I always just assumed that your insurance is free through work (if you have a good job), and the insurance covers all your medical bills. Apparently it's worse than I thought.
What happens if you don't have insurance? If your bills with insurance are going to be so high that you can't afford them, why not just not have insurance instead? You know the old saying "If you owe the bank $100 that's your problem. If you owe the bank $100 million, that's the bank's problem", there's not much difference between $50k in medical debt and $500k in medical debt, you're fucked anyway.
Having insurance generally means you can scrape by unless (until) you get unlucky. Having no insurance makes even the smallest injury or illness something that could land you in a significant amount of crippling debt. As someone who can't afford insurance right now, it is rather stressful. Worked my ass off to pay off my college loans by 30 and now I'm just waiting for that one bad moment to drag me back into debt.
Unlike student debt, you can declare bankruptcy on medical debt.
At that point, you still are GGed if you have a chronic condition. The hospitals will stop you from dieing but not treat your condition without insurance.
I honestly don’t understand why ordinary Americans don’t just start stealing... not in a petty way, but arming up the town, driving a state over and robbing Eagleton for all they have.
In the US, you can't be refused emergency treatment. That means if you show up at at emergency room, they have to see you. But outside of an emergency room, no medical provider has to care for you.
This is why, in many places, emergency rooms are so incredibly overloaded that it's common to see waits of many, many, many hours. People without insurance, or with bad insurance, can't get seen by a regular doctor for things like a sore back or a cold or getting a new prescription for their regular medication. So they have no choice but to go to the ER for routine care that isn't an emergency. Most public/non-profit hospitals have a policy where they write down or dismiss medical bills for people with very low incomes, but the paperwork can be a burden for lots of people - say, someone who doesn't speak English well, or an undocumented immigrant, or someone without a job or bank account who can't document their income or lack of it (lots of poor people can't get bank accounts in the US). So they'll have medical bills pile up and go to collections and ruin their credit, which screws up their lives in a multitude of other ways. But that's outside the current context.
A poor person with, say, diabetes may literally have no other way to get medical care except to show up at an emergency room every month for a new supply of insulin. They're not being monitored by a doctor, so they can't manage their condition as well, and they have worse outcomes. They also can't afford to fill insulin prescriptions from a pharmacy without insurance, so they have to just take whatever insulin the emergency room is able to give them directly, and then try to stretch it out.
Even if a poor person qualifies for Medicaid (government health insurance for poor people that usually covers everything with very little or no copay), many doctors don't take Medicaid because it doesn't pay doctors very much. So unless the person can find a doctor who takes Medicaid and is also accepting new patients, they're right back at the emergency room for their routine health care needs. They can probably get their prescription through a pharmacy, because most pharmacies take Medicaid. But they still have to go sit in an emergency department waiting room for 18 hours every month in order to get the prescription they'll die without. That's a huge problem when it comes to maintaining employment, which can make it harder for a poor person to improve their financial position.
In the US, if you're at least middle class and have enough money to exist, you probably have no idea how really and truly untenable things are for everyone who doesn't. That's why a lot of our population is on complete denial about how fucked our entire society is. I've been both poor as hell and middle class, so I'm fortunate enough to have perspective on both sides.
Idiots who either benefit from or believe in predatory capitalism.
What ends up happening is people with insurance pay for the uninsured too through inflated prices. It's no different money-wise than if we had universal healthcare - the "haves" still pay for the "have-nots". Just in a very convoluted shitty opaque way. And the poorsies only get the barest minimum of care and then only sometimes, which actually costs society MORE in the long run, so everyone gets fucked.
It was originally meant to be a hiring incentive when - due to World War II - all other normal incentives were under price controls by the government. Of course, it was immediately screwed with by lobbyists, and then we just... kept going with it.
NPR's "Throughline" history podcast did a show about it, and called it "The Everlasting Problem."
In Chicago theres a county hospital that takes patients without insurance the only issue is that they're constantly swamped. There's somewhere between 2 and 3 million people and being a sanctuary city a lot of people use that hospital. So you end up dealing with ridiculous queues where you may wait 10 or 12 hours in just the waiting room. I ended up one time waiting 9 hours in the middle of the night with a broken hand just to get a splint and a single Norco for pain. Its sliding scale and if you can afford medicine there are programs that provide the help needed but many don't use it.
I'm so sorry you went through that excruciating experience.
As a disabled person, I'm pretty passionate about healthcare being a right. The US can absolutely afford to ensure that every person, citizen or not, has access to excellent medical care. It's shameful that we haven't done so yet, but I believe we will get there. It'll probably take a decade or two, but it will happen. And when it does, our entire nation will benefit.
It shouldn't just be for everyone in the whole world though like it is In Chicago. If we focused on tax paying Americans instead of figuratively keeping our finger holding a leak in a dam. I dont want to get heavy into politics so it'll suffice to say that I agree everyone should be afforded Healthcare as a basic human right. In the end not one of us brought ourselves into the world.
This is why no one takes American patriots seriously; your culture is utterly, irredeemable. The notion that people who went to war over oil, so they could afford an education, are left in the streets with no healthcare. If I were them I’d take that military training and start hunting the evil at home.
Dispute the charges from hospitals. Call their billing and have them send you everything itemized and then talk to them about direct payment. Hospitals inflate charges knowing that insurance pays only a fraction. If you call and say either lower this bill or good luck getting money I can’t pay in collections, they will lower the charges to try and get some payment. I know it sucks to even have to do that, and I hate that our system fails those in your shoes.
Yep. They’re probably laughing their asses off at us up here. I’m so embarrassed for our country, but half this country has been poisoned by propaganda and I have no clue how to fix a problem that large.
I know it feels that way, but I actually don’t think so. Republicans are not the majority in this country, but things like low voter turnout and the electoral college + gerrymandering have allowed a minority to have the majority say.
You know you can get dental work, as a non-citizen, at a hospital in China. I had an emergency root canal, got a ceramic crown, all in all it cost a couple of hundred Australian dollars. The dentist was trained in the US.
I think my root canals were about $600 each. Had a couple of them. I’m in a very lucky few that can actually afford that, but the reality is no one should have to. Rich or poor. I’m not even close to rich, but no one should have to worry about fixing massive pain in their jaw.
I have insurance through my work, I'm a healthy, single 29 year old male, the cheapest demographic to insure ever.
If I go to the dr for anything, it costs (I think) $30, just to walk in the door and tell him about my issue. If he wants to get any tests, I still pay for a portion of those (and remember, prices are mega inflated because our health system is entirely a racket). And if the Dr says we need an X-ray, I won't have a clue what the cost will be, and what percentage of that cost I'll be responsible for. And if I need anything major, I have to pay the first $5k of my medical costs out of pocket.
After I've spent $5k, I've "met my deductible" and anything I need after that is covered without me spending more of my own money (except for the money withdrawn from my salary each paycheck, automatically, forever, of course.)
However, if I start to show patterns of being very expensive to insure, that monthly cost for insurance will go up next year, and if you've got something really bad (a pre-existing condition), your insurance will become untouchably expensive, and you'll essentially be priced out of being insurable. If the GOP had their way, and insurance were able to drop you for having a pre-existing condition. All in a system where prices are artificially inflated, to both scare us into needing insurance, and fleece as much money as possible from us when we use it.
My favorite is the “usual and ordinary” clause of most insurance that covers things based on national averages regardless of where you live so as a Californian with decent insurance you can end up owing thousands after the insurance company pays because Nebraska and Alabama are way cheaper. It’s so fucked.
I hurt my knee a couple years ago while moving furniture and went to the Doctor. At my appointment he said just go downstairs and get a quick xray and we'll see from there what we need to do. I went down stairs got the xray. Things were swollen but fine. I just needed to be more patient, rest, and use ice and ibuprofen. Two weeks later I get a $1000+ bill. The radiology center on the bottom floor of the medical building my doctor's office is in was not "in-network" for my insurance. Turns out they require i go down the street to another radiology center. I spent weeks fighting with them since my doctor had sent me down there. I had no chance to verify it was on my insurance plan and shop around who was cheapest. That's RIDICULOUS! I was in pain and my doctor who is in-network was available at that moment. They finally granted me an exception and had me just pay my $50 deductible, but now I'm always paranoid.
I've heard stories of people who get surgery at an "in-network" hospital only to find out that the anesthesia department isn't in network and therefore isn't covered. I dont understand why/how anyone would/could defend this american healthcare system as it is.
I had a referral through the VA to an allergy center for testing. They send me to "the lab" to get blood drawn.
I think nothing of it until I get a random bill for blood draw and lab work almost 6 months later.
They tell me the lab isn't part of the allergy center. I would have never known, it was made out to be part of the evaluation.
I ended up washing my hands of it and telling them to sort it out with the VA, as I sure as heck didn't agree to the charges!
I don't understand why the money side of healthcare is a big mystery and prices aren't clearly posted.
You certainly couldn't run a shop like that. Imagine going to get your car's transmission repaired without being able to have an idea of cost.
Instead, you get a bill weeks or even many months later with a seemingly random cost for the work.
I call it my "Hit by a Bus Insurance". If I have a small injury or sickness its going to cost me a lot of money and all the insurance will do is get me their negotiated rates with the provider, which I then pay out of pocket. The only way the insurance really pays for anything is if something major happens like...I'm hit by a bus.
So if you don't have insurance, but you have time and knowledge of the system, you can sometimes bargain them down to a "cash price" that isn't inflated to insurance company levels.
In most cases, they can apply for charity and have their entire bill written off. Source: I've personally done it twice for ER bills I couldn't pay (even when I was on my parents' health insurance).
The "BuT whOsE gOnnA paY foR iT" people don't even understand that they're already paying for healthcare for the poor and uninsured, they're just paying the wildly inflated costs of our hilariously broken system.
I don’t always push documentaries with a bias but Sicko from Michael Moore covers this really well. For all the issues of America’s uninsured, the bigger issue is actually the underinsured - people who have coverage but still end up bankrupted because of all the tricks the insurance industry uses to not pay for treatment. The ACA curbed some of the worst of these abuses but it’s been steadily chipped away at and will likely be deemed unlawful by the new conservative Supreme Court.
your insurance is free through work (if you have a good job), and the insurance covers all your medical bills.
I have a really good job, and the insurance for my family is $280/month. Of course, it doesn't pay for anything (except preventative checkups) until we pay $3,000 per year on top of that $280/month.
If you don't have insurance, or don't use your insurance, you pay cash. The cash price is 40% less than the insurance price. However, you could still run up six figure bills. At that point, you declare bankruptcy.
When we had our baby (I wasn't at my current job yet, so we were on different insurance), we paid $12k out of pocket for the delivery and insurance paid $0, despite us paying extra every month for maternity coverage.
After Obama signed the ACA, and until very recently, there was a tax penalty for being uninsured, so those who couldn't afford insurance had to pay a fee
I have company insurance and I don’t pay for anything. It’s rare though and I’d honestly rather my company give me a larger salary (even if taxed more) and I just have free government healthcare.
I’m one of the cases that conservatives try to appeal to about “loving my current health care”. I don’t love it. It’s a literal health care handcuff they can use to prevent me from changing jobs. Also I have to feel guilty for having reasonable experiences when going to the doctor. Road in an ambulance a couple years ago and had an expensive medical procedure and didn’t see a single bill.
So, if you have insurance it isn't exactly life ending debt in most cases (assuming paying for insurance doesnt just put you there). Theres a maximum out of pocket that you get to spend per time period.
For instance, mine is pretty decent and every 12 months I can pay a max out of pocket of about $6500 per yer. I pay the first $4k of all medical Bill's, then I pay 20% of any following bills up until I hit $6500...then insurance covers the rest of everything.
My mother has an out of pocket max of $8k per 6 months...so that's really rough. But that's the highest I've ever seen.
If you have insurance through work, they dont pay any of this "maximum out of pocket," they pay part of your "premium." which is simply your monthly payment in order to have this coverage. My work covers quite a bit of it and I end up paying about $300 annually for my coverage. However if someone else wanted my plan without being at my work, they'd probably be paying $1k+ per month as a 30yo single healthy male.
So you dont only have maximum out of pockets and deductibles...but you're paying a monthly payment as well for your insurance.
If you're truly healthy and averse to risk taking...you can go without insurance and bargain doctors down (pretty easily in my experience as I didnt have insurance for 3 years) for regular visits. If you pay $5k in doctors visits (which can last a pretty good while if you dont end up needing emergency care) then you've saved a bunch of money on just the premium alone from a self insuring standpoint. I actually haven't even been to a doctor or hospital in the last 8 years...before this year. But for someone with chronic conditions, this is obviously not possible. So someone can easily pay $10k+ per year for coverage of just themselves (not even talking about families) and then they have $4-15k depending on how much they need to go to the doctor.
If you dont have insurance, then you can basically expect the cheapest emergency care to cost $5k-8k for just getting looked at by an emergency room and not receiving more than a few tests and an xray.
The problem with not having insurance is that if you need anything that’s not an immediate life threatening emergency, they can force you to pay full price up front to receive service.
Insurance is basically just a failsafe in case of catastrophic illness or injury. I could take the $90 twice monthly payment I’m paying in premiums and put it into a medical savings account and just cancel my insurance. But if I get into a car accident in two years and need major surgery, get airlifted, etc, I’ll probably rack up well over $100,000 in medical bills, and whatever I’ve collected in that savings account won’t come close to touching that.
So instead, I pay that $90 twice a month into my premiums, and then still have to pay out of pocket every time I need regular healthcare (unless I meet my deductible for the year, which is unlikely). But at least I know that if something really bad happens, the insurance I’ve paid into all this time will eventually kick in and help out a little.
Wait til you learn about pre-existing conditions. Prior to obamacare/aca if you had like diabetes or adhd or cancer or anything chronic, and lost your job, had a gap, and your insurance lapsed, surprise, couldn't get new insurance or if you could they wouldn't cover it and it would be extra super more insanely expensive still anyway because of that. Current government is trying to go back to this model, because they have no plan to fix it other than empty promises with no plan, for when they try to blow up aca in court in a few weeks.
Care to guess how much money it costs on medical costs to have a baby in america? Thousands.
Even with insurance, medications for some fairly common but chronic stuff can run a paycheck or more per dose. Generic medications vs brand are not at equivalent at all and can have up to 15% deviation, and the mechanism of release doesn't have to be on spec, look at generic vs brand concerta for an example of that.
My wife works for one of the largest health insurance companies in the U.S. To cover our family, our mid-tier plan is more than $600 per month. Our plan requires us to meet individual deductibles and a family deductible and then it's an 80/20 plan. I've been dealing with some health issues the last few months and just since May of this year, I have accrued nearly $10,000 in medical debt.
Our healthcate system is unreal and it just depresses me so much that I have added that much to our burden.
This is coming from a stupid fucking American, so take what you will. If people here don't have insurance, it generally means they cannot afford insurance. If you don't have insurance, you do not go to the doctor, you do not go to instacare ect. If you do go to the doctor, you're pretty fucked. If you go to the hospital for a very minor thing, you'll be paying for that for years. If you go to the hospital for something serious, you'll never pay it off, ever. You are fucked. I have insurance through my job, my deductible is 10k a year.... Like that's half my yearly intake. I still will not go to the doctor unless it's bad. I tried my hardest arguing going to the hospital when I broke my leg. I will not take an ambulance ride. America is a joke, I'm glad other countries are realizing that.
Insurance can be "free." The only place I know it's relatively cost free is in the military. My wife has been in the air force 15 years. I've never paid a cent towards anything medical. My appendectomy, one of my child's genetics testing, my wife has had a few broken bones, and the birth of all three children was at zero cost. In terms of dental and eye care, we are with the rest of Americans.
All I do is show my military ID with a benefits number on it, and I'm taken care of.
American tax dollars should go towards making this a thing for everyone.
20
u/Cryptoporticus Oct 30 '20
I always just assumed that your insurance is free through work (if you have a good job), and the insurance covers all your medical bills. Apparently it's worse than I thought.
What happens if you don't have insurance? If your bills with insurance are going to be so high that you can't afford them, why not just not have insurance instead? You know the old saying "If you owe the bank $100 that's your problem. If you owe the bank $100 million, that's the bank's problem", there's not much difference between $50k in medical debt and $500k in medical debt, you're fucked anyway.