To be appalled at people dying in the USA because of the cost of insulin

[WeBuiltThisBuffetOnSausageRoll]

A 27yo man in Virginia, who had type 1 diabetes, died last month because he couldn't afford to pay for the insulin that he needed to keep him alive and healthy.

Up to the age of 25, he was covered on his step-father's medical insurance, but once he turned 26, he was on his own. He was in a low-paying job which didn't come with adequate health insurance, so he saw no alternative but to buy the much less effective (and much less suitable for his needs) cheap variant over-the-counter at Walmart and then ration it to eke it out as much as he could.

I saw a report today suggesting that this is far from the norm. One family has a child whose insulin costs them £1,200 a month. It's their biggest single family outgoing and they sometimes have to sit in the dark or the mother go without food herself to be able to afford it. Of course, as he grows, he will be needing to eat more food and therefore need more insulin. Whatever would the family do if they had another child who developed T1D?

At best, it seems that ordinary people can find themselves very limited in their job/career choices and will often have to take any job based on what insurance cover it comes with, rather than one based on their skills, abilities, qualifications, experience, interests etc. At worst, the poorest, most vulnerable and/or least educated will not be able to get into any job that comes with the cover they or their families need.

It's much, much cheaper in Canada, so Americans who live anywhere near the northern border travel over and stock up there whenever they're able to; but the USA is a huge country, so this will not be a feasible option for the vast majority.

We see and hear all of the heartbreaking reports and appeals from poor countries in Africa, Asia and eastern Europe, but THE USA?!?!

I know our NHS is far from perfect, but we have an immense amount to be grateful for.

How do American MNers manage to deal with this; or indeed, people from anywhere without an NHS or similar public set-up? Are these the full, true facts? Are people in the richest country on Earth really just tossed into the trash so easily and left to die for getting ill?

The US and UK are not the only possible models. In Switzerland, everyone is entitled to basic health insurance. It covers all conditions and all approved medicines. You pay a little bit out of pocket and the insurance covers the rest.
I have been using Swiss medical care for the last 14 years including 4 births. It’s vastly better than the NHS.

why should I pay for you to have xxx? You should work harder and buy xxx for yourself".

I hear this here too.

I really don't understand how it works.

So, say you are very low income and get hit by a car (or shot by a gun). You have to insurance but are treated anyway.

Can you refuse to be treated on grounds you can't pay? Does this happen? Can you pre-arrange not to be treated in case you're unconscious?

If you are treated and cannot pay even with payment plans- do you then, as a car accident victim, go to jail? How long (ish) for? Is the bill wiped after do jail time? If not - what happens when you still can't pay it after going to jail?

@FATEdestiny it's the leading cause of people losing their homes. Bankruptcy, homelessness etc. It's horrific.
One of my online friends told me that they spend nearly a third of their household income on medical coverage and they then have to pay for all sorts of stuff on top of that. So she keeps forcing herself back to unsuitable jobs and then getting more unwell again and having to quit.

The american attitude to taxes and healthcare is just utterly bizarre.

Was in New York earlier this year and ended up chatting to someone about this subject. I can't remember the exact figures but I'm sure we worked out that the nhs takes up around 20% of the UKs total budget and that someone earning the average wage (£24k) would contribute around £1800pa or £150pm towards healthcare.
In contrast they paid $200pm for their healthcare but had to pay extra charges for certain things as they aren't covered under their plan and yet when I pointed out they'd be far better just paying that $200 to a nhs style system where they'd be covered for everything they just couldn't bear the idea that someone paying less might benefit from that sort of system.

Are people in the richest country on Earth really just tossed into the trash so easily and left to die for getting ill?

Yes. Yes they are. After they go bankrupt. Gotta get that last dollar off them beforehand.

Are people in the richest country on Earth
Btw, I know you meant us in the US, but the US is not the richest country on Earth.

Brit living in the us. Can we try to minimize the sweeping 'americans think this' and 'americans are anti this' please? Large country, lots of different opinions.

Mine (for what it's worth) - HC generally here is v expensive even with good insurance and, depending on your doctor, can have unnecessary treatments, procedures etc. In the 10 years I've been here, I've learnt to not go to those doctors but seek out the ones who work with me to find the most appropriate treatment not the most expensive. One thing I've noticed is that nurses are sometimes not allowed to do procedures that they would be ok doing in the NHS. This means that I've waited for a doctor on call when in the UK, a nurse would have treated me and I'd be on my way. All adds cost.

However I have an auto immune disease which was never diagnosed in the UK but within 6 months of being here was diagnosed and I was getting treatment so swings and roundabouts I guess. I do have fairly comprehensive insurance though plus a salary which means I can avoid the initial $2000 I need to pay at the start of every year.

What gives me hope is that all the serious democratic candidates are talking about some form of national health care. Be that an expansion to Obamacare through a public option, through opt in Medicare to single payer Medicare for all. These were never discussed in serious ways even 4 years ago. This gives me hope that some Americans are starting to realize that having people die or have to go bankrupt in order to stay alive is not the best sign of a "first world democracy".

$500 for an ambulance sounds cheap, tbh. Friend of mine had an accident and was taken to hospital 20 mins away - ambulance bill was $2500. She was later transferred to another hospital in a bigger city - ambulance bill was $7500. Insurance refused to pay.

It’s not just insulin either. A relative has inflammatory asthma - he had to pay around $600 for an inhaler for one month. That was after the insurance had covered part of it.

Health care in the US can be great, but not always. The pricing though is a complete scam.

The hospital is five minutes away!

Health Visitors - we don't want anyone coming to out homes and telling us how to live. We want to choose our own health advisors.
-Schools telling us what we can/can't put in packed lunches and doing weight checks on children and reporting them to SS/HV.
-Closed courts. Parents have children taken and put up for adoption and not allowed legal representation or an avenue for appeal. Worst
that the newspapers/TV stations cannot report on these cases.

You can turn down a health visitor. They aren't mandatory.
You can turn down a child's weight check. Children's weights are not reported to HV/SS
Closed courts are to protect children. No one is denied legal representation.

Where do you get this shit???

Is there such a thing as less effective insulin; does that just mean lower concentration?

Little anecdote:
Cancer left my (American) aunt with huge crater on her nose, she needed plastic surgery to repair. This was ~2010, her surgery was delayd probably linked to her poor health insurance (low income, medicare maybe?). Republican aunts ranted at Xmas gathering about Obamacare plan. They asked me about NHS.

I tried to be neutral coz I didn't understand Obamacare, tho' I NHS. Just said that under NHS aunt would have had a timetable quickly for her treatment, that NHS is amazing value, plus amazing for emergency health care. Basic worry aunts had was that that govt. health care will always mean huge delays to get any treatment and lots of "computer says No." They would be horrified at QALYs.

I agree with others that NHS & USA are not only models to talk about.

If you simply can’t pay for something like a gunshot wound or car accident, the hospital just has to not get paid. This in turn raises rates for people who can pay. So we already have a form of socialized medicine, it is just incredibly inefficient and leaves some people bankrupt.

@FATEdestiny

As said they are treated. No person is denied life saving care if they show up to a hospital. Then their financial situation will be looked at and if they don’t have insurance, are under the poverty line or deemed unable to pay most of the bill is written off * They will be given the chance to pay the remainder in installments and if they are unable to keep up it will be reported to the credit bureaus. At that point it will affect their credit score until it falls off in 7 years.

The insurance system works for the vast majority of Americans. I for one shudder at the thought of an NHS style system. I can’t believe the stories I read on here about wait times and hospital conditions. Even the ones coming from those praising the NHS. The simple truth is the majority of Americans are not prepared to accept the service and care level that comes with the NHS.

The only place you will find a ward room with more than two beds in it is post-op. Everyone leaves surgery, is monitored, and wakes up in a ward room, then you are transferred to either a shared double room or private room for the rest of your hospital stay.

Even the poorest of mothers only has 1 other person in their room and even that is being quickly phased out in favor of all private rooms. Emergency rooms are also quickly being converted to single bed bays with walls and doors.

Personally, I want the freedom to choose my doctors, see a specialist, and be an active participant in guiding my healthcare. Is the system perfect, of course not. It is the system I prefer over any others I have researched.

• the write offs are part of the reason that prices are high to begin with, as the cost is factored into what everyone else then pays.

So, say you are very low income and get hit by a car (or shot by a gun). You have to insurance but are treated anyway.

The very low income have Medicaid, which is part of our welfare system so they get basic healthcare for accidents/injury for free. The problem is that there are millions that have incomes too high for Medicaid but not high enough to afford health insurance or to self-pay in the event of a health event (accident, injury, major illness).

Can you refuse to be treated on grounds you can't pay? Yes if you are conscious.

Does this happen? Can you pre-arrange not to be treated in case you're unconscious?. Yes. Pre-arrangement is limit. You can set up a living will saying you reject care and do not wish to be resuscitated. But there is no central database so emergency responders will ambulance you to a hospital and you would be stabilized. Your next of kin would usually then bring in your living will but by this time you would’ve racked up a good 10k plus in medical expenses.

If you are treated and cannot pay even with payment plans- do you then, as a car accident victim, go to jail? How long (ish) for? Is the bill wiped after do jail time? If not - what happens when you still can't pay it after going to jail?. No, you don’t go to jail, you file bankruptcy. The courts then decide whether you can have the debt wiped clear or if you have the income/means to pay the debt back through a court ordered repayment plan or liquidation of any assets. Some states force you to sell your home, auction your car/possessions and cash out your 401(k) etc.

Sorry but my sister had a hell of a long wait for a diagnosis - much longer than NHS because it’s an unglamorous and unprofitable area, with no cure to be absolutely blunt.

Her doctors and specialists have been - bluntly- absolute (well paid) arseholes too - blurting out (terminal) diagnosis as if by accident ‘oh well my other XXX patients...’ then getting shitty when she asks intelligent questions (my sister is very smart and curious).

And bugger having a room to yourself. The NHS treated both my parents excellently when they were ill. Any mum did have a room to herself after her cancer op - but that fancy curtains made not a blind bit of difference to her care or prognosis.

and if they are unable to keep up it will be reported to the credit bureaus. At that point it will affect their credit score until it falls off in 7 years.

I think you are minimizing what hospital debt does. There is the being hounded by debt collectors for one. It’s a lot more serious than a black mark on your credit report....which actually lasts for 7yrs after the debt is no longer active. Not 7yrs total.

The insurance system works for the vast majority of Americans.
But it does not work for a significant minority numbering several million who are experiencing poor health and lower life expectancy due to lack of even the most basic healthcare.

I would welcome universal healthcare like the NHS or German system. But then I’ve been stationed in Europe and so have seen how well it works firsthand.

We need to be very careful to ensure we don't lose our NHS.

About a year ago I collapsed and was taken to hospital by ambulance. There I received immediate treatment in a very impressive well run department which involved nurses, doctors and technicians. All NHS and all free at the point of contact.

Over the last several years my DD has had her DCs at the same hospital.

In a midwife led unit she had her own room with her own bathroom, birthing pool and various other birthing aids.

After the birth she was transferred to another room of her own, also with her own bathroom, and stayed overnight there. Again, all free at point of contact.

In both our cases the staff were fantastic.

I know not all hospitals are like ours and we are very lucky. I know in some hospitals have serious difficulties in some areas but even in the most ill equipped and under funded NHS hospital no one will be left to die because they can't afford treatment.

No, you don’t go to jail, you file bankruptcy. The courts then decide whether you can have the debt wiped clear or if you have the income/means to pay the debt back through a court ordered repayment plan or liquidation of any assets. Some states force you to sell your home, auction your car/possessions and cash out your 401(k) etc.

This is a simplistic description of bankruptcy, there are protected assets including primary homes, retirement accounts and possessions. And you are not forced to declare bankruptcy, you can choose not to pay and not to declare bankruptcy and your debt will go to collections where you can either ignore until it goes away or negotiate a settlement with the debt company who bought the debt from the hospital.

But it does not work for a significant minority numbering several million who are experiencing poor health and lower life expectancy due to lack of even the most basic healthcare.

And that’s why I’m in favor of expanding some of the safety nets, but I’m not willing to trash an entire system for a minority.

American once who said that healthcare is a privilege, not a right wow good luck to them not finding out they have a hereditary illness. I do know of someone (NY) conveniently let go from his work when he had a recurrence or cancer - work just didn’t like him having time off. Imagine your health depending on your shitty boss! Argh!

Anyone remember scrubs and the fiddle then did when come across someone with out insurance? (Basically claiming off the deceased) I wonder if this is true. But it was done in the programme so they could continue to treat the patients.

Most people's perceptions of what the US is like are usually completely wrong. Until very recently, and still today to some extent, we've all been fed a lie by the media that it's a rich, wonderful country where the sun always shines, something to aspire to. We've been fed a very rosy picture in films and on TV. If you just go on holiday there you don't see what it's really like.

I was certainly shocked when I lived there. I've never wanted to go back and I haven't in 28 years. And things are much worse there now.

The poor are usually viewed with contempt. If you can't afford medical care it's your own fault. American culture is very harsh.

@Georgiagirl52

1. Health visitors need your permission to visit and there are never enough of them to cover the demand. They are there to make your life easier, not harder. If you have something you're so desperate to hide from your health visitors, I'd venture a pretty confident guess at where your problem truly lies.
2. Obesity is easier to prevent than cure. Again, weight checks are there to help.
3. Taking a child away from the parents is the lenghtiest, most arduous process peppered with support and littered with every effort to avoid taking the child away. If you are actually talking to someone who actually got their kids removed that way, chances are you are looking at someone with intractable and well documented pathways of child neglect and/or abuse.
4. US press isn't free. It prints what those who bankroll it want you to think. Not to say it doesn't happen here, but not to such an extent.

According to a Kaiser Family Foundation and New York Times survey conducted in 2016, 20% of Americans with health insurance found that when trying to pay off their medical bills, they had serious financial challenges and even changes in employment and lifestyle. For those uninsured, the number rose to 53%. Although it’s clear insurance helped in terms of people’s ability to make payments, about the same amount of people — insured and uninsured alike — still said their medical bills had a huge effect on their families.

The insurance system does not even work for everyone that has health insurance.