Ask Slashdot: IT Contractors, How's Your Health Insurance?

An anonymous reader writes "In the tech industry, as the economy continues its downturn, IT folks in my circles who were either laid off or let go are turning to contract work to pay their bills. Layoffs and a decline in tech jobs has affected older IT workers the most. Many of us find it more lucrative and enjoyable in the long run and leave the world of cubicles forever. However, there is much to be said for working for a large company or corporation, and health insurance is one of the benefits we value most. But what happens to those who find themselves in this position at mid-career or later in life? Hopefully they have accumulated enough savings or have enough money in an HSA to survive a major medical emergency. Unfortunately, many do not and some find themselves in dire straits with their lives depending on others for help. I have been working IT contracts mostly now for the past 11 years and I've done very well. I belong to a group insurance plan and the coverage is decent, but as I get older, premiums and copays go up and coverage goes down. If you work contracts exclusively, what do you think is the best plan for insurance? Any preferences?"

Comments

there are only two correct answers...

[Razgorov Prikazka]

1 or 0

Re:there are only two correct answers...

[cayenne8]

Nah...easy question to answer.

If your contracting..first...incorporate yourself, I went for the subchapter "S" version, look it up, lots of benefits to this, including saving yourself significant payroll taxes (SS, medicare, etc)...

After this..get a high deductible insurance policy...my deductible was about $1200....this is for major medical, the emergency route, heart attack, hit by a bus..etc.

With a high deductible account..set up a HSA...and load it with money pre-tax...it is not a use it or lose it...at the end, you can roll it over for retirement if you wish..but load this up pre-tax for routine care.

Do this immediately when starting contracting. I am currently W2...and really miss doing my healthcare this way....although I still have funds in the HSA I can access...I just can't add more to it due to Obama admins even more restrictive terms on HSA's with the affordable care act (I still can't understand why they added more restrictions on it rather than opening it up to make it easier to get and use one)...

But this worked well for me...insurance premiums were quite reasonable and easy to get..and I'm older than the usual Slashdotter, and I do have pre-existing conditions (sky high triglycerides)...and no problem getting covered. First insurace covered was a little fly by night, but got them, kept them for about 8mos...and then switched to BCBS....

I had to go that route because I screwed up and let my last W2 insurance drop...it is much easier to get new insurance when you have coverage rather than letting it lapse too long. Get that Cobra if you have to to fill the gap.

Of course there are special circumstances...but I think this is an excellent system....you maintain it..you shop around for your own Dr. and make your decisions with your Dr.

I also found, that often, when I told the caregiver I was paying myself, I got up to about 15% discount right of the top....I had an MRI where they did this.

Re:there are only two correct answers...

[IICV]

It looks like you probably need an ellipsectomy too, but that might be a pre-existing condition.

Re:there are only two correct answers...

[Rich0]

I also found, that often, when I told the caregiver I was paying myself, I got up to about 15% discount right of the top....I had an MRI where they did this.

You apparently think you got a good deal. The last time I looked at an EOB from my insurer they're getting about an 80% discount, and I pay only 10% of that (ie 2% of the original bill).

I've had to deal with quite a bit of catastrophic care. For something like heart surgery expect the bills to come in at $100k, the insurance company to pay $10-20k, and you pay about $1-2k or your out-of-pocket limit if you hit that first on a 10% coinsurnace plan (you pay twice as much on a 20% plan obviously). I'm sure the doctors would offer you a discount if you didn't have insurance, but do you really think you'll talk them down to 10-20% of the original offer?

I'd love to see healthcare reform in the US, including more insurance reform, but insurance is not the only reason that care is so expensive. The uninsured just don't get to see what everybody else is paying so they think that the doctor letting them pay 50% of the bill is kind and generous, when the reality is that they are ripping them off.

Best Preference

[maroberts]

Have UK Citizenship

Re:Best Preference

[girlintraining]

Have UK Citizenship

Or Canada, Spain, Mexico... a lot of countries offer varying degrees and types of nationalized healthcare. The United States stands alone in being the only G8 country that lacks it.

Re:Best Preference

[kramulous]

Yup. I dropped by to say pretty much the same thing: Move to a country that gives a fuck about the health of its citizens.

Wealthiest nation on earth, my arse.

Re:Best Preference

[Urza9814]

Most Europeans I have met, particularly those who were only staying for a year or so, never STOPPED complaining if they had any cause to visit a hospital while here. Months later they'd still be complaining about the costs to anyone who would listen. Of course, as a recent college grad, most of those were students here on visas...and I can't imagine how you'd get health insurance in such a situation...no work, no family, not gonna be here long term...

Re:Best Preference

[PopeRatzo]

Or Canada, Spain, Mexico...

or Italy, Belgium, Israel, Norway, Denmark, Sweden, Switzerland, Netherlands, Japan... ...Kuwait, Austria, Finland, Slovenia, Ireland, Portugal, Iceland, Cyprus, Hong Kong, Singapore, Spain, France, Bahrain...

Re:Best Preference

[Dan667]

You must not know any UK expats.

Re:Best Preference

[cluedweasel]

You may jest, but this is my backup plan. As a UK citizen in the US, I hope to make it on the plane and back to Blighty if I get seriously ill. My $780 a month private health insurance is bugger-all use most of the time. With deductibles and doctors who don't seem to be able to diagnose anything without $20k worth of tests, it costs me an arm and a leg.

Re:Best Preference

[fm6]

My mother actually traveled to Canada for cataract surgery. She was no longer a Canadian citizen, but she was eligible as a recipient of the Canadian equivalent of Social Security.

She could have had it done under Medicare, but would have had to cover huge co-payments.

Re:Best Preference

[scot4875]

How many patients in the US are denied care per year? Care to dig up those statistics? Care to dig up projections on how that number will change under the ACA?

Because without context, the numbers and anecdotes you've provided are absolutely meaningless.

--Jeremy

Re:Best Preference

[Sir_Sri]

Please subtract Canada and the UK.

Please stop watching fox news.

The latest story I heard is that the UK is cutting doctor salaries (in order to balance the government budget) and it's leading to many doctors quitting

Probably, the conservatives are gutting the local trusts or whatever they're called too. But that doesn't mean there's going to be a massive shortage of doctors in the UK. When you make cuts and those doctors can pack up an move to switzerland or the US inevitably some will. And then you expand immigration or raise salaries and attract a bunch more. This isn't anything new. The UK can still attract doctors from eastern europe for example.

But as a canadian, there is no way in hell I would trade what we have here for the US system. For the french system or the british system, sure, they have different cost/benefit tradeoffs, but all of us provide on average better care, for less money than the US, and if you're in the US and you care about healthcare the answer is to leave.

After reading the various horror stories of patients unable to find a doctor, or being left to die in waiting rooms, or denied basic preventative measures like PAP smears

The reason you hear about is because we take these things very very seriously. Governments and government agencies are held accountable when they fuck up like this. It does happen, sometimes intentionally so too, as I say with the example of the conservatives in the UK, or with the 'voucher' programme proposed by Paul Ryan for Medicare, when you elect politicians they have a platform they run on for healthcare, sometimes that's good, sometimes bad, and most of the time somewhere inbetween.

And YES I know you've had nothing but great service in your CA or UK care.

No, you really don't understand. Between canada and the UK there are 95 million people, within canada each province runs it's own healthcare service under federal law, in the UK the NHS covers england and wales and northern ireland but not scotland I believe. Inevitably there will be things that go wrong, and an underfunded department will perform as well as any under funded agency will, some doctors are corrupt, some nurses are incompetent, some places can't attract enough qualified people especially in rural canada there aren't going to magically people who want to move 2 hours from the nearest walmart to provide healthcare etc.

http://www.who.int/healthinfo/paper30.pdf is pretty much the definitive guide to healthcare outcomes and assessment methodology, I suggest you read that. Seriously. It's not particularly complicated. If you're scared of reading page 18 has the table summary that's important.

That combines coverage, quality and spending into a single index. The French and Italians have the best systems overall (along with san marino) even though they have very different spending profiles.

Now in the long run 'Obamacare' which is basically a copy of the swiss system should be reasonably be expected to have similiar costs to canada (around 11.5% of GDP today), and produce better outcomes (as the swiss system does). So in 2016 or 2017 you might have an argument. But english canada only judges our healthcare system compared to the US, so we pay less, and have better outcomes, and as long that's true no one is going to rock the boat, even though there are better options available. And I'll point out that the swiss system is worse than the UK on both cost and coverage, so theirs isn't really the system you want to copy.

You hear horror stories from our healthcare systems because we actually care about these things as problems that need to be solved. In the US healthcare system you have one party base that advocates "let them die" and 'vouchers' as a policy platform, so we're not even having the same debate. In the US the question is whether or not you should even try to cover people, in canada in the UK it is a question of how best to do that, and who is responsible when something goes wrong.

Re:Best Preference

[Sir_Sri]

I can't imagine how you'd get health insurance in such a situation

Don't schools provide health insurance for students? I'm in canada and our foreign students automatically get insurance for things that aren't covered by the government (which guarantees them certain healthcare as part of their entrance visa).

Re:Best Preference

[ColaMan]

So what's your opinion on forcing everyone to pay for a military to protect your free society?

For things that have to service an entire populace, 'Free Society' sucks. Everyone's out to look after #1 and everyone else suffers as a result.

Re:Best Preference

[scot4875]

The problem with your argument, and the point you seem to be missing, is that the health care system is ALREADY fucked up. It is becoming increasingly fucked up as time goes on. And there is little incentive for the health care system to fix itself, because it is already insanely profitable.

Every speculative argument (except, of course, the non-sequiturs about dogfood and the post office) you make against government-run health care (and you have made many of them) ALREADY APPLIES to the system we have TODAY. And we have MANY real-life, working examples of government-run health care elsewhere in the world where they DO NOT have the problems that our system has. You're hilariously willing to strike Canada off that list of examples because of a couple anecdotes you read about, but even then you STILL have nothing to say about the dozens of other systems that are -- objectively -- measurably better than ours.

For someone as notoriously cheap as you are, you sure are penny-wise pound-foolish in this case.

--Jeremy

Re:Best Preference

[cayenne8]

Thing is a lot of those countries can concentrate on their spending on healthcare (especially in the EU) because they don't have to pay much money for defense....why?

Because we in the US cover them for that.

Let's pull most of our bases out of there...save ourselves some money and let these countries start picking up the tab for their own defense....we can use the savings to put towards our own health care....

Re:Best Preference

[Kagato]

I think emulating the Swiss would be fantastic. There are incredibly capitalistic. Almost all the insurance companies are private, but they can't make a profit on health insurance. To level the playing field the gov't sets the price list and claims policy.

What I find most interesting is while the companies actually ended up fine in the end. They can't make money on core health insurance, but they can sell other insurance products to the customers at a profit. In the end studies show the insurance companies ended up making more money because they had a semi-captive customer base to market and bundle other products too.

We pay way too much for services here in the US. MRI in the US is $1500-2500. MRI in Japan is under $200. A Cardiac Surgeon in the US makes a seven figure salary. That level of salary would be a scandal in other parts of the world.

Re:Best Preference

[Kagato]

The UK and Canada have their issues. But there are a lot of countries that came after them and got it right.

Moreover, people have a very rose colored view of the current US system when it comes to wait times. It's not unusual to see the exact same wait issues in the US. In particular since insurance companies and HMO have specific plan networks that limit choice of who, when and where one can see a doctor.

The classic example I see is hip and knee replacement. You hear stories about Canadians coming to the US and paying cash and getting right in. In the US system Cash talks. If you have insurance it's not unusual to have mandated second opinions and referrals (which can take weeks or more). There can also be limits on who/when/where it can take place. A doctor can serve multiple hospitals in a metropolitan area, but a care network may only credential him for a specific hospital. At the very least a major surgery is going to require a pre-claim to be submitted to the insurance company. A lot of the time that means your patient records will be sent off to India or Eastern Europe where a "doctor" will review them and determine if you really need that surgery or not.

You get all sorts of red tape. And unlike single payer systems, there are dozens of different red tape. That means a billing department is dozens of people unlike everywhere else where it's a handful. Who pays for that? You do. The consultants the providers hire to optimize their claims to get the most out of the insurance company. You pay for that too. The consultants the insurance companies hire to optimization their claims process to pay the least amount of money. You get to pay for them as well.

Re:Best Preference

[Surt]

In all fairness you have to remember that US surgeons are less competent than their Japanese peers, and so factor in the appropriate incompetence pay factor like for CEOs who wreck companies. I mean, unlike CEOs, incompetent cardiac surgeons actually kill people.

Re:Best Preference

[jjohnson]

And yet, by every aggregate measure of health outcomes, Canada and the UK do far, far better than the U.S. Longer life expectancy, lower infant mortality rate, fewer complications, shorter hospital stays... It's almost like you're being fed bullshit propaganda slandering the two nearest examples of health care systems that work vastly better than your own.

Re:Best Preference

[fm6]

As they say in Wikipedia, attribution required. While there's a lot online about Green's fight with cancer, I can't seem to find anything resembling the 9-month delay.

This sounds like a typical internet meme. While you often hear Canadians complain about delays, it's always for stuff that can wait, not for something that's likely to kill you soon. Of course, by the time this is filtered through the right-wing blogosphere it's "we're going to have to let you die because we don't have enough beds."

Re:Best Preference

[QuantumRiff]

Wow.. Nice. You know, not all of the other countries that have better health care than us have a huge, monolithic government agency with death panels, right? Maybe you should read up on Germany, and how they switched. Or singapore, or how health care is handled in Japan. Its not all as scary as people seem to keep trying to make Canada's system sound. (except, all my friends from Canada laugh at those comments, and say its nothing like what the politicians and people against it claim, you know.. the people that have actually been there).

Maybe you should also read a little into Amtrak while your at it. Little things, like Amtrak is not allowed to own track. At all. They cannot build or purchase their own routes. They must run secondary on most tracks, meaning they have to pull over and wait for any cargo train. (on the west coast, delays of 12 hours are more common that ontime routes) Perhaps you will also read about how the major train companies were forced to own stock in amtrak, but are not allowed to sell it, so they are stuck with it, but can't make a profit at all, so they treat it like crap. Maybe you'll also learn that EVERY SINGLE damn politician who screams about amtrak costs, gets very, very upset when they talk about closing train stations in the towns with 5,000 people in their jurisdictions.. Just look at the line from Seattle to Chicago.. there are > 40 stops. Most in towns you have never, ever heard of. Each stop adds how much time? slowing down, stopping, and then starting again? That route could be less than half the 40 hours it is now.

After that, maybe you can read about how the Postal Service has to fund 70 years of pension obligations in one decade.. Nobody else, anywhere, has 70 years of pension money sitting in an account. But it was added to a bill a few years ago, by a guy who got a TON of campaign contributions from the two companies that would benefit most to the Post office having problems. And they also pointed out that the Fed could then borrow against that money, since, even though the Post Office is supposed to be independent, they have to store this money with the Treasury. Same as amtrak, they also get very, very angry politicians when they try to close post offices in unused places.

The problem with all of these things is not that its "government" doing it, its that politicians are involved. Government runs fine in most countries, here, its actually falling apart around us, because we would rather scream about things like abortion and guns, then give people that actually understand what they are doing the tools necessary to do them.

Re:Best Preference

[PopeRatzo]

So if you are rich or have a very GOLDEN medical package with your work, the US is definitely the better option; for everyone else, they are the worst. And when I say GOLDEN, I mean you better be paying upwards of $1000 US per month as a healthy 30 year old or you'll be sorry when it comes time to collect.....

Or be a member of congress, who unfortunately do not believe the rest of the country deserves the same level of medical care that they get. Or I should say that about half of them don't believe the rest of the country deserves the same level of health care they get.

Funny, that half will all be in Tampa, FL this weekend and a hurricane is bearing down on them. Unfortunately, life isn't fair so they'll probably all be safe. You won't see members of the House of Representatives floating face down in the streets of a hurricane-ravaged city. Pity.

Re:Best Preference

[stephanruby]

Actually, you don't want the UK for anything urgent. In the UK, unless you're willing to pay for a private clinic, you'll usually need to wait at least 6 months before you can see a specialist.

Having lived in the UK, France, and the US, I'd pick the French system for most cases over the American one and then I'd pick the American system over the British one. At least in the US, you can get treated in time (if you or your family are insistent enough), even it means you won't be able to pay your hospital bills afterwards. And for preventative medicine, like prenatal care for instance, then I'd pick France or the UK over the US, so the UK is not all as bad as I made it out to be.

Re:Best Preference

[nbauman]

Knee replacement surgery is a bad example to prove the superiority of the American health care system. It proves the opposite. You shouldn't rush patients into surgery. Canadian doctors say that the long waits are a benefit of their system -- they give people a chance to find out the facts and decide whether the treatment is a good thing.

First of all, most of the people who get knee replacements are in their 60s or 70s, so in the US they get it under Medicare -- single payer health care.

Second, Total knee replacements are the fastest-growing and most expensive surgeries in Medicare. Doctors are rushing patients into knee surgery who shouldn't have it. So this is free-market medical abuse on steroids. (In fact steroids turned out to have some bad outcomes.)

TKR isn't trivial. It's among the most painful procedures in medicine, and if the patient doesn't complete painful physical rehabilitation, the replacement won't work. They usually use Oxycodone for a month or two, but this being the US a lot of surgeons under-dose and leave the patients in pain that drives them to tears (read Jane Brody's account of her own TKR in the New York Times). It's several days in the hospital, a week in a rehabilitation center, a week to a month at home in bed, and 3 to 6 months before you've recovered the function you started with. Then you start to improve, and after 6 months to a year most people can walk and stand again.

But many people don't. About 15% of TKR patients have permanent moderate to severe pain that can't be cured. They're worse off for having the surgery. Some of them get surgery because they're using a cane as a result of their surgery wind up in a wheelchair. What are the risks? Nobody knows for sure because surgeons have been replacing knees without doing good outcome studies. Countries with national health care systems do outcome studies. Denmark is doing a big randomized study, so we should know the outcomes in 10 years.

In Denmark, the current practice is that they don't give TKR until the patient has tried less drastic measures for 6 months and they haven't been adequate. The first step is to lose weight, down to a body mass index of 25 ideally. They also give them exercise/physical rehabilitation and non-steroidal anti-inflammatory drugs. People who are overweight or obese have a worse outcome after surgery, and in some cases, after weight loss, exercise/rehab, and NSAIDs, they don't need surgery after all. Why go through all that pain, bed confinement and risk when you can get the same results without it?

Overtreatment is endemic in US health care. Look at the fastest-growing, largest Medicare expenses besides hip and knee replacement. According to a series of articles in the New England Journal of Medicine, CT scans (another big money-maker for doctors and device companies, a major growing expense for Medicare) are widely overused and a major cause of cancer (about 1/10,000 major CT scans result in an additional cancer, more for CT scans of children). Erythropoietin, a drug that stimulates the growth of red blood cells, was the Medicare/Medicaid's single most expensive drug (=profitable for drug companies and doctors), used in kidney dialysis, and after they finally did the research, it turned out to be actually killing people at the high (profitable) doses they were using. Hormone replacement therapy for post-menopausal women actually turned out to be a major cause of breast cancer in the formulations they were using. There was a significant bump in the breast cancer incidence curve because of these heavily-promoted estrogen drugs.

The Canadian health care system has quality as good as ours, costs them half as much, and the tradeoff is that they do have to wait longer (and sometimes don't get advanced procedures that we get here). They have their flaws. But it's not the backward third-world system that conservatives (Google "Manhattan Institute) would have you believe.

Here's a couple of interesting stories on the Canadian system.

Re:Best Preference

[fm6]

No, it sounds like the doctors tried to tell the guy that further treatment would only prolong his mother's suffering and he didn't want to hear it.

I've been through the same thing several times with family members and friends. There comes a time when it doesn't make sense to inflict any more painful chemo, radiation, or surgery. In each case, the ultimate decision was made by patient themselves, and in each case I saw some relative angrily reject their decision as "giving up".

And this time, we have a convenient scapegoat in the Canadian health care system. But guess what? Cancer survival rates are about the same in Canada as they are in the U.S.

Re:Best Preference

[Anonymous Coward]

People who make below $25k are covered by Medicaid already. Of course, this program is under attack by the Tea Party, but it works reasonably well.

People who make over $100k per year can generally afford the cost of $1,200 per month to insure a family (or have employer covered insurance). The median cost of insurance for a family of 4 in the US is about $20,500 per year. This is the median across the board, meaning half are higher (and half are lower).

This leaves the rest out to dry. Self-employed people making under $100k, students over 25, and about 40% of the middle class. These are the people who can't get insurance.

These are the EXACT people who most deserve to be covered based on their potential future income, and the benefits to society by keeping them healthy. They're also the least expensive group to ensure. It's completely insane to leave only this group out of coverage, but include the rest (elderly, poor, corporate employees) when leaving out mid-life entrepreneurs and self-employed people, etc. WTF?

I've lived in both the US and Canada and spent 4 months waiting for an important surgery TWICE while living in the US because my insurance company was stalling to avoid paying benefits and as a result, I have a permanent problem with my knee. I had to retain a lawyer and pay for the procedure out of pocket to get it done (and then threaten to sue unless they reimburse me).

This procedure would have been covered by Canadian provincial health care system and handled in less time (no less than 4 weeks based on the severity right now).

When someone has an enormous amount of money, they generally are not willing to wait for services, so they pay out of pocket. Folks like celebrities will fly to the Mayo Clinic for cancer treatment and pay out of pocket, no matter where in the world they live - even wealthy Chinese and Africans fly to the Mayo Clinic or UCLA Medical, etc for this type of procedure. There's a number of such centres or advanced medicine in other places (like Europe and Japan) as well.

On the other hand, the most prominent heart-surgery facility in the world is in Belgium, and several Americans have traveled there for that surgery, if they have the $100k to pay out of pocket. That doesn't make the Belgian system better, it's just a quirk.

On the other hand, many Americans in the south travel to Mexico for procedures to avoid the extraordinarily high cost of services in the USA. This doesn't mean the Mexican system is better, it's simply targeted differently.

Re:Best Preference

[loom_weaver]

Answer: obviously the cost is split across the entire tax-payer base.

Now imagine this scenario... his dad has heart trouble and emergency surgery ends up bankrupting him. While he doesn't croak from his sickness his insurance company conveniently drops him afterwards. Further complications cause him to lose his job as he's unable to work.

He ends up spending the next 20 years on welfare and medicaid. Given that there's no such thing as a free lunch, who pays for it?

Re:Best Preference

[slim]

Actually, you don't want the UK for anything urgent. In the UK, unless you're willing to pay for a private clinic, you'll usually need to wait at least 6 months before you can see a specialist.

[citation needed]

Two NHS anecdotes of my own:

I had a pain in the left side of my chest while running. Looked at the NHS direct web site, which told me to call an ambulance. I didn't, but I went to A&E soon afterwards. Within 5 minutes I was being interviewed by a nurse, and within 20 minutes I was on an ECG. Within 2 hours I'd had a chest X-ray and a second ECG. Happily I was given a clean bill of health -- the pain was just caused by muscle tension. But I was astonished by the rapid and thorough response.

More recently, a couple of friends noticed a mole on my back which they thought I should get checked out. I phoned for a GP appointment, and got one 3 days hence. The GP referred me to a consultant dermatologist. That appointment was about a week later. I got to the hospital 10 minutes early, and was seen 5 minutes early. The consultant gave me a thorough examination and recommended a biopsy. I had to take a form to reception -- where there was no queue -- and made an appointment for the biopsy scraping, 1 week later. Again I was seen on time, treated with immaculate professionalism. A couple of days later the test results came through the post -- all clear.

I appreciate some people have had bad NHS experiences, and of course we must relentlessly maintain/improve standards. But mostly I sense that people in general are pleased with the NHS. In particular, I'm of an age where lots of my friends are having babies, and not one has complained about NHS maternity care.

Also you say "for anything urgent". My sense is that the NHS is very good at prioritising. If you find yourself waiting, it's because someone with a more urgent need has taken precedence. For example, with my chest pain, I jumped a queue of bleeding but stable A&E patients.

Re:Best Preference

[Tyndmyr]

The biggest problem in assuming health care costs from America will match those in ANY other country is not realizing how fat we are. Any system we put in isn't going to magically make the diet of fat and sugar cheap to care for.

Critical illness

[roman_mir]

Treat insurance as insurance, not as a health care account, buy critical illness with a high deductible (maybe 10-20K), but make sure it covers 5-10 years of your expenses for sure. For the normal every day stuff just pay out of pocket.

Re:Critical illness

[Anonymous Coward]

Wrong. You'll pay several times more out of pocket than an insurance company would pay, because of their quantity discounts. It is NOT a competitive free market or anything of the sort. It's monopolies all the way down, and they have the literal power of life and death over you, and they use it.

Re:Critical illness

[Ichijo]

Wrong. You'll pay several times more out of pocket than an insurance company would pay...

Wrong:

A recent article in the Los Angeles Times reported a CT scan of the abdomen costs about $2,400 for patients insured by Blue Shield of California, while the Los Alamitos (Calif.) Medical Center cash price is only $250... Another local California hospital charges insured patients $415 for blood tests that cost only $95 in cash.

Re:Critical illness

[HornWumpus]

Unless you ask for cash discounts before receiving services. Then you will pay about what the insurance companies do.

They love cash, they also love to not have to bill insurance companies.

Re:Critical illness

[Cute Fuzzy Bunny]

Wrong. You'll pay several times more out of pocket than an insurance company would pay, because of their quantity discounts. It is NOT a competitive free market or anything of the sort. It's monopolies all the way down, and they have the literal power of life and death over you, and they use it.

Yup. You'll be buying $800 band aids to pay for the 50 people who got sick without health care, because they wanted a choice. That's socialism. It's just 'feel good' socialism where you feel like a free wheeling loner that doesn't want to be told what to do.

He's also the guy who hits your car without auto insurance, even though the state mandates it. Ha ha, not his problem. The free wheeling individual decision making loner strikes again.

Re:Critical illness

[TXG1112]

You are assuming you will never have a significant medical need. This is a very poor assumption and it is obvious that you are not capable of doing the necessary risk/cost calculations. Bear in mind that one hospitalization will run you $10k, if you need to have a major procedure done that will likely cost you $25k or more. These are just for one time events. If you get a chronic condition, these numbers can go way up.

The reason insurance is required under the new plan is that people are stupid and short sighted.

Re:Critical illness

[jedidiah]

He is assuming nothing. However, you are.

The whole sub-argument is about traditional major medical coverage that handles precisely the sort of large out of pocket costs you're talking about.

Insurance simply does not scale down.

For smaller claims, the transactional overhead if more than the cost of the service itself. Everyone is better off just paying cash and avoiding the overhead of the small stuff.

You avoid the immediate transaction costs of the small stuff plus the any scaling issues you will trigger from magnifying the size of the claims management apparatus.

Re:Critical illness

[SecurityTheatre]

Part of the issue here, is that for every hour of hospital service, 1-2 hours of paperwork is required to deal with insurance companies.

The overhead alone increases health care costs in the US by at least 30% and as much as 45%.

Additionally, insured patients are used to subsidize the hospitals for mandatory services performed on uninsured patients in the ER, which often account for 30-40% of hospital's billing.

Those together automatically double the costs, or more, simply because the US system is broken in those fundamental ways.

Decent hospitals will not, however, pass those costs on to patients who pay out of pocket.

the no pre existing condition/ no drop rule + exch

[Joe_Dragon]

the no pre existing condition/ no drop rule and exchanges (not tied to jobs) is a big boost.

Affordable Care Act might make this easier

[dkleinsc]

I'm assuming OP is in the US, because in most other countries this is a non-issue.

This was the kind of situation that Obamacare is intended to address, by making the individual market a viable option for people who aren't getting insurance through their employment, eliminating exclusions for preexisting conditions and requiring no more than 20% overhead (for reference, Medicare runs at about 3% overhead and the VA closer to 1%).

Other approaches, while you're waiting for that law to fully kick in:
- If you're married, and your spouse is a full-time employee somewhere, use their group plan.
- If you've saved up a lot, which it sounds like you have, consider focusing on catastrophic coverage.
- If you're older than 50, consider the AARP. They provide all sorts of discounts, including on health insurance.
- If your life situation allows, you might be able to relocate to a civilized country. This is obviously a big change, so you wouldn't want to make this lightly.
- Put up with the higher rates and less insurance. It's not pleasant, of course, but it sounds like you can afford it.

Re:Affordable Care Act might make this easier

[gurps_npc]

Most civilized countries are relatively happy to accept American citizens.

We aren't refugees, there aren't a huge number of us clamoring to get in, and most of us don't even think of leaving the country unless we are well educated and have some financial resources.

Now, if there were a huge disaster and millions of Americans, particularly poor Americans, were to pack and and try to move, that would be a different story.

Just buy insurance...it's honestly that simple.

[Anonymous Coward]

I contracted for 2 years. During that time, I purchased health insurance for myself, wife and 3 children from a health insurance company. It's actually really easy. I comparison shopped online, picked an insurer with a plan that had good coverage at a rate I could afford, called them up and bought a policy. The insurer did a check of our medical histories, which took about a week, and involved them calling doctors. Fine. The policy took effect about 2 weeks after the medical checks were complete.

I was paying about $300 / mo for myself, wife and my 3 kids - and that includes a kid with autism, which the insurer could not turn down, thanks to the Affordable Care Act (GObama! Sorry, had to :) ). They did charge me $10 extra a month for my autistic child, but that seemed more than reasonable to me. $300 / mo might seem high, but it's only about $50 more than what I pay when getting insurance through an employer. The copays were competitive ($10 prescriptions, $30 doctor visits and such). The other deductibles, co-insurance, etc were a bit higher, but not insanely higher than what you'd see through a plan from an employer.

There was one thing that stunk about the plan, though - if my wife got pregnant, the insurer would drop her coverage. That sucks. In fact, I couldn't find a single insurer that would cover pregnancy - nor would they cover things like IUD, birth control pills, etc. Basically everything you'd typically associate with a woman's health was completely not covered, which is ridiculous.

Once the Affordable Care Act goes completely "live" in 2014, though, insurers won't be able to deny women health coverage if they're pregnant, and they'll have to cover basic women's health care. Anyhow, wasn't trying to make this a political statement, it's just interesting how broken the current system is for women.

Re:Just buy insurance...it's honestly that simple.

[drgroove]

Damn, thought I was logged in for that comment. Sorry about that.

Re:Just buy insurance...it's honestly that simple.

[hadge]

Good god, no coverage for pregnancy? I'm glad I live in Canada... My wife just had a baby, no complications mind you, but all I paid was 14 dollars for a 7 day parking pass, and they even sent us home loaded down with diapers and creme and crap. Same thing for all the leadup tests, ultrasounds, followups, etc. Nothing paid out of pocket. Of course, lets not discuss dental care, or vision care, or drug coverage, etc. We Canadians still need private. A cancer diagnosis can still finish with you in the poor house from the necessary drugs. 300$ seems like a reasonable price to me. I pay almost 150$ for my half of my employer supplied private insurance that covers the dental, vision, presecription, massage, chiropractor, etc)

Re:Just buy insurance...it's honestly that simple.

[sl4shd0rk]

it's just interesting how broken the current system is for women.

Har.. You ain't seen nothing yet.
- Mitt

Re:Just buy insurance...it's honestly that simple.

[Demosthenex]

I've been independent for over 4 years now, and for my family of five including my autistic son with a major genetic disorder our insurance started at $400 per month. Catastrophic only, any doctors bills, RX, etc was strictly out of pocket and always hundreds of dollars. I clearly recall one week my three kids caught the same flu and I spent $900 out of pocket for 3 doctors visits.

Every year the rates went up and covered less. I now spend $620/month on a plan without dental, maternity, or vision. I'm spending about $4000 this month on minor dental work (ie: cleanings and a filling!) for myself and my wife, and new glasses for us and one son.

I expect my rates to exceed $700/mo next summer at the rate it's going. I fully expect that should I get injured or require hospitalization my insurance will weasel out, and I'll be bankrupt in 90 days. I feel that I'd get the same value if I just took the money out back and burned it each month.

As a result, I'm looking to emigrate to a first world nation that does have universal coverage. This system is broken and shows no signs of being fixed, Obamacare or not.

Re:Just buy insurance...it's honestly that simple.

[Slashdot Parent]

Yeah, $300/mo sounds very, very low. Either his deductible is in the stratosphere, or he might be mis-remembering that premium amount.

Max out your HSA

[darkwing_bmf]

When times are good, save up for times that will be bad. An HSA is one tax efficient vehicle for medical expenses but due to contribution limits you'll probably need more than that. Basically spend less than you earn and save the rest for the future. If you're smart enough to be in IT then you're smart enough to know that you will have medical expenses in the future and you're being paid better than the average worker now. Plan accordingly.

High Deductible Health Plan

[Anonymous Coward]

In my experience, High Deductible Health Plans from *major* carriers are quite good. I'm not talking about those discount $50/mo. plans you can get through trade organizations. I'm talking about "High Deductible" plans from Aetna, Blue Cross, etc... You might have to cover the first $2k - $3k per year out of pocket, but after that you're often covered at the 90% to 95% level with no upper limit for major medical events like cancer, etc...

If you're self-employed, you ought to easily have $2k - $3k per year available to pay pre-deductible health expenses. It's really not that much money.
My observation is that most people seem conditioned to have this totally irrational expectation that ALL of their health expenses should be covered, with maybe a nominal $20 "co-pay" at every office visit. That's silly! Why not just pay for ordinary expenses out of pocket, and save your insurance premiums for the truly disastrous stuff (i.e. broken bones, appendicitis, car accidents, etc...)?

I'm just continually blown away by two income professional households with $120k+ income who just absolutely can not bring themselves to shell out a few thousand dollars per year out of pocket to pay the doctor. What's the big deal? 5% of your income is too much out of pocket expense? They'll happily blow $1500/year on mobile phone service, but $2k - $3k / year on pre-deductible health expenses are too much? But I digress......

High Deductible Health Plan from major carrier. The only way to go.

Mine's outstanding, but...

[Lucas123]

I have a great job and my company affords me a fantastic health plan. Unfortunately, a close friend of mine got laid off after a head injury caused a concussion and after six months of short term disability he was fired from the job where he'd worked for 13 years. He had been making about $60,000 a year. His wife didn't work. He lives in good 'ol Massachusetts, and his unemployment is too high to warrant MassHealth, so he's paying $1,300 a month for Cobra to cover his wife and two children. His savings are almost depleted and he's still recovering (headaches, dizziness, contant pain). While I fully support a national healthcare plan, the one we have in place -- get healthcare or pay the fine -- ain't doing it. More needs to be done to help those in need of health coverage so they don't wind up going into emergency rooms for chronic illness care. Any study worth its salt shows preventative care is cheaper than reactive care.

Re:Mine's outstanding, but...

[stevemoink]

If he is in MA, he can buy healthcare from the state exchange for a lot less than $1300/month.

Re:The only choice is to vote DEM / obama

[Cute Fuzzy Bunny]

"Require you to buy some" is hardly an insurance plan.

I think every state requires you to buy auto insurance and all mortgage companies require homeowners insurance. This is to prevent dumbasses from not doing something they really have to do.

But I'm perfectly okay with people who want to make their own choices, as long as they accept the consequences of their choices. Which means if you waaah about not buying health insurance, then when you're sick or injured...you stay home and help yourself unless you can bring cash or a valid credit card with $50,000 available on it to the emergency room. After all, you're the one in charge making the decisions, and the one you made is basically to die or fall on the charity of others WHEN something happens to you. And by the way, I ain't in the mood to be your freaking charity.

The problem we have with the world today is everyone wants choices, but when the consequences show up its someone elses fault and they need a bailout.

If people hate the 'socialism' of medicine, then I hope they're not driving on the interstates, sending their kids to public school, and won't be accepting social security and medicare, neither of which you 'paid for', but which are paid to you by others as your tax dollars paid for your elders as you worked.

I'm 51 and have a couple of minor pre-existing conditions that I've resolved by losing a lot of weight gained after suffering a back injury. Even though I'm pretty healthy now, if I lost my current group health absolutely nobody would insure me at any price. Even a high deductible plan and HSA combined with a serious injury or illness would destroy my family finances pretty much for good.

So shall we all stop weinering about coming to the same damn conclusion that just about everyone else on the planet has? People are too stupid and shortsighted to buy health insurance, but you have to have it, since almost nobody can pay out of pocket for a major car accident, cancer or a heart attack.

You can still have your choice. Pack up and go live in the new mexico desert or the deep plains of wyoming, far from a hospital. I'm quite sure nobody will come to your camp and make you pay.

If you cant afford it, you get it for free or cheap. Same general idea as what Romney did in MA. So lets stop the stupid bickering and random shenanigans and get on with what we grown ups need to do, shall we?

Ehhh...and so we stay on the right side of the fence, voted republican until GW's second term, have voted for Mickey Mouse since.

Re:After 20+ years of contracting...

[Jackie_Chan_Fan]

Actually, expect LESS increases due to "Obama Care"

The reason is more people will be paying in to plans because they have to by law.

I've paid for my own health care since I was 18. I require it due to having moderate to severe Psoriasis. I pay $1300 a month right now for Blue Cross Blue Shield in NY. Yes... Its fucking insane.

The same plan was $250 a month 15 years ago.

Every year they want to increase it about $150.

The theory with Obama Care is more people will now have to pay for a plan so more people paying in, should slow the increase in rates. However we will see if that happens in practice.

Initially the democrats fought for control over price increases but republicans and the insurance lobbyists obviously won that battle.

This country is out of control insane. If you are sick, you better be rich, or just die. That is how our country looks at people. We are burdens on society, and they would rather us all die than provide some kind of help. That is a fact.

America is a disgusting fucking country that I am ashamed to say I belong to. We simply do not care about doing the right thing.

Obama Care is a step in the right direction but its been corrupted by the insurance industry. The public option was eliminated. Single Payer universal Not for Profit insurance wasnt even considered. Big Money runs this place... and Big money sees us all as a burden and thinks the sick should simply die.

If you want health insurance in America. Either you have to pay very high monthly rates, or simply move to another country.

Re:Spouse

[Cute Fuzzy Bunny]

Funny you mention that because I did marry someone with health benefits, and I didn't really like her that much at the time. But to avoid paying $12,000 a year for health insurance...eh...I'm puckering up.

Re:The only choice is to vote DEM / obama

[medcalf]

Except that's crap. I've been a contractor for more than a decade and am in my forties. Love the independence, and buy my own insurance. When Obamacare kicks all the way in, it's going to raise my insurance costs a lot, possibly to the point that I will have to go to work as an employee to afford it. So actually, for the situation the poster describes, which is mine, repealing Obamacare, which requires voting Obama out, is actually the better option.

Re:Time to emigrate.

[Cute Fuzzy Bunny]

If your young, fit and trying make it the US might be the place for you. When you insurance is telling you that you are (actuarially speaking) no longer young or fit and your bank is telling you you haven't made it, it's time to get the hell out of Dodge. Emigrate while you still can to a more civilized part of the world.

When Rome fell it wasn't a particularly swell place to be. Unless you had a look at anywhere else. You ought to have a look at Greece right now. Everything is covered with grafiti. Everything.

Re:Vitamins

[Just Some Guy]

There's no "sort of". It was an educated gamble, though. My wife and I have some money saved back and can afford to pay for the little stuff outright. At our ages and health conditions, it was exceedingly unlikely that we'd experience a catastrophic illness in that small time window. I'm still exceedingly happy to be back on a health plan in the very near future.

Re:The only choice is to vote DEM / obama

[whoever57]

You fail at logic. You think that it is OK for people to have a "choice" to not buy insurance and must live with the consequences, but note that you would not be able to buy insurance if you lost your current coverage.

Yes, perfectly healthy people below age 50 may have a choice. Many others, who don't have a perfect history of health don't actually have a choice if they lost their current insurance. You admit that you are in this position.

So, yes, many people have a choice to not buy insurance. Unfortunately, many others do not have a choice to buy insurance.

What is the problem here?

[bobbied]

I've always thought that the biggest problem WAS insurance. There is no other area where the consumer generally has *no idea* what the cost is of what they consume. They just care about their copay or out of pocket and don't usually know (or care) what the real costs for the services they consume are. It follows that when someone else is paying for it, people tend to consume more than they really need, which drives up costs for everybody.

Running a close second is malpractice liability and the host of "cover my butt" testing now done by doctors. With the patient not really knowing what all this stuff costs and the doctor facing increasing malpractice insurance costs the pressure to do tests "just in case" is huge, even if the test is unlikely to ever catch anything and is expensive. You know that a good percentage of medical testing falls into this category, and this simply drives up medical costs and insurance premiums.

I suggest that we attack this problem on two fronts (once we get the current "Affordable Health Care Act" off the books.)

First, I think the expansion of HealthCare Security Accounts (HSA) is in order. Make it possible for folks to buy catastrophic health care plans (with very high deductibles) but allow them to put pre-tax money into HSAs up to the max out of pocket per year. Structure them like 401Ks and encourage folks to save though out their lives for medical expenses and allow these accounts to be passed down to others upon death. This will put the patient back into a position to care about costs and make it easier for them to refuse unnecessary testing.

Second, we need to put caps on medical malpractice awards for pain and suffering and make the looser pay legal fees in medical malpractice cases. Awards need to be for actual damages (i.e. for past/future medical expenses, lost earning potential etc) but pain and suffering and punitive awards need to be capped. The "looser pays winner's legal fees" will effectively eliminate those who are gaming the system by filing frivolous suits and their lawyers who are looking for a lucky million dollar award from a jury. All this would serve to lower malpractice insurance costs and lower the pressure on Doctors to perform unnecessary testing that drive up costs.

All in all, we need to get back to a system where the patient can take responsibility for the cost of their care. Only then can we hope to contain the ever expanding costs.

Vote for People Who Support Single Payer

[reallocate]

Seriously.

When health insurance and health care are sold as a for-profit products, it is inevitable that some people will go without insurance and/or care. Why? Because they can't pay enough to make it profitable to sell to them. The market is fine and all, but it can't survive without profit.

Your best bet now is to look very hard for some form of group insurance. The older you are, the greater the probability you will succumb to somthing that requires surgery and/or long-term treatment/rehabilitation. i.e., things that generate 6-figure bills. (Think about things happening that cost $500,000 to deal with. Think about pills that cost $100 a pop.) Better to have good coverage for that eventuality and poor coverage of things like routine doctor visits than vice-versa.

Re:Doctors, Dentists and Hospitals *love* cash

[rycamor]

This accords with what I have experienced. Generally we pay less than 50% of the sticker price for all medical care, if we offer cash.

When my latest was born in 2008, we got everything covered for under $5000 at a very good hospital, simply because we offered cash up front. In fact, we were informed that the price would triple if we couldn't pay the full amount up front--even if we paid all the remainder within a week. That's the nature of risk management in the medical business.

As a family man with 3 kids, we find that life is MUCH cheaper without insurance. If you have a generally healthy family, and actually bother to make sure your family eats well and exercises well (growing your own garden is a major plus), and if you bother to learn a little something about health on your own (my wife is a nurse), you can actually manage to live without constant "health care". Seriously, when did people start needing medical care as an ongoing service, like electricity and water? It's pretty easy nowadays to check your own blood pressure, cholesterol, heart rate, and quite a few other things. We only go to doctors when something doesn't add up.

I see the world today as gone somewhat mad about how to take care of the body. I know younger people in their 30s who are already on multiple medications--statins, beta blockers, blood-thinners, you name it. Diabetics are everywhere, and Coca Cola sales are exceeding forecasts. We are finding that "diet food" actually makes you fatter. We are finding that a certain amount of sun is actually good for you. We are finding that sitting all day in a cubicle is horrible for your health. It's time to start putting two and two together. If you want a healthier population, the first thing we need to do is get everyone exercising regularly, spending some time outdoors instead of under florescent lighting or the pallid glows of their LCD screens, and eating real food instead of the crap that comes from factories (and most grocery stores, unfortunately).

Re:the no pre existing condition/ no drop rule + e

[h4rr4r]

And this right here folks is what is wrong with our country, the "fuck you, I got mine" in the flesh.

This is why we have to force people to get car insurance, because this asshole wants to ripoff society. He can't possibly be expected to actual like a responsible adult.

Re:Doctors, Dentists and Hospitals *love* cash

[h4rr4r]

So what happens when you get cancer? Or something else that costs hundred of thousands to millions to deal with?

I know what will happen, you will leave me the insurance buyer stuck for your unpaid bills.

Re:Doctors, Dentists and Hospitals *love* cash

[cazzazullu]

Here in Belgium it was in the news some weeks ago that delivering a baby was getting disgracefully expensive here, up to 1000 euros for normal delivery, and up to the outrageous sum of 1500 euro for a cesarean. This includes everything by the way, no really, everything.I guess it's all relative...

Re:I have been contacting for just shy of 15 years

[Waffle Iron]

Yeah, and if one of your kids gets leukemia, you're going to go bankrupt and then dump the unpaid medical expenses on the rest of us.

Thanks.

It's great, thanks for asking!

[viperidaenz]

I don't suffer the misfortune of living in USA. My country has a half way decent free public heath system and being self employed I pay less tax to replace some public cover with private. I end up only paying an extra $500/yr to get full private heath insurance and life insurance for myself and my wife.

Re:It's shitty

[Magius_AR]

It is what happens to them right now. I know of cases of it, they died rather than lose the money and their spouse would need after they died.

Why is it that this never used to happen in our healthcare system -- then, we greatly ramp up government/insurance company/employer involvement in healthcare -- then healthcare ends up being a disaster -- and then the next logical step is more of the same, or more government? How does that follow? What's wrong with recognizing a problem we created and undoing it?

Re:the no pre existing condition/ no drop rule + e

[RabidReindeer]

So, the govt should force me to be my brothers keeper? Where is that in the constitution?

Somewhere right about the part where they force me to support armed forces so that Communists can't move in and carry you and yours off to re-education camps.

NOBODY has a choice not to buy insurance

[circletimessquare]

what happens when mr. young stupid and poor ayn rand acolyte with no health insurance breaks his arm?

he avoids the bill or declares bankruptcy

then the hospital passes the unpaid bills on to the state and feds and WE pay, with our taxes, for the moron's "choice" not to be financially responsible for his own healthcare

to "choose" not to have health insurance is to choose to be freeloading shortsighted irresponsible asshole

health insurance must be mandatory

because too many assholes think freedom means freedom from responsibility

Well, that makes sense

[SmallFurryCreature]

Have you been to Japan? They are TINY! You can fit three inside a single MRI and no bits sticking out. Hell, if they bent their knees a bit, they can walk through.

Mean while the average American needs to go to the docks to get x-rayed in line with shipping containers.