Hey all, I’m British so I don’t really know the ins and outs of the US healthcare system. Apologies for asking what is probably a rather simple question.
So like most of you, I see many posts and gofundmes about people having astronomically high medical bills. Most recently, someone having a $27k bill even after his death.
However, I have an American friend who is quick to point out that apparently nobody actually pays those bills. They’re just some elaborate dance between insurance companies and hospitals. If you don’t have insurance, the cost is lower or removed entirely. Supposedly.
So I’m just asking… How accurate is that? Consider someone without insurance, a minor physical ailment, a neurodivergent mind and no interest in fighting off harassing people for the rest of their life.
How much would such a person expect to pay, out of their own pocket, for things like check ups, x rays, meds, counselling and so on?
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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.
I pay $50/mo and then $25 for appts and $50 for ER visits.
On average they actually spend $12.500 per year (total, PPP adjusted, at leat that’s the number for 2022)
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
You as a Brit spend $5.500 (also adjusted) (And as a bonus, at the same time you’re also expected to live 2.8 years longer than the average American.)
Plus the Brit coverage is universal while the US has a significant number of uninsured. We pay double on average including for those that aren’t covered at all. Even though the long lines myths are overblown for countries with universal care, it is important to remember that in the US a lot of people never get the care and we still have massively long wait lines unless we can afford to be first in line. The wealthy have a fast pass.
it is important to remember that in the US a lot of people never get the care and we still have massively long wait lines unless we can afford to be first in line
This is really important for non-Americans to understand. Yeah there are waits to see specialists and so forth in countries with a public system. We also have waits…but it’s for people who can’t afford the procedure. They have to wait until they can afford it, and if they can’t they simply have to live with their condition indefinitely or until it’s bad enough that they go to the emergency room. People who are uninsured go to the emergency room for everything because, legally speaking, they can’t turn you away. They have to at least diagnose and stabilize you. Because these people are broke, they generally end up not paying the bill, which means everyone else’s costs go up.
You couldn’t devise a worse system if you tried.
I had to go to the emergency room for a staph infection. No insurance. Got billed 4k lol. Even though it’s destroyed my credit, I refuse to pay it. In the US this unpaid bill will fall off of me credit report in 7 years, it’s been 3 thus far. 4 more to go!
Sooner if Biden or Harris can get the legislation hrough
Yeah they’re really CLAMORING to hurt the bottom line of their biggest donors and their entire cabinet. /s
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.sanders.senate.gov/wp-content/uploads/Fact-Sheet_Medicare-for-All-2023.pdf
In 2017, Harris was the first senator to co-sponsor Bernie Sanders’ bill, the Medicare for All Act of 2017. “Here, I’ll break some news,” she said that year at a town hall in Oakland, California. “I intend to co-sponsor the Medicare-for-all bill, because it’s just the right thing to do.” 15 other Democrats eventually joined her.
That bill, if enacted, would have abolished private health insurance for all age groups (including Medicare beneficiaries) and replaced it with a government-run single-payer system to benefit “every individual who is a resident of the United States,” including undocumented immigrants.
https://www.forbes.com/sites/johngoodman/2024/08/13/why-health-policy-problems-rarely-get-solved/?
yeah too neolib, better to stick with Trump, he’ll really get the single payer socialist healthcare going with the fascism and stuff, cause he really cares about people. /s
Going to make another post here, because I want to explain that American’s aren’t entirely irrational with our health care.
I spent time in the UK and the US, and I have to say that FOR ME, my personal, EXTREMELY privileged situation - The US healthcare system is better than the UK NHS. I say this knowing that if I lose my job, or I get a major illness, that could quickly change.
I pay a reasonable percentage of my paycheck for health insurance. I live in a mid sized town, in reasonable driving distance to several major cities, and the company I work is the single largest employer in the area, which means every doctor in this area is “in network” and I don’t have to do any extra paperwork for medical billing.
If I need an MRI for a sports injury, I can get it within a day or two. If I need a CT scan because something unusual comes up on a test, I can get it the same day. If I need surgery for just about any injury, it’ll be done within the week. If I need to talk to an expert, I can drive about 2 hours and get an appointment probably within a month (or less if it is an emergency.)
I will pay $0 additional out of pocket for any of the above… AGAIN, ASSUMING MY SITUATION DOES NOT CHANGE.
My employer, who spends quite a bit on this insurance, very much enjoys this setup. They are the reason that I have this insurance, and I will lose it if I quit.
To be clear, I know there are serious problems with the NHS especially considering waiting times and mental health. I can imagine for a well off, lucky American the quality of care will be much higher than here in the UK.
We have waiting times too, the more elective it is the longer it is.
For my yearly checkup, the first time I went, their first availability was 3 months later. It’s the same time every year now because I book next years appointment at each visit.
I thought I needed a CPAP, I had to wait a week to get the home sleep study equipment and then two more weeks to meet with the doctor. I had a copay of $50 with that doctor but had to buy the CPAP for about $800
I scheduled a vasectomy and it took 3 months for the consult and another 6 for the procedure and it cost $750 out of pocket.
I pay $350/no for my insurance plan which has now has no copays and no coinsurance until I reach my yearly deductible of $3500 (which means I pay 100% of all medical costs before my insurance does anything) and my employer covers about $300/mo. So $7800/yr in total to basically just have protection in case a major accident happens.
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.
That is completely terrifying. You must be spending a large part of your life desperately dealing with medical bills and trying to juggle the unreasonable requirements of the various parties.
And of course, having health insurance through an employer binds you to that employer, so you are less free to switch even if the conditions are otherwise deplorable.
yes, that’s about right.
I work for one of the largest healthcare providers in the US. I pay $450/mo for health insurance. This is not including vision, dental, or money I set aside for FSA (a pre-tax savings account restricted for use for paying for healthcare) and for and HRA (similar to FSA, but intended for when you’re older, and our company partially matches our contributions). The FSA has been refusing to pay for legitimate doctor visits that insurance has sanctioned. I pay out of pocket for a lot of procedures that the insurance ducks, such as laser eye surgery, vasectomy or even for birth control pills prior to the vasectomy.
The laser eye surgery was ~$5,000 out of pocket, the vasectomy was ~$2,000.
I had a visit to the ER - I was driven by my partner to avoid ambulance costs, and with insurance, had to pay $450 only for the doctors to stay they couldn’t figure out what was wrong and I end back up there later that week for another $450.
I was in a car crash a few years ago and my medical costs (again, with insurance) came out to ~$250,000.
This is while making $85,000/yr working as a Senior IT Engineer, and paying $2,700/mo for rent.
Generally speaking, with insurance, we’re probably paying about twice as much for any given situation, but insurance itself is also expensive and likes to dodge paying for as much as possible.
Thanks for the info! For a comparison I’ll give you mine:
Switzerland has the worlds second most expensive healthcare system, also with private insurance providers. There are some differences to the US though. Having health insurance is mandatory and there are state contributions for people who couldn’t afford it otherwise. And we have a certain defined level of base insurance with defined coverage that the insurers all have to offer and that you can’t be denied for.
Anyway I pay $480/mo for mine, which has a few extras over the base, like sharing a room with only one instead of three people in a hospital stay. I haven’t used it much though, so I can’t tell you from experience what sort of co-pay I would be looking at, but I believe it’s capped. https://www.bag.admin.ch/bag/en/home/versicherungen/krankenversicherung/krankenversicherung-versicherte-mit-wohnsitz-in-der-schweiz/praemien-kostenbeteiligung.html
This is while making $85,000/yr working as a Senior IT Engineer, and paying $2,700/mo for rent.
Oh shit, I thought IT people in the US made more than here in Switzerland?! Or is that only in specific areas of California?
I live on the outskirts of Zürich and rent for our 3 room flat is $3’200/mo. However, I started on about $100’000/yr as a Junior Network Engineer directly after completing my master’s degree in Computer Science in 2021.
I had a vasectomy this year, it came at a negative price for me as food and three days in hospital were covered.
That’s what I said, but of course I paid a little for it out of my salary.
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.
The real truth of what happens is substantially more complicated due to America being made of 50 states. The medical debt numbers are highly debatable (Related Snopes) and do not account for Regional differences. In some states such as New York there are catchalls/emergency funding so that usually anyone making below low six figures can get their bills paid. Other states make collections difficult such as New Jersey not allowing reporting to credit agencies, making ignoring a debt kind of a non-issue. Then there are states such as Florida that require the barest of insurance to keep rates low and provide no patient protections, so when an accident does occur out of pocket costs can be huge as your insurance covers nothing. In all these events the Hospital assumes that big pocket insurance is paying first so they break out the expensive menu, when they realize they can’t get blood from a stone they are grateful if you cover their wholesale price.
For me, I recently got a checkup and some blood work done. It came out to free, I didn’t have to pay anything.
I also have pretty good health insurance.
TL;DR: mine is $660/month for health, $42/month for dental
Most folks in the US aren’t aware of how much they pay for health insurance. I live in California, where law requires full time employees (>30 hrs a week, >130 hrs month) be provided some amount of health insurance. The type of coverage varies not just from job to job, but also within the same job the employee must often choose their own plan from several company selected options at varying price tiers and types/amount of coverage. Usually the employee only sees the amount of the monthly cost that THEY are responsible for, which is then automatically removed from their paycheck. What most folks are unaware of is that the employer is also paying some of the cost (which is the part that the law makes them do). The part that makes it extra frustrating to deal with an already broken and overly expensive system, is that the rate paid by employers is negotiated in bulk with the insurance providers. Larger employers (national corporations with hundreds of thousands of employees) are paying much less than an individual or small employer would. This is the one of the largest reasons becoming unemployed is so dangerous in the US. In addition to not having income for food or housing, people often forego health insurance due to the expense. If you lose (or leave) your job you’re eligible to keep your current insurance plan for 18-36 months with COBRA (Consolidated Omnibus Budget Reconciliation Act, which is such a ridiculous backronym that I had to google it just now). This is often the only time people realize the true cost of their insurance as the entirety of it is then passed on to them directly (at the employer negotiated rate) and it shows up as a new monthly bill.
I recently left my employer to start my own business and discovered that my true cost of insurance is ~$700/month ($660 Health/$42 Dental). Keep in mind, this doesn’t mean that I have zero medical bills should I actually visit a doctor or hospital. This is pretty good health insurance, but I still have to pay $5,000 out pocket (annually) before it kicks in at the full coverage amount. Since I had ear surgery earlier in the year and hit that limit, and wanted to be able to continue seeing the same doctors I had for already scheduled follow ups, I decided to keep the same insurance. That $5,000 isn’t the only expense that landed on my shoulders, there’s a bunch of rules that I honestly don’t fully understand and I’ve probably ended up paying somewhere between $7,500-$10,000 for the surgery I had (in addition to the monthly premium).
The main reason I keep paying insurance (in addition to the fact that you’ll now be charged a penalty on your taxes if you go uninsured for a month), is my fear that you mentioned in the original post. Having a car hit me while I’m walking down the street and ending up with a $50,000 visit to the emergency room is a very real possibility without health insurance. California recently limited ambulance rides to a maximum cost of $1,200, so that’s… good?
