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That's something I've never understood around so many of these discussions, particularly post-ACA. I get there are some gaps around the out of pocket maximum, b

That's something I've never understood around so many of these discussions, particularly post-ACA. I get there are some gaps around the out of pocket maximum, but if you have healthcare, even a serious medical event shouldn't be ruinous. Are all these anecdotes just people that had no coverage at all?

jakub_g 1y ago
(EU person) From my reading, the cost is just the start. Others are: insurance companies rejecting claims for stupid reasons; providers overdoing treatments to maximize their bills; the stress involved navigating all this hostile system etc.
- alex43578 1y ago
  I don’t disagree that secondary issues don’t exist, but I also don’t think they’re unique to the American system. I’d think that there’s stress inherent to Canada or Britain’s system, with months-long waits, for instance. The cost thing has just always been the part of online discourse that sticks out to me, because it’s clear under current laws that it shouldn’t be the financial apocalypse people paint it as, unless they have 0 insurance.
  - spacedcowboy 1y ago
    Here’s something that’s different. When my wife walked into ER, she was just a little worried about a heavy period. Turns out it was a “time of life thing, stuff go crazy” but they also noticed her Sodium was low when they drew blood and admitted her. ER being what it is, beds are at a premium, and they want to “turn beds” if they can, just like a restaurant wants to turn tables. They’re both run as a business. They tried to speed up my wife’s care and gave her too much Sodium too quickly (actually about 2x the rate recommended). She went into a coma. They tried a bunch of things to bring her back. I’ll always remember the doctor saying “I don’t think she’ll die” is an almost bored, disinterested tone as she lay there. She wasn’t responding so they moved her to share a room where a woman was undergoing assisted suicide while they waited for her to revive. ER beds are at a premium, remember. They’re can charge a lot for those, so she was taking up valuable space. She did eventually surface, but it’s not like the movies. You don’t just “wake up” and everything starts to get better. Things were so bad your brain shut down, that has consequences. She is awake, but she is not the same person, she’s terrified of, well, everything. There were months of neuropathic pain all over her body. Pain that wouldn’t go away with either OTC painkillers or anything else they tried, all the way up to opioids. Have you ever heard someone lose their voice from screaming so much ? She was still screaming in agony, but she wasn’t making a sound. She has been in and out of mental health asylums over the last two years while we struggled to try and fix things. It hasn’t worked. I’ve had to give up my job to care for her, a job I loved, working at Apple these last 20 years. We leave the country, permanently, on 4th July, because we can’t live in San Jose without an income, we don’t have anyone else to help, and I can retire in the UK with my family around to help out on the days we need it. I’ve only really been waiting until the kid finished the year at school. Doctors everywhere make mistakes. Not everywhere has a money/profit motive to drive treatment though, that’s pretty much only in the USA. I had excellent health insurance which covered our family but that makes no difference when the hospital just see you as a figure on a balance sheet. Granny Weatherwax (created by a Brit, of course) had the right of it. The root of all evil is treating people as things. People as things, that’s it. In our experience, the US “healthcare” system does not treat people as humans, they’re just figures on a balance sheet. It’s too late for it to get much better for my wife, and hell, the stress and pressure of the last 2 years has taken its toll on me too, apparently prolonged stress and the body’s reaction to it can provoke type-1 LADA diabetes, so now I’m fucked too. Not as badly as my wife, with a pump connected to me, I can live an almost normal life, but still. The benefit of the UK’s system is that it’s based on patient care, not a balance sheet. Like I said, I’ve had long experience of both, and this idea that you “wait months” is not how it really works in the UK, in fact we have waited longer to see specialists in the USA (again, with gold-plated insurance) than I’ve ever waited in the UK. It doesn’t matter how much money you have (presumably bar Musk-like money) if the expert you need isn’t available… The UK will prioritise people in need (my mother has recovered from two different cancers with very timely treatment, my uncle was in open-heart surgery the next day after his yearly physical,…) but will “slot you in” if there’s no medical emergency. It’s not perfect, and it’s now recovering from a decade or so of underfunding as the Tories tried to sell it off bit by bit, but I do not believe my wife would have experienced the same treatment as she did in the US - there just isn’t the same approach to medicine. My advice: never go to O’Connor hospital in San Jose. They might just fuck up your life completely, so they can make more money.
    - jakub_g 1y ago
      Dammit. So sorry for you and your wife. Take care.
const_cast 1y ago
Well, there's a lot going on here: 1. Bad plans have really, really high deductibles and high OOP max. If you're looking at 9K OOP max then you can absolutely be financially ruined. I mean, for many people that's more than their car. 2. Out of network charges and ridiculous billing. You can get denied, you can be given the run-around, and you WILL pay more than whatever your OOP max is. Your hospital visit will result in you getting bills 3 months later. Things will conveniently slip through the cracks. 3. Not everything is covered, for example, long-term care. If you're old and sick and need to be in a nursing home, you're 100% fucked. You need medicaid for that. Not medicare, that doesn't cover it, you need medicaid. So you need to basically forfeit all your money you've ever made. Or, pay 10k a month, which is functionally equivalent for almost everyone.
- alex43578 1y ago
  I get $9K can be a hit, but is the expectation that tens of thousands or hundreds of thousands of dollars in medical care is just free? Let's say that $9K OOP max is for a significant health event - like a badly broken leg. In the NHS, approx 4.5% of the person's income is directed to the NHS via taxes, and at an average income of 37,430 that's a yearly 1,684 going to medical expenses, or an equivalent $2,426 PPP. Are you having a health crisis every 4 years where the NHS system would be more manageable financially? That's all even before you get into the write-offs, reductions, and relative unenforceability of US medical debt, especially for lower-income people. If you're in a place where you can't pay $9K, you're also medical "debt-resistant", really. As for LTC, there is LTC insurance and Medicaid as a last resort. Ignoring the idea of a Medicaid trust, doesn't it seem fair that you would spend down your estate in exchange for this very expensive care you're receiving? I can only imagine the reaction from the left if a multi-millionaire's kids got to inherit the estate while the taxpayer picks up the tab for his care. In some other countries, euthanasia is increasingly being positioned as an alternative to long-term care because of the challenges with bed-availability, which seems equally unpalatable to the public.
  - const_cast 1y ago
    > I get $9K can be a hit, but is the expectation that tens of thousands or hundreds of thousands of dollars in medical care is just free? Largely, yes, it is free in most of the developed world. Or close to. > Are you having a health crisis every 4 years where the NHS system would be more manageable financially? Yes, the average US citizen pays about 12K dollars a year for healthcare. That's twelve. That's including health care costs, insurance, and taxes - because yes, we also burn tax dollars on healthcare. That's the average. Are you noticing something? How is it so much more expensive? It's because US healthcare is also socialized, just like the NHS, but it's done shitty. It's done in thousands of tiny little fiefdoms which produces one of the most inefficient medical systems imaginable. And, what I think you and other's really need to understand, is that the US does not have good healthcare. We have consistently worse healthcare outcomes than other developed countries. Not only are we paying sometimes an order of magnitude more per person, we don't get anything for that. It's not like we have high-quality healthcare. > In some other countries, euthanasia is increasingly being positioned as an alternative to long-term care because of the challenges with bed-availability, which seems equally unpalatable to the public. Yeah, we also do this in the US. Again, not only is our care very expensive, it's also very bad.

jakub_g 1y ago

(EU person) From my reading, the cost is just the start. Others are: insurance companies rejecting claims for stupid reasons; providers overdoing treatments to maximize their bills; the stress involved navigating all this hostile system etc.

alex43578 1y ago
I don’t disagree that secondary issues don’t exist, but I also don’t think they’re unique to the American system. I’d think that there’s stress inherent to Canada or Britain’s system, with months-long waits, for instance. The cost thing has just always been the part of online discourse that sticks out to me, because it’s clear under current laws that it shouldn’t be the financial apocalypse people paint it as, unless they have 0 insurance.
- spacedcowboy 1y ago
  Here’s something that’s different. When my wife walked into ER, she was just a little worried about a heavy period. Turns out it was a “time of life thing, stuff go crazy” but they also noticed her Sodium was low when they drew blood and admitted her. ER being what it is, beds are at a premium, and they want to “turn beds” if they can, just like a restaurant wants to turn tables. They’re both run as a business. They tried to speed up my wife’s care and gave her too much Sodium too quickly (actually about 2x the rate recommended). She went into a coma. They tried a bunch of things to bring her back. I’ll always remember the doctor saying “I don’t think she’ll die” is an almost bored, disinterested tone as she lay there. She wasn’t responding so they moved her to share a room where a woman was undergoing assisted suicide while they waited for her to revive. ER beds are at a premium, remember. They’re can charge a lot for those, so she was taking up valuable space. She did eventually surface, but it’s not like the movies. You don’t just “wake up” and everything starts to get better. Things were so bad your brain shut down, that has consequences. She is awake, but she is not the same person, she’s terrified of, well, everything. There were months of neuropathic pain all over her body. Pain that wouldn’t go away with either OTC painkillers or anything else they tried, all the way up to opioids. Have you ever heard someone lose their voice from screaming so much ? She was still screaming in agony, but she wasn’t making a sound. She has been in and out of mental health asylums over the last two years while we struggled to try and fix things. It hasn’t worked. I’ve had to give up my job to care for her, a job I loved, working at Apple these last 20 years. We leave the country, permanently, on 4th July, because we can’t live in San Jose without an income, we don’t have anyone else to help, and I can retire in the UK with my family around to help out on the days we need it. I’ve only really been waiting until the kid finished the year at school. Doctors everywhere make mistakes. Not everywhere has a money/profit motive to drive treatment though, that’s pretty much only in the USA. I had excellent health insurance which covered our family but that makes no difference when the hospital just see you as a figure on a balance sheet. Granny Weatherwax (created by a Brit, of course) had the right of it. The root of all evil is treating people as things. People as things, that’s it. In our experience, the US “healthcare” system does not treat people as humans, they’re just figures on a balance sheet. It’s too late for it to get much better for my wife, and hell, the stress and pressure of the last 2 years has taken its toll on me too, apparently prolonged stress and the body’s reaction to it can provoke type-1 LADA diabetes, so now I’m fucked too. Not as badly as my wife, with a pump connected to me, I can live an almost normal life, but still. The benefit of the UK’s system is that it’s based on patient care, not a balance sheet. Like I said, I’ve had long experience of both, and this idea that you “wait months” is not how it really works in the UK, in fact we have waited longer to see specialists in the USA (again, with gold-plated insurance) than I’ve ever waited in the UK. It doesn’t matter how much money you have (presumably bar Musk-like money) if the expert you need isn’t available… The UK will prioritise people in need (my mother has recovered from two different cancers with very timely treatment, my uncle was in open-heart surgery the next day after his yearly physical,…) but will “slot you in” if there’s no medical emergency. It’s not perfect, and it’s now recovering from a decade or so of underfunding as the Tories tried to sell it off bit by bit, but I do not believe my wife would have experienced the same treatment as she did in the US - there just isn’t the same approach to medicine. My advice: never go to O’Connor hospital in San Jose. They might just fuck up your life completely, so they can make more money.
  - jakub_g 1y ago
    Dammit. So sorry for you and your wife. Take care.

const_cast 1y ago

Well, there's a lot going on here: 1. Bad plans have really, really high deductibles and high OOP max. If you're looking at 9K OOP max then you can absolutely be financially ruined. I mean, for many people that's more than their car. 2. Out of network charges and ridiculous billing. You can get denied, you can be given the run-around, and you WILL pay more than whatever your OOP max is. Your hospital visit will result in you getting bills 3 months later. Things will conveniently slip through the cracks. 3. Not everything is covered, for example, long-term care. If you're old and sick and need to be in a nursing home, you're 100% fucked. You need medicaid for that. Not medicare, that doesn't cover it, you need medicaid. So you need to basically forfeit all your money you've ever made. Or, pay 10k a month, which is functionally equivalent for almost everyone.

alex43578 1y ago
I get $9K can be a hit, but is the expectation that tens of thousands or hundreds of thousands of dollars in medical care is just free? Let's say that $9K OOP max is for a significant health event - like a badly broken leg. In the NHS, approx 4.5% of the person's income is directed to the NHS via taxes, and at an average income of 37,430 that's a yearly 1,684 going to medical expenses, or an equivalent $2,426 PPP. Are you having a health crisis every 4 years where the NHS system would be more manageable financially? That's all even before you get into the write-offs, reductions, and relative unenforceability of US medical debt, especially for lower-income people. If you're in a place where you can't pay $9K, you're also medical "debt-resistant", really. As for LTC, there is LTC insurance and Medicaid as a last resort. Ignoring the idea of a Medicaid trust, doesn't it seem fair that you would spend down your estate in exchange for this very expensive care you're receiving? I can only imagine the reaction from the left if a multi-millionaire's kids got to inherit the estate while the taxpayer picks up the tab for his care. In some other countries, euthanasia is increasingly being positioned as an alternative to long-term care because of the challenges with bed-availability, which seems equally unpalatable to the public.
- const_cast 1y ago
  > I get $9K can be a hit, but is the expectation that tens of thousands or hundreds of thousands of dollars in medical care is just free? Largely, yes, it is free in most of the developed world. Or close to. > Are you having a health crisis every 4 years where the NHS system would be more manageable financially? Yes, the average US citizen pays about 12K dollars a year for healthcare. That's twelve. That's including health care costs, insurance, and taxes - because yes, we also burn tax dollars on healthcare. That's the average. Are you noticing something? How is it so much more expensive? It's because US healthcare is also socialized, just like the NHS, but it's done shitty. It's done in thousands of tiny little fiefdoms which produces one of the most inefficient medical systems imaginable. And, what I think you and other's really need to understand, is that the US does not have good healthcare. We have consistently worse healthcare outcomes than other developed countries. Not only are we paying sometimes an order of magnitude more per person, we don't get anything for that. It's not like we have high-quality healthcare. > In some other countries, euthanasia is increasingly being positioned as an alternative to long-term care because of the challenges with bed-availability, which seems equally unpalatable to the public. Yeah, we also do this in the US. Again, not only is our care very expensive, it's also very bad.