Help me understand the economic state of the US

[K. A. Pital]

Ah, in this case I agree. It is not as simple as inflation, true. I do find it ironic, in a very grim way, that poor people, even sometimes malnourished people, and people who can never afford their own home, nowadays do have high-speed internet and it is commonplace around most of the industrialized world - including the parts of it that are less well-off. They may also have smartphones.

[Broomstick]

It's possible to be poor in the industrial/first world and still live well....but it takes knowledge and self-discipline, which are both in short supply in any socio-economic class, but especially among the poor.

By "live well" I mean have one's true necessities - food, clothing, shelter (alas, not medical care!) - with a couple luxuries on top of that. However, the lack of/difficulty of upward mobility plus the societal contempt for the poor still can induce misery.

There is also the problem of obtaining quality food, clothing, and shelter - again, possible, but only with the application of knowledge and some self-discipline.

[K. A. Pital]

Well, in the US you cannot have medical care. In Europe, Russia etc. it is still free, so even a poor person is not locked out of the system.

[Broomstick]

Saying "if you're in the US and you're poor you can't have medical care" is a bit simplistic - the reality is hellishly complex, meaning if you're poor and ill it's a total crapshoot whether or not you can get care.

[Elheru Aran]

You CAN get medical care in the US... emergency medical care, for a life-saving situation. They are legally obligated to treat you. Granted, they'll slap you with a heinous bill afterwards, but you are still guaranteed that if you are in dire need of medical care to save your life, they will give it to you. Whether it's worth going into debt for pretty much the rest of your life may be another question, but generally most people decide living is worth it, and aren't in a condition to object at the moment.

There are also a (very few) free/cheap clinics available. A number of drugstore chains are starting to come out with 'minute clinic' setups where you pay a nominal fee (~30-40 dollars) to be looked at by a nurse who can then prescribe a generic medication or recommend an OTC alternative, or if your case is more serious, refer you to a MD. If you have insurance, generally they'll accept it. Not quite as good as a proper clinic, but much less hassle-- and if you get a prescription, well, you're already in a drug-store aren't you? Convenient.

And of course, there's Medicaid/Medicare. Those aren't just limited to elderly and disabled people-- in most states, children under 18 can receive it (provided that the family does not have sufficient income to cover their children), pregnant women can receive coverage up to a year after giving birth, and if you're in certain welfare situations you can receive coverage (depends on the state). Of course, all this can be highly situational, and it's quite possible that the closest providers of health care won't accept Medicaid/Medicare because they don't want to deal with the extra paperwork. So it's a bit of a toss-up. Medicare also often doesn't cover dental (though I could be wrong about that).

Finally, there's the health insurance marketplace. Is it ideal? No. Is it cheap? Fuck no (unless you get ridiculously lucky or get a ridiculously lousy plan). But it is an option, *if* one has enough extra cash that they can justify spending money on buying insurance.

Are all these options as good as how the European system has it (for a relative value of 'good', I'm sure it has its own problems)? No. But it's better than absolutely nothing. The trick is being aware of these options and being in a position to use them.

(Quick addendum while I'm thinking of it. Obviously it's not health care, but some employers-- usually the larger ones-- do offer 'protection plans' which you can pay into from your wages, where they'll disburse you some money if you have to take time off due to injury or illness. I've got a couple of those on my paycheck. I don't know if it's relevant, but it might be something.)

[K. A. Pital]

From what I understood, being poor and not old neither a child (between 18 and 65), means you do not qualify for Medicare/Medicaid, it also means that without wage income or other regular income, it is impossible to get insurance, and that having no insurance means obscene bills and lifetime debt. That still counts as a lock-out for me. I mean, even Second World systems are superior to that kind of ruthless "work or die" approach...

[Terralthra]

Medicaid covers low-income individuals of any age, but is notoriously a pain in the ass.

[K. A. Pital]

Even childless adults? Is Obamacare actually that good - almost a European-like universal coverage? What is the income limit - 30k per family of two (like, 15k each) or lower? That is interesting.

[Terralthra]

Even childless adults. It existed before the Affordable Care Act. The ACA expanded it to cover individuals (citizens and legal residents) who make up to 133% of the federal poverty line. For an unmarried, childless adult, that's $15,654 annual income in the contiguous 48, $21,186 for a married couple. That only applies in states which have agreed to the coverage expansion mandate. Not all states do so. States which do not agree to the coverage expansion mandate do not necessarily cover unmarried, childless individuals. It's a state-by-state thing.

[K. A. Pital]

What is the reason for so many people not having any kind of insurance before?

[Terralthra]

That's a long, stupid, complicated story.

[Jub]

What is the reason for so many people not having any kind of insurance before?

From my understanding, it was a combination of price gouging and being turned away due to a laundry list of pre-existing conditions. Plus some amount of circumstance and ignorance leading to people trying to save money by going uninsured.

[Simon_Jester]

When you're young, going uninsured can actually be a good bet, at least for a while. One of the most controversial provisions of the ACA is that it requires everyone to sign up for health insurance (or pay a fine), while exercising price controls to keep the price of said insurance under some semblance of control.

Which is an ugly approach and honestly we should have gone single-payer like the rest of the civilized world, but it does at least have the advantage of lowering overall insurance premiums by making sure that not only the chronically ill need to buy the insurance.

[K. A. Pital]

When you're young, going uninsured can actually be a good bet, at least for a while.

So when you break your leg, arm, etc. hiking or just by accident, you end up financially crippled for life? Good bet? Sonds more like the dumbest bet to ever make.

[Broomstick]

Medicaid covers low-income individuals of any age, but is notoriously a pain in the ass.

Depends on the state.

In some states, a childless adult does not qualify for Medicaid no matter how poor.

In other states, Medicaid does cover childless adults.

Which is why I said describing the exact situation regarding the US poor and healthcare is actually quite complex - you have something like at least 52 different sets of rules to consider, most dependent on geography.

[Broomstick]

When you're young, going uninsured can actually be a good bet, at least for a while.

So when you break your leg, arm, etc. hiking or just by accident, you end up financially crippled for life? Good bet? Sonds more like the dumbest bet to ever make.

A simple fracture usually doesn't bankrupt someone. If you were that poor the hospital would likely just eat the cost (then try to recoup it by raising prices for everyone else). Hospitals and clinics have been known to agree to crazy payment plans like $10/month. Might take a couple years to pay off, but it's doable.

What gets truly disastrous is a major accident, cancer, etc. Most people have zero comprehension of just how expensive a truly catastrophic medical thing can be.

[Darmalus]

When you're young, going uninsured can actually be a good bet, at least for a while.

So when you break your leg, arm, etc. hiking or just by accident, you end up financially crippled for life? Good bet? Sonds more like the dumbest bet to ever make.

Risk evaluation is not just about consequences, but also frequency. A quick glance through injury statistics all tend to look like this:



So while the consequences of uninsured injury may be pretty dire, the likelihood of actually facing them is pretty minimal before middle age, when you presumably have enough money to afford decent insurance.

[K. A. Pital]

I am positively sure that even though the likelihood is small, the fact that home, workplace and leisure injuries can be extremely diverse and unpredictable, while the consequences are quite dire, is good grounds not to ignore this risk. Then again, I have never been exposed to a system where anyone is uninsured. Perhaps this is strange, but I feel that the needless chance of someone uninsured suffering extreme consequences just because a government fails to offer universal healthcare... Is just stupid. How can a person know in advance he or she will not be hit by a car, for example? I certainly don't know that, so I am cautious, but even then I always feel the danger that the environment poses. I think that when people are young, they have a problem with the fake perception of invulnerability. Then again, I come from an entirely different environment and the very idea of betting on your health seems utterly alien to me.

[Broomstick]

I've known significant numbers of people who restrict either their own activities or those of their children to minimize injury. Even so, catastrophe can happen to anyone, no matter how careful.

[Darmalus]

It's a lot easier to take the cautious route when the cautious route is both mandatory and not priced like a high end luxury good. I know I'd like health insurance (real health insurance that actually covers stuff), so either I'm going to win the lottery or the USA will go single payer. I'm pretty sure I'll die long before either.

[Simon_Jester]

When you're young, going uninsured can actually be a good bet, at least for a while.

So when you break your leg, arm, etc. hiking or just by accident, you end up financially crippled for life? Good bet? Sonds more like the dumbest bet to ever make.

That depends.

If you are poor enough that you can barely cover your basic physical needs and are chronically going into debt- that is to say, if you are a member of the American working class- then the 'bet' comes down to spending X hundred dollars a month on health insurance (which you could very much use for other things) or taking a moderate risk of suffering a serious injury that will probably cost you a single-digit thousand number of dollars.

A rational entity might well make that calculation and decide not to buy health insurance. After all, the insurance companies charge premiums that enable them to make a profit. It is in some sense like gambling; someone has to be losing money on the deal, or the insurance companies would go out of business. Most of us accept that we're losing money on our health insurance because we're paying for certainty, but if you're already accustomed to accepting risks as part of the cost of physical survival, then the perceived value of certainty is low, and the perceived value of money in your pocket is high.

It's not a stupid bet, it is a bet that rational humans make in an unpleasant situation. Just as it can be rational for an animal to gnaw off a leg to escape a trap.