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Comment by pbhjpbhj | Hacker News Reader

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?

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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.

>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.

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?

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."

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.

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