[HN Gopher] Show HN: Healthcare Is Dumb
___________________________________________________________________
Show HN: Healthcare Is Dumb
Author : antcas
Score : 197 points
Date : 2020-08-28 19:54 UTC (3 hours ago)
(HTM) web link (healthcareisdumb.com)
(TXT) w3m dump (healthcareisdumb.com)
| padseeker wrote:
| this is kinda brilliant.
| legitster wrote:
| Looking at the first plan on the list, Auburn:
| https://www.uhcsr.com/uhcsrbrochures/Public/BenefitSummaryFl...
|
| On first blush, this looks like _phenomenally_ good coverage for
| the cost. $1970 for the year. $7150 out of pocket maximum. 80%
| coinsurance after a $250(!) deductible.
|
| The ACA limited how much cost discrimination insurance companies
| can do by age, and I am wondering if college plans are a
| workaround - it's not _age_ descrimination, per-say. But the risk
| associated with students is much, much lower than on the
| marketplaces.
| antcas wrote:
| College plans are considered "special-risk" plans and therefore
| aren't obliged to follow ACA guidelines at all.
|
| So they can do tricky stuff ACA banned like have low lifetime
| maximums, exclusions, and kick you off the plan when you drop
| out of school because you're too sick.
| lotsofpulp wrote:
| It is age discrimination. People who were silo'd in employer
| plans and other lower risk pools than the general public were
| incensed they would have to help pay for everyone's healthcare,
| so they lobbied to be exempt from ACA.
|
| It's a major hindrance to proper insurance mechanisms when your
| healthiest lives aren't on healthcare.gov. Ideally everyone
| would be forced into the same marketplace subject to the same
| sick and healthy lives proportions so the costs are spread out
| evenly.
| dusted wrote:
| $500/MONTH is considered cheap? gosh damn, I'm sorry USA but you
| really, deeply fucked yourself over on this one..
| antcas wrote:
| yea, it's pretty dumb
| rossdavidh wrote:
| While I am not one to subscribe to the "Europe does everything
| better"-style thinking of U.S. progressives, the reality is, in
| this particular field, there is absolutely no way to defend the
| U.S. system.
| RandallBrown wrote:
| How much do you pay per month for health insurance where you
| live? (Or if you don't know, how much does your country spend
| per capita on healthcare?)
|
| My wife and I pay way less than $500/month, but her employer
| pays some of it so I'm not sure what the total cost is. When I
| was looking for it on my state's healthcare exchange it was
| also considerably cheaper than $500/month, but then since I was
| unemployed at the time, it ended up being free.
|
| Healthcare in the US is a real problem that needs to be
| resolved, but it's not a simple situation.
| CogitoCogito wrote:
| > How much do you pay per month for health insurance where
| you live? (Or if you don't know, how much does your country
| spend per capita on healthcare?)
|
| The cost per capita in the US is apparently 85% than in
| Sweden [0] while the gdp per capita in the US is only around
| 27% more than in Sweden [1]. I'm not sure how
| current/accurate those numbers are, but they do fit in with
| everything I've read over the years.
|
| > Healthcare in the US is a real problem that needs to be
| resolved, but it's not a simple situation.
|
| I don't really understand this sentiment. There are so many
| other systems to look to for comparison. If you mean that
| powerful entrenched interests that would stand to make less
| money and they are hard to fight, then sure that's hard, but
| it's not like we don't know better systems. They are
| everywhere if we choose to look. I think the main problem is
| that too many Americans seem incapable of recognizing that
| the system there really is worse than many high-tax socialist
| countries. They don't really have any reason to believe this,
| but they know this deeply in their heart. It only hurts the
| US and plays into the hands of the aforementioned entrenched
| interests (which to be fair certainly work hard to propagate
| the lies that Americans later believe).
|
| By the way, I'm both an American and Swedish citizen. I was
| born in Sweden, lived most of my life in the US, and am now
| back in Sweden. I definitely identify more as American than a
| Swede. In my experiences of the US and Swedish systems I'd
| take the Swedish one (i.e. the cheapest setup without any of
| the possible extra insurance which can be purchased extra
| here) over the US system any day of the week. I think the
| Americans who have knee-jerk reactions against "socialized
| medicine" are either totally ignorant or deluded. It's sad.
| Such self-defeating attitudes weaken American as a nation.
|
| [0] https://www.businessinsider.com/personal-finance/cost-of-
| hea... [1] https://en.wikipedia.org/wiki/List_of_countries_by
| _GDP_%28no...
| jimbokun wrote:
| That...is actually kind of clever.
|
| Wonder how long before these loopholes get shut down.
| antcas wrote:
| In the ideal world this loophole would be made irrelevant by
| universal healthcare.
|
| Realistically the minimum credit hour requirements might be
| increased at some schools, but otherwise if you take advantage
| of this system you're pretty much using the system as designed.
|
| Insurers already account for the fact that healthy and insured
| students are less likely to opt-in for their student health
| plans.
| lotsofpulp wrote:
| That was the ideal with ACA (since taxpayer funded healthcare
| is such a bad word for many US voters), but the voters got up
| in arms about having to pay for others' healthcare so they
| got to keep their silo'd school/church/employer health
| insurance pools.
| kyuudou wrote:
| Sadly it shouldn't be considered a "loophole" as society gets
| an individual looking to educate themselves (since
| realistically you'd have to try hard enough to not get kicked
| out so you're bound to learn useful things) that is also
| health-insured. Right? That's what I think, anyway.
| finaliteration wrote:
| While I think this project and the data are interesting, one
| thing that becomes problematic is that you actually DO have to
| invest time in whatever courses you register for at most colleges
| and universities (or at least the ones that I've seen).
|
| Generally, if you aren't making adequate progress in a course,
| you can be dropped by the instructor mid-semester/quarter or
| placed on academic probation, both of which can cause you to fall
| below the minimum number of credits needed to be eligible for
| healthcare coverage.
|
| So while you may save some money on health insurance, you lose a
| potentially large amount of time due to having to keep up with
| coursework to maintain eligibility.
|
| That being said, this may not be a problem if they are courses
| you are actually interested in and can dedicate time to
| completing.
| rossdavidh wrote:
| True that, but in many cases, if you just need to stay enrolled
| and don't have the stress of needing a good grade or to juggle
| a full load, it could be just eating into your TV couch potato
| time, be way more interesting and rewarding, and be a win as
| well. Depends on how much you have to take to get the
| insurance, though.
| nip180 wrote:
| Funny, I was thinking that the opportunity to spend time in
| classes sounds like a win. I'd love to brush up on discrete
| math and take a bowling credit for the next five months.
| antcas wrote:
| 100%
|
| This works out best if you're taking classes that are relevant
| to you so that you're getting value from the time spent as
| well.
|
| Otherwise your goal should be to find the easiest most phone-
| in-able class possible.
| ethbro wrote:
| > _Otherwise your goal should be to find the easiest most
| phone-in-able class possible._
|
| Thanks, COVID!
| alanbernstein wrote:
| Take big engineering classes at a state school, nobody will pay
| any attention to you.
| antcas wrote:
| I built a spreadsheet showing how many credits you have to take
| at a school to qualify for their health insurance plan. In many
| states, the cost of taking the class + health insurance costs is
| actually lower than monthly premiums for a plan within the state.
| [deleted]
| deegles wrote:
| What would this do to the university or state's finances if a
| ton of people did it? Would it make budget shortfalls? Or do
| insurance companies just make less from those plans?
| vonmoltke wrote:
| I suspect more schools would adopt schemes like Rutgers. They
| charge part-time students over twice as much as full-time:
| https://riskmanagement.rutgers.edu/student-
| information/rates...
| pitaa wrote:
| So I've had some limited involvement university fee
| structures and their health clinics. I actually had a
| conversation with the director of one about these plans. He
| explained:
|
| * The university already has the clinic that is funded by
| student fees and a bit from the university general fund
|
| * Uninsured students are seen for free and just pay for
| supplies used ($10 for a lab test, $5 for an xray, etc)
|
| * They wave all copays for students with outside insurance
|
| * For students on the student insurance plan, they are
| expected to use the clinic for general/minor needs. In these
| cases, the university agrees to eat the cost and not bill the
| insurer.
|
| So all the insurance company is paying is major medical
| expenses for services not rendered by the school. Its just
| like large companies that have an on site clinic to save on
| their premiums.
|
| So technically, it does end up costing the school a bit more
| if students buy the insurance through them because the school
| pays for all the supplies that they would normally be
| reimbursed for. If more student use the clinic, the
| university will end up having to expend their budget. But in
| comparison to how much money the university already bleeds,
| the clinic is a pretty minor cost. I think the whole clinic
| costs less to run than they pay their athletic director.
|
| One interesting side note was regarding students that have
| outside insurance. Many times, they don't even bother billing
| the insurance if its just an office visit. Because medical
| billing is such a mess, they realized that it was actually
| costing them money to pay someone to deal with it when the
| insurance will only pay them ~$40 anyway. So they'll only
| bother if there are additional procedures and they expect a
| reimbursement >$100.
| antcas wrote:
| Both the school and the insurer would make a bunch more money
| in the short-term.
|
| Might bite the insurer's in the long term if a bunch of sick
| people sign up, but very sick people don't tend to stay in
| school.
| alanbernstein wrote:
| Perhaps college plans are inexpensive in part because those
| insured are generally younger and healthier than the overall
| population? If a representative sample of the general
| population did this, presumably the prices would adjust
| upward.
| antcas wrote:
| This is part of it, however there's positive price pressure
| from "anti-selection".
|
| Basically healthy young students are more likely to already
| be insured or be on their parents plans so they opt-out
| more frequently.
|
| Wrote a thread with more deets the other day: https://twitt
| er.com/AnthonyCastrio/status/129870277198685798...
| IshKebab wrote:
| Perhaps, but I think it's more likely just price
| differentiation the same as any other student discount.
|
| Plus universities have better negotiating power than
| individuals.
| [deleted]
| vonmoltke wrote:
| Any idea what level of coverage you get for these rates? It's
| hard to compare these options to exchange plans, some of which
| are significantly cheaper. I tried doing it for Rutgers, but the
| site they use won't let me see plans without a student ID number.
| antcas wrote:
| Most of the plans you can find on the school website's with
| some digging.
|
| Some common gotcha's are low lifetime maximums and exceptions.
| Also, the the sickest students are most likely to drop out of
| school and lose their coverage.
| jamestimmins wrote:
| It's wild that less than $500/month for health insurance is a win
| in the United States
| nicoburns wrote:
| For comparison, in the UK we spent PS197.4 billion in 2017, or
| approximately PS2,989 spent per person [0]. Which works out as:
|
| ~PS250/per person/per month. Which is $330. Or $350 adjusted
| for inflation since 2017.
|
| That covers _everything_ : emergency room, ambulances, giving
| birth, cancer treatment. Everything: no copays (except very
| small ones (<PS10) for prescription medicines). And it covers
| the entire population.
|
| * Except dentistry. For some reason that is separate.
|
| [0]: https://www.ons.gov.uk/peoplepopulationandcommunity/health
| an....
| garmaine wrote:
| To compare apples to apples, note that the American number is
| just the premium. In my case for example, I need to spend an
| additional $6800 before the insurance kicks in and starts
| paying out.
| maxerickson wrote:
| It's more complex than that. Certain services are built
| into the premiums.
|
| An annual primary care visit, cancer screening,
| vaccinations, and so on. So for example if you have medical
| need for a colonoscopy, it will be covered before the
| deductible has been met.
| garmaine wrote:
| Yes, but in a system with national health case, the
| preventative care would be covered as well.
| gnopgnip wrote:
| Preventative care is covered in the US as well, at no
| cost
| bhupy wrote:
| You think that's cheap? Singapore's total per capita health
| expenditure in 2017 was $2,619[1] per person per year, or
| $219 per month.
|
| It's just about the lowest per capita health expenditure in
| the developed world.
|
| [1] https://knoema.com/atlas/Singapore/Health-expenditure-
| per-ca...
| tyoma wrote:
| Its also fascinating to note that US _public_ spending on
| healthcare is greater than the UK, both in terms of absolute
| numbers and as share of GDP [0].
|
| [0]. https://www.bbc.com/news/uk-42950587
| nicoffeine wrote:
| The not-so-secret reason the business community is fighting
| single payer in the US is because 18-20% of our economy
| depends on the healthcare industry. A good portion of that
| is paper shuffling, marketing, accounting, and related
| middle/upper management -- they would serve no purpose in a
| system where you show up with identification, prove you're
| a citizen, and then get healthcare. So single payer means
| maybe 8-10% of the country is out of a job.
|
| That's why Medicare/Medicaid is cheaper per person even
| though they serve the poor and elderly.
| jdeibele wrote:
| My mom worked very hard and well for a company that
| administered benefits for union employees. The way that
| things worked would be that if you worked at least a
| certain number of hours in January you would have medical
| insurance coverage in March. But not February. If you
| worked the required number of hours in February, you'd be
| covered for April. And so on.
|
| In going through her things after she died, I found
| letters to her bosses about how well she'd treated the
| plumbers, electricians, etc. I know she would take work
| home and do it off the clock.
|
| What was really unfortunate, for me, is believing that
| her job shouldn't exist. To me it's crazy the expenses we
| have a universal healthcare system.
|
| Of course, that also applies to avoiding taxes, etc.
| There was an attorney interviewed on a recent podcast
| about tariffs - he specialized in finding things like
| shipping bikes from China without tires and the tires
| from Vietnam would be much less in tariffs than just
| shipping from China.
| cortesoft wrote:
| Sometimes I wonder if the way to make changes in these
| sorts of industries (with a powerful rent seeker that
| prevents change... e.g. health insurance, tax prep, etc)
| is to bite the bullet and just agree to bribe them...
| say, "we are winding down private insurance... we will
| pay you guys what your profit has been each year,
| diminishing each year, for the next 10 years. You can
| take that money and try another industry."
|
| It might seem expensive and wasteful, but it might be
| better than the status quo.
| SL61 wrote:
| Not trying to draw too much of a comparison here, but
| Britain did this when they formally abolished slavery.
| It's still very controversial today, but it _did_ thwart
| the opposition to abolition among Parliament 's pro-
| slavery lobby and plantation owners, particularly in the
| Caribbean. Paying off health insurers for years' worth of
| profits would be _very_ expensive, but on the flip side I
| doubt it would be as unpopular as the slavery payments.
|
| https://en.wikipedia.org/wiki/Slave_Compensation_Act_1837
| Red_Leaves_Flyy wrote:
| I believe that's called a transition period and we saw
| how it worked with Obama care.
|
| We could also drag the obstructionist leeches into the
| capital and roast them like Jim gaffigan just roasted
| Karen.
|
| When someone's abusing an entire country you don't pay
| them to stop, you throw them in jail. People are dying
| are dying by the truckload and we care about
| silvestrov wrote:
| > maybe 8-10% of the country is out of a job
|
| what do all these people do in the UK, Scandinavia and
| other countries with single-payer health care?
| nicoffeine wrote:
| They work in small businesses or for themselves[1]
| because they don't have to worry about health insurance.
| Or they become a teacher[2]. Or they don't have to work
| at all because they are raising kids or getting a better
| education - again, because they don't have to worry about
| health insurance.
|
| Eventually, they would join other parts of the economy in
| the US, but in the short term, the unemployment rate
| would spike and the economy in general would suffer.
|
| [1] https://www.cepr.net/documents/publications/small-
| business-2... [2] https://www.nationmaster.com/country-
| info/stats/Education/Se...
| Spivak wrote:
| Hopefully something more useful but the point is that
| nobody wants to be the administration that created 10%+
| unemployment overnight and the ensuing ripples.
| bhupy wrote:
| Just the tax subsidy for employer-sponsored health
| insurance costs the Federal government $273 billion per
| year: https://www.taxpolicycenter.org/briefing-book/how-
| does-tax-e...
|
| The US healthcare system is a Rube Goldberg machine.
| CraigJPerry wrote:
| The median salary in the UK is PS24,400 (ONS, 2018)
| +PS2,033 paid per month -PS 149 national insurance
| (healthcare, welfare, etc.) -PS 198 income tax
| =PS1,686 take home pay (=$2,224)
|
| The median salary in the US is $49,764 (BLS, 2020)
| +$4,148 paid per month -$ 317 social security
| -$ 357 federal tax =$3,474 take home pay
|
| =$1250 per month in favour of the US median earner.
|
| $1250 per month should go a fair way to covering health
| insurance premium, deductible, co-pays & drugs (these are all
| PS0 in scotland)
| notJim wrote:
| For comparison purposes, it's useful to think of things
| like retirement contributions and healthcare premiums as
| taxes, even if they're not formally taxes. There is an
| article comparing this across countries that argues that if
| you take this view, US taxes are actually pretty high,
| because our health insurance is so expensive.
| https://www.peoplespolicyproject.org/2019/04/08/us-
| workers-a...
| BeetleB wrote:
| For national financial comparisons - sure.
|
| The real difference, of course, is that taxes will ensure
| you're covered even if you're low income.
| bhupy wrote:
| In the US, you're already covered if you're low income,
| through Medicaid and ACA subsidies, that's part of where
| the current taxes go. It's certainly debatable if the
| existing programs are optimally structured.
| CraigJPerry wrote:
| Do you get the same level of cover when you're low
| income?
| bhupy wrote:
| Ironically, you get some of the best coverage when you're
| low income, since Medicaid is so generous.
| notJim wrote:
| You can also make the taxes progressive, so wealthier pay
| more. I'm also not sure if this looks at total costs or
| only premiums. People don't go bankrupt or have surprise
| bills [1] for medical reasons in other countries the way
| they do here.
|
| [1]: https://www.marketwatch.com/story/1-in-5-americans-
| get-hit-w...
| excalibur wrote:
| > Except dentistry. For some reason that is separate.
|
| Would the reason be that British teeth are maintained like
| American waistlines?
| nicoburns wrote:
| It might be part of the explanation, but I think it's also
| cultural. People just don't care about good teeth here the
| same way that they seem to in the US. Or rather: they have
| a different idea of what good teeth are. If your teeth are
| actually black or rotting or missing, then that's seen as
| bad. But a little crooked or yellow is mostly seen as
| normal.
| anadem wrote:
| Teeth seem in the USA to be a class marker, where in the
| UK class markers are different (used to be accent when I
| lived there aeons ago).
| nostromo wrote:
| It really depends. If you're single and under 40 it's not so
| bad.
|
| But if you have a partner, kids, and are a bit older then
| suddenly it can be quite expensive.
| bfrog wrote:
| I mean, even if your young its ridiculous. I'm mid thirties
| now with a wife and kid, healthcare costs are double my
| mortgage. For the highest deductible I can get. None of us
| have any illnesses or do anything other than see the
| physician on the usual prescribed basis. It's insane.
| treis wrote:
| You've got much cheaper housing or much more expensive
| insurance than the average person.
| garmaine wrote:
| His numbers seem correct if you assume national-average
| housing costs, not Bay Area figures. Which is fair
| because the insurance cost does not vary much between
| locales.
| lotsofpulp wrote:
| It's because you're not paying for your healthcare when
| you're young.
|
| Health insurance is just a tax, with the premiums going
| towards paying for healthcare for the sick and elderly (in
| the US, people 55+).
|
| ACA specifically capped health insurance premiums for the
| elderly as a multiple of a 21 year old's premiums.
|
| Otherwise health insurance premiums for 20 year olds would
| be $30 a month and $3000 a month for 60 year olds.
| antcas wrote:
| Also FYI to anyone reading this, these plans are all
| individual-rate plans but many also offer family or spouse
| plans for not that much more.
| antcas wrote:
| It's pretty dumb tbh
| asdasfasdfasdf wrote:
| I pay $1200 a month for my family and don't even really get to
| use it for anything but routine checkups (which I still pay
| $30/ea for) until I hit my $5k deductible (and to another
| extent, the $8k out-of-pocket max).
|
| A few times a year I spend an hour on the phone arguing about
| coverage or an incorrect billing code.
|
| This is all for peace of mind that if I get hit by a car or
| fall off my roof that I won't instantly be ruined by debt.
|
| In the event of one of those accidents I fully expect to have
| to _fight_ the company I pay over $10k a year to actually
| provide that "I'm broke but at least I'm not bankrupt"
| coverage.
|
| Oh also, we need a separate plan to insure our teeth for some
| reason and most plans only cover $1500 a year. I needed to get
| my wisdom teeth out and ended up splitting it over two years so
| I didn't have to pay the full uninsured price.
|
| Our "liberal" presidential candidate is painted as "radical" by
| the current president, and said "radical liberal" has said on
| multiple occasions that "people love their insurance"
|
| I've considered trying to move to another country simply
| because of healthcare. I am immediately skeptical of anyone who
| thinks this is a reasonable system.
| war1025 wrote:
| And then think about how it shakes out for a family plan.
|
| Health insurance in the US is an untenable situation and I
| really just hope it explodes sooner rather than later.
|
| The biggest issue, in my opinion, is how much of the cost is
| shielded by employer contributions that no one ever thinks
| about.
|
| This makes it too easy for people with good employer-sponsored
| health insurance to scoff at and dismiss all the people who
| aren't in that situation.
|
| When your employer is shouldering $20k in health insurance
| premiums without really telling you, it's easy to feel like the
| costs aren't a problem.
| koolba wrote:
| It's a double whammy because the employer gets to deduct 100%
| of their contribution but the little guy buying it on the
| open market has to use post tax dollars.
| zrail wrote:
| Which is _bullshit_. Everyone should be able to deduct
| their out of pocket premium costs.
| zbrozek wrote:
| Or better yet, nobody.
| zrail wrote:
| Yeah either way. The playing field should be level.
| hooande wrote:
| last I saw, roughly 80% of people in the US have employer
| provided healthcare. In a democracy a 20% minority has to be
| VERY vocal
|
| edit: I was incorrect, this is 80% of people get healthcare
| from their employer OR the government. Only 20% of people are
| responsible for paying for their healthcare separate from
| their employer (if they have one)
| garmaine wrote:
| Is that number out of the total of insured people? Because
| I guarantee you there are a LOT of people that faced with
| that choice _don't_ get insurance.
| runako wrote:
| That sounds fishy given the huge numbers of people covered
| by Medicare, Medicaid, and the VA.
| NationalPark wrote:
| That must be 80% of people who have insurance and work full
| time. Something like 30-40% of Americans are on medicare,
| medicaid, or both.
| coding123 wrote:
| I think that's where the scam sits. The cost is not being
| driven by the cost of actual healthcare anymore. It's being
| driven by how much companies are willing to pay for each
| employee. So instead of companies just paying the employees
| more per year, they're paying an insurance company about 10%
| to 20% of their salary.
| javajosh wrote:
| Well, I think the actual problem is that there is no
| downward pressure at all for healthcare costs. And in fact
| all pressure is all upward, starting with the provider and
| the small network of sub-providers they represent. The
| complexity of billing allows the provider to "not know"
| what their own services cost! So anyone who complains is
| considered a cheapskate trying to skimp on their own
| health, or worse, on someone else's.
|
| Its horrible. I had one billing department lady in the US
| literally tell me when I complained about the exorbitant
| cost of a simple ER visit (in the thousands), "Well, how
| much is your life worth?" After the steam stopped coming
| out of my ears, I was able to come back with: if that's
| your position, then why stop at 5k? Why not charge 50k? Or
| 500k? Why not take everything I have or will ever have? She
| didn't respond, and just looked at me thoughtfully, as if
| I'd just given her a really good idea.
| Red_Leaves_Flyy wrote:
| That lady is in the wrong line of work.
| lotsofpulp wrote:
| The scam is that employers get to purchase the insurance
| with pretax money, whereas a person whose employer doesn't
| offer health insurance gets to purchase it with post tax
| money.
| nickjj wrote:
| > When your employer is shouldering $20k in health insurance
| premiums without really telling you, it's easy to feel like
| the costs aren't a problem.
|
| Yes and this makes it really suck if you happen to be a sole
| proprietor or self employed.
|
| It's over $500 a month here to get insurance for a single
| adult for the absolute most basic insurance possible with the
| worst possible service you can expect.
|
| I don't understand how society puts up with this. It's not
| that just the service is horrible and massively over priced
| but it's a torturous experience just to interact with
| anything related to medical insurance. Like having to wait 30
| minutes on hold or spending weeks trying to resolve things,
| or spending a month trying to find a doctor who even takes
| your insurance, etc..
|
| Suddenly instead of getting the best treatment plan for your
| issue, it becomes a game of trying to extort you for doing
| the minimum amount of work while making sure you pay as much
| as possible out of pocket while already paying for insurance.
|
| And then on top of that, it's like btw, $500 / month please
| or you run the risk of being bankrupt if you step foot inside
| of a hospital for anything that's non-trivial.
| iagovar wrote:
| In my outsider opinion, aside from very complicated
| legislation, it seems that your main problem is that you
| don't have a public, universal and suficiently competent
| competitor.
|
| In Spain private healthcare is somewhat affordable, even full
| coverage plans, because everyone can walk away any moment.
|
| AFAIK the situation is very similar in many other countries.
| MrFantastic wrote:
| That's just for insurance. You still going to be paying 20% of
| the actual medical bill. You can easily run up a $100k bill in
| a week.
| maxerickson wrote:
| Under the ACA, out of pocket maximums are ~$8000 or $16,000
| (individual/family).
|
| That leaves care that doesn't get covered by insurance of
| course, but people aren't on the hook for 20% of the bill
| that insurance covers.
| TuringNYC wrote:
| It is only a "win" in a very general sense if you just need
| catastrophic coverage.
|
| You cannot really judge a win w/o seeing what is/isnt covered,
| co-pays, deductibles, co-insurance, networks, and a variety of
| other factors.
| oneplane wrote:
| All of that just points out how bad it is, even with
| 'insurance'.
| TuringNYC wrote:
| Exactly. One of the really bad things about US health
| insurance is that you dont know how bad it is until you
| have a John-Q type event
| (https://en.wikipedia.org/wiki/John_Q.) or a difficult
| pregnancy or a surgery.
|
| Healthy people go in for annual visits and think "wow, this
| is great" not knowing what exception scenarios are like.
| Then people vote for politicians who uphold the status quo
| thinking everything is fine.
| oneplane wrote:
| Not sure where I read it, but a theory was that since
| there is some sort of extreme self-reliance doctrine at
| the base of many sociological and political concepts in
| the USA it's frowned upon to ask for help, or help each
| other, or create a system where everybody agrees that
| helping each other by default is a good thing.
|
| Keeps most things as-is, keeps people fighting over who
| gets to proxy-kill sick people and what the best way to
| screw each other for perceived personal gain is.
|
| Edit: here on HN there was a comment from someone along
| the lines of "from the outside looking in, the USA looks
| like people fighting over who gets to punch babies and
| you're not allowed to not want to be on either side
| because that's taking a side as well".
| notJim wrote:
| What's even wilder is that in the recent primaries (both 2020
| and 2016) of the "left" party a major argument was that this
| system is so awesome that it must be protected at all costs,
| even if moving to something like single-payer would be cheaper
| while covering more people [1].
|
| [1]: https://www.peoplespolicyproject.org/2018/07/30/mercatus-
| stu...
| peter_1233 wrote:
| I think this math is off, as it assumes a single semester lasts a
| full year. For a full year you would need to pay for multiple
| semesters of tuition, probably 3 at most universities to cover
| the summer.
| antcas wrote:
| Let me double check, should be multiplying semester by 2 when
| necessary.
|
| Annual insurance fee is already calculated annually.
| finaliteration wrote:
| Portland State is actually on a quarter system, so you'd need
| to multiple those values by 3 or 4 (depending on if you
| include the Summer quarter or not).
|
| Source: I'm a Portland State alumnus.
| antcas wrote:
| Thanks for this note!
|
| I'll include this when I build out v2.
| adrianmonk wrote:
| I thought about summer as well. I checked my alma mater's
| web site. Seems you can get year-round health insurance
| without registering for summer classes.
|
| The exception is when summer is the first time you attend
| and you want to start insurance before fall. Then you need
| to meet minimum hour requirements.
|
| I'd guess most schools are similar because otherwise they'd
| practically force every student to take summer classes. But
| it's good to verify.
| peter_1233 wrote:
| Thanks. I didn't realize most schools allow only 2 semesters
| for insurance coverage but that makes sense.
|
| I did the math with Auburn University and it's definitely
| off. Unless that school allows an entire semester to last a
| year? (1 credit hours * $430 per credit) + $2028 insurance
| cost / 12 = $204. I think it would be 2 credit hours, so: (2
| credit hours * $430 per credit) + $2028 insurance cost / 12 =
| $240
| antcas wrote:
| Okay you were right, should be fixed now, thanks!
|
| Now the tuition is doubled.
|
| The insurance premium stays the same though because that's
| already the annual rate.
| nostromo wrote:
| I wonder how many of those schools would kick you out for never
| showing up and failing all your courses every quarter.
|
| Maybe you could filter this list for those schools.
|
| Or perhaps you could subcontract our your schooling online and
| just pay people to do the minimum required to get a passing
| grade. :-)
| antcas wrote:
| If you don't show up to class then technically you won't
| qualify for a lot of these plans.
|
| In the policy they require in-person classes.
|
| How that's going to work this year with online-only classes is
| an open question.
| sharps_xp wrote:
| Where can I find more stories like this where someone who has a
| familiarity with a system finds some form of leverage that is
| often overlooked? stuff like this excites me
| antcas wrote:
| For healthcare specifically I'd check out
| https://twitter.com/nikillinit
|
| More generally HN is a good place ;)
| VikingCoder wrote:
| http://reddit.com/r/lifeprotips
| adrianmonk wrote:
| I guess you have to actually try to pass the class as well,
| right? Otherwise you trash your academic record and/or jeopardize
| your ability to do this again next year.
|
| That not only requires your time, it might also require you to
| spend money on textbooks, etc.
|
| Although maybe not if there are schools that let you drop all
| your classes but stay eligible for health insurance for the rest
| of the term.
| antcas wrote:
| You don't have to pass the class you just can't get kicked out
| of the school.
|
| One BIG caveat with these plans is that coverage ends if you
| leave school.
|
| That's how the insurers cover their asses. They're able to
| provide cheaper plans because many of the sickest will drop
| out.
|
| It's dumb.
|
| Read this article by Charles Gaba for deeper insights than I
| can muster: http://acasignups.net/20/08/26/updated-how-much-
| can-risk-poo...
| jjoonathan wrote:
| That's not dumb, that's evil.
| kube-system wrote:
| Or neither dumb or evil, but just an expected result of the
| way group insurance works.
|
| 1. University: Has group of people they want to insure
|
| 2. Insurer: Measures risk of that group
|
| You're either in the group or your not. Sick people drop
| out of school not because insurance is making them drop
| out, but because academics is hard to do when your health
| issue prevents you from doing so.
|
| The people at fault are your representatives, who forgot
| about university group plans when drafting COBRA.
| antcas wrote:
| Why not both?
| Skunkleton wrote:
| Because it isn't dumb.
| rajangdavis wrote:
| The monthly cost for health insurance through using Cal Maritime
| ($627) is more than what I spent for health insurance for a
| single person via COBRA ($494.36) in California from 2018 -
| Spring 2019.
| antcas wrote:
| If you qualify for COBRA or Medicaid that might be a better
| option.
|
| California is also an odd bird in general and a lot of their
| public schools didn't offer a student health plan for part time
| students that I could find.
| pkaye wrote:
| Its this a big issue for most on HN? If even junior engineers are
| making $200k these days they should have pretty nice health
| plans.
| rossdavidh wrote:
| Well, the key word here is "most". Not everyone on HN is in a
| tech job.
| Rebelgecko wrote:
| I imagine it could be helpful for people who are self employed
| or semi-retired and make too much for maximum Obamacare
| subsidies while not being old enough for Medicare
|
| You can go take a ballroom dancing class with a bunch of 20
| year olds while getting slightly cheaper insurance
| psim1 wrote:
| I might be misunderstanding this chart, but it appears the author
| is saying that by enrolling for the minimum number of credits,
| you will receive the associated insurance for free. For at least
| one university listed -- Penn State -- that is not true. You must
| also purchase the insurance plan.
| antcas wrote:
| No, you also have to opt-in and pay the annual premium.
|
| This is included in the cost calculation (see notes section at
| the bottom for details).
| psim1 wrote:
| OK, I did misunderstand. The numbers make more sense now. I
| believe step 3 "enroll, get that cheap insurance" should make
| this a little more clear. (It's not just the act of
| enrollment that gets you the insurance.)
| antcas wrote:
| This is a good point, and also kind of an unintentional pun
| since enroll could refer to either enrolling in school or
| enrolling in the healthplan.
|
| Some (many?) schools you are enrolled automatically to the
| healthcare plan unless you opt-out.
| xenonite wrote:
| Won't this drive up the costs for students in the long run?
| antcas wrote:
| Mentioned in another reply, but insurers already take into
| consideration the fact that sicker students are more likely to
| need their insurance. This is mitigated by lower maximums than
| normal and the fact that the sickest students will tend to drop
| out.
| burnte wrote:
| So many things in healthcare are screwed up. I was in IT for 20+
| years and ready to move into law when a healthcare IT management
| job fell in my lap. 5 years later I still love healthcare IT
| because there is SO MUCH OPPORTUNITY to improve things, save
| money, make things better for users and patients. The entire
| system needs an overhaul, but the really odd thing is that as a
| nation (USA) we actually CAN do all the things we need to fix it.
| It's all payment and administrative stuff we need to fix.
| rexelhoff wrote:
| > US Healthcare Is Dumb FTFY
| marvinblum wrote:
| I just checked, and I paid 189,60 EUR for my health insurance
| last month, in Germany.
| benibela wrote:
| I once paid 350EUR/month when I made 200EUR/month
|
| The minimal self-employment fee
| est31 wrote:
| It's been reduced since 2019, now it's 156EUR.
| CincinnatiMan wrote:
| Does that include the healthcare-related taxes you paid? Not
| being snarky, genuinely wondering.
| oneplane wrote:
| There are no extra healthcare taxes.
| est31 wrote:
| https://www.krankenkassen-
| direkt.de/themen/thema.pl?id=47494...
|
| The public insurance which covers 88% of the population gets
| 15 billion tax EUR annually, with total revenue of public
| insurances being 250 billion.
|
| https://de.statista.com/statistik/daten/studie/192409/umfrag.
| ..
|
| So most money comes from the insured people. The maximum you
| pay for the public insurance is 703EUR per month, and it
| covers your children and non working spouse.
| oneplane wrote:
| About 139 here in The Netherlands.
| antcas wrote:
| Germany doesn't let us Americans in anymore unfortunately.
| davidw wrote:
| Even before COVID-19, you'd have to get a work visa, which
| probably isn't too tough for most software people, but can be
| a hassle.
| didip wrote:
| OP actually confirms my long term suspicion. Thanks!
|
| For the longest time, one of my early retirement plan is to
| simply go back to school, learn everything that excites me and
| enjoy the health insurance offered by the school.
| sacred_numbers wrote:
| The data here may not be totally accurate, but the sentiment is
| right. For my local school it's showing the marginal cost of the
| first credit hour, but the average cost per credit hour is
| substantially lower once you get to the minimum number of credit
| hours to qualify for insurance. After correcting for that mistake
| it cut the monthly cost for tuition+insurance for my local school
| in half. In addition, some schools offer insurance for spouses
| and children as well, which usually drives the cost per person
| down even further. For our situation, the total cost of tuition
| (9 credit hours per semester) plus insurance (2 people) is about
| $870 per month. A comparable ACA-compliant insurance plan would
| be about $1,000 per month.
|
| Even with a "gold level" insurance plan we ended up spending
| around $4,000 for an accident that occurred on campus that
| required an ambulance to the University hospital (1 mile away)
| and about 4 hours in the emergency room to get stitches and
| confirm that a head injury was not a concussion. It's hard to
| visualize how much money has been legally stolen from the
| American people over the last few decades due to the giant scam
| that is the health insurance industry. The combined salaries of
| every single doctor in America could be paid for with 8% of what
| we spend on healthcare every year. If you add in the salaries of
| nurses, pharmacists, drug researchers, etc. it's probably under
| 25% of what we pay. Unfortunately there are literally millions of
| middlemen and unnecessary administrators who soak up a very large
| percentage of healthcare spending without really doing anything.
|
| Canada and Australia spend less than half as much per capita as
| we do on healthcare despite having similar levels of GDP per
| capita and better average life expectancies. If the US could save
| 50% on healthcare we could probably solve climate change single-
| handedly. This is not even an exaggeration, it's an illustration
| of just how much we spend on healthcare.
| supernova87a wrote:
| I find it sad, yet interesting, how many
| things/institutions/processes have built up in a way that you
| would never actively choose as an option.
|
| As in, if given the choice between building the current system
| and some alternative, there is no way you'd say, "for sure, build
| again what we have now, it's great".
|
| Yet that's what we kind of do every year implicitly by continuing
| through inertia. Healthcare, financial/banking, transportation,
| rocket launches, etc.
|
| I guess that's how a country gets old and slow -- too many legacy
| things that have to be supported or can't be changed without
| disruption to people's established habits or ways that they've
| come to rely on. (or make a profit from)
|
| And it's not until some outside actor shows you it's possible
| that you're shocked into knowing that it can be done differently.
| Or forced to do it differently out of necessity now.
| brundolf wrote:
| https://en.wikipedia.org/wiki/Recurrent_laryngeal_nerve
| Metacelsus wrote:
| For those wondering:
|
| >The extreme detour of the recurrent laryngeal nerves, about
| 4.6 metres (15 ft) in the case of giraffes,[26]:74-75 is
| cited as evidence of evolution, as opposed to Intelligent
| Design. The nerve's route would have been direct in the fish-
| like ancestors of modern tetrapods, traveling from the brain,
| past the heart, to the gills (as it does in modern fish).
| Over the course of evolution, as the neck extended and the
| heart became lower in the body, the laryngeal nerve was
| caught on the wrong side of the heart. Natural selection
| gradually lengthened the nerve by tiny increments to
| accommodate, resulting in the circuitous route now observed
| rossdavidh wrote:
| While everything you say is true, my experience in software
| with the Big Rewrite suggests that continuing through inertia,
| while by no means always the right choice, is also not always
| the worst choice. Big projects can end up going very badly, and
| the devil you know is sometimes the lesser evil.
|
| Although, in the case of healthcare pricing in the U.S., maybe
| not.
| amirkdv wrote:
| > given the choice between building the current system and some
| alternative, there is no way you'd say, "for sure, build again
| what we have now, it's great".
|
| > Yet that's what we kind of do every year implicitly by
| continuing through inertia. Healthcare, financial/banking,
| transportation, rocket launches, etc.
|
| Also on this absurd list: academic publishing
| MattGaiser wrote:
| I am currently in government. I would say that most processes
| are not really designed at all. They are the sum of a lot of
| other decisions kludged together.
|
| We are currently putting together a software system for
| managing parking contracts and in doing so are excruciatingly
| copying how those contracts are currently handled (often to an
| absurd level). Nobody thinks the current process makes sense,
| but here we are baking it into a mega project.
| dutchmartin wrote:
| It is sad indeed, but I guess no manager wants to change
| things not be responsible for changes that fail.
| pbronez wrote:
| Here's a whole article about that! "Kludgeocracy in America"
| (2013)
|
| https://www.nationalaffairs.com/publications/detail/kludgeoc.
| ..
| pbronez wrote:
| Posted in its own thread:
|
| Kludgeocracy in America (2013)
| https://news.ycombinator.com/item?id=24310523
| rosstex wrote:
| What's wrong with rocket launches?
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