America has socialized healthcare with a hundred extra steps and implemented in the most inefficient way possible so that everyone comes out worse.
Hospitals aren't allowed to deny care (obviously). They will bill people outrageous amounts and know that they will only ever see a fraction of it. So prices for people who do pay are raised considerably to make up for it.
People don't get early preventive care due to costs or because they are uninsured.
Supply of doctors is artificially limited by the ABMS so that demand stays high.
The government doesn't negotiate or mandate prices, so drug manufacturers, equipment manufacturers, researchers, hospitals and everyone else in the ecosystem squeezes out as much profit as they can to make up for all the countries where they are not allowed to.
The end result is that the average American knowingly or unknowingly pays a lot more for healthcare than any other country in the world while receiving sub-par care.
> Hospitals aren't allowed to deny care (obviously). They will bill people outrageous amounts and know that they will only ever see a fraction of it. So prices for people who do pay are raised considerably to make up for it.
They absolutely can. They just can't refuse care if you're actively dying or your condition's quickly deteriorating (they have to "stabilize" you). This makes the ER loophole, such as it is, useless as a backdoor for obtaining most hospital care. Plus if you go in for something that's not actually an emergency, they'll just make you wait until you leave. They'll never treat you.
This is an important distinction. Nobody is getting free chemo or radiation therapy, treatment for chronic illness or anything like. For example, diabetics are not going to get a supply of insulin from the ER, especially if they can't pay, and someone with cancer isn't going to get treatment, either. Plenty of people die in the US from the inability to afford the medical care they need to live.
If you're brought into the ER because of a heart attack or are bleeding profusely, your care won't be denied, but you will pay for it in some way later.
"Nobody is getting free chemo or radiation therapy, treatment for chronic illness or anything like"
Sure you can. In the US, you cannot be denied chemo or other treatments. You will be billed after the fact, and it's going to be a ton of money, but it's not as if they have security escort you out just because you don't have an insurance card. That simply doesn't happen. You'll get care, and if you don't qualify for aid programs or indigent care schemes (of which there are many), you'll probably file for bankruptcy and have the slate wiped clean.
By law, nonprofit hospitals must provide charity care to needy patients. 57% of US hospitals are non-profit. Only 24% are for-profit. (The rest are government run)
> Sure you can. In the US, you cannot be denied chemo or other treatments. You will be billed after the fact, and it's going to be a ton of money, but it's not as if they have security escort you out just because you don't have an insurance card. That simply doesn't happen.
I've known many people denied care, myself included, I've been asked to pay up up front or we don't admit you. This includes treatment for brain tumors and infection.
ERs can't deny life saving care, but that's the exception.
Is this the conception people have of the US healthcare system? That everyone's taken care of so why are they complaining?
Also, something like 20-33% of health care dollars go to claim submission/processing at the doctor/hospital and the insurance company. Those people do nothing but argue with each other
There's a highly rated HMO around here. Their costs are significantly lower than regular insurance, and they seem to pass some of that on to customers in the form of health care.
> Hospitals aren't allowed to deny care (obviously). They will bill people outrageous amounts and know that they will only ever see a fraction of it. So prices for people who do pay are raised considerably to make up for it.
This supposed truth is widely misunderstood to the point of simply being not true.
Hospital ERs will stabilize you. That's all.
If you have something that requires long-term care like diabetes or cancer, you're fucked. If you have Type 1 Diabetes and can't afford insulin, the hospital won't just give you a supply. They'll wait until you're about to die from diabetic ketoacidosis.
A friend of mine had testicular cancer but had no money for treatment and no insurance. Hospitals straight-up told him that they won't treat him unless he's terminal. That's right, they wouldn't take care of him until he's on death's door, at which point all they'll be able to do is pump him full of painkillers to make him comfortable for his last couple hours. Luckily, the ACA passed, banning pre-existing condition clauses, and he was able to get some affordable insurance and treatment. Of course, anyone that has had cancer can tell you it likely never goes away [0]. He's always worried that a new tumor will appear somewhere.
The primary limit on the supply of doctors right now is lack of federal (Medicare) funding for residency training slots. Every year, students graduate from accredited medical schools but are never able to practice medicine because they can't get matched to residency program. This also impacts foreign doctors who want to immigrate and practice here. Ask Congress to increase funding.
I never understood why if they have a cap to at least increase it as population increases. Also we need to give more medical decisions over to advance level (but not doctors) levels of people like Physicians Assistants and Nurse Practitioners.
In my country doctors don't give a shit about who you are or how much money you have. They do triage. You can be a millionaire yet have to wait 3 months for a new hip because there is someone with more urgent medical needs. It is pure unadultared fact based medicine to allocate scarce resources instead of market forces that turns you into a drone.
Universal healthcare is beatiful but also utterly terrifying. It is pure communism without the "some animals are more equal". It will lift up many Americans no doubt but for the prosperous it is not an automatic win.
I'm trying to understand what point you're trying to make here. Are you saying America's system is better or worse than that of your country?
I'm in America, and I have fantastic health insurance (by American standards) and waited over a year for a hip replacement surgery. Even with insurance, I paid almost $10,000 for the surgery.
Without insurance it would have cost well over $100k. I suspect that in any other country that provides universal health care it would have been less expensive (for everyone) and I would have waited less then 15 months to have it done.
Why do you assume you would have gotten authorized for a hip replacement at all? Many elective qualify of life surgeries aren’t covered in European health care systems.
Look, there is no free lunch. The UK NHS has strict standards of “cost effectiveness” that would shock Americans: https://www.nice.org.uk/media/default/guidance/lgb10-briefin.... 20-30,000 pounds per quality adjusted life year. American end of life care can cost hundreds of thousands of dollars for a year or two of extra life and American insurance companies will pay it without blinking. A friend of the family was diagnosed with terminal cancer and given six months to live. She received treatment costing hundreds of thousands of dollars, and lived almost two years. In European systems she would have been sent into hospice.
She might have been better off in hospice (end of life care can be rather grim and there is a reason many older Americans are terrified of the process and results) and society in general would have been better off if she died sooner in hospice care.
The European system is much better because it does not hide reality from people who seem to have difficulty grasping the concept that they, and the people they cherish, are eventually going to die. Instead of giving one old lady and additional 18 months of end of life care the Euro system has the ability to make sure that basic health needs of the entire population are actually taken care of, something at which the American system fails completely. An approach based on cost effective treatment is easy to attack using cherry-picked sob stories, but overall it is a far superior system to the 'you only get what you can pay for' American approach.
> A friend of the family was diagnosed with terminal cancer and given six months to live. She received treatment costing hundreds of thousands of dollars, and lived almost two years. In European systems she would have been sent into hospice
I’m not sure why you’re being downvoted, this seems factual.
It’s also the part of the problem that’s never discussed - the big cancerous whale in the room. Culturally, Americans can’t accept that sometimes people are going to die, and let it happen. 2 years of chemo and carT treatments with neurological damage, organ damage, chemo brain, the list goes on, isn’t worth it for most people. But they don’t even realize that until they’re almost gone.
Taking a holistic look at the health of the patient and running costa / benefit on quality of life vs treatment are two ways that the uk controls costa really well. As far as I’m aware it’s the same with obese people. There are limits on their reimbursement amounts for certain things and they need to buy extra insurance to cover that (someone from the uk correct me if I’m wrong?)
> I’m not sure why you’re being downvoted, this seems factual.
I’ll make a guess at why. Because some folks in the US who want universal healthcare have a misunderstanding of what that actually means to make it affordable. Any comment criticizing or expressing what might be perceived as negative of any aspect of “European style healthcare” (as if that is a singular thing) will get downvoted by these folks. They have a belief that the level of end of life care most folks currently receive in the US will continue. Their 89 year old grandmothers with cancer are still going to get experimental and expensive chemotherapy all the way up to her dying breath.
why can't the 89-year old grandmother get supplemental insurance that covers the fancy therapies?
I don't buy that there's no way to get people state-covered insulin and chemo without consigning everyone to bread lines. just make Medicare universal, and let people buy BCBS or Kaiser etc. on top, to skip the lines or cover more end of life stuff.
> why can't the 89-year old grandmother get supplemental insurance that covers the fancy therapies?
I think they can, but I also think that most people advocating for “Medicare for all” in the US don’t even realize supplemental private health insurance exists in many if not most European systems.
Healthcare is a systems engineering problem to explore design trade offs within a solution space. Most people don’t think of it that way.
Not saying that she can’t, but I am saying that the expectation of universal healthcare from many of the folks supporting it is that she won’t have to buy supplemental coverage, but will get the same or better care.
It wouldn't be safe to assume that I'd have been authorized for an elective surgery, so fair point.
I also never suggested that it should be free.
> American end of life care can cost hundreds of thousands of dollars for a year or two of extra life and American insurance companies will pay it without blinking.
This hasn't been my experience. Before my dad died from glioblastoma last year, his insurance refused to pay anything for his treatment. They refused to pay for anything, fighting us every step of the way. A single chemo pill cost over $2200, and he needed 60 of them, and they wouldn't cover any portion of them. And that was just one of many the things they wouldn't pay for. They wouldn't even cover anti-nausea medication. I did, and it cost less than $30. They wouldn't even cover hospice care.
My dad paid premiums to that same insurance company for 20 years, and was healthy the entire time. No major health issues, non-smoker, non-drinker, no heart problems, no accidents. He learned about his rapidly growing tumor on his own. He decided, mostly out of curiosity about the technology, to pay for a full body MRI (at his own expense of course) and found it. He spent his life savings trying to fight the cancer and the insurance company, just so he could have enough time to say goodbye to people. He died within 8 months of discovering the tumor.
The money he paid that insurance company over a 20 year period would have covered all of the costs had he put the money into a savings account, even if he made zero interest and accounting for inflation.
I know that there will be those who say "but what about Medicare/Medicaid?" - he didn't qualify for either of them.
The only outside help he might have had was from an organization that houses people near cancer facilities, but they pulled their support the moment the pandemic was declared, shutting down all their housing facilities. The irony there, as well, is that that particular organization, even in non-pandemic times, required 6 months lead time before they could place an individual. He'd have been dead before they were able to place them. I paid for an AirBnB instead, which cost me close to $5k for the duration of his treatment, which he paid for out of pocket.
My dad's story isn't uncommon either. Why would insurance companies have any incentive to step up when they know that if they just wait things out, they'll be able to keep their money?
The American health care system is utterly broken, perhaps even criminally corrupt.
I’m sorry to hear your dad’s experience. It’s the nature of a private system in a country of 300 million people that experiences will differ. Aggressive glioblastoma is something that won’t be covered with the cost effectiveness thresholds in many European systems. The median survival duration of treated patients is just over one year, with costs, as you outline above, of $120-250k. The typical upper end in the UK NHS is 30,000 pounds per quality adjusted life year ($36,000). The UK recently introduced a cancer drugs fund that can go beyond that, but it’s been intensely controversial within the UK, because in that country there is a deeply established focus on cost effectiveness and “NICE” protocol. But US insurance companies routinely pay hundreds of thousands of dollars for glioblastoma treatment. Median insurance payments for high grade glioma were $180,000 in one study: https://ar.iiarjournals.org/content/anticanres/39/3/1375.ful...
The paper you linked to is hardly proof that US insurance companies routinely pay hundreds of thousands for GBM treatment. It's a very narrowly focused description of what it cost Excellus BlueCross/BlueShield, the sponsors of the paper, to treat 88 patients insured by Excellus. They try to suggest that excluding data from "national datasets" improves the quality of the research.
> The patient cohort involved 88 patients with over 44,000 separate insurance claims. This dataset represented a happy medium that is large enough to provide a good estimate of overall patient costs, but small enough to individually verify each patient diagnosis and treatment rather than relying on administratively coded national datasets.
It's marketing disguised as scientific research that tries to justify the high cost of health care by claiming that those costs, and commercial insurance, are strongly correlated with higher survival rates.
> Healthcare payments for HGGs patients were substantial and such high healthcare expenditures were positively associated with patient survival and commercial insurance.
Translated: our costs are high, and so are our customer's premiums, but it's worth it because patients last a few extra months compared to the inferior Medicare options.
Private insurance companies don't just fight their customer's claims, they fund "research" that "proves" anything other than private health insurance is worse.
Then there's those 88 patients. With a median age of 59, and a median KPS score of 90, they're cherry picking patients who, would, statistically, survive the longest.
Over the years so many people have patiently explained why and how you're wrong whenever you mention the NHS that I can only think you're choosing to misrepresent the information now.
And here you're repeating the claim that US health insurance is a unlimited source of healthcare funds for anyone who wants it, even though someone else is telling you that's not their personal experience.
"It’s not unusual for insurers to deny some claims or say they won’t cover a test, procedure, or service that doctors order. You can appeal many types of health insurance decisions – sometimes even things that are written into your health plan’s contract. You can appeal Medicare claim denials, too."
All the available evidence directly contradicts your claims about the generosity of health insurance.
Dan, over the years you’ve baselessly accused me of misrepresenting how the NHS system works, without any substance. The UK NHS’s use of QALY is well established: https://bmchealthservres.biomedcentral.com/articles/10.1186/... (“The U.K. National Institute for Health and Care Excellence (NICE) currently uses a cost-effectiveness threshold in the range of £20,000 to £30,000 per quality-adjusted life year (QALY) for reimbursing new drugs in the National Health Service”). I also mentioned to the cancer drugs fund.
And the US system, unlike the UK NHS, is a highly fragmented contractual system. Obviously there’s going to be a wide range of experiences with willingness to pay. But I cited specific sources for the median insurance reimbursement of glioblastoma being over $180,000.
So please tell me, with particularity, what part do you disagree with?
You're claiming that this is a limit for treatment and that this is maximum amount the NHS will spend per patient. That's simply untrue.
Yet again: that figure is the negotiation amount used by the NHS when dealing with companies designing meds to be sold into the NHS. It has nothing at all to do with how much the NHS will spend per patient per year.
The cancer drugs fund is useful: the first version had to be scrapped because it was spending billions of pounds on new meds that were fantastically expensive but didn't extend life, nor improve quality of life, and which often made QoL worse or shortened life. https://www.newscientist.com/article/dn26785-the-uks-cancer-...
> But I cited specific sources for the median insurance reimbursement of glioblastoma being over $180,000
You're doing a few things here. 1) You're implying that US treatment is good, and 2) you're insinuating that people in the UK aren't going to be treated for glioblastoma because the cost is greater than the NICE guideline for cost of treatment.
> The Assessment Group reported that the Food and Drug Administration (FDA) in the USA expressed several concerns when it evaluated the trial. There was an imbalance between the types of tumours in the study arms, which could have favoured carmustine implants. The FDA requested a review of histological diagnoses and a sensitivity analysis was performed using diagnoses by an alternative pathologist. A further concern was that the manufacturer's analysis treated death as an event when measuring time to progression. A reanalysis was performed of the data on the time to progression as determined by decline of neurological symptoms and performance status, with deaths being censored. In addition, the manufacturer's analysis of the overall survival data included stratification by country, and the data were reanalysed without stratification. The data reported below relate to the unstratified analysis unless otherwise stated. [...]
> There was no difference in progression-free survival between treatment groups. Median time to progression was 5.9 months (95% CI 4.4 to 8.3 months) in the carmustine implant group and 5.9 months (95% CI 4.7 to 7.4 months) in the placebo group (using stratified analysis). The manufacturer's analysis suggested that both the time to decline of KPS score and the time to progression on neurological indices were statistically significantly improved (that is, increased) in the carmustine implant group. The FDA reanalysis of these data found that there were no statistically significant differences in these measures of progression-free survival and that the differences resulted from variations in survival times between the treatment arms.
> [...] The effect of temozolomide on the quality of life of patients was investigated in the largest RCT using a cancer-specific quality-of-life questionnaire. Of seven preselected scales, the only statistically significant difference between treatment groups was in social functioning at the first follow-up during adjuvant treatment with temozolomide (in favour of the radiotherapy alone group).
US treatment gives people brain damage, decreases quality of life, doesn't do much to increase length of life, and then because the US doesn't negotiate drug prices costs a lot of money. In the US with its expensive treatment we still see that the five year survival rate on less than 10%, that the average life expectancy is only 8 months, and that these very expensive treatments (which can severely degrade QoL) extend life by maybe a couple of months. Remember, these aren't months when you're walking around living normal life, they're time spent in hospital. Regret rates for cancer treatment ("I wish I didn't have that treatment, I wish I'd done something else") are very high.
2) It's simply untrue to suggest that people in England[1] don't get treatment for gioblastoma. They do get treatment. What does happen is that they don't get ripped off for meds.
By the way, if you'd actually like to do something about this that benefits real people right now, RIP Medical Debt (mentioned in the article and has good ratings) buys debt at 1% of its face value and immediately forgives it.
Old medical debt (the kind you get for 1%) doesn't have a big impact on credit scores and don't they owe income tax on the forgiven debt?
I wouldn't pay income tax on something like half million dollars for a slightly better chance to be able to take out a loan at what will be 10% or so soon.
Right, which is nice, I guess, but it's more of a feel-good project for those who run it, rather than actual help.
99% of hospitals have financial assistance programs that will either completely eliminate your debt or reduce it by a substantial amount if you fall under a certain bracket of income (usually some multiple 3x or 4x poverty level), which essentially does the same thing.
It doesn't address the fact that hospitals prices ballooned out of control due to perverse incentives with insurance companies and dumb regulation that limits profits to a percentage (incentivizing absolute increases in prices, rather than price controls like NHS does)
- Hospitals recorded their most profitable year on record in 2019, notching an aggregate profit margin of 7.6%
- From 2012 to 2016, prices for medical care surged 16%, almost four times the rate of overall inflation
- Last year the average annual deductible for a single worker with job-based coverage topped $1,400, almost four times what it was in 2006... Family deductibles can top $10,000
Facilities charge exorbitant prices for procedures and insurance companies pass more and more of these costs on to patients via higher deductibles and premiums. It will continue to get worse unless there is colossal change.
Proposed colossal change: a common practice of paying for healthcare out of pocket, instead of through healthcare insurance.
Yes, this sounds unreasonable right now because prices are so high. But bear with me for a second.
Most healthcare in the US is paid through insurance. Insurance creates moral hazard. Insured patients generally don't even need to know the prices of what they're buying, much less negotiate those prices. And here's a dirty secret: insurers don't care much either. They simply add a margin on top of their actuarially-forecasted cost. So healthcare prices rise dramatically over time, because relatively few people are directly exposed to them and push back on them. From this perspective, healthcare insurance is a problem, not a solution.
Don't get me wrong, there are admittedly some obstacles to patients paying out of pocket right now. My point is that we know properly functioning markets set fair prices, and we know our healthcare market is dysfunctional. Healthcare insurance plays a part in that dysfunction.
Patients negotiating directly for better prices eliminates moral hazard and restores market function. Strategically, that would finally restore pressure on healthcare providers, who have become accustomed to raising prices with very little push-back. Without some kind of push-back, providers will continue raising prices - because they can.
> My point is that we know properly functioning markets set fair prices
For frequently-repeated purchases of goods with robust competition for close alternatives where the approximate total infinite-horizon costs and utilities resulting from the decision are both entirely experienced by the participants to the exchange and very clear before or quickly after it occurs so that behavior can rapidly adjust to more optimal alternatives when suboptimal choices are made, in other words where the perfect knowledge assumption underlying rational choice theory is, while it is never actually accurate, at least closely approximated in the relevant market, and there are no externalities making inefficient in the global sense actions efficient from the perspective of participants.
Yeah, although the negotions between insurance companies and providers theoretically should approach a functioning market.
It painfully obviously does not. It is literally a market with both buyer and seller colluding to raise the prices!
Why? A few reasons. Insurance profit is capped as a percentage of expenditure, so if they think there is more money they could extract from the insurance customers total if things cost more, it is in the insurance company's interest for prices to go up. Providers are not going to balk at getting mopre money.
This is only one of the many ways the system is screwed. The fact that medical billing coders need to customize the codes they submit for the exact same procdure to depending on what insurance company it is being sent to (for example, this is common for a procedure that is not a perfect fit for any standardized codes, or where some insurers are still using the older revisions of the medical coding standards, etc) and other similar nonsense also artificially inflates costs.
Basically everything about the system from top the bottom seems to be designed to prevent market based price discovery from working well.
High deductible health plans are widely available and members pay for most routine care out of pocket (often via an HSA). However in practice this does little to hold down costs. Most patients aren't able to do effective price comparisons, and can't really switch providers just to save a few dollars.
There's pretty much a free open market for cosmetic medical procedures not covered by insurance. But markets can never really work for medically necessary treatments. Demand is essentially fixed regardless of price. Patients who are in pain or at risk of death will pay everything they have and go into debt besides in order to get treatment. On a large scale basis the only effective means of holding down costs is some combination of rationing and price fixing.
Not only are HDHPs widely available, they are widely used! I've seen numbers to where a third to half of all private-industry health insurance coverage is under a high deductible health plan.
These people, me being one of them, are extremely cost-conscious, believe me. It doesn't help for basically the reasons you mention.
Medical patients are not really "consumers" in the normal sense of the word. A patient may be unconscious when they arrive at a hospital and doctors will just start to treat them (as they should). A patient's doctor may refuse to change where they'll do the operation even if it'll save their patient a lot of money. A patient may decide they're going to have a procedure done at a surgery center, a facility that is typically much cheaper than a hospital, but they can't predict if they'll have a complication that will drastically change the cost of their procedure. Patients can't just walk up to a menu and decide that because they have chest tightness they want a stent put in. That's not how medicine works. The doctor typically sets the treatment plan and there's very little veering off that plan. The doctor really isn't even the one that sets the prices. Insurance companies are heavily involved in that and it varies by health insurance and plan.
The cheapest prices in US healthcare are the prices paid by Medicare. There are so many people on Medicare so this leads to a lot of bargaining power. Hospitals would never refuse to treat Medicare patients (because there are so many). So, Medicare decides "We're only going to pay $10,000 for a total knee replacement." And hospitals have to say "Okay, sounds good. Can't really say no to 60 million patients." Insurance companies do not have that type of bargaining power. They say "We only want to pay $20,000 for a total knee replacement." And the hospital goes "Nope, we're charging you $30,000." And the insurance company sheepishly goes, "Okay..." and then sets really high premiums, deductibles, and out of pocket maxes so they don't have to bear the weight of the cost.
Without competition, there is no avenue for "negotiation". And you don't even have to go as far as you've described - simply mandating that providers can only charge uniform prices across all payers (ie end their collusion with "insurance" companies), along with eliminating the laws that allow providers to substantiate bills without needing to form contracts (ie agreeing to prices or shop rates up front), would go a long way towards triaging the immediate insanity.
IMO, your proposal should separate emergency care, "capital investment", cosmetic, and routine healthcare. Cosmetic & routine should be more market-driven. However, emergency care is unplanned by definition (so can't be properly budgeted for). "Capital investment" would cover the range of expensive procedures ranging from "needed within the next five years to prevent an early death from cancer, but otherwise not time-sensitive" to expensive quality-of-life upgrades, such as knee replacements. Emergency & investment services would need something other than pure market pricing.
hm, interesting. Even better: potentially, instead of negotiating prices one on one, we could form some sort of large collective enterprise that was beholden to us so that it could negotiate prices on our behalf. I'd bet if there was such an group that represented a large enough % of us, we could get some pretty good deals. Now, what would we call it...
not that it honestly matters. the whole cabal of private healthcare has become such a teetering house of cards post covid that credit reporting agencies no longer count medical debt in your score.
I will just chip in to point out the obvious: the US healthcare is the teetering house of cards etc etc etc. Many other countries managed this just fine, so the question is, why not also in the US? Follow the money: who gains out of this chaos?
My wife had a decent chunk of medical debt when we got married which was long before COVID. Even at that time medical debt didn't count terribly against her. Maybe a 10 pt drop in her score. And eventually the debt fell off her credit.
This is one of many reasons why hospitals charge so much. Medical debt is extremely difficult to actually collect because refusing to pay has basically no consequences. Hospitals have to eat those costs and make up for it by squeezing patients who do pay for as much as possible.
I did the same thing with an ER bill I couldn't afford a while back. I just never paid it and suffered virtually no consequences.
But they still have the debt, right? It's great if it's not counted against them, but to say "it doesn't matter" seems unfair - won't they still be hounded by collections agencies and potentially sued?
I don't know why people see this as a good thing. Healthcare is expensive for precisely the reason that people skip out on paying their debt. Now it's harder to collect so what's the result? Costs are going to go up to subsidize the increased cost of collection.
None of these metrics will change the political stance our one majority party took. They have shut their eyes and ears and are hell bent on preserving the interests of the lobbying companies and fetishizing “free market competition”. I can bet a sizeable amount of money that nothing will change in the next 50yrs even. Today there is still a rule that a hospital cannot say no to a patient, I strongly believe that is one rule that will fall down next. It makes too much profit for the health care providers to not attack that. In fact after Roe fell I can see that as the next one.
I make this comment in a lot of threads, but if democrats wanted to fix this problem, they would write legislation for it and try to get it passed. Instead, all we get (from both parties) are massive 1000+ page bills that include a bunch of completely unrelated stuff. Why haven't democrats produce a 10 page bill with a tl;dr of "medical debt is hereby abolished"?
Stop pretending the clowns pretending to be politicians are doing anything to help us. This is about the rich not wanting to give up their money, and both sides are just protecting them.
Here’s Medicare for All. It’s 130 pages. But double spaced with massive margins and indentation space and geriatric sized fonts so really probably about 20 pages. You can read it pretty quickly (I have).
Last time I proposed this same thing in a blog comment section (Lawyers, Guns, and Money) a couple of people said "but filibuster" and the rest went straight to an absolute firehose of middle-school-level verbal abuse. I've had similar reactions from other self-proclaimed progressives. Nonetheless I stand by the idea. These big omnibus bills give every single opponent (and some "mavericks" a.k.a. turncoats in one's own party) their very own personal reason to vote against it without political consequence. A more focused bill at least has a slight chance of prying loose a few around the edges, if only because they know that their "no" vote will be used effectively against them in the next election cycle with no room for excuses. When your legislative success rate (not counting bills to name post offices) is close to zero already, might as well try something different.
It just seems like it'd be such a huge win from a PR angle, even if the bills fail. You could literally post screenshots of the bills in their entirety on twitter showing how simple they are (student debt is abolished, college is free, medicine is free, etc) and just say "here is what we tried to do for you, and here are the people who said no."
I think the most productive change we could make to our government right now would be to set a page limit on new legislation. But this might produce legislation that actually helps normal people, which is why it'll never happen.
that doesn't sound like a very good idea to me. legislation is not complex only because of pork; there are always edgecases and loopholes to be handled. I highly doubt a reasonable solution to any of the problems you listed could be described in a mere ten pages.
take student debt for instance. imo there's a decent case for erasing undergrad debt under a certain threshold, but if you took on a six figure debt to attend a fancy liberal arts college, that's on you to unfuck. similarly, people like lawyers and doctors take on a lot of education debt, but that's also priced into their respective salaries. a professional paying off an outsized debt with an outsized salary doesn't need or deserve the assistance of the median taxpayer. a naive implementation of such could potentially be net regressive.
obviously you might disagree with some of that, my point is just to show that "abolish student debt" is controversial and complex even among people that agree at a high level.
A single sentence bill might indeed be too short to address edge cases and attract support, but it can still be single topic and probably no more than ten or twenty pages. Literally no legislator actually reads all of these 1000-page entire-legislative-agenda monstrosities. At best they have their own aides do it and summarize the highlights. More often, they just follow their own party's "leadership" on what parts to use as excuses.
Short, 10-page bills, don't exist because Legalese needs to exist because otherwise people find every loophole in any perceived ambiguity in the wording.
Like, imagine a mom seeing her kid jumping on the bed, and the kid says "I'm not jumping, I'm hopping. The difference is ..." and so the parent tells them to stop hopping and leaves. They come back later and the kid is sitting down, but bouncing up and down.
Eventually, the parent says something like "You may not jump, leap, spring, bounce, hop, dance, or otherwise engage in an oscillating vertical motion using the mattress of the bed as leverage or propellant."
Bam. That's legalese, and is the reason laws are 1,000 pages long. Except in this case, the parent has left open the loophole of allowing the kid to jump from their dresser onto the bed.
1000+ page bills that include a lot of stuff is an outcome of the political negotiation needed to get enough votes. A 10 page bill is exactly the kind of law that will face stiff opposition because you have to make major concessions to get votes from both Republicans and the more conservative Democrats who are ideologically closer to Republicans on this issue.
US Democrats did write legislation for the issue and did try to get it passed. They even chose an approach originally developed by conservative representatives to try to appeal to conservatives traditionally opposed to government funded/managed healthcare. It's now known as Obamacare and it passed with the slimmest majority then Congress subsequently tried to repeal, deauthorize, defund, or otherwise destroy it like a 100 times [1].
You could just as easily say that if the majority of citizens actually wanted to fix this problem, they would vote out anyone who voted against a conclusive bill. But doesn't happen because voters actually approve of these politicians anyway. You can spend all your money on publicizing "who voted against this healthcare bill" and accomplish exactly nothing, anyone who cares can easily find out anyway.
Democrats have no problem getting bills passed in the House. They'd need 60 seats in the Senate to make those bills law with a Democratic president, 66 with a Republican president. Majoritarian rule is not a feature of the US political system. It's a federation. The states elect the president, and the states control the Senate. Individual states are federations of counties. Politicians aren't held to account for massively unpopular policies (or failure to enact massively popular policies) because the electoral machinery simply isn't built that way.
You got some short memory, republicans fought tooth and nail against Obama and made an effort to have the worst possible legislation passed so they could prove universal healthcare cannot succeed.
I like that the article shows how this affects regular people pretty much randomly.
One thing I missed on the article was a section about "how did we get here" (including things like Hospitals not disclosing prices for their treatments and forcing people to sign papers under duress). And a section about "who benefits from all this suffering" would complete it.
making it insanely difficult to track services on invoices they send you. I had a 3 night stay a 2 years ago and received bills from 5 different 'companies'. I even paid one that I was incorrectly billed for and had to jump through hoops to get the money back.
What depresses me the most about this situation is the callous, unempathetic disregard a significant portion of the population has for everyone not like them. "Just get a good paying job with health insurance" is not and should not be the basis for a health care policy.
Americans are profoundly selfish and that's getting harder and harder to ignore.
Many will defend such practices in the name of "freedom". "Freedom" will often be an integral part of their identity. The sad truth is that these people seem so desperate for someone telling them what to do.
Supporters of universal access to health care simply want people not to be denied life-saving or life-changing medical care and not to be bankrupted by that. That's literally it. Yet such people are so often demonized as "socialists" or "communists".
The Bezoses and Buffetts of the world has so successfully propagandized and manipulated these people, choosing billionaires having a little bit more money over people literally dying in the streets.
I really do worry this country will be lost to white Christian fascism in the not too distant future.
> What depresses me the most about this situation is the callous, unempathetic disregard a significant portion of the population has for everyone not like them. "Just get a good paying job with health insurance" is not and should not be the basis for a health care policy.
The problem is this is a straw-man argument. We can agree that healthcare costs are too high, and have empathy for people who are being screwed over, but not agree that massive government intervention is a reasonable solution to the problem. In fact, there is an argument to be made that the only reason healthcare is expensive in the US is because of lawmakers failure to account for the second-order effects of their decisions (e.g. EMTALA). In the early 90s you could buy decent health insurance for less than the cost of Cable TV.
Unfortunately, the oft-repeated "solution" to the current crisis always involves forcibly taking tax dollars, and then directly funneling them into one of the most dysfunctional and corrupt institutions of all time (Healthcare), then lying to voters and telling them that doing so would magically turn the USA into Sweden or something. The people who don't support a public option are so exhausted making these arguments that they will tell you "It's socialism" and walk away from the conversation.
This is a borderline bad faith argument because the US stands alone as pretty much the only developed nation without universal health care [1] while simultaneously throwing our hands up in the air saying there's nothing we can do.
And that's the problem.
Insulin as just one example is spectacularly expensive in the US [2] for absolutely no good reason and the only way this is allowed to happen is that the Federal government has been successfully lobbied to not negotiate pricing AND to disallow the importation of the exact same medication from other countries.
> AND to disallow the importation of the exact same medication from other countries.
In other words, "free markets" only and exactly when it benefits the owners of American corporations.
And please don't throw some stupid safety and efficacy arguments this way. Pretty sure people in other countries don't like buying tainted drugs either.
Anyone interested in this topic who wishes to explore it in depth should read Marty Markary's 2019 book "The Price We Pay".
While slightly out-of-date due to legislation that has passed since then, the book does an excellent job of explaining a lot of the perverse incentives at all levels throughout the medical industry that contribute to the outrageously high cost of healthcare in the US. Worth a read.
I'm not assuming anything, I'm wondering about their methodology (and since it's a self-reporting survey, how people were answering the questions).
Medical debt is a huge problem but to craft solutions we need to fully understand that problem. Should, for example, insurance companies collect "deductibles" ahead of time and refund those not used, similar to how you could use an HSA? Should healthcare providers and insurance companies be required to offer 0% financing for 12 months for certain amounts or certain customers?
The vast takeaway is usually "this survey supports what I think should be done" which often results in not much of anything being done, or getting something worse than what was before.
$1000 is $2 / day for les than 2 years (if you can do math unlike commenter below, that's including nearly 20% APR). I'm sorry but even the poor in america can come up with some way to make $14 in a week, if nothing else by picking up some cans.
I live in a city where a segment of impoverished people come up with ways to spend $20+ a day in fentanyl, and they don't seem to have much trouble coming up with that even while living in a tent.
You're taking one person's experience, who has mild medical expenses and applying their situation to loads of poor people as if their experience exemplifies the experiences of millions. Frankly, that's disgusting and while I don't wish you awful medical debt, it sounds like you could stand to be humbled by some.
Think of bigger medical expenses over the same period -- 10k. That's 20/day. 100k -- 200/day. Now add ACA monthly costs (300-400/mo). Then rent, then food. Etc etc.
>You're taking one person's experience, who has mild medical
"You" being the parent OPs who I responded to who introduced the nation of $1000, which happens to be above the median for my state and most states shown in the article? Remember I'm RESPONDING to the $1000 comment, not introducing the figure. But maybe they said something about the $1000 you agreed about, so you went with the disingenuous approach of only impugning someone commenting on it and in bad faith accusing THAT person of introducing the figure.
The MAJORITY in my state and most states have less than $1000 in medical debt. Millions. This isn't some edge case. $1000 "exemplifies" the median medical debt in most states, according to the article.
>sounds like you could stand to be humbled by some
Yeah a subtle suggestion I ought to experience medical problems. Keep it classy. "Frankly, that's disgusting."
>Think of bigger medical expenses over the same period -- 10k. That's 20/day. 100k -- 200/day. Now add ACA monthly costs (300-400/mo). Then rent, then food. Etc etc.
Yes I thought about it, and then decided my $2/day figure still holds as a possible approach for paying off median medical debt. Thanks for the thought exercise!
I'm not sure how throwing around a $100k figure is supposed to make your point any better. If it's worth considering the 100k case of the minority it's worth considering the half of person's in these states for whom the debt is under $1k.
My intention was never to show that someone with $100k of medical debt could get out of it as easily as the majority with far less.
If you're not eating it follows you're eating $0 worth of food. So it is what you said, unless you're implying someone is spending money on food without eating any of it.
I'm interested in the meals you suggest that you think are "eating ok" while maintaining the nutrition to work, $2 all in per day (food cost + transport to buy the food + cost to cook the food + depreciation on any utinsils / cookware).
Also keep in mind many poor people live in a food desert so if you're counting on discount food you're gonna need a bus ticket or a hell of a long walk once in awhile.
As an aside, it's worth noting if your suggestion is true and one can truly eat ok on $2 a day, then the median medical debt holder who spends say $4 a day on food can easily pay off their loans in a few years following your cooking advice. You just came up with a way for them to produce $2 / day without any additional income.
There are multiple meals per day if one has to skip some of them to make ends meat then they are "not eating" those meals.
It's a bit more complicated than you are making it out to be, it would not hurt to remember you are talking about fellow human beings and not just numbers in a spreadsheet.
Got it, the typical person can browse reddit, come up with an "ok" diet for $2 day, saving them $3+ a day vs what even the typical working class person spends on food. And simultaneously you believe it is achievable to save this $3+ per day eating following your reddit suggestion while somehow not being able to use $2 of those $3+ to pay your medical bills?
Do you find that being this uncharitable is an effective way to communicate with others?
You haven't actually been poor like that in the US. That isn't a question, it is a statement. I have as have others I know so yes even a few dollars per day can make/break the budget.
>You haven't actually been poor like that in the US. That isn't a question, it is a statement. I have as have others I know so yes even a few dollars per day can make/break the budget.
I don't know how poor you have been or are. And you don't know how poor I have been either. I'm not going to play oppression olympics with you. I have been homeless, sleeping in ditches and parks before, living off of minimum wage day labor. Even back then, if I needed $2 I simply worked an extra 15 minutes moving drywall at construction sites or whatever. Those who can't work may end up buying snacks with their foodstamp card and hawking them to high schoolers walking to school or something (as I see many homeless do near my house). There are very few people who aren't already covered by medicaid/medicare who are incapable of coming up with $2 / day somehow, and if they are they are the extreme case. Again even _drug addicts_ in my neighborhood, while high out of their minds, somehow manage to come up with $20/day for their fentanyl habit and that doesn't even cover the rest of their necessities.
And as an aside, I'm not buying the argument that being broke somehow makes you more of an expert on how to budget. The poor in this country are notoriously victims of sub-par education which sadly leaves many of them poorly situated to navigate managing their own economic future. If I want budgeting advice I'd much rather ask say a guy who started his own restaurant vs some random broke person on the street.
> I'm not going to play oppression olympics with you.
That wasn't my point. Honestly please take a look at your interaction with me and reflect on it, it isn't necessary to engage in such a hostile fashion. You have read a lot into what I have written that simply isn't there.
You have read a lot into what I have written that simply isn't there. It's not a good look to clam up and play the victim when called out on your presumptuous and contradictory statements, including your assuming the economic background of someone based on a short dialogue. Remember just one post ago you found it completely valid to retort about how I "haven't actually been poor like that" and how you have.
Please take a look at your interaction with me and reflect on it, and think to yourself about how you can be less presumptuous.
Yes, if you are living in a tent and are addicted to opiates, I doubt that "medical debt" would be anything that even registers on your radar. You'll get emergency medical care as needed at the nearest public ER, and since you don't have an address they probably won't even bother to try to send you a bill.
No need to wonder. You can read the poll and results methodology yourself.
The answer is two clicks from the article, both links above the fold on their respective page. If you’re being genuine in your curiosity, it would improve the discussion here if you shared what answer you find.
> The survey was designed to reach adults who currently have health care debt or have had health care debt in the last five years. In order to do this, the probability panel sample included an oversample of panel members with annual household incomes less than $30,000, individuals with current or past health care debt (n=641) were included in the sample. In addition, 52 adults with past or current health care debt were reached by calling back respondents that had previously completed an interview on the SSRS Omnibus poll (and other RDD polls) and reported an annual household income of less than $25,000.
> The combined online and telephone samples, excluding oversamples, were weighted to match the sample’s demographics to the U.S. population using data from the Census Bureau’s 2021 Current Population Survey (CPS). On the basis of this weighted sample, parameters for the debt and no-debt populations were extracted. Weighting parameters for each group included sex, age, education, race/ethnicity, region, education, and income, as well as patterns of civic engagement from the September 2017 Volunteering and Civic Life Supplement data from the CPS. The sample was also weighted to match population density parameters from the Census Planning Database 2020. The weights take into account differences in the probability of selection for each sample type. This includes adjustment for the sample design and geographic stratification of the cell phone sample, within household probability of selection, and the design of the panel-recruitment procedure.
So they intentionally targeted people with debt, so the "63% percent of respondents" is not able to be read as "63% percent of Americans".
The 100M in the title is extrapolated, and is likely correct, but people are not reading the percentages as they should be read.
The key takeaway from the study is that not all medical debt is reported as such, and poor people have difficulty paying bills, one type of which is medical bills.
I also intentionally go in to debt for any of my expenses subject to deductible, because my hospital offers zero-interest payment plans. I then pay their payment plan with a credit card, get 2% back, and pay it off at the end of the month.
This also ties into that commonly statistic that 60+% of bankruptcies are caused by medical bills. The study is more complicated than that, and it's not the best summary:
This is exactly the kind of thing I'm getting at - absolutely 100% of bankruptcies are caused by debt; perhaps 60% of them also have medical debt somewhere in there, but that may be a distraction (after all, once you're on the path to bankruptcy why bother trying to make medical payments, they're not going to repossess your lung but they very well may repossess your house).
The US has a major debt problem and the solution at some point is going to be curtailing just how much debt you can accumulate with just a signature.
A lot of people read that statistic as "medical debt is crippling" but there are also correlations with lot of other life circumstances going on in that figure too.
Most of the people who file something like chapter 7 have little to no income, don't have big bank accounts, luxury cars, second homes, etc. This often correlates with people who have medical issues and rack up big bills, and can't work a job. These people can file "no-asset" chapter 7 cases, in which case, they lose absolutely nothing. This is what happens in the majority of chapter 7 cases filed. So, for a lot of the people who do choose to file, this is because it is a good option, not because it is a life crippling choice forced upon them.
I'm very surprised they do not charge the credit card processing fee here. But I guess since you are actually paying they are making such high margin they don't even care.
This is 100% the case, the billing side is completely and absolutely disconnected from the care side it's not even funny. As long as the inflows from customers and insurances companies roughly equal the outflows in expenses, they really don't care much how everything is billed.
Which is why you can often do better paying cash at a "expensive" hospital that is overflowing with money than at a "budget" one that is having difficulty making the numbers balance. The latter is more likely to hard-line.
At worst they'd put you as one of the 37% of people who haven't had to cut spending on food, clothing, or other basics.
Of course, 63% of the people with health care debt have (according to study).
So while your case is interesting from a technical point of view, it isn't really practically or morally interesting, and can only serve to detract from the important points of the study.
These studies are always self-reporting and taken at much more than they actually say. Checking the methodology is important and should be done more often, especially on surveys based on self-reporting and not on large amounts of data.
You are right. I tried to caveat my analysis with "(according to study)". My prior is not that the study is completely accurate, but that it is accurate enough to make the broader points described. I may be wrong, and you're right that everyone should be more cautious.
But I think there is a difference between cautioning neutrally (the comment I'm replying to now) versus obliquely cautioning in a way that casts doubt with negative consequences (the comment I replied to previously).
2/3 childbirths we missed one (tiny, in both cases) medical bill and it ended up in collections.
We were getting like 3-5 letters per provider per visit, and many visits resulted in bills from multiple providers.
"NOT A BILL" (so why the fuck are you sending it to me?) same thing again from insurance for some reason, incorrect bills we had to fight, insurance refusing to pay on things they should so that drags out for months and you're getting "FINAL BILL" in the meantime but the hospital billing people are telling you not to pay them until insurance is sorted out.
Many providers sending a bill exactly once and it goes to collections if you don't pay in 30 days, no calls or follow-ups (that's how both of ours ended up there—again, they were tiny, we'd have paid them instantly if we'd known about them).
Bills showing up two months after a visit and you've had 30 medical appointments in the last year so you can't remember WTF it was for. I think in one case we were still sorting crap out from the birth and prenatal care when the kid was 6 months old.
Hospital requiring full payment months in advance for the births. And getting it very wrong in one case (on the high side, of course—every billing error is in the hospital's favor, super weird how that works, bet it's just an accident and not them being actual no-bullshit criminals, though eyeroll) because they refused to use our version of what insurance would pay (which was correct) and basically just made up a number.
Total fucking mess. Horrible experience every time. Can't wait to get to deal with this horseshit when one of us is actually, seriously sick. I've added hospital billing departments to the list of medical-related folks I truly, sincerely wish the worst on, and I mean the worst—show me the headline, I'll open the champagne. They're either shockingly incompetent in ways that mess up people's lives, or they're malicious. Maybe both.
My wife and I have good insurance (like $200 out of pocket for surgery good) and I still hate going to the doctor because I know I'm going to get stuck with an involuntary side hustle as a medical billing clerk if I want the benefits we're entitled to to actually be honored. Our insurance paid maybe ~6k in charges one time, then 6 months later retroactively denied the claims and billed us for them. There's just no repose ever at any time, and you have to deal with a system that is always stacked against you.
No joke. If we'd been compensated at any kind of reasonable rate (not even our day-job rates) for time spent dealing with billing and insurance crap, it would've covered a good chunk of our (substantial) bills.
We've encountered similar situations (especially the "NOT A BILL" fuckery) and the "oh don't pay it when it arrives because insurance is always slow" shit - but luckily none of our three births have been that bad cost/handling wise, even though we used three different hospitals (same insurance).
The smaller hospitals in general have been better but it's so obviously a giant clusterfuck.
I can't even imagine how someone without partner support (who the hell wants to deal with hospital fuckery post-partum) does it.
I truly don't think everyone involved could be making so many mistakes in their own favor if it weren't the result of policies tuned to ensure that happens.
The policies are designed to find errors in the client's favor, that's manifestly clear.
Penalties need to be attached to misbilling; it needs to be made effectively illegal and allow others to help collect the penalties, then an industry of scummy lawyers will appear to help customers reduce their bills at the expense of the hospitals.
Yeah I was going to say, I would be 0% surprised if I had old outstanding medical bills somewhere just because of the general chaos of the process. I have plenty of cash to pay whatever I owe, it's just a low-visibility clusterfuck.
Yep. I'm dealing with a situation where speech therapy as rehab from a surgery is covered by by plan. But the hospital just submitted the claim with some general code. The insurance says they need the therapist to change the billing code. They won't allow us or the surgeon to submit anything to prove it should be covered. We have to wait for the inept therapist to change the code. All the while thousands in bills hang over our heads and we wonder if insurance will pay out.
And rarely, if ever, can you get the insurance company to admit what the secret billing code is before you have the procedure done. You have to hear it in whispered conversations from those in the know.
Just watched John Q (2002) last night, and can't believe that despite all the attention it gets, nothing has changed at all. Can't say I'm surprised though.
Basically the way things work in the US is that even if you can get an overwhelming majority of people to agree that something is a problem, you will never get them to agree on a solution.
In this instance, the two proposed solutions are: make healthcare the government's responsibility like many countries that don't have this problem, or do nothing because that solution isn't perfect.
I literally linked those two polls just yesterday, hah [0]. Did you see my comment, or did you just happen to do a similar search and get those results?
As I mention in my other comment, I speculate the possibility that people think "Single payer" and "Medicare For All" are different things [1] and so report a different opinion on each, similar to how the ACA was viewed MUCH more favorably than ObamaCare despite one being the nickname for the other.
[1] ACKSHUALLY, single-payer doesn't HAVE to be simply expanding Medicare to everyone. It could be done in some other way, but the core idea of the government paying for everyone's healthcare is still the same.
Further, neither side (seems to) accept incremental change and loves making the perfect the enemy of the good -- especially, imo, the left -- so they get nothing and complain about it.
You're going to have to elaborate on that one, considering that the ACA came from the Obama administration and was about the smallest incremental change possible. Not that republicans didn't try to repeal it several times anyway.
Sometimes incremental change happens, like the ACA, sometimes people go all accelerationist[0]/Bernie-or-bust on us and then someone vastly worse[1] gets elected. Seems like it's more the latter than the former these days considering how divided we are, politically.
Yeah, but they're ridiculoisly overpriced, and regulatory capture around medical devices means new entrants' devices will never be approved by the FDA.
Before Michael Crichton wrote fiction, he was a doctor and his first book, "Five Patients", was actually an examination of different topics in healthcare in the 1960's. One topic was the massive cost increases even back then. It's a pretty interesting read too.
I hate the way the health-care system works and how it's affected me and those close to me. I spent much of my adult life paying off medical debt exactly like they describe. Defrayed by parents somewhat, but still a significant burden for many years. On one hand, we have debt and bankruptcy as a tool to help individuals deal with costs that would be impossible to save up for. On the other hand, this quote from the article rings true:
> “We have a health care system almost perfectly designed to create debt.”
As implied in another comment, the real solution is one people don't want to consider - forbid people from taking debt on in certain circumstances.
But this immediately appears as "unfair" even if predatory lending is a huge problem.
Meanwhile those who already have some money wouldn't be affected by it much, for example, a law requiring all credit cards that charge interest on balances to be secured ones (where if you have a $1k credit line you must have $1k cash/cash equivalent in the bank).
Yes. Debt is the entire story of the American economy, from top to bottom, it's not inherently evil. It's useful for creating new wealth. But of course it gets misused also.
I don't think anyone is arguing that debt can't be another tool in the toolbox, but when you consider that the debt/equity ratio has risen considerably since the second half of the 20th century, you start to get the sense that this is somewhat "centrally" planned.
It is always the same poor journalism tactic of obscuring the distribution of data to make a “plausible” controversial claim. Similar to the oft quoted “Americans cannot afford a $500 emergency”.
Yep but if you add a note for the reason of bankruptcy into your credit application, the credit provider would still take that into consideration and STILL charge you a higher interest rate.
Depending on the absolved medical debt (being discharged by your bankruptcy), and its would-be crushing monthly payments, the higher interest rate of your new (mortgage/credit) credit lines and its monthly payments are often less than the impact by (then dissolved) medical payments therefore your living standard would still improve after such medical-related bankruptcy.
As someone from the other side of the Atlantic, I've always been surprised at how much people in the US rely on debt and credit lines for their daily lives (besides very infrequent, very expensive purchases such as a house). I'm personally extremely wary of spending money I don't have.
My mortgage is 2.25% and the car we financed was 0%.
The saddest part was with each creditor that asked about the bankruptcy and we explained it was due to medical debt, they would just say something like "oh no problem, get those all the time" or "bad things happened to good people", like it was no issue.
It was like, having crushing medical debt is normal, for people.
Urgent care had my girlfriend go to ER when she went in for Epinephrine shot. Because, apparently, they call an ambulance for anybody who shows up with something potentially dangerous (including EKG readings they can't read, according the the ambulance driver who took us).
We just sat on a chair for a couple hours for 'monitoring', and sure enough we got a $1700 bill from them, since she hadn't met her deductible yet.
Of course people are in debt if they get hit with bills like that.
It's ridiculous in the year 2022 we still have people making a decision to not seek medical treatment of any kind because they are afraid it will bankrupt their family, they won't be able to pay their rent or mortgage on time, they might have to go without food, take out loans or borrow money that puts them in even more debt causing more health issues. I'm not sure what the solution is but I feel like there's got to be a better way.
Tangential to health care debt, Some times I wonder if the only true innovation happens in facilitating debt and making huge debt seem like easily tackleable. 30yr mortgage, 15 and 10yr arm, car payments sold as “only $199 a month!”. Buy now pay later is the latest in a long line of these encouraging people to pile on debt.
It's an entire industry based on fraud and deception. My wife recently had surgery and we got hit with a $1500 surprise facility fee. It likely won't be covered by insurance due to some fuckery around not reimbursing the fee if the in plan physician owns the facility.
We knew enough to ask about the anesthesiologist and any surgery assistants. But they came up with some new bullshit and got us. When the world gets wise to this nonsense they'll come up with something else. It's a business deeply rooted and based on scamming their customers.
And 70m of the population is 18 and under. So apparently the percentage of people with medical debt who are over 18 is quite substantial. Didn't realize it was so significant myself.
I don't see why this is a bad number. It is easy to get on a 0% payment plan for medical procedures, or to contest a medical bill that is "a debt" that will get paid eventually.
This is the expected result of median deductibles being larger than median savings accounts. Small amounts of debt <$1000 are not necessarily problematic amounts of debt, especially considering that they can typically be paid off over time with no interest.
This is not intended to be political - all politicians are corrupt. That said, if only we could've saved a few of the billions we sent to Ukraine or Iraq and use that to pay for healthcare for common Americans.
Fortunately as an engineer, shelling out $4k a year on top of my basically "free" health insurance through my employer is more of a nuisance than something I lose sleep over. That said, people in this country need better healthcare. Doing this will unsaddle startups and businesses from having to provide it directly. Healthcare is something I would pay more taxes for, but above all I command the government to spend in ways that BENEFIT the American people not just corporate donors.
I have a bunch of medical debt but not really, just waiting for treatment to be “finished” and someone else’s car insurance to foot the bill.
I have debt collectors calling me which i ignore now because me describing the situation and them “putting a note in my file” has zero effect on how often they contact me.
In the end I’ll owe $0 it will just take time to settle.
But there is something coming close to $10k of “debt” out there with my name on it.
I see any suggestion to the contrary of Socialized medicine being downvoted. Honest question. How do you propose to expand healthcare with 130% Debt to GDP and 8.9% inflation? It seems we are broke and there is a demand from the HN community to spend more? Feels like hitting the accelerator as one drives off a cliff and invokes memories of Thelma & Louise
We pay nearly double for our privatized monstrosity, compared to the most expensive socialized systems. Such savings! So cheap! Very efficient! Can the treasury possibly bear the expense of spending less than double?
------
Yeah, a transition is going to be an expensive shitshow and now is not a good time, but just about any other time in the last decade was a good time and in a year or two it will be a decent time again. We'd better rip this bandaid before it soaks all our blood out.
Politics aside, money puts a cap on everything: wars, social services, etc.
The issue at hand is to take something the public spends nothing on, that the government gets for "free" and to put that on the public balance sheet - a huge cost. I guess we could balance that out with a tax, but who would like that? And even if we were to raise taxes - it wouldn't help our balance sheet since we already spend 30% more than we take in. Looking at the balance sheet as it stands today, we can't even afford what we currently spend. And inflation is on the rise.
I just don't see it ever happening. Save a collapse and total reset of the current monetary system.
You are obviously a very smart guy, jjoonathan. Why do you suppose the Democrats didn't even propose this when they had 60 Senate votes, the Presidency and the House? If its a 101 level problem why do you think that is?
We have a hybrid system here in Australia where there are tax benefits for having private health insurance but we also have a high quality public system. The public system actually comes out consistently as being more efficient than the private one, so the cost to society is less.
The rebates for private health insurance (to convince people to take out private insurance to “take pressure off the public system) have actually made things worse, for most people it’s subsidised by 30% by the Government (and you avoid an extra health levy), but over the last decade or two, the premiums have just gone up significantly and the amount of things covered has been dropping. It would have been better to just put that money into the public system (which is a bit overstretched due to underfunding). So mostly the subsidy has just gone into profits for insurers. It’s hard to get people to take out the private insurance without it and tax offset, but as I said before, since the public system is more efficient, the cost to society would be less without subsidising private insurance.
I agree and have always felt all of this is the wrong debate. The focus should be on fixing the root cause of most medical issues. "An ounce of prevention...." yada yada... Just Type-2 diabetes alone will bankrupt the US by 2040 or sooner according to the CDC as reported in an interview on Joe Rogan. [1] There are a myriad of other CDC studies that show us going bankrupt sooner regardless of who pays for medical issues. I have no idea where all this money will come from short of conquering some other countries. For me personally, I will just focus on proactive measures. Here [2][3] are a couple of the reports.
As a side note I am about to go feed Thelma and Louise. Ill pet them and say hi for you.
"Socialized" explicitly means government ownership of the means of production (1-3). Weaker definitions include ideas like regulation, administration, or control. But let's stick with ownership. Your word, so let's work with that.
If the government owns the system, the government can establish all sorts of controls (4). What do you think the margin is in these sectors (% is of $3.5T in 2017)
Hospital care (33%)
Physician and clinical services (20%)
Retail drugs (10%)
Other health, residential personal care services (5%)
If you're not incredibly rich, you're just temporarily holding all your savings & retirement accounts for the hospitals and nursing homes that'll eventually take all of it. And then some.
Yep the entire end-of-life industry is incentivized to drain all the wealth from the old and terminally ill before they die. That is why my plan is to opt out. DNR, living will, I will not enter a care facility or hospital I'd rather die on my own terms and have my children inherit whatever I have managed to accumulate.
You can file bankruptcy which will protect your retirement accounts. There are other way to protect your assets and money as you get older and risk gets higher.
It should not be this way though because mostly the wealthy take advantage of protecting their assets as it requires some money.
Was your uncle qualified for medicare? We recently had several members need end of life care and they didn't have to pay any of the hospital bills. Many bills we did receive, we called the charging company and they were waived immediately "oh I guess we made a $100K mistake" or "medicare already reimbursed us, that was just a courtesy notice."
Honestly, I am not sure. I wasn't well versed in personal finance/healthcare/money back then. He destroyed his family and his wife left him. His kids don't really want to discuss that period of their life at all, so we never talk about it.
Sometimes services are rendered which insurance does not deem required, and then refuses to pay for, and some items are simply not covered at all. For example, insulin may be covered by insurance, but needles and syringes are not.
On top of that, it's basically impossible to anticipate the cost ahead of time for many procedures. One person I know was quoted $2,000 to $30,000 for a portion of a surgery that is not covered by insurance, depending on exactly what needed to be done. How do you even plan for that? At one end, it's like buying ~2 new refrigerators of pain, and the other end is a brand new, top of the line Chevy Bolt.
For many people, hitting max out of pocket is simply not possible without debt. It's common to see 3-5k MOOP, but taking a modest standard of living on an average salary, it's an incredible amount of time to make up for it.
E.g. $5,000 household income (60k annual)
* $800 rent
* $1,000 childcare
* $250 gas
* $200 utilities
* $500 groceries
* $500 income taxes
* $250 student loan payments
* $100 car insurance
$1,400 leftover, but there have been no incidental expenses, $800 is probably lower than you could find a 2 bedroom apartment in Iowa, and I'm assuming they own their car outright. Once you hit January 1, your deductible and max out of pocket reset, so you could be like a friend of mine and get MRI's on December 31 and January 1 while staying in the hospital for a couple days on either end. They had to pay their full max out twice because of the timing in the year when they got sick.
That's terrifying. The healthcare issue with the US is what seriously makes me want to live in Europe, at least to try it. The thought of your whole life falling apart just because you need medical care is horrible. I'm living the double-software-engineer-income, no kids life with my partner, and even then I think a major medical issue would be life changing. As a risk-averse person, the US feels like a place to get high rewards as a SWE, but there are massively high risks that don't get talked about often enough.
It's not like you can get whatever, whenever medical care in Europe. Whether private or public, the entity that's paying the bills will be making decisions on what procedures are or are not "necessary" and how much they will pay.
My uncle in Denmark had cancer, and they basically put him in a hospice-type facility to die, because anything else would have not been justified due to his age, the cost, and the low probability of success.
In the USA, he or his family would likely have demanded aggressive surgery and/or chemo or radiation, he would have died anyway, and there would have been hundreds of thousands of dollars of "medical debt" created.
I suspect many people who like the idea of socialized medicine are not prepared for the reality of the limits on care that would bring, particularly for the old and terminally ill.
> In the USA, he or his family would likely have demanded aggressive surgery and/or chemo or radiation
In the US, if you can't afford it, medical care basically isn't even an option. If you have a lot of money, then you're set. In Europe if you don't have much money, you at least have some options, and if you have a lot of money, you can still go to the US. Or if you're open to $100k's of debt, you could've easily gone to the US for treatment, too. Your scenario just proves my point that the situation is way better in europe
Well, I'm saying that he had no options. He went to a (very nice) facility to die. They kept him comfortable and relatively pain-free.
Any other option he had, should he have wished to pursue it, would have been outside of the Danish social medical system.
That may be "better" than what would have happened in the USA under Medicare/Medicaid, but my point was there really wasn't a choice in the matter for him. He didn't have to pay for it, other than the taxes he paid his whole life, so I guess there's that.
> Well, I'm saying that he had no options. He went to a (very nice) facility to die. They kept him comfortable and relatively pain-free
I'm just saying that's an option that he took. Just because it wasn't ideal, doesn't mean it wasn't something. If he was in the US, that wouldn't have been an option in the first place. Still a massive improvement over the US.
> Sometimes services are rendered which insurance does not deem required, and then refuses to pay for
This shouldn't be legal.
Do insurance companies even employ actual medical doctors that are educated, trained, and experienced in health care so that they're qualified to make these calls?
They do employ medical doctors to review cases, give prior authorization for specific treatments and diagnostic tests, etc. There can also be doctor to doctor calls to explain why a particular item was justified. The thought of some random doctor reviewing your file and the notes generated from a visit and making a determination having never seen you sucks. It's been passed ok'd as "ensuring doctors are following the best practices and ensuring consistent standards of care", which it may to an extent.
As with most aspects of US healthcare, when viewed through through the perspective of the recipient, it's atrocious. Every medical facility requires you to sign a paper that you'll pay all the medical expenses if they aren't covered by insurance. They can't give you an estimate that they promise they'll stick to in terms of cost. There's no way a non-doctor could know what the typical course of treatment would be, so they're stuck trying to get straight answers from an insurance company if they don't want a surprise massive bill.
Provider bills insurance an insane amount which is then arbitrarily discounted. Provider can't bill different amounts for insured or uninsured patients (illegal from my understanding). If insurance doesn't cover something, it's between the patient and provider to settle.
Basically you go to a hospital that is "in network", get some work done, but it turns out that some doctor (often some side-channel like a radiologist) who reviewed your case was out of network. So your insurance doesn't cover him and the hospital sends you the full bill. Out of pocket max doesn't matter, because that only limits costs where insurance actually accepts the claim.
It was outlawed by US congress this year (The "no surprises" bill), but there are some exceptions like ground ambulances, so I guess we citizens are supposed to remember not to take those to the hospital unless we are rich.
Drs and other high earners in the states that introduce socialized health care will leave immediately as the state institutes price controls. There is a reason so many Drs trained in Canada immigrate to the US.
Hot take: The only reason ACA passed is because the government did not want to foot the entire healthcare bill for our aging boomer generation. So ACA became a way to partially distribute those costs to the rest of the US population by forcing them into a healthcare plan.
Sure, in theory those forced into the ACA are protected from financial disaster in case they get sick, but in practice, the younger generation won't need healthcare for quite a long time, thereby once again kicking this can of worms down the road.
Edit: By "that assumption", I mean that the portion of the number made up of people who only owe a few bucks and only briefly is significant enough to call for a dismissive attitude.
Note that this data is from a poll, not actual investigations of medical account balances. It includes the following, very broad, categories in the original polling methodology:
“c. Any debt you owe to a bank, collection agency, or other lender that includes debt or loans used to pay medical or dental bills.
d. Any medical or dental bills that you have put on a credit card, and are paying off over time.”
Thus, by one interpretation, if you’re already in over $5,000 of credit card debt, and you charge a $10 prescription fill or $25 copay to that credit card, their methodology will now include you in the medical debt and medical debt amount statistics as having medical debt over $5,000. The specific wording of the “amount” question seemingly tries to prevent this, but considering the above was classified as medical debt prior in the polling, it’s not hard at all to imagine people answering in the affirmative.
Is this really true? I don’t know, that’s a complicated discussion. There are certainly people who are paying medical costs with credit cards. They deserve to be included. But it does seem possibly a bit too broad.
Please just read the article if you want to argue about it, it's not that long.
> And about 1 in 5 with any amount of debt said they don't expect to ever pay it off.
That's 20 million people.
> About 1 in 7 people with debt said they've been denied access to a hospital, doctor, or other provider because of unpaid bills, according to the poll.
That's 14 million people.
> An even greater share ― about two-thirds ― have put off care they or a family member need because of cost.
That's 66 million people.
> Half of U.S. adults don't have the cash to cover an unexpected $500 health care bill
That's 129 million people.
Again, please read the whole thing, whether or not you want to comment more. This is important information for US residents.
> Half of U.S. adults don't have the cash to cover an unexpected $500 health care bill
I recognize that this is an important discussion to have to improve US healthcare, so I’m not outright disagreeing with you.
But I think this is a bit editorialized. Paying with cash is so rare in society. I don’t even have the cash to pay for my lunch - I just use a credit card. It shouldn’t be surprising.
Half of U.S. adults said they would pay it immediately.(30% using savings,20% using a credit card they pay off that month)
A further 21% said they would pay with a credit card and pay it off over time. (Anyone who is already in other forms of debt will probably take this option as they, by definition, don’t have the cash for other things.)
Another 5% said they would make a payment plan with a provider / pay overtime.
That’s 76% of the country that is knowledgeable about reasonable ways to pay for the services. Now, 24% using worse off options or not knowing - that’s not good at all. But it’s a far cry from the implication that “half of people can’t pay”
But still this isn’t really a metric on the U.S. healthcare system directly - that would be asking why we have unexpected $500 bills, not which payment method people are using. And alternatively, or even in tandem, why people are not saving and planning ahead.
Well, no. You certainly could be someone who *could* pay it off but chooses not to for a variety of reasons. Many otherwise financially people I know carry some credit card debt.
Now is that a large portion of people? I have no clue, and my anecdotal evidence certainly isn’t qualified to answer the question.
There are 48 Democrat Sentors and 2 Independents who caucus with the Democrats, one of whom has sought the Democratic nomination for President. That’s 50 votes, plus the Democratic VP to break any tie. While it might be correct to say the Democrats do not have a majority in the Senate, its not incorrect to say they do control the Senate.
In the context of voting for taxpayer funded healthcare, or any other broad population wide benefit program / tax increase, it would be inaccurate to label Manchin and Sinema as Democrats.
Same as when Affordable Care Act was being molded, a couple of “Democrat” senators like Leiberman sank any chance a taxpayer funded option. Just like Manchin and Sinema sank Biden’s universal preschool/daycare and paid parental leave proposal last year.
Eh, both Manchin and Sinema self-identify as democracts, which some argue is all you really need these days. More importantly to me, however, if we rely on actions and not words, they consciously elect to remain members of Democractic party ( as opposed to say.. being Republican, Independent, Green or whatever ).
For all practical reporting purposes, they are Democracts. The moment you apply 'but they voted for X', you can cast McConnel as a democract, because he greenlighted new gun deal.
Context matters. The original post I replied to was admonishing Democrats as a bloc for not trying to reform healthcare, specifically with a taxpayer funded option.
The reality is that Democrats, as a bloc, are the only ones to have even attempted taxpayer funded healthcare, and somewhat succeeded. Just because a couple people who label themselves Democrats, but do not vote with them does not make sense to blame Democrats as a whole for holding back progress in taxpayer funded healthcare, and ignore the 50 Republicans voting against it.
This is all ignoring the fact that in the context of taxpayer funded healthcare, you need 60 votes to do anything, so the measure for “control” of the Senate would be 60 votes.
It is my bad. I did not read down-voted comment closely enough. I do have a problem with casting senate control as 60 votes, but your rationale makes sense now.
I think, because, in theory at least[1], simple majority in Senate is all that you should need to pass a bill. To the best of my understanding, 60 is just for being filibuster-proof.
Your question is qualified enough to relate specifically to the bill listed by OP, but, again in theory, if the bill wasn't so off-putting that senators decided to filibuster, maybe it would pass.
In other words, 60 is not control; 60 is safety. 50+1 is control albeit minimal.
I agree with your characterization. I supposed we will see more support of getting rid of filibusters via “nuclear option” as the bipartisanship gets less and less likely.
Democrats would not be able to bring a vote without 60 votes, or without using the nuclear option to rid the filibuster.
Which would burn a lot of political good will for no reason, considering the likelihood of how Sinema and Manchin would vote.
The point being that evidence points to Democrats by and large supporting taxpayer funded healthcare options. It specifically was removed in 2009 from ACA because of 1 senator from Connecticut.
Let's get a vote in the House to see where everyone actually stands. My point is that the Democrat majority seems to be against Medicare for All, and I want to see it in a vote.
It's not really fair to pin Lieberman's opposition to the public option or expanding Medicare as some personal opinion, he had previously supported expanding Medicare until he abruptly... got new orders? Seems like the the $930,000 in bribes he accepted from the health industry could have played a role:
The problem is, the democrats have done a lot of these symbolic votes, on issues that majorities (55% or more) of the public support. They take down the vote, and the public doesn't notice.
Even with public support for their ideas, they are losing the messaging war against the other party. Most voters don't pay attention to candidates' voting records, and barring the unforseen the Republicans appear poised for a major victory in the House, with the senate in play as well. We are in for some bad times ahead.
Blame Democrats for the college educated urban-dominated coalition they’ve deliberately chosen. I recall some activist types talking a few years ago about whether pro life Dems like Manchin should be kicked out of the party. Though it’s the House not the Senate, Dems just lost a longtime majority-Hispanic seat in south Texas: https://www.texastribune.org/2022/06/14/texas-special-electi.... To give you an idea of the temperature of that room, the Dem candidate had run as “a ‘conservative Democrat’ and ‘pro-life’ Catholic.” National Dems are making a deliberate choice to abandon those Dem voters, just as they did with working class white people in the Midwest. Remember when Dems had 60 Senate seats, including in states like South Dakota? It wasn’t ancient history it was 2008.
Republicans abandoned people who are in favor of abortion. Republicans abandoned liberal Republicans like Bill Weld. Every party abandons people. Democrats consistently hold majority views on a wide range of policy issues and consistently have more votes in national elections. Gerrymandering so that urban centers lose their voting power and other election rigging techniques is what is holding back Democratic policies. The Democratic Party should not abandon its highly popular core principles to cater to the deranged apportionment that the U.S. has.
> Gerrymandering so that urban centers lose their voting power and other election rigging techniques is what is holding back Democratic policies.
I mean gerrymandering doesn't help but the Democrats aren't one cohesive unit otherwise they'd have no issue doing stuff right now. Sure people claim they only have 50+1 in the senate so they can be filibustered but they can just remove the filibuster with 50+1 and then do w/e they want. Democrats don't achieve their "party position's" because they're not the position that each member of the party has.
The same is true for Republicans. Look at Trump's campaign promises [1] which were often parroted by Republicans in congress but they only major thing they achieved was the Tax Cuts and Jobs Act [2]. ACA was not repealed because some Republicans voted no. One thing news orgs commonly bring up with Trump is he appointed a bunch of judges but that's just because Republicans changed the filibuster so they could; if RBG retired when Obama told her too or Democrats made the same changes, Obama would have appointed a bunch more judges.
Republicans were never going to get rid of ACA; it’s their plan after all. Republicans were never going to build a wall. These were just talking points. What Republican lawmakers are great at is being united in thwarting Democratic policies and doing what it takes to enhance their own power. Republican lawmakers are much more united when it comes to core principles:
1. This is kind of vague but Republicans do vote on Democrat-lead bills [1] which is a pretty poor way of thwarting them.
2. I did forget about mentioning that one. Republicans could have easily restricted it in 2016 if they as a cohesive unit wanted to. They do not. It's much more useful to leave it in the current state where it can constantly be brought up every election cycle as a way to drum up supporters who have no object permanence.
3. You got me here but that's also the thing I listed as their only accomplishment.
4. This one is very bi-partisan. The military has no issue with losing funding and especially wants to optimize funding by doing things such as closing low-utilized bases and moving those staff to other under-utilized bases. However doing so affects congressional districts and their congress representative have no interest in losing jobs (money) for their region. The lack of awareness of defense spending as a jobs program is a big pet peeve of mine :/
> What Republican lawmakers are great at is being united in thwarting Democratic policies and doing what it takes to enhance their own power.
5. Sure but Democrats have this issue as well. There have long been calls for things such as Ranked Choice Voting, Approval Voting, etc and Democrats and Republicans have long tried to even overturn those efforts even when decided by voters as a ballot measure. Both of them know that allowing this will degrade the "both sides" situation going on as other parties will gain a foothold. However it also leads to situations where voting for your first choice (a 3rd party) in close elections (i.e 2016 [2] vs 2020 [3] and 2000 [4]) can allow your second favorite candidate to lose but Democrats collectively are ok with losing every 3rd presidency (~1/10yr) as long as it doesn't eat into their powerhold (every other elected position).
There really is no reason to argue about the Republicans here. We have a bunch of states such as North AND South Dakota strictly to increase the number of republican senators [5]. Or more recently, in 2000 when Republicans in US Supreme Court overruled Florida's Supreme Court about if a recount should occur [6] (so much for states rights!). SO yes, it's a moot point that Republicans are power hungry and don't care about consistency only power.
> Republicans abandoned people who are in favor of abortion. Republicans abandoned liberal Republicans like Bill Weld. Every party abandons people.
Sure. My point is that the party made this choice deliberately. Trying to pin the blame on Joe Manchin, who is doing yeoman’s work holding onto a key part of the old FDR coalition, is disingenuous.
> Democrats consistently hold majority views on a wide range of policy issues and consistently have more votes in national elections.
The views of the party leadership and donor base and closely affiliated NGOs do not have consistent majority support. For example, Dems have basically allowed NARAL, etc., to be the voice of the party on abortion. But a strong majority of Americans oppose second trimester abortions, which are guaranteed by Roe, and a quarter of democrats identify as “pro life.” That’s more than ones who identify as “very liberal.” The party used to get that, carving out a space for folks like Manchin in WV and Tom Daschle in SD.
> Gerrymandering so that urban centers lose their voting power and other election rigging techniques is what is holding back Democratic policies.
Republicans have won the Congressional popular vote slightly more than half of the time since 1990. They’re about to do it again. Gerrymandering doesn’t affect that.
Even in the electoral college, it benefitted Democrats not only throughout the 1960s-1980s, but as recently as 2012. Obama would have been able to win a second term even if he lost the popular vote.
> The Democratic Party should not abandon its highly popular core principles to cater to the deranged apportionment that the U.S. has.
Democratic leaders and donors are deeply confused about what those “core principles” are, and who is in their coalition. The coalition is one of urban liberals who vote democrat for ideological reasons, and minorities and immigrants who vote Democrat out of self interest. My parents are the type of immigrant who turned Virginia blue. They care about Obamacare. They’ll accommodate some things the urban liberals want to get that. But that doesn’t mean they agree with college educated urban white people about what kids should learn in schools.
The fact is that a big chunk of the Democratic coalition has social values closer to Republicans than to liberal Democrats. Moreover, those are the party’s marginal votes in states like Arizona and Nevada and Georgia. Urban Democrats should live in that reality.
You are absolutely wrong in thinking Gerrymandering does not affect Congressional popular vote. It absolutely does. Especially in non-Presidential years. There are secondary effects you are ignoring with this incorrect belief. In recent years, since SCOTUS abandoned voting rights, the closure of polling stations also affects voting numbers.
We do not have proportional representation in the House, and the person with the most votes for President lost in 2000 and in 2016. The way Congressional districts are made and the weirdness of the Senate representation is such that we will soon be governed by a minoritist party. Who cares how things were in the 60s and 70s when the topic at hand is about the present day?
EDIT: The Republican Party has overtly attempted to subvert the political norms of the country and continues to do so. Arguing about this or that policy is meaningless unless the messed up way the Senate and House seats are allocated is fixed. That won’t be addressed anytime soon so the situation is essentially hopeless. Oh, and Manchin sabotaged voting rights legislation.
> You are absolutely wrong in thinking Gerrymandering does not affect Congressional popular vote.
Gerrymandering does not even consistently hurt democrats in the number of House seats. Dems in 2020 won the same number of seats as their share of the Congressional popular vote.
> There are secondary effects you are ignoring with this incorrect belief. In recent years, since SCOTUS abandoned voting rights, the closure of polling stations also affects voting numbers.
This is the Democrat equivalent of believing the Big Lie.
> The way Congressional districts are made and the weirdness of the Senate representation is such that we will soon be governed by a minoritist party.
What’s Biden’s approval rating again?
> Who cares how things were in the 60s and 70s when the topic at hand is about the present day?
Because Democrats still claim to be the party of FDR, who stitched together a winning coalition. The electoral system benefited that coalition—when Biden became a Senator, Democrats had 10 percentage points more House seats than their share of the Congressional popular vote. That coalition is still viable. Obamacare was enacted on that coalition. Urban Dems have chosen deliberately to prioritize other things instead.
You are very much wrong in your assessments. Closing hundreds of polling locations absolutely affects voting outcomes and number of voters. That isn’t a big lie. It is a provable fact. There is no point in discussing this topic with someone who refuses to acknowledge indisputable facts.
You are completely wrong on your assessment regarding Gerrymandering. You clearly don’t understand how total national vote total has nothing to do with whether or not Gerrymandering causes one party to have more seats than they otherwise ought to have. Here’s a hint: A Representative from California res presents far more people than the one from North Dakota. Here’s another hint: Heavily Democratic distinct overwhelmingly votes Democrat while three districts with slight majority Republican vote elect Republicans and the overall vote totals are mostly even. Both hints must be used to see why overall vote total means nothing when it comes to determining if Congressional representation is skewed.
> You clearly don’t understand how total national vote total has nothing to do with whether or not Gerrymandering causes one party to have more seats than they otherwise ought to have.
You're mixing up completely different things. The Congressional popular vote represents the total number of people that voted for each party in House elections. It's an absolute number of votes, irrespective of number of seats. Republicans have won this absolute count more often than not since 1990. For example, in 2016, Republicans won 63,182,073 votes (49.1%) and Democrats won 61,765,832 votes. Also, you can cross check it against the generic Congressional ballot, which is based on polling and isn’t affected by gerrymandering: https://projects.fivethirtyeight.com/polls. Republicans are ahead right now. That’s not a “minority party.”
> Here’s a hint: A Representative from California res presents far more people than the one from North Dakota.
It's actually the opposite, though it's a rounding error. California has 53 representatives and 39 million people, or 736,000 people per rep. North Dakota has 1 representative and 760,000 people.
These sites are peddlers of election falsehoods, just like Breitbart or Newsmax.
The irony of all this is that progressive election lies are used to disenfranchise minorities within the Democratic Party. Disproportionately white progressives invoke the notion that Democrats have overwhelming popular support but elections are close because of dirty tricks, to boost their own power within the party. That happens at the expense of disproportionately conservative and moderate democrats, who are disproportionately minorities.
Political parties aren’t one big happy family. The truth is that there’s trade offs between the interests of different factions and we should be honest about those. If Obama hadn’t run to the right on social issues in 2008, we wouldn’t have Obamacare today (which cut the number of uninsured Black people by half). That’s the reality of the trade offs between different factions of the party.
Manchin is not doing yeoman's work when he throws hissy fits over his name on a WH press release about something he'd already done (negotiated with Biden)
The Dems might have had 60 seats in name only, but even that was for a few months (Jul 2009 to Jan 2010). More importantly, a couple Democrats like Lieberman do not tow the party line, and frequently vote like Repubs, so I would not say Democrats ever had 60 seats.
> Democrats held at least 57 seats as a result of the election. When the new senators were first sworn in, the balance was 58–41 in favor of the Democrats, with the unresolved election in Minnesota causing that seat to remain vacant. The April 2009 party switch of Pennsylvania senator Arlen Specter from Republican to Democrat and the July 2009 resolution of the Minnesota election in favor of Democrat Al Franken increased the Democratic majority to 60–40 (providing the Democrats, including the two Independent senators who caucus with them, a supermajority and thus able to hypothetically over-ride any filibusters). Republicans gained a seat in a January 2010 special election in Massachusetts, thereby making the balance 59–41 before the start of the next election cycle.
They had 60 votes to get Obamacare enacted, which was a historic achievement. Obviously your coalition won’t agree on everything and you have to keep the marginal votes on board. That’s just how politics works. My point is that there is a more potent democratic coalition out there even within the framework of the Senate system. To the contrary, the Senate system long benefited Democrats because it favors working class rural areas over moneyed industries (finance, tech, etc.) concentrated on the coasts.
The country and politics of the nation have shifted. The divide is rural/urban now. The cities have the vast majority of the wealth but not the accompanying representation. The rural areas of the country are overwhelmingly conservative and increasingly white nationalist in sentiment. What the state of things 50 years ago was is no longer relevant.
The election of Donald Trump was clearly a white nationalist backlash. This is obvious and it was an enabling event for more extreme elements of white nationalism. One only needs to look at the rhetoric used to see this. Don’t confuse “white nationalist” with “white supremecist” (though the latter is a subset of the former).
The underpinnings of white nationalism have been around for a while but really came to the fore in 2016. The desire to keep “our America” and other catch phrases are indicative.
EDIT: Having white, nationalist sentiments or leanings is not necessarily bad or wrong. It’s quite natural for a majority population to have such sentiments when their status as a majority gets threatened. The demographics and gender power structure of the nation is noticeably changing and having a backlash against that change is common.
did they put the Medicare for all on vote? if not, you can't just assume that if they didn't want more reckless government spending(thank God they stpped at that, the damage is already immense) they also don't want medicare for all.
But NPR tried their damnedest to hide it from me. A while ago you could reject tracking and get the text only version of the article. Today I only saw "agree" and "see how we use cookies". No official pointer to the text site.
If you think our current system doesn't have rationing, I'm not sure what to tell you. "Long wait times" are one way to ration care -- but equally effective is just denying 30 million people the ability to get any care at all due to unaffordable insurance and ruinous costs for any 'touch' with the system. Another effective way to ration care is to make routine things so expensive that people self-select out of receiving care or filling prescriptions even when they are insured.
Literally the entire point of copays and other forms of cost sharing is to 'ration' healthcare by reducing demand. There might be health insurance out there without cost sharing, but I've never seen it and it's certainly not the norm in the US.
Is having 41% of adults in America in debt really worth "innovation" for the rest of the world?
And what exactly is "rationing" - I bet almost every adult in America knows someone (or is that someone) who has delayed going to the doctor/for a procedure (or just never got it entirely) because of how much it is going to cost? Doesn't the inability to even get the required care due to the cost really count as "rationing" in the system we already have?
Is this just sarcasm? Rage bait? Are you out of touch? Poor people already ration care. I experienced it first hand working in a grocery store. God forbid you got hurt or sick because you'd be losing work days aka income. Then you'd be eating less or borrowing money or skipping a few medications. But, sure, socialism in healthcare * like every other developed economy* will stifle innovation.
U.S. healthcare underperforms in most verticals. High cost is the primary reason that prevents Americans from accessing health care services. Americans with below-average incomes are much more affected, since visiting a physician when sick, getting a recommended test, or follow-up care has become unaffordable.
https://www.commonwealthfund.org/publications/issue-briefs/2...
idk. Most innovation in the field of medicine comes from research in universities, which are pretty socialized for the most part. The workers that are doing the innovation are also educated in a mostly socialized learning system. And there are plenty of economies with mostly socialized medicine that do plenty of innovation (including the USA). So I think your fears of collective funding of important institutions are unfounded.
The commonly accepted definition of innovation is the practical implementation of ideas that result in the introduction of new goods and services. So while the ideas may come from research in universities, I struggle to think of examples of practical implementations resulting in new goods and services. Do you have any examples?
I'm no socialist, but you can actually have a system of government health insurance but keep private healthcare. Or basic free healthcare (government run hospitals/clinics) and if you want better, pay out of pocket for private.
For example, in my wife's home country, she give birth in an awesome private maternity hospital for about $2k out of pocket for everything. I mean everything. But if we wanted, she could have done it in the government run hospital for $0.
> you can actually have a system of government health insurance but keep private healthcare.
This is what we currently have in the US. In fact, the US government is the largest healthcare insurer in the US (through Medicare and Medicaid) [1].
Interestingly, economists have found the US government becoming a healthcare insurer substantially increased US healthcare prices. For example: "Finkelstein estimates that the introduction of Medicare was associated with a 23 percent increase in total hospital expenditures (for all ages) between 1965 and 1970" [2].
It turns out making healthcare "free" to certain people caused them to demand more healthcare. Higher demand caused higher prices. Congress "didn't consider the effect of the increased demand that Medicare set off." [3] Now healthcare prices are high AND Medicare/Medicaid is being paid through deficit spending.
If we want to solve the problem of unreasonably high prices for healthcare, and the debt that causes, we can't keep doing the same thing and expecting different results. We need to fix what we've broken with the healthcare market so it can operate like markets do and find a fair price.
can you elaborate on the "rationing" part?
I'm guessing you tied "socialist" and "rationing" together, but did you do it in the context of other developed economies (i.e most of Europe?)
Go ask any law enforcement officer, fire fighter, or EMT how many times a week they hear "please don't call an ambulance, I can't afford it" and the answer will be so depressing that you may change your tone about this.
Fun fact about the US's system too - even when ambulances are called for things like heart attacks -- they take much longer to show up in poor areas compared to wealthier ones;
There are some common agreed upon thresholds that strongly correlate with positive outcomes, e.g. 15 minute response time after a heart attack. In wealthy areas, this outcome was achieved 97% of the time vs. only 93% of the time in poorer ones. That doesn't sound too bad, but that means you were something like 230% more likely to miss that cutoff if you were in a poor neighborhood. But at least it's not "socialist".
My friend who lives in the USA had to deliver her own baby in a hospital hallway because all the rooms were full and the doctors were too busy to tend to her.
The hospital still sent her a $30k bill for the delivery.
Defining the problem so broadly makes it less likely that it will be solved. We already have high inflation in part because of high government transfers during the pandemic, and handing out money to 100M people with medical debt or student loan debt would aggravate this.
I find it odd that when talking about inflation or moral hazard people bring up money spent given to individuals but not about the trillions spent given to businesses. I think it is immoral for a country as wealthy as the United States to have so many people with medical debt. There should be universal, almost free healthcare. The moral imperative is far more important to me than considerations about inflation.
Reminds me of my joke policy that meets many people's stated goals yet would be universally unpopular: the government should fight inflation by confiscating money from billionaires and then destroying it.
I dislike adding morals into this discussion. However, there is a real question of whether society in its current state can, in fact, function well. I personally would argue that right now society is very dysfunctional and that dysfunction is primarily benefiting those at the top. And the usual issue with dysfunctional societies is that they tend to fall apart. Now, reasonable person would argue that would not be a good thing even for those on the top of the pile, but clearly no one is scared enough yet.
All I want is balance. That societal balance does not exist now. Hence the tension that seems to be increasing.
I very much agree overall with your observations and points. I do think though that one should always consider moral aspects to policies and decision making since peoples’ lives are affected. Making policy based on economic theory without considering moral aspects seems like a bad idea in general.
Milton Friedman famously said: “Inflation is always and everywhere a monetary phenomenon, in the sense that it is and can be produced only by a more rapid increase in the quantity of money than in output.”
Well, he's wrong, given that output has been knocked about by a large number of non-monetary factors such as COVID, supply chain issues, the war with Russia, and (yet again) oil and gas.
The way I see it, even if there’s a war or Covid or whatever, if people don’t have more money to spend, they can’t pay higher prices. Then you get a recession.
If they do have the money (because you printed more) they pay the higher prices. Then you get inflation.
We have a housing crisis and an energy crisis. There's absolutely no need to drag monetary theory in when the outcome is due to failed industrial policy.
Why can't it be all three? I understand that it is easier to sell it as a specific political problem, but I am genuinely tired of arguing partial inflation problem, because discussing it as a whole undermines some political angle.
Two wildly different issues. Medical debt is still generally owed to payers, student loan debt (as considered in debt relief) is largely federal. The impacts of forgiveness of either would seem radically different.
I have issues with how they did their analysis. They count anyone who paid for medical services on a credit card and then is carrying that on their credit card balance month to month. Folks… that’s how many Americans pay for all goods and services and run their finances. The last time I checked, 60% of Americans carry a credit card balance from month to month. The findings in their report seem aligned to that.
I think people are reading too much into a poor analysis, created and reported on by institutions with an obvious agenda.
Also known as 100M people who may have died without medical care, but were provided it despite their inability to pay for it. If you remove the ability for medical workers to seek payment for their services, most medical workers are just gonna say fuck it and not work for free.
Medical care providers have families they have to feed too.
The alternative isn't denying care. It is providing the same care without having people get into debt, which every other developed country (and a lot of undeveloped countries) in the world manages to do.
except that you redistribute according to means, seeing as tax is correlated to income. so instead of having a random dice roll ("ah, you're working multiple low-hour jobs and you just got cancer? game over!"), you pay a bit more of your income as tax
The US doesn't have universal healthcare, so there's not a great mechanism for health care workers to earn a living without charging client for it. Some charities excepted.
The money going into medicare is enough to extend coverage to all americans provided the system is run with the cost efficiency of the typical EU healthcare system.
Well I think that's the entire point of this article: to call attention to the overwhelming crisis of medical debt in the US, and the need for us to create a great mechanism to deal with it.
Just because we don't currently have a functioning healthcare system doesn't mean we can't have one ever. As more people are made aware of how pervasive the issue is, there will be more impetus for those in power to start doing something about it.
The "why are people expecting doctors to work for free?" argument is such a bad faith take.
You know damn well that nobody is expecting doctors to work without pay. I refuse to believe someone could actually believe such an idiotic argument is being made. So why act like it is?
Ah I see, doctors aren't supposed to work for free, just other taxpayers (who most likely make far less than a doctor) working for free to pay the (much higher salary) to cover someone elses expenses. Got it.
I'm opposed to tax funded police, roads, and schools. If you want to create a roads charity, by all mean I'm fine with that.
Sometimes tax payers are funding their own expense, sometimes not. What I take issue with is being involuntarily compelled to pay someone else's expense at gunpoint.
Nobody is forcing you to pay at gunpoint, you are free to leave at any time and no longer pay. Paying taxes is no different than mortgage or rent, either pay it or get out. You don't fully own the property you live on even if it's paid off, it is the soil of the country you live in, if you want your own soil fight for your own sovereign territory and keep it through force without any help, good luck.
>Nobody is forcing you to pay at gunpoint, you are free to leave at any time and no longer pay.
OK so if a robber comes to my house and says pay up or leave, then that's not a forceful action at gunpoint?
>you are free to leave at any time and no longer pay.
That's not how it works -- allow me to inform you of tax law in the US. US Citizens are responsible for filing, and possibly paying taxes on income earned ANYWHERE IN THE WORLD. The US, and I believe Eritrea, are the only two nation's I'm aware of in the world like that. Now you could renounce citizenship, but even then that wouldn't satisfy your condition of "no longer pay" because you even have to pay over $2000 just to renounce citizenship, and that has to be done outside of the US. The US has been known to engage in "extraordinary rendition" which is to say they target/extract citizens even out of countries when there is no legal mechanism for them to do so.
In short your claim here is incredibly innacurate.
>Paying taxes is no different than mortgage or rent
When I pay rent/mortgage it's for my own use of property in a private contract, in a voluntary exchange. Tax is an involuntary transaction. A very different thing.
>, if you want your own soil fight for your own sovereign territory and keep it through force without any help, good luck.
You start off saying nobody is forcing this at gunpoint but then you go on to challenge me to "keep it through force." You're starting to look like a violent person. It's really comical how quickly the façade drops of persons such as yourself who turn out to be persons of great violence who are quick to challenge others to engage in such activity.
>OK so if a robber comes to my house and says pay up or leave, then that's not a forceful action at gunpoint?
They are not a robber they are a landlord, you are on their land, pay taxes or leave your choice. They are not forcing you to stay and work and pay taxes at gunpoint, you have the choice to leave. However while you are there you must fund the services they are currently providing to you, if you willfully evade that payment then you are committing a crime, but you have the option not to, you always have choice.
>That's not how it works -- allow me to inform you of tax law in the US. US Citizens are responsible for filing, and possibly paying taxes on income earned ANYWHERE IN THE WORLD.
Most standard income is covered under FEIE and FTC, that is you won't pay taxes twice if your paying taxes in another country utilizing their social service instead and if you have been truly living in working for almost a full year you pay no tax on the income.
Note since you are US citizen you still benefit from their social service while living abroad, the are many protections upheld to US citizens traveling abroad you would no longer have if you renounce.
>Now you could renounce citizenship, but even then that wouldn't satisfy your condition of "no longer pay" because you even have to pay over $2000 just to renounce citizenship, and that has to be done outside of the US.
Exactly, you must pay your final rent payment and get out, no one is forcing you to stay. If you don't have the money to pay then you are not making income to pay taxes either.
>When I pay rent/mortgage it's for my own use of property in a private contract, in a voluntary exchange. Tax is an involuntary transaction. A very different thing.
You have agreed to the social contract [1], you are voluntarily staying in the country and utilizing the social services and resources (military and police protection, roads, public spaces etc.) to make money and live safely and productively. No one is forcing you to stay, there are places in this world that do not tax you for police and schools.
>You start off saying nobody is forcing this at gunpoint but then you go on to challenge me to "keep it through force."
That's the point, the reason you don't have to defend your property and life through force on a daily basis is because you have voluntarily agreed to live in a country that has the monopoly on violence [2] and in exchange for the social service of military and police protection you must pay taxes if you profit from that protection.
People are social animals, they work together to solve problems no individual could on their own, money facilitates this and is needed to fund the large social framework you live under hence taxes. If government disappeared tomorrow, it's would be reformed quickly in not so pleasant ways. You may not like it but that doesn't matter because others will form large groups and impose it on you regardless and you will have no choice over its form.
I understand the 'notion' of social contract. However I choose not to accept the terms of the contract as envisioned by above. A key element of 'contract' is consent.
Then you must move out to someplace else that you wish to consent to or forge your own social contract which will require force unless you find un-inhabited unclaimed land.
By staying within the bounds of a country you are consenting to its laws or are considered a criminal or foreign aggressor.
How about you move. It's hilarious to suggest the contract is still intact when the government violates the contract itself, such as abridging 4th and 2nd amendment rights, rendering the contract void. Just a few months ago, I had a warrant served where a homeland security official lied and said a drug dog had "alerted on my buttocks" and I was forcefully strip-searched and dragged to a hospital to be "internally examined." Sorry the government themselves violated the contract.
And it's worth noting, even though the "contract" legitimize this, the last president didn't even have the assent of the majority of voters.
>By staying within the bounds of a country you are consenting to its laws or are considered a criminal or foreign aggressor.
I'm not too worried about whatever ad-hominem you'd like to label.
>Note since you are US citizen you still benefit from their social service while living abroad, the are many protections upheld to US citizens traveling abroad you would no longer have if you renounce.
This is so hilarious as to make me wonder if you've ever actually been to a US consulate abroad. I have, against my wishes due to riding in the same taxi with a 'friend.' We had both overstayed our visas, and the consular services basically said "lol get fucked, good luck!" I could have obtained the same services talking to a wall. I'm good on their services.
>Exactly, you must pay your final rent payment and get out, no one is forcing you to stay. I
If I've already "gotten out" including paying my taxes this rent analogy makes even less sense, not that it was a good one to begin with. I never signed a contract saying if I leave the non-existent contract I agree to pay $2000 to back out.
> you don't have to defend your property and life through force on a daily basis
I wonder if you've even been to the United States? It was not so long ago someone tried to rob me at gunpoint. I still have a scar from fighting back. On a daily basis, people are violently assaulted in my city. Nowadays I'm forced to have "protection" that I have daily in case someone tries to use lethal force against me again. The police have no legal duty to "defend" you per the supreme court. The type of protection police provide here, I wouldn't wish on my worst enemy.
As for military protection, I actually have fought as a self-funded volunteer in a foreign militia (YPG) against ISIS, so I'm willing to put my money where my mouth is about not using tax money to defend life.
>However while you are there you must fund the services they are currently providing to you
You don't get to just provide services for someone, who never agreed to it, and then demand payment. Payment for services is predicated on the parties consenting to the transaction. Providing service without the other party agreeing is charity at best, unwelcome intrusion at worst.
>no one is forcing you to stay
Except some people have had their passports revoked, and occasionally without even owing anyone anything ("for national security reasons.") In fact DHS has threatened to revoke my passport before, despite not breaking any law. It is a crime to leave the US without a passport. So the US does 'force' some people to stay.
>People are social animals, they work together to solve problems no individual could on their own, money facilitates this and is needed to fund the large social framework
People are capable of doing this in a consensual manner. In fact many businesses operate on this principle of consensual mutual benefit.
>You may not like it but that doesn't matter because others will form large groups and impose it on you regardless and you will have no choice over its form.
Back to your contradictory argument of "no one is forcing you at gunpoint" -- except you reneg and say actually they are.
What's "excessively naive" is to act like you're not suggesting people work for free, when indeed you are. You're simply performing a sleight of hand: instead of framing it as the doctor working for free, you shift the free labor onto mostly people making a lesser income. You sir/mam, are both deceptive and disingenuous.
>The actual argument you wanted to make
And how incredibly good faith of you to bring up taxation of roads, school, and police and then have the gall to act like it's a waste to discuss the very subject YOU YOURSELF INTRODUCED. My brother, I did not mention anything about the taxation of roads/police/schools until you brought it up, it's beginning to look like that's the real argument YOU wanted to introduce.
Is there evidence that the high cost of healthcare is due to paying frontline medical workers?
This is an honest question I don’t know the answer to, but based on my analogous experience with academia and the high cost of tuition, I would guess the answer is “no”.
I think that's only a fraction. I agree we should eliminate licensing and regulations, which in part are responsible for burdensome administrative parasites.
Not everything is binary. 10k for an emergency X-ray and sitting on a bed for 3hs is very far from not getting paid. That gray area in between is what needs to be looked at.
> Elizabeth Woodruff drained her retirement account and took on three jobs after she and her husband were sued for nearly $10,000 by the New York hospital where his infected leg was amputated.
I'm not sure what sort of retirement they had planned to have on less than 10k, but it looks like in this case the hospital knew they could afford to pay but preferred not to. When people use number of jobs rather than hours worked per week it's typically beacuse number of jobs is greater than one and hours is less than forty.
> Ariane Buck, a young father in Arizona who sells health insurance, couldn’t make an appointment with his doctor for a dangerous intestinal infection because the office said he had outstanding bills.
The emergency room was available to him. What was the total he was asked to pay? Why didn't he pay it?
> Allyson Ward and her husband loaded up credit cards, borrowed from relatives, and delayed repaying student loans after the premature birth of their twins left them with $80,000 in debt. Ward, a nurse practitioner, took on extra nursing shifts, working days and nights.
Average nurse practitioner salary 115k. Why are they putting medical debt on credit cards? The emergency room wasn't going to stop care to those kids if they didn't pay immediately. If they were poor the kids would get CHIP, so I think they probably had too high income and maybe decided to forgo health insurance and work as contractors for additional pay. What was the plan for the birth? Was the problem that they were early and they didn't have a chance to get insurance at the last second?
>Average nurse practitioner salary 115k. Why are they putting medical debt on credit cards?
Are you asking why they couldn't afford 70% of an average salary (which, there is a 50% chance this person made less than the average) in one shot?
Your entire post seems to be victim blaming based on a few sentences of context. You don't know what other debts and obligations these people had, nor what other avenues they tried to exercise.
Maybe what they are asking is how someone making an average of 115k, who is also in healthcare doesn’t have better health coverage and still decides to have a kid.
That's not at all a normal cost of having a kid. It says she ended up with twins and they were born prematurely. That said, I have no idea why it wasn't covered or how she ended up getting stuck with the bill. I've had catastrophic occurrences like this, too, years worth of spine surgeries in which I racked up a few million dollars of expenses, but my out of pocket max was $4,000 and that was all I ever had to pay in a year. Any charges denied by the insurance were just dropped by the provider, not pushed to me.
So it raises the question of what kind of shitty coverage she had that was able to do this, or if she just had no coverage at all for some reason, which as far I understand, is supposed to be illegal after PPACA (you can always buy from the exchanges and they can't say no).
Sure, but it's not uncommon, either. If you ever find yourself in a fight with a chronic or long-term condition, check the statement of benefits your insurer sends you every month. They're denying massive amounts of things that you never get a bill for. I even asked my main surgeon's office manager about this once, and he explained to me that insurance companies don't have any sort of upfront published caps on what they're willing to pay and for what, so both sides are kind of winging it. The providers simply bill some very large number that they know is so ridiculous that it has to be larger than the max that will get reimbursed, figuring that by doing so they'll at least guarantee they get that max and not inadvertently sell themselves short.
So when you see things like a $14,000 charge for someone consulting over video for 10 minutes of work, or $800 for a bandaid, and you wonder how the hell a charge can possibly be that high, the answer is often that it isn't. That's just an artifact of this blind bidding thing going on between providers and insurers where providers send the largest conceivable bill they can to insurers knowing damn well they won't actually get that much.
This also feeds back into why insurance companies have such a horrible incentive to default deny everything. They know the providers are overcharging and charging for bullshit. Both sides are forced into taking equally extreme baseline negotiating positions by the total lack of pricing transparency.
It points at a very specific dysfunction of our system that goes well beyond the question of whether the government or private insurance purchasers should bear the bulk of the cost. This is a totally separate and orthogonal problem that both buyer and seller, no matter who they are, treat all transactions, no matter how mundane, like it's a blind silent auction for a rare Vermeer that hasn't seen a public market in 300 years.
Oh, I know the incentives. I strongly suspect there's even an additional one you don't list - tax writeoffs.
And you're going onto a tangent that I am very much in agreement with (that the whole system is massively broken and suffers all sorts of perverse incentives), but -my- point, if you'll recall, is that not everything gets written off. People still get unexpected medical bills -all the time-, for things their insurance didn't fully cover; this despite their deductible and/or max out of pocket.
Or, as I commented before, and which you're...agreeing to, in a whole lot of words, it's a provider choice, and not guaranteed. I.e., every time you go to the doc you're rolling the die; doubly so for emergency stuff that you can't get pre-authorized. "It doesn't happen -that- often" seems to maybe be your argument, but it happens enough, and the consequences of it happening at all are devastating.
The American Dream. Must make 115k+ (what is that, 2x or 3x the average American?) and pay out the ass for coverage just so you can have the privilege of having a kid without being judged by random people on the internet.
I’ve made much less than 115k for most of my working life and I never had such shitty coverage. I don’t agree that having twins or whatever should be 80k, don’t get me wrong. But if you’re in healthcare and make enough to have a decent plan and choose not to, and on top of that you decide to have kid/s, you know what you’re getting into.
At 38k a year I had a max out of pocket of 7k. It can be done.
It’s as if I opened a web server in my home with all the ports open, a password that is “changeme” and then complained that someone else should’ve been protecting me.
She wouldn't of had any coverage at all. Obamacare puts the out of pocket max well below 80k. At that income level and field, that's a choice. Is the idea that I'm supposed to pick up the tab or feel sorry for her? I make less than she does and I pay for my health insurance.
From both the context and the picture it's clear she's not actually, you know, retiring. The amount in someone's retirement account is meaningless unless you know their age and their income. Yeah, $10k isn't a lot if you're in your 60s and living a lifestyle that costs 6+ figures a year; it's a lot if you're making $30k a year and are in your 20s, and quite understandable if in your 30s at that income level. Three jobs are quoted because yeah, they probably are part time (and just saying "works 60 hours a week" or whatever doesn't carry the same punch), but -they may not be able to get a full time job-. Or else...you know, they might have healthcare.
The emergency room has ludicrously high costs, and none of his medical history. You're literally saying "don't expect to be able to see your primary care provider, go to the emergency room instead" -because of existing debt-.
You're making a lot of assumptions...all of which miss the point. Why is life shattering medical debt a common thing we tolerate in this country, given every other Western country has managed to make it a rarity? But, to your assumptions - maybe and she gave birth prematurely and ended up being seen by a hospital who were out of network and her insurance didn't cover it. Or even went to an in-network hospital, but was seen by doctors who were out of network, as frequently can happen, especially in emergencies when you can't personally vet the doctor is in network for you before you see them. Certainly, something unexpected happened (maybe even the pregnancy itself! Something to look forward to with the Supreme Court set to overturn Roe v Wade), and insurance wasn't there. Why is that acceptable in this country?
I work in healthcare and grew up poor in the US, and had medical debt of my own so I can read between the lines here. People absolutely get screwed over by medical debt, I'm just saying these are terrible examples of that happening.
> When people use number of jobs rather than hours worked per week it's typically beacuse number of jobs is greater than one and hours is less than forty.
It’s hard to imagine a person wanting to take on multiple jobs if instead they had the option to work one for the needed amount of hours and pay. Hours at one job != hours at three jobs, especially when you add in commuting time and lack of benefits because you’re not full time.
Medical debt is very low recourse. If you don't pay your electric bill they shut the power off, they won't unamputate your leg if you fail to pay. If you don't have substantial assets, taking the credit hit is the better choice. I can't envision a situation where it makes sense to trade low recourse medical debt for high recourse credit card debt.
Hospitals aren't allowed to deny care (obviously). They will bill people outrageous amounts and know that they will only ever see a fraction of it. So prices for people who do pay are raised considerably to make up for it.
People don't get early preventive care due to costs or because they are uninsured.
Supply of doctors is artificially limited by the ABMS so that demand stays high.
The government doesn't negotiate or mandate prices, so drug manufacturers, equipment manufacturers, researchers, hospitals and everyone else in the ecosystem squeezes out as much profit as they can to make up for all the countries where they are not allowed to.
The end result is that the average American knowingly or unknowingly pays a lot more for healthcare than any other country in the world while receiving sub-par care.