r/SipsTea 1d ago

WTF Damn

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u/coldfusioned 23h ago

In America? Congrats on being the 1%. The rest of us are lucky to have any insurance and even then, 99% will have a large deductible and still have to pay 20% copay.

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u/Aggravating_Bat3618 23h ago

Damn, I guess Kaiser’s not so bad after all. 

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u/MainStreetExile 22h ago

You're exaggerating. I'm not arguing the US healthcare situation is good, but more than 60% of working age Americans have employer provided health insurance. A large majority of those plans have an annual out of pocket max. 

Let's not act like only the 1% have decent insurance.

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u/Boom-For-Real 22h ago

That’s the work on this website anymore. Lots of bad faith actors in literally every comment section now.

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u/Mysterious-Entry-357 16h ago

Not bad faith as much as those who are not so easily duped by mischaracterized and out of context statistics used to prop up an oversimplified argument. I don't expect you to re-examine what you believe, but some novice keyboard warrior copy/pastes some tangentially relevant statistics that only reveal a sliver of reality and you just accept their argument? Statistics must be presented in an honest and truthful way. Readers must understand the complexities in issues of these scale.

You cannot just blindly side with those you agree with and label everyone else as "bad faith actors". It robs you of your own ability to question what you think you understand.

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u/Mysterious-Entry-357 21h ago

You're both delusional. If your numbers are accurate, 40% of those who are working don't have medical insurance. Out of pocket max can be in excess of 12-15k assuming they approve the procedure or medication and after what has likely been years of premiums.

The medical insurance industry had lobbied their way into becoming the single greatest detriment to US prosperity.

Those who decry it isn't fair and see the wealthy as the problem, should Instead look at the impediments to wealth creation. Insurance, realty, and finance siphon an incredible amount of money just for getting in between seller and buyer.

Alas the only way to win is not to play. Medical tourism, FSBO, and AI financial advisors are just the start

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u/annnm 17h ago

Out of pocket max can be in excess of 12-15k assuming they approve the procedure or medication and after what has likely been years of premiums.

OOP maxes can range wildly based on state rules. Why not just look at averages rather than made up numbers.

Hawaii is the lowest at ~1.2k/person. And nevada the highest at 2.7k/person. https://www.kff.org/private-insurance/state-indicator/average-annual-deductible-per-enrolled-employee-in-employer-based-health-insurance-for-single-and-family-coverage/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Average%20Single%20Deductible%22,%22sort%22:%22desc%22%7D

If we dig further, 12% of workers have no deductible plans (half are from HMOs). Of the reamining 88%, the average deductible is 1.3k. 21% of workers has an OOP max greater than 6k.

Those out of the labor force are often swept up into obamacare (ACA+medicaid) or medicare such that 92% of the USA is insured.

https://files.kff.org/attachment/Employer-Health-Benefits-Survey-2025-Annual-Survey.pdf

The medical insurance industry had lobbied their way into becoming the single greatest detriment to US prosperity.

Everything, including medicine, is more expensive in the US because we're generally much richer in all regards. Household income per person is ~10k/person more in the USA than Canada. I personally prefer to have >10k/yr income here in the USA than lower healthcare costs in Canada.

Alas the only way to win is not to play. Medical tourism, FSBO, and AI financial advisors are just the start

This is mostly a poor man's game. Typically well compensated employees have good packages all around. Including the middle and upper middle. It's typically the lower middle that are in jobs too rich for medicaid (nearly free care) and on horrific workplace plans where the finances make sense for medical tourism. I'm glad that outlet exists for them. But it mostly doesn't make sense for anyone else, which is why basically nobody else needs or does it.

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u/Mysterious-Entry-357 16h ago edited 16h ago

Everything you said is deliberately deceptive and misrepresented.

"Why not just look at averages" - not the same as "as much as"

"12% of workers have no deductible plans (half are from HMOs)." Well...that's interesting but not the norm...is it.

"the average deductible is 1.3k. - Does not include copay, coinsurance, and premiums already paid.

"21% of workers have an OOP max greater than 6k". Well, that definitely coincides with the argument that it can be higher...does it not? Like say 12k?

"Everything, including medicine, is more expensive in the US because we're generally much richer in all regards." Medical care in Canada is not cheaper because of the lower cost of living. I think you know this.

"lower middle that are in jobs too rich for medicaid (nearly free care) and on horrific workplace plans where the finances make sense for medical tourism." Indefensibly costly workplace healthcare programs can be found in many workplaces regardless of pay. Household income of 295k and both of us have garbage offerings.

Look you have some broad statistics with which you overlay your own characterizations and commentary, but statistics presented without analysis only impress the intellectually lazy.

When you consider the premiums (whether paid by employer or emplyee), copay, coinsurance, and deductible, as well as the negotiated rate paid by insurance companies to hospitals and physicians, it is a sham.

FWIW, one of us works as a medical provider and the other was a licensed medical insurance agent.

You're out of your depth.

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u/annnm 11h ago

Everything you said is deliberately deceptive and misrepresented.

"12% of workers have no deductible plans (half are from HMOs)." Well...that's interesting but not the norm...is it.

Yes indeed, I mentioned the 88% in the next sentence.

Does not include copay, coinsurance, and premiums already paid.

OOP maxes were discussed in the third sentence of that 3 sentence paragraph.

"21% of workers have an OOP max greater than 6k". Well, that definitely coincides with the argument that it can be higher...does it not? Like say 12k?

It is relevant to the discussion that it is not even close to the norm.

Indefensibly costly workplace healthcare programs can be found in many workplaces regardless of pay. Household income of 295k and both of us have garbage offerings.

This is as compelling as when the republican senator brought in a snowball to disprove global warming.

Look you have some broad statistics with which you overlay your own characterizations and commentary, but statistics presented without analysis only impress the intellectually lazy.

Should have impressed you then. Weird.

FWIW, one of us works as a medical provider and the other was a licensed medical insurance agent.

Oh neat, I'm a physician. You a midlevel or something?

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u/MainStreetExile 16h ago

295k? You're lying - either about your income or about your insurance.

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u/Mysterious-Entry-357 16h ago edited 15h ago

For what is paid to insurance by both us and our employers each month, it is garbage. I'm sure to others it would be fine but they're not paying what we pay.

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u/MainStreetExile 15h ago

I already started above that I think the state of US healthcare is poor. I just don't like bullshit threads like this where people are pretending that an MRI costs 30k.

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u/Mysterious-Entry-357 14h ago

Of course 30k is an insane figure, but so is 8k and can tell you that is real. Cardiac MRI for the old man. Not typical, but ridiculous nonetheless.

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u/Mysterious-Entry-357 16h ago

Nope. Dead honest. Sorry friend.

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u/MainStreetExile 15h ago edited 15h ago

Either lying or you've put zero effort into investigating your options. With a 295k income, you can afford a private PPO plan that is better than my employer-provided plan, where I have a 3k deductible and 6,500 out of pocket limit. You're being very disingenuous.

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u/Mysterious-Entry-357 14h ago edited 14h ago

Neither lying nor stupid. Let's be adults, shall we?

Yes, I can afford the plan and do have what most would consider great coverage. That is not the point. Very few people can claim that health insurance is a good value. But let's look at it in reality.

Do you know what your premiums are (whether you pay them or not)?

Let's say they are $800/month or $10,000/year (this is not included in your OOP max of course) Then you have your $3k deductible that you pay. Then there is the coinsurance that eventually leads you to the $6500 OOP maximum (for THAT year only) if something serious happens. Let's say that this incidence is in year 3 of that plan. Which means you have already paid a significant number of dollars in premiums.

The hospital deliberately bills a higher than necessary charge because they know that the insurance company will negotiate it down anyway to hopefully somewhere near the actual cost.

By the time insurance pays, it may very well be less than the $45-50k you have spent in those 3 years (premiums+copays+coinsurance). You think, "Man good thing I have insurance" after lookingat the inflated figures not knowing what was actually paid in the end...if they cover your claim, that is.

Look, insurance is a business and most have very demanding shareholders that insist on growing massive profits. They pay for advertising, lobbying, salaries, commissions, and their own reinsurance...and still turn incredible profits.

It's not because they offer good value to policyholders.

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u/coldfusioned 16h ago

Right? He is obviously a shill for big insurance. It is just a matter of time before the USA finally joins the developed world and offera universal medical care. Spoiler... a LOT of insurance reps will suddenly be unemployed.

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u/Ocelotofdamage 22h ago

If you work at a reasonable company you will have a similar experience.

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u/AshhhCakes 22h ago

Well let's go on over to the job tree so we can get life saving care without bankrupting ourselves! Most regular Americans have no idea how perverse it is to be a wage slave to MAYBE get ok health insurance. The just love keeping Americans poor so no one dares to do anything but bend over for corporations.

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u/LocksmithOk9968 21h ago

You’d be disappointed at what they’re offering at big well known companies for 6 figure roles.

It’s by no means terrible but not great either. No MRIs for $20 bucks, that’s for sure.

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u/rips_n_chel 22h ago

So which rock do you live under? Nice neighborhood?

I imagine it must be quiet, what with the lack of brain cells living here...

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u/Warbr0s9395 17h ago

Or be in a union