[facetube]

Honest question: have you ever worked a job in that service economy and fallen seriously ill? Things turn in to a shitshow really quickly when six-figure bills start raining in from oncology, your for-profit insurer starts denying claims after you've cleared the massive $5,000 deductible and $6,250 out-of-pocket maximum, you're technically "self-employed" and have no access to employee protections like paid sick time or FMLA, every bad health day you have is another couple hundred dollars foregone that could have gone to medical bills, and then the IRS piles on with self-employment tax to add insult to (literal) injury.

Disruption in the US health care system would be great; until that happens, my excitement over having cat litter delivered to my door in an hour or less will, sadly, be dampened by the fact that some Americans are literally doing their own minor surgeries over a bathroom sink right now. Wart removal is a really common one, presumably because it routinely bills out $250-$350 per visit in larger practices, and the typical visit count is high.

[mahyarm]

Your an employee with cancer, and your for profit insurance still deny's your insurance, you quickly run out of paid and unpaid leave through the FMLA and your still up shit creek with cancer. The employee designation doesn't seem much better as far as I know.

The real problem are laws that try to offload welfare to employers when it should be paid through a govt. tax system.

You have to take whatever IC income you get and divide it by 1.4 to get the equivalent pay as an employee after benefits.

How is it like for people with no savings on medicaid or mediCAL?

[facetube]

Being an employee in the US can, in some cases, help preserve both your job and your employer-facilitated health insurance while you're sick. The company needs to have 50 or more employees for it to apply, IIRC, and you need to have worked there for at least a year. There are slightly more generous laws in some states. It's quite close to nothing, but still slightly better than nothing.

I definitely agree that employment (or lack thereof) should have nothing to do with health care.

[j-pb]

Or you know, you could come to Europe, found your startup here and get free healthcare.

I would guess immigration isn't that hard for a highly skilled computer scientist.

My meds cost 100€ per day (MS) and I have to worry about my disease but not about paying for treatment.

[jrk_]

Not sure which part of Europe you are speaking of, but I have to pay around 15% of my income for the (mandatory) insurance, which then provides me with (almost) unlimited health care. If you are unemployed it is a lot harder to get health benefits, especially if you are a foreigner and haven't worked (==payed for the insurance) before. Just saying, that it's not like "come here, we have free health care and everything".

Anecdotally I can tell you that I also need regular medication (not in the same range as you, but still), and I was unemployed after college for some time. I got the meds, but only because my parents paid the minimum "social tariff" for health insurance, which is around 150€/month.

[facetube]

One of our (US) employers pays about 10% - 15% of our combined total compensation (read: salary plus "other personnel expenses") for a $250 deductible health insurance plan. And that's just the insurance premium. Dental is extra. 20% co-pay. Bills are always a surprise and full of errors. Sometimes the same service is coded in radically different ways, leading to claim denials and hundreds of dollars of variation in what's billed. It can take six months for a provider to get paid. People here routinely finance life-preserving medical treatment using credit cards. The per-practice administrative overhead for dealing with private insurance claims is estimated by quite a few (peer-reviewed) papers at between 15% and 30%.

If the wrong one of us changes jobs, all of this comes crashing down and I'm back to reading 200-page policies, figuring out what network I'm now in, and trying to determine if I can still see my normal doctor.

15% of after-tax income for no-questions-asked health care, sans any form of billing, sounds like a utopia to me.

[humanrebar]

> have you ever worked a job in that service economy and fallen seriously ill?

I'm confused. Is this a hypothetical where the employee doesn't have short- and long-term disability insurance?

The practical answer is to have insurance to cover risks.

[facetube]

This is the realistic scenario, where non-W2 service industry jobs provide few if any benefits, and individual policies are expensive, complicate and often require individual underwriting. Individual underwriting can require proof of a stable income (they pay a percentage of this in benefits if you get sick), and many have exclusions that can be difficult for people to fully understand, let alone compare against their own risk factors (if they're even understood). Other factors: affordability, exclusion due to medical history.

Take a look at the "service" lines in this 2014 BLS report: http://www.bls.gov/opub/btn/volume-4/pdf/disability-insuranc.... 76 percent of the service industry jobs they surveyed provided no access to short-term or long-term disability benefits whatsoever. And this is probably optimistic, it includes lots of non-contract W-2 employees. Where employer-facilitated plans are available, most employers provide them at zero or near-zero net cost to the employee (take a look at access vs. participation).

SSDI exists, but has a five-month waiting period and (IIRC) pretty substantial past-income restrictions.

I'd love to see employers get out of the health care arena altogether, but I'm also not convinced private and/or for-profit insurance plans can completely solve the problem.

[hadeharian]

" Wart removal is a really common one" Have you tried duct tape? It's offers higher chances of success.

[facetube]

I've heard that. I haven't ever had them and can't speak personal from experience, but I've heard from a couple docs that cantharidin works really well, and cryotherapy ranges from might-work to total-garbage. Only downside is the whole "high potential for toxicity and misuse" thing; apparently people have taken cantharidin internally as a supposed aphrodisiac, which is clearly a terrible thing to do with a blistering agent.