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Related post from a very harsh doctor who really has lost hope in American healthcare. In the comments he mentions essentially collapse as the only way out he s
by noobermin 4y ago
Related post from a very harsh doctor who really has lost hope in American healthcare. In the comments he mentions essentially collapse as the only way out he sees.
https://news.ycombinator.com/item?id=34347962 https://news.ycombinator.com/item?id=34347962
- rr808 4y agoLike the article says, US is probably the best of the Western healthcare systems right now.
- soperj 4y agoOnly if you're loaded.
- doubleg72 4y agoIdk, I have had many jobs with great health care and never been loaded. Two kids now and out of pocket expenses never exceeded $500 for either of them. You're clearly very ignorant regarding this topic and should work on that before making such incorrect assumptions.
- hotpotamus 4y ago[flagged]
- adamredwoods 4y agoSeems sus. I don't think donations from the street will pay for bills as efficiently as getting a job-- not that finding a job is an easy feat. Additionally, many hospitals have financial assistance programs (for example) : https://www.texaschildrens.org/patients-and-visitors/insurance-financial-billing-matters/financial-arrangements-and-assistance https://www.texaschildrens.org/patients-and-visitors/insuran... The Ronald McDonald house also helps families with a lot of other expenses: https://rmhc.org/ https://rmhc.org/
- hotpotamus 4y agoAs a habit I don't trust anyone asking me for money, but they looked reasonably legit. I wonder how long it would take to save up enough money to pay for pediatric brain surgery on $15/hour - I would imagine longer than the presumed prognosis of the infant. I also thought that if we had universal care within the United States, I would not have to guess whether it was a scam or not - I would just know that the child would receive some hopefully reasonable amount of medical care.
- adamredwoods 4y agoIt's not for the per-hour, it's for the group-based health insurance, even for part-time employees. If that's what a parent needs to do, then that's the most efficient path. Even a sliver of insurance allows delays in payments while allowing the hospital to perform service up front. It's lousy to claim bankruptcy over medical bills, but if it gets your child the help they need, this is IMO a viable path.
- hotpotamus 4y agoYes, I have some inkling, though it's interesting that the goal of this seems to have nothing to do with actually paying the medical providers who would presumably be helping the child. I will say that I have friends in all walks of life who do all kinds of jobs, and many of them can't even get coverage for themselves, let alone for families, so it might be more challenging than you think. That said, this is one reason among dozens why I will never have children.
- gedy 4y agoFamily living in Texas also had child with cancer, Cooks Children Hospital covered whatever they couldn't pay. I'm sorry to be cynical but I suspect a scam.
- refurb 4y agoNot to mention Medicaid which covers children and pregnant women even in the States that didn’t expand coverage.
- lotsofpulp 4y agoI would assume that was a scam. It is common for people to use children to garner more donations.
- wombatpm 4y agoRefer them to St Jude’s Childrens hospital. Childhood cancer is their thing
- throwayyy479087 4y agoAnd they don’t charge a penny. Even the cafeteria is free for patients.
- nubinetwork 4y agoI have a friend that lives near Boston... He had to visit a hospital recently, while he never disclosed to me what his medical condition was, at the end he mentioned that his hospital bill was almost $1500... "Only to find out I'm also allergic to penicillin" and that "if I would have taken an ambulance it would have doubled the bill"
- 1over137 4y ago>I have had many jobs with great health care That is a kind of "loaded". Joe Average with a crap job, or no job, is not so lucky.
- lotsofpulp 4y agoIf your out of pocket maximum for family coverage was $500 after ACA was passed, you were probably receiving at least $20k if not $30k+ per year in benefits via employer subsidized health insurance. Just the health insurance benefits alone were worth half or more the median annual income in the US. https://fred.stlouisfed.org/series/MEPAINUSA646N https://fred.stlouisfed.org/series/MEPAINUSA646N
- TrueGeek 4y agoAre you and your kids healthy? I also have kids and, like most people on HN, have “good” health insurance that comes with a tech job. But get one family member that needs to see a cardiologist or neurologist every few months and you’re hitting your $6,500 deductible every April.
- wombatpm 4y agoI have a diabetic child. There was a point in time where I had the high deductible plan with a max out of pocket of 10,500. When I ran the numbers for other plans, what I was allowed to save pretax, etc. the high deductible plan actually made economic sense. With bloodwork and prescriptions, I would hit that by September.
- seszett 4y ago> Two kids now and out of pocket expenses never exceeded $500 for either of them. Do I understand right that this means you might have to pay up to $500 for medical problems? That seems huge to me, it's higher than what one pays "out of their pocket" here for a childbirth for example and I don't think you can expect a regular person to spend this unexpectedly, that's about a third of the average wage (in Belgium).
- lotsofpulp 4y ago> Do I understand right that this means you might have to pay up to $500 for medical problems? I expect to pay at least $200 anytime I receive healthcare, even just for a 5 minute consultation with the doctor. Childbirth is minimum $4k to $6k, assuming vaginal and hospital stay is 2 nights. If C section and 3 nights, then add $2k to $3k. If using epidural, add $3k more. For both of our kids, we reached annual out of pocket maximum of $5k to $7k in the calendar year, for regular, non complicated vaginal births. Deductible: What you pay before insurance company starts paying. Usually at least $2k, but varies anywhere from $0 to $10k. Could even be as high as the out of pocket maximum. Out of pocket maximum: The maximum you pay in any calendar year for healthcare. After that, all responsibility falls on insurance company. Legal maximum for 2023 is $9,100 for individuals and $18,200 for families. Usually this is $5k per individual and $10k per family, give or take a few thousand. The higher the deductible and out of pocket maximum, the lower the insurance premium (like any other insurance). Insurance premiums are $400 to $1,200 per month per person from age 0 to 64, give it take a few hundred. That means for a family of 4, health insurance will be ~ $400 per month for each kid, and $500 to $900 per month for each parent. So roughly $24k to $36k per year in insurance premiums, plus out of pocket maximum is ~$10k, which means $30k to $45k per year will pay for a family’s (of 4) healthcare in a calendar year. If receiving health insurance via employer, the employer will usually pay 70% of the insurance premiums. Sometimes more. If not receiving health insurance from employer, and you are lower income, then you can get tax credits (government subsidy). This lower income is usually $100k per year and below, the lower the income, the higher the tax credit. Age 65+, the federal government starts paying for your hospital emergency healthcare, but you may or may not need to pay for medicines and outpatient (non hospital) healthcare depending on your income/wealth.
- 4y ago
- Broken_Hippo 4y agoI'm not sure if I've ever paid less than $500 for the deductible, let alone have that be a total for a year. The plans tended to be that I had to pay 10-20% after the deductible, and max out of pocket was in the thousands. This wasn't even counting premiums. On top of it all, some things just had set prices: You always had to pay some for the ER, for example. And prices have only went up since I've left the US 9 or 10 years ago. And I was pretty lucky: Family members had started jobs where the family plan for health insurance literally exceeded their pay. Heck, I had a job like that, but I didn't have a family to worry about. A lot of folks' health care sucks unless they have money or get very lucky indeed. It doesn't sound like you know the plight of others very well.
- saint_fiasco 4y agoAn alternative way to look at this is that you are very much loaded. You just don't realize because a significant part of your compensation goes implicitly towards health insurance.
- nivenkos 4y agoMost American professionals are compared to the rest of the world though. Like almost every professional career from software engineering to law, medicine, engineering, finance, etc. pays 2-4x the same roles outside the US, and usually includes great health insurance. Whereas almost all public insurance in Europe, etc. doesn't cover preventative screening, so you better hope any disease you get starts with clear symptoms.
- amrocha 4y agoSo it's ok to let poor people die then? Or people without health insurance for whatever reason?
- hugs_vs_toph 4y agoIt's optimal
- amf12 4y agoIsn't that because (1) US spends the most out of rich countries, and (2) people who don't absolutely have to go to the doctor/hospital avoid it because of high expenses?
- 88913527 4y agoAs a patient, I wish I could utilize healthcare (eg: access to a doctor) without all the intermediary parties. But like software development (where we specialize in front/back end), it's a group effort, and no one doctor can be the answer to everything. Plus you need special equipment. You need prescriptions. It's a problem perfectly designed to middle-feeders to get their cut, since the problem demands so many different stakeholders with their own specialties.
- amf12 4y agoLast year I had the misfortune of having to visit doctors for non-hospital related condition. It is a miserable experience. I got charged a lot for simple (scheduled for 15-30m, but ended early) follow up appointments, finding a specialist who had an appointment in a reasonable amount of time (<3 months). A specialist who had an appointment wasn't in-network, so I had to spend out of pocket, because, out-of-network has a different deductible, expensive prescriptions. I was lucky that I had a good insurance plan, but still, trying to navigate the system when I wasn't unable to was the absolute worst experience.
- 88913527 4y agoI called a dozen offices seeking a primary physician (didn't have one) and all of them were booked solid in 2020-2021. I did eventually find one. Note that these offices aren't urgent care or ER centers, I just wanted an annual physical (a reasonable thing that the medical system largely recommends to everyone) and even that was nigh impossible. And my annual physical found an anomaly! So clearly that practice is based in some sort of empirical value. I went back for a 2nd test, it was nothing.
- Scoundreller 4y ago> wanted an annual physical (a reasonable thing that the medical system largely recommends to everyone) Which medical system recommends that? And why? My jurisdiction stopped paying for those because they don't have any evidence of net benefit. It makes more sense to target exams based on your risk of having issues. https://www.ncbi.nlm.nih.gov/books/NBK82767/ https://www.ncbi.nlm.nih.gov/books/NBK82767/ https://time.com/5095920/annual-physical-exam/ https://time.com/5095920/annual-physical-exam/ https://www.ncbi.nlm.nih.gov/books/NBK82767/ https://www.ncbi.nlm.nih.gov/books/NBK82767/
- adamredwoods 4y agoI'm confused. Why a collapse versus finding new process and iterating on existing ones until we find a system that other models can transition to? A collapse is catastrophic, and with the amount of money and knowledge the US has, I feel this can be avoided.
- noobermin 4y agoTbf, I was surprised he said that too, and asked in that comment thread (you can see it below) whether collapse really is the only end state, but the OP only made the post and a continuation in a comment and that was it.
- donw 4y agoBecause the existing system actively fights reform.
- pasquinelli 4y ago> Why a collapse versus finding new process and iterating on existing ones until we find a system that other models can transition to? were you not around for the obamacare debate? i was, and it was made perfectly clear that a majority in the house and senate + the presidency, all in theory working toward the same thing, couldn't really change anything. without legal intervention, who's iterating and innovating process? and to what end?
- int_19h 4y agoIt doesn't have to come at the federal level. Americans who support public healthcare generally seem to like how it works in Canada, but few seem to be aware that the Canadian system originated with the provinces - one adopted public healthcare, the voters liked it, another province followed suit etc. Eventually the feds noticed and got involved to coordinate matters, but even today, any province could, in theory, leave the federal system entirely and run their own - it's just that anyone proposing that would be committing political suicide. If Canada could do it that way, why not US?
- 4y ago
- hef19898 4y agoDeriving any lessons or insights on the global state of health by looking at a single country doesn't work. Especially if said country is the US...