I went to ER a couple of months ago for a relatively minor issue and stayed for a few hours total. This was in-network hospital, doctors and so on. Purely by co-pays this ended up being a ~$800 bill after all the insurance kicked in.

If I didn't have a comfy software engineer salary, and instead lived paycheck to paycheck, this would've been devastating, even with insurance.

Very similar story, in the US as well. Went in, had a couple of tests that ruled out anything serious and was on my way in ~1.5 hours including all of the various wait times. Saw one doctor for maybe 1 minute and had a couple of nurses spend about 10 minutes with me total during the various tests.

Insurance was billed ~10k, with coinsurance I had to pay $1,400. This is after the hospital billing in multiple rounds and forgetting to bill insurance on one of them and also forgetting to send the bill to me (which if I hadn't been proactive about following up with would have led to it getting sent over to collections).

I'm assuming I have better health insurance than a decent percentage of the population and I can afford the bill but how the hell can most people? What a terrible, terrible choice for someone to have to make between getting care when they're at their most desperate and avoiding financial ruin

As a Norwegian expat living in Australia for nearly two decades, that just comes across [insert many expletives] insane. Depending on the nature and urgency of the tests, my guess is you'd not be up for anything at all in either of Norway (which is very similar to all of Europe, I guess) or Australia.

I see USA as a country where, if the car crash didn't kill you, the medical bills certainly will.

Which is ridiculous. We're at the point where the insurance is just covering the cost of the overhead that necessitates having insurance in the first place. There's no way the real charge should be $800, let alone co-pay.

> Which is ridiculous. We're at the point where the insurance is just covering the cost of the overhead that necessitates having insurance in the first place. There's no way the real charge should be $800, let alone co-pay.

You're right. Of course the private insurance premiums have a negative expected value. Aside from insurance always having a negative expected cash value by definition, private insurance premiums are literally used to subsidize care of Medicare, Medicaid, and uninsured patients.

This is exactly right.

That $800 is cheap. I have a high deductible plan, and a recent visit will easily wipe out $4,500 of the $6,000 I had saved in my HSA. For a family of 4, I have been trying to save $8,500 (my OOP family maximum) for 3 years, but the HSA max contribution caps me at $6,750. Can't get there.

I just spent over a year and countless phone calls arguing with the hospital over bills for the birth of my son. We had two employer paid insurance companies and HRA, and they still managed to send us to collections until we threatened to take them to court. They eventually sent us a refund of $600.

Similar experience w/ twins in the NICU. when you have 2 employer paid insurance plans, the two insurers fight over who pays and the hospital doesn't get paid, which leads to them coming after you.

> You only go bankrupt if you're uninsured

This is absolutely not true [1]

[1] http://www.cnbc.com/id/100840148

>NerdWallet estimates nearly 10 million adults with year-round health-insurance coverage will still accumulate medical bills that they can't pay off this year.

That's only saying that you'll have bills you can't pay, not that you'll go bankrupt from it. Most (if not all) insurance plans have a maximum out-of-pocket expense amount that's like $10k. Yes, that's more than some middle-class Americans can afford to pay in a year, but it's not enough to go bankrupt over. They just defer paying it until they can afford to.

> That's only saying that you'll have bills you can't pay, not that you'll go bankrupt from it.

This is one of the things Obama-care addressed, because before that most bankruptcy's in America where caused by medical bills. I'll see if I can find the article. [1] But with Obama-care going away/being changed this might be a thing again.

[1] "A study done at Harvard University indicates that this is the biggest cause of bankruptcy, representing 62% of all personal bankruptcies. One of the interesting caveats of this study shows that 78% of filers had some form of health insurance, thus bucking the myth that medical bills affect only the uninsured.

Rare or serious diseases or injuries can easily result in hundreds of thousands of dollars in medical bills - bills that can quickly wipe out savings and retirement accounts, college education funds and home equity. Once these have been exhausted, bankruptcy may be the only shelter left, regardless of whether the patient or his or her family was able to apply health coverage to a portion of the bill or not. (Find out what you can do to avoid a financial meltdown when there's a medical emergency. " http://www.investopedia.com/slide-show/top-5-reasons-why-peo...

> Most (if not all) insurance plans have a maximum out-of-pocket expense amount that's like $10k

It's more like $6800 for 2016 and $7100 for 2017. That's the federally-mandated cap; many private plans set their cap even lower.

2x those for a family.

I just logged in to say this (trying to comment less and read more) but this needed said.

Even with a vanishing middle class, the middle and upper class that remains still have largely great healthcare and healthcare plans, it's the poor who are largely being screwed. Even then, they don't support universal healthcare (it's mostly us hipsters or whatever) because they are still weary of the government and we're still dealing with post-mccarthyism where any sort of government service for the public benefit is socialism.

"You only go bankrupt if you're uninsured"

With copays and out of network stuff a lot of people will go bankrupt in case of a serious illness.

Not to mention the historical "lifetime limits", which only since the ACA have been lifted. You could have an unimaginable great plan with a huge network and no deductible, but an extended hospital would still bankrupt you.

> With copays and out of network stuff a lot of people will go bankrupt in case of a serious illness.

By law, those are capped for people with insurance. The maximum that you will have to pay out-of-pocket can be no more than about $7,000, and many private plans set the cap at a lot less.

$7,000 is a non-trivial amount, but it's not a large number of people that both are insured and can't afford their out-of-pocket maximum without bankruptcy.

Max contribution to an HSA is about $6,800/year. I have been putting $600/month into it for three years and have never been able to get more than $6k saved; family of 4 and no dental insurance (employer dropped it).

This is the equivalent of a car payment for the rest of my working life.

You can easily add tens of thousands of out of network costs with some medical issues.

> You can easily add tens of thousands of out of network costs with some medical issues

It doesn't matter, because that's still capped.

I know people who have run up medical bills in the hundreds of thousands due to a long term illness despite having insurance. I don't know how this could happen, but it did.

> I know people who have run up medical bills in the hundreds of thousands due to a long term illness despite having insurance. I don't know how this could happen, but it did.

The bills themselves aren't capped. The amount they are obligated to pay is. Insurers make up some of the difference, and the rest is forgotten about. (It's not written down in the accounting sense, because the hospital doesn't necessarily actually treat the entire billed amount as receivable.)

I explained in a top-level comment how this works and why it works this way.

I hear what you are saying but I know people who have 6 figure medical debt despite being insured. This happens.

Indeed it doesn't take much imagination: chronic illness + prescriptions + high deductibles. Worse if multiple family members are sick (so many problems are inheritable and so on).

Also worth mentioning, it's been broken for a while (e.g.: ACA is not even broken in yet).