Post by Kimby on Jul 9, 2023 18:08:27 GMT
(I apologize if there is another thread like this. Point me to it if there is, and I’ll move my comments there and take this one down.)
Everyone - except many Americans - knows that a national, universal “free” (meaning you pay taxes for it, but otherwise don’t get nickled and dimed for every bit of health care you need) is the best way to go.
Yet America, in its profound aversion to anything “socialistic”, persists in maintaining a complicated, multilevel, fragmented system that actually costs us more AND results in worse outcomes for many people. And in embarrassingly low rankings in mortality data among civilized - I mean industrialized - nations.
We Americans have to “shop for” insurance policies, hoping to find one that covers all our conditions and maybe even includes some of the preventative stuff at a price we can afford.
We have to consider deductibles and co-pays, in-network and out-of-network providers, will I be covered if I get sick or injured while traveling, etc., etc.
Then, when we NEED our health insurance, when we’re feeling sick or recovering from surgery, we have to deal with the bean-counters whose job it is to try to make sure they pay out as little as possible to keep profits up.
Obama, with the Affordable Care Act, was able to get rid of exclusions for pre-existing conditions, and lifetime caps, and to force insurers to include young people up to age 26 on their parents’ plan.
And Republicans in Congress tried multiple times to “get rid of Obamacare”. The mandate that everyone buy insurance so the pot of money would be enough to cover the sickest was anathema to Republicans, and they did their best to weaken the ACA. But it was such an improvement over the way it was before that today you’d have a hard time getting it away from people who have come to depend on it.
But it’s still such a hodgepodge of rules and regulations and requires a lot of attention from health care “subscribers” to get the best plan for their family.
And worst of all, it supports an industry - Health Insurers - that adds NO VALUE to our health care system, just skims its profits off the top to support an army of insurance agents and adjusters who aren’t really looking out for our best interests.
How much better it would be to have a national health care system that removes all this red tape and just looks out for the health of its citizens.
In the meantime, we could expand Medicare, the national plan that pays for doctor visits and hospitalizations for those over 65, to include younger people. Perhaps age 55 and up to start with. The insurance companies could still cover the under 55 population, but being a healthier cohort they should have less expensive health care needs. Eventually, when people saw how well that worked, it could become Medicare For All, and the insurance industry could mostly go away.
Though there will still be a need for insurance to cover things above and beyond what society deems acceptable to cover for everyone. Should stomach-stapling be covered for weight loss? How about plastic surgery? Some is deemed “medically necessary”: like breast reductions for women with back pain and eyelid surgery for drooping eyelids that reduce your peripheral vision, a safety issue for drivers.
The Kimby’s were lucky to have pretty good insurance through Dr. Kimby’s job, but when he retired we had a hard time finding an insurance company to take us on. Three turned us down in spite of being healthy-weight, active non-smokers! Pre-existing “conditions” made us a bad risk, I guess. I had had an ultrasound that revealed a previously unknown kidney stone (still no symptoms 11 years later) and he had had a MRI for a painful hip (still not operated on).
Luckily, COBRA allowed us to stay on his work health insurance for 18 months - at our own expense, though - and by a stroke of luck and good timing, the ACA kicked in the day our COBRA expired. After 5+ years of ACA (no subsidies for us and huge annual deductibles), we are now both on Medicare, paying only a $20 co-pay per doctor visit once we’ve met our annual deductible.
There are still lots of decisions to make: which Medicare plan (we chose N, because we travel and can’t be tied to a PPO = preferred provider network) for which we each pay about $95 a month for premiums, Part D (drugs) or not (we chose not, as we aren’t on many drugs and the ones we take are generic and inexpensive), Medicare Advantage Plan or Medicare Supplement plan (we chose supplement).
It’s exhausting, and so unnecessary. How do other countries do health care? I have some vague ideas but it’d be great to hear in more detail from those living under various systems. And how do ex-pats do health care in their new homes?
.
Everyone - except many Americans - knows that a national, universal “free” (meaning you pay taxes for it, but otherwise don’t get nickled and dimed for every bit of health care you need) is the best way to go.
Yet America, in its profound aversion to anything “socialistic”, persists in maintaining a complicated, multilevel, fragmented system that actually costs us more AND results in worse outcomes for many people. And in embarrassingly low rankings in mortality data among civilized - I mean industrialized - nations.
We Americans have to “shop for” insurance policies, hoping to find one that covers all our conditions and maybe even includes some of the preventative stuff at a price we can afford.
We have to consider deductibles and co-pays, in-network and out-of-network providers, will I be covered if I get sick or injured while traveling, etc., etc.
Then, when we NEED our health insurance, when we’re feeling sick or recovering from surgery, we have to deal with the bean-counters whose job it is to try to make sure they pay out as little as possible to keep profits up.
Obama, with the Affordable Care Act, was able to get rid of exclusions for pre-existing conditions, and lifetime caps, and to force insurers to include young people up to age 26 on their parents’ plan.
And Republicans in Congress tried multiple times to “get rid of Obamacare”. The mandate that everyone buy insurance so the pot of money would be enough to cover the sickest was anathema to Republicans, and they did their best to weaken the ACA. But it was such an improvement over the way it was before that today you’d have a hard time getting it away from people who have come to depend on it.
But it’s still such a hodgepodge of rules and regulations and requires a lot of attention from health care “subscribers” to get the best plan for their family.
And worst of all, it supports an industry - Health Insurers - that adds NO VALUE to our health care system, just skims its profits off the top to support an army of insurance agents and adjusters who aren’t really looking out for our best interests.
How much better it would be to have a national health care system that removes all this red tape and just looks out for the health of its citizens.
In the meantime, we could expand Medicare, the national plan that pays for doctor visits and hospitalizations for those over 65, to include younger people. Perhaps age 55 and up to start with. The insurance companies could still cover the under 55 population, but being a healthier cohort they should have less expensive health care needs. Eventually, when people saw how well that worked, it could become Medicare For All, and the insurance industry could mostly go away.
Though there will still be a need for insurance to cover things above and beyond what society deems acceptable to cover for everyone. Should stomach-stapling be covered for weight loss? How about plastic surgery? Some is deemed “medically necessary”: like breast reductions for women with back pain and eyelid surgery for drooping eyelids that reduce your peripheral vision, a safety issue for drivers.
The Kimby’s were lucky to have pretty good insurance through Dr. Kimby’s job, but when he retired we had a hard time finding an insurance company to take us on. Three turned us down in spite of being healthy-weight, active non-smokers! Pre-existing “conditions” made us a bad risk, I guess. I had had an ultrasound that revealed a previously unknown kidney stone (still no symptoms 11 years later) and he had had a MRI for a painful hip (still not operated on).
Luckily, COBRA allowed us to stay on his work health insurance for 18 months - at our own expense, though - and by a stroke of luck and good timing, the ACA kicked in the day our COBRA expired. After 5+ years of ACA (no subsidies for us and huge annual deductibles), we are now both on Medicare, paying only a $20 co-pay per doctor visit once we’ve met our annual deductible.
There are still lots of decisions to make: which Medicare plan (we chose N, because we travel and can’t be tied to a PPO = preferred provider network) for which we each pay about $95 a month for premiums, Part D (drugs) or not (we chose not, as we aren’t on many drugs and the ones we take are generic and inexpensive), Medicare Advantage Plan or Medicare Supplement plan (we chose supplement).
It’s exhausting, and so unnecessary. How do other countries do health care? I have some vague ideas but it’d be great to hear in more detail from those living under various systems. And how do ex-pats do health care in their new homes?
.
