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Healthcare in the US

As an European, I'm really curious as to how the healthcare system works in the United States and how it varies from ours. As far as the legend over here goes many underclass people working badly paid jobs have next to no chance on getting aid which include ambulance transport, major surgeries while insurance companies try to screw their clients out of paying the bills.


Is there any truth to this or is it a totally flawed view which us Europeans have on how medical care is ran in the US?

I'm also curious as to what the Obamacare act really meant - as I understood it, employers were obliged by law to provide a certain modicum of insurance to their employees.

As someone who grew up with the NHS and after living in the states for 6 years with only a weird travel insurance (in case of a accident/emergency) I finally have health insurance.

It;s works very differently here.

In the UK for instance, if you get ill, it's all covered. No out of pocket costs apart form maybe a small flat fee for aftercare medicine/prescriptions.

In the UK, your priorized by what is wrong with you. SO for instance, my grandad needed a knee replacement. They deemed it as non-critical and was given the choice to wait 8 months on the NHS, or go private pay for it himself and have it a week later. Same Dr. Same facility.

Over here, there's no priority system for thsoe with insurance. You need it done, it gets done but the costs can be insane.

I've got one mate over here that said the wrong thing to a girl while waiting in line for food at a cinco de mayo street party and woke up in hospital 6 months later to a $1.4m bill. His health insurance paid for most but he was still $80k in debt.

The way it now works with the ACA (Obamacare) is that you buy insurance, which usually has a total out of pocket annual limit (the total figure you can be charged in a year for any combined medicare) say $6000, but then usually a set deductable (say $1000) and then a co-pay amount which is often something about 30%.

So if you had an accident and it cost $10k, the first $1000 is out of pocket for you. You pay that.

Then of the next $9k you pay 30% which is $2700. So you've just paid $3700 for a $10,000 medical bill.

If you then had another $10k accident, you would only pay $2300 because you would have already hit your $6k OOP max. And then anything after that is free after you pay the deductible.

insurance plans get more expensive based on the lower deductible and lower OOP total. Usually there's a co-pay for doctors in network so they are capped at the tier set in your plan (around $40 for the plan I'm describing).

If you have no insurance, there are many local and state run facilities that offer free healtcare but it's usually emergency or for more serious things. You basically have to pay if you get flu and need to see a dr for antibiotics and if you can;t pay then you don't get to a see a dr.

Many larger hospitals (like Cedars Sinai here in LA) are run as Non profits but it's a bit of a joke as they make billions a year. But if you happen to get taken there with an accident and you're uninsured, they will first bill you something ridiculous, then comes a lengthy negotiation spanning several months and in some cases they will write the debt off as part of the NPO mandate (basically using money from paying patients to subsidize those who can't pay).

The worst situation in some ways to be in, is those with a small income that don't quality for the charity care providers, but don't have enough to pay for insurance.

That's really complex!

quote:

Originally posted by DJ RANN I've got one mate over here that said the wrong thing to a girl while waiting in line for food at a cinco de mayo street party and woke up in hospital 6 months later to a $1.4m bill. His health insurance paid for most but he was still $80k in debt.

Pretty much what RANN said. It's kind of shit system. Basic insurance plan start at $3,500/yr with like 5k deductible. A low deductible plan is $5k+ The older you get the more they charge. If you have a good job for a big company/government they subsidize the cost of insurance. Low income get subsidized by the government. But if you fall in between you get squeezed. Increasingly companies look for ways push the cost on to the employees by hiring you as a contractor or as part time just below the number of hours that would qualify as full time.

Yeah, it is shit really.

It's a tragedy that the single payer option didn't go through.

The bullshit is, that even though the NHS isn't perfect (and if you listen to conservatives on this subject, they'll describe the NHS like this hellish makeshift triage that Haiti would be embarrassed of) you pay about 4-5 times more here for the same level of care or same medicine. It's bonkers.

Then people say "but aren't you taxes to shit for it?" and "why are you paying for other people's healthcare who don't work?".

And then I tell them I pay more in taxes here in the Land of the Free, than I did in the UK. And they have free healthcare. Which I have to pay for here.

You;re right about the hours thing though. Total bullshit. I know people who got told by their employers that their hours were being reduced to 38 per week from 40 just to negate their eligibility from the company healthcare plan. ******s.

moral hazard would have some great stories to tell.

Thanks for the expanation, you two. Bad to see that the American hospital system is not covered by the government for everyone, like you pointed out about the UK.

quote:

Originally posted by DJ RANN If you have no insurance, there are many local and state run facilities that offer free healtcare but it's usually emergency or for more serious things. You basically have to pay if you get flu and need to see a dr for antibiotics and if you can;t pay then you don't get to a see a dr.

Out of curiosity, how much would such a consult cost?

As others have said, the system over here sucks. Also, when considering the Affordable Care Act it's important to consider the massively dysfunctional government we have trying to deal with it.

I am a fan of Obama and the intentions of his "signature legislation" but the administration has done such a shitty job from the start with the whole thing.

[QUOTE ]Originally posted by Chimney
Thanks for the expanation, you two. Bad to see that the American hospital system is not covered by the government for everyone, like you pointed out about the UK.



Out of curiosity, how much would such a consult cost? [/QUOte]


Out of curiosity, how much would such a consult cost?

Physical exam $100
Blood work $200
Antibiotics $100

quote:

Originally posted by Jon_Snow [QUOTE ]Originally posted by Chimney Thanks for the expanation, you two. Bad to see that the American hospital system is not covered by the government for everyone, like you pointed out about the UK. Out of curiosity, how much would such a consult cost?

Physical exam $100
Blood work $200
Antibiotics $100 [/QUOTE]

Don't you get a prescription through which you pick antibiotics up at the pharmacy?

Dr writes you a script, you take it to a pharmacy and pay them to fill it.

quote:

Originally posted by Jon_Snow Dr writes you a script, you take it to a pharmacy and pay them to fill it.

That pricing is insane.

quote:

Originally posted by Chimney That pricing is insane.

Not really, I would consider that as a best case scenario. If you were diagnosed with anything serious there are no limits to how much it might cost. That's why people pay that much for insurance.

I suppose the Canadian system is very similar to the NHS in the UK.

Priorities based on your illness/injury and it's all free, except dentistry and some parts of vision care. (I think dentistry is free in the UK but I could be wrong).

The most annoying part of our system has to be the emergency room visits.

Since the system is free and family doctors are in such short supply (especially here in Quebec) you end up waiting a ridiculous amount of time because people show up to the ER with the most insignificant medical problems like colds and green boogers demanding MRIs to make sure they don't have something life-threatening.

Luckily, however, if you actually have a serious illness you are well taken care of and you don't pay for any of it (apart from taxes obviously).

Some up here would like more private options, and I couldn't agree more because it would ease the strain on the public system's resources if the rich people could have their treatment at a private facility and receive their surgeries privately as well.

quote:

Originally posted by Big Worm As others have said, the system over here sucks. Also, when considering the Affordable Care Act it's important to consider the massively dysfunctional government we have trying to deal with it. I am a fan of Obama and the intentions of his "signature legislation" but the administration has done such a shitty job from the start with the whole thing.

I agree with this.

I'm all for Socialized healthcare (although using the "S" word in public here gets you the same reaction as saying you like to burn American flags in your spare time) but sadly, the resistance against the ACA and the Dems being too pussy to bulldoze it fully through, meant we were left with a bloated and wasteful version of the law.

The main problem was that it should have been single payer - i.e. everyone has to be in and we all pay a standardized amount. Not this "it's up to you if you want to opt in" bullshit.

Yes, there is a "fine" if you don't have insurance now, but it's only in the form a minimal tax deduction exception. In other words, you get like $85 per year less tax deduction. That hasn't scared anyone in to making sure they're covered.

The other problem is that the administration REALLY fuck up the launched.

The company they used to build the website was a Canadian company (lol how unamerican is that?) called CGI that completely fucked it up. They already had a disaster over a Canadian healthcare site so there were questions as to why they were given it but then again, they are a big international government IT contractor so they should have been able to do it.

Long story short, they built it on a poor software platform, missed deadlines and the end product really just didn't work.

It's all since been fixed and now you sign up either via your job, a broker or your state's portal (which is how it should have been dine in the first place).

I'm not totally happy with the current system but there are two crucial things that have changed since the ACA came in to effect.

1, Despite republican's endless scaremongering about Obamacare, Healthcare costs have gone down for the vast majority of people (estimates put it at 80% of the population now have lower insurance premiums).

2, It's single biggest achievement: allowed people with pre-exising conditions to finally get coverage. Prior to this, insurance companies would just decline from covering you. That means any old injury, any previous or current illness (asthma, diabetes, arthritis, high blood pressure - you name it) meant it was either impossible to find a provider or they would charge so much you'd be better off just paying out of pocket.

That more than anything has been the game changer for health coverage.

The ridiculous part is that the republicans are doing everything possible to repeal it (the count is now above 50 votes/motions - all failed) but what needs to happen for it to properly work, is for it to go further; No opt out, everyone pays, and if you don't much less tax deductions. It would drive costs down further and make the entire system cheaper.

Spot on DJ RANN

Ignorant commenters in this thread: the issue with ACA is the constitutionality of the exchanges. In other words, you can't have some citizens pay higher fees for their State's inaction and reluctancy to set up local exchanges; citizens need protection against their own states' stupidity.

Obama stole all of the ideas from California anyways.

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