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Comment by jedberg | Hacker News Reader

Health care in the US is bimodal -- if you have good insurance and are wealthy, you'll get the best care in the world.

If you aren't rich, you'll get care on par with developing nations. And our life expectancy reflects that. If you break down life expectancy by wealth, wealthy people in the Us live longer than wealthy people in most other places, but poor people fare far worse.

I hope we can find a system that maintains our exceptional outcomes while expanding who that applies to. I think the systems in France and Japan are pretty good. France has a public/private hybrid system and Japan has public insurance but also employer based insurance.

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I think this is overly optimistic. Lots of interesting numbers in the link below, but in particular a couple of stats stand out.

https://spendmenot.com/blog/medical-bankruptcy-statistics/

Medical bankruptcies represent 62% of all personal bankruptcies.

39% of those who have issues with medical bill payments already have employer insurance

I think you're right that if you have good insurance and you're wealthy you do ok, but it's easy to have employer medical insurance, have a serious illness, and have serious issues being able pay or expending a significant amount of personal wealth during that serious illness.

I wouldn't consider someone who has to work wealthy.

Jeff has to work to be wealthy. Otherwise Amazon would just skip away. Like it or not Jeff is the driving force behind Amazon's success. And he has an insane work program every day.

That's ridiculous. First off, I'm sure he's already put things in place in case he is suddenly unable to work, like if he gets sick or dies. Secondly, I doubt they would lose all their value if he left.

If Jeff stepped down today, he'd still be a billionaire, and besides he can just sell some stock first. He's probably already got a few 10s of millions just sitting around in cash "just in case"

That's fair enough, but I think that means you're not really talking about anyone with employer insurance.

I know a lot of people who don't have to work, they simply choose to work, in large part to get the insurance. They are usually older and near the end of their career, before medicare kicks in.

That sounds like having to work to me. It seems like a fairly thin distinction - especially if the choice is being not able to afford health insurance or working.

They can afford health insurance, they just don't want to.

>Medical bankruptcies represent 62% of all personal bankruptcies.

The 62% number generally comes from: https://www.amjmed.com/article/S0002-9343%2809%2900404-5/pdf

    Table 2
    Debtor said medical bills were reason for bankruptcy  29.0%
    Medical bills >$5000 or >10% of annual family income  34.7%
    Mortgaged home to pay medical bills                    5.7%
    Medical bill problems (any of above 3)                57.1%
    Debtor or spouse lost >=2 weeks of income due         38.2%
     to illness or became completely disabled
    Debtor or spouse lost >=2 weeks of income to           6.8%
     care for ill family member
    Income loss due to illness (either of above 2)        40.3%
    Debtor said medical problem of self or spouse         32.1%
     was reason for bankruptcy
    Debtor said medical problem of other family           10.8%
    Any of above                                          62.1%

>Medical bankruptcies represent 62% of all personal bankruptcies.

Only 4% of US bankruptcies are because of medical bills (https://www.washingtonpost.com/blogs/post-partisan/wp/2018/0...). A tipoff that [insert large percentage here] of bankruptcies aren't actually because of medical costs is that only 6% of bankruptcies by those without health insurance are because of that cause. The biggest cause of bankruptcies is lack of income, which health insurance doesn't affect.

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