The cost of two weeks in an pediatric/infant ICU

https://www.colorado.edu/today/2020/04/30/affordable-care-ac...

I agree with you that we should revisit and strengthen ACA and add that component back in.

- percent uninsured decreased

- number of people skipping treatment for cost reasons decreased

- number of people with "pre-existing conditions" covered increased

- satisfaction with coverage increased

- growth of healthcare costs slowed

Not to mention other provisions that are broadly popular such as children being allowed to stay on their parents health insurance through the age of 26 and mandates that require all plans to cover basic services.

https://www.cbpp.org/research/health/chart-book-accomplishme...

There are private clinics specialized on Western European patient with staff speaking fluent English, German etc.

This is maybe true but the actual number you pay is a total gamble depending on whatever the hospital feels like they can discount this month, whatever loopholes the insurance has found for not paying, whatever hoops the insurance or hospital have set up and you have jumped through correctly or not and how much time you have for the next few months or years to fight the bill.

It’s a totally insane and arbitrary system. Probably the pinnacle of a large and unaccountable bureaucracy. Sometimes I wonder if dealing with the mob is a more straightforward and reliable thing vs going to a hospital.

I don't understand why the word free always gets thrown around for country's with socialized medicine. You are paying for it.

So, not to defend the (out of control) prices, but only to say no two NICU stays are exactly alike. We can run the gamut from "a nurse could handle 100% of their care" to "we need 4 different specialists with decades of experience each to keep this person alive" and the costs fluctuate accordingly.

Yes, exactly, which is why it doesn’t actually happen. I’m not sure where the OP got this idea, but this isn’t how insurance billing works in the United States.

Edit: I was informed that it's not 10% co-pay but coinsurance. So I updated my post to reflect that.

" Sorry! We can't give you a quote. We don't know if you will use the on-flight entertainment on the flight, or if you will end up clogging the toilet midflight, or if you will eat 4 bags of pretzels. There's also the chance we will have to make an unscheduled stop due to weather. That is why we can only bill you once we arrive at your destination"

I've never even heard of such a thing in the UK NHS - i guess some kind of cost accounting must occur but I don't think it goes anywhere near patients or care givers.

You pay whether the doctor killed you or not. Roughly a quarter million Americans are murdered annually by preventable medical errors, and nobody cares. Furthermore, your estate gets full billing after they kill you.

Connecting billing to outcomes would go a long way to fixing this disaster of a system. It would help align incentives for these sociopathic quacks to stop murdering their patients en masse.

You pay: $reasonable_amount if your oncologist gets your cancer into remission, but you pay precisely $0 if the attending physician didn't bother reading your chart because they had to tee off at 3pm and then grab dinner at Fleming's with their mistress, so you got the wrong medication/procedure and you're confined to a wheelchair for life, or dead.

I can't think of any other profession, other than attorneys, where outcomes aren't intimately tied with compensation. Doctors and nurses, as modernity's new Gods, need to be brought down a few pegs with regard to this extravagant privilege.

... to say nothing of the fact that they are worse diagnosticians than a buggy Expert System written in Perl by a drunk college student in 1994, but because they are human, we should rely on them to make life or death decisions. But that's a discussion for another day.

Even when it's not an emergency, it's an amazing bucket of crap.

I take a specialized drug that's very expensive (~85k$/yr). I was considering changing jobs. No one in the HR of the new company, or the CSR side of the new insurer would tell me with any certainty that it'd be covered. The best I could get out of anyone is "we think it's covered, but we cannot promise it will be, nor will we pay out of pocket if it isn't". My doctor's office would just say "most of our patients on <x> insurance can get coverage. Not all, but most"

The bit about not covering it out of pocket might be a statement on how much they wanted me, but the first part is just maddening. It's a large part of the reason I didn't switch jobs. At least I know I can get insurance to cover the drug for now.

This absolutely does happen in the UK, although I'd pick our health over the US's any day of the week.

Everywhere I've lived (except the US) has had a totally free public system, and every time I've still paid for private insurance. I'm not rich by any means, and I don't have any particularly special requirements. I'm not even looking for better doctors or machines, since they are mostly shared or equivalent between public and private care.

The only reason it's worth it for me to spend money on private insurance is waiting times. On the private system, I can see a consultant in one month instead of six, or get a surgery in three months instead of three years. This is all for non-emergency care of course.

There are lots of elderly people waiting on operations like hip replacement on the public system, and it's expected that some will die before their turn comes up. It's a compromise that's built into the way the government operates their national health system. It not obviously the wrong way to do things, since carrying out all these operations would be very expensive and have limited benefit in terms of quality and quantity of life. It also sucks for the people waiting, especially since others who can afford to skip the line by paying (usually through private insurance) may even be seen by the same surgeon in the same OR.

I don't mean to argue for or against this system, but just to point out that people often die waiting for (non-emergency) care in at least several large public healthcare systems in highly-developed countries in Europe.

https://www.healthcare-now.org/legislation/national-timeline...

Ironically it is because of the USA that many Europeans are keenly aware of the davistating consequences of allowing for a hyper-capitalistic approach to healthcare. People here often assume the worst about that system, and are completely bewildered when I tell them how it actually works. (Especially in regards to having children, parental leave, and childc care.)

https://www.lancsteachinghospitals.nhs.uk/latest-news/happy-...

You have a source for that claim? Two weeks in the nicu is not that long tbh.

The folks at the poverty line with a "free" fully subsidized Bronze ACA plan has an enormous deductible that may be $6-12k before that coverage actually starts paying out. The ACA's max out-of-pocket for a family in 2021 is $17,100. (https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...)

That's not meaningful access to healthcare for someone making $30k a year.

That’s not what surveys show:

> Americans' satisfaction with the way the healthcare system works for them varies by the type of insurance they have. Satisfaction is highest among those with veterans or military health insurance, Medicare and Medicaid, and is lower among those with employer-paid and self-paid insurance. Americans with no health insurance are least satisfied of all.

https://news.gallup.com/poll/186527/americans-government-hea...

CMS also publishes assessments of its own performance:

https://www.cms.gov/Research-Statistics-Data-and-Systems/Res...

This probably varies regionally.

My local - upstate NY - DMV is quick, efficient, and the folks there are pleasant and competent.

My private health insurer hasn't been able to fix my website login for four years, routinely denies care for chronic conditions, and fulfills most of the nasty stereotypes about government bureaucracies.

And yet, people will also defend SS and Medicare/Medicaid till the ends of the earth. I personally find the only people that endlessly rag on social services, and to a large extent, government services, are people that have money and usually a lot of it. It's fine to argue for stopping inefficiencies, but to argue that the only way to stop inefficiencies is the complete abolishing of a government service is the peak of a particularly American argument. The argument usually comes from a place of "I have money, why do I have to put up with this, why do I deserve this?", which is an odd position to take. Americans usually carry the view that quality of service should scale with how much money you make or have, but that leads to a perverse view where worse off people, or low wage earners "deserve" the care they get in a dog eat dog world. When you have socialized healthcare options, that mindset comes across as bizarre if also irrelevant. "Deserving" never comes into the discussion aside from the idea that everyone deserves healthcare, which is the starting premise/assumption anyway.

> Worse, there are stories of friends in places like CAN...

> The system in the US is a mess, but those people reason that its the least worst option of the available choices.

The odd thing is, Canadians might criticize the Canadian healthcare system, but I have never met a single Canadian who would suggest the American patchwork is the "least worst option". It's that kind of reasoning that a lot of people from outside the US find nearly delusional.

This is a feature, as far as major companies and lobbying organizations are concerned. It's a major reason behind the resistance to universal healthcare because the duress of losing health insurance is the only way some companies keep their employees.

uhh, what? Is employment in general "a form of feudalism" because people depend on it to fund their basic needs?

Maybe if that system had VERY strong economic regulations (like, the government would set prices for everything and let private carers compete in "value added".)

list them?

The US spends 2-3x per capita (counting both public and private spending; https://data.oecd.org/healthres/health-spending.htm) than the rest of the OECD, with remarkably similar health outcomes.

> I pay about $300 per month for the entire family, $5K out of pocket max.

You're just paying your healthcare tax to your employer (in the form of lost salary; they're not chipping in the other $1-2k/month out of charity) instead of the government. It's silly to only count your contribution instead of the overall per-capita cost of healthcare.

Do your family and friends have the same insurance plan? What will happen to them if they don’t?

Seems short-sighted, yet telling, to talk only about the present time, and only about yourself.

While I disagree with nearly all of your post, I can find reason in the closing statement.

I feel like this logic often evades the people asking for higher taxes to support their causes. It’s always the middle class that ends up paying for it. It creates a lot of resentment which is exactly what fuels the rest of your post.

I wish there was a way this could be avoided, but obviously, it’s by design.

> In the end, the poor will benefit greatly

"The true measure of any society can be found in how it treats its most vulnerable members." -Gandhi.

From my experience, a decent insurance for the family is somewhere in $20k-ish range per year, which is closer to 10% of your income.

This lines up with 10% UK National Health Services charges HM's subjects.

It will not have a similar level of quality though, forget it. The lines will get longer and the definition of "medically necessary" will become way more frugal.

And for your income level it probably won't cost you less. Neither for mine. Nor for that of many HN users. But it will solve SO MANY annoying problems for so many people at once that I still think it's justified.

First, losing job does will not mean you're losing your medical coverage. You probably have not lost a job for a prolonged period of time. Neither did I. But the fact that it might potentially happen gives me uneasy feeling. If (when?) I lose my job, medical insurance will be the single biggest charge on my account, probably more than all other stuff combined.

Second, all these infamous cases when someone with insurance was admitted into the hospital, but then it suddenly turned out some junior aide to the senior anesthesiologist is out of network, therefore the insurance won't pay him. This doesn't happen often enough for most people to start pestering their congressmen, but it nevertheless happens.

Third, it will make the gap between salaried employees and contractors smaller. There are a lot of talks about whether such-and-such is actually not a contractor, but a salaried employee. And usually it all drills down to the benefits the person receives. One of the ways of solving this problem is making the benefits the same for contractors and for the employees. While it will not close the gap completely, it will make it more palatable.

Fourth, those willing to get a higher level of service will be able to buy private insurance. In countries with national healthcare private medical insurance is cheap - may be 10% of what we're paying now.

I can keep going. The trick is that none of these cases on its own is big enough to affect the majority of population, but combined I'm sure each of us will eventually be hit by one of them.

It turns out 8% of GDP is almost exactly what the UK spends on health care in total, including public and private spending. So your taxes to the federal government are paying about the same proportionately that we are for health care here in the UK, and you are also paying thousands of dollars a year for private health care on top. There's no way to spin this, you are getting utterly and completely shafted.

As it happens I also get private health care through my employer in the UK, but it only costs me £380 per year because the vast majority of my health care needs are met by the NHS promptly and to an excellent standard. The private top-up care only matters in truly exceptional situations, and even then it's mainly about comfort and maybe bypassing a queue for non-urgent care. Bearing in mind all the care I and my family have received over the years, and the zero stress I have ever had about affording it, I pay my taxes to the NHS with a happy heart.

A typical health insurance plan for a family of 4 costs closer to $1,500-$2,500 per month in the US if you are looking for something close(r) to the level of coverage available in socialized medicine countries (or in the parts of the US medical system that are socialized). That cost is on top of the automatic taxes we pay to cover Medicare, Medicaid, and the VA medical system (these 3 together account for a majority of US healthcare spending).

The wait time for an American at the poverty line seeking care for an expensive but non-emergency chronic condition can be effectively infinite.

My wife receives treatment for chronic pain. Getting treatment at a pain clinic started required five visits (including being able to physically get there in the first place), lab work, etc. Each of those required a hefty co-pay, and someone on a Bronze ACA plan will have a multi-thousand dollar deductible to meet before even those kick in.

If you're working minimum wage and have a pain condition, treatment is likely inaccessible, even if you technically have fully subsidized health insurance.

To me, the NHS in the UK is run by the NHS (chiefs, trusts, executives, etc). It's funded and meddled with by the government. But it outlives each successive government.

You'll hear far more positive stories than negative ones if you ask any one in the UK.

My kid spent a week in infant ICU. Cost to me zero. Total cost of pregnancy zero. Time thinking about the cost until now zero.

Money and healthcare are two exclusive concepts to the average British person. If we thought more about cost and healthcare maybe people would be willing to pay more tax for it. But they think it's free.

In reality, "negative stories" aren't much of a strong signal. There are likely as many "positive stories" that don't get as much traction, particularly because there is quite a lot of effort invested in the US into spreading FUD about single-payer healthcare systems. Though I do agree that this effort is effective on many people.

My grandmothers neighbor is in her 70’s and not great health. She needs a hip transplant and the doctor is basically like “nope, you don’t have many years left, better to prioritize a 50 year old”. Which makes perfect sense from a population perspective but sucks balls at an individual level.

Less. https://data.oecd.org/healthres/health-spending.htm has a chart of all OECD healthcare spending, both public and private. The US clearly stands out at the end. Employer-provided healthcare "gets taken out of your paycheck" all the same, just less visibly. This is a significant part of the political problem in the US; the true costs are hidden.

> And who the hell has an 8k deductible?

Most folks on an ACA Bronze plan.

https://news.ehealthinsurance.com/insights-blog/lower-premiu...

"For a family of four, average Bronze plan deductibles are rising by 3% (from $13,017 to $13,394), while the average maximum out-of-pocket limit is increasing 4% (from $14,916 to $15,462)."

"Universal coverage" is not "we pay for everything without question or approval process". In both systems, there are people who decide what's covered, and for whom. As for "exploding costs", the US is more expensive - in both public and private spending - than the "universal coverage" spots. https://data.oecd.org/healthres/health-spending.htm

My heart goes out to all the families with babies in the NICU. It is beyond stressful and obviously the financial side is nothing compared to the wellbeing of your baby, but then it hits you a few months later.

Also the purchase is non-refundable...

If aliens landed they'd think we're really strange.

I don't see this working without other substantial changes. They do this with Medicaid and Medicare already. The reimbursement rate is pretty low and the actual costs of some services actually exceed the payment. Without fully going to a government run system, I don't think setting standard prices will work well due to the quality and cost differences from location to location.

A better solution might be some sort of truth in advertising/billing that changes how the providers and insurance companies run that process, like presenting actual cost of care, actual payment by insurance, and protecting individuals from any charge that exceeds the cost of care plus some profit limit like 2%. I'm sure there are a lot of details to prevent loopholes, but that's my general view.

Nope. That's a separate line item. Appreciate the weird sarcasm though, as if I thought it would be magically administered for free?

>resp tx initial or subsequent qty 33@$318 total $ 10,494 (note: "tx" == therapy)

Also, 3ml takes 5 to 15 minutes to administer. So, even if I'm generous, that respiratory therapist costs $1272/hour.