We have a unique and many faceted system. I would recommend a good web search of sites related to the USA health care system. Let me take on a basic outline here:
Most employed people and their families get much of their health care paid by insurance schemes largely funded by and tied to their employer. Such health care often includes dental and related care. Employees pay parts of these premium for that insurance as a benefit of your employment. These premiums are often growing faster than the general cost of living. In some cases, in lower paying jobs, or high paying jobs, the employee has to pay all or a large part of that insurance. Depending on the type of insurance, that could be a $3000 to 10,000 a year in premiums for a family, depending on type of insurance one has. This has become a huge overhead cost for business in the USA, and hurts the competitiveness of USA companies. One usually pays a co-payment for each doctor visit ($10-25) and pays part of the costs for other medical services. The insurance companies pay a highly discounted rate for services from the 'list' prices. There are different schemes including 'HMO
' (Health Maintainance Organizations) and 'PPO' (preferred provider organizations). HMO
's are usually less expensive in their premiums, but except in emergencies, your insurance will only pay the full or a large part of services costs from specified doctors and other health services providers. They became popular because because of their lower premiums, as they pay even lower prices for services and were the first ones to have low fixed co-pays for services. PPO's allow you a greater range of doctors one can go to at a base co-pay, or gives you a partial payment with a cap on the price they will pay for services, and you have to pay the balance.
Traditional health care still exists too, that is you pay whatever the bill is. This is mainly for the very rich or those whom don't have any health insurance or don't qualify for government paid insurance. For many Americans whom are employed in low level jobs, they are often stuck with huge medical costs that can cripple their finances.
Medicare is the government run schemes for those whom are disabled or over the age of 65. This came to being in 1965. One if able pays a small premium out of their Social security or disability check and much of the cost is paid by a tax of about 4% payroll income tax (half from the employer and half deducted out of an employee's paycheck). You also have co-pays. Medicare pays very cheap prices for services. Medicare doesn't pay for most dental care, non-hospital drug prescriptions or most long term nursing care. That they don't pay for non-hospital prescription drugs is a very serious problem
Medicade is the generic term for health care for the poor. This is in part paid for by the Federal and State governments. Care can be spotty, somewhat like an HMO
. Often private insurance companies administer the payments. This is primarly for the poor, those on welfare, those on unemployment benefits and certain types of disabled persons. The problem is that many that are practically poor, even if working do not qualify to get Medicade.
If you are in a car accident, or injured on someone's property, your or the other parties' insurer is to pay for the health care needed.
If you are injured in a work related situation, then 'workers compensation' insurance kicks in. This exists to pay for medical care connected with the injury. One can also get death benefits from workers comp plans if they are killed or die from a work related injury.
We also have a legal system that allows one to sue doctors or other health care providers for malpractice. In many HMO
plans, one cannot sue their doctors but the insurance companies have to pay for corrective procedures. That in most insurance schemes one can sue for malpractice has raised the cost of health care and related insurance premiums. All doctors need to have malpractice insurance. For some doctors, they have stopped doing certain services or procedures or left the professions due to the exploding cost of marpractice insurance or having to deal with false claims.
I am quite sure I made some errors and forgotten some details here, but I hope this helps.