US healthcare is excellent – if you can afford it.

US healthcare is excellent?? The country where doctors were bribed to prescribe opioids to anyone and everyone and created a massive drug abuse crisis that is still ongoing?????

Yeah that's the crux isn't it? Either you provide healthcare for everyone and thus have to ration it or you make it unavailable for the poors.

So why are so many of your citizens without even basic affordable healthcare?

They aren't. Anyone can go to the ER, and if you're poor it'll be billed through Medicaid. When I was young and poor, I had a multi-day hospital stay and multiple surgeries that totaled to $3.50 out of pocket. Urgent cares are everywhere and affordable.

I had a cholecystectomy a few years ago and had a complication that caused a gallstone to get lodged in my common bile duct after removal. Three days after surgery I was in the ER, I let them know I was in debilitating pain and that I just had surgery. They made me sit in the waiting room for 8 hours and only took me back when a doctor walked passed and noticed I was jaundiced. After his shift ended, the nurse who was watching me overnight while I waited to have an emergency surgery (because the surgeon had already gone home for the day by the time I got triaged) was told to keep an eye on me and do blood draws hourly. I didn't get seen once and by morning my liver enzymes were so high they were off the testing scale.

Sure you can go to the ER. The level of treatment you get heavily depends on luck

That's a ER triage complaint, not a financing complaint.

Can you recommend a good ER for getting dental fillings or an annual checkup?

ER isn't the only part of healthcare that matters. Most things can be prevented with easy access to GP level care.

ER is for accidents and when health problems get out of hand. If you end up at ER with a preventable problem the system has already failed you.

Only having free access to ER doesn't constitute healthcare.

> Anyone can go to the ER

They'll treat you if you have a heart attack and make it in alive. They won't put you on blood thinners or statins 10 years before that to keep you out of the ER in the first place.

I don't think ERs do chemotherapy either.

Yup, ERs are not a replacement for actual medical care.

Their only goal/duty is to stabilize you during an acute medical emergency so you don't immediately die.

What do you do to address health concerns before they become ER-level?

Medicaid or ACA subsidized insurance

>> so many of your citizens without even basic affordable healthcare

> They aren't. Anyone can go to the ER, and if you're poor it'll be billed through Medicaid.

You guys are both wrong, and arguing with broad brushes about something that's complicated and subtle.

Health insurance is available to everyone in the country, but it's expensive and extremely complicated (among other things: you don't "bill through" Medicaid and lots of folks who qualify aren't on it because they can't figure it out).

It's true that the pre-ACA world where getting sick without employer-provided insurance means dying poor is gone. Almost everyone who needs serious care in the US gets it in some form, but lots of care is delayed because people aren't covered, as getting covered is "affordable" but extremely expensive (unsubsidized family plans run $20k/year and up!). It's much better than it used to be but not a great system.

The flip side is that it's also true that the large-payer corporate insurance system provides "better" care in the sense of access and outcomes[1] than the state-run systems in Europe. It's extremely rare in the US to hear the "on a waiting list" stories about elective care that you hear especially in regard to the NHS.

It's complicated, basically, and not well-suited to yelling on the internet.

[1] Obviously the system pays for this with much (and I mean much) higher service rates than the rest of the world extracts for the same care. US doctors and health systems do very well.

It’s good if you’re rich I assume

Not "rich", but "employed by a major corporation". Large-payer private insurance in the US is fine and produces outcomes at or above the level you see in the rest of the industrialized world. All the yelling is about ACA plans and subsidy programs.

Healthcare trilemma

Define "so many". Most people have health insurance through their job, which translates to them having basic affordable healthcare. Not everyone has this, so I'm not saying it's perfect, but it's not some abysmal state of affairs where most of the country is suffering.

What is the 'INSERTNAME' law that explains how all conversations on HN, which is ostensibly focused on tech, devolve (evolve) into the realm of the humanities?

Seems like a corollary of Godwin’s Law.

UK isn't EU, especially when it comes to health system. I lived in the US for quite some time (from Fr), the healthcare is great... if you can afford an expensive health insurance AND pay some extra money when required. The avg US people can not pay and when you can not pay the experience is just far worth than terrible.