Socialized Medicine - What's it like?

In My Humble Opinion
61

Well, you can’t swich when your pregnant unless it’s to a guaranteed issue plane, it’s considered a pre-existing condition. Those hospital expenses seem awful high for a normal, healthy, vaginal birth. Most insurance plans pay the hospital $2k total and they take it.

Anyway, when I popped in your correct ages and zip, what I came up with was about $100/month more than your paying now, but with one huge difference-the deductable is about the same, but it only applies to hospitalization, meaning that you only pay $20 for a sick visit to the doc, $25 for a check up. There’s no deductable for things like chemotherapy(god forbit) or medevac services. Perscriptions have a seperate deductable of their own, but it’s only $50/year. Overall you’re getting a lot more coverage for you money, but like I said, it’s about $100 more a month. Illinois is obviously more expensive than Maryland.

Oh, and I omitted maternity coverage, that’s one area we’re not the strongest on (and a moot point anyway, as I said, you can’t swich while preggers)

62

Thanks! She’s due end of April-- and I assume Weirddave will post somewhere when yours finally decides to brave the U.S. :slight_smile:

63

I’m very happy with the Israeli system. It’s basically a hybrid - there are competing, non-government owned health care providers, but the premiums are paid for by Social Security, along with subsidies for expensive procedures and medicines. Besides covering hospital costs, each of these companies has its own clinics and member physicians. Because these companies receive their money from the government they cannot turn applicants down, and mainly compete with each other for service, as members can change between them at will.

For instance: my wife and I are members of Maccabi, one of the largest insurance companies. When we found outt we were having a baby we checked the Maccabi listings for an OB-GYN in the area, and made an appointment for the following week. Because we pay a few shekels as a special monthly charge (I forget how much, but it’s no more than $10) we get a free choice of Maccabi doctors.

The checkups with the doctor were free of charge - all he did was sipe our charge - and the Maccabi plan covered certain basic tests (5 ultrasounds, I believe) as well as certain perscription drugs. We wanted a few more advanced scans, mainly out of first-pregnancy fears, and ended up paying about $150. Besides that, there were no extra charges.

Around her 7th week my wife suddenly started feling sharp pains in her lower abdoman. Our doctor wasn’t available, so she called the Maccabi hotline, which immediately found an available doctor and called to make an appointment. Half ann hour later she had already finished with her scan and was told that the baby was fine, she ws fine, and it was probably something she ate. Again, we were not charged. If no doctor had been available, she could have gone to the E.R., but she might have had a longer wait.

64

Thanks for looking, Weirddave! It’s nice to know that while I’m getting ripped off, I’m getting ripped off for fair market value. :smiley: Yep, we’re in a 'spensive neck of the woods.

The numbers I gave for an uncomplicated birth are what someone around here would pay if they didn’t have insurance at all, no negotiating between insurance companies and hospitals. (There’s another issue that makes my ears steam. Why should an uninsured person pay more?) The OB number is straight from my OB, the other two numbers are what I paid for WhyKid’s birth 11 years ago, and in a cheaper suburb, so they’re probably a little low.

65

When I went to ehealthinsurance.com and put in you and your husband as 31, your first kid as 5 and your second one as a month old I got some quotes as low as $170/month with a 2000 deductible for your zip code.

66

Wow! I got $174 with our actual ages and fudging the baby as having been born this week. Thanks so, so much. I will bookmark this and check the rates again in June. The out-of-pocket and co-pays are higher, but since we hardly use medical treatment anyway, I think it’s a better plan for us.

67

Be very, VERY careful with places like e-health-the site markets based upon premium price. When you go with one of those ultra cheep plans, you give up a LOT of coverage. Carefirst Blue Cross/Blue Shield is one of the plans around here that markets like that, and I have clients swiching off of it all the time because they’re want to get a plan that actually pays for something. True story-a couple of months ago I had a client who had gone in for surgery with Carefirst’s P.C plan (Piece of Cra…er, Personal Comp). Of a total bill of $15,000, Carefirst arbitrarily disallowed $12,000. They paid about $2K (she had a $1000 deductable), and she had to pay the rest. With the payment plan she set up, it’ll take her 5 years. A good rule of thumb to remember is that you can’t buy a Cadillac for the price of a Cavalier. If y’all don’t use much health care, period, you might want to look at an HSA come June.

Also, just FTR, I am not personally trying to sell anything here, I can’t, Illionois is a state I’m not licensed in. I’m just sharing my knowledge, using the company I work for as an example.

68

Yeah you’re right. The $174 plan is crap and doesn’t cover much. The plans with better coverage and a 2k deductible are around $260/month.

Does anyone know what rating methods you can use to tell if an insurance company is good? Is going to the better business bureau the only way or are there consumer reports-esqe rating systems? Ehealthinsurance only carries carriers with an A or A- from the AMBest system, but I don’t think that alone is enough to trust a company. Carefirst Blue Cross is rated a B+ under AM Best.

69

This sounds like the best of both worlds, though is there a mandate that hospitals and clinics must cover certain areas - what if one goes bust? Also, do they compete on price, or is that fixed by the government?

70

What happens to you if you come from one of these countries that doesn’t have a healthy service and you get sick?

Presumably you’re not left to die (or are you?)

Also how does the ambulence service work - presumably they come to every emergency? So who pays for that then? Do they automatically take you to the nearest hospital or is cost and insurance an issue?

71

I don’t like a lot of things about the NHS in the UK, but free birth control pills for all is one of the most sensible ideas there is.

As are fixed prescription costs, and free prescriptions for the chronically ill.

72

I don’t know about clinics, but all the major hospitals are government-owned, and they cover virtually the entire country. There are also private hospitals for elective surgery, but they don’t proide emergency services.

The prices are set by the government.

73

In the US, any emergency room has to take any patient who walks in the door and give them stabilizing treatment: they have to do what they need to in order to make sure they probably won’t die in the next 48 hours or so. Beyond that, there are low cost clinics, some free clinics in the big cities, and there is Medicare, a government run health care program which pays medical expenses for the truly poor. The problems are several:

A. Waiting to go to the ER means people wait until they’re very sick before seeking treatment. No one wants to wait there for several hours for a minor thing. So most people wait until they’re nearly at death’s door before going in.

B. Follow-up treatment still needs to be done with a private doctor or clinic. It’s often impossible to get people to schedule follow-up visits, either because they don’t have the time off work or the money to pay.

C. Most people don’t qualify for Medicare. That would be people like me and my family, who make too much money to qualify, but really struggle to pay for private insurance.

An ambulance is supposed to take you to the nearest hospital that provides the kind of service you need (trauma, burn unit, etc.). There is a practice, now illegal, called “patient dumping” where well-to-do hospitals refuse patients with no insurance, instructing the ambulance to “dump” them at less desirable hospitals, often those serving primarily inner city poor with less advanced equipment, overworked staff and other problems.

The ambulance company will send you a bill for their services, generally around $500 in Chicago.

Interestingly enough, organ transplants are one of the few extreme services provided to anyone, regardless of their ability to pay. Of course, there is a severe shortage of donor organs. But everyone from the homeless drunk to the corporate CEO goes on one organ needed list. Organs are assigned based on tissue matches and the level of illness (sicker gets one first), not whether or not you have insurance. (Many Americans claim this is not the case, that if you don’t have money, you won’t get an organ, but a good friend of mine is a transplant specialist, and assures me she’s seen the uninsured get them just as often as the insured.)

So, no, technically we don’t let people die because they can’t pay, but the system encourages them to let themselves get very sick before seeking treatment, dumps them in the worst hospitals and then shrugs when they die.

74

Try Standard & Poor’s as well.

75

http://www.insbuyer.com/insurancerating.htm

Supposedly there are at least 5 raters, as well as things like the better business bureau. But I don’t know what they rate, I am looking for how likely the company is to pay for medical services instead of weasel out of them.

76

Now that’s where the insurance commissioner for your state comes into play. I googled “insurance commissioner complaint report Maryland”, for example, and after just a little bit of searching I got this pdf file. You’ll notice there are two sections: complaints involving medical necessity and complaints not involving medical necessity. The first is far more important. The second is people complaining about their insurance not paying for stuff like removing a mole from one’s face because you don’t want to look like Marilyn Monroe, but the first is no shit, you could die kind of stuff. Most if not all states will have this information available online. Hope that helps.

Oh, and FTR, the primary raters of insurance companys are AM Best, Standard and Poor, Duff and Phelps, Fitch and one I am totally blanking on right now

77

I grew up in Oregon but have lived in the UK for the last 4 1/2 years (with NO intention of returning to the US), thus have experienced plenty on both sides.

US experience:
As a kid we rarely went to the doctor unless it was *really * bad. The cost was just too much for my folks. As a teen (16) it was worse, especially when I crashed my car into a tree ending up in the ER, the ambulance bills, etc. I had to get a job to pay the bills as my folks couldn’t afford it.

Watched as my folks were forced out of their insurance when dad found out he had cancer. Their insurance went from a couple hundred dollars a month, for the two of them, to nearly a thousand. How the hell could they afford that?? It was quite sad.

The last time I was home (to say good bye to my dad as he died of cancer), I found out I was pregnant. One night we were in the ER with my dad when I started cramping badly. Nurse asked what was wrong and I told her (impending miscarriage). They rushed me back to be examined, scanned (found twins), bloods taken, etc. I told them OVER and OVER and OVER I couldn’t pay AT ALL but was told it was hospital policy to take anyone and everyone regardless - they just took my UK details and got on with things. Two weeks later my dad died. Two weeks later our other twin died. Few weeks later *hubby * gets a bill from the hospital in the US demanding payment in full of over $2500!! We were SO pissed off it wasn’t funny.
UK experience:
On my second trip to the UK I got off a train, raced up the stairs to get to the pub and rammed my shoulder into a phone box sticking out of the wall. Friend to me to A&E, but I was worried about getting a bill for thousands of pounds. I explained my tourist status but was told not to worry about it. X-rays, doctors and such were all free! Nothing broken - what a relief - but had badly bruised the bone and couldn’t move my arm for a few days.

In the 4 1/2 years of living here I’ve been diagnosed with diabetes, had carpal tunnel surgery, my gall bladder out (subsequent emergency surgery from major infection), and a C-section that had me in the hospital 4 days. All free.

Was able to sign up to a GP as soon as I needed to see one - GREAT fella by the way. When we (hubby or I) need to be seen it’s usually within a day or two. We’ve also had several home visits when I’ve been too poorly to even get out of bed, let alone the house. No extra charge here - unless you count the cuppa tea he gets :slight_smile:

I’ve paid private a couple times for dental treatment and laughed at the cost. Paid £30 for a mouth guard as grinding my teeth was loosening several every night and it was getting bad. Also had a bad tooth ache and saw private - think I paid about £15 (?). People complain about the high price of private dental but in comparison to US prices it’s cheap as chips!

Prescriptions and dental treatment are free for elderly, children under 16 (18 if going to college) and those with medical conditions requiring lots of meds. Pregnant women are also exempt from paying for prescriptions and dental treatment.

Which do I prefer? Despite having every gadget under the sun at hand in the US, I prefer the UK treatment I receive.

The NHS isn’t perfect by any means, but it beats having to bankrupt onself to get medical treatment.

78

One thing I would point out is that there is no political party or movement in Britain to get rid of the NHS.

All of us are signed up to the idea - although some of us would like to restructure it (some quite radically) no one wants to get rid of the basic idea.

Reading this thread reminds me why.

79

Owlstretchingtime is absolutely right. And I’m saying that as one whose political views (I think) are probably different from his/hers.

It is sort of remarkable, but it really would be death for any political party to announce a plan to kill off the NHS. Oh, disagree about how to administer it, yes, but as a concept, and a part of our society, it is pretty much sacrosanct. It is not without its problems, but I’ll find gold at the end of the rainbow before I find anythign that is completely perfect.

I rather like knowing that my father can be treated for diabetes problems, and that if my mother’s breast cancer shoudl return, well, t’would be very horrible, but at least affording treatment would not be part of the worry.

Some earlier posts here - those referring to the USA-based complexities of whether to chose this or that healthcare system have left me SO glad not to have to do that amount of arithmetical calculation about healthcare. Oh that sounds too flippant, but I can jsut guess that while I spent weeks and months working it all out, well, right in the middle of that time woudl be when I would break a leg or acquire some dread disease.
Hmm - I rather meant to write more and more thoughtfully, but suddenly busy and have to go.

Good health to all! :slight_smile:

80

The same would happen in the US if someone tried to kill off Medicare