I've been "risking it" since my last job in 2009. I've had remarkably good health so it hasn't been much of an issue.
Even when I had great insurance and used it with all the correct providers and plans and centers there was still always some issue that would lead to insane bills for every minor visit. I've known two separate people who had good health insurance and skilled well paying jobs and they still got completely wiped out by medical bills and eventually decided to eliminate the six figures of debt by sticking a 12 gauge barrel in their mouth.
It's not really "insurance" if you're getting screwed with massive bills anyway. Call it something else, whatever label you choose the system seems to have stopped working.
55k/year. The coverage is garbage. The phrase "50% covered after coinsurance" pops up everywhere. Only 3 primary care visits per year. Dental that only covers 50% of anything beyond a checkup.
I am in the same boat. Me and my wife had Kaiser Bronze for 750 a month. Recently my wife had to go to emergency and we were billed 6000ish because emergency room services are not 100 percent covered. It would have been more but our out of pocket Max was reached. This is northern Cal.
When we were in the ER I was too panicked to ask any questions regarding pricing for any recommended tests or if it was necessary. Later when we were billed I asked them to send an itemized bill. There was not much I could understand from the bill. We ended up setting up a monthly plan to pay the hospital bill.
I couldn't keep up with the payments in 2018. I lost my coverage in August and got lucky. I cant afford to go to the dentist even when I still had my insurance. I have a broken tooth, a cracked crown and probably 3 cavities.
Wow. In Germany you’d be paying 15% of your income for health insurance, and no more than 800$ per person if you make more than 5k a month (around that)
This might be a bit of a tangent, but I'll throw in my perspective as one of those who has been "risking it" for the last 4 months or so. (I won't go into why I'm risking it unless asked)
I think it's difficult for a lot of people to justify paying a lot for things that don't provide much of a tangible/measurable benefit. Ideally, insurance would cover a person if something catastrophic happens, but otherwise it's difficult for the human mind to believe it's not essentially setting money on fire when they pay for things that don't have an immediate return. This is probably true now more than ever given our culture of immediate gratification.
Someone might feel better about paying for insurance(aka health care) if they believed they were actually being taken care of today by the dollars being spent today. What I mean is that I know of almost nobody who has anything good to say about any aspect of the health care system; everyone seems to have to shop through several doctors to find one who knows what they're talking about, after having spent maybe 5 minutes with doctors a-piece before being sent home with a prescription for what the doctor concludes to be a textbook diagnosis. Many people complain that doctors don't listen to them, and I can attest to this myself having had doctors completely ignore my evidence that I have a specific genetic condition that can be traced to my grandfather who has the identical symptoms(as one example). A friend of mine with a chronic pain issue(I'm talking severe) regularly has to deal with doctors and healthcare staff not doing their jobs whether it's not refilling prescriptions when they said they would, not returning phone calls, failing to communicate with pharmaceutical firms, telephone ping pong caused by nobody knowing who has the authority to do what, nobody can tell you what the price for a treatment will be, etc. It's often chaos. And we're supposed to pay thousands a year for that shit?
People need to have faith in what they're putting their money towards. If someone doesn't have faith that the health care system actually cares for them, they're more likely to not pay for it out of spite and take the risk when they have to. Those with a lot of money and well established careers might have the time and resources to navigate the bullshit, but many people don't.
I know this has to do with health insurance, but I feel the same with auto insurance as well. It still feels like burning money. For example, I've been paying about $120/month for car insurance since I was 18, give or take. Never been in an accident. That's about $14k I've given to an insurance company for literally doing nothing.
Isn’t the only car insurance mandated the one that pays for others? I.e. it is not about you but about making sure that, if you damage someone else or their car, they will get paid disregarding of how much you have on your account.
I was hit by a driver 6 weeks ago. He and insurance company accepted 100% liability. My 2015 Audi was totalled due to multiple airbag deployments (though the vehicle is largely intact other than frame, so will be healthily recouped by the insurer on the parts market).
Despite this...
I got a settlement offer from my insurer (who, bear in mind, are going to subrogate this to the opposing side) of $5K less than KBB for the vehicle (which was bought a year old, and is now 3 years into a 5 year loan), and $3K short of my outstanding loan (don't even start me on gap insurance - I've never seen that pay out, there's always a loophole).
So the insurer's idea of indemnifying me, mitigating my risk is for a 0% fault accident, I:
1) lose my car, which was in excellent condition, and barely 4 years old;
2) lose 3 years of equity in a five year loan;
3) do not have a car;
4) still owe my bank ~$3,000;
5) need to come up with a down-payment and a new loan for a vehicle within 7 calendar days of their (pitiful) settlement offer.
All the while getting condescending remarks like:
"Gap insurance would have protected you" (not in my experience, and my credit union 'neither recommended nor required it based on the FMV at purchase', and the only reason there's a deficit is your woefully inadequate settlement offer)
"We're looking after you - remember we've been paying your medical bills so far" (how ominous, "so far") - and I've been paying for a policy which included PIP for nearly a decade, so you'll forgive me for not lauding you fulfilling your contractual obligations _for which you have been compensated_.
To add insult to injury? They direct debited my premiums, including for the vehicle they totaled, and I had to explain this to a CSR. Who then said they'd take the amount they'd erroneously debited, and "apply it as a credit across the remaining 7 months of your policy on your other vehicle". No, thank you, I just want you to refund it.
I think more and more that the Medicare For All movement makes sense. If people want more, then they can buy additional insurance, but otherwise the basics are covered. I can also deal with long waits for elective treatment as long as I know that an accident or serious illness won't bankrupt me.
I've tried to understand the circumstances preventing socialized medicine in america. I understand there are arguments against socialized medicine, but they make no sense to me on their face (eg. the idea that long wait times would occur, when wait times for USA and wait times for other first world countries with socialized medicine isn't very differe. The idea that socialized medicine would cause less medicine research and advancements, when increasingly medicine advancements are coming from countries with socialized medicine- the US seems to be falling behind in this respect.)
Could someone explain to me this phenomenon? I struggle because I do not want to believe the easy, dehumanizing position that 'the people who do not believe what I believe are just too stupid to know I am right'.
Our government is busted. In many cases, it fails to function at all. Thousands of regulations, which are effectively laws, switch back and forth every time the president changes. Both parties blame the other and some independents blame both parties. We have become, as a society, incapable of forming and abiding to compromises. Our healthcare is a shit show, but it's not nearly as much of a shit show as our government, so we're scared of putting one in charge of the other.
In the formula “just do X”, the problem isn’t so much the “X”, it’s the “do”, for the reasons outlined by the GP comment.
In this particular case, the notion that Medicare works at all (let alone well) is a point that about half the country will not concede because it’s one of many a shibboleth that keeps the “sides” at each other’s throats.
"In this particular case, the notion that Medicare works at all (let alone well) is a point that about half the country will not concede because it’s one of many a shibboleth that keeps the “sides” at each other’s throats. "
One half will throw a fit no matter what gets done. It would be interesting if Trump suddenly announced support for single payer Medicare for all. Republicans would think it's the best thing ever and Democrats would suddenly be against it...
Way too much blind ideology in this country. Before I came here I thought the US is a pragmatic country that gets things done but now I see that leadership can't even agree on a shared perception of reality. When you talk to right wingers or left wingers you don't even recognize that they are in the same country.
> It would be interesting if Trump suddenly announced support for single payer Medicare for all. Republicans would think it's the best thing ever and Democrats would suddenly be against it...
I think you’ve got this wrong. I think that in most cases partisanship and hero worship is a lot stronger than support for specific policies. I think you’d find that people wouldn’t change their stated views on single-payer, they’d just reframe the situation so that they can continue to love/hate Trump and blame the other side for everything they don’t like.
Look at bump stocks. I know staunch Trump supporters who have bump stocks and strongly oppose almost any form of gun control. Does Trump’s bump stock ban make them like Trump a little less? Perhaps. But it certainly doesn’t change their political affiliation in any measurable way.
Same goes for those who oppose Trump. I’m sure they agree that the bump stock ban is nice, but do you think they’re suddenly “coming around” on Trump? I doubt it.
That's what I am saying. People keep supporting parties and not issues. If the Republicans make an 180 and support single payer their supporters will suddenly love single payer and Democrats will be skeptical.
Just look at deficits. A few years ago Obama's deficits were the number one concern. Now Trump has raised them even more and all concerns are forgotten.
Well, if you are a gun nut, your only options are to support Trump or support his opponents who want to restrict guns in a very serious way. Naturally, you still support Trump even after bump stock ban. This is perfectly rational. Nothing partisanship about it, IMO.
Supporting Trump even when he bans bump stocks when one would oppose Democrats doing the same, and believing Democrats will always be worse than Republicans on gun control, is the definition of partisanship.
The actual truth is both parties believe in gun control and both parties believe in the Second Amendment. One side just panders to gun owners and the NRA more than the other.
I'm just saying, the non-partisan choice would be to treat Trump or any Republican the same as any Democrat, based on their actions and not their affiliation.
As far as their options, it depends on what they want. If they want the complete repeal of all gun laws... no lawmaker is going to support that. Everything else is a matter of negotiation, though.
> Republicans would think it's the best thing ever and Democrats would suddenly be against it...
Any evidence of this? Because there is plenty of polling data to show the R camp switching positions based on who is in charge. Never seen it apply the other way.
I agree that the government is busted. But from what I understand, one of the two ruling parties is at least somewhat pro-socialized medicine. I do not understand what needs to be compromised about socialized medicine. I struggle with the idea that fear of the government is greater than the desire for universal medical coverage.
Eh, the two ruling parties have cleverly worked things out so that they never have to actually implement any of the policies they claim to support. They can always just blame the other party for making their policies impossible. Both parties benefit from this system.
Look at Obamacare. A lot of Democrats will say that this was a genuine attempt to move toward single-payer, a public option, etc. and that they simply had to make compromises to get what they got passed (a change that undoubtedly helps many people but does so with a regressive tax, and certainly doesn’t simplify anything).
It was a compromise. The only way they could get Joe Lieberman's crucial 60th vote was to kill the public option, which he strongly opposed (for what reason who knows).
they simply had to make compromises to get what they got passed
For much of that Congress, the Democrat caucus had complete control (with filibuster-proof control of the Senate); they didn't have to "compromise" with a single Republican, hence zero Republican votes.
Imagine if there were several powerful allied special interest groups that all made a bunch of money from healthcare staying expensive.
And they're not just trying to change your mind. They're also working to get the support of the electorate directly.
Now imagine some of those groups had absolutely superb PR. Literally making childhood cancer sufferers healthy again.
Now imagine, like every industry that wants government influence, they hire your friends into highly paid do-nothing jobs, donate generously when you raise money for your charitable foundation, and so on.
Now imagine they're a big employer. And they've got a whole bunch of jobs. Office jobs. Highly paid high-level jobs. Well paid mid-level jobs. Jobs that employ lots of minority groups.
Now imagine that the most efficient outcome would be to shut down all the insurance companies and nationalise all the hospitals, but you don't have the political capital to deliver that, it'd make a lot of people very nervous, and you're not even sure it'd be a moral thing to do anyway. So you'll probably have to settle for a middle ground that keeps a lot of the existing middlemen fat and happy.
Now imagine, even if your reform is a huge success and goes way better than you have any right to expect, people are still going to die in hospitals, and some people are going to say some of them are your fault.
Now imagine turning a blind eye to the problem has been working just fine for the last 20 years. It'd be so easy to just let sleeping dogs lie...
What makes single-payer healthcare, like Canada and the UK, a disaster? I'm from Canada and currently live in the US. I don't have many complaints about the canadian healthcare system. I got a suprise bill yesterday in the US healthcare system for routine bloodwork.
I'll second that. Due to a couple of significant illnesses growing up my family would have been bankrupted two times over if we lived in the US. Also, when one of my parents passed after a couples months of hospitalization, emergency room visits and an ambulance ride, they didn't owe a single loonie (Canadian dollar coin) for the care.
If it was the US, my bereaved parent would not only owe thousands but they would have to be on guard to verify the accuracy of each bill, negotiate with the provider and then setup a payment plan stretching into infinity.
The US healthcare system is another area where capitalism and the 'free market' is failing the consumer.
Frankly, when I hear see someone stridently decrying socialized medicine or single-payer healthcare I wonder if their tune would change after their first medically induced bankruptcy or not being able to afford medication that would keep them alive.
The NHS in the UK continues to be underfunded to the extent of what it's trying to provide. It takes about 7.5% of the UK's GDP and is continuing to rise. But as I point out it's underfunded to the extent that there are long multi-year waiting lists for things like hip replacement operations.
No surprise really, the word "socialism" has been used to attack any pro consumer / pro employee policies since the first red scare 100 years ago. Indeed up to the '70s, even civil rights was painted as "commie".
Compared to dying because treatment a private health insurer pays for would simply be denied, as other payers are prohibited.
Why would you want to make medicare supplemental coverage illegal, or forced to be completely separate, which is a characteristic of single-payer health care (as opposed to multiple payer universal health care coverage)?
As an Australian expat who's lived in all three situations (Australia with single-payer, USA with high level private insurance and Switzerland with government required and regulated), I much prefer single-payer.
Pure private like the US is just insane. It technically works but when you go in you have no idea what you're paying. Random service providers can bill you months later and there's not much you can do to stop it. Plus you have to be sure your provider is in-network and a bunch of other pointless nonsense. Finally, insurers can charge you whatever they want.
Switzerland's eliminates most of these problems. Everyone is required to have a "basic" level of cover, where "basic" is defined by the government to include basically everything medically necessary (in much more precise terms than mine). The maximum premium is fixed to be just a little over what's profitable for a well-run company but customers get to choose their deductible, up to a mandated maximum. All procedures and medications have fixed prices.
Thanks to the regulated premiums and procedure prices, you end up with everyone paying roughly the same amount for the same thing but to different people. Service providers have to send and process bills for 30 or 40 different insurers or hundreds of individual customers. Customers have to pay bills to their insurer and/or each service provider they visit.
This makes no sense to me. When everyone's paying the same amount for the same thing, it doesn't matter that there are different choices. By centralizing everything with one insurer, you can drastically reduce the paperwork for everyone. Providers send bills to one insurer. Customers pay bills to one insurer.
I think people are holding on to the hope that competition in the marketplace will control prices and bring them back to reasonable levels. I know I held on to that hope for a long time, but it's becoming clear that mere competition among insurance providers isn't a strong enough force. Medical prices are so high now that I think people are ready to consider drastic change.
I wouldn't expect competition among insurance companies to lower prices by very much. Insurance companies are already constrained by law as to how much profit they can make and there is only so much overhead you can remove.
In terms of competition, the real problem is the artificially low numbers of health care workers and facilities. The Drs are limited by the low number of medical schools, etc and the number of facilities are limited by requiring Certificates of Need, etc.
First remove these barriers to entry and require transparent pricing. Then... maybe competition would result in lower prices.
>...Seven of the top 10 most profitable hospitals in the United States are nonprofit facilities that each netted more than $150 million from caring for patients in 2013,
>...The study’s main purpose was to determine the characteristics of the nation’s most profitable hospitals. They found that facilities that were part of a system were more profitable because they were able to dominate their local market, which gives them greater clout in negotiating higher prices from private insurers. It also means consumers end up paying more if their health-care provider is out of network, Anderson said.
It's not clear that this will have the intended effect (since insurance always pays a heavily discounted price), but I think it's a step in the right direction.
People firmly believe competition will control prices.
But people also firmly believe they don't want price discrimination once they're on fixed incomes, and want government to take whatever steps are necessary to pay for that.
Healthcare costs for old people is most of the game, and those are regulated. No one is willing to challenge that.
Thus, we have a market that remains too regulated for presently-allowable-competition to make a difference.
The majority of Americans do support a single payer health plan (though there is a larger divide over Obamacare/Trumpcare for various partisan and non-partisan reasons). Instead of asking why the minority does not, you should probably ask why the government is not fulfilling the will of the people. I'm sure lobbyists from the multi billion dollar healthcare industry have something to do with it.
> circumstances preventing socialized medicine in america
Honestly I think it has a lot to do with the popularity of Fox News and its bias against any centrist/left policy. Also, keep in mind that the US was for decades fighting a war against communism which branded any socialist idea as evil and even going so far as to overthrow socialist governments. So, there are decades of propaganda that needs to be overcome.
In fact I think we have the millennials to thank as they grew up after the cold war and did not experience much of the propaganda that older generations did, so they are more open to policies like universal healthcare.
edit: quickly downvoted? If you disagree that's fine, but at least share what you think I've got wrong.
It's a bit ironic that those of us who grew up in actual communism understand the difference between government-planned healthcare and government-funded healthcare better than Americans. Even as the communist regime was being torn apart, I don't remember anyone wanting to take down the health system. It's still chronically underfunded and many people also purchase third-party health insurance in order to have access to better facilities, but the rates never reach even within an order of magnitude of USA's.
Yes, that's why I think the word 'propaganda' is fitting, because for a lot of older Americans the 'C' word was bad full stop and didn't merit any further discussion on what parts were bad and what parts may make some sense.
Why would we trust the government that just fed us the propaganda you're talking about to run a healthcare system in our interest?
> "In fact I think we have the millennials to thank as they grew up after the cold war and did not experience much of the propaganda that older generations did, so they are more open to policies like universal healthcare."
So they haven't seen the negative consequences of too much government power and thus are too quick to call for government solutions.
Great question, one that I'll flip on you as well. Why would we trust private companies to make a healthcare decision that might sacrifice profit for my health? Anticipating your answer that the marketplace solves that issue, but that doesn't exactly help the people that were adversely affected before the marketplace stepped in to solve the problem.
Answering your question, I put more trust in my government than private corporations because government ostensibly works for me, and citizens get to influence the makeup of our government. (Note, I'm not American, if I lived under the US democracy I might feel differently).
Because those private companies actually have some kind of incentive to keep you happy. If Company A doesn’t give you a good deal on your healthcare, Company B will, meaning Company A will lose out. It’s not a difficult concept.
You really trust the government to take care of you? How blind are you? The UK government wasted £12 billion of taxpayer money on an abandoned IT system.
> if Company A doesn’t give you a good deal on your healthcare
... well, too late, because your insurance was chosen and paid for by your employer (if you have one), and your clinical decisions were made for you. Oh, and if you try to change insurers you will be denied coverage for your "pre-existing condition".
The UK is far from perfect, but it does the basics well (antibiotics, contraceptives, emergency care, insulin). And there's zero risk of it making your state worse by bankrupting you.
And for those who want faster care, private insurance is still an option. It's just that: an option. Not something that people have to desperately scramble for.
That’s debatable, and I suppose relative. I’m still bitter about homeopathy and breast implants being given to patients on the NHS, which I am paying for through taxes.
> If Company A doesn’t give you a good deal on your healthcare, Company B will
Then when you need to make a claim you discover that Company B gave a good deal because in the fine print they added exclusions that result in your claim being rejected for some arbitrary reason. So yes, in the long term the competitive landscape works as word gets out that Company B's plan is garbage, but in the short term you are forced into personal bankruptcy or a worse health outcome.
> Why would we trust private companies to make a healthcare decision that might sacrifice profit for my health?
I would say that if there was no government involvement, then their profit would depend on providing quality healthcare service. Right now there are so many regulations and government controls that I can't even choose between multiple providers, pitting them against each other to offer better service.
I'd actually love to purchase private insurance from another country if that was an option. Let's use globalization for good to lower healthcare costs for all. Imagine consulting with a doctor in India over an iOS app and ordering drugs from Mexico...
All of that would only be possible by removing the government from the picture.
I've read about South & Central America's attempts to move towards the left and how after each attempt the US responded by spending millions to bring down legitimate democratic movements, or even worse installed devastating puppet right wing regimes with chilling affects that we still see today.
Regardless, my point was simply that the fear mongering against socialism bled into a fear of social welfare programs in general. If you took my comment as advocating for changing the US to socialism then I was unclear with my intent.
The real arguments only rarely get stated by politicians, and it's the reason we don't get other universal services, either. It's ideological. The economic efficiency, competency, or access arguments (government can't do anything right, it's wasteful, etc.) while they do get used (and are certainly believed to various degrees) aren't the core (cultural) reasons. They are a belief that:
- society should be dog eat dog, red and tooth and claw, and that the weak and sick should merely die. Not only is that not bad, it's desirable, as the weak and sick bring down the rest and having them disappear strengthens the society / species
- the world should be every-man-for-himself, that you should be on your own, and never expect anyone to help you outside of blood relatives, or if you're lucky, charity.
- that everything must be "earned," discounting the ideas that it's society itself and all of its trappings (trade rules, police, roads, availability of skilled workers trained with public money, etc.) that's allow said money to be earned in the first place. If you don't earn it you don't deserve it, regardless of what that means for you.
- that government should simply not be in the business of providing services, period. It should exist only as a nightwatchman state that protects from "force and fraud" when it applies to domestic policies (empire building and maintenance + policies to further theocracy and political chauvinism are a big divide over spending on the right)
- taxation is theft. If one "earns" money, one should be able to keep basically all of it (minus force+fraud taxes, though ancaps don't even want that one.)
Now, mind you, this doesn't actually reflect the will of people in the US (recent poll links: https://twitter.com/GunnelsWarren/status/1078510910317174785), but large parts of the right-wing establishment (many of which inhabit the Democratic party, not just the Republican one.) This includes large donors, corporations, and powerful think tanks.
One thing that has to be understood about the US, is that since its very founding, it has largely opposed redistribution (the General Welfare clause notwithstanding.) People should remember Madison:
"Landholders ought to have a share in the government, to support these invaluable interests, and to balance and check the other. They ought to be so constituted as to protect the minority of the opulent against the majority."
FYI, these kind of beliefs surface mainly when people engage in groupthink. Few individuals actually believe these things. The vast majority believe in helping each other, but they prefer to help voluntarily rather than forcefully. Helping forcefully is often seen as a loss of freedom. Individuals are often OK with that loss of freedom, even though it hurts.
I hope that perspective helps you in your future discussions. :-)
The people that own insurance companies would become less wealthy. The industries (the 6 companies that own the majority of the media industry https://www.morriscreative.com/6-corporations-control-90-of-... ) that rely on the revenue from all the insurance ads would suffer. There's a decent amount of jobs created by all the inefficiency. Overall it's a boost to the US economy, but at the cost of immense suffering from those who are most vulnerable.
No, inefficiency does not boost the economy. That spending would get allocated more efficiently otherwise which should actually be an overall boost to the economy.
By that logic you could just impose more busy work on the economy and it would get a boost. Let's say we mandate that every employee needs to have someone that follows them every day and boom, we have doubled up the number of jobs.
The money for these inefficiencies has to come from somewhere and that area will suffer.
I've tried to understand the circumstances preventing socialized medicine in america.
Just like Dorothy in The Wizard of Oz, the answer was staring you in the face this whole time: "socialized". You say that magic combination of "social" and any of "ist", "ism", "ized", and g-ddamn it, my Granddad didn't fight Mussolini in the war just to the let the socialists take over. I swear to $DEITY that I do not exaggerate that amongst many, the mere utterance is assumed to end the discussion.
"Well, that sounds a lot like socialism."
"Hmm, when you put it that way, I suppose we have nothing further to discuss."
It is literally the reason we didn't get socialized medicine when Truman suggested it in the 1940s, because the AMA stuck the S-word onto it at the start of the Cold War.
More annoying is that many of that ilk that I personally know would be hard-pressed to give an even basic, accurate definition of what socialism is (almost guaranteed it'll come out sounding like communism). It's as if someone many years ago said, "anything labelled 'socialism' is bad", and entire nation shrugged its shoulders and said, "okay" without ever looking up what they were on about.
> many of that ilk that I personally know would be hard-pressed to give an even basic, accurate definition of what socialism is (almost guaranteed it'll come out sounding like communism)
Yeah that might be because “The goal of socialism is communism.”
I honestly don’t get it either. Medicare takes care of some of the sickest and most complex patients—the elderly and those with ESRD—and manages to do it with an administrative overhead of 2%, compared to 17% for private insurers, and appears to be more efficient overall as well.[1] That’s a simple fact. Expanding Medicare to cover all Americans would substantially increase access and drive down costs for everyone, simply by adding younger and healthier individuals to the risk pool.
>...(eg. the idea that long wait times would occur, when wait times for USA and wait times for other first world countries with socialized medicine isn't very differe
Do you have a citation for that?
>...The idea that socialized medicine would cause less medicine research and advancements, when increasingly medicine advancements are coming from countries with socialized medicine-
Can you expand on that? What medical advancements are increasingly coming from countries with socialized medicine? The usual argument is simply that since the US doesn't have the price controls on drugs, that companies make a good deal of their profits from the US market.
I have the best insurance money can buy: a plane ticket to %anycountry (business class if needed)
Cost of emergency endoscopic shoulder surgery in a private for-profit hospital in France, when totally uninsured, and paying by credit card: 1900 Eur - including anesthesiologist fee, surgeon fee, facility fee, radiology, drugs, private room etc. So around $2200 total, done the same day, after being arranged by phone. It was in France just because I couldn't do that in Thailand (great hospitals and food, like France, but also great beaches during recovery)
Add plane ticket + out of pocket costs, divide by 12: about $200/month, 0 deductible - and $0 for the years I don't need anything.
Alternative options for the risk averse: purchase local insurance in %anycountry, all inclusive. Cost of health insurance in Europe for non residents: around $70 per month.
Just pay, and get treated in that country if you need it. Of course, you still need the plane ticket to fly there.
Still getting treated abroad is way way way cheaper than the alternatives.
Am I risking it? No. I'm making an educated decision.
Not travelling because of some pain? Painkillers + business class.
Not travelling because I'm unconscious or in a critical condition? Foreign insurance + air repatriation.
Some countries do sell that, even to non residents. Just get world coverage - it's a bit more than $70, but if something bad happen, you get med evac'ed to that country and treated there.
I'm exploring that option as I discover the wonder of medical tourism.
It's going to be rough on you if you're hit by a car in Chicago and you only have insurance in France. There's a world of difference between emergency endoscopic surgery and a trip to the ED (or ER, or A&E, or whatever your country calls it).
My spouse had a trip to the ER at one of the most expansive hospital in Spain: 700 Eur, so about $900, all inclusive (radiology + seeing 2 doctors + bandages + the various fees they sprinkle the bill with). Top service. No delay. No hassle. They even provide a translator to follow you around in the hospital and make sure you get a great experience and come back again.
Considering the medican income in Spain in around $1100, I understand why they like clients who can pay $900 no question asked.
We are now investigating getting coverage in some European or Asian country, where they sell insurance for non residents + world coverage + air repatriation (in case of a serious condition, like getting hit by a car in Chicago) at a decent price.
Best we've found so far is around $120 month, with something around a $1000 all-inclusive medevac fee (that gets you in a plane, with a doctor and everything needed)
> We are now investigating getting coverage in some European or Asian country, where they sell insurance for non residents + world coverage + air repatriation (in case of a serious condition, like getting hit by a car in Chicago) at a decent price.
Good luck. You'll still be required to be stabilized locally (with all the bills associated therewith), and cleared for air repatriation (by no means a guarantee).
I have seen ridiculousness (I work both in EMS, and in health insurance software development), like Heli EMS for serious car accidents to a trauma center being denied due to lack of pre-approval.
This might also provide a cautionary tale between 'what is promised, and what you get':
The other thing to note is that travel insurance is typically "Only for emergency care while traveling". You cannot use it to travel abroad for non-emergent surgery, nor for anything that might require LTC (long term care).
This is exactly the goal. I would never use medevac option for non emergency care.
My plan is local insurance for non resident for normal non emergency care (we pay for flights) + the option for repatriation in case of emergency surgery required abroad
This works fine for some issues but if you have an accident or something like cancer you are still f...ed. Also, surgeries have a certain risk of complication. Unless you have the time and money to fly back and forth during that period the US system will still happily bankrupt you if that happens.
Do you know what the actual costs associated with common accidents and hospital trips are? I got in a car accident and had 3 surgeries and a one week stay in the hospital.
The bill was over $120,000. And I was not in any condition to reject treatment or shop around, as you seem to do in your fantasy scenario.
My European point of view is that on many social issues America is primitive, not only healthcare. I didn't realize it before I lived there. Although some people would argue that it's a feature and not a bug, in the sense that Americans pay lower taxes and are free not to spend on healthcare if they don't want too.
> free not to spend on healthcare if they don't want too
At an individual level that is correct. But at the macro level it is wrong because when a person gets sick those costs are realized in the economy (eg. instead of cheap preventive care up front avoidance of early treatment means some percent will end up in much more expensive ER services that will cost more than if all those individuals saw a family physician).
What's the cost of a checkup at the doctor for a foreign tourist? (who I assume will get results also within 24h, and be informed about upfront costs if it's the law)
What's the medican income in Belgium? In the US?
I just don't understand how people in HN of all place complain about the costs of healthcare. I believe America has a better system, especially if you are in the hacker mindset (and with IT salaries!). Just fly to wherever, and get treated for a great price and quality.
And that's not specific to the US. I've heard Eastern Europe provides great dentistry services and that even Western Europeans fly there to get treated.
Medecine is a business just like any other. If your local shop tries to screw you, take your business elsewhere
Read the article, family situation and not profession related. The amount of narcism you seem to have is astonishing. I'm not sure if you are very young or just don't know many people outside IT.
I'm happy that my non IT-friends are also able to afford healthcare when it goes wrong. Not everyone does IT and only cares about their own situation.
You mention that the wages are a lot more, but here we don't need a scholarship to send your children to a good school. I'm wondering where your children will go to school if you travel around everywhere.
Ps. You need to be a Belgian to get the government to repay you. So you can't get it at the same price of us. So, that's another place where your "logic" fails.
What if your mother, brother and dad get sick within the year and they "don't do IT". Here the OCMW will help you. They won't help other nationalities.
Ps 2. I hate to categorize my "non IT friends", for me everyone is the same. I'm not handy and someone else can't work with a computer. Tomayto, tomahto
The entire article is about payable health care and the unpayable US health insurance.
We have a social system for healthcare for Belgians. You are not Belgian.
If you can travel to here and pay the additional cost, you are not a discussed group of people in the article.
Coming to here won't solve the problems for the people that can't afford US health insurance, which is what the article is writing about.
Your argument doesn't make any sense.
You don't grasp the concept of a affordable health insurance, where everyone can afford it, everyone is insured and only a small percentage needs it. Thanks to the government.
Edit:
Old comment adjusted, summarized: Mentioned travelling abroad and going to eg. India for everything is delusional. What about family, does your wife come along, what if you need to stay for 9 months therapy, ... Many variables haven't been taken into account.
That is assuming you have the choice. Many people simply can't afford to "take their business elsewhere". The American system may be great if you have the money - but a society is measured by how it treats its weakest members, not its strongest.
Because if you are not earning a whole lot and risk getting hit with a $100k hospital bill, it just make no sense whatsoever to just take the week off (or even quit!) and get treated abroad using your credit card.
Yes, medicine is a business, an industry, and obeys the same rules as other businesses.
But the goods it produces, "healthcare", are not like other goods. Demand is infinite, supply is scarce, and on a national level it makes sense to make sure it is distributed on a needs basis instead of a can-afford basis, because that leads to a healthier and more productive population, which is good for everyone.
> it makes sense to make sure it is distributed on a needs basis
"to everyone according to their needs" - that reminds me of some political movement!
Joke aside, I just disagree. It is not the "FYGM" you said. It is reasoning about the problem. Some countries have higher costs. Some have lower cost. Specialization of labor is wonderful - everyone gets richer, even if a country has a net advantage in productivity in all sectors. That's economic 101.
There is no reason for healthcare supply to be scare. It takes money. Instead of spending thousands of dollars in the US (or your Euros in Belgium), spend them in another country where it cost less.
It will also create incentive to build more healthcare supply there -- good for the residents of this country, and good for you too.
If the best option for healthcare in a country is for the citizens to leave the country, then that country is a complete failure. Healthcare isn't a luxury, it's a basic necessity for making sure your workforce is competitive, along with education.
And the results of this failure are visible in statistics, in the US the average life expectancy is dropping, unlike in other first-world countries. That's bad for the US economy as a whole, which in turn is bad for you as an individual, which is why you should care.
Also, healthcare is not just large interventions and procedures where travel cost can be offset by the ridiculous treatment costs in the US compared to another country, but the most important part of a healthcare system is the regular checkups and just having access to someone to look at you and talk to you, and make sure you can prevent larger problems in the future. Medical tourism can't supply that.
The point of the article was that salary is no longer an indicator of healthcare availability.
> Medecine (sic) is a business just like any other.
This is the ideology that functions as the crux of the matter. In the US, medicine is a business from which people involved should earn profit. Healthcare (and health, by extension) is not a right. In other places, I suspect it's the opposite. In a herd you can either strengthen your weak, or let them die off. Either way, the theory is that your herd will get stronger. The US has implicitly chosen the latter of the choices.
> If your local shop tries to screw you, take your business elsewhere.
It's not that simple. Everyone gets sick. Not everyone needs an iPhone XR or a brand new pair of Nikes. You can get by with a flip phone and a pair of brand x sneakers. Freedom of choice is great for goods and certain services. Healthcare isn't one of those services where "taking your business elsewhere" is any good, mostly because of the pricing collusion between the providers.
> The point of the article was that salary is no longer an indicator of healthcare availability.
And this is why I comment. This is wrong! You should not have to stretch on healthcare if you know how to spend your money.
Get treated abroad. It's as simple as that.
EDIT: You may lose your job. It's a consequence of life. You will still have saved a bunch of money when taking into count the savings on healthcare and the lower cost of living abroad
>And this is why I comment. This is wrong! You should not have to stretch on healthcare if you know how to spend your money.
> Get treated abroad. It's as simple as that.
> EDIT: You may lose your job. It's a consequence of life. You will still have saved a bunch of money when taking into count the savings on healthcare and the lower cost of living abroad
It isn't a matter of managing your money properly. There will still be people who are disadvantaged despite making what everyone else would see as the right choices. They can even be in a position where they are at a disadvantage while being fully employed. You can blame it on the structure of the economy and society, or just blame it on bad luck.
Some of these disadvantaged people are covered by existing welfare programs (e.g. Medicaid), but a lot of them aren't.
Insisting that having healthcare is only a matter of financial literacy is naive and disregards reality.
I am Belgian and I lived in the US for about 8 years.
Taking everything into account, taxes are not that much lower in the US (ignoring sales tax or VAT).
While I was working for a multinational, I enjoyed excellent health insurance (including dental). Still, filling a cavity in Belgium without insurance was cheaper than in the US with insurance.
"Keith and Diana Buchanan of North Carolina gave up their expensive health insurance this year, and bought a Bowflex exercise machine. Keith said he got into the best shape of his life: “A lot of it is a result of knowing that we’re going to have to take care of our own health a little better,” he said." Unfortunately, being in shape doesn't prevent so many health conditions.
The problem I see is that even if ACA was "working as intended," it would still be an incomplete solution.
We buy off our state marketplace, but can only afford bronze tier plans with the subsidy. All plans are the same at low tiers, and all make you pay the deductible before the insurance company pays a dime (not counting "negotiated discounts," which are completely invisible until after the bill is generated)
That means we're not really signing up to be able to go the doctor, but to not go bankrupt in case of major illness. We buy insurance only to cap our risk at the annual out-of-pocket max. That we get a "free" physical is just a consolation prize.
I think a lot of people don't see it that way. As others said, most people see it as money wasted if they don't get sick. And that's a problem.
I don't blame the ACA for our issues in the USA, I blame everyone in the government who worked tirelessly to ensure insurance companies can continue to tax our doctor visits for shareholder returns.
We need Medicare For All. No one should have to skip going to the doctor because the insurance requires $6k-$8k of blood money before they start performing their function and paying for healthcare, or even let us pay "just" a co-pay.
If I have to endure another moment of these borderline abusive, "nasty voice", over estrogenic commentators on Bloomberg . . . somebody please point me to an app that shuts down these auto play videos
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[ 5.3 ms ] story [ 187 ms ] threadEven when I had great insurance and used it with all the correct providers and plans and centers there was still always some issue that would lead to insane bills for every minor visit. I've known two separate people who had good health insurance and skilled well paying jobs and they still got completely wiped out by medical bills and eventually decided to eliminate the six figures of debt by sticking a 12 gauge barrel in their mouth.
It's not really "insurance" if you're getting screwed with massive bills anyway. Call it something else, whatever label you choose the system seems to have stopped working.
When we were in the ER I was too panicked to ask any questions regarding pricing for any recommended tests or if it was necessary. Later when we were billed I asked them to send an itemized bill. There was not much I could understand from the bill. We ended up setting up a monthly plan to pay the hospital bill.
I think it's difficult for a lot of people to justify paying a lot for things that don't provide much of a tangible/measurable benefit. Ideally, insurance would cover a person if something catastrophic happens, but otherwise it's difficult for the human mind to believe it's not essentially setting money on fire when they pay for things that don't have an immediate return. This is probably true now more than ever given our culture of immediate gratification.
Someone might feel better about paying for insurance(aka health care) if they believed they were actually being taken care of today by the dollars being spent today. What I mean is that I know of almost nobody who has anything good to say about any aspect of the health care system; everyone seems to have to shop through several doctors to find one who knows what they're talking about, after having spent maybe 5 minutes with doctors a-piece before being sent home with a prescription for what the doctor concludes to be a textbook diagnosis. Many people complain that doctors don't listen to them, and I can attest to this myself having had doctors completely ignore my evidence that I have a specific genetic condition that can be traced to my grandfather who has the identical symptoms(as one example). A friend of mine with a chronic pain issue(I'm talking severe) regularly has to deal with doctors and healthcare staff not doing their jobs whether it's not refilling prescriptions when they said they would, not returning phone calls, failing to communicate with pharmaceutical firms, telephone ping pong caused by nobody knowing who has the authority to do what, nobody can tell you what the price for a treatment will be, etc. It's often chaos. And we're supposed to pay thousands a year for that shit?
People need to have faith in what they're putting their money towards. If someone doesn't have faith that the health care system actually cares for them, they're more likely to not pay for it out of spite and take the risk when they have to. Those with a lot of money and well established careers might have the time and resources to navigate the bullshit, but many people don't.
I was hit by a driver 6 weeks ago. He and insurance company accepted 100% liability. My 2015 Audi was totalled due to multiple airbag deployments (though the vehicle is largely intact other than frame, so will be healthily recouped by the insurer on the parts market).
Despite this...
I got a settlement offer from my insurer (who, bear in mind, are going to subrogate this to the opposing side) of $5K less than KBB for the vehicle (which was bought a year old, and is now 3 years into a 5 year loan), and $3K short of my outstanding loan (don't even start me on gap insurance - I've never seen that pay out, there's always a loophole).
So the insurer's idea of indemnifying me, mitigating my risk is for a 0% fault accident, I:
1) lose my car, which was in excellent condition, and barely 4 years old;
2) lose 3 years of equity in a five year loan;
3) do not have a car;
4) still owe my bank ~$3,000;
5) need to come up with a down-payment and a new loan for a vehicle within 7 calendar days of their (pitiful) settlement offer.
All the while getting condescending remarks like:
"Gap insurance would have protected you" (not in my experience, and my credit union 'neither recommended nor required it based on the FMV at purchase', and the only reason there's a deficit is your woefully inadequate settlement offer)
"We're looking after you - remember we've been paying your medical bills so far" (how ominous, "so far") - and I've been paying for a policy which included PIP for nearly a decade, so you'll forgive me for not lauding you fulfilling your contractual obligations _for which you have been compensated_.
To add insult to injury? They direct debited my premiums, including for the vehicle they totaled, and I had to explain this to a CSR. Who then said they'd take the amount they'd erroneously debited, and "apply it as a credit across the remaining 7 months of your policy on your other vehicle". No, thank you, I just want you to refund it.
Could someone explain to me this phenomenon? I struggle because I do not want to believe the easy, dehumanizing position that 'the people who do not believe what I believe are just too stupid to know I am right'.
In this particular case, the notion that Medicare works at all (let alone well) is a point that about half the country will not concede because it’s one of many a shibboleth that keeps the “sides” at each other’s throats.
One half will throw a fit no matter what gets done. It would be interesting if Trump suddenly announced support for single payer Medicare for all. Republicans would think it's the best thing ever and Democrats would suddenly be against it...
Way too much blind ideology in this country. Before I came here I thought the US is a pragmatic country that gets things done but now I see that leadership can't even agree on a shared perception of reality. When you talk to right wingers or left wingers you don't even recognize that they are in the same country.
I think you’ve got this wrong. I think that in most cases partisanship and hero worship is a lot stronger than support for specific policies. I think you’d find that people wouldn’t change their stated views on single-payer, they’d just reframe the situation so that they can continue to love/hate Trump and blame the other side for everything they don’t like.
Look at bump stocks. I know staunch Trump supporters who have bump stocks and strongly oppose almost any form of gun control. Does Trump’s bump stock ban make them like Trump a little less? Perhaps. But it certainly doesn’t change their political affiliation in any measurable way.
Same goes for those who oppose Trump. I’m sure they agree that the bump stock ban is nice, but do you think they’re suddenly “coming around” on Trump? I doubt it.
Just look at deficits. A few years ago Obama's deficits were the number one concern. Now Trump has raised them even more and all concerns are forgotten.
The actual truth is both parties believe in gun control and both parties believe in the Second Amendment. One side just panders to gun owners and the NRA more than the other.
And, tbh, democrats do not hold NRA in high regard, so thinking that they always be worse on gun control sounds like a reasonable assumption to me.
I mean, I get your point, but guns does not illustrate it well.
As far as their options, it depends on what they want. If they want the complete repeal of all gun laws... no lawmaker is going to support that. Everything else is a matter of negotiation, though.
Is that accurate? Sounds more like NRA propaganda to me to keep people in line.
Any evidence of this? Because there is plenty of polling data to show the R camp switching positions based on who is in charge. Never seen it apply the other way.
https://www.bostonglobe.com/news/nation/2017/10/25/republica...
Look at Obamacare. A lot of Democrats will say that this was a genuine attempt to move toward single-payer, a public option, etc. and that they simply had to make compromises to get what they got passed (a change that undoubtedly helps many people but does so with a regressive tax, and certainly doesn’t simplify anything).
And they're not just trying to change your mind. They're also working to get the support of the electorate directly.
Now imagine some of those groups had absolutely superb PR. Literally making childhood cancer sufferers healthy again.
Now imagine, like every industry that wants government influence, they hire your friends into highly paid do-nothing jobs, donate generously when you raise money for your charitable foundation, and so on.
Now imagine they're a big employer. And they've got a whole bunch of jobs. Office jobs. Highly paid high-level jobs. Well paid mid-level jobs. Jobs that employ lots of minority groups.
Now imagine that the most efficient outcome would be to shut down all the insurance companies and nationalise all the hospitals, but you don't have the political capital to deliver that, it'd make a lot of people very nervous, and you're not even sure it'd be a moral thing to do anyway. So you'll probably have to settle for a middle ground that keeps a lot of the existing middlemen fat and happy.
Now imagine, even if your reform is a huge success and goes way better than you have any right to expect, people are still going to die in hospitals, and some people are going to say some of them are your fault.
Now imagine turning a blind eye to the problem has been working just fine for the last 20 years. It'd be so easy to just let sleeping dogs lie...
If you mean government required and subsidized, like the systems of France and Germany, which have great healthcare systems, that sounds wonderful.
If you mean single-payer healthcare, like Canada and the UK, screw that disaster.
If it was the US, my bereaved parent would not only owe thousands but they would have to be on guard to verify the accuracy of each bill, negotiate with the provider and then setup a payment plan stretching into infinity.
The US healthcare system is another area where capitalism and the 'free market' is failing the consumer.
Frankly, when I hear see someone stridently decrying socialized medicine or single-payer healthcare I wonder if their tune would change after their first medically induced bankruptcy or not being able to afford medication that would keep them alive.
Why would you want to make medicare supplemental coverage illegal, or forced to be completely separate, which is a characteristic of single-payer health care (as opposed to multiple payer universal health care coverage)?
Or maybe you mean the disaster of there not being upwards of 40,000 deaths a year due to not being able to receive basic health care.
...
Oh wait that is all problems they don't have in Canada and the UK but we do have in America.
Pure private like the US is just insane. It technically works but when you go in you have no idea what you're paying. Random service providers can bill you months later and there's not much you can do to stop it. Plus you have to be sure your provider is in-network and a bunch of other pointless nonsense. Finally, insurers can charge you whatever they want.
Switzerland's eliminates most of these problems. Everyone is required to have a "basic" level of cover, where "basic" is defined by the government to include basically everything medically necessary (in much more precise terms than mine). The maximum premium is fixed to be just a little over what's profitable for a well-run company but customers get to choose their deductible, up to a mandated maximum. All procedures and medications have fixed prices.
Thanks to the regulated premiums and procedure prices, you end up with everyone paying roughly the same amount for the same thing but to different people. Service providers have to send and process bills for 30 or 40 different insurers or hundreds of individual customers. Customers have to pay bills to their insurer and/or each service provider they visit.
This makes no sense to me. When everyone's paying the same amount for the same thing, it doesn't matter that there are different choices. By centralizing everything with one insurer, you can drastically reduce the paperwork for everyone. Providers send bills to one insurer. Customers pay bills to one insurer.
In terms of competition, the real problem is the artificially low numbers of health care workers and facilities. The Drs are limited by the low number of medical schools, etc and the number of facilities are limited by requiring Certificates of Need, etc.
First remove these barriers to entry and require transparent pricing. Then... maybe competition would result in lower prices.
>...Seven of the top 10 most profitable hospitals in the United States are nonprofit facilities that each netted more than $150 million from caring for patients in 2013,
>...The study’s main purpose was to determine the characteristics of the nation’s most profitable hospitals. They found that facilities that were part of a system were more profitable because they were able to dominate their local market, which gives them greater clout in negotiating higher prices from private insurers. It also means consumers end up paying more if their health-care provider is out of network, Anderson said.
https://www.washingtonpost.com/news/to-your-health/wp/2016/0...
Also:
>...Nonprofit hospitals have higher profit margins than most for-profit hospitals after accounting for their tax obligations.
http://thehealthcareblog.com/blog/2017/04/25/the-fairy-tale-...
How does anything about the way medical care is administered in the US work in the context of the mythical "free market"?
https://www.healthleadersmedia.com/finance/put-chargemaster-...
It's not clear that this will have the intended effect (since insurance always pays a heavily discounted price), but I think it's a step in the right direction.
But people also firmly believe they don't want price discrimination once they're on fixed incomes, and want government to take whatever steps are necessary to pay for that.
Healthcare costs for old people is most of the game, and those are regulated. No one is willing to challenge that.
Thus, we have a market that remains too regulated for presently-allowable-competition to make a difference.
Honestly I think it has a lot to do with the popularity of Fox News and its bias against any centrist/left policy. Also, keep in mind that the US was for decades fighting a war against communism which branded any socialist idea as evil and even going so far as to overthrow socialist governments. So, there are decades of propaganda that needs to be overcome.
In fact I think we have the millennials to thank as they grew up after the cold war and did not experience much of the propaganda that older generations did, so they are more open to policies like universal healthcare.
edit: quickly downvoted? If you disagree that's fine, but at least share what you think I've got wrong.
> "In fact I think we have the millennials to thank as they grew up after the cold war and did not experience much of the propaganda that older generations did, so they are more open to policies like universal healthcare."
So they haven't seen the negative consequences of too much government power and thus are too quick to call for government solutions.
Answering your question, I put more trust in my government than private corporations because government ostensibly works for me, and citizens get to influence the makeup of our government. (Note, I'm not American, if I lived under the US democracy I might feel differently).
You really trust the government to take care of you? How blind are you? The UK government wasted £12 billion of taxpayer money on an abandoned IT system.
... well, too late, because your insurance was chosen and paid for by your employer (if you have one), and your clinical decisions were made for you. Oh, and if you try to change insurers you will be denied coverage for your "pre-existing condition".
The UK is far from perfect, but it does the basics well (antibiotics, contraceptives, emergency care, insulin). And there's zero risk of it making your state worse by bankrupting you.
And for those who want faster care, private insurance is still an option. It's just that: an option. Not something that people have to desperately scramble for.
Then when you need to make a claim you discover that Company B gave a good deal because in the fine print they added exclusions that result in your claim being rejected for some arbitrary reason. So yes, in the long term the competitive landscape works as word gets out that Company B's plan is garbage, but in the short term you are forced into personal bankruptcy or a worse health outcome.
[0]: https://yourlogicalfallacyis.com/special-pleading
I would say that if there was no government involvement, then their profit would depend on providing quality healthcare service. Right now there are so many regulations and government controls that I can't even choose between multiple providers, pitting them against each other to offer better service.
I'd actually love to purchase private insurance from another country if that was an option. Let's use globalization for good to lower healthcare costs for all. Imagine consulting with a doctor in India over an iOS app and ordering drugs from Mexico...
All of that would only be possible by removing the government from the picture.
An orange is not necessarily orange.
A government with social programs is not the definition of Socialism.
Socialism is two things:
- No profit
- No private property
The consequence in 100% of historic attempts has been immense suffering. More than even the Nazis could deal out.
It’s not propaganda. Open a history book.
Regards,
A left-wing liberal who’s ancestors suffered first under Nazi occupation, and then under Communism — which is the goal of Socialism.
I've read about South & Central America's attempts to move towards the left and how after each attempt the US responded by spending millions to bring down legitimate democratic movements, or even worse installed devastating puppet right wing regimes with chilling affects that we still see today.
Regardless, my point was simply that the fear mongering against socialism bled into a fear of social welfare programs in general. If you took my comment as advocating for changing the US to socialism then I was unclear with my intent.
- society should be dog eat dog, red and tooth and claw, and that the weak and sick should merely die. Not only is that not bad, it's desirable, as the weak and sick bring down the rest and having them disappear strengthens the society / species
- the world should be every-man-for-himself, that you should be on your own, and never expect anyone to help you outside of blood relatives, or if you're lucky, charity.
- that everything must be "earned," discounting the ideas that it's society itself and all of its trappings (trade rules, police, roads, availability of skilled workers trained with public money, etc.) that's allow said money to be earned in the first place. If you don't earn it you don't deserve it, regardless of what that means for you.
- that government should simply not be in the business of providing services, period. It should exist only as a nightwatchman state that protects from "force and fraud" when it applies to domestic policies (empire building and maintenance + policies to further theocracy and political chauvinism are a big divide over spending on the right)
- taxation is theft. If one "earns" money, one should be able to keep basically all of it (minus force+fraud taxes, though ancaps don't even want that one.)
Now, mind you, this doesn't actually reflect the will of people in the US (recent poll links: https://twitter.com/GunnelsWarren/status/1078510910317174785), but large parts of the right-wing establishment (many of which inhabit the Democratic party, not just the Republican one.) This includes large donors, corporations, and powerful think tanks.
One thing that has to be understood about the US, is that since its very founding, it has largely opposed redistribution (the General Welfare clause notwithstanding.) People should remember Madison:
"Landholders ought to have a share in the government, to support these invaluable interests, and to balance and check the other. They ought to be so constituted as to protect the minority of the opulent against the majority."
I hope that perspective helps you in your future discussions. :-)
The money for these inefficiencies has to come from somewhere and that area will suffer.
Just like Dorothy in The Wizard of Oz, the answer was staring you in the face this whole time: "socialized". You say that magic combination of "social" and any of "ist", "ism", "ized", and g-ddamn it, my Granddad didn't fight Mussolini in the war just to the let the socialists take over. I swear to $DEITY that I do not exaggerate that amongst many, the mere utterance is assumed to end the discussion.
"Well, that sounds a lot like socialism."
"Hmm, when you put it that way, I suppose we have nothing further to discuss."
It is literally the reason we didn't get socialized medicine when Truman suggested it in the 1940s, because the AMA stuck the S-word onto it at the start of the Cold War.
More annoying is that many of that ilk that I personally know would be hard-pressed to give an even basic, accurate definition of what socialism is (almost guaranteed it'll come out sounding like communism). It's as if someone many years ago said, "anything labelled 'socialism' is bad", and entire nation shrugged its shoulders and said, "okay" without ever looking up what they were on about.
Yeah that might be because “The goal of socialism is communism.”
[1]: https://www.healthaffairs.org/do/10.1377/hblog20110920.01339...
Do you have a citation for that?
>...The idea that socialized medicine would cause less medicine research and advancements, when increasingly medicine advancements are coming from countries with socialized medicine-
Can you expand on that? What medical advancements are increasingly coming from countries with socialized medicine? The usual argument is simply that since the US doesn't have the price controls on drugs, that companies make a good deal of their profits from the US market.
Cost of emergency endoscopic shoulder surgery in a private for-profit hospital in France, when totally uninsured, and paying by credit card: 1900 Eur - including anesthesiologist fee, surgeon fee, facility fee, radiology, drugs, private room etc. So around $2200 total, done the same day, after being arranged by phone. It was in France just because I couldn't do that in Thailand (great hospitals and food, like France, but also great beaches during recovery)
Add plane ticket + out of pocket costs, divide by 12: about $200/month, 0 deductible - and $0 for the years I don't need anything.
Alternative options for the risk averse: purchase local insurance in %anycountry, all inclusive. Cost of health insurance in Europe for non residents: around $70 per month. Just pay, and get treated in that country if you need it. Of course, you still need the plane ticket to fly there.
Still getting treated abroad is way way way cheaper than the alternatives.
Am I risking it? No. I'm making an educated decision.
Not travelling because I'm unconscious or in a critical condition? Foreign insurance + air repatriation.
Some countries do sell that, even to non residents. Just get world coverage - it's a bit more than $70, but if something bad happen, you get med evac'ed to that country and treated there.
I'm exploring that option as I discover the wonder of medical tourism.
If you have an accident you will already be >50k in the negative before you even wake up. And nobody will fly you around with serious injuries.
I thought it's only for people with residence + VIP client in a bank or something.
You will be surprised what some places offer.
Who would take that advice? It's the worst advice I heard in several years.
I thought travelling was about places that you want to see and trying to avoid hospitals.
https://www.rega.ch/en/about-us/faq.aspx?kid=56&gid=250#Frag...
Just when you are travelling with them in the first place... Not for this use-case, where your fall ill in your home country.
And, nothing there says they will pay you back fully.
Even repatriation is only when you are travelling, not going abroad for visiting a hospital.
Considering the medican income in Spain in around $1100, I understand why they like clients who can pay $900 no question asked.
We are now investigating getting coverage in some European or Asian country, where they sell insurance for non residents + world coverage + air repatriation (in case of a serious condition, like getting hit by a car in Chicago) at a decent price.
Best we've found so far is around $120 month, with something around a $1000 all-inclusive medevac fee (that gets you in a plane, with a doctor and everything needed)
Good luck. You'll still be required to be stabilized locally (with all the bills associated therewith), and cleared for air repatriation (by no means a guarantee).
I have seen ridiculousness (I work both in EMS, and in health insurance software development), like Heli EMS for serious car accidents to a trauma center being denied due to lack of pre-approval.
This might also provide a cautionary tale between 'what is promised, and what you get':
https://medium.com/@ryanbadger/how-insure-and-go-left-me-wit...
and associated HN comments on the above: https://news.ycombinator.com/item?id=17548285
My plan is local insurance for non resident for normal non emergency care (we pay for flights) + the option for repatriation in case of emergency surgery required abroad
But who will pay for the doctor on the flight with you, you mentioned that it was included also for 120/month.
...
Again, some proof would be nice.
Ps. Should be easy since you found it already.
The bill was over $120,000. And I was not in any condition to reject treatment or shop around, as you seem to do in your fantasy scenario.
I can't let it go that someone is ... Well, like that. He's lucky that he hasn't got any life experience in this situations.
Naming yourselve "educated" is a far stretch. Unknowing would be more appropriate.
Health insurance should be affordable for anyone to get local threatment without selling an arm or a leg ( Dutch expression)
We pay a lot of taxes, but at least I don't have to worry about money, if i would get severely sick.
Eg.
- A checkup at the doctor ( blood) costs 2€, results within 24 hours.
- Additional costs are required upfront by law. If I'm not mistaken, you can't even get an estimate on the US.
At an individual level that is correct. But at the macro level it is wrong because when a person gets sick those costs are realized in the economy (eg. instead of cheap preventive care up front avoidance of early treatment means some percent will end up in much more expensive ER services that will cost more than if all those individuals saw a family physician).
What's the medican income in Belgium? In the US?
I just don't understand how people in HN of all place complain about the costs of healthcare. I believe America has a better system, especially if you are in the hacker mindset (and with IT salaries!). Just fly to wherever, and get treated for a great price and quality.
And that's not specific to the US. I've heard Eastern Europe provides great dentistry services and that even Western Europeans fly there to get treated.
Medecine is a business just like any other. If your local shop tries to screw you, take your business elsewhere
I'm happy that my non IT-friends are also able to afford healthcare when it goes wrong. Not everyone does IT and only cares about their own situation.
You mention that the wages are a lot more, but here we don't need a scholarship to send your children to a good school. I'm wondering where your children will go to school if you travel around everywhere.
Ps. You need to be a Belgian to get the government to repay you. So you can't get it at the same price of us. So, that's another place where your "logic" fails.
What if your mother, brother and dad get sick within the year and they "don't do IT". Here the OCMW will help you. They won't help other nationalities.
Ps 2. I hate to categorize my "non IT friends", for me everyone is the same. I'm not handy and someone else can't work with a computer. Tomayto, tomahto
I don't expect to pay the same price as you. I will pay more. If it is still less than the US price, so I will buy from your country.
And yes, there are private for-profit insurance in some countries aimed at non nationals.
We have a social system for healthcare for Belgians. You are not Belgian.
If you can travel to here and pay the additional cost, you are not a discussed group of people in the article.
Coming to here won't solve the problems for the people that can't afford US health insurance, which is what the article is writing about.
Your argument doesn't make any sense.
You don't grasp the concept of a affordable health insurance, where everyone can afford it, everyone is insured and only a small percentage needs it. Thanks to the government.
Edit: Old comment adjusted, summarized: Mentioned travelling abroad and going to eg. India for everything is delusional. What about family, does your wife come along, what if you need to stay for 9 months therapy, ... Many variables haven't been taken into account.
In India, people speak English. It is one of the national languages (!!) And in the US, we have credit cards. This is money available immediately.
You are refusing to understand, your tone is inflammatory, and you are making personal claims and attack about me.
I'm done talking with you.
Because if you are not earning a whole lot and risk getting hit with a $100k hospital bill, it just make no sense whatsoever to just take the week off (or even quit!) and get treated abroad using your credit card.
Serious, go troll somewhere else.
Yes, medicine is a business, an industry, and obeys the same rules as other businesses.
But the goods it produces, "healthcare", are not like other goods. Demand is infinite, supply is scarce, and on a national level it makes sense to make sure it is distributed on a needs basis instead of a can-afford basis, because that leads to a healthier and more productive population, which is good for everyone.
"to everyone according to their needs" - that reminds me of some political movement!
Joke aside, I just disagree. It is not the "FYGM" you said. It is reasoning about the problem. Some countries have higher costs. Some have lower cost. Specialization of labor is wonderful - everyone gets richer, even if a country has a net advantage in productivity in all sectors. That's economic 101.
There is no reason for healthcare supply to be scare. It takes money. Instead of spending thousands of dollars in the US (or your Euros in Belgium), spend them in another country where it cost less.
It will also create incentive to build more healthcare supply there -- good for the residents of this country, and good for you too.
Your logic is flawed on every post. You should visit a doctor tomorrow, don't forget to fly abroad for a simple visit...
And the results of this failure are visible in statistics, in the US the average life expectancy is dropping, unlike in other first-world countries. That's bad for the US economy as a whole, which in turn is bad for you as an individual, which is why you should care.
Also, healthcare is not just large interventions and procedures where travel cost can be offset by the ridiculous treatment costs in the US compared to another country, but the most important part of a healthcare system is the regular checkups and just having access to someone to look at you and talk to you, and make sure you can prevent larger problems in the future. Medical tourism can't supply that.
Others won't go broke even, since the social system supports this...
That's the entire discussion of the article...
I don't even understand how your can also use Belgium wrong, in using it as an argument...
Your previous comment related "common healthcare" to IT-salaries, last time I checked, this isn't anywhere related.
None of your arguments make any sense.
Did you even read anything? All your arguments prove that the US healthcare is flawed, so I don't know why you are even arguing with me.
The point of the article was that salary is no longer an indicator of healthcare availability.
> Medecine (sic) is a business just like any other.
This is the ideology that functions as the crux of the matter. In the US, medicine is a business from which people involved should earn profit. Healthcare (and health, by extension) is not a right. In other places, I suspect it's the opposite. In a herd you can either strengthen your weak, or let them die off. Either way, the theory is that your herd will get stronger. The US has implicitly chosen the latter of the choices.
> If your local shop tries to screw you, take your business elsewhere.
It's not that simple. Everyone gets sick. Not everyone needs an iPhone XR or a brand new pair of Nikes. You can get by with a flip phone and a pair of brand x sneakers. Freedom of choice is great for goods and certain services. Healthcare isn't one of those services where "taking your business elsewhere" is any good, mostly because of the pricing collusion between the providers.
And this is why I comment. This is wrong! You should not have to stretch on healthcare if you know how to spend your money.
Get treated abroad. It's as simple as that.
EDIT: You may lose your job. It's a consequence of life. You will still have saved a bunch of money when taking into count the savings on healthcare and the lower cost of living abroad
You seem to describe it as some sort of vacation even.
Again, your narcism for life changing events is astonishing.
> Get treated abroad. It's as simple as that.
> EDIT: You may lose your job. It's a consequence of life. You will still have saved a bunch of money when taking into count the savings on healthcare and the lower cost of living abroad
It isn't a matter of managing your money properly. There will still be people who are disadvantaged despite making what everyone else would see as the right choices. They can even be in a position where they are at a disadvantage while being fully employed. You can blame it on the structure of the economy and society, or just blame it on bad luck.
Some of these disadvantaged people are covered by existing welfare programs (e.g. Medicaid), but a lot of them aren't.
Insisting that having healthcare is only a matter of financial literacy is naive and disregards reality.
Taking everything into account, taxes are not that much lower in the US (ignoring sales tax or VAT).
While I was working for a multinational, I enjoyed excellent health insurance (including dental). Still, filling a cavity in Belgium without insurance was cheaper than in the US with insurance.
I'm also from Belgium, and this feels so retarded. And what's even stranger is that some people in America even support this system. Wtf?
We buy off our state marketplace, but can only afford bronze tier plans with the subsidy. All plans are the same at low tiers, and all make you pay the deductible before the insurance company pays a dime (not counting "negotiated discounts," which are completely invisible until after the bill is generated)
That means we're not really signing up to be able to go the doctor, but to not go bankrupt in case of major illness. We buy insurance only to cap our risk at the annual out-of-pocket max. That we get a "free" physical is just a consolation prize.
I think a lot of people don't see it that way. As others said, most people see it as money wasted if they don't get sick. And that's a problem.
I don't blame the ACA for our issues in the USA, I blame everyone in the government who worked tirelessly to ensure insurance companies can continue to tax our doctor visits for shareholder returns.
We need Medicare For All. No one should have to skip going to the doctor because the insurance requires $6k-$8k of blood money before they start performing their function and paying for healthcare, or even let us pay "just" a co-pay.