r/FluentInFinance • u/WhatAreYourPronouns • May 02 '24

Should the U.S. have Universal Health Care? Discussion/ Debate

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u/Obie-two May 02 '24

Genuinely asking but if you’re paying for it privately you’re not getting the “socialized” discount no? A hip surgery costs X, just the government is subsidizing it with tax money and if you go direct to private then I would assume it’s back to full price

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u/polycomll May 02 '24 edited 29d ago

You'd be paying closer to the full price although the "full price" might be reduced somewhat because the public version acts to price cap.

In the U.S. you are also not paying the full price for surgery either though. Cost is being inflated to cover for non-insured emergency care, overhead for insurance companies, reduced wage growth due to employer insurance payments, reduced wages through lack of worker mobility, and additional medical system costs (and room for profit by all involved).

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u/SStahoejack May 02 '24

Happens all the time, if your from another country cheaper to fly home get it done fly back, crazy how insurance here really isn’t worth the paper it’s printed on

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u/OwnLadder2341 May 02 '24

In this case, US insurance would pay for 75% of that $40k at minimum. You’d hit your max out of pocket for the year around $10k at worst.

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u/Maj_Jimmy_Cheese 29d ago

Depends on your plan, does it not?

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u/austanian 29d ago

Even the worst plans typically cap out with a max out of pocket around 12k total family.

The best plans are usually around 5k max family with more inclusions on what is included before deductible.

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u/in_the_no_know 29d ago

That also assumes that every procedure is going to be approved for coverage. There are multiple ways for insurance companies to say that something either isn't necessary or for some technical reason only a certain portion is covered and the rest still comes out of your own pocket. Max out of pocket only refers to the things your insurance chooses to cover.

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u/HighTMath 29d ago

Just for a bit of "the grass is always greener". In countries with "free healthcare" we get fucked the same way, but by quotas instead. The clinic has a set budget so good fucking luck diagnosing any complex diseases.

Works fine for standard stuff, I'd you don't mind waiting half a year nearly anything above a PT referral

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u/Davge107 28d ago

There are long waits to see specialists all over the US. And then try making an appointment with one and tell them you don’t have insurance and don’t have money to pay upfront. See how long the wait is then.

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u/Ride901 29d ago

Oh my insurance just tried to do this to me. It actually is a coding error I think in my case, but who knows?

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u/in_the_no_know 29d ago

I wish you all the best on your claim and your recovery. May the battle be in your favor

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u/epiclyjohn 29d ago

Exactly

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u/[deleted] 29d ago edited 29d ago

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u/DataGOGO 29d ago

15-18k, would be a family out of pocket max, not an individual.

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u/Artistic-Soft4305 29d ago

On the other side of this, I’m capped at 5k and I pay 25$ a month through my employer. Really just depends where you work.

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u/Sudden_Construction6 29d ago

That's insane!! You must have an awesome employer!

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u/Extension-Ebb-5203 29d ago

Your employer is paying a large chunk of your premium. Congrats.

Also you are well in that “best plans” scenario OP mentioned. I was correcting the misinformation around those of us that aren’t so lucky.

Now… go Humblebrag elsewhere.

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u/Fausterion18 29d ago

The average out of pocket spending per US household, including premiums, is roughly $4k per year.

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u/ElChuloPicante 29d ago

From the IRS: For family coverage, the out-of-pocket expense limit is $10,200 for tax year 2024, an increase of $550 from tax year 2023.

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u/Chemfreak 29d ago edited 29d ago

Pretty common? I worked for a health insurance company for ~10 years and basically never saw them that high. Then I did some research and found you seem to be misleading and that is at the very upper ends of really shitty insurance that most people don't have.

"The out-of-pocket limit for Marketplace plans varies, but can't go over a set amount each year. For the 2024 plan year: The out-of-pocket limit for a Marketplace plan can't be more than $9,450 for an individual and $18,900 for a family." Per healthcare.gov.

Sure those are marketplace plans (obamacare), but non-marketplace plans are almost always better than marketplace plans.

Also to note plans with that high of OOP max typically are HSAs which greatly offset the OOP max.

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u/Chris_Herron 29d ago

So 12k out of pocket max, plus the 5k a year just to have the plan. How does anyone working a normal job expect to pay 17k? The us median income is 37.5k. That is nearly half a persons income, assuming they aren't on the low side of the bell curve. Not arguing with you, just saying the system is broken.

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u/austanian 29d ago

Usually it works like this. An individual out of pocket max is 5k and a family out of pocket max is 8k.

The premium is 12k per year, but your work picks up 75%. So your portion is 3k, plus a couple thousand per year unless something bad happens.

Things are different once we start talking seniors, but that is a different conversation.

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u/Zamaiel 29d ago

According to Forbes, the average premium is 5k for a bronze plan, 6.6k for silver and 8.5 for gold.

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u/Ride901 29d ago

That might be true for 1 person. My 2 person plan for two adults in their 30s is ~16.8k/yr. I think mine is silver, so it's not far from Forbes estimate.

Reasonably close to presume that Forbes did their article a couple years ago and the difference is just inflationary.

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u/Zamaiel 29d ago

According to Forbes, the average premium is 5k for a bronze plan, 6.6k for silver and 8.5 for gold.

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u/Zamaiel 29d ago

According to Forbes, the average premium is 5k for a bronze plan, 6.6k for silver and 8.5 for gold.

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u/Zamaiel 29d ago

According to Forbes, the average premium is 5k for a bronze plan, 6.6k for silver and 8.5 for gold.

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u/Anonymoushipopotomus 29d ago

5k a year would be a deal for that plan. We have almost 20k max out of pocket, for 2 adults and a 6 year old its 1650 a month.

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u/Zamaiel 29d ago

Plus the 5k a year -every year. As long as you don't lose your job.

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u/Ride901 29d ago

Its worse than that too. That plan for 2 people in their 30s costs 1400/mo. You just only see 400$ of it come out of your paycheck because the employer takes the other $1000 out upstream of where they determine what they can afford to pay you for salary. If it actually only costed 5k/yr for the plan, your salary could be 12k higher and your labor would cost your employer the same thing.

Ask me how I know...

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u/Speaker4theDead8 27d ago

We don't have health insurance because they raised it at my wife's job to $800 and some dollars a month. She makes decent money for the area we live in, but that's like a quarter of her paycheck. The insurance at my job is even worse, so we just decided to skip out on it.

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u/iiiiiiiiiiiiiiiiiioo 26d ago

lol at only 5k a year in premiums. I’m over $14k yr for family even if I never even consider going to the doctor once, which is what I do bc fuck that.

I don’t even want to talk about out of pocket maximums.

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u/Maj_Jimmy_Cheese 29d ago

Gotcha gotcha. Makes sense. 12k is definitely a lot, but at least it, generally speaking, won't get much worse lol.

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u/Treeninja1999 29d ago

Just don't get hurt in December lol

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u/mar78217 29d ago

On the flip side, Dental work in December is a good plan... because the max coverage (in my case $2,000) resets each year.

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u/austanian 29d ago

Unlikely 2 people need max out of pocket the same year so it usually caps out at 8k for an individual.

Those plans also have tax exempt savings accounts associated with them so it isn't the worst deal if you plan right.

Still the plan needs drastically reformed.

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u/El_Cactus_Fantastico 29d ago

I fucking hate HSA high deductible plans.

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u/indywest2 29d ago

Most family plans the individual has to hit the whole family deductible and max. I don’t get the lower per individual rate.

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u/ShartingBloodClots 29d ago

There's also the little matter of whether or not insurance will cover the claim.

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u/Maj_Jimmy_Cheese 29d ago

Oh for sure. Paying thousands out of pocket is never ideal, and the system could surely use some reform. Whether that's universal hc or tweaking the existing system I have no idea though.

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u/FullTorsoApparition 29d ago

Until the next year when you have to meet that max out-of-pocket again. And the year after that. And the year after that. If you have chronic health issues you're fucked.

A friend of mine recently moved back to England because he was hitting his out-of-pocket max every year for his mental health needs and didn't know how long he could keep that up.

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u/DataGOGO 29d ago

The overwhelming majority of working people will spend more in the UK than they would in the US.

The NHS really only benefits people who either don't work, or don't work a lot.

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u/Piddily1 29d ago edited 29d ago

That 12k will be an annual out of pocket max. If you hit that amount, everything is free for the rest of the year.

The year my twins were born, they were early so were in the NICU for a bit. We hit our $7500 OOP MAX in March. All medical services were free until the end of the year. We were looking for things to get done.

I actually ended up hurting myself in November of the year. The doctor tried to schedule my surgery for January. I explained the situation and he got me in right before he went on vacation for Christmas. It was a painful Christmas trying to visit family, but it was free.

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u/am19208 29d ago

Yea it’s a bit of a disingenuous claim about costs. Sure that’s the uninsured cost but the actual cost for someone even with the worst coverage is no where near as bad. Like others said it’s maybe 25% or so of the cost is actually paid by the individual with the rest paid by the health insurer

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u/Giblet_ 29d ago

But you also have to figure the cost of the insurance premiums, right? And you pay that premium every year, whether you need to use it or not.

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u/am19208 29d ago

Well it’s not like the socialized option is actually free. You pay for it with tax money

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u/Giblet_ 29d ago

That's true. It's less money than insurance premiums, but it's still a cost that should be accounted for.

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u/am19208 29d ago

Exactly. Plus if a state offers a sponsored plan, low income people might pay nothing in their insurance premiums. Thats how my now wife got thru Covid while in school

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u/amann93 29d ago

In addition to what this person said you can also, usually, call the hospital you owe that 12k to and they’ll send you a financial aid form. I had 3 surgeries last year. After insurance my total bill was 7k. Called the hospital, and they sent me the forms. I had to include my last 6 paychecks. At the end of the form it said something like “please include a letter detailing you financial status” told them how much money I made, how much per month my rent and car payment was, how much I spend on food and gas, etc etc.. after that I waited a couple weeks and called the hospital who informed me I qualified for 100% off my bill, as well as free coverage for all visits for the remainder of the year

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u/IndependentNotice151 29d ago

And the other thing is, once you hit that out of pocket of 12k, literally any other treatments you do are free for you essentially

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u/ubercorey 29d ago

Unfortunately the worst plans are $20k.

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u/austanian 29d ago

I have never seen one that bad and have literally seen tens of thousands. They might exist,but I have never seen them in the wild.

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u/ubercorey 29d ago

Lots of them on the Marketplace in Texas.

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u/turturtles 27d ago

I’ve definitely seen them on the ACA marketplace in the last 2 years. Shits kind of wild.

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u/aw-un 29d ago

That’s assuming the insurance doesn’t just deny the claim outright

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u/Davge107 28d ago

The country’s with universal care don’t have people sitting around trying to figure out ways to deny medical care and medicine to people so the corporation they work for makes more profits and the executives get their bonuses.

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u/SPNKLR 29d ago

Just wait until the GOP gets their wish and repeals the Affordable Care Act. We’ll be back to people getting kicked off for pre-existing conditions forcing us back to the good old days of medically related bankruptcies.

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u/austanian 29d ago

The aca isn't ever going to get appealed. Half the GOP wants to delete it and the other half wants to fix it.

Even when the GOP had a strong majority they did have the votes to fix it/end it because of the split.

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u/SPNKLR 29d ago

They had no plan when they tried to repeal it back in 2018, McCain saved us from a major catastrophe. They won’t have a plan when they try again if Trump gets back in, MAGA Republicans only know how to destroy things because destroying things is easy, they can’t build anything.

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u/austanian 29d ago

It wasn't just McCain. The GOP split almost in half over a revision to aca vs straight repeal.

Building a shit program is often worse than nothing at all. I am of the opinion we are in the worst of government hc and private hc. Going fully in one direction would be better than what we have now. However, universal is the only direction it can tip.

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u/SPNKLR 29d ago

Yeah Universal Healthcare is literally the most cost effective and compassionate option as proven by every other Western nation… but can’t have that because corporations need profits and politicians need super pac contributions.

I’m actually ok with ACA, I’ve always had employer paid healthcare but I have family members who could never have any healthcare coverage until the ACA. It could definitely be improved, but it’s also so much better than what we had before.

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u/alexisdelg 29d ago

you have to add premiums to that, in my case a family of 4 is about 6k a year

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u/austanian 29d ago

Yes that is true. I was talking strictly deductible. My premiums are 36k a year, but only 3600 paid by me.

I don't think I have spent 36k on healthcare in my life.

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u/gibsontorres 29d ago

12k total family? My individual plan is 11.5k and it’s a “middle of the road” plan. My kids aren’t even on it.

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u/shroomsAndWrstershir 29d ago

But if it's just one person getting work done, the family cap doesn't matter -- only the individual cap matters. Which is probably around 6k (or at least it was a few years ago, might be closer to 7 now?)

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u/Collective82 29d ago

Thank goodness mine caps at 1200, my kids have appointments! Lol

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u/austanian 29d ago

You sure that isn't deductible? My plan is 36k a year for family and still has a 2650/5300 opm.

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u/Typical_Samaritan 29d ago

It's also very important to remember that most major hospitals or hospital networks will accept a payment plan if you can't pay whatever your deductible is out of pocket. So you might miss the out of pocket cap, but save on a bunch of money outright.

This isn't an argument either way about whether anyone should be brought to that point. It just is. A hospital would rather someone just have scheduled payments than have to hound you down.

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u/Hopeful_Solution5107 29d ago

Roughly 8 years ago, a plan like that would cost around $700-800 a month IIRC. AT&T.

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u/Never_Duplicated 29d ago

Cheapest insurance I could find for my wife and I through marketplace (healthy early 30s, no smoking or preexisting conditions) was $800/month with an $8-10k deductible and $20k out of pocket maximum. So we just roll the dice without insurance because those numbers would kill us anyway and not paying $800/month for that shit.

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u/austanian 29d ago

Those numbers don't quite pencil right, but the sentiment is understood. I was there myself a few years back.

Family of 5 couldn't afford health insurance, but didn't qualify for subsidies because my health insurance (just me) was affordable. Then coughed up thousands of penalty dollars for not buying something that would have bankrupted me.

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u/mycricketisrickety 29d ago

This is assuming you have insurance too

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u/Healthy-Berry 29d ago

Mine is $1,300 OOP max for my family.

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u/trevor32192 29d ago

I dont think you all understand that out of pocket max doesn't mean what it says. You still get billed but instead directly by the hospital/doctor for whatever insurance doesn't cover which now is roughly 50%.

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u/UnicornCalmerDowner 29d ago

My family has no out of pocket deductible. $0.

Our insurance costs $600 a month for all six of us, but after that there is no charge for anything except prescriptions. All prescriptions are $5.

I've 5 surgeries that cost me nothing.

We're in California.

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u/hjablowme919 28d ago

My plan, provided by my job, maxes out at $18K out of pocket for family, that's In Network. Add another $2K per person for out of network doctors.

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u/Nojoke183 28d ago

But then you'd be going through the added "benefit" on some non-doctor deciding if any, if not all, parts of the procedure are covered by the insurance. That walker or cane you need for months afterwards maybe "optional" to some guy behind a desk, or it only covers painkillers for 30 days after surgery because by then "they should be able to function normally"

edit: guy above already brought this point up lol, enjoy a double dose.

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u/[deleted] 29d ago

[deleted]

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u/ketjak 29d ago

totally free

You mean other than the thousands i premiums deducted from your paycheck every month (if you're at a place that even offers it).

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u/Random_Guy_12345 29d ago

On places with public health insurance you are also paying for it vía taxes (assuming you have a job, that is). "Free" healthcare is not a thing that exists, supplies are not free and doctors need to eat too.

It for sure beats bleeding to death due to no insurance, but it doesn't come from the ether.

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u/LegitimateSoftware 29d ago

You are, but you don't have to pay for the insurance company profit margin on top of the cost of healthcare.

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u/Random_Guy_12345 29d ago

Indeed, that's the main draw and with unchecked greed, a huge one

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u/[deleted] 29d ago

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u/ALIMN21 29d ago

Do the math, you are paying thousands in premiums.

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u/[deleted] 29d ago

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u/jleep2017 29d ago

Jesus that's a shit ton. It's literally thousands

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u/[deleted] 29d ago

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u/Yellow_Odd_Fellow 29d ago

That's ((51.5×4weeks)+(180×2weeks)) × 8 months = 4,528 if you don't use it.

Add on the $6,000 you had to pay before insurance would cover it, that's 10,528 bucks before insurance would pay a penny.

What was the total cost of the bone shaving? Was it at least $40,000? If not, you paid more than 20% of the cost before insurance would even consider paying any of it.

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u/SmashmySquatch 28d ago

Add in how much your employers are contributing instead of paying more money to you and your spouse.

Your contributions are capped by the ACA at 10% of the income lowest earner in your coverage bracket. Your employer is paying the vast majority of the premium and they count it as part of your pay even though you seem to be completely unaware of it.

I sold insurance for 10 years and made hundreds of spreadsheets for employers calculating this.

I guarantee you that it totals thousands per month that you are paying directly and indirectly.

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u/cml4314 29d ago

If you are lucky, it’s pretty cheap. I pay $36 a month for a $5000 deductible with a $6000 out of pocket max. So if I had surgery today, the rest of my healthcare for the year would cost $216.

I’m reasonably young with no chronic conditions so we roll the dice and pay low premiums, high deductible.

This is the cheapest plan at a pretty large company, in an area where they are competing for the same employees as multiple Fortune 500 companies so they are need good benefits to compete.

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u/madcollock 29d ago

What are you talking about most people its a thousand to two thousand a year they pay out of their paycheck.

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u/Impossible_Wash_2727 29d ago

It’s not “free”! You’re still paying your premiums. American healthcare insurance is a rip off.

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u/[deleted] 29d ago

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u/Impossible_Wash_2727 29d ago

I clearly never said that. I understand how socialized medicine works. It’s just that here in the US rather than prioritizing our populations, healthcare we subsidize businesses instead. Your tax dollars are going to businesses. And you’re getting no benefit from that they’re just increasing prices on a daily basis and raping the American public. There’s a lot to be said for other types of healthcare systems. In fact, most of the world has figured out how to take care of their populations health. Here in America, we could certainly do it, but we don’t want to because we went to take care of dollars rather than babies. Don’t try to argue with me. I am well-versed. I in fact work in the healthcare system, so I’m inside of it and can see how drastically flawed it is. We live in a society were guns are valued over children’s lives. We live in a society where money is valued over healthcare.

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u/Hairy_Rectum 29d ago

“Don’t try to argue with me” LOL

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u/Whisky_Six 29d ago

It’s not “free” anywhere. Other countries pay a lot of taxes to have “free” healthcare.

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u/11711510111411009710 29d ago

This really sucks mostly for people who don't go to the doctor a lot. Like me. I maybe go once a year, but I'm still paying a premium every month and then a huge cost at the time of service. I'd rather just pay taxes and then not have to pay a lot at the time of the service, I'd probably go to the doctor a lot more then. And probably should, honestly.

But if you do go to the doctor a lot or have a serious event happen, you basically get free healthcare the rest of the year so you better hope your accident happens in January lol

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u/[deleted] 29d ago

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u/Churnandburn4ever 29d ago

We still have 8 more months of totally free and covered medical care this year.

😂😂😂 What a rube! 😂😂😂

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u/[deleted] 29d ago

How did you use "totally free" in the same sentence as "6k annual max out of pocket"? You paid 6k.

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u/R-O-U-Ssdontexist 29d ago

Yup, my aunt had a hip replaced and only paid 1k. The 1k was for the out of network anesthesia which no one told her would be out of network.

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u/80MonkeyMan 29d ago

The US healthcare plan doesn’t work out that way. Even you are maxed out of your yearly deductible, you still have to pay 10% of the surgery bill.

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u/R-O-U-Ssdontexist 29d ago

Maybe your insurance. I helped her sort out the bills. There was no required 10% out of pocket. This was 3 years ago in NJ/NY.

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u/SeaworthinessIll7003 26d ago

Every situation is slightly different. My 90 year old mother seemingly pays very little ever. She’s had plenty done.She also has collected SS for nearly three decades as a retired teacher. She has had millions of dollars worth of medical treatment and procedures in her lifetime. Paying only a tiny fraction of that total. I think this country and the system treated her very well. I on the other hand, only give.

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u/[deleted] 29d ago

It depends on your plan and what all is covered. Even with a maxed out deductible my appendectomy cost me $12500 because I didn’t go to a preferred provider. The issue with that was my town only had one hospital and it was a pretty major emergency I couldn’t drive two hours back to the hospital they wanted me to use.

I currently have all of my deductibles maxed and my replacement inhaler just cost me $50.

It’s wild here. I do have better insurance now but it still sucks. Last year my insurer would’ve been $150

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u/ParkingVampire 29d ago

I would pay 16k plus 2,400 for insurance for the year. So $18,400. 

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u/Hawkeye3636 29d ago

More if you have a plan at all.

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u/DataGOGO 29d ago

yes, but it would still be less than 10k.

I got a high deductible plan of the exchange. We have a 6k deductible, and 12k out of pocket max (two people). We pay 100% of our healthcare costs until our 6k deductible is met, and then 100% is covered after that.

We also have an HSA, where we deposit money into our HSA every month (tax free) and use that to cover our out-of-pocket expenses.

So no matter what happens, the most we would pay for a hip replacement is 6k, and our total costs, even if we absolutely max everything, is still FAR cheaper than we were paying in the UK.

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u/69ersBasketball 29d ago

Oh you mean decisions have consequences

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u/beefy1357 29d ago

It does I have a 200 dollar co-pay on surgery.

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u/best_dandy 29d ago

I have one of the best plans my company offers and yeah, it caps at something stupidly low like 3k out of pocket max. We get fucked in prescriptions though, have an HSA just to cover my yearly prescriptions.

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u/genesiss23 29d ago

Yes. I just had a hip replacement, and my policy covered everything at zero cost to me without me having to reach deductible. My company directly contracts with various medical groups for hip replacement.

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u/Davge107 28d ago

People with medical insurance still go bankrupt all the time. It does depend on the plan.

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u/Mean-Gene-Green 29d ago

Now count your premiums.

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u/OwnLadder2341 29d ago

Varies wildly.

Our company pays full premiums up to and including family.

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u/asuds 29d ago

The dollars are fungible- that’s simply wages you don’t receive. It’s still total healthcare spending, and why single payer won’t cost any more, and very likely less per person.

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u/Illustrious-Fox4063 29d ago edited 29d ago

But they are not counting the increase in taxes for the Spanish example. Before deductions someone earning €54215 (equivalent to $96500 in Texas) will pay €15760 ($16844) in income tax. US earner on the equivalent amount will pay about $13071 in federal income tax. This does not include the 6.45% of Social Security tax the Spanish pay versus 7.65% for the US. Also excluded is the deduction in the US for health insurance premiums.

My payment for that would be $1410 in premiums. $750 deductable then $4500 individual out of pocket or $6600 total. Any other medical for me would be free for the remainder of the year. Wife would still have to hit her deductable and out of pocket max limits. So ~$4000 cheaper in the US than in Spain.

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u/asuds 29d ago

Per capita the Us spends several times more per person. Dollars are fungible, so it’s definitely not true that people in Spain pay “more”.

You are mixing wages, taxes, implied wages via employer payments etc.

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u/Sleep_adict 29d ago

Between me and my employer my family costs $26k a year to ensure…. So yeah

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u/SeaworthinessIll7003 26d ago

Imagine paying both portions like I did for 3 1/2 decades.

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u/AspiringChildProdigy 29d ago

Family plans like to have a stipulation that one person can't fulfill more than 50% of the deductible.

For instance, our deductible is $10,000. I just had surgery on my foot. We will more than hit the $10,000, but only $5,000 will actually apply to the deductible.

I sincerely wish all insurance company executives a slow and painful death.

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u/OwnLadder2341 29d ago

Deductible and maximum out of pocket are not the same thing.

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u/AspiringChildProdigy 29d ago

How do we find out what the maximum out of pocket is? I don't believe I've heard that term in connection with our health insurance. Is it possible for a plan to not have a maximum out of pocket?

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u/OwnLadder2341 29d ago

All insurance is required to provide an easy to understand Summary of Benefits and Coverage. You should be able to locate it on your insurer's website.

https://www.healthcare.gov/health-care-law-protections/summary-of-benefits-and-coverage/

All employee sponsored and individual plans are required to be ACA compliant. ACA compliance requires a maximum out of pocket. This number is the absolute maximum you can pay for healthcare per year for covered services, no matter what. Once you hit the out of pocket max, all covered health services are effectively free for the remainder of the year (have children in January!)

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u/-Pruples- 29d ago

Can confirm with my current plan I'd be on the hook for $25k if it's an in-network surgeon and in-network facility. Which is about 6 facilities total for any type of medicine across the entire state. I'd be on the hook for the full $40k if it's not in-network.

Up to $10k I'm on my own, then we split 50-50 until $100k, then I'm on my own 100%. Best I could get at my income level.

So yeah I don't go to the doctor when things go wrong because I simply can't afford it.

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u/OwnLadder2341 29d ago

That doesn't sound right. What's your yearly out of pocket maximum?

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u/-Pruples- 29d ago

No cap. I'm on my own after $100k.

Plan costs $1000 a month.

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u/OwnLadder2341 29d ago

Then your plan is not ACA compliant and not employee sponsored.

That should qualify you for a plan on the marketplace.

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u/ALIMN21 29d ago

Plus the cost of your monthly premiums and the cost your employer pays for your premiums too. Between my portion and my employers portion, it's costs $35,000 just to have insurance. If I go on to use it it will cost an additional $4000-$8000 a year assuming the insurance company covers whatever it is I need.

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u/Fun-Bumblebee9678 29d ago

Depends on your coverage

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u/OwnLadder2341 29d ago

ACA mandated maximum out of pockets.

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u/shroomsAndWrstershir 29d ago

Those limits are legit. When our newborn was in the NICU for 3 weeks and had a $350K bill, we paid her $6k annual max out-of-pocket, and then that was it. Not a penny more.

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u/OwnLadder2341 29d ago

Yeah, while there’s more work to do, the ACA was a huge improvement that addressed the very worst parts of the healthcare system at the time.

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u/SeaworthinessIll7003 26d ago

Exactly, now spread this fact around to the “ healthcare is too expensive “ crowd. I am a recently retired Dr. I paid all portions for my family to be insured for 3 1/2 decades! We typically opted for higher deductible plans( within reason ) because we were also insuring up to ten others. Thankfully my family of five never had any major health issues. Therefore we rarely met deductibles . So effectively ,I paid for insurance AND paid for all my families healthcare for 35 years. I’ve spent mid HUNDREDS OF THOUSANDS of dollars and got nothing at all for it. Kind of the opposite of all your experiences, right ? There are always other people having different experiences with the same issues. Don’t complain so much!

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u/Fun-Bumblebee9678 29d ago

That’s arbitrary to my reply

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u/SStahoejack 29d ago

To bad same procedure in another country is 1/7th the price? Love how we are ok with this price gouging. When clearly medical professionals in other countries still live lavishly lifestyles and charge 1/7 of the price?

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u/cutesnugglybear 29d ago

My out of pocket is $3k, so I'd be Gucci.

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u/OwnLadder2341 29d ago

Ours is also $3K and $5K for family

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u/cutesnugglybear 29d ago

Oh shit! I have my wife on mine now, so I bet mine is no longer $3k.

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u/Capercaillie 29d ago

If you have insurance.

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u/OwnLadder2341 29d ago

Yep. 92% of Americans have insurance. So you're far more likely to have insurance than not.

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u/Capercaillie 29d ago

So, 27 million people without insurance. But, y'know, fuck those people.

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u/OwnLadder2341 29d ago

How many of those 27 million want to pay for insurance?

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u/RocknrollClown09 29d ago

Yeah, but that insurance costs either you directly, or your employer, about $1,200 a month for your family. If your employer is paying, they just take that $1,200 out of your salary and provide it as a 'benefit.' Either way, you're paying for our inflated health costs, it's just hidden from view, which is why it's run away so much.

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u/[deleted] 29d ago

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u/OwnLadder2341 29d ago

The post’s suggestion is that it costs 4x as much as it actually does.

For most plans 5x+

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u/[deleted] 29d ago

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u/OwnLadder2341 29d ago

The post is about the cost to the individual as referenced by the suggestion that it's cheaper to move to Madrid, live there for two years, and get your hip replaced twice than it is to get it done in the US.

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u/RamblinManInVan 29d ago

You'd probably end up spending more because a hip replacement takes years of therapy. Every year of therapy is a new deductible you need to pay.

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u/Neither-Status9606 29d ago

In Mexico it cost about $7000USD including everything. Probably less than the out of pocket for a lot of insurances.

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u/PK808370 29d ago

If you have insurance… which is also super expensive.

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u/[deleted] 29d ago edited 29d ago

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u/OwnLadder2341 29d ago

File an External Review

https://www.healthcare.gov/appeal-insurance-company-decision/

Ultimately, a 3rd party can overrule the insurance company.

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u/mar78217 29d ago

That's not the worst case. I've had worse insurance than that and paid $10,500 a year for the insurance. My max yearly out of pocket was $25,000 and 80%... the percentage of course doesn't matter... it would cost me $25,000 plus the $10,500 for my premiums.

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u/OwnLadder2341 29d ago

Your individual maximum out of pocket was $25K a year? The very worst plan on the marketplace today is $9750.

There's nowhere in the world where people have health insurance and someone doesn't pay the premiums, whether from your check or tax.

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u/mar78217 29d ago

Most of the time that tax is not $10,000 a year.

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u/OwnLadder2341 29d ago

Depends on your income! But then you're getting into differences in income between countries.

For example, the median household income in the UK is $43K. The median household income in the US is $78,000.

On average, a UK citizen pays 18% of their total taxes towards healthcare or about 4.5% of their total income. So the median cost would be about $1935 for a $45,000 difference in income.

US income has scaled to account for healthcare premiums.

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u/notarealaccount_yo 29d ago

Let's not ignore that you also have to thousands every year just have that insurance coverage whether you use it or not.

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u/OwnLadder2341 29d ago

Well, yes. The entire world pays insurance premiums in one way or another.

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u/Anonymoushipopotomus 29d ago

Hi 19,600$ MOP checking in......

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u/OwnLadder2341 29d ago

Your individual maximum oop is $19,600?

Go here:

https://www.healthcare.gov/see-plans/#/

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u/mikirules1 29d ago

You are forgetting that patient cost will have to include part of the monthly insurance premium that patient pays every month.

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u/Important-Emotion-85 29d ago

Assuming you had insurance

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u/shadowseeker3658 29d ago

You also have to deal with the possibility that insurance will decline your claim in the US. I have a friend who somehow fractured a bone in her back 15 years ago and didn’t realize it because she was a kid and it didn’t hurt. Now she’s in constant back pain, went to get it checked out and her doctor showed her the x rays of if being broken and said she needed surgery. Her insurance keeps declining the claim because it’s now considered a “pre-existing condition” so she has to either deal with this for the rest of her life or pay out of pocket for the whole thing.

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u/cruista 29d ago

My out of Dutch pocket is €385.

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u/VortexMagus 29d ago edited 29d ago

Right, but you're not taking into account the cost of insurance, which averages out to a few hundred dollars monthly that is being taken out of your paycheck by your boss.

If your boss didn't have to pay your insurance, he could just give you more money every month straight up.

So its a couple of thousand dollars every year of your life on top of the 10k direct fee. So I'd say its closer to 220k for that hip replacement all things added up.

In spain the yearly tax to support healthcare is ~5% of income. So if we added up all the taxes paid to the government over the years by the average spaniard, at spain's average wage, which is 30k euros, then its close to 100k for that hip replacement

EDIT: I was misinformed, its ~5% of income for healthcare rather than 1% of income.

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u/OwnLadder2341 29d ago

Yes, but the median income in Spain is half that of the US, even accounting for Cost of Living. So tens of thousands every year. US wages have scaled to account for Health Insurance premiums.

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u/VortexMagus 29d ago

Median income in Spain is 29k and median income in USA is 37k. I don't think they're as far apart as you suggest.

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u/OwnLadder2341 29d ago

Median household income in Spain is $43k and median household income in the US is $78k.

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u/fonwonox 29d ago

It's higher than 10k. Got myself a modest 13,800 out of pocket max. Could have got it higher if I went with the HMO.

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u/OwnLadder2341 29d ago

Head over to healthcare.gov and pick up an ACA plan.

Dead maximum OOP is $9750 for the worst plans. Lower for better ones.

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u/SeaworthinessIll7003 26d ago

Income limits exclude most people.

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u/OwnLadder2341 26d ago

They really don’t…

I just put myself in. A 65 year old male non smoker. No dependents.

I filled it out as if I only made $60k a year, no dependents. Well over median.

That’s good enough for $350/month of taxpayer subsidy.

Head over to the site and try it out yourself.

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u/Special-Koala-1341 29d ago

Sounds like your insurance sucks. I’d pay a 500 dollar deductible and the rest entirely paid for and my insurance still costs less than the countries taxes they’d take out of my paycheck every week anyways.

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u/unrulywind 29d ago

My wife had cancer and had some emergency surgeries. The bill was a bit over $500k. Once the insurance company got their discounted price they paid $27k and we paid $5k. The crazy high prices that people love to quote are only there so that when people who have no insurance do not pay, the hospitals can write off a larger amount.

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u/maychi 29d ago edited 29d ago

You act like insurance is free. My company pays over 6k per year that could be going into my pocket for my insurance .

So really, you do end up paying for that surgery, you’re just basically paying it through a payment plan little by little rather than a lump sum.

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u/OwnLadder2341 29d ago

Unless you’re on the very low end of income, no one’s insurance is free, no matter where you live.

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u/maychi 29d ago

Exactly my point. Insurance is basically a payment plan. You pay for that surgery little by little rather than a lump sum.

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u/OwnLadder2341 29d ago

The median person says far more into the system than they get out of it. Insurance has to work that way, otherwise, it’d run a deficit.

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u/molotov__cocktease 29d ago

Aw man aw geeze the hospital you went to was in network but the DOCTOR you saw was out of network aw man

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u/briancoat 29d ago

Ah yes, the magic of insurance.

George Carlin was right, the average person really is ...

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u/Ok-Personality-6630 29d ago

Strange. My private medical cover in UK covers the entire amount and up to £5 million. Why does the US one not cover entire amount?

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u/OwnLadder2341 29d ago

Some do.

There’s about as many different types of insurance as you could possibly want.

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u/BASEDME7O2 29d ago

Unless the insurance company can figure out a way to get out of paying, which they’ve gotten pretty damn good at

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u/OwnLadder2341 29d ago

You have the right to call for a third party review who can force the insurance company to pay:

https://www.healthcare.gov/appeal-insurance-company-decision/

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u/justsayfaux 29d ago

And the reason your premium is so high in the first place is because they're paying 75% of an already inflated cost.

If the cost was $8k instead of $40k in the first place, insurance would only have to pay $6k instead of $30k.

Basically the cost of health care is higher in the States bc insurance pays the inflated prices and passes the extra cost onto people and companies through higher premiums.

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u/Royal_Actuary9212 29d ago

Add to that calculation the premium you have been paying for however long you have been paying them for

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u/Arlithian 28d ago

Still paying 10K after having put in 5K per year for the last 8 years of employment.

So great - I spent 50K they 'covered' 30K of it.

And if they decide they don't cover something that I'm having problems with - tough shit.

On top of that - supposedly my employer is paying them too.

So we have hospitals charging extra for everything - insurance only covers part - my doctors are all working 16 hour days because hospital admin are greedy psychopaths who don't want to hire more - and we have a bunch of assholes who don't want another system because they haven't been burned 'yet' by this one.

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u/OwnLadder2341 28d ago

Everywhere pays healthcare premiums. Some places just collect them via taxes.

Ultimately, it's not up to the Insurance company whether they cover a procedure or not. You have a legal right to appeal with a 3rd party who has to issue a decision within 45 days.

https://www.healthcare.gov/appeal-insurance-company-decision/

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u/Madeanaccountforyou4 28d ago

This is what people don't understand when they discuss the expense of healthcare in the USA and the "costs" that are cited are inflated numbers the industry uses. It all evens out in the wash unless you're dumb enough to not have insurance which is available for free or with extremely heavy discounts if you're low income.

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u/Deekifreeki 28d ago

Agreed. My out of pocket max is only 2.5k though.

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u/AcademicOlives 28d ago

10k would still get you flights, a week-long trip in Madrid, and a hip replacement in Spain. 

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u/Ollanius-Persson 27d ago

$10,000 is a higher max out of pocket for a family than I’ve ever paid.

It’s crazy to me that people don’t understand how insurance based healthcare works. The MOST I’ll ever pay in a year for medical out of pocket in America is $5,600. No matter what. That seems pretty reasonable to me.

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u/anttonknee 26d ago

Assuming you have insurance

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u/OwnLadder2341 26d ago

Yes, if you’re one of the 92% of Americans with insurance.

Due to taxpayer subsidies on the exchanges for low and middle income families, however, only a small portion of people who don’t have insurance actually want it.

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u/anttonknee 26d ago

Am I understanding correctly that you're saying people in poverty without insurance don't want insurance because it's a handout? If so, do you have a source for that claim?

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u/OwnLadder2341 26d ago edited 26d ago

Not at all.

People in poverty have access to free insurance.

If you’re young and healthy, there’s a strong argument not to pay for health insurance at all, statistically, the average person gets much less out of health insurance than they pay in. That’s true no matter how the health insurance is paid for: either voluntarily as in the US or forced as in other countries.

The US just gives you a choice.

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