Is the American healthcare system really so broken?

Okay; something has to be done about the uninsured people who make too much to be on Medicaid but can't afford insurance premiums. Granted. I'm on record advocating that Medicaid or Medicare be expanded to cover these people (with affordable premiums, of course).

That having been said, I have a run-of-the-mill health insurance policy- certainly nothing special; and my premiums, while costly, are not Earth shattering.

On Sunday, I was at a small family party and speaking to my wife's uncle, who happens to be a doctor. I told him about the fact that annoying respiratory infections have been bothering me on and off all winter. So, he tells me I should get some blood work to rule out allergies and he wants me to get some sinus and chest x-rays. He asked me for my fax number.

Yesterday at 11:30 AM, he faxed me a series of 3 prescriptions for blood work and two x-rays. Now, keep in mind that yesterday was a federal holiday in the US (President's Day), when you would expect many non-vital medical offices to be closed.

With a few clicks and a phone call, I set up appointments to get the x-rays and blood work done. I left my office at 2:50. By 4:15, I had the x-rays done and the blood samples taken. It could have been earlier if I'd had wanted it so. I chose that time of day. Of the 1:25 between the time I left the office and the time I left the imaging center, about 15 minutes were lost based on wrong turns because I was relying on my itouch as a navigation system to get from the blood drawing center to the imaging center and I wandered in and out of hot spots.

The results for both will be reported to my doctor later in the week.

My total time spent in both waiting rooms was about 10 minutes; maybe 15 tops.

Yes, the day cost me a few bucks in co-pays; but nothing major, I assure you.

This is not meant as a challenge. I'll believe what you tell me. But, would I have gotten the same level of service under the NHS or in Canada?

We spend so much time moaning about the healthcare system, maybe we never stop and think that things could be worse than they are; and that maybe things really aren't that bad after all.

Originally posted by sh76
Okay; something has to be done about the uninsured people who make too much to be on Medicaid but can't afford insurance premiums. Granted. I'm on record advocating that Medicaid or Medicare be expanded to cover these people (with affordable premiums, of course).

That having been said, I have a run-of-the-mill health insurance policy- certainly nothing speci ...[text shortened]... ngs could be worse than they are; and that maybe things really aren't that bad after all.

What would happen if for some reason, you found your coverage was no longer adequate, or became too expensive, or was no longer available? Would you personally be able to get good coverage elsewhere?

If you have personal connections you get good healthcare. If you don't, you're screwed. That's the way it works for my in-laws in Serbia - if we call our friends for connections we get good medicine for them. If we don't and they just "walk in", they get screwed. I guess American medicine is already beginning to compare to Obama's dream of socialized medicine.

In the states I'm already beginning to find that if you have a doctor who has a personal connection with you and is willing to stand up to the insurance companies and make a case for getting you tests, you'll get it. But most doctors will bow to the insurance companies on a daily basis and not fight for the healthcare you need.

Originally posted by Melanerpes
What would happen if for some reason, you found your coverage was no longer adequate, or became too expensive, or was no longer available? Would you personally be able to get good coverage elsewhere?

But why would that happen though?

New York does not allow an insurance company to refuse to take an insured because of a pre-existing condition and it certainly cannot drop someone because of an illness.

I concede that there's a problem in the gap between the people eligible for Medicaid/ CHIP and similar programs and people who can pay the premiums.

But for the rest of us, what's the problem?

Originally posted by Melanerpes
What would happen if for some reason, you found your coverage was no longer adequate, or became too expensive, or was no longer available? Would you personally be able to get good coverage elsewhere?

For what its worth, a sibling of mine went to a private clinic for what turned out to be pnuemonia (sp?).
No insurance. He gave them 100 bucks upfront. He was diagnosed and given treatment. The bill came to an additional $180. The doctor told the lady at the window he was out of work,no insurance and to put him at level "such and such"
100 bucks is knocked off,and he got billed for the remaining 80 a couple of weeks later.

Originally posted by joneschr
If you have personal connections you get good healthcare. If you don't, you're screwed. That's the way it works for my in-laws in Serbia - if we call our friends for connections we get good medicine for them. If we don't and they just "walk in", they get screwed. I guess American medicine is already beginning to compare to Obama's dream of socialized m ...[text shortened]... to the insurance companies on a daily basis and not fight for the healthcare you need.

I'm not sure if you meant my uncle being a "personal connection." But that had nothing to do with it. My GP could have given me the exact same prescription (for another small co-pay, of course). It's now 1:30 PM. I guarantee you I could see my GP this afternoon if I wanted to.

You can get private insurance here for $100 per month (actually $200, government pays half the bill). It covers anything life-threatening. If you're poor, it's basically free (unless you want additional insurance like dental care or physiotherapy). Insurance companies are forced to accept anyone, and they use a risk pooling system so that it makes sense for them to insure people with poor health. The chronically ill are insured through a Medicare-style government programme.

The problem with US health care is not so much that it's bad (if you have good coverage), it's just that's it's so horribly inefficient and wasteful. If it wasn't so extremely inefficient, then most poor people would be able to afford it too.

Originally posted by sh76
But why would that happen though?

New York does not allow an insurance company to refuse to take an insured because of a pre-existing condition and it certainly cannot drop someone because of an illness.

I concede that there's a problem in the gap between the people eligible for Medicaid/ CHIP and similar programs and people who can pay the premiums.

But for the rest of us, what's the problem?

Maybe your insurance company goes out of business. Maybe it suddenly decides it doesn't want to cover the doctors you like. Maybe it decides to greatly raise premiums. Who knows - maybe the company just hires new management that just doesn't know how to properly run things. Do you have alternative options?

And while your insurer can't drop you because of a pre-existing condition, is there anything to prevent it from raising your premiums to absurd levels because of that condition?

Originally posted by sh76
I'm not sure if you meant my uncle being a "personal connection." But that had nothing to do with it. My GP could have given me the exact same prescription (for another small co-pay, of course). It's now 1:30 PM. I guarantee you I could see my GP this afternoon if I wanted to.

he probably doesn't get much work from all those sturdy New Englanders walking daily up and down the snowy hills.

Originally posted by Melanerpes
Maybe your insurance company goes out of business. Maybe it suddenly decides it doesn't want to cover the doctors you like. Maybe it decides to greatly raise premiums. Who knows - maybe the company just hires new management that just doesn't know how to properly run things. Do you have alternative options?

And while your insurer can't drop you because ...[text shortened]... anything to prevent it from raising your premiums to absurd levels because of that condition?

Maybe your insurance company goes out of business.

Then I'll pick one of its 7 competitors.

Maybe it suddenly decides it doesn't want to cover the doctors you like.

Unlikely. But if it does, I'll either pick a new doctor or a new insurer.

Maybe it decides to greatly raise premiums. Who knows - maybe the company just hires new management that just doesn't know how to properly run things. Do you have alternative options?

Yes

And while your insurer can't drop you because of a pre-existing condition, is there anything to prevent it from raising your premiums to absurd levels because of that condition?

Yes. Under NY law, you can't charge higher premiums because of a pre-existing condition either (pretty stupid law, huh?) The rates are pretty much the same for everyone in your class, whether you're a ripped health nut with a 20 BMI or have lung cancer.

Originally posted by sh76
[b]Maybe your insurance company goes out of business.

Then I'll pick one of its 7 competitors.

Maybe it suddenly decides it doesn't want to cover the doctors you like.

Unlikely. But if it does, I'll either pick a new doctor or a new insurer.

Maybe it decides to greatly raise premiums. Who knows - maybe the company just hires new manag yone in your class, whether you're a ripped health nut with a 20 BMI or have lung cancer.

[/b]You have 7 competitors. That might be a reason why you like your situation. All the insurance companies know they can't afford to screw people. All it takes is one horror story to get out and it's curtains for your market share. I think a lot of the problems arise in markets where this kind of competition doesn't exist.

It's interesting that under the rules, your insurance company is able to cover every sick person that seeks coverage and can still charge premiums that are extremely reasonable for everyone. How does it do it? Maybe the answer really is just making sure that every insurance market has at least 7 competitors?

Originally posted by Melanerpes
You have 7 competitors. That might be a reason why you like your situation. All the insurance companies know they can't afford to screw people. All it takes is one horror story to get out and it's curtains for your market share. I think a lot of the problems arise in markets where this kind of competition doesn't exist.

It's interesting that under ...[text shortened]... he answer really is just making sure that every insurance market has at least 7 competitors?[/b]

More likely the answer is forcing insurers to accept anyone.

Originally posted by KazetNagorra
More likely the answer is forcing insurers to accept anyone.

The problem when insurers have to accept anyone, is that if they end up with too many chronically sick people in the pool, the only way to make a profit is to charge premiums that are so high that the healthy people will flee. But if too many healthy people flee, the insurer has to charge even HIGHER premiums -- or else they have to greatly restrict the amount of coverage everyone actually gets.

The trick is finding a way to keep premiums low enough to keep most of the healthy people in the pool, while keeping benefits high enough to allow all the sick people to get the care they need.

Originally posted by sh76
[/b]Maybe your insurance company goes out of business.

Then I'll pick one of its 7 competitors.

Maybe it suddenly decides it doesn't want to cover the doctors you like.

Unlikely. But if it does, I'll either pick a new doctor or a new insurer.

Maybe it decides to greatly raise premiums. Who knows - maybe the company just hires new manag yone in your class, whether you're a ripped health nut with a 20 BMI or have lung cancer.

Being in the NYC MSA distorts your perception of the competitiveness of the health insurance market. Of course, there's going to be more competition in the largest population and financial/insurance center in the nation. But for the counry as a whole there's little competitiveness in the health insurance industry. According to a study by the AMA in 2007, two companies control 36% of the national market for commercial health insurance (and are trying to obtain more by buying out smaller companies) and:

In the combined HMO/PPO product market, 96 percent
(299) of the MSAs are highly concentrated (HHI>1,800),
applying the 1997 Merger Guidelines.

http://www.ama-assn.org/ama1/pub/upload/mm/368/compstudy_52006.pdf

Certainly this is a factor in why average insurance premiums for both single and family coverage have more than doubled in the last 10 years. http://www.ncsl.org/IssuesResearch/Health/HealthInsurancePremiumsNCSL/tabid/14514/Default.aspx

Will you be as content with your coverage in 10 years when its price doubles?

Originally posted by no1marauder
Being in the NYC MSA distorts your perception of the competitiveness of the health insurance market. Of course, there's going to be more competition in the largest population and financial/insurance center in the nation. But for the counry as a whole there's little competitiveness in the health insurance industry. According to a study by the AMA in 2007, ...[text shortened]...
Will you be as content with your coverage in 10 years when its price doubles?

Fair point. I'm using anecdotal evidence too much, perhaps.

However, given that my experience is probably shared by many people across the country, I can see why people are reluctant to change to the unknown when most people probably don't feel like their system is broken.