# $&@&#% Health Insurance **URL:** \ **Category:** The BBQ Pit\ **Created:** [October 14, 2018, 8:23am UTC](https://boards.straightdope.com/t/health-insurance/822926 "2018-10-14T08:23:49Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [October 17, 2018, 4:39am UTC](https://boards.straightdope.com/t/health-insurance/822926/41 "2018-10-17T04:39:22Z")
> [@snowthx](#): > > For those not in the US - this is how employer-based health coverage works. Most people in the US have employer-based coverage, and it is not horrible. The pain points being expressed here are mainly for the individual market (I think), so the rules of engagement are different, and costs are higher and benefits lesser. In the individual market, the risks to the pool are less predictable as well. Only when you get into government programs like Medicare are prices set for the individual. Not horrible, MY ASS. I don’t think I’ll ever get over the trauma of finding out how many basic services were not covered, over how much paperwork the stupidest little visit required, or over how much I had to invoke my inner lawyer\* in order to actually get the covered stuff accepted as being covered. A fifteen minute visit would require multiple hours of paperwork, over at least two rounds, in order to get accepted as covered. That y’all are used to it doesn’t make it “not horrible”. I’m used to period pains but that doesn’t make them less painful. - My paternal family includes multiple generations of lawyers and accountants, trained at the Jesuits for centuries. Boy, can I do paperwork. ---
**Author:** ![mhendo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mhendo/32/3159_2.png) [@mhendo](https://boards.straightdope.com/u/mhendo)\ **Post date:** [October 17, 2018, 6:22am UTC](https://boards.straightdope.com/t/health-insurance/822926/42 "2018-10-17T06:22:09Z")
> [@snowthx](#): > > For those not in the US - this is how employer-based health coverage works. Most people in the US have employer-based coverage, and it is not horrible. Yeah, I’m going with **Nava** here. I have pretty good employer-provided health coverage in the US. I have also lived considerable portions of my adult life in three countries with some form of universal healthcare. Even when it’s good, the American system sucks. Even leaving aside the issue of out-of-pocket costs, the hassle of finding out which providers you can see and what is covered is a big pain in the ass, and the mountains of paperwork and phone calls over the simplest issues can be mind-numbing. There are times when I think that a considerable portion of the profit in the American healthcare system comes from sheer exhaustion, as people simply give up trying to deal with the myriad hurdles placed in the way of their coverage. Give me the labyrinthine nightmare of a government bureaucracy over the hellscape of the American private insurance system any day. ---
**Author:** ![kambuckta](https://avatars.discourse-cdn.com/v4/letter/k/53a042/32.png) [@kambuckta](https://boards.straightdope.com/u/kambuckta)\ **Post date:** [October 17, 2018, 6:30am UTC](https://boards.straightdope.com/t/health-insurance/822926/43 "2018-10-17T06:30:59Z")
> [@snowthx](#): > > It has to do with risk pools - the larger the pool, the less risk that one expensive person drains the whole pool. When you are an individual, the risk is high that you will drain away the portion you added to the pool, so the rate is high. When you are one of many, all contributing to the pool, when you get sick, the pool is large so it can cover your cost more easily. And that is why UHC works so well when administered by a normal western govt. EVERY taxpayer pays in. Everyone. When you are one of 14 million or so taxpayers (as per Aus) it makes sense. It would make even greater sense in a country like the US with a greater pool. But yeah, you have to fight against the vested interests who will battle to the death to retain the status quo in the US. Just remember, it’s likely to be YOUR deaths and not those of the CEOs of the health insurance companies. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [October 17, 2018, 6:51am UTC](https://boards.straightdope.com/t/health-insurance/822926/44 "2018-10-17T06:51:07Z")
> [@snowthx](#): > > For those not in the US - this is how employer-based health coverage works. Most people in the US have employer-based coverage, and it is not horrible. The pain points being expressed here are mainly for the individual market (I think), so the rules of engagement are different, and costs are higher and benefits lesser. In the individual market, the risks to the pool are less predictable as well. Only when you get into government programs like Medicare are prices set for the individual. I’m going to do a +3 to the comments already expressed about this by **Nava** and **mhendo** , and I base that not just on all the published data but on horse’s mouth evidence from people I know who moved from Canada to high-level executive and research positions in the US and who have little good to say about US health care and nothing good to say about the insurance system, and they have among the best plans going. No private insurance plan is going to remove the incredibly burdensome and exacting paperwork required – of which I have exactly zero; no private plan is going to remove the scrutinizing of each claim, resulting in sometimes arbitrary rulings that make no sense but somehow always manage to save the insurance company money – which I have never experienced under single-payer, ever; no private plan is going to eliminate all deductibles and co-pays – of which I have exactly zero. All you’re really saying here is that group insurance from a good major employer is better and cheaper than individual insurance, especially when the employer picks up all or most of the cost. Which only means that it doesn’t suck totally as much as individual insurance, which is a catastrophe, but it definitely doesn’t mean it’s “not horrible”. Your rationale about a large risk pool is quite accurate, but in single-payer the risk pool is the entire population. In one sense single-payer is group insurance for the entire country, but in another important sense it’s much better than that, because it permits great simplifications and the elimination of bureaucracy, paperwork, and claims denials. ---
**Author:** ![JohnT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnt/32/15048_2.png) [@JohnT](https://boards.straightdope.com/u/JohnT)\ **Post date:** [October 17, 2018, 1:12pm UTC](https://boards.straightdope.com/t/health-insurance/822926/45 "2018-10-17T13:12:54Z")
> [@snowthx](#): > > An employer-based health plan, especially a large employer, gets a decent rate from the insurer. It has to do with risk pools - the larger the pool, the less risk that one expensive person drains the whole pool. When you are an individual, the risk is high that you will drain away the portion you added to the pool, so the rate is high. When you are one of many, all contributing to the pool, when you get sick, the pool is large so it can cover your cost more easily. Well, hell, if that’s how it works it appears the most logical course would be to, you know, _place the entire country into a single pool._ Like, I don’t know… like the rest of the developed world? ---
**Author:** ![snowthx](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/snowthx/32/10660_2.png) [@snowthx](https://boards.straightdope.com/u/snowthx)\ **Post date:** [October 17, 2018, 1:20pm UTC](https://boards.straightdope.com/t/health-insurance/822926/46 "2018-10-17T13:20:27Z")
Look, everyone. I am 100% in agreement that a single-payer system would be monumentally better than the system we have now, where health insurance is linked to your employment, and where individuals without employer-based insurance are at greater risk. 100% in agreement there. But if we are going with anecdotes, I have my own as well. I have employer-based health insurance, and it covers me and my family. My wife had a procedure last year that was priced at over $10K, but our insurance meant it cost us only around $700. A friend of mine had a heart attack last year. He is on his wife’s insurance (she is a teacher, so has good benefits thru her job). At the end of his ordeal, when it came time to settle-up, the hospital explained what was covered and what they owed, which was a few hundred dollars. When he asked why it was so little, they said “you have great insurance”. Granted, the teachers union probably negotiated the insurance deal. The situation is not ideal in this country, far from it. But not everyone here is suffering thru insurance hell. Our insurance system is more costly and does not have the best outcomes compared to other civilized countries, except where it is government-run (Medicare), where we are on-par with other centralized systems. I was only trying to explain why the individual insurance market is more expensive and with poorer benefits, to my understanding, compared to employer-based insurance, which was in response to the OP. Most Americans have employer-based, and for most people it works, and is better, rate-wise, than individual plans. No where would I say it is on par with Canada or the UK. ---
**Author:** ![Red\_Wiggler](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/red_wiggler/32/13190_2.png) [@Red\_Wiggler](https://boards.straightdope.com/u/Red_Wiggler)\ **Post date:** [October 17, 2018, 1:31pm UTC](https://boards.straightdope.com/t/health-insurance/822926/47 "2018-10-17T13:31:18Z")
> [@JohnT](#): > > Well, hell, if that’s how it works it appears the most logical course would be to, you know, _place the entire country into a single pool._ Like, I don’t know… like the rest of the developed world? Somehow, according to opponents in the U.S., a single pool would actually \*increase \*costs. We are exceptional in that manner. No, I don’t get it, either. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [October 17, 2018, 2:35pm UTC](https://boards.straightdope.com/t/health-insurance/822926/48 "2018-10-17T14:35:53Z")
> [@snowthx](#): > > Look, everyone. I am 100% in agreement that a single-payer system would be monumentally better than the system we have now, where health insurance is linked to your employment, and where individuals without employer-based insurance are at greater risk. 100% in agreement there. But if we are going with anecdotes, I have my own as well. I have employer-based health insurance, and it covers me and my family. My wife had a procedure last year that was priced at over $10K, but our insurance meant it cost us only around $700. A friend of mine had a heart attack last year. He is on his wife’s insurance (she is a teacher, so has good benefits thru her job). At the end of his ordeal, when it came time to settle-up, the hospital explained what was covered and what they owed, which was a few hundred dollars. When he asked why it was so little, they said “you have great insurance”. Granted, the teachers union probably negotiated the insurance deal. > > The situation is not ideal in this country, far from it. But not everyone here is suffering thru insurance hell. Our insurance system is more costly and does not have the best outcomes compared to other civilized countries, except where it is government-run (Medicare), where we are on-par with other centralized systems. I was only trying to explain why the individual insurance market is more expensive and with poorer benefits, to my understanding, compared to employer-based insurance, which was in response to the OP. Most Americans have employer-based, and for most people it works, and is better, rate-wise, than individual plans. No where would I say it is on par with Canada or the UK. There are many who have nice employer based insurance. But, just because it is employer based, doesn’t mean that it is good insurance. I know a number of people in entry level jobs who have their employer based insurance which is pretty much the same as you can buy off the ACA. There are two tiers of insurance here, the type you are talking about, where you are pretty much going to be out a few hundred bucks at most, and the type that many others have, that will barely cover anything at all, leaving you with most of the bill. Many don’t know which they have until it is time to use it. Of course, one of the biggest benefits of having a UHC is for the self employed. It is dangerous to be an entrepreneur and to open and grow a small business, because you cannot afford that really nice insurance that you are talking about there. Employer based insurance benefits only one group, employers. You have no control over what happens with your health, because you are at the mercy of your emp,pyer. If they decide to cut back, and decrease your benefits, you can’t really vote against aht. If they decide to increase your part of the premiums, or increase your deductible, that’s just what you get. If they decide to fire or lay you off, then you don’t have that plan at all anymore. It puts you in a position where you have to decide between your desire for self actualization, and a need to have good medical coverage. If you decide that you don’t like your job anymore, and you want to set out on your own, what are you going to do for insurance? ---
**Author:** ![Steve\_McQwark](https://avatars.discourse-cdn.com/v4/letter/s/4da419/32.png) [@Steve\_McQwark](https://boards.straightdope.com/u/Steve_McQwark)\ **Post date:** [October 17, 2018, 2:44pm UTC](https://boards.straightdope.com/t/health-insurance/822926/49 "2018-10-17T14:44:18Z")
> [@Red\_Wiggler](#): > > Somehow, according to opponents in the U.S., a single pool would actually \*increase \*costs. We are exceptional in that manner. > > No, I don’t get it, either. I believe it works like this. Uninsured people end up in the emergency room when things get really bad. They don’t have insurance and so the bills get paid by the owners of the hospital. Private hospitals dump these patients on the public hospitals. The public hospitals treat the patient and the local city or county ends up on the hook for the bills. I live in Dallas county and the public hospital is Parkland. There is an ongoing battle between Dallas county and the surrounding counties trying to get the surrounding counties to kick in tax money for Parkland because they are sending their indigent patients there. Dallas county is predominately Democratic and the surrounding counties are predominately Republican. If we get UHC, the residents outside of Dallas county will probably see their taxes go up because they are not paying their fair share now. So even if the overall costs go down, their individual taxes will go up and that is all that matters to team R. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [October 18, 2018, 11:41pm UTC](https://boards.straightdope.com/t/health-insurance/822926/50 "2018-10-18T23:41:43Z")
Except if you get UHC, you don’t have uninsured people going to the ER for ordinary care, Because they’ll be able to go to a clinic, which costs less. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [October 18, 2018, 11:55pm UTC](https://boards.straightdope.com/t/health-insurance/822926/51 "2018-10-18T23:55:21Z")
> [@Northern\_Piper](#): > > Except if you get UHC, you don’t have uninsured people going to the ER for ordinary care, > Because they’ll be able to go to a clinic, which costs less. People don’t go to the ER for ordinary care. They go to the ER when they should have gone to the clinic for ordinary care months or years ago, to treat a condition that is now life threatening and very expeisve to treat, compared to how it would have been if they had caught it at an earlier stage when symptoms were just starting, or at a regular health check-up. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [October 19, 2018, 4:56am UTC](https://boards.straightdope.com/t/health-insurance/822926/52 "2018-10-19T04:56:40Z")
> [@k9bfriender](#): > > People don’t go to the ER for ordinary care. In countries with UHC they do, actually, when that ordinary care is off-hours; it’s one of the reasons to have “nurse by phone” type services, you call those to ask “should I go see a doc, call one to come, or wait?”. By the same reasoning as going to the clinic, mind you: since I can afford to go now, I don’t have to wait until I get worse. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [October 19, 2018, 1:45pm UTC](https://boards.straightdope.com/t/health-insurance/822926/53 "2018-10-19T13:45:38Z")
> [@Nava](#): > > In countries with UHC they do, actually, when that ordinary care is off-hours; it’s one of the reasons to have “nurse by phone” type services, you call those to ask “should I go see a doc, call one to come, or wait?”. By the same reasoning as going to the clinic, mind you: since I can afford to go now, I don’t have to wait until I get worse. Fair enough, I’m just saying that without UHC, there are many people who put off health problems until they become life threatening, when an earlier detection of the condition would have been much easier and cheaper to treat. ---
**Author:** ![MandaJo](https://avatars.discourse-cdn.com/v4/letter/m/ac91a4/32.png) [@MandaJo](https://boards.straightdope.com/u/MandaJo)\ **Post date:** [October 19, 2018, 2:17pm UTC](https://boards.straightdope.com/t/health-insurance/822926/54 "2018-10-19T14:17:33Z")
I am a teacher. To cover my family with a shitty plan that has a $2000/person deductible and 20% co-pay after that, I pay over $1000 month. If it were just me, my employer contribution ($300) would cover most of the cost, but the cost of family coverage is insane. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [October 20, 2018, 4:19am UTC](https://boards.straightdope.com/t/health-insurance/822926/55 "2018-10-20T04:19:35Z")
With that kind of prices damn yeah it makes sense to stay uninsured, if you’re in decent health. Desert Nomad used to have medical insurance which covered him in every country but one. I’ve got travel medical insurance which covers me in every country but one. I’ve got third-party company liability insurance which covers me in every country but one. Someday before I die, I’d like to see that “but one” repeating bit disappear! ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [October 20, 2018, 4:46am UTC](https://boards.straightdope.com/t/health-insurance/822926/56 "2018-10-20T04:46:26Z")
> [@psychobunny](#): > > I just got my information about my health insurance for next year. For context, this is an individual plan purchased through the ACA exchange. Previously, I basically had a Cadillac plan for $800 a month. > 2015-changed to ACA plan with $500 deductible for $577 a month. > 2016-deductible up to $1000 and cost up to $677. > 2017-deductible up to $1500 and cost up to $815. > 2018-they said the closest plan would require changing from a PPO to an HMO with deductible up to $2500 and price up to $1167. I found a PPO with a $500 deductible for $1287 which I thought was insane. > 2019- The “equivalent” plan now has a deductible back to $1500 and a price of $1960. That is right, the cost is now more than tripled in the past 3 years for crappier coverage. I am going to have to change to a very high deductible plan with terrible coverage. I honestly don’t see how people afford insurance. Most people do not benefit from the exchange. You might want to talk to the agent who handles your other insurances (i.e. car and house) and they may be able to find you a better, less expensive plan. If they can’t, they may be able to refer you to someone who can. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [October 20, 2018, 4:47am UTC](https://boards.straightdope.com/t/health-insurance/822926/57 "2018-10-20T04:47:45Z")
> [@Nava](#): > > Desert Nomad used to have medical insurance which covered him in every country but one. I’ve got travel medical insurance which covers me in every country but one. I’ve got third-party company liability insurance which covers me in every country but one. Someday before I die, I’d like to see that “but one” repeating bit disappear! Just curious: What country is that? (I have a pretty good idea what it is.) ---
**Author:** ![Muffin](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/muffin/32/4341_2.png) [@Muffin](https://boards.straightdope.com/u/Muffin)\ **Post date:** [October 20, 2018, 9:17am UTC](https://boards.straightdope.com/t/health-insurance/822926/58 "2018-10-20T09:17:54Z")
Emigrate to a first world country while you’re still healthy, or develop a single payor socialized health care system. It’s that simple. Really. As long as you insist on being a special snowflake when it comes to health care, you are doomed to melt. (Which brings us to an even more important issue . . . global warming.) So get out there and vote, and drag every left leaning person you can off their ass and to the polls. A healthy life will not come to you if you continue to sit about whinging. It is something you have to work for both individually and collectively. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [October 21, 2018, 8:36am UTC](https://boards.straightdope.com/t/health-insurance/822926/59 "2018-10-21T08:36:16Z")
> [@nearwildheaven](#): > > Just curious: What country is that? (I have a pretty good idea what it is.) The USA. For all three cases. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [October 21, 2018, 6:34pm UTC](https://boards.straightdope.com/t/health-insurance/822926/60 "2018-10-21T18:34:39Z")
> [@nearwildheaven](#): > > Just curious: What country is that? (I have a pretty good idea what it is.) The only country where per capita health care spending is $10,000. [![](https://upload.wikimedia.org/wikipedia/commons/thumb/0/0b/OECD_health_expenditure_per_capita_by_country.svg/600px-OECD_health_expenditure_per_capita_by_country.svg.png) ](https://upload.wikimedia.org/wikipedia/commons/thumb/0/0b/OECD_health_expenditure_per_capita_by_country.svg/600px-OECD_health_expenditure_per_capita_by_country.svg.png) [Previous page](https://boards.straightdope.com/t/health-insurance/822926.md?page=2) [Next page](https://boards.straightdope.com/t/health-insurance/822926.md?page=4)