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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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.)
I spend more than that just for insurance for two. Actually using it costs far more. Strep? $250. Video call a random person when I’m in bed after puking my brains out? $100 for a five minute call where they tell me to drink water. Minor surgery? Thousands of dollars in bills sent between two months and two years after the surgery.
I really wish you people that it’ll become better one day. It’s just a rip-off and and a way to funnel money from normal people to the rich. Looking at other countries, you could do away with the scary bills. And on top have an extra free $5.000 each year. Per person. And I think it’s extra cruel to rip off people with their health.
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.
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The United Kingdom provides public healthcare to all permanent residents, about 58 million people. Healthcare coverage is free at the point of need, and is paid for by general taxation. About 18% of a citizen’s income tax goes towards healthcare, which is about 4.5% of the average citizen’s income. Overall, around 8.4 percent of the UK’s gross domestic product is spent on healthcare (an amount of around 0.18984 trillion GBP). UK also has a
growing private healthcare sector that is still much smaller than the public sector.( http://assets.ce.columbia.edu/pdf/actu/actu-uk.pdf )
So it should be more like £1.200 for you?!
And I think the study I linked is total healthcare expenditure. So it also covers the extra private insurance and the medication you buy that isn’t covered at all. I’m not 100% sure.
But yeah, that’s how statistics works. For everyone who pays less than the average, there has to be someone who pays more than the average. And I also think it should work with solidarity. Rich people can afford to pay more.
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Was that pre ACA? When we had our kid, we only paid a $175 hospital stay copay. Granted… we’re very lucky with the insurance coverage provided by my employer, but we were under the understanding that the reason we didn’t have OBGYN copays and otherwise throughout the pregnancy was because the ACA made sure it was covered.
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On top of your premiums, any insurance through a job means the job is paying thousands of dollars a year to insurance instead of paying you on top of what you paid.
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I think you may have read that backwards.(didn’t see edit till I finished posting so I’m keeping the rest)If the plan is ‘good’, then the part the employee ‘pays’ each month is low and could be in the hundreds each year before paying for any care they actually receive. But the employer is shouldering the rest of the costs behind the scene as part of the cost to employ. That means whatever they spend on insurance is money not going to your income so it really doesn’t matter if it is paid directly by the employer or employee, that is all smoke an mirrors.
As an example for state employee plans from 2020:
While health insurance premiums varied greatly across the states, the average per-employee per-month premium was $959; states paid an average of $805 (nearly 84 percent) toward premium contributions.
This means the insurance company is collecting $959 dollars per state employee per month just to have them on the plan ($11,508 /yr) -The state is paying $808 per month ($9,696 /yr) -The employee is paying $154 per month ($1848 /yr)
This is all before office copays, medicine, emergency room copays, hospital bills, care clinic visits, and any service where you pay something to access service. This is generally decent to good insurance in the US and we pay well over the cost per person in other countries just to be insured.
To drive home that this is not an outlier, this is the cost that each country spends on health care per person United States $12,555 Switzerland $8,049 Germany $8,011 Norway $7,898 Netherlands $7,358 Austria $7,275 Belgium $6,600 Australia $6,597 France $6,517 Sweden $6,438
Everyone in Sweden is covered for healthcare, they don’t need to pay at the point of service, and they spend about half of what the US does on average including the uninsured.
My employer’s insurance plan, which is REALLY good mind you, takes $2800 annually in premiums, then actually starts to cover your expenses after you’ve spent $1600 on health care. That is, unless you’re “out of network”, AKA the hospital/office doesn’t have a contract with your insurance company, in which case it kicks in after $3200. So basically, minimum of $4400, max of $6000, and that’s for like the top 1% best insurance available, assuming you’re only doing things your insurance covers.
My insurance costs several times that but I still have plan where everything is a small copay (except of course dental)
that’d be $4400 and $6000
I shouldn’t write Lemmy posts while driving, my math becomes silly 💀
you uh… probably should not be on your phone while driving. stay safe, friend.
Different ask lemmy thread about crazy stuff seen while driving is leaking.
That’s so useless. I had 3 surgeries and multiple visits to doctors last year. I paid the equivalent of $150 for that. I love Sweden.
I wonder how this compares to my Canadian tax contribution to healthcare
It doesn’t, since govt. subsidies still go to healthcare in America, so I’m paying for this privilege in taxes and insurance premiums.
The portion per capita that Americans pay for Medicare and Medicaid is about the same as Canadians pay for our Healthcare. Then they get the privilege of paying insurers and others for the coverage they have if they don’t qualify for those two programs.
I have insurance. Just to give you perspective. I had a video call for some mental health diagnosis. I now have a bill of $568 dollars. Reminder, this is WITH insurance. I have to pay that out of pocket. And I even have to set up additional appointments. Which will be probably around the same price.
I also have an inhaler. I had a doctor’s appointment to get a refill on my medication because I don’t have to use the inhaler too much (meaning I don’t have to refill often). I try to stay healthy and workout and only have to use it when working out/exercising. $300 dollars for the appointment. Another $212 for the actual medication that I picked up. In the last 30 days I have blown over a grand on medical. And I’m not even sick/unhealthy.
My wife on the other hand has very expensive monthly medication for a rare disease. She hits her max out of pocket every year which is 5k. Which we just have to pay forever. If I was on her healthcare plan, we would end up paying 10k every year just for healthcare.
I would say on a regular year. We pay around 7k in healthcare costs with our insurance (depending on how healthy I am throughout the year). On a light year 5.5k.
Is it possible to get health insurance with no copay at all in the US? My insurance in Berlin is about 1500€ per month, for which my employer pays half. If I lose my job, the unemployment office pays it and the price drops to 100€. The same happens if my salary drops, because the insurance cost is a percentage from my salary.
But if I came to the US, what kind of insurance would I get with $1500 per month?
Yeah if you make less than 10k/yr or something, sometimes you can get state health insurance and it covered everything for me.
When I was on welfare, I got Medicaid. (Free health insurance from the government.) I chose the plan with no copays or deductibles. It was nice.
They had another plan where the copay was $3. I had it before I moved to the no copay plan. It’s fine, but being on welfare at the time, every dollar counted.
Now I have my employer plan and my copays range from $15 - $50, depending on the type of appointment I see. I pay about $1k/month in premiums.
Typically you have a choice between public Medicare/Medicaid, high deductible health care plan through work. Or co pay plan through work. And as for per month. It really depends on the job. Everything depends on where you work. If you work at a company with good healthcare you will probably pay more. But have a lower max out of pocket.
If you want I could look up what I pay on a monthly basis for my healthcare and get back to you.
Like the whole stress of needing to pay anything if needing medical help… If I would avoid that, it is worth even a bigger monthly pay.
Like, in Berlin I can just walk to a doctor, to a hospital or to a pharmacy, plug my insurance card to a machine and it is all settled. I never see any money changing hands, or at maximum 10 euros copay if getting expensive prescription drugs.
Completely removing the stress of having a huge bill suddenly is worth the money I put into the insurance every month.
Oh totally agree with you. Our system is sooooo dumb. Plus, this is all just the payments for the actual healthcare and how it interacts with my insurance. This does not include the insurance premiums I pay every paycheck.
I spend all of this on top of my insurance premiums.
That 27k bill will come out of your estate. So if you have a house, it will be sold to pay that bill before your children can inherit it, if they, for whatever reason, can’t cover it.
Private Healthcare in this country is a nightmare. And with Covid slowly disabling everyone, it’s only going to get worse. Saving the NHS is worth it.
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.
It’s bad, a large percentage of bankruptcies in the USA are for medical reasons and a large percentage of those did in fact have insurance. The system is broken.
My experience is pretty similar to others. Basically, if you have insurance (most people do, and there are lots of government subsidies to help afford it), and you’re relatively healthy, it’s predictable. If you get seriously ill, or have chronic health problems, the expenses can quickly bury you.
I’ll add one thing about pharmacies. The same medication can be $300 at one place, and $40 next door. You just never know. There are also pharmacy discount programs that can radically reduce the price. I had one that was around $150 with the insurance, then the pharmacist performed some type of incantation on the computer, and suddenly it was about $16 without the insurance.
A lot of people simply don’t because they can’t. It’s absurdly expensive because the system isn’t designed for people to pay for it out of pocket. If someone doesn’t have insurance, they’ll either beg the hospital for mercy or ignore the medical debt because it doesn’t count against your credit score. Even if they do have insurance, it often doesn’t cover a portion of the cost, the insurance is extremely expensive, or both. The people with quality insurance through their employer have it good, but the system expects everyone to have that privilege.
The answer is “it depends”. There are so many hoops and loopholes and gotchas built into the system that 2 identical people with the exact same background and ailment(s) could go see the exact same medical staff and yet still end up having to pay 2 completely different amounts for their care. But it’s more complicated than that, because there are a myriad factors that come into play (insurance versus none, location/state of residence, etc) so there’s no one concise and accurate answer to these types of questions.
Most non-wealthy people who don’t have insurance, but who don’t qualify for government/public medical care, simply go without care. Or they use the emergency room loophole to get some kind of treatment. The loophole, with lots of nuance and caveats, is that the emergency room has to at least give you enough treatment to temporarily stabilize your condition, regardless of your ability to pay.
For check-ups and counseling - In a lot of places that sort of stuff requires you to pay up front. You can sometimes haggle or work out a payment plan. If you’re poor enough to qualify for government aid, it may be free. Otherwise, you’re expected to have insurance and pay the co-pay. If that doesn’t apply, these places usually have a “cash” price that’s slightly more affordable, but still usually require payment ahead of time.
For meds, you basically always pay up front. There’s really no concept of pharmacies providing medications in a manner where you can pay later. No money means no meds. It’s also ridiculous to even ask how much a person would expect to pay for meds, it could be as little as a few USD to thousands, really depends on the meds, quantity needed, location, etc.
Xrays - This is where debt might actually come into play. You usually pay for these after the fact. If you go to the doctor, you might have to pay the standard fee (or copay) up front, but all the other services/tests/etc are charged after the fact. So you’ll end up getting a bill after you’ve gotten the xray and consultation. To be honest, I don’t know the average out of pocket cost for an x-ray if you don’t have insurance, but it would differ from location to location and region to region. If you don’t pay that bill, you’ll get harassed and most likely you’ll have to change doctors because the office you owe money to won’t see you again until your debt is paid or you’ve worked out a payment plan.
For people with insurance, there’s pretty much always a maximum yearly out of pocket amount, after which things are basically all paid for by insurance. Again there are nuances and caveats. And the maximum out of pocket varies by insurance policy, number of people insured, etc, but $8,000 - $20,000 are not uncommon amounts. To be honest, I don’t even know what mine is, I’ve never actually reached it. Not everything is covered by the maximum out of pocket, though.
$27,000 medical debt could possibly be from someone who was uninsured or it may be several years of medical debt.
To give you an idea of how crazy the system is: I had a hairline fracture several years ago and what was deemed as “good” insurance. By the time everything was done, it ended up costing me around $3,000 out of pocket. That’s for co-pays, x-rays, medication, etc over the course of months.
On the other hand: A family member of mine had a heart attack, required emergency surgery, had no insurance, and had no money to pay for anything. In the end cost them less than a few hundred USD out of pocket. Hospital wiped the debt clean. Government programs and drug company programs paid for meds. Eventually disability stuff kicked in and took care of everything else.
For people with insurance, there’s pretty much always a maximum yearly out of pocket amount, after which things are basically all paid for by insurance.
With a few caveats, yes. At least with the insurance I had last year when I hit the max for the first time, it has to be both deemed medically necessary to do, and be in network. Just because you hit your annual out-of-pocket max doesn’t mean you can get free cosmetic surgery, for example. Out of network treatment also had a separate annual max, so if I saw the wrong specialist or went to the wrong hospital during an emergency, I could still have gotten hit with another $10,000 in bills before that kicked in. And finally, I learned that there are actually annual maximums for certain types of treatment. In my case, I have an autoimmune condition and my doctor wanted me to get blood work done for it every 3 months. In their boundless wisdom, my insurance decided I shouldn’t need blood work more than three times a year, and I got a $1,700 bill for going over the annual limit for such care.
The limitlessness of their wisdom and beneficence is matched only by my pettiness, so I had the pleasure of having my first colonoscopy and an endoscopy the day after Christmas because my gastro said there was a tiny possibility of me having a problem more serious than hemorrhoids and I knew those assholes would have to pay for it, since they pre-authorized it, which added a few grand to what they had to pay for the year.
The American “healthcare” system is fundamentally broken, and no amount of patchwork fixes will change that. We need to throw it all out and start from scratch.
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.
“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.”
Partial Truth.
Healthcare providers have negotiated prices for services. These prices are negotiated per insurer.
Blue Cross and Blue shield will pay them X dollars for Deep Sleep anesthesia. United Healthe care will pay them a different amount. Medicare will pay them yet a different amount. Bob’s backyard healthcare will pay more because they don’t have buying power.
If you walk in without coverage, the provider “can” charge you a reduced rate. They are not required to. They do NOT universally offer that.
If you get the procedure done anyway, agree to pay and cannot pay your health bill, the provider “can” just let you off the hook or reduce your rate. They do NOT usually do that. That’s the exception.
If you go to a provider that accepts your insurance (they all do not) and book a procedure, the provider has to get the procedure covered by the insurer. If the insurer decides not to cover the procedure, you can call the provider and try to create a grievance. The back-and-forth is maddening.
My local doctor said I needed a colonoscopy (it’s just that time, no emergent issues)
My insurer authorized the procedure but not the anesthesia.
The office offered to pay out of pocket for the anesthesia ($1200), but I declined because I couldn’t afford it. They also offered to set up payments if I paid 50% upfront, but I declined because that didn’t help me. I can’t take on another $100 / month for 12 months.
I spoke with the GI doctor, a second GI doctor, and my General Practitioner. They all said that people here really don’t get the procedure without anesthesia, and it was a bad idea for both the doctor performing the procedure and for me.
I contacted the insurer, but they refused. Another GI doctor contacted the insurer, but they refused.
My insurer decided in January that they will not cover anesthesia for a colonoscopy unless someone can prove you’re frail enough it might kill you.
We have federal laws that mandate insurers to cover the anesthesia for this procedure, but state-level insurers (hint: they’re all state now) don’t have to follow their rules.
So here I am, two years late for a colonoscopy, wondering if I have pre-cancer or cancer brewing down there, but can’t manage to pay for what is considered by all providers here a necessary part of the procedure.
It’s not great here.
You need to consider your health first and only. You get the anesthesia and then you either ignore the bills or pay a little bit what you can. Either way eventually you’ll be able to close it out by paying maybe half.
Alternatively, you can tell the doc to either give you the anesthesia for free or go with the insurance attitude and have the procedure without it and - should something go wrong because it is not what you are supposed to do - then you have yourself a juicy malpractice suit for them.
The investors who make money from this bullshit write our laws. That’s the problem. We allowed it to happen by having such dumb fucking morons for citizenry who vote for these monsters who then turn around and rape them. And then they vote for them again. Our people are mostly absolute morons who can’t think for themselves and so they follow the shiniest trinket they obey the loudest voice with the bleached smile and the most promises.
And yes, conservatives are to blame and yes, there are awful liberals as well but the simple truth is republicans need to fucking die. They are a deadly cancer to our society because all they do is ruin everything except their own pockets.
Doc will not provide anesthesia for free. The insurance company will not budge.
I’m not in a situation where I can just keep hopping over doctors while they all send me to collections, even though $600 is too much to swallow at the moment.
If I do end up with any form of GI cancer, a lawsuit against the insurer seems pretty reasonable.
I’m really sorry for your situation. I would personally just get it done, commit to paying them and then just stretch it out maybe a few bucks at a time. Your health is more important. But I do wish you the best of health.
I was on Medicaid for many years but I’m really lucky now my wife is in the teachers union and we have very decent insurance. But the entire system is a big stinking chaotic farce to which the terms “broken” and “mayhem” are even too light to apply.
But as long as our government is in the employ of the 1% nothing is gonna change. We seriously need to start stringing up some billionaires and take their money for everyone.
I have Blue Cross and Blue Shield. a mid-upper tier plan. They just decided to stop covering this.
WTF? I have to say this makes no sense to me. I think you need to double and triple check, try another facility perhaps? Something. To cover a colonoscopy but not anesthesia is unheard of, and even freakin Medicaid would pay for it.
https://www.anthem.com/dam/medpolicies/abcbs/active/guidelines/gl_pw_a050126.html
Anthem BCBS classifies it as not medically necessary so they will not pay for it since April of this year.
Jesus. That’s disgusting.
Edit: Hang on I just skimmed that document it seems to indicate it IS considered medically necessary.
Edit edit:
* Prolonged or therapeutic endoscopic procedure requiring deep sedation such as endoscopic retrograde cholangiopancreatography (ERCP) or repeat colonoscopy due to tortuous colon; **or** * A history of or anticipated poor response due to cross tolerance or paradoxical reaction to standard sedatives used during moderate (conscious) sedation specifically due to narcotics or benzodiazepines; **or** * Increased risk for complication due to severe comorbidity (American Society of Anesthesiologists \[ASA] class III physical status or greater. See Appendix for physical status classifications); **or** * Individuals over 70; **or** * Individuals under the age of 18; **or** * Pregnancy; **or** * History of drug or alcohol abuse; **or** * Uncooperative or acutely agitated individuals (for example, delirium, organic brain disease, senile dementia); **or**Uncooperative or acutely agitated individuals. Tell the doc to tell the insurance that it makes you crazy without it and you can’t tolerate it. Jeez is your doctor new at doing these things? That’s what they do they submit whatever criteria is accepted that they don’t have to prove with charts.
The people here already spoke of the option of medical tourism, can’t you look up that ? A colonoscopy is not some advanced tech, any decent hospital in latin america will be able to do that. Since you earn US dollars, you could research about making a trip to Mexico (possibly the cheapest option, because it can be done by bus or car), Cuba (possibly the cheapest too, because of the conversion rate and short plane distance), Brazil, etc for the travel, lodging and procedure (and even a little tourism too if you have the time and will XD ).
I’m mid-atlantic. Procedure + flight + basic accommodation is still around 2/3 of the anesthesia. Medical tourism works well when you’re uninsured or when the whole procedure isn’t covered. Sadly, I’m already paying a fortune for the insurance. It’s a mid-high plan Blue Cross. F’ing insane they’re taking this line.
The insurance companies having more say than doctors about what procedures you can and can’t get is peak insanity, and yet here we are.
Plus all of that negotiating is baked into the end costs which is why in the US on average we spend twice as much on medical care with worse outcomes and not everyone is covered.
If you are and remain healthy it is very expensive. If you get sick or injured or ill
It costs more than you have
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.
Also, to be completely clear, I still hope that we end up with system that is much closer to the NHS. While the current system benefits me individually, I would much prefer a system that benefits EVERYONE, and I think it’s a disgrace that the US continues to have the system it does.
The only people it benefits are Insurance bigwigs and large employers that use the system to trap workers.
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.
Your problems with NHS wait times are entirely due to your conservatives trying to run it into the ground so they can have the US style predatory care.
Oh yeah, absolutely. Fuck the Tories.
