The uninsured. The underinsured. People on the "wrong" insurance plan. People without the budget slack for $100s or $1000s per month for the medication they need. Poor people who don't bother going to the doctor to get needed prescriptions because they can't afford the initial visit. Rich people whose doctors fail to mention the drug that costs $250k because no past patients cleared for it could afford it. People going to the doctor who gets financial kickbacks from the inferior drug's drugmaker. People prescribed drugs that kill them.
If your question was actually serious, this is a non-exhaustive list.
When the GP said "basic medicines", they probably meant all the generic stuff that can be had without insurance for a few dollars; all the stuff that is on the WHO list of essential medicines[0], that is.
I'd venture that drugs that cost hundreds of dollars or more per month in the US are all cutting-edge stuff. I mean, sure, you have stories of people getting charged $10 for a pill of acetaminophen at a hospital, but that's a separate matter unrelated to the fact that you can get a bottle of 500 pills for single-digit dollars at your local Walmart.
> The uninsured. The underinsured. People on the "wrong" insurance plan.
Plenty to criticize about the US healthcare system, but let's remember that countries with nationalized medical care also suffer from their own ills, mainly in the form of long wait times. Ultimately, no place has enough doctors per capita that every sick person can be treated promptly and cheaply; so care must be gated one way or another. In America, you pay with money; in most other countries, you pay with time.
The WHO list of essential medicines is not just over-the-counter drugs. It includes things like the chemotherapy drug cisplatin. I happened to need that for testicular cancer ~10 years ago, and the treatment cost was $50k (as "payed" by insurance). That overall seems pretty reasonable to me for the treatment I received, but definitely not something I'd expect the median American to be able to pay out of pocket.
The median American would not have to pay out of pocket, as nearly every American has health insurance (since the ACA, it is actually illegal not to have insurance).
I think it's accurate to say that the median American is insured, with only 8% of the population uninsured [1]. Although, to put that percentage in perspective, that's 26 million people and likely thousands in excess mortality relative to the insured poplulation.
I believe you're referring to the ACA's "individual mandate", which imposed a federal tax penalty for being uninsured. I won't argue whether that makes it illegal or not, but I can say that the individual madate was eliminated by the Tax Cuts and Jobs Act in 2019 [1]. There's no longer a federal tax penality for being uninsured.
This is purely anecdotal, but of that 8% (26 million), I would posit that most of those people are uninsured by choice. e.g., probably mostly young, maybe part-time workers without chronic illnesses.
I find it amusing that people are basically advocating for the government to become every citizen's Medical Daddy (the GP of this comment) backed by the threat of state violence in a thread that is ostensibly about freedom from the security state.
My question is serious. The US Government spends $2 trillion per year for health care for the poor and the elderly, and also spends a significant amount for for tax credits for health insurance for those that are neither poor or elderly. Furthermore, hospitals always treat regardless of the ability to pay.
How many more $ trillions and how many fascist medical bureaucracies would achieve your ends comrade?
I am not a fan of the American healthcare system. Navigating it takes brains and effort that shouldn't be required. But if you have them it is essentially not possible to die here from lack of healthcare, and it's possible but surprisingly difficult to go bankrupt (except from lost wages, which is also a leading cause of bankruptcy in the UK).
Yes, so this is where the brains and effort (and time, forgot time) come in.
The anecdotes in your links (that I read - can't get through all of them right now) have a common theme, which is that people died because they either needed very expensive and/or experimental treatment that probably would not be affordably provided to them under any plausible healthcare system, or else they got a bill, decided they couldn't pay it, and did without or tried to self-ration their healthcare.
The correct course of action in that case is to call the healthcare provider and negotiate A) a 90+% discount and B) a payment plan, both of which are pretty readily available in the American system. You have to know that's possible, and you shouldn't have to, but it is possible. Then you reach out to the charities, government programs, and/or nonprofits from my original link to cover what you still can't afford. Same deal if you get screwed by an insurance company as in the Guardian article.
This is, again, not something I'm trying to defend. It's not the way a sane healthcare system would run. But it is a system that works, more or less, for those who know how to work within it.
The anecdotes show that this is not an 'occasional' or 'edge case' thing but a systemic thing. The statistics show that at least 40,000 people die a year for not having enough money for healthcare and these are the people we know. The statistics don't include those who never go to the hospital to avoid risking medical bankruptcy for their families even if they die themselves. Just being in a hospital bed for one night without anything being done costs $3000/night, whereas waiting in the ER without anything being done can cost $100/hour.
This is a systemic thing. Its not 'not a sane healthcare system'. Its literally a machine that kills people to maximize profit. And it became like this only because people let it and justified this or that other thing in the system.
> Just being in a hospital bed for one night without anything being done costs $3000/night
No, it doesn't. It costs whatever you can negotiate it to cost. I've been without insurance; one experience isn't data, but in my experience just telling the hospital you haven't got insurance is, again, good for 90+% off by itself.
Hospitals (ed: non-profit ones, but I'm pretty sure similar rules apply elsewhere) in particular are required by federal law to have 'well-publicized' financial assistance policies.
> Its literally a machine that kills people to maximize profit.
If that were true it would do a good job of maximizing profit. It's not even that good. Healthcare margins in the U.S. are 0.7%, which sucks. If you're the proverbial evil billionaire or whatever you'd rather own almost anything else.
It's not like mental health problems are fringe lately.
It feels to me like you're speaking as though you are in the middle of the bell curve, but from my perspective people who can navigate this system are an exception.
That whole EpiPen debacle springs to mind... I'm sure if you looked into it you'd find other examples of basic medicines being unavailable to large sectors of the population purely due to the cost.
There are many people that don't qualify for free health care (and some that do!) but can't afford co-pays and co-insurance, and must go without that medicine.
If your question was actually serious, this is a non-exhaustive list.