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this post was submitted on 22 Aug 2023
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Politics
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Oh, in that case I don't have a comment on the American healthcare system.
Oh, you scoundrel.
Seriously, this is one of those topics that can head South quickly, since the legislation on its face is helpful to people with these plans because it expands coverage. On the other hand, the overall situation is ripe for abuse. I can already see the GOP pushing these on folks who can’t afford the deductible as a ‘solution’ and then use it as an excuse not to consider any real reform. It is understandable that Dems are split.
My immediate thought too🤣
Wow, the number of comments that are just "oh, yeah, these are great, I have one" is... Wow...
No wonder you guys are fucked. Too many of y'all are spending your time supporting shit like this when you could be screaming about single payer, like the rest of the developed world has.
Are you equating ‘single payer’ with universal health care, which most of the world has, or true single payer in the sense that private insurance is effectively outlawed? The latter isn’t quite as ubiquitous, as you know, and is politically a heavier lift in the U.S. compared to the starting point of simply guaranteeing universal basic coverage through something like medicare (state insurance) expansion.
The latter approach, incidentally, has majority support here, if polls are to be believed. I share your astonishment that we have somehow been unable to successfully agitate for it. We could realistically get to where Germany or France are, but somehow … can’t.
The US has basically all 4 major healthcare insurance systems in a single country.
The Beveridge model, used in the UK for its National Health Service, is essentially socialized medicine where the government literally owns the hospitals/clinics and employs the doctors and other professionals who work within that system. It exists in the U.S., too, in the Veterans Health Administration system, and the military's own hospitals, plus a few smaller systems like the Indian Health Service.
The Bismarck model, common in much of continental Europe, is essentially an "all payer" system where private insurance can still exist, but where all the insurers are paying the providers the same prices for services. Providers are private, but the highly regulated price structure means that private providers can't just demand their own prices (lest they get cut out of the insurance system entirely). Insurers can be private, too, but all plans must offer specific features, in a way that ends up pushing the pricing and coverage to be fairly uniform throughout the system. This exists in the U.S. in the employer-provided health insurance system, or the "Obamacare" ACA exchanges, where most states regulate what insurance coverage there can be, what prices they can charge, and then all the providers and insurers negotiate prices that end up looking pretty similar. Realistically, someone who gets Aetna through their employer doesn't have all that different of an experience from Blue Cross Blue Shield or Cigna or United.
The Medicare model, or single payer model, basically puts everyone on one public insurance plan and has that insurance system negotiate prices with providers as a monopsony. Doctors and other providers don't have much room to just opt out of the system, because in a society where everyone has insurance for no or low out of pocket expenses, doctors won't be able to charge significant out of pocket expenses for normal services. It's what Canada has, and what the United States has for everyone over the age of 65, as well as everyone under the age of 18, and most people below the poverty line.
The chaotic market-driven model, where patients and providers essentially shop around and negotiate one-off pricing for services, is basically what remains for anyone not covered by the three models above. It might be how markets work for most other stuff in the western world, but among developed nations only the U.S. uses it in a significant way for health care markets.
Single payer, or Medicare for All, is at least something that one can envision for the United States, but I think it's far more likely we end up with something like the German/Swiss model, which probably would be the easiest transition among the 3 major universal health care models. One disadvantage is that it doesn't really look like what we see in other English-speaking countries (Canada's single payer, UK's socialized medicine), so there aren't as many people explicitly calling on the U.S. to adopt models already implemented in other countries.
Great perspective. Thanks.
I mean. yeah single payer is nice, however that's really not even on the horizon for the US. For most Americans, especially those who actually have to know how to fully utilize their insurance (if lucky enough to have it), there's no benefit for them to worry too much about a single-payer or socialized system. They have immediate needs and immediate solutions. They need to get their prescriptions, their surgeries, and their doctor's appointments. It's not "supporting" it, as so much as it is the devil you know.
Practically speaking, compared to standard PPO/HMO insurance, HDHPs are pretty good. If you are low-maintenance health-wise, you don't pay for your physical, are going to spend maybe couple hundred bucks on sick care and maintenance meds. If you have chronic illness, you will only pay the deductible before your care is 100 percent covered, so a hospital stay would be enough to meet your out-of-pocket max, and everything else is covered 100% by your insurer (whereas the traditional plans have 6-10k limits, the HDHPs are much lower at 1-2k for a person and 2-3 for a family). Especially with HSAs, which are savings/retirement accounts for medical expenses, that some employers will pay into, so basically free money to pay copays, prescriptions, even stuff like aspirin and bandages.
LIke 15% of the nation is working in healthcare if you include insurance and all the supporting industries. No wonder our health care costs are high. My medical bill has to keep 15% of the nation afloat and most of it ain't going to the doctors and nurses.
Simplify the system, more doctors and nurses, fewer insurance executives. Single payer would do this.
Genuine question, because my liberal dad didn't understand what I meant when I asked - isn't a deductible basically just another tactic for the insurance company to further weasel out of its responsibilities? I'm pretty sure the deductible of the insurance I get through my job is higher than I already pay them yearly. If my expenses are lower than that, I've basically given them ~$1500 for doing literally nothing. I may as well just pay out of pocket, but I can't since insurance fucked the system for the uninsured.
The idea with high deductible plans is that the ordinary policyholder just pays out of pocket for everything in a normal year, but they're covered against catastrophic loss in years when they get in a $50,000 car accident or need $750,000 worth of chemo and cancer treatments. The insurance might not provide much for the 30 or 40 years of your life in which you spend less than $1,000 per year on a few doctor's visits, but it'll pay for itself that one year when you're paying $5,000 instead of $1,000,000.
You call that a high deductible? I have a deductible that high and I'm being eaten alive by premiums! It never ceases to amaze me that people aren't out rioting over this rampant thievery.
I thought that high-deductible health insurance plans were already the norm.
I haven't seen a deductible that low in a very long time! As a teacher, I think our lowest deductible offered was 4 or 5K.
I went for a high deductible plan this year. Unfortunately, that made the monthly cost of a single medication more expensive than my entire premium the year before. Huge mistake, since they don't cover prescriptions AT ALL until deductible has been hit.
I have an ACA high deductable plan. It is like a no brainer for me. In my state if you pay full cost, it comes down to how you want to phase in costs. High deductable is cheaper if your healthy or if your are very sick and reach the out of pocket max. In between it will depend on your exact details.
My girlfriend just got on a high-deductible plan for the first time and it's the worst plan I've ever seen due to her need for many medications. She changed jobs which is what triggered it and the new plan means her real new income is much less than her old, which we were not expecting since plan details were not available during recruitment. Feels like a bait and switch.
Always ask about benefits during recruiting imo. America is bloodthirsty to fuck over the poors if they don't ask the right questions.
Kind of depends on your exact situation. If your getting a plan through a company they pay a lot of the costs.
If your having to pay for a plan yourself it costs a lot. My wife and I pay about $18000/year for the two of us if you count insurance and out of pocket. It is a good plan, but the cost is kind of scary. I like high deductible in this case because I'd rather pay lower insurance costs even though that may be partially made up by out of pocket. Your going to pay it either way presuming that your paying all the costs. On the other hand, if someone else is paying for part or all of the insurance costs, your conclusions may be different.
Also meds. Check out GoodRX and switch to the specific generic that is the cheapest of the class you need. I save almost $2K a year doing this. That is if you can. If not, drugs are just expensive.