Question about US health care
 

I'm sitting and watching a Baby Story (love that show) and was wondering... is ANYTHING free in health care? like if you walk into a hospital and have a baby.... natural.. no epidural no c-section.. will you still get a bill? Or are the basics covered but like if you want an epidural.. you have to pay for that. Also what if your baby is born and needs intensive care and you can't afford that? I have a hard time wrapping my head around how it works.

If you don't have private insurance here, there are government funded programs that sometimes people (usually low income) qualify for. In an emergency hospitals legally are not supposed to turn away anyone....but I know they don't get the best of care, like a privately insured person might.

Nothing is free in the US healthcare system. Certainly not having a baby, which is fairly expensive due to the liability issues. BUT hospitals are required to provide care to anyone who walks in. Since many people are too poor to pay, the hospital "writes it off". But they make it up by overcharging everyone else.

Our healthcare system is broken here. I have health insurance that is paid for by my employer. But I am seeing the cost go up while benefits are being reduced. I think eventually we are going to go to a system like Canada, but we are going to have to fight the insurance lobby.

I have friends in Canada, several of whom are physicians, and they love the Canadian system.

If you have private insurance (which is usually offered if you hold a full-time job through your employer), you will most likely be paying a certain amount every month for it. Then when you go to the doctor or hospital you may have a copay or deductible to meet and then the insurance pays. Sometimes they don't cover everything and you get a bill for what the insurance company doesn't pay.

This is totally different from government funded programs if you can't afford it. They pay everything but it could be a challenge qualifying for these.

Most, if not all, hospitals have a certain amount of money that they give away per year for those that can't afford services. You you don't have insurance and you have an emergency you can go to the hospital and the bill will be sent to you. You can try applying for this program then (after you generate a bill in some or all hospitals). It doesn't mean you'll get accepted though.

If you go to the doctor with no insurance you pay the bill.

It's hard to say whether this is the same across the US though.

I hope I explained that right.:)

Hmmm, I've recently met a Canadian physician that moved to the States because he didn't approve of how he was restricted in offering care to his patients.

I think our system here needs to change....but I don't want a system where I have to wait for appointments/procedures or have my doctors be any more restricted than they are currently by HMO's.

that's what we are dealing with here in Canada... while EVERYONE gets care for free... the waiting list for procedures is long. We think that in time we will be more like your health care- what we are calling a two-tiered health care. There will be both private and public. Many people are complaining about this (the ones that would be unable to afford private) but the way i see it is if those who can afford private go that route it will DEFINITLY decrease the waiting times in public health care. I suppose "free" Is wonderful but i think both have their flaws.

Many of our Doctors are going to the U.S.A. in order to make more money. In Ontario, there is a set amount of what they are paid, for procedures. Yes, there is an extensive wait to see a specialist. However, it is still paid for. When you consider, even with some coverage, you can face financial ruin, or be told what Doctors you are allowed to see, I think I still like our system. I lived in the U.S. for six years recently, with no coverage and was faced with paying for procedures. It was NOT cheap.

I have a friend who moved to Texas to get married a couple years ago and she just had a baby. She told me she will be paying off her childbirth for a long time. I've been wanting to move to the states for a year so I can live in a warm climate for once, but the heathcare is definitely my biggest concern! I have talked to my friend about it and she said I should try to get private healthcare, but it will probably be very hard because I have kidney problems and need to see specialists and have testing done on a regular basis.

My husband is self employed, which means we don't have any health insurance. It's very expensive when someone gets sick($500 for removing stuff my husband got in his eye while working). In two days I take the kids for a cleaning and xrays at the dentist, $300. Not poor enough for medicaid, not rich enough to afford our own. Really sucks :thumbdown

does each individual hosptial/dentist have their own prices or is an x ray the same price no matter where you go? Is there somewhere you can look up what each hospital will charge so you can "shop around"?

The US healthcare system needs a serious update. Many businesses are dropping healthcare coverage to save money. More and more people are going without and hoping nothing goes wrong.

If you are self employed, it really sucks. You can't get any coverage from the government and it costs a fortune to get private insurance. The deductible is high and the coverage sucks. We've been self employed for over 20 years and deal with this problem. My husband has a family history of high blood pressure and heart problems, so his Dr. put him on medication for cholesterol and high blood pressure, for precautionary purposes, now we have a terrible time getting any coverage for him.

Our premiums right now are over $850.00 a month with a $1500. deductible for each of us per incident, so we basically don't have any coverage. I've thought of going out and getting a "real" job, (as people call it) but I can't afford to let our other business fail because I'm not there to work. Jobs are not like they used to be around here either. Most jobs don't pay much and don't offer any benefits, so it is a vicious cycle. We are pretty much stuck where we are. We work harder than most people who work a regular job, and we are penalized for it.

With gas prices, food costs, utilities, just about everything is going up and with all the flooding, it is going to get much worse, we don't know what is going to happen to us. When it comes to, do we pay our insurance or buy food and heat, I guess the insurance will have to go and we'll just have to pray that nothing serious happens.

We have property up in Canada, and have been thinking we would retire and live up there so we'd have some healthcare, but nothing is perfect and every county has it problems.

they have thier own prices ...:rolleyes: but a good documentry is called "Sicko" I want to live in France because of what I have seen on that movie! ;)

it sounds like a horrible "Cycle" that you jsut cna't get out of. I suppose free health care, no matter the draw backs, is better than no health care. And even though there is usually a "wait" (I had to wait 3 months for a gallbladder operation... three loonnng months) however, had i gone to emerge in severe pain.. it would have been gone that day. so i guess if you are "serious" enough you get moved to the front of the line which is great but sucks for those who are not "serious" *sigh* i hear France has a good health care system :p OH and dogs are allowed EVERYWHERE.. lol

My Husband is self employed and our Insurance was too high to keep up with and it covered very little. There is a new state run insurance program for people without Health coverage and we applied for it so I hope we get it.

Me too! I just need to brush up on my french speaking skills lol

It's so complicated. Health "insurance" varies and can be anything from a high-deductible plan which means you pay everything until you hit $1000 or even $5000 and then insurance pays 100%, or a plan where they pay 90% of everything. Some people pay $5 for prescriptions (with ins.) and others pay $50 for the same drug (with a different ins.)

My biggest issue with our system right now is that it is tied to your job. My husband works for a small company that does not offer insurance. I work as a secretary making very little $$ but the place I work for offers good insurance. I hate working here and we are moving soon so I put in my notice and we immediately applied for an "individual" plan (independent of our jobs) and we were denied. We are willing and able to pay for health insurance but they do not have to accept us, even for one of those "high deductible" plans where they are not likely to have to pay for any expenses. They have an "underwriter" that looks at the application and sees that my husband has high blood pressure and I had surgery last year and stamps a big fat DENIED on it. The only other option is to go get a different job that offers insurance because they have to accept us on their plan. So much for those who choose to be entrepreneurs and be self-employed, or those who wish to work part-time like moms who otherwise stay home with their kids.

See, the way the laws work here, if you work at a job that offers insurance the insurance carrier is required to accept you into the insurance plan. Sometimes there is a waiting period of 1-3 months and sometimes the employer pays part of it and sometimes they don't. Sometimes they have good insurance where you can see any doctor (PPO) and some have HMO's where you can only see a certain doctor that may be 30 minutes away. However, if you do not have a job that offers insurance or if you are self-employed, etc. you have to apply for individual coverage and they are NOT required to accept you. Insurance is a FOR-profit industry and they have a responsibility to their shareholders to maximize profits as much as possible. That means denying claims and hoping that you don't fight them and denying anyone who has any sort of medical condition that might cost them $$.

Part of the problem is that it is inconsistent. When you go get an MRI it's like $1000 if you don't have insurance. If you do, then the insurance pays their "agreed" price to the hospital (say $600) and then you pay 10% or 20% of that as your "co-insurance" so you pay $60 or $120. Since people don't usually pay attention to this and get a bill for $60, they don't shop around for a better deal or pay attention to how much things actually cost. SOME plans just have a $20 co-pay and then people REALLY don't pay attention to how much things cost. My mom's doctor sent her for an MRI once (she had cancer a long time ago and they were worried about something) and the insurance refused to pay for it even though the doctor ordered it and said she needed it. They can do that, and there is nothing to stop them because you are one person and they are a multi-billion-dollar company with lawyers and politicians on their side.

It's true that they have to treat you at the ER, but then they send you an inflated bill. What ends up happening is people without insurance wait until it gets really bad before going, requiring twice the expense, or people who can't see a doctor (because many don't accept "self-pay" patients) will go to the ER for a sore throat.

The system is really messed up and the politics of it is disgusting. The politicians are all in bed with the health insurance companies. I'm all for personal responsibility and taking care of myself, but I shouldn't be forced to work a dead-end, low paying job just to get health insurance.

I think part of the solution is going back to actual INSURANCE not these 90% health care plans. I am perfectly happy to pay for my Dr. visit and antibiotic as long as I'm covered if I break my arm or I have to have surgery. However, doctors are so used to OVER-charging because their rates then get "discounted" by the insurers that everyone would have to go to this type of system before it became a competitive free market.

There is a bill in the works called HR676 that would allow anyone who chooses to to buy into medicare (which is the system provided to the elderly and the disabled). This would be a great option for diabetics, people with high blood pressure, people who otherwise are denied coverage. But the politicians won't let it go through. They are scaring people by screaming "socialized medicine" All I'm asking is that I be able to buy insurance to be on the same level playing field as my neighbor who has insurance through his job.

Another example of why this is unfair is that my husband is happy with his job so insurance through another job for him is not an option right now. Therefore I am the only one who can get a job that has health insurance. When we have children I would like to stay home with them, therefore loosing our health coverage at a very important time. There are no options for situations like this and it's very sad. Something needs to change and as hopeful as I am about a change in November, in order for this to change more people need to be outraged. Those who are just plugging along think things are just fine, until they lose a job, change jobs, have a baby, etc.

Oh, also if you change jobs and insurance your deductible starts over. You can't take your insurance with you from job to job. The whole system stinks.

I sympathize with anyone in your situation, I think it's worse for you than any other group. At least if you're low income, some assistance is available.

Although through DH employer we have always had insurance, it's still tough to meet the deductibles, co-pay's and now even gas to travel to Dr.'s appointments, if your income is not considerable. But still, in your case being in between is scary!

Same goes for your situation Erin, I didn't see your excellent post until after.....

Oh dental is even more fun. Every dentist is different so you can shop around, but it is still expensive. If you are lucky enough to have dental insurance (most don't, typically if you work in a union or for a LARGE corporation you do) they pay 80% or 50% of what they call usual and customary. See dentists don't contract like doctors and hospitals. So if they insurance says that "usual and customary" (what they think the dentist *should* charge) is say, $50 for a filling, and the dentist really charges a more realistic $80, then insurance only pays 50% of U&C so they pay $25 of an $80 bill. It's really confusing for people who think they are covered and then get a huge bill. That's why it's VERY important to know your policy, shop around, be informed but unfortunately most of the people I know do not do this.

You can shop around for doctors and hospitals but they insurance companies still get better rates. Sometimes you can get a "cash" discount but it means negotiating EVERY time you have any procedure done. If I go to the Dr. and have bloodwork done, they send it out to their lab - I don't get a choice or the opportunity to shop around. I just get a bill. The consumer has very little power.

When I had surgery I could have called around and found the cheapest hospital, but then my Dr. only does surgery at one hospital so then I would have had to find a new Dr. (a specialist, who are not on every corner) You can possibly negotiate hospital fees but then you don't get to choose your radiologist, your pathologist, your anesthesiologist..... etc. You just get bills in the mail. Anyone who has had any procedures done knows that it turns into a part-time job trying to keep it all straight.

All insurance policies are different...ours is a good insurance...pays a lot, but we have to pay for some visits all up front...like all, dental & vision..we have to pay the whole bill at the time of our appt. Then, we get reimbursed...we have a great insurance lady w/ our turn over time being less then a week to get our money back.

Other visits, we just pay our $20 copay (doctors, dermatologist, etc)....and nothing else.

Medicines are $4-$20 (depending on if they are generic or name brand medicines).

When I went for a CAT-scan awhile back....I had to pay a bill from my doctor, the hospital and THEN the tech who did the scan!!! I could NOT believe that! It seems they charge you for everything and everyone who walks buy charges you for seeing them too! :biggrin:

I thank God everyday we have good health insurance. The government covers retired policemen (US Park Service) we pay very small premiums for the two of us...and medication is $5..one prescription Bill takes runs $265 a month without ins...somebody has got to do something to help the uninsured, this is a crisis! I know dozens of people without health care...

When my brother lost his insurance he had to start going to the Veterans hospital.. he is very grateful he can...they are wonderful in Birmingham ALA.

I agree that our health care situation here stinks but I don't think anyone has a good idea on what to do. Quite frankly I don't want to go on a waiting list to see a doctor because Billy Bob stubbed his big toe. Everyone that NEEDS help won't get it. My grandma has cancer and last year had to go to the Mayo clinic and there was a gentleman from Canada there that came here for help. I know it stinks for a lot of self employed families. Many of my family members are self employed, my great uncle owns a tire shop and and took up a second job to get insurance, (he drives a school bus). While hubby was in school we didn't have insurance. We just had to suck it up, which sounds mean but we knew until he had a good job we would have to tough it out.

We are self employed and I did take on a second job and a third...I also drive school bus and I sell Avon and we still can't afford health insurance. And because I can't be at our business for more than an hour and a half, between bus routes, I had to hire another person to do my bookkeeping.

It just burns me that we have to work so hard to make a decent living and we have all sorts of people coming here illegally, and getting the heathcare from the government that should be entitled to us hard working people.

It is a no win situation, that will never change. JMHO......