They aren't. Anyone can go to the ER, and if you're poor it'll be billed through Medicaid. When I was young and poor, I had a multi-day hospital stay and multiple surgeries that totaled to $3.50 out of pocket. Urgent cares are everywhere and affordable.

Can you recommend a good ER for getting dental fillings or an annual checkup?

ER isn't the only part of healthcare that matters. Most things can be prevented with easy access to GP level care.

ER is for accidents and when health problems get out of hand. If you end up at ER with a preventable problem the system has already failed you.

Only having free access to ER doesn't constitute healthcare.

> Anyone can go to the ER

They'll treat you if you have a heart attack and make it in alive. They won't put you on blood thinners or statins 10 years before that to keep you out of the ER in the first place.

I don't think ERs do chemotherapy either.

What do you do to address health concerns before they become ER-level?

>> so many of your citizens without even basic affordable healthcare

> They aren't. Anyone can go to the ER, and if you're poor it'll be billed through Medicaid.

You guys are both wrong, and arguing with broad brushes about something that's complicated and subtle.

Health insurance is available to everyone in the country, but it's expensive and extremely complicated (among other things: you don't "bill through" Medicaid and lots of folks who qualify aren't on it because they can't figure it out).

It's true that the pre-ACA world where getting sick without employer-provided insurance means dying poor is gone. Almost everyone who needs serious care in the US gets it in some form, but lots of care is delayed because people aren't covered, as getting covered is "affordable" but extremely expensive (unsubsidized family plans run $20k/year and up!). It's much better than it used to be but not a great system.

The flip side is that it's also true that the large-payer corporate insurance system provides "better" care in the sense of access and outcomes[1] than the state-run systems in Europe. It's extremely rare in the US to hear the "on a waiting list" stories about elective care that you hear especially in regard to the NHS.

It's complicated, basically, and not well-suited to yelling on the internet.

[1] Obviously the system pays for this with much (and I mean much) higher service rates than the rest of the world extracts for the same care. US doctors and health systems do very well.