[bryan11]

As employers switch to High Deductible Health Plans where insurance doesn't kick in until one has spent a deductible of several thousand dollars, many people are delaying health care in general. A doctor's visit that once cost a co-pay of $30 is now frequently a cash price from $130 to $400, plus more for lab work. With higher costs and much of them unknown in advance, many skip getting things checked until it seems absolutely necessary.

[peteradio]

I paid 400 dollars to have a doctor tell me to neti pot my nose after having sinus infection for 3 months. Might not be rational but fuck everything about this system. Who is pocketing all this goddamn money?

[brudgers]

Through no fault of the author, this comment thread explains the trick. The article talks about US health care access but the discussion quickly goes off into the weeds of the US health insurance market. As soon as we start talking about premiums we adopt business language and metrics and abandon medical language and metrics.

All that money is pocketed by businesses run for profit. It's pocketed because it can be. It can be because untreated a sinus infection can kill you. Not a bad business to be in by the standards of business.

[war1025]

I just paid $1436 because we took our 1 year old son in when he had a stomach bug and they decided they needed to keep him for 24 hours for observation after giving him an IV to re-hydrate him. Glad he's okay, but if I knew we would be out $1500, I don't know that we would have taken him in.

[colechristensen]

Malpractice lawyers and insurance, administrative juggling of data and insurance claims, medical equipment manufactures and certification, doctors (by proxy medical schools and loan providers), practices recovering unpaid bills, and real estate owners.

[mattigames]

Does it matter who? They charge you because they can, America decided your survival (AKA health) is just another business an you can be charged as much as you are willing to pay for it; and those companies -with the help of cultural baggage- have convinced a significant chunk of the population that this shady business is part of the "freedoms" you have as American, because controlling the prices would be "communism" or "socialism", words we all were taught to associate with evilness and enemies.

[bequanna]

The armies of administrative workers:

1. https://www.advisory.com/daily-briefing/2018/07/23/administr...

2. https://www.athenahealth.com/insight/expert-forum-rise-and-r...

[usaar333]

> many skip getting things checked until it seems absolutely necessary

True, but isn't that the entire point of hdhps, to minimize unnecessary visits?

They still provide no additional cost annual physicals, so you'll get the required yearly screening.

Additionally, many offices have no cost phone or email advice.

I'm personally quite happy with my family HDHP - and it is nice to have additional retirement savings.

But you have to have a savings mindset; many people don't which is what leads to medical spending increases when a refund comes in.

[JonGarfield]

Just because something is minor does not mean it isn't urgent or best tended to sooner rather than later. Strangely enough, those of us with universal health care don't make it a hobby to go to the doctor's office because it is "free" at point of use. We only go when necessary, we just don't have to weigh the possible trade off of food, shelter or savings in the equation that turns minor, easily treated conditions into major, life threatening ones.

[rootusrootus]

> They still provide no additional cost annual physicals, so you'll get the required yearly screening.

Well, until you find out that you can only get the physical for free, and physicals are really not worth much. If you discuss anything at all with your doctor that is outside a routine physical, ask any questions, get any advice, and he codes it when he submits the bill -- it won't be free at all, it'll cost you a couple hundred bucks. So there is incentive not to bother.

[stevenwoo]

The co-pay was $10 for me in 1989. I had outpatient arthroscopic knee surgery in 1993 and it cost me nothing including X-Rays/MRI/CAT scan (the ortho was having trouble diagnosing it). All the pricing stories I hear today scare the heck out of me.

[JumpCrisscross]

> High Deductible Health Plans where insurance doesn't kick in until one has spent a deductible of several thousand dollars

HDHPs are a great deal for anyone who can set aside the deductible’s value in cash. They are a bad default. But a good thing to consider if you can set aside some cash.

(The problem with HSA-compatible plans is they have a maximum deductible. They’re thus almost as expensive as non-HDHP plans.)

[maxxxxx]

There is definitely a psychological problem. When I had a high deductible plan I always set the max aside but considering the potential cost of a doctors visit I often hesitated. 1000 dollars is still 1000 dollars even if you have set them aside beforehand.

[mgkimsal]

why is it a problem to have a maximum deductible?

Relatedly, it seems like there's roughly some 'max' insurance expects you to pay each year, and you can decide whether to take the risk using a high deductible plan, and potentially not have many expenses, but lower premium, or have higher premium up front.

8 years ago, our HDHP was ... $280/month. It's now north of $800, and the deductible went up. Yes, we're a bit older, too but it's still a bit crazy.

$280/month, with high deductible, meant that, in a bad year, we might have $15k in expenses before the insurance covered everything else. Now, it's more like $10k per year in premiums, and another $10k+ before insurance really would kick in. Catastrophic need? It's fine - I don't want to have to face a $400k bill. Day to day? This stinks.

[exabrial]

Actually I find that with my high ductable Health Plan, my visits did not change price. And you failed to mention how you get to save/grow/spend your money tax free. I made 12% on my HSA last great and didn't pay a dime of tax.

[usaar333]

A lot of folks are in California on this board which hurts the investment case for HSAs (state taxes investment and contributions). New Jersey similarly doesn't recognize HSAs.

[chaosbutters314]

I'm even researching medical tourism. The unknown financial risks are too high

[derblitzmann]

And if I am wrong please correct me, but I recall high deductible health insurance became more common/prominent since "obamacare". Which i viewed as at best a half measure at the time.