What is Health Insurance, and Why Do You Need It?: Health Care Triage #2

hi I'm dr. Aaron Carroll and welcome back to healthcare triage we're going to be doing this show every week now so make sure you subscribe right down there in the first episode we talked a lot about Obamacare and how people without insurance we're going to try to start getting it but that led to a lot of questions about insurance in general yeah exactly what am I going to stop having to pay for my insurance you're still going to have to pay for your insurance Obamacare is about access and this was supposed to be a big government giveaway to friends of Obama I am friends with Obama I don't understand what went wrong nothing went wrong let's start this week with the basics of health insurance how does it work how much is it going to cost we're going to answer that and more in this episode of healthcare triage comprehensive health insurance isn't as old as you think the first real plans appeared in the u.s. around the time of the Civil War and really those were just types of accident insurance in case you got injured while traveling on a train or a steamboat this wasn't nothing since trains and steamboats exploded pretty regularly in those days but it didn't do much to help with what we would all consider routine health care well into the 20th century there just wasn't that much need for health insurance after all what would you do with it there wasn't much health care to buy if he got sick it wasn't like there was an MRI scanner or artificial heart that you were gonna get you went to the doctor for leeches and laudanum but if you got really sick well you sort of died but as doctors and hospitals learned how to do more than amputate legs and shake their heads wistfully they realized there was real money in this gig so in 1929 a bunch of them joined up and formed an insurance plan called Blue Cross to help people buy their services doctors didn't like the idea of hospitals being in charge so they created their own plan in 1939 which they called blue shield so you had your Blue Cross for hospital services and your Blue Shield for position services until they merged to form Blue Cross and Blue Shield in 1982 for the most part people bought health insurance on their own if they wanted it some jobs offered it but employer sponsored insurance wasn't really a thing until World War two wartime emergency plans put wage controls in place and so by law companies couldn't compete for workers by paying them more with so many men fighting overseas employees were relatively scarce so employers started competing for workers by offering them benefits like health insurance those weren't restricted by wage controls and soon lots of jobs were paying for more and more comprehensive coverage after World War Two President Harry Truman proposed scrapping this system for one of universal public health insurance people love this idea but doctors hospitals and many businesses hated it they'd already invested quite a bit in the current system labor unions also realized they had a lot to gain by keeping insurance tied to jobs they'd fought hard to get benefits for their members and changing to a national insurance system would have made these gains moot Truman lost employer-based health insurance won over the next 20 years private insurance increased in popularity but remained mostly unavailable to the elderly the poor and the unemployed no one wanted the cover seniors because they get sick a lot and a ton of money but this meant that more and more people were faced with the difficult decision of going broker letting their parents die this was intolerable to many Americans because all of them expected to be old one day and they had no interest being stuck in this dilemma after years of fighting President Johnson signed Medicare and Medicaid into law to cover the elderly and the poor and today government programs cover about one-third of Americans the rest of the insured are covered by private insurance but why do we even need insurance to put it simply health care is very very expensive my oldest son had to go to the emergency department about a month ago he received just an ultrasound and a doctor read it turns out he was fine and he just needed an antibiotic the cost of that visit $6,000 and that's cheap compared to really big things like a hospital stay last year we spent something like 2.7 trillion dollars on health care that's upwards of 18 percent of our GDP most people don't have the kind of money to pay for care if they get sick that's where insurance comes in everyone individually pays less but sick people get the money we pool risk and the money goes to whoever needs it by the way anyone that complains that they don't like paying for someone else's health care is completely missing the point insurance is always about paying for someone else's health care it transfers money from the healthy to the sick how does insurance work well the first thing you do is pick a plan plans differ on the amount of actuarial value they have that's a fancy term for describing the approximate percentage of the cost of care that insurance will cover if a plan has 60% actuarial value then it covers 60% of the cost and you cover 40% plans with higher actuarial value cost more you pay more upfront and pay less later and the insurance exchanges which we talked about in our last video bronze plans have a 60% actuarial value silver plans are 70 percent and gold plans are 80 percent insurance also has networks of physicians these are doctors or hospitals with whom the companies have negotiated lower rates you get better coverage if you stay in-network and pay more if you go out of network so if there are certain doctors you really want to see you need to make sure they're part of your plan the money you pay upfront is called a premium that's often charged monthly that's what you see when you find out how much a plan costs but that is not all the spending you'll do pretty much every plan comes with a deductible this is an amount of money that you're responsible for paying even after the premiums before insurance coverage kicks in the reason plans use this is that they think correctly that you're less likely to spend your money than their money it prevents you from going out and getting a ton of care that you might not need more expensive plans which have more upfront money usually have lower deductibles less expensive plans have higher deductibles not all care is subject to the deductible for instance most preventive care is fully paid for by your insurance right away even after you spend the deductible you're not done most plans come with co-pays these are set fees that you have to pay each time you access the healthcare system they may be $20 for a doctor's visit or $100 for an emergency department visit and it gets better there's also coinsurance it's the amount that you yourself have to pay for care above what your insurance pays and then you have to give them a firstborn child two wishes and an ounce of ground unicorn horn just kidding it's actually only one wish okay I'm kidding about the whole thing it's just the coinsurance is real it's not all bad plans now come with an annual out-of-pocket maximum for a family it's at most twelve thousand seven hundred dollars and for an individual at six thousand three hundred fifty dollars so after you've paid that amount of deductibles co-pays and coinsurance you are done it's all on the insurance after that even better there are no longer any annual or lifetime limits your insurance can never run out so if you bought a silver plan say with an actual rate value of 70 percent for yourself from the exchange in Indiana the premium might be around four thousand dollars a year or just over three hundred fifty dollars a month let's say it has a fifteen hundred dollar deductible $20 in co-pays for doctor visits and 15 percent coinsurance when the year starts even with the insurance you'd be paying for almost everything until you spent the fifteen hundred dollars then you'd be paying $20 for each visit plus 15% of other charges until you hit six thousand three hundred fifty dollars in a bad year you could be on the hook for a total of about 10 grand or the cost of the premium plus the maximum out-of-pocket expenses this is going to come as a shock to people who assume that health insurance would now be cheap or even free but you have to look at what might have happened without it what if it had been you had to go to the emergency department a month go instead of costing you $6,000 under this plan you would have been responsible for a $350 copay and $900 coinsurance payment that $1,250 is much less than $6,000 and this could happen a couple times a year or you could get really sick or you could have a kid the average price for having a baby in the United States is $30,000 if you have a cesarean section it's $50,000 people with insurance are way way way better off than those without it so do your research figure out what you're willing to pay upfront and premiums but don't forget that networks deductibles co-pays and coinsurance matter to figure out if you'd rather pay more upfront or gamble that you won't need to and pay more later but make an informed decision now you know and knowing is half the battle I always wanted to say that go Joe you


  1. I'm sick right now. I can't afford healthcare and I can't afford health insurance so when I die my family is instructed to sue the federal government for my preventable death.

  2. What is health insurance? A business. Who needs it? Anyone that wishes to spend their hard earned money on it rather than a good steak, new car or a new house. Is it part of the free market? No, it's now a monopoly and you no longer have a choice to purchase a service you are forced to buy a service by way of law.

  3. 1 simple question. Why are any of this that expensive? Tell me why the cost of delivering a healthy baby costs $30,000. Please.

  4. Better off with insurance? Hardly.

    The insurance pools can be done in a purely non-profit way that includes no profit, advertising and no CEO salaries and bonuses. This would represent a tremendous savings.

    The first thing we need to do in reforming US health care is to remove private health insurance company participation.

  5. i just don't understand one thing. why does not america, such a rich country, provide free health care system.
    they can regulate the system. charging for 6k$ for just a simple ultrason check is simply robbery.

  6. I surgeon had to remove 3 teeth because I had a maxillary sinus surgery. Does my insurance cover the teeth replacement.

  7. But your son would be paying $6k a year in premiums anyway. Then you still have to pay until you meet your deductable. Then you hope your insurance covers your problem if you if meet your maxumum. So whats the point?

  8. About 25 years ago I was reading the Bible when I came across James 3:13-18 and When i applied the things I was seeing in our lives then, I came to the conclusion that all types of insurance is devilish and should not exist.
    James 3:14:18 …"But if you have bitter envying and strife in your hearts…this wisdom descends not from above [God], but is earthly sensual, devilish. For where envying and strife is, there is confusion and every evil work…"
    Now look at the bitter envying and strife caused by insurance: millions of Americans couldn't get it and died, and billions worldwide. Then if you look at the confusion: will their insurance pay for this? Which hospital should he go to? Etc. Capitalists should not be allowed near a healthcare system! The poor people envy the rich who have insurance (many kinds), etc. Anything that is this confusing is clearly devilish, which mostly exists (as this man explains its connected to employers) only for the few who work for corporations or government, all this confusion, envy and strife related to insurance shows that it should not exist, and also that unequal wealth should not exist, and that wage slavery should not exist. It shows that America chose a way that was very wrong: wage slavery, aka capitalism. Obviously when a few very rich people own everything and then create a few jobs that have never paid enough, and insurance that is terrible, and retirements/Social Security, etc, then it's very wrong. All people should own all things worldwide. America forced every attempt at an alternative system to fail (ROGUE STATE, Wm Blum+).

  9. even if you end up just paying 350 a month and 20 per healthcare access, thats still hella much money! In the netherlands I pay 130 euros (apx 160 dollars) and thats gets me dental care, all ER services, most prescription drugs, all sorts of hospital services and labor care + after care. im thinking of moving to Los Angeles for work but I dont know for sure due to my recurring healthissues

  10. We need to get back to a free market system. When they have to compete prices will come down. We don,t need health insurance.. Just look at at other countries that don,t have health insurance. Some countries you get open heart surgery for as little as $2000.00, now that is cheap. doctors and hospitals won,t like it but who cares besides them.

  11. I rather pay up front for preventive care and let insurance handle catastrophes – like getting ovarian cancer from your baby powder.

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  13. Watch on a daily as ETOH, Meth users, COPD current smokers, and people use the ED as their PMD continue to have free healthcare as I strive to convince my insurance company that I worth insuring….for my current price………F'ing unbelievable!!!! Do things right and you pay for those who could give a s**t what it cost. Which is to put a band aid on their bad HC decisions!!!!! While we all pay for it. WAKE UP!!!!!!!!!!

  14. Lord what an idiotic system. How about you pay taxes, and those taxes pay for a free healthcare public system? I'm so glad I'm an European.

  15. What I don't find fair is that my father being an upper middle class man (in my state's standards) had to cancel our family health insurance because it got ridiculously expensive but the poor folks can definitely get their insurance for free or for a very, very low price.

    P.S. This is not an attack on poor people, I just find it ironic and absurd that my family being much more fortunate than a quarter of Americans doesn't have healthcare

  16. $30,000 to have a baby? Humans have been giving birth for millennia and all of the sudden the price has sky rocketed. Isn't it fraud to say that is a fair price (especially when it's a lot cheaper to safely have a baby in Germany or India)?

  17. when we go hospital then only we know insurance company true face. don't waste ur money in insurance company. always condition apply words they use everything

  18. last year i had a surgery in my country wich costs 5k plus in the usa plus the ER visit plus the two nights at the hospital and i paid zero, Its all cover in the 15 USD i pay a month, and you still dare to call us "third world" lol

  19. You should stop calling it Obamacare and use its actual name, The Affordable Healthcare Act. It's astounding how many people don't know that they are one and the same.

  20. this kind of feels like a vanilla version of the issue. insurance costs are more than just the patient risk management factor. Hopefully in later videos he will get more into that.

  21. This video was very informative for me in regards to health insurance and healthcare. The fun fact that caught me by surprise is how health insurance came about because of competition. Jobs had to find an advantage to get workers, and health insurance benefits were the answer!

    People get mad that they're paying health insurance for the sick. Just like the video said, they're missing the point. I believe that this part of insurance, everyone paying less but it benefits the sick more is good. The ones that are healthy can complain about paying for insurance when it doesn't apply to them… until they get sick! Then they're in the same boat as the people they're complaining about. Nice informative video Healthcare Triage!

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  23. Yep. I am soon to be 32 years old, and not one mandatory course in all my years of schooling taught me any of these basic fundamental concepts. I realize one can't expect to be handed life on a silver platter, but it still baffles me that children and young adults aren't taught this stuff before they are sent out into "REAL" life and expected to work full-time and function as proper adults.

  24. Granted, insurance may be expensive for some, but it is important. Personally, I would rather pay for insurance and copays than have to worry about the hefty fees of medical care when I need it. It is apparent in the U.S. that tests such as MRIs or CT scans, hospitals stays, and prescriptions are overpriced. When something happens to you and you have to utilize these things, it would be more beneficial for you to already have insurance. It will save you money and stress in the long run. For example, one time I had a prescription for an eye infection at my local pharmacy. They told me it was $40, which I thought was a little higher than expected because I had insurance that usually covered it. I asked the pharmacist if they put in the discount for my insurance and they told me that they did and the prescription was originally $200. The bottle the prescription came in was half the size in length of a pencil. I was astounded by this. It made me realize that those that have urgent medical conditions or illnesses may not be getting the proper care because they cannot afford it without insurance.

    Our insurance and health care system seems quite complicated but I do believe that Obama Care was a step in the right direction. Of course it is not perfect but it helps us to cover more uninsured people. I think by making a few adjustments to this law, it would be more beneficial for those that are still uninsured. Again, I believe insurance is very important and many people do not recognize that. Medical costs will be higher for a given person than those of buying insurance in the long run. Some may say that they are healthy and do not need it but you never know what could happen in the near future. It's better to be safe and covered than sorry when you get your medical bills.

  25. How Do I Find Affordable Medical Insurance?
    Here in Answer:

  26. What? Six grands for ultrasound? That's fucked up. Usually I kind of disagree with people saying that Europe is much better (because it's mostly the same), but in this case I have to agree.. Wow

  27. Wait. (starting at 6:30 ish) — having the silver plan on a bad year will be $10k, but not having a plan…is $1,200 ??? Can someone clarify this?

  28. Pfffft. The US health insurance system is so complex. I'm happy I don't live there.
    I pay about $1300 (€1000) a year and I'm done. No Actuarial Value, no co-pays, no deductibles or any of those things.

  29. Great show Doctor! I have a question perhaps you could do a video on. Supplements is a huge market for bodybuilding and fitness programs. Claims like "1 gram of protein for 1 pound of body mass," "eat 5 meals." Is this a bunch of nonsense? Are protein supplements healthy? I've read nitrogen balance is important in building muscle and simply counting caloric intake. Though what is the healthy approach and is protein supplementation effective and safe? I know that's sort of a lot and a bit scattered, but fitness is very important to me and I want to do and educate it correctly! Plus I'm curious what research you find.

  30. Fact   Doctors , hospital, dentist, ect are OVERCHARGING you .  Why Health care insurance.  Americans are stupid.

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