
Ask HN: Should I forgoe health insurance in US? - simplecomplex
My wife and I take no medications and are healthy. Our combined premium is now nearing $1000&#x2F;mo. I am self employed. I would much rather save the $12,000 a year.<p>The argument I hear for having health insurance is that they pay for unexpected expenses. But that doesn&#x27;t make sense to me. If some unexpected health event happened and we ended up in the hospital, and then ended up with $100k bill, wouldn&#x27;t we be able to just pay that down over time like any other debt? Why is it necessary that insurance pays the debt?<p>The fact that we currently spend 20% of our after-tax income on health insurance is starting to seem absurd, when we don&#x27;t actually foresee needing anything but emergency hospital treatment for unexpected accidents.
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uberman
Do you have $100k up front to pay your bill? Hospitals are not banks. They
typically don't do "pay over time" and frequently require the uninsured to
pre-pay before getting treatment.

You are healthy now, but there are efforts underway to repeal laws that
forgive pre-existing conditions. If You you develop a condition that you felt
warranted the expense you might (in the future) find it impossible to get
coverage.

Why do you feel like you need to pay after tax? If you are self employed, you
can typically deduct the cost of health insurance for you and your family
unless you are otherwise covered by some other plan or make no income, but as
you stated you do have an income. Talk to your accountant.

You feel like making $60k after tax it would be no big deal to pay down an
addition $100k medical expense, but the reality is that is probably unlikely.
If you have a big medical bill, are you certain you will even be able to
continue to make your $60k after tax? I don't think it is unreasonable to
question this. For context, two thirds of all bankruptcies in the USA are a
result of inability to pay medical expenses and that includes those who
actually have insurance.

I/We are well insured thankfully and when my kid broke their arm the cost for
the ambulance ride from urgent care to the hospital (urgent care thought it
was much too serious for them to deal with) was $1000 just for the 5 min ride.
Med-Evac can be 30k or more and these are charges prior to even setting foot
in the ER. God forbid you or your family gets injured, but a car wreck
involving the primary bread winner will almost certainly ruin you financially
for the rest of your life.

In the end though, insurance (all insurance) is a gamble. In the case of
health insurance, young/healthy people feel often feel like it is not a good
bet.

~~~
schoen
> You feel like making $60k after tax it would be no big deal to pay down an
> addition $100k medical expense, but the reality is that is probably
> unlikely. If you have a big medical bill, are you certain you will even be
> able to continue to make your $60k after tax?

By the way, another option related to this specific concern is private
disability insurance. It can also apparently be a lot cheaper than some kinds
of medical coverage and is meant to deal specifically with the risk of lost
income due to an unforeseen medical problem. It can potentially provide much
higher and longer-lasting coverage than mandatory state disability insurance.

~~~
byoung2
My wife and I have disability insurance and it is very reasonable (approx $120
a month for a benefit of about $11000 per month for me, and maybe $80 a month
for about $7000 for my wife). It kicks in after 90 days and will continue to
pay as long as you are unable to work in your chosen profession up until the
end of your working years (65). People typically picture a broken leg in a
skiing accident and a security guard can't work, but it is more appropriate
for something like cancer or pregnancy-related complications that will prevent
you from working for months or years.

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seanmcdirmid
It really depends. Consider:

1\. How many assets do you have to protect? Houses, investments, a business.
If you have a bit of those, then insurance is good protection against losing
them if you get sick for some reason.

2\. Are you young with a good health history? Rolling the dice, you are
probably low risk and won’t need much in the near future. But it is definitely
a dice roll.

3\. Hospitals charge more to uninsured than they charge insured. This is
because uninsured typically don’t pay and are harder to collect from, so
treatment goes up.

4\. Likewise, if you don’t pay or they suspect you won’t pay, they don’t have
to do a lot of things: just stabilize and release. Got cancer? Well, charity
care doesn’t really include that specialist that might save your life.

5\. Medical tourism might work if you are open to going to Thailand or India
if you get anything serious. Problem is you probably won’t be able to get
there for anything emergency.

6\. Insurance for individuals (as opposed to group plans) really sucks: it is
more expensive (people who don’t get insurance from work are higher risk), it
isn’t very tax deductible (employers get a tax break on giving insurance to
their employees). It is almost a bad deal, so I get why people would hesitate
about it.

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rdtwo
What you are missing is that in the us hospital rates are different for
everyone. If you are uninsured you might get billed 5-10x what someone with
insurance might get billed. So in the event of something minor like a hospital
visit you will get hit with a bill for 10k just for showing up at the hospital
and 20-40k for an overnight stay. Catastrophic is the way to go if you need a
somewhat deferrable surgery you can go to a different country or game the
requirement for a life event that would allow enrollment in a health plan.

Keep in mind that insurance reimbursement/negotiated rates matter. You want an
insurance that negotiated a super low payout (though that will limit where you
can go for procedures) as that will often greatly reduce your out of pocket
payment in situations where you don’t hit the catastrophic cap which will be
99% of cases.

~~~
greenyoda
It's not just hospital rates. It's also visits to a doctor, lab tests, urgent
care facilities, drugs, etc. Providers who are in your insurance "network"
negotiate rates with your insurance company that are _much_ lower than the
retail rates. The difference can be a factor of 10.

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greenyoda
> My wife and I take no medications and are healthy.

Unfortunately, that could change overnight. Even young, healthy people can get
nasty diseases, be in catastrophic accidents, etc. I knew a young, healthy
person who went in for a routine checkup and ended up diagnosed with cancer.

While a single hospital stay might cost you $100K, being diagnosed with a
chronic disease that requires years of treatment and follow-up could be much
more expensive. And especially if your condition leaves you unable to work,
your bills might bankrupt you.

> when we don't actually foresee needing anything but emergency hospital
> treatment for unexpected accidents

Life is inherently unpredictable. Things happen to you that you can't foresee.

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schoen
If, by chance, you're both under 30, you could apparently also consider a
"catastrophic" plan.

[https://www.healthcare.gov/choose-a-plan/catastrophic-
health...](https://www.healthcare.gov/choose-a-plan/catastrophic-health-
plans/)

It sounds like some states may be allowed to expand the permissible kinds of
less-comprehensive plans in the future under the TCJA. If that can and does
happen in your state, you might have more cheaper options in the future that
are closer to catastrophic plans but perhaps available to more people.

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blacksqr
A lot of places won't treat you at all if you don't have insurance, unless you
have an immediately life-threatening medical condition.

The insurance card is your access ticket to urgent but non-emergency medical
care.

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blackflame7000
No, you should at least get catastrophic coverage.

