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> Blaming Kennedy is a take I hadn't heard before. Carter wanted to pass legislation to give every American catastrophic healthcare coverage, so that a major m

> Blaming Kennedy is a take I hadn't heard before. Carter wanted to pass legislation to give every American catastrophic healthcare coverage, so that a major medical incident would no longer bankrupt families, as a stepping stone towards universal coverage. Kennedy opposed this, despite being on record supporting universal coverage. It would have been a major win for Carter, but Kennedy already knew he wanted to run against the sitting President.

eru 2y ago
You can buy catastrophic healthcare coverage, can't you?
- jliptzin 2y ago
  Everyone already has it, the cost is just absorbed by the public instead of being taken out of the taxes of the person receiving the emergency care, assuming they can’t afford the hospital bill.
  - rbetts 2y ago
    Many studies find that a majority of personal bankruptcies in the US involve medical debt with some estimates of ~500,000 medical-cost contributed bankruptcies per year. A hospital (might) not kick you to the curb if you are dying in their emergency room. However, this is not the same as catastrophic coverage.
    - jliptzin 2y ago
      It is functionally the same for the recipient of the medical care who wouldn’t be able to afford it out of pocket. You get the medical care, and you don’t pay for it. Then declare bankruptcy if you have to.
  - chefandy 2y ago
    Nope. EMTALA means hospitals have to evaluate, and if necessary, stabilize you, and that’s it. If you’ve got a growing cancer or some expensive chronic disease that’s causing serious problems, they’ll do what they can to stop those problems from killing you in any given visit, but they absolutely will not treat cancer with the intent of curing it or help you control a chronic disease knowing they’ll never recoup payment. They’ll give you a prescription for insulin but they’re certainly not going to fill it for you, no matter how big of an emergency it is or how much the hospital visit cost. Even then, they still bill you for all of the services they do render and medical bills still bankrupt people. Needing to make sure someone isn’t going to die in the next few hours is very different from taking the financial responsibility for treating a very expensive medical problem.
    - jliptzin 2y ago
      This is not much different from how many insured people approach their healthcare. My friends who live paycheck to paycheck do not seek medical attention unless it is some extreme life or death situation. Even though they are insured, they are afraid of paying copays and deductibles of $100-$500 for routine visits. If their annual physical results in even just a $50 bill, they will not go. Only when they are in severe 10/10 pain will they start to think about seeing a doctor.
      - chefandy 2y ago
        And at that level of expense, having no insurance, bad regular insurance, and catastrophic insurance is not much different. However, if you get into a car accident, have diabetes, eat a burger with E. coli oh157 which destroys your kidneys and you need dialysis to stay alive, get appendicitis, get HIV, get cancer, or possibly get exposed to rabies and need human rabies immune globulin, having no insurance is very very very very very different. If you have bad insurance you haven’t used that year, it will cost you $500 or whatever your deductible is. More than that with catastrophic insurance. When my wife and I were exposed to rabies during a fantastic stay at a super clean and well-run air bnb and needed the shots, the insurance company portion of our bill was $38,000.
  - johnnyanmac 2y ago
    > taken out of the taxes of the person receiving the emergency care, if it's that catastropic, I imagine their income would fall drastically that year, or years. What taxes?
    - jliptzin 2y ago
      Taxes from their income they’ve been paying their whole lives
  - steego 2y ago
    Having doctors treat and stabilize patients because they are required by EMTALA is an entirely different animal than having catastrophic medical insurance. Real catastrophic medical insurance caps how much you owe whereas the debt you accumulate from a doctor who was obligated to treat you is not capped. That debt follows you until you pay it off or declare bankruptcy like the 500,000 other Americans do each year. To add insult to injury, we already spend $5000 per capita on our publicly funded healthcare system, which is enough to fund basic universal healthcare systems in other countries. Let that sink in. We spend $11,000 per capita on healthcare per year. 45% is publicly funded with taxes and the other 55% is privately funded. We’re already spending enough for TWO universal healthcare systems (for many countries), yet we have 500,000 filing for bankruptcy due to medical bills each year. Based on what we’re spending, we can afford two systems: A socialist system that covers everyone and a private healthcare systems that provides world class treatments to anyone who can afford the insurance premiums. Instead, we have two corrupt and dysfunctional systems, a lot of gaps, and a record number of people profiting off our dysfunction.
    - eru 2y ago
      > We’re already spending enough for TWO universal healthcare systems (for many countries), yet we have 500,000 filing for bankruptcy due to medical bills each year. Well, you are spending approximately twice as much as the Brits in terms of percentage of GDP. (Comparing total healthcare expenditure, ie private plus public.) But that doesn't mean that NHS-style healthcare is the best. Singapore spends roughly health as much as Britain, and has no worse health outcomes. And we don't have a single payer system here.
- efitz 2y ago
  Not by itself, not anymore, because of ACA. For most people, the most cost effective insurance is catastrophic major medical + self-pay for anything else. What passes for insurance now really isn’t “insurance” in the sense that completely expected, and even likely, events are covered. It’s more like paying for discount healthcare but has the major medical built in.
  - pkulak 2y ago
    You can buy it as long as you also have an HSA account, which you should have anyway because it’s pre tax.
    - lotsofpulp 2y ago
      That is a High Deductible Health Plan, which have out of pocket maximums capped in the $10k per calendar year range. While $10k is a lot to a lot of people, it’s a drop in the bucket for an actual catastrophic healthcare event.
      - pkulak 2y ago
        What are you trying to say? Max out of pocket is the max out of your pocket, not the insurance company's.
  - gigatree 2y ago
    Stupid question but does that mean the “discount” comes from tax dollars? i.e. medical costs are spread out more but we’re also collectively spending more of our income on it?
    - lotsofpulp 2y ago
      The discount is from a knowledgeable entity who buys lots of healthcare knowing what they are buying (theoretically preventing fraud) and what competing healthcare providers are selling at, and also negotiating with the collecting purchasing decision of thousands or millions of insureds. Edit: since I can’t respond to comment below due to hitting too fast posting limit: Post ACA and pre ACA plans are completely different products due to out of pocket maximum, age rating factor caps, and inability to screen for pre existing conditions. Hence comparing pre and post ACA health insurance prices is not meaningful.

eru 2y ago

You can buy catastrophic healthcare coverage, can't you?

jliptzin 2y ago
Everyone already has it, the cost is just absorbed by the public instead of being taken out of the taxes of the person receiving the emergency care, assuming they can’t afford the hospital bill.
- rbetts 2y ago
  Many studies find that a majority of personal bankruptcies in the US involve medical debt with some estimates of ~500,000 medical-cost contributed bankruptcies per year. A hospital (might) not kick you to the curb if you are dying in their emergency room. However, this is not the same as catastrophic coverage.
  - jliptzin 2y ago
    It is functionally the same for the recipient of the medical care who wouldn’t be able to afford it out of pocket. You get the medical care, and you don’t pay for it. Then declare bankruptcy if you have to.
- chefandy 2y ago
  Nope. EMTALA means hospitals have to evaluate, and if necessary, stabilize you, and that’s it. If you’ve got a growing cancer or some expensive chronic disease that’s causing serious problems, they’ll do what they can to stop those problems from killing you in any given visit, but they absolutely will not treat cancer with the intent of curing it or help you control a chronic disease knowing they’ll never recoup payment. They’ll give you a prescription for insulin but they’re certainly not going to fill it for you, no matter how big of an emergency it is or how much the hospital visit cost. Even then, they still bill you for all of the services they do render and medical bills still bankrupt people. Needing to make sure someone isn’t going to die in the next few hours is very different from taking the financial responsibility for treating a very expensive medical problem.
  - jliptzin 2y ago
    This is not much different from how many insured people approach their healthcare. My friends who live paycheck to paycheck do not seek medical attention unless it is some extreme life or death situation. Even though they are insured, they are afraid of paying copays and deductibles of $100-$500 for routine visits. If their annual physical results in even just a $50 bill, they will not go. Only when they are in severe 10/10 pain will they start to think about seeing a doctor.
    - chefandy 2y ago
      And at that level of expense, having no insurance, bad regular insurance, and catastrophic insurance is not much different. However, if you get into a car accident, have diabetes, eat a burger with E. coli oh157 which destroys your kidneys and you need dialysis to stay alive, get appendicitis, get HIV, get cancer, or possibly get exposed to rabies and need human rabies immune globulin, having no insurance is very very very very very different. If you have bad insurance you haven’t used that year, it will cost you $500 or whatever your deductible is. More than that with catastrophic insurance. When my wife and I were exposed to rabies during a fantastic stay at a super clean and well-run air bnb and needed the shots, the insurance company portion of our bill was $38,000.
- johnnyanmac 2y ago
  > taken out of the taxes of the person receiving the emergency care, if it's that catastropic, I imagine their income would fall drastically that year, or years. What taxes?
  - jliptzin 2y ago
    Taxes from their income they’ve been paying their whole lives
- steego 2y ago
  Having doctors treat and stabilize patients because they are required by EMTALA is an entirely different animal than having catastrophic medical insurance. Real catastrophic medical insurance caps how much you owe whereas the debt you accumulate from a doctor who was obligated to treat you is not capped. That debt follows you until you pay it off or declare bankruptcy like the 500,000 other Americans do each year. To add insult to injury, we already spend $5000 per capita on our publicly funded healthcare system, which is enough to fund basic universal healthcare systems in other countries. Let that sink in. We spend $11,000 per capita on healthcare per year. 45% is publicly funded with taxes and the other 55% is privately funded. We’re already spending enough for TWO universal healthcare systems (for many countries), yet we have 500,000 filing for bankruptcy due to medical bills each year. Based on what we’re spending, we can afford two systems: A socialist system that covers everyone and a private healthcare systems that provides world class treatments to anyone who can afford the insurance premiums. Instead, we have two corrupt and dysfunctional systems, a lot of gaps, and a record number of people profiting off our dysfunction.
  - eru 2y ago
    > We’re already spending enough for TWO universal healthcare systems (for many countries), yet we have 500,000 filing for bankruptcy due to medical bills each year. Well, you are spending approximately twice as much as the Brits in terms of percentage of GDP. (Comparing total healthcare expenditure, ie private plus public.) But that doesn't mean that NHS-style healthcare is the best. Singapore spends roughly health as much as Britain, and has no worse health outcomes. And we don't have a single payer system here.
efitz 2y ago
Not by itself, not anymore, because of ACA. For most people, the most cost effective insurance is catastrophic major medical + self-pay for anything else. What passes for insurance now really isn’t “insurance” in the sense that completely expected, and even likely, events are covered. It’s more like paying for discount healthcare but has the major medical built in.
- pkulak 2y ago
  You can buy it as long as you also have an HSA account, which you should have anyway because it’s pre tax.
  - lotsofpulp 2y ago
    That is a High Deductible Health Plan, which have out of pocket maximums capped in the $10k per calendar year range. While $10k is a lot to a lot of people, it’s a drop in the bucket for an actual catastrophic healthcare event.
    - pkulak 2y ago
      What are you trying to say? Max out of pocket is the max out of your pocket, not the insurance company's.
- gigatree 2y ago
  Stupid question but does that mean the “discount” comes from tax dollars? i.e. medical costs are spread out more but we’re also collectively spending more of our income on it?
  - lotsofpulp 2y ago
    The discount is from a knowledgeable entity who buys lots of healthcare knowing what they are buying (theoretically preventing fraud) and what competing healthcare providers are selling at, and also negotiating with the collecting purchasing decision of thousands or millions of insureds. Edit: since I can’t respond to comment below due to hitting too fast posting limit: Post ACA and pre ACA plans are completely different products due to out of pocket maximum, age rating factor caps, and inability to screen for pre existing conditions. Hence comparing pre and post ACA health insurance prices is not meaningful.