Health Care Reform in the US

[jessicasimpson]

I will go farther than that and say that I DO trust them to get it wrong. It's what they do best.

Why do you hate America?

[PeterGustafsson]

Hi!

Most health insurance is an absolute waste of money, and I do not want it to be mandatory.

Where I live, in New York, a modest health insurance plan for a family of 4 costs more than $2,000 per month.

SNIP

On the other hand, paying out of pocket for a doctor visit to a good Park Avenue doctor runs about $150.

For comparison, here are prices in my district of Sweden, an areas with about 1 million inhabitants:

Pediatric care(under 12 years), child+youth physicatry, child rehabiliation: Free

Health department visit
Visit at primary health care clinic, by patient designated as his 1st-choice unit: 120 kr
Visit at other PHCC: 200 kr
Visiting a nurse at a PHCC or hospital department: 0 kr
Other specialist doctor: 300 kr
Othe specialist doctor, after prior remittance by other doctor/nurse: 180 kr
Hospital visit, without doctor visit: 200 kr
Prenatal, postnatal, and toddler care: 0 kr
Health information by telephone 0 kr
Gynaecological health care checkup: 120 kr
Mammography: 120 kr

Acute care
Akut- och jourbesök
Visit at doctor, acute case: 300 kr
Acute visit at hospital: 300 kr
Visiting acute case reception (ER) after remittance by doctor at doctor´s acute case center: 0 kr

Missed time, or unbooking within 24 hours from the booked time, will be paid in full.

Misspellings and clunky translations are mine. Right now, the Swedish Krona stands at 0.147 USD. Some average monthly wages over here, for comparison:
Primary and jr. High school teacher: 24500 SEK/month
High school teacher 26300
Senior doctor: 55000
Engineer: 27 100

There are reasons it's so expensive -- healthy folks who never go to the doctor are lumped together with sick folks and hypochondriacs who go all the time -- insurance companies have to give you a policy even if you've already gotten an expensive-to-treat condition -- all kinds of stupid stuff like acupuncture and holistic crap has to be covered. So premiums do not reflect YOUR risk, they represent the risk of the expensive health-care users.
SNIP

In Sweden, all people get lumped together - strong body or healthy lifestyle do not give deductions. However, the prices of alcohol and tobacco are heavily taxed, in order to depress use. Since all citizens, and most other inhabitants, are enrolled in the national health care system at birth the issue of preexisting conditions is moot.

There is a law/national policy that all medical care must "be grounded in science and tried experience". This is a severe limitation on many nonscientific treatment modes. It is not a political decision on what should pass that hurdle, instead there is a subcommittee in the "The National Board of Health and Welfare", a FDA-like organization, but with a lot more medical stuff on its slate. The committee members are doctors and unelected career bureaucrats, and not much in the way of touchy-feely mush gets past them.

Once in a blue moon, some really costly users skew the system over here. I read an article about the medicine consumption in various local counties, and one small county was head and shoulders over the rest. In the article, it was stated that this was solely due to the fact that there was a family with an unusual heriditary disease there. With medication, they could live a full life, without, they would die. Those 4 people pulled up the average medicine cost for that 15,000-person county some 50%, IIRC. Treatment of them was not difficult, just extremely costly.

Health insurance would make sense if it only covered emergency needs -- you take care of the inexpensive doctor visits, but the insurance is there in case someone breaks a leg or gets in a car accident or gets cancer. But that's not how it works here. It's all or nothing.

Health insurance would make sense if your premiums reflected your own risk of ever needing to use it. Healthy people who exercise and don't smoke and only go to the doctor for their annual checkup should not have to pay as much as constant smokers or emergency room frequent fliers. But that's not how it works here.

Over here, individual health care users pay the costs listed above out of pocket until they have reached the maximum cost limit, that is that they have payed 900 SEK during the latest 365 days rolling. Anything over that, and the state pitches in. There are also separate maximum cost limits for dental treatment and medicine costs. By doing it this way, no one is bankrupted by medical costs, and those who only have relatively minor costs have to pay most of it themselves. The dreariness of sitting in a hospital waiting room is deterrent enough for most people.


Have a nice time!

Peter Gustafsson