>"1 in 25 Americans being born will not make it to their 40th birthday."
>(The cardio health one doesn't seem as strong).
Here's a bit of an anecdote, but I bet my family isn't alone in this type of story... my cousin died from cardiac arrest at age 45. Keeping the story here brief - he was a high-income business owner who got into a tough spot in his marriage and business, found himself without health insurance when he had a medical episode. Knew something was wrong and would likely bankrupt him - and we think that's why he didn't follow up with his doctor and was dead two weeks later. Congenital issue, could have been easily resolved - but without health insurance it was probably a death sentence either physically or financially.
Now, this was just as the ACA was coming into play - but I'd argue it's moot. The ACA was well-intentioned, but has not actually improved the insurance or care situation for the majority of Americans. I need a surgery at present that won't be covered by my insurance to any meaningful degree, and being in rural America my care options are limited. So I'll live with regular pain because the system doesn't work. And I hear stories like this in my social circles weekly.
JFYI, the ACA did have a large impact on the health insurance coverage through expanding medicaid. The percentage uninsured was halved from 18.4% to 9.1-9.8% (in states which expanded medicaid. In nonexpansion states, the uninsured percentage went from 22.7% to 17.1-19%).
I hear you about the health care situation though. Health insurance is definitely not the same thing as health care.
My buddy separated his shoulder snowboarding when he was 22, but had no health insurance because he was working at the ski resort for something like $6/hr (US Ski Resorts are legally allowed to pay below minimum wage... go figure).
So he never went to the Doctor, because he couldn't afford it. He's 41 now, and that shoulder impacts almost every day of his life.
I never understand why you guys put up with this. The French are burning Paris to the ground because their retirement age got put up 2 years. But America puts up with the most outrageous hardship with barely a whimper.
> I never understand why you guys put up with this
Oh, I'm not American, and actually I was there as a 22 year old Australian and was horrified. The idea that people in a Developed country didn't have access to a doctor was shocking - I'd never seen that before, and simply didn't understand. I thought everyone could just go to the doctor when they needed to.
> For plans purchased through employers the sky is the limit
Almost everyone with insurance has a maximum out of pocket limit now. It's possible to have a grandfathered employer health plan, but they'd have to have been running it since 2010 without substantial changes since then, including in benefits or cost increases. There are very few employer health insurance plans that would have met that criteria, and even fewer who tried to.
They also have to directly inform you that you're on a grandfathered plan, so it should not be a mystery to those who somehow are.
> Almost everyone with insurance has a maximum out of pocket limit now.
"maximum out of pocket" does not mean what any normal person would interpret it to mean. More than one year I have had to pay way more than the "maximum out of pocket".
The insurance company gets to decide unilaterally how much of what you pay out of pocket is credited toward their tally of what you supposedly paid out of pocket. In several years I've paid a lot more out of pocket than what the insurance statement credits me for having paid.
Why? Can you give me an example here, particularly as it relates to a medically necessary surgery or procedure? Or does it come down to difference in interpretation of what is medically necessary?
I don't have a specific example handy, it's been a few years.
How it works is that blue shield (with employers I've typically always had blue shield in California) sends a statement saying your doctor visit cost $XXXX, blue shield will pay $YYY and this will credit $ZZZ towards your annual out of pocket total.
But $XXXX - $YYY > $ZZZ, so what I actually had to pay to the doctor was more than blue shield credits me for having paid. So at the end of the year what I've actually had to pay has been well above the so-called "out of pocket maximum".
It doesn't happen most years (to me), but has happened on multiple years.
Based on the providers contract with Blue Shield, you should not be liable for anything beyond what they consider to be your out of pocket cost. If they requested more, you could have just refused to pay it, and get your insurance involved if they pushed back.
Labs that don't have a clear medical justification are probably easy to end up paying for out of pocket without getting the amount counted against the out of pocket insurance limit.
Would expect that to be clearly delineated on the bills though.
Here's a bit of an anecdote, but I bet my family isn't alone in this type of story... my cousin died from cardiac arrest at age 45. Keeping the story here brief - he was a high-income business owner who got into a tough spot in his marriage and business, found himself without health insurance when he had a medical episode. Knew something was wrong and would likely bankrupt him - and we think that's why he didn't follow up with his doctor and was dead two weeks later. Congenital issue, could have been easily resolved - but without health insurance it was probably a death sentence either physically or financially.
Now, this was just as the ACA was coming into play - but I'd argue it's moot. The ACA was well-intentioned, but has not actually improved the insurance or care situation for the majority of Americans. I need a surgery at present that won't be covered by my insurance to any meaningful degree, and being in rural America my care options are limited. So I'll live with regular pain because the system doesn't work. And I hear stories like this in my social circles weekly.