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Comment by noncoml | Hacker News Reader

I have an acquaintance who is working in a top Bay Area tech company with a total compensation of close to $200k.

Her parents visited her and sadly her Dad had a cardiac episode and had to be taken to ER.

They stabilized him and thankfully he managed to go back to his home country and get proper treatment.

The ER bill was about $50k and she decided that the best way to pay it was by creating a GoFundMe campaign before she even tried to negotiate with the hospital or fight it with the insurance.

She managed to raise $15k.

After seeing that I am reluctant to donate any money to GoFundMe campaigns.

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Maybe I'm just being dumb, but I don't really understand why that makes you reluctant to donate.

It's not like your friend is trying to scam you or anything. That money is actually going to a bill that they are required to pay. Most people I talk to don't even know they can negotiate hospital bills.

Seems weird to act like your friend or GoFundMe is the villain here, when the issue is really a healthcare system that has a "secret menu".

isn't the issue the fact that said friend could afford to pay the bill?

This is not to detract from your comment about the system being broken

I am not so sure. When she has the money to pay for it, but instead chooses to portrait like she doesn't and asks others to pay for it, I think it's at least immoral.

It goes without saying that the healthcare system is completely broken, but that doesn't justify above behavior.

200K in the bay area is not exactly wealthy. It's a solid middle to upper-middle class wage. Taking a 50K hit for something you did nothing to deserve, just because you love your parent is stupid. I would hate it if my daughter tried to do that for me.

What did their friends and acquaintances do to deserve the bill?

Sorry but this sounds a little bit backward to me. Helping a friend in need or being altruistic is never a punishment. It's like refusing to donate money to some cause because what did I do to deserve that? Really an odd statement.

Nothing, but GoFundMe isn't an obligation, it's an ask.

Until "hi how you doing, I saw you decided not to fund my father's healthcare" or "wow, $30, he makes 200k a year! What an asshole!"

She wouldn’t take the bill as far it is concerned legally (as far as I know and dealt with medical bills myself).

She might get mails and phone calls but the collection agency will not go after her assets, well unless her dad has assets in the USA.

The story lacks some details but if she contact the hospital and negotiate based on that, they would likely reduce the bill. Is this moral or not that’s another question, but I agree that she had few options before asking people for money early on. Specially when making 200k.

" I would hate it if my daughter tried to do that for me."

But you are OK if other well-meaning people pay? If you make 200k you can take the hit and you should have known better.

You do realise that if you buy insurance and don't claim anything that's literally you paying for other people's healthcare, right? That's how insurance works. The only difference between that and the socialised national health systems around the world is that you also pay for the insurance company's profit.

I feel like I have to say this to everyone all the time when they try to defend the US as having the greatest healthcare system ever. It's literally impossible to offer the same service as a socialized, government program for cheaper when the non-socialized option has to make a profit. If a non-socialized system can drive costs down, so can a socialized provider. There's literally no situation where the socialized system loses on this.

> There's literally no situation where the socialized system loses on this

Actually, there is- it's when the socialized system decides they're good enough, and stops trying.

Thankfully here in the UK that sort of situation is incredibly rare. 99.9% of necessary treatments are available. That's one of the advantages of having socialised healthcare in a very wealthy country.

It's not "literally impossible". The socialized healthcare system could be corrupt, poorly run, or have other serious problems.

So can a private company. We're talking about the comparison of private to public. All things being equal, a public trust will always cost less because profit is not necessary as part of the cost of service.

Huh? So really, all services should be socialized is what you are saying?

There is literally no way a private company could offer something cheaper and better than the government?

In theory, no. A private company (by the commonly understood definition) always needs growth and profit to continue providing a good service. Neither of those things are compatible with being cheaper than a provider that doesn't have to optimise for those things.

Obviously in practice that's not how things work out, so in most cases private companies end up moving faster, leveraging efficiencies, utilising innovation better, and generally being cheaper. The lesson shouldn't be that means the government shouldn't provide services though, but rather that the government should act more like a business and do things businesses do to be competitive.

It's very noticeable that when government does this it works really well. The UK government has brought a lot of it's web and IT services in-house in the past decade, and they're so much better now.

I never said all services should be socialized. For example, I don't think auto repair services should be socialized. Do you see how silly your statement is?

And no... there is no way that a private company could offer something cheaper because both entities function the same way except that a private company also has to make a profit. Governments are not profit-making entities. Take whatever method a private company has to make something cheaper and remove profit and you have something the government can handle.

I didn't realize we were talking fantasy hypotheticals. Reality is, private companies can and will always do better than the government in almost everything. For the exact reason that you claim to be the problem. They want profit.

Industries like healthcare are plagued with government interference. Some regulations are important. Many just serve as a moat around the oligopoly that is the current private health Care system.

No one's talking fantasy hypotheticals except for you. The "reality" that you're claiming is not at all actually reality considering that every other industrialized nation on the planet pays less for healthcare and prescription drugs than we do in the United States. If private industry can drive prices down, then so can government. The USPS was the poster child for efficient and effective government service until Republicans decided to absolutely decimate it because of lobbying from private industry. Government services don't need to make a profit, they don't need to lobby, and they don't have any of the greed-driven motivation that private companies do.

You're either being intentionally obtuse or you're intentionally being misleading for some reason. This isn't rocket science. If two things are equal and one has the requirement to also generate profit, there's no way the other can possibly cost more.

I agree with you but this is not what this is about.

To put family first before other people ? Of course.

That's not putting family before other people. That's asking other people to put your family before themselves.

200k may not be wealthy, but I bet it's enough for an annual vacation abroad. That is a luxury many cannot afford. I think it's really inappropriate to create a gofundme campaign in this situation.

Because she should be responsible for her fathers condition?

Because they are not in a position of need. There are other people which were more reliant on such help to avoid a disastrous situation. If this family got no crowd sourced help, I think they would have been OK. Of course, there are a lot of assumptions in this assessment.

My comment has nothing to do with my opinion on the cost of medical services in the US. If you would like that, I think the Affordable Care Act used up a very rare opportunity for improvement to put us into a worse situation. What we really needed was a public option for the private companies to compete with.

Here in California our subsidized option, Covered California, was horrendous, at least at launch. Also, subsidized was not enough to help, and the subsidization counted as taxable income which was a slap in the face for those who needed it.

It's a high enough salary where the 50k bill is easily affordable on a repayment plan, which most hospitals offer interest free. She didn't need to beg others for money.

Firstly, I don't see how she has any legal obligation to pay for the medical care, at all. Your friend didn't get the medical care, her father did. Unless the father is a legal dependent of your friend, she isn't responsible for his medical expenses, at all.

Secondly, it sounds like you are making assumptions about her overall financial status, based on what you know about her current salary.

She might have substantial student debt, medical debt, spousal debt, be upside-down on a mortgage, have other family that she is supporting financially, etc.

Just knowing someone's salary doesn't provide a very clear picture of their overall financial status.

she started a page to help her father, she isnt responsible for paying all of his bills, she just wanted to help out. At least thats what it seems to me.

The story is missing some details so it isn't clear whether she actually has a legal obligation to pay the bill.

No legal obligation

The problem to me looks here

> The ER bill was about $50k and she decided that the best way to pay it was by creating a GoFundMe campaign before she even tried to negotiate with the hospital or fight it with the insurance.

For me it sounds like she could have done more on her own to solve this problem before “socializing” the solution.

PS: Yes, healthcare is broken but at the end, she as a resident knows that and when someone comes to visit it is her responsibility to advise or buy a travelers insurance. It is not that expensive.

> It is not that expensive.

It's prohibitively expensive for a wide range of people not in perfect health.

No, travel insurance is not. They don't even ask health questions. The cost is based on the cost of your trip, and can be as little as $50-$100 for a decent plan on a $5k trip, and about $500 for a year.

This article is about people who've had cancer at some point in their lives, even if they're currently cancer free and not having any treatment. That's what the FCA report focused on, but this problem affects 15 million people in the UK.

https://www.bbc.co.uk/news/business-44601046

They might not ask health questions, but if you're not careful and don't disclose anything material, they're probably going to find a way to get out of paying when it comes to it.

Travel insurance for older people with prior conditions can be expensive. My parents visited the US for a few weeks and their insurance cost something like $800 with a $500 deductible. Wasn't even that good either, with a stack of pages with terms and conditions. Fortunately they didn't have to use it.

In Germany, I pay about 12 USD per year for a travel insurance that covers an unlimited number of trips up to two months each, including repatriation if medically advised.

Honestly most people who haven't dealt with the healthcare system before wouldn't even consider that negotiating your freaking hospital bill is an option. No sane person would (especially if they grew up in another country).

"The ER bill was about $50k and she decided that the best way to pay it was by creating a GoFundMe campaign before she even tried to negotiate with the hospital or fight it with the insurance.

at a minimum she should have tried to deal with the insurance and the hospital first. She makes 200k. There are other people who are much more deserving of help.

Donations aren't a zero sum game. If she's soliciting her social network, odds are most of these donations aren't being diverted from other GoFundMes. Most of the money donated would probably be spent in other ways if the campaign didn't exist.

Personally I have seen a pattern where people who are making more money are less reluctant to ask for money versus people who really don’t have money. They often seem to suffer in silence. I have now seen several occasions where people who are making very good money are hitting others up for money for health care or weddings. It leaves a bad taste with me. From a certain income you should take care of yourself.

A donation isnt an obligation. If you're willing give then by all means do so, if not then it's not a big deal and if your friend gives you trouble for it then tell her off.

I see your discomfort with her making a GoFundMe the same as you view her not trying to negotiate the price down. When you're comfortable setting boundaries a lot of the discomfort in life goes away and things like trying to negotiate with someone or being uncomfortable with friends looking for (perhaps unnecessary) help on a bill become things you can handle

Most people visiting the US have travel insurance which can cover most or all related costs for about $1/day.

Yes. But you usually have to fight it to get it. They will very often try to play the “pre-existing condition” card, as they did in this case.

Which is the fundamental problem with private healthcare.

Fine if you win the genetic lottery. Not so much if you’re born with pre-existing conditions.

If only it was just genetics. I broke my right leg (femur) when I was 4 years old. After it healed, I never had a single problem with it. Played basketball, baseball, and I still lift weights today. I'm not in great shape, but probably better than average. My right knee started giving me problems. Meniscus tear. Didn't need a surgical solution just PT. Insurance denied paying for my PT because of "strain on the ligaments caused by prior break to femur". 39 years later? Maybe. But to deny PT sessions over that? That's stretching it.

You don't. Your insurance company back home will fight with the US provider.

Moreover, when on J1 visa you can get qualifying insurance for 30$/yr. It seems that such insurances may not cover long disability - you may need to go to your home country for a serious treatment.

Not at all. A good insurance that gets you actually covered for more than tipping over in your shoelace is much more.

1 month:

https://ibb.co/fnq4d1v

Details:

https://ibb.co/PTrSFHx

https://ibb.co/cvyPvjW

Depends on the country. In Israel, it's between $1-$3 per day.

What does what she make have to do with a bill for her parents?

Can a medical bill follow you back to your home country?

Of course. It's no different than any other debt. In theory the provider can obtain a judgment against the patient and then ask the home country's court system to enforce it. But in practice this is so expensive, uncertain, and time consuming that most creditors will just write it off as bad debt.

I recently read about people with US student loan debt escaping from it by going abroad where their credit history wouldn't follow them and the loan companies would't be able to get wage garnishments. It's at least possible that this woman's father had no real incentive to pay the bill, making the GoFundMe triply redundant.

So, I cannot speak how easy/hard is to collect debt abroad but I do know that it is possible for prospective employers to query the credit history.

I have recently applied for a job in the finance industry in Denmark, the institution did poke into my American financial life. That also happened when I worked for banks the UK and Wall Street.

I sometimes give to them, but I also make a donation to politicians or groups fighting for an actual fix for the health care system in this country.

200k is lower middle class in sf

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