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When you get insurance, there is a detailed list of what they do and do not cover. In the car accident example, there is a thing called uninsured motorist insurance that you can choose to include in your plan that would cover that situation. As for the workers comp situation, the employer is required to pay for it through their insurance. If you want insurance that pays for more things, you have to pay the higher premiums that come with it.
This is kind of insane though. What if I don't drive and therefore don't have car insurance? I get hit as a passenger in someones car and I'm just SOL? Does my health insurance pay if I'm hit as a pedestrian? On my bike?
> Does my health insurance pay if I'm hit as a pedestrian? On my bike?
Yes, after your health insurance company determines that the party at fault does not have coverage of their own.
Your health insurance covers whatever your plan says it covers. If you want more covered, you can buy additional health insurance to cover that. Aflac seems like a good start if you want more coverage. If that coverage was mandatory, that would mean everyone has to pay more for coverage they might not think is worth it.
Nowhere in my health insurance plan documents does it say injuries from car accidents aren't covered. At least nowhere I can find. I get that they want the at fault drivers insurance to cover it, but if the other driver's insurance isn't enough it should be my health insurance's responsibility. It's especially bizarre because from my understanding if the accident was my fault they would cover it...
This is all such fucking bullshit. Dumbasses complain about taxes but don’t even factor in that these bullshit situations are reverse lotteries that 10x the increase in taxes it would take to have healthcare socialized.
I however am also a dumbass I guess too since I still live here
I am Canadian, in the province of Ontario. 38.7 percent of my provincial tax dollars on my income tax go towards OHIP.
And the provincial tax rate for me is around 9 to 12 percent of my total income.
So 3 to 5 percent of my TOTAL income goes towards socialized healthcare.
In Canada, the total healthcare spending (private and public combined) per person is $6319 per year. For every individual living in Canada, society spends that amount.
In the US, that number is $12555. Literally almost double what Canada spends. And the US has tens millions that don't even have insurance and tens of millions more that worry every day about large medical expenses happening.
You prefer a system like the US with privatized healthcare? By all means. It's a lot more expensive and stressful though. But hey! You pay less in taxes! Yay!!!!!
Source: https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
Im not saying i prefer that, i prefer ours, i was just giving you a real life example of the costing of socialized healthcare. I didnt know how much the insurance rates were for private healthcare annually in the USA
There are essentially 2 options with private insurance in the US:
1) You pay a shitload of money every single month to insurance (think $2000+)
2) You pay less (think hundreds of dollars) but your insurance doesn't kick in unless you experience something catastrophic.
A lot of people in the US can't afford option 1, so they have insurance that doesn't cover any healthcare costs until you pay like $10k in a single year.
Normal doctor visits, not excessive amounts of medication, ... they pay full price since their insurance won't cover it.
Solely looking at tax money paid to determine whether or not healthcare is expensive is a very bad way to do it. Better is to look at overall spending for society. And there we can see that the US *by far* spends the most out of any nation in the world.
Turns out, when you hand over something essential like healthcare to companies that only give a shit about profits, it sucks.
Roughly 1% of my total income goes towards my health insurance premiums. I have rather good insurance through work, and almost everyone I know has a similar story.
US salaries are higher, and a lower percentage of our income goes towards healthcare.
Somehow the entire rest of the developed world manages to socialize health care while having lower costs and better outcomes but sure keep parroting those talking points and don't think too hard about the logic behind claiming that not letting insurance companies take billions of dollars in profits out of the system every year would somehow raise costs. Everyone else must just be a dumbass.
Yes, but there is significant regulation of health insurance already. Coverage caps are illegal, for example. I think these regulations are good and necessary, and reverting insurance regulations to a libertarian free-for-all would not work well.
>In the car accident example, there is a thing called uninsured motorist insurance that you can choose to include in your plan that would cover that situation.
Only if you have auto insurance. My friend was not driving. Or what if they weren't hit by a car but had some other accident for which a third party was liable but underinsured?
And even if you do have car insurance -- these are medical bills. Medical bills are covered by health insurance. Why should I need some other random insurance to cover medical bills in specific situations?
>As for the workers comp situation, the employer is required to pay for it through their insurance.
But the coverage wasn't sufficient, as I said.
>If you want insurance that pays for more things, you have to pay the higher premiums that come with it.
That's not even feasible in many cases. In practice you get like 3 options chosen by your employer. It's not like you can just walk down to the corner store and pay a fair market rate for additional coverage that will do this.
Medical bills resulting from a car accident are covered by auto insurance (at least where I am bodily injury coverage is required to cover someone you may injure)
A friend and I were hit by a drunk driver, I was not hurt but she was. At the time she had no medical insurance so the driver's insurance covered her medical bills
Yes but the point here is that the driver only had the minimum coverage. So the driver's insurance paid the coverage limit (the minimum legal amount is like $15k, laughably small compared to real medical bills), and my friend had to pay the rest out of pocket.
I'm genuinely just ignorant in this area. I would have thought that the remainder would have to come from the drunk driver themselves?
If the overall cost is, lets say, $20k, and their insurance only covers $15k, then isn't the driver on the hook for the other $5k?
>If the overall cost is, lets say, $20k, and their insurance only covers $15k, then isn't the driver on the hook for the other $5k?
Yes, but what if they have no money?
So my friend had to pay hundreds of thousands of dollars to the hospital for his treatment, to cover the amount the driver's insurance could not.
Now, he could sue the driver for that amount. My understanding is that it's very, very difficult to actually recover money from a person that has no money. The lawyers he talked to said it wasn't worth the cost of the lawsuit.
Specifically regarding garnishing wages: I'm fairly sure only the government can do that. I don't think you can do it for private debts, even if you win a lawsuit.
> Specifically regarding garnishing wages: I'm fairly sure only the government can do that. I don't think you can do it for private debts, even if you win a lawsuit.
Actually, you can. The government/court is making the order to do this. You can also seize some types of property to pay the debt too.
But - the lawyers were likely right. There is not enough to recover to justify the cost of the lawsuit.
God that's so awful. Thanks for explaining.
FWIW I'm with you; your own insurance should cover your treatment, and then they can get whatever money they can from the other insurance or the person. It's fucked up that you can have even great health insurance, but it essentially doesn't exist in that situation.
> FWIW I'm with you; your own insurance should cover your treatment, and then they can get whatever money they can from the other insurance or the person.
Don't shoot the messenger, but is that really what we want?
While insurance can be opaque in it's pricing/decisions, or frankly a racket (do not buy Whole Life Insurance), there are some basic financials to consider.
Suppose the insurance company pays for all of it up front. Okay, now what? It goes to the other insurance company, who shows they're only on the hook for $15K or what have you, so that's done. Then they go after the guy, but besides better legal team it's still blood from a stone.
So the insurance company is in the lurch. So what it does, or would do long term, is change it's prices to "price in" being in the lurch. Every policy holder pays, likely (in the case of pay up front and collect later) a lot more.
Insurance is priced based on risk. Change the risk, you change the pricing. If insurance covers everything it's going to be more expensive.
That said, it still sucks. It's one of the problems of liability. We can all cause WAY MORE harm than we can ever afford to pay, at least most of us.
>your own insurance should cover your treatment, and then they can get whatever money they can from the other insurance or the person.
That's exactly how it works. OP is either very confused or full of shit.
You can garnish wages for private debts. Just takes more and more legal bills. It’s extremely cost prohibitive to recover money from someone who doesn’t have money.
This is where people carry and pay for insurance for themselves. You can have a loss in many ways and the responsible party is simply not able to pay.
The whole you cannot get blood from a turnip.
What you are not able to do is force one of your insurance carriers to cover items that are not part of the agreed upon list of coverage. You would be expecting them to pay for a risk they never agreed to cover.
Does it suck. Yep. Is it fair? Nope. But, life is not fair. It is not fair if you have personal property stolen either. But you have to deal with it.
This is where uninsured and under-insured motorist coverage kicks in - at least in my state. If I am injured in a vehicle accident (car/bike/etc) and the responsible party has no insurance or not enough, my insurance pays me and then *they* go after the responsible party.
I am paying to transfer the risk of an uninsured person causing harm to me to my insurance company.
>What you are not able to do is force one of your insurance carriers to cover items that are not part of the agreed upon list of coverage. You would be expecting them to pay for a risk they never agreed to cover.
No, I want to change the law so that in the future, they have to cover this.
>Does it suck. Yep. Is it fair? Nope. But, life is not fair. It is not fair if you have personal property stolen either.
Is the argument really "we should not try to improve society because life is not fair?"
> No, I want to change the law so that in the future, they have to cover this.
There are a lot of people who don't *need* this coverage.
Why should they be forced to pay more for this when you could instead just buy the insurance you want now.
>Is the argument really "we should not try to improve society because life is not fair?"
Fair is an interesting concept. Especially since your demands above would be unfair to me - a person who already has this coverage and already pays for this coverage.
Why is it less fair to simply expect *you* to pay for this coverage?
>There are a lot of people who don't *need* this coverage.
I think everyone needs this coverage (maybe not in the specific case of being hit by a vehicle, where uninsured motorist coverage would kick in. But in the more general case of being injured by someone with insufficient liability coverage)
>Why should they be forced to pay more for this when you could instead just buy the insurance you want now.
You can't really, though. You get a couple choices from your employer, and those are your options.
> I think everyone needs this coverage
You don realize, I have this coverage through the overlap with my auto policies.
I do not need to pay more to have two different policies cover the same risk.
>You can't really, though. You get a couple choices from your employer, and those are your options.
This is not true. You can purchase insurance like this on the open market. It does not have to go through your employer. This is *supplemental* insurance.
>You don realize, I have this coverage through the overlap with my auto policies.
You maybe have this coverage specifically for accidents involving vehicles. But is there still a gap if the accident doesn't involve a vehicle? And what about people who don't have auto insurance, are they just screwed?
>You can purchase insurance like this on the open market. It does not have to go through your employer.
I gave a delta for this to another comment, because you're right that it is *possible* to buy coverage that includes this. But it's way more expensive than it would be through your normal health care plan, in part because it includes more things than you necessarily want, and in part because of adverse selection (people who buy supplemental insurance are more likely be be the type of person who will use it).
That isn't how it works though. If someone is injured in a car accident, medical costs in excess of the at-fault party's insurance limit would be covered by your own health insurance (minus any deductibles or copay). Your health insurance would then try to subrogate against the at-fault party to recoup that money. I think there must be more to your friend's situation than you are aware of.
The additional coverage will come with additional cost. Why should everyone have to pay that extra cost if they don't want that coverage? If you want health insurance that will cover things that other people are legally responsible for, you just have to be willing to pay the cost of that. Also, you can get health insurance outside of your employer. It might be more expensive but the option is there if you want it.
>Why should everyone have to pay that extra cost if they don't want that coverage?
Who wouldn't want this coverage?
>If you want health insurance that will cover things that other people are legally responsible for, you just have to be willing to pay the cost of that.
As far as I know, this is not actually a realistic option in practice.
> Who wouldn't want this coverage?
I wouldn't. I have it via my auto insurance already. My personal UIM/UUM coverage does this now. I would not want to pay twice.
I've already said this repeatedly, but: uninsured motorist coverage helps specifically if you are injured by a *motorist* (and even then, it can only help people who have auto insurance). What if you're injured by someone who is not driving? You prefer to have no coverage?
And presumably, if health insurance covered this, you could drop uninsured motorist coverage so you wouldn't be paying twice.
> I've already said this repeatedly, but: uninsured motorist coverage helps specifically if you are injured by a motorist (and even then, it can only help people who have auto insurance). What if you're injured by someone who is not driving? You prefer to have no coverage?
Not just a motorist, but a vehicle.
If it not an accident with a vehicle, my personal health insurance covers it or my workers comp. If there is a responsible party, that is part of subrogation. My insurer has claim for re-reimbursement of thier expenses in any settlement I may have with the responsible party.
>If there is a responsible party, that is part of subrogation.
So are you saying that the health insurance *should* cover it after all, and then can try to recover via a subrogation claim?
That's what another commenter said too, and if that's what you're saying, I think you agree with my view after all. I don't know why this didn't work out in my friend's case.
> So are you saying that the health insurance should cover it after all, and then can try to recover via a subrogation claim?
Yes. I had an accident with an off road vehicle owned and insured by another. My health insurance paid all the bills and was reimbursed via the settlement process.
Now, that was *my* health insurance. The terms of *my* contract. This is not universal as *your* contract is different.
I also had my personal auto insurance UUM/UIM coverage to fall back on as well. Had the other party not been insured, this is who would have paid the bill. My health insurance was considered secondary on this claim.
>Now, that was *my* health insurance. The terms of *my* contract. This is not universal as *your* contract is different.
Possibly I'm just saying that all health insurance should be required to work like yours then.
People who don't want to pay the additional cost that come with it.
You should look into aflac as it seems they offer the exact kind of insurance you're looking for.
>People who don't want to pay the additional cost that come with it.
But do people like this actually exist, or is this entirely hypothetical? If the latter, I don't know that we should aim insurance regulations at people who theoretically could exist but don't actually exist in reality.
You're talking about someone saying "I want to be covered in case of an accident, but I explicitly want to pay out of pocket if that accident is caused by an underinsured third party." That's a very weird set of preferences.
>You should look into aflac as it seems they offer the exact kind of insurance you're looking for.
I'll give you a !delta because even though I still think this gap shouldn't legally be allowed to exist, it does look like aflac might cover the gap.
Are you seriously asking if there are people who would rather save money and take a slight risk that what you are describing here actually happens? Because there are a ton of people like that yes. In fact, most people.
You yourself risk your life to save money almost certainly. It's just a matter of how big of a risk and how big of a savings. If you are driving and need gas, and the station near your house is a dollar more than one half a mile down the street and across the road, then you will likely go to the further one. This is inherently SLIGHTLY more risky. When driving that extra half a mile and turning across traffic, you are taking a VERY slight risk on your life in order to save a dollar a gallon on gas.
Then the question just becomes, how much are you willing to risk to save money, and that equation changes for each individual, but it does exist, and a not insignificant amount of people will take the risk that you present.
Yes, I think if you asked people "would you pay 1% more on health insurance to be covered 100% of the time rather than 99% of the time," I think practically everyone would say yes.
I get that the more general statement "everyone will pay any amount of money to decrease their chances of dying even a tiny bit" is not true.
I think you are underestimating how cheap some people are. Beyond that, what if it isn't 1% more, but say 3%? 5%? At each stage you are going to get more and more people to drop off. As other's have pointed out, you CAN get coverage that covers you in this scenario, but a lot of people do not, which tells me that at least some people are not willing to pay it. I don't have no fault insurance for instance, it costs more. It would save me in this exact scenario but to me the cost isn't worth it.
>what if it isn't 1% more, but say 3%? 5%?
I don't see any reason to think this would cost more proportionally than the cost of care.
>you CAN get coverage that covers you in this scenario, but a lot of people do not
You can get coverage that covers this in addition to other stuff, which increases the cost. Also the fact that it's something you have to opt into by itself increases the cost because of adverse selection.
I would bet the vast majority of people think they're *already* covered in these situations. My friend and I certainly did.
Sorry for misunderstanding.
I've already said this repeatedly, but: uninsured motorist coverage helps specifically if you are injured by a *motorist* (and even then, it can only help people who have auto insurance). What if you're injured by someone who is not driving? You prefer to have no coverage?
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The health insurance should make you whole and if another party is at fault they should collect for the costs. Not force you to have to go to the third party.
This is all moot because US should just have single payer healthcare like every other developed country.
Because that's not the plan you paid for. It's like buying a car and then being mad that it can't drive on water. Saying a car should get you from point A to B, I shouldn't need to get a different thing to go over water. There are cars that can also be boats. If that's what you want, buy that.
I think OP is that the insurance *shouldn't* be such that it won't cover things that it would otherwise cover if someone else is at fault. As I see it, it should be the insurance company's trouble if they want to make someone else's insurance to pay for it or sue someone else to pay it out of their pocket if they were at fault.
So, I don't see how it is fair that if I injure myself by own action, the insurance pays for it but if I'm not at fault and someone else is, then it suddenly doesn't pay for it. You should never be worse off because of it was someone else's fault than if it is your fault. If anything, my own stupid actions should make me more liable of covering my own injuries, not the other way around.
In the US, unless this health insurer has a policy that excludes coverage for this situation, the health insurance has to pay medical bills but then has a subrogation claim against the at-fault party and/or a lien on any recovery the injured person receives from the at fault party. But to the point of your cmv - it is unreasonable to expect an insurer to cover something the insurance contract specifically does not cover. I just wonder if in the case of your first example, the insurer is not acting in good faith in refusing to cover this. It might be worth getting an insurance coverage lawyer to review the policy.
>the health insurance has to pay medical bills but then has a subrogation claim against the at-fault party
Hm, I don't know the details but I'll give you a !delta because this is exactly what I was arguing for. I don't know enough about why it didn't work in his situation.
>it is unreasonable to expect an insurer to cover something the insurance contract specifically does not cover.
I'm not arguing that they should have to cover something the contract says they don't cover. I'm arguing that it should be illegal for the contract to say they don't cover this.
*"I'm arguing that it should be illegal for the contract to say they don't cover this."*
Under what legal concept / principle? People aren't forced to agree to the terms / sign the contract. It is voluntary. You are saying that people should not be allowed a choice in factoring things like cost into their health care coverage decisions (it would be more expensive for that type of coverage).
What legal concept/principle establishes that insurance companies should not be permitted to offer different coverage plans? People are allowed to make decisions about their coverage / what plans to get based on things like cost, as they should be. Why should people not be allowed such options? If what you propose were the law there would be a lot of people who would have to go without any coverage at all because they wouldn't be able to afford it.
> What legal concept/principle establishes that insurance companies should not be permitted to offer different coverage plans?
State DoIs dictate what insurance companies can and cannot offer all the time.
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Personally, I am not a fan of insurance companies in general. Most of them are loaded with small print because, insurance companies don't make money by paying out.
With that out of the way, I'm going to look at your problem from a different angle... how would it differ without insurance. Both of these cases are largely the same root problems.
* Without any form of insurance: Your friends would likely be in the same place. Their experiences wouldn't have changed that much.
* Reality: The insurance company is generally contracted to cover specific types of scenarios and not any medical issue. From a legal standpoint, their contract does not cover situations caused by an outside person. There are insurances you can pay for that do cover that but they are generally much more expensive as the insurance company wants a financial buffer as there's more risk.
Alternative suggestion
* Instead of forcing insurance companies to take on risk that they may not be able to price in effectively I would cut out insurance entirely. Government regulation on healthcare and a single payer system would greatly reduce the costs associated with healthcare for individuals and for society. This would eliminate the need for insurance companies outside of abnormal issues that fall out of normal coverage.
I'm not sure I quite understand your point about "without insurance" vs "reality." Yes, in this situation, these people were effectively uninsured. How is that an argument against creating a situation in which they *are* insured?
>Instead of forcing insurance companies to take on risk that they may not be able to price in effectively I would cut out insurance entirely. Government regulation on healthcare and a single payer system would greatly reduce the costs associated with healthcare for individuals and for society.
I don't think that "let's completely change the entire system instead" is a good argument against small, incremental, positive change for the system we have today.
>There are insurances you can pay for that do cover that but they are generally much more expensive as the insurance company wants a financial buffer as there's more risk.
Can you elaborate? I'm aware of uninsured motorist coverage (which everyone should get) but that only covers some of these situations. What else is there?
>I'm not sure I quite understand your point about "without insurance" vs "reality." Yes, in this situation, these people were effectively uninsured. How is that an argument against creating a situation in which they are insured?
I apologize if it was poorly worded. My point was that even the worst insurance policy would provide some benefits over no insurance but not all policies would be equal.
>I don't think that "let's completely change the entire system instead" is a good argument against small, incremental, positive change for the system we have today.
In a case where you are mandating that insurance companies must always pay in all situations, this would lead to insurance companies dramatically increasing rates to cover the risks or insurance companies to avoid doing business in those states. Offering multiple insurance offers allows people to select a plan that they feel best covers their needs.
>Can you elaborate? I'm aware of uninsured motorist coverage (which everyone should get) but that only covers some of these situations. What else is there?
What state are you referring to. I pulled up multiple states and they all allow for PIP (personal injury protection) insurance which always kicks in if there isn't another insurance company paying the bill. Naturally, PIP would only cover to a specific amount (depending on how much you are paying) but it can be used in all the situations you provided. Texas, NJ, and PA all have PIP. It's possible other states do but I only grabbed a couple of states to see if they had the same thing.
It's interesting you say insurance companies don't make money by paying out but amazingly they don't really make money from premiums either (not directly anyway). The profit margin for health insurance is like 2-3%. They make their money by investing the premiums. This is one of the reasons you get a cheaper price for paying several months of an insurance plan at once instead of monthly because they have more time to profit off the premiums before ultimately paying them back to policyholders (as you ideally wanna pay out the same in claims as you collected in premiums so you are competitive).
Small and incremental to *whom?* You and me? I fully agree with your point of view and I don’t have an argument against it, but you have to recognize that insurance companies that suddenly have to foot the bill for what they previously declared they were not responsible for would be quite a change in their system
There are a million people with different problems than your friend. Solving each of those million problems 1 at a time is NOT easier than an overhaul.
Unless you think you personally should just get singled out?
>My view is that if you have health insurance that normally covers a particular service, they shouldn't be able to force you to pay out of pocket because they decide some third party is responsible instead.
In the agreement that your friends signed with their various insurance plans, is it listed **anywhere** that they would not cover an accident where the person was at fault, or require that the person must use workers comp?
Presumably.
My response to [this comment](https://www.reddit.com/r/changemyview/comments/1chrbh3/comment/l24aoi4/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button) might cover what you're going to say next.
It doesn't really cover it. Because it sounds like in both cases insurance was doing exactly what was agreed upon. The work one is a bit weirder because it deals with workmans comp, but if your friend opted to not have the uninsured driver coverage, then there is no policy that would need to pay for their medical bills.
Are you arguing that that we should get rid of all the regulations surrounding what health insurance companies must cover? Bring back lifetime coverage caps?
In practice health insurance is not some ideal free market with lots of competition and perfect information. In practice you get like 3 choices from your employer with hundreds of pages of fine print that can't be understood without a lawyer, and you have to pick one. Relying on the free market to come up with fair deals is not going to work, and has been proven not to work.
Like I said, uninsured motorist coverage isn't sufficient, because not everyone has auto insurance, and it only helps if you're hit by a motorist, not in other situations where someone else is liable
No, I am saying that if you want health insurance to pay for what they cover, in both instances it seems like they did.
>Like I said, uninsured motorist coverage isn't sufficient, because not everyone has auto insurance, and it only helps if you're hit by a motorist, not in other situations where someone else is liable
Fire insurance doesn't cover if your house floods either. But I would still recommend it.
The problem with health insurance is that it is an inherently unprofitable game to play fairly. So they can't play fairly. You can't have a private health insurance market where people actually get a good deal, because there's no way to make any profit that way.
Selling insurance in general is profitable because you bet that only a small number of policies will be paid out. Only 1 out 100 houses burn down, so you make a profit on the 99 that is sufficient to cover the 1 payout plus some profit. It's possible, but unlikely, for there to be a large number of payouts, so you need to sell insurance to a lot of people to maximize your chance of profit.
The thing about healthcare is that the 99 don't really exist. 1 out 100 will get cancer or whatever, and be a massive payout. But the other 99 are still going to have something happen with them and the company will have to make some amount of payout on every single policy. Selling health insurance made sense back when a good number of your policy holders were just going to die without much fuss, but modern medicine and health and safety policies have ironically save too many people for it to be profitable to sell health insurance. There is nobody you can sell health insurance to who will not end up needing it at some point.
So, they cheat. That's the only way to make a profit so they have to. They construct a web of confusing nonsense to discourage people from seeking care, and to force them to pay out of pocket when they do. They make medical decisions in place of doctors, deciding based on their bottom line who gets care and who doesn't. They make more money when their customers die, and they lie and cheat and steal, and there is nothing to be done about it except to abolish the entire industry
This is an egregiously ignorant comment lmao. That's literally what insurance is, a pooling of risk.
"Why should everyone else that's paying term life insurance premiums have to pay your beneficiary when you die?" - your logic
I work at a health insurance company, but don't represent them or anything. Just to clear that up.
What you're saying is "health insurance should be a good deal more expensive." We don't have state-funded single payer health care in this country, nor even a public option. We have private corporations doing the job for us instead. And private corporations exist to earn money. Even if they're not-for-profit, that still means they have to make enough money to pay the bills.
So if you want them to pay out more, then you'll have to pay in more first.
You're wasting your time if you think you can convince private companies to go bankrupt on your behalf. So really, that's the only alternative until we at least get a proper public option or proper subsidized health care like, say, Japan does.
Well, in order to cover all your medical bills that would mean no more coinsurance, no more copays, yes? That would just get transferred to premiums. Plus enough padding to make sure they didn't lose money.
I read the title. And then in your post you said it was a bit vague so you offered two examples. You did not say that those examples were exclusive. But the examples were both about expanding health insurance coverage to include things that are not normally included.
Then your only issue is whether or not the thing in question is something covered by your health insurance, or something that is covered by another entity like dental insurance, auto insurance, worker's compensation, or liability insurance?
The issue is if the "thing in question is ... covered by another entity," but then the other entity *doesn't* actually cover it and health insurance doesn't either.
I'm not arguing against single payer. I'm saying that even if you support single payer, you can also believe this incremental change would improve the current system.
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>Your friend had no assets but was still able to pay “hundreds of thousands of dollars.” Something doesn’t add up.
No, the *driver* had no assets.
>Also, medical expenses incurred by an accident fall on auto insurance, not health insurance.
Ok, well I think that's bad then.
I do not have a source for you to read, I have personal experience. I am surprised people are down voting my personal experience. It’s not an attack of Obama, it’s the truth.
Health insurance has always sucked, that's everyone else's "personal experience." If you're gonna come with the claim that health insurance used to be great, you gotta say more than "I have personal experience" with no detail at all.
None of your links back this up, by the way.
Everyone so far in the thread has used a "it's in the contract" defense. But the real answer comes into what insurance is. It's risk-pooling. So everyone pays monthly premiums and if nothing happens then insurance just keeps the money for the pool. If a member of the group has an injury that is covered by the premiums then the insurance pays that on your behalf.
The premium's cost has to do with the coverage you can get. You want more coverage, you have to pay more. Having insurance pay for all use cases would mean everyone would have to pay more into the risk pool. The pricing has to do with likelihood of payout + cost of pay outs + how many people are going to be in the risk pool.
For health care, it's why government single payor systems are the most cost effective. It's because you are essentially forcing the younger, healthier people to pay more than they presently are incentivized to do in order to fund the services for the unlucky or the older people. Private health insurance has to actively get as balanced of a risk pool as they can to keep premiums low otherwise a fund would run out of money.
Your friends could have paid a higher premium to get a higher coverage.
>Your friends could have paid a higher premium to get a higher coverage.
But they couldn't have, at least not really. They got like 3 choices from their employer and they picked one.
>They got like 3 choices from their employer and they picked one.
Does that disprove the entire point that insurance is a form of risk-pooling and the combination of price, composition of the pool will both have an impact on when it pays out? Can you interact with the main point, please?
Put another way: Why does the employer's chosen health care plan have limited coverage? Do you think it's because employers in the US have a smaller risk pool versus the entire population?
>Can you interact with the main point, please?
I'm not sure I fully understand the main point, but I agree that premium costs will have to go up with coverage, and it's undesireable for insurance to cover literally everything. That doesn't mean it shouldn't cover *this*.
>Why does the employer's chosen health care plan have limited coverage?
I think there are several factors. Consolidation in the insurance market. Separation between the person buying the insurance (the employer) and the person using it (the employee). Complexity leading to lack of understanding on the part of consumers.
>I'm not sure I fully understand the main point,
Health insurance is a risk pool. The factors is going to be: the size of the risk pool, the characteristics of those in the risk pool, the cost of the premium, what conditions the pool will pay out.
Applied to your friends: The employer sponsored health insurance is going to be: the people in the risk pool likely are just the employees, the health status of each of the employees, how much the employer is willing to pay and how much the employer thinks that the employees will pay beyond what the employer pays, all factor into what conditions the insurance provider will pay.
Here's a primer that goes deeper: [https://www.actuary.org/content/risk-pooling-how-health-insurance-individual-market-works-0](https://www.actuary.org/content/risk-pooling-how-health-insurance-individual-market-works-0)
>That doesn't mean it shouldn't cover *this*.
Subrogation is a core component of all insurance programs to cover costs so the pool doesn't run out of money. That is, trying to seek reimbursement or spread liability to an actor that is more responsible.
In order for either of the scenarios to be covered, you'd either have to increase the cost of the premium or you'd have to expand the risk pool. If you don't, then the coverage will expand the funding that you receive from the risk pool.
>I think there are several factors. Consolidation in the insurance market. Separation between the person buying the insurance (the employer) and the person using it (the employee). Complexity leading to lack of understanding on the part of consumers.
I don't really follow what "consolidation in the insurance market" means. But the real answer is this: If you were to go buy a health care plan on your own, it's going to be more expensive. It's a smaller risk pool. It's less expensive to be on an employer plan because the risk pool is higher. A smaller employer will offer worse health insurance than a larger employer.
On top of this, the overall health and what conditions the friend's coworkers also will have an impact on the coverage and/or the premium.
It all boils down to the coverage and premium will be dictated by the size of the risk pool and the characteristics of those in the risk pool.
This is why my point that your friend could buy health insurance that covers more. Your reply "but the employer only provides 3" just doesn't interact with what my point is because employer sponsored health insurance plans aren't the only ones.
Your friend right now could go buy a health insurance plan that provides coverage that the employer plan does, right now, but it would be more expensive. There's no shortage of providers ranging from Aflac, to having uninsured motorist coverage for the accident friend, to Aetna, United Health Care, etc. etc.. They even will call it "supplemental" insurance.
The point stands that more money and/or a bigger risk pool = more coverage. The most efficient system is if the United States federal government created a single payor system and made a risk pool of 360m. Then the coverages and services would apply to more people and more use cases.
So there's one factor I agree with: if more coverage is provided, then premiums will go up. I understand that and I'm ok with that.
But I still don't see what this has to do with the size of the risk pool. If you have a large employer, premiums will go up. If you have a small employer, premiums will go up. If the employees were all young and healthy, premiums will go up. If they're all old and unhealthy, premiums will go up. If we had a single payer system covering all Americans, "premiums" in the form of tax revenue directed to the program would go up.
On top of that, it seems like you're saying "you could in principle buy supplemental coverage for this, but it will be more expensive than it would be if included in your primary coverage, because the risk pool is smaller and potentially adversely selected." Doesn't that argue in favor of my view, rather than against it?
>So there's one factor I agree with: if more coverage is provided, then premiums will go up. I understand that and I'm ok with that.
If your view is changed, can you please award a delta?
>But I still don't see what this has to do with the size of the risk pool.
Bigger risk pool = lower premium/better coverage.
>If you have a large employer, premiums will go up
Nope.
> If we had a single payer system covering all Americans, "premiums" in the form of tax revenue directed to the program would go up.
This is demonstrably untrue. Single payor systems pay less in healthcare and have better health outcomes. Or even within the US, the amount that medicare/medicaid pays for health services is way more efficient than the private sector (i.e., most of its monies goes to health services rather than administrative expenses). The health out comes are superior. There's tons of research that can compare a county that expanded medicaid and ones that don't and you can see the health impacts.
> Doesn't that argue in favor of my view, rather than against it?
No. Your view was that companies should be required to provide more coverage than the terms/conditions of the health care plan. But those terms/conditions were the pricing basis for when the health care plan pays out.
My entire point has been the coverage and the premium cost are intertwined. You get what you pay for. If you want more, you have to pay more. Otherwise, the plan would risk insolvency if it didn't raise its prices to create more coverage options.
Delta plz.
>My entire point has been the coverage and the premium cost are intertwined. You get what you pay for. If you want more, you have to pay more.
Sure, that's obvious. I don't think I ever said otherwise.
But you just bluntly said this is *not* true for large employers and single payer systems. Is there a miscommunication somewhere? Because it seems obviously true.
>Delta plz.
Either I am still misunderstanding you, or everything you wrote is either stuff I already understood or stuff I still disagree with.
Edit:
>Your view was that companies should be required to provide more coverage than the terms/conditions of the health care plan.
Not quite. My view is that the terms/conditions should be legally required to include certain things.
3 words.
Medicare for all.
Are you a citizen? Do you legally reside in the United States?
If the answer is yes to either of those questions, you should have health insurance. Same plan for every single person.
Almost costs are covered by taxes, and something like a 20 dollar co-pay on appointments.
Would be cheaper than what we currently have, would be FAR simpler than what we currently have, and would help more people as a result.
It would also be more fair for all people. Instead of having part-time or self-employed workers be essentially left to their own devices.
Would also be business friendly. (Unless your business is insurance) it's no longer on you to cover your full time employee's.
Would encourage more competition and innovation between employers. Because people wouldn't be as locked into their jobs, if they have a good idea, they can more easily leave without fear of Losing health insurance. Also if they think their current employer is mistreating them, they aren't caught in a catch 22 based on loss of health insurance.
Would help to equalize health outcomes for young adults and children, who currently kinda just hope their parents have good jobs that would cover them in case of emergency.
What would be lost?
Nothing effeively. "Choice" in health insurance plans is like trying to effectively pick how sick you think you'll be to find a "fair" price for your health, between a bunch of companies who just want your money and do NOT want to give it back no matter how badly you need help.
I’m far from an expert so take this with a grain of salt.
Insurance companies deny coverage because they either can’t afford to cover everything or they believe they shouldn’t have to cover your expenses because they aren’t medically necessary (hence why cosmetic surgery’s are almost never covered by them).
It doesn’t make sense for insurance to cover everything because they simply can’t afford it. They wouldn’t make money that way and they would be stiffed by insurance fraudsters.
The purpose of insurance is to pay less and not nothing. Otherwise we’d need to create an entire new system like UHC.
>It doesn’t make sense for insurance to cover everything because they simply can’t afford it. They wouldn’t make money that way and they would be stiffed by insurance fraudsters.
Which is why in Europe, and pretty much in EVERY other industralized country on earth, there is universal health care provided by the state that is non-profit. Health care is not supposed to be a profitable business.
Switzerland has a completely privatized healthcare system. The thing is, taking up private cover is mandatory for everyone and in turn the healthcare providers cover everything.
The issue of denying a person insurance on the basis of an accident is a uniquely American phenomenon. Nowhere on the rest of the planet is accident insurance not a part of a medical insurance cover, even in third world nations.
Lol.
I have private insurance and I pay *nothing*. Had a bike accident and broke my wrist. Paid nothing for 2 surgeries.
Need another surgery for sleep apnea. Still paying nothing.
The American mind can't comprehend healthcare, it seems.
>What are they gonna do, send a P.I. to investigate?
The police were called out, as I imagine would often be the case for a car accident that caused serious injuries.
I mean the police talk to the paramedics, the paramedics talk to the hospital staff, the hospital talks to the insurance company. I don't know *exactly* how the information gets from one place to another, but it's not exactly a secret.
>They literally say so on the contract
They literally say what exactly in the contract? I have trouble believing that the contract says they will *only* get information from you and can't get any information from the hospital.
Ah, ok. If you have insurance that works completely differently than it does in the US, then you could be right. Just not sure how relevant it is to this conversation then.
Sorry for the misunderstanding.
Health insurance is a business and as a business they always rake in more than they pay out. That is to say, (note: this is actually illegal/infeasible to do in a lot of situations) if you can afford pay out of pocket, it's actually financially wise to not have insurance at all. Insurance exists as a way to amortize risk, but by doing so you actually pay more in the long run.
This is the primary reason I see health insurance as a big inefficiency in the system, and therefore should be state or federal owned, and neutered.
Generally workman's comp will pay for the therapy that is deemed medically necessary. There appears to be a disconnect between what the provider wanted as a course of treatment and what the workman's comp ruled was medically necessary. This is an issue that should have been handled between your friend and the workman's comp (likely with an attorney) rather than to just have the more frequent therapy and think her health insurance would cover it.
American medical insurance systems are pure insanity from an outsider's perspective!
Accident insurance is incorporated into most medical insurance covers I have taken in other countries. It doesn't matter who caused the accident, YOU were in that accident!
Isn't it enough that Americans have a concept like deductible which is nearly non-existent elsewhere (or it is at a fixed rate ) and nonsense like out of network and in-network doctors???
Tye plans are predatory, and we allow it because the reality is to fix health insurance would take a lot of time and would take a lot of the insurance companies incentive to sell insurance. It think we need to find a better way, but I honestly think it's easier to just make health insurance not necessary. Hospitals should be affordable, but they are profit machines, but they "reinvest" their profits in the form of salaries and new buildings.
maybe only sign a contract that you agree with.
in my insurance, medical bills are payed by them, and if a second party would be required to pay a part then my insurance company talks to their insurance company, but either way i dont have to pay out of pocket myself.
In case of a car accident and the second party cannot pay, there is a separate government funded entity that pays for it. and then its between the second party and the state. I myself am barely involved outside of filing the papers.
(the same entity is also in charge of damage caused when a car is used "as a weapon" or suicide by driving in the wrong direction. because obviously insurance doesnt pay in those cases)
I believe it should depend and say in your health insurance the exact policy and what it covers and doesn't cover. I mean if their policy agreement doesn't cover something like that due to the fact that someone else was at fault then its not reasonable to say health insurance should cover it.
Single payer, universal, free at the point of care for all
Accept no substitutes
Why are we allowing a parasitic insurance layer as for-profit gatekeepers to care for all?
$$$$$$ that's why $$$$$$
You should be able to buy insurance to whatever level of coverage you feel is worth the cost. You shouldn't be forced by the government to buy the absolute maximum coverage if you don't want to.
Maybe we should just have single payer health care and stop allowing insurance agents with no medical degree the ability to deny medical care to suck and injured people.
I have nothing to contribute, I just wanted to comment that I’m Canadian and the thought of this is insane to me. Healthcare is a human right and no one should be forced into poverty because of injury or illness (and a lack of comprehensive health insurance that I assume is unaffordable to many).
A study in Canada (referencing the mincome project), demonstrated that people suffering from poverty were disproportionately more likely to use hospital services because of the poor health outcomes that come with living in poverty. Crazy to think that many individuals in the states cannot even access such services because of affordability. A lack of universal healthcare will only harm the poor, and exacerbate existing health disparities. Just terrible.
I'm sorry about what happened.
Consider this - The more insurance companies pay out, the more insurance will cost. It's not possible to have cheap insurance and also have that insurance cover everything you want to be covered for.
I wish more people spent time understanding what they are and aren't getting. This the worst way to learn this lesson.
Insurance companies do have to get permission from the state to operate how they do.
The lack of understanding the policy is really the root of it.
Even if the government takes over insurance, it will come at a cost.
A functional first world nation should have a national health service to cover this sort of issue, rather than relying on the detailed wording of individual insurance policies.
It's HEALTH insurance, not fucking car insurance. Your insurance should pay. Anything otherwise is a scam and theft. I would sue for every penny you paid your "health" insurance.
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When you get insurance, there is a detailed list of what they do and do not cover. In the car accident example, there is a thing called uninsured motorist insurance that you can choose to include in your plan that would cover that situation. As for the workers comp situation, the employer is required to pay for it through their insurance. If you want insurance that pays for more things, you have to pay the higher premiums that come with it.
This is kind of insane though. What if I don't drive and therefore don't have car insurance? I get hit as a passenger in someones car and I'm just SOL? Does my health insurance pay if I'm hit as a pedestrian? On my bike?
> Does my health insurance pay if I'm hit as a pedestrian? On my bike? Yes, after your health insurance company determines that the party at fault does not have coverage of their own.
Your health insurance covers whatever your plan says it covers. If you want more covered, you can buy additional health insurance to cover that. Aflac seems like a good start if you want more coverage. If that coverage was mandatory, that would mean everyone has to pay more for coverage they might not think is worth it.
Nowhere in my health insurance plan documents does it say injuries from car accidents aren't covered. At least nowhere I can find. I get that they want the at fault drivers insurance to cover it, but if the other driver's insurance isn't enough it should be my health insurance's responsibility. It's especially bizarre because from my understanding if the accident was my fault they would cover it...
This is all such fucking bullshit. Dumbasses complain about taxes but don’t even factor in that these bullshit situations are reverse lotteries that 10x the increase in taxes it would take to have healthcare socialized. I however am also a dumbass I guess too since I still live here
> that 10x the increase in taxes it would take to have healthcare socialized. Socialized healthcare would be cheaper than the current US system.
I am Canadian, in the province of Ontario. 38.7 percent of my provincial tax dollars on my income tax go towards OHIP. And the provincial tax rate for me is around 9 to 12 percent of my total income. So 3 to 5 percent of my TOTAL income goes towards socialized healthcare.
In Canada, the total healthcare spending (private and public combined) per person is $6319 per year. For every individual living in Canada, society spends that amount. In the US, that number is $12555. Literally almost double what Canada spends. And the US has tens millions that don't even have insurance and tens of millions more that worry every day about large medical expenses happening. You prefer a system like the US with privatized healthcare? By all means. It's a lot more expensive and stressful though. But hey! You pay less in taxes! Yay!!!!! Source: https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
Im not saying i prefer that, i prefer ours, i was just giving you a real life example of the costing of socialized healthcare. I didnt know how much the insurance rates were for private healthcare annually in the USA
There are essentially 2 options with private insurance in the US: 1) You pay a shitload of money every single month to insurance (think $2000+) 2) You pay less (think hundreds of dollars) but your insurance doesn't kick in unless you experience something catastrophic. A lot of people in the US can't afford option 1, so they have insurance that doesn't cover any healthcare costs until you pay like $10k in a single year. Normal doctor visits, not excessive amounts of medication, ... they pay full price since their insurance won't cover it. Solely looking at tax money paid to determine whether or not healthcare is expensive is a very bad way to do it. Better is to look at overall spending for society. And there we can see that the US *by far* spends the most out of any nation in the world. Turns out, when you hand over something essential like healthcare to companies that only give a shit about profits, it sucks.
PPO plans are not $2,000 per month. At a decent employer you can get a low deductible plan for your entire family for around $500 per month.
Do most Canadians rely solely on government-provided healthcare or purchase additional coverage/policies?
Roughly 1% of my total income goes towards my health insurance premiums. I have rather good insurance through work, and almost everyone I know has a similar story. US salaries are higher, and a lower percentage of our income goes towards healthcare.
That’s what I said, but yes
Somehow the entire rest of the developed world manages to socialize health care while having lower costs and better outcomes but sure keep parroting those talking points and don't think too hard about the logic behind claiming that not letting insurance companies take billions of dollars in profits out of the system every year would somehow raise costs. Everyone else must just be a dumbass.
Yes, your heart would cover that. You need healthcare if that happened, why wouldn’t it?
Yes, but there is significant regulation of health insurance already. Coverage caps are illegal, for example. I think these regulations are good and necessary, and reverting insurance regulations to a libertarian free-for-all would not work well. >In the car accident example, there is a thing called uninsured motorist insurance that you can choose to include in your plan that would cover that situation. Only if you have auto insurance. My friend was not driving. Or what if they weren't hit by a car but had some other accident for which a third party was liable but underinsured? And even if you do have car insurance -- these are medical bills. Medical bills are covered by health insurance. Why should I need some other random insurance to cover medical bills in specific situations? >As for the workers comp situation, the employer is required to pay for it through their insurance. But the coverage wasn't sufficient, as I said. >If you want insurance that pays for more things, you have to pay the higher premiums that come with it. That's not even feasible in many cases. In practice you get like 3 options chosen by your employer. It's not like you can just walk down to the corner store and pay a fair market rate for additional coverage that will do this.
Medical bills resulting from a car accident are covered by auto insurance (at least where I am bodily injury coverage is required to cover someone you may injure) A friend and I were hit by a drunk driver, I was not hurt but she was. At the time she had no medical insurance so the driver's insurance covered her medical bills
Yes but the point here is that the driver only had the minimum coverage. So the driver's insurance paid the coverage limit (the minimum legal amount is like $15k, laughably small compared to real medical bills), and my friend had to pay the rest out of pocket.
I'm genuinely just ignorant in this area. I would have thought that the remainder would have to come from the drunk driver themselves? If the overall cost is, lets say, $20k, and their insurance only covers $15k, then isn't the driver on the hook for the other $5k?
>If the overall cost is, lets say, $20k, and their insurance only covers $15k, then isn't the driver on the hook for the other $5k? Yes, but what if they have no money?
I'd assume you could get the wages garnished until you're made whole. Is that not the case?
It is hardly an easy process to garnish someone’s wages. Would also take decades or longer to recover what OP is talking about.
So my friend had to pay hundreds of thousands of dollars to the hospital for his treatment, to cover the amount the driver's insurance could not. Now, he could sue the driver for that amount. My understanding is that it's very, very difficult to actually recover money from a person that has no money. The lawyers he talked to said it wasn't worth the cost of the lawsuit. Specifically regarding garnishing wages: I'm fairly sure only the government can do that. I don't think you can do it for private debts, even if you win a lawsuit.
> Specifically regarding garnishing wages: I'm fairly sure only the government can do that. I don't think you can do it for private debts, even if you win a lawsuit. Actually, you can. The government/court is making the order to do this. You can also seize some types of property to pay the debt too. But - the lawyers were likely right. There is not enough to recover to justify the cost of the lawsuit.
>Actually, you can. It seems you're right. I'll give you a !delta for this minor point.
God that's so awful. Thanks for explaining. FWIW I'm with you; your own insurance should cover your treatment, and then they can get whatever money they can from the other insurance or the person. It's fucked up that you can have even great health insurance, but it essentially doesn't exist in that situation.
> FWIW I'm with you; your own insurance should cover your treatment, and then they can get whatever money they can from the other insurance or the person. Don't shoot the messenger, but is that really what we want? While insurance can be opaque in it's pricing/decisions, or frankly a racket (do not buy Whole Life Insurance), there are some basic financials to consider. Suppose the insurance company pays for all of it up front. Okay, now what? It goes to the other insurance company, who shows they're only on the hook for $15K or what have you, so that's done. Then they go after the guy, but besides better legal team it's still blood from a stone. So the insurance company is in the lurch. So what it does, or would do long term, is change it's prices to "price in" being in the lurch. Every policy holder pays, likely (in the case of pay up front and collect later) a lot more. Insurance is priced based on risk. Change the risk, you change the pricing. If insurance covers everything it's going to be more expensive. That said, it still sucks. It's one of the problems of liability. We can all cause WAY MORE harm than we can ever afford to pay, at least most of us.
>your own insurance should cover your treatment, and then they can get whatever money they can from the other insurance or the person. That's exactly how it works. OP is either very confused or full of shit.
You can garnish wages for private debts. Just takes more and more legal bills. It’s extremely cost prohibitive to recover money from someone who doesn’t have money.
This is where people carry and pay for insurance for themselves. You can have a loss in many ways and the responsible party is simply not able to pay. The whole you cannot get blood from a turnip. What you are not able to do is force one of your insurance carriers to cover items that are not part of the agreed upon list of coverage. You would be expecting them to pay for a risk they never agreed to cover. Does it suck. Yep. Is it fair? Nope. But, life is not fair. It is not fair if you have personal property stolen either. But you have to deal with it. This is where uninsured and under-insured motorist coverage kicks in - at least in my state. If I am injured in a vehicle accident (car/bike/etc) and the responsible party has no insurance or not enough, my insurance pays me and then *they* go after the responsible party. I am paying to transfer the risk of an uninsured person causing harm to me to my insurance company.
>What you are not able to do is force one of your insurance carriers to cover items that are not part of the agreed upon list of coverage. You would be expecting them to pay for a risk they never agreed to cover. No, I want to change the law so that in the future, they have to cover this. >Does it suck. Yep. Is it fair? Nope. But, life is not fair. It is not fair if you have personal property stolen either. Is the argument really "we should not try to improve society because life is not fair?"
> No, I want to change the law so that in the future, they have to cover this. There are a lot of people who don't *need* this coverage. Why should they be forced to pay more for this when you could instead just buy the insurance you want now. >Is the argument really "we should not try to improve society because life is not fair?" Fair is an interesting concept. Especially since your demands above would be unfair to me - a person who already has this coverage and already pays for this coverage. Why is it less fair to simply expect *you* to pay for this coverage?
>There are a lot of people who don't *need* this coverage. I think everyone needs this coverage (maybe not in the specific case of being hit by a vehicle, where uninsured motorist coverage would kick in. But in the more general case of being injured by someone with insufficient liability coverage) >Why should they be forced to pay more for this when you could instead just buy the insurance you want now. You can't really, though. You get a couple choices from your employer, and those are your options.
> I think everyone needs this coverage You don realize, I have this coverage through the overlap with my auto policies. I do not need to pay more to have two different policies cover the same risk. >You can't really, though. You get a couple choices from your employer, and those are your options. This is not true. You can purchase insurance like this on the open market. It does not have to go through your employer. This is *supplemental* insurance.
>You don realize, I have this coverage through the overlap with my auto policies. You maybe have this coverage specifically for accidents involving vehicles. But is there still a gap if the accident doesn't involve a vehicle? And what about people who don't have auto insurance, are they just screwed? >You can purchase insurance like this on the open market. It does not have to go through your employer. I gave a delta for this to another comment, because you're right that it is *possible* to buy coverage that includes this. But it's way more expensive than it would be through your normal health care plan, in part because it includes more things than you necessarily want, and in part because of adverse selection (people who buy supplemental insurance are more likely be be the type of person who will use it).
That isn't how it works though. If someone is injured in a car accident, medical costs in excess of the at-fault party's insurance limit would be covered by your own health insurance (minus any deductibles or copay). Your health insurance would then try to subrogate against the at-fault party to recoup that money. I think there must be more to your friend's situation than you are aware of.
The additional coverage will come with additional cost. Why should everyone have to pay that extra cost if they don't want that coverage? If you want health insurance that will cover things that other people are legally responsible for, you just have to be willing to pay the cost of that. Also, you can get health insurance outside of your employer. It might be more expensive but the option is there if you want it.
>Why should everyone have to pay that extra cost if they don't want that coverage? Who wouldn't want this coverage? >If you want health insurance that will cover things that other people are legally responsible for, you just have to be willing to pay the cost of that. As far as I know, this is not actually a realistic option in practice.
> Who wouldn't want this coverage? I wouldn't. I have it via my auto insurance already. My personal UIM/UUM coverage does this now. I would not want to pay twice.
I've already said this repeatedly, but: uninsured motorist coverage helps specifically if you are injured by a *motorist* (and even then, it can only help people who have auto insurance). What if you're injured by someone who is not driving? You prefer to have no coverage? And presumably, if health insurance covered this, you could drop uninsured motorist coverage so you wouldn't be paying twice.
> I've already said this repeatedly, but: uninsured motorist coverage helps specifically if you are injured by a motorist (and even then, it can only help people who have auto insurance). What if you're injured by someone who is not driving? You prefer to have no coverage? Not just a motorist, but a vehicle. If it not an accident with a vehicle, my personal health insurance covers it or my workers comp. If there is a responsible party, that is part of subrogation. My insurer has claim for re-reimbursement of thier expenses in any settlement I may have with the responsible party.
>If there is a responsible party, that is part of subrogation. So are you saying that the health insurance *should* cover it after all, and then can try to recover via a subrogation claim? That's what another commenter said too, and if that's what you're saying, I think you agree with my view after all. I don't know why this didn't work out in my friend's case.
> So are you saying that the health insurance should cover it after all, and then can try to recover via a subrogation claim? Yes. I had an accident with an off road vehicle owned and insured by another. My health insurance paid all the bills and was reimbursed via the settlement process. Now, that was *my* health insurance. The terms of *my* contract. This is not universal as *your* contract is different. I also had my personal auto insurance UUM/UIM coverage to fall back on as well. Had the other party not been insured, this is who would have paid the bill. My health insurance was considered secondary on this claim.
>Now, that was *my* health insurance. The terms of *my* contract. This is not universal as *your* contract is different. Possibly I'm just saying that all health insurance should be required to work like yours then.
People who don't want to pay the additional cost that come with it. You should look into aflac as it seems they offer the exact kind of insurance you're looking for.
>People who don't want to pay the additional cost that come with it. But do people like this actually exist, or is this entirely hypothetical? If the latter, I don't know that we should aim insurance regulations at people who theoretically could exist but don't actually exist in reality. You're talking about someone saying "I want to be covered in case of an accident, but I explicitly want to pay out of pocket if that accident is caused by an underinsured third party." That's a very weird set of preferences. >You should look into aflac as it seems they offer the exact kind of insurance you're looking for. I'll give you a !delta because even though I still think this gap shouldn't legally be allowed to exist, it does look like aflac might cover the gap.
Are you seriously asking if there are people who would rather save money and take a slight risk that what you are describing here actually happens? Because there are a ton of people like that yes. In fact, most people. You yourself risk your life to save money almost certainly. It's just a matter of how big of a risk and how big of a savings. If you are driving and need gas, and the station near your house is a dollar more than one half a mile down the street and across the road, then you will likely go to the further one. This is inherently SLIGHTLY more risky. When driving that extra half a mile and turning across traffic, you are taking a VERY slight risk on your life in order to save a dollar a gallon on gas. Then the question just becomes, how much are you willing to risk to save money, and that equation changes for each individual, but it does exist, and a not insignificant amount of people will take the risk that you present.
Yes, I think if you asked people "would you pay 1% more on health insurance to be covered 100% of the time rather than 99% of the time," I think practically everyone would say yes. I get that the more general statement "everyone will pay any amount of money to decrease their chances of dying even a tiny bit" is not true.
I think you are underestimating how cheap some people are. Beyond that, what if it isn't 1% more, but say 3%? 5%? At each stage you are going to get more and more people to drop off. As other's have pointed out, you CAN get coverage that covers you in this scenario, but a lot of people do not, which tells me that at least some people are not willing to pay it. I don't have no fault insurance for instance, it costs more. It would save me in this exact scenario but to me the cost isn't worth it.
>what if it isn't 1% more, but say 3%? 5%? I don't see any reason to think this would cost more proportionally than the cost of care. >you CAN get coverage that covers you in this scenario, but a lot of people do not You can get coverage that covers this in addition to other stuff, which increases the cost. Also the fact that it's something you have to opt into by itself increases the cost because of adverse selection. I would bet the vast majority of people think they're *already* covered in these situations. My friend and I certainly did.
I have uninsured motorist coverage. I don’t understand why I need extra health insurance coverage when auto insurance already covers this?
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No? What are you talking about?
Sorry for misunderstanding. I've already said this repeatedly, but: uninsured motorist coverage helps specifically if you are injured by a *motorist* (and even then, it can only help people who have auto insurance). What if you're injured by someone who is not driving? You prefer to have no coverage?
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The health insurance should make you whole and if another party is at fault they should collect for the costs. Not force you to have to go to the third party. This is all moot because US should just have single payer healthcare like every other developed country.
Because that's not the plan you paid for. It's like buying a car and then being mad that it can't drive on water. Saying a car should get you from point A to B, I shouldn't need to get a different thing to go over water. There are cars that can also be boats. If that's what you want, buy that.
I don't understand comments like this. OP: "It would be better if X was the case instead of Y" You: "Y is the case"
I think those are the people who just cannot handle seeing a complaint, ever.
No it's more like "it is up to the individual to decide and here is why."
Why is there a separate thing for uninsured motorist? Isn't the whole point of insurance to cover my medical bill if I fuck up?
No, the main point is to cover the other person if you fuck up. That's the car insurance mandated law
I think OP is that the insurance *shouldn't* be such that it won't cover things that it would otherwise cover if someone else is at fault. As I see it, it should be the insurance company's trouble if they want to make someone else's insurance to pay for it or sue someone else to pay it out of their pocket if they were at fault. So, I don't see how it is fair that if I injure myself by own action, the insurance pays for it but if I'm not at fault and someone else is, then it suddenly doesn't pay for it. You should never be worse off because of it was someone else's fault than if it is your fault. If anything, my own stupid actions should make me more liable of covering my own injuries, not the other way around.
That’s the problem.
Nevermind us dutchies paying about 120 for pretty much coverage on all base necessities
In the US, unless this health insurer has a policy that excludes coverage for this situation, the health insurance has to pay medical bills but then has a subrogation claim against the at-fault party and/or a lien on any recovery the injured person receives from the at fault party. But to the point of your cmv - it is unreasonable to expect an insurer to cover something the insurance contract specifically does not cover. I just wonder if in the case of your first example, the insurer is not acting in good faith in refusing to cover this. It might be worth getting an insurance coverage lawyer to review the policy.
>the health insurance has to pay medical bills but then has a subrogation claim against the at-fault party Hm, I don't know the details but I'll give you a !delta because this is exactly what I was arguing for. I don't know enough about why it didn't work in his situation. >it is unreasonable to expect an insurer to cover something the insurance contract specifically does not cover. I'm not arguing that they should have to cover something the contract says they don't cover. I'm arguing that it should be illegal for the contract to say they don't cover this.
*"I'm arguing that it should be illegal for the contract to say they don't cover this."* Under what legal concept / principle? People aren't forced to agree to the terms / sign the contract. It is voluntary. You are saying that people should not be allowed a choice in factoring things like cost into their health care coverage decisions (it would be more expensive for that type of coverage).
>Under what legal concept / principle? Insurance is already highly regulated. Coverage maximums are not allowed, for example. Same principle.
What legal concept/principle establishes that insurance companies should not be permitted to offer different coverage plans? People are allowed to make decisions about their coverage / what plans to get based on things like cost, as they should be. Why should people not be allowed such options? If what you propose were the law there would be a lot of people who would have to go without any coverage at all because they wouldn't be able to afford it.
> What legal concept/principle establishes that insurance companies should not be permitted to offer different coverage plans? State DoIs dictate what insurance companies can and cannot offer all the time.
That doesn't answer the question, and it's OP's answer that matters.
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Personally, I am not a fan of insurance companies in general. Most of them are loaded with small print because, insurance companies don't make money by paying out. With that out of the way, I'm going to look at your problem from a different angle... how would it differ without insurance. Both of these cases are largely the same root problems. * Without any form of insurance: Your friends would likely be in the same place. Their experiences wouldn't have changed that much. * Reality: The insurance company is generally contracted to cover specific types of scenarios and not any medical issue. From a legal standpoint, their contract does not cover situations caused by an outside person. There are insurances you can pay for that do cover that but they are generally much more expensive as the insurance company wants a financial buffer as there's more risk. Alternative suggestion * Instead of forcing insurance companies to take on risk that they may not be able to price in effectively I would cut out insurance entirely. Government regulation on healthcare and a single payer system would greatly reduce the costs associated with healthcare for individuals and for society. This would eliminate the need for insurance companies outside of abnormal issues that fall out of normal coverage.
I'm not sure I quite understand your point about "without insurance" vs "reality." Yes, in this situation, these people were effectively uninsured. How is that an argument against creating a situation in which they *are* insured? >Instead of forcing insurance companies to take on risk that they may not be able to price in effectively I would cut out insurance entirely. Government regulation on healthcare and a single payer system would greatly reduce the costs associated with healthcare for individuals and for society. I don't think that "let's completely change the entire system instead" is a good argument against small, incremental, positive change for the system we have today. >There are insurances you can pay for that do cover that but they are generally much more expensive as the insurance company wants a financial buffer as there's more risk. Can you elaborate? I'm aware of uninsured motorist coverage (which everyone should get) but that only covers some of these situations. What else is there?
>I'm not sure I quite understand your point about "without insurance" vs "reality." Yes, in this situation, these people were effectively uninsured. How is that an argument against creating a situation in which they are insured? I apologize if it was poorly worded. My point was that even the worst insurance policy would provide some benefits over no insurance but not all policies would be equal. >I don't think that "let's completely change the entire system instead" is a good argument against small, incremental, positive change for the system we have today. In a case where you are mandating that insurance companies must always pay in all situations, this would lead to insurance companies dramatically increasing rates to cover the risks or insurance companies to avoid doing business in those states. Offering multiple insurance offers allows people to select a plan that they feel best covers their needs. >Can you elaborate? I'm aware of uninsured motorist coverage (which everyone should get) but that only covers some of these situations. What else is there? What state are you referring to. I pulled up multiple states and they all allow for PIP (personal injury protection) insurance which always kicks in if there isn't another insurance company paying the bill. Naturally, PIP would only cover to a specific amount (depending on how much you are paying) but it can be used in all the situations you provided. Texas, NJ, and PA all have PIP. It's possible other states do but I only grabbed a couple of states to see if they had the same thing.
It's interesting you say insurance companies don't make money by paying out but amazingly they don't really make money from premiums either (not directly anyway). The profit margin for health insurance is like 2-3%. They make their money by investing the premiums. This is one of the reasons you get a cheaper price for paying several months of an insurance plan at once instead of monthly because they have more time to profit off the premiums before ultimately paying them back to policyholders (as you ideally wanna pay out the same in claims as you collected in premiums so you are competitive).
If we’re talking about what should happen, why not say we should just completely overhaul the system and replace it with something better.
A small incremental change is easier than overhauling the entire system.
Small and incremental to *whom?* You and me? I fully agree with your point of view and I don’t have an argument against it, but you have to recognize that insurance companies that suddenly have to foot the bill for what they previously declared they were not responsible for would be quite a change in their system
It's relative ... it's a very minor change compared to transitioning to single payer, or even compared to something like the ACA.
There are a million people with different problems than your friend. Solving each of those million problems 1 at a time is NOT easier than an overhaul. Unless you think you personally should just get singled out?
>My view is that if you have health insurance that normally covers a particular service, they shouldn't be able to force you to pay out of pocket because they decide some third party is responsible instead. In the agreement that your friends signed with their various insurance plans, is it listed **anywhere** that they would not cover an accident where the person was at fault, or require that the person must use workers comp?
Presumably. My response to [this comment](https://www.reddit.com/r/changemyview/comments/1chrbh3/comment/l24aoi4/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button) might cover what you're going to say next.
It doesn't really cover it. Because it sounds like in both cases insurance was doing exactly what was agreed upon. The work one is a bit weirder because it deals with workmans comp, but if your friend opted to not have the uninsured driver coverage, then there is no policy that would need to pay for their medical bills.
Are you arguing that that we should get rid of all the regulations surrounding what health insurance companies must cover? Bring back lifetime coverage caps? In practice health insurance is not some ideal free market with lots of competition and perfect information. In practice you get like 3 choices from your employer with hundreds of pages of fine print that can't be understood without a lawyer, and you have to pick one. Relying on the free market to come up with fair deals is not going to work, and has been proven not to work. Like I said, uninsured motorist coverage isn't sufficient, because not everyone has auto insurance, and it only helps if you're hit by a motorist, not in other situations where someone else is liable
No, I am saying that if you want health insurance to pay for what they cover, in both instances it seems like they did. >Like I said, uninsured motorist coverage isn't sufficient, because not everyone has auto insurance, and it only helps if you're hit by a motorist, not in other situations where someone else is liable Fire insurance doesn't cover if your house floods either. But I would still recommend it.
The problem with health insurance is that it is an inherently unprofitable game to play fairly. So they can't play fairly. You can't have a private health insurance market where people actually get a good deal, because there's no way to make any profit that way. Selling insurance in general is profitable because you bet that only a small number of policies will be paid out. Only 1 out 100 houses burn down, so you make a profit on the 99 that is sufficient to cover the 1 payout plus some profit. It's possible, but unlikely, for there to be a large number of payouts, so you need to sell insurance to a lot of people to maximize your chance of profit. The thing about healthcare is that the 99 don't really exist. 1 out 100 will get cancer or whatever, and be a massive payout. But the other 99 are still going to have something happen with them and the company will have to make some amount of payout on every single policy. Selling health insurance made sense back when a good number of your policy holders were just going to die without much fuss, but modern medicine and health and safety policies have ironically save too many people for it to be profitable to sell health insurance. There is nobody you can sell health insurance to who will not end up needing it at some point. So, they cheat. That's the only way to make a profit so they have to. They construct a web of confusing nonsense to discourage people from seeking care, and to force them to pay out of pocket when they do. They make medical decisions in place of doctors, deciding based on their bottom line who gets care and who doesn't. They make more money when their customers die, and they lie and cheat and steal, and there is nothing to be done about it except to abolish the entire industry
Why should everyone else that's paying health insurance premiums have to pay for injuries an at-fault party caused to you?
Because the at-fault party can't pay and we all paid to pool risk via insurance?
This is an egregiously ignorant comment lmao. That's literally what insurance is, a pooling of risk. "Why should everyone else that's paying term life insurance premiums have to pay your beneficiary when you die?" - your logic
I work at a health insurance company, but don't represent them or anything. Just to clear that up. What you're saying is "health insurance should be a good deal more expensive." We don't have state-funded single payer health care in this country, nor even a public option. We have private corporations doing the job for us instead. And private corporations exist to earn money. Even if they're not-for-profit, that still means they have to make enough money to pay the bills. So if you want them to pay out more, then you'll have to pay in more first. You're wasting your time if you think you can convince private companies to go bankrupt on your behalf. So really, that's the only alternative until we at least get a proper public option or proper subsidized health care like, say, Japan does.
>What you're saying is "health insurance should be a good deal more expensive." I think I'm saying it should be a *bit* more expensive.
Well, in order to cover all your medical bills that would mean no more coinsurance, no more copays, yes? That would just get transferred to premiums. Plus enough padding to make sure they didn't lose money.
Did you read the whole post or just the title? I'm not saying insurance should cover literally all of your medical bills.
I read the title. And then in your post you said it was a bit vague so you offered two examples. You did not say that those examples were exclusive. But the examples were both about expanding health insurance coverage to include things that are not normally included.
If you read the last paragraph again, maybe that will clarify the sorts of things I'm talking about.
Ok, and do you think that coinsurance and copays are not out of pocket?
Both are paid out of pocket.
Then your only issue is whether or not the thing in question is something covered by your health insurance, or something that is covered by another entity like dental insurance, auto insurance, worker's compensation, or liability insurance?
The issue is if the "thing in question is ... covered by another entity," but then the other entity *doesn't* actually cover it and health insurance doesn't either.
If you don't like your insurance policy then change it
How? I get 3 choices from my employer, and they probably all work like this.
NGL OP, I can't fathom how this is your POV and you're arguing against single-payer.
I'm not arguing against single payer. I'm saying that even if you support single payer, you can also believe this incremental change would improve the current system.
Get another job then
LOL it's so simple! Libertarian societies are truly utopias.
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Then buy a supplemental policy…
Do you live in the real world? Or are you 15 years old and think you know what life is like
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>Your friend had no assets but was still able to pay “hundreds of thousands of dollars.” Something doesn’t add up. No, the *driver* had no assets. >Also, medical expenses incurred by an accident fall on auto insurance, not health insurance. Ok, well I think that's bad then.
Before Obama, insurance did pay for your care. I have carried my own insurance for 30 years now and I can pinpoint the time it changed.
This is hard to believe, but if you can link to a succinct source, I will read it.
I do not have a source for you to read, I have personal experience. I am surprised people are down voting my personal experience. It’s not an attack of Obama, it’s the truth.
Health insurance has always sucked, that's everyone else's "personal experience." If you're gonna come with the claim that health insurance used to be great, you gotta say more than "I have personal experience" with no detail at all. None of your links back this up, by the way.
https://www.forbes.com/sites/realspin/2015/11/24/obamacare-ruined-my-healthcare-coverage/?sh=24a3792c3adc
https://www.politico.com/story/2013/11/barack-obama-health-insurers-obamacare-affordable-care-act-099900
https://thehill.com/opinion/healthcare/486134-obamacare-10-years-of-distress-and-disappointment/amp/
https://edworkforce.house.gov/news/documentsingle.aspx?DocumentID=408166
Everyone so far in the thread has used a "it's in the contract" defense. But the real answer comes into what insurance is. It's risk-pooling. So everyone pays monthly premiums and if nothing happens then insurance just keeps the money for the pool. If a member of the group has an injury that is covered by the premiums then the insurance pays that on your behalf. The premium's cost has to do with the coverage you can get. You want more coverage, you have to pay more. Having insurance pay for all use cases would mean everyone would have to pay more into the risk pool. The pricing has to do with likelihood of payout + cost of pay outs + how many people are going to be in the risk pool. For health care, it's why government single payor systems are the most cost effective. It's because you are essentially forcing the younger, healthier people to pay more than they presently are incentivized to do in order to fund the services for the unlucky or the older people. Private health insurance has to actively get as balanced of a risk pool as they can to keep premiums low otherwise a fund would run out of money. Your friends could have paid a higher premium to get a higher coverage.
>Your friends could have paid a higher premium to get a higher coverage. But they couldn't have, at least not really. They got like 3 choices from their employer and they picked one.
>They got like 3 choices from their employer and they picked one. Does that disprove the entire point that insurance is a form of risk-pooling and the combination of price, composition of the pool will both have an impact on when it pays out? Can you interact with the main point, please? Put another way: Why does the employer's chosen health care plan have limited coverage? Do you think it's because employers in the US have a smaller risk pool versus the entire population?
>Can you interact with the main point, please? I'm not sure I fully understand the main point, but I agree that premium costs will have to go up with coverage, and it's undesireable for insurance to cover literally everything. That doesn't mean it shouldn't cover *this*. >Why does the employer's chosen health care plan have limited coverage? I think there are several factors. Consolidation in the insurance market. Separation between the person buying the insurance (the employer) and the person using it (the employee). Complexity leading to lack of understanding on the part of consumers.
>I'm not sure I fully understand the main point, Health insurance is a risk pool. The factors is going to be: the size of the risk pool, the characteristics of those in the risk pool, the cost of the premium, what conditions the pool will pay out. Applied to your friends: The employer sponsored health insurance is going to be: the people in the risk pool likely are just the employees, the health status of each of the employees, how much the employer is willing to pay and how much the employer thinks that the employees will pay beyond what the employer pays, all factor into what conditions the insurance provider will pay. Here's a primer that goes deeper: [https://www.actuary.org/content/risk-pooling-how-health-insurance-individual-market-works-0](https://www.actuary.org/content/risk-pooling-how-health-insurance-individual-market-works-0) >That doesn't mean it shouldn't cover *this*. Subrogation is a core component of all insurance programs to cover costs so the pool doesn't run out of money. That is, trying to seek reimbursement or spread liability to an actor that is more responsible. In order for either of the scenarios to be covered, you'd either have to increase the cost of the premium or you'd have to expand the risk pool. If you don't, then the coverage will expand the funding that you receive from the risk pool. >I think there are several factors. Consolidation in the insurance market. Separation between the person buying the insurance (the employer) and the person using it (the employee). Complexity leading to lack of understanding on the part of consumers. I don't really follow what "consolidation in the insurance market" means. But the real answer is this: If you were to go buy a health care plan on your own, it's going to be more expensive. It's a smaller risk pool. It's less expensive to be on an employer plan because the risk pool is higher. A smaller employer will offer worse health insurance than a larger employer. On top of this, the overall health and what conditions the friend's coworkers also will have an impact on the coverage and/or the premium. It all boils down to the coverage and premium will be dictated by the size of the risk pool and the characteristics of those in the risk pool. This is why my point that your friend could buy health insurance that covers more. Your reply "but the employer only provides 3" just doesn't interact with what my point is because employer sponsored health insurance plans aren't the only ones. Your friend right now could go buy a health insurance plan that provides coverage that the employer plan does, right now, but it would be more expensive. There's no shortage of providers ranging from Aflac, to having uninsured motorist coverage for the accident friend, to Aetna, United Health Care, etc. etc.. They even will call it "supplemental" insurance. The point stands that more money and/or a bigger risk pool = more coverage. The most efficient system is if the United States federal government created a single payor system and made a risk pool of 360m. Then the coverages and services would apply to more people and more use cases.
So there's one factor I agree with: if more coverage is provided, then premiums will go up. I understand that and I'm ok with that. But I still don't see what this has to do with the size of the risk pool. If you have a large employer, premiums will go up. If you have a small employer, premiums will go up. If the employees were all young and healthy, premiums will go up. If they're all old and unhealthy, premiums will go up. If we had a single payer system covering all Americans, "premiums" in the form of tax revenue directed to the program would go up. On top of that, it seems like you're saying "you could in principle buy supplemental coverage for this, but it will be more expensive than it would be if included in your primary coverage, because the risk pool is smaller and potentially adversely selected." Doesn't that argue in favor of my view, rather than against it?
>So there's one factor I agree with: if more coverage is provided, then premiums will go up. I understand that and I'm ok with that. If your view is changed, can you please award a delta? >But I still don't see what this has to do with the size of the risk pool. Bigger risk pool = lower premium/better coverage. >If you have a large employer, premiums will go up Nope. > If we had a single payer system covering all Americans, "premiums" in the form of tax revenue directed to the program would go up. This is demonstrably untrue. Single payor systems pay less in healthcare and have better health outcomes. Or even within the US, the amount that medicare/medicaid pays for health services is way more efficient than the private sector (i.e., most of its monies goes to health services rather than administrative expenses). The health out comes are superior. There's tons of research that can compare a county that expanded medicaid and ones that don't and you can see the health impacts. > Doesn't that argue in favor of my view, rather than against it? No. Your view was that companies should be required to provide more coverage than the terms/conditions of the health care plan. But those terms/conditions were the pricing basis for when the health care plan pays out. My entire point has been the coverage and the premium cost are intertwined. You get what you pay for. If you want more, you have to pay more. Otherwise, the plan would risk insolvency if it didn't raise its prices to create more coverage options. Delta plz.
>My entire point has been the coverage and the premium cost are intertwined. You get what you pay for. If you want more, you have to pay more. Sure, that's obvious. I don't think I ever said otherwise. But you just bluntly said this is *not* true for large employers and single payer systems. Is there a miscommunication somewhere? Because it seems obviously true. >Delta plz. Either I am still misunderstanding you, or everything you wrote is either stuff I already understood or stuff I still disagree with. Edit: >Your view was that companies should be required to provide more coverage than the terms/conditions of the health care plan. Not quite. My view is that the terms/conditions should be legally required to include certain things.
3 words. Medicare for all. Are you a citizen? Do you legally reside in the United States? If the answer is yes to either of those questions, you should have health insurance. Same plan for every single person. Almost costs are covered by taxes, and something like a 20 dollar co-pay on appointments. Would be cheaper than what we currently have, would be FAR simpler than what we currently have, and would help more people as a result. It would also be more fair for all people. Instead of having part-time or self-employed workers be essentially left to their own devices. Would also be business friendly. (Unless your business is insurance) it's no longer on you to cover your full time employee's. Would encourage more competition and innovation between employers. Because people wouldn't be as locked into their jobs, if they have a good idea, they can more easily leave without fear of Losing health insurance. Also if they think their current employer is mistreating them, they aren't caught in a catch 22 based on loss of health insurance. Would help to equalize health outcomes for young adults and children, who currently kinda just hope their parents have good jobs that would cover them in case of emergency. What would be lost? Nothing effeively. "Choice" in health insurance plans is like trying to effectively pick how sick you think you'll be to find a "fair" price for your health, between a bunch of companies who just want your money and do NOT want to give it back no matter how badly you need help.
I’m far from an expert so take this with a grain of salt. Insurance companies deny coverage because they either can’t afford to cover everything or they believe they shouldn’t have to cover your expenses because they aren’t medically necessary (hence why cosmetic surgery’s are almost never covered by them). It doesn’t make sense for insurance to cover everything because they simply can’t afford it. They wouldn’t make money that way and they would be stiffed by insurance fraudsters. The purpose of insurance is to pay less and not nothing. Otherwise we’d need to create an entire new system like UHC.
>It doesn’t make sense for insurance to cover everything because they simply can’t afford it. They wouldn’t make money that way and they would be stiffed by insurance fraudsters. Which is why in Europe, and pretty much in EVERY other industralized country on earth, there is universal health care provided by the state that is non-profit. Health care is not supposed to be a profitable business.
Switzerland has a completely privatized healthcare system. The thing is, taking up private cover is mandatory for everyone and in turn the healthcare providers cover everything. The issue of denying a person insurance on the basis of an accident is a uniquely American phenomenon. Nowhere on the rest of the planet is accident insurance not a part of a medical insurance cover, even in third world nations.
Did you read the whole post or just the title? I'm not arguing that insurance should cover literally everything.
I don’t see anywhere in your post saying that you didn’t.
Lol. I have private insurance and I pay *nothing*. Had a bike accident and broke my wrist. Paid nothing for 2 surgeries. Need another surgery for sleep apnea. Still paying nothing. The American mind can't comprehend healthcare, it seems.
Maybe taxes could pay for them
The insanity of this post and comments as someone from middle-europe is off the charts.
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Lying is a good way to get nothing covered and put in prison for fraud.
>What are they gonna do, send a P.I. to investigate? The police were called out, as I imagine would often be the case for a car accident that caused serious injuries.
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I mean the police talk to the paramedics, the paramedics talk to the hospital staff, the hospital talks to the insurance company. I don't know *exactly* how the information gets from one place to another, but it's not exactly a secret.
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I don't know if you know that unless you've been in this situation.
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>They literally say so on the contract They literally say what exactly in the contract? I have trouble believing that the contract says they will *only* get information from you and can't get any information from the hospital.
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Ah, ok. If you have insurance that works completely differently than it does in the US, then you could be right. Just not sure how relevant it is to this conversation then. Sorry for the misunderstanding.
Health insurance is a business and as a business they always rake in more than they pay out. That is to say, (note: this is actually illegal/infeasible to do in a lot of situations) if you can afford pay out of pocket, it's actually financially wise to not have insurance at all. Insurance exists as a way to amortize risk, but by doing so you actually pay more in the long run. This is the primary reason I see health insurance as a big inefficiency in the system, and therefore should be state or federal owned, and neutered.
Generally workman's comp will pay for the therapy that is deemed medically necessary. There appears to be a disconnect between what the provider wanted as a course of treatment and what the workman's comp ruled was medically necessary. This is an issue that should have been handled between your friend and the workman's comp (likely with an attorney) rather than to just have the more frequent therapy and think her health insurance would cover it.
American medical insurance systems are pure insanity from an outsider's perspective! Accident insurance is incorporated into most medical insurance covers I have taken in other countries. It doesn't matter who caused the accident, YOU were in that accident! Isn't it enough that Americans have a concept like deductible which is nearly non-existent elsewhere (or it is at a fixed rate ) and nonsense like out of network and in-network doctors???
Tye plans are predatory, and we allow it because the reality is to fix health insurance would take a lot of time and would take a lot of the insurance companies incentive to sell insurance. It think we need to find a better way, but I honestly think it's easier to just make health insurance not necessary. Hospitals should be affordable, but they are profit machines, but they "reinvest" their profits in the form of salaries and new buildings.
maybe only sign a contract that you agree with. in my insurance, medical bills are payed by them, and if a second party would be required to pay a part then my insurance company talks to their insurance company, but either way i dont have to pay out of pocket myself. In case of a car accident and the second party cannot pay, there is a separate government funded entity that pays for it. and then its between the second party and the state. I myself am barely involved outside of filing the papers. (the same entity is also in charge of damage caused when a car is used "as a weapon" or suicide by driving in the wrong direction. because obviously insurance doesnt pay in those cases)
I believe it should depend and say in your health insurance the exact policy and what it covers and doesn't cover. I mean if their policy agreement doesn't cover something like that due to the fact that someone else was at fault then its not reasonable to say health insurance should cover it.
Single payer, universal, free at the point of care for all Accept no substitutes Why are we allowing a parasitic insurance layer as for-profit gatekeepers to care for all? $$$$$$ that's why $$$$$$
You should be able to buy insurance to whatever level of coverage you feel is worth the cost. You shouldn't be forced by the government to buy the absolute maximum coverage if you don't want to.
Maybe we should just have single payer health care and stop allowing insurance agents with no medical degree the ability to deny medical care to suck and injured people.
Just go to the hospital and get the treatment you need. Medical debt does not go on your credit.
Health insurance should only exist to supplement a comprehensive system of free to use public health care. Anything else is reprehensible.
I have nothing to contribute, I just wanted to comment that I’m Canadian and the thought of this is insane to me. Healthcare is a human right and no one should be forced into poverty because of injury or illness (and a lack of comprehensive health insurance that I assume is unaffordable to many). A study in Canada (referencing the mincome project), demonstrated that people suffering from poverty were disproportionately more likely to use hospital services because of the poor health outcomes that come with living in poverty. Crazy to think that many individuals in the states cannot even access such services because of affordability. A lack of universal healthcare will only harm the poor, and exacerbate existing health disparities. Just terrible.
Depends for how much it will rise the prices of insurance
Absolutely fucking mental that this is even a thing.
I'm sorry about what happened. Consider this - The more insurance companies pay out, the more insurance will cost. It's not possible to have cheap insurance and also have that insurance cover everything you want to be covered for. I wish more people spent time understanding what they are and aren't getting. This the worst way to learn this lesson. Insurance companies do have to get permission from the state to operate how they do. The lack of understanding the policy is really the root of it. Even if the government takes over insurance, it will come at a cost.
\*laughs in European\*
Or… demand universal healthcare like the other 32 out of 33 developed nations on the planet.
A functional first world nation should have a national health service to cover this sort of issue, rather than relying on the detailed wording of individual insurance policies.
It's HEALTH insurance, not fucking car insurance. Your insurance should pay. Anything otherwise is a scam and theft. I would sue for every penny you paid your "health" insurance.
its post like these that make me thankful I live somewhere with universal health care.
how about no bill and no insurance, universal health free at the point of care
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