Quote:
Originally Posted by PBO
I don't have a clear understanding of where US health care was & is being taken too
Can someone give me the abridged version so I can avoid hours of research?
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Nearly all hospitals, doctor practices, and medical companies are privately owned (ie not owned by the govt.) Health Insurance, which is used to defer risk of high medical expenses (as does house, fire, auto, etc.,) in the US is primarily provided by your employer if you work for a large company, or member of a union, or work for the gov't.
People who work for small companies, small business owners, trade workers (ie plumbers, carpenters,) low wage workers or the unemployed have no health insurance provided to them. They have to buy insurance on the open market, as an individual with thier own wages.
The cronically ill, the elderly, as well as children of very low income families are provided coverage provided by the gov't. These programs are known as Medicaid, Medicare, and SChip respectively. These programs were put into place as these groups (minus the kids) tend to be very expensive to care for, and usually cannot purchase H Ins that is affordable, bc of their high medical costs and H. Ins companies cannot provide plans that would be profitable.
The major problems with the
current system in a nutshell:
1.) Healthcare costs for US citizens are the most expensive per capita and as per % of GDP in the world. However, life expecancy is lower than many other industrialized countries, and lags behind the UK, France, Singapore, Japan, and more (see below.) Its questionable whether the much higher expenses has translated into a healthier society.
2.) Healthcare costs outpaces inflation and wage growth. HC inflation has been in the double digits for many years. The ranks of uninsured has grown dramtically since the economic meltdown and high unemployment.
3.) Millions are uninsured and have no coverage. People with no coverage either forgo care, pay entirely out of pocket, or just don't pay hosiptal bills entirely. Roughly 1/4 to 1/3rd of all personal banruptcies are due to medical expenses.
4.) As health insurance is provided by for-profit private industries, they have adopted many unpopular and controversial policies to limit layouts. These include: Lifetime benefit caps (usually $1M,) pre-existing condition exclusions, and a a practice known as recision. Policies can also be dropped at nearly anytime.
Pre-existing condition exclusions is a practice where a new insurance policy can deny coverage of any treatment towards a medical condition that was there before the policy was initiated.
Recisions are retro-active denials of coverage is the insurance company determines/decides that a medical condition arises from some other condition before the policy was initiated, or the policy holder is determined to have not fully disclosed all health history, and the Ins provider did not have all the facts when it wrote the policy.
-In effect, there are two different systems of HC coverage, depending on how you are employed. One, if someone is a member of a group plan (via a large employer) Pre-exisiting condition exclusions and recisions are generally not applied as the policy is written for the group as a whole.
Two, if a person carries individual coverage, Pre-E Excl generally apply, and recisons can occur. They are also more subject to price volitility and coverage droppage, as they do not have the protections of the group.
The worst highlights of the system is where an individ policy holder becomes sick, say a heart attack. The initial treatment will usually be covered, but the patient is now high risk. They can then be dropped by their Ins Co. They have to buy more insurance to have continued coverage, but any new policy is likely to have Pre-E excl's in place, that will limit coverage of heart related med problems. Since they are also now high risk, premium costs soar. Very high risk patients may not be able to find any insurance provider, and thus pays 100% of bills of a very expensive system. This is how most med bankruptcies occur. Basically you pay or you die.
There have been instances where the insurance companies run algorthyms that analyze medical patterns of a policy holder, to determine pro-actively if they may become high risk and high cost. Say, scan for prescriptions for drugs that might be used by HIV infected patients, or by people likely to be diabetic. They are then summarily dropped before high med bills roll in.
All in all, an Ins Co's priority is to maximize profits and return shareholder value. This can lead to certain abuses of coverage.
Eventually, policy holders stay in the private insurance system when they are young and healthy, paying low-risk/high-profit premiums. By the time they are elderly, most people move to Medicare, as they are the highest risk and unlikely to be affordibly covered under private ins (and thus are covered by gov't at great expense.)
Some retirees qualify for Health Plan benefits through their employer if they qualify (and are not laid off first ;) and don't have to be covered/paid.) Generally, HC coverage ends when employment ends, unless retired. Unemployed people get F'd generally.