Into the Night
Contributor
Nah. He's just scared. He has never experienced any other way. He doesn't know what it was like.
Repeal or replace?
- Thread starter Diogenes
- Start date
Life is Golden
The Sage
No, the mandate to buy coverage is gone.
I have group insurance, so it doesn’t affect me. The bigger issue is people misunderstand what health insurance is for. It’s not supposed to cover every office visit for a few dollars. It exists to keep you from going bankrupt if you end up with a hospital bill in the six- or seven-figure range.
I have a high-deductible PPO. I pay the negotiated rate for routine care, and the most I can owe in a year is $3,000.
That said, some small business owners have to buy their own insurance, and high premiums limit what they can afford. In that case, subsidies can make a real difference. The situation isn’t black and white, and there are no simplistic solutions.
Life is Golden
The Sage
I know exactly how it used to be. I know a great deal about it, actually.
I don't agree that a hospital stay would cost $300k if insurance was eliminated.
I respect your opinion. Is it based on logic? I posted stats and pretiniet points, and it seems like you're ignoring them, except to say one of the stats was "false", and you never proved that it was false, AFAIK.
Before widespread health insurance in the mid-20th century, people managed medical costs through a mix of personal savings, community support, and lower overall expenses.
Here's how it worked in practice, focusing on the U.S., with context from the 19th and early 20th centuries:
- Low costs: A doctor's house call in 1900 cost ~$1–$2 (about $35–$70 today, adjusted for inflation). Hospital stays were rare and short; a basic room might run $3–$5/day. Surgery, if needed, was straightforward—no MRIs, chemo, or organ transplants. Can't afford those? Well, neither can a lot of taxpayers. You do know that insurers routinely refuse to authorize many treatment options and deny claims for "heroic" remedies anyway, right?
- Limited interventions: Most care involved rest, basic meds, or minor procedures. Big Pharma wasn't colluding with PBM to jack up prices and profitability, so costs tended to be much lower.
- Cash payments: Gasp! Patients sometimes even paid doctors directly in cash or, perish the thought, barter (e.g., farmers trading chickens or workers trading labor), or, doctors gave extended credit. Doctors often adjusted fees based on ability to pay ("sliding scale").
- Families often budgeted for medical emergencies like any other expense. Middle-class households might set aside 1–2% of income for "doctor funds."
- Immigrant groups, unions, and fraternal organizations (e.g., Elks, Odd Fellows) ran "lodge practices." Members paid small dues (~$1–$2/year) for access to contracted doctors. By 1910, ~30% of industrial workers belonged to such groups.
- Religious or charitable hospitals (e.g., funded by churches or donors ) treated the poor for free or low cost. Donors funded them; doctors often donated their time pro bono.
- Some employers hired physicians for their workers.
- People were accustomed to accepted risk. Bankruptcy from medical bills was rare because bills were small and society expected self-reliance whenever possible and organizations extended charity when it wasn't.
"She". @Life is Golden is a woman. She may be frightened; I don't know, but it's illogical to pretend that she's never experienced life without a safety net.
Based on the latest data (primarily from 2021–2023, with projections to 2025 - per WHO's 2023 UHC Global Monitoring Report. This figure is based on the UHC Service Coverage Index (SCI), which measures access to 16 essential services. Global SCI stagnated at ~68/100 from 2015–2021, with low-income countries averaging ~46/100).
If the data is even close to accurate, approximately ~4 billion people don't have employer-paid or private health insurance or government funded medical services. This estimate includes those without any insurance-like mechanisms (public or private).
Life is Golden
The Sage
If by "safety net" you mean health insurance, that is correct. I have always maintained health insurance, either through an employer or myself. It is stupid not to as life can turn on a dime.
Anyone who does not have health insurance is one hospital visit away from financial devastation. Not to mention the poor care you have to settle for if you don't have it.
I wouldn't presume to criticize your choices.
That's often true even with health insurance, isn't it?
Really? Because I pay my healthcare providers directly, I can control which ones I find acceptable. Insurance plans would limit my options.
Pole who don't have the money to buy nice things generally can't be picky. That's life.
As detailed above, there are options.
Frankly,I'd be disgusted if a medical professional based their quality of care on someone's ability to pay. Hippocratic oath, professional ethics, and legal considerations, right?
Life is Golden
The Sage
No, it isn’t. The out-of-pocket maximum is the total amount you’re responsible for in a calendar year, a finite limit.
I’m not sure I understand. Are you saying you don’t have health insurance and pay for everything yourself? If you’re healthy, that’s fine, for now. But it can change in an instant if you get sick or injured and you can be responsible for a six or seven digit bill. I have homeowner's insurance, never filed a claim. But it's there in case of catastrophic damage. Same with health insurance.
Physicians have bills to pay too. They didn't pay hundreds of thousands in school loans to run a charity. Hippocratic oath does not mean "works for free." People are not entitled to the services of another person.
Life is Golden
The Sage
Please clarify, are you suggesting the alternative to Obamacare is for everyone to pay out of pocket with no insurance? That was actually Obama’s original idea: to put private insurers out of business and move toward a single-payer system. Keeping the current program intact is what prevents that outcome. You think what we have now is bad? Wait until that happens. Lots of people will die.
Yes, people with health insurance still go bankrupt due to medical debt.
Even with coverage, medical debt remains a leading cause of personal bankruptcy in the U.S.
Over 90% of Americans have health insurance, yet high deductibles, copays, coinsurance, claim denials, out-of-network charges, and uncovered treatments can pile up into crushing financial burdens, especially for chronic conditions or emergencies.
Recent data show that about 550,000 people file for bankruptcy each year because of medical bills or lost income from illness.
Roughly 62% of all bankruptcies involve medical debt, affecting around 500,000 families annually.
Notably, more insured people (21%) file for medical-related bankruptcy than uninsured people (14%).
About 9% of adults with employer-sponsored insurance have filed due to health costs.The problem has persisted after the Affordable Care Act (ACA).
A 2024 study using 2019 data found that 66.5% of bankruptcy debtors cited medical bills or illness, nearly the same as 62.1% in 2007, before the ACA.
There was no significant difference between states that expanded Medicaid and those that didn’t.
Total U.S. medical debt is estimated at $195–$200 billion.
About 23 million adults (9% of the population) owe more than $250, and one in four people with insurance struggle to pay medical bills.
One-third of working-age adults carry medical debt, and 15% of households report it.
In 2024, there were 517,308 total bankruptcies, up 14% from 2023, with medical bills consistently ranking as a top cause, alongside job loss. The median medical debt among filers is $2,326.
Why This Happens to Insured People:
Insurance doesn’t protect against potential financial collapse. Key reasons include:
- High cost-sharing: Average individual deductibles reached $1,735 in 2023; family plans often exceed $8,000. Serious illness can trigger thousands in out-of-pocket costs before full coverage begins.
- Claim denials and surprise billing: About 26% of insured people with bill problems face denied claims. Even with the 2022 No Surprises Act, unexpected out-of-network charges still occur.
- Chronic or catastrophic care: Ongoing treatments (like cancer or diabetes) add up through repeated copays and coinsurance.
- Underinsurance: Nearly one in four insured adults is underinsured—meaning they have coverage but still face unaffordable costs.
- Rising premiums and plan design: Employer plans, which cover 66% of Americans, increasingly shift costs to workers. Average individual premiums hit $7,739 in 2023.
Medical debt forces many to skip care—one in three delay treatment due to cost—leading to worse health and deeper poverty. It hits low- and middle-income families hardest, especially those owing over $10,000, with 14% considering bankruptcy. The 50–64 age group is most affected, just before Medicare kicks in.
Recent changes help slightly: since 2023, credit reports exclude medical debt under $500, aiding about 15 million people. But larger debts remain, and bankruptcy filings rose in 2024 amid lingering post-COVID financial strain.
Bottom line: Insurance doesn’t eliminate risk. Around 530,000 medical-related bankruptcies happen each year. Options like payment plans, charity care, or state assistance can help.
I have saved enough (by not paying premiums) to be able to handle an emergency. If not, I have family and other options (listed above) available, and I assume you do too.
Then there's this:
- Turn 65 → automatic enrollment in Part A (and usually Part B) the first day of your birthday month (or month before, if birthday is on the 1st).
- No premium for most (earned via 40+ quarters of payroll taxes).
- You can decline Part B (see below), but Part A stays unless you actively reject it.
- Comes with a $174.70/month premium (2025 standard) — deducted from your Social Security check.
- You can decline Part B by returning the Medicare card with a signed refusal form (CMS-1763).
- No penalty if you have creditable employer coverage (20+ employees).
It’s not a valid comparison because health insurance is not true “catastrophic-only” coverage—and the way people actually use and pay for it proves the analogy breaks down in practice. Here's why, point by point:
1. You Will Use Health Insurance — Often and Predictably
- Homeowners’ insurance: Most people never file a claim. It’s rare, one-time, and catastrophic (fire, flood, tornado).
- Health insurance: Most people use it every year — doctor visits, bloodwork, medications, screenings, childbirth, injuries, chronic conditions like diabetes or hypertension.
But you do get annual checkups, flu shots, or prescriptions — and pay deductibles, copays, and coinsurance for them.
2. Deductibles and Cost-Sharing Are Built for Routine Use
- Homeowners: Deductibles are high ($1,000–$5,000+) because claims are rare. You pay it once in a lifetime.
- Health insurance: Deductibles average $1,735 (individual) or $3,655 (family) in 2023 — and you hit them every single year if you have any medical need.
3. Catastrophic Events Are Rare in Homes, Common in Health
- A house burning down? 1 in 3,500 chance per year.
- A serious medical event (cancer, heart attack, stroke)? 1 in 8 lifetime risk for cancer alone. And many people live with ongoing conditions.
4. True Catastrophic Health Plans Exist — But Most People Don’t Have Them
There are high-deductible, catastrophic-only plans (allowed under the ACA for under-30s or hardship exemptions), but:
- They’re not what most Americans have.
- Even then, out-of-pocket maximums cap exposure (~$9,450 individual in 2025) — unlike homeowners, where you could lose everything.
5. Insurance Math Doesn’t Work the Same
- Homeowners: Low premiums because risk is spread over rare events.
- Health: High premiums + high cost-sharing because someone in your pool is getting chemo, dialysis, or neonatal care right now.
Health insurance is less like fire insurance and more like a gym membership with a $2,000 entry fee every January.
So no — saying “I have health insurance like homeowners’ for catastrophes” doesn’t hold up.
It’s there for the routine, the chronic, and the catastrophic — and you will pay through the nose for all of it, even with coverage.That’s why insured people still go bankrupt.
It’s not a safety net. It’s a tightrope with a deductible.
Filing a homeowners’ insurance claim frequently leads to higher premiums, and in some cases, policy cancellation or non-renewal. It’s one of the biggest practical differences from health insurance — and another reason the “catastrophic coverage” analogy doesn’t hold.
And commercial lenders insist on homeowners' cover. If you let it lapse, they'll force-place as policy of their own choosing it and charge you for it on the back end.
They could've gotten that education paid for. Not my fault they opted not to. Medical professionals can defray education costs through scholarships, loan forgiveness, and military service programs. These pathways exist and help thousands of doctors, nurses, and other providers each year.
For example,
1. Military Service: The Health Professions Scholarship Program (HPSP)
- Branches: Army, Navy, Air Force
- What it covers:
- 100% tuition
- Books, fees, equipment
- $2,400+/month stipend
- Service commitment: 1 year active duty per year of scholarship (minimum 3–4 years)
- After residency: Serve as a military physician (e.g., at bases, VA, or deployed)
- Pay during service: ~$110K–$150K/year (O-3/O-4 rank) + benefits
2. National Health Service Corps (NHSC) & Loan Repayment
- For: MDs, DOs, NPs, PAs, dentists, mental health pros
- Award: Up to $50,000–$100,000+ in loan repayment
- Commitment: 2–4+ years in Health Professional Shortage Areas (HPSAs) — rural clinics, inner cities, prisons
- Tax-free repayment
3. Public Service Loan Forgiveness (PSLF)
- For: Any doctor working full-time for 501(c)(3) nonprofit (e.g., community hospitals, FQHCs, universities)
- After 10 years (120 payments): Remaining federal loans forgiven, tax-free
- Income-driven repayment (IDR) caps payments at 10% of discretionary income
4. State & Institutional Programs
- Examples:
- New York: Doctors in rural areas → $120K forgiveness over 4 years
- California: $300K for OB/GYNs in underserved zones
- Medical schools: Merit scholarships (e.g., NYU free tuition 2018–present)
- Military reserves: $50K bonus + loan repayment for part-time service
Nobody said it does. It does require a quality of care regardless of a patient's economic status.
Jake Starkey
Verified User
Fix ACA up is the answer.
Life is Golden
The Sage
People with health insurance cannot go bankrupt from medical bills. You have a deductible and an out-of-pocket maximum; once that max is reached, insurance covers 100% of covered costs. Of course, coverage rules apply, like staying in-network with an HMO.
From your AI-generated response, it’s clear you don’t understand the basics of how health insurance works. You can’t have a real discussion if you’re just copying and pasting from ChatGPT.
You started this thread but haven’t answered the actual question. Try giving your own answer. There’s no simplistic fix. “Save money and pay out of pocket” is absurd. Repealing Obamacare wouldn’t lower prices, it would trigger a government takeover, which is far worse. Suggesting otherwise shows a lack of grasp on the realities of today’s health care system.
From your AI-generated response, it’s clear you don’t understand the basics of how health insurance works. You can’t have a real discussion if you’re just copying and pasting from ChatGPT.
You started this thread but haven’t answered the actual question. Try giving your own answer. There’s no simplistic fix. “Save money and pay out of pocket” is absurd. Repealing Obamacare wouldn’t lower prices, it would trigger a government takeover, which is far worse. Suggesting otherwise shows a lack of grasp on the realities of today’s health care system.
Jake Starkey
Verified User
I have no idea. I am not in the field. More than 22 million people have insurance now than before ACA.
No one in Europe bankrupts because of medical bills.
There must be a way.,
No one in Europe bankrupts because of medical bills.
There must be a way.,
Yes, people with health insurance in the US can and do go bankrupt due to medical bills, even if they believe their coverage is comprehensive.
Here's why it's possible, with evidence:1. Deductibles, Copays, and Out-of-Pocket Maximums Are Often Massive
- Many plans have high deductibles ($5,000–$10,000+ per year) that must be paid before insurance kicks in.
- Even after the deductible, patients pay 20–40% coinsurance until hitting the out-of-pocket max (which can be $9,450 for individuals or $18,900 for families in 2025 under ACA rules).
- Example: A cancer patient with a $10,000 deductible + 20% coinsurance on $200,000 in chemo could owe $40,000+ out-of-pocket even with "good" insurance.
- Despite the No Surprises Act (2022), patients get hit with bills from out-of-network anesthesiologists, labs, or air ambulances.
- A 2023 Kaiser Family Foundation study found 1 in 5 emergency visits still result in surprise bills, averaging $650–$1,200.
- A 2019 study in The American Journal of Public Health (Himmelstein et al.) found 530,000 bankruptcies annually are due to medical bills/debt—66.5% of which involved people with insurance.
- A 2024 Consumer Financial Protection Bureau report showed $88 billion in medical debt on credit reports, with insured patients making up the majority of collections.
- NPR/ProPublica (2023): A Texas teacher with "gold" insurance faced $100,000+ in bills after a heart attack due to out-of-network surgeons and denied claims.
- GoFundMe data: Over 250,000 campaigns yearly are for medical bills—60% from insured patients (2024 analysis).
You're technically correct about how insurance is supposed to work—but in practice, that protection is full of holes. Even after hitting the out-of-pocket max, people with insurance still go bankrupt. Here's why the "deductible + OOP max = total safety" claim falls apart:
1. Out-of-Pocket Maximums Are Insanely High
- 2025 ACA limits: $9,450 individual / $18,900 family.
- That’s catastrophic for most households. Median US savings: ~$5,000. Median income: ~$74,000.
- Paying $9,450–$18,900 in one year can wipe out savings, force loans, or trigger bankruptcy—even if insurance covers 100% after.
2. "Covered Costs" Is a Trap
- Insurance only pays 100% after OOP max for in-network, medically necessary, contractually covered services.
- Denials are rampant:
- Pre-authorization denied? You pay 100%.
- Experimental treatment (e.g., certain cancer drugs)? Not covered.
- Out-of-network provider (even unknowingly)? You pay full price—no OOP max applies.
3. Non-Medical Costs Aren’t Covered
- Lost wages (can’t work during treatment)
- Travel, lodging, childcare
- Home health aides, medical equipment
- These add $10K–$100K+ and no insurance caps them.
4. Billing Errors & Balance Billing Still Happen
- Hospitals overbill → you fight for months.
- Even with No Surprises Act, air ambulances, ground ambulances, and some labs are exempt.
- A 2025 Vox investigation: 18% of insured patients got balance bills after OOP max due to coding errors or loopholes.
5. Bankruptcy Stats Don’t Lie
- 66.5% of medical bankruptcies involve insured people (2019 AJPH study).
- A 2023 Northwestern study: Insured patients file for bankruptcy at higher rates than uninsured in catastrophic cases—because they access more care (and rack up bigger allowed charges before OOP max).
Bottom Line:
"Once you hit OOP max, insurance covers 100%" is like saying "Once you pay $18,900, you're safe."
For millions, $18,900 is financial ruin—and that’s before denials, non-covered care, or lost income.
Your friend is describing the brochure version of insurance.
Reality: It’s a leaky lifeboat in a tsunami. Yes, insured people go bankrupt from medical bills—routinely.
Why not? I'm not using ChatGPT, BTW.
I don't find it absurd. I didn;t judge your choice. Why judge mine?
I disagree. The "government takeover" claim is a scare tactic that doesn't match evidence or economics.
1. Repealing Obamacare (ACA) Would NOT Trigger a "Government Takeover"
- What is the ACA? Individual mandate, subsidies, Medicaid expansion, pre-existing condition rules, essential benefits.
- Repeal without replacement → No single-payer, no Medicare-for-All, no "takeover".
- It would return to pre-2010 rules:
- Insurers deny for pre-existing conditions
- No subsidies → premiums skyrocket for middle class
- High-risk pools (failed in 35 states pre-ACA)
- Result: More uninsured (CBO: +24 million), not a government system.
2. Would Repeal Lower Prices? YES—For Some. NO—For Others.
- Healthy, young: Pre-ACA premiums were $50–$150/month. Post-repeal, likely $40–$120/month (no mandates).
- Sick, older, poor: Pre-ACA, denied or $1,000+/month. Post-repeal, denied or $1,500+. There's always Medicare/Medicaid.
- Hospitals: More uncompensated care → costs shifted to insured. Problem?
- Evidence: Utah & Kentucky experimented with partial ACA opt-outs → healthy saw 20–40% premium drops (Heritage Foundation, 2021).
- Hospital prices rose 3–5x inflation since 1990—both before and after ACA.
- Root causes:
- No price transparency
- Certificate-of-need laws (block competition)
- Medicare price-fixing distorts markets
- 3rd-party payer disconnect (patients don’t shop)
- ACA made this worse by:
- Mandating coverage of low-value services
- Adding 2,000+ pages of regs
- Subsidizing demand without supply
The real fix? Price transparency, competition, and tort reform—not more mandates or Medicare-for-All."
Tbird19482
Verified User
Trump and the MAGAS were suppose to repeal AND replace Obamacare in his first term, Trump said he had already had a new healthcare plan ready to go in place right away as soon as he took office.
SO where is it?
It was suppose to be bigger, better and cheaper then Obamacare, so again what happened to it?
Why hasn't it been in effect for the last 8 years or so?
Looks like Trump and his MAGAS followers lied again, who would have guessed?
Nor I, we can still discuss it, though.
That's not a reason to keep it as-is.
People in Europe can and do go bankrupt from medical bills—just far less often than in the US. The claim is a myth of absolutes.
Europe Is Not "Bankruptcy-Proof"
- Co-pays, deductibles, and uncovered costs exist
- Germany: €10–€20 per doctor visit, €10/day hospital stay (up to 28 days/year). Dental, glasses, and many drugs = full out-of-pocket.
- France: 30% coinsurance on most care (reimbursed later via mutuelle—private top-up insurance). No mutuelle? You pay.
- Switzerland: Mandatory private insurance with deductibles up to CHF 2,500 (~$2,900) + 10% coinsurance. Average family pays CHF 7,000/year out-of-pocket (OECD, 2024).
- Private or non-reimbursed care adds up fast
- Cancer drugs not on national list? IVF? Cosmetic/rehab? 100% patient pay.
- Long-term care (nursing homes) often costs €3,000–€6,000/month—not fully covered. Families go into debt or sell homes.
- Bankruptcies happen—just under different names
- UK: NHS is free at point of use, but private debt from dental, optical, or lost wages leads to 100,000+ personal insolvencies/year (UK Insolvency Service, 2024)—some tied to health costs.
- Sweden: Rare, but dental care (80% private pay) triggers ~5,000 medical-related debt cases/year (Kronofogden, 2023).
- Netherlands: 1 in 200 households has unpayable medical bills (NIVEL, 2022).
I hope so.
Well, he's not a king, so I guess he couldn't get it through Congress.
You know what they say:
Tbird19482
Verified User
OH so he LIED again.Well, he's not a king, so I guess he couldn't get it through Congress.
You know what they say:
He said he ALREADY had a healthcare plan that was bigger , better , and cheaper then Obamacare IF that was true I am sure it would have gotten through Congress easily .
Did trump even put it forth to Congress?
I don't remember him doing so, I think it was nothing but a lie to get as many MAGAS he could to vote for him, just another on of his thousands of lies.
Jake Starkey
Verified User
No, bankruptcies don't happen under other names. Loss of money because of such care is infinitesimally small compared to bankruptcy loss in America.