Money Won’t Buy You Health Insurance

This really highlights how utterly insane our system is. I'm living off of my own business, which means that I don't have an employer to cover me under group insurance. But I really only make enough to live frugally and save a tiny amount each month--to me, an affordable health insurance plan would be between $50-$100 a month.<p>Fat chance of that happening. And if it did, the deductible would be so high as to make the plan worthless for anything short of a car-crash-emergency-type-situation.<p>But not only would it not happen at that price, but as the article says, it wouldn't happen <i>period</i>--even though I'm a healthy, nonsmoking, active 26-year-old male, I've had cubital tunnel problems in the past (typing) and surgery on my wrist (badly broken in an accident). If I applied, I would surely be denied--and again, as the article states, if you're denied once, your chances of being accepted in the future just dropped by a big percentage.<p>It literally makes more financial sense for me to pay minor expenses out of pocket and declare bankruptcy in the chance of crippling bills than to be insured.<p>Healthcare in America is utterly, utterly broken; it's damaging poor, middle-class, and rich people alike, and stifling innovation. I have the ability to innovate with my company because I'm young, single, and healthy; but many smart people have existing medical problems, families, or other factors that make them indentured servants to the company that pays their healthcare. As a nation we're under the thumb of the insurance companies, and instead of doing anything serious about it, we've done almost the worst possible option: require every one of us to be a customer of these monstrous companies, with little regulation on cost or other government oversight. I'm the first person to back health insurance reform, but we've reformed it in the name of shoveling more money into the pockets of industry instead of for regular people needing real care.<p>It's crap like this that's compelling me to make my current expat lifestyle permanent. America might still get the tax dollars my business generates (the only country to still tax you if you live abroad) but it won't get my brain or my talent within its borders.

The subtle but crazy part about this is at the bottom when it details the author: "Donna Dubinsky, a co-founder of Palm Computer and Handspring, is the chief executive of a computer software company."<p>I'm going to go out on a limb and say money is not an issue for Donna, yet she still can't even <i>buy</i> insurance if she wants to. I've always thought healthcare access was a bigger hurdle for entrepreneurs than tax rates. If I make a lot of money with my startup, great, I really could care less if I pay 15% or 40% of that to the gov't, because it will be a whole lot more than I make now. But not having health care insurance (or worse, having crappy insurance that denies you all the time like most individual plans do) is so damn risky it makes me afraid to step out on my own.

I would have died at the age of 19 if it weren't for the help of the UK's National Health Service. My parents and I didn't have to worry about hospital bills, future insurance issues, being tied to a job, any of that crap. Just get some rest, get better, go out there and be productive again. The American system looks like a horrible joke from over here. I just can't understand any of it.

I'm no expert, but isn't this one of the major issues that the health care reform bill of 2010 is going to fix? Granted, it doesn't go into effect (for adults) until Jan 1, 2014, but I thought that insurance companies will be prohibited from denying coverage or charging higher rates based on pre-existing medical conditions. Am I mistaken?<p><a href="http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act#Provisions" rel="nofollow">http://en.wikipedia.org/wiki/Patient_Protection_and_Affordab...</a>

The US government spends $793B on medicare &#38; medicaid, and give $215B in tax deductions for health insurance. This total $1.008 trillion/yr on healthcare costs, which totals $3272/per capita/yr.<p>Japan spends $2249/per capita on healthcare. The UK spends $2317/per capita on healthcare. Sweden spends $2745/per capita/yr on healtchare. You get the idea.<p>You are already paying the government for healthcare. You pay higher taxes to offset the loses for the health insurance deduction. The IRS collects medicare along with the Social Security.<p>However, you don't get the healthcare you pay for. Instead, you have to pay again to actually get healthcare. In some countries, they call this a bribe. However, America has institutionalized it.

Health insurance is broken because the people who pay the bills (the insurance companies) are not the people receiving the services (patients).<p>If patients were actually paying the bills, they would be much more price-conscious and you would see price competition on that stupid-expensive MRI (for evidence, look at how much cheaper LASIK surgery has become and how much better it has become, yet insurance does not cover it).<p>Doctors, on the other hand, are far more concerned about making sure the people paying the bills are taken care of. The proof that you aren't the customer is the 90 minute wait that is <i>expected</i> when you see a doctor. What other industry would force their customer to wait that long after making an appointment? But, since you are not the customer, that's OK, isn't it.<p>Having had a gastric bypass, I will never be able to get insurance outside of a group plan. My wife can't get coverage for other reasons. One of my four kids can't get coverage, either. I'm 9 months into my COBRA for the start-up I'm working on. If we don't have a group plan in the next 6 months, I will have to bail on the company.<p>And our government can't even bother to have a real dialog on the subject. Pisses me off.

I left the Army where I had free healthcare for me and my family - I got spoiled. I really can't afford it now that I'm out and not with a big company. I've thought of going into the Reserves just to have the option to buy it again.<p>Healthcare really does suck.

The irony is: the same Congresscritters who vote against universal health insurance get top-notch health insurance paid for by taxpayers: <a href="http://www.suite101.com/content/health-care-for-the-us-congress-a72870" rel="nofollow">http://www.suite101.com/content/health-care-for-the-us-congr...</a><p>After 5 years of service, they get lifetime health insurance, the same as all federal employees and retirees:<a href="http://www.opm.gov/insure/retirees/index.asp?MainQuestionId=6" rel="nofollow">http://www.opm.gov/insure/retirees/index.asp?MainQuestionId=...</a>

I'm an entrepreneur with a wife and son. I'm 23. We pay $360/mo for individual insurance and it is pretty crappy. The deductible is high and there are several "up-front" visits, which means the first X times we go to the doctor the insurance pays nothing and deducts one of our up-front visits. Each of us have X of these, so the first X times wife goes in, and then the same for me, they are not taken from the same pool. This accumulates to several hundred dollars of visits before insurance pays for anything, and then we still have the deductible to churn through, and they've applied regular visits to that as well.<p>We're struggling to make ends meet here; our clients are good and we're trying to build a steadier base, but the pay is irregular and sometimes we have trouble meeting monthly obligations.<p>They make it such a hassle to do anything and they rip us off so hard (providers and insurers alike) that we usually just don't pay our medical bills except what we have to pay up-front. It's too much crap to deal with, the insurance always makes up a reason not to cover things, and it's absurdly expensive. Every time we have tried to pay the people have come back saying we'd owe literally 10x more than they we were originally told we would owe. It's just not worth the headache or the hassle, much easier to silence unrecognized numbers from bill collectors and let their corrupt and evil system rot in on itself.<p>We don't really have the option of <i>not</i> getting health care and dying, we don't go to the doctor for fun, we only go when we have to.

I have my family on a $10,000 deductible per person ($30,000 for family). That still costs over $500/month.<p>Unless you have cancer, heart surgery, or some other major thing, and are in good health you'll save far more over buying a lower deductible plan.<p>We used to have reasonable insurance, but the annual increases have been enormous, without any claims.<p>More people will drop insurance, leaving the companies with only the sick, if they keep pushing younger, healthier people out of the system.

In the past three years, I have made significant career decisions based on the insurance costs and coverage of the employer.<p>In one case, I turned down what was clearly a great hacking gig with a hacker whose work I really respected. The root issue there was that not only was the position a lot less in salary than I was previously making (this was fine and known when I started looking into the job), but the huge cost of obtaining a private policy for myself and my family blew me away. I was quite naive and assume I would be paying a small multiple more (2x or 3x) but the numbers looked to be at least double that.<p>So, the cost of health insurance prevented me from taking a pay cut to do more interesting work. Of course, the employer was pretty strapped, if they had higher money to offer, I would have been all over it. The private health policy costs just took me by surprise.

Can someone please explain to me why five thousand self employed people can't form a corporation together and get group insurance? Do shell corporations like that already exist?

So, people in the U.S. are billed an astronomical sum for a MRI, even with insurance?<p>The most expensive MRI bill for someone in the "mutualism" system here in Uruguay is U$ 100.<p>I tried to explain the Uruguayan "mutualist" socialist health system here:<p><a href="http://news.ycombinator.com/item?id=1627862" rel="nofollow">http://news.ycombinator.com/item?id=1627862</a><p>"Mutual organisations do not have external shareholders - they are controlled by their members. Members may be users of the mutual, employees, other stakeholders or a combination of these Mutual organisations are either owned by and run in the interests of existing members, as is the case in building societies, cooperatives and friendly societies, or, as in many public services, owned on behalf of the wider community and run in the interests of the wider community"<p>A HN member compared them to credit unions, I think it's a valid analogy.<p>The mutualist system is always near bankruptcy and is perfectible (and the government is always meddling), but it doesn't bankrupt it's users and it kind of works (life expectancy here in Uruguay is the same as in the U.S.).<p>Edit - funnily, it seems it's very similar to the Japanese case (and MRI's cost U$ 98 there too):<p><a href="http://news.ycombinator.com/item?id=2247969" rel="nofollow">http://news.ycombinator.com/item?id=2247969</a>

I've had some luck with hacking my family's healthcare expenses in the last couple of years. I am a healthy 26 y/o with a wife and son. We were living in Seattle and healthcare was the most expensive when I was employed full-time and my wife was pregnant.<p>Luckily, the company nearly tanked and let me go along with my entire department. I've been a self-employed consultant since then (almost 3 years) and went without insurance for about a year just so I could afford to pay for my wife and kid.<p>Then I figured out some hacks. I found a startup health practice called Qliance in Seattle which Michael Dell, Jeff Bezos and Drew Carey have funded (nice article about it here: <a href="http://www.techflash.com/seattle/2010/04/jeff_bezos_michael_dell_drew_carey_and_others_back_health_care_startup.html" rel="nofollow">http://www.techflash.com/seattle/2010/04/jeff_bezos_michael_...</a>).<p>For about $50/month each for my wife and I and $40 for my kid (total of ~$140) were able to see a doctor any time we wanted for non-emergencies without co-pays.<p>I can't tell you how much weight this was off my back. Staff was friendly, service was great, modern offices, experienced doctors. Couldn't have asked for more. We got a high deductible family plan along with it which added about $200 to the costs. If you are in the Seattle area and are self-employed, this is probably your best option.<p>The second hack was that we moved to Japan about a year ago. As others have mentioned, they have a very consumer-friendly system over here. I had a big health scare when we first moved which required lots of medication and several doctor visits, but it didn't set us back more than a couple hundred bucks.<p>I'm really worried about moving back to the US now. I hope things get better before we move back in a couple of years.

Shameless plug: I'm working on a startup that, while it won't be able to directly fix people being denied coverage, will hopefully help people to understand their coverage a bit better. <a href="http://cakehealth.com" rel="nofollow">http://cakehealth.com</a>. Not yet open to all but you can sign up if that sounds interesting to you. We &#60;3 beta users.<p>And on a related note, I have noprocrast enabled so apologies for the n00b-looking account, real uid = andrewpbrett. Someone alerted me that this was being discussed.

&#62; "If members of Congress feel so strongly about undoing this important legislation, perhaps we should stop providing them with health insurance. Let’s credit their pay for the amount that has been paid by the taxpayers, and let them try to buy health insurance in the individual market...Health insurance reform might suddenly not seem to them like such a bad idea."<p>Hell yes. While we're at it, lawmakers should be required to do their own taxes at least once every few years as well.<p>In terms of systemic change, I think requiring our legislators to eat their own dogfood would do much more for our country than all of our disjointed attempts at campaign finance reform and the like.

I'm glad we don't have these issues in Australia. The American healthcare system would be one of the only reasons not to move there to start a business.

Does anyone have any experience with small-business health-care pools as an alternative to buying individual insurance? They've been talked about for a <i>long</i> time, and some states supposedly have programs for them, but I haven't heard much about how or if they work. Can you join one and get insurance at any sort of vaguely group-negotiated price with fewer of these kinds of problems?

I used to be a long-time believer of free market. But for health care and Education system things are quite different. All the participants taking care of their own interest doesn't mean the interest of the whole society will be maximized. Some poor countries might be better than the States. Believe or not, check the healthcare of Cuba!

I find it absolutely impossible to believe that her coverage was denied for the reasons she described - I have been approved for and paid for my own insurance for years (including my family's insurance) with medical issues far more serious than those.<p>I concede that the system is totally messed up and the new health care bill makes it even worse.<p>Employers shouldn't be required to provide health benefits - eliminate the necessity of group plans.<p>Open up the state lines, allow insurance companies to compete for your business and watch prices drop dramatically. I'm certainly in favor of some basic oversight but not the egregiously burdensome regulation of the current system.<p>Anecdotally speaking, I have several friends, colleagues and family from various backgrounds that are doctors and nurses in different states and I have yet to find one of them that agrees the new health care bill is a good idea. They all think it dramatically complicate how they treat patients and ultimately marginalize the overall quality of care they will be able to provide. (Again, this is anecdotal but has definitely influenced my opinion. I have been shocked to find out that not one of these people I know actually support the new bill. Having said that, I know there are those that agree with the new bill.)

"Group of 2" in California can be husband and wife. (We did this, because the plans are better, the rates are better, and they can't limit you based on pre-existing conditions.) Just make a partnership and pay the state taxes annually (ugh).

Something to add to the discussion: She says "my recent M.R.I. cost $1,300 at the “retail” rate, while the rate negotiated by the insurance company was $700."<p>I have insurance and the insurance company (BCBS) will only pay what it thinks is appropriate for a service, not some negotiated rate. That is, if the doctor, hospital, or lab says that it costs $1,300, but the insurance company wants to pay $700, I'm stuck for the other $600. The result is that in order to meet the high deductible (at which point I no longer have to pay out of pocket like this), I pay way beyond the amount of the deductible since only the approved rates are applied. In practice, I end up paying out 175% or more of the deductible amount.<p>I suspect that our experience will soon become the norm, if its not already.

The cost of healthcare and college basically scared me away from migrating to the US. It's a definite trade off but here in Australia, having paid off my house, I can live almost free of overheads. It is incredibly liberating to get up in the morning and know I can go to work on my own business without worrying that some freak accident or illness will destroy me financially.<p>On the other hand, I do think that the lack of these other costs is one reason that we have some of the highest house prices in the world. When you take away these other costs people just devote their disposable income elsewhere. Even so, I think it's better used that way than paying executives in health insurance companies.

&#62; The difference is significant: my recent M.R.I. cost $1,300 at the “retail” rate, while the rate negotiated by the insurance company was $700.<p>The shocking thing is, if you get an MRI at a cash only diagnostics facility it can cost as little as $300.

I might be living in a socialist paradise (Australia) or some thing but my last visit to the doctor (broken toe) was free.<p>I am truly horrified by the state of the US health system, sure Australia's might be a bit messed up at times but it is so much better than what Americans have to deal with.<p>Move your startup to Australia! Seriously, cheap/free heathcare for minor-&#62;medium problems (the bad stuff is still going to throw up some major bills but not bankruptcy worthy). As a plus we have a superior economy right now, better living standards and hot women.<p>Not sure the state of the laws regarding Americans access to our healthcare but worth a look.

My wife and I are healthy. But we've seen our rates more than double in the last year. I've heard <i>many</i> stories like the one referenced in the article where healthy people are having hard time even finding insurance.<p>A friend (a plumber) told me the other day that he was really struggling to afford insurance for his family because his premiums had more than doubled as well. He said he had incurred 3 rate increases in 3 months.<p>I'm just curious how many people have seen any benefit yet from health care reform? I know most of it doesn't go into effect until 2014. But something is seriously out of whack here.

I just wish her report include some mention of WHAT the new legislation will in reality do for her?<p>Because I suspect it will do little for serious health problems. IF they can pay for it, all it will do is prevent the insurance companies dropping her when she gets sick someday or stop paying out when they hit a limit like on cancer.<p>I say that's not a lot because they ARE allowed to raise the premiums so high that the patient has to drop the insurance on their own because there's no way to for it.<p>So the legislation is useless for the serious stuff.

If you want to revolutionize medicine, you need to revolutionize how everyone in medicine is paid.<p>The revolutionary technology already exists: telemedicine (TM) through live video conferencing, store &#38; forward of image data for dermatology, radiology, or ophthalmology, home health monitoring, wearable monitoring systems, online health management systems, personal health records, genome sequencing, its all here! So what's the problem? Doctors can't get paid for any of this.<p>Despite common belief, doctors don't get paid that much, particularly doctors that work in the public setting and must deal with Medicare (and in California, MediCal) patients. If a neurologist in San Francisco sees a Medicare patient in Los Angeles through video conferencing they can't bill Medicare because LA is not a non-Metropolitan Statistical Area. No doctor wants to deal with dismal MediCal rates. There are little to no codes to bill for home-based monitoring, and if even those exist, there is no code for a specialist to diagnose remotely. We have 30 years of academic literature praising TM. So who's holding everything up?<p>We need a new insurance company that focuses on TM and monitoring technologies from the start to usher in what everyone and their mom has been describing as "preventive" healthcare. Sure, we'll still need traditional methods for surgeries and catastrophic events, but I'd pay out of pocket to be able to forward an image of a rash to a dermatologist or the back of my throat to my physician any day. Fast, instant, convenient.<p>Someone in the comments mentioned Qliance, which looks promising. I'm surprised someone in SV hasn't taken advantage of something similar there. Geeks love to be on the cutting edge, why not be the cutting edge medical patient?

I couldn't get surgery approved on my employer's health insurance. I eventually decided not to let that stop me from changing jobs and doing what I wanted to do, despite not being able to afford surgery out of pocket and despite an inferior choice of health insurance plans. I suppose I could emigrate to England if all else fails. I can do this as my mother was a British citizen otherwise than by descent, though it is an involved process.<p>The present system is designed to impose a huge negative externality on would-be entrepreneurs and others who might have left their jobs to pursue other opportunities. And you are subsidizing the profits of the industries that benefit from the relative immobility of labor. That negative externality you pay is someone else's subsidy. If it were up to me, I'd rather pay into a universal health care system than pay the negative externality to stay tied to an employer on account of health care coverage.<p>Another negative externality is the administrative burden imposed on companies to handle employee health care.

Countries like India, Malaysia are starting to see a boom in Medical Tourism. It costs approximately $4500 for a open heart surgery at the best hospitals compared to $15-$20K in the US.<p><a href="http://en.wikipedia.org/wiki/Medical_tourism" rel="nofollow">http://en.wikipedia.org/wiki/Medical_tourism</a>

I was in France not too long ago and had to go to the emergency room for stitches. The wait was not much longer than in the US--we started talking about payment (I didn't have my insurance card on me...doh!. Finally, I asked them what the bill was--around 20 Euro. I paid cash...I talked to a doctor on the bus ride back and part of it is a combination of low malpractice suits (I think a minor part) , taxes, and the fact that doctor salaries are much lower than they are here in the US...<p>I agree that the system is broke here.

the problem in this country is that not enough people are paying for their own health care or insurance.<p>Some people are getting medicare others are getting medicaid, others have benefits from the VA or a government job. Others get it from unions or employers. Only the people who are responsible for paying their own bills truly understand the state of our health care industry.<p>Because of that it is always someone else's problem and no one really minds paying 48k for 2 nights of saline drip in the hospital when the only cost to them is the 500.00 deductible. The hospital collecting the 48k certainly does not want that to change neither do any of the other predators in that food chain.<p>Put a high tax on employer sponsored insurance plans so that all employers stop offering it as a benefit. Then we will see real reform.

It's simple. The US needs to stop subsidizing the bad calories (i.e. sweetners and hydrogenated oils) and enabling the treatments (i.e. dialysis, statins) that treat resulting diseases of civilization (i.e. diabetes, heart disease).

It is broken ...and expensive.<p>My health insurance (not from US) has worldwide 100% coverage, except for the US. To get a US coverage, I would have to double what I am paying now.<p>The US health system is twice as expensive as any other health system in the world.

The article does not mention that money _can_ buy you health _care_. Given this, there should be market opportunity for a company which courts the supposed legions of people denied for picayune reasons.

Can anyone shed some light on the oft-repeated "let them compete across state lines" conservative argument? Is there any chance that less regulation could actually foster some healthy competition?

Sounds like an industry ripe with opportunity for the right hacker.

When I am back in the USA next month, I am planning on cancelling my virtually worthless health insurance ($90/month) and signing up for cryonics ($30/month).

Link without registration: &#60;removed&#62;<p>Edit: Apparently you need to go through Google for this to work. See comment below.

I'm 35, single, and paying something like $120 per month for Blue Cross coverage that I found on ehealthinsurance. I've used them each time I've not been actively employed, and I've always found an acceptable deal.<p>Mind you, I took the high deductible route since I'm only concerned with catastrophic illness at right now. Also, the moment anything serious comes up, they can cleverly drop me, since they have ludicrous things on their forms like, "have you EVER received ANY medical treatment not listed on this form." It would be essentially impossible to answer that question unless writing about a newborn.<p>By the way, Blue Cross tried to ratchet up my rates last year. I went back to ehealthinsurance and found a plan for about 25% less than the exact same plan directly through Blue Cross. There is no loyalty incentive whatsoever.

I went down this path myself, the company I was with in California went under and I had ended up consulting, COBRA runs out after 6 mos so I decided to buy some health insurance and I got denied. The reason being that years previously I had "asked" a consultant about a procedure that I never actually went ahead with and that was in my records which they dug up.<p>I moved back to the UK and now enjoy the wonders of the NHS and this was one of the biggest reasons I left since I really didn't want to lose my house to pay medical bills if I got seriously ill.

I'm an example -- I have private health insurance out of necessity. It was an arduous process, and I'm lucky to have managed to get it -- even though I'm healthy. If I had so much as one serious problem, I'm convinced I would have been turned down.<p>It is broken. Seriously broken.

Ug, this kind of article brings out the worst in Hacker News. Less like this, please. I can get this on reddit.