I think most people around here know that our healthcare payment structure is totally whack. However, we're not the people who need to know this.<p>Try showing an NPR article about universal healthcare to Joe USA. I guarantee you'll get one or all of the following responses:<p>1: I don't want my taxes to go up<p>2: I don't want to pay for illegals to go to the doctor for free<p>3: My insurance will get worse<p>4: I like my doctor, I don't want to be forced to go to a worse one<p>5: I don't want the government deciding when I go to the doctor<p>6: I don't want to wait six months for a doctor appointment<p>7: NPR has a liberal agenda<p>Many of my family and extended social circles are quite conservative (in the USA sense) because of how I was brought up. I have heard all of these and more every time the concept of universal healthcare is brought up.<p>Most of the reasoning I hear is not based on facts, but on emotionally misleading arguments from the network of memes and punditry where they get their info. And when they vote, they vote for people who oppose universal healthcare on these fallacious bases.<p>How do you convince someone like this that universal healthcare is better for all of us?
These are going to be recognized as a policy disaster.<p>There are many cases where a somewhat expensive treatment saves a very expensive hospitalization.<p>For instance, a steroid inhaler for asthma costs about $200 a month, maybe you have two $200 specialist visits a year. So for $2800 a year (not covered by high-deductible insurance) you can probably be symptom free or you can take your chances and have an exacerbation and a $28,000 hospitalization (which insurance will pay some of after the deductible)<p>Docs hate them too.<p>With real insurance, you have maybe a $20 copay you pay at time of service and they know they are going to get paid by the insurance.<p>With fake insurance, they don't know what you are going to pay until months later when the insurance gets around to telling them. Then you get a bill that says you owe $291.44 for some unspecified service you got 6 to 18 months ago.<p>(They can't tell you what it was because that would violate your privacy)<p>Needless to say they have a big accounts receivable this way, many people don't pay or they pay late (e.g. a few months after getting a bill they don't understand as well as something that says "THIS IS NOT A BILL" they don't understand). This is not good for their finances or their state of mind.<p>In theory high-deductible plans might lead you to shop around between providers to get a better price but in practice nobody can or will tell you what things costs and it doesn't work.<p>It's a perfect example of the neoliberal mind at work.
This is starting to feel like the mortgage crisis again - specialty tools that are not in themselves bad, are being misused to bolster affordability and in the process create very bad financial situation.<p>The HDHP + HSA are great for those that can afford them AND are in good health overall. Good employers also add to your HSA each year to help with the initial costs.<p>The HSA is a lot better than the FSA, which creates bad incentives on use it or lose it money.<p>The problem becomes when HDHP is used without a well funded HSA and with insufficient income to handle the deductible, together with health problems.
The health care system in this country is a crime. It is structured to take advantage of people at their weakest and most helpless. We spend 3 times as much per capita as most other industrialized nations and get worse outcomes overall.
This shouldn't be surprising. If you're on an employer-based healthcare plan, a HDHP only makes sense if you're young, healthy, have no dependents, don't take expensive medication, <i>and</i> your employer pays most of the annual cap into your linked HSA.<p>I fit most of those checkboxes, but I take PrEP (preventative HIV med) that is something like $1500/month before deductible, and the math for HDHP vs traditional plan does not check out in that case at all.
Obamacare is unfortunately a band aid solution and does nothing to address the fundamental issues:<p>1) complete lack of price transparency, which means virtually no price competition between clinics / doctors
2) artificially low supply of doctors to jack up prices
3) corrupt regulation to prevent consumer health startups from existing<p>Fixing these issues is going to take a lot more than just taxing people for not buying high deductible health insurance.<p>There's no fundamental reason why most doctors should get paid more than airplane mechanics for example. Either way if they mess up, people die.
I got an individual HDHP as soon as I turned 18 in 2004. Shopping around on these plans is not easy, I'm really the only one to do it. I thought it would get easier as more people got HDHPs, it got a little bit better over the years and then drastically went downhill after the ACA. Two main reasons: reduced competition, and our bizarro culture where no one blinks at an $800 surprise bill.<p>I used to have a couple imaging facilities that I went to because their rates were low. In the past few years they have all been bought up by some sort of conglomerate and prices have gone up. It’s not advertised, so I literally have to call the place, talk to the back office and find out if they’ve been bought. So last year I go to the one place that hasn’t been bought, rates were good, I go this year and the bill was a surprise. Even my blood test rates have gone up this year, I’ve asked several doctors and they’re like “Yeah, it’s pretty much Quest or Labcorp now.” So my rule now is, if the back office has no clue what they're doing, they will likely be cheap, and they will likely either get bought up or go out of business.<p>Many years ago when I’d go to the doctor I think I was literally the only one with an HDHP, and the allowable amount would come out to $200, and they’d go “Oh, that’s not right. How about $60?” And just take $60 from me and call it a day. Now when I ask “Will this test cost me more than $200?” No one has an answer or seems to care like we are in some crazy bureaucracy.
I’ve had a HSA+HDHP for years.<p>I’ve always contributed the annual maximum into the HSA so there was never a question for me of running out of money to pay for care, and it hasn’t held me back from seeking medical care or treatment.<p>However, it’s perfectly possible for someone to elect the HDHP and not contribute to their HSA, in which case you could be facing a $3000 or higher bill without the money to pay for it. It seems like this is the case described in the article.<p>With a fully funded HSA I almost feel like I have the opposite problem, which is I don’t feel a need to attempt to shop around and compare prices.<p>In general it feels like the HSA/HDCP experiment has failed although I’ll keep using it for as long as it’s offered, as I like the ability to build up my savings every year in the HSA and eventually use it as a second retirement account unless I have a huge medical problem in the future.
When selecting from health insurance options, I only ever consider HSA plans, which typically have large deductables.<p>Why?<p>The US has the best health CARE in the world, but with a crappy health insurance system. The health insurance has been regulated to a hot mess by cronies and politicians that is slowly destroying the care system.<p>An HSA gives you more control of your care.<p>Rationing care is not the answer to solve the insurance problems. I'm not interested in waiting for long periods of time for rationed care, such as what is seen in Canada.<p><a href="https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2017" rel="nofollow">https://www.fraserinstitute.org/studies/waiting-your-turn-wa...</a><p>For all its faults, at least I can get an MRI within a day or two, and can see a specialist within a day or two. That's way better than waiting on rationed care.
i hope this is a transitional cost. i am on the fairly liberal end of things but was hoping high deductible plans would force prices lower by getting consumers involved while still protecting against catastrophic events.<p>and we are starting to see pressure on drug companies and medical care (epic pen issue for example) as consumers push for reform now that they are feeling it in their pocketbooks more directly.
Switching from a co-pay based insurance to an HDHP + HSA was a big change. My deductible is quite high, so all normal, non-catastrophic medical costs are paid for without insurance.<p>A doctor visit starts at $139 and may be from $300 to $500 depending on the diagnosis. One cannot determine the cost in advance. Any lab work is extra. Is it worth $1000 every year to have a doctor do standard blood tests?<p>Like anything that suddenly becomes very expensive, it makes one look at things differently and question whether they are necessary. Some people put off doctor visits longer until things seem unbearable. Some research online and try to self medicate with over the counter things.
I'm exhibit A. I signed up for an HDHP because I didn't want to pay a monthly premium and thought and HSA sounded like a great way to save for health expenses. I had a bout of rhabdomyolysis after pushing myself while at the gym, after doing some research and learning that it probably wasn't life threatening I decided to wait it out and self treat instead of going to the ER.
I have found that by paying the same amount as the premium of the PPO into my HSA that I come out even, if I end up spending the whole deductible, or ahead (i.e. building savings), if I don't. In other words, I don't see any disadvantage to HDHP+HSA vs. PPO plan.
A little off track rant but the tax and health policies of USA are super freaking unbelievable. Why on Earth can one not be eligible for a HSA when they don't have a HDHP? The healthcare is screwed up. The least you could let people do is use their pre tax monies for the health treatments.<p>And don't even get me started on FSA and forfeiture. That's MY money. What the hell do you mean the amount is forfitted?<p>Apologies for my language. The policies are making me go crazy.