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Health Insurance for the Self-Employed?
SharkJumper writes "Looks like this question has been asked before, but might be due for an update. I'm a self-employed programmer who is about to become a father. Previously, my family's insurance has come through my wife's employer, but she is eagerly looking forward to being a stay-at-home mom. We must look for that elusive low-cost insurance in order to enable her to do this. Losing her insurance is not a huge loss as, due to failed negotiations, the hospital in our city (3rd largest city in the state), along with most of the doctors that refer to it, is dumping the network (largest in the state) that our insurance uses. On the individual coverage plan front, my research shows story after story of deception, fraud, and general run-around or obfuscation by most of the major players and nearly all the minors. With all of the bad experiences out there, I've yet to see a good review of an insurance company. What does the Slashdot crowd use and recommend? Company and plan-type? PPO? HMO? HDHP + HSA (High Deductible Health Plan + Health Savings Account)?"
But you'll need a plan that has a low co-pay for doctor visits since you will take your kid just about all the time for everything from his/her first sniffles (OMIGOD TB!) to fevers (OMIGOD FLU!) to standard vaccinations (OMIGOD YOU'RE GOING TO STICK HIM WITH A NEEDLE!). The cumulative costs of a high co-pay is going to eclipse the savings you'd see with that sort of plan. The higher-cost low co-pay plan pays off in the long run with kids.
For yourself you probably can get by with catastrophic coverage unless there's an existing medical condition that you haven't mentioned. And if there is, you're just about out of luck anyway since many carriers won't cover existing conditions. So unless you go to the doctor for anything except the most serious ailments, stick with catastrophic.
Instead of great health coverage for you, get LIFE INSURANCE. You can probably get some cheap 30-year term insurance which will cover your family in case something happens to you. You may want to cover your wife as well in case something happens to her and you need to hire extra help to take care of your kids. This is less common, but no less a concern.
Health insurance for your wife should probably be kept at the same level it is now, if possible. She will need extra care immediately after the birth, but once the first year rolls on she'll get into the swing of things and probably not need any special coverage. I'd argue against catastrophic-only coverage for her since if she gets sick the whole household suffers, so having the ability to go to the doctor for anything questionable will be a good investment, if only for the peace of mind of having that security.
I wonder if there isn't a self-employed plan that covers people just like you already offerred by your local carriers. I'd be surprised if there weren't. But don't kid yourself. It's expensive. You want to go with a carrier who isn't going to drop you the first time you make a claim. That's a local issue that would be well served by some research (like, I suppose, asking us idiots).
Good luck.
A while back, on the radio (WTOP in the Washington, DC area), they played an advertisement for a small business association, or something like that. One of the benefits of joining was that they had offered a group health plan to the member companies.
... that might've been what I remember. As does NFIB ... just type 'small business association' into your favorite search engine.
I don't know for sure if it was specifically a small business association, or that's what I just remember it as, or if it was a local or national thing, but you can try asking around. (or someone else might be able to follow up with some knowledge of these sorts of groups)
A quick look online suggests that the ASBA has some sort of discount on health insurance
Build it, and they will come^Hplain.
It's not such a wonderful plan if the insurance company tries to weasel out of paying valid claims. Some companies will tell you to fuck off, and if you don't like it, file a lawsuit.
Mea navis aericumbens anguillis abundat
Congratulations on becoming a father !
Seriously, how dare you call yourself the "best country in the world" if you don't even have nationally implemented healthcare?
Europe, glorious old lady that she is has long ago implemented the National healthcare to make sure that
A; Everyone has access to proper healthcare.
B; Everyone automatically pays into the healthcare fund so it can be maintained
C; Good quality in healthcare is guaranteed by state checkups.
In those days there were no "private" health insurance companies, but look what trusting in those has brought you? Deception, Fraud, and general run-around or obfuscation from most if not all of the private insurance companies.
IMHO, healthcare is not, and has never been something companies should be in charge of. A companies purpose is to make money. The state however, if it's run by others then the idiots running the American state, should be more interested in keeping it's taxpayers ALIVE and healthy so they can work and pay taxes next year.
First, you are about to find out just incredibly broken our health care system is. I doubt if you will get private insurance, as they are denying older applicants out of hand, and if you have ANY problem forget about it.
Many states have an expensive health insurance pool that has high deductible insurance that will only take care of you in catastrophic conditions. If you go for the low deductible, expect to find very high premiums and equally high copays.
With the high deductible plan you can start a health savings account (who has money to save these days?), but that may be your best option.
Most important, keep your coverage with your wife current as long as you can as you may get your prexisting conditions covered without a waiting period.
In my circumstance at least, I have found that health insurance companies have no reason to want to insure anyone that may be a liability down the road. I do not see a political solution to this, as congress is corrupt. The best they could do was pass a bill that made it hard for sick people who got burried by medical bills more difficult to declare bankruptcy. And another program that was essentially a handout to drug companies that foisted a compkicated hard to use drug plan onto seniors. That's all they have done. This last congress was the most do-nothing congress ever. It seems the only thing they had time for was to take bribes from abramoff and hit up underage pages for sex and try to cover up the trail later. The health care industry is not much better with their costs outpacing inflation 3 to 1 at least.
I know neocons are not going to like what I'm about to say, and how important that it is fighting alquaida over in Iraq blah blah blah, but the fact is with what we have spent on this war to knock over a tin horn dictator I bet we could have paid for everybody's current medical expenses in the US, let alone making it affordable.
If you're healthy and have job, you probably will not won't give what I have to say a second thought. But if your sick as I am and can't find coverage or a doctor, you know how bad it is. If your self employed doubly so. Even if you do have coverage, you have got to be noticing how your insurance premiums are getting more expensive and its covering less, your deductible is more, and prescriptions are through the roof.
But the greatest crime of the Iraq war is that it has taken attention completely away from the health care crisis. I have talked to my politicians to no avail. Gratefully though, a challenger for state office DID talk about it and it got him elected.
We had no business screwing around in Iraq (esp. with the WMD big lie) without taking care of our own at home first. It's that simple. If things aren't working for you, it's important to let your politicians and everyone around you know how you feel. Only this way will there be hope for change.
BTW, make sure that the high deductible health savings account pays for 100% above a certain point. 80%, and you still could (likely)lose your shirt if you get sick.
I use an HMO program offered by my state's BlueCross BlueShield company. It's the same plan they sell to employers, but with me paying the full premium. It's not cheap (and for someone with a family it'd be even less so), but it's... affordable, and in the few years I've been using it, it's been a lot easier to budget the monthly premiums than it would have been to pay the medical bills I've had, and definitely made my recent visit to the ER less stressful, knowing I wouldn't have to pay for it.
http://alternatives.rzero.com/
Here's a good reason why you can't:
The insurance companies negotiate with all of your providers, including some you're not even aware exist, for lower rates. And while you can do some negotiation yourself, that is a very difficult thing if you're lying on a stretcher unconcious.
At my most recent physical, the lab billed $900 for all of the tests. The insurance company paid $300 and the rest was the "negotiated discount".
The medical system in the US is fundamentally flawed, and facing it WITHOUT insurance could easily bancrupt you.
While a humorous comment, it highlights what makes the American health care system so unique. We are so fiercely independent, that a good majority of Americans don't like having the government telling us what to do, and this includes how we take care of our body and our health. This system allows for many benefits as well as problems. The most visible problem is the ever-increasing cost of health care, and the number of people like yourselves who are falling through the cracks because good health insurance is only available through employers who can command group rates. On the flip side, because the state is not dictating how health care is conducting itself, American health care is a hot-bed of new procedures and techniques that push the limits of health care because people are willing to pay for an unproven technique even if it has even a small chance of success if the alternative is not acceptable. For example, the second son of a friend of mine was diagnose with Spina Bifida and instead of accepting that his child would be born paralyzed, was able to find a surgeon who was willing to perform surgery on the child while he was still in the womb! (notice that of the four hospitals in the world that perform this unique and complicated surgery, all of them are located in the United States)
As a graduate student, I am faced with paying for a cut-rate, we-don't-pay-for-anything-unless-you-get-hit-by-a- bus student plan, or a much more expensive individual plan. There are very few national health care providers, and you would be well suited to search for and find a regional health insurance company. In the mid-west, I have been leaning towards Anthem as my insurance provider, and hope to have a plan from them to help me start off the new year.
I haven't lost my mind!
It is backed up on disk...somewhere...
Actually, the nasty thing is that it can also bankrupt you WITH insurance. At a certain point, even 20% of the medical bill will be too much. Especially considering that you're not likely to start working immediately after a procedure that expensive.
Oh, and the reason it "has to be so difficult" is because the companies purposely make it difficult. Their beancounters figured out long ago that the harder they make it to decipher the plans, the fewer claims they get because their customers can't figure out if they're covered or not, or how to file claims, or whether they can appeal denials of coverage. It's a serious racket. So let's not act like this is child's play.
"We can categorically state we have not released man-eating badgers into the area." - UK military spokesman, July 2007
Buying insurance just on your own is expensive. There are various parameters you can fiddle to help (e.g. register kid and parents separately, though this means you don't share a deductible; set your deductible as high as possible -- here the highest I could get was $5000/yr, which really ends up being more like $10K), but it's really expensive -- we were paying about $300 a month and were in perfect health -- that was almost 4K + deductible per annum.
(it's even worse for a small company under 25 employees!)
If you're a member of the IEEE or any other "entrepreur" association you qualify for a group policy via them. That's usually a good deal. For example a quick search of "self-employed association" just showed as its first hit an association that offers health insurance. I have no connection and won't shill for them by including the URL.
If you live in CA I hear Kaiser is quite good though I've never used 'em myself.
Good luck. You'll find a lot of "well baby" visits will be needed in the first year or so. Well, at more than you need as an adult anyway. The insurance companies usually subsidise them because it's cheaper to catch something in the bud.
And finally, in all seriousness, consider moving to my home country, Australia. There's a preference for computer programmers under 40, and it's a great place to be or raise a kid. (though I live in California right now myself...)
Oh and have fun. One thing to be careful of / manage: I basically didn't work for the first couple of years after my kid was born and again when he was perhaps 4-6. That was really great. Try to find a way to balance the time with the family with making sure there's some regular income!
The government loves telling us what to do and as long as most voters don't disagree vehemently, they will.
On topic, I run my own business, a two-member LLC (my wife and me) doing consulting (mostly Linux stuff) and we are screwed royally as far as insurance goes. We have a child with a disability so: (a) being w/o insurance is not an option, and (b) we get the highest rate they can legally charge us: over $1,000/month. (imagine goatse man here, that's how disgusting it is)
Oh, and good luck with Anthem. They're great! (That's sarcasm...two guesses who my insurance provider is...and the first one doesn't count.)
Here's a tip. Save.
I hope you have a lot of money saved up. Heart attack: over $10k including drugs, a few days in ICU or the coronary care unit, and an angiography. Oh, and if you need bypass surgery, the going rate was around $35k last time I checked. So we're up to about $45k. We're still not talking about the $200 in medication you'll be spending every month, plus the semi annual visits to your cardiologist at around $300 each, and the yearly stress test, etc.
How much did you say you have saved up? Make sure you don't have a heart attack at 40 years old or you are screwed.
Seven puppies were harmed during the making of this post.
Before you drop your wife's insurance let me tell you what I am currently finding out the hard way. You will be hard pressed to find an insurance policy on a pregnant woman. Group policies can be more forgiving, but so far everyone I've talked to says it is a 'pre-existing condition' and they won't cover my 7-weeks pregnant wife. If you are going to get a policy, your wife can't deliver for 11 months from the date the policy becomes effective or it's not covered.
I just got out of the Air Force and am now working as an independent contractor. Tricare does have a COBRA-type polkicy I can get but it's very expensive. I can't just get the coverage for my wife, I have to be on the policy, so I'm having to pay about $2200/3 months for it. At least it comes in 3 month chunks, so I won't have to carry it longer than I need it.
If there weren't that program available to me, I don't know what I'd do. In Georgia where I live there is a Medicade program for pregnant women, but I make too much money to qualify for that. If you make more than $1600/week with a family of 4 (they count the unborn) you make too much. My wife had to have a c-section last time and I saw the bill Tricare got. For everything throughout the pregnancy they paid out over $60k.
I have heard that if you can't get coverage and you talk to OB docs, they can usually work with you and sometimes you can end up paying less than if you had insurance. I have not looked in to that yet. Good luck!
Yeah, for one thing, you need to have commited a crime.
I'd recommend a high deductible plan if you're self employed. You should already have money saved up to weather the rough times, so just add some more to cover the deductible. The amount you save is significant. The baby will most certainly have you going to the doctor a lot. I've used eHealthInsurance myself, and my only complaint is that the fine print is hard to find or not available until after you purchase a policy. But the policies they offer are from the major carriers.
For the record, the place I got in trouble was picking the cheaper plan and then getting a physical. Burried back in the fine print was a clause that they don't cover anything preventative, but that wasn't obvious when I was ordering the plan or looking through the main section of the booklet. Had I clicked a link to the provider's comparison of all their plans, it would have jumped out like a sore thumb. Personally I think it borders on criminal when a company doesn't make it obvious where you risk owing a lot of money and what coverage is missing that many others would frequently include.
And a final note, always get the price an uninsured person will be responsible for up front for everything! This is what you'll be stuck paying when the insurance company says they aren't responsible, and you should be able to afford it. My family's neighbor (a doctor), myself, and many others agree, the medical system in the US is broken. Insurance is complicated, costs are going up, and lawsuits are giving insane sums of money for just about anything. My biggest peeve is that you aren't told how much you owe until a month after the procedure is done. Admittedly this is a service and things may fluctuate when you find a problem, but every doctor uses charge codes and their office knows their fee for that code, and the insurance companies know what they have agreed for those codes. But no one will tell you those numbers until after you've had the service. Congress would do a lot for people by requiring every insurance provider to publish how much they cover and what the patent is responsible for on a standard list of charge codes, and make it available before signing up for that coverage.
It's true for the spina bifida surgery (I was tempted to disagree, but I re-checked).
However, this is because the operation is still in a trial phase. It still has to be proven that the intrauterine operation gives a better outcome than a postnatal operation. I guess that all other hospitals around the world are waiting for the outcome - they don't want to be the ones to have performed complex and risky procedures that later turned out to be no better (or worse) than the conventional, tested approach.
Join the IEEE.
:).
They have some good group deals for insurance setup just for cases like yours. They also have group life and a few other things that might be of interest.
Oh, and its a good organization to boot
One should not theorize before one has data. -Sherlock Holmes-
You know, one of those where it's recognized that decent healthcare for everyone is a good thing.
It's quite silly, the way you do it in USA. It prevents people from acting rationally, to the detriment of all. (it's the same in *parts* of Europe, you guys aren't alone about it.)
For example, a friend of mine (living in the USA) is currently at home (watching his baby) while the mother works. He works a little evenings and earns a little extra for the family, but little enough that he was still health-insured trough his wife.
Then he got offered a larger position. He had to turn it down. It'd have put him above the limit where he'd need his own health-insurance, so in the end he'd have ended up working *more* and getting *less*, which is nonsense.
Everyone is a loser in this scenario:
Stupid. Very stupid.
It should pay to work. Putting someone in a situation where they get *less* for working *more* just serves as an insurance that these people won't, infact, work more.
There's similar mechanisms in welfare-programs too, where you earn $100 more and get $150 less from welfare. The effects are similar. (it'd have been different if you'd earned $100 more and as a consequence gotten $50 less from welfare, that'd have been fine)
Agreed. I have worked in health insurance for 4 years, and I've posted on other threads that I am now a major 'consumer' of health care.
A couple things to consider. - Shop for insurance looking for these items: Are my favorite doctors in net? Pharmacy? Are my drugs covered, must I buy a generic? Is Chiropractic covered? Mental Health?
- 'In Network' is golden. if you prefer to leave the network, you will pay that doctor's standard rate, often even after your 'Out of Network Max' has been exceeded, because Insurance company's set a 'Usual and Customary' (U&C) value for every procedure, and only pay that amount... MDs, since they are discounting services paid for by insurance companies, up their normal rates to cover the difference (if 20% are paying cash, and 80% are paying via insurance 80% of the 'real costs, the 20% are paying for their costs plus paying for the discount given to the 'network' patient)
- If you are young, healthy, good cash flow (real paying jobs) and have good investing habits... do a High deductible PLUS an HSA... and be disciplined to invest the difference in premiums between the low deductible/HMO and the HDHP in the HSA. Your HSA becomes both your rainy day health fund, but if you maintain good health, eventually it kicks into a retirement fund vehicle.
- Look for these perks
-- 100% coverage on annual exams
-- 100% coverage on immunizations for children
-- Nurse Line (avoid unnecessary trips to the doctor)
-- A good web site, that allows you to track your claim history, medical record, has a real procedure cost estimator and a good network physician lookup
Finally,
- Insurance buys you 'insurability', ie, your current insurance must provide you a certificate of coverage which is the chit that gets you into most group plans even if you have a chronic condition. So being continuously insured when you are diagnosed usually gaurantees you if you ever want to switch plans that you can get insurance (albeit maybe at a higher rate, but at that point coverage is important, not price).
Also known as "employer of record" - they exist for independents who need "big corp" sorts of benefits like access to health insurance. Here is one that I haved used in the past - MyBizOffice. Despite the stupid, formerly-trendy name, they are one of the largest out there and do a pretty good job of things.
When information is power, privacy is freedom.
You're still missing the point.
Insurance companies, in advance, negotiate discounts.
The comparable action for an individual (which is of course impractical) is to negotiate, in advance, discounts, while not in critical condition.
So if you were to go without insurance, then you would instead be calling all these hospital to arrange advance discounts -- not in critical condition.
There's a reason why that wouldn't work -- it's impractical and hospitals couldn't justify the expense of negotiations for just one person. The reason it wouldn't work has NOTHING to do with difficulties in negotiating while in critical condition.
The reason I belabor this point is because on another health insurance thread, a moron kept switching between talking about paying the hospital, and talking about shopping for insurance, when you'd be in critical condition in one but not the other, which made it impossible to rationally discuss the issue with him. So, I have to be careful that people don't continue that error.
Apology to Ubuntu forum.
Not to be a completely insensitive asshole, but who exactly do you expect to pay for you child's care? I'm not opposed to government(and therefore taxpayer) provided, baseline health care services(which would hopefully cover most of your needs), but you used the 'insurance' word, and large, probable expenses cost a lot to insure, because the insurance amounts to prepayment of the expenses.
I realize that you would get better rates if you were hidden in a large employee pool, which is why I like the idea of socialistic baseline care(the US is filthy rich, we can afford it), it makes the cost sharing pool as large as possible.
Nerd rage is the funniest rage.
Even if your wife leaves her job, she (and the family, if you have a family policy) can stay on her former employer's health insurance for 18 months under COBRA. But they can charge you the actual cost of the policy plus two percent. (Meaning if she currently plays 80% of the cost of the policy through deductions and the company pays the other 20% percent, after you go on COBRA you'll pay the 80% + 20% + up to 2%. The HR department of her company can tell you the COBRA rates.)
After the 18 months of COBRA runs out, the insurance company is required to offer you a non-group policy that is not medically underwritten. I think they usually call this a HIPAA policy. This will probably be more expensive than the policy you get through COBRA, but you can't be denied for pre-existing conditions.
It's been a while since I've read the DOL publication on COBRA, so follow the link above to verify that none of the details have changed.
HDHP + HSA is the way to go if you are at all heathy and fiscally prudent. Low deductible insurance is a money loser. With a low deductible, you are all but guaranteed to pay more in premiums each year than you would by saving the money and paying from savings. The tax-deferred/tax-free nature of the HSA makes this even more true.
Also, the HSA regs give you tax advantaged savings based on the money you put into the HSA (not the money you take out of it). Check with your accountant, but I believe that nothing in the IRS regs says you must pay for all healthcare expenses with HSA money. Yes, you can't use HSA money for anything but healthcare (unless you are over 65 or disabled), but that doesn't imply that you can't use non-HSA money for healthcare costs. An HSA is a great way to build more tax-deferred savings if you've hit the limits on other tax-deferred savings programs.
Two wrongs don't make a right, but three lefts do.
A while back the WSJ published an article on where US health care costs go. Around a third of the costs went to two places - lawyers and terminal care. Medical procedures don't always have a happy ending. All too often - when they don't have a good outcome, Americans tend to sue. The last stages of life in America are very expensive. Most Americans die in a hospital attached to tubes and instruments. And this doesn't count costs like defensive medicine (too many tests to avoid potential litigation). So more use of hospice services and real tort reform would go a long way to lowering costs of health care. Of course this would negatively impact profits at commercial hospitals and income of trial lawyers. Don't expect action from either political party any time soon.
[Insert pithy quote here]
Unfortunately, I have way too much experience with health insurance, so here's my suggestions.
1. Extend your wife's plan with COBRA even after she quits at least until your baby is born. Do this, even if that means traveling further because your closest hospital is no longer in network. My first child required an emergency C-section and a few days in the neonatal ICU. He was almost 11 pounds at birth and there was no way he was coming out through the in door, so to speak. The bill was pretty amazing, but I didn't have to pay much out-of-pocket. So, if there are additional expenses related to your child's birth, at least you won't be completely screwed. On a side note, my son ended up with cerebral palsy, possibly due to decisions made by our doctor and his team. Learn up front about what can go wrong, and don't assume the experts are paying close attention to your wife/child.
2. Never go without health insurance and life insurance. I was 33 years old and my wife was pregnant with our third child when I found out I had testicular cancer. I caught it before the cancer had spread, but I still required one minor and one major operation, all kinds of diagnostics, and years of follow-up. My bills, way back in 1994, were well over $100K. My insurance at the time covered almost all expenses. Because I had life insurance, I had one less thing to worry about. Without life insurance, I probably would have died simply from stress.
3. If you have pre-existing conditions, you really need some type of group plan. Individual insurance plans are out of the question if you have any kind of serious pre-existing condition (cerebral palsy, testicular cancer, etc.). I know, because I tried this route. I pay around $10K per year for medical/dental at my current company. I thought that was a ripoff until I tried to get insurance on my own. Your only reasonable way to get health insurance is to be in some kind of group plan where your risks can be spread across a large pool of individuals. Even then you may have problems if you have any coverage gaps or you aren't going into a large enough group plan. If you have no pre-existing conditions and are healthy, the medical savings plan along with a high deductable plan is a cost-effective approach.
4. Without health insurance, you pay much higher rates for the same procedures/care. I recently had a 4-day stay in the hospital (as a result of the cancer surgery 10 years earlier). The unadjusted bill was 3 times the amount of the adjusted bill. Without insurance, you get the unadjusted bill and no expert on your side to help negotiate the bill down.
Hopefully your luck will be better than mine when it comes to health. However, I can say that insurance has saved me from financial ruin on more than one occasion. More important, insurance allowed me to make career and life decisions (like having more than one child) that I may not have made if I was paying out the ass for the rest of my life due to one bad medical experience.
I wish I had an answer for our country's current medical insurance problem. I don't think a government-based single-provider solution is best, but I think government may need to help fund large group plans that are affordable for the tens of millions of americans that want insurance but can't afford it. The uninsured are driving up costs for the rest of us by waiting too long to get care, and then entering the system directly through hospital emergency rooms. I'm encouraged by the pay-as-you-go clinics that are popping up at Wal-Marts and elsewhere for non-emergency care. It costs a lot less to pay $25 at a clinic to have your kid checked out than to wait until your kid is seriously ill and then take him/her to the emergency room.
Best of luck with your new family.
I know it's not all black and white but there is, as always, a middle ground here.
In Finland for example, there is the normal European Union type of healthcare sate, but you also have private doctors, dentists, etc... I know from one of my Ex girlfriends father, that when he needed an immediate hearth surgery, it was arranged that very same day, by the public healthcare channels. They juggle the times to try and give those who need it most service first if there are waiting lists.
When you are in a hurry and need something done now,something not very important for your life, then you go to the private healthcare. That costs you more of course, but you get service pronto.
Otherwise it's mostly better to go through the public healthcare, because pretty much all of it it reimbursed by the state.
It might be a bit harder to get a job due to the "extra" taxation from the American point of view, and yes the extra health security and money from the state for those unemployed are things that make some into mooches. But on the other side, with the EU style of government, Everyone gets superior education, great healthcare, a guaranteed minimum income to survive on and free extra education if want it while you're looking for a job.
That in my book at least outshines anything the USA has to offer. Canada on the other hand, I would actually consider moving there instead of dismissing it out of hand like the USA. No insult meant, but I find living in the USA something I hope I never have to put up with. IMO I think the place would drive me nuts wondering where the hell these supposed "freedoms" are. The USA that the family Bush is trying to create seems like NAZI wonderland to me, that I hope I never have to experience firsthand.
I am a surgeon, and it sickens me what the HMOs often do to patients. They send patients to me, and then won't even let me take an X-Ray. So then they have to take a prescription, go to their gate keeper MD, fight that paperwork, get the X-Ray at another location, and then bring it back to me. Worse is if they deny it, then I have to fight it out with some high school graduate, reading a script, as to why this person needs an MRI.
Now it's 2-3 weeks later. Often the X-Rays are lousy, not the right ones, etc. If they have a broken bone it means that I'll have to re-break it to set it straight. If they have a tumor, then that's just another 3 weeks that it has a chance to metastasize.
If an HMO patient has a broken bone, then I have to use heavy plaster casts, instead of light fiberglass, because what the insurance pays me means I'll actually lose money on the fiberglass cast.
HMO's are O.K. if you don't get sick - do yourself a favor and get a PPO.
..........FULL STOP.
Frankly, I'm lucky I could even get insurance. The government, through threat of force, has to make insurance companies cover us. Because the CEO and BoD for Anthem, et. al., look at (as you said) "large, probable expenses" and essentially say, "we choose not to insure your son, let him die, it's not our problem" except the laws of the land say, "no, that won't do" and require coverage...but only if you know the hoops you have to jump through to get accepted. Forgive me for seeing that as dispicable.
Do I trust the government to run socialized health care? NO. They screw up most things they put their grubby paws into. Frankly, I don't know WHAT the solution is. Thank God I'm not in charge because I'd probably royally screw it up for the entire nation.
I agree. The health care system is totally broken. My family is blacklisted from buying insurance privately. Both my parents had cancer, and so had their parents. No one in my immediate family can purchase health care , as no company will accept the risk. The only way any of us have any health insurance is through employers, as no employees can be denied under a company plan.
/you/ can not get it. Your employer can get it for you, but you can't. I hate insurance companies. (I used to work in a large insurance company, and have had great coverage -- and have also not been able to get coverage.) Many people in the USA trash the idea of a state health care system, but they have not had the displeasure of not being /able /to be insured.
When my father was laid off...no insurance for anyone but my sister, who could purchase it from school. I broke my shoulder, and I am still paying for it (I was at a retail job, no health care plan offered, now I am salaried again and have health care through my employer). Thank goodness he found a job (a menial one at that) and was at the company long enough to get on their plan before my mom was found to have cancer, otherwise that would have broken our family. There would be no way we could have footed that bill.
So, in my experience, if you have a history of needing health care --
|plastic....or gasoline?|
Actually I don't listen to talk radio, mostly because radio talk show hosts are there to entertain you and they do so by espousing their view on different subjects, without regard to the facts. In academia, what we learn is based on studies and fact, and exploration of ideas and questions about what we observe. While we may have opinions about why things are as they are, those opinions may drive us to study why we think what we think, and explore other options in coming up with a reasonable conclusion.
There are many factors that are contributing to the increasing cost of health care in the United States, however medicare and medicaid are not reasons why Joe Citizen is paying more for health insurance. As those are government programs, the taxpayer is paying for any fraud. If you are talking about Medicare Part D, and the federal government not being able to directly negotiate drug prices, of course they don't negotiate drug prices, that is the job of the health insurance companies who operate under the Part D rules, they directly negotiate with the drug companies so that they can offer a drug plan that is less expensive than the other Part D plans, so they can attract the seniors, disabled and the poor to their plan! The more they attract, the more clout they have, and the lower the price they can get from the drug companies. Medicare is only reimbursing the health insurance companies depending on how many people have signed up for their plan. For every person they have signed up for their plan, they get a set amount of money from the government. No more or no less than any other health insurance company.
Part D is a good plan that utilizes the skill-set of an established industry, and doesn't mandate government control over the pharmaceutical industry. As a result, government spending for this program has been much less than originally estimated. Because of Part D more senior citizens, disabled, and poor are able to receive prescription drugs for chronic problems. Also, Part D has been able to actually lower the cost of health care for this particular group of people (compare Part D plans to other prescription drug plans).
If we had a coherent national health system, costs would be much more reasonable.Depends on what you mean by a coherent national health system. Hilary Clinton proposed a coherent national health system in the early '90s but there was too much resistance to the idea. If you mean a nationalized system like Canada or the United Kingdom, the lower cost comes at a loss of growth in development of new procedures and techniques. Consider my earlier example, where if my friend had been in a country with a nationalized health care system, his son would have been born paralyzed, and the government would have had to pay for his care for his entire lifetime. Without investment in new techniques and procedures, he would not have had the opportunity to walk or care for himself. Surely a smaller investment up front is better than a lifetime of costs? However, developing those techniques and procedures can be very expensive, and it is very hard to justify those expenses in a nationalized health care system when the primary focus is on keeping costs low, and utilizing proven techniques and procedures rather than experimental ones.
While every business is in business to make money, most would take the 2% over cost that medicare and medicaid grant over the alternative; patients without the means to pay for their own health care who default on payments, or declare bankruptcy. There are a lot more stakeholders involved in the United States health care than just insurance and pharmaceutical companies.
I haven't lost my mind!
It is backed up on disk...somewhere...
My rather extreme example of this negotiated discount:
I have BCBS of NC. My daughter was born 6 weeks early, and in the NICU for 5 weeks 2 days ("apnea of prematurity" meant she had to stay monitored). The hospital bill (not counting the neonatologists) was $58000. They wrote off $52000, BCBS paid their 90% at $5.mumblek, and I paid $662.
So BCBS can get all that care (1/4 of a nurse, 24 hours a day, 37 days), for $6k. I would have had to pay $58k had I not had insurance (=years-to-a-lifetime of bankruptcy). The socialist in me is disgusted that it's that much more expensive to be poor. The poor person in me is glad that I didn't have to pay $6k for my 10%, though.
Many European health care systems, like France's, have nothing to do with the government telling anyone what to do. Actually, the government has hardly any leverage to tell patients and doctors what to do, much less than i.e. HMOs have. What they have in Europe is a single, mandatory insurance system. It is like all the employers being mandated to provide "benefits" consisting in subscribing to a regulated not-for-profit insurance organization. Self-employed people also have to subscribe. The benefits is massive risk dilution, non-discrimination of higher risk people, huge leverage in negociating with providers like big pharmas, implicit financial backing by the state (low financial risk premiums). Regulations do try to keep costs in check (preventing fraud, inefficient drugs and treatments, etc), but mostly it targets societal concerns, such as making the cost structure of the insurance family friendly, maintaining benefits to the unemployed, etc. Until very recently in France you didn't have to declare a primary care physician for ex, you could go see anyone you wanted, or several of them if you fancied so. There is only a very small penalty if you still do that now, or if you go see a specialist without a referral.
One of the big ones is that a very small number of people spend an ASSANINELY LARGE AMOUNT of money. Some people are on drugs that cost $400,000/year.
As long as we are unwilling to say "You know what, it's too expensive to keep you alive", a lot of people are going to die because they can't afford to subsidize the healthcare costs of the extremely sick and therefore can't get even basic healthcare.
We need insurance plans that cap maximum expense - so you can sign up for death if you catch something that's going to cost 3 million to fix so you can survive the far more likely chance you get a disease/injury that costs $40,000 without going bankrupt.
paintball
Canada is no panacea either. Here is how Canada works. For the most part things that are common get covered, myself I pay about $100 a month for insurance to the state (provincial level), $50 for my group plan from my employer (a similar non-group plan would cost $300 for my family). My health insurance would be more to the state but because my wife is stay at home we put the kids under her free plan from the state. (For some reason there is no law requiring a family claim together). I think it would be around $200 a month if we claimed together and her and the kids would pay a whole bunch of user fees and lose a bunch of benefits. That is the funny thing, I pay more and am covered for less. Anyway, so how it works is anything that is expensive doesn't get covered, or they don't have enough machines so you merely die on a waiting list rather than getting denied coverage. In anything cutting edge we are far behind the latest technology so that it doesn't cost so much. Basically, health care in Canada is cheap because we ride on the coattails of the expensive US system that develops the technology. And the system weasels its way out of anything expensive that isn't common. Get Cancer in Canada and you will spend $3000 a month buying drugs. The funny thing is its also ripe with corruption and misallocation of resources.
I'm in the same boat. Been there for years, and it's frustrating.
/month. This will save you about $300 per month which you can use for medical expenses when you need it. If your family is reasonably healthy, you shouldn't have $300 /mo that often (but it will happen sometimes - so be prepared). In the end you come out better because you get to pocket the money you budget for medical expenses if you don't use it.
Ideal: put $10,000 - $15,000 in the bank for emergency use and go with a super-high deductible ppo. Your rates will be low, maybe about $150
Next best thing: I went with Farm Bureau (www.fb.com) - I'm not a farmer, but they help self-employed people get insurance. The rates were the most reasonable I could find, and there was a person I could go talk to. They also do retirement planning and other types of insurance - most importantly, they have good rates on long-term-disability, which you should definitely have if you're self employed and you care about the long-term needs of your family. They also have life insurance at fair rates, but I got a better rate through my home/car insurance company (allstate).
Lots of good comments and suggestions. I notice costs vary widely around the country. Just to aid comparison.
1. I pay $135 month for $5K deductible at age 57. Every five year increment goes up a few bucks. Every year the whole grid goes up a few bucks. "Full" insurance with a small deductible and small co-pays would be about $550/month. Rationale: At $550/month that's, umm $6600/year. $135 is $1620. If I get 'really' sick, I break even. In any case it would appear this is a lot less expensive than some of you are paying for a similar $5K deductible.
2. Several people seem to think voting Democratic or moving to Canada/Britain/etc. will solve the problem. Does anyone really think nationalized health care will give us a BETTER system? Do you REALLY want Hiliary calling the shots here? Just look at our military or the VA system. The VA, if you can get on it, is totally free. I won't say it's a bad system, but let me say this. My father was on it. I thought it was a good deal at the time. But had he been on medicare plus a supplemental he could have used local doctors instead of the long ride to a VA facility--and he just might still be alive today. I dunno, it's hard to figure it out in hindsight, but I wish we had the option of doing his health care over again the other way. He DID get a free slot in the wall at the Veteran's Cemetery, though.
3. The worst problem, imho, is that we've messed up by insisting health care be part of employment. Now people think employer-paid insurance is a "right" and will strike if the employer wants to reduce some costs with a co-pay. Insurance companies have lept on this, too because by and large if you are working, you are healthy. Really sick people can't hold a job. It's in insurance companies' best interests to further such a system. People keep working in terrible jobs just to keep insurance. I have a buddy who could otherwise retire. I say to him, "Why not?" and he always says, "Insurance." Now that sucks.
4. Health care is not in the Constitution. On the one hand we demand government be responsible and take care of every individual every time he has a cold and winds up going to the emergency room for it, stupidly. We are so risk averse that we blame anyone we can for anything that happens to us. Government is a prime target, but so is anyone, including McDodalds with hot coffee. Then we turn around and say, well, government should not invade my privacy (which isn't exactly in the Constiution either.) The thing is, we have INVITED government into our lives on a very personal basis, then wonder why it is there. You can't expect government to NOT be in your life if you won't take responsibility for your own life in the first place.
I would prefer government NOT be in my life, or there as little as possible. I will trade that for taking responsibility for my own health and my own life. Just get out and leave me alone. We'll all be better for it.
How about a moderation of -1 pedantic.
You're not really in Canada, are you? I suspect you're some Karl Rove wannabe, spreading FUD, sitting in his mom's basement eating doritos and playing video games. You're carrying water for the private insurance industry, which is scared shitless by the notion of single-payer, and you're probably doing it for nothing. Quite sad, really.
I grew up in the US, lived there for 30 years, but moved to Canada in 1997. The care of me and my family under the Canadian system has been outstanding at every stage, and really points out what a perverse, sadistic farce the U.S. "system" is. In the US, doctors have to have an army of back office monkeys to do battle with the HMO overseers, who fight every step the doctor wants to take.
Here in Nova Scotia, we are charged NOTHING above what we pay in taxes for hospital care, ER care, and office visits. Not One Dime. We don't pay for insurance of ANY KIND for basic medical care. I'll say that again - our monthly cost we pay out of pocket for hospitalization and doctor visit coverage is ZERO.
Examples:
When I went to find my first family practice MD here, I found one within minutes, got in the next day, doc ordered blood work which I got same day, and results came the day after that. By the end of the week I was in his office talking treatment options and getting a prescription. Company drug plan paid for that, but even if it hadn't, the drugs are so much cheaper here than in the US that it wouldn't have been a show-stopper. I paid ZERO DOLLARS for the office visit and lab tests, by the way. In fact, when people in Canada refer to a "health plan" or "health insurance" they are talking ONLY about prescription drug coverage, or coverage which gives them additional amenities, like a private room, or an ambulance with a disco ball and an 8-speaker sound system. In other words, shit you don't need anyway.
In Nova Scotia, my stepdad got a hernia diagnosis, had a CT scan within one week, and got surgery within one month. World-class care facility. In the US, you'd be fighting for insurance company approval for three months, minimum. He got NO BILL OF ANY KIND.
Three times our daughter had to go to the ER when growing up (she's 21 now) she was seen immediately, treated promptly (with tests varying from x-ray to blood work), and we went home with ZERO BILL OF ANY KIND.
My wife last year was feeling dizzy and nauseous one morning, so we took her to the hospital, where she was seen immediately, given an EKG with cardiologist consult, thankfully pronounced okay, and... can you guess? Got NO BILL OF ANY KIND.
Nothing came in the mail, and we didn't have to skip a mortgage payment to afford any kind of treatment or visit.
People here may have minor gripes about the system as it performs here, but these are people with no perspective of how bad it can get - people who have never lived in the U.S. or Calcutta. There are people in the U.S. who would kill to have the coverage that some Canadians gripe about on a daily basis.
If the U.S. insurance industry manages to dismantle Canadian Medicare and turn it into a for-profit system, then Canadians WILL have something to gripe about.
I know it is not cool these days, but my father was self employed with 4 kids and we never had health insurance. If we went to the doctor or hospital, he just paid for it. Usually if you don't have insurance but are willing to pay, hospitals/doctors will work with you on price and payment plans. My brother who works for my dad now has two kids and no health insurance.
They tell you that health insurance will save you from catastrophes, but if you look at the numbers, roughly 70% of people who go bankrupt due to medical bills have health insurance. I believe, 70% is pretty close to the number of people who have health insurance. So, if you have a health catastrophe your probably fucked anyways.
Don't listen to me though, I am in the military. Although I have to say, FULL medical coverage for your entire family is NICE, but the lines can be long and seeing a specialist is a pain.
A corporation is a legal entity... a legal individual... who's sole purpose is to do what is best for that corporation (and in modern America, this is to make a dollar value profit). Its purpose is not to do what is best for any other individual (shareholders are by extension a part of the corporation). It is by nature a sociopathic entity. It cares about others only if they help the corporation to get what it needs. Now while corporations keep us employed, which is a good thing, they are not benign friendly entities who care about us. Call Ronald a clown and he'll likely rip your heart out.
You want something that is socialistic, something that likes to work with society and help others, specifically your kid in this case, but you want it delivered by something that is a sociopath. While I am not a doctor, I think you might be developing some sort of self induced bi-polar disorder by the forced realization that corporations while an important part of a capitalistic society, are not about benefiting a society in a 'humanistic sense'; only themselves. It is a kind of symbiotic thing.
For you, a possible solution would be to make the argument to the (sociopath) corporate sector of society (since you prefer them to run the medical system) that your kid will ultimately be able to output more dollar value in productivity for the corporations than the money they will put into him/her. While you quite rightly love your child, a sociopath does not, and will not ever. They need to see some benefit. That is their efficiency. And if you cannot make this proof, don't be surprised if they don't care to help you out. It is not in their interest.
I know this sounds harsh, but it seems to me that as how you seem to prefer sociopathic medicine over social medicine, you probably wouldn't give a rat's ass about a decent society if you didn't have a crippled child and extra medical bills because of him/her. So my suggestion is to stop your hand wringing, revel in the system you prefer, and quietly eat the cost. Too easy. It is one or the other. You either want society's input and the slight inefficiency that it brings (and I am not convinced government handling contributes any more ineffiency than corporate profit making/taking does), or not. And if you do want it, would you want it still if you didn't have the added cost of a disabled child (take a cold hard look). Are you really just like the corporations? All efficiency and no heart. I am making no judgement here, this is how they work. And that is why they have to be forced to provide you insurance even with the added cost. You know they wouldn't even do that if they could get away with it.
Don't get me wrong, I believe for the most part, the way our capitalistic western society operates seems to work quite well (though there is always room for improvement)... sociopathic corporations and all. The biggest problem I have with social programs is that they are often screwed up by the amnesty international crowd (e.g. in Canada when they tried to make chronic welfare victims put something back into society by sweeping the streets a couple of times a week, this was shot down as some sort of human rights violation... bullshit if you ask me). However, I believe in some cases social values are required. Medicare is one area. I think we should look to parts of Europe and other places that have integrated public/private health care (this brings in more government control than in the United States) as they seem to be working better than either Canada's system (which has too much government control) or the United State's (which has too little). I have been in both of the latter two's systems, and they desperately need some sort of help... especially Canada's (mainly because most Canadians are in a state of denial about it... more money won't help).
I find it hard to understand people who want it all but don't want to pay the cost. Or want it all because they realize that the system they asked for just turned around and bit them.
-- I ignore anonymous replies to my comments and postings.
Most of the civilized world would, I think, call you a cold heartless bastard.
I would like to point out, that anytime you make a bet that you won't get sick, that is a supremely stupid bet, unless it is a very very short term bet. The chance you will need doctor services in the next 10 years is 100%. It's only 'nearly 100%' if you eschew routine things such as yearly checkups.
The problem is that health insurance is being run as an INSURANCE company. The point of society and government is to spread large individual expenses over portions of the population. That road you drove on - you could never pay for it, nor could you and everyone who drove on it pay for it via tolls. Sames goes for healthcare.
Also not every HMO (which is not traditional health insurance - not the same as indemnity insurance) is a for-profit institution.
By the way, I view the health insurance situation in the US as a global competitive liability. The healthcare system reduces individual employer flexibility - you can't just change jobs if you are relying on it for healthcare coverage. Your parting shot in your post was "quit your job and get a new one". Why should one choose their employer based on something tangential as healthcare?
The employer lockin caused by health coverage also impedes the free market of workers. It provides artificial barriers for workers to move from bad companies to other companies or to work for themselves. Strangely enough, you aren't really toeing the standard line of American Entrepreneurialism. After all, isnt the ideal to work for yourself? One that is impossible apparently...
One of the GP posters said that they didn't trust the government to run healthcare, that they would screw it up. Well, certainly with that expectation, yeah they would screw it up. The problem isn't that government screws up everything it touches (it certainly ruined the nuclear weapons programme in the 50s, lost that war apparently), it's just people expect the government to be screwups, thus when they are, people don't complain. After all, the overall health of Canadians with a government run healthcare system is higher than Americans, so clearly the concept of government can't be all that bad - it works for our friends up north, no?
Insurance isn't meant to be used for routine services. You don't buy auto insurance expecting it to cover oil changes and new tires. Why should a health insurance policy cover routine physicals.
Insurance is supposed to protect you from unforeseen disasters.
I have a high deductible PPO. It costs me $50 per month and I pay everything up to $3,500. Then they pay everything up. If I'm in a major accident or get cancer, I'm in pretty good shape.
I don't want to pay $300+ per month for a policy that pays for annual physicals when an annual physical cost $250 max.
As a result of the lower cost, I've now saved more than my annual deductible. Focus on getting an insurance policy that is that -- and insurance policy and save the difference in premium so you have enough to cover the deductible and pay routine expenses when you need it.
That said, when my wife and I were planning on having a baby, I compared a few plans and picked one that had a higher monthly fee and a lower deductible. As soon as the baby was born, we switched back to a high deductible plan. For that year, there was a point where the lower deductible and higher monthly fee made sense for us because it was a planned "procedure".
He who called bullshit is right, but BC does persist with the premium. But that's not the real point.
The point is that ultimately, the single payer system makes the delivery of adequate levels of health care a responsibilty of elected officials, and that matters. You may be able to go from HMO to HMO, but you can't escape the profit-logic that allows, as the surgeon above noted, a high-school graduate reading a script to determine levels of your or your kid's or your parent's care, and by then it's too late. But if my MP doesn't support public health care, we vote the bastard out. My doctor operates with independence, and based on clinical, not financial criteria. And I know many people who have lived in the states all or most of their lives, who know our system and who, as they age, are moving to Canada. Why?
And as an aside, my son had open-heart surgery at age three that would have meant that I would have lost my house if I had had to pay for a fraction of it, as I would have if I were one of the tens of millions inadequately insured or uninsured in the states. It was a condition that we might not have known about, had we not had easy access to health care professionals, connected to world-class teaching hospitals, and with superb surgical and diagnostic factilities. Untreated, he would have keeled over dead sometime in the last 5 years. Not everyone has it so good here (we live in Toronto), but ultimately, no-one here needs to have their child undiagnosed or untreated for serious disease.
While he was in recovery, we met families literally from around the world who had had their kids flown to have similar, and in many cases much more serious cases dealt with, including heart transplants. Free. This was at the expense of the hospital and the Canadian government, with help from aid agencies. That doesn't sound like quite the antiquated, inadequate and over-stressed system that Canadian national health care is usually characterized as, does it?
You DO NOT get what you pay for in the US for-profit system, which, by the way, I am opposed to. My wofe died of cancer this year. She was barely in her 30s. I had access, via my company, to the finest PPO providers. I was paying almost $5,000 a year for this policy. Despite having the best coverage the company offered, I ended up paying well over 10,000 out of my own pocket for things that should have been covered. What's the fracking point of having insurace if not everything is covered.
I got wise after a few visits after getting bills for crap that should have been covered. I started requesting itemized bills from every provider. Guess what? The hospitals and doctors ARE out to screw you if you do not pay attention to your bills.
The hospital stay before my wife died sent me an itemized bill for crap like "mucous ecovery system -- $129" Guess what that was? A fracking box of Kleenex they gave her at her bedside. They charged her over $500 for a couple of doses of readily available prescription sleeping pills that would have costed less that $50 even without insurace.
My wife has been dead for months and I'm still getting bills. They send them to her, and the sad point is, they should know she's no longer alive. I sent everyone death certificates to try and avoid aying the bills the cheap insurance companies would not pay, but they still try and fight me to get money. For-profit medicine is evil, period. Healthcare is a basic human right. Now, alot of you who have never gone through what I have will poo-poo my assertions, but trust me, when the chips are down, the insurance companies will not even try to help you.