bluesky74656
Line Up and Wait
That’s after the subsidy. It took me a while to even find what the unsubsidized rate is: it’s about $21.5k annually. So that’s right in line with Bryan’s, actually, my employer just kicks in more.
[NA] Health Insurance. US vs. Elsewhere
- Thread starter SixPapaCharlie
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danhagan
En-Route
That's non-insured patient care is emergency ONLY and to stabilize a patient. With government insurance and no secondary, see if you can get cardiac bypass (CABG), hip or knee replacement after 75 years of age. They won't put it in writing in the ACA rules, but you won't get that kind of medical care after 75 ... stents only for cardiac as it is 5k rather than 150k.
I have a relative that is 74 and told me I was full of %$#@ ... his hips are bone on bone and they won't inject anymore. Ortho doc told him he needed to replace BOTH this year, or pay for them himself next year. I told him this years ago ... told him I hope is heart doesn't need more than a stent.
idahoflier
Pattern Altitude
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idahoflier
Oh, I agree completely! What I was trying to say is said doctor, hospital, whatever should charge the same price for the same service regardless of whether a person has insurance. If you set and cast a broken arm for $500.00 then that should be the price charged for everyone...
jrcox19
Pre-takeoff checklist
Similar to Ted's story, I've had various insurance through various aerospace employers. Some have been great, others just decent. My most recent experience was this spring where my out of pocket cost was $400, and the hospital bill ended up just short of $200k ($199,989). At that time my insurance cost me and my wife about $350/month IIRC. Now I'm on a CDHP/HSA plan with a new employer, but it's cheaper monthly obviously
danhagan
En-Route
My son fractured his wrist in a game a few years ago: Hospital didn't apply insurance correctly and attempted to bill $22,000 for a 2 view x-ray and splint (which wasn't splinted correctly anyway) for a Friday night private pay ER rate. Ortho doc reset correctly also needing a 2 view x-ray for $99 on Monday in his office. Most ERs are now physician asistant or nurse practicioner (no MDs)
midwestpa24
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midwestpa24
Thats exactly what I've said for years. Health insurance today is not insurance anymore. It is simply a payment plan administered by a third party, for profit. I've often wondered how the health care industry would look if the current insurance industry never existed. You simply went to the doctor and paid your bill for the service just like any other industry. Just think of all the overhead involved in the insurance world.
The only reason it doesn't work that way is the powers that be have decided (and I'm not disagreeing entirely) that access to healthcare is a right, regardless of ability to pay.
rwellner98
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rw2
This will give you the comparative costs in some other first world nations. tl;dr The US is hella expensive and has worse outcomes. So we don't get added value for added spend.
https://www.healthsystemtracker.org...alth-consumption-expenditures-per-capita-2019
Since I mostly live in Mexico, I can also answer your question about other systems. So long as I spend six months and a day outside the US, I can get health insurance that covers me anywhere on earth for about $3000 a year. It would be cheaper if I didn't care to have coverage during the time I'm in the US.
https://www.healthsystemtracker.org...alth-consumption-expenditures-per-capita-2019
Since I mostly live in Mexico, I can also answer your question about other systems. So long as I spend six months and a day outside the US, I can get health insurance that covers me anywhere on earth for about $3000 a year. It would be cheaper if I didn't care to have coverage during the time I'm in the US.
steingar
Taxi to Parking
Some of our poor outcomes are due to geography. A lot harder to walk to work or walk to the metro in most American cities. Many are due to our lifestyles, too many calories with too little exercise. But we do have among the worst medical outcomes in any industrialized nation nearly across the board. And yes, we pay for that out the nose.
JOhnH
Touchdown! Greaser!
Regarding those countries that have "better", "free" health care, and the higher taxes to go with it,
What would those taxes be if they also had the defense budget that we have?
Perhaps if we chopped about $600 billion off our defense budget we could afford that too. Any takers? If we unilaterally disarm, surely will Russia and China do likewise?
Example:
The US has a defense budget around $780B.
France has a defense budget around $53B.
Others:
Country $Bil %GDP
1
United States 778.0 3.7
2
China[a] 252.0 1.7
3
India 72.9 2.9
4
Russian Federation 61.7 4.3
5
United Kingdom 59.2 2.2
6
Saudi Arabia[a] 57.5 8.4
7
Germany 52.8 1.4
8
France 52.7 2.1
9
Japan 49.1 1.0
10
South Korea 45.7 2.8
11
Italy 28.9 1.6
12
Australia 27.5 2.1
What would those taxes be if they also had the defense budget that we have?
Perhaps if we chopped about $600 billion off our defense budget we could afford that too. Any takers? If we unilaterally disarm, surely will Russia and China do likewise?
Example:
The US has a defense budget around $780B.
France has a defense budget around $53B.
Others:
Country $Bil %GDP
1
United States 778.0 3.72
China[a] 252.0 1.73
India 72.9 2.94
Russian Federation 61.7 4.35
United Kingdom 59.2 2.26
Saudi Arabia[a] 57.5 8.4 7
Germany 52.8 1.48
France 52.7 2.19
Japan 49.1 1.0 10
South Korea 45.7 2.811
Italy 28.9 1.612
Australia 27.5 2.1
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bflynn
Final Approach
Having studied the economic drivers, I'm fairly well convinced that the major factor that isn't considered is diversification coupled with malpractice. Diversification is great for specialization, but it also incurs higher costs. What a single doctor used to do with a couple of nurses is now done by 5 doctors, each with 3 nurses, billing specialist, front desk people, etc. When you look at the number of people involved with your healthcare, you should not be surprised at the cost.
So what does malpractice have to do with it? Because, through malpractice insurance, insurance companies are causing increased diversification. Example right now for me. 25 years ago, my dentist did a root canal and crown. Today, his malpractice insurance will not allow him to look at the crown again, so I'm heading for a specialist at twice the cost. He would have the equipment and do the work if he could, but isn't allowed to because his malpractice insurance wants to charge him an exorbitant amount for it. So, his insurance company has artificially created the need for a specialist.
Bringing it back to aviation - same thing with an 80 year old flying retractable. Almost none do because the insurance companies won't cover them. Whether they are an actual risk or not, they're deemed a risk, so it's a no go.
So what does malpractice have to do with it? Because, through malpractice insurance, insurance companies are causing increased diversification. Example right now for me. 25 years ago, my dentist did a root canal and crown. Today, his malpractice insurance will not allow him to look at the crown again, so I'm heading for a specialist at twice the cost. He would have the equipment and do the work if he could, but isn't allowed to because his malpractice insurance wants to charge him an exorbitant amount for it. So, his insurance company has artificially created the need for a specialist.
Bringing it back to aviation - same thing with an 80 year old flying retractable. Almost none do because the insurance companies won't cover them. Whether they are an actual risk or not, they're deemed a risk, so it's a no go.
Ghery
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Ghery Pettit
Not really. As long as the bottom line to me was reasonable I didn't care.
That's how my last employer (before I retired) handled it. Out of pocket for them, paperwork handled by a third party. It seemed to work.
$500/month for a family of 5 is a darned good deal. I pay more than that just for the supplement to Medicare for my wife and I. The good thing is that we are basically fully covered for whatever we need. My parent's had it as Dad was retired from the University (professor) and Mom still is covered. My wife retired as a school teacher and we are covered by the same insurance for our supplement.
Rough estimate, that's about $30 million for the executive staff. With 4+ million members that's $7.5 / member on an annual basis. So, if the whole executive staff worked for free your bill would go down about 62 cents a month.
Crazy that they are paid that much, but it's not that big of an impact to your monthly bill.
PaulS
Touchdown! Greaser!
don't worry, wicked smaht politicians are on it.... of course wicked smaht politicians created this mess to start.
Your premiums are right in line with what I pay, except I don't have anyone to pay half of it.
Your premiums are right in line with what I pay, except I don't have anyone to pay half of it.
I want to what happened? We used to pay for insurance and our deductibles were small. I had gallstones 20 years or so ago and our portion of the bill was something small, like $100 or $200. Now we'd have to pay thousands of dollars just to meet our annual deductible. WTF?!
I blame Obamacare, because that's when the shift seems to have occurred, but it could be coincidental. Either way, where the heck is the money going? We are paying more, but getting less.
Before I got married, when I was young, healthy and "indestructible", I got major medical insurance. It was effectively what we have now. I had a $5,000 deductible, so basically just good for hospital visits; which was fine as I rarely needed to see a doctor. It was dirt cheap. I forget how cheap, but it was so low I paid for it in one annual bill, not monthly.
So, where the heck is the money going? We're not paying two or three times more than that, we're paying 70-100 times more. It's nuts.
I blame Obamacare, because that's when the shift seems to have occurred, but it could be coincidental. Either way, where the heck is the money going? We are paying more, but getting less.
Before I got married, when I was young, healthy and "indestructible", I got major medical insurance. It was effectively what we have now. I had a $5,000 deductible, so basically just good for hospital visits; which was fine as I rarely needed to see a doctor. It was dirt cheap. I forget how cheap, but it was so low I paid for it in one annual bill, not monthly.
So, where the heck is the money going? We're not paying two or three times more than that, we're paying 70-100 times more. It's nuts.
Sinistar
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Brad
@SixPapaCharlie - The first thing to really understand (mentioned at least once earlier) is whether your company is self insured (sometimes called ASO = administrative services only). Think of a company like Caterpillar. Definitely cheaper for them to self insure (ASO). The insurance company primarily makes money off of the administrative services. Basically the handle the billing and tell the company when to transfer more money into the escrow account or whatever it is called. The company then also buys catastrophic polices for when employees get cancer. Otherwise in the modern HSA world you pay the first $4500 for you family. Along with the premiums. The company pays the rest. If you have a $150K hospital bill that isn't under their catastrophic plan, your company owner pays the rest (after your premiums). Our company is self insured. Periodically they break down all the costs and present to all employees. You can really tell where excessive ER usage happens, etc. Sometimes the owners might even cover things that are not mandatory but its rare. I have heard of cases where the owners have stepped in to really help out the families but the $$$$ are not ever listed. That is why big companies are instituting just about every cost saving, preventative thing they can. If done right a bit more money they get to keep. A bad year and it hits their bottom line.
If you are not self insured than your company is looked at and studied (every individual) that is on the plan and they look back to previous year. If you have 125 employees and 1 has a rare blood disease and the other has a crazy diabetes problem that counted up to an extra $1.25M then the next year they are going to look at studies and try estimate how much of that will happen again in the next year. After that is is basic numbers, the insurance company doesn't want to go negative (not on a large percentage of their accounts). So that extra bill is factored in. They then try to get the employer to pay as much as possible. They are only willing to go so far and the rest is passed on to each of the people.
If a insurance company isn't going to net 7% or better across all those smaller accounts they'd be better to invest in the market.
You will also see each large insurance company go into modes where they take on more losses until they hit a limit. So one company will propose such high premiums because of those high cost individuals and they then seek another company that is wanting to grow membership a bit. Weird how it bounces around. Sure, there can be pre-existing conditions. But the insurance company (not self insured) is also free to quote the premiums they need.
Self insured vs standard policies are very different.
I've seen the millions that the company pays going the self insured route. I am sure the owners would rather we all have our own policies but them pitching in what they do is in the end more of benefit than most realize.
That just my take and understanding. Married to a insurance underwriter now turned actuary.
If you are not self insured than your company is looked at and studied (every individual) that is on the plan and they look back to previous year. If you have 125 employees and 1 has a rare blood disease and the other has a crazy diabetes problem that counted up to an extra $1.25M then the next year they are going to look at studies and try estimate how much of that will happen again in the next year. After that is is basic numbers, the insurance company doesn't want to go negative (not on a large percentage of their accounts). So that extra bill is factored in. They then try to get the employer to pay as much as possible. They are only willing to go so far and the rest is passed on to each of the people.
If a insurance company isn't going to net 7% or better across all those smaller accounts they'd be better to invest in the market.
You will also see each large insurance company go into modes where they take on more losses until they hit a limit. So one company will propose such high premiums because of those high cost individuals and they then seek another company that is wanting to grow membership a bit. Weird how it bounces around. Sure, there can be pre-existing conditions. But the insurance company (not self insured) is also free to quote the premiums they need.
Self insured vs standard policies are very different.
I've seen the millions that the company pays going the self insured route. I am sure the owners would rather we all have our own policies but them pitching in what they do is in the end more of benefit than most realize.
That just my take and understanding. Married to a insurance underwriter now turned actuary.
Ted
The pilot formerly known as Twin Engine Ted
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iFlyNothing
Average American: "But it's not MY cancer, why should I pay for it?"
Also Average American: "I have cancer? But I can't pay these bills!"
Man, you got a better ROI than I did apparently. Of course I'm on the $0 out of pocket plan so I think it balances out overall. I think my bills came out to a total of around $1500, and I think the total non-adjusted bills were probably around $20k. Hard to keep track since everyone bills separately.
Michael and I agree, shocking. In NYC growing up you saw very few overweight people. Part of that was the vain nature of the city, but the other part is the fact that people simply walk a whole lot more and exercise is surprisingly easier than for those of us in areas where you drive everywhere. At the start of Covid my daily walks around the work campus stopped, and I was surprised to feel my legs atrophy (although I didn't gain weight, at least not until this winter - which I have lost again).
I've put a lot more focus into my diet and exercise recently, and started cutting out carbs. It's amazing how difficult it can be to do - added sugar seems to be in everything. But, I feel a lot better and my body is clearly happier. So am I.
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Velocity173
A lot of hospitals get city, state and federal assistance. The hospital I work for used to be operating in the red until the CEO lobbied and got millions to help with indigent care losses.
So yeah, somebody (tax payers) will end up paying for those who can’t.
Tantalum
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San_Diego_Pilot
Indeed, I've done that math a number of times lol! It's the costs that are out of control. A simple blood panel is hundreds of dollars, for an underpaid nurse to stab your arm for a moment, and an underpaid lab tech to put your sample in a centrifuge and machine - to go to a doctor to read the results from a $25K Abbot machine
The whole system though is inefficient.. but the audience is captive and regulatory hurdles are astronomical.. so that's what we get. There really isn't any one low-hanging fruit; it just is the way it is
I've done the same math with car insurance. Car insurance is compulsory where I live but if I had put the equivalent of my premium into a series of ETFs over the last 10 years I'd have a serious amount of money in there.. instead my good driving habits are subsidizing everybody else
Tantalum
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San_Diego_Pilot
Or won't.. tons of people simply paid the uninsured tax penalty because it was still cheaper/easier than getting insurance
Insurance is really just legalized gambling. You're betting you're going to get sick or hurt, the insurance casino is betting you won't, and as always, the odds favor the house.
Interestingly, in New Zealand (my son in law is a Kiwi) car insurance is dirt cheap because it doesn't have to cover any medical costs.
Interestingly, in New Zealand (my son in law is a Kiwi) car insurance is dirt cheap because it doesn't have to cover any medical costs.
Everskyward
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Everskyward
I see very few overweight people in San Francisco, probably for the same reasons as NYC. Not only that, SF has a more moderate climate. Rarely too hot, never too cold for outdoor activity. When I first moved here I was surprised at the number of people who didn't own a car. Even though I'm older, I'm in better shape than when I lived in Colorado and worked. As a pilot, the only exercise I got was loading baggage...
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Mantis Toboggan, MD
...and there's no, or very limited, personal liability. It's a foreign concept to most Americans (no pun or offense intended).
Nauga,
a beneficiary of New Zealand's medical system
Llewtrah381
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Llewtrah
Wow. I seriously commend people on this thread for some very good conversations around a typically emotional topic.
I’m a physician, retired from the Air Force, and worked extensively with TRICARE at the end of that time plus spent a few years in leadership at a not-for-profit system and then did the quality checks required of hospitals that take Medicare for a while. I also worked directly quite a bit with systems in Europe while on active duty. All that to say the system - OUR system - is amazingly complex, with numerous weird incentives. And health insurance for us started as a perk in WWII when salaries were frozen, as opposed to “socialized” by Bismarck in Germany in the 1800s.
I honestly don’t know how we morph to a more sensible program at this point and in this environment.
There are numerous rabbit-hole conversations to be had on this topic. I sincerely encourage people to keep an open mind and learn about how we got where we are, the limits of that, and the options.
Good example: Medicare doesn’t pick up coverage until well after someone’s lifestyle has already set in their likely medical future yet, unlike any other insurance, it’s not risk adjusted AND it has no real opportunity to manage the risk “early” - either through, say, smoking cessation or cancer screening.
Imagine if K-12 education had begun as an employment perk rather than a public entitlement.
In any case, my sincere compliments to everyone for a good conversation so far!
I’m a physician, retired from the Air Force, and worked extensively with TRICARE at the end of that time plus spent a few years in leadership at a not-for-profit system and then did the quality checks required of hospitals that take Medicare for a while. I also worked directly quite a bit with systems in Europe while on active duty. All that to say the system - OUR system - is amazingly complex, with numerous weird incentives. And health insurance for us started as a perk in WWII when salaries were frozen, as opposed to “socialized” by Bismarck in Germany in the 1800s.
I honestly don’t know how we morph to a more sensible program at this point and in this environment.
There are numerous rabbit-hole conversations to be had on this topic. I sincerely encourage people to keep an open mind and learn about how we got where we are, the limits of that, and the options.
Good example: Medicare doesn’t pick up coverage until well after someone’s lifestyle has already set in their likely medical future yet, unlike any other insurance, it’s not risk adjusted AND it has no real opportunity to manage the risk “early” - either through, say, smoking cessation or cancer screening.
Imagine if K-12 education had begun as an employment perk rather than a public entitlement.
In any case, my sincere compliments to everyone for a good conversation so far!
MauleSkinner
Touchdown! Greaser!
My company has their own(self-insured, managed) program. My wife hit her deductible a few years ago and suddenly the “rules” changed…things that were supposed to be covered weren’t. One doctor had to provide a written statement on clinic letterhead that said he wasn’t in network, because after my wife hit her deductible, they started treating him like an in-network provider.
the next year we saw similar shenanigans, and the following year went with one of the Christian sharing plans. What we save over our fraction of the health insurance premiums makes up for the expenses that supposedly were covered under the health insurance plan. It’s more like a “catastrophic” plan…we keep ourselves healthy, and will get help with expenses due to major illness (I.e., cancer) or injury.
the next year we saw similar shenanigans, and the following year went with one of the Christian sharing plans. What we save over our fraction of the health insurance premiums makes up for the expenses that supposedly were covered under the health insurance plan. It’s more like a “catastrophic” plan…we keep ourselves healthy, and will get help with expenses due to major illness (I.e., cancer) or injury.
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Morgan3820
En-Route
New Zealand also limits the number of lawyers that it graduates from its only law school. No ambulance chasers running around making mischief.
kyleb
Final Approach
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Drake the Outlaw
Here's the thing. Insurance is there to protect you from the big expense. A quadruple bypass costs a fortune. A child with serious congenital problems costs a fortune. So you're paying $900/mo for downside protection against being bankrupted by one of those events.
Warmi
Line Up and Wait
Cancel survival rates in the US are consistently some of the best in the world - obviously we can talk about costs etc but ultimately if you have to deal with a disease like cancer I would rather be here than “over there”…
https://worldpopulationreview.com/country-rankings/cancer-survival-rates-by-country
https://worldpopulationreview.com/country-rankings/cancer-survival-rates-by-country
On the other hand my Indian co-workers are shocked my parents are almost 80 years old and still traveling internationally; if COVID wasn’t blocking things. First that they are still alive and healthy, then that they live on their own, and really surprised on their travel. People from other countries may not be as surprised by that. My parents can’t wait to get back to traveling.
They are also surprised that in my mid 50’s I’m running 5k/10k races and working out to get back into HMs and triathlons, and my wife who is older than me is still playing tennis; ALTA A6, and I forget her USTA level.
They are also surprised that in my mid 50’s I’m running 5k/10k races and working out to get back into HMs and triathlons, and my wife who is older than me is still playing tennis; ALTA A6, and I forget her USTA level.
Tarheelpilot
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Tarheelpilot
That’s funny. I know several Canadian and EU citizens that have fled their country of origin to the US for similar reasons.
I can’t take a side because I haven’t lost anything outside of this country. I’m happy where I am.
cowman
Final Approach
Do you have a link or something for that?
I’m on the cheapest plan I could find in IL for a healthy family of 3 and it’s around 1300/mo. We could probably pay for all the health care we use in a year out of pocket for that $1300 and have some left over.
I really really wish I could just buy a cheap catastrophic only plan that paid for absolutely nothing below some high deductible…. say 10-20k. That’s all I actually want/need not this obnoxious crap that forces me to jump through hoops and carry the administrative cost of paying for little $60 office visits and $50 bottles of pills for me.
I really want to drop coverage completely and pay out of pocket but the whole what if some huge 6-figure or worse thing befell us is too much to chance.
some of our ‘worse outcomes’ is because we’re willing to try where other countries give up. Take infant mortality for example. The US is more likely to count a birth as a “live birth” compared to other countries. So while our infant mortality may loom higher, it’s really that we’re willing to try (waste money?) as compare to other healthcare systems.
yes, it sucks that our insurance is tied to our jobs and we have our issues. But we do have it pretty good here in the USA.
https://samaritanministries.org/
There's a couple others, just search for "health share". Some of them have restrictions on things like skydiving & snowmobiling (and I presume flying), Samaritan doesn't. It's not for everybody, but it's been great for us. It was weird getting a bunch of $200 checks in the mail.
Let'sgoflying!
Touchdown! Greaser!
Oldmanb777
Line Up and Wait
Very interesting discussion. Since I traveled for work and was often responsible for co workers who got sick, I have seen all kinds of healthcare. some really, and surprisingly great, some extremely poor. It often wasn't about being in first world, instead of some less fortunate places. In fact some of the worst I ever saw was in first world countries. Mostly with "free" medical care. those were always the worst. Ours system is certainly broken and a very poor system, its just better than the rest. Until everyone takes responsibility for your own care and the price of it, it won't get better. The more everyone thinks that they are not paying and its someone else's bill, it will only get worse. Case in point. I had some hand surgery. The physical therapist said I needed a glove for my hand. I asked about the cost. "you don't need to pay for it, it's covered." I still wanted to know. they insisted that since I didn't have to pay for it , I should not be concerned about the price. I insisted, and they finaly came up with the price. $65. I went to the pharmacy down stairs and bought the same exact glove for $15. Who do you think ultimately will pay for that over marked up glove, YOU WILL!
cowman
Final Approach
What I think we did with the ACA was have a massive national argument over the merits and disadvantages of capitalist vs socialist style health care models. (And to be fair they both have advantages and disadvantages). Then what we actually did after all the arguing was make a system with all the disadvantages of both and few of the advantages of either.
Something is going to have to change because whatever side of it you’re on, this is just ridiculous.
Something is going to have to change because whatever side of it you’re on, this is just ridiculous.
David Megginson
Pattern Altitude
It's a complex problem, because your taxes in the U.S. already cover healthcare for a lot of people (the elderly via Medicare, the economically disadvantaged via Medicaid, and, IIRC, veterans via the VHA). Many countries with universal healthcare partner with private companies and still have deductions from paycheques.
The best thing to do is to look at the % of GDP different rich countries spend on healthcare, and what the public/private split is. It's all at https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS
Here are some examples:
- US: 17% of GDP (50:50 public/private)
- Canada: 11% of GDP (73:27 public/private)
- France: 11% of GDP (73:27 public/private)
- UK: 10% of GDP (79:21 public/private)
- Australia: 9% of GDP (69:31 public/private)
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hindsight2020
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hindsight2020
I find your attempt at minimizing (via false equivalence fallacy) the legitimacy of my family's grievance and consideration of expatriation, rather imprudent. Very weird flex to pursue for someone not even burdened by this problem, by your own admission. But it is the internet, I brought it upon myself to speak about such a personal matter. I'll digress here as nothing but a lockable/ban hammer retort on my part would be incoming. I wish you and your loved ones health and happiness.
Tarheelpilot
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Tarheelpilot
I’m not minimizing anything. You should not take it that way. I don’t know the details of your situation and frankly don’t want to. It is not any of my business. I was simply commenting on how it’s interesting to know multiple people with seemingly the same problem from opposite sides of the tracks and pointed out that I have no frame of reference and therefore had no opinion of my own. But if you want it to perceive it as an insult feel free. I can’t stop you.
Clip4
Final Approach
At $860 a month and I would be seeking a new employer with more favorable insurance pool.
PaulS
Touchdown! Greaser!
Just a point here, I assume when you say "you're paying $900/ mo.." you are talking about the OP, who said his deduction is $860 per month from his pay check. He is actually paying the full $1720 per month, half out of pocket, the other half is compensation for his employment, the company "gives" him nothing, he works for it. It's a very important point in this conversation.