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Comment by KaiserPro | Hacker News Reader

None of this is going to be resolved this week or month.

THe next big thing to watch out for is the virus spread in the USA.

Now, unless something changes, I am not overly hopeful in containment for the USA. The rumours of poor/non standard testing, and the limited access to healthcare is going to make one hell of a mess.

Could a US person explain who pays for the test/on going healthcare if an uninsured person rocks up to the ER with relevant history and flu like symptoms?

Does the government step in to fund care? or is it left to the hospital to foot the bill?

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Hospitals in the US with emergency rooms are not allowed to turn away patients who are sick. Ultimately it's the taxpayers who foot the bill. (Federal, State and Local Governments pay for it I believe.) This also explains why so many private hospitals have shut down their emergency rooms. I also believe that many private hospitals will transfer patients who cant pay to public hospitals.

Is it likely that many people without insurance will be reticent to go, fearing they'll end up with a huge bill they can't afford?

Yes, self-rationing care is already a huge problem in the US.

Actually most of the uninsured in the States are covered by public funds and consume more healthcare than other cohorts. It’s the underinsured and those with high deductible plans that may not go to a doctor due to cost,

The outcome is the same but the health cohort might be a surprise depending on your mental model.

Many people with money but without insurance do go and get b*tch slapped later by their ~$10k-$200k medical bill. It’s a reason why medical debt is the LEADING cause of bankruptcy in the US.

Many people without money or insurance also go but since they don’t have assets, they just don’t pay and the hospitals can’t collect on them. So the hospitals have to raise costs on people with money to pay for people without money.

The second scenario actually caused a hospital I knew of in Dallas Texas to close down because it had (according to the locals) “too many illegal immigrants taking advantage of free healthcare”. Dallas Texas is somewhat close to the Mexico border.

I personally knew of a vagrant woman with a prior medical issue that bragged about happily racking up the hospital over a million dollars in expenses after staying in a hospital bed for a few months. She didn’t express concern about having to pay for any of it since she doesn’t work. I wasn’t sure how to feel about that.

I once paid $8k while my health insurance paid $43k when I spent just half a day in a hospital bed in Colorado after I fell and broke a bone.

> I personally knew of a vagrant woman with a prior medical issue that bragged about happily racking up the hospital over a million dollars in expenses after staying in a hospital bed for a few months.

The on-paper cost and the actual cost are wildly disparate.

It's not uncommon to see a $40k bill get "adjusted" to something like $4k when insurance is present.

>Many people with money but without insurance do go and get b*tch slapped later by their ~$10k-$200k medical bill. It’s a reason why medical debt is the LEADING cause of bankruptcy in the US.

Only 4% of US bankruptcies are because of medical bills https://www.washingtonpost.com/blogs/post-partisan/wp/2018/0... . A tipoff that [insert large percentage here] of bankruptcies aren't actually because of medical costs is that only 6% of bankruptcies by those without health insurance are because of that cause. The biggest cause of bankruptcies is lack of income, which health insurance doesn't affect.

My citation says 66% of US Bankruptcies are tied to medical issues. Which of our citations is right?

https://www.google.com/amp/s/www.cnbc.com/amp/2019/02/11/thi...

You’re quite clever in saying that bankruptcies are caused by lack of income. I suppose more income would solve 100% of bankruptcies lol

>My citation says 66% of US Bankruptcies are tied to medical issues.

Your citation says

>A new study from academic researchers found that 66.5 percent of all bankruptcies were tied to medical issues —either because of high costs for care or time out of work.

(My emphasis.) In other words, people going bankrupt because health problems = lack of work = lack of income. That does not contradict my citation which states that 4% of US bankruptcies are because of medical bills; that is, bills for health care treatment exceeding available income.

Your article goes on to quote a study author who carefully elides the difference between the two. Oh, by the way, he is a prominent proponent of Medicare for All! Imagine that.

> I once paid $8k while my health insurance paid $43k when I spent just half a day in a hospital bed in Colorado after I fell and broke a bone.

what on earth did they do to you to cost that much?

to put that in perspective, your co-pay is the cost of a hip replacement in the UK: https://www.statista.com/statistics/687462/cost-of-bone-trea...

While true the hospitals cannot turn away patients who are sick, it pretty much guarantees anyone who has any form of assets will never do so. U.S. is based on percentages, ie. company may be allowed by law to make only 20% profit. So, the bill is made multiple orders of magnitude higher at first bill. Then, "insurance earns its money" by lowering that bill. Then, you usually have to negotiate the final bill and deal with all the associated third-party charges. Finally, medical bills are very hard to discharge.

The only people who think the U.S. has a good health care system are the rich who can afford anything and the poor who watch the news (propaganda) extolling how good our system is but don't actually take part in it. Even if you have insurance, you have to be very careful about what you use and when.

I believe the patient also gets bankrupted in the process.

Depends what you mean. The uninsured person is still technically liable for the price of care, which is why so many people in the US go bankrupt for healthcare reasons (you get a fat bill in the mail that you have absolutely no hope of paying). If they are completely unable to pay, the hospital foots whatever portion of the bill the person was unable to pay.

This source is old, but maybe someone else will answer with a better one: taxpayers [1]. We just do so at a larger cost because we're willing to publicly fund emergencies but not preventative care.

[1]https://www.ncbi.nlm.nih.gov/books/NBK221653/#_ddd00055_

When you say publicly fund emergencies, do you mean that it is covered, or that you will get a bill in the mail, but you won't be denied care; it's just that you have to pay hundreds of thousands of dollars after the fact?

I mean that federal and state goverments provide subsidies to the hospitals to cover the shortfalls that can't be billed. As an individual you still end up screwed.

The person would be billed, but if they can’t pay it, the hospital sicks debt collectors on them and maybe eats it down the road. Hospitals are pretty good at wrecking people’s lives to get their due though.

There have been cases of them putting liens on people’s houses while their still hospitalized if the expected cost of treatment is expensive enough.

The hospital sics debt collectors. The patients are already sick.

> Could a US person explain who pays for the test/on going healthcare if an uninsured person rocks up to the ER with relevant history and flu like symptoms?

> Does the government step in to fund care? or is it left to the hospital to foot the bill?

AFAIK, currently it'd be just like if someone uninsured came in with any other illness: the hospital gives the care, the patient gets a bill they can't pay. The hospital essentially extends credit to the patient.

From my understanding of the viral testing, the CDC distributes the tests to local healthcare professionals, however they don't seem providing enough to get in front of the issue. That is why there is an article floating around that the govn't of British Columbia (Canada) has tested more patients for COVID than the entire USA.

I'm not super informed on the issue, take this with a grain of salt.

> Could a US person explain who pays for the test/on going healthcare if an uninsured person rocks up to the ER with relevant history and flu like symptoms?

They don't. They keep working because there's no way to afford the time off or the sick child care, even if the taxpayer does foot the bill for the ER visit.

Kids keep going to school and adults keep rocking into work.

That especially goes for food service workers.

When you combine high-deductible health insurance plans with no paid sickleave which is really common in foodservice and bars, it’s just asking for something like coronavirus to spread.

Also Coronavirus doesn’t know the difference between someone making minimum wage and $10million/year. This can and will cause an economic downturn, possibly a recession. Hopefully we as a nation get it though our heads that universal healthcare and paid sick leave is something that is needed to prevent further disease outbreaks.

In our BigCo they've already instituted the "tell on your officemate" policy which is easy to do thanks to the beautiful densely packed open floor plan. So we're prepared and will do great.

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