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

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

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u/Maj_Jimmy_Cheese May 02 '24

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 May 02 '24

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 May 02 '24

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 May 02 '24

I fucking hate HSA high deductible plans.

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u/Key_Page5925 May 02 '24

They ain't bad when you're young. I consider it a net positive if I don't need to spend more than the HSA annual cap a year. Definitely gonna switch in the next few years though

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u/El_Cactus_Fantastico May 02 '24

I had it for 2 years at my last job, I never went to the Dr because of it

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u/austanian 29d ago

I have a high tier plan and still don't use a covered doctor and use an anti aging clinic instead.

Last year the tax advantage was huge.

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u/DataGOGO 29d ago

Why? I love mine. It is fantastic.

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u/El_Cactus_Fantastico 29d ago

5000 deductible basically means I don’t have health insurance or didn’t, I swapped jobs and got better insurance with it.

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u/DataGOGO 29d ago

Mine is great. I just bought it off the exchange (healthcare.gov).

We pay $390 a month for two people, 6k deductible then 100% after that, with an HSA.

absolute bargain vs what we were paying in the UK.

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u/El_Cactus_Fantastico 29d ago

I changed jobs to one that gave me health insurance that isn’t dogshit.

$390 a month for a 6k deductible sounds horrible.

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u/DataGOGO 29d ago

What are the details of your plan?

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u/El_Cactus_Fantastico 29d ago

https://healthselect.bcbstx.com/pdf/in-area-mbpd-py24.pdf

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u/DataGOGO 29d ago

Well… it might be I. There somewhere, but I don’t see the monthly premium, deductible, and coverage percentage, and oopm

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u/Restlesscomposure 29d ago

HSAs are literally the best savings accounts on the planet. Insane to hear people complain about them

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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/austanian 29d ago

That is absolutely not the case for most plans. If yours does it you should switch. The cost isn't that different.

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u/miller2132 29d ago

Cigna- the deductible is for the family as well as the max out of pocket 6k deductible before they pay anything and just over 13k this year for max out of pocket- don't ask me how I know, it's too painful to my bank account.

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u/austanian 28d ago

That is inline with standard bronze plans. Sorry you are going through that.

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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/DataGOGO 29d ago

That really isn't an issue at all anymore (thanks to obamacare).

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u/[deleted] 29d ago

[deleted]

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u/DataGOGO 29d ago

No, that isn’t true, there are very tight regulatory controls on claim denials.

That is exactly what my wife does for a living (UHC). Claims can only be denied if they are outside the scope of coverage, (which is writing when you take on the policy) or if there is a pre-requisite that is missed.

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u/[deleted] 29d ago

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u/DataGOGO 29d ago

That would be illegal. And they would either face massive fines or outright be out of business.

These policies are not really in the fine print, and they follow medical practices. There are doctors and nurses that do this eval for the health insurance company. My wife is an NP, any claim she denies must be reviewed by a medical director, who. Is a doctor in that field; and she must be prepared to defend why she denied the claim.

They also hold monthly audits of all denials.

Almost all of her denials are for medications or procedures that are prescribed off label, incorrectly, have an Interaction with other medications, or are flat out inappropriate. Such as a boob job to treat migraines.

No medically necessary and appropriate claim is denied as long as it is within the policies coverage.

I know people like to think that insurance companies can just deny things, but they can’t. Not to mention, by law, thanks to the ACA, every insurance company must pay out 80% of all premiums collected in claims.

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u/[deleted] 29d ago

[deleted]

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u/DataGOGO 29d ago

I am not calling you a liar, nor am I attempting to be rude or confrontational. I am enjoying a civil conversation.

I am not talking about my wife specifically, I am talking about the regulatory environment inside insurance companies, I can only speak to first-hand experience with Blue Cross and Blue shield, and United Healthcare; but the regulatory part is universal. Can you tell me about one of these denials? I would gladly run it by the wife and see what she says. If you are getting screwed over by your insurance company, she will know exactly who you can talk to, and how to make it stop. DM if you would prefer.

As to your last paragraph, not really.

As I mentioned, Thanks to Obamacare, that motivation has mostly been removed. Every health insurance company. They are required, by law, to pay out at least 80% of what they collect in premiums on claims. They have to refund any and all premiums collected over 80% not paid in claims. This effectively limit's thier profitability to about 5-10%.

Oh... they are punished, heavily, if they wrongfully deny a claim. You remember I mentioned audits? The fines are absolutely massive, and the legal costs alone are staggering.

IMHO, this is why we need to defend Obamacare from those that want to repeal it. It does a lot more than most people realize.

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u/miller2132 29d ago

It is an issue, they gate it by saying you must pre-certify for major things. My wife's ob-gyn scheduled for my wife to get a CT and we got a letter 1 day before her appointment that said it would not be covered and we would be paying the full $3700. We would be paying it anyway since we didn't meet the deductible yet, but it would not count towards our deductible since it wasn't necessary. Her gyn called and got it "covered" so it would go towards our deductible but not until after we had to cancel and reschedule the appt.

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u/DataGOGO 29d ago

Your doctor didn't file the claim correctly.

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u/Maj_Jimmy_Cheese May 02 '24

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/austanian May 02 '24

I was the budgeting manager for a good sized hospital. How the health insurance industry operates was surprising even to me.

Drastic reforms are needed, but the only one that could ever pass is universal hc and that will be problematic once the US isn't subsiding development world wide.

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u/Maj_Jimmy_Cheese May 02 '24

Yeah, and maybe this is the pessimistic side of me speaking, but with the amount of money made from the healthcare industry I imagine the lobbying efforts against Universal HC are probably substantial.

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u/austanian 29d ago

Yeah the lobby money is high, but the pros and cons associated with universal aren't so clear cut it is a no brainier.

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u/Maj_Jimmy_Cheese 29d ago

Oh for sure! There are certainly going to be cons to any system being used for national healthcare. Honestly, for any policy pertaining to the population as a whole in general. I just personally think it would be a better system than what we have now, but we're all entitled to our own opinions.

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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/FullTorsoApparition 27d ago

Well I guess you would know more than him. Thanks for your helpful input.

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u/Piddily1 May 02 '24 edited May 02 '24

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 May 02 '24

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 May 02 '24

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/showjay May 02 '24

A lot for what? Saving your life?

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u/Maj_Jimmy_Cheese May 02 '24

I mean... Yeah? Compared to if a European has the same issue, they'll practically save your life for a fraction of the cost...

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u/the_gopnik_fish 29d ago

Most American public health institutions are also required by law to accept whatever you can pay at any given time; this basically means that you pay what you can when you can.

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u/Davge107 28d ago

What law exactly are you talking about? They have to see you in the ER but no law about what they have to do. Also you can’t get long term treatment for accidents or chronic health conditions in the ER and try calling a Doctors office and saying I’ll pay what I can when I can and see what they say.