Too broke for the ER

[Rachmaninoff]

I'm sure this isn't anything new, people refusing treatment since they don't have insurance to cover it. Full story can be found here:

[URL="http://www.msnbc.msn.com/id/30628634/"][U]Recession forces many to leave ?against medical advice,? doctors say[/U][/URL]

The main reason this stuck in my mind is a number of the school districts around here have reduced the hours of all part time teachers so they no longer qualify for medical insurance. So for many of them, starting this fall, they'll have no medical insurance since purchasing a policy separately is more than they can afford. So the claim to not having a means to pay for it, is all to real.

I lucked out and this won't happen to me, though I'm at a university which is seperate from the state schools, but still. o_O I understand they need to cut back, but it seems like a really cheap move to do that instead of cutting back on other things.

So anyone here affect by this kind of thing? Have you ended up with no insurance or do you know someone who has?

[James]

[font=franklin gothic medium]I've seen quite a few articles like this before and I think they are really sad. I just can't imagine living in a country where there's no significant safety net, in terms of basic medical care (especially in emergency cases).

To give some context, I should probably try to explain how this basically works in Australia.

Here we have a similar system to many other countries - Medicare. Our Medicare system is essentially a public system.

If you visit a GP who bulk bills (not all do), then your visits are paid for by Medicare. If you are prescribed medication, then you [i]do[/i] have to pay for it, but high-cost medications are subsidised by the Pharmaceutical Benefits Scheme (PBS).

In terms of hospitals, Australia has both public and private hospitals.

Public hospitals are funded by the relevant State health departments, so they are literally just public facilities. If you present to a public hospital (whether in emergency or for other necessary operations), your costs are covered by Medicare up to a point.

Medicare does have a limit that kicks in, so, say your operation costs $10,000 all up. Medicare might pay $8,500 and there will be a "gap" that you will have to pay yourself.

I'm not sure exactly where the Medicare ceiling sits, but it's reasonably high, so most operations are simply covered without the patient needing to pay a cent.

In our public system, you still have quite a bit of flexibility depending on the hospital. So you can generally still choose your own doctor/surgeon and sometimes you can also choose a room just for yourself (although this depends on availability).

Then there is the private system. Some GP offices do not bulk bill - they charge private fees. This is really the choice of the individual practice. Some practices even do both - they will either charge privately [i]or[/i] bulk bill depending on the circumstances.

There are also private hospitals in Australia. These hospitals can do some treatment via the Medicare system I think (i.e. if you present to their emergency department because they're the closest hospital). In other words, an ambulance will take you to the nearest emergency room and they won't be concerned about whether or not it's public. All emergency rooms are obligated to treat the cases that come to them.

In the private hospital system you have a bit more flexibility simply because you're paying privately (usually through private health insurance). You can tend to get your own room and you are usually guaranteed various options (choice of surgeon etc). Also in some cases waiting lists are a bit shorter, although they are certainly not excessively long in the public system.

In terms of private health insurance here... it's not quite the same as in America.

For instance, I have private health cover. I choose to have it because it takes a bit of pressure off the public system and (at the moment) I can afford it. It also allows me to get rebates for various things (like I can spend up to $500 per year on glasses for instance).

However, let's say I need to have that $10,000 operation. I can do this privately and it'll be covered. But what if, for some reason, I want to use a public hospital?

In that case, Medicare would pay up to its ceiling (say $8,500) and my private insurance would then kick in and pay the "gap". So I'd be left with no bill.

In this way public and private complement each other in Australia.

I've heard a lot of arguments from Americans that somehow our system is doable either a) because of our smaller population or b) because we're happy to waste money on the system and it probably costs us a fortune.

Well, wrong on both counts. Population size is really irrelevant, because everything is proportional - if you have more patients, you also inherently have a bigger tax base with which to fund them.

Secondly, my understanding is that our Medicare system is one of the few on Earth that is financially viable. This is because there is a system of balances involved with how it is funded and how it pays out.

In Australia, everybody who works pays a Medicare levy as part of their income tax. I think that for people under a certain wage it's $1 per day (so $365 per year). If you hit a certain income level, the levy doubles.

As I mentioned, this comes out of your income tax component. So it's not really like an extra dip of money that they take out.

And secondly, nobody really minds this simply because all Australians draw on it regularly. If I visit a GP tomorrow and they bulk bill, I don't have to pay - because my income tax is already helping to fund the system.

There are a million other things I could mention - and I'm sorry for rambling on so long - but I felt I had to explain this a bit, so that other people can understand where I'm coming from.

To me - and I'm sure to most Australians - the idea of people simply not accepting necessary treatment because they don't have insurance is just... unfathomable. It sounds like something from the dark ages, in all honesty.

Plus it doesn't make sense even for economic reasons. If people are discouraged from treating themselves at an earlier stage, they will tend to only present at emergency rooms later on with far more severe conditions. The end result? Costs go up substantially - even health insurers would face higher costs, because they would now have to deal with a situation that wouldn't have happened if the patient had been able to get proper care earlier on.

So, please feel free not to read through my rambling if it bores you or something... but for those interested, it may give you some insight into why various people just don't understand these types of news stories.

Edit: I nearly forgot, there are two big exceptions to the rules above.

One is dental - as far as I know, Medicare does not cover any dentistry work. If you have private insurance you can get that cover, but otherwise you have to pay. Many dentists in Australia do not require up-front payment, however, and allow customers to enter into a payment plan.

And two, cosmetic surgery (also known as "elective surgery") is not covered under Medicare. This is paid privately depending on your private health cover arrangements.

So there are definitely exceptions and our system does not go nearly as far as some European systems in terms of covering everything (which is probably partly why it's viable).[/font] :catgirl:

[Sara]

[size=1]That's interesting, James. By contrast, I once read a great post from an "industry insider" about how complicated health insurance is in the US. I'm trying to find it again, but having very little luck. (Basically, I knew it was complicated, but had no idea just how much so it is.)

I'll be uninsured starting in January. I'm no longer a full-time student (hurrah for graduation?), so starting with the next calendar year I cannot be covered under my parents' insurance. And trying to find a full-time job right now is, well, difficult. I have two part-time jobs (starting next month) that [i]should[/i] cover my groceries and rent (we'll have to see how my budget and hours work out), but employer-provided insurance isn't going to happen.

I took a look at being self-insured, and [url=http://en.wikipedia.org/wiki/Blue_Cross]Blue Cross Blue Shield (wiki link)[/url] in my state offers health coverage tailored for "young adults not planning on starting families yet." It's about a hundred dollars per month, but that's a hundred dollars I don't know if I have yet.[/size]

[Vicky]

[size=1]...Wait, $600 for an evaluation? O_o

It's quite a big problem and quite unfair. Someone can end up dying because they can't afford treatment. I'm not sure how things work here in the UK but the only thing I had to pay for were my anti-depressants and anti-psychotics when I dropped out of college - which is pretty stupid because I [i]dropped[/i] out of college mainly due to depression so I was paying for medication they wanted to keep me on that obviously wasn't working.

Money leeches.[/size]

[Rachmaninoff]

Oh I can certainly see why you would find such stories hard to understand James. But for us, unfortunately, they're pretty common. I'll use one of my parents friends to give an example. She's a divorced mother of three kids and worked as a teacher with just enough part time hours so she could get insurance for her kids.

The cut back means that as of September, they'll have no insurance at all. She can't just go and pick up private insurance since the cut back in hours means she'll have no money to pay the monthly insurance premium. When you get it through work, your employer pays part of it for you, or you get a much better rate than on your own.

If I remember correctly, she was paying $110 a month for herself and her three kids. Private insurance would cost around $300 a month, something that with the decrease in pay, she simply won't have the money for.

A lot of people object to the idea of a health system that includes everyone, but I find the idea of millions of people having no insurance at all, far worse.

[eleanor]

[font=trebuchet ms] I don't have health insurance, which makes it awkward for me when I have to visit the doctor. For vaccinations and such I just go to the public health clinic and wait several hours, and if I feel the need to go to the doctor for something else I either 1) suck it up or 2) pay cash. I get weird comments from my friends about not having a family doctor or health insurance, but for the time being it seems fine. Although sometimes I do wonder my parents don't do it, it has never really bothered me I guess.[/font]

[Horendithas]

[FONT="Arial"][COLOR="Indigo"]I personally think our current system sucks since it leaves so many people without insurance. I have issues with asthma and allergies so the idea of needing to pay for that without any form of insurance, is something I'd rather not have to deal with. It's expensive enough [I]with[/I] insurance.

Like Sara, when I finish school, I will no longer be able to get insurance through the university and private pay has a clause that doesn't cover preexisting conditions at first, so you have to wait an entire year for coverage.

So not only do you have higher premiums, but you have to pay full cost for a lot of things. Though this is if you don't manage to get a job with insurance. I actually just accepted a part time job offer that will go full time when I finish school.

However, since I'm getting married this fall, I'll end up getting insured through where my fiancé works, which fortunately, has excellent benefits and no waiting period for coverage on preexisting conditions. I feel bad for people stuck in the situation of having no means to pay for care. [/COLOR][/FONT]

[Nathan]

[FONT="Arial"]Any time people balk over the notion of universal health care, I am reminded of all the people who can't even afford care when faced with a life threatening condition. There is nothing more frustrating than being sent on a call only to see someone you know [I]needs[/I] treatment, refuse it because they can't pay for it. In my opinion, that shouldn't be happening, period.

I am slightly comforted by the knowledge that we do have a certain amount of what's considered charity funds that pay for people who have no insurance. However, with all the economic issues, they've been tightened to only include those who are literally the most poor in our city.

So those who are in between are still being left out since they make enough to not qualify and yet no where near enough to pay for care. It's pretty disheartening really. Last time I read up on it, the number of people without insurance was close to 50 million. [/FONT]