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

[PrettyLittleLiar20]

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?

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

And yet there was massive opposition to Obamacare.

They fear socialism even more.

mathanxiety

But how is mental health treatment then paid for? Would the patient be given a bill for treatment they had to be forced by law to have against their will?

Thanks for the explanations as well.

I live in the US. One of the things you have to bear in mind when you consider why American's opposed the ACA and single-payer options is that the way medical bills and insurance companies show costs creates an air of fear.

The other week I had some blood tests. I'm below my deductable (excess) right now so had to pay the full cost. Initially, the doctor's office billed me $120. I ended up paying $16 because of my insurance "negotiating" a discount.

Every medical transaction goes this way. If you knew nothing else, wouldn't you feel that your insurance is doing a good job in negotiating you that discount?

What is terrifying is that, if you're uninsured, you're getting charged that $120 and it's incumbent on you to negotiate that down... without the benefit of scale, lobbyists, marketing teams etc that the insurance companies have.

You will get the healthcare if you're in critical condition and need it, but you will receive the bill after. In some cases, hospitals forgive medical debt (less likely), but more often courts will end up garnishing payments from your paycheck.

The debt doesn't stay with the hospitals as it is a commodity- billions in medical debt is sold to companies who then reap the rewards of monthly payments. There are now non-profits who buy up and forgive medical debt en masse, but it should not be this way: www.cnbc.com/2019/07/01/meet-the-18-year-old-who-helped-wipe-out-6-point-7-million-dollars-in-medical-debt.html

A friend in the US had an injury that totally mangled his legs. His insurance patched him up but wouldn't do the extensive surgery he required because they said that the insurance of the company’s property he was on when he had the accident needed to pay. While this was battled out in court he was in hives amounts of pain and was in a wheelchair. It took over a year to sort it and he got a massive pay out. But that’s not really the point.
And he had all the proper insurances.

@Xenia wait till you start getting older. I was never ill, never saw a doctor from one year to the next, robust and healthy I was. When I got to 64 everything changed, and then you discover how awful it is to have something that could be serious, but isn't treated with any interest or urgency because you are not at deaths door and not in imminent danger of dying (probably). I potentially have a heart condition, but I can't find out now as my appt. with the cardiologist for the other day was cancelled because of coronavirus.

That depends on the insurer and the laws of the state or DC, KenDodd.

It's a grey area at the moment, with insurers trying to gain a place at the table to determine who needs to be committed and the medical profession strongly resisting, but hospitals concerned about the bottom line still needing to be paid.

I'm sure she's rather have an American system where she wouldn't have to help pay for poorer people's medical care.

If that's what she would prefer then she doesn't understand how private health insurance works. You don't just pay for your own potential healthcare with private insurance and feel good that your personal risk might be low. You pay for the potential healthcare cost risk of your age cohort and other cohorts you happen to fall into.

On the myth that Americans pay less tax: when we moved from the UK to the US we paid waaay more tax over there. We were in California, which is a high-tax state.

The US system just seems so complicated to me.

You can die in the UK due to being refused treatment too though. Your woman the other week there called 999 and got refused an ambulance and died due to coronavirus.

Not quite true, she was assessed by a paramedic who determined she didn't need hospital treatment at that time, she deteriorated the following day and she or her dh should have called another ambulance.

I was watching an episode of New AMsterdam (I know it's fiction) but reminded me of something I saw ages ago, which wasn't fiction.

Both had couples divorcing to get health care. IN the fiction it was a child, the insurance had paid for a transplant but wouldn't pay for the immunosuppressives, dad earned too much for medcare/aid but they couldn't afford the meds.

If they divorced then mum could get medicare/aid for her and the child.

The one I saw in real life was about dementia care.

ANd it's not just a case of medical problems, Andrea Yates had a number of mental health issues and was being treated as an inpatient.

Her insurance ran out so she was discharged.

She killed her children.

Two trials and a long time in Jail she was sent to a secure mental hospital.

Who knows how much money has been spent on her incarceration, but more importantly 5 children died because their mother was ill.

A standard birth costs about £10k and is estimated with pre and postnatal care to be £30k

I had "good" health insurance when my DC were born and we paid about $3K per birth as the insurance deductible (plus the insurance premiums, of course) so it wasn't exactly a cheap experience!

One thing that directly paying for healthcare does is encourage you to take advantage of everything that's covered by the insurance premiums. Annual physicals for the whole family, mammograms for me, flu shots, etc. That means that we've got a good chance of spotting conditions at early stages, e.g., breast or prostate cancers. I'd never do as @Xenia said and go to the doctor's once in 15 years!

The self-employed people I know have all bought health insurance through their state's version of Obamacare and you receive subsidies if you're on a lower income.

I'd never risk being without health insurance here. The NHS is an amazing institution, I wish Americans would stop being so obtuse and agree on some type of universal healthcare system.

Re : comments on higher taxes. I wish everyone understood that narrowing the income gap results in better life outcomes ( things like health and feeling safe on the streets ) for everyone in society, even those in the top income brackets

Wow, there is some really alarming information here.

Yes, some people do not have health care, but there are lots of programs for those who don't have health insurance such as Medicare and Medicaid which are federal programs

www.medicalnewstoday.com/articles/323858#medicaid

Most people will have insurance through their employer, but lots of states will have their own programs.

There is also County Hospitals which are free.

Take note this is what our Tory government wanted our health service to be in the future!

What's the system in Ireland that's being referred to?

The American system is horrific. I've heard various tales over the years, ranging from a Doctor being given buckets of berries for treating people who had no money. The cleaning bill for giving birth in an ambulance not covered by insurance.
Going back a few years to the football world cup being held in the states, one of the UK commentators suffered a burst appendix. His colleague took him to hospital they forgot the insurance certificate. The poor guy was left sitting outside the hospital while the colleague went back to the hotel for the insurance documents.

I think the Covid 19 will change many things in the long term. And countries all over the world will be reviewing their health care.

...there are lots of programs for those who don't have health insurance such as Medicare and Medicaid which are federal programs.

Medicaid is means tested. You can't just decide not to get health insurance and Medicaid will take care of you.
Medicare is an entitlement (if you are employed, a portion of your paycheque is taken out and goes into the fund). You are entitled to use your Medicare coverage when you are 65. There is supplemental coverage you can buy to cover gaps in your Medicare coverage.

Most people will have insurance through their employer, but lots of states will have their own programs.
?
Many people have insurance through their employer.
Each state administers its own Medicaid programmes, which are means tested. You need to be making virtually nothing in most states to qualify for Medicaid. In general, states that vote GOP tend to have limited Medicaid coverage and resisted the access widening envisioned under the ACA, while states that vote Democratic tend to have better programmes, with more people covered and fewer hoops to jump through in order to apply.

Then there is KidCare or its equivalent, for pregnant women and babies and children up to 18.

There is also a Medicaid programme you can apply for if you find yourself caring for a severely disabled dependent who needs, for instance, 24 hour care, skilled nursing to take care of the dependent by day so you can work.

There is also County Hospitals which are free.
County hospitals are not free. All hospitals levy charges, and either you or your insurance or a combination of the two, or Medicaid must pay what is billed.

en.wikipedia.org/wiki/Healthcare_in_the_Republic_of_Ireland

It's basically a hybrid public/private system, with charges for services and medication, with some exceptions (maternity care, for instance).

We have private medical insurance and private GP and so rarely use the NHS. I know plenty of people who didn’t give birth on the NHS. I did because we pay enough taxes and I wanted something back from it for a change.

Having said that the US system is deplorable. It is obvious that many more people will die of covid-19 in the US, the worlds richest economy because of their insurance system. No way I would want that system in the UK.

Take note this is what our Tory government wanted our health service to be in the future!

Absolute rubbish. And you KNOW it is, you are just putting out propaganda. This is not the time for playing politics.

My cousin lives in Kentucky & said all care for Covid 19 is covered free for everyone. Apparently it depends on the state & governor.

I had to go to A&E while living there, I had gold plated insurance as part of my job. If I hadn't had a job like all the Americans who've been made unemployed in the past weeks, I would have been refused if I didn't have the money.

The bit that stood out was the ambulance to hospital which was about $15000.
It was a 6 minute drive that my DP took a taxi for at $6.
I wasn't in any state that needed able ambulance, but I had to go to a doctor to be referred before going to A&E as if you turn up to A&E without being referred and aren't admitted for some reason you'll pay $200 upfront non refundable, just for walking through the door.

I am always shocked that more British people don't seem to understand this is how bad it is there... or that Americans seem to accept this as the stays quo!

Sorry $1500! Too many zeros. Total treatment for being in hospital for about 6 hours was over $100,000 (no zero mistakes!).

It's unbelievable.

Many years ago I lived in a country (not America) where everyone had to pay to visit a GP. The price wasn't high, probably the equivalent of about £20 but it was a deterrent. It did make people think twice before a visit, and the appointments were easy to get and the doctor spent as much time as needed with each patient (so this did sometimes lead to long waits). Those without any income, the equivalent of those here on benefits, could claim free treatment. It worked well. The hospitals were run by nurses (nuns/charities) and care was provided free of charge but doctors, operations, xrays etc had to be paid for but most employed people were covered by insurance. It cost £2000 (20+ years ago) to have a doctor present at the birth for example but a nurse led birth was free. Again those on benefits got a basic free service with the bill paid for by the state. Most employers paid the insurance premiums in full or people joined discounted group schemes. It was quite a good hybrid scheme that worked better than the NHS without going to the extremes of the US.

Thing about charging for a GP visit though, as a deterrent, well for one, I don't think people should be deterred from going to the GP. Two, surely it wouldn't apply to most of the people who go anyway. I guessing exceptions would be for pregnant women, children, the unemployed/poor, disabled and the elderly, between them that would be the vast majority of visits. It's like prescription charges, most are dispensed free.