If you're single and willing to pay over $500/month you can get some pretty okay health insurance. Families throw a huge wrench in that plan though. Currently I'm just using COBRA.
Nothing crystalizes support for medicare-for-all faster than ten seconds looking at the public health insurance marketplace.
"pretty okay" is unfortunately about the best you'll find, and even that can be iffy depending on where you are.
If someone's work is truly all-remote I'd seriously recommend looking into residency visas to places with functioning governments and healthcare. I'm currently working remotely at a US client from several locations in the Pacific.
I just had a complete auditory workup to diagnose some recent hearing changes that included consultation with a US-educated doctor, and some medication, and the total cost without any sort of insurance was ~250 USD. My monthly insurance premium at home is 400 USD and likely wouldn't even have covered half of that, because fuck you, that's why.
Well it's more limited right now but under normal circumstances most of southern Europe, Pacific Asia, New Zealand, European-associated Caribbean islands, Costa Rica, Belize, etc, are all decent options.
I spent several months working from the Canary Islands and other than my difficulties in mastering the local Spanish it was great.
> Families throw a huge wrench in that plan though.
> Nothing crystalizes support for medicare-for-all faster...
It's pretty messed up that the lack of universal healthcare throws a huge wrench in the thing that generates the future of society, at least among financially self-aware young people.
It used to be even worse just a few years ago. Before the ACA insurance companies often considered pregnancy a pre-existing condition:
Since you posted the myth that health insurance is better when you pay more, I highly recommend reading this article explaining why the lowest cost plan is likely the best during the most expensive medical situations https://efficiencyiseverything.com/engineering-conclusions-o...
Don't get me wrong, healthcare is the most corrupt industry in the United States (by lobbying dollars). But I give some blame to my peers for not even attempting to understand how insurance works.
> Make sure your hospital, clinics, doctors, accept your insurance
I understand what they're saying but no one plans to get sick (pregnancies aside). Cheaper plans within the same insurance group is probably ok. Which hospital you can go to can be the difference between life and death, especially these days: https://www.nytimes.com/2020/07/01/nyregion/Coronavirus-hosp...
Yeah maybe its where the chronic conditions comes in. A normal healthy person can pay their way for regular stuff that comes along. You need the insurance for car accidents, cancer etc. Its the people with Chronic diseases that really need those gold plans.
I came to this conclusion myself a few months ago, that getting the cheapest plan and hitting the max out of pocket every single year is the cheapest course of action if you buy your own insurance plan.
Kind of figured there was a catch though, maybe not!
Yeah, as far as I could tell when shopping for exchange plans, they all mostly cover the same stuff, and once you pick the company and HMO/EPO/PPO the metal choice definitely doesn't change what's covered or the provider network.
At that point, different metals might hit the out of pocket max sooner, but I just went for the one with the least total of premiums and out of pocket max, which was also the one with the least total of premiums, so I save money if I don't use it or if we hit the cap.
Well for many reasons (good and bad) healthcare is more expensive in the US than any other country.
But why is healthcare bought individually more expensive than healthcare an employer buys for all their employees?
One is real and one is hidden.
The hidden price difference is that most employees think they pay $200 per month in health insurance, but actually their employer is paying $600 and chips in $400 so the employee only pays $200. And of course, $200 taken out of a paycheck before you receive it doesn't feel as bad as a monthly $200 charge to your credit card.
The other reason is adverse selection: When an entire employee base gets health insurance together, the people needing expensive care and the people not needing any care all average out together.
But in the individual market, less healthy people are insured but more sick people are. Healthy people forgo health insurance, so the average cost per person rises.
> When an entire employee base gets health insurance together, the people needing expensive care and the people not needing any care all average out together.
Often/usually, the people needing very expensive care aren't employed in the first place, as they're often not able to work, or at least not able to work in a company with employer-provided health insurance in the first place.
That is sometimes the case, but you also don't have to work a job to be covered under employer-sponsored health insurance -- you could simply be related to someone with a job.
Or, at least, the young healthy people buy the cheapest insurance they can find while people who know they'll have a lot of expenses will tend to buy the gold-plated offerings.
Quick story. Once upon a time I was in a Contract-to-hire position where the contract house (CH) was paying my salary/etc until I was on-boarded.
However, this was a small shop, they had 3 people running the business and less than 2 dozen contractors under them at a time.
Between the Owner's Knee surgery, and some health issues I had had years prior, the CH's premiums were going to jump by 200$ (both on their end and the employee's). Thankfully they were able to find another insurance provider, but it was a pretty clear cut example of how sick people in the pool can sway costs by a large amount.
That's part of why a lot of US companies now will give you discounts for various wellness tasks. My BIL's company offered an insurance credit just for taking a smoking cessation course (not even STOPPING.)
I think there are two parts to the answer. Firstly, health care in the US is extremely expensive. There are long articles written about this but IMO a main reason is market failure. The US, especially republicans, place a lot of value on free markets but people are willing to pay almost anything not to die.
The second part of the story is that the US is richer than Europe. I moved to the US from Western Europe. Before I moved here I didn't expect how much more everything is more expensive here, but at the same time salaries are also higher. The US's GDP per capita is $62k, Germany's is $47k. But that doesn't tell full story. In the US there is a big difference between low paying and high paying jobs, rural and urban areas.
Overly naïve and simplistic rhetoric about "the market" invariably fails to mention that while ideal markets are effectively forced to price commodities as close to the minimal margin of efficient production, it doesn't take much of a barrier to entry for suppliers to silently shift to pricing at the point of pain because they know it makes them all more money.
The recent collapse of movie theatres clearly illustrates that there is no reason they could be getting away with making $10 margins on popcorn, of all things, other than customers were being charged exactly as much as they would tolerate without telling the proprietors where to stick it.
> but people are willing to pay almost anything not to die.
No, not really. This is a narrow picture of reality. People are often willing to sabotage their own bodies and drive their bodies toward obesity, clogged arteries, and liver disease while not spending the money to go to a doctor for annual checkups or flu shots.
The dollar menu is cheaper & tastier option than buying a salad and people consistently choose the cheaper, tastier option
I think the clearest evidence for market failure is the complete lack of price transparency. Medical providers simply don't compete on price.
Prices quoted aren't actually prices. You have zero idea how much it's going to cost you until you get the bills, often split across dozens of providers, and what you see are the results of negotiations between providers and insurers.
You're also now 10 years older. Health insurance pricing never goes down as you get older, only up. That $77 might have been $150-200+ for someone your age now 10 years ago.
Well it got rid of insurers denying coverage or charging more for pre-existing conditions, which is obviously the morally right thing to do, but is roughly like being able to buy fire insurance while your house is already half burned down. IMO the conclusion is just that insurance is a bad model for healthcare coverage.
It sounds like you had the equivalent of “short term health insurance.” They might not have called it that back then, but it’s sold now under that name (with limitations on how long you can remain in the policy that were relaxed recently) to remain ACA compliant. You can still buy these type of plans (at least in my state, North Carolina) for under $100/mo. There are lifetime maximums, exclusions for pre existing conditions, and high deductibles, but that’s probably the same as what you had pre-ACA as well.
These plans are typically referred to as “junk insurance” but if you can’t afford or just don’t want a more comprehensive plan they’re better than nothing.
It's not. I had a low deductible and a low yearly maximum out of pocket. They didnt deny me for a pre existing condition, my knees, and I had 2 knee surgeries while on the insurance and my low deductible and co-insurance meant I spent less the $3000 for both surgeries combined.
While the physician salaries in the U.S. are indeed much higher than in Germany, I believe the time to become a fully accredited doctor is roughly the same.
In the U.S. it's 8 years of school plus a 3- to 7-year residency program, versus 6.5 years of school plus a 5- to 6-year residency program in Germany.
As an American, I do believe that the US has some of the best doctors, research, and medical technology in the world. I also believe it's really, really expensive, and out of reach for too much of our population, largely due to how to tie health insurance plans to employment. That makes sense in industries with a high injury rate, but the US doesn't have that kind of economy anymore.
Plenty of European countries offer the same if not better technology, health service, and professionalism. I had 3 surgeries in the US, 2 were so and so, 1 was "botched" in one of the most prestigious hospitals in the US (Stanford). Treated of course like no more than someone whose insurance is paying, not a follow up beyond what is required by law. I would much prefer to have my next (hopefully in a distant future) surgery in my native European country. And at least they tend to see you as a human and not a cash cow.
I think you've hit on why it's also so hard to change the system in the US. Quite a number of people do have this great care. They work (or are trapped working) for big companies or the gov. who subsidize their health insurance. They simply don't understand when people say the US has all these issues because for them there are no issues.
This is just another example of the US being a place where the gap between the haves and have nots is extremely large.
a) Costs/prices in the US are inflated in the entire industry for a bunch of reasons that basically boil down to half a century of lack of incentive to control costs
b) Your cost isn't actually $100. Your cost at the point of service is $100 but you're paying more taxes which subsidize your healthcare (among other things).
edit: And before some snarky jerk tries to score some cheap virtue points by saying something to the tune of "well I am perfectly ok paying more taxes for healthcare". I was deliberately avoiding making a value judgement one way of the other and simply explaining why his bill at the point of service is lower.
I don't think difference in taxes is as much as people think.
I have lived and worked in many cities in the US as well as a couple of central European countries. Once you get into a high salary range the taxes aren't much different. The exception being if you have a bunch of kids then you will pay lower taxes in the US. However, you will also have increased costs including medical for the kids.
To add another US data point, for my family of 4 I pay $770 per month for health insurance and my employer pays an additional $1,370 per month.
My health insurance is through my employer, a large publicly-traded company. My insurer is one of the large well known providers.
Our insurance is very mediocre. We pay the first $3,000 out of pocket and 20% of the cost beyond that, but that's only if a doctor is "in network" (which is sometimes hard to find). Out of network doctors have a separate deductible.
I also pay 1.45% of my paycheck to Medicare, and my employer pays another 1.45% on my behalf. Plus my wife and I pay an extra 0.9% of our paychecks for all combined wages above $250,000. But I won't be eligible for Medicare until I'm 65 years old.
This is kind of off topic... but if something were to happen and you were unable to work for a medical reason (disability), you would be able to claim Medicare at any age, correct?
[I am a US citizen and also have the ability to google this, but just wanted to ask another human being...]
> Plus my wife and I pay an extra 0.9% of our paychecks for all combined wages above $250,000.
Calculate how much taxes you'd pay in e.g. Germany or Belgium, and put half of that towards health expenditures. I think you'll still come out ahead by a large margin.
Healthcare is provided for everyone in my country from central taxation - same as police, education, defence. You can top it up with private care which can offer you things like more convenient appointments, quicker appointments for non-urgent cases, nicer accommodation if you do have to stay in, etc.
For a healthy, non-smoking 35-year-old you're looking around $80 a month.
For a healthy, non-smoking 70-year-old you're looking at 3 times that.
A family with a couple c. 40 and a couple of 10 year old kids is around $200-$300 a month (with no excess). With a $1300 excess that drops to $120 a month.
I guess so - very few people (1 in 7 I think) have health insurance in the UK, but I assume it's like car insurance - if my car is written off, I have to pay the first £250, and the company pays the next £10k (or whatever it's worth)
Most European private health insurance isn't actually 100% private, as well. Often you will have some state provided healthcare in there (especially for major trauma in ER).
Many many reasons. Health care in the US is very expensive because providers have monopolies in most markets. Pharmaceuticals are also the most expensive in the world. The govt spends a lot of money, but in a way that makes market efficiencies impossible to achieve. Ultimately, that results in very high prices.
Essentially, no participant in the market has an interest in reducing costs.
Furthermore, the business goal of health insurance companies is to not pay for health care, to the greatest extent possible, given regulations and market dynamics. They even call it "medical loss". It's right on the tin.
What is your take home pay as a software dev after insurance, vs the US? My math says the US still wins big for the top half of society (and loses for the bottom)
Nothing crystalizes support for medicare-for-all faster than ten seconds looking at the public health insurance marketplace.