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I am close to retirement but far away from Medicare age. The health care situation alone makes me want to leave this country. It’s such a mess. And I don’t see any movement to improve things. It’s just getting worse every year.
The lack of health coverage has been what has stopped me from starting my own business. I do not want to risk any of my family getting sick and not being able to cover it, but I also don't want to blow through all my savings paying for health insurance waiting until I get a VC to give me money.
It actually gives you more control.

Assuming you have business income to pay for insurance.

I’ve basically opted out. I can’t see that the healthcare system has any incentives to keep me healthy. In fact all the incentives are to keep me medicated indefinitely. No thanks. I have a plan for catastrophic coverage but I stay as far away from hospitals and doctors as I can otherwise.
What's your maximum out-of-pocket for the catastrophic plan?

Btw-- make sure to double the MOOP since catastrophes can easily straddle the end of one 12-month period and the beginning of the next 12-month period.

> No thanks. I have a plan for catastrophic coverage but I stay as far away from hospitals and doctors as I can otherwise.

This is pretty much the Republican plan for healthcare.

But you'll get to learn about part D medication plans and Medigap part F*, G, N, and the other 7 gotcha plans that are run mostly by for-profit megacorps that get to change their prices every year. Oh and Medicare Advantage (part C, not to be confused with Medigap parts) is a total scam with lifetime limits that has already fooled 54% of recipients. Traditional Medicare is way too complicated and should be thrown away and replaced with a universal single-payer system without any for-profit corporate bullshit. Also not covered: dental, vision, hearing aids, long-term care, skilled nursing... you and your family need to be be completely broke to receive Medicaid for long-term care.

* So sorry, you can't have this one anymore because part B deductibles are no longer covered due to the neoliberal MACRA 2015 that doesn't care about costs borne by the poorest Medicare recipients.

It’s not better elsewhere. Healthcare is fundamentally expensive. You can choose between cost, availability of specialists or new treatments, and speed of being seen. The bureaucracy and vague denials under some government healthcare programs make United, Aetna, etc look good.
It's at least better in not making the system a confusing mess of coverage tiers, copays, deductibles, in-network staff in out-network facilities, and all the other jargon used to complicate it to the point where many people don't know if they are covered or not.

Nowhere is absolutely perfect but it's much easier to navigate, and many developed countries have very good care for emergencies and/or life-threatening ailments. It might suck to investigate something chronic but non-life threatening, it won't stress you if you think you are having a stroke and need to call an ambulance.

That isn't really true. The US just happens to train really few physicians and therefore has really few physicians per capita.

In Sweden it's about 2x higher. Of course, they're still experts, so it's somewhat expensive, but not like in the US.

Pardon the internet lingo, but this is cope. Americans pay way more for their healthcare than citizens of countries with universal healthcare, like France, and their life expectancy is still lower. So clearly, it is better elsewhere. Don't fall into helplessness, the situation can be improved, it will "just" require actual political will to do so, that you unfortunately can't find anywhere among the Right or "moderate" democrats.
For-profit pay-viders (payer-provider mergers) should be illegal. In theory they can drive greater efficiencies that pass down to consumers, but in practice pay-vider integration makes available a lot more levers to screw consumers. All of those levers are easier to pull than increasing efficiency of care delivery.

If you want to act as both insurer and provider, then you should have to be a non-profit and have thorough performance monitoring in place to ensure you're passing what's possible back to consumers.

Does anyone have something positive to share about UnitedHealth?
Yeah I really like their rewards program: https://e-i.uhc.com/uhcrewards

Each year they pay me $1,000 (in the form of HSA deposits, which I can invest) to do basic things like get a checkup, get a flu shot, and get a blood test. I sync my wear-able data and they pay me $1-2 each time I exercise or get enough sleep.

It's great!

>I sync my wear-able data and they pay me $1-2 each time I exercise or get enough sleep

I wonder if the data is sold off and if so whether it's properly anonymized...

We have a UHC choice plan at work and it’s been completely invisible, both for me and coworkers I know.

Health insurers are like Congressmen. Most people hate the institution, but are satisfied with their own insurer. https://www.kff.org/affordable-care-act/kff-survey-of-consum...

I had them via a previous employer and had serious surgery; they asked me to go through the “get a second opinion” process which was getting all the records to their system and then a virtual/video call, but after that, they paid for everything.
I don't. I have their "platinum" insurance, and they still seem to fight any claim we file.

For example, my wife got knee surgery recently, and the doctor recommended we rent a CPM machine to help her knee avoid atrophying. Renting the machine is $200 a week. Insurance said it was "optional" and refused to cover any of it. We ended up buying a used one on eBay for about $900, which is a lot but not insurmountable for us.

It kind of annoys me though, because not all their clients are yuppie software people who have disposable income. A lot of people can't afford to rent a machine for $200 a week or buy one for $900 on eBay, but they do make it much easier for the leg to heal better. Isn't "stuff that most people can't afford but would help with healing" the stated purpose for health insurance? It seems more than a little unfair that my wife's leg is more likely to heal better purely because she's married to a software engineer.

I really have no fucking idea what the difference between the cheap and expensive UHC plans. It sure seems like I'm paying many thousands of dollars more for medical stuff than I was for equivalent services with Anthem. Oh, well, at least my premiums are higher too, so that's fun.

Hopefully obviously I don't advise shooting a CEO for several reasons (both ethical and legal), but I have to say that I was unable to cry many tears when I heard it happened.

>Isn't "stuff that most people can't afford but would help with healing" the stated purpose for health insurance?

I thought the operative term was "medically necessary"? "would help with healing" can theoretically cover everything from protein shakes for knee injuries, to iPads to help with stroke recovery. A CPM machine is on the far end of this, closer to "medically necessary" than the other examples, but you have to draw the line somewhere, so some reasonable-but-theoretically-optional equipment gets excluded.

> Isn't "stuff that most people can't afford but would help with healing" the stated purpose for health insurance?

You are confusing "health insurance" with a "system that guarantees healthcare as a human-right". Those are different things.

The purpose of health insurance is:

- To constrain healthcare coverage to the minimum allowed by law or the plan contract, therefore maximizing profit margins.

- To provide a shared risk coverage pool to pay for treatment for catastrophic health events that are unforeseen.

- To provide a product to be used as leverage by employers over employees as part of the "benefits" of a compensation package.

Healthcare as a human-right doesn't exist in the United States unless a health situation has gotten so bad that you end up in the emergency room, which is then legally required to provide you emergency healthcare.

No, but working at a company that was founded by a bunch of former gov employees, the coverage is mostly ok and some having to manage the refusal bs. What was new to me - a gap that went employed -> consulting -> employed - (same company family) - how damn expensive top tier coverage for a family of three really is - $3700/mo. Insane.
if you don't have anything nice to say... :3
Here's a point about all the insurance companies: UHC administers the medical plan on behalf of your employer. For all practical purposes, they are a whipping boy for the real 'man behind the curtain' (your employer).

Your company (for self-funded plans) actually decides what’s covered and what isn’t, sets copays and deductibles, and ultimately saves or spends money on healthcare costs. UHC’s role is to apply those rules, maintain the provider network, and handle the billing and customer service.

If your company offers insurance, there is someone who can tell the "insurance company" to cover the service they are not covering. Usually the HR Benefits Administrator, or 'plan sponsor'. And they do it all the time! If you have a sad story and the budget is ok for the quarter, they will help! If you are a company officer, you can also have whatever your company can afford.

This only applies to large employers. Smaller ones are just presentef a limited list of plans to pick from, and the plans change every year. Most of the time, as a startup, you can’t buy a Mag7 equivalent health plan for any amount of money off the marketplace
Insurance companies are a whipping boy, but for doctors not your employer.

Doctors charge massively high prices, which is why insurance bills are high. Doctors have the most powerful trade union on the planet and strictly limit residencies, thus limiting new doctor supply and keeping prices super high.

The law of supply and demand controls the high prices we see in healthcare. Doctors have the most powerful trade union on earth and have lobbies for strict limits on the number of new doctors per year by limiting residencies.

Shrink the federal government and its overbearing regulations in healthcare and allow many more people to go through residency to become doctors.

It’s terrible that this is an area that is caught up in political ideology. Somehow, healthcare MUST be decoupled from capitalistic incentives. I don’t pretend to have the answer but continuing on this path will lead to worsening patient outcomes. We cannot have corporations expecting to make a dollar off human life.
Afaict the original sin of the US healthcare system is having the healthcare providers chosen by employers. That means that the patient is not the customer, the patient's employer is. That in itself has dire consequences.

Privatized health care need not be so bad. Germany has privatized health care, but it's pretty much fine, at least for patients. It's regulated to the moon and back, but afaict so is the US system, just with very different goals. The ACA feels a bit like the beginnings of a German-style system.

> We cannot have corporations expecting to make a dollar off human life.

That's literally a political ideology.

The answer to problems like this isn't to pretend politics is some kind of abstract system imposed by higher-order beings, its to use political power to fix it.

> Somehow, healthcare MUST be decoupled from capitalistic incentives. I don’t pretend to have the answer but continuing on this path will lead to worsening patient outcomes. We cannot have corporations expecting to make a dollar off human life.

Give yourself more credit! You just stated the answer above.

> healthcare MUST be decoupled from capitalistic incentives

Capitalism pays for our healthcare.

The problem is that Healthcare has an infinite hunger for resources - there is always more that could be spent - and it is always morally correct to spend more (people's lives have high priority).

There needs to be some manner of allocating limited resources between different people with different needs.

Every country seems to find different ways to deal with the fundamental friction of healthcare (unlimited demand and limited resources).

Unfortunately voters don't like the reality of limitations.

But the answer is easy. Just look toward the North.
Canadian health care sucks but in a different way; so that’s not the solution either. You can look up the wait times for different procedures on the provincial websites.

Things you can get in 72 hours anywhere near a decently sized American city such as an MRI scan can take months in Canada.

Food, housing, and a living wage too. The bare necessities to live must be decoupled from capitalistic incentives.
> The bare necessities to live must be decoupled from capitalistic incentives

We don’t have evidence we live in sufficient abundance to guarantee this sustainably even in rich countries. Particularly when bare necessities are decried as cruelty and so cost creep comes to pass.

What we can do: free basic nutrition for all, free prenatal and neonatal care, free preventative medicine and annual check-ups, free access to generics where medically necessary, and a fixed amount of water and electricity to each household. Not enough to be remotely comfortable or long lived. But enough to survive.

I think the incentive itself is good, but there's too much corrupt abstraction in between.

Ultimately I want good providers to be paid well and poor providers to struggle. That is a good system. We don't have that. We MUST recouple healthcare and capitalistic incentives.

United Healthcare isn’t the reason healthcare is unaffordable any more than Geico causes car repairs to be expensive. American demand for healthcare is insatiable, and doctors are a scarce and greedy bunch. That there is a middle man trying to get his 5% isn’t the problem.
> any more than Geico causes car repairs to be expensive

Given how much cheaper things like body shop repairs are if you do not have insurance, is it really clear that Geico does not cause car repairs to be expensive?

And for that matter, get emergency health care without insurance and then fight the cost to get a massive reduction, and you'll wonder whether it actually is UHC and their ilk that help make healthcare unaffordable ...

> United Healthcare isn’t the reason healthcare is unaffordable any more than Geico causes car repairs to be expensive. American demand for healthcare is insatiable, and doctors are a scarce and greedy bunch. That there is a middle man trying to get his 5% isn’t the problem.

Spoken as a software developer who's salaries are approaching or even surpassing doctor salaries while working on optimising "engagement" (or how to make their app the most addictive).

there is a multi-pronged solution necessary that is both intertwined with insurers and also completely separate, so in that part I agree with you

the costs of services are arbitrary and need to be addressed before we can realistically deal with how any insurance pool works, in the US both parties have chiseled at this over the last decade - from getting prices more transparent, to attempting to have a large scale state negotiator - and this makes the conversation more palatable in gaining consensus

not close, but it's not as partisan as people think, despite the parallel existence of entrenched interests

what doesn't have consensus is a forced insurance pool that doesn't address the costs and has no ability to negotiate those costs (yes, this is partially due to the bill being gutted and a handicapped version being the only thing that passed) a deeper review and regulation of costs is the only thing that can help reach consensus

United is a disaster of a company. Physicians hate them. Patients hate them. I feel bad for anyone forced to deal with their BS.

Their reputation is so bad I wouldn’t be surprised if they rename the company at some point in hoping people forget that they’re United Healthcare.

My girlfriend is nurse practitioner and she says United is the worst to deal with. They deny everything and it sucks up enormous amounts of time to appeal.
I really hope my employer changes to pretty much any of the other ones eventually. I really hate having to argue on the phone with with a poor representative over everything.

Anthem BCBS and Aetna never gave as much trouble. I know they both have their scandals and it's not like I love any American health insurance company, but I definitely rank UHC lower.

I found it’s terrible too. Especially with dental insurance they negotiate terrible rates so you end up paying a lot more than if you went with the local Blue Cross Blue Shield or Delta dental.
My experience with United Health Care has been terrible.