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Comment by StavrosK | Hacker News Reader

This didn't sink in until my recent trip to the States.

"So if you're poor and you get sick you just... die?" "Pretty much."

No, not pretty much.

Usually you end up in a lot of debt. But it is actually illegal in the US (last I checked) to actually turn away a dying person at the emergency room because of a lack of coverage.

Now, they may wish they had died when they get the bill, but that's another argument.

Hospitals are obligated to provide care that will immediately save your life. They are not obligated - and won't - provide care to sustain your life.

Suppose you have cancer. An operation costs $100,000. If you get it within six weeks, you live, otherwise, it metastasizes and you die. If you haven't got the $100K in the U.S., they won't operate, and are under no obligation to do so. It's not an emergent condition.

Now, 16 weeks later when you're dying, they'll put you in a hospital bed, give you oxygen and morphine, and try to ease you into death - regardless of your ability to pay (though they'll try to get paid from your assets and your family, of course). But that "guaranteed" care is perhaps not as comforting as getting the operation and staying alive would have been.

Getting life-saving help at the ER is not the same as having access to drugs or other medical care that could have prevented you from needing emergency care in the first place. In fact, there have been studies proving that giving poorer people better access to medical care, even for little things, ends up being cheaper than limiting their care to emergency room visits only.

How do the hospitals get payed if people can't pay them? Do people go to jail because they had no money when they were about to die?

This looks as efficient to hospitals as writing a bill to a rock or a tree

There is the HCRA surcharge (at least in New York state) that gets applied to many hospital and physician services. Part of the money from that is used to pay for these hospital services.

Edit: Clarification

The hospital charges the rich people more. It's socialized medicine, just set up differently than people expect.

Not quite. The rich people have insurance policies that put the screws to the hospital to get an amazingly good deal. The make-up money comes from people who have crappy insurance policies and/or just enough money to pay. If you can spend the rest of your life paying off your hospital stay, you will.

The rich people have insurance policies that put the screws to the hospital to get an amazingly good deal. The make-up money comes from people who have crappy insurance policies and/or just enough money to pay.

Hospitals over-charge a lot. If you call hospital billing and negotiate a bit, you can get a much lower bill.

If you can spend the rest of your life paying off your hospital stay, you will.

Well this part, I'm OK with. I will gladly take credit on my future earning in exchange for a shot at having future earnings.

And bankruptcy is much less painful in the US than in Europe, though you won't be able to get any sort of credit for quite a while.

We were talking about more long-term illnesses like cancer and the like, not emergency care, in that specific occasion.

To be fair, everyone with cancer dies of it, the rich just generally get to try a few more (mostly unsuccessful) treatment options and extend life a bit (at quite the cost to them).

My sister has cancer, hardly counts as rich, yet she got the chemo she needed. The bills are huge, but so far we have been able to pay them. I'm not closing the door to anything different from what we have, just saying that it's probably not as bad as you might think it is.

To be fair, most people with cancer don't die of it. It all depends on the kind of cancer, but these are the general statistics http://seer.cancer.gov/csr/1975_2009_pops09/browse_csr.php?s...

If you're poor and sick, you get treatment, and you might end up in one of the following situations: 1. You fill out financial hardship paperwork, have most of the cost written off, have a small debt to pay off, 2. You fail to fill out financial hardship paperwork or aren't quite poor enough to get the cost reduced much, you pay it off slowly over time or file bankrupcty.

I've been in both situations when I didn't have insurance. Economically, it would be much better off if we had universal health insurance, so major sickness wasn't so crushing economically, but we don't "just die".

What is true is that people die sometimes because they don't have insurance and can't afford preventative treatment for conditions they don't know about until it is too late.

Slightly more complex - and worse than that.

If you are completely poor, you are 'almost' OK. Hospitals don't actually dump people on the street (well a few did). The problem is that the costs for everyone else are hugely inflated to pay for this.

So if you have a job and go to hospital and your insurance doesn't cover you - for some administrative reason, or you just changed job and the insurance doesn't kick in, or it's an existing condition and your new insurance doesn't cover it. Then you are really screwed - you are looking at the price of a new car for a relatively minor case (broken leg, appendix) or your house for anything major.

The major problem (and the reason the US has a 3rd world life expectancy) is that the system really doesn't fit for any sort of preventative medicine. Vaccinations, healthy lifestyle stuff and especially screening are a fraction of what they would be in Europe.

> "the US has a 3rd world life expectancy"

No it doesn't.

http://en.wikipedia.org/wiki/List_of_countries_by_life_expec...

(Not disagreeing with your overall point.)

Ok, a little hyperbola. And some of it is due to ethnic makeup of the population.

But diet, pre/post natal care and screening for eg. cancer are the things that make a HUGE difference to life expectancy - not high-tech scanners and specialist brain surgeons. And these aren't things that are addressed by the US system.

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