Comment by floatingatoll | Hacker News Reader

Comment by floatingatoll | Hacker News Reader

For non-US folks who need a translation here -

In the US, we have a nationwide public healthcare system called “Medicare”. You generally only qualify for Medicare once you’re 65 except in special circumstances. Many of our citizens can’t afford to be diagnosed with cancer at an earlier age, as it will increase their non-Medicare private insurance premiums^, result in denied coverage for unrelated issues, and potentially send them into bankruptcy if treated. So they wait until they turn 65, and only then bring in pre-existing conditions for diagnosis and treatment, confident that they can no longer be bankrupted by doing so.

^ Insurance premiums average $300-$700 USD per month per person nationwide, when not available through full-time employment or (65+) Medicare. ~75.000.000 US citizens age 18-64 are employed full-time, which compels their employers to subsidize their monthly health insurance costs; the remaining ~127.000.000 citizens are not employed full-time and thus do not qualify for mandatory employer-provided insurance.

EDIT - Military veterans, poor people, and so on often have access to additional free public health systems other than Medicare, offered either nationwide or by member states of our union or by non-governmental organizations; degree of subsidy and quality of coverage varies wildly among them.

# The above estimates were constructed using napkin math and the below links.

“Average Monthly Benchmark Plan Premiums for a 27-Year-Old in Plan Year 2020 in Healthcare.gov States” https://www.investopedia.com/how-much-does-health-insurance-...

"Population estimates": https://www.census.gov/quickfacts/fact/table/US

"The U.S. labor force": https://en.wikipedia.org/wiki/Labor_force_in_the_United_Stat...

>Insurance premiums average $300-$700 USD per month per person nationwide, when not available through full-time employment or (65+) Medicare.

Well, until recently:

https://www.economist.com/united-states/2021/02/27/smuggled-...

Health insurance is now guaranteed affordable (8.5% of income or less) in every state except Wyoming, Wisconsin, South Dakota, Texas, Kansas, Louisiana, Tennessee, North Carolina, South Carolina, Georgia, Alabama, Mississippi and Florida (Medicaid gap).

That's excellent news. Thank you for sharing.

Though: The article lists the poverty line as $51,520; 8.5% of the poverty line is $365/month, so that's well within $300-700. Mississippi has the lowest median income in the US at $45,081; 8.5% of that is $319/month, which is still within $300-700. You would need to make less than $42k/year, which is about 80% of the poverty threshold, in order to fall below the thresholds I napkin-mathed. Many do make less than that, and this will greatly benefit them.

Non-US translation for that last bit, though -

37 out of 50 of our member states chose to enforce an 8.5% of annual income limit on health care insurance premiums for citizens of their states; 13 refused to.

Just to clarify, that's ($51,250) not the poverty line, it's the (old) subsidy line. The poverty line is $12880 + $4540d, where d is the number of dependents. But yes, healthcare premiums do float above $300/mo for some people.

Thanks, I totally misunderstood!

I feel like 2 exceptions is the limit for 'every state except', some other construction is more reasonable if there are 13.

"in most states. The exceptions are..." or whatever.

> only qualify for Medicare once you’re 65

That seems simultaneously useless and more expensive than early treatment—since folks would just bring in a baggage of chronic illnesses, pretty much like the article says.

Some of the people who are least likely to have insurance are those who "retire early" aka lose their job in their 50s or early 60s and are unable to find a replacement job with similar benefits and pay. Other people in blu collar jobs can no longer keep up with the physical demands of their profession once they hit mid 50s. Sometimes they have enough saved to scrape by until they can collect social security, which they unfortunately often do at 62 and forgo 30% of their monthly income permanently. Medical coverage is a huge problem for these people. Fortunately Obamacare makes it so they can now buy coverage at this age (before they would be rejected for likely pre-existing conditions), but any plan with reasonable premiums has a huge deductible (up to $10,000) that needs to be exceeded before insurance kicks in. For many people they would rather do without insurance that doesn't cover anything that is not catastrophic and save on the premiums.

Medicare is an umbrella for several different forms of insurance, it isn't a healthcare system.

It's large enough that most healthcare providers to accept it.

What about Medicaid for unemployed or under poverty level? I was on it briefly when I was out of work and everything was free from tests to meds. It was simply amazing not getting surprise bills or worrying.

I wonder if living in the US with Medicaid Is what it feels like to live in a different country with universal healthcare, does anyone know?

It's probably closer! I believe California leads the pack in that area — for example, if you're poor enough, you can get better insurance coverage for transgender care (as in, no-argument treatments and surgeries) than you can get with a $1000/month private insurance plan.

Reply on news.ycombinator.com