I assume it's unpopular because the vast majority of people in the US aren't earning 100k being employed with decent insurance ?

To your point, rich people in the west have prime access to world class care, and if it's not an emergency they'll fly to wherever they need to get the best clinics they can afford. People flying to Korea for plastic surgery is a thing.

Even at upper middle class you can go through non subsidized clinics if you want prioritized and/or special care.

Being even mildly rich will always help.

Specifically, $100,000 is about 80th percentile income in the US.

For a conversation about healthcare, household income is probably more relevant than personal income (since members of a household usually, but not always, are in the same health care plan)

About a third of American households make 100k a year. Median household is about 70k a year:

https://dqydj.com/household-income-percentile-calculator/

Perhaps the relevant thing is "household where at least one person makes >100K/yr" since the benefits are probably tied to the type of job.

But I suspect the person making the claim was just picking an arbitrary number where most people in that salary band will have decent benefits, and can usually afford the out of pocket portion also

> Perhaps the relevant thing is "household where at least one person makes >100K/yr" since the benefits are probably tied to the type of job.

I think you're reading too much into the OP's off-hand guesstimate. At every company I've worked for, the engineers earning $200K are on the same health insurance as the high school graduate in the warehouse earning $40K/year. The higher compensation makes it easier to clear the deductible/out of pocket maximum hurdles, obviously, but there wasn't a secret insurance plan that got unlocked at higher compensation.

Another factor is how much the employer pays for this which indirectly leads to a smaller paycheck as well. You are also at the mercy of your employer for what health plans are available. You might have to change doctors of your employer changes who they work with or if you change employers.

> To your point, rich people in the west have prime access to world class care, and if it's not an emergency they'll fly to wherever they need to get the best clinics they can afford. People flying to Korea for plastic surgery is a thing.

I feel like a lot of such medical tourism has more to do with cost than quality of care.

If you're unemployed, you almost certainly qualify for Medicaid in 41 states. It's the best insurance money can't buy. It covers everything. You pay for nothing. In fact, it's illegal to charge you for anything. Balance billing doesn't exist. You cease to be a mark for the healthcare racket if you can engineer your income to $0 on paper. The vast majority of medical providers will accept it. It is the best insurance I've ever had. If it were possible to get private insurance for $0 premiums, or pay $500 a month out of pocket for individual Medicaid coverage, I'd pick Medicaid every single time. I cannot overemphasize how much I despise the private insurance racket. The only reason we don't have a public option is because it would destroy the private racket overnight.

Mental healthcare is a different story, but it's not any better with private insurance. Every therapist or psychiatrist in the insurance racketeer's provider directory is either dead, moved out of state, or not taking patients. "Ghost networks," they're called...

The worst insurance I've ever had was at a FANG, via United Healthcare. It covered nothing. Hardly anyone accepted it, apart from the on-site health clinic. It was worse than a university health plan, for god's sake. As to quality, you say it's the best in the world, but the fact that the US now has a life expectancy lower than China, Cuba, and Albania determines that this is a lie.

Unpopular truth on this forum: the healthcare system in this country is owned and operated by organized crime entities. It is completely illegitimate. It consumes 19% of GDP of the richest country on the planet, and Americans are some of the least healthy people outside of active war zones. Unless you're using your doctor as your Xanax dealer (John Mulaney explains how that hustle works: https://www.tiktok.com/@funkytownmc/video/722624028419819447...), this system sucks for you too.

I would be shocked if the Mexican cartels weren't deeply involved with United Healthcare and all these other corporate gangsters. This industry is the greatest crime of all time.

> As to quality, you say it's the best in the world, but the fact that the US now has a life expectancy lower than China, Cuba, and Albania determines that this is a lie.

The sad truth about those stats is that if you split them by social class, you get two distinct groups: disenfranchised people with some of the worst health outcomes in the world, and privileged people with some of the best.

The childibrth related mortality rate for black american women is 3x higher than for white women, for example.

The US is also extremely segregated, and a substantial percentage of black Americans live in those confederate states that have not expanded Medicaid yet. Texas has a higher maternal mortality rate than Iran.

Geography is a greater determinant of health than race. People die a full 7 years earlier on average in Mississippi than California or Massachusetts, and 6 years earlier in West Virginia.

There's a clear correlation with income here, but one can easily argue that both income and life expectancy are downstream of policy. Red state policies are simply bad for your health and your wallet.

Good luck finding high quality doctors though, especially specialists, that take Medicaid and don't make you wait over an hour beyond your scheduled appointment time. The reimbursement rates for Medicaid are notoriously low, and as a result, a lot of doctors severely limit the number of patients they'll see on it.

I kept the same PCP at an Ivy League affiliated medical center. I had to see a couple specialists, no issues whatsoever with them accepting insurance. It might vary by state, but that's not my experience whatsoever. Private insurance plans are far worse in this regard.

It's really just mental healthcare and dentistry that are basically impossible, but again, not much better with a private health plan.

Take the blinders off, stop pretending you're not getting robbed, and maybe we can fix it. There is no silver lining to private healthcare. You're not getting better care. Social determinants of health are very real, but they're driven by those 9 states without Medicaid expansion dragging the averages way down, a lifetime of bad care before the ACA, and also that medicine can't solve the many problems caused by poverty.

We would all be better off in literally any other system. Everyone thinks they're an above average driver. Everyone thinks they'll live longer than average. The truth is, you're just not that special. Unless you're a politician that gets to go to Walter Reed, or you have a wing in the hospital named after you, you're getting the abysmal standard of care that everyone gets.

I tried to find a GP for a young adult on Medicaid this year, and the first half dozen that I tried (selecting specifically places that said on their website they took Medicaid) would not take a new patient on Medicaid. So yes, your experience as someone who already had a doctor may be much better than it is for the normal Medicaid recipient, who did not start with private insurance.

At the same time, I was looking for a new dentist for myself and for this kid. There are a half dozen dentists who would see me within ten minutes walk. I finally found her a dentist some 20 minutes drive away (bonus: she can't drive).

And the mental health provider we found who would take Medicaid did intake for new patients on Friday mornings between 9am and 12 noon, no appointments, recommend you arrive early in order to be seen.

This is in WA.

Mental health providers are nearly impossible to find in the Seattle area, no matter the insurance, or even paying cash.

For whatever bloody reason they just don't exist in anything near enough quantity.

Have you tried to find a new GP for an adult with private insurance recently? Many areas have a shortage in general. This has little to do with insurance coverage, and everything to do with the bad incentives of the medical profession. Who would become a GP with your MD, when you can make twice as much money as a specialist instead? It's like getting a CS degree from Stanford and deciding to become a sysadmin at a high school with it, instead of becoming a SWE.

Conversely, I'm surprised you found a dentist and a mental health provider that takes any insurance at all, and didn't have a months-long wait list. I've almost always had to self pay for both...

Yes, in fact several of the doctors I called would have been happy to take her on if she had private insurance. This has everything to do with insurance.

Important information if true. What is your basis for believing it?

Do you for example have data showing that life expectancy in this group is higher than, e.g., the life expectancy of an average citizen of France?

I don't think this in an unpopular truth. USA is renowned for having some of the best healthcare in the world. It's the equity and access to the healthcare that is the issue. Not quality of healthcare.

You better not get laid off or fired.

I would second this statement.

Availability maybe. Quality is questionable/regional. Cost absolutely definitely not.

Add up what a person making $100k pays in insurance premiums, plus what the employer kicks in on those same premiums, plus the deductibles and co-pays for every procedure, plus drug costs even with insurance and it's not even in the same ballpark. Even if you are healthy and don't go to the hospital the premiums are huge for even basic health plans.

Worth noting poor health tends to impact $100k / year earnings.

This is a hard lesson for many later in life and why social safety nets are so important for everyone.

Right up until you get cancer, max out FMLA, get laid off, max out cobra, and then are on your own for payments.

At some point in that process you should be able to get onto Medicaid and/or Social Security Disability. Of course that can take a while and it's not easy for a patient to deal with cancer treatments and navigate those systems simultaneously.

Medicaid and disability are not as golden as you make them out to be. It’s actually quite difficult to get treatment.

I never claimed that Medicaid and disability were "golden". Go back and read my comment again. Those are last resorts for people in bad situations. But anyone eligible should go ahead and apply, at least to get the process started.

Disability in America is a death trap imma be honest with you, if you’ve never personally tried to navigate it I don’t think you should be recommending it anywhere. It’s normal to be denied, then spend over a year on the appeal, and then you must never own more than a small amount of money.

I am not "recommending" disability. I totally understand that it can be difficult to navigate the application process. But anyone who meets the eligibility criteria should go ahead and apply to hopefully get some financial support.

Even so it's a maddeningly complicated system. If you end up in front of a doctor outside of your magic network, you might end up with a sudden several thousand dollar bill instead of $400.

Minor mistakes and games can also create odd billing situations that are opaque and difficult to fight.

True, but the No Surprises Act has eliminated some of the worst abuses in that area.

https://www.cms.gov/nosurprises

The big problem is that 1) the potential cost is essentially unbounded and can end up being ruinous even for someone relatively well-to-do 2) there is an unfortunately high likelihood of losing the job and insurance coming on the heels of getting a diagnosis where you really need care.

I was unemployed for a year and paid under $200/month for a good insurance through market place, which I happened to use twice. That's not a lot of money. And I don't think the US healthcare system is as terrible as people think it is, particularly after Obamacare. There's a lot of variation of course, if you are in a big metro area chances are you have access to one of the best doctors and facilities in the world. I have colon cancer and heart disease screenings and I pay a few hundred dollars combined every few years. Copayments to see specialists are $35. Xrays are free, medicines are a few bucks. Biggest expense to date was shoulder surgery at under $2000 out of pocket, but I was taken care of by one of the world lead experts in the subject. For something that can alter your life forever I happily pay to have promptly access to such level of care instead of being on a wait list to be operated by the next available doctor picked by the system. From that perspective $2000 is cheap.

That certainly wasn't my experience. I didn't know any better until I moved to another country.