“I’m an Australian, low-income earner and have no private health insurance.
I pay app $500 per year into the public health system (Medicare) via my tax payments.
For that, I can see a doctor whenever I wish, be referred to medical specialists as
per need, and have surgery also as needed at no extra expense. If I am seriously ill
or have been involved in an accident, I will be treated at a world-class medical
centre by world-class doctors.”
“If you don’t have it and are poor you get Medicaid, which is like what you have.”
I revise my earlier comment about puddlegum’s experience with Medicaid. There is no place in America that has any medical insurance, private or public, that approaches what Australia offers. If you work for a hedge fund that provides full medical insurance coverage, the cost is 50 times or more the cost given in the above post.
As a Canadian, I will chime in to say that our situation is similar to Australia. When my father was in the hospital for almost a week recently, the main financial concern was the high cost of parking when we went to visit him ($3.50 per ½ hour!). I actually have supplemental health insurance that covers prescriptions, glasses, dental, and other miscellaneous stuff that is usually not covered by the government health services. It costs $80 a month. When I hit 65, my prescriptions will then also be covered by the government.
Exactly this. And some of us live in states that chose NOT to expand Medicaid which has to this day left lots of very poor Americans who can’t afford Obamacare premiums completely uninsured even after passage of the ACA.
It’ll be interesting to see if Trump and the repub Congress is able to do as he said and come up with something “much better” that would make everyone happy. I seriously doubt it, but as we’ve recently seen, maybe it’s best to never say never…
The premium jumps this year have little to do with Obamacare. Insurance payments went up for me and I’m not on it. Insurance companies need to cover their costs and the $66 million their CEO gets.
The issue is that of cost control, and a big factor of that is drug prices. Remember Martin Shkrelli, the “pharma bro”? He was castigated for the insane increase in his prices. Or the Epipen scandal a month ago? Those are egregious examples, but people aren’t realizing that all prescription drug prices are increasing. And generics aren’t helping – they sell for less than brand names, but their prices have been going up, and generic drug makers tend to charge the same prices for their drugs as other generic drug makers. It’s not price fixing, since there’s no overt collusion, but the result is the same.
Their argument is that most people pay lower prices than list, but that’s just false ingenuousness. Sure your insurance company can negotiate a lower price, but the negotiation begins at the company’s list price. If they triple it, that’s where the negotiations begin. They’ll knock it down at only a 50% increase and pretend they’re doing you a favor. And your insurance company has to pay for that increase.
At the same time, hospitals are charging more for their services. The high prices were supposedly justified to pay for uninsured patients, but the prices have gone up even though there are 20 million fewer uninsured. Most hospitals are monopolies these days, with lip service about how it gives a central place to care, but it also means they have a captive audience.
Basically, the health care industry is not in business for your health.
I had VERY nice health insurance - the kind that gets you admitted and have doctors actually WANT to talk with you.
I went to an ER
Bill presented to insurance company:
$2800
Insurance company: You know that Deductible on your policy? We’ll just put this bill against that (at least they credited the full $2800, instead of the amount they would have paid*)
So: I am now personally liable for $2800 for about 30 minutes of work (during which no fewer than THREE doctors found something to say to me**.
I call the hospital - “We were expecting the insurance to pay us. What happened?”.
Me: “They put it all toward the Deductible”.
Hospital: “Yeah, that’s what we figured”.
Upshot: They’ll (the hospital, and only the hospital) settle for $600.
(the insurance company will never pay more than $1100, no matter what. If you don’t have insurance, you get billed for $2800. Many do not realize that is highly negotiable)
** - the hospital bill is for the physical structures and (some) equipment. Doctor’s fees, comestibles (fluids, single-use tools, etc) and drugs are EACH separate bills. ER doctors rarely get paid full rates, and often do not get paid at all. When someone with real insurance comes in, they see: PAYDAY at Last!
Just to add a little more - insurance may mean that some, but possibly not all of the costs are taken care of.
So, typically, if someone insured wants to see a doctor, they’ll pay a co-pay for the visit (it depends on the insurance plan. Somewhere between $20 & $40 is normal). Then the doctor’s office will bill the insurance company. The insurance company & doctor will come to some kind of conclusion about how much the visit ended up costing. For many services, insurance doesn’t cover any of the costs until the patient has paid a certain amount themselves (“met their deductible”) for the year (anywhere from a few hundred to a few thousand dollars). If the patient hasn’t done that, the doctor will bill the patient for the amount that the doctor & insurance negotiated.
If the patient has met the deductible, then, depending on the type of service, insurance covers a certain percent of the costs. The insurance company pays their share, the doctor bills the patient for their share. (Just to add, if you seeing more than one medical professional (e.g., there are multiple doctors or you’re using a lab or visiting a hospital), it’s likely that each one is a separate transaction and will be evaluated and billed separately).
So, assuming you’re insured, should you want to see a doctor it could cost anywhere from a few bucks to several thousand, depending on the service, the doctor, the time of year, and type and level of insurance. And you probably won’t know exactly how much until after you get the bill.
One thing that would seem to be easy to fix is the ridiculous billing procedure where provides produce fictional bills that are often 10x more than the rates that the pre-negotiated rates that insurance companies actually pay. What drawback or opposition could there be to simply passing legislation that all providers must bill everyone at the same rate for the same service? None of this nonsense of a $10,000 bill when the hospital has agreed to provide the service to an insurance company for $800. It would require some oversight to prevent cheating by calling a substantially identical service something different, but heavy fines should do the trick.
You are exactly right about the first part. My state is in the south and though it flipped a couple die-hard red counties blue this past gen election, the majority of the state is very red. The GOP governor chose not to expand Medicaid. Many poor adults are in the “coverage gap” and have no insurance at all even with the ACA. Including lots who vote republican, against their own self interest, over and over. A story old as time.
This sucks so bad. But you know what? At least most hospitals and clinics and even some physicians will let you make payments when it’s a high amount like that. In my experience, as long as you stay in contact with them so as not to look like you’re a deadbeat trying to dodge the bill, mostly they’re good about coming up with an amount you can afford to pay each month until it’s paid off.
You’re also right that fees can be and often are negotiated, sometimes before the patient even receives the bill. On such bills sometimes there will be a column that shows the “list price” so to speak for a procedure and right next to it a column that says outright “negotiated amount” or similar. Sometimes the difference is very significant.
In Australia a doctors visit costs around $70 -$80 where I am. Depending on which doctor you see some are ‘bulk-billing’, that is, everything gets charged to Medicare and you don’t pay anything out of pocket when you see the doctor as long as you have a valid Medicare card.
I go to a billing practice, so I pay $75 at the time of the consultation but get about 50% of that refunded within a few days directly to an account of my choosing via Medicare.
The main difference in the different type of billing model tends to be that the ‘bulk-billing’ joints are more of a ‘walk-in’, get the next doc available on the list sort of affairs while with a charging practice you tend to have a choice of GP and can continue to see the one you prefer.
Most specialist fees or test procedures are covered by a mix of Medicare, private health insurance and on occasion some out-of-pocket expenses.
I know you said ‘tend’, but with the advent of online booking, it’s dead-easy to see your doc of choice even in a bulk-billing joint. Of course, if it’s more urgent, you’ll get the next available doc regardless, but if it’s urgent I’m sure we don’t actually give a toss who we’re seeing.
I suspect that ACA will largely be left intact, with some changes (including adoption of Medicaid expansion by red states) so the GOP can take credit for it. The alternative would be too disruptive; dissolving ACA now would cause too much anti-GOP anger. Perhaps this is too optimistic, but the GOP claim that they want to repeal Obamacare has always been mainly an anti-Obama publicity campaign.
It will be interesting to see how the GOP amends ACA. Most of the good changes would be to make the program even more “progressive,” so Republicans have a real challenge threading this needle!
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Is this $500 related to your income? Would you pay more if you earned more, less if you earned less? In that case you are a victim of Marxism: “From each according to his abilities; to each according to his needs.” You foreigners are living just like the slaves of North Korea and don’t even know it. Right-thinking Americans know that if you can’t afford a doctor, and your ethnicity appeals to no well-funded charity, then you do not deserve medical care. [/sarcasm]
Do we fill out different tax returns in Oregon than everyone else? There is a box that you check on the form that waives the fee for not having insurance if you couldn’t afford it. We couldn’t afford it last year, so we didn’t have any. We made 60k. The fee was waived for us because we didn’t have the funds to pay 900 a month each foe insurance…
Everyone I know in Texas that was uninsured seemed to have to pay this fee and they made a lot less than we did last year.