you realize this is literally only as of the ACA in 2010? and if the trump administration has its way (there's a supreme court case on the docket to completely kill ACA) we're going back to that?
I agree that the US health system is beyond fucked up, but the statements in this comment are dramatization and not accurate on their own without a ton of qualifiers and clarifying statements.
“Out of network” doesn’t mean your health insurance plan doesn’t pay for anything. It usually just changes coinsurance rate. Anyone who has a major expensive hospital event while insured will just hit their maximum annual out of pocket amount and that coinsurance rate won’t matter. That’s not a good thing but it also means that this comment is misleading, implying that being out of network means that the insured person just has to foot the bill and that their insurance company dips out.
The whole point of the insurance network is that your health insurance company is encouraging you to take your routine doctor’s visits and scheduled non-emergency procedures to a place where they negotiate.
And acne and pregnancy aren’t disqualifying. What are you even saying they’re disqualified for? That’s a vast exaggeration.
1. Even in the event of Emergency visits to in network hospitals, one is often charged out of network fees if one of the doctors present is out of network. Which one is not notified of and has no say over, regardless. So going to an in nerwork hospital (which is the best one can do to align to their plan) means nothing.
2. When charged out of network, it most certainly does not mean only the coinsurance rate changes, you are also charged 10 to 50× more. So you are charged say 40% of $5000 rather than 20% of $300. Again, at an in network hospital.
3. Out of pocket max differs dramatically in network to out of network, in some plans going away completely in out of network scenario.
What you are saying above is not just a minimization its completely misleading and wrong.
It seems maximum "maximum out of pocket" is 8200$ [0] I find it strange that it's not tied to salary. For people earning 30k/year 8200 per year is a lot.
the part about preexisting conditions is completely wrong since the ACA.
the person who replied to you is wrong about out-of-network services though. they seem to be describing a ppo plan. my high deductible plan is quite clear on the fact that out-of-network is not covered at all. doesn't even count towards the out-of-pocket max.
My plan will not even apply my out of pocket payments to the deductible. There are wide swaths of the U.S. where I'm 100% pay out of pocket for emergencies, heck, even inside my own state. Most people are completely unaware of how poorly they are covered when they travel on vacation, within their own country.
In Germany, does your health insurance cost >$600 per month for 1 person if your employer or government doesn't subsidize it (for example, if you are self-employed and earning more than minimum wage from it)?
There are upper limits for the national health insurance which is based on a fixed percentage of your monthly income. I've passed that border this year (earning around 66 k€/year) and from now on, I will not have to pay more, so my procentual share actually goes down from now on.
If I'd marry now, my wife and any children would also be covered by my percentage, it's called "family insurance". Pretty fair after all. (Some limitations apply, but if my wife would stop working, she would be covered through my insurance.)
Similar to Germany here: Insurance costs around € 100 per month per adult, kids under 18 are free. If you have a low income (below roughly 40k per year) you effectively pay less all the way down to zero (if your income is below about 14k per year), because the government pays part of your premium for you.
God I wish, it's about double that [0]: 162€ (health insurance) + 32€ (statutory nursing care insurance) for those making ~1k€/month or less. Not counting any gov support. Btw ~870€ seems to be the max, if you earn ~4700€/month or more.
And from what I remember there is a way to opt out of the public system and switch to private insurance, but this is kind of discouraged by being hard to switch back and requiring significant income in the first place.
In Germany insurers are required by law to provide a minimum standard of coverage comparable to some of the best employer-provided healthcare in the US, insurance costs are heavily regulated and progressive, all employers are required to cover part of the cost, treatment price is heavily regulated, and no one can be rejected.
They tried that in the US with Obama's mandate. You had a choice of getting of getting health insurance or paying a penalty roughly the same cost as getting the insurance.
Trump getting rid of that mandate is one of the few things I'm grateful for in his presidency. No longer am I forced to pay for terrible insurance that had high copays and ridiculous deductibles.
I'm a low income worker and in exchange for almost 7% of my income I get 1 free doctor checkup a year and catastrophic coverage.
Sorry but $2000 cash is worth a lot more to me than an imaginary $100,000 hospital bill. Anything less than $2000 I spend on my health in a year is cash money in my pocket. Being "rational" about insurance is a luxury for wealthy. I would rather dispute the cost with my hospital and let the debt go to collections where I can reduce it even further.
Obama basically made this happen, but the net result was that all of healthy young adults (the kind that least needed insurance) were forced to start paying for insurance to subsidize the unhealthy older adults (or pay a penalty).
So basically it was just a disguised tax targeting the young and healthy.
Insurance implies you have a choice in the matter (i.e. it is optional), but in this case (Obama-era health insurance) it wasn't optional. So why not just call it a tax, which is what it really was?
To me it sounds very similar to social security tax - the young being forced to pay to subsidize the old.
> the net result was that all of [low risk group] were forced to start paying for insurance to subsidize the [high risk group]
This is literally insurance.
Obama's plan failed because the public option was removed, employers and states refused to play along, and the Supreme Court undermined even the part you're complaining about. It was also not a great plan begin with, compared to European programs.
not really. most forms of insurance are not mandated by law and try to charge people something like the expected value of their claims over a certain period plus a profit margin. if health insurance were allowed to operate more like other kinds of insurance, healthy young people would pay a couple hundred bucks a year and old people would pay tens, if not hundreds of thousands of dollars. an eighty year old buying health insurance is the equivalent of someone with five DUIs, multiple at-fault accidents, and a ferrari trying to purchase car insurance.
So you mean about half my taxes? SS and MC/MA/CHIP are roughly ~50% of federal expense? Why am I paying for grandpa sitting at home retiring and going to the doctor, he should get a job and pay for insurance keeping in mind that the majority of healthcare costs go to cover the aging population?
Well, you know, at some time in the future, those "healthy young adults" will be the "unhealthy older adults" and other young people will subsidize them then. That's pretty much how those social insurance systems work.
Maybe Americans are missing something to understand that, but it's not socialism or communism if you actually care about all people in the state, no matter how healthy or old they are.
This person is actually going to pay less than many people who are insured precisely because they’re uninsured.
Someone who is insured in the US is not allowed to negotiate.
This person can call the billing department and say “I can’t pay” and watch that bill plummet.
The 50% or so of Americans who get their healthcare from solid employers will exhaust their deductible but otherwise be generally fine. Then there’s another chunk of people on Medicaid and Medicare (government healthcare for elderly or poor) who would be fine in this situation.
The group of people in the United States who are screwed fall into a few categories: hourly workers who aren’t offered insurance or who are offered bad insurance from their employers, or business owners that have to self insure.
The ACA (Obamacare) attempted to help this situation by making health insurance mandatory and essentially going the route of Germany, but the mandate has been handicapped by numerous compromises in the bill itself, court rulings, and political turmoil. Also the high unregulated cost of drugs doesn’t help. It was not able to defeat the for-profit health insurance industry.
It’s wild to me that these political parties that claim to be pro-business don’t support separating healthcare coverage from employment. This is probably because of status-quo lobbying and a desire to keep people wage enslaved until retirement age.
I think it works that way, you think it doesn’t work that way. So in that sense there’s no way to know based on “trusting random commenters.”
But I can tell you this: there aren’t a lot of ways in which that debt collector can collect. They can’t take your home, they can’t take your car (as if the uninsured person even owns their car outright), and I don’t even think they can garnish wages.
The statue of limitations on debt is as short as 3 years in some states, and it won’t even affect your credit score beyond 7 years.
If that person never answers the phone and never admits to the debt, it basically just goes away on its own from my understanding.
Even if they decide to settle, that debt collector purchased the debt for pennies on the dollar. That person settling is not paying anything close to the full cost. The hospitals know that a bill going to collections is already a lost cause, and is basically written off as charity care.
Unfortunately a credit report can be a part of some jobs. I found this out the hard way when I tried to do what you said - ignore the calls - and there was an unpaid debt from 6 years ago on my credit report anyway when I had to get a clearance.
Many people frame this as a "say this magic phrase to get your bill reduced" and I just don't think it's that simple any more. Some of the consequences from not paying just come back down the road.
Wait so there isn't a Healthcare cost problem in America then? I don't live in US but if your uninsured and can just call, say I can't pay and pay much less or just have your insurer pay, it seems to be OK either way?
It doesn't work like the comment described at all. If you can't pay you end up in debt collection and then get a lot of extra fees on top of the already ridiculously high bill. In the end it will bankrupt a lot of families.
The US healthcare system is messed up in a lot of ways.
I’m just saying that many people who are uninsured at the emergency room will end up with a lower total than people who are insured with unsubsidized low quality insurance.
In Germany you are required by law to have it.