Would someone please do me the favour of explaining the American health insurance system (I'm easily confused) from what I read here it sound like you cant see a doctor,get medication or much else if you don't have insurance either paid for by you or your employer.

Here in Oz we have a national health insurance that every one pays even if you are on welfare benefits you still pay the 1.5% into that insurance, that mostly covers basic medical needs in public health facilities.

There is also private health insurance provided by health insurance company's & the $ cost depends on the cover you require,for instance when Nina went through her mastectomy last year national health insurance covered about 25%; private health covered 65% & we paid the rest that was then claimed as out of pocket expense on our tax assessment that returned 33% of that out of pocket, the total cost was in the vicinity of AU $30,000.

The total cost of health insurance for both of us is about $ 5,525 a year & to see a GP will cost between $60 & $90 depending where you live, in Karratha we pay $85/per visit & in the big smoke I paid $66 last week.

Satisfy my curiosity please.
Cheers
Barry 

For NZ, most medical costs are free or very highly subsidised. If I see the GP I pay NZ$15 (about US$10) per visit, with most prescriptions costing NZ$3 (US$2), although not everything is fully subsidized. For my CH medication, verapamil is NZ$3 and I get my oxygen free via the home oxygen service, although I privately pay for a small cylinder which is a lot more portable. People who use imitrex pay NZ$3 for each injection.

Hospital visits are free, be it a trip to the ER or a week long stay. The only extras you'll pay are for things like a TV and parking for relatives visiting.

Of course, this has to be paid indirectly, so it comes out of taxes plus there can be long(ish) waiting lists for many non-urgent treatments.

In the US you can get health care without insurance.  The medical facilities just want you to prove that they will get paid for their services.

If you're flat broke you can go to a hospital emergency room.  They can't refuse treatment to anyone.

If you are low income you can get Medicaid Insurance paid for by the taxpayers.  Medicaid covers most health costs.

Some large cities, like Los Angeles, have hospitals that never turn anyone away, regardless of their $ situation.

If you are collecting Social Security (a forced government retirement payment plan) you also get Medicare Insurance to cover the health costs.  We pay into this program each month from our paychecks while we are working.  The Government then takes that money and uses it for other purposes than healt care payments so now there is no money left (see how well the Govt. handles $).

Some buy their own health insurance from private companies and some have it provided by their employer as a benifit.  These plans vary greatly in the amount of coverage, copayments, deductibles, etc.

I have Blue Cross and pay $20 per doctor visit and $5 per perscription.

Bob did a pretty good job.

When it comes to things like Medicare and especially Medicaid, which is welfare medical insurance, is that it's abused...mostly by doctors and medical facilities. I get in trouble for letting doctors know my view that just because I have insurance, doesn't mean that they have to use it. By this I mean their ordering lots of redundant tests, too many specialists, drug overkill and unnecessary office visits. It's a BIG cash cow for them. I don't need an MRI for sore toe.

There's something very wrong with the system when hospitals and iffy medical facilities pepper the roadside with billboards. It's legal but it's also an ugly development.

Private insurance works when private insurers say so. It's an incredibly lucrative business.

Charlie

Brew works for a larger multi-national company with many thousands of employees.  We pay (for a family of 3), about $500 a month for health, dental, vision, prescriptions, and a health care savings account.

The HCSA allows us to take money out of his paycheck (pre-tax) and put it in an account to pay for things like co-pays, durable medical goods, prescriptions, some over-the-counter meds, and other medical related items that the insurance won't pay for. The downside of the HCSA is if the money isn't used up by the end of the year, it forfeits to the company.  We used to buy lots of OTC meds at the end of the year (like ibuprofen and vitamins, etc.,) but Obamacare outlawed those things beginning this year.  The co-pays are $20 for each office visit to our primary care providers, $40 for a specialist, $50 for urgent care, and $100 for an emergency room visit (waived if you are admitted to the facility).

The insurance covers O2 on demand with little or no co-pay (he hasn't used it for so long, I've forgotten what it might cost - YAY!)

Our prescriptions run the gamut of costs, from $5 for generic every day drugs to hundreds of dollars for more specialized items.  We have access to a mail-order pharmacy that allows us to get three months of a regularly prescribed drug (like blood pressure pills, for instance) at a very reduced rate.

All of our doctors, providers, hospitals and clinics must be in our insurance company's network in order to get this coverage.  With a multinational company, the network is HUGE.  We check every year at renewal time to make sure we can be seen and cared for where we want to be seen.

Charlie,

I know you like to blame the Drs, etc for the fraud involved with Medicaid and Medicare, and there is some of that there.  However, a lot of the excess testing is simply CYA to be sure they aren't sued for malpractice (also a MAJOR cash cow for the lawyers).  There is also a tremendous amount of fraud and misuse from those getting the benefits.  As with any government run operation there is no incentive for them to keep costs under control as it is done by a private individual, hence waste, fraud, and abuse are rampant on all sides.

Jerry

Thanks people that clears my confused mind.

Bob P
The medical facilities just want you to prove that they will get paid for their services.

That explains the bulk of my question, I just could not see that a medical facility or Doctors practice could turn away a sick person & when I saw posts with the wording “ I cant see a headache specialist because I don’t have insurance”, that’s what really threw me.

Some large cities, like Los Angeles, have hospitals that never turn anyone away, regardless of their $ situation.

It’s the same Australia wide here in Government owned hospitals but Private hospitals may ask for a prepayment or payment arrangement for the cost over & above the standard charges set by Government.
Standard charges are reviewed periodically by Government & the Australian Medical Association which is the body representing the medical fraternity.

If you are collecting Social Security (a forced government retirement payment plan) you also get Medicare Insurance to cover the health costs. We pay into this program each month from our paychecks while we are working. The Government then takes that money and uses it for other purposes than health care payments so now there is no money left (see how well the Govt. handles $).

This is very much the same as our nationally funded Medicare programme where money paid through our pay is used to cover medial cost for the community as a whole regardless of your financial position & generally the full cost is covered in public owned facilities & may cost a little more in private facilities.

Charlie
By this I mean their ordering lots of redundant tests, too many specialists, drug overkill and unnecessary office visits. It's a BIG cash cow for them. I don't need an MRI for sore toe.

This sort of thing did happen & in some cases may still happen but in general the Government’s both Federal & State clamped down pretty hard some years ago.

Private insurance works when private insurers say so. It's an incredibly lucrative business.

We generally don’t see this sort of thing happening as it is highly regulated here & perhaps that’s where Big Brother works at its best.

With some of the costs posted here if I was considering immigrating anywhere I recon it would be to Kiwi land thems is good costs.

Once again thanks folks you have returned my faith in humanity. “I think”

Cheers
Barry

PS: Why is the word "abreviated: such a long bloody word.

With our insurance we have no copays, no deductables nothing.  It pays 100% of the bill of which I never see.  This is because my husband works for the insurance company of an HMO (a group of clinics).  Our insurance only cost us $50/month.  This is the best insurance we have ever had. 

While I know the following is off the mark, I have to say it:

Several times while standing in line at the drug store, I've watched retirees on Medicare--it's a badly designed system when it comes to medication--having to pick and choose among the prescriptions they were able to afford. Lowering doses against doctors orders or simply not having the cash was their only choice and required a life-threatening decision by them. It happens every day, even in my small town.

I have had direct experience buying drugs from Canada. Some years ago, drug company lobbying pretty much ended the direct sale to the US. The stuff I ordered from my Canadian supplier had to be shipped from Calcutta. It took 3 months to get a prescribed skin cream.

"Only in America," as we are fond of saying.

Charlie

Quote:

Cheers Barry PS: Why is the word "abreviated: such a long bloody word.

Hey Barry?  It's even longer than you'd expect.  It's spelt with 2 B'S       (abbreviated)     lo....l jest having some fun with you my friend. ;D

Oh! BB Bugger. Note to self: Use spell check.

Cheers
BB Barry

Well, I LIKE medicare... Having gone years without insurance, I'm happy to HAVE insurance...

I don't get sick much, and my doc doesn't do a lot of tests, so we don't abuse the system. I have a supplement policy that I pay about $179 a month to pay the extra 20% that medicare does not pay.

My office visits are FREE to me (no co-pay). I also pay $41 a month for a medicare RX plan that pays most of my scripts (both of them) and my drug bill is $14 a month (ok, I could go to Wallyworld and it would be $8, but I like the local pharmacy where I get "personalized" service - worth the extra $3 to me).

And yes, there are some drugs that are NOT on the "A" list for $7, but they're at a BIG reduction, so I'm not complaining after spending years paying FULL price for them.

I did have to have my gallbladder out last year (emergency fluke) and it cost me -0- out of pocket. I liked that. A few years ago - well... I'm just glad the darn thing waited...

But all in all... right now I'm just happy I can AFFORD to get sick (don't plan to, but before Medicare - I couldn't AFFORD to).

:-*