> better than anywhere else

Spoken like a salesman!

It's mostly false. Last time I did a deep dive on this, the US had a genuine but small edge in treatment for diabetes and breast cancer, but that was it -- and the edge was nowhere near proportional to price.

That's something I've always been very curious about as someone who doesn't live in the US and was very unimpressed by the healthcare there when he lived there and had to deal with issues with my Asthma.

What documentation/studies did you find in your deep dive?

> US had a genuine but small edge in treatment for diabetes and breast cancer

You’re looking at gross statistics. On average, American healthcare is average. If you zoom into the top 10%, it outperforms other countries’ top 10% (in general; of course there are exceptions). This goes from virtually instant imaging with concierge medicine to the Cleveland Clinic’s global medical evacuation jets and helicopters.

Not just if you have money. If you have a lot of money. The majority of the country is one major accident away from being completely wiped out. It's the number one cause of bankruptcy.

I had an emergency this year within a very tiny insurance gap between employers and now all of my savings and retirement are gone.

I'm really not sure who it works out better for versus universal healthcare, but I can't imagine it's a whole lot.

You weren’t able to use COBRA? Or was the coverage just very poor even with it?

My probably naive understanding was that COBRA can be activated retroactively if you get in an accident during the coverage gap.

Yeah, I tried all of that. I'll spare you the details, but things just lined up in a way that made me ineligible for COBRA, but the insurance that I had at my previous employer was absolute trash and they wouldn't have covered a single thing anyway. It was the only option given aside from Kaiser (my Kaiser saga is an even longer story), and even before this emergency it covered almost nothing.

My prescriptions seemed kind of high so I checked with GoodRx and they were cheaper! Cheaper without insurance than with, like how does that even make sense?

Right now I'm trying to negotiate on my last and only unpaid bill, the hospital won't negotiate with 1st parties so I've been trying to go through a newer company called Goodbill or something. I can't vouch for them yet as it's still in process, but just trying to get this all out of the way so I can just move on. Honestly, this whole thing has been so terrible that I'm just like, nope you're not even going in the worry pile. I'll go through the motions, pay it as best I can, and move on. I'll save the worry for the next totally normal work meeting coming up :)

I'm just very fortunate that I don't have a family to support or a mortgage to pay, even though I've been very close to breaking my lease and moving in with my parents until I can get back on my feet. I mean, I make good money too, I never thought I'd be in this situation.

I will absolutely go through the insurance options with a fine toothed comb when I interview again. Mama mía, aye yay yay

> hospital won't negotiate with 1st parties

Talk to an FCRA lawyer. There are certain notices that if you send them and they are ignored can let you remove the lines from your credit report should they mark them as defaulted on. They will likely also help if the hospital chooses to sue.

I very much appreciate the tip, I'll check that out. Thank you! It's amazing how much time and work I've put into this and more info just keeps coming up. Crazy thing for people to navigate.

I don't know about poster, but offering COBRA isn't required for companies below a certain size. (I had to unexpectedly obtain private insurance to cover a gap in the pre-Obamacare era because the co I worked for only had a few employees.) It is a qualifying event for using the exchanges, but no idea about that being retroactive.

That shit is so expensive. I think I paid nearly $800 a month for a good short term policy during my gap.

Fun Fact: COBRA coverage doesn’t exist when your startup shuts down and you’re laid off.

This did not stop my insurance company from cashing my premium payments for over three months, even though they silently canceled my policy (no email, mail, or phone call). I only learned I had no coverage when I actually tried to have a dental appointment. Refunds of these premium payments took another another 3 months to be returned!

COBRA is fuxking expensive. I have no desire to pay for it again on a low salary.

Sigh. This isn't your fault. But COBRA is retroactive. EG. You have 60 days to find new insurance with a new employer. So you don't have to ever pay for COBRA. IF / when something happens - you pay all the missed bills and you are covered. That is the entire point of COBRA. People paying for COBRA are using it wrong or can't find employment in 60 days.

> So you don't have to ever pay for COBRA.

Not technically true when I used it last. I did have to pay for it.

"Employers may require individuals to pay for COBRA continuation coverage. Premiums cannot exceed the full cost of coverage, plus a 2 percent administration charge." But yes, the American Rescue Plan act allocated funds to make COBRA free. I wouldn't doubt that I was using cobra wrong at the time either prior to the passage of the act. Small pdf warning: https://www.google.com/url?sa=t&source=web&rct=j&url=https:/...

Was retroactively electing cobra not an option for some reason?

Longer story, but the timing of the emergency and recovery period fell within an ineligibility window for COBRA. My previous insurance company wouldn't have covered it anyway. It was the worst Blue Shield plan that I didn't even know could be legal. Also, I got the first few bills, was like okay, I'll just pay these off and move on and not even bother. These were the only bills I could find in their patient portal at the time. Then I got hit with the massive ones that made my head spin. By that time I had started at my new employer, my new insurance hadn't kicked in and I was outside of the COBRA window, not that it would have covered it anyway.

From now on I'm making sure I have good insurance, which requires a crazy amount of due diligence, but not something I'll take for granted anymore. It's one of reasons I'm currently trying to move to another country. Quality of healthcare is important, but how much does it matter if you're in massive debt, lost nearly everything, and don't have a retirement anymore?

What ineligibility window are you talking about?

You have 60 days to file (in writing by mail, in my case) once you leave your previous job, I didn't have enough time between jobs to really need it, emergency happens + a few weeks of recovery time where I'm incapable of basically doing anything, I get a few bills, I pay them, start working at my new job, get more and much larger bills, now I'm ineligible for Cobra. Not that it would have mattered with that insurer anyway in my case.

> better than anywhere else in the world if you have money and a chronic condition.

Which isn’t saying much. Even for wealthy people in the US, chronic conditions get you labeled anywhere from annoying to chronic drug seeker to mentally ill. Many doctors simply don’t believe that conditions that thousands to millions of people have are real, and no amount of money will change their minds. You do however get targeted for all kinds of scams!

also: when wealthy you become a customer instead of a patient.

So they will do all kinds of useless tests and treatments because that is what they earn money on.

You will never really know if this treatment is good for you or good for the hospital.

This might be true initially. But such people have networks who know people, pull strings, and move them pretty quickly to "the best" hospital in the area. You know, the Mayo Clinics, the Johns Hopkins, the Cedar Sinais of the world. It makes the hospitals happy, too because they run fundraisers and happy rich patients tend to give a lot, for just this reason.

> American healthcare works well if you have money and better than anywhere else in the world if you have money and a chronic condition.

Citation needed.

Disagree. A friend who had dual citizenship moved from Canada to the US because Medicaid covered her kids rare disease drug but Canada didn’t.

Medicaid is actually very good coverage.

With rare diseases this is always the case. Here in NW Europe we have the same issue with some one in a million diseases. The main issue is the insane prices charged by the companies to recouperate in a few years time to appease shareholders instead of several decades, which results in the cold truth it is not worth the effort looking at the grand scheme of things.

That’s the thing. The US system is expensive not only due to inefficiency but also due to a willingness to pay for things other countries don’t.

If you happen to have a kid with a rare disease, that matters.

> Medicaid is actually very good coverage.

As the saying goes, "it's the best insurance money can't buy".

Bullshit.