
Half of Americans fear a health-related bankruptcy - srameshc
https://www.axios.com/health-bankruptcy-fears-poll-ce3c4905-53c6-4f43-ba4f-fde22f4ef849.html
======
jschwartzi
Yeah this is 95% of what my fiance and I talked about when deciding whether we
wanted to have a baby. It wasn't about paying for the kid's schooling or where
we were going to live. It literally boiled down to whether we were willing to
potentially wipe out our entire savings and go into debt to have a child.

And when she quit her job earlier this year it was mainly because we didn't
want her to get sick and hospitalized because then I would get sick and
hospitalized, and that would completely erase our savings.

Thank god her previous employer had good medical insurance so we could do
COBRA. Now we just have to have a kid within 18 months of her separation date.

The insurance system in the US is completely broken because it doesn't
actually insure you against catestrophic costs.

~~~
lotsofpulp
If anything, it does insure you against catastrophic loss. ACA took away
maximum benefit amounts.

The problem is most people don’t have enough cash to even pay for out of
pocket maximums, which is around $25k to $30k for a family ($12k to $15k per
year, but you need to have two year’s worth in case something happens to you
at the end of the year and costs continue into the next year).

~~~
mattacular
On paper it may seem to insure you against catastrophic loss, that is, if the
insurance company can't find a way to deny your claim for one reason or
another. You can surely bet they will be trying.

~~~
adanto6840
I'm "self-employed", ie employed by the company that I own, and so I have to
shoulder the entirety of health insurance cost for my family of 4. Because I'm
the only FT employee, we aren't eligible for "business/small group" health
plans; which means we either have to buy private health insurance (often not
meeting ACA Essential Coverage requirements) and/or purchase health insurance
from the 'health exchange' marketplace administered by our state.

The first year, we could actually purchase decent coverage and while it was
expensive, it was a solid PPO plan. The past two years however, there isn't
even a single PPO plan offered on the exchange in my state -- not one -- I
don't even think there were any "Platinum" coverages offered. The end result
is that we pay essentially a mortgage-size payment each month and in exchange
we get relatively abysmal coverage.

Worse yet? It seems they categorically deny ~75% of claims, which generally
means we have to appeal & fight them on it (our success rate is high but it's
time-consuming); if it's testing/labs that need done, we also have to front
the cash out of pocket to avoid delaying diagnosis & any potentially needed
treatment. Often that means $800+ out of pocket PLUS a 4-8 hour time
investment over a 3-4 month span in order to try to recoup that money -- all
the while, we're of course paying the absurd premiums each month.

Insurance & the financial aspect of healthcare is so completely broken in the
US that it's sickening. I believe the problem is so severe that it's really
hurting our country's economy and is incredibly stifling for individuals &
small businesses. I wish I knew how to fix it. :(

~~~
throwaway31338
I abandoned my business of 15 years last year because of worry about
availability of health insurance. It looks like I was in a similar situation
to you.

My business was going well. I was making equivalent income of a bit more than
a high-end salary for my skill set in my area. I was fine (grudgingly) paying
the premiums.

The problem was that there was absolutely no assurance insurance that would
actually cover anything would be available in the future. We had "marketplace"
plans for a number of years. Eventually there were no "silver" marketplace
plans available in my locale (and "bronze", with 20% "co-insurance", means I'm
going bankrupt if I have any significant events anyway, so I might as well
just have no coverage).

I gave up and took a job. I couldn't expose my family to the risk of not
having any insurance available. It was crushing.

I took the route of not having employees and was unable to qualify for
"business" plans. I guess I wasn't "successful" after all, since I didn't
aspire to grow the business beyond what would support my family.

~~~
heavyset_go
Stories like these are reflective of the fact that there are higher rates of
entrepreneurship in countries with universal healthcare.

------
PopeDotNinja
I don’t. Already had one! I had full coverage and got sent to a hospital that
wasn’t contracted with my insurance company. 4 days in the hospital for a bike
accident with 6 broken bones and surgery cost hit me back with $100k in out of
network hospital bills.

I don’t know if this is still the case, but in 2006, San Francisco General
Hospital (now the Zuckerberg themed hospital) was the only level 1 head trauma
hospital in the city. I had head trauma and was forced to go there. I asked
them if they took my insurance. They said yes. What they meant is they’d bill
my insurance and hit me with anything insurance wouldn’t cover. That ended up
putting me into a spiral of depression that took years to recover from, on top
of the physical recovery. What a shit show.

~~~
ryandrake
Yea, one lesson I also learned the hard way is to stop asking doctors if they
"take my insurance". They _all_ will gladly take your insurance, meaning they
take the insurance card and laugh at you while knowing that none of what they
bill will actually be covered.

Don't ask the doctor anything. Ask your insurance company whether the doctor
in question is in-network. This of course assumes you are conscious, and can
do such due diligence.

~~~
EForEndeavour
This reads like something straight out of a William Gibson novel. How much
longer can Americans tolerate this ever-worsening shitshow of a system before
something gives? What will that look like?

------
Taek
No price transparency, no ability to choose between doctors, your job decides
your insurance.

There is no room for a market to function in our health system. With no
ability for consumers to move around or even see the differences between
different providers, prices will naturally go up, and there will be no
pressure to improve care.

~~~
rolobio
I can't think of any other business that can get away with not even giving you
a ball-park estimate on costs. If my car breaks down, my mechanic will at
least give me an estimate within a hundred bucks or so. But a hospital has no
idea what it will cost (and neither does insurance) until they finally
negotiate that specific case.

Another issue is that insurance does not have to compete across state lines.
They've divvied up the country and are sticking to their corners (much like
ISPs).

Insurance should be required to accept customers from anywhere in the country.
Hospitals should be required to publish prices. These seem like no-brainers to
me. But hospitals and insurance make too much money, and give too much of it
to congress for any real change.

~~~
dbbk
Why should a hospital have a price list? Does the fire department? The police?

~~~
exolymph
Hospitals are not particularly equivalent to fire departments or the police,
since the latter two are paid for by taxes. Some hospitals definitely do get
some money from taxes, but as far as I know that isn't the norm.

~~~
dbbk
This is my point... it should be a public service paid for by tax.

------
notacoward
Yep. I've been thinking about retiring, and almost certainly would have
already if not for the twin spectres of private health-insurance cost vs.
unreimbursed medical expense risk. And I'm one of the lucky ones, with healthy
savings and no significant medical issues. If it feels like Scylla and
Charybdis for me, how terrifying must it be for those less fortunate?

~~~
elliekelly
Before the pandemic I was a "digital nomad" and I had private health insurance
that covered me literally anywhere in the world... except the United States.
And here's the kicker: one _year 's_ worth of coverage was less than one
_month 's_ worth of health insurance in the US.

~~~
kgin
United States prices are so out of whack with the rest of the world, they
can’t even be included in worldwide insurance without drastically increasing
premiums

------
parsimo2010
More between the lines: Half of Americans know they're under-insured and
haven't done/can't do anything about it.

A deeper cut is that some Americans are just rolling the dice, they could
afford better insurance but choose not to, even though after they got hit with
a huge bill they would probably say something like, "in hindsight I probably
should have paid the higher premiums for better coverage and could have taken
a vacation to Missouri instead of Europe."

But there are also a lot of Americans that may not be able to afford higher
premiums, even if they were better at budgeting.

And then politicians pick and choose which group of people they use as
examples when talking about the healthcare system, depending on their
goals/party. The truth is that both of the previously mentioned groups exist
and get screwed if they have an emergency. It's a easier to say "tough luck"
to the first group that was rolling the dice, but I would love to see actual
change in the healthcare system.

I did my dissertation research using insurance claims data, so I've seen the
actual amount of money that's changing hands and it's ridiculous. Even if
normal people were able to get the negotiated rates that the insurance
companies get, most families could not afford a surgery and week long hospital
stay. I don't know exactly what the solution is, but I think one of the main
roadblocks is that there are some people making a bunch of money and they are
quite happy with the way everything works right now.

~~~
43920
> I did my dissertation research using insurance claims data

Is your research published publicly anywhere?

~~~
parsimo2010
It is currently embargoed and the raw data will never be released because of
HIPAA. I didn't focus on the costs, so even when my dissertation is published
next year the costs won't be discussed. It's just one of those things that I
couldn't help but write a quick query because the information was present.

There were a few extreme cases where a person had over 10,000 claim lines in a
single year at a cost of millions of dollars. And insurance actually paid,
because I only saw adjudicated claims. But a more typical person has a dozen
or so claims costing maybe a thousand dollars in a year. There are also people
that go years without a single medical encounter, but as soon as they need
treatment for something it tends to be an expensive year. The issue I see is
that most people probably don't have good enough savings habits to be able to
afford basic healthcare if they don't have their premiums on autopay or pulled
out of their paycheck before they have a chance to spend it. So although most
people could save $1k in a year, insurance is like a savings account that you
have to make deposits to and can bail you out if you really need more.

------
axaxs
This is ridiculous. I'm what most here would consider pretty conservative, but
even I have trouble understanding the arguments against universal healthcare.
Do that many people exist that really vote against it? Please don't point at
ACA, that was nothing close to it.

~~~
pm90
It polls favorably but the GOP won’t vote for it, likely because of
ideological (Govt is bad!) and financial (insurance industry lobby) reasons.

~~~
mmcnl
What is Biden wins the election? Democrat Senate + House + POTUS would make
UHC actually within reach, no?

~~~
Clubber
Biden is against UHC I believe. He said he would veto Medicare-For-All in a
debate.

------
tedmcory77
Every health event is literally a blank check to _multiple_ unknown providers.
There's nothing to stop them from charging _whatever_ they want.

~~~
Clubber
This is absolutely correct. In fact, most of their master price list is
artificially inflated as a negotiating point with insurance companies. If you
are unable to negotiate before your care, you get the hospital's mater price
list price.

The worst part is most medical care is inelastic, meaning you don't really get
to pick and choose, like in an emergency.

------
kaesar14
Not sure how much factual basis I have to back this up, but from my
observations, the insurance system the US has was created by accident, but is
absolutely maintained on purpose. Keeping health insurance tied to employment
was a nice benefit for when insurance wasn't universal in many other
countries, and healthcare wasn't nearly as expensive (as it wasn't as good as
it is now). Now, keeping it tied to employment keeps people working, in
service to large corporations that can afford insurance and less likely to
take risks like working at upstart companies that could challenge established
market players, or protest and try to make change in a broken political
system. It's all pretty nefarious.

------
mjayhn
I was laid off, I've got a $500/mo prescription that keeps me out of a dark
pit and gives me the ability to even work, I either pay that or pay $850/mo
for COBRA to extend my healthcare. Or, what, medicaid? I'll probably be
employed by the time that goes through. Six week wait to see a $250/hr cash-
only psych.

Telehealth "loosened" red tape for everyone BUT people with mood disorders. I
still need to go in person for an appointment to get the medication I need.

This is bad. I'm super privileged even being unemployed right now. I have
savings. I feel for the people who can't afford any of this right now who are
going through serious things.

If I come down with COVID I'll be bankrupted forever I'd imagine.

------
101008
For those not in USA, can someone summarize? I know (from reading online) that
if you go a hospital, the bill can be scary. But what happens when companies
offer health insurace with a position? That means it covers everything? Just a
%? It depends on the topic (for example, hearth related sickes are covered,
not more cosmetics ones)?

Who are the people who is becoming profitable with this? Doctors? Companies?
Are doctors allowed to open their own offices and have high prices? From the
outisde everything seem so confusing!

~~~
mayneack
In theory you can predict the total cost for things covered by insurance, but
there are many layers of complex bureaucracy involved and the insurance
company is actively trying to get you to fall through a crack and end up on
the hook for a real bill. The insurance company also is practically the
arbiter of whether or not you did it correctly.

The best example, is that you can go in for a surgery or something at a
covered hospital for a covered procedure, but you can be surprised because
some doctor assigned to you isn't in your network. Sometimes this happens
after you're already under knocked out for the surgery, so you can't
practically consult your complex policy at the time.

~~~
mmcnl
How can your example even be legal?

~~~
mayneack
The positive spin on this is that it allows for more "consumer" choices. With
300 million people, it's easy to find a few individuals pushed into a worse
situation. People consistently underrate how bad the status quo is.

------
solutron
Not to sound conspiratorial, but the politicians that put these mechanisms in
place know exactly what they're doing and this is a tool to keep the masses
compliant and afraid of taking collective action against the overlord ruling
class. Decoupling healthcare from employers, and making health care affordable
are a direct threat to the entrenched status quo.

------
baron816
Free markets do a really good job of allocating resources most of the time.
People are generally very good about making decisions about what clothes to
buy, what food to eat, what house to live in, etc. There are some exceptions
there, but its easy to design market incentives to guide them to better
choices.

Heath care really doesn’t work with free markets though. People just aren’t
able to make good decisions when it comes to health care, and profit focused
business are able to exploit that, which results in horrible outcomes. It’s
not hard for a lay person to assess the advantages and disadvantages of
different cell phones sold from different retailers and from different
providers, but how can people assess the pros and cons of different cancer
treatments from different doctors at different hospitals? The complexity of
biology and medical treatment is much much greater than anything people have
to deal with in their normal lives. Decisions are almost impossible to make.

Also consider that allocated resources based on a price/demand relationship
doesn’t really work. Right now, health care companies focus on developing
treatments for conditions that mostly afflict the rich, rather than treatments
that could help the most people. It would not be hard for a medical board to
make decisions about where research and treatment priorities are. We have lots
of good data on how people are getting sick and how they get better.

Lastly, if you get sick for no fault of your own, whose burden should that be?
That burden should be spread across society as a whole.

~~~
Clubber
It's not a free market if the prices are hidden. Consumers can't make educated
decisions without prices.

~~~
jjav
As any negotiator knows, you only have leverage if you are willing to walk
away.

Health care will never be like this because if you need it to not die, you
need it.

------
afarrell
As a US->UK immigrant, I really appreciate the degree to which free-at-point-
of-care encapsulates complexity.

Unencapsulated complexity imposes real stress on:

\- Hospital administrators, who then hire more colleagues and pay their
salaries[1]

\- Government agencies trying to implement a new law...or even determine which
agency is responsible for pieces of that law[2]

\- Patients trying to access medications[3], who then might go without care or
go to the ER.

There is inherent complexity in healthcare because bodies are complex. It is
stressful enough dealing with a medical condition itself. Dealing with the
incidental complexity of insurance on top of that is... bad.

When there is new attempt to reform US healthcare, can we also get Prof John
K. Osterhout in the room where it happens?

[1] [https://time.com/5759972/health-care-administrative-
costs/](https://time.com/5759972/health-care-administrative-costs/)

[2] [https://digital.hbs.edu/platform-rctom/submission/the-
failed...](https://digital.hbs.edu/platform-rctom/submission/the-failed-
launch-of-www-healthcare-gov/)

[3]
[https://www.youtube.com/watch?v=aKUdadCsuRE](https://www.youtube.com/watch?v=aKUdadCsuRE)

------
bgun
Perhaps "give me your tired, your poor, your huddled masses yearning to
breathe free" doesn't carry the same meaning when no better life awaits. The
exodus will happen slowly, then suddenly.

------
tboyd47
COVID-19 made this much worse, but the current system is too complicated. It
took me years to learn how to navigate it and it's probably going to change
dramatically again very soon.

Most ACA plans are a ripoff if you're not getting a subsidy. Who can save
$9,000 in a year for a deductible while paying $1,000 a month in premiums?
Nobody I know.

It's well-known that hospitals jack up their prices. It's a crooked system.
Good luck fixing that with a magic wand from Washington.

But- it seems to me that the underlying problem is the epidemic of chronic
illness. Chronic illness is crippling this country. We're spending so much
because we're actually all sick.

I'd like to know, what's making us sick?

~~~
chrisjarvis
[https://www.cdc.gov/obesity/data/adult.html](https://www.cdc.gov/obesity/data/adult.html)

>The prevalence of obesity was 42.4% in 2017~2018

This is one chronic illness (mostly unique to America in the developed world)
that makes socialized health care very expensive.

~~~
sacred_numbers
According to that link the medical cost of obesity is $147 billion. Healthcare
spending in the US is around 3.3 trillion. Obesity is a problem, but it is not
the main driver of medical costs. Also, we are already paying for the
healthcare of obese people through insurance premiums and taxes. Proper
socialized health care would incentivize and allow for more preventative
treatment for obesity-related problems.

------
sudosysgen
This is not good for any demand-driven economy.

~~~
mrweasel
It's honestly a little weird, America health insurance can't be driven by
demand. If it where, it would be cheaper.

Why is it that the providers and insurance companies isn't trying to undercut
each other on price? I know very little about US health insurance, but I can
only assume that it's not truly a capitalist system, something else most be at
play, driving the prices up.

~~~
macintux
There’s absolutely no transparency, which makes it hard for an informed
consumer to make decisions based on price. And frankly picking a health care
provider based on price feels scary: do you really want the cheapest LASIK
procedure around, e.g.

------
jupp0r
Let's just hope that all these people get out and vote this November. This is
a fixable problem.

~~~
blackflame7000
Neither of the candidates are going to fix this problem

~~~
jupp0r
You don't think that banning denying coverage for preexisting conditions is a
huge step into solving this problem?

~~~
tehwebguy
That has been law since Jan 1, 2014. It is part of the ACA[0].

It is not surprising that some people do not know this, as the president has
recently said he would sign an EO mandating this, even though it is already
law[1]. It’s unclear if he is unaware that the ACA already includes this
mandate or if it is a deliberate misinformation campaign.

[0] [https://www.hhs.gov/healthcare/about-the-aca/pre-existing-
co...](https://www.hhs.gov/healthcare/about-the-aca/pre-existing-
conditions/index.html)

[1]
[https://www.usatoday.com/story/news/politics/2020/08/08/trum...](https://www.usatoday.com/story/news/politics/2020/08/08/trump-
pursuing-executive-order-covering-pre-existing-conditions/3326123001/)

~~~
dbbk
His words on this are meaningless as his actions are the polar opposite, they
are in court arguing that the entire ACA needs to be voided, and with it the
pre-existing condition protections.

------
surfmike
Even insurance doesn’t protect against this. Case in point: family member
battling cancer had over $50K in costs not covered by insurance. Not to
mention costs that they had to pay initially until the insurance company
accepted the claim. (They usually had a few back and forth a where the
insurance co would initially refuse to pay)

------
refurb
As someone with good insurance through my employer I've seen first hand the
incredible hassle the US system is.

It really stood out when I was traveling with my kid they needed a hospital
stay. This was in SE Asia and at a private, international hospital.

My kid stayed in a private room, all meals included (including for family) for
3 days. I was a little nervous about the cost, but knew it wasn't going to be
more than a few thousand dollars and my insurance would cover some.

The final bill? $600. A one-page, itemized bill with things like "antibiotic
tablet - $0.50; 72 hr hospital room stay w/ nurse - $350".

Of course the cost is going to be much lower in a developing country, but
damn, it was refreshing to see such a smooth process and clear price
transparency.

Ignoring the insurance side for a moment - just knowing what things cost would
be a _massive_ step up for the US system.

------
kgin
I have the cheapest ACA / Obamacare bronze-level plan available to me in my
area.

It costs $500 monthly (no subsidies if you make more than 45k a year) and has
a $7000 deductible. It provides zero coverage (except life/limb emergency)
outside of my metro area.

This isn’t working for me but I have no other options.

------
_huayra_
I really wish apologists for the current US healthcare system could actually
agree that it's nothing like their vaunted "free market apples" example of
capitalism. If anything, actual competition, within some limitations to avoid
monopolies capturing key markets (insulin anyone?) could do wonders:

If I want an apple, I see a price, think "yep sounds good" and pay it. If the
apple is rotten and I return it only to have the vendor say "sorry sucker!", I
take my money elsewhere.

If I get in a bad accident, I am in no decision to make decisions about where
to get care; I may not even be conscious. Moreover, I am orders of magnitude
more knowledgeable about what apples I like and what they ought to cost than I
am about what medical procedures I need. Delegating those decisions ought to
be a sacred act enshrined in law, the Hippocratic oath, and relatively high
pay for medical professionals (that job is hard).

So long as the US has the right to emergency care for anyone, taxpayers will
continue shouldering that bill when folks can't pay. I get being for "personal
liberty and freedom", but paying for Unemployed Uncle Fred's blood pressure
medication is a far cheaper prospect than his massive heart attack.

I'm so glad I moved out of there to a sane country that, although it doesn't
have single-payer, has a heavily regulated free market and no crazy medical
bankruptcies.

------
yawz
This country is the land of contradictions (and I'm saying this as a
resident). More than half of the Americans are not happy with the state of the
healthcare, but more than half of the Americans are not happy to contribute to
a better healthcare system. Go figure!

~~~
cyberlurker
If you are privileged with a good job and good coverage, it’s far better to be
in the system we have now. Your chances of incurring huge costs are relatively
low and you’re saving tens of thousands of dollars by not paying to benefit
others. Also if you need to get a specific treatment you don’t need to go
through a government bureaucracy, you just pay for the treatment or insurance
might cover part of it.

Of course there are significant downsides if you aren’t privileged or if you
care about other people. If you have a kid that is born with diabetes for
example it can be a huge unnecessary cost, but that’s probably due to drug
pricing in America which is a whole other topic.

My point is it isn’t fair to say that the current system is universally bad
for everyone. But I personally think we would all be better off as a society
if everyone had access to good medical care without the risk of financial
ruin.

~~~
matthewmacleod
_Your chances of incurring huge costs are relatively low and you’re saving
tens of thousands of dollars by not paying to benefit others._

Is this actually true though? It seems that the chance of encountering huge
expenses are non-negligible, and that you wouldn’t actually save any
appreciable amount of money.

 _Also if you need to get a specific treatment you don’t need to go through a
government bureaucracy, you just pay for the treatment or insurance might
cover part of it._

Using the UK as an example, obtaining necessary treatment involves no
“government bureaucracy”. It just involves that treatment being deemed
medically necessary and then provided. No messing around with insurance and
hospital billing departments. Of course, you are still free to pay private
providers for services, or indeed to take out private medical insurance.

------
duxup
It's so sad.

When I changed jobs doing so / not had a lot of considerations to do with
keeping / getting health insurance.

I feel like people would feel so much more flexible not having that tied to
employment.

~~~
war1025
> I feel like people would feel so much more flexible not having that tied to
> employment.

This should be a bi-partisan issue since both sides claim to love "small
business."

Health insurance is unaffordable for any small business and prevents many from
striking out on their own.

It's also a hidden expense that many never realize they have.

If you looked at my "out of my bank account" spending, I could spend probably
5-10 years unemployed and be fine.

Add in the extra $20-30k/yr for health insurance premiums and that drops down
to maybe two years if I was lucky.

~~~
duxup
And you'd hope businesses would be happy to be out of that game too....

------
brundolf
For those who are concerned about this problem and can afford to help, this is
a charity that buys up medical debt for pennies and forgives it:
[https://ripmedicaldebt.org/](https://ripmedicaldebt.org/)

It's obviously a band-aid for a deeply broken system, but it can un-ruin real
people's lives in the immediate-term.

------
perfectstorm
Having my health insurance tied to my employer terrifies me. Fortunately i
have good insurance through my employer but what if i lose my job? I still
can't fathom how having a universal healthcare is a political issue. It should
be a basic human right. Even poorer developing nations have started
recognizing it and making healthcare free.

------
say_it_as_it_is
The other half who reported not fearing health-related bankruptcy work in
government and now have better health benefits than those in the private
sector. They don't see anything wrong with the healthcare system because it
hasn't affected them.

------
tehwebguy
Yeah but that’s barely the tip of the iceberg.

People are afraid of having a major, expensive surgery or treatment and that’s
a _valid_ fear but what about the years you spend hitting (or almost hitting)
your deductible just trying to find out what’s wrong with you?

------
thatmathguy
Seeing that the potential presidential candidate whose platform was mostly
centred around healthcare did not advance to a full candidature implies that
either the survey was not representative or the fear is outweighed by other
political worries.

------
andrewl
Bill Moyers has a good segment on this subject:

 _Profits Before Patients_

[http://www.pbs.org/moyers/journal/07102009/profile.html](http://www.pbs.org/moyers/journal/07102009/profile.html)

------
costcopizza
I wish we could cut as many of the PBMs, claims, and overall middlemen out of
this damn system.

Health insurance costs would be significantly lower if it was as direct as
possible, as transparent as possible, and the end user had a say.

------
bfrog
The other 48-49% are just cluelessly oblivious to what reality is. One person
getting sick in the family is all it takes.

------
tickerticker
Another poll said that 67% of Americans could not scrape $2,000 together to
cover an emergency expense.

------
AsyncAwait
And _only_ Americans.

Every other developed, even developing, nation has a superior, if not perfect,
solution.

~~~
dbbk
As a European, this is just one of many reasons why I would never fathom
moving to America. Your quality of life would be just way below what you can
get almost anywhere else in the industrialised world.

------
utf_8x
A "socialist" public healthcare system could never work!

Well... Unless you're in Austria, Belarus, Bulgaria, Croatia, Czech Republic,
Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Isle of Man,
Italy, Luxembourg, Malta, Moldova, Norway, Poland, Portugal, Romania, Russia,
Serbia, Spain, Sweden, Switzerland, Turkey, Ukraine, United Kingdom or many
other countries...

------
Bubbadoo
Health insurance in the United States' for-profit healthcare complex is a
nightmare. Besides the fact the premiums are onerous, it is the health
insurance carriers that evaluate if and how much insurance will cover an
expenditure, usually after a copay and possibly coinsurance has been paid. To
say nothing of ever-growing deductible limits. On top of that, the Trump
Administration is working overtime to purge what little insurance benefits are
provided via Obamacare (in it's quest to eliminate any legacy of the Obama
Administration). Unfortunately, the GOP is woefully short on replacement
ideas. One does get the idea--in the true spirit of the Republican Party--the
replacement will consist of costly, high-deductible health insurance that will
include many exclusions from its coverage.

All this begs the question: quality of life in the US, especially for the
middle class, is crashing compared to our friends in other industrialized
nations. Why middle class especially? Because the middle class is most likely
to have an employer-sponsored plan that has deductibles and exclusions. In
fact, most of those carrying employer sponsored health insurance never really
know how much of the bill insurance will cover. Poor and indigent people, in
many states, can still obtain health care without insurance and many states
have funds just for this so the bill is paid by the tax payers in one form or
another.

And since the healthcare complex is an aggressive lobby in Washington, this
situation is not likely to change. Not under Biden, certainly not under Trump.
And to those Democrats who say millions of people who have employer-sponsored
health insurance love their coverage and don't want to give it up, I say
poppycock! I don't know anyone, outside of public union members, who really
like their coverage, employer-furnished or not. Year-to-year premium increases
with less coverage over time effects this group more than any other.

~~~
lotsofpulp
> Besides the fact the premiums are onerous, it is the health insurance
> carriers that evaluate if and how much insurance will cover an expenditure,
> usually after a copay and possibly coinsurance has been paid.

This is not true. ACA requires health insurance companies to pay for all
healthcare expenses after reaching one’s out of pocket maximum.

And they have some discretion to call out fraud, but insurance companies have
to by and large follow medical procedure guidelines. They don’t have to cover
experimental treatments, but if they are denying appropriate healthcare, they
would get nailed by various government agencies.

~~~
Bubbadoo
The 'ACA' is not one plan and it certainly does not require health insurance
carriers to pay for 'ALL' healthcare expenses after you reach your deductible.
Coverage varies by state and by level (ie., gold or platinum). Many plans do
not cover out-of-network doctor visits for example. On top of this, you need
to get prior approval for every medical procedure because not ALL are covered.
In some cases, the insurance company will recommend a different treatment,
instead of the prescribed treatment. I speak from experience.

AHCA coverage is superior to what we had before, but it isn't enough. It was
drafted with the Health Insurance lobby in the room, so do the arithmetic.

~~~
lotsofpulp
ACA requires insurers to pay for all healthcare expenses at in network
providers for coveted procedures, unlike pre ACA where the insurer could
simply stop paying at a certain dollar amount.

And health insurance does recommend different treatment depending on what the
insurance’s doctors think. That’s the entity with the knowledge to be able to
challenge a doctor, since the patient rarely has sufficient knowledge to do
so.

The alternative system of a check and balance is if the government pays for
healthcare and a government employed doctor approves or suggests alternative
treatment. That’s what the UK does.

Either way, you have to have a second opinion to avoid mistreatment or
overcharging by the healthcare provider. This isn’t an issue specific to
healthcare, it’s present in any sufficiently complicated field.

------
ectqmbe
Was going to post this in response to a comment stating that COBRA is
affordable and when you can't you qualify for medicaid, but it was deleted.
Here's some uncomfortable facts:

In truth, most can't afford COBRA and many of the most COVID hard-hit
industries don't even have that option because they were never offered
employer-based healthcare to begin with

A lot of Conservative|Libertarian folks will tell you: "The current system
works and when it fails there are social protections to help people." This is
simply a nice fantasy perpetuated by those that have never had to rely on the
American social safety net. In truth, our social safety net has never been
that strong and has been weakened by ~60 years of conservative-led entitlement
cuts while we have expanded military spending and corporate welfare.

Most workers who've lost their job cannot afford an additional $20k/year for
COBRA while not being employed (see quote from EPI below). In fact, it's much
worse than that: 50% of Americans struggle to confront an unexpected $400
expense.
([https://www.federalreserve.gov/publications/files/2018-repor...](https://www.federalreserve.gov/publications/files/2018-report-
economic-well-being-us-households-201905.pdf))

Check these statements from the director of the Economic Policy Institute:
([https://www.marketplace.org/2020/05/13/cobra-health-
insuranc...](https://www.marketplace.org/2020/05/13/cobra-health-insurance-
covid-19-jobs/))

"""

EPI (Economic Policy Institute) research director Josh Bivens said that fewer
than half of all workers receive health insurance from their employer, and
COVID-19 has hit the hardest among workers with low pay and meager benefits.
“Job losses so far in this crisis have been pretty concentrated in sectors
like accommodations and restaurants that don’t tend to offer employer-provided
health insurance,” he said.

Workers who get their health insurance through their employers can keep it.
Under a provision of federal benefits law called COBRA, most employees who
lose or leave a job can remain on their employer’s health plan for at least 18
months.

But it isn’t cheap.

“Very few people sign up for COBRA,” said Matthew Rae, associate director of
the Health Care Marketplace project at the Kaiser Family Foundation. “And the
reason is, it’s unbelievably expensive. The worker’s got to pay the full cost,
so you end up paying — for a family of four — somewhere north, on average, of
$20,000 a year.”

"""

The gap from "affording cobra" to "no assets and no income" which is the basic
requirement for medicaid is pretty far. States use the federal poverty
guideline which has been kept too low for years due to politics to determine
eligibility. For a single person that's $12,490 and for a family of four
that's $25,750. Where in the US are either of those a livable wage? Do any of
those places have reasonable access to work and social services?

In fact, I'm actually surprised that _only half_ of American's fear this. I'd
surmise that those who don't are either unaware of the potential for the
looming crisis or otherwise fatalistic.

------
Pfhreak
In another thread, I was told that $19k was enough for an American, and that
someone making $60k was just interested in making money. That if the median
income wasn't enough, then we "have bigger problems as a country".

And yet here we are.

~~~
duxup
You should go ask that person in the other thread.

