3 ms·

I am sorry if this question comes of as naive. Is the medical cost so high that it can only be covered with an insurance? Would a small amount of savings set as

I am sorry if this question comes of as naive. Is the medical cost so high that it can only be covered with an insurance? Would a small amount of savings set aside for this purpose be viable in case somebody loses their medical insurance? Also would you not be able to take your own medical insurance which is independent of the company you work for? I am just trying to understand how the medical system there works. I hope I phrased the question appropriately.

bkeroack 11y ago
Medical expenses for major problems can very easily run into the millions of US dollars (open heart surgery, etc). I'm not joking. The market for private insurance is somewhat better now with Obamacare (depending heavily upon the state you live in) but it still can be very expensive. Especially if you're unemployed. If you have a family member in poor health, employer-sponsored health coverage can be worth an order of magnitude more than your cash salary. If not more.
x0x0 11y ago
CA/usa, broken ankle, two surgeries: $110k in billings. All told, probably 10-12 doctor-hours. Insurance, beyond insuring you, does something perhaps more important: they negotiate massive discounts with all medical practices/hospitals/etc. My insurer negotiated that to something reasonable (approx $35k, though memory fails me); I could even afford that if I needed to. Crucially (and I understand this is fucking stupid; go 'murica), uninsured people pay way more than insured people even including what the insurance pays. Like integer multiples greater than 3 and up to 20 times more.
- carlob 11y ago
  > Like integer multiples greater than 3 and up to 20 times more. Or maybe even real multiples. :)
- jsudhams 11y ago
  wow that is lot of money, India should seriously kick medical tourism. Already happens but this can scale lot more. May be US can sponser MBBS students (There is huge amount of students does not opt for MBBS due to cost of up to $150,000 which includes donation to institutions) and then setup operting theators here in India.
- rasz_pl 11y ago
  Anecdote/comparison: there is a guy on YT doing Taiwan motorcycle tours, one of the US guests broke an ankle falling off the scooter with no tourist insurance. They went to the hospital and asked to pay in cash. Xray, cast, emergency room, all in all few hours of work came down to below $1K no questions asked.
- VLM 11y ago
  "uninsured people pay way more" A minor but important correction is they are billed way more, not necessarily pay way more. For example I dated a girl who just out of high school with no insurance had a really badly broken arm (car accident IIRC) and the hospital "charged" her, in total, $100K+ as an imaginary amount, complained at her for awhile, and then they wrote her off after some token payment (more than they would have gotten in bankruptcy, less than it would have cost her in legal fees to file bankruptcy, but a moderately huge amount of money at part time minimum wage income). Now whats important is the difference between the imaginary retail price of $100K and what it actually cost to provide services is incredibly valuable from an accounting standpoint. Also from a marketing standpoint her "$100K" of services was donated by a gracious company to the poor, they sure as heck don't publicize the actual cost of providing that service was only $10K even including minor surgery and recuperation. They did a good job, by the time I met her, I had no idea her arm had been so ruined just a year or two ago until she told me and showed me her arm, by no means did they cheap out on her care or recovery just because she was uninsured. Finally the hope is that if they charged that poor girl a fair $10K then it would be hanging over her head for years until she could pay it off or more likely bankruptcy filing fees costing less than $10K they'd get nothing at all, but if they "charge" $100K then they might jackpot and she could qualify for some govt grant or fundraiser or whatever. If they know she's going to declare bankruptcy no matter what they charge and they're going to get $0 revenue, then game theory shows they should ask for $100M on the off chance by a miracle she wins the lottery, or qualifies from some weird govt grant or school support fund or something. I think something foreigners often don't understand is we charge poor people $100K for a broken arm but we only charge them like $2K to file bankruptcy, so there are no acute medical problems that cost more than $2K, and for chronic problems they make life hell until either the chronic problem goes away and so do the bankruptcy bills, or the victim dies, but its not really expensive. The business model ruins middle class aspirations (how will I have the vacation home and RV if I file bankruptcy?) but we solved that problem by shipping off all the middle clss jobs to China, not having a middle class means not having to worry about a middle class anymore, there's just really rich people and peasants who own nothing.
  - hwstar 11y ago
    Except: 1. Bankruptcy can only be filed once every 7 years. What happens if there are medical complications and you are re-hospitalized after you filed for bankruptcy? Answer: You are screwed. 2. It's usually far cheaper and less hassle to purchase an ACA policy to prevent being presented with these large bills in the first place.
- eru 11y ago
  Do you think it would help if prices were openly displayed before the procedures? (That would certainly encourage shopping around.)
alistairSH 11y ago
Yes, even minor* medical issues can run into six-figures. I developed a non-critical arrhythmia last year, medication didn't fully control it, so I opted for catheter ablation. The procedure itself, plus the related office appointments and tests, was around $50,000 (after insurance discounts). That included separate bills from the surgery center, the hospital (I was admitted overnight), the cardiologist, and the anesthesiologist. That's for a one-off problem that is now corrected. If it were cancer, or something else that required ongoing treatment, costs rise rapidly. * To the degree that any medical issue can be minor; my life was never in danger and risk permanent disability was low.
- Domenic_S 11y ago
  I'd call "minor" something like wart removal or an ear infection, not heart surgery.
dredmorbius 11y ago
There are a few elements to this. Many providers, including public providers, are exceptionally reluctant to see uninsured patients. If push comes to shove they cannot outright refuse, but they can be highly disinclined. Insurance isn't just "we cover your bills", but "we negotiate rates with providers". Much healthcare billing is basically funny money. Or more specifically, there are huge fixed costs, but charges are based on specific services billed (HMOs excepted, though internally they likely operate somewhat similarly), so that what in a tremendous number of cases, the healthcare provider cannot tell you, as a private individual, what you'd be billed for treatment. But some hospital procedure or stay can billed entirely differently depending on who paying, with hugely varying rates. And, since the uninsured has zero effective bargaining leverage (health plans can threaten to drop a provider or apply other leverage), they get the highest rates. On top of all this, billing is tremendously disaggregated. You might see charges for facility, individual supplies, labs, transport, and individual medical personnel who charge independently. Many (if not most) doctors aren't employees of a hospital, but are independent service providers who charge separately. It's a mess. And a distressingly ineffective one. There's been very little real improvement in health outcomes since the 1950s (and for quite some time they got worse). Much of the improvement can be chalked up to improved environmental and lifestyle factors (removing lead from paint and gasoline, asbestos, less smoking and drinking). It's been improved health outcomes for the poor and minorities which account for much of the life expectancy gains as well. Earlier improvements largely came from public health measures: fresh, clean drinking water, sewerage systems, municipal waste removal, and quarantines for infectious disease. Even vaccinations and antibiotics were relatively late and minor interventions by comparison.
kale 11y ago
As it's been stated, the problem is that insurance negotiates a lower rate, in addition to helping pay for it. Example: I needed a sinoplasty/septoplasty. The procedure was $26k if I was uninsured. My insurance company had negotiated the procedure to $4k. I owed 10% of the procedure cost at $400. This is for a minor outpatient procedure. So, losing insurance means paying 6500% more for healthcare in this case.

bkeroack 11y ago

Medical expenses for major problems can very easily run into the millions of US dollars (open heart surgery, etc). I'm not joking. The market for private insurance is somewhat better now with Obamacare (depending heavily upon the state you live in) but it still can be very expensive. Especially if you're unemployed. If you have a family member in poor health, employer-sponsored health coverage can be worth an order of magnitude more than your cash salary. If not more.

x0x0 11y ago

CA/usa, broken ankle, two surgeries: $110k in billings. All told, probably 10-12 doctor-hours. Insurance, beyond insuring you, does something perhaps more important: they negotiate massive discounts with all medical practices/hospitals/etc. My insurer negotiated that to something reasonable (approx $35k, though memory fails me); I could even afford that if I needed to. Crucially (and I understand this is fucking stupid; go 'murica), uninsured people pay way more than insured people even including what the insurance pays. Like integer multiples greater than 3 and up to 20 times more.

carlob 11y ago
> Like integer multiples greater than 3 and up to 20 times more. Or maybe even real multiples. :)
jsudhams 11y ago
wow that is lot of money, India should seriously kick medical tourism. Already happens but this can scale lot more. May be US can sponser MBBS students (There is huge amount of students does not opt for MBBS due to cost of up to $150,000 which includes donation to institutions) and then setup operting theators here in India.
rasz_pl 11y ago
Anecdote/comparison: there is a guy on YT doing Taiwan motorcycle tours, one of the US guests broke an ankle falling off the scooter with no tourist insurance. They went to the hospital and asked to pay in cash. Xray, cast, emergency room, all in all few hours of work came down to below $1K no questions asked.
VLM 11y ago
"uninsured people pay way more" A minor but important correction is they are billed way more, not necessarily pay way more. For example I dated a girl who just out of high school with no insurance had a really badly broken arm (car accident IIRC) and the hospital "charged" her, in total, $100K+ as an imaginary amount, complained at her for awhile, and then they wrote her off after some token payment (more than they would have gotten in bankruptcy, less than it would have cost her in legal fees to file bankruptcy, but a moderately huge amount of money at part time minimum wage income). Now whats important is the difference between the imaginary retail price of $100K and what it actually cost to provide services is incredibly valuable from an accounting standpoint. Also from a marketing standpoint her "$100K" of services was donated by a gracious company to the poor, they sure as heck don't publicize the actual cost of providing that service was only $10K even including minor surgery and recuperation. They did a good job, by the time I met her, I had no idea her arm had been so ruined just a year or two ago until she told me and showed me her arm, by no means did they cheap out on her care or recovery just because she was uninsured. Finally the hope is that if they charged that poor girl a fair $10K then it would be hanging over her head for years until she could pay it off or more likely bankruptcy filing fees costing less than $10K they'd get nothing at all, but if they "charge" $100K then they might jackpot and she could qualify for some govt grant or fundraiser or whatever. If they know she's going to declare bankruptcy no matter what they charge and they're going to get $0 revenue, then game theory shows they should ask for $100M on the off chance by a miracle she wins the lottery, or qualifies from some weird govt grant or school support fund or something. I think something foreigners often don't understand is we charge poor people $100K for a broken arm but we only charge them like $2K to file bankruptcy, so there are no acute medical problems that cost more than $2K, and for chronic problems they make life hell until either the chronic problem goes away and so do the bankruptcy bills, or the victim dies, but its not really expensive. The business model ruins middle class aspirations (how will I have the vacation home and RV if I file bankruptcy?) but we solved that problem by shipping off all the middle clss jobs to China, not having a middle class means not having to worry about a middle class anymore, there's just really rich people and peasants who own nothing.
- hwstar 11y ago
  Except: 1. Bankruptcy can only be filed once every 7 years. What happens if there are medical complications and you are re-hospitalized after you filed for bankruptcy? Answer: You are screwed. 2. It's usually far cheaper and less hassle to purchase an ACA policy to prevent being presented with these large bills in the first place.
eru 11y ago
Do you think it would help if prices were openly displayed before the procedures? (That would certainly encourage shopping around.)

alistairSH 11y ago

Yes, even minor* medical issues can run into six-figures. I developed a non-critical arrhythmia last year, medication didn't fully control it, so I opted for catheter ablation. The procedure itself, plus the related office appointments and tests, was around $50,000 (after insurance discounts). That included separate bills from the surgery center, the hospital (I was admitted overnight), the cardiologist, and the anesthesiologist. That's for a one-off problem that is now corrected. If it were cancer, or something else that required ongoing treatment, costs rise rapidly. * To the degree that any medical issue can be minor; my life was never in danger and risk permanent disability was low.

Domenic_S 11y ago
I'd call "minor" something like wart removal or an ear infection, not heart surgery.

dredmorbius 11y ago

There are a few elements to this. Many providers, including public providers, are exceptionally reluctant to see uninsured patients. If push comes to shove they cannot outright refuse, but they can be highly disinclined. Insurance isn't just "we cover your bills", but "we negotiate rates with providers". Much healthcare billing is basically funny money. Or more specifically, there are huge fixed costs, but charges are based on specific services billed (HMOs excepted, though internally they likely operate somewhat similarly), so that what in a tremendous number of cases, the healthcare provider cannot tell you, as a private individual, what you'd be billed for treatment. But some hospital procedure or stay can billed entirely differently depending on who paying, with hugely varying rates. And, since the uninsured has zero effective bargaining leverage (health plans can threaten to drop a provider or apply other leverage), they get the highest rates. On top of all this, billing is tremendously disaggregated. You might see charges for facility, individual supplies, labs, transport, and individual medical personnel who charge independently. Many (if not most) doctors aren't employees of a hospital, but are independent service providers who charge separately. It's a mess. And a distressingly ineffective one. There's been very little real improvement in health outcomes since the 1950s (and for quite some time they got worse). Much of the improvement can be chalked up to improved environmental and lifestyle factors (removing lead from paint and gasoline, asbestos, less smoking and drinking). It's been improved health outcomes for the poor and minorities which account for much of the life expectancy gains as well. Earlier improvements largely came from public health measures: fresh, clean drinking water, sewerage systems, municipal waste removal, and quarantines for infectious disease. Even vaccinations and antibiotics were relatively late and minor interventions by comparison.

kale 11y ago

As it's been stated, the problem is that insurance negotiates a lower rate, in addition to helping pay for it. Example: I needed a sinoplasty/septoplasty. The procedure was $26k if I was uninsured. My insurance company had negotiated the procedure to $4k. I owed 10% of the procedure cost at $400. This is for a minor outpatient procedure. So, losing insurance means paying 6500% more for healthcare in this case.