I was on a Marketplace plan for a couple years. It ended up being a really good plan. Not sure what's happening with costs right now, though. It's so completely fucked up and broken.

I've ended up with a HSA plan that's more like catastrophic insurance because the deductible is almost 7k. If I end up spending that much in a year my finances will, indeed, be a catastrophe.

I try and not go to the doctor for anything because of the cost even with insurance.

It sucks.

For all the shortcomings of the NHS, when I listen to Americans talking about the cost of their healthcare, I am so grateful for knowing that I can see a doctor for free.

There are huge problems with the NHS, mostly due to funding cuts. Hospitals are run by healthcare trusts, and they decide how to spend their money. So a treatment offered by one trust won't necessarily be offered by the one in the next town. It's called the 'postcode lottery' of healthcare, and what treatment you get depends on where you live.

I also have BUPA private medical insurance paid for by my employer. Most big employers offer it. The waiting lists for non-urgent treatments can be several years. It makes sense for employers to pay for private health insurance so that someone who needs, say, a hip or knee replacement doesn't have to wait until they are unable to walk at all (and thus unable to work) before they can get it done.

I had surgery paid for by my private health insurance which I'd have waited several years for on the NHS, or (in the case of an angioma) I wouldn't have been allowed surgery for on the NHS, notwithstanding that it was causing discomfort and bled like a mofo if it was scratched. It took ten minutes at my local private hospital, and all I had to pay was the £100 excess (deductible) on my BUPA policy.

BUPA doesn't cover things like an annual checkup (unless I pay for it), and the NHS tends to be a reactive, rather than a preventative, model. People go to the doctor when they feel ill, but there's not much in the way of checks and screenings.

The NHS is being stretched by two things - people are living longer, so caring for people with dementia or age-related illness has increased enormously. Also we are getting much fatter, and dealing with obesity-related issues, including diabetes, is taking up far more NHS resources than even ten years ago.

But, dear God, the stories of people in America dying because they can't afford their insulin - it's fucking barbaric.

I have a suspicion that in the US it's seen as your own fault if you are ill or injured and doubly so if you didn't "plan well enough" to be able to buy an expensive policy. Therefore it is only those who "deserve" it who die bankrupt due to maladies.

I've ended up with a HSA plan that's more like catastrophic insurance because the deductible is almost 7k.

The normal (non-HSA) policy I have now (the one that is doubling in cost) has a 7K individual deductible. The deductible will be increasing, too.