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Comment by tlrobinson | Hacker News Reader

Are there services that will handle this nonsense for you?

In rich countries outside of the US it’s called “the government”

Other countries are slipping, though. For example, Germany does not actually have a single-payer system, but instead a "system" of public and private health insurance companies. As an employee you`re usually in the public system, which can be more expensive for higher-earners because the fees are based on your income (although the health taxes are regressive, capped above like 65K income per year). Self-employed people are often in the private system, and higher income earners can also opt into the private system.

The problem is you can´t easily opt back into the public system once you´re out (especially once you´re old), so there are tens of thousands (if not hundreds), that get stuck in the private system without being able to pay the fees because they´ve become poor (possibly because of health reasons), and then they get denied coverage and thus access to medical services.

Immigrants can fall through the cracks in the over-complicated system as well.

The problem is not as insane as in the US, happens "at the fringes", but it still affects thousands and is mostly outside of the perception of society, since everybody just assumes they got the best system in the world.

Please. Let’s not turn this into whataboutery. This isn’t about other countries doing things poorly, and more specifically Germany was not named by the parent commenter. This is about the US doing things significantly worse than basically any other developed country. I live in Germany, and know that the German healthcare system is not perfect, but I also know, as an American, that it is significantly better by essentially any metric than the US, and it’s unfair to pretend otherwise. I’m glad I don’t live in a society anymore in which I have to worry about taking an ambulance for an emergency because I can’t afford the fucking $500 price.

I think all systems have their downsides. In the UK for example, we've started doing citizenship checks for anyone who looks remotely like a foreigner, which to my mind is perverse and unnecessary, and part of a governmental preoccupation with trying to become as racist as possible via the back-door. (essentially, if we can blame the foreigners, we can absolve the government)

However, I think we can still say "America's system is totally screwy" and also say "and btw, as a warning, X country seems to be heading down that route too" - I don't think, phrased the way ant6n's post was, it takes away from criticism of America.

Essentially, in a perfect world, nobody would be made bankrupt because they got ill, and it seems right that governments should do everything they can to prevent that. If there is a class of people who get forced into that position because of something they cannot change, then that system is broken - whether or not that broken system adversely affects you personally. For example, the American system is not broken for rich people, and especially those in perfect health. For those people, it works just right.

And even if you are the only person in a country that is given the choice between feeding their family or investigating an abnormal lump, it doesn't matter how many people benefit from the upsides of that system, it doesn't matter if all your neighbours can visit their GP for a weekly checkup without penalty - without a doubt that system is broken and unjust and needs fixing.

But yes, I think most developed-country-based non-Americans would rate America's system as somewhere between "more broken than mine" and "perverse and cruel". The fact that we all use America's system as the yardstick for what a bad system looks like says it all.

The rest of the developed world, especially Switzerland, also has to thank the US for single-handedly ensuring the profits for its pharmaceutical industry.

Downvoters might read up on which country those pharma profits overwhelmingly come from and why companies like Novartis or Roche are worth what they are worth. As a European the US healthcare system gives me a failed-state vibe, but there are people close to me profiting directly from the absurd prices it pays for drugs.

> The problem is you can´t easily opt back into the public system once you´re out (especially once you´re old), so there are tens of thousands (if not hundreds), that get stuck in the private system without being able to pay the fees because they´ve become poor (possibly because of health reasons), and then they get denied coverage and thus access to medical services.

Although I recognize the personal hardship this can cause, I fail to accept this as a general injustice. In the German healthcare system nobody is forced to choose a private insurance instead of the public one. Choosing a private insurance when you're allowed to (which often means because you're in a higher income bracket) is usually only cheaper if you're young and healthy. It's basically a gamble on your own health for wealthy people.

And if the wealthy young and healthy population don't contribute to the public health insurance system which also pays for the not-so-wealthy and not-so-healthy (older) population, the public insurance system isn't sustainable.

The real problem with this system is its division in public and private insurance. Mandatory public insurance would mean lower insurance fees for public insurance and the problem of being stuck in private insurance would no longer exist.

The point is that there exist cracks in that many people will fall through and society at large doesn't even know that they are there; society as a whole is in denial about the problem because they can look at utterly dysfunctional systems like the US and and say "we're so much better here". Part of the problem is that many of those who are aware of the problem blame the individuals themselves for falling through the cracks in the system (like you do, based on some notion of 'choice'). One possible solution (it seems you agree with me here), is to remove the division between public and private systems. The first step ist to accept the existence of a problem instead of denying it (blaming individuals is a form of denying systemic issues).

I was commenting on a specific point made by the parent comment. It's pretty far fetched I'm in denial of the root issue when I even mentioned the real solution which you're agreeing with.

So while I get your sentiment you're really arguing against the wrong person here.

Besides that in my opinion there is a significant difference between "falling through the cracks" and making wrong decisions poorer people aren't even allowed to make - and then wanting those poorer people pay for your errors.

There’s a whole industry segment of attorneys specializing in denied medical claims.

I want a cheap mostly automated service that monitors medical expenses looking for irregularities etc.

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