Hacker News Reader

Comment by dibujante | Hacker News Reader

As a Canadian, I am astonished at how expensive even the cheapest of these plans are. My monthly healthcare cost amounts to $178, once you factor in the taxes I pay that go to healthcare. That's cheaper than any of the plans in this article. How do people find these prices bearable?

View on HN

I had an emergency appendectomy done in a little rinky-dink Quebec hospital. I was driven in an ambulance 150 miles, had general anesthesia, scope surgery, and an overnight stay in the hospital. Had to pay out-of-pocket for the procedure in cash. It was, all told, less expensive than the half-hour echocardiogram I had a couple years ago. Similar surgeries in the States have cost my insurance north of twenty grand.

It's insane.

> Similar surgeries in the States have cost my insurance north of twenty grand.

I'm assuming you're referring to the amount your insurance company had to pay, not the amount that you had to pay. If so, keep in mind that the prices insurance companies pay for procedures are not designed to make sense on an individual level[0].

I've explained this in more detail on previous comments, but basically, hospitals lose money on publicly-insured patients (Medicare/Medicaid), and so they have to make up the difference by overcharging private insurers. This is why the sticker price for procedures is so heavily inflated - they're intended to be the starting point for negotiation, and the insurers then negotiate standard rates (still inflated, but less so) for in-network providers.

In other words, the amount that your insurer had to pay for your ECG includes an amortization of the amount of excess cost that your insurer bears in order to (effectively) subsidize the patients on public insurance.

In theory, this should not affect your out-of-pocket costs (though of course, in the end, it all does come out of patients fixed monthly premiums, so you still are paying for it in some way).

Yes, this is unnecessarily complicated, but that's the way billing works.

[0] That is not to say that the amount that the insured patients pay for procedures shouldn't make sense on an individual level - just the amount that the insurer pays on top.

I still had to pay my $2500 deductible on the $2600 ECG, so the insurance company didn't worry about haggling them too much.

If you're young, relatively healthy, non-clumsy, male, and childless, chances are you might not go to the doctor once in a year, so it'd be a gamble, but you might very well statistically be better off pocketing the insurance premiums.

Better yet, put on a furry suit, bark convincingly, and go to a vet if you need some common medications or procedures that are mind-bogglingly expensive when prescribed for humans.

$2600 for an ECG is a ridiculous sum.

Out of curiosity, I checked how much my insurance pays a doctor for an ECG (I live in Austria). My insurance (SVAGW) pays 36€ for an ECG. Of course, the total bill would be a bit more since the doctor would likely also charge for consultation (33€), draw blood, order lab diagnostics (6€) etc. The total would probably be well under 200€.

You are lucky that you are in Austria and can check prices somewhere. In US It is really hard to get prices for any medical services (including serious and expensive surgeries) before they are scheduled or you already received them.

My friend had a C-section during the delivery, hospital billed insurance 40K. She paid her deductible. C-section just like many other procedures are not planned and doctors are making decision on-fly during the delivery and obviously you do not have enough time to discuss pricing or negotiate them. So normally in this kind of cases you see the price 1st time in the bill, when you get it in your mail in couple weeks after the fact.

In the macroeconomic figures Canada is reported to spend 10% of GDP[1] or about 4300 USD per capita on healthcare vs your 1524 USD/year[2]. There's two thirds missing right there, and if you are one of the higher payers (average includes kids, pensioners, students, unemployed/disabled etc), there's an even bigger gap. What explains it?

[1] https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... [2] 178 CAD -> 127 USD, times 12 - ok this is missing the PPP correction because [1] GDP is PPP corrected, so might be a little off

They're cheaper than getting sick and not having insurance. I'll pay almost anything to ensure that a sudden medical event doesn't bankrupt me.

> "I'll pay almost anything to ensure that a sudden medical event doesn't bankrupt me."

Exactly, and reflects the mafia-esque choice imposed on the consumer when rates are increased: pay the absurd rate or face absolute ruin if (when) a sudden medical event occurs.

It's mildly terrifying. If you're unlucky enough to break a major bone or get cancer or something like that, you could literally be on the hook for millions of dollars. I lived overseas for a couple of years, and when I got back to the US one of the first things I did was obtain health insurance because of this.

Might be a better option to just declare bankruptcy.

In many cases that's true. Medical debt is the cause of most personal bankruptcies in the US. But it's not a good option either, so better to avoid both if you can. If you have substantial savings then you'd stand to lose those to your creditors in bankruptcy. If you have no savings and don't plan on taking out any loans for a long time then it might be a decent option.

This is one of several reasons I have written off moving back to the US. A unexpected bonus of being an expat is I have no Obamacare requirement. I don't have to buy US insurance (since I couldn't use it anyway) and I don't face an IRS penalty.

Where's your greener pasture?

Thailand. It's not for everybody. But you can get world class medical care at a fraction of the price here.

The end result of the "Affordable" "Care" Act for myself and many others is that we pay more for lesser insurance. So we do pay "almost anything," then sudden medical events can, if not bankrupt us, still cost a pretty penny thanks to the high deductibles.

How high is your deductible? I think the highest I've seen is $5k, which is nothing to sneeze at, but also not really in the realm of bankrupting most families.

The plan I have currently has a $6k deductible for my family, for in-network care - $10k outside of network. This would not bankrupt us currently, no, but it would have as recently as a few months ago, and almost all other times in my life.

I thought that the vast majority of healthcare providers are amenable to payment plans and other forms of assistance.

Definitely, they'd much rather collect late or partially than have you try to evade collection or declare bankruptcy.

However, your room for negotiation is much smaller when you're paying a huge insurance deductible than if you're completely uninsured. Hospitals charge outrageous prices for the uninsured, partly so they have room to make a profit when insurance companies negotiate down, partly to make up for the fact that a lot of uninsured people will never pay, and partly because some people will pay it so they might as well try.

If you're insured with a high deductible, the insurance company has already negotiated prices down by an order of magnitude. Any further negotiation with your deductible starts to really hurt their bottom line, and might run into problems with their arrangement with the insurance company too.

I have to imagine that a payment plan could be arranged without too much difficulty, but actually reducing the total amount could be challenging.

we don't. It is akin to a mafiosi stopping by every month asking for his "protection" money in case a terrorist group will take you hostage and ransack your place. In all other "normal" cases where you need security that said mafiosi says you have to pay for it yourself. The ACA proponent gladly accepts this outrageous proposition.

AIUI, your mafiosi are also obliged to protect you if you are a veteran, when you get old and when you have an emergency, and this makes regular protection much more expensive for you unless he gets protection money from everyone.

They don't, which is why they won't pay for them...

We don't.

That's because, at least in part, the costs in Canada and much of Western Europe are paid for indirectly through other taxes.

No, I factored taxes into my calculation. I am aware that "free" healthcare is not "free" unless you do not pay tax.

According to this [1] which is fairly consistent with other things I've read, US costs are maybe 25% higher than in Canada. What that means is debatable in the context of waiting times, etc.

[1] https://en.wikipedia.org/wiki/Comparison_of_the_healthcare_s...

Looks like it's almost double in the US:

https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

Anecdotally, waiting to see a regular old doctor was faster in Italy than in the US. Some specialist visits involved longer waiting times in Italy. Going private in Italy was generally both fast and cheap: something like 100 euro for a chest X-ray done the next day.

Canada's health care system is good, I guess, but it's generally not ranked quite as highly as places like France and Italy, IIRC. More comparisons tend to be made with Canada and the UK because of the common language.

My understanding is that the Canadian system is a step above the US system but not otherwise that great on a global scale. This is pretty much Canada's national motto.

The US government was spending 25% more on healthcare, pre-ACA, and with less comprehensive healthcare than Canada. Actual healthcare cost overall (on average) is roughly double for all of the year's listed in the chart.

Reply on news.ycombinator.com