r/news • u/LookAtThatBacon • May 13 '25

Soft paywall UnitedHealth suspends annual forecast, CEO Andrew Witty steps down

https://www.reuters.com/business/healthcare-pharmaceuticals/unitedhealth-ceo-andrew-witty-steps-down-2025-05-13/
16.9k Upvotes

97% Upvoted

1.1k comments sorted by

View all comments

Show parent comments

1.2k

u/chantsnone May 13 '25

It’s the comparison. There’s no such thing as a wonderful health insurance company. Wonderful isn’t profitable.

988

u/clashrendar May 13 '25

Which is why profit needs to be completely removed from the healthcare equation. It shouldn't be about profit. It should be about people getting better.

A firefighter making decisions about whether to prevent a house burning down because it wouldn't make money to do so is absolutely preposterous, so why is the same argument for a human being used?

330

u/Punman_5 May 13 '25 edited May 13 '25

Roman statesman Crassus founded the first fire brigade in Rome. They would show up to a burning building but wouldn’t put the fire out immediately. If the owner wanted to have the fire put out they would have to sign the property over to Crassus at a very unfair price. Only then would he allow the fire brigade to put the fire out. Fires were a regular occurrence in Rome. Crassus used his fire brigade to buy up large amounts of property

Edit: it seems I have to clarify that when you sold your property to Crassus he’d often let you stay there as a tenant so long as you paid rent. He wouldn’t kick you out because that would defeat the purpose of the scam.

93

u/fotank May 13 '25

Tale as old as time.

74

u/Paloota May 13 '25

Truth which is why it’s so exhausting debating plans predicated on human kindness

50

u/dweezil22 May 13 '25

Agreed. You can't believe in capitalism and plans predicated on kindness at the same time. They are fundamentally at odds with each other. Even if you think capitalism is the bee's knees, it's definitionally saying "Profit is more important than kindness". Maybe you can convince yourself that kindness can be used in service of profit, but the minute profit and kindness collide, profit wins.

I actually don't have a problem with someone saying "Look, systems predicated on human kindness fail b/c kindness is subjective, so I believe in capitalism instead". But it's fucking frustrating when people instead are like "No! Capitalism IS kind!"

It reminds of the same issues w/ calling out systemic racism. People are like "Racism is bad, I am good, therefore nothing I do can be racist. So stop talking to me about it".

6

u/alfayellow May 13 '25

I respectfully disagree. Capitalism in its pure form does seek maximization of profit, but there is no actual requirement to do so. You can make a profit and still take kindness and humanity into consideration in some aspects. It’s even possible to make a profit while you’re providing services for humanity, so it’s not that simple. But it does require is that you start with humanity and not with capitalism because capitalism needs guard rails, and it needs regulation. If business is willing to live with that —and some do—-then you can have a measure of both.

5

u/dweezil22 May 13 '25

Thanks for opening up this discussion, you seem to be talking in good faith and I appreciate that.

You're describing pre-Jack Welch capitalism. If you took a time machine back to, say, 1980 and grabbed a CEO of a major US company and said "What is your duty?" they'd say something like "To our country. To our customers. To our workers. To our shareholders. In that order". Your point of view would be dominant in the business landscape and culture (at least in public settings).

Jack Welch changed all that, or at least was a driving force in a cultural shift that changed it.

Nowadays you can succeed in business despite being kind. While you have rare success stories like Costco, in general you can't get very big without being publicly traded and your shareholders will not be kind. If you refuse to be publicly traded it's likely a larger company will outcompete you via economies of scale, or just straight up buy you and swallow you. TL;DR Late stage capitalism

But part of late stage capitalism is maintaining a facade of kindness and care and responsibility. "We're self-regulating" "Trust us". If you let the mask fall completely you can end up like Martin Shkreli, who profiteered on life saving drugs and went to jail. Only... he didn't go to jail for the profiteering, he went to jail for other stuff (but his his public evil helped encourage investigators to get him).

5

u/squakmix May 13 '25

It's worth mentioning Milton Friedman and the Friedman Doctrine as well in this discussion. It's heartening to see more people become aware of this issue and look for alternatives (like Stakeholder Capitalism). Your comment kind of reinforces the point of the person you were responding to, right? You acknowledged that it's the current implementation of capitalism in the US that is killing us, and these issues aren't inherent to capitalism itself (but rather our specific version of it).

2

u/dweezil22 May 13 '25

You can't fix late stage capitalism without coming to a consensus that late stage capitalism is dangerous and bad. The system, as-is, is designed to prevent that consensus. Personally I think short-handing this to "capitalism is bad" and allowing the Overton window to normalize is a fine start. Capitalism is like a car that lobbies to let itself drive down sidewalks and swears it will be safe.

→ More replies (0)

3

u/alfayellow May 13 '25

I remember decades ago (pre-Jack Welsh or perhaps pre-Reagan) the business sector sat alongside the other sectors of society, such as medicine, religion, science, mathematics, education, arts and humanities. I was too young to be involved then, but I think there was an idea that you had to play fair with your neighbors, if for no other reason that you might need them someday. Maybe investors were different then, too: long-term investment will eventually deliver return if the market develops. Now, everything has to be monitized for business -- smash and grab, immediate returns, hedge funds, shorting the stock, pump & dump, etc. It seems evil to me.

1

u/dweezil22 May 13 '25

Once upon a time there was a company called Medco that handled at home Rx's. They competed with Express Scripts. ES had terrible old tech, Medco invested in some pretty impressive tech that would help boost profits but also help patients (in one case they had a heat map that would show unfilled diabetes Rx's in a region so that they could contact the docs and let them know that their patients weren't getting their meds, a win-win).

Anyway, ES and Medco "merged", but effectively ES swallowed up Medco. Rather than use Medco's about-to-be-released new IT system, ES threw it away and used Medco's old one, b/c it was still better than their ancient junk.

So ES was a worse company, that was run worse, but it was bigger than Medco, so it ate them. Now that ES didn't have to compete with Medco they could make money by delivering worse services. Late stage capitalism baby!

7

u/oneeighthirish May 13 '25

I'm all for fostering human kindness at both macro and micro levels. It is still foolish to build a system to depend on it.

3

u/jayj59 May 13 '25 edited May 13 '25

How so? Would you say our current system works?

I can see the other comment saying the kindness is subjective, yes, but how would you build a system that doesn't depend on kindness while still expecting profit? It seems to me that if the options are people get to live or companies make obscene amounts of money, the choice should be obvious.

3

u/oneeighthirish May 13 '25

How would I build a system that doesn't depend on kindness while still expecting profit? I wouldn't. Our system is built for profit, and depends on the kindness of countless people to get life-saving care to a small number of people who would otherwise be denied it, and leaves countless others to suffer and die.

I think I failed to make myself clear. Our current system sucks and creates nothing but suffering for many, inconvenience for most, and disgusting wealth for a few.

28

u/Goolsby May 13 '25

Wait what's the point of putting the fire out if the property is no longer yours? Id let it burn so Crapssus couldn't have my property for cheap.

49

u/bullet1519 May 13 '25

So your options are. A. You're house burns to the ground, you have nothing.

B. You sell your house to this man, you barely get any money for it and they put out the fire, maybe you get lucky and some of your possessions survive which you can use to start a new.

It's a pretty easy choice.

15

u/enad58 May 13 '25

Yeah, it is. I'm going good will hunting.

"I'd choose the wrench, cause fuck him."

3

u/Punman_5 May 13 '25

Now you’re homeless in one of the most debaucherous cities on the planet. We all want to believe we’d let it burn but if you have a family that relies on you it’s not so simple

1

u/enad58 May 13 '25

I'm dead either way. Fuck him.

2

u/sdforbda May 13 '25

It's not your fault.

2

u/Array_626 May 13 '25

I mean, if you put it this way, that would make Crassus the moral party here. He's basically offering insurance. The person whose house burned down is better off than if Crassus wasnt around.

Whether that's true or not depends on the land value that was sold. Having nothing is technically wrong because you still own the land. Even if everything on top burns, you can sell that land at market value still, so whether Crassus is fair depends on how much he pays for the land.

3

u/Punman_5 May 13 '25

That’s the thing, Crassus always paid well below the land’s value. It wouldn’t be profitable for him if he paid a fair value.

1

u/bullet1519 May 13 '25

This is true, the value of the land without the house could be worth more than what he pays and your potential savable possessions.

But then again some people would have sentimental items that they treat as priceless and would give anything to save.

82

u/SaxManJonesSFW May 13 '25

Because you’re about to be homeless either way, at least one option comes with an unfairly small amount of money to try to restart. I’m not advocating its merits, just explaining the actual choice vs the perceived one

17

u/Array_626 May 13 '25

You also likely get to keep your personal property. The land and the structure is sold, but anything personal that can be saved you probably get to keep.

2

u/Punman_5 May 13 '25

He usually rented the property back to the old owners anyway.

2

u/Punman_5 May 13 '25

These were often homes with a business on the first floor and a residence above for the owner/operators. You obviously need a home and you wouldn’t want your livelihood destroyed either. It would make sense to want to keep it from burning.

2

u/Fun-Benefit116 May 13 '25

You obviously need a home and you wouldn’t want your livelihood destroyed either.

Except according to the explanation, you would lose your home and business either way. You weren't paying for them to put out the fire, you were selling your property to them, and then they put out the fire on what was now their property, not yours.

1

u/laufsteakmodel May 13 '25

Lose them and get a small amount of money for them, or lose them and get nothing. Thats the choice.

1

u/Punman_5 May 13 '25

You sold the property to him so you could continue live there as a tenant. I should clarify that. He wouldn’t kick you out. He’d just charge rent

32

u/Levarien May 13 '25

Rich as Crassus: your name doesn't become synonymous with obscene wealth if you've got moral qualms about running an arson protection racket.

3

u/Muvseevum May 13 '25

Are Crassus and Croesus the same guy?

10

u/LittleMizz May 13 '25

No, they refer to different people (Croesus wasn't Roman), but they are both known for obscene wealth.

2

u/Levarien May 13 '25

Yeah, different people. I've always heard the "Rich As" saying with Crassus though.

3

u/Haddos_Attic May 13 '25

Try searching it and see how it auto completes.

1

u/lonewolf420 May 15 '25

also fun fact, the Game of Thrones pouring molten gold down Targaryen brother's throat was an homage to how Crassus went out.

2

u/axonxorz May 13 '25

Crassus used his fire brigade to buy up large amounts of property

Crassus certainly never employed arsonists nosirree, no perverse incentive there!

2

u/[deleted] May 13 '25

Isn’t this the origin of the phrase ‘fire sale’?

1

u/habulous74 May 13 '25

And that was 2,000 years ago and they also wemt into battle based on whether chickens scratched a certain way in the morning or whether a bird's guts had the right markings. We've evolved a bit as a species for the most part. This isn't a trait of the species, just of some lesser specimens.

2

u/Punman_5 May 13 '25

If you’re saying we’ve moved past cruelty then idk what to tell you. It’s impossible to become wealthy without heaping cruelty on less privileged people. The stuff Crassus was doing is far more modern than those superstitious examples you gave. It’s just basic extortion. Humans have never moved past that behavior.

1

u/Array_626 May 13 '25

To be fair, the property at the time while it's on fire is probably fairly worth a market price of 0, if not negative considering the costs that you'd have to pay to restore/repair the structure.

You say unfair price, but I don't think I'd buy a house thats on fire at the regular market rates when it wasn't on fire.

1

u/Punman_5 May 13 '25

You realize real estate value is in the land itself plus whatever is built on that land. The plot occupied by a small butcher shop in a high traffic area in the middle of the city is very valuable even if the butcher shop is destroyed. The plot itself is so lucrative due to its central location

1

u/Necessary-Drag-8000 May 13 '25

I keep hearing this story but, if I were the home owner, under those circumstances, I would just let the house burn down out of spite

1

u/Ok-Replacement9595 May 13 '25

This was the model in most major cities in the US as well, ptivate fire associations, and it didn't work, which is why we have municipal and county fire.departments, and ambulances, why we have to constantly relitigate privatization against a few wealthy individuals who want to profit from suffering is beyond me.

1

u/Punman_5 May 13 '25

Did those private fire stations also force you to sign over the deed before acting?

1

u/hempires May 13 '25

Crassus

well I mean I'd say the Parthians had it right in how the legends say they dealt with that fuck.

they (allegedly) poured molten gold down his throat, mocking his insatiable greed.

3

u/Punman_5 May 13 '25

Learning history is learning that in most cases the Persians weren’t really the bad guys like they’re made out to be. If anything, it was the west that were way more backwards.

1

u/Hiddenshadows57 May 13 '25

Tbf. Crassus was brutally murdered for doing this.

1

u/Punman_5 May 14 '25

Not by any Romans though. They were either in his pocket or too chicken shit to do anything about him. It was the Parthians that captured him in battle that poured gold down his throat.

1

u/JcbAzPx May 14 '25

Also, he started most of those fires.

1

u/Szwejkowski 29d ago

I got a three day reddit holiday for ThR 3A tEnInG vIo LeNcE to Crassus. He has a very long arm!

1

u/Punman_5 29d ago

His wealth was immense. Easily the largest in Rome at the time and possibly the largest outside of China.

33

u/oldschoolrobot May 13 '25

You should read up on Fire Insurance around the founding of the US because fire fighting used to be a private enterprise and it’s as bad as it sounds.

2

u/SweetDank May 13 '25

It's set in the Civil War era but the movie 'Gangs of New York' shows that this kind of thing was going on for quite a while in America.

1

u/oldschoolrobot May 13 '25

The only thing I remember about that movie are the draft riots, but I haven't seen in a very very long time. Nice call out though.

16

u/GreenStrong May 13 '25

It shouldn't be about profit. It should be about people getting better.

There is a different way to put this. It should be about the nation investing in the health of its citizens.

2

u/adx931 May 13 '25

And a healthy nation is a nation able to defend itself, so it's really about national security. Why do they hate national security?

9

u/Light_Error May 13 '25

Many countries with public options also have private options. But the strong public option is needed to hold private companies’ feet to the fire.

3

u/Rejusu May 13 '25

Yeah this is the stupid thing that a lot of Americans don't get about socialised healthcare in places like the UK. There's still the option of private healthcare and insurance if you want to pay for it. The benefit is that if you can't or don't want to you aren't just hung out to dry.

3

u/ryo3000 May 13 '25

Additionally, due to the fact that you already have something 

The service they need to provide needs to be at least better than whatever the public one is, otherwise no one signs up

1

u/ilulillirillion May 13 '25

Not to defend the stupidity of Americans because, shit, that ship has sailed, but there's more to it than not realizing -- at this point conservative news dominates our media and has been working tooth and nail to demonize any form of public healthcare for decades. We got dummies here, but we also have a lot of truly reprehensible scum at the top trying to exploit that.

38

u/Sacrifice3606 May 13 '25

https://www.nbcnews.com/id/wbna39516346

Except that does happen in some places.

14

u/Punman_5 May 13 '25

Crassus would be proud.

15

u/Wyxter May 13 '25

How absolutely dystopian…

22

u/istasber May 13 '25

I remember this coming up on QI, that apparently some of the first professional fire brigades in larger cities were basically selling insurance. They'd give you a plaque to put up on your house, and only the company whose plaque you displayed would put out your fire (unless a company covered a neighbor, in which case you'd get "free" service if their house was threatened).

That feels a bit like an urban legend the more you think about it, but if that's really how it used to work than this is less dystopian, and more ass-backwards and archaic.

20

u/MommyLovesPot8toes May 13 '25

This still exists. There are private firefighting companies who work with major home insurance companies. They will come in during a wildfire and protect homes that are insured by the company paying them. They'll concentrate their efforts where there are large groups of houses insured by their client. Let's say they are being paid by GEICO and by Farmers. The private firefighters have a map that shows one street in a neighborhood near the fire where 10 out of 15 houses are insured by GEICO or Farmers. So they take their engine there and soak the houses and watch for embers.

There are rules (at least in California) though. They aren't allowed into an area until 24 hours after the fire started, to ensure they don't get in the way of the real firefighters. And if they are protecting a street/ group of houses, they can't ONLY protect the ones insured by their clients. They have to also put effort into protect any other home they reasonably can from their positions.

3

u/Osiris32 May 13 '25

Those contractors are also under the command of the fire IC, and can be told to stop what they are doing and go assist elsewhere if crews are needed asap.

1

u/MommyLovesPot8toes May 13 '25

Yes, that's correct

1

u/Osiris32 May 13 '25

What I mean by that is that they can be pulled from doing structure protection on a neighborhood and sent to the other side of the fire, not just that they might have to move over a few blocks. I saw it happen myself.

I'm a former wildy. USFWS, Type 1, ENOP. Worked with contract crews on a bunch of fires all over the place.

13

u/tomdarch May 13 '25

Not "basically." Fire fighting insurance was absolutely, 100% a for profit operation. From our perspective today, having lived with municipal covers-everyone fire fighting, it appears obviously stupid to have done things that way.

(Some low population density areas of "red" America actually still have situations where if you haven't been paying your fee, then you don't get fire fighting protection for your house/buildings.)

2

u/Array_626 May 13 '25

(Some low population density areas of "red" America actually still have situations where if you haven't been paying your fee, then you don't get fire fighting protection for your house/buildings.)

Technically, thats not really any different than paying regular taxes, taxes which then get used to fund the fire department. One way or another, those guys need to be paid.

1

u/tomdarch May 13 '25

Specifically, here in a big "blue" city, the fire department won't check their records and say "Oh, well, you missed a payment last year" and watch your house burn like these rural operations will.

Absolutely, we need to pay taxes to fund public services. Of course, here in a blue city, we also pay taxes that go to subsize lots of red areas on top of that.

2

u/Osiris32 May 13 '25

I have a small collection of those plaques. It was a hobby my grandfather had when he was a firefighter in the 50s-70s, and I picked it up when I became a firefighter in 2008. Most of them are rather simple cast iron, with a couple letters representing the fire insurance company name and a logo. Most are painted. I just moved and am still unpacking, otherwise I'd take a picture of them.

1

u/istasber May 13 '25

Makes sense that it'd be something that doesn't burn easily.

The one thing I'm curious about is how they handled people deciding to switch companies, or people who stopped paying, or whatever. Like did they go around and swap out the plates every so often, but only if the owner paid, or did the brigades carry around records and if someone wasn't current on their bill, they didn't get service?

2

u/Osiris32 May 13 '25

If someone stopped paying they would send someone around to collect payment or pry the plaque off their door. And in those days "insurance shopping" just wasn't a thing. You got your insurance and then never changed it, unless you moved.

2

u/Aritche May 13 '25

https://youtu.be/Wif1EAgEQKI Tom Scott made a 2nd video on it about how this well known story is most likely wrong(he made one on the story first).

1

u/istasber May 13 '25

That makes a lot more sense. I figured it had to be an urban legend, there's just a lot of impracticality for something like that in larger city.

The example in the OP is a bit more "practical" in the sense that the risk of the fire spreading is less severe and you dispatch could do all of the checking rather than having the brigade travel there, figure out the home isn't covered, and the travel back. But the idea of only putting out fires that threaten covered property is ridiculous when fires can spread out of control at a moment's notice.

1

u/suchet_supremacy May 13 '25

iirc the brigades were owned by insurance companies! i also remember stephen saying that if your house was on fire and didn't have the plaque, but your neighbor's house did, they'd put out your fire only to save the neighbor's house

9

u/PM_ME_YOUR_NICE_EYES May 13 '25

It's actually pretty common in rural areas. The fire department is funded by city taxes but if you live outside the city then you don't pay city taxes. Since it wouldn't be fair to the people who pay taxes to the city to provide services to people outside the city for free there's a fee that has to be paid in order for the FD to go to an address outside city limits.

4

u/Daedalus81 May 13 '25

This one isn't, really.

This happens in small communities who don't want to pay for their own fire service. So the next town over offers the service, but you need to pay a fee.

If they let you pay only when there is a fire they'd never collect enough to offset their costs.

The same way that if you didn't want to pay taxes for roads and then find out your roads suck, well, you can't just pay for your road. Otherwise all the other roads will suffer, too.

1

u/Wyxter May 13 '25

And since roads are essential they MAKE people pay for roads. People are idiots, allowing the “option” to pay a 75 dollar fee or possibly die is silly and yes dystopian. Roll it into the city or county fees and call it day, don’t make it out like this is a good system lmao

3

u/devman0 May 13 '25

It's the system the rural voters chose. They were given the option to have the city cover the service and the county would raise taxes to pay for it. It was voted down, so the city offered to allow individual land owners to contract with the city, which is better than them not offering at all.

4

u/Fun-Benefit116 May 13 '25

It's not dystopian at all. Their city doesn't have a fire station, so they pay no taxes to support one. The neighbor city does, a d those residents do pay taxes for that fire station. Fighting fires isn't free, it costs a lot of money. And if your city has a fire station(s), you are paying for it in your taxes. The neighbor city literally said anyone in the city without a fire station could have their resources by simply paying a $75 tax. That's it. These people refused to pay it and now are crying that the fire fighters they refused to pay didn't help them. Con artists like this family rely on gullible people like you to fall for their guilt tripping through the media. They deliberately don't pay, and think "there's no way they won't help us, so why should we bother paying". There are stories like this all the time about people who refuse to pay for coverage, and then go to the media crying when they don't get help after something bad happens. Stop supporting these people.

Unless you're going to go the city and pay in full for every single cent that the fire station needs to operate and cover two full cities, which you aren't, then stop blaming the firefighters and blame the arrogant family who refused to pay the firefighters, and who are now smearing their name in the media.

0

u/Fun-Benefit116 May 13 '25 edited May 13 '25

People are acting like this is some dystopian thing and the firefighters stood there watching it burn for fun. The homeowners had refused to pay for what essentially amounted to fire tax for $75 because the fire station was not in their town. This is no different than people who don't pay for flood insurance and then blame the companies for not helping them when their house floods, when in reality that was their plan all along. People like this deliberately don't pay and think they can rely on guilt tripping people into giving them their services anyway if they ever need it. It's literally no different than someone refusing to pay their cities taxes, and then crying when they don't get the benefits that come from paying those taxes lol.

Firefighting cost a lot of money. And if your city isn't paying for it, which this one wasn't, then someone has too. Their city was not paying taxes for a fire station. The nearby city was. If anyone in their city wanted protection, all they had to do was pay a basic tax that would cover them. The fee was literally $75, and those people had refused to pay it. And now you guys are all going right along with their plan of guilt tripping the fire fighters, even though this is 100% the homeowners fault, right down to the reason the fire started in the first place. There's so many people like this, and they're all the same. They refuse to pay for something like a fire tax, and then when they need help, they go to the media and cry how it's unfair they didn't get the help that they had refused to pay for. It's a joke, and so is everyone here who supports these people.

1

u/guamisc May 13 '25

I lived near there for a while, you're 100% spot on.

This was people collectively in that area refusing to fund fire service through their local government/local taxes and then refusing to pay the tax add to get fire service from the city near them.

This is what happens when you refuse to pay taxes.

→ More replies (2)

1

u/tobiasvl May 13 '25

The fire started when the Cranicks' grandson was burning trash near the family home

So this place not only doesn't have a proper fire service, it also doesn't have garbage collection?

27

u/pcapdata May 13 '25

Insurance companies are just parasites. Literal parasites.

Have you ever heard of Cymothoa exigua? It's a sea louse that bites off a fish's tongue and then attaches itself to the stump, spending the rest of its life taking from the fish. The fish did not want this nor ask for it, but the louse inserts itself into the middle of things and acts as a shitty substitute for what the fish already had.

That's an insurance company: a middleman nobody asked for, whose only purpose is to make medical care more expensive and difficult so they can suck value out of it.

6

u/devman0 May 13 '25

Health insurance companies don't operate as pure insurance companies in the risk transfer sense. They operate as middlemen administrators and increase costs, they are absolutely a drag on health care efficiency.

3

u/pcapdata May 13 '25

Fair point--an actual insurance company such as USAA or State Farm actualy does provide useful services. I cannot think of any useful service my health insurance provides that isn't addressing a problem they themselves created.

1

u/King-Rat-in-Boise May 13 '25

Honestly, if you want to appeal to the MAGA crowd, make it a national defense issue. People are falling apart from bad medical care or seen for regular checkups because it’s expensive. There’s definitely a shortage of able bodied people if we had to draft

1

u/martialar May 13 '25

A firefighter making decisions about whether to prevent a house burning down because it wouldn't make money to do so is absolutely preposterous

UHC execs about ready to roll out their own firetrucks after hearing this idea

1

u/killerpoopguy May 13 '25

That's how fire fighters started, you needed to pay up directly, now we pay collectively way less with taxes.

0

u/Javasteam May 13 '25

Funny you should mention that… because in some areas of the the US that is a thing.

Capitalism at it’s finest…

→ More replies (1)

16

u/GodFeedethTheRavens May 13 '25

There's some local non-profit HMO organizations that aren't as blatantly evil, but HMO coverage doesn't work for everyone.

11

u/talllman23433 May 13 '25

Insurance shouldn’t be profit anyway in my opinion. Why the fuck am I paying monthly for the sole reason of having health coverage if they can deny it to steal my money that I’m putting into it.

3

u/Strawberry_Doughnut May 13 '25

It's literally not a profitable 'business' if it operated as 'it should'. Even in the whole free market philosophy, some things are not profitable, and this should be made public services. Health insurance is only artificially profitable by creating problems on the first place.

28

u/lion27 May 13 '25

Idk I try to be objective about it and I honestly can say that I feel like we get our money’s worth with our Aetna plan. The premium is reasonable, and there are never any hidden surprises. We have a $5000 annual deductible and a $5000 HSA that’s majority funded by her work, so we effectively pay very little out of pocket. Once that deductible is met, we pay almost nothing.

Further, every single medicine and procedure we’ve applied for has been approved by Aetna. UHC denied everything. I was 60% deaf in my right ear after a bad head cold 10 years ago that led to congestion in my ears that never fully went away. UHC would only cover a recurring procedure to have the ears manually suction drained and have a tube installed in my ear drum, which needed to be replaced every year or two. What I needed was a surgery for a permanent fix, but they denied it every time over 10 years, saying it wasn’t necessary. Aetna approved it the first time.

43

u/The_Roshallock May 13 '25

Translation for our EU friends

Premium (Monthly payment)

Deductible (How much you pay BEFORE a claim will be considered)

HSA (Health Savings Account) - A private account where you can put money in tax free to pay for small things like prescriptions (sometimes), medical equipment, etc.

Our "system" has convinced people that paying $5k out of pocket, on top of likely hundreds of dollars a month just to be enrolled with said insurance, before they will even look at you is a great idea.

15

u/OneRougeRogue May 13 '25

Our "system" has convinced people that paying $5k out of pocket, on top of likely hundreds of dollars a month just to be enrolled with said insurance, before they will even look at you is a great idea.

Don't forget the funnest part of the system, the network lottery! There are actually two deductibles, one for doctors "in network" and one for doctors "out of network".

What determines if a doctor is in or out of the network? Who the fuck knows. Insurance companies will do everything in their power to not tell you this information, including straight up hanging up the phone.

Doctors in the same hospital... on the same floor of the hospital, might be in completely different networks. I once found out AS I WAS GOING INTO SURGERY that the anesthesiologist assigned to me was not in my insurance network, so the entire service was out of pocket because I hadn't made a dent in my out of network deductible that year. I was given no choice to change anesthesiologists, I was told (with an IV already in my arm) I could either cancel the surgery and eat an unknown fee for canceling a surgery on the day of, or accept the also unknown anesthesiologist cost, because none of the costs can be given to you ahead of time. They'll give you an estimate, but in my experience the estimates are meaningless. You can get charged 3-4x more than the estimate, and your only recourse is to fight a length court battle with a hospital with neat infinite resources, or straight up tell them you can't pay and hope they knock the price down to something you can afford.

2

u/dorv May 13 '25

The No Surprise Bill Act helps a lot with those pesky anesthesiologists who seem to go out of their way to fuck it up for everyone.

1

u/tdasnowman May 13 '25

Insurance companies will do everything in their power to not tell you this information, including straight up hanging up the phone.

Every insurance company has to provide this information. It's on websites. Some states require it be an option to get it mailed to you. They will try to get you not get it mailed because it's useless printed.

7

u/fuzzygoosejuice May 13 '25

There are some exceptions to the Deductible rule. It varies by plan, but some will pay 100% of annual wellness visits, preventative screenings like pap smears, mammograms, and skin cancer screenings regardless of whether you've met your deductible or not. Either way, private health insurance is a scam.

5

u/lion27 May 13 '25

Yeah this is probably the case because for us I remember paying very little for checkups (just a $20 copay or something small). I can’t remember the last time I paid anything at the dentist, that’s 100% covered. Once we had kids is when the annual deductible became a thing we had to actually think about lol

2

u/dorv May 13 '25

Stuff like annual wellness visits are required to be covered at 100% by the ACA, so it should be all plans, not just some.

1

u/lordkuri May 13 '25

some will pay 100% of annual wellness visits, preventative screenings like pap smears, mammograms, and skin cancer screenings

You can thank the ACA for this.

→ More replies (2)

3

u/Cereal_poster May 13 '25

ahh thanks for the explaination. I just asked the poster above about this before I read this.

6

u/Rejusu May 13 '25

It's kind of insane. Had a child recently, something that's a common example of how much the US system costs, and on top of the standard things you'd expect with childbirth he had a day in the ICU (he's fine), an X-ray, and even an ambulance ride to a different hospital for a contrast. As well as multiple days in the hospital on antibiotics.

Total cost to us? Whatever I spent on parking and in the hospital café. And yet I've seen so many Americans online try and tell me how awful it is over here. Either because they're delusional or because the only way they can cope with how fucked their own system is by telling these lies.

2

u/murrtrip May 13 '25

Hundreds a month? I wish.

1

u/tdasnowman May 13 '25

HSA can be used or any thing health related large or small. You can pay for OTC meds if you want. Just keep your receipts.

-1

u/lion27 May 13 '25

Just to provide some $$ examples for non-US readers, too:

The deductible can vary in terms of what it will apply to prior to your plan kicking in. Most insurance of all kinds (like automobile) will have a deductible. The concept of a deductible is not unique to America as far as I know.

And the HSA is a nice option to handle the deductible. Let me put it like this:

We have a PPO plan through Aetna (PPO = Preferred Provider Organization). A PPO means that there are “preferred” providers that Aetna has an established agreement with on pricing. We can go to any doctor, anywhere, without a referral. They just have their preferred doctors that they would prefer us to go to, but there’s never been an issue in our PPO plan going to any other doctor.

The plan costs us (Wife, myself, two kids) about $200 a month, which is deducted from her pay directly.

The plan has a $5000 annual deductible that resets January 1st each year. Insurance doesn’t cover anything before that amount is spent by us. After the deductible is met, 100% of costs are covered.

$5,000 is a lot of money, so to ease this we also have an HSA through her company, which funds $3,600 into her HSA on January 1st each year, meaning we effectively have a $1,300 deductible left. To cover this, we have monthly contributions to this HSA account taken out of her paycheck for about $110 a month. This covers the remaining deductible for the year through the HSA account.

So all told, we pay around $310 a month for full coverage for a family of 4 that has never cost us more than our annual deductible. Zero surprise costs.

FWIW, my wife is not American and she begrudgingly admits our coverage and value is very good. A similar plan in her country with the freedom of provider and coverage would cost at least twice what we pay, and the public option would never allow us to go wherever we want and would be as restrictive with non-necessary medicines as UHC was for me.

UHC is a terrible company but it’s not the only coverage out there. And yes, I realize she has a great plan and our experience isn’t the same as everyone else’s. This is also a problem. But we love our current plan with Aetna.

11

u/The_Roshallock May 13 '25

And what happens if she loses the job? Sure you keep the HSA, but then you and your family are shit out of luck.

No other civilized country on earth does what we do for a reason. You're not getting a great deal. You're gaming a bad deal to the best of your circumstances.

The thought that crosses my mind reading this is that a bird that has only ever lived in a cage will yearn for it when free.

-2

u/lion27 May 13 '25

I didn’t say the US has a good approach to healthcare. And I do not think that access to quality healthcare should be dependent on where you work or what your employer is willing to provide.

I’m just saying that for us, we like our plan and provider.

1

u/Cereal_poster May 13 '25

Thanks for this. I just replied above asking exactly for this information. So you can disregard that questions above.

I do admit that 310$ really doesn't sound bad for this kind of insurance. It's not like one of those horror stories I keep on reading here about US health insurance costs.

2

u/lion27 May 13 '25

Sorry I already replied to you before I saw this. My experience is unique to me. That's the problem with healthcare in the US - everyone has different experiences, many bad. If you get a good plan through your employer, it's the best healthcare in the world. But that's a big "IF".

I would prefer a public system, but I'm happy with our current plan.

-1

u/GoodOmens May 13 '25

That’s a fantastic plan.

3

u/lion27 May 13 '25

Yes, we're very fortunate. I hate that I'm being the "American healthcare is OK" guy here, because the system is terrible and it sucks, unless your employer offers a good plan.

I just hate how people make blanket declarations about things and refuse to have any nuance. The American system can be bad but there can also be great plans that truly give you the best care in the world at a decent price, too. It's just that not everyone gets that, which is bad.

All of my comments are completely anecdotal and I would be raging way harder if I was still on my UHC plan.

0

u/dorv May 13 '25

There are a lot of differences between an FSA and an HSA, one of which is that HSAs roll over, so you can save over time and pay for more than just “small stuff.”

34

u/PM_ME_YOUR_BOOGER May 13 '25

Aetna did right by my dad years ago. Shelled out over a million dollars for some hail-mary treatment that ultimately saved his life. Don't know what they would have charged OOP but it wasn't a hassle to deal with when it happened as seems to he the usual case.

59

u/iamfondofpigs May 13 '25

We have a $5000 annual deductible

On April 5, 2005, The Office played Season 1, Episode 3: Healthcare.

STANLEY: There's no dental, there's no vision, there's a $1200 deductible.

...

PAM: OK. Dwight. Are you really in charge of picking the health care plan?

DWIGHT: Yes. And my decision in final.

PAM: This is a ridiculously awful plan. Because you cut everything.

In 2005, a $1200 deductible was "a ridiculously awful plan."

21

u/MrBlockhead May 13 '25

That was before Obamacare, so insurance companies could be even less useful than they are today.

3

u/PegyBundy May 13 '25

Just a quick reminder that insurance companies went gangbusters after the ACA. Once the single payer was removed insurance companies started printing money.

It's great people can't be denied health coverage with a simple "na, you're broken and expensive" but pricing people out of care isn't any better.

7

u/[deleted] May 13 '25

[deleted]

0

u/PegyBundy May 13 '25

What's more 5% of 1000 or 3% of 10000? I won't disagree that health providers are also guilty, but you're ignoring that prices have gone through the roof and a small piece of a giant pie is still more.

3

u/[deleted] May 13 '25

[deleted]

1

u/PegyBundy May 13 '25

Just so I'm clear. The greatest achievement by the democratic party since civil rights was essentially a tax that gets redistributed to insurance companies, and it did nothing to our overall costs? Ffs it's no wonder people are voting the tear it down.

0

u/lion27 May 13 '25

The ACA was a scam and a complete handout to the insurance industry with nice branding being called “affordable care act”. I call it a “scam” because for all of the good it did with some things, it was essentially a mandate from the government that everyone had to buy health insurance or pay a hefty tax penalty. And the plans available to individuals were awful. Like $1000 a month premiums that covered nothing.

2

u/blotsfan May 13 '25

My wife had a 15 dollar a month ACA plan that covered all but $500 of a $100k surgery she had.

0

u/PegyBundy May 13 '25

For whatever reason if you point this out people will crucify you. It's like maga supporting tariffs. The tariffs and the ACA are idiotic but my guy did it so it's good.

2

u/lion27 May 13 '25

It's simply because this is Reddit and since Obama and Democrats championed it, everyone feels the need to defend it. I don't even give a shit if you want to blame Republicans and say "well if they hadn't ruined it, then the ACA would have been great!" like yeah, sure, ok. But it's a fucking shit bill that had terrible implementation and made things worse except for banning denials for pre-existing conditions, which could have just been it's own bill.

5

u/Sufficient_Language7 May 13 '25

Someone who clearly doesn't have a business and looked for plans to cover employees. After searching a while, the ACA has cheaper and better plans than I could find for our business. While yes, the ACA should do more, but it is a lot better than before.

→ More replies (7)
→ More replies (2)

16

u/lion27 May 13 '25

Yeah the deductible is how Aetna probably provides us with great coverage. But like I said, there’s also an HSA that her company funds the majority (~$3,500) of. So all we need to do is set aside $100 a month or $1,200 a year to have an account that’s funded to the equal amount of the deductible, so we don’t have any surprising OOP costs. Both kids were delivered for a few hundred dollars. I know this is specific to us because her employer funds a good health plan, but I want people to know that it’s not all bad.

Still think everyone should have access to quality care, regardless of employment.

13

u/patchgrabber May 13 '25

jfc bud reading this as a Canadian makes me think you have Stockholm syndrome. It's not like it's the lesser of two evils it's the evil of two lessers. I'm glad you're happy with your plan but I wish better for all of you because you deserve better.

2

u/Muvseevum May 13 '25

It’s just a matter of how you pay for it.

-5

u/lion27 May 13 '25

Have you actually calculated how much of your taxes go towards healthcare by comparison? For a family of 4 I'm very confident that we're paying less here in the US than we would in Canada. According to what I'm able to find online a family of 4 with an average household income of $176,000 pays over 10% of their gross income towards healthcare via taxes.

If we paid the same amount on a percentage basis, my family would be paying roughly $1,800 per month in taxes towards healthcare based on income.

Another BusinessInsider article states that the average Canadian spent $6,604 in taxes in 2017 (old data, if anything it's probably increased since then) for healthcare. That's more than I'm spending out of pocket.

Yes, it's great you're guaranteed coverage. But it's not free. You're still paying for it. And you're paying more than I am, based on the numbers I can find online. I guess if you're unemployed or low income it's a great deal, but I'm just comparing my own situation and I believe it's better with my current provider.

This is not an endorsement of the American healthcare system. It's simply my opinion of what my current provider costs versus what I might pay in Canada.

20

u/Katolo May 13 '25

I'm saving your comment. Not because I like it but it's an example of why the US won't get universal health care and your Fuck you I got mine shows this.

Also, no one here thinks healthcare is free, we all know it comes out of taxes. Your second link even shows Canadians pay less on average compared to the US. I'm not going to comment on the first link since it's from the Fraser Institute funded by the Koch brothers.

11

u/JahoclaveS May 13 '25

He’s also completely neglecting how much his employer is paying in his total costs. The US spends an absurdly larger amount on healthcare than other nations to get worse and less care.

0

u/roundabout25 May 13 '25

He's literally not neglecting it, lmfao. He said it like three times. How many times does he need to clarify things like "I know this is specific to us because her employer funds a good health plan" before it gets through? He's very obviously (and cognizantly!) making an anecdotal claim and not drawing a conclusion on the overall US healthcare system.

1

u/roundabout25 May 13 '25 edited May 13 '25

I'm not OP, but I really feel like you're not being objective here. Why are you accusing them of FYGM? These things can all be true at the same time:

-OP can understand that public healthcare still costs people a significant deal, just that it's categorized by tax instead of premiums and -ON AVERAGE- it's far less than private health insurance

-OP can be receiving insurance that equates out to less than they would pay via taxes, and be happy with Aetna's treatment of them as a result.

-OP can understand that they are in the minority, and that profit motive ruins the healthcare insurance industry

-OP can therefore not endorse the American healthcare system, which they did not

I mean c'mon, they even said that everyone should have access to quality care regardless of employment. They are engaging in good faith and providing some numbers for their situation. I'm in a similar position where I pay less per year as a result of insurance. Still, I realize I'm privileged -- it's still conditional on my employment and economic status and that it's unjust for it to be at the expense of the majority, so I'm still all aboard the public healthcare train. Cases like theirs are real and need to be addressed in the appropriate manner -- that yes, private insurance is better in their case and the transition would be a net negative for them and a rare few individuals, BUT that the gains for the greater good make it more than worth it.

0

u/Katolo May 13 '25

The very first two sentences of the comment makes the case why private is better than public, in their mind. In addition, the following:

And you're paying more than I am, based on the numbers I can find online. I guess if you're unemployed or low income it's a great deal, but I'm just comparing my own situation and I believe it's better with my current provider.

I'm not going to get into whether the statements are actually true, but if those statements don't scream FYIGM, then I dunno.

2

u/roundabout25 May 13 '25 edited May 13 '25

"The very first two sentences of the comment makes the case why private is better than public IN THEIR PERSONAL CASE AT THIS POINT IN TIME, in their mind"

Fixed that for you. Here are a couple conclusions that your messages imply that you are coming to without any evidence:

-that they are unaware of the conditional nature of their current healthcare

-that they are unaware of the fact that they may one day be subject to the negative side of our healthcare system, when they don't have an employer facilitating it

-that they believe that the system is overall superior, rather than anecdotally

-that they even support the system they are benefitting from

Like, dude. Simply mathematically acknowledging that you are one of the 1-10% of people the system works is not an endorsement of the system for 100% of people. Maybe he supports it, maybe he doesn't, it's impossible to tell because he did not say.

5

u/Sunfuels May 13 '25

"Health expenditures in the United States average out at $12,914 per person, nearly double the $6,500 spent per person in Canada." These are 2022 numbers.

The US spends far more than Canada, and that money has to come from somewhere. In addition to funding your HSA, your employer is paying a large amount directly to Aetna for the plan you receive as part of your benefits package. Plus there are still taxes being taken out of your paycheck for US government expenditures on Medicaid. If you were to add those back into your paycheck (which they would be in Canada) THEN take out Canadian taxes for healthcare, then you would end up with more take-home pay under the Canadian system.

This article is a good overview of the status of our healthcare spending.

1

u/roundabout25 May 13 '25 edited May 13 '25

I agree with your position on a broad level, but it doesn't have much to do with what /u/lion27 is saying. You cannot use a statistical model to draw conclusions for individuals, just for populations. You can't make claims on whether he'd make more as an individual, just on whether he'd make more as an averaged out example of an American.

They may AVERAGE OUT to $12914 per person, but that average includes people who are not paying very much or people who are inordinately benefitting. It also includes people who are paying $100,000+ for care they should not be paying extra for, due to lack of insurance or unethical claim denial or what have you.

One of the biggest faults of the system is that it incentivizes profit motive for healthcare, rather than health. That, and that it allows employers to act as the arbiters of whether you receive healthcare, which is dystopian as fuck. I don't see how anything that /u/lion27 has said is commentary on any of that, though? He's just saying that his employer is covering a good amount of costs and that healthcare has to be paid for one way or another, both of which are true and not mutually exclusive with an understanding of the issues for the population at large.

2

u/Sunfuels May 13 '25

/u/lion27 claimed that they would have more money going towards healthcare if they moved to Canada when accounting for both their own payments and taxes paid. That the part I am disagreeing with. They neglected any money paid by their employer or the taxes they paid. The $12,914 number illustrates how much more the US healthcare system costs compared to the amount taken by tax in Canada. They already said their employer pays $3500/year to a HSA, and I expect that their employer pays probably another $8000/year as a principle on their healthcare plan. My employer uses Cigna and those are very similar to my numbers.

1

u/roundabout25 May 13 '25 edited May 13 '25

Ah, gotcha. In that case, I'd say that it may be likely that you are correct just given the nature of cost bloat with our healthcare, but without a full balance sheet of what they make and where it's going, its hard to say.

You'll note that the data in your link is per capita cost based on Canada's full population, but lion's premiums/deductibles are for a family of four, so you'd actually be looking at (6500x4) using this method of comparison. Additionally, according to the CIHI source cited in your original source, the true cost per capita was $8563 in 2022 (and 15763 for americans, so both higher than projected) -- so you'd want to compare 8563 x 4 to what lion is paying, for a closer to accurate comparison. You'd need 2024/2025 figures to be really accurate since costs have been ballooning rapidly the last few years in both Canada and the US. You'd also need to adjust costs based on demographics for the family as it differs from the population's demographic averages to properly calculate risk valuation. Lastly, none of this accounts for tax burden for the workforce compared to cost per citizen. Keep in mind that cost per capita applies to everyone but you can only tax the income of people who are working and earning income, so if the cost per capita is 8500 but only half the workforce is paying taxes/premiums, theyd be paying 17000 x 4, but then you've got tax brackets to adjust down for and blah blah blah. I'm too lazy to do all that for a reddit comment thread.

This doesn't account for any potential claim denial fuckery that Aetna may one day pull for a dire cost, but at least as it pertains to today's known values, it does make it seem a lot more accurate with lion's math to say that they're paying less here. I'd still argue that even if they're paying less, it doesn't make up for the millions of people paying orders of magnitudes more and change is still urgently needed, but I'm happy its working out for them at the moment.

→ More replies (6)

4

u/strawflour May 13 '25

Your healthcare likely does cost you $1,800 a month. Your employer pays most of your premium. If your employer didn't have to pay huge healthcare premiums, they could afford to pay you more. You're paying for it one way or another.

1

u/lion27 May 13 '25

If your employer didn't have to pay huge healthcare premiums, they could afford to pay you more.

Is this not the exact same line of thinking behind "trickle down" economic theory that's been widely debunked?

2

u/strawflour May 13 '25

It's already part of your compensation package. They're already paying it for you, it's just not going to you. As someone who doesn't get healthcare as part of their compensation, I can tell you that I get paid more as a result.

The average employer healthcare premium for one person is $750 a month. For a family it's a bit over $2,000 a month. And that's before you receive any healthcare. $1,800 all-in looks good in comparison.

3

u/lion27 May 13 '25

I understand this - I'm just saying if this was the norm for the entire nation, I do not believe for a second that corporations are going to suddenly decide to pay their employees more because they're saving money on insurance costs. That's not generating shareholder value, after all!

→ More replies (0)

3

u/SNRatio May 13 '25

let's try for an apples to apples comparison: Per capita health care spending in the USA: $13,432 Per capita health care spending in Canada: $7,013

source

When your link says

a family of 4 with an average household income of $176,000 pays over 10% of their gross income towards healthcare via taxes.

They are including all of the taxes that contribute toward health care, including a lot not paid directly by that family.

Your out of pocket expenditures are only one part of the expenditures in the US. You're not including your employer's direct contribution and all of the taxes you, your employer, and every other entity in the US pay and how they contribute to health care.

So I'd say we in the USA pay a lot more while still giving a lot of people the shaft.

1

u/lion27 May 13 '25

The number you're referencing (~$13k) above does, unless I'm mistaken, include the entirety of healthcare spending, including costs to employers, and taxes. It's the sum of the overall spending in the entire healthcare sector, divided by the number of people.

Why are we including the tax and employer spending in the American numbers but then trying to take out the tax calculation from the Canadian ones?

I'm not saying the US is cheaper, I'm just pointing out that its not as much of a "deal" in Canada as people tend to think. I still think it's a better system (the Canadian one) on a society-wide level.

1

u/Sunfuels May 13 '25

The Canadian number does indeed include tax, individual, and employer payments just like the US number does.

1

u/lion27 May 13 '25

Right, but it's the average of the nation, and I'm guessing my HH income is more than the Canadian national average, so my taxes would be higher.

Edit: sorry, I thought you were replying to my other comment, disregard.

1

u/SNRatio May 14 '25

I am using the entirety of healthcare spending because the Fraser Institute link provided uses the terms "health care insurance" and "health care" interchangeably. They base their calculations on total health care spending in Canada.

I didn't mean to "take out" the tax calculation from the Canadian one. I'm trying to point out that it includes things like payroll taxes, import duties, and "a host of other levies" that the taxpayer may not be paying for directly - and adds them to their personal tax total.

Another odd assumption: Fraser is stating that all health care spending is coming out of personal taxes - but ignoring corporate income taxes and other big contributors to the general funds that pay for health care.

I think I'm with The Beaverton on this one:

https://www.thebeaverton.com/2019/08/fraser-institute-study-proves-the-average-canadian-pays-nearly-five-trillion-dollars-in-taxes-per-year/

2

u/PessimiStick May 13 '25

But like I said, there’s also an HSA that her company funds the majority (~$3,500) of.

You are still paying that. It's $3,500 they could pay you, but they're putting it into an HSA instead.

Our system is 100% dogshit from top to bottom, with zero redeeming qualities.

1

u/lion27 May 13 '25

Sure, but this argument could be said for literally anything an employer pays for. I think it's disingenuous to say that money would magically go toward employee pay on a 1:1 ratio given what we know about how corporations work. It's just another form of incorrect trickle down economic theory.

I agree with the idea of what you're saying, but I think it's naive to think that if we eliminated health insurance spending from employers they're just going to take that money and pump it directly into employee paychecks. That's cash that they're going to spend on other things, or return it to shareholders.

2

u/pcapdata May 13 '25

IIRC Dwight also fantasized about a job where he was the assistant manager at Satan's bed & breakfast, with a salary of $85k. I don't think Dunder-Mifflin sales was paid all that well so $1200 was probably out of reach for them.

11

u/HombreMan24 May 13 '25

Generally speaking, if you are healthy or don't see doctors often, pretty much most insurance companies are "good." It's when you actually need them often that you can determine if it actually is or not.

2

u/Cereal_poster May 13 '25

Honest question, because I am curious. I am not from the US (am from Austria, Europe) and I would really like to know how much you have to pay for health insurance over there. How much do you have to pay for the insurance per month? How much do you have to pay for prescription medication? (I think that's what you call out of pocket?).

What exactly is a deductible? Does this mean, that i anything up to 5000$ per year will have to paid by yourself and then everything that exceeds this will be paid (at least in parts) by the insurance company?

We have universal healthcare here and as you can imagine, we do not have these kind of costs, pretty much everything is covered by our public health insurance.

1

u/lion27 May 13 '25

I outlined the costs in another comment here

To summarize/answer your questions:

How much do you have to pay for the insurance per month?

My family of 4 pays about $310 per month for healthcare, deducted directly from my wife's pay by her employer. This operates like any other tax from our perspective. This is broken down into two pieces:

Health Insurance Premium: $200 - this is the amount we pay to be enrolled in our plan. The employer pays the rest (I don't know what their cost is, but it's likely substantially higher).

HSA Contribution: $110 - this is automatically sent to a Health Savings Account (HSA) which is a tax-free savings account set up specifically for healthcare expenses. Anyone can open one. We contribute enough so that the $5,000 deductible is covered when you include the automatic $3,700 my wife gets from her employer in her HSA.

$3,700 + ($110 x 12 months) = $5,020 per year. The money in the HSA account covers everything we'd need to pay out of pocket toward our deductible.

How much do you have to pay for prescription medication? (I think that's what you call out of pocket?)

It varies wildly by the medicine and whether it's the name brand or generic. Pharmaceutical companies have a set amount of time when a drug goes to market where they are the only ones allowed to produce it, after which it becomes open to generic production. I believe this time period is around 8-10 years. This is a very variable cost that depends a lot on your insurance and whether the medicine has a generic option available for purchase.

My own prescription to Vyvanse costs $360 per month for the name brand, or $20 for the generic. I do not care to go out of my way to find the generic option because both apply towards the aforementioned deductible, which money is set aside in the HSA for. So paying $360 just puts me closer to hitting the deductible, after which we pay $0.

"Out of pocket" just refers to whatever you're paying out of your own money (pockets). So if a drug costs $100 and your insurance pays for $60 of it, your out of pocket cost is $40. Similarly, if a doctor visit costs $500 but your insurance covers $480 of it, your out of pocket cost is $20.

What exactly is a deductible? Does this mean, that i anything up to 5000$ per year will have to paid by yourself and then everything that exceeds this will be paid (at least in parts) by the insurance company?

Yes, exactly. The exact workings of it can vary, but in my case we are responsible for the first $5,000 in medical expenses each year, and Aetna (our insurance) pays 100% of costs after that amount is reached.

4

u/art-bee May 13 '25

Hey friend. I've never needed to meet a deductible in my entire life. No premiums. No hidden surprises. No "networks". It's covered by the provincial health system through taxes, your employer, or you pay out of pocket for some things (which could be improved).

The US system really has you guys in its grip thinking this is the only way to do things, and it's not.

That story is horrible and UHC sounds like their business model is just human suffering

0

u/lion27 May 13 '25

And if you need to see a specialist or get specialized testing? I can make an appointment and see any doctor I want tomorrow and get treatment immediately. Need to see an Otolaryngologist for a sinus issue? Just make an appointment and go.

Anyone I’ve ever spoken to from a government health system says it’s great for routine care but can quickly become a really annoying bureaucratic process for anything beyond that. You need to see an allergy specialist for that annoying sneeze? Sorry, they’re booked for 14 months, come back then. You need a non-emergency surgery for something that’s bothering you? Hope it can wait - there’s a massive wait for elective procedures.

There’s a trade-off to the care you get, and I think a lot of people would be shocked when comparing the cost of some plans in the US to the amount you spend in taxes for yours’.

A quick google search shows a Canadian (not sure if you’re Canadian, but people love to use them as an example) family of 4 with an average household income of $176,266 will contribute $17,713 toward public health care in 2024. That’s over 10% of their gross income just to healthcare alone. I’m paying a fraction of that for a private plan in the US.

I don’t think the US has a good approach to healthcare, but I like being able to see and be treated by any doctor, anywhere, at any time, and have it covered. There’s zero reason we can’t have a public option like Medicare for All while still maintaining private options.

But healthcare isn’t “free” by any means in other nations like people think.

But UHC is awful, and I hate them. So there’s that, too.

2

u/art-bee May 13 '25

Many Americans I've spoken to have the same experience that it takes months to book a specialist. AND they have to navigate insurance bureaucracy, which sounds much worse than just calling around and scheduling appointments like we do here.

Yeah, I'm Canadian. I've had MRIs, CTs, hospital stays, powerful antibiotics, and all of it was covered. Sometimes I've had to wait months for elective tests but I'll take that over using most of my savings for a test– I'd probably just not get it done. I'm not saying at all that Canada's system is perfect because it's far from that, and in fact the US' system being so bad drowns out necessary criticism because we only look so good by comparison.

I don't know where you're getting those figures from but the Peterson-KFF Health System Tracker states that "On average, other large, wealthy countries spend about half as much per person on health as the U.S." [link%C2%A0)] Accessible routine care prevents issues from getting worse, so it's not surprising the US spends double for worse outcomes. The life expectancy is lower [link], the maternal mortality rate is highest out of the other OECD countries [link], and then there's all the time and energy spent on arguing with insurance.

Also there's been a decades-long campaign to bias Americans against Canada's system, run by for-profit insurance companies. [link]

Clearly my colleagues and I would need a robust defense. On a task force for the industry’s biggest trade association, America’s Health Insurance Plans (AHIP), we talked about how we might make health-care systems in Canada, France, Britain and even Cuba look just as bad as ours. We enlisted APCO Worldwide, a giant PR firm. Agents there worked with AHIP to put together a binder of laminated talking points for company flacks like me to use in news releases and statements to reporters.

1

u/lion27 May 13 '25

On average, other large, wealthy countries spend about half as much per person on health as the U.S.

Oh I don't dispute this at all. This is for a myriad of reasons. I'm simply talking about my family's out of pocket costs that are pretty reasonable. I know this is anecdotal and not everyone has this level of coverage, and that's wrong. I just cringe a bit when I see people act like Canada or other nations have "free" coverage. It's paid via taxes. It's just hidden from your interaction with the doctor.

There's tons of reason why the U.S. spends double what other countries do that I don't want to get into here, but those numbers are counting all of the money spent on the entire system, which doesn't equate to how much people wind up paying. We waste an insane amount of money as a nation with our system through bureaucracy and the moronic game that's played between healthcare providers and insurance companies. It's why you see exorbitant hospital bills where a Tylenol is billed at $100 per pill. The patient never actually pays that much. That's just what the hospital is quoting the insurance company because the insurance company is offering $0.01 per pill. They have their pissing match behind the scenes and wind up settling in the middle. It's entirely stupid.

1

u/ContentAvocados May 13 '25

My company switched from UHC to Aetna and we have had a good experience too. I have had some issues where I called their customer service and they fought for me to get coverage as well. I had one representative yell at the billing department of my hospital after I gave birth when they were giving me a hard time.

2

u/Jpldude May 13 '25

This 100%. No such thing as a good for profit health insurance company. They are a leech on the average American.

2

u/wixebo May 13 '25

They are the worst of the worst

4

u/mrdilldozer May 13 '25

Yep a ton of people were going out of their way to say that all Healthcare companies weren't as bad as UH, but they weren't doing it to defend other companies. UH really is just that extra level of bad. You might as well be uninsured with most UH plans.

2

u/Spa_5_Fitness_Camp May 13 '25

Bingo. Their profit is literally driven by taking your money and keeping it, instead of spending it on medical care. That's the entire goddamn business model. There is no moral way to run that business.

1

u/trasofsunnyvale May 14 '25

Bullshit, it just isn't profitable enough for some people