Ask Lemmy

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.

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

https://lemmy.one/comment/10571241

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.

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.

Firstly, thanks everyone for all the responses. I appreciate it, and I hope that some of you felt better after having a vent.

American friend predictably says there's a problem with "healthcare literacy" and that you just don't have to pay the bills and they probably won't chase it up. I don't beleive that at all.

I figured it might be interesting to share how much I pay for stuff up here in Scotland.

I have a decent well paying job so I pay some money to the NHS in taxes, specifically ~£2000 a year. I get antidepressants and doctors appointments completely free from that. Dental I don't get free because my income is too large, but it's only like £20 for most routine things. I have a free eye test booked next week, and I splurged £10 extra to get fancy 3D imaging stuff done.

I do require mental health treatment though, and the NHS doesn't cover that for autistic people (as a competence issue, rather than a policy choice). A session with a counsellor costs £45 per hour for me privately.

Honestly, the surprising thing to me isn't that you have an insurance system (Switzerland has a similar thing, iirc), it's just how inflated prices are compared to here.

I work for a public school district. We're signing up for insurance now to begin sept 1. These are our available plans. I always take the HD (high deductible) plan because i contribute to an HSA (health savings account- pretax money that you put into an account. They send you a card and you can use that to pay med expenses.)

ETA- forgot to finish my thought- I may switch to the higher plan because i see it's only $75 per month more but saves $2k in deductible and $1100 out of pocket max. I'm considering a knee surgery this year, so i would likely meet those. This is an area where you have to pay your bill if you want to ever go back. I still owe $700 to the anesthesiologist for the other knee surgery 3 years ago. I will have to pay that to schedule another. For emergencies, hospitals are required to treat. My son without insurance had an emergency appendectomy 5 years ago and has never paid a dollar of the $5k he owes. They continue to send bills and he continues to throw them away. If he had another emergency, he could show up at the ER and they would treat him and the cycle would continue forever until he needed a scheduled procedure with that hospital system. Then they would likely require that he pay a certain amount upfront. My other son has obamacare. He pays $250/mo for it because he sees a weekly therapist that's $75 without insurance or $20 with insurance. It's all a very complex game of which is cheaper, what are you getting, how much are you willing to risk/commit, and do you expect to get sick or have an accident. My husband cannot add me to his insurance because i have access to it through my work. I was on his dental insurance and they dropped me because we couldn't find our marriage certificate from 30 years ago. 30 years of tax records showing we filed as married were not sufficient. It's really just their way of getting spouses and families off the plan. It's all a scam.

Back in 2007, I had just finished college and was traveling cross country to start a new job. I had to stop and get emergency surgery on the way there and ended up in the hospital for a few days. I ended up paying around $70,000 over the next few years and the hospital finally forgave the rest of the bill.

How do you pay for car insurance or renters insurance? It's not too dissimilar to that.

Though, I've moved to a state that has deemed me poor enough to give me Medicaid so the taxpayers pay for mine weather I want it or not. It beats paying almost $800 because living with my mother disqualifies me from the affordable care act subsidy.

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 pay $30 per doctor's visit and $40 if the visit is for a specialist. I also pay $0 for a yearly checkup and $0 for telehealth. For any hospital visits, I pay 20% of whatever the actual bill is after a $300 copay (basically a down payment), which came out to a total of $600 when I went to the ER. Lastly, my prescription drugs are capped at $10 per month for generics and $150 for some brand-name drugs.

I use a ton of healthcare and the costs have been super manageable, but affordability is going to vary wildly between people. A ton of insurance plans don't start working until you hit an out-of-pocket minimum of several thousand dollars, and others work like mine except with way higher copays.

Lastly, insurance often doesn't cover certain drugs or procedures. As someone with really good insurance with good customer service, it's still an issue every so often, and the solution is either to find an alternative, try to find a manufacturer's coupon and pay up, or suck it up and move on. There are insurance companies that use shady tactics to get them out of paying for certain expensive drugs that they're supposed to cover.

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.

Dragoneer?

Currently, nothing.

If your income is low enough, you can get free insurance through the government. In my experience, the regular doctor checkups and stuff is covered, along with prescriptions and any emergency room visits. The dental portion only covers the worst dentist in town, and vision is non existent.

It's not great, but medically necessary things are covered without copay or arguing with an insurance company to get it paid for. It's good enough that I've known people who purposely kept their income low to continue to qualify for the free insurance.

I quit even responding to them. After two or three years I'll get sued for a very small amount. It will be some radiologist who looked over a xray who has sold his debt to some bottom feeders. I wait until I'm served then I pay it. Within six months some other bottom feeder will serve me again for the same debt. When I go to court showing it was paid I can generally get my money back from the second bottom feeder. I've done this three times and got paid twice. The third time cost me nothing but time. Its long drawn out and stupid but its the shit sandwich we are forced to eat to live in the Home of the fee.

A lot of it depends on what insurance you have and what insurance you have depends on who you work for.

I had EXCELLENT coverage with Kaiser Permanente, and other than a couple of hundred dollars a pay check and an in-office co-pay for treatment, I never had a bill.

When I had my heart attack, the Emergency Room was $150. 8 days in the hospital and open heart surgery from the head of the department was $100. The prescriptions and all the oxygen bottles I could carry was $100.

4 weeks into recovery, my company got bought. :( The new company didn't do Kaiser in Oregon. If I lived in California or Washington, I would have been fine, not Oregon.

So they switched my insurance to Aetna which meant I lost all of my doctors and had to start over at a new hospital. Kaiser is members only and I was no longer a member.

Naturally I started having complications, congestive heart failure. That was an ER visit followed by 7 days in the hospital.

Under the new insurance, they start by paying 80% and there is an out of pocket maximum of $6,500. Once you pay that, all other treatment is free the rest of the year. No co pays, nothing.

So I hit my $6,500 about 1/2 way through January. Goodbye signing bonus! But all the other complications I had the rest of the year were covered 100%.

Now... if I had NO insurance? 15 days in the hospital x 2 hospitals? Open heart surgery? All the tests and such? 24 oxygen bottles? A million dollars, maybe more?