Greg Knauss's 10-year-old son's $23,800 bug bite

Even Canada? Canada by its location would be at acute risk for medical tourism from the US, if it didn't bill for ER treatment. That problem isn't as big for Europe, Australia, etc.

Also, unless my memory is totally off, each country has to pay up for EHIC, depending on who used what, and visa versa. So the cost should be evened out.

Edit, because I cannot reply to you later down: I think we have a different view on what emergency medical care is. In most of the world you will get fixed up so that you are no longer in life threatening condition, this is the case in USA, Denmark and Norway. But afterwards you will have to pay, even in Denmark, as long as you're not apart of EU and have the European Health Insurance Card or a citizen of any of the Nordic countries, which has a special agreement.

My travel insurance reimbursed everything but you'd better have money on your credit card...

Before getting my work holiday visa, I had to prove that I had medical insurance covering me during my stay in Canada.

[edit: I'm from Belgium]

It's more broken if you're middle-class-or-below (as you mention) or an entrepreneur who isn't either early-20s-and-healthy or raking in huge piles of cash. The part that seems most out of keeping with the American ethos is how anti-entrepreneur it is: you get good collectivized coverage if you work for IBM or Microsoft or Google (because it's socialized across their employee base), but if you start your own company or are trying to buy insurance for a 10-person company's employees, well then you're screwed.

I agree with your point: the reason the country isn't completely behind health care reform is that they get it from their employer and don't understand how it works. Of course, they're also getting screwed financially in the process.

I'm self employed, and even if I go back to working for a larger company, I would prefer to continue to keep my private insurance. I have private homeowner's insurance. I have private car insurance. I have private life insurance. Why oh why do we demand/insist that employers provide health care, to the detriment of market forces favoring individual purchasing?

Conservatives in this country should be in an uproar that the 'free market' isn't allowed to run its course because of the combined interference of big business, big labor and big govt over the past several decades, but they're not.

Quite a few hospitals with ERs also have a 'urgent care' or 'express care' clinic attached which are quite effective as they can a lot of things a ER can do, and expedite transfer to the ER if can't be treated there.

The only question is how the rate of growth will slow/stop.

And I can tell you that for my own part, even with health insurance, the deductible is so high that it might as well not exist as far as basic checkups and doctor visits go.

1 http://ucatlas.ucsc.edu/spend.php

2. http://blogs.ngm.com/blog_central/2009/12/the-cost-of-care.h...

3. http://www.economist.com/blogs/buttonwood/2011/03/health_cos...

This is a view that's strongly distorted by the UK. It's seems to hold there, and the wait times sound terrible, but it's definitely not the case in the majority of countries, by a long shot. As far as I can tell from personal experience, wait times are not an issue in The Netherlands, Sweden, Germany, or France; outside of that I've never heard of really long waits in any country of Europe, with the exception of the UK.

The European systems are all different in sometimes surprising ways, throwing them together into one bucket is an incorrect generalization. E.g. the UK system with the NHS is entirely tax funded, where the Germany system has insurance paid 50/50 by employee and employer, and the Swiss system has 100% privately paid but mandatory and state regulated insurance.

These are really massively different systems, and the effects on e.g. waiting times are huge. They are all state regulated and sometimes state funded, but that's by far not the only interesting characteristic of medical systems.

We do gain some outcome advantage from earlier screening, in that it means we will catch some cancers early enough to treat that Europeans would miss, but the outcome differences aren't nearly as big as the 5 year survival stats lead some people to believe.

As far as seeing specialists goes, the US does do well, although I believe Germany and maybe Japan have us beat--showing that universal affordable coverage can be achieved without having to give up reasonable wait times to see specialists.

The thing that makes me sad about the US system is this. Take the top, say, 10 non-US systems. They have quite a diverse range of approaches, ranging from straight up socialized medicine to highly capitalistic market-based systems. All they have in common is that in most areas they have equal or better outcomes than the US, with universal or near universal coverage, for a lot less cost per patient or as a percent of GDP. Based on the evidence, it doesn't appear hard to design a good healthcare system for a first world country. Only the US seems to be able to botch this. WTF!?

There are far more difficult places to gain citizenship (e.g. Liechtenstein, China).

Some shady anesthetologists (and others) often try to bill you out of network. In-network charges are subject to insurance company price controls while out of network charges are not.

Once you make it clear you are paying in-network, as you kindly explained to the receptionist (who told you it was all covered), they back down real quick. It's just a scam they try to pull on the uninformed.

(side note I could probably get by without almost everything on this list except for food and roads. I'm disregarding internet, as the gov't doesn't provide that).

Don't drive on the roads. -do want roads, those the gov't should provide

Do put out your own fires if you house catches fire. - i have a sprinkler system installed so it's unlikely I'll need them. I suspect I could get private insurance to cover this though in a free-market. pay small money into pool (just like taxes) and we can all have firemen without your government. Also, if you don't live in a city, it is very possible that there are no firefighters who will come to your house.

Do hire private police for your security. - Police are nice for keeping things relatively civil, but most of the time they are minutes away when you have a few seconds of need. They come and do paperwork about the thing that happened to you that they couldn't stop.

Don't use public transportation. - i don't

Don't use the Internet (including HN). - since when did the gov't start providing me internet? I should really stop paying charter to provide it for me.

Don't use, or have your children use public schooling. - i think our public schools are pathetic, and I'm seriously considering home schooling.

Do pay completely, without subsidy or federal grant, for all your higher education. - i did. I probably helped pay for yours though with my taxes too.

Pay for a septic tank if available, or do not use public sewers. - no problem. will do.

Don't drink water from city water. - city water mostly sucks. I have to filter it anyways, I might as well filter water from a well.

Better yet, don't drink water at all: EPA endorses cleaner environmental health. - I could do with less from the EPA.

Don't eat food unless you grew it: All food is inspected by FDA. - I could also do with less FDA. Turns out Kroger has a vested interest in not poisoning me. It's likely I'll start going to Publix if they do.

> Um, that's kinda the point of any kind of insurance.

No, the point of insurance is not to buy into or share the risk of others, but to amortize one's own risk over time. An insurance policy can have a single applicant and still function as it should -- the issuer is betting that the applicant won't suffer a loss, the applicant is betting that he will. An actuary sets the rate based on his best guess about the possibility of a claim.

This thesis is proven by the classic alternative to buying insurance -- self-insurance, a scheme in which an individual sets aside his own cushion against loss, or "self-insures" -- accepts risk using his own resources.

Many states will accept an alternative to otherwise mandatory car insurance -- a personal bond against claims. The advantage to the individual is that the bond can earn money as an investment while it stands as proof of personal responsibility.

So the idea that insurance means joining a pool of insured individuals may be true in many cases, but it isn't a requirement for insurance to function. And it certainly isn't "the point".

As to happening to anyone yes in the same way that anyone could get hit by a car. It's a rare occurrence. most people will not be getting staph from a bug bite. It's totally possible that 23k is an egregious amount to bill for his treatment but I think you are going about making that argument from the wrong position.

Are you capable of diagnosing an MRSA Staph infection? What all exactly is involved in diagnosing it? Looking at it? or do you need complicated lab tests? Does it require a consult with someone who specializes in infectious diseases or can just anyone do it? How do you dispose of medical waste from treatment? Are there any complicated regulations that increase the cost there?

All of these questions should be what fuels the debate around medical billing. The fact that you as a patient have very little visibility into all of that is in my mind the issue.

Arguing about how anyone could be hit with life threatening illness or injury is a potent and emotional distraction.

The whole problem with MRSA is that you need boutique antibiotics to treat it! You don't have to be a doctor to know that, by the way; Wikipedia will tell you that part.

Agreed with you on the baby delivery part. Though it only costs that much in a hospital. In states where alternate arrangements involving a midwife are legal (not Illinois!) the cost can be much more reasonable for a no-complications birth.

As a type 1 diabetic... yeah, I'd say it is medically required.

Most citizens in Canada don't have free (or reduced cost) medication unless they are below the poverty line.

I came out of the hospital with an $800/month medication bill after a diagnosis of colitis, after missing 2 months of work being bed-ridden, while self-employed with no personal health insurance.

In the USA (don't have stats for Canada) there were 4 billion medication prescriptions written by doctors in the USA... in 2011 alone. That equals 13.3 per person (w/ 300 million population) and around $4 billion dollars. Most of those medication bills go to people will serious chronic illnesses and can easily cost >$1000/month.

The effect of paying for medication on a persons financial stability can't be discredited in this discussion.

It's not even waiting that is the problem. The quality is down right shoddy at best. Doctors flat out lied to us. We had doctors recommending committing our son to a home because "you can get on with your life." At one point, we had our son get approved after waiting 6 months to get into a special program that would help him. That was a wonderful day.

That afternoon, I shit you not, we get a call again from the same place, and they say "Oh, I'm sorry, we can't take him. He has autism, and we don't take children with autism."

I understand their are problems with the US system. I'm not blind to the issues. But people like to prop up Canada's system as something that works.

It was child abuse. It's hard to explain. I firmly believe that Quebec should shut down it's autism support, and stop pretending to care. At least then parents will know they had better leave. Every day makes a difference. If I'd known earlier, if I hadn't waited...

Years. Years of waiting. A system that requires that is a failure, pitiful, evil system.

First, the US pays more in a lot of markets. By and large, that's because we can.

Second, capitalism isn't applied. That sounds like it's some sort of regulatory tool that just isn't being used correctly. Capitalism is the absence of government force in an economic market with the notable exception of enforcing private property rights. You can say a lot about the US healthcare situation, but "applied capitalism" it is not.

I lived in Canada for 10 years. I live in the US now. While living in Canada, I paid more to the government then I pay now. My health care costs for myself and my family are much cheaper. In fact, ignoring the costs of insurance (which was effectively the same) and taxes (which were 3 times higher in Canada, and on everything), my costs for equal service I receive now would have been more than $36,000 more in Canada. That's partly a lie though. The services would not have been equal, as we can get home care here, whereas in Canada, we could not.

This also ignores the 1-2 year waiting list for private care we would have had to deal with in Canada. In the US, we had treatment started within 2 weeks of moving here.

The answer, I think, is partially politics, but also partly whether you think the competition a system like this (in theory) encourages outweighs the cost of profits.

Only if you own a car and drive it on public roads.

Personally, I think bootstrapping, taking no outside investment at all is also a completely reasonable model (and often ends up with a more sustainable business, and can be executed by people that lack the sales skills to get investment)

If you are bootstrapping? 18 months is not a reasonable period of time to get something to the point where you can get group coverage. (In most states, to get group coverage, you need at least two employees on that insurance.)

also, I think it's quite valid to support yourself doing contract work. same problem; if you don't want a body shop to take half your pay, well, you need two employees before you can get group coverage.

If so, there are many cases where a founder or their family member has a pre-existing condition that makes them uninsurable. If someone loses the genetic lottery and has a severe case of asthma it can greatly change their calculus. Would you advise someone to start a company if they knew that in 12 months they'd have to hit it big or give up due to the prospect of future medical bills?