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Comment by VWWHFSfQ | Hacker News Reader

> I think it would be easier to become "filthy rich" for a poor person when they start in a nation with free healthcare and education.

Poor people in USA have both free healthcare and education. If they're willing to fill-out some forms.

Edit:

Yes, contrary to the popular belief, poor people in USA do, in fact, get free health care and education.

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I almost accepted this and went on my way, but it only tells like 7% of the story. The first thing is that your eligibility stops as soon as you start making more money (i.e. single earner > $17,000). But that increase in money does not cover the new costs for healthcare.

Aha! But at such a low income you get the ACA subsidy! But the insurance plans you can get have really high deductibles. If you're making $20,000 a year and have a $17,000 deductible... that's life ruining if you actually get sick. That's not to mention all the other oddities that go with having these higher-deductible lower premium plans like having to work around non-formulary medications, getting referrals to covered providers (you will be really lucky to have a PCP that does the homework to make sure you are referred in-network), and general insurance fuckery.

I think it's just a little bit more complex than filling out a few forms.

> you will be really lucky to have a PCP that does the home work to make sure you are referred in-network

They have whole databases on their computers that do this for them. Maybe they refer you to someone across town, or the next town over. But they're going to try hard to keep you in-network. This is also why Canadians are constantly paying out-of-pocket to come to USA to get their knee surgeries and back surgeries.

The accuracy of those databases is questionable as evidenced by $InsuranceCompany calling around to providers asking if they accept $InsuranceCompany. Of course, the better the insurance you have, the easier this problem is to solve because more providers are in-network.

> If they're willing to fill-out some forms.

How does that part work in practise? Are these forms something someone from a poor uneducated background can actually realistically fill out?

The way I see it many Americans I had the chance to talk with either take a gamble on their health or they spend not unsignificant time and energy to find their ways through the system. The first choice can turn out just fine, or (in many cases) completely catastrophic. The second choice takes away time and resources that could have been spent somewhere else.

Any poor person can walk into an urgent care or go to some place like ZocDoc and get help signing-up for Medicaid or Obamacare.

Likewise, any poor person can go to the local community college and tell the person at the desk that they want to enroll in some classes and they will be directed to the financial aide office where they will receive help to sign up for FAFSA [0] and Pell Grants [1].

All of these forms are printed in about 5 languages. There are people in the offices there to literally help the poor people write their own names on the forms.

[0] https://studentaid.gov/h/apply-for-aid/fafsa

[1] https://studentaid.gov/understand-aid/types/grants/pell

It works pretty well. 23% of Americans use Medicaid. (which means it surprisingly covers more people than UK's NHS) About half of all births in the US are paid for by Medicaid.

The Americans you hear about on the news that don't have healthcare are people who have incomes above the eligibility threshold to qualify for Medicaid, or are too young to qualify for Medicare. It's the people in the middle who fall through the cracks in the US.

> It's the people in the middle who fall through the cracks in the US.

You mean the people who potentially start out with their own business to get "filthy rich"?

I don’t understand your comment. I’m referring to people who have incomes too high to qualify for Medicaid but do not have a high enough income to afford good health insurance.

>How does that part work in practice? Are these forms something someone from a poor uneducated background can actually realistically fill out?

Yes, at least in the 3 states where I know anything about how the systems work. It's all the same information you fill out to get your driver's license, kid's school lunch which, contrary to the prevailing trope around here, being poor does not make you too stupid to do. It's way less arcane than reporting loan interest on your taxes or trying to register a used car last registered by a dead guy.

The larger problem is not simply getting access to medicaid, it's also that the US defines poverty essentially based on access to medicaid... Where a non-trivial portion of the population does not qualify for medicaid, but are also far from being financially secure.

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