$300 is a steal.
[1] “after premiums” is roughly the same as “after taxes”, right?
In the US, I've already payed thousands in after-premium medical expenses for my very healthy young children, just in copays and ER visit fees for normal accidents that kids get into, and that after having what in the US is considered amazing health insurance, so I'm a very lucky person.
I had to go to the ER in the UK as a tourist recently. They refused to take payment since I wasn't admitted to the hospital.
> [1] “after premiums” is roughly the same as “after taxes”, right?
For the purposes of comparison between the US and other OECD countries, yes.
My wife and I have never paid four figures for a doctor visit, despite having two surgeries (one oral), a calf strain, and a dislocated shoulder (with ER visit) between us. The state of medical care in the US is bad enough as it is; you don't need to make up hyperbolic bullshit to make it seem worse.
My son had a laceration glued together (dermabond in lieu of one or two stitches) and that was either close to or slightly over four digits after totaling the hospital bill and doctor bill, both in network.
I'm fine with paying a premium for trained professionals, I'm fine with paying doctors a high wage. $120 is crazy for a doctor who already has an opening in their schedule taking less than 10 minutes to glance at a wound and slap some steri-strips on it.
> Maybe consider that your experience is the exceptional, not the people you call hyperbolic.
I'm not saying I'm typical. I'm saying that four-figure Mexican bills aren't. If they were, then I'm an extreme outlier, which I don't accept.
It's also about what we paid for my wife's shoulder. Which, like I said, is bad enough on its own.
On the top of that, he didn't charge you for what it was, but for what it wasn't and confirming it.
Take for instance if that muscle spasm actually lead to something darn serious, the doctor ruled that out, that's why he sent you back after 10 mins. For some weird reason (or counter-intuitive economic reasoning which everyone has got), if you had a serious problem, and the doctor had identified it in that 10 mins, then you'd be ok with that billing.
See it this way, if you're tech security contractor and the CEO calls you urgently to come take a look at suspicious behavior on his computer which he thinks might be a hacker hacking his computer, but it turns out to be a quite known windows bug, that doesn't mean you shouldn't charge him your regular fee if it was an actual hacking attempt. You're getting paid for being on call.
Your mileage will vary depending on the bill collector, hospital system, staff etc., but keep in mind someone has to be paying the bills. American, work in tech, post on Hackernews? It’s probably going to be you.
Always worth a shot though. Worst case they’ll usually let you go on a 0% APR payment plan for years and years.
When I did ask, their response was basically a more nicely worded version of that.
Just because there wasn't anything wrong doesn't mean you don't have to pay a person for their services.
How much does an ER visit like that cost in a sane country? I mean the actual cost, not the “free” that the patient might see from a socialized system. It’s nowhere near that high.
I guess I shouldn’t have gotten injured on a federal holiday.
We have a friend whose hospital tried to charge them $15k for a delivery room they never used - never used because the doctors forgot about them and she delivered her own baby in the hallway. Talk about two major fuckups in a row.
With insurance we paid $800 for her to lay in the Er for 3 hours.
When I had back surgery I was with a public employer PPO. Total out of pocket was like $300 for about $500k of procedures. Half the people in my recovery PT were selling cars and emptying 401ks to make the mortgage.
I never said it doesn't happen, which seems to be the strawman most people are responding to. However, there is a huge gap between "it happens" and
> happy if your cost for seeing a doctor is less than 4 digits
which I indicates this is common and typical.
Socialized insurance rates in Germany are 15% of income. Unless your family doesn't earn any money, they have been paying far more than 50 Euros.
> In the US you can happy if your cost for seeing a doctor is less than 4 digits.
That isn't generally true. Every insurance plan is different. Cheap plans have a high deductible. It's similar to private insurance in Germany.
It's basically like this: If you're gonna be poor, go to Germany. Everyone else will pay for you. If you're going to earn well, leave Germany, otherwise you're going to be paying for everyone else.
1. The 15% of income has a cap. It's something like after 60k EUR in wages you don't pay anymore. Also, only 7.5% comes out of your paycheck, the employer pays the other half. When I was there a few years ago I was self employed so I had to pay "both sides". It would've worked out to roughly 750EUR/month for health insurance which had _0 deductible_ and _0 coinsurance_ for doctors visits or ER care and would've covered my entire family no matter on my children I had. Compare that with a typical HDHP family plan offered in the US and you're looking at $400/mo in premiums, with a $3k deductible and max OOP of $6k. The final cost is comparable.
2. The 15% is only if you participate in the public system - the private is not tied to your income.
You might delude yourself that this "other half" is paid by the employer, but in reality your employer takes that cost into account when employing you, so they offer you lower gross salary because of that. In other words: it's still paid by you, just indirectly.
EDIT: more clear wording.
That distinction is imaginary. It all comes out of your total cost for employer, which either goes to you or to (possibly earmarked) taxes.
This doesn't mean the amount is not fair (it very well might be). But it's important to realize it all comes from your paycheck.
This just means that paychecks are 7.5% lower then they would otherwise be. It is a mistake to think that the employer paid benefits are "free". The market adjusts. You find that out right quick of you are self-employed (at least in the US).
But still, if you count everything together, for a 2keur net paycheck you have to charge your customers 4.8k in my country (slovenia), and the government takes 2.8k (social benefits, pension, health, income tax and VAT). Say what you want, but 4.8k->2k is a huge amount of taxes.
...at which point progressive income tax starts kicking in badly.
> Also, only 7.5% comes out of your paycheck, the employer pays the other half.
Guess what, the employer pays 100% of your paycheck, including your vacation, pension, healthcare and taxes. It doesn't really matter to the employer how the cost is labeled. That's why you get to charge more when self-employed.
> The final cost is comparable.
Comparable? It's almost double if you don't take any care. Also, what if you don't have children? It's apples and oranges.
> The 15% is only if you participate in the public system - the private is not tied to your income.
Caveat: You are forced to take part in the public system unless you earn well or you are self-employed.
You should add this to your algorithm for location choice: If you get a serious health problem and want to become poor, come to the US.
However, if I were to get seriously and chronically sick I would back to my home country. Not that i couldn’t get very good care in the US, but the system here is just a massive burden compared to countries with universal coverage.
If you already have a serious health problem, you'll be hard pressed to find any country to take you and just take care of it pro-bono, if you're uninsured.
German public insurance only covers the bare minimum. I know enough people who are poor because of serious health issues. Sure, their medical costs were covered, but they're now welfare cases. They can't afford many treatments that would make their lives better. They would've had to buy extra insurance, but they chose not to, or couldn't afford it.
Relating that to the US: Don't skimp on insurance. Don't get an insurance that is capped at a low number, otherwise you will go bankrupt if shit hits the fan.
But shit will not hit the fan for the overwhelming majority of people. There's no good reason for someone in their 20s (or 30s) with, no dependents, no history of medical problems and doesn't partake in a dangerous lifestyle to load up on coverage. Loading up on coverage in that situation might make you feel warm and fuzzy. It might win you internet points. It is not financially sound.
And that's kinda the point of the parents' post, I think. If I were paying 15% of my income for socialized health care, I would be pissed if I ever had to pay anything out of pocket for my own medical needs.
Comments like this always miss the larger point, which is that healthcare overall is cheaper in socialized systems because the government as a large entity negotiates on behalf of citizens and puts strong downward pressure on prices.
https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
Salaries for doctors are the highest in the US. If we want to move to a single payer system they will have to take significant pay cuts.
What happens in socialized systems is that the government does price fixing, which makes healthcare worse and it limits supply. Try getting a specialist appointment with socialized healthcare in Germany, it can take several months. Get private insurance (or pay out of pocket) and suddenly appointments become available. Doctors are leaving the country in droves.
Some of the hospitals in Germany are in an abysmal state, MRSA rates are extremely high:
https://correctiv.org/en/latest-stories/super-bugs/2017/01/1...
They negotiate prices based on the size of the pool. This is why if you are a small business the rates you will get will be worse than if you were a large enterprise.
With socialized healthcare, the pool is the entire citizenry, which is what gives the government substantial leverage when negotiating.
That's not to say the American system is good, but I can't stand all this talk about how socialized healthcare is so great. It isn't. A lot of what people are calling "socialized" systems are actually private systems with a compulsion to purchase insurance, for example Switzerland, Netherlands, Australia. Even Germany technically has a dual system (public and private) but only the top earners are allowed to go private.
Incorrect. In the public system, the fees are negotiated between the GKV Spitzenverband (federal association of public health insurers) and the KBV (federal association of public doctors).
Germany still is in the top group regarding quality of care indicators.
As a Canadian, I will say there are a lot of people dissatisfied with the Canadian system. Likely to a lesser degree than in the US, but the system is far from perfect.
I'm 40, and my Mom was telling me about how my brother cut his head as a child, and the local small town doctor came in after hours to stitch it up. Different era.
ER is open 24/7 and doesn't turn people away even if they don't accept their insurance plan.
In two years we were there with our baby two times. Not charged a penny. During this time, I went once, my wife went once. In all instances we were reassured that it was appropriate to visit the hospital instead of visiting the GP the next day.
My wife firmly believes the US healthcare system is a giant scam where insurance companies leech off people without actually providing any value.
Health insurance in the US is built around providing value to employers. Most employers are concerned about which network is going to upset the fewest key employees and cost the least amount of money for the employer, while fulfilling all legal obligations, without making the employees spend too much time dealing with the insurance company when they could be working. Nicer employers may want to cover more of the cost, or want to upset fewer employees, or have specific things they want covered that aren't legally obligated.
There's also the problem that different groups of people want totally different things from the system. I like integrated care, because it provides me with a single place to go, that handles everything, even though it may not always be the best care. Other people are more focused on getting the best care, and are ok with (or prefer) to pick the individuals who provide each service, even though it means visiting multiple locations. Nicer employers offer you a choice of providers, but it would probably be less expensive for them if everyone was on one plan, at the cost of upsetting more employees.
The fact that you would go without thought of the cost but in a similiar situation would avoid because of the direct costs shows why the Ontario system is a poor model. The costs are hidden so more services are used. If costs were direct paid for out of your Ontario fund (a yearly budget that if not used would be carried forwarded or removed from your taxes) than a better balance could be found.
> The fact that you would go without thought of the cost but in a similar situation would avoid because of the direct costs shows why the Ontario system is a poor model
The pricing is hidden from me regardless, except that in one case people get the care they need and go on with their lives, and in the other I hear stories of people getting a surprise 4-digit bill in the mail three weeks later, after already paying through the nose for insurance.
When you look at international rankings of standard of living, the Ontario system is considered a good model (along with other similar healthcare systems such as those in nordic countries). The US model is poorer on several fronts, from pricing opaqueness to availability for low income people, and let's not even go into medical bankruptcies...
Lol. I wish. For me it was 5 digits. Closer to 6 than 4. And I had a $1,800/month premium for a family of 4. Spent multiple hours per week for months on end playing phone tag for the hospital and insurance company until it got resolved. Hospital billing also told me to not worry because nothing ever gets paid until both sides start suing eachother.
Yeah, this is peak efficiency. I just love taking up "resolving medical bills" as an unpaid part time job for the better part of a year.
But many places don't have any kind of Urgent Care centers, much less one that is open 24 hours a day.
* Potentially life-threatening emergency: ER
* Something like a broken bone or fever that needs to be fixed asap, but not life-threatening: Urgent Care
* Everything else that can wait a bit: regular doctor appt
They don't want anyone to risk staying home with their child if there's a chance that they are in danger
This is in Australia and there is no cost for this
We have late-night general practitioner services here (at least in the city), which I have used for less-urgent stuff.
They didn't have urgent care back then, but I understand there were "clinics" that could give those shots.