The US Healthcare System..........anyone? (Full Version)

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agirl -> The US Healthcare System..........anyone? (9/25/2011 1:25:15 PM)

.....have the patience to explain a little how it works from the perspective of the people on the ground, so to speak?

I have a private dentist out of choice but could have basic NHS dentistry if I wanted to but this differs from NHS medical care to a degree as NHS dentstry has been reduced to fire-fighting.

agirl




Muttling -> RE: The US Healthcare System..........anyone? (9/25/2011 4:26:22 PM)

U.S. healthcare works pretty similar to your dentistry.

What you get and how much you pay varies widely depending on the health care insurance you purchase or are provided by your employer.   While there are a few laws governing they are not at all the same so it's hard to really answer your question.

Some self employed folks just carry major medical which means they pay out of pocket for everything except major stuff.

Most folks who are insured (and many are not) have access to a doctor for check ups and the like with a copay of some sort.   How much they pay and what is covered varies widely.   Typically the pretty cheap and pretty common stuff is easily covered, it's when you get to the more expensive stuff that the insurance companies balk.   I'm a severe juvenile diabetic and my stuff isn't cheap, I wind up going round with the insurance company at least once a year over coverage.  

What's more, I am "uninsurable" if it's just me trying to get insurance alone so the State will help me with coverage like someone who is too disabled to work but the coverage is pretty poor for the price.   Thus, I could never go out and start a business on my own for health care reasons.   Even more entertaining, I can't work for an employer with less 50 or so employees as everyone's insurance rates jump through the roof as soon as the insurance company finds out who I am (takes about a year and...yes, this did happen to me.)

It's pretty much a profit making business, they only want to insure the young and health.




DeviantlyD -> RE: The US Healthcare System..........anyone? (9/25/2011 4:57:10 PM)

I work in the US healthcare system and I still don't fully understand the insurance thing. *LOL*

Muttling is so right about all of it. Healthcare insurance (outside of Medicare and Medicaid) is pretty much all private and it's about making a profit or at the very least not increasing their costs. I think the most telling bit of information about healthcare insurance in this country is that the number one reason for personal bankruptcy is due to healthcare costs. Approximately 10% of this nation's citizens do not have healthcare insurance because they cannot afford it. My personal philosophy is that prevention should be at the core of health care and that is twofold in practise. First there is the idea that everyone should take personal responsibility for their health by living as healthy a lifestyle as possible. Clearly this doesn't happen as can be witnessed by those who make unhealthy choices such as smoking, poor diet, etc. Secondly there is the idea of monitoring one's health so that if and when a problem arises, it is caught early enough to intervene in a manner that is more cost effective than treating it after the disease has progressed, when it is considerably more costly to treat. This second part is largely not followed by those without health insurance. If an individual has to pay to see a doctor and pay for ensuing tests, they will not do so until a problem can no longer be ignored and usually at that point, a disease has progressed far beyond an easily intervenient point.

Health care insurance is far from ideal in this country.




LafayetteLady -> RE: The US Healthcare System..........anyone? (9/25/2011 11:34:56 PM)

Are you sure that the number is only 10% that don't have health insurance in this country? Seems to me the number is much higher, and 10% would represent approximately only the unemployed.

To the OP:

I think the simplest answer to your question is that we don't have a national healthcare system and people are either insured through their employer (mostly with them paying a portion out of their pay), they pay for their own health insurance (which can be financially prohibitive), they receive medicare (aged and disabled) and/or medicaid (which includes the poor) or they have nothing and pray every night they don't suffer anything catastrophic.




Iamsemisweet -> RE: The US Healthcare System..........anyone? (9/25/2011 11:52:57 PM)

The other thing to know about healthcare in this country is that private health insurance is very expensive, and increases more every year. On the other hand, paying for health care out of your own pocket will bankrupt you very quickly. So it is a rock and a hard place kind of scenario. The insurance companies also heavily influence what kind of care you can and cannot get, by setting limits and rules as to what they will pay for". In some instances, doctors are rewarded for not prescribing or conducting certain tests or treatments, even if it might be in the patients best interest.
The US also has something called HMOs that you join and receive health care from. It is like insurance but you are largely limited to receiving care only at the HMOs' facilities.




Arpig -> RE: The US Healthcare System..........anyone? (9/26/2011 2:04:44 AM)

Basically it's a system for making money, and every once in a while, somebody actually gets medical treatment for what ails them, though I'm sure that if the insurance companies could figure out a way of preventing that they would.




DeviantlyD -> RE: The US Healthcare System..........anyone? (9/26/2011 2:18:33 AM)


quote:

ORIGINAL: LafayetteLady

Are you sure that the number is only 10% that don't have health insurance in this country? Seems to me the number is much higher, and 10% would represent approximately only the unemployed.


That is the number i have seen frequently referenced, but I did a quick search and you are right. It has risen a fair bit in the last few years. It is now approaching 20%, according to an article published by USA Today last year. http://www.usatoday.com/news/nation/2010-09-17-uninsured17_ST_N.htm

Personally I think it is obscene that so many people, especially children and the elderly, are not insured in a country with so much personal wealth.




AdorkableAiley -> RE: The US Healthcare System..........anyone? (9/26/2011 2:20:54 AM)

quote:

ORIGINAL: LafayetteLady

Are you sure that the number is only 10% that don't have health insurance in this country? Seems to me the number is much higher, and 10% would represent approximately only the unemployed.

To the OP:

I think the simplest answer to your question is that we don't have a national healthcare system and people are either insured through their employer (mostly with them paying a portion out of their pay), they pay for their own health insurance (which can be financially prohibitive), they receive medicare (aged and disabled) and/or medicaid (which includes the poor) or they have nothing and pray every night they don't suffer anything catastrophic.


Naa actually the unemployed should have the least problem getting insurance, at least in NY if you have an income of zero or under $900 a month  for a single person (which it would be if you are unemployed) then you qualify for medicaid and in NY they no longer go by assets they go purely by income so even if you own a house or have a savings you can still get medicaid. It used to be if you have more than $3000 in assets you couldn't get state help. The problem here is the people who are employed and make too much to recieve state help but too little to be able to afford health coverage on top of other bills, Medicaid should really work on a sliding scale for payments for when you are in the group that makes to much yet too little.


Ailey




DeviantlyD -> RE: The US Healthcare System..........anyone? (9/26/2011 2:36:27 AM)

AdorkableAiley: I have an online friend who lives in Florida. He needs health care. I have tried convincing him to get help, including speaking with his mother to offer suggestions. He claims he cannot get federal aid. I don't know if he's being entirely forthcoming, but it does sound like he's having difficulty in getting aid, particularly after speaking with his mom. He has no assets and hasn't worked in about two years now. It's a very frustrating and heartbreaking situation. So it sounds like Florida and NY are quite different. Unfortunately.




AdorkableAiley -> RE: The US Healthcare System..........anyone? (9/26/2011 2:40:21 AM)

quote:

ORIGINAL: DeviantlyD

AdorkableAiley: I have an online friend who lives in Florida. He needs health care. I have tried convincing him to get help, including speaking with his mother to offer suggestions. He claims he cannot get federal aid. I don't know if he's being entirely forthcoming, but it does sound like he's having difficulty in getting aid, particularly after speaking with his mom. He has no assets and hasn't worked in about two years now. It's a very frustrating and heartbreaking situation. So it sounds like Florida and NY are quite different. Unfortunately.


I am sorry I am unfamiliar with Floridas Medicaid laws though I do know laws are different state to state. I can only speak on NY laws as they are the ones I know. I do know if he was ever on Medicaid before for any reason and lied about anything to get on it he would be disqualified for life from ever getting aid again. I think that law is in every state but I could be wrong, it has happened before.


Ailey whom is often wrong




tazzygirl -> RE: The US Healthcare System..........anyone? (9/26/2011 2:46:13 AM)

Unemployed is really 15 - 16%. Not to say all unemployed have no insurance.

Here are some figures for you....

According to the United States Census Bureau, approximately 85% of Americans have health insurance; nearly 60% obtain it through an employer, while about 9% purchase it directly.[2] Various government agencies provide coverage to about 28% of Americans (there is some overlap in these figures).[2]

In 2007, there were nearly 46 million people in the US (over 15% of the population) who were without health insurance for at least part of that year.[2] Over 1 million workers lost their health care coverage in January, February and March 2009. Approximately, 268,400 more workers lost health care coverage in March 2009 than in March 2008. Proving that today, that number is markedly higher as many workers who have lost their jobs have also lost their employer-provided health insurance.[3] The percentage of the non-elderly population who are uninsured has been generally increasing since the year 2000.[4] There is considerable debate in the US on the causes of and possible remedies for this level of uninsurance as well as the impact it has on the overall US health care system.


http://en.wikipedia.org/wiki/Health_insurance_in_the_United_States

Yes, its wiki... but it often does get the stats right.

Now, from the Census

FOR IMMEDIATE RELEASE: TUESDAY, SEPT. 13, 2011

Between 2009 and 2010, the percentage of people covered by private health insurance declined from 64.5 percent to 64.0 percent, while the percentage covered by government health insurance increased from 30.6 percent to 31.0 percent. The percentage covered by employment-based health insurance declined from 56.1 percent to 55.3 percent.

The number of people with health insurance increased to 256.2 million in 2010 from 255.3 million in 2009. The percentage of people with health insurance was not statistically different from 2009.

The percentage covered by Medicaid (15.9 percent) was not statistically different from 2009

The uninsured rate for children in poverty (15.4 percent) was greater than the rate for all children (9.8 percent).

In 2010, the uninsured rates decreased as household income increased from 26.9 percent for those in households with annual incomes less than $25,000 to 8.0 percent in households with incomes of $75,000 or more.

http://www.census.gov/newsroom/releases/archives/income_wealth/cb11-157.html

The percentage of people without
health insurance in 2008 was not
statistically diff erent from 2007 at
15.4 percent. The number of uninsured increased to 46.3 million in
2008, from 45.7 million in 2007
(Table 7 and Figure 6).
37

The number of people with health
insurance increased to 255.1 million in 2008—up from 253.4 million in 2007. The number of people
covered by private health insurance decreased to 201.0 million in
2008—down from 202.0 million in
2007. The number of people covered by government health insurance increased to 87.4 million—up
from 83.0 million in 2007.

The percentage of people covered
by private health insurance was
66.7 percent in 2008—down from
67.5 percent in 2007 (Figure 7).
The percentage of people covered
by employment-based health
insurance decreased to 58.5 percent in 2008, from 59.3 percent
in 2007. The number of people
covered by employment-based
health insurance decreased to
176.3 million in 2008, from 177.4
million in 2007.

The percentage of people covered
by government health insurance
programs increased to 29.0 percent in 2008, from 27.8 percent in
2007. The percentage and number
of people covered by Medicaid
increased to 14.1 percent and 42.6
million in 2008, from 13.2 percent
and 39.6 million in 2007. The
percentage and number of people
covered by Medicare increased to
14.3 percent and 43.0 million in
2008, from 13.8 percent and 41.4
million in 2007.
38

In 2008, the percentage and
number of children under 18
without health insurance were
9.9 percent and 7.3 million, lower
than they were in 2007 at 11.0
percent and 8.1 million (Table 7).
The uninsured rate and number of
uninsured for children are the lowest since 1987, the fi rst year that
comparable health insurance data
were collected. Although the uninsured rate for children in poverty
decreased to 15.7 percent in 2008,
from 17.6 percent in 2007, children in poverty were more likely
to be uninsured than all children.
39

Most people (58.5 percent) were covered by an employment-based health
insurance plan for some or all of
2008. The rate of employment-based
coverage in 2008 was lower than
the rate in 2007. The rate of private
coverage decreased in 2008 to 66.7
percent, from 67.5 percent in 2007
(Figure 7). The number of people
covered by private insurance also
decreased to 201.0 million in 2008,
from 202.0 million in 2007.
The percentage of people covered
by government health programs
increased to 29.0 percent in 2008,

http://www.census.gov/prod/2009pubs/p60-236.pdf

Statistics are always interesting.

Basically, as I read it... the employer based insurance was decreasing even in 2008. Private held insurance also decreased. Government run insurance programs increased...

The nice little tid bit is that insurance rates went down.




DeviantlyD -> RE: The US Healthcare System..........anyone? (9/26/2011 2:56:28 AM)


quote:

ORIGINAL: AdorkableAiley

I am sorry I am unfamiliar with Floridas Medicaid laws though I do know laws are different state to state. I can only speak on NY laws as they are the ones I know. I do know if he was ever on Medicaid before for any reason and lied about anything to get on it he would be disqualified for life from ever getting aid again. I think that law is in every state but I could be wrong, it has happened before.


As far as I know, he was never on Medicaid before. I just feel for the guy so much because he's been screwed over by his ex-wife and now that he isn't working, he can't get access for the care he needs. It sucks feeling helpless like this.




AdorkableAiley -> RE: The US Healthcare System..........anyone? (9/26/2011 2:57:52 AM)

quote:

ORIGINAL: tazzygirl

Unemployed is really 15 - 16%. Not to say all unemployed have no insurance.

Here are some figures for you....

According to the United States Census Bureau, approximately 85% of Americans have health insurance; nearly 60% obtain it through an employer, while about 9% purchase it directly.[2] Various government agencies provide coverage to about 28% of Americans (there is some overlap in these figures).[2]

In 2007, there were nearly 46 million people in the US (over 15% of the population) who were without health insurance for at least part of that year.[2] Over 1 million workers lost their health care coverage in January, February and March 2009. Approximately, 268,400 more workers lost health care coverage in March 2009 than in March 2008. Proving that today, that number is markedly higher as many workers who have lost their jobs have also lost their employer-provided health insurance.[3] The percentage of the non-elderly population who are uninsured has been generally increasing since the year 2000.[4] There is considerable debate in the US on the causes of and possible remedies for this level of uninsurance as well as the impact it has on the overall US health care system.


http://en.wikipedia.org/wiki/Health_insurance_in_the_United_States

Yes, its wiki... but it often does get the stats right.

Now, from the Census

FOR IMMEDIATE RELEASE: TUESDAY, SEPT. 13, 2011

Between 2009 and 2010, the percentage of people covered by private health insurance declined from 64.5 percent to 64.0 percent, while the percentage covered by government health insurance increased from 30.6 percent to 31.0 percent. The percentage covered by employment-based health insurance declined from 56.1 percent to 55.3 percent.

The number of people with health insurance increased to 256.2 million in 2010 from 255.3 million in 2009. The percentage of people with health insurance was not statistically different from 2009.

The percentage covered by Medicaid (15.9 percent) was not statistically different from 2009

The uninsured rate for children in poverty (15.4 percent) was greater than the rate for all children (9.8 percent).

In 2010, the uninsured rates decreased as household income increased from 26.9 percent for those in households with annual incomes less than $25,000 to 8.0 percent in households with incomes of $75,000 or more.

http://www.census.gov/newsroom/releases/archives/income_wealth/cb11-157.html

The percentage of people without
health insurance in 2008 was not
statistically diff erent from 2007 at
15.4 percent. The number of uninsured increased to 46.3 million in
2008, from 45.7 million in 2007
(Table 7 and Figure 6).
37

The number of people with health
insurance increased to 255.1 million in 2008—up from 253.4 million in 2007. The number of people
covered by private health insurance decreased to 201.0 million in
2008—down from 202.0 million in
2007. The number of people covered by government health insurance increased to 87.4 million—up
from 83.0 million in 2007.

The percentage of people covered
by private health insurance was
66.7 percent in 2008—down from
67.5 percent in 2007 (Figure 7).
The percentage of people covered
by employment-based health
insurance decreased to 58.5 percent in 2008, from 59.3 percent
in 2007. The number of people
covered by employment-based
health insurance decreased to
176.3 million in 2008, from 177.4
million in 2007.

The percentage of people covered
by government health insurance
programs increased to 29.0 percent in 2008, from 27.8 percent in
2007. The percentage and number
of people covered by Medicaid
increased to 14.1 percent and 42.6
million in 2008, from 13.2 percent
and 39.6 million in 2007. The
percentage and number of people
covered by Medicare increased to
14.3 percent and 43.0 million in
2008, from 13.8 percent and 41.4
million in 2007.
38

In 2008, the percentage and
number of children under 18
without health insurance were
9.9 percent and 7.3 million, lower
than they were in 2007 at 11.0
percent and 8.1 million (Table 7).
The uninsured rate and number of
uninsured for children are the lowest since 1987, the fi rst year that
comparable health insurance data
were collected. Although the uninsured rate for children in poverty
decreased to 15.7 percent in 2008,
from 17.6 percent in 2007, children in poverty were more likely
to be uninsured than all children.
39

Most people (58.5 percent) were covered by an employment-based health
insurance plan for some or all of
2008. The rate of employment-based
coverage in 2008 was lower than
the rate in 2007. The rate of private
coverage decreased in 2008 to 66.7
percent, from 67.5 percent in 2007
(Figure 7). The number of people
covered by private insurance also
decreased to 201.0 million in 2008,
from 202.0 million in 2007.
The percentage of people covered
by government health programs
increased to 29.0 percent in 2008,

http://www.census.gov/prod/2009pubs/p60-236.pdf

Statistics are always interesting.

Basically, as I read it... the employer based insurance was decreasing even in 2008. Private held insurance also decreased. Government run insurance programs increased...

The nice little tid bit is that insurance rates went down.


83% or all statistics are made up right on the spot...


Ailey who totaly made that up




tazzygirl -> RE: The US Healthcare System..........anyone? (9/26/2011 3:03:14 AM)

Not every state covers those who are merely poor... as bad as that may sound.

Some states require a disability.... seems Florida is one of those states... for Medicaid coverage.




AdorkableAiley -> RE: The US Healthcare System..........anyone? (9/26/2011 3:05:51 AM)

quote:

ORIGINAL: tazzygirl

Not every state covers those who are merely poor... as bad as that may sound.

Some states require a disability.... seems Florida is one of those states... for Medicaid coverage.


Then that would be Medicare wouldn't it? Ack I don't know why the laws differ so much, here in NY Medicare is for the elderly and disabled and Medicaid is for people who can't afford it as well as any pregnant woman and any child.

Ailey




rulemylife -> RE: The US Healthcare System..........anyone? (9/26/2011 3:31:47 AM)

quote:

ORIGINAL: DeviantlyD

I work in the US healthcare system and I still don't fully understand the insurance thing. *LOL*

Muttling is so right about all of it. Healthcare insurance (outside of Medicare and Medicaid) is pretty much all private and it's about making a profit or at the very least not increasing their costs. I think the most telling bit of information about healthcare insurance in this country is that the number one reason for personal bankruptcy is due to healthcare costs. Approximately 10% of this nation's citizens do not have healthcare insurance because they cannot afford it. My personal philosophy is that prevention should be at the core of health care and that is twofold in practise. First there is the idea that everyone should take personal responsibility for their health by living as healthy a lifestyle as possible. Clearly this doesn't happen as can be witnessed by those who make unhealthy choices such as smoking, poor diet, etc. Secondly there is the idea of monitoring one's health so that if and when a problem arises, it is caught early enough to intervene in a manner that is more cost effective than treating it after the disease has progressed, when it is considerably more costly to treat. This second part is largely not followed by those without health insurance. If an individual has to pay to see a doctor and pay for ensuing tests, they will not do so until a problem can no longer be ignored and usually at that point, a disease has progressed far beyond an easily intervenient point.

Health care insurance is far from ideal in this country.


You are trying to include two unrelated points.

Most people have bad habits.  I don't anyone who does not have some habit that will affect their health, whether it be smoking , drinking, or lack of exercise.




DeviantlyD -> RE: The US Healthcare System..........anyone? (9/26/2011 3:35:47 AM)


quote:

ORIGINAL: rulemylife

quote:

ORIGINAL: DeviantlyD

I work in the US healthcare system and I still don't fully understand the insurance thing. *LOL*

Muttling is so right about all of it. Healthcare insurance (outside of Medicare and Medicaid) is pretty much all private and it's about making a profit or at the very least not increasing their costs. I think the most telling bit of information about healthcare insurance in this country is that the number one reason for personal bankruptcy is due to healthcare costs. Approximately 10% of this nation's citizens do not have healthcare insurance because they cannot afford it. My personal philosophy is that prevention should be at the core of health care and that is twofold in practise. First there is the idea that everyone should take personal responsibility for their health by living as healthy a lifestyle as possible. Clearly this doesn't happen as can be witnessed by those who make unhealthy choices such as smoking, poor diet, etc. Secondly there is the idea of monitoring one's health so that if and when a problem arises, it is caught early enough to intervene in a manner that is more cost effective than treating it after the disease has progressed, when it is considerably more costly to treat. This second part is largely not followed by those without health insurance. If an individual has to pay to see a doctor and pay for ensuing tests, they will not do so until a problem can no longer be ignored and usually at that point, a disease has progressed far beyond an easily intervenient point.

Health care insurance is far from ideal in this country.


You are trying to include two unrelated points.

Most people have bad habits.  I don't anyone who does not have some habit that will affect their health, whether it be smoking , drinking, or lack of exercise.



The two points are related to preventative medicine. Which...is what I mentioned in my post.

And I did already say that number 1 doesn't frequently happen, although in my world it would. *grins*




tazzygirl -> RE: The US Healthcare System..........anyone? (9/26/2011 3:40:19 AM)


quote:

ORIGINAL: AdorkableAiley

quote:

ORIGINAL: tazzygirl

Not every state covers those who are merely poor... as bad as that may sound.

Some states require a disability.... seems Florida is one of those states... for Medicaid coverage.


Then that would be Medicare wouldn't it? Ack I don't know why the laws differ so much, here in NY Medicare is for the elderly and disabled and Medicaid is for people who can't afford it as well as any pregnant woman and any child.

Ailey


No no no hun... Medicare and Medicaid laws are so different.

With Medicaid, there are certain things they have to offer, regardless of the state. There are also things they can limit on a state by state basis.

PA didnt care how much money I wasnt making. Food stamps were extremely easy to get... I had no income.

Medical (Medicaid), I had to prove disability... it was the only way I could get it.




tazzygirl -> RE: The US Healthcare System..........anyone? (9/26/2011 3:53:47 AM)

quote:

The two points are related to preventative medicine.


Preventative medicine isnt just about bad habits.

Primary prevention Primary prevention strategies intend to avoid the development of disease.[7] Most population-based health promotion activities are primary preventive measures.

Secondary prevention Secondary prevention strategies attempt to diagnose and treat an existing disease in its early stages before it results in significant morbidity.[8]

Tertiary prevention These treatments aim to reduce the negative impact of established disease by restoring function and reducing disease-related complications.[9]

Quaternary prevention This term describes the set of health activities that mitigate or avoid the consequences of unnecessary or excessive interventions in the health system.[10]

http://en.wikipedia.org/wiki/Preventive_medicine

Everyone wants to go with the simple definition of...

Preventive medicine or preventive care refers to measures taken to prevent diseases,[1] (or injuries) rather than curing them or treating their symptoms.

However, curing or treating one symptom may/can prevent another symptom or disease.




AdorkableAiley -> RE: The US Healthcare System..........anyone? (9/26/2011 4:35:46 AM)

quote:

ORIGINAL: tazzygirl


quote:

ORIGINAL: AdorkableAiley

quote:

ORIGINAL: tazzygirl

Not every state covers those who are merely poor... as bad as that may sound.

Some states require a disability.... seems Florida is one of those states... for Medicaid coverage.


Then that would be Medicare wouldn't it? Ack I don't know why the laws differ so much, here in NY Medicare is for the elderly and disabled and Medicaid is for people who can't afford it as well as any pregnant woman and any child.

Ailey


No no no hun... Medicare and Medicaid laws are so different.

With Medicaid, there are certain things they have to offer, regardless of the state. There are also things they can limit on a state by state basis.

PA didnt care how much money I wasnt making. Food stamps were extremely easy to get... I had no income.

Medical (Medicaid), I had to prove disability... it was the only way I could get it.


Wow that is so different than NY. In NY if you want Medicare you need to prove disability and you get it regardless of income Medicaid is based on income.

Ailey




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