Being a health maintenance organization, as you pointed out, HMOs are usually quite involved in preventative care and have a number of resources available to their members which many are unaware of. The HMOs which are made available to employees at my company offer weight-loss and exercise programs, pre-conception seminars, smoking cessation programs, a number of different health screenings, immunization clinics for children and flu shot programs in the workplace for their largest corporate planholders.
They also have programs for well mother, well baby and well child care and specialized services for diabetics, asthmatics and others with special ongoing health issues. Routine screenings – pap smears, manual breast and testicle exams by a physician, mammography, colo-rectal cancer checks, cholesterol checks and now bone-density tests are also free or available for only the cost for a normal office visit.
Two of our HMOs also offer optometry or opthalmology (if you have medical vision problems) at a significantly reduced price. Members get low cost exams and subsidized eyeglasses or contact lenses. (This is separate from our corporae vision benefit, which can significantly reduce the cost of exams and eyewear from other opticians.) None of the HMOs currently cover dental care, one is talkin about it, though. We offer separate dental insurance that is quite comprehensive. ($20 for an office visit, 75-85% coverage for all procedures or devices including orthodontia.)
You are misunderstanding in a way. No one is being kicked off of medications that their doctor says is medically necessary. No one is being told that they cannot see their doctor when they are legitimately ill with something treatable – obviously, though, they do attempt to triage and not necessarily have everyone with the common cold trooping into the office when nothing can be done for them or going into the ER with problems which aren’t truly emergent.
That’s not to say that all is peachy keen. The biggest thing with HMOs has been the speed at which people are discharged after hospital stays. Laws have been passed to prevent them from forcing women to go home less than 24 hours after giving birth. There is certainly some room for concern, but it’s not as if they’re telling people who are in the middle of treatment for some acute problem to o home because they’re out of money.
I have a little experience with the differences - my family lived in the US for a year and did the whole HMO thing - and I know all about the Australian system.
Yes we pay higher taxes here. Considerably higher. (0% for the first A$6000, 17% for the next A$14000 etc up to 47% for everything over A$60000) But I would much rather be sick or elderly (or unemployed, but that’s another issue) here than in the US. Without question.
I pay A$80 per month for the absolute top hospital and extras cover as a young single. (With $500 hospital excess). I’m covered for more things than I’ll probably need and I’ve not been more than about $10 or $20 out of pocket on doctor/dentist/physio etc visits.
I should also add that my post was only to address Anth’s personal income tax question. It’s important to note that a comparison of income tax rates between countries is of little value. Sales taxes, the company tax rate (which will be reflected in the prices paid by consumers for goods and services), transaction taxes and other government taxes must be considered for an accurate comparison between countries.
(And yes, it is generally agreed that the overall tax burden in America is less than that in Commonwealth nations. I’ll try to dig up a cite.)
There are indirect taxes to consider, but you say not to count those. The highest rate of income tax in the UK is 40%, so your 55% figure seems somewhat unlikely.
In the UK, you pay for “National Insurance”, which is like Social Security and Medicare in the US. National Insurance is something like 10%, but stops at about $45k, I believe (I left 6 years ago and haven’t kept up to date). The US rate is lower, being something like 7.5%, but social security goes up to about $85k and medicare never stops.
With state taxes thrown in, the income tax rates in the US are actually higher at the upper end than in the UK (39% + state versus 40%). However, you have to earn a lot more in the US than the UK to hit the highest rate. In the UK, at $90k you would be a 40% tax payer from $50k up, whereas in the US it is more like $250k when the maximum rate kicks in. Also, the US has more tax credits and allowances.
Our health care system is based on the premise that every single person is entitled to basic health care irrespective of their level of income. The majority of hospitals in Australia are public hospitals, with private hospitals having been intended to serve the needs of the more affluent.
I’ve thrown out this year’s Tax Pack, but I’ll go to the ATO website and check out how much you’d pay in the Medicare Levy Anthracite - it’s calculated separately from general taxes, and there’s a reduction in the amount you pay if you have private health insurance.
You CAN go to any doctor you wish in Australia without a referral, but neither Medicare nor any of the health insurance providers will reimburse you any part of the cost of a visit to a specialist unless you were referred.
When Medibank (now Medicare) was first introduced, there were three basic health care options;
public hospital/public medical - which meant paying only the Medibank levy and having all medical and hospital costs paid for by Medibank;
public hospital/private medical - which meant paying the Medibank levy plus a private medical insurance premium. This option allowed people to be treated by the doctor of their choice in a public hospital;
private hospital/private medical - which meant paying premiums for both medical and hospital insurance, but allowed you to be treated by the doctor of your choice in either a public or a private hospital and entitled you to a private room in a public hospital if one was available.
In those days, the premiums you paid for your hospital/medical insurance meant that you weren’t out of pocket.
Over time, as doctors and hospitals increased their charges, the “gap” started to emerge, and even those with the highest possible level of medical and hospital insurance were finding themselves substantially out of pocket. This caused many people to abandon private health insurance altogether and rely instead on the public health care system (for which they were paying via the Medicare levy).
Now there are so many different types of health insurance plans available to choose from it would make your head spin. You can elect to pay lower premiums but carry an “excess” on each hospital admission. You can totally exclude certain kinds of coverage (hip replacements, for instance) from your plan. You can get plans which will refund part of your gym membership or partly reimburse you for visits to the naturopath. All of these options have encouraged people to take up private health insurance again, although often they are doing it more to get back some of the money they were already spending on dental, optical, gym, alternative medicine etc, than to cover themselves against medical and hospital costs.
Pretty much anything which would be classified as “catastrophic” will land you in the public hospital system, which you are already paying for through the Medicare levy.
They don’t control how many times you visit the doctor, but they do put a lot of pressure on. What has happened to me many times is that the insurance company refuses to pay a claim from the doctor. The doctor then tries to get me to pay. For nearly two years I managed by simply throwing their demands away, but eventually they catch up. Actually, it was always the insurance company at fault. It seemed like they would invent reasons for not paying. One of their favorites was “treatment not authorized by primary care physician.” Only after I pointed out that all these treatments were BY the primary care physician did they give in.
"Primary Care Physician is another joke. This is a doctor who you go to first but that rarely gives you any treatment. His/her role is to aim you at a more specialized doctor (and to collect your co-pay). Dentists are worse - I’ve been to my “main” dentist 6 - 8 times and he’s never given me any treatment - he just sends me off elsewhere. Extractions are done by a dental surgeon, root canals by a periodontist, cosmetic stuff by an orthodontist. Each of these will sting you for the consultation fee before deciding whether to do any treatment, and of course the insurance only covers one consultation per six months.
My lesbian lover here, who is English, has this to offer:
"Are you perhaps not considering the Rates? (It used to be the “poll tax”, because that would take the place of US “State taxes”) The Rates works by going off the value of your property, but it’s varied by the number of people living in the property, but not necessarily by the owner (say it is a rented property - she is renting her house out over there right now). It pays for the services provided by that county and town, such as road repairs, police, garbage, education, etc. For my house, a property valued at about 50k pounds, would be about 800 pounds a year.
I am also unaware that National Health stops at 45k (Dollars? Could it be pounds instead?), and I wonder if you are thinking of the opt-out of the pay-as-you-earn scheme, which allows you to opt out of the higher portion of the tax to give you a pension more proportional to your earnings, but you have to pay the same amount of money?"
That 40 million number has been bandied about as a failure of the medical establishment to provide for a number of people who cannot provide for themeslves, but that’s not necessarily accurate. That 40 million number includes a significant number of children who are completely eligible for free coverage under the CHIP program but whose parents have not signed up. They’re uninsured at the moment, but do not have to be.
Then there is the segment within that number – not necessarily huge but not insignificant – who are not insured because they are capable of paying out of pocket for their health care. There is another segment within that number who are not insured because they put no stock in modern or conventional medical practices for religious or spiritual reasons, including old order Amish and Mennonites, Christian Scientists and adherents to countless holistic practices.
It’s not difficult to determine how many Americans are uninsured. It’s a bit more difficult to determine exactly how many Americans need to be insured which is something different entirely.
Actually, a person earning $90000 per year would pay $1350 Medicare levy. If that person had private health insurance the would be exempt from the 1% Medicare levy surcharge which the government imposes on high income earners without private health insurance. As a single person earning more than $50,000 per year, Anthracite would be liable for $900 per year Medicare levy surcharge if she did not have private health insurance.
Nope. The rates are the equivalent of the US property tax, and are based on the property, not the number of people living there. My UK rates (or council tax, as it was called then) were about the same as my US property tax is now.
Opt-out allows you to redirect 2% (I think) of your state pension contributions to a personal pension plan. Yes, this is exactly the same plan as is causing all the uproar in the US about “privatizing social security”.
Actually health insurance in the US is not quite like car insurance, because the government provides tax incentives to employers to provide health insurance to employees. As a result employees are loathe to choose a provider outside of those provided by their employer. There is much greater freedom of choice for car insurance, the insurers know that, and IMHO car insurance is much better.
My employer-sponsored health plan is a PPO, which was mentioned earlier in this thread. The main difference between a PPO and a HMO is that I can go to any doctor I choose, and my insurance will cover it. My PPO is administrered by Blue Cross (probably the U.S.'s largest insurance provider), and since almost every doctor I know of belongs to Blue Cross…
I have a co-payment of US$10 every time I go to the doctor. My prescription cost is riduclously low – US$5 for a month’s supply of meds I regularly take, for example. Vision is also covered, except for eyeglasses.
I also have a dental plan that works pretty much the same way, except that the choices aren’t so broad. There’s a lot the plan won’t cover, but for the basics like twice-yearly checkups and such, it’s great.
The downside? My company takes $30 out of my paycheck every week for all this. To me it’s a small price to pay for what I get.
FWIW, I have many acquaintances who fall under the “underemployed” banner. Most of them work part-time, and sad to say, a lot of companies, including mine, don’t offer health insurance if you work less than 40 hours/week.
To be eligible for Medicaid (the federal government health insurance plan), you have to fall under their income guidelines, which I translate as “You have to be destitute”.
As other Dopers have said, it’s the people caught in the middle who suffer the most from our health system. A woman I work with has horrible carpal tunnel syndrome – wears braces on both wrists, etc. – her doctor says she needs an operation or else eventually lost entire use of both hands. Because she’s part-time, she’s not eligible for insurance. Her husband’s been laid off for almost a year…:eek:
Note that the variety of PPO or HMO offered between employers can vary; I think it depends on what “package” the employer contracts with the insurance provider to offer to employees. My husband is with Blue Cross PPO and has to pay the first $200 or so worth of health expenses in a calendar year; after that the PPO covers either 100% or 80% depending on what is being done, in addition to the copayment.
Some employers will offer a variety of health care plans - my current job offered two HMOs and a PPO, my last one had at least 4 choices - with differing rates and coverage for each. Others will offer only one plan.
I’m with Blue Cross HMO since I prefer the system (I don’t mind getting referrals and going to certain doctors). I know my workplace’s version of that plan offers psychiatric coverage, which some HMOs don’t. One benefit of HMOs that I don’t think was mentioned in my reading of this thread is that many do not have a “pre-existing condition” clause when you start with them - many PPOs or traditional insurance plans won’t want to cover any treatment for a pre-existing condition for a few months when you start their plan, but the HMOs that I’ve seen do not have this restriction. (There may be some out there that do, however.)
For the most part, these plans don’t heavily limit what they will cover. If you need to see a doctor, you make an appointment. If you’re with a HMO, you make one with your primary care physician (a family practitioner, internal medicine physician, etc.), and he/she will refer you to a specialist as needed. HMOs will review what is being done to be certain that tests aren’t being performed simply for the sake of doing them, but in the several years that I worked in a specialty physician office (pediatric cardiology), I don’t recall a HMO rejecting a test or procedure that we said was necessary.
Most cosmetic procedures aren’t covered, laser eye surgery usually isn’t, nor are treatments for difficulty with conception for the most part.
And I agree with other posters who say that usually the ones in the worst straits are those who are “underemployed” - some employers work “part-time” people for ~35 hours and thus get a lot of work out of them but don’t have to pay benefits and so forth. This makes it rough trying to hold down another part-time job when one job takes up so much of your time. Some of the families that came to my last workplace did better at keeping appointments when they were on Medicare (I think that’s the one that covers kids), as they could at least afford the doctor that way.
There are 40 million people in the United States without any health insurance, and 60% of them are employed. How do they deal with health expenses? They put off health care until it is serious, then they sign the papers and get the care. If they can’t afford the bills, the healthcare providers turn the accounts over to collection agencies, who file lawsuits against the individiuals. This results in the loss of their homes, retirement savings and any other assets that can be garnished. If the individual has no assets, the healthcare provider is stuck with the bill, so he passes the expense on to other patients who do have insurance. So their insurance companies have no choice but to raise insurance premiums, causing businesses the cut back on health insurance, resulting in fewer people with health insurance.
It’s not the best system, but it’s the American way; that’s the important thing.
While waiting for a dental appointment this morning I was reading an article in US News & World Report that said much the same thing as above. What was surprising is that of the 41 million uninsured, nearly one third are in households with incomes of over $50,000.
There was also a projection that because of ever rising health costs (increased 12.7% last year), in 5 years time health insurance will amount to 25% of the wages employers pay. Of course, that will not really happen - employers are beginning to cut back on providing health insurance.
Oh, and my dental treatment cost $3,600. I might get up to $1,000 back from my dental insurance, but the rest is down to me.
Heath insurance is not mandatory. The fact that there are 40 million people without insurance is no cause for alarm. Some people simply choose not buy coverage even if they can afford it. Younger people, 18-29, tend to make up most of the uninsured for good reason. The likelihood of a catastrophic disease or disabling injury in that demographic probably doesn’t justify the cost of the premiums. Health insurance was intended to cover catastrophic illness, but it’s being increasingly used to cover even routine appointments and expenses - things that people used to pay for out of pocket as needed. For a young kid fresh out of college, that one or two thousand dollar premium might be better spent on rent, car payments, or loan repayments.
At what point would the level of uninsured alarm you evilhanz? 60 million? 100 million? The trend is showing a rapid increase in the number of uninsured (1 million per year), with a projected 1 in 5 under the age of 65 uniinsured by 2010. You should be alarmed, because the more people that “choose” to be uninsured, the greater the pressure on public health care facilities (your taxes go up), as well as defaults on bills owed to health care providers, which causes the services you pay for to increase, as well as an increase in the premiums you and your employer pay for your coverage. Sooner or later, even you will be unable to afford insurance or medical care. And no one should be alarmed?
