Speaker 1: If you look at lists regarding which countries have the best healthcare system you'll likely see Sweden, Denmark, Canada, Germany, Switzerland, Japan, the Netherlands, and Singapore somewhere on the lists. But how do they compile such lists? Well, taken into account is how much countries spend on healthcare, the quality of that healthcare, the availability of it, and of course how effective it is in keeping the country's populace healthy. Another thing on the list is how much people might have to pay up front for the healthcare. If anything at all, this is one of the reasons you won't find the USA on these lists. With the American media often telling us being sick in the US can bankrupt a family, today we'll find out how this happens in this episode of The Infographics Show, US Healthcare System Explained. Before we begin to explain the system, we might ask if medical bills do actually cause so many problems in the USA. According to CNBC that is indeed a fact, with one report saying medical bills are the leading cause of bankruptcy in the country. How many bankruptcies? No one knows exactly. You'll find some statistics saying that around 650,000 Americans every year go bankrupt because of medical bills. President Obama said there was a medical bill-related bankruptcy in the US every 30 seconds, but that was way back in 2009. These numbers have been contested, and skeptics tell us there is always more to bankruptcy in these cases than just medical bills. Maybe those bills were just the straw that broke the camel's back, but one thing we can take from the stats, even if not entirely accurate, is that America, a country so developed and rich, might not be doing a good enough job looking after its citizens. The website The Balance wrote a very, uh, balanced article on this topic. It came to the conclusion that one must save in America, as sickness or accidents can lead to astronomical bills. The advice it gives? Save for a rainy day in a hospital bed, and live a life in line with not getting an ailment often unavoidable, such as diabetes. Shouldn't a developed nation have safety nets in place, though? That's a question many Americans ask. How many Danes go bankrupt because they were unfortunate enough to be hit by a bus? We might recall the recent video that went viral of a woman who had her leg trapped by a subway train in Boston. Don't call an ambulance, she cried, as shocked bystanders witnessed her bone coming through her leg. Why, they asked. She replied, do you know how much an ambulance costs? So, what's going on? The Department for Professional Employees tells us this, the American healthcare system is unique, at least for an advanced nation. That's mainly because the USA is the only industrialized nation without universal healthcare coverage. That doesn't mean it doesn't spend a lot on healthcare. In fact, it spends a lot, a hell of a lot, about 17.9% of the GDP in 2016, or $3.3 trillion. We are told that Americans shop for health insurance just as they shop for anything else. Around 156 million Americans are insured through their work, which is called employer-provided private insurance. Then you have publicly funded Medicare for old folks and the disabled, and Medicaid for the poor. It's thought around 120 million Americans are part of these schemes. That's why the system has been called a public-private hybrid. But when we talk about insurance given or subsidized by employers, it all depends on what kind of insurance you have. It may not pay for everything, so some people still end up going bankrupt. Then you have the Affordable Health Care Act, or ACA, aka, Obamacare, which attempted to make it easier for employers to give better health insurance plans for their workers. It also made it possible to give the maximum time limit for short-term insurance plans, and make it possible for employers to give their workers pre-tax cash to buy their own coverage. As we said though, insurance providers don't always give you exactly what you want. They usually have a network of doctors or hospitals and you must use them, and in some cases you are not always covered for the treatment you need. In the past, some people with pre-existing conditions couldn't afford their insurance or were even denied it, which is just a part of cutthroat capitalism. Obamacare was put in place to prevent this. But let's go back to insurance. When you choose a plan, you must look at these things, deductibles, copayments, coinsurance, and premiums. The package you buy according to these things might save or break you. Premiums are what you pay even if you don't make a claim. These can be very high. Coinsurance is a percentage of the cost you pay. A deductible is what you pay before insurance pays for anything, which can be as much as $10,000. A copayment is what you must pay for every visit to the hospital or clinic, and you'll pay that before the insurance company pays anything. So, choosing the right plan is important. As one writer puts it, you've got to be an odds maker on your own health. So, what if you have no insurance? As we said, there are government-funded schemes for those in need. Also, because of the Emergency Medical Treatment and Active Labor Act of 1986, hospitals can't just turn you away if you're at the doctor with blood spurting from your neck. There's also the Hippocratic Oath, which means all doctors must try to treat you the best they can and do it ethically. But if you can't pay, there will be a bill, and in the US it will likely be a large bill. That could lead to debt collectors coming for you, your wages being garnished, part of the money taken out, your credit being ruined, having a tax refund withheld, someone wanting to take your house, or you could suffer bankruptcy. But surely those with decent insurance won't hit rock bottom. Not according to the Kaiser Family Foundation. That tells us more than 25% of US adults with insurance have difficulty paying their medical bills. You see, we are told that 63% of Americans who have had these medical bill woes had to spend most or all of their savings on those bills. Another 42% had to get a second job. CNBC wrote in 2018, only 39% of Americans have enough savings to cover a $1,000 emergency. Experts tell us Americans should downgrade their lifestyle in case they get sick, even if they have insurance, as going bankrupt could mean you might not get a loan again, or be able to rent a house, or even get a job. Sure, the poor and needy might get government help, but those that fall somewhere in the not-poor-but-far-from-being-comfortable category are often those who have to risk average insurance and the possibility of getting sick ruining your life. Another thing we are told is that 1 in 10 Americans delay getting treated because they are worried about the cost. That's what you might call a vicious cycle, because waiting can just make things worse. Some folks can't even afford the deductible, even when it's just $500. The bills themselves may often surprise those that got treated. According to a story in The Atlantic in 2014, one man had a herniated disc surgery in America. He made sure he had enough cash for the surgery. As the article said, $56,000 in hospital charge, the $4,300 anesthesiologist bill, and the $133,000 fee for the orthopedist, but there was an extra $117,000 for an assistant surgeon that it turned up. One would think at these prices you could walk out of the hospital not only fixed, but in a Hugo Boss suit with the keys to a new car and two tickets to the next World Cup final. But no, you get fixed and leave with only a big bill. This is mainly because of administrative costs, the sometimes ridiculous cost of drugs, the fact that you pay for the possibility of doctors being sued, paying healthcare workers wages, new technologies, and medical institutions just charging you what they want. We are told by Reader's Digest that some hospitals charge $8 for a mucus recovery system. Hmm, they are usually called tissues. An investigation revealed one patient was charged $53 per pair of non-sterile rubber gloves. Sterile gloves were more. Total cost for the stay, just in gloves, was $5,141. That plastic cup they use to hand you your drugs? $10, with an average of $440 in cups for a patient's stay in the hospital. Alcohol swabs, of which you may need many, $23 a time. One person was charged $137 for an IV bag. The cost of that bag? $1. This is mostly due to something called the Chargemaster, which allows hospitals to charge out-of-this-world prices. These codex of costs are hospital-specific, meaning each hospital makes up its own prices. Some critics have called such costs fiction, and are critical of the lack of transparency hospitals provide about this hidden menu. The loser, of course, is the consumer, whose life may depend on that five-star menu. Vox reports that one woman who hit her head and went to the ER, left with only an ice pack and a bandage. Her bill? $5,751. Her insurance paid $862, and she had to pay $4,989. Ok, she paid for assistance and expert evaluation, but come on. In fact, most drugs or treatments will cost Americans much more than citizens of other countries. In fact, the Washington Post tells us, America has the most expensive but least effective healthcare in the developed world. Now you might see why people in the US are going bankrupt, and why the country is not on any best healthcare lists. This is a huge debate in America, and today we may have been quite critical of the healthcare system. We'd love to hear counter arguments, or even your own experiences with the healthcare system. Let us know in the comments. Also, be sure to check out our other video Most Horrific Crimes – The Italian Mafia. Thanks for watching, and as always, please don't forget to like, share and subscribe.