How does the American Health System work?

[Anne Hartung]

Just curious.
As I work as a nurse/ deal with insurances here in Germany, I am really interested how the American (or Australien, UK, ...) System works , just to compare. There will be strenghts and weaknesses in every system for sure.

If a German gets the flu, he will see the family doctor. This is for free, costs are covered by Health Insurance as long as one is covered by Health Insurance.
Medication is either free (children and poor), copayment (every other) or full cost (minor sicknesses like cold, herbal stuff or considered as "not working" - diet pills to mention). Seeing the dentist is free, but copayment for replacing and -nice- repair ist *sigh*.

If hospital/ER/ambulance is required, it is with limited copayment - I think it is about 200€ pa at the moment.

The common Health Insurance is obligatory for every working person (families are covered for free). Originally invented by chanchellor Otto v. Bismarck 1890+ to hold down socialists.

In general I like the public Health Insurance, but to some points I do not agree. F.e., they also pay for "legal" abortions (which I consider as murder). Working in home care, I also met enough people, who gave a s***t for their health and benefit, too (§$$%&!!!).

How do you do? (really, really curious)

Love, A.

 

[tim-from-pa]

Just curious.
As I work as a nurse/ deal with insurances here in Germany, I am really interested how the American (or Australien, UK, ...) System works , just to compare. There will be strenghts and weaknesses in every system for sure.

If a German gets the flu, he will see the family doctor. This is for free, costs are covered by Health Insurance as long as one is covered by Health Insurance.
Medication is either free (children and poor), copayment (every other) or full cost (minor sicknesses like cold, herbal stuff or considered as "not working" - diet pills to mention). Seeing the dentist is free, but copayment for replacing and -nice- repair ist *sigh*.

If hospital/ER/ambulance is required, it is with limited copayment - I think it is about 200€ pa at the moment.

The common Health Insurance is obligatory for every working person (families are covered for free). Originally invented by chanchellor Otto v. Bismarck 1890+ to hold down socialists.

In general I like the public Health Insurance, but to some points I do not agree. F.e., they also pay for "legal" abortions (which I consider as murder). Working in home care, I also met enough people, who gave a s***t for their health and benefit, too (§$$%&!!!).

How do you do? (really, really curious)

Love, A.

OK, let me give my "two cents". First off, I'm not really one to go to the doctor. I watch my own health as I am suspicious of most (not all) medications and some medical practices.

For insurance, most people are covered by their employers. This has been for awhile now but with new government rules it has put things into a spin. Insurance companies and employers feel burdened. Most of us partly pay for our insurance. It's just a fraction, but there's a deduction taken out of our paychecks for that. In addition, when we go to doctors, they all require "co-pays" of maybe $25 or even $50 or whatever. There's nothing set. It varies. If the doctor's visit is say, $125, the insurance will pay the rest. Generic drugs also have co-pays ($5 or about) but name brand drugs have a higher co-pay. So far you can see that we have "insurance", but with every service we have to pay a fraction of it up front. In addition, doctors are in networks so that there is strong pressure to go to the doctor they (insurance) want you to go to in a specified group. Typically, a procedure (such as colonoscopy) may be 20% and insurance pays the rest. But if you go to a doctor of your choice they may have you pay higher like 80%. Same with hospital stays. One thing I forgot to mention is that the insurance basically sets the price for services, thus that is the reason for the networks. And they will pay the limit minus the co-pay. Some doctors will accept that, but if they don't, you are billed in addition to the co-pay. So in the case of that $125 doctor, they may agree to pay up to $75 plus your co-pay of say$25. If the doctor does not like that, he/she can bill you for the other $25 but you can see then that is a "dirty player" and such a doctor probably would not be in the network if they do that often enough. So while his "official" price for the office visit is $125, he/she will allow a lower charge. Perhaps the rich or those without insurance can pay that. I think that many doctors decide to charge the full price and say out of the cheaper networks leaving them for the "lesser" doctors of some sort such as new doctors. They still accept insurance coverage, but those in the premium category.

Now.... some of my own personal opinions why prices are so high here in the USA and we have such a messed up system:

1) Over-prescribing, especially for "prevention". If you are a man over 50, like me, he can't go to a doctor any longer without telling him he "needs" some sort of drug. This is a newer way of thinking. And the drugs are usually what I call useless "number lowering" drugs such as cholesterol, Blood pressure, sugar, etc. and don't address the root cause, nor do they extend life any longer. Drugs should be for a limited time, which I say is OK. But not forever. Basically instead of finding causes, the message from the doctor to the patient is, "Here is another pill you have to take for the rest of your life".
2) Too much unnecessary testing. This hi-tech equipment takes money to run, ya know.
3) Unneeded surgery. If one has a potentially fatal blood clot, or a bone sticking out of their skin, OK, but some of the surgery they recommend, e.g. I was told I could get surgery to fix my double-jointed jaw, is ridiculous.

All that said, I read at one time that 70% of all medical costs here in the USA are one or several of these 3. Save the 30% for those who really need it.

For the high cost, people have to realize that they are probably not as sick as they are being told. The lucrative drug companies are merchandising off the people for $$$. The key is to have them believe they "need" the medication or procedure. People have to wake up and fight the medical beast NOT find a way to fund it so that we can have more. I want less. Until the mindset is changed, and people are duped into believing they are sick, this will never be resolved. That's how this works here and that's what I see.

 

[Michael74]

The American health care system works wonderfully for the rich. The rich from around the world travel to the US for first class treatment. Not so well for the majority, who can't afford US cash prices. Many have insurance that helps with the cost. The trade off is insurance may only cover "medically necessary things", which someone other than the patient defines. Also, some insurance has costly deductibles and co-pays. The non rich uninsured or under-insured are in a situation, as US cash prices are many times what they are in the rest of the world.

 

[WIP]

For insurance, most people are covered by their employers. This has been for awhile now but with new government rules it has put things into a spin. Insurance companies and employers feel burdened. Most of us partly pay for our insurance. It's just a fraction, but there's a deduction taken out of our paychecks for that. In addition, when we go to doctors, they all require "co-pays" of maybe $25 or even $50 or whatever. There's nothing set. It varies. If the doctor's visit is say, $125, the insurance will pay the rest. Generic drugs also have co-pays ($5 or about) but name brand drugs have a higher co-pay. So far you can see that we have "insurance", but with every service we have to pay a fraction of it up front. In addition, doctors are in networks so that there is strong pressure to go to the doctor they (insurance) want you to go to in a specified group. Typically, a procedure (such as colonoscopy) may be 20% and insurance pays the rest. But if you go to a doctor of your choice they may have you pay higher like 80%. Same with hospital stays. One thing I forgot to mention is that the insurance basically sets the price for services, thus that is the reason for the networks. And they will pay the limit minus the co-pay. Some doctors will accept that, but if they don't, you are billed in addition to the co-pay. So in the case of that $125 doctor, they may agree to pay up to $75 plus your co-pay of say$25. If the doctor does not like that, he/she can bill you for the other $25 but you can see then that is a "dirty player" and such a doctor probably would not be in the network if they do that often enough. So while his "official" price for the office visit is $125, he/she will allow a lower charge. Perhaps the rich or those without insurance can pay that. I think that many doctors decide to charge the full price and say out of the cheaper networks leaving them for the "lesser" doctors of some sort such as new doctors. They still accept insurance coverage, but those in the premium category.

Some of this is a little....well...slanted is the word that comes to mind.

The insurance companies don't set the price for services. They negotiate the prices with the health care providers in their networks. I'm speaking of private insurance companies. In return those that are insured by the insurance company are encouraged to use the in network providers. So if I choose to be insured by company A and use the providers which company A has negotiated a contract with, then I will be provided better coverage to encourage me to use those providers in the network because of the negotiated lower cost. I can choose to use a provider outside the network but because there is no contract between those providers and the insurance company, the costs for the service are likely higher and that added cost is passed on to me for making that choice.

I'm only guessing but I expect Medicare is handled differently and that is why some providers will not accept patients on Medicare. Medicare is a government entity and that opens a whole new can of worms.

 

[Christ_empowered]

hi. healthcare in the US is a hot mess. people still go bankrupt over medical bills, even if they have some health coverage. back when the economy tanked during the "Great Recession," stories hit the papers now and then over people keeling over, dead, from relatively minor problems. No health insurance, over worked charity clinics, no resources=sick people, dead people. Unnecessary.

I"m on disability, for "severe mental illness." I use the " " because a lot of my "disability" is from stigma. Who hires "Schizophrenics?" Very few people. Anyway....for me, Medicaid (its medical coverage for poor and disabled) covers my psychiatric stuff at a local, state-funded community mental health clinic completely. That's a -huge- blessing. My 2 prescriptions are covered at a very low co-pay, which is a big deal, because even though both are now generic...they're both still -very- expensive. I do not require any blood monitoring for my treatment.

In the event I had a car accident or...something....some hospitals accept Medicaid, and the treatment would be provided w/o much in the way of payment from me or my parents. Dental work is rarely covered by Medicare (some disabled people, retired people), even less often by Medicaid. Thankfully, I'm doing well in that area.

Some states (not mine...) have done "Medicaid expansion," so instead of Medicaid only covering very poor people, the disabled, etc., Medicaid in those states now covers the working poor...people who work and cannot afford private insurance, aren't poor enough for what's left of welfare, etc. In those areas, it seems to have been a -huge- success; workers are healthier, kids are healthier, healthcare costs are going down, life is better. And yet...

more so than I think many other nations, the rich (and many people, really) in America -hate- poor people. I mean...whoa. So, now some states that expanded Medicaid are shifting gears, because Trump is President and just...honestly, it seems like for every 2 steps forward in America, there's 3 steps back. There's a lot of angry, angry people, and poor people, brown people, gay people, trans people, immigrant people...are being scapegoated, and its kinda scary.

so, some states are scaling back on Medicaid expansion. Disability advocates are straight up terrified both of Trump and the way the GOP is going with him as their fearless leader. Its...getting ugly.

Back to me, lol. At this point, if I did get a job, I'd have to find a way to pay for "treatment" myself. Drop out of treatment, probably get committed or something, then stuck with a tab. Maybe not for me....my parents have more resources and higher status now, so I get treated a bit better, but...yeah. Happens. Even state funded clinics want $$$, and they've started using collections agencies to go after people who don't pay up (this from a former shrink, btw).

So...for a lot of people (Not just "mental patients," but definitely "mental patients," in particular...) its far easier and less painful to just get on and stay on disability than to deal with the rat race and all that jazz, especially in more conservative areas. For me, it isn't terrible...I get SSI, medicaid, my parents are "comfortable" or whatever, so my life is remarkably easy, but...whoa. There's a lot of suffering in America that just doesn't seem to happen in other affluent, developed nations...