Healthcare for self employed engineer in the U.S

[EEVblog]

But as you hint in your post. I do think health insurance for all is a good thing.

Not hinted at, it's essential in a modern society.

Not everyone is fortunate to be born with good genes, or be a male (in terms of cost of health insurance women are much more costly).

That is why I said "through lifestyle choice". If you decide to smoke and get all the related problems, I think you should pay more.
If you chose to eat too much and get obese and get all the related problems, you should pay more.

As far as people who take "advantage of the system" go.. by being carelessly unhealthy when it's in their control to improve it.. you'll always have dead weight. If their own health isn't an incentive enough to get healthier.. money or anything else isn't going to make a difference either.

It's not about making a difference (although financial incentives can help make a difference), it's about fairness.
If you use the system more through your own willful preventable actions, you should pay at least a small penalty for that.

Note that I'm not suggesting that people who can't afford it must pay or go bankrupt or not get medical care, that's what universal health care is for. But for those working and paying taxes and who abuse themselves into needing the system should pay more some way.
And our government does this in a round-about way anyway by for example taxing the crap out of cigarettes.
There has also been the suggestion in recent times of a tax on sugar based junk food products.

[EEVblog]

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? 

We have a fixed "value" for procedures here, i.e. every operation/procedure has a declared value under medicare.
If you want it for free then you wait and get it done in a public hospital. If you want it done by a surgeon of your choice then you pay whatever they charge (better ones charge more) and you can only claim back the declared amount.

My knee operation for example would have been free in a public hospital (probably 6 months wait as it's not life threatening), or I could chose a private doctor either in a public hospital or a private hospital and have it done right away. I chose the later, did my research and got the best surgeon in the country if not a world leading one, and I payed the cost up front. About $4500 up front and then I claimed back about $2500 through medicare.
Bargain.

[EEVblog]

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.

Wow, that's just crazy. Here it's simply a matter of having a comparable wage, nothing else really factors into it much. Ok, maybe professional indemnity insurance (mine costs $800/year), but that's basically it unless you become a Pty Ltd company (greater tax accounting burden, I pay $4k+/year for accounting), but health insurance remains the same regardless, both (universal health care) public and private.
I don't know anyone who gets private health insurance paid for by an employer in this country. Some companies offer some bonuses like income protection insurance and life insurance for example though.

[Moshly]

The insurance side of things is only part of the problem.
Have a look at this -> (skip to 8:30    )

[sibeen]

I'm a 55 year old self employed engineer and the thought of worrying about health insurance never entered my mind. 18 months ago I had a heart attack. Full on cardiac arrest - no half measures. Was on the operating table about 40 minutes later and then spent 10 days in hospital getting fed, watered and annoyed by nurses at weird hours. Walked out and the bastards made me pay about $60 for a months worth of take home prescription drugs.

Sucks to live in a first world country.

[EEVblog]

The insurance side of things is only part of the problem.
Have a look at this -> (skip to 8:30    )

 
They abandoned THAT?

[daveyk]

I'm a 55 year old self employed engineer and the thought of worrying about health insurance never entered my mind. 18 months ago I had a heart attack. Full on cardiac arrest - no half measures. Was on the operating table about 40 minutes later and then spent 10 days in hospital getting fed, watered and annoyed by nurses at weird hours. Walked out and the bastards made me pay about $60 for a months worth of take home prescription drugs.

Sucks to live in a first world country.

$60 is cheap. When I went to pick up my mother in laws pills after she had a heart attack, one month's supply was $800! I bought her a week's supply and got her signed up for the Pace program in PA. A both supply was then maybe $20, but she on has SS and a $93 a month pension so she qualified.

My wife is disabled with her inherited heart decease , but since I make more than $12 an hour she can not collect. She worked for someone for $15 years who collected SS tax every week for her (it's on the paycheck stubs) but he never turned it in! As far as SS is concerned she never worked. That guys is now dead and his estate liquidated. 

I will have early retirement income which not enough to live on but it still puts me over the top so she can't collect or we would be fine.

So without having health insurance and that long hospital stay, what kind of hospital bill did you get and what can you do about it?

Dave


Sent from my iPhone using Tapatalk

[Muttley Snickers]

They awarded me a certificate with mine back in February and if I ever won the lottery at least I now know exactly what to do with it after the fantastic care and consideration they showed me recently in a public hospital, never needed it before but I needed it then, a life changing experience for me.   

[sokoloff]

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.

The adjusters that you are complaining about are serving the role of determining what claims (or portions of claims) are legitimate. I suspect that neither of us have any idea the depth of fraud in the auto insurance claims industry and "legitimate" is a pretty important word there. Every time I've had to go into an auto insurance discussion, I've sensed the grime oozing out of the entire process. IMO, most of it is not placed there by the insurance company, but rather by greedy or dishonest users. Even things as simple as "we'll pay your deductible!" ads from bodyshops are, IMO, blatant theft from the insurance company, and that's just the tip of the iceberg.

It was a happy day when I could stop paying collision insurance and only carry (high limits of) liability on our cars.

[james_s]

The adjusters that you are complaining about are serving the role of determining what claims (or portions of claims) are legitimate. I suspect that neither of us have any idea the depth of fraud in the auto insurance claims industry and "legitimate" is a pretty important word there. Every time I've had to go into an auto insurance discussion, I've sensed the grime oozing out of the entire process. IMO, most of it is not placed there by the insurance company, but rather by greedy or dishonest users. Even things as simple as "we'll pay your deductible!" ads from bodyshops are, IMO, blatant theft from the insurance company, and that's just the tip of the iceberg.

It was a happy day when I could stop paying collision insurance and only carry (high limits of) liability on our cars.

I'm perhaps a bit biased because I'm not a scammer, I've never once been at fault for an accident, hell I've never even been pulled over before or had so much as a parking ticket. I've been rear ended numerous times and the times I've had to deal with the insurance I've always been lowballed and had to fight tooth and nail just to get enough to pay for repairs or buy a comparable car and even then I'm usually out a significant amount. My brothers have both been rear ended and had cars totaled from it, my dad was recently rear ended and his car was totaled, they've all been a huge hassle and cost a lot of money even when it's perfectly clear they were not at fault. When someone is stopped and someone rear ends them there should be absolutely no question of who is at fault, there is zero excuse for rear ending a car unless you are hit from behind and pushed into them in which case there is zero excuse for the guy in the back. When I was a kid we were hit by a diabetic driver who let his blood sugar drop then got in his car to go buy food to raise it, he passed out behind the wheel and hit us nearly head on then hit two other cars too. Turns out he had the same insurance company as us so instead of helping us the insurance company tried to fight us, tried to say the accident was partially my dad's fault, then failing that they tried to say it was no fault, they lost in court of course but it was a huge hassle that dragged on for years. I have no issue with adjusters looking for fraud but the games I've seen them pull to try to weasel out of paying legitimate claims is appalling. A friend of mine worked as an adjuster for a couple years and left because he felt like he was forced to screw innocent people. You watch the commercials and they all talk as though they care about you and are there to help but that's a bunch of hot air. They don't give a shit about you, they care about making a profit and quarterly gains for their shareholders. If I believed in Hell and had any say in the matter I would reserve a special place in it for insurance adjusters and some reserve space for certain others in the industry.

[cdev]

There is an interesting story thats in part about Canadian province Ontario's (failed) effort to create a no-fault single-payer provincial auto-insurance co-op on Page 8 of the PDF here under "A Cautionary Tale". Note, the PDF is about NAFTA which was the undoing of the project but its generally applicable and a good introduction to the subject of "indirect expropriation", a legal concept thats extremely important to health care issues. Highly recommended.

[suicidaleggroll]

The adjusters that you are complaining about are serving the role of determining what claims (or portions of claims) are legitimate. I suspect that neither of us have any idea the depth of fraud in the auto insurance claims industry and "legitimate" is a pretty important word there. Every time I've had to go into an auto insurance discussion, I've sensed the grime oozing out of the entire process. IMO, most of it is not placed there by the insurance company, but rather by greedy or dishonest users. Even things as simple as "we'll pay your deductible!" ads from bodyshops are, IMO, blatant theft from the insurance company, and that's just the tip of the iceberg.

It was a happy day when I could stop paying collision insurance and only carry (high limits of) liability on our cars.

I'm perhaps a bit biased because I'm not a scammer, I've never once been at fault for an accident, hell I've never even been pulled over before or had so much as a parking ticket. I've been rear ended numerous times and the times I've had to deal with the insurance I've always been lowballed and had to fight tooth and nail just to get enough to pay for repairs or buy a comparable car and even then I'm usually out a significant amount. My brothers have both been rear ended and had cars totaled from it, my dad was recently rear ended and his car was totaled, they've all been a huge hassle and cost a lot of money even when it's perfectly clear they were not at fault. When someone is stopped and someone rear ends them there should be absolutely no question of who is at fault, there is zero excuse for rear ending a car unless you are hit from behind and pushed into them in which case there is zero excuse for the guy in the back. When I was a kid we were hit by a diabetic driver who let his blood sugar drop then got in his car to go buy food to raise it, he passed out behind the wheel and hit us nearly head on then hit two other cars too. Turns out he had the same insurance company as us so instead of helping us the insurance company tried to fight us, tried to say the accident was partially my dad's fault, then failing that they tried to say it was no fault, they lost in court of course but it was a huge hassle that dragged on for years. I have no issue with adjusters looking for fraud but the games I've seen them pull to try to weasel out of paying legitimate claims is appalling. A friend of mine worked as an adjuster for a couple years and left because he felt like he was forced to screw innocent people. You watch the commercials and they all talk as though they care about you and are there to help but that's a bunch of hot air. They don't give a shit about you, they care about making a profit and quarterly gains for their shareholders. If I believed in Hell and had any say in the matter I would reserve a special place in it for insurance adjusters and some reserve space for certain others in the industry.

My experience has been nothing like yours.  When I was 17 I was driving down the road at about 45 when a car pulled out of a parking lot just a few feet in front of me.  Totaled both cars, her fault, my family had a check in-hand for more than we had paid for the car literally 2 days later (accident happened on a Wednesday, got the check on Friday, had a new car on Saturday).  She had State Farm, I was blown away by how easy and fast it was.

A few years later I was driving my dad's car down a back road, hit a slick spot, and slid off of the road, hitting a fence.  No structural damage, just paint.  We took the car to 3 body shops, got repair estimates from each, and the insurance company sent us a check for the amount of the middle estimate.  No argument, no fuss.

A couple of years ago my car was parked outside during a hail storm, got lit up pretty bad.  I filed an insurance claim, the adjuster came out to meet me at my office, and while I worked inside she tallied up the dents in the parking lot.  An hour or so later she had the final count, about 3x more dents than I had counted.  She was finding ones I couldn't even see...you had to get down on your hands and knees and catch the sun reflecting off of the paint at just the right angle, it was nuts.  Anyway, a couple of days later I had a check for more than I expected, no fuss.

Honestly, it just sounds like you have an incredibly shitty insurance company.  Who is it, if you don't mind me asking?  I'd like to make sure I never use them.  The no-name companies that advertise on late night TV to suck in people without jobs are typically the ones that pull that kind of crap.  It's the price you pay for scraping the bottom of the barrel to get the cheapest monthly rates you can.

[sokoloff]

Honestly, it just sounds like you have an incredibly shitty insurance company.  Who is it, if you don't mind me asking?  I'd like to make sure I never use them.  The no-name companies that advertise on late night TV to suck in people without jobs are typically the ones that pull that kind of crap.  It's the price you pay for scraping the bottom of the barrel to get the cheapest monthly rates you can.

I can give you one name: Arbella. (Wasn't my insurance, which is generally awesome [USAA], but was the insurance of the guy who hit me turning left across a travel lane I was in.)

You can't always pick the insurance company you're going to use or interact with. In the Arbella case, they didn't want to pay for the dent on the door or scratches on the wheels. (I hit the guy front left, then my car turned right, hitting his bumper with both wheels, the door, and the front fender. They agreed the bumper and fender were "theirs", but the exactl same height and profile dent in the door and chips/scratches on the wheel were "unrelated parking lot damage". My ass. I went 'round and 'round with them for a few weeks and finally just called up my insurance and told them I was submitting through them. Had to pay the deductible, which they then later recovered via subrogation.)

[aiq25]

We have a fixed "value" for procedures here, i.e. every operation/procedure has a declared value under medicare.

Here in the great U.S.A. you can have the same procedure cost differ 100%-300% between hospitals within the same geographic area (there was a survey done in 2012-ish, if anyone is interested I can try to find it again). This is the stuff that makes no sense to me. I can understand little bit of difference but not when it costs three times as much.

Just for a office visit, I looked online and the estimated price range from my insurance company was $110-$400, kid you not. Just for a office visit (I had the flu)! After the co-pay I would still have to pay $90+.

[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.

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? 

It doesn't work that way. Many surgeons over here are independant contractors. Over here the ratings of a hospital gets is made public so name & shame works to keep the good doctors in and kick the bad ones out.

[james_s]

Honestly, it just sounds like you have an incredibly shitty insurance company.  Who is it, if you don't mind me asking?  I'd like to make sure I never use them.  The no-name companies that advertise on late night TV to suck in people without jobs are typically the ones that pull that kind of crap.  It's the price you pay for scraping the bottom of the barrel to get the cheapest monthly rates you can.

I've always been with State Farm, as has most of my family. They've been ok as these things go but the problem is I can't choose what insurance the people who hit me have, it's almost never anything good. In one case the woman had no insurance at all, in the most recent case it was a self insured trucking company. In that case they have steadfastly refused to waive my deductible which is something an attorney I've worked with in the past is surprised by given it was not my fault. Other than that I have few complaints about them but generally it's been the other company. In my dad's most recent incident the at-fault driver has Geico insurance and they've been awful. I've already found their incessant advertisements to be such an annoyance that I would never in a million years go to them for insurance but this experience has really sealed the deal.

The other issue I've had is that I've always driven somewhat unusual vintage cars that are a labor of love to restore and maintain, they are essentially irreplaceable, the appraised value may not be all that high but what does that matter if I can't just go out and buy another one? I've had reasonable luck convincing the adjusters of that but it's always a battle, they try to say it's worth peanuts and total it for minor damage. Then I have to make them search for a comparable car in my region and of course they fail.

[medical-nerd]

Hiya

The rate for a private clinic appointment is usually about £100 in the UK.

The only real personal cost for treatment (other than taxes!!) in our NHS for recognised/authorised treatments are the community prescription drug costs which at £8.60 is about $13 us per item. This is usually a months dose of a drug e.g. a hypertensive.

These costs can rapidly build up if you are on multiple medications but you can buy a prepayment certificate for £29.10 about $37 us which will cover all prescription costs for 3 months.

If you have or develop a recognised long term disease e.g. diabetes, then prescription costs are free for life.

The downsides are waiting months for elective surgery, including cardiac. Urgent or emergency treatment is relatively quick in hospitals.

Unfortunately cut backs mean that too many people are attending hospital A/E units instead of seeing GPs in primary care. An urgent appointment to see a GP can take weeks. This is a consequence of a misguided contract change for GPs allowing them to stop providing out of hours care for a small drop in payments with no substitute in place. (GPs are usually self-employed with their services being contracted for by the NHS).

Despite the problems we are very lucky to have the NHS in the UK, I read in horror the state of the healthcare system in the USA.

Cheers

[mtdoc]

As someone who works within the US healthcare system (I'm here now goofing off!), I can say with certainty that the system is completely, irreparably broken. 

The entire concept of healthcare "insurance" is fundamentally flawed. Everyone, except those who are healthy until killed immediately in an accident, will eventually have many, large, health care expenses. Insurance should be reserved for unlikely events - fires, floods, car accidents, early death, etc.

Employer sponsored health care insurance in the US is a historical artifact that developed due to policies adopted during WWII.

I am 100% in favor of free market economics for almost everything. But there are rare exceptions and health care is one of them. There is no way for a free market to function without true price discovery which does not and cannot truly happen with health care.  "You want how much to remove my ruptured appendix? That's too much, I'm going to shop around", etc.

The AHCA (aka "Obamacare") is a fatally flawed compromise with the health insurance, medical device and pharmaceutical  industries that was never going to fix things.  It did do some good things but it did not fix most things. Health care and health insurance costs where already on an unsustainable trajectory and it did nothing to remedy that.  Now that trajectory is pinned on Obamacare (partly justified IMO).

Unfortunately political ideologues, political tribalism, and market fundamentalism, has prevented any chance of implementing a rational "single payer" system such as exists in almost every other developed country.

Eventually it will probably happen, but only after things get more broken - enough so that the majority of people are willing to elect a real leader who can overcome the petty politics (if any such leaders still exist!).

[edavid]

That is why I said "through lifestyle choice". If you decide to smoke and get all the related problems, I think you should pay more.
If you chose to eat too much and get obese and get all the related problems, you should pay more.

This is way too simplistic.  There is some evidence that smokers and the obese use less lifetime healthcare, because they die faster.  In that case, should they pay lower premiums?

What about women who give birth after age 40?  Is that a poor lifestyle choice?  It certainly increases healthcare costs.

How about parents who let their kids go outside without sunscreen?  Should they have to pay into a skin cancer fund?

[james_s]

This is way too simplistic.  There is some evidence that smokers and the obese use less lifetime healthcare, because they die faster.  In that case, should they pay lower premiums?

What about women who give birth after age 40?  Is that a poor lifestyle choice?  It certainly increases healthcare costs.

How about parents who let their kids go outside without sunscreen?  Should they have to pay into a skin cancer fund?

My own opinion is that we should all pay in the same for health insurance, and there should be other incentives to live a more healthy lifestyle. Not the least of which being you generally get to live longer. I would also suggest triage placing self inflicted illnesses lower in priority for treatment may be viable.

[T3sl4co1l]

My own opinion is that we should all pay in the same for health insurance, and there should be other incentives to live a more healthy lifestyle. Not the least of which being you generally get to live longer. I would also suggest triage placing self inflicted illnesses lower in priority for treatment may be viable.

You're kidding, right?  Few people can think a year ahead, let alone the better part of a century.

And there's the fraction of people who don't want to live long.  Do we "help" them?  Or do we force continued existence upon them?

The question for society is, do we (as a whole) benefit from forcing those people to reconsider their life choices?  (The answer seems to be a modest yes -- if they're productive in the process...)

Tim

[cdev]

No, thats not what's really blocking it. As I said before, the US signed a binding international agreement which when understood in the context of our "specific commitments" one of which is unusually health insurance, blocks many of the things that would save money systematically. It reaches down into not only our healthcare and health insurance policy, it regulates what our national state local and quasi-governmental bodies can do in almost every area of economic importance. "Everything you cannot drop on your foot".

We can't just vote in new everybody and have it change. It subsumes elected leaders. Thats the main goal. To prevent democracy from changing the things that corporations depend on.

This is a short course on its dispute resolution system, you can get a short overview from it.

Quote from: mtdoc on Today at 15:07:53

The AHCA (aka "Obamacare") is a fatally flawed compromise with the health insurance, medical device and pharmaceutical  industries that was never going to fix things.  It did do some good things but it did not fix most things. Health care and health insurance costs where already on an unsustainable trajectory and it did nothing to remedy that.  Now that trajectory is pinned on Obamacare (partly justified IMO).

Unfortunately political ideologues, political tribalism, and market fundamentalism, has prevented any chance of implementing a rational "single payer" system such as exists in almost every other developed country.

Eventually it will probably happen, but only after things get more broken - enough so that the majority of people are willing to elect a real leader who can overcome the petty politics (if any such leaders still exist!).

[james_s]

No I'm not kidding, I see no fair way in a single payer system where everyone has health care to charge differently based on lifestyle. If someone doesn't want to live long then why force them? If they die sooner that actually results in considerably less expense. In the US we spend a huge proportion of our health care expenses in the last few years of life. People who live an unhealthy lifestyle typically die younger and more rapidly. It would be interesting to see the numbers but I suspect it evens out. I believe basic health care to be a fundamental human right in any developed nation. The US is the only place on earth I've ever been to where that is actually hotly contested.

[cdev]

A single payer system has to be noncommercial (essentially free) to be legal under the WTO rules. Also, its the only payer. It combines everything we have into one.

Think about it this way, single payer saves a lot of money by simplifying everything. But you cant have thet be "optional" that doesnt simplify anything. Nor does it save money because people have to pay more because there is duplication of expensive equipment unnecessarily, and all that figuring out what a doctor can propose to a patient based on their insurance and who can get what test and who cant is insanely complicated.

So, suppose people did have to pay and somebody didn't. Under single payer? (Under single payer all the bills are covered by taxes) What then? In the for profit system, then you either have to deny them care or give them really crappy care. But, then you have to complicate everything by having different rules based on payment. Then you rapidly lose all the advantages of single payers simplicity and the fact that under single payer people can go to the doctor right away and you lose all the savings and then its what we have or on the road to it.

So, under the WTO rules, if its public it has to be noncommercial..

So essentially, single payer has to be free.

Here is the text that that principle is based on. A full explanation is complicated but I am giving you some good links below, also you could Google that text and find quite a bit about it. Its controversial because lots of countries - countries where money is charged for a service like the US arent allowed under WTO law to fix things, it gives corporations more rights than people. And thats a big problem.

The two legal experts that have written the most on this are Markus Krajewski and Rudolf Adlung.

Article I:3 of the agreement states:

"For the purposes of this Agreement...

(b) 'services' includes any service in any sector except services supplied in the exercise of governmental authority;

(c) 'a service supplied in the exercise of governmental authority' means any service which is supplied neither on a commercial basis, nor in competition with one or more service suppliers."

------------

Here are some essays about how this has played out in the world now..

No Watertight Compartments- Trade Agreements, International Health Care Reform, and the Legal Politics of Public Sector Exemptions-

Interpretation of Article I, Section 3 (b) and (c) of GATS

Public Services and the GATS

Putting Health First (Canada)

And on medicine - this has nothing to do with GATS it explains why its cheaper in Canada to make it free..  Myth of User Fees and Healthcare Utilization

[mtdoc]

We can't just vote in new everybody and have it change. It subsumes elected leaders. Thats the main goal. To prevent democracy from changing the things that corporations depend on.

I don't disagree but I do think that very strong honest political leadership (if such a thing is still possible) can take on the corporations and lobbyists and make a difference. FDR is the classic example (but Eisenhower, JFK and even Nixon did the same to some extent.) The only way that happens if to be a strong enough leader to both engage strong public support and resist the pressures from the vested interests.

Barring some "end of world as we know it"  scenario, it will happen, eventually.  The current system is unsustainable and no partial fix (a la the AHCA) is going to work.