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Comment by Lewisham | Hacker News Reader

Even after all other factors that are mentioned already, the one significant difference I feel (having come to the US from the UK) is one of constant fear. Can I afford to go to the doctor with my co-pay? If something bad happens to me, will my insurance company look after me, or do whatever they can to ensure they don't pay out? If I get a terminal disease, will the co-pay for the medication I need to live as long as I can bankrupt my family?

With the NHS, while the Brits like to complain about it, the fear isn't there. You will always be looked after if you need to be. Here... I'm not so confident.

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Yeah, this is the biggest issue for me too (as an American who hasn't lived anywhere else). In particular, the tying to your employment status makes everything complicated and coverage uncertain for everyone except career employees who stay with one firm. For example, I switched from a full-time student to part-time for one semester in grad school. Oops, this means I don't get the student health insurance anymore and have to buy gap coverage. So I had to research gap insurance, fill out a bunch of paperwork, wait to be approved, and then still hope that I don't really have to use it, because now the recent change in insurance gives them excuses to claim things were preexisting and thus excluded.

And I don't even have any major chronic conditions! People with major chronic health issues are pretty much required to stay in their current job forever, because if they lose their health insurance they're screwed. The whole employment-tying thing puts a huge drain on entrepreneurship, imo, because lots of people who would start companies are scared of losing their health insurance, and even if you can figure it out, it's a huge bureaucratic hassle. One area where the private sector has managed to gallantly out-bureaucratize any government.

In short, I really, really wish that health-insurance was completely decoupled from employment. It would reduce a lot of friction in the economy, imo.

Can't upvote this enough.

On NPR an economist said that one thing that makes the US economy different (in a good way) from the EU economy is the extreme mobility of our workforce - that when times are tough, a reasonable portion of US people can and will pack up and move to a state where they can find jobs. If that is true, conversely isn't the effect of having health insurance so tightly coupled to employment equally detrimental? I mean it just blows my mind that we tie employment and healthcare together.

Many private health insurance policies feature annual out-of-pocket maximums (for deductibles, co-payments, etc.) so that you do not have a potential limitless liability for out-of-pocket cost-sharing during a given plan year - unless, of course, you happen to hit a lifetime limit on benefit coverage under the policy (another common feature - one that I believe the health insurance reform will phase out). Under the terms of such out-of-pocket maximums, once you hit the annual limit, you may have no further liability for deductibles, co-payments, etc.) during the balance of the plan year. Double check the terms of your policy.

This is another part of it: It's very difficult to compare health care in the same way you can compare, say, auto insurance. I've got a policy from my university, but it's still a significant document of legalese that doesn't easily explain what I am and am not entitled to.

It would have been nice if the health care reform created some sort of common labeling for policies that allows you to quickly scan your coverage. Or even some online "what if" simulator, where you can ask questions about what the policy will and will not cover (startup idea here?)

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