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Comment by Sohcahtoa82 | Hacker News Reader

Hospitals suing patients to get them to pay medical bills is something that could only happen in America.

Totally false.

If you are in Caribbean country for example, and get services, if you don't pay you will literally not be allowed to leave the country until you settle up.

Generally the costs are fractions of what they are in the US. But they are not playing - they don't have confidence that once you are back in US or wherever that you'll pay.

Some countries even have exit fees etc. You are there until you pay to leave.

Yeah the grand irony of comments like this is that it is a brand of thinking that is actually very characteristic of a specific group of Americans who blindly view the rest of the world as some utopia(and they are mostly just equating Europe with the rest of the world here) and America as this embodiment of everything terrible. So you get to seem worldly while in my mind projecting a very limited view of the realities of the broader world.

Slate Star Codex (Astral Codex Ten now) has an amazing piece on the sociology and psychology of the phenomenon of "Blue/Left American's" who enjoying trash talking America where he points out that these people who make an identity out of trash talking "America" as well as things like white men who write articles about "how terrible white men are" are not being self critical because those terms in this context are a code word for "Red/Right America" who are stereotypically more openly patriotic.

So it creates this great rhetorical tool of getting to seem humble and self critical on the surface while everyone knows you are really just complaining about the other side.

https://slatestarcodex.com/2014/09/30/i-can-tolerate-anythin...

Truly one of my favorite things I have ever read. Put words on so many things that I felt but struggled to articulate.

Worth pointing out that I don't identify with conservative or right politics. I know because I'm critiquing one side here but it's not an indication of me being on the other side. I just find it to be an interesting point that matches my lived experience.

I'm also an American expat.

Lots of other countries do this as well, outside of the Caribbean.

Looking into the human rights campaigns about this from Chatham House we have

"• In some parts of the world it is common practice for patients to be detained in hospital for non-payment of healthcare bills.

• Such detentions occur in public as well as private medical facilities, and there appears to be wide societal acceptance in certain countries of the assumed right of health providers to imprison vulnerable people in this way.

• The true scale of these hospital detention practices, or ‘medical detentions’, is unknown, but the limited academic research to date suggests that hundreds of thousands of people are likely to be affected every year....

Women requiring life-saving emergency caesarean sections, and their babies, are particularly vulnerable to detention in medical facilities."

Yeah - they "arrested" the vessel I was on once until someone's medical bill was settled up (not mine). Certainly worked, company involved wired money promptly.

The other thing - you can be turned away for lack of payment more easily (or just not get great care) in other countries. In the US you can do a $10M bill on critical care at a hospital without paying anything - that just doesn't happen in some other countries in most cases - they don't have the $10M lying around etc or have more competing needs so you just can't stay on full support for years the way you might in US.

In most other countries, that same level of critical care would not even come close to $10M. The sticker price of healthcare in the US is so wildly inflated as to be meaningless.

Other countries don't come close to keeping people alive as long as folks try in the US.

New Jersey for example allows for a religious objection to a medical declaration of brain death etc. As long as your heart keeps pumping you can be called alive and provided with intensive care (for years). And yes, your heart pumping can be mechanically driven, they can do feeding tubes and IV's etc - so this means "alive" for a very long time.

We need to be clear - that other countries will not provide govt or mandatory care in these types of cases.

In places like New Jersey - it is a crime to stop providing care (even when person is fully brain dead) or to stop paying for care if someone has a religious belief someone is alive.

“No health care practitioner or other health care provider, and no health service plan, insurer, or governmental authority, shall deny coverage or exclude from the benefits of service any individual solely because of that individual’s personal religious beliefs regarding the application of neurological criteria for declaring death.”

You can imagine the costs of these types of laws.

There is a small industry in places like California which cap malpractice awards in cases of death but don't if someone is alive to get folks to new jersey where they can be kept "alive" indefinitely to maximum legal payouts etc.

Are there other countries where a person might be responsible for their own bills? I think there are, right? This may be a bit of a silly question, but how do the systems in those countries collect from individuals who will not otherwise pay?

" own bills"

The problem is that Hospitals can charge any amount they feel is correct but you cannot find that out UNTIL AFTER the service is delivered. Yes you could ask for cash prices but try doing that at a regular hospital and see how quickly you get them in a clear and concise manner.

I'm replying to you because you're the top comment, but this is a general response, because I feel like many replies have misconstrued my meaning.

I am not asking what happens in countries with socialized healthcare. I'm also not asking what are the flaws of private healthcare. I am only asking, supposing that there are other countries where there is private healthcare, how those countries deal with nonpayment. If there are no other such countries the question is moot but I had been led to believe that there are some.

In my country, without insurance you will usually be required to place cash deposit before the hospital approves any expensive treatment. If you don't have any money for the deposit, you will need to secure financial assistant somewhere else first (government assistance, charity, etc). This limit hospital's risk, but put extra pressure to patients. Luckily healthcare cost is relatively cheaper here.

In many social democratic countries citizens will only pay a small fixed fee for necessary operations. For private bills, or if your travel-insurance doesn't cover medical bills in other countries, you could still get stuck with a hefty bill.

In most cases, you pay peanuts and people get their health back so they can go back to work and live life as before.

But GP was talking about countries in general, not just wealthy western social democratic countries.

The same way America handles it when eventually enough people don't pay. They bail the companies out with a ton of tax payer money so the companies can continue their practices.

In other countries, people don't get billed for their healthcare, or the bill is small enough to be insignificant for most of the population.

But we can't have that in America, because half the country is convinced that would be SOCIALISM!!

I know that this is true for many other countries, but is this in fact true for all other countries?

Not all, but most.

To be fair America has the Veterans Affairs administration, which is socialized medicine, albeit for a small subset of the population, veterans.

If you recall from Donald Trump's presidency, one of the things he campaigned on for veterans, is the ability to choose your own healthcare, such that they wouldn't be locked into the veterans affairs medical system, which was found to be far insufficient.

This isn't an apples to apples but it's worth considering that there are examples of the alternative model not working in America either.

I, like many veterans, love the VA. https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5328

My understanding is that that the veterans' choice private options would still have been payed for by the VA.

https://www.va.gov/COMMUNITYCARE/providers/index.asp https://www.politifact.com/truth-o-meter/promises/trumpomete...

> one of the things he campaigned on for veterans, is the ability to choose your own healthcare

Veterans can already do that.

> such that they wouldn't be locked into the veterans affairs medical system, which was found to be far insufficient.

They aren't locked into the VA, and whether or not the VA is sufficient depends on who you ask.

Veterans already have the choice of choosing their own healthcare or using the VA. If the VA is considered insufficient, but they're using it anyways, then that means that their other choices are even worse.

Don't be fooled. Republicans want to gut the VA as a way to cut spending so they can give the rich even more tax cuts. They will happily do this at the cost of healthcare for veterans while framing it as expanding freedom by giving them a choice that they already had.

> To be fair America has the Veterans Affairs administration, which is socialized medicine, albeit for a small subset of the population, veterans.

It also has TriCare (military & dependents, ~10M), Medicare (Aged/Disabled, 61.2M in 2020), and Medicaid (medically indigent, 68M in 2020). With around 9M in Veteran Health Administration, the US has socialized medicine for nearly 150M people out of the 330M population.

Medicare and Medicaid are not exclusive. They call it "dual eligible".

(PDF WARNING) https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-...

This lists 20% of Medicare and 15% of Medicaid enrolled are dual eligible. So that's somewhere between 10.2 and 12.2 million lower, using your numbers.

(And yes, those numbers are obviously off somewhere, since the two should match. But it's good enough and I'm not sure it's even possible to track down the actual numbers used in the given link.)

> Medicare and Medicaid are not exclusive. They call it "dual eligible".

Good call. Forgot to consider dual eligibles; which drops it closer to 1/3 the population than half with socialized medicine.

Dangerously ill-informed comment. Have you ever been to a hospital in a country that embraced socialism? In some countries you pay effectively zero for socialized healthcare. What an awesome, marketable for votes delusion.

Guess what. You get exactly what you paid for. Chronic mismanagement, apathy, deteriorating conditions, lack of resources. Need to schedule a procedure? Get into a virtual line 10000 persons long. "Oh you are in pain? I'm sorry. Thermometers are the only medication we can offer". In CIS countries, the only way to get something done is to bribe an official (to move you up the line by a 100 or so) or a private clinic (but socialism is so great! right?) If a country with socialized healthcare manages float it's healthcare services on an "average" (aka meh) level, it's only because of the private donors, private insurances, private donations, and financial aid and subsidies from US (but capitalism is so awful, right??)

Grass is always greener aka you have no idea what you are talking about

I have - I had an emergency procedure done within hours, without noticing particular mismanagement, apathy, deteriorating conditions, or lack of resources.

It was annoying that they didn't want to give out narcotic painkillers, but given addiction rates here, understandable. Not a question of resources, just a different approach.

Of course, as a foreigner who was going to have to pay cash, I can't be positive that the experience would be the same for citizens on Taiwan's national plan, but the people I was staying with said I was being treated the same as they'd seen anyone else...

I don't think the countries of the ex-USSR are what anyone is talking about when they're talking about socialized medicine.

> or a private clinic (but socialism is so great! right?)

Having to pay out of pocket after paying 50%+ tax rate! Incredible!

How many different countries do you hold law degrees (or even a rudimentary understand of law) in?

Factually incorrect. Travel abroad to Germany, get care, and then attempt to default on your bills. You will be threatened with legal action.

And then what? They send it to some collection agency, who sends you letters reminding you over 2-3 years...and..if the amount is a couple of hundred€ drop the matter...it'd cost them more to pursue it further...

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