Just to kick this one off, I have had no health insurance for almost 15 years and go to a doc in a box when absolutely necessary.
"Why that's insane!", you say.
No, the US health care system is insane. This was immediately obvious to me when I emigrated to the US from Canada 20 years ago.
The biggest hindrance to entrepreneurial activity in the US is the health care morass. I was discussing this with a friend 4 days ago. He just graduated college this past spring semester and longer has school mandated coverage.
Hours later he took a mallet to the face playing bike polo and went to the emergency room where they told him that just to look at him would cost 400 dollars. Any services would would be more and they did not know how much more until he agreed to pay the 400 bucks.
Fortunately a mutual friend is a nurse and he was able to text him and get a surgeon to unofficially give him a look over and let him know he did not need stitches.
He was not convinced when first discussed the issue but less than 24 hours later he agreed based on his new experience as a member of the newly uninsured.
As a Canadian who will be moving soon to the US, can you give me some advice re: medical care? I'm looking into buying health insurance above and beyond what my employer is offering (which is quite honestly extremely poor).
I find the entire thought of the health care system being private to be completely unnerving, and as you put it, insane. Why a man has to worry about his bodily well-being to the extent that if he has to give up his life savings for an accidental injury is confusing to me. This hardly even seems civilized, much less wise.
It not only makes no sense individually, it is also insane as a whole - by not covering preventative care for everyone you are increasing the virulence of your disease outbreaks, and even in non-contagious diseases and conditions you're still spending much more money in the end than if you nipped the problem in the bud via regular checkups and whatnot.
I know most of HN is American, and you have to excuse me for saying this, but as someone who's never lived long-term in the US your health care situation seems like something out of a bad dream. I cannot imagine the fear that you guys live with - the fear that I'm about to face in a couple months time. Oy.
The part that's frightening is major medical expenses. Any trip to the Emergency Room or stay in the hospital is going to run into the thousands, and easily into the tens of thousands of dollars. The regular non-emergent basic stuff can and should be taken care of at an Urgent Care or at your primary care physician's office. Those visits are usually less than a couple hundred bucks. And, those can be managed by paying cash.
They're a non-profit consumer advocacy company, and my $25 yearly subscription to their website pays for itself every single year. Great information and great advice.
If you move somewhere Kaiser Permanente serves, I've been very happy with them. For all the histronics about how bad the health care system is in the US, I've found the care is quite good if you do some research and are willing to pay for it. My policy is about $250 per month, covers all emergency and severe horrible things, I can visit my doctor within a few days of scheduling, I can get a metabolic panel and have the results emailed to me for $10, etc.
Looks like Seattle isn't covered by them - any other suggestions for providers? I've looked at Blue Cross, but I'm really quite clueless when it comes to which ones to go with and which ones to avoid. Any help would be awesome.
For the record, the company's offering is through Aetna - and my brief overview online comes up with some pretty bad horror stories. What's the general impression of them on HN?
I had them for a couple years through my last employer ("AHF POS II" policy in California, FWIW), with some moderate medical expenses, and I have no complaints.
When I had to buy insurance on my own I ended up with KP after similar online research, scared off by the stories too, but there seem to be horror stories about all the providers; as far as I can tell, at best you can only choose a lower probability of them.
I hope you are at least putting away a good chunk of change so that you have some cushion if disaster strikes. A mallet to the face is one thing, but what about a progressive disease like cancer?
I've worked as an ER/Critical Care nurse for 15 years, and this author is correct in saying that health care costs in this country are particularly opaque. I have absolutely no idea how much the stuff I do costs. That can be a good thing as well as a bad thing. I'm not tempted to ration care at all because someone doesn't have insurance. So, if you get sick, we take care of you regardless of ability to pay. We have to, it's the law.
But, the other part of the problem, is that people without insurance often come to the ER when they are ill, because they haven't established a relationship with a doctor or clinic. So, when they get sick, they go to the ER and purchase the most expensive care possible for their earache or sore throat.
Think about it, in the ER, we are trained and prepared to save lives in a heart attack, keep you alive long enough to have an operation if you get shot in the chest, or administer antidotes in case you get bitten by a rattle snake. We have all that equipment lying around just in case, and we're trained to use it. But, many of our patients have ear infections, runny noses, back aches and sore throats. Not exactly cost effective care.
A big reason for the lack of transparency in hospitl billing is that there are different tiers of payment depending on insurance. The hospital negotiates different rates with different categories of insurers.
Out of network private insurance pays full
price or at times refuses to pay full price. In-network private insurance generally negotiates a 70-80% rate. Medicare and state public insurance generally pays a 15-50% rate. Non-Insured patients get billed at the full rate, but generally only 20-30% of those people fully pay their bills. So, many hospitals will give you a discount if you pay cash within a month
or two of your visit.
Also, doctors aren't able to bill by the time they spend with you. Because of Medicare, the whole industry pays per diagnosis. So, if you get diagnosed with a pneumonia, Medicare pays a flat rate no matter how long you stay in the hospital, either 1 day or 10.
Finally, most hospitals, if they are making money at all, are operating on a 1-2% profit margin. It doesn't take much for them to go under, and they often need and get subsidized from the state or federal level.
15 years ago, I was very Conservative politically, thinking that market forces would sort it all out. But, the longer I work in health care, the more I think that we should just go to a single party payer system. I actually think that it would actually eliminate a lot of bureaucracy and cut a lot of costs. It'd be a hard sell in this country, though.
Think about it, in the ER, we are trained and prepared to save lives in a heart attack, keep you alive long enough to have an operation if you get shot in the chest, or administer antidotes in case you get bitten by a rattle snake. We have all that equipment lying around just in case, and we're trained to use it. But, many of our patients have ear infections, runny noses, back aches and sore throats. Not exactly cost effective care.
That's one of the biggest goofs of the American medical system. Trying to treat catastrophic care and routine care in exactly the same way makes it difficult to craft a system that works. The right insurance policy to pay a $50,000 accidental injury claim is not the right policy to get $25 worth of tetracycline. In trying to combine an insurance policy against large unforeseen medical costs with a prepaid, tax-free, employer sponsored routine care spending account, we've created an ungainly monster that just about does neither. Like those ridiculous "boat-cars" they tried to build in the 60's. Look! Its a boat and a car! No, its a car that barely drives and a boat that barely floats.
prices can't emerge without healthy competition. we'll never have an accurate idea of medical care costs until artificial barriers to competition are removed.
The tech sector had a crash (remember that one?!) and it was not based on decades of old technology. I fail to see how the banking sector is based on decades of old technology. If you ask my friends at GS or Citadel (who went to CMU for CS), I think they'd give you an earful for that line. It could be argued that the bubble was amplified by technology that made it easier to bundle and trade CDS's. Once we snip that bit, it becomes:
They lack transparency; they are overly complicated industries.
It should not be difficult to see how this encourages bubbles. In such industries, it'd be difficult to guess the real value being created, and we know from psychological research that people are apt to create speculative bubbles even without being given this nugget (see http://en.wikipedia.org/wiki/Herd_behavior).
"The tech sector had a crash (remember that one?!) and it was not based on decades of old technology."
Was it?
I've heard a rather compelling argument that the cause of the 2001 recession wasn't Sept 11 or the dot-com bubble, but the huge drop off in corporate IT spending after Y2K. The enterprise software market enjoyed a huge run-up from 1996-2000 as enormous companies replaced their aging COBOL mainframes with new Y2K-compliant enterprise Java systems. Most of the Indian IT consultancy market owes its existence to this, and many other domestic firms (notably Sun Microsystems) also benefited heavily from it. The consumer dot-com bubble was a relative sideshow compared to this. And enterprise software is about as price-opaque as you can get.
When Y2K rolled around and nothing much happened, all that spending evaporated. Suddenly, all these companies that had hired a bunch of mediocre Java-monkeys to do quick Y2K fixes found themselves without customers.
It does seem a bit different though; in the examples he cites, the industries themselves collapsed, perhaps because of outdated technology and lack of transparency. In the tech industry, the tech industry's replacement of its own outdated technology created a huge bubble, and then collapsed once that bubble was no longer necessary.
Tennessee was once considered to be "the West". Gives you an idea of how settled the country was at the time, and the difficulty of crossing the Appalachians in those times.
"Text based and code numbers? That's like my insurance company -- but half of their software now has a GUI. (I'd also put my bank in there, but they got rid of their text-based system two years ago.) My optometrist and dentist both use paperless systems with pull-down menus (no code memorization) and intelligent forms. But the local hospitals? They seem to still use text-based entry forms circa Windows95. Sounds like old technology to me... It's enough to make a guy sick."
Whether an application is text based or GUI has nothing to do with how effective it is.
Paperless, pull-down menus, and intelligent forms can be programmed either way. In fact, many text-based systems are much more effective than GUIs because they are simpler; the user never has to worry about the mouse.
I have personally "deconverted" 3 large scale systems from GUI back to the original text based system, then enhanced those systems to do what was needed. In each case (which flushed over $10 million down the toilet), the PHBs thought the move from text to GUI would magically solve all their problems.
Too bad those PHBs knew nothing about systems analysis, business processes, or project management. Apparently, neither does OP.
