Not to mention the historical "lifetime limits", which only since the ACA have been lifted. You could have an unimaginable great plan with a huge network and no deductible, but an extended hospital would still bankrupt you.

> With copays and out of network stuff a lot of people will go bankrupt in case of a serious illness.

By law, those are capped for people with insurance. The maximum that you will have to pay out-of-pocket can be no more than about $7,000, and many private plans set the cap at a lot less.

$7,000 is a non-trivial amount, but it's not a large number of people that both are insured and can't afford their out-of-pocket maximum without bankruptcy.

Max contribution to an HSA is about $6,800/year. I have been putting $600/month into it for three years and have never been able to get more than $6k saved; family of 4 and no dental insurance (employer dropped it).

This is the equivalent of a car payment for the rest of my working life.

You can easily add tens of thousands of out of network costs with some medical issues.

> You can easily add tens of thousands of out of network costs with some medical issues

It doesn't matter, because that's still capped.

I know people who have run up medical bills in the hundreds of thousands due to a long term illness despite having insurance. I don't know how this could happen, but it did.

> I know people who have run up medical bills in the hundreds of thousands due to a long term illness despite having insurance. I don't know how this could happen, but it did.

The bills themselves aren't capped. The amount they are obligated to pay is. Insurers make up some of the difference, and the rest is forgotten about. (It's not written down in the accounting sense, because the hospital doesn't necessarily actually treat the entire billed amount as receivable.)

I explained in a top-level comment how this works and why it works this way.

I hear what you are saying but I know people who have 6 figure medical debt despite being insured. This happens.

Indeed it doesn't take much imagination: chronic illness + prescriptions + high deductibles. Worse if multiple family members are sick (so many problems are inheritable and so on).

Also worth mentioning, it's been broken for a while (e.g.: ACA is not even broken in yet).