It's apparently quite expensive here. Federal minimum wage is $7.25 an hour, while one reported cost [0] for the test is:
>$3,270 two weeks after his test. He will be responsible for $1,400 of that bill.
That's almost 10% of my annual gross before insurance and I have almost 14 years at my job. For someone working a minimum wage job that's more than 11 week's gross income. I imagine they are limiting the number of tests on people that could have any number of other things and waiting for symptoms to strongly point towards the virus due to the simple fact that the tests cost so much. If a patient can't pay, whatever hospital has to carry that cost for potentially years before the patient can repay them (or not get paid at all if it pushes someone to bankruptcy).
Until the government sets aside money to subsidize the tests, I imagine the testing rates will remain low.
[0] https://www.independent.co.uk/news/world/americas/coronaviru...
If what you're saying is true about prices, there really will be a full blown outbreak if people can't afford to be tested. I presume some sort of emergency order will be given Nationwide to make testing available for free.
Only if someone takes action, which will likely only happen with public outcry, which will also only likely happen if a whole lot of people die or at least a few celebrities. I'd wager money against it.
I think your ultimate conclusion is far too cynical and pessimistic.
The popularity of universal healthcare just in the last 15 years has gone from "herpes" to "acceptable as long as it is a business-driven solution that doesn't rock the boat too much" to "you're disqualified from running for the Democratic nomination for the presidency if this isn't at the heart of your campaign". It polls extremely well on a bipartisan basis, and why shouldn't it? Insurance companies are almost unanimously loathed.
Seventy+ percent popularity for healthcare reform plus the possibility of a national crisis that could stretch our systems to the breaking point, damage the economy, and cause individual spending? This could be the push that finally brings a national health system to the US.
At this point, people around the world are getting testing, treatment, and hospitalization that costs little or nothing. In the US, the health secretary is strongly implying that people will have to pay for vaccines and care.
I have to expect that Americans will wonder how it can be that the world's richest country, a superpower, with supposedly the best health care in the world, is also the only country in which people go bankrupt just trying to stay alive during a pandemic.
* Does that mean someone who gets minimum wage (which probably doesn’t have an additional health insurance except for a default one) needs to pay for $1400 to test? (If true, that’s insane - why does the government only take cares of $1700 and not something like $3000?)
* Does people who come from Wuhan/other places where COVID-19 is spreading (lets say an american that comes from Daegu - the district with the most patients in Korea) also have to pay the high price to be tested?
In the example case given from the article, that person likely made too much money to qualify for Medicaid, so they probably have a bad health insurance plan that has a high deductible. Which is why they're getting stuck with a huge bill for something that really shouldn't cost anywhere near $3000.
Anyone that pretends that the way the US health care system functions right now is good is either lying or an idiot.
Edit: As another person pointed out, to complicate things even more every state has a different implementation of Medicaid. If you're in one of those states that believes your poverty is your own fault, you probably have no health coverage at all.
Oh, that’s much, much more assuring to know. Looks like
> Anyone that pretends that the way the US health care system functions right now is good is either lying or an idiot.
Looks like the general consensus of HN agrees; I hope the US decides to overhaul the healthcare system to provide better care if everything I’m hearing in this thread is true, it’s a topic that’s saddening to hear about.
So part of the reason you're paying $3000 for a test that actually costs $300 is because you're paying for 9 other people who couldn't pay.
And of course, there are the asshole states that did not expand Medicaid coverage. In those states, people making such little money are fucked. The ACA may help with discounts but I doubt any reasonable insurance can be had. Hell, I can't find decent insurance through the ACA in my state and I'm willing to pay anything. Super fucked up. I totally agree that people who defend this system are assholes or idiots. No other way around it.
- The US has a few nationalized (single-payer) insurance programs... TriCare for military, Medicare for retirees, and Medicaid for the indigent. - Obtaining Medicaid is not easy - you have to be truly indigent in many states (it's federally funded, but states manage their own programs) - Everybody else is left to buy their own insurance policy. Sometimes this is partially funded by an employer, but not always. - Due to the high cost of insurance (and health care in general), many plans have very high copays and deductibles.
So, even with an average health instance policy, a person could be stuck with the full cost of that test because of a deductible. In the past, I've had deductibles as high as $5000/individual, $12,000/family (note: I don't know, we're back on a PPO with a $2000 deductible).
When I use a medical service, I usually receive a statement that lists retail prices for services rendered, negotiated fees (between MD and insurance), and sometimes an excess amount that I owe.
If the hospital is "out of network" (no contract between insurance and hospital), I could be due a larger chunk of the bill personally (up to 100%, depending on insurance plan). This is called "balance billing" - google will give you all sorts of insane results from $50,000 helicopter rides to entire hospital centers that don't work with a single insurance provider so they can bill whatever they want.
As noted elsewhere, it's a complete mess and embarrassment for one of the wealthiest nations on the planet.
We have a healthcare system that demands my wife goes into the doctors office when fully healthy during the midst of flu season with an unknown epidemic ongoing just to get a refill for the same maintenance meds she's been on for over 30 years. Simply because they haven't billed us anything for over 6 months.
These policies actively spread infection and expose a larger number of the population to infected people.
That's so reassuring!
The US government does spend huge sums of money on healthcare.
Medicare and Medicaid are 21% and 16%, respectively, of total healthcare spending as of 2018. [0]
That's 37% of the total.
Given that total healthcare spending is about $11,172 per capita, that's $4,133.64 per capita. [0]
The UK spent £2,989 per person in 2017 in total. [1]
It's not correct to do so, but using today's GBP to USD exchange rate that's roughly $3850.
This puts US per capita government spending alone (keep in mind it's Federal + state) in the same ballpark as the UK's entire healthcare expenditure per capita.
> On top of that, the actual cost of care is far, far higher than in other developed nations for the same procedures, due to many systemic problems.
Sure is. This is a huge issue and IMO the issue to solve. But sadly, no candidate is really digging into why costs are so much higher outside of administrative overhead (which is real, but eliminating it doesn't solve the problem).
[0] https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...
[1] https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
Has anyone estimated the impact of costly lawsuits->higher professional insurance costs->higher prices->higher medical insurance prices vicious cycle ?
https://www.sciencedirect.com/science/article/pii/S001429212...
If you read more, I believe diagnostic testing comes out to 0.5% of GDP in the UK vs. 2% of GDP in the US, a far bigger effect than the difference in salaries.
So yes, there is some indication that lawsuits can lead to more tests and thus wildly higher testing costs.
I wonder if this is also leading to doctors to favoring newer medications that should be "the best" versus cheaper generics that would be more cost effective for a particular ailment.
Speaking of which, the way drug approvals and patents work also increases costs, and there are perhaps some small tweaks like permitting foreign first-world drug approvals to count in the US as well that might also help keep a lid on costs.
Currently, Virginia is capped at $2.4 million. https://law.lis.virginia.gov/vacode/title8.01/chapter21.1/se...
Sounds like a lot on first glance, but if you're young and lose a lifetime of income, or need a lifetime of assistance/follow-on care, due to negligence, it's a drop in the bucket.
Ok, I misspoke there, but the US government does not spend anything on you if you don't qualify for one of these two programs.
That's not true. Poor people can get Medicaid, old people can get Medicare, and there are also various other ways of getting one's health care expenses subsidized by the government if you're poor or have medical reasons for not being able to work.
Just to be clear:
I'm for 100% state-funded medical care, but it's simply not true that "the government doesn't pay for anything; only private insurers do". The government does pay for quite a lot, even if many people in the US don't qualify for such aid.
They absolutely should qualify for such aid, in my view, but my opinion doesn't change anything. Some people qualify, some don't, and the government does pay for some, and private insurance does not pay for absolutely everything in the US. These are just facts.
Lots and lots of people already have "government healthcare". Just not enough.
And even in states where you might be eligible, it's not going to help you (or the public) if you haven't enrolled.
The US government spends about the same on healthcare as many other governments, which makes the terrible standard of care even more confusing.
https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
Someone who makes the minimum wage, working full time, will make ~$22,000 per year, and that is above the income limit in my state. Therefore they will not qualify for state Medicaid. They will have to pay out of pocket for this test, whatever their private for-profit health care plan does not pay. And whether they get their own health care plan, or the employer pays some of it through an employer provided health care plan, depends on how many employees the company has. And in fact it's no longer compulsory that individuals even have a health care plan, the individual mandate no longer exists. And there is no such thing as an option to buy into a public plan, either Medicaid or Medicare (people over 65).
If this person worked part time instead, they'd actually be in a better position in terms of health care, where Medicaid would pretty much cover the cost of this test.
Only in states that expanded Medicaid under the ACA. The entire South and much of the mid-West didn't expand Medicaid.
Also minimum wage in the Us ranges from $7 to about $15 in very expensive areas. So depending on you let salary you are left with 2 choices
1. Get tested if you have a severe flu or cold like symptoms and not eat and pay rent for a few weeks.
2. Tough it out , wait a few days/weeks and hope it goes away.
Oh, I thought that the government provides a default one; realized that US doesn’t have a ‘default’ insurance from the sibling comment.
> that means they'd be in the hook for the entire amount.
Thats... insane and sad.
Some states took federal funding to expand Medicaid and make it available to anyone making 138% of the federal poverty line -- think around $35k annually for a family of four.
Others did not. Consider Texas: medicaid is available for children, pregnant women, adults caring for children, and a few other special groups (children transitioning out of foster care, certain disabilities, etc.) It is not something that is available for all Texans.
In Texas, a single parent caring for one child would have to make less than $103 per month to receive coverage.
https://yourtexasbenefits.hhsc.texas.gov/programs/health/you...
Except it wouldn’t.
It’s really more of a starting point for the negotiations between the insurance company and the hospital.
What’s paid at the end is anyone’s guess.
Because a government that does healthcare is socialism that that's considered inherently evil by many.
And you're right: the healthcare system is absolutely insane.
If you can afford it (like I do), it's obviously world class in its medical abilities, but it's a disaster in terms of administrative overhead and its inability to serve the general population.
That's what socialism is.
The individual in that article likely had reasonably good insurance, someone earning minimum wage likely would have insurance that would cover very little if anything and they'd likely owe the entire 3* amount.
The countries doing lots of testing are basically countries with socialized medicine, the cost is being passed on to the tax payers. For the United States you are responsible for your medical costs, if you are fortunate you have good insurance that will cover varying percentages of your medical insurance.
I have 'good' insurance, several years ago I required hospitalization and ended up incurring somewhere between 13 and 15k USD in bills for about 30 hours in the hospital and the ambulance ride. I ended up paying something like 12-13% of that. At a start I personally owed 100 USD for every single doctor that touched my case which ended up being 5 doctors if I recall correctly, only 3 of which I ever met. In this instance the hospital was very courteous and allowed me to set up a payment plan and repay them, interest free, over many months. I paid the debt off over a year and a half if I recall correctly.
They then wanted more blood over the next several days and had to see a primary care physician to get my medical leave paperwork filled out and those two things cost me another 200-300 USD after insurance.
That’s worser than I thought :-( I was thinking that $1400 is too pricey to anybody — turns out that it was higher for people who don’t have insurance.
> For the United States you are responsible for your medical costs
Is this a culture/mind difference, or does everybody in the US doesn’t like this but has no time to fix it? Genuinely interested, as most people in our country almost everybody relies on only the default insurance — is this a cultural difference between the US(western world) and here? Are countries in the Europe similar?
Poor public administration makes people lose trust in government, which contributes to political debate.
This is a vicious cycle.
As applied to healthcare, many Americans, including leftists, simply aren’t confident the government can achieve major public programs.
Obamacare is a good example: it has been slowly gutted. How? By litigating it again and again at different levels and forums of government.
After congress passed the law, states had to agree to go along, courts federal courts had to sign off, stage courts had to sign off, etc.
There’s no way to enact major changes in American society anymore.
So most Americans, very logically and rationally, favor small incremental changes over big programs.
This is just the way it is. We don't know anything else and when you start talking about changing it a lot of people lash out and can get quite heated.
Our government is not the best at managing things efficiently, socialized medicine means it gets paid via taxes, the medical and drug companies have lobbyists and can largely get away with setting whatever prices they want right now, etc.
Personally I'd be fairly hesitant to get on board with socialized medicine here in the United States purely for the fact I would fear it would be just as corrupt and I don't know if the increased taxes would be more than I pay for my insurance currently considering my employer pays more of the cost of my insurance than I do and I doubt that sudden savings would be passed on to me as increased pay.
He's giving you false information, that's not actually true.
If you are poor you don't usually have a deductible in your insurance (because it's government subsidized), which means you are responsible for LESS of the bill, not more.
People have a lot of false views on US healthcare, mainly because it's a political issue, so people have a strong motivation to spin it one way or another.
Could you explain this logic a little more? Unless the false negative is something very high (do we know what it is?), I don't understand why identifying none is better than identifying some some, especially with an exponential spread.
> its best to go ahead and quarantine them,
In an ideal world, you wouldn't let them go. A test only allow to send people out of a quarantine.
I'm going with a large bureaucracy reacting slowly, which is also hampered by being staffed according to political alignment rather than by the best candidates.
Elections and the Olympics are coming up.
- Hanlon’s razor
1. SK used to be under a dictatorship (until 1987 democratization) and as a result its administrative power is still far-reaching.
When the Shincheonji (SCJ hereafter) church in Daegu was revealed to be a very problematic cohort, essentially every SCJ follower in Daegu was contacted for check-up, to the point that some hiding SCJ follower was tracked via police power (!). Not that SCJ's behavior is acceptable, but SK government has too much information to track individuals when deemed necessary. It is really a lucky coincidence that the current government doesn't try to do too much bad thing with that power.
2. Unlike other countries, many, if not most, infections in SK can be readily tracked to a single cohort (SCJ followers) and that makes the containment look still viable.
Okay, I actually disagree as the prevalent (and secretive) nature of the SCJ makes the containment impossible at this stage. I believe the SK government knows that too but continues the containment as a last resort (that is, better than not trying at all). Combined with strong administrative power and pretty stable diagnostic capacity, this "last" resort can be extended much further. It is not necessarily a bad thing though because a big pile of data resulting from lots of tests will be useful later anyway.
3. There is no other incentive for countries to test every (pseudo)patient.
It is now clear that only some---mostly already vulnerable---COVID-19 patients develop severe symptoms and most can be recovered without too much hassle. Sending every patient to the hospital is a significant burden to the domestic medical system and eventually only severe patients would have to be sent. Having this information, countries can skip the investigative phase (in this case, thankfully done by China and SK) and simply execute the eventual strategy.
The eventual strategy also has a side effect of the smaller number of reported patients. It would be a conspiracy theory that this is a motivating factor for most other countries, but it is compelling as a side effect of what they have to eventually do anyway. WHO had to accept Japan's absurd claim that the "international conveyance" is not a part of Japan because they needed Japan to at least report proper numbers. I don't think Japan is in the unique position in this regard. Even SK would be doing the same unless SK is between two highly impacted countries...
I mean, you are supposed to self-quarantine while waiting, which means no pay for that period. If you are positive after the result, there is more quarantine. More time without pay.
You can let the bill go to collections if they don't require upfront payment, but few can go 2-6 weeks without pay at all. People need to eat.
You'd be surprised - even though most businesses are fast at reacting to global events and responding accordingly, the US government is notoriously slow. The US hasn't faced or reacted to a serious pandemic before (the swine flu in 2009 was largely considered part of flu season).
Citation needed. I wont declare the govt to respond quickly, but the incentives, experiences, and expertise at companies dont tell me they are likely to respond in the best way. Some, certainly. Many? Maybe. Most? Prove it.
I was pointing out that a conspiracy that will obviously collapse under its own weight as infections obviously increase is not a good conspiracy. (not to insult the theory, just the premise such a theory would describe).
Countries deliberately underreporting infections early on simply doesn't make sense except perhaps for China, before it spread beyond its borders, hoping to keep a lid on things.
Now that it's starting to spread in other countries, it's too late to pretend like it won't continue to get at least somewhat larger. Any numbers you falsify today will look bad tomorrow, clearly. Which is what China found out. Which is why I don't think such a conspiracy theory holds water.
"Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith."
Yeah, that's true. Nobody is doing well, and South Korea is also having an outbreak as well.
> Get off your high horse.
I'm not here to brag about my country, I have enough problems with the current government here. What I'm asking is the reason why the US and Japan gov is doing nothing.
> Pres. Mun Jaein failed to put stops on people flowing in from China
AFAIK, Korea and Japan boyh banned people from coming from the Wuhan-district; they didn't ban everyone from China - which makes the three countries the same level. Also, AFAIK no Chinese people occurred secondary infection, every infection case was from a Korean citizen that came from China - which means blocking the Chinese wouldn't have helped.
> Handing out masks and doing drive-in clinics are just a publicity stunt in S.Korea to look like they're controlling the spread.
So, you think masks/fast tests are ineffective and they can't help controlling the spread?
> Don't just give me numbers, give me info how those numbers were acquired.
What info do you think isn't provided yet?
Edit: Got feedback that the US did ban every Chinese (not just from Wuhan), so removed the inaccurate mention.
I've seen reports this has happened, but the medical reporting is saying the person(s) may not have completely recovered before showing signs of the infection again. I saw two interviews with doctors who related the infection has ups and downs and while someone may have been feeling better - they might have thought they were over it, when in fact, they really weren't.
The reporting on this is all over the map and most of the stuff I've read is pretty tentative in what they actually know and can document as fact.
The OP is absolutely right to be appalled at how little testing the US is doing compared to South Korea.
Also your "get off your high horse" comment is not constructive, and is against HN guidelines[1], which ask:
"Be kind. Don't be snarky. Comments should get more thoughtful and substantive, not less, as a topic gets more divisive."
"Don't feed egregious comments by replying; flag them instead."
It is ironic that South Koreans would be worried about Americans and Japanese given the state of corona in SK.
I personally find that South Koreans are overreacting, but you can't really deny that their efforts to track the virus far eclipse those of Americans and/or Japanese. The people sitting in the White House don't really seem to care at all. Abe seems to only care about the coming Olympics (I mean, just look at how he handled the Diamond Princess situation).
In the long term, I believe we're going to see more cases of novel viruses spreading around the world as global warming unleashes dormant viruses. High density urban planning and new viruses is not a good combo. We'll probably need to drastically change our lifestyles to really combat future global epidemics.
Why is it that people need to be told the same thing over and over again?
Never mind: (1) the R0 [1] of this virus is somewhere between 3-4 and that of the flu virus is closer to 1, that means that you can have a lot more cases, and quite fast. (2) the flu virus has a mortality around 0.1%, this virus is somewhere between 2-3% [2]. (3) the chances of severe complications (pneumonia) with lasting damage are about 20% once infected.
This has nothing to do with global warming or 'dormant viruses', it is an example of Zoonosis [3] , a pathogen crossing the 'some animal' -> humans species barrier.
[1] https://en.wikipedia.org/wiki/Basic_reproduction_number
[2] https://en.wikipedia.org/wiki/Mortality_rate
[3] https://en.wikipedia.org/wiki/Zoonosis
If this were a start-up you'd all recognize that it is positioned quite well to scale up, 'go viral', so to speak, no growth hacking required. Investors would be tripping over each other trying to get in on the ground floor, success almost guaranteed.
Regarding global warming, again, you're right that this virus is an example of zoonosis. I was more talking about the potential for additional novel viruses spreading around the globe.
That depends. The virus doesn't really care that you're young, healthy and have easy access to healthcare.
Yes, age is a factor, but you being young doesn't stop you from spreading it to those you love who may not be young, healthy and have easy access to healthcare.
That easy access to healthcare is predicated on a system that is not yet overloaded with cases in the 'critical' and 'serious' category.
It's all bell curves. So your personal perspective can (and will) shift as this thing develops.
People should definitely be more concerned than they are about the flu every year.
Way fewer people would die from the flu every year if more people took it seriously and got vaccinated. Some people get vaccinated, but not nearly enough. Also, every year many people continue going in to work (even if they can take sick leave) when they feel sick. That spreads the disease and increases the risk that other people will die.
Fortunately people are starting to wake up to the risks of COVID-19, and will probably change their habits (by washing their hands more and staying home when they're sick) to make the spread of both diseases less likely. Unfortunately, after the outbreak is over they'll probably go back to business as usual in respect to the regular flu.
The government is doing so much more to control the spread of the virus in South Korea. As such I can reasonably trust that the number produced by South Korean is trustworthy. The same thing cannot be said for the Japanese or U.S. government. The Japanese have an incentive to under report numbers because they've prepared many years for the olympics and don't want it to be cancelled.
I'd rather a government overreact than be complacent and baselessly optimistic and do nothing.
Hmm, what we heard was that the US only tested people who had symptoms, and people who didn’t wasn’t under quarantine. Looks like people thinks that self-quarantine disqualified as quarantine; they were worried that people can spread the virus while getting to their homes. Maybe this probably isn’t that much a big problem in US compared to Korea where public transport is less used?
Which is a crap shoot to begin with since the symptoms are fever, coughing and shortness of breath. A lot of the original patients were misdiagnosed as just having pneumonia since it has the same symptoms.
There's still a TON of misinformation out there as well. Just like in the Times today where they said in one sentence:
Yet the patient tested positive, and may be the first person to be infected through community spread in the United States, the Centers for Disease Control and Prevention said Wednesday.
So then, they don't know where he got it then? Wow, that must be serious, right? But wait, this is the VERY NEXT PARAGRAPH:
C.D.C. officials said it was possible the patient was exposed to a returning traveler who was infected.
https://www.nytimes.com/2020/02/27/health/coronavirus-testin...
They first say its the first patient who was infected through community spread, then back off the very next sentence to say its actually possible he was infected by someone else? I'm not sure how this type of reporting is helping anything, other than by spreading fear, which during an epidemic is exactly what you don't want.
In the U.S. we're papering over incompetency, corruption, and mental illness as much as possible. What will be the CDC version of Clownstick's NOAA Sharpie incident? I'm supremely confident there will be an equivalent of ordering scientists to lie to the American public, because that's what he does. It isn't a conspiracy, it's incompetency. And it is contagious. Defending incompetency is itself incompetent.
Edit: Oh look it's already happening. U.S. health officials can't make their own statements on the progression of Coronavirus, they have to clear their statements with Pence first. https://www.nytimes.com/2020/02/27/us/politics/us-coronaviru...
I don't like conspiracy theories, but seriously it looks like they are trying to lessen the numbers on the paper instead of really trying to find the patients. Compare the numbers that the countries are testing[0], US is less than a thousand and Japan is about 1300.
Edit: Just for people who are curious in how things are working in South Korea, we test everyone who has: pneumonia symptoms, or has been in the same place with already discovered patients for free - and anyone who is concerned can test with about $100 - which is refunded if one turns out to be positive. We track every COVID-19 patient's routes and test everyone who was in the same place; which means that the government (mostly) knows exactly how the virus is being spread. Based on data that was announced 10 hours ago[1] (we announce data and roadmap twice every day), we have tested 66,652 people with 1,766 cases found, and currently 25,568 tests are on-going. 1,727 people are being quarantined, and 26 people have fully recovered from COVID-19.
Second Edit: Okay, I'm not really skilled in English; if this felt like bragging how South Korea is well handling this situation, that is not my intent - we have a lot of complaints of how the government should handle this. My intent was asking why the US/Japan is not doing at least this much, considering that both countries are much powerful & richer than Korea. Both countries are basically the Korea's wannabe-countries; and everybody here is pretty shocked (literally - there is a lot of news/SNS posts/internet memes on how Japan/US is handling the situation) that they aren't doing well.
[0] https://i.imgur.com/BAROczt.jpg
[1] http://ncov.mohw.go.kr/tcmBoardView.do?brdId=&brdGubun=&data... (Korean, sorry :-()