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?

Many years ago I read a post from an American lady on a forum, she said "if I get sick then I'll be hoping that I die". She was an otherwise healthy woman in her 40's but couldn't afford insurance. Absolutely terrible that she had to think like that.

@arcof

I think there are some misconceptions here.

Someone mentioned pre existing conditions up thread - insurers have had to cover these since the Affordable Care Act in 2010.

There is Medicaid for low income families and Medicare for the elderly. My only experience with Medicare has been with my in laws, and there's been some issues which I'm working on with them but for the most part it seems like a good plan.

30 million are uninsured but apparently about half of those could be insured via Medicaid or the marketplace.

I think the right balance is to let those who like their private insurance keep it, and to expand Medicaid to more people. Hopefully this administration will make some headway on that.

Which would make a 2 tier health system. Lovely.

Dh is a Dr. We have a good, comfortable life working for the NHS. If he worked fully in a privatised system, you could probably add a zero to his salary.

A privatised system is all about the money. Making as much as possible. A nationalised system attempts to get best value for money for all. Means a £££ treatment with minimal benefit may not happen.

There is no perfect system unless you are absolutely loaded. Medical inflation massively outstrips normal inflation.

I feel so priveleged to have the NHS.

The other issue is that some people with a lot of insurance cover are kept alive on support systems until the insurance runs out and then the plug is pulled, known as “gofers” (keep going until the insurance runs out).

When I was visiting family in the States, my cousin’s friend was on life support, but actually dying with her body all puffed up. It was very distressing that family could not legally ask the hospital to stop treatment as she didn’t have a “living will”. Due to this her family and friends all arranged for “living wills” for themselves so that if they were in the same situation treatment could be stopped.

My aunt lives in the US. She has health insurance. When she was diagnosed with breast cancer her insurance paid for treatment but not reconstruction. She told her boss (a billionaire investment banker). He said “send me the bill”. Not everyone will respond like this. I have huge arguments with American friends about their healthcare. It’s a total shit show. To add another friend whose dad is a leading surgeon on the east coast who is paid in excess of half a million a year. About $100k goes on insurance to protect from malpractice

An American visitor came into the pharmacy one day with a problem. A few questions and I was able to sell him what he needed (which would almost certainly have cured the issue) for £5 or £6. He was astounded and said the whole process would have cost £200 in the US.

People do get treated in the ER. Hospitals will usually work with people without insurance to get them treated (basically this is one of the reasons US health insurance premiums are SO high - hospitals cover their costs from treating the uninsured by over-charging the insurance companies).
However, medical bills are the main cause of bankruptcy in the US (even with insurance because the deductibles and co-pays can be crippling). So, you will probably get treated but you will likely lose your house and all your savings until you (possibly) can become poor enough to be eligible for some kind of medicaid or charity care (depending on state).
It's an awful system and both inefficient and inegalitarian. They spend tons (including A LOT of public money - it' sjust hidden) and still can't cover everyone. It's not US system or the NHS - there are many other decent health care systems which are a million times better than the US one. It's probably the worst system possible!

I do love the ads for medicine though - ‘ask your doctor for XYZ for your acne (may cause skin to fall off, heart failure and death)’. Ads for liver transplant surgery in the sides of buses...

I'm from the United States originally. It is a nightmare. People go bankrupt over small medical issues.

We need to do everything we can to protect the NHS.

I would worry. My assumption is that insurance companies are in the business of not paying out! We had a small prang with the car and it took over a year to get the burgers to pay out!

One of my friends had an ectopic pregnancy and was rushed in for emergency surgery as she was about to die. She got an $80k bill afterwards. She had months of stress trying to get support from one of the charities to help her pay it. I can’t imagine dealing with that after the trauma of a miscarriage and nearly losing her life. Her and her dh aren’t poor enough to get aid and fall in the middle where they can’t afford to pay these sums, can’t afford insurance but also don’t qualify for aid to pay. She said she’d be better off if she quit her job.
I couldn’t cope living there

I just watched a totally fictional show where a man committed a crime to get sent to jail as he had cancer and would get free treatment.
As I said it was fictional but it did make me wonder

In many cases there are caps on what you’re insurance will pay for. People facing lung transplants, for example, are oft denied some of the essential drugs or the actual transplant.
If you’re very poor, it’s unfortunate.

Thank goodness for the NHS - sadly half the country don’t know when we’re well off and the other half seem to want to undermine it at every opportunity.

Drs in the states are, typically, millionaires

@hernamewasrio

BUT the facilities are amazing, modern, fully staffed, no waiting lists and referrals happen instantly. I had a melanoma diagnosed and removed within a week thanks to preventative skin checks that happen routinely there. I also had a mammogram annually from 40 and cervical smear annually.

Healthcare for everyone is a human right but the UK's NHS is not providing adequate preventative care due to inadequate funds. The buildings are old and unsafe. We need a middle ground. I'd be happy to pay for more preventative checks here and that revenue reinvested in the free service for others.

I would comment on the frequency of testing and scanning.

Some testing involve radiation and at population level run the risk of causing cancer (just like radiation from flying can). Not all, obvs. There is a balance to be struck between frequent scans (which reassure patients and pick up some cancers) and less frequent scans (which cause less health stress, less false positives and cause fewer cancers).

I would not want a mammogram every year at 40. I realise for an individual it can be very reassuring and for the health care system very £££

I did wonder what would happen if you had an accident -would you really have to think twice before calling for an ambulance?

I saw a programme where a woman collapsed in the street, unconscious, and a passer-by called an ambulance. When she woke up in hospital, she sued the passer-by for saddling her with a huge bill!

My DS had a fit aged 2 when we were on holiday in the US and was taken to hospital in an ambulance. Apart from the fact that our insurer argued over the high cost of the ambulance for ages, they did every possible treatment in the hospital that wouldn't be done in the UK, including the unethical - he'd had a urine test before in the UK by putting a pad in his nappy but they insisted on putting a catheter in a distressed 2 year old and of course charged for it. "Bare bones" is not what the NHS is. Evidence based and compassionate is what it is.

I wonder if illness also ultimately affects your employment too. for example, I used to work overseas where you had to have medical insurance like the US. One of our employees got cancer and was having treatment which amounted to about USD1m. In the end, our HR Director made him redundant as the bills got too high. I don't think they had to pay his bills, but their insurance premiums went up and that's why they got rid of him.

But @hernamewasrio the experience you describe is only like that because others aren't in the queue with you. If the whole country had the same access as you, your treatment wouldn't be so wonderful as there would be a sharing of resources. The US system works amazingly if you are lucky enough to be included in it. For everyone else, it's second or third class care - or nothing.

@UhtredRagnarson

Well done, you have explained precisely why the US system is so awful. You, a higher earner save money and get the best healthcare possible whilst poorer people are shafted. It is certainly ‘not for everyone’.

My thoughts exactly when I read that post. Of course the system is great for that poster!

Actually the US spends greater proportion of GDP on healthcare than other developed nations and does not have better outcomes overall. For the wealthy it's great, for others not do much. My cousin was laid off from his job, got another one quicklybut had a couple of weeks before he started. In that time he got eat HD thought was a UTI but turned out yo be kidney cancer. He had insurance through work but it was now a preexisting condition so excluded. On top of that his new employer instantly fired him. At the she of 50 he had to sell his house and move his family in with his mum.

My daughters got me hooked on tiktok of all things and there's an American lady on there who now lives in Leeds. She talks about this a lot. How lucky we are to have the NHS and how in the states profits are more important than people. She also blames their system for her opioid addiction, at one point she was being prescribed morphine for an ingrown toenail.

@mathanxiety

Why do Americans think this system works? Sounds dreadful.

Because of the poison that is moralism.

Americans who are privileged believe that everyone gets what they deserve. The 'prosperity gospel' and its earlier incarnations have a lot to answer for.

And as a British person, I can see where they got this idea.

I watched a video on YT how it’s cheaper to fly to Mexico see a doctor for chronic illnesses and get a three month supply of medication for $600 vs $5000 in the states. It’s madness! So basically a couple with chronic illnesses like diabetes or heart problems can both save loads on their medication by going across the boarder !

I like travelling to the US and know many wonderful people but I still can’t get just how terrible their healthcare system is. Even with great insurance, it can cover you once or twice but what if you need to see doctors frequently? Tests and imagining twice or three times a year on top of your usual dental/smear/general examination tests? It just seems so much.

What's really sad is that while people have workplace insurance the healthcare providers just keep loading them up with more and more medications and investigations to claim the maximum per visit from insurance.....

The costs are insane and can be quite high even if you have good insurance. I had DS1 in the US. At the time we had great health insurance through DH's work - literally gold standard - and I had a normal delivery at 39+ weeks with no complications, no special care, I had an epidural and was kept in for 3 days post-delivery because I'd tested +ve for group b strep, so DS and I had to be monitored. Cost was about $25k. We had to pay the deductible (i.e. the excess), which was around 10% or 20% of that. We could afford it, but a bill like that would be ruinous for a lot of people, and by US medical standards it was a small bill!