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.

It varies a lot for people, and the bills you actually pay depend on a lot of things. It’s complicated here.

I would say I’m the average “I have healthcare through work” person. But that’s not average for the population (many people have no healthcare).

I pay about $600 a month for a plan that lets me go to any doctor (called a ppo). If I wanted a cheaper monthly bill, I could get on board with the plan where you have to go to the doctors and facilities that are “in the insurers network”. I’ve had problems with these plans as they’ve become more and more run by the insurers than actual doctors - leading to shoddy care. So $600 a month for my family it is.

I did require major surgery about 10 years ago. I was in the hospital for a month and had a million office visits. The grand total “bill” was just over a half million dollars. My portion of that was about $10,000. It was crazy to look at the itemized bill though. Two Advils cost like $50. An X-ray? Like $1000. But that’s like this this fucky-fuck game insurers and providers play with each other. Sometimes people are flat broke, and the hospitals still have to care for them if they wander into the ER - and they get paid nothing. It’s a weird system.

If you don’t have health insurance-you’re kind of in trouble. Interestingly, those $1000 X-rays become $200 if you’re uninsured. Definitely more manageable-but you’d be screwed if you required major surgery. You’d be bankrupt.

Basically it’s very American-it works great for people doing well in life - screw everyone else less fortunate- get a job…

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

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

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