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.