Do Americans still need extra health care / medical insurance after reform to health care? [U.S.]
I think it is too early to tell. They changed so many variables in an incredibly complex system, and a lot of it will depend on how the requirements in the legislation look once the bureaucrats and insurance companies get a chance to interpret them and implement them as policy. My gut feeling is that for most people, you should plan on some pretty price increases for insurance in the next few years as insurance companies try cover the costs of removing lifetime caps and insuring people with pre-existing conditions. That said, the personal finance issue that you really should be planning for is your portfolio not your insurance costs. The bill includes almost a 4% increase in capital gains taxes.
I don't see how this is an example of throwing more money at the problem.  I see this as an issue of taking for-profit health insurance providers out of the equation, and making the U.S. government (i.e. the taxpayer) the sole payer for health care services in the United States.  Just like almost every other developed nation does it. Thats a good question. You don't have any argument from me on that. However, I have friends who have done that and after a few years living like that, its extremely hard on them if they get sick, because the system THAT I AM TELLING YOU ABOUT, will ruin them *in a flash*. Its increasingly designed to take ALL of people's money when they are at their most vulnerable, when they are sick. And IT doesn't care. Single payer systems will just fix you up, you dont get a bill. They have to be free, which you can tell [by reading this](http://www.iatp.org/files/GATS_and_Public_Service_Systems.htm) - which explains why. "Its the economics subreddit. People post here to talk about economics. I assume people here have attention spans long enough to read a few paragraphs.  I can understand your issue with principal. I understand people who will willingly take a worse system that costs more just to fuck over a drug addict. I'm not one of them.  Personally, I would pay zero dollars extra to fuck over drug addicts and I have no desire to have worse quality care so drug addicts can be denied care.  I want the system that is a good balance between cost and quality. Sure, the trade off of paying ""less for better"" is when everyone else is covered, there will be people who I don't like, and who made poor choices that will also get that coverage. I suppose one could make a single payer system that also doesn't cover drug addicts. Maybe that would be ideal for you. However, studies also find that paying for these drug addicts/lazy assholes also saves money in the long run. I assume you don't want to explore the theories as to why statistically this is the case because you know.....TL DR.  I'm sorry you don't like the ideas. Don't worry about ideas. Worry about facts and reality. Base what you ""agree with"" on reality. I'm going to go out on a limb, I think if you thought about it, saving yourself and your family money for better treatment will rank higher than the principal of denying treatment to those who you don't like.    Once you establish what you value, abandon ideology. See what works best with what you value and go from there. I would make a guess that one of the reasons Americans are absolutely ripped off when it comes to medical costs is because people don't agree with ""ideas""." The special rights for corporations come automatically when US companies become a multinational. And that binds the US, just like it did, for example, Slovakia, [blocking their right to have affordable health care](http://www.italaw.com/sites/default/files/case-documents/italaw3206.pdf), because an insurance company had silently, invisibly finagled a SUPERIOR right to massive compensation, basically free money. Article was about insurers not liking the uncertainty. Some insurers want Obamacare repealed, some of them want it to stay. But they all don't want to political climate of uncertainty. A situation where people wouldn't be mandated to buy insurance because they don't fear the IRS actually requiring them, but where the actual regulations haven't been changed yet is a nightmare for insurers. "I had an HSA for two or three years. I found very routinely that my insurance company had negotiated rates with in-network providers. So as I never hit the deductible, I always had to pay 100% of the negotiated rate, but it was still much less than the providers general rate. Sometimes dramatically so. Like I had some blood and urine tests done and the general rate was $450 but the negotiated rate was only $40. I had laser eye surgery and the general rate was something like $1500 but the negotiated rate was more like $500. Et cetera. Other times it was the same or trivially different, like routine office visits it made no difference. I found that I could call the insurance company and ask for the negotiated rate and they would tell me. When I asked the doctor or the hospital, they either couldn't tell me or they wouldn't. It's possible that the doctor's office doesn't really know what rates they've agreed to, they might have just signed some contract with the insurance company that says, yes, we'll accept whatever you give us. But either way, I had to go to the insurance company to find out. You'd think they'd just publish the list on a web site or something. After all, it's to the insurance company's advantage if you go to the cheapest provider. With a ""regular"" non-HSA plan, they're share of the total is less. Even with an HSA plan if you go to a cheaper provider you are less likely to hit the deductible. Yes, medical care in the U.S. is rather bizarre in that providers routinely expect you to commit to paying for their services before they will tell you the price. Can you imagine any other industry working this way? Can you imagine buying a car and the dealer saying, ""I have no idea what this car costs. If you like it, great, take it and drive it home, and in a few weeks we'll send you a bill. And of course whatever amount we put on that bill you are legally obligated to pay, but we refuse to tell you what that amount will be."" The American Medical Association used to have a policy that they considered it ""unethical"" for doctors to tell patients the price of treatment in advance. I don't know if they still do." "This is the best tl;dr I could make, [original](https://www.bloomberg.com/view/articles/2017-07-20/spending-a-lot-on-health-care-is-the-american-way) reduced by 86%. (I'm a bot) ***** &gt; Why? And might we hope to get this spending down? Unfortunately, expensive health care is embedded in the American way of life - more specifically, the American desire to live it up with high consumption.  &gt; Why is American consumption so disproportionate to American GDP? One reason is the relatively low household savings rate, or possibly American net wealth is high relative to GDP. Consumption in the U.S., per capita, measures about 50 percent higher than in the European Union.  &gt; To put it most simply, we Americans spend a lot on health care because we spend a lot period.   ***** [**Extended Summary**](http://np.reddit.com/r/autotldr/comments/6pl8ob/spending_a_lot_on_health_care_is_the_american_way/) | [FAQ](http://np.reddit.com/r/autotldr/comments/31b9fm/faq_autotldr_bot/ ""Version 1.65, ~175686 tl;drs so far."") | [Feedback](http://np.reddit.com/message/compose?to=%23autotldr ""PM's and comments are monitored, constructive feedback is welcome."") | *Top* *keywords*: **American**^#1 **consumption**^#2 **spend**^#3 **health-care**^#4 **more**^#5" "The way you phrased what you said was bothering me.  What is happening is that many, a great many, die from diseases that would be effectively treated in other countries. Here the care keeps getting more and more abbreviated and more and more people fall through the cracks. Also, the US is [trying to use trade with the US](http://www.ttip2014.eu) as a means of eliminating new public healthcare and incrementally dismantling existing public health care and access to generic medicines around the globe.   Since thats obviously ""what rich Americans want"" &lt;/sarc&gt; (people really say that) having elected neoliberal Obama." As others have said, it depends entirely on what benefits are provided, and how much of the cost of those benefits is paid by the employer and how much is paid by the employee, and compare that to what it would cost to obtain the necessary/equivalent coverage without employer assistance. In my case, my employer pays more than $10,000 per year toward the cost of medical, dental, vision, disability, and life insurance for myself and my family. That's almost 20% of the average total household income in my state, so it is not an insignificant amount at all. Americans want cheaper health care. They do not want one where you have to wait months for a blood test and sometimes they cut off the wrong leg (see video on Canadian health care system below).  https://www.youtube.com/watch?v=q2jijuj1ysw  There is a medium between a monopoly market (what exists today) and a socialized one. It is called a free market. "For most situations the ""no need"" answers are 100% correct. The corner case to think about depends on your health and your family history.  Not to be morose, but if folks in your family who died young from heart issues, clusters of cancer or other terminal illnesses, you may want to consider getting medically qualified for a modest amount of insurance when you are young. Then, when you have children, you usually have the option of incrementally upgrading your coverage over time." "No, I think the US should be under a single payer system. Care in the US is is shitty as it is. ""It is hard to ignore that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy... Comparisons also reveal that the United States is falling farther behind each year"" [New England Journal of Medicine](http://www.nejm.org/doi/full/10.1056/NEJMp0910064). Also another point I didn't mention is that most US 'middle class' families are literally only one sickness away from having to choose between medical bills or mortgage payments. I personally have had friends who had to drop out of college after their dad got sick, and I wouldn't mind paying more taxes if it meant that never happened again, or happened to my children once I start a family." "What you have here is an interesting argument. Right now, this is totally complicated by the state of ""forced insurance"" that is currently in such hot debate right now.  As a general rule of thumb though, most Americans pay their medical bills in one way or another. Though It is also accurate to say that most Americans have avoided paying a medical bill at one point or another.  I will give an example that will help clarify. My wife gets a Iron infusion shot one every year or so. We choose not to have insurance. The cost to us is around $275. We know this upfront and have always paid it up front. Except for one year. One year we had insurance. The facility that does the infusions charged us $23,500 to do the infusion that year. The insurance paid $275 to them. We refused to pay the remaining  $23,225.  This is a real example using real numbers.  SO while we are more then able to pay the ""normal"" amount, and we could, in theory, pay the inflated amount, We out right refuse to.  The medical facility tried to negotiated the amount down to $11,000 but we refused. They then tried to talk us into a credit plan. We refused. Then they negotiated the entire thing down to $500. We refused. Finally, after 2 years of fighting they agreed that the service had been pair for by the insurance. And sent us a $0 bill.  The entire time, that facility was more then willing to keep doing this annual service for $275.At no time were we denied care. We did have a dent in our credit for a while, but honestly it didn't matter to us. Wrap Up It is fair to say that most Americans do pay their medical bills, but it is also fair to say that most Americans do not pay all their medical bills. The situation is complicated, and made more so by recent changes.  Heath insurance is the U.S. is nearly criminal and while some changes have been made in recent years the same overriding truth exists. Sometimes, a medical bill, when going through insurance, is just plain silly, and the only recourse you have as a customer is to not pay it, for a while, till you get it sorted out." It's possible.  Our healthcare systems is a serious mess, but universal healthcare could also make things worse.  The problem is that our healthcare system is afflicted by a litany of regulations neither guarantee care to the most vulnerable nor allow the market mechanisms to work.  The Mises Institute has a few good pieces on this ([here's one](https://mises.org/blog/how-government-regulations-made-healthcare-so-expensive)), but to put it very simply, the issue is we are letting bureaucrats run our healthcare instead of leaving medical choices to physicians.    I'd wager that NZ physicians have greater freedom to practice than US ones, but that's only a guess.  That's the key though.  Medical choices need to be left up to doctors and patients whether we adopt a market-oriented system or a universal care scheme.  If this isn't done, quality of care will be poor and costs (direct or indirect) will be high.  At the end of the day we could screw up either approach.    I will say, that I've read Sen. Rand Paul's [proposal](https://www.paul.senate.gov/imo/media/doc/ObamacareReplacementActSections.pdf) (not the current Republican plan) and it seems like a good example of practical market reforms. No, I'd prefer a healthcare environment where prices are so reasonable you don't need outlandish insurance and trillion dollar government programs.  But no, the government refuses to negotiate. Why? Because the almost all healthcare legislation is created to enrich the industry itself. Obamacare is nice in theory, but what it really does is give the insurance industry 30 million new customers without so much as a token discount. Medicare has a provision that specifically prohibits negotiation of prices on drugs.   So you tell me, should the role of the government be to enrich the companies by feeding them more customers, err.... I mean enrolling more citizens. Or should the role of government be to keep regulation in check to where it doesn't cost $80 for a single pair of latex gloves.