4 ms·

So how come I keep hearing that a significant portion of homeless in the US have lost their houses in a medical-event-realted bankruptcy?

alistairSH 6y ago
Retirees qualify for nationalized health insurance. In theory, those 65+ would be mostly immune for health-related bankruptcy (although co-pays/deductibles can still be problematic). Anybody younger has to pay for health care out of pocket or buy insurance. The cost of paying OOP is exorbitant. Even buying insurance on the open market is outrageously expensive. In either case, major medical issues can easily escalate to be financially disastrous. Edit - in my original post, I stated doubling my net worth (or income or whatever) wouldn't allow me to retire in my 50s due to potential medical costs. This is what I mean - even with a few million in the bank, retirement isn't feasible due to the cost of buying healthcare in the US. I had this conversation with an uncle who lives in Scotland. He didn't understand why my dad was still working (at age 60). Medical insurance was the only reason. As soon as he got Medicare, he retired.
- mikem170 6y ago
  For the benefit of others who may be reading I'll mention a couple of other programs... There's Medicaid, the federally funded healthcare program for the poor. It is free. As a single person there are really low limits on how much assets and income you can have and qualify. Kids are more easily qualified, even if there parents may not be. Doctor choice is limited, there are lines, etc. There's also the VA, available for veterans. I'm not sure of the rules around this. But those qualified get free care. Throughout the country hospitals are supposed to patch up anyone who shows up with an emergency. The patient will get a bill after, but they won't be left to bleed to death. This doesn't help with slowly developing problems, though. Beyond these free programs, (and Medicare for retired folks, talked about earlier), there's also Obamacare, which subsidizes medical coverage for those making too much to qualify for Medicaid. Someone working full time for minimum wage and making $14k per year (which is enough to rent a room and have a junk car), might end up with a subsidized plan having a $6k+ deductable (which they don't have!), someone making double that (enough for an inexpensive apartment and a used car) would pay $175 a month for the same plan. Obamacare details vary by state. People with jobs making more than the above often have health care offered through work, and no longer qualify for Obamacare plans. At the low end these plans may not be as good as the Obamacare plans. Typically these plans might cost the employee $100-$200/month and up if there are multiple plans to choose from (the employer may be contributing 2-5x that, depending on the job), and have a deductable of several thousand dollars, with yearly exams and routine screening included for free. The problem becomes that you have to pay for everything else up to your deductable, then costs are shared up to a max limit perhaps $15k, then the plan covers all costs for all covered care. The deductable and maximum double for family plans. One big problem with all the plans with deductables is that it is near impossible to find out what anything non-trivial will cost, which is discouraging when you have to pay some of these costs. Government employees typically have the best plans, similar to what the average white collar worker had 20-30 years ago. Small copayments instead of large deductables. These plans were phased out by most private employers because they were too expensive, for both employers and most employees.
mikem170 6y ago
I would guess the typical example of this might be a working age person who lived paycheck to paycheck then had a non-trivial medical issue to deal with. They may have already had other house/car/student/credit-card debt. The medical problem may have interfered with their ability to work. They may qualify for other free-care programs after they burn through all their savings. (That's where putting those savings in retirement accounts would have helped, but with few exceptions you can't access that money before the age of about 60, and also remember that it's a borrow and spend culture here, not saving for a rainy day.) The best one could say is that bankruptcy is a way to get a clean slate, wiping out prior debts, and to be sure that the homeless statistic you are looking at doesn't count those who moved back in with family as homeless (some do). The worst one can say is that the system is optimized to extract as much money as possible form as many people as possible...

alistairSH 6y ago

Retirees qualify for nationalized health insurance. In theory, those 65+ would be mostly immune for health-related bankruptcy (although co-pays/deductibles can still be problematic). Anybody younger has to pay for health care out of pocket or buy insurance. The cost of paying OOP is exorbitant. Even buying insurance on the open market is outrageously expensive. In either case, major medical issues can easily escalate to be financially disastrous. Edit - in my original post, I stated doubling my net worth (or income or whatever) wouldn't allow me to retire in my 50s due to potential medical costs. This is what I mean - even with a few million in the bank, retirement isn't feasible due to the cost of buying healthcare in the US. I had this conversation with an uncle who lives in Scotland. He didn't understand why my dad was still working (at age 60). Medical insurance was the only reason. As soon as he got Medicare, he retired.

mikem170 6y ago
For the benefit of others who may be reading I'll mention a couple of other programs... There's Medicaid, the federally funded healthcare program for the poor. It is free. As a single person there are really low limits on how much assets and income you can have and qualify. Kids are more easily qualified, even if there parents may not be. Doctor choice is limited, there are lines, etc. There's also the VA, available for veterans. I'm not sure of the rules around this. But those qualified get free care. Throughout the country hospitals are supposed to patch up anyone who shows up with an emergency. The patient will get a bill after, but they won't be left to bleed to death. This doesn't help with slowly developing problems, though. Beyond these free programs, (and Medicare for retired folks, talked about earlier), there's also Obamacare, which subsidizes medical coverage for those making too much to qualify for Medicaid. Someone working full time for minimum wage and making $14k per year (which is enough to rent a room and have a junk car), might end up with a subsidized plan having a $6k+ deductable (which they don't have!), someone making double that (enough for an inexpensive apartment and a used car) would pay $175 a month for the same plan. Obamacare details vary by state. People with jobs making more than the above often have health care offered through work, and no longer qualify for Obamacare plans. At the low end these plans may not be as good as the Obamacare plans. Typically these plans might cost the employee $100-$200/month and up if there are multiple plans to choose from (the employer may be contributing 2-5x that, depending on the job), and have a deductable of several thousand dollars, with yearly exams and routine screening included for free. The problem becomes that you have to pay for everything else up to your deductable, then costs are shared up to a max limit perhaps $15k, then the plan covers all costs for all covered care. The deductable and maximum double for family plans. One big problem with all the plans with deductables is that it is near impossible to find out what anything non-trivial will cost, which is discouraging when you have to pay some of these costs. Government employees typically have the best plans, similar to what the average white collar worker had 20-30 years ago. Small copayments instead of large deductables. These plans were phased out by most private employers because they were too expensive, for both employers and most employees.

mikem170 6y ago

I would guess the typical example of this might be a working age person who lived paycheck to paycheck then had a non-trivial medical issue to deal with. They may have already had other house/car/student/credit-card debt. The medical problem may have interfered with their ability to work. They may qualify for other free-care programs after they burn through all their savings. (That's where putting those savings in retirement accounts would have helped, but with few exceptions you can't access that money before the age of about 60, and also remember that it's a borrow and spend culture here, not saving for a rainy day.) The best one could say is that bankruptcy is a way to get a clean slate, wiping out prior debts, and to be sure that the homeless statistic you are looking at doesn't count those who moved back in with family as homeless (some do). The worst one can say is that the system is optimized to extract as much money as possible form as many people as possible...