What do I Need to Know About Healthcare Reform?

September 4, 2009 12:26 PM

I want to learn about American healthcare, where do I start?

My SO is very invested in the healthcare reform stuff that's being talked about at the moment, but I find it rather difficult to engage in any kind of conversation on the topic, since my knowledge of American healthcare is almost nonexistent. I'm a Brit, so all I know is the NHS -- and I can already tell it's a totally different game for healthcare, but that's about all I know. I'd like to learn more about it, but I don't know where to start.

There have been past questions similar to this, but they seem to focus solely on the healthcare reform bill, and I'd like to get a little foreknowledge first.

So where do I start?

posted by nostrich to society & culture (21 comments total)

The Wikipedia article on Universal Healthcare is a good start, especially the part about the US. There's also an article on the various health care systems of the world.
posted by Brandon Blatcher at 12:31 PM on September 4

Ira Glass mentioned that there is an upcoming episode of This American Life on the healthcare system. They did one on the financial crisis and it was really good. Keep an eye out for that.
posted by special-k at 12:35 PM on September 4

Go to the Henry J. Kaiser Family Foundation sites and read away. Start at www.kff.org.
posted by jgirl at 1:00 PM on September 4

Here's a long list of top-notch links to commentary on American health-care reform. I know it's way more than you need, but maybe you can find something useful in there.
posted by Jaltcoh at 1:01 PM on September 4

If you are an American, you are:

1) insured through your employer, or your spouse's employer
2) poor and eligible for government insurance (Medicaid)
3) old and eligible for government insurance (Medicare)
4) a child and eligible for government insurance (varies by state)
5) screwed (no insurance at all)

Lots of people fall into category 5, which means that if they want to go to the doctor, they pay for it out of pocket. Many just avoid going if at all possible. Hospitals are legally obligated to serve you in a life threatening situation, even if you don't have insurance. They WILL work out payment plans with you, but medical bankruptcies are common.

Even if you do have insurance, you still pay for healthcare. My plan is pretty good, and I have a $500 deductible and a $20 copay (each time I go to the doctor, it costs me $20). Some plans will only pay for visits to doctors on their list. Some pay 100% for doctors on their list, and some lesser percentage for "out of network" doctors. Hospital stays are almost never fully covered. I was in the hospital for 3 days and still owe $2000 (the insurance co paid 80%).

I really can't comment on Medicare or Medicaid, having had no experience with either.
posted by desjardins at 1:05 PM on September 4

[please folks - this is really not the place to talk about your bad experiences with the healthcare industry. Can you please offer the OP some answers to their questions or keep it to yourself?]
posted by jessamyn at 1:13 PM on September 4

There is also 5a) Buy private individual insurance, which can be renegged at any time for any reason, is not available in every region, is wildly expensive (up to 1k a month for a _single healthy person_), and is subject to basically no regulatory laws (all of which apply to Employer insurance plans, not individual), and with no set cost (IE, your monthly cost can rise at any time they deem applicable, say if you go see a doctor, +$15/mo for your insurance).

So in a nutshell, one of the bigger problems with the industry is that insurance is tied pretty directly to employment, and aside from COBRA (only available in certain cases, also extremely expensive), there are little to no health insurance options for people out of work or working with small companies.

There are other problems, but this is the root of why so many people are uninsured (IMO).
posted by shownomercy at 1:27 PM on September 4

Previously on metafilter: the health care debate on the back of 4 napkins
posted by slow graffiti at 1:27 PM on September 4

Don't forget:

6) Buy insurance for yourself on the open market. There are a range of options here, from hit-by-a-bus (premiums generally inexpensive, relatively speaking, but it really will only cover Big Things, like if you get hit by a bus, and might not cover all of it) to covers-mostly-everything, which is very expensive. This is the option where you are most likely to not be covered for previously existing conditions.

Also, desjardins' #s 2, 3, and 4 have holes - they may not cover all or parts of prescriptions, vision, dental, etc., so you either pay out-of-pocket for that (and that can be expensive) or you have what's called co-insurance, which will cover all or some of those things. You may pay for the co-insurance yourself, or you may have it covered by the state/feds, depending.

Another also: Medicare (program for the elderly) is national. Medicaid (for the poor and disabled) is administered at the state level, and every state funds and manages its program differently. And if a state is having budget troubles, they may change their eligibility requirements (e.g. lower the income level so that fewer people qualify) or eliminate some services (dental, mental health).

Some people are what is called dual-eligibles - they are on both Medicare and Medicaid. That is a whole 'nother kettle of fish.
posted by rtha at 1:28 PM on September 4

desjardins left out one major group out:

6) insured through through a private insurance company at the level in which you want to be insured.

This is without a doubt the best article I've seen on healthcare in the states. It addresses the actual flaws in our system and is one of the only articles that makes the vital distinction between price and cost.
posted by thekiltedwonder at 1:34 PM on September 4 [1 favorite]

Previously on metafilter: the health care debate on the back of 4 napkins

Be aware that there are some severe misstatements in that piece, e.g. that all health insurance in the US is private (or all except Medicare).
posted by Jaltcoh at 1:37 PM on September 4

With respect to the notion of buying insurance as an individual on the open market, what is available varies by state as insurance is regulated at the state level. In some states, it is (allegedly) possible to purchase disaster coverage that would cover what rtha referred to as "Big Things" like, say, a cancer diagnosis and would not contribute anything toward routine maintenance like check-ups. But such policies, which could work well for a lot of people, are not available in every state (e.g., New York).

Generally however, what is available on the open market for individuals (a) rarely offers the kind of coverage offered through the group plans available through employment, and (b) is usually prohibitively expensive for most people.
posted by SuzB at 2:12 PM on September 4

Nostrich, if you would like an idea of how much health insurance costs and what it covers, go to a site like vimo.com or ehealthinsurance.com, enter a zip code for the locality/state of your choice, and go from there.

SuzB is right in that costs vary widely among the different states. A single man in his late 20s in NY would have to pay $700+ a month for health insurance if he did not get it through his employer. In Illinois, he could get a comprehensive plan for about $110. There are additional costs with co-pays and such.

She is not correct, IMO, about getting insurance as an individual vs. through an employer. I recently went through the employer - cobra - individual transition and was somewhat amazed that my employer was paying so much for a pretty limited plan. What was available to me as an individual is a lot better and the cost is reasonable.

Anyway, with an employer plan, you take whatever your company purchased and you usually have to contribute to it. As an individual you can purchase from whatever companies are licensed in your state and choose whatever coverage you want - assuming you don't live in New York.

On the plus side for New York, you can't be turned down for pre-existing conditions. Illinois allows denial of coverage for pre-existing condtions but, like NY, your insurance can't be canceled because you get sick. For more cross-state info, see Georgetown University's healthinsuranceinfo.net.
posted by txvtchick at 3:21 PM on September 4

Well, since nobody's mentioned it, I imagine you could watch Sicko, Michael Moore's movie about the health industry in the US. (I haven't seen it.) Most libraries have it to check out for free, and it's still available on many streaming sites since apparently there hasn't been much of an effort to have it taken down. Of course, it's promoting a health-reform agenda, but it will probably also give you some idea of why your SO is so fired up.

It can be very difficult to get the big picture on the US healthcare system, because one person will tell you one thing that's absolutely true in their experience (for their age, health condition, and state), and another person will tell you the opposite, and it'll be true for them too--witness suzb and txvtchick.

This article, although it doesn't give you the big picture, also gives you some idea of another reason why it's so confusing--our "system" has elements of lots of other kinds of systems in it.
posted by wintersweet at 4:25 PM on September 4

Illinois allows denial of coverage for pre-existing condtions but, like NY, your insurance can't be canceled because you get sick.

They can't say they are canceling the individual policy because you get sick but they can go back through your history with a fine tooth comb and turn up something that allows them to deny paying. Also, at the end of the year after you're sick they can raise your rates by hundreds of dollars a month.
posted by Bunglegirl at 4:26 PM on September 4

...at which point I would go to my local insurance commissioner.
posted by txvtchick at 6:01 PM on September 4

They can't say they are canceling the individual policy because you get sick but they can go back through your history with a fine tooth comb and turn up something that allows them to deny paying. Also, at the end of the year after you're sick they can raise your rates by hundreds of dollars a month.

That's one of the things the new health care bill is supposed to ban, as I understand it.

Also, just on a historical note: Broadly speaking, the reason the U.S. evolved a employer-provided health care system is that during WWII there were widespread wage freezes coupled with high marginal tax rates --- over 80% for the top bracket. Employers competing in the tight war time labor market therefore started looking at other types of benefits in order to attract workers, such as offering health insurance. Unions were very successful at getting health insurance incorporated into contracts during this era, and though the idea of universal health care was floated by Truman after the war, with the unions mostly covered and white collar workers able to afford private insurance, the Red Scare was sufficeint to crush such a move.
posted by Diablevert at 6:19 PM on September 4

How American Health Care Killed My Father by David Goldhill in the Atlantic is a great overview, the best I've come across so far.
posted by luckypozzo at 7:37 AM on September 5 [1 favorite]

American healthcare system is great....

as long as you don't use it.

OK fine its more like this. Who has the leverage? If you work for a REALLY big company and you get REALLY sick...then you will probably be covered because ... its written into the contract that pre existing conditions are covered, you employer is on your side and will tell the insurance company to cover you or they'll go buy a plan elsewhere, or you make enough of a stink on the news that your employers looks bad, leans on the insurance company and they capitulate.

Individual insurance? Good luck pal!

Pre-existing conditions: Either you knew about them, reported them and were denied coverage (or are charged way more than you make) or you didn't know about them, got too sick, they figured it out (even if you were not diagnosed via your paperwork) and are denied coverage. Take your choice.

Pay the insurance: Its fine when you are well, but get sick and just try to work. Then you get dropped if you don't pay your premiums. Of course you could have disability insurance but then that might get delayed/denied and oopsie, you missed a payment. Re apply and maybe we will accept you.

Go to the emergency room. Hospitals DO have to take SOME people but they have their GOMER systems too. They have to get the money to pay for YOUR care you dying deadbeat.

If you get real sick they will weight the costs of your care versis the cost of putting you off. The only leverage you have then is email, phone calls and letters ... and the insurance industry has set up TONS of deflections for those. They are counting on you dying before they have to pay. So complain all you want to your congressman, he's been collecting contributions from them for more years than you've been alive. Call the state insurance commissioner, AKA former CEO of the company and/or golf buddy to the current CEO. Sue them (for years), if you can find a lawyer you live long enough you might win. Or your family sues (for years) for wrongful death which is often a much cheaper claim to pay than the original care and hey, you were sick, which part of the sick is their fault?

So, leave your health up to government bureaucrats who will have to follow guidelines or corporate bureaucrats who will follow the money. Its your choice.
posted by CodeMonkey at 3:56 PM on September 6

Be aware that there are some severe misstatements in that piece, e.g. that all health insurance in the US is private (or all except Medicare).

Are there misstatements which affect his fundamental points, though? e.g., yes, in this case there's also things like Medicaid, and government employees and veterans have government-provided insurance, etc., but I don't see that alters the basic points he's making. Are there other misstatements which do compromise his points? (This is meant as a sincere question, not an attack.)
posted by DevilsAdvocate at 8:54 AM on September 16

[please don't turn this into your pwn platform for what you do/do not like about healthcare reform. You can email people directly if you just want to complain about how it's going. thank you]
posted by jessamyn at 12:17 PM on September 16