> Sorry, are you seriously trying to claim an HSA is better than universal healthcare?

It's not an HSA and nothing else. It looks like it's similar to my employer plan which is actually more generous than some universal systems - I/my partner use about the same services here and in Australia and I pay less here. Mainly because universal systems don't always cover dentists/specialists/mental health.

I said it pretty clearly, it's not Amazon's fault that US healthcare is broken. Comparing EU to US for wages is thus largely fruitless. Fix our healthcare then your comparison might be useful.

I was attempting to nicely dismiss your comparison.

It is not Amazon's fault but there is nothing legally preventing them from doing better. That is a choice by Amazon. They offer worse health insurance for more money than I have available to me.

> Sorry, are you seriously trying to claim an HSA is better than universal healthcare?

I think it can be. Depends on the details but an HSA comes with a high-deductible plan. This is normally ideal for young people, who are generally healthy and only need insurance for rare catastrophic illness or serious accidents. Normal, routine care (checkups, immunizations, etc.) can be budgeted and paid out of the HSA tax-free. I don't see why that stuff should be "free" for most people, any more than groceries or utilities or housing should be.

> I don't see why that stuff should be "free" for most people

I do. Having a healthy population benefits me. Having people immunised, cared for and well keeps me healthier and safer. Having people lose homes and jobs and potentially their lives because they can’t afford healthcare is not something I support.

There are actually tons of studies that show preventive healthcare reduces spend later on. For instance, if you pay for someone's routine checkup you might catch a heart issue or cancer early. Both insurance companies and the government (Medicaid/Medicare) would save money by paying for preventative care.

Study by the NIH: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296930/

An HSA doesn't mean that you don't have preventative care. I have a high deductible plan plus HSA and there are things like annual checkups covered without going into deductible.

So about those.

I started with a new doctor after finally getting insurance a few years back. I told them I needed to come in for my annual check-up, and came in with a list of the things that had been bothering me and that I hadn't been able to get looked at (this is common for people who have not had healthcare access). The doctor spent 15 minutes with me, doing the bare minimum of setting up outside testing/imaging - as in, basically no guidance that day - and then coded it as a 45-minute, in-depth consultation ("because of the number of issues addressed"). $250. Before any tests or treatment. For reference, that was about 1% of my annual take-home. For a lot of you, that's like paying a grand or more just for your doctor to direct you elsewhere.

So, yeah, certain things are "covered." But the structure of our healthcare system forces our clinics and hospitals to operate like many other American businesses, which is "in a predatorial manner."

You went for a preventative check, and asked for a bunch of issues to be addressed and you’re surprised it cost you money?

What, exactly, is a preventative check, if not a discussion with your GP about your current physiological status? Given the time described (15 minutes), and the lack of immediate diagnostics, it sounds exactly like what I would expect from a check-in with my doctor here in Canada. The only other option I could see counting as a preventative check is a physical, which would be more involved than what was described.

It’s a matter of billing. A preventive visit does a set of screening and evaluation of results.

If you say “my knee hurts lately”, then that’s separate as the physician will do an evaluation that is separate from a routine physical.

And it’s not just the US. I have family in Canada and they were told maximum of 2 complaints can be addressed as they can only bill for a certain amount of time. Beyond that the doctor is working for free. Another separate appointment is needed.

So, yes, this is the problem. Healthcare should not be a business. It should be obvious that people who have been denied access before will come in to their first visit with multiple concerns, and the system should be accommodating to that without a massive "onboarding" fee. After all, it's not their fault that previous incarnations of said system did not supply care adequately.

If you view a person and their health in a holistic manner, you can't just say, "Well, I've got you set up to check for diabetes and Crohn's, but if you want me to consider that mole then you'll have to pay me another $300 and/or wait a few weeks until I'm not so booked."

My point was that "free preventative care" is not a panacea. Any time a doctor is incentivized to turn that visit into a money-maker, they'll gladly attempt to. And that's wrong.

So you’re against how universal care is setup in Canada? Each visit has a billing code for a certain amount of work. If you brought up other issues you’d be told to make another appointment.

Of course not. Canada's healthcare system is not, at the point-of-care, a business. Whatever business arrangement that exists is between the government and providers, not me and my doctor, so the latter relationship is not directly constrained by economic concerns, as is the case here in the US. If that appointment had taken place in Canada - and let's be clear first that it would not have, as I would have been insured unconditionally since birth and able to deal with each issue as it arose - the doctor would have either helped set up a treatment plan then and there, or she would have let me know that it would require another visit or two to go over everything, as here.

The difference is that I would not personally be out 1-3 weeks worth of food money for each visit, just establishing my baseline. In neither case would what happened be a "matter of billing" because I would never receive a bill.

It’s the same issue of billing for the doctor in Canada as the US.

The doctor gets paid $X for a preventive visit. If you start adding things on that will be flagged to ensure doctor get paid more, typically through additional billing codes.

The original comment was “why do I get billed more when I bring up issues during a preventative visit”?

That’s why.

Universal Healthcare systems can and do provide a significantly better coverage and vastly more cost efficient system. What you just said is selfish healthcare provision, look out for yourself and to heck with everyone else.

You have no empathy for people who can never afford ridiculous health care systems in private systems. This optimises the failed "rugged individual" philosophy that has only lead to ruin.

If you have a HSA it is just as good as any other universal health care. Depending on what you decide to value you can argue it is better or worse, but either way for practical purposes you don't have to worry about going to the doctor when you need to.

> If you have a HSA it is just as good as any other universal health care.

I’m not American and have only just learned about HSAs and totally fail to understand your comment. Could you explain how they help someone poor pay for medical expenses? Doesn’t the account get low/empty and then you’re out of funds?

When the HSA gets to zero you reach your yearly max and insurance takes over and you don't pay any more.

I'm not sure how Amazon works, but my plans works something like (I'm rounding to make it easy, the reality is slightly more complex) that I pay everything for the first $3000, then for the next $15,000 I pay 20%, and thereafter I pay nothing. My total out of pocket is $6000/year, which is also the most I can put into the HSA per year, and my employer matches some of my contributions to in reality I'm getting $7k/year while only a few rare loop holes can get me close to needing that much. It is very rare for anyone to have more than $18k in medical expense per year (I had a baby last year and still am well below that), so for most people the HSA is another retirement account.

Now the HSA does mean I'm not paying $100/month for my insurance, but instead $600/month. However most of the money is invested using the HSA as a retirement account for my medical needs. The idea of the HSA (which has not worked out in practice) is because the money is mine I'll have incentive to shop around for cheaper medical procedures to make sure there is more money for my future retirement, and this should lower costs (in practice most medical things can't be shopped around for, but a few people do look at their itemized bills and sometimes notice a billed procedure that wasn't done).

Now that $600 is $3-4/hr, which is not insignificant to someone making $15/hr. However here again things get complex. That money is pre-tax income, so your taxes are almost cut in half for the year (granted this is only $500 - and only for a single person who can't claim anything else).

Thank you for this - I get it a bit better and HSAs do more than I thought they did.

It’s a phenomenal sum of money to spend, and while you have clearly considered your options, it really shows how expensive it is in the US.

That said, I was surprised to see how high it is in New Zealand where I am ($4204) and how much less you are spending than the average in the US ($10906).

https://www.healthsystemtracker.org/chart-collection/health-...

Average spending isn't very meaningful here because it's just a few people spending a lot - mostly elderly people, which of course has the effect of nobody inheriting anything anymore because it went to hospital bills.

The median person in the US doesn't spend much more on healthcare than the median European and their income is much higher. (Median income in a poor state like Alabama is higher than the UK.)

Plus we have working clothes dryers. Meanwhile in Sweden they're so poor they have to ration the tvättstuga.

> Average spending isn't very meaningful here because it's just a few people spending a lot - mostly elderly people, which of course has the effect of nobody inheriting anything anymore because it went to hospital bills.

That’s the same everywhere though. If you want to record the most expensive year of healthcare in someone’s lifetime, it’s a safe bet that the last year is going to be at, or near the top. Like has been compared with like.

> Plus we have working clothes dryers.

I’m missing something, and I suspect it’s obvious. What’s this about sorry?

> That’s the same everywhere though. If you want to record the most expensive year of healthcare in someone’s lifetime, it’s a safe bet that the last year is going to be at, or near the top. Like has been compared with like.

You're right it is comparable, although it's affected by the country's demographics. I just mean if you're moving to the US as a working-age person, it is not going to represent your situation. A median or age distribution would be more informative.

> I’m missing something, and I suspect it’s obvious. What’s this about sorry?

That's just a fun quality of life fact about the US. Europe has better transit, we have better and bigger housing and our appliances work better. We're more likely to have air conditioning too.

(Clothes dryers don't work very well unless they're vented to the outside, and in older brick buildings like Europe, and for some reason also in Japan, they aren't always.)