How does the USA medical insurance work? How come if you pay into an insurance do you still have to pay extra for meds and hospital.Do none of the insurances pay 100%. We had medical ins in south Africa, the company we worked for paid the fees and we only paid a minimal amount for prescriptions.It just seems that you all pay so much for being sick that the National health here doesnt seem so bad .
Lisa, thank you for caring and asking. Yes we pay way too much for what we get. Everyone's circumstance is different, but everyone is impacted. Some employers (not the majority) do still pay 100% of the cost of insurance for their employees, but since insurance is so costly, even those with 100% paid insurance are hurt, because employers can't afford to increase their salaries the way the would if insurance rates were more reasonable.
And every insurance policy has a deductible which must be met before benefits will be paid. Some plans will pay 100% after the deductible has been met, some will only pay 80%.
In my personal situation, my husband is self-employed and we must pay the entire cost ourselves. It costs us over 0 a month, and then we have to cover the first ,000 as a deductible before our insurance even kicks in!
It's a very complicated mess. Physicians and hospitals charge extremely high prices for services - in part because of the cost of dealing with the bureaucracy of the insurance companies. Insurance companies charge a lot for coverage they say because physicans and hospitals charge so much for services. It's a viscious circle. Physicians and hospitals also have to pay extremely high malpractice insurance because there aren't caps on the amounts awarded in malpractice lawsuits, and because people are so quick to sue.
Where our government is involved, such as with Medicare and Medicaid, things are poorly managed and bureaucracy is again a major factor. For that reason, many folks are afraid of what a government run insurance plan would provide, so they are against it. They are also very concerned about the cost of taxes to pay for such a system, which I can certainly understand. But I would think the money I am already spending could be put to better use, and I would get more for my money with universal health care. But we need some really brilliant minds to create such a program and to oversee it's operation, and brilliant minds are in short supply in Washington.
So there you have it, we are damned if we do and damned if we don't, and no one in government is likely to tackle the problem, because it will be so difficult to design and bring to fruition.
Yep, that about sums it up. The other thing is that the insurance companies do not have to cover you. We are the same as hillhoney in that my hubby is self employed and we pay a very high premium. I just tried to shop for cheaper insurance and most of the companies won't even consider covering me, at any rate, because they deem me to sick! Too sick for insurance, what a ridiculous idea!Just one thing. Not all plans have a "deductible". My plan is fully 100% paid by my employer and I have a copay for primary care visits and copay for specialist visits. My prescriptions are for generic and for brand name. Hospital stays are 100%, emergency room is (I think)
Anyway, there are many different types of plans in the US. I know it is much more difficult and expensive for self-employed people. I believe we need some kind of universal health care, but I am at a loss for how it might work.
I would hate for us to have to go to a strictly state run system, because I am VERY afraid of beuracracies (sp). Frankly I don't have any answers and feel very fortunate to have the insurance I have. Just wanted to let you know that not all policies have deductibles.
Now for someone that doesn't have any medical problems this sounds like money waisted for my employer.....but for someone like me that has on going health issues it's been very valuable. A year on Humira alone is over ,000. My premiums totalled a little over ,250 in a years time. So you can see that for that one medication alone....not to mention the repeated office visit and lab work it's been a HUGE savings for me.
I'm not sure I would get the same care if our Government was in charge of it all. I think for those that are not covered under a policy like I am anything would be better than nothing; but I highly doubt it would be anything like I have now. Just the thought of it worries me and I really am not sure how I feel about the idea. I'd have to be convinced that it would be a good idea.....because as it is; I'm not sure it would be.
Oh; prescriptions are on a 3 tier program. I pay either , or depending on what medication it is. Humira was a month. It didn't matter if there was 2 injection or 4 in a months time it didn't change.
I really never knew that you paid so much to stay healthy, gosh its a crime especially when you all suffer a chronic illness.I cant believe you have generic and name brand meds.We pay £6.50 per prescription what ever name our meds are.
I am not saying the National health system is the answer, it definetly has its faults.One big fault is mis-management of it and the other is the "post code lottery" ( post code is your zip code) depending on where you live in the uk will decide if you recieve certain medication.
There is a lady who has breast cancer and she cant recieve the same drug as another lady who lives a few miles from her because she lives in the wrong area.
A lot of people cant get prescribed Biologics because they are out of area zone.
Does anyone else from other countries have problems like this?
Thanks to everyone .
Lisa
What a shame! Do they change what drugs a certain area receives and if so, how often? I would think this would be enough to cause people to move. That is sad.Pin Cushion, we have the same situation where it depends on what Province you live in (although the vast majority of necessary treatments are covered everywhere). Also, another problem we have is long wait times for some surgeries. Other than that, no one is uninsured, no one has to enroll in clinical trials because they can't afford medication, and doctor and hospital visits cost nothing. Costs of prescriptions are based on income. Pin cushion. We have a good policy. The company my husband works forOWIEDEB- No the meds arent changed around.There is a breast cancer drug out that is having great results and this lady went on T.V to say she was denied it due to where she lived as the british health service doesnt supply it to her area.I get my Humira supplied by the NHS ( National health service) but someone who lives 25 miles from me cant get it as theres not enough money to supply everyone so depending on where you live as to where the money is being spent(death sentence for some people)
Gimpy- you health service sounds fair, does it work well. it sounds very much like the UK.
Lorster- your policy does sound good, better than most i have read
Well, it's not perfect, but I wouldn't trade it for any other country's that I'm familiar with! (There may be better systems in some European countries).Even with all of the problems associated with the insurance companies, I'll keep my private health insurance. A perfect world would have a plan for everyone, equally, but.........You can't compare U.S. with Canadian healthcare. It's like comparing apples and oranges. The Canadian population is roughly the same population as California. It would just about be impossible to cover every single person in the U.S. The cost would be astronomical. Where's the money coming from for such a venture? The basic economic structure of the U.S. is banking, investments, and surprisingly the health insurance company. If there weren't private health insurance companies our economic structure would weaken further.
For the most part the Medicare program is run smoothly. Take a look at some of the reports available on line. You're going to see good and bad. I worked in the health insurance industry for years after I left nursing and believe me this was always debated and discussed. Some insurance companies wish they ran as well as Medicare.
It would be wonderful to have a national healthcare plan, but believe me when I tell you that you'll be giving up a lot. You'll be told that no, you have to wait 2 years for your knee replacement because of the waiting list. Many drugs aren't covered or prescribed because they're not available. Why do so many people travel to the United States with severe problems and have surgery done here. Can't be because we have some of the finest minds and medical equipment available? Unfortunately, it's just not available to everyone but it's here and being used.
My insurance covers 100% of medical costs after a .00 copay, including hospitalization. I don't have a deductible. It's something that we worked long and hard to have when we retired. We did the work for this coverage, it wasn't given to us gratis. We won't have to depend on Medicare for coverage because our health insurance is lifetime through Stan's employer. We'll be forced to use Medicare but our primary will fall into the secondary status and pick up 100% that Medicare doesn't pay.
The health insurance arena in the U.S. isn't all bad. There is a very large group of Americans that can't afford coverage. They are what is known as the "working poor" and I think that the gap is widening for those individuals. There should be a national healthcare plan that targets these families. As a nation we should be ashamed that we have a husband and wife, working 2-4 jobs and they still can't afford health insurance. The very poor are covered, the working who can afford health insurance, and the 65 years and older all have coverage. Why not the "working poor." That's where our national health insurance should be placed. I don't need it or want and there are many of who who don't need it or want it. We should be exempt.
This isn't something that I want to debate; I just wanted to share some thoughts with you. I debated this way too many times when I worked with Hiliary Clinton's task force on a national health insurance plan. Myself and two others from the Bay area were invited to Washington for several weeks to educate the politicians about the crisis in healthcare and health insurance. Quite an eyeopener. Good intentions but economically unsound.
It's a hot topic and I'm glad to see a thread addressing the issues. Lindy
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