How much does US medical insurance cost?

February 5, 2006 10:35 PM

How much does medical insurance cost in the US?

Questions about US medical insurance seem to crop up regularly on AskMe, usually in relation to somebody receiving treatment whilst being uninsured. So, I'm curious as to how much average medical coverage costs in the US.

As an example: A family of 2 adults and 2 preteen children, all reasonably healthy, with no pre-existing conditions. How much would they pay a month to be covered for any treatment that they might reasonably be expected to require, both routine and emergency?

I'm in the UK, btw. I have private medical insurance here, for the above situation, but I'm assuming that it's subsidised somewhat by the existence of our National Health Service. Anyway, I pay £120 a month for a family of four. How does the US compare?

posted by mad judge pickles to health & fitness (51 comments total)

It's a derail, and it doesn't address your question so much, but the real problem I have with health insurance here is that those most in need of it - those with pre-existing conditions - are usually unable to obtain it. Granted, it's not a fiscally responsible move for a private company to effectively subsidize a cancer patient's care when they know there will be large bills. That's the problem, though, it shouldn't be a gamble between private companies and healthy people.

Say you have a minor skin cancer, a fairly common cancer. You may be unable to obtain private life or health insurance again EVER, even if you have a predicted lifespan comparable to healthy individuals your age. You will still be able to obtain group insurance through an employer, but that may still entail 6-18 month waiting periods and other hoops.

For reference, I pay about $10/mo for my employer's top plan, and have paid $30/mo at most in the past for the same. Single male in my mid-20's. COBRA indicates this would be $300/mo or so should I continue it on my own. I'd say anywhere from $500-1k USD for your situation, and that may be fairly basic HMO coverage.
posted by kcm at 10:48 PM on February 5, 2006

This still includes co-pays of tens of dollars ($15-50) for primary care (PCP/GP) visits and specialists, similar for most meds, and anywhere from 80-100% coverage for everything else after you've paid a yearly deductible that is within the range of $100-1000 (more for multiple person policies, say 250-2500).

Oh and dental insurance is pretty much a separate issue that more or less pays for cleanings and not a terrible amount more than that. It's been called less "insurance" and more "prepaying" by some dentists I've talked to. It helps, but it's not really great. Vision is even worse -- usually it covers yearly/bi-yearly exams and frames, and that's it (I don't know much about that since I don't need it though).
posted by kcm at 10:56 PM on February 5, 2006

If you work for the state of Texas (at least in some capacities), you pay ~$350/month for coverage for you and your family.

It gets complicated after that because of copays and such.
posted by ROU_Xenophobe at 10:57 PM on February 5, 2006

For awhile I was with BlueCross/BlueShield of Illinois (in fact, I have to sign up again real soon now). I paid $76/£43 per month (actually, $152/£86 every other month).

That plan gave me 100% coverage at a member hospital (most of the ones in my area) and 80% coverage at others. There was a $1000/£586 deductible (IIRC) and no vision or dental plan. So I don't guess it would be very good for a family of four, but it was okay for me.

Some things -- like dermatology visits (that fell under the "cosmetic" category) -- worked in weird ways. They wouldn't pay for it, but part of it went towards my deductible. I never really stopped to figure it all out because it wasn't all that important to me.
posted by sbutler at 11:01 PM on February 5, 2006

...more than I can afford.

As a 39-yr-old smoker who works as a bartender and has a wife with multiple sclerosis, health insurance for me and mine would be >$500/mo. That's assuming my employer offered it, which they don't.

I'm screwed.

Oh well, at least the state will have to pay to put me in a pauper's grave.

Actually, now that I think about it, they'll probably sue my surviving spouse for non-payment.
posted by BitterOldPunk at 11:06 PM on February 5, 2006

You'll have to provide much more detail about the services you expect if you want to compare prices. Entering the familiy details you provided into Blue Cross of California's PlanFinder suggested 16 of their plans ranging in price from $205.00 a month to $1,143.00 a month. Most of these plans have either a several thousand dollar annual deductible or require one to pay a significant percentage of most expenses (and some have both).
posted by RichardP at 11:09 PM on February 5, 2006

Single, Healthy non-smoking Male with College Degree (these all affect my cost, though I'm not entirely sure how)... I pay $100 / month for what amounts to "emergency only" healthcare. I have a yearly deductable of $5000, which means that I have to pay the bills until it goes over $5000... considering that my last medical bill was three years ago when I thought I broke my ankle (my uncle is a dentist and I have perfect vision), I haven't cared one way or another about my insurance... I wouldn't have gone then, except that I was still covered under my parents' insurance, and that was 100% paid, so I didnt worry about costs...

The Agency I work for offers insurance with benefits I could see myself using eventually for the same price I pay now, but it's a contract-to-perm position for 3 months, so I haven't looked into it...

I looked at getting COBRA when my parents' insurance stopped covering me... It ended up being nearly twice what I have now for the same coverage as what I have... ended up being the same provider... I'm not sure how that worked, don't ask me...

I'm guessing kcm is probably right on track...
posted by hatsix at 11:11 PM on February 5, 2006

Thanks for the answers, everybody.

RichardP, sorry, here's some more details. Basically, my insurance covers me for:

- All treatment, including long-term medication, surgery, physiotherapy, counselling, etc.

- All stays in hospitals. If the hospital is private, the bill is paid. If the hospital is NHS (and we don't get a private room), we get paid £250 per night that we stay.

- All but the first visit to a specialist. This is the only 'deductible', in that an initial visit to a consultant will probably cost ~£100. It would be an extra ~£60 a month to avoid this, so it's not worth it.

- Parental stopover. If one of the kids is in hospital, accomodation for one parent is also provided.

- No dental. (There's a joke in there somewhere.)

This being the UK, we already have (what I think is) a great health service that is largely free at the point of delivery. The main benefit I get from private medical insurance is that I don't have to worry about waiting to see a specialist. Here, waiting lists for non-terminal illness can stretch past a year.

Finally, in the UK, prescriptions are subsidised as part of the NHS, so it makes no sense for those to be covered by private insurance. I think it costs about ~£7 to have a prescription for anything filled. Children, students, pregnant women, pensioners, and the long-term sick don't have to pay anything.
posted by mad judge pickles at 11:40 PM on February 5, 2006

With the additional details you've provided (and assuming all member of the hypothetical family are non-smokers) and limiting the choice of plans to those without an annual deductible and without a percentage fee for inpatient hospital care, only two of the Blue Cross of California plans remain. They are:

Individual Select HMO: The family would pay $588.00/month, $25 copayment for visits, $250 per day for hospital inpatient services, 20% for hospital outpatient services, $10 copay for generic drugs ($30 copay after a $250 deductible for brand name drugs). After an annual maximum limit of $3000/member is reached, 100% of the family's out-of-pocket costs are covered.

Blue Cross Individual HMO: The family would pay $1,143.00/month, $10 copayment for visits, no charge for inpatient hospital services, $100 emergency room copay (waived if admitted), 20% for hospital or emergency outpatient services, $10 copay for generic drugs ($30 copay after a $250 deductible for brand name drugs). After an annual maximum limit of $3000/member is reached, 100% of the family's out-of-pocket costs are covered.

Both of the above plans are Health Maintenance Organization (HMO) plans, in which one's primary care physician (a general practitioner) chooses and coordinates referrals to specialists. Preferred Provider Organization (PPO) plans are also popular in the US. PPO's allow one to not only chose one's own doctor and to go directly to a specialist as one wishes (you can visit any physician under the PPO plans but you save money by chosing to visit doctors and specialists who are members of the PPO network.) All of Blue Cross of California's PPO plans either have an annual deductible ($500 - $5000) or require you to pay a percentage of expenses (0% - 40%).
posted by RichardP at 12:27 AM on February 6, 2006

I'm 20, in good health, non-smoker, male and self-employed. I pay BCBS of Arizona $109/month, which includes some pretty high deductible, but nothing over $1,000. I forget which plan I jumped on—I was nearly dying of pnuemonia at the time and thought I might swing onto actual insurance before going to the hospital. Yeah, that didn't work.
posted by disillusioned at 12:42 AM on February 6, 2006

Health insurance costs are a snakepit. Here are my numbers.

When I was self-employed and just out of graduate school I had state-sponsored health care in Washington state. I had to have low-income to qualify and one of the participating medical centers actually picked up my premiums which were $37/month. Medicine cost a $5 or $10 co-pay except for birth control which was $15/month and some things which were flat out not covered at all. I had one major accident and one major health scare whiel I had that coverage and was suprised at how much they covered. My out-of-pocket was like $250 for a couple-day hospital stay.

When I moved to Vermont and got a job I was covered through work. I paid $260/mo and my work paid the other $130 or something. This was basically the same coverage. When I left that job I had the option to continue paying my full premiums -- as opposed to trying to get my own coverage somewhere else, it's usually cheaper if you have some sort of "group" coverage -- which I did for a month at $390.

Then I got a low-paying job, so low-paying in fact that I qualified again for state sponsored health care. This meant very low premiums [$11/mo] as long as I kept my income level below a certain level $1100/mo or something. My decision at this point was a) marry my long term boyfriend and get on his student care which was emergency-only sort of stuff for about $100/mo which would double if I got on it b) decide not to take unemploymnet payments I was entitled to from my last job so that I would continue to qualify for health care. I did the math and discovered it was better for me in the long run to not take the unemployment checks, though I wrote pissed off letters to all my government representatives saying that no one should have to make choices like this. All the various insurances I've been on were all Blue Cross at some level or another.

It's really only because I did a lot of legwork that I figured out that I was even eligible for low-cost health care. Many people pay way too much because they don't even know there are options. Websites like e-healthinsurance basically just say "sorry" when I enter my zip code here in rual New England.

In a short answer to your question, assuming you were working your health insurance might be covered by your job, at least somewhat, many employers pay a percentage of your premiums, good jobs cover all your premiums, this often doesn't include things like dental, optical and a host of other crap. Insurance for you and your family would cost somewhere between $600-$1200 and still at that level wouldn't cover a lot of the stuff you're used to health insurance covering [counseling is a tricky issue. parental stopover? wow.]
posted by jessamyn at 4:55 AM on February 6, 2006

There's no real way to compare NHS+BUPA coverage with American plans, because you're dealing with a completely different system, implemented across different states.

My wife's PPO costs just under $400/mo, with $15-30 deductibles on basic visits to the doctor, varying deductibles on prescriptions, and fairly high deductible on other treatments.

Something that isn't often mentioned is provider availability: finding a specialist who'll accept a particular policy can often be the most difficult aspect of getting treatment.
posted by holgate at 5:01 AM on February 6, 2006

When I had my own company, I paid $1400/month. Two adults, two kids. Small copay per doctor visit ($20 or so). Small copay per prescription ($10 or so).

Now I pay about $400/month through an employer. But they only pick up 80% or so, so I've actually ended up paying more.
posted by bh at 5:22 AM on February 6, 2006

Mad judge pickles- I see the possible point of humor, but just FYI, most US medical plans do not cover dental either. We have to buy a separate dental insurance plan for dental coverage.
posted by whoda at 5:33 AM on February 6, 2006

I guess I should count myself lucky. I pay $90 monthly and have a yearly detuctable of $250. Drug copays are $25 or 20%.
posted by DieHipsterDie at 5:56 AM on February 6, 2006

Not that I have any experience with either, but I think BUPA doesn't cover emergency treatment (since there's only one private A&E in the country), whereas American plans do. That surely makes a difference.
posted by cillit bang at 6:19 AM on February 6, 2006

Realize that most people don't get medical insurance except through work programs which are usually partially subsidized by the emplyer. Not to mention that insurance through an employer is less strict than signing up on your own. It is now rare but some employers may pick up the entire cost of the insurance. It also varies whether you want an HMO (Health Maintenance Organization) or a private doctor and what sort of deductable you want to pay. It is complex and hard to come up with a comparable answer to what you pay.
posted by JJ86 at 6:35 AM on February 6, 2006

I pay a total of about $850 USD per month, with a little more than half of that actually covered by my employer. I have no deductible, but I make copayments of between $15-30 for various services (doctor visits, pharmacy, etc).

This covers myself, my wife, and two year old.

Does not include Dental insurance, or vision care.
posted by poppo at 6:40 AM on February 6, 2006

People have already mentioned the problem of not being able to get insurance...THe other big problem with it is even if you' have insurance, you don't get free choice of doctors. I've asked a lot of people and no one here has even heard of a plan where you can go to any doctor you like and it's covered.

Also, I'm not entirely sure how this works, but I've picked up hints of things that seem to indicate that your insurance company A) Gets access to your medical record (more than just "she received services X, Y, and Z, here's the bill"), so no doc/patient confidentiality there and B) Gets to weigh in on your medical decisions. So in other words, the insurance company can decide that while you and your doctor may think that one course of treatment is the best option for you, they won't pay for that course of treatement (possibly with: they'll pay for some other course of treatment instead).

I'm a single, female and my health insurance (paid for by a fellowship) is about 3.5K/year. However, I don't get free choice of doctors. I have to go to a doctor at my university's health office for most things (even relatively urgent things). I have grown to like my doctors a lot, though I still can't stand the practice they work in, but I have no choice but to go there. I've also seen hints of my docs having to ask permission from the insurance company before they can do some things. And while I'm not entirely positive, there are some "mistakes" in my medical record that on further thought it occurred to me might be there to ensure coverage for treatment. It would be nice if I could have an accurate medical record without worrying that I'd be a 100K in debt as a result.
posted by duck at 6:51 AM on February 6, 2006

Oh, and doctors are often essentially employed by the insurance company, so there's plenty of opportunity for conflice of interest. I assume that's part of the reason nobody will let you choose your own doctor freely.
posted by duck at 6:56 AM on February 6, 2006

Duck - Some insurance plans do allow you to choose your doctor. However, you do pay a substantial premium.

The doctors do have to answer to the insurance companies. A few years ago, I was diagnosed with a [very expensive to treat] problem. My doctor had to get my treatment approved through the insurance company before we could proceed.
posted by bh at 7:32 AM on February 6, 2006

Duck - Some insurance plans do allow you to choose your doctor. However, you do pay a substantial premium.

Any licenced doctor and fully covered? Or a doctor from their list and/or pay for it yourself? I've asked and asked and you're the first person whose ever heard of a plan letting you choose your doctor.
posted by duck at 8:24 AM on February 6, 2006

(short derail)
duck, I'm assuming you mean that you get to choose from a small list, otherwise there'd be less complaining. My insurance covers a good portion of doctors in my area directly; looking at the web site for my insurance company I can see 148 "family practice" doctors listed within ten miles of my home using their search. I'd imagine some of these are pediatricians and therefore not for me, but that's still a considerable number. My plan allows me to use "out of network" doctors but I would pay substantially more out of pocket.

Getting back to the topic, my employer pays most of the cost of my insurance plan. We have the option to choose between three insurance plans (two different companies, one with two levels of coverage). For a single person such as myself, it costs me $40 to $70 (depending on plan) per month, on top of whatever my company is paying. Two adults and a variable number of children would be between $110 and $190, depending on coverage.
posted by mikeh at 9:00 AM on February 6, 2006

To be more specific, for "Physician Office Medical Services (including preventive services)" I can choose an "out of network" physician if I pay my deductible ($200!) plus 30% coinsurance. If I go to an "in network" physician then I just pay a co-payment ($15). In other words, I'd be paying a lot more money to choose my own physician. There's a maximum on out of pocket expenses ($1000) but I'm not sure if it applies to out of network care.
posted by mikeh at 9:07 AM on February 6, 2006

I'm on a plan provided by my employer (gigantic corporation that is always in the top 20 of the "best places to work" rankings).

There is no charge for the employee to be covered. If we have dependents (no matter how many) it's about $90 per month. I pay $20 to see my primary care physician, $40 to see a specialist and $5 to $25 for prescriptions. I think I pay $50 if I go the the emergency room or am admitted to the hospital.

For the dentist I pay 20% of the charge up to $500 per year. I also have some vision coverage that, I believe, provides for 2 visits to the optometrist and two pairs of glasses per year.
posted by Carbolic at 9:14 AM on February 6, 2006

Yeah, I've heard of longer lists, what meant I'd never heard of in the US is not having a list.

I think lists of any length are a problem because I don't think the insurance companies should have any say in people's healthcare decisions (they should just shut up and pay). Lists of any length should be illegal, because they can force people to change doctors just because they change jobs or plans, and they can prevent people from having the same doctor as their family members if they would like that, and of course, they can prevent people from having the doctor of their choice, if their choice is not on the list.

My list is about 20 family doctors, all located in the same building which is a 40 minute walk from my apartment/20 minute bus/20 minte walk+subway from my apartment. They also have some specialities there and if they have specialist X there, I have to see that one. So for example, they have one opthalmologist there, so he's the only opthalmologist I can see. I've grown to like him a lot, but I hate his office and his office staff. But I don't get a choice.

I can have 3 appointments per year outside of their system, but I have to pay $10 for those (actually I think I have to pay $10 for any appointment outside that building even if it is one of the people on their list).

Essentially, when you get insurance in the US, the insurance company that you're paying places all sorts of limits on the healthcare you can get. Choosing which plan is about choosing which limits you want. So the ultimate cost to you will depend on how limited you're willing to be. My care is pretty limited which is why it's only 3K for a year. You can get fewer limits, but it can cost you well over a thousand per year per person, and even with those they will still try to boss you around. That makes the costs very difficult to compare even within the US (since no two plans will have idential limits) and nearly impossible to compare to plans in other places that don't limit your doctors because there's no similar plan in the US to use as a comparison point.
posted by duck at 9:19 AM on February 6, 2006

My dad is a doctor, so I know nothing about the costs of such things, but I have a few questions I'd like to tack on if I may:

1. My dad, as well as other physicians, claim that they'd never really turn someone away for care because they don't have insurance. How does this work?

2. If you have a large nuclear family, how do you possibly afford health insurance for all of your dependants?
posted by matkline at 9:43 AM on February 6, 2006

Other things that have not been mentioned:
-Mental Health Coverage. Some employers offer this, most of them separate from the regular medical coverage. There is a very small number of Mental/Behavioral Health insurance companies in America, and they are very restrictive in what they cover. Inpatient hospitalizations are usually covered, drug and alcohol rehab, etc. Weekly 1-hr visits to an in-network provider are usually covered through the 12th visit or so. After the 12th visit, they may only cover 60%, if you're lucky. If you choose to go out of network (which I do, for example), they may cover 60% up to a certain number of visits, after which you're on your own. For some insurers, you have to go through them to even get an appointment with somebody, so it can suck. Also, my therapist has told me that some insurers can be sticklers about what they will reimburse for, which may result in the health provider making a more serious diagnosis than what the patient actually has, just to get reimbursed for their time.
-Prescription coverage. I have a separate prescription benefit through my employer (which gets confusing at the pharmacy, but whatever). I think my employer chose to do this because they do offer several different plans, all which had different formularies, so some people were having to choose between keeping their regular family doctor or paying super-high prescription costs. This Prescription Benefit Provider has a mail-order service where you get the drug at a discounted rate from what you would pay at your local pharmacy (basically 3 months of drug for 2 months of cost). I guess it makes them money, but I haven't used it so much.
-Flexible Spending Plans/Accounts. A lot of employers are now offering a kind-of "health spending account," where you can specify that a certain amount of your paycheck (above what you already contribute for health benefits) be taken out and placed into this account to be used solely for medical expenses. You may still have to file a claim to get it paid, or some places have a "check card" type of thing associated with the account. Most people use their flex accounts for things like eyeglasses and extra dental costs (braces, etc.). However, a former coworker of mine used hers as a cushion of sorts. Her long time doctor stopped taking most insurances. My coworker switched to the cheapest insurance our employer offered, which in fact was covered entirely by our employer, then put money in her flex account to cover her doctor's visits. I believe in the end she was paying about as much as she would have paid with one of the more expensive insurances. (Please note, my employer offers like 5 different medical insurers: like 3 HMOs, 1 PPO, and some other types that I don't really understand. Most employers don't do this. They usually have one insurance company, with an HMO plan and a PPO plan.)
-Clinical Trials. It's not clear to me if this is different from the UK or the EU, but most "experimental" treatments are still not covered by insurance in America. I am not referring to a healthy person being a guinea pig, but rather sick people who go to a teaching hospital, where their sole treatment may be "experimental." (I'm putting that in quotes because there are some treatments which have been in practice for many years, but are still technically part of a clinical trial for long-term outcome or some such thing.) However, my understanding is that if the trial is funded by the National Institutes of Health in some way, then an insurance company *must* cover the costs just like any other treatment. (If I am wrong, please, someone correct me.) This is extremely important, because many new cancer treatments are extremely expensive. You could reach your lifetime cap after 6 months of a particular chemotherapy for Non-Hodgkin's Lymphoma, so it gets tricky.

There is a lot of information in this thread, and I've learned a lot myself, so thanks, everyone.
posted by sarahnade at 9:47 AM on February 6, 2006

If you have a large nuclear family, how do you possibly afford health insurance for all of your dependants?

They (usually? often? sometimes?) have a category for "family" which costs the same whether you have one kid or ten -- there's employee-only, employee+spouse, or employee+family. I imagine it's costed out for an average or average+1SD family, so small families partially subsidize larger ones.
posted by ROU_Xenophobe at 9:50 AM on February 6, 2006

Oh, I forgot to say, in regards to the Flexible Health Spending Account, most of these accounts are "use it or lose it," where if you have money left in the account at the end of the year, you simply lose it to the insurer, it does not carry over to the next year. This is why you see all sorts of signs on eyeglass shops "Use your Flex Account here!" etc. So, that can be tricky as well.
posted by sarahnade at 9:51 AM on February 6, 2006

The Kaiser Family Foundation 2005 Employer Health Benefits Survery found that (for people getting health insurance through an employer -- which is almost of us in the U.S.) annual medical costs were:

$4,024 for Single coverage
$10,880 for Family coverage

The numbers are broken down in nearly every imaginable way in the full findings (which you can read here).

I didn't have the chance to read all the comments, but the people (of which I'm one) who always pipe up with stories about individual insurance varying by state blah blah blah are right.
posted by MarkAnd at 10:04 AM on February 6, 2006

Oh, and doctors are often essentially employed by the insurance company, so there's plenty of opportunity for conflice of interest. I assume that's part of the reason nobody will let you choose your own doctor freely.

Wrong.
posted by docpops at 10:11 AM on February 6, 2006

Me: Oh, and doctors are often essentially employed by the insurance company, so there's plenty of opportunity for conflice of interest. I assume that's part of the reason nobody will let you choose your own doctor freely.

Docpops: Wrong.

Please explain (e.g. which part is wrong?).

My doctors are employed by the university who pays for my insurance. Part of my insurance fee is insurance that pays specifically and only for my access to doctors in this building. Is not that insurance employing these doctors?

I've seen a bunch of doctor's offices that are basically named after insurance companies: "Harvard Pilgrim Health Associates" and such.

Now I believe you since as I've said, the things I said were just what I've been able to piece together from my own experience, so not something I've read up on. But in the first case surely they're employed by the insurer, and in the second, if they're not, why would they name themselves after the insurer? Niether place looks at all like a normal doctor's office. They look more like companies that provide medical care than like doctor's offices. (Yes, I realize doctor's offices are companies that provide medical care, but I mean for example that you don't get the sense that the doctors are in charge of the place).

How does all this work?
posted by duck at 10:22 AM on February 6, 2006

My doctors are employed by the university who pays for my insurance. Part of my insurance fee is insurance that pays specifically and only for my access to doctors in this building. Is not that insurance employing these doctors?

What you're describing, the staff model HMO, is all but dead. There are some hold-outs, but even if you're going to a Harvard Pilgrim or Vanguard center these days, people with Tufts or BlueCross insurance also have access to those doctors.

How it works largely these days is that a group practice, for example, contracts with a lot of different insurance networks and agrees to accept their negotiated fees for the services they provide. So, you're not wrong when you say that doctors get paid by insurers, but they're generally not captive to one. In my experience, if you want to hear complaints about insurance companies, start by talking to doctors. They will universally tell you they're getting pinched.
posted by MarkAnd at 10:35 AM on February 6, 2006

Oh I'm sure the doctors are screwed as much as the patients. But are they employees or business owners, then? It sounds like they're still employees, though not of the insurance company. Is that right?
posted by duck at 10:42 AM on February 6, 2006

Oh I'm sure the doctors are screwed as much as the patients. But are they employees or business owners, then? It sounds like they're still employees, though not of the insurance company. Is that right?

Doctors are very rarely employed directly by insurers these days.

Private practices still exist (one doctor working by him/herself), although group practices are much more common (for obvious reasons like reduction of overhead, but also because dealing with insurance companies is an onerous task and better to have pooled resources for that). The death of the private practice is another thing you can get doctors to talk about fairly easily, in my experience.

There are, I'm sure, lots of doctors who could answer this question better.
posted by MarkAnd at 10:48 AM on February 6, 2006

My doctors are employed by the university who pays for my insurance. Part of my insurance fee is insurance that pays specifically and only for my access to doctors in this building. Is not that insurance employing these doctors?

That model, where you have to go to a specific clinic at least for the first visit, is limited almost completely to university students; it sounds like your fellowship classes you as a student.

Well, military health care works like that too, but that's different.

But are they employees or business owners, then?

Others with more information can correct errors here:

They are business owners. The physicians are a partnership, often an unlimited partnership. The partnership has contracts with different insurers, in which the partnership agrees to provide specified services at some agreed-upon price.

Normally, you're free to see any physician with a contract with your insurer. Physicans are free to contract with whichever insurers they wish.

I think lists of any length are a problem because I don't think the insurance companies should have any say in people's healthcare decisions (they should just shut up and pay).

That's silly, because there's always such a list. In the US, the length of lists varies depending on who your insurer is. In the UK, the list is NHS physicians but not private ones. In Canada, the list is all physicians, because it's effectively illegal to provide private medical services -- but there's still a list, because you still can't see the private physician who can't legally open, they've just set up the law so that you can't see the physicians your health insurance won't let you go to.
posted by ROU_Xenophobe at 11:39 AM on February 6, 2006

My doctor in Canada is in private practice. Most doctors are. My health insurance in Canada will pay for me to see anybody licenced to practice medicine in the province. So yes, the list is only licenced doctors, that's true. I'm not sure how it would work to cover unlicenced doctors, that would be a little strange.

But thanks for the clarifications on US doctor's employment statuses.
posted by duck at 11:47 AM on February 6, 2006

That's not what I meant. AFAIK, it's illegal or effectively impossible to practice medicine in Canada and just charge patients money instead of accepting the provincial health plan's payment. That's what I meant by "private."

In the case of Canada, the physicians who are "off the list" are the private-in-that-sense offices that don't exist, or that exist over the border.
posted by ROU_Xenophobe at 12:44 PM on February 6, 2006

ROU_Xenophobe: That's not exactly how it works here in Canada. There are plenty of private medical services here in Canada, in the sense that most doctor's offices are private corporations. The doctors (in most cases) run their own practices, and bill their services to the public health plan.

Basic medical care like a visit to a GP is entirely covered under my province's health plan (which costs our family $88/month, $66 of which is covered by my spouse's employer), and I can go to whatever doctor I choose to go to, as long as that doctor is licensed to practice medicine. Of course, if they aren't licensed by the provincial regulatory body, they technically aren't a doctor, are they?

In addition, I can go to pretty much any licensed doctor in the country, and have the services covered by my provincial plan - the services don't have to be within the province that I live in.
posted by gwenzel at 1:05 PM on February 6, 2006

Ack, didn't hit preview...

ROU_Xenophobe: If a doctor (say, a standard GP) tried to charge a direct fee for their services (notwithstanding that such things aren't permitted), they wouldn't get very many patients. Why would somebody pay out-of-pocket if the service (provided elsewhere) is fully paid for out of the public plan?
posted by gwenzel at 1:07 PM on February 6, 2006

sarahnade writes "Oh, I forgot to say, in regards to the Flexible Health Spending Account, most of these accounts are 'use it or lose it,' where if you have money left in the account at the end of the year, you simply lose it to the insurer, it does not carry over to the next year."

Also, don't forget that in addition to the "Flexible Heath Spending Accounts", there are also "Health Savings Accounts", which allow you to squirrel away money to be spent on health care with some tax benefits. You need a so-called high-deductable (>$1,050/yr/individual) plan to qualify for these accounts. They do not expire at the end of each year. These are the accounts that the Bush administration is going to be pushing hard this year.

When I realized that there was a difference between the Flexible Health Spending Accounts and the Health Savings Accounts, I nearly burst into tears. Could they make it any more difficult? Maybe if there were also a Flexible Savings Account for Health or something...
posted by mr_roboto at 1:32 PM on February 6, 2006

I'm aware that medical care in Canada is run as a single-payer with essentially private firms providing the services.

If a doctor (say, a standard GP) tried to charge a direct fee for their services (notwithstanding that such things aren't permitted)

That's what I mean. It's not possible in Canada for someone to set up a doesn't-deal-with-the-government clinic to do knee-replacements for people who really want them done and are willing to pay to jump the queue, or to provide MRIs-for-cash for people who want one for whatever reason.

There's still a list of physicians you're allowed to see in Canada: ones that will accept the provincial payment. Canada just took the extra step of legislating the other health care providers out of existence. But your choice is just as restricted as if Canada had not done so and there were a thriving market in doesn't-deal-with-the-government health care, as I gather there is in the UK.

Look at it this way. I have BCBS, and can use physicians with BCBS contracts. If the evil people who run BCBS summoned Cthulhu (peace be upon it) to eat the body and soul of every physician in Texas who didn't have a contract with BCBS, then I would be able to see any licensed physician in Texas and yet my choice would still be restricted to physicians who will deal with BCBS.

costs our family $88/month

...plus some indeterminate but significant amount of taxes.

None of this means that I particularly like our health care system. I'd prefer a Canadian- or European-style system. But it bothers me when people can't see that their choices are still limited, or that there's still a conflict-of-interest between the payer and the patient, or when they have naive ideas of what their health care costs, and so on.
posted by ROU_Xenophobe at 1:51 PM on February 6, 2006

Can I ask why you guys don't all vote for a socialised medicine system? Or didn't when you had the chance?
posted by A189Nut at 2:07 PM on February 6, 2006

My dad, as well as other physicians, claim that they'd never really turn someone away for care because they don't have insurance. How does this work?

Oh, it works fine. Someone comes to my office and I interview and examine them and render a diagnosis, and I tell my office staff not to bill.

I then advise them that, for best practice, they need a $14,000 operation and lifetime medication costing $600 a month. I gravely inform them of this and wonder why they aren't more grateful.

To the original poster: the comparison you're trying to make can't be made. Very ill people here in the US have specialists and options available to them that aren't available in the UK at any price. And the "worried well" consume vast amounts of healthcare resources, which I understand doesn't happen quite so much under your system.

There's also something interesting with the extremely ill: people who have met their insurance "lifetime cap" (usually $1 million of expenditure by the insurance company.) Those folks are basically dropped by the insurance company, and can't get more insurance either.

The dirty little secret of healthcare in the USA is that the demand and supply curves aren't independent; the higher the supply, the higher the demand for care. If everyone were allowed untrammelled access to top-quality healthcare, economists agree that the costs of providing care would quickly exceed the US gross domestic product.
posted by ikkyu2 at 3:08 PM on February 6, 2006

Thank you to everyone here for giving those of us with nationalized medicare a peek into the other options. Reading this makes me so glad to be a Canadian where I don't have to worry about any of this. It puts into sharp relief why we need to defend what we have here. Thanks.
posted by raedyn at 7:21 AM on February 7, 2006

If everyone were allowed untrammelled access to top-quality healthcare, economists agree that the costs of providing care would quickly exceed the US gross domestic product.

Er. Maybe if you let anyone and everyone have all the cosmetic surgery their hearts desire or something.... I disagree with the idea that if going to doctor cost less, people would go nuts using their services frivolously and inefficiently.

As it is now, people with no insurance tend not to get checkups. So diseases and so forth are not caught early - in fact, rather than being prevented or nipped in the bud they explode into a crisis condition that leaves the person at the county emergency room, costing the taxpayers way more than it would have if they'd had the chance to see a doctor early on.

So we end up spending a lot more on the same condition, with the addition of extra human suffering along with it. And of course, it's on the public dime. The thing is - more money per condition/disease means more $$ on the bottom line, which is growth! And growth is good! Every industry wants to grow, right!?!? Sorry. I get a little carried away.

Seriously, treating medicine like a business is always going to be weird. Health costs are something you want to minimize, not maximize. And then there's the pharmaceutical industry, which I refer to as "profit at the point of a gun". It's basically "buy this, or die (or suffer terribly)". It's the total opposite of a free market.

Sorry. I got a bit ranty there. May have something to do with the fact that I just lost my insurance, and since I have a big fat pill-requiring pre-existing condition, my chances of being able to afford individual coverage (even if I could get it, which is questionable) are nil. I'd leave the country, but all those lovely places with the great state health insurance only want to bring in healthy people that won't tax the system. Grrr.
posted by beth at 7:47 AM on February 7, 2006

Reading this makes me so glad to be a Canadian where I don't have to worry about any of this.

If I had a nickel for every Canadian I've treated in the US, who told me, "Well, when I got <serious neurological disease> I didn't want to trust myself to the Canadian health system," I'd be rich.

I'm glad you don't have to worry about it, too, but I hope you understand why you don't have to worry about it.
posted by ikkyu2 at 3:24 PM on February 7, 2006

If I had a nickel for every Canadian I've treated in the US, who told me, "Well, when I got I didn't want to trust myself to the Canadian health system," I'd be rich. - ikkyu2

Well great for the people that can afford to come see you in the US, or can afford extra insurance that will send them there. Super for them. For the majority of us who cannot, it's good to know that we don't have to have $5000 minimum set aside for medical emergencies in addition to paying every month for coverage. When I got pregnant and gave birth to my daughter when I was young and working at a gas station, I only had to worry about the new addition to our family, not about how I was going to pay for the hospital stay.
posted by raedyn at 7:46 AM on February 8, 2006

ROU_Xenophobe: There's actually a movement here to have certain procedures available on a pay-for-the-service-directly basis. There are private MRI clinics here in Alberta. The idea is that having such services will reduce the load on the public system, and reduce waiting times, but many people don't buy that argument. It's commonly referred to as "two-tier health care" and is vehemently opposed by many people.

As to the list of physicians, it's hard to say there's a "list" when it includes every doctor in the country.

I'm curious about how it works when you travel within the USA. You say that you have BCBS (which I assume is an insurance plan). What happens if you travel outside of your home state, and there aren't any BCBS doctors in the state that you're travelling in? Do you still get covered, or not? Or is it something that you need extra coverage (like traveller's medical insurance) for?
posted by gwenzel at 8:18 AM on February 8, 2006

You say that you have BCBS (which I assume is an insurance plan). What happens if you travel outside of your home state, and there aren't any BCBS doctors in the state that you're travelling in? Do you still get covered, or not?

It depends on the policy, and the kind of treatment you need. Some policies automatically cover out-of-state emergency treatment (excluding deductibles and co-pays); some allow you to make out-of-state claims for other treatment.
posted by holgate at 12:33 PM on February 8, 2006