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POLICY: Self-employed, and going it alone

If you want to understand why an individual mandate in a community rated state won’t work without both significant reforms to the insurance systems and a whole new range of taxes and subsidies, read this experience of a healthy mid-20s writer in New Jersey who’s self-employed, and going it alone. Of course if she was living in California, she’d be able to buy a much cheaper policy–but then no sick person in California can get individual insurance.

Perhaps enough of this and it will dawn on people that we need a single pool funded by ability to pay….

On a side-note, any idiot can see that a single pool guaranteed universal system would help solo freelancers and small business people. And of course the NFIB leads the charge against it.

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Matthew HolttcoyoteBretforHealthBrian Klepper Recent comment authors
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Matthew Holt
Guest

tcoytoe is right. I emailed her and told her to move to California. But of course if we went the Shaddegg way then no sick person in any state could get coverage…
which always leads back to us needing a dedicated single risk pool funded on ability to pay

tcoyote
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tcoyote

The scandal is that Self-Employed’s premium ought to be about $30 a month for the coverage she’s getting. How we get from a reasonable, actuarially determined rate for a healthy 27 year old to $450 a month is a tale of politics. You can bet that mandated coverages, guaranteed issue, community rating, the insurance broker community and state insurance regulators all play a role. She is a textbook case of someone who would benefit by a fifty state, Internet based health insurance market. Her story is worth further exploration. . . Peter is probably right- she’s probably better off self-insuring,… Read more »

Peter
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Peter

Bret, I hope you realize that you probably paid about 4 times the “insurance charged” rate for that cat scan since you were in effect paying cash and would be considered without insurance at that point. Another aspect to this dishonest system we call American Healthcare.
Your Total liability is $13k + PER YEAR, not per incident year to year. I hope you and your family never really get seriously sick for a long time. Having health insurance does not take the worry out of getting sick.

Bret
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Bret

Peter,
Just to clarify my current policy (Me + Spouse + 1):
Annual Deductible: $3,600
Out-Of-Pocket Maximum: $10,000
Coverage (after deductible): 90%
Premium: ~$250/mo
So I guess my total liability is ($250*12) + $10,000
Or $13k. Almost 1/3rd what I pay in taxes!
For $3k a year, I’m hedging my bet against catastrophe. Last year my wife had serious food poisoning and the cat scan cost us a fortune. Had it been more serious than food poisoning I would have easily gone over the Out Of Pocket Maximum.
Side note: I just realized that BC/BS “out-of-pocket” maximums do not include the deductible, but UHC “out-of-pocket” maximums do.

Peter
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Peter

Brian, if I were to be hit by a truck I could sue the other party for my medical bills. Why don’t you calculate what my insurance premium would be if I ONLY carried, “Hit by Truck” Insurance, I’ll bet it’s so low because of the probability that I’d sure buy it if I could get it. But we all know that we’re paying way more for health premiums than just for those improbable occurances. Do you think “Self-Employed” is paying premiums even with those high deductibles based on “Hit-by-Truck”, or all the other stuff she will never get given… Read more »

Bret
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Bret

So my first response to this post is that I agree with Peter. I didn’t opt out of the game all together, but it wasn’t hard for me to find catastrophic insurance for my family that was well within my budget, especially considering I can now put money away into an HSA and avoid taxes. Now we pay for office visits and prescription drugs, but so what? $100 to visit the doctor or two tanks of gas? My out of pocket is maxed out at around $10k I guess, but in a few years I should have that amount securely… Read more »

forHealth
Guest

I too quit playing the insurance game. There is very little ROI when paying premiums. There are fights to cover even promised services. I now let my money work for me by investing it in a high interest savings account. Sure things happen, but I have much less stress now that I no longer have to deal with the insurance company.

Brian Klepper
Guest

Let’s hope you don’t get hit by a truck, Peter. An unexpected event that doesn’t permit planning would wipe most of us out financially.

Peter
Guest
Peter

Self-Employed should re-assess her need for insurance. Think what she could do with those insurance premiums if they were put to keeping herself healthy and put into her own bank as a separate health account for future use. She’d be able to enjoy playing soccer and pay for that broken leg as well. If she can really afford a $10k deductible plus over $5k in yearly premiums, what’s she trying to protect against with insurance? Also think about that $10,000 deductible. That’s PER YEAR, not per incident. So if she gets sick, say at the end of a year, she’d… Read more »