I hope the US Federal Government does something to fix the situation for Healthcare. Healthcare and Education seem like the biggest issues in the US currently, just being unlucky on either aspect, even if you make amazing money can throw you into poverty it seems.. seems like a horrible way to live in constant fear.
As a consultant, with a couple of monthly prescriptions (thyroid, asthma, allergies), and a wife with a couple of monthly prescriptions (allergies, asthma), we pay just under $2000/mo for insurance, then about $200 every few months for doctor bills, and around $150/mo for all of our prescriptions.
All in all, we spend about half the median household income each year in health care. When my wife got pneumonia after the flu, we had to drop thousands on an ER visit.
If I wasn't well paid, between our allergies and asthma, we'd probably dead.
This is where my family was in 2017. In 2018 I took a FT job with my biggest client when they offered to pay 100% of a significantly better health plan for my entire family. I didn't regret it then and I don't regret it now.
In the US if you leave your job for any reason you don't lose your insurance. You have access to the same plan for at least 18 months (some situations up to 36 months) through a law named COBRA. You have to pay all the premiums but that's what an emergency fund is for.
That doesn't address the underlying problem, namely the absolutely bat-shit insanely high cost of health care in the US. I have the cheapest family plan I can get. It comes with a ~$12k annual deductible and still manages to cost more than my mortgage every month.
Under COBRA, you have to pay the employee portion plus a 2% administration fee, which means that for the average family you'll be paying 3x to 4x as much.
This is the crazy part to me. You have private insurance, but the quality of the insurance is so piss poor that one wonders what the point of it is in the first place. Nothing seems to ever be fully covered under it.
The insurance is there to pay for the $20k+ heart attacks, premature babies needing NICU at probably $100k+, hemophilics needing $500k+ medications, etc. Also, if you're young, you're subsidizing healthcare for the old. If you're not poor (per government definition) and don't qualify for health insurance premium tax credits, then you're subsidizing them too. And if you're a male, you're subsidizing childbirth and other women specific costs. And who knows what else.
In other words, it's the same as a tax to pay for healthcare for the country, except it goes to insurance companies, and you have to deal with in network and out of network. Except this tax goes up the older you get (but capped at 3x what youngest/healthiest person pays).
Presumably, if you add up all the insurance premiums paid for every year of a person's life, it should theoretically add up to close to how much the insurance company expects to spend on you (plus some profit, capped at 20% by ACA).
The biggest joke is that Americans think that the amounts they are charged for healthcare services is what those services really cost to administer. It's really not even close. A heart attack does not cost $20k+ to treat in other developed countries. A broken arm costs maybe $200 equivalent in the UK vs multiple thousands in the US. I'm not talking about how much the patient is charged, I'm talking about paying the doctors for their time and affording the equipment to perform the treatment.
There's always the anecdata that floats around the internet claiming that you can fly to Spain, live their for 6 months, get a hip replacement, and fly back to the US for the same amount as the outpatient surgery costs in the US. It's basically true, though the numbers may have drifted slightly since it first started making the rounds.
> it's the same as a tax to pay for healthcare for the country, except it goes to insurance companies, and you have to deal with in network and out of network
I think this is one of the strongest ways to frame government-provided healthcare. It's no different paying a tax vs paying the company directly, and in the former case you have the whole US government bargaining on your behalf for reasonable healthcare costs (in the case of single-payer a la M4A).
> capped at 20% by ACA
20% is a lot when we're talking about these outrageous numbers.
> 20% is a lot when we're talking about these outrageous numbers.
It’s not 20% net income, it’s 80% of premiums have to be paid out to healthcare providers. There’s still all the costs of operating the insurance organization, and financials of publicly listed health insurance companies show net income in the 3% to 6% range.
For my high wage, my NHS fee would be just under £7k for the year, my taxes just about at 30%.
Granted here in the US, my taxes are ONLY 25%, but my healthcare costs are close to $30k/year.
That $20k difference is ridiculous ($11k more than in the UK when comparing tax+health), and I HAVEN'T gone to the hospital for a heart attack or premature baby or hemophilia, but if my wife did have a baby, it would cost us out of pocket around $8k (according to the likely VERY skewed numbers in my insurance packet).
A colleague I know is 54, he is single, has only catastrophic coverage and pays $1200/mo. Nothing is covered except 40% of any emergency hospitalizations. The bronze plan was $2000 and had a $15k deductible, and also was basically only co-insurance with $30 generics.
The way we are doing this here in the US is literally killing people. Medical debt is increasing.
My little sister-in-law was on vacation and walking along a path on a jetty with handrails, and benches, and dozens of other people. A rogue wave came and hit her and her friend. She was taken under, knocked unconscious and drowned (and died), until a random stranger who was standing near her finally found her and resuscitated her. She was medivaced to a hospital by helicopter that insurance only covered 10% of because she was out of network, she was then treated by a dozen or so doctors for multiple days as she got pneumonia and broken bones, and head trauma, all out of network. She ended up owing close to $100k with her insurance only covering the first $25k. In any other first-world country, she'd be out of pocket maybe a few hundred bucks. Not in collections for being unable to pay $75k for a freak accident.
Interesting that your NHS fees are at £7k for the year. That's about the amount I pay for my family's annual insurance premiums + deductible.
I'm no fan of insurance/hospital bureaucracy, but at least I can go to any specialist doctor I want without having to see a GP first. And I pick the job and insurance provider I want to reduce the amount my family pays each year.
Emergency situations like the last one you mentioned, if they are out of network, are still covered at in network rates, thanks to my insurance plan specifically stating that in their plan documentation. I feel bad for your sister-in-law and am glad she survived, but she did have a not so great insurance plan. I would strongly consider getting a different job or lobbying hard with my workplace HR if I had a plan that would only pay 10% in true emergency situations.
> That's about the amount I pay for my family's annual insurance premiums + deductible.
Look at what it would cost to cover you and your family on the individual market without government or employer subsidies. As a contractor, I pay double what you do on the individual market, and that is only coverage for myself.
Your employer must be paying for a portion of your health insurance premiums, so you have to include that if you’re going to compare to the $7k GBP figure.
And everyone would get a different job with nice health insurance offerings, if they could.
Not to disprove my original point about how affordable the NHS is compared to my Made in America insurance, but the £7k is only the employee side, the employers also pay a bit (though much less), but a common benefit of most employers is private insurance on top of national insurance.
If my math is correct, employer + employee national health fee for £140k salaried employee is a few quid short of £10k which is still half of my annual health care expense, so my original point still stands.
> And if you're a male, you're subsidizing childbirth and other women specific costs.
And to that I say: fine. I will happily subsidize, through my tax dollars, health care to pregnant women, addicts, the obese, down-and-outers, whoever, so long as it means that everyone has access to doctors and hospitals when they need it.
I am far less worried about paying a few bucks a year to support someone whose condition I will never have, than I am about sustaining this spider's web of private health insurance, with its unaffordable deductibles and an endless list of shady practices. America doesn't need health insurance companies to act as intermediaries between us and our doctors. They add nothing.
> Men die younger than women, and they are more burdened by illness during life. They fall ill at a younger age and have more chronic illnesses than women. For example, men are nearly 10 times more likely to get inguinal hernias than women, and five times more likely to have aortic aneurysms. American men are about four times more likely to be hit by gout; they are more than three times more likely than women to develop kidney stones, to become alcoholics, or to have bladder cancer. And they are about twice as likely to suffer from emphysema or a duodenal ulcer. Although women see doctors more often than men, men cost our society much more for medical care beyond age 65.
Yes, it's very likely I am wrong about that statement.
I assumed that because before ACA, childbirth was not covered by insurance and insurance pricing based on gender was allowed, and post ACA, childbirth was mandatory and insurance pricing based on gender disallowed, that it must mean that, in general, healthcare costs more for women than it did for men.
But perhaps that's only true for young men and women, if true at all?
Depends on where they live[1], there are several states that didn't expand Medicaid under the ACA. They'd also have to make under 100-138% of the federal poverty level, which is ~$12,490-17,236.20 for individuals and ~$16,910-23,335.80 for couples.
In most states to qualify for that you have to be very poorly paid. And in many states, like Georgia for instance, Medicaid covers needy children, pregnant women, parents/caretakers, elderly, disabled and blind residents and people in need of nursing home care.
Unfortunately the people who are most impacted by this are the people who are least able to afford the move to another state. Especially when nearly every state in the south decided not to expand medicaid.
healthcare is getting so bad that eventually medicare for all will be a republican position too. They will call it something else, but it will happen. the party has fundamentally changed.
Oligarchs know that money has to be spent to keep the plebs just well enough to prevent revolt.
There was also a survey (not filtered by party affiliation) asking if people would support a single-payer program with an elimination of private insurance. A majority said "Yes."
I'm not sure where the confidence comes from when in 2017, Republicans in the House and Senate tried to repeal the ACA without a replacement. It's on their radar and part of their platform is removing any type of protections or public access to healthcare.
but what did the president say in his recent address? he said the opposite. he said that because it's popular with his base. the republican party is now his party, and the old core ideals will be washed away.
like I said, they'll call it something else. repeal obamacare and make something new that will basically be medicare for all in some shape or form. it will be a handout to the big insurance, drug, and healthcare companies, I'm sure.
The president also said he had a great healthcare plan, trust him, and that he'd repeal the ACA with that great replacement. When it came time to repeal the ACA, there was no such replacement. The president says a lot of things, many of which aren't true.
Yeah, I know, he's a buffoon. What's important to me is his base. Other than the evangelical vote that is single-issue (abortion), the base is essentially just "rage against the elites" and they need healthcare badly.
I didn't specify before but I'm talking like 8-12 years down the line.
So every other country in the first world offering some form of socialized medicine will inevitably be like this, the US is just "winning" and leading the charge?
Or are we more the token outlier with a "worst of all worlds" system?
Government-run health care systems tend to lead to higher healthcare costs, since the beneficiaries aren't the payers.
Around the world, it appears that low costs lead to universal healthcare, not the other way around.
What America needs to do is make it cheaper and easier to become a medical practitioner without taking on half a million dollars in debt and wasting half of one's pre-retirement life. No fancy government program will work without first addressing that issue.
What is your evidence for this? The US is almost alone amongst developed countries in not having a government-run general heal care system, and has the highest costs (while not covering everyone).
And Medicaid, Medicare, and the Veterans Administration (the three big government run healthcare systems here) all run more efficiently by every measure than any private health insurance system.
Note that I fully recognize the problems that the VA has had, but when you really look at it fairly, they have many parallels to problems in the commercial side of the system, we just don't tolerate that when it comes to government (nor should we).
Both private insurance and taxpayer-subsidized programs pay astronomically high prices for healthcare; I haven't seen any examples of Medicare paying European-level prices for services.
> Government-run health care systems tend to lead to higher healthcare costs
I know this feels true because laissez-faire and commie-bashing rhetoric is still common in the Western world, but there have been numerous studies recently showing that the US is the most costly per capita. The next 3 countries (by 2016 numbers) are all places where most things are more expensive because the country and its citizens are relatively rich: Switzerland, Luxembourg, and Norway.
