
Show HN: Healthcare Is Dumb - antcas
https://healthcareisdumb.com/
======
godzillabrennus
Before my father qualified for Medicare he figured out this hack.

He has a severe chronic condition.

Health insurance for him as a self employed person at the time was $4k/month

Tuition at the local public college at the time came with a senior discount
for folks in his age group and insurance for $10k/year.

He loved the classes and saved a bundle on health insurance.

He needed a life flight and weeks of hospitalization related to his chronic
illness. The insurance had him covered. I think it was a non-trivial payout
for the insurance company.

The following year the insurance company changed the terms with the university
to charge more if you didn’t live on campus.

My father went to a different school with a different insurer after that.

He’s finally on Medicare.

We shouldn’t tie healthcare coverage to employment in our country.

It’s stupidly expensive.

~~~
thayne
Tying health insurance to your employer is incredibly dumb. It means
insurarers compete for your employers business, not yours, which influences
their incentives. It means if you don't like your insurance company, your only
option is to change jobs. It disincitives people from being self employed,
because then health insurance is prohibitively expensive.

~~~
sukilot
It's not dumb, it's smart for employers who want to trap employees.

~~~
gnicholas
How does it trap employees? If I’m considering switching jobs, wouldn’t my new
employer offer the benefit also?

~~~
judge2020
Not all providers and plans are the same, so some treatment for some health
condition you have that is 75% paid for by insurance might go down to 25% or
even 0% (not covered) with your new employer's health insurance plan. You also
might just not have another job to go to immediately, like what happened at
the beginning of Covid-19, in which you'd either need to pay for your previous
insurance in full or cancel treatment.

~~~
culturestate
This happened recently to someone I know. They were offered a significant pay
bump and a leadership position in a well-respected organization that lines up
with their personal goals, but the new employer doesn’t offer insurance.

They eventually decided to take the job, but having to even _consider_
healthcare access in that calculus is ridiculous.

------
supernova87a
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.

~~~
MattGaiser
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.

~~~
pbronez
Here’s a whole article about that! “Kludgeocracy in America” (2013)

[https://www.nationalaffairs.com/publications/detail/kludgeoc...](https://www.nationalaffairs.com/publications/detail/kludgeocracy-
in-america)

~~~
pbronez
Posted in its own thread:

Kludgeocracy in America (2013)
[https://news.ycombinator.com/item?id=24310523](https://news.ycombinator.com/item?id=24310523)

------
antcas
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.

~~~
deegles
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?

~~~
alanbernstein
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
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://twitter.com/AnthonyCastrio/status/129870277198685798...](https://twitter.com/AnthonyCastrio/status/1298702771986857989)

------
jamestimmins
It's wild that less than $500/month for health insurance is a win in the
United States

~~~
nicoburns
For comparison, in the UK we spent £197.4 billion in 2017, or approximately
£2,989 spent per person [0]. Which works out as:

~£250/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 (<£10) for
prescription medicines). And it covers the entire population.

* Except dentistry. For some reason that is separate.

[0]:
[https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...](https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/bulletins/ukhealthaccounts/2017#:~:text=In%202017%2C%20spending%20on%20healthcare,equal%20to%209.7%25%20of%20GDP).

~~~
CraigJPerry
The median salary in the UK is £24,400 (ONS, 2018)

    
    
        +£2,033 paid per month
        -£  149 national insurance (healthcare, welfare, etc.)
        -£  198 income tax
        =£1,686 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 £0 in scotland)

~~~
kelnos
If you make too much below the median salary in the US, you probably still
can't afford health insurance.

Also consider that everything isn't covered when your employer pays for your
health insurance. Americans still have a lot of out-of-pocket costs.

And remember that there are a lot of people who are unemployed or
underemployed, or work under arrangements that don't provide them health
insurance at all. They also probably make a bit less than the median salary.
So sure, maybe 50+% of the US could afford their own health insurance, but is
it ok there's some percentage, regardless of how small, that can't afford it
and has to do without? I say no.

~~~
bhupy
If you make too much below the median salary in the US, you either qualify for
Medicaid (at best) or direct ACA subsidies (at worst).

~~~
kelnos
Sure, but there are several bands of income levels where you're basically
screwed. The ACA subsidies have some phasing in/out based on income levels,
but they're far from perfect, and depend on often-unreliable definitions of
the "poverty line".

------
finaliteration
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.

~~~
antcas
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
> _Otherwise your goal should be to find the easiest most phone-in-able class
> possible._

Thanks, COVID!

------
dusted
$500/MONTH is considered cheap? gosh damn, I'm sorry USA but you really,
deeply fucked yourself over on this one..

~~~
RandallBrown
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.

~~~
pessimizer
The US _government_ spends around as much or more on healthcare per capita as
any country with socialized healthcare. Every penny that you pay and your
employer pays on your behalf is due to graft/rentseeking.

------
sacred_numbers
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.

~~~
Supermancho
Eastern/Western Washington State University is listed...

[https://cougarhealth.wsu.edu/studentinsurance/insurance-
cove...](https://cougarhealth.wsu.edu/studentinsurance/insurance-coverage-
assistance/)

[https://inside.ewu.edu/bewell/optional-medical-
insurance/](https://inside.ewu.edu/bewell/optional-medical-insurance/)

This spreadsheet is inaccurate, at best. Also, what kind of insurance matters.
I can get you 50$ a month insurance that wont cover anything. Without context,
this spreadsheet is a big list of rumours for you go look up and be
disappointed.

~~~
exikyut
I'm curious how one would actually sign up for $50/mo insurance that doesn't
cover anything. How is it marketed? Where is this sort of thing found?

(The argument being that there's got to be some kind of fraudulence-meets-
loophole sort of thing going on for this to work at all.)

~~~
Supermancho
Getting foreign car insurance is pretty common, which gets you nothing when
you try to make a claim in the US. For healthcare it goes down to 30$ (that
I've found, I assume it's more like 50 per employee with their business
healthplan), again with the vast majority of claims being rejected - eg Apria
Healthcare. You might need to learn to speak some Tagalog.

------
nostromo
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
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.

------
legitster
Looking at the first plan on the list, Auburn:
[https://www.uhcsr.com/uhcsrbrochures/Public/BenefitSummaryFl...](https://www.uhcsr.com/uhcsrbrochures/Public/BenefitSummaryFlyers/2020-38-1%20Summary%20Brochure.pdf)

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
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.

------
didip
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.

------
peter_1233
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
Let me double check, should be multiplying semester by 2 when necessary.

Annual insurance fee is already calculated annually.

~~~
finaliteration
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.

~~~
adrianmonk
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.

------
marvinblum
I just checked, and I paid 189,60 € for my health insurance last month, in
Germany.

~~~
CincinnatiMan
Does that include the healthcare-related taxes you paid? Not being snarky,
genuinely wondering.

~~~
est31
[https://www.krankenkassen-
direkt.de/themen/thema.pl?id=47494...](https://www.krankenkassen-
direkt.de/themen/thema.pl?id=474948)

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...](https://de.statista.com/statistik/daten/studie/192409/umfrage/einnahmen-
und-ausgaben-der-gesetzlichen-krankenversicherungen-in-deutschland/)

So most money comes from the insured people. The maximum you pay for the
public insurance is 703€ per month, and it covers your children and non
working spouse.

~~~
kid_atticus
Note that the cost is split with your employer. So the maximum you will have
to pay is €365/month I think. Less if you income is not high.

------
burnte
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.

~~~
sk5t
It's unrolling the entire system of economic incentives that needs to be
fixed. This is going to be monstrously difficult... there is lots of potential
to improve healthcare but actually trying to achieve it is a bit Quixotic.

~~~
burnte
Nah, we can fix it chunk by chunk. It's actually doable. People IN healthcare
WANT it, so that helps a lot.

------
LordHeini
You can do something similar in Germany to get access to cheap public
transport.

Just enroll in an University which cost around 280€ for half a year. This will
get you a ticket which you can use in busses and trains for quite some
distance. Usually a whole Bundesland (County or whatever the US equivalent
is).

This is a fraction of the cost of a regular ticket and nobody checks if you
pick an unpopular field like physics.

I know people doing this for many years.

And yes the US should totally get a proper public Healthcare system...

~~~
TeMPOraL
Where I lived (Kraków, Poland; but arguably, similar schemes apply across the
country), you'd get half-priced tickets if you're a student under 26. After
finishing their 5 years at the uni, many people then sign up with whatever
private school offers the cheapest nonsense course in underwater basket
weaving or whatnot, and continue to use the public transport for half the
price (as well as using many other discounts for things like trains, cinemas,
etc., for which a student card makes you eligible).

~~~
Tade0
My friend did something similar - he started studying _something_ at the
University of Warsaw's Faculty of Education - really easy to get in and since
this is UW, academic progress is judged on an annual basis.

He even showed up there a few times.

------
sharps_xp
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

~~~
quickthrower2
In the UK there is moneysavingexpert.co.uk that sometimes goes to ludicrous
lengths to save a quid (a British pound)!

Think sign up for a credit card using a cash back site to buy an easy jet
plane ticket using a promo code to fly for free kind of thing!

------
adrianmonk
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
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...](http://acasignups.net/20/08/26/updated-how-much-can-risk-pools-vary-
heres-stunning-real-world-example)

~~~
jjoonathan
That's not dumb, that's evil.

~~~
kube-system
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.

~~~
jjoonathan
As long as it exists, private health insurance will incentivize providers to
cherry-pick, lemon-drop, and sell insurance that they have every intention of
not making good on. Those are the core "innovations" they are in a position to
deliver, and they are the core innovations that get delivered. The concept is
evil, the act of carrying it out is evil, and regulators are to blame
precisely to the extent that they allow private health insurance to exist in
the first place. They are complicit, to be sure, but "simply following
incentives" does not absolve the private side of this equation from moral
responsibility. Legal responsibility, yes, moral responsibility, no. Hence:
evil.

~~~
kube-system
What would a moral insurance company do to fulfill their moral obligation in
the above example?

~~~
jjoonathan
Are they a company that maximizes their profit or are they moral? In this
case, the profit motive points in the wrong direction, so they can't be both.

~~~
kube-system
The implied “all for-profit companies are evil” argument is radically
oversimplified, IMO. It is possible to maximize profit by efficiently
providing value.

Most of the downward pressure to cut corners in any industry is not from
profiteers but from customers themselves.

------
jimbokun
That...is actually kind of clever.

Wonder how long before these loopholes get shut down.

~~~
antcas
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
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.

~~~
newen
It probably was insurance companies that got up in arms about it rather than
voters since insurance companies are incentivized to silo their clients as
much as they can. Also insurance companies are the ones who have actual say in
the matter of writing the law compared to the voters.

~~~
lotsofpulp
I remember people being pissed off their premiums went up because people with
pre existing conditions and pregnancy and whatnot had to be covered now.

People are still pissed off about having to pay increased premiums so more
people can get more healthcare.

Insurance companies, by statute, can earn up to 15% to 20% of healthcare
expenses they pay for, so increasing the population they cover is in their
interest.

------
abeppu
One of these is a medical school. Can you imagine?

You apply, you get admitted, you go to your first class. You meet young
bright-eyed students.

"I want to be an oncologist! My aunt's battle with cancer really inspired me."

"I want to be a neurologist. The brain is just so fascinating!"

"I wanted health coverage."

~~~
desdiv
A Soviet Russia joke goes:

A toy factory worker wanted to get his son a nice toy for Christmas, but
couldn't afford it. So he sneaks out a single component from the factory every
day. When he assembled it, it turned out to be a machine gun.

The topical American joke would be:

At a medical school graduation party, the whole class started discussing their
future career prospects. It turns out that none of them would become doctors;
all of them joined for the healthcare coverage.

------
vonmoltke
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
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.

------
fblp
Are you eligible for health insurance with these universities if you live out
of state?

------
rajangdavis
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
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.

------
quickthrower2
I’m sorry USA that this site needs to exist for you guys. Hope you get
affordable healthcare soon :-(

It should be $0 and no hack required, for all, ideally at point of care (so no
invoice).

------
29athrowaway
When I quit my job a couple of years ago, I bought my own insurance for about
$400 a month. This was not done via COBRA.

I don't fully understand the need for this. Can someone explain?

------
xenonite
Won’t this drive up the costs for students in the long run?

~~~
antcas
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.

------
psim1
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
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
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
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.

------
rexelhoff
> US Healthcare Is Dumb FTFY

------
padseeker
this is kinda brilliant.

------
1f60c
> Health insurance in the United States is expensive (duh). Healthcare through
> a university is less expensive. Using this website you can find insurance
> for less than

...

> $500 per month.

 _jaw drops to the floor_

The fact that "just" paying $500 per month (in premiums, I assume?) is
considered an improvement...

------
pkaye
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.

~~~
dmcginty
I'm a mid-level engineer making half that. Please point me towards these
entry-level jobs that are offering $200k.

~~~
pkaye
My comment was mostly a poke at the claim on HN and elsewhere that starting
engineers make a vast amount of money.

