4 ms·

My worries about US healthcare don't revolve around the cost or the quality, but more about the instability. If I know roughly how much I'll need to pay I can p

My worries about US healthcare don't revolve around the cost or the quality, but more about the instability. If I know roughly how much I'll need to pay I can plan for it, even if it's quite a bit. But if I get into a crash in another state and taken to an out-of-network hospital without even being conscious, that can fuck up your finances straight away. What I'd like to know is how much NHS-level healthcare would cost me in the US. Given a monthly payment, I want 100% of everything covered all the time. No out-of-pocket, no out-of-network, everything with no exceptions. I'm happy with generics, a bit of a wait and a non-private room, but I want 0 unexpected bills. Maybe companies like Kaiser do things like that?

nostromo 6y ago
> What I'd like to know is how much NHS-level healthcare would cost me in the US. If you're employed by a tech company, the out-of-pocket costs to you will be $0, and your standard of care will probably go up. Yes, you will occasionally have a $10 or $20 co-pay, but on a tech salary costs are negligible unless you're on a ton of meds. The problem with care in the US is how it's impacting the lower-middle class and the poor. The professional class generally have great care and don't pay much for it.
- kmonsen 6y ago
  Not sure why parent is downvoted, as a European that has lived in Zurich, London and Oslo + NYC and SF healthcare cost is a non-issue for those of us lucky enough to work at a company that provides healthcare. This applied from what I understand to even the smallest startups. US healthcare sucks in general, but for the wealthy (and most of the people reading this site falls into this category) it is actually pretty good. Health care cost, or the predictability of it, is not an issue to not move to the US IMHO.
  - capableweb 6y ago
    > for the wealthy [...] it is actually pretty good. Yeah, I mean no shit. It's like that all over the world. What is really important is how healthcare is for the 99% rest of population, who needs help more than you who are wealthy. That's the problem.
    - kmonsen 6y ago
      I really agree with you, and I am all in on M4A. But for the thread the important part is that if you are a software engineer moving to the US is safe.
  - brnt 6y ago
    Sounds like a pair of golden handcuffs. Is your family at least covered as well? What if your partner gets in that car crash, or your kid has an expensive birth defect? Expensive care is a matter of time, not a matter of luck. It really makes me uncomfortable as well that timing or location (or employment) seem to matter.
    - kmonsen 6y ago
      Your full family is covered yes. My wife was covered before we were married as well, being in a stable relationship was enough. And yes agree I would like healthcare to be not tied to employment.
    - kmonsen 6y ago
      And for the handcuffs if you get any other job it almost certainly has similar insurance. The main issue is if you have no job, when you live you are offered what is called I think Cobra that will keep you on a similar plan. I’ve heard from coworkers that left, sometimes not voluntarily, that it is not cheap at all. California also has decent options for private insurance.
- DanBC 6y ago
  > The professional class generally have great care and don't pay much for it. Wealthy people in the US are over-tested, which leads to over-diagnosis and over-treatment, and these things cause harm.
dcolkitt 6y ago
Zero out of pocket seems like a silly line in the sand. Why wouldn't you care about out-of-pocket max? The only reason I can see about a well-paid professional caring about $20 co-pays is because of a psychological aversion to being paid for healthcare. (Not saying this feeling is necessarily wrong. Humans may have evolved a feeling that their community should take care of the sick and injured. Demanding more for this act, I think makes a lot of people feel tawdry and icky, in a similar way to paying for sex. Still this is a psychological, not an economic argument.) Imagine, that you insisted on car insurance that covered every oil change and car wash starting at dollar zero. It'd probably be astronomically expensive.
- dukeyukey 6y ago
  Ah, sorry for not being clear; if I moved to the US, I wouldn't look for a plan like this. I'm convinced a US developer salary/benefits would be more than enough for me. I'm more curious what an NHS level of healthcare would cost, so set the parameters based on my experience.
- danlugo92 6y ago
  Hes thinking not of 20$ out of pocket but more like the $20k horror stories we sometimes hear about.
lhorie 6y ago
My beef w/ the US healthcare system is that doesn't even need to be an accident. My wife went to see a specialist for a checkup. At the front desk, they said she had to pay around $200. She's the type to decide whether to do things based on cost, so she asked: "That's all?" Them: "Yes." Six months later, I get a letter from a collections agency saying I owed $700. Confused, I call Kaiser to find out that not only was the $200 not the entire amount, they also apparently had no way of quoting accurately ahead of time (even though they knew exactly what she was coming in for), and as the icing on the cake, they forgot to mail us the bill, which is how it ended up going to collections. I had to then press them to get an actual bill with itemized numbers, but it doesn't matter because the numbers make no sense anyways: none of the numbers match up to the amounts we paid, the insurance quoted price or the collections amounts. When pressed they all basically shrugged and said they don't understand how any of it works, and that's just how it is. And the reason for this whole ordeal? We changed health insurance plans and Kaiser said they couldn't renew a prescription because it was a 2-in-1 and insurance only covered the two drugs if they came in separate vials.
- cgriswald 6y ago
  That wasn’t the reason. I went to the ER with no insurance. While I was lying in a bed between visits from the doctor a woman came in and wanted payment for the ER. I asked in no uncertain language if it covered my ER visit and explained I knew the doctor would charge me separately. She said yes, so I paid. I went home. The doctor billed me. I paid. The X-ray tech billed me (a surprisingly small amount). I paid. The hospital never billed me. Then the collections calls started.
  - maxerickson 6y ago
    Was it the X-ray tech or a radiologist that billed you? Radiologist is often $30 or whatever. (I would expect the cost of the tech to be included in the hospital billing)

nostromo 6y ago

> What I'd like to know is how much NHS-level healthcare would cost me in the US. If you're employed by a tech company, the out-of-pocket costs to you will be $0, and your standard of care will probably go up. Yes, you will occasionally have a $10 or $20 co-pay, but on a tech salary costs are negligible unless you're on a ton of meds. The problem with care in the US is how it's impacting the lower-middle class and the poor. The professional class generally have great care and don't pay much for it.

kmonsen 6y ago
Not sure why parent is downvoted, as a European that has lived in Zurich, London and Oslo + NYC and SF healthcare cost is a non-issue for those of us lucky enough to work at a company that provides healthcare. This applied from what I understand to even the smallest startups. US healthcare sucks in general, but for the wealthy (and most of the people reading this site falls into this category) it is actually pretty good. Health care cost, or the predictability of it, is not an issue to not move to the US IMHO.
- capableweb 6y ago
  > for the wealthy [...] it is actually pretty good. Yeah, I mean no shit. It's like that all over the world. What is really important is how healthcare is for the 99% rest of population, who needs help more than you who are wealthy. That's the problem.
  - kmonsen 6y ago
    I really agree with you, and I am all in on M4A. But for the thread the important part is that if you are a software engineer moving to the US is safe.
- brnt 6y ago
  Sounds like a pair of golden handcuffs. Is your family at least covered as well? What if your partner gets in that car crash, or your kid has an expensive birth defect? Expensive care is a matter of time, not a matter of luck. It really makes me uncomfortable as well that timing or location (or employment) seem to matter.
  - kmonsen 6y ago
    Your full family is covered yes. My wife was covered before we were married as well, being in a stable relationship was enough. And yes agree I would like healthcare to be not tied to employment.
  - kmonsen 6y ago
    And for the handcuffs if you get any other job it almost certainly has similar insurance. The main issue is if you have no job, when you live you are offered what is called I think Cobra that will keep you on a similar plan. I’ve heard from coworkers that left, sometimes not voluntarily, that it is not cheap at all. California also has decent options for private insurance.
DanBC 6y ago
> The professional class generally have great care and don't pay much for it. Wealthy people in the US are over-tested, which leads to over-diagnosis and over-treatment, and these things cause harm.

dcolkitt 6y ago

Zero out of pocket seems like a silly line in the sand. Why wouldn't you care about out-of-pocket max? The only reason I can see about a well-paid professional caring about $20 co-pays is because of a psychological aversion to being paid for healthcare. (Not saying this feeling is necessarily wrong. Humans may have evolved a feeling that their community should take care of the sick and injured. Demanding more for this act, I think makes a lot of people feel tawdry and icky, in a similar way to paying for sex. Still this is a psychological, not an economic argument.) Imagine, that you insisted on car insurance that covered every oil change and car wash starting at dollar zero. It'd probably be astronomically expensive.

dukeyukey 6y ago
Ah, sorry for not being clear; if I moved to the US, I wouldn't look for a plan like this. I'm convinced a US developer salary/benefits would be more than enough for me. I'm more curious what an NHS level of healthcare would cost, so set the parameters based on my experience.
danlugo92 6y ago
Hes thinking not of 20$ out of pocket but more like the $20k horror stories we sometimes hear about.

lhorie 6y ago

My beef w/ the US healthcare system is that doesn't even need to be an accident. My wife went to see a specialist for a checkup. At the front desk, they said she had to pay around $200. She's the type to decide whether to do things based on cost, so she asked: "That's all?" Them: "Yes." Six months later, I get a letter from a collections agency saying I owed $700. Confused, I call Kaiser to find out that not only was the $200 not the entire amount, they also apparently had no way of quoting accurately ahead of time (even though they knew exactly what she was coming in for), and as the icing on the cake, they forgot to mail us the bill, which is how it ended up going to collections. I had to then press them to get an actual bill with itemized numbers, but it doesn't matter because the numbers make no sense anyways: none of the numbers match up to the amounts we paid, the insurance quoted price or the collections amounts. When pressed they all basically shrugged and said they don't understand how any of it works, and that's just how it is. And the reason for this whole ordeal? We changed health insurance plans and Kaiser said they couldn't renew a prescription because it was a 2-in-1 and insurance only covered the two drugs if they came in separate vials.

cgriswald 6y ago
That wasn’t the reason. I went to the ER with no insurance. While I was lying in a bed between visits from the doctor a woman came in and wanted payment for the ER. I asked in no uncertain language if it covered my ER visit and explained I knew the doctor would charge me separately. She said yes, so I paid. I went home. The doctor billed me. I paid. The X-ray tech billed me (a surprisingly small amount). I paid. The hospital never billed me. Then the collections calls started.
- maxerickson 6y ago
  Was it the X-ray tech or a radiologist that billed you? Radiologist is often $30 or whatever. (I would expect the cost of the tech to be included in the hospital billing)