American Health Care Question

Hello all,

I recently saw the movie “Sicko” and was wondering…

Suppose I get in an accident in America, and I’m unconscious.
The ambulance takes me to the closest hospital, and let’s say I don’t have any I.D. on me, what will happen?

If the hospital can’t establish that my insurance will cover it, will they just let me die, or will they only do the minimum required to keep me alive and wait for me to give them my insurance papers?

We drive over once a month to go shopping and visit, and the film has got me a bit worried about needing medical help there.

If there is any truth to that film, my heart goes out to you guys, I just can’t understand the notion of letting people die because they don’t have insurance, or because the insurance companies weasel out of paying.


In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual’s ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.

From here:

Speaking as someone who has landed in the ER in the US a few times, and in one instance did not have insurance, if it’s a genuine emergency they’ll treat you first, then ask for ID and insurance later. Even if you don’t have insurance, emergency conditions will still receive treatment, after which you will be referred to the accounting area to arrange a payment plan. They won’t just leave you to die.

Occasionally they do.

The real issue is when you need non-emergency care and don’t have insurance. Getting treatment in those cases can be very difficult.

As others have said, people get great care every day without insurance. They have to treat everyone in some way when they come to the emergency room even if it is a hangnail. This leads to a big inefficency where uninsured people use emergency rooms as primary care facilities causing delays for people that have true emergencies.

It is a myth that the very poor can’t get good health care in the U.S. There is nothing to take from them so they don’t have to worry about the hospital bills at all and the system already has their lack of resources built in. There are also many charity hospitals around that have a sliding pay scale that goes down to zero for many for all medical care. Many of those are teaching hospitals and have cutting edge treatment. The TV show ER for example is based in a charity hosptial.

The real risk in our health care system lies not with the truly poor or the well-off. It lies with the middle class people that don’t have health insurance. They might have some money to take but it might destroy them if an illness or accident forces them into bankruptcy.

There is also Medicaid , a government program which provides health care to folks with low incomes.

As Shagnasty says, the real issue lies with middle class families (and individuals) who don’t qualify for medicaid but can’t afford to pay for health insurance. If you’re self employed or otherwise not covered by an employer’s group plan, health insurance costs are prohibitive. Between $7,500 and $10,000 for a family plan where I live. The median household income is just under $50k, but even at $75k or $100k, that’s tough to afford.

It’s a huge gamble, because out of pocket expenses for yearly checkups and the occasional sick visit aren’t going to cost anywhere near that much money. But if one of your kids breaks a leg or you get a sudden attack of appendicitis, the costs will either deplete your savings or bankrupt you.

Remember, Moore states in the movie that Sicko isn’t about people who are un-insured (like the dude who chopped of his fingers), it’s about people who are insured but get screwed over by their insurance companies.

One example from the movie is the woman who took her baby to the ER and it was determined that the baby needed procedures that would not be covered by her insurance at that particular hospital. While the mother and the insurance company fought over moving the baby to the hospital across town that was covered by her insurance (instead of staying put, doing the procedures and mom paying out-of-pocket), the baby died.

In that instance, the baby might have been better off if she had no insurance. The mother would have been completely in charge of the situation and not had to rely on the “guidance” of the insurance company.

That’s not quite true. It is a myth that the very poor can’t get good emergency health care in the U.S. Virtually every other kind of health care requires demonstration of insurance or ability to pay.

There are in some urban areas and rural areas (never seen one in a suburban area, but I suppose it’s possible :wink: ) free clinics that provide non-emergency care, usually funded by local governments or charities. These do not exist everywhere, and typically they have very limited resources compared to any for-profit health care practice, clinic, or hospital.

How poor is very poor? Obviously people living on the streets don’t wind up paying a lot of medical bills. They also don’t wind up getting much non-emergency medical care.

People who have little ability to pay (they may still make some money or own some property) are still hit with medical bills in the United States. I’m not sure how you can believe that poor people in the U.S. don’t go bankrupt for medical reasons:

Although it is not disputed that many medical bankruptcies and debtors in the U.S. are middle class, the poor also bear a considerable burden of medical debt - perhaps more than the middle class.

In my ER we refuse to accept information about a pts ability to pay until they’re on their way out.

What do those numbers represent? Me and my husband are both self-employed, and we pay about $3k/year for insurance for the two of us with a well-rated company. It doesn’t pay for most day to day things, but will pay 100% of anything about $1500/year.

If we had a kid, it would be about 30% more. Still well under the $7500 you state.

I work for an insurance clearinghouse for mega-corps. A traditional, fully insured health plan for a family usually runs about 8k - 9k a year between the employer and the employee. The nicer ones can go up to 12k a year and aren’t even rare. It sounds like you have a pretty good deal.

Yeah, but we’re not talking about employer-based health care plans. anson2995 specifically said “If you’re self employed or otherwise not covered by an employer’s group plan” and those are the rates I’m talking about.

Comparing what I have to an employer-based plan is apples to oranges. Employer plans always cost more, and they’re (in my experience) much more likely to cover day-to-day problems and routine procedures.

I don’t think I have a great deal. What I have is better than nothing. But it doesn’t cost what anson2995 seems to think private insurance costs, either.

Then by all means please contact me offline and let me know who your carrier is. I’ve been self employed since 2001 and that’s what I pay.

Plus, you wrote “Employer plans always cost more.” I can’t see how that’s possible. Employers often pay part of the premium, so the net cost to the employee is substantially lower. Additionally, they get better rates as part of a group plan. So even if the employer doesn’t make any contributions, I would still expect the rates to be lower.

I have Golden Rule insurance. I’ve never had cause to use it, so I can’t vouch for it in that sense, but last time I checked it was rated well. I do know an acquaintance who has a pretty rare, bad form of cancer, and they had to fight a little bit with Golden Rule to get them to cover the treatment they wanted, but in the end the company ante’d up and they’re happy with it. We pay ~$250/month for 100% coverage of anything above $1500/year. I’m 37, Mr. Athena is 50, we’re both in good health with the exception that he takes medication for high blood pressure (which did make the rates go up, but only by $30/month or so).

The only drawback is that the rates do go up over time. We had it for a couple years while we were both self-employed, then I got a job that offered health care for a while, then went back to self-employment. During the few years we had it before, it went up between 15 and 25% every year. If you’ve had the same plan for several years, shop around. Getting into a new plan will get your rates back down to a reasonable cost.

My plan going forward is to switch to another carrier when it gets too crazy high again, then go back and forth every few years. I even discussed this with Golden Rule, and they said yeah, that’s the way to keep the rates down. Of course, if something bad develops, that might not be possible.

You also might talk to our own WeirdDave. I ultimately didn’t go with the insurance his company offers because our local representative couldn’t be bothered to return my phone calls. But Dave is a wonderful resource, explains things really well, and I wish he offered insurance where I live. His plan doesn’t go up astronomically every year!

I was referring to the overall cost, not just the cost to the employee. Of course the out-of-pocket for the employee is lower if the company pays for part of it. In my experience, employer plans are more expensive because 1) they offer more than individual health care and 2) they are forced to cover all employees, regardless of pre-existing conditions.

My family of four pays $9408 a year for health insurance. We have two separate plans, one for me and the kids and one for Mr. Legend, because he has pre-existing conditions that make him high-risk. We’re just lucky that our state has a program that creates an insurance pool for people like him and has a premium cap of 140% of the standard risk rate. The family policy for me and the girls has a $1000 deductible (each) and Mr. Legend’s has a $2000 deductible.

This year, we’re getting HPV vaccines for the kids, Mr. Legend had to have a CT scan and various other expensive tests, and I’m supposed to be getting a mammogram (and I will, after the dust settles from the other expenses). It looks like we’ll all get close to our deductibles, but we won’t exceed them. This means we’ll be paying around $12,000 for medical insurance and medical bills this year. Tell me again how terrible and expensive a single-payer health plan would be.

for comparison:
I and my spouse have recently had a CT scan, a mammogram, a colonoscopy, a gastroscopy, a minor surgery and a visit to the emergency room. It cost us : ZERO.

But then, we live in an evil country with semi-socialized medicine.
( where everybody pays 6% of each paycheck in health tax, collected by the government, which then passes the money on the the privately-run HMO’s. All the HMO’s must by law provide an identical and very specifically defined set of services, as determined by the government.

No , it isn’t a perfect system. But it works , and when it screws up, at least it screws everybody equally.