Explain US Medical Care to an ignorant Englander?

[AntiLove_SuperStar]

I'm not quite clear on this and I'd like some clarification because being USA based, this kind of thing comes up a lot on posts...

 

What's the deal with healthcare in the USA? Do you have to pay for everything? Always? What about in emergencies?

 

Here we have a National Health Service that is free...for everything, doctors, emergencies, hospitals, treatmemt (most treatments anyway), psych help... its a little slow sometimes though, so you CAN pay for private healthcare if you want, but you still get the national free stuff, and it doesnt necessarily get you a HIGHER quality of care, just a faster one!

 

how does it work for you American people?

[keenan]

There is some government assistance if you're disabled or if your income is low enough to qualify, but if you don't fall into that category you're on your own. Most people with full-time jobs have a benefits package through their work. Typically a number of insurance plans will be offered, and you pick the one that meets your needs (or is cheapest!). These vary quite a bit, but one common scheme is to be able to see a doctor who is approved by your plan (who can then refer you to specialists if needed), and pay either a smallish flat rate, or a percentage of the fee (often 20%) after a deductable is met (again, varies quite a bit, but could be a couple of thousand dollars in a year). As for dental and optical, those are harder to get. If you're lucky you'll be allowed to see a dentist a couple times a year, and an eye doctor one/year or once every two years. In order to be a member of these plans, the company witholds a small-large monthly or quarterly portion of our salary. Generally we pay a portion of the costs for prescription medications, but if the medication isn't covered on the insurance plan, you have to pay the whole amount. It can be very expensive. Benefits really vary a lot by the company you work for, and by the plan that you choose within a company. Generally, these health benefits are one of the biggest reasons that people really seek stable full-time jobs.

 

Oh yeah, and emergencies: Again, it depends on the plan. Some will cover ambulance trips to the hospital and treatments by an emergency doc, but it has to be documented that it was really an emergency!

[shes2smart]

Pretty much we have to pay for health care services we receive -- either in the form of payments directly to docs & other providers or via health insurance premiums.

 

I've been lucky enough to have been continuously employed and covered through insurance from work for all but 3 months of my adult life. (And you'd better believe I was keeping my fingers crossed and hoping nothing happened during those 3 months...I had just started a new job and the new employer had a 90 day waiting period to get on their health insurance. My former employer's health insurance ended as soon as I was off their payroll)

 

Employers generally pick up a percentage of your health insurance premium (as one of your full-time employee benefits) and deduct the rest out of your paycheck. As a f'rinstance, health insurance (doesn't include dental or vision) for me & my husband ran about $70 per pay check (I get paid every other week). We switched over to his job's health insurance because it was a little cheaper and because he had to pay for coverage for his kids...but I'm getting off point.

 

Anyway, I've encountered 2 basic types of health insurance. First kind is you pick whatever docs/providers you want, and the insurance picks up 80% of the tab and you're responsible for the other 20%. Of course, that only covers what your policy specifies. Anything not specified in the policy is 100% your responsibility.

 

The other kind is an HMO (Health Maintenance Organization) or PPO (Preferred Provider Oragnization)....where the insurance company has a list of docs & other providers that agree to be paid a set fee. As long as you pick from the list of HMO/PPO docs, and you're within the confines of the policy, they pick up the tab with the exception of a small co-pay (like, $20 or $30 for an office visit or $100 for an emergency room visit).

 

If you don't have insurance, you'd better hope you don't have any serious medical issues 'cause you're basically screwed. There are some hospitals that are required to provide emergency care to anyone regardless of their ability to pay, and there are various federal, state, and local welfare/charity programs. But those have various limits and requirements to them...not everyone without health insurance qualifies. It's the people who are the "working poor" who get the shaft here -- they're not poor enough to get free assistance, they don't have enough money to pay out of their pocket, and they don't have a job that provides health insurance (because they're not full time) or pays so little that they can't afford the health insurance offered.

 

I don't know a whole lot about any of those since, as I said before, I've been pretty lucky with being employed full-time my entire adult life.

 

Then there's separate insurance for prescription drugs. If you don't have prescription drug coverage, you'd better hope your doc can prescribe something generic...otherwise you could be looking a bill for meds that's higher than your rent.

[southerngirl]

Well, my husband's insurance covers health and psychiatric care but no dental.. When I checked into it , found out it would be VERY expensive.

 

The cost of health care is very high and you basically do have to pay for everything unless you are lucky enough to have an employer to cover the insurance as a benifit... us we still pay like 50 a week for healthcare premium even though his work pays the rest its EXPENSIVE.

 

I did check into finding out if we would qualify for dental through the state and i was told that he makes too much money.

 

I think its a big problem today and wish that things were different but MOST people who work can not afford health care and alot of employers do not provide it or if they do they can not afford the 40-80 per week it would cost for the premium coming out of EACH paycheck.

[ElektraHere]

On a side note AntiLoveSuperStar.....

 

It is great to see your eyes your a pretty gal Ever see The Breakfast Club? You remind me of the Ally Sheedy character. I like this look a whole lot

 

Oh and American health care only works for the people who can afford it. I have health insurance but I must say every year the premiums go up and some services arent covered. I would love to live in Norway now there is a country that knows how to take care of their people.

[KweenofDenyl]

The most recent data available on U.S. health insurance coverage is from 2004.

Consider this: One-third of U.S. firms did not even OFFER health insurance coverage to employees in 2004 and there are 46 million Americans without health insurance.

 

I work full-time and do not have health insurance, nor could I afford it even if it were offered by my employer. I owe twice my annual income in medical bills at this point.

 

For some interesting facts about U.S. health care/insurance try link removed

[AntiLove_SuperStar]

Thank you all very much for explaining it..and thank you for the eye compliment! I did once see the breakfast club, albeit very late one night, my memory's a little hazy..

[darkblue]

All Americans should have health insurance.

 

I have it, and the NHS would cover me, here in the UK.

I just don't trust them...

[keenan]

All Americans should have health insurance.

 

Especially kids! Many (most? half of?) Americans agree with you, darkblue....

[darkblue]

A former enotalonerer, whose name I shall not mention, once told me of how he had crashed his car and had to receive emergency hospital treatment.

 

After spending ONE NIGHT in hospital for possible concussion - he was released and charged $110!!

 

Health insurance is a must.

 

I do thank the UK for having the NHS, for those who cannot afford private healthcare, but I wouldn't go in for treatment under their care.

I simply don't trust them.

 

Our NHS have so much of a work-load that it's impossible to deliver high quality care.

[keenan]

Honestly, darkblue...that sounds like a real bargain! When I was in college (10 years ago), I went to the emergency room for an asthma attack. The visit lasted a half hour, and I was charged 100 bucks that I could *not* afford. If I spent the night in the hospital with no health insurance, I wouldn't be surprised to get a bill for closer to 1000 dollars!

[darkblue]

That is insane!

 

What do you pay taxes for?!!

[keenan]

Bombs, apparently.

[darkblue]

LOL!!

 

Clever.

[RandomAdvisor]

Yup. $110 is nothing!

 

Here in NYC, the local emergency rooms charge you $200 just to be seen. For a night in the hospital, I've heard the cost can sometimes be as much as $1,000 a night or more. I know a man who had to have surgery for lung problems he was having - he was a smoker at the time. When he was in the hopsital recovering for a few days, he was charged $1,000 and change per night...

[shes2smart]

$110...AND he stayed overnight? That's a deal.

 

Last October we took in a stray cat. I went to pick her up to put her in the basement (we were still getting her and our old cat used to each other)....well, she decided she didn't want to be picked up and smacked me with her paw. She got me right in the eye with her little claws and knocked out my contact lens. When my eye stopped watering, I went to the bathroom to have a look and I had scratches around my eyebrows/eyelid, and a big scratch and blood in the white of my eye.

 

The urgent care was closed for the night, otherwise I would've gone there. So, we were off to the hospital's ER. Since I wasn't bleeding to death, having a heart attack, or about to give birth, I was way low on the priority list.

 

4 hours later, a doc finally got around to looking at me (for all of 10 minutes), checking my vision, giving me a tetanus shot and a prescription for antibiotic eyedrops.

 

The cost for this? $500....of which I was responsible for $100....and that didn't include the cost of the eyedrops.

[darkblue]

This is just ridiculous.

 

Ludacris sums of money for that kind of care?

I wouldn't pay it.

[RayKay]

Despite the flaws in our system - like longer waiting times, I honestly am so grateful that here we do have 'free healthcare' (we pay for it with taxes obviously!).

 

I have known so many families to face serious illnesses here whom at least were not having the added burden of debts. There is something terrible about having a sick child and having to also worry about not having a home even if that child recovers. Unfortunately others I know in the US have taken on enormous medical bills in some case simply to survive. Never mind those whom are too afraid to go to get help as they can't afford it, so things are discovered so late.

 

 

And the waiting is not that bad. My mother was diagnosed with advanced breast cancer on December 18th and had started treatment by the beginning of January. I had a late bf with an illness whom received fantastic medical care from some wonderful doctors and nurses. And I have seen some wonderful palliative care for grandparents. Sometimes you have to be your own advocate, but the care is great. The delays tend to be more for 'elective surgeries' or more minor things which are not the same priority, and I think that is acceptable.It's not perfect, but it IS available for EVERYONE. For those whom want to get in sooner or don't feel they get enough, and can afford it, they tend to go down to Mayo or something.

 

Most work health plans also cover dental, vision and additional care like chiropactors, massage therapy, etc too pretty well.

[RandomAdvisor]

A recent survey found the #1 cause of bankruptcy in the US is - you guessed it, medical bills!

 

That was from 2004. I'm sure it's still true.

[RayKay]

A recent survey found the #1 cause of bankruptcy in the US is - you guessed it, medical bills!

 

That was from 2004. I'm sure it's still true.

 

When my mum was first dx'd, I spent some time on a breast cancer board, and heard the stories of many women whom were hundreds of thousands of dollars in debts - often as they did not have proper insurance or full employment, or had recently changed jobs before being diagnosed.

 

Made me feel somewhat thankful that despite my mum's illness, we would not as a family also be facing the complications of how to afford the best care she needs.

[KweenofDenyl]

I owe a little over $40,000 for a broken arm.

[keenan]

I owe a little over $40,000 for a broken arm.

 

Did it require surgery?

[KweenofDenyl]

Yes, but only because I received substandard care to begin with...because I don't have health insurance!

 

It was a 6 month ordeal during which time I did not have the use of my arm and I couldn't work for at least 3 of those months...adding to my indebtedness.

 

The surgery was about a month ago. I will never have full use of my arm like before--it will always be weaker and numb in certain spots on my hand.

[shes2smart]

Oh, I forgot the punchline to my eye injury story.

 

We hadn't decided on a name for the cat until this incident. We named her "Tyson."

[RandomAdvisor]

I owe a little over $40,000 for a broken arm.

 

This is why I havn't gone to the doctor myself despite the fact I've been in pain since early February.

 

I havn't mentioned it on this site before, but some people may remember that I commute by bike. On February 4th a small pain I'd been having in my groin was suddenly excruciating, and after consulting some people on a biking forum I was told I should go to the doctor, that it sounded serious. I did see a doctor more than a week later through the health center at my school, and although the pain had (has) subsided, it still isn't completely gone yet.

 

What I really need is a sonogram or an MRI. I was able to apply for some free health insurance through my school, but I have to wait for the paperwork to go through and nothing is paid for retroactivly. It's been nearly two months. Havn't ridden my bike since. I'm still in pain. Insurance should come through in about another week and a half or so.

 

Hopefully it's just a simple torn/pulled muscle that's taking a long time to heal. Or, it could be something more serious like a hernia or possibly even testicular cancer.

 

Anyone familiar with the new bankruptcy bill? The majority of bankruptcy filings are from people going into debt via medical bills. They recently reformed bankrupty laws forcing people to pay back every last penny, even if they are unable. There are no exceptions even if you went into debt from illness....

 

link removed It went into effect last October.