Fantasizing about what you could buy instead of health insurance

Cockeyed's Rob Cockerham lost his job last year and now works as a contractor. He now buys his own medical insurance:

And man, oh man, is it expensive.

Our family's policy, two adults and two kids, for medical, dental and vision, costs $1,320.87 per month. That's the insurance premium. If we actually use the care, we have to pay a deductable too (called a co-pay), but honestly, after paying $1,320.87 per month, almost any co-pay seems like pocket change.

He began fantasizing about what he could buy with that much month every month:

Visiting car dealerships was fun when I had a potential $1320/month to spend, but maybe that money would be better spent elsewhere. No, not on health insurance, for every extraneous monthly expense I could dream of!

Like Netflix, streaming subscription with 8 DVDs out ($51.88/month), plus a World of Warcraft subscription ($15/month), plus a gym membership ($25/month), a home security monitoring system ($32/month), Gamefly service ($22.95/month), plus a membership to a tanning club ($9.95/month), plus Amazon Prime ($6.66/month), plus Hulu Plus ($7.99), Time Magazine ($2.50/month), Newsweek ($3.25/month), Playboy ($1.33/month), Wired ($1.25), Martha Stewart Living ($2.00/month), a lawn service ($50/month), Dana's Housekeeping service -- four hours/week ($312/month).... uh, plus FullBelly Farms weekly vegetable & flower deliveries ($127.50/month), plus sponsoring a child in Haiti ($35/month), plus Disneyland deluxe annual passes for the whole family ($127.36/month total) plus a large supreme pizza from Pizza Hut delivered every night ($428.40/month). Those things total $1267.02 per month, leaving enough to give the pizza guy a $53 tip.

What I Could Buy Instead of Health Insurance

• [Just_Ok]

  Socialized or capitalized, we can’t afford health care.

  • [EH]

    Only because the bankers and wars are sucking up trillions of dollars of federal revenue. A minor quibble, I know.

  • [Alpacaman]

     Publicised, sure you can. Just emigrate to NZ, Australia, much of Europe, parts of Asia – we manage.

  • [PrettyBoyTim]

    The UK spends £106billion a year on the NHS, which provides free healthcare to all UK residents. With a population of around 61 million people, that works out as a cost per year per person of around £1700 ($2650). Affordable healthcare is achievable.

    • [Palomino]

      And a large percentage of that is preventative, right? That’s the key. 

  • [RoofusKit]

    Do you realize that the chances of this man paying more than $932 a year for health insurance after the Affordable Care Act fully kicks in are very slim? Unless of course he is doing very well, which as a (now) independent contractor, I can’t imagine he is.

    • [jayson]

      You’re claiming that the ACA is going to drive the cost of health insurance down so far that he’ll end up paying less in a YEAR than he currently pays every MONTH? 

      How, exactly, is the magic trick of making health insurance that cheap going to happen? I’m all ears.

      • [RoofusKit]

        Those of us who’ve actually read the bill know that it holds a provision that subsidizes health care premiums for those who earn wages even up to 400% of the poverty line. At that, the highest level, the maximum premium they will pay a year is $8,379 for a family of 4. The number is lower the closer you get to the poverty line.

        Currently that 400% line is $92,200 for a family of 4. Or for an Individual $44,680. Except in Alaska and Hawaii where the poverty line is set at a higher income level.

        In 2008 countrywide the median income level for a 4 person household was $67,019. I imagine it’s gone down since then.

        It’s called the Patient Protection and Affordable Care Act for a reason

        (I may have made a rash assumption about the amount of his income, where I live independent contractors have struggled since 2008. But that does not change the fact that the law stands to lower costs for much of America.)

        • [jayson]

          How are those subsidies paid? Is it a tax credit that you get a year later, or something that lowers the amount you have to pay up front?

          For an individual who makes more than $44k / year, yet still has trouble paying a bill of about $600 a month, is there any relief? Living in any major city on a salary like that would still make it incredibly difficult to take on the cost of health insurance. 

          I want to believe that costs will come down, but I can’t imagine them coming down so low that anyone who can’t afford it today will be able to afford it when the ACA kicks in. No matter what things look like to a legislator in D.C., hitting someone with a new expense for several hundred dollars a month is going to be hard for them to handle.

          I’m not “Those of us who’ve actually read the bill,” so any education from someone who has would be most welcome.

      • [RoofusKit]

        I am unable to reply to the appropriate question because of thread limitations, but here is the answer nonetheless.

        The credit is advance-able, meaning you can apply for it, if you qualify based on your previous year and projected income, your premium will be reduced. Most who do not already have health insurance cannot afford it and will either receive Medicaid or this subsidy.

        From the website made to educate people about the new law.

        http://www.healthcare.gov/law/full/index.html

        And the ACTUAL full text of the bill

        http://en.wikisource.org/wiki/Patient_Protection_and_Affordable_Care_Act

        The part referring to the federal subsidy.

        http://en.wikisource.org/wiki/Patient_Protection_and_Affordable_Care_Act/Title_I/Subtitle_E/Part_I/Subpart_A

  • [Palomino]

    Healthcare can’t afford us.

• [Trace]

  Time to get your priorities straight. Health insurance benefits everyone.

  • [jayson]

    At those prices, it only benefits the insurance companies. 

• [scatterfingers]

  That’s insane. I mean, I pay more taxes as a Canadian, but that amount is larger than my mortgage payment!

  • [AnthonyC]

    And also larger than the share of your taxes that goes to health care. That’s kind of the point – socialized medicine saves money because most of the cost of our care in the US has little to do with actually improving health.

    • [SoItBegins]

      Random: In BC, the government health care payment for one family is….
      $120/month. Not per person, for the whole family.

      (Note: This doesn’t cover dental or vision.)

      • [Richard Dagenais]

        Dental and vision plus a plethora of other stuff is another 120/mth via private supplemental insurance.

        • [SoItBegins]

           Actually, I get mine for $288 a year through the local university.

• [mudrummer012]

  $1,320.87?  Needs to find a better insurance broker BAD.When I was a contractor I only paid about $750 for all my insurances for my family and my self (health, vision, dental)

  • [chgoliz]

    Depends on where you live, what insurance is available, and if there is any possibility of potential future problems (yes, I’ve been turned down for insurance that wouldn’t have covered either maternity care or infertility treatments, because they said I had a “potential for future infertility”….I was 4 months’ pregnant at the time with my first child).

    BTW, the catastrophic-only policy I was finally able to get for my family costs a heckuva lot more than Cockerham’s. I’d love to pay only $1,300/month. But it’s the only policy I was able to get. 2014 can’t come quickly enough for us.

  • [Antinous / Moderator]

    And that was how long ago? My premiums (single person) have gone from $425 to $596 in two years. And by all accounts, that’s a smaller rise than other insurance companies.

    • [mudrummer012]

      1 year ago

  • [Thorzdad]

     $1,320/mo. is right in-line with what we pay for our family coverage. Actually, he’s getting a better deal because his plan includes dental. Most plans don’t. You usually have to add dental through a third-party. We do get some minor vision coverage…co-pay on the exam and a small discount on glasses.

    Maybe you were a contractor 6 years ago or more? That’s about when we started having to purchase private coverage, and it was around $800/mo. then. It just keeps rocketing up every year, no matter whether you use it or not.

• [Jim Cleek]

  So the money to pay for this “free” healthcare comes from where again? Its interesting that nobody talks about where the money comes from, just that its “free”. Sooner or later we all pay for it. There is no such thing as free.

  • [Rotwang]

     http://lifehacker.com/5922382/how-will-the-new-health-care-law-affect-me

  • [Mark_Frauenfelder]

    Rob is not saying anything about who should shoulder the burden of heathcare costs. He’s simply griping (in a funny way) that it is damn expensive. It’s comedy, Jim.

  • [Tynam]

    Ummm… who said ‘free’?  Other than you?  There’s a LOT of room in between ‘free’ and ‘the prices you get charged in the US’.  Enough room for ‘the prices charged in the entire rest of the developed world’, for a start.

    • [Jim Cleek]

      He didn’t say “free” but he certainly indicates it would cost nothing thereby allowing that money to be spent on more important things like Netflix. How can you do that unless it is “free”?

      I get the joke. The problem is that the joke is on us and it seems most of us either aren’t paying attention or simply don’t care. That, folks, is what is flushing us down the toilet.

      • [Mark_Frauenfelder]

        “he certainly indicates it would cost nothing “ 

        Could you please point out where he indicates that? Rob’s a pretty smart guy. I think he realizes that health insurance has a cost.

        “I get the joke [A]. The problem is that the joke [B] is on us”

        You are conflating two different jokers.

        “ it seems most of us either aren’t paying attention or simply don’t care.”

        If you read or watch the news, you will find out that health care is very much on the minds of most of us, and that most of us do care. 

        “That, folks, is what is flushing us down the toilet.”

        What is your proposal to keep us from being flushed down the toilet?

        • [Al Billings]

           He doesn’t have one besides voting Republican even though they proposed this same system earlier.

      • [RoofusKit]

        It’s a fantasy, the point is that it couldn’t happen. Just like imagining you can fly.

  • [chgoliz]

    Hint: it’s cheaper (and fairer) when capitalists don’t override doctors in deciding who needs what medical treatment.

    • [cinerik]

      Or when insurance companies sit in between the patient and the doctor, taking their own slice.

  • [J]

     In Canada, “free healthcare” isn’t free.  Everyone knows that.   But there are huge benefits that help keep the final costs lower then they might be.

    Imagine you buy a brand new car and never take it to a mechanic for maintenance.  What condition is that car in 20 years later?
    Now imagine the same car dealer maintained.
    That’s what we have in Canada. 

    • [oasisob1]

      Yeah, but I don’t like having MY oil changed every 3 months. :-)

    • [donna m]

      I agree. But we’ve also got a catch 22 here. Many of us don’t go to the doctor ~because~ it’s so expensive.

      • [RoofusKit]

        Which is exactly why the Affordable Care Act eliminates all preventative care co-payments and deductibles.

  • [Dustin Driver]

    We could buy fewer billion-dollar jets that asphyxiate their pilots. That would cover a huge chunk of it. Oh, and we could make rich people pay taxes.

  • [Wreckrob8]

    The NHS in the UK is normally described as being free at the point of use. Even the most ill-informed of voters realize that that means payment through taxation. But if free means freedom from the additional stress and psychological trauma worrying about your financial health at a time when you are perhaps least able to cope then it is free. I have yet to come across anyone here in the UK who worries about their tax bill in quite the same way Americans worry about their health insurance.

  • [Laura Harden]

    Who is paying for it now? Do you know how many American’s use the emergency room as primary care because they have no coverage. Wanna know how much more it costs taxpayers to cover “emergency room primary care”?

• [Nora Sawyer]

  I played a similar game when my health insurance refused to cover a $55,499.15 bill (because the tumor I’d had surgery to remove must have been a pre-existing condition, as it was discovered less than 6 months after I bought insurance).

  • [Red Pill Junkie]

     In Mexico you need to wait 2 whole years before the insurance allows you to have cancer.

    I’m a designer, so I pay for my own insurance. About 100 dollars a month, which might not seem too much, but for me it is!

    • [Nora Sawyer]

      I only had to wait another 6 months for follow up surgery, at which point my (luckily benign) tumor ceased to be a pre-existing condition. Somehow.

      • [Red Pill Junkie]

        I’m glad it turned out OK :)

• [Jason Coyne]

  Single payer would still have him paying this, it would just be via taxes, or additional debt passed on to the next generation.

  • [Chesterfield]

    You’re assuming that a single-payer system couldn’t be more efficient, and that seems hard to believe. In fact, it would be difficult for me to think of a way to make the current system less efficient. 
    A huge part of your monthly premiums pays for stuff like advertising.

    That said, you are right that health care is expensive and has to be paid for in some way. I think through taxes is reasonable.

    • [stuck411]

      Don’t forget the take the insurance salesman makes for signing you up. Some company’s pay too much to their salesmen to push inferior product.

  • [dragonfrog]

    We pay more taxes in Canada, but not $1320/month more.  And certainly not most heavily when we can least afford it (there isn’t a special $1320/month tax that is only levied on the unemployed).

  • [Buelah Man]

     You are incorrect.

  • [Cowicide]

    Have you ever read this FAQ in detail?  It doesn’t appear that you have.

    http://www.pnhp.org/facts/single-payer-faq/

• [Ashley Yakeley]

  How about a two-week vacation to Japan (from Seattle) five times a year?

  • [sgtdoom]

    It’s truly bizarre:  all during the discussion of that health insurance legislation in America (and always please emphasize health insurance, there’s little pertaining to healthcare reform), there was absolutely no mention of the top three cost drivers?

    Yes, it is a for-profit, fee-based system, which is exactly why it is so sensitive to cost driver number one:  hedge fund speculation across the entire healthcare sector.

    Which is why it is sensitive to cost driver number two:  private equity leveraged buyouts across the healthcare sector, whether hospitals and clinics, or companies making orthopedic implants, or personnel firms involved with outsourcing physician services, etc.

    Number three is the abject corruption of criminal corporations (and some organized crime, the small ethnic outfits compared with the giant criminal corporations).

    One wonders why?

    • [cogbi]

      Yes. How wonderful it will be when the health care system  is efficient, effective and free from corruption. Just like everything else the government does.

      • [Al Billings]

         That beats the current choices unless you’re rich.

      • [Ashley Yakeley]

        Government does a lot of things pretty damn well, given how massively underfunded it is (besides defence, of course).

        • [cogbi]

          You’ve convinced me! The government is great at managing money, allocating resources efficiently and resisting the evil influence of the rich. We just need to give it even more money and power. Politicians will no doubt use it wisely. We have nothing to fear from an ever-growing all-powerful state. How could I have not seen this before? Well played sir!… Since boingboing wiped out my reply to Ashley Yahkely below, I’ll post it here. Threats from the government: the drug war, police brutality, drone strikes that kill civilians, wiretapping, war. Pretending that an expanding state can be contained by voting is like pretending that you can control the outcome of a war. You are fooling yourself. Neither votes nor hugs will stop it if you keep pouring in money and giving up power to it. If you don’t like something a corporation is doing, don’t buy from them. Vote counted.

        • [Antinous / Moderator]

          You’re just a meme machine.

        • [cogbi]

          Thanks Antinous. Another devastating reply from an original thinker. I’m humbled.

        • [Ashley Yakeley]

          Better at managing money than Wall Street, apparently. More efficient at allocating healthcare resources than  insurance companies, which must pay their shareholders. And we have rather more to fear from an ever-growing all-powerful private sector, since we can’t vote them out of power when they don’t serve our interests.

        • [cinerik]

          “If you don’t like something a corporation is doing don’t buy from them” doesn’t work when it’s healthcare.  

• [Brian Bishop]

  Plans through COBRA are insanely high. Considerably higher than equivalent insurance on the individual market, IF you can get it. Plans under COBRA have the advantage of prohibiting the insurers from declining you coverage however.

  Our family, which is stuck on the individual market, is generally healthy (fortunately) and has opted for a catastrophic plan (deductible = $10K). Premiums are “only” $240/month and the plan still covers most of our preventive/check-ups/doctor visits, but wouldn’t cover hospitalization or emergency visits.

  A high deductible plan is not a good idea for families with pre-existing health problems, nor for families without cushion money in the bank, but it is a good option for a lot of younger, healthier families with some savings.

  • [Catherine Shaffer]

    Why on earth would you buy health insurance that doesn’t cover hospitalization or emergencies?

    • [Brian Bishop]

      Sorry, I phrased that poorly. My deductible is high, which largely only applies to hospitalization and emergency services. So the first $10K of those services is largely (but not completely) uncovered. After $10K is 100% covered.

      • [Antinous / Moderator]

        I have an HMO:
        Drug co-pay $10
        MD visit co-pay $25
        ER visit co-pay $100
        Hospital stay $200 per day co-pay
        Sundry things like colonoscopy $200 co-pay

        • [Brian Bishop]

          Conscious Sedation (noun): a process which allows one to describe a procedure as traumatic as a colonoscopy as “sundry”

          Those co-pay amounts seem to be in the range of what I’d consider reasonable, with perhaps some sort of additional assistance for low income individuals.

        • [Antinous / Moderator]

          I refused sedation for my colonoscopy, just a little pain medication. It’s really no big deal.

      • [Catherine Shaffer]

        Ok, got it.

  • [Clevername]

     What sort of catastrophe doesn’t include hospitalization or emergency visits?

    • [Just_Ok]

      affordable catastrophes

      • [Gyrofrog]

        You never know, check the policy… I was in a car accident, and wasn’t seriously injured, but did have to go to the hospital.  The auto insurance paid the bill, but only up to a point, and the hospital was trying to collect the rest (which I could not afford).

        Meanwhile I had been paying something like $40/month for health insurance like you describe.  Somehow, they found out that I had been taken to the hospital in an ambulance.  To them, this meant “catastrophe” and they covered the rest.  (I never even called them; don’t know who they found out. Like you I figured the deductible was too high for them to have gotten involved.)

        • [Just_Ok]

          “The New Brunswick government is recommending the cap on damages for minor personal injuries sustained in automobile accidents be increased to $7,500, up from $2,500″

        • [Palomino]

          One thing to consider is where and how your emergency services are covered. Depending on the circumstances, how you were transported (ambulance usually means E.R.) and how you are admitted. If you are admitted into one hospital and transferred to another via ambulance, you should be covered. But not always.

          There’s different people wearing different hats inside one building. Most people get screwed with hospital lab and diagnostic imaging. Think hospital gift shop, it doesn’t accept your insurance, so their lab and imaging “departments” might not either.

          Rural coverage sucks. I worked in claims, helicopter transport claims were the worst. The biggest part was figuring out IF the chopper could have met up with a surface ambulance. Another was overshooting one hospital and continuing on to a much farther one, say a first class burn unit or even if the first one simply didn’t have a bed or accept the patient’s insurance.

• [futnuh]

  With the exception of the vegetable deliveries and gym membership, there’s nothing on the list that benefits Rob or his family’s personal health. Pizza every night? Really, that’s the best he could come up with for 30% of his premium?

  • [Rob Cockerham]

    As I mentioned in the article, those 20 items were every monthly charge I could think up that I didn’t already have (e.g. I already have a cell phone bill). Can you think of another service which is charged monthly, which you don’t currently pay for? The goal is to illustrate how crazy awesome your life would be if you were blowing $1320/month on luxuries.

    • [penguinchris]

      What struck me from your list, actually, was how little you really get for all that cash – beyond the point about health insurance costs you’re making, there’s a second point about how expensive all these services really are (services that nobody really needs). 

      While if I had access I might use a lot of them, those things are not worth anywhere near that much money to me and other than a couple of things (like unlimited Disneyland) they don’t really strike me as even indicating a particularly luxurious lifestyle.

      Everybody’s different, of course :) I could certainly find a way to blow that much extra money each month, it just wouldn’t be on services and the like.

      • [Rob Cockerham]

        You want real luxury? I started off the article with car leases. I visited three dealerships to find out what kind of ride I could get for $1320/month. The dealers’ concensus was “Anything out here, that’s enough money to lease a $100,000 car. ”A rational answer would be to put it towards retirement, or our kids’ college fund, but that wouldn’t be a very interesting article. 

        • [penguinchris]

          Yep I read the article – been enjoying your site for years and it’s always worth it to read the whole thing – despite Antinous’ funny comment below ;)

          I was going to comment that personally I’d want to buy my car and not lease, but given the intent behind your thought experiment leasing makes sense because that’s what luxurious people would do. That $1320 a month wouldn’t buy you something as nice as it would lease you.

    • [Antinous / Moderator]

      As I mentioned in the article…

      You really are an optimist.

• [Bashtarle]

  In B4 even more bloated health insurance system. 

  When you look at things like Progesterone that was developed with tax payer dollars, who’s production was awarded to a single pharmaceutics company. That went from $10 a shot to $1.5k  because “that’s what the market would bear” 

  Then there is something fundamentally wrong with the market.

  I mean I see where they are going and in theory it works.

  I guess my main problem is they are taking something that is already bloated and nearly broken and just shoveling money at it, in hopes of the best. What could possibly go wrong with that plan >.> 

• [You-Are-Paying-TooMuch]

  Look if you’re american, you have to pay health insurance. The point here is that you are paying TOO MUCH. To cover my foreign relatives visit to Canada for a year costs me $5k from RBC in health insurance for 2 people older than 60.

  It’s not just YOU paying for others, its YOU paying way too much regardless of the others involved and YOU were paying too much. Health shouldn’t cost you a mortage.

  I see all these comments here “and now I have to pay for poor people too”, you aren’t getting it, you were already paying too much for very little, you shouldn’t be arguing about having to pay a little more, you should be arguing about having to pay so much for so long.

  Grow up America, get out of bed.

• [Art]

  For the money that I’ve spent on health insurance these past years I could have built my own damn museum to house all of my damn Steampunk sculptures :)

  • [Art]

    I would call the museum,

    “The Art Donovan (OOOPS! He’s dead now because he cut his finger in his workshop, which became massively infected and he couldn’t afford to go for a Tetanus shot at the ER because he spent all his money building his) Steampunk Museum” .

• [Eric Simonson]

  With that money you could pay my mortgage with insurance and cover the property tax, with $200 a month left over.

• [guyfromsocialistgermany]

  Health is the most important thing in your life and everyone needs a doctor sooner or later. I wouldn’t want to spend this money on anything else.

  • [doingmarxswork]

     It’s nice to have the choice, isn’t it?

• [Mark Lee McDonald]

  Jason Coyne, Jim Cleek, et al – oh come on, it’s a fundamental tenet of capitalism that as volume increases per unit costs decrease. 

• [luckyguy]

  Wow, that’s bad. Just as a reference, health insurance in Switzerland costs around $300/month, and taxes are quite manageable too…

  • [RoofusKit]

    Most Americans will pay even less than that starting in 2014. Many won’t pay more than $932 a year. But most people have no idea that our new law they hate so much does that for them.

• [strugglngwriter]

  And imagine how much this would help those small businesses Republicans pretend to care about. If everyone would be able to use their money on these things instead of health insurance.

• [menand]

  The new healthcare law is almost certainly not going to provide you free healthcare. The supreme court decision upheld the part of the law that REQUIRED you to have health insurance. That doesn’t make it free, it just forces you to buy it (or pay the “tax” if you don’t, I say tax since the decision holds the mandate constitutional only if you think of it as a tax). There are subsidies for some but if you can afford $1300/month now I doubt you will qualify and if you do it won’t be much. 

  • [kcmpls]

     The new health care law also allows you to easily compare prices for health coverage, so it is possible they will be able to find cheaper coverage more easily. It also lowers the costs of everyone’s insurance, by taking uncompensated care out of everyone’s costs, so that should lower premiums. It is likely they will pay less in insurance in a year or two after implementation.

• [samari711]

  “Working as a contract worker, I’m earning a sweet hourly wage, but I’m not getting any of the perks that a full-boat regular salaried employee would earn.”
  Well no shit you’re paying more for health care.  Intel can pay you that sweet hourly wage exactly because they’re not paying for you health insurance.  The fact that we tie health insurance to jobs is a big part of why our health care system is so screwed  up to begin with.

  • [Rob Cockerham]

    The revelation was not that I had to pay more, the revelation was that HP had been paying $1320 per month to keep my family covered with health insurance. That might be “no shit” to you, but it was surprising to me. 

  • [Robert Drop]

    I’d say it’s pretty non-obvious, especially since what your company pays for your health insurance is a lot less than what you end up paying when you’re buying it yourself.

• [novium]

  To the folks having a freakout over HEALTHCARE ISN’T FREE and HEALTH IS IMPORTANT: lighten up, why don’t ya? You’ve never looked at some bill you’ve had to pay month in and month out and kind of sighed to yourself and wondered what it’d be like to have that kind of money to burn?

  I certainly have. Every time I write a check for my student loans, for one. And that’s not because I’m waiting for someone else to pay for my loans (though if anyone is inclined, I’m not going to say no) or because I don’t value my education…it’s just because it’s a huge chunk of my monthly income and it’s nice to have a little fantasy about what I could do with an extra $307 a month. 

  And that’s really the fantasy part, because if healthcare (or my student loans) were magically free, the money wouldn’t probably end up going to trips to Japan or lifetime subscriptions to whatever. In reality, it’d go to getting the car fixed or repairing the roof or paying off more of some other loan or going into the college fund  or paying for groceries during a period of unemployment. Beecause that’s life. But it’s nice to think of other things, you know?

• [BadIdeaSociety]

  I came back to America from Japan after several years in the fall of last year. I opted to get coverage for my wife and I.  The insurance company put a treatment rider on me for my entire right leg because I had a torn meniscus  injury from playing soccer, any illness related to the potential risks of being exposed to radiation (ie: Fukushima), and any injury or illness obtained while engaging in sports (including: weight lifting at a sports club or jogging). My monthly fee: $1027 per month. 

  Thank goodness we got jobs and got subsidized insurance coverage.

  I would be lying if we weren’t thinking about going back to Japan for the rest of our lives for the costs of insurance alone. In spite of the occasional moments of condescending racism, I would be healthier and probably happier. The amount of money I would lose in income I would gain in not paying so much for insurance through my employer.

  • [andygates]

     The exclusions for preexisting conditions and the limits on payout are a spectacular evil — they show that the system is a profit-making business not a healthcare system.  Huge props to these reforms for getting rid of that, because when a wild cancer appears, it doesn’t back down just because there’s no more money.

    • [BadIdeaSociety]

       The thing that really burns me up about the people who are against healthcare reform is the number of people who are so against the idea of being forced to get health insurance. The 10 days after coming back to the states without health insurance were the most worrisome for my life.  The mild headache I got after the flight home had me thinking, “What is this is cancer?  I am screwed.” 

• [lydia daugherty]

  We had been paying just over $1200/month for insurance with my husbands portion covered by his employer.  We have 3 healthy children.  We also had copays and a 3000 deductible and 80/20 coverage.  His company sold themselves to a large business and we now pay 600/month with copays…no deductible (except outside the “inhouse” providers) and it sure makes a difference to have that extra cash in our pocket to pay our mortgage on time and pay our own bills.  

  We’re in a tough ethical time.  We have the ability to fix and take care of people upwards and beyond many millions of dollars, but where do we draw the line?  Is the premature infant born at 24 weeks gestational age any different than the 57 year old man that survives the abdominal aortic aneurysm.  Both stay in an ICU setting for weeks and/or months before they die (or live).  Should we try?  Should we pay the millions?  Is it job security for health care workers, the people who sell the health care machines, the people who draw blood, the people who design the hospital beds, the union organizers for the nurses and housekeeping, the flowershops, the Hallmark card company, baby blanket knitters on etsy, photographers, airlines, food service, etc etc etc?

  I don’t know the answer.  I am thankful my husband has a job that provides benefits.  Mine does not.  We have to do something.

  • [Chesterfield]

    It makes absolutely no sense for health insurance benefits to be provided as an employment benefit. If it did, then your employer would also insure your car and your home.

    I would vote for Obama 10 times in the next if he would promise to ban employers from providing health insurance benefits. 

    • [Antinous / Moderator]

      It makes absolutely no sense for health insurance benefits to be provided as an employment benefit. If it did, then your employer would also insure your car and your home.

      It makes perfect sense because it’s a natural way to spread risk across groups. And some employers do form groups for other types of insurance. I even had group legal insurance for a while.

    • [chgoliz]

      There’s actually a historical reason for it.

      During the war (I believe both WWI and WWII, but more effectively during WWII) the federal government put a wage freeze on.  Larger companies came up with a work-around to entice the smaller pool of able-bodied men who were not in the military to work for them: they started offering non-wage benefits such as health insurance.

      Perks like a company car and even company financing to help you get a home are pretty standard for executives now.  It’s all part of the same situation: make the position you’re hiring for more attractive to the best candidates than some other’s company’s offer.

      So, yeah, the US government is the cause of this imbalance that stacks the deck against smaller companies.  Oh, and American citizens in general.

  • [greenberger]

    There’s not really any tough ethics at play here- it’s about as black-and-white an issue as you can see in this ridiculous world of politics. Before we get to your ethical questions, we can trim out all the fat built into the current system and change it from an exploited, for-profit, overly-abused system to a streamlined logical one with one simple ideal- to provide everyone with healthcare. If we ever got to the point where we actually didn’t have enough resources to cover old people, then we can start debating who gets kicked off the island- but we’re far from that point now. Like other basic infrastructure needs we have (roads, a fire department) health care should be a basic priority of the government. Meanwhile, we need to live healthy lives- which means ignoring all the advertisements for Pizza Hut pizzas, watching a lot less tv and just being conscious about how we live and eat. Change those two things and health are costs will go down dramatically as if it were magic. 

    I am a freelancer who has no health care. I would rather take keep the $1300 evcry month and take my chances, rather than give those bastards a penny. Last year, my wife had a medical emergency and we had to pay like $1600 in expenses for a very simple thing. Ridiculous, but I’d rather pay $1600 every so often than $15,600 every year. We eat well and stay active; that’s basically my “health plan” right now. I do have a daughter and we do pay for her health care because she’s a kid, which isn’t too bad comparatively- but I refuse to play ball by their stupid rules. Yes, if I get cancer or AIDS or something I might be fucked, but I’m fucked anyway if that happens, and they use that fear of the unknown to get you to bend over for a good old-fashioned rape session. No thanks, HMO’s! 

    I am all for a single-payer system, and until that happens I’m taking those 1300 monthly bucks and putting them in the bank. Rob can blow it on video games and pizza if he wants.

    • [Rob Cockerham]

      Don’t forget the tanning.

    • [Al Billings]

       Hope no one needs surgery. Then you found out that $15,600 is way cheaper than $150,000.

      • [greenberger]

        Even using your numbers- let’s say surgery does cost 150k. If I need surgery once in a decade, I’ve still got more money in the bank leftover. Don’t you see? The cost has surpassed whatever fear-factor bullshit they’ve been selling America on for decades. Talk about the house always winning- almost all of us are actually better off saving their money and paying the ridiculous, inflated hospital costs. And if the costs came down to logical levels, forget it- there would be no need for a health care industry whatsoever. The system is so insanely illogical, and that’s why I want no part of it.

        • [Roy Benevidez]

          Do you also own a mansion and a yacht? You sock away over $150,000 per decade?

          http://www.dailymotion.com/video/xc94j_elmer-j-fudd-millionaire_news 

• [jbond]

  Thank goodness its different outside the USA.  #WeLoveTheNHS

• [howaboutthisdangit]

  If everyone were covered by insurance, and more people were getting routine checkups as a result, then a higher percentage of health problems would be treated in a timely manner, rather than being put off until they became acute and required a much more costly visit to the ER, which many uninsured cannot afford and do not pay and therefore pass the costs along to everyone who IS insured.

  It’s not a tax, it’s an investment which will result in savings down the road, as long as profiteers are kept under control.

• [PrettyBoyTim]

  I don’t understand how it can be so expensive. That’s over twice what the average employee pays in income tax in the UK, and yet we get our health care for free.

  • [Thorzdad]

     Your government, as with almost all the other developed nations, set the prices and fees for services, medications, etc. That’s the big difference. There are no cost controls in healthcare in the US.

    • [RoofusKit]

      Correction, there WERE no cost controls in healthcare in the US. Over the next few years they will be rolling out as part of the ACA.

  • [BlackPanda]

     This is one of the few occasions I’m really glad I was born in England. Especially as someone who still has medically-unexplained symptoms after 3 years.

• [Ian Wood]

  I’ve been deeply involved with the medical-industrial complex for the past several years because of my mother’s chronic illness and her frequent hospitalizations.

  The reality is this: when I open a bill with a $14,000 charge on it, within several weeks I will open a notice of payment from Medicare which indicates that they paid, say, $158, and my mother is not liable for the rest. Where did the other $13,842 go? No one seems to know.

  The entire American healthcare edifice, like the financial sector, is built on imaginary numbers. Losses are dispersed and shuffled around, and every entity involved in the shuffling makes a bit of money on the process, or profits somehow. Was the infusion my mother required really worth $14,000? Clearly not, because the entity that charged that amount eventually received a mere fraction of that. But that entity then gets to–for example–declare that $13,842 a loss, or claim it as a credit in some other sector of its business. And on and on it goes.

  But we’ve run out of capital, and we’ve run out of time. This edifice of imaginary numbers is going to collapse. “Obamacare,” so-called, is not going to fix this. The healthcare system is intricately interwoven with the rest of our economic system, a system that includes rampant speculation, massive debt, illusory bubbles in sector after sector, deep-rooted corruption, and outright thievery.

  Our current political class, as a whole, is neither honorable or intelligent enough to solve this problem: it is too complex and too entrenched. So the problem, along with the systems that created and nourished it, is going to resolve itself by imploding.

  If something can’t go on forever, it won’t. That doesn’t mean that I know what’s coming next. All I know is that the demographic bulge is going to be very, very unhappy in its senescence, and the rest of us are going to suffer right along with it.

  • [catgrin]

    Medical pricing is based on more than on thing. The face price you see when you’re billed at an office includes the risk that you won’t pay – even though you’ve signed a contract as a patient that you will (the contract just allows you to be legally pursued for funds). So, if a doctor’s office charges $100 for services, they really don’t expect to get that. That’s the maximum they can charge before penalties and interest to a client who makes collections difficult.  

    Here’s how insurance pricing works: Insurance pricing is pre-established at a percentage discounted rate because the company guarantees payment for all patients who are members of the insurance group. Because a larger company has more people paying their rates, they can more easily guarantee payment to a doctor, and so may get a better rate. For example, that same $100, may only be $50.

    As a patient, if you are uninsured, you can get the best rate by paying at the time of treatment. That’s called “cash patient” and all you’re doing is providing the same guarantee that the insurance company provides. Rates may not be as low as insurance rates, but you’ll at least get a discount.

    If you have insurance, the rate displayed on your bill will first show as the full doctor’s fee, which is then handled by the insurance company at whatever previously agreed rate they pay. You then pay your insurance the rate you’ve previously agreed upon to fulfill your part of the contract (office visits = $10 + deductible). If you only use your insurance once in a year and for something inexpensive, you may find that one visit costing a lot more. That’s because a deductible is typically a few hundred dollars. Insurance companies collect from you three ways:

    Rates (standard fees), Deductibles, Itemized billing

    Altogether they manage to clean up! However….

    If people used their doctors more intelligently, they’d do better with their insurance as well. For example: several less expensive trips to the doctor for preventative care actually come out less expensive if you complete them in one year. You should assume the base cost of your insurance is your yearly fees plus your deductible, and then try to arrange for good, basic care. It will spread costs and keep you healthier.

    • [R_Young]

      I appreciate your understanding and sharing of the system, but doesn’t this point to a huge flaw if we, as fairly educated informational consumers, still have difficulty understanding the consumers?  How much of this country has simply a high-school diploma, or even less?  How can the system be at all functional when it requires a complex understanding of the government/private-insurance pay structures to be able to afford not dying?

• [Roy Benevidez]

  I am surprised that no one has mentioned the already hidden but very real taxable cost in that you, the taxpayers in revolt over this “tax” (penalty), are already subsidizing my health insurance simply due to the fact that I and my employer receive favorable tax benefits for providing and partaking of health insurance.

  • [RoofusKit]

    They’ll all shut up when 2014 hits and all these people realize that not only do they already have insurance, but they will be paying a LOT less for it.

• [eviladrian]

  The smart thing to buy would be shares in insurance companies, those guys make crazy profit!

• [lumpygravy2]

  Too bad Congress people and the Whitehouse get complete Health Care at 0 cost to thier pocket.  What’s good for the goose.

• [binarymutant]

  wish I could afford insurance so that I could not pay it and buy a car

• [pKp]

  Wow.

  Hey guys : in France, you pay around 30% of your wages in life insurance (minimum wage is around 1000€ for a full-time gig, full-time meaning 35 hours/wk (yeah, you read that right)). Your boss kicks in about the same. No job ? Student ? Retired ? The governement floats nearly the wole bill. You can get private insurance if you want, it can be interesting for some stuff (dental, vision, “comfort” treatments), but basically, if not having a procedure means that you’ll die or be severely handicapped, then you can have that procedure basically for free. I’m thinking surgery, chemo, MRI, all the crazy-expensive stuff.

  Of course, times being what they are, that means our hospitals are being gutted – less manpower, less maintenance, less beds, etc. Public hospitals can be a bit dicey, and some procedures are better underwent in private clinics. But for the most part, healthcare is free or cheap.

  I will do my damnedest NEVER to move to a country that doesn’t have such a system.

• [PJG]

  I’m a freelancer living in BC, my Medical Services Plan premiums are $68 a month, same goes for my husband. No copay at the ER or doctor’s check ups (or limits to the amount of visits, though if your doctor notices you at his door every other week, he’ll probably give you a stern finger wag). We pay extra for dental, prescriptions and eye care but since I only change my glasses out every other year or so, the two hundred bucks for glasses and $80 for an eye exam isn’t a huge deal. My husband has a little over a hundred a month he pays for meds related to high blood pressure, and recently I had a wisdom tooth pulled which came to around $500.  With things as tight as they are sometimes, I can’t imagine paying more than we do in RENT for insurance.  I mean, that’s fucking barbaric.

• [anharmyenone]

  Instead of buying insurance, you could invest that $1,320.87 a month in a diversified portfolio. When bills arrive, pay them out of the investment. It’s what insurance companies do on your behalf–you’d just be cutting out the middlemen and the administrative overhead. Seek out doctors and hospitals that give a discount for paying cash (you’re saving them money by them not having to deal with insurance paperwork and many insurance companies have already negotiated their own discounts so “full price” is really a fake price for medical services). There is some risk to this approach, of course, so it’s not for the risk-averse.

  • [Antinous / Moderator]

    Instead of buying insurance, you could invest that $1,320.87 a month in a diversified portfolio. When bills arrive, pay them out of the investment.

    Congratulations on your successful travel a decade into the future. You might want to check out the current global financial situation before making any major fiscal decisions.

  • [Jonathan Badger]

    I’m sure insurance companies may do a bit of investment on the side (maybe some of them go to Vegas or bet on horses — same thing, really, as investment is just genteel gambling), but their business model doesn’t need that — it just requires that more people pay in more than then they need because of great health then those who do the opposite. But if you are one of those who come up with cancer at an early age…

    • [chgoliz]

      Actually, their business model does require investing.  They have to hedge against large payouts happening in a short time frame due to catastrophic events, for example.  There’s a lot of money management involved.

      /professional hat removed

• [Scott R]

  And the cost of an sudden, serious illness without insurance: priceless.

• [Palomino]

  Order pay-per-view one after the other, you should hit your target before the end of the month. 

• [Sheryl]

  He pays in insurance roughly what I make in a month. Is there any wonder people like me don’t have insurance? The provisions in the ACA can’t kick in soon enough as far as I’m concerned.