# Trying to understand the basics of health insurance **URL:** \ **Category:** Great Debates\ **Created:** [October 15, 2013, 6:17pm UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330 "2013-10-15T18:17:12Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![jacobsta811](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jacobsta811/32/2893_2.png) [@jacobsta811](https://boards.straightdope.com/u/jacobsta811)\ **Post date:** [October 16, 2013, 2:53am UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/21 "2013-10-16T02:53:02Z")
Giving more people access to services almost invariably raises the use of those services - so I would bet big, big money that the ACA will increase the use of health services and thus health care costs at least over the short and medium term. But that is a stupid way to measure it. You don’t make health care universal because it saves big bucks, you do it because it extends lives and makes your population healthier, and because it can benefit your economy through entrepreneurship (before the ACA, doing a startup as anyone but a straight out of college kid was an insane risk, especially if you ever had any health issue at all ever). ---
**Author:** ![glee](https://avatars.discourse-cdn.com/v4/letter/g/b5a626/32.png) [@glee](https://boards.straightdope.com/u/glee)\ **Post date:** [October 16, 2013, 10:35am UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/22 "2013-10-16T10:35:58Z")
> [@glee](#): > > It’s simple. The politicians who tell you there will be huge costs are lying. > > Just look at all the countries that already have universal health care. They have two things in common: > > - tremendous support for the system (from taxpayers and ill people alike) > - no Tea Party :smack: > [@Chessic\_Sense](#): > > There’s tremendous UHC support in other countries, so therefore it doesn’t cost anything? Ah, yes, that makes sense. Likewise, the US military is tremendously popular, so it must not have “huge costs” that “increase the federal debt by zillions.” I swear I heard a certain political group arguing otherwise… Wow. I state correctly that UHC is tremendously popular and you say that means it doesn’t cost anything? :smack: Your desperation is showing. Let me try again. UHC is tremendously popular because taxpayers recognise that the cost is well worth it. it improves the quality of life at a reasonable (not huge) cost. In case it helps: - when I visit Europe, I fill in one form and my medical costs are covered - when I visit the US, I take out insurance for $1,000,000 The Tea Party spread lies about UHC purely because they hate Obama. P.S. I like Americans and enjoyed my visits there. UHC will improve their lives. ---
**Author:** ![Isilder](https://avatars.discourse-cdn.com/v4/letter/i/cc9497/32.png) [@Isilder](https://boards.straightdope.com/u/Isilder)\ **Post date:** [October 16, 2013, 10:58am UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/23 "2013-10-16T10:58:31Z")
> [@glee](#): > > Let me try again. UHC is tremendously popular because taxpayers recognise that the cost is well worth it. it improves the quality of life at a reasonable (not huge) cost. > In case it helps: > > - when I visit Europe, I fill in one form and my medical costs are covered > - when I visit the US, I take out insurance for $1,000,000 Hey that’s socialist. All USA residents must fight against socialism, because …well what was the reasn given … hmm it wasnt very good, so hard t remember, ah yes "because its only word away from communism… " ---
**Author:** ![Si\_Amigo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/si_amigo/32/2877_2.png) [@Si\_Amigo](https://boards.straightdope.com/u/Si_Amigo)\ **Post date:** [October 16, 2013, 12:21pm UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/24 "2013-10-16T12:21:02Z")
> [@Isilder](#): > > Hey that’s socialist. All USA residents must fight against socialism, because …well what was the reasn given … hmm it wasnt very good, so hard t remember, ah yes "because its only word away from communism… " Because President Obama may be a socialist (we don’t know but suspect so, heard it on Fox News so there must be some truth to it); that alone is reason enough to hate socialism. ---
**Author:** ![Rachellelogram](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rachellelogram/32/8689_2.png) [@Rachellelogram](https://boards.straightdope.com/u/Rachellelogram)\ **Post date:** [October 16, 2013, 2:19pm UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/25 "2013-10-16T14:19:44Z")
> [@Chessic\_Sense](#): > > So in summary, it’s expensive for taxpayers, but a windfall for insurance companies, old people, and poor people. > > See how that gets expensive? American taxpayers are \*already \*footing those expenses. It’s not like the obligation doesn’t exist. We’re just paying it in the form of higher costs when we need medical treatment, so the cost is more hidden. ---
**Author:** ![Colibri](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/colibri/32/1841_2.png) [@Colibri](https://boards.straightdope.com/u/Colibri)\ **Post date:** [October 16, 2013, 2:28pm UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/26 "2013-10-16T14:28:09Z")
Since this is largely a political question, let’s move it to Great Debates. Colibri General Questions Moderator ---
**Author:** ![Chessic\_Sense](https://avatars.discourse-cdn.com/v4/letter/c/7c8e57/32.png) [@Chessic\_Sense](https://boards.straightdope.com/u/Chessic_Sense)\ **Post date:** [October 16, 2013, 3:29pm UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/27 "2013-10-16T15:29:19Z")
> [@Colibri](#): > > Since this is largely a political question, let’s move it to Great Debates. That’s it. There’s no saving this board anymore. This is NOT a political question. It is a fiduciary question, plain and simple, but the board’s raging liberals simply can’t leaving it at that. Somebody says “Obamacare,” and they have to go on their Tea Party screed. They have mock ridiculous strawman caricatures of their political opponents until the thread is so far off-topic that it gets a forum change. You want examples? Here: > [@](#): > > Because President Obama may be a socialist (we don’t know but suspect so, heard it on Fox News so there must be some truth to it); that alone is reason enough to hate socialism. > [@](#): > > Hey that’s socialist. All USA residents must fight against socialism, because …well what was the reasn given … hmm it wasnt very good, so hard t remember, ah yes "because its only word away from communism… " And to a lesser extent, but still in the vein… > [@](#): > > UHC is tremendously popular because taxpayers recognise that the cost is well worth it. Who said ‘socialist’ first in this thread, liberals or conservatives? Did the OP, at any point, ask whether the cost was well worth it? Whether it’s about evolution, healthcare, debt, or guns, it’s like you all just can’t resist the opportunity to use every thread to recite the party line. ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [October 16, 2013, 3:37pm UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/28 "2013-10-16T15:37:12Z")
Yours was the second reply to this thread and you referred to yourself as the “taxpayer” and those whose policies would be subsidized as the “tax takers”. How does a loaded term like “tax taker” not contribute to the politicization of the discussion? ---
**Author:** ![scr4](https://avatars.discourse-cdn.com/v4/letter/s/59ef9b/32.png) [@scr4](https://boards.straightdope.com/u/scr4)\ **Post date:** [October 16, 2013, 3:45pm UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/29 "2013-10-16T15:45:26Z")
> [@jacobsta811](#): > > Giving more people access to services almost invariably raises the use of those services - so I would bet big, big money that the ACA will increase the use of health services and thus health care costs at least over the short and medium term. Not if it changes what type of medical services are used. As already pointed out, people without health insurance tend to use the emergency room as their first and only medical care. Emergency rooms are _very_ expensive to operate. Also, preventive care and management of chronic diseases can reduce the need for more drastic procedures which costs more. > [@](#): > > But that is a stupid way to measure it. You don’t make health care universal because it saves big bucks… But it just happens that it saves big bucks, as evident from comparing US health care costs to countries with universal health care. ---
**Author:** ![Bryan\_Ekers](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bryan_ekers/32/183_2.png) [@Bryan\_Ekers](https://boards.straightdope.com/u/Bryan_Ekers)\ **Post date:** [October 16, 2013, 3:52pm UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/30 "2013-10-16T15:52:58Z")
Heck, I know the costs. I pay higher taxes than an American citizen of comparable income and expenses. But I also know I rather badly (well, it looked worse than it really was) cut the little finger of my left hand on a table saw about seven weeks ago and did not pay the equivalent of half a year’s salary getting it treated. I have pictures of my finger if anyone wants to be grossed out a little. I can also show pictures of my still-full wallet if the appetite is for anti-GOP outrage. ---
**Author:** ![Chessic\_Sense](https://avatars.discourse-cdn.com/v4/letter/c/7c8e57/32.png) [@Chessic\_Sense](https://boards.straightdope.com/u/Chessic_Sense)\ **Post date:** [October 16, 2013, 3:58pm UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/31 "2013-10-16T15:58:04Z")
> [@Dewey\_Finn](#): > > Yours was the second reply to this thread and you referred to yourself as the “taxpayer” and those whose policies would be subsidized as the “tax takers”. How does a loaded term like “tax taker” not contribute to the politicization of the discussion? The OP seemed to think Obamacare was some sort of federal insurance company and couldn’t understand how it could cost the government money if those companies make profit (i.e., have a “pile of money”). I corrected that by pointing out the subsidies and saying it’s only expensive _for taxpayers_. Obviously, for everyone else, it’s not expensive at all. In fact, it’s a windfall. ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [October 16, 2013, 4:13pm UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/32 "2013-10-16T16:13:41Z")
But _everyone_ pays taxes. If not income tax, than FICA, or sales taxes, or property taxes or some other sort of taxes. I don’t think there are any people in the US who pay no taxes (except perhaps for small children). And as someone pointed out, those of us who already had insurance already pay for medical care for the uninsured, in the form of inflated costs. The US spends more on health care per capita than other countries and yet we have had millions of uninsured people. ---
**Author:** ![Farin](https://avatars.discourse-cdn.com/v4/letter/f/e79b87/32.png) [@Farin](https://boards.straightdope.com/u/Farin)\ **Post date:** [October 16, 2013, 4:19pm UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/33 "2013-10-16T16:19:20Z")
> [@snowthx](#): > > The current system is in a run-away cost structure that is unsustainable. The costs the insurance companies are charging is based on them making some profit, but is also due of out-of control doctor and hospital costs, as well as expensive drug treatments. The run away cost structure is because of how medicare/medicaid was changed to curtail costs in the 90s. They basically went “We are going to pay THIS RATE.” instead of negotiating rates and then all the insurance companies jump on to that rate, too. The hospitals increased their costs because those medicare rates are largely unsustainable and tend to over-inflate costs across the board to try and eek more money out. Add into that the for-profit status of hospitals and this sort of billing monkey business becomes par for the course. Insurance companies also make out because they can advertise that of the infinity dollars in submitted claims they only paid 12 cents and a mars bar when trying to attract new customers. > [@Nars\_Glinley](#): > > I’ve heard this often but wonder how true it will be in reality. ISTM that most of the plans that the poor can afford are high deductible/catastrophic type plans. Since they’d likely be paying for the doctors visits themselves, why would they change their tactics? Preventative care visits (yearly physical) are included as no-cost-to-insured services in the ACA. > [@glee](#): > > It’s simple. The politicians who tell you there will be huge costs are lying. > > Just look at all the countries that already have universal health care. They have two things in common: > > - tremendous support for the system (from taxpayers and ill people alike) > - no Tea Party :smack: No, there WILL be huge costs. And: > [@glee](#): > > Wow. I state correctly that UHC is tremendously popular and you say that means it doesn’t cost anything? :smack: > Your desperation is showing. > > Let me try again. UHC is tremendously popular because taxpayers recognise that the cost is well worth it. it improves the quality of life at a reasonable (not huge) cost. > In case it helps: > > - when I visit Europe, I fill in one form and my medical costs are covered > - when I visit the US, I take out insurance for $1,000,000 > > The Tea Party spread lies about UHC purely because they hate Obama. > > P.S. I like Americans and enjoyed my visits there. UHC will improve their lives. This isn’t UHC. This is universal _insurance_. Since all of the insurance companies and hospitals in the US are for-profit and not run by the government, this will increase costs beyond what UHC in other countries is. We pay the most per-capita in health care in the world. And the ACA does nothing to address that. It adds insurance requirements that are needed but expensive on top of our old cost structure and then mandates that everyone must purchase the insurance. The “affordability” comes from the subsidies paid to people and not any actual change in the US’s health care system. I’m glad you like to visit, but the situation won’t change for your visits. You’ll still need to get insurance to protect yourself. > [@scr4](#): > > Also, providing health insurance to more people is thought to have a stimulus effect on the entire economy, which should increase revenue from other taxes. For example, ACA already calls for young people up to age 26 to be covered by their parents’ health insurance, and this has reduced unemployment in that age group. Has it reduced unemployment because, since they have health insurance, they don’t need to try and get a job? Or because they can take a shittier job that doesn’t require insurance? Or for another reason? > [@scr4](#): > > It’s unclear whether these new revenues and expenses will balance out, or one would win over the other. The Congressional Budget Office has analyzed this and concluding that repealing the ACA would result in an increased deficit, which would imply that the revenues would be greater than the expense. The short term revenues will not cover it. The longer-term revenues will likely match the outlay in the 80-120% range, if all of the estimates turn out to be true. Problem is, the CBO has a poor track record of future estimates because Congress continues to monkey with just about every law it passes. Constantly. Take what the CBO says with a grain of salt because of Congressional sabotage. ---
**Author:** ![Farin](https://avatars.discourse-cdn.com/v4/letter/f/e79b87/32.png) [@Farin](https://boards.straightdope.com/u/Farin)\ **Post date:** [October 16, 2013, 4:42pm UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/34 "2013-10-16T16:42:39Z")
> [@Dewey\_Finn](#): > > But _everyone_ pays taxes. If not income tax, than FICA, or sales taxes, or property taxes or some other sort of taxes. I don’t think there are any people in the US who pay no taxes (except perhaps for small children). And as someone pointed out, those of us who already had insurance already pay for medical care for the uninsured, in the form of inflated costs. The US spends more on health care per capita than other countries and yet we have had millions of uninsured people. But that expense is a product of the _for-profit_ insurance and hospital industries. HealthOne isn’t running a conglomerate health agency for the benefit of us, it’s for the benefit of HealthOne’s shareholders. So if they can get away with charging you $812 for the 16 aspirin you received across the two hours you were there, they are going to do it. If you look at Canada or Britain, you become a doctor and generally get paid by the government not on a per-incident fee but on a meritory or statutory salary. So you go to work for the government (unless you go into something like cosmetic surgery) and they control access to the services of the doctors, generally on an immediate-need basis and then followed by FCFS. They can spend quite a bit less on health care for it. Funding is a little different for Canada versus Britain, though. BC as far as I know, does a premium-type cost every month while the other provinces pull it out of income tax receipts and Britain does a straight income tax method. ---
**Author:** ![Chessic\_Sense](https://avatars.discourse-cdn.com/v4/letter/c/7c8e57/32.png) [@Chessic\_Sense](https://boards.straightdope.com/u/Chessic_Sense)\ **Post date:** [October 16, 2013, 4:48pm UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/35 "2013-10-16T16:48:06Z")
> [@Farin](#): > > The short term revenues will not cover it. The longer-term revenues will likely match the outlay in the 80-120% range, if all of the estimates turn out to be true. Problem is, the CBO has a poor track record of future estimates because Congress continues to monkey with just about every law it passes. Constantly. Take what the CBO says with a grain of salt because of Congressional sabotage. _Especially_ if Congress removes the medical device tax, which is currently the compromise _du jour_ with the shutdown/debt ceiling. ---
**Author:** ![Farin](https://avatars.discourse-cdn.com/v4/letter/f/e79b87/32.png) [@Farin](https://boards.straightdope.com/u/Farin)\ **Post date:** [October 16, 2013, 5:01pm UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/36 "2013-10-16T17:01:40Z")
> [@Chessic\_Sense](#): > > _Especially_ if Congress removes the medical device tax, which is currently the compromise _du jour_ with the shutdown/debt ceiling. I was never sold on that adding the estimated $3 Billion per year (for the next ten years). It’s an excise tax, which means a tax on importing/MFR sales of the devices (not to be confused with a direct sales tax to the consumer). For anything not destined to US consumption, they would get re-routed. Medical devices would start to get manufactured in China/India, for instance, and shipped to the rest of the world to avoid it and devices that are imported and later exported would likely evaporate, leaving only devices that are going to be sold here actually on our soil with us. We might get $3 billion a year for the next two years, but I suspect that conditions would change enough to drop that significantly after that two year time frame. ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [October 16, 2013, 5:20pm UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/37 "2013-10-16T17:20:19Z")
> [@Farin](#): > > But that expense is a product of the _for-profit_ insurance and hospital industries. HealthOne isn’t running a conglomerate health agency for the benefit of us, it’s for the benefit of HealthOne’s shareholders. So if they can get away with charging you $812 for the 16 aspirin you received across the two hours you were there, they are going to do it. Believe me, my preference would be a true single-payer UHC system, or at least Medicare-for-all, so that the uninsured could choose to pay into Medicare or buy private health insurance. The ACA system is far from ideal. ---
**Author:** ![thatguyjeff](https://avatars.discourse-cdn.com/v4/letter/t/6de8d8/32.png) [@thatguyjeff](https://boards.straightdope.com/u/thatguyjeff)\ **Post date:** [October 16, 2013, 5:41pm UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/38 "2013-10-16T17:41:00Z")
> [@Farin](#): > > Since all of the insurance companies and hospitals in the US are for-profit and not run by the government, this will increase costs beyond what UHC in other countries is. This is patently false. Just because an entity is not government run/funded, does not make it a for profit company. There are MANY hospitals AND health insurance companies around the country that are not-for-profit/non-profit. Minnesota, for example, has state regulations which severely limit for-profit health insurance companies. United Healthcare Group - the largest health insurer in the country - is a for-profit with its headquarters in Minnesota and they are not allowed to market/sell many of their products in their home state because of their for-profit status. And as far as I’m aware, there isn’t a single for-profit hospital in that state. ---
**Author:** ![BrightSunshine](https://avatars.discourse-cdn.com/v4/letter/b/b3f665/32.png) [@BrightSunshine](https://boards.straightdope.com/u/BrightSunshine)\ **Post date:** [October 16, 2013, 7:13pm UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/39 "2013-10-16T19:13:46Z")
The elephant in the room that is so often ignored – those of us with employer-sponsored plans are already getting a ton of government subsidies on our health care plans, in the form of tax deductibility. We (family of 3, top 10% household income) get $5300/year of health care for free, courtesy of tax payers (fed and state), pre-ACA. I just don’t see how just because we are high income employees of a nice employer we deserve it any more than the working poor. Under ACA, a single mom with 2 kids making $35k now gets about the same federal subsidy as we do. I really can’t see being outraged about that. ---
**Author:** ![Nars\_Glinley](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/nars_glinley/32/8177_2.png) [@Nars\_Glinley](https://boards.straightdope.com/u/Nars_Glinley)\ **Post date:** [October 17, 2013, 12:37am UTC](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330/40 "2013-10-17T00:37:41Z")
> [@Farin](#): > > Preventative care visits (yearly physical) are included as no-cost-to-insured services in the ACA. True but I don’t think that’s the issue. People are going to the ER for minor illnesses, not physicals. People will (IMHO) continue to have routine illnesses and abuse the ER system due to high deductibles. [Previous page](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330.md?page=1) [Next page](https://boards.straightdope.com/t/trying-to-understand-the-basics-of-health-insurance/671330.md?page=3)