Healthcare in USA

Most people get insurance through their job or their spouse’s job. After age 65, the government provides it. You can also buy your own insurance.

R1 Thanks. But how much does the insurance cost? What about those who don't have insurance? What if you don't have a job. Do you need to pay for it yourself? Sorry, this is all so foreign to me. Hospital stays are free here. We pay for it with our taxes.

Don’t feed the troll.

R3 I am not a troll. I'm curious about how it works. I started thinking about it when my dad was hospitalized. I'm very thankful I live in a country where it's free.

Even if you get it through an employer, you may part of the premium.

If you don’t have it through an employer, it’s very unaffordable, though government subsidies are available to cover some of it.

I pay $1.2k a month and have a deductible of $7k, because I have to purchase it through my state’s marketplace. And my insurance sucks.

You have to have a good job or it's too expensive (with a bad job, health insurance is like $300 - $400/mo.). Even Obamacare is too pricey.

You can drop out, go on welfare and get Medicaid. Or just go to the E.R. and tell them you're unable to pay.

Healthcare in the USA is a joke and somewhat of a privilege. However, if you're completely unemployed and almost destitute, it is paid for by the government. Sometimes the coverage you get if this is the case is far better than what you can get if you are employed full time at a job. It's kind of nuts. BUT, If you have a job and work full time but you work in a smaller place, the employer doesn't even have to provide any health insurance for you and you have to buy your own, which can be quite costly. If you work at a good employer, sometimes they will pay a good portion of your health insurance and you pay a smaller monthly amount. Very rarely, employers will pay the ENTIRE cost, but this is very, very rare. I have been on all sides of the equation throughout my life, so I happen to know. I was even on 100% Medicaid in the past five years while I was making zero dollar and got better coverage than a friend who was working full time and making a lot of money.

See? It's really quite stupid. And it's not a right at all, the government here is not about caring for its people. It's really about making money.

[quote] Thanks. But how much does the insurance cost? What about those who don't have insurance? What if you don't have a job?

Thanks to the Affordable Care Act everyone can purchase insurance as an individual if you don’t get it through an employer, spouses employer, government assistance or Medicaid. But it’s extremely expensive and the coverage is poor. At one time it really was affordable but no longer. There was also a time when in some states there simply was no means of purchasing insurance at all if you weren’t able to from the above mentioned sources.

People have lost their houses and all their savings from a family member having a severe illness etc. At one time the ACA protected people from that, but Republicans (who at one time were actually for affordable healthcare for all but no longer) talked about it as a form of socialism and stoked resentment among their constituents. Plus it was passed during the Obama years and the implication was that it was black Americans who needed it most so white republicans resented it even more.

I think in reality regardless the ACA was more like a bandaid that wasn’t going to work long term. I don’t understand the ins and outs but the general consensus amongst though that do understand it all is that the American healthcare system is severely fucked and there is no way to really make it accessible for all.

From what have seen the healthcare systems that really work best are in smaller homogeneous countries. Because even countries that offer universal, there is always a lot of drawbacks too.

Anyone reading this please correct inaccuracies. This is just what I understand.

R3: OP hasn't told us where he is.

Think quick, OP: where are you? Then we can dissect your healthcare system.

R6, R7 and R8. Thank you. That was very helpful. I think it's very interesting. I am aware the healthcare in my country is far from perfect, it could be a lot better, but at least it's (mostly) free.

R9 I'm from Norway.

I was on medical and they took away all the meds that I needed to breathe. They did this to a lot of people. They don't give people insulin either so I guess without meds we are expected to die.

I am a U.S. citizen by birth and lived most of my life there. I now live in Spain where I have public health care.

In the U.S. seven years ago, I had insurance through my employer. The cost was $1400 a month for the highest coverage plan offered through my employer. There was a $3000 out-of-pocket amount that I had to pay annually before the insurance took effect. At which point it took effect it covered different services at different percentages, typically 80%. In addition prescription drugs were treated similarly: after I paid the first $2500 from my pocket, the insurer would pay 80%, and after the first $10,000 I paid as my %, the insurer would pay all subsequent charges (for approved drugs )

In addition to my contribution of $16,800 annually for employer health coverage, I had to pay the first $5500 of expenses for medical services and prescription drugs. And beyond that had to contribute 1/5 of the additional charges for those same.

One prescription had a retail cost of $54,000 a year in the U.S. For those not covered by the Spanish health system, the exact same pills are available at $1440 (one of a handful of highest priced drugs in the country) - but are routinely dispensed without charge if anyone says they cannot pay easily (and hospitals will ask because the charge is so extraordinarily high).

Private health insurance for someone in middle age in Spain is anywhere from $50 to 200 a month and covers everything. It gets slightly more expensive when a new policy is initiated for a much older person. There are existing conditions clauses which can result in higher policy costs at a very modest additional charge; is a patient cannot find coverage for the rarest and costliest of existing conditions, the government will provide coverage (usually covering the additional costs if a normal policy.) Private insurance is used by the rich (often as a supplement to national healthcare) and by foreign residents on visas that require private coverage. Coverage is a full 100% in all cases, though some policies may have a $25 or $35 minimum payment for each coverage issue.

National health care in Spain has its differences from U.S. healthcare. Everything is centralized. Your psychiatrist can see what vaccines you have had and all of your medical history. Your general physician that you see for everyday needs can look at records of your prescriptions and treatment for specialty conditions. Your age and other factors trigger automatic notices of recommended vaccines which you can schedule with your neighborhood clinic. For a CAT scan or a certain group of specialists, you may have to go to a different hospital or health center than your normal one, only because some specialties are geographically concentrated within a city system. The process of appointments is centralized; online you can see a record of all upcoming appointments and reschedule as needed. If you push back a blood draw and analytical visit, the date for the corresponding visit to a specialist doctor will be pushed back as well, and you can move that around at that time or prior to the re-appointment.

If a blood draw leaves you queasy, if a hospital stay leaves you tired and weak you will be offered an ambulance to take you home and see you inside your home if you like. Free.

And never a bill for anything except routine pharmacy drugs. These are vastly cheaper than the same in the U.S. and the patient's part of the cost is usually $2 to $4; for a very expensive drug it might be $10 or $12 per month before any discounts available if the total monthly cost is more than $20 or so.

It's a night and day difference, and doesn't favor the U.S.

Everytime the US government (both parties) takes a step forward, there are always a lot of strings attached.

I like the idea of health savings accounts. They are like healthcare 401ks. You can put money in pre-tax and then use it to pay medical expenses when needed. But of course they make it really difficult to have them.

I think that when FDR introduced Social Security was the time when the government should have also worked in Social Healthcare.

It’s obscene that the US government can send billions to Ukraine but can’t help Americans with their healthcare.

[quote]It’s obscene that the US government can send billions to Ukraine but can’t help Americans with their healthcare.

Very different matters, but more important to your poor argument, very different sums.

The U.S. government has spent about $75 billion on Ukraine in more than 2 years. In the same period, the U.S. government has spent close to $4 TRILLION on healthcare programs.

Ukraine spending represents barely 1% of healthcare spending.

That doesn't make US healthcare less a crime, but don't blame an expense for an entirely different set of objectives when it's barely a drop in a bucket.

R13 Same here in Norway as Spain. We have a website and app, where we can see recent prescriptions, book appointments to see a doctor etc. If you need an ambulance, it's free. Medicine for chronic illnesses are mostly covered by the state. Other meds are fairly cheap. I'm on antibiotics now, I think I paid about 15 dollars, not too bad. I got a cheap copy of the one my doctor prescribed. If there's a cheaper copy of the medicine we have a prescrption for we're asked if we accept it. It's the same, only cheaper. And like I said: hospitalization costs nothing. Surgeries cost nothing.

I know someone who was raped. She immediately reported it and went to the hospital for a rape kit and PEP. A few weeks later, she received a bill from the attending physician for her post-rape hospital treatment and a rape kit that may or may not even get processed. This is not uncommon in the US.

I am retired, but not eligible for Medicare for another two years. Because my retirement income is low, I get a subsidized plan through the ACA (knows as PENNIE here in Pennsylvania). I pay less than $60 a month for a full medical plan, plus dental and vision. If I had to pay full price for my medical, it would be well over $900 a month. Thanks to the ACA (Obamacare), I can still get my healthcare and not go broke. Republicans want to take this away, along with my Social Security and Medicare. If that evil orange piece of shit gets back into the WH this year, millions of Americans my age and older could be destroyed financially.

Here is how it works for me. My husband and I are covered under my insurance. I get 264 dollars every two weeks taken out of my paycheck to cover us both. The plan is called a PPO. We can go to any doctor but get better coverage for "in-plan" doctors. Thanks to the ACA, we do not have to worry about denial of coverage for pre-existing conditions or lifetime caps on payouts. (Previously before Obama and Biden, you could be denied coverage if you changed jobs and had an ailment covered by another insurance company as well as a lifetime pay out of 1 million dollars on insurance - which is easy to rack up if you get very sick). We have what is called an out-of-pocket max. For us it Is 1500 dollars before insurance kicks in and 3000 dollars maximum per year. Meaning things that are not covered under "routine visits" like surgery etc, I am responsible for the first 1500 dollars. After that my insurance pays 80% of the costs and I pay 20% until I hit 3000 dollars out of my pocket and then all medical costs are covered 100% for the year. It resets every year.

[quote]How does it work?

It doesn't.

I don't understand why a lot of low income people don't take advantage of Medicaid.

R21 It's harder than you'd think to qualify/stay qualified for in a lot of states.

It is a nightmare, op. The state of healthcare in the United States reflects our true shithole status. Countries with fare fewer resources can afford to take care of their citizens.

For some years I worked at a Fortune 100 company, then for 25 or so years at a state agency and large university. Though I never made much in salary, I had what used to be called "Cadillac" health insurance.

When i left the workforce in late 2015 to 1) Care for my two parents with dementia and other health issues; and 2) Look after my own health issues that for years waxed and waned, then began more waxing than waning, I was shunted off my new ACA Blue Cross plan and onto our state's recently expanded Medicaid insurance.

While I was grateful for the insurance, it was so strange and disheartening to witness my own freefall in real time, descending (to quote the Robert Hazard song) the "Escalator of Life." Suddenly all the doctors, dentists, physical therapists, etc., who'd been thrilled to treat me the previous 30+ years couldn't get out the words "Yeah, no, we don't take Medicaid or any "Obama Insurances" (yes, they actually called it that). They couldn't lose me fast enough.

9 years later, it still galls me how poorly this country and its "Best Healthcare in the entire world" treat low/no income citizens. It's just half-past 6:30pm, and I have spent the last three hours in bed, lying on my left side in agony because 10 days ago while waxing the floor I slipped in my dining room, did an entire split, then crashed to the floor. My right hamstring *literally* went "PING!" and I went "Oh, SHIT--not again!" Because this was the third time since 11th grade I have severely injured that same hamstring.

First time I injured it, my parents had Rolls-Royce insurance, so I was seen and treated quickly. Second time I was in grad school on a really nice fellowship, so I was treated quickly and well. This third time? I have called 80% of the ortho and neuro clinics in my city, but none will accept Medicaid. My primary care person, an NP, has done what she can for me, and is as frustrated and angry as I am.

I mean, it brings me to tears realizing yet again that we're considered poor trash, unworthy of treatment or regard.

OP, I dearly hope you're never faced with a situation like this.

When I was on Medicaid, I had nothing but great care, and I live in a deep red state. Cancer treatment (radiation and chemo). Yearly CT scans. Check-ups with 2 cancer doctors and my GP. At no cost.

Here’s mine. I had to quit my job. I decided to do my state’s healthcare marketplace. I chose a bronze plan, lower tier, but it is accepted everywhere in my town. That’s about $425 a month and I added dental, which is $12.

The COBRA paperwork arrived today. To continue the plan I was on would have been around $785 with vision and dental.

Our vision coverage was lousy. I have a Costco card and it would come out less.

I hate having insurance attached to a job. Hate it.

Where I live, getting in for a routine checkup takes months. I’ve been using the hospital-affiliated urgent care for stuff like a sinus infection and pink eye (fun week) and it works out well.

[quote]I hate having insurance attached to a job. Hate it.

It's nuts, and yet Americans just accept it as the normal thing. Among other things, it affects when someone can retire: standard retirement ages for Social Security (a national pension plan of a sort that provides a very modest level of monthly income) is available at full retirement age of 67 to 70 (different according to birth year). One can retire as early as 62 and receive Social Security but at a reduced rate for initiating coverage early, but to do so leaves a gap in healthcare insurance.

Medicare (public health plan for older people) is available only from age 65, and further health coverage via Medicaid national plans is available only from 65. To retire at 62 or 64 means the retiree must fund his own insurance coverage until he reaches 65. Health insurance is wildly expensive in the U.S. and much more so in one's 60s and beyond. Obamacare options made serious improvements in bridging this gap but they are far from perfect or cheap. It's fine for financially stable and healthy people who retire early from jobs with high incomes, often less so for people who find themselves out of a job because of consolidations and cost-cutting measures, and disguised discriminatory practices (forcing out older, expensive workers then quickly scurrying to replace them with young people new to the workforce.

To be 54 or 61 or 65 for many Americans is to face years of trying to hold onto a job because the coat of insuring themselves is ruinous and with no safety net for being uninsured.

The US may have individual hospitals/research centers of excellence or that are doing cutting edge research.

But overall, the US healthcare system - both care and the adminstrative/money structure that is intertwined with care - is atrocious on many, many levels.

R24 I'm so sorry to hear this. Thankfully I live in a country where most of it is free (well... not free, we pay for it with our taxes). My dad has been hospitalized for almost two weeks now. It didn't cost a penny. He has also had multiple surgeries in the past, those were "free" too. Medicine for chronic illnesses are free, but we need to pay for other illnesses. The medicine is usually cheap anyway though, as we are offered a cheaper copy of the drug. We have a cap of 3000 kr a year on doctor appointments, when we have reached that limit it's free for the rest of the year.

R29 you're very lucky.

Unfortunately in the US, healthcare is just another moneymaking cog in our intense hyperturbo capitalist machine. Care is not rendered based on need or outcomes but rather on how much money can be made. And the corporate structure drives most local hospitals, which are all running with overworked, underpaid workers, while the upper management and CEOs make many millions.

[quote]R29, you're very lucky.

[quote]Unfortunately in the US, healthcare is just another moneymaking cog in our intense hyperturbo capitalist machine.

R30, it's not so much that other countries are lucky to have some sort of universal or free healthcare, it's the U.S. that is unlucky not to have by its own stupid choice. Capitalism in other countries is not especially tied to not having universal healthcare.

The countries tinted in red all have universal/free health care as of 2021. The countries that do not: the U.S., many African countries, some -stans, India, and a few spots in Southeast Asia.

R31 You're right, other capitalist countries have universal healthcare.

And I'm not a socialist or communist - I still say the tentacles of capitalism, of what I would term extreme capitalism, and of making money, versus patient outcomes, are so intertwined with our health care system that it boggles the mind. We have multiple layers - not just care itself and the costs and profit targets in the delivery of care, but also health insurance and its insatiable hunger for profit.

I seem to remember as a kid in the 70s that care was better, that so many more people would be in a doctor's office or hospital. (I had severe allergies and asthma as a kid and spent a lot of time in the hospital.) I think the state of chaos I'm talking about all started as part of the same Reagan era leadership, where the administration of everything became "running a business" - even the Post Office, etc. All so that corporations and millionaires could have their taxes cut.

Agreed, R30/R32. Absolutely. The US protects unbridled private profit in healthcare above healthcare for its citizens. I only meant to point out that there's an American illusion that it's a handful of atheistic/socialistic countries teetering on the edge of collapse that embrace the oddity of universal healthcare. But universal healthcare isn't the oddity if you take a world view. And the company the US keeps in withholding healthcare from its citizens is not the best.

Many Americans will insist they have the very best healthcare system -- and even insist they should pay through the teeth for it, as some god-given American value. What they don't know keeps them from getting too far ahead in life, and relieves them of their higher salaries compared to other countries.

Thanks R33. My comments were ultimately trying to say that despite all the rah rah jingoism of America Is The Best, we don't have anything even resembling the best. I couldn't have stated it any better.....the insistence on paying a la carte, so to speak, instead of paying more taxes, means a fool and his money are soon parted.

(r34 = also me at r30 and r32)

I live in CA and have medical. With Medical you might as well not have insurance at all. This year my insurance took away all my meds. I have severe asthma and have to use a nebulizer and they took that medicine away along with Breo and gave me a subpar rescue inhaler. Those are the only meds I take. So now I would have to pay for those myself which is more than I make a month.

Newsom made CA a sanctuary city for illegal immigrants and trannies. They get free healthcare and meds. He kicked a bunch of CA citizens off medical this year.

r37, don't raise the bridge. Lower the river.

You let everything slide until you qualify for Medicare, then let them pay for everything that's wrong with you.

r37 Is that you Tomi?

In case people might not know what the last several posters meant, the CA posters are talking about Medi-Cal.

Get it? Cal? Medical? It's California's expansion of Medicaid.

[quote] Newsom made CA a sanctuary city

He must be pretty powerful if he can make a whole state a city

Look OP, most people have some form of health insurance (thanks to Obama), but any hospital in the US that gets any funding from the government (which most do) can not refuse to treat someone for the lack of ability to pay. Some try, but they usually end up in big trouble. Every larger city has a "public hospital" that takes anyone no matter their financial ability. And these outlandish bills you hear about that people get when they don't have insurance, well trust me, the hospitals don't expect to ever get that money. Pres. Biden has now made "health debt" far less of a burden on people than it was before.

How so R43

Here's how R44.

[quote] "How does it work?"

It doesn't.

Move to the UK and experience their travesty of a healthcare system, and get back to us about how bad the US system is. And from what I'm hearing lately Canada's system isn't a lot better than the UK system.

[quote] And these outlandish bills you hear about that people get when they don't have insurance, well trust me, the hospitals don't expect to ever get that money

But if you have assets you’re fucked. Say bye to your house and/or your retirement savings. No big deal.

OP where are you from and where is your Dad’s care? I assume in a country with a universal care system.

Health insurance in the US is a very mixed bag from Medicaid to Medicare, the the Affordable Health Care Act (which is regulated private insurance with govt subsidies) to private insurance which is a for profit business.

You think it costs zero.

[quote]You think it costs zero.

No. Nobody thinks healthcare comes without cost. It's not a mystery that the cost is paid through taxes and money from the state.

Americans have the idea that they only want to pay for the shit that they like: for the highways that they use, for the schools their kids attend, for their minor health care needs (because they --unlike the poors, and the immigrants, and the Democrats-- take care of their health), and that $905Billion on defense.

The rest of the world (and it is the great majority of the rest of the world's countries) spend money on health so that when people need it is is available to them, so that health care is not a luxury but a given. The US allows insane prices for drugs that cost next to nothing in other countries not because the US drugs are better, but because the US takes no interest in curbing drug costs. And that's just the start of it.

Salary deductions for health insurance, copays, minimum out of pocket expenses, and costs without any control. That's the US system.

R49 I'm from Norway. My dad had a severe infection so he was hospitalized about two weeks ago. Since then he's gotten antibiotics, a ct scan, an mri scan etc. Cost him nothing. He also gets food every day, of course. That's free too.

Now more hospitals are requiring payment up front.

From the article:

“Some who paid up discovered later they were overcharged, then had to fight for refunds.”

Never ever pay a hospital bill without an itemized breakdown of every charge. Discover the joys of being charged 20$ for a single Tylenol. Or a 200$ fee for having your new baby laid on your chest.

[quote]Move to the UK and experience their travesty of a healthcare system, and get back to us about how bad the US system is

I wonder what the percentage is of UK citizens who would like to adopt America's health care system.