John123456

A friend of mine had a private Lasic eye surgery in Australia, that was in 2003, she paid AUD 4K only, with all these pre and post surgery consultations.

John123456

so, even if you are retired at , say 65 yo, covered by Medicare, you still could be bankrupted if you don't buy additional insurance?
What's TriCare?
So, people, I suspect get around, what, $1500 on average as their retirement pension and they still need to buy some additional health insurance?

John123456

This is an interesting read:

America is subsidizing Europe's socialist medicine — with higher drug prices here

https://thehill.com/opinion/healthcare/529049-america-is-subsidizing-europes-socialist-medicine-with-higher-drug-prices

Nutmegger

Medicare isn’t free—the premium is deducted at source from social security. Then there is the medigap and drug coverage to buy.

Steerpike

Medicare is a complex subject; there's basic Medicare, there's part A, part B, part D, Medicare advantage, etc etc. You pay different premiums for different levels of coverage. It's way too detailed to explain here; this is an overview. Bottom line is, you can pay different premiums for different coverage levels, just like most other insurance. The key points are that Medicare is not free but it is MUCH cheaper than 'private' insurance that you have to get before 65, and generally offers better coverages. So I, for example, am counting the days when I only have to pay a few hundred in premiums rather than many hundreds in premiums. If you can't afford those premiums there are programs in place to assist you.

Anyone who has worked a sufficient number of years in the US gets a government pension called 'Social Security'. Unlike the UK govt. pension, which maxes out around 179 GBP / week (778 GBP/mo, 9,339 GBP/yr) for 'fully paid up' people, US Social Security pays out a variable amount (for those who've 'fully paid up') based on your earnings record, and your SS can be as high as $3,100/mo ($37,000 / yr) - more than double the UK pension (one of the few areas where the US is more generous in terms of 'benefits' I believe). But yes, as you said, the average SS payment in the US is about $1,500/mo. Now, 'many people' (I don't know the percentage) in the US don't rely on SS alone for their pension; there are numerous incentives to encourage people to save for their retirement (on top of SS) in the form of "IRA"s and "401Ks". In talking to my family in the UK, I have the impression that there is more reliance in the UK on the government pension (alone) than in the US.

In terms of how you can be bankrupted even with insurance - the reasons are complicated, but until the recent 'ACA' (affordable care act) most insurance had 'caps' on payments by the insurance company. For example, a policy may have a 'lifetime cap' of $1m. So if your care cost more than that, they would only pay $1m. This was a terrible practice, and was eliminated by the ACA. Similarly, insurance companies, pre-ACA, were allowed to 'exclude' a 'pre-existing condition'. So lets say you have diabetes when you apply for insurance; they could say they would cover you 'in general' but wouldn't cover anything related to your diabetes. This was also outlawed by the ACA. These two issues clearly demonstrate why the ACA was a big deal. Medicare never had these two features, though, so going bankrupt on medicare would be different. Long-term care is typically not covered by Medicare; so that's one way you could easily run out of money ... if you needed long term care.
Lasik is a simple, routine, surface treatment of the Cornea. What my g/f had was a repair of the retina, which is inside the eye and at the back ... basically they inserted multiple needles and micro-tools to work on the inside back of the eye ... AFTER draining all the fluid from the eye ... yuk!

civilservant

State Medicaid pays for long term care as long as you are eligible. It will require you to spend down your liquid resources to an extremely low level (not more than $2k here in GA) but it will not make you bankrupt because of needing LTC.

Medicare co-pays can be pretty large. $1450+ deductible on a hospital stay, plus up to $371 per day if you spend more than 60 days as an inpatient. Then Nursing Facility stays for rehab are $181.50 per day from says 21-100. You max out your rehab days and don't have supplemental insurance and you'll owe $14,520. Not astronomical by US healthcare standards, but enough to be a considerable strain on most retired peope.

robtuck

I am sure it is far more nuanced than a single article or my opinion can muster, but this could be spun another way - Europe's Healthcare systems ensure significant purchasing power for drugs, pushing down prices while the USA continues to structure like a local drug pusher system.

robin1234

Isn’t that one way Medicare Advantage is different from traditional Medicare. Medicare Advantage structures it’s coverage and copays differently, so you don’t end up paying the potentially high per diems for long hospital stays.

durham_lad

The USA's biggest single purchaser of drugs is Medicare and Congress made it illegal for Medicare to use its purchasing power to negotiate for low drug prices, throwing Big Pharma a huge piece of pork. Congress is trying to change that but it almost certainly won't happen this year by all accounts.

https://www.forbes.com/sites/johnwas...h=4c58b063302b

civilservant

In some cases yes. In reality they save themselves money by not issuing authorizations, or limiting authorizations, for care that would be covered longer under Medicare.

For example, a knee replacement under a UHC Medicare Advantage plan might only get approved for 16-20 days of rehab inpatient therapy. With traditional Medicare, as long as you are making progress they wlll continue to pay up to day 100.

Many MA plans (typically UHC and some Aetna) also carry the same copays as traditional Medicare.

That's one of the reasons I say avoid Medicare Advantage like the plague. You are asking an insurance company, with a profit motive, to administer your guaranteed benefits. They are ALWAYS going to be looking at their profit margin.

My staff frequently get the question 'why am I being discharged already? I don't feel like I'm safe to go home' and I hate when the answer we have to give is 'because your insurance won't pay for any longer' - Especially when it's an 80-somthing widower, living by herself, who has just had a hip replacement.

TexanScot

Whilst I don't want to defend the ridiculous prices that pharmaceutical companies charge, it's worth bearing in mind the astronomical cost of bringing even one new drug to market.

There's a hell of a lot of basic doctoral and post-doctoral research that's carried out at universities across the world before even one promising research compound goes forward for Phase 1 trials, and of the ones that do get that far then only a minority again are ever going to see the inside of a human body, let alone a full scale trial and eventual marketing authorization.

I'm not sure that drug companies need to be charging quite the astronomical sums that they do, but every new drug needs to cover not only it's own development costs but the entire pipeline of everything that came before yet failed to make it out of Phase 1.

The US (and the UK to an extent) is very good at funding basic research in universities using public money, but it's the private sector that typically invests the R&D money once a laboratory compound shows any sort of promise.

I've seen a lot of hot takes over the years where well-intentioned but naïve politicians state that the NHS should cut out Big Pharma and produce it's own drugs, without having any real concept of what goes into bringing a drug to market.

Steerpike

Thanks for that info; so in this latter situation - maxing out covered days - if you actually run out of money as a result, does 'State Medicaid' kick in for you also?

civilservant

Possibly, depending on eligibility.

In GA, you usually only auto qualify if you have income very low (sub-$1000) otherwise they look at resources and anything above $2000 in resources would make you inelligable as a single person.

Steerpike

Is there any meaningful measure of how many new drugs are introduced by US companies vs, say, EU or UK companies? That may offer a guide perhaps to the effectiveness of the process.

Of course, based on the relentless TV advertising here in the US, one could get the impression the US companies are churning out non-essential skin rash medication, ED medication, and such - profitable but not exactly medically essential stuff.

MidAtlantic

Yes, I continued to work. The health provider was as helpful as possible arranging my treatment usually late in the afternoon. Yes, it has gone but still monitored.

She missed work for several months, taking some time as sick leave, then unpaid leave during which she paid the full insurance cost (i.e. her employer's contribution as well as her own).

In my experience disability insurance is separate from health insurance and you get what you pay for.