Posted by brandonb 11/4/2025
Assuming you have business income to pay for insurance.
I don't think my current gig is so bad about that, but ironically I feel less of a compulsion to leave my current gig and start my own thing because I actually like this job.
Not in California though. One of the (many) reasons we live here.
It's also arguably one of the reasons that the innovation ecosystem that is here exists, and persists.
For reasons that I've never fully understood, I have had a strong distaste towards California my entire life, else I would have moved there by now. Probably my inner hipster my necessity to feel like I'm doing things different.
Btw-- make sure to double the MOOP since catastrophes can easily straddle the end of one 12-month period and the beginning of the next 12-month period.
If you are saying you only have $5k saved then your plan effectively reduces potential bankruptcy-level of healthcare debt down to a manageable level of healthcare debt.
If you have a high-deductible healthcare plan (HDHP) through an employer, look into setting up regular contributions from your paycheck into a health savings account (HSA). You can use an HSA to build a healthcare emergency fund (and later invest those saving like you would in a regular retirement account, which is what it turns into when you hit retirement age).
It's an amount that would be somewhat disruptive but would not be bankrupting. That's exactly what you want insurance for. People misunderstand insurance when it comes to health care, they think they should never have to pay out of pocket for anything, but that isn't how insurance works for anything else. Insurance is protection from catastrophe, not something that makes routine, predictable expenses go away.
And yes I have an HSA, it is required for HDHP plans. And I make close to the max contribution every year. I've been at that long enough that I have several multiples of my max OOP saved.
This is pretty much the Republican plan for healthcare.
"Expanding Access to Health Insurance: Consumers to Gain Access to “Catastrophic” Health Insurance Plans in 2026 Plan Year"
https://www.cms.gov/newsroom/fact-sheets/expanding-access-he...
* So sorry, you can't have this one anymore because part B deductibles are no longer covered due to the neoliberal MACRA 2015 that doesn't care about costs borne by the poorest Medicare recipients.
Nowhere is absolutely perfect but it's much easier to navigate, and many developed countries have very good care for emergencies and/or life-threatening ailments. It might suck to investigate something chronic but non-life threatening, it won't stress you if you think you are having a stroke and need to call an ambulance.
In Sweden it's about 2x higher. Of course, they're still experts, so it's somewhat expensive, but not like in the US.
If you want to act as both insurer and provider, then you should have to be a non-profit and have thorough performance monitoring in place to ensure you're passing what's possible back to consumers.
Each year they pay me $1,000 (in the form of HSA deposits, which I can invest) to do basic things like get a checkup, get a flu shot, and get a blood test. I sync my wear-able data and they pay me $1-2 each time I exercise or get enough sleep.
It's great!
I wonder if the data is sold off and if so whether it's properly anonymized...
Health insurers are like Congressmen. Most people hate the institution, but are satisfied with their own insurer. https://www.kff.org/affordable-care-act/kff-survey-of-consum...
It's not acceptable to comment like this on HN, no matter who it is or what it's in reply to. The guidelines ask us to "assume good faith", "edit out swipes" and "be kind". That applies equally to all of us and in replies to anyone else on HN. If someone posts a comment that's egregious, just flag it, don't abuse the commenter, as it just makes the place worse for everyone.
> usually post racism
If there's evidence of this you should include links in your comment or email us so we can investigate and take action. Rayiner is of South Asian heritage and was born in Asia, which – of course – doesn't preclude racism, but it does at least require us to think twice before presuming his views to come from a place of Western-born white privilege.
> corporate bootlicking
This is an ideologically-charged epithet that’s invoked specifically to be profoundly demeaning. The comment you replied to was simply sharing of his personal experience as a customer of a health insurer. Anyone should be able to do this without being belittled in this way. (Besides that it’s inaccurate; I see Rayiner criticizing corporations often.)
As we've said before, Rayiner takes a lot of arrows on HN because he's about the only well-known participant we have who is notable for regularly espousing conservative/libertarian positions. He also contributes plenty of valuable perspectives from his personal experience as an immigrant, a lawyer, and a compiler-hacker. He's subject to the guidelines like anyone else, and his positions are frequently debated, refuted and flagged by other community members, which is fine. But HN would be the poorer without him.
In this case you're the one who has been escalatory and hostile, and you need to take responsibility for your own conduct before pointing the finger at others.
For example, my wife got knee surgery recently, and the doctor recommended we rent a CPM machine to help her knee avoid atrophying. Renting the machine is $200 a week. Insurance said it was "optional" and refused to cover any of it. We ended up buying a used one on eBay for about $900, which is a lot but not insurmountable for us.
It kind of annoys me though, because not all their clients are yuppie software people who have disposable income. A lot of people can't afford to rent a machine for $200 a week or buy one for $900 on eBay, but they do make it much easier for the leg to heal better. Isn't "stuff that most people can't afford but would help with healing" the stated purpose for health insurance? It seems more than a little unfair that my wife's leg is more likely to heal better purely because she's married to a software engineer.
I really have no fucking idea what the difference between the cheap and expensive UHC plans. It sure seems like I'm paying many thousands of dollars more for medical stuff than I was for equivalent services with Anthem. Oh, well, at least my premiums are higher too, so that's fun.
Hopefully obviously I don't advise shooting a CEO for several reasons (both ethical and legal), but I have to say that I was unable to cry many tears when I heard it happened.
I thought the operative term was "medically necessary"? "would help with healing" can theoretically cover everything from protein shakes for knee injuries, to iPads to help with stroke recovery. A CPM machine is on the far end of this, closer to "medically necessary" than the other examples, but you have to draw the line somewhere, so some reasonable-but-theoretically-optional equipment gets excluded.
There are plenty of things that aren't strictly "necessary" but are still provided by insurance. My wife's painkiller medication isn't strictly necessary, she wouldn't die without it and the leg would probably heal the same way, but they covered that because obviously they should cover that. I feel like a piece of medical equipment like a CPM machine is more necessary than painkillers.
My guess was that a CPM might fall into this category (I did PhD research in bio mechanics in MatSci). So I googled it and it returned a quote:
> Do doctors still use CPM machines? > The machines are no longer widely used because of the multiple studies that found CPM following knee replacement surgery has minimal benefits. However, some surgeons still recommend CPM following knee surgery when the limited pros outweigh the cons in a particular case. (1)
From an insurers perspective it makes sense not to cover a marginally useful piece of equipment. The better use of resources would probably be covering PT where there's movement and weight on the joint.
1: https://www.verywellhealth.com/do-i-need-a-cpm-following-kne...
Even if its benefits are marginal, they’re probably still more tangible than acupuncture and chiropractic, both of which are apparently covered by my insurance, and the CPM machine probably doesn’t cause a stroke like chiropractic does.
You are confusing "health insurance" with a "system that guarantees healthcare as a human-right". Those are different things.
The purpose of health insurance is:
- To constrain healthcare coverage to the minimum allowed by law or the plan contract, therefore maximizing profit margins.
- To provide a shared risk coverage pool to pay for treatment for catastrophic health events that are unforeseen.
- To provide a product to be used as leverage by employers over employees as part of the "benefits" of a compensation package.
Healthcare as a human-right doesn't exist in the United States unless a health situation has gotten so bad that you end up in the emergency room, which is then legally required to provide you emergency healthcare.
One, it was a middle manager with a CEO title.
Two, genuine question, can you point out how UnitedHealth’s profits relative to peers changed after the shooting versus before?
Your company (for self-funded plans) actually decides what’s covered and what isn’t, sets copays and deductibles, and ultimately saves or spends money on healthcare costs. UHC’s role is to apply those rules, maintain the provider network, and handle the billing and customer service.
If your company offers insurance, there is someone who can tell the "insurance company" to cover the service they are not covering. Usually the HR Benefits Administrator, or 'plan sponsor'. And they do it all the time! If you have a sad story and the budget is ok for the quarter, they will help! If you are a company officer, you can also have whatever your company can afford.
If it's a 'fully insured' group plan then the insurance company is technically in charge, but your company can do an Employer-paid exception (aka carve-out reimbursement) to cover something thats getting rejected. They also have the option to purchase add-on policies to add coverage for upper class stuff like fertility treatments, weight loss drugs, or gender-affirming care.
Doctors charge massively high prices, which is why insurance bills are high. Doctors have the most powerful trade union on the planet and strictly limit residencies, thus limiting new doctor supply and keeping prices super high.
Shrink the federal government and its overbearing regulations in healthcare and allow many more people to go through residency to become doctors.
Privatized health care need not be so bad. Germany has privatized health care, but it's pretty much fine, at least for patients. It's regulated to the moon and back, but afaict so is the US system, just with very different goals. The ACA feels a bit like the beginnings of a German-style system.
That's literally a political ideology.
The answer to problems like this isn't to pretend politics is some kind of abstract system imposed by higher-order beings, its to use political power to fix it.
Give yourself more credit! You just stated the answer above.
Capitalism pays for our healthcare.
The problem is that Healthcare has an infinite hunger for resources - there is always more that could be spent - and it is always morally correct to spend more (people's lives have high priority).
There needs to be some manner of allocating limited resources between different people with different needs.
Every country seems to find different ways to deal with the fundamental friction of healthcare (unlimited demand and limited resources).
Unfortunately voters don't like the reality of limitations.
Things you can get in 72 hours anywhere near a decently sized American city such as an MRI scan can take months in Canada.
We don’t have evidence we live in sufficient abundance to guarantee this sustainably even in rich countries. Particularly when bare necessities are decried as cruelty and so cost creep comes to pass.
What we can do: free basic nutrition for all, free prenatal and neonatal care, free preventative medicine and annual check-ups, free access to generics where medically necessary, and a fixed amount of water and electricity to each household. Not enough to be remotely comfortable or long lived. But enough to survive.
Who votes for higher taxes on themselves?
People who don't want to have to live amidst poverty. Or vote alongside folks who are struggling. In summary, good people.
Even if you're selfish (and a lot of people are community spirited), the same people who as shareholders vote for the company to grow rather than to pay out more dividends.
Ultimately I want good providers to be paid well and poor providers to struggle. That is a good system. We don't have that. We MUST recouple healthcare and capitalistic incentives.
Given how much cheaper things like body shop repairs are if you do not have insurance, is it really clear that Geico does not cause car repairs to be expensive?
And for that matter, get emergency health care without insurance and then fight the cost to get a massive reduction, and you'll wonder whether it actually is UHC and their ilk that help make healthcare unaffordable ...
Spoken as a software developer who's salaries are approaching or even surpassing doctor salaries while working on optimising "engagement" (or how to make their app the most addictive).
the costs of services are arbitrary and need to be addressed before we can realistically deal with how any insurance pool works, in the US both parties have chiseled at this over the last decade - from getting prices more transparent, to attempting to have a large scale state negotiator - and this makes the conversation more palatable in gaining consensus
not close, but it's not as partisan as people think, despite the parallel existence of entrenched interests
what doesn't have consensus is a forced insurance pool that doesn't address the costs and has no ability to negotiate those costs (yes, this is partially due to the bill being gutted and a handicapped version being the only thing that passed) a deeper review and regulation of costs is the only thing that can help reach consensus
And its not even a product we want. We dont buy it. The companies we work for do, and never have to dogfood any of it. But for the rest of us, its a take it or leave it proposition.
> doctors are a scarce and greedy bunch.
Speaking of that, an MD is the ONLY profession who is solely controlled how many can apply is controlled by Congress.
Get rid of that, and that would fix a facet.
But getting rid of insurance companies would also work a great deal. Or at least, decoupling work/med insurance would be a start.
Even going full competitive capitalism OR full socialism would be better than the garbage we have now.
Their reputation is so bad I wouldn’t be surprised if they rename the company at some point in hoping people forget that they’re United Healthcare.
Anthem BCBS and Aetna never gave as much trouble. I know they both have their scandals and it's not like I love any American health insurance company, but I definitely rank UHC lower.