Sunday, July 12, 2009

Health Care Part Two The US Healthcare System

Following on from first post about the good the bad and the ugly of the British National Health Service Here are my thoughts of how the current US system works or does not work according to your point of view ( if you did not read the first post please take the time to read it before thinking I am being disengenerous to the US system only ) In a similar way to my first post about the British NHS these are my perceptions not facts about the US Health Care System.

The US Health Care System

The US health care system is made up of two primary parts , Social Health care for those who are entitled to it and Private Health Insurance combined with Private funded and managed Health care Providers.

When reading the following it is important to note the following is an extremely important figure Health Care in the US is 16.8% of GDP ( compared with UK under 10% ) . or more simply for every hundred dollars earned $16,80 is for health careOnly 6 in 10 have private health care coverage, Lowering month by Month of those 1 in 4 work for the federal government or State Government meaning many of those in politics do not understand how the general population who are not government employees are affected with health care costs and lack of coverage.

I must admit I do not have any personal knowledge of how well or how badly the current Medicare / Medicaid System works only what I have learned from reading and talking to those affected .

From my own perceptions the cost for Medicare and Medicaid is a tremendous burden on the US Taxpayer without providing the depth or levels of service provided by the British NHS , we have a friend who is well past retirement age 70 + who is forced to continue work as a Walmart Greeter primarily to pay for her health care costs which implies that even for those who have spent their lives working and paying taxes and Social security are not covered under the current system , we also have a friend whose wife needed a kidney transplant but because her husband still worked ( his employment, health care benefits and salary would not cover the costs and he was forced to stop working so at least his wife could go into the Social Health care system to start the long long wait for the operation. ). A story much closer to home was Zoes own dad who did not have any work and could not afford health care coverage and only went to a free clinic when the pain became unbearable. He was told he had an advanced form of Liver Cancer but due to paperwork and the time to go through the system would have to wait for Medicare approval , for anyone who has understanding of these type of Cancers , the sooner treatment is administered the more likely a positive outcome . Needless to say by the time the paperwork went through the system the advance of Cancer was beyond a clinical solution and he died very shortly afterwards.

I will not attempt to give The Good The Bad and The ugly for the current US social health care system because my lack of working knowledge does not provide me with enough knowledge to do so .

Private Health Care System

Callie covers our health insurance from her job as a nurse ( I did look into obtaining private health care insurance but the cost was prohibitive due to my age and health issues together with Callies MS and Diabetes) so we rely on Callies Health care for which she pays about $600,00 per month towards our cover.

I believe our Co-Pay is in the region of 10% plus for all services so for example our Scripts between us cost in the region of $250.00 per month. Family practitioners visit Co-Pay $25.00. The cost for my broken ankle earlier in the year ended at about $3,000 Co-Pay towards a bill of about $45,000. Because of Callies MS and requirements for a MRI once or twice a year the Co-Pay cost is about $500.00 per year. Co-Pay costs do vary greatly on the insurance provider and coverage purchased so these are just examples.

I have not given these just to tell how much we pay more as an example of Co-Pay costs to those from other countries and to show even with insurance Co-Pay can be a significant chunk of change.

The Good
From my own perspective my treatment and Callies treatment are far far superior than we could expect in the UK, our Family practitioner is caring and takes the time to find out medical issues , she is also so nice I have never been great lover of Doctors or Hospitals I expect it's a bloke thing but trust her implicitly . She even took some time to pop into the hospital when I broke my ankle and check I was OK and say hello. Also When I broke my ankle the staff at the A and E were looking at and evaluating damage before we had even provided insurance details , the service from everyone involved Doctors, Nurses, Surgeon, Anesthetist, Aftercare and Heart consultant was professional, Caring , Understanding and I Believe could not have been better anywhere in the world and far far beyond what would happen in the British NHS.

1. You can choose Doctors and nurses that you wish to use ( especially good for us because of Callies knowledge of the Health care providers in the area. )

2. The overall service is caring, efficient and professional .

3. Medical facilities specifically the Hospitals I have seen are better staffed, funded and equipped than the UK.

The Bad

1. The costs are increasing exponentially for those with private health care as the numbers of uninsured increases and Insurance Companies, Drug Companies and Health Care Providers need to make the same profits

2. The cost of drugs which were first used from 5 years to 18 years ago continue to increase beyond any rational amount ( a good example is the highly prescribed Cholesterol tablet Lipitor where the Co-Pay has increased by nearly 30% in 12 months

3. The costs by differing health care providers differ significantly for the same treatment , just one example is an MRI, an important tool in diagnosis for many illnesses ( generally the same machine is used in most hospitals ) but can range from less than $500.00 to $4,000 depending on the location and provider.

4. Overall health care costs and Insurance has far outstripped any economic logic reasons are multiple

a. Higher Profit Taking By all involved

b. The Medicare decision to only pay pennies on the dollar for health care provision forcing the health care industry to increase prices by higher percentages meaning they would receive more from Medicare when they supply services , I can remember discussing this with a member of staff during my hospital stay and being quite shocked that attempting to save on medicare had forced the burden on those who are willing and able to pay for private health care.

5. Having spoken to a number of doctors and others in the health care profession one of the biggest bones of contention appears to be the high cost of Insurance to cover Lawsuits. ( the litigation mentality in America stuns me sometimes as most class action suits make more for the lawyers involved than those affected at the sharp end ) I am sure this also has some effect on the cost of prescription drugs.

6. I find it fascinating that most health care providers are registered charities often meaning they are not liable to state taxes or property taxes but those running these """" Charities """" are earning in excess of $1,000,000 per year , they are also massive advertisers on TV spending many millions to promote their company / Charity

The Downright Ugly

I am a strong advocate of free health care for all children regardless of race, status or money , how can any civilised society think that not ensuring a child can see the blackboard, Read correctly ( dyslexia ) or hear the teacher depends on parental ability to pay for health care, surely this only deepens the poverty trap by ensuring Public Education only works for those who can afford health care for their children.

I am sorry this post has been so long but many of
The Good The Bad and The Ugly I tried to highlight lead to my own views on what and how I would change the current US health care system and how to fund it.


Jean said...

As I said yesterday, even good health insurance has its pitfalls.

I cannot even imagine what I would do without any insurance.

Then again, I also know that my doctors charge more when my insurance is "operational" because the insurance companies have set percentages they pay. In order to get what they really want, the doctors probably have to charge more.

And, as you suggest, the cost of malpractice insurance is incredible.

There HAS to be a better way.

Katharine Swan said...

I absolutely agree with you regarding children's health care. Regardless of whether politicians can agree on whether the rest of us deserve guaranteed health care, to punish children for their parents' lack of ability to pay into the system is downright barbaric.

And I totally know what you mean about rising costs. My copays for my diabetic supplies recently MORE THAN DOUBLED. That kind of cost increase is ridiculous and ought to be prohibited entirely.

The one thing you forgot to mention is that U.S. health insurance companies can flat-out refuse to cover someone if they aren't already bound to do so. As a type 1 diabetic, no insurance company will cover me unless they are forced to (i.e., via an employer-sponsored group plan). So since I'm self-employed, if my husband loses his job, I won't be able to get health insurance. AT ALL.

That is DISCRIMINATION, plain and simple!

John and Regina Zdravich said...

I am so glad you wrote about this. now the trick for me will be to keep these comments under control -- I could write a dissertation here. This is a subject that is of the utmost importance to me. We have been thru it all with the American health system -- insured thru jobs, insured on our own (I!!$$$$!!!), and then when we had a claim with John's broken collar bone which resulted in surgery, even though WE WERE INSURED our portion of the bill was $10K!! Outrageous!! We have friends in the UK who have visited us several times, and have made extended trips to Europe (Italy, Germany, Serbia). Our Scottish friends tell us about their experiences iwth healthcare, and we are just in awe of how easy and inexpensive it all sounds. While in Italy I had bronchitis and had to see a physician, and outside of a long wait, received an exam and prescription and it did not cost me more than 40 Euro (even as a foreigner). Our German exchange student was in a serious car accident after she left us and went back home. She almost died -- was in a coma, had to learn to talk and walk all over again, spent months in a rehab facility...we visited her when she was almost finished with rehab. Her family did not have to worry about the financial aspect of her care AT ALL. They could concentrate on helping her get better. And she received excellent care, and recovered fully. Here, if you are faced with a life-threatening health matter, you also have to be stressed to death over the financial aspect of what you are facing. I worked for an accounting firm helping with income taxes and saw that clients would DIVORCE if one of them were seriously ill so that they did not have to go completely bankrupt -- one spouse would still have some assets left so they could both continue to live in their home, have a car, etc.....I could go ON AND ON!!! WE MUST DO SOMETHING IN THIS COUNTRY! IF THE REST OF THE WORLD CAN DO IT, SO CAN WE!!

John and Regina Zdravich said...

Sorry, but it is me again....forgot to mention something. My crown came off of my tooth when we were in Serbia. We went to the local dentist with 50 Euro just in case....their currency is Dinars, but they accept Euros....Well, he re-cemented my crown and only charged me 5 Euro!!! In this country, I would have needed every penny of the $50.

White Horse Pilgrim said...

I've just been to the doctor today in England, as my back muscles were in spasm. I phoned at 9am and got an 11am appointment at our new medical centre in the town. I was seen after a 10 minute wait, given a good examination, and sent out with advice and a prescription. The visit was free, and the prescription cost about $20 (that's $10 each for two types of drug.) It would have been free for people who are unemployed or a pensioner, and some other drugs (cancer, thyroid, etc) are free to anyone. People needing regular prescriptions can buy a "season ticket" that gives a good discount. I pay 9% of my salary in National Insurance towards medical care, unemployment fund, education, etc. It's a good system, reliable and open to all. And, judging by what I have heard, it is cheaper per capita than the American system too.

A couple of differences come to mind.

The European legal systems don't recognise punitive damages. That keeps settlements down at reasonable levels, hence malpractice insurance too.

A doctor here might earn as much as a senior engineer or suchlike professional - a good income but not enormous. I remember hearing about how a chiropractor (the ex of someone I knew) in California had a hundred acre ranch from the proceeds of his employment. Here a chiropractor would live in an ordinary house and drive a normal car.

These two factors mean that you could not (without changes) have quite such am economical medical system as the British - but the general principle could transfer easily enough.

Breathe said...

Sorry to be so late to this post.

My daughter, who had heart surgery at 7 months of age, is now, at age 10, an automatic decline. I can't work in our family business or continue my solo consulting career because I can only get her covered as part of a group.

Make sure you are making your views known on this issue in Congress. The insurance companies are ramping up the fight. Silence on this will be deadly for too many Americans...