Can someone explain American health care for me?

Factual Questions
21

I wrote earlier:

For those of you unfamiliar with the US’s Medicaid: Medicaid is the only true needs-based governmental “safety net” insurance program in the US. You are generally entitled to it if and when you are entitled to “welfare” (public assistance), but they tend to investigate your overall financial situation. If you have assets, your Medicaid case is subjected to something called a “spend-down”, meaning that they wait for you to liquidate your assets and spend them on health care and then when you are pretty much dead broke they start providing coverage.

The situation where most people not previously impoverished run into Medicaid is with regards to long term care (skilled nursing facility, etc) to which people get discharged if their condition stabilizes but they still need medical care. Very few health insurance systems (Medicare, private) will cover care in such a facility for very long, and after that you’re on your own until/unless you qualify for Medicaid.

So they wait until you empty any bank accounts, perhaps sell your house and move into a rental if you’re a homeowner, etc., and then start paying the nursing home bills.

22

Single provider insurance carrier. Ie, government or gov’t corp manages the money, rather than many insurance companies, HMOs (Health Maintenance Organizations), etc.

The advantage would be the many dollars now going to dividends and redundant management expenses by multiple companies would not have to be paid by the population.

23

We have TennCare.

It is a relatively inefficient universal health insurance system.

Anybody can get it, and it is essentially affordable.

But it is so badly run, that it has serious problems.

24

Actually, the Canadian “single-payer” (and it’s single payer per province, not nationwide) does not exclude the existence of private health insurers. Rather, the single-payer Provincial Corporation (e.g. the Québec Régie) provides one same “core” universal coverage and one single place and format for all bills to be sent, and the private outfits provide extras (Sort of like Medicare Plus programs in the USA). Every healthcare provider in the province, even if in private practice, has to accept the Provincial coverage. Hospitals, even if operationally independent, are mostly if not completely public-owned and part of a regulated “system” so they do not compete w. each other or duplicate services. And every citizen has to access the hospital or the private MD through the Provincial Coverage – using the Health Coverage is mandatory, you can’t can’t just walk into University Hospital and say “F**k the Health Board, eh? I have here two suitcases full of CA$100 notes that says I’m getting admitted today!”

One other thing that has not been mentioned about the US hospitals, is that not only are the vast majority not “public” hospitals – i.e. they are owned by private entities – but on top of that you have a mix of owners, you can have both for-profit (corporations like Humana) and nonprofit (churches, universities, foundations) hospitals. And don’t be fooled, some of those “nonprofits” will cost you a pretty penny.

BTW – (many? most?) hospitals in the US still separate a portion fo their budget for “charity care”, where they do not expect even the local government to pay.
In the USA, at the high end of the market, anyone for whom the cost will not cause pain, be it due to having the money at hand or excellent private insurance or a certified, authorized government-supported case, can get a treatment pretty much when and where s/he wants it.

25

Yes. On paper, it’s a good system. Growing up in Canada in the '70s and '80s, it was fine. However, now there are problems. These are mostly due to government underfunding in the pursuit of balanced budgets. Close proximity to the most expensive healthcare in the world (i.e. the US) doesn’t help, either.

We now live in Cleveland, home to two well-respected private hospitals, a good medical school, and more wealthy middle-eastern patients than any other city in the US (including Rochester, MN, home of the Mayo Clinic). Two of our doctors are Canadian, lured here by better opportunities (both research and Clinical).

Assuming you have a good job with good insurance, and live in or near a city with a major medical center or school, chances are you will get excellent care. If you live in east tumbleweed, or work flipping burgers, chances are you will not have good access to medical care.

In Canada, it doesn’t matter who you are, and how much or little money you have - you get the same care. However, it has been declining so bad that, in comparison to what you get in the US (assuming good job & major city) is a sad joke.

Two examples:

A few months ago I had sharp pains in my neck. I saw a neurologist, who checked me out, then sent me to get an MRI. I was offered the choice of getting the MRI “tomorrow morning or afternoon?”. If I had been in Ottawa (capital of Canada), I would have waited 5 months (!) for the MRI.

A relative needed heart-valve replacement surgery. His surgeon was the best in Montreal, and when the surgeon said “you need the operation now!”, he had to wait 3 months. We considered bringing him to Cleveland for the operation (it’s one of those “your money or your life” situations), but his health was stable so we waited. When the surgery was complete, we figured out what the problem was - lack of recovery room space. Montreal General, largest hospital in Montreal, has a surgical ICU with a dozen beds. This is shared with trauma! In comparison to Cleveland hospitals, Montreal General is a sad joke.

26

The above is why I also have a law degree & practice forensic medicine. No fee limits set by the government & yes I get to bill attorneys- & bill upfront. BTW, the number of wanna be docs is rapidly on the decline: all the above says why.