
Money Won’t Buy You Health Insurance - epall
http://www.nytimes.com/2011/02/20/opinion/20Dubinsky.html?src=twrhp
======
acabal
This really highlights how utterly insane our system is. I'm living off of my
own business, which means that I don't have an employer to cover me under
group insurance. But I really only make enough to live frugally and save a
tiny amount each month--to me, an affordable health insurance plan would be
between $50-$100 a month.

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.

~~~
Groxx
> _to me, an affordable health insurance plan would be between $50-$100 a
> month.

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.

\---

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.

\---

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.

~~~
muhfuhkuh
Japan forces their doctors to charge only what's published in a book that the
government issues and negotiates prices periodically. Simple price fixing in
an otherwise private healthcare market. In return, Japanese doctors and
hospitals (FYI, there are more private hospitals in Japan than the US) are
allowed to set whatever prices for ancillary services (like private or semi-
private rooms) that they want. BTW, the average stay overnight in a private
room at a Japanese hospital is about $100. An MRI (which was 1400 negotiated
down to 700 FTA) is $98, due largely to the fact that the Japanese have more
MRIs and CT scanners per capita than the US. I mean, wasn't technology
supposed to be our superiority play?

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

~~~
damoncali
What people don't like to admit is that free markets don't work for
healthcare. What is the price you're willing to pay for curing that tumor in
your gut? Everything you have. There is no supply vs. demand. Only supply vs
infinity.

What would happen to the food market were it not for the generally high supply
of food? It wouldn't be pretty.

Because of that, some sort of non-market intervention is simply unavoidable.
As are the inefficiencies that go along with price controls and other similar
endeavors. Ugly stuff, this healthcare business.

~~~
tptacek
This is a weird summary of how "free markets" and "supply and demand" work.
Yes, you will pay everything you have for a cure. But the guy who will offer
you a cure for "everything you have minus one dollar" is going to get your
business.

~~~
joe_the_user
_But the guy who will offer you a cure for "everything you have minus one
dollar" is going to get your business._

Not necessarily. Suppose you have a deadly condition. Your information is
extremely limited as non-professional. Would ... you can pay all your money
now for the cure your doctor offers or you can wander over to an unknown
provider for the best price? The quality of unknown providers is ... unknown
and your doctor is known. And he _knows_ he's got by the genitalia and will
charge accordingly since with even a thousand unknown providers, your real
choices are very limited.

Just as much. Presently, no American hospital publishes its price list. I
believe there's no regulation about this. Why hasn't "the market" _impelled_
these providers to publish their prices.

~~~
Zak
_Presently, no American hospital publishes its price list._

Almost every American hospital publishes its price list to its primary
customers: the insurance companies. The problem as I see it is that the
insurance companies are the only entities that can get fair prices for health
care, and they want to keep it that way. A potential solution would be to ban
insurance discounts; a health-care provider could charge any price it wants,
but it would be required to charge all customers the _same_ price. Insurance
companies would still negotiate for lower prices, so it would benefit all of
us.

~~~
cookiecaper
My experience has been that if you don't have insurance, the hospital will cut
a big chunk out of your bill immediately. Their "negotiated rates" are all
just made up things they put on the insurance bill because insurers can pay a
lot of money. The insurer calls and says "Hello, I would like a discount". And
the guy says "Ah, yes, our standard rate is cash rate + $1000, but for you,
I'll take off $500".

For instance, a podiatrist I know charges $350 to the insurance company (which
shows this as the discounted, negotiated rate) but $150 cash to remove an
ingrown toenail.

I'm sure there are exceptions.

~~~
caseysoftware
Just had a pair of major surgeries in my immediate family. When we offered to
pay cash, they immediately knocked 50-66% off all the costs. That included
anaesthesiologist, room rental, and doctor's time.

This "retail rate" mentioned in the article is crap.

------
krschultz
The subtle but crazy part about this is at the bottom when it details the
author: "Donna Dubinsky, a co-founder of Palm Computer and Handspring, is the
chief executive of a computer software company."

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.

~~~
sammcd
I think she _could_ buy insurance if she really wanted.

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.

~~~
cookiecaper
A two-person group is not going to fare much better than an individual plan,
and I'm not so sure that there are that many companies that accept two-person
groups anyway.

~~~
joeag
Not true in CA anyway, you can have a 2 person company and apply for small
employer group coverage. You can't be denied for pre-existing conditions and
your rates have to be within 10% of larger group rates.

------
SandB0x
I would have died at the age of 19 if it weren't for the help of the UK's
National Health Service. My parents and I didn't have to worry about hospital
bills, future insurance issues, being tied to a job, any of that crap. Just
get some rest, get better, go out there and be productive again. The American
system looks like a horrible joke from over here. I just can't understand any
of it.

~~~
carlygeehr
I challenge anyone with a painful but non-life-threatening injury - say, a
torn labrum, or a torn ACL - to go live in Canada or the UK and see what their
treatment is like compared to here. Anyone?

~~~
s3graham
I have not torn an ACL in the US, but when I did in Canada, I found the
treatment professional and quite reasonable in timeliness (Vancouver, BC).

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??)

~~~
bzbarsky
For your last question, it depends. Some plans are country-wide. Some are
specific to a state except for emergency services.

There's the separate concept of in-network and out-of-network doctors, of
course....

------
ryanwaggoner
I'm no expert, but isn't this one of the major issues that the health care
reform bill of 2010 is going to fix? Granted, it doesn't go into effect (for
adults) until Jan 1, 2014, but I thought that insurance companies will be
prohibited from denying coverage or charging higher rates based on pre-
existing medical conditions. Am I mistaken?

[http://en.wikipedia.org/wiki/Patient_Protection_and_Affordab...](http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act#Provisions)

~~~
nostrademons
If it's not repealed first. I believe that's what this article's addressing -
she's trying to educate people enough that they will not support a repeal of
Obamacare.

------
gersh
The US government spends $793B on medicare & medicaid, and give $215B in tax
deductions for health insurance. This total $1.008 trillion/yr on healthcare
costs, which totals $3272/per capita/yr.

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.

------
SoftwareMaven
Health insurance is broken because the people who pay the bills (the insurance
companies) are not the people receiving the services (patients).

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.

~~~
cookiecaper
Heh, I paid almost $1000/mo for COBRA coverage for six months last year. I
think that the only plausible thing to do in that situation is to flee to
Canada, or figure out how to consistently receive medical care without paying
for it.

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.

------
nhangen
I left the Army where I had free healthcare for me and my family - I got
spoiled. I really can't afford it now that I'm out and not with a big company.
I've thought of going into the Reserves just to have the option to buy it
again.

Healthcare really does suck.

~~~
tonfa
If you are inclined to move somewhere else, there are lots of countries with
affordable healthcare (most of Europe, and I guess Canada for example).

~~~
shiny
How easy are these countries to get into (and become a working member of their
society)? I know Switzerland and New Zealand are particularly tough.

~~~
jasonlotito
Did you miss the Montreal open-source thread here yesterday? =)

Canada is great for tech people looking for work. We need people up here.
Sure, it gets cold in the winter, but it's really not that bad.

------
ajays
The irony is: the same Congresscritters who vote against universal health
insurance get top-notch health insurance paid for by taxpayers:
[http://www.suite101.com/content/health-care-for-the-us-
congr...](http://www.suite101.com/content/health-care-for-the-us-
congress-a72870)

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.opm.gov/insure/retirees/index.asp?MainQuestionId=6)

~~~
klenwell
A few tea partiers turned down the insurance this year on principle. One was
interviewed on NPR, where he acknowledged that the insurance rates he found on
the open marker were a bit of a shock:

[http://www.npr.org/2011/02/09/133629806/16-Freshmen-GOP-
Decl...](http://www.npr.org/2011/02/09/133629806/16-Freshmen-GOP-Decline-
Federal-Health-Coverage)

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.

~~~
ajays
IMHO, Obama and company got carried away. They saw this opportunity to enact
something comparable to Social Security and Medicare, and wanted to go down in
the history books as having achieved something similar. Unfortunately, like
any big project in Washington, this one was laden with loopholes, sweeteners,
etc. In other words, a total mess.

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.

~~~
sethg
Social Security had plenty of loopholes when it was first passed, too.

If Obamacare had merely outlawed discrimination based on pre-existing
conditions, then premiums would have gone through the roof, because lots of
healthy people would have put off buying insurance until they got sick. So the
law needed to include a provision requiring everyone to buy insurance. If
everyone has to buy insurance, then there also have to be subsidies for people
who make too much to qualify for Medicaid but not enough to afford insurance.
If there are subsidies, then money to cover the cost of subsidies has to be
found, through a combination of tax increases and cost savings elsewhere in
the system. Those are the pillars of Obamacare; everything else is gravy.

Also, one of the sad realities of the American political system is that the
only way to pass a law that pisses off some powerful interest group is to buy
off other powerful interest groups at the same time.

------
health-anon
I'm an entrepreneur with a wife and son. I'm 23. We pay $360/mo for individual
insurance and it is pretty crappy. The deductible is high and there are
several "up-front" visits, which means the first X times we go to the doctor
the insurance pays nothing and deducts one of our up-front visits. Each of us
have X of these, so the first X times wife goes in, and then the same for me,
they are not taken from the same pool. This accumulates to several hundred
dollars of visits before insurance pays for anything, and then we still have
the deductible to churn through, and they've applied regular visits to that as
well.

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.

------
coffeedrinker
I have my family on a $10,000 deductible per person ($30,000 for family). That
still costs over $500/month.

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.

------
tom_b
In the past three years, I have made significant career decisions based on the
insurance costs and coverage of the employer.

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.

------
mrshoe
Can someone please explain to me why five thousand self employed people can't
form a corporation together and get group insurance? Do shell corporations
like that already exist?

~~~
zdw
They do. Usually they handle not only health insurance, but most of the other
benefits and paperwork regarding employement (payroll, etc.).

------
GFischer
So, people in the U.S. are billed an astronomical sum for a MRI, even with
insurance?

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):

<http://news.ycombinator.com/item?id=2247969>

~~~
SapphireSun
We have vaguely similar, but smaller versions, of the system you are talking
about in the US. They are called "self insured entities" and are typically
companies that bankroll their employees directly. They typically hire a
professional insurance company as a "Third Party Administrator" to handle
administering claims. I am unsure as to their efficacy, although scale
certainly affects their performance.

------
hnl2sea2nrt
I've had some luck with hacking my family's healthcare expenses in the last
couple of years. I am a healthy 26 y/o with a wife and son. We were living in
Seattle and healthcare was the most expensive when I was employed full-time
and my wife was pregnant.

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_...](http://www.techflash.com/seattle/2010/04/jeff_bezos_michael_dell_drew_carey_and_others_back_health_care_startup.html)).

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.

------
andrewpbrett1
Shameless plug: I'm working on a startup that, while it won't be able to
directly fix people being denied coverage, will hopefully help people to
understand their coverage a bit better. <http://cakehealth.com>. Not yet open
to all but you can sign up if that sounds interesting to you. We <3 beta
users.

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.

------
tapp
> "If members of Congress feel so strongly about undoing this important
> legislation, perhaps we should stop providing them with health insurance.
> Let’s credit their pay for the amount that has been paid by the taxpayers,
> and let them try to buy health insurance in the individual market...Health
> insurance reform might suddenly not seem to them like such a bad idea."

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.

------
Dramatize
I'm glad we don't have these issues in Australia. The American healthcare
system would be one of the only reasons not to move there to start a business.

~~~
jacques_chester
Australia has a hybrid public/private system. You can rely on the public
system for pretty much everything, but only catastrophic medical services are
well-funded (and even then ...). Otherwise you will need to get used to
waiting in a queue.

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).

------
_delirium
Does anyone have any experience with small-business health-care pools as an
alternative to buying individual insurance? They've been talked about for a
_long_ time, and some states supposedly have programs for them, but I haven't
heard much about how or if they work. Can you join one and get insurance at
any sort of vaguely group-negotiated price with fewer of these kinds of
problems?

~~~
coffeedrinker
I've talked to an agent about that. In Washington State, she said a group plan
v. individual would not make much difference. At least not enough to warrant
they additional paperwork and/or insurance company switch.

------
jjcc
I used to be a long-time believer of free market. But for health care and
Education system things are quite different. All the participants taking care
of their own interest doesn't mean the interest of the whole society will be
maximized. Some poor countries might be better than the States. Believe or
not, check the healthcare of Cuba!

------
sportsTAKES
I find it absolutely impossible to believe that her coverage was denied for
the reasons she described - I have been approved for and paid for my own
insurance for years (including my family's insurance) with medical issues far
more serious than those.

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.)

~~~
helmut_hed
Your success in getting private health insurance may be due to the fact that
you have "been approved for and paid for my own insurance for years". Bear in
mind that the OP had group health insurance through her employer, and _then_
tried to get private health insurance. I had much the same experience with
minor things from the time I had group insurance being considered "pre-
existing conditions" and justifying a denial of coverage.

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.

~~~
sportsTAKES
To clarify, I have been approved for private insurance at different times
(three times actually) over roughly twelve years with intermittent times of
receiving benefits from employers - I have worked off and on as an independent
contractor during that time.

------
herf
"Group of 2" in California can be husband and wife. (We did this, because the
plans are better, the rates are better, and they can't limit you based on pre-
existing conditions.) Just make a partnership and pay the state taxes annually
(ugh).

------
thinkingeric
Something to add to the discussion: She says "my recent M.R.I. cost $1,300 at
the “retail” rate, while the rate negotiated by the insurance company was
$700."

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.

~~~
thinkingeric
Also, this is of course over and above what my company pays in premiums.
Altogether it is a significant amount of money for a family of four that has
no major medical problems. For a small business, the overall burden is
problematic.

------
zmmmmm
The cost of healthcare and college basically scared me away from migrating to
the US. It's a definite trade off but here in Australia, having paid off my
house, I can live almost free of overheads. It is incredibly liberating to get
up in the morning and know I can go to work on my own business without
worrying that some freak accident or illness will destroy me financially.

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.

------
mrkurt
> The difference is significant: my recent M.R.I. cost $1,300 at the “retail”
> rate, while the rate negotiated by the insurance company was $700.

The shocking thing is, if you get an MRI at a cash only diagnostics facility
it can cost as little as $300.

~~~
mikebike
I've never understood the meaning of the "retail" rates. How many people are
there who can afford to pay these rates and also don't have health insurance?

~~~
pessimizer
I had a bad asthma attack while uninsured and got hit with a bill that took me
7 years to pay off.

~~~
mikebike
Yipe! Were you able to negotiate the bill down at all when working out a
payment plan, or did the hospital end up charging you the full amount?

~~~
pessimizer
Didn't negotiate a thing. I was pretty naive about that sort of thing at the
time (really was still until the last few years, and I'm 35 now) and didn't
know that bargaining was an option. I was just unemployed, broke and 22 and
had a giant bill that I didn't know what to do with. I thought a bill was a
bill and a debt was a debt, and had never even had a credit card in my life.
Soon after that, I got a $9 an hour job at a factory and started making
payments...

------
hartror
I might be living in a socialist paradise (Australia) or some thing but my
last visit to the doctor (broken toe) was free.

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.

~~~
rdouble
There's no visa that will let you do this.

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.

~~~
hartror
That is sad, given our current prosperity it would be great if we could
leverage it to bring super talented entrepreneurs here to start more great
businesses.

------
harold
My wife and I are healthy. But we've seen our rates more than double in the
last year. I've heard _many_ stories like the one referenced in the article
where healthy people are having hard time even finding insurance.

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.

~~~
cschneid
My early-twenties girlfriend is able to stay on her dad's health insurance.
Which is good because she has a chronic condition that would cancel any chance
of purchasing individual insurance.

So yes, people have seen benefits.

------
quattrofan
I went down this path myself, the company I was with in California went under
and I had ended up consulting, COBRA runs out after 6 mos so I decided to buy
some health insurance and I got denied. The reason being that years previously
I had "asked" a consultant about a procedure that I never actually went ahead
with and that was in my records which they dug up.

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.

------
ck2
I just wish her report include some mention of WHAT the new legislation will
in reality do for her?

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.

------
hparra
If you want to revolutionize medicine, you need to revolutionize how everyone
in medicine is paid.

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?

------
ChristianMarks
I couldn't get surgery approved on my employer's health insurance. I
eventually decided not to let that stop me from changing jobs and doing what I
wanted to do, despite not being able to afford surgery out of pocket and
despite an inferior choice of health insurance plans. I suppose I could
emigrate to England if all else fails. I can do this as my mother was a
British citizen otherwise than by descent, though it is an involved process.

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.

------
ashbrahma
Countries like India, Malaysia are starting to see a boom in Medical Tourism.
It costs approximately $4500 for a open heart surgery at the best hospitals
compared to $15-$20K in the US.

<http://en.wikipedia.org/wiki/Medical_tourism>

~~~
Ras_
Going to a dentist on your holiday would be a casual example.

~~~
twistedanimator
That's exactly what I did when I went to El Salvador last year. It cost me $30
for a routine cleaning as opposed to $150 in the US.

------
ylem
I was in France not too long ago and had to go to the emergency room for
stitches. The wait was not much longer than in the US--we started talking
about payment (I didn't have my insurance card on me...doh!. Finally, I asked
them what the bill was--around 20 Euro. I paid cash...I talked to a doctor on
the bus ride back and part of it is a combination of low malpractice suits (I
think a minor part) , taxes, and the fact that doctor salaries are much lower
than they are here in the US...

I agree that the system is broke here.

------
imechura
the problem in this country is that not enough people are paying for their own
health care or insurance.

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.

------
scottshapiro
It's simple. The US needs to stop subsidizing the bad calories (i.e. sweetners
and hydrogenated oils) and enabling the treatments (i.e. dialysis, statins)
that treat resulting diseases of civilization (i.e. diabetes, heart disease).

------
yaix
It is broken ...and expensive.

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.

------
Uhhrrr
The article does not mention that money _can_ buy you health _care_. Given
this, there should be market opportunity for a company which courts the
supposed legions of people denied for picayune reasons.

~~~
marshray
Not in any fair-market sort of way.

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.

~~~
Uhhrrr
Which is to say, you can indeed purchase health care. You might not get the
volume discount that Blue Cross et al do, but you can buy it.

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.

------
danbmil99
Can anyone shed some light on the oft-repeated "let them compete across state
lines" conservative argument? Is there any chance that less regulation could
actually foster some healthy competition?

~~~
danssig
No, health care is an inelastic market. A free market is not the best way to
handle health care (which is why no other first world country even tries to).

------
jasongullickson
Sounds like an industry ripe with opportunity for the right hacker.

~~~
danssig
Except for all the barriers that the established players have put in place to
keep said hacker out.

------
rms
When I am back in the USA next month, I am planning on cancelling my virtually
worthless health insurance ($90/month) and signing up for cryonics
($30/month).

------
theoj
Link without registration: <removed>

Edit: Apparently you need to go through Google for this to work. See comment
below.

~~~
bluishgreen
dint work, but click thru from google works

[http://www.google.com/search?sourceid=chrome&ie=UTF-8...](http://www.google.com/search?sourceid=chrome&ie=UTF-8&q=money+cant+bye+health+insurance#hl=en&sugexp=elsfph&xhr=t&q=Money+Wont+Buy+You+Health+Insurance+-+NYTimes.com&cp=50&qe=TW9uZXkgV29uJ3QgQnV5IFlvdSBIZWFsdGggSW5zdXJhbmNlIC0gTllUaW1lcy5jb20&qesig=rcbfvWvet2J5DX7wG0xMAA&pkc=AFgZ2tl1CKSYKfo9K59o-qj2w1_c09EpC_W1_oFlB_OK3jWc2mzq1ajNC-M68aCWMIvhIRnSHQrSI46jrNwVbe4ukokwW_3cRw&pf=p&sclient=psy&aq=f&aqi=&aql=&oq=Money+Wont+Buy+You+Health+Insurance+-+NYTimes.com&pbx=1&bav=on.1,or.&fp=681127d0c6f645aa)

------
georgieporgie
I'm 35, single, and paying something like $120 per month for Blue Cross
coverage that I found on ehealthinsurance. I've used them each time I've not
been actively employed, and I've always found an acceptable deal.

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.

~~~
krschultz
Have you actually tried getting a big claim paid by them. My GF is currently
embroiled in a dispute with United Healthcare over a temporary insurance plan
she bought to cover the gap between graduating college and when her full time
position started covering her (wouldn't it have been great if the new
healthcare law was in effect at the time and she could have stayed on her
parents insurance). Anyway, she had a hospital visit for $3k and United
Healthcare is denying her simply because she didn't stay overnight. We
_thought_ we had insurance, but as soon as push came to shove it really
doesn't mean anything if you are an individual buyer because they will just
screw you over and theres no reason not to.

~~~
rikthevik
This is the very frightening thing. You fill out your forms, you pay your
premiums and you still get screwed.

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.

~~~
cookiecaper
Is it cheaper to hire a good lawyer or just to pay the bill? Unless it's
catastrophic it's probably cheaper to just pay the bill than to fight it.

------
sabat
I'm an example -- I have private health insurance out of necessity. It was an
arduous process, and I'm lucky to have managed to get it -- even though I'm
healthy. If I had so much as one serious problem, I'm convinced I would have
been turned down.

It is broken. Seriously broken.

------
jacoblyles
Ug, this kind of article brings out the worst in Hacker News. Less like this,
please. I can get this on reddit.

