Choosing not to have health insurance

[SoonerTexan]

So I swing by the city-data boards every once in awhile and this caught my eye:

I am self employed and do not have health insurance. I could take out a policy on my own if I really wanted to, but the costs are ridiculous per month. I have actually saved $100,000 in the past 10 years by not having insurance. I rarely need to see the doctor, as I have a very healthy lifestyle. I figure if something catastrophic happens like cancer or a bad car accident, both of which are statistically unlikely especially given my safe driving and healthy habits, I still will have saved in the long run since I've saved over $100k in the past 10 years from not paying health insurance. I had to get surgery one time about six years ago, but I went through a non-profit hospital that works with people without insurance, so the costs to me were very little.

Well, I just moved here to the Dallas area, and I've heard good things about Parkland hospital. If I ever need to see a doctor or go to the emergency room for something (assuming it's not a life threatening emergency), should I just go there? How does it work? I'm not a Texas resident yet, does that matter? What do I need to do to get treatment at Parkland? Does anyone have experience with it?

Also I need advice on behalf of a friend/neighbor of mine. He does not half health insurance either, and he encountered a situation a few weeks ago where he was having chest pain and trouble breathing. He went to the emergency room at the Presbyterian Hospital in Allen, only to be seen by a doctor for literally 30 seconds, told he was dehydrated, given some fluids, and sent home. He was later mailed a bill for $2980. To me, that seems exorbitant... but is that normal around here? I've known people who had their tonsils removed and didn't have insurance, and they paid less than that... He is a fairly low income individual, and cannot pay more than about $400 of it (and that would be paid out over a year!). He thinks his best option is to just ignore bill, not pay anything, and take the credit hit. Anyone have any better advice for him?

What are your thoughts on something like this--when someone can afford insurance but doesn't buy it? I actually see this a lot of photography boards--private insurance would be a BIG squeeze, so many photographers forgo it, though they probably could "afford" something.

I say at least have "catastrophic health insurance" and would even venture to say not doing so if you can afford it is irresponsible. I realize "if you can afford it" is really subjective.

I really want to hear from Scrub-Jay on this one! I realize this ties heavily into the health care debate.

Some background on Parkland--it's relatively unique in this day and age http://en.wikipedia.org/wiki/Parkland_Memorial_Hospital

[scrub-jay]

I really want to hear from Scrub-Jay on this one!

I'm stuck in a training, but I have tons to say on this later!

[HouseofWool]

I would agree that catastrophic coverage is needed at a minimum. So often I see our patients who don't have insurance needing it following an accident of some kind. By then it is too late and they will always have a pre-existing condition that will preclude them from getting decent coverage in the future.

[diggitydot]

Sorry, I think this guy is living in La La Land. Completely delusional. Many cancers and medical conditions have NOTHING to do with whatever healthy habits or safe lifestyle he may or may not have. He's the patient who is a drain on the system because he gets ZERO preventative care and when he suddenly has some sort of issue, just moseys into an ER and expects them to treat whatever he has neglected over the years. Oh, and then considers not paying the bill because he, in his infinite knowledge of medicine, believes it to be too much. Oh, excuse me -- his "friend" would do this. Whatever.

Of course his "friend's" visit was expensive. ERs aren't cheap. They're for EMERGENCIES. I bet his "friend" wouldn't be bitching if he was having a heart attack and things came out just fine. Before any tests are run, an ER visit is drastically more expensive than an office visit or even some scheduled procedures.

I'm sorry, people like that piss me off.

[scrub-jay]

I still have way more to say, but a few initial thoughts because I can't help myself:

Someone is paying for this person's healthcare coverage, there is NO free lunch. At Parkland, it looks like it is Dallas residents fund it through a special property tax. So everyone else pays for their insurance, but you who chose to save some money would prefer to have taxpayers pay for your care? This is not sustainable if everyone were to take this option - Parkland is very unique in its funding, many hospitals and EDs end up eating the cost.

Under EMTALA, EDs must stabilize patients regardless of their insurance status or ability to pay. This ensures that if you get a car crash and your wallet flies out... you are still treated and the payment is sorted out later. You can't pay? - medicare might have to step in, but hospitals/physicians eat much of the cost. This is a huge contributor to the out-of-control healthcare costs in the U.S. as hospitals have to increase prices of services for insured individuals to make up the difference of eating the costs on uninsured individuals. What do insurance companies do? Raise premiums. And...more people can't afford insurance... in a painful cycle. This dovetails into my next point - we have uninsured individuals with chronic conditions, let's say diabetes... no insurance usually means no preventative care (as that is not covered under EMTALA where you are entitled to emergency care) so they let chronic conditions become emergent and end up in the ED requiring very expensive care for a most-likely preventable issue.

My take-home message: The poster on your other board is suggesting s/he benefit in a system that will increase costs for everyone else, just to save a few dollars personally. It is NOT a sustainable plan for the future of health care and one of the arguments for the individual mandate provision of the ACA (which I am actually preparing for my "ACA info series" starting next week... so don't burst my little bubble!)

[v-girl]

That's irresponsible. Our good friends have a family of 6. All they can afford is catastrophic, but at least they have something. If they have to see the doctor, it's expensive, but they pull from savings or put it on a credit card if necessary. They certainly would not go without just because they and their kids are healthy! Duh.

[GrayMatterWife]

HAHAHAHAHAHAHAHA!!!!

That's HYSTERICAL! NEVER TAKE ADVICE RE: ANYTHING MEDICAL FROM SOMEONE WHO HAS "HEARD GOOD THINGS ABOUT PARKLAND"!!!!!

I gave birth there (and they are FAB-U for high-risk deliveries, by the way, but I assume that is not what this guy is worried about). DH trained there in medical school. This guy clearly is clueless about anything medical. It is a hell-hole in a lot of ways: financially, moral, resources...

[scrub-jay]

*hijack* It reminds me of people I've talked to who *try* to get defined as permanently disabled to get out of student loans. (Oh yes, I've heard of this as a "plan") The sense of entitlement in some people is overwhelming.

[MissCrabette]

Yeah, he's irresponsible and pissing me off.

One thing that hasn't been mentioned is that catastrophes don't always wait to happen until after you've squirreled $100k away.

I'm also sick and tired of hearing people complain about individual insurance being out of their budget. I've had it for years, and a plan with a middle-of-the-road deductible isn't as expensive as they claim.

True, that's for a single person, so the cost to a large family can be substantial, but people should think about that beforehand.

[scrub-jay]

This thread is making me excited to talk about up-and-coming provisions (for good and bad)... Get excited people, get excited.

[diggitydot]

HAHAHAHAHAHAHAHA!!!!

That's HYSTERICAL! NEVER TAKE ADVICE RE: ANYTHING MEDICAL FROM SOMEONE WHO HAS "HEARD GOOD THINGS ABOUT PARKLAND"!!!!!

I was thinking the same thing...

[PrincessFiona]

This ruffles my feathers. He is getting care st the expense of others. We know a family that was like this. Dad fell off a ladder and fractured his arm very badly. He needed surgery, had a hospital stay and had to do physical therapy.

They got insurance after that.

We didn't take out a life insurance policy for me after training. We crunched the numbers and decided to wait. We had a conversation about it a month before I was dx with lymphoma. Thanks to the issues that are related to chemi/radiation a policy for me now won't happen.

Damnit were we stupid!!!!

Kris

[GrayMatterWife]

*hijack* It reminds me of people I've talked to who *try* to get defined as permanently disabled to get out of student loans. (Oh yes, I've heard of this as a "plan") The sense of entitlement in some people is overwhelming.

Now THIS is something I know a LOT about!! In bankruptcy court, we see this all the time.

Why? Because, in general, student loans are not dischargeable in bankruptcy. That means, even if you go through the bankruptcy process, you will still owe all your student loan debt. The only exception to this is very narrow and hard to achieve: you have to show, essentially, an extreme hardship. This usually means being profoundly disabled, ill, or have had some kind of catastrophic situation.

When a debtor files a "Complaint to Determine Dischargeability as to an Education Loan," the debtor is suing for a declaratory judgment of the court that his student loan debt is dischargeable because it falls within the narrow exception.

We have seen dozens of these in the past six years. The debtor has never won. Ever.

It is actually really sad, in a lot of circumstances. Many of the debtors (most of them) who file those complaints did not go to a four-year college, but attended a vo-tech type of post-high school school. Those are for-profit organizations, and many of them really overcharge compared to what their graduates can earn upon graduation. These people who were trying to better themselves end up in bankruptcy.

[poky]

We have seen dozens of these in the past six years. The debtor has never won. Ever.

It is actually really sad, in a lot of circumstances. Many of the debtors (most of them) who file those complaints did not go to a four-year college, but attended a vo-tech type of post-high school school. Those are for-profit organizations, and many of them really overcharge compared to what their graduates can earn upon graduation. These people who were trying to better themselves end up in bankruptcy.

Not to derail the discussion (I'm looking forward to scrub-jay's teaching about the provisions of the ACA!), but a friend of mine works part-time as a teacher at an Art Institute (a large chain of for-profit colleges), and is desperately looking for a job so she can quit working there, because their focus on getting federal loan money at the expense of their students (and their faculty!) is pretty sickening. I'm not at all shocked that people coming out of those schools end up in bankruptcy.

[scrub-jay]

Now THIS is something I know a LOT about!! In bankruptcy court, we see this all the time.

Why? Because, in general, student loans are not dischargeable in bankruptcy. That means, even if you go through the bankruptcy process, you will still owe all your student loan debt. The only exception to this is very narrow and hard to achieve: you have to show, essentially, an extreme hardship. This usually means being profoundly disabled, ill, or have had some kind of catastrophic situation.

When a debtor files a "Complaint to Determine Dischargeability as to an Education Loan," the debtor is suing for a declaratory judgment of the court that his student loan debt is dischargeable because it falls within the narrow exception.

We have seen dozens of these in the past six years. The debtor has never won. Ever.

It is actually really sad, in a lot of circumstances. Many of the debtors (most of them) who file those complaints did not go to a four-year college, but attended a vo-tech type of post-high school school. Those are for-profit organizations, and many of them really overcharge compared to what their graduates can earn upon graduation. These people who were trying to better themselves end up in bankruptcy.

I've known one woman who was successful in her "goal" but she spent her entire life doing everything she could to get out of paying for her student loans. She has no retirement, has never been able to buy a house, and has nothing to leave her children or grandchildren. It took her several decades to convince doctors to help her get the permanently disabled status. She would've been far better off just paying the loans away. So so so sad.