Health Insurance Y/N

levi r said:
Afaik there was a penalty but it was removed in the first Trump presidency. I paid the penalty a time or two under Obama.
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I paid it once, but as I was making juuust under the threshhold for 100% free coverage, I went ahead and signed up. When I get full time work at my current rates, I will really have to look closely at the numbers, but I was looking last month, and I think I would be paying like $17/month/person for my family of three. That of course comes with the highest deductible, but at that point, it's just to keep me from bankrupting whoever I can find to loan me the money, because I don't have a penny that isn't tied up in building my house.
 
levi r said:
Bankruptcy ain't so bad, if you have no assets!
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until my house is built, the land doesn't count as my primary residence, so I would be forced to sell it, and all my tools. I don't know what I would do, but it would probably force me to move to Florida to live with my mom, or NC to live with my sister. All three of us moving in indefinitely would be pretty stressful, as they don't have space like that.
 
Yeah it’s a tough pill to swallow yet something totally needed when it’s needed.

Granted it wasn’t health insurance but I had my first claim with my other insurances. This was to defend myself as I was accused of trespassing to get to my home, because my neighbors couldn’t find record of my easement. I paid $1000 out of pocket and they paid over $200k on my behalf. We basically won and they moved..

Likewise with health insurance, my partner had a procedure, and we had to pay something like 8-9k. Oddly insurance wouldn’t pay for the surgeon because there is no billing code for the procedure. But they paid for the OR and all other expenses. Something near $90k

One strategy is get a HSA, with a higher deductible, and avoid using it in 2025, schedule all appointments needed for Jan 1-December 31 2026. Change plans at a higher cost but lower deductible in 2026.
This works good for a family with all the checkups and things like that. If done right there really isn’t any lapses just playing the calendar and policy cycle.

Be sure to get LMN’s from your doctor, this can open up tax advantages for certain expenses. Owners can have a benefit of company paid medical expenses. Essentially a policy of all salaried workers get said benefit. Or over x number of hours..
for the employees I pay a monthly bonus, as one gets bomber health insurance through their partner.. obviously I can’t dictate what it’s spent on, but the intention is for medical type experience.
 
Matias said:
until my house is built, the land doesn't count as my primary residence, so I would be forced to sell it, and all my tools. I don't know what I would do, but it would probably force me to move to Florida to live with my mom, or NC to live with my sister. All three of us moving in indefinitely would be pretty stressful, as they don't have space like that.
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Form a LLC, transfer your tools to that. Then rent the tools to yourself…
 
surveyor said:
Most providers will give a discount for service provided if you pay out of pocket, so they don't have to deal with insurance paperwork.
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We get 50% at the hospital and offices they own...but not labs or radiology, etc that they send out. That's usually no discount.
 
Boomslang said:
"Absolutely needed". As in, without this necessary procedure the patient's quality of life will be negatively impacted or they'll die.
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OK...I'll play "quality of life negatively impacted". Hair loss treatments? Hair removal? Cosmetic surgery (not related to another injury)?

With "or they'll die"...97 year old with failing heart. Do they get a heart transplant? If not, they'll die next week.

Boomslang said:
And that's the real rub with privatized healthcare and capitalism. You start having individuals use people as investments. We have it up here with the real estate market.

In my opinion, the basic needs of humanity (water, food, shelter, medicine) should be made as high quality and affordable as possible. Everything else can be left to the bourgeoisie to play with.
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I don't entirety disagree...and I operate my company with the philosophy that if i take care of my clients, they take care of me. I don't have sales targets I expect to hit, etc...we just try to do the right thing. Not that I'm perfect and altruistic in my business endeavors...but we aren't driven to bring in certain ROI on everything we do.

Where I do depart a little from your statement "..the basic needs of humanity (water, food, shelter, medicine) should be made as high quality and affordable as possible...". Obviously you imply a balance of quality and cost. But one person will interpret that (especially in health care) "high quality" being everything and anything to give a dying person 3 more weeks of life...even at a cost of millions of dollars.

Boomslang said:
Develop something similar to a mechanic's book time. It takes X time and Y materials/personnel to complete Z procedure. Doc gets paid based on those standards.
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That exists...kinda. in at least 2 formats. First, Medicare/Medicaid has prices they will pay. Some doctors won't treat patients for those prices. Sometimes because it doesn't meet their ROI expectations. Other times because they literally loose money at those rates.

There is also a healthcare bluebook. But it is non-binding. And because the patient doesn't pay, they don't care and won't shop around so there's little incentive for a provider to abide by those prices.

Also, like a dishonest mechanic, there is plenty of space to dodge those numbers, add extra services, double bill, etc.

Then, like the example, I shared earlier of the person with the $110k elective heart procedure (approved by insurance because it "improves quality of life" - though it didn't work out that way) turned into a $200k procedure because of the hospital stay after (that would have been necessary...but would not have been at all if not for the elective procedure...so do you call that necessary or elective???).
 
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ATH said:
OK...I'll play "quality of life negatively impacted". Hair loss treatments? Hair removal? Cosmetic surgery (not related to another injury)?

With "or they'll die"...97 year old with failing heart. Do they get a heart transplant? If not, they'll die next week.


I don't entirety disagree...and I operate my company with the philosophy that if i take care of my clients, they take care of me. I don't have sales targets I expect to hit, etc...we just try to do the right thing. Not that I'm perfect and altruistic in my business endeavors...but we aren't driven to bring in certain ROI on everything we do.

Where I do depart a little from your statement "..the basic needs of humanity (water, food, shelter, medicine) should be made as high quality and affordable as possible...". Obviously you imply a balance of quality and cost. But one person will interpret that (especially in health care) "high quality" being everything and anything to give a dying person 3 more weeks of life...even at a cost of millions of dollars.


That exists...kinda. in at least 2 formats. First, Medicare/Medicaid has prices they will pay. Some doctors won't treat patients for those prices. Sometimes because it doesn't meet their ROI expectations. Other times because they literally loose money at those rates.

There is also a healthcare bluebook. But it is non-binding. And because the patient doesn't pay, they don't care and won't shop around so there's little incentive for a provider to abide by those prices.

Also, like a dishonest mechanic, there is plenty of space to dodge those numbers, add extra services, double bill, etc.

Then, like the example, I shared earlier of the person with the $110k elective heart procedure (approved by insurance because it "improves quality of life" - though it didn't work out that way) turned into a $200k procedure because of the hospital stay after (that would have been necessary...but would not have been at all if not for the elective procedure...so do you call that necessary or elective???).
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I understand you're playing devil's advocate here and appreciate you bringing a different perspective to the conversation, but your examples are extreme. Hair or cosmetics as medically necessary? I can't see any doctor signing off on that. Maybe they need a mental health expert instead. A 97 year old heart transplant recipient? My first question would be how did that person get to the top of the transplant list. And then I doubt any surgeon would even recommend that procedure due to the low likelihood of the patient surviving the operation, let alone long term.

I'm obviously far from qualified to make decisions regarding healthcare, but any improvement over the status quo would be welcome.

This profits over all else mentality has got to stop, although society seems so complacent with how things are that I doubt anything changes.
 
Gratefully, I'm supplied with insurance by a corporation. Premiums for myself $114/mo, $1700 deductible. Despite what this article claims, I'd say the number one problem is we're a bunch of fast food and energy drink consuming fat fucks that drive everywhere. Hang on though, the incoming administration has a concept of a plan.

Seven reasons why Americans pay more for health care than any other nation

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ATH said:
I'm gonna disagree with that. To me, "middle class" should mean pretty self sufficient. Not depending on subsidies. So complaining subsidies aren't enough just sounds out of whack. I'd suggest those being screwed over the worst are those paying for well more than they are buying. Sure, "they" are rich. But there's a lot of (upper) "middle class" in there too - $200k per year or so range - that are paying full price + subsidizing their neighbors who make $90k per year.

Another thing to remember... NOBODY wanted the affordable care act as it was passed. It was supposed to go to committee and get worked over and improved. But when Kennedy died, and it was clear there wouldn't be enough seats in the Senate to pass an improved bill, this was shoved down our throats... before anybody had opportunity to read it.
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The make healthcare unaffordable act was an absolute disaster. Signed
In by the obamanation. Another way the dems stuck it to America and made big healthcare even richer. Wake up america. Only took how long for some people to see part of the picture this past election?

You're right subsidy is just bs. Shouldn'tbe needed for the middleclass. At the core subsidies are designed to keep people down and disisentivize people to work harder or more and get ahead because they will lose it.

Unfortunately subsidies buy voters.
 
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Boomslang said:
I understand you're playing devil's advocate here and appreciate you bringing a different perspective to the conversation, but your examples are extreme. Hair or cosmetics as medically necessary? I can't see any doctor signing off on that. Maybe they need a mental health expert instead. A 97 year old heart transplant recipient? My first question would be how did that person get to the top of the transplant list. And then I doubt any surgeon would even recommend that procedure due to the low likelihood of the patient surviving the operation, let alone long term.

I'm obviously far from qualified to make decisions regarding healthcare, but any improvement over the status quo would be welcome.

This profits over all else mentality has got to stop, although society seems so complacent with how things are that I doubt anything changes.
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Yeah...but those are real things. You said "...necessary procedure the patient's quality of life will be negatively impacted...". There are people who will argue (DO argue) that cosmetic procedures are 'necessary' for quality of life. I'll agree, again, that a mental health expert is probably a better fit...but nobody asked me. Where is the line? It's a DEEP hole once you start to dig into the "quality of life" health care with some very controversial issues wrapped up in there.

I know the 97 year old heart transplant is an extreme example...but again, somebody's gotta make the call. Where do you cut that off? 85, 75, 65, 35??? It's necessary, or the patient will die next week. (I know, even with the heart he probably won't make it until next year...but that 35 year old with a new heart will eventually die too, so there is that...).

I think, for the most part, people making the decisions will say they are doing their best at balancing cost:benefit. But people will disagree and call the decision makers evil.
 
Mike H said:
Yes, pay for health insurance or workman's comp insurance. It doesn't feel worth the cost until you need the service. My hospitalization would have cost over $110,000 last year. I wasn't in the shape to be shopping from the menu of procedures and the system spared no expense because I was insured. About $10,000 out of pocket on a payment plan for the next few years but the alternate outcome might have been bankruptcy.
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So with insurance you reached your total out of pocket cost for the year that you are paying off, or is the $10k ontop of that for things not covered (out of network or past allowable? Brutal!
 
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