Comment by philbarr | Hacker News Reader

Comment by philbarr | Hacker News Reader

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Coming from the UK, I'm always amazed at how important health insurance is in the US, and what a broad range of quality of healthcare there is. Our company provide a free, private healthcare (BUPA), but I've never felt the need to use it.

Recently, I had surgery for an ACL tear. Unfortunately, for some reason, it later went septic. The day the consultant found it was septic he rushed me into surgery that afternoon and I spent the next 6 nights on IV antibiotics, followed by a course of oral antibiotics. At no point did I have to worry about how much all this cost - and I didn't ring BUPA just because I couldn't be bothered and it was all perfectly satisfactory care.

When I was a kid I had extremely bad asthma. A new respirator type device had just been invented and I was one of the first in the North West to have one. These things cost thousands of pounds at the time and there's no way my parents would have been able to afford it, but they got it loaned to them completely free. It quite possibly saved my life.

I used to think how lucky I was that I wasn't born in some third world country where I would probably not have survived, but recently I've started to be glad I wasn't born in the US.

You guys really need to sort this out.

All that would likely have happened in the US also. Most people have health insurance. The ones who don't still get medical care, it just costs them money. If they don't have the money, they can settle with the hospital on a payment plan they can afford. It's definitely not perfect, but it's not as bad as it seems at first glance. I'll see posts about people's 30,000 dollar hospital bill, but in reality they'll never end up paying that much.

But, still, medical bills are a major (#1?) cause of bankruptcy. And our health outcomes are significantly worsened by how many people never get preventative care.

Health insurance in the US is highly variable. Many plans expect consumers to pay a substantial portion of their medical bills. The term "underinsured" tries to capture this segment of the population that is nominally insured but in reality would incur huge bills if they took advantage of their insurance. And while some people manage to get out of paying their bills by exploiting HIPAA, most just take the massive hit to their credit and walk away from it. So no they don't end up paying that much, but the stress and economic fallout they endure is nothing to wave away either.

I work for one of the top 10 hospitals in the United States. Our health insurance, ironically, isn't all that great. Co-pays are relatively high, certain things not covered, etc. So it got me thinking about health insurance and how it affects us (US residents), in comparison to our European counterparts.

One may argue that Europe went too far with their "social" expenses (hence, the current financial meltdown). Possibly. However, their view of healthcare (education, and other items) as a BASIC human right is one I strongly believe in. Healthcare should NOT be a luxury item. Yet, it is treated as such in the US. Almost exactly a year ago, I had a bike accident right off the Golden Gate Bridge. For 10 minutes I was limping my way to Sausalito until I happened to run into a police officer who thought I should be picked up by an ambulance to taken to the hospital (although they suspected that I had a concussion, broke my arm and shoulder, I came out with just scratches). I HAVE insurance, but for weeks after this injury, I was opening my mailbox at home, expecting a $20K bill (just the 15 minute ambulance ride was $2000). I was absolutely terrified. Imagine... and I HAVE insurance. Luckily, I ended up paying just a few co-pays, and the issue was resolved.

One of the benefits of a great employer in the US (like you have -- Microsoft, for example) is "Health insurance, Dental covered" etc. That's how they post it in job boards. Shouldn't health insurance be a given??

To your argument that things are settled through loans, etc: I am utterly against it. Obviously, statistics show that these things don't work. The hospital I work for serves an under-served population. People suffering from chronic diseases and who should be seeing a doctor on a regular basis do not. Why? Cost. They end up showing up in the ER with a MAJOR issue months later. Their condition is much more complicated to treat, and significantly costlier. So, we "saved" on a silly, cheap follow-up, but ended up spending a huge amount later. And guess what? These patients can't pay their bill anyhow, so we have to write the expense off.

I am familiar with quite a few people who would have loved to change their jobs, or even start their own business, but are too worried about losing their health insurance benefits. Is that the right way to go for the US? Probably not.

[edited: put it initially under the wrong parent. text left as is]

>One may argue that Europe went too far with their "social" expenses (hence, the current financial meltdown).

I'm not sure Greece in particular went too far, as such; isn't the problem that they've got a massive epidemic of tax evasion, and no political will to tackle it? If they were enforcing the tax laws on the books, maybe they'd have the money to pay for the services they're providing.

>So, we "saved" on a silly, cheap follow-up, but ended up spending a huge amount later. And guess what? These patients can't pay their bill anyhow, so we have to write the expense off.

Hear, hear.

> One may argue that Europe went too far with their "social" expenses (hence, the current financial meltdown)

One may argue that if she has no understanding of the European financial meltdown, and just wants to find evidence for the failure of the welfare state where there is none. The crisis happened primarily because of the Spanish real estate crisis, and it became exacerbated because of (1) structural flaws in the monetary union and (2) imposition of rapid austerity.

As for the rest, I agree.

> One may argue that if she has no understanding of the European financial meltdown, and just wants to find evidence for the failure of the welfare state where there is none

There there. Relax. I was not arguing that the social measures were the only cause of the financial meltdown. They are, probably, a contributing factor. You brought up Spain, which in particular, I am quite familiar with due to personal relations with a Spanish. Real estate was the major factor (as it was in the US), that is true. However, when Spanish citizens tell me they show up at the ER for a sore throat because the ER is closer to work/fit their schedule/whatever instead of setting an appointment with a doctor, I think that's a big "social" expense that could and should be avoided. Why do they do that? Because it's free! So who cares, right? There's nothing wrong with providing free health insurance (and I'm a big advocate for it), but showing up to the ER without a reason should be penalized.

Also, when I hear that people who have no desire to work (because they're homemakers, for example) show up at the unemployment office simply to collect unemployment or just to be eligible to "fun" courses (to fill up their days), that's a social expense (in Spain, if you're unemployed, even for an extended period of time, the government will pay for all kinds of courses, be it knitting, accounting, or something else). Those are expenses that affect a country's well-being. I AM all for these things. But that's what I meant that they may have gone too far.

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