I dunno if it’s really so simplistic. I hear the wait time complaint about Canada a lot but it’s partly because we care for everyone, so sometimes you’ve got to wait if you’re not in real trouble.
Especially with emergency care it’s quite fast. Back in August my son fell off the monkey bars and his elbow exploded. Ambulance in 7 mins. Hospital triage in 5 mins. Doctor 5 mins after. X-ray took 5 mins. Waited 7 mins. Diagnosis and sent to Children’s hospital one town over. More x-rays, surgery prep, surgery with two paediatric orthopaedic surgeons, four steel pins inserted, post-op, sleep, and he was home by 7am. Three more checkups with the main surgeon followed over the months.
Cost us $8 in parking. Never even saw a bill. I would never, ever, trade this for the American approach. I need to know that every kid on that playground gets this exact same level of care.
Since you have a specific anecdote as an argument, could you expand on your “American approach” concept and how it applies to your situation?
I don’t mean talk in vague assertions about how you have read some other specific yet unrelated anecdotes about childbirth costing $125,000 or something. I mean how much would your son’s specific situation cost you in a comparable area of America for a family of comparable income?
The reason I ask is because the general approach should not be argued against with anecdotes. You commonly hear of wait time issues in universal healthcare countries. You commonly hear about cost of care issues in America. Generally speaking there is an obvious trade off.
And just like wait times and cost are preferences, your preference is equal care for children. In America that does not happen. That is part of the trade off.
I am not implying that all things are equal. I am unhappy with the health insurance cartels that drive up cost in America making the lower middle class suffer. I am unhappy with the inconsistent care availability from region to region across the country.
But I also resist the implication that American healthcare always bankrupts a person and that free / low cost care is a simple decision.
I mean how much would your son’s specific situation cost you in a comparable area of America for a family of comparable income?
That's the fun thing about the US system. The only way to find out how much it costs is to wait for the bill. So while your question is a fair one, logically speaking, it's unanswerable in practice.
I wouldn't go that far. But it is true that there are far many more possible outcomes because of how diverse the private insurance system is.
At the very least one guaranteed difference is that you would NOT not get a bill.
Then, a common scenario is a health insurance setup that covers 100% of the cost beyond a threshold, while the individual is responsible for the cost below that threshold.
My threshold is $6k for example. In the above scenario with the elbow, I estimate that the total cost would be around $100-200k. So I would end up paying the full $6k, and the insurance would take care of the rest.
The other common scenario is one where the threshold is much lower (e.g. $200) but the insurance covers e.g. 90% of the total cost. I find that option more risky, because I know the total costs can be staggeringly high, and 10% of a staggering number is usually also a staggering number :-)
You might know that you won't have to pay more than $X, but you generally can't find out beforehand the theoretical cost of the procedure as billed to the insurer. So if you're on the hook for any fraction of that (as in your second scenario) then you're very much in unknown territory.
There is also the question of how well you really understand the terms of your insurance policy, which can be extremely complex.
What gets me about the insurance billing is that besides being complex for me, it is also complex for the insurance company - people on the other side are just people, after all, not some infallible super-intelligent aliens. And the failures that come out of that are kind of hard to believe for people used to nationalized health care; my favorite example was a $15k bill I received months after a surgery that I called back to get more details, upon which the agent said something like "oh that's coded wrong" and after a few keyboard taps I owed $500. What if I had paid the original amount without asking? How many people do not ask? And the cynical question, how often do the "coding errors" happen the other way?
I can speak to even routine things like a childbirth still costing thousands of dollars with "good" insurance with a "low" out of pocket maximum and 100% coverage after the deductible.
It still cost 3 or 4 thousand dollars. So it's not necessarily those six figure costs that are tough to deal with but even routine hospital care that gets very expensive in the US. I'm fortunate that we can afford that cost. But for a lot of people even making the payments on that would be a hardship. We didn't even know it would cost that much even though we had called our insurance to try to figure it out. Nobody can tell you how much it will cost until you incur the cost which is absurd. And the hospital "price lists" are beyond useless.
It shouldn't cost anything to birth a child in a hospital setting like a birth center in any civilized country, and we shouldn't have to deal with billing issues and insurance companies in the insane first 12 weeks of a child's life when we're sleep deprived and just dealing with actual medical issues and adjustment. We've spent collectively hours on the phone with insurance for this and various other charges. The "private payer" "employer provided" system constantly produces bad experiences and outcomes for everyone. Every insurance provider I've had over the past 5 years is a company that constantly screws up and that I can't fire, unlike my car insurance.
The American healthcare system doesn't bankrupt us right away, but it does so slowly by bleeding us for costs we shouldn't have to pay and by robbing us of time right when we need it most.
My daughter was premature and spent weeks in the NICU.
My family paid exactly $0 for this experience, with good US insurance.
People paying thousands of dollars with insurance have chosen to purchase cheaper insurance premiums, and then bear higher costs when there’s an expensive event.
This is a fine choice to make. It does not mean the US healthcare system is especially expensive for middle class people.
Like many parts of the US economic system, the US healthcare system isn’t very good for poor people. But don’t go thinking it performs poorly for the upper half of the income distribution.
I didn't choose to purchase cheaper insurance. It's provided by my employer, by law. Paying thousands per month for "better" insurance isn't an option.
I made the mistake of touching on a complicated, important, and oft-contentious topic just before starting my work day. Not ghosting you, but I'll do my best to get back to this when I have the time required to offer a worthwhile response.
Same. I appreciate the reply but apparently this beehive isn’t worth kicking here. Seems like folks don’t know how to avoid the downvote button on emotional topics. I would love to have a deeper conversation about it but HN probably isn’t the place where I will find intellectual satisfaction on this topic.
Comments
I dunno if it’s really so simplistic. I hear the wait time complaint about Canada a lot but it’s partly because we care for everyone, so sometimes you’ve got to wait if you’re not in real trouble.
Especially with emergency care it’s quite fast. Back in August my son fell off the monkey bars and his elbow exploded. Ambulance in 7 mins. Hospital triage in 5 mins. Doctor 5 mins after. X-ray took 5 mins. Waited 7 mins. Diagnosis and sent to Children’s hospital one town over. More x-rays, surgery prep, surgery with two paediatric orthopaedic surgeons, four steel pins inserted, post-op, sleep, and he was home by 7am. Three more checkups with the main surgeon followed over the months.
Cost us $8 in parking. Never even saw a bill. I would never, ever, trade this for the American approach. I need to know that every kid on that playground gets this exact same level of care.
Since you have a specific anecdote as an argument, could you expand on your “American approach” concept and how it applies to your situation?
I don’t mean talk in vague assertions about how you have read some other specific yet unrelated anecdotes about childbirth costing $125,000 or something. I mean how much would your son’s specific situation cost you in a comparable area of America for a family of comparable income?
The reason I ask is because the general approach should not be argued against with anecdotes. You commonly hear of wait time issues in universal healthcare countries. You commonly hear about cost of care issues in America. Generally speaking there is an obvious trade off.
And just like wait times and cost are preferences, your preference is equal care for children. In America that does not happen. That is part of the trade off.
I am not implying that all things are equal. I am unhappy with the health insurance cartels that drive up cost in America making the lower middle class suffer. I am unhappy with the inconsistent care availability from region to region across the country.
But I also resist the implication that American healthcare always bankrupts a person and that free / low cost care is a simple decision.
That's the fun thing about the US system. The only way to find out how much it costs is to wait for the bill. So while your question is a fair one, logically speaking, it's unanswerable in practice.
I wouldn't go that far. But it is true that there are far many more possible outcomes because of how diverse the private insurance system is.
At the very least one guaranteed difference is that you would NOT not get a bill.
Then, a common scenario is a health insurance setup that covers 100% of the cost beyond a threshold, while the individual is responsible for the cost below that threshold.
My threshold is $6k for example. In the above scenario with the elbow, I estimate that the total cost would be around $100-200k. So I would end up paying the full $6k, and the insurance would take care of the rest.
The other common scenario is one where the threshold is much lower (e.g. $200) but the insurance covers e.g. 90% of the total cost. I find that option more risky, because I know the total costs can be staggeringly high, and 10% of a staggering number is usually also a staggering number :-)
You might know that you won't have to pay more than $X, but you generally can't find out beforehand the theoretical cost of the procedure as billed to the insurer. So if you're on the hook for any fraction of that (as in your second scenario) then you're very much in unknown territory.
There is also the question of how well you really understand the terms of your insurance policy, which can be extremely complex.
What gets me about the insurance billing is that besides being complex for me, it is also complex for the insurance company - people on the other side are just people, after all, not some infallible super-intelligent aliens. And the failures that come out of that are kind of hard to believe for people used to nationalized health care; my favorite example was a $15k bill I received months after a surgery that I called back to get more details, upon which the agent said something like "oh that's coded wrong" and after a few keyboard taps I owed $500. What if I had paid the original amount without asking? How many people do not ask? And the cynical question, how often do the "coding errors" happen the other way?
I can speak to even routine things like a childbirth still costing thousands of dollars with "good" insurance with a "low" out of pocket maximum and 100% coverage after the deductible.
It still cost 3 or 4 thousand dollars. So it's not necessarily those six figure costs that are tough to deal with but even routine hospital care that gets very expensive in the US. I'm fortunate that we can afford that cost. But for a lot of people even making the payments on that would be a hardship. We didn't even know it would cost that much even though we had called our insurance to try to figure it out. Nobody can tell you how much it will cost until you incur the cost which is absurd. And the hospital "price lists" are beyond useless.
It shouldn't cost anything to birth a child in a hospital setting like a birth center in any civilized country, and we shouldn't have to deal with billing issues and insurance companies in the insane first 12 weeks of a child's life when we're sleep deprived and just dealing with actual medical issues and adjustment. We've spent collectively hours on the phone with insurance for this and various other charges. The "private payer" "employer provided" system constantly produces bad experiences and outcomes for everyone. Every insurance provider I've had over the past 5 years is a company that constantly screws up and that I can't fire, unlike my car insurance.
The American healthcare system doesn't bankrupt us right away, but it does so slowly by bleeding us for costs we shouldn't have to pay and by robbing us of time right when we need it most.
My daughter was premature and spent weeks in the NICU.
My family paid exactly $0 for this experience, with good US insurance.
People paying thousands of dollars with insurance have chosen to purchase cheaper insurance premiums, and then bear higher costs when there’s an expensive event.
This is a fine choice to make. It does not mean the US healthcare system is especially expensive for middle class people.
Like many parts of the US economic system, the US healthcare system isn’t very good for poor people. But don’t go thinking it performs poorly for the upper half of the income distribution.
I didn't choose to purchase cheaper insurance. It's provided by my employer, by law. Paying thousands per month for "better" insurance isn't an option.
I made the mistake of touching on a complicated, important, and oft-contentious topic just before starting my work day. Not ghosting you, but I'll do my best to get back to this when I have the time required to offer a worthwhile response.
Same. I appreciate the reply but apparently this beehive isn’t worth kicking here. Seems like folks don’t know how to avoid the downvote button on emotional topics. I would love to have a deeper conversation about it but HN probably isn’t the place where I will find intellectual satisfaction on this topic.