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Silly question! What happens if you can’t afford hospital care I’m America?

166 replies

PrettyLittleLiar20 · 02/04/2020 19:38

This is going to make me sound stupid I know!

So here in the UK we have the nhs and even if you’re working you’re hospital stay and care is free!

So what happens in the US if you work but can’t afford to pay hospital fees? Do you have to pay it in instalments or are things like having a baby and cancer treatment free?

OP posts:
DontPetTheSweatyStuff · 03/04/2020 15:32

@LilacTree1 did you get them? And I didn't say the health care system in the UK is perfect, I guess it just comes down to what's normal to you.

Pharmacies and insurers are a money making businesses. It pays to keep people sick, wherever you live.

MrsTerryPratchett · 03/04/2020 15:48

I can assure you, they don’t leave people dying in the street under normal circumstances

Ever heard of patient dumping?

mathanxiety · 04/04/2020 06:20

How does the US manage with mental illness?

I assume people can be sectioned there?

@KenDodd

Yes, you can be sectioned. It requires a court order, as obv there could otherwise be serious abuses. A committee of the local health department and social services reviews the case in some states or DC. Minimum involuntary inpatient stay is 72 hours afaik. You can also be committed/sectioned into outpatient (community) treatment. Danger to self or others is the most often used criteria, with various nuances and supplemental standards to that in different states.

If you voluntarily admit yourself to a MH ward but then sign papers requesting to leave, you are held for a cooling down period of 48 hours starting at the time you signed the request to leave papers (in some states and DC), during which an evaluation committee (local public health, doctor at facility, legal individual) is automatically convened to look at your case and recommend either discharge at the 48 hour point or involuntary committal (which can occur before the 48 hour period ends, depending on transport availability and bed availability in the facility or other facility you can be transported to). Again in that case involuntary committal is usually for a minimum of 72 hours though practices and protocols vary by state. There may be designated officers handling committal proceedings, depending on what state you live in.

Interested in this thread?

Then you might like threads about this subject:

mathanxiety · 04/04/2020 06:23

Pandemic planning must have been a thing in America as well?
@KenDodd
Yes, it was. Trump fired the pandemic planning office and pretty much scrapped it as soon as he could after taking office. It had been a feature of the Obama presidency, you see.

billy1966 · 04/04/2020 07:01

The American system has been a failure for decade's.

It is a great system if you are highly insured as the care and medical options are often very advanced.

But the percentage in the country who avail of this superior service is small.

A huge portion of Americans dread the thought of getting ill or developing a disease.

They most certainly will not treat uninsured cancer treatments.

Someone close to me lives a lovely middle class life there with her family, for 30 years.

By chance she was working pre having children for a very big name. She didn't particularly want to continue work after having children but went back for reduced hours because she had a superb health plan.

Turns out she never left the company.
Still works there because she has her whole family highly insured through them, even though she only works part time.

She could never justify leaving the company because this perk was so huge.

She works 16 hours a week now and she earns about the same as her top tier family package would cost her a month.

She feels very lucky.

I think many people, particularly the young, have no idea how awful a country America is if you are poor, sick, old, or injured..without good health insurance.

Give me Europe ANY DAY.

lotusbell · 04/04/2020 07:28

My dad was taken ill on a cruise to Alaska and was treated on the ship and in a local hospital. Every test, tablet, sample etc was billed and itemised. He was lucky to be able to put it all on his credit card and pay that off and claim on his insurance but I think he still ended up paying for some of it. What a pain in the arse to try and sort out on his return home when he was still quite poorly and recovering. I dread to think what would've happened had he not been able to stick it on his card.

lljkk · 04/04/2020 07:36

The ppl most affected by covid are age 65+; medicare kicks in at age 65 and younger for some target groups. Medicare is free at point of use. Plus Obamacare & other state-level options reduce costs.

Folk who most need treatment for covid will get free or at least affordable care.

Sostenueto · 04/04/2020 07:37

Emigrate! After all America doesn't have a health system just a huge insurance industry!

Deathraystare · 04/04/2020 07:45

I remember being in a walk in centre when an American breezed in (actually he didn't breeze in, he had a bad back and was blind, but would have if he could). He had been an ambulance worker or some such and thought that meant he got to the head of the queue - well that and being an American.

He then ran down the NHS which did not go down well with everyone. He could have always got on a plane to his wonderful country and it's wonderful healthcare. Oh wait..he would have to pay!

AlternativePerspective · 04/04/2020 07:51

NHS healthcare is free at the point of use. It's not free. It's not some gift from the gods. We all pay for it through taxation. ah but Americans pay tax as well and don’t get free healthcare. So to all intents and purposes it is free.

WouldShouldCould · 04/04/2020 08:01

Interesting post, hadn't thought about it.

Etinox · 04/04/2020 08:11

If you go to the States it’s obvious how many people are have ‘fallen through the gaps’. Many more people obviously unmediated for MH problems than here. Many more ‘un operated-upon’ orthopaedic patients using crutches or limping and adverts for healthcare charities that treat conditions we get free- like eye tests and glasses for children.

FlamingoAndJohn · 04/04/2020 08:12

I’m more than happy to pay for the NHS through my taxes.
I don’t want any parent to have a sick child and to be worrying about the bill on top of everything else. Can you imagine standing there knowing that you need to take your child to hospital and worrying about the cost? Nope. I’m happy to pay.

TKAAHUARTG · 04/04/2020 08:15

I live in the US and every time I go to a doctor they are very keen to refer me on for more expensive treatment. I know that Americans feel this is because they are being thorough and investigating every possibility. They're not, they just want more money. It is all for profit. Health should never be a luxury.

Balhammom · 04/04/2020 08:24

@AlternativePerspective

While the US pay taxes, they pay much lower taxes because they are not funding universal healthcare.

Any healthcare system has to be paid for somehow.

BunnytheBee · 04/04/2020 08:29

I am surprised at the reaction to Xenia’a post or maybe I read it differently. I took it as, like another PP said, the two systems (UK and US) are two extremes. US - everyone has to pay for what they need UK - everyone has equal right to treatment (subject to conditions of living in the UK etc I assume) and we pay for it in taxes but we don’t all pay equal taxes. That’s true. Some do pay way more than others.

I would rather be in a system where the people don’t have to worry about money when they are having a hard time eg need serious medical treatment.

However, I do sometimes wonder, for example, why o can’t get a GP appointment when I need one. There are a number of GPs working in my local surgery at one time and the appointments are 10 mins long and yet it is difficult to get an appointment for that day or in a 3 week period. I wonder who needs all these appointments. I’m sure some of them are needed but then I’m sure there are people who take up these appointments unnecessarily and would think twice about doing that if they didn’t have to pay for it. Maybe that’s an entirely separate issue though.

I wonder whether US citizens pay a comparable amount of tax to us.

Goes to google...

CountFosco · 04/04/2020 08:45

A lot of our customers are in the states, I work in pharma and we often talk about healthcare. We are all well educated professionals on high salaries and working in an industry that provides excellent healthcare. The Americans on paper earn about double what the Brits do. But whereas my private healthcare insurance is about £1kpa (and I have the NHS as well) they are paying thousands per month on their monthly healthcare. They then have copayments, they say it is common to have £5k+ in copayments a year.

The NHS has massive block buying power so we get drugs as cheaply as is possible to get. An standard blue inhaler costs the NHS a few pounds, in America it can cost $75. The hospitals there are all individually purchasing from the suppliers and all get different rates. Then there is the whole issue of hospitals inflating the prices they charge insurance, insurance then negotiating the price down and claiming they've saved you money but it all seems so stressful and designed to get as much money as possible out of people in a vulnerable state.

The NHS isn't perfect but the principle of universal healthcare free at the point of delivery should not be eroded. It always costs everyone more once insurance companies are involved. Maybe after the pandemic we'll realise that we should pay more for the NHS and it will be better funded.

As far as rationing goes I'd far rather drugs were not prescribed because NICE have looked at the evidence and have decided which drugs give the best outcomes for the most patients per pound than that drugs were not prescribed because a patient couldn't afford them (or indeed were prescribed to a rich patient despite there being no evidence of clinical benefit).

n00bMaster69 · 04/04/2020 08:49

However, I do sometimes wonder, for example, why o can’t get a GP appointment when I need one. There are a number of GPs working in my local surgery at one time and the appointments are 10 mins long and yet it is difficult to get an appointment for that day or in a 3 week period. I wonder who needs all these appointments. I’m sure some of them are needed but then I’m sure there are people who take up these appointments unnecessarily and would think twice about doing that if they didn’t have to pay for it

Poor people suffer worse health and so in the UK they will be visiting the GP.
In the USA poor people also suffer worse health but can't afford to visit a GP so they don't.
= shorter waiting times.

mathanxiety · 04/04/2020 08:53

Balhammom
While the US pay taxes, they pay much lower taxes because they are not funding universal healthcare.

Any healthcare system has to be paid for somehow.

The claim about US taxes has often been made here on MN. It's not true.
US taxes are actually pretty high.
And they are divided up - federal, state, local (in the form of property taxes), sales taxes that apply to everything.

In addition there are paycheck deductions - for Medicaid and Social Security.

And in addition to that, there are charges for water and sewer and garbage disposal, you have to tax your car annually, and in many municipalities you pay through the nose for a street parking permit too..

BunnytheBee · 04/04/2020 08:55

Well yes

But we don’t know that it’s “poor“ people taking up the appointments here. I think anyone would think twice about making a GP appointment if it was going to cost them, unless they really needed it. If it cost £100 for every GP appointment, I could afford to pay that but I might think twice about it, if you see what I mean.

HugoSpritz · 04/04/2020 08:59

This reply has been deleted

Message withdrawn at poster's request.

mathanxiety · 04/04/2020 09:15

Poor people suffer worse health and so in the UK they will be visiting the GP.
In the USA poor people also suffer worse health but can't afford to visit a GP so they don't.
= shorter waiting times.

You don't normally visit a GP in the US unless you have HMO insurance or need a referral for a specialist because you don't know if you need, for instance, a hip replacement or physiotherapy. If you have Medicaid you will also be in a HMO-type situation.

Those with a PPO can go straight to whatever specialist they think they need. Psychiatrist, OB/GYN, ENT, general surgeon, neurologist, oncologist, etc.

America has a shortage of doctors in general. Some rural areas are particularly badly hit by the shortage. Cities have little independent storefront clinics and also for-profit chains, treating mainly Medicare patients, advertising heavily for clients, but appointments are available fairly easily.

The very poor in the US have Medicaid or Medicare, and there is also the VA system, which is for veterans. It's the people who are a tier above the very poor who are really badly hit by the 'insurance industry model masquerading as a healthcare system' model. People who have jobs that offer crappy health insurance (60/40) or who have jobs with hours and conditions cunningly designed to let employers off the hook for insurance provision are really squeezed.

Your wait time will depend on the specialist you want to see, in general, and also the location of your doctor's practice.

For instance, my family's pediatrician office was headed by the professor of pediatrics in a local urban university hospital, and the waiting room was always heaving.
For one frustrating year we took our business elsewhere, closer to our suburban home, to the office of a pediatrician who had admitting privileges in a nearby for profit hospital. No waiting times. No decent phone triage either, so they would blithely tell you to come in and have the doctor take a look at whatever your child was complaining about, tell you it was probably a virus, and bill you.

By contrast I had to almost beg and plead with nurses over the phone to get to see a pediatrician in the university clinic. While this may sound horrible, it actually saved me $$$. And over the years, with little or no nurse turnover, the staff got to know me and trusted my assessment of whether my child had an ear infection, etc.

I had a local GP until two years ago. I had strep and couldn't get an appointment until ten days after I called to croak over the phone that I needed to see a doctor. I walked in at the local Walgreens in-store clinic and got the throat swab there from the nurse practitioner.

ocarinan · 04/04/2020 11:14

I am surprised at the reaction to Xenia’a post or maybe I read it differently.

It's because she constantly complains about the amount if tac she pays and acts like we should all be grateful. I'm sure she's rather have an American system where she wouldn't have to help pay for poorer people's medical care.

cologne4711 · 04/04/2020 12:15

A huge portion of Americans dread the thought of getting ill or developing a disease

And yet there was massive opposition to Obamacare.

Doingtheboxerbeat · 04/04/2020 12:45

Slightly off topic, but does anyone else remember the thread about the tipping culture in the US? It all makes sense now doesn't it?