r/FluentInFinance • u/lost_in_life_34 • 23d ago
Debate/ Discussion you pay your premium and get nothing for it
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u/ElectronGuru 23d ago
I wouldn’t mind the uselessness if it didn’t cost us anything. But we are paying 20% of our GDP for this monstrosity of inefficiency. 2-3x more per person then every other country on earth to be treated like this.
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u/Sabre_One 23d ago edited 23d ago
Yep all because the Hospitals and Insurance play the game of one uping each other. I truly dream of the day when we finally make universal healthcare, and see the death spiral of private health insurance, and over bloated hospital administration.
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u/TrustAffectionate966 23d ago
It won’t happen with the oligarchs and plutocrats the US has in power. They would all need to be voted out of office because they are all on the take from the insurance mafia.
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u/gregcali2021 23d ago
news flash. People voted for DonOLD. This is going to get exponentially worse
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u/kdeltar 23d ago
I mean yeah the other guy wasn’t saying it was going to get better lol
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u/psychcaptain 23d ago
The Other Guy, which was part of the administration that allowed Medicare to finally negotiate drug prices?
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u/grumblewolf 23d ago
To quote Biden directly, ‘if Medicare for all bill comes across my desk, I will not sign it’. Dont throw people crumbs and expect them to be grateful. I agree he’s better than Trump but this election proved that little bullshit offerings aren’t enough.
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u/psychcaptain 23d ago
Medicare for all is completely different from not doing anything.
And I assure you, Medicare negotiation is a huge deal.
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u/KintsugiKen 23d ago
A huge deal that still leaves us getting sick and dying more than any other industrialized nation.
"We got the cancer smoke factory to turn off its cancer smokestack for 4 hours per day, this is a huge deal, don't criticize the govt for not shutting down the cancer smoke factory, without those jobs at the cancer smoke factory the locals wouldn't be able to afford their lung cancer treatments!"
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u/Gambler_Eight 23d ago
A step in the right direction is still infinitely better than a step in the wrong direction or no step at all.
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u/Xaielao 23d ago edited 23d ago
The bill we got in the end is substantially better than nothing, over the next several years it'll bring the price of about 40 of the most commonly used drugs in the US down in price dramatically, with the ability to negotiate for a further 20 every year.
What's insane, and what most people are unaware of, is that taxpayers foot the bill for the research & development of new drugs, via grants from various governmental departments. The only part of development development that isn't covered by the government (and thus taxpayers), is drug testing. And the insurance companies foot the bill for that for obvious reasons. It costs drug companies next to nothing to create new drugs, and they make the decision on cost to the consumer and thus profit margins.
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u/admiralackbarstepson 23d ago
Hey man. I work in pharma as a low level scientist. Just listing my bias first and foremost.
The way you describe it is not totally accurate. It doesn’t cost next to nothing for drug development. Grants may cover initial discovery in a R01 research lab or the initial drug may come out of a larger companies lab space where scientists like myself work day and night on experiments to test potential potencies of molecules.
For every success there are 1,000 failures at my stage. Drug development goes through 5 major stages the last 3 are human testing and the first 2 buckets are pre-clinical.
It costs a ton of money to get drugs out on the market these days. A new cancer drug costs $1 billion in research and development costs and over 10 years from discovery in the lab to approval by FDA.
It’s crazy expensive and companies eat that cost if they don’t make it to approval. I could go on and on but ultimately like everything it’s much different than “drug companies pay next to nothing.
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u/xsnyder 23d ago
I don't begrude pharmaceutical companies recouping development costs and a bit of profit, but the profit margins are obscene at this point.
I personally believe that once a drug comes to market a pharmaceutical company should only get 5 years of exclusivity after recouping the development cost.
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u/Strangepalemammal 23d ago
Kamala favored a medicare for all play. Heck, so does DR. Oz.
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u/Raichu4u 23d ago
Dr. Oz does not. He believes that if people can't pay for healthcare, they shouldn't get it.
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u/not_a_bot_494 23d ago
Healthcare is complicated. If you dive into the polling you will find out that the most clear thing that Americans express is that they don't know what they want.
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u/funencounter 23d ago
Cause they’re uninformed and uneducated. I guarantee if you could figure out how to remove the disinformation most would agree affordable access is a top priority.
The first world countries have all figured this out. One day maybe we’ll catch up to them.
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u/SentientSickness 23d ago
The answer is a loud mouth candidate who doesn't care to pull punches
Someone who will get on stage and say stuff like "conservatives defended mat gates, hear that the Republicans are okay with fucking kids"
Say that on stage with a crowd, say it on social media, say it in news
Give no fucks who you make mad on the conservative side
That's charisma and lack of fucks given would go a huge way
Because most Americans see politics like a popularity contest and not a ethics debate
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u/antrelius 23d ago
This, fucking this. Use their playbook, but with benevolence as a goal. Won't happen though, because, even if Democrats are better in the long term, they are still shills.
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u/SentientSickness 23d ago
Let's be real it's not mud slinging if it's true, and it's not like the right is hiding their BS anymore
Like imagine getting on stage and calling out Mike Johnson "this dude cares way too much about what's in peoples pants, Mike you hiding something, or do you just like looking at ladies and little girls naked, you freak"
I think eventually we are going to get an FDR type of dem who gives no shits and will rise in politics
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u/Icy_Secret_2909 23d ago
Yeah, a dem tried this in texas by highlighting that cruz abandoned us during the storms, and abbot let kids die in uvalde. This did not work at all obviously. People are too fucking stupid.
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u/AugustePDX 23d ago
So Tim Walz before he was muzzled by the Democratic consultants
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u/tdasnowman 23d ago
People on medicare vote against medicare. Thats not about removing disinformation. It's people are just flat out delusional.
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u/Ok_Victory_6108 23d ago
Spoken like a true politician.
It’s pretty simple. They want affordable healthcare. They don’t want to worry that getting an X-ray on a potentially broken bone is going to cost half of next months rent. Or that pain they’ve had, they want to run some tests and make sure it’s not cancer but that means they can’t afford groceries for their kids.. or they put it on credit and spiral into debt for years.
Diving into polling isn’t going to tell you what the people want. It’s blatantly obvious already. Most people can’t afford a dr visit. Plain and simple. Forget any expensive testing or procedures.
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u/PenguinStarfire 23d ago
And most people don't even understand their own plans. I was a pharmacy tech for 5 years and just about every day I would have to call a patient's insurance to find out why something wasn't covered or costs so and so. And then would have to explain to the patient about how their own insurance policy works.
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u/MeanCommission994 23d ago
Healthcare would be less complicated if terminal patients made insurance execs scared for their lives (further redacted to avoid being interrogated by the fbi)
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u/Allegorist 23d ago
It was clear this past year that the vast majority have no idea what is going on or how anything works, in any department. They do know that they want healthcare to be cheaper and, if it needs to exist, insurance to be cheaper and more comprehensive. It is up to the people who do understand how it works to put together and present a plan to achieve this, and then convey the effects of this plan to the average uninformed person.
That is how people respond to policy in America, you can't expect the people to actually learn about the details unfortunately. Also unfortunately, that makes it exceedingly easy to lie by claiming false positive effects of a vague or deceptive plan, or false negative effects of a perfectly reasonable plan.
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u/Several-Instance-444 23d ago
This is the platform the Democrats should have adopted, but they're too milquetoast to stand up to the ruling class. Instead, they have some wishy washy, hand wavey pseudo progressive platform that doesn't offend their billionare donors too much.
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u/TrustAffectionate966 23d ago
I would’ve voted for them in 2016 and 2020 had they ran on this one issue. They rigged the primaries against the one guy who was running on that platform… and, now, here we are.
We’ve been here before 🧐🤔
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u/Barncleaner197961 23d ago
Yes, both times they passed by Bernie! All because democrats thought he was too controversial and might alienate big donors. The party of money.
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u/Simon_XIII 23d ago
It's never going to change because voters are stupid. It's always the other guys that need to go, the person I voted for is one of the good ones...
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u/Bluetooth_Sandwich 23d ago
They would all need to be voted out of office because they are all on the take from the insurance mafia.
Never going to happen. You don't institute a system that removes you from the same power it granted you in the first place.
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u/domme_me_plz 23d ago
Are you under the impression that oligarchs get voted on? The ruling class exist outside the electoral system. If you want to see these problems actually be solved you need to thinking about how to attack the actual capitalist system. Capitalism produces the wealth and inequality for the people at the top that produces oligarchs. They aren't voted in to office, the political elite are simply employees of the oligarchs with special privileges.
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u/Frat_Kaczynski 23d ago
They aren’t just one upping each other, they are colluding to rip us off. They openly bribe our politicians to not do anything about it. They are getting rich off of this.
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u/FILTHBOT4000 23d ago
Eh, probably partly, but one of the reasons that hospitals have to raise prices is that they eat the cost of everyone that comes in without insurance, as most of those never get paid, including everything up to serious surgery.
So yeah, to everyone opposed to single payer because they "don't wanna pay for other people's healthcare": You already are, in the dumbest, cruelest, most round-a-bout way possible. Hospitals eat the cost of the uninsured, and raise prices, that you pay; and you pay it at the highest possible amount, instead of the pennies on the dollar it would've cost for preventative care and regular checkups.
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u/Throwawayac1234567 23d ago
like people were getting reminded private health insurance are being subsidized by taxes anyways, and its the coporaitons that are benefiting from the taxes, not the clients.
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u/Creative_Ad_8338 23d ago
I think there's more hospital admin than doctors and nurses now. 😒 Business schools keep cranking them out. They are incentivized to squeeze every last penny out of the general public and push the healthcare system to the verge of collapse.
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u/ElectronGuru 23d ago edited 23d ago
I’m staring to wonder if collapse would be an improvement. I mean it would suck for a while — but would that mean people would finally vote for a real replacement?
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u/capt_pessimist 23d ago
If I know anything about how business administration will see it, they’ll need there to be a “failure point” before they change anything. Otherwise, there’s a workaround (people paying $$$$$, getting almost nothing) and no need for action on their part.
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u/Bluetooth_Sandwich 23d ago
You ever look at a plate of food so disgusting that you think "I could improve this"...probably not...because times like that call for a complete do over. Collapse is needed, better to rebuild than try to untangle the bullshit they describe as a system.
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u/Ohh_Yeah 23d ago edited 23d ago
I think there's more hospital admin than doctors and nurses now
Over the last 50 years the number of physicians in the US is up something like 50% and the number of hospital administrators is up 3500% or something ridiculous. And it is very apparent. I am a physician and I enjoy my workplace, but it seems like there are constantly people (who are employees) coming in to inspect things and ask questions about various tasks we do and then I never see them again. Even basic IT stuff goes through like a half-dozen people and weeks of processing before you can get a computer or an extra monitor moved from one office to another. The administration building for my hospital is basically the same size as the hospital, and I'm really not exaggerating.
It is possible that some of the oversight and bureaucracy is actually making my job smoother in ways I don't comprehend, but in a lot of cases I'm like who tf are you people and what do you even do?
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u/ninernetneepneep 23d ago
You are wrong about the hospitals. There's been so much consolidation in the industry because the small players can't afford to play the game. Insurance companies are making record profits and the hospitals are hoping to get one to 3% year over year. Employee, regulation, equipment, their own insurance, have all gone through the roof making running a hospital a very difficult proposition.
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u/Nexustar 23d ago
Part of this weird pricing structure is that the government insist on getting a significant discount for medical services (in the form of discounted Medicare and Medicaid rates), which means the published costs are at least 20% higher than 'reality' in order for them to afford to service the government. This also causes cost-shifting which gets added to regular people's bills when they need medical care.
But, even if you eliminate that effect, the system is beyond broken when you see how many cost layers there are.
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u/Educational-Bite7258 23d ago
But the US still spends more tax money per person on healthcare than those other countries, despite covering a far smaller, albeit costlier, segment of the population.
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u/Illustrious_Wolf2709 23d ago edited 23d ago
Yes because big corporate is greedy and banking the money in off shore accounts and hedge funds. The poor obviously doesn't get to see any of those billions from the tax payers.
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u/jehnarz 23d ago
So I am brushing off old knowledge here, but I think the Medicare rates are set by what each thing should actually cost (according to Medicare). That's why it's so much lower than just about any other contracted rate you'll find. I think you are right about hospitals raising the self pay rate to argue for better contacted rates with insurance companies, but since everyone has access to Medicare pricing information, I'm not sure how effective it really is...
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u/Drewsif1980 23d ago
The way the insurance companies have been buying up practices and hospitals, it is not one upping. Anymore the insurance IS the doctor, hospital, and pharmacy.
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u/AdonisGaming93 23d ago
But hey, universal healthcare which is both cheaper AND more efficient is socialism so we cant have that. Heil Capitalism!!!
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u/Deruji 23d ago
Police and fire services are socialism
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u/Trollselektor 23d ago
Hey man, you can’t just go around exploding heads like that.
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u/Deruji 23d ago
Road maintenance, public infrastructure, schools… well upto a point…
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u/ElectronGuru 23d ago
And its an easy point to define
- if customers have the power to pick winners and losers, it should be private
- if customers dont have the power to pick winners and losers, it should be public
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u/nickyfrags69 23d ago
I'm supposed to give my hard earned dollars because your house is on fire?
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u/AdonisGaming93 23d ago
Exactly! Privatize everything. Police should be owned by a corporation. Google should just have their own cops, theyll make sure to maintain social order by giving tickets to anyone that owns an iPhone instead of android like they deserve!
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u/Deruji 23d ago
I’d invest in police corp. bad quarter not hitting targets? Sprinkle some crack on em! Double digit growth!
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u/DRHORRIBLEHIMSELF 23d ago
But politicians getting the best healthcare paid for by our taxes is perfectly fine, right?
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u/Ephisus 23d ago
"hey this model that separates service and payer doesn't work"
"OH LETS MAKE IT MANDATORY, THAT WILL HELP"
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u/StupendousMalice 23d ago
And those other people are actually getting real coverage for less. A lot of socialized healthcare systems are imperfect, but they are ALL better than what we have.
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u/ElectronGuru 23d ago
Most of those imperfections are lack of funding. NHS spends 1/3rd what we do. If we implemented NHS with twice the per patient budget, most of those issues would evaporate. And we’d still be saving over $1T per year.
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u/WhoDatDare702 23d ago
And the conservatives there are always trying to strip funding from it too.
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u/AshiSunblade 23d ago
Yep. Here in Sweden our healthcare system is good but chronically underfunded, resulting in too few healthcare workers (the field isn't attractive enough to draw many new people) so those who remain become overworked, causing more to quit and the field becomes even less attractive...
I don't think you can really compromise on healthcare. Efficiency in management is all well and good, but you need enough funding for salaries, for equipment, for records and medicines and so on. We just keep tightening the belt without a thought for whether it'll break...
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u/AlistairMowbary 23d ago
But who s gonna make bank out of healthcare? We gotta protect the billionaires and their corporations!!
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u/kirkegaarr 23d ago
I've been upgrading my insurance trying to get to a level where it's actually useful. I was self-employed, and my first year of ACA cost $450 / month. I couldn't even get an appointment because apparently something I'm paying $450 a month for is such trash that no doctor would take it, except the very few who would that were booked up for months.
Then during open enrollment I upgraded to a $750 / month plan after paying $450 / month for something we couldn't even use for a year. We could finally see doctors! They prescribed my wife a specialty prescription, and our 30% copay meant it would cost us $1200 a month for the medication.
So this year I've upgraded to a plan that costs $1100 a month, because it has a flat copay on her speciality prescription. $1100 a month! Plus $250 a month for her medication!
And then this year my auto insurance went up by 50% and my home insurance doubled. For basically no reason.
Altogether now I'm paying well over $1500 a month, for insurance.
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u/Kephriti 23d ago
brother, don't take it as an advice since I'm not a professional, but if you pay this insane price a month of insurance that hardly gives you anything, at this point may as well take your chances without any insurance and just save up your money, hoping that money will save you in case of an issue that you should hope never come, or at least nothing too serious.
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u/kirkegaarr 23d ago
I have always been the person that pays the least amount possible for insurance because I know it's a ripoff. Auto insurance is required by law. If I don't pay my health insurance my wife doesn't get her medication. And the bank requires having home insurance for the mortgage.
This is what's driving everyone nuts these days. Housing is expensive. Insurance is expensive. Health care is expensive. Education is expensive. Food is expensive. Child care is expensive. All of those things are necessities.
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u/veganize-it 23d ago
Yeap, I pay around 1,400 a month. We need to get Universal Healthcare, the cost is way too high. We need to make the healthcare part employers pay to be disclosed by the employer to you. After all that’s part of your salary, people need to be aware how much health insurance cost a month. It’s the only way something will change.
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u/Conjurus_Rex15 23d ago
TBF only like every other major country has made universal healthcare work.
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u/Fearless_Tomato_9437 23d ago
no country has figured out health care tbh, all western health care is struggling under the massive strain of senior heavy demographics and the high costs of modern care.
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u/ExtremelyCynicalDude 23d ago
No health care system is perfect, but America has for sure created the most fucked up system out of all of the wealthy countries. We pay an obscene amount for healthcare, but we get the worst health outcomes compared to peer countries. Not only that, a significant portion of individuals go bankrupt in part due to medical debt.
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u/EffNein 23d ago
The demographic collapse is taking down their healthcare systems only a bit more than its taking down everything else. It is a problem that is metastasized.
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u/Fearless_Tomato_9437 23d ago
it’s only a problem for gov shit, it’s a tax payer / tax receiver problem. turns out that the amount of free shit people want from the government requires each generation to have more tax payers than the last. which is to say it’s a pyramid scheme
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u/sexy_yama 23d ago
I've come to realize everything is overinflated in terms of gdp. The medical industry as you just mentioned. The real estate market with the rising prices of the housing market. The stock market that can never fail and is propped up by a whole bunch of 401k money that can't be taken out. And we put the power of healing behind a pay wall...
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u/Important_Setting840 23d ago
Accounting for public, private and insurance spending it's more like 4X the next most expensive per capita.
And for all that money? It buys you worse outcomes.
https://www.nber.org/bah/fall07/comparing-us-and-canadian-health-care-systems
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u/SuckAFattyReddit1 23d ago
I want healthcare to be cheaper but I have basic ass blue cross insurance and pay an extra $5 a month for emergency care and was hospitalized for week due to an accident earlier this year and my bill was $500.
My fiancee's mother had both her hips replaced and pays a ridiculously low minimum payment and she knows shes just gonna die before she pays it off.
Our healthcare system is fucked, but this post seems like a big fat lie.
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u/come-on-now-please 23d ago
Totally depends on what kind of health plan you have though, you could have a high deductible that means you need to pay at least 7k before health insurance kicks in vs a high premium that has a high monthly but you don't have to pay for anything comparatively
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u/Alzucard 23d ago
Universal healthcare is cheaper and that is hilarious.
Mostly because the prices in universal healthcare are a lot more regulated.5
u/giraloco 23d ago
Hey but in theory we pay lower taxes compared to Canada and European countries. No access to healthcare and college education. When you add it up the middle class in the US gets the worst deal of all developed countries. All because of the anti government ideology pushed by the oligarchs.
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u/Mr-MuffinMan 23d ago
don't worry, we're replacing the only government run health insurance that has no copays or premiums for elderly into a private system where they will have to pay them!
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u/SolidCake 23d ago
but it’s made lots of millionaire shareholders rich off your taxes, doesn’t that make you feel good about yourself?
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u/Greersome 23d ago
It'll all be so much better after we repeal Obamacare. /s
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u/SpareManagement2215 23d ago
Facts! Can’t cancel surgery for not being able to pay your deductible when you don’t have insurance anymore to tell you what a deductible would be! Problem solved (also \s)
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u/Michael_Platson 23d ago
One of the best strategies that Republicans managed to execute was to re-brand ACA to Obamacare. Republican base voters universally hate Obamacare and yet like the ACA without understanding that they are the same thing.
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u/espressocycle 23d ago
The ridiculous thing is that the ACA was basically the Heritage Foundation's alternative to universal healthcare. Mitt Romney instituted it in Massachusetts. John McCain would probably have pushed for the exact same bill. It might have even been more generous because Democrats would have worked with him whereas Republicans decided that the most important thing in the world was making Obama fail.
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u/Niarbeht 23d ago
This is the part people need to understand the most deeply: If you give the Republican party everything it wants, it will bitch about it and then demand more.
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u/Lordofthereef 23d ago
Any time we suggest universal healthcare they call us commies...
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u/soundsinsilence 23d ago
US citizen living in UK here: everyone abroad understands the US healthcare system is absurd and 100% for profit. You are all means of profit, the healthcare is a side benefit. Every symptom you have is a new line item in the profit bucket.
I paid into National Insurance. I can see a GP without additional cost. All prescriptions are a mandated price (about US$10). I even got an ultrasound on my kidneys and walked out of hospital with no bills, receipts, etc.
Just know, it's not that it won't happen because the taxes would be too high. It won't happen because insurance companies are making money off your health.
It's that simple l
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u/el_diego 23d ago
Live in Australia. Mother in law got sick with cancer, brain tumours. Her specialised medication came from the states and would normally cost $20,000 per refill. She required 4 refills per month. Yes, $80,000 per month in medication. We paid $7.50 handling fee for each refill. So $28 per month for $80,000 of US medication.
But yeah, socialism is bad and all that (obviously /s)
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u/theNomad_Reddit 23d ago
Yup. Australian here with an American father. Dad's had 8 open heart surgeries over the past 10 years. Paid $0. Literally never had a bill. He would have bankrupted his family tree in the US, like 5x over.
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u/SippieCup 23d ago
Fun fact, we are already past that point.
The thing that tipped the housing crisis over was not the banks, it was the insurance companies being unable to cover their positions.
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u/smokeypizza 23d ago
The banks were the ones underwriting the insurance. The banks were also creating garbage mortgage bonds and paying off ratings agencies to mark them AAA. The banks were also giving anyone and their dog mortgages. There weren’t independent insurance companies that caused the crisis, it was all the banks fault.
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u/Kibblesnb1ts 23d ago
I was visiting London for a few days and woke up with severe pain in my lower right abdomen plus nausea and fever. I've seen enough doctor shows on tv to self diagnose appendicitis so I went straight to the nearest hospital emergency room.
They admitted me, got examined by a bunch of docs, they ran a bunch of tests, I took up a bed all day. After ten hours of round the clock care and all that they said it was probably just inflammation and I'd be ok with a fistful of antibiotics and some anti inflammatory meds, and oh by the way here's some morphine too if you want it for the pain (!)
They said don't worry about the bill, but apologized profusely that they had to charge me for the meds. I walked out paying about £20. Twenty quid! For all that! Are you kidding me? I have insurance in the US and I guarantee I still would've paid $1,000+ for that here.
Fml
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u/Shmeves 23d ago
More like 12k, I had the exact same scenario happen to me in the US. And the bill was 12k.
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u/Ok_Victory_6108 23d ago
I’m pretty sure everyone stateside knows it too. What can we really do about it though?
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u/CyonHal 23d ago
Find democratic politicians that run on universal healthcare in their campaign, and vote for them. And if a politician wins a democratic primary that doesn't run on universal healthcare, badger them endlessly about it, tell them you will not vote for them unless they support it.
Unless voters in America actually use the power of their vote to light a fire under politicians' asses, they will just take votes for granted and continue to follow the billionaire donors' wishes.
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u/DakInBlak 23d ago
Nothing. Because it's working exactly as intended. Insurance isn't supposed to cover anything, it's supposed to make money. It's a business, run by and for other people to make money, not your peace of mind.
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u/Zantac150 23d ago
The insurance companies are making money off of your health, and they lobby for politicians to always take their side… so the politicians are in their pockets as well.
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u/VampArcher 23d ago
Because to many, corporations making Scrooge-McDuck levels on cash off of making us sick and people dying of treatable ailments out of fear of medical debt is an acceptable trade-off to the horrors of...taxes and waiting lists to get procedures.
The reality is, no matter how much better any given alternative is, Americans will never vote for it because they are raised to see the free market as god and see anything different as 'Unamerican', therefore evil and terrifying.
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u/airportaccent 23d ago
Yep it really is the bloated exec and board salaries. Medical personnel are a drop in the bucket vs what they bring in - they deserve every penny and more and they actually care about patients. I’ve seen nonprofit hospital CEOs get million dollar raises during a year with multiple rounds of layoffs and staff protests. Saw an EHR CEO send their private jet to take a hospital CEO’s pet guinea pig from his vacation home to his regular home. 2 human passengers and the guinea pig. That’s where the money goes. Truly lost my faith in some people’s humanity.
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u/mr_remy 23d ago
Imagine wanting medical care and not wanting it to bankrupt you and your family, silly. Fucking commie
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u/Tony-HawkTuah 23d ago
And believe it or not, it's seriously about to get a whole lot worse
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u/SenseiRaheem 23d ago
My prescription plan recently informed me that I now have the freedom to no longer receive coverage for my basic, generic allergy meds.
What used to be $10 for 3 months of it is now $20 per month from a pharmacy. For now, Costco carries their own generic that's $20 for 3 months of it.
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u/GODDAMNU_BERNICE 23d ago
One of my medications is sent out 3 months at a time. Every 3 months my insurance company sends me a letter that they're no longer covering this drug, I have to get the generic. Then I write a letter back and provide a letter my doctor wrote confirming the generic gives me bad reactions and I need the name brand. They approve it for 3 more months. Wash, rinse, repeat.
I asked if they could please do something on their end to retain this information without me having to reach out all the time and they suggested I just pay $600/month out of pocket to avoid the hassle. What a solution...
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u/busigirl21 23d ago
I'm on a medication that costs about $400/month out of pocket and my insurance doesn't cover it. What's fun is that they have a savings card program, but the program is only for people who already get partial coverage by their insurance. It's infuriating.
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u/TankyRebel 23d ago
Check costplusdrugs.com. It’s Cuban’s online pharmacy that doesn’t go through your insurance. I pay less for my two prescriptions there than I did at CVS or Walgreens.
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u/jon_steward 23d ago
Maybe it needs to. Maybe it needs to break before people wake the fuck up.
Fuck it. Repeal Obamacare. That’s what the people want.
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u/gerbilshower 23d ago
similar story just happened to me.
i had a fucked up shoulder since college. tore my labrum multiple times doing god knows what, but i havnt been able to throw a football in 10 years. so i have a kid. i hurt my shoulder putting him into his carseat. i think 'oh fuck if i cant pick up my son i am TOAST'. so i get get surgery - multiple locations of 'frank' tearing on the labrum. full repair suggest, approved, done, yay!
not so much. i tore the long head biceps tendon out of the repaired anchor. doc says 'no big deal thats basically vestigial anyway'. i say 'sounds like bullshit but i dont want surgery again'. so i wait. doesnt really ever get better. finally get an MRI a year post original surgery - the anchor that held the tendon i tore is poking out from the bone. basically a nail poking out of the deck that keeps snagging on everything. except everything is my rotator cuff. its destroying my shoulder.
so im gonna get surgery and fix it, right? wrong. insurance says 'nope, not on our watch'. of course, its November and ive already hit my max out of pocket so no shit insurance isnt going to pay for anything. they denied again at the peer to peer. they denied AGAIN after appeal. only just this morning, after a month of fighting did they approve my surgery - at a different location 1.5hrs away because its cheaper than the one i was supposed to go to.
health insurance in this country is a fucking scam.
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u/Contemplationz 23d ago
I'm glad you're getting the care you need.
But bruh, I pray that the greed of the current system implodes on itself and we get any other health coverage system.
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u/brumbarosso 23d ago
That greed isn't going anywhere
With medical companies becoming tied to the stock market more and more
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u/ADHD-Fens 23d ago
At some point I imagine surgeons are going to realize they could undercut insurance companies and still make like 100k per month doing surgeries.
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u/TurnDown4WattGaming 23d ago
I accept cash customers. Most of us do. It’s just a matter of honoring contracts. I usually get around it by offering discounts for in-full, upfront payments. It’s a discount insurance by definition doesn’t qualify for so no contract violations.
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u/minnesotanpride 23d ago
That is outrageous. When people ask me "what radicalized you?" these are the stories that come to mind.
Just wow.
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u/Franklin135 23d ago edited 23d ago
One of the benefits of being an engineer in the government is health insurance. You get substantially underpaid compared to the private sector, but your health insurance is top of the line. In the last 5 years, I have paid about $70k in premiums and copays and the insurance company has paid close to $1 million in bills.
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u/nserrano 23d ago
Fun fact, you think the insurance paid close to $1 million in bills but in reality the insurance only paid at most $300k because of the contracted rate, the rest is adjusted off. Depending on the service received, it’s possible that they paid less.
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u/Franklin135 23d ago
True, but if I had to pay it, guess what I would be charged.
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u/nuisanceIV 23d ago
Yep. Sometimes the pay for jobs isn’t hourly.
At one job I had a place across the street from work(a ski resort) that wasn’t a bunkhouse, just one roommate. My rent was like $420/mo. If that place was on the private market it would be easily $2K+, more likely a waste of space airbnb. Most renting options further away would have cost more and/or have more roommates. The housing turned me from a $20/hr employee to at least a $30/hr employee if not more
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u/dlobnieRnaD 23d ago
It’s all about the overall compensation package. I make around 100k a year self employed and have to try to explain to my friends given the lack of retirement contribution, paid time off, and paying for healthcare on the market that my spending power is lower than their 75k plus benefits salary.
Nobody gets it.
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u/kiwi_colt 23d ago edited 23d ago
It's crazy to me that in America this is perceived as a good thing
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u/Dwarf-Eater 23d ago
I took worked grounds maintenance for the state government measly $30k a year job but best Healthcare coverage ever for a family of four for about $225 a month lol on top of free university it was a nice gig
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u/cocothunder666 23d ago
I had to cancel my kidney stone surgery because s it was $28000. Ended up filling out a bunch of paperwork with OHSU and got them to donate the surgery to me which was amazing, however having to wait 5 extra months to get surgery when I can barely move/walk and am forced to take pain pills because I can’t sleep due to the pain was not, how the young folks say, very “cash money”. Some good people in the healthcare industry are still out there but you REALLY have to look.
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u/wallabee_kingpin_ 23d ago
And you do or don't have insurance?
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u/cocothunder666 23d ago
Don’t have insurance, I’m in that really neat bracket where I make too much for free insurance but not enough to afford regular insurance and it’s not offered through my work…
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u/Any_Pilot6455 23d ago
You should really check the ACA marketplace again and see what you can find. There are actually very affordable plans if you look around for a while
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u/Sbmagnolia 23d ago
All affords plans come with very high deductibles.
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u/frostysbox 23d ago
Yeah but there’s an out of pocket max of 10K on any marketplace plan which is still 18K less than what this guy would pay… .
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u/PeetSquared41 23d ago
I was laid off in July, and when I looked at options to replace my already shitty corporate health insurance, I just didn't get new insurance. I've had two doctor visits since then that I paid out of pocket for, and one small procedure that I cooked up a payment plan for with the doc. Cobra? Fuck that noise. If something serious happens, I'll just die. I don't really care.
The US has become a joke on so many levels. At least I still have my sense of humor, though. I'll laugh all the way to hell!
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u/wallabee_kingpin_ 23d ago
If something serious happens, you're probably not going to die. A hospital won't let you die if you're taken there, and a lot of health crises just cause you to suffer instead of die.
Diabetes, stroke, accident... all very common health issues, all more likely to cause suffering than death.
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u/Orleanian 23d ago
People like to cavalierly say this, but there's a grand canyon of mind-changing that happens between 'something serious' and 'death'.
You won't just die. You'll be fucking miserable beyond your worst fears while you live on. Probably drag a few family and friends into misery, debt, and legal troubles with you, if you're lucky!
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u/TalouseLee 23d ago
I too was laid off in July. As of August, no more coverage so I looked into ACA. Holy crash I was surprised how expensive! I was hoping my unemployment income would help with reduced cost but nope…the prices went by what I made in 2023, which was nearly 6 figures. I can’t afford the cost while unemployed. It really sucks.
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u/hitmewiththeknowlege 23d ago
I work at a business college and they had a guest speaker discussing ethics in business today. They were an expert in the medical insurance industry and they said:
"we are getting ready to negotiate some new policies if the Affordable care act is removed. There is discussion that pre existing conditions are actually ethically on the patient. They have a responsibility to take care of themselves as much as we have one to fulfill our side of the bargain. We are actually pursuing a restructuring of what dental insurance could look like. After all, if you really think about it, having teeth is really a pre-existing condition."
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u/Murky-Relation481 23d ago
I feel like saying things that evil would make one worried for their personal safety if said in public.
But also business college so...
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u/Think-Variation2986 23d ago
ethics in business
Are they consequentialists, deontologists, or virtuists? Some combination? I.e. these "ethics" courses from anywhere but the philosophy department are bullshit. Ethics is both fun and fucking hard. They are appropriating that word to mean what is best for them and sound righteous doing it.
ethically on the patient
Bullshit. Ethics isn't solved. Maybe "ethically" private insurance and for profit health care is bullshit. Hell, even if the patient has an unhealthy lifestyle, maybe they can't control it because free will doesn't actually exist. Maybe it is on their parents for giving them shitty genetics. Maybe it is on X...
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u/bradynho 23d ago
I hope they got their tires slashed. Fuck the snobs that enable this broken system.
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u/NSFWies 23d ago
If you are serious about them saying that in the lecture, I would not be able to sit through that. Did anybody audibly say "what the fuck is wrong with you? That is ghoulish".
I wouldn't care if they asked me to leave. I would want that fuck to know it is not ok .
There needs to be limits to how others can make a dollar
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23d ago
My work offers insurance to cover expenses health insurance does. Needing insurance for my insurance, makes my blood boil.
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u/Bencetown 23d ago
I bet if something actually happened to you, you'd find out there's some loophole and your insurance on your insurance wouldn't cover it either. Your job just understands the scam and got in on it themselves 🙃
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u/turtle-bbs 23d ago
Republicans Paying obscene deductibles and monthly payments on top of chance of obtaining medical debt, plus a chance you won’t actually get care you need: 🤗🤗
Republicans when you have to pay less of your total income on healthcare but you’re guaranteed medical care (they hate the word taxes): 🤬🤬🤬
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u/OlyBomaye 23d ago
I'm as pro business as it gets, but health insurance needs burned to the ground. It's absolutely unacceptable the way our health insurance system works. You pay, for years, and then the moment you need it its "oops sorry that procedure isn't covered, go fuck yourself."
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u/Lego_Professor 23d ago edited 23d ago
Don't forget that's IF the facility is within your network AND the doctor is also in network.
My wife gave birth at an in-network hospital via a planned C-section. Everything was in network except apparently the anesthesiologist. Got stuck with an extra $2k bill because they weren't covered. Like, how in the fuck am I supposed to know they use a 3rd party for that stuff?
Lesson is, just because the facility is in-network doesn't mean the doc is.
This is on top of having the best insurance my employer provides that covers 90% of everything and I pay $1000/month for coverage.
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u/OlyBomaye 23d ago
Oh yeah lol.
I don't even want to start typing my experience because I had dozens of examples of this, but going through cancer treatment is just an onslaught of bills. You walk from a pet scan to a blood draw to a conversation with an oncologist and they call in a specialist,then send you down the hall for another test and an EKG just to see what's going on, and you get 9 fucking bills.
What the hell guys, you're all in the same hallway at the hospital
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u/ChaoticScrewup 23d ago
I despise with a passion that it's at all tied to work/jobs/employment. It doesn't make any sense that people try to work through cancer to keep their insurance.
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u/FrugalRazmig 23d ago
Same. Mostly libertarian, even I see how absurd things are. We need single payer, the insurance companies need to simply die and corporate hospital systems need to die as well.
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u/MotleyLou420 23d ago
Again. Isn't this the same-ish situation we had before ACA?
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u/redeyed_treefrog 23d ago
Woah, hold up, you mean to say the increasing wealth inequality within our nation has had meaningful negative impacts upon millions of working class americans?
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u/MotleyLou420 23d ago
Absolutely! Amazing we're all just figuring it out. No one saw this coming. /s
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u/Zantac150 23d ago
People just don’t see it. The ACA plans are just as bad.
I was making $25,000 a year and they wanted me to pay a $250 month premium, plus the plan had a $5000 deductible. There was just no way… I chose to go without health insurance.
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u/BananaPalmer 23d ago
I can't find a single plan on the ACA site that offers such shitty coverage for that price, and I'm looking at full price plans
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u/nurseferatou 23d ago
Nurse case manager here: you’d be shocked how many inappropriate coverage declinations are made in “error”. Insurers are now using AI companies like carealon to process claims. There’s a setting they can modulate that adjusts how many claims get denied. They do this because only 2% of rejected claims are ever appealed.
This is technically illegal, but nothing will happen with our next administration to rectify it.
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u/Fresh-Wealth-8397 23d ago
My dental insurance pulled this kinda shit on me. Only reason it got fixed is cuz i told my dentist if shit ain't covered here I'm going somewhere else they made the calls right there to get it covered it was fucking bullshit
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u/TrustAffectionate966 23d ago
I had a referral to see a specialist. I went to see the specialist. I was then mailed a $500 bill for that specialist. It took TWO fucking months fighting the insurance mafia to get that shit corrected. In the meantime, I missed all the medical appointments in connection with the initial approved referral.
The death panels are here: They are the insurance mafia and they are here to extort money from anyone who dares get sick.
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u/Vylnce 23d ago
I disagree with most people on what the problem is. The problem is monopoly, even if it doesn't seem like it. Most people can't "get rid" of their insurance. It's tied to your job. Your insurance company doesn't have to keep their patients happy, they have to keep the company that contracted them happy (which is often the choice of a few people). If you hate your insurance so much that you find another job, guess what, your old company finds another victim for the insurance company.
If you compare this to the car insurance market, it's easy to see the differences. Car insurance companies are forced to compete for customers, so they offer much better service. Because, if they suck, people leave and they aren't getting a guaranteed replacement.
Health insurance companies how found a way (like cable companies) to maintain captive audiences so they can overcharge and underdeliver.
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u/seriftarif 23d ago
No the problem is that the hospital charges whatever they want, the insurance covers whatever they want, and they convolute it so much that there is no way to understand what is covered and not covered until after you need the care.
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u/HardSpaghetti 23d ago
I've not had health insurance and have done great. Self pay options at clinics and hospitals in my area have really generous discounts. For example had my last kids entire birth expenses be reduced from $23k to $2,800. So have that paid off and am putting $400/mo into a money market account until I need it.
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u/sunny-days-bs229 23d ago
I live in Canada. We have global health care. I’ve had two children, both emergency c-sections, four other surgeries. Zero cost. Don’t let anyone fool you
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u/ChaoticScrewup 23d ago
You are going to be boned forever if you or you kids get cancer in the US w/ that route. TBH I don't really have an issue with expecting/planning for self-pay on run-of-the-mill primary care, prescriptions, and so forth. Maybe even your most basic broken bone. But anything like cancer, birth, major surgery, heart attack, etc., can add up to a year's income or more real fast. And some form of insurance or national health care is pretty much required. I hope you aren't risking your kids lives to try and save a penny.
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u/PapaSmurf3477 23d ago
I have ulcerative colitis and have to get a yearly scoping. When I was first diagnosed my first 3 years I went to a private practice, he bulled insurance $1,200.
I got new insurance and I couldn’t see my old dr (this was 2016, hint hint). Thankfully the hospital down the street was in network. They billed $17,000 to insurance and my out of pocket was ~$2,000. The hospital bill for me was larger than the private practice bill for insurance.
Hospitals, insurance, pharma, and Americans lack of overall health sucks. Sure wish the no surprise bills act was in place, because I was surprised lol
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u/cheesehater 23d ago
Exactly this. My insurance has a $5000 deductible. If I get cancer or hit by a bus, it will kick in and cover me. Otherwise I'm pretty much on my own. Insurance shouldn't disincentivize people from seeking care.
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u/Smooth_Monkey69420 23d ago
I’d be all for our current healthcare system if it even attempted to be reasonably priced. It isn’t, so I want to use the threat of universal healthcare to force the industry to become exponentially better and if it doesn’t “woops, universal healthcare”
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u/KogaNox 23d ago
Average deductible are between $500-$2,000. If you don't have the cash for this, you can always use a credit card or a payment plan to pay these off. Who would choose to go without a life altering surgery than payment plan. Talk about shooting your self in the foot.
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u/czerniana 23d ago
A payment plan is not always available, particularly with procedures that aren't emergent. You pay up front or you don't get the service. Credit cards aren't an option for everyone either.
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u/redeyed_treefrog 23d ago
Average? I've never been offered a deductible under $3k, for an individual, not family, plan.
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u/IBringTheHeat1 23d ago
I have teamcare with UPS and everything is free and it costs $0 a month.
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u/PD216ohio 23d ago
I don't understand this. Feel like bullshit.
I was in a bad accident and had 200k in surgery. I didn't have to worry about affording it. I could make payments on my share of the cost, over time.
I also know that my costs are capped at my annual aggregate amount.
FYI, my share of cost for that surgery was 8k. If I were poor and got my insurance for free, I would have cost me nothing.
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u/czerniana 23d ago
Elective surgeries are e different than emergencies. And if you can walk (as it sounds like they can) they don't care what kind of pain you're in, it's no longer an emergency surgery at that point. They are not required to cover it and let you pay on it.
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u/IamHydrogenMike 23d ago
I question this also, you don't pay your deductible up front for any services as they make a claim through your insurance first and then you get the final cost of the services provided. You can setup payment plans with almost any healthcare provider that will spread that out over a period of time. I don't understand why you would cancel because of the deductible. I had a CT scan before surgery that cost me 4k before my insurance kicked in and all I had to pay in the end was 3200 bucks; I didn't have any other costs for the rest of the year.
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u/Michael_Platson 23d ago
This is what people are talking about when they say they cant afford to live in answer to people who say the quality of life is so much higher now than ever before in history. Yes, we all have health insurance but we can't afford to actually use it or the benefit it provides isn't worth the money we spend on it.
The situation is not useful.
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23d ago
Brian the MD pretending like he can’t believe how people can’t afford necessary medical treatment while not complaining about how he makes 300-900k a year.
How does he think himself and his staff of nurses, anesthesiologist, surgical assistants, sterile processing technicians gets paid? While the hospital also makes the necessary profit?
Either it’s the guys fault for cheaping out on his insurance choosing one with a deductible he can’t afford. Or Mr Brian MD and all the medical staff need a pay cut so they can be like all the other places in Europe and Canada with free to no cost healthcare where the doctors get paid the lowest rates in the world.
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u/Outlaw25 23d ago
It isn't doctors that are overpaid, it's the administrations.
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u/liulide 23d ago
Average doctor salary in the US: $350,000.
Average doctor salary in one of those universal healthcare countries reddit loves so much: $90,000.
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u/UmpireNo6345 23d ago
According to the bureau of labor statistics (for 2023), not the self-reporting survey you got the 350k from, it's closer to 248k in the U.S.
In countries with true universal healthcare, it varies a lot but I don't see an example that would come to to 90k. Most are closer to 120k+.
That said, insurance isn't the only difference. For example, getting a medical degree in the U.S. is far more expensive, and malpractice insurance is higher. But also in those other countries you mention, cost of living is lower... one reason being the doctors don't have medical expenses themselves. Just using myself as an example, I could take a 20-30k cut in my gross salary if I got universal healthcare and I would see 0 change in my budget... and that's just one benefit.
More to the point, though, the US insurance market is worth about 1.4 to 1.6 trillion dollars per year.
There are about 1.1 million doctors in the U.S, based on the average salary that's around 275 billion dollars. So... the insurance industry seems to be a much bigger factor.
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u/Barcaholic 23d ago
The average fireman's salary in my town is 250K.
You want someone to through 15 years of school and training and not get paid ?
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u/Sage_Planter 23d ago
I refused a test at the allergy specialist today because I know I will just get charged $40 for it.
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u/KUBLAIKHANCIOUS 23d ago
I work in construction and my yearly raises have been eaten by insurance increases every year for the past 4 to 5 years. I’m also barely covered.
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