American Healthcare System

I couldn't agree more Ottoluv!! 

We have crappy insurance right now.  $5000 deductible so essentially we pay out of pocket for everything.  But once we hit that max we pay nothing.  However, whatever we want whenever we want, we get it.  We wait for nothing.  When you go the emergency room (at least in my experience) they start treatment on you and then ask if you have insurance, not the other way around.  I believe it is illegal for a hospital to turn you away if you don't have insurance.

My dad's friend was DENIED knee replacement surgery in Canada because he was too old (he was 70) and because he had a history of cancer so they figured it was going to be a waste of money.  His other friend had to wait 4 years for his surgery (have you ever known someone that needs knee surgery - waiting 4 years is like a lifetime).  They were fortunate because they had the means to come to the US and get surgery by paying $$.  Can you imagine how people in the US would feel if the government told them they couldn't have a surgery they needed because it wasn't life threatening and "they" deemed unnecessary?  People will freak out.  All people hear is "free healthcare" and everyone screams yes!  They don't realize that nothing is free and you have to give up something for it.  I am not willing to give up my freedom of choice, especially when it comes to my daughter. 

Think about it, can you imagine the government telling you that you can't see a certain vet specialist or your dog can't have a specific surgery because "they" deem it unnecessary...yeah, I thought so.

I agree with Kelly too,. I haven't done a ton of research but enough to know that what we have is far better than socialized medicine. 

I have Blue Shield and it's been fabulous. When my Dr, found that I had a growth on my thyroid, they sent me for a biopsy and it came back as non-cancerous. The next year, it had grown a tiny bit and they were going to send me for the biopsy again. I asked my Dr. if they couldn't just remove it for cosmetic reasons (it was a visible lump on my neck). He said "yep, I don't we'll have any problem getting that approved" and they didn't. I was in surgery a few weeks later and treated very nicely. I couldn't be happier with my healthcare and I feel very lucky.

 I don't have anything against the DOCTORS in this country, I have huge issues with the INSURERS who deliberately engage in tactics to reduce their payouts.  I HAVE been turned away from numerous doctors' offices because of problems with CIGNA and the COBRA providers' computer systems being screwed up and showing I had no insurance when I did.  (The monthly feeds from the employers were never posted to the insurer's system until long past the 15th of each month.)  The result was a much more expensive visit to an ER which could not turn me away rather than a $25 copay at my primary care doctor because my insurance showed inactive.  It's nice to hear that in other areas of the country, "Where's your insurance card" is not the first question asked, but in the areas that I have lived, it is.  In fact, in my current area, there are several offices who WILL NOT SEE YOU if you don't have your card.  Even if you have all the info, without the card in your hand, you won't be seen. Period.

I have luckily not had life-threatening emergencies or conditions requiring surgery while living in other countries, but I can tell you that care I received in Australia and Japan was higher quality and lower cost, so there are places in the world where insurance isn't the first topic of conversation before vital signs are even taken.  Having a physician come to our home (or hotel room), treat, prescribe and dispense meds for around $50 beats the US system by miles!

Ask a few doctors how they feel about the "system" here.  The "system" meaning the fact that LPNs and RNs working for the insurance companies are making their treatment decisions for them based on cost and not need.  I know several GREAT physicians who are leaving the field completely because of it.   

BCMixs

I don't have anything against the DOCTORS in this country, I have huge issues with the INSURERS who deliberately engage in tactics to reduce their payouts.

 

I agree. I have a friend who has undergone two kidney transplants and now his current kidney was removed b/c the same disease developed and attacked it.  He has spent months at Mayo being studied and the Dr's want him to try a new drug, rather than keep doing transplants that only work for a few years.  However his insurance company told him numerous times they would not help cover the drug.  OK, I understand if that's the rule, but this guy went back to school and ended up sitting next to a girl that worked for this insurance company.  He explained it to her and she told him it was BS, the company would help cover the drug as long as he filled out the appropriate papers and I think had to have 3 dr's make the recommendation.  So basically he spent yet another year on dialysis being lied to by the insurance company telling him they can't cover the drug that will eventually save his life.  All it took was meeting the right person to get the ball rolling.  He's lucky that happened, but what about other people who are told the same thing repeatedly and never run into someone from the company willing to actually do their job?

However I also agree w/ Kelly that Americans are just as much at fault.  It's sad that we have the catch 22 of health care providers having to charge so much to cover their arses against the public and then the public complains about how much they make/charge when they are the ones threatening to sue over every little thing. 

There's more than one side to the story.  Can't lump the insurance companies, the health care providers, and JQP into one group. 

That's very true about the lawsuits.  My OB/GYN that I loved left practicing medicine because of the lawsuits involved in maternal medicine.  That's an unfortunate double-edged sword, you want to have the option of suing in the case of gross negligence or serious error, but that option comes at a high cost to the overall system.  My HMO kept telling me my previously diagnosed and surgically treated endometriosis was all in my head until I told them I was suing, suddenly I was all cleared for a 2nd surgery!  My ex has been controller at several companies.  One of them was insuring themselves but having a company process the claims.  It was clearly communicated that the claims were not to be paid before 45 days and huge batches would be "delayed" if the timing of the cash flow wasn't right.  

There was just something on the Today show about a baby who needed prescription food to live and was denied by the insurance companies. There's some new bill in the works, but I didn't get all the details. 

SalemsMom

DH and I pay $300 / month for our insurance and my employer pays the other $300.

 

Holy crap!   Here I was refusing to get health insurance because it would cost me upwards of $56/month.

I don't really understand health insurance. I haven't had ay health insurance for years. I pay a medicare levy if I earn over $50 000 a year and the levy is either 1 or 3% of my taxable income. The government has just raised the threshold to that from some lower figure that meant I was paying about $300 Medicare levy. When I go to the GP, a consultation costs me $55 and I get $32, I think, back. All the basic prescription medicines are subsidised, I think. At least, the contraceptive pill I'm on is and anything else I get usually costs around $12-$25 for a course. Families have a safety net where they don't pay anymore for prescriptions after a certain point, I think it's $1000. If I need an ultrasound for a muscle injury, or an x-ray, I pay about a third of the cost. If I need to see a specialist, I pay either nothing or the usual docotor's fee depending on the nature of the specialist. I'm sure there are specialists that cost a lot more, but I haven't been referred to any, yet. I can get elective surgery for free if my doctor says I can, but I have to wait, possibly 12 months or more. I've never heard of anyone's doctor refusing to get them elective surgery. Dental is what annoys me, because I don't get any cover at all for that unless I have private health insurance. I've been to the ER once and wasn't charged a cent. I had a pap smear done the other day and only had to pay the consultation fee, but when I had an ongoing UTI, they charged me for the first 2 urine analyses, but not for the second 2. Pathology is a little different, though.

It's true that I don't really get my choice of who I want to see through the public system. I can choose my GP and my specialist to a certain extent, and I can choose my hospital in at least some circumstances, but that's about as far as the choices go. To be honest, I'm fine with that. I'm also fine with paying for the health care of people sicker/stupider/lazier than me. Maybe it's all I know, but the only thing I don't like about Medicare (apart from the dental and long waits for elective surgery) is that I still have to pay a small fee to see the doctor and how that adds up when you get a bit of an ongoing issue.

Wow!  After reading about the health care system, I see there are different sides to it, both good and bad.

Here, I pay $56 a month to my employer for my extra medical insurance, so it covers not only regular healthcare and prescriptions, but also dental, eyes and hearing.  It is good, because with my health card I can walk into any doctors office and get treated without paying anything above my 56$ a month to my employer.  Even without having medical insurance through my employer I can still go to hospital or the doctor and not pay anything.  I would just have to pay for dental and such and for perscriptions.  Right now with my health insurance, I pay $1 for my prescriptions.

It is really good to have this freedom.  However, to get an appointment for a specialist you need a referral from your doctor.  Making an appointment with the specialist is easy enough, however you are looking at seeing the specialist sometimes 4-5 months later sometimes even longer.

 One of the things that does bother me is the lack of availability of Medicaid services if you don't live in a city.  Suburban docs often don't take Medicaid because the reimbursements are so low, and someone like my BF, who is severely disabled, has to go outside the community for some services, such as dental (he gets partial dentures covered, which I had to pay for because he had no money - $250.  If I wanted partial dentures, it would cost me $1600 and I have insurance, plus I would have to wait a full year for the lowers if I had the uppers done first).  The system may be the best in the world, but some of us who don't make doctors' salaries, are drowning in it - we don't go for care because the deductibles or the co-pays would kill us.  That's not OK, IMO.  We need to do something to make this as equitable as possible, both for the patients and the providers, and no, I'm sure I would not want to wait four years for surgery, but I also don't want to see my neighbors and co-workers get nothing because the premiums eat up so much of their pay that they can't put gas in the car to get to work, or feed their kids.  For some people, it has gotten that bad, especially the seniors.

l.michelle, can you adopt me?  I'll pay you the difference between the $56 you're paying and the $450/mo. I'm paying for a $2500 deductible for medical, $1500 deductible for prescriptions and no eye care whatsoever!

Those Canadian men are looking hotter every day! LOL!

If you're facing a divorce (as I was long ago), make sure health and life insurance is covered in your settlement.  You don't realize how important it is or how negatively it can impact your life until you don't have it!
 

l.michelle

It is really good to have this freedom.  However, to get an appointment for a specialist you need a referral from your doctor.  Making an appointment with the specialist is easy enough, however you are looking at seeing the specialist sometimes 4-5 months later sometimes even longer.

 

We have that here with some HMOs.  Not only do you need referrals for specialist, but you can only choose a primary Dr. on your HMO's list and you can't switch unless you file paperwork first.  Last year, it took my DH 6 months just to get a regular physical exam with his primary doctor.  I think it works both ways though, if I understand correctly many specialist only accept referrals, so it's sometimes the specialists themselves, not the insurance companies, making that requirement.  To me that makes sense b/c so many people incorrectly self-diagnose and it would be a waste of a specialists time to accept anyone that wanted their services, even though referrals lengthen the process.  Since DH is a student, I have him use the health clinic at school b/c it's $15 for students.  He can get in within a week instead of waiting months for his physician and then even more months, should he need to see a specialist.

Our insurance plan has copay for routine visits, but there are stipulations like which Dr's you can see and how often you can see them or they won't pay.  They cover prescriptions, but it depends on which one.  Mine is $10 for 3 months, but DH's is only covered 60% and his pills cost $2-$4 a day.  Also, they don't cover routine blood work required by the physician and neurologist, which I think is crazy.  I put off getting labs done on myself b/c of cost, and luckily where I work offered a free "health screen" where they drew blood and tested glucose, HDL, cholesterol, etc.  Now I just have to see if the Dr. is OK with me faxing her that report b/c I'm not paying hundreds for labs when I had it done for free.

Sounds great...for a young healthy person. I expect Cathy's ex is more what's in store as one ages and becomes less fit overall. That goes for both types. IMO.

I don't have an issue with our health insurance really, my issue is that I just don't get *why* certain stuff costs as much as it does.  I went to the OBGYN and just got a normal exam that you get to get your birth control refilled.  When I looked at the before insurance total is was $615!  I could have my vet come out to the barn and do the same thing (and just as good a job) to a horse for less than $150.

Jack's surgery to remove the underwear was $1100.  My surgery to remove my appendix was $13,000.  

sillysally

I don't have an issue with our health insurance really, my issue is that I just don't get *why* certain stuff costs as much as it does.  I went to the OBGYN and just got a normal exam that you get to get your birth control refilled.  When I looked at the before insurance total is was $615!  I could have my vet come out to the barn and do the same thing (and just as good a job) to a horse for less than $150.

Jack's surgery to remove the underwear was $1100.  My surgery to remove my appendix was $13,000.  

 

First, because the standard of medicine is much lower for animals then it is for people.  There are much stricter rules for how things must be sterilized or what cannot be cleaned and reused in the operating room for humans and requirements about medications.  For example, a vile of medication cannot be shared between patients, so even if you use a 1/4 of a vile of medicine, you pay for the entire thing.  Some of the anesthetics we use in the OR are much, much newer then the old ones they use in animals and have much better safety profiles, but they are exceedingly expensive.  In addition, the physicians liability is astronomical compared to a vet.  If your horse dies, you vet won't get slapped with a ten million dollar suit as he could if you die.  Your vet doesn't pay 150000 a year in liability insurance as your OB/Gyn does.  You also require two doctors for the surgery, a surgeon and an anesthesiologist, plus two nurses (a scrub and a circulator).  You also have a second team and third team of nurses, one in the PACU and one on the floor after surgery.  Sorry, but it's not the same thing at all.  I would doubt also, your doctor used a 50,000 laparoscope  to operate on your dog so that he could have three tiny incisions (although many places still do open appendectomies).  Also about your OB/Gyn visit, the pathology is read by a second doctor as well.  If they are wrong and don't diagnose cervical cancer, they get slapped with a 10 million dollar suit as well.  It all adds up as you can see.  Many of the expense of human medicine is due to the history of malpractice suits which influences all the rules we follow, and it will only likely get worse unless there is more legislation to protect hospitals and physicians from frivilous lawsuits.  Some of these changes are good and add to patient safety, but many are worthless and only add to patient expense.  Something like 90% of medical malpractice suits are thrown out, but they still cost money.  It's like comparing a CIA operative to a security guard at walmart IMO.  (not anything against vet medicine, they just don't have the money to use as we do so they don't do/use many of the things we do).
 

 The vet's also don't charge $5 per maxi pad after the spay either.  Abuses abound, check your bill, bring as many of your own meds as possible and wear your own pajamas if going in for a surgery, the hospital tried to charge me $100 for pajamas that would have been left with them had I not brought all of my own supplies AND insisted the nurses note it on the chart.  $35 for two ibuprofen????  Are you kidding me????  Of course, I had to get royally screwed during my 2nd c-section to realize the games they play.  Most people don't even LOOK at their bills or insist on an itemized bill so they can review the charges.  That's why a simple surgery costs thousands and thousands of dollars!  The in-room and pharmacy charges for my c-section exceeded the OR and physician's charges!

 

Yes but BC, you don't have a pharmD making sure your medications don't interact with the anesthesia and other mediations you are given when you are at home or a nurse administering it to you, making sure you don't have a reaction.  You are looking at it the wrong way, it's not the med that's 35 dollars, it's the med plus everything else.  You also in general cannot take your own meds at the hospital because I don't know for sure what you are taking and I will not allow myself to be liable for your mistakes.  Some charges are trumped up, but some are not.  I agree you should look at your bill, but don't make assumptions about the "games" that are played.  Hospitals get only a few cents on the dollar for what they charge, so you need to understand that too.  Hospitals are just trying to break even, or make up for losses in other areas.  The only two areas in the hospital that make money in general are the OR and NICU.  Money from there goes to cover huge losses elsewhere like emergency departments.