Maybe that 4% is correct, but for sure how to deal with paying for medical care is a big worry for many people in the US.

There was a post a few days ago (or comments at least) discussing how many people working low wage jobs in the US are working 29 hours or fewer specifically so their employer doesn't need to provide health insurance. Are there social programs that cover those people, or do they just not go to the doctor when sick?

My general experience when not going in to deal with a discrete injury is that I pay 50 bucks to have someone ask me some questions, shrug, and give me the card to someone else who would cost another 50 bucks that I can no longer spare.

Details vary by state, but generally Medicaid, a public insurance program, kicks in for those below a certain income level.

Contrary to what Reddit would have you believe, 91% of Americans have medical insurance (<https://www.census.gov/library/publications/2020/demo/p60-27...>), whether through their employers, or government programs like Medicare/Medicaid. That's compared to 95-97% in other developed countries because there are always some people who fall through cracks, like (say) a Canadian who doesn't get a new provincial health care card after moving, or a German who neglects to buy into a new sickness fund after changing careers.

Two thirds of Americans have private medical insurance. One third have public insurance of some type, including 20% from the aforementioned Medicaid.

Some large chunk of the 4-6% differential in the US versus other countries is illegal aliens who don't qualify for public insurance and are working cash jobs that don't provide private insurance. The only such national systems with actual 100% (or as close to it as possible) coverage is something like the UK NHS, which does not have a requirement to show a membership card (because, well, there isn't one) to receive treatment.

Here is a different take from a newer paper.

> The majority (58.5%) “very much” or “somewhat” agreed that medical expenses contributed, and 44.3% cited illness-related work loss; 66.5% cited at least one of these two medical contributors—equivalent to about 530 000 medical bankruptcies annually.

Really though it suggests the US has both a medical bankruptcy problem as well as a missing safety net problem. I know I’m seriously thinking about leaving to avoid a likely major medical event killing my net worth in later life.

This paper is by Himmelstein and Woolhandler, the same authors who wrote the earlier one that the authors the Post piece cites was responding to. As the Post piece says:

>So Carlos Dobkin, Amy Finkelstein, Raymond Kluender and Matthew J. Notowidigdo did what’s called an “event study.” Instead of looking at bankruptcies to see how many involved medical bills, they started with the illness, and asked how much more likely people were to declare bankruptcy after they got sick. That’s a much better way to tease out causation than asking whether someone who just went through a financially ruinous divorce also owed his or her dermatologist thousands of dollars.

In other words, it's not surprising that someone who declares bankruptcy owes medical bills among all the bills he is behind on. While "correlation is not causation" is used far too often by people who don't really understand its meaning, this is an example. Again, from the Post piece:

>That jibes with what we’ve seen in the bankruptcy data since Obamacare passed. If medical bills really were driving so many people into bankruptcy, then we would have expected filings to plummet after 2013, when millions of people gained health insurance coverage. Instead we see a smooth decline from the recession-era peak.