For my kids, health insurance premium would have been almost $2k per month. In a typical year we spend about $1,200 total on medical stuff just paying out of pocket. Also keep in mind that premiums are not all you pay - there's also deductible and co-pays on top of that!
It's not hard to math that up and see how insane doing the health insurance would be. Yes there's the catastrophic risk of a bad accident or ER visit or something, and that's worth some cost, but even saving half the premiums in a money market account not only provides a good cushion for that, but if we don't use the money we actually get to keep it!
"but even saving half the premiums in a money market account not only provides a good cushion for that, but if we don't use the money we actually get to keep it!"
Until they require a $50k life flight or $100k brain, heart, etc surgery.
The problem is that insurance was intended to cover the large, infrequent costs - house fires, totaled cars, etc. The deductibles are intended to influence people to pay out of pocket for the smaller expenses.
The problem with health insurance is that the deductibles, premiums, and cost of care are out of control. The laws mandate significant amounts of coverage for a plan. The costs can be as high as a house fire, but happen much more frequently within the population. You can't get a plan that just covers expenses over $10k-20k per year. You can get kind of close with the super high deductibles but it still has to cover some things before the limit. Even if you could get to that, you're still looking at high costs when you consider the odds of something like 1 out of 100 people might need a $100k procedure in a year (made up numbers).
Genuine question: How does it happen that a heart surgery costs 100k? 2 surgeons (200$/h) + 6 nurses(100$/h) for 10 hours would be 10k. Where do the other 100k come from? Is it the equipment cost? Consumables? After care? Or are the margins just ridiculous?
Lots of equipment, consumable and facility costs. Catheters with realted imaging and machines to place it, meds, anesthesia, cost of the building, specialized HVAC, liability coverage, etc. Margins can also be bad since they'll charge some people more than others.
> happen much more frequently within the population
I assume the high premium reflects this frequency -- a higher frequency than many people realize. I do not assume the insurance companies are price gouging, but rather pricing their plans to break even/slightly profit.
Reminder if you are in the Pacific Northwest/Hawaii Life Flight membership is only $85, or bit more to cover ambulance if you are in Oregon. If you drive a lot of highway miles, ski, mountainbike, hike, vacation in Hawaii it's worth thinking about.
It would be nice if health insurance were, well, insurance, and not some bastard mix of cost sharing and collective bargaining. The closest you get to "catastrophic only" insurance is an obamacare bronze and/or a high deductible plan with an HSA. Same service, same networks, but you pay less premiums and thus keep what you don't spend.
Health catastrophes are more likely than you may think, so I would suggest a HDHP+HSA at the very least. It's very difficult to self insure against a cancer diagnosis that may blow a million dollars in a year.
I'm a fairly high net worth individual with a high deductible plan. Setting aside the deductible amount in savings (often, tax free with the HSA) and keeping it every year you have good health is OP.
> this paradigm completely fails for almost anyone with an income that isn't above the 50th percentile
I'm in Wyoming, and our threshold is under 200% the poverty line. That's $53,300 for a family of 3 [1]. Median household income–nationally–is $84k [2]. In Wyoming, it's $75k [3].
I don't know, I think there's some benefit to health insurance being more than insurance.
I think there's public-health benefits to subsidizing preventative/routine care, since
1. People are dumb and will decline to pay the $100-$300 it takes to decide
whether something needs treating even if they can afford it
2. It's just kind of inhumane to make people struggling on the edge actually do the math on whether they should pay sticker price to get e.g. an ingrown nail treated or just wait and hope it doesn't get infected, costing them vastly more or losing them a toe, and that's even if the probabilistic and cost information was readily available.
3. Even if we assume a perfectly informed and rational populace, rational individual decisions aren't the same as rational societal decisions. For example, a lot of people actually probably shouldn't pay $1000 for a given vaccine, since their risk of infection is pretty low as long as enough other people are vaccinated and pretty high if enough other are not, whether or not they're vaccinated. However, across a society, paying ~$1,000 per head to get everyone vaccinated might be worth it to get to the break point where we go from 250 million lost workdays and 1 million deaths to 1 million lost workdays and 1 thousand deaths. And then if you're making 300 million vaccines instead of 500 thousand, you can probably get the price down to at least $500, maybe less.
Maybe these things shouldn't be a function of health insurance. Maybe we should just directly subsidize the specific care we want to be widely available. But a lot of other countries seem to have decided it makes sense to gather public health expenditure and cost-sharing into one umbrella also called "insurance," so I'm not convinced it would make that little sense for us.
That's why I liked catastrophic health care plans. Insurance works best when it covers rare, expensive events. Otherwise, it interferes with the process. My car insurance doesn't cover oil changes or new tires, but if I get I crash and injure someone, it kicks in. Homeowners insurance doesn't cover a routine roof replacement, but it will if there's storm damage. That's how health insurance should work.
A catastrophic health care plan has low premiums and high deductibles. You also get access to a tax advantaged savings account to save up for future events. So you can take the money you saved on premiums and pay for medical expenses tax free. Or let the money accumulate to cover future medical expenses or even retirement!
"A catastrophic health care plan has low premiums and high deductibles."
Except they don't really exist anymore. You can get really high deductibles, but the premiums are still ridiculous. The plans have to cover many non-catastrophic events now by law.
The other problem is that the cost and frequency of things like auto accidents or home damage is generally much lower than for health events, and generally include much lower caps on how much they will payout.
This was the intent of the insurance agencies, they sold catastrophic plans but didn't really make a ton on them, so they negotiated basically not being able to sell them anymore.
Self-insurance is the final catastrophic plan and the numbers keep looking better every day.
I would like to get a catastrophic plan that doesn't cover things I would categorize as consequences of bad choices. I get that covering these things is less costly for society than just letting things run their course, but it does drive costs onto everyone else's premium.
Catastrophic plans are still quite costly because they aren't really a pure insurance product. Mine is over 2k/month for 3 people on an ACA Bronze plan with HSA.
Maybe if car insurance discounted new tires and oil changes on a reasonable interval, people would crash less, and insurance rates wouldn't even have to go up that much.
I suspect that the parent does in fact pay for any healthcare that they need or that their kids need. They just aren't buying insurance because the price of the insurance far outweighs their normal spending.
This is the real problem with health insurance is that it covers relatively routine and non emergency healthcare services where you can ship around and have market forces encourage people to find efficiency.
I understand the "if I'm dying from a car crash I can't shop around" argument and I agree. But that's very different than shopping for a family doc you like for the half dozen times a year you or your family will need to see someone for a strep test and maybe antibiotics.
> And this is why you can't have a system where people can opt out of paying for healthcare.
We do pay for our healthcare. We don't pay for health insurance. I get the general point you're making and I'm not trying to be pedantic, but I do think it's important to distinguish between the two in order to have a productive exchange.
But you wouldn't pay for your healthcare if you had a major event that cost $500k+. The rest of us would be left holding the bag.
I don't think you're doing anything wrong, but I do think we need a system everyone is a part of paying for, via health insurance mandate, single payer, etc.
Or we let people opt out completely, to where a family like yours just wouldn't receive care if you can't pay for it, but I don't think this is the world we want to live in.
The value you get from the health care system isn't just from the services they provide when/if you need them.
It's from the system existing and being ready to help you.
We're not talking about widgets, onions, haircuts, or pork bellies here. You can't opt out of the system existing. And you can't opt out of the horrific consequences if the system doesn't exist.
So it's a bit silly to talk about health care like it's something that has a free market.
There are programs in the US to give poor people healthcare for free; I was unemployed for a while and on one. Surprisingly simple and easy to set up.
The issue highlighted in this article seems to largely be due to illegal immigration, not due to a lack of support. If we curbed illegal immigration the problem would likely fix itself, although this article isn't very clear on who is or isn't a citizen in their numbers which makes it hard to use for anything useful
> Do undocumented immigrants qualify for federal healthcare benefits?
No. Undocumented immigrants do not have access to federally funded healthcare coverage, including Medicaid, Medicare, or the Children’s Health Insurance Program (CHIP). They are also unable to purchase health insurance coverage from the Affordable Care Act (ACA) Marketplace.
In fairness this does not work in practice. If a child is rushed to the hospital with a life threatening injury no US doctor is going to send them away. America is not really evil it just likes to LARP it.
As the very piece we're discussing mentions, the care in question for children is not emergency care. I assert America is evil, because these are active healthcare policy choices. We could fix this today with enough Congressional votes, it is a choice not to.
Right, they shouldn't have access to ACA, nor should a citizen of Denmark or India. They are foreign nationals and including them in the 4 million uninsured children in the US statistic makes the statistic worthless.
My issue with this article is it suggests there's some massive child uninsured problem in the US, but to get that number they're including foreign citizens. If we included all of south america I'm sure we could find tens of millions of uninsured people. If we included the rest of the world it might be closer to hundreds of millions. That doesn't mean there's a problem with the ACA. There could be a problem with it, but this 4 million number doesn't get us closer to an answer.
So you believe this number is a material amount of undocumented children and not US citizens? Can you prove this assertion? Numbers I was able to find indicate 1-1.1 million undocumented children in the US under 18. Let us assume they are a part of this 4 million stat for the sake of argument. What about the other 3 million children? Is 3 million children not a "massive child uninsured problem"? I believe its an emergency, but I am curious what the other side of that argument is.
To be frank, through policy, we can see that the federal government hates children through Medicaid cuts and states not expanding Medicaid and making it easy to get coverage for children. This is objective fact, based on the data. Otherwise, there would be zero uninsured US citizen children. The message is clear: don't have children in the US, or get out of the US if you intend to have children and can. If you are stuck in the US by having the misfortune to have been born on the wrong soil and without means to leave, my condolences for bad luck.
> “Especially in today’s climate, there are families where the child is a citizen and the parent is an immigrant, and they’re fearful of interacting with government,” Alker says. But such fears can only explain a small proportion of those who are uninsured, she notes.
So what's your goal here? My patience level is incredibly thin for people that are very clearly taking the article out of context to push some remarkably dumb agenta.
My point is, and remains, that you can't use figures like the one that headlines the article if it includes unrelated data like foreign nationals. The reasoning is because it ends with the exact situation we have now. What we know for sure is the US has a free health care system (ACA) for those who actually need it, I know because I've used it. What we don't know is how many children are uninsured, because the data they're relying on is worthless. Using fake data and then claiming "it's probably not off by much" doesn't contribute much to the overall discussion.
I'd also like to point out HN isn't really for political discussion, it's for technical discussion. This is a methodology issue in the article, not my personal opinions on US health care.
The US government should track how many Americans don't have health insurance, instead of caring so much about GDP or the stock market. It's a KPI that would clearly show how poorly the economy is actually functioning.
> US government should track how many Americans don't have health insurance
"Source: The U.S. Census Bureau American Community Survey (data)". FTFA. You don't even have to read it. It's the source for the first graph. The one blown up before you even have to scroll.
The OP is claiming the country should re-align its priorities to optimize this health-insured number, not claiming the gov does not already track this number.
> OP is claiming the country should re-align its priorities to optimize this health-insured number, not claiming the gov does not already track this number
They absolutely claimed the latter.
But even to the first, they didn't make any policy claims! They said it "would clearly show how poorly the economy is actually functioning." That's not true! You can have a fabulous economy (with a well-performing "GDP or...stock market") with terrible healthcare KPIs, this is basically a petrostate.
Healthcare is measured. And it's discussed. One can debate how the total-insured figure should play into policy. That wasn't that comment.
Everyone is born and at some point will die. The costs associated with this vary hugely but the certainty of those two end points are inescapable. Almost every other developed country in the world recognises that and shares both the risks and the costs recognising that health is a golden crown worn by (and invisible to) those who have it. As someone with a spinal injury who would be most likely bankrupt and unemployed in the US I just don't understand why you don't get a proper, profit-free healthcare system. You spend the most on it in the world and don't get the greatest outcomes!
> don't understand why you don't get a proper, profit-free healthcare system. You spend the most on it in the world and don't get the greatest outcomes
American healthcare for the top 10 to 15% (about $150k+) is the best in the world. By a long shot. (The bottom ninety-something percent of the world's top 1% get their care here for a reason.)
Another 40% are covered by Medicare or Medicaid [1] which, while nothing to brag about, exceeds the median OECD healthcare experience.
That leaves half of the population with crappy employer-provided healthcare, the VA, scams or no insurance at all. For most of them, until they have an accident, this coverage is fine.
In summary, you have a system that works terrifically for the rich, well for the poor and old, and well enough for the rest that reform is challenging.
"In summary, you have a system that works ... well for the poor".
You don't actually know any poor people, do you? Their lives are not governed by your theoretical models.
And as the GP said, our healthcare - not the best of the best of our healthcare, as you cherrypicked, but the kind ordinary people have - is appalling overpriced for its mediocre quality.
Recently, friends and family in other countries have asked about health care in the US and I've been very surprised by what they imagine is going on here.
Let's compare notes? If I go to a hospital (emergency) for any reason, I will be seen within an hour at worst. If I'm bleeding or something I'll be seen immediately. A clinic for surgery might be same day or up to a couple of weeks, depends on severity. More specialized surgery could be 5-6 weeks. American average monthly cost for health insurance is around $600 for a family. Individuals without a family are around $450 so they kind of get screwed. The expenditures for health care, including the $600/mo are tax deductible. This number can go as high as $1200 in places like New York where income is significantly higher as is cost of living.
Overall, averaging co-payment and deductible with accidents, you should expect to spend around $3,000 / yr on average per person in total for health care as part of a family in the US. This number varies greatly by age, and both income and health care in the US is socialized so your wages determine your healthcare liability. (Make more money? Get less social services.)
This should cover everyone, but you have issues where poor people don't file taxes, and don't file for health care. Those people will still be seen in an emergency room.
Conversely, my friends and family in other countries with "free" healthcare pay roughly the same total for their medical portion of tax liability as I pay for health care in total. But their wait times are astronomically greater when it comes to receiving care.
I've often helped financially because their wait time for something like shoulder surgery might be 10 to 12 months or even longer, but the same doctor will see them in a week if it's paid privately. So I've worked out payment plans where I contribute $1k/mo for their "add-on" private care so that they can be seen in a reasonable amount of time. That's in addition to what they already paid in medical tax.
Maybe that helps to understand. From my perspective, in a lot of countries you are told that you have free healthcare, but in fact you're paying for it in taxes, and then someone in the US will still have to pay for it when you actually need it anyway. Double payment. Hope you've got friends. (Maybe that's not true for everyone, I'm just going by what I've seen and paid for myself for my own family.)
I personally think that Europe and other countries don't have better health care, it's much worse. I've lived in several countries for 1-2 months to years in each and I've never seen health care remotely on the level that I see in the US. I would venture to guess it's the best in the world.
If it's hard to understand how people live in a modern high tech country without healthcare, it's because they don't. It's just about which rich person is paying for it. Health care is very expensive, and that's true around the world. And around the world, if you don't file/register for health care, your outcomes are generally much worse. The US is no different in that regard.
I believe you need to compare notes on a societal level, of course that richer Americans will have great healthcare. The quality of care is not the problem, it's the accessibility of it.
Waitlists do mean this is not as comparable as you make it out to be. With a 1-year waitlist for heart surgery ... you effectively do not have heart surgery cover, because you'll be dead before it happens.
Now of course, mostly people just lose a few years of life and have a number of very painful months due to delays, that it is the direct cause of death is fortunately rare.
Oh and before you say it, most of the difference in life expectancy is due to the the difference in overweight people, not medical care.
But of course people have voted everyone has care and can claim everything's great and they've done everything needed. That it doesn't translate into reality ... "is not their fault". Meanwhile you read there is such a doctor shortage in for example Southern Italy that seeing a doctor in under and hour is outright impossible ... because there isn't a doctor less than an hour's drive away from some villages, even without waitlists. And the doctor shortage is getting worse, not better.
I don't disagree with anything you said, but the simple answer to your question is that most American households are happy with their current health insurance and don't want it to change, so we keep patching the current (severely flawed) system as "needed" rather than starting over with a new one or making what would be seen as radical changes.
That poll doesn't say they're happy with their health insurance, it says they're at least somewhat satisfied with the coverage. You'd see very different results if you asked about health insurance prices.
I believe most people would incorporate the value received into their satisfaction rating.
Most people also don't have any idea how much their insurance costs in total or how it compares to alternatives, so that would be a challenging question to write with any reasonable expectation of getting a coherent response.
> The problem is the cost.
You could say this about almost anything that isn't free, and could still say it about a number of things even if they were free.
Feel free to look at the many, many, many alternative polls over the years. This is well known to anyone who has done any research into the topic at all.
Take the poll in 2026 after ACA subsides evaporate and Medicaid cuts. Highest satisfaction is for government run insurance (Medicare, Medicaid, Tricare).
https://www.nbcnews.com/politics/politics-news/poll-are-sati... ("Overall, 82% of Americans said they’re satisfied with their health care coverage, including a third who said they are very satisfied with their current coverage. The group that reported being the most satisfied were older adults, with 9 in 10 Americans over 65 years old saying they were satisfied. And 42% in that age group reported being “very satisfied.”. Roughly 9 in 10 of those who have public health insurance coverage through Medicare or Medicaid also reported being satisfied with coverage, compared to 77% of those with private health care coverage.")
https://www.citizen.org/article/public-support-for-medicare-... ("Support for Medicare-for-All continues to rise, whether in Congress, state legislatures, or among the American people. Recent polls indicate that six in ten Americans support Medicare-for-All. In addition, more than 60 percent believe that government is responsible for ensuring health coverage for all Americans. And nearly 70 percent of all voters, including battleground voters, identify health care as an important issue in upcoming elections.")
Yes, it's noted in the poll I linked (which is the same one as your first link) that the highest satisfaction is with government run insurance.
Not enough people are on ACA with subsidies to move the poll results that much, and Medicaid cuts aren't going to make people less satisfied with their private insurance.
I have no idea why you and so many other people seem to be taking my explanation as to why the US doesn't adopt universal socialized medicine as some sort of endorsement of the status quo.
The Child Health Insurance Program (CHIP) has covered health insurance for children in middle-income families since 1997: https://ccf.georgetown.edu/2017/08/03/what-every-policy-make.... CHIP eligibility ranges from 175% of the federal poverty line in Wyoming to 405%. So how are their children who don't have coverage?
IDRTA but they probably are in family situations where the parents are borderline or actually incompetent. They just don't sign up, or aren't aware that it's available, when they need care they go to the ER and don't pay anyway so why do more than that?
This is the reality (and the system actually handles this "relatively" well, all things considered).
There's a reason that if you dip your toe into ANY of the various support things, they ALL immediately apply for you.
(Kids in general and for the large part are pretty healthy, the numbers of "major health issues" that aren't broken bones/scrapes/flu are pretty small overall. So if you're poor/don't care, you just roll the dice. 999/1000 it's going to come out ahead for you.)
I know a real case where a child was in the intensive care unit and had their health insurance dropped because their parent missed a few days to be with them. The health insurance situation in the US is terrifying and heartbreaking.
Terrible. COBRA would have been best option in this situation, I think. By law, (for a steep COBRA fee) no one is supposed to lose their insurance on such short notice.
COBRA lets you pay the full premium to continue. If your company has been covering 80% or more, the premiums alone will be insane. Also this comes at a time when you just lost your job...
I realize COBRA is the full premium. My claim is that, if company coverage is lost in the middle of an expensive treatment, COBRA is more affordable than the out-of-pocket cost.
COBRA is older than ACA. Special enrollment in ACA under the job loss enrollment period exemption may be a better option than COBRA.
Your claim is that if they are independently wealthy, OR are willing to forego food and housing, COBRA will save them from unexpected healthcare costs.
I did not claim it would save from unexpected costs. The full premium is an unexpected cost. I claimed COBRA is more affordable than out-of-pocket healthcare if you are in the middle of an expensive treatment at the moment you lose employer coverage.
Jumping onto ACA via unemployment exemption or Medicaid could require a transfer to a different doctor, etc. in the middle of treatment.
Someone exhausted the concern for children on other topics like identifying people on the web (so children don't watch porn), scanning the content of people's devices and communications (so children are safe from predators), etc.
They reached the bottom of the barrel just when it came to making sure children can get treatment when sick.
If only there was a party on the ballot that supported universal healthcare. (I know there are third-parties that do, but they are pretty effectively excluded from the process.)
> If only there was a party on the ballot that supported universal healthcare
There are plenty of advocacy groups for universal healthcare. You could join them. You could also support electeds pressing for this, and call your elected to make it known it's a priority.
Civic engagement doesn't start and end at the ballot box.
We cannot afford both, the elderly are too expensive current state. 1/4th of Medicare spending is someone's last year of life. So, life expectancy has ballooned spending on the elderly while not paying for child healthcare.
Medicare’s Real Fiscal Crisis Is Much Worse than Trust Fund Insolvency - https://www.cato.org/blog/medicares-real-fiscal-crisis-much-... - October 8th, 2025 ("Medicare isn’t just facing a trust fund shortfall—it’s threatening America’s entire fiscal future. While headlines warn that the Hospital Insurance (HI) Trust Fund2 will run out in 2033, the real danger comes from a different part of the program: Supplementary Medical Insurance (SMI). SMI refers to Medicare spending by Part B (doctors’ visits and outpatient services) and Part D (prescription drugs). Unlike the HI fund, SMI is set up to take whatever it needs from taxpayers—no limits, no debate. In 2024 alone, Medicare Parts B and D financed under SMI added $498 billion straight onto the national credit card. Unless Congress makes fundamental reforms to Medicare, federal healthcare spending will drive the US toward a catastrophic fiscal crisis.")
Medicare Spending at the End of Life: A Snapshot of Beneficiaries Who Died in 2014 and the Cost of Their Care - https://www.kff.org/medicare/medicare-spending-at-the-end-of... - July 14th, 2016 ("Of the 2.6 million people who died in the U.S. in 2014, 2.1 million, or eight out of 10, were people on Medicare, making Medicare the largest insurer of medical care provided at the end of life. Spending on Medicare beneficiaries in their last year of life accounts for about 25% of total Medicare spending on beneficiaries age 65 or older. The fact that a disproportionate share of Medicare spending goes to beneficiaries at the end of life is not surprising given that many have serious illnesses or multiple chronic conditions and often use costly services, including inpatient hospitalizations, post-acute care, and hospice, in the year leading up to their death.")
Because you are not providing facts, just feelings. I am here to argue facts, not feelings. The citations in my comment you replied to literally describe why this spending is unsustainable and we cannot afford it and your response is "nah". Can't debate ignoring facts.
Medicare should cover prenatal, neonatal and pediatric care for all American children. Frame it as a pro-birther initiative.
And sure, give parents a total opt out when it comes to vaccination. Just because they're dumbfucks doesn't mean their kid need run a fever into brain-cooking temperatures out of fear of an ER bill.
It's a working national health programme. Expanding it makes more sense than starting anew. My proposal is to expand its mandate to covering pregnant mothers and children directly.
Some of the gap may be illegal/undocumented children.
Some of it is families in the gap where they can't get employment that pays fully for family healthcare, but make too much to qualify for CHIP/Medicaid.
Some will have been disqualified for other reasons, perhaps.
> Some of the gap may be illegal/undocumented children
Do we know what fraction? If most American children have access to healthcare–a claim I'm sceptical of–then I'm not seeing an urgent problem that has to be solved by the healthcare system.
To be precise "have no health insurance" and "have access to healthcare" are not two sides of the same coin.
Everyone in the USA has access to emergency care and stabilization, the practical results of which are that for emergencies, you get helped, payment is worked out later.
If you have no problem with having no intention of paying, the system absorbs the cost.
If a child isn't covered by medicaid for income reasons, then CHIP is a program that kicks in to cover kids at higher income levels. These are all federally backed state run programs though so it's going to be hard to figure out exact details and surely someone is slipping through some cracks. Some states combine the programs, some have both. They can vary on the income levels. There is also some level of transition as the paperwork can be cumbersome, unclear and confusing, so kids may be kicked out of the programs while these processes play out, usually with retroactive statuses of eligibility.
Well, people who aren't citizens still use the healthcare system, regardless if they have insurance or not. All those undocumented kids aren't just not getting sick -- they'll end up using the ER as primary care, clogging up the system, just like everyone else that doesn't have insurance.
> Given there are something like 20 million people in the US illegally
You should probably check your sources on that one. That number is highly suspect and came from someone who was trying to sell you on upping budgets for ICE.
> seems counter productive to count people who aren't citizens in a article primarily about US health statistics.
You’ll probably get downvoted here for mentioning this. But I am with you.
I think we need to get out of this bad mix of insurance and health care being a crisis. But for that to happen, state benefits need to be locked down iron-clad to only us citizens. Not to your general tax payer base but only to US citizens and that includes ACA subsidies. States subsidies should be included in “government assistance” that makes beneficiaries ineligible for citizenship and permanent residency.
That is a problem that shouldn’t need a big discussion to solve in Congress. But given the current political scenarios it won’t.
It's not hard to math that up and see how insane doing the health insurance would be. Yes there's the catastrophic risk of a bad accident or ER visit or something, and that's worth some cost, but even saving half the premiums in a money market account not only provides a good cushion for that, but if we don't use the money we actually get to keep it!
Until they require a $50k life flight or $100k brain, heart, etc surgery.
The problem is that insurance was intended to cover the large, infrequent costs - house fires, totaled cars, etc. The deductibles are intended to influence people to pay out of pocket for the smaller expenses.
The problem with health insurance is that the deductibles, premiums, and cost of care are out of control. The laws mandate significant amounts of coverage for a plan. The costs can be as high as a house fire, but happen much more frequently within the population. You can't get a plan that just covers expenses over $10k-20k per year. You can get kind of close with the super high deductibles but it still has to cover some things before the limit. Even if you could get to that, you're still looking at high costs when you consider the odds of something like 1 out of 100 people might need a $100k procedure in a year (made up numbers).
> happen much more frequently within the population
I assume the high premium reflects this frequency -- a higher frequency than many people realize. I do not assume the insurance companies are price gouging, but rather pricing their plans to break even/slightly profit.
Compare health insurer profit margin to FAANG.
https://www.lifeflight.org/membership/#pricing
Health catastrophes are more likely than you may think, so I would suggest a HDHP+HSA at the very least. It's very difficult to self insure against a cancer diagnosis that may blow a million dollars in a year.
I'm a fairly high net worth individual with a high deductible plan. Setting aside the deductible amount in savings (often, tax free with the HSA) and keeping it every year you have good health is OP.
I'm in Wyoming, and our threshold is under 200% the poverty line. That's $53,300 for a family of 3 [1]. Median household income–nationally–is $84k [2]. In Wyoming, it's $75k [3].
That's a gap. But it's a workable one.
[1] https://health.wyo.gov/healthcarefin/chip/doesmychildqualify...
[2] https://fred.stlouisfed.org/series/MEHOINUSA672N
[3] https://usafacts.org/answers/what-is-the-income-of-a-us-hous...
I think there's public-health benefits to subsidizing preventative/routine care, since
1. People are dumb and will decline to pay the $100-$300 it takes to decide whether something needs treating even if they can afford it
2. It's just kind of inhumane to make people struggling on the edge actually do the math on whether they should pay sticker price to get e.g. an ingrown nail treated or just wait and hope it doesn't get infected, costing them vastly more or losing them a toe, and that's even if the probabilistic and cost information was readily available.
3. Even if we assume a perfectly informed and rational populace, rational individual decisions aren't the same as rational societal decisions. For example, a lot of people actually probably shouldn't pay $1000 for a given vaccine, since their risk of infection is pretty low as long as enough other people are vaccinated and pretty high if enough other are not, whether or not they're vaccinated. However, across a society, paying ~$1,000 per head to get everyone vaccinated might be worth it to get to the break point where we go from 250 million lost workdays and 1 million deaths to 1 million lost workdays and 1 thousand deaths. And then if you're making 300 million vaccines instead of 500 thousand, you can probably get the price down to at least $500, maybe less.
Maybe these things shouldn't be a function of health insurance. Maybe we should just directly subsidize the specific care we want to be widely available. But a lot of other countries seem to have decided it makes sense to gather public health expenditure and cost-sharing into one umbrella also called "insurance," so I'm not convinced it would make that little sense for us.
A catastrophic health care plan has low premiums and high deductibles. You also get access to a tax advantaged savings account to save up for future events. So you can take the money you saved on premiums and pay for medical expenses tax free. Or let the money accumulate to cover future medical expenses or even retirement!
Except they don't really exist anymore. You can get really high deductibles, but the premiums are still ridiculous. The plans have to cover many non-catastrophic events now by law.
The other problem is that the cost and frequency of things like auto accidents or home damage is generally much lower than for health events, and generally include much lower caps on how much they will payout.
Self-insurance is the final catastrophic plan and the numbers keep looking better every day.
Catastrophic plans are still quite costly because they aren't really a pure insurance product. Mine is over 2k/month for 3 people on an ACA Bronze plan with HSA.
Like what?
This is the real problem with health insurance is that it covers relatively routine and non emergency healthcare services where you can ship around and have market forces encourage people to find efficiency.
I understand the "if I'm dying from a car crash I can't shop around" argument and I agree. But that's very different than shopping for a family doc you like for the half dozen times a year you or your family will need to see someone for a strep test and maybe antibiotics.
We do pay for our healthcare. We don't pay for health insurance. I get the general point you're making and I'm not trying to be pedantic, but I do think it's important to distinguish between the two in order to have a productive exchange.
I don't think you're doing anything wrong, but I do think we need a system everyone is a part of paying for, via health insurance mandate, single payer, etc.
Or we let people opt out completely, to where a family like yours just wouldn't receive care if you can't pay for it, but I don't think this is the world we want to live in.
It's from the system existing and being ready to help you.
We're not talking about widgets, onions, haircuts, or pork bellies here. You can't opt out of the system existing. And you can't opt out of the horrific consequences if the system doesn't exist.
So it's a bit silly to talk about health care like it's something that has a free market.
It’s in their interests to have the provider costs be as high as possible as it directly limits their own profits.
To put it another way, when the private equity that bought your local doctor’s office raises their prices, your insurance company wins.
The issue highlighted in this article seems to largely be due to illegal immigration, not due to a lack of support. If we curbed illegal immigration the problem would likely fix itself, although this article isn't very clear on who is or isn't a citizen in their numbers which makes it hard to use for anything useful
https://usafacts.org/just-the-facts/do-you-qualify/health/
https://usafacts.org/articles/how-will-the-obbb-impact-medic...
https://www.congress.gov/crs-product/IF11912
https://www.kff.org/racial-equity-and-health-policy/5-key-fa...
https://www.americanimmigrationcouncil.org/blog/undocumented...
> Do undocumented immigrants qualify for federal healthcare benefits?
No. Undocumented immigrants do not have access to federally funded healthcare coverage, including Medicaid, Medicare, or the Children’s Health Insurance Program (CHIP). They are also unable to purchase health insurance coverage from the Affordable Care Act (ACA) Marketplace.
Someone will pay the bills.
As the very piece we're discussing mentions, the care in question for children is not emergency care. I assert America is evil, because these are active healthcare policy choices. We could fix this today with enough Congressional votes, it is a choice not to.
My issue with this article is it suggests there's some massive child uninsured problem in the US, but to get that number they're including foreign citizens. If we included all of south america I'm sure we could find tens of millions of uninsured people. If we included the rest of the world it might be closer to hundreds of millions. That doesn't mean there's a problem with the ACA. There could be a problem with it, but this 4 million number doesn't get us closer to an answer.
To be frank, through policy, we can see that the federal government hates children through Medicaid cuts and states not expanding Medicaid and making it easy to get coverage for children. This is objective fact, based on the data. Otherwise, there would be zero uninsured US citizen children. The message is clear: don't have children in the US, or get out of the US if you intend to have children and can. If you are stuck in the US by having the misfortune to have been born on the wrong soil and without means to leave, my condolences for bad luck.
> “Especially in today’s climate, there are families where the child is a citizen and the parent is an immigrant, and they’re fearful of interacting with government,” Alker says. But such fears can only explain a small proportion of those who are uninsured, she notes.
So what's your goal here? My patience level is incredibly thin for people that are very clearly taking the article out of context to push some remarkably dumb agenta.
I'd also like to point out HN isn't really for political discussion, it's for technical discussion. This is a methodology issue in the article, not my personal opinions on US health care.
"Source: The U.S. Census Bureau American Community Survey (data)". FTFA. You don't even have to read it. It's the source for the first graph. The one blown up before you even have to scroll.
They absolutely claimed the latter.
But even to the first, they didn't make any policy claims! They said it "would clearly show how poorly the economy is actually functioning." That's not true! You can have a fabulous economy (with a well-performing "GDP or...stock market") with terrible healthcare KPIs, this is basically a petrostate.
Healthcare is measured. And it's discussed. One can debate how the total-insured figure should play into policy. That wasn't that comment.
The first erroneously said the US doesn't track it, but the next two of you didn't read the rest of their post.
It's clear to me that they were just looking for a launching point to complain about capitalism and didn't really care where that came from.
American healthcare for the top 10 to 15% (about $150k+) is the best in the world. By a long shot. (The bottom ninety-something percent of the world's top 1% get their care here for a reason.)
Another 40% are covered by Medicare or Medicaid [1] which, while nothing to brag about, exceeds the median OECD healthcare experience.
That leaves half of the population with crappy employer-provided healthcare, the VA, scams or no insurance at all. For most of them, until they have an accident, this coverage is fine.
In summary, you have a system that works terrifically for the rich, well for the poor and old, and well enough for the rest that reform is challenging.
[1] https://www.census.gov/library/publications/2024/demo/p60-28...
You don't actually know any poor people, do you? Their lives are not governed by your theoretical models.
And as the GP said, our healthcare - not the best of the best of our healthcare, as you cherrypicked, but the kind ordinary people have - is appalling overpriced for its mediocre quality.
Let's compare notes? If I go to a hospital (emergency) for any reason, I will be seen within an hour at worst. If I'm bleeding or something I'll be seen immediately. A clinic for surgery might be same day or up to a couple of weeks, depends on severity. More specialized surgery could be 5-6 weeks. American average monthly cost for health insurance is around $600 for a family. Individuals without a family are around $450 so they kind of get screwed. The expenditures for health care, including the $600/mo are tax deductible. This number can go as high as $1200 in places like New York where income is significantly higher as is cost of living.
Overall, averaging co-payment and deductible with accidents, you should expect to spend around $3,000 / yr on average per person in total for health care as part of a family in the US. This number varies greatly by age, and both income and health care in the US is socialized so your wages determine your healthcare liability. (Make more money? Get less social services.)
This should cover everyone, but you have issues where poor people don't file taxes, and don't file for health care. Those people will still be seen in an emergency room.
Conversely, my friends and family in other countries with "free" healthcare pay roughly the same total for their medical portion of tax liability as I pay for health care in total. But their wait times are astronomically greater when it comes to receiving care.
I've often helped financially because their wait time for something like shoulder surgery might be 10 to 12 months or even longer, but the same doctor will see them in a week if it's paid privately. So I've worked out payment plans where I contribute $1k/mo for their "add-on" private care so that they can be seen in a reasonable amount of time. That's in addition to what they already paid in medical tax.
Maybe that helps to understand. From my perspective, in a lot of countries you are told that you have free healthcare, but in fact you're paying for it in taxes, and then someone in the US will still have to pay for it when you actually need it anyway. Double payment. Hope you've got friends. (Maybe that's not true for everyone, I'm just going by what I've seen and paid for myself for my own family.)
I personally think that Europe and other countries don't have better health care, it's much worse. I've lived in several countries for 1-2 months to years in each and I've never seen health care remotely on the level that I see in the US. I would venture to guess it's the best in the world.
If it's hard to understand how people live in a modern high tech country without healthcare, it's because they don't. It's just about which rich person is paying for it. Health care is very expensive, and that's true around the world. And around the world, if you don't file/register for health care, your outcomes are generally much worse. The US is no different in that regard.
Now of course, mostly people just lose a few years of life and have a number of very painful months due to delays, that it is the direct cause of death is fortunately rare.
Oh and before you say it, most of the difference in life expectancy is due to the the difference in overweight people, not medical care.
But of course people have voted everyone has care and can claim everything's great and they've done everything needed. That it doesn't translate into reality ... "is not their fault". Meanwhile you read there is such a doctor shortage in for example Southern Italy that seeing a doctor in under and hour is outright impossible ... because there isn't a doctor less than an hour's drive away from some villages, even without waitlists. And the doctor shortage is getting worse, not better.
--- Edit ---
For the kneejerk downvoters who seem very confused, this was released yesterday: https://thehill.com/policy/healthcare/5650010-survey-aca-cov...
This has been an issue for decades now, with countless polls to back it up.
The problem is the cost.
Most people also don't have any idea how much their insurance costs in total or how it compares to alternatives, so that would be a challenging question to write with any reasonable expectation of getting a coherent response.
> The problem is the cost.
You could say this about almost anything that isn't free, and could still say it about a number of things even if they were free.
https://thehill.com/policy/healthcare/5650010-survey-aca-cov...
Feel free to look at the many, many, many alternative polls over the years. This is well known to anyone who has done any research into the topic at all.
https://www.nbcnews.com/politics/politics-news/poll-are-sati... ("Overall, 82% of Americans said they’re satisfied with their health care coverage, including a third who said they are very satisfied with their current coverage. The group that reported being the most satisfied were older adults, with 9 in 10 Americans over 65 years old saying they were satisfied. And 42% in that age group reported being “very satisfied.”. Roughly 9 in 10 of those who have public health insurance coverage through Medicare or Medicaid also reported being satisfied with coverage, compared to 77% of those with private health care coverage.")
https://www.kff.org/medicare/overall-satisfaction-with-medic...
https://www.citizen.org/article/public-support-for-medicare-... ("Support for Medicare-for-All continues to rise, whether in Congress, state legislatures, or among the American people. Recent polls indicate that six in ten Americans support Medicare-for-All. In addition, more than 60 percent believe that government is responsible for ensuring health coverage for all Americans. And nearly 70 percent of all voters, including battleground voters, identify health care as an important issue in upcoming elections.")
My comment with citations from six years ago showing the trend holds: https://news.ycombinator.com/item?id=22550774 (March 11th, 2020)
Americans With Government Health Plans Most Satisfied - https://news.gallup.com/poll/186527/americans-government-hea... - November 6th, 2015
Not enough people are on ACA with subsidies to move the poll results that much, and Medicaid cuts aren't going to make people less satisfied with their private insurance.
I have no idea why you and so many other people seem to be taking my explanation as to why the US doesn't adopt universal socialized medicine as some sort of endorsement of the status quo.
There's a reason that if you dip your toe into ANY of the various support things, they ALL immediately apply for you.
(Kids in general and for the large part are pretty healthy, the numbers of "major health issues" that aren't broken bones/scrapes/flu are pretty small overall. So if you're poor/don't care, you just roll the dice. 999/1000 it's going to come out ahead for you.)
My deductible is $8300, but at least it's 100% coverage once I hit that.
It's just not a real pressing problem for most people, because either they're covered by CHIP or similar, or covered by work, or just don't care.
https://news.ycombinator.com/item?id=46287251
In my country healthcare for under 18 is free. Just putting it out there.
COBRA is older than ACA. Special enrollment in ACA under the job loss enrollment period exemption may be a better option than COBRA.
Jumping onto ACA via unemployment exemption or Medicaid could require a transfer to a different doctor, etc. in the middle of treatment.
They reached the bottom of the barrel just when it came to making sure children can get treatment when sick.
There are plenty of advocacy groups for universal healthcare. You could join them. You could also support electeds pressing for this, and call your elected to make it known it's a priority.
Civic engagement doesn't start and end at the ballot box.
Medicare’s Real Fiscal Crisis Is Much Worse than Trust Fund Insolvency - https://www.cato.org/blog/medicares-real-fiscal-crisis-much-... - October 8th, 2025 ("Medicare isn’t just facing a trust fund shortfall—it’s threatening America’s entire fiscal future. While headlines warn that the Hospital Insurance (HI) Trust Fund2 will run out in 2033, the real danger comes from a different part of the program: Supplementary Medical Insurance (SMI). SMI refers to Medicare spending by Part B (doctors’ visits and outpatient services) and Part D (prescription drugs). Unlike the HI fund, SMI is set up to take whatever it needs from taxpayers—no limits, no debate. In 2024 alone, Medicare Parts B and D financed under SMI added $498 billion straight onto the national credit card. Unless Congress makes fundamental reforms to Medicare, federal healthcare spending will drive the US toward a catastrophic fiscal crisis.")
Medicare Spending at the End of Life: A Snapshot of Beneficiaries Who Died in 2014 and the Cost of Their Care - https://www.kff.org/medicare/medicare-spending-at-the-end-of... - July 14th, 2016 ("Of the 2.6 million people who died in the U.S. in 2014, 2.1 million, or eight out of 10, were people on Medicare, making Medicare the largest insurer of medical care provided at the end of life. Spending on Medicare beneficiaries in their last year of life accounts for about 25% of total Medicare spending on beneficiaries age 65 or older. The fact that a disproportionate share of Medicare spending goes to beneficiaries at the end of life is not surprising given that many have serious illnesses or multiple chronic conditions and often use costly services, including inpatient hospitalizations, post-acute care, and hospice, in the year leading up to their death.")
Is there a reason you are so argumentative about basic, seemingly indisputable facts related to this topic?
This is the key - to cover the insane costs for elderly, insurance companies have had to raise costs on the healthy, which includes children.
31% of Wealth Owned by People Over 70 - https://www.apolloacademy.com/31-percent-of-wealth-owned-by-... - December 7th, 2025
And sure, give parents a total opt out when it comes to vaccination. Just because they're dumbfucks doesn't mean their kid need run a fever into brain-cooking temperatures out of fear of an ER bill.
It's a working national health programme. Expanding it makes more sense than starting anew. My proposal is to expand its mandate to covering pregnant mothers and children directly.
The article says "many uninsured children are eligible for Medicaid," but it doesn't say all. Do you know what constitutes the gap?
My issue with expanding Medicaid is it's run by the states. That limits the opportunities for cost and messaging savings.
Some of it is families in the gap where they can't get employment that pays fully for family healthcare, but make too much to qualify for CHIP/Medicaid.
Some will have been disqualified for other reasons, perhaps.
Do we know what fraction? If most American children have access to healthcare–a claim I'm sceptical of–then I'm not seeing an urgent problem that has to be solved by the healthcare system.
Everyone in the USA has access to emergency care and stabilization, the practical results of which are that for emergencies, you get helped, payment is worked out later.
If you have no problem with having no intention of paying, the system absorbs the cost.
No they don't, they just don't address it. Neither does your comment.
You should probably check your sources on that one. That number is highly suspect and came from someone who was trying to sell you on upping budgets for ICE.
> seems counter productive to count people who aren't citizens in a article primarily about US health statistics.
Non-citizens are still people.
I think we need to get out of this bad mix of insurance and health care being a crisis. But for that to happen, state benefits need to be locked down iron-clad to only us citizens. Not to your general tax payer base but only to US citizens and that includes ACA subsidies. States subsidies should be included in “government assistance” that makes beneficiaries ineligible for citizenship and permanent residency.
That is a problem that shouldn’t need a big discussion to solve in Congress. But given the current political scenarios it won’t.