Is this family crazy to not buy health insurance?

[mdcrim]

A quick story re: health insurance (my story).

Part one:

Uninsured childless couple in mid-20's. She (me) had been experiencing what was diagnosed as severe heartburn for 2+ yrs. Job with insurance started in June, by September, ended up in hospital with pancreatitis related to gallstones that were blocking bile duct. After 5 days in intensive care, finally well enough for gallbladder surgery. Cost to patient-roughly $200. Cost to health insurance- $10's of thousands (exact amount unknown, but not cheap).

Part two:

Couple in mid-30's, one child, good health insurance. Both parents very healthy, yearly physicals, etc. He (husband) gets blurry spot in left eye that starts intermittently but then becomes permanent. Eye doctor finds no problem but MRI reveals pituitary tumor, requiring surgery (and 5 days in intensive care). Surgery is not effective and part of tumor remains. Tumor regrows, threatening carotid artory. Gamma Knife radiation is done and tumor is stable (no more growth, for now). For the first two years, it appeared as though he was also going to be required to have a lifetime of hormone replacing medications (thank godness for low medication co-pays). In the meantime, husband is diagnosed with a completely unrelated Cerebral Spinal Fluid leak (hereditary defect), resulting in surgery to fix a hole in the skull and 7 days in intensive care). Total cost to patients, a few hundred bucks, total to insurance, hundreds of thousands of dollars. These issues occurred over an 18 month period of time with no prior problems or issues.

Had we not had insurance, we would still be recovering from the bankruptcy we would have been forced to file after all of our other resources were tapped out...

This is my argument for insurance, no matter the cost. FYI- we still use the same insurance company, even though their rates continue to increase more than "comparable" insurance. Because we know they will pay, without question or issue. And, more importantly, you never know what will happen.

[PrincessPerky]

How often do they go to the dr? I don't have health insurance, nor does my husband, we visit the urgent care about once a year, maybe twice (haven't done so yet this winter) would cost far more to insure us than it does for two visits a year.

I see a midwife for my pregnancies, and do not go to yearly checkups, not saying it is right, just saying we don't, so I wouldn't know if anything was wrong to have a big bill to have to pay for it.

In the OP situation I would prolly skip till jobs are secure again, if they tend to skip drs already, if not I would get insurance.

Insurance was on the todo list before the job loss...but until it is back, eh. Not like I have been to a dr in.....7 years for anything other than a baby or a respiratory infection.

This is not a skip your insurance argument, just opinion from the other side.

[maat55]

How often do they go to the dr? I don't have health insurance, nor does my husband, we visit the urgent care about once a year, maybe twice (haven't done so yet this winter) would cost far more to insure us than it does for two visits a year.

I see a midwife for my pregnancies, and do not go to yearly checkups, not saying it is right, just saying we don't, so I wouldn't know if anything was wrong to have a big bill to have to pay for it.

In the OP situation I would prolly skip till jobs are secure again, if they tend to skip drs already, if not I would get insurance.

Insurance was on the todo list before the job loss...but until it is back, eh. Not like I have been to a dr in.....7 years for anything other than a baby or a respiratory infection.

This is not a skip your insurance argument, just opinion from the other side.

What would you do if there were no allowed BK's on medical bills?

It is a fact that this world has managed to populate without modern healthcare. The mortatlity rate was higher, but that was how it was.

IMO, there is nothing wrong with choosing less healthcare, or cheaper means of healthcare. But with it should come the responsibility of the decision.

IMO, if healthcare were treated like buying a TV it would be much more affordable for all. The rich would get the best and so down the line. At the end of the day, Scarcity decides how much will be available, for the masses to get the most, the free market has to be allowed to work.

You should have the freedom to choose as you have, but you should also be held to that decision in however your circumstance plays out.

There is always charity and compromise between the provider and patient in the free market, to minimize the lack of healthcare for the truly needy.

[Goldy1]

It's not even as simple as choosing to buy it and voila! either. There are pre existing conditions excluded for 180 days and other issues. I read some horror stories in newsweek about people on the individual market getting insurance canceled after a claim b/c they search for a slight ommision on the form which requires you to detail every time you sneezed or moved in any dr's office the past decade.
What if one can't detail each and every time and diagnous etc and test result done at each visit. Not everyone keeps these records(I do, but I can't guarantee I am not missing one or can explain each diagnosis or if I have it)

[disneysteve]

How often do they go to the dr? I don't have health insurance, nor does my husband, we visit the urgent care about once a year, maybe twice (haven't done so yet this winter) would cost far more to insure us than it does for two visits a year.

You are completely missing the point of insurance. It isn't to cover the everyday stuff. It is to cover the catastrophic stuff. I bet you have auto insurance, right. Why? It doesn't cover oil changes, air filters or new tires, but it sure comes in handy when some idiot on a cell phone plows into you or you come out to an empty parking space after your car gets stolen.

Medical insurance is the same way. It isn't for when you have a stomach virus or strep throat or a splinter in your finger. It is for when you slip on the steps and break a leg or get a kidney stone or appendicitis or find a lump in your breast and need surgery. One short hospital stay with a basic operation can easily run 25K or more. Add in any complications and you could be looking at 100K or more. That's what insurance is for.

[jasonnoguchi]

Seriously, I don't know how they got 60k in saving in their extremely dire condition but if they do have that money, they should get health insurance as a family like this can never afford emergency medical expenses. This is probably the best leverage they can get for their money now. And I agree with Disney that they should do it even if it cuts down or eats into their tremendous savings which will barely be enough if an emergency strikes.

To me, insurance is an extremely powerful form of leverage and no matter how rich you are, insurance is compulsory.

[Goldy1]

When you consider the big picture of thier financial situation, it's not "extremely dire" They have low expenses and could get a low paying job and get by without tapping much into savings, and move up again.

not to be condescending, but what is so hard to understand about someone aquiring assets through working almost 2 decades in a well paid job being DINKS a long time, getting laid off, and not likely to return to this income due to the job being in the auto field? Your wealth is more than current income.

Dire would be cc debt, forclosure looming, no finance skills, no retirement. etc.
This couple is almost mortgage free and was frugal and saved.

You can have assets and be savings and get laid off in a heartbeat.

No one goes broke from strep throat. Like Steve said, it's the big stuff.

[disneysteve]

not likely to return to this income due to the job being in the auto field?

Is this couple in Michigan? If so, have they considered selling that nearly paid-for house and moving? The job market is trashed in that area and isn't coming back anytime soon, if ever. They've gone from dual income to no income and he is looking to take a barely above minimum wage job. How long can they last like that?

[Scanner]

Reminds me of patients who come in and whine they don't have health insurance, can't afford it, but are sitting on 60K in savings.

Absolutely they should have to pony up for their healthcare, just as if they were driving a car. The wife or husband gets catastrophically ill and the taxpayor has to foot the bill after the 60K is depleted as the hospital gets bailed out.

This is why this bill in Washington is such a good idea but the GOP is running obstructionist on it.

[wnlbutterfly]

My two cents is GET the health coverage. No one expects health issues. And with children you are looking at all the common illnesses, not to mention the possible broken bone and other stuff that happens. My DD has had stitches on the forehead from bouncing on Granny's bed, stitches because she tripped and fell in the house on a footstool, ER visit because she got Easter grass in her eye and I couldn't get it out, stitches on the knee due to bike accident and of course the broken glass (as a teenager) that required another trip and stitches (that was $1,000 right there). One son put a lego up his nose (to the point you couldn't see it) E/R trip, one fell out of a van while we were packing for a trip and had a HUGE bump. DH had a car accident and was transported from the scene to the ER. Two of my kids have asthma.

Then there is the rare situation of a child with a brain tumor. That happened with our oldest son, at 16 yr old. Granted, this isn't common, but it DOES happen. If we hadn't had insurance we would have been bankrupt.

You can't base the decision on health at the moment right now....accidents happen, the unspeakable happens, basically LIFE happens.

I have a cousin's daughter broke her arm and the local hospital didn't set it right, they ended up having to go to the city hospital and have surgery done. Total cost they are now trying to pay is $16,000.

[PrincessPerky]

If insurance is for catastrophic issues, why don't they offer insurance as such? I did the research for insurance last year (like I said it was on the todo list) I found a mess of copays and covered issues, but had no way of sorting out which was actual 'insurance' as opposed to a dr visit plan.

Like I said I don't go to the dr, I don't need insurance to cover for my one respiratory infection a year (this year I visited an acupuncturist early in allergy season, no infection pretty nifty).

I would have no problem buying coverage for real problems, anyone else want to explain to me which one that is? I was very close to deciphering the complicated tables and figuring out how to get insurance, or taking a stab in the dark and praying it was good enough, then my husband lost his job, so I tabled the issue. (my kids btw have typical insurance, because I couldn't find real insurance)

Seriously it isn't that easy, remember I haven't had a work option in years, those are simple choose the luxury, the midline, or the cheap plan and you are done. Independently I have to look at a ton of options that make no sense, and none really offer what I want (Cause when they try to sell them, they are trying to sell to folk who visit drs and like low co-pays)

Health insurance is a huge mess, if it were like Auto it would make sense and be easy to buy a 'cheap plan', not to mention folk with healthy lifestyles would get cheaper coverage. (just like 'good drivers' discount on auto) But no we use health insurance to pay for every sniffle and 'oil change'. Making the cost astronomical, and for folk who prefer to deal with sniffles on their own, it is a very hard pill to swallow.

[Like2Plan]

PrincessPerky,

Maybe a Health Savings Account combined with a qualifying high-deductible health insurance plan might meet your needs?

[disneysteve]

L2P beat me to it. What you are describing is an HDHP-HSA. You pay out of pocket for most minor stuff but you get to do so with pre-tax dollars. If something serious happens, once you've met your deductible, the insurance kicks in. Sounds like that would be perfect for you.

The problem, as you've alluded to, is that most people don't think like you. Most Americans want insurance that pays for every sniffle and sneeze with the lowest possible out of pocket cost. When most people are considering their options at work, they pick the one with the lowest premium and lowest copays. That's all they care about. Personally, I tend to pick the plan with the highest deductible, highest copays and worst drug plan.

[LivingAlmostLarge]

PP, just coming to offer a different perspective as well. You should definitely get a HDHP-HSA.

But personally i just delivered my first baby 1:51 am this morning and am still up at 11 pm, too excited maybe to sleep.

She was almost to term 36 weeks. But there were complications and I ended up not having natural childbirth (got an epidural when I threw up and fainted at 6 cm), and her being vaccumed out because of the same fever that induced early labor, also caused her to go into distress and she came out with a 101 fever.

So she and I are on antibiotics. What do you think this delivery ended up costing? A lot, and probably a lot more than I would have predicted, considering, I am 30, had an easy pregnany, worked out, not overweight, and in excellent shape! No morning sickness, I walked over 3 miles/day, etc.

I caught a cold that ended up spiking Saturday night to early sunday and it went awry.

Oh and she was super big for being 36 weeks, 7 lbs and 19.5 inches. Growing very well!

I don't think I would reccomend any women go pay OOP to deliver a baby. One complication and you'd be probably facing BK due to medical bills. Hence why medical for child bearing women is expensive.

[Mike75]

Congrats!!! I hope your baby grows up to be healthy and beautiful.

About this family not having health insurance, there are many families in this country who can't afford health insurance. So, they are not alone, The recession has raised this number to catastrophic proportions. The government must come up with their healthcare plan as soon as possible.

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