In Answer To George…

George, from “George Says”, who is one of the very few true English gentlemen left in Great Britain today, made a comment on the last post asking for clarification of the term, ‘co-pay’, as it relates to medical insurance, so for the sake of all Her Britannic Majesty’s citizenry, who have the advantage of socialized medicine at no cost other than a paltry prescription charge (though none of this will last much longer!), allow me to explain the workings of the capitalist system as it applies to the average US citizen:

Medical insurance is now compulsory, since the advent of what’s commonly called ‘Obamacare’. But just like car or home insurance the vultures demand their pound of flesh in the form of co-pays. In some way it’s similar to the ‘excess’ you agree to pay up front if your house burns down, or your car is wrecked. However, that’s a gross over-simplification because, rest assured, nothing about US capitalist medicine is ever remotely simple.

One obvious difference is that the insured doesn’t have a choice when it comes to the amount of his co-pay. The insurance company sets the amount. Because my wife worked for the federal government for thirty years we have what is considered one of the best medical insurances available. It costs around $1,450 (975 GBP) a month, but the federal government pays 60% of that.

Beginning January 1st each year, we pay the whole of any medical costs incurred, up to $750. Once that threshold is reached the insurance company will usually pay 90% of any future costs that year. The remaining 10% is down to us. Hence, when I had my artery stent fitted, the bill came to about $32,000. We had to find a co-pay of $3,200 out of our own pockets. However, for some lesser costing items, such as doctor’s visits, the co-pay increases. A fifteen minute appointment with a family doctor (GP) costs $120, of which the co-pay is $20 and the insurance covers the rest.

And remember, this is one of the best insurance plans in the nation. Many don’t cover half as much, and demand greater financial input from the insured, making many medical procedures way too expensive for ordinary folk to even consider.

It may appear that $32,000 (20,000 GBP) for an artery stent is quite expensive. If we’d not had insurance our bill for that procedure would have been over $50,000 (33,000 GBP). Why? Because the insurance companies have this nice little arrangement with the hospitals whereby said company sets the price it will pay for any procedure, from a heart transplant to a doctor’s visit, and the hospital/doctor agrees to abide by that. It means that by paying huge insurance premiums you get a cheaper hospital/doctor rate, well – in reality, the insurance company does.

For many years, a vast number of Americans couldn’t afford health insurance. Traditionally, it’s always been part of a ‘package’ offered to employees by their employers. So, ‘out of work’ meant no health insurance. The lowest paid jobs (Wal-Mart, McDonalds, etc) usually offer medical plans, but often they’re too expensive and don’t cover part-time workers. Small businesses often can’t afford the premiums for their workers.

Wal-Mart, hardly a ‘small business’, just announced it’s scrapping its healthcare plans for 30,000 part time workers, and raising the premiums for other employees. The reason given: the additional cost of meeting the provisions of Obamacare. The company estimates it’s healthcare costs for 2015, without these cuts, would have increased by $500 million. Obviously, with over $100 billion in the bank (after all costs/expenses have been deducted) they can’t possibly afford this.[1]

One of the quickest routes to bankruptcy (and the one most often taken in the US) is to become ill. Without insurance, my artery stent would probably have bankrupted us. We’d have had to sell our house, or at best, take out a massive loan against the property to pay the hospital.

Has Obamacare changed all that? No. It’s helped, but thanks to enormous opposition to the bill from Congress, and amazingly from the public at large, it was watered down to such a degree as to be even less than a token effort to provide affordable healthcare for all in America.

But rest assured, if David Cameron and Jeremy Hunt get their way, you Brits will be enjoying the same wondrous world of capitalist medicine as do your cousins across the pond.

I hope that clarified the situation for you, George?

[1] “Wal-Mart to End Health Insurance for Some Part-Time Employees” WSJ, October 7th 2014

2 Replies to “In Answer To George…”

  1. Thanks RJ.

    It sort of clarifies…although it’s a bit early in the morning for me to get my head around all that!

    Didn’t know you’d had a stent fitted. Hope all is now well.

    A friend of mine had a heart attack a couple of weeks ago and was rushed into hospital. She tells me she had two stents fitted.
    I have no idea what it cost and, so far as I know, neither has she.

    So perhaps our NHS (with all its faults) aint so bad.

    ‘English gentleman’ ? Now you’re making me blush!

  2. George – how many times have I told you not to read Sparrow Chat at the breakfast table? You know you always get it covered in egg yoke.

    I had the stent fitted in 2008. I used to walk a mile and a half every morning before driving the school bus, but this one morning the weather was too bad so I put it off until after my morning shift. I’d always considered myself fairly fit, but by the time I got to the end of the road I was doubled up in pain and had trouble breathing. Being the stubborn old sod that I am I wasn’t going to let it stop me so I continued and finished my walk. The pain had eased somewhat, but I emailed my wife at her work and told her about it. She drove home at once and took me to the emergency room (A&E). I later learned one of my main cardiac arteries was almost 100% blocked. The cardiologist told me I’d had a massive angina attack and if I hadn’t come in when I did I would almost certainly have had a fatal heart attack within three weeks. It was a wake up call for me, and since then I’ve exercised regularly and eaten more wisely (no more McDonalds!). I’m fine now. Had a check up in April and the cardiologist is happy not to see me again for two years.
    Believe me, the NHS isn’t half bad. Unfortunately, Cameron and Co are doing their damnedest to make it as bad as possible so they can privatize it.
    If you find the US system difficult to comprehend then join the club. There are 300,000,000 Americans who can’t comprehend its intricacies either.
    PS Always considered you a true gent, George.

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