A European asks: Just how do you get health care in the US? Read the answer....

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A European asks: Just how do you get health care in the US? Read the answer....

A European moving to the United States asks what he needs to do to make the move easy. This reply outlines the decisions he will have to make with health care. Incredulous Europeans reply in the link below.
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You'll need an American to help you with the health insurance. There is no such thing as "standard" insurance. Even if you get it from your employer, there will be a bewildering array of choices involving PPO, HMO, MSA, deductibles, HSA, HRA and FSA. There will be multiple variations such as PPO 1500, PPO 3500 and PPO 5000 while some can be combined such as HSA with HDHP, not to mention endless variations on copays and in-network vs out of network. Then there will be fine print on what prescriptions are covered, generics vs non-generics etc.

If you are working for a large employer you will just pick one and be done. If you have to get one for yourself then you will have to fill out a massive long form. For example several years ago when I had to get individual coverage one required me to list every single medical thing in the last 10 years. The other was happy with two, but also wanted a complete copy of all my medical records.

Note that they don't care about the accuracy of the information nor is it checked. Instead if something happens to your further down the road (eg you get cancer) they'll find one tiny detail wrong, refund your premiums and leave you on your own. Of course at that point no one will give you insurance so you'll be screwed.

The health "insurance" is not actually insurance. It is a way to obscure how much things costs. For a laugh ask up front at a medical place how much something would cost - they will be unable to give you a straight answer. Additionally when you do get bills they will baffle you as they'll include lots of numbers such as how much was "billed", negotiated rates, amounts actually paid, write downs and other numbers from who knows where. And you won't get one bill. You'll get one for the doctor, one for the facility, one for the medications etc.

In general the higher the monthly premiums the more obfuscated everything will be.

If you are young and in good health then what I recommend is a high deductible plan (lower premiums) together with an HSA (health saving account). You can put before tax money into the HSA (this year the limit is $3,050). The high deductible plan will typically not pay anything until you have spent the deductible for the year (mine is $3,500) after which they pay 100%. You can use your HSA for any medical expenses including dental, glasses/contact lenses etc. And if something catastrophic happens at least you'll know what the worst case will be.

I'd also strongly recommend joining Costco - $50 per year. They have good quality stuff for good prices.

Also get your prescriptions etc there as their prices are very good. Most places are desperate for prescriptions as most people only pay the first $5-$15 or so and insurance is bilked for the rest.

In response to a further question he replies
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For children they are usually covered by the individual state, rather than from the federal government. Each state has its own rules as to what they cover and the federal government usually provides some of the funding. In some cases individual cities may also have some sort of coverage too. Of course in these bad economic times everyone is cutting back.

The states have far more control than you'd realise. For example individual states issue drivers licenses - there is no "USA" driving license. If you move states then you have to get another one from the state you move to. Same story about the police. Even commerce rules. Banks used to be per state until not too long ago. Even the health insurance companies are often per state.

The funny thing about all the healthcare "debate" is that the government already provides close to half of all healthcare anyway. There are three major schemes - medicaid for very poor people, medicare for those over 65, veterans, but many others such as schemes for federal employees, military service members and their families, state employees, prisoners etc.

So if you do manage to get your kid treated, they will still be screwed once they become an adult as no insurance company would cover them.

You never "need" insurance. You can always go to an emergency room and they have to treat you. Of course this is the most complicated and least effective way of dealing with healthcare, but that is the US for you.

Then begins the fun bit. If you have insurance, the amount that gets paid is low. If you do not have insurance the medical practise will then charge you a lot more. ie those least able to pay are charged the most, and they don't charge everyone the same. There are several reasons for this. One is that they don't expect the uninsured to pay. Another is no law stopping them from doing this. Another is that states will often compensate medical practises for their losses. By making these be as high as possible, the medical practise tries to get more from the compensation pool than others as they are often distributed proportionally. Of course anyone who is uninsured and does try to pay has a strong chance of going bankrupt.

For the unemployed things are even worse. If you have an employer provided health plan then you can continue to pay for it for 18 months under a scheme known as COBRA but most can't afford it - they are unemployed and have zero income!

As an example, lets say that your monthly wage is $2,000. Your employer provides health insurance. What would typically happen is that the premium is split between you. So for example you may be paying $200 per month of the premium and the employer pays $300 per month. To you it looks like health care is 10% of your wages ($200 out of $2,000). When you become unemployed you can continue that coverage, but paying all of it - $500. Of course if $200 was a burden while being employed, $500 is even worse with no income! (Unemployment is up to each state, again with federal contributions. Benefits usually can't be claimed for up to the first month and run out after six months. They are often a similar amount to how much a family would have to pay for health insurance premiums - ie not covering food, housing, utilities etc).

Taking a step back, there are several downright awful undercurrents floating through the US. In general if things happen they must be your fault, and it is your problem. This explains the health side of things and the strong passions - no one wants to pay for anyone else, right up until the point they get sick. The worse off in society (prisoners, homeless, unemployed) are treated really badly - again because it is their fault. Even the whole abortion thing - you chose to be promiscuous and have sex, so assume the consequences.

Not everyone is like this of course, but enough that that is the ways things are slanted. Fixing them is "socialism". It means you would be paying for other people and stuff that happened to them, even though it is their fault.

Read the rest, including comments from others on the link http://www.reddit.com/r/Ask...

Original thread http://www.reddit.com/r/Ask...
By netchicken: posted on 28-2-2010

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