When I lived in Iceland, I found a lump. I had no idea how to navigate finding a doctor, so I went to our show's production manager.— Mary Robinette Kowal (@MaryRobinette) June 3, 2019
Me: I found a lump. Can you help me find a doctor?
PM: Just go to the cancer center.
Me: Okay. How do a get a referral?
PM: What's a referral?
The tweet above is a perfect example of how complicated the U.S. health care system can be: a web of referrals, predeterminations, preapprovals, billing codes, etc. And in the end: an unpredictable bill often in the thousands of dollars for the same procedures that cost very little elsewhere.
My wrist fracture required immediate surgery, and thus a hospital stay. Now, like many people, I have health insurance through a group plan offered by my employer. I am lucky the particular plan I am on has excellent coverage, and therefore I didn’t really worry about costs. For others, however, their first concern often is whether they can afford the surgery. And after, whether insurance will cover things like physical therapy to fully recover.
Despite having great insurance, I have so far received bills totaling over $1,500 in co-pays and deductibles. The insurance company still covers the lion’s share of the expenses, which is in the tens of thousands. For people with catastrophic1 or no insurance, medical bankruptcy or long-term payment plans are often the only way forward.
This message brought to you by the bill I just got for an MRI that I needed.— Geraldine (@everywhereist) June 14, 2019
The procedure was covered by insurance (insurance that we pay for).
Insurance paid out for the procedure.
I still owe $600.
Apart from billing, there’s often uncertainty as to exactly what the plan covers. Certain procedures require pre-approval, a back-and-forth between health care provider and insurance which can take weeks to resolve. Too long for medical issues that require urgent attention. It is no wonder a lot of people are fed up by the state of health care in the U.S.
The Rest of the World
Over the years, I have lived in four different countries, and have used the health care system in a couple more during my travels. At no point was my bill ever more than a couple of hundred dollars, and at no point do people elsewhere worry about whether medical treatment will bankrupt them. A quick overview:
- The Netherlands: the monthly insurance premiums are about €110 ($122; up from around €80 or $90 from when I lived there seven years ago). There is a deductible (“eigen risico”) of €385 ($433), which you can further increase if you want to lower your premium.
- United Kingdom: health care is completely free except for prescription drugs which sometimes require a co-pay of around £8 ($10).
- Australia: as a temporary resident, I paid A$91 ($63) monthly. For citizens and permanent residents, health care is free.
Back to the tweet from the introduction. Turns out, Iceland has pretty affordable health care too:
So I go. The nurse checking me in apologizes because, since I'm not Icelandic, I'll have to pay for the visit.— Mary Robinette Kowal (@MaryRobinette) June 3, 2019
It's 3 krónur.
That's 3 dollars at that point.
I pay and sit down to wait.
CC: You found a lump.
In all these countries, costs are minimal. In the U.S., however, you still have to deal with co-pays, deductibles, and co-insurance after paying your hefty monthly premium. Even with good insurance, you might have to pay thousands out-of-pocket.
Why? Just search for “Insurance and Pharmaceutical Companies”.
After spending 7 years abroad, the single worse thing about moving back to the US is the health care system. If I ever leave again, it will probably be why. https://t.co/ml975HMnjg— Mark Manson (@IAmMarkManson) June 5, 2019
It’s both sad and concerning that people avoid going to the doctor simply because they are afraid of what it might cost. Or having to worry not about their disease, but the bills that come with it. I’m lucky I can move to any European country in the blink of an eye might something serious happen, but not everyone is that well off. What this country really needs is an overhaul of the medical system. One can dream right?
- A health plan with a high deductible, often thousands of dollars, which need to be met first before the plan starts paying out. [return]