"Molly was employed at the small NPO Knowbility as the Open Web Evangelist. Knowbility was able to put her on Family and Medical Leave which allowed Molly to retain her health insurance coverage. The FMLA time period has ended and the only coverage available now is through COBRA."
So she had health insurance, but now that she's ill and has to stop work, it is stopping? If health insurance doesn't help you when you are sick, when does it help you?
> Medical problems caused 62% of all personal bankruptcies filed in the U.S. in 2007, according to a study by Harvard researchers. And in a finding that surprised even the researchers, 78% of those filers had medical insurance at the start of their illness, including 60.3% who had private coverage, not Medicare or Medicaid.
That's the point. An extreme event will be something that puts you out of work for at least a month, and for many people, they will no longer have a job after not working for a month. Since their insurance is coupled in intricate ways with their job, it ends when they need it most.
Right but that has no bearing on if the concept of insurance is a scam or not. Sure, health insurance in this country is tied to a job due to WW2 wage controls but that doesn't invalidate the entire concept of insurance.
I don't think DanBC is saying that insurance per se is a scam, but that the U.S. health insurance industry is unavoidably scammy.
EDIT: Put another way: you're 100% correct that that's what insurance should do and purports to do, but that's not how it actually plays out with American health insurance.
No! I'm very much saying that most insurance (car insurance, home contents insurance, payer-protection insurance, flood protection insurance, etc etc) is rife with scammy practices and awful awful people - the scum of the earth.
Agreed. On the scale of insurers, there's no risk - it's just cost averaging a.k.a. what the government should be doing. There's no way to lose money at it.
Insurance is a scam because insurance companies sell products with simple, big, headlines but complex fine print. They go to extreme measures to avoid paying out if possible.
If this were actually true then word would get around quickly and insurance companies would lose business as honest rivals emerge. (Hint: This hasn't happened. Because it's not true.)
See, from a cancer patient writing three days ago who had her insurance canceled because of Obamacare:
http://online.wsj.com/news/articles/SB1000142405270230452750...
"The second element essential to my fight is a United Healthcare PPO (preferred provider organization) health-insurance policy. Since March 2007 United Healthcare has paid $1.2 million to help keep me alive, and it has never once questioned any treatment or procedure recommended by my medical team. The company pays a fair price to the doctors and hospitals, on time, and is responsive to the emergency treatment requirements of late-stage cancer. Its caring people in the claims office have been readily available to talk to me and my providers."
People buy life insurance based on price. Whether you're alive or dead isn't generally difficult to establish.
People buy other types of insurance based in part on price and in part on reputation. There are plenty of discussions (I've participated in some) about how insurance company X is too difficult to deal with, and insurance company Y is better when your car is totaled, etc.
That's because the system is setup so that the payouts go from a pool of money that would otherwise be "profit" for the company. If the company's "profit" is independent of the payouts, maybe this would help. Probably have a separate pool of the money from where to settle claims. You could split up the premium into two parts:
1) The money for the payout pool. No profit should be extracted from here.
2) Money that you will invest and thus earn profit from.
You could use actuarial science to make sure that you have enough collections to statistically be able to pay out every claim. And in this model, the company would have no incentive to NOT payout
Isn't that why most insurance companies used to be mutual co-ops and only recently have become corporations? Essentially there are insurance companies that are exactly what you describe, people in a large group pooling their money.
If you watch our politics (please spare yourself) you could have seen a packed convention center for one of our two major political parties a few years ago cheering the idea that we should let people get ill and die if they could not afford to treat themselves. This is not an exaggeration, I am sure it is on youtube somewhere. [1]
Oh and serving in the military means your claim request will be backlogged for a year, so that doesn't mean you are safe either.
> "cheering the idea that we should let people get ill and die if they could not afford to treat themselves"
For an extra level of sadness, said candidates were simultaneously criticizing other countries for allegedly letting people die unnecessarily (see: "death panels").
The standard in the US is that this is a different type of insurance (disability insurance) and it's often sold in parallel with life insurance.
Disability benefits can also (often) become available in this situation, meaning that this is one of the only situations in which the fed will actually give you money (most other benefits are paid out by the state).
Not saying that this is a good situation, just clearing up some misconceptions.
Specifically, there are both short-term and long-term disability insurances. Both pay some percentage of your base pay (often 60%-80%, or even 100% for short-term) at the time of the qualifying event. Short-term kicks in first, but eventually runs out and the long-term insurance kicks in. Long-term insurance often covers the individual to retirement age.
Take it from me, you really want to make sure you've got both, because shit happens.
Noted spastic blabbermouth Jim Cramer makes a point of this in his books. He more or less calls disability insurance the most important financial product that people can buy.
The thing that's really weird to me as an generic continental European is that there are bounds to medical leave, when an employee gets sick around here there is some sort of fund that kicks in and the person retains pay and benefits for as long as she's out of work.
It's not just about universal healthcare it's also about not losing your salary if you are sick for a couple of months (or losing your holidays if you are sick for a couple of weeks).
The standard response is that she needed disability insurance on top of her medical insurance. So yeah, you need 2 different insurances in case you get a real illness in the US. This is how fucked up it is here. Unfortunately the GOP and conservative democrats killed any "public option" in the ACA so we'll never have anything like the NHS here.
Oh, I have this secondary insurance. It also sucks and will cost me a lot of money to take care of myself if I ever get as sick as Molly. I might have a chance of not losing my house with this insurance.
That's on top of student loans you're paying off and other things Europeans don't have to worry about, but according to HN libertarians its all "welfare nanny state statism" and somehow Ron and Rand Paul would fix everything if we could just make them dictators for life.
"Unfortunately the GOP and conservative democrats killed any "public option" in the ACA so we'll never have anything like the NHS here."
Hardly a permanent situation. When you have a corrupt enough system, just like a scrambled enough computer, the best bet is to hurry up and reboot the system so you can bring it up clean. After the reboot we'll have sensible insurance. The problem is surviving until after the reboot. There is too much money to be made by crooks so we have to nurse the existing system along until enough blood has been squeezed from stones.
You're much more optimistic than me. I could see, maybe, my grandkids ushering in something like the NHS, but now or in the near future? Where the political discourse is split between being Eisenhower style Republicans (democrats) and some insane fascist theocracy (Republicans/Tea party)? Yeah, this not the formula for progressive politics.
Part of the confusion is that "health insurance" isn't so much insurance any more but part payment gateway, part tax deduction system and part salary augmentation.
It's better to say she lost her health care when she lost the ability to keep paying for it. The real insurance is called disability insurance now.
I stopped paying my health insurance once and I didn't die.
Perhaps you mean if you don't pay for health insurance you are more likely to declare bankruptcy as a result of an unexpected healthcare issue however to equate declaring bankruptcy with death is a bit extreme imo.
You're healthy, you don't have any life-critical problems at the moment. You don't need insurance.
But when you do need it - if you have an accident, get cancer, or otherwise ill - and you don't have it: well, no medicine for you. Go die in the streets.
And before you say this is an extreme position, no. I have worked with homeless and despondent people in America, on the streets, and time and again encountered people who simply didn't have the money for the treatment they needed, so they were on the streets. Dying of cancer. All over America.
Best wishes to Molly for a speedy recovery and to feel better soon.
Thank goodness she is famous, even if lesser known by the mainstream and friends can appeal to help her.
For those that think the ACA (obamacare) will solve this after January, nope.
A full half of the states [1] have denied medicaid expansion (because the supreme court ruled they could turn it down) which means if you fall into the gap where you "make too much money" ($12k - $16k) you cannot get health insurance.
So if you got ill but were trying to work part time to stay in your home/pay rent, you will probably make too much to get health insurance!
This is probably going to cause "healthcare migration" where people who get ill have to move to get assistance if they have some income but not enough.
> Thank goodness she is famous, even if lesser known by the mainstream and friends can appeal to help her.
Healthcare in the US sucks, no doubt. But I'd say she's not getting support just because she's famous, which sounds cynical to me. Personally, I feel a great deal of gratitude toward her. Like others in the thread, her books helped me start my career. So it's not just about being famous - she's spent her life helping other people and now people want to help her back.
You are right, that is definitely a better way to put it and what I actually meant.
I didn't mean famous like just because her name is recognizable, I meant famous for good reasons (like the word "famous" is actually supposed to mean, vs infamous).
If you make less than (I believe its) 4x federal level of poverty in your area you are eligible for subsidies on your health insurance via the marketplace. The issue you are pointing out is where you make too much to qualify for your state's medicare plan but not enough to be able to pay for private insurance even with subsidies.
So its not that you make "too much" to get health insurance, but you make too much to get free health insurance but too little to live off of and pay for private health insurance.
It is worse than that in states that decided not to expand Medicaid. Subsidies are available for people who make 100% to 400% of the federal poverty level. The Medicaid expansion was supposed to cover people up 138% the federal poverty level, but In states without Medicaid expansion, there are people who aren't eligible for Medicaid under old rules and aren't eligible for subsidy because they make less than 100% of poverty level.
"subsidies" is the new fancy term for "welfare" or "handouts". That's what it is, and there's no such thing as "free health insurance" only taxpayer-provided health insurance.
Pure pedantry. Nobody is under the illusion that doctors and nurses work for free. When people say "free" they mean "free for the user at the point of service", which is a bit of a mouthful.
Exactly zero people believe that the health care doesn't have to be paid for by someone at some point. This is a straw man.
Also, "tax breaks" is the fancy term for "welfare" or "handouts". See, I can do meaningless feel-good rhetoric! Let's debate these issues at their core, not resort to meaningless weasel words.
Molly's books were what really got me started with web development. She was kind enough to send me a signed copy of one of her books when I was probably ~13 years old after emailing her. About ten years later, I was able to meet up with her here in the UK for a coffee, which was lovely.
If you can, please support Molly's treatment with a donation. Thank you.
I want to help, but all I have is time and skills. So if anyone here needs some English language proof reading done (I do have some tech skills but they are very rusty) contact me, I will do the work, and you can donate something to this cause.
Email is in my profile, and I'm the head teacher for a language school so my skills are good. My problem is I have two small babies and I live in a low income country so even $10 is tough for me to give right now, but I'm a worker, and I will pull an all nighter to do this.
Honor code, I trust you to donate, send proof if you can, but either way I hope I can do something to help. I don't care how much (I know people who need English proof reading are probably coming from low income countries too) but anything would be good.
If you live in the US, this should serve as a warning that you need Long Term Disability insurance. If your employer doesn't offer it, get it yourself. Healthcare is still broken and ObamaCare doesn't fix this situation.
My one story about Molly - I met her as a speaker at an XML Conference around 1999 or 2000. She was extremely welcoming and kind to me, a wet behind the ears nobody at the time. We went for a speakers' pre-conference dinner that night, and it was decided we would have Sushi.
As a Northern Brit I had never seen nor eaten sushi before, never mind looked at the menu. I asked if she minded ordering for me, and she graciously did so.
As my first time eating sushi I assumed the small amount of guacamole provided would be topped up once I finished it, so I happily spread the top of a piece of sushi with half of my "guacamole". Never have I wanted to scream so much in my life. Molly just kindly passed me some extra water and made sure I was OK.
I never really kept up with her, but she'll always be there sat next to me when I had my first ever wasabi experience.
She was on employer provided insurance, which won't undergo any huge changes that would change her situation. After the FMLA time period (where her employer could keep her on their insurance without her paying extra), she's now on COBRA which is basically an additional period where you can pay the full cost of your employer's plan to the insurance company directly, and extend your coverage by 18-36 months.
The only difference under the ACA is that if she became unemployed during the annual open enrollment window, then she would be able to immediately jump to individual insurance rather than using COBRA. Depending on her income level, she might be eligible for a subsidy if she made the change. So depending on income, her state's insurance market, and when she gets sick she might be able to get insurance for less than $1000/mo she's paying in COBRA premiums.
My understanding is that she wouldn't be able to jump to individual insurance given her health status until pre-existing condition coverage kicks in this January.
Kinda. My GF can get a cobra during an unpaid leave.
So my GF is expecting a baby in December, so for the 6 months she has discounted healthcare and then if she doesn't come back. She gets unpaid leave and Cobra.
Technically she wont be terminated, but she will have Cobra.
COBRA is available immediately once you're unemployed (left voluntarily or most of the time if you're fired), and it will still be the only short-term option for someone in Molly's position under the ACA. If you become unemployed and ill, you'll still need COBRA to cover you until you can get on an individual plan which will be available at the start of the next calendar year.
What happens to people in USA with similar situation (employer-provided insurance ends, life sustaining healthcare is needed, no income to pay for that) who don't get a successful fundraiser?
Bankruptcy due to unpaid medical bills? Withheld treatment because of non-payment, possibly causing death? Both of these?
No offense, I'm simply curious on how the system works.
Life sustaining you'll get for free by the hospital which merely raises everyone elses rates. We already have socialized medicine, its just the "wrong" middlemen are profiteering.
From personal experience via a friend with a broken arm, the hospital will eventually present you with the most amazing collection of bills you've ever seen with the most unimaginable rates, so a simple non-compound arm fracture and cast will end up billed as $50K. The goal of the hospital is to book as large of a paper loss as possible, so the paper loss will probably exceed actual service cost by a couple orders of magnitude. Somehow the ER doc who spent about 15 minutes verifying yes it is indeed broken will charge 6 hours of dedicated time, you'll be billed for entire jars of painkillers if they give you a single pill, etc. It'll take about six months for all the bills to arrive from all the doctors and the hospital, but bill collectors will start calling before the first bill arrives. Once you're sure you have all the bills, its bankruptcy time, which costs some time and money. So the real cost of any lifesaving medical procedure never exceeds maybe $2K to a lawyer, maybe less. She needed the car insurance money from the accident to get the car to continue to attend school and work, don't recall how she paid for the bankrupcty. Bankruptcy is actually pretty expensive and not surprisingly the sharks in the biz only take cash. The bankruptcy doesn't really matter, because part time no benefits minimum wage retail cashiers are not going to get mortgages and new car loans anyway. Legally officially it could be an issue for 7 years or whatever, in practice its not an issue after a couple years at most. I suppose if you had the misfortune to break your arm the week before graduation and you get a real job, you'd be out a substantial amount of money. It would be highly unwise to get married if you're poor, because if she was my wife at the time, I'd have had my financial life destroyed by her mere car accident and broken arm. At least that's how it was in the early 90s. Other than prices probably going up an order of magnitude or so, I suspect nothing has really changed.
"Molly was employed at the small NPO Knowbility as the Open Web Evangelist. Knowbility was able to put her on Family and Medical Leave which allowed Molly to retain her health insurance coverage. The FMLA time period has ended and the only coverage available now is through COBRA."
So she had health insurance, but now that she's ill and has to stop work, it is stopping? If health insurance doesn't help you when you are sick, when does it help you?
Thank god (and the Labour party) for the NHS.