
Rising health insurance deductibles fuel middle-class anger and resentment - pseudolus
https://www.latimes.com/politics/la-na-pol-health-insurance-angry-patients-20190628-story.html
======
MichaelApproved
I have $6,500 deductable. It's insane how much work I need to do to get
healthcare.

The biggest issue is price transparency. To get a price, I need the tax-id of
the medical office and the procedure code. Often times the procedure code is
unknown because I might have any number of different procedures, depending on
what the diagnosis is.

So, I take my list of codes to the health insurance company with the tax ID
and wait while they look everything up. This whole thing can take 2 hours.

That's if everyone knows what they're doing. Medical offices are so used to
patients not asking about price, their back-office has no idea what to do when
someone actually asks how much a procedure will cost.

Then there's the insanity of cash price being cheaper than the insurance
price. So, I need to decide if I want to pay $600 and have it go towards my
deductible or $450 and pay cash.

I agreed to pay $450 cash and no one in the office understood how to handle
it. I finally get to pay the $450 cash and I still got a bill from my
insurance for $600 because they _also_ billed my insurance.

You get that? I paid cash and my insurance company still got billed.

Then we have billing errors. I got billed for things I never asked for and/or
never received. More wasted time addressing that. Of course, back office is
not used to patients reviewing their bill, so there's more confusion to deal
with.

I also have an HSA tax free bank account that lets me pay for this stupidity
tax free, yay! Dozens of more hours were thrown away trying to understand how
HSA accounts work, what I can charge to the HSA account and picking a bank to
handle the HSA account.

I spent nearly 100 hours in the last few years dealing with health insurance
bullshit.

Imagine how many more wasted hours other Americans deal with.

Fuck this shit already.

~~~
linuxftw
Literally half the country tried to warn against this exact same thing
happening before the ACA passed.

~~~
germinalphrase
This pattern of exploding healthcare costs didn’t begin with the passage of
the ACA (though the ACA is also obviously not the solution). The ACA _did_
increase costs as insurance companies couldn’t suddenly refuse service because
they are actually sick (preexisting conditions), but what is our healthcare
system doing if it’s NOT treating sick people?

~~~
linuxftw
> ACA did increase costs as insurance companies couldn’t suddenly refuse
> service because they are actually sick

Insurance companies are in business to make a profit. What the ACA did was
ensure insurance companies have captive customers. A plan with a $6500
deductible vs pay a fine, nonsense. I should be free to choose between the
plan or no fine. If it's all sick people in the plan pool because healthy
people opted-out, that's the insurance company's problem, not mine.

Now that the individual mandate is gone, we can watch the deductibles climb
ever higher and push people out of insurance.

For many people $6500 might as well be $50k.

I would support a full repeal of ACA and replacement with government payer for
all, so long as private insurance is not outlawed and can go back to pre ACA
form (I'd like to see more changes, but that's a starting point).

~~~
scarface74
_I should be free to choose between the plan or no fine_

That’s fine as long as you support getting rid of laws that force hospitals to
treat you whether or not you have insurance and you medical bills are not
dischargeable in bankruptcy if you don’t have insurance.

------
arcanus
Anger is insufficient. Without consumer choice, there is no mechanism for
individuals to impose pressure on Healthcare providers and insurers. They can
continue to 'milk the cow'.

~~~
mooreds
Just give consumers access to a price list before service is provided. That
will go a long way towards helping the problem.

(Not that you are going to price shop for every service--a trip to the
emergency room for a broken bone wonte get shopped--but some portion of health
Care is discretionary or is deliberate enough it can be shopped.)

~~~
koolba
That’s not enough. What the people should do is demand that corporate health
insurance be banned _and_ demand uniform/transparent pricing. (Removing the
corporate tax deduction and adding a personal one would have the same effect)

That’d lower the cost of the average policy as their would be an influx of (on
average) healthier people to the market for insurance.

~~~
mywittyname
We need to eliminate tax deductions as well. They distort behavior yet only
benefit the wealthy.

Families making under $50k aren't paying much in federal taxes as it is. The
federal tax bill for a family of 4 making $50k/yr is $2,739. Cutting their tax
bill in half gives them back a little over $100/mo.

~~~
koolba
The individual tax deduction is meant to be a temporary bait and switch. A
full top line individual deduction of health insurance premium would allow
corporations to shift their current contributions to their employees with no
net tax consequence (income paid is deductible for the corporation and the
premium would be for the individual).

Once that’s in place the next step would be making the general populace aware
that the majority of the deductions, at higher tax brackets mind you, are
going to the top. That would give the political capital to eliminating the
“fat cat insurance deductions” and gradually get us to sanity.

------
geggam
I have started going to Mexico for many things. I get better care from a Dr 3
hrs away than I do my primary care doctor and the after surgery care is so
good I can call the Dr 3 years after and still get free advice about things.

I cant even get my prescription renewed in the US without a 300 dollar checkup

Screw the US insurance companies and the mess they made of our healthcare

------
pmorici
All I know is that in 2013 I was able to get insurance in the private market
to cover myself. It was ~$80 a month and the deductible was $2000.

Now, there is only one company left in my state that will even offer plans in
the private market. The closest plan to what I used to have has gone up ~6x in
price and the deductible has tripled.

The prices started going up immediately after the ACA came into being I think
the cause and effect are pretty clear.

~~~
MichaelApproved
Your $80 insurance was trash. You think you had coverage but the moment
anything serious happened to you, you'd get thrown off.

Cancer? Bye.

Heart problems? See you later.

They were a fraud and you were getting ripped off.

ADA put an end to that fraud. Insurance companies could no longer arbitrarily
throw you off. That's why premiums went up from $80. They had to actually
provide coverage.

Now you know two things.

~~~
pmorici
I liked it just fine, I'm aware of the change the ACA brought into effect with
regard to the preexisting conditions. I'd rather have affordable options than
a single un-affordable choice. Whether the insurance company doesn't cover a
pre-existing condition or you can't afford the premiums the out come is the
same. I'd argue that no insurance at all is worse but reasonable people could
differ on that.

------
mywittyname
I doubt the people in this article are middle class. Only one income is
mentioned, but $40k for a family of three is below the definition of middle
class for most of the USA. Lots of people who think they are middle class are
really poor.

We need a Federal expansion of Medicaid to be available to _everyone_ with
pricing based on income. Once wealthier people start moving over to it, the
private insurance racket will collapse. I'd move over in a heartbeat, even if
the costs were higher because the plans I have available to me are garbage and
my family can't all see the same doctors because my insurance won't cover my
partner's and vice-versa.

~~~
1PlayerOne
Poor whites think government is the problem. Wealthy people have private
insurance from their employers. We are stuck with the current system, there is
no impetus for change. Just a lot of stupid coming out of the white house.
Sad!

~~~
AnimalMuppet
Off topic, but... when you end your posts with "Sad!" like that, you sound
just like a Trump tweet. Given your content, you probably don't want that
(unless you're trying to parody Trump, and I didn't notice).

~~~
1PlayerOne
I don't know about you, but I see Trump tweets everywhere; the very stable
genius has made a YUGE impact on everyday discourse.

------
mAEStro-paNDa
I used to work at a med school, and often I would be in the classroom. Once
the Dean gave a presentation over the _true_ cost of healthcare in the US.
What was his final conclusion to the class? _No one_ knows the true cost of
healthcare. It's nonsensical.

The situation with healthcare in the US has been beyond ridiculous for quite
some time. Often the conversation centers around those without insurance, but
being under-insured is just as much of an issue.

We need to decouple healthcare from employment. We need a single-payer system.
This would save _everyone_ money on healthcare in the long run.

~~~
mises
> single-payer system

Why could I not buy my own insurance? Or why can't I self-insure? If I want to
pay for the best, I ought to be able to buy it (again, _if_ I will pay).

There's a difference between actual single-payer (in which there is a _single_
entity which _pays_ , the government) and a government health-care plan. For
which are you advocating?

~~~
mAEStro-paNDa
>For which are you advocating?

A single-payer system, as I said.

>Why could I not buy my own insurance? Or why can't I self-insure?

These are leading questions. There exists healthcare systems that are a hybrid
of single-payer/private insurance.

~~~
mises
These are not leading questions. "Single payer" definitionally means there is
a _single_ entity which _pays_ , meaning no insurance or private pay. You're
using it like it means a government plan; it doesn't. The reason I'm asking is
because some politicians are crazy enough to want to prohibit any thing but a
government plan, and I don't know where you fall.

~~~
mAEStro-paNDa
They are leading questions. You're assumptions about single-payer, based on
what you think "some politicians" said, are baked into your questions. Again,
there exists hybrid systems. Take a look at Spain or Australia. Canada almost
exclusively works off it's public system, yet private insurance still has a
minor role.

Maybe I'm "crazy enough" to think that there should be zero profit-motive in
health insurance, but even I can confidently say that a public policy scenario
wherein all but a government plan is prohibited just isn't realistic, nor does
it reflect what many other western countries have done for 30+ years.

------
p_roz
Health insurance should be decoupled from employment. Its tax advantaged
treatment causes distortions in the costs and coverage offered. I’d rather see
people get more of their compensation in cash rather than a health insurance
benefit. It would especially help poorer workers who would have more
flexibility and choice.

~~~
mises
More employers ought to do this, for sure. If I'm a young, healthy, twenty-
six-year-old man, I almost certainly don't need medical care. If I've got a
good job, I can essentially self-insure. I might want to keep _actual
insurance_ , i.e. high-deductible protection for catastrophic events, but
nothing more.

~~~
1PlayerOne
Think about the consequence for society as a whole if everyone did what you
did.

~~~
mises
1\. I act in the interests of society, rather than my own. It's the issue of
the prisoners' dilemma; I'm not going to be the sucker.

2\. I honestly don't know what you mean here. I will almost certainly not draw
much in the way of health expenses; this is _exactly the way insurance is
supposed to work_. What is wrong with not billing every thing to insurance and
not paying for the privilege? If every one did this, consumers would be price-
sensitive and costs would drop.

~~~
1PlayerOne
I am not sure what you are describing is "exactly the way insurance is
supposed to work." If you have an open mind about it, you might want to read
about the three-legged stool[1].

[1]
[http://web.archive.org/web/20170716081909/https://www.nytime...](http://web.archive.org/web/20170716081909/https://www.nytimes.com/2017/07/10/opinion/obamacare-
repeal.html)

------
mises
The problem here is that years of abusing "insurance" \- billing regular
prescriptions to something intended to be used for catastrophic events - have
led to prices being raised without the consumer feeling the net effect, _right
away_. It was a band-aid, nothing more.

There was an article a few months back about an indian gentleman who was
essentially industrializing health-care. This is what we need. Maybe some one
who does routine carpal-tunnel surgery does not need a full MD? Some how,
medicine was one of the few industries which never industrialized. By doing
this, we can go back to looking at insurance the right way: something for
_catastrophic events_. Regular health care is expensive, and no system can
realistically have the balance of its members taking out more than they put in
long-term.

------
cascom
1\. Give employees a statement showing how much the employer paid along with
their full year comp and other benefits 2\. Detach health insurance from
employers 3\. Create price transparency for services

~~~
zacherates
"Give employees a statement showing how much the employer paid..."

Box 12, code DD on your W-2 reports "the cost of coverage under an employer-
sponsored group health plan" as required by the ACA [1] (includes the premiums
you paid, but you can subtract those out).

[1] [https://www.irs.gov/affordable-care-
act/form-w-2-reporting-o...](https://www.irs.gov/affordable-care-
act/form-w-2-reporting-of-employer-sponsored-health-coverage)

------
mattmcknight
So much of the existing system could be simplified if providers were required
to charge every customer the same price. It would be dead simple to implement-
add to the Medicare regulations that if you accept Medicare, you can't charge
any customer more than you charge Medicare. The massive subsidy that the
privately insured provided to Medicare and Medicaid would be diminished so
those prices would rise somewhat, but there would be no inefficient haggling
with each individual customer. We would all effectively get the
Medicare/Medicaid price for all health care. In-network out-of-network would
go away. The differentiation on insurers would be how much they reimburse for
particular procedures, not what price they happen to have negotiated with the
provider closest to your home. The providers could have different prices from
each other, but one provider could not charge a different price to each
customer.

Instead, under the current system, we let the providers lose money on Medicare
and Medicaid patients, while they soak the privately insured and uninsured for
massive profits. Everyone coming in the door should pay the same published
price.

"Most workers blame drug companies and health insurers for high healthcare
costs" How did the hospitals and doctors pull this off? The number one driver
of higher health care prices in the US is the provider cost, but everyone
wants to blame insurance.

~~~
AnimalMuppet
That would probably bankrupt Medicare.

Now, I'm not in favor of Medicare paying less than cost. It's a dishonest
hidden subsidy. But be careful of how you fix it...

------
TYPE_FASTER
I would like to know why, in the past ~20yrs, health insurance premium costs
have nearly quadrupled ([https://www.kff.org/report-section/2018-employer-
health-bene...](https://www.kff.org/report-section/2018-employer-health-
benefits-survey-section-1-cost-of-health-insurance/attachment/figure-1-10/)).

I don't understand the push for price lists. Forecasting is hard enough with
software, I can't imagine what it's like for medical procedures where every
person is different. Hospitals treat patients regardless of ability to pay,
and attempt to recoup losses for patients who can't pay. Why shop around on
price if it's unpredictable due to the nature of the system, shopping around
on quality of care would seem more important to me.

------
GiorgioG
Healthcare is turning me into a single-issue voter.

------
YeahSureWhyNot
but all Dems promised free health care to illegal immigrants. is it going to
be a surprise when Trump gets reelected?

~~~
dang
Please don't take HN threads into partisan flamewar. It's off topic here.

[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html)

------
m4r35n357
USA needs an NHS

------
PaulHoule
I wonder if the "you can keep your private health insurance if you want it" is
a dogwhistle for "we won't blow a hole in your stock portfolio."

The only people I know who like their health insurance are union members,
government employees, and people on Medicare or medicaid.

------
rb808
I have a high deducible plan and think its a good idea that everyone gets one.
It means you're much more aware of costs and much more careful. One of the
reasons the total US healthcare bill is so high is that many/most people get
lots of unnecessary tests, lots of marginally useful procedures and lots of
expensive emergency work instead of trying to be healthy in the first place.

Finally having people feel the sting of the bills will hopefully pressure
people to change the system that is both very inefficient and overpays
doctors, drug companies and hospitals.

~~~
Ididntdothis
With employer based insurance and lack of price transparency there is almost
nothing the patient can do to reduce costs. You can’t get any upfront pricing,
it’s hard to evaluate whether a test is needed, you can’t change insurance.

You are giving the patient responsibility for something they have almost no
chance to understand.

~~~
MichaelApproved
On top of that, it's impossible to shop around for some of the biggest
purchases.

Broke your leg, now what? Start calling local hospitals to see who offers the
best price?

It's impossible to be an educated consumer with healthcare. Impossible.

~~~
AnimalMuppet
Worse: One hospital charges less. Will I get equally good care there? Or is
their rate of complications higher? Will I suffer consequences down the road,
maybe for the rest of my life? Do I really want the less expensive hospital in
that case? How much money is a lower chance of complications worth?

