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?

Michael Moore did a film about this. He visited various countries including France, where a lady comes to your house to help with the laundry if you've recently had a baby, and the UK, where he found an expenses office in an NHS hospital that repays people their travelling costs for getting to their appointments.

It was so eye opening. One thing I noticed was that US drugstores are much more like supermarkets. Treating yourself at home for things we'd see a HCP for is relatively common, hence all the YouTube videos of Americans lancing their own boils and pulling their own teeth.

They have some schemes like medicare which is for over 65-year-olds.

Ironically lots of right-wing Americans bring up the tax cost of socialised healthcare, but really theirs costs more since the majority of healthcare costs for a population are for the older generations. Also if you have someone who can't afford to get preventative care the tax payer ends up having to cover the cost when they get serious and can't take care of themselves, whereas in another system they would have been treated earlier and at a much cheaper cost.

Actually the US also spends just as much public tax money on healthcare as the UK - medicaid, medicare, veterans, various top ups and subsidies. It's just the private money is way way more. So Americans pay in tax the same as British people do but then huge amounts of private spending which simply doesn't happen in the UK
As a SYSTEM, the NHS is pretty decent. It's relatively efficient (this may be surprising but the American sytem spends way more on admin - a lot of money goes into deciding which claims do and don't get paid, billing people, following up on bills etc etc) and it's relatively egalitarian - everyone is covered and more or less entitled to the same, there's some private care but the basics are all covered).

If the NHS had anything approaching the US spending, it'd be simply top notch. It's good as a system, it's just underfunded.

I thought all children were automatically eligible for government healthcare in the USA? Shocking.

I want to laugh because otherwise I'd cry. That would be nice. Some states do make it more accessible for children, but many don't.

I find it interesting the few well insured adults singing the US's systems praises aren't really taking into account the major issue that even if you do have great insurance if your child presents at the emergency room without your details, they will be treated as if they have no insurance, because they - on their own - don't. Even if Gillick competent, a child in the US system pretty much has no control of their healthcare. Even the few and far between places that do free clinics, many are very difficult for a minor to access (and some don't allow minors) and this is part of the reason some prefer it how it is. They can talk about freedom, individuality and personal responsibility all they want, but it comes down to control. Insurance controls what is acceptable to do and the person with the insurance controls access for everyone under them.

My father had a great job when I was young, his insurance wasn't an issue. When I was 15, while he was out on a business trip because of said job, I had to go to A&E I walked for hours because I was in a really bad state and wasn't thinking clearly, they basically ensured that I wasn't going to die, and then shoved into a little side room with just a bed and left on my own for hours. My father then showed and I was taken home because that's what he thought was best that I was still hurt and in the middle of a major mental health episode wasn't as important. I was then sent to religious "counseling" whose first words to me were basically how anything I told to her could be told to my father if she deemed it important enough.

Compared to the UK where my my son, when he was at camp and had to be taken to A&E due to a severe shoulder injury. Not only was he well treated before I was even informed (this happened in the middle of the night), he got an appointment to recheck his injuries back at home within the week and was given - to him - a letter with a number where he could call if he had any issues in the next year. I was just so bloody grateful that he was treated as an individual.

People like to tell me how much better the US is and how the UK is bare bones in comparison, but all I remember is being a 15 year old rocking away in the tiniest bare bones room that literally only had room for a bed with no bedding and a tiny walkway -- all because I was a child who dared to go to the emergency room without a parent. I was being a personally responsible as I could be, I knew I needed help, but I had no freedom or individuality in my care because I was just a teenager.

And yes, I am aware of people with POTS, certain types of epilepsy, and conditions that cause black outs that basically wear a medical band that says 'Do not call an ambulance' because the hospital can't really do much once you come to, but you're still stuck with the bill if you're taken there while you're out. So much freedom.

With my old dad there was one of his innumerable doctors (podiatrist) who in effect said if he didn’t start attending more regularly his insurance would no longer cover that specialism. He didn’t have any foot condition and attended general check ups but some dementia meant he started to resist additional appointments where he didn’t understand the need (actually sounds rational). Awful. Remember almost forcing him to one appointment with sibling so I could kind of frog March him into door and he wouldn’t do a bolt (he became quite good at this) really just to keep insurance going. Actually angry now I think back on all of that nonsense.
His calendar became full of appointments all over the place to highly specialised doctors many of which seemed to be money based with him as grist fir their mill (he did also get great required core care)

I work in private medical insurance and the cost of treatment in the USA vs private treatment in the U.K. is insane. I’ve seen $40k bills for an appendicectomy in New York, even in a top London hospital the same op would be £5k.

I listen to a podcast about diseases (this podcast will kill you - it’s excellent) and they talked to guy in the USA who a chronic illness that could be treated with medication (I forget which one). His company insurance covered his medication which was great, except he hated his job but was stuck working there as he couldn’t afford to pay for the drugs and he has no guarantee of cover if he gets a new job. That’s a sad state of affairs.

I read not too long ago that another issue with the system in the states is insurance companies and self pay customers are billed the same over-inflated amounts. Someone self paying will have to pay the full amount, insurance companies on the other hand negotiate the percentage they will pay and it's usually a fraction of the amount billed.

My Dad lives in the US and told me that even decent health insurance doesn’t cover all treatment. Eg if you have cancer you will be covered for either radio or chemo but rarely both.
My dad knew someone years ago whose child died from leukaemia because the father had lost his job just before diagnosis and struggled to find work. By the time he found work, the leukaemia counted as a pre-existing condition and they weren’t covered.

I'm assuming these are all covered by health insurance.

HAHAHAHAHAHAHA.

No. Even with health insurance, most people are paying hefty copay amounts, and insurers will not cover some things at all. The reality is that for a LOT of Americans, even those with health insurance, a diagnosis of something like cancer means a very real chance of losing their home. It is utterly disgraceful.

@zafferana

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!

That deductible is not a large amount at all though? $2500 tops I presume? That’s not too much for good care, imo, in the average US hospital. Yeah, I know it’s all free through the NHS but the treatment just feels so bare bones and inadequate.

In maternity care, there seems to be a lot of efforts to save money at the patient’s expense in the NHS. Should be a more robust, competitive private system and people encouraged to use it and doctors paid a premium for it.

I do prefer the Australian system from what I hear, personally. But people are ideologically attached to the NHS and you can’t argue with them at all.

Also, the USA spends more per capita on health than the UK because of the high costs

@AngelicaSchuylerAndHerSisters

My Dad lives in the US and told me that even decent health insurance doesn’t cover all treatment. Eg if you have cancer you will be covered for either radio or chemo but rarely both. My dad knew someone years ago whose child died from leukaemia because the father had lost his job just before diagnosis and struggled to find work. By the time he found work, the leukaemia counted as a pre-existing condition and they weren’t covered.

This sounds fake. No one is denied treatment in the US. But it used to be that coverage could be denied for pre-existing conditions but that’s not been the case for years.

Half a million Americans a year declare medical bankruptcy. The system is entirely in humane.

www.theguardian.com/us-news/2019/nov/14/health-insurance-medical-bankruptcy-debt

I think the US system could be vastly improved by one thing - do not allow insurers make a profit.

When profit is involved insurance companies' first concern is to not pay out or only pay out as little as possible. The companies often have an entire department working to deny claims.

One thing that seems to hardly get a mention in these debates is the impact on public health.

In the 1990s there was a lot of TB in New York, TB treatment lasts six months most of that time you feel well so when it is a choice of rent, food or medicine you put the medicine last. This led to a resistant strain of TB that New York gave to the US and from there the rest of the world.

TB got so bad that the city employed people to go to the homes of people with TB, take the drug with them and then pay the person when they took the pills.

Childhood vaccinations are among the highest levels in the world from the age children enter kindergarten, because your child cannot attend without their vaccinations.

I have no idea why American children need a paediatrician to give them a jab.

You'd rather spend somewhere between $2500 and $5000 in the US than get the same treatment for free in the UK @UsedUpUsername? Er ... okay! Clearly you have money to burn, but the point of this thread is that many people don't. For a lot of families a bill like that would cause them a real problem. The care WAS good, I can't fault it, but then so was the care I got when I had DS2 in our local NHS hospital and I wasn't talked into getting an epidural I didn't want that time either, so that was a bonus!

Also, can someone tell me what exactly is so wrong with a two-tier health system? Government healthcare can function nicely as a safety net, but why not encourage those who can to use private care? Would take a lot of pressure off the NHS ...

Out of interest how much is a covid jab in the US, and are there different prices depending which jab you have? (ie Pfizer, Moderna etc)

@Moonmelodies

Out of interest how much is a covid jab in the US, and are there different prices depending which jab you have? (ie Pfizer, Moderna etc)

As far as I know a federal programme is delivering those at no cost.

@UsedUpUsername

Actually the deductible can be huge and many families struggle to afford it. The 'catastrophic care' plans for example had deducibles of $10,000 plus. People were paying for coverage which, in essence, would still make them bankrupt before they even got to use it.

Even a few thousand dollars can be crippling for lower income households, especially in those states which refused to expand medicaid.

@UsedUpUsername I know maternity care here isn't perfect but I'm not sure you can use it as an example of the US system being so much better. The maternal mortality rate is the worst of the high income countries. It's more than double (almost triple) the uk rate (going on 2018 figures).

@UsedUpUsername

Also, can someone tell me what exactly is so wrong with a two-tier health system? Government healthcare can function nicely as a safety net, but why not encourage those who can to use private care? Would take a lot of pressure off the NHS ...

I suppose my concern would be it ends up the way dental care works in the UK. In theory lots of people should be eligible for NHS dentistry but cant get it, and even if you do have an NHS dentist you have to visit them at wierd times because they spend the rest of their time on private patients. When I had braces as a teenager it was NHS, but we could only get appointments for wednesday mornings, plus they kept pushing and pushing my mum to switch to private because it was better - which my mum couldnt afford. I am not complaining about this - my teeth are straightish now so yay. But I would not want any broken bones, cancer, pregnancy complications to be treated like my teeth were.

@UsedUpUsername And I know the UK and US (stereotypically) have different priorities when it comes to having good teeth.

@zafferana

You'd rather spend somewhere between $2500 and $5000 in the US than get the same treatment for free in the UK *@UsedUpUsername*? Er ... okay! Clearly you have money to burn, but the point of this thread is that many people don't. For a lot of families a bill like that would cause them a real problem. The care WAS good, I can't fault it, but then so was the care I got when I had DS2 in our local NHS hospital and I wasn't talked into getting an epidural I didn't want that time either, so that was a bonus!

Having been denied an epidural (would absolutely never have happened in the US) colours my perspective here.

I met a US woman who had a British partner, she had some bleeding post birth after she had been discharged, and her partner had to get her to hospital and he couldn't work out what to do or how the insurance worked while she is practically passing out, and there was all this crap about payment/ insurance - where it was covered as part of the birth process insurance or was something additional, there was lots of arse covering by the hospital as they didn't want to be liable to her for discharging her too quickly, or admit any fault and were reluctant to treat or something, that and the paperwork, so completely traumatised her partner that they moved to the UK.

He couldn't believe how shit it was.

Nope, you absolutely wouldn't be denied ANYTHING in an American hospital, because everything you agree to, they can bill you for! I was in active labour and they were threatening to wheel me up to the OR and give me a caesarean if I didn't hurry up and deliver and if they hadn't given me the fucking epidural I didn't want I'd have been more able to push effectively, but I digress. Just be careful what you wish for ...

The dentistry analogy is a good reason why a two-tier system isn't a great idea. So many people in the UK now can't find a dentist who'll take them as NHS patients, so they don't have dentistry. And if you do manage to get NHS dentistry, it's bare bones and anything you actually want done you have to pay for or wait years. My poor old dad has reluctantly switched to a private dentist, because he simply cannot get an appointment to get his teeth fixed on the NHS. He's been eating on one side of his mouth for a year now.