I’ll put it this way:

At least 68,000 Americans die every single year due to not being able to afford healthcare.

We pay an extra $450 BILLION annually to enrich unnecessary middlemen and ALL of our politicians are being bribed (or primaried) to prevent Single Payer. You’ll hear people like Kamala and Warren talk about “access” to healthcare while they receive massive bribes from healthcare companies to pull support away from Single Payer and offer a “choice” or “access to health care”. Remember 2016 and 2020? The DNC pulled out all stops to prevent Single Payer. Remember when Bloomberg ran for office and claimed , “under my governorship, New York had less uninsured people than at any time in history” while failing to mention that he enacted steep penalties for being uninsured? That’s neoliberal gaslighting 101! Kamala loves to do it too! But yeah vote for her because she’s “one of the good guys” and certainly wasn’t one of the people that was tasked with preventing Bernie Sanders from winning the primary two cycles in a row, offering “Medicare for All who want it” so stacked with asterisks and legalese means-testing that probably like 50 people would qualify.

Edit: In my opinion, anyone who is paid to run for office and vote against Single Payer is a murderer guilty of (or at least partly responsible for) the slow, often-painful execution of these 68,000 American citizens per year.

I have student loans that I’d love forgiven but I don’t even mention that issue because true Single Payer (and Gaza obviously) are my moral lines in the sand that almost everyone in Congress except Rashida Tlaib has brazenly trampled.

https://www.newsweek.com/medicare-all-would-save-450-billion-annually-while-preventing-68000-deaths-new-study-shows-1487862

https://www.sanders.senate.gov/wp-content/uploads/Fact-Sheet_Medicare-for-All-2023.pdf

I read something from last year that said about half a million Americans go into bankruptcy due to medical debt each year.

That's it, that's what happens. You lose everything and you start over, if you're healthy enough.

Protect your NHS.

WILDLY depends. And it is never simple.

If I break an arm, and I go to the hospital, and there's not much that's done aside from a cast, and some PT at the end, I pay $0.

Now, what does that mean?

We have had our insurance for a long time, and as we pay our monthly premiums, a little money goes into an account called an FSA. This pays some of the co-pay, deductibles, etc. in the background for us.

What happens if I get cancer and need to have some care for 7 years? Eventually that FSA runs out. Every insurance has a deductible that you pay before they start paying for everything. So we might have to pay $5k out of pocket annually and then insurance pays the rest.

What if I need to travel to another city to talk to a specialist? There might be airfare, hotels, food, etc. that we pay that is "part of the treatment" but not paid for by insurance.

What if I need medication? Might be $25 every trip to the pharmacy. Might be $300. Depends on the medication, how new it is, are there cheaper alternatives?

What if I get sick long enough where I lose my job? I might lose my insurance as well, and then have to apply for government assistance, that might make other medical bills different.

"However, I have an American friend who is quick to point out that apparently nobody actually pays those bills. They’re just some elaborate dance between insurance companies and hospitals. If you don’t have insurance, the cost is lower or removed entirely. Supposedly."

Partial Truth.

Healthcare providers have negotiated prices for services. These prices are negotiated per insurer.

Blue Cross and Blue shield will pay them X dollars for Deep Sleep anesthesia. United Healthe care will pay them a different amount. Medicare will pay them yet a different amount. Bob's backyard healthcare will pay more because they don't have buying power.

If you walk in without coverage, the provider "can" charge you a reduced rate. They are not required to. They do NOT universally offer that.

If you get the procedure done anyway, agree to pay and cannot pay your health bill, the provider "can" just let you off the hook or reduce your rate. They do NOT usually do that. That's the exception.

If you go to a provider that accepts your insurance (they all do not) and book a procedure, the provider has to get the procedure covered by the insurer. If the insurer decides not to cover the procedure, you can call the provider and try to create a grievance. The back-and-forth is maddening.

My local doctor said I needed a colonoscopy (it's just that time, no emergent issues)

My insurer authorized the procedure but not the anesthesia.

The office offered to pay out of pocket for the anesthesia ($1200), but I declined because I couldn't afford it. They also offered to set up payments if I paid 50% upfront, but I declined because that didn't help me. I can't take on another $100 / month for 12 months.

I spoke with the GI doctor, a second GI doctor, and my General Practitioner. They all said that people here really don't get the procedure without anesthesia, and it was a bad idea for both the doctor performing the procedure and for me.

I contacted the insurer, but they refused. Another GI doctor contacted the insurer, but they refused.

My insurer decided in January that they will not cover anesthesia for a colonoscopy unless someone can prove you're frail enough it might kill you.

We have federal laws that mandate insurers to cover the anesthesia for this procedure, but state-level insurers (hint: they're all state now) don't have to follow their rules.

So here I am, two years late for a colonoscopy, wondering if I have pre-cancer or cancer brewing down there, but can't manage to pay for what is considered by all providers here a necessary part of the procedure.

It's not great here.

I work for one of the largest healthcare providers in the US. I pay $450/mo for health insurance. This is not including vision, dental, or money I set aside for FSA (a pre-tax savings account restricted for use for paying for healthcare) and for and HRA (similar to FSA, but intended for when you're older, and our company partially matches our contributions). The FSA has been refusing to pay for legitimate doctor visits that insurance has sanctioned. I pay out of pocket for a lot of procedures that the insurance ducks, such as laser eye surgery, vasectomy or even for birth control pills prior to the vasectomy.

The laser eye surgery was ~$5,000 out of pocket, the vasectomy was ~$2,000.

I had a visit to the ER - I was driven by my partner to avoid ambulance costs, and with insurance, had to pay $450 only for the doctors to stay they couldn't figure out what was wrong and I end back up there later that week for another $450.

I was in a car crash a few years ago and my medical costs (again, with insurance) came out to ~$250,000.

This is while making $85,000/yr working as a Senior IT Engineer, and paying $2,700/mo for rent.

Generally speaking, with insurance, we're probably paying about twice as much for any given situation, but insurance itself is also expensive and likes to dodge paying for as much as possible.

i have to pay ~1000/month just so i can walk in their front door of the hospital. after that, insurance companies do everything they can to not pay my bills.

america absolutely fucking sucks. insurance companies only make money when human beings suffer. think about that for a minute, their profits are literally built on the back of human suffering.

If you are and remain healthy it is very expensive. If you get sick or injured or ill

It costs more than you have

On average they actually spend $12.500 per year (total, PPP adjusted, at leat that's the number for 2022)

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

You as a Brit spend $5.500 (also adjusted) (And as a bonus, at the same time you're also expected to live 2.8 years longer than the average American.)

You may have heard about "Obamacare" or the "Affordable Care Act". This did a lot of things which helped some but also did not do much.

For example, insurance premiums can cost hundreds of dollars per month, but if you get subsidies you can reduce that cost down to, potentially, zero. Unfortunately these subsidies are in the form of tax credits, which means if you don't work you do not get any subsidies.

Additionally, if you happen to live in a red state, then your state probably didn't expand Medicaid. Medicaid is the government insurance for poor people. If your state didn't expand it, then your state only gives Medicaid to families and disabled people (basically). So if you don't have kids, you don't qualify for it.

For me, this means that when I stopped working and got insurance through the ACA, I had to pay $500 per month in health insurance premiums (dental and vision are separate insurance plans and not typically covered in standard health insurance). Did I mention this was while I wasn't working?

With that $500 per month, I still had a $900 deductible (so I had to pay $900 before the insurance company would pay anything). After that $900, my insurance company paid different rates depending on the service (often called coinsurance). A common percentage is 80/20, which means insurance will pay 80% and you will pay 20%. So hospital bills tend to be thousands of dollars. BUT insurance plans also have what's called an "out of pocket max" which means your insurance will cover services at 100%. So any medical things you do after that magic number are basically free for you (you still have to pay the premium).

Ok, but you might have also heard that elderly folks have their own government insurance - called Medicare. Medicare is also available for disabled people like me.

Medicare is confusing AF. It has multiple parts to it - I will only talk about what's called "traditional Medicare", which basically means everything is between you and the government (There's other Medicare plans through private insurance companies, and those plans are similar to what I described above).

So with traditional Medicare there's Part A (hospital), Part B (basically outpatient services), and Part D (prescriptions). Part A is free for most people, part B currently costs about $75 per month, and part D varies but is much like the private insurance above. If you only have part A, then only hospital visits will be covered. If you only have A and B, then none of your medications will be covered! It sucks.

So remember how I said about the deductibles and coinsurance? So Medicare has their deductibles and coinsurance separate for each part! For my part A, if I go to the hospital, it comes out to about $1300 per DAY, but only for short hospital stays. Oh and that's only for room and board. Longer hospital stays have different rates. Also, if you stay in the hospital too long, it starts going against your lifetime hospital days. That's right, if you use up all your lifetime hospital days, then Medicare will just...not cover your hospitalization anymore. Ever. For the rest of your life!

And don't forget you still have to pay extra for any imaging, medications, and doctor visits you had while in the hospital because the daily rate is basically for the bed.

Part B is a straight 80/20 coinsurance. But part B also doesn't have an out of pocket maximum. So if you have a lot of outpatient procedures, then you will end up paying out the nose for it. Currently I basically just end up paying around $30 for each doctor's appointment (not including lab work or any procedures).

Part D depends on what plan you get. Mine was basically 80/20, which means I was going to have to pay outrageous amounts for medications! I'm on like 25 medications and it was going to be hundreds of dollars each month just for the prescriptions. Luckily, we have programs like GoodRx! Which is basically a coupon but for medications. Unfortunately, you can't use insurance if you use GoodRx. Also, the pharmacy won't usually automatically compare the prices to see which method would come out cheaper for the patient. Oh, also, each pharmacy has a different price for the same medication! I'm not even talking a few dollars. Some medications can be hundreds of dollars different in pricing depending on which pharmacy you go to! And it's not consistent either. So basically if you're on Medicare you get to go on GoodRx every month for each prescription and see where you can get it the cheapest at and then either ask your doc to send it there or try to get it transferred. Imagine doing that with 25 prescriptions every single month!

Luckily for me, I qualify for what's called "Extra Help." This program pays for my Part B premium ($75) as well as part of my part D premium (it was about $100 but with the help it's down to $75). They also bring all my prescription costs to $1.55 per medication per month. Unless it's a brand name medication.... 😬

If you're following, when I had private insurance I was paying $500 per month in premiums alone, plus about $50-100 per month in doctor's visits, plus about $50-100 per month in prescriptions until I met my out of pocket maximum. Then just the premium.

Nowadays, I have Medicare + Extra Help. So I pay $75 per month for my prescription premiums, plus currently about $200/month in doctor's visits, plus about $50/month in prescriptions. So it comes out cheaper currently but if I have to go to the hospital again....well, I'm fucked.

By the way, most insurance plans do not have out of network coverage...so if you go somewhere that doesn't have a contract with your insurance company then you will probably have to foot the bill. And a lot of the charity programs that hospitals and doctors have won't let you apply if you have insurance soooooooooooo....

A few years ago, I went to a treatment center for a few months. My total bill was almost $200,000. My personal portion was supposed to be around $15,000. Did I mention I wasn't working? Right. Luckily the treatment center enjoys the tax benefits they get when they write off people's bills, because they wrote mine off. I still had to file for bankruptcy though, because that wasn't my only medical bill.

PS insurance is often provided by your job here so if you lose your job you, at maximum, have until the end of the month with your insurance :) so don't quit your job at the end of the month ;) there is a thing called COBRA which is supposed to bridge the gap between jobs, but it's usually something ridiculously expensive like $700 per month for a single person's premium (yeah, you have to pay more premiums if you want your spouse and/or kids to be covered).

I have (what I believe) is considered "very good" insurance. I pay $100 a month for premiums.

When my child was born, there were some complications and we needed to move to another hospital for emergency surgery.

The birth: ~$2500 deductible/copay/whatever you want to call it. I think this is all I would've had to pay if there weren't more complications.

Surgery and aftercare for baby: ~$5600

Care for momma: ~$2000

But here's a crazy twist. When moving hospitals, we rode in an ambulance. But this was an "out of network ambulance". What the hell is even that? Under what circumstances do you have a say in which ambulance you ride?

Out of network ambulance ride: $4500

Basically it's all just bullshit.

In addition to the actual costs other people are talking about, the mental costs of dealing with the system are inmense.

You have to update your information whenever you change your job. It's not like your social security number that'd given once and you memorize.

Every year you probably have to review your insurance options and pick one. This is essentially gambling- if you pick a low cost one you save money, unless you actually need to use it.

You probably need to find doctors that are "in network" or pay a lot more.

Sometimes bills are sent directly to you and that's a mistake. But sometimes you're supposed to pay and be reimbursed.

You typically don't know what the costs will be up front, so you have to guess what the best option is. Take a nasty spill on a bike? Is it worth calling an ambulance? Does your insurance cover that? Maybe just walk into the emergency room. But does your insurance cover that? Maybe just call a regular doctor?

In short, there's a lot of stuff you have to think about as the end user. I'd rather it was just "oh shit you're hurt, let's take you to the doctor. Don't worry about money"

I had an explosive migraine a couple years ago and went to the emergency room because I thought I was dying. I had to wait for about 3 hours before being seen. Once I was seen they did a brain x ray and gave me an IV migraine medication. I had a bad sinus infection and inflammation that was pressing on facial nerves and triggering the migraine. They told me to take Claritin and sent me home.

After about a month I got the bill, over $8000. I forgot what my "good" insurance paid to the hospital but my part of it was $8k. For an x ray and IV. They also charged $200 for IV hydration which I didn't ask for or consent to, and didn't need because I keep myself well hydrated always.

Also it turned out that this infection was bacterial because about a week after I went to the hospital I started getting 103-105°F fevers. I then went to an urgent care and had to pay $180 to get told that I need to wait at least 3 weeks with the infection before they will treat it with antibiotics. So I suffered like that for another 2 weeks and finally got antibiotics from a different place. The nerve pain I got from that infection was unlike anything I've ever felt before. I was literally screaming and thrashing around, completely delirious with fever and pain and my wife trying to keep me alive. I fucking hate this country.

Oh I just remembered, I also got sent an additional $300 bill for the specific doctor I saw at the hospital. Yeah that's a thing in a America too. You sometimes have to pay both the hospital you went to and the individual doctor who saw you, separately.

Currently $1700/mo for a very healthy, young, family of three. That comes with a $5000 deductible per person (or maximum out-of-pocket of $13000 for the family).

Oversimplification, but we basically pay $33,400 per year before insurance kicks in to cover costs.

That’s ridiculous, yes. But my last uninsured trip to the ER was for an unbearable stomach pain. The 4 hour visit consisted of a shot of pain killer, a scan that showed nothing, and observation by a couple of nurses during that time. I got a RX for some chalky pill and was told to cut back on NSAIDS and alcohol. Fair enough.

The bill from the hospital was $16,000 for the bed, nurses, and scan. Then there were separate bills for the radiologist and the ER doctor, and some lab work bringing the total to ~$17,500.

I currently do not have insurance because I cannot afford it. People treat me like I’m crazy for being overly cautious about getting COVID-19, but without insurance , I could easily go bankrupt if I get it.

American healthcare is truly awful.

Okay, so the American system is an employer based model, meaning that your health plan, if you have one, is determined by your employer. This means a few key things:

• Your plan may (and probably does) vary wildly in nearly every regard from someone else's despite both of you being with the same insurer.

• You are not the customer, but the user. Your boss is the customer. As such, the insurance company doesn't really care if they piss you off, because you can't just fire them and go with some other plan. They only care about not pissing off your boss. Well, you can technically, but individual insurance is so expensive and bad (and there's only a few big players in the market anyway) that it's an obviously better choice to just get jerked around by your employer's plan.

• The entire healthcare payment process is so arcane, unintuitive, and complex that no lay person outside the system can be really expected to navigate it if someone says "whoops, we're not paying because the florp code was misapplied during Venus Wednesdays, and though you flipped your florp last month, some businesspeople made a deal just last week to agree that florps will only be covered by approved Todds (the closest is a convenient 600 miles from you). This judgment is final, may God have mercy on your soul." As an example, I've had insurance pre-approve something and then turn around and deny it once it got billed, and because I didn't think to get physical proof of pre-approval first, the insurance basically just ended it with "nuh uh, we never said that, do you have a receipt?" Lesson learned. And a lot of times, the people inside of it don't have the full picture. There are people whose entire profession is either arguing with insurance companies all day to force them to pay what's due, or helping patients navigate the system. It makes it really, really easy to rip off both patients and health providers.

• Government insurance like Medicare also sucks. Their reimbursement rates are terrible, among other factors, and it's caused more and more providers (those who can choose, anyway) to stop seeing these patients, meaning that you start ending up with a few Medicaid clinics whose soonest appointment is months from now and spend about 20 seconds per patient. This is largely a result of our conservatives trying to prove that government doesn't work by making the government not work. Just so we're clear, private insurance holders also have long wait times and doctors that are pressed for time, it just tends to be a little less bad.

• Since insurers have figured out that there's money to be gouged in medication, they've gotten into the mail order pharmacy and pharmacy Benefit manager (if you want to get a tummy ache, read up on PBMs, they're the biggest bastards in a field full of absolute bastards) game. Since then, they've managed to kill off most small business pharmacies and turn just getting your medication into the same bureaucratic, clown energy pain in the ass as trying to arrange an MRI. (YMMV by insurer, plan, medication, etc)

On top of all that, about a decade or two back, private equity figured out that healthcare in the US is practically a license to print money, so they've come in, taken all kinds of stuff over, made everything worse for everyone involved but the businesspeople, all while jacking up prices and cutting services. Yaaaaaaaaay

Dr. Glaucomflecken on YouTube provides a pretty good (and funny / simultaneously infuriating) insight into the mess of healthcare in the US from a providers perspective.

Put it this way: like 70,000 people die in the US each year from lack of healthcare due to the cost.

Health insurance is a profit-driven industry, so denying claims for those that DO have health insurance is standard practice.

Most don't see an actual physician. The average clinic visit takes about two hours after everything is said and done; you engage with a health professional a median of 12 minutes.

People drive themselves in serious medical distress or try to take an uber to the hospital instead of an ambulance.

Doctors themselves hate the medical system in the United States.

Nurses are fleeing the industry. Projected shortage of 80,000 nurses in 2025. "About 100,000 registered nurses left the workforce during the past two years due to stress, burnout and retirements, and another 610,388 reported an intent to leave by 2027." This while baby boomers consume more and more medical resources as they age.

Medical bills are the #1 cause of bankruptcy.

So, it's not great, no.

As you mentioned there is a dance between insurance companies and care providers. You should never pay a bill on the spot or upon first receiving it. Always wait until it says final warning. Often by then the bill has been reduced significantly.

There are many ways for the system to suck. When my wife and I were working it was less expensive for me to be covered by my company's insurance and her by hers because adding a spouse to one policy was more expensive. This is because when you are working for a company that has a plan (not all provide this) the company usually pitches in on the cost of the insurance. The amount the company pays relative to the employee has typically been shrinking over the years. Combined the two of us paid about $500/month. Now that we are retired it is about $1500/month and the deductible has doubled to about $700 (which as I understand it isn't too bad). There is also something called a co-pay, which is a small amount you pay for normal office visits regardless of anything else. Ours was $25. Now it is $50.

Coverages were all over the place. For a while we paid more to both be in the same insurance because my wife's insurance would not cover alternative forms of birth control. My wife could not take the pill because it caused her to get blood clots. Ironically they would have paid (way more) for the birth of a child.

When my wife had a major issue, we found that ambulance services do not negotiate prices with insurance the same way as doctors, if at all. She was airlifted for a cost of $55k. Insurance paid $11k for some reason. The hospital stay (approx. 5 days) was $120k. Her max out-of-pocket was $16k, which we paid. Despite this, the air ambulance service was insisting that we pay the $44k and the insurance company was not budging on this. We had the same problem with the ground ambulance for $1600. This went on for like 2 years while my wife acted as intermediary trying to get the ambulance service to lower their price and the insurance company to raise theirs, figuring that having hit our maximum out-of-pocket meant we were off the hook. Not so. We were expected to pay this. Ultimately we were saved in the end when my wife's employer paid those bills.

After that, assuming that because we had hit our max, it would be good for me to get my colonoscopy, we wound up paying the whole co-pay and deductible because I was not considered family. Yup, I'm a spouse. Apparently family means children. Why didn't they say this? Probably to get people to do what I did.

So one of the biggest problems I think is when people don't have insurance or they do have insurance but no real savings to speak of, they avoid getting health care for fear of the high cost.

In New York a while back there was a viral video of a woman who had her leg trapped between the subway train and the platform and all of the people on the platform teamed up to tilt the entire train a bit to free her. It is an awesome video of humans being kind. What wasn't as viral was the fact that the woman had just prior to that, pleaded with the people on the platform NOT to call for help because she couldn't afford it. Very sad for a country with so many resources.

My employer's insurance plan, which is REALLY good mind you, takes $2800 annually in premiums, then actually starts to cover your expenses after you've spent $1600 on health care. That is, unless you're "out of network", AKA the hospital/office doesn't have a contract with your insurance company, in which case it kicks in after $3200. So basically, minimum of $4400, max of $6000, and that's for like the top 1% best insurance available, assuming you're only doing things your insurance covers.

I had to go to the emergency room for a staph infection. No insurance. Got billed 4k lol. Even though it's destroyed my credit, I refuse to pay it. In the US this unpaid bill will fall off of me credit report in 7 years, it's been 3 thus far. 4 more to go!

My wife recently had to get an array of bloodwork done. It was ~$700 after all of the office visits and lab stuff had been completed. And that’s all out-of-pocket, because our deductible (how much we have to pay per calendar year before insurance kicks in) is several thousand dollars. And we pay them ~$600 per month out of my paycheck for coverage, for just myself and my wife; If we ever have kids, the full family coverage (as opposed to just two people being covered) spikes up to nearly $1600 per month.

The monthly premium being $600, plus the deductible means we end up paying ~$10k per year before insurance even begins covering things. And even after the deductible, they only cover 80% of the bill, and we’re responsible for the remaining 20%. So if one of us has an extended stay in a hospital with a $150k bill, we’ll end up paying the $3k deductible, plus $29,400 (that’s 20% of the remaining $147k.)

And all of that is assuming everything is “in network”. Insurance companies have networked doctors, who have contracts with the company. If you see an out-of-network doctor, the insurance will often refuse to cover it, or cover it at a vastly reduced rate. Not-so-fun fact: Nearly all anesthesiologists are out of network, because they have a separate labor union that refuses to sign network contracts with insurance companies. So if you go into a surgery, even if you insist that every single doctor, nurse, aid, etc is in network, you’ll still always get an out-of-network bill from the anesthesiologist.

Oh, also, dental and vision are entirely separate plans. Because somewhere along the lines, insurance companies decided that you need to pay for a totally separate plan to have functioning teeth or eyes.

There’s a reason medical debt has historically been the #1 cause of bankruptcy in the US.

The American "healthcare" system is fundamentally broken, and no amount of patchwork fixes will change that. We need to throw it all out and start from scratch.

I had to pay 4000 yesterday because I went to the hospital for a heart-related scare which turned out to be nothing (and some low potassium) after some tests. That was with insurance. Without, it would have been just over $75,000.

Edit: I stayed at the hospital overnight for 3 days and 2 nights.

The answer is "it depends". There are so many hoops and loopholes and gotchas built into the system that 2 identical people with the exact same background and ailment(s) could go see the exact same medical staff and yet still end up having to pay 2 completely different amounts for their care. But it's more complicated than that, because there are a myriad factors that come into play (insurance versus none, location/state of residence, etc) so there's no one concise and accurate answer to these types of questions.

Most non-wealthy people who don't have insurance, but who don't qualify for government/public medical care, simply go without care. Or they use the emergency room loophole to get some kind of treatment. The loophole, with lots of nuance and caveats, is that the emergency room has to at least give you enough treatment to temporarily stabilize your condition, regardless of your ability to pay.

For check-ups and counseling - In a lot of places that sort of stuff requires you to pay up front. You can sometimes haggle or work out a payment plan. If you're poor enough to qualify for government aid, it may be free. Otherwise, you're expected to have insurance and pay the co-pay. If that doesn't apply, these places usually have a "cash" price that's slightly more affordable, but still usually require payment ahead of time.

For meds, you basically always pay up front. There's really no concept of pharmacies providing medications in a manner where you can pay later. No money means no meds. It's also ridiculous to even ask how much a person would expect to pay for meds, it could be as little as a few USD to thousands, really depends on the meds, quantity needed, location, etc.

Xrays - This is where debt might actually come into play. You usually pay for these after the fact. If you go to the doctor, you might have to pay the standard fee (or copay) up front, but all the other services/tests/etc are charged after the fact. So you'll end up getting a bill after you've gotten the xray and consultation. To be honest, I don't know the average out of pocket cost for an x-ray if you don't have insurance, but it would differ from location to location and region to region. If you don't pay that bill, you'll get harassed and most likely you'll have to change doctors because the office you owe money to won't see you again until your debt is paid or you've worked out a payment plan.

For people with insurance, there's pretty much always a maximum yearly out of pocket amount, after which things are basically all paid for by insurance. Again there are nuances and caveats. And the maximum out of pocket varies by insurance policy, number of people insured, etc, but $8,000 - $20,000 are not uncommon amounts. To be honest, I don't even know what mine is, I've never actually reached it. Not everything is covered by the maximum out of pocket, though.

$27,000 medical debt could possibly be from someone who was uninsured or it may be several years of medical debt.

To give you an idea of how crazy the system is: I had a hairline fracture several years ago and what was deemed as "good" insurance. By the time everything was done, it ended up costing me around $3,000 out of pocket. That's for co-pays, x-rays, medication, etc over the course of months.

On the other hand: A family member of mine had a heart attack, required emergency surgery, had no insurance, and had no money to pay for anything. In the end cost them less than a few hundred USD out of pocket. Hospital wiped the debt clean. Government programs and drug company programs paid for meds. Eventually disability stuff kicked in and took care of everything else.

It’s bad, a large percentage of bankruptcies in the USA are for medical reasons and a large percentage of those did in fact have insurance. The system is broken.

My friend (low income, on food stamps) recently got hit with a $65k bill following a s*****e attempt, after Medicaid

I've been charged $2k for a 15 minute urgent but not life threatening ambulance ride

Here's a break down of my last healthcare stuff.

Weekly insurance out of paycheck: $127

Psychiatrist (ADHD) $150ish a visit, meds are ~$98

Last PCP visit (included some general blood tests) $217 (mostly lab which wasn't covered)

Last ER visit: $792, waited over 10 hrs told to take an Advil and go home. Turns out I tore some of the sack (for lack of a better word) around my organs from weightlifting. it was thought a suspect gall bladder issue. I learned this from not the hospital.

And my appendix removal ended up costing me just over $9,000.

This is all what I paid out of pocket, the actual numbers for gross was, well, gross. I don't need medical aid too often but it ends up pricey if I do.

$7200 annually in $300 bi-weekly installments.

Before I have even seen a doctor or used my "benefits" in any way.

I'm trans in the US. After insurance I pay about $300 to $400 every 3 months for blood tests and a follow up. My meds cost me an additional $90 for 3 months as well. They are my hormones and another medication unrelated to me being trans. I get my meds at a local independent pharmacy, so they are relatively cheap. I used to get them at a large chain pharmacy and they were about twice as much there.

I also used to work as a cashier at a pharmacy. I once had to ring someone up who was paying over $3,000 for some cancer medication. It also wasn't uncommon to see people paying around $500 for medications that they need to be alive.

For a real example, my 10 year old swallowed a button battery (yes she should know better). Of course we went to the pediatric ER immediately. She was seen by a doctor, got some X-rays, then puked the battery out. She's totally fine. In the end I'm paying about $2000 out of pocket for that. That's on top of the monthly premiums I and my employer pay.

My premiums are about $280 per month for health, dental and vision for me and my kids. Premiums are pre-tax so there's a bit of savings there. My employer pays about $1100 per month on top of what I pay. My wife is on her employers plan because they would charge about triple that for all of us to be in the same plan. that's about $100 per month for her.

On top of that I have a special pre-tax savings account for health expenses only called a Flexible Spending Account, which helps a bit but it's kinda silly and not very flexible. I have to determine at the beginning of each year how much I might spend that year, then that amount will be taken automatically out of my checks. If I don't spend it all, it's gone.

I really recommend this video to understand (or not) the complexity of the US health care system https://youtu.be/-wpHszfnJns?si=Wi48w7TCkETdIUQQ

I lived in the US until a few years ago. I take daily ADHD medication and took birth control for several years, but not always. Otherwise, I was pretty healthy and didn’t have much medical intervention, but I have bad teeth.

I got the most cost effective insurance plan for me based on that medical history available at roughly $240 per two-week pay period, with a $5,000 deductible. The medication I took cost about $300/month and I had to pay for monthly drs visits and urine tests, to make sure I wasn’t abusing it. I don’t remember how much those cost, but I generally spent about $11k a year.

As a healthy (if neurodivergent) person in my 20s.

If I hadn’t had insurance, it would have been much more expensive, which is nuts. I got a tooth pulled and an implant put in, which cost about $8k all told, of which $2k was covered.

When I was in my early twenties, I got a chemical burn on my eye which required lots of treatments in the emergency room which I tried to pay, but there were twenty different places billing me for it and I just lost track of it. I had no assets and a bad job and they went into collections, but never showed up on my credit report and I essentially faced no consequences for doing so, except for much increased stress. If I had tried to do that with the tooth, they wouldn’t have given me the implant without upfront payment. If my payment had bounced, I had a better job and more money than earlier, so they might have tried to garnish my wages or sue me for payment.

I started a new job this week, in the US, and for a family of four I'm going to pay $30,000 per year in premiums....only premiums.

I haven't seen any other posters mention Medicare/Medicaid. I am about to lose Medicaid (for good reasons) but I have used it in California, Washington and Oregon and overall it's a lot better than nothing.

Medicaid has covered full childbirth expenses, a ligament replacement surgery, years of mental health therapy, my HRT, dental care, glasses (in some states) and everything else pretty much. I have paid zero out of pocket except for glasses in one state that doesn't cover them for adults and i think Washington didn't cover Dental maybe.

The care is NOT as good as when I had $700/mo techbro insurance for instance i hurt my back (ruptured disc) and medicare doctors refused to even image it because i can walk and stand so they just say to eat ibuprofen. I'm really excited to get private insurance and actually get an MRI and treatment because the back part sucks.

But the country hasn't left me to die in the streets. Medicaid and SNAP have been feeding my family and taking care of our health care for a couple years now while we pivoted and my partner went to school (also paid for by the gov) and now we are back to the productive portion of society. Social safety nets work and the left coast at least has useful ones if you meet the criteria and have the capacity to jump through the hoops.

Let's put it this way, for most Americans it would be cheaper to fly to Cuba, stay in a hotel and have any medical work done there than it would be to pay for similar healthcare in the US.

You can get amazing world class healthcare in the US but you pay a similarly amazing world class price for it.

(Edit: Oh and by the way shitty healthcare also carries these world class prices, think of the shareholders!)

$896 per month in premiums, and about $18k out of pocket so far this year in addition. Me and two kids.

I injured my arm in 2016 while working on a trailer. The doctor sent me to get an X-ray. With my wife’s insurance (the highest tier her company offers) the X-ray was $650. A visit to the doctor was $65 last time I went (2016), and an Emergency Room visit is $75.

In late 2016 I broke my nose on a movie set and had to get stitches. Production did not file the paperwork so they refused to pay the $2700 bill (ER visit plus 3 stitches, the set medic set my nose for them). I finally found a copy of the paperwork the set medic gave me in case production pulled anything. They paid the bill the day I emailed the paperwork, but that was almost 2 years of fighting with them.

I have insurance. Just to give you perspective. I had a video call for some mental health diagnosis. I now have a bill of $568 dollars. Reminder, this is WITH insurance. I have to pay that out of pocket. And I even have to set up additional appointments. Which will be probably around the same price.

I also have an inhaler. I had a doctor's appointment to get a refill on my medication because I don't have to use the inhaler too much (meaning I don't have to refill often). I try to stay healthy and workout and only have to use it when working out/exercising. $300 dollars for the appointment. Another $212 for the actual medication that I picked up. In the last 30 days I have blown over a grand on medical. And I'm not even sick/unhealthy.

My wife on the other hand has very expensive monthly medication for a rare disease. She hits her max out of pocket every year which is 5k. Which we just have to pay forever. If I was on her healthcare plan, we would end up paying 10k every year just for healthcare.

I would say on a regular year. We pay around 7k in healthcare costs with our insurance (depending on how healthy I am throughout the year). On a light year 5.5k.

I paid about $1750 in insurance premiums last year and an additional $9,000 in deductibles. This year should be a little more in premiums and hopefully, just $7500 in deductibles. (Wife was treated for cancer last year and had reconstructive surgery this year. I had a routine colonoscopy for the higher expense that I won't need again for a few years. )

My insurance is probably better than most since my employer is huge.

My experience is pretty similar to others. Basically, if you have insurance (most people do, and there are lots of government subsidies to help afford it), and you're relatively healthy, it's predictable. If you get seriously ill, or have chronic health problems, the expenses can quickly bury you.

I'll add one thing about pharmacies. The same medication can be $300 at one place, and $40 next door. You just never know. There are also pharmacy discount programs that can radically reduce the price. I had one that was around $150 with the insurance, then the pharmacist performed some type of incantation on the computer, and suddenly it was about $16 without the insurance.

America is a 2nd world country without universal health care. Just stick to your first world country.

Vet here, so I get some shit covered by the VA... but as a full time surgical tech and part time student, I can't afford actual health insurance. Haven't any kind of check up since I was active duty.

Hopefully if I get sick or injured I'll be able to bullshit a reason for it being service connected and have the VA do it.

If it's something serious... idk... Just deal with it, medical tourism, or suicide?

That 27k bill will come out of your estate. So if you have a house, it will be sold to pay that bill before your children can inherit it, if they, for whatever reason, can't cover it.

Private Healthcare in this country is a nightmare. And with Covid slowly disabling everyone, it's only going to get worse. Saving the NHS is worth it.

This last winter I was unemployed and I got sick enough to need antibiotics.

I couldn't prove that I didn't have a job, so the 'sliding scale clinic' charged me $586 to talk to someone (not a doctor). I knew what I needed. I was forced to take an unnecessary STD test ($180) and to promise I would go in for additional testing and scanning (undisclosed price, to be determined AFTER).

The meds were around $40 for a week of pills (15 pills).

I knew my issue, and just needed a prescription for the antibiotics.

I have a job now. They want about $200 a month for the basic coverage. I have on average, $20-$30 at the end of the pay period. So I could get insurance, but it means skipping more meals (I already skip several a week to save money).

So I just hope nothing ever goes wrong because if it does, I'll need to be close to death before I get help that will take me years to pay for.

I’ll give you some anecdotal evidence.

I make okay money. Not great, but I’m not starving. Lower middle class, probably. But I’m a single man, so if I had a family I’d be lower class no question. (This all just to give you an idea of my income without sharing my personal data online, we’re all working class)

I tried getting insurance this year, and the cheapest plan I could find was $700/mo. That means I pay an insurance company $700 every month, whether I go to the doctor or not. Now, if I were going for a general checkup, I’d pay a “copay,” so a base cost for the office visit. Probably $40-$50.

Then, depending on what I get done, tests, lab work, medicine, I’d still probably pay at least a portion of that, the medicine is likely to be discounted.

But then there’s this thing called a “deductible.” That means I have to spend the amount of the deductible in the year out of my own pocket before the insurance company would be paying for anything major. My deductible for this $700/mo plan was something like $7,000. Something like that, $5-$7k. That’s my cost before the insurance company is obligated to pay for anything. Small stuff they’ll probably cover (depending on the doctor I went to…) but before I spend that $7k of my own money in this calendar year, they’re not gonna pay for much of anything, if really anything at all.

So before we get into the absurdity of how much medicinal care costs here, there’s all that insanely stupid system to pay off and figure out.

We pay $500 a month for family "health care" because we're forced to. Every doctor visit I go to I get a $40 bill just for walking in the door, on top of paying for my medicine copays. It really sucks.

You either have a good job, or you have to choose between not getting medical attention or being chased around your entire life over medical debt. Be prepared to flee the country if the latter.

on the one hand - my wife and i didn't have insurance when my oldest was born, as i was doing contractor work overseas. Between one thing and another over the course of that year, we paid like $8k in medical expenses, including all the obgyn visits and the actual delivery, plus a hernia repair for me. The hospital was very easy to work with. Our income was very high so it was not exactly a burden. (8k was about 2% of total salary)

on the other hand - this year, with insurance we're going to pay about $6k in insurance premiums and $8k in medical expenses before we hit our deductible (~7% of total salary)

on the gripping hand - last year we had really excellent insurance. we paid a total of $1200 for the year in premiums, $50/pay period, and our deductible was only $2k. (~1% of total salary)

So it definitely varies a lot

Consider that most Americans are pay 2x to 5x more in insurance premiums each month than folks in the 32 other developed nations with national healthcare coverage pay monthly in taxes for health care. Consider that Americans still pay deductibles and copays. Consider that insurance won't cover pre-existing conditions (which are many). Consider the insurance frequently denies claims and requests for further tests and specialists. Consider that most insurance only works within the limited network of the insurance companies designated healthcare providers.

I work a multinational company that has moved staff from Japan, Canada, and the UK to the USA for periods of work. All of these folks were shocked and horrified by the American insurance system.

I had a two part visit, about 45 min each, to test to see if I had asthma. My out of pocket after insurance was about $1,200.

I had a surgery that ended up costing a few thousand dollars after insurance and we have ok insurance at work.

You're fucked if you don't have insurance, which is common for a lot of the working class.

It is true that nobody pays the cartoonishly high bills that you see posted online. It is also true that we spend way more on healthcare than basically anyone else.

My company offers very good insurance. Anything "in network" is free after the first $3000 every year, and the monthly premium is around ~$330. Note that this is a company that intentionally offers very good health insurance so they can be less competitive when it comes to salary and time off. I'd say in a given year, I spend around $7,000.

But really, one of the biggest practical issues with our healthcare system is its opacity. Most people are unable to figure out what most things will cost them before they consent to care.

My father has had two heart attacks. The first was a pretty standard one by heart attack standards, required a stint to be put in and two days at the hospital. The cost was ~$40k and after insurance we were left with I think a $4-5k deductible (pretty good county employee insurance). His second one luckily (ha) happened while on the job and required another stint to be put in (he got amazingly lucky, as it was a widow maker of a heart attack) and was covered under his works insurance.

For reference, I'm healthy and in my late 20s, I pay ~$250 a month through my employer's health plan, $25 for an office visit, $500 to walk through the doors of the ER, with a $3k in network deductible ($6k out of network). Believe me when I say you are amazingly lucky to have the NHS.

Depends.

I pay $600/mo for insurance, mid-grade, without using it. Co-pays, medication, or any other medical procedures are all varying costs and extra out of our pockets. Some things are “free”, like vaccinations, and maybe some basic meds might be zero copay at the pharmacy, but it all comes out of the paycheck. Out of network doctor or specialist? Way more.

Things that are not covered are any extra insurance like long or short term disability. Long term care. Psych care. There are some things that cost extra, like ED visits, specialty treatments maybe like dental implants or hearing aids. We pay extra for some of these.

I have a good job, so does my spouse. The monthly costs are in the vicinity of $800 for a family of four, so $9,600 a year. They aren’t big costs, but nonetheless it’s money spent making some insurance company profitable gambling on my continued health. We also take money out of pay for what amounts to a pre-tax bank account that can be used for medical expenses only. You can pay for meds, dental visits, etc. with it. It’s pre-tax, so that’s great, but you don’t get to spend the money if you need it elsewhere.

It’s also all gone if I lose my job - the insurance is through my employer. Too sick to work? Gone. Injury and disabled? Gone. There’s no safety net except Medicare or -aid, and that’s a shitty plan that has all kinds of caveats like Medicaid can essentially take your home as “payment” in certain situations. Completely fucked up.

My insurance constantly gets more expensive and my services become more restricted every time my employer sees fit to reassess their insurance costs.

I would gladly pay a tax (or whatever they call it in countries that don’t call it a tax) in a more level paying field that isn’t tied to my job, that I have to choose what care or physicians I go to because of how much more it costs, or whether I should see a doctor, that doesn’t go to making some assholes rich based on whether or not I get a more costly or denied treatment.

A lot of people simply don't because they can't. It's absurdly expensive because the system isn't designed for people to pay for it out of pocket. If someone doesn't have insurance, they'll either beg the hospital for mercy or ignore the medical debt because it doesn't count against your credit score. Even if they do have insurance, it often doesn't cover a portion of the cost, the insurance is extremely expensive, or both. The people with quality insurance through their employer have it good, but the system expects everyone to have that privilege.

TL;DR: mine is $660/month for health, $42/month for dental

Most folks in the US aren’t aware of how much they pay for health insurance. I live in California, where law requires full time employees (>30 hrs a week, >130 hrs month) be provided some amount of health insurance. The type of coverage varies not just from job to job, but also within the same job the employee must often choose their own plan from several company selected options at varying price tiers and types/amount of coverage. Usually the employee only sees the amount of the monthly cost that THEY are responsible for, which is then automatically removed from their paycheck. What most folks are unaware of is that the employer is also paying some of the cost (which is the part that the law makes them do). The part that makes it extra frustrating to deal with an already broken and overly expensive system, is that the rate paid by employers is negotiated in bulk with the insurance providers. Larger employers (national corporations with hundreds of thousands of employees) are paying much less than an individual or small employer would. This is the one of the largest reasons becoming unemployed is so dangerous in the US. In addition to not having income for food or housing, people often forego health insurance due to the expense. If you lose (or leave) your job you’re eligible to keep your current insurance plan for 18-36 months with COBRA (Consolidated Omnibus Budget Reconciliation Act, which is such a ridiculous backronym that I had to google it just now). This is often the only time people realize the true cost of their insurance as the entirety of it is then passed on to them directly (at the employer negotiated rate) and it shows up as a new monthly bill.

I recently left my employer to start my own business and discovered that my true cost of insurance is ~$700/month ($660 Health/$42 Dental). Keep in mind, this doesn’t mean that I have zero medical bills should I actually visit a doctor or hospital. This is pretty good health insurance, but I still have to pay $5,000 out pocket (annually) before it kicks in at the full coverage amount. Since I had ear surgery earlier in the year and hit that limit, and wanted to be able to continue seeing the same doctors I had for already scheduled follow ups, I decided to keep the same insurance. That $5,000 isn’t the only expense that landed on my shoulders, there’s a bunch of rules that I honestly don’t fully understand and I’ve probably ended up paying somewhere between $7,500-$10,000 for the surgery I had (in addition to the monthly premium).

The main reason I keep paying insurance (in addition to the fact that you’ll now be charged a penalty on your taxes if you go uninsured for a month), is my fear that you mentioned in the original post. Having a car hit me while I’m walking down the street and ending up with a $50,000 visit to the emergency room is a very real possibility without health insurance. California recently limited ambulance rides to a maximum cost of $1,200, so that’s… good?

I posted a tad about costs with my son undergoing cancer treatment:

https://lemmy.one/comment/10571241

It really depends. Some people have insurance that limits their liability to $500 or whatever for hospital visits, but if so they probably are paying a lot out of each paycheck for that.

I have family coverage and this plan pays essentially zero towards anything, except pays 100% of the annual wellness visits to GYN, GP, and dermatologist, any vaccines considered preventative too. Then there is a "deductible " of 6,850 per person with a maximum of 8,000 a year, then it would then pay 80% of anything above that $8k until we paid $16k, then it would cover 100% of anything above that. So basically it really is "insurance" not healthcare.

Which would be ok except that the plan itself costs almost $7k a year in premiums. I am not getting that much value out of it. And that's not even the total, my employer is paying some too!

So most years this costs us in total maybe 8,000, the premiums plus a couple of visits and any drugs.

The only people winning in this system are the insurance companies, the one who owns our plan made revenue of $371 billion last year and a net PROFIT of $22 billion.

Oh and as you are asking about uninsured, I was for a long time, and you have to negotiate your own prices in that case, argue for a cash price. And hope nothing big happens. The mammogram cost almost $600 when I had to get a diagnostic one, colonoscopy $1,500. Childbirth, at home with midwife including all prenatal about $8k. Doctor visits between $80 and $200.

I have good insurance. I pay $20 per paycheck for my wife’s coverage. Our typical visit costs 20-35 depending. Our medications cost 10-20 per 3 month supply.

Most people don’t have insurance this good.

A lot.