Health Care and your experiences

[gmbteach]

From discussions with Bilby, I gather this has been discussed ad nauseum before, however, I am curious about how you access health care.

Here in Australia, you can generally visit your General Practitioner (GP) for a nil out-of-pocket expense. The doctor will 'bulk-bill' Medicare - a.k.a the government, who foots the bill. Should you require further assistance, your doctor can then recommend one of two things.

Either you go public - you go on a waiting list, and you see a doctor at your local hospital who fits you in to their schedule around emergencies. For urgent matters, such as traumatic accidents, you can access a top quality specialist immediately under Medicare, and you can be treated at no expense to you.

Or you can go private. This is where your GP will refer you to a specialist and you can usually get to see them within a couple of weeks. These specialists are paid via partial refund from Medicare, partial refund from your Private Health Fund, and sometimes ask for a Gap Payment, which is usually minuscule.

Also, here in Australia, you can choose the Health Care Fund you want, and the scale of cover you want, depending upon your circumstances. For example, as I am now a woman over 50 with no reproductive organs, I don't need obstetrics, though I still need access to a gynecologist. You can also choose a co-payment for hospitals, to reduce our premiums.

In exchange for this, we pay a Medicare Levy, which is 2% of the taxable income and we pay a premium to our Health Care Provider (We currently pay about $500 a month for the top level of cover for two singles as we haven't changed it to couples yet, which should be a little cheaper).

Under Medicare you are entitled to: Visits to your doctor, or any public hospital in an emergency, or to have a doctor visit your home after hours; a health care plan every year as dictated by your doctor to a range of specialists such as dietitians, physios, podiatrists etc and a free eye exam every year. In other words - basic health care. In addition, women over 40 can have a free mammogram every 2 years, and men over 50, a prostate exam. There is also the pharmaceutical safety net for those people on multiple medications, which means that once you spend a certain amount, our medications are at a reduced cost, or even free. Partially funded are specialist appointments and dental care. Pensioners get reduced pharmaceutical benefits all year and get free medications once they reach the safety net limit.

Under your Health fund, you are entitled to specialists, hospital care (usually completely covered if you choose not to have a co-payment), spectacles, dental, physio, in fact, pretty much any specialist you want to see. Usually, this is covered by the Health Fund, unless the doctor charges more than the Fund will provide - the scheduled fee.

So what does this mean to me.

My mum was recently diagnosed with breast cancer. She had her bi-annual mammogram, followed by a core biopsy, and was given her results. On Friday, two days after being told her diagnosis, she was given an appointment for Monday to see someone about an action plan. All of this has been covered by the government. But she doesn't get to chose her doctor.

I have had a small out-of-pocket expense to see my chosen specialist. I have paid the surgeon $300 for the surgery - the rest is covered by Medicare and my Private Health Fund. I will pay the hospital a $250 co-payment. I will pay for any medications I take with me from the hospital. The Anesthesiologist will accept fund and medicare payments only - so no cost to me. All up, we will be out of pocket less than $600. Not bad.

So, two scenarios... Two different stories. However, from what I hear, not bad considering what other people need to go through..

How does your health system stack up?

 

[bigfield]

Either you go public - you go on a waiting list, and you see a doctor at your local hospital who fits you in to their schedule around emergencies. For urgent matters, such as traumatic accidents, you can access a top quality specialist immediately under Medicare, and you can be treated at no expense to you.

But you might have to share a hospital room with other people! The horror!

The system works well, although the rising demand for things like hip replacements means that waiting lists for painful and damaging medical conditions can be quite long in both the public and private systems.

Hospital care is very good in Australia. I don't know if Australia's hospitals are as good as the NHS in the UK--they appear to have a very impressive system--but the facilities are excellent and the nurses and doctors are awesome.

 

[DolphinDynasty]

From discussions with Bilby, I gather this has been discussed ad nauseum before, however, I am curious about how you access health care.

Here in Australia, you can generally visit your General Practitioner (GP) for a nil out-of-pocket expense. The doctor will 'bulk-bill' Medicare - a.k.a the government, who foots the bill. Should you require further assistance, your doctor can then recommend one of two things.

Either you go public - you go on a waiting list, and you see a doctor at your local hospital who fits you in to their schedule around emergencies. For urgent matters, such as traumatic accidents, you can access a top quality specialist immediately under Medicare, and you can be treated at no expense to you.

Or you can go private. This is where your GP will refer you to a specialist and you can usually get to see them within a couple of weeks. These specialists are paid via partial refund from Medicare, partial refund from your Private Health Fund, and sometimes ask for a Gap Payment, which is usually minuscule.

Also, here in Australia, you can choose the Health Care Fund you want, and the scale of cover you want, depending upon your circumstances. For example, as I am now a woman over 50 with no reproductive organs, I don't need obstetrics, though I still need access to a gynecologist. You can also choose a co-payment for hospitals, to reduce our premiums.

In exchange for this, we pay a Medicare Levy, which is 2% of the taxable income and we pay a premium to our Health Care Provider (We currently pay about $500 a month for the top level of cover for two singles as we haven't changed it to couples yet, which should be a little cheaper).

Under Medicare you are entitled to: Visits to your doctor, or any public hospital in an emergency, or to have a doctor visit your home after hours; a health care plan every year as dictated by your doctor to a range of specialists such as dietitians, physios, podiatrists etc and a free eye exam every year. In other words - basic health care. In addition, women over 40 can have a free mammogram every 2 years, and men over 50, a prostate exam. There is also the pharmaceutical safety net for those people on multiple medications, which means that once you spend a certain amount, our medications are at a reduced cost, or even free. Partially funded are specialist appointments and dental care. Pensioners get reduced pharmaceutical benefits all year and get free medications once they reach the safety net limit.

Under your Health fund, you are entitled to specialists, hospital care (usually completely covered if you choose not to have a co-payment), spectacles, dental, physio, in fact, pretty much any specialist you want to see. Usually, this is covered by the Health Fund, unless the doctor charges more than the Fund will provide - the scheduled fee.

So what does this mean to me.

My mum was recently diagnosed with breast cancer. She had her bi-annual mammogram, followed by a core biopsy, and was given her results. On Friday, two days after being told her diagnosis, she was given an appointment for Monday to see someone about an action plan. All of this has been covered by the government. But she doesn't get to chose her doctor.

I have had a small out-of-pocket expense to see my chosen specialist. I have paid the surgeon $300 for the surgery - the rest is covered by Medicare and my Private Health Fund. I will pay the hospital a $250 co-payment. I will pay for any medications I take with me from the hospital. The Anesthesiologist will accept fund and medicare payments only - so no cost to me. All up, we will be out of pocket less than $600. Not bad.

So, two scenarios... Two different stories. However, from what I hear, not bad considering what other people need to go through..

How does your health system stack up?

This is where I contend that being ill/disabled and in America is just abut as bad as being ill/disabled in a third world country, but with more discrimination possible. You wait weeks to months for a specialist, who if they take you insurance, will still bill that insurance 1/43 less than if you had no insurance, and then the copay as well, plus copay for medicine, IF it covered, and then the stigma and abuse form the masses, plus if an insurance company considers something like blindness or teeth or preventative care or whatever condition some ins rep or pharmacist denies as existing r relevant and eyes to not be a medical issue, then it is not covered. My best option, as it turns out, so to come up with enough free cash to sell my home and LEAVE, which sucks as I kinda loved it here when a kid, thought the world of our constitution. Then I got sick, and then disabled, and then sick again and my life has been entirely worthless in the minds of more than 50% of my countrymen/women/other ever since. Also, for emergency care cuz it is almost never covered by ins providers unless on Medicaid Part E, which ONLY covers emergency room visits, hence the people on it only using the ER to get treatment for longstanding conditions.

 

[braces_for_impact]

I live in the US. My job was shipped overseas last November, so I don't have healthcare at all. Any appointment I make will ask what insurance I have, and if I tell them none, I must fork out several hundred dollars in advance to be seen - if this particular medical practitioner will see people that don't possess insurance. If I have a medical emergency, the Emergency room cannot refuse me stabilizing treatment, and assuming I survive, a nice social worker will come around and knock some of the balance off, but I'll be on the hook for thousands of dollars. Because I cannot pay, it will be reported to my credit (as it has been already from a past period of unemployment) and my credit score now resides in the shitter. So anything that requires credit: car, apartment, etc. will cost more or I'll do without.

I currently have a bone spur in my neck pressing on a nerve, along with several bulging and collapsed discs and arthritis in my neck, all of which causes severe pain and headaches. I am currently about to exhaust my unemployment. I'm on food stamps, and my girlfriend (a good woman that deserves better) is working her ass off trying to make ends meet. But, as a household, we ourselves and our two kids make too much money - so I don't qualify for medicaid.

Once I lost my medical benefits from my job, the opioids I was on reared their ugly head. I always took them as directed, but nevertheless I've been on them for three years, and once they ran out, not only did my pain come raging back with a vengeance, so did opiate withdrawal - something I had never experienced. I was sick like I've never been until my girlfriend suggested I try kratom. Taking the kratom instantly removed the sickness and does as good a job as the prescription tramadol I was on with regards to the pain. So I pay for this out of pocket. There are various governmental agencies trying to outlaw it here (as a schedule 1!) but so far, thankfully it remains legal.

I did qualify for a government retraining program and I am taking classes to certify in A+, Network+ and Security+. I like the tech, and I like the work. It's a struggle to make ends meet, to study and hang on, but I keep working at it. If I graduate successfully in May or June I'll about double my possible salary, be well in demand, and get my health care back. My GF has developed back problems and bulging discs in her back over the last couple of years (honestly, probably from working so hard at physical labor) and is in much the same predicament I am. While this has been one hell of a struggle, if my family can pull this off it will be worth it.

You asked!

 

[LordKiran]

Either you go public - you go on a waiting list, and you see a doctor at your local hospital who fits you in to their schedule around emergencies. For urgent matters, such as traumatic accidents, you can access a top quality specialist immediately under Medicare, and you can be treated at no expense to you.

But you might have to share a hospital room with other people! The horror!

The system works well, although the rising demand for things like hip replacements means that waiting lists for painful and damaging medical conditions can be quite long in both the public and private systems.

Hospital care is very good in Australia. I don't know if Australia's hospitals are as good as the NHS in the UK--they appear to have a very impressive system--but the facilities are excellent and the nurses and doctors are awesome.

In a lot of areas we lack access to supply. Nevermind sharing a room. The people who get rooms are the lucky ones in some cases.

My boyfriend went to the hospital after a bout of intense pain that culminated in the throwing up of blood. He had private insurance but because the public hospital was closest that's where he went. In his entire 10-12 hour stay, he never got a room, was never offered food, and had to spend large amounts of time without any kind of attention other than mine especially when an accident came in. The best part is they wouldn't let him stay the night when they released him at 11 at night in the rain. he also had no shoes by the way. We had to call a favor just to burrow money so we could get a cab home. Despite what was (Thankfully?) my worst hospital experience to date, I recognize that this is a problem related to staff and finite resources rather than public care being simply inept. The reason the private hospital would have given him far better care isn't because you necessarily get what you pay for, but because those places have fewer people going to them. The big problem with public care is that we just don't spend enough on it. In a lot of cases we just outright need more hospitals and people to staff them.

 

[LordKiran]

I live in the US. My job was shipped overseas last November, so I don't have healthcare at all. Any appointment I make will ask what insurance I have, and if I tell them none, I must fork out several hundred dollars in advance to be seen - if this particular medical practitioner will see people that don't possess insurance. If I have a medical emergency, the Emergency room cannot refuse me stabilizing treatment, and assuming I survive, a nice social worker will come around and knock some of the balance off, but I'll be on the hook for thousands of dollars. Because I cannot pay, it will be reported to my credit (as it has been already from a past period of unemployment) and my credit score now resides in the shitter. So anything that requires credit: car, apartment, etc. will cost more or I'll do without.

I currently have a bone spur in my neck pressing on a nerve, along with several bulging and collapsed discs and arthritis in my neck, all of which causes severe pain and headaches. I am currently about to exhaust my unemployment. I'm on food stamps, and my girlfriend (a good woman that deserves better) is working her ass off trying to make ends meet. But, as a household, we ourselves and our two kids make too much money - so I don't qualify for medicaid.

Once I lost my medical benefits from my job, the opioids I was on reared their ugly head. I always took them as directed, but nevertheless I've been on them for three years, and once they ran out, not only did my pain come raging back with a vengeance, so did opiate withdrawal - something I had never experienced. I was sick like I've never been until my girlfriend suggested I try kratom. Taking the kratom instantly removed the sickness and does as good a job as the prescription tramadol I was on with regards to the pain. So I pay for this out of pocket. There are various governmental agencies trying to outlaw it here (as a schedule 1!) but so far, thankfully it remains legal.

I did qualify for a government retraining program and I am taking classes to certify in A+, Network+ and Security+. I like the tech, and I like the work. It's a struggle to make ends meet, to study and hang on, but I keep working at it. If I graduate successfully in May or June I'll about double my possible salary, be well in demand, and get my health care back. My GF has developed back problems and bulging discs in her back over the last couple of years (honestly, probably from working so hard at physical labor) and is in much the same predicament I am. While this has been one hell of a struggle, if my family can pull this off it will be worth it.

You asked!

Obviously the problem here is you just arent working hard enough. I mean what do you expect, for the evil government to take care of you? You should be ashamed of yourself!

 

[braces_for_impact]

I live in the US. My job was shipped overseas last November, so I don't have healthcare at all. Any appointment I make will ask what insurance I have, and if I tell them none, I must fork out several hundred dollars in advance to be seen - if this particular medical practitioner will see people that don't possess insurance. If I have a medical emergency, the Emergency room cannot refuse me stabilizing treatment, and assuming I survive, a nice social worker will come around and knock some of the balance off, but I'll be on the hook for thousands of dollars. Because I cannot pay, it will be reported to my credit (as it has been already from a past period of unemployment) and my credit score now resides in the shitter. So anything that requires credit: car, apartment, etc. will cost more or I'll do without.

I currently have a bone spur in my neck pressing on a nerve, along with several bulging and collapsed discs and arthritis in my neck, all of which causes severe pain and headaches. I am currently about to exhaust my unemployment. I'm on food stamps, and my girlfriend (a good woman that deserves better) is working her ass off trying to make ends meet. But, as a household, we ourselves and our two kids make too much money - so I don't qualify for medicaid.

Once I lost my medical benefits from my job, the opioids I was on reared their ugly head. I always took them as directed, but nevertheless I've been on them for three years, and once they ran out, not only did my pain come raging back with a vengeance, so did opiate withdrawal - something I had never experienced. I was sick like I've never been until my girlfriend suggested I try kratom. Taking the kratom instantly removed the sickness and does as good a job as the prescription tramadol I was on with regards to the pain. So I pay for this out of pocket. There are various governmental agencies trying to outlaw it here (as a schedule 1!) but so far, thankfully it remains legal.

I did qualify for a government retraining program and I am taking classes to certify in A+, Network+ and Security+. I like the tech, and I like the work. It's a struggle to make ends meet, to study and hang on, but I keep working at it. If I graduate successfully in May or June I'll about double my possible salary, be well in demand, and get my health care back. My GF has developed back problems and bulging discs in her back over the last couple of years (honestly, probably from working so hard at physical labor) and is in much the same predicament I am. While this has been one hell of a struggle, if my family can pull this off it will be worth it.

You asked!

Obviously the problem here is you just arent working hard enough. I mean what do you expect, for the evil government to take care of you? You should be ashamed of yourself!

Well I've never had an iPhone, so there's that.

 

[T.G.G. Moogly]

I've always had private insurance through an employer since leaving the military.

Recently my wife developed thyroid cancer and had to have the thyroid removed, and then years of follow up treatment and monitoring. Except for some copays on visits and meds the cost was minimal and the service was great. My employer pays about 800 dollars a month in premiums for the two of us.

Dental and eye care is at my expense unless I choose a plan, all of which are expensive so I go without. I pay for everything out of pocket which ends up being less expensive in the long run even though it runs into the thousands of dollars.

In a few more years I'll be old enough to claim Medicare. We'll see how that goes.

 

[DolphinDynasty]

I've always had private insurance through an employer since leaving the military.

Recently my wife developed thyroid cancer and had to have the thyroid removed, and then years of follow up treatment and monitoring. Except for some copays on visits and meds the cost was minimal and the service was great. My employer pays about 800 dollars a month in premiums for the two of us.

Dental and eye care is at my expense unless I choose a plan, all of which are expensive so I go without. I pay for everything out of pocket which ends up being less expensive in the long run even though it runs into the thousands of dollars.

In a few more years I'll be old enough to claim Medicare. We'll see how that goes.

Good for you. Medicare without an armed services record is shit, unless you're healthy and never need it. Same with all other "insurance"
or other benefits.

 

[gmbteach]

Wow! I knew we had it good, but didn't realise how Good!

 

[barbos]

braces_for_impact Obamacare does nothing for unemployed?

 

[rousseau]

When I was 10ish years old I broke my leg playing in a hockey game. The next day my leg was fixed, and in a cast, at no cost to my family. That pretty much sums it up.

For Canadians, health-care is something that we simply do not worry about.

 

[T.G.G. Moogly]

When I was 10ish years old I broke my leg playing in a hockey game. The next day my leg was fixed, and in a cast, at no cost to my family. That pretty much sums it up.

For Canadians, health-care is something that we simply do not worry about.

Americans like to brag about how many aircraft carrier battle groups they have, guns or butter and all that. Personally I prefer less guns and more butter.

I'm forever intrigued by people who vote for candidates that have guaranteed public pensions and healthcare, but lack same. You'd think they would be somewhat reluctant to pay for someone else's guaranteed retirement when they don't have one of their own. Stupid is as stupid does I guess.

 

[RavenSky]

braces_for_impact Obamacare does nothing for unemployed?

Rick Scott made sure that ACA's "expanded Medicaid" provision was not allowed in Florida. In other words, yes Obamacare would have helped the unemployed and working poor with health care coverage... except for the fucking Republicans blocking it

 

[Loren Pechtel]

braces_for_impact Obamacare does nothing for unemployed?

The problem is having enough money for the premiums.

 

[southernhybrid]

I am a semi retired RN and I am over 65 so first of all, let me explain Medicare to those that don't know much about it. We all pay into medicare as part of our payroll tax, but you must be disabled for two years or at least 65 to enroll in Medicare. It's complicated.

Medicare A is free and it pays for hospitalization, skilled home health services if provided by an agency that is certified by Medicare and hospice. There is a deducible around 1400 dollars for each hospitalization.

Medicare B costs me about 109 dollars a month but for those who enroll this year, the premium is around 140 per month. If you are very low income, you might qualify for coverage to be paid by Medicaid. ( the insurance for lower income folks ) Part B covers 80% of out patient services, like doctor's visits, and procedures, etc. Part B pays 100% for labs if they are done during an annual wellness visit or if they are ordered with an appropriate diagnosis code. B also pays 100% for yearly mammograms, bone density tests and colonoscopy exams. You can also get a yearly wellness exam without a copay. Doctors and other providers who take Medicare can only charge the patient the amount that Medicare permits. ( More about that later )

Part C plans are heavily subsidized by the government and are usually low cost or in some cases free. They cover A and B usually without copays but they are also highly restricted, basically like an HMOs. Sometimes people like them if they are pretty healthy, but not so much if they have a lot of serious health problems and want more choice of care providers.

Part D. Until 2003, Medicare didn't cover any drugs other than some like chemo that were delivered in a doctor's office or hospital. Part D is a private supplement for drug coverage. There are many different ones in different areas of the country. Their prices vary and they all have copays. I pay about 22 dollars a month for one that covers two of my three drugs. The copays are very tiny. But, I also use HRT and none of the plans cover hormones for older women. My PA convinced my drug plan to help pay for my hormones. My co pay is 80 dollars a month compared to about 160 a month if I had to pay the entire amount. Part D also has something called the donut hole. Once you have received a certain amount of drug coverage, you are responsible for paying for your drugs until you reach another point. I've never used it so I don't remember what the actual figures are, but they were lowered thanks to Obamacare. That will revert back if the ACA is over turned. If you don't buy a Part D plan when you turn 65, you will be penalized. The penalty grows as you age, so the smartest thing to do is buy a plan as soon as you turn 65. If you have Medicaid, that pays for you drugs, so you don't need a Part D plan. You can change plans once a year during open enrollment.

Medicare doesn't pay for dental, or vision care and it only pays for rehab care if you need a few weeks in a skilled nursing home. The only thing that pays for long term in patient care is Medicaid and that only kicks in once all of your assets have been used up. You can keep your home if a spouse is living in it, but the government can claw back the money from the sale of your home after your death.

There are also private supplements to part B, which range in cost from about 100/month to 400/month depending on your age and several other factors. The supplements only cover the 20% that Medicare doesn't. They don't cover services which aren't approved by Medicare.

Now as to the cost of things. Medicare has standard reimbursement fees and if a provider is willing to accept M'care clients than he/she must accept the amount Medicare pays. They can't bill the patient over that amount. Some providers don't accept Medicare patients but where I live, those are pretty rare. Private insurance that younger people have through their employers usually pay more than Medicare. For example, M'care might pay 350 for a brain scan, but a good private insurance policy might pay 1000 for the same exam. Medicaid usually pays less than either of those, which is why it's sometimes hard to find providers who take M'caid patients. The nuttiest thing is that if you don't have insurance, your bill will be even higher. You will be asked to pay whatever the providers feel the entire charge should be. There are some states that will give you temporary M'caid if you are fairly low income and had a very expensive event. For example, a good friend of mine was in the hospital last week for several days. She has a job but no insurance. She only makes 16 dollars an hour and has two dependents, so she might qualify for help.

Now to Obama care, actually known as the ACA. My husband isn't 65 until October, so he has had an ACA plan for the past two years when the company he worked at as an engineer shut down. He pays about 550 a month with a deductible of about 6K. We get a small subsidy of about 80 dollars a month or our cost would be higher. He gets discounts on drugs and such since he has insurance, but no drugs are completely covered. He has only had two or three doctor's appointments since he's been on the plan, but we are glad to have it since any major event could wipe out much of our retirement nest egg if we didn't have the ACA. I have a 58 year old sister who also has an ACA plan. She has savings but a very low income so she gets a generous subsidy. I have no idea how she will afford insurance if the Republicans replace the ACA. Their plan will be a lot more expensive for people her age, even though she is healthy. She only makes 10/hr.

I could write a book about our bad a lot of our actual care is, but for now, does anyone have any questions about the above?

 

[southernhybrid]

One thing I forgot to add. You must have paid into SS and Medicare for at least ten years to be eligible for either of those. If you haven't paid in, and are very poor, you may be eligible for Medicaid. I have several patients who have never worked and are only on Medicaid.

 

[braces_for_impact]

braces_for_impact Obamacare does nothing for unemployed?

Rick Scott made sure that ACA's "expanded Medicaid" provision was not allowed in Florida. In other words, yes Obamacare would have helped the unemployed and working poor with health care coverage... except for the fucking Republicans blocking it

This, and as Loren says, one still needs enough money to pay the premiums and copays as well. If I were lucky, I would be able to perhaps afford bronze plan premiums, but the deductible is so high the plans are all but useless except in the case of a hospital stay. Note the average deductible for a single payer in Obamacare is $6092.00.

ETA: Oh, and if I spend more than half the year uninsured I get hit with the tax penalty next year.

 

[T.G.G. Moogly]

southernhybrid,

As I am quite dense I never understood exactly how medicare worked until reading your post. Now I understand it completely. Thank-you!

 

[Loren Pechtel]

Rick Scott made sure that ACA's "expanded Medicaid" provision was not allowed in Florida. In other words, yes Obamacare would have helped the unemployed and working poor with health care coverage... except for the fucking Republicans blocking it

This, and as Loren says, one still needs enough money to pay the premiums and copays as well. If I were lucky, I would be able to perhaps afford bronze plan premiums, but the deductible is so high the plans are all but useless except in the case of a hospital stay. Note the average deductible for a single payer in Obamacare is $6092.00.

ETA: Oh, and if I spend more than half the year uninsured I get hit with the tax penalty next year.

Even if it doesn't pay a penny it's useful for knocking bills down to reasonable.

I recall some years back a repeated go-round with the lab. They got a date wrong and got a claim rejected. I didn't meet the deductible that year, it was going to be entirely out of pocket, I just wanted the insurance to approve it so the charge would be what's appropriate, not the ~10x amount the lab wanted. The lab just kept blindly resubmitting the bill without fixing the problem and ended up dropping the whole thing when the insurance company finally rejected it as too late rather than duplicate.