
What We Learned from a Year of Americans ‘Risking It’ Without Insurance - petethomas
https://www.bloomberg.com/news/articles/2018-12-28/what-we-learned-from-a-year-of-americans-risking-it-without-insurance
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SolaceQuantum
I've tried to understand the circumstances _preventing_ socialized medicine in
america. I understand there are arguments against socialized medicine, but
they make no sense to me on their face (eg. the idea that long wait times
would occur, when wait times for USA and wait times for other first world
countries with socialized medicine isn't very differe. The idea that
socialized medicine would cause less medicine research and advancements, when
increasingly medicine advancements are coming from countries with socialized
medicine- the US seems to be falling behind in this respect.)

Could someone explain to me this phenomenon? I struggle because I do not want
to believe the easy, dehumanizing position that 'the people who do not believe
what I believe are just too stupid to know I am right'.

~~~
jmalicki
What do you mean by socialized medicine?

If you mean government required and subsidized, like the systems of France and
Germany, which have great healthcare systems, that sounds _wonderful_.

If you mean single-payer healthcare, like Canada and the UK, screw that
disaster.

~~~
SolaceQuantum
What makes single-payer healthcare, like Canada and the UK, a disaster? I'm
from Canada and currently live in the US. I don't have many complaints about
the canadian healthcare system. I got a suprise bill yesterday in the US
healthcare system for routine bloodwork.

~~~
bitrrrate
I'll second that. Due to a couple of significant illnesses growing up my
family would have been bankrupted two times over if we lived in the US. Also,
when one of my parents passed after a couples months of hospitalization,
emergency room visits and an ambulance ride, they didn't owe a single loonie
(Canadian dollar coin) for the care.

If it was the US, my bereaved parent would not only owe thousands but they
would have to be on guard to verify the accuracy of each bill, negotiate with
the provider and then setup a payment plan stretching into infinity.

The US healthcare system is another area where capitalism and the 'free
market' is failing the consumer.

Frankly, when I hear see someone stridently decrying socialized medicine or
single-payer healthcare I wonder if their tune would change after their first
medically induced bankruptcy or not being able to afford medication that would
keep them alive.

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NicoJuicy
Wow, being used to Belgian healthcare... This article really makes America
look primitive.

We pay a lot of taxes, but at least I don't have to worry about money, if i
would get severely sick.

Eg.

\- A checkup at the doctor ( blood) costs 2€, results within 24 hours.

\- Additional costs are required upfront by law. If I'm not mistaken, you
can't even get an estimate on the US.

~~~
devereaux
What's the cost of a checkup at the doctor for a foreign tourist? (who I
assume will get results also within 24h, and be informed about upfront costs
if it's the law)

What's the medican income in Belgium? In the US?

I just don't understand how people in HN of all place complain about the costs
of healthcare. I believe America has a better system, especially if you are in
the hacker mindset (and with IT salaries!). Just fly to wherever, and get
treated for a great price and quality.

And that's not specific to the US. I've heard Eastern Europe provides great
dentistry services and that even Western Europeans fly there to get treated.

Medecine is a business just like any other. If your local shop tries to screw
you, take your business elsewhere

~~~
henrikschroder
You're basically saying "fuck you, I got mine".

Yes, medicine is a business, an industry, and obeys the same rules as other
businesses.

But the goods it produces, "healthcare", are not like other goods. Demand is
infinite, supply is scarce, and on a national level it makes sense to make
sure it is distributed on a needs basis instead of a can-afford basis, because
that leads to a healthier and more productive population, which is good for
everyone.

~~~
devereaux
> it makes sense to make sure it is distributed on a needs basis

"to everyone according to their needs" \- that reminds me of some political
movement!

Joke aside, I just disagree. It is not the "FYGM" you said. It is reasoning
about the problem. Some countries have higher costs. Some have lower cost.
Specialization of labor is wonderful - everyone gets richer, even if a country
has a net advantage in productivity in all sectors. That's economic 101.

There is no reason for healthcare supply to be scare. It takes money. Instead
of spending thousands of dollars in the US (or your Euros in Belgium), spend
them in another country where it cost less.

It will also create incentive to build more healthcare supply there -- good
for the residents of this country, and good for you too.

~~~
NicoJuicy
It's cheap enough in Belgium, I can stay here.

Others won't go broke even, since the social system supports this...

That's the entire discussion of the article...

I don't even understand how your can also use Belgium wrong, in using it as an
argument...

Your previous comment related "common healthcare" to IT-salaries, last time I
checked, this isn't anywhere related.

None of your arguments make any sense.

Did you even read anything? All your arguments prove that the US healthcare is
flawed, so I don't know why you are even arguing with me.

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ravenstine
This might be a bit of a tangent, but I'll throw in my perspective as one of
those who has been "risking it" for the last 4 months or so. (I won't go into
why I'm risking it unless asked)

I think it's difficult for a lot of people to justify paying a lot for things
that don't provide much of a tangible/measurable benefit. Ideally, insurance
would cover a person if something catastrophic happens, but otherwise it's
difficult for the human mind to believe it's not essentially setting money on
fire when they pay for things that don't have an immediate return. This is
probably true now more than ever given our culture of immediate gratification.

Someone might feel better about paying for insurance(aka health care) if they
believed they were actually being taken care of today by the dollars being
spent _today_. What I mean is that I know of almost nobody who has anything
good to say about any aspect of the health care system; everyone seems to have
to shop through several doctors to find one who knows what they're talking
about, after having spent maybe 5 minutes with doctors a-piece before being
sent home with a prescription for what the doctor concludes to be a textbook
diagnosis. Many people complain that doctors don't listen to them, and I can
attest to this myself having had doctors completely ignore my evidence that I
have a specific genetic condition that can be traced to my grandfather who has
the identical symptoms(as one example). A friend of mine with a chronic pain
issue(I'm talking severe) regularly has to deal with doctors and healthcare
staff not doing their jobs whether it's not refilling prescriptions when they
said they would, not returning phone calls, failing to communicate with
pharmaceutical firms, telephone ping pong caused by nobody knowing who has the
authority to do what, nobody can tell you what the price for a treatment will
be, etc. It's often chaos. And we're supposed to pay thousands a year for that
shit?

People need to have faith in what they're putting their money towards. If
someone doesn't have faith that the health care system actually cares for
them, they're more likely to not pay for it out of spite and take the risk
when they have to. Those with a lot of money and well established careers
might have the time and resources to navigate the bullshit, but many people
don't.

~~~
heydonovan
I know this has to do with health insurance, but I feel the same with auto
insurance as well. It still feels like burning money. For example, I've been
paying about $120/month for car insurance since I was 18, give or take. Never
been in an accident. That's about $14k I've given to an insurance company for
literally doing nothing.

~~~
FireBeyond
And then when you do need it?

I was hit by a driver 6 weeks ago. He and insurance company accepted 100%
liability. My 2015 Audi was totalled due to multiple airbag deployments
(though the vehicle is largely intact other than frame, so will be healthily
recouped by the insurer on the parts market).

Despite this...

I got a settlement offer from my insurer (who, bear in mind, are going to
subrogate this to the opposing side) of $5K less than KBB for the vehicle
(which was bought a year old, and is now 3 years into a 5 year loan), and $3K
short of my outstanding loan (don't even start me on gap insurance - I've
never seen that pay out, there's always a loophole).

So the insurer's idea of indemnifying me, mitigating my risk is for a 0% fault
accident, I:

1) lose my car, which was in excellent condition, and barely 4 years old;

2) lose 3 years of equity in a five year loan;

3) do not have a car;

4) still owe my bank ~$3,000;

5) need to come up with a down-payment and a new loan for a vehicle within 7
calendar days of their (pitiful) settlement offer.

All the while getting condescending remarks like:

"Gap insurance would have protected you" (not in my experience, and my credit
union 'neither recommended nor required it based on the FMV at purchase', and
the only reason there's a deficit is your woefully inadequate settlement
offer)

"We're looking after you - remember we've been paying your medical bills so
far" (how ominous, "so far") - and I've been paying for a policy which
included PIP for nearly a decade, so you'll forgive me for not lauding you
fulfilling your contractual obligations _for which you have been compensated_.

To add insult to injury? They direct debited my premiums, including for the
vehicle they totaled, and I had to explain this to a CSR. Who then said they'd
take the amount they'd erroneously debited, and "apply it as a credit across
the remaining 7 months of your policy on your other vehicle". No, thank you, I
just want you to refund it.

------
maxxxxx
I think more and more that the Medicare For All movement makes sense. If
people want more, then they can buy additional insurance, but otherwise the
basics are covered. I can also deal with long waits for elective treatment as
long as I know that an accident or serious illness won't bankrupt me.

------
CptFribble
The problem I see is that even if ACA was "working as intended," it would
still be an incomplete solution.

We buy off our state marketplace, but can only afford bronze tier plans with
the subsidy. All plans are the same at low tiers, and all make you pay the
deductible before the insurance company pays a dime (not counting "negotiated
discounts," which are completely invisible until after the bill is generated)

That means we're not really signing up to be able to go the doctor, but to not
go bankrupt in case of major illness. We buy insurance only to cap our risk at
the annual out-of-pocket max. That we get a "free" physical is just a
consolation prize.

I think a lot of people don't see it that way. As others said, most people see
it as money wasted if they don't get sick. And that's a problem.

I don't blame the ACA for our issues in the USA, I blame everyone in the
government who worked tirelessly to ensure insurance companies can continue to
tax our doctor visits for shareholder returns.

We need Medicare For All. No one should have to skip going to the doctor
because the insurance requires $6k-$8k of blood money before they start
performing their function and paying for healthcare, or even let us pay "just"
a co-pay.

------
danmaz74
"Keith and Diana Buchanan of North Carolina gave up their expensive health
insurance this year, and bought a Bowflex exercise machine. Keith said he got
into the best shape of his life: “A lot of it is a result of knowing that
we’re going to have to take care of our own health a little better,” he said."
Unfortunately, being in shape doesn't prevent so many health conditions.

------
berbec
No insurance from my job since I'm freelance. It's $900/month for me and my
wife.

~~~
whatinsurance
I am in the same boat. Me and my wife had Kaiser Bronze for 750 a month.
Recently my wife had to go to emergency and we were billed 6000ish because
emergency room services are not 100 percent covered. It would have been more
but our out of pocket Max was reached. This is northern Cal.

When we were in the ER I was too panicked to ask any questions regarding
pricing for any recommended tests or if it was necessary. Later when we were
billed I asked them to send an itemized bill. There was not much I could
understand from the bill. We ended up setting up a monthly plan to pay the
hospital bill.

~~~
berbec
I couldn't keep up with the payments in 2018. I lost my coverage in August and
got lucky. I cant afford to go to the dentist even when I still had my
insurance. I have a broken tooth, a cracked crown and probably 3 cavities.

------
devereaux
I have the best insurance money can buy: a plane ticket to %anycountry
(business class if needed)

Cost of emergency endoscopic shoulder surgery in a private for-profit hospital
in France, when totally uninsured, and paying by credit card: 1900 Eur -
including anesthesiologist fee, surgeon fee, facility fee, radiology, drugs,
private room etc. So around $2200 total, done the same day, after being
arranged by phone. It was in France just because I couldn't do that in
Thailand (great hospitals and food, like France, but also great beaches during
recovery)

Add plane ticket + out of pocket costs, divide by 12: about $200/month, 0
deductible - and $0 for the years I don't need anything.

Alternative options for the risk averse: purchase local insurance in
%anycountry, all inclusive. Cost of health insurance in Europe for non
residents: around $70 per month. Just pay, and get treated in that country if
you need it. Of course, you still need the plane ticket to fly there.

Still getting treated abroad is way way way cheaper than the alternatives.

Am I risking it? No. I'm making an educated decision.

~~~
TheLuddite
That's a good idea, but what if you cannot travel because of your health?

~~~
devereaux
Not travelling because of some pain? Painkillers + business class.

Not travelling because I'm unconscious or in a critical condition? Foreign
insurance + air repatriation.

Some countries do sell that, even to non residents. Just get world coverage -
it's a bit more than $70, but if something bad happen, you get med evac'ed to
that country and treated there.

I'm exploring that option as I discover the wonder of medical tourism.

~~~
TheLuddite
Thanks, that's really surprising...not the stiff upper lip...but the
repatriation.

I thought it's only for people with residence + VIP client in a bank or
something.

~~~
ahakki
Rega offers the service for 25.- a year iirc

[https://www.rega.ch/en/about-
us/faq.aspx?kid=56&gid=250#Frag...](https://www.rega.ch/en/about-
us/faq.aspx?kid=56&gid=250#Frage451)

~~~
NicoJuicy
> If travellers have a medical problem while they are abroad.

Just when you are travelling with them in the first place... Not for this use-
case, where your fall ill in your home country.

And, nothing there says they will pay you back fully.

~~~
ahakki
Rega is not a traveling agency. It’s an air ambulance company.

------
tboyd47
A health insurance startup with a medical tourism option to Cuba, Canada, or
India would be a promising venture, for sure.

------
devilkin
I find this so strange and confusing. A healthy society is a productive
society that pays taxes.

I'm also from Belgium, and this feels so retarded. And what's even stranger is
that some people in America even support this system. Wtf?

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gammateam
I need to get out of here.

------
rememberbitcoin
I've been "risking it" since my last job in 2009. I've had remarkably good
health so it hasn't been much of an issue.

Even when I had great insurance and used it with all the correct providers and
plans and centers there was still always some issue that would lead to insane
bills for every minor visit. I've known two separate people who had good
health insurance and skilled well paying jobs and they still got completely
wiped out by medical bills and eventually decided to eliminate the six figures
of debt by sticking a 12 gauge barrel in their mouth.

It's not really "insurance" if you're getting screwed with massive bills
anyway. Call it something else, whatever label you choose the system seems to
have stopped working.

