With some health plans, even a doctor doesn’t seek health care

What a terrific piece of reporting Marketplace health beat reporter Dan Gorenstein turned in on the show last night!

It followed a comment from the likely new secretary of Health and Human Services at his confirmation hearings yesterday.

Tom Price said high-deductible catastrophic health plans make sense for a lot of people. And maybe they do, although how they work isn’t often explained.

Gorenstein explained it last evening from the perspective of whether it makes health care better for people. He did so through the story of Dr. Ashish Jha, a physician and Harvard professor who could apparently afford to try to insure his family with such a plan just for the academic exercise.

“I thought…it would be really useful, as a family, to know what it actually feels like to have to pay for everything out of pocket at least until you hit your deductible,” said Jha.

Nice life.

His plan, like most high-deductible plans, requires the policyholder to pay for everything until a certain amount — in his case: $6,000 — is reached.

One night, he might have been having a heart attack, Gorenstein reports. And he wouldn’t go to the hospital. Keep in mind: This guy’s a doctor.

These episodes usually pass quickly. But the most recent one, which Jha experienced after a bruising international business trip, was a particularly bad bout. At half-an-hour, his heart was still racing. After an hour, his wife urged Jha to go to the Emergency Room.

“And I was resisting it. She actually asked me, ‘if a patient of yours called you with this, what would you recommend to them?’ And I said, ‘oh, yeah, that’s easy. Go to the [Emergency Department],'” Jha said.

Though he knew he could be experiencing a heart attack, Jha didn’t want to spend $2,000 or more getting checked out in the ER — even though he said he could afford that. In retrospect, Jha said he should have gone to the hospital.

“But, you know, I knew there was a big bill waiting for me if I did, and I rolled the dice,” he said.

Jha got lucky. After an hour his heart rate began to slow.

But his experiment, putting his family on a high-deductible plan, is helping him see the reality of what many health care researchers are finding: these plans can put people in difficult positions. Sometimes, in fact, they can force people to make decisions as if they were their own doctor; and that’s something even a physician struggled to do for himself.

It was a brilliant piece of reporting to explain an important concept of health insurance alternatives.

Related: How To Create A Workable Republican Health Care System (Forbes)

How Large Employer Health Plans Could Be Affected By Obamacare Overhaul (NPR)

  • guest

    Decades ago a “good job” came with zero healthcare premiums and zero out-of-pocket. I had 3 children with not a dime of my own expense. When a child had a cough my wife would take the child in to be checked out (sweet to have a stay-at-home spouse & a car).
    When we had to pay for each doctor visit I found myself waiting until the symptoms got better or got worse before going in to find out whether anything needed to be done.

    That was just a small payment, but I was amazed at how willing I became to let our child cough or sniffle or be “down” until I was certain.

  • Anna

    Years ago when I was interviewing for a legal secretary job for a bankruptcy attorney, I questioned her about the cause of most bankruptcies and interestingly enough, she said it was not due to bad credit card debt—-an overwhelming majority are caused by a catastrophic illness or the catastrophic loss of a job.

    Catastrophic plans are great if the only thing you want to avoid is losing your home. If you want to avoid major disability due to an avoidable stroke (think adequately controlled hypertension) genetic heart disease or Type I diabetes, you need a plan that covers prescriptions and ongoing specialty care.

    Anyone can get access to healthcare. All you have to do is walk into an emergency room and they have to provide care. It’s the law. It’s called EMTALA (Emergency Medical Treatment and Active Labor Act).

    Getting adequate and reasonable care is another matter entirely.

    High deductible plans do exactly what Dr. Jha related in his story. People avoid care because they need to buy school clothes and supplies for their children, put adequate food on the table and keep the lights on not to mention paying a mortgage if they are lucky enough to afford a house and provide for transportation to and from a job for both wage earners. For many young couples, the wife works just to pay for the cost of daycare for young infants and pre-school children.

    I had the chance to talk with a family physician from Missouri on my train trip down to my father’s funeral. She works at a sliding fee scale clinic and she related exactly what Dr. Jha said. Parents avoid care for themselves and their children because of the high deductibles.

    If it’s happening in Missouri then it’s happening all over the country.

    I’m not a mind reader but as many commenters on this blog have stated, the Republicans have had 7 years to work out a plan to replace the ACA.

    Where is the plan?

    I have a message for Donald Trump. It’s an old adage that has been around in business for generations: Never promise more than you can deliver.

    The Republicans know they can’t deliver so they are putting up a smokescreen and promising over and over that they have a plan.

    If wishes were horses, beggars would ride.

    • >>Catastrophic plans are great if the only thing you want to avoid is losing your home. If you want to avoid major disability due to an avoidable stroke (think adequately controlled hypertension) genetic heart disease or Type I diabetes, you need a plan that covers prescriptions and ongoing specialty care.<<

      I had to live this the last time I was out of work (18 months during the height of the recession). I was terrified I was going to have an accident or get sick and the "high" deductible plan was $18k…yes, $18,000.00. That was the only one I could afford for me and my kids. Needless to say, we were fortunate to not have to use it.

      We need a national basic healthcare plan for EVERYONE.

      • Jack

        Amen to that.

        We are on such a plan but luckily our max out of pocket is just shy of $10,000 per year in network. Sure enough – we hit the max two years straight thanks to a major medical incident in December 2015 that continued through 1st quarter of 2016. Since we fully funded the HSA every year that we were in it, we could take the hit and still have money left.

        If it had happened out of network, we would have been in deep troubled as the max out of pocket would have been $20,000 per year.

        Time for some serious action where everyone gets comprehensive affordable healthcare. This is a basic human right.

    • yesimpayingattn

      “Anyone can get access to healthcare. All you have to do is walk into an emergency room and they have to provide care. It’s the law. It’s called EMTALA (Emergency Medical Treatment and Active Labor Act).”

      I have only one complaint about your posting. This statement is technically correct but the problem is with the definition of the word “care”. All the ER is required to do is treat you, stabilize you, but chronic illness such as diabetes, requires ongoing, multiple visits, follow-up visits, medication, constant monitoring, etc. etc. none of which can be or will be provided by an ER on an ongoing basis.

      • jasper

        And, you forget, they will bill you. And bill you the full, undiscounted amount. So, yes, the emergency care is there, but that hospital bill will follow you relentlessly. I speak from $70,000 of experience. Did you know that physical therapists bill out at $1,200/hour? After seeing that first bill I made up my own PT.

        • Yes, I went to one PT session after a recent injury and blew the rest off. They give you the exercises at the first session. Although mine was only billed at $250 an hour.

  • Rob

    As the story notes, Jha could afford to go on this plan and treat it as an academic exercise. Most people with catastrophic plans don’t have that luxury. Jha’s decision to delay treatment sounds like it was based more on obtuseness and being a dude (as we know, men are, in general, far less likely to take care of their own medical concerns than women are) than anything else. Thank goodness his wife stayed on him to take care of it; she probably saved his life.

    • Mike Worcester

      Imagine if he did not have others around him to cajole his trip to the ER? This could have turned out to be more than just an academic exercise :O

      • Rob

        Yup. My guess is if he’d been sans spouse, the EMTs would have eventually gotten a call for a “non-responsive middle-aged guy.”

        • >>”non-responsive middle-aged guy.”

          My wife calls me that when I play Xbox and have my headphones in.

  • John O.

    He probably didn’t have to worry either about whether to pay for his prescription(s) or the monthly mortgage payment.

  • Mike

    This is a problem that Obama and the Democratic Party could have gone a long way toward solving if they had been willing to enact some form of public option in the ACA. But keeping health insurance companies in business was more of a priority.

    I have no expectations that Trump and the Republicans will do any better. It’s likely they’ll do worse, but in any case now they’ll have to own whatever they enact. That’s assuming that a bunch of Democrats don’t vote for whatever it is, giving the Republicans political cover. Then again, I never count on political savvy from the Democrats.

    • Rob

      I don’t count on moral courage or conviction from either party, and that’s what it would take to enact universal health care.

      • Mike

        Me neither, but the Republicans play the game better. That’s probably because they’re less conflicted; they don’t have to pretend to care about the less fortunate like the Democrats do.

        • Rob

          Good point.

        • Jeff

          I think it’s more the ideology that the marketplace will take care of everything.

      • yesimpayingattn

        From the article, “the public option failed as a result of many factors, including lack of support from moderate and conservative Democrats,”
        Yes, the public option failed because we have a bunch of DINOS.

        “Edwards saw the public option as a potential transition to single-payer insurance.” Well this is where the Republicans got the meme that the ACA was just the intermediate step to socialist, single-payer and they ran with it.

        Edwards also understood that many Americans “like the health care they have and are nervous about entirely government-controlled health care.”

        So why are American’s nervous about entirely government-controlled health care? Because too many Americans believe that socialism is our biggest threat to our democratic freedoms and Republicans have exploited that fear and DINOS have done little to attempt to educate people about the differences between single-payer (U.S. Medicare, Canada), government controlled health care (U.S. Veterans Affairs, U.K.) insurance based (U.S. ACA, Germany) and the benefits. Meanwhile, we spend $3.2 trillion annually, 17.8% of our GDP on health care, That’s $9,990 for every man woman child.

        If Republicans pass ‘reform’ that lowers premiums, we will either have a $40 trillion debt by the end of Trump’s term or our health care system will be in shambles. Or both. Maybe that’s what is necessary to make Americans understand that the Republican approach to health care reform will be much, much much worse than ‘socialist’, single payer.

    • MikeB

      If they would have had the votes to do so, they would have. They had to operate within the political constraints they had at the time.

      • Mike

        If they had wanted to fight harder for it, they could have changed the rules in the Senate so that a simple majority, rather than 60 votes, would be needed. That’s always the prerogative of the majority party. The Democrats decided they didn’t want to do that.

  • Jeff C.

    The advantage of a high deductible health plan (HDHP) is that the monthly premiums are less than with a traditional plan where you pay a small co-pay at the time of service and the plan pays the rest of the bill. HDHPs are great for people who use the plan rarely. Yes, you have a $150 bill to visit the doctor instead of a $20 copay, but you also pay $100 (or something like that) less every month. In the end, you can save more than you spend (although it doesn’t feel that way). What if you have a major problem? Check your plan, but there is a good chance that you don’t have 100% coverage for big-ticket things like surgeries. If you have to pay 20% of your $10,000 surgery, you’ll have a $2,000 bill waiting for you when you come home from the hospital – along with your high monthly premiums. HDHPs are usually 100% coverage after you hit the deductible. Oh, and HDHPs often do cover preventative care 100% since the plan owners know it is cheaper to keep people from getting sick with a major problem than paying the bills after they start chemo.

    Personally, I know I’m going to hit my deductible every year. The question is “when”, not “if”. Knowing that, I go to the doctor when I need to in the start of the year and get “free” care at the end of the year.

    • Jack

      Here’s my humble opinion on moving to the HDHP as you mentioned above. The premiums are less – bank the difference into a HSA account and eventually you will be able to absorb a bad year or two.

      I understand that this may not be possible for everyone but even banking a little into the HSA will help in the long run as these funds belong to you – you don’t lose them like so many people do with a Flexible Spending Account (FSA). I know – I used to administer benefits at a different employer.

      Also – HSA contributions are excluded from your taxable income so you get a tax break (at least under the current law and assuming you aren’t losing part of that due to income phase-out) for what you set aside each year.

      I’m not a fan of investing the “excess” like many HSA financial institutions would like you to do – it’s emergency money that can’t wait for the market to recover.

      Oh and that max out of pocket? I’d like to thank the plan for the “free” Epipen at the end of the year since I couldn’t pay anymore in 2016. Don’t worry, that will get recovered in the increased premiums I’m paying this year. Just hoping that we can get through the year with minimum medical care needed.

  • Brian

    I think we have two choices when it comes to reducing health care costs:

    1. We can move most people to high deductible plans like this. Then market forces should reduce the cost of care eventually.

    2. Some sort of public option / single payer / NHS.

    I don’t understand how anyone thinks health care costs will go down the way things are now. What incentive is there if most people are on plans where their cost is mostly divorced from the amount of care they receive? The story above is a good example of why I don’t think the first option is tenable, but at least that debate would be truthful.

    • I skip follow-up appointments. My co-pay is $50 for them. So we’re not entirely divorced from the cost of care. I have a $1200 out-of-pocket limit which I didn’t touch until a few weeks ago when I needed to go to the ER. I thought about it.

      I also bought two hearing aids because I’m going deaf. They cost me $3500 (I should’ve waited a couple of weeks to push it into 2017; stupid me).

      The cost of care isn’t entirely invisible to most people. And I CAN make my health care costs go down simply by not seeking health care.

      • Brian

        I’m not an expert in health care costs, but my intuition says that those considerations aren’t enough to make a hospital charge less for an ER visit or a clinic charge less for follow up appointments. Maybe I just assume most people aren’t as conscientious about it as you are?

        Also, you did end up going to the ER. And wasn’t part of the point of the story above that Dr. Jha should have too? Health care is so important that, in aggregate, people will get it almost no matter the cost, at least for important stuff.

        • The point of the story above isn’t that he should have gone to the ER. It’s that he didn’t. Gorenstein’s effort is partly to help answer the question of whether high deductible plans have an effect on health care and, of so, what is it.

          Am I more conscientious ? I don’t know. Is failing to go to follow up appointments smart? Stupid? In between? I don’t know, not do I know that other people aren’t making decisions based on personal cost. I just know that a lot of people say they’re not.

          The other thing about “important stuff” is we don’t know what the important stuff is. Face it, that includes especially guys. What you’re describing is EMERGENCY care, which I think is not a definition of health care. It’s merely a part of it.

          Few people, I suspect, found their breast cancer in an emergency setting, for example.

          • dukepowell

            Preventable care is, or was supposed to be, covered outside the deductible. Mammograms should be a preventable care expense covered by the insurance.

            Also, I’m not so sure the good doctor had to go to the ER. That’s why I said, earlier, that a lot of detail was missing from the Marketplace story.

          • Brian

            I guess I chose the ER since it is an easy example, but I think the logic applies more generally. Do people shop around for breast cancer care based on cost? Maybe there is more incentive to do so with a high deductible plan. There isn’t much incentive at all if all you are paying is a co-pay.

            Although, in some ways even with high deductible plans the incentives all go out the window once you have a reasonable expectation of hitting the out-of-pocket max. We had a baby this year and knew we’d hit it (luckily split by person, so only $5500 for my wife, plus the extra for my son. We didn’t hit the $11,000 family max) so we didn’t bother worrying about cost that much after a point.

            But I suppose my ultimate point is: If we don’t want to go the government route, I think we have to start making us feel the cost of care more. This story is an example the consequences of making that choice.

          • I was listening to the Marketplace discussion on this last night and one point that struck a chord is that it’s not really possible for consumers to shop around for health care. Does one shop for it strictly on the basis of cost? Is there a relationship between quality and cost? The consumer doesn’t have access to ANY of that information under the present system.

            I still, by the way, think people should also have the right to terminate their life after a certain age when faced with catastrophic illness. Many do so now out of cost impact on family.

          • dukepowell

            “it’s not really possible for consumers to shop around for health care.”

            This is generally true, but not always. If one is shopping around for private insurance, a broker or a financial planner may find coverage that would surprise you.

          • Right, but I’m talking about actual CARE, not the insurance cost. I am totally unprepared and underresourced in shopping for care other than get it/don’t get it.

          • dukepowell

            Well, Bob, you are certainly asking the right questions and getting into detail that actually reveals the problems we have.

            As for you being “unprepared and underresourced,” my response would be that this fault lies in the fact we don’t have a health-care market place.

            If you need an MRI and are paying for it out-of-pocket, you have no idea who offers the cheapest and best option. Not only that, the provider, whether it be United hospital, North Memorial, HCMC or some stand lone private entity, will be able to quote you a cost.

            Isn’t that wonderful…. Nobody, but nobody, knows what anything costs in the health care “market.” Which means, or course, there is no market at all

          • Veronica

            While you can’t find the cost of an MRI, you can find out the cost of care for a lot of different things. http://www.mnhospitals.org/data-reporting/minnesota-hospital-price-check/hospital-report

          • To be of proper usage, however, i would think this sort of data needs to be cross referenced and cross linked with some sort quality/outcomes barometer.

          • dukepowell

            Sorry, not ignoring you, just having fun responding to your other posts.

            Yep, good site, and thanks for directing the readers to it……

            If I remember correctly, I may have had a little something to do with requiring these disclosures. …. or maybe not. My memory of that time is blurry. 😉

          • Veronica
          • Jack

            I do not shop for care based on cost. I want quality care and I’m willing to pay for it for myself and my family.

            I’ve spent too many years finding a decent doctor so now that we’ve found one, we’re sticking with him even if he ends up out of network.

            Going for cheaper care can end up costing more in the end both financially and health-wise.

            My health care plans rates the providers based on what cost/quality. I don’t always agree with them – I’d rather pay the extra for quality.

          • Veronica

            I have written about the cost of Maternity Care in MN for the last 3 years with pretty little tables and PEOPLE DON’T CARE. It takes me hours to do, and people don’t care. They care about a lot of other things, but not that. And this is a medical cost you have 30 weeks or so to figure out.

          • // PEOPLE DON’T CARE

            what’s your measurement for determining this? What do they care about when choosing maternity care?

      • yesimpayingattn

        “And I CAN make my health care costs go down simply by not seeking health care.”
        Well la di da. Maybe. For a while. The problem with that approach is that not seeking care can lead to deteriorating health situation, more expensive care needed later, when your condition deteriorates to the point that you are no longer able to function. That’s what we’re saying to people with these high deductible plans–Stick it out as long as you can. Function at a lower level. Stay away from the doctor. So that cancer can progress from stage I survivable to stage IV not usually survivable because you avoided going to the doctor. That’s just one of the reasons we have a health care system that is the most expensive in the world with some of the poorest outcomes for a developed country.

    • >>Then market forces should reduce the cost of care eventually.<<

      This has yet to be seen.

  • dukepowell

    I’m gonna regret this…….

    …..but I read this post right after Bob put it up and have been wondering whether or not to respond. I read through the post and clicked (and read) all the links. I also went to the trouble to look at the physician’s personal blog and scanned that.

    My thoughts on this post are going to be different than anyone here, probably.

    The problem is a full response would be so long that no one would care to read it and I wouldn’t care to write it. Having said that, I’ll refer you all to the post Bob wrote yesterday titled “Details matter in discussion of health care.” It was a thoughtful entry that elicited a lot of comments.

    Details do matter. The lack of detail is the concern I have about the Marketplace report. My experience as an urban paramedic for 36 years, my lifetime of being around academic researchers, and my time as a health care policy maker gives me an insight not commonly understood by the public.

    Would added detail matter to the reading public? No, probably not. But it does made a difference to me. There is a lot wrong with this story, much of which most wouldn’t be able to guess.

    Since NewsCut wants a discussion, I’m willing to sit here and have one. Fire away.

    • Sure. Any additional detail about the question of high deductibles/coverage and the effect — if any — on health care would be well appreciated, I’m sure.

      • dukepowell

        I haven’t studied HSA’s for quite some time, and the rules have changed, but this is what I remember…

        One can trade the cost of health insurance for a yearly deductible with an eye on keeping your monthly payment more within you means. The higher the deductible the less the monthly payment. Dr. Jha’s deductible appears to be on the low side of available options.

        After the deductible for the year is met, the idea is that any further payment for care is covered by the insurance. So what the insured has is a “stop loss” arrangement, on a yearly basis, with the insurance company.

        What is frequently forgotten is this – the monthly payment not only covers the cost of the insurance but a contribution to a savings account as well. This account can be used toward your yearly deductible. If you have a “healthy” year, the money remaining in this account carries over into the next year.

        This is why these types of arrangements are better for some than for others. A young man, just out of school, may understand the need for protection that heath insurance provides. He also may understand that he is quite likely to remain healthy (and this is statistically a likelihood) and seldom use the insurance he purchases.

        In exchange for catastrophic, and relatively cheap, coverage he is also able to pay forward the cost of insurance in the future.

        • On my EOB’s, the amount the insurance pays is subtracted from the amount the hospital charges and that — minus copays and the 20% I’m responsible for — ends up being the whole deal. But the numbers never add up to what the hospital/clinic/doctor submitted for charges. With high deductible plans, does the patient pay the bigger number that the hospital/clinic/doctor charges or the smaller amount that they agree to take from the insurance company?

          My wife’s employer just announced its dropping insurance and forcing people onto HSAs. They’ll make a small contribution. Nothing like the previous insurance plan. Still not sure how that’s supposed to work but I’m planning on taking a hit.

          • Brian

            At least with mine, we pay the smaller amount.

          • dukepowell

            Well, here is where detail matters.

            This is a great question, “With high deductible plans, does the patient pay the bigger number that the hospital/clinic/doctor charges or the smaller amount that they agree to take from the insurance company?”

            My answer is, “Beats me,” but I do know that providers have always said that, here in Minnesota, the only thing they get paid full price on is auto accidents – up to $20,000 per patient.

            I suspect that your specific insurance payments to specific providers has been “negotiated.” Whether or not your new plan pays more or less than any previous coverage is impossible for me (and maybe you) to know.

          • Any idea what the markup is from the providers on, say, auto accidents?

          • dukepowell

            Yes, I am very well versed on this subject….

            First of all, as far as I know, there is no “mark up.” Providers have customary charges which are negotiated down by the payors,

            Minnesota is a “no fault” state. According to no-fault law, anyone injured, no matter how little, (and it is VERY subjective) is covered up to $20,000 per patient per occurrence.

            The auto insurance company will pay the bill, without audit. They will pay on a “first come, first serve” basis until the $20,000 is expended.

            As I said before, no provider is paid 100% of their charges in this state with the exception being auto accidents.

            If you look on your auto insurance statement, this charge to you is listed as PIP or Personal Injury Protection.

          • Veronica

            I’m going to make a VERY serious offer, but if you need someone to do an informal Q and A on the matter, I can try to help.

            When you have a medical procedure done, the insurance company gets a bill that lists a “usual and customary charge”. The contract the insurance has with the provider will specify a lower charge. Depending on the kind of insurance, the person is responsible for either the deductible or co-pay…..or both.

            Amount billed aka “Usual and Customary” minus Contract Obligations equal Adjusted Amount

            Patient Responsibility (Made up of Co-Pays and Deductibles) plus Payment Made by Insurance Company equals Adjusted Amount

            Duke, get the details right please. And if you don’t know…GOOGLE!

            And Duke is arguing for medical care by GoFundMe. Very nice.

          • dukepowell

            Well, Veronica, I almost used the phrase “usual and customary” earlier. But then I remembered that this is a term of art.

            In the health care industry, usual and customary means (or it used to mean 10 years ago) what medicare or medicaid paid for a procedure.

            Back when I dealt with these issues, lobbyists did not want to hear that term.

            Veronica, I willing to be wrong, but that is exactly what I remember.

        • Tyler

          HSA don’t work that way. The monthly payment (premium) is separate from the contribution to the actual savings account. So the whole “value” in the way you perceive HSAs falls apart.

          My employer uses HSAs. It’s still better than what’s on the open market, but it’s a racket, and I would love to have anything else.

    • Anna

      The purchase of healthcare insurance is not anything remotely similar to buying a house, making a stock purchase or buying a car or starting a bank account and we have to stop thinking of ourselves as healthcare “consumers” as a story on NPR a few days ago appropriately pointed out.

      The difference between Democrats’ views on healthcare and Republicans’ views on healthcare is that Democrats look at it as a right and a need and Republicans look at it as a privilege and a want.

      Republicans see it as just another discretionary purchase and Democrats see it as a necessity.

      IMHO, therein lies the rub.

      • dukepowell

        Nonsense.

        The question is how do we assure that each person gets, and pays for, the health care that they want and need.

        I believe that the individual gets to decide what he/she needs – not some governmental agency that insists that a single male HAS to pay for OB/GYN insurance.

        • Brian

          That isn’t how insurance works. The whole system breaks down if we get to choose what is and isn’t covered for other people.

          • dukepowell

            I don’t have a life insurance policy anymore because I don’t have a need for it.

            Are you saying I have to buy it to help cover you?

          • Carolie

            You have to buy it so that my tax money doesn’t have to pay for your trauma care when you get hit by a car driven by someone without insurance.

          • dukepowell

            You know, we should start of list of things everyone has to buy to help pay the costs down for everybody else – I’ll start with this:

            Bus pass.

            Feel free to jump in.

          • Police and firefighters…

          • dukepowell

            Got me – you made me laugh.

          • Rob

            You don’t have a need for it? You’re either immortal or you won the gazillion-dollar lottery.

        • Veronica

          Oh, you went the lady parts route.

          There is no OBGYN insurance. There is health insurance. If you have a right to have your genitals and internal organs covered by insurance without having any extra fees, so do I. That’s it. Nothing else. No arguments.

          • dukepowell

            Okay, let’s go another route.

            I’m in the market for health insurance and I don’t drink or abuse other substances. Why should I have to pay for insurance that covers treatment for these maladies?

            Answer: Because government says so.

          • Veronica

            Did you know you can get lung cancer without smoking? Liver Cancer without drinking? Try again!

            Nobody is immune and nobody is special.

          • dukepowell

            OK, let’s try this route.

            I don’t want to buy insurance at all.

            Would you, Veronica, make me buy it?

          • Veronica

            Yes, I do.

            I want it mandated and if you chose not to have it, no medical care for you NONE. Kind of like…driving a car.

          • dukepowell

            I just knew you were going to say that.

          • Brian

            I’ve always thought these were the only rational choices: require insurance or refuse care without it. We rightly (as a society) don’t think it is ok to refuse care, so we are really only left with one fair option.

          • Jay T. Berken

            “I don’t want to buy insurance at all.”

            That is complete hyperbole. Even if you do not buy insurance, the doctor took a hippocratic oath to take care of you, which means the costs are past on to the rest of the consumers if the bill wasn’t paid. Before the ACA there was universal healthcare, who pays for it (in a general sense) is where the ACA steered healthcare.

          • Rob

            You’re clear on the concept of risk pools/risk spreading as the backbone of how insurance works, right?

          • Rob

            Totally cool comment!

        • Rob

          Wrong. Everyone needs health care coverage, but if left to their own devices, a significant number of people would elect not to obtain coverage.

    • yesimpayingattn

      “There is a lot wrong with this story, much of which most wouldn’t be able to guess.”

      Nice posting. You offered not one example. This is a condescending post. Yes, I would appreciate your insights, but you offered none and told the rest of us that we’ll never be able to guess what those insights might be. Way to go.

  • D. Robot

    As someone who’s had different jobs and healthcare plans, I chose the HSA with HDCP out of a sense of owning my own health care and not being afraid to pay for it. I looked at the traditional insurance cost provided through my employer of about $400/month and then $30 copay any time you see the doctor and compared it to the maybe $75/month for being in the HDCP and then using my HSA (pretax) money to pay for any services used. Realistically, neither I, nor my wife, nor my child need to see the doctor every month. If I put the same money per month into my HDCP/HSA, I’m banking somewhere over $3000/year in the HSA and that is MY money for my healthcare (or my covered family members). If I lose my job, it’s still mine. I would still have to pay that $75/month, but that’s much easier than $400!

    I pay maybe $250 each time I take my kid to the doctor, but I’m not reluctant to do it. I figure we’re still saving money by not paying $400/month for something we might well not use on any given month. Also, after several years of accumulating money in the HSA, I’ve exceeded the annual maximum out of pocket expense…. So unless something really bad and expensive happens in December and continues into January, I figure we should be fine. This is a great option for us but it requires analysis and planning and long term thinking.

    • Jack

      You explained perfectly what I was typing further below. And yes – we did survive the December/January situation with max out of pocket. I pray that we don’t have a repeat this year but I still can absorb it since we’ve been in the HSA for six years. Looking forward to turning 55 soon so I can do the catch-up amount.

      You are absolutely right about long term thinking.

      • So more a younger person product?

        • D.Robot

          In my personal,example, I’d say it’s useful for someone planning to live at least three more years…

        • Jack

          More like a healthy person product and wouldn’t necessarily have to be completely healthy.

          We were on the plan about 5 years before I needed to tap it for the major event. Before that, I just paid the occasional office visit out of pocket.

          You can’t pay employer plan premiums from it but you can use it in retirement to cover premiums. Also it is not figured in your assets for FAFSA purposes and you can sock away a good amount.

          • Right, but older people tend to require more health care as things begin to break down.

          • Jack

            I agree. Still irritated that my folks didn’t spring for the extended warranty 😉

  • kevins

    Interesting, informative and respectful discussion below..thanks.