Sick and struggling to pay, 100M people in the U.S. live with medical debt
npr.org
npr.org
Hospitals aren't allowed to deny care (obviously). They will bill people outrageous amounts and know that they will only ever see a fraction of it. So prices for people who do pay are raised considerably to make up for it.
People don't get early preventive care due to costs or because they are uninsured.
Supply of doctors is artificially limited by the ABMS so that demand stays high.
The government doesn't negotiate or mandate prices, so drug manufacturers, equipment manufacturers, researchers, hospitals and everyone else in the ecosystem squeezes out as much profit as they can to make up for all the countries where they are not allowed to.
The end result is that the average American knowingly or unknowingly pays a lot more for healthcare than any other country in the world while receiving sub-par care.
Hospitals that do not accept Medicare can run a 24 hour, high level of service department and deny care all they want.
There's no requirement to provide non-stabilizing care.
There's a highly rated HMO around here. Their costs are significantly lower than regular insurance, and they seem to pass some of that on to customers in the form of health care.
They absolutely can. They just can't refuse care if you're actively dying or your condition's quickly deteriorating (they have to "stabilize" you). This makes the ER loophole, such as it is, useless as a backdoor for obtaining most hospital care. Plus if you go in for something that's not actually an emergency, they'll just make you wait until you leave. They'll never treat you.
If you're brought into the ER because of a heart attack or are bleeding profusely, your care won't be denied, but you will pay for it in some way later.
Sure you can. In the US, you cannot be denied chemo or other treatments. You will be billed after the fact, and it's going to be a ton of money, but it's not as if they have security escort you out just because you don't have an insurance card. That simply doesn't happen. You'll get care, and if you don't qualify for aid programs or indigent care schemes (of which there are many), you'll probably file for bankruptcy and have the slate wiped clean.
By law, nonprofit hospitals must provide charity care to needy patients. 57% of US hospitals are non-profit. Only 24% are for-profit. (The rest are government run)
ERs can't deny life saving care, but that's the exception.
Is this the conception people have of the US healthcare system? That everyone's taken care of so why are they complaining?
Let me disabuse you of that notion.
This does, indeed, happen all of the time.
This supposed truth is widely misunderstood to the point of simply being not true.
Hospital ERs will stabilize you. That's all.
If you have something that requires long-term care like diabetes or cancer, you're fucked. If you have Type 1 Diabetes and can't afford insulin, the hospital won't just give you a supply. They'll wait until you're about to die from diabetic ketoacidosis.
A friend of mine had testicular cancer but had no money for treatment and no insurance. Hospitals straight-up told him that they won't treat him unless he's terminal. That's right, they wouldn't take care of him until he's on death's door, at which point all they'll be able to do is pump him full of painkillers to make him comfortable for his last couple hours. Luckily, the ACA passed, banning pre-existing condition clauses, and he was able to get some affordable insurance and treatment. Of course, anyone that has had cancer can tell you it likely never goes away [0]. He's always worried that a new tumor will appear somewhere.
In my country doctors don't give a shit about who you are or how much money you have. They do triage. You can be a millionaire yet have to wait 3 months for a new hip because there is someone with more urgent medical needs. It is pure unadultared fact based medicine to allocate scarce resources instead of market forces that turns you into a drone.
Universal healthcare is beatiful but also utterly terrifying. It is pure communism without the "some animals are more equal". It will lift up many Americans no doubt but for the prosperous it is not an automatic win.
I'm in America, and I have fantastic health insurance (by American standards) and waited over a year for a hip replacement surgery. Even with insurance, I paid almost $10,000 for the surgery.
Without insurance it would have cost well over $100k. I suspect that in any other country that provides universal health care it would have been less expensive (for everyone) and I would have waited less then 15 months to have it done.
Look, there is no free lunch. The UK NHS has strict standards of “cost effectiveness” that would shock Americans: https://www.nice.org.uk/media/default/guidance/lgb10-briefin.... 20-30,000 pounds per quality adjusted life year. American end of life care can cost hundreds of thousands of dollars for a year or two of extra life and American insurance companies will pay it without blinking. A friend of the family was diagnosed with terminal cancer and given six months to live. She received treatment costing hundreds of thousands of dollars, and lived almost two years. In European systems she would have been sent into hospice.
I’m not sure why you’re being downvoted, this seems factual.
It’s also the part of the problem that’s never discussed - the big cancerous whale in the room. Culturally, Americans can’t accept that sometimes people are going to die, and let it happen. 2 years of chemo and carT treatments with neurological damage, organ damage, chemo brain, the list goes on, isn’t worth it for most people. But they don’t even realize that until they’re almost gone.
Taking a holistic look at the health of the patient and running costa / benefit on quality of life vs treatment are two ways that the uk controls costa really well. As far as I’m aware it’s the same with obese people. There are limits on their reimbursement amounts for certain things and they need to buy extra insurance to cover that (someone from the uk correct me if I’m wrong?)
I’ll make a guess at why. Because some folks in the US who want universal healthcare have a misunderstanding of what that actually means to make it affordable. Any comment criticizing or expressing what might be perceived as negative of any aspect of “European style healthcare” (as if that is a singular thing) will get downvoted by these folks. They have a belief that the level of end of life care most folks currently receive in the US will continue. Their 89 year old grandmothers with cancer are still going to get experimental and expensive chemotherapy all the way up to her dying breath.
And don’t you dare suggest that she is not!
I don't buy that there's no way to get people state-covered insulin and chemo without consigning everyone to bread lines. just make Medicare universal, and let people buy BCBS or Kaiser etc. on top, to skip the lines or cover more end of life stuff.
I think they can, but I also think that most people advocating for “Medicare for all” in the US don’t even realize supplemental private health insurance exists in many if not most European systems.
Healthcare is a systems engineering problem to explore design trade offs within a solution space. Most people don’t think of it that way.
She might have been better off in hospice (end of life care can be rather grim and there is a reason many older Americans are terrified of the process and results) and society in general would have been better off if she died sooner in hospice care.
The European system is much better because it does not hide reality from people who seem to have difficulty grasping the concept that they, and the people they cherish, are eventually going to die. Instead of giving one old lady and additional 18 months of end of life care the Euro system has the ability to make sure that basic health needs of the entire population are actually taken care of, something at which the American system fails completely. An approach based on cost effective treatment is easy to attack using cherry-picked sob stories, but overall it is a far superior system to the 'you only get what you can pay for' American approach.
I also never suggested that it should be free.
> American end of life care can cost hundreds of thousands of dollars for a year or two of extra life and American insurance companies will pay it without blinking.
This hasn't been my experience. Before my dad died from glioblastoma last year, his insurance refused to pay anything for his treatment. They refused to pay for anything, fighting us every step of the way. A single chemo pill cost over $2200, and he needed 60 of them, and they wouldn't cover any portion of them. And that was just one of many the things they wouldn't pay for. They wouldn't even cover anti-nausea medication. I did, and it cost less than $30. They wouldn't even cover hospice care.
My dad paid premiums to that same insurance company for 20 years, and was healthy the entire time. No major health issues, non-smoker, non-drinker, no heart problems, no accidents. He learned about his rapidly growing tumor on his own. He decided, mostly out of curiosity about the technology, to pay for a full body MRI (at his own expense of course) and found it. He spent his life savings trying to fight the cancer and the insurance company, just so he could have enough time to say goodbye to people. He died within 8 months of discovering the tumor.
The money he paid that insurance company over a 20 year period would have covered all of the costs had he put the money into a savings account, even if he made zero interest and accounting for inflation.
I know that there will be those who say "but what about Medicare/Medicaid?" - he didn't qualify for either of them.
The only outside help he might have had was from an organization that houses people near cancer facilities, but they pulled their support the moment the pandemic was declared, shutting down all their housing facilities. The irony there, as well, is that that particular organization, even in non-pandemic times, required 6 months lead time before they could place an individual. He'd have been dead before they were able to place them. I paid for an AirBnB instead, which cost me close to $5k for the duration of his treatment, which he paid for out of pocket.
My dad's story isn't uncommon either. Why would insurance companies have any incentive to step up when they know that if they just wait things out, they'll be able to keep their money?
The American health care system is utterly broken, perhaps even criminally corrupt.
And here you're repeating the claim that US health insurance is a unlimited source of healthcare funds for anyone who wants it, even though someone else is telling you that's not their personal experience.
Denial of health insurance is so common in the US the charitable orgs give advice about how to deal with it: https://www.cancer.org/treatment/finding-and-paying-for-trea...
"It’s not unusual for insurers to deny some claims or say they won’t cover a test, procedure, or service that doctors order. You can appeal many types of health insurance decisions – sometimes even things that are written into your health plan’s contract. You can appeal Medicare claim denials, too."
All the available evidence directly contradicts your claims about the generosity of health insurance.
And the US system, unlike the UK NHS, is a highly fragmented contractual system. Obviously there’s going to be a wide range of experiences with willingness to pay. But I cited specific sources for the median insurance reimbursement of glioblastoma being over $180,000.
So please tell me, with particularity, what part do you disagree with?
Yet again: that figure is the negotiation amount used by the NHS when dealing with companies designing meds to be sold into the NHS. It has nothing at all to do with how much the NHS will spend per patient per year.
The cancer drugs fund is useful: the first version had to be scrapped because it was spending billions of pounds on new meds that were fantastically expensive but didn't extend life, nor improve quality of life, and which often made QoL worse or shortened life. https://www.newscientist.com/article/dn26785-the-uks-cancer-...
> But I cited specific sources for the median insurance reimbursement of glioblastoma being over $180,000
You're doing a few things here. 1) You're implying that US treatment is good, and 2) you're insinuating that people in the UK aren't going to be treated for glioblastoma because the cost is greater than the NICE guideline for cost of treatment.
1) https://www.nice.org.uk/guidance/ta121/chapter/4-Evidence-an...
> The Assessment Group reported that the Food and Drug Administration (FDA) in the USA expressed several concerns when it evaluated the trial. There was an imbalance between the types of tumours in the study arms, which could have favoured carmustine implants. The FDA requested a review of histological diagnoses and a sensitivity analysis was performed using diagnoses by an alternative pathologist. A further concern was that the manufacturer's analysis treated death as an event when measuring time to progression. A reanalysis was performed of the data on the time to progression as determined by decline of neurological symptoms and performance status, with deaths being censored. In addition, the manufacturer's analysis of the overall survival data included stratification by country, and the data were reanalysed without stratification. The data reported below relate to the unstratified analysis unless otherwise stated. [...]
> There was no difference in progression-free survival between treatment groups. Median time to progression was 5.9 months (95% CI 4.4 to 8.3 months) in the carmustine implant group and 5.9 months (95% CI 4.7 to 7.4 months) in the placebo group (using stratified analysis). The manufacturer's analysis suggested that both the time to decline of KPS score and the time to progression on neurological indices were statistically significantly improved (that is, increased) in the carmustine implant group. The FDA reanalysis of these data found that there were no statistically significant differences in these measures of progression-free survival and that the differences resulted from variations in survival times between the treatment arms.
> [...] The effect of temozolomide on the quality of life of patients was investigated in the largest RCT using a cancer-specific quality-of-life questionnaire. Of seven preselected scales, the only statistically significant difference between treatment groups was in social functioning at the first follow-up during adjuvant treatment with temozolomide (in favour of the radiotherapy alone group).
US treatment gives people brain damage, decreases quality of life, doesn't do much to increase length of life, and then because the US doesn't negotiate drug prices costs a lot of money. In the US with its expensive treatment we still see that the five year survival rate on less than 10%, that the average life expectancy is only 8 months, and that these very expensive treatments (which can severely degrade QoL) extend life by maybe a couple of months. Remember, these aren't months when you're walking around living normal life, they're time spent in hospital. Regret rates for cancer treatment ("I wish I didn't have that treatment, I wish I'd done something else") are very high.
2) It's simply untrue to suggest that people in England[1] don't get treatment for gioblastoma. They do get treatment. What does happen is that they don't get ripped off for meds.
https://bnf.nice.org.uk/drugs/carmustine/medicinal-forms/
> Carmustine NHS indicative price £5,203.00 (Hospital only)
https://bnf.nice.org.uk/drugs/temozolomide/medicinal-forms/
> Temozolomide 250 mg NHS indicative price £814.00 (Hospital only)
> The patient cohort involved 88 patients with over 44,000 separate insurance claims. This dataset represented a happy medium that is large enough to provide a good estimate of overall patient costs, but small enough to individually verify each patient diagnosis and treatment rather than relying on administratively coded national datasets.
It's marketing disguised as scientific research that tries to justify the high cost of health care by claiming that those costs, and commercial insurance, are strongly correlated with higher survival rates.
> Healthcare payments for HGGs patients were substantial and such high healthcare expenditures were positively associated with patient survival and commercial insurance.
Translated: our costs are high, and so are our customer's premiums, but it's worth it because patients last a few extra months compared to the inferior Medicare options.
Private insurance companies don't just fight their customer's claims, they fund "research" that "proves" anything other than private health insurance is worse.
Then there's those 88 patients. With a median age of 59, and a median KPS score of 90, they're cherry picking patients who, would, statistically, survive the longest.
Or is it kind of a site that buys debt that the hospital has 0% chance of collecting anyway?
So yes, the latter.
Basically, that site helps people to not get phone calls about bills they were never going to pay.
99% of hospitals have financial assistance programs that will either completely eliminate your debt or reduce it by a substantial amount if you fall under a certain bracket of income (usually some multiple 3x or 4x poverty level), which essentially does the same thing.
It doesn't address the fact that hospitals prices ballooned out of control due to perverse incentives with insurance companies and dumb regulation that limits profits to a percentage (incentivizing absolute increases in prices, rather than price controls like NHS does)
I wouldn't pay income tax on something like half million dollars for a slightly better chance to be able to take out a loan at what will be 10% or so soon.
- Hospitals recorded their most profitable year on record in 2019, notching an aggregate profit margin of 7.6%
- From 2012 to 2016, prices for medical care surged 16%, almost four times the rate of overall inflation
- Last year the average annual deductible for a single worker with job-based coverage topped $1,400, almost four times what it was in 2006... Family deductibles can top $10,000
Facilities charge exorbitant prices for procedures and insurance companies pass more and more of these costs on to patients via higher deductibles and premiums. It will continue to get worse unless there is colossal change.
Yes, this sounds unreasonable right now because prices are so high. But bear with me for a second.
Most healthcare in the US is paid through insurance. Insurance creates moral hazard. Insured patients generally don't even need to know the prices of what they're buying, much less negotiate those prices. And here's a dirty secret: insurers don't care much either. They simply add a margin on top of their actuarially-forecasted cost. So healthcare prices rise dramatically over time, because relatively few people are directly exposed to them and push back on them. From this perspective, healthcare insurance is a problem, not a solution.
Don't get me wrong, there are admittedly some obstacles to patients paying out of pocket right now. My point is that we know properly functioning markets set fair prices, and we know our healthcare market is dysfunctional. Healthcare insurance plays a part in that dysfunction.
Patients negotiating directly for better prices eliminates moral hazard and restores market function. Strategically, that would finally restore pressure on healthcare providers, who have become accustomed to raising prices with very little push-back. Without some kind of push-back, providers will continue raising prices - because they can.
For frequently-repeated purchases of goods with robust competition for close alternatives where the approximate total infinite-horizon costs and utilities resulting from the decision are both entirely experienced by the participants to the exchange and very clear before or quickly after it occurs so that behavior can rapidly adjust to more optimal alternatives when suboptimal choices are made, in other words where the perfect knowledge assumption underlying rational choice theory is, while it is never actually accurate, at least closely approximated in the relevant market, and there are no externalities making inefficient in the global sense actions efficient from the perspective of participants.
Medical care very much does not fit this pattern.
It painfully obviously does not. It is literally a market with both buyer and seller colluding to raise the prices!
Why? A few reasons. Insurance profit is capped as a percentage of expenditure, so if they think there is more money they could extract from the insurance customers total if things cost more, it is in the insurance company's interest for prices to go up. Providers are not going to balk at getting mopre money.
This is only one of the many ways the system is screwed. The fact that medical billing coders need to customize the codes they submit for the exact same procdure to depending on what insurance company it is being sent to (for example, this is common for a procedure that is not a perfect fit for any standardized codes, or where some insurers are still using the older revisions of the medical coding standards, etc) and other similar nonsense also artificially inflates costs.
Basically everything about the system from top the bottom seems to be designed to prevent market based price discovery from working well.
https://www.healthcare.gov/high-deductible-health-plan/hdhp-...
There's pretty much a free open market for cosmetic medical procedures not covered by insurance. But markets can never really work for medically necessary treatments. Demand is essentially fixed regardless of price. Patients who are in pain or at risk of death will pay everything they have and go into debt besides in order to get treatment. On a large scale basis the only effective means of holding down costs is some combination of rationing and price fixing.
These people, me being one of them, are extremely cost-conscious, believe me. It doesn't help for basically the reasons you mention.
The cheapest prices in US healthcare are the prices paid by Medicare. There are so many people on Medicare so this leads to a lot of bargaining power. Hospitals would never refuse to treat Medicare patients (because there are so many). So, Medicare decides "We're only going to pay $10,000 for a total knee replacement." And hospitals have to say "Okay, sounds good. Can't really say no to 60 million patients." Insurance companies do not have that type of bargaining power. They say "We only want to pay $20,000 for a total knee replacement." And the hospital goes "Nope, we're charging you $30,000." And the insurance company sheepishly goes, "Okay..." and then sets really high premiums, deductibles, and out of pocket maxes so they don't have to bear the weight of the cost.
https://www.forbes.com/advisor/personal-finance/medical-debt...
Simply walking away from medical debt if there is only a minor impact on credit score seems like a decent option if not.
I did the same thing with an ER bill I couldn't afford a while back. I just never paid it and suffered virtually no consequences.
Stop pretending the clowns pretending to be politicians are doing anything to help us. This is about the rich not wanting to give up their money, and both sides are just protecting them.
I think the most productive change we could make to our government right now would be to set a page limit on new legislation. But this might produce legislation that actually helps normal people, which is why it'll never happen.
take student debt for instance. imo there's a decent case for erasing undergrad debt under a certain threshold, but if you took on a six figure debt to attend a fancy liberal arts college, that's on you to unfuck. similarly, people like lawyers and doctors take on a lot of education debt, but that's also priced into their respective salaries. a professional paying off an outsized debt with an outsized salary doesn't need or deserve the assistance of the median taxpayer. a naive implementation of such could potentially be net regressive.
obviously you might disagree with some of that, my point is just to show that "abolish student debt" is controversial and complex even among people that agree at a high level.
US Democrats did write legislation for the issue and did try to get it passed. They even chose an approach originally developed by conservative representatives to try to appeal to conservatives traditionally opposed to government funded/managed healthcare. It's now known as Obamacare and it passed with the slimmest majority then Congress subsequently tried to repeal, deauthorize, defund, or otherwise destroy it like a 100 times [1].
You could just as easily say that if the majority of citizens actually wanted to fix this problem, they would vote out anyone who voted against a conclusive bill. But doesn't happen because voters actually approve of these politicians anyway. You can spend all your money on publicizing "who voted against this healthcare bill" and accomplish exactly nothing, anyone who cares can easily find out anyway.
But sure, it's always rich people's fault.
[1] https://howmanytimeshasthehousevotedtorepealobamacare.com/
Like, imagine a mom seeing her kid jumping on the bed, and the kid says "I'm not jumping, I'm hopping. The difference is ..." and so the parent tells them to stop hopping and leaves. They come back later and the kid is sitting down, but bouncing up and down.
Eventually, the parent says something like "You may not jump, leap, spring, bounce, hop, dance, or otherwise engage in an oscillating vertical motion using the mattress of the bed as leverage or propellant."
Bam. That's legalese, and is the reason laws are 1,000 pages long. Except in this case, the parent has left open the loophole of allowing the kid to jump from their dresser onto the bed.
https://www.congress.gov/117/bills/hr1976/BILLS-117hr1976ih....
One thing I missed on the article was a section about "how did we get here" (including things like Hospitals not disclosing prices for their treatments and forcing people to sign papers under duress). And a section about "who benefits from all this suffering" would complete it.
Americans are profoundly selfish and that's getting harder and harder to ignore.
Many will defend such practices in the name of "freedom". "Freedom" will often be an integral part of their identity. The sad truth is that these people seem so desperate for someone telling them what to do.
Supporters of universal access to health care simply want people not to be denied life-saving or life-changing medical care and not to be bankrupted by that. That's literally it. Yet such people are so often demonized as "socialists" or "communists".
The Bezoses and Buffetts of the world has so successfully propagandized and manipulated these people, choosing billionaires having a little bit more money over people literally dying in the streets.
I really do worry this country will be lost to white Christian fascism in the not too distant future.
The problem is this is a straw-man argument. We can agree that healthcare costs are too high, and have empathy for people who are being screwed over, but not agree that massive government intervention is a reasonable solution to the problem. In fact, there is an argument to be made that the only reason healthcare is expensive in the US is because of lawmakers failure to account for the second-order effects of their decisions (e.g. EMTALA). In the early 90s you could buy decent health insurance for less than the cost of Cable TV.
Unfortunately, the oft-repeated "solution" to the current crisis always involves forcibly taking tax dollars, and then directly funneling them into one of the most dysfunctional and corrupt institutions of all time (Healthcare), then lying to voters and telling them that doing so would magically turn the USA into Sweden or something. The people who don't support a public option are so exhausted making these arguments that they will tell you "It's socialism" and walk away from the conversation.
And that's the problem.
Insulin as just one example is spectacularly expensive in the US [2] for absolutely no good reason and the only way this is allowed to happen is that the Federal government has been successfully lobbied to not negotiate pricing AND to disallow the importation of the exact same medication from other countries.
[1]: https://www.theatlantic.com/international/archive/2012/06/he...
[2]: https://worldpopulationreview.com/country-rankings/cost-of-i...
In other words, "free markets" only and exactly when it benefits the owners of American corporations.
And please don't throw some stupid safety and efficacy arguments this way. Pretty sure people in other countries don't like buying tainted drugs either.
I would love to see some evidence that US policy has caused the skyrocketing medical bills.
US already spends THE MOST tax money on healthcare even though it doesn't offer healthcare like ALL the other 1st world nations.
While slightly out-of-date due to legislation that has passed since then, the book does an excellent job of explaining a lot of the perverse incentives at all levels throughout the medical industry that contribute to the outrageously high cost of healthcare in the US. Worth a read.
> For many Americans, debt from medical or dental care may be relatively low. About a third owe less than $1,000, the KFF poll found.
I wonder how they'd count me, who puts all expenses on a credit card and pays it off each month, technically I'm going into debt ...
https://www.politifact.com/factchecks/2009/jun/11/chris-dodd...
The US has a major debt problem and the solution at some point is going to be curtailing just how much debt you can accumulate with just a signature.
Most of the people who file something like chapter 7 have little to no income, don't have big bank accounts, luxury cars, second homes, etc. This often correlates with people who have medical issues and rack up big bills, and can't work a job. These people can file "no-asset" chapter 7 cases, in which case, they lose absolutely nothing. This is what happens in the majority of chapter 7 cases filed. So, for a lot of the people who do choose to file, this is because it is a good option, not because it is a life crippling choice forced upon them.
If you call them up, they'll usually just say "what can you pay?" and agree to just about anything you propose.
Which is why you can often do better paying cash at a "expensive" hospital that is overflowing with money than at a "budget" one that is having difficulty making the numbers balance. The latter is more likely to hard-line.
We were getting like 3-5 letters per provider per visit, and many visits resulted in bills from multiple providers.
"NOT A BILL" (so why the fuck are you sending it to me?) same thing again from insurance for some reason, incorrect bills we had to fight, insurance refusing to pay on things they should so that drags out for months and you're getting "FINAL BILL" in the meantime but the hospital billing people are telling you not to pay them until insurance is sorted out.
Many providers sending a bill exactly once and it goes to collections if you don't pay in 30 days, no calls or follow-ups (that's how both of ours ended up there—again, they were tiny, we'd have paid them instantly if we'd known about them).
Bills showing up two months after a visit and you've had 30 medical appointments in the last year so you can't remember WTF it was for. I think in one case we were still sorting crap out from the birth and prenatal care when the kid was 6 months old.
Hospital requiring full payment months in advance for the births. And getting it very wrong in one case (on the high side, of course—every billing error is in the hospital's favor, super weird how that works, bet it's just an accident and not them being actual no-bullshit criminals, though eyeroll) because they refused to use our version of what insurance would pay (which was correct) and basically just made up a number.
Total fucking mess. Horrible experience every time. Can't wait to get to deal with this horseshit when one of us is actually, seriously sick. I've added hospital billing departments to the list of medical-related folks I truly, sincerely wish the worst on, and I mean the worst—show me the headline, I'll open the champagne. They're either shockingly incompetent in ways that mess up people's lives, or they're malicious. Maybe both.
Thou shalt never assume malice so sayeth lord Hanlon (brought to you by Carl's jr.)
Penalties need to be attached to misbilling; it needs to be made effectively illegal and allow others to help collect the penalties, then an industry of scummy lawyers will appear to help customers reduce their bills at the expense of the hospitals.
And they'd deserve it.
The smaller hospitals in general have been better but it's so obviously a giant clusterfuck.
I can't even imagine how someone without partner support (who the hell wants to deal with hospital fuckery post-partum) does it.
Of course, 63% of the people with health care debt have (according to study).
So while your case is interesting from a technical point of view, it isn't really practically or morally interesting, and can only serve to detract from the important points of the study.
But I think there is a difference between cautioning neutrally (the comment I'm replying to now) versus obliquely cautioning in a way that casts doubt with negative consequences (the comment I replied to previously).
I live in a city where a segment of impoverished people come up with ways to spend $20+ a day in fentanyl, and they don't seem to have much trouble coming up with that even while living in a tent.
They can’t make more money and save it, because their needs will always exceed their income short of massive windfalls
>difference
> eating ok
> not eating
If you're not eating it follows you're eating $0 worth of food. So it is what you said, unless you're implying someone is spending money on food without eating any of it.
I'm interested in the meals you suggest that you think are "eating ok" while maintaining the nutrition to work, $2 all in per day (food cost + transport to buy the food + cost to cook the food + depreciation on any utinsils / cookware).
Also keep in mind many poor people live in a food desert so if you're counting on discount food you're gonna need a bus ticket or a hell of a long walk once in awhile.
As an aside, it's worth noting if your suggestion is true and one can truly eat ok on $2 a day, then the median medical debt holder who spends say $4 a day on food can easily pay off their loans in a few years following your cooking advice. You just came up with a way for them to produce $2 / day without any additional income.
It's a bit more complicated than you are making it out to be, it would not hurt to remember you are talking about fellow human beings and not just numbers in a spreadsheet.
As for inexpensive ways to eat please see https://old.reddit.com/r/EatCheapAndHealthy/
You haven't actually been poor like that in the US. That isn't a question, it is a statement. I have as have others I know so yes even a few dollars per day can make/break the budget.
I don't know how poor you have been or are. And you don't know how poor I have been either. I'm not going to play oppression olympics with you. I have been homeless, sleeping in ditches and parks before, living off of minimum wage day labor. Even back then, if I needed $2 I simply worked an extra 15 minutes moving drywall at construction sites or whatever. Those who can't work may end up buying snacks with their foodstamp card and hawking them to high schoolers walking to school or something (as I see many homeless do near my house). There are very few people who aren't already covered by medicaid/medicare who are incapable of coming up with $2 / day somehow, and if they are they are the extreme case. Again even _drug addicts_ in my neighborhood, while high out of their minds, somehow manage to come up with $20/day for their fentanyl habit and that doesn't even cover the rest of their necessities.
And as an aside, I'm not buying the argument that being broke somehow makes you more of an expert on how to budget. The poor in this country are notoriously victims of sub-par education which sadly leaves many of them poorly situated to navigate managing their own economic future. If I want budgeting advice I'd much rather ask say a guy who started his own restaurant vs some random broke person on the street.
That wasn't my point. Honestly please take a look at your interaction with me and reflect on it, it isn't necessary to engage in such a hostile fashion. You have read a lot into what I have written that simply isn't there.
You have a pleasant rest of your day.
Please take a look at your interaction with me and reflect on it, and think to yourself about how you can be less presumptuous.
>You have a pleasant rest of your day.
Likewise!
Think of bigger medical expenses over the same period -- 10k. That's 20/day. 100k -- 200/day. Now add ACA monthly costs (300-400/mo). Then rent, then food. Etc etc.
"You" being the parent OPs who I responded to who introduced the nation of $1000, which happens to be above the median for my state and most states shown in the article? Remember I'm RESPONDING to the $1000 comment, not introducing the figure. But maybe they said something about the $1000 you agreed about, so you went with the disingenuous approach of only impugning someone commenting on it and in bad faith accusing THAT person of introducing the figure.
The MAJORITY in my state and most states have less than $1000 in medical debt. Millions. This isn't some edge case. $1000 "exemplifies" the median medical debt in most states, according to the article.
>sounds like you could stand to be humbled by some
Yeah a subtle suggestion I ought to experience medical problems. Keep it classy. "Frankly, that's disgusting."
>Think of bigger medical expenses over the same period -- 10k. That's 20/day. 100k -- 200/day. Now add ACA monthly costs (300-400/mo). Then rent, then food. Etc etc.
Yes I thought about it, and then decided my $2/day figure still holds as a possible approach for paying off median medical debt. Thanks for the thought exercise!
My intention was never to show that someone with $100k of medical debt could get out of it as easily as the majority with far less.
Medical debt is a huge problem but to craft solutions we need to fully understand that problem. Should, for example, insurance companies collect "deductibles" ahead of time and refund those not used, similar to how you could use an HSA? Should healthcare providers and insurance companies be required to offer 0% financing for 12 months for certain amounts or certain customers?
The vast takeaway is usually "this survey supports what I think should be done" which often results in not much of anything being done, or getting something worse than what was before.
The answer is two clicks from the article, both links above the fold on their respective page. If you’re being genuine in your curiosity, it would improve the discussion here if you shared what answer you find.
> The combined online and telephone samples, excluding oversamples, were weighted to match the sample’s demographics to the U.S. population using data from the Census Bureau’s 2021 Current Population Survey (CPS). On the basis of this weighted sample, parameters for the debt and no-debt populations were extracted. Weighting parameters for each group included sex, age, education, race/ethnicity, region, education, and income, as well as patterns of civic engagement from the September 2017 Volunteering and Civic Life Supplement data from the CPS. The sample was also weighted to match population density parameters from the Census Planning Database 2020. The weights take into account differences in the probability of selection for each sample type. This includes adjustment for the sample design and geographic stratification of the cell phone sample, within household probability of selection, and the design of the panel-recruitment procedure.
So they intentionally targeted people with debt, so the "63% percent of respondents" is not able to be read as "63% percent of Americans".
The 100M in the title is extrapolated, and is likely correct, but people are not reading the percentages as they should be read.
The key takeaway from the study is that not all medical debt is reported as such, and poor people have difficulty paying bills, one type of which is medical bills.
No, that's not how it works. You oversample a group you are interested in and then weight it.
To be honest, you don't know enough about statistics to evaluate this. You should either learn more or accept the conclusions of those who know more.
> The 100M in the title is extrapolated, and is likely correct,
What's the problem with their comment, exactly?
In this instance, the two proposed solutions are: make healthcare the government's responsibility like many countries that don't have this problem, or do nothing because that solution isn't perfect.
0: https://en.wikipedia.org/wiki/Accelerationism
1: edited to add: imo. And probably in their o as well.
When Obamacare was passed, 70% of the population wanted Medicare for all instead:
https://thehill.com/hilltv/what-americas-thinking/412545-70-...
In 2020, 54% supported single payer health care:
https://www.pewresearch.org/fact-tank/2020/09/29/increasing-... overage/
I can't find any post-covid polls, but states are currently trying to step in and implement it locally. Don't hold your breath.
Edit: the medicare for all poll was under trump
As I mention in my other comment, I speculate the possibility that people think "Single payer" and "Medicare For All" are different things [1] and so report a different opinion on each, similar to how the ACA was viewed MUCH more favorably than ObamaCare despite one being the nickname for the other.
[0] https://news.ycombinator.com/item?id=31755822
[1] ACKSHUALLY, single-payer doesn't HAVE to be simply expanding Medicare to everyone. It could be done in some other way, but the core idea of the government paying for everyone's healthcare is still the same.
Medicare is generally understood to work with supplemental insurance. Single Payer is often marketed as a prohibiting supplemental insurance.
The whole topic is disgusting, particularly the rejection of opt-in Medicare at cost by both sides.
This rejection is hypocritical to everything either party claims to stand for.
Yet.
> “We have a health care system almost perfectly designed to create debt.”
This was true before the ACA – and is still true.
But this immediately appears as "unfair" even if predatory lending is a huge problem.
Meanwhile those who already have some money wouldn't be affected by it much, for example, a law requiring all credit cards that charge interest on balances to be secured ones (where if you have a $1k credit line you must have $1k cash/cash equivalent in the bank).
Really? How about year-long debt or 30-60-90 day breakout chart by amount?
We filed for bankruptcy, so screw the whole medical industry.
Honestly, it wasn't bad and within 18 months bought a new car, new house and started life over again.
Depending on the absolved medical debt (being discharged by your bankruptcy), and its would-be crushing monthly payments, the higher interest rate of your new (mortgage/credit) credit lines and its monthly payments are often less than the impact by (then dissolved) medical payments therefore your living standard would still improve after such medical-related bankruptcy.
My mortgage is 2.25% and the car we financed was 0%.
The saddest part was with each creditor that asked about the bankruptcy and we explained it was due to medical debt, they would just say something like "oh no problem, get those all the time" or "bad things happened to good people", like it was no issue.
It was like, having crushing medical debt is normal, for people.
Either to save lives: https://www.scientificamerican.com/article/universal-health-...
Or to save money: https://www.pnas.org/doi/full/10.1073/pnas.2200536119
The aversion to it honestly baffles me.
We just sat on a chair for a couple hours for 'monitoring', and sure enough we got a $1700 bill from them, since she hadn't met her deductible yet.
Of course people are in debt if they get hit with bills like that.
Universal healthcare? Like any other Western country?
We knew enough to ask about the anesthesiologist and any surgery assistants. But they came up with some new bullshit and got us. When the world gets wise to this nonsense they'll come up with something else. It's a business deeply rooted and based on scamming their customers.
Fortunately as an engineer, shelling out $4k a year on top of my basically "free" health insurance through my employer is more of a nuisance than something I lose sleep over. That said, people in this country need better healthcare. Doing this will unsaddle startups and businesses from having to provide it directly. Healthcare is something I would pay more taxes for, but above all I command the government to spend in ways that BENEFIT the American people not just corporate donors.
I have debt collectors calling me which i ignore now because me describing the situation and them “putting a note in my file” has zero effect on how often they contact me.
In the end I’ll owe $0 it will just take time to settle.
But there is something coming close to $10k of “debt” out there with my name on it.
------
Yeah, a transition is going to be an expensive shitshow and now is not a good time, but just about any other time in the last decade was a good time and in a year or two it will be a decent time again. We'd better rip this bandaid before it soaks all our blood out.
The issue at hand is to take something the public spends nothing on, that the government gets for "free" and to put that on the public balance sheet - a huge cost. I guess we could balance that out with a tax, but who would like that? And even if we were to raise taxes - it wouldn't help our balance sheet since we already spend 30% more than we take in. Looking at the balance sheet as it stands today, we can't even afford what we currently spend. And inflation is on the rise.
I just don't see it ever happening. Save a collapse and total reset of the current monetary system.
What part of "we pay nearly double" didn't make it through?
We can't afford the enormous premium we are paying for privatized care.
> I guess we could balance that out with a tax
Payroll tax. In the vacancy left by private insurance. Scribble off one memo line, write in another. Come on, this is a 101 level objection.
You are obviously a very smart guy, jjoonathan. Why do you suppose the Democrats didn't even propose this when they had 60 Senate votes, the Presidency and the House? If its a 101 level problem why do you think that is?
The rebates for private health insurance (to convince people to take out private insurance to “take pressure off the public system) have actually made things worse, for most people it’s subsidised by 30% by the Government (and you avoid an extra health levy), but over the last decade or two, the premiums have just gone up significantly and the amount of things covered has been dropping. It would have been better to just put that money into the public system (which is a bit overstretched due to underfunding). So mostly the subsidy has just gone into profits for insurers. It’s hard to get people to take out the private insurance without it and tax offset, but as I said before, since the public system is more efficient, the cost to society would be less without subsidising private insurance.
If the government owns the system, the government can establish all sorts of controls (4). What do you think the margin is in these sectors (% is of $3.5T in 2017)
Hospital care (33%)
Physician and clinical services (20%)
Retail drugs (10%)
Other health, residential personal care services (5%)
Nursing care facilities (5%)
Dental (4%)
Home health (3%)
Other professional services (3%)
Other non-durable medical products (2%)
Durable medical equipment (2%)
(1) https://www.britannica.com/topic/socialism
(2) https://www.merriam-webster.com/dictionary/socialism
(3) https://en.wikipedia.org/wiki/Socialism
(4) https://www.cms.gov/research-statistics-data-and-systems/sta...
As a side note I am about to go feed Thelma and Louise. Ill pet them and say hi for you.
[1] - https://www.youtube.com/watch?v=5LTWJOi3bCo [video] [joes t-shirt nsfw, minimize browser]
[2] - https://www.cdc.gov/media/releases/2017/p0718-diabetes-repor...
[3] - https://diabetesjournals.org/care/article/41/5/917/36518
It should not be this way though because mostly the wealthy take advantage of protecting their assets as it requires some money.
Basically the hospital took the house he worked his whole life for.
They just don't understand the FREEDOM that high health care costs provide! /s
On top of that, it's basically impossible to anticipate the cost ahead of time for many procedures. One person I know was quoted $2,000 to $30,000 for a portion of a surgery that is not covered by insurance, depending on exactly what needed to be done. How do you even plan for that? At one end, it's like buying ~2 new refrigerators of pain, and the other end is a brand new, top of the line Chevy Bolt.
For many people, hitting max out of pocket is simply not possible without debt. It's common to see 3-5k MOOP, but taking a modest standard of living on an average salary, it's an incredible amount of time to make up for it.
E.g. $5,000 household income (60k annual) * $800 rent
* $1,000 childcare
* $250 gas
* $200 utilities
* $500 groceries
* $500 income taxes
* $250 student loan payments
* $100 car insurance
$1,400 leftover, but there have been no incidental expenses, $800 is probably lower than you could find a 2 bedroom apartment in Iowa, and I'm assuming they own their car outright. Once you hit January 1, your deductible and max out of pocket reset, so you could be like a friend of mine and get MRI's on December 31 and January 1 while staying in the hospital for a couple days on either end. They had to pay their full max out twice because of the timing in the year when they got sick.
My uncle in Denmark had cancer, and they basically put him in a hospice-type facility to die, because anything else would have not been justified due to his age, the cost, and the low probability of success.
In the USA, he or his family would likely have demanded aggressive surgery and/or chemo or radiation, he would have died anyway, and there would have been hundreds of thousands of dollars of "medical debt" created.
I suspect many people who like the idea of socialized medicine are not prepared for the reality of the limits on care that would bring, particularly for the old and terminally ill.
In the US, if you can't afford it, medical care basically isn't even an option. If you have a lot of money, then you're set. In Europe if you don't have much money, you at least have some options, and if you have a lot of money, you can still go to the US. Or if you're open to $100k's of debt, you could've easily gone to the US for treatment, too. Your scenario just proves my point that the situation is way better in europe
Any other option he had, should he have wished to pursue it, would have been outside of the Danish social medical system.
That may be "better" than what would have happened in the USA under Medicare/Medicaid, but my point was there really wasn't a choice in the matter for him. He didn't have to pay for it, other than the taxes he paid his whole life, so I guess there's that.
I'm just saying that's an option that he took. Just because it wasn't ideal, doesn't mean it wasn't something. If he was in the US, that wouldn't have been an option in the first place. Still a massive improvement over the US.
This shouldn't be legal.
Do insurance companies even employ actual medical doctors that are educated, trained, and experienced in health care so that they're qualified to make these calls?
As with most aspects of US healthcare, when viewed through through the perspective of the recipient, it's atrocious. Every medical facility requires you to sign a paper that you'll pay all the medical expenses if they aren't covered by insurance. They can't give you an estimate that they promise they'll stick to in terms of cost. There's no way a non-doctor could know what the typical course of treatment would be, so they're stuck trying to get straight answers from an insurance company if they don't want a surprise massive bill.
Provider bills insurance an insane amount which is then arbitrarily discounted. Provider can't bill different amounts for insured or uninsured patients (illegal from my understanding). If insurance doesn't cover something, it's between the patient and provider to settle.
Basically you go to a hospital that is "in network", get some work done, but it turns out that some doctor (often some side-channel like a radiologist) who reviewed your case was out of network. So your insurance doesn't cover him and the hospital sends you the full bill. Out of pocket max doesn't matter, because that only limits costs where insurance actually accepts the claim.
It was outlawed by US congress this year (The "no surprises" bill), but there are some exceptions like ground ambulances, so I guess we citizens are supposed to remember not to take those to the hospital unless we are rich.
Yes, its insane.
Hot take: The only reason ACA passed is because the government did not want to foot the entire healthcare bill for our aging boomer generation. So ACA became a way to partially distribute those costs to the rest of the US population by forcing them into a healthcare plan.
Sure, in theory those forced into the ACA are protected from financial disaster in case they get sick, but in practice, the younger generation won't need healthcare for quite a long time, thereby once again kicking this can of worms down the road.
So no, they can keep their article.
Downvote away though :p
https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
There are some common agreed upon thresholds that strongly correlate with positive outcomes, e.g. 15 minute response time after a heart attack. In wealthy areas, this outcome was achieved 97% of the time vs. only 93% of the time in poorer ones. That doesn't sound too bad, but that means you were something like 230% more likely to miss that cutoff if you were in a poor neighborhood. But at least it's not "socialist".
Comments talking about voting (including this one) are worthless, and deserve every down vote they get.
The hospital still sent her a $30k bill for the delivery.
And what exactly is "rationing" - I bet almost every adult in America knows someone (or is that someone) who has delayed going to the doctor/for a procedure (or just never got it entirely) because of how much it is going to cost? Doesn't the inability to even get the required care due to the cost really count as "rationing" in the system we already have?
Yes, technically I could pay the couple thousand dollars out of pocket, but in most socialized health care systems you can do that as well.
U.S. healthcare underperforms in most verticals. High cost is the primary reason that prevents Americans from accessing health care services. Americans with below-average incomes are much more affected, since visiting a physician when sick, getting a recommended test, or follow-up care has become unaffordable. https://www.commonwealthfund.org/publications/issue-briefs/2...
For example, in my wife's home country, she give birth in an awesome private maternity hospital for about $2k out of pocket for everything. I mean everything. But if we wanted, she could have done it in the government run hospital for $0.
This is what we currently have in the US. In fact, the US government is the largest healthcare insurer in the US (through Medicare and Medicaid) [1].
Interestingly, economists have found the US government becoming a healthcare insurer substantially increased US healthcare prices. For example: "Finkelstein estimates that the introduction of Medicare was associated with a 23 percent increase in total hospital expenditures (for all ages) between 1965 and 1970" [2].
It turns out making healthcare "free" to certain people caused them to demand more healthcare. Higher demand caused higher prices. Congress "didn't consider the effect of the increased demand that Medicare set off." [3] Now healthcare prices are high AND Medicare/Medicaid is being paid through deficit spending.
If we want to solve the problem of unreasonably high prices for healthcare, and the debt that causes, we can't keep doing the same thing and expecting different results. We need to fix what we've broken with the healthcare market so it can operate like markets do and find a fair price.
[1] https://www.trillianthealth.com/insights/the-compass/the-gov... [2] https://www.nber.org/digest/apr06/medicare-and-its-impact [3] https://reason.com/1993/01/01/the-medicare-monster/
Also, note that 63% of the people in debt are already literally rationing.
"Cut spending on food, clothing, and other basics" - 63%
All I want is balance. That societal balance does not exist now. Hence the tension that seems to be increasing.
The government would like you to believe that, but a good chunk of the problem is supply-side, not demand-side.
If they do have the money (because you printed more) they pay the higher prices. Then you get inflation.
I don't understand that point of view. It seems pretty cold to me.
I think people are reading too much into a poor analysis, created and reported on by institutions with an obvious agenda.
Medical care providers have families they have to feed too.
Just because we don't currently have a functioning healthcare system doesn't mean we can't have one ever. As more people are made aware of how pervasive the issue is, there will be more impetus for those in power to start doing something about it.
Where doctors also make much more modest salaries
I would say that they are "less high", but not "modest", given that the cost of life is also lower.
Also you have to factor in that they don't have to sell their house if they get cancer.
You know damn well that nobody is expecting doctors to work without pay. I refuse to believe someone could actually believe such an idiotic argument is being made. So why act like it is?
My tax money goes to building roads that I won't drive on.
My tax money goes to police dealing with crimes I'm not a victim of.
Do you consider EVERYTHING funded by tax payers to be the result of people "work for free to cover someone else's expenses"?
Sometimes tax payers are funding their own expense, sometimes not. What I take issue with is being involuntarily compelled to pay someone else's expense at gunpoint.
OK so if a robber comes to my house and says pay up or leave, then that's not a forceful action at gunpoint?
>you are free to leave at any time and no longer pay.
That's not how it works -- allow me to inform you of tax law in the US. US Citizens are responsible for filing, and possibly paying taxes on income earned ANYWHERE IN THE WORLD. The US, and I believe Eritrea, are the only two nation's I'm aware of in the world like that. Now you could renounce citizenship, but even then that wouldn't satisfy your condition of "no longer pay" because you even have to pay over $2000 just to renounce citizenship, and that has to be done outside of the US. The US has been known to engage in "extraordinary rendition" which is to say they target/extract citizens even out of countries when there is no legal mechanism for them to do so.
In short your claim here is incredibly innacurate.
>Paying taxes is no different than mortgage or rent
When I pay rent/mortgage it's for my own use of property in a private contract, in a voluntary exchange. Tax is an involuntary transaction. A very different thing.
>, if you want your own soil fight for your own sovereign territory and keep it through force without any help, good luck.
You start off saying nobody is forcing this at gunpoint but then you go on to challenge me to "keep it through force." You're starting to look like a violent person. It's really comical how quickly the façade drops of persons such as yourself who turn out to be persons of great violence who are quick to challenge others to engage in such activity.
They are not a robber they are a landlord, you are on their land, pay taxes or leave your choice. They are not forcing you to stay and work and pay taxes at gunpoint, you have the choice to leave. However while you are there you must fund the services they are currently providing to you, if you willfully evade that payment then you are committing a crime, but you have the option not to, you always have choice.
>That's not how it works -- allow me to inform you of tax law in the US. US Citizens are responsible for filing, and possibly paying taxes on income earned ANYWHERE IN THE WORLD.
Most standard income is covered under FEIE and FTC, that is you won't pay taxes twice if your paying taxes in another country utilizing their social service instead and if you have been truly living in working for almost a full year you pay no tax on the income.
Note since you are US citizen you still benefit from their social service while living abroad, the are many protections upheld to US citizens traveling abroad you would no longer have if you renounce.
>Now you could renounce citizenship, but even then that wouldn't satisfy your condition of "no longer pay" because you even have to pay over $2000 just to renounce citizenship, and that has to be done outside of the US.
Exactly, you must pay your final rent payment and get out, no one is forcing you to stay. If you don't have the money to pay then you are not making income to pay taxes either.
>When I pay rent/mortgage it's for my own use of property in a private contract, in a voluntary exchange. Tax is an involuntary transaction. A very different thing.
You have agreed to the social contract [1], you are voluntarily staying in the country and utilizing the social services and resources (military and police protection, roads, public spaces etc.) to make money and live safely and productively. No one is forcing you to stay, there are places in this world that do not tax you for police and schools.
>You start off saying nobody is forcing this at gunpoint but then you go on to challenge me to "keep it through force."
That's the point, the reason you don't have to defend your property and life through force on a daily basis is because you have voluntarily agreed to live in a country that has the monopoly on violence [2] and in exchange for the social service of military and police protection you must pay taxes if you profit from that protection.
People are social animals, they work together to solve problems no individual could on their own, money facilitates this and is needed to fund the large social framework you live under hence taxes. If government disappeared tomorrow, it's would be reformed quickly in not so pleasant ways. You may not like it but that doesn't matter because others will form large groups and impose it on you regardless and you will have no choice over its form.
People like the GP reject the notion of social contract.
By staying within the bounds of a country you are consenting to its laws or are considered a criminal or foreign aggressor.
How about you move. It's hilarious to suggest the contract is still intact when the government violates the contract itself, such as abridging 4th and 2nd amendment rights, rendering the contract void. Just a few months ago, I had a warrant served where a homeland security official lied and said a drug dog had "alerted on my buttocks" and I was forcefully strip-searched and dragged to a hospital to be "internally examined." Sorry the government themselves violated the contract.
And it's worth noting, even though the "contract" legitimize this, the last president didn't even have the assent of the majority of voters.
>By staying within the bounds of a country you are consenting to its laws or are considered a criminal or foreign aggressor.
I'm not too worried about whatever ad-hominem you'd like to label.
>Note since you are US citizen you still benefit from their social service while living abroad, the are many protections upheld to US citizens traveling abroad you would no longer have if you renounce.
This is so hilarious as to make me wonder if you've ever actually been to a US consulate abroad. I have, against my wishes due to riding in the same taxi with a 'friend.' We had both overstayed our visas, and the consular services basically said "lol get fucked, good luck!" I could have obtained the same services talking to a wall. I'm good on their services.
>Exactly, you must pay your final rent payment and get out, no one is forcing you to stay. I
If I've already "gotten out" including paying my taxes this rent analogy makes even less sense, not that it was a good one to begin with. I never signed a contract saying if I leave the non-existent contract I agree to pay $2000 to back out.
> you don't have to defend your property and life through force on a daily basis
I wonder if you've even been to the United States? It was not so long ago someone tried to rob me at gunpoint. I still have a scar from fighting back. On a daily basis, people are violently assaulted in my city. Nowadays I'm forced to have "protection" that I have daily in case someone tries to use lethal force against me again. The police have no legal duty to "defend" you per the supreme court. The type of protection police provide here, I wouldn't wish on my worst enemy.
As for military protection, I actually have fought as a self-funded volunteer in a foreign militia (YPG) against ISIS, so I'm willing to put my money where my mouth is about not using tax money to defend life.
>However while you are there you must fund the services they are currently providing to you
You don't get to just provide services for someone, who never agreed to it, and then demand payment. Payment for services is predicated on the parties consenting to the transaction. Providing service without the other party agreeing is charity at best, unwelcome intrusion at worst.
>no one is forcing you to stay
Except some people have had their passports revoked, and occasionally without even owing anyone anything ("for national security reasons.") In fact DHS has threatened to revoke my passport before, despite not breaking any law. It is a crime to leave the US without a passport. So the US does 'force' some people to stay.
>People are social animals, they work together to solve problems no individual could on their own, money facilitates this and is needed to fund the large social framework
People are capable of doing this in a consensual manner. In fact many businesses operate on this principle of consensual mutual benefit.
>You may not like it but that doesn't matter because others will form large groups and impose it on you regardless and you will have no choice over its form.
Back to your contradictory argument of "no one is forcing you at gunpoint" -- except you reneg and say actually they are.
I don't waste my time talking to people with that excessively naive viewpoint. Have a good day.
>The actual argument you wanted to make
And how incredibly good faith of you to bring up taxation of roads, school, and police and then have the gall to act like it's a waste to discuss the very subject YOU YOURSELF INTRODUCED. My brother, I did not mention anything about the taxation of roads/police/schools until you brought it up, it's beginning to look like that's the real argument YOU wanted to introduce.
This is an honest question I don’t know the answer to, but based on my analogous experience with academia and the high cost of tuition, I would guess the answer is “no”.
I'm not sure what sort of retirement they had planned to have on less than 10k, but it looks like in this case the hospital knew they could afford to pay but preferred not to. When people use number of jobs rather than hours worked per week it's typically beacuse number of jobs is greater than one and hours is less than forty.
> Ariane Buck, a young father in Arizona who sells health insurance, couldn’t make an appointment with his doctor for a dangerous intestinal infection because the office said he had outstanding bills.
The emergency room was available to him. What was the total he was asked to pay? Why didn't he pay it?
> Allyson Ward and her husband loaded up credit cards, borrowed from relatives, and delayed repaying student loans after the premature birth of their twins left them with $80,000 in debt. Ward, a nurse practitioner, took on extra nursing shifts, working days and nights.
Average nurse practitioner salary 115k. Why are they putting medical debt on credit cards? The emergency room wasn't going to stop care to those kids if they didn't pay immediately. If they were poor the kids would get CHIP, so I think they probably had too high income and maybe decided to forgo health insurance and work as contractors for additional pay. What was the plan for the birth? Was the problem that they were early and they didn't have a chance to get insurance at the last second?
I'm pretty sure that's on purpose.
It could also be the companies aren't willing to have someone on full-time, because then they'd have to pay for medical and other benefits.
Are you asking why they couldn't afford 70% of an average salary (which, there is a 50% chance this person made less than the average) in one shot?
Your entire post seems to be victim blaming based on a few sentences of context. You don't know what other debts and obligations these people had, nor what other avenues they tried to exercise.
At 38k a year I had a max out of pocket of 7k. It can be done.
It’s as if I opened a web server in my home with all the ports open, a password that is “changeme” and then complained that someone else should’ve been protecting me.
So it raises the question of what kind of shitty coverage she had that was able to do this, or if she just had no coverage at all for some reason, which as far I understand, is supposed to be illegal after PPACA (you can always buy from the exchanges and they can't say no).
That's a provider choice, and not guaranteed.
So when you see things like a $14,000 charge for someone consulting over video for 10 minutes of work, or $800 for a bandaid, and you wonder how the hell a charge can possibly be that high, the answer is often that it isn't. That's just an artifact of this blind bidding thing going on between providers and insurers where providers send the largest conceivable bill they can to insurers knowing damn well they won't actually get that much.
This also feeds back into why insurance companies have such a horrible incentive to default deny everything. They know the providers are overcharging and charging for bullshit. Both sides are forced into taking equally extreme baseline negotiating positions by the total lack of pricing transparency.
It points at a very specific dysfunction of our system that goes well beyond the question of whether the government or private insurance purchasers should bear the bulk of the cost. This is a totally separate and orthogonal problem that both buyer and seller, no matter who they are, treat all transactions, no matter how mundane, like it's a blind silent auction for a rare Vermeer that hasn't seen a public market in 300 years.
And you're going onto a tangent that I am very much in agreement with (that the whole system is massively broken and suffers all sorts of perverse incentives), but -my- point, if you'll recall, is that not everything gets written off. People still get unexpected medical bills -all the time-, for things their insurance didn't fully cover; this despite their deductible and/or max out of pocket.
Or, as I commented before, and which you're...agreeing to, in a whole lot of words, it's a provider choice, and not guaranteed. I.e., every time you go to the doc you're rolling the die; doubly so for emergency stuff that you can't get pre-authorized. "It doesn't happen -that- often" seems to maybe be your argument, but it happens enough, and the consequences of it happening at all are devastating.
> Why are they putting medical debt on credit cards?
Doesn't say they did - reads to me like they built up debt on the credit card with regular living expenses while servicing the medical debt.
The emergency room has ludicrously high costs, and none of his medical history. You're literally saying "don't expect to be able to see your primary care provider, go to the emergency room instead" -because of existing debt-.
You're making a lot of assumptions...all of which miss the point. Why is life shattering medical debt a common thing we tolerate in this country, given every other Western country has managed to make it a rarity? But, to your assumptions - maybe and she gave birth prematurely and ended up being seen by a hospital who were out of network and her insurance didn't cover it. Or even went to an in-network hospital, but was seen by doctors who were out of network, as frequently can happen, especially in emergencies when you can't personally vet the doctor is in network for you before you see them. Certainly, something unexpected happened (maybe even the pregnancy itself! Something to look forward to with the Supreme Court set to overturn Roe v Wade), and insurance wasn't there. Why is that acceptable in this country?
It’s hard to imagine a person wanting to take on multiple jobs if instead they had the option to work one for the needed amount of hours and pay. Hours at one job != hours at three jobs, especially when you add in commuting time and lack of benefits because you’re not full time.