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comment by steve
steve  ·  651 days ago  ·  link  ·    ·  parent  ·  post: Human Mealworm says people should choose between "iphones" and healthcare

My employer and I will spend exactly $15,694.32 this year on health insurance premiums ($1307.86 per month) for a family. For that low, low price, I get a $4000 In-Network deductible and a $10,000 Out-Of-Network deductible. There is no prescription coverage until I hit the deductible. Oh... and when/if I hit that deductible? They pay 80% of the bills until I hit my "out of pocket maximum" which I think is $6000. So assuming I get to stay in network.... I get to pay the first $4000 straight - then I pay $2000 of the next $10000 worth of medical expenses.

If I have ZERO healthcare expenses... I have put $15k into the system. If I have a "normal" year when a kid or two get a runny nose/ear infection, maybe a broken bone or a bad rash... I'm dropping a couple hundred bucks per Doctor visit... maybe a couple thousand bucks. So I'm pumping $17k into the system. Even in a year when my wife gave birth to one of these mongrels... I think the most healthcare we consumed was about $25k.

And for some reason I feel lucky.... like I won the healthcare lottery... because I have it..

Look - if I'm paying $17k to have a healthy year? This system is MESSED UP.

kleinbl00  ·  651 days ago  ·  link  ·  

The Week had an editorial last week about a woman salty that nobody would let her have an elective c-section. I told my wife and she said "what, nobody wants to give her $80k in free surgery? shocker."

The c-section rate in the United States is about 1 in 3. If you take a normal hospital delivery ($20-22k) and average two of them with a c-section, the average cost for a birth in the United States is $40k.

Primera Blue Cross will pay us $3200. Why? We're not a hospital, we don't do c-sections, and we don't have ninetynine skidillion ICD10 codes to bill. But then, we also don't have the overhead of a hospital. Shit, take away the malpractice and we don't have the overhead of a dentist's office.

Down in LA insurance wasn't required to pay my wife at all. She was a cash-pay business. So people would pay her $4500 and she'd say "you should at least get a high-deductible policy in case we need to go to the hospital" because statistically speaking, there was a 1 in 5 chance they would. At least a couple times people with no insurance ended up $120k out of pocket.

It's fucked up from all sides. (and by the way, here's a working link Having seen it from the patient side, having seen it from the provider side, and having seen it from the insurance side, the reason the system is so disfunctional is it's a zero sum game. If you want your nation to be healthy, you need to pay for them to be healthy. That's what everybody else does. But then, nobody else has dismantled a $200b industry before.