[sixhobbits]

Compared to Europe there is more upside and downside risk in the US. You can earn more but you are more likely to be financially wiped out if you get cancer or have an accident (high medical costs). Most countries in Europe have more social support built in at every level, not just healthcare, so its unusual to go from living comfortably to being on the street. Some argue the US way is good (more downward mobility is necessary for a lot of upward mobility) but it also leads to a lot of survivorship bias. The people who fall off do not get talked about much

[blackhaz]

I live in London. Developed a persistent headache which goes on for a few months already. Just got appointment to a neurologist for August 2023. Today is September 2022. Although, is UK in Europe?...

[badpun]

Yep, that's how the coveted socialized health care system looks like in practice in many European countries. Sometimes the queue is short and you can use it. Sometimes it's not and you go to a private doctor instead. Sometimes, the nececessary drug is refunded and you get it for nearly free. Other times it's not and you buy it out of pocket. If it happens to be expensive, it will bankrupt your family just the same (or, more often, just die instead, because you don't want to do that to your family for an off chance of surviving the illness).

[thephyber]

Anecdote: my friend in Silicon Valley is having debilitating headaches and her soonest (employer sponsored health insurance) neurologist appointment was 4 months away.

“The” US health care system in practice is extremely broken unless you have a concierge doctor or you donated enough to get your name on a hospital wing. Rural areas of the US are losing access as hospitals have been closing and urban/suburban areas have seen hospital consolidation. Our system is not an envy of the world, despite the marketing that makes so many people think that.

[brnt]

> Yep, that's how the coveted socialized health care system looks like in practice in many European countries.

The NHS really stands out negatively in Europe, no matter how great the Brits think it is. Unfortunately, English-speakers living where they do, this is not really voiced in the English press. Out of all of the Anglophonic world, yes, the NHS is probably the best.

[nabogh]

Australian healthcare is pretty good. NHS sounds much worse to me but I've only heard horror stories.

[wbsss4412]

Meanwhile my friend here I’m the US has to wait until may 2023 to see a dermatologist.

Long wait times exist in the US as well, we just like to pretend that it’s a socialized medicine thing.

[credit_guy]

Yes, but it's most likely a top dermatologist. There are lots of dermatologists around. For the first visit, it's normal to have to wait one or two months. Almost one year is definitely not normal.

[wbsss4412]

> Yes, but it's most likely a top dermatologist.

It is not. It is a dermatologist.

> Almost one year is definitely not normal.

I would like to believe that too, but I don’t know what to tell you.

[p1esk]

How many dermatologists have you called before giving up and agreeing to wait until May? In my experience it takes 3-5 calls to find someone willing to see me within a few days.

[SamReidHughes]

This is not the experience of my family members.

[quickthrower2]

Sounds typical UK. But, how much is your health insurance costing, and could you land a $500,000 bill if you go to the wrong hospital?

[blackhaz]

Costs nothing if I'm dead, I guess.

[Scoundreller]

No longer, because 350 million pounds a week was being diverted from the NHS into Brussels.

[beardyw]

The pitch was the other way around, that £350 million going into the EU (if you believe that figure) could go to the NHS (it won't).

[dna_polymerase]

According to a big red bus.

[whiddershins]

No, if you have health insurance this isn't true. None of this is how it actually is in the US. Outside of addicts and the severely mentally ill it is rare to "fall off" middle class status.

[thephyber]

note this comment is likely very misleading.

> According to a study published in February 2019, about 530,000 bankruptcies filed annually are because of debt accrued due to a medical illness. The study found that even the Obama administration’s landmark Affordable Care Act (known as Obamacare) has failed to change the proportion of bankruptcies caused by medical debts, with poor health insurance cited as one of the main culprits.[1]

530k households into medical bankruptcy annually from medical costs in a country with 123,600k households. In 30 years, that would be more than 10% of the country, on average.

[1] https://theguardian.com/us-news/2019/nov/14/health-insurance...

[0xBDB]

If 92% of American households have health insurance, which they do, and by law there is an annual out-of-pocket maximum on health insurance, which there is, I find it somewhat unlikely that 10% of the country will be medically bankrupt in a generation.

I'm not saying it's impossible to go bankrupt on a capped 10k of medical bills, given that so many Americans live paycheck to paycheck. But if it happens there may be confounding factors. Or, you know, it's possible people facing bankruptcy have some incentive to exaggerate to a federal judge the reason they're standing there.

[thephyber]

You aren’t being creative enough.

Health insurance companies know about the annual caps and have strong incentives to deny as many costs as uncovered as possible. The out-of-pocket maximums only apply to covered costs. There are lots of costs that health insurance companies deny coverage for: - Incidents that the covered think are emergencies, but the insurer thinks aren’t. - Any time the insured doesn’t follow the policy procedures, such as visiting a specialist without first getting a recommendation from their primary care physician - Out of network providers. - Claims received after the insurer says the policy is cancelled

And there are dozens of reasons related to ineptitude (bad coding, mistyping, lack of cost transparency).

a blog article listing the top 10 types: https://mbamedical.com/blog/8-reasons-why-your-insurance-cla...

[0xBDB]

That's true, though as another comment in this thread points out I still don't think the math works. But also it doesn't seem to be what that study found:

"A new study from academic researchers found that 66.5 percent of all bankruptcies were tied to medical issues —either because of high costs for care or time out of work. An estimated 530,000 families turn to bankruptcy each year because of medical issues and bills, the research found."

So to compare the U.S. to Europe we'd need to know how many are due to bills, which only really happens in the U.S., and how many are due to being out of work due to medical issues, which happens everywhere and apparently causes 8.2% of bankruptcies in the U.K., for example.

https://balancingeverything.com/medical-bankruptcies-statist...

[TMWNN]

>> According to a study published in February 2019, about 530,000 bankruptcies filed annually are because of debt accrued due to a medical illness.

That's the same bogus study that Elizabeth Warren has been pushing for years, which attributes any bankruptcy in which medical bills are involved to mean that medical bills caused the bankruptcy. Only 4% of US bankruptcies are because of medical bills <https://www.washingtonpost.com/blogs/post-partisan/wp/2018/0...>. A tipoff that [insert large percentage here] of bankruptcies aren't actually because of medical costs is that only 6% of bankruptcies by those without health insurance are because of that cause. The biggest cause of bankruptcies is lack of income, which health insurance doesn't affect.

[thephyber]

You bring an interesting point. I completely admit that I didn’t research the source of the study or any refutations of it.

> The biggest cause of bankruptcies is lack of income, which health insurance doesn't affect.

An obvious counter observation: Isn’t an extended medical issue likely to cause a person to lose their job and health insurance?

Remember that in the USA most health insurance is company sponsored. When you lose your job, you either pay premiums at COBRA rates or you lose coverage.

And although it is illegal, companies do fire people (or find creative substitutes) for employees who are very expensive to cover.

[TMWNN]

>An obvious counter observation: Isn’t an extended medical issue likely to cause a person to lose their job and health insurance?

You are correct in that most US health insurance is tied to employment. But the discussion point was the claim that "[insert high percentage here] of US bankruptcies are because of medical bills".

Any illness, extended long enough, is going to cause people to lose their jobs, whether in the US or elsewhere. Certainly any illness long enough to exhaust COBRA coverage. That said, in the US that's where Medicaid will step in, assuming that the loss of income is sufficient to trigger Medicaid's income-based eligibility.

[thephyber]

If you have an illness long enough to lose your job and your health insurance, you probably aren’t able to pay all of your bills. Hence medical bills are likely a distal cause.

[molotovh]

And for the kind of jobs we're talking about (outside of maybe start-ups that haven't got benefits figured out quite yet), the commercial insurance offered by employers tends to be quite good. As a personal anecdote, my wife has a union job and I do not. She switched to my healthcare insurance because the benefits were better than what the union offered. (In a pure analysis, my job is technically less secure, but realistically I am in no danger of losing it. When correctly managed, increased risks yield increased rewards.)