[jwilbs]

Two weeks, I had open heart surgery in my mid-20s in the US.

My main takeaway is this: those of us who work in tech or companies with decent health insurance are extremely fortunate.

In total (knock on wood that this doesn’t go up), I spent around $10k out of pocket.

This included more than surgery itself:

- multiple ER visits because of my deteriorating valve

- a LOT of dentist work (cleanings, fillings, wisdom teeth removal); these things increase your risk of stroke/heart attack after heart surgery.

- multiple visits with cardiologist and surgeon consultations

- pre-operation

- six days in the hospital recovering

To be honest, that’s a lot less than I expected to pay. However, I can’t help but think of people in less fortunate positions that would 1) get fucked by the bills if they had no insurance or 2) still go into debt despite having insurance. When you really think about it, all options are ridiculous for an operation that is literally do-or-die.

I’d also like to add a note on specialized vs ‘routine’ care here in the US. Or my experience with it, anyway.

All specialized treatment I received (dentist, heart surgery, cardiologist) was outstanding.

Routine cafe was awful, and ER visits were nothing short of ridiculous. I went in with chest pain/shortness of breath (that I now know was very serious). I waited for 6 hours. They gave me some blood work and an ekg and sent me on my way. I went again the next week, because my symptoms were getting progressively worse. Once again, I waited about 6 hours in the waiting room before getting an ekg and some blood work. Both visits were a complete waste of time. Luckily, I saw a cardiologist shortly after who gave me an echocardiogram and identified the valve issue.

This (the shortness of breath, dentist visits, surgery) was all done within the last two months. Were I in a less fortunate financial position, I probably would have hesitated to even go to the cardiologist. Especially after having thrown money at the ER for nothing.

It’s unfortunate how our healthcare system mirrors some sort of class-based hierarchy: If you can afford it, great! Else, get fucked.

[toasterlovin]

Medicaid provides free healthcare for low-income Americans. It covers 23% of the population.

https://en.wikipedia.org/wiki/Medicaid

[fucking_tragedy]

Medicaid is only expanded via the ACA in 36 states. In the remaining states that denied Medicaid expansion via the ACA, Medicaid is not available based on income at all.

In the states that expanded Medicaid, it is only available to individuals making less than 100-138% of the federal poverty level. The FPL for a single individual in 2019 is $12,490.

Individuals making more than 138% of the FPL, which is $17,236, are not eligible for Medicaid.

I'd argue that making slightly more than 138% of the FPL is still poverty level income, however Medicaid is not available to these individuals.

[rrss]

Did the ER send you on your way with a recommendation to see your PCP or a cardiologist?

[jwilbs]

Nope! Just told me to reach out to a cardiologist if things didn’t get better, and suggested it’s probably anxiety. I suppose I can’t blame them given my age, but it makes me wonder how many cardiac deaths (#1 source of deaths in the US [1]) are preventable.

[1] https://www.healthline.com/health/leading-causes-of-death#ca...

[malvosenior]

> It’s unfortunate how our healthcare system mirrors some sort of class-based hierarchy: If you can afford it, great! Else, get fucked.

It's not widely known in the upper/upper middle classes but healthcare is more or less free if you're poor in the US (even for major things like cancer treatment). It's really the middle class that has it the worst as they don't qualify for free health care.

Edit:

Some additional information to back up my assertion:

72.5 million people are covered by Medicaid: https://www.medicaid.gov/medicaid/eligibility/index.html

The vast majority of medical services are available for free to Medicaid members: https://www.medicaid.gov/medicaid/benefits/index.html

[dragonwriter]

> healthcare is more or less free if you're poor in the US

If you qualify for Medicaid, you have government-provided insurance available, but that doesn't mean care is free even then, because Medicaid rules allow state plans to incorporate either or both of premiums and beneficiary cost sharing as part of the state Medicaid plans.

Also note that many people (particularly adults) that would meet many definitions of poor are not qualified for Medicaid, because several states don't cover adults (especially non-parents) with Medicaid above a small fraction of the federal poverty level (and sometimes not at all for non-parents).

See, https://www.kff.org/health-reform/state-indicator/medicaid-i...

[jwilbs]

I was on Medicaid just a few years ago. It was definitely a lifesend, but the network is very tiny and, as a result, scheduling visits with specialists (in my experience, so anecdotally) took about three months.

I am very grateful I was not on Medicaid during the past few months. But I am happy it’s an option.

[AlexTWithBeard]

scheduling visits with specialists (in my experience, so anecdotally) took about three months.

From my own experience, that's approximately what it takes to schedule a specialist visit in the UK.

Unless (surprise!) you have a private insurance.

[seanmcdirmid]

Emergency healthcare is free. Cancer treatment might be free, but good luck seeing the specialists needed to get that treatment without some very explicit charity.

[malvosenior]

This is incorrect. You can see specialists for free as well. There are no restrictions on treatment.

[seanmcdirmid]

Maybe if they already know you have cancer, but just some symptoms? The emergency room typically isn’t going to make a cancer diagnosis.

A lot of healthcare is simply best effort, and you won’t typically get that best effort if you aren’t paying.

[malvosenior]

Medicade is full blown health coverage, it's not just for emergency room visits: https://www.medicaid.gov/

[dragonwriter]

> Medicade is full blown health coverage,

Medicaid is (1) not available to anywhere close to all poor people in the US (though it would have been for a particular poverty definition had ACA expansion been universal), and (2) doesn't provide free care to all the poor people to whom it is available (both premiums and cost sharing—effectively, deductibles—are allowed in State Medicaid plans), and (3) very often does have limits on available services, so while Medicaid exists, it does not meet the description made of healthcare being free in the US if you are poor without treatment restrictions that has been made.

[dragonwriter]

> You can see specialists for free as well

What specific program are you talking about? Because you're wrong when you state this as an unqualified generality about poor people in the US, but identifying the exact error requires knowing what program you think is involved.

> There are no restrictions on treatment.

There is no program for low income healthcare for which this is true.