The only real benefit of having "insurance" in the US is having reasonable access to basic preventative care. Don't get me wrong, it is a massive advantage to have default access to basic preventative care (without it being a cost-benefit tradeoff each time), but that is in no way/shape/form "insurance" in the typical meaning of the term.

It's terrible that these things happen at all, and we CERTAINLY need to improve the US healthcare system, but exaggerations like "the only benefit of insurance in the US is access to preventative care" doesn't help. If people were regularly getting fucked like that the system wouldn't have the entrenched support it does from the "but I want to keep my insurance" camp, and so speaking in generalities like that just makes you appear uninformed to the millions who regularly see doctors, get treatment, have surgery, etc, without these problems.

It also cheapens the inequality problem: the gap isn't just "has access to preventive care" vs "doesn't have that access." The gap is "has hundreds of thousands of dollars, or even millions, of bills turn into nothing" vs "bankrupt if they seek treatment for any serious problem."

I'm sorry, but I just can't see how this is true. Do you only go to the doctor for a yearly checkup, or something?

I've had "good" coverage (paid for by big employers with cushy all inclusive packages), and I've also had the cheapest option on CA’s exchange, and the only difference was whether I had to pay the receptionist $25 or $150.

The "we won't cover this" and the "surprise, this costs 50x what you were told!" billing nightmare comes six months later. This has happened with every insurer I've ever had.

In my experience it does help to have an HMO. My mom uses Kaiser. So there's none of this in- vs out-of-network. One billing system, one insurance, etc. She has nothing but positive things to say about them. My dad had a similar experience towards the end of his life. He loved 'em. And nobody was left destitute as the result of his medical care.

Lets look at it this way: If that was the true price, what percentage of the US population do you think has the funds to actually pay $420k/year in for medication?

> what percentage of the US population do you think has the funds to actually pay $420k/year in for medication?

Zero, plus or minus. That's why the manufacturers basically give it away to people who can't afford it. Because they can, and it helps them somewhat mitigate the bad PR.

I don’t see how that follows.

The “I’ve got mine” camp doesn’t care that it happens to those other people, and also doesn’t understand that it could happen to them in their old age (or simply after bad luck) because they’ve only made short visits into the system.

Of my different health insurance policies, the longest duration in an ICU that was covered by any of those insurance policies was 60 days. My father was "lucky" in that he was on a subsidized Obamacare policy that "only" charged $350 per month (which was cheaper than my employer's policy) but was FAR superior to any of my employers' health insurance in every aspect.

I'm not sure what point you're trying to make, but it sounds like you're making the claim that people in the US don't regularly end up with massive surprise medical bills? This entire conversation is about action the government is taking because it happens so often.

> "has hundreds of thousands of dollars, or even millions, of bills turn into nothing"

That's not really how that works. It's not like your insurance company is actually paying "millions of dollars", they're paying some level of reasonable negotiated rate. If they actually had to pay "millions of dollars", that's when they claim something is not covered and you get stuck with a bill anyways.

Edit: First quote was just wrong from a bad copy/paste

Wouldn't it be better if you went to the hospital, gave them your insurance information, and that's the last you ever were involved with anything regarding payment? Isn't that one of the reasons we have insurance?

What insurance do you have where the cost of the annual premium is less than what the out of pocket costs would be for annual checkups for the covered individuals?

I have the cheapest insurance I can get. Yes, it pays for basic preventative care (basically a checkup per person per year), and it also costs more than my mortgage.

There are plenty of medical practices and institutions that function well and deliver good value to the patient. But there are many that do not.

As someone who doesn't have friends inside the health care industry, it can be extremely difficult to figure out what to do in an emergency. Quite often your options are limited especially if you are caring for a loved one rather than yourself.

The best advice I can give is to find good doctors before you need them, and when conversations come up about someone else's medical care, be willing to ask, who is your doctor and how good are they? Or, which hospital did you go to, and do you feel you had a good experience?

Often there is little out-of-pocket difference between the cost of excellent medical care and lower quality care, if you have good insurance.

If you don't have good insurance and you are looking at a potentially significant medical procedure, ask to speak to someone about financial assistance. Good practices and good hospital systems are not looking to bankrupt their patients.

most US doctors are part of a bigger group in order to provide more comprehensive coverage (and due to systematic buyouts), which in turn have preferred insurance providers and additional out-of-network providers, and emergency services are generally for wherever an ambulance takes you. your physician may be great, but they are just a tiny cog in a broken machine

one of the only outs, afaict, is something like working & living near a big & strong HMO like kaiser. but that comes at the cost of pretty firm boundaries on what services they allow: capped care

(my SO is also a physician at one of the nation's best hospitals, and despite that, patients struggle w the broader system outside of her practical daily control)

People also want cutting edge care from some of the smartest and most highly educated people in the world (which is in short supply) for cheap.

Actually, people just want someone to help them with their health issues and not treat them like shit.

Sure, I guess you could find people with the above attitude, but it's mostly a straw man you are using to deflect responsibility from the health industry.

Perhaps what we need is something like the WTO's most-favored-nation rule for domestic insurers, but imposed statutorily. If you're treating an out-of-network patient extemporaneously, you can only charge that person's insurer at the lowest rate you'd charge an in-network provider.

This would remove the incentive for out-of-network providers to eagerly provide many services. That has its own downsides, of course, but it might help to resolve many of these billing nightmares.

But, heck, maybe something like that already exists. Obamacare (aka ACA) comprehensively thought through many of these dilemmas. But enforcement has been gutted by the GOP.

As far as whether facilities could be "nicer", I mean... maybe? I actually kind of prefer healthcare to be like schools in this way— if I don't think it's nice enough for me, then I need to lobby the province to collect more taxes and make it nicer for everyone rather than just taking my dollars elsewhere.

And that doesn't even address the whole billing-surprise angle. I would happily wait forever if the alternative was not knowing if I was going to randomly be stuck with a $10M bill.

To be fair, Americans have a very low standard for “functioning healthcare system” due to the American healthcare system.

I also do not buy that doctors do not know which code will be used. I don’t care if the doctor themself does not know, surely someone that works with them knows and can provide it.

It should be dead simple to go to a doctor’s website and find the codes for routine procedure that they will bill. If something in the visit happens outside of that, the doctor can feel free to say that is outside of the scope of the visit, just like a mechanic can tell me he will not fix the transmission if I am in for a brake job.

And no one can really afford that, but instead of spreading the costs around to all taxpayers, we were spreading it around by inflating everything else. ACA helps with this, but today’s announcement about out of network care will help more too.

That can't be true, everyone knows that people are only greedy and stupid, and it's really the citizens' fault for the prices of the current healthcare setup. The industry itself is all made up of kind-hearted super heroes who would never think of manipulating prices to syphon more money from patients.

I would also point to the unnecessarily arduous and lengthy process of becoming a doctor in the US as one of the US system’s problems.

If I’m going to be asked to sacrifice all of my 20s and maybe early 30s and worked on 24 hour shifts during the prime of my life, I am also going to be making sure I get paid a ton for it. Otherwise, I would choose a different career.

I know a lot of doctors that advise their kids to not pursue medicine even if they want to do it, simply because the cost benefit is not worth it anymore (if you have other options).

I recently had a family member get surgery for a life threatening condition where a cutting edge treatment greatly reduces complications. The equipment only exists in a small number of hospitals on the planet and their normal hospital, which wasn’t even a particularly fancy US hospital, had one. It's probably not an issue for small and rich countries though. Probably more-so for medium income countries.