4 ms·

"Poverty, which the study defined as less than half the median U.S. income" I wonder how much of this can be attributed to medical bankruptcy. If you cannot af

"Poverty, which the study defined as less than half the median U.S. income" I wonder how much of this can be attributed to medical bankruptcy. If you cannot afford insurance, get injured, can't afford treatment...pretty straightforward doom loop to an early grave

abudabi123 3y ago
Democracy, the poor can't afford
TMWNN 3y ago
>I wonder how much of this can be attributed to medical bankruptcy. Only 4% of US bankruptcies are because of medical bills <https://www.washingtonpost.com/blogs/post-partisan/wp/2018/03/26/the-truth-about-medical-bankruptcies/ https://www.washingtonpost.com/blogs/post-partisan/wp/2018/0...>. A tipoff that [insert large percentage here] of bankruptcies aren't actually because of medical costs is that only 6% of bankruptcies by those without health insurance are because of that cause. The biggest cause of bankruptcies is lack of income, which health insurance doesn't affect. 91% of Americans have medical insurance, whether through their employers, or government programs like Medicare/Medicaid. That's compared to 95-97% in other developed countries because there are always some people who fall through cracks, like (say) a Canadian who doesn't get a new provincial health care card after moving, or a German who neglects to buy into a new sickness fund after changing careers. The only such systems with actual 100% (or as close to it as possible) coverage is something like the UK NHS, which does not have a requirement to show a membership card (because, well, there isn't one) to receive treatment. There are things I'd certainly improve about the US system—decoupling primary healthcare coverage from employment, for one—but the way people online ~~lie~~ exaggerate it's not surprising that so many non-Americans believe that every American is one hangnail away from bankruptcy. PS - Obamacare did not greatly expand coverage. 85% of Americans had medical insurance pre-Obamacare.
- monetus 3y ago
  The extremes are what people will talk about most, for sure; I lived that experience in a state where medicaid wasn't expanded and have trouble shutting up about it. Most everyone around me avoided that experience, almost everyone in my social circles.
  - qgin 3y ago
    States without medicaid expansion are very rough. Most people don't realize that ACA plans have a minimum income to qualify. Medicaid was supposed to take over below that income level. If you're in Florida or Texas and are an adult who isn't currently pregnant (or have a legally declared disability), and make less than 150% of the federal poverty limit, there is literally no insurance you can get except paying full retail price for a private plan (which would consume about 1/2 of your income in premiums and deductibles).
    - AndrewKemendo 3y ago
      You describe precicely my situation after being laid off last year $1600 a month for health insurance
      - jacquesm 3y ago
        That's absolutely indecent. Has this been solved by now? Are you managing? (email in profile if you want)
        AndrewKemendo 3y ago
        Thanks. I'll email
    - wang_li 3y ago
      The details vary but if you don’t earn much you usually qualify for additional cost-sharing reductions which cuts the costs of insurance plans under the ACA substantially.
- spamizbad 3y ago
  That 91% figure comes with a big caveat: it's the percentage of people who reported they had health insurance at any point during the year. So if you had coverage on January 1st but lost coverage on January 2nd and never resumed coverage for the year - you're still considered part of that 91%. There's also the challenge that not all coverage is equal here. The ACA (and certain follow-up legislation) set some baseline, and states may also have their own minimum coverage criteria, but it can vary wildly. The ACA's biggest impact was mandating coverage for common-but-critical things like childbirth etc. Source: https://www.census.gov/library/publications/2022/demo/p60-278.html https://www.census.gov/library/publications/2022/demo/p60-27...
- flagrant_taco 3y ago
  Obama are became Trumpcare became Bidencare. Obama may have put his name on that shit sandwich of a plan, but both parties have been in charge since and no one has explained how the bastardized middle ground of not quite socialized Healthcare is the right answer, or proposed a proper fix to the broken attempt at a crawl/walk/run strategy.
- mindslight 3y ago
  > the way people online ~~lie~~ exaggerate it's not surprising that so many non-Americans believe that every American is one hangnail away from bankruptcy. People exaggerating online certainly don't cause more confusion than the routine lies of medical providers, sending bills with completely-fictitious humongous numbers claiming to be the price. And then even if you do have "insurance" (which isn't actually insurance, but rather more of an anticompetitive protection racket), the provider and the "insurance" company both continue to keep the actual prices obfuscated with those fictitious numbers and a whole bunch of "adjustments", rather than ever just plainly stating prices. There are certainly a lot of overly simplistic narratives about US healthcare, like every political topic. But the entire system is death by a thousand cuts of patently absurd behavior (like the above), that would be plainly illegal with any sort of sane regulation. Like imagine going to the grocery store, paying the cashier, and then getting shaken down months later by food distributors claiming that you only paid the cashier to bag and that you owe them money.
  - friendzis 3y ago
    > the provider and the "insurance" company both continue to keep the actual prices obfuscated with those fictitious numbers and a whole bunch of "adjustments", rather than ever just plainly stating prices. That's the name of the game, not unique to USofA. Once you have majority/monopoly payer (be that private insurance or tax-supported state health fund) it becomes a game of cat and mouse. Health providers try to extract as much per case as possible, insurance providers try to cut per-case payment to the minimum. Inflating list prices on provider's end, establishing various per-item limits and per-case adjustments on payer's end are the low hanging fruit towards the goal. State insurance systems just have this less visible as the patient is usually not involved in the invoicing process, but nevertheless it is there. The sad reality is that there is very little to none incentive for list prices to remain low or reflective of actual cost.
- jacquesm 3y ago
  > Only 4% of US bankruptcies are because of medical bills That's not 'only'. In quite a few other countries that percentage is zero.
  - refurb 3y ago
    Such as? In Canada, with universal healthcare that cost $0 at the point of care, bankruptcies due to health issues is actually pretty high (15% for seniors). Why? Because a big driver of medical bankruptcy is not the medical costs, but the fact you can no longer work and any assistance you get doesn't cover your cost of living.
    - jacquesm 3y ago
      That's already indirect rather than direct. Canada has a lot of problems, this is one of them. On paper everything works but in practice lots of people fall through the cracks, I've seen this up closed (lived in Canada for many years).
- twelve40 3y ago
  yeah although medical does contribute, I bet the bulk of it is consumer debt. There are trillions and trillions made by industries pushing on people shit they can't afford. After you max out on iphones and other stupid shit, you either have to put up with snowballing interest (forget the principal) or declare bankruptcy. The latest innovation is bnpl where people buy food, groceries on credit :facepalm:
- WeylandYutani 3y ago
  Health insurance is a nebulous concept.My basic plan for instance doesn't cover dentistry so I got a 500 euro bill. This inspired me to donate to an NGO that provides oral healthcare for the poor.
refurb 3y ago
Considering 41 out of 50 states have expanded Medicaid to include people up to include adults up to 138% of federal poverty level, and Medicaid has very low out of pocket costs, I'd argue that the very poor actually have better medical insurance than middle class people in the US.

abudabi123 3y ago

Democracy, the poor can't afford

TMWNN 3y ago

>I wonder how much of this can be attributed to medical bankruptcy. Only 4% of US bankruptcies are because of medical bills <https://www.washingtonpost.com/blogs/post-partisan/wp/2018/03/26/the-truth-about-medical-bankruptcies/ https://www.washingtonpost.com/blogs/post-partisan/wp/2018/0...>. A tipoff that [insert large percentage here] of bankruptcies aren't actually because of medical costs is that only 6% of bankruptcies by those without health insurance are because of that cause. The biggest cause of bankruptcies is lack of income, which health insurance doesn't affect. 91% of Americans have medical insurance, whether through their employers, or government programs like Medicare/Medicaid. That's compared to 95-97% in other developed countries because there are always some people who fall through cracks, like (say) a Canadian who doesn't get a new provincial health care card after moving, or a German who neglects to buy into a new sickness fund after changing careers. The only such systems with actual 100% (or as close to it as possible) coverage is something like the UK NHS, which does not have a requirement to show a membership card (because, well, there isn't one) to receive treatment. There are things I'd certainly improve about the US system—decoupling primary healthcare coverage from employment, for one—but the way people online ~~lie~~ exaggerate it's not surprising that so many non-Americans believe that every American is one hangnail away from bankruptcy. PS - Obamacare did not greatly expand coverage. 85% of Americans had medical insurance pre-Obamacare.

monetus 3y ago
The extremes are what people will talk about most, for sure; I lived that experience in a state where medicaid wasn't expanded and have trouble shutting up about it. Most everyone around me avoided that experience, almost everyone in my social circles.
- qgin 3y ago
  States without medicaid expansion are very rough. Most people don't realize that ACA plans have a minimum income to qualify. Medicaid was supposed to take over below that income level. If you're in Florida or Texas and are an adult who isn't currently pregnant (or have a legally declared disability), and make less than 150% of the federal poverty limit, there is literally no insurance you can get except paying full retail price for a private plan (which would consume about 1/2 of your income in premiums and deductibles).
  - AndrewKemendo 3y ago
    You describe precicely my situation after being laid off last year $1600 a month for health insurance
    - jacquesm 3y ago
      That's absolutely indecent. Has this been solved by now? Are you managing? (email in profile if you want)
      - AndrewKemendo 3y ago
        Thanks. I'll email
  - wang_li 3y ago
    The details vary but if you don’t earn much you usually qualify for additional cost-sharing reductions which cuts the costs of insurance plans under the ACA substantially.
spamizbad 3y ago
That 91% figure comes with a big caveat: it's the percentage of people who reported they had health insurance at any point during the year. So if you had coverage on January 1st but lost coverage on January 2nd and never resumed coverage for the year - you're still considered part of that 91%. There's also the challenge that not all coverage is equal here. The ACA (and certain follow-up legislation) set some baseline, and states may also have their own minimum coverage criteria, but it can vary wildly. The ACA's biggest impact was mandating coverage for common-but-critical things like childbirth etc. Source: https://www.census.gov/library/publications/2022/demo/p60-278.html https://www.census.gov/library/publications/2022/demo/p60-27...
flagrant_taco 3y ago
Obama are became Trumpcare became Bidencare. Obama may have put his name on that shit sandwich of a plan, but both parties have been in charge since and no one has explained how the bastardized middle ground of not quite socialized Healthcare is the right answer, or proposed a proper fix to the broken attempt at a crawl/walk/run strategy.
mindslight 3y ago
> the way people online ~~lie~~ exaggerate it's not surprising that so many non-Americans believe that every American is one hangnail away from bankruptcy. People exaggerating online certainly don't cause more confusion than the routine lies of medical providers, sending bills with completely-fictitious humongous numbers claiming to be the price. And then even if you do have "insurance" (which isn't actually insurance, but rather more of an anticompetitive protection racket), the provider and the "insurance" company both continue to keep the actual prices obfuscated with those fictitious numbers and a whole bunch of "adjustments", rather than ever just plainly stating prices. There are certainly a lot of overly simplistic narratives about US healthcare, like every political topic. But the entire system is death by a thousand cuts of patently absurd behavior (like the above), that would be plainly illegal with any sort of sane regulation. Like imagine going to the grocery store, paying the cashier, and then getting shaken down months later by food distributors claiming that you only paid the cashier to bag and that you owe them money.
- friendzis 3y ago
  > the provider and the "insurance" company both continue to keep the actual prices obfuscated with those fictitious numbers and a whole bunch of "adjustments", rather than ever just plainly stating prices. That's the name of the game, not unique to USofA. Once you have majority/monopoly payer (be that private insurance or tax-supported state health fund) it becomes a game of cat and mouse. Health providers try to extract as much per case as possible, insurance providers try to cut per-case payment to the minimum. Inflating list prices on provider's end, establishing various per-item limits and per-case adjustments on payer's end are the low hanging fruit towards the goal. State insurance systems just have this less visible as the patient is usually not involved in the invoicing process, but nevertheless it is there. The sad reality is that there is very little to none incentive for list prices to remain low or reflective of actual cost.
jacquesm 3y ago
> Only 4% of US bankruptcies are because of medical bills That's not 'only'. In quite a few other countries that percentage is zero.
- refurb 3y ago
  Such as? In Canada, with universal healthcare that cost $0 at the point of care, bankruptcies due to health issues is actually pretty high (15% for seniors). Why? Because a big driver of medical bankruptcy is not the medical costs, but the fact you can no longer work and any assistance you get doesn't cover your cost of living.
  - jacquesm 3y ago
    That's already indirect rather than direct. Canada has a lot of problems, this is one of them. On paper everything works but in practice lots of people fall through the cracks, I've seen this up closed (lived in Canada for many years).
twelve40 3y ago
yeah although medical does contribute, I bet the bulk of it is consumer debt. There are trillions and trillions made by industries pushing on people shit they can't afford. After you max out on iphones and other stupid shit, you either have to put up with snowballing interest (forget the principal) or declare bankruptcy. The latest innovation is bnpl where people buy food, groceries on credit :facepalm:
WeylandYutani 3y ago
Health insurance is a nebulous concept.My basic plan for instance doesn't cover dentistry so I got a 500 euro bill. This inspired me to donate to an NGO that provides oral healthcare for the poor.

refurb 3y ago

Considering 41 out of 50 states have expanded Medicaid to include people up to include adults up to 138% of federal poverty level, and Medicaid has very low out of pocket costs, I'd argue that the very poor actually have better medical insurance than middle class people in the US.