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Comment by sillysaurus3 | Hacker News Reader

You're quite lucky that you could afford that hospital trip. In the US, it would typically go like "My doctor made some tests and he said that it doesn't look like a heart attack but something is wrong with one of the lines on my ECG. He asked me if its ok to call the ambulance for doing more checks at the hospital. I said no, I can't afford that. So I died four weeks later."

This isn't an exaggeration. Many people live paycheck to paycheck and can't afford the thousands of dollars a hospital trip would entail.

View on HN

My mother was a nurse for 20 years. She was extremely good at her job and worked in the ICU unit of Vanderbilt Hospital. One day she had a severe headache at home and once it subsided she sent me an email detailing five possible causes. Every item on the list was trivial except the fifth item which said "small aneurysm bleed". I, along with the rest of the family, asked her to go to the hospital but she refused because she did not want to burden the family with a $5,000+ CAT scan and hefty doctor expenses over what she insisted was a just an overreaction to a bad migraine. I assumed, because she was such a good nurse, that she knew best. I ended up moving near her soon after and had the privilege of spending many days with her and my brothers as a family until I received a phone call one night telling me she was rushed to the hospital. When I arrived at the hospital a clerk attempted to block my way to fill out insurance paperwork, I rushed by her and headed to the ICU. When I arrived to the ICU I was told the aneurysm had applied too much pressure to her brain, the doctor said there was no chance of recovery. Even in death she still helped others, her organs saved two other individuals that day. In my home upon my desk I have a photo of my mother and I, a print out of her email, an award she received for being one of the first volunteer nurses to arrive in Louisiana after Hurricane Katrina, and a big pile of bills (ambulance ride, doctor examination, bed and care costs, etc).

Yes, I would agree, most people do not go to the hospital in the USA unless they are 100% positive it is required. This prevents many early visits to the doctor. People will often wait until the very last moment to get help.

How fucked up is that? I teared a little as i read your story. I can't imagine a mother not getting help for the sake of a measly 5000$. What kind of a society is the US if it lets its people die because they can't cough up a $ 5k medical fee? I had a very visceral reaction as i read your story.

May your mother rest in peace. tears in my eyes

This is an exaggeration, and it's an unfortunate one, since it distracts from the truth of what you're saying.

As many have pointed out, a person who chose to be taken to the hospital would be taken to the hospital and treated whether they could pay for it or not. The result of this would be a serious amount of debt, but likely could be paid down with a monthly payment. The worst case scenario is bankruptcy, which sucks (though it sucks much less if you're already poor and have no credit to destroy). Best case scenario, is that you make a lot of sacrifices, cope with making the monthly payments for many years, and eventually become debt free again. Like I said: best case scenario.

I think that anyone would agree, though, that either outcome is far better than dying young. (Also note that none of these scenarios includes going to prison for failure to pay your debts. There is no such thing in the U.S. legal system, except for certain debts owed to the U.S. government, and even this situation is rare and typically involves willful failure to pay, not mere inability. Private debts are just that: private.)

The real problem is that people in the U.S. are forced to make this sort of choice -- i.e., the choice between healthcare and basic material comfort. An ancillary problem is that people believe the myths that you're perpetuating -- if they think they won't be treated, or that they will go to jail if they don't pay, they may avoid treatment and die, essentially, only out of ignorance. This wouldn't be their fault. This would be the fault of a healthcare system that sends all the wrong signals, and secondarily the fault of the people who spread half truths about the healthcare system to score political points. (And I say this as an ObamaCare supporting, lifelong democrat.)

Which part is an exaggeration? The death? Hardly. It usually takes some time to get someone to an emergency room, so if their heart fully clogs, the outcome is often death.

Or that people will usually forego seeking treatment because they can't afford to rack up huge bills? Again, not really an exaggeration. If you have a house that you live in with your spouse and child, then you need that house, and people will often make decisions with the best chance of preserving it. If you go bankrupt, you can lose your house except in some specific circumstances (http://www.nolo.com/legal-encyclopedia/lose-home-file-chapte...).

It's easy to forget, as programmers, that most people don't enjoy the same benefits we do. Most people are living paycheck to paycheck with little savings and children.

It is an exagerration to say that the situation you described was typical (though "too common" might fit). You implied that you could not obtain treatment if you cannot afford it. And now you're adding the largely fictional risk of losing your home into the mix. Yes, it is possible to lose your home in bankruptcy but only if the equity in your home exceeds your state's homestead exemption (often, but not always, $50,000) by an amount large enough to make it worth selling. This will not often be the case for a person who is driven into bankruptcy by medical bills.

I do agree (as I said) that people should not be put in the situation of having to choose between preserving the lives they have built for themselves, and obtaining healthcare. But I think it's important to be scrupulously accurate and responsible on this topic since the discussion itself could influence somebody's decision not to seek treatment.

The important thing to note here is that the scaremongering is precisely what contributes to more deaths.

If you're marching around saying lives will be ruined if you seek treatment , then YOU, not some other person, are the problem.

Think carefully if the point you imagine you're making is worth that.

Right. I'm "scaremongering" by explaining the situation faced by many middle class families in the US on a forum for programmers, and I'm personally contributing to more deaths, not the poor healthcare system. Okay.

While it's true you may not lose your house (which I clearly articulated in my previous comment), there's more to life than a house. If you can't drive to work because you no longer have a car, then that's a huge problem. If you're putting your children through school, then suddenly you're jeopardizing their life by seeking to preserve your own unless the doctors know quickly and precisely what's wrong with you.

I don't understand why this is so controversial: People make suboptimal decisions, especially when the choices don't have clear outcomes. Here's some evidence that this actually happens in practice: https://news.ycombinator.com/item?id=8551522

Yes. You're scaremongering. You're (by your own admission) using an extreme situation to make a point.

If you choose to emphasize this extreme situation, as you did, then yes, you own some personal responsibility.

If you don't like that, then don't use extreme cases to make whatever point you want to make.

Hm. Actually, I think I love it. I'm going to go out of my way to use the most extreme situations in order to contribute to as many deaths as possible, simply by having conversations on the internet. Bonus points if my rhetoric influences the death of a small malnourished Dachshund. Thank you for pointing out my previously-unknown power over life and death. This is awesome!

You're (by your own admission) using an extreme situation to make a point.

No, the situations aren't extreme. Like I said, people typically live paycheck to paycheck and can't afford trips to the hospital. The fact that someone on HN had direct evidence of this shows us how common the situation actually is. We should choose not to like that, and do something about it through voting.

I am similarly perplexed about why this argument is dragging on. This position:

> People make suboptimal decisions, especially when the choices don't have clear outcomes.

Is nuanced and, I think, correct. But your original comment didn't clearly say this (though now that I know your actual position, I'm able to read back and see what you meant). It sounded like you were saying -- like many other people -- that if you don't have insurance in the U.S. you can't get treatment, so you die.

Distinguishing between the two is important because to the extent that the latter view is perpetuated, it is a major reason why people "make suboptimal decisions."

I suspect that you and I have the same views about healthcare in America. I'm simply trying to get you to tighten up your somewhat loose talk about it. Things are bad, but you seem hell bent on making things sound even worse than they are. This impulse itself is harmful for precisely the reason that I and waterlesscloud have now both pointed out to you.

Case in point: did you know that there is also an automobile exemption in Chapter 7 bankruptcy that works similarly to the homestead exemption?

If you're marching around saying lives will be ruined if you seek treatment

But lives are often ruined when people seek treatment, given that medical bills are the largest single cause of personal bankruptcy in the US. I don't think people get scared of seeking treatment because of the number of people pointing this out, as much as they get scared because of the number of bankruptcies.

>And now you're adding the largely fictional risk of losing your home into the mix. Yes, it is possible to lose your home in bankruptcy but only if the equity in your home exceeds your state's homestead exemption (often, but not always, $50,000) by an amount large enough to make it worth selling.

So what about this is fiction? As the proud owner of a 1-million-dollar spinal cord injury treated within the US, I don't understand where the fiction starts. Also, I was insured.

(also, is 'largely fiction' synonymous with 'rarely'?)

"The risk of a head-on-collision during city driving is largely fictional." doesn't sound quite right.

People will weigh the risk/benefit differently if there is a large cost involved. A doctor says "everything seems to be fine, but I'd like you to go to the hospital to be on the safe side." If you have good insurance or socialized healthcare, there is no question -- you will go to the hospital and get checked out. There is no reason not to, and it could save your life. If you have no insurance, then the question becomes "is it worth the certainty of a huge expense, for a small chance that I have a disease?"

Everyone has a threshold of what they consider serious enough to warrant a hospital visit. When you introduce massive expenses you shift that threshold upwards, which means missed diagnoses and an increase in avoidable deaths.

You would be surprised to know that hospitals would treat the person with the cheapest drugs and not do the major heart surgery. Not all hospitals, mind you, I know Mt Sinai (NYC) will most likely treat the person fully, but some will give enough heart meds to make the person feel "okay" until he/she dies.

Also, often after treatment, hospitals will just write the treatment as a "loss" and get a tax break. I've had friends pay $20 for a broken arm fixed. The problem is that many will give sub-par treatment, won't do the surgery, etc.

American health care system is an atrocity.

Yes, there are cases where things are worse than I described. But the comment I was responding to, and thus my comment, was addressed to what is "typical" in the U.S. system. What's typical, is that a person has insurance, goes to the hospital, and everything is more or less fine. What is not typical, but still entirely too common, is that an uninsured patient takes on an obscene amount of debt that has a major impact detrimental impact on his life. But that is far better than dying, which many would have you believe is the only option.

It is also true that people sometimes get this calculation wrong and die as a result. This is due, as I mentioned, to a system that inhumanely forces this choice upon you, as well as people who spread misinformation about how our system works.

Actually we ALL pay for their treatment. In Florida, if you have no insurance you are taken to the closest public hospital (county hospital). They treat you (barely - don't expect a private room). If you can't afford to deal with the bill, the county pays. And then we all pay via taxes.

It's a serious problem.

I have met two people in my life with over $250,000 in medical debt. Both were under 30, and neither had a job paying over $15/hr. They each seemed to be doing alright but had accepted that the medical debt was something they would never pay off. They both still needed infrequent care, and one of them was still building his debt faster than his income could keep up with.

I didn't know what to think, and still don't.

The two people should just leave the United States, start a life elsewhere. Argentina, Germany, Thailand, whatever.

I suggest the same thing to folks with unmanageable student loan debts with no clear answer in sight.

I think it's unfair for society to have burdened such debts on people who didn't know any better, who weren't equipped with the resources or the knowledge to make the right decisions. What do you do? Be 'unfair to society right back, don't pay, get away, start over again somewhere else.

So, run out of money - steal? That's hardly moral. Its part of the entitled "I'm so sad I got into this hole, and somebody should let me out" culture.

> So, run out of money - steal?

Pretty much. Though, compared with how corporations are fucking over little people left and right, it's hardly unwarranted.

This is not an unfamiliar story. There are people who did everything right, were kind and philanthropic their entire life, more than they should have been probably, but they find their whole lives suddenly ruined with just one accident. There are supposed to be certain trade-offs in a society, when one agreed to a social contract that they'll be nice to everyone, be law-abiding, pay their taxes which in part fund medical research, fund creation of roads and infrastructure that enable corporations to function and rake in money, etc., they expected for the system to be there for them in return when they had a time of sudden misfortune. If it's not there, I say fuck it, this is then time they also stop playing nice.

Straw man. This dude was suggesting dumping your student loans. I can guess that there are good reasons for that, but I didn't hear any.

The law, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, and to steal bread. - Anatole France

As soon as price enters the equation, you're not going to maximize your life expectancy. This is math.

> I think that anyone would agree, though, that either outcome is far better than dying young.

Right, but how can you be sure? Doctors are clearly overly precautions because they don't want true negatives. In some cases (e.g. if you need to support kids) it may be reasonable to risk that.

You are wrong. I have actually had a doctor check something and then ask which health insurance I had before recomending a follow up examination (which actually revealed something serious).

If I had had lesser insurance and he had left me with a "it's probably fine", I might indeed be dead now as with the op.

You're conflating two different things: the inclusion of price as a factor in medical decision-making, and hospitals' refusing to provide needed care to people who cannot pay.

The former, I agree, is a real problem (as I have now said repeatedly). The latter is generally a myth perpetuated by irresponsible people who want to score cheap points in the healthcare policy debate.

If whether someone has medical tests recommended by their doctor is based on their level of insurance, then that is refusing care to those who cannot pay.

I don't really want to wade into a political argument about health care, but this one specific part:

> The worst case scenario is bankruptcy, which sucks (though it sucks much less if you're already poor and have no credit to destroy).

Even though you immediately followed it with kind of a "but", I think you're seriously underestimating the effects of debt on someone in the U.S.

I have struggled financially for over a decade, after a period of doing really well. I could spend hours talking about the consequences of being poor (in U.S. terms).

1. Your housing options automatically become drastically limited. If you have bad credit, you don't get to pick and choose apartments or rental houses; you're more likely to end up in shared living arrangements or in the kind of apartment complexes that are willing to house people with bad credit, which also means your stuff is more likely to be stolen -- stuff that you can't afford to replace. (Having a load of laundry stolen was a hardship for me for about a year.)

2. Your employment options also become more limited. A lot of jobs, especially those that pay well, now do cursory background and credit checks as a proxy for judging whether or not you might try to rip them off. That of course makes it even harder to pay off your debt.

3. Forget about having reliable transportation. I've gone through 9 cars in less than 15 years: from one junker to the next. Used car prices are insane right now, so you're going to be stuck with someone's $500 or $1000 mechanic's special -- because that's all the cash you've managed to scrape together -- or you'll be doing a lot of walking and public transportation, neither of which are terribly convenient in most places in the U.S., which again limits your job options.

4. That beater you drive, if you drive one, becomes a target for law enforcement. They are most interested in cars that look like their registration may not be current, look like they may be a road hazard, look like they may be driven by a college kid with marijuana under the seat, look like they have a broken window ... the increased scrutiny is not only irritating, it can get expensive too, depending on just how poor you are.

5. Because your finances are limited by a lower-paying job, you're more likely to lack access to higher education, better quality food, or healthy hobbies.

6. You end up paying more for everything. You don't get to take advantage of discounts (for example, paying 12 months of insurance up-front), and if you do have any credit cards, you'll pay more on their rates.

7. If you don't have credit cards, every unexpected personal financial problem becomes a disaster. Oh, your radiator just blew a seam? Well, I guess you won't be driving anywhere for a while.

I'll stop there. Anyway, I don't completely disagree with you, but let's not just skip over the consequences of having a lot of debt. They can be really serious and long-term and dramatically change the quality of life someone has -- for the rest of their life.

Part of the reason I believe people think they won't be treated is because that is very much the perception given to them by the front office staff of most hospitals and clinics. I'm not sure if this is what you are referring to when you say "the fault of a healthcare system that sends all the wrong signals", but I hope it is, and I feel it deserves a stronger highlight as the root of the problem.

The gentleman up-thread mentioned that when he went to visit his mother in ICU, he had to actively dodge the front desk person who wanted to discuss payment with him rather than letting him spend the last few minutes of his mother's life in her presence.

In the 90s, when I drove myself to the hospital suffering from appendicitis and I collapsed in the ambulance driveway trying to walk into the ER, since I was still lucid, albeit in pain, they felt it was more important to wheel me in to the billing booth and secure payment by taking all my available credit card information than to send me straight back to the examination room. They sounded quite pleasant and convincing that they were doing everything they could to get me seen right away, and they were very helpful in that they could just take the cards and write down the information after I was sent back, I just had to scrawl my signature on the release forms to get it started. It took me a decade to pay off that debt while avoiding bankruptcy and almost another decade to get my credit rating back up to a level that I could apply for some small bit of credit without fear of getting nasty looks from the person processing the application as a deadbeat.

While rationally, anyone would agree that either outcome is better than dying young, our society has become twisted in on itself in such a way that it is very easy to miss being rational when looking at the huge inconvenience and stress involved in incurring that cost versus the irrational hope that it is something small and it will pass on its own.

Couldn't this whole thread just be about wishing 'mindcrime' a speedy recovery and healthy future, rather than wading into politics?

Not really a reasonable expectation, unfortunately. To discuss stories of "I know this other person who also similarly fell sick" and "The current system is so bad if you get into trouble, X,Y, and Z should be different for better results" is very much a part of the coping and mourning process. And of course we wish mindcrime a speedy recovery.

Fair enough.

@mindcrime -- I am so happy to hear that you got fast treatment and that you seem to be doing alright. I hope that you bounce back quickly and that you are able to look back on this as a brief dip in an otherwise rich and rewarding life.

About 16%[1][2] of Americans don't have health insurance. While the situation you describe is tragic and too common, it is a gross exaggeration to say it's "typical." Someone unfamiliar with the United States would read what you wrote and assume that this is the usual situation, when in fact it is relatively rare.

Should something be done to help that 16%? Yes, of course. Is it common? No.

[1] http://www.gallup.com/poll/168248/uninsured-rate-lowest-2008... [2] http://www.census.gov/content/dam/Census/library/publication...

That's a peculiar interpretation of 16%.

Something that is true for 1 in every 6 people surely isn't a rare event.

I said it is "relatively rare"; it is definitely not "typical," as the original poster wrote.

It is often typical for those with health insurance. Back in 2009, 75% of the families bankrupted by medical bills in the US had health insurance.

http://www.reuters.com/article/2009/06/04/us-healthcare-bank...

This does not tell us that it's "typical" for those with health insurance in any sense. It tells us only that bankrupcies of insured people are often caused by health bills. This does not imply the inverse, that insured people's health bills often cause bankruptcies.

This is reasoning backwards: you are starting with the conclusion you'd like to see (that bankruptcy is typical for people with health insurance), then trying to adapt the evidence to fit that conclusion. Let's try it the other way around, looking at the data first, and then drawing conclusions:

There were about 1 million non-business bankruptcies in the US in 2013[1]. Reuters says that 60% of them were caused by health bills, and of those, 75% had insurance. Taking the bankruptcy and the Reuters figures at face value, this gives us about (1m * 60%) = 600,000 bankruptcies due to medical bills in the US annually; and of those, (600k * 75%)=450k had health insurance.

Going by the earlier Census.gov figure that 16% of Americans are uninsured, and a US population of about 316 million[2], this means that about 265 million Americans have health insurance.

We can then calculate that of those American who have health insurance, only 0.17% (450k/265m) wind up in bankruptcy due to medical bills; in other words, 99.83% of Americans with health insurance do not wind up in bankruptcy.

I think we can thus safely say that it is definitely not typical for an American with health insurance to wind up in bankruptcy due to health bills. It does happen, but it's very rare.

[1] http://news.uscourts.gov/bankruptcy-filings-drop-12-percent-...

[2] http://www.census.gov/popclock/

That's the yearly percentage, not the lifetime percentage. The chance of something happening to someone in a given year is vastly smaller than the chance of something happening to someone during their life.

So if 600,000 medical bankruptcies a year happen, how does that compare to other yearly numbers? Well, there are about 4 million births a year in the USA, so someone being born in the USA happens only 7 times more often than someone becoming bankrupt through medical bills.

It may have been slightly inaccurate to use the word typical, however these figures seem to indicate that it is at least fairly common.

It's a partial truth though, right? There is a system for emergency healthcare for those without even medical insurance, isn't there?

Also, wouldn't you "just" get treated, rack up a bill and then go to prison for non-payment - guess that might be worse than dying?

>It's a partial truth though, right? There is a system for emergency healthcare for those without even medical insurance, isn't there?

yes

>Also, wouldn't you "just" get treated, rack up a bill and then go to prison for non-payment - guess that might be worse than dying?

yes, but you don't go to prison. the only entity you can go to prison for not paying is the government. instead you will go through bankruptcy, in which all of your assets will be taken and your wages will be garnished for some period of time.

You would absolutely be treated. That's a requirement the federal government makes of any hospital that receives medicare/medicaid payment (if you're interested in learning more, google 'EMTALA').

You will also absolutely get a bill, which could be quite large, and could be sent to collections, and could destroy your credit history.

While those last three aren't certain, they're common enough that they should give you pause to think...

Note that EMTALA only requires hospitals to give you stabilizing treatment.

You would go to the hospital, get treated and, if you couldn't pay the bills, declare medical bankruptcy. It sucks, but not it's not people dying in the streets or going to debtor's prison either.

The US doesn't have debtor's prison. One would simply have a potentially staggering amount of debt with which to deal.

You say this as if being in debt and unable to make the payments, is no big deal. Getting calls from aggressive debt collectors at work, at home, on my cell, even to relatives and coworkers, is a form of "debtor's prison".

When I asked for breakdowns of the debt itself, which I'm allowed to do under the FDCPA, I rarely got a breakdown of the total debt. One company responded to my request by serving me papers and filing a lawsuit. When I hired a lawyer to intervene and respond to the lawsuit, they dropped the lawsuit a couple of days before the date.

So the constant harassment, threats and stressors of being in over your head, is a kind of debtor's prison.

Getting calls from aggressive debt collectors at work, at home, on my cell, even to relatives and coworkers, is a form of "debtor's prison"

Well, have I got great news for you! There is this thing called the Fair Debt Collection Practices Act. Here it is:

http://www.ftc.gov/enforcement/rules/rulemaking-regulatory-r...

Want to stop calls to your work, at home, on your cell and even to your relatives and coworkers? Send them one registered letter telling them to stop calling you. Instantly gone. Why?

Because every single call they make to you about this debt after that one letter means they owe you $1,000 in statutory damages. When you sue them they even have to pay your attorney's fees so there are a million attorneys willing to take these cases for contingency!

Here's a quick write-up of what you can do for the harassment you described:

http://www.nolo.com/legal-encyclopedia/what-can-you-do-if-de...

Frankly, if you've been living in a "debtor's prison" like you've described, I'm assuming you haven't lifted a single finger to get out of it because this information is widely known in the U.S.

Did you even read my post? I mentioned the FDCPA. I'm very well aware of what my rights are under it. Most of the companies I dealt with didn't give a shit about it and simply passed my debts along to different companies who each got to take a whoops and pass it on again..

It's clear you didn't read the post you replied to.

Check your political response reflex. It might be too hair-trigger.

You've put words in my mouth and then battered a straw man; if something is "staggering" it is quite serious/severe.

A rephrasing might be "no, you won't go to prison, but will be made miserable via other methods."

There is, but people only use it in emergency situations. Getting someone to the emergency room usually takes at least 10 minutes, so if the artery clogs 100%, it often results in death. The key factor in the above scenario was the exploratory treatment to figure out what was wrong, and discover the 99% clogged artery. Such treatment is possible in the US, but it will definitely rack up a huge bill if you decide to pursue it. You won't go to prison for nonpayment, but it's possible you'll lose your assets. And if your dependents need those assets, like a house, it's easy to make the "wrong" choice of avoiding treatment unless doctors know exactly what the problem is.

Health insurance is ostensibly for this type of situation, but in reality if you're going to the hospital because "There's something wrong with me but nobody knows what," then the fear of insurance companies not covering it is very real. I don't know if they're legally allowed not to cover it in that scenario, but people have been screwed so often by insurance companies that the default decision making calculus is usually to assume the insurance company won't pay for anything.

This all assumes that you're someone with a relatively standard job and life. If you're lucky enough to have good health insurance and a fair amount of savings, then none of this applies, of course, since you can just get treatment in the same way as the parent commenter.

A reasonable person knowing that they would die without treatment would surely take the enormous debt.

But the problem is that "feeling some pain in your chest" is a long way from knowing that death is certain. And if your habit is to avoid going to the doctor because you know the bills could ruin your life, then your default will be "I'm fine!" As the OP made clear, getting to the hospital quickly can be the difference between life and death.

I just did a quick Google search, and a reasonable estimate puts the number of deaths from not having insurance in the same ballpark as gun deaths or car deaths: http://www.pnhp.org/news/2008/january/make_that_22000_uni.ph...

"A reasonable person knowing that they would die without treatment would surely take the enormous debt."

Single guy detected. Nothing wrong with that, just saying. Its a balance, lifelong economic death penalty for the three of them, vs they get to hang around with me for a couple decades... in the homeless shelter.

And that's assuming treatment means a cure. Most of the time, especially when the Drs are "mystified", all treatment means is the survivors are much poorer.

Currently I have great insurance, although that'll end soon enough, making these kind of balance decisions interesting in the future.

Excellent point. I hadn't thought about that.

  > A reasonable person knowing that they would die without treatment would surely take the enormous debt.

If there's nobody depending on you? Yes, you're right.

But suppose your family is depending on you. If you die, they get a decent life insurance payment. If you live but rack up crippling debt, maybe they lose the house and the cars and now nobody can pay for the kids' education.

Choice gets a little murkier then.

In many cases you don't know. You have a suspicion. It is probably nothing. Nope, it was something. Don't underestimate the human capacity for denial.

On top of that you have interesting incentives that you get to think about with your doctor: are they recommending this treatment to make more money?

I have cyclothymia and panic attacks, and these issues were worst at 25-27. At that time, I worked for a startup and had no insurance. (Now I have shitty insurance, but that's a world better than none.) Of course, panic attacks are brilliant and creative in their ability to throw weird symptoms (phantom smells were my "favorite") and every time, I'd worry about the (small) chance that "this time" it was a physical health problem, which I couldn't afford to have. I still have a brutal (and, objectively, unreasonable) fear of hospitals. It's not so bad that I wouldn't go if I needed to, but even if it's to visit someone who's fine, it takes serious chemical assistance. I can take on a cross-country plane ride without klonopin (hell, most "normal" people in the professional world can't do that, these days; granted, that has more to do with yuppies being pussies than a real anxiety condition, though) and doctor's offices are fine, but hospitals... fuck. Too many horrible memories.

There are some great individual doctors and nurses, for sure, but our mean-spirited, psychotic medical/insurance system taps into this deep-seated fear that humans have of being abandoned. Abandonment is a more vicious fear than death, for most of us. Death (when it comes peacefully; granted, that's not as common as we'd like to believe) is either nonexistence or something that's probably very interesting.

To answer your question, you can go to the ER and get treatment without insurance, but that's not going to get you preventative heart surgery or cancer treatment. If you get cancer, you can't walk into an ER and demand chemo. For plenty of Americans with cancer, their first medical attention is when the fucking thing throws a clot or causes organ failure and it's past too late.

You won't go to prison for non-payment, but you will get a huge bill, because while insurance companies are good at negotiating medical bills, you can't. If you can't pay it (and U.S. medical bills can easily top $10,000 for a routine ER visit) then you can be taken to court, have a judgment against you, and end up with your credit destroyed (there's nothing on your credit report to say that the cause of your debt or bankruptcy is a black-swan medical event, or even medical at all) and your wages garnished.

It's not like these horror stories are common, but they certainly happen and most Americans know someone who's been involved in one. It's not like 25-year-olds dying on the street due to our bad medical system is a common event, but it is a terrible system that ruins lives on a fairly regular basis. The sword of Damocles hangs over all of us. Even with insurance, it's easy to get fucked. Michael Moore's Sicko (whatever you think of him, that documentary was incredibly well-researched and important) was about people who had insurance.

> I have cyclothymia and panic attacks, and these issues were worst at 25-27.

Weird. I had my first panic attack at 25, nearly 26. The medical folks thought I was having a heart attack at first, but the symptoms and tests didn't quite add up. Fortunately, I've been able to manage it reasonably well with the help of my GP, but I do occasionally have recurring episodes if I don't take care to avoid triggers (my fault, really, I'm bad about that sort of thing).

Oddly, reading this makes me feel better knowing that there's someone else who had the same thing happen in the same age range. What's funny is that you know in the back of your mind you're not a statistical outlier, but when you don't know anyone in your immediate circle who suffers from the malady, you can almost convince yourself there's something horribly wrong. ;)

I never did get the phantom smells, but it often expresses itself differently for different people.

Cheers, mate.

I know how you feel, went through the same thing. Stress is a killer, and combined with poor health, even more lethal.

He is in the US? UNC Chapel Hill hospital?

Yes.

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