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The American Health Care System

Posted: Sun Mar 13, 2005 9:35 pm
by Catatonic
I need to do a presentation tomorrow which briefly touches on the US health care system, could someone give us some help in giving me some facts on this subject ie. what is medicare, who does it cover, why you need health insurance, what happens if you dont have insurance, what is the basic structure of the health care system in the US etc. Many thanks

RE: The American Health Care System

Posted: Sun Mar 13, 2005 11:14 pm
by ltbewr
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.

RE: The American Health Care System

Posted: Sun Mar 13, 2005 11:39 pm
by Catatonic
Wow, thanks LTBEWR for your help and the amount of detail you went into, youve been a great help and welcome to my RU list!

RE: The American Health Care System

Posted: Sun Mar 13, 2005 11:42 pm
by cptkrell
Kinda late to start doing research on such a complex issue, eh?


(1) If I can afford healthcare insurance, I pay for it.

(2) If my employer can afford healthcare insurance, I pay for it (it's part of the compensation package).

(3) If someone else cannot afford healthcare insurance, I (and others) still pay for it, through taxes and higher direct and indirect costs of my own care.

Got it ?? Regards...Jack

RE: The American Health Care System

Posted: Sun Mar 13, 2005 11:55 pm
by JetService
My family has seen all kinds of coverage examples that may be useful for your research...

My parents had coverage when I was growing up. Then my dad had employment problems and we found ourselves not covered. After this happened, my mother had a coronary arrest and spend about 6 weeks in Intensive Care. She was signed in with no healthcare (but was of course still treated). The hospital bills totalled six-figures. My dad had no money and evetually filed bankrupcy. All the providers had to write off the expenses.

Post bankrupcy, my father lived a very modest life with my mother who needed constant supervision (the heart-attack damaged her brain slightly). He developed throat cancer and was treated for two-years before he died from the disease. He was in the Marine Corp and a veteran of the Viet Nam war so the federal government treated him at no cost in a VA hospital. VA hospitals are not known to have the best technology, so many treatments were outsourced to a local private hospital where the costs were still covered by the gov't.

My sis is a working single mom who now looks after her young son and mom (mom is better and helps her with day-care). Mom gets social-security disability; sis has Medicare for the son and has personal coverage through her job. They've had no major medical problems (knocking on wood)

My family of 5 is fully covered through my company's family plan for the cost of about $400/mo. I pay a deductable for certain things ($75 for ER visit; $20 for Dr. visit; $15 for RX). My family has definately taken advantage of this coverage as I have had open-heart surgery (valve replacement) which was 6-figures; all three of my kids' births had complications with NICU stays of about 2 weeks. My daughter had a brain hemmorhage at birth and was the most expensive. To this day she has a learning disability from this and has 8 years of speech therapy, occupational therapy and physical therapy. All of this has been covered through insurance. My youngest son was born with severe hearing loss. He had cochlear implant surgery which costs tens-of-thousands. He has had intense speech therapy since birth. Together, my family has probably cost insurance companies close to a half-million dollars. Out-of-pocket, it probably costs me only around $2000. This is is over years and no problem to pay.

After all that mess everyone is doing well right now  Smile I still have routine medications (for the rest of my life) which cost me only around $60/mo. (insurance pays the rest) and routine lab work for blood coagulation tests. My blood has to be 'thinned' for the rest of my life with the valve. My youngest is still in speech therapy, but should be done by the time he gets to pre-school where he is expected to by at 100%. The daughter has no more therapy and now only requires minor special ed from the public school which is no extra cost, to get her back to where she needs to be (she's about 2 grades behind).

RE: The American Health Care System

Posted: Sun Mar 13, 2005 11:55 pm
by ANCFlyer
In some cases, like mine, the Veterans Administration pays for medical care for retired military personnel. I have some small co-payments for prescriptions and other things, but otherwise, I pay for nothing. For now. Our wonderful congress and presidential administrations (regardless of political affiliation) continue to crank down our retirement benefits and foget the promises they made to thousands of soldiers, sailors, airmen and Marines.

For now, it's all gratis with a few co-payments . . .

RE: The American Health Care System

Posted: Mon Mar 14, 2005 1:02 am
by airplay
LTBEWR, here's a a new paragraph.


Catatonic, in my opinion no study is complete unless you can make comparisons. Check out this site:

It will help make some comparisons to the health system you are accustomed to.

It contains some farily valuable indicators for healthcare in various countries. For example, even though Americans are the second richest people in the world (per capita) the infant mortality rate there is higher than many countries inlcuding places like Slovenia, Macau, Czech Republic, Aruba and Guam.

Life expectancy is also lower than many other countries even though the US government invests about as much public money (per capita) into the health system as countries like the UK and Canada. As a matter of fact, the US spends more on health by percent GDP than any country on health but with no universal access and poorer results than many other poorer countries.