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It's about a fifth of the US economy, if you're insured it involves monthly payments that will make up a significant portion of your paycheck or be significant deductions from it, if you're uninsured and poor you get regular paperwork from Medicaid that you have to fill or correctly or can end up in deep shit, and the reimbursement and deduction system drives a lot of other (often dumber) behaviors.
And if you have a pregnancy, or a serious illness, or a chronic illness, it gets a lot more in-your-face.
Yeah I guess the monthly payments are a pain in the ass. But so is FICA or Fed Income Tax, etc.
My wife and I have kids. Her heath care during pregnancy was fine. Wasn’t enough to orient our life around health care as a topic.
But assuming you fit the demographics of the average Motte reader, you likely have good to very good insurance no? That puts you in the upper bracket. How much did you end up paying for your wife's pregnancy care? How long did it take you to pay that off? Had she had to have been rushed to an out of network hospital, how would that have impacted your finances? What if her doctor was in network but the lab her doctor used was not?
I moved from the UK to the US so I have experienced both healthcare systems as an adult, and they both have their advantages and disadvantages, but the US one definitely requires more engagement, which isn't necessarily bad, but the more issues you have with executive function and planning the worse it gets. I can get a good chunk off my premiums by getting a yearly physical and then a yearly biometrics test, and by getting a prostate exam and by getting a dental exam and so on and so forth. For a planner like me with experience working through bureaucracies that works pretty well (though even for me the inability to know if a recent colonoscopy was going to be coded as routine or diagnostic in advance and therefore not knowing if was going to be out of pocket for around 600 dollars or 6,000 was literally a pain in the ass).
Treatment in the US is usually good and quicker than the NHS (though in rural or urban areas it can be comparable, it took me 6 months to get in with my PCP when I moved to a small town in the US, and it looks close to that now I have moved back to the city), but it does require much more engagement and does give you much more uncertainty about what is exactly going to be paid for or not. On balance I would say it is probably better, but it is also more stressful. It took 3 months before I knew for sure my bill was going to be 700 bucks, not 6,000.
We have an HSA. Just set up payment plan and used that. It didn’t impact our finances in any noticeable way.
Which goes to the point I think, only somewhere between 1 in 6 and 1 in 10 Americans have an HSA in the first place. And presumably you must have made the choice to set up/pay into one at some point, thus spending more time thinking about and planning for health spending.
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I think it's mostly a way to score points against the US and praise the European social democracies (+Canada) that leftists in the US tend to idealize.
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