What do Americans do if they have no healthcare?

[summeriscomingsoon]

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?

That's for @UsedUpUsername

UsedUpUsername because I want to live in a country where healthcare is free at the point of service, because I don't want clinicians to make decisions on how and when to treat someone due to insurance provisions.

Because I don't want people to have their health care determined by them being employed.

You just don't get any healthcare. There are some free and low cost options, but you usually have to demonstrate significant need. I know I was looking to access free or subsidised healthcare and I had to prove that my income from the previous tax year was below a certain threshold. But my previous year's income was fine, because I was employed (and had health insurance!). In was right then and there where I could not afford healthcare, because I'd been made redundant and had no health insurance.

I had a situation just before I lost my job where I'd had a smear done. The results were abnormal, but there had been a mix up and they'd given me someone else's results (normal). Then a month later, called to say actually there had been a mistake and I needed a colposcopy and biopsy. But in that month, I'd lost my health insurance. I tried to have the colposcopy done at planned parenthood or another sort of charity that offered low cost women's health care. But even then the colposcopy was $1000! I couldn't afford that being unemployed and then even when I was employed again, I had no health insurance as my employer didn't offer it. I waited 2 years while I may have possibly had cervical cancer until I had insurance again and could afford the colposcopy. In the end, the damn thing still cost me $600 with my expensive health insurance - which if I'd known, I would have taken out a loan to try to afford it years before!

Thankfully, the biopsy was okay and the cells were abnormal, but not cancerous. I was very lucky. There are many people are not so lucky. Dh had a friend when we lived in the US who lost his house to pay for his cancer treatment. It cost $200,000. He had no insurance and the hospital will usually write off some of it, but that was the bit left for him to pay.

No idea what it's like now with the Affordable Care Act and the changes brought in by Obama, because I left as soon as I could get a visa to move to the UK and have never looked back. But back in 2003, I was paying $600 a month for health insurance, plus co-pays for visits and extra for tests (thank god I never needed a hospital stay), and that was just for me. I couldn't imagine how I'd afford that now with a family and all the costs of being an adult. Back then I was like 20 and I had almost no living expenses and everything just went on my car and insurance.

I think maternal care is something that needs to be looked into in the UK. I am not sure if this is specifically about how it is funded though, so much as about attitude towards birth ("natural" versus "medicalised") and crucially, how much mothers are listened to. I have lived in France and the Netherlands, both countries fund their health systems in similar ways but they have very very different approaches towards pregnancy and childbirth - the rate of c-sections in France is very high, the rate of home births in the Netherlands is one of the highest in the developed world. One person can say that they love the Dutch system because it "is less medicalised than other countries, they dont treat pregnancy like a disease, they empower women to have natural non-medicalised births, you can have a home birth, its midwife led" blah blah blah. Someone else can HATE the dutch system for exactly the same reasons. It all comes down to individual attitudes and, crucicaly, each womens individual experience of labour. If I had given birth in France, the UK or probably the US I think I would have been induced due to circumstances. In the Netherlands I wasnt - this was perfect for me, the birth proceeded slowly but naturally and all was fine so I think it was the right thing. If the birth hadnt or my baby had had an infection though I would have felt very different about it.

If people want to go private for maternity care they can. There's nothing stopping them. And most NHS hospitals offer private rooms at a small charge. I'm not sure what they charge now but when I had my dd 22 years ago it was £40 a night for an ensuite room. Our hospital also used to have a private hospital in the grounds. A bit like a cottage hospital....... Those who could afford it could pay to stay there. Basic health checks would be carried out there, it was all private rooms rather than bays but they'd go to the big hospital over the road for treatments. It closed a few years ago because nobody used it and is used as part of a chemo ward now.

TL:DR getting or not getting an epidural in a UK hospital isnt about the perils of socialised medecine as such...

I’ve seen $40k bills for an appendicectomy in New York, even in a top London hospital the same op would be £5k I had a major surgery with one of the best surgeons in the U.K, two nights sleep at a private ward , total £11k, a quick search shows it would have cost close to $80k in the US.

I remember looking at data around pregnancy and births when I was pregnant with DC2. The US has the highest rate of maternal mortality in the western world, because of women leaving it to the last minute to get to the hospital, having poorly managed pre-existing conditions like diabetes etc. I saw a quote on Buzzfeed about parenting, which mentioned standard baby injections being $200 per baby - the father was querying why they'd been billed twice, but they had twins so two costs. My youngest has been in hospital this week; I've been stressing to her older brother how lucky we were to get a free ambulance and only have to pay for a taxi home compared to the costs in the US.

@MobyDicksTinyCanoe Yes! cross posted. Another plus about that is that because of the NHS, the private health care has to be really nice to make up for the fact its private - so the rooms are like a fancy hotel room etc.

I know NHS could be better - some other European models for example might be better ... although the centralised nature of the NHS is largely to thank for the incredibly fast vaccine roll out. My friend in France says not much incentive for individual GPs to use their time and resources doing so. Everything in life has its trade offs. NHS achieves incredible outcomes in spite of years of underfunding.

they find out you have good insurance and do the works

^^ this thinking applies regardless of the industry. We have pet insurance and find it miraculous how the veterinary treatment always just reaches our maximum

It always makes me think of that lad in his early 20s who was Type 1 Diabetic and went to his parents house for Christmas dinner. They were unable to afford his insulin so he went into a coma after the meal and he died Boxing Day. A completely preventable death due to lack of a drug that costs literally pennies for an individual, but is marketed at tenfold it's production cost. My heart aches for the poor family.

The idea that a cancer diagnosis is consumed by the thoughts of cost is deplorable. Most people there are a few malign cells away from financial destruction.

I was 8w pregnant on holiday in the US, started bleeding very heavily and went straight to the nearest hospital. Literally the first thing that happened was that DH was taken away to sort out the insurance paperwork (we had travel insurance, but required several international phone calls to get the right details for the hospital at what was approx 2am UK time). So I spent one of the worst hours of my life in alone in a bay in A&E because the money was more important. Luckily, DS was fine, but I decided there and then that I'd never move to the US while they still have this system! The actual treatment was great, and to be fair probably better / faster than under the NHS, but the focus on the payment made the whole thing much more traumatic than it needed to be. And if we hadn't had insurance, I can only imagine how much worse it would be...

Yeah, I know it’s all free through the NHS but the treatment just feels so bare bones and inadequate.

Except outcomes for many conditions are the same, or better, in the NHS than for the US. And if it feels “bare bones” it’s because successive Tory Governments have driven down funding and salaries (lagging well behind inflation), which has put extra pressure on staff and lead to a shortage of HCP. Brexit hasn’t helped in that regard either.

“The UK ranks below the average of high-income OECD countries in terms of both the number of practising nurses and the annual number of new nurse graduates relative to its population. The UK has just under 8 practising nurses per 1,000 population (7.8), while the OECD average is 9. Germany has over 13 practising nurses per 1,000 population, while Australia has 12 and Belgium and the Netherlands each have 11.” [health.org]

My friend was a paramedic in the US and even she didn't have insurance! She does now but it is co-pay.

Sometimes doctors will give you sample treatment (that they have been given by Pharma companies). Most though chase the money!

Doctors routinely become very wealthy.

A friend's Uncle could only have treatment for his cancer at no cost because it was experimental.

My ex-boss (who was American) just couldn't understand how we work. He firmly believed in everyone paying for insurance although some cannot afford and some are not eligible. He was an Italian immigrant!

It is an outrage that in the richest country in the world your life/health/education depends on lots of money!

"Why the fuck anyone over here, other than the greedy rich bastards who want to milk us all for even more money, thinks that moving the NHS over to a US style private system is a good idea is totally beyond me."

@PaterPower nails it. That is exactly why, sadly.
The NHS has its flaws god knows but we've needed it so badly recently and it is a bloody gem beyond compare to the US situation

I lived in the us for a while and I do think their system is ridiculously complicated and leaves out many there is no doubt their standard of healthcare is much higher than the NHS. My insurance covered most things an employers must pay for health insurance for employees. As for the breaking bad story line, public sector workers actually get very good healthcare plans- it’s one of the perks.

Also some states do have provision for poorer people so it’s pretty complicated and not uniform across the US.

I do prefer a universal system but we should not think the NHS is perfect or fail to look objectively at other systems. One thing about the US is that older people get Medicare treatment that they just wouldn’t get on the NHS.

Also I don’t think anyone at all is suggesting moving the NHS to a US style system. No one at all. So let’s be realistic

@zafferana

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.

Thanks but my epidural the next time round was very lovely.

Also, yeah, I know you get nickel and dimed in the US, but everyone knows you can have the ability to negotiate the final bill by like, a lot. Just like insurance companies do!

I’d rather have a two-tier than shit-tier for everyone. You can say it’s because of lack of funding, but no one is willing to put the kind of money you’d need to make that potentially work, and the UK will only be less and less able to fund this kind of stuff in the future, imo.

Now I don’t have experience in Australian medical care, but do they not have a two-tier system?

Also, the NHS does not pay your doctors/dentists nearly what they are worth. I’m also shocked by how little they are paid.

We just have fundamental disagreements on this. I don’t mind paying for good care. I’ve visited the folks back home and paid for care as an uninsured patient. You can get a pretty good rate that way as long as you stay out of the ER ...

My ex’ family had to declare bankruptcy three times while he was growing up following medical treatment for various family members.

Worth noting that time and again American physicians’ associations vote against healthcare reform. Much as our doctors mostly didn’t want an NHS back in the 40s. Unfortunately they often can’t see past their own self interest, at least initially.

@jivedive

UsedUpUsername because I want to live in a country where healthcare is free at the point of service, because I don't want clinicians to make decisions on how and when to treat someone due to insurance provisions.

Because I don't want people to have their health care determined by them being employed.

That happens due to NHS budgets anyway, so don’t know what you’re on about.

Also, you can always go to another doctor within your network. You should always get a second opinion anyway.

And employment insurance is a perk, you can buy insurance on the open market like many freelancers and small business owners do.

To be clear, not saying the US is perfect AT ALL. But some combination of private and public would be much better imo

Having been denied an epidural (would absolutely never have happened in the US) colours my perspective hereUnless you're a teenager (there is a lot of disparity in access with lack of or different types of insurance and race as well - really getting into absolutes of terrible things never happening erases a lot of people).

Having had a friend die in childbirth in the US colours my perspective.
Having been a teenager denied healthcare in the US and seeing my own teenager get great care on the NHS colours my perspective
Knowing the massive hoops people have to jump through to access free clinics colours in the US my perspective: it's not a safety net, most won't let you access them if you're say homeless, for example - you have to have all the right papers and tick all the boxes - colours my perspective.
That abuse in the US includes someone with insurance not giving access to it to someone in their household that relies on it, including children, colours my perspective.

Yes, the NHS has a lot of issues that need to be worked on, mostly that it's been cut to the bone with the most vital areas being worst hit over layers of managers and issues of trying to get medical abuse properly investigated (though the US also has those issues with state funded care). The US is not the example of how to improve that if we want to include the most vulnerable members of society. The US doesn't have a 2-tier system, it has several tiers. That there are now guides out there to help people negotiate their medical costs because all the prices are so over-inflated and it's impossible to do the responsible thing of ringing around and asking for costs beforehand should be dozens of red flags that as much as they espouse freedom, it's far more about control and politics. I mean, we're discussing a country that literally has it's tax preparation companies lobby against taxes being more streamlined or automatic for those employed as most other countries have and they have consistently won that argument - the systems are incentivised to be as complicated as possible for corporate benefits, not people's needs.

Is the us turning infectious covid patients away from the hospital if they can’t pay or have no insurance ?

What happens in that case ?

@apalledandshocked

TL:DR getting or not getting an epidural in a UK hospital isnt about the perils of socialised medecine as such...

It’s my personal experience of cost-cutting measures. There are plenty of stories on here of being denied csections as well as the frankly barbaric persistence of using forceps in the UK as again, as a cost-saving measure.

This is just maternity care. What about other types of care? Are they cutting things there too?

Having a mixture of two systems that covers the same treatments is a problem. I have seen it with Medicaid. There are doctors who don’t accept it. Then they both blamed each other for the rise of health cost

And with some people who are incapable to handle stress, they sometimes don’t want to deal with bills and insurance. I certainly don’t and I usually let my husband handle it. I am under his insurance too.