Hey all, I’m British so I don’t really know the ins and outs of the US healthcare system. Apologies for asking what is probably a rather simple question.
So like most of you, I see many posts and gofundmes about people having astronomically high medical bills. Most recently, someone having a $27k bill even after his death.
However, I have an American friend who is quick to point out that apparently nobody actually pays those bills. They’re just some elaborate dance between insurance companies and hospitals. If you don’t have insurance, the cost is lower or removed entirely. Supposedly.
So I’m just asking… How accurate is that? Consider someone without insurance, a minor physical ailment, a neurodivergent mind and no interest in fighting off harassing people for the rest of their life.
How much would such a person expect to pay, out of their own pocket, for things like check ups, x rays, meds, counselling and so on?
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Here’s a break down of my last healthcare stuff.
Weekly insurance out of paycheck: $127
Psychiatrist (ADHD) $150ish a visit, meds are ~$98
Last PCP visit (included some general blood tests) $217 (mostly lab which wasn’t covered)
Last ER visit: $792, waited over 10 hrs told to take an Advil and go home. Turns out I tore some of the sack (for lack of a better word) around my organs from weightlifting. it was thought a suspect gall bladder issue. I learned this from not the hospital.
And my appendix removal ended up costing me just over $9,000.
This is all what I paid out of pocket, the actual numbers for gross was, well, gross. I don’t need medical aid too often but it ends up pricey if I do.
I have good insurance. I pay $20 per paycheck for my wife’s coverage. Our typical visit costs 20-35 depending. Our medications cost 10-20 per 3 month supply.
Most people don’t have insurance this good.
TL;DR: mine is $660/month for health, $42/month for dental
Most folks in the US aren’t aware of how much they pay for health insurance. I live in California, where law requires full time employees (>30 hrs a week, >130 hrs month) be provided some amount of health insurance. The type of coverage varies not just from job to job, but also within the same job the employee must often choose their own plan from several company selected options at varying price tiers and types/amount of coverage. Usually the employee only sees the amount of the monthly cost that THEY are responsible for, which is then automatically removed from their paycheck. What most folks are unaware of is that the employer is also paying some of the cost (which is the part that the law makes them do). The part that makes it extra frustrating to deal with an already broken and overly expensive system, is that the rate paid by employers is negotiated in bulk with the insurance providers. Larger employers (national corporations with hundreds of thousands of employees) are paying much less than an individual or small employer would. This is the one of the largest reasons becoming unemployed is so dangerous in the US. In addition to not having income for food or housing, people often forego health insurance due to the expense. If you lose (or leave) your job you’re eligible to keep your current insurance plan for 18-36 months with COBRA (Consolidated Omnibus Budget Reconciliation Act, which is such a ridiculous backronym that I had to google it just now). This is often the only time people realize the true cost of their insurance as the entirety of it is then passed on to them directly (at the employer negotiated rate) and it shows up as a new monthly bill.
I recently left my employer to start my own business and discovered that my true cost of insurance is ~$700/month ($660 Health/$42 Dental). Keep in mind, this doesn’t mean that I have zero medical bills should I actually visit a doctor or hospital. This is pretty good health insurance, but I still have to pay $5,000 out pocket (annually) before it kicks in at the full coverage amount. Since I had ear surgery earlier in the year and hit that limit, and wanted to be able to continue seeing the same doctors I had for already scheduled follow ups, I decided to keep the same insurance. That $5,000 isn’t the only expense that landed on my shoulders, there’s a bunch of rules that I honestly don’t fully understand and I’ve probably ended up paying somewhere between $7,500-$10,000 for the surgery I had (in addition to the monthly premium).
The main reason I keep paying insurance (in addition to the fact that you’ll now be charged a penalty on your taxes if you go uninsured for a month), is my fear that you mentioned in the original post. Having a car hit me while I’m walking down the street and ending up with a $50,000 visit to the emergency room is a very real possibility without health insurance. California recently limited ambulance rides to a maximum cost of $1,200, so that’s… good?
It cost us almost $4000 to have our first kid and we have pretty damn good (the premiums were not insignificant either) healthcare. No complications, no surprises, typical short hospital stay (like 3 days).
Was that pre ACA? When we had our kid, we only paid a $175 hospital stay copay. Granted… we’re very lucky with the insurance coverage provided by my employer, but we were under the understanding that the reason we didn’t have OBGYN copays and otherwise throughout the pregnancy was because the ACA made sure it was covered.
2020 major private university insurance! Kind of wild tbh still. When I saw the bill I asked my partner to see how much was pulled from their paycheck each month and to show me their plan. I made adjustments since we definitely were not getting good value so I at least wanted more cash on our pocket.
On top of your premiums, any insurance through a job means the job is paying thousands of dollars a year to insurance instead of paying you on top of what you paid.
Eh not thousands but yes upwards of $800-$1500 typically if the plan is good.Read it as a month not a year lol you’re correct
I think you may have read that backwards.(didn’t see edit till I finished posting so I’m keeping the rest)If the plan is ‘good’, then the part the employee ‘pays’ each month is low and could be in the hundreds each year before paying for any care they actually receive. But the employer is shouldering the rest of the costs behind the scene as part of the cost to employ. That means whatever they spend on insurance is money not going to your income so it really doesn’t matter if it is paid directly by the employer or employee, that is all smoke an mirrors.
As an example for state employee plans from 2020:
While health insurance premiums varied greatly across the states, the average per-employee per-month premium was $959; states paid an average of $805 (nearly 84 percent) toward premium contributions.
This means the insurance company is collecting $959 dollars per state employee per month just to have them on the plan ($11,508 /yr) -The state is paying $808 per month ($9,696 /yr) -The employee is paying $154 per month ($1848 /yr)
This is all before office copays, medicine, emergency room copays, hospital bills, care clinic visits, and any service where you pay something to access service. This is generally decent to good insurance in the US and we pay well over the cost per person in other countries just to be insured.
To drive home that this is not an outlier, this is the cost that each country spends on health care per person United States $12,555 Switzerland $8,049 Germany $8,011 Norway $7,898 Netherlands $7,358 Austria $7,275 Belgium $6,600 Australia $6,597 France $6,517 Sweden $6,438
Everyone in Sweden is covered for healthcare, they don’t need to pay at the point of service, and they spend about half of what the US does on average including the uninsured.
On average they actually spend $12.500 per year (PPP adjusted, at leat that’s the number for 2022)
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
You as a Brit spend $5.500 (also adjusted) (And as a bonus, you’re also expected to live 2.8 years longer than the average American.)
Plus the Brit coverage is universal while the US has a significant number of uninsured. We pay double on average including for those that aren’t covered at all. Even though the long lines myths are overblown for countries with universal care, it is important to remember that in the US a lot of people never get the care and we still have massively long wait lines unless we can afford to be first in line. The wealthy have a fast pass.
it is important to remember that in the US a lot of people never get the care and we still have massively long wait lines unless we can afford to be first in line
This is really important for non-Americans to understand. Yeah there are waits to see specialists and so forth in countries with a public system. We also have waits…but it’s for people who can’t afford the procedure. They have to wait until they can afford it, and if they can’t they simply have to live with their condition indefinitely or until it’s bad enough that they go to the emergency room. People who are uninsured go to the emergency room for everything because, legally speaking, they can’t turn you away. They have to at least diagnose and stabilize you. Because these people are broke, they generally end up not paying the bill, which means everyone else’s costs go up.
You couldn’t devise a worse system if you tried.
I spend more than that just for insurance for two. Actually using it costs far more. Strep? $250. Video call a random person when I’m in bed after puking my brains out? $100 for a five minute call where they tell me to drink water. Minor surgery? Thousands of dollars in bills sent between two months and two years after the surgery.
You as a Brit spend $5,500
Eh, on average that may be true. But most people pay far less than that. The NHS’s budget is £153bn, and the government raises £950bn in revenue. Of the 950bn, around 25% is from income tax.
So by that logic, the amount of my income tax that goes to the NHS is about 0.25*153/950 = 4.0%. Last year I paid £6644 in income tax, so that’s about £265 to the NHS. I’m not counting National Insurance as those contributions are not for the NHS.
VAT is also 15% of government revenue, so if I wildly guess that I bought £10k worth of “stuff” last year then that’s £2000 in VAT (@ 20% - it’s not all necessarily 20% but to simplify), of which £300 went to the NHS.
So I’m still not even paying £600/year. There are some other small contributions that you could count, but it’s not going to make much difference to the final figure. I’m far from rich but I’m more well-off than most people, so the majority of citizens are paying less than me.
What I’m saying is, for most citizens we actually pay relatively little and get huge value out of the NHS. The rich pay proportionally a lot more, which is how it should be.
WILDLY depends. And it is never simple.
If I break an arm, and I go to the hospital, and there’s not much that’s done aside from a cast, and some PT at the end, I pay $0.
Now, what does that mean?
We have had our insurance for a long time, and as we pay our monthly premiums, a little money goes into an account called an FSA. This pays some of the co-pay, deductibles, etc. in the background for us.
What happens if I get cancer and need to have some care for 7 years? Eventually that FSA runs out. Every insurance has a deductible that you pay before they start paying for everything. So we might have to pay $5k out of pocket annually and then insurance pays the rest.
What if I need to travel to another city to talk to a specialist? There might be airfare, hotels, food, etc. that we pay that is “part of the treatment” but not paid for by insurance.
What if I need medication? Might be $25 every trip to the pharmacy. Might be $300. Depends on the medication, how new it is, are there cheaper alternatives?
What if I get sick long enough where I lose my job? I might lose my insurance as well, and then have to apply for government assistance, that might make other medical bills different.
And not to forget that sometimes cheaper but equally effective drugs aren’t available under the insurance plan. Like auto insurance and their prefered shops and stuff.
Oh plus that FSA must run out really quick when private hospitals charge bug money for an aspirin because they trying to gouge the insurance company who probably doesn’t even care for other twisted reasons.
Not always. There’s still a max annual out of pocket expense, which is what is covered by the FSA. A single event, or an illness or accident that only requires care for a single year or two, regardless of how expensive, would not deplete the FSA. It’s only a chronic condition that requires hitting the max out of pocket for multiple consecutive years that would start to deplete that buffer.
That’s all assuming that I can continue to work, and don’t have any other non-medical expenses during the recovery.
I assume you need to have health insurance? As in, you mention paying 0$ if you break your arm. But do you have to pay monthly premiums for it to be 0 at the hospital ?
And I have no idea but - presumably you would claim on the insurance for the broken arm, does that then impact your monthly premiums or coverage afterwards?
If you have insurance through your employer, then no the insurance company can’t raise your rates. And part of the reason for the Affordable Care Act (ACA, sometimes called Obamacare) was to make it so people who are getting the insurance themselves also can’t have their rates raised or get turned down for insurance because they have pre-existing conditions. However insurance companies can raise everyone’s rates when the insurance is up for renewal each year.
Most insurance plans have several different costs: 1. The monthly premium you pay to have insurance coverage. Some employers pay this themselves, otherwise it gets taken out of every pay check.
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Co-pay: Usually a set amount ($30, for example) you pay to see a doctor for office appointments that aren’t an annual check-up*. So say I get an ear infection and see my primary doctor to get it treated, I’d pay the co-pay for that visit. Sometimes things like x-rays, blood work, CTs can be a set amount, other times it’s something like insurance will cover 65% of the cost. For some plans, co-pays are included when figuring out if you’ve reached your deductible.
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Deductible: The amount you have to pay before “co-insurance” kicks in. Co-insurance being the percent of your bill insurance will pay (for us it’s 75% after we pay $3500 in a calendar year).
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Out of pocket max: When you’ve spent this amount in a calendar year after that insurance covers 100%. Often plans have both individual and family maximums, with the family amount being higher.
Usually the more you pay in monthly premiums, the lower your deductible and out of pocket maximums will be. So each year people have to try and decide what they think their health bills will be next year when picking their plan (you can’t change plans mid-year unless something happens like changing job, getting married/divorced, having a kid). If you’re pretty healthy you might pick a lower monthly plan with higher out of pocket amounts because you don’t expect to have to pay much out of pocket. If you’re someone with a chronic condition or you’re expecting to need surgery or a costly treatment you might go with the higher monthly plan so you don’t have as high of out of pocket amounts.
For example, my spouse had to go to the ER a few years ago for what turned out to be a collapsed lung. They didn’t have to stay in the hospital overnight. I forget the total bill (or I’ve just blocked it from my memory), but our part ended up being about $5,000. Insurance kicked in after the bill got to $3,500, and they covered 75% of everything that was over $3,500. The most we would’ve paid was $6,000 (the individual out of pocket max), however we would still have to pay bills for myself and our kid up to $12,000 (family out of pocket max).
*Another part of the ACA was to make annual preventative screenings (like annual physical, mammogram for women over a certain age, prostate screening for men, etc) free.
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As part of our employment, our employer has negotiated that we pay $400 a month for my family to have insurance under these terms.
If I had a different employer, those terms could be wildly different. I would have no choice.
It is EXTREMELY complicated, and extremely different for everyone in the country, and depends heavily on how your employer sets up the benefits. This is a major benefit for large corporations, and a major burden for smaller businesses.
If you buy insurance through the private market, it is usually far more expensive, but often subsidized by the government, since you often only buy from the market if you are unemployed or low income.
you often only buy from the market if you are unemployed or low income.
Don’t forget self employed or at a workplace with workplace insurance so bad it’s actually cheaper to go through private (so basically low income)
I know multiple small business owners who also have a regular corporate job JUST so they have insurance. The whole second job has nothing to do with salary, only health insurance.
Every family farm I know, the husband works the farm while the wife works a normal job for insurance and stable base income to help keep everything afloat
They also contribute to their FSA which wasn’t really explained, so they did pay for that too
I don’t contribute to the FSA, that’s an automatic part of my health insurance.
Some people contribute separately to an FSA or an HSA depending on their insurance, but that’s not an option for my situation.
You’re right I’m conflating a typical HSA and FSA good correction. Need my morning coffee lol
It’s understandable, the people I work with get them mixed up all the time.
The nice thing about an FSA is that I don’t pay any extra for it. The bad thing is that if I cancel insurance with this company, or change jobs, I lose that built up money and need to start over.
An HSA stays with me, but it requires extra deposits, and more work on the back end to get reimbursed for expenses.
I’ll put it this way:
At least 68,000 Americans die every single year due to not being able to afford healthcare.
https://www.sanders.senate.gov/wp-content/uploads/Fact-Sheet_Medicare-for-All-2023.pdf
In 2017, Harris was the first senator to co-sponsor Bernie Sanders’ bill, the Medicare for All Act of 2017. “Here, I’ll break some news,” she said that year at a town hall in Oakland, California. “I intend to co-sponsor the Medicare-for-all bill, because it’s just the right thing to do.” 15 other Democrats eventually joined her.
That bill, if enacted, would have abolished private health insurance for all age groups (including Medicare beneficiaries) and replaced it with a government-run single-payer system to benefit “every individual who is a resident of the United States,” including undocumented immigrants.
https://www.forbes.com/sites/johngoodman/2024/08/13/why-health-policy-problems-rarely-get-solved/?
yeah too neolib, better to stick with Trump, he’ll really get the single payer socialist healthcare going with the fascism and stuff, cause he really cares about people.
Do you sometimes forget to breathe? I’m a leftist and am very anti-Trump. I just so happen to also have intellectual honesty where I can speak my mind and I don’t have to forget my integrity like you for fear of some simple minded asshole misinterpreting my intent.
It must be physically painful to be such a fucking sheep that you break all people can break down into two distinct groups: Trump supporters and Trump enemies.
In conclusion, go fuck yourself. Don’t come crying to me when Kamala loses to a man who just survived an assasination attempt. Maybe someday the DNC can field an opponent to the GOP’s candidate that is actually a leftist.
I know! Let’s try and push Kamala left! /s
You’re the one telling people not to vote for her.
That’s neoliberal gaslighting 101! Kamala loves to do it too! But yeah vote for her because she’s “one of the good guys” and certainly wasn’t…
Until Nov 2024 she is the only option. She’s not perfect but now is not the time to seek a perfect Bernie. Political realities matter. Criticism is fine but anyone saying “do you really want to vote for her” is either a Russian mouthpiece or very clueless.
Did I tell people not to vote for her? Show me where? All I did was speak the fucking truth about Kamala the fucking Cop.
I consider it an honor to be called clueless by a fucking moron that has suspended their disbelief in the face of professional wrestling level fiction, pretending that voting even matters at all when the two choices aren’t even required by law to be chosen by voters and are not subject to election bylaws since the ONLY two parties are private organizations.
It’s better than excusing a fake democracy and trying to cast shame on people who want to literally speak the truth. In the name of true democracy, fuck you for coming at me for telling the truth.
You do realize she literally cannot win, right? Check back here in mid November. I’ll be here laughing at your tacit approval and rabid defense of a sham democracy. I hope it was worth giving up your integrity for a losing candidate.
I’m sure none of the people that you gaslighted will remember how easily manipulated into attacking fellow leftists you were. /s
You do realize she literally cannot win, right? Check back here in mid November.
Ok
HI! Was I right?
@RemindMe@programming.dev 87 days
And regardless of differing opinions, calling someone an asshole and moron is not at all condusive to productive discussion, and is downright rude and disrespectful.
How does that help anything? We’re both for single payer healthcare as a human right, and support for the neolib right now is quickest path to get there. I don’t like it either, but infighting only helps fascists.
I read something from last year that said about half a million Americans go into bankruptcy due to medical debt each year.
That’s it, that’s what happens. You lose everything and you start over, if you’re healthy enough.
Protect your NHS.
The real truth of what happens is substantially more complicated due to America being made of 50 states. The medical debt numbers are highly debatable (Related Snopes) and do not account for Regional differences. In some states such as New York there are catchalls/emergency funding so that usually anyone making below low six figures can get their bills paid. Other states make collections difficult such as New Jersey not allowing reporting to credit agencies, making ignoring a debt kind of a non-issue. Then there are states such as Florida that require the barest of insurance to keep rates low and provide no patient protections, so when an accident does occur out of pocket costs can be huge as your insurance covers nothing. In all these events the Hospital assumes that big pocket insurance is paying first so they break out the expensive menu, when they realize they can’t get blood from a stone they are grateful if you cover their wholesale price.
Thanks for the reality check. It’s definitely a horrendous situation to have a for-profit medical sector, whatever the exact figures are.
Funny you should mention New York actually, that’s where my friend lives so I guess it explains why he thinks it’s not that bad.
Have those people actually lost everything or is it just some scheme to pay less?
Bankruptcy is an expensive and not-fun process. Basically, similar to what happens on death all creditors are carefully listed out and prioritized, assets beyond the bare minimum to live are liquidated to pay creditors what they can and of course the bankruptcy lawyers fees don’t help with the mountains of debt and costs. Certain debts cannot be discharged through bankruptcy so basically you trash your finances, mental health and credit for a shot at maybe being able to fix your finances with less debt payments
https://apnews.com/article/medical-debt-legislation-2a4f2fab7e2c58a68ac4541b8309c7aa
I’ll let you figure it out.
about half a million Americans go into bankruptcy due to medical debt each year.
That’s a huuuge shame for a country that calls itself civilized and developed etc.
Nobody sane who lives there calls it that
Because otherwise they do …what…to him? :)
But yes, I have heard some people from there who understood it right.
Luckily there doesn’t seem to be any large desire in the general population to move away from the NHS. Even the most conservative people I know support it (and I live in a pretty conservative area).
Some of our political parties however seem to pretend like they support it while quietly trying to undermine it. Let’s see what Labour do in the coming years.
Undermining it is how conservative parties will get rid of it. Keep decreasing funding. Do more with less. Quality drops. Wealthier people start moving to health insurance. Jobs start offering health insurance. Funding decreases further. People start to wonder why it’s even needed.
on the one hand - my wife and i didn’t have insurance when my oldest was born, as i was doing contractor work overseas. Between one thing and another over the course of that year, we paid like $8k in medical expenses, including all the obgyn visits and the actual delivery, plus a hernia repair for me. The hospital was very easy to work with. Our income was very high so it was not exactly a burden. (8k was about 2% of total salary)
on the other hand - this year, with insurance we’re going to pay about $6k in insurance premiums and $8k in medical expenses before we hit our deductible (~7% of total salary)
on the gripping hand - last year we had really excellent insurance. we paid a total of $1200 for the year in premiums, $50/pay period, and our deductible was only $2k. (~1% of total salary)
So it definitely varies a lot
n the other hand - this year, with insurance we’re going to pay about $6k in insurance premiums and $8k in medical expenses before we hit our deductible (~7% of total salary)
First world countries spend like $6,000 - $8,000 per person on care for better outcomes. The US pays more in employer subsidies and premiums than other countries pay altogether for medical care, and they don’t have to worry about it at the point of service.
thanks for explaining things i already know, and that have no fucking bearing on the question OP asked.
this isn’t “whose health care experience is better and less costly” - the question was “what does US health care cost”, which is the question i answered.
You left out the absolutely massive amount of costs hidden by employer subsidies by focusing on the point of service costs.
Also, your username checks out.
i have to pay ~1000/month just so i can walk in their front door of the hospital. after that, insurance companies do everything they can to not pay my bills.
america absolutely fucking sucks. insurance companies only make money when human beings suffer. think about that for a minute, their profits are literally built on the back of human suffering.
That 27k bill will come out of your estate. So if you have a house, it will be sold to pay that bill before your children can inherit it, if they, for whatever reason, can’t cover it.
Private Healthcare in this country is a nightmare. And with Covid slowly disabling everyone, it’s only going to get worse. Saving the NHS is worth it.
My experience is pretty similar to others. Basically, if you have insurance (most people do, and there are lots of government subsidies to help afford it), and you’re relatively healthy, it’s predictable. If you get seriously ill, or have chronic health problems, the expenses can quickly bury you.
I’ll add one thing about pharmacies. The same medication can be $300 at one place, and $40 next door. You just never know. There are also pharmacy discount programs that can radically reduce the price. I had one that was around $150 with the insurance, then the pharmacist performed some type of incantation on the computer, and suddenly it was about $16 without the insurance.
I had to pay 4000 yesterday because I went to the hospital for a heart-related scare which turned out to be nothing (and some low potassium) after some tests. That was with insurance. Without, it would have been just over $75,000.
Edit: I stayed at the hospital overnight for 3 days and 2 nights.
Back in 2007, I had just finished college and was traveling cross country to start a new job. I had to stop and get emergency surgery on the way there and ended up in the hospital for a few days. I ended up paying around $70,000 over the next few years and the hospital finally forgave the rest of the bill.
My father has had two heart attacks. The first was a pretty standard one by heart attack standards, required a stint to be put in and two days at the hospital. The cost was ~$40k and after insurance we were left with I think a $4-5k deductible (pretty good county employee insurance). His second one luckily (ha) happened while on the job and required another stint to be put in (he got amazingly lucky, as it was a widow maker of a heart attack) and was covered under his works insurance.
For reference, I’m healthy and in my late 20s, I pay ~$250 a month through my employer’s health plan, $25 for an office visit, $500 to walk through the doors of the ER, with a $3k in network deductible ($6k out of network). Believe me when I say you are amazingly lucky to have the NHS.
