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First off, I don't understand the law fully, but I'll describe the situation as it seems to be.


If you make between 100% to 400% of the poverty line (around 13k-52k) you receive a tax credit to help you pay for health insurance. This can drop the cost of health insurance for a working class person from $300 a month for a basic plan to around $60 per month making it affordable.

Of course that doesn't mean that this person won't have healthcare expenditures, there's co-pays (you pay part of your doctor visit) and deductibles and other things, especially with basic plans.


Now here's where I think the system is broken. If you make 99% of the poverty line, the government gives you absolutely no help. So you either have to pay the $300 per month for health insurance or pay a fine of $695 or 2.5% of gross household income (whichever is greater)

So you either spend a large amount of your income to get health insurance, or a fairly big fine. About 8 Million people where hit with the fine in 2016.



Now if you're 65 or older, and you've worked for 10 years at a job where you paid medicare taxes, you're covered, I think you're also covered for life if you're military, with the drawback that there are very few military hospitals so you may wait for a very long time.

A few notes, it seems that in most cases there is an exemption for the tax penalty, it is based however on technicalities.
I think this might be the last year where there will be a tax penalty. Starting in 2019 it may be an option to be uninsured without penalty.

That's just the financial side of it.


So, health insurance in the US is messed up.


How about how much money we spend for how much we get back?

I've lived in a different country before the US and I remember the hospitals and the doctors as deeply entrenched into an almost military like system, supported by a lot of government infrastructure in their day job. You'd go in, and you'd get taken care of. You could go to a private practice instead and you'd pay a reasonable amount, health insurance or not.


My experience in the US has turned me away from seeking the help of doctors at every turn. I have what is considered to be good health insurance.

I avoid doctors all together. I've broken a bone that I set myself and I've even sewn myself up. I'd never have done this living in another country. I just don't want to foot a $1000 dollar bill from the ER or have to pay off the cabal of moneymakers that are the gatekeepers of getting mostly substandard healthcare here in the US.


The hospitals are a joke, they feel unsupported by an organized government and even have volunteers on staff. Basically free labor. Some doctors won't give you any more insight then what a few hours of personal research on the internet and will look at you for a few minutes, after hours of waiting. They may expect 500-1500 dollars for this service.


A lot of doctors seem not to really care about the patients, whether they will die or not. A lot more still seem to see their patients as just a source of income.

So this is just my anecdote of what we get, we could get down to numbers but I think everyone has seen the charts. We spend about 18% of GDP, this is about more than double then what most countries spend. About half of it seems to be public and about half of it seems to be private.

We get worse healthcare outcomes than most countries. We're not living longer, we have more disability.
https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-u-s-highest-rate-deaths-amenable-health-care-among-comparable-oecd-countries



I don't get it. Why is healthcare such a joke here.

Same for me. I come for deputation in USA. what surprised me that taking appointment with regular doctor is nightmare. Even with insurance , I paid much more what I pay in my home country. Charged $1200 for ultrasound, paid $240 from my pocket.
Surprisingly it cost $15 in my home country without any insurance. If I paid $240 in my home country instead of taking appointment, I can ask the hospital to seek appointment with me. :)

@OP. You must live in a state that didn't accept the Medicaid expansion. Otherwise, if you make 99% of the poverty line, you would get Medicaid. But hey, State's rights and all. ::)
All I can recommend is move to Colorful Colorado. You should be able to get Medicaid as soon as you establish residency. Unfortunately, housing costs are a little high in the Denver metro. Maybe live in one of the rural areas on the plains.

2 People replying so far, both have pictures of hats as their profiles.

I make more than the poverty line.
I'll look into the medicaid expansion. I love Colorado, unfortunately I live in Florida.



That's the kind of experience I'm talking about. It's really shocking. I know I could go and get a filling at a dentist or even go to the hospital and I'd pay a reasonable amount for it where I came from. Over here it's a fake inflated price and the actual service is worse.






Here's a video excerpt that's relevant from someone I love to watch. He talks a little bit about his health insurance and care here in the US, it's very entertaining.

https://youtu.be/HX2wiU7ndZ0?t=1500

Edit: Added the line about making more than the poverty line.

Why are you worried about efficiency and value for your money when the system is highly profitable?

Welcome to capitalism.

Thanks Nixon!

https://en.wikipedia.org/wiki/Health_Maintenance_Organization_Act_of_1973

Meanwhile....
https://www.newsweek.com/pentagon-rushes-spend-billions-end-month-1137552

Pentagon gets a $700-billion budget while citizens can't afford average healthcare  ;D

I've posted about the US healthcare system before on this forum, so I'll quote a relevant section of one of my previous posts below. The US healthcare system is the worst in the developed world. US citizens spend significantly more of their income on healthcare, and the US government spends significantly more of its GDP on healthcare, than any other developed nation. And for that astronomical price, US citizens get the worst healthcare in the developed world.

The US just needs to move over to the undeveloped category, then we'll be the best.

Next?

I guess we should really start to seek how we can de attach from traditional health care procedures especially with the public sector. It turns out that billions of dollars are spent in an annual basis for overcosted expenses both from patients or healthcare service providers. Blockchain projects can help reduce these costs and connect correctly the 2 sides on this life chess. Last relevant project I checked is HiNounou token, which has the capacity to deliver above all a nice living standard for its long term users/patients via its home wellness kit. There are a lot of healthcare projects in the space after all like OPU Labs also, etc. We should focus on how we can bring them in market and start having some real use cases!

There's always a lot of debate over health care (obviously people like being healthy go figure eh!).

There isn't a perfect system and there are a number of different approaches around the world.

The biggest problem in the US health care system IMO is the incentive is for diagnosis and treatment.  There is no financial incentive in prevention...  Fortunately there are lots of professionals that look beyond financial incentive to provide some preventative information but the industry itself has little to no financial incentive to focus on preventative medicine.  I don't mean this as a knock on doctors and nurse's they are doing a great job and change lives everyday with their skill, compassion and dedication.  This is much more of an industry level issue.

You are a better customer to the medical bean counters if you have to see the doctor and use meds etc more often than not.

A lot of countries have taken the regulation step to stop this but there focus still isn't IMO enough on prevention.

I think that perhaps some smart people should look at how to redistribute the incentives for the medical share holders.  If somehow the system was changed to a value based system where doctors and hospitals made more money the healthier their patients are?

I honestly have no fucking clue how that would work or look like TBH but the principal of keeping the government regulations limited and allowing a more free market system might be possible if somehow the incentive for healthy patients was the primary motive?

There are systems based on per-capita prepayment, e.g. Kaiser Permanente. The costs are still outrageous. The quality might be better, not sure.

Still above all, you guys remain the champion of the world regarding Human rights.
take your time if you can and come down to Africa.

i doubt if you will be able to state your complaints again about your healthcare.

Well, that's complete nonsense.

Bernie Sanders released a brilliant video that showcases the differences in healthcare between the UK and US.
https://www.youtube.com/watch?v=Cen5fkIwFjU

There is a US Citizen student with type 1 diabetes who could not move back stateside after getting a masters because of healthcare cost.

Seriously, can anyone say brain drain?

Every educated person we lose makes us a shittier country and this yet another issue that no-one seems to talk about in the multifaceted dumpster fire filled with the corpses of US Citizens that is our healthcare system.

Edit: Added link to the video. How could I forget.

Sorry for you man but you have to change of country  :(

Healthcare, education and prisons are completely fucked up in USA.

In those 3 categories, USA is the Western country spending the most (by that I mean the biggest portion of its global GDP) but still get the worst results and the most unequal treatment.

The system is completely private and monopolized by big corporations. That means there is no reason to not make you pay all they can. You have no choice so they can squeeze every $ from you, what are you going to do?

Healthcare in particular shows how inefficient and unfair private corporations manage basic human needs. Capitalism might be great to produce Iphones but not so great when it's about educated people, keeping them healthy and safe...

Just come to EU. I pay 40€ of health insurance every month and my "expenses" on healthcare are basically 20% of small interventions (like going to the doctor or small drugs). If there is a heavy operation or sickness, usually you don't pay anything.

If you don't mind, just for reference in which country do you live in the EU?

This sounds like a great deal if I were to move to the EU for healthcare England would be my first choice.
I think healthcare is such a hot issue here that we may actually change to a good system soon. Or maybe we can re-elect Trump.

A little off-topic past this point, skip if not interested.

I'm originally from Greece, my situation is a little complicated, I've been labelled as dodging my military service when the consulate fucked up my papers. I think I can still get an EU passport.

I don't know if I can justify it to myself to keep living here in the states. Another big factor where the US is far behind Europe is food quality. You can't buy vegetables that haven't either been grown too fast or picked at the wrong time or left in storage for so long so most of it tastes bad.

Most meat is also sub-par.

Another issue here is that you don't really have that much freedom to be anywhere at any time. There's a lot of suspicious people and the police creating a hostile environment in all public spaces, especially in populated areas.

Living here without a lot of money traps you here, you get stuck just paying the bills month after month.

I don't really feel like moving, There are things I don't know about every other country. I know Greece would be great for me in everything with the exception of having earning potential.

I'll stay in the US in the hope that I can make enough money to live 6 months out of the year in Greece and 6 months out of the year stateside.

If I can get into shape I'll join the military so I'll have insurance and money to pay for an education and 30 days vacation time a year.

If you can do that then you can probably make enough money to pay for decent health insurance. Granted that doesn't solve the other problems.

Or you can use my plan... work 2-3 jobs for 20 years and retire early. The US is a great place to do that because for all its faults hard work is still highly rewarded here compared to most of the rest of the world.

That video is ridiculous. I love the Fox News anchor foaming at the mouth with rage about the UK health service, when UK healthcare demonstrably and provably outranks US healthcare in every measurable way, including access to care and timeliness of care. Also, $1000 a month for insulin is utterly insane. Here are a few screenshots from the UK's national drug formulary (https://en.wikipedia.org/wiki/British_National_Formulary). Each of these are for vials of 1000 units of various types of insulin, which would last a month or more for most people:

https://i.imgur.com/uSLgoAx.jpg

https://i.imgur.com/fii0fq4.jpg

https://i.imgur.com/akRQRuq.jpg

https://i.imgur.com/KWNEgAu.jpg

So we are talking around 1-2% of the price that someone in the US is being charged. But UK residents don't even have to pay that - they get it for free. And the UK government spends literally half as much of its GDP on healthcare as the US government spends. If this doesn't convince you that US healthcare is broken, then I don't know what will.

As a side note, is this why US residents are so averse to socialized healthcare? Do they honestly believe the price of insulin is $1000 a month? Or that it costs $40,000 to give birth or have a joint replaced? Or that a cancer treatment costs $300,000-$1,000,000. I always figured people realized they were being monumentally ripped off. But I suppose if they honestly believe those are the prices, and they believed that their taxes would have to go up even more so the government could spend even more of its GDP to cover a socialized plan, it would explain why they are so against it. It's completely wrong, but it's a possible explanation.

Basically, yes.

US residents know that it would be a gigantic fuckup to let these ridiculous costs get frozen into a socialized health care system, and they know that's what would happen to them, given the deep state and the way the lobbyists work in Washington DC.

Bad as it is, it has the potential to get a lot worse.

Most people don't have the slightest clue about pricing, which BTW isn't quite as simple as $1000 or $40k. Providers (of which there will be numerous ones even for a simple 2-day hospital stay without complications - doctors, nurses, room, drugs, food, even the fucking TV in the room is billed separately) bill you $40k, insurance "negotiates" down to $14570, you pay $1750 deductible plus 30% above that up to your individual out-of-pocket maximum of $5600 but not exceeding your family OOP of $8700 and also depending on other expenses your family had that year (numbers vary depending on your plan), some of which you might be able to deduct on your tax return. So how much does it cost to give birth?

And that's relatively simple compared to pre-Obamacare shit that had pre-existing condition exclusions (pregnancy was obviously one of those) and lifetime maximums and other BS.

But the biggest perceived issue seems to be the fear of "rationing" that many associate with "socialism", despite there being no rationing in Medicare or VA or other government healthcare programs.

Can you blame them when it's that complicated? Here's the pricing in most developed countries: Every treatment/prescription/surgery/therapy/consultation: $0.


Lol. Just lol.

Filthy communists.


BTW women pre-Obamacare also used to have higher health insurance premiums, because apparently men have nothing to do with childbirth whatsoever. If that's not proof of immaculate conception I don't know what is.

I'm now close to retirement and thankfully still have my health.
But speaking as a British ex-pat and holding both a US and UK passport,(and a UK  National Health#... akin to a US ss#)
if  there was any reason for me to move back to my  "home" country to maybe retire,
it would most certainly have something to do the ridiculous state of health care in this country (ie... the USA).

You might want it cheap, or you might want it equally priced. Any experienced actuary can develop tables of what you will get for x number of dollars input under any such premises.

But when the controlling factor is industry lobbyists, a good deal you will not get.

Not sure if you meant it this way or not but this is literally why the rest of the developed world has legislated the private sector and lobbyist out of healthcare as much as possible.  Ironically enough the commies that do this spend WAY less tax dollars while providing WAY better healthcare for it's citizens.  As long as the corporations can continue to trick stupid people into believing any government intervention will end up in a communist state in 3 years Americans will continue to die earlier and spend more public money on healthcare than the rest of the developed world!

The corporations purposely conflate socialized healthcare with government making your pants and cars etc and uneducated or down right stupid people eat it up like a fat kid eats cake.

I can assure you that living in a country that has socialized healthcare does not lead to the government making my jeans and phones, but it does have one side affect, my family never has to worry about declaring bankruptcy from a medical condition or not seeing a doctor because we don't have insurance and can't afford it.

Fuck your snotty know it all talk, I'm telling you what would happen in the USA.

Good old "thoughts and prayers, nothing can be done" method :)

I think there is a couple of ways this can work out. Either the youngsters will vote the dinosaurs out instead of just whining on the intertubes, or the federal government will cannibalize itself with tax cuts so states will say "fuck it" and implement proper healthcare on their own.

Well I was gonna comment but I don't want to be a snotty know it all....

California, Texas, Florida etc could go it alone but states like Vermont, Wyoming, the Dakota's etc would probably need federal assistance to make it work.

It might be interesting to see California create a state run healthcare system.  All the smaller states could be shown how it works at home and in a couple dozens years might figure out what the rest of the world figured out decades ago!

I don't see a problem for Vermont, there are tiny countries in Europe doing it reasonably well. In the US itself most insurance groups are smaller than the smallest state. And Wyoming doesn't want communism anyway so who cares ;D

Another side of this whole healthcare bullshit that rarely gets mentioned is how it hurts businesses, particularly small ones. Healthcare is expected to be a "benefit" provided by the employer. Which is obviously not free and it costs the employers and by extension the employees those 18% of the GDP.

Large employers have a huge advantage as they can spread the risk over a large pool, much like a state-run system would but with fewer elderly and disabled and other "expensive" individuals. Midsize employers are still ok-ish until one person gets cancer, which could double the costs for a 1000-employee business (unless the person dies quickly). And small businesses are utterly fucked. Even if by law they're not required to provide insurance (below 50 employees IIRC) - that still means they can't compete with big businesses in the hiring process.

It also makes businesses less competitive in the global market, stifles freelancing (domestically and globally), and discourages anyone over the age of 50 and/or not in 100% perfect health from entrepreneurship. That can't be good in the long run.

Admit ignorance, you don't know anything about CA's state run healthcare.

Smaller states need to band together, sure....it's the REPUBLICANS THAT HAVE BEEN SAYING THAT, and it's your Democrat friends that have at every chance, stopped or stalled availablility of healthcare plans "across state lines."

Why? Because of the influence of health care lobbyists on their agendas.

The health care lobby is strictly for higher cash flow and profits, it doesn't care what you call the plans.