Hey all, I’m British so I don’t really know the ins and outs of the US healthcare system. Apologies for asking what is probably a rather simple question.
So like most of you, I see many posts and gofundmes about people having astronomically high medical bills. Most recently, someone having a $27k bill even after his death.
However, I have an American friend who is quick to point out that apparently nobody actually pays those bills. They’re just some elaborate dance between insurance companies and hospitals. If you don’t have insurance, the cost is lower or removed entirely. Supposedly.
So I’m just asking… How accurate is that? Consider someone without insurance, a minor physical ailment, a neurodivergent mind and no interest in fighting off harassing people for the rest of their life.
How much would such a person expect to pay, out of their own pocket, for things like check ups, x rays, meds, counselling and so on?
I’ll put it this way:
At least 68,000 Americans die every single year due to not being able to afford healthcare.
We pay an extra $450 BILLION annually to enrich unnecessary middlemen and ALL of our politicians are being bribed (or primaried) to prevent Single Payer. You’ll hear people like Kamala and Warren talk about “access” to healthcare while they receive massive bribes from healthcare companies to pull support away from Single Payer and offer a “choice” or “access to health care”. Remember 2016 and 2020? The DNC pulled out all stops to prevent Single Payer. Remember when Bloomberg ran for office and claimed , “under my governorship, New York had less uninsured people than at any time in history” while failing to mention that he enacted steep penalties for being uninsured? That’s neoliberal gaslighting 101! Kamala loves to do it too! But yeah vote for her because she’s “one of the good guys” and certainly wasn’t one of the people that was tasked with preventing Bernie Sanders from winning the primary two cycles in a row, offering “Medicare for All who want it” so stacked with asterisks and legalese means-testing that probably like 50 people would qualify.
Edit: In my opinion, anyone who is paid to run for office and vote against Single Payer is a murderer guilty of (or at least partly responsible for) the slow, often-painful execution of these 68,000 American citizens per year.
I have student loans that I’d love forgiven but I don’t even mention that issue because true Single Payer (and Gaza obviously) are my moral lines in the sand that almost everyone in Congress except Rashida Tlaib has brazenly trampled.
https://www.sanders.senate.gov/wp-content/uploads/Fact-Sheet_Medicare-for-All-2023.pdf
In 2017, Harris was the first senator to co-sponsor Bernie Sanders’ bill, the Medicare for All Act of 2017. “Here, I’ll break some news,” she said that year at a town hall in Oakland, California. “I intend to co-sponsor the Medicare-for-all bill, because it’s just the right thing to do.” 15 other Democrats eventually joined her.
That bill, if enacted, would have abolished private health insurance for all age groups (including Medicare beneficiaries) and replaced it with a government-run single-payer system to benefit “every individual who is a resident of the United States,” including undocumented immigrants.
https://www.forbes.com/sites/johngoodman/2024/08/13/why-health-policy-problems-rarely-get-solved/?
yeah too neolib, better to stick with Trump, he’ll really get the single payer socialist healthcare going with the fascism and stuff, cause he really cares about people. /s
You’re the one telling people not to vote for her.
That’s neoliberal gaslighting 101! Kamala loves to do it too! But yeah vote for her because she’s “one of the good guys” and certainly wasn’t…
Until Nov 2024 she is the only option. She’s not perfect but now is not the time to seek a perfect Bernie. Political realities matter. Criticism is fine but anyone saying “do you really want to vote for her” is either a Russian mouthpiece or very clueless.
I read something from last year that said about half a million Americans go into bankruptcy due to medical debt each year.
That’s it, that’s what happens. You lose everything and you start over, if you’re healthy enough.
Protect your NHS.
The real truth of what happens is substantially more complicated due to America being made of 50 states. The medical debt numbers are highly debatable (Related Snopes) and do not account for Regional differences. In some states such as New York there are catchalls/emergency funding so that usually anyone making below low six figures can get their bills paid. Other states make collections difficult such as New Jersey not allowing reporting to credit agencies, making ignoring a debt kind of a non-issue. Then there are states such as Florida that require the barest of insurance to keep rates low and provide no patient protections, so when an accident does occur out of pocket costs can be huge as your insurance covers nothing. In all these events the Hospital assumes that big pocket insurance is paying first so they break out the expensive menu, when they realize they can’t get blood from a stone they are grateful if you cover their wholesale price.
about half a million Americans go into bankruptcy due to medical debt each year.
That’s a huuuge shame for a country that calls itself civilized and developed etc.
Luckily there doesn’t seem to be any large desire in the general population to move away from the NHS. Even the most conservative people I know support it (and I live in a pretty conservative area).
Some of our political parties however seem to pretend like they support it while quietly trying to undermine it. Let’s see what Labour do in the coming years.
Undermining it is how conservative parties will get rid of it. Keep decreasing funding. Do more with less. Quality drops. Wealthier people start moving to health insurance. Jobs start offering health insurance. Funding decreases further. People start to wonder why it’s even needed.
Have those people actually lost everything or is it just some scheme to pay less?
Bankruptcy is an expensive and not-fun process. Basically, similar to what happens on death all creditors are carefully listed out and prioritized, assets beyond the bare minimum to live are liquidated to pay creditors what they can and of course the bankruptcy lawyers fees don’t help with the mountains of debt and costs. Certain debts cannot be discharged through bankruptcy so basically you trash your finances, mental health and credit for a shot at maybe being able to fix your finances with less debt payments
https://apnews.com/article/medical-debt-legislation-2a4f2fab7e2c58a68ac4541b8309c7aa
I’ll let you figure it out.
WILDLY depends. And it is never simple.
If I break an arm, and I go to the hospital, and there’s not much that’s done aside from a cast, and some PT at the end, I pay $0.
Now, what does that mean?
We have had our insurance for a long time, and as we pay our monthly premiums, a little money goes into an account called an FSA. This pays some of the co-pay, deductibles, etc. in the background for us.
What happens if I get cancer and need to have some care for 7 years? Eventually that FSA runs out. Every insurance has a deductible that you pay before they start paying for everything. So we might have to pay $5k out of pocket annually and then insurance pays the rest.
What if I need to travel to another city to talk to a specialist? There might be airfare, hotels, food, etc. that we pay that is “part of the treatment” but not paid for by insurance.
What if I need medication? Might be $25 every trip to the pharmacy. Might be $300. Depends on the medication, how new it is, are there cheaper alternatives?
What if I get sick long enough where I lose my job? I might lose my insurance as well, and then have to apply for government assistance, that might make other medical bills different.
I assume you need to have health insurance? As in, you mention paying 0$ if you break your arm. But do you have to pay monthly premiums for it to be 0 at the hospital ?
And I have no idea but - presumably you would claim on the insurance for the broken arm, does that then impact your monthly premiums or coverage afterwards?
As part of our employment, our employer has negotiated that we pay $400 a month for my family to have insurance under these terms.
If I had a different employer, those terms could be wildly different. I would have no choice.
It is EXTREMELY complicated, and extremely different for everyone in the country, and depends heavily on how your employer sets up the benefits. This is a major benefit for large corporations, and a major burden for smaller businesses.
If you buy insurance through the private market, it is usually far more expensive, but often subsidized by the government, since you often only buy from the market if you are unemployed or low income.
you often only buy from the market if you are unemployed or low income.
Don’t forget self employed or at a workplace with workplace insurance so bad it’s actually cheaper to go through private (so basically low income)
I don’t contribute to the FSA, that’s an automatic part of my health insurance.
Some people contribute separately to an FSA or an HSA depending on their insurance, but that’s not an option for my situation.
If you have insurance through your employer, then no the insurance company can’t raise your rates. And part of the reason for the Affordable Care Act (ACA, sometimes called Obamacare) was to make it so people who are getting the insurance themselves also can’t have their rates raised or get turned down for insurance because they have pre-existing conditions. However insurance companies can raise everyone’s rates when the insurance is up for renewal each year.
Most insurance plans have several different costs: 1. The monthly premium you pay to have insurance coverage. Some employers pay this themselves, otherwise it gets taken out of every pay check.
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Co-pay: Usually a set amount ($30, for example) you pay to see a doctor for office appointments that aren’t an annual check-up*. So say I get an ear infection and see my primary doctor to get it treated, I’d pay the co-pay for that visit. Sometimes things like x-rays, blood work, CTs can be a set amount, other times it’s something like insurance will cover 65% of the cost. For some plans, co-pays are included when figuring out if you’ve reached your deductible.
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Deductible: The amount you have to pay before “co-insurance” kicks in. Co-insurance being the percent of your bill insurance will pay (for us it’s 75% after we pay $3500 in a calendar year).
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Out of pocket max: When you’ve spent this amount in a calendar year after that insurance covers 100%. Often plans have both individual and family maximums, with the family amount being higher.
Usually the more you pay in monthly premiums, the lower your deductible and out of pocket maximums will be. So each year people have to try and decide what they think their health bills will be next year when picking their plan (you can’t change plans mid-year unless something happens like changing job, getting married/divorced, having a kid). If you’re pretty healthy you might pick a lower monthly plan with higher out of pocket amounts because you don’t expect to have to pay much out of pocket. If you’re someone with a chronic condition or you’re expecting to need surgery or a costly treatment you might go with the higher monthly plan so you don’t have as high of out of pocket amounts.
For example, my spouse had to go to the ER a few years ago for what turned out to be a collapsed lung. They didn’t have to stay in the hospital overnight. I forget the total bill (or I’ve just blocked it from my memory), but our part ended up being about $5,000. Insurance kicked in after the bill got to $3,500, and they covered 75% of everything that was over $3,500. The most we would’ve paid was $6,000 (the individual out of pocket max), however we would still have to pay bills for myself and our kid up to $12,000 (family out of pocket max).
*Another part of the ACA was to make annual preventative screenings (like annual physical, mammogram for women over a certain age, prostate screening for men, etc) free.
And not to forget that sometimes cheaper but equally effective drugs aren’t available under the insurance plan. Like auto insurance and their prefered shops and stuff.
Oh plus that FSA must run out really quick when private hospitals charge bug money for an aspirin because they trying to gouge the insurance company who probably doesn’t even care for other twisted reasons.
Not always. There’s still a max annual out of pocket expense, which is what is covered by the FSA. A single event, or an illness or accident that only requires care for a single year or two, regardless of how expensive, would not deplete the FSA. It’s only a chronic condition that requires hitting the max out of pocket for multiple consecutive years that would start to deplete that buffer.
That’s all assuming that I can continue to work, and don’t have any other non-medical expenses during the recovery.
“However, I have an American friend who is quick to point out that apparently nobody actually pays those bills. They’re just some elaborate dance between insurance companies and hospitals. If you don’t have insurance, the cost is lower or removed entirely. Supposedly.”
Partial Truth.
Healthcare providers have negotiated prices for services. These prices are negotiated per insurer.
Blue Cross and Blue shield will pay them X dollars for Deep Sleep anesthesia. United Healthe care will pay them a different amount. Medicare will pay them yet a different amount. Bob’s backyard healthcare will pay more because they don’t have buying power.
If you walk in without coverage, the provider “can” charge you a reduced rate. They are not required to. They do NOT universally offer that.
If you get the procedure done anyway, agree to pay and cannot pay your health bill, the provider “can” just let you off the hook or reduce your rate. They do NOT usually do that. That’s the exception.
If you go to a provider that accepts your insurance (they all do not) and book a procedure, the provider has to get the procedure covered by the insurer. If the insurer decides not to cover the procedure, you can call the provider and try to create a grievance. The back-and-forth is maddening.
My local doctor said I needed a colonoscopy (it’s just that time, no emergent issues)
My insurer authorized the procedure but not the anesthesia.
The office offered to pay out of pocket for the anesthesia ($1200), but I declined because I couldn’t afford it. They also offered to set up payments if I paid 50% upfront, but I declined because that didn’t help me. I can’t take on another $100 / month for 12 months.
I spoke with the GI doctor, a second GI doctor, and my General Practitioner. They all said that people here really don’t get the procedure without anesthesia, and it was a bad idea for both the doctor performing the procedure and for me.
I contacted the insurer, but they refused. Another GI doctor contacted the insurer, but they refused.
My insurer decided in January that they will not cover anesthesia for a colonoscopy unless someone can prove you’re frail enough it might kill you.
We have federal laws that mandate insurers to cover the anesthesia for this procedure, but state-level insurers (hint: they’re all state now) don’t have to follow their rules.
So here I am, two years late for a colonoscopy, wondering if I have pre-cancer or cancer brewing down there, but can’t manage to pay for what is considered by all providers here a necessary part of the procedure.
It’s not great here.
You need to consider your health first and only. You get the anesthesia and then you either ignore the bills or pay a little bit what you can. Either way eventually you’ll be able to close it out by paying maybe half.
Alternatively, you can tell the doc to either give you the anesthesia for free or go with the insurance attitude and have the procedure without it and - should something go wrong because it is not what you are supposed to do - then you have yourself a juicy malpractice suit for them.
The investors who make money from this bullshit write our laws. That’s the problem. We allowed it to happen by having such dumb fucking morons for citizenry who vote for these monsters who then turn around and rape them. And then they vote for them again. Our people are mostly absolute morons who can’t think for themselves and so they follow the shiniest trinket they obey the loudest voice with the bleached smile and the most promises.
And yes, conservatives are to blame and yes, there are awful liberals as well but the simple truth is republicans need to fucking die. They are a deadly cancer to our society because all they do is ruin everything except their own pockets.
Doc will not provide anesthesia for free. The insurance company will not budge.
I’m not in a situation where I can just keep hopping over doctors while they all send me to collections, even though $600 is too much to swallow at the moment.
If I do end up with any form of GI cancer, a lawsuit against the insurer seems pretty reasonable.
The people here already spoke of the option of medical tourism, can’t you look up that ? A colonoscopy is not some advanced tech, any decent hospital in latin america will be able to do that. Since you earn US dollars, you could research about making a trip to Mexico (possibly the cheapest option, because it can be done by bus or car), Cuba (possibly the cheapest too, because of the conversion rate and short plane distance), Brazil, etc for the travel, lodging and procedure (and even a little tourism too if you have the time and will XD ).
I’m really sorry for your situation. I would personally just get it done, commit to paying them and then just stretch it out maybe a few bucks at a time. Your health is more important. But I do wish you the best of health.
I was on Medicaid for many years but I’m really lucky now my wife is in the teachers union and we have very decent insurance. But the entire system is a big stinking chaotic farce to which the terms “broken” and “mayhem” are even too light to apply.
But as long as our government is in the employ of the 1% nothing is gonna change. We seriously need to start stringing up some billionaires and take their money for everyone.
I work for one of the largest healthcare providers in the US. I pay $450/mo for health insurance. This is not including vision, dental, or money I set aside for FSA (a pre-tax savings account restricted for use for paying for healthcare) and for and HRA (similar to FSA, but intended for when you’re older, and our company partially matches our contributions). The FSA has been refusing to pay for legitimate doctor visits that insurance has sanctioned. I pay out of pocket for a lot of procedures that the insurance ducks, such as laser eye surgery, vasectomy or even for birth control pills prior to the vasectomy.
The laser eye surgery was ~$5,000 out of pocket, the vasectomy was ~$2,000.
I had a visit to the ER - I was driven by my partner to avoid ambulance costs, and with insurance, had to pay $450 only for the doctors to stay they couldn’t figure out what was wrong and I end back up there later that week for another $450.
I was in a car crash a few years ago and my medical costs (again, with insurance) came out to ~$250,000.
This is while making $85,000/yr working as a Senior IT Engineer, and paying $2,700/mo for rent.
Generally speaking, with insurance, we’re probably paying about twice as much for any given situation, but insurance itself is also expensive and likes to dodge paying for as much as possible.
Thanks for the info! For a comparison I’ll give you mine:
Switzerland has the worlds second most expensive healthcare system, also with private insurance providers. There are some differences to the US though. Having health insurance is mandatory and there are state contributions for people who couldn’t afford it otherwise. And we have a certain defined level of base insurance with defined coverage that the insurers all have to offer and that you can’t be denied for.
Anyway I pay $480/mo for mine, which has a few extras over the base, like sharing a room with only one instead of three people in a hospital stay. I haven’t used it much though, so I can’t tell you from experience what sort of co-pay I would be looking at, but I believe it’s capped. https://www.bag.admin.ch/bag/en/home/versicherungen/krankenversicherung/krankenversicherung-versicherte-mit-wohnsitz-in-der-schweiz/praemien-kostenbeteiligung.html
This is while making $85,000/yr working as a Senior IT Engineer, and paying $2,700/mo for rent.
Oh shit, I thought IT people in the US made more than here in Switzerland?! Or is that only in specific areas of California?
I live on the outskirts of Zürich and rent for our 3 room flat is $3’200/mo. However, I started on about $100’000/yr as a Junior Network Engineer directly after completing my master’s degree in Computer Science in 2021.
