Max out-of-pocket for insurance plans now is very reasonable. If you can afford a $250k house, you can afford the max out-of-pocket cost for many many years.
Don't you also have to pay the actual insurance premium as well? Before you even get to the out-of-pocket costs? I have friends in the US who pay thousands a month for health insurance premiums.
At 65 you're eligible for single-payer, government-supported Medicare.
I'm not old enough to be keeping an eye on the numbers, but it looks like ~$450 / month for hospital (free) + doctor (subsidized) + prescription (pay).
Then you consider that the total unsubsidized out of pocket cost for a surgery at a private hospital in one of the medical tourism destinations amounts to only a few months of premiums. And on top of it the service and hospitality with which the medical care is delivered is unlike any you've ever even imagined in the US.
All except the smallest employers are required by law to provide health insurance to full-time employees and may have employees contribute up to only 10% of their household income.
I did some random shopping for a typical family of 5 and found a max rate of ~$1600/mo for insurance premiums. You would only pay this if you were self-employed, part-time employed at a pretty shitty job, or unemployed and run out of the various mechanisms to keep your insurance. After that you have to spend your net worth until you qualify for the insurance benefits for the poor in your state.
In reality, with various employers I have paid between $0 and $200/month for insuring just myself. (I have paid $0, I don't remember the most expensive, but it was <$200 in any case)
Who gets screwed and bankrupt are the lower-middle class who can't manage to get a full time job, especially single parents who get sick. The system is biased towards benefitting married partners with children, only one person needs that full time job to cover everyone. If you are in the middle class or above and do only a small amount of planning, you're fine. If you are below the middle, you generally have to lose everything or go bankrupt before the system will help you – people in that position are often the least equipped to figure out and head through the optimal path for themselves and end up making very bad decisions.
We don't need public healthcare, we need better support which reaches higher up the income scale and better education.
I find the idea that employers should have anything to do with healthcare quite revolting. Healthcare should be a deal between you and the government for which you should pay taxes. This and some other reasons are why I cannot fathom living in the US under 250K a year.
> Healthcare should be a deal between you and the government
No, health care should be between me and my physician and whatever other experts I decide to consult. The government has no business meddling in it.
Health insurance or health care cost sharing might be things we could arrange cooperatively through government, but it doesn't seem like it's possible to do that without having the government try to meddle in what care people get.
Well then there will be a variable cost depending on the treatment you need and the prices that the market decides. No amount of money in your bank could give you any financial security as you are basically one accident, surgery or even treatment away from bankruptcy. It could be that this one pill you need is suddenly priced at a million dollars a pill and you cant survive anymore. (Hypothetically can happen in a totally free market).
I for one wouldn't like this level of risk with something so vital to my wellbeing. I would rather prefer that the government took this risk on my behalf of me and just charged me a flat rate throughout my life. (Btw this is the case already in almost all developed countries)
In general there are some things where government intervention is needed. Police, Education, Healthcare and Pension as these things cannot have a totally variable cost decided by a free market.
> It could be that this one pill you need is suddenly priced at a million dollars a pill and you cant survive anymore. (Hypothetically can happen in a totally free market).
No, it can't, because in a totally free market nobody would have monopoly rights to produce particular drugs or provide particular treatments, so if one provider tried to charge a price nobody who needed the treatment could afford, they would go out of business. If it proved to be impossible for anyone to make the drug or provide the treatment at a price anyone could afford, then that would be a failure of the free market, yes; but it's an extremely unlikely failure mode as compared with the much more common failure modes of government granted monopolies and government determined prices.
That said, in a democratic country if the majority shares your risk preference, then that majority can vote for politicians who will enact it:
> I would rather prefer that the government took this risk on my behalf of me and just charged me a flat rate throughout my life.
And that would be a form of cost sharing, which I mentioned--all taxpayers share the costs of expensive treatments, on the assumption that only a small percentage of them will actually end up having an illness that incurs those costs.
However, that still only protects you on the assumption that in fact only a small percentage of people end up having the costly illnesses. But the illnesses people are generally worried about with respect to high costs--cancer, heart disease, arterial sclerosis leading to a high risk of stroke, liver disease, kidney disease, diabetes--are not that rare. So either we keep paying more and more taxes as a higher and higher percentage of people have the illness, to the point where we are just as badly off as if we each paid our own costs individually, or many people end up not getting the treatments at all because there isn't enough money to go around, so the risk you thought you were offloading to the government is back on you again.
This scheme also ignores the possibility of making the treatments cheaper. But the way to do that is to allow free market competition; we don't have that in the US since prices are not set by supply and demand but by a combination of government agencies and private health insurance companies.
> In general there are some things where government intervention is needed. Police, Education, Healthcare and Pension as these things cannot have a totally variable cost decided by a free market.
This is not the obvious truth you appear to think it is. It is an extremely strong claim which is not at all clearly established by actual historical evidence.
> so if one provider tried to charge a price nobody who needed the treatment could afford, they would go out of business
Lets be realistic here. What happens is that most drugs are either actually manufactured overseas or at least can be shipped from overseas for pennies. However due to regulations and lobbying drug companies charge really high prices for the same drugs and they make sure it is illegal to import those drugs. In case the government itself was paying for these drugs it would be much harder for the companies to game the system like this and an individual would be protected from such predatory practices.
> So either we keep paying more and more taxes as a higher and higher percentage of people have the illness, to the point where we are just as badly off as if we each paid our own costs individually,
This is not true if you observe the tax rates in any countries with government funded healthcare. The taxes more or less remain the same but of course there are differences in the healthcare budget.
> This scheme also ignores the possibility of making the treatments cheaper.
Once again the healthcare costs in the US have actually risen quite significantly under the private system.
> This is not the obvious truth you appear to think it is. It is an extremely strong claim which is not at all clearly established by actual historical evidence.
Police and education it already is true even in the US. Even pension has significant regulation. The only reason healthcare is not is aggressive lobbying by private companies.
One of the large bureaucracies will be there as long as you're alive, and there is no need to switch between health provider paperwork or worry it will disappear when you change jobs or become unemployed.
One word: accountability. Your employer is not accountable to you, you’re at best a cost center. Your government is accountable to you via process known as democracy.
No, it, literally and directly does, that's the definition of it. Your representatives are accountable to you via vote. If not that, then what do you think democracy even means?
I think democracy generally means that the population elects representatives who establish policy. That’s certainly true. But in what sense is the government actually accountable to an individual in any meaningful sense? If you are wronged by a democratic government do you honestly believe that you have a remotely decent chance of holding the government accountable? And how about for individuals who are among the least fortunate in society?
I mean, this tends to be covered in high school civics classes.
The government is bound by a constitution. Violations of your constitutional rights are remediated on an individual basis through the judicial branch. You may individually hold the entire government responsible for violating your constitutional rights. This happens regularly.
The government is also accountable to you in aggregate through the voting process. Yes you don't get to vote on each individual issue, as you're not an expert on literally everything and have other things to do, so you delegate. Less delegation happens in America than in basically every other established democracy. You don't like what your representative did, vote for someone else, or run for office.
The least fortunate are the disproportionate beneficiaries of constitutional rights. Yes it's not perfect, and direct democracy tends to lead to squelching the rights of minority groups, but that's why America has a constitution plus 3 branches of government with various checks and balances.
Your employer has literally none of the above, which is why it has no business in your healthcare. If you get fired from your job and lose access to healthcare you don't get to run for CEO, you get to fend for yourself. If you're wrongly denied cover under a socialized medical system you can sue anyone and everyone involved and also vote them out, while still having access to the private markets to fend for yourself just as you would have if you left the company you worked at.
And I'm asking you not just to show that a bunch of bad stuff has happened, but that in its totality at least one country most people would consider a democracy (a good but imperfect shortcut for this is if Freedom House rates them as such) has essentially no accountability.
Well, if you think that showing many many examples of democratic governments wronging individuals and then not being held accountable for those wrongs (including many examples of long-standing systematic wrongs, not just one-off extreme cases) is NOT sufficient evidence for the claim “democratic governments are not accountable to you,” then I don’t know what evidence would satisfy you.
Let me guess: you're thinking of civil foreiture and qualified immunity in the US?
I don't dispute the US is non ideal, I do dispute that as a whole the government is unaccountable. For example, what do you think would happen if Gavin Newsome (governor of California) had someone killed for disrespecting him? That's the kind of thing really unaccountable governments get away with.
So I'm asking you to not only show that bad things have happened and not been adequately punished, but that the government is fundamentally as unaccountable as a reference unaccountable government, like the U.S.S.R under Stalin or Britain under Oliver Cromwell.
Yes, that's an extreme requirement. But you made an extreme claim when you said not just that democracies are insufficiently accountable to be completely just but that they are unaccountable.
I didn’t have specific examples in mind, and my argument is not about what type of government is ideal or even whether it’s possible to do better. My claim was simply that democratic governments are not accountable to individuals in any ordinary meaningful sense, and I stand by that.
Of course many governmental officials would likely be held accountable for extreme misconduct if they weren’t able to cover up the evidence. And of course certain governments are more accountable than others.
Just the everyday definition that people use in normal conversation, not subtle insinuation about political philosophy or anything like that. I’m accountable to my employer for showing up and doing solid work. A student is accountable to their instructor. I’m accountable to the government for my income taxes (and many other laws). It just means that there is a fairly clear set of expectations and a pretty reliable and straightforward process that disincentivizes violation of those expectations in practice (not just in theory).
You may be in the fortunate position that your government is not in an adversarial relationship with you. There are many people with that good fortune. But there are also many people who are not in that position.
Because I want to switch jobs without switching doctors loads of paper work, and health is the sort of fickle thing where if I get really sick they will always be able to price-gouge me so I rather remove the profit motive.
>I have friends in the US who pay thousands a month for health insurance premiums.
This sounds like an entire family with a higher-level plan, correct? Higher-level plans have correspondingly reduced out-of-pocket maximums, to the point where the out-of-pocket maximum can be as low as $2000/year — so your premium is nearly your entire spending.
I am just about to sell my father's $320,000 house so I can pay for his nursing home care. He sadly did not have the foresight to acquire long-term disability insurance or put his assets into a trust so we'll be paying out of pocket until his money runs out and he goes on Medicaid, which will still only cover 60% of his care.
$320,000 / $8000+ a month (not including rising costs) means he has 3.25 years of care coverage paying out of pocket which I don't consider many years.
Don't forget about the annual max gift tax limit (15k for 2020). Your father could reasonably gift you 15k a year (possibly another 15k to your spouse if you happen to be married) to reduce his savings a tiny bit quicker, so medicaid kicks in a bit sooner. At that point you could maybe even claim your parent as a dependent, and help him pay for his medical costs (which I think you can also deduct?).
I'm not sure on the particulars, and certainly don't take the above as any kind of financial advice -- I just started looking into this for an aging parent myself. Though, it might be worth talking to an accountant and see what is applicable for your location.
If I understand correctly from my non-CPA googling, $15K is just the amount you don't have to report to the IRS. You can give more, up to a lifetime limit of several million, before the gifts are taxed. How that interacts with medicaid, I have no idea.
There are the local medicaid/medicare administrations and elder care law specialists that can advise on medical care as well as the various tax writeoffs and eligibility for programs that the poster should investigate now since rules vary so much from state to state in the USA, and he is talking about years of care.
> I am just about to sell my father's $320,000 house so I can pay for his nursing home care.
You’d be doing this in the UK on the NHS too. The patient needs to pay until their assets are drawn down until a certain amount, and then the government will take over until death.
Is he not eligible for Medicare? I thought even the pricier Part C plans would be less than $8k for a whole year's worth of premiums + the out of pocket maximum
The last time I had to look at this, one cannot have any assets in excess of a small dollar number for Medicaid, so one has to start drawing down all savings to pay for care, and Medicare does not cover long term care, only short stays for specific reasons.
Now you know why I'm waiting to see my PCP despite having earlyish symptoms of heart disease. Should I have a heart attack it's better to leave my wife a cheap, dead corpse and a life insurance payout rather than an expensive out of work husband. That's the calculus of the American medical system.
Get checked. Think about it. If you're worried about money you will spend less if you catch and manage something early than if you're late and whatever you have doesn't kill you but makes you very sick.
If you're not insured, get insured. Financial planning via expecting death is just foolish.
Whoa, I always figured that Rabies would be like a state covered thing, given that generally every case makes a news article. Sorry that happened to you, did you for sure come in contact with Rabies or just suspected?
Max out-of-pocket for insurance plans now is very reasonable. If you can afford a $250k house, you can afford the max out-of-pocket cost for many many years.