The answer is “it depends”. There are so many hoops and loopholes and gotchas built into the system that 2 identical people with the exact same background and ailment(s) could go see the exact same medical staff and yet still end up having to pay 2 completely different amounts for their care. But it’s more complicated than that, because there are a myriad factors that come into play (insurance versus none, location/state of residence, etc) so there’s no one concise and accurate answer to these types of questions.

Most non-wealthy people who don’t have insurance, but who don’t qualify for government/public medical care, simply go without care. Or they use the emergency room loophole to get some kind of treatment. The loophole, with lots of nuance and caveats, is that the emergency room has to at least give you enough treatment to temporarily stabilize your condition, regardless of your ability to pay.

For check-ups and counseling - In a lot of places that sort of stuff requires you to pay up front. You can sometimes haggle or work out a payment plan. If you’re poor enough to qualify for government aid, it may be free. Otherwise, you’re expected to have insurance and pay the co-pay. If that doesn’t apply, these places usually have a “cash” price that’s slightly more affordable, but still usually require payment ahead of time.

For meds, you basically always pay up front. There’s really no concept of pharmacies providing medications in a manner where you can pay later. No money means no meds. It’s also ridiculous to even ask how much a person would expect to pay for meds, it could be as little as a few USD to thousands, really depends on the meds, quantity needed, location, etc.

Xrays - This is where debt might actually come into play. You usually pay for these after the fact. If you go to the doctor, you might have to pay the standard fee (or copay) up front, but all the other services/tests/etc are charged after the fact. So you’ll end up getting a bill after you’ve gotten the xray and consultation. To be honest, I don’t know the average out of pocket cost for an x-ray if you don’t have insurance, but it would differ from location to location and region to region. If you don’t pay that bill, you’ll get harassed and most likely you’ll have to change doctors because the office you owe money to won’t see you again until your debt is paid or you’ve worked out a payment plan.

For people with insurance, there’s pretty much always a maximum yearly out of pocket amount, after which things are basically all paid for by insurance. Again there are nuances and caveats. And the maximum out of pocket varies by insurance policy, number of people insured, etc, but $8,000 - $20,000 are not uncommon amounts. To be honest, I don’t even know what mine is, I’ve never actually reached it. Not everything is covered by the maximum out of pocket, though.

$27,000 medical debt could possibly be from someone who was uninsured or it may be several years of medical debt.

To give you an idea of how crazy the system is: I had a hairline fracture several years ago and what was deemed as “good” insurance. By the time everything was done, it ended up costing me around $3,000 out of pocket. That’s for co-pays, x-rays, medication, etc over the course of months.

On the other hand: A family member of mine had a heart attack, required emergency surgery, had no insurance, and had no money to pay for anything. In the end cost them less than a few hundred USD out of pocket. Hospital wiped the debt clean. Government programs and drug company programs paid for meds. Eventually disability stuff kicked in and took care of everything else.

Your friend should let all the Americans going into bankruptcy each year due to medical debt that they imagined it all along.

i have to pay ~1000/month just so i can walk in their front door of the hospital. after that, insurance companies do everything they can to not pay my bills.

america absolutely fucking sucks. insurance companies only make money when human beings suffer. think about that for a minute, their profits are literally built on the back of human suffering.

I pay 9.79$/month for medical only, pre-tax, myself only on the plan, working for a mental healthcare nonprofit. My medical copays have been free lately for routine office visits. I have to get labs done 4 times a year for the meds I take and those have all been free so far. Because they’re classed as “preventative” to make sure nothing goes wrong with the meds, it’s free 🤷🏽‍♂️. Non preventative things have a 2000$ deductible, so I have to pay that much before medical care for the calendar year becomes free to me. That means that if I get sick in December, I have to pay 2000$to cover for December and again in January to cover for the next year.

Dental coverage is free. I pay 40$/visit as a copay for cleanings and all else (if I’m not in perfect health) I pay 30% of that bill. Recently I had periodontitis and my bill after treatment was 600$.

For a real example, my 10 year old swallowed a button battery (yes she should know better). Of course we went to the pediatric ER immediately. She was seen by a doctor, got some X-rays, then puked the battery out. She’s totally fine. In the end I’m paying about $2000 out of pocket for that. That’s on top of the monthly premiums I and my employer pay.

My premiums are about $280 per month for health, dental and vision for me and my kids. Premiums are pre-tax so there’s a bit of savings there. My employer pays about $1100 per month on top of what I pay. My wife is on her employers plan because they would charge about triple that for all of us to be in the same plan. that’s about $100 per month for her.

On top of that I have a special pre-tax savings account for health expenses only called a Flexible Spending Account, which helps a bit but it’s kinda silly and not very flexible. I have to determine at the beginning of each year how much I might spend that year, then that amount will be taken automatically out of my checks. If I don’t spend it all, it’s gone.

I really recommend this video to understand (or not) the complexity of the US health care system https://youtu.be/-wpHszfnJns?si=Wi48w7TCkETdIUQQ

It’s bad, a large percentage of bankruptcies in the USA are for medical reasons and a large percentage of those did in fact have insurance. The system is broken.

I injured my arm in 2016 while working on a trailer. The doctor sent me to get an X-ray. With my wife’s insurance (the highest tier her company offers) the X-ray was $650. A visit to the doctor was $65 last time I went (2016), and an Emergency Room visit is $75.

In late 2016 I broke my nose on a movie set and had to get stitches. Production did not file the paperwork so they refused to pay the $2700 bill (ER visit plus 3 stitches, the set medic set my nose for them). I finally found a copy of the paperwork the set medic gave me in case production pulled anything. They paid the bill the day I emailed the paperwork, but that was almost 2 years of fighting with them.

On average they actually spend $12.500 per year (total, PPP adjusted, at leat that’s the number for 2022)

https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

You as a Brit spend $5.500 (also adjusted) (And as a bonus, at the same time you’re also expected to live 2.8 years longer than the average American.)

nobody actually pays those bills. They’re just some elaborate dance between insurance companies and hospitals.

Sometimes there is an elaborate dance between the two on pricing. Sometimes the insurance company dances on its own to determine why the service is not covered.

If you don’t have insurance, the cost is lower

Depends what you mean by cost. insurance is always out to make money, that means paying less, and negotiating lower prices with providers. However, there are some situations where it benefits both the service provider and the insurance provider to inflate the initial price, and negotiate a steep “discount” to a final price (a portion of which the patient pays) that is higher than the non-insurance price. But I don’t remember the exact details, and I may be conflating this with some other healthcare industry scheme.

or removed entirely. Supposedly.

If a hospital is nonprofit, I believe they are required to have a (self determined) charity care policy that they must follow. If you make below a certain amount, you can apply for relief, but that also applies for to after-insurance costs, not just no-insurance costs. For-profit hospitals will rake you over the coals and send collections after you. Part of the problem with charity care, is that you may have to ask for it, and few people know enough about it to do so. And you may have to ask for it in the right way. If you aren’t specific enough, they may offer you “financial assistance” which is just a payment plan. Then they’ll treat you the same as a for-profit hospital would.

If you’re interested in a deeper dive, the Arm and a Leg podcast is a great show about healthcare costs in the US.

You essentially gamble a little bit. Most people get insurance through work (or they are part of a family plan). Generally, you’ll have a few plans to choose from. If you are older, or have recurring issues, you might pick a plan that’s a little more expensive, but covers more costs. If you are young and healthy, you might pick a cheap plan, essentially betting that you won’t really need healthcare other than your yearly checkup and some vaccines.

The biggest thing with healthcare in the US is that it’s very complex. Even if you have insurance that should cover something, it can be hard to find a doctor that’s part of your insurance, so people often put off going to the doctor, which is part of the reason why costs are high. Teeth and eyes have separate insurance cause they are optional, apparently.

You basically have “premiums” that are your monthly payment. If you get your insurance through work, they cover a percentage of that; generally a pretty hefty amount of it. They usually don’t outright tell you what percentage, though, so many people think insurance is cheap, and get a rude awakening when they lose a job, and suddenly can’t afford $1000 a month when they used to be paying $100. Those premiums are taken out of your paycheck pre-tax, too, which gives you even more of a benefit if you have a job.

Depending on the “style” of the plans, they cover things differently. They all (I think) cover “preventative care” completely, which includes your yearly checkup, vaccines, and birth control for women. After that, some plans have “co-pays”, which are set costs for a few things, like $25 for a normal doctors visit, $50 for a specialist, $100 for an emergency room visit. Some just cover a percentage of those costs, and some don’t pay anything until you hit a limit (the deductible). Finally, there’s an “out of pocket” limit. That’s most you’ll have to pay in a year, after which point the insurance covers everything.

All together, I pay less than $1000 a year for healthcare, but if I got really sick, and needed a bunch of expensive healthcare, I would quickly hit my out of pocket maximum, which I think is like $6,000. I could cover that, but many people cannot cover an expense like that on short notice.

The number on bills is very misleading. The hospitals know that insurance will negotiate down, so they start high, and then after the negotiations, insurance will pay some or all of the remainder. If you don’t have insurance, you typically don’t pay that whole number on the bill, either, cause the hospitals recognize that they dont have to adjust it up for the negotiation. You can still negotiate on your own, though.

In addition to the actual costs other people are talking about, the mental costs of dealing with the system are inmense.

You have to update your information whenever you change your job. It’s not like your social security number that’d given once and you memorize.

Every year you probably have to review your insurance options and pick one. This is essentially gambling- if you pick a low cost one you save money, unless you actually need to use it.

You probably need to find doctors that are “in network” or pay a lot more.

Sometimes bills are sent directly to you and that’s a mistake. But sometimes you’re supposed to pay and be reimbursed.

You typically don’t know what the costs will be up front, so you have to guess what the best option is. Take a nasty spill on a bike? Is it worth calling an ambulance? Does your insurance cover that? Maybe just walk into the emergency room. But does your insurance cover that? Maybe just call a regular doctor?

In short, there’s a lot of stuff you have to think about as the end user. I’d rather it was just “oh shit you’re hurt, let’s take you to the doctor. Don’t worry about money”

mine is decently inexpensive through Obamacare, and I’m in a low enough income bracket. but it still isn’t ideal, I needed a sleep study. with or without my insurance it was going to cost $1,000 so I just never had it

I had a surgery that ended up costing a few thousand dollars after insurance and we have ok insurance at work.

You’re fucked if you don’t have insurance, which is common for a lot of the working class.

I read something from last year that said about half a million Americans go into bankruptcy due to medical debt each year.

That’s it, that’s what happens. You lose everything and you start over, if you’re healthy enough.

Protect your NHS.

It cost us almost $4000 to have our first kid and we have pretty damn good (the premiums were not insignificant either) healthcare. No complications, no surprises, typical short hospital stay (like 3 days).