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> give a fake name to the ER, and if you're poor in America, what else can you do? The American government spends something approaching a trillion dollars annu

> give a fake name to the ER, and if you're poor in America, what else can you do? The American government spends something approaching a trillion dollars annually on Medicaid, "a government program that provides health insurance for adults and children with limited income and resources."[1] Seperately, Obamacare[2] created a private health insurance market where low income people can obtain free or heavily discounted private health insurance coverage, according to their income. [1] https://en.wikipedia.org/wiki/Medicaid https://en.wikipedia.org/wiki/Medicaid [2] https://en.wikipedia.org/wiki/Affordable_Care_Act https://en.wikipedia.org/wiki/Affordable_Care_Act

notaustinpowers 2y ago
Obamacare is (largely) a failure due to insurance meddling and laws preventing government insurance programs from negotiating prices with drug companies. I'm a healthy individual, not even 30 yet, never smoked, never broken a bone, and never even had stitches in my life. And when I last checked their prices, I was making only $45k/yr. For coverage with Obamacare, I would be paying $350/month for the "catastrophic" plan. Which includes no prescription copay, no dental, no vision, and only kicks in after I've spent $100,000 in one year, and it takes 6 months to take effect after signing up. It's only there for serious issues like losing a leg or cancer.
- dangrossman 2y ago
  Obamacare is not a plan, it's a law that set minimum standards for health insurance plans, created marketplaces to cross-shop plans across providers on a single website, and created a system where you can receive government subsidies towards their cost if your income is low enough. At $45K, you would receive subsidies towards your insurance premiums. I've bought my insurance on the ACA marketplace since it opened ten years ago. There's no difference I can see between the plans offered on the health insurance marketplace and those offered directly from the websites of the same insurers that offer coverage in my state (Blue Cross, CVS Aetna, United, Ambetter, etc). The very highest deductible "catastrophic" plan offered on the marketplace in California for a 29 year old has a $9450/year deductible, which is also the maximum out-of-pocket expense for the year if you have this plan. A $100K deductible plan does not exist, and when you enroll during the annual enrollment period or after a qualifying life event, plans take effect the day you make your first payment, not months later. I'm 10 years your senior and pay less than $350 per month with a lower deductible than the plan quoted above, with no government subsidies.
  - notaustinpowers 2y ago
    I use Obamacare in the rural southern way, referencing ACA and healthcare.gov, lol. I'm also in Georgia which may have different regulations regarding the deductibles. I remember looking at the plans around 2 years ago and realizing that there was no way I could afford the premium, let alone the yearly deductible. I just took another quick look at a non-Healthcare.gov site. Insurance for me would be $313/month with a $9,100 deductible. But it does not cover doctor visits, generic drugs, or specialist visits until after I pay the full $9,100. Why would I want to pay $313/month for essentially no coverage until I spend 20% of my income towards a deductible before I see any benefits?
    - dangrossman 2y ago
      You get an annual doctor visit for free with any insurance plan. There is no deductible or copay. There are other categories that are covered with no deductible. My wife had a $13,000 IUD insertion under anesthesia at a hospital due to complications, and this cost her $0 with insurance, without having met her deductible, since reproductive health is covered with no out of pocket cost under all ACA plans. I'm on healthcare.gov looking at Georgia's plans this year for someone with $45K of income. You have options starting at $129/month. Many of these sub-$200 plans get you doctors visits for $40-60, prescription drugs for under $25 each, mental health treatment for under $60 per visit. This is all without hitting your deductible at all, they're day 1 prices. If you paid the cash prices for many of these doctors, specialists, therapists, they'd be many times higher than the insurance negotiated costs. Look under the "covered costs" estimates for things like mental health treatment, diabetes maintenance, broken bone treatment, etc and you'll see that the estimated annual cost for the insured is often half or less the plan's deductible -- which tells you that hitting the deductible is not when the savings start. I don't think my wife or I have ever hit our out-of-pocket maximums in a year, yet the insurance has saved us more than it's cost in most years. You're going to start interacting with the healthcare system a lot more than you have in your 20s once you're in your 30s. We all do at that age. And if you have even the worst ACA plan, you'll start to understand what it's doing for you regardless of the deductible.
    - phonon 2y ago
softsound 2y ago
It's still expensive, I worked as a contractor full time for a tech company for a year which basically means I pay for my own insurance through Obamacare (though they did suggest insurance at work but they didn't pay anything towards it so it is just is in case you want a 4th party to help you help yourself). Still long before that I basically just said I didn't have insurance and would get the price knocked down considerably. Half the time it's cheaper not to even have insurance... But now I'm "responsible" in the hopes it might bring down the price for other things in the future. For planned events I recommend health insurance, despite how often it's not all that worth it. Honestly though my current insurance copay cost as much as being uninsured in other countries so I kinda laugh at this crazy idea. I pay about $100 to visit any specialist doctor and it only cost $80 to be uninsured in some other countries on top of the $350 a month I already pay.
silverquiet 2y ago
We live in Texas.
- pjlegato 2y ago
  Sounds like your issue is with Texas, then, not with America. Why perpetuate crude and inaccurate stereotypes that smear and disparage America in general? America is spending a huge amount of money every year precisely on providing healthcare for the poor. Besides which, it looks like Medicaid does indeed operate in Texas, which is discoverable in less than 10 seconds of Internet searching: https://www.hhs.texas.gov/services/health/medicaid-chip/about-medicaid-chip/chip-state-plan https://www.hhs.texas.gov/services/health/medicaid-chip/abou... And, seperately, Obamacare's marketplace works nationally, including in Texas: "More Texans than ever before enrolled in ACA health plans in 2024"[1] [1] https://www.texastribune.org/2024/01/24/texas-aca-health-insurance-enrollment/ https://www.texastribune.org/2024/01/24/texas-aca-health-ins...
  - silverquiet 2y ago
    Have you considered perhaps that because I live in Texas, I know a bit more about those programs than you who have just googled and linked the top results? And that perhaps because I live in Texas, I indeed have issues with Texas (still a part of America in spite of the wishes of some on the right wing)? From your own article (I knew this stat would be in there): > Currently, Texas leads the nation in the number of uninsured residents with nearly 5 million people living here without health insurance coverage, nearly double the national average. Why do you think so many are uninsured if it is so simple for them to get health coverage?
    - pjlegato 2y ago
      You said giving a fake name at the ER was the only option for poor AMERICANS to obtain healthcare. That is categorically false, and testifes to some sort of deep seated bias against our own country profoundly embedded in your worldview -- one which extends all the way to glib counterfactual promotion of verifiably false information about the country and its supposed moral shortcomings. 2) Texas has a much larger population than 49 of the other 50 states -- about 30 million, higher than any state but California. Of course the number of uninsured residents will be higher than the national average. You didn't control for uninsured per capita. Why are so many uninsured if it's possible (I didn't say easy) for them to get coverage? Probably, a large part of the reason is people who go around promoting the (completely false) common trope that "poor Americans just can't get health coverage, the government does nothing for them."
heavyset_go 2y ago
Medicaid wasn't expanded in several states with tens of millions of people living in them[1]. For example, in Texas, nobody is eligible for Medicaid based solely on their income alone. Where Medicaid is expanded, the income requirements for Medicaid are far from sane. If you make over 100% to 138% of the federal poverty line, which is $15,060/year for an individual, you are not eligible for coverage. For example, someone who makes $16k to $21k a year, depending on where they live, is ineligible for coverage despite making poverty wages. [1] https://www.kff.org/affordable-care-act/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/ https://www.kff.org/affordable-care-act/issue-brief/status-o...
rmah 2y ago
Most Americans don't realize just how huge and extensive medicare/medicaid is. They cover 65mil and 88mil people respectively, including 40mil children. That's 153mil people out of 330mil population -- that's 46% of the USA's population. Total spending is $1.9T for both. A cost of $12,400/person covered. $1.9T is 7.5% of the total US GDP of $25.44T. Medicare/medicaid is a massive program. Bigger than social security at $1.4T. It's crazy huge.
- silverquiet 2y ago
  In that case, why not just go all the way to Medicare for All?
  - jonfromsf 2y ago
    Because with the current medical cost, it would be absolutely ruinous. The root problem is American health care is far too expensive. The entire system is massively wasteful and complex.
    - silverquiet 2y ago
      Seems like unifying it under a single, already-extant federal system would greatly reduce administrative overhead though, don’t you think? What’s funny is I’m probably one of the people whose paycheck is dependent on me not understanding that to paraphrase Upton Sinclair. When I started at my current employer, one of the devs straight up said the government should be doing what we do and we shouldn’t have a business.
    - deleted 2y ago
      [deleted]
  - quickthrowman 2y ago
    Unfortunately, several million people work in medical billing and insurance. No politician that is aiming to get re-elected wants to double the employment rate. It would cure inflation almost instantly though!

notaustinpowers 2y ago

Obamacare is (largely) a failure due to insurance meddling and laws preventing government insurance programs from negotiating prices with drug companies. I'm a healthy individual, not even 30 yet, never smoked, never broken a bone, and never even had stitches in my life. And when I last checked their prices, I was making only $45k/yr. For coverage with Obamacare, I would be paying $350/month for the "catastrophic" plan. Which includes no prescription copay, no dental, no vision, and only kicks in after I've spent $100,000 in one year, and it takes 6 months to take effect after signing up. It's only there for serious issues like losing a leg or cancer.

dangrossman 2y ago
Obamacare is not a plan, it's a law that set minimum standards for health insurance plans, created marketplaces to cross-shop plans across providers on a single website, and created a system where you can receive government subsidies towards their cost if your income is low enough. At $45K, you would receive subsidies towards your insurance premiums. I've bought my insurance on the ACA marketplace since it opened ten years ago. There's no difference I can see between the plans offered on the health insurance marketplace and those offered directly from the websites of the same insurers that offer coverage in my state (Blue Cross, CVS Aetna, United, Ambetter, etc). The very highest deductible "catastrophic" plan offered on the marketplace in California for a 29 year old has a $9450/year deductible, which is also the maximum out-of-pocket expense for the year if you have this plan. A $100K deductible plan does not exist, and when you enroll during the annual enrollment period or after a qualifying life event, plans take effect the day you make your first payment, not months later. I'm 10 years your senior and pay less than $350 per month with a lower deductible than the plan quoted above, with no government subsidies.
- notaustinpowers 2y ago
  I use Obamacare in the rural southern way, referencing ACA and healthcare.gov, lol. I'm also in Georgia which may have different regulations regarding the deductibles. I remember looking at the plans around 2 years ago and realizing that there was no way I could afford the premium, let alone the yearly deductible. I just took another quick look at a non-Healthcare.gov site. Insurance for me would be $313/month with a $9,100 deductible. But it does not cover doctor visits, generic drugs, or specialist visits until after I pay the full $9,100. Why would I want to pay $313/month for essentially no coverage until I spend 20% of my income towards a deductible before I see any benefits?
  - dangrossman 2y ago
    You get an annual doctor visit for free with any insurance plan. There is no deductible or copay. There are other categories that are covered with no deductible. My wife had a $13,000 IUD insertion under anesthesia at a hospital due to complications, and this cost her $0 with insurance, without having met her deductible, since reproductive health is covered with no out of pocket cost under all ACA plans. I'm on healthcare.gov looking at Georgia's plans this year for someone with $45K of income. You have options starting at $129/month. Many of these sub-$200 plans get you doctors visits for $40-60, prescription drugs for under $25 each, mental health treatment for under $60 per visit. This is all without hitting your deductible at all, they're day 1 prices. If you paid the cash prices for many of these doctors, specialists, therapists, they'd be many times higher than the insurance negotiated costs. Look under the "covered costs" estimates for things like mental health treatment, diabetes maintenance, broken bone treatment, etc and you'll see that the estimated annual cost for the insured is often half or less the plan's deductible -- which tells you that hitting the deductible is not when the savings start. I don't think my wife or I have ever hit our out-of-pocket maximums in a year, yet the insurance has saved us more than it's cost in most years. You're going to start interacting with the healthcare system a lot more than you have in your 20s once you're in your 30s. We all do at that age. And if you have even the worst ACA plan, you'll start to understand what it's doing for you regardless of the deductible.
  - phonon 2y ago

softsound 2y ago

It's still expensive, I worked as a contractor full time for a tech company for a year which basically means I pay for my own insurance through Obamacare (though they did suggest insurance at work but they didn't pay anything towards it so it is just is in case you want a 4th party to help you help yourself). Still long before that I basically just said I didn't have insurance and would get the price knocked down considerably. Half the time it's cheaper not to even have insurance... But now I'm "responsible" in the hopes it might bring down the price for other things in the future. For planned events I recommend health insurance, despite how often it's not all that worth it. Honestly though my current insurance copay cost as much as being uninsured in other countries so I kinda laugh at this crazy idea. I pay about $100 to visit any specialist doctor and it only cost $80 to be uninsured in some other countries on top of the $350 a month I already pay.

silverquiet 2y ago

We live in Texas.

pjlegato 2y ago
Sounds like your issue is with Texas, then, not with America. Why perpetuate crude and inaccurate stereotypes that smear and disparage America in general? America is spending a huge amount of money every year precisely on providing healthcare for the poor. Besides which, it looks like Medicaid does indeed operate in Texas, which is discoverable in less than 10 seconds of Internet searching: https://www.hhs.texas.gov/services/health/medicaid-chip/about-medicaid-chip/chip-state-plan https://www.hhs.texas.gov/services/health/medicaid-chip/abou... And, seperately, Obamacare's marketplace works nationally, including in Texas: "More Texans than ever before enrolled in ACA health plans in 2024"[1] [1] https://www.texastribune.org/2024/01/24/texas-aca-health-insurance-enrollment/ https://www.texastribune.org/2024/01/24/texas-aca-health-ins...
- silverquiet 2y ago
  Have you considered perhaps that because I live in Texas, I know a bit more about those programs than you who have just googled and linked the top results? And that perhaps because I live in Texas, I indeed have issues with Texas (still a part of America in spite of the wishes of some on the right wing)? From your own article (I knew this stat would be in there): > Currently, Texas leads the nation in the number of uninsured residents with nearly 5 million people living here without health insurance coverage, nearly double the national average. Why do you think so many are uninsured if it is so simple for them to get health coverage?
  - pjlegato 2y ago
    You said giving a fake name at the ER was the only option for poor AMERICANS to obtain healthcare. That is categorically false, and testifes to some sort of deep seated bias against our own country profoundly embedded in your worldview -- one which extends all the way to glib counterfactual promotion of verifiably false information about the country and its supposed moral shortcomings. 2) Texas has a much larger population than 49 of the other 50 states -- about 30 million, higher than any state but California. Of course the number of uninsured residents will be higher than the national average. You didn't control for uninsured per capita. Why are so many uninsured if it's possible (I didn't say easy) for them to get coverage? Probably, a large part of the reason is people who go around promoting the (completely false) common trope that "poor Americans just can't get health coverage, the government does nothing for them."

heavyset_go 2y ago

Medicaid wasn't expanded in several states with tens of millions of people living in them[1]. For example, in Texas, nobody is eligible for Medicaid based solely on their income alone. Where Medicaid is expanded, the income requirements for Medicaid are far from sane. If you make over 100% to 138% of the federal poverty line, which is $15,060/year for an individual, you are not eligible for coverage. For example, someone who makes $16k to $21k a year, depending on where they live, is ineligible for coverage despite making poverty wages. [1] https://www.kff.org/affordable-care-act/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/ https://www.kff.org/affordable-care-act/issue-brief/status-o...

rmah 2y ago

Most Americans don't realize just how huge and extensive medicare/medicaid is. They cover 65mil and 88mil people respectively, including 40mil children. That's 153mil people out of 330mil population -- that's 46% of the USA's population. Total spending is $1.9T for both. A cost of $12,400/person covered. $1.9T is 7.5% of the total US GDP of $25.44T. Medicare/medicaid is a massive program. Bigger than social security at $1.4T. It's crazy huge.

silverquiet 2y ago
In that case, why not just go all the way to Medicare for All?
- jonfromsf 2y ago
  Because with the current medical cost, it would be absolutely ruinous. The root problem is American health care is far too expensive. The entire system is massively wasteful and complex.
  - silverquiet 2y ago
    Seems like unifying it under a single, already-extant federal system would greatly reduce administrative overhead though, don’t you think? What’s funny is I’m probably one of the people whose paycheck is dependent on me not understanding that to paraphrase Upton Sinclair. When I started at my current employer, one of the devs straight up said the government should be doing what we do and we shouldn’t have a business.
  - deleted 2y ago
    [deleted]
- quickthrowman 2y ago
  Unfortunately, several million people work in medical billing and insurance. No politician that is aiming to get re-elected wants to double the employment rate. It would cure inflation almost instantly though!