Re: American Health Care
Hi. Maybe I can weigh in. I used to work in healthcare and have recently been scarce here on the board as I seriously injured my left forearm near the wrist. This required surgery and a permanent titanium plate and screws to repair my shattered radius. I am also currently going through physical therapy and still require some meds. In other words, I have used my insurance to most of its extremes lately.
As Todash eloquently explained, the services for the uninsured are not the best here. Medicare is for those over 65, or in some cases those determined disabled. My mom qualifies for this as she is 60 but suffers from a disease that has kept her from being able to work. In most of those cases, however, this coverage is provided via Medicaid. Medicaid is funded via the Medicare fund, but is a disbursement given to each state. The state then funds a portion too and it is provided to low income persons, people like my mom and for some services such as nursing homes. To qualify for it, however, you have to be almost destitute or completely helpless.
If you have nothing, which often happens to those who are in the area that isn't poor enough, but too poor to afford private insurance, illegal immigrants, etc., the you can go the emergency room for serious injuries or go to the "free clinic" or "DHS" that counties (or parishes) provide via state and Medicaid funding. You can get immunizations there, women's checks (PAP, etc.) and some basic services. It is mostly free, but sometimes involves a small charge of a few dollars. A newer thing for basic cold, flu, sinus infections, etc., are "Minute Clinics" in large chain drug stores. They will diagnose basic illnesses for free via nurse practitioner and write you a prescription for basic antibiotics. Beyond that, if you are seriously injured (as I was) the options pretty much suck. You are in the hands of charity at that point.
So my recent experience: I have employer insurance, and comparatively good insurance. I have my whole family on it and pay about $200/week for health, dental and vision. It has a deductible of $500 per person and $1500 for the family. That means that for covered procedures I have to pay the first $500 out of pocket and then 20%. The coinsurance (the 20%) and the copays (like the $25 Todash mentioned, mine is $20 for regular docs, $40 for specialists) each count toward the out of pocket max, which is $2500 per calendar year for everything. That basically means that if I was to have a major illness or injury, the most I am supposed to pay for the services, etc (that are COVERED) out of my pocket is $2500 for everyone covered for the year. This does NOT include the weekly premiums I pay for the insurance in the first place. So in reality, for a major thing, with premiums, around $10K a year would come out of my pocket, but none of that includes meds on most plans. Confused yet? Therein lies the problem and the debate.
Before the health care law that was so maligned by the neocon windbags, there was almost no way to know how much something would actually wind up costing you and also very hard to determine what was covered at times.
My surgery had a retail price tag of around $35000. since my surgeon was "in network" they write off a huge portion of the cost and for everything it has wound up costing me around $1500 out of pocket. The other jacked up thing about this is the surgeon,m facility and even the surgical staff and anesthesiologist all bill separately and may or may not be "in network"!! I actually got a bill fro the anesth for $9000 for putting me out. This is because the insurance said his fee was too high and decided he was not in network, even though he works for the surgical facility that is!! HUH?!?!?!??? This can be remedied by making some calls, etc and many hours of dealing with these jokers, but imagine when you're recovering and not well trying to deal with all that crap. And this is WITH good private insurance. It's a joke frankly.
When you lay it out with a real world scenario like this, you can see why many of us are effin' sick of this sh!t and demand national health care. As a matter of fact, the simple reason that I never actually know how much it will wind up costing me in the end to see a doctor, has made me avoid the doctor for many years now. I go in for a yearly check, but if I get sick, I just tough it out typically. This is because insurance companies will do everything they can to deny anything they can. Because it's all for profit. No one has ever been able to explain how a for profit company who does better if you pay in and they don't pay out, could ever have my best interest at heart if it is less profitable for them to pay for the treatment needed. Beyond that, the only argument those opposed to "Medicare for all" essentially boils down to the providers are greedy and don't want to control their fees because that is "anti-american" somehow to do so.
In short it's all a confusing expensive mess, driven by greed first and with a low emphasis on the best thing for the consumer.
U-S-A!! U-S-A!!! U-S-A!!
Reply With Quote
Originally Posted by hossenpepper
..*SN
RT!* yeah that one was a pretty freakin' good one, wuddnit
?) , and thus give up, hmm, well what else, perhaps shoes, refrigeration?
!
Bookmarks