People who do take care of themselves better than the norm essentially subsidize people who don't. In my mind, the question then becomes how a person might get out of the situation of subsidizing others.
Well, some people take care of themselves, some don't. Some take care of themselves but are cursed with rare, extremely expensive genetic disorders. Others don't take care of themselves but eventually get into a car wreck and die fast before any of their chronic problems become expensive.
So, I think a better way of looking at it is "people who by necessity utilize services more are subsidized by those who do not", and I'd say that's the most basic definition of what insurance is supposed to be that I can imagine. It is spreading risk.
I don't
want to get out of the situation of subsidizing others; I want everyone to have access to a high quality of healthcare. I think it's a basic human right. The things I am complaining about are the complexity of the systems and the fact that something like 40% of medical spending just goes to "support" the insurance infrastructure. Plus all the problems
@Greg Sacramento has brought up about billing private individuals vs insurance negotiated rates.
From what I'm able to gather, you and your family do much better than the norm in taking care of yourselves. So I would say your "risks" of not having a plan with a $1,000-$5,000 deductible is rather small. To me, it's all about adequately--and unemotionally I guess--assessing the risks.
Erm, if we'd been uninsured, or on a "catastrophic only" plan, in 2018 -- we would have come out of the year with insurmountable medical debt and possibly gone bankrupt. This is because my wife had this misfortune of a fall which broke her arm and led to some issues that needed ongoing treatment, during the same year that our child had an event which required an ambulance ride, ER visit, and overnight stay in the ICU for the three of us.
So -- no matter how well you take care of yourself, I think everyone who does not have some kind of insurance with some reasonable out of pocket maximum, is just at immediate risk of medical bankruptcy, at all times.
If we were lower income, I believe there would be subsidized options on the state exchanges which would mitigate these costs, probably significantly. Based on that, it seems reasonable to say that by buying a more expensive plan, I am likely subsidizing the costs for people who earn less. That doesn't bother me, both for altruistic reasons, but pragmatically because I personally benefit the fewer sick or incapacitated people there are in my town.
Some uninsured driver hitting you, or a bad slip on a stairway at night, can trivially turn into events that lead to $100,000+ bills for people with no health insurance. As soon as you're in an ambulance on your way to a facility you're into four digit territory, and if you're there overnight, you probably edge into five digits pretty fast. Of course this will vary tremendously on what services you need.
I do agree that using HSAs intelligently with high deductible plans to build up actual savings over time is a good goal, but, I am also not willing to put myself in a position where my out of pocket maximum is more than I could afford, because in 2018 I think we "spent" something like $20,000 on services, largely down to those two events.
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