Depends on the policy, but in my experience the out of pocket deductible is usually before any insurance is used, so you pay 100% up to the max deductible (no help from insurance on many costs), then you pay 5-10% of bills after that. But that was a few years ago so maybe policies are different now (though I doubt it).
It’s a common argument that somehow people who live in countries with good health coverage have to wait a very long time for health services. Things that are not urgent, this can be true. And you can certainly hear anecdotes here and there about more serious problems. But most of the time for the vast majority of people in the vast majority of situations, healthcare is delivered when it’s needed, on time, without dangerous delay. This talking point that somehow elevates the American approach because it is faster is misguided.
True, there is a reason why many international health insurance plans will cover services anywhere in the world except the United States. The US is quite an outlier on what it charges for healthcare compared to most of the rest of the world. And the odd thing is that the care is not justified by the price, it’s not like it’s significantly different than what you get in most European nations.
When I lived in the United States, the annual deductible was in the many thousands, even with a fairly good health insurance plan, you could easily end up with a bill for $10,000 if you spent a few nights in the hospital. This was also the fact that the insurance would only cover up to a certain percentage of the total bill, so even if you are left owing five or 10%, that could still be quite a lot of money when the hospital is charging well into the six figures.
It’s unfortunate that debt must be seen in the United States as a precursor to getting healthy. Most of the western world has long ago moved past such notions, and the concept of any kind of medical debt is foreign in many European countries, for example.