So I keep on hearing everywhere that American health care will screw you over if you’re poor but the rich have it pretty good. What I want to know is what the actual mechanics of it are. Say you’re someone working and making, say $200,000 a year in a professional position. A lawyer or an architect or something. What sort of health care coverage would you have? Is there any one health insurance company that’s known for servicing the high end? Like, the rolls royce of health care? If your company provides health care, how much choice do you have? What if you were self employed or something? About how much would health care cost per month? What are the benifits like?
Hmmm. I think we may have slightly different definitions of ‘rich’ - if you are rich you don’t need insurance, because you just cover the bill in cash, but that’s probably going to need more than $200K a year in income. You’re also going to be very popular with your healthcare provider, because they don’t have to worry about any paperwork other than banking your benjamins.
I always understood that phrase to mean that when the wealthiest people in the world got sick they generally prefer to walk into a top US hospital like the Mayo clinic or Johns Hopkins and say 'my medical chappie says I need treatment X for my Y. Can you have one of your specialists take a look and do the necessary? Just send the bill to Coutts and they’ll take care of it" rather than patronise hospitals in other countries. The US has the best high-end medical care in the world, it’s just eye-wateringly expensive.
Well, in the US many companies are turning towards staffing with temps and ‘part time’ [define as 30 hours per week and under IIRC] who do not qualify for employer provided health insurance.
Hence, you can be more or less fully employed and not eligible for any sort of health program other than perhaps WIC [or whatever they call the state provided health care for children when the parents cant afford or qualify for health insurance from an employer]
There is a program called COBRA that somehow allows you to make the total health insurance payment for whatever HMO your previous employer arranged without still being employed, and many temps I know use it. One friend of mine temped for 4 years before she found a permanent job with insurance. She was paying about 700 $US per month for her health insurance. In my company, I pay a total of about $100US per month for mrAru and myself, with medical dental and eye care.
Well, in America the poor have either no insurance, or Medicaid. Many doctors won’t take Medicaid because the reimbursement rates are not up to snuff for them.
And the poor tend to have more chronic illnesses. If you’ve got chronic kidney disease and have to go to dialysis three days a week, it’s difficult to hold a job. So those people tend to be on Medicaid and also more expensive to treat.
America has got great technology and research facilities. If you’re a stockbroker who has a heart attack, you will get your open heart surgery covered. Your ventilator for post-surgery is covered. And if there are complications that are not covered, if you are rich you will have the wherewithal to pay the hospital bills.
We absolutely have great care and training in this country. Our technology is brilliant, but it is very very expensive. If you are poor and come into an ED in lifethreatening distress, you only have to be treated until you are stabilized. Then you can be sent to a different facility. In Seattle, the county hospital is also the major trauma unit for 4 or 5 states and the only good burn unit in the area so it’s different than a lot of other places. In other areas, if you get stabilized they can send you to a place with worse equipment, worse staffing, etc.
FWIW, I make ~$14/hour and have pretty good coverage. Of course, I work in a hospital. There’s no Rolls Royce of insurance that I know of, but I know boutique health care was pioneered here.
(I will try to look for cites tomorrow if anyone wants, but I’m way too tired now.)
People with lousy-to-no insurance – in my observation, anyway – tend to get what I consider “minimal care.” My SIL had a mastectomy and spent one day in the hospital. She was responsible for managing the drains, etc. on her own.
I also think people with more money/better jobs tend to have access to “the best” doctors in their fields, just through hearsay, word-of-mouth, maybe even went to school with them. When I had my hideous fish-hook-in-the-eye accident, my dad’s boss got me an appointment with one of the top ophthalmalogist’s office within two days; normally, this guy was booked six months out. Sometimes it’s who you know.
The rich and well-to-do can also afford to hire home health care aides, nurses, housekeepers, and other helpers. When I had an MRSA a few years ago, I spent some time in the hospital, and then had IV treatments at home. While it was less expensive to have a home health nurse come out and treat me rather than staying longer in the hospital, it was still not cheap. I’m lucky that I do have good insurance. I’m amazed that your SIL was sent home one day after surgery.
Fish hook in the EYE!?!?!? :eek: :eek: :eek: :eek: :eek: I think that I now have a new fear. Not that I fish anyway, but now I’m not gonna even go NEAR anyone fishing!
Here’s one of my more colorful recaps of the incident. It might make you throw up a little in your mouth. http://boards.straightdope.com/sdmb/showthread.php?p=7016747#post7016747
Also, a common practice in the US is for corporations to dump workers from high-paying jobs as they age. They typicially have to take much lower-paying jobs, and sometimes have to take jobs without insurance coverage, because guess what: very few employers are willing to hire workers who are old enough to need insurance.
There are 45 million Americans without medical insurance, their options generally are emergency rooms for emergencies, doc in the box for minor stuff if they can afford it, and hoping OTC medicines will take care of biz if they can’t.
If you aren’t rich or have good medical insurance, and there are a lot of Americans who fill that bill … American medical care sucks, sucks, sucks, sucks, sucks.
There isn’t one company; each company offers several different plans. They’re offered to your employer, who chooses a couple and offers them to you. Employers typically pick up a lot of the cost, but their share is shrinking.
According to the New York Times,
The FRBSF Economic Letter has increases health care costs to employees more than eating up gains in income. And, of course health care is crippling GM, where:
Yeah, US health insurance blows if you’re poor, I GET IT… What I’m wondering is what it’s like if you’re earning $200K a year.
Well, as an example, my BIL and SIL are currently having a $1M+ house built in Sedona. They’ve got money. Now…because my SIL once wrenched her back (a one-time incident, mind you; not chronic back pain), they couldn’t even get insurance for love or money, until they applied for AARP health insurance. They got good coverage, but have exclusions for pre-existing issues. They’re paying $1700 per MONTH for coverage. So there ya go.
AARP?
American Association of Retired Persons. They are one of the most powerful lobbying organizations in the country.
If it wasn’t for AARP, they would not be insured. Period. They applied at many companies and were turned down; they would not insure them for ANY price. And I’m talking about previous, no-big-deal illnesses. In fact, one other issue that excluded them was sinus issues. Practically everyone I know has recurring sinus headaches, etc. that have been treated by a doctor. I’ve also seen people turned down for ear infections. You pretty much have to have lived in a clean room all your life to get retirement-to-medicare coverage.
Remind me not to moan about the NHS next time I’m waiting 30 minutes in the GP’s waiting room.
Actually I don’t moan that much. Mrs Marcus has diabetes and hypothyroidism and the stories from sufferers in the States - even well insured sufferers - are enough to make you thank the Lord for social medicine.
It’s not so much that they have access to some kind of luxury insurance company that the rest of us don’t know about, it’s that they have the cash to cover the gaps in the insurance. If they have insurance through their employer, but the insurance doesn’t cover certain prescriptions or caps out on long term illnesses like cancer, they just pay for it themselves. Most people have to choose between a cheaper alternative and a cutting edge treatment if their insurance won’t cover it, but a rich person just goes with whatever treatment is best.
For example, if you are diagnosed with cancer and you want to get a new or experimental treatment, often you have to fight your insurance company to cover it. If you have your own cash, you have more options and thus a better chance at survival. You can also pay to fly to that great specialist, and not worry that s/he is not one of your covered providers.
Better paying jobs are more likely to offer the type of group insurance that gives the patient the maximum amount of flexibility and the least out-of-pocket expenses. With Preferred Provider Organizations, you get to choose your doctor, your doctor is freer to order whatever tests, prescriptions, procedures, etc. he or she chooses without having them questioned or nitpicked by the insurer. The patient is also freer to go directly to a specialist without having to work through a primary care physician, so you save time and hassle as well.
I work in an HR consulting firm that represents mega-corps and millions of employees nationwide. People earning 200K get the same insurance that people making 20K in the same corporation get. That is what group insurance is about and there aren’t that many nationwide insurance companies although they offer a huge array of plans for companies to choose from. I am curious why you chose the 200K number. That is certainly upper middle class but by no means rich at least around here. Families making that much just fill out the same benefits enrollment form as the regular plebes and get the same menu of insurance.
Indeed. At the company I work for, every salaried worker gets the same insurance, from the six-figure people to the groundskeepers and cafeteria staff. I am not making anywhere near six figures but I have outstanding medical coverage that would be extended to my spouse and dependents if I had either.
Usually an employer offers more than one, including at least one “basic” plan that costs half as much and offers fewer benefits. If you’re making 200K you can get the big multipart, low/no copay, no pre-approval for specialists, pays your health club membership plan.