General Question

LanceVance's avatar

What's with the health care in the US?

Asked by LanceVance (645points) August 17th, 2008

I’ve listened to the presidential candidates and they keep saying they’re going to take care of the health care system; but as a European citizen, I’m not aware of how the US health system works and why it is in such bad shape that it needs to be reformed. Thanks

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32 Answers

tinyfaery's avatar

The main problem is the lack of insurance, and inflated prices for drugs and medical tests. Health care is a part of the free market; it’s a for profit system.

LanceVance's avatar

So you’re saying that US residents don’t have the basic insurance plan – the one which the employers pay for the employees?

tinyfaery's avatar

Many employers are not required to offer insurance, but of course, this varies by state. If you are a small employer for instance, with a small number of employees, most states do not require you to offer insurance.

augustlan's avatar

And even if they do offer insurance, it’s just an offer, not a given. Employees routinely pay a big portion of the cost of the insurance, with employers contributing to the cost. To get it on your own, it costs a fortune. Aside from that, there are a large number of the “working poor”, too well off to qualify for government health assistance, not well enough off to afford insurance.

syz's avatar

1. High health care costs
2. Lack of universal coverage
3. Medical decisions being made by bean counters rather than doctors
4. Record breaking profits by (many) insurance companies

kevbo's avatar

Here’s more information than you ever wanted to know on the state of health care in the US. The basic trade off for our system is that we can get access to (state of the art) care much faster than in a nation with socialized medicine. In return, we are allowed to spend ourselves into bankruptcy paying for our own, individual medical bills.

Watch Michael Moore’s Sicko for an entertaining look at US health care.

syz's avatar

Kevbo, you have such insightful answers!

PeterM's avatar

More and more employers are either not offering health insurance, or are requiring the employees to pay an ever-higher proportion of the costs. The costs themselves have been rising much faster than the general inflation rate for many years; the price of health insurance for a family is simply ruinous. And, of course millions of Americans are completely uninsured – including millions of children.

Those who have insurance are often badly under-served. The system tends to reward doctors who see as many patients as possible, which has led to a “treat and street” mentality. Doctors who spend extra time with their patients are often punished by the insurance companies.

Medications are restricted, based entirely on the cost to the health insurer. Mental health treatment is particularly poorly handled by most of the US system; that’s a horror story in itself. Women who give birth are generally expected to be out of the hospital within 48 hours after delivery. Follow-up care is usually minimal or virtually nonexistent for many.

The poorer you are, the worse care you’re likely to receive. Clinics in low-income towns often simply prescribe whatever antidepressant is popular that day, based on the incentives that drug company salesmen pass out. When patients don’t respond well to a drug, the most common response is to simply up the dosage. When the patient experiences a major crisis as a result of having their symptoms ignored and over-medicated, they generally end up in an emergency room.

The profit factor is the major problem. The health insurance companies sit between the doctors and their patients, reaping a maximum of profit from every interchange. Rabid right-wing pundits screech about the evils of “socialized medicine”, but they never breathe a word about the evils – and real loss to society, even in a financial sense – of millions of children who never get to see a doctor.

Our system is the most expensive in the world, and yet millions of Americans get some of the worse care in the world. As it stands, health insurance companies (or the vast majority of them) are parasites. They’re making incredibly profits while millions go without even the most minimal care.

The only sane response would be to put a government-run single-payer system in place. This will not happen any time soon, however. That’s mainly because our utterly corrupt Congress is largely in the pocket of the lobbyist industry, and the health insurance companies have plenty of lobbyists.

That said, there are strong signs that the US health care system as it is simply cannot endure much longer. The inefficiencies and failure to treat millions of citizens, along with soaring costs, are contributing to the breakdown of the US economy. It may not happen until after the economy collapses, but at some point the US will have to follow the lead of every other industrialized country and go with a single-payer system.

jrpowell's avatar

I am 30 years old, and only one of my employers has ever offered insurance. I don’t have it.

The system is broken.

edit :: I looked into paying for it but it turned into a food vs. insurance thing. We went with food.

xxporkxsodaxx's avatar

It sucks compared to France.

xxporkxsodaxx's avatar

Might I also mention that a few 3rd world countries have better healthcare than the US.

Lovelocke's avatar

@Pork – Like Canada.

Health care’s a tricky issue, but the basic point is, most people don’t have it, and with the economy looking how it does today, even fewer people can afford it. On the county level (It goes State, then County, then City) there are county hospitals that exist on tax payer cash: As long as you have some kind of job, you can “buy into” a co-pay card with that particular hospital, but that doesn’t entitle you to any special treatment. Basically as long as you have legal documents (birth certificate, social security card, bills with your address on them, and paychecks for X weeks back) you can get a card every three months that’s good to help out with things like X-Rays, Medicine, Doctor visits and so on. It’s “like” having insurance, in that they’ll help out more than if you didn’t have it, but they’re not as good as having actual health insurance.

Being able to pay into a healthcare plan allows you to call up a doctor because you have some pain in your left butt cheek from sitting on the internet all day, schedule an appointment at your convenience, where you go in, have a cup of coffee and read a magazine while the doctor gets the room at an appropriate temperature to have you in. If your butt cheek hurts and you decide you need valium and hydrocodone to solve it, then the doctor will be happy to write you a script for 12 month supplies of the highest dosage possible, plus a $50 spot on location.

Some plans? They’ll actually GIVE you cash for losing a finger, or a limb or something. The county hospital’s co-pay plan? It makes it easier to pay the doctor for the time he wasted hacking off your leg with a serrated steak knife, plus the disposal fee (aka: Closing up the bag and throwing it in the dumpster outback labeled “Biohazard”).

hearkat's avatar

From both working in the health care system and having been without insurance as a single mother, I can honestly say that the Insurance Companies are primarily to blame.

wundayatta's avatar

Americans’ love of “competition” means we will do anything to make us feel like we haven’t broken our values. In health care, this means that we guarantee a profit to the health insurers in the name of competition. We allow the health insurers to “compete” over who gets to insure the healthy people, while we insure the unhealthy people using public funds.

We have two public programs for the unhealthy people: Medicaid, which insures the poor; and Medicare, which insures the elderly. No one would insure these populations if they had to purchase insurance privately, since the cost of that insurance would be prohibitive for all but the most wealthy. It goes without saying that the poor are not wealthy. It turns out, as well, that the elderly are overrepresented amongst the poor.

Having any private insurance market at all would be impossible if we, the people, didn’t guarantee to private insurers that they don’t have to insure people they can’t make money on. So, this country has perpetrated an enormous fraud upon Americans. We have played their love of compeition, and fooled them so they will accept fake compeition,. We essentially subsidize the health insurers profits, by making sure they don’t have to deal with people that might hurt their profitability. If they can’t make money insuring healthy people, they have to be idiots. We, the people, guarantee them a profit.

The most efficient way to run an insurance system where everyone gets the product, whether they can pay for it or not, is to put everyone in the same insurance pool. This way the risk is spread out over the largest group, instead of artificially segmenting it into the expensive health care users group, which the public pays for, and the less expensive health care users group, which the health insurers get to fight over. As Peter said, a single payer system is the way to go. It is most efficient, and fair. There’s a reason why so many other nations in the world use it. Americans are blinded by ideals, and we end up shooting ourselves in our feet, as a result.

xxporkxsodaxx's avatar

@Lovelocke, Canada is considered a 3rd world country, well as of this neat color coated map of the world from the cold war. But a few 3 world countries that are in front of us are Oman, Cyprus, Saudi Arabia, The UAE, Chile, Costa Rica, and Dominica. I might have missed one or two but we are also only two notches up from Cuba, but they’re a 2nd world country as of the cold war, they might be 3rd now.

kevbo's avatar

@syz and GA’er- thanks!

jholler's avatar

simple solution…outlaw health insurance. Without insurance companies willing to pay doctors insane amounts, said doctors soon would not be able to charge insane amounts, because nobody would pay them out of pocket. Simple result, hospitals must charge less for the same services in order to be able to collect any payment, since it would be me and you paying instead of some huge corporation. (blood from a turnip?)
Bonus: more people become physicians because they want to do good, rather than because they want to be wealthy….possibly an even better class of healers.

xxporkxsodaxx's avatar

Of course, outlawing it!...NOT, health insurance companies try to do everything they can NOT to pay for the operations, they want to keep the money, not spend it.

jholler's avatar

but when they DO pay, it’s a he’ll of a lot more than I would be willing to pay. Ever had a doctor bill you, then just write off whatever the insurance won’t pay? Think they’d do that for you or me?

jholler's avatar

stupid autocorrect.

augustlan's avatar

Jholler: You are misinformed…health insurance companies pay a far lower amount to docs, hospitals, labs than private payors do. Prices have gone up for a variety of reasons, but let’s not forget the “sue ‘em” mentality of most Americans. Malpractice insurance rates that docs pay have gone through the roof, forcing some docs out of state (Maryland)...due to the huge awards juries give.

augustlan's avatar

Also, they have to write off what the insurance and your copay or deductible doesn’t cover, because the insurance companies require them to…they must accept that as full payment, or they cannot accept patients with that insurance.

xxporkxsodaxx's avatar

I’m talking more than you’d imagine, like if you were working on something and cut your fingers off with a bandsaw, if you want to get them reattached and your job could depend on it, insurance will weasel their way out of it somehow, even if you pay for full coverage they might say something about the location wasn’t covered on the plan so you end up losing your fingers and your job.

wundayatta's avatar

@augustian: I’ve heard a lot of people blame malpractice for health care spending increases over the years, but I’ve never seen any proof of it’s impact. It can drive docs out of state, I suppose, when they find their malpractice insurance premiums to be too high, but who is to say that isn’t exactly the result we want? Do we want negligent docs to continue providing care to folks?

augustlan's avatar

@daloon: Good point…but my state lost almost all of it’s midwives in one fell swoop, due to an astronomical premium increase. I don’t think most of them had a reputation of negligence, and they were such a valuable resource in our community. I was sad to see them go.

dsjhfsg's avatar


Your statement that “the basic point is, most people don’t have it” is completely false.

Only about 15% of the US doesn’t have health insurance, and that number probably includes both 1) illegal aliens who couldn’t get it anyway, and 2) wealthy and/or self-employed people who do not want it.

Many people who can’t afford insurance, or do not “qualify” due to existing conditions, have state or local government assistance.

The problem is that SOME people who can’t get insurance are also not able to get government assistance. Only relatively minor tuning is needed for US healthcare which is working otherwise. Democrats, and sadly some republicans, are wanting to trash an entire industry that serves 85% of the population and replace it with a government agency.

wundayatta's avatar

There are 45 million uninsured in the US. They aren’t all illegal aliens or wealthy people. Or else, those populations are a whole lot larger than any census ever showed. It also isn’t true they are eligible for state programs.

By far, most of the uninsured work in low wage jobs, that earn them enough money so they aren’t eligible for government benefits, but are working for companies that can’t afford to offer health insurance, even if they wanted to.

dsjhfsg's avatar

I didn’t say “all”, I said it “includes”. Argue with yourself all you want, but leave me out of it.

wundayatta's avatar

Sorry, dsjhfsq, but while you certainly did say “includes,” you did it in a way that was quite intellectually dishonest. Rhetorically, you made a statement that made it seem as if an element of the uninsured that probably make up less than one percent of the unisured, really accounted for almost all of them.

You were playing on people’s prejudices against undocumented aliens. So I felt it important to clear up any misimpressions people may have gotten from your sleazy argumentative techniques. If you don’t play intellectually dishonest tricks, I won’t call you on it.

Another thing. If you can’t handle it when people point out your errors in logic, you always have the option of not posting anything. In the future, however, I’d appreciated it if you didn’t tell me what to do. I’m perfectly capable of guiding myself. Well. Mostly. But I’m not taking any advice from you.

dsjhfsg's avatar

How you inferred “less than one percent” as the inverse of “includes,” I have no idea. But however you did it, the event occurred inside your head.

What “prejudices?” If someone is here illegally and without documentation, I can’t imagine how they will end up enrolled in government health insurance, nor do I see how that should be a goal. That’s not a “prejudice”, it seems like an almost certain fact.

And if you are still confused, 45 million is 15% of 300 million. Something less than 15% of US citizens both want and lack health insurance, which is very different from Lovelocke’s statement that “most people don’t have it”.

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Idear's avatar

I am an American citizen, but couldn’t afford healthcare. Now that I live in Europe, all of my health-care needs are provided for. While I lived in America, the best way for me to deal with my health problems was to add a yoga routine. Sometimes, even the yoga music can be soothing and helpful.

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