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Comment by michaelt | Hacker News Reader

  my employer and I pay through the nose for my decent
  healthcare right now [...]
  Under your universal single-payer healthcare system,
  will I still be able to pay quadruple-through-the-nose
  to buy supplemental insurance

Here in the UK, the private health insurance arranged by my employer costs them $450 per year.

I don't know how much US insurance costs your employer, but I assume it's several times more, rather than several times less, than mine pays!

After all, in the UK private medical insurance doesn't have to cover ambulances or emergency surgery or pre-existing conditions or chronic illnesses or old age or organ transplants or childbirth.

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> I don't know how much US insurance costs your employer, but I assume it's several times more, rather than several times less, than mine pays!

You also likely make half what I make and that's before taxes (my wife is from the UK, I looked at jobs over there and rural US IT salaries can beat London IT salaries). I prefer my deal to yours.

That’s true, but how much of that extra money you get to keep in the long run is determined by the health lottery. If you end up having cancer for 5 years, you can kiss it all goodbye.

But yes, one thing that's tough for Europeans who haven't lived in the US to comprehend is that Americans really do prefer being able to buy a bigger TV to having proper security when it comes to health care.

If I lived in the London with the salaries they wanted to pay I'd be poor either way. It was enough to live in a tenement block. take public transport and eat cheap food. In the US I own a home, two cars, and support my entire family from just my salary. If I got cancer in the US I'd have be forced to live in a tenement block. take public transport and eat cheap food just like if I was "lucky" in the UK.

I'm not sure exactly what you mean by a "tenement block", but a typical tech salary in New York or San Fransisco isn't going to be enough to live in a town house. If you're in a city, you're going to be in an apartment, and that apartment is probably going to be in a block of apartments.

>If I got cancer in the US I'd have be forced to live in a tenement block. take public transport and eat cheap food just like if I was "lucky" in the UK.

That's an interesting perspective on public transport. Public transport is a far more pleasant way to get around London than driving :)

But, no, you could end up in a far worse situation than that in the US. Medical costs are very unpredictable and bear no relation to your wealth. You could easily end up bankrupt and unable to pay for vital medical treatment. I realize that most Americans like to live in complete denial of this fact, but it's inarguably true.

Also, even taking what you say at face value, it's quite incredible that you're satisfied with this. Why should you have to take a massive hit in living standards just because you get sick?

>but a typical tech salary in New York or San Fransisco isn't going to be enough to live in a town house.

That's true, but then I'd be talking about salaries that aren't double of what is offered in London but 5 or 6 fold higher. I own my home and support my wife and daughter by myself in a low crime suburban area in the US, that isn't possible anywhere I could find in the UK. Did I also mention I didn't go to college?

>But, no, you could end up in a far worse situation than that in the US. Medical costs are very unpredictable and bear no relation to your wealth. You could easily end up bankrupt and unable to pay for vital medical treatment.

When you get that sick you end up on socialized medicine, SSDI and medicaid cover those costs at that point. Also while you will receive medical bills you don't actually have to pay them while hospitals are not allowed to refuse you life saving treatment.

Tech salaries in NYC and SF aren't 5 or 6 times higher than tech salaries in London.

>I own my home and support my wife and daughter by myself in a low crime suburban area in the US, that isn't possible anywhere I could find in the UK.

I'm not sure what you're saying at this point. I grew up in a low crime suburban area in the UK. My Dad worked, my mom stayed at home. They owned the house. My Dad works as a programmer.

>When you get that sick you end up on socialized medicine, SSDI and medicaid cover those costs at that point.

Erm, no. You will not likely meet the eligibility requirements for medicaid. That's just wishful thinking. If that's how the system worked, medical bankruptcies wouldn't happen.

>Also while you will receive medical bills you don't actually have to pay them while hospitals are not allowed to refuse you life saving treatment.

They're not allowed to refuse you life-saving emergency treatment. They sure can refuse to give you chemo, refuse to give you reconstructive surgery if you've been badly burned, etc. etc.

It's astonishing how unaware you are of how the health system works your own country. America has a lot of work to do on this issue.

You really could suddenly end up with a $500,000 medical bill. It's tough to face up to that fact, but it is a fact. https://www.nbcnews.com/health/health-care/first-kidney-fail...

> Tech salaries in NYC and SF aren't 5 or 6 times higher than tech salaries in London.

I've seen 75k USD salaries commonly in London and 400k+ is not unheard of in fang companies.

>Erm, no. You will not likely meet the eligibility requirements for medicaid. That's just wishful thinking. If that's how the system worked, medical bankruptcies wouldn't happen.

If I have money and insurance why do I need assistance? The disaster situation you were describing seemed to imply that I would no longer be working and have insurance. If I'm working and have insurance I'll just pay my copays and get care that way. If I have no income due to a disability, I'd get SSDI and medicaid.

>They're not allowed to refuse you life-saving emergency treatment. They sure can refuse to give you chemo, refuse to give you reconstructive surgery if you've been badly burned, etc. etc.

Care to cite a time where that ever happened?

>I've seen 75k USD salaries commonly in London and 400k+ is not unheard of in fang companies.

You're just comparing a typical dev salary in London to an unusually high dev salary for NYC or SF. I don't see what insight you hope to gain by doing that. (The people making big money as software developers in London work as independent consultants rather than employees, by the way, as it's more favorable from a tax point of view and - lol - you don't have to worry about not having health insurance.)

>If I have money and insurance why do I need assistance?

Because you don't have enough money. There's no cap on medical bills. See for example the article I linked to regarding the $500,000 bill for dialysis. The person in question had insurance.

>Care to cite a time where that ever happened?

Holy crap, you really mean it. It happens all the time, as you can find out just by googling. Hospitals are under no obligation to give you chemo if you can't pay for it.

https://www.upi.com/Health_News/2016/06/03/Study-One-quarter...

https://www.webmd.com/cancer/news/20170221/many-younger-canc...

>You're just comparing a typical dev salary in London to an unusually high dev salary for NYC or SF.

If you make much less than that in SF or NYC, there is no point in living in such an expensive place. Go make that London salary working in a rural area of the US.

>Because you don't have enough money. There's no cap on medical bills. See for example the article I linked to regarding the $500,000 bill for dialysis. The person in question had insurance.

From your article: "A few days after the treatments began, an insurance case manager called the Valentines warning them that since Fresenius was out-of-network, they could be required to pay whatever the insurer didn’t cover. The manager added that there were no in-network dialysis clinics in Montana, according to Jessica’s handwritten notes from the conversation. (The insurance company disputes this, saying that its case manager told Jessica there were no in-network dialysis clinics in Missoula.)

Jessica repeatedly asked both the dialysis clinic staff and the insurer how much they could expect to be charged, but couldn’t get an answer.

Then the bills came."

So basically, insurance said they would not pay for the clinic this person selected and since they have zero agency they kept going and got the bill that they were told they were going to get. So sad. Did they actually pay the bill? Of course not. They took a credit hit.

>Holy crap, you really mean it. It happens all the time, as you can find out just by googling.

What was one individuals name who this happened to. Not a study. Not "we think it happens". What is the persons name?

>If you make much less than that in SF or NYC, there is no point in living in such an expensive place. Go make that London salary working in a rural area of the US.

The median household income in New York is $50,000. I would rather live in London than in a rural area of the US - thanks. You talk as if people have no preferences besides maximizing the salary to cost of living ratio.

> So basically, insurance said they would not pay for the clinic this person selected and since they have zero agency they kept going and got the bill that they were told they were going to get.

I can’t figure out exactly what you’re trying to say here. It seems you are trying to find some way to convince yourself that these people deserved to get a $500,000 bill so that you can kid yourself that this could never happen to you. Yes, it’s their fault for failing to fly to another state in the middle of a medical crisis to find an in network provider, in the absence of any clear information regarding treatment costs from from medical staff or the insurance company.

> Did they actually pay the bill? Of course not. They took a credit hit.

We don’t know from the article how much they ended up paying. In any case, taking a credit hit is not a trivial thing. In your earlier comments, for example, you clearly placed a large value on home ownership. It’s difficult to buy a home with bad credit.

>What was one individuals name who this happened to. Not a study. Not "we think it happens". What is the persons name?

This article collects a number of stories involving named individuals:

https://www.bustle.com/p/these-20-stories-refute-the-idea-th...

You are citing bustle who is in turn citing tweets with that article. That's your best evidence? Can't find a AP article anywhere? Shouldn't there be thousands and thousands of examples to pick from?

You asked for personal stories. If you want something more robust, check the Harvard Medical School study:

https://pnhp.org/excessdeaths/health-insurance-and-mortality...

"Care to cite a time where that ever happened?"

There's a documentary about the Mayo clinic on netflix. In it, a woman finally recieves a diagnosis of her mysterious and debilitating illness, of which she is pretty sure she would die from without diagnosis or treatment. She responds to initial treatment, which makes her hopeful the quality of life will finally approve. Then she no longer has money, and cannot have treatment anymore. She leaves the clinic and we never know what happens to her.

From what I'm told should be thousands of stories like this, why can't you find one where you can prove that the person died? It's all rumor and second hand stories. If someone in my family died due to someone refusing them medical care I'd be all over the media about it.

https://www.thenation.com/article/the-devastating-process-of...

https://www.theguardian.com/us-news/2017/jun/24/us-healthcar...

https://www.patheos.com/blogs/dispatches/2018/10/15/study-45...

https://www.nap.edu/catalog/10367/care-without-coverage-too-...

https://www.bustle.com/p/these-20-stories-refute-the-idea-th...

??? There are studies that directly show that not having insurance is deadly.

From the first example: "By the time Portillo found out about a small county program that sends health workers to the homes of low-income, bedridden patients, her father had been at home without pain medication for two and a half months. The nurse practitioner who came, spurred by Aquilino’s obvious suffering, rushed to order medication to make him more comfortable. Two days later, when the morphine had barely had a chance to soothe him, he was gone."

There was a program, they didn't use it until the end, he was going to die anyway. He did not die due to lack of medical care.

I'm not going to go through each one, give me your best example.

>??? There are studies that directly show that not having insurance is deadly.

Also that tobacco doesn't cause cancer, guess what those studies have in common?

"Also that tobacco doesn't cause cancer, guess what those studies have in common?"

No, please do tell me exactly what those studies have in common, with citations.

You asked for something that isn't rumor and second hand stories. I provided. Now you move the goalposts and ask for my single best story. Please clarify your behavior and your motivations in engaging in this discussion: Do you actually wish to process data that is contrary to your belief on how the world functions?

The people who produce them benefit from the result.

Who says we need massive governmental spending in healthcare? Why governmental healthcare authorities of course! I'm skeptical, especially when the specific examples provided don't match up with the rhetoric.

Also the burden would not even be that people die from lack of healthcare in the US, it would be that more people die from lack of healthcare in the US than people die from healthcare rationing in the UK. He's a case of someone who actually died from that[0].

[0]https://en.wikipedia.org/wiki/Charlie_Gard_case

"The people who produce them benefit from the result."

Can you cite specific studies, their specific researchers, and their specific funding grants?

"Also the burden would not even be that people die from lack of healthcare in the US, it would be that more people die from lack of healthcare in the US than people die from healthcare rationing in the UK"

This is not what you claimed. Please clarify the contradiction between your statements.

Readers will see my point, I don't need to get into the weeds with you like this over minor details.

Please clarify: What is your point? You asked for any evidence, and when provided, denied it as evidence, reiterated that you had always asked for specific evidence.

Nobody can seem to find a specific person who died due to lack of healthcare with anything more than a tweet to back it up. Lots of "almost" cases but no definitive deaths. Why do you think that is given you claim this is happening all day every day.

At least one reader certainly doesn't. You're asking everybody for evidence that could stand up even in court while you respond with anecdotal data and personal experience based on biased, incomplete, or generic data.

"I live and work in rural US and suddenly I can afford a lot more than I could if I had one of those jobs I found after an internet search for London" does not pass the bar you expect other people's evidence to. Not by a long shot.

"People are dying due to lack of healthcare!"

"Who?"

"This guy tweeted about it"

"I'm going to need more than that"

"Here is a study where they claim it happens in aggregate"

"Who died specifically and what were the circumstances of that death"

"PEOPLE ARE DYING"

pretty much how this debate goes every single time

If you consider that study data bad so be it. But then accept that your data is equally bad at best. And I'm being generous here, you provided no "data" to speak of. No aggregate data, no study, not even a hint of specificity.

On one hand you talk about London (very specific), on the other it's "rural US" (97% of US!). Nothing about the actual job or its conditions, what you looked at to compare, etc.

I mean it's absurd to discredit a study with sources and actual figures but try to pretend your claim looks like anything more than an impulse comment.

To make this anecdote into a data point the GP should post his whole financial history. E.g. how much they made and spent. What do they own and then we can also check what can they buy.

For example, can he buy a typical hip surgery, which over time is likely? CLL treatments? Medical transport should it be necessary? Hire a nurse? Get a broken limb in a cast?

... Not lose a job because they cannot get to it for a month because of bum leg?

Cost of each of these can be actually checked ahead of time, for UK and for US. Including a split between in network vs out network in the US.

If people are dying, we can count deaths due to causes that would be preventable in UK and in the US, as well as cost in each case.

No, he would have to say something just slightly more specific like: "rural means a suburb of City X". Or "I'm a programmer working remotely for a Fortune 500 company". Anything that can make the rest of the statement meaningful. I mean I understand not wanting to give out personal details but then don't bring it up if it's so generic.

I can tell you rural Kazakhstan can pay 5 times more than the same job in US. But without giving you details it will seem like an exaggeration or flat out lie. It's not, just a cherry picked example.

If a study comes up with figures that don't have particular names attached (data protection and all that) then unless you have some evidence to disprove it we can take it at face value. Fighting it with empty hands and generic unverifiable counterarguments feels like trying to save face.

It’s dishonest to refer to the Charlie Gard case as an instance of healthcare rationing. Doctors refused (experimental, zero-chance) treatment for purely medical reasons: it wasn’t the best thing for the baby. The resulting court case was over the question of whether doctors are required to (a) act in accord with the best interests of the child or (b) do whatever the child’s parents want. The answer turns out to be (a). Financial considerations never entered into the decision. The deciding factor was medical: a series of epileptic seizures which reduced the chance of a successful outcome to ~0. It isn’t ethical to torture a baby with ineffectual treatments just because the parents are (understandably) not ready to accept that the baby is going to die.

It's not just about dying. It's about living. I have had minimal to no access to quality medical care in America since I went through this. I have had to choose NOT to seek care for things I needed to because I cannot pay for it. I have been denied many things a reasonable person would expect to receive. There is only one reason people defend this system...ego. They cannot accept that American Capitalism isn't the best thing ever. Their pride matters more than other people. It's shameful.

Most employer sponsored healthcare plans in the US have a maximum out of pocket the patient can be charged per year.

The average cost for someone with cancer and an employer sponsored plan in the US is around $6000 per year. That's $500 a month.

https://www.cheatsheet.com/health-fitness/how-much-you-can-r...

Both my parents had cancer and survived in US, so I do know from first hand experience. They did not get ruined financially.

That said, I do support healthcare for all in the US.

>Most employer sponsored healthcare plans in the US have a maximum out of pocket the patient can be charged per year.

Yeah, but that's irrelevant if you have to use an out of network provider in an emergency situation, or if you need a treatment that your insurance provider refuses to cover.

The lack of global insurance policy for actual emergencies is a crime of this insurance system you have in the US.

This is where the government is supposed to step in. Nobody is in any position to predict where they will be taken for emergency care, and copays for random amounts is essentially ransom.

How much paid vacation do you get? Sick days? How much maternity leave does your wife get? What sort of employment protection do you have?

The difference isn't as clear cut as it seems on the surface.

Four weeks. No sick days part of the four weeks. None but I can afford to support her while she is home with our daughter for as long as they need. None besides about 5 job offers in my inbox per day.

On one hand you ask for exact names of people who have gone through unfortunate health or medical bills related moments but on the other hand you compare esoteric "identical jobs" with no consistency or transparency. One in London which barely pays for an apartment in a tenement building, public transport, and nothing else. The other is in "rural US", pays double, you can afford a house, 2 cars, and to support your whole family by yourself, and a whole list of other benefits (some unusual for the US).

Are they really the same job? Are the 2 salaries/conditions representative of the job or you just got lucky? Are they actually identical (what happens if you're sick for 6 months?)? Are the salaries that you could find published on the internet representative for London? What's "rural" US? Are you working from home for a big company or do you have to be on site? If you have to work in your town/suburb what other career opportunities are available for you and your family there compared to London? You may be happy with your salary now but if there's no room to grow, or you have no choice if you lose you job/company goes bust, then it's not quite ideal.

I understand you may not want to provide details about your personal life but as it stands you have anecdotal evidence that may or may not be based on flawed data (cherry picked examples or low quality information), while everyone else supported their claims with actual links.

Just in case: I'm not British, nor do I live there.

You're privileged enough to be in the right industry in the right location, with the right skill sets and experience, at the right time. If things were different you'd get no holidays, no job security, etc. I know people in tech on the east coast of the US who struggle to get two weeks leave and struggle to change jobs. Four weeks is something the rest of the world just takes for granted. I also know people that have been bankrupted because of health costs, this was my uncle who was a millionaire and had the best insurance money could buy. His wife got cancer, they fought the insurance company, sold the business and the car collection and houses, she died, he went bankrupt. It was very sad.

I used to work in the bay area but ultimately decided to come home. Here in NZ in the tech industry I earn a couple of hundred thousand which is admittedly less than I'd learn in the US but while things like employment protection aren't important to me right now I also take comfort by the fact that if I get hit by a car ACC will cover my loss of income and rehabilitation, I simply don't have to worry about getting sick or injured. I also take comfort by the fact that everyone, be it a barista or a barrister, has the same perks (like four weeks paid leave, sick leave) and protection that I do.

Another example: a company I worked for in NZ was a US multinational, they did a big restructure where they laid off thousands. Because of employment law most of the lay offs were people in the US, South America, and Asia. Europe and New Zealand were almost completely unscathed, it was just easier.

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