It is worth it imo but it could be better. This is my back of napkin mental model but I have convinced myself that most of our troubles are because health insurance morphed from truly emergencies to every day care. Routine care (both primary and specialist) have to hire deep staff to handle insurance claims with the different payers. It’s a constant game.
For myself I always pick the high deductible plan. It’s the next best thing to an emergency only plan in my opinion. I am also lucky that I have an employer that picks this kind of plan as an option. Everyone should be on this type of plan imo. I think have a direct primary care (directs don’t take any insurance) for the family that costs $200 a month for 3 of us. The insurance cost is $100 with a max out of pocket I think around $8000. Now we are lucky in that these dollar figures don’t bother us, not true for everyone but I do think most of us would be better off if we have better forms of true emergency insurance. I want to pool the risk of a catastrophic illness or accident, not my doctors visit for a cough.
I pay my dpc directly for all testing and it’s cheap. A lot cheaper than if it was billed via insurance.
Study after study finds that a health care model where you can visit a doctor frequently leads to much better overall heath for people.
The system we have here forces people to wait until minor issues turn into life or death situations that require much more intensive and expensive care.
OK, but...
Let's suppose that a doctor's visit costs $200 for someone without insurance. And let's say that the two options are 1) insurance premiums are $1000/month, but it's only a $20 copay to visit the doctor, and 2) major-only insurance at $100/month. I can visit the doctor pretty regularly on that difference of $900/month.
All this hypothetical tells us is that you're young, healthy, single, and have a good income. Which is exactly the issue with our health system -- it only works when you don't get sick.
The median household income in the US is $83k. That's for a whole family. I would challenge you to come up with a monthly budget for four people that can support anything like $1000 a month for insurance (which for a family is actually going to be more like $2000) OR handle multiple $200 doctor visits per month. And mind you there is no such things as a doctor visit that costs only $200 unless you're talking about a routine physical. Because the first thing that happens when you're sick is the doctor starts ordering tests and referring you to specialists. And let's hope nobody needs a prescription!
And then you find what life looks like for 150 million Americans -- you're constantly putting off healthcare until it becomes an emergency. You're gambling with your own life and the life of your children trying to not go bankrupt.
Author here.
DPC is terrific if you have an option near you! Paired with catastrophic insurance, it's a great bet for relatively healthy people.
The DPC Alliance map is well worth a visit: https://mapper.dpcfrontier.com/
And I wrote about DPC a while back: https://church.substack.com/p/direct-primary-care
I'm on the other side. A high deductible plan for me means I'm guaranteed to have to pay that amount, due to medication and visits.
If I take the low deductible plan with the higher Max OOP I am actually spending less on a yearly basis because the insurance kicks in immediately.
Of course, when something catastropic happens, like cancer, yea, the high-deductible plan would've been better, but that (knocks on wood) doesn't happen every year.
It's like a poker game, except it's your real life. Welcome to.. America?
Not sure what to call it at this point. We're all meat for the grinder. Unless you're a billionaire.
if this were true why is it that countries w universal healthcare spend less per patient and get better health outcomes with a longer life expectancy?
I don’t believe this is really what I was talking about. I think there is a case for universal insurance but someone at the end of the day is still making a financial decision.
I tend to question that--I don't see how long wait times for serious conditions leads to better health outcomes. It would logically seem like it would lead to more and earlier deaths if truly spending less per patient. I suspect there are statistical shenanigans.
You seem to be more confident in universal healthcare having "long wait times for serious conditions" than in universal healthcare resulting in better health outcomes at a lower cost per citizen. What makes you trust the first premise more than the second one?
as we delve further into the mass media spectacle one thing has become clear as everything else has become very muddy: the truth isn't what the facts support, it's what you hear three times from people you consider your peers. the fact is that the data that show increased wait times are for elective surgery (https://www.comparethemarket.com.au/health-insurance/feature...) which (by nature of being elective) doesn't correspond to increased mortality or cost, but the wait times on emergency care are comparable for single payer and individual payer systems are comparable, with the US doing slightly better in waits for people who actually receive care but, again, no indication of how many people avoid care due to the cost.
https://ourworldindata.org/grapher/life-expectancy-vs-health...
The data are there. If there's a problem with the data, it's not enough for you to simply suspect it. You kinda have to determine what the problem is and show it to us. After all, no one waits longer for healthcare than someone who never gets it because they can't afford it.
This happened because of inflation. Costs rose so much that people had to make claims.
Huh? Part of the problem in at least the us system is with insurance you have to run such a tight operational ship. I don’t believe inflation plays a large of a roll but you add significant headcount and leapt force practices to have scale to meet those headcount numbers.