be a couple of relatively quiet years medically, and then you can only hope that you don't end up paying more than $10k in bills that year. With every X-ray, mammogram, MRI, or other routine imaging procedure costing $500+, and a fifteen minute appointment costing $100-$200, it really adds up.
For a multi-millionaire it's doable, but pretty difficult for anyone else.
The most expensive MRI bill for someone in the "mutualism" system here in Uruguay is U$ 100.
I tried to explain the Uruguayan "mutualist" socialist health system here:
http://news.ycombinator.com/item?id=1627862
"Mutual organisations do not have external shareholders - they are controlled by their members. Members may be users of the mutual, employees, other stakeholders or a combination of these Mutual organisations are either owned by and run in the interests of existing members, as is the case in building societies, cooperatives and friendly societies, or, as in many public services, owned on behalf of the wider community and run in the interests of the wider community"
A HN member compared them to credit unions, I think it's a valid analogy.
The mutualist system is always near bankruptcy and is perfectible (and the government is always meddling), but it doesn't bankrupt it's users and it kind of works (life expectancy here in Uruguay is the same as in the U.S.).
Edit - funnily, it seems it's very similar to the Japanese case (and MRI's cost U$ 98 there too):
Private health insurance then allows you to get the frills and to do so without waiting.
If you have private cover and need surgery to treat a non life-threatening issue, then you can usually get it done almost immediately. If you don't have private cover, you may be waiting for years.
Still, in US terms, our private cover is very cheap. I'm a single, non-smoking, exercising male, 30 years old. I pay about $1200 a year with a $500 gap. But I also pay $20,000 in taxes, a goodly portion of which make their way into the public health system (and far too much of which goes into middle class welfare, but that's by the by).
I have insurance and the insurance company (BCBS) will only pay what it thinks is appropriate for a service, not some negotiated rate. That is, if the doctor, hospital, or lab says that it costs $1,300, but the insurance company wants to pay $700, I'm stuck for the other $600. The result is that in order to meet the high deductible (at which point I no longer have to pay out of pocket like this), I pay way beyond the amount of the deductible since only the approved rates are applied. In practice, I end up paying out 175% or more of the deductible amount.
I suspect that our experience will soon become the norm, if its not already.
A friend (a plumber) told me the other day that he was really struggling to afford insurance for his family because his premiums had more than doubled as well. He said he had incurred 3 rate increases in 3 months.
I'm just curious how many people have seen any benefit yet from health care reform? I know most of it doesn't go into effect until 2014. But something is seriously out of whack here.
So yes, people have seen benefits.
Edit: Apparently you need to go through Google for this to work. See comment below.
Japan spends $2249/per capita on healthcare. The UK spends $2317/per capita on healthcare. Sweden spends $2745/per capita/yr on healtchare. You get the idea.
You are already paying the government for healthcare. You pay higher taxes to offset the loses for the health insurance deduction. The IRS collects medicare along with the Social Security.
However, you don't get the healthcare you pay for. Instead, you have to pay again to actually get healthcare. In some countries, they call this a bribe. However, America has institutionalized it.
We're struggling to make ends meet here; our clients are good and we're trying to build a steadier base, but the pay is irregular and sometimes we have trouble meeting monthly obligations.
They make it such a hassle to do anything and they rip us off so hard (providers and insurers alike) that we usually just don't pay our medical bills except what we have to pay up-front. It's too much crap to deal with, the insurance always makes up a reason not to cover things, and it's absurdly expensive. Every time we have tried to pay the people have come back saying we'd owe literally 10x more than they we were originally told we would owe. It's just not worth the headache or the hassle, much easier to silence unrecognized numbers from bill collectors and let their corrupt and evil system rot in on itself.
We don't really have the option of not getting health care and dying, we don't go to the doctor for fun, we only go when we have to.
Unless you have cancer, heart surgery, or some other major thing, and are in good health you'll save far more over buying a lower deductible plan.
We used to have reasonable insurance, but the annual increases have been enormous, without any claims.
More people will drop insurance, leaving the companies with only the sick, if they keep pushing younger, healthier people out of the system.
In one case, I turned down what was clearly a great hacking gig with a hacker whose work I really respected. The root issue there was that not only was the position a lot less in salary than I was previously making (this was fine and known when I started looking into the job), but the huge cost of obtaining a private policy for myself and my family blew me away. I was quite naive and assume I would be paying a small multiple more (2x or 3x) but the numbers looked to be at least double that.
So, the cost of health insurance prevented me from taking a pay cut to do more interesting work. Of course, the employer was pretty strapped, if they had higher money to offer, I would have been all over it. The private health policy costs just took me by surprise.
Luckily, the company nearly tanked and let me go along with my entire department. I've been a self-employed consultant since then (almost 3 years) and went without insurance for about a year just so I could afford to pay for my wife and kid.
Then I figured out some hacks. I found a startup health practice called Qliance in Seattle which Michael Dell, Jeff Bezos and Drew Carey have funded (nice article about it here: http://www.techflash.com/seattle/2010/04/jeff_bezos_michael_...).
For about $50/month each for my wife and I and $40 for my kid (total of ~$140) were able to see a doctor any time we wanted for non-emergencies without co-pays.
I can't tell you how much weight this was off my back. Staff was friendly, service was great, modern offices, experienced doctors. Couldn't have asked for more. We got a high deductible family plan along with it which added about $200 to the costs. If you are in the Seattle area and are self-employed, this is probably your best option.
The second hack was that we moved to Japan about a year ago. As others have mentioned, they have a very consumer-friendly system over here. I had a big health scare when we first moved which required lots of medication and several doctor visits, but it didn't set us back more than a couple hundred bucks.
I'm really worried about moving back to the US now. I hope things get better before we move back in a couple of years.
And on a related note, I have noprocrast enabled so apologies for the n00b-looking account, real uid = andrewpbrett. Someone alerted me that this was being discussed.
Hell yes. While we're at it, lawmakers should be required to do their own taxes at least once every few years as well.
In terms of systemic change, I think requiring our legislators to eat their own dogfood would do much more for our country than all of our disjointed attempts at campaign finance reform and the like.
On the other hand, I do think that the lack of these other costs is one reason that we have some of the highest house prices in the world. When you take away these other costs people just devote their disposable income elsewhere. Even so, I think it's better used that way than paying executives in health insurance companies.
Because I suspect it will do little for serious health problems. IF they can pay for it, all it will do is prevent the insurance companies dropping her when she gets sick someday or stop paying out when they hit a limit like on cancer.
I say that's not a lot because they ARE allowed to raise the premiums so high that the patient has to drop the insurance on their own because there's no way to for it.
So the legislation is useless for the serious stuff.
The revolutionary technology already exists: telemedicine (TM) through live video conferencing, store & forward of image data for dermatology, radiology, or ophthalmology, home health monitoring, wearable monitoring systems, online health management systems, personal health records, genome sequencing, its all here! So what's the problem? Doctors can't get paid for any of this.
Despite common belief, doctors don't get paid that much, particularly doctors that work in the public setting and must deal with Medicare (and in California, MediCal) patients. If a neurologist in San Francisco sees a Medicare patient in Los Angeles through video conferencing they can't bill Medicare because LA is not a non-Metropolitan Statistical Area. No doctor wants to deal with dismal MediCal rates. There are little to no codes to bill for home-based monitoring, and if even those exist, there is no code for a specialist to diagnose remotely. We have 30 years of academic literature praising TM. So who's holding everything up?
We need a new insurance company that focuses on TM and monitoring technologies from the start to usher in what everyone and their mom has been describing as "preventive" healthcare. Sure, we'll still need traditional methods for surgeries and catastrophic events, but I'd pay out of pocket to be able to forward an image of a rash to a dermatologist or the back of my throat to my physician any day. Fast, instant, convenient.
Someone in the comments mentioned Qliance, which looks promising. I'm surprised someone in SV hasn't taken advantage of something similar there. Geeks love to be on the cutting edge, why not be the cutting edge medical patient?
The present system is designed to impose a huge negative externality on would-be entrepreneurs and others who might have left their jobs to pursue other opportunities. And you are subsidizing the profits of the industries that benefit from the relative immobility of labor. That negative externality you pay is someone else's subsidy. If it were up to me, I'd rather pay into a universal health care system than pay the negative externality to stay tied to an employer on account of health care coverage.
Another negative externality is the administrative burden imposed on companies to handle employee health care.
I agree that the system is broke here.
Some people are getting medicare others are getting medicaid, others have benefits from the VA or a government job. Others get it from unions or employers. Only the people who are responsible for paying their own bills truly understand the state of our health care industry.
Because of that it is always someone else's problem and no one really minds paying 48k for 2 nights of saline drip in the hospital when the only cost to them is the 500.00 deductible. The hospital collecting the 48k certainly does not want that to change neither do any of the other predators in that food chain.
Put a high tax on employer sponsored insurance plans so that all employers stop offering it as a benefit. Then we will see real reform.
My health insurance (not from US) has worldwide 100% coverage, except for the US. To get a US coverage, I would have to double what I am paying now.
The US health system is twice as expensive as any other health system in the world.
I moved back to the UK and now enjoy the wonders of the NHS and this was one of the biggest reasons I left since I really didn't want to lose my house to pay medical bills if I got seriously ill.
It is broken. Seriously broken.