I'm not saying that all US companies offer decent healthcare options, but that's often because employees don't value that as a negotiation point. I did, and my son was in a horrible car crash and died after many days in ICU and many surgeries. My out of pocket cost was a few thousand to hit the max. Because I cared about healthcare coverage instead of a slightly higher salary.
People often forget that freedom of choice in the marketplace is freedom to allow some people to make dumb choices or bad choices. Often times when I hear people complaining about the lack of health care in the US It's because they prioritize short-term gains over budgeting for health care. They're gambling with their health, most people win but some people lose and they lose hard. They're hindsight isn't that they teach people that they should get health care and prioritize that in their budget. Rather they talk about socializing the costs because their irresponsibility somehow a burden to every other responsible person in society.
This is not the case for me and mine. We had the best insurance money could buy, and a hospital still decided to prioritise money over patient need, which put my wife into a coma and ruined her (and my, for that matter) life.
I’ve posted elsewhere in the thread if you want more details (just look for the fucking long comments) but bottom line: money über alles is not the way to run a health service, IMHO.
So doesn't that then leave Medicare/Medicaid/ACA Exchange plans with their significant subsidies?
To anchor the ACA discussion, a calculator is showing someone making $26K at McDonald's would be paying $23 a month in premiums after subsidies (about 1% of their household income). They'll have copays, sure, but there is an OOP max; and while $23 a month isn't nothing at that income level, it's an important part of the budget IMO.
The "One Big Beautiful Bill" (OBBB) is changing some of that. It will be $23 a month after their application of the tax credits is approved.
Currently you get the credits immediately and if it turns out they are too high or too low that is taken care of next year when you do your taxes.
With the change in the OBBB you will have to pay the full amount while the application for tax credits is being verified.
Also currently if you are happy with your current plan you don't have to do anything to reenroll for the next year. The marketplace can automatically enroll you in the same plan next year (or an equivalent one if your insurance company has changed their offerings). The marketplace can automatically get your tax information and handle getting you set up for the tax credits for the next year.
The OBBB is changing that so that every year you have to reapply for the tax credit, and so potentially each year you might have to pay the full amount while that is being verified.
The net result of the OBBB will be about 1/3 of the people currently on ACA not being able to remain on it [1].
Yes, this is very true. I do think part of the problem is people aren't taught about this and adding it in to their budget. It's not nothing, but even for low wage earners it's the cost of a few energy drinks or maybe forgoing the newest iPhone/Samsung.
All you said is true. However, people are also competing with each other on lifestyle. It makes it mandatory to meet a certain level of financial performance if you want, for example, interesting friends or a girlfriend, let alone the same house as everyone, and kids. People who are a bit lower on the social scale then must part with the social insurance to increase their immediate lifestyle. Whereas when health insurance is mandatory for everyone, you won’t be competing with people who financially offer more during dates (except drug dealers and tax evaders; in Europe, professions which deal with cash like manual workers, have a much better lifestyle than engineers compared to their income).
Yes. Costs can vary dramatically based on what we're calling emergency care, however. Some people go to an emergency room for flu-like symptoms, others are brought in with major trauma from a car crash. Understandably those can result in very different bills and very different care-for-$ perceptions.
1. The US health insurance market is not a free marketplace. It's almost as far away from a free marketplace as you can get. It's socialized medicine, just done in smaller, shittier fiefdoms.
2. I've never in my life seen anyone successfully negotiate health insurance with their employer. You get a pamphlet with your pre-determined shitty options and you have to pick one.
That's something I've never understood around so many of these discussions, particularly post-ACA. I get there are some gaps around the out of pocket maximum, but if you have healthcare, even a serious medical event shouldn't be ruinous.
Are all these anecdotes just people that had no coverage at all?
1. Bad plans have really, really high deductibles and high OOP max. If you're looking at 9K OOP max then you can absolutely be financially ruined. I mean, for many people that's more than their car.
2. Out of network charges and ridiculous billing. You can get denied, you can be given the run-around, and you WILL pay more than whatever your OOP max is. Your hospital visit will result in you getting bills 3 months later. Things will conveniently slip through the cracks.
3. Not everything is covered, for example, long-term care. If you're old and sick and need to be in a nursing home, you're 100% fucked. You need medicaid for that. Not medicare, that doesn't cover it, you need medicaid. So you need to basically forfeit all your money you've ever made. Or, pay 10k a month, which is functionally equivalent for almost everyone.
I get $9K can be a hit, but is the expectation that tens of thousands or hundreds of thousands of dollars in medical care is just free?
Let's say that $9K OOP max is for a significant health event - like a badly broken leg. In the NHS, approx 4.5% of the person's income is directed to the NHS via taxes, and at an average income of 37,430 that's a yearly 1,684 going to medical expenses, or an equivalent $2,426 PPP. Are you having a health crisis every 4 years where the NHS system would be more manageable financially?
That's all even before you get into the write-offs, reductions, and relative unenforceability of US medical debt, especially for lower-income people. If you're in a place where you can't pay $9K, you're also medical "debt-resistant", really.
As for LTC, there is LTC insurance and Medicaid as a last resort. Ignoring the idea of a Medicaid trust, doesn't it seem fair that you would spend down your estate in exchange for this very expensive care you're receiving? I can only imagine the reaction from the left if a multi-millionaire's kids got to inherit the estate while the taxpayer picks up the tab for his care. In some other countries, euthanasia is increasingly being positioned as an alternative to long-term care because of the challenges with bed-availability, which seems equally unpalatable to the public.
> I get $9K can be a hit, but is the expectation that tens of thousands or hundreds of thousands of dollars in medical care is just free?
Largely, yes, it is free in most of the developed world. Or close to.
> Are you having a health crisis every 4 years where the NHS system would be more manageable financially?
Yes, the average US citizen pays about 12K dollars a year for healthcare. That's twelve. That's including health care costs, insurance, and taxes - because yes, we also burn tax dollars on healthcare.
That's the average. Are you noticing something? How is it so much more expensive?
It's because US healthcare is also socialized, just like the NHS, but it's done shitty. It's done in thousands of tiny little fiefdoms which produces one of the most inefficient medical systems imaginable.
And, what I think you and other's really need to understand, is that the US does not have good healthcare. We have consistently worse healthcare outcomes than other developed countries.
Not only are we paying sometimes an order of magnitude more per person, we don't get anything for that. It's not like we have high-quality healthcare.
> In some other countries, euthanasia is increasingly being positioned as an alternative to long-term care because of the challenges with bed-availability, which seems equally unpalatable to the public.
Yeah, we also do this in the US. Again, not only is our care very expensive, it's also very bad.
It's definitely not free. Someone is paying for it: the government, the taxpayer, etc. On a person by person basis, you can call it free because that individual doesn't pay, but that's just because they're making their neighbors pay for them.
I accept the US does pay more, but the original question I had was confined to how individuals are finding themselves in 5 to 6 figures of medical debt, given a 9K OOP maximum. The apparent answer is some combination of they weren't paying for insurance (even the comparatively tiny post-subsidy ACA plan amounts) and a broader "insurance billing is tough and messy".
As for health outcomes, the part you're leaving unsaid is just how much money in American healthcare is going to treat and manage costly chronic conditions. As just one example, the "obesity rate in the U.S. is 42%, which is a whopping 134% higher than the average of the other five nations (Spain, Italy, Iceland, Japan, Switzerland)", and the CDC estimates "obesity alone costs the US healthcare system a colossal $147 billion annually" [1].
Do you think centralizing our healthcare into a single payer or government run model would address the fact that so many Americans are so unhealthy as to consistently need thousands of dollars of care a year? Is the Canadian, UK, or US VA healthcare systems a "model system" in your opinion?
> s the Canadian, UK, or US VA healthcare systems a "model system" in your opinion?
No, because every system has problems. But they are better.
Single-payer systems are more efficient by definition. When you don't have thousands of insurers and the logistical overhead of that, you save money.
Also, yes America is unhealthy... but not that unhealthy in the scheme of western countries. Obesity is very slightly lower in the UK, for instance. And we have less tobacco use than the UK.
(EU person) From my reading, the cost is just the start. Others are: insurance companies rejecting claims for stupid reasons; providers overdoing treatments to maximize their bills; the stress involved navigating all this hostile system etc.
I don’t disagree that secondary issues don’t exist, but I also don’t think they’re unique to the American system. I’d think that there’s stress inherent to Canada or Britain’s system, with months-long waits, for instance.
The cost thing has just always been the part of online discourse that sticks out to me, because it’s clear under current laws that it shouldn’t be the financial apocalypse people paint it as, unless they have 0 insurance.
When my wife walked into ER, she was just a little worried about a heavy period. Turns out it was a “time of life thing, stuff go crazy” but they also noticed her Sodium was low when they drew blood and admitted her.
ER being what it is, beds are at a premium, and they want to “turn beds” if they can, just like a restaurant wants to turn tables. They’re both run as a business. They tried to speed up my wife’s care and gave her too much Sodium too quickly (actually about 2x the rate recommended). She went into a coma.
They tried a bunch of things to bring her back. I’ll always remember the doctor saying “I don’t think she’ll die” is an almost bored, disinterested tone as she lay there. She wasn’t responding so they moved her to share a room where a woman was undergoing assisted suicide while they waited for her to revive. ER beds are at a premium, remember. They’re can charge a lot for those, so she was taking up valuable space.
She did eventually surface, but it’s not like the movies. You don’t just “wake up” and everything starts to get better. Things were so bad your brain shut down, that has consequences. She is awake, but she is not the same person, she’s terrified of, well, everything. There were months of neuropathic pain all over her body. Pain that wouldn’t go away with either OTC painkillers or anything else they tried, all the way up to opioids. Have you ever heard someone lose their voice from screaming so much ? She was still screaming in agony, but she wasn’t making a sound.
She has been in and out of mental health asylums over the last two years while we struggled to try and fix things. It hasn’t worked. I’ve had to give up my job to care for her, a job I loved, working at Apple these last 20 years. We leave the country, permanently, on 4th July, because we can’t live in San Jose without an income, we don’t have anyone else to help, and I can retire in the UK with my family around to help out on the days we need it. I’ve only really been waiting until the kid finished the year at school.
Doctors everywhere make mistakes. Not everywhere has a money/profit motive to drive treatment though, that’s pretty much only in the USA. I had excellent health insurance which covered our family but that makes no difference when the hospital just see you as a figure on a balance sheet.
Granny Weatherwax (created by a Brit, of course) had the right of it. The root of all evil is treating people as things. People as things, that’s it. In our experience, the US “healthcare” system does not treat people as humans, they’re just figures on a balance sheet.
It’s too late for it to get much better for my wife, and hell, the stress and pressure of the last 2 years has taken its toll on me too, apparently prolonged stress and the body’s reaction to it can provoke type-1 LADA diabetes, so now I’m fucked too. Not as badly as my wife, with a pump connected to me, I can live an almost normal life, but still.
The benefit of the UK’s system is that it’s based on patient care, not a balance sheet. Like I said, I’ve had long experience of both, and this idea that you “wait months” is not how it really works in the UK, in fact we have waited longer to see specialists in the USA (again, with gold-plated insurance) than I’ve ever waited in the UK. It doesn’t matter how much money you have (presumably bar Musk-like money) if the expert you need isn’t available…
The UK will prioritise people in need (my mother has recovered from two different cancers with very timely treatment, my uncle was in open-heart surgery the next day after his yearly physical,…) but will “slot you in” if there’s no medical emergency. It’s not perfect, and it’s now recovering from a decade or so of underfunding as the Tories tried to sell it off bit by bit, but I do not believe my wife would have experienced the same treatment as she did in the US - there just isn’t the same approach to medicine.
My advice: never go to O’Connor hospital in San Jose. They might just fuck up your life completely, so they can make more money.
I would say it's more of a value choice. I value freedom to make choices and make my own risk vs reward decisions. I want to be in a society where others are encouraged to think critically about their choices (yes I know it largely doesn't happen). Others like to just be taken care of, without having to consider different choices. So any view of "better" will be subjective.
When it comes to risk-reward decisions, I think humans are pretty bad at this. Individual circumstances often influence decisions more than statistical reasoning. The chance that a human will need the expertise of a health professional at some point in their life is close to 100%, but it’s impossible to predict when and in what capacity.
I baffled that you think a society is better off leaving it up to individual choice whether to have any healthcare at all. That’s actually one of the main reasons why healthcare is so expensive and out of reach for many people in the US: leaving healthcare decisions to individuals leads to fragmented risk pools, higher administrative costs, and generally worse outcomes.
People often forget that freedom of choice in the marketplace is freedom to allow some people to make dumb choices or bad choices. Often times when I hear people complaining about the lack of health care in the US It's because they prioritize short-term gains over budgeting for health care. They're gambling with their health, most people win but some people lose and they lose hard. They're hindsight isn't that they teach people that they should get health care and prioritize that in their budget. Rather they talk about socializing the costs because their irresponsibility somehow a burden to every other responsible person in society.