Don't Get Sick in America | Hacker News Reader

Don't Get Sick in America

blogography.com

31 pointsspeckx29 comments

I caught a diagnosis of cancer last year. Fortunately, I'm in the US and have a good PPO. I only wiped out half of my emergency savings in the last 12 months. I had the foresight to keep 12 months of expenses on hand, 6 months like they advise is the bare minimum.

Less than three months passed between the diagnosis and when I first got sent to collections.

You wouldn't believe the deluge of bills that come in from doctors, imaging centers, and various labs. If you need to get in an ambulance, you may get bills from both the ambulance company AND the fire fighers who show up and check out the action while the paramedics work. That audience alone set me back $225. I think the ambulance wanted another $200 on top of that. They dinged my insurance $2800. I was driven 700 feet to the emergency room. I don't recall a whole lot, but I asked for and received 7 heated blankets in the ER. $50 each.

The bill that got me sent to collections was for less than $60 for a lab in Texas. They sent two bills that got buried in the pile next to the door. At the time I got the collections call, I found it challenging to walk from my bed to the mailbox. My surgeon wanted me to walk one mile per day. My credit is about 80 points lower now.

I had hoped that the ACA would be a stepping stone to a better health system in this country. It could still happen, but not while we allow corporations to seek rents as we all inevitably fall ill. Until then, OP is right, don't get sick in America.

> One health problem has me hitting 75% of my full-price, high deductible... and this doesn’t even include my much more intensive second surgery yet.

I'm confused, don't you want to reach your deductible as soon as possible? Isn't that when your insurance actually starts paying out?

Well, if your deductible is like $8000 or something (high deductible), you kind of want to avoid hitting that if possible, because you're out $8000

Don't forget the extra-fun deductible reset button that insurance companies get to hit every year. If your timing is particularly unlucky, you can end up paying that deductible twice (or nearly twice) for some health event.

If you have hundreds of thousands in medical bills at once, sure. That's good bang for your buck. If you've been paying monthly for medical insurance, get a tear in your eye that needs surgery, and now how to pay fully out of pocket for that surgery because it still isn't expensive enough for insurance to step in, that's a lot of money.

Of course, the post has no numbers, so it's impossible to judge the quality of the insurance plan. And the deductible isn't exactly a surprise, you know it when you get the plan, so paying this much when you have an emergency shouldn't be a surprise either. It still sucks if you can't afford better.

Doesn't a high deductible policy have lower monthly premium? Couldn't you have paid more for a policy with a lower deductible? The author chose the lower premiums and self insured (bet) they would not need to use it enough to meet the high deductible.

Sure but its a good news bad news kind of thing. Yay I hit my deductible I only need to shell out the co-pay!

Translation:

1. I spent the absolute maximum amount of money which can be substantial if you're on a high deductible plan

2. I had a very unhealthy year

I read a very interesting AMA from an Indian woman that had lived in India, Canada and the US.

Takeaway:

Canada is great cost wise, but poor in wait times.

India offers a smorgasbord— you can pay very little, or you can pay more for better service. You get what you pay for.

The US is worst cost wise, probably second to India in wait time, but the best if you have anything outside a plain vanilla medical condition.

Whenever I worry about the cost of groceries, I think about the amount of healthcare spending (and pain) one can avoid if healthy - it helps.

Meanwhile the median wait for treatment is approximately 7 months in Canada

Are you Canadian? I ask because I’ve never met someone from a Western country with free healthcare who wishes they had our healthcare system.

I lived in Australia for five years and when I came home to the USA, I realized that most people here in America are indoctrinated to believe our system (for anything not just healthcare) is better than everyone else’s when it just isn’t true

This. Whenever I hear somebody defending the US healthcare system (or criticizing another country's healthcare plan), my immediate questions are:

1. Where are you from?

2. Have you actually LIVED in another country and thus have some personal experience with other systems?

For the record, I lived in Taiwan for years and was enrolled in the NHI (National Health Insurance) and received far better care including surgical procedures than I ever did in the states even with a PPO.

Yep. Costs for healthcare in other countries have a basis in reality. Here it’s about charging as much as they can get away with. No competition or transparency.

I worked with a Canadian who moved to the US. Her sister still lived in Canada, and they had the same congenital defect that could lead to a condition that required immediate back surgery.

They both ended up needing the surgery. When the sister in the US visited her doctor, and he noticed the condition, the first thing he asked was if she had eaten breakfast. If she hadn't, he could schedule the surgery for that day, otherwise he'd have to schedule it for the next morning.

When the sister in Canada had the same condition, her doctor scheduled the next available surgery, and prescribed bed rest until then. She could get out of bed to use the bathroom and bathe, but otherwise should be laying down until she had the surgery, because a small mishap could damage her spine and cause permanent paralysis. Despite the severe risk of injury and the extreme side effects of prolonged bed rest, it took six months to get the surgery. If she didn't have support of her family, she wouldn't have been able to afford waiting that long.

When a medical condition impacts your ability to work, traveling to the US to pay cash for the surgery may be cheaper than waiting. There's even an official Canadian web page with advice for traveling outside of Canada to get medical care (https://travel.gc.ca/travelling/health-safety/medical-care-o...) and it expressly lists bullet points of the benefits of doing so.

Counter-anecdote. Wife had a herniated disc. It took six months to get back surgery. This happened in America in 2022. She was in bed the entire time.

It was literally months of going through various hoops to get approval from the insurance company. When the surgery happened, the surgeon billed $80k for about 2.5 hour surgery. Not sure what the insurance company ultimately paid. That wasn't including the anesthesiologist and the facility fees.

If you're dying or in critical condition, you'll get treatment now. There is a problem with non-emergency cases taking a long time to go through the system (especially major and complex procedures, because I've never waited anywhere near 7 months). But the solution to this is to stop the provinces from trying to sabotage public healthcare, then train more doctors and make systematic improvements. Not insert layers of private industry middlemen whose life's calling is converting human suffering into cash at maximum exchange rates. Everyone I know here would gladly take our system over yours.

Maybe the title should be "Don't be Poor in America" . If you're rich then there's really no issue.

I was well off, 20 years at Apple, didn’t help me or my wife [1]. I don’t think the NHS is perfect, but I also don’t think they’d intentionally mistreat someone to make more profit. Healthcare in the USA is genuinely fucked, and in some cases, genuinely evil.

1:https://news.ycombinator.com/item?id=44217106

Wow, damn, I'm so sorry. I have to dig up my British passport.

There's a six month wait for me to see a pediatric gastroenterologist. Not even to get treatment. Just to see someone. Right here in the good ole USA.

Why is this a worthwhile measurement? Some cases can wait without having any negative medical implications, this measurement seems to gloss over this and to me it isn't obvious what the median ought to be. Is it obvious to you?

And yet if you ask any canadian, they all prefer their system to ours.

All?

Let's see what the Canadian Medical Association survey says.

https://www.cma.ca/our-focus/public-and-private-health-care/...

This was commissioned by the Canadian Medical Association and it is certain that the CMA is cherry picking which results to show on their site. The surveyed doctors are only members of the CMA.

Also this survey dates back to 2023, post pandemic, a time when wait times were longer than usual.

Ok, "most". I think it's a hard sell to go to people that have socialized health care and be like "what if instead of a slightly longer wait, instead you had a system where bureaucrats at insurance providers pull rank over doctors on the treatments you're allowed to receive, and your ability to get healthcare is tied to your employment, and if you get sick you're going to go bankrupt"

Also, the wait time in OUR system sucks too. Try to find a psychiatrist that isn't booked like 3 months in advance. (AI isn't helping with the number of people that need psychiatric services..)

Look, it's a limited resource, and it boils down to: do you want doctors or accounts on your death panels.

How isn't AI helping? I don't know what the balance is, but it's there at 2am when you're in crisis in a way that your therapist isn't.

The doom trolling mixed with social media hysteria is creating a huge mental health crisis (not to mention the AI psychosis going on). I was talking to my psychiatrist the other day and she's freaked out. Social media IMO was a huge cause of our current mental health crises, and now AI hysteria is just throwing gasoline on the fire.

Health insurance in America is criminal. It provides as little service as possible as opaquely as possible via dystopian attrition processes to obstruct you in every way possible. Then its's the most expensive in the world. It's a garbage product. I almost cancel it every year then wonder why I didn't.

Some of this sounds exactly line what Obamacare was trying to fix.

Reply on news.ycombinator.com