
Americans Are Going Bankrupt from Getting Sick - clumsysmurf
https://www.theatlantic.com/health/archive/2019/03/hospital-bills-medical-debt-bankruptcy/584998/
======
lordnacho
I remember when I heard about my uncle passing away in America. He had the
symptoms this lady had. For some reason he didn't go to the doctor, and it
really puzzled me. At the time I'd put it down to inherited stubbornness,
because my dad had had the same thing happen as well and would only go to the
hospital because I forced him to.

Now I'm wondering whether my uncle was simply scared of the bill. I found out
he'd told colleagues he was feeling numb on one side and had blurry vision,
yet still didn't go to the hospital.

My uncle died, it was more serious that he thought.

My dad survived and still lives. In Denmark you rarely think about the cost,
but rather the queue to see a doctor (if you have something minor, you might
wait a long time). The doctors knew what was going on immediately, so it
wasn't a long wait.

Is it common for blue collar workers to be without health insurance in the US?
I don't want to ask my cousins about it, too painful and it would probably
trigger a big rant about healthcare.

Also, if your healthcare is tied to your job, what do you do between jobs?
Just be really careful when chopping the onions?

~~~
raincom
If one is a blue collar worker for a large corp (not a small biz), he/she
usually have a health insurance. However, it comes with lots of co payments,
out-of-network payments, etc; this can ruin a person financially.

Many employees of small businesses don't have insurance or super crappy
insurance with lots of copayments.

How about Uber drivers? They don't have any health insurance.

------
rayiner
I think we should have universal healthcare, but I don’t know how I feel about
the “medical bankruptcy” angle. It strikes a chord with the middle/upper
middle class readers of the Atlantic because those people fear losing their
financial status. But to me, protecting the financial status of middle class
people seems like a particularly poor _justification_ for universal health
care.

Why should the government use tax dollars to keep a middle class person from
going bankrupt, instead of giving that money to someone who started at $0 and
stayed at $0? You’re a middle class professional and you get unlucky and get
cancer, the government will pay hundreds of thousands of dollars for your
treatment. But if you’re unlucky in a different way, say you are born in the
ghetto to poor parents, the government won’t give you hundreds of thousands of
dollars. That seems completely backward.

Say you raise taxes hundreds of billions of dollars. Is protecting middle
class people from being wiped out financially if they have a medical
catestrophe really the highest and best use of that money? For about $100
billion you could give every child born into poverty an “inheritance” of
$100,000. Wouldn’t that be a better use of the money?

~~~
raesene9
Isn't the best idea to make healthcare affordable/free at point of use for
everyone (rich or poor) with the rich contributing more (through taxes) to
subsidise the poor.

That way no-one gets into medical bankruptcy :)

------
tapland
Don't fall for the 'yes, but countries that have cheap healthcare pay for it
with taxes'. The US pays more than most from taxes[0].

In Sweden we pay less per capita than americans do (from taxes) and my total
_maximum_ healthcare costs for _all_ treatments, medications, surgury etc,
that in the US would be paid by your employer or yourself are:

$125/year max for all visits and procedures [1]

\+ $250/year max for all prescribed medications (with up to 75% discounts
before reaching those $250)[2].

This makes treating my Crohn's + MEN-1 an issue of going to visits, doing
surguries and scans, and picking up my medications at the local pharmacy (I
order in their app since my medications are rare) every three months.

[0] [https://www.visualcapitalist.com/u-s-spends-public-money-
hea...](https://www.visualcapitalist.com/u-s-spends-public-money-healthcare-
sweden-canada/)

[1] [https://www.1177.se/Stockholm/Regler-och-
rattigheter/Hogkost...](https://www.1177.se/Stockholm/Regler-och-
rattigheter/Hogkostnadsskydd/)

[2] [https://www.apoteket.se/mina-recept-inloggad/mer-om-
hogkostn...](https://www.apoteket.se/mina-recept-inloggad/mer-om-
hogkostnadsskydd/)

~~~
enraged_camel
>>Don't fall for the 'yes, but countries that have cheap healthcare pay for it
with taxes'. The US pays more than most from taxes[0].

Americans don't actually have an objection to paying more for healthcare.

What they do have an objection to is paying for _other people 's_ healthcare.

America is a deeply individualistic society, and the idea of one's tax dollars
being spent to benefit others lies at the root of most people's objections to
single-payer, or anything else that smells like "socialism".

~~~
MiddleEndian
Ironically, I support single payer healthcare (or at least a dramatic
restructuring that decouples pricing from employment) specifically because of
individualism.

Right now, you need to work at a corporation to get collective bargaining for
healthcare prices. This presents a huge disadvantage to people wanting to be
contractors, self-employed artists, people wanting to start small businesses,
people who only want to work every other year for whatever reason, etc.

Your options are limited because you need to be part of a corporate collective
to get reasonable healthcare options.

~~~
User23
I support a variant of single payer healthcare too: you pay for your own
healthcare out of pocket. All this requires is that wages be high enough and
health care costs be controlled. If this sounds impossible, you should
consider that it was how our system worked in the USA in living memory.

~~~
Retra
You then deny that health insurance is a reasonable way to plan for illness?

~~~
User23
As currently implemented? Absolutely, it observably isn't. Why do we need
middlemen preying on fear, confusion, and preventing any reasonable price
discovery from occurring while driving an absolutely absurd inflation rate[1].
Please note those are monthly, not annual numbers, and some months alone hit
5%! Keeping costs down and wages up has plenty of other positive effects too.

[1]
[https://ycharts.com/indicators/us_health_care_inflation_rate](https://ycharts.com/indicators/us_health_care_inflation_rate)

------
morningmoon
\- 65% of Americans don't save, despite most having the ability to do so. 1 in
3 have less than $5,000 saved for retirement! It's a massive cultural problem.
[1]

\- Most Americans live unhealthy lifestyles that contribute to _$1.5 trillion_
in estimated healthcare costs from preventable disease. 1 in 3 Americans have
pre-diabetes and 2 in 3 Americans are overweight. 1 in 3 Americans are obese.
Again, a cultural problem. [2]

Our culture is toxic and unsustainable. Government can't fix this. It's a
generational problem that's been growing with each generation.

[1]: [https://www.cnbc.com/2018/03/15/bankrate-65-percent-of-
ameri...](https://www.cnbc.com/2018/03/15/bankrate-65-percent-of-americans-
save-little-or-nothing.html)

[2]: [https://blog.bcbsnc.com/2014/06/costly-
habits-1-5-trillion-l...](https://blog.bcbsnc.com/2014/06/costly-
habits-1-5-trillion-looks-like/) [3]:

~~~
nosianu
_2nd reply, for some reason HN refuses to accept my edit of the 1st one where
I appended this, although it still lets me open the "Edit" option even when I
reload._

As for your second point, I have a similar argument to make as in my first
reply about your fist point about "saving". Unless you think that suddenly,
within the last fifty years somehow humans especially in the US were born
radically different than any human or pre-human generation in the million
years before them, it's kind of strange to blame it on the individuals. I
would say humans have stayed pretty much the same. So if the outcome suddenly
is bad, why do look for the reasons in the individuals who did not change?
There must be something outside people that changed, and I would say that is
where one should look for a solution. Not in changing the people ("You buy
wrong! You eat wrong!"), which won't work.

The Guardian has just written an article along those lines:
[https://www.theguardian.com/books/2019/mar/16/snack-
attacks-...](https://www.theguardian.com/books/2019/mar/16/snack-attacks-the-
toxic-truth-about-the-way-we-eat)

~~~
cam_l
You have touched on what i think is the critical underlying difference between
Left and Right thinking.

Systemic responsibility vs personal responsibility.

The thing is, they are not mutually exclusive. They are more like two sides of
the same coin. And while those two sides may not be exactly equal, most
arguments between the sides seem to centre on the disjunct between these two
ways of thinking.

If you can acknowledge, but frame the very real issue of personal
responsibility within the context of a system, we may find it easier to bridge
this divide.

For example, judge the responsibility of three hypothetical people with a
sweet tooth.

1\. Tries to eat healthy, but goes out to buy a cake every day.

2\. Tries to eat healthy, but friend brings around cake every day to tempt.

3\. Tries to eat healthy, but friend brings around cake everyday, and empties
pantry of all other healthy food.

Most people will waver on 2. or 3. But depending on where you live, 3. may
well be the closest to reality.

~~~
nosianu
That is not a difference of politics but of what you are looking at. If the
subject is public health policy you look at statistics and the big picture. If
you look at one particular patient you don't. Same here: If the subject is the
fate of one person and one person only (meaning that person isn't a "Fake"
stand-in example and the subject really is the big picture) then you can and
should talk about that person's behavior. If the subject is the big picture
that's useless because you can't change people and you should make policies
that work and don't demand a huge genetic change. Same in crime: Individuals
_are_ and should be held accountable, but public policy should not and does
not rely on people to change but sets the framework.

So, no contradiction necessary. The exact same person can have both views -
depending on what the subject is. However, lots of discussions and comments
focus on individuals (even if no concrete one is chosen) when the subject is
the big picture.

I think so-called conservatives and progressives would find that they are not
actually all that far apart at all if they really looked at _individual_
cases. It must be _true_ individual cases - people tend to extrapolate and
still think about the population (coming up with things like "slippery slope"
arguments, or giving small criminals huge sentences to "send a signal").

~~~
cam_l
Fully agree, but i think the crux is you cannot have an individual without a
system.

Which i think the Right don't really understand. And of course the left speak
as if the individual is theoretical when looking at the system.

------
bellerose
I met a guy at university who suffered a car crash and where he wasn't at
fault. Guy spent a month in a hospital bed and now has trouble walking. Owes
50k+ in medical bills and doesn't want to declare bankruptcy. He was in CS so
he will probably survive but I just feel it's completely unnecessary that he
suffer the added stress in life of owing finances for medical treatment.
Specifically when he had no control over the accident and is in no way to
blame. I left America for Canada because morally the country makes me sick.

------
acconrad
Regardless of where you stand on this issue politically, I think what upsets
me the most is that we have the means to solve this problem. And hunger. The
most basic needs for all humans _can_ be solved: we have enough food to feed
everyone. We have enough money and doctors to treat everyone without going
destitute.

We have more than enough.

We choose to not to.

------
anoncoward111
And it is entirely because the powers that be have rigged the market so that
they can charge whatever they want.

How have they accomplished this? First, they set strict quotas on who can be a
doctor. Then, they set strict quotas on who can offer what medical goods and
products. Then, they strap everyone up with student and business debt.

I'm not saying it is the correct way or not, but there's a reason that in
other countries you can buy over the counter things that you can't in the USA.

~~~
Pharmakon
Every functional society regulates who can be a doctor and who can produce
medical goods and services, that really isn’t a problem. It can probably be
helpful to try and look for differences between countries as opposed to just
going for a libertarian end-run. Problems with the US system are an out-of-
control pricing structure due to fragmentation of bargaining power, insane
patenting laws which allow evergreening strategies, ideological opposition to
functional and prove reforms, and good old fashioned cronyism.

The need to regulate the healthcare space is unavoidable, but simply bending
over in the name of a free market that isn’t free is _quite_ avoidable. The
nature of for example, pharmaceuticals as a natural monopoly is acknowledged
and confronted in those countries which offer OTC or generic options where the
US doesn’t. The need for a strong bargaining position to negotiate pricing has
been consistently undermined in the US.

~~~
rayiner
> It can probably be helpful to try and look for differences between countries
> as opposed to just going for a libertarian end-run. Problems with the US
> system are an out-of-control pricing structure due to fragmentation of
> bargaining power, insane patenting laws which allow evergreening strategies,
> ideological opposition to functional and prove reforms, and good old
> fashioned cronyism.

It’s funny what “differences” people choose to fixate on. For example, patent
systems are very similar between the US and Europe. And I doubt you can
quantify any difference in “cronyism.” Supply of medical professionals, and
doctor salaries, are quite different. So to are limits on what the state will
pay for end-of-life and terminal care. (For example, when you see stories
about people reaching their lifetime limit on insurance in the US, go check if
the UK NHS’s death panels would have allowed anywhere near those expenses
under their QALY calculations.)

I’d also love to hear your theory for how pharmaceuticals are a “natural
monopoly.” EU countries lower drug prices through good old monopsony (single
buyer), which has similar detrimental effects to a monopoly (single seller).
They just get away with it because the US continues to resist such efforts.

------
enraged_camel
I accidentally stabbed myself in the finger while cutting open a package using
a knife. Stupid, I know.

The would was small, maybe 1 centimeter, but deep enough that it wouldn't stop
bleeding on its own. My girlfriend insisted we go to the ER (urgent cares
around here are closed on Sundays), so we did.

I was the only one there that day. I was ushered in to see a doctor. The
doctor looked at the wound, and said, "this is way too small for stiches,
let's just use glue." So the ER nurse handed him a skin glue, and he used it
to close the wound. After a few minutes, the wound was closed. I was
prescribed antibiotics (kitchen knife, in case it had salmonella etc.) and
sent my way.

Three months later, the bill arrived: $2,600.

That isn't a typo. Two thousand six hundred god damn dollars for skin glue on
a small cut on the finger.

My insurance successfully negotiated it down, but still, the audacity of
charging four figures for five minutes of medical care is just absolutely
insane.

We desperately need single-payer healthcare in this country.

~~~
lisper
You weren't paying for the glue and the five minutes. You were paying for the
overhead of maintaining all the other stuff that was there that you might have
needed under different circumstances but happened not to need that day.

~~~
yongjik
While that's true, that's also true for all other countries where hospitals
don't bill you $2,600 for glue and five minutes. So now the question merely
shifts to why America needs that much money for stocking supplies and keeping
doctors sitting at hospital.

~~~
lisper
Good point. There are three additional items that U.S. hospitals have to pay
for that non-US hospitals don't (or that they have to pay a lot more for):

1\. Malpractice insurance

2\. The overhead incurred by insurance companies and

3\. The cost of serving uninsured patients who can't pay out of pocket.

The third one is huge. US emergency rooms by law must treat serious conditions
-- but only serious conditions -- whether the patient can pay or not (for some
value of "serious" \-- I'm not sure of the details, but that don't really
matter here). So there's a substantial population that can't get preventive
treatment and so have no choice but to let minor conditions go untreated until
they become serious (and, of course, much more expensive to deal with).

~~~
bb88
So currently if you get sick, you "win" the sick lottery and get to pay for
other people's illness as a result.

What's a fair rate for a cut that just needs skin glue and some antibiotics?
$500? or is it more like $2600? Because it sounds like he's paying somewhere
around a 5x multiplier just because 1) he got a cut and 2) he can pay it.

At some point that won't be sustainable, and emergency rooms will shut down
from the cost. People will just stop going to emergency rooms if it means
getting a bill for 5x for what it should cost.

~~~
lisper
It’s already not sustainable.

