an insurance question for the Americans

Ugh, learning about healthcare in ANY country from Sicko is like getting recon from Baghdad Bob. There are far far better actual documentaries (like on 20/20) on healthcare done by actual newspeople.

Grukar, why do you not qualifiy for disability? Crohn's disease is now recognized as a true disability and if you are unable to work, you qualify for disability. You have paid into a system for all of your working years and should not feel like you are not worthy of it just because you are a younger person. I am also a younger person that was going to college and worked multiple jobs while supporting my wife and I before I got too sick to work. Sorry, I don't mean to hijack this thread but this pertains to the topic of insurance also. We all need to know what resources are there for us when we lose our insurance or occupation due to our disease. If your doctors have determined that you are too sick to work, then you need to apply for SSDI and medicare. In the meantime you may have to apply for medicaid to have some type of coverage until you are approved. Do not be turned put off if you are denied a couple times, this is all part of the process of weeding out those that are truly disabled. There are many people that try to game the disability system making it hard for us to get the financial and medical support that you need and deserve. Hang in there and feel free to message me anytime if you need some help with the process. None of us should ever have to be denied medical or financial care because we have a chronic disease that causes the cost of group rates or insurance rates to go up. We did not choose Crohn's disease, Crohn's disease chose us.

Disability through the government is actually Social Security. It is pretty much the same thing that you would receive if you were to retire and when you reach the age that you are eligible for retirement it automatically changes over for you. Basically Social Security Disability (SSDI) is medical retirement. I never wanted to go onto SSDI initially but I was under my longterm retirement through my employer and they determined that I would never be able to come back to work for them due to my Crohn's disease. They then hired a law firm to handle the whole process for me. I figured that because I was a 27 year old man that they would never approve me and they said that I had to apply inorder to maintain my longterm disability through them. They applied, I was turned down pretty quickly and then accepted the second time. I now collect the SSDI because I had worked long enough to earn enough credits to qualify for it and the long term insurance policy that I was under through my employer sends a second check to make up the difference of what I was make before. At first I felt very guilty like I did not deserve it, but all of my doctors told me I was more than qualified and had paid into the system my whole working life. I am so grateful I went through the process because now I do not have to worry about the uncertainty of finances and always of the option of having medicare if we were to lose my wife's insurance. This has taken a huge weight off of my shoulders and the eliminated stress has greatly improved my disease. If you are truly diagnosed with a firm diagnosis, have all of your doctor's support of your decision, and can not work, then there is no reason not to apply for the SSDI. There is a reason why it is taken out of each of your working paychecks your whole life and you deserve to use it if the time comes that you need it. The same goes with the medicare health insurance benefits. I never considered myself before to be truly disabled because I was not in a wheel chair and had full mental abilities.(in my opinion but my wife may have a difference of opinion here) I now understand and accept that our trial is just as hard as any other more socially acceptable disability but just not as easy to recognize. Our lives are just as much impacted as anyone else with major medical problems but just in different ways. We need not feel guilty for our conditions and become apologists to the many critics and skeptics that see our fight as weak.

Back to Ivy's original question: the way I understand it (and I could be wrong) is that during World War II, factories were only permitted to pay workers a fixed amount, and no more. In order to attract better/more workers, the only way to do so was with benefits- and health insurance was one of those. After the war ended, it just became one of those things associated as a benefit for the American worker.

Today, it seems as natural as anything else for an employee- health benefits. But it seems awkward when viewed in context; the American worker doesn't get home insurance through their employer. They usually don't get car insurance through their employer. Why is health insurance any different?

It's crept into the American subconsciousness that a job = health insurance, unless one can purchase it privately. I was fortunate in that I bought my own before I got ill. Being self-employed, that's a big help. Of course, if I were to drop it and try to find insurance elsewhere- lots of luck, pal. Nasty pre-existing condition? Good luck finding insurance.

ankylos, the answer to your question is that a healthy employee is a better investment for the employer. whether that works in the real world with folks free to smoke or not excercise, is a debate i don't want. i would like to amend, if i may, a bit of your excellent response. i was a union man and have a perspective that i feel needs to be aired. ivy, i'm not being acrimonious here (see ). if you could hear the inflection in my typing voice, you'd know.

those 'benefits' didn't just kinda happen. they were hard fought and negotiated benefits that are now disappearing along with, sadly, the death of unions. if we get into a discussion about why unions are dying, i'm afraid we'll lose the handle on the acrimony thing. i fear for the future work environment for my grandchildren. i'm afraid that some day they will read on a forum somewhere that it 'crept into the American consciousness that a job = vacation time, or = overtime, or = a minimum wage.'

GDEN, i don't believe michael moore presents his documentaries as a news reporter. he does, however, 'document' everything he puts out there for those interested or unbiased enough to look.

vv

Post Edited (vietvet) : 1/30/2010 10:35:16 PM (GMT-7)

Ivy do you guys have insurance for everyone like Canada and the UK do? Or how do your fellow countrymen obtain insurance. Just curious.

I think it's very easy to find "several" patients who've had good or bad experiences with any health care system, so the views of "several" people are probably not very representative.

Nanners, all citizens are entitled to free hospital care here -- see my earlier post somewhere in this thread.

I'm paying about $7,000/year  with a $1,000 deductible and then 20% of the bills until I've paid $10,000 then it pays 100%.

It pays nothing for office visits unless they were related to a recent surgery.  A scope  is considered a procedue so every time I have a scope it's a grand + 20%.

It pays nothing for drugs.

My last two hospitalizations cost about $400,000.  I don't have much more than that left of my lifetime benefit. 

Good questions. I've been told by people who've been treated in Britain that public clinics are divided into districts and residents are only allowed to go to the one they live in, like public schools in the US. As a result, how well equipped, funded, staffed, etc. a clinic depends largely on how wealthy its district is, like public schools in the US.

Hi Broomhilda,

1. Well, I'm not quite sure what "preferred physicians" means, so I'm guessing that doesn't happen here. I can see any gp I want. You can only see a specialist if you're referred to one by your gp or another specialist, and they tend to refer to someone they know and trust. I haven't had any problems yet.

2. Are you penalised for opting out? No, I don't think so. Actually, I think it probably costs more for people to go with private insurance, but that makes sense because they're choosing to pay for swankier treatment. Privately insured people, for instance, can choose to see any specialist they want (instead of the one they're referred to) but I think it's a Clayton's choice, really, as you tend to be referred to the most suitable doctor for your needs anyway.

It may well be that I've just been lucky, though, and that other Australians will come along with an alternative viewpoint.

3. Can they deny or reduce your coverage because you have a pre-existing condition?
I *think* this is illegal. We do, however, have to wait a certain time (two years, I think) before they'll provide coverage for treating a pre-existing condition. This isn't a huge problem, though, as the public system is free -- it's not as if you'll get no treatment, as a person could in the US.

4. What happens if a medication is not on the "subsidy list"?
That is a huge problem! I lost years of my life being extremely sick and out of medical options while waiting for Rem... and then Humira... to come on the subsidised list.

I must stress, though, that if a medication and / or treatment is on the subsidised list and you meet the federally-set criteria for treatment, you'll be given that treatment. No bureaucrat will knock a qualified person back, as would happen in the US. (I've heard about Americans being denied bone marrow transplants or proven but expensive life-saving treatments, just because the insurance companies want to save a bit of $)

5. What happens if you get sick and need care outside of your state or country?

Out of state? Not a problem. I can go to any public hospital I want. It can be hard to access gps in certain areas, just because there are doctor shortages in some places and they may have limited slots for new patients, but there are always hospitals to treat us.

Out of country? Australia has reciprocal arrangements with many countries - ie we'll treat their sick tourists for free if they treat ours. If I were going to a place like America, I'd have to take out private health insurance, or not go at all.


GDen, I don't know if British people are assigned to regional clinics, as you claim, but I can tell you that it *certainly* does NOT happen here. If I wanted to travel 200km or 1000km to see a gp, I could - nothing's stopping me, except time and travel costs .

Ivy.

While traveling through Spain in 2007, my daughter came down with a sinus infection. So we went to the pharmacy a few blocks away, where the pharmacist was authorized to prescribe AND fill the prescription for Zithromax. Total cost: US$30. Took less than an hour.

Back in the States, I had to first make an appointment to see a doctor - waited three days. Then drove to appointment and got the prescription (after two hours), then drove to pharmacy with prescription, then found out pharmacy was out of brand name, then drove to another pharmacy they were out of brand too. So called around, found pharmacy in yet another town, and waited 30 minutes for prescription to be filled. Total cost, aside from a wasted 1/2 day, gasoline, and delayed treatment: US$30 copay for doc, a little over US$40 for the medicine = total of $70+.

So even we in the US with health insurance can get stuck paying MORE than people in Spain for a (irony of ironies) med made by a US-based manufacturer.

I would've gone to one of the numerous clinics popping up staffed by nurse practitioners, like The Little Clinic. They take walk-ins, never seem busy, and the NP can prescribe drugs, which I can take right across the hall to the in-store pharmacy and get filled in about half an hour. TLC's cheap too--about the cost of a co-pay or a bit more. Unfortunately that drug isn't one of the $4 ones, but maybe a substitution is.

Rider Fan said...

vietvet said...

ivy, it's kind of like the 'stockholm syndrome'. we have been in an abusive relationship for so long that Americans have a heck of a time wrapping their minds around what you guys accept as normal and just. we've come to accept what we know, and fear what the rest of the world considers natural. not surprising since the insurance industry spends billions to create that fear. fear is a powerful weapon, and a fairly easy one to use.

I nominate for quote of the day! Well said.

Everything's all roses in Canada? How exactly has the insurance industry spent these "billions" to create this "fear"?