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Marisa T 讲师的专栏

What Never Fails to Surprise Me: The American Healthcare System

周间主题: What Surprised You Recently?

2021年6月6日

You, as the reader, are probably thinking: "Oh my god, what a boring, complex subject! You couldn't come up with anything more enticing than healthcare?" Frankly, no. And you're about to find out why.

But first, I'd like to give some background before jumping into larger details. For those who don't know, the American healthcare system is a DISASTER. It might as well not even exist due to how poorly it operates. Anyone living outside of the U.S. who comes over to the U.S. to live will eventually have questions about how to navigate our medical system. Unfortunately, they often walk away with their questions unanswered because Americans, like myself, don't understand how the system works, either. But I'm going to attempt to do so in this article, so buckle up!

The American government spends approximately $3 trillion per year to provide healthcare services to its citizens, and yet, more than half of those same citizens admit to struggling with paying their medical bills each year. Tens of thousands of Americans die each year because they lack health insurance, ultimately not being able to afford to see a doctor. Americans are unwilling to call an ambulance during a medical emergency because they don't want to pay the cost of the ride to the hospital (which, in the States, can run you into the thousands of dollars). Our medical system is so archaic that a sick person would rather slowly die in their home than take the trip to a hospital. This is all because of the fact that insurance companies are largely unregulated, meaning that they're allowed to charge exorbitant fees. These costs can go up or down without reason because they're at the mercy of these insurance companies.

I'm going to take a moment to go into some detail about the main obstacles that can be found in American healthcare. I will try to make my language as simplistic as possible. First of all, Americans must pay something called a deductible. A deductible is the amount of money you must pay your insurance company in order for them to cover your medical bills. Each company has its own set of plans, each with its own yearly requirements. It could cost a person anywhere from hundreds to thousands of dollars per month.

Let's meet John. John's deductible at the Silverwing Health Insurance Company is $3,000 USD. During the first half of the year, he's managed to pay off $2,700, almost the full amount. On one particularly rainy afternoon, John gets into a car accident and need emergency corrective surgery. The surgery goes well, the doctors are kind to John and tell him he's going to be fine. After a few days of rest, John is sent home. A couple weeks go by, until one day John receives a letter in the mail from the hospital/ insurance company. It's a bill for $62,500!!

If John hasn't payed that $3,000 deductible, he'll be financially responsible for ALL of his medical bills ON TOP of the remaining deductible amount. Don't forget, he's recovering from a life-saving surgical procedure. John may have to spend money on medication, physical therapy, or even a specialized diet. All of these costs will come straight out of his own pocket. You might be thinking to yourself, "But if I pay the full deductible right then and there, then I won't have to worry about paying for the hospital bills, right?" Wrong. There's a good chance that your insurance provider will look at your deductible as a sort of debt. If they see that you haven't met the payment, they won't feel obligated to help you pay that $62,500.

What about this scenario? Let's say that John met his deductible months before the tragic accident. Woohoo! e's laying in the hospital bed with a relieved sense of accomplishment on his face, thinking, "I'm happy I acted quickly, otherwise I'd have to pay thousands of dollars on this surgery." Good for you! BUT WAIT! Did you know that insurance companies don't have to pay for specific procedures, medications, treatments, or even doctors? That's right, even DOCTORS. An insurance company might be able to help you pay the cost of whatever type of medicine you need, but at the same time won't help you pay for the services of a specialized physician.

I once spoke to a woman- I'll call her Jenna- back in college who was a classmate at the time. Jenna was an older woman who decided to go back to college to take on a different career path. As we got to know each other, we talked about our families, hopes and dreams. She told me a bit about the day her oldest son was born, how her insurance wound up covering only part of her medical bills, even though she'd been certain that it would be fully covered. During the time when she was still pregnant, Jenna had wanted to employ a doula to accompany her to the hospital once the baby was ready to arrive. (A doula provides emotional support to women in labor and are rather popular in America). However, Jenna's insurance only covered the services of the doctor who would personally deliver her son, not the doula. By the way, having a baby in the U.S. can cost tens of thousands of dollars!

Another thing that American citizens must contend with is copays. A copay, or copayment, is a fee that is shared between you and your insurance company in order to buy a medical product or service. For example, the insurance company that covers me in New York requires that I pay $50- $100 USD (again, depending on the insurance coverage as well as the kind of doctor I want to see) each time I enter a medical clinic to consult a general care physician for whatever reason. It could be for a a regular checkup or a specific, health-related question. The insurance company pays the other half.

To many people, this part of American healthcare makes at least some sense. However, I'd like you to keep in mind the fact that, with all of these excessive payments looming overhead, Americans are not earning high wages in most cases. Sure, some very successful Americans are making upwards of $60,000 a year, but many aren't making anywhere near that sort of income. Minimum wages vary by state, which means that your hourly wage in a job located in Chicago can be wildly different from the hourly wage earned in the same job located in Boston. A person you walk past on the street could be making $12 an hour, while the next person to pass you might make $7 an hour. It's not exactly legal, but it happens all the time.

So, if you're working a minimum wage job at $8 per hour, 12 hours a day, from Monday to Friday, it doesn't matter what kind of health insurance your employer gives you because. Those who work that exact schedule in America makes an abysmal $23,000 a year, basically living in poverty. How can we expect our fellow Americans to pay for anything resembling John's $62,500 bill on a wage that low? Impossible. And for this reason, many Americans, especially young Americans under the age of 40, are terrified of seeing a doctor or going to the hospital.

Somewhere around 30 million Americans are either uninsured or underinsured at this moment, and our government couldn't care less. In fact, it could be more than 30 million after Covid-19. We spend more on healthcare per capita than any other western nation, and yet, according to government statistics, over 20% of well-insured Americans claim to have a hard time paying their medical bills.

If you're curious to learn more about the American healthcare system, a Youtube channel called Second Thought has some pretty accurate information about it: https://www.youtube.com/watch?v=wO1IoKN0AkY  The person who uploads these videos does a ton of research and I think he sums up modern American, socio-political systems very well. Feel free to book a free talk lesson with me, too, if you'd like to talk about it together.  :)

The more I read about people's experiences with our system, the more angry, depressed, and  confused I become. I decided to write about this problem not only because it was something that has surprised me lately as per this week's column topic, but because I feel that it's something that everyone should be aware of, American citizen or otherwise. That being said, if you ever plan on coming to the U.S., enjoy the sights, the people, and the food... but please try not to get sick.

- Marisa T.

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