The insights provided are very helpful. I would like to address a couple points brought up, just to clarify:
I'm not saying this flippantly, but no one seems to have raised - maybe you could move?
I wish this were an option. I'm a US citizen by birth, so many of the benefits you speak of are not options, as far as moving, barring a countries' unconditional acceptance of my citizenship, and Australia is one of the worst for obtaining it. England may be easier, but many countries with universal healthcare require you to pay in (thru taxes) for a time before you can get benefits. So at the very least, I would need to have a work visa to even get into most, and attain somthing like the US equivalent of permanent residency to secure benefits. If I'm going to do that just to get insurance, I may as well stay in the US and work till normal retirement, and draw SS medicare, etc. I'm not dismissing the benefits of these healthcare systems out of hand; you have to realize this endeavor requires an investment of my time, and confidence that it will achieve a result better than what's set before me at present. I don't have that, mostly since I've never left the states, so I would need to take that step before even
considering moving abroad.
Now me & my husband. I am a medical disaster. I had cancer and was successfully treated before I was 30 (try getting life insurance with that baggage). I now have multiple chronic endocrinological issues. They are all managed and I lead an excellent quality of life, but that could turn at any moment. My husband is in better general health but has drug managed genetic high blood pressure. Financially, we could be FI now if we wanted to live like church mice or within 5 years if we wanted to upgrade to just cheapskates. Unfortunately due to our health issues (mostly mine) we will alway work, preferably for a large corporation who can bury my sucky health in a pool of healthy people. Now we probably both won't always work.
I understand your feelings. To be fair, I'll share my medical 'problems":
I was diagnosed Type I diabetic when I was 22. I had the good circumstance of actually having a 'real' job at the time (fortune 100 company), with insurance so good, after going to the emergency room (sent there while on the clock) testing a 400+ Blood glucose, and after 2 weeks off work in the hospital (I recieved my regular pay while there), My part of an 12k bill was the 25 dollar emergency room copay. If a doctor had sent me there, it would have been nothing. That was nearly 20 years ago, and savings like that are grossly unrealistic, even with 'cadillac' insurance. I don't expect that from having insurance, but given I have other issues beyond that (this is the fun one), I have the benefit of seeing what it would cost me without insurance, because my present insurer shows what I pay, and what they pay. Insulin I always knew was expensive (about 600/mo wo ins.), but since I use a pump, the supply costs are actually MORE (about 1k/mo!). My part of that is like 60/mo with my insurance, but the issue is this: can I pretend to believe I can find insurance that will pay THAT much of my prescription costs!?!! it's like a 90/10 split at these amounts, in 90 day supply allotments! Even if I fudge it with the supply costs (recycling--you didn't hear that from me!) I STILL have to buy them, and I can assure you, having a A1c of 7 isn't great, it's better than an A1c of 10.5 for the past 7 years, WITHOUT a pump. Insurers are unkind to cancer survivors; I know, I sold insurance riders for it. But, they curse Type 1 Diabetics, simply because there aren't many, and the few there are recieve very poor care, if they don't have spectacular insurance, which leads to poor health and expensive complications. Being FIRE won't help me, like actually being poor did with emergency room check ins if things go south one bad day, because of full disclosure of assets the hospitals around here require now (yay.) And, they could charge more if I don't have insurance (they could charge less-it's all a coinflip... makes long term planning fun!). I'm trying not to exaggerate, but this has been my experience, and I've had a lot with hospitals recently.
I had understood "self insure" to mean "pay out of one's own savings" rather than "buy insurance directly rather than through an employer." Maybe we should clarify terms because I'm not sure we're all talking about the same thing.
The ACA has certainly made a huge change in how I see ER. Before it was impossible, as I have a chronic condition and support someone with a chronic condition. I had already tried to get insurance on the open market and couldn't. Now I am insurance through my employer, but supposedly I am now guaranteed insurance through ACA. What worries me a bit is that a good proportion of the country reportedly loathes the idea of the ACA and wants to repeal it. What happens if I FIRE and the ACA is repealed and my insurance option goes away?
Self insuring is actually an option, believe it or not, and depending on the resources I can commit, it could be the most realistic long term one. When I was working in insurance, I learned that in the state I live in, I can actually set up a self funded policy pretty easy, and I can go a step further in having it managed by an insurer on my behalf, to take advantage of any discounts/dr networks they have. Based on how I set it up, I may never actually have premiums; it would be self sustaining.
The issue is how much; 15 years ago, it took 500k-1MM to do a policy for one that required no premiums thereafter; the capital in the policy would accure at a rate high enough to cover medical expenses projected without depletion. But, costs were less then, so I'm not certain if 1MM is enough now; for me, at least. And, I'm not married, no kids, and I'd like to pretend this might be in my future yet. And I wonder about if the insurance options could change, too, should there be a 'revision' to ACA. I'm told SS and Medicare went thru the same, but I wasn't around to see, and I'm under the impression compromise was more prevalent in the past.
Her premiums this year (post-ACA) are HALF of what they were last year, for superior coverage. I think she is now in the $400/month range for premiums and just commented to me last weekend about how much she was paying out of pocket last year compared to this year
Thanks for the numbers. This is helpful for comparision. My employer pays more than that, but I only pay about 70/mo for my part of my insurance, and I have the best policy they offer. When I glanced at the exchanges, I couldn't find anything similar in 'gold' or 'platinum' to what I have (my insurance offers more than these), so I really don't know the exact comparision, and since I'm working, it's hard to get a number on healthcare.gov without revealing a lot more than I want to. And, I'm comparing the total cost, not just my part of the insurance cost with my employer.
We've been taking advantage of COBRA because the rates/co-insurance/deductibles end up being less out of pocket than I can get on the Exchange, directly from the insurance providers, or from my husband's (small company) employer provided health plan
I dealt with that when I left the employer that paid for my 2wk stay when I was diagnosed with Diabetes. It was more than I could afford, they cut most of my benefits (just to make it that 'cheap'), and it would only last 24-36 months (I think-it's been a while), assuming I paid without missing (I did. I was 40 percent of my unemployment! I had to choose between keeping my house, eating, and paying for insurance! I could only do 2 of 3!) Since this was around 9/11, it wasn't like it was raining jobs...
I saw this one late, but I felt I should add it...
I would guess from your user name that you are a type 1 diabetic? If that is the case (or something similar) I can surely see that your medical expenses wil never really decrease, insulin is expensive! I have a few diabetic friends, and one of them is beyond thrilled with the ACA and how it makes her meds affordable. It is expensive yes, but before this there was a time when working as a temp without insurance offered that she was needing to spend more than half of her pay just on meds, crazy!
LOL! To think, I came up with that LONG before I was!! Your deduction is correct, though actually circumstancial. It's actually a video game association; I'm sure some on this Forum are old enough to remember R-Type. That's partially where it comes from. There's more, but suffice to say, I wasn't a diabetic when I came up with it, and the 1 had only been there as a placeholder, but it's stuck there because I've not changed it in a while.
Please continue to comment! Everyone has been very helpful! I had not looked at this post in a while, and I'm glad so many feel like I do! Many hands make the load light!