Healthcare in the US is a disaster! Warning: Rant

[KonstantinosM]

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.

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[r1s2g3]

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.

[bones261]

@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.

[KonstantinosM]

@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.

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.

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.

[coins4commies]

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

Welcome to capitalism.

[bluefirecorp_]

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

Since President Nixon signed The HMO Act of 1973 into law, healthcare has been a commodity or luxury instead of something all Americans should have. With profit as a motive, significantly less money is spent on actual patient care and treatment decisions are based on balance sheets instead of medical needs.

[Coinifyx]

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 

[o_e_l_e_o]

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 healthcare system is broken. In a Commonwealth Fund Report the US ranked last overall, as well as last for efficiency, equity, and cost-related access. The only category the US came first on was price - so as well as being the worst healthcare system in the developed world, the US is also the most expensive in the world, spending approximately 6-7% more of its GDP on health.



If you compare actual dollars per citizen the difference is even more striking - the UK's NHS, the highest rated healthcare system in the world spends $3,405 per citizen per year on healthcare. The US spends a whopping $8,508, and despite spending 2.5x per citizen, those citizen receive significantly worse care and outcomes. That's without even touching on the astronomical individual cost of health insurance, and the fact that any US citizen is a single major illness or disease away from bankruptcy.

[Spendulus]

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?

[iknowsatoshe]

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.

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!

[Flying Hellfish]

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?

[suchmoon]

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.

[Goodvalony]

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.

[Spendulus]

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... ....

Well, that's complete nonsense.

[KonstantinosM]

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.

[mOgliE]

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.

[KonstantinosM]

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.

[suchmoon]

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 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.

[o_e_l_e_o]

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

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. Each of these are for vials of 1000 units of various types of insulin, which would last a month or more for most people:









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.

[Spendulus]

....
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.

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.