This hits home for me.. my son (now 4 years old) was born very premature at 29 weeks and some change. He spent 7 weeks and 4 days in the NICU. The total hospital bill that was charged to insurance (before settling it between themselves) was roughly 960_000$.
If you include the additional services and whatnot in the few months following being discharged from the hospital he was a million dollar baby.
Complete insanity frankly.. few things make my blood boil more than the sad state of health insurance in the US. Sure, it has gotten better since the ACA… but there is soo much more that needs to change.
It depends quite a bit on what happens in that NICU. Our daughter was 32 as well and had a relatively uneventful stay. Same for many other infants. Our (insurance) bill was ~30-40k and out of pocket was minimal. Other's were not so lucky, having all manner of procedures including bowel resections / repair, heart surgery, etc. Many things look routine but I can assure you pediatric heart surgery is anything but.
So, not to defend the (out of control) prices, but only to say no two NICU stays are exactly alike. We can run the gamut from "a nurse could handle 100% of their care" to "we need 4 different specialists with decades of experience each to keep this person alive" and the costs fluctuate accordingly.
It was free to you, but not the system. NICU is very expensive even outside the US, you’re talking several thousand a day. So 6 weeks could run $100,000+ easily.
The marginal cost to the patient for having that treatment was zero.
Meanwhile in the US the federal government spends 8% of GDP in tax payer funds on health care, for things like Medicare, Medicaid, CHIP, etc. That's the same as the UK pays for health care, counting public and private expenditure combined. You are already paying the cost of an entire first world health care system in your federal taxes, and as an employee you and your company also still have to pay for your own private health care to actually get any treatment for yourself.
Yes, we are paying for it, but given that governments negotiate prices for 100% of the population you get much better deals. Also, looking at taxation rates in the USA [1] vs. Europe [2] I don't see a difference big enough to justify the need for privatizing healthcare.
Furthermore, considering the Europeans also get basically free higher education (I payed around 20USD every 3 months to get my CS degree) I believe people living in the US got a far worse deal.
Finally, I don't blame US citizens as I have many colleagues and friends from across the pond, but I don't understand how you guys can tolerate the practice of "lobbying", which is what created your healthcare system.
Nothing is free. Even if no money exchanged hands, someone put in some time and effort, which has a cost, even if it was just going and picking an apple for themselves to eat, from their own tree.
Pointing that out isn't helpful; it's not relevant to the point at hand, and everyone knows there is still a cost.
This American fixation with the word "free" always makes me chuckle. Aa when a bus driver in Las Vegas got angry when I asked them if thag was the "free" bus, and he angrily replied "it's not free, its complimentary " .
Maybe you saw it on a previous story where I shared it as well? If you look through my comments you'll find it. Albeit a bit more expanded I think. Sorry if this bothered you.
True, but that said, rates in US hospitals are massively over-inflated. They get away with it, insurance companies are not pressuring enough to lower cost (they're probably in on it), and there is no real competition.
I don't disagree I just dislike the dishonesty being presented. The word free is used to make it seem much more palatable to put in universal healthcare and they know it. The reality is there are downsides to having universal healthcare.
Because mental funds are non-fungible. Amortising health costs through progressive income tax helps a) keep overall costs down, as the state centrally organises the health system / collectively negotiates with providers and b) is more fair. It doesn't feel like you're being utterly screwed through no fault of your own - e.g.: medical bill after an accident or violent attack. Instead society at large acknowledges two things a) we all need medical care and b) our need is largely disconnected from our capacity to pay.
I think I'd find the uncertainty that seem inherent in your system completely terrifying - its bad enough being sick but then to not know what that would cost seems crazy.
I can't help thinking of the book title by Aneurin Bevan, founder of the UK NHS: "In Place of Fear":
Yes, the uncertainty is by far the worst part. I personally won't seek medical help unless I am completely sure I have a problem I can't handle myself (which will likely get me killed eventually, but at least my family will be able to pay for the funeral). A large part of that is not having any way to pre-budget the cost. If I don't know for sure I have a problem I can't deal with, I could go through thousands of dollars worth of testing only to find that it's acid reflux. And at that point the reflux would become worse because I'll develop ulcers just thinking of the debt.
The billing system is a complete farce. Here’s a large made up number for the total bill, ok here’s another large number because we like your insurance, and finally here’s what your insurance actually paid.
My wife had complications the first time and the total bill was like $35k, insurance paid $9k, and our cost was $0. We actually got our $250 admission back.
Nobody pays the made of number from the first bill not even the uninsured.
“Nobody pays the made of number from the first bill not even the uninsured.”
This is maybe true but the actual number you pay is a total gamble depending on whatever the hospital feels like they can discount this month, whatever loopholes the insurance has found for not paying, whatever hoops the insurance or hospital have set up and you have jumped through correctly or not and how much time you have for the next few months or years to fight the bill.
It’s a totally insane and arbitrary system. Probably the pinnacle of a large and unaccountable bureaucracy. Sometimes I wonder if dealing with the mob is a more straightforward and reliable thing vs going to a hospital.
And therefore it's always a gamble of whether one should go in and causes many to not go when they should because "is this really worth we potentially having a thousand plus dollar bill?"
That’s my position. Especially with deductibles I am very hesitant to go to a doctor. Is it really worth $3000 deductible plus other unknowable cost to have something checked out?
Imagine the life you could setup for a child, with a million dollars to start off with. Instead, it just lines the pockets of the corrupt healthcare industry.
Wow. My daughter was born at 25 weeks and spend 4 months and 1 day in NICU, just over 10 years ago. This was in the UK. If my memory serves me correctly (which it may not, my brain was pretty fried throughout that time), we were told that the total cost to the NHS was roughly 150,000 GBP.
Here are a number of metrics that have improved since the ACA.
- percent uninsured decreased
- number of people skipping treatment for cost reasons decreased
- number of people with "pre-existing conditions" covered increased
- satisfaction with coverage increased
- growth of healthcare costs slowed
Not to mention other provisions that are broadly popular such as children being allowed to stay on their parents health insurance through the age of 26 and mandates that require all plans to cover basic services.
I filed for bankruptcy about 10 years ago due to a family member's medical bills. Funny, a year afterwards, when establishing credit again, all the financial institutions were like "yep, no problem, it happens".
24 months later, credit was back to normal-ish, bought new car, financed new home, and no medical debt.
Depends on who you ask. Before Obamacare if your employer didn't pick a great insurance plan and you got seriously sick the insurance could cut you off after you hit a lifetime maximum and then future policies wouldn't cover that specific condition because it was considered pre-existing.
This happened to my parents in the 90s and we went through multiple lifetime maximums and had to pay hundreds of thousands of dollars over the course of 10 years.
Obamacare is great for making health insurance actually act like insurance.
People on individual market with no subsidies (making over, say $50k) got absolutely raped by the ACA. It's great that many uninsured got insurance, but many people like myself spent years uninsured post-ACA because the cost was higher than a mortgage payment with absolutely zero realized benefit until the massively high deductible was met. People who couldn't afford this were then charged thousands by the IRS as a penalty with zero benefit. I find myself not a fan of it from a policy perspective. Didn't like the way it was passed, written, or implemented. Some good effects, but truly bad effects as well. Scrapping the mandate was beneficial for people in my position (starting businesses), but still the healthcare system in the US is a train wreck. It's neither a free market system nor a public system. It is fundamentally broken unless you are an employee of a larger corporation that offers benefits.
That's insane. At most it would have cost just a few thousand in many countries in Asia with comparable medical competencies. So is there a new strategy of going to non-western countries to deliver babies and have expensive surgeries?
Of course I don't need to mention that in Canada and most countries in Europe this wouldn't have even been an issue. That would be pedantic. /s
Not entirely true any more, unfortunately. Many (Western) Europeans go to countries like Poland, Hungary, Turkey for treatments that are typically not (fully) covered by health insurances, like manydental or laser eye surgery.
There are private clinics specialized on Western European patient with staff speaking fluent English, German etc.
Pole here. Recently my friend gave birth at 27 weeks to two boys, 700g (1.5 pound) each. Premature newborns spent over 3 months in the hospital (pediatric ICU), were unable to breathe by themselves. Parents got vaccinated in January against corona and the official "early birds" vaccination process for the population started about 3 months later (for public service). Everything was free of charge. I can't imagine having to pay for a visit in the hospital.
EDIT: Also, I know a guy from Denmark who flies to Poland just to fix his teeth.
Same. My wife gave birth last year at 26 weeks. 3 months in the NICU was over $1MM and that doesn't even include the delivery. We were extremely fortunate that my wife works and has good insurance because I had just been laid off a couple weeks prior. We were big proponents of a medicare-for-all-like system before all that, and even bigger proponents now.
Of course the hospital never expects to receive this amount of money. Either they will negotiate it down for uninsured patients, or they will accept a lesser amount from the insurance company.
Insurance companies like this over representation of costs because:
1. If you have a percentage copay (edit: "coinsurance"), say 10%, they will tell you to pay $25k because it's 10%, but they might only pay $75k. In this example you clearly paid 25% but they tell you it's only 10%.
2. A quarter million dollars is terrifying and you better not ever lose your insurance.
The obligatory comment about how crazy this is on many levels.
1. You are being charged prices that you are not expected to pay, but need to negotiate on
2. When you go to a doctor to have a procedure or have an emergency then you don't know what you are paying.
In normal countries there is A price list, which is THE price list for all hospitals that are part of the national health care system. If they want to have a contract with the national health insurance, then they need to agree to these prices for all the possible procedures. So when someone is saying "but we can't be sure of the price, maybe there are complications and additional costs" then this is bs, many-many other countries manage to have fixed price lists. Or maybe there is an item there for exceptional cases, when something addtional needs to be done in addition to the original procedure? Either way, it's already handled, the patient doesn't need to worry about this stuff. And the same goes for private clinics, they also have a fixed price list, nobody would go to them if you could get a surprise bill that would be 2-3-10x the amount originally agreed upon, that would be insane and.. very bad PR for the clinic.
indeed. Think how far airlines would get if they said:
" Sorry! We can't give you a quote. We don't know if you will use the on-flight entertainment on the flight, or if you will end up clogging the toilet midflight, or if you will eat 4 bags of pretzels. There's also the chance we will have to make an unscheduled stop due to weather. That is why we can only bill you once we arrive at your destination"
I've never even heard of such a thing in the UK NHS - i guess some kind of cost accounting must occur but I don't think it goes anywhere near patients or care givers.
In Romania there is a price list on display at my public insurance general practitioner which applies if you're uninsured but private practices also have pricelists on display.
In Austria I've also never seen a pricelist in the public system as the system assumes everyone must be insured if they live here but you do get a bill at the end of a hospital stay to pay for food and such things. Ironically, many private practices here also have a scummy system where they don't share their pricelist publicly neither online, neither by phone, you only know the prices after a "talk with the doctor" (that you also pay for), presumably to keep their competitors and their customers, sorry, I meant patients, in the dark about the market prices.
I wasn't implying that there isn't a price list - just that for the overwhelming majority of cases it is irrelevant to both patients and medical staff.
Also, as far as I understand it there are only prescription charges in England and not in the rest of the UK. Certainly here in Scotland there are no prescription charges anywhere.
> 2. When you go to a doctor to have a procedure or have an emergency then you don't know what you are paying.
Even when it's not an emergency, it's an amazing bucket of crap.
I take a specialized drug that's very expensive (~85k$/yr). I was considering changing jobs. No one in the HR of the new company, or the CSR side of the new insurer would tell me with any certainty that it'd be covered. The best I could get out of anyone is "we think it's covered, but we cannot promise it will be, nor will we pay out of pocket if it isn't". My doctor's office would just say "most of our patients on <x> insurance can get coverage. Not all, but most"
The bit about not covering it out of pocket might be a statement on how much they wanted me, but the first part is just maddening. It's a large part of the reason I didn't switch jobs. At least I know I can get insurance to cover the drug for now.
You pay whether the doctor killed you or not. Roughly a quarter million Americans are murdered annually by preventable medical errors, and nobody cares. Furthermore, your estate gets full billing after they kill you.
Connecting billing to outcomes would go a long way to fixing this disaster of a system. It would help align incentives for these sociopathic quacks to stop murdering their patients en masse.
You pay: $reasonable_amount if your oncologist gets your cancer into remission, but you pay precisely $0 if the attending physician didn't bother reading your chart because they had to tee off at 3pm and then grab dinner at Fleming's with their mistress, so you got the wrong medication/procedure and you're confined to a wheelchair for life, or dead.
I can't think of any other profession, other than attorneys, where outcomes aren't intimately tied with compensation. Doctors and nurses, as modernity's new Gods, need to be brought down a few pegs with regard to this extravagant privilege.
... to say nothing of the fact that they are worse diagnosticians than a buggy Expert System written in Perl by a drunk college student in 1994, but because they are human, we should rely on them to make life or death decisions. But that's a discussion for another day.
Although in Belgium I've found out that you can still have unexpected costs because for some reason, only one type of procedure per day can be reimbursed. Which means if you have a problem that takes two (or more) ultrasound scans to be diagnosed, only one of those will get reimbursed and you'll have to pay for the others.
This happened to us with our kid, first hospital did a scan, concluded that we should go to the children's hospital close by for better treatment, the doctor there did a scan there the same day to see for himself (at 23:30! half an hour later and it would have been reimbursed) and of course this one had to be paid for. Which is beyond stupid IMO. Well at least it wasn't US-level prices.
We took a baby to the hospital while in NZ. Thought baby had chicken pox, turned out to be just "Hand Foot Mouth" which is not as bad. There was a big price list on the wall at check in. Paid $70 up front and baby got to see a german doktor, all done in half an hour. I think the price was cheaper or even free if you were a NZ citizen.
> If you have a percentage copay, say 10%, they will tell you to pay $25k because it's 10% [of $250k], but they might only pay $75k [after negotiating the $250k down to $75k].
Yes, exactly, which is why it doesn’t actually happen. I’m not sure where the OP got this idea, but this isn’t how insurance billing works in the United States.
Nope, it's fraud and the insurance company will / should be destroyed. But they will probably settle out of court for the damage + a little extra to not be stuck in court for a decade.
> If you have a percentage copay, say 10%, they will tell you to pay $25k because it's 10%, but they might only pay $75k. In this example you clearly paid 25% but they tell you it's only 10%.
I think this is coinsurance, not copay. Copay is the $50 (or whatever) flat fee you pay every time you see a specialist. Coinsurance is a percentage of costs that you share with the insurance company, up to some maximum out of pocket amount. I believe that this percentage is always on the negotiated rate, not on the original charge.
Thanks I edited my comment to say it's called coinsurance. But the point is the same, and in my experience it is not always based on the final negotiated amount actually paid to the healthcare provider.
A lot of insurance companies will have a 10-20% coinsurance for hospital visits, not a traditional co-pay like you went to a specialist. That 10-20% goes against the deductible, so depending on the bill you might not even pay the full 10% because it hits your deductible max.
Edit: I was informed that it's not 10% co-pay but coinsurance. So I updated my post to reflect that.
At least for the insurance I have had over the years the insurance caps are applied prior to the co-pay. In some bills you can see the charge, and how much the insurance paid instead.
My 1 week old was in a neonatal ICU for 2 weeks. This included an ambulance run from one city to another one 1 hour away because they original NICU didn't have the right equipment.
Total bill was $97,000, insurance bumped it down to $68,000.
How does #1 work in practice? I've went through several insurance providers over the years, and they always have "Amount billed by the provider", "amount negotiated", "co-insurance" which is on the amount negotiated.
It doesn’t actually happen. When you get a bill, you can see clearly how much hospital charged, how much insurance negotiated down, and how much is your share. If insurance sent you this, but then secretly conspired with hospital to pay even less than what they told you they pay, that would be criminal fraud. Suffice to say, this almost never happens.
It happened to me in the US and I asked a friend who was a practicing medical doctor at the time, plus another person who worked at a major insurance company. They both confirmed it can be done.
I don't understand how people can be so anti-universal healthcare in the US. When you have an $8k deductible, your insurance is basically a gift to the CEO's yacht fund.
There are many problems with our Canadian system, it's certainly not perfect. And single payer is not the only way to approach this problem. But I'm overall happy with its compromises in our system. Like any economic resource, it's rationed. But it's rationed, generally, on the basis of need. And that "from each according to their abilities to each according to their needs" philosophy may be the ideological curse on it that will prevent it from ever having adoption in the US with its virulent anti-communist past. It would never happen in Canada now, it was a product of the 1960s and early 70s and the way things were then. And it's consistently under threat from its ideological foes here, even if it's immensely popular among the Canadian public.
What boggles my mind about the US system is the blatant way it makes working people dependant on employment for health coverage. In a way it's a form of feudalism, tying people physically to their employment.
You're contradicting yourself by claiming it's tied to employment and then saying you can buy it for a price.
It's one or the other.
Or you can claim the price makes it effectively tied to employment.
I agree the cultural ties it has to employment ought to end, but that's a peculiarity of the american system, not a fundamental feature of a private healthcare system.
>So there is no way to get affordable insurance to cover the gap in employment in a way that preserves cash reserves.
I fail to see how it's any different than "there is no way to get affordable housing/food to cover the gap in employment in a way that preserves cash reserves". I suppose you could argue that with housing/food your costs stay the same regardless of your employment status, but from a finance perspective it's still the same. There's no difference between losing a $6000/month paycheck and losing a $5500/month paycheck and $500/month in insurance subsidies.
I dont know if the Canadian, the British or even the German model are the best. But what is clear to me is that for profit insurance is a system that doesn't make sense. There should be a way to align the interests of both the organisation providing the service as and the individual using/paying for it. In the American model these two are completely opposite, which doesn't make sense in an inelastic market.
Maybe if that system had VERY strong economic regulations (like, the government would set prices for everything and let private carers compete in "value added".)
Absolutely. If the NHS and National Insurance weren't already invented I'm positive they would never be implemented today. I mean can you imagine someone like Clem Atlee in power today?
>In a way it's a form of feudalism, tying people physically to their employment.
This is a feature, as far as major companies and lobbying organizations are concerned. It's a major reason behind the resistance to universal healthcare because the duress of losing health insurance is the only way some companies keep their employees.
Because in the US, if you're reasonably healthy, employed, live in a city with good hospitals and have private insurance, it "feels" better. It's easier to get better care.
I'm Canadian, now living in the US, and I'll be honest: for the first couple of years, where I had some medium sized health issues, the US system felt so much better. The hospital I was treated at was leagues better than anything I saw in Canada. The amount I had to pay on my paychecks was lower than the complementary insurance I had in Canada. I had dental insurance everywhere I worked! My teeth are a trainwreck from the years I didn't have access to good dental insurance).
So if someone was to dig in my old social media posts, they'd see my old stance of "I would prefer universal healthcare because its more fair, but if I was only thinking about myself, the US system is better".
Then, as anyone who knows better could have predicted, it went downhill and I was proven wrong. If you have something that's hard to diagnose, the insurance starts fighting against you/your provider to get lesser care (eg: getting a full sleep study is super hard because insurance companies will just want you to take a cheap at home sleep apnea test. If you have a sleep disorder that's not sleep apnea, good fucking luck).
Some providers will not talk to you if they're not in contract with your insurance. Good luck getting behavioral health care. Lots of clinics are in bed with very specific insurance, and will not even take self pay. So you have to call 15 of them because even the ones on your insurer's website may not want to speak with you.
The paperwork. Holy shit the paperwork. I had surgery once, and I was still getting bills for it 6 months later. SO MANY BILLS. Some of them were absolute bullshit, but who has time to call insurance and hospitals over and over and over to fight every single one when there's douzens for a single procedure. So I just paid the co-insurance fees and suck it up. I never had a way to tell when I was getting "the last bill".
In the end, I'm reasonably well off, and I have pretty much the best insurance one can have (no deductible, no employee contribution on paycheck, covers virtually everything), and it's STILL a pain in the ass. A pain enough that I've offered some providers to just pay cash to avoid the bullshit. THEY SAID NO and sent me on my way.
Oh, and if I want to start a business, work for a pre-seed startup, or just want to take some time between jobs, I need to coordinate with my significant other to make sure they are not planning on quitting any time soon so we don't have to deal with COBRA or worse.
This is due to the tying of healthcare unnecessarily to employment with discounts if negotiated that way, not a fundamental part of private healthcare.
Said entrepreneur can also buy a plan from an exchange
You go to the emergency room and let the bill go to collections. Just make sure you have a different phone number for medical stuff so bill collectors don't bother you while you are working.
Having experienced both system as well, the Canadian system is much less burdensome, but if I had serious cancer I’d take the US system any day. They throw the kitchen sink and more at you in the US and insurance will pay for most of it.
My grandmothers neighbor is in her 70’s and not great health. She needs a hip transplant and the doctor is basically like “nope, you don’t have many years left, better to prioritize a 50 year old”. Which makes perfect sense from a population perspective but sucks balls at an individual level.
Ehhh. Insurance will pay for what they want to pay. That means some treatments will be completely covered, and other treatments that your doctor really think should happen, won't be approved. Sometimes its because the doctor's out of wack and the insurance is calling bullshit on them (that's good!), sometimes insurance are just cheap (that's bad).
The biggest issue to me is getting far enough to even diagnose the cancer. In the US, they tend to just want to go through as many patients as possible. Maybe toss you some pills, but that's it. It's hard to get doctors to go through the more advanced diagnostics.
I had gallbladder stones for a while and it took FOUR YEARS of every doctor I talked to dismissing it as GERD (wtf) and countless ER visits before one lost patience and did the ultra sound here and there. "Oh, look at that, its not just plain stomach pain".
But who cares about finding the root cause when you can just keep billing patients after patients for GR visits where all you do is take their vitals and prescribe PPIs. If I had cancer, I'd be dead.
But yes, on the other end of the spectrum, my grandmother in Canada almost died because of critical and time sensitive heart surgery she needed that got cancelled and rescheduled over and over and over...
> Having experienced both system as well, the Canadian system is much less burdensome, but if I had serious cancer I’d take the US system any day. They throw the kitchen sink and more at you in the US and insurance will pay for most of it.
Of course this means they'll also push incredibly expensive but dubious interventions for all patients (even those that are clearly terminal).
I have no idea whether Canada etc are better in this regard, but all the incentives line up to treat all patients in the most expensive way possible to the "bitter end." I've seen this personally with terminal patients, resulting in them squandering their final months on brutal and ineffective treatment as they follow that "false hope" to gain some "extra time," but it also means expensive (and high risk) surgery is encouraged way more often than e.g. physical therapy for minor issues.
I guess if you're a very savvy consumer this system could work for the better, because you would only opt for the truly necessary and likely to be effective expensive procedures, but it's incredibly difficult to make clear-eyed decisions in moments of health crises.
The people who are against universal healthcare usually pitch it as an argument for "choice", as if I'm going to compare prices when I have a ruptured appendix. It's also usually couched in anti-government sentiment, where they draw comparisons to "lines at the DMV", as if other countries with universal healthcare have people dying while waiting in line for care, something that also doesn't happen.
It's also worth mentioning that private health care and insurance both exist in the UK.
Individuals still get the choice to go to any private doctor they want, they'll just have to pay for it themselves. Just like the US, except the NHS provides an excellent safety net for everyone without private insurance or the means to pay for private care.
And in some cases it involves NHS facilities too. There are definitely some questionable aspects of our public/private healthcare. But again, this isn't always how it works, and the ethics involved are also complicated.
I know someone whose condition rapidly deteriorated while receiving treatment in a private hospital and when things were looking really bad they got transferred to an NHS hospital.
I hope the person you know was OK. That transfer is actually not surprising. Emergency/intensive care is almost always NHS here.
Private options tend to be better in situations like having multiple treatments available where one is significantly more effective or more reliable but also costs a lot more. Sometimes the NHS will only offer a cheaper but inferior alternative, which sounds horrible until you think that there is a huge but ultimately pooled budget and any time policy allows more spending on one treatment there is always someone losing out somewhere else.
Agreed on both points. The UK system is far from perfect but for balance we should also say that it is not normal or expected for something as bad as that to happen here. Even in recent times, with the extra pressures of COVID, critical care has mostly kept up and the emergency overflow facilities that were built very quickly in case of overwhelming demand mostly went unused.
Obviously there will always be limits and the available resources will run out if one of them is reached. In the aftermath of a major incident or an unusually busy period it can happen. I expect a lot of us from the UK might agree that the limits need to be raised further by investing more into the NHS. But I would still choose this type of system over a US-style one every time. I've never heard of anyone here dying because they couldn't afford tens of thousands for routine medication to treat a common condition.
I'm a big fan of universal healthcare, and have made great use of both public and private hospitals in Europe and the US.
Everywhere I've lived (except the US) has had a totally free public system, and every time I've still paid for private insurance. I'm not rich by any means, and I don't have any particularly special requirements. I'm not even looking for better doctors or machines, since they are mostly shared or equivalent between public and private care.
The only reason it's worth it for me to spend money on private insurance is waiting times. On the private system, I can see a consultant in one month instead of six, or get a surgery in three months instead of three years. This is all for non-emergency care of course.
There are lots of elderly people waiting on operations like hip replacement on the public system, and it's expected that some will die before their turn comes up. It's a compromise that's built into the way the government operates their national health system. It not obviously the wrong way to do things, since carrying out all these operations would be very expensive and have limited benefit in terms of quality and quantity of life. It also sucks for the people waiting, especially since others who can afford to skip the line by paying (usually through private insurance) may even be seen by the same surgeon in the same OR.
I don't mean to argue for or against this system, but just to point out that people often die waiting for (non-emergency) care in at least several large public healthcare systems in highly-developed countries in Europe.
> On the private system, I can see a consultant in one month instead of six, or get a surgery in three months instead of three years. This is all for non-emergency care of course.
Have you considered that you are essentially jumping in line just because you have a larger wallet than other people?
Yes. I find it difficult to deal with morally. Fwiw, I'm not particularly well-off, and I only spend about two weeks' worth of take-home pay a year on my insurance.
My intention was not to flame you individually, but to emphasize that the argument "well, the lines are shorter" is pretty shallow without some background information on what that means in practice.
The countries I have direct experience with, France and Germany, don't have any issues with people dying while waiting for procedures. Experts are usually readily available, so there are exceptions.
I don't know of any public health care system in developed countries that have really these issues. I do know so, that a lot of that comes from a PR campaign run by US insurances against the Canadian system.
When you say they don't have any issues, do you mean it doesn't happen?
I'm more familiar with the Spanish, Irish and UK systems. I tried to find a nice document giving numbers for what I was describing, but most of what I can find is anecdotal, and the official reports are weren't quantitative.
I'm certainly open to US insurance companies paying me to shill on hn against Canadian healthcare, but right now I'm only saying these things out of the goodness of my heart.
Waiting times do happen, usually end of quarters when the quarterly budget runs out. No issues in so far as these waiting times don't affect emergency procedures.
And no, I don't see a direct link between public health care and wait times. The German issues are mostly caused by a bloated bureaucracy.
I think we're pretty much in agreement then. Emergency procedures don't have long waiting times in any of these nice European countries. (Of course, even in the US they will give some urgent life-saving care to someone who can't pay.)
I also think that these (some several year) wait times aren't unavoidable. Management of these national public health systems is fabulously complicated and difficult and expensive, but it could certainly be done much better. In the end I think a country that really wanted to, and was willing to pay, could have a public system at least as good as what a 1%er in the US gets.
Absolutely in agreement. IMHO in Germany the main reason is budget, defined quarterly. So of course a Doctor might push out appointments to the next quarter if he can when he ran out of budget already. And the ratio by which doctors practices are assigned and planned. That leads to an abundance in cities and a shortage elsewhere. And that imbalances cam, and do, drive wait times up. Going from experience so, it got better.
Theoretically I could switch to Germany's private insurance scheme. I have no willingness to do so.
The issue is less about coverage and more about the insane, opaque, and fradulent medical care pricing in the US. No other industry has such a black box cost structure to it.
Coverage is very important, but it must be done in tandem with cost transparency and freedom to choose different insurance plans.
Whether or not a policy with a deductible like that is a gift to the CEO's yacht fund depends on the monthly payments and is, imho, orthogonal to a discussion about universal healthcare.
Considering how hard they actually fight when you actually have to get care (e.g. having the doctor submit tons of justification that you actually need the required treatment vs. some half-assed cheaper approach), I don't think the monthly payments actually matter.
AFAICT, Universe healthcare is akin to a single monopolist insurer who bases the premium on your income, not your medical profile. (Plus the hospitals and pharma industry self-organizes into a cartel) I don't understand how anyone rational can agree that's fair.
Single payer healthcare systems in Europe were introduced a long time ago. Back then, politics was different, not least because of an imminent threat of the Soviet Bloc just around the corner and a need to answer it by "carrot", too, not just "stick".
They are now status quo, but in another version of history, where such systems would have to be introduced today, I am not certain whether they could clear the political obstacles, much like the U.S.
Size matters and prior to the Cold War, social security nets were smallish, not least because the willingness to pay enough in taxes for their upkeep just wasn't there.
Bismarck mainly introduced some rudimentary social security to decrease worker support for socialist parties, so it was a reaction to socialism (albeit not directly the USSR) from the start. However before WW2 it was very limited in all countries (and much smaller scale than for example what's currently available in the US) before the 40's and 50's.
As an American who immigrated to Europe four years ago, I disagree that modern-Europe would not be able to recreate their healthcare systems under today's polticial climate.
Ironically it is because of the USA that many Europeans are keenly aware of the davistating consequences of allowing for a hyper-capitalistic approach to healthcare. People here often assume the worst about that system, and are completely bewildered when I tell them how it actually works. (Especially in regards to having children, parental leave, and childc care.)
Agreed - I'd like to see the list too, because I'm genuinely interested in trying to find a better health care system than what the US has.
I like poking around through here to compare and contrast options: https://www.commonwealthfund.org/international-health-policy.... Some things I notice mainly are that the countries with private health insurance have at least two other things the US lacks:
1. They provide universal health care.
2. They have regulations of the market.
How they go about doing that varies a bit, but I believe these are critical points we miss for all the various reasons we see in this link and in many other discussions on the topic.
I think often in the US when we talk about private-sector, we also implicitly also mean for-profit, whereas many of the other options require them to be private non-profits. I think it's notable they are de-prioritized or outright banned, though I'll admit I don't really know if this is a critical detail or not. So I think to the GP point, perhaps this is a way to change private sector options for the better?
Switzerland has a system that basically works like a beefed up and less hogtied ACA. It's a very heavily regulated private market that would likely not be considered ideal for America, though some have suggested it as an option.
$8k deductible might be reasonable if $250k bills are the norm.
It is not spoken out loud a lot (more during COVID), but the people who are against universal healthcare are likely pro high birth rate and survival of the fittest (unless they have money, of course).
You need a high birthrate to continue to suppress wages, don't forget about that! Once to population curve starts to flatten out, I do not see private insure prices going down as they will not be able to let go of the profit hence driving prices up higher.
There are really bad things with the current system, but you asked a question.
People are exposed on a regular basis to the DMV, the SBA, to Social Security or to Medicare. Then they compare that experience with the avg experience with a commercial insurer, and it does feel like a better experience (of course, if their employer can afford it)
Worse, there are stories of friends in places like CAN, where insider doctors hurriedly email their friends about a new doctor X that is available for appointments, in order to skip a 6 month wait...
The system in the US is a mess, but those people reason that its the least worst option of the available choices.
If they could be given a 3rd or 4th choice, like for example, make take health insurance companies and turn them into public utilities so the "CEO" is not getting his "yatch fund" from taxpayers, that's worth talking about (as longas you don't forget to look to CA, and their wonderful brownouts + utility-enabled wildfires)
> People are exposed on a regular basis to the DMV, the SBA, to Social Security or to Medicare. Then they compare that experience with the avg experience with a commercial insurer, and it does feel like a better experience (of course, if their employer can afford it)
That’s not what surveys show:
> Americans' satisfaction with the way the healthcare system works for them varies by the type of insurance they have. Satisfaction is highest among those with veterans or military health insurance, Medicare and Medicaid, and is lower among those with employer-paid and self-paid insurance. Americans with no health insurance are least satisfied of all.
Selection effects. The poor and elderly are likely to be on Medicare and other public programs. If you can't afford healthcare and get it for free of course you'll be happy
It's like my charcoal Weber. I found it on the side of the road. Its dirty, dinged, and the wheels are falling off. But it was free and I can grill on it, so I'm extremely happy with it
On the other hand if I paid for a Weber and got that, I'd be pissed.
> People are exposed on a regular basis to the DMV, the SBA, to Social Security or to Medicare. Then they compare that experience with the avg experience with a commercial insurer, and it does feel like a better experience (of course, if their employer can afford it)
And yet, people will also defend SS and Medicare/Medicaid till the ends of the earth. I personally find the only people that endlessly rag on social services, and to a large extent, government services, are people that have money and usually a lot of it. It's fine to argue for stopping inefficiencies, but to argue that the only way to stop inefficiencies is the complete abolishing of a government service is the peak of a particularly American argument. The argument usually comes from a place of "I have money, why do I have to put up with this, why do I deserve this?", which is an odd position to take. Americans usually carry the view that quality of service should scale with how much money you make or have, but that leads to a perverse view where worse off people, or low wage earners "deserve" the care they get in a dog eat dog world. When you have socialized healthcare options, that mindset comes across as bizarre if also irrelevant. "Deserving" never comes into the discussion aside from the idea that everyone deserves healthcare, which is the starting premise/assumption anyway.
> Worse, there are stories of friends in places like CAN...
> The system in the US is a mess, but those people reason that its the least worst option of the available choices.
The odd thing is, Canadians might criticize the Canadian healthcare system, but I have never met a single Canadian who would suggest the American patchwork is the "least worst option". It's that kind of reasoning that a lot of people from outside the US find nearly delusional.
> People are exposed on a regular basis to the DMV, the SBA, to Social Security or to Medicare. Then they compare that experience with the avg experience with a commercial insurer, and it does feel like a better experience (of course, if their employer can afford it)
This probably varies regionally.
My local - upstate NY - DMV is quick, efficient, and the folks there are pleasant and competent.
My private health insurer hasn't been able to fix my website login for four years, routinely denies care for chronic conditions, and fulfills most of the nasty stereotypes about government bureaucracies.
The reason universal wouldn’t work is cost is an issue. You can’t just say, sure, we’ll pay for everything. Recipe for exploding healthcare costs.
So how to reign costs in? Cut physician salaries? Not likely. Limit procedures? Maybe. Stop paying for the latest cancer drugs the day the FDA approves them? Probably.
You know universal coverage exists, right? Europe, Japan, Australia, New Zealand... you can't claim it's impossible to structure when there are dozens of functional examples out there.
"Universal coverage" is not "we pay for everything without question or approval process". In both systems, there are people who decide what's covered, and for whom. As for "exploding costs", the US is more expensive - in both public and private spending - than the "universal coverage" spots. https://data.oecd.org/healthres/health-spending.htm
How much do you think gets taken out of your paycheck before you get it in country's with universal healthcare? And that happens even if you don't use it.
And who the hell has an 8k deductible?
This choice isn't 8k deductible or "free" healthcare. That's a farce.
> How much do you think gets taken out of your paycheck before you get it in country's with universal healthcare?
Less. https://data.oecd.org/healthres/health-spending.htm has a chart of all OECD healthcare spending, both public and private. The US clearly stands out at the end. Employer-provided healthcare "gets taken out of your paycheck" all the same, just less visibly. This is a significant part of the political problem in the US; the true costs are hidden.
"For a family of four, average Bronze plan deductibles are rising by 3% (from $13,017 to $13,394), while the average maximum out-of-pocket limit is increasing 4% (from $14,916 to $15,462)."
You realize they choose the bronze plan so they can pay less right? They're not forced into having an 8k deductible. They do this so they can have less taken out of pocket and only really use the healthcare in a major emergency. This would support the idea that people prefer the US system and not universal healthcare.
The simplest answer: the Senate overweights rural voters, who in turn hate government spending and big government. Until the Senate is representative of the US population, we will never have sweeping programs like this. Even if the Senate is fixed, the supreme court could likely strike down any legislation that's too progressive, since it's now 6-3 conservative lean due to the Senate and McConnells robbery of the Garland spot. It's a messed up system, sigh.
Healthcare is scarce and i prefer market allocation to a wait list for allocation. Nation with government health care is also having scarcity problem, some things on waitlist. With a market i can throw more money at health problems, waitlist i am at the mercy of bureaucrat. This is better for me since I have worked very hard on making money and these days i have some extra i can spend for this.
I am healthy also, young somewhat, and wanting to be in healthy young risk pool to lower my costs not be in giant all-nation pool where I am accepting more financial burden.
Your comment misses the point. There are two reasons why this bill is so high: 1. Some doctors and some hospitals are make tremendous amount of money - hospital revenue is about $1T and doctor revenue is about .5T. 2. This country has an insatiable demand for expensive healthcare.
There’s no country with universal coverage where a child with little chance for survival would have received this level of care.
> As the Obama administration sought to reform the US healthcare system in 2009, the US Investor’s Business Daily argued that Stephen Hawking “wouldn’t have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless”.
> It was duly pointed out that Hawking was not only born and educated in England, but received more care than most from the nation’s health service. “I wouldn’t be here today if it were not for the NHS,” Hawking told the Guardian at the time. “I have received a large amount of high-quality treatment without which I would not have survived.”
It also does so to anyone who needs it regardless of ability to pay, and at overall half the cost of health care per person in the population compared to the US. You can also still pay for enhanced private health care if you want.
And yet, while many american insurers cover expensive gene therapies, European autorhities simply pretend the drugs are unsafe and refuse to cover them.
> Yes, it goes both ways, but it goes much further one way over the other.
That's fair.
For gene therapy, I was referring to Zolgensma, which was delayed substantially in Europe and forced many to seek treatment in America. The delay was mainly due to cost savings, and the delay was clinically meaningful (since treatment is time sensitive).
Portugal too. Our system is far from perfect (the best medication is sometimes prohibitively expensive for some people who really need it - chronic patients, pensioners) but there are many examples of our national health system investing heavily in particular individuals with little chance for survival.
A recent example is health system paying for Zolgensma, the most expensive medication in the world, leading to millions of expense per year[1][2] on this medication alone for a very small amount of babies.
The US has universal care, it passed in 2009 and it establishes that everyone does their part and buy insurance. It establishes help for low income individuals. There are caps on annual expenses. You may not like how it’s structured. You may not like the amount that people are expected to pay. But twelve years later the only people who don’t have coverage are people who are not meeting their civic obligations. And I’m fine with that.
> But twelve years later the only people who don’t have coverage are people who are not meeting their civic obligations.
The folks at the poverty line with a "free" fully subsidized Bronze ACA plan has an enormous deductible that may be $6-12k before that coverage actually starts paying out. The ACA's max out-of-pocket for a family in 2021 is $17,100. (https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...)
That's not meaningful access to healthcare for someone making $30k a year.
My uncle-in-law just signed up for health insurance under ACA in Colorado. He pays a $22/mo premium and has a $700 max out of pocket. Yes, 2 zeros. I was totally shocked but I reviewed all his paperwork and it’s true. Meanwhile I’m paying $1,200/mo for a young and healthy family of 3 with a $7,000 max out of pocket.
Out of pocket expenses for any individual is capped $8550 regardless of whether they have family coverage or individual coverage. Additionally, those earning less than 250% the federal poverty level qualify for additional cost sharing reductions (CSR) which dramatically lower the out of pocket expenses, e.g deductibles and copays. Details will vary but a family of four with a household income of $30k with CSR would have their deductible reduced to a few hundred dollars and annual out of packet caps also to the hundreds of dollars range. The same plan without CSR might have a $7000 deductible. But CSR is available in the situation you describe.
Regardless, this is arguing over the burden that Obama, Pelosi, et. al. decided was appropriate for Americans. It's not a question of whether there is universal health care in the US. There undeniably is.
The worst tactical move the "left" has ever done in the US is allow itself to be tied ideologically to the ACA. To my outsider's view this is nothing but an entrenchment of the 'feudal' nature of the US health care system, and a direct subsidy to private insurance companies (even if obligations were forced on them). From a pragmatic POV I see why it was put in place, but frankly it's just awful.
If the Health Care system HAS to be a feudal system I would much rather be tied to the government than a job that can fire me at any time for any reason or one I have to stick to if anything serious happens.
> I don't understand how people can be so anti-universal healthcare in the US.
Because I have zero faith that it will end up costing me less, and have a similar level of quality. I’m in tech. Combined HHI is something in the $200s. I pay about $300 per month for the entire family, $5K out of pocket max. So in a worst case scenario, let’s say healthcare costs me $9K per year. That’s what, 4% of my HHI? Will a universal healthcare plan hit me via taxes for 4% or less? Fat fucking chance. And again, we’re not even talking about quality of care, just price.
In the end, the poor will benefit greatly, the rich will carry on as usual, and people in the middle will get squeezed to death.
> I pay about $300 per month for the entire family, $5K out of pocket max.
You're just paying your healthcare tax to your employer (in the form of lost salary; they're not chipping in the other $1-2k/month out of charity) instead of the government. It's silly to only count your contribution instead of the overall per-capita cost of healthcare.
Just to make this point explicit: Your health care does not cost $300 a month. Your employer is paying for it as well, and as ceejayoz suggested it might be $1-2k a month. Add that in to your calculations.
The problem is the anti-single payer faction in the US is large, powerful and well funded. They would do their level best to cripple any such system as badly as possible, so they could say "I told you so", as they did with Obamacare. Therefore it is quite possible a single payer system in the US would not work out anywhere near as good a deal as it has almost everywhere else.
It's hard to believe it could possibly still end up worse than the current system, but I worry that it would be a 'hold my beer' moment.
You also pay for Medicare, Medicaid, CHIP, health care exchange subsidies and lots more through your general taxes. This comes to $1.5 Trillion in Federal health care spending per year, or 8% of GDP funded by your taxes.
It turns out 8% of GDP is almost exactly what the UK spends on health care in total, including public and private spending. So your taxes to the federal government are paying about the same proportionately that we are for health care here in the UK, and you are also paying thousands of dollars a year for private health care on top. There's no way to spin this, you are getting utterly and completely shafted.
As it happens I also get private health care through my employer in the UK, but it only costs me £380 per year because the vast majority of my health care needs are met by the NHS promptly and to an excellent standard. The private top-up care only matters in truly exceptional situations, and even then it's mainly about comfort and maybe bypassing a queue for non-urgent care. Bearing in mind all the care I and my family have received over the years, and the zero stress I have ever had about affording it, I pay my taxes to the NHS with a happy heart.
That $300 per month you're paying for the whole family - does it include employer's contribution?
From my experience, a decent insurance for the family is somewhere in $20k-ish range per year, which is closer to 10% of your income.
This lines up with 10% UK National Health Services charges HM's subjects.
It will not have a similar level of quality though, forget it. The lines will get longer and the definition of "medically necessary" will become way more frugal.
And for your income level it probably won't cost you less. Neither for mine. Nor for that of many HN users. But it will solve SO MANY annoying problems for so many people at once that I still think it's justified.
First, losing job does will not mean you're losing your medical coverage. You probably have not lost a job for a prolonged period of time. Neither did I. But the fact that it might potentially happen gives me uneasy feeling. If (when?) I lose my job, medical insurance will be the single biggest charge on my account, probably more than all other stuff combined.
Second, all these infamous cases when someone with insurance was admitted into the hospital, but then it suddenly turned out some junior aide to the senior anesthesiologist is out of network, therefore the insurance won't pay him. This doesn't happen often enough for most people to start pestering their congressmen, but it nevertheless happens.
Third, it will make the gap between salaried employees and contractors smaller. There are a lot of talks about whether such-and-such is actually not a contractor, but a salaried employee. And usually it all drills down to the benefits the person receives. One of the ways of solving this problem is making the benefits the same for contractors and for the employees. While it will not close the gap completely, it will make it more palatable.
Fourth, those willing to get a higher level of service will be able to buy private insurance. In countries with national healthcare private medical insurance is cheap - may be 10% of what we're paying now.
I can keep going. The trick is that none of these cases on its own is big enough to affect the majority of population, but combined I'm sure each of us will eventually be hit by one of them.
I....just have no words. Do you really believe everything you wrote? And like....that's probably the worst example of individualism and "me first" attitude I've seen on this website.
For non-Americans reading this: $300/month is not a health insurance cost for a family anywhere in the United States. Either a) the employer is eating most of the cost or b) this is not what you have in mind when you think "health insurance".
A typical health insurance plan for a family of 4 costs closer to $1,500-$2,500 per month in the US if you are looking for something close(r) to the level of coverage available in socialized medicine countries (or in the parts of the US medical system that are socialized). That cost is on top of the automatic taxes we pay to cover Medicare, Medicaid, and the VA medical system (these 3 together account for a majority of US healthcare spending).
> In the end, the poor will benefit greatly, the rich will carry on as usual, and people in the middle will get squeezed to death.
While I disagree with nearly all of your post, I can find reason in the closing statement.
I feel like this logic often evades the people asking for higher taxes to support their causes. It’s always the middle class that ends up paying for it. It creates a lot of resentment which is exactly what fuels the rest of your post.
I wish there was a way this could be avoided, but obviously, it’s by design.
This is a systematic issue though, not an intent problem. Why do the middle class end up paying for it while the rich which own 40% of the assets don't? Due to lobbying and constantly electing politicians that are the same over and over again. The top 10% in the US own 70% of the assets. Just make the rich pay their taxes and the situation is resolved but we just keep gouging the middle class. Middle class should establish a fund to pay for lobbyists.
> This is a systematic issue though, not an intent problem.
It’s definitely systemic/systematic, but it’s also intent?
The tax system is intentionally designed by the ruling/wealth classes to extract the working classes money. Each individual tax may not have this explicit intent, but the sheer number of loopholes and bypasses are omnipresent.
When people retire, they are automatically covered by the socialized Medicare insurance program. Medicare is extremely popular among its recipients, many of whom nonetheless oppose socialized medicine for the general populace.
I've heard a lot of negative stories about the British health system including people waiting 6+ months to see doctors (while in pain or having other symptoms that lower quality of life significantly). If you think an American universal health system will be somehow better than that then I suspect you're a lot more optimistic about the US government than most people.
edit: I do love echo chambers, someone asks a question about why a certain groups thinks a certain way, you answer and you get downvoted. Why bother being on a discussion forum if you don't ever want to hear what the other side sees things as even when directly asked? Especially amusing since I do support universal healthcare but actually try to understand why people oppose it rather than covering my eyes and ears whenever they talk.
> I've heard a lot of negative stories about the British health system including people waiting 6+ months to see doctors...
The wait time for an American at the poverty line seeking care for an expensive but non-emergency chronic condition can be effectively infinite.
My wife receives treatment for chronic pain. Getting treatment at a pain clinic started required five visits (including being able to physically get there in the first place), lab work, etc. Each of those required a hefty co-pay, and someone on a Bronze ACA plan will have a multi-thousand dollar deductible to meet before even those kick in.
If you're working minimum wage and have a pain condition, treatment is likely inaccessible, even if you technically have fully subsidized health insurance.
The question was about how can people be anti-universal healthcare. As you pointed out the group most impacted are those who are poor but not so poor as to be on Medicaid. You also need to exclude ex-military as they have VA benefits. And those over 65 who are on Medicare. That's not a majority or close to it of the population.
partially fault of stringent regulation on pain medication because often it is consisting of controlled substance. bad penalties if doctor is not careful enough about giving to anybody.
It's an example, but it's hardly unique to pain treatment. Any specialist is going to bill out at a couple hundred bucks for a quick visit, and might be scheduling 3-6 months out; that's entirely your financial responsibility if you haven't met your deductible.
Anything that requires ongoing treatments or regular doctors' visits is going to be largely inaccessible to a low-income person on a high-deductible plan.
Why do American people think it's the 'government' that will be providing the healthcare?
To me, the NHS in the UK is run by the NHS (chiefs, trusts, executives, etc). It's funded and meddled with by the government. But it outlives each successive government.
You'll hear far more positive stories than negative ones if you ask any one in the UK.
My kid spent a week in infant ICU. Cost to me zero. Total cost of pregnancy zero. Time thinking about the cost until now zero.
Money and healthcare are two exclusive concepts to the average British person. If we thought more about cost and healthcare maybe people would be willing to pay more tax for it. But they think it's free.
It is worth noting for clarity that there is no "British health system" – the constituent nations of the UK have separate and distinct healthcare systems.
In reality, "negative stories" aren't much of a strong signal. There are likely as many "positive stories" that don't get as much traction, particularly because there is quite a lot of effort invested in the US into spreading FUD about single-payer healthcare systems. Though I do agree that this effort is effective on many people.
Shouldn't the point of comparison be the current state of US healthcare, were many people don't get to see a doctor at all because they're uninsured and poor? (Or at least that's the impression I get as an outsider from discussions on the Internet about the topic)
If you are actually poor in the US, you qualify for free or highly subsidized healthcare. US has plenty of those social welfare programs, and people online typically are well off enough that they aren’t even aware of them.
The question was why people don't like universal health care and not an objective measurement of its value to society as a while. Around 10% of the US population is uninsured so 90% does have insurance. So 90% of the population isn't comparing it to a system with no-insurance.
Also worth adding is that most of those uninsured are present in the country illegally. For comparison, UK’s NHS does not offer free services beyond primary care to those unlawfully present either, and I think this is true of most other public healthcare systems around the world.
Many American's don't however since they hear the bad stories but are perfectly happy with the care they get under their insurance. Which was the question asked and not "which health system is objectively better."
My first son spent a week in the NICU since he had to be on antibiotics, otherwise was fine. The hospital entered in my insurance card incorrectly so we were billed as uninsured. Turns out a week at the NICU for a healthy newborn is about $40,000!
It took almost 2 years of back and forth with my insurance provider and the hospital to clear up that bill. The hospital kept sending to to debt collectors too which was particularly annoying.
And to make it even more annoying, the hospital later changed it's policy on newborns on antibiotics - if they are otherwise healthy they don't need to stay in the NICU anymore. It would have saved us a lot of trouble.
> And to make it even more annoying, the hospital later changed it's policy on newborns on antibiotics - if they are otherwise healthy they don't need to stay in the NICU anymore.
That sounds like a good policy change thou? Whilst I understand it must've been a grave ordeal to sort it out, I'd try to be glad for the families in similar situations now that wouldn't have to suffer from this any more instead of being annoyed.
Yes, sorry I meant it would have made things much easier.
My heart goes out to all the families with babies in the NICU. It is beyond stressful and obviously the financial side is nothing compared to the wellbeing of your baby, but then it hits you a few months later.
Yeah, we were there during peak COVID too, so it was our room, her room, and nowhere in between. I worked almost every day from her ICU room. I can still find myself hearing the beeps/alarms without actually hearing them, sort of like symptoms of PTSD.
For those unfamiliar with the weirdness of the US insurance system: Nobody pays the prices on these bills. This is a pre-insurance bill with inflated values:
> Why am I sharing one of her (pre-insurance) bills?
Insurance companies have negotiated maximum allowed prices for every line item on this bill. Different insurance companies will have different negotiated rates.
The insurance companies will pay either the minimum of their negotiated rate for each service or the hospital’s biller charge, whichever is lower. As such, the hospitals will greatly inflate their costs presented to insurance companies to avoid leaving any money on the table. This bill would go through a round of price reductions with the insurance company that can be very significant (I’ve seen $1000+ pre-insurance bills turn into less than $100 after insurance negotiated rates were applied).
I’m not defending the system — Obviously it’s not great. However, it’s a mistake to look at these pre-insurance bills and assume that anyone is actually paying those amounts.
Also, US insurance policies have what’s known as an “out of pocket maximum” that is the upper ceiling on how much you can pay for medical services in a year before insurance covers 100%.
Also keep in mind that about half of US births are paid for by Medicaid, which is one of our socialized healthcare programs. The issue is often misrepresented as the US not having socialized medicine, but the reality is that a lot of US citizens are already covered by our socialized medicine programs in one way or another. The issue is the people who fall through the cracks by either not qualifying for these programs/subsidies, not being covered by their employers, and not buying a subsidized insurance plan on the ACA market.
Again, not defending the system, but I think it’s important to know how these systems work to understand why Americans aren’t actually paying these multi-million dollar pre-insurance bills, which is why the voting public is often so complacent about exploring other options.
Imagine if any other market operated like this. You walk into BestBuy and the price of a TV is $50,000. But if you take it to the cashier you will be charged some lesser amount based on what your credit card company negotiated with BestBuy.
Actually the situation is a bit worse than that. It'd be like if you bought the $50k TV and you only knew what your price was once it showed up on your cc statement.
This kind of actually does describe buying a car in the US. It is generally not permitted to buy directly from the manufacturer, so you need to go through a dealer. It is kind of messed up presently, but in normal times there isn't really a "vehicle shortage" or whatever it is getting called now. The advertised price can be completely disconnected from the actual price you pay.
There are problems with car buying but I'd argue they are different problems.
At least when you go to a dealership they'll give you a firm price before you sign the paperwork. The biggest issue I have with health care is that this isn't the case.
Yes but at least higher education’s “negotiating” (which really isn’t negotiations since the avenues to get the cost down is far easier with Scholarships and FAFSA) is more upfront and better known.
Medical bankruptcy is the most common reason people declare bankruptcy in the United States, making up some 70% of all new bankruptcies in the US.
Being asked to pay for medical bills you cannot afford is incredibly common in America, to the point that it’s the main reason people declare bankruptcy.
By “nobody” do you mean literally nobody or nobody that isn’t otherwise marginalized?
There is such a thing as medical induced bankruptcy in the US. There are bill collectors who collect medical debt. I would be utterly shocked if those prebills were not used to scare and shock certain groups of people. Nor would I be surprised if there are modern indentured servants paying off an impossible debt based upon them in some jurisdictions in the US.
Maybe generally, if you’re employed, white, speak English, etc… you’ll never pay that stuff
In 2018, age 31 I emigrated from the UK to the USA. I'd spent my entire life under the NHS and taken it for granted.
In Jan 21 my first child arrived, 8 weeks early. This led to a lengthy 49 day NICU stay spread across two hospitals. Ask me to put a price on the work those doctors did to save my families lives (8hrs in the OR and both nearly died several times) and I'd give you all I could.
In the end, the bills we've received so far exceed $350k. For the joy and relief that they both made it out the otherside healthy, it's worth every penny. And this speaks to perhaps why Americans rationalise exorbitant healthcare costs - because we're tied up in the emotion of it all.
I'm lucky to work for a company who provide a high deductible plan which means my max annual out of pocket cost is $6k. On the face of it, $6k sounds like a lot - but the level of care we received far exceeded anything I've ever experienced in the NHS. Private rooms, appointments with my GP without doing the 8am phone purgatory British Drs surgeries require, world class NICU care at a world renowned facility (Chapel Hill).
But we must also factor in that in the UK I pay for healthcare whether I use it or not via taxes. Indeed my take home in the UK was about 15-20% less than here after the government had taken their share. However here, I have the choice to contribute to my HSA up to $7,200 annually. In the end, I feel like I end up paying about the same despite the high sticker price.
But the key difference is that in the UK model I look after my neighbour without any choice in the matter. Whereas here, it speaks to the underlying American pysche of individualism.
My conclusion is that as an individual, with a good tech job, the system works - for me. But there is a nagging sense of guilt about how the experience I've had is not available to all. A bit like the suburban sprawl discussion I fear that this way of doing things is so deeply ingrained in so many people that they can't even imagine changing the system to work better for all for fear of what might come to pass.
I'm very happy in the US on a day to day level, but it truly is a very weird place. Simultaneously a forward looking tech hub, leading the way in the world in many ways. And yet, it's an incredible backwards, self-preserving, individualistic society where dramatic social change is probably impossible.
Interesting perspective from someone who can legitimately compare the experience…
I disagree with how it is characterized that Americans are rationalizing healthcare costs as a result of being wrapped up in emotions. While emotions certainly influenced most decisions being made at the time, the costs didn’t feel even remotely in the realm of something that can be controlled. The nature of emergencies (such as the birth of a child in this context), the fact that the costs aren’t even communicated until months go by, and the fact that healthcare coverage is tethered to your employer (resulting in a spectrum of experiences) are all aspects that I believe serve to maintain the status quo.
For instance, with this pandemic… I was laid off, and while I was incredibly fortunate to be able to have multiple options for new employment, it caused unnecessary stress on ensuring health care coverage was continuous. It also played a role in how I ultimately chose which company I decided to work for despite the difficulty I have generally experienced in getting prospective employers to be forthcoming about their health insurance options. And some things just literally aren’t available such as whether your current doctors / specialists are considered “in-network” —- which really matters when in the context of a helping a premature child get “caught up” in life. Oh, and I don’t want to forget pointing out that changing employers also resets those deductibles and max out-of-pockets…
We had premature twins who both stayed in the NICU for around three months. Our total hospital bills came out to just under five million dollars. Fortunately we also had great insurance and received great care.
We fought with the insurance/hospital/vendors for over a year and was on the phone with them every single week for hours to get the covered procedures included. An annoyance, but we were able to navigate it. Our twins are thriving today.
Other families were not so lucky. We watched under or uninsured parents have to make decisions between the health of their sick children and their own financial livelihood. As educated privileged workers, the system worked for us. But it fails many. There has got to be a better way
That's exactly who I am advocating for, not for myself, my wife, child, family were all loved and taken care of, which isn't the case for some children.
My wife and I walked by ICU beds daily that had children just starring at the ceiling, during the peak of their development, they have nothing/no one (except the love of hospital staff), for whatever reason, either in the care of the state, of their parents are at work to afford their child's ICU stay. We learnt we couldn't judge.
Anyone who has ever spent any significant amount of time in any hospital knows just how crazy & broken the system is. It's absolute madness. Sometimes it seems like the worse part comes in the months after you get out when random bills start coming and other random bills end up in collections for no apparent reason.
I see at the bottom of this article they "are creating a charity to help bring awareness to the issue, to help sick children and their families, and to try improve the system in whatever way we can... we can use all the help with can get."
hey, thank you for this! I didn't want self promote, and CTA's just seems sleazy in this sense, but I'd be lying if I didn't want people to read about the charity, because we want change!
I feel a lot of empathy for OP, but there are some choices I find very difficult to understand.
> our child, with life-saving intervention, surgeries, and therapy, could, and should live a happy, healthy, fulfilled life, at least until adulthood
Sorry, but I can't grasp why you would condemn a 24 weeks old fetus to a life of a) possibly not suffering and b) only living until you're 20 or so years old, when you have the choice of termination. Even if (and that's a big if) you try your best and your child lives until she's a young adult, all of that will be taken from her in her young age because you made the decision to give birth to her regardless, even if you knew all the hardships that would be coming for her.
I am very sorry for her death, but a lot of suffering could have been avoided if they had listened to their medical professionals.
We didn't know about half of my daughter's conditions until after she was born. We lived in Indiana, and had treatment in Illinois, because of whatever laws, we were rushed into deciding whether to continue with the pregnancy, but after I had seen her little face/profile on the CT scan, I knew I had to meet her, and I loved every single moment with my little girl, I'd do it again if I could have more time with her.
But in hindsight, watching her battle through her 8 months, the 9 surgeries, the horrific recoveries, the constant diagnosis', watching her code in front of me and the nurse's chest compressions break her ribs in the process. We tried to make her life as beautiful as we could, but she really suffered, more than I or anyone could imagine, and now I have the imagine of her last breathe imprinted in my head, and watching videos of her in the hospital and hearing the beeps and alarms is super triggering.
My wife and I were lucky that we made it, considering parents of children with disabilities commonly result in divorce. It was one of the most horrific things I/my wife have ever gone through, and we've both lost parents as teens. I know many couples/relationships/children aren't so lucky.
Anyway, I'm going to advocate for:
- more testing when abnormalities are found at 20-22 week scan
- extend termination limits to allow for further testing to be carried out
- advocate for easier access to terminations, support parents on how difficult the process will be, whether they can handle it, resources on when times are difficult, etc
- regardless of my daughter's diagnosis/disabilities, she didn't qualify for Medicaid off the bat, she actually passed away without any government assistance, even though she severely disabled. So obviously, advocate for children of disabilities and everything wrong with this post
diagnosed at 21 weeks, in fact. important because the difference between 21 and 24 weeks crosses the boundary of legality in many states. furthermore, right wing activists are constantly agitating to lower the threshold even further. had that been the case here, this family would have discovered the congenital defect at the anatomy scan only afterwards.
> listened to their medical professionals
it's highly unlikely that their care team would have actively recommended termination. standard is to explain the diagnosis, the prognosis, and the options to continue the pregnancy or terminate. then leave it to the family to decide.
Thank you, this is exactly my argument. Early COVID, late appointment, we had days to decide, and once the limit had passed, I/we no longer considered it an option and the only other options were to intervene with surgeries, or, to have her live out her natural life.
are you the parent in the link? i'm sorry you went through this. nobody should judge you for your choice. it is exactly that - your choice - which pro-choice people advocate for. for you and other parents in these incredibly difficult circumstances to be fully educated, fully informed, and empowered to make whatever decision is right for you.
He compensates his staff AND PATIENTS accordingly to the level of fraud that they can detect on hospital bills. So they will leave no stone unturned.
DISCLAIMER: I don't know or have ever talked to Adam Russo. I don't work, have any relationship, or financial connection with their firm. I have only heard they do good work and I am only an admirer of what they do.
Without insurance, it goes for about $20 for a batch of 30 in the US. You need to go to goodrx to get a coupon, but there's no cost or signin to that. Sure, it's stupid, but the cost is most definitively _NOT_ $5,000.
If the hospital is saying it's charging 5,000 for it, then it's an example of "we'll put a huge number here, then bring it way down when it's time to pay". Which is also stupid. But once again, nobody is paying that amount. The two arguments "the system is stupid" and "the price is insane" are different arguments.
Sure, I get it. But I think this is one of those cases, like with identity theft, where you and I are just so used to the status quo that we can't accept how messed up the whole thing is. It feels normal, and we know how to work the system, so it's okay.
If aliens landed they'd think we're really strange.
I'm sure they play tons of games so it's not considered an error.
That said, the government needs to step in and set prices for health care. The free market has failed, in this case. Nobody can afford to shop around for a cheaper health care provider in an emergency, and even then there's no real competition.
"That said, the government needs to step in and set prices for health care."
I don't see this working without other substantial changes. They do this with Medicaid and Medicare already. The reimbursement rate is pretty low and the actual costs of some services actually exceed the payment. Without fully going to a government run system, I don't think setting standard prices will work well due to the quality and cost differences from location to location.
A better solution might be some sort of truth in advertising/billing that changes how the providers and insurance companies run that process, like presenting actual cost of care, actual payment by insurance, and protecting individuals from any charge that exceeds the cost of care plus some profit limit like 2%. I'm sure there are a lot of details to prevent loopholes, but that's my general view.
Plenty of countries have affordable healthcare. I don't think we need to reinvent the wheel, (in the US,) when we can look at how other countries run their healthcare systems and see what works and what doesn't.
The economics of treating rare diseases and is very different than handling a broken leg or a heart attack. Unfortunately, when we talk about healthcare we tend to lump both problems into the same boat, when paying for rare conditions versus common conditions are two very different things with very different solutions.
If you've read this far, you probably realize that I'm beating around the bush, but if you understand how technology development starts with an expensive iPad, and then a decade later there are cheap generic tablets, I think you can understand the gist of what I'm saying.
What would be even more informative is (1) what does the hospital/doctors actually receive from the insurance company (2) what would the hospital/doctors get if the parents had zero insurance (3) what would a hospital in each of the 99%+ other countries' hospital/doctors with a national system get for the same issue and timeframe. That's essentially the argument of the US getting some kind of single payer system that works (Medicare atm is only semi-working as it doesn't completely function due to political interference and bureaucratic inertia).
In the US the system is designed to ensure profits are higher than the cost of treating patients who have no insurance, and patients on Medicare/Medicaid/VA where negotiated pricing is limiting to profits. So the major task for healthcare companies is to do everything to maximize the profits and minimize costs that don't support higher profits, and for the insurance companies to collect more from companies and individuals to cover the healthcare companies need for profits, while maximizing their profits as well.
While healthcare in other countries may also wish to keep costs under control, if there is no profit requirement, they have much more flexibility. Of course there is no universal solution to healthcare, but the incentive outside the US is different as long as profit is not the only thing that matters.
This might sound pedantic, but as an economist, I feel duty bound to point out that "charge", "cost", "value", and "price" are different things.
In this case, the amount being charged is the provider's starting position in the negotiation process. It is not relevant to how much it actually cost to provide the service.
We are stuck with this system as a consequence of another attempt by government to try to control prices. Because companies were prohibited by government from paying workers above certain amounts, they tried to compete on other dimensions which were not covered by the wage controls. Then, the malady remained endemic long after the wage controls were lifted.
There are no rational prices in the U.S. healthcare system. The largest component of the system is Medicare, and it reimburses doctors using RVUs[1] which, if you squint enough, are based on labor theory of value[2] (the "value" of something is determined by how much work went into it rather than how useful it is to the recipient).
Maybe, just maybe it also includes the cost of actually administering it by a professional and? Scotty aint gonna beam it into ya…
So once it’s negotiated down to $800 - it’s mostly labor of people involved in the process of taking it from pharmacy all the way inside you
The administration part includes getting the instruction to do so, retrieving medicine from storage, going to the patient, administering the drug, going back to nursing station and filling in the paper work for the action (there are actually several forms to be filled out).
So in reality it takes more like 40 min per IV.
You seem confused. This is saline for a nebulizer. It would be pretty weird to do that with an IV :)
The line item is for the saline ampoule only, NHRIC item 0487-9003-60. It's in the "Pharmacy" category on the page. The respiratory therapist charges, I already mentioned, are separate.
My mom was in an ICU quality rehab hospital for six weeks while recovering from covid. The nominal cost was some 200,000.00, which they settled with medicare as per a long-running contract for 60,000.00.
Somewhere in the medical cost bureaucracy is a lump of pitchblend hooked up to a geiger counter being used as a random number generator.
How does a pharmacy charge someone more than $5000 for things such as sodium chloride? Actually pretty much everything on that list is complete bullshit.
This is fraud and taking advantage of people in distress. These criminals should be behind bars.
I know it makes me a terrible asshole, but reading this makes me seethe about the infant who was brought into existence without her consent only to suffer and die (like all of us, but this is a terrible compression of that sequence with little to distract her from it-- what did this tiny suffering animal know about the beauty of sunsets? Fuckall is what)just as much as it makes me exhausted about the medical insurance system in America.
What a perfect example of gambling on the credit of the unborn. And then to be further punished by the absurd healthcare system in this country.
I hate how they bleed you via a thousand cuts. My kid saw a urologist at Nemours. Total appointment was maybe an hour and a half. He was experiencing pain while urinating. Turns out he just needed to stop holding his bladder and just go to the bathroom when he felt he needed to go. They took a urine sample, and an ultrasound. Over a year and a half later and I am still getting bills for it. Each bill is between $35 and $100 dollars. I have gotten ~20 of them. Every couple weeks to couple months another one or two come in.
$1400 for cholecalciferate - aka Vitamin D-3
$700 for sterile water
I don't comprehend how charges like that are even remotely feasible for anything other than the deferal of liability from the hospital to the mfg., who charges a premium. But I suppose that goes under the liability insurance domain.
But that's only half of the story. Billing is a negotiation process between the practitioners or their institution and the insurance providers, so naturally the hospital is going to wring every penny out that they can which means they'll "charge" you $500 for a $10 bag of saline, and leave you at the mercy of wolves.
Just another perverted feedback loop, the insurance industry is so well established that it's become necessity, and treatment is made expensive by insurance, and will presumably continue in that direction because of its huge inertia.
Sildenafil citrate is also a treatment for other problems - see e.g. [0]. That's very different to the usual problems that are treated with the codename "viagra".
It's the same chemical regardless of brand name. GP was clearly pointing out that Sildenafil citrate bought over the counter as Viagra is extremely cheap, not that they gave a baby Viagra.
I think the point was less "haha idiot doctors gave a baby viagra" - it was originally discovered in a search for a treatment for chest pain, after all - and more "wtf viagra doesn't cost that much".
Most important parts of human existence have been colonized. I don’t know how we will be able to recover our freedom. Who would have thought 50 years ago that drinking water is something we would pay for. Healthcare which citizens need most has also been colonized. I read a sad story where a devout husband had to divorce his very sick wife so that she could get medicaid payment to pay her bills.
my sibling was born premature and spent 78 days in the hospital when born. I was a young child myself so I haven't a clue as to cost but it put my parents into bankruptcy.
Your story is very common in the USA. Medical bankruptcy is a menace and should be made illegal. This is a completely avoidable issue, we just need to make the choices to change our system.
>When it comes to bankruptcy, the study cited court records of bankruptcy filers from 2013 to 2016, with the end result showing that 66.5 percent were tied to medical issues.
My daughter recently had a telemedicine office visit with a specialist at Children's Hospital Los Angeles. For 41 minutes of telemedicine we were billed $1011.00.
First, it's not front-and-center; it's small at and the end. But, for those of you who may wish to do more other than comment:
> My wife and I are creating a charity to help bring awareness to the issue, to help sick children and their families, and to try improve the system in whatever way we can... we can use all the help with can get.
My daughter - at 7 (she's now 12, okay, and quite happy) - had a week-stay in the hospital with Kawasaki Disease. That was easily the worst week of my life. The cost of just the treatment, without the hospital room charges, etc., was $26,000 per dose, and she needed several rounds (3, IIRC). To make matters worse, she was allergic to the IVIg, which added additional complications and costs.
I'll be honest, I don't begrudge Doctors and nurses for being paid very well. I'm very good at my job and I expect to be well compensated. I also expect to be better compensated than most SWEs. I also expect SWEs who are better than I am to make more than I do.
Nor do I begrudge pharma companies for making some serious bank of some very expensive R&D (without that profit, would we even have a COVID vaccine?).
What does bother me is:
* Not having a say. When you're rushed to an ER, you can't price shop, you aren't thinking about insurance coverage (if you're conscious at all), and you can't refuse treatment if it's between "bankruptcy or death".
* I don't care how much info is out there on the internet. I will never, ever, ever have as much knowledge or experience related to my health care as my Dr. The best I can do is mention things I've read, thumb-in-the-wind, use my spidey senses, ask questions, or get a second opinion. But, at the end of the day, if my doctors say "you need X", they are the expert.
* A lot of prices insane due to (IMO) fallacious thinking. Yes, an MRI costs ~$1M. But, at $1000 per image, that sucker has (most likely) paid for itself in months. And the upkeep there-after is not $1M/year. The cost of a single scan should be a small percent of `upkeep + salary of those involved + modest yearly profit`. And that should be normalized and enforced across the entire country. If your hospital bought a better MRI or pays their employees more or have a better Dr interpreting the results? They charge more, but it's likely +/- $50 to the patient.
* Pharma prices are obviously a bit different. An individual pill may only cost them $2, but the first pill cost $500M. I do believe there should be supply and demand involved, but not in the typical way. I don't think "demand" - for medicine - should be based on need. For example, it should be illegal to price gouge someone who will die without your cure. However, if there are only 1000 people in the country with a particular disease, the "demand" doesn't exist to justify the cost of developing a cure. So, in that case, yes, I can understand charging more.
At the end of the day, I don't know that I want 100% universal coverage in the way Canada and Europe have it. I think what we have sucks, and I do think that coverage for children (say < 18) should be 100% covered. No parent should have to ever weigh the cost of their child's health. But, what the US does have is a system that does encourage doctors to be better, pharma to develop cures, etc. I think we have to be able to come up with something that is the best of both worlds.
I understand your concerns but I do think you are also missing very important pieces.
Just like some software engineers are almost useless and others are extremely bright, so are doctors.
If the Hospital attempts to recruit better doctors - it will be a lot more expensive. Just like some developers make $100k and others $600 - so do doctors. Most Hospitals are non-profit and do you know if any private hospital company in the top of fortune 100 companies? No, because they don’t make that much profit, it all goes to salaries and equipment.
You’re ER case is very valid up to a point - you usually can’t make any decisions at the time. But if you are in a situation where you’re unconscious in the ER - you don’t need to! You are 100% hitting your max out of pocket and that’s it for the year. Same if you have a severe condition.
The only time you care about the cost is if you have a mild condition with optional treatment, in which case you can shop for prices, just like most do with a dentist.
This is the single reason why I could not live in the US. Each time I'd receive such bill, even when insured, I'd have a heart attack. How can people in the US think about anything else? It is so daunting and depressing from my point of view.
Probably because it’s not a real bill?
These numbers bear no relation to money and nobody cares about them.
The actual bill will be sent to insurance company, it will be 25-35% of this number, which is realistic given the cost of ultra modern equipment and high salaries for doctors.
You will pay up to your maximum out of pocket, which is the real number you look at when shopping for a plan.
Insurance for people who know they need lots of care is a bit more per month but has very low max out of pocket per year: $3-4k, super cheap plans for young people who never go to the hospital offer about $7k per year per person max.
So this bill was never intended for the patient and there is no reason for this guy posting it except to grab some clicks and pity.
If no one ever pays those bills why bother making these numbers up? Why not charge $5B? Or even $3T for that matter. Wouldn't it save everyone time and money to give the right price first? What is the purpose of this game?
You can find an detailed answer to that in thread, in short - making sure that the negotiated price is that asking price is never less than real negotiated price
Just noting that ~60% of all US hospitals are non-profit hospitals (although you wouldn't know it from the bills). What this means is that people who have no insurance pay significantly reduced prices via payment plans, or pay nothing at all.
To be clear, it's not like the hospital won't attempt to collect payment from them; they will. And some are downright assholes about it and will resort to scare tactics (usually farming the work out to a 3rd party). But, to maintain their tax breaks as a non-profit, etc. they are required to work with - and even forgive - patients who cannot pay.
Note: some hospitals are also assholes with the services they provide. They can't let someone die because they can't pay, but once "stable", then can boot you out.
Below this point is possible misinformation. It's my current understanding, but if someone with more direct knowledge can weigh in, I'd be very appreciative.
The above is where a large chunk of the costs for everyone else comes from. Basically, those who can pay are expected to pay for those who can't.
Where it really hurts is for those people who are - what I'll call - barely middle class. They probably make ~$50k / year and if they have health insurance, it's probably not a great plan: very high deductible and/or max out of pocket. Since they are insured, they will get a much higher bill (initially sent to the insurance company) designed to compensate for everyone else who is getting cheap/free treatment. And, because they insured, legally the hospital doesn't have to reduce the cost or forgive the debt.
I have friends that came over from Europe for hospital stay - they got the bill, sent their objection and the hospital reduced to the usual 35%.
If you live in the US you always can buy insurance that will cap your max out of pocket to about $8k pre tax a year. Also if you’re employer doesn’t provide insurance - you’re probably in an “entry level job” that is not meant for long term employment, but rather quick money for young adults, who are still on their parents insurance (up to 27yo)
If you include the additional services and whatnot in the few months following being discharged from the hospital he was a million dollar baby.
Complete insanity frankly.. few things make my blood boil more than the sad state of health insurance in the US. Sure, it has gotten better since the ACA… but there is soo much more that needs to change.