Healthcare for self employed engineer in the U.S

[daveyk]

Health insurance in the US is a complete nightmare, it traps people in their jobs because most of us rely on our employers to provide it via group negotiated policies. The ACA helped in some ways and hurt in others. It has the serious flaw of no cost controls, something that is shared by proposed successors. IMHO health insurance should not be a private for-profit industry, and all citizens should have some sort of basic healthcare, at least for catastrophic illness and some forms of preventative care. Nobody should ever have to choose between dying and bankruptcy, we are a wealthy enough society that there is no excuse for allowing people to die of treatable illnesses.

Agreed thank you. I've worked for the same company for 36 years. Two days after Trump was elected, they announced we are being closed and moved overseas. In about 3or 4 months, I'll be 57 with no healthcare for my family and my wife has severe heart problems. We have no idea how we will keep getting her 18 pills a day; no idea.




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[basinstreetdesign]

One of out field guys was on a job in England and broke a leg.  He was in the hospital there for a week and when he left, he did not have a bill; they covered him, or so I was told.  Wow.  Germany has health care for their citizens and free university.  Yes, they may have a high federal tax, but I bet it's cheaper than us paying federal tax, state tax, SS tax, Medicare tax, local tax, etc and then paying insurance health insurance premiums on top of that.  Plus when they loose a job, they still have health coverage.  England is similar from what I am told along with Canada. Sure you may have a long wait for elective surgeries, but that is acceptable in most cases.   Our health care payment and coverage system is becoming the joke of the world.

Whenever I hear someone talk about how the health system works in the USA I'm dumbfounded.  And then flabbergasted by the talk of people who insist that they dont want Government meddling with their doctorin'..  Thank God I live in Canada!.
How much do you think the following health history would have cost you in the states?
2 heart attacks,
triple bypass surgery,
gall bladder surgery,
HUNDREDS of doctor visits,
4 angiogram procedures,
2 ambulance rides,


So far the total bill for all of that has been $10 for a couple of phone calls.  The only thing I regret is that I never got lights and sirens with the ambulance rides!  All of this was laid on by the Ontario health plan, OHIP.  I never paid a cent in premiums, payroll deductions or anyway else.  All of it is covered through payroll contributions from the employers.  They make the payments starting when they hire someone.

Despite all of the BS spewed by politicos who have an axe to grind or are being paid under the table by the big health care companies,  I cant say enough about the system here.

And another thing, for someone with a cardiac history, how do you think I would have fared if I had to worry about the cost of all this?

My best advice is to go talk to someone (lawmaker) who legitimately WANTS to change things for the better not just ensure their perpetuation in office.

[daveyk]

One of out field guys was on a job in England and broke a leg.  He was in the hospital there for a week and when he left, he did not have a bill; they covered him, or so I was told.  Wow.  Germany has health care for their citizens and free university.  Yes, they may have a high federal tax, but I bet it's cheaper than us paying federal tax, state tax, SS tax, Medicare tax, local tax, etc and then paying insurance health insurance premiums on top of that.  Plus when they loose a job, they still have health coverage.  England is similar from what I am told along with Canada. Sure you may have a long wait for elective surgeries, but that is acceptable in most cases.   Our health care payment and coverage system is becoming the joke of the world.

Whenever I hear someone talk about how the health system works in the USA I'm dumbfounded.  And then flabbergasted by the talk of people who insist that they dont want Government meddling with their doctorin'..  Thank God I live in Canada!.
How much do you think the following health history would have cost you in the states?
2 heart attacks,
triple bypass surgery,
gall bladder surgery,
HUNDREDS of doctor visits,
4 angiogram procedures,
2 ambulance rides,


So far the total bill for all of that has been $10 for a couple of phone calls.  The only thing I regret is that I never got lights and sirens with the ambulance rides!  All of this was laid on by the Ontario health plan, OHIP.  I never paid a cent in premiums, payroll deductions or anyway else.  All of it is covered through payroll contributions from the employers.  They make the payments starting when they hire someone.

Despite all of the BS spewed by politicos who have an axe to grind or are being paid under the table by the big health care companies,  I cant say enough about the system here.

And another thing, for someone with a cardiac history, how do you think I would have fared if I had to worry about the cost of all this?

My wife has severe heart issues that have to made worse by her worrying about how we are going to pay for it all. This year I had 1000$ in an HRA and $2550 in an FSA and we spent every cent so far.  My wife's echo-cardiogram cost us about $2100 after it was run through our insurance!!


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[nctnico]

The simplest starting point I've seen suggested to fix this, is:
Require hospitals to post a fixed rate, or estimate at least, for standard operations, in a suitable location (lobby, office, handouts, whatever).

That is how it works over here. The government has set a fixed price for every procedure. Healthcare doesn't work otherwise because people tend to get scared they don't get the best.

[james_s]

I've heard lots of horror stories about the Canadian healthcare system, but I haven't had much success finding these mythical Canadians who have had such horrible experiences. I'm sure some of them exist, but almost universally the Canadians (and those from other developed nations) I've encountered are appalled by the state of things down here in the US and the fact that such vast numbers of people in such a wealthy nation have no health coverage at all. As much as I love my country, we certainly have flaws and our healthcare is a glaring one. I mean the care is great, arguably the best in the world, if you can afford it. The problem is that's a very big "if"!

[rdl]

How long after emigrating to Canada from the US would it take to be eligible for their health care?

[suicidaleggroll]

How much do you think the following health history would have cost you in the states?
2 heart attacks,
triple bypass surgery,
gall bladder surgery,
HUNDREDS of doctor visits,
4 angiogram procedures,
2 ambulance rides,

With insurance, I'd estimate in the several tens of thousands of dollars, depending of course on the insurance plan you had and over how many years all of this occurred (most plans have yearly out-of-pocket maximums).

Without insurance, I'd guess several hundred thousand dollars.  Enough to put most people into bankruptcy at least once.

Our healthcare system is a joke.

[cdev]

Its very expensive unless you can get it through a professional organization and thats getting harder. The cost varies a great deal depending on where you are both by state and locality with the most expensive health care being in places like New York City. If I told you how expensive you would likely think I was lying so see the screenshot below. This is from 2009.

The prices have fallen from then because of "Obamacare" a sort of insurance of last resort for self employed working people, which is certainly better than nothing although it does have extremely high deductibles in most of their plans as far as I know. Whats likely to happen is because a great many people did manage to get insurance which lessened the write-offs when people got really sick and basically there was zero chance they would be able to pay because they had no assets which could be taken, so what will happen is because that will no longer be the case the prices for self employed people as well as employer plans are going to soar back up again because they have to get that money somewhere. Also, we will be back to the situation pre 1998 (WTO rules explicitly say and a declaration the US participated in at the Shanghai G20 meeting  implies we are supposed to roll back our "protectionist" regulation to the state before Feb 1998) Anyway, back then it was truly hellish for sick people and there were a lot fewer people working without insurance, many people don't remember but we were in a horrible situation back in the 1990s- for example,  when if somebody at a small company got some serious illness their company would see huge price hikes - invariably resulting in their getting laid off "in order to save the rest of the employees insurance".  People who had some illness in their families were basically blacklisted from getting employment.

This is not a good time for the US, and they are not getting better. if you were thinking of moving here I would think long and hard about whether you can afford it..

[boffin]

Health insurance in the US is a complete nightmare, it traps people in their jobs because most of us rely on our employers to provide it via group negotiated policies. The ACA helped in some ways and hurt in others. It has the serious flaw of no cost controls, something that is shared by proposed successors. IMHO health insurance should not be a private for-profit industry, and all citizens should have some sort of basic healthcare, at least for catastrophic illness and some forms of preventative care. Nobody should ever have to choose between dying and bankruptcy, we are a wealthy enough society that there is no excuse for allowing people to die of treatable illnesses.

Agreed thank you. I've worked for the same company for 36 years. Two days after Trump was elected, they announced we are being closed and moved overseas. In about 3or 4 months, I'll be 57 with no healthcare for my family and my wife has severe heart problems. We have no idea how we will keep getting her 18 pills a day; no idea.

Depending on your education (you need a BSc in an engerineering subject), but if you can get a job in Canada, welcome to canada under the existing free trade agreement.
https://www.tnvisabulletin.com/tn-visa-scientist-occupations

Once you have your job offer and your transcripts, it's not much more difficult than showing up at the border.

[rstofer]

The simplest starting point I've seen suggested to fix this, is:
Require hospitals to post a fixed rate, or estimate at least, for standard operations, in a suitable location (lobby, office, handouts, whatever).

That is how it works over here. The government has set a fixed price for every procedure. Healthcare doesn't work otherwise because people tend to get scared they don't get the best.

A system like that will degenerate to mediocrity.  What's the point in becoming the 'best' in your field if you get paid the same as the donkeys? 

Most of the cardiologists around here are independent contractors (they aren't employees of a hospital) and bill separately for their services.  The hospital bills separately for everything they provide.  It's a nightmare!

I agree that our system is hosed and, personally, it will get worse when my wife retires (again).  We still don't know how  medical is going to work out.

[basinstreetdesign]

How long after emigrating to Canada from the US would it take to be eligible for their health care?

Just made a cursory perusal of the Canadian Government website re immigration:

http://www.cic.gc.ca/english/residents/new_immigrants.asp

If you click on "Start your New Life In Canada", then "Health Insurance"  it tells you that it can take up to 3 months AFTER you get a Permanent Resident card (but then keep in mind that we ARE talking about the federal government here).  I cant find where it says how long it takes to get a PR card...

Then again, if you have no insurance where you are and are willing to spend a few months landing a job somewhere in Canada, what's 3 mo.?

[cdev]

If you are in Canada and suffer an emergency or if you are legally resident in Canada its my understanding that means you can go to the doctor. As far as I know they are not equipped to take your money. That doesnt apply to prescriptions there many people have insurance through work. The prices of drugs in Canada are much lower than in the US though and they are identical drugs . More than a decade I lived for ten years next to a household that was mixed Canadian and French, so have had lots of exposure to opinions about the Canadian healthcare system. This was in SF and my Canadian next door neighbors (we shared our back porches and our doors were always open) used to fly home whenever they needed medical care. That tells you something.

The two least complicated ways the WTO rules work you either take money and are completely commercial (like the US) or you are completely noncommercial and money is never taken like Canada. There is no such thing as a "public option" if you didnt already have something in 1995. (Date the WTO came into force) Whatever you had then however you can keep. As long as you dont change it.

Canada has wisely taken the second path and avoided the express route to privatization that the UK is now on because of the WTO GATS agreement.  Australia has a hybrid system which is more difficult and potentially dangerous- unless they explicitly carve out all their public services from trade agreements.




Quote from: rdl on Today at 18:49:09

How long after emigrating to Canada from the US would it take to be eligible for their health care?

[cdev]

I have two American friends who lived in Holland for quite some time and came back to the US a few years ago. They still are on their Dutch health insurance because they have not been able to find health insurance in the US they could afford. One of them is an engineer, I dont know his current state of employment. He may be working but it sounds like his job doesn't seem to offer insurance. they are in the Bay Area. Their rent is also astronomical now. They live in a warehouse mixed live work space.

I should add this link. This is a brilliant paper on the causes of our health care mess written by a 27 year old law student who was pushing for single payer in 2009, he was a third year law student at Northwestern University in Chicago.  he died not long after it was published from unknown causes.





here is a video that was taken of him around five weeks earlier.

This PDF is also very informative on the current US healthcare situation.


Quote from: nctnico on Today at 18:31:23>Quote from: T3sl4co1l on Today at 15:12:25

The simplest starting point I've seen suggested to fix this, is:
Require hospitals to post a fixed rate, or estimate at least, for standard operations, in a suitable location (lobby, office, handouts, whatever).

That is how it works over here. The government has set a fixed price for every procedure. Healthcare doesn't work otherwise because people tend to get scared they don't get the best.

[Dielectric]

...depending of course on the insurance plan you had and over how many years all of this occurred (most plans have yearly out-of-pocket maximums).

...
Our healthcare system is a joke.

Ha, guess how I learned to make sure we get pregnant in the first quarter of the year?  Health care deductibles reset on Jan 1, no matter if you're in the "middle" of something or not.

[cdev]

If your business has a professional organization I would look there first. If you are legitimately employed in your profession in the past (less so now because its become so hard to find) there usually was some kind of organization of people who do what you do whatever it is that offered/offers group insurance.

IMHO health insurance should not be connected to jobs.

Quote from: aiq25 on Today at 10:47:29

I always wondered what people do about health insurance in the U.S. who are self employed. I tried to buy healthcare insurance for my mom and man there wasn't any comparable plan to what she had before getting laid off (she was a machine operator).

I figure it can't be any better for those who have their own business. Anyone have any experience? I think someday I would like to work on a contract basis (my current employer allows this once you have enough experience) just to get a bit more flexibility and try to work on different types of products/projects. Not anytime soon though. Things will probably change quite a bit when I get to this stage.

Note: I am not trying to start up a political debate. Just curious.

[aiq25]

If your business has a professional organization I would look there first. If you are legitimately employed in your profession in the past (less so now because its become so hard to find there usually was some kind of organization of people who do what you do whatever it is that offered/offers group insurance.

Currently I have very good insurance, compared to what I have to pay and the benefits. My previous company (which was a much larger organization), I was so surprised at how good the insurance was. I had zero out of pocket costs, except for co-pays (not even deductible). I have to go see a eye specialist at least twice a year (I am extremely nearsighted). Under my old employer these were considered office visits (even the tests they run). My new employer and my first job I have to pay the deductible for the test and the office visit.

Based on these posts I don't think I will go the contract route or even my own business, it doesn't seem worth it unless I can pay like $30k-$40k a year on health insurance for my family (I mean including the premiums, deductibles, co-pay, etc...).

[aiq25]

I didn't want to bring up Obamacare but since many have brought it up, I agree there are tons of disadvantages but I have two family members who benefited from it (or will/can), after it helps someone close to you I think you realize the advantages.

My Aunt was diagnosed with breast cancer back in 2006/07 and her insurance (through her employer) dropped her coverage after finding out. Yup, they dropped her coverage. She was lucky because she was able to get private insurance, at a whopping $400/month. I know it sounds cheap compared to now a days but she was making around $18,000/year but at least she had coverage. One of my other family member was able to get insurance through Obamacare.

Yeah the situation in the U.S. is horrible. I'm just glad my employer offers it and I have decent enough income to be able to afford the extra costs.

I just don't understand why this topic becomes so political (at least to the general public). Me and my friend were talking about it today... We really think insurance in general should not be profit. Same with the education system.

If you guys (who are outside the U.S.) think the healthcare insurance is bad, our auto insurance is not as good either. I live around the Detroit area and used to pay about $300/month for coverage (now it has dropped to $155/month since I moved a bit further north).

[cdev]

There are a number of supplements that can dramatically cut risk of heart problems. One is high DHA fish oil, omega 3s, another is resveratrol (which helps dozens of things, all sorts of things, its also good for the eyes, for the back, its good for your brain)


Resveratrol works best if you let it soak into the membranes in your mouth, rather than swallowing it.  PubMed will be helpful in looking up medical conditions.

[james_s]

Car insurance is a complete racket too. They're more than happy to take your money for years and act like they're there to help you. Then when something happens and you need them they have teams of adjusters who's sole purpose is to reduce payouts through whatever means possible. Then they jack up your premiums to recover all that they paid out and then some. Things like the "accident free discount" are scams, it's not a discount, it's the regular price which they then jack up if you ever file a claim. Then if you end up suing them an winning they can blacklist you which means they drop you and the other insurance companies raise your rates way up. It's like dealing with the mafia.

Insurance absolutely should not be a for-profit business. It should be a collective, everybody pays in as needed and it pays out when a legitimate claim is filed.

[cdev]

See attached image for an example of how much costs can vary with pregnancies. This shows why caps on allowed charges are potentially very valuable and are bad to lose. Nothing is worse for health than so called balance billing.

There are so many changes and Americans are so math challenged I think the AHCA is going to be a much worse disaster than anybody realizes. They dont get how out of control the system is or how costs wont go away they will just get shifted.

Balance billing can mean that somebody who does everything right can get hit with a totally unexpected bill out of the blue for huge amounts. One person I know had a spine operation had good insurance, went to an in network hospital, bla bla, and it turned out they had to use a different anesthesiologist- cost $70,000  He disputed the bill and eventually got it whittled down - to $18,000

This is why increasingly only very rich people in America can go to the doctor without fear now.  Everybody else has to really stay on top of it because if you don't, they will sock you.


BTW, I think I know what the GOP healthcare plan may be.  India.  Dem plan was likely to be too. I'm not kidding.

[cdev]

Alq25, they won't tell the country this but they actually signed away the right to do that (have real non-profit health care) 22 years ago in a binding trade agreement. And never told the country a damn thing about it. I am not kidding. However because there still are no foreign insurers in the US there still is a sliver of "hope" but its vanishing rapidly. There is no hope if the entire country has been successfully deceived.

Now there is a cover up of this and you would never know. Politicians have run on a platform of single payer and never told the country that this old "pre-existing" FTA and a new one almost done in Geneva are on the verge of making it truly impossible for good.

Its a global agreement. So the US isn't the only country that is getting lied to. Read my other post, especially the PDFs I link to. Thats the real story.

[LabSpokane]

Don't forget that if you are self-employed you also have to pay self employment tax.  You have to pay double for social security and medicare.

 
Seriously?

No joke.  The country of innovation puts up huge barriers to self-employment.  Most engineers grotesquely underestimate what their hourly rate must be when going on their own in order to have a comparable wage and benefits to what they were when employed by The Man. 

[SkyMaster]

How long after emigrating to Canada from the US would it take to be eligible for their health care?

Just made a cursory perusal of the Canadian Government website re immigration:

http://www.cic.gc.ca/english/residents/new_immigrants.asp

If you click on "Start your New Life In Canada", then "Health Insurance"  it tells you that it can take up to 3 months AFTER you get a Permanent Resident card (but then keep in mind that we ARE talking about the federal government here).  I cant find where it says how long it takes to get a PR card...

Then again, if you have no insurance where you are and are willing to spend a few months landing a job somewhere in Canada, what's 3 mo.?

It is after 3 months in the province of Quebec.

But this service is not cheap. 50% of my income go into taxes of various forms, and then 45% of all the taxes I paid go to the provincial health care system.

The bottom line is that I pay 22.5% of my income to cover the health care system. Also, the health care system does not cover everything when you are not inside a hospital. Among other things, medications are not covered.

 

[basinstreetdesign]

How long after emigrating to Canada from the US would it take to be eligible for their health care?

Just made a cursory perusal of the Canadian Government website re immigration:

http://www.cic.gc.ca/english/residents/new_immigrants.asp

If you click on "Start your New Life In Canada", then "Health Insurance"  it tells you that it can take up to 3 months AFTER you get a Permanent Resident card (but then keep in mind that we ARE talking about the federal government here).  I cant find where it says how long it takes to get a PR card...

Then again, if you have no insurance where you are and are willing to spend a few months landing a job somewhere in Canada, what's 3 mo.?

It is after 3 months in the province of Quebec.

But this service is not cheap. 50% of my income go into taxes of various forms, and then 45% of all the taxes I paid go to the provincial health care system.

The bottom line is that I pay 22.5% of my income to cover the health care system. Also, the health care system does not cover everything when you are not inside a hospital. Among other things, medications are not covered.

 

Quebec's rules are ALWAYS different than the rest of Canada on just about everything, mostly because they want it that way...

The Ontario gov has been covering about 2/3 of my drugs since 2007 when I left work and now when I turn 65 it costs me $6.11 per script at the drug store no matter what the drug is and at the rate I use drugs the coverage amounts to even more than 2/3 but cant estimate it on short notice.  I pay about $150/year.

Yeah, the taxes may seem high here.  It has been estimated that the average Canadian pays about 52% of gross income in taxes of all sorts (income, sales, land transfer, etc) but at my time of life it gets better since the less you make the less tax you pay.  I haven't paid income tax in a decade.

Oh and did I say that the health care benefit stops when you lose your job?   Well, guess what!

It doesn't!  EVERYBODY gets it no matter what their situation!  And don't believe the lies the GOP will tell you about outrageous waits times.  The 2nd to last time I had an angiogram it was arranged in less than 24 hours - surprised me but there you are.

[HackedFridgeMagnet]

I am not really sure how they work this stuff out but this picture certainly makes a point.

it's from http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129547594