To be shocked that a US friend is paying $1970 a month health insurance

[crunchymint]

That is her monthly premium for health insurance and is an insane amount of money.

Another issue is that the high cost of healthcare also drives up the cost of other insurance. My car and house insurance is many times the cost of what it was in the UK, and you need to ensure you have adequate liability coverage in case someone gets hurt on your property and they decide to sue, which is highly likely considering the costs they’d be likely to face.

I know volunteers organising events in the US have to pay a lot for insurance. Here if someone is hurt the NHS pays for their treatment. There people have to sue to get the cost of their treatment covered. And even minor accidents can cost a lot. Here insurance for events that are unlikely to lead to serious injuries, is usually cheap.

Oh and there's a reason lawyers are so rich. If I get hit by a car in the UK, I go to A&E, get fixed up and maybe miss a bit of work, which is generally covered by sick time. Normally. No point suing.

If I get hit by a car in the States I might have to sue the driver to get my medical bills paid, lost work etc.

@MrsTerryPratchett

Litigation culture spread to the UK as well hence why some of the NHS funding is spent on middle management etc.

Absolutely. But the scale is vastly different.

This does explain, in part, the numbers of mentally ill people we saw walking around the city in San Francisco on a recent tour. Heart breaking to see the numbers of homeless and 'dirt' poor. It was shocking as one expects the USA to be a '1st' world country. From what I saw on the west coast it is anything but that.

Actually I thought the NHS had a very high rating from WHO for efficiency?
The issue is money.
Sorry just seen this.

No the issue is more nuanced than that, because then we get into an argument of "not true labour" and the current spend

We do not come first for efficiency or outcome, if its as simple as throwing more money at it then accept the issues we currently have with the idea of just throwing money at it, and if we are to work it on a GDP basis then the conservatives are spending more than Brown and Blair did, so we now start getting into either a nuanced debate of NHS reform or party political crap.

QuiteChic - that and the shocking levels of drug addiction in cities like San Fran

Prime minister may use NHS as part of trade negotiations. Has anybody heard anything about this? This came up on my Facebook feed...

home.38degrees.org.uk/2018/02/09/nhs-trade/

Why wasn't Obamacare popular?

My sister lives in America and her take on it is that most Americans don't want to pay into an nhs type healthcare system as they think is paying for other people rather than benefitting everyone. People believe everyone should pay their own way and reply on themselves. There shouldn't be government support. They like lower taxes and wouldn't pay more for better services.

When she talks about it I thank my lucky stars I am not poor and living over there. It seems ok if you're rich but no one cares about the poor.

The admin for Obamacare is massively complex. Not saying I approve or disapprove (not my place as I don’t live there) but the admin burden on employers and providers is very heavy

I pay similar for mine and also have a $4000 a year deductible. That means every year the first $4000 of medical bills are mine and not paid for by insurance. Thats EVERY year, over and above the cost of the plan.
Dh just had a tooth crack, after dental insurance it was $6000 to fix

Its insane

The ACA was poorly written and terribly executed.

For example it didn’t extend coverage to part time workers. Which not only doesn’t benefit those already working part time (who are predominately women), it screws over casual workers, especially those in service industries who saw their hours cut to stop them becoming eligible. So now they’re earning less money and still don’t have health insurance.

Then you’ve got the fact that the math simply didn’t work. It was supposed to pay for itself, but whilst it was successful for obvious reasons with sick low income people, essentially those who don’t pay much in but take a lot out of the system, they failed to attract enough well paid healthy people (probably because their existing plans offered better value) to balance it out. This made it unprofitable for health insurance companies to participate. For example, Blue Cross Shield of Kansas City lost a $100 million on obamacare over two years. Unsurprisingly they’ve now dropped out of the scheme.

Then you’ve got the political aspect. Republicans (who have a majority in Congress and the senate) are never going to be in favour of any kind of state run health care. So there’s not enough political support to mend it.

Another issue here is out of network doctors. If you go to the ER you see who ever is there, and heure not necessarily covered by your insurance company.

Also during operations this can happen if you don’t know to ask in advance who will be part of your care. An expat I know here got a 28k bill after her DH had a heart op. Not sure how the appeal is going to have it reduced or paid by insurance. But at the same time they’ve taken some nice holidays during this saga, money that could have been applied against the bill.

Obamacare was popular, but there's a misconception that it provided free or very low cost healthcare for the whole of the USA. It didn't - it provided more choice of plans, employers were mandated to offer it over a certain size, but you still had to pay for it and everyone had to have it. There's a % of people who didn't think they should be told what to do (often tying in universal healthcare with communism...) and some states refused to support it.

The other interesting thing is Americans already pay out contributions to medicare and medicaid through similar contributions to UK NI, its just that most ppl won't benefit as its used to support retired ppl, ppl who can't work (disability etc)

We had 4 plan options this year, ranging from $330 - $950 a month for a family (not including dental or vision) the cheapest one = the most outlay before insurance kicks in. The crazy thing in, that the price to us is AFTER our employer had subsidized the plan by up to ~80%

Personally I think given how the nhs operates that seems quite cheap.

If dp had been in the US maybe his life would be different. He would have not been left till it was too late

I asked the same question about obamacare on an American friend's Facebook page.

I had no way of checking, of course, but about ten people of her American friend's replied and said they were much worse off because their insurance premiums had gone up so much. They saw that as them having to pay for others, which they resented.

Friends. Not friend's. Stupid phone!

I think it's a myth that Americans pay less tax.

Americans pay federal and state tax. They pay medicaid tax and for the ponzi scheme known as social security. All of those items are deducted from pay cheques.

They also pay property tax and they are taxed by their municipality. Those taxes are paid to their county of residence from an escrow account if they have a mortgage, and to the county directly by them if they have no mortgage. Depending on the estimated taxable valuation of your property you could pay tens of thousands of dollars (or even more) annually in property tax. People I know pay $50k in property tax annually, on top of all the rest. When you go to buy a house/condo the latest assessment is provided along with the other details of the property by the realtor.

They pay sewage, water and garbage removal charges. They pay tax on every single item they buy including baby food and aspirin and tampons and children's shoes. They pay tax on items bought online.

When it comes to municipal charges, municipal spending and levying of taxes, and county levies and spending, American voters get a direct and an indirect say. They vote for the county (property tax) assessor. They vote in local referenda on expenditure to expand the local public high school or to rebuild the middle school, and on the local parks department master plan from now until 2025, or whatever else is proposed. They don't get as much say in federal or state policy/tax/expenditure but they care all the same. However, the habit of following proposals and feeling involved in the decision making process at local level gives the impression that Americans are obsessed with keeping taxes low and the rugged independence/ every man for himself philosophy. There are places where people vote for expenditure on great public facilities, partly because a fantastic library, parks/rec facilities, and local school system keep the resale value of their houses high.

Then there are student loans that Americans are often saddled with, amounting to a tax on graduates in many cases. Six months after graduation your loans come due and there is no income threshold you have to reach in order to start paying.

It's amazing how many people don't know about risk pools, SaucyJane.

Everyone with private health insurance is paying for others.

This is topical for us as we have just moved from a country with no NHS.

Yesterday we got some post through from our previous address. There was a letter addressed to my 13 year-old son. I saw it and it looked like a receipt of some sort, so I assumed it was something he had bought online and left it for him to open.

It wasn’t. It was an invoice addressed to HIM for $400 to pay for the ambulance that took him to hospital when he was suicidal 😢.

Hang on.

No, it is because she has had lots of health problems, but it is so much.

In the US people are no longer charged more for insurance based on health conditions. Your friend's premium is not high because of health problems now or in the past.

My DBs policy is $1,000,000 total

There are no lifetime caps in medical insurance policies in the US. These were made illegal by the introduction of the ACA (much like premiums that were high because of pre-existing conditions).

OTOH if you want to discuss the fact that premiums and expenses are ridiculously high, I entirely agree.

Another curiosity my DB noticed was that US clinics love to do scans and tests. Loads of them. And give you the results (he's got a library of DVDs with his MRI, PET and CAT scans). But that's more about covering doctors in case of litigation than patient care.

Is it just about litigation or also about ramping up costs? Everything in the US is highly medicalised, even having a baby with low risk straight forward delivery involves far more medical care and costs thousands and the outcome is not necessarily better. This seems ironic when the Mum then has to rush back to work after a few weeks of giving birth in order to keep her job and pay for her healthcare

Lol at the idea that if you have insurance you're only paying for yourself. Actually, your premiums provide revenue enabling your insurer to fulfil its contractual obligations to all its customers.

The only way to pay your own way is to pay all your bills direct to the doctor and carry no insurance.

I do remember some years back, a friend of mine returning from the US, absolutely raving about how great the medical care was. I do get the feeling that in the US you get the best care on the planet - if the doctor is paid. Whereas in nationalised systems you only get whatever quality the state is willing to fund.

Several years ago my sister used to pay $800 a month for herself and her daughter and she wasn't at all well off - widowed when niece was only 7.
She once cut a finger very badly - I said, well, at least you've got insurance.
She said, You're joking - there was a $2000 excess.
And we just take for granted that we go to A&E to get sorted for free.