Why don't Americans have free health care

United States Health System

Nowhere in the world is medical care as expensive as in the United States. Even vacationers who take out health insurance abroad will notice that tariffs that include treatments in the USA are more expensive than tariffs without the USA.

Why is the cost of medical treatment in the US so high?

The reasons for the expensive treatment costs are high research and development costs. The fact that doctors or hospitals can be sued for very large sums in the event of unsuccessful treatment also plays a role in pricing. Doctors in private practice have to protect themselves against such lawsuits with expensive public liability insurance. All of these costs are passed on to the treatments. In contrast to Germany, there is no fixed fee catalog for these in the USA after billing takes place. Hospitals and doctors are allowed to price their services individually and in some cases do so generously.

The health system in the USA differs significantly from that in Germany. In contrast to Germany, in the USA there is no obligation to have health insurance. As a result, around 50 million people living in the United States are uninsured. Among them are around 11 million illegal immigrants. The health system is a mix of public and private care, important components of public insurance include the state insurance for the elderly “Medicare” and the poor “Medicaid”.

Many Americans have health insurance through their employer

The majority of Americans (almost 60%) have health insurance through their employers. Health insurance is sometimes offered as an incentive for jobs, which is inconceivable in Germany because it goes without saying. Five out of six Americans who are employed are covered by insurance that is either shared by the employee or shared by the employee and employer. These health insurances differ greatly in their services. Some only insure emergencies and basic services, while others also cover psychiatric treatment or the cost of dentures.

HMOs as an alternative to traditional health insurance

An alternative for people who want to take out private insurance are the “Health Maintenance Organizations”. These organizations consist of a team of doctors who take care of all health care for a person if a certain fee has been paid in advance. The topic of preventive care is particularly important in HMOs, as the HMOs also have to assume the treatment costs if services beyond the HMO are to be used. Thorough preventive measures are designed to prevent these costs. HMOs are becoming increasingly popular with Americans as a recognized means of keeping medical expenses in check. However, the fact that HMOs do not provide for a free choice of doctor, but rather restrict this right, is viewed critically.

For the self-employed there is the possibility of taking out group insurance. This means that several self-employed or small companies from the same industry get together and form a community through which they can then get cheaper tariffs than individual people could.

Around 50 million Americans do not have health insurance

Basically, the majority of Americans have health insurance. However, there are still many people who cannot afford insurance. Medicaid and Medicare are two important building blocks for these people. These programs are financed through contributions from insured persons, social security contributions and government grants. Every American who is eligible for Social Security benefits is also covered by Medicare.

The Americans whose employers do not offer health insurance, those whose incomes are just above the poverty line, or those who are illegally in the USA remain without insurance. Although these people are also helped in an emergency and the bills are often borne by public authorities, the lack of preventive care for these people is the main problem, which helps to avoid serious illnesses or to detect them at an early stage.

Obamacare aims to improve the health system

Former US President Barack Obama passed the Patient Protection and Affordable Care Act, also known as Obamacare, in 2010. Obamacare plans to make health insurance compulsory so that every American is covered even if they are not covered by their employer.

Exceptions are included in the draft law, including members of some religious groups and people who are not covered by Medicaid because of their poverty and cannot afford insurance. Insurance companies, on the other hand, are obliged to admit every patient and not to link their acceptance into insurance to health exams or missing information on their medical history.

This is how the conclusion of an insurance for previously uninsured within the scope of "Obamacare" works

For all insurance companies, a basic service package was introduced as part of Obamacare, which has to get by without additional payments or spending caps (bronze). In addition to this service core, there are higher-quality packages that are standardized and offer even more services (silver and gold). On comparison portals specially set up by the US states, citizens can find out more about the various insurers, and all insurance providers can use these portals to present their services and premiums. Citizens enter their data in this portal and then receive the packages that suit them clearly. Anyone who has not yet had health insurance can register with an insurance company via this portal. Only those who register via these portals also receive subsidies and tax advantages.

Further modifications were also made to Medicaid in the course of Obamacare. Not only citizens just above the poverty line, but also below the poverty line can now insure themselves. In addition, additional grants are made available for low-income insured persons. Smaller companies can also apply for group insurance grants. With 50 or more employees, employees must be offered at least bronze-level insurance, or the company must participate in the health reform through fees. Since 2015, anyone who is not insured and is not subject to any of the exceptions has had to pay an amount equal to the actual insurance premium as a kind of tax to the state.

What are the benefits of the healthcare reform?

The benefits of Obamacare are better insurance for workers in smaller companies and the financial participation of large companies in public health. In addition, all citizens should be able to access health insurance and a refusal of admission or an increase in contributions due to previous illnesses is no longer possible.

With President Trump, who wants to abolish the system introduced by Barack Obama and change it, 14 million people can lose their health insurance again.

What does health insurance cost in the US?

The cost of health insurance in the United States is relatively high. Private tariffs are not available for less than US $ 250 to US $ 300 a month, even with the best medical history. Even those who are insured through their employer may have to pay this amount, but some employees also pay 80 or 90 percent of the premiums, then only a two-digit sum remains for the employee. It is difficult to make a general statement about this, the various insurance options are too diverse and complex.

What about family health insurance in the United States?

Often, insurance policies through the employer also apply to the entire family. If this is not the case, family insurance must be taken out for all family members. For a family of four, $ 800 or more per month can quickly become due, but here too the costs depend on so many factors that it is difficult to give a flat rate.

German long-term health insurance abroad is a good option for emigrants

Anyone who comes to the USA as an emigrant and does not have health insurance through their new American employer should take out German long-term health insurance abroad. These tariffs are often valid for up to five years and can be renewed even after this period has expired. It is important to consider the following points when taking out this insurance:

  • Are dentures covered by the insurance?
  • Can the insurance be terminated by the insurer due to age?
  • What happens to the temporary contract in the event of a serious, protracted illness?
  • Can the temporary contract be converted into an unlimited one and will a new health examination be necessary?
  • How is the billing agreement regulated for cost-intensive treatments and inpatient hospital stays?
  • Are there any restrictions on fee schedules that are common in Germany?

The German insurance conditions are much more patient-friendly than the American ones

Even if insurance through the American employer is possible, it can make sense to keep a private German health insurance. Those insured in Germany are still subject to the German Insurance Contract Act and thus benefit from significantly better conditions and benefits than those insured under the American system.

Anyone who takes out health insurance in America because they are not insured through an employer must definitely compare benefits. As in Germany, these vary enormously. The most important components of an insurance policy should be:

  • Dental care
  • Normal medical care including preventive examinations
  • Ophthalmological care
  • Assumption of drug costs

Depending on the module and structure of the insurance, various co-payments are conceivable, which can vary from area to area. For example, in the Dental area 50 & co-payments may be due, while only 30% deductibles are provided for ophthalmological treatments. Depending on personal preference, a policy should then be taken out - important points for many people are also the assumption of costs for psychotherapy and possible alternative treatment methods such as acupuncture.

Since the costs of insurance usually explode if everything is to be covered 100% and without a deductible, it makes sense to calculate carefully whether a certain deductible is not worthwhile if it reduces the monthly insurance premium. For example, many Americans only insure serious illnesses and risks, such as operations and hospital stays, and tend to use their own wallet for minor treatments.

Medicine is a business in the United States

Medicine is an open market and health is a business in the United States, so advertising for medical services is not uncommon. Special offers - for example for dental treatments - are also not uncommon and it is worthwhile to compare prices. The fact that Germans who are used to just handing their cards over the counter are initially unfamiliar with being asked about the type of payment as soon as one enters a practice in the USA becomes normal over time.