But have you seen how they gouge the uninsured? I was in a minor bike accident last year and I had a 5k deductible. Just had an ambulance ride and got checked out at the emergency room. The bill was $6000 without insurance, which was reduced to $1500 with insurance.

Hospitals have such poor cost accounting.. they basically make something up if you're uninsured. It completely eliminates going without insurance. The charges would be outrageous.

Edit: The 4x multiple in my bill isn't anywhere near the worst. There are hospitals that charge up to 12x (so 1500 turns into 18000): https://www.washingtonpost.com/national/health-science/why-s... Add to that, hospitals won't tell you what something will cost up front... so you get to find out when they send you the bill.

I would love to be able to get, from my insurer, a low cost option just for this: patient pays 100% of their standard negotiated rates. I go to the same network, they pay the doctor and bill me for the payment. Premiums just need to cover their admin cost plus some insurance that kicks in if I do not pay.

Doctors should not care -- they still get the same $$ from the same source the same way. Catastrophic coverage can be arranged separately, but the above schema I think would provide much of the current insurance benefits at the much lower cost.

The benefits of health insurance aren't those your alluding to here.

The benefits of health insurance are the flow of money from your bank account to the insurer.

Your premiums are going up 74% next year, what are you going to do about it? Complain on an internet forum. Go ahead.

There are plenty of generic meds that cost less than $10 with the discount negotiated by the insurance company but cost upwards of $100 if you don't get the discount.

The calculation that "you get nothing with a high deductable plan" is not entirely accurate if you take these into account.

(that's what lots of drug discount cards are, you get a negotiated price instead of the cash price)

So having a PBM price is an included detail of insurance plans, I'm not sure how useful it is (I expect the formulary used by cheap insurance ends up similar to the free stuff).

What's also annoying is you can't determine ahead of time what something is going to cost, so even when it's not an emergency you can't shop around.

Well, it's insurance. It's there so if you have twins in the NICU for two months because they were born in the second trimester (like I did) you don't wind up with a multi-million dollar bill to pay. Most people will incur more premiums than benefits. That's normal.

At what point does subsidizing other people's outlier events become unacceptable? I will never have kids (biological issues). I will likely die from a one off critical heart failure (also genetic in my family) rather than anything that will cost me significant amounts of money. I do not drive, leave the house much, or do any risky activities, yet as the parent said, I pay _hilarious_ amounts of money each year for insurance.

And the real kicker for me, I've developed some conditions related to stress-side effects, sedentary behavior, and joint issues because of my work. So the insurance money would be BETTER SERVED being reinvested so I could stop working in such a way that damages my body.

Now, you can say this is selfish, but as I said, I'm taking an intentionally selfish point of view for this argument. At what point do we draw the line of "I need this money for me now" or "someone else needs the net effect of re-balancing costs across a society?"

I will openly admit that as I've gone through a decent chunk of my career without incurring any major events, but while incurring major costs, where I sit on being OK with the current arrangement has shifted.

At what point do we stop holding up infant mortality as the gold standard of medical care? Spending untold resources on keeping alive infants who would otherwise die is inherently dysgenic, and allowing whatever conflagration of genetic anomalies that contribute to the necessity of postpartum care will inevitably lead to higher incidences of these cases in the future, as these genes are allowed to propagate into future generations.

Infant mortality is emotionally devastating, but preventing it will almost certainly increase our society's long-term medical costs.

Finland which is number one, "used the least resources and attained average results, making Finland the most efficient public sector health service producer according to the study's authors"

https://www.washingtonpost.com/news/wonk/wp/2014/09/29/our-i...

Granted it's way better than many other countries, but still we shouldn't be so off.

https://www.cia.gov/library/publications/the-world-factbook/...

Just look at the established tradeoff our species makes- our children are born helpless. Isn't caring for them dysgenic? But, being able to care for & protect them enables significant brain development to happen outside the womb.

Swaddling, clearing a wrapped umbilical cord, suctioning the nose & mouth... there are lots of things we do that improve mortality that are trivial.

That said: most of the improvement is through public health measures (clean drinking water, sewerage systems, municipal waste collection) and nutrition. Heroic measures are very much the outlier. That may be an even stronger argument against them -- other than as a learning experience, the resources they consume relative to providing much more basic, and effective, outcomes interventions is difficult to defend.

From the CDC: Infant mortality in the US <1 year was "up to" 30% in 1900. Maternal mortality was around 0.8% in 1900.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm

> Spending untold resources on keeping alive infants who would otherwise die is inherently dysgenic, and allowing whatever conflagration of genetic anomalies that contribute to the necessity of postpartum care will inevitably lead to higher incidences of these cases in the future, as these genes are allowed to propagate into future generations.

The closest thing I have to an answer for you is single-payer like the rest of the developed world, where they pay substantially lower medical costs for similar health outcomes.

I do hope to see our society mature a bit on end-of-life care. Dying is disproportionately expensive (http://time.com/money/2793643/cutting-the-high-cost-of-end-o...) and that money often results in little benefit to the patient (and at times, probably causes active harm).

It looks like many countries are moving that way in the past 20 years: https://en.wikipedia.org/wiki/Legality_of_euthanasia

Patients who'd like to undertake euthanasia and can't would get a DNR order. Medicare isn't spending massive billions on folks with DNRs - it's the folks that won't accept a terminal cancer diagnosis and put grandma through intensive chemo instead of prioritizing quality of life that costs.

But health "insurance" has crept into regular health maintenance. But that's not really insurance; that's more like an extended warranty for your life.

[1] And certainly things like dental insurance are pretty much just "extended warranties" rather than insurance against catastrophic expenses.

Those who work for a company and receive a W-2 form can look at Box 12 on the W-2 to see how much their employers paid for their side of their health insurance policy (coded with "dd").

You might think "who cares" but that's money that could have gone towards your salary.

I don't think this is in spite of subsidies but beacuse of them. Just like the epipen mess, the less of a bill the customer sees the more you can raise it.

Outside of health care specifically, this is also why disability plans tend to be relatively inexpensive for large companies to offer but are pretty pricey--when you can even get them--for individuals.

Same with disability, examine the individual coming in to make sure they don't already have a disability that's being covered, but after that why would the individual odds be any different than accepting a whole group? If you do an actual exam, they might actually be better.

There are non-employer group plans for certain types of insurance e.g. through something like the IEEE but generally not for healthcare AFAIK.

With respect to disability--leaving aside that an exam won't find all pre-existing conditions such as joint problems--there's still adverse selection. The people who would even apply for disability insurance are a higher risk pool (probably older for one thing) than the working population as a whole or all employees working at a large company.

Orthopedic replacement $23,000 one year. Other years combined $2600

Not worth it. But plan your surgeries and up the coverage for that year. That strategy can work (not dental)

Even with a high out of pocket it is smart.