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I don't really want to wade into a political argument about health care, but this one specific part:

> The worst case scenario is bankruptcy, which sucks (though it sucks much less if you're already poor and have no credit to destroy).

Even though you immediately followed it with kind of a "but", I think you're seriously underestimating the effects of debt on someone in the U.S.

I have struggled financially for over a decade, after a period of doing really well. I could spend hours talking about the consequences of being poor (in U.S. terms).

1. Your housing options automatically become drastically limited. If you have bad credit, you don't get to pick and choose apartments or rental houses; you're more likely to end up in shared living arrangements or in the kind of apartment complexes that are willing to house people with bad credit, which also means your stuff is more likely to be stolen -- stuff that you can't afford to replace. (Having a load of laundry stolen was a hardship for me for about a year.)

2. Your employment options also become more limited. A lot of jobs, especially those that pay well, now do cursory background and credit checks as a proxy for judging whether or not you might try to rip them off. That of course makes it even harder to pay off your debt.

3. Forget about having reliable transportation. I've gone through 9 cars in less than 15 years: from one junker to the next. Used car prices are insane right now, so you're going to be stuck with someone's $500 or $1000 mechanic's special -- because that's all the cash you've managed to scrape together -- or you'll be doing a lot of walking and public transportation, neither of which are terribly convenient in most places in the U.S., which again limits your job options.

4. That beater you drive, if you drive one, becomes a target for law enforcement. They are most interested in cars that look like their registration may not be current, look like they may be a road hazard, look like they may be driven by a college kid with marijuana under the seat, look like they have a broken window ... the increased scrutiny is not only irritating, it can get expensive too, depending on just how poor you are.

5. Because your finances are limited by a lower-paying job, you're more likely to lack access to higher education, better quality food, or healthy hobbies.

6. You end up paying more for everything. You don't get to take advantage of discounts (for example, paying 12 months of insurance up-front), and if you do have any credit cards, you'll pay more on their rates.

7. If you don't have credit cards, every unexpected personal financial problem becomes a disaster. Oh, your radiator just blew a seam? Well, I guess you won't be driving anywhere for a while.

I'll stop there. Anyway, I don't completely disagree with you, but let's not just skip over the consequences of having a lot of debt. They can be really serious and long-term and dramatically change the quality of life someone has -- for the rest of their life.

People will weigh the risk/benefit differently if there is a large cost involved. A doctor says "everything seems to be fine, but I'd like you to go to the hospital to be on the safe side." If you have good insurance or socialized healthcare, there is no question -- you will go to the hospital and get checked out. There is no reason not to, and it could save your life. If you have no insurance, then the question becomes "is it worth the certainty of a huge expense, for a small chance that I have a disease?"

Everyone has a threshold of what they consider serious enough to warrant a hospital visit. When you introduce massive expenses you shift that threshold upwards, which means missed diagnoses and an increase in avoidable deaths.

Which part is an exaggeration? The death? Hardly. It usually takes some time to get someone to an emergency room, so if their heart fully clogs, the outcome is often death.

Or that people will usually forego seeking treatment because they can't afford to rack up huge bills? Again, not really an exaggeration. If you have a house that you live in with your spouse and child, then you need that house, and people will often make decisions with the best chance of preserving it. If you go bankrupt, you can lose your house except in some specific circumstances (http://www.nolo.com/legal-encyclopedia/lose-home-file-chapte...).

It's easy to forget, as programmers, that most people don't enjoy the same benefits we do. Most people are living paycheck to paycheck with little savings and children.

It is an exagerration to say that the situation you described was typical (though "too common" might fit). You implied that you could not obtain treatment if you cannot afford it. And now you're adding the largely fictional risk of losing your home into the mix. Yes, it is possible to lose your home in bankruptcy but only if the equity in your home exceeds your state's homestead exemption (often, but not always, $50,000) by an amount large enough to make it worth selling. This will not often be the case for a person who is driven into bankruptcy by medical bills.

I do agree (as I said) that people should not be put in the situation of having to choose between preserving the lives they have built for themselves, and obtaining healthcare. But I think it's important to be scrupulously accurate and responsible on this topic since the discussion itself could influence somebody's decision not to seek treatment.

The important thing to note here is that the scaremongering is precisely what contributes to more deaths.

If you're marching around saying lives will be ruined if you seek treatment , then YOU, not some other person, are the problem.

Think carefully if the point you imagine you're making is worth that.

Right. I'm "scaremongering" by explaining the situation faced by many middle class families in the US on a forum for programmers, and I'm personally contributing to more deaths, not the poor healthcare system. Okay.

While it's true you may not lose your house (which I clearly articulated in my previous comment), there's more to life than a house. If you can't drive to work because you no longer have a car, then that's a huge problem. If you're putting your children through school, then suddenly you're jeopardizing their life by seeking to preserve your own unless the doctors know quickly and precisely what's wrong with you.

I don't understand why this is so controversial: People make suboptimal decisions, especially when the choices don't have clear outcomes. Here's some evidence that this actually happens in practice: https://news.ycombinator.com/item?id=8551522

Yes. You're scaremongering. You're (by your own admission) using an extreme situation to make a point.

If you choose to emphasize this extreme situation, as you did, then yes, you own some personal responsibility.

If you don't like that, then don't use extreme cases to make whatever point you want to make.

Hm. Actually, I think I love it. I'm going to go out of my way to use the most extreme situations in order to contribute to as many deaths as possible, simply by having conversations on the internet. Bonus points if my rhetoric influences the death of a small malnourished Dachshund. Thank you for pointing out my previously-unknown power over life and death. This is awesome!

You're (by your own admission) using an extreme situation to make a point.

No, the situations aren't extreme. Like I said, people typically live paycheck to paycheck and can't afford trips to the hospital. The fact that someone on HN had direct evidence of this shows us how common the situation actually is. We should choose not to like that, and do something about it through voting.

I am similarly perplexed about why this argument is dragging on. This position:

> People make suboptimal decisions, especially when the choices don't have clear outcomes.

Is nuanced and, I think, correct. But your original comment didn't clearly say this (though now that I know your actual position, I'm able to read back and see what you meant). It sounded like you were saying -- like many other people -- that if you don't have insurance in the U.S. you can't get treatment, so you die.

Distinguishing between the two is important because to the extent that the latter view is perpetuated, it is a major reason why people "make suboptimal decisions."

I suspect that you and I have the same views about healthcare in America. I'm simply trying to get you to tighten up your somewhat loose talk about it. Things are bad, but you seem hell bent on making things sound even worse than they are. This impulse itself is harmful for precisely the reason that I and waterlesscloud have now both pointed out to you.

Case in point: did you know that there is also an automobile exemption in Chapter 7 bankruptcy that works similarly to the homestead exemption?

If you're marching around saying lives will be ruined if you seek treatment

But lives are often ruined when people seek treatment, given that medical bills are the largest single cause of personal bankruptcy in the US. I don't think people get scared of seeking treatment because of the number of people pointing this out, as much as they get scared because of the number of bankruptcies.

>And now you're adding the largely fictional risk of losing your home into the mix. Yes, it is possible to lose your home in bankruptcy but only if the equity in your home exceeds your state's homestead exemption (often, but not always, $50,000) by an amount large enough to make it worth selling.

So what about this is fiction? As the proud owner of a 1-million-dollar spinal cord injury treated within the US, I don't understand where the fiction starts. Also, I was insured.

(also, is 'largely fiction' synonymous with 'rarely'?)

"The risk of a head-on-collision during city driving is largely fictional." doesn't sound quite right.

I have met two people in my life with over $250,000 in medical debt. Both were under 30, and neither had a job paying over $15/hr. They each seemed to be doing alright but had accepted that the medical debt was something they would never pay off. They both still needed infrequent care, and one of them was still building his debt faster than his income could keep up with.

I didn't know what to think, and still don't.

The two people should just leave the United States, start a life elsewhere. Argentina, Germany, Thailand, whatever.

I suggest the same thing to folks with unmanageable student loan debts with no clear answer in sight.

I think it's unfair for society to have burdened such debts on people who didn't know any better, who weren't equipped with the resources or the knowledge to make the right decisions. What do you do? Be 'unfair to society right back, don't pay, get away, start over again somewhere else.

So, run out of money - steal? That's hardly moral. Its part of the entitled "I'm so sad I got into this hole, and somebody should let me out" culture.

> So, run out of money - steal?

Pretty much. Though, compared with how corporations are fucking over little people left and right, it's hardly unwarranted.

This is not an unfamiliar story. There are people who did everything right, were kind and philanthropic their entire life, more than they should have been probably, but they find their whole lives suddenly ruined with just one accident. There are supposed to be certain trade-offs in a society, when one agreed to a social contract that they'll be nice to everyone, be law-abiding, pay their taxes which in part fund medical research, fund creation of roads and infrastructure that enable corporations to function and rake in money, etc., they expected for the system to be there for them in return when they had a time of sudden misfortune. If it's not there, I say fuck it, this is then time they also stop playing nice.

Straw man. This dude was suggesting dumping your student loans. I can guess that there are good reasons for that, but I didn't hear any.

The law, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, and to steal bread. - Anatole France

Part of the reason I believe people think they won't be treated is because that is very much the perception given to them by the front office staff of most hospitals and clinics. I'm not sure if this is what you are referring to when you say "the fault of a healthcare system that sends all the wrong signals", but I hope it is, and I feel it deserves a stronger highlight as the root of the problem.

The gentleman up-thread mentioned that when he went to visit his mother in ICU, he had to actively dodge the front desk person who wanted to discuss payment with him rather than letting him spend the last few minutes of his mother's life in her presence.

In the 90s, when I drove myself to the hospital suffering from appendicitis and I collapsed in the ambulance driveway trying to walk into the ER, since I was still lucid, albeit in pain, they felt it was more important to wheel me in to the billing booth and secure payment by taking all my available credit card information than to send me straight back to the examination room. They sounded quite pleasant and convincing that they were doing everything they could to get me seen right away, and they were very helpful in that they could just take the cards and write down the information after I was sent back, I just had to scrawl my signature on the release forms to get it started. It took me a decade to pay off that debt while avoiding bankruptcy and almost another decade to get my credit rating back up to a level that I could apply for some small bit of credit without fear of getting nasty looks from the person processing the application as a deadbeat.

While rationally, anyone would agree that either outcome is better than dying young, our society has become twisted in on itself in such a way that it is very easy to miss being rational when looking at the huge inconvenience and stress involved in incurring that cost versus the irrational hope that it is something small and it will pass on its own.

You would be surprised to know that hospitals would treat the person with the cheapest drugs and not do the major heart surgery. Not all hospitals, mind you, I know Mt Sinai (NYC) will most likely treat the person fully, but some will give enough heart meds to make the person feel "okay" until he/she dies.

Also, often after treatment, hospitals will just write the treatment as a "loss" and get a tax break. I've had friends pay $20 for a broken arm fixed. The problem is that many will give sub-par treatment, won't do the surgery, etc.

American health care system is an atrocity.

Yes, there are cases where things are worse than I described. But the comment I was responding to, and thus my comment, was addressed to what is "typical" in the U.S. system. What's typical, is that a person has insurance, goes to the hospital, and everything is more or less fine. What is not typical, but still entirely too common, is that an uninsured patient takes on an obscene amount of debt that has a major impact detrimental impact on his life. But that is far better than dying, which many would have you believe is the only option.

It is also true that people sometimes get this calculation wrong and die as a result. This is due, as I mentioned, to a system that inhumanely forces this choice upon you, as well as people who spread misinformation about how our system works.

Actually we ALL pay for their treatment. In Florida, if you have no insurance you are taken to the closest public hospital (county hospital). They treat you (barely - don't expect a private room). If you can't afford to deal with the bill, the county pays. And then we all pay via taxes.

It's a serious problem.

You are wrong. I have actually had a doctor check something and then ask which health insurance I had before recomending a follow up examination (which actually revealed something serious).

If I had had lesser insurance and he had left me with a "it's probably fine", I might indeed be dead now as with the op.

You're conflating two different things: the inclusion of price as a factor in medical decision-making, and hospitals' refusing to provide needed care to people who cannot pay.

The former, I agree, is a real problem (as I have now said repeatedly). The latter is generally a myth perpetuated by irresponsible people who want to score cheap points in the healthcare policy debate.

If whether someone has medical tests recommended by their doctor is based on their level of insurance, then that is refusing care to those who cannot pay.

As soon as price enters the equation, you're not going to maximize your life expectancy. This is math.

> I think that anyone would agree, though, that either outcome is far better than dying young.

Right, but how can you be sure? Doctors are clearly overly precautions because they don't want true negatives. In some cases (e.g. if you need to support kids) it may be reasonable to risk that.