this post was submitted on 03 Oct 2024
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Asklemmy
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The intense income disparity.
Healthcare bills.
I suppose these are cliche topics but as a non-american non-tourist the first thing that has stood out to me is that the highs are so incredibly high, and the lows are so incredibly low. Being a Canadian, it's not like we don't also have income disparity...but the gap is not as insane. The rich in the US have yachts that are 100's of millions of dollars, and the poor literally carry their kids on their backs while selling fruit on the side of the highway. You can see both in the same day.
Also I don't think Americans truly understand that you can get weeks of hospital care in Canada and not even receive a bill. Like a month in a private hospital room and i paid for a phone bill, a wifi bill, and some parking fees. In the US if you even so much as flash your eyelashes at a doctor you get a bill for hundreds of dollars.
I'm getting my shoulder repaired next week (I completely tore my supraspinatus tendon, wooo...). It's going to cost me $16,000. That's relatively cheap in the US; if I had insurance (which I don't), I'd have to have surgery done in a hospital, and my insurance would be billed >$30k. I've looked into medical tourism, but I just don't have the time; if it was still 80% torn, I could fly to Spain or something, pay cash, take 2-3 weeks to recover, do touristy shit, fly home, and still come out ahead. Unfortunately, once a tendon is fully separated, you need to address it ASAP.
And, BTW, I'm very, very lucky that I have $16k in a 401(k) that I can withdraw in the first place; if this had happened to me 10 years ago, i would have just lost partial use of my right arm for the rest of my life.
...And why don't I have insurance? The only insurance available to me costs >$500/mo., and the annual deductible (the amount I have to pay before insurance covers anything aside from routine care and prescriptions) is $9000. My costs would be almost identical if I had the only insurance that's available to me.
EDIT - OTOH, it's generally a little faster for people in the US to get non-emergency care. E.g., if my supraspinatus was torn, but not completely separated, I would generally have a longer wait for surgery in the UK or Canada than I would in the US. But that's a pretty small positive for the US system compared to a huge ton of negatives.
The statement for my wife's first month-long hospital stint was upwards of $957k.
My auntie had 4 major surgeries to overcome a situation she found herself in. It was serious ICU and ER stuff.
She's been there a month now, recuperating, and once she's fully tapered off the morphine she can go home with a visiting nurse.
Only expenses so far are vending machines when she wants some Peak Freens.
My wife's hospital had a taqueria
While I agree with the essence of what you are saying. I want to say, if you have insurance the "bill" might be hundreds, but my share might only be 20 usd, if anything at all. If my "bill" was thousands, I might see my share be a couple hundred usd at most. It is possible for it to be far less then a couple hundred.
The other thing people don't mention is, if I honestly can't pay my share. I can walk into the billing office at the clinic /hospital and explain I honestly can't afford my share. The hospital will bill the insurance what they can, then look for extra funding. Most hospitals have a charity fund. It is based on my income. If I am broke and make crap wages, my share might be reduced to 0 usd.
Should we have a better system? Yes, but many times there are real options out there.
Currently working through this with the local hospital and about $8k of various visits over the last 4 years of so while we had some mix of no insurance, garbage insurance and Medicaid (federally funded low income insurance) and it's literally all being wiped away. The lady who processes the applications explained to me that it's on a sliding scale, so if you make $1 over the threshhold for 100% waiver, it might be a 95% waiver. Notably some of the debt turned out to be a billing error where they should have billed Medicaid in the first place, but that was one of the smaller bills in the pile of debt
As a Canadian it's insane to me to have a bill at all after going through some sort of health ordeal the last thing you need is a big scary bill with something to do.
So the ask here is for someone who already need to work every waking moment, and then just lost a bunch of hours being hurt/sick, to then spend their time explaining multiple times to the billing dept that they cant afford it (this is degrading) and then their bill MIGHT be reduced but it also MIGHT go to collections and which further goes to damage the individual by hurting their credit. just seems like a burden on the poor.
But yeah i mean its a difference in systems. I think about how canada builds it into taxes - everyone pays in at a rate consistent with their income levels and benefits similarly - but the US way is donations. And I hope that works too. It seems to work from what i've seen so far. but it seems like a round about way to get it done.
I basically agree with what you are saying, just to clarify, it isn't asking multiple times or explaining multiple times. The one time I had to ask for help, I talked to one person. They looked and said, don't worry about the bill.
But yeah we do need a better system.
I appreciate having your first hand insight and appreciate the convo
User fees invoke a chilling effect on care usage, especially preventative care.
And when you're seen as a cash cow and as a patient, there can be a conflict of interest.
Drive through rural Mississippi. The wealth gap is nuts just from what you can see on the highway.