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.

What is never communicated to British people are the state programs or MH provision in schools. I've noticed the rate of eating disorders here is much lower compared to the U.K. and I put it down to the system of having guidance counselors in schools available who are qualified psychologists.

In some areas there are enough GPs. I can easily get an appointment on the same day. It varies across the country dependent on GP vacancies.

@Oliversmumsarmy pay for a push doctor online consult with a private GP and they will write you a referral letter you can use for the insurer to approve an appointment with a private consultant

Dp is a qualified professional and when we have looked at jobs in the US there appears a £ to $ parity. I.e salary £100,000 jobs are $100,000

That's not the norm for professional jobs. The very general rule of thumb for anyone moving to the US from the UK is to aim for double in dollars what you're currently earning in sterling so £100k -> $200k. I'm not saying everyone gets that but that's the only way you can afford the cost of living. I don't agree with a previous poster who said the cost of living is lower unless you're in a big city. I think if you've come over from the UK, that all things taken into account, the cost of living is higher. If you're earning £100k in the UK and came to the US on $100k, you'd be facing a significant decrease in lifestyle.

As far as employment health insurance premiums, there is a HUGE gamut of amounts for the same coverage (a 'basic' 80/20 low deductible), depending on the employer and the health insurance company.

DS2 just started a new job and he has 22 plans to choose from. The premiums run from -0- to $225.00 per month. He's chosen a very good plan for $8.00 per month. It has zero deductible and reasonable co-pay amounts. The MH coverage is excellent which is important for him.

When we lived in the States and had excellent company healthcare insurance, we realised just how fortunate we were to be supported by an employer, and also how bloody lucky we are to have the NHS in the UK. Free at the point of entry; no papers, no insurance, no worries if we would or could afford to be treated.

One trip to the accident room for a child's head wound needing a couple of stiches ran up bills totalling in excess of $9,000. It's insane.

bananafish81 it is too late for dp.

The reason I thought it was £-$ parity was because dp a few years ago went for a promotion based in the US office of the company he works for. I remember the salary was only slightly more.

My current job I am paid about £18.15/hr.
In my home town I would be paid $19-$21/hr for same type of work.
That would include medical, at least!

Bumble - the admin burden for employers is crazy, and I don't know why (other than "it's always been like this and the government would only mess it up and charge more for it") there isn't push back from business leaders

Even if the day to day admin is outsourced, choosing an annual plan, understanding the implcations for employers and employees, presenting this to staff, following up with staff etc etc every year is a huge admin burden on businesses

There is huge push back from leaders. It's an insane system that everyone accepts because a universal system country wide would be a disaster and the cost of not having it is too high.

Now, if they could fix the VA and get that running efficiently, they could use that as the model for a parallel system. If that happened who would PT for all drugs for the third world. Every single day I walk by the Pfizer HQ in Manhattan and every single day I'm angry that we deny our own people medical care so I can look at a poster of a kid in Africa (or some other country) who received medical care. Seriously, some of the people working in that building looking at the poster can't afford to use their healthcare plan. It's all ok though that we pay astronomical amounts for drugs because some people elsewhere benefit. It's absolutely nuts.

PT - pay

I don't know why there isn't more pushback from business leaders either. Essentially, US businesses are in competition in many cases with businesses abroad that are not carrying the expense of administering health insurance, or the cost of the insurance itself.

Want2bSupermum Sat 21-Apr-18 11:23:53
What is never communicated to British people are the state programs or MH provision in schools. I've noticed the rate of eating disorders here is much lower compared to the U.K. and I put it down to the system of having guidance counselors in schools available who are qualified psychologists.

The counsellors in my local high school tend to be arts/humanities majors and they focus on student course selection, dropping courses, assessing workload, issues with grades, advice on college applications, co-ordination of the school role in applications to university. They also refer students to the deans of discipline and to the school social workers.

The school has grouped the intervention support in teams comprised of counsellor, social worker, dean of discipline. All students see the counsellor for scheduled meetings a few times per year. A small number of students spends time with the dean of discipline as well as the counsellor, and some of those students will also spend time with a social worker. A small number of students will see the social worker and counsellor.

Some students are referred to the school social workers by their counsellor because the police have flagged them due to behaviour outside of school but also due to police calls for DV issues in the family or because family members have been involved with the police for some other reason. Some are assessed for social worker intervention due to social/emotional/psychological issues, problems with their family relationships, teen parenthood, drug/alcohol abuse, LGBT issues, stress, anxiety.

On top of all that, there is a student-led mediation service supervised by one of the deans where students can go and talk their way through disputes.

Schools really provide wrap-around formal services on top of the informal care and mentoring that teachers and coaches provide.

Last time I looked, the local HS had an annual budget of $77million.

Kids in Africa will likely be given generic drugs made by manufacterers more local to them, want2be. The third world is not the target market for drugs made by Pfizer, many of which will be lifestyle related.

I don’t think drug costs are high in the states to subsidise treatment in other countries, I think it’s down to the system in the US. Not having a joined up healthcare system doesn’t help eg if you want your drug to be approved for routine use in the NHS then it will go through NICE. If the cost is so high that it outweighs the benefits of treatment, it won’t get through. NICE can and do negotiate with drug companies on price. The NHS could not remotely pay the prices that drug companies set for the states.

bolshy The drug prices here are extremely high compared to every country in the world. Just as the NHS couldn't afford US drug prices neither can the majority of Americans.

I take issue with the fact that Pfizer advertises the charity work they do in Africa as a way to justify their price gouging in the American market.

Well they’re using that as an excuse because I’d be pretty surprised if all the money they make from the American market is being poured into charity work! The amount of research they do into third world diseases will be minuscule compared to lifestyle related illnesses. Drug prices in the US are scandalaous, as a non-American I don’t really understand why they are allowed to be set so high. You could probably explain this better than me.

Well it starts with pharma being a very lucrative career. It makes Wall Street look like working at mcdonalds.

it starts with pharma being a very lucrative career
and big tech wants a share of the big pharma action
www.chicagotribune.com/news/opinion/commentary/ct-perspec-health-facebook-data-profit-0419-20180418-story.html

It is not surprising that Facebook wants to move into the digital health market: So do Amazon, Google, Apple, Uber and all of the other big tech companies. These businesses see an opportunity to profit from users’ personal health data because, unlike narrowly defined medical data, health and wellness data is not considered protected health information and therefore is not protected by privacy laws

the lack of transparency, increasing interconnection of health and technology, and growing reliance on risk modeling in health care mean that combining health- and medical-data sources to target patients could harm anyone who has a serious illness or the risk of developing one. The insurance industry uses social media intelligence and profiling to inform algorithms that automate pricing, claims handling and fraud detection. When health risks are understood as financial risks, contextual information from users' digital profiles can be used against them to raise premiums or deny claims. That means everyone is at risk.

That explains why people work in Pharma, but not why the drug companies are able to sell at such exorbitant prices. Why aren’t the government or insurance companies forcing them to drop prices? I’m guessing the drug companies set their prices high because they can? That the lack of a joined up system in healthcare or a national body means that there is no negotiating power in the US. Plus it’s a rich country where at least some people are willing to pay these prices and healthcare is very market driven (you do not get tv adverts for drugs in the uk!).

The drug companies are able to keep prices astronomical because they lobby very effectively.

It also springs from the concept of healthcare as an industry (as opposed to a necessary human service) where people and companies have a valid interest in turning a profit.

Why aren’t the government or insurance companies forcing them to drop prices? I’m guessing the drug companies set their prices high because they can? That the lack of a joined up system in healthcare or a national body means that there is no negotiating power in the US.

IIRC, Congress keeps blocking laws that would deal with this. It drives Americans insane too. This is something even Trump wants to fix. There are many varied fixes needed, but they tend to get bogged down in bigger questions like 'Shall we repeal Obamacare' (again). More here www.nytimes.com/2017/09/23/sunday-review/prescription-drugs-prices.html

Having said that, before Congress looked into the outrageous price of Epipens, they were $600 a pair. Now they are $300 a pair (still outrageous) but there are now several generic competitors - I suspect Congress found a way to get the FDA to speed up their approval. We didn't pay a penny for our new Auvi-Q auto injectors.

Although they are always depicted as the bad guys, medical insurance companies are playing a small part in reducing pharmaceutical costs by refusing to cover brand name drugs when there are generics available. We've seen that several times recently with our prescriptions.

When I say lucrative career I mean it's extremely well lobbied and the patent process prevents any true competition.

The whole epipen fiasco really opened everyone's eyes to how greedy these companies are.

A lot of the reasons that the health and pharma systems remain broken are because our governmental system is itself broken.

I'm in Australia and we have a system that is somewhat a hybrid between an American-style system and the UK system. I think it is much better than either single system.

We have a public system, which is free at the point of use. You can go to any ER at any minute and not worry about paying anything out of pocket. Necessary surgeries are also completely subsidised under this system, but the drawback is potentially (and often realistically) long waiting lists.

The majority of doctors require an upfront copayment. This could be up to $70 for a single consultation with your GP. But a substantial amount is then credited back into your account by Medicare. There are also bulk billing doctors, and their service is free at the point of use and is completely subsidised (through levies such as the 2.0% Medicare Levy everyone pays in addition to their income tax). There tends to be at least one of these in most areas.

Ambulance cover is on the individual. It's relatively inexpensive, at around $60 per year, or is covered automatically under private health insurance.

Private health insurance is relatively common to have. You can choose to have private hospital cover or not, choose which extras you want and which you don't, and you can use the public system simultaneously despite holding PHI. This reduces the upfront cost of things like dental, optical, physio etc. which would typically be costly and not often covered (even partially) under the Medicare system.

Prescriptions are not - for the most post - subsidised. A prescription over $40 can be reduced in price if you have a letter from your doctor certifying its medical necessity. The vast majority of people will pay the full price for the vast majority of their prescriptions.

It's a system which works relatively well. It's not being bled dry, and people - like me - who do not have chronic health conditions and are not regularly ill do not feel the pinch of the upfront costs any more than any other regular life expense. But it provides well for those who do not have the means to afford PHI and it means that the service that they provide is better because the system is not being weighed down by people who can afford to pay but do not want to.

insurance companies will do anything to keep things as profitable as they are now

I think that is the crux - insurance is for profit, it should be non profit. In the UK prices at private hospitals are to a certain extent controlled by the insurance companies.

If BUPA say a hip replacement cost £3000 that is all it will pay, in theory the 'top up' of a bill should be passed on to the patient but in reality the pirate hospital with swallow the difference.