7 ms·

A lot of folks are looking at the higher US comp but aren't correctly pricing in the long-term risk. You can be fine for years, but a single, major medical eve

by diob 11mo ago

A lot of folks are looking at the higher US comp but aren't correctly pricing in the long-term risk. You can be fine for years, but a single, major medical event can zero out those salary gains and lead directly to bankruptcy. It's a systemic flaw that isn't obvious until it's your turn to deal with it.

jmspring 11mo ago
If one lives in a state like CA, the taxes (income, sales, etc) basically are equal to that of Norway/etc. The downside, we don't get any real benefit from those taxes paid out.
kamaal 11mo ago
I know of Indian immigrants who suffered for decades/years on H1B, endless anxiety and tensions, eventually make it to GC, then a passport. Then all of a sudden fall ill, lose everything and return back to India. People keep forgetting the US society is a giant stack/pyramid ranking system, the structure keeps getting narrow as you move upwards. You get pushed off the sides, in the ever narrowing funnel, and you need increasing levels of luck at every level to survive. BTW, this is not just with regards to health care. You could lose your job, suffer from ageism. Lose your home, run out of money. A million different things can happen, that can cause the above said phenomenon.
- mothballed 11mo ago
  [flagged]
  - para_parolu 11mo ago
    I’m honestly surprised to see a comment like this on HN. You’re making a pretty negative assumption about someone you only know from a single comment, and nothing in that comment actually supports the assumption.
    - mothballed 11mo ago
      Commenter asserted they are US citizen, lost everything (so $0 to their name), and ill. Take a quick look and note that the person in india in that situation puts them around the bottom 5% of their country, who live on less than $3 a day, commonly in mega-slums (these are the sorts of places you end up when you have absolutely nothing and unable to work) without running water and sewage running through the alley, and economic mobility back into the professional class even worse than USA. Anyone with a room temperature IQ and a dual US-India citizenship is not moving to India as the place to be completely broke, ill, unable to work, and to go live in a slum that would make Skid Row look an absolute joke. Their story does not make any sense whatsoever. There is money or assets or property squirreled away, if there wasn't they would live on the meager assistance USA provides to citizens (even if stuck outside in a tent for awhile) before living on less than $3 a day in one of the mega slums people end up in when they are in India in that unfortunate situation. And to be clear, I don't think commenter is lying about what they've been told. I'm not making any sort of dig at them.
rootusrootus 11mo ago
You can use the difference in comp to buy a Cadillac level plan with zero deductible, zero out of pocket max. You won’t be going bankrupt.
- im_down_w_otp 11mo ago
  This helps with the denials how exactly? You can pay a lot of money in premiums, have a $0 deductible, and now OoP maximum, and still end up having claims denied.
  - 15155 11mo ago
    Do you think countries with even the most coveted universal healthcare just approve everything blindly? Should everyone (anyone?) receive monoclonal antibodies, gene therapies, biologic medications? What criteria should be used to make these determinations?
    - Turskarama 11mo ago
      Everything? No. But routine stuff will NEVER be denied. If your doctor thinks you need a scan, you're getting the scan. I have quite literally NEVER heard of someone in my country (Australia) going bankrupt from medical bills. It can happen but the rate is so low it's not something anyone ever worries about happening to them.
      - terminalshort 11mo ago
        Routine stuff is never denied in the US either. I've never had one thing denied ever and I even have a weird condition that requires expensive testing to diagnose and even more expensive treatment (narcolepsy). The insurance companies will throw up annoying bureaucracy like prior authorizations, and made me switch medication to generic when it came out (reasonable) and then back from the generic to another brand name when it came out (WTF??), but never actually a denial.
        11mo ago
franczesko 11mo ago
Horrible system.
heavyset_go 11mo ago
You can be a small business owner, employer and (low) multimillionaire, and still have it go down the drain via an accident, illness or disability that affects you and/or your family. Over time, disabilities can cost millions of dollars. Surviving a heart attack can cost hundreds of thousands to a million dollars. Long-term care insurance can still deny coverage based on pre-existing conditions, and long-term care is very expensive.
IG_Semmelweiss 11mo ago
This is why insurance plans have out of pocket maximums. To prevent this exact issue. We can say whether those maximums are still too high (some really are), but the mechanism is there. The real issue is that most people don't have a rainy day fund to deal with such emergencies. And that they are too expensive anyway. There are 2 concepts you should always keep in mind. 1. Always avoid the hospital unless you are literally dying. Surgery centers are owned by doctors who will negotiate a fixed fee, because there's someone to negotiate with (unlike Hospitals which run on the CYA principle). Also, most doctors can do procedures in office, if they have the right one. 2. Medical debt will never lead to collections. Hospitals may sue you, depending on the state, but that carriers reputational risk. A good PR push and a decent lawyer to threaten discovery will be enough to fend off even the most aggressive hospitals - this allow you to setle at a very reasonable price vs what insurance would normally pay.
- jalapenos 11mo ago
  Your country is twisted dude
- diob 11mo ago
  That analysis is flawed because it misses the systemic nature of the risk. The Out-of-Pocket Max is an annual liability, not a one-time fix. A single serious illness, like cancer, spans multiple plan years. A $9,200 OOPM hitting three years in a row, on top of $15k-$18k in annual premiums, is the bankruptcy. This also assumes 100% in-network care, which is a fantasy in a real emergency when you don't get to pick the ambulance or the anesthesiologist. This isn't a "rainy day fund" problem. This is a system that requires a $50k-$100k emergency fund just to handle a single medical event, all while assuming you're still healthy enough to keep the job that provides the plan. "Always avoid the hospital" isn't a choice either. You don't "negotiate" with a surgery center for a heart attack, a stroke, or a major car accident, which are some of the common events that cause this. And the claim that "medical debt will never lead to collections" is factually incorrect. It is the number one cause of collections in the United States. The idea that every citizen can just "hire a decent lawyer" or "run a good PR push" to settle debt isn't a functional or scalable mechanism, nor is it reality.
- 11mo ago
kakacik 11mo ago
That's the 'societal' part of living in society, sharing the risks and yes sharing the gains a bit too. I know some right wing folks see it as unnecessary burden, either they are above the financial cut or (dumbly) believe their health is and will remain stellar for rest of their lives. That tiny minority shouldn't ever decide such societal policies and shouldn't be let to do so. Its shortsighted and plain stupid and properly selfish move. It works rather well short term if one simply doesn't give a fuck about suffering of others, but even thats shortsighted and stupid long term - we live in hyper-interconnected society and not some prepper wet dream, what goes around always comes around. Another similar is public education, literally defining future of society. How dumb is to not have it in stellar shape, shitting on one's own kids and mankind future. But hell will freeze sooner than majority of americans will realize and accept that. Till then, if its important enough for you, you can vote with your feet, its easier than ever.

by diob 11mo ago

jmspring 11mo ago

If one lives in a state like CA, the taxes (income, sales, etc) basically are equal to that of Norway/etc. The downside, we don't get any real benefit from those taxes paid out.

kamaal 11mo ago

I know of Indian immigrants who suffered for decades/years on H1B, endless anxiety and tensions, eventually make it to GC, then a passport. Then all of a sudden fall ill, lose everything and return back to India. People keep forgetting the US society is a giant stack/pyramid ranking system, the structure keeps getting narrow as you move upwards. You get pushed off the sides, in the ever narrowing funnel, and you need increasing levels of luck at every level to survive. BTW, this is not just with regards to health care. You could lose your job, suffer from ageism. Lose your home, run out of money. A million different things can happen, that can cause the above said phenomenon.

mothballed 11mo ago
[flagged]
- para_parolu 11mo ago
  I’m honestly surprised to see a comment like this on HN. You’re making a pretty negative assumption about someone you only know from a single comment, and nothing in that comment actually supports the assumption.
  - mothballed 11mo ago
    Commenter asserted they are US citizen, lost everything (so $0 to their name), and ill. Take a quick look and note that the person in india in that situation puts them around the bottom 5% of their country, who live on less than $3 a day, commonly in mega-slums (these are the sorts of places you end up when you have absolutely nothing and unable to work) without running water and sewage running through the alley, and economic mobility back into the professional class even worse than USA. Anyone with a room temperature IQ and a dual US-India citizenship is not moving to India as the place to be completely broke, ill, unable to work, and to go live in a slum that would make Skid Row look an absolute joke. Their story does not make any sense whatsoever. There is money or assets or property squirreled away, if there wasn't they would live on the meager assistance USA provides to citizens (even if stuck outside in a tent for awhile) before living on less than $3 a day in one of the mega slums people end up in when they are in India in that unfortunate situation. And to be clear, I don't think commenter is lying about what they've been told. I'm not making any sort of dig at them.

rootusrootus 11mo ago

You can use the difference in comp to buy a Cadillac level plan with zero deductible, zero out of pocket max. You won’t be going bankrupt.

im_down_w_otp 11mo ago
This helps with the denials how exactly? You can pay a lot of money in premiums, have a $0 deductible, and now OoP maximum, and still end up having claims denied.
- 15155 11mo ago
  Do you think countries with even the most coveted universal healthcare just approve everything blindly? Should everyone (anyone?) receive monoclonal antibodies, gene therapies, biologic medications? What criteria should be used to make these determinations?
  - Turskarama 11mo ago
    Everything? No. But routine stuff will NEVER be denied. If your doctor thinks you need a scan, you're getting the scan. I have quite literally NEVER heard of someone in my country (Australia) going bankrupt from medical bills. It can happen but the rate is so low it's not something anyone ever worries about happening to them.
    - terminalshort 11mo ago
      Routine stuff is never denied in the US either. I've never had one thing denied ever and I even have a weird condition that requires expensive testing to diagnose and even more expensive treatment (narcolepsy). The insurance companies will throw up annoying bureaucracy like prior authorizations, and made me switch medication to generic when it came out (reasonable) and then back from the generic to another brand name when it came out (WTF??), but never actually a denial.
      - 11mo ago

franczesko 11mo ago

Horrible system.

heavyset_go 11mo ago

You can be a small business owner, employer and (low) multimillionaire, and still have it go down the drain via an accident, illness or disability that affects you and/or your family. Over time, disabilities can cost millions of dollars. Surviving a heart attack can cost hundreds of thousands to a million dollars. Long-term care insurance can still deny coverage based on pre-existing conditions, and long-term care is very expensive.

IG_Semmelweiss 11mo ago

This is why insurance plans have out of pocket maximums. To prevent this exact issue. We can say whether those maximums are still too high (some really are), but the mechanism is there. The real issue is that most people don't have a rainy day fund to deal with such emergencies. And that they are too expensive anyway. There are 2 concepts you should always keep in mind. 1. Always avoid the hospital unless you are literally dying. Surgery centers are owned by doctors who will negotiate a fixed fee, because there's someone to negotiate with (unlike Hospitals which run on the CYA principle). Also, most doctors can do procedures in office, if they have the right one. 2. Medical debt will never lead to collections. Hospitals may sue you, depending on the state, but that carriers reputational risk. A good PR push and a decent lawyer to threaten discovery will be enough to fend off even the most aggressive hospitals - this allow you to setle at a very reasonable price vs what insurance would normally pay.

jalapenos 11mo ago
Your country is twisted dude
diob 11mo ago
That analysis is flawed because it misses the systemic nature of the risk. The Out-of-Pocket Max is an annual liability, not a one-time fix. A single serious illness, like cancer, spans multiple plan years. A $9,200 OOPM hitting three years in a row, on top of $15k-$18k in annual premiums, is the bankruptcy. This also assumes 100% in-network care, which is a fantasy in a real emergency when you don't get to pick the ambulance or the anesthesiologist. This isn't a "rainy day fund" problem. This is a system that requires a $50k-$100k emergency fund just to handle a single medical event, all while assuming you're still healthy enough to keep the job that provides the plan. "Always avoid the hospital" isn't a choice either. You don't "negotiate" with a surgery center for a heart attack, a stroke, or a major car accident, which are some of the common events that cause this. And the claim that "medical debt will never lead to collections" is factually incorrect. It is the number one cause of collections in the United States. The idea that every citizen can just "hire a decent lawyer" or "run a good PR push" to settle debt isn't a functional or scalable mechanism, nor is it reality.
11mo ago

kakacik 11mo ago

That's the 'societal' part of living in society, sharing the risks and yes sharing the gains a bit too. I know some right wing folks see it as unnecessary burden, either they are above the financial cut or (dumbly) believe their health is and will remain stellar for rest of their lives. That tiny minority shouldn't ever decide such societal policies and shouldn't be let to do so. Its shortsighted and plain stupid and properly selfish move. It works rather well short term if one simply doesn't give a fuck about suffering of others, but even thats shortsighted and stupid long term - we live in hyper-interconnected society and not some prepper wet dream, what goes around always comes around. Another similar is public education, literally defining future of society. How dumb is to not have it in stellar shape, shitting on one's own kids and mankind future. But hell will freeze sooner than majority of americans will realize and accept that. Till then, if its important enough for you, you can vote with your feet, its easier than ever.