I have to say that my response to "not knowing what you're going to pay for something until you're billed" is basically, "well I guess we'll see if I can pay it then". You sort of start asking yourself, "what if I just don't pay?". I have a (deadbeat) buddy who's entire medical plan is essentially to give a fake name to the ER, and if you're poor in America, what else can you do?
I worked in a couple of emergency rooms for a total of 6 years, and you aren't wrong. Assuming the care you need can be entirely performed within the ER, then that's a viable strategy so long as you don't intend to re-visit the hospital.
Hospitals are obligated to provide care regardless of your ability to pay in the moment, and of course they often take care of indigent and foreign patients, with the understanding that they won't be able to recoup their costs.
If you don't have your identification on you, then they simply give you a number to call and they usually ask to respond within a few business days because after that, it's harder to get insurance approval.
This all changes if you're admitted to the hospital and need surgery, because I think there's pre-approval required from your insurance carrier. Though since I worked in the ER, my memory is hazy on that.
If they believe you were deceptive and simply refused to be identified, then that is technically illegal, so they will put up your picture and will alert the police if they see you again. But if you never intend to visit the hospital again, it doesn't really matter. No one is going to hunt you down unless you're doing it on such a large scale that it can't be ignored.
This all said, I want to say that I still think it's an unethical thing to do.
I have a friend that incurred massive medical debts in college when their (college-provided) insurance refused to cover services rendered at the (college) hospital. The college then made all sorts of threats like “you won’t be able to graduate until this $$,$$$ bill is paid!!!”. Keep in mind my friend was only able to attend college on a full scholarship as a result of coming from a poor ESL family.
They ignored all the threats, the department in charge of threatening seemingly didn’t talk to the department in charge of graduation, and to this day (5 years later) they still receive near-daily letters in the mail requesting payment. I can’t say I find my friend’s actions unethical in the slightest.
Aren't inmates technically supposed to get healthcare? Could be a last-ditch option I suppose if you can't get something covered any other way. Personally I'm trying to stay employed to keep my coverage, but sometimes you can't outrun the layoffs.
> give a fake name to the ER, and if you're poor in America, what else can you do?
The American government spends something approaching a trillion dollars annually on Medicaid, "a government program that provides health insurance for adults and children with limited income and resources."[1]
Seperately, Obamacare[2] created a private health insurance market where low income people can obtain free or heavily discounted private health insurance coverage, according to their income.
Medicaid wasn't expanded in several states with tens of millions of people living in them[1]. For example, in Texas, nobody is eligible for Medicaid based solely on their income alone.
Where Medicaid is expanded, the income requirements for Medicaid are far from sane. If you make over 100% to 138% of the federal poverty line, which is $15,060/year for an individual, you are not eligible for coverage. For example, someone who makes $16k to $21k a year, depending on where they live, is ineligible for coverage despite making poverty wages.
Obamacare is (largely) a failure due to insurance meddling and laws preventing government insurance programs from negotiating prices with drug companies.
I'm a healthy individual, not even 30 yet, never smoked, never broken a bone, and never even had stitches in my life. And when I last checked their prices, I was making only $45k/yr. For coverage with Obamacare, I would be paying $350/month for the "catastrophic" plan. Which includes no prescription copay, no dental, no vision, and only kicks in after I've spent $100,000 in one year, and it takes 6 months to take effect after signing up. It's only there for serious issues like losing a leg or cancer.
Obamacare is not a plan, it's a law that set minimum standards for health insurance plans, created marketplaces to cross-shop plans across providers on a single website, and created a system where you can receive government subsidies towards their cost if your income is low enough. At $45K, you would receive subsidies towards your insurance premiums.
I've bought my insurance on the ACA marketplace since it opened ten years ago. There's no difference I can see between the plans offered on the health insurance marketplace and those offered directly from the websites of the same insurers that offer coverage in my state (Blue Cross, CVS Aetna, United, Ambetter, etc).
The very highest deductible "catastrophic" plan offered on the marketplace in California for a 29 year old has a $9450/year deductible, which is also the maximum out-of-pocket expense for the year if you have this plan. A $100K deductible plan does not exist, and when you enroll during the annual enrollment period or after a qualifying life event, plans take effect the day you make your first payment, not months later.
I'm 10 years your senior and pay less than $350 per month with a lower deductible than the plan quoted above, with no government subsidies.
I use Obamacare in the rural southern way, referencing ACA and healthcare.gov, lol.
I'm also in Georgia which may have different regulations regarding the deductibles. I remember looking at the plans around 2 years ago and realizing that there was no way I could afford the premium, let alone the yearly deductible.
I just took another quick look at a non-Healthcare.gov site. Insurance for me would be $313/month with a $9,100 deductible. But it does not cover doctor visits, generic drugs, or specialist visits until after I pay the full $9,100.
Why would I want to pay $313/month for essentially no coverage until I spend 20% of my income towards a deductible before I see any benefits?
You get an annual doctor visit for free with any insurance plan. There is no deductible or copay. There are other categories that are covered with no deductible. My wife had a $13,000 IUD insertion under anesthesia at a hospital due to complications, and this cost her $0 with insurance, without having met her deductible, since reproductive health is covered with no out of pocket cost under all ACA plans.
I'm on healthcare.gov looking at Georgia's plans this year for someone with $45K of income. You have options starting at $129/month. Many of these sub-$200 plans get you doctors visits for $40-60, prescription drugs for under $25 each, mental health treatment for under $60 per visit. This is all without hitting your deductible at all, they're day 1 prices.
If you paid the cash prices for many of these doctors, specialists, therapists, they'd be many times higher than the insurance negotiated costs. Look under the "covered costs" estimates for things like mental health treatment, diabetes maintenance, broken bone treatment, etc and you'll see that the estimated annual cost for the insured is often half or less the plan's deductible -- which tells you that hitting the deductible is not when the savings start. I don't think my wife or I have ever hit our out-of-pocket maximums in a year, yet the insurance has saved us more than it's cost in most years.
You're going to start interacting with the healthcare system a lot more than you have in your 20s once you're in your 30s. We all do at that age. And if you have even the worst ACA plan, you'll start to understand what it's doing for you regardless of the deductible.
This is the cheapest plan I could find in GA. It said it would subsidize the $357/m cost down to $113 for $45k 40 year old Male non-smoker, single. It seems quite a bit better than what you are suggesting. (I used https://www.healthsherpa.com/ to more easily check out available plans.)
It covers preventative care, and after the $9100 deductible, it seems to cover pretty much everything with $0 copay, as long as its in-network.
(You also get their negotiated rates when you go to the doctor, I assume.)
It's still expensive, I worked as a contractor full time for a tech company for a year which basically means I pay for my own insurance through Obamacare (though they did suggest insurance at work but they didn't pay anything towards it so it is just is in case you want a 4th party to help you help yourself). Still long before that I basically just said I didn't have insurance and would get the price knocked down considerably. Half the time it's cheaper not to even have insurance... But now I'm "responsible" in the hopes it might bring down the price for other things in the future. For planned events I recommend health insurance, despite how often it's not all that worth it. Honestly though my current insurance copay cost as much as being uninsured in other countries so I kinda laugh at this crazy idea. I pay about $100 to visit any specialist doctor and it only cost $80 to be uninsured in some other countries on top of the $350 a month I already pay.
Most Americans don't realize just how huge and extensive medicare/medicaid is. They cover 65mil and 88mil people respectively, including 40mil children. That's 153mil people out of 330mil population -- that's 46% of the USA's population. Total spending is $1.9T for both. A cost of $12,400/person covered. $1.9T is 7.5% of the total US GDP of $25.44T. Medicare/medicaid is a massive program. Bigger than social security at $1.4T. It's crazy huge.
Because with the current medical cost, it would be absolutely ruinous. The root problem is American health care is far too expensive. The entire system is massively wasteful and complex.
Seems like unifying it under a single, already-extant federal system would greatly reduce administrative overhead though, don’t you think?
What’s funny is I’m probably one of the people whose paycheck is dependent on me not understanding that to paraphrase Upton Sinclair. When I started at my current employer, one of the devs straight up said the government should be doing what we do and we shouldn’t have a business.
Unfortunately, several million people work in medical billing and insurance. No politician that is aiming to get re-elected wants to double the employment rate. It would cure inflation almost instantly though!
Sounds like your issue is with Texas, then, not with America.
Why perpetuate crude and inaccurate stereotypes that smear and disparage America in general? America is spending a huge amount of money every year precisely on providing healthcare for the poor.
Have you considered perhaps that because I live in Texas, I know a bit more about those programs than you who have just googled and linked the top results? And that perhaps because I live in Texas, I indeed have issues with Texas (still a part of America in spite of the wishes of some on the right wing)?
From your own article (I knew this stat would be in there):
> Currently, Texas leads the nation in the number of uninsured residents with nearly 5 million people living here without health insurance coverage, nearly double the national average.
Why do you think so many are uninsured if it is so simple for them to get health coverage?
You said giving a fake name at the ER was the only option for poor AMERICANS to obtain healthcare.
That is categorically false, and testifes to some sort of deep seated bias against our own country profoundly embedded in your worldview -- one which extends all the way to glib counterfactual promotion of verifiably false information about the country and its supposed moral shortcomings.
2) Texas has a much larger population than 49 of the other 50 states -- about 30 million, higher than any state but California. Of course the number of uninsured residents will be higher than the national average. You didn't control for uninsured per capita.
Why are so many uninsured if it's possible (I didn't say easy) for them to get coverage? Probably, a large part of the reason is people who go around promoting the (completely false) common trope that "poor Americans just can't get health coverage, the government does nothing for them."
Pretty sure my buddy is an American - I've known him almost all my life. I'm quite sure he's poor - he asks me for money a bit more than I'd like. The fake name thing was just a strategy he developed after going to the ER due to a blow to the head which caused him to forget his name; I'm sure there are many creative ways to get healthcare, but most of the of poor Texans (whom I'm also pretty sure are Americans considering I'm related to a few of them) I've known just go to the ER and ignore the bills. It's probably not the best system, but it's the one we've got I guess.
As to point 2) I thought about including the info in my previous comment, but it wasn't in your own source material and I'm a bit lazy. So here, I'll do it in this one.
> Texas is still the state with the highest percentage of uninsured residents, at nearly 17 percent, according to the most recent U.S. Census Bureau survey released Thursday. [0]
Speaking as a Texan (also pretty sure I'm American) who lives with some disability, I can tell you that I've looked at the systems and it's a real fear of mine that I'll end up as one of these statistics.
Well hi, also fellow Texan here. State law requires hospitals to take in and treat any patient with injuries “incompatible with life”. This means a fake name is unnecessary, you can give the same name. You may be asked about a previous bill but that will in no way preclude you from getting treatment.
> Why do you think so many are uninsured if it is so simple for them to get health coverage?
High numbers of people who have illegally immigrated and are worried about getting into programs subsidized by the government which might result in questions about residency status leading to deportation?
High rates of misinformation surrounding the costs of insurance and availability of welfare programs in the state?
I just looked up getting a plan in Texas. 40 year old male non-smoker in Texas earning $45k/yr can get insurance for $128/mo. They're eligible for an HSA, so they can put tax-free savings that roll over every year into an investment account to help cover the $7,400 deductible. PCP and preventative care visits are free. Generic drugs are $10. Urgent care out of pocket is $160. Other plans have slightly higher premiums but much lower deductibles, some have different co-pays.
Yes - my plan if ever separated from employer insurance is to manipulate my income and expenses (I have significant investments I can draw upon and access to a family real estate portfolio that allows me to live rent-free) in order to get the full subsidy. Most people are not like me however; my buddy has several times had his car impounded for not paying car insurance. I don’t think health insurance will make the cut in his budget.
