American Health Care

[Mary19]

Hey everbody. Although I have a general idea about the American health care system, I don't really have a strong sense of what it's about, who get's it etc. It's a hot topic in the news all the time but I'm very curious about details. Please chime in if you care to educate me. If you don't buy insurance do you really get nothing? How much does decent health care cost? Why is Canada so different?

[Todash]

LOL ... Well, Mary, it's rather like the Facebook relationship status "It's complicated." There's a safety net for older adults, Medicare, and also Medicaid, which is for certain low-income adults and their children, plus people with some disabilities (although qualifying for that is quite a task, I hear). Most of us are covered by private plans through work, some of which is usually paid for by the employer as part of your benefits, and some of which is usually paid for by the employee. More and more, the employee is having to pay for a larger portion. There are plans you can buy individually, but those tend to be really expensive, easily running hundreds of dollars a month, and they may not provide much coverage. There are a few plan types, but I do not know anyone who can go to the doctor or get medication without paying something. My office copay is $25, which means I pay $25 every time I see a doctor. If I go into the hospital for any reason, I'll pay $200 plus 10% (I think), as long as it's "in network," which means that the hospital and my insurer have an agreement about how much they get paid for what services. Otherwise it, as any out-of-network service, is much more expensive. My drug copays are $10/$30/$50, meaning I pay $10 for any generic, $30 for any preferred medication, and $50 for any non-preferred medication. That's for one round of medication or a month's worth, whichever is shorter. I've had insurance before that was HSA, meaning that although I paid out of my paycheck every month, I still got the privilege of paying out of pocket for my medical expenses until I reached the out of pocket max, which typically I don't in a year. I'm still a little fuzzy on what I got out of that deal. Oh wait, that's right: "the 'freedom' to make my own choices and control my own expenses."

Unless you qualify for Medicare or Medicaid, if you don't have insurance, yes, you get nothing. Lots of people who are employed feel that this is not their problem, but the truth is that anyone can lose insurance at any time, and if you happen to be under a doctor's care at the time, that can in some instances prevent you from being reinsured. This is not hypothetical, it's a real thing. Plenty of people with cancer have lost coverage and simply died because they were unable to get insurance or afford treatment on their own. Capitalism at its finest! So hard to see how anyone thinks that might be flawed.

Now, there is one place that care is guaranteed: the emergency room. That, of course, is where you are supposed to go if you've broken a large bone, feel chest pain, have been stabbed, have a fever that's on the verge of causing brain damage, etc. If you go to the ER, they have to stabilize you regardless of your ability to pay. Guess where people who can't pay to see a regular doctor go when they have, oh, say, a migraine? That's right, the ER. Guess who pays for that? The rest of us, through higher insurance rates.

Yeah, we don't got no problems with our current setup. It's AWESOME. Until it's not. And then you just die ... but hey, you are dying in the greatest country in the world, right? Surely that's the shiniest of all silver linings.

[GNTLGNT]

....Yikes-a-mighty!....wouldn't even know where to start 'splainin' that one Lucy!...I will only say that there are those without, and at the other end of the spectrum-those that receive pretty much free health care...and the rest with varying costs, fall in-between...

[PatInTheHat]

Simple, American health care is a profit driven commodity, no more, no less, not really.

[fljoe0]

It's not complicated

DON'T GET SICK

[JordyVerrill]

I purchase my own health insurance and pay $180 a month for it. I have a $30 office copay and a $6000 deductible. I have to pay $180 a month because I have a pre-existing condition, otherwise I would only be paying $120 a month. How many people who complain about the cost of health insurance or don't think they can afford it easily spend $120-$180 a month on cell phones and cable TV?

[nygene40]

Insurance is a nightmare, especially when you get sick (and I'm talking life threateningly sick) you spend as much time undergoing medical treatments as you do having your mailbox crammed with notices from the insurance companies denying to coverage for this, that and the other thing. Filing appeals is a full time job, which isn't easy when you are sick and having reactions to the treatments. Heartless paperpushers!

[Todash]

I purchase my own health insurance and pay $180 a month for it. I have a $30 office copay and a $6000 deductible. I have to pay $180 a month because I have a pre-existing condition, otherwise I would only be paying $120 a month. How many people who complain about the cost of health insurance or don't think they can afford it easily spend $120-$180 a month on cell phones and cable TV?

Wow, that's not too bad, actually. I think that's about what I pay as my portion through work. I can tell you that the people I personally know with no insurance fall into two categories:

1. Employed but no insurance offered through their employers, at an income level where the cell phone bill is often prepay, nothing fancy, and there's definitely no cable.
2. Employed, making decent money, cannot get employer's insurance because of preexisting conditions combined with being out of work just long enough to have to back pay thousands for COBRA, OR they can pay hundreds a month for health insurance on their own. (In the specific case I'm thinking of, my friend is a breast cancer survivor, which makes the insurance extremely expensive, and the problem with that is that being out of work for several months, even being careful, she ate through her emergency fund and other sources and is using what she has now to catch up to avoid losing assets like her house.)

I'm not saying that there aren't people who can afford insurance but choose not to. I'm just saying there are a lot of people who have to choose between health insurance and eating. It is a real thing.

[Mary19]

I know it's a tough question, thanks to everyone who is replying. We get taxed to death in Canada right off the hop which frustrates me but anything I need medically for the most part I get. I never pay to see a doctor and if anyone needs an operation of any kind they get it. The more we make the more we pay in taxes which supplements those who don't make anything or very little. I have been on both sides of this fence because my family had no money when I was young and my father had several medical issues. If we had stayed in the states he would have been screwed, but in Canada he got excellent care. My husband and I make decent money now but we get nailed in taxes because of it. When I get mad about that, I think of all the people out there like my father and it stings a little less.

[PatInTheHat]

I purchase my own health insurance and pay $180 a month for it. I have a $30 office copay and a $6000 deductible. I have to pay $180 a month because I have a pre-existing condition, otherwise I would only be paying $120 a month. How many people who complain about the cost of health insurance or don't think they can afford it easily spend $120-$180 a month on cell phones and cable TV?

Yeah that would be the responsible thing to do, pay every single discretionary ducat you have to the overpriced, over lauded, under performing, 24/7 butt covering, takes no responsibility (because it's the "practice" of medicine you silly gooses) American health care system, that is, and whatever's left over, go buy yourself somethin' pretty, like light maybe.
Your plan with the six large worth of a deductible (the size of which also lowered your initial premium costs I take it, not to mention your co-pay), is well beyond those I think your speaking about meager budgets, with or without electronics, thus, with a lower deductible in a range they might be able to meet, how much more would they have to cough up every single month (and we're not counting those fun fun fun for the whole family premium rate increases, which oddly do not so very often correlate with many folkens pay raises..*SNRT!* yeah that one was a pretty freakin' good one, wuddnit?) , and thus give up, hmm, well what else, perhaps shoes, refrigeration?
By the way, who is your insurer?
See I got kin up in Cincy that could really use a lower premium, and yours, even with that hard deductible, is scratch & dent bargain basement, and as for what my insurance would be right at this moment, well, I don't think even has a dollar number coined for it yet, so big kudos & props to you, and though it almost sounds like a waste of good hard earned dough, well you know, if it wasn't for that beat down of a deductible, I toast to your very good health!