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Old 12th September 2019, 11:48 AM   #81
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Originally Posted by xjx388 View Post
Arguments about the benefits of universal healthcare don’t really address my fundamental question. I understand that other countries have universal healthcare. However, they don’t have universal “foodcare,” where groceries are free at the point of purchase.
So where is your evidence of large scale starvation in modern industrial western nations?


Quote:
They don’t have universal housing where shelter costs nothing.
And we should look at their homelessness problems separately.
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Old 12th September 2019, 11:50 AM   #82
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Originally Posted by rdwight View Post
I am always partially on the fence about these kind of things, depending on the circumstances. From people I know, charity care at hospitals have covered a large portion or completely what they owed since they were in the range of income that allowed for it.

While I understand there are people that fall into the portion of the population where charity or medicaid/state insurance are not obtainable due to their income being too high, but still lack the income to pay for health insurance. I do have an issue with a certain portion that *could* afford it but take the gamble and then cry about that gamble not paying off. Sacrifices in life are necessary, and healthcare is one of those that should not be gambled and then complained about. The worst cases are always put forward but I wonder how much they represent the majority. Any studies that break down the situation further that I could look into to help form an opinion?
Why pretend that even having decent health insurance is enough to prevent you from going bankrupt from medical bills? A serious percentage of medical bankruptcies had insurance.

"Of the 60% of individuals filing for bankruptcy, due to high medical costs, 80% had medical insurance. Their medical costs were still simply too much to bear."

https://www.piu.org/communicators/medical-bankruptcy
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Old 12th September 2019, 11:56 AM   #83
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Originally Posted by kellyb View Post
It says (this is the full text):



(the "very much" figure in the table is 37%, and "somewhat" is 21%)

I'm not seeing anything about "everyone that had over $1,000 in medical bills or were out of work for two weeks at any point in the past two years" anywhere in there.



I saw that, too, and also thought it wasn't very useful data for doing a US vs Canada comparison.
Disability and social security would have been better examples.
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Old 12th September 2019, 12:23 PM   #84
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Originally Posted by kellyb View Post
$5k in medical bills was the minimum they mentioned, not the max. Most of these people will have bills in serious excess of $5k.
I read through the study mentioned in the snopes article by Prof Austin and it decently went through quite a few studies and the detractors positions to them. It is worth a read. Study

His own study came to the conclusion of between 18-26%(not sure why snopes says 25%). But some of the averages he came to are what gives me pause.

Quote:
The average unsecured debt for debtors in this study was $55,967.78, while the average annual income was $40,920. Of these debtors, 9% had Revised Medical Debt greater than half of their total unsecured debt, and 15% had Revised Medical Debt greater than annual income. Combined, 18% of all debtors had Revised Medical Debt greater than half their total unsecured debt or annual income. This indicates that medical debt was the predominant factor in 18% of consumer bankruptcies.
So 18% outliers with that level of burden, but an overall average of $9,374.09 medical adjusted to the $55,967.78 total average unsecured debt. While an unforeseen medical expense could definitely put a certain level over the edge where bankruptcy is a better long term financial strategy, it seems like most fall into the range where it simply compounded existing issues.


Quote:
Also, most of the people in the study I linked to earlier were paying for insurance that didn't actually end up preventing them from having to file for bankruptcy over medical bills after falling ill, so I guess you could call that "bad spending and savings habits".
Choosing a plan with a higher deductible to lower your monthly costs is a choice. Not having that deductible in case you need it is a saving habit. This is not cut and dry, as not everyone is in a position to do either. I am hesitant to believe without evidence the majority always fall in the 'can't' as opposed to 'didn't'.

In the end, 18%-26% is still an unacceptable number. I don't have to agree with 67% to think there should be changes made.
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Old 12th September 2019, 01:04 PM   #85
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Originally Posted by rdwight View Post
I read through the study mentioned in the snopes article by Prof Austin and it decently went through quite a few studies and the detractors positions to them. It is worth a read. Study

His own study came to the conclusion of between 18-26%(not sure why snopes says 25%). But some of the averages he came to are what gives me pause.



So 18% outliers with that level of burden, but an overall average of $9,374.09 medical adjusted to the $55,967.78 total average unsecured debt. While an unforeseen medical expense could definitely put a certain level over the edge where bankruptcy is a better long term financial strategy, it seems like most fall into the range where it simply compounded existing issues.
It also says:
Quote:
Medical debt is the single largest cause of consumer bankruptcy as shown by debtor responses to the survey. Debtors chose medical bills as the reason they filed more than any other specific reason. Second was loss of job, followed by excessive spending.
And:
Quote:
The average credit card debt was $14,796, of which
23% is $3,403.08. Adding this amount to the medical debt actually reported by
debtors gives a sum of $9,374.09, which is the average Revised Medical Debt. In other words, in 2013, a typical Schedule F filed in a consumer bankruptcy reflected an average of $9,374 in medical debt.
Does the "$55,967.78 total average unsecured debt" include mortgages?
eta:
Oh, it's not mortgages, it's probably student loans there. Those are "unsecured".
I'm not sure if having recklessly accumulated at $50k tab on college that isn't paid off before falling ill and having the medical bill collectors coming for your bank account is my idea of irresponsibly putting yourself on the edge of bankruptcy.

Quote:
In the end, 18%-26% is still an unacceptable number. I don't have to agree with 67% to think there should be changes made.
Sounds good to me.
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Last edited by kellyb; 12th September 2019 at 01:17 PM.
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Old 12th September 2019, 01:17 PM   #86
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Originally Posted by rdwight View Post
Choosing a plan with a higher deductible to lower your monthly costs is a choice.

That is increasingly untrue, at least in the US where the predominant source of health insurance is one's employer.

More and more employers are offering only single one-size-fits-all plans, instead of two or three options as had been common in the past. These plans are increasingly high-deductible/low-premium with very limited coverage.

And even when employers do offer multiple plans, very often the only significant difference between them is EPO vs. PPO, deductibles are still high and coverage is still low in both cases.

That way, they keep their own costs down, and spend much less time and effort negotiating plans. Of course, the only reason so many still offer health insurance at all is because it's cheaper for them to put the money into "benefits" than it is into salary (lower/nonexistent taxes on benefits payments vs. salary payments).
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Old 12th September 2019, 01:26 PM   #87
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I basically think the 18% is an underestimate.

http://medicaldebthub.com/2018/06/wh...wing-problems/
Quote:
Debtors in my sample also reported an average of $55,967 in unsecured debt and annual income of $40,920. Of these, a total of 18% of debtors had medical debt that was greater than half of their total unsecured debt or half of their annual income.
I don't think your medical debt needs to exceed your student loan debt to count as a "medical bankruptcy" personally.
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Old 13th September 2019, 09:11 AM   #88
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Originally Posted by kellyb View Post
It also says:

Quote:
Medical debt is the single largest cause of consumer bankruptcy as shown by debtor responses to the survey. Debtors chose medical bills as the reason they filed more than any other specific reason. Second was loss of job, followed by excessive spending.
Yes, at 26%. Obviously an issue but a far cry from 62-67%.

Originally Posted by kellyb View Post
And:

Quote:
The average credit card debt was $14,796, of which
23% is $3,403.08. Adding this amount to the medical debt actually reported by
debtors gives a sum of $9,374.09, which is the average Revised Medical Debt. In other words, in 2013, a typical Schedule F filed in a consumer bankruptcy reflected an average of $9,374 in medical debt.
Does the "$55,967.78 total average unsecured debt" include mortgages?
eta:
Oh, it's not mortgages, it's probably student loans there. Those are "unsecured".
I'm not sure if having recklessly accumulated at $50k tab on college that isn't paid off before falling ill and having the medical bill collectors coming for your bank account is my idea of irresponsibly putting yourself on the edge of bankruptcy.
Since student loans would only be covered under the 'Other' choice (19%), I think that's an optimistic view.


Originally Posted by kellyb View Post
I basically think the 18% is an underestimate.

http://medicaldebthub.com/2018/06/wh...wing-problems/


I don't think your medical debt needs to exceed your student loan debt to count as a "medical bankruptcy" personally.
It might well be an underestimate. But other studies have put the burden at a much lower amount, to get to a much higher percentage. For example Himmelstein 2009 study included anyone with $1,000 in medical debt in the previous 2 years. A counter point was that average spending of a comparable income family is $4,500 on medical care for a two year period.

There are counter points to each and every study, so none can really be taken as completely accurate. If we are not moving towards a universal healthcare ala the UK with great speed, breaking down the causes can help find solutions in the interim. I would rather not look at them as excuses and more as examples on what can be fixed now and how.
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Old 13th September 2019, 09:26 AM   #89
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Originally Posted by luchog View Post
That is increasingly untrue, at least in the US where the predominant source of health insurance is one's employer.

More and more employers are offering only single one-size-fits-all plans, instead of two or three options as had been common in the past. These plans are increasingly high-deductible/low-premium with very limited coverage.

And even when employers do offer multiple plans, very often the only significant difference between them is EPO vs. PPO, deductibles are still high and coverage is still low in both cases.

That way, they keep their own costs down, and spend much less time and effort negotiating plans. Of course, the only reason so many still offer health insurance at all is because it's cheaper for them to put the money into "benefits" than it is into salary (lower/nonexistent taxes on benefits payments vs. salary payments).
Conceded. I don't have employee provided insurance and haven't for some years, but that definitely can be a contributing factor given its a job perk that won't be replaced monetarily if it is not used. Been at least 9 years since I had experience with it and there were multiple options to choose from.

I also admit that certain locations in the country will have much smaller options in regards to insurance than others. Even where I live over the past 3 years my own plan has gone from no deductible, to 1k, to 3k. Monthly price went up, services covered but didn't affect deductible were moved to covered after deductible met.

My choice is not the cheapest plan though and is chosen for the lower deductible and out of pocket max, to cover myself as best as possible. But at this rate my options will match what others experience where there isnt necessarily a good choice, just less bad. So probably not a good point by me, consider it refuted.
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Old 13th September 2019, 09:45 AM   #90
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Originally Posted by rdwight View Post
Conceded. I don't have employee provided insurance and haven't for some years, but that definitely can be a contributing factor given its a job perk that won't be replaced monetarily if it is not used. Been at least 9 years since I had experience with it and there were multiple options to choose from.

I also admit that certain locations in the country will have much smaller options in regards to insurance than others. Even where I live over the past 3 years my own plan has gone from no deductible, to 1k, to 3k. Monthly price went up, services covered but didn't affect deductible were moved to covered after deductible met.

My choice is not the cheapest plan though and is chosen for the lower deductible and out of pocket max, to cover myself as best as possible. But at this rate my options will match what others experience where there isnt necessarily a good choice, just less bad. So probably not a good point by me, consider it refuted.
I like this post.
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Old 13th September 2019, 11:44 AM   #91
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Originally Posted by rdwight View Post

Since student loans would only be covered under the 'Other' choice (19%), I think that's an optimistic view.
Can you quote the part you're talking about?
It says:

Quote:
Except for secured debts such as home mortgages and car loans, most
consumer debt is nonpriority unsecured debt19 and typically includes claims such as credit card debt, medical bills, utility bills, personal loans, legal claims, and student loans. These types of debt are generally dischargeable in consumer bankruptcy, with certain exceptions.
And:

Quote:
The average medical debt directly reported on bankruptcy schedules was $5,970.80. However, in order to account for medical debt charged to credit cards, I take the amount of medical debt reported by the debtor on Schedule F, and add 23% of the total credit card debt, which is also listed on Schedule F. This provides the Revised Medical Debt. The average credit card debt was $14,796, of which 23% is $3,403.08.
What would the missing ~$40k be, if not mostly student loans?

ETA:


Where you were talking about "'Other' choice (19%)," - are you referring to "Table 1: Survey Answers" on "the reason they filed for bankruptcy" question?

Because a vast majority of the $55,967.78 of unsecured debt (roughly $40k after the $14k average in credit card debt) could be student loans, and since they can't discharge any of it with the bankruptcy, it won't be a listed reason. They'd just factored paying off the student loans in as a monthly bill/payment they'd have to pay for decades.
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Last edited by kellyb; 13th September 2019 at 12:00 PM.
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Old 14th September 2019, 09:25 AM   #92
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Originally Posted by kellyb View Post
No argument from me. It's why a lot of Americans go down to Mexico to pay out of pocket for care.
Yes, we live right on the border so we see this a lot. Especially for surgery and dentistry.

Quote:
How would a patient know they're getting the best price? How would they verify that?
They could call other doctors offices but I doubt those doctors would be able to give them clear pricing. It’s just not how things usually work here -which is a big problem, I think. They could call labs but I have all the commercial lab pricing schedules and I know we are lower than every lab’s patient cash pay prices. There are several retail storefront labs where patients can just walk in and get a limited set of tests -we are lower than them too.

Quote:
Couldn't other doctors have other "client prices" what are lower than the patient price directly from the lab? There could be a cheaper doc and a cheaper "client price" from a lab out there.
I guess there could be, but I seriously doubt it. Most docs just send cash patients directly to the lab and let them deal with it. As far as lower client prices, I doubt that too. I shop around regularly for the best client prices. The docs I work for are partners at a local hospital and that hospital has the absolute lowest client pricing I’ve seen offered. It’s very important to the docs I work for that their patients have access to all the services they might need so part of my job is to negotiate with outside providers like lab, imaging, specialists, etc to get the lowest possible prices.

Quote:
How much does she charge for a cancer diagnosis and treatment on average? For breast cancer, or kidney cancer? From initial visit to surgery/chemo/whatever, how much does that run on average?
Well, she’s a primary care doc. When her patients see her at her Direct Primary Care practice, it’s all covered by the monthly fee. But the oncology/surgery is referred out. I know she has friends that she works with to get cash prices (not just cancer) and I know that she has negotiated charity care with the local hospital where she is a partner at as well as at MD Anderson and University Hospital in San Antonio. But I couldn’t tell you what it would cost otherwise.
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Old 14th September 2019, 09:35 AM   #93
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I am still alive 11 years post diagnosis of an incurable lethal disease because of my access to some quite expensive medical procedures. I had/have that access because (1) my employer offered several insurance plans, including some high end options, (2) I chose long ago to opt for one of the more comprehensive coverage plans, and (3) I have been able to pay the much higher employee contributions/premiums required for me to subscribe to these higher option plans compared to the more limited coverage plans also offered by my employer.

I cannot describe my terror when every year or so my employer re-considers the health insurance options to be offered to us employees. Literally it is a life or death matter to me. Clearly they are trying to drop the more expensive plans and limit my options to those with higher co- pays, more limited access to excessive drugs (such as those keeping me alive), and a more restricted access to medical specialists and procedures.

So far I've still been able to find an offered plan that covers what I need to keep alive, although at the cost of paying many thousands per year more than the prior plans. But any year in the future I may suddenly discover that the $125,000 a year drug that keeps me alive will no longer be covered by any of the insurance plans offered. Then my choice will be to backrupt my family before I die, or just die quickly.

Something about this feels wrong...

Oh, BTW, am I being selfish by wanting expensive medical treatments just to keep alive a few more years? Damn straight!

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Old 14th September 2019, 10:00 AM   #94
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Originally Posted by xjx388 View Post
Arguments about the benefits of universal healthcare don’t really address my fundamental question. I understand that other countries have universal healthcare. However, they don’t have universal “foodcare,” where groceries are free at the point of purchase. They don’t have universal housing where shelter costs nothing. Food and shelter are even more fundamental needs than healthcare. Imagine the health outcomes and cost savings in a system where healthy food is provided free of charge and every citizen is given safe shelter with clean drinking water. Yet those two industries are left to the same “evil-profit-over-lives” system that the US healthcare system is condemned for.
Almost all countries provide universal access to police and fire protection. Many countries, at least the wealthier ones, also provide financial assistance to ensure that their citizens have adequate food and housing to avoid them dying on the streets (these programs do not provide access to just any food one might desire but neither will any of the universal health care plans that have been proposed).

If many of these countries are able to simultaneously provide universal health care why cannot the USA, one of the wealthiest countries in history?

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Old 14th September 2019, 10:12 AM   #95
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Originally Posted by xjx388 View Post
...... However, they don’t have universal “food care,” .........
Food, shelter, and clothing is free in the US.

Just look at the facts ... if these things were NOT free ... everyone with no income would starve to death in a matter of a few days

I wager starving to death is exceeding rare in the US ...
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Old 14th September 2019, 10:21 AM   #96
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Originally Posted by xjx388 View Post
Arguments about the benefits of universal healthcare don’t really address my fundamental question. I understand that other countries have universal healthcare. However, they don’t have universal “foodcare,” where groceries are free at the point of purchase. They don’t have universal housing where shelter costs nothing. Food and shelter are even more fundamental needs than healthcare. Imagine the health outcomes and cost savings in a system where healthy food is provided free of charge and every citizen is given safe shelter with clean drinking water. Yet those two industries are left to the same “evil-profit-over-lives” system that the US healthcare system is condemned for.

Can I just check that the opposite of universal foodcare is letting the citizens of the richest country in the world starve to death?
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Old 14th September 2019, 03:35 PM   #97
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Originally Posted by kellyb View Post
ETA:

Where you were talking about "'Other' choice (19%)," - are you referring to "Table 1: Survey Answers" on "the reason they filed for bankruptcy" question?

Because a vast majority of the $55,967.78 of unsecured debt (roughly $40k after the $14k average in credit card debt) could be student loans, and since they can't discharge any of it with the bankruptcy, it won't be a listed reason. They'd just factored paying off the student loans in as a monthly bill/payment they'd have to pay for decades.
Yes, that is the section. Couldn't tell you a breakdown as one wasn't given to the other averages. Also a little difficult to find much information in regards to student debt and it's influence on bankruptcy. This study by LendEdu came to 32% of the bankruptcy they were provided details on had student loan debt. Of that group, 49% of their total debt was student loan debt on average.

Student loan debt is another topic though, and since it was willingly taken on in a much different way than medical debt, I don't think the two issues should be compared or interconnected.
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Old 14th September 2019, 05:42 PM   #98
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Originally Posted by kellyb View Post
........Because a vast majority of the $55,967.78 of unsecured debt .... could be student loans, and since they can't discharge any of it with the bankruptcy, it won't be a listed reason. They'd just factored paying off the student loans in as a monthly bill/payment they'd have to pay for decades.
I'm probably a bit off topic now ...but ... the trick with that is to pay off the student loans with credit cards (over a period of 3 or 4 years) THEN go bankrupt.
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Old 14th September 2019, 07:39 PM   #99
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Originally Posted by rdwight View Post
Yes, that is the section. Couldn't tell you a breakdown as one wasn't given to the other averages. Also a little difficult to find much information in regards to student debt and it's influence on bankruptcy. This study by LendEdu came to 32% of the bankruptcy they were provided details on had student loan debt. Of that group, 49% of their total debt was student loan debt on average.

Student loan debt is another topic though, and since it was willingly taken on in a much different way than medical debt, I don't think the two issues should be compared or interconnected.
I'm not sure they should be, either, but the author of the study interconnected them, by making the litmus test of something being real "medical debt" or not be "more than half of total unsecured debt coming from medical bills."

Also, this argument:

Quote:
When i see the number of insured people that require bankruptcy due to medical bills, I can't help but question what weight is given to such bills as opposed to general financial decisions. Being on the brink of bankruptcy due to bad spending and savings habits but being put over the edge by a 5k medical bill should not on its face being something the system should be blamed with.
...If most of the other half of unsecured debt was student loans, does having chosen to go to college qualify as "bad spending and savings habits"?

One other thing is, the survey that showed 26% was medical bills also showed 15% listed as "Illness or injury", for a total of 41%, which is close to:

Quote:
Himmelstein’s 2005 study (hereinafter Himmelstein 2005), a study of debtors who filed bankruptcy in 2001, in which they asserted that 46.2% of debtors had filed because of medical costs.54
...where "medical costs" include "illness and injury" in addition to "medical bills.".

So, the survey results in the study you linked to, and the Himmelstein study (the first one, at least) actually are roughly in line with one another.
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Old 14th September 2019, 08:15 PM   #100
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Originally Posted by xjx388 View Post
Well, she’s a primary care doc. When her patients see her at her Direct Primary Care practice, it’s all covered by the monthly fee. But the oncology/surgery is referred out. I know she has friends that she works with to get cash prices (not just cancer) and I know that she has negotiated charity care with the local hospital where she is a partner at as well as at MD Anderson and University Hospital in San Antonio. But I couldn’t tell you what it would cost otherwise.
I certainly understand why PCPs want to escape the third party payers, but this really doesn't sound like an alternative to insurance or a national health service.
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