American Healthcare System

I won't speak to the bigger issue...as that tends to get nasty LOL.

We have it thru DH's work...I have never been without coverage even as a lowly retail worker....I paid for it sometimes and other times it was free. We use ours often enough with 2 kids....ours has never let us down, has covered what needed covering...and even tho my son's been kept in the hosp a couple of times...and my daughter's broken her leg...we've never had to sell things or be overly stressed making our portion of the payments for their care...or our own. Our scrips are reasonable. If my husband brought home the money he spends on health insurance we'd no doubt have spent it on more junk we don't need, LOL.

We always can get the kids into the doc when they are ill or we have concerns, typically that day...ditto my woman appts or yearly check ups...not a problem. Our wait times in office are around 10-15mins aside from the optho guy who's a lousy timekeeper...heh.

I don't really have anything to complain about aside from the lack of choices coming next year with dh's work as they're all rah rah over the healthcare savings account.

rwbeagles summed up the way I feel about it too. I have no complaints about the healthcare I get. I always get in the same day I call if one of us is sick. My brother had AIDS with no health insurance and the hospital social workers got him set up on a state plan and he never saw a bill for the 3 years he was sick before he died. He alos got the best of care with nurses even coming to the house to check on him a few times a week.

I have never been with out health care and hopefully never will be. We only consider jobs that offer healthcare.

l.michelle

In the US i have heard that the healthcare system isn't a "help first, ask questions later"  but to me, that doesn't seem right.

 

LOL, quite the opposite!  My experience with our health care system can be summed up by the time I needed treatment for a chronic foot injury and instead of the doctor giving me my options, he first asked what insurance coverage I had, because that limited my options.  So basically he decided how to go about it based on the insurance card I had in my purse at the time.

Like Gina said, getting health care has not at all been difficult (ie, plenty of dr's, urgent care centers, ERs to choose from).  I've never had a problem getting into a Dr or using an urgent care center if the Dr is not it.  It's paying for it that's the problem.  I have health insurance through my employer, but like a lot of people, there is a deductible that we never reach.  For example, say my deductible is $1000, that means I have to pay that much before insurance starts covering, so what's the point of insurance?  Sure, it helps if you get in a major accident that costs tens of thousands of dollars for surgeries, but for normal people that need yearly appointments and might have some non-life threatening conditions that require expensive medications and routine blood work, insurance never kicks in and even when it's supposed to, the companies fight you tooth and nail so a lot of times we just give up.  A few years ago, I was on a trip with my parents and we stopped at a Subway.  There was a message board at this gas station and one of the flyers had a picture of a newborn infant in an incubator.  The flyer was advertising a local bake sale, b/c this baby needed heart surgery to survive, the hospital would not do it b/c the parents were not sufficiently insured, so they were fundraising to save their baby.  My mom and I found it so sick, we still talk about it.  We are a first world nation and our citizen have to hold bake sales to save their babies?  Both DH and I have foregone health treatment b/c of cost.  DH has epilepsy and we had to cancel an EEG test.  We still have no idea why he has seizures or how long we have to pay $2/day for his medication.  I have an untreated chronic joint problem in my right foot.  We are still paying off the cast I had to wear for 2 months 2 summers ago so I haven't been able to look into new treatments.

Private insurance and private medicine is great....if you have REALLY good insurance!  Otherwise, YOU always pay.  The upper-middle class and above loves private health care b/c they get good insurance and/or can afford their deductibles anyway.  The middle class and below are screwed b/c insurance is taken out as a percentage of your pay check but you never get to use it b/c of the high deductibles.  I have what I would consider a very low deductible.  Like others, benefits/health care are a huge part of my job decisions.  I know some people in California who have to pay $5000 or more before insurance starts covering.  Sometimes it's more advantageous NOT to have any health care, b/c the county hospitals cannot turn you away and their are social programs that offer help.

I'm not really sure how I personally feel about it.  Every system has its pros and cons.  I do think there's something to be said about EVERY other developed country in the world besides the US using some form of universal health care system and the US slides farther and farther down on the Human Development Index.  Despite how we appear to the world, we are not the wealthiest nation. 

I have never been without health insurance either.  With all of the insurances I have ever had (both on my own and through a group plan), routine Dr visits were always covered with just a copay as long as I used an in network Dr.  I had to have surgery a couple years ago and I was on insurance independently and it cost me a lot more than it would have if I had been on the group plan I am on now.  However, I saw what the total charges were and even with my deductible and then paying 50% after that, I saved a lot of money b/c I paid at the insurance companies discounted rate. 

I have never had trouble getting into a Dr the same day if I am sick.  For routine checkups I usually call a few weeks in advance.  I think one big difference is the availability here of special equipment.  Just as an example, for me to see a specialist here with special equipment, I would have 10-15 choices in the metroplex where I live and would probably get in within a couple months if not less.  From what my clients have told me, in Canada, they may only have 10-15 of those machines in all of Canada and it could take 9-12 months to get in plus you have to travel to get there.  That sucks if you are in pain and have to wait that long to know why.  There is also government assistance here for people without insurance, but if you land in the wrong place income wise, you can fall right through the cracks b/c you will be seen but charged full price for the services.  I have a co-worker who doesn't have insurance and is in this boat exactly. 

Well, some employers pay for the benefit, some don't, and some pay part.  The main issue is expense, and the fact that the really good plans (the ones that used to pay 95% of usual and customary charges, but you didn't pay a balance) have mostly been replaced with HMO's (health maintenance organizations) that DO have an influence on treatment plans, especially as regards prescription drugs or experimental or unusual treatment.  An individual policy of that type costs most people about $500/month, with family coverage being much more expensive.  Many people choose jobs based on coverage, not what they would really like to do for work...  The only way you get a free ride on Medicaid is if you are destitute or disabled. 

DH and I pay $300 / month for our insurance and my employer pays the other $300. The deductible is so high that I will never really use it. The only thing that it covers is 1 yearly physical and 1 yearly well woman exam (with a copay of $20 for each). Anything above that I basically pay for out of pocket because we have a high deducible that I will never reach.

I have been without insurance and because I have a chronic condition (severe asthma) that will always require medication it was rediculous. When I was in college I made $200 / week working and because I made that income I was not eligable for medicaid. All of my doctors visits and medications were out of pocket and I often had to go without because they require you to pay when you recieve the service and they wouldn't bill me. Because I couldn't afford my medication my asthma would flare and I would end up in the ER which was even more expensive. It was a vicious cycle. The hospital sent me into collections because I would only afford to make minimal payments with my crappy income. When I broke my ankle I tried to get by for 2 days hoping it was only a sprain because I just couldn't fathom spending more money on medical care. It was broken and because I tried walking on it for 2 days it never healed correctly even after I went to the ER to get it set. I still have problems with it, and it sprains constantly now. I've only just recently managed to get out of my previous medical debt, and now I've been laid off so I will need to do without insurance again until I'm able to get another job. At least I'm well stocked on medication.

l.michelle

In the US i have heard that the healthcare system isn't a "help first, ask questions later"  but to me, that doesn't seem right.

DH is a firefighter and I know that they have to treat and transport every patient that requests it, regardless of their insurance coverage or ability to pay, so in that case, it really is a "help first, ask questions later" situation. For a patient on MediCal, the reimbursement to the city is $45 but for anyone who has to pay or has insurance coverage, it's several hundred dollars, and that's just for the transport and doesn't include other treatment provided.

 

Basically it is a private health system as opposed to a government-run system.  Hospitals and doctors are essentially self-running, independent practices.

Health insurance companies (also independent of the government) provide a method of payment to US citizens to cover medical costs (regular office visits, surgeries, medications, etc).  Most people get this coverage as a benefit from their employer.  The employers cover all or some of the insurance premiums in most cases (mine pays for half, the other half is taken from my paychecks).  As an employee, I don't think you are ever required to have the health insurance offered by your employer; it is optional.  Some employers offer multiple options of insurance packages that the individual employee can choose from and some just offer one plan.  That is up to the employer, and many of the plans vary based on the size of the company (ie-number of employees a single company has on the plan).

There are also individual health insurance plans, that someone can get independently of their employer.  This is often used by folks who are self-employed, who choose not to get coverage from their employer, or who's employer does not offer insurance as a benefit.  Also some employers don't cover family members, so a woman who is covered by her employer may choose to get an individual plan for her kids.  These tend to be more costly, because the premiums are not being covered in part or in full by an employer, and many have high deductibles (as Liesje explained).

There are some government-subsidized health plans, mainly targeted to the elderly, disabled, and children in poorer families.  Also, it should be noted that it is illegal for hospitals to deny emergency care to a person for the simple fact that they do not have insurance.  Everyone, insured or not, has access to health care.  There are many local government run clinics around the country that offer free non-emergency health services to folks without insurance, so ERs are not the only option for the uninsured.  These clinics are funded on the local (county, city) level by taxes.  I've been to them before, in college when I didn't have insurance.  You wait a while (hour or so), but it's free.

I'll leave my opinions out as well.  I'm not in the mood for a firestorm today, LOL.  I just wanted to explain basically how it works here.

 

Oh I forgot.....I've had 2 kids and with each the bail to get outta the hospital was between $200-500 which I consider reasonable.

As others have said...it sucks to pay for it...but honestly I'd be doing NOTHING productive with the money if dh brought it home...I freely admit that. But maybe that'd be better for the economy? who knows?

Our deductible...lol...when you have 2 kids, you reach it pretty easily...LOL. We've met ours before. I think ours is on the low end tho.

If you have money, it's great.  If you don't, it sucks.  If you are relatively healthy, it's great.  If you get sick, it sucks.

I've had several different types of plan with different employers.  Some HMOs, some PPOs, some employer sponsored plans.  The common denominator among them is the tactic of "not receiving" claims multiple times, and then denying perfectly valid claims multiple times in the hopes that the insured will give up, get nervous and just pay the claim themselves and give up.  This happened repeatedly with my former in-laws who grew up in the generation of paying bills the minute they were received.  They could not let an account go to 90 days and did not understand how to fight with the insurance company to make them pay.  My son broke his back and it took getting not one but 3 representatives of the insurance company PLUS the human resources manager on multiple conference calls to get the claims paid.  The following enrollment year, CIGNA lost that account as a result of us bringing the problems to light to the people responsible for choosing the provider.  I had one company tell me in response to denial of a claim "We don't cover feet".  Seriously, they had eliminated an entire body part as being covered!

I recently came off a COBRA plan and if not for federal laws requiring the insurers to issue me a policy, I would be uninsured due to pre-existing conditions.  As it is they were forced (unhappily) to issue me the minimal policy at the maximum cost.  I anticipate much resistance to paying any claim I may submit.   

On the good side, you can access a specialist of your choosing if you have the proper plan or the money.  Also, there are laws that require hospitals to provide service, so if you show up in distress, you have to be treated (up to a certain level of stabilization), but it will probably bankrupt you if you don't have insurance.

It's a mess, honestly.  I've seen and experienced care in other countries and I think our system is in need of a major overhaul.  But the greed-driven corporations that govern it will never let that happen.  I didn't find Michael Moore's "Sicko" to be all that off-base from my experiences.

I have Kaiser and while I'm not thrilled with it for a lot of reasons, I can't really complain much about it either.  Everything is covered, and if I have an urgent situation I'll see a doctor the same day.  I might have to drive to a different clinic in a different city, but I'll get in somewhere. I pay separately for Kaiser for my grandson and his is $208 a month with a $25 co-pay.  Fortunately he doesn't need to see a doctor all that often.

Joyce

I'm not too big of a fan, honestly. I've been uninsured since I graduated HS in '08 - I had state-funded low cost insurance up until then. I've been lucky that my GYN lets me get away with 1 exam every 2 years, and keeps refilling my birth control prescription. When I went for my well-women exam in February, I got out of there for $200, plus another $100 in labs *sigh*. An entire week's paycheck. Before Wally-mart had $9 generic BC, I quit taking them because the GENERIC was $60 and I need that money for things like, you know, food.

And as for free county/city clinics, ours don't cover you if you're a college student, BUT the health clinic on campus doesn't take care of you if you live off-campus. It's a catch-22 really. Sometimes I am really, really jealous of people with insurance - doG forbid I get seriously injured or something, I don't know what I'd do.

sl2crmeg

Sometimes I am really, really jealous of people with insurance - doG forbid I get seriously injured or something, I don't know what I'd do.

If you're injured and wind up in the ER, they have to treat you for whatever the problem is even if means emergency surgery. Legally, they can't turn you away.  A lot of people have medical bills probably ranging up into the thousands and I'm sure most of  them will never  be able to pay them ... but it's not like they can put your appendix back in if you don't have the money to pay for it.

Joyce

Honestly, these threads make me want to vomit. I am astounded how little people actually know about the healthcare system here in the united states and those in other countries. There is much that needs to be improved here, but it's the greatest healthcare system in the world. In countries like sweeden, healthcare is VERY paternalistic. The literature is intersting actually, your doctor in that country gets to decide if when to pull the plug if you are sick. They get to decide pretty much every aspect of your healthcare. Americans just don't jive with that enviornment. Socialized medicine does not breed innovation or greatness. The united states actually has very specific rules about doctors coming over here to work from canada because soo many of them were flooding the united states. The greatest medical breakthroughs in the world don't come from there and the enviornment sucks. How would you like someone to tell you what hospital you have to go to? What doctor you have to see? Whether you get a mastectomy or a lumpectomy? How about waiting 5 months for a colonoscopy when you are having rectal bleeding? A significant portion of that stupid movie sicko is incorrect. I wish that idiot would go to cuba fore his healthcare. Dr. Sanjay Gupta's special on it was very good last year. If you think if you get sick and have no insurance you will be turned away you have no idea about how medicine works in this country. It IS HELP FIRST ASK QUESTIONS LATER. Your acute care is the same regardless of what you can pay or if you have insurance. What is different is what you have at your fingertips after you leave like physical therapy and what particular doctors you can see. You will get taken care of, but you won't get me just because you want me. If you are diagnosed with colon cancer and need surgery, you can go to county and have it done essentially for free. You may not get a private room or a laparoscopic colon resection like at cedars, but you will be well taken care of following the standard of care. One of the biggest problems in this country is the huge population of people who can pay for it but don't. In addition those that think they are above the county system and abuse the private sector. People in this country don't value medical care at all. They go and pay more on an accupuncturist for their dog or their hair cut then it would cost to be insured. I would love to see people for once have a positive thread with real suggestions or thoughts about how to improve it instead of it sucks, everywhere in the world is better. Guess what, doctors, nurses, pharmacists deserve to be paid a lot. They sacrafice many, many years, hundreds of thousands of dollars in loans, personal stresses of being responsible for people's lives. Imagine being responsible for a decision that could kill a patients. Imagine being responsible for a decision that could mean a lawsuit that will bankrupt you and or your hospital/practice. The money to pay these well educated, hardworking people has to come from somewhere. You get what you pay for guys. What are you willing to pay for? Do you want to go to county? Or would you like to come to cedars? If medicine in this country was universal and socialized you get county, sorry no choice. It is the obligation of the rich to help the needy IMO. It's not the obligation of others to help the stupid, lazy, and selfish. Americans are the problem as much as the healthcare system is.