To think it is terrible that Americans with health insurance have such high deductibles

[crunchymint]

I have been reading this article about American healthcare.

www.motherjones.com/politics/2018/01/go-fund-yourself-health-care-popularity-contest/

It says -

"With health care costs and high-deductible plans on the rise for more than a decade, medical expenses are the largest single cause of bankruptcies nationwide. Despite Obamacare’s efforts to rein in costs, the average deductible on a typical plan under the Affordable Care Act is $2,550—nearly as much as the entire monthly take-home pay of the average American worker. President Donald Trump’s efforts to destabilize Obamacare have already raised premiums, and experts predict the cost of a deductible under some versions of Republican health care legislation would rise to an average of at least $4,100."

Basically when someone has health insurance, they still have to pay a certain amount out of their own pocket. Typically they have to pay a certain amount to visit a Dr and for any treatment - with insurance covering the rest. So even someone with insurance who has a chronic or serious illness, still has to pay a substantial amount of money out on top of their insurance premiums.

American here as well. My family has wonderful insurance through DH’s employer.

It didn’t save us from a $40,000 hospital bill when he had to spend a night in the ICU due to an allergic reaction to surgical anesthesia.

What can we do other than pay it and be glad he’s alive?

@PrincessNutella

I am American and have mixed feelings about our healthcare system. I hate how many people fall through the cracks and the ways they can fall through the cracks. There are ways that people can get tricked into having high bills. I don't really mind the deductible part, I figure that somewhere along the line, it is part of what one has to pay for healthcare, whether it is through taxes or insurance or whatever.

On the plus side, I think good U.S. health care is probably the best in the world, and that's why people with serious conditions will flock here if they can. I have a friend whose child is studying to become a doctor in the UK and I am shocked at how much easier it is in every way to become a physician in your country than ours. It takes fewer years, and the residencies are much less grueling. In the US, it is incredibly competitive and serious. I was really not impressed with what I saw. Doctors from other countries have to retrain to become doctors here. From what I read on a thread here, this is true for nursing, also. My mother and SIL were nurses and they were/are incredibly smart and technically proficient. Nursing is a very competitive profession as well. I have had some experience as a patient of having hard to diagnose problems, and found that sometimes, going to the absolute best doctors can cut right to the chase. Because I have good insurance, I could go to a top rheumatologist, and in one visit, he diagnosed my autoimmune disease and got me appropriate medication. I could also get care in Sloan-Kettering, the best cancer hospital in the world when I needed it. I felt very reassured that the smartest people possible were giving me personalized care.

It is difficult. I want everyone to have a basic level of healthcare. So in that sense, it's fine to have a system that is basic and provides a certain level of care for all. But if I had a kid with an unusual form of cancer, I would want to be in a reasonable American healthcare plan where I could access top level American- medical specialists.

I'm also an American and agree with this completely. I'm an HCP who has proved care for many foreigners, including many Brits, who have come here for treatments that are simply unavailable under their own national health care systems. And as @PrincessNutella points out, the care is generally excellent and we don't have waiting lists. We also do more cancer screening than seems to be the case in the UK.

The American system of providing and paying for health care is quite complex, so it's easy to look at part of it in isolation without understanding how it relates to the rest. High deductible insurance plans are designed to be used with Health Savings Accounts, to which you make tax deductible contributions to fund your initial costs. The money carries over if you don't use it and can also be used to pay insurance premiums.

High Deductible Health Plans (HDHPs) & Health Savings Accounts (HSAs)

The attraction is that the premiums are much, much lower than standard plans and you can use the savings to fund your HSA. I know people who have them and love them. My own health insurance has a $500 per person annual deductible and an out-of-pocket maximum of $5,000. I'm fine with both.

I think there is more work to do to expand coverage, but it's not really the dystopian nightmare it's made out to be on MN. I think the Biden administration will improve access by allowing people to buy into Medicare, the Federal insurance program for the elderly.

I have a friend whose child is studying to become a doctor in the UK and I am shocked at how much easier it is in every way to become a physician in your country than ours. It takes fewer years, and the residencies are much less grueling. In the US, it is incredibly competitive and serious. I was really not impressed with what I saw. Doctors from other countries have to retrain to become doctors here.

Gosh, in the UK any old person can become a doctor. Just roll up and they'll hand you a scalpel.

@ShamelessCurtainTwitcher

American here as well. My family has wonderful insurance through DH’s employer.

It didn’t save us from a $40,000 hospital bill when he had to spend a night in the ICU due to an allergic reaction to surgical anesthesia.

What can we do other than pay it and be glad he’s alive?

Could you explain this please? How is your insurance wonderful if you got landed with a $40k bill?

We aren’t covered 100% for hospital stays.

We had met our deductible but we were responsible for a small percentage of a very very expensive overnight in the ICU.

I’m in pancreatitis groups and it’s terrible the Americans often avoid getting treatment due to cost or having no insurance anymore as they’ve lost their job thanks to health issues and then lost their insurance. It’s awful.

We in the UK have voted to move to this type of system, so i hope it works out well.

Let’s not be smug about healthcare in this country. NHS is a second class system where people wait for months, sometimes years for routine procedures. You calm the GP and have to fight am with a receptionist who thinks she is the gatekeeper for an appointment. It’s all very well saying Americans pay a lot, but then they don’t have to suffer in agony and get the treatment.

We have a high-deductible insurance plan for our family and the deductible is $6K per year. As a PP said, we have a special health savings account that we use to cover medical and dental costs. Certain things, like annual physicals, mammograms, immunizations, etc. are fully covered by our insurance (no deductible). But I recently had a 15-minute video visit with my GP for an existing condition and just received the $170 bill.

The positive side is that we can access pretty much any medical treatment we need, we don’t need a referral to see a consultant. My kids see a pediatrician and I easily made an appointment with a dermatologist when DD had a mysterious rash, etc. But everything has to be paid for.

It would be much more interesting to hear from Americans who are under-insured, rather than those who gloat.

@sst1234

Let’s not be smug about healthcare in this country. NHS is a second class system where people wait for months, sometimes years for routine procedures. You calm the GP and have to fight am with a receptionist who thinks she is the gatekeeper for an appointment. It’s all very well saying Americans pay a lot, but then they don’t have to suffer in agony and get the treatment.

Yes, they do.

Even if you have insurance and can pay, you will still deal with the same gatekeeping through the insurer. It can take months for a routine procedure to be approved. This isn't just anecdata, though I can provide you with plenty of examples. The insurance does a good job of preserving their profits through gatekeeping. And even if your insurance does approve a procedure without question, you still have to wait for a provider and a facility, same as the NHS. Some areas are better resourced than others, same as the NHS.

@CraftyGin

It would be much more interesting to hear from Americans who are under-insured, rather than those who gloat.

I am certainly not gloating.

The healthcare system is shameful here in the US. Deductibles are the least of people's worries - even worse are the hundreds of thousands of dollars in medical bills that a person can rack up just for being sick. I have a terminally ill cousin who has finally exhausted the family finances, and simply cannot keep up with the bills. So on top of worrying about dying, he and his family have to worry about losing their home.

I know of people who have committed suicide due to this problem. I think one reason we have such a terrible problem with gun violence - in addition to the obvious reason that guns are way too available - is because people here just do not get access to adequate mental health care. They are usually held for a couple days, then kicked right back into the same situation they came from, with no long term help if they're poor.

Ciaobaby92 you said it all right there. Absolutely correct.

Even if you have insurance and can pay, you will still deal with the same gatekeeping through the insurer. It can take months for a routine procedure to be approved. This isn't just anecdata, though I can provide you with plenty of examples. The insurance does a good job of preserving their profits through gatekeeping. And even if your insurance does approve a procedure without question, you still have to wait for a provider and a facility, same as the NHS. Some areas are better resourced than others, same as the NHS.

I've never experienced this with any American insurance company. The only grounds they have for denying coverage for a procedure is if it is experimental or medically unnecessary, and it they do, there is an appeals process. I recently had hip surgery and no prior approval was required. I had to wait 10 days for the surgery to be scheduled because the surgeon was on holiday for a week.

The healthcare system is shameful here in the US. Deductibles are the least of people's worries - even worse are the hundreds of thousands of dollars in medical bills that a person can rack up just for being sick. I have a terminally ill cousin who has finally exhausted the family finances, and simply cannot keep up with the bills. So on top of worrying about dying, he and his family have to worry about losing their home.

Did the cousin not have insurance at all, not even Medicaid? Since 2011 there has been a limit on annual out of pocket expenses.

www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

@MissConductUS

Even if you have insurance and can pay, you will still deal with the same gatekeeping through the insurer. It can take months for a routine procedure to be approved. This isn't just anecdata, though I can provide you with plenty of examples. The insurance does a good job of preserving their profits through gatekeeping. And even if your insurance does approve a procedure without question, you still have to wait for a provider and a facility, same as the NHS. Some areas are better resourced than others, same as the NHS.

I've never experienced this with any American insurance company. The only grounds they have for denying coverage for a procedure is if it is experimental or medically unnecessary, and it they do, there is an appeals process. I recently had hip surgery and no prior approval was required. I had to wait 10 days for the surgery to be scheduled because the surgeon was on holiday for a week.

I'm glad you've never experienced it. I have. I know others who have.

What an insurance company deems "medically unnecessary" can be deemed "critical" by your care team, and unless your care team can do the peer-to-peer and you have the energy to fight the insurance company, it isn't happening.

For example, my ultrasounds and gestational diabetes treatment weren't considered "medically necessary" and did not fall inside of the "maternity is 100% covered" of Aetna. Without them, what would the outcome of my pregnancy have been? What would have happened if I hadn't been in a position to pay 100% out of pocket?

I've a friend who was supposed to have a CT scan for her debilitating migraines yesterday, but insurance says it's not medically necessary. So she will go through the appeals process, while she is in pain. Another friend who did win the appeals process was initially denied for his follow up cancer care. You can't tell me insurance doesn't gatekeep, or that these are frivolous procedures.

The NHS wait times are nothing compared to this.

[quote MissConductUS]The healthcare system is shameful here in the US. Deductibles are the least of people's worries - even worse are the hundreds of thousands of dollars in medical bills that a person can rack up just for being sick. I have a terminally ill cousin who has finally exhausted the family finances, and simply cannot keep up with the bills. So on top of worrying about dying, he and his family have to worry about losing their home.

Did the cousin not have insurance at all, not even Medicaid? Since 2011 there has been a limit on annual out of pocket expenses.

www.healthcare.gov/glossary/out-of-pocket-maximum-limit/[/quote]
My best guess would be multiple providers and treatments as well as any number of loopholes designed to protect profits.

I'm surprised that you were surprised by this @crunchymint . Did you think that us Americans with health insurance, even good health insurance, just waltz in to our doctor's offices and never pay a penny? I have pretty good coverage. I have to pay a $25 co-pay to see my primary care physician, and $50 to see a specialist. (That's every time I have a visit.) Medications are $10 for generics and $30 for name brand.

I watched a really interesting video not so long ago about the American healthcare system in comparison to healthcare around the world, and I found it quite shocking. It said that healthcare in USA cost more per person than anywhere in the world and yet the life expectancy was the lowest.
But the part that really got me was a story about a young man who needlessly died. He was type 1 diabetic and when he turned 21 he was no longer covered on the health insurance provided by his parents work. He went to purchase a months worth of insulin and was told the list price was $2000+. He couldn’t afford it and later died of Diabetic Ketoacidosis. This struck a particular chord with me as my son is type 1 diabetic, he had DKA (that was how he was diagnosed), received exceptional care at our local NHS hospital, has a team of specialists looking after him, a dietician and a psychologist available as and when he needs it. He’s just been fitted with a continual glucose monitor and an insulin pump. All funded by the NHS. He will never need to worry about whether or not he can afford his insulin, purely by virtue of the country he was born in to. I get very emotional if I stop and think about it for too long because I’m so immensely grateful that the NHS provide all of this!

@FrogsHiccups

I watched a really interesting video not so long ago about the American healthcare system in comparison to healthcare around the world, and I found it quite shocking. It said that healthcare in USA cost more per person than anywhere in the world and yet the life expectancy was the lowest. But the part that really got me was a story about a young man who needlessly died. He was type 1 diabetic and when he turned 21 he was no longer covered on the health insurance provided by his parents work. He went to purchase a months worth of insulin and was told the list price was $2000+. He couldn’t afford it and later died of Diabetic Ketoacidosis. This struck a particular chord with me as my son is type 1 diabetic, he had DKA (that was how he was diagnosed), received exceptional care at our local NHS hospital, has a team of specialists looking after him, a dietician and a psychologist available as and when he needs it. He’s just been fitted with a continual glucose monitor and an insulin pump. All funded by the NHS. He will never need to worry about whether or not he can afford his insulin, purely by virtue of the country he was born in to. I get very emotional if I stop and think about it for too long because I’m so immensely grateful that the NHS provide all of this!

I agree with you that the American health care system is broken. It's better than it was thanks to the efforts of President Obama. For example, kids can stay on their parents insurance until they are 26 now. But yes, it still needs a lot of work.

But you are completely wrong about life expectancy being lower here than anywhere else in the world! If you stop and think about it for a second, you'll realize that that can't possibly be true.

www.worldometers.info/demographics/life-expectancy/

@FrogsHiccups

I watched a really interesting video not so long ago about the American healthcare system in comparison to healthcare around the world, and I found it quite shocking. It said that healthcare in USA cost more per person than anywhere in the world and yet the life expectancy was the lowest. But the part that really got me was a story about a young man who needlessly died. He was type 1 diabetic and when he turned 21 he was no longer covered on the health insurance provided by his parents work. He went to purchase a months worth of insulin and was told the list price was $2000+. He couldn’t afford it and later died of Diabetic Ketoacidosis. This struck a particular chord with me as my son is type 1 diabetic, he had DKA (that was how he was diagnosed), received exceptional care at our local NHS hospital, has a team of specialists looking after him, a dietician and a psychologist available as and when he needs it. He’s just been fitted with a continual glucose monitor and an insulin pump. All funded by the NHS. He will never need to worry about whether or not he can afford his insulin, purely by virtue of the country he was born in to. I get very emotional if I stop and think about it for too long because I’m so immensely grateful that the NHS provide all of this!

My prior insurance company did not cover insulin (I am not diabetic but have had gestational diabetes while in the US) because with GD it is considered "medically unnecessary" even though my clinician wanted me on it for the best results. It was indeed $2000 per prescription.

The insurance company's appeals process denied it multiple times. Their approved treatment plan for gestational diabetes was cheaper and did not match my particular situation or diagnosis.

So I guess insurance works if you've never needed something the insurance didn't want to cover, but the second you do, it's an argument -- even if it saves your baby's life.

Getting back to the training of US v UK doctors. They actually spend a similar time being trained in medicine. US doctors have to do an undergraduate course first, but on the other hand, UK students generally finish school at a higher academic level than US students (not saying they are more intelligent, just that the English, in particular, system is more geared to passing academic exams at an earlier stage). The medical students and doctors I know are among the very brightest of the academic crop: the kids who could have done almost anything they wanted.

UK medical students often intercalate (take an extra degree in a year) during their five-year medical degree course. Quite a number switch from other undergraduate degrees, too.

As far as are they as good... Obviously the US system has more money behind it and a bigger population so more strength in depth. Perhaps there are rarer cancers where American doctors have expertise because there's funding for research that there isn't in a smaller economy.

To work in the US British doctors have to sit very rigorous exams, but that's not the same as saying they have to 'retrain'.

Don't know as much about nurses as none currently in the family.

@Anonymous48
Sorry, I didn’t word that quite right. It was the highest cost per person in the world (I’m pretty sure). Life expectancy was the lowest of the nations the video was comparing the USA healthcare system to IYSWIM. I think the nations were Uk, Germany, Sweden, Singapore, Japan and a couple more.

Here is the link anyway 🙂

I remember when I was on a forum for a specialist surgery I was having to chat to other people about post op care. Most were in the US. I had mine done privately through Bupa in the uk, my excess was £100 and the total cost of surgery was £4000 including 24hr stay in hospital as I got the itemised bill.

The costs for identical surgery in the US with no overnight stay was in the region of $100,000. I was horrified (as were they when they heard my price!)