When I lived in the states I was on a medication I needed to get filled every month (Methylphenidate for the curious) due to life situation my cost to do so varied in this manner over the span of half a year:

30$ (1$/pill) while on uni insurance

0$ on state healthcare while unemployed (Green Mountain Care)

270$ (9$/pill) while employed and not qualifying for employer healthcare

120$ (4$/pill) while employed with my brand name uncovered (but discounted due to an Aetna preferred rate)

3$ (10c/pill) while employed after switching to the generic

Healthcare costs in the US are unpredictable, arbitrary and cruel.

Yeah. A lot of people focus on the insured vs uninsured gap - if you're uninsured you're fucked. But the reality is that, even with insurance, medical care is a disaster. Finding a doctor in your network, waiting months to see them, completely unpredictable costs that, to me, borders on fraud, etc.

I've recently started a company, and at the same time a friend was laid off, and over the last 6 or so months I've gotten to experience the absurdity of this system from a few angles. It has been eye opening.

The whole waiting months thing is so shameful, since it is a major talking point from people arguing in favor of the status quo. They point to wait times in Canada, which are entirely misinterpreted and never point to the fact that it can take months to see a specialist in your network in the US. Heck, the number of times I've been told "this Dr. is not taking any new patients" or some version of that, is astronomical.

I'm up here in Canada - my wife's uncle had to wait three months for cataracts surgery, cataracts surgery is good in the long run and extremely non-urgent. He also had to have a rotoplasty in his heart to clear out plaque, he was booked into surgery within a week - my wife's aunt fell off a cliff (a small one) and got a concussion, she had excellent care.

In Canada non-urgent procedures have moderate wait lists, and urgent procedures get immediate attention. In the US monied patients get immediate attention and poor patients get long wait lines.

Honestly, this rationing BS needs to stop, the people spreading it are either maliciously disingenuous or misinformed and I'd bet quite a few are acting maliciously.

It's pretty crazy how this works. Despite having pretty good coverage, I often use GoodRx because the prices are so much cheaper than using my insurance...

Ha! So I work adjacent to the insurance industry and, hilariously, sometimes tier based copays on medication fills can exceed the pharmacy's price - usually pharmacists will catch this and just never bill the insurer, but sometimes patients can end up paying more for a drug because of their insurance.

Healthcare is all kinds of insane at every level.

Gonna go out on a limb and assume you have good health insurance. Many (most?) Americans do not. I'm on an HDHP for example, so the first several thousand dollars in medical expenses per year come directly out of my pocket before insurance starts helping at all.

Or the debt collectors haven't caught up yet. That happened to me around 2012 in the US. Went to the emergency room, had some tests done, got the hospital bill and paid a few hundred bucks. Then like 9 months later I get calls from a debt collector saying I owed $1,500 to a separate medical testing company that apparently provided the test I was given at the ER. I had never received that bill and it just took a while for them to send it to collection apparently.

Right, but you also benefit from the fact that it's an HDHP, right? Must you be on an HDHP (because the other plan is too expensive, or because another plan is not offered) or did you choose the HDHP even when presented with the options?

The big up-front deductible and an HSA is pretty much the point of the plan, and it's mostly advantageous to those that are young and/or don't have to go to the doctor that often, with a max downside of their deductible + catastrophic.

EDITL To be clear, I also believe significant reform is required, but there is also a lot of misunderstanding about how plans work which is not helping. The whole industry is extremely opaque.

The HDHP works out in years in which you need no medical treatment beyond the covered annual physical. Once you start needing anything, it ends up being a worse option. I discovered this a few years ago when I broke my ankle.

The big upfront deductible seems like exactly the wrong way to structure a healthcare plan, as it disincentives getting treatment until things get really bad.

True, but if you can offset that with an HSA to cover your entire deductible and sweep the rest into a qualifying retirement plan it makes a lot of sense _and_ you don't have to worry as much about the deductible. Note: I am on a typical PPO and optimizing for minimum catastrophic amounts, generally so this is not the way I usually go but many colleagues seem to like these plans

i work for a tech company in the fortune 500 top 25... i would assume the best insurance possible, still killing us (paid nearly $7000 out of pocket last year + the actual premium costs of several thousand more). i've got three small kids including one with a heart condition, so it's particularly bad right now.

> i would assume the best insurance possible

That's usually not a good assumption to make, not even among the FANG. There is extreme variability even with the same insurance company, depending on the negotiation between the company and the provider. And very few companies actually have any incentive to even provide the best 'possible' coverage.

Just looked it up and we're only in the top 50 (insert crying smiley).

For insurance, I have found it's difficult to beat the negotiating power of the multiple large Federal Government offerings - and you can shop before you decide to join:

https://www.opm.gov/healthcare-insurance/healthcare/plan-inf...

And I got downvoted here for saying that I would require a LOT higher salary to move from Sweden to the US. Your example is why.

A $5k bump in salary should probably make up the difference in the average year. That's not a "LOT higher salary" by my reckoning. Hell, the difference in tax rate alone would easily make up for that, even if the US salary is lower (which seems likely to be opposite of what would actually happen).

Went to the ER last year with fever because the insurance told me to go to an ER. Saw the doctor for five minutes and was sent home. Still calling the insurance and the hospital over a $500 bill that was supposed to be covered but somehow they keep sending it. My girlfriend once got a $300000 after a surgery that required a five hour stay at the hospital. It took her two years to clear that up.