[beezlebroxxxxxx]

> That’s a financial product, not a medical one.

It often goes unsaid, but America, on a cultural and political level, is really ideologically fixated on a distinction between working and non-working individuals, and, in a far deeper sense, whether an individual "deserves" healthcare or not. This makes access to healthcare intricately connected to class, wealth, and income, in America. That's why access to healthcare is seen as a product in and of itself. You can either afford it ("you've earned it"), or you go into debt for it ("you have to earn it"), or you simply have no expectation of ever paying for it ("you cheated the system").

The entire conversation is often dominated by these ideas in a way that often makes talking about healthcare with Americans baffling to people that come from many single-payer or universal systems.

[somerandomqaguy]

To a degree. You have to keep in mind that a hospital emergency room isn't legally permitted to turn you away even if you can't pay under the Emergency Medical Treatment and Active Labor Act.

So the wealthy and insured are covered. The lowest rungs and those that don't care and will just run away are covered. It's mostly lower / middle lower class that this really hurts, ironically.

[FireBeyond]

> The lowest rungs and those that don't care and will just run away are covered.

They're really not. They are only entitled to "stabilizing care".

I work as a paramedic. We have had situations with "frequent fliers" where when we've called the hospital to give a report as we are transporting, the hospital will say "let us know when you're here", and when we've done so, there's literally been a physician come out to the ambulance.

"Hey, X, what's happening?"

"I got a lot of fluid in my gut (he had ascites)."

"Okay, well, that's not new, and it looks like you have an appointment for having that fluid drawn in two days."

"Oh, okay."

"Anything else bothering you?"

"Nope."

"Alright, we're good then." Gives us a nod.

"We're going in then?"

"Uh, no. You have been by a physician, you're stable, you're good to go, you can jump off their gurney and head home now."

Which is harsh - but also this person at this point was being transported 4+ times _per day_.

But EMTALA only requires acute stabilizing care, not definitive management.

[coffeecat]

I think your premise is flawed. In America, the access-to-healthcare versus income curve is U-shaped.

If you have literally no income (or your income is entirely "off the books"), then you qualify for medicaid; everything is covered with no premiums, copays, or deductibles. At a middle-class level of income, you're probably looking at either a comparatively shitty ACA marketplace plan, or a comparatively shitty employer-provided HDHP plan. At an upper-class level of income, you can afford top-of-the-line healthcare.

[xdfgh1112]

I get this feeling a lot. For example the UK typically has unlimited paid sick days for salaried jobs, while I have heard of US employees pooling together and "donating" sick days to someone. The UK has a ton of benefits for the sick, unemployed, single mothers, carers etc. in the US I am sure those exist but I get the sense that charity is supposed to play more of a role.

[xp84]

FYI it’s not common to allow sick days to be transferable.

TBH I think in the US it’s more than anything about how much more competitive industries here are vs in the UK. If X company feels it’s worth the extra cost by allowing unlimited PTO and 2 years of parental leave, etc. the worry is that X will be trounced by Y Company, who is ruthless enough to not offer those things and as such has much cheaper labor costs.

If you take an industry like retail, those companies have a point - Walmart and Amazon offer low benefits compared to what companies once offered. Their lower prices are part of how they killed off most of the department stores and put the rest on life support.

And if you think about a highly paid job, even though our fringe benefits suck compared to Europe style, my impression is that US salaries are higher for equivalent jobs, enough that it makes up for it. So we value the money more than we would the benefits, apparently. Only problem is you can’t use all that money to buy more time with your family (except for by taking breaks between jobs, if you’re good at saving!)

[miki123211]

Be aware that in many single-payer systems, insurance is also tied to working (or unemployment / retirement / pensions).

In my opinion, this is actually the reason for why we have so little innovation in Europe.

Mandatory, single-payer insurance very significantly raises the cost to be self-employed / have a sole proprietorship, which you practically need to run any side project that you want to eventually make money from. This means that if you launch a startup, you either need it to be profitable on day one, or you're vasting significant amounts of your money, not just your time.

[tsimionescu]

> Be aware that in many single-payer systems, insurance is also tied to working (or unemployment / retirement / pensions).

This is true.

> This means that if you launch a startup, you either need it to be profitable on day one, or you're vasting significant amounts of your money, not just your time.

This is a false dichotomy. First of all, even ignoring health-care, you're still spending money on housing, food, electricity etc. If you're not employed and your startup is not profitable, you're paying money out of pocket to live.

Second of all, even in the USA, you are still going to pay for health insurance even if you are currently founding a startup. You could argue you are allowed to gamble that our health is good enough that you don't need health insurance for a few years, but that's just tossing coins. You could just as well not pay your taxes in the EU for a year or two, and gamble that the authorities will not catch on right away.

[xp84]

I don’t get it, why is a self-employed person paying so much more than others for single payer healthcare where you are? That sounds exactly like the USA where those not employed as a normal full-time employee pay the most for equivalent insurance, so people here definitely do stay at their regular jobs instead of quitting to found a startup. Insurance outside of those group plans is even more expensive than the already shocking normal cost, and of course normal full time employment (what we call W-2 jobs) usually provides a generous healthcare subsidy.

[miki123211]

Because healthcare is often paid per "working relationship", so if you work for a company and are doing something on the side, you have to pay twice, and the second fee comes out of your pocket.

[thayne]

Living in America, I have never met anyone who doesn't think our health care system is a complete mess. That includes doctors, nurses, people who work in HR, and people on both sides of the political spectrum. There is however disagreement about how it should be fixed. But from what I've seen that disagreement isn't about whether people who don't get insurance from their employer "cheated the system", it's about whether the system should be controlled by the state or private companies.

[LtWorf]

You can praise/blame the puritans for this weird idea.