[try_again]

When you state "in this country", please specify what country that is. Despite the use of English as the lingua franca here we're amongst a geographically diverse group. I'm going to assume you mean the US. If that's a correct guess, as a European the US work standards frighten me. Health insurance so tightly coupled to work that if you get into an accident shortly after being laid off and don't have (expensive) private insurance you could be bankrupted by it. Two weeks vacation per year seems to be common and I've repeatedly heard that employees are being pressured to not actually use their full paid time off. Maybe I've just been too coddled by the working conditions here in Belgium but I simply can't imagine working in the US without going completely mad or sinking into a depression. I know that I pay incredibly high taxes, but a higher income at the cost of living in such a cutthroat environment simply doesn't seem worth it to me. And to be honest I consider my standard of living to be very high and comfortable, both in spite of and thanks to taxes.

[TheRealDunkirk]

This is a forum run by a US VC firm talking about US startups. One could almost forgive the assumption that people would understand that I was referring to the US. ;-)

[betwixthewires]

We both know it's better than a guess. Most of the users here are Americans, no need to have a cow over it.

[graycat]

> you could be bankrupted by it

It's tough to be an expert, to be well informed on how US medical care gets paid for. I'm no expert, but I know a little more than nothing:

So, for "bankrupted", yes, sort of ....

But the US has Hill-Burton hospitals, likely named after two guys in Congress who got the bill passed. With the Hill-Burton act, if are starting a hospital, then can get funding via the act. BUT: Have to accept all patients independent of ability to pay. Soooo, a large fraction of city hospitals are Hill-Burton. Then there are the medical school teaching-research hospitals -- again commonly or always, patients are accepted independent of ability to pay.

If someone really is broke, then they can qualify for Medicaid -- "never receive a bill for medical care."

For people old enough to be retired, there is Medicare. Part A covers a major fraction of hospital charges and is free. Part B covers physician charges, and is not free, maybe a few $hundred a month. There is another part for drugs.

For poor people, there is the HRSA (Federal Health Resources Services Administration) or some such -- clinics with sliding scale charges based on ability of patients to pay.

It goes on this way. It's a patchwork system. Not all the important details are really clear. E.g., there is a lot of over billing, that is, charging too much, and in this case the insurance company has a talk with the physician/hospital and negotiates lower charges. For drugs, the prices can vary enormously based on whatever.

There has been at least one effort to get the medical providers to publish a price list, i.e., to clear up the lack of cost information.

I don't know all the details, but my understanding is that it is very rare for medical care charges actually to bankrupt someone.

E.g., one approach is for a patient who owes big bucks to pay, say, $10 a month for 6 years -- then by laws of debts, the rest owed is forgiven, that is, not owed.

One way and another, in summary, from 50,000 feet up, generally, the US tries really hard not to have all of medical care run by the Federal government, or any level of government. E.g., there could be a system single payer where the there is only one entity that pays for anything about medical care; of course, that entity likely is run by the Federal government and gets a lot of tax money. Single payer has been proposed 220,872,879 times and rejected by that many times.

Some of the scare is that single payer would result in some or all of (a) taxes way too high, (b) too much just wasteful, silly, and unneeded medical care, (c) low quality of care and, thus, too many people hurt or dead, (d) too little capacity where too many patients die from waiting too long for care, etc. I don't know what if anything is right/wrong with (a) -- (d), but these are concerns commonly voiced.

Maybe the US could borrow from, at least learn from, Switzerland, England, ....

But actually bankrupt from just losing a job? I suspect that is actually not very common.

Oh, by the way, if fired, then commonly get to continue medical insurance coverage for some length of time.

[beckman466]

> Oh, by the way, if fired, then commonly get to continue medical insurance coverage for some length of time.

tell me then, why do a bunch of my US friends not have health insurance? even the ones who left their jobs during the pandemic?

to be frank, it sounds like your income is too high for you to actually know what happens when dealing with this 'patchwork' (as you call it) shitshow system in real life, to try to get the care you need to survive.

> Some of the scare is that single payer would result in some or all of (a) taxes way too high, (b) too much just wasteful, silly, and unneeded medical care, (c) low quality of care and, thus, too many people hurt or dead, (d) too little capacity where too many patients die from waiting too long for care, etc. I don't know what if anything is right/wrong with (a) -- (d), but these are concerns commonly voiced.

why state all these downsides and try to play this sort of 'neutral' card by saying "I don't know what if anything is right/wrong"? all of these so called reasons (or fears/scares) are just completely irrelevant when we can see that all other global north nations have single payer systems.

let me repeat that: the US is the only country that doesn't provide universal healthcare to the working class.

can you help me understand why you posted this comment? to me it just looks like a laundry list of the many failed strategies used by the US govt and huge pharmaceutical corporations that have helped them scam the working class out of trillions of dollars in the form of medical debt and pharmaceutical drugs, etc.. i could probably find all this on some wikipedia page about the history of the US medical care system.

[graycat]

beckman466:

On your post

https://news.ycombinator.com/item?id=29474353

> tell me then, why do a bunch of my US friends not have health insurance? even the ones who left their jobs during the pandemic?

I don't know anything about the circumstances of your friends.

> to be frank, it sounds like your income is too high for you to actually know what happens when dealing with this 'patchwork' (as you call it) shitshow system in real life, to try to get the care you need to survive.

Without going into my "income", it turns out I know something about the US HRSA system: They run clinics that can do well providing primary care and then can refer patients to more advanced care when needed.

Charges vary but generally are low: At a clinic, the really poor pay nothing. If they have a little money, maybe the cost is $20 a visit. With a little more, the cost is $75 a visit.

> can you help me understand why you posted this comment?

I was responding to user

try_again

and their post at

https://news.ycombinator.com/item?id=29472346

with in part:

> If that's a correct guess, as a European the US work standards frighten me. Health insurance so tightly coupled to work that if you get into an accident shortly after being laid off and don't have (expensive) private insurance you could be bankrupted by it.

So, I wanted to add some information to the issue of "bankrupted by it".

For your

> why state all these downsides and try to play this sort of 'neutral' card by saying "I don't know what if anything is right/wrong"? all of these so called reasons (or fears/scares) are just completely irrelevant when we can see that all other global north nations have single payer systems.

The "fears/scares" I listed really are "commonly voiced". Soooo, take this list as the POLITICAL answer to why the US does not have single payer, etc., not the rational, economic, financial, moral, medical, etc. but just the POLITICAL answer for the post of user

beckman466

at

https://news.ycombinator.com/item?id=29474353

Or can't give a good, rational answer to

beckman466

using only what is rational, economic, financial, moral, medical, etc. and instead must at least include some of the politics. Here define politics as using false information, cherry picking evidence, quotes out of context, lies, manipulation to fool people!

[vertak]

This was an informative counter-argument to what I normally read about US healthcare, thanks for taking the time to share this info.

This site gives several survey findings related to medical bankruptcy. The data is complex and conflicting at times (like you would expect given something as complex as 300+ million people’s healthcare) but the number that the stats seem to fluctuate around is 1 million people. 1 million people declare bankruptcy a year due to medical-related costs. That’s 0.333% per year.

So there are a lot of people (1 million if you believe the data in that link) per year being affected by this.

[TheRealDunkirk]

Medical reasons are now the leading cause of bankruptcy. (https://www.investopedia.com/financial-edge/0310/top-5-reaso... -> 66.5%)

Half of all GoFundMe's are now medical-expense related.

These are absolutely indefensible statistics about our current system. Literally, anything else (already in use in other countries) would be better.