this post was submitted on 13 Aug 2024
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Hey all, I'm British so I don't really know the ins and outs of the US healthcare system. Apologies for asking what is probably a rather simple question.

So like most of you, I see many posts and gofundmes about people having astronomically high medical bills. Most recently, someone having a $27k bill even after his death.

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.

So I'm just asking... How accurate is that? Consider someone without insurance, a minor physical ailment, a neurodivergent mind and no interest in fighting off harassing people for the rest of their life.

How much would such a person expect to pay, out of their own pocket, for things like check ups, x rays, meds, counselling and so on?

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[–] [email protected] 20 points 4 months ago* (last edited 4 months ago) (2 children)

It cost us almost $4000 to have our first kid and we have pretty damn good (the premiums were not insignificant either) healthcare. No complications, no surprises, typical short hospital stay (like 3 days).

[–] [email protected] 4 points 4 months ago (1 children)

Was that pre ACA? When we had our kid, we only paid a $175 hospital stay copay. Granted… we’re very lucky with the insurance coverage provided by my employer, but we were under the understanding that the reason we didn’t have OBGYN copays and otherwise throughout the pregnancy was because the ACA made sure it was covered.

[–] [email protected] 7 points 4 months ago* (last edited 4 months ago)

2018 major private university insurance! Kind of wild tbh still. When I saw the bill I asked my partner to see how much was pulled from their paycheck each month and to show me their plan. I made adjustments since we definitely were not getting good value so I at least wanted more cash on our pocket.

[–] [email protected] 2 points 4 months ago (1 children)

On top of your premiums, any insurance through a job means the job is paying thousands of dollars a year to insurance instead of paying you on top of what you paid.

[–] [email protected] 1 points 4 months ago* (last edited 4 months ago) (1 children)

~~Eh not thousands but yes upwards of $800-$1500 typically if the plan is good.~~

Read it as a month not a year lol you’re correct

[–] [email protected] 2 points 4 months ago* (last edited 4 months ago)

~~I think you may have read that backwards.~~ (didn't see edit till I finished posting so I'm keeping the rest)

If the plan is 'good', then the part the employee 'pays' each month is low and could be in the hundreds each year before paying for any care they actually receive. But the employer is shouldering the rest of the costs behind the scene as part of the cost to employ. That means whatever they spend on insurance is money not going to your income so it really doesn't matter if it is paid directly by the employer or employee, that is all smoke an mirrors.

As an example for state employee plans from 2020:

While health insurance premiums varied greatly across the states, the average per-employee per-month premium was $959; states paid an average of $805 (nearly 84 percent) toward premium contributions.

This means the insurance company is collecting $959 dollars per state employee per month just to have them on the plan ($11,508 /yr) -The state is paying $808 per month ($9,696 /yr) -The employee is paying $154 per month ($1848 /yr)

This is all before office copays, medicine, emergency room copays, hospital bills, care clinic visits, and any service where you pay something to access service. This is generally decent to good insurance in the US and we pay well over the cost per person in other countries just to be insured.

To drive home that this is not an outlier, this is the cost that each country spends on health care per person United States $12,555 Switzerland $8,049 Germany $8,011 Norway $7,898 Netherlands $7,358 Austria $7,275 Belgium $6,600 Australia $6,597 France $6,517 Sweden $6,438

Everyone in Sweden is covered for healthcare, they don't need to pay at the point of service, and they spend about half of what the US does on average including the uninsured.