3 ms·

I'm not sure I agree with this -- how do you distinguish between "the system works for 80% of the people" and "79% of the people don't have medical emergencies

by bo1024 7y ago

I'm not sure I agree with this -- how do you distinguish between "the system works for 80% of the people" and "79% of the people don't have medical emergencies (but the system would fail them if they did)"?

dahfizz 7y ago
> but the system would fail them if they did I'm not convinced on this point. Over 90% of Americans have health insurance[1]. Sure, insurance might not cover every dime of every bill, but I can't imagine falling ill is an instant and universal cause for financial ruin like people claim. Disclaimer: I've been lucky enough to not have to use my health insurance for anything serious. But I have had to use other kinds of insurance (car, home) and by and large it's been fine. We hear horror stories a lot because they're sensational and they sell well, but people continue to buy insurance because it actually does provide value. [1]https://www.census.gov/library/publications/2019/demo/p60-267.html https://www.census.gov/library/publications/2019/demo/p60-26...
- rjzzleep 7y ago
  There's also this[1] study about cancer and debt in the US. Insurance isn't equal to insurance. The car insurances in the US are the most comfortable in the world. Something happens, you're covered, the insurance pays. Not so in other parts of the world. You drive out of the parking lot scratch another car? It's considered normal in the US. Not so in Germany. You scratch someones car by accident? Anything is possible now. Why compare apples and bananas? I had a surgery in Taiwan and worked in Healthcare in a couple of countries. I also had health insurance when I was working in the US and got hit by a car while on a bike. And while the insurance and the other drivers car insurance paid for most, man you sure have to be careful that someone can tell the emergency not to take you to the wrong hospital. Let's stop pretending there isn't something seriously wrong with the US healthcare system. If all stars align everything is fine, but just an MRI can take anything from 1000 to 2000 or more dollars depending on whether you have insurance or not. You don't have to pay the 2000 dollars if you know better, but it's basically like a bazaar where you have to bargain if your insurance hasn't done so already. Germany was at that point in the 1920s(or sometime around that) actually. I'm not a fan of Germanies healthcare system, especially since it's such a huge chunk of an already low income, but all the issues you describe about other countries are mostly non issues in Germany. https://www.amjmed.com/article/S0002-9343(18)30509-6/fulltext https://www.amjmed.com/article/S0002-9343(18)30509-6/fulltex...
  - virmundi 7y ago
    A minor piece of anacdata, I had an MRI. Paid for it out of pocket because I can. Private company provided it. $200. Done. Don’t have cancer and I do have a DVD of my brain that I will never watch because I’m squeamish. The private market can bring down prices if given a chance. Yes we need to fix things, but look at the US track record on the VA.
    - dahfizz 7y ago
      I assume this was a researched and planned procedure on your part? I am a much bigger believer in "the market" than most people. But the problem with the medical industry is that many / most things happen under serious time pressure. The seriousness and imediatness of medical procedures means that competition and choice often do not get to play a role in your decision making. For many people in many circumstances, the MRI machine nearest them has a complete monopoly. How do we bring the miraculous efficiency of the market to an industry where people often cannot make consenting and informed decisions? Its a very hard problem to solve.
      - virmundi 7y ago
        That is true. However urgent care is a small fraction of the US procedures. Cancer treatments, heart operations, etc are most often planned care. They also care touted as likely to bankrupt you. Can we try to optimize the majority of our system first before we rebuild it because of painful corner cases?
        dahfizz 7y ago
        That's a fair point, chronic / planned care is definitely a significant portion of the market.
  - dahfizz 7y ago
    I'm sorry if I came off an deceptive or disengenious. I don't mean to compare apples and oranges, I'm just making the best comparison I can. This is where my question stems from I suppose. How well insured is the average American? How often do people get stuck at out-of-network care and how much does that cost? The study you linked is very interesting. My main takeaway is that the average loss after 2 years is 92k, which is significant. It doesn't seem like they control for employment status? Cancer and cancer treatment can often mean people are unable to work. So, medical bills or not, I could see keeping up with your mortgage and expenses getting near that figure.
- paulie_a 7y ago
  I fell ill and I happened to luck out with exceptional insurance. I'm the 99.9 percent tier of best insurance available. If I had anything like like a typical individual I would be in financial ruin ending in bankruptcy if I don't die first. I'm 37, sometimes devastating illness comes out of nowhere. I'm lucky I was covered. Most people in that situation would be fucked.

by bo1024 7y ago

dahfizz 7y ago

> but the system would fail them if they did I'm not convinced on this point. Over 90% of Americans have health insurance[1]. Sure, insurance might not cover every dime of every bill, but I can't imagine falling ill is an instant and universal cause for financial ruin like people claim. Disclaimer: I've been lucky enough to not have to use my health insurance for anything serious. But I have had to use other kinds of insurance (car, home) and by and large it's been fine. We hear horror stories a lot because they're sensational and they sell well, but people continue to buy insurance because it actually does provide value. [1]https://www.census.gov/library/publications/2019/demo/p60-267.html https://www.census.gov/library/publications/2019/demo/p60-26...

rjzzleep 7y ago
There's also this[1] study about cancer and debt in the US. Insurance isn't equal to insurance. The car insurances in the US are the most comfortable in the world. Something happens, you're covered, the insurance pays. Not so in other parts of the world. You drive out of the parking lot scratch another car? It's considered normal in the US. Not so in Germany. You scratch someones car by accident? Anything is possible now. Why compare apples and bananas? I had a surgery in Taiwan and worked in Healthcare in a couple of countries. I also had health insurance when I was working in the US and got hit by a car while on a bike. And while the insurance and the other drivers car insurance paid for most, man you sure have to be careful that someone can tell the emergency not to take you to the wrong hospital. Let's stop pretending there isn't something seriously wrong with the US healthcare system. If all stars align everything is fine, but just an MRI can take anything from 1000 to 2000 or more dollars depending on whether you have insurance or not. You don't have to pay the 2000 dollars if you know better, but it's basically like a bazaar where you have to bargain if your insurance hasn't done so already. Germany was at that point in the 1920s(or sometime around that) actually. I'm not a fan of Germanies healthcare system, especially since it's such a huge chunk of an already low income, but all the issues you describe about other countries are mostly non issues in Germany. https://www.amjmed.com/article/S0002-9343(18)30509-6/fulltext https://www.amjmed.com/article/S0002-9343(18)30509-6/fulltex...
- virmundi 7y ago
  A minor piece of anacdata, I had an MRI. Paid for it out of pocket because I can. Private company provided it. $200. Done. Don’t have cancer and I do have a DVD of my brain that I will never watch because I’m squeamish. The private market can bring down prices if given a chance. Yes we need to fix things, but look at the US track record on the VA.
  - dahfizz 7y ago
    I assume this was a researched and planned procedure on your part? I am a much bigger believer in "the market" than most people. But the problem with the medical industry is that many / most things happen under serious time pressure. The seriousness and imediatness of medical procedures means that competition and choice often do not get to play a role in your decision making. For many people in many circumstances, the MRI machine nearest them has a complete monopoly. How do we bring the miraculous efficiency of the market to an industry where people often cannot make consenting and informed decisions? Its a very hard problem to solve.
    - virmundi 7y ago
      That is true. However urgent care is a small fraction of the US procedures. Cancer treatments, heart operations, etc are most often planned care. They also care touted as likely to bankrupt you. Can we try to optimize the majority of our system first before we rebuild it because of painful corner cases?
      - dahfizz 7y ago
        That's a fair point, chronic / planned care is definitely a significant portion of the market.
- dahfizz 7y ago
  I'm sorry if I came off an deceptive or disengenious. I don't mean to compare apples and oranges, I'm just making the best comparison I can. This is where my question stems from I suppose. How well insured is the average American? How often do people get stuck at out-of-network care and how much does that cost? The study you linked is very interesting. My main takeaway is that the average loss after 2 years is 92k, which is significant. It doesn't seem like they control for employment status? Cancer and cancer treatment can often mean people are unable to work. So, medical bills or not, I could see keeping up with your mortgage and expenses getting near that figure.
paulie_a 7y ago
I fell ill and I happened to luck out with exceptional insurance. I'm the 99.9 percent tier of best insurance available. If I had anything like like a typical individual I would be in financial ruin ending in bankruptcy if I don't die first. I'm 37, sometimes devastating illness comes out of nowhere. I'm lucky I was covered. Most people in that situation would be fucked.