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Comment by brianwawok | Hacker News Reader

The top earning 50% of Americans with a stable w2 job (union + white collar jobs) get very "good" insurance where their job pays most of, while they pay a modest copay.

The bottom earning 25% of Americans have 0 assets and 0 money, so health care is effectively free. Go to a hospital, they must treat you, you can't pay the bill, so it gets written off.

The 26-49th percentile of people who have some money but no insurance are the people screwed by the current system.

So the reason why American's tolerate it.. is it works decently for 75% of the population. And it is hard for 25% of the population to really change anything. And of those, many are young and healthy so they don't really care. So maybe we are talking about 12.5% of the population being actively screwed by the system at any given time...

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The bottom 25% of Americans don't have free health care. They won't be treated for anything that is not an emergency. There is a huge difference. Some die because diseases aren't detected until it is too late.

A large fraction of Americans in the bottom income quartile are on government Medicare and/or Medicaid plans. They can access regular treatment and preventative care, although the provider networks are limited in some areas.

it is even worse than the parent post.

28% of US population is low-income(<200% federal poverty level) and 21% are covered by Medicaid/CHIP. This leaves 6 percent who are low income and uncovered.

https://files.kff.org/attachment/fact-sheet-medicaid-state-U...

Right. Some people would use it. Other's, typically rural Americans, have a deep distrust of the medical profession. They aren't going to go in for a yearly checkup, free or not free. It's very complicated.

Something that's a stark difference between US-style healthcare and British socialised-style healthcare is I don't get a yearly checkup in the UK - it's just not a service they offer. When I ask about this some people say it's not needed any way... not sure if that's right or not.

Routine annual checkups aren't medically justified for most healthy adults.

https://time.com/5095920/annual-physical-exam/

I wouldn’t say all of the 26-49 are screwed. A portion of those folks might be choosing not to pay for healthcare. They may be screwed if they get sick, but in general, if you opt out of paying intentionally and don’t get sick…you kind of “win”.

My biggest issue with the ACA was that it really didn’t fix the 26-49% and in many ways by mandating people buy insurance, especially young families making less than around $75k a year. made things worse.

My understanding was the 'modest' copay can be thousands of dollars. Is that not right? Can you buy insurance to pay the copay?

Per year? I think as an employee the most I ever paid for a year of insurance for myself and my family was maybe $2k? On a salary of over 100k, it was pretty tiny.

Insurance to pay the copay makes no sense, insurance is not free money. It's a risk pool to allow you to be able to afford the million dollar surgery only 1/100 people need.

(I now own a business so am on the other side of the coin. I want nothing to do with health care. Why do I have to be involved? It's real dumb).

> Insurance to pay the copay makes no sense

Why not I can pay a small sum to eliminate any potential copay on my car insurance?

Guaranteed to pay a small amount vs possibly going to have to pay a larger amount - that's the whole idea of insurance.

Sorry I am blending terms. Copay as your % of the insurance premium that your work buys you.

Example: Plan cost $2,000 per month. You have a $400 a month copay.

In retrospect, that is a bad term to use here, because copay means something totally different in insurance plans. There is also a copay for treatmeat, but not what I was talking about.

I’m not completely sure, but you seem to be confusing copay with the insurance premiums? Copay is the residual part of the cost of any given treatment that you have to pay after your insurance has (hopefully) paid for most of it.

As the sibling says, there is nothing inherently nonsensical about insuring against copay.

Sorry I am blending terms. Copay as your % of the insurance premium that your work buys you.

Example: Plan cost $2,000 per month. You have a $400 a month copay.

In retrospect, that is a bad term to use here, because copay means something totally different in insurance plans. There is also a copay for treatmeat, but not what I was talking about.

You can buy a HSA, which is basically an non-taxable interest bearing savings account used to pay healthcare expenses where your contributions to it also decrease your taxable income.

So, it’s not insurance, but it’s a way to essentially decrease your out of pocket co-pays especially if it rolls over year to year and earns interest.

> The top earning 50% of Americans with a stable w2 job (union + white collar jobs) get very "good" insurance where their job pays most of, while they pay a modest copay.

These folks are getting squeezed too, though. Copays keep increasing, employee contribution to premium increases, and healthcare increases have eaten compensation increases for 25 years.

Yeah, my "good" insurance is costing me $500 per month. And I'm considered one of the lucky ones! For anyone curious that's for a family, but still!

I would expect the total costs to be $1,500 or more, meaning the employer is also paying > $1,000/mo for this plan. That's $18,000 annually that didn't go to each employee.

You are correct! And it's amazing how many Americans never take this into account when discussing single payer options. I'm not saying single payer or universal healthcare options are better, but at least when evaluating the different options and their costs we should be putting all the facts on the table.

> Go to a hospital, they must treat you

For emergency care, sure, but they don’t have to offer you expensive treatments for whatever health conditions you might have. It’s wishful thinking to think that poor Americans are getting adequate health care.

Right. It's not perfect, but it's pretty workable in a pinch.

In no means am I saying the current system is good or the right way, but simply offering reasons why there aren't enough people up in arms about the status quo.

Err, no. Using emergency care as your only source of care is not “workable in a pinch”. It represents a vastly lower standard of care than that available to poor people in most first world countries. Face it: if someone you loved had no money and no health insurance, you wouldn’t feel reassured that they’d be able to access the care that they needed.

The question isn’t “no money”. It’s “no income”. Lots of people and even some with high incomes have no money. If you have “no income” there are options available to you for government healthcare coverage.

Great. Convince more voters that this is true, and put pressure on the government to change it.

The first step to convincing more voters that it’s true is to stop repeating the untruth that poor Americans somehow receive adequate healthcare in spite of not being insured. But I’m not American, so it’s not really my job.

Not many people outside the top 5% by net worth of Americans are on hacker news, so step would be to find another venue...

there were enough people up in arms about it to elect obama, who ran on healthcare reform.

The 2008 election top issue was based on the economy and energy (gas price). Health care and education were #3 and #4, where they often tend to live (per my OP for reasons why)

https://www.pewresearch.org/politics/2008/08/21/section-3-is...

Unless you lose your job or are self employed...

A major problem I read is insurance companies trying to find excuses to not pay or condition not being covered.

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