What do Americans do if they have no healthcare?

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Seeing posts on Reddit about the costs of routine medical visits and the astronomical breakdown of figures charged, but I'm assuming these are all covered by health insurance.

But what if you have no insurance. What happens if you get cancer etc. Are you left to die?

Risks and benefits of breast screening

www.nhs.uk/conditions/breast-cancer-screening/why-its-offered/

It's never black and white. There is often a balance to be made hence the frequency it is offered. Enough to work as a screening tool, but not so much that the risks out weigh the benefits.

Of course if you want, you can pay someone to do it every year.

[quote Kitkat151]@tilder
Yes there will be a risk....but the benefits usually far outweigh the risks.... you are perfectly entitled to make your own informed decision as an adult with capacity....you are entitled to make unwise decisions...your body ....your health.[/quote]
Depends on the test. Plus individuals have different tolerance for risk.

*Just exactly how much is 'fund it properly' going to cost?

More and more money is pumped in hand-over-fist, year on year.

It needs stripping back and rebuilding, or completely scrapping in favour of something like a French style system, or preferably the German type.*

Two completely opposing points and completely inaccurate.

The French and German systems are funded at a far, far higher level than the NHS.
The NHS has had significant reductions in funding over the past two decades. It doesn’t need stripping back. It needs investment.

Where are the promised forty new hospitals? We need a health service that is funded equitably with other developed nations. That remains free at point of delivery for all.

The NHS is about the most efficient healthcare service in the world. Imagine how fantastic it could be if it had the money of other EU countries.

@mathanxiety

The result is that many women are subsequently harmed by treatments that they do not need.

That's utter nonsense, and there is no logic to your argument against annual exams either.

You’re wrong, but it’s your choice.

@Nandocushion

In every hospital I've been to here there are signs up in the lobby/ER saying that if you don't have insurance they will set up a plan for you to pay. I'm not going to muse on what that might be or how affordable it is - we all know the stories! But it's not about being "left to die", more that you'll be treated but will then pay for the rest of your life/declare bankruptcy etc.

We're leaving US for Canada in a few months and leaving the ridiculous US health insurance system is what we're most looking forward to. I have some stories about it I'll be telling for the rest of my life.

I’m so jealous

I’m desperate to move to Canada

There’s lots of evidence.....loads and loads....there is a wealth of literature out there by people far more educated than you and far more intelligent.....you don’t want the screening ....fine, don’t have it....but keep your Ignorant comments to yourself

Why do you get to silence me? Do you think insults are good arguments?

This is a valid debate and the risks and benefits of screening are nowhere near as clear cut as you portray. You may decide that screening is for you, but there are most definitely risks, and screening undoubtedly does harm as well as good. Surely someone as intelligent as you can see this?

And back on topic, screening is easy money and looks like something is being done.

While my politics generally lean to the right, I am entirely in favour of an NHS which is taxpayer funded and free to all (legally here).

That doesn't mean that the NHS we have is perfect and incapable of improvement, or that simply throwing more money at it is all that is needed. To take an example, I have had two long-term conditions, one fortunately now resolved but the other ongoing, for which I need(ed) periodic outpatient check-ups at a regional centre of excellence hospital.

There are usually about four doctors or consultant nurses in the clinic, and each is supported by a nurse. As the clinics often run late, I have spent quite a bit of time in the waiting room observing that the doctors (and receptionists) are clearly working pretty hard but the nurses are doing little more than weighing each patient as they arrive. While that falls to the taxpayer rather than me personally, I am a taxpayer and it seems to me that from that and other experiences there are a lot of areas where the NHS could work smarter and get more done for the same money.

While my politics generally lean to the right, I am entirely in favour of an NHS which is taxpayer funded and free to all (legally here).

Given that you lean to the right I wonder if you'd be so supportive of a 'free' health service if you didn't have health issues yourself? From reading MN some right leaning posters are very resentful of the money they put into other people's treatment. Personally, I don't see how it's that much different to how insurance works.
I lean to the left and am very lucky that myself and my family are all in just about perfect health and hardly ever see a doctor. Hopefully this will continue our whole lives and I am more than happy to have a better funded NHS and pay more tax for it even if I never need it myself.

Screening does only good.

You are absolutely and completely wrong, @WiseUpJanetWeiss.

Your statements to the contrary and your insinuations of greed on the part of the medical profession are not valid contributions to any debate.

I've had hearing aids on the NHS for 30 years, with expectation of new ones every 5 years or if they break earlier. All audiology and tuning and re-tuning covered.

My uncle has similar needs in America. He got the medical parts mostly paid for by his veterans' cover, and some of the aids magically-enhanced $3000 cost (the NHS pays £150 for essentially the same model but like John Lewis it has a different model number) was covered, but he couldn't afford them until he got Medicare at 65. I think he paid for one once he was 60 so he could still work and waited for the other.

My cousin, similar problems, less good veterans' insurance, has never been able to afford hearing aids so lost his job. Turns out there are some veterans' charities that will pay, but it's a bit late now.

It's the co-pays that are so often crippling. I have several friends in America who are earning well and paying for their best options via employer health insurance and have loads of money left, so I wonder why they are in tiny cheap houses and act poor - because several of the families are paying an extra $1000 a month or more in prescriptions and other healthcare costs, not to mention the time it all takes up dealing with it. What surprises me is that car hire firms a d rival insurance firms will sell you insurance to cover your car hire excess, but I don't know of insurance to cover medical insurance excesses.

DH has some family in America. One had a really really good job, the absolute top insurance.
Unfortunately he got the wrong cancer they wouldn’t cover treating it. So that was that. They paid for what they could and his widow is poor now.

Pelvic exams on asymptomatic women are mostly agreed to be pointless and thus are only done for money - or because the docs are a bunch of pervs, so I'd prefer to believe the former.
www.aafp.org/news/health-of-the-public/20200225pelvicexams.html

"The American College of Obstetricians and Gynecologists recognizes that no evidence supports routine speculum examination or bimanual pelvic examination in healthy asymptomatic women younger than 21 years and recommends that these examinations be performed only when medically indicated," the authors wrote. "Our results showed that despite the recommendation, many young women without discernable medical indication received potentially unnecessary BPE or Pap tests, which may be a reflection of a longstanding clinical practice in the United States."

For its part, the AAFP recommends against screening pelvic exams in asymptomatic women regardless of age. That stance differs from that of the USPSTF, which in its 2017 final recommendation statement found insufficient evidence to assess the balance of benefits and harms of performing screening pelvic exams in asymptomatic, nonpregnant adult women "for the early detection and treatment of a range of gynecologic conditions."

Women have in the past been denied prescriptions for contraceptives if they refuse a pelvic exam or smear test in America, which rather makes a mockery of free informed consent.

I'm a frequent user of lots of parts of the NHS - which has kept me well enough to work to pay tax to cover most of it. IME it simply needs more funding and more retention of staff. Which includes those 'wasteful' staff like receptionists and managers who have been savagely cut in recent years - I've been in many clinics where a poor receptionist has been permanently on the phone as other medics try to track down their patients, wasting time and capacity in the rest of the hospital that an extra person taking calls would have solved. And you need managers to fight to put such staff where they are needed!

@Kendodd

While my politics generally lean to the right, I am entirely in favour of an NHS which is taxpayer funded and free to all (legally here).

Given that you lean to the right I wonder if you'd be so supportive of a 'free' health service if you didn't have health issues yourself? From reading MN some right leaning posters are very resentful of the money they put into other people's treatment. Personally, I don't see how it's that much different to how insurance works.
I lean to the left and am very lucky that myself and my family are all in just about perfect health and hardly ever see a doctor. Hopefully this will continue our whole lives and I am more than happy to have a better funded NHS and pay more tax for it even if I never need it myself.

No. That was also my view when I was younger and apparently healthy and barely saw a doctor from one year to the next.

It is the function of the state to provide services collectively to its citizens at the taxpayer's expense. Most people would accept that these include (in no particular order)

Military
Police, courts and prisons
Roads
Education for ages 5-18
Financial support for those unable to support themselves, particularly where that results from age or disability
Free or subsidised housing for those unable to afford it themselves
Subsidies for other forms of transport
Subsidies for industries where considered important for national wellbeing
Funding for important scientific and medical research

It seems it's only Americans who have difficulty with the idea of adding healthcare to that list.

Equally, arguments about paying for other people's treatment could also be made about paying for the education of other people's children by the childless or by those who have chosen private education, but never gain much traction here, nor, as far as I can tell, do they get much support in America.

Turning to insurance companies, as the state is not seeking to make a profit, then it should be able to provide healthcare more cost-effectively, provided it does so with at least the same level of efficiency. As well as the example I gave before, I think that there is a strong argument that senior doctors in the UK are often overpaid as they seek comparison with private sector professionals such as lawyers and accountants while happily accepting the job security and pensions that go with state employment and avoiding the risks of business. There may also be economies of scale. (Plus as a result of extensive experience both personally and professionally, I wouldn't trust an insurance company as far as I could throw it.)

But I can quite happily hold that view and also believe that wealth-creating industries are better off if they are only regulated to the degree necessary (and there can of course be debate on that) and that politicians are kept a long, long way away from their day-to-day operations.

@mathanxiety

Screening does only good.

You are absolutely and completely wrong, @WiseUpJanetWeiss.

Your statements to the contrary and your insinuations of greed on the part of the medical profession are not valid contributions to any debate.

Absolutely untrue.

Whilst screening has undoubtedly saved many lives, it is not entirely risk free or harm free. There is a downside.

www.ncbi.nlm.nih.gov/pmc/articles/PMC4589101/

bmjopen.bmj.com/content/3/4/e002703

www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30553-1/fulltext?rss=yes

@mathanxiety

Screening does only good.

You are absolutely and completely wrong, @WiseUpJanetWeiss.

Your statements to the contrary and your insinuations of greed on the part of the medical profession are not valid contributions to any debate.

That’s simply not true. Why are you so angry and defensive?

Here’s a starting point. www.theguardian.com/science/blog/2014/jan/03/patients-truth-health-screening-harm-good?CMP=Share_iOSApp_Other

It is undisputed that screening causes harm to individuals. Screening programmes are only approved if the benefits outweigh the harms and the programme is cost effective.
That is not a matter of opinion.

Well, in most cases you actually would be getting the bill two or three months later but it’s no different than paying the funeral home, though is it?

I think there are very few people who lost their homes through paying for a funeral. If you really think that the two situations are the same, you’re clearly in a position of incredible privilege. And the large numbers of posts from your less fortunate fellow citizens would seem to bear that out.

An old friend of mine moved out there years ago when she married an American. They had to pay about 12k for her birth because it wasn’t all covered by their insurance, it took them years to pay it off and they couldn’t afford to have a second child as a result. Crazy.

Totally agree with the mixed impact of screening and the need for screening programs to be carefully evaluated in order to optimize benefits.

I don't, though, think the USA's over use of screening is simply down to greedy doctors. The US population in general sadly has the same mindset as several people on this thread and it seems most people cannot conceive of the idea that it might be in their best interests to not have a test. So a lot of pressure for testing comes directly from patients. There is also legal pressure, since it's hard to be sued for doing a test whereas not doing one opens a doctor up to a greater chance of court action and liability.

@MrsFezziwig

Well, in most cases you actually would be getting the bill two or three months later but it’s no different than paying the funeral home, though is it?

I think there are very few people who lost their homes through paying for a funeral. If you really think that the two situations are the same, you’re clearly in a position of incredible privilege. And the large numbers of posts from your less fortunate fellow citizens would seem to bear that out.

I am not, in fact. Just because you’re poor doesn’t mean you think yourself free of responsibility.

But the idea that paying for a service is somehow adding to a tragedy is one I find puzzling.

We have poor maternal outcomes here because of our complete freedom to be stupid. 47 years ago I decided to martyr myself by having all my prenatal care and birth at DC General hospital, thankfully now gone. It was an inner city hospital that catered to poor intercity/ghetto and the inmates of the connected DC jail. I spent over two weeks as patient there before and after the birth. The women didn't give a single fuck about the the well being of their unborn/newborn babies. There was drug abuse, drinking, extremely poor diets and immense ignorance. It was shocking say the least. Hospitals such as the DC General are where most of the poor maternal outcomes and infant mortalities are coming from. If you want a healthy baby you can. Mine was very healthy. It's the attitude and behaviors of the mothers not the doctors/staff.

Good way of culling a load of those awful crappy people eh?

The women didn't give a single fuck about the the well being of their unborn/newborn babies. There was drug abuse, drinking, extremely poor diets and immense ignorance.

Maybe if they could afford contraception and had access to abortion they wouldn't be having babies they didn't care about.

If you want a healthy baby you can.

What a load of bollox. You can do all the right things and still have a stillbirth or a disabled child.

My sister in law had gold plated top employers insurance. After her first baby, which was a long labour ending in emergency c section including catastrophic haemorrhage at home days later, she was sent a bill for well over $100k which the insurance wouldn’t fully cover. They threatened to sue the hospital for causing the haemmorhage and it was eventually waived (over a year later). Even with top insurance it costs you money to have a baby. I met a family in Silicon Valley once whose third baby - vaginal, no pain relief - cost £3k in co pays which is a lot more than they’d have had to pay the NHS. The profit is ridiculous.

Mother in law gets Medicare (over 65) but every year you have to reapply and every single year they tell her she’s not eligible and she has months of wrangling with bureaucracy and the kids have to step in. If something happens to her in one of these breaks, she’ll be screwed.

Someone else I know over there, a young woman, has already had to declare bankruptcy because of the bills for treating endometriosis. Don’t even get me started on the pressure put upon young women by American gynaecologists to have hysterectomies; combined with the financial pressure they have an extraordinarily high rate of hysterectomies in young women compared to Europe.

Plus of course the whole system is set up to prevent whistleblowing and crucially, learning from screw ups. I know cover ups happen here; the money exacerbates it hugely.

@sashh

The women didn't give a single fuck about the the well being of their unborn/newborn babies. There was drug abuse, drinking, extremely poor diets and immense ignorance.

Maybe if they could afford contraception and had access to abortion they wouldn't be having babies they didn't care about.

If you want a healthy baby you can.

What a load of bollox. You can do all the right things and still have a stillbirth or a disabled child.

This is really far from the communities she’s talking about. There are Planned Parenthoods aplenty in the poor urban communities she’s talking about. And contraception is free through Medicaid (and PP has a sliding fee scale).

You are using outdated talking points here.

I don’t know where this idea that America has restricted access to contraceptives comes from. Though I agree birth control pills should be cheaply available OTC

Free! They should be free!