[twoquestions]

Considering the bills for a condition like this, I'd be wondering if it's even worth it to go to the doctor. My life isn't worth the destitution visited on everyone I know necessary to keep me alive, and I can't imagine the moral calculus his family had to go through.

I'm glad this guy could get the care needed to survive, and I wish him the very best in his recovery.

[corry]

He's Canadian I believe; so while I'm not sure how his care in NYC would be billed, I think it would be still covered by OHIP (the public health insurance in Ontario Canada) or maybe travel insurance.

Certainly all the care he received in Toronto would have been covered, assuming he's Canadian.

[corry]

Don't want to spark a healthcare debate, but want to mention that I bet NONE of the non-US readers on HN would have given a single thought about the costs involved if this was happening in their countries.

It's wild to me that the potential financial impact of this was part of the picture for many of the US people reading it (especially the startup founders who are probably without insurance right now, and this would leave absolutely financially ruined for life).

[jwr]

I am from Europe and I can confirm that nobody would even consider the "costs involved". It's just not something you think about.

I am puzzled by why the richest nation in the world prefers to spend 3.1 billions of dollars on arming Israel, or spend $700 billion military budget (even though its territory isn't being threatened in any way), rather than provide universal healtcare and education to its citizens, who live in fear of becoming sick.

I mean, I can understand why if you own a military supplier company, you'd rather have it that way. But I don't get why voters do not want universal healthcare.

[AnIdiotOnTheNet]

It's a cultural thing. Americans, by and large, hate other Americans. The idea that someone else is getting something "they didn't earn" induces rage in the American brain. This is why you see people willing to spend $10 to avoid accidentally giving $1 to a welfare recipient who "doesn't deserve it" in their eyes.

[raincom]

Was this attitude common even before the civil rights act of 1964, despite the confederation?

[mnm1]

Last poll I checked, universal healthcare is supported by over 70% of Americans. We want it. We don't have a democracy to get it. It's that simple. A country where the person who gets the most votes doesn't win is not a democracy. And that's just the start of why it's not.

[sixplusone]

> even though its territory isn't being threatened in any way

It isn't threatened because of its powerful military; also why Europeans can spend all that money on healthcare instead of defense: a benevolent democracy to provide safety. Not to mention it stokes the richest economy and innovation.

[close04]

Nothing is for free so benevolence is out of the question.

Payment comes in many forms. When a dictator on the other side of the world needs a "democracy" shot, or a country needs some additional sanctions for national security, the fact that European countries offer support makes the difference between greed/aggression and a "righteousness".

[sixplusone]

A surgeon gets paid to cure my illness ... therefore he can't be kind or have good will toward me? How about a non-volunteer firefighter risking his life?

[jwr]

> It isn't threatened because of its powerful military

Seriously? You'd expect an invasion from Canada, or Mexico?

I am not against a powerful military, but it seems the US has gone way beyond that and mostly projects its force around the world, with poor results to show for everyone including the US.

[jdsully]

You’ll find the US already spends comparably per capita. They just get much less for the money.

[10122018]

Nope. I'm in Australia and enduring a living hell due to not being able to afford medical (dental) treatment. Affordable healthcare is not a problem that is exclusive to the US.

[stordoff]

> Don't want to spark a healthcare debate, but want to mention that I bet NONE of the non-US readers on HN would have given a single thought about the costs involved if this was happening in their countries.

UK, and I wouldn't think about it - it's just not a consideration.

I will caveat that by saying dental care is not free[1], but the prices are reasonable - maximum charge £270 (for a single course of treatment and anything within two months of it, for treatments such as bridges, crowns, and denatures), and "If you require urgent care, you'll pay a Band 1 charge of £22.70."/ "There's no dental charge [...] if your dentist has to stop blood loss".

[1] unless you receive certain benefits

[merpnderp]

Before the ACA, I contracted, and only carried catastrophic coverage on myself. I had no coverage until my yearly bills reached $5k, but that was also my max out of pocket. My insurance ran $63/month - which was ridiculously cheap and the worst I could ever be "ruined" was $5k.

Keep in mind I live in the backwoods of a small state in the US and could have a catscan in an hour, an MRI tomorrow, would likely only wait 15-45 minutes at an ER, had access to proton cancer treatment years before a single person in Europe had it, and was covered by MD Anderson, the top rated cancer treatment center in the world.

The extra money the US pays into healthcare isn't all for naught.

[hestipod]

I have told my story over and over so anyone truly interested can look in my history as I won't write it all again, but I lost my life due to America's system and have sunk further as an ironic consequence of only having access to it. Every time these topics come up I see people defending it or making claims that are simply false.

ACA was a horrible compromise because the right would not allow proper Universal Healthcare. In my state, as in many, there is a gap where you can be denied a subsidized ACA plan and Medicaid. I fall in that gap and get nothing but the privilege of buying a full priced ACA, poor coverage, plan for something like 7-800usd a month plus something like 6000usd yearly deductible plus the multi thousand coverage floor you mentioned. All of which is impossible for me. I did things right. I had a significant savings when this happened, spent most all of it on this stuff, I have a few hundred a month pension I was lucky to have, it doesn't cover my needs, I have no insurance or benefits. I was denied disability. This is America.

Someone else below also brought out the "I know lots of people from Europe who come to the USA for superior healthcare" line as well. I lived in Europe and never met or heard of a single person who did this. It surely happens. But its not "lots" nor proof of some superiority.

I recently got another diagnosis after having to really fight and spend a lot because the system is so broken. The 3-5min you get and insane costs for everything hinders care. I was already on the edge as my history points to...and have been trying desperately to move back to Europe where its not perfect, but even in the paid, private system I would have access to for the first years I can get far superior care to here for less. But the hits just keep coming and I don't see making it anywhere now. I wish people would care about others and how this system hurts them, rather than their politics. I will lose my life because of politics I never chose to be born into and that have continually reduced my quality of life. I just cannot understand why people continually deny this is the case and fight against that which helps all of us. I have mostly passed anger and am in intense disappointment on the issue. I just want to live. I am not allowed to.

[arthurdenture]

That's great as long as the insurance company deigns to cover you. Before the ACA, that was not guaranteed.

[gamblor956]

Universal Healthcare is generally only a thing in Canada and the EU. It's great if you need to wait a few months to see a doctor, but I know plenty of Canadians and Europeans who come to the US for medical care so they don't have to wait.

[jwr]

Not Europeans — while you might have to wait for non-emergency things (depending on the country), emergencies are treated immediately. And I've never heard of anyone from the EU going to the US for medical care, that actually sounds rather amusing :-)

[criddell]

> And I've never heard of anyone from the EU going to the US for medical care

It definitely happens, especially for things like plastic and reconstructive surgery.

[epitrochoidal]

I don't know how it is in Europe, but those sorts of things are not typically covered by insurance in the US, except in cases where the reconstruction is related to a medical condition or accident (I got a nicer nose after breaking the original in a bicycling accident; the reconstruction was covered by health insurance). I assume those coming from EU to US for treatment would be self-pay for the treatment, yes?

[PhasmaFelis]

It may not be perfect, but if I had to choose between having to wait weeks or months for non-emergency care, and risking financial ruin and unnecessary death if I come down with a drastic disease, the choice seems clear.

[stordoff]

If you need emergency care, you don't have to wait (UK). My grandfather had a fall recently where he hit his head, and had a brain CT within two hours (he fell about 1am; he was admitted, assessed, treated, and discharged by 6am). A family member had an urgent referral for a mammogram last Thursday, and was assessed and given the results today.

Routine GPs appointments can generally be gotten within a week, and emergency[1] appointments (where we wait until the GP is done at the end of the surgery, and are then seen) if the triage nurse determines you need to be seen sooner can be gotten on the day. You also have the option of speaking to your local pharmacist, many of whom can prescribe medication for certain conditions if appropriate, or otherwise point you at suitable over-the-counter primary care.

A number of places also have walk-in centres for minor ailments where you don't need an appointment, and they generally have long opening hours (8am-10pm, 365 days a year for my local one). Urgent dental care is also available 24/7 in many places.

You may have to wait longer for non-emergency / non-priority / time-insensitive treatments - my routine MRIs have a lead time of about 8 weeks, and a specialist referral can be something in the region of 6-12 weeks (sometimes longer) - but I think that's a fair trade off. You do of course also have the option of paying for private care as well if you don't want to wait (often NHS doctors / semi-retired doctors working evenings in my limited experience).

[1] bit of a misnomer really - urgent but not critical is more accurate

[gambiting]

If you have a condition now you will be seen the same day even if it's not an emergency. I had a high fever for a couple of weeks and finally decided to see a GP - got an appointment in 2 hours of the call to the surgery, GP told me to go to the ambulatory care department at the nearest hospital(nothing to do with emergency care there) and I was admitted and seen pretty much within an hour of arriving. Spent several days over the next month in and out of the hospital, had some treatments done = no bill was ever produced.

Also when my wife had to get an MRI done going private wasn't that much quicker than NHS - you still had to wait a couple weeks through her private health insurance at work.

[gamblor956]

My wait for a routine MRI is about 2 hours....

My wait for a specialist referral is 2-3 days and any delay is usually on my end.

There are just some things the US healthcare system accidentally does much better than Europe.

[gambiting]

So you want to tell me that from the point when you ring your healtcare provider saying "I want to get an MRI done", to you lying down on the table being scanned the time is around 2 hours?

[TotempaaltJ]

I'm Dutch, and I've never had to wait for more than a week to see my GP. Never more than a month for a procedure.

Additionally, when I lived in the US, we got a special Dutch health insurance plan for temporary expats. They sent us a letter that if one of us ever had to go to the hospital, they'd fly them over to the Netherlands unless the situation required immediate attention.

[pnutjam]

I live in the midwest and it takes me about a month to get an appt with my GP. If I want to see an NP, and block out about 4 hours to sit in the office, I can be seen that week, usually.

[arisAlexis]

not really, in most EU countries you don't wait for emergency problems

[gamblor956]

That doesn't describe the experiences of any of my former EU co-workers. (They're still in the EU, just not coworkers any more.)

[hylaride]

It would NOT be covered by OHIP. He'd need travel insurance, which most Canadians have via benefits (depending on how established his company was, he may or may not have it). Most travel insurance will pay up to the point of bringing you back home when it's medically safe.

[refurb]

Generally OHIP does not cover medical care outside of Canada.[1] Apparently they'll cover $400 CDN per day of US hospital stay, so probably less than 4%.

I sure hope he had travel insurance. Likely did as most companies offer it for employment travel.

[1] https://www.cbc.ca/news/canada/windsor/medical-emergencies-i...

[mnm1]

So what? He's Canadian. Good luck to the debt collectors trying to collect that.

[refurb]

That would align with what American’s do when getting treatment in Canada.

[realshowbiz]

Yes. You have one life, and it’s worth living with or without money.

[10122018]

Spoken like somebody who has money. Do you have any idea how much pain and suffering a person can endure due to having no money? I don't think it's your place to say that person's life is worth living.

[Raphmedia]

Growing up in total poverty, raised by a single mother who fought cancers and died twice on operating tables let me tell you one thing.

Money is nothing. Poverty won't make you unhappy.

Humans are good at finding new baselines. Poverty will simply become your new normal and the little things of life will still bring you joy. Seeing a loved one will still make you a smile. Life is worth living even without any ressources.

[10122018]

> Money is nothing. Poverty won't make you unhappy.

I'm sure the millions of people living in poverty, dying of treatable diseases and starving to death right now are ecstatic about it. Or are we just pretending those people don't exist?

[PhasmaFelis]

> Poverty won't make you unhappy.

I'm glad you and your family managed to beat the odds, but this is demonstrably false on a statistical level.

[Raphmedia]

From my experience, poverty do increase your sadness and make your life really harder. It yanks away a lot of control from you and your ability to exert your free will is reduced. It also comes with stress, especially in countries without social networks and safety nets.

It won't however make your positive moments any less important. You will be more likely to suffer from mental health issues but that's statistics and they don't represent daily life of people accurately.

If you are not suffering from something such as depression you will still find satisfaction from social encounters, from your community and your family. Unless living in a dangerous situation, your will still be able to feel content about your life. Love will still matter just as much.

That being said, this is my experience living below the poverty line in Canada where healthcare and social programs exists.

[christiansakai]

What do you mean by your mother died twice? Serious question

[Raphmedia]

One surgery had complications, they had to remove a large portion of her carotid artery during an emergency procedure. She was dead for a bit too long and suffered brain damage from it. The other time, she bleed out from a hysterectomy.

[rfrey]

twoquestions seems more concerned about impoverishing everyone they love.

[fzeroracer]

Is your life worth subjecting your family to a lifetime of debt?

This is a serious question people ask themselves whenever they get sick. It's one no one should have to ask, but one many Americans have had to sincerely consider.

[AnIdiotOnTheNet]

I entertain similar thoughts, though less out of lack of value for my own life than sheer stubborn spitefulness for the predatory health care industry in the US. Sure, i could exhaust all my money and I might live, but I think I might actually rather die just to keep it out of their grubby hands.

[udkl]

Can anyone make a good guess on how much this would have cost here in the US and if it had happened in Canada ?

[waterside81]

If it had happened in Canada the cost is zero. We don’t have deductibles or anything like that for these sorts of surgeries. Drugs yes, operations no.

[Ididntdothis]

In the US the cost must have been in the millions. I know people who ran up several million dollar bills during cancer treatment.

[arisAlexis]

do they deny you treatment if you don't have that kind of money?

[saalweachter]

I don't know the current (post-ACA) situation, but the short answer about the US's emergency care laws is "sometimes".

For instance, suppose you trip and fall, and in catching yourself, shatter your shoulder joint.

The emergency room would be obligated to keep that from killing you -- making sure the bone fragments weren't going to sever an artery or anything, stitching up open wounds and the like.

The emergency room would not be obligated to restore you to (as much as possible) functioning. If you need an expensive 20-hour surgery with a team of specialists to put all the pieces of your shoulder back together, well, that's too bad. Sure, your shoulder will heal into an immobile lump without treatment, but it won't kill you, so not actually an emergency.

[Balgair]

No, they cannot deny essential treatment in the US due to financial issues. The type of treatment can be argued about and fiddled with (elective surgueries and whatnot, prisioners needing co-pay money they do not have, etc). But in a life-saving case like the one in the article, they cannot not deny treatment. As another example, if you need a C-section, you are getting a C-section.

That said, fiscally, it's a total gamble in the US these days. You may be saddled with a $20/mo debt that will likely never end ever, or you may be facing a bill for $1M that is due in 30 days. The range is essentially unbounded and unknowable in any real way.

US healthcare is shockingly cruel, financially speaking.

[hanniabu]

Sometimes they do. A person at my mom's work need an organ transplant, but they denied them the surgery because their finances didn't show they could afford it, let alone the medicine you need to take for life after that to fight off rejection.

[Ididntdothis]

I really don’t know. They usually say everybody gets treated but I would guess quality will suffer. Or you will get relaxed as quickly as possible.

[Ididntdothis]

“Released” not “relaxed”. You won’t be relaxed after getting the bill.

[novaRom]

But most will be covered by the insurance company, or not?

[Ididntdothis]

Be ready to spend months or years on the phone fighting with the insurance though. It’s not uncommon to receive a $300k bill that you then have to clear up with many many phone calls.

[mnm1]

What? Go to the ER, save your life, then declare bankruptcy. That's the American way. What destitution on everyone you know? I don't understand what you mean. You think your family would be happier with you dead instead of bankrupt?