[EvanAnderson]

If you have enough money for that gamble to pay off over the long haul the cost of health insurance would be immaterial to you anyway. You might get away with it in your youth, or you might have a catastrophic loss and have your finances wrecked.

You're often able to negotiate discounts for cash payment from providers, but back when I had insurance that excluded a pre-existing condition I ran into providers who steadfastly demanded the full list price (under threat of collections). It only takes one of those standing pat on a high 5 or low 6-figure bill to cause you to lose on your "bet".

[JohnFen]

> you might have a catastrophic loss and have your finances wrecked.

If you have health insurance (in the US) and you have a catastrophic event, your finances are going to be totally wrecked anyway. You're likely to have to declare bankruptcy unless you are pretty wealthy. At least, that's how it's gone with every friend and family member of mine that had to navigate such an event. That's on top of the painful nightmare that is dealing with insurance company claims (which, to add insult to injury, you have to do when you're injured or sick).

The premiums are also so high that I'm very far from convinced that holding an actual health insurance policy is a better option than putting that premium money into an emergency fund.

[arjie]

I had a catastrophic event and it was not particularly wrecking to my finances. Judge for yourself: https://wiki.roshangeorge.dev/w/Motorcycle_Accident

I had quite a few not-bills of the sort you see there totaling more than a few hundred thousand. Insurance coverage did work in my case.

[EvanAnderson]

I would agree that it's objectively terrible dealing with insurance companies, providers who are incredulous you care about the pricing of services, etc. There is no free market for healthcare services. Advocating for yourself is tremendously draining.

I'm happy with the ROI I've had with my insurance premiums over my life. I haven't had a catastrophic event but I've certainly had reasonably sizable claims. If I'd invested the last 20+ years of premium expense (about $400K to date) and had no claims I'd have a ton more money, but not enough to cover a catastrophic event later in life. The principal would also have been completely wiped-out a couple of times when I did have claims, however.

I pay the premiums because I'm not comfortable holding bets on both the market and on my health. I'm also unwilling to consider bankruptcy as a morally / socially acceptable solution.

This mixed socialized and capitalist "system" we've allowed to grow up feels like the worst possible one. Healthcare and health insurance expense are a mechanism to extract value from the middle class (i.e. everyone who has money but isn't wealthy enough to buy their way out of the "system").

My preference would be for a fully socialized system, built primarily around protection for catastrophic loss, where everyone contributes w/ no opting-out permitted.

Failing that I'll grudgingly take a fully capitalist system where people who can't afford to pay are left to fend for charity or die.

What we've got is a mix of the worst parts of both.

[hobonation]

Depends.

I got $300,000 in coverage for a catastrophic event and wound up paying $ 3,100.

But I did have good insurance with United Healthcare.

[myrmidon]

Quick numbers that I found suggest lifetime healthcare costs of >$300k even if you're 65 already (with current yearly spending trending more towards $600k-ish).

So even with a (single) catastrophic event just paying yourself might save you money still (which seems insane to me).

[plagiarist]

Catastrophic events seem to wipe people out financially regardless of insurance status. I keep hearing of people divorcing so their former spouse can keep some assets while they are battling cancer. There's just no winning unless you never need care.

[all2]

I'm essentially of the mindset of JohnFen (adjacent comment). If I have a health issue that crops up, I'm financially done anyway. Given this, I might as well control the money rather than throw it into a pit and hope something useful pops out in an emergency.

[tracker1]

The collection laws also vary from state to state on this... in some states, medical collections are all but toothless, short of actually filing a lawsuit, which isn't likely, except some facilities actually have staff lawyers willing to harass and sue.

[ButlerianJihad]

Well, you can try for sure to default on medical debts without suffering a hit to your credit, but goood luck obtaining future care from any provider that you’ve stiffed.

How many big medical systems/districts in your region can you run up a balance until none will serve you, except through the E.D.?

[tracker1]

I have an 18yo bill for a medical lab, and I still get my regular bloodwork there... It gets brought up now and then on current visits, and I just say, "I'm not paying that bill."

As to the why, it's because I switched jobs and got my regular labs done and apparently was between coverage that week... they tried to charge me a large multiple of what they charged insurance for the same labs, so I refused to pay.

I also had several bills that were never paid from a week long hospital stay in my mid 30's... Most of them got paid if they'd agree to reasonable payments or settle for lower amounts when I had the money (tax return time, bonus, side work). After 7 years, they were all off my credit and I stopped bothering...