> We just can't deal with it, because we are exposed directly to unnecessary complexity.
I'd argue though that those best adept at handling the complexity are actually winning in this model. If you are reasonably healthy already and can navigate HDHP/HSA rules, you can have a much higher take-home income + savings than in other countries with government run healthcare systems.
You are missing the point. It is not about being healthy. You are always worried about the "what if I have to go see a doctor" situation in America because you don't know what it will cost and you definitely don't know what kind of issues you will have to fight through with incorrect claims, incorrect bills and what not. If someone can address that here in US, I am willing to keep the current system as is.
I agree there is complexity cost, but that doesn't mean you can't benefit from it if you generally can navigate said complexity. I've never had issues getting reasonable price estimates from independent doctors (large systems refuse to reveal their negotiated rates) - emergency situations are certainly costly, but under a plausible worse-case scenario I'm still solidly saving having an HDHP.
Ironically, the whole point of HDHPs was to put downward pricing pressure on the medical system by encouraging people to price-shop. Alas, due to a variety of market/regulatory factors, that hasn't happened.
My max out of pocket spending is $2,600 a year and I can put $3,500 pretax money into my HSA every year which I do. What I am supposed to worried about?
We have a pretty pricey insurance plan: family of 4, 36k/year. When my wife had a gall bladder attack and had to get it removed, the insurance company quickly paid the surgeon's bill, and followup doctor visits.
But the insurance company denied the anesthesiologist bill, the hospital surgery room rental bill, and the hospital recovery room bill all as "medically unnecessary", also known as: they won't be covering it.
We tried talking to the original doctor and surgeon but of course they got paid and their offices said the rest of this wasn't their concern. We weren't really sure who we should be talking to to help us show the insurance company that anesthesia is fucking necessary when someone cuts you open.
After about 8 months of stress it was all eventually resolved for a fraction of the original price. In those 8 months though everyone who wasn't getting paid were sending us notices about how we didn't pay yet and how we could set up a payment plan. We talked to hospital billing and they said they usually just drop bills insurance doesn't cover. Usually. And that we shouldn't worry since this happens all the time and that it usually isn't resolved until lawyers get involved.
I have a similar plan and a good income. I am in good health and I make my yearly budget assuming I might have to pay the out of pocket max if I have a health problem.
the usual "gotcha" that people mention is going in for a planned procedure and accidentally receiving care from an out-of-network physician. this makes your out of pocket max irrelevant. I've never had this happen to me and I have no idea how often it actually occurs (outliers are always the loudest on the internet), but it still worries me.
worry about the fact that your health insurance company can change or they can change the terms on you. That a starting point. Plenty more to worry about but I have typed enough on other threads here.
I'd argue though that those best adept at handling the complexity are actually winning in this model. If you are reasonably healthy already and can navigate HDHP/HSA rules, you can have a much higher take-home income + savings than in other countries with government run healthcare systems.