Insurance etc in the US

[gwenllian111]

Please forgive me for what seems a very ignorant question - but I wanted to ask about the healthcare system in the US.

In the UK, we have the NHS - free healthcare. Why do American's not want this type of healthcare system, as I understand there is a huge divide about it.

Also, how does your insurance work? What if you have a pre existing condition? What if you don't work?

Thank you,

Gwen

[annekat]

It would be hard to talk about this much without getting into politics, but if you follow Sangye on Twitter you will probably run into some discourse on it. To answer your some of questions, THIS American would like a national healthcare system. People are resistant to it because it doesn't seem American to them, and they'd prefer to let the current free market health care system continue without government interference. The new reforms in place do prohibit discrimination based on pre-existing conditions. If you don't work, or have a job that doesn't provide coverage, you have to pay for your own insurance, but there will be provisions for helping low-income people in the new system, which hasn't fully taken effect yet. We do currently have Medicare for seniors and the disabled, with relatively low premiums but with significant copays, and Medicaid for very low income people. That's about all I know, which isn't much. And it's not an ignorant question, as it is a confusing issue with lots of inaccurate hearsay being repeated, possibly on both sides.

[annekat]

I might add that some aspects of health care are controlled or facilitated by individual states, and some states have adopted their own health care systems. Examples: "Romneycare" in Massachusetts, which I honestly don't know much about, and in my home state of Washington we have Basic Health for very low income people, which has been cut back and been threatened with closure due to lack of funding. I was on that and paid a ridiculously low premium, and then there were some copays, but a lot was covered. I would have been glad to pay a higher premium for better coverage or so that more people could benefit. I'm now on Medicare and it is costing me more than being on Basic Health, but I had no choice once I'd been on SS Disability for 2 years, with my retroactive benefits entering into the calculation.

[Pete]

It all gets down to this maxim that I learned from my company's VP of human resources and a designer of many benefits programs over the years: With health care insurance, employees want (1) high quality, (2) easy access, and (3) low costs. Unfortunately, they can only have two of the three in any given plan. The economics don't work if you try to provide all three. Most Americans seem to prefer high quality and easy access, thus annual costs have risen at a rate that is double the rate of inflation (or more). Hope this helps you understand the USA's market-driven health care "system".

[crackers]

when i joined this site back in 2008 i used to sit here and shake my head in disbelief at the posts of our US cousins.their stories of battling with insurance companies to get treatment and/or drugs was baffling to me as a Brit.i remember seeing coverage on BBC news of the controversy that president obama's health care plan was causing.i couldn't understand how someone would want to deny his neighbour healthcare.our NHS isn't perfect but i wouldn't want to change it for any other healthcare system in the world.in the last five years i've had three surgeries,spent months in hospital,had chemotherapy and had too many mri and ct scans to mention.add to that numerous angios and tests and ongoing care then my bill must run into tens if not hundreds of thousands of pounds.a rather arrogant x-ray technician once said to me "well that's your x-ray done for free thanks to the nhs".i quickly told him that i had started work at 15 and had paid my national insurance contributions for over 40 years so it was hardly free.for our US cousins every person who works pays a small percentage of their wages to pay for the NHS (national insurance).because the majority of us have grown up with the NHS we don't see it as socialist or political it's just our NHS and it's there when we need it.
john.

[KathyB]

Great explanations from all of you! My two adult sons have no health insurance because they can't afford it and their jobs don't provide it. Scary!! My oldest son pays large premiums but needs it and is grateful for all he can get. My case is different--premiums were very reasonable until I retired. OMG now! Without disability, the premiums are over half of my retirement benefit! But I need it and will continue to pay. No other company would ever insure me!!

KB

[annekat]

Great explanations from all of you! My two adult sons have no health insurance because they can't afford it and their jobs don't provide it. Scary!! My oldest son pays large premiums but needs it and is grateful for all he can get. My case is different--premiums were very reasonable until I retired. OMG now! Without disability, the premiums are over half of my retirement benefit! But I need it and will continue to pay. No other company would ever insure me!!

KB With the recent healthcare reform, no other company can deny you coverage on the basis of a pre-existing condition! However, whether the premiums would be any lower, I don't know.

[Sangye]

It would be hard to talk about this much without getting into politics, but if you follow Sangye on Twitter you will probably run into some discourse on it. .
LOL Yes, by "some" you mean "OMG so much."

I don't think I can respond to this post without going into politics.

[Palmyra]

With the recent healthcare reform, no other company can deny you coverage on the basis of a pre-existing condition! However, whether the premiums would be any lower, I don't know.

Premiums are not lower. Health insurance companies in the US are still very profit driven and famously top heavy with administrative costs that only add to the recipient burden. They now have to insure you, but extract every loving cent and beyond to add you to their policy. Some years ago my daughter was mysteriously "dropped" from an existing policy some time after her diagnosis with Weg. I was advised by legal counsel that the battle to fight would be too expensive to consider, and it was best to fold and count our losses.

She is currently insured through a high risk health pool in our state and premiums are very high. Companies that provide health insurance benefits are fewer and far between because the cost is just too high.

Benefits in the independently maintained high risk pool do not begin until a hefty deductible is first met. This may potentially change with the provisions that are rolling in over the next two years....of course this all depends on our upcoming election as all could turn on its head if the opposition party is elected/continues to hold a majority in our congress. The sad fact is that money really does affect one's health outcomes in the US. The more you have, the more likely you are to have access to premium care.

This not meant to be a political statement...but I would encourage the conversation further. How is one able to afford top quality care and medication without money/access? It is a problem world wide, I am sure.

[Sangye]

The sad fact is that money really does affect one's health outcomes in the US. The more you have, the more likely you are to have access to premium care.
.
I would revise this to say "The more you have, the more likely you are to have access to ANY care." 55 million Americans have no insurance at all. They make too much money to qualify for Medicaid (which is really lousy coverage anyway) but not enough to afford insurance.

It always upsets me to hear Medicaid listed as if it's equivalent to private insurance.

[annekat]

Under the new health care reform, I've heard there is a provision whereby companies must refund part of the money you spent on premiums if more than a certain percentage would have gone for profits vs. the actual care you got. Or something like that.

I can imagine care of Weggies getting very expensive. I have been lucky so far; it hasn't been expensive, though I have had trouble with some copays because I'm low income. But right now, month to month, I'm not having to put a lot out for treatment or drugs. I know that could change.

[mishb]

For us Aussies, everyone gets access to Medicare and we pay 1.5% of our salary (part of our tax) for this pleasure.
Low income earners get it for nothing and receive a health care card which enables them to low cost medications etc.
For high income earners it is compulsory for them to take out Health Insurance.

Medicare means that everyone has access to the Public Hospitals and Public Doctors/Specialists - you don't get to choose your doctor and the waiting periods are through the roof, especially for elective surgeries.
With Health Insurance you then have access to Private Hospitals, your choice of doctor and/or specialist and basically no waiting periods.......you do have to pay a deductible in most cases (on top of your health premiums).

I feel really ill and so sad/sorry that Americans have to put up with the lot they have. :sad:

[annekat]

Michelle, the negatives you mention in your system, such as long waiting periods, are some of the reasons people here give for not wanting nationalized health care. But it would be so much better than so many people having no coverage at all and wondering what they will do if they get sick. Those that have good coverage and want to keep it private seem to conveniently disregard all those people.

[Girly3800]

It is true - there is a provision to refund some premiums if the payouts weren't as great as estimated which then resulted in higher profits for the insurance company. My company received a refund earlier this year for somewhere around $850.00. Mind you our premiums were almost $200,000.00 a year (for 11 employees and some families). Company pays all premiums so there was nothing to refund employees - the company was entitled to the refund.

[Tim Roberts]

The whole issue of health insurance and how we in the US deal with our health care system is not only a political issue but also VERY profitable for the insurance industry. I have a son living in Calgary, Alberta, Canada and because of that I have learned a great deal about the Canadian health care system. To be honest, I was completely ignorant until he resided there even though I have been there countless times to fish in Ontario. As I travel up to Calgary, I always talk to the folks who live there about their health care system especially now that I have wegener's and am more aware of the need for quality health care. I have not talked to one of the Canadian folks that was distraught with their system and it is pretty hard to argue that everyone has health care there AND everyone has access to physicals and preventative health care which is far from what we have in the US. I have also heard about the horror stories about people waiting for months and months for surgeries and coming to the US and paying for the cost themselves. To be honest, I have never met any of these people and I just wonder if this is strictly propoganda put out by our own health insurance industry to scare people in the US. In the end, the best quote I ever heard from one of the Canadian folks made absolute sense to me and everyone in the US should hear this. They indicated that in Canada their money is spent on health care and in the US we spend our money on health insurance. Think of the billions of dollars that we spend on huge profits for the health insurers and if that money was used to benefit health care directly, where would we be then? Interesting thought.

[crackers]

i realise that in the US healthcare is political and here in the UK also but not to the same extent.about a week before a tumour was found in my bowel, which then perforated needing life saving surgery, i watched Michael Moore's film "Sicko". i know Mr Moore is not everyones cup of tea in the US but parts of that film brought tears to my eyes especially the 9/11 emergency workers.i believe healthcare should transcend politics as healthcare is necessary for every human being to live a full and productive life.keep politics out of healthcare? i'm not holding my breath.
john.

[Palmyra]

"I have also heard about the horror stories about people waiting for months and months for surgeries and coming to the US and paying for the cost themselves. To be honest, I have never met any of these people and I just wonder if this is strictly propoganda put out by our own health insurance industry to scare people in the US. In the end, the best quote I ever heard from one of the Canadian folks made absolute sense to me and everyone in the US should hear this. They indicated that in Canada their money is spent on health care and in the US we spend our money on health insurance."


Isn't it funny...all of the horror stories are of a gossip nature. "I did not actually know this person, but I heard of someone outside of the US that had to wait months or years to receive care for this or that...if we pay for it directly, we can chose our own price and fate and get immediate care."

Well, if you have a chronic disorder, your fate has already been determined. We have lots to learn.

JTF:mad1::sneaky:

[pberggren1]

Next time yo go to Calgary Tim look me up. You have to pass my house on the way. And we do have good healthcare here.

[Barry]

The one thing 90% + of us in the US will agree on is our health system needs fixed. However we are so polorized and most people don't believe our government can handle health care.

[Tim Roberts]

Phil: I will gladly stop and I agree, you folks in Canada do have great health care. We in the US need to think in terms of not what we have always done but what we could do. Barry, I think you are absolutely right and I understand completely because I have worked for the government for over 30 years and to be honest, there are times I don't have much faith in it either. Yes, we have become so polarized that very often people in positions of authority who could change things simply won't. We all need to set aside our political differences and realize that healthcare is far, far to important an issue to be driven by politics and we need to consider what other counties have done very successfully. No reason it couldn't work here in the US either if we could only get past what we have always done.

[Sangye]

One of the myths that we Americans languish under is that we have the best healthcare in the world. Statistics easily disprove that. Our infant mortality rate is among the worst in the developed world-- 34th! Many other statistics are similarly abysmal. As long as people ignore these facts and insist that our healthcare is the greatest, there is no incentive to change it. Add the remaining ingredients: the notion that not everyone deserves healthcare and the influence of the pharmaceutical and insurance companies and there you have it. Our big mess.

[pberggren1]

Unfortunately you are right Sangy. I don't know any stats for Canada though. I am grateful to live in Canada and just to be alive period.