can-o-worms: Medical insurance and debt.

"Grindintosecond" (Grindintosecond) 06/28/2018 at 14:17 • Filed to: None

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I’m sorry folks, but even with empl oyment at a Fortune top company to work for that has, I swear, some of the best insurance I’ve ever seen, I still have trouble believing the system of today is good.

I had a family illness. Our insurance was great. But with a major event actually demonstrating what the true insurance is capable of, the out of pocket deductible cap and then the 80/20 to the max cap still leaves a family with annual bills approaching $7k for one person, or $10k for the whole household. Now, this would have been mitigated if I had time to actually save money in to the HSA account it goes with, but this hit seven months after I got the new job on probationary pay. Meaning not much was there to help.

Since I am truly lucky and grateful to be doing reasonably well, if I carried any debt at all, paying for this on top of that debt would really be a strain. In fact it is until my upcoming raise and even then we won’t have much breathing room for a year after. Especially since I just had some HOA mandatory landscaping done and then received a surprise medical bill in the mail that, combined, is making my comfortable credit card limit not so comfortable . Let’s place an average-average family into that scenario where both work hard and bring home a respectable income.

Even with that insurance, one of them would be taking days off for doctor visits, or days off for rest due to condition or treatment fatigue and income would drop. Paying the bills I saw, even when insurance took care of a huge portion of it, for them, without any extra work like landscaping or nice neighborhood living, will crush dreams and mini- vacations and camp for their kids for several years. The current system still relies horribly on the average citizen users paying out what they still can’t really afford.

Obamacare? Well, had Rubio and his friends not torpedoed the buffer account that would have theoretically kept it stable (the Achilles heel of the program) , it would have had a much more favorable result. Perhaps not perfect, but it never had a chance since that account was killed off way before the system went active. And then they point and call it a Democratic/Liberal failure. Kinda funny really, like intentionally taking all the air out of your tires and driving your car on the interstate, crashing into a tree, then blaming the tire maker for it’s terrible handling and financial disaster .

Socialized? Quite a few point out the benefits. And quite a few point to their relatives in Canada or people they know who’ve had to use it, “ and how much more horrib le it is in comparison.” But really, it’s that or commit your citizens to raging debt and despair and depression (yay! more medical treatment!)

My opinion: Health care insurers and providers must be non-profits and have no business in political funding. Prices go up? Well, because of the costs to fix people , not the need to give their CEO’s a gigantic bonus and meet a stock price projection . I wonder how much care the CEO bonuses would have paid for. !!!error: Indecipherable SUB-paragraph formatting!!!

!!! UNKNOWN CONTENT TYPE !!!

(Modern Healthcare-Apr.27, 2017)

Just like the screaming over term limits, Socialized healthcare can only work if it’s reasonably done. Not too overbearing. Not under performing . Give me a base package, and i’ll gladly pay a bit more to cover the social care problems everyone whose never experienced it themselves complains about.

punkgoose17 > Grindintosecond 06/28/2018 at 14:30

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The current system is horrible. My wife is has had many medical problems. We always max out and drain our HSA, and after 4 years of increasing medical debt last year was the first year we broke even or made some progress on the debt only because I pulled money out of my retirement. I work as an engineer and make decent money but with student loans everything is painfully tight. At Cummins I had horrible insurance with huge out of pocket costs, at my current job the insurance is much better, but it is still really tough.

farscythe - makin da cawfee! > Grindintosecond 06/28/2018 at 14:33

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welp over here (netherlands) medical insurance is mandatory (if i refuse to pick an insurer the gubment will pick one for me and send me the monthly bill) i pay about $250 a month for the 3 of us and the first $350 of medical expenses comes out of my own pocket.. wich most years means i pay for everything out of me own pocket.. but if any of us ever end up in hospital or long term sick its a bargain

im not covered for everything as i just have the bare minimum of coverage... but im pretty much covered for all common problems

its a pretty good system imo (dunno what you’d call it... single payer?)

Grindintosecond > punkgoose17 06/28/2018 at 14:37

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And theres pressure coming through the courts to eliminate the provision that keeps insurance from denying people due to pre-existing conditions.

Grindintosecond > farscythe - makin da cawfee! 06/28/2018 at 14:38

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i call it interesting. Are your insurance companies billion dollar profit corporations? Or non-profit?

Jay, the practical enthusiast > Grindintosecond 06/28/2018 at 14:43

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We have the second best coverage policy because the monthly premium is half that of the top policy but the deductible is only $1000 more.

We are having a baby this year. After the deductible we still have to pay 20% of the total cost. We have enough in our HSA to cover the deductible ($2700) but will still pay out about $3000 out of pocket.

To me the problem is not just the cost of insurance, it’s the outrageous cost of health care in the U.S.

farscythe - makin da cawfee! > Grindintosecond 06/28/2018 at 14:43

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most are for profit.. some are non profit.. prices are pretty similar

partially coz the gubment will only allow so much price gauging.. and partially coz the non profits keep the for profits honest (i guess...i may have pulled that last bit out of thin air)

Ash78, voting early and often > Grindintosecond 06/28/2018 at 14:44

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I could go on forever on this, but we’re doing ok, but close enough that a single year like your would put us into the red for a year or more. Our company has a few nice things like HSA bonuses, but in the end it’s still a high-deductible plan. A doctor visit might be $40 or $200, and that’s before any lab work. If you say the wrong thing at your “free” annual physical exam, it could take months to chase down all the coding because you veered outside the realm of what the doctor “felt” a physical would entail.

That said, I would like to add that the complexities and unknowns in the plans — and in the EOBs and doctor bills — is beyond the comprehension of most ordinary people. Even people with lots of financial modeling experience or healthcare expertise can rarely turn the benefits booklet into a realistic set of expectations for their families.

When I sit down in a restaurant, everything is laid out. The menu has prices. Upcharges are listed. You leave knowing exactly what you paid for. You don’t get a second and third check from the restaurant months later with “restroom fee” and “hostess surcharge.”

Pricing and services MUST be made more transparent or both doctors and patients are going to lose (mostly patients). I just left my doctor of 10 years over 5 or 6 consecutive billing disputes.

Of course I lost every one because it’s my word against theirs.

farscythe - makin da cawfee! > Grindintosecond 06/28/2018 at 14:53

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welp.. after some googling... i got that the wrong way around...

most are non profit... some are for profit

Eric @ opposite-lock.com > Grindintosecond 06/28/2018 at 14:56

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If you have an HSA, that’s some kind of HDHP... HDHPs aren’t designed for people with health problems or those with even middling income, they’re for people with high incomes. We ran all the numbers at my last couple employers and found that an HDHP is great for people that don’t go in much and that make enough to max out an HSA (plus have the remainder of the maximum out of pocket on hand or readily available when needed until they have enough in their HSA - HSA contribution limits should be set by the max out of pocket of the HDHP that makes you eligible for one). Everyone else is likely better off with a more traditional plan.

I’m lucky because I work in tech and my employer generously completely covers a PPO with a crazy low deductible, but I also work in tech and that’s pretty common in my industry. My wife has worked at a number of companies that provided nothing and my last employer only offered an HDHP that we had to pay for, which was fine for those of us in Engineering and upper management, but it seriously screwed our manufacturing workers on average hourly wages over because they couldn’t put away a decent amount to pay for anything. She was on an exchange plan that cost $350/month (it was a mid-range PPO plan) for the year before I landed my current job because it was cheaper than the additional cost of my HDHP with the two of us, which was ridiculous.

The ultimate problem is that healthcare has skyrocketed in price due to a number of issues. The main one is that it is among a very small number of services/products you use that t racks true inflation, plus it’s controlled by a government-sanctioned cartel that creates scarcity to increase the incomes of a tiny protected class . Most things we deal with daily do not track inflation at all (ex: groceries, cars , and gasoline).

Textured Soy Protein > Grindintosecond 06/28/2018 at 14:58

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Yep, it’s a mess.

Last fall I had an outpatient procedure done while I was on my wife’s insurance from her now-former job at a healthcare provider (hospital/HMO etc.) Even with her insurance I was still on the hook for about $2500 out of pocket.

The most annoying part was the way it was billed. I tried in advance to get as much information on how things would be billed, so I would know what to expect. But basically everything the people told me in response to these questions turned out to be inaccurate.

I was expecting everything to be under one bill, but it was split out into 3 different chunks, want generated at different times. I got one EOB and bill, went to pay it, then saw additional charges I didn’t understand, and then wasted a bunch of time with the billing people from the provider trying to get an explanation of why this was different from what I was told before they procedure, and then after waiting for a while, I logged back in to set up a payment plan for what I thought was the full amount only to see ANOTHER new chunk.

So then I had to go round and round again trying to figure out what THOSE charges were, and of course whatever the explanation was didn’t really matter because I was on the hook for that crap no matter what.

Now we’re on the insurance through my job, which is “good,” but that’s only a relative term. It still sucks.

The system is so big and complicated and convoluted and disconnected from the goal of providing people with quality care at a reasonable cost, there’s no one thing that fix all of it.

But here are a few ideas...

https://oppositelock.kinja.com/how-to-make-real-improvements-to-healthcare-1793729501

Of course, Trump and the GOP have only continued to chip away at and undermine different pieces  of the ACA since I wrote that.

punkgoose17 > Grindintosecond 06/28/2018 at 15:05

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If they deny pre-existing conditions there is little reason to buy health insurance. The solution will be to stop paying medical bills, or leave the country.

Grindintosecond > punkgoose17 06/28/2018 at 15:07

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Or deny certain coverage dealing with that condition, but pay out for other stuff like accidents, etc. Since my wife HAD cancer, any further claims would then be on me, wiping me out, but then they would cover my suicide attempt and treatment later over the issue. lol

TheRealBicycleBuck > Grindintosecond 06/28/2018 at 15:20

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We were almost bankrupted because of medical bills. In one year, my daughter spent three days in the hospital from an unknown/un- diagnosed illness, my wife fell down some stairs and hurt her back, and I ended up having emergency surgery. It took us several years to pay back just the deductibles.

punkgoose17 > Grindintosecond 06/28/2018 at 15:21

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It is completely ridiculous.

Highlander-Datsuns are Forever > Grindintosecond 06/28/2018 at 15:21

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US health insurance is terrible and is only going to get worse. I’m at $500 out of pocket plus employer contribution of about $1000/month for a $ 3,000 person /$ 9,000 family plan with an HSA that my employer puts $1500 into per year. I like the HSA but knowing that we are paying something like $20,000 per year for shitty insurance is infuriating .

I have not used anything but my HSA since being on this plan.

BigBlock440 > Grindintosecond 06/28/2018 at 15:22

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without any extra work like landscaping or nice neighborhood living, will crush dreams and mini-vacations and camp for th eir kids for several years

Landscaping, a house in a HOA, vacations and summer camp. Yeah, none of that’s a necessity. Sorry if I don’t feel sympathy for somebody who has to forgo landscaping to pay a medical bill, that’s called life, you sometimes sacrifice the wants for the needs. There’s tons of people who forgo that to be able to eat. We’re fortunate enough in this country that we can complain about maybe not being able to afford some wants right now, and have to wait a year or two , there’s billions of people who can’t even afford the needs.

Svend > farscythe - makin da cawfee! 06/28/2018 at 15:31

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I don’t know why but I thought Holland had a system like we have in the U.K.

Do you know what other European countries are like yours as I honestly thought they were all like the British universal care system.

Our system isn’t perfect* after years of reduced national funding but all parties are working on improving the funding and making the system better.

*but it's bloody close. The U.S. system is archaic and self destructive. 

someassemblyrequired > Grindintosecond 06/28/2018 at 16:33

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My aunt and cousin both died after long battles with cancer in Toronto. Their out of pocket costs were $2/day for a phone at their bedside when they were hospitalized, and $20 if you wanted a private room (though for hospice care there was no charge for that) . The level of care in Toronto is the same as you’d get in Boston or New York - no expense spared, latest drugs and experimental therapies when things turned south. It’s public insurance in Ontario, and you pay your premium with your taxes (starts at $60/yr if you make over $21000 and maxes out at $900/yr).

My wife’s parents both had serious illnesses, and those were trainwrecks financially.  We have the equivalent of medicare (my wife is military) and it is a million times better than any private insurance I’ve seen.

Demand Medicare-for-all. Accept nothing less.

gettingoldercarguy > Grindintosecond 06/28/2018 at 16:38

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I’m looking forward to Amazon's inevitable take on healthcare.

gettingoldercarguy > Eric @ opposite-lock.com 06/28/2018 at 16:48

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Yeah, HSAs are a great way for us to add an  extra tiny bit of cash into investments tax free.  Always funny when I hear people wanting the same thing for education.

Svend > Grindintosecond 06/28/2018 at 16:56

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It truly boggles me how expensive it is for healthcare in the U.S. and not just that the U.S. Doesn’t have universal healthcare.

The U.K. system has been underfunded for years as several governments have wanted to save money here and there (not just healthcare but roads, policing, etc...), but now there is more pressure from people and will of people in government on all sides to increase funding and improve services.

But at any point in my life I’ve been able to go to hospital for anything and know I’ll be taken car of.

When my mother had a heart attack recently, at no point was money brought up and they did a barrage of texts to find out why it happened even testing a wort I on her right hand. Until she stabilised and things showed signs of improving she was on a heart ward with five staff watching every move. 

Eric @ opposite-lock.com > gettingoldercarguy 06/28/2018 at 18:02

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I have yet to have an HSA that allows me to invest the money in anything, sadly. Most also have fees if you have a balance that is too low.

It would be awesome if everyone could get them, considering you’ll eventually get old and need money stashed away for the almost inevitable medical expenses.

farscythe - makin da cawfee! > Svend 06/29/2018 at 00:14

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honestly not sure how the rest of europe does it

but really the only similarity to the nhs we have here is that care will be provided even if your not covered.. and the gp is free of charge

and perscription medicine is reasonably priced.. the not quite the flat 7.50 you have (least i think it was 7.50)

Svend > farscythe - makin da cawfee! 06/29/2018 at 01:36

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We prescription charges in England but not in Scotland. 

Grindintosecond > someassemblyrequired 06/29/2018 at 02:25

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ohhh but those death panels! and if your old you get nothing! Ohhh! (paraphrasing the Palin monster.)

Grindintosecond > BigBlock440 06/29/2018 at 02:33

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I understand that. What I’m seeing lately is any house in a relatively newer area is most likely HOA’d. Any new area is built with that by the builders as a selling point. There are mandatory things that must be done, but regardless, anyone living in such a place doesn’t mean they’re affluent/rich at all. It’s just where they live as a family of four trying to make it with finally a decent gap of space. All it takes is one good shock and suddenly whatever was going good is no more and quite possibly, commonly for many, the house is lost. Sold at a loss after all the fees just to afford the bills coming. That’s the point of all this. The family of four is finally doing alright and the kids are in middle school and finally...people ha ve their little piece. Nope. no more. Not with a sudden bout of Cancer.

Grindintosecond > TheRealBicycleBuck 06/29/2018 at 02:34

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Holy damn I’m glad everyone’s better again. Sorry to hear about the strain....it is a s train.

Dusty Ventures > Grindintosecond 06/29/2018 at 04:11

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So a few years ago one of my rally friends was diagnosed with lukemia. He’s an expat from PA, now living in the UK. Shortly after the start of his treatments he wrote an excellent piece contrasting medical coverage and costs in his home country vs his current country. It’s a long read, but it’s a damn good read, and one I wish everyone would look at.

TheRealBicycleBuck > Grindintosecond 06/29/2018 at 06:30

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Thanks. It was a stark reminder that all of us have a tenuous hold on financial stability. One run of bad luck can bankrupt anybody. 

someassemblyrequired > Grindintosecond 06/29/2018 at 09:36

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The death panels argument is ridiculous. My cousin got a $30K/month drug for the last months of her life. If it’s medically necessary, you get it, free of charge, without deductibles. I was reading another stat where heart patients in some regional hospitals in Canada, have fewer complications than the same surgeries performed in Boston.

And how the heck do they think Medicare works anyways? It’s EXACTLY the same .  It’s like people live in an alternate reality.