4 ms·

How does the healthcare system work in the USA? You have to pay hospital out of your pocket? Somebody who has not enough funds will not be treated?

by itry 12y ago

davidw 12y ago
It's complicated, and it's been abundantly discussed on the internet, if you'd care to use a service like Google to research it. Let's keep this thread about helping this one guy, rather than debating the merits of various health care systems.
- adamnemecek 12y ago
  At the same time, maybe it's situations like this that influence peoples' opinion on the matter.
  - davidw 12y ago
    Then let it speak for itself (I think it does). Politics are a poisonous topic for sites like this and are off-topic according to the guidelines. https://news.ycombinator.com/item?id=6120530 https://news.ycombinator.com/item?id=6120530
    - tzs 12y ago
      > Politics [...] are off-topic according to the guidelines Most submissions about politics are off-topic according to the guidelines. Nothing in the guidelines says that comments about politics are off-topic.
      - davidw 12y ago
        Long term, you can have one of these things: * A high quality site, with interesting, possibly spirited, but civil discussions about various topics. * Politics. Your call.
        tptacek 12y ago
        We've all three been here long enough to know what the guidelines are trying to say. It drives me nuts that they won't update them. In the meantime: we're all on the same page on this, so this is probably a fake discussion.
- rtpg 12y ago
  Is there a real debate? Literally every other highly-developed nation in the world does not have this problem. A significant portion of HN are US-based software engineers or related. That probably means significant amounts of disposable income and some possibility of changing this. We should help this guy, but we should also be donating to political candidates not afraid to tackle this problem. We should be as loud as possible about how as a country, we have failed to create an environment where people can exert their right to a modicum of healthcare access without first having to lose everything they own (through bankruptcy or otherwise). Look at these cases straight-on and acknowledge that this is an absolute disgrace.
  - byEngineer 12y ago
    Please, please, please don't look on healthcare just from money perspective (i.e. affordability). Look on it from life saving efficiency too. Actually foremost. Renial Cancer I was suspected of having had chances of recovery in Germany of 60%. In the US over 90%. Yes, in Germany it is funded by taxpayer. Yes in the US I would be bankrupt. But I think it is obvious which system is much better in that particular case. I think that all of us would rather be bankrupt than dead. And this is big issue that just isn't discussed in the politics and media.
    - VikingCoder 12y ago
      I'll take your numbers at face value... That's great that Germany gave you a free 60% chance of recovery! If you couldn't afford the 90% chance in the US, your chance of recovery was probably 0%. So, presenting it as 60% or 90% is a false comparison. Nothing prevents you from spending more on your recovery, if you have the money. What you fail to understand is that many people in the United States would like the same 60% chance funded by the taxpayer that you enjoy in Germany. To quote some other numbers at you, Infant Mortality rate (deaths per 1,000 live births) by the CIA 2013 estimate in the United States is 5.2, in Germany it's 3.48. http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate http://en.wikipedia.org/wiki/List_of_countries_by_infant_mor... So, it's not like healthcare is uniformly better in the United States than other countries, and it absolutely is inaccessible to many of our citizens. Not something I'm proud of.
_delirium 12y ago
For things like this, yes. If you land in the emergency room with an acute emergency (heart attack, stroke, car accident, etc.), anyone will be stabilized regardless of ability to pay, but that doesn't apply to things that aren't stabilization of an acute emergency, like rehabilitation or chemotherapy. The case here is in the 2nd category.
jessedhillon 12y ago
If you have insurance, your insurance needs to cover the treatment recommended by your doctor. In many cases it will be covered without and issue, but some treatments will not be covered in favor of other (usually less expensive) services. Having insurance is usually the only feasible way to get preventative care. Even with insurance you are often still responsible for a portion of your care, at least until a certain amount. This obligation to pay renews every year in most cases, so even if you reach the limit of your obligation this year, next year you will have to reach it again. If you are not insured, you will have to pay out of pocket. Hospitals cannot deny you care if you are in an emergency condition, but they are only required to get you to a stable condition. I believe you are still required to pay, but they aren't allowed to deny you care if you can't.
rdl 12y ago
This isn't raising money for just direct medical expenses; if you work as a contractor, consultant, speaker, etc., and for some reason can't work for a few months, it doesn't really matter if all your medical expenses are paid 100% -- you have no income, and for a lot of people, that means paying regular bills becomes difficult. It's not like your rent expenses at home go away just because you're staying in a hospital instead.
- kuon 12y ago
  Here you just have insurance for this. You get 80% of your salary while you can't work.
  - rdl 12y ago
    Getting disability insurance is strongly encouraged for contractors and others in the US (we have both short term and long term). There are actually federal (and some state) programs to pay disability if a worker is disabled, but enrollment takes some time, and generally the support is at poverty level, not based on salary. A serious complication for people who freelance, contract, etc. is that aside from Social Security Disability (SSI, generally for long-term disability), the programs are related to unemployment insurance, which is related to wage income. If you, for instance, are bootstrapping a company from savings and not paying yourself a salary, then get in an accident, even if your medical insurance covers 100% of medical costs, you're probably screwed on everything else.
IvyMike 12y ago
> You have to pay hospital out of your pocket? Surgery for cardiac arrest is far more expensive than $5000. The cost of such a surgery (without insurance) is easily over $100K and if you said "it was $1M" people would be like "that's a little high" rather than "impossible!" This must be for incidental costs incurred or for recovery not covered by insurance. (Like: Some insurances might only cover physical therapy twice a week. They probably cite some study saying that is sufficient for recovery. But other people might argue more frequent sessions are better, so this money could cover the more frequent sessions.)
cookiecaper 12y ago
>Somebody who has not enough funds will not be treated? They'll be treated, they'll just have to file for bankruptcy.
- lotsofcows 12y ago
  Number one cause of bankrupty in USA, land of the free fans!
thomaskcr 12y ago
He has medicare advantage plus according to his comments on his personal site -- so his care + rehab was covered. He talks a lot about billable work though, I have a feeling this is more for personal expenses and making it so he doesn't feel like he always needs to work and he can work until its not enjoyable and then relax and recoup.

How does the healthcare system work in the USA? You have to pay hospital out of your pocket? Somebody who has not enough funds will not be treated?

by itry 12y ago

How does the healthcare system work in the USA? You have to pay hospital out of your pocket? Somebody who has not enough funds will not be treated?

davidw 12y ago

It's complicated, and it's been abundantly discussed on the internet, if you'd care to use a service like Google to research it. Let's keep this thread about helping this one guy, rather than debating the merits of various health care systems.

adamnemecek 12y ago
At the same time, maybe it's situations like this that influence peoples' opinion on the matter.
- davidw 12y ago
  Then let it speak for itself (I think it does). Politics are a poisonous topic for sites like this and are off-topic according to the guidelines. https://news.ycombinator.com/item?id=6120530 https://news.ycombinator.com/item?id=6120530
  - tzs 12y ago
    > Politics [...] are off-topic according to the guidelines Most submissions about politics are off-topic according to the guidelines. Nothing in the guidelines says that comments about politics are off-topic.
    - davidw 12y ago
      Long term, you can have one of these things: * A high quality site, with interesting, possibly spirited, but civil discussions about various topics. * Politics. Your call.
      - tptacek 12y ago
        We've all three been here long enough to know what the guidelines are trying to say. It drives me nuts that they won't update them. In the meantime: we're all on the same page on this, so this is probably a fake discussion.
rtpg 12y ago
Is there a real debate? Literally every other highly-developed nation in the world does not have this problem. A significant portion of HN are US-based software engineers or related. That probably means significant amounts of disposable income and some possibility of changing this. We should help this guy, but we should also be donating to political candidates not afraid to tackle this problem. We should be as loud as possible about how as a country, we have failed to create an environment where people can exert their right to a modicum of healthcare access without first having to lose everything they own (through bankruptcy or otherwise). Look at these cases straight-on and acknowledge that this is an absolute disgrace.
- byEngineer 12y ago
  Please, please, please don't look on healthcare just from money perspective (i.e. affordability). Look on it from life saving efficiency too. Actually foremost. Renial Cancer I was suspected of having had chances of recovery in Germany of 60%. In the US over 90%. Yes, in Germany it is funded by taxpayer. Yes in the US I would be bankrupt. But I think it is obvious which system is much better in that particular case. I think that all of us would rather be bankrupt than dead. And this is big issue that just isn't discussed in the politics and media.
  - VikingCoder 12y ago
    I'll take your numbers at face value... That's great that Germany gave you a free 60% chance of recovery! If you couldn't afford the 90% chance in the US, your chance of recovery was probably 0%. So, presenting it as 60% or 90% is a false comparison. Nothing prevents you from spending more on your recovery, if you have the money. What you fail to understand is that many people in the United States would like the same 60% chance funded by the taxpayer that you enjoy in Germany. To quote some other numbers at you, Infant Mortality rate (deaths per 1,000 live births) by the CIA 2013 estimate in the United States is 5.2, in Germany it's 3.48. http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate http://en.wikipedia.org/wiki/List_of_countries_by_infant_mor... So, it's not like healthcare is uniformly better in the United States than other countries, and it absolutely is inaccessible to many of our citizens. Not something I'm proud of.

_delirium 12y ago

For things like this, yes. If you land in the emergency room with an acute emergency (heart attack, stroke, car accident, etc.), anyone will be stabilized regardless of ability to pay, but that doesn't apply to things that aren't stabilization of an acute emergency, like rehabilitation or chemotherapy. The case here is in the 2nd category.

jessedhillon 12y ago

If you have insurance, your insurance needs to cover the treatment recommended by your doctor. In many cases it will be covered without and issue, but some treatments will not be covered in favor of other (usually less expensive) services. Having insurance is usually the only feasible way to get preventative care. Even with insurance you are often still responsible for a portion of your care, at least until a certain amount. This obligation to pay renews every year in most cases, so even if you reach the limit of your obligation this year, next year you will have to reach it again. If you are not insured, you will have to pay out of pocket. Hospitals cannot deny you care if you are in an emergency condition, but they are only required to get you to a stable condition. I believe you are still required to pay, but they aren't allowed to deny you care if you can't.

rdl 12y ago

This isn't raising money for just direct medical expenses; if you work as a contractor, consultant, speaker, etc., and for some reason can't work for a few months, it doesn't really matter if all your medical expenses are paid 100% -- you have no income, and for a lot of people, that means paying regular bills becomes difficult. It's not like your rent expenses at home go away just because you're staying in a hospital instead.

kuon 12y ago
Here you just have insurance for this. You get 80% of your salary while you can't work.
- rdl 12y ago
  Getting disability insurance is strongly encouraged for contractors and others in the US (we have both short term and long term). There are actually federal (and some state) programs to pay disability if a worker is disabled, but enrollment takes some time, and generally the support is at poverty level, not based on salary. A serious complication for people who freelance, contract, etc. is that aside from Social Security Disability (SSI, generally for long-term disability), the programs are related to unemployment insurance, which is related to wage income. If you, for instance, are bootstrapping a company from savings and not paying yourself a salary, then get in an accident, even if your medical insurance covers 100% of medical costs, you're probably screwed on everything else.

IvyMike 12y ago

> You have to pay hospital out of your pocket? Surgery for cardiac arrest is far more expensive than $5000. The cost of such a surgery (without insurance) is easily over $100K and if you said "it was $1M" people would be like "that's a little high" rather than "impossible!" This must be for incidental costs incurred or for recovery not covered by insurance. (Like: Some insurances might only cover physical therapy twice a week. They probably cite some study saying that is sufficient for recovery. But other people might argue more frequent sessions are better, so this money could cover the more frequent sessions.)

cookiecaper 12y ago

>Somebody who has not enough funds will not be treated? They'll be treated, they'll just have to file for bankruptcy.

lotsofcows 12y ago
Number one cause of bankrupty in USA, land of the free fans!

thomaskcr 12y ago

He has medicare advantage plus according to his comments on his personal site -- so his care + rehab was covered. He talks a lot about billable work though, I have a feeling this is more for personal expenses and making it so he doesn't feel like he always needs to work and he can work until its not enjoyable and then relax and recoup.