Monday, July 2, 2018

Opinion : The Healthcare System of the United States

Whenever I talk about health policy especially as we try to reform it here in the United States I get a lot of requests to talk about how exactly health care works in different countries lots of countries it's not that I don't think those are great questions I do it's that summarizing a healthcare system in just a few minutes isn't easy but we don't shirk from difficult tasks here and so we're going to start tackling countries one by one starting with the United States here on healthcare triage the United States healthcare system is similar to that of many other countries and that it's a mixture of both private and public components let's start with the easy stuff almost all care is provided for by the private sector although some hospitals are run by the government most are run by private organizations about 70% of hospitals are nonprofit leaving the rest in for-profit hands most physicians therefore also work for private organizations and are not employed by the public sector other components of the health care system are also in the private sector including pharmaceutical and medical device companies research is paid for by both public and private sources with a little bit more coming from the private side added together however US spending on medical research accounts for the vast

Majority of R&D; spending in the world but where countries differ the most is in how they give citizens access to their systems in this area the United States is somewhat of an anachronism until recently about 15% of people in the United States
were uninsured this meant that if they needed care they'd have to pay for it out of their own pocket and unless you've been living under a rock you should know that health care in the United States is really really expensive so that's a problem it means that a lot of people don't get the care they need and it means that we're failing a large number of people who live in the United States about 60% of US citizens get health insurance from their employer these plans usually don't charge people different amounts based upon factors such as age gender or past medical history they range of benefits but for the most part they cover preventive care care if he gets sick and prescription drugs plans vary in terms of how much people have to pay out-of-pocket for them but we already did a video on how private insurance works and you really should have watched that already about 15% of americans are covered Medicare and most of them are elderly people Medicare is a national social insurance program run and administered by the federal government

It's the closest thing we have to what most people refer to as a single-payer system where all people are covered by one type of insurance but Medicare is pretty complicated first there's Medicare Part A which covers you if you're hospitalized it's pretty much free to most people over the age of 65 and almost no one doesn't get it Medicare Part B covers outpatient services and is sometimes deferred by people who are still getting insurance from their jobs it is a pretty low deductible and then has coinsurance of 20% it covers tons of stuff including pretty much all tests or procedures you might get outside the hospital as well as lots of medical equipment that you might use there are private supplemental Medigap policies that are offered by private companies that often cover the co-pays or coinsurance or add in extra benefits almost everyone buys one of these two so that elderly individuals wind up paying much less for their health care than you'd expect Medicare Part C or Medicare Advantage is an opportunity for private companies to offer Medicare like benefits better than the government can if they do and they do it for less money

They get to keep the extra in profit Medicare beneficiaries can opt in to Medicare Advantage plans instead of traditional Medicare they sometimes have different benefits that appeal to them and about a quarter of them choose such a plan now Medicare Part D contains the prescription drug plans they're actually designed and run by private insurance companies but they're approved and paid for by the federal government individual Medicare beneficiaries pick the Part D plan they like depending on what drugs they think they might need that's Medicare cost us about five hundred thirty six billion dollars last year the other big government program is Medicaid unlike Medicare Medicaid is a state-based program basically

It's supposed to provide health care coverage for the poorest among us there are some minimal federal guidelines that are set for Medicaid and then each state gets to implement it as it sees fit some states are more generous and some less so generally Medicaid is meant to cover those at the low end of the socio-economic spectrum the government defines poor this way while you look at that remember this amazing fact a single parent with a child who makes minimum wage earns more than the poverty level that's how low the line is regardless traditional Medicaid must cover kid under 6 years of age to 133 percent of the poverty line and kids 6 to 18 to a hundred percent of the poverty line the state children's health insurance plan RS chip ups this to about 300 percent of the poverty line in most states Medicaid also covers pregnant women up to 133 percent of the poverty line and parents the 1996 welfare levels

Finally it covers the elderly and those with disabilities who receive Supplemental Security income the first important thing to note is that adults without children aren't mentioned at all and in most states they can't get medicaid let me say that again in most states even the poorest adults without children even those who make nothing at all don't get medica and it gets worse those 1996 welfare levels can be super low so low that for instance in Arkansas couple with two children making three thousand eight hundred and twenty dollars a year is too rich for Medicaid granted some states are more generous but in many of them parents have to be very very poor in order to get medicaid the Medicaid expansion in the Affordable Care Act was supposed to fix this it was supposed to give Medicaid to everyone who makes less than 138 percent of the poverty line regardless of whether or not they have kids it would have finally made Medicaid the universal program for the poor 

That many already believe it to be but because of the Supreme Court decision that made the Medicaid expansion optional lots of states are refusing it leaving an additional 5 million people with low incomes with no insurance this year in 2009 Medicaid cover more than 60 million Americans about one in three children are covered by Medicaid and one in three births is covered by Medicaid a lot of Americans are in poverty in 2011 Medicaid cost us about four hundred fourteen billion dollars there's also the Veterans Health Administration which is totally a government-run system that provides care to veterans and TRICARE the military health insurance program that applies to some veterans military personnel and retirees and dependents TRICARE works more like private insurance think that sounds complicated it is interestingly while about two-thirds or so people get their insurance from private companies only about one third of spending comes from the private sector in other words the government has to cover about one-third of people in the United States but has to pay about two-thirds of the bill tell me again now the government isn't the short end of the stick the money involved in health care in the United States is simply unbelievable you may remember this video of John's which talks about how out of control our spending is go watch it again it's based in part in a series

I did on my blog and the link for that is in the video info section below I've also added a link to a series on quality in our system which is well not what you'd hope for given all that spending Obamacare will change some of what I said but not by much basically we hope to get some people who didn't get insurance with their jobs Medicaid or community rated guaranteed-issue insurance like employed people get with respect to the Affordable Care Act we're only talking about 30 million people or so we're about 10% of our population and for more info on that go watch our first episode so that's the US healthcare system is neaten packaged as I can make it in under 10 minutes it's private insurance for most Medicare and Medicaid for some and VA or TRICARE for a few how does this compare to other countries keep watching future episodes to find out