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Course: The Brookings Institution > Unit 1
Lesson 1: Introduction to health care in the U.S.- Introduction to the U.S. health care system
- Medicare
- Medicaid
- The U.S. uninsured population
- Paying for medicines: copays and deductibles
- Paying for medicines: tiering and formularies
- Understanding your medical bill
- Health care costs
- Private health insurance
- Health care for the chronically ill
- Health care exercise
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Introduction to the U.S. health care system
Confused about the U.S. health care system? This introduction uses one patient as an example to illustrate how money flows within the system. This will serve as the basis for deeper dives into each program as well as health care delivery and payment reform. Created by Brookings Institution.
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What is the difference between Medicare and Medicaid?(17 votes)
Medicare is the assistance program for older citizens because these citizens tend to have higher health costs and lower income. In one sense you pay for your own Medicare through social security taxes.
On the other hand, Medicaid is designed to assist low-income individuals and those with other financial needs.
It is possible to receive both Medicare and Medicaid assistance, but they are different ideas.(17 votes)
Why doesn't the government simply pay the insurance premium for all citizens? Wouldn't that be less expensive than maintaining Medicaid and Medicare?(4 votes)
That is certainly an argument made by many Americans, but the majority don't see it that way. Any expansion of government, especially something as huge as the entire healthcare industry, will be hotly contested by Republicans.
However, the United States government actually spends more money per person on healthcare than almost every other country, and yet we still pay almost that same amount again in additional private spending on healthcare. For that huge price tag, the United States has mediocre performance on most health related metrics.(12 votes)
How do people find insurance companies? I know that employers give options to employees for insurance companies, but what about the other half? How do they pick their insurance companies? Also, how does the Affordable Care Act change how people can make insurance plans?(3 votes)
Some employers give their employees a choice of companies / policies to choose from, other do not - they simply make a single plan available, like it or not. Typically, when employees are given a choice, they do not spend a lot of time trying to decide which policy is best. I have read that the average employee spends less than 10 minutes trying to decide. In any case, choices should be made on the bases of what each policy covers or does not cover, what the co-pays and deductibles are, which hospitals and physicians are part of the policy network, what medications are covered and at what cost, etc. These are the types of comparisons and decisions that an employee must make if he/she is choosing a policy on one of the new health care marketplaces. For example, if you or a family member have/has diabetes and kidney disease you might want to make sure that the policy you choose covers organ (kidney) transplants. On the other hand, if your mother has early onset Alzheimer's and you fear you may develop the disease, you might want to take a careful look at coverage for drugs to treat Alzheimer's disease. Similarly, if you or a family member is a longtime smoker, coverage for Advair and Spiriva (both under patent protection and quite expensive) are covered. Different policies cover different conditions, procedures and medications.(4 votes)
Several times the speaker stated that employers paid the health care premiums for health insurance and the patient only had to pay deductibles and co-pays, but isn't it more often the case that the patient has money deducted from each paycheck to help pay for those health care premiums?(4 votes)
It depends on the employer really. I have payroll deductions for some of the premium, but my employer does pay the majority of the premium.(2 votes)
- What does deductible mean?(3 votes)
- Deductible is an amount that you have to pay as a portion of the total expenses, towards your consultation charges/hospitalization charges etc.
For example, if you delivered a baby in hospital, the charges of doctors, stay, services etc expenses could be $45000 - $50000. So you need to pay $500 to hospital and rest the insurance will pay to hospital.
It depends on the plan that you choose & within that the premium you are paying.(2 votes)
- Is care directed toward preventing illness also covered in a risk sharing model?(1 vote)
- prevention is an important factor in promoting health and reducing health care costs(1 vote)
How do health care providers (3:12-3:30) determine the premiums that customers must pay? Is it usually a set rate for all customers or is it determined by previous conditions, family history, etc.? Or both? Or neither?(1 vote)- The practice of evaluating how risky a potential insurance customer is, and setting the price of their premium, is called underwriting. Underwriting used to be the bread and butter of commercial insurance. They would have you fill out dozens of pages of paperwork to find out everything about your previous medical history, and that of your family, in order to best guess how much you would cost to cover. However, the affordable care act (Obamacare), insurance companies can no longer set their prices based on pre-existing conditions. They can only set their prices based on age and geographic area. This greatly reduces the need for underwriting, and has streamlined the purchasing of individual insurance.(2 votes)
When were these videos made? Are they still applicable today?(1 vote)
This video was published February 7, 2014, much of the information is still applicable, however with the House of Representatives' approval of the American Health Care Act much remains in flux. The Senate is currently considering proposals for the bill.(1 vote)
- From an international perspective, which system do you believe provides the best outcomes with respect to access, cost, and quality? Beveridge? Bismarck? Canadian Medicare?
It is good to remember that many nations of the world seems to have found ways to provide medical care to their people more effectively than has the profit-driven, oligarch-run, US system. Which nation do you feel might provide the best model for US healthcare?(1 vote) - they games childern when that get fish(1 vote)
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