"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).

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.

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!

And this is why you can't have a system where people can opt out of paying for healthcare.

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

> 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.

> 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.

[1] https://www.census.gov/library/publications/2024/demo/p60-28...

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 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.

--- 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.

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?

Does CHIP include children without paperwork?

Because of course it's not genuine. It's always a smokescreen for policing morality.

Because the US already has CHIP and various other programs that mean the vast majority of children DO have healthcare, if they need it.

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.

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.

> 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 can afford both, because we already pay for the elderly and children are extremely inexpensive to insure overall.

Medicare is for those over age 65. They aren't having a lot of babies.

Medicaid already does that.

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.

Non-citizens are still people.

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.