Lion in Winter

The crucial difference betweeen the for-profit US system and the public-funded system used by pretty much every other developed country is that the weaknesses of our public-funded system, the NHS, are due to not having enough government involvement in terms of funding, organisation and delivery, not too much. At least I certainly can't see where this public/private hybrid that we have now is superior to the one I grew up with.

I also have direct personal experience of what it's like to live with the US system while being low-income and without an employer-provided group plan to buy into. Thankfully that stage is now past for me, but I haven't forgotten that this cannot be just a theoretical ideology-based discussion among the comfortably-off who are risking nothing. Real people are in trouble out there.

robin1234

If only big government would get out of the business of testing and approving new drugs. Distant Washington bureaucrats encroaching on our local freedoms. Why can't drugs be approved at county or town level? Surely it's the town drug administration who know what local needs & preferences are? In fact, in New York, this could happen at village level.

petitefrancaise

Big pharma would eat them for breakfast. I'd trust a government department with lots of people at least trying to do the right thing over big pharma anyday.

Giantaxe

+1

Rete

Fully agree and thanks for posting this.

morpeth

I lived in an area where quite a few people earned too much for Medicaid, but not enough to pay for medical insurance even in some cases when the employer offered. As a result seeing a doctor always had to be balanced against the cost as opposed to necessity. I wonder what the ultimate costs are of people refraining from seeing the doctor when they should.

mrken30

The ultimate cost of not seeking medical advice in the early stages is a lot of people used to end up in ER. I think that was one of the reasons for mandating "free" preventative care visits under the ACA.

petitefrancaise

Did you not find this happening in the UK? Certainly amongst the older patients who "don't want to bother the dr". One of the biggest things I noticed once I left the UK was that people went to the dr a lot more for things I probably wouldn't have done.

SanDiegogirl

Surprised that no-one has mentioned Medicare (the system for Senior Citizens)

That is controlled by the Government, funded by payroll Medicare charges throughout your working life and is single payer (Medicare)when you come to use it.

The majority of Seniors love their Medicare. You can go with Medicare basic, add a supplementary plan if you wish (and there are many to choose from), the charges for procedures are controlled and your deductibles are reasonable.

You need to add a prescription plan, but I found these to be very reasonable too.

Nutmegger

Yes, you make contributions throughout your working life and then keep on paying, via premiums, once you become eligible! Choosing the cheapest options, it's still going to run a couple of thousand dollars a year. My deductible is $3,500 p.a. My coverage comes from the government program and two different companies for "medigap" and drugs.

SanDiegogirl

Where does your deductible of $3,500 per annum come from?

Part B deductible is only $183 per annum; Part A (hospitalization) $1,316. Sure Medicare only pays 80% of costs but Advantage plans can eliminate those.

Nutmegger

My "medigap" policy. I have a high deductible F plan -- low premiums, high deductible.

Asg123

When I went on Medicare, I was surprised that there seemed to be no out of pocket maximum, whereas I had one at $10,000 before, so I assume that if I was sick and the bill was $200,000, I would have to pay 20% or $40,000. Is this right? So I paid over $100/month for an advantage plan, in addition to my part B premium, so I would have an out of pocket maximum of around $4,500. Is there any other (better) way of buying an out of pocket maximum?

robin1234

Yes, I believe you are correct. I think the reason is that traditional Medicare was set up a very long time ago, 1960s, before the modern type of insurance plan was developed and became standard. So traditional Medicare has some features that seem arse-backwards when compared to regular healthcare policies. For instance, I think if you exceed the maximum number of covered days in hospital in a year, you have to pay the whole bill for subsequent days in hospital. So there's no out of pocket max.

As you suggest, that's one of the rationales of advantage plans. They essentially take the money that Medicare has earmarked for you, including the Pt. B premium, and reallocate coverage into a more mainstream pattern, including an out of pocket maximum.

My advantage plan has no additional premium, though. All I pay is my Pt. B premium.

Asg123

I see. Thank you.