Put it this way: like 70,000 people die in the US each year from lack of healthcare due to the cost.

Health insurance is a profit-driven industry, so denying claims for those that DO have health insurance is standard practice.

Most don’t see an actual physician. The average clinic visit takes about two hours after everything is said and done; you engage with a health professional a median of 12 minutes.

People drive themselves in serious medical distress or try to take an uber to the hospital instead of an ambulance.

Doctors themselves hate the medical system in the United States.

Nurses are fleeing the industry. Projected shortage of 80,000 nurses in 2025. “About 100,000 registered nurses left the workforce during the past two years due to stress, burnout and retirements, and another 610,388 reported an intent to leave by 2027.” This while baby boomers consume more and more medical resources as they age.

Medical bills are the #1 cause of bankruptcy.

So, it’s not great, no.

I’ll put it this way:

At least 68,000 Americans die every single year due to not being able to afford healthcare.

We pay an extra $450 BILLION annually to enrich unnecessary middlemen and ALL of our politicians are being bribed (or primaried) to prevent Single Payer. You’ll hear people like Kamala and Warren talk about “access” to healthcare while they receive massive bribes from healthcare companies to pull support away from Single Payer and offer a “choice” or “access to health care”. Remember 2016 and 2020? The DNC pulled out all stops to prevent Single Payer. Remember when Bloomberg ran for office and claimed , “under my governorship, New York had less uninsured people than at any time in history” while failing to mention that he enacted steep penalties for being uninsured? That’s neoliberal gaslighting 101! Kamala loves to do it too! But yeah vote for her because she’s “one of the good guys” and certainly wasn’t one of the people that was tasked with preventing Bernie Sanders from winning the primary two cycles in a row, offering “Medicare for All who want it” so stacked with asterisks and legalese means-testing that probably like 50 people would qualify.

Edit: In my opinion, anyone who is paid to run for office and vote against Single Payer is a murderer guilty of (or at least partly responsible for) the slow, often-painful execution of these 68,000 American citizens per year.

I have student loans that I’d love forgiven but I don’t even mention that issue because true Single Payer (and Gaza obviously) are my moral lines in the sand that almost everyone in Congress except Rashida Tlaib has brazenly trampled.

https://www.newsweek.com/medicare-all-would-save-450-billion-annually-while-preventing-68000-deaths-new-study-shows-1487862

https://www.sanders.senate.gov/wp-content/uploads/Fact-Sheet_Medicare-for-All-2023.pdf

You may have heard about “Obamacare” or the “Affordable Care Act”. This did a lot of things which helped some but also did not do much.

For example, insurance premiums can cost hundreds of dollars per month, but if you get subsidies you can reduce that cost down to, potentially, zero. Unfortunately these subsidies are in the form of tax credits, which means if you don’t work you do not get any subsidies.

Additionally, if you happen to live in a red state, then your state probably didn’t expand Medicaid. Medicaid is the government insurance for poor people. If your state didn’t expand it, then your state only gives Medicaid to families and disabled people (basically). So if you don’t have kids, you don’t qualify for it.

For me, this means that when I stopped working and got insurance through the ACA, I had to pay $500 per month in health insurance premiums (dental and vision are separate insurance plans and not typically covered in standard health insurance). Did I mention this was while I wasn’t working?

With that $500 per month, I still had a $900 deductible (so I had to pay $900 before the insurance company would pay anything). After that $900, my insurance company paid different rates depending on the service (often called coinsurance). A common percentage is 80/20, which means insurance will pay 80% and you will pay 20%. So hospital bills tend to be thousands of dollars. BUT insurance plans also have what’s called an “out of pocket max” which means your insurance will cover services at 100%. So any medical things you do after that magic number are basically free for you (you still have to pay the premium).

Ok, but you might have also heard that elderly folks have their own government insurance - called Medicare. Medicare is also available for disabled people like me.

Medicare is confusing AF. It has multiple parts to it - I will only talk about what’s called “traditional Medicare”, which basically means everything is between you and the government (There’s other Medicare plans through private insurance companies, and those plans are similar to what I described above).

So with traditional Medicare there’s Part A (hospital), Part B (basically outpatient services), and Part D (prescriptions). Part A is free for most people, part B currently costs about $75 per month, and part D varies but is much like the private insurance above. If you only have part A, then only hospital visits will be covered. If you only have A and B, then none of your medications will be covered! It sucks.

So remember how I said about the deductibles and coinsurance? So Medicare has their deductibles and coinsurance separate for each part! For my part A, if I go to the hospital, it comes out to about $1300 per DAY, but only for short hospital stays. Oh and that’s only for room and board. Longer hospital stays have different rates. Also, if you stay in the hospital too long, it starts going against your lifetime hospital days. That’s right, if you use up all your lifetime hospital days, then Medicare will just…not cover your hospitalization anymore. Ever. For the rest of your life!

And don’t forget you still have to pay extra for any imaging, medications, and doctor visits you had while in the hospital because the daily rate is basically for the bed.

Part B is a straight 80/20 coinsurance. But part B also doesn’t have an out of pocket maximum. So if you have a lot of outpatient procedures, then you will end up paying out the nose for it. Currently I basically just end up paying around $30 for each doctor’s appointment (not including lab work or any procedures).

Part D depends on what plan you get. Mine was basically 80/20, which means I was going to have to pay outrageous amounts for medications! I’m on like 25 medications and it was going to be hundreds of dollars each month just for the prescriptions. Luckily, we have programs like GoodRx! Which is basically a coupon but for medications. Unfortunately, you can’t use insurance if you use GoodRx. Also, the pharmacy won’t usually automatically compare the prices to see which method would come out cheaper for the patient. Oh, also, each pharmacy has a different price for the same medication! I’m not even talking a few dollars. Some medications can be hundreds of dollars different in pricing depending on which pharmacy you go to! And it’s not consistent either. So basically if you’re on Medicare you get to go on GoodRx every month for each prescription and see where you can get it the cheapest at and then either ask your doc to send it there or try to get it transferred. Imagine doing that with 25 prescriptions every single month!

Luckily for me, I qualify for what’s called “Extra Help.” This program pays for my Part B premium ($75) as well as part of my part D premium (it was about $100 but with the help it’s down to $75). They also bring all my prescription costs to $1.55 per medication per month. Unless it’s a brand name medication… 😬

If you’re following, when I had private insurance I was paying $500 per month in premiums alone, plus about $50-100 per month in doctor’s visits, plus about $50-100 per month in prescriptions until I met my out of pocket maximum. Then just the premium.

Nowadays, I have Medicare + Extra Help. So I pay $75 per month for my prescription premiums, plus currently about $200/month in doctor’s visits, plus about $50/month in prescriptions. So it comes out cheaper currently but if I have to go to the hospital again…well, I’m fucked.

By the way, most insurance plans do not have out of network coverage…so if you go somewhere that doesn’t have a contract with your insurance company then you will probably have to foot the bill. And a lot of the charity programs that hospitals and doctors have won’t let you apply if you have insurance soooooooooooo…

A few years ago, I went to a treatment center for a few months. My total bill was almost $200,000. My personal portion was supposed to be around $15,000. Did I mention I wasn’t working? Right. Luckily the treatment center enjoys the tax benefits they get when they write off people’s bills, because they wrote mine off. I still had to file for bankruptcy though, because that wasn’t my only medical bill.

PS insurance is often provided by your job here so if you lose your job you, at maximum, have until the end of the month with your insurance :) so don’t quit your job at the end of the month ;) there is a thing called COBRA which is supposed to bridge the gap between jobs, but it’s usually something ridiculously expensive like $700 per month for a single person’s premium (yeah, you have to pay more premiums if you want your spouse and/or kids to be covered).

For a real example, my 10 year old swallowed a button battery (yes she should know better). Of course we went to the pediatric ER immediately. She was seen by a doctor, got some X-rays, then puked the battery out. She’s totally fine. In the end I’m paying about $2000 out of pocket for that. That’s on top of the monthly premiums I and my employer pay.

My premiums are about $280 per month for health, dental and vision for me and my kids. Premiums are pre-tax so there’s a bit of savings there. My employer pays about $1100 per month on top of what I pay. My wife is on her employers plan because they would charge about triple that for all of us to be in the same plan. that’s about $100 per month for her.

On top of that I have a special pre-tax savings account for health expenses only called a Flexible Spending Account, which helps a bit but it’s kinda silly and not very flexible. I have to determine at the beginning of each year how much I might spend that year, then that amount will be taken automatically out of my checks. If I don’t spend it all, it’s gone.

I really recommend this video to understand (or not) the complexity of the US health care system https://youtu.be/-wpHszfnJns?si=Wi48w7TCkETdIUQQ

I read something from last year that said about half a million Americans go into bankruptcy due to medical debt each year.

That’s it, that’s what happens. You lose everything and you start over, if you’re healthy enough.

Protect your NHS.

I started a new job this week, in the US, and for a family of four I’m going to pay $30,000 per year in premiums…only premiums.

$896 per month in premiums, and about $18k out of pocket so far this year in addition. Me and two kids.

I paid about $1750 in insurance premiums last year and an additional $9,000 in deductibles. This year should be a little more in premiums and hopefully, just $7500 in deductibles. (Wife was treated for cancer last year and had reconstructive surgery this year. I had a routine colonoscopy for the higher expense that I won’t need again for a few years. )

My insurance is probably better than most since my employer is huge.

This last winter I was unemployed and I got sick enough to need antibiotics.

I couldn’t prove that I didn’t have a job, so the ‘sliding scale clinic’ charged me $586 to talk to someone (not a doctor). I knew what I needed. I was forced to take an unnecessary STD test ($180) and to promise I would go in for additional testing and scanning (undisclosed price, to be determined AFTER).

The meds were around $40 for a week of pills (15 pills).

I knew my issue, and just needed a prescription for the antibiotics.

I have a job now. They want about $200 a month for the basic coverage. I have on average, $20-$30 at the end of the pay period. So I could get insurance, but it means skipping more meals (I already skip several a week to save money).

So I just hope nothing ever goes wrong because if it does, I’ll need to be close to death before I get help that will take me years to pay for.

You either have a good job, or you have to choose between not getting medical attention or being chased around your entire life over medical debt. Be prepared to flee the country if the latter.

We pay $500 a month for family “health care” because we’re forced to. Every doctor visit I go to I get a $40 bill just for walking in the door, on top of paying for my medicine copays. It really sucks.

Consider that most Americans are pay 2x to 5x more in insurance premiums each month than folks in the 32 other developed nations with national healthcare coverage pay monthly in taxes for health care. Consider that Americans still pay deductibles and copays. Consider that insurance won’t cover pre-existing conditions (which are many). Consider the insurance frequently denies claims and requests for further tests and specialists. Consider that most insurance only works within the limited network of the insurance companies designated healthcare providers.

I work a multinational company that has moved staff from Japan, Canada, and the UK to the USA for periods of work. All of these folks were shocked and horrified by the American insurance system.

I’ll give you some anecdotal evidence.

I make okay money. Not great, but I’m not starving. Lower middle class, probably. But I’m a single man, so if I had a family I’d be lower class no question. (This all just to give you an idea of my income without sharing my personal data online, we’re all working class)

I tried getting insurance this year, and the cheapest plan I could find was $700/mo. That means I pay an insurance company $700 every month, whether I go to the doctor or not. Now, if I were going for a general checkup, I’d pay a “copay,” so a base cost for the office visit. Probably $40-$50.

Then, depending on what I get done, tests, lab work, medicine, I’d still probably pay at least a portion of that, the medicine is likely to be discounted.

But then there’s this thing called a “deductible.” That means I have to spend the amount of the deductible in the year out of my own pocket before the insurance company would be paying for anything major. My deductible for this $700/mo plan was something like $7,000. Something like that, $5-$7k. That’s my cost before the insurance company is obligated to pay for anything. Small stuff they’ll probably cover (depending on the doctor I went to…) but before I spend that $7k of my own money in this calendar year, they’re not gonna pay for much of anything, if really anything at all.

So before we get into the absurdity of how much medicinal care costs here, there’s all that insanely stupid system to pay off and figure out.

As you mentioned there is a dance between insurance companies and care providers. You should never pay a bill on the spot or upon first receiving it. Always wait until it says final warning. Often by then the bill has been reduced significantly.

There are many ways for the system to suck. When my wife and I were working it was less expensive for me to be covered by my company’s insurance and her by hers because adding a spouse to one policy was more expensive. This is because when you are working for a company that has a plan (not all provide this) the company usually pitches in on the cost of the insurance. The amount the company pays relative to the employee has typically been shrinking over the years. Combined the two of us paid about $500/month. Now that we are retired it is about $1500/month and the deductible has doubled to about $700 (which as I understand it isn’t too bad). There is also something called a co-pay, which is a small amount you pay for normal office visits regardless of anything else. Ours was $25. Now it is $50.

Coverages were all over the place. For a while we paid more to both be in the same insurance because my wife’s insurance would not cover alternative forms of birth control. My wife could not take the pill because it caused her to get blood clots. Ironically they would have paid (way more) for the birth of a child.

When my wife had a major issue, we found that ambulance services do not negotiate prices with insurance the same way as doctors, if at all. She was airlifted for a cost of $55k. Insurance paid $11k for some reason. The hospital stay (approx. 5 days) was $120k. Her max out-of-pocket was $16k, which we paid. Despite this, the air ambulance service was insisting that we pay the $44k and the insurance company was not budging on this. We had the same problem with the ground ambulance for $1600. This went on for like 2 years while my wife acted as intermediary trying to get the ambulance service to lower their price and the insurance company to raise theirs, figuring that having hit our maximum out-of-pocket meant we were off the hook. Not so. We were expected to pay this. Ultimately we were saved in the end when my wife’s employer paid those bills.

After that, assuming that because we had hit our max, it would be good for me to get my colonoscopy, we wound up paying the whole co-pay and deductible because I was not considered family. Yup, I’m a spouse. Apparently family means children. Why didn’t they say this? Probably to get people to do what I did.

So one of the biggest problems I think is when people don’t have insurance or they do have insurance but no real savings to speak of, they avoid getting health care for fear of the high cost.

In New York a while back there was a viral video of a woman who had her leg trapped between the subway train and the platform and all of the people on the platform teamed up to tilt the entire train a bit to free her. It is an awesome video of humans being kind. What wasn’t as viral was the fact that the woman had just prior to that, pleaded with the people on the platform NOT to call for help because she couldn’t afford it. Very sad for a country with so many resources.

Currently $1700/mo for a very healthy, young, family of three. That comes with a $5000 deductible per person (or maximum out-of-pocket of $13000 for the family).

Oversimplification, but we basically pay $33,400 per year before insurance kicks in to cover costs.

That’s ridiculous, yes. But my last uninsured trip to the ER was for an unbearable stomach pain. The 4 hour visit consisted of a shot of pain killer, a scan that showed nothing, and observation by a couple of nurses during that time. I got a RX for some chalky pill and was told to cut back on NSAIDS and alcohol. Fair enough.

The bill from the hospital was $16,000 for the bed, nurses, and scan. Then there were separate bills for the radiologist and the ER doctor, and some lab work bringing the total to ~$17,500.

I currently do not have insurance because I cannot afford it. People treat me like I’m crazy for being overly cautious about getting COVID-19, but without insurance , I could easily go bankrupt if I get it.

American healthcare is truly awful.