[tptacek]

Here is a list, I feel like it's fairly representative, of conditions that will generate an "automatic decline" for a regional health insurer. I chose it because it was the first on the Google SERP; I can be more rigorous if I need to be:

http://echealthinsurance.com/health-insurance-advisor/wp-con...

The fun stuff starts on age 18.

A huge number of Americans have conditions with a "D" in the right-hand column, which is "automatic decline coverage". Many of those people cannot get insurance on the private market at any cost.

Why do you have a hard time believing that our health care system needlessly bankrupts people?

Is it something along the lines of, "there is a savvy way to negotiate this system without having health insurance"? I'm prepared to concede that someone knows someone who's mom paid pennies on the dollar for care by playing hardball with providers. I just don't think that's a viable solution to the problem overall; providers will more often than not just send the bills to collections.

[lotharbot]

I submit that the system does needlessly bankrupt some people, but there are also a number of alternatives which allow a large percentage of the uninsured to avoid such a fate.

If I may submit two personal stories in place of rigorous data:

my incredibly poor sister recently injured herself and was facing nominal charges of about $40,000. She was able to get that written down to a few grand and then get donations from family, friends, and charities to cover her bills. She didn't have to "play hardball"; she just explained her situation and the hospital bent over backwards to help her. The hospital staff treated it as a routine occurrence.

My wife and I do not have health insurance at all. We use something called "Christian Healthcare Ministries" [0] which is not insurance, and (at our level of participation) doesn't cover routine visits or small problems, but covers us in case of conditions that might otherwise bankrupt us. So while I personally cannot get insurance on the open market, and routinely get counted in the "not insured" category, I still have coverage.

(Note that I'm not defending the US health care system overall, just introducing some information about alternatives that help people avoid bankruptcy.)

[0] https://www.chministries.org/

[Retric]

They might not call it heath insurance, but it still is de facto heath insurance. Also, nominal charges of 40k is small potatoes in the healthcare world, that can literally be a few days of moderate care in some hospitals. However, a lot of medical bankruptcys are around end of life care, where medicare forces people to 'go broke' before picking up the rest of the tab.

PS: I have awesome medical coverage, that limits out of pocket expenses to 2k per year with an unlimited sealing. However, many plans cap lifetime expenditures to 1million in coverage because people really do spend that much and far more.

[lotharbot]

> "it still is de facto heath insurance"

But without "automatic decline" conditions, which were critical to tptacek's point.

> "nominal charges of 40k is small potatoes"

Sure. But the cover story of CHM's latest newsletter [0] is a woman with a $300k bill that was reduced to $20k. Elsewhere in the newsletter is a request for donations to cover about $60k of a bill that has had $200k of reductions. There are, occasionally, bills that break the $1 million mark, though they usually come with reductions in the $500k+ range. Point being, very substantial reductions and charitable donations are common.

Again, I'm not specifically defending the status quo. I'm just saying, there are definitely options that allow some people with pre-existing conditions or catastrophic illness to avoid bankruptcy.

[0] https://www.chministries.org/downloads/newsletters/CHMSeptem...

[yummyfajitas]

Why do you have a hard time believing that our health care system needlessly bankrupts people?

I'd like to see good evidence that it's a significant problem. You haven't provided any. No one I've asked has provided any, beyond Elizabeth Warren's study and the claim that it's "obvious".

As for "savvy way", it's paying in cash, up front. Prices magically drop when payment is convenient. In my experience, and those of the many uninsured people I know, it's that simple. I'm going to speculate that you don't know very many uninsured people...

(Sadly, there is little data on this. If you have some, I'd love to see it.)