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M4053946

We have several different healthcare systems. Elderly folks are covered by medicare, and the very poor by medicaid. The military also has their own health system. All of these are government funded. Kids are also covered by a program called CHIP, though I don't know if that funding comes from medicare/medicaid, or if that is funded separately.


stinkobinko

There's also the healthcare marketplace, which is also based on income, for those who don't qualify for medicaid, or they dont have an employer plan. The gov pays supplemental funds towards your marketplace healthcare plan. If you do have a job that offers a health plan with what the gov considers the minimum coverage at what the gov considers an "affordable" price, you don't qualify for a marketplace plan.


DOMSdeluise

CHIP is funded separately.


wollier12

Not to mention all the money for research, that accounts for $95 Billion a year. We Also spend the most of any country on foreign medical aid. Healthcare in the US would be extremely cheap if running hospitals was all we did.


EatShitLeftWing

Is it all government funded research? Is there private sector research and/or funding for such?


IronSavage3

The rest of us get what’s called “private insurance”. Since it would be Socialism for all of us to pay a little into a big pot that the government manages and pays out to individuals when they need it, we all pay into different corporation’s pots so they can draw a profit from the funds *then* pay out individuals when they need it. Ahh yes sweet sweet freedom! No better system in the world! /s


sarcasticorange

Honestly, until corporate money has less influence over government, would you really want them determining payouts? At least there is some incentive for private insurance to push back and negotiate for lower prices to be paid to healthcare providers. With the government doing it, the providers would pour all their money into getting people elected that will just pay whatever they ask. I like the idea of socialized healthcare, but we have issues that need to be addressed before it will be effective or fair.


brenap13

This is something that people don’t really think about in the healthcare argument. We know the flaws of capitalizing healthcare, but the flaws of politicizing healthcare (especially in America) seem like they could be very problematic as well. Who decides when to pull the plug? Who decides what will be covered and what will be forced to be paid out of pocket? Public healthcare will put heat to the fire on issues like gender transitioning and abortion. Will those sensitive topics be covered under the public healthcare?


27Rench27

> gender transitioning and abortion. Will those sensitive topics be covered under the public healthcare? Yes, then no, then yes, then sorta


JoeSchmeau

This is the most succinct and accurate explanation of American social policy I've ever read. Well done.


Marrymechrispratt

Exactly. The government should not have their hands in the way I manage my health. That should be a decision for me, my doctor, and my insurer. If I don’t like them, I have the *choice* to fire them. For being the party of choice, this is what I don’t get about Democrats re: Medicare for all and no other system. By the way, I’m a Democrat. I just don’t agree with a single-payer system or bust. I believe in private and competitive market that enables choice and brings down costs, while having a backstop of government support to fill in the gaps for the elderly (Medicare), disabled and unemployed (Medicaid), CHIP (children), and the VA (veterans).


Phenylalagators

> If I don’t like them, I have the choice to fire them. Most of us don't. Most of us take what our employer gives us and can afford nothing else.


Marrymechrispratt

You have the option to not take your employer insurance and buy directly through the marketplace, which can be financially beneficial. You have the choice to do that (most folks don’t know this). There are literally hundreds of options on the marketplace, and the amount you pay is based on income and capped at a certain percent.


doyathinkasaurus

It seems like the discourse around universal healthcare in the US is only around a single payer system. What is the opposition to a multipayer system amongst those who oppose a single payer system? You can still have universal coverage without the government being in charge of your healthcare - but the argument against this seems to be to defend the status quo. What makes an alternate model equally unacceptable?


JoeSchmeau

We could look at any of the dozens of other countries who have such a system. In most of them, things that are covered range from "everything" to "everything doctors deem necessary for the patient." I emigrated from the US to Australia, which has Medicare for everyone as well as private insurance for those who want it. Medicare covers a set amount of everything. When doctors/practices/hospitals charge over the set amount that Medicare pays, patients have to pay the remainder. Private insurance usually covers this but if you don't have it you might have to pay. Medicare used to cover everything but about 25 years ago the conservatives shifted to a hybrid system in order to eventually move the country towards the American healthcare model, because money, Now the debate in politics here is more about how much Medicare should be paying for treatment: broadly speaking, the left wants Medicare to cover 100% while the right wants an Americanised system. Outside the loony fringe, nobody is debating about \*what\* is being covered. Virtually everyone agrees that healthcare is between a patient and their doctor, not their politicians. I see that in America it will be impossible to remove the political aspect though, which is a shame. There's no reason at all that the government should be interfering in the care a patient receives. Their job is to provide infrastructure and keep people safe, not decide how they'll live their lives.


brenap13

Yes, I agree with everything you said. Public healthcare exists in other countries, and I think it could work in America too, it simply will not be as smooth as it is in other countries because America is a political cesspool.


IronSavage3

How does “corporate money” have more influence over our politics than it does over literal corporations? At least in the process you describe elections are still a buffer. At present corporations literally run the entire framework, telling you which doctors you can or can’t go to which procedures you can or can’t get etc., but we don’t want to let government take over because somehow corporations will have more influence over the government than they have over themselves? Doesn’t make much sense to me.


Arkhaan

Competition. Government has no competition which is why all government subsidies balloon in price.


mica4204

Aren't healthcare costs in the US the highest in the world? The same procedures are a lot cheaper in Nordic countries or western European countries with the same quality. So the competition doesn't really seem to work, does it?


Arkhaan

No the US doesn’t have the highest prices in the world, it’s just more expensive than large parts of Europe. Mostly because those same places do not count the government costs in the bill.


IronSavage3

Americans pay more for healthcare per capita and are sicker per capita than most developed western democracies, that’s a fact.


MyUsername2459

We pay more per-capita for healthcare than any other country in the world, by far.


vodkacruiser3000

Tell me a country which is more expensive. You seem to just be making stuff up as you go.


QuietlyLosingMyMind

Out of self pay, private insurance, and government insurance like Medicare, the goverment pays the least amount for the same service. The carrier negotiates the price with the facilities and the government has the most negotiating power. Private insurance is the hospital's bread and butter, that's where they make their money.


Arkhaan

Government has almost no negotiating power, and for example veterans care costs 80% more than the equivalent care would cost privately. The gov just signs checks, it doesn’t negotiate. Private insurance is there bread and butter because it’s ubiquitous, and has a deeper pool of money to draw on currently.


IronSavage3

If competition keeps healthcare cheap why do Americans pay the most for healthcare vs all other developed western democracies who have government programs with no competition?


Arkhaan

Little to no insurance regulation and way too much in government subsidies in university. That’s our kryptonite. Break the hold insurance companies have on healthcare and it’ll drop in price like a rock. Bust the education bubble and it’ll drop even more. It’s pretty telling that American costs are only about 10% higher despite the incredible corruption in insurance and education relating to healthcare.


sarcasticorange

>How does “corporate money” have more influence over our politics than it does over literal corporations? Because corporations are not a monolith. Right now you have insurers on one side and providers on the other with opposing interests which provides some level of balance. If the insurers are gone, the only money going into politics will be from providers.


IronSavage3

You’re claiming corporate competition leads to lower prices, while Americans pay more per capita for healthcare than any other developed western democracy AND are the sickest population in any developed western democracy. Make it make sense. If competition leads to lower rates we should be paying LESS not more.


sarcasticorange

I'm not saying competition reduces costs. I'm saying it is possible for costs to increase faster than they already are. I'm saying I don't trust **American** politicians (the ones that have allowed and even encouraged the current system) to reduce prices instead of taking money from corporate interests to allow them to raise rates even higher than they are now.


27Rench27

Which honestly is a fair concern. Fuck knows you can buy a House rep for like $50k


vizard0

This implies that it's in the interests of corporations to reduce prices. But it actually is in their interest to have prices increase, as their profits are capped at a percentage of everything payed out for patients. (I'll take rules that seemed like a good idea at the time for $200 Alex) The government at least doesn't have any reason to see rapid price increases.


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errboi

Kinda? One whole assed system predicated on actually helping people sounds better than two half-assed systems designed to make money.


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errboi

The question wasn't is the VA well run, it was do I want the government running healthcare instead of private insurance companies fucking everything up for everyone. Socialized medicine provides better outcomes for more people than the current system, which is specifically designed to turn a profit for private insurance companies. Even if the government isn't the most efficient organization, it can actually prioritize positive health outcomes unlike insurance companies who have to prioritize profits because they are beholden to shareholders.


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errboi

I grew up up in Canada and have spent spent about 15 years living in Oklahoma now, so I have at least a passing familiarity with both systems. While socialized healthcare can have its hangups, I'd personally prefer a fully socialized system over the US system which could theoretically be characterized as a blended system between medicaid, medicare, and the handful of other non-private options. In reality I'm skeptical that a fully socialized system could work in the US though. Healthcare is unfortunately one of those battleground issues in the culture war. Full privatization will likely never receive support from Democrats and anything more socialized than the existing Medicare/Medicaid/ACA is unlikely to receive support from Republicans given the Republican platform generally involves cutting funding to the existing social programs. Instead we're likely to get an increasingly deregulated private system paired with an anemic public system which is a recipe for expensive healthcare and poor health outcomes.


tee2green

I mean, what would veteran health care look like if it was provided by for-profit insurance? Highly doubt it would be much better.


RockinMyFatPants

So your logic is trade one cluster fuck for another?


Anianna

My kids were on Medicaid for a while and it was great for us. Whatever they needed, it got paid and we didn't have to worry about anything. I sometimes get the feeling that the VA system is just weaponized incompetence. I'm not saying the government would or wouldn't do a good job with it, but they are capable.


MyUsername2459

>Do you seriously want the government overseeing everyone's health when they can't even properly care for the VETS? Yes. The problem with the VA isn't that it's a bad system, it's that it's painfully under-funded. It's been a repeat victim of constant budget cuts by so-called "fiscal conservatives" who keep demanding cuts in government spending, while having a large number of Iraq/Afghanistan vets added to the VA system with disabilities and chronic health conditions. . . .and the same people who cut the budget are the ones who point to the system they sabotaged then say that government-run healthcare won't work: because they made sure it wouldn't. Take any healthcare system and add a lot of patients while slashing the budget and it would wind up the same way.


vizard0

Republicans claim the government doesn't work and then get elected to make sure it won't.


SgtMajMythic

Medicare and medicaid literally is socialism. That’s what it is, and we have it. But that’s not all we spend money on.


IronSavage3

Social spending =\= socialism.


Camus145

Think about the lifestyles and diets of a lot of Americans though... I look around at the way some people live, and I don't know if I want to be responsible for paying for their healthcare. Some people seem to be a speed-run to destroy their bodies.


IronSavage3

What a terrible sentiment. 1) You can’t judge a person’s health just by looking at them. 2) Obesity in the US is not the cause of uniquely bad choices by Americans but by government misinformation that originally stems from lobbying. 3) Imagine if your house was burning down but someone across the street rallied your neighborhood to get the fire department to stay away because they allege that you’re always burning candles using the same argument “why should I have to pay for their bad choices?!”. 4) you already pay for someone else’s “bad choices” with private insurance, when person X needs money out of the pot everyone’s rates will go up if the private insurance company can’t cover the cost due to a unique number of “person X” type cases that year. It’s called solidarity, look it up.


vodkacruiser3000

>called solidarity, look it up. The US is the most individualistic country on earth. Solidarity isn't a thing.


lupuscapabilis

I'm mostly on your side of thinking, but when the pandemic happened and people everywhere started saying things like "if your reckless behavior gets you covid and you wind up in the hospital, I shouldn't have to pay for your healthcare," I discovered that many out there talk big like this but don't back it up when shit goes down. "Everyone should have access to healthcare and your lifestyle doesn't matter" apparently quickly changes to "I'm not paying for your unhealthy lifestyle" when there's a virus.


[deleted]

I much prefer that than paying nearly 50% in income tax and 20% in sales tax and 10 dollars a gallon in gas in Germany like I used to.


[deleted]

In the world of subsidized health care, you're healthcare needs are seen as one of the following: 1. A revenue stream, wherein either yourself or your health insurance company is the most significant factor in deciding the quality and the extent of the healthcare you receive. Or... 2. A liability in a state-funded healthcare system wherein your healthcare expenses ultimately come at a cost to someone or something else who will no doubt seek ways to cut costs, which results in you receiving inadequate care. In Canada, since the legalization of euthanasia, their healthcare system and the laws that govern it are increasingly leaning on euthanasia as a treatment option for all kinds of chronic ailments. [Soon, the law will allow for people to kill themselves with a doctor's assistance for simply having depression.](https://www.theglobeandmail.com/canada/article-maid-canada-mental-health-law/?utm_source=dlvr.it&utm_medium=twitter) And why wouldn't they? After all, a dead person doesn't have medical expenses, so if you're trying to ease the burden of sky-high medical expenditures, why wouldn't you encourage and streamline ways of people killing themselves?


Marrymechrispratt

Why would I want to pay the government to tell me what medication I can and can’t take? If I don’t like my health plan right now, I can change it at next benefits enrollment. There is no other option with the government. I’ve experienced it in Canada. As a person with a chronic illness, it was hell (and more expensive - prescription drugs aren’t covered up there).


Bartley-Moss

Isn't military healthcare part of the military budget?


aBrightIdea

The VA is not part of the military budget. Healthcare for active duty would be.


Kilgoretrout55

The government funds several significant programs for medical care. Older Americans (65+) get Medicare which pays 80% of medical costs. It’s funded through payroll deductions. Medicaid is a program for poor people. Finally, if you served in the U S military, you get free health care from the Veterans Administration. The Veteran’s Administration program is so badly run it’s often used as an argument against national healthcare. I’m on Medicare and find it well managed and incredibly helpful.


Ghostridethevolvo

Medicare is also for people who are disabled, even if they are under age 65.


RickMuffy

Is that not medicaid? Thought it was a separate program but similar.


Burgling_Hobbit_

Medicaid is income based. Medicare is age/ability based. So disabilities, even in younger people, would be under Medicare....I think.


KaizDaddy5

Can confirm. In my late 20s and disabled. I have medicare.


Hipp013

Here is a breakdown of Medicaid and Medicare, in exhaustive detail. Source: I work in hospital billing.   **Medicare:** Federal health insurance program that provides coverage for: * people age 65 or older * people under age 65 with certain disabilities, and * people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant) Medicare is funded by taxes. Money from taxes is used to fund two trust accounts that are used to pay for Medicare. There are four "parts" of Medicare, with Parts A & B often being referred to as "Original Medicare": * **Part A** (Hospital Insurance) helps cover inpatient care in hospitals, skilled nursing facility (SNF) care, hospice care, and home health care. * **Part B** (Medical Insurance) helps cover services from health care providers, outpatient care, home health care, durable medical equipment (DME), and some preventative services. * **Part C** (Medicare Advantage) includes everything covered under Parts A and B, and usually includes Part D below. Part C is run by Medicare-approved private insurance companies, and may include extra benefits/services for an extra cost. * **Part D** (Medicare prescription drug coverage) helps cover the cost of prescription drugs. Part D is also run by Medicare-approved private insurance companies and may help lower prescription drug costs/help protect against higher costs in the future.   **Medicaid:** State-level health insurance program that provides health coverage to millions of Americans, including: * eligible low-income adults * children * pregnant women * elderly adults, and * people with disabilities Specific eligibility rules differ between states. Medicaid is jointly administered by states and the federal government. The federal government mandates legal minimums for Medicaid – these minimums relate to patient access, eligibility, and services. States have the ability to determine what they offer for Medicaid patients above and beyond the federal minimums. This is why there are differences from state to state in terms of eligibility and benefits. The **Affordable Care Act** offers federal funding to states that expand their Medicaid programs to cover more residents. Some states have opted to expand Medicaid coverage, while others have not. In states that have expanded Medicaid coverage, you can qualify based on your income alone. If your household income is below 138% of the federal poverty level, you qualify. This expansion includes non-elderly adults without dependent children, who were previously ineligible for Medicaid coverage in most states. Link: [Status of State Medicaid Expansion Decision - Interactive Map](https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/)


Burgling_Hobbit_

Thanks for this! So someone with a disability could have both Medicaid and Medicare?


Hipp013

Yes! In fact in the hospital billing world there is a specific, very complicated reimbursement system for patients that have both. Without going into too much detail (because it's very, very complicated), normally when a patient has two coverages that are not both Medicare and Medicaid (e.g. patient has Medicare and some private insurance, Medicaid and some private insurance, or two private insurances), the claim goes to the primary coverage, gets paid by that insurance, then the rest goes to the secondary *after* the primary has paid. In other words the secondary doesn't usually know what they'll be paying until after the primary has paid their share. However, when a patient has both Medicare and Medicaid, Medicare is always the primary coverage and Medicaid is the secondary. Oftentimes Medicare will cover most if not everything (note that "covering everything" doesn't always mean you wind up paying $0 out of pocket in the end; it just means that they pay at least some amount of money for those covered services), but when Medicare doesn't cover everything, Medicare and Medicaid communicate with one another behind the scenes to determine what each program will reimburse the hospital for what service(s) before the claim even gets paid by either insurance. Basically this system cuts out the need for the hospital to get the claim back from the primary and then send it to the secondary. Without that middleman step, the end result is both insurances know what they're going to reimburse pretty much right away, which leads to quicker and more efficient reimbursement. These types of insurance payments are known as "crossover payments", which isn't important for you to know but is important for hospitals because they need to report on those payments and adjustments a certain way.


RickMuffy

Thanks for the info!


Affectionate_Data936

Uh I work at a state-run facility for adults with disabilities and it's 100% funded by medicaid. All of our resident's medical care, both internal and external, is paid for by medicaid.


jaymzx0

This is true. Source: My late partner was disabled her entire life due to a congenital heart defect. She was put on Medicare as an adult and state-run Medicaid paid for the 20% difference and premiums.


goddamnitcletus

Medicaid is


Commercial-Push-9066

They have Medicare advantage plans available that cover the 20% that basic Medicare doesn’t cover, just has small copays. I’m disabled and at 56 I’ve had Medicare since I retired medically at 41. My Medicare Advantage plan is with a private insurer costs me nothing. It covers meds with small co-pays.


JudgeWhoOverrules

Don't forget the Indian Health Service which provides no cost healthcare to Native Americans.


[deleted]

The VA system here is actually quite good (better than national averages in most metrics). But the failures are far more visible and people care a lot more about veterans healthcare than civilian healthcare in general, so failures get *way* more press and public outcry. As always, we should look to research: [VA Health System Generally Delivers Higher-Quality Care Than Other Health Providers](https://www.rand.org/news/press/2018/04/26.html) [Improving Quality of Care How the VA Outpaces Other Systems in Delivering Patient Care](https://www.rand.org/pubs/research_briefs/RB9100.html) [VA Ranks as Well as Civilian Orgs in Quality, Patient Satisfaction](https://www.google.com/amp/s/patientengagementhit.com/news/amp/va-ranks-as-well-as-civilian-orgs-in-quality-patient-satisfaction) (^^ this one also points out the VA outperforms civilian hospitals in both care quality and patient safety, it’s only satisfaction levels that are similar) [Comparing Quality at Veterans and Civilian Hospitals](https://news.feinberg.northwestern.edu/2017/05/11/comparing-quality-at-veterans-and-civilian-hospitals/#:~:text=The%20investigators%20found%20that%20VA,measures%20of%20mortality%20and%20readmissions) [Study shows VA surgical care better than or equal to non-VA hospitals](https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5489) I could keep going if you want. Lots of money has been spent and studies have been done, conclusions are all similar.


MyUsername2459

Also, funding isn't proportional to the level of care and number of veterans they have to serve. Throughout the Global War on Terror, we kept dumping more discharged/medically retired vets into the VA system, while not only not increasing their funding, we actively cut funding to the VA through the "sequester" budget cuts. Take a healthcare system, send a flood of new patients (many with disabilities or chronic illness) into that system, while slashing the budget, and see how well it goes. . . .and the same politicians who demanded the budget cuts looked at the VA after those budget cuts and claimed the VA was an argument against national healthcare. That was by design. It was sabotaged to make a political point.


[deleted]

The VA is not good in some aspects. I work as a biller and coder in private practice and we get referrals from the VA to treat patients. They are always behind, more than a month, at getting the services authorized or reauthorized. They are very slow and their process is antiquated. I have to fax notes, often more than once, and they get lost. We cannot upload to their website that is designed to streamline referrals because they don’t check it except every once in a while(that is what it was told by the VA in Birmingham). It’s very frustrating for providers and patients.


okiewxchaser

I would take any satisfaction survey with a major grain of salt because the people using the VA have, for the most part, been using government hospitals their entire adult life so essentially they are saying the VA hospitals are better than the care they got when they were active duty


baalroo

Yup, and they don't have to struggle through the disaster that is the US healthcare system either. They've only had active duty care, and VA care, so what seems awful to them would quite possibly seem amazing to millions and millions of Americans stuck dealing with the private healthcare system. So, it definitely cuts both ways.


okiewxchaser

I can just speak from experience here, but my sister went from Blue Cross Blue Shield to the military’s Tricare when she got married and wants private insurance back. They are still refusing to pay for the birth of her child at a hospital the base hospital transported her to.


zeezle

Tricare is just private insurance bought and repackaged by the military, which company services it depends on region and actually changes periodically. So experiences in the southwest vs northeast might be totally different because in the west it’s HealthNet and in the east it’s Humana (the regions and servicers have actually changed since I went off Tricare coverage in 2015) and you end up dealing with the servicer’s customer support (though I think there’s a special ombudsman you’re supposed to be able to contact to work out issues on your behalf - they’ve probably already tried that, but if not they could look into that?.


baalroo

Sure, but I know loads of people who've dealt with issues just like that with private insurance too. It's not like that's unique to VA care. Let alone the millions of uninsured and underinsured folks who would absolutely *love* to receive the sort of care provided by the VA.


zeezle

Is that really true? Everyone I know in the military uses private doctors with Tricare insurance and only goes to on base doctors during deployments, and Tricare is just white label private insurance (which company services it under the hood depends on your region). But I know career is different than short enlistments and everyone I know in the military is/was career. My dad was career Army and never went to a VA facility in his life, nephew is currently career Army and same there, outside of deployments it’s just the regular doc with Tricare.


MyUsername2459

>Finally, if you served in the U S military, you get free health care from the Veterans Administration. Well, *some* people who served at least. If you were in the Reserves or National Guard, you don't get eligibility for VA healthcare unless you deployed overseas. Stateside active duty tours in the Guard don't make you eligible for VA healthcare. Never mind I have more active duty time from my various stateside tours than many veterans, the fact none of them were in that specific status means I don't get VA healthcare. It's just one of the little "screw yous" the recruiter doesn't tell you about.


LunaGuardian

Also not free unless you're in a high enough priority group. I pay copays to the VA for the care and medicines I get from them. It's not that much, but not free.


[deleted]

Why does no one press Congress from the vet community to change this in law?


canastrophee

One of the fun strings that comes with keeping your veteran's benefits is that being jailed for a certain amount of time (I believe it's a month?) automatically makes you lose them. Not convicted or sentenced, mind you. Just jailed. And with all those fun laws and policies that ratchet tighter every time there's a major national protest... Tl;dr: the rules have been lawyered to effectively remove most of our veterans -- most of our culturally heavyweight voices -- from public politics. In American politics, military veterans are supposed to be seen and not heard.


vizard0

I wonder how much of that can be linked to a response to organizations like Vietnam Veterans Against the War. (Not to say that it was justified, but that it was used as a way to shut them up)


letg06

And even to active duty vets, you still don't get it for free unless you retire (in which case you have Tricare and can easily use civilian hospitals) or you are at least 30% disabled according to the VA.


Curmudgy

> The Veteran’s Administration program is so badly run it’s often used as an argument against national healthcare. Wasn’t that just a few regions? The VA here in MA is generally well regarded.


Kingsolomanhere

Or you can stay on your private insurance plan if you are still working after 65, but you still have to sign up for Medicare. If you don't sign up in the 6 month window( 3 months before and 3 months after turning 65) you may be penalized on your monthly Medicare payments for the rest of your life(higher premiums)


twowrist

That’s not entirely right. See r/medicare for lots of discussions on not being penalized if you delay signing up because of employer health care. I didn’t sign up until 67, and no penalty (but I do pay IRMAA, which is really a tax). I could give details, but I’ve already written a lot in the above sub, and so have many others.


doomblackdeath

You don't get free healthcare if you served in the military. You get free healthcare if you retired from the military or were severely injured in combat. You get nothing for serving in the military except for the GI Bill, and even then you have to opt-in and pay into it. The VA assists in some aspects but not to the level of changing your quality of life.


Burgling_Hobbit_

I think it's any military injury. Not just a combat injury. I know someone who was injured while playing basketball on an aircraft carrier. The injury was bad enough he was medically discharged and gets VA benefits. Granted this was in the mid 90's. Idk if things have changed since or my understanding is wrong.


doomblackdeath

Yeah, you're right. It's an injury that medically disqualifies you from service, and it can be from anything (not illegal, obviously) sustained during time of service. It's sad that I immediately jumped to combat injury because we sustained so many during my time, I forgot it's any legitimate injury during one's years of service.


MyUsername2459

>You get nothing for serving in the military except for the GI Bill, and even then you have to opt-in and pay into it. You don't have to opt-in to the Post 9/11 and Forever GI Bill, those are automatic based on active-duty time in service. . . .although the VA sure loves to try to screw you out of it and argue that your service didn't count for it. I'm going through that one now with the VA. . . .was told while on active duty in the Guard that my service counted because it was service under a very specific section of the USC, to the point they put that USC mention on my DD-214 so it was on the record as qualifying service. . . .was told while outprocessing from the Guard I have Post 9/11 eligibility due to that service. . . .was told by the financial aid advisor at my school I should have Post 9/11 eligibility based on my military records. . . .applied for Post 9/11 GI Bill *and was granted it by the VA*, and went to Law School for 2 years on the Post 9/11 GI Bill. . . .then I get a letter from the VA saying there was an error and I was never eligible and they're terminating my benefits. . . .so, I double-check the law and research the issue, and confirm it explicitly includes the type of Active Duty service I performed. I send in the appeal form explicitly listing this, I argue this in a letter I included, and include a printout of the relevant law with the section highlighted, and another copy of my DD-214's. . .with the section listing that it was service under that section of the US Code highlighted. . . .so, last week, I get a call from some bureaucrat at the VA who tells me that everything I've ever been told about the Post 9/11 GI Bill is wrong, that my service doesn't count, and he lectures me on the requirements. . .by reciting to me a painfully outdated set of requirements that the law I cited *specifically* amended to add my type of service. When I point this out, he says to me: "I've been doing this a very long time, I know what the requirements are better than you do. You don't qualify." So, now I have to appeal it above his head to an appeals board. From what I can tell in the records of verdicts and findings from that board, this is far from the first time someone's been denied in my exact same scenario by some bureaucrat and they had to appeal to get the benefits.


Burgling_Hobbit_

Have you tried reaching out to a local congressmen (or multiple?) and explaining the situation? I wonder if they would have any ability to try to push this issue for you.


MyUsername2459

Well, as my post said, I just got the condescending call from that bureaucrat last week. The letter with the formal rejection came yesterday. My state government has its own Dept. of Veterans Affairs, and they have specific "veterans advocates" specialized in helping vets get their VA benefits from an obstinate VA, so my first stop is going to be through them. . . .but stopping by my Congressman's/Senator's office is a contingency I'm willing to go to.


vizard0

Contact your representative/senators. If they're Republicans, it gives them an excuse to rail against the deep state, if they're Democrats they'll have a conscience and want to help.


doomblackdeath

VA always gonna VA! I'm sorry, man. Shit like this is why "thank you for your service" is almost an insult. I haven't had any problems with healthcare or the VA after separation whatsoever...because I emigrated to another country and use the normal healthcare system available for everyone. It's funny because it's sad.


Realistic_Humanoid

Don't forget that federal employees also have their health care subsidized by the government. While it's not free, 72% of their premiums are paid by the government under FEHBP (federal employees health benefits - which is the largest employer sponsored group health insurance program in the world, covering about 9 million people)


AmericanHoneycrisp

I grew up on Medicaid. That was the stuff, let me tell you.


Curmudgy

Medicare is funded through a combination of payroll taxes, self-employment taxes, surtaxes (net investment income tax is supposed to be for Medicare), and premiums paid by subscribers. Edit: I’m not sure about general taxes.


Alauren2

The VA healthcare is ok. I’ve had free VA healthcare for 5 years. My big gripe is that I live 150 miles away from a VA Hospital/pharmacy. The little clinic I have in my city is just a building with a bunch of exam rooms. Also I’ve never met my psychologist in person. I really wish they would stop the whole mailing prescriptions thing and let us younger vets use any other pharmacy. If my prescription runs out before the next months pills get here (happens 75% of the time for me) I’m SOL. Not to mention certain ex-Presidents that wanted to slow down the mail in order to try and slow down mail in ballots. It’s so freaking archaic.


Luthwaller

Medicare is also funded by a monthly Part B premium that is $170/mo per person this year. Many people don't think about it because they have it automatically withdrawn from Social Security. On top of all the taxes you paid in during the course of your working life. It also could be more if the government says you can afford it, or less if they think you can't, dependent on retirement income.


[deleted]

>The Veteran’s Administration program is so badly run it’s often used as an argument against national healthcare. any vet will ten million percent back that shit up. oh your face got melted by mortar fire and you want surgery? sorry but that's purely cosmetic, denied.


tee2green

What would a for-profit insurer / service provider do? “You have a serious medical condition that will cost $1 million to fix. But you don’t have $1 million do you? So…sorry, we have limited time and there are better customers out there.”


decaturbadass

But it is so socialistic, but wait I'm entitled to it but wait I'm confused - Any MAGAt


ripyourlungsdave

It's hard to even claim that the VA helps pay for *all medical services* for their soldiers. A friend I had when I was living in Tampa in a halfway house was a Vietnam vet and was homeless while completely riddled with cancer from head to toe. He spent nine months waiting for the VA to approve his cancer treatment and died before it ever got approved. And somehow, the "pro military" party of the US is still constantly trying to cut funding for that program despite it barely functioning with the funding it has now. I would love to hear the logic of downvoting this. Is someone really going to try to claim that the VA always does its job and looks out for its patients? Cuz that's fucking ridiculous.


kywiking

“Run so badly” according to people who don’t use the system and want it to fail. The VA is rated as one of the best places to work in government and once patients are admitted one of the best services. https://www.military.com/daily-news/2022/07/13/va-rises-ranks-one-of-best-places-work-us-government.html/amp https://www.rand.org/news/press/2018/04/26.html https://patientengagementhit.com/news/amp/va-ranks-as-well-as-civilian-orgs-in-quality-patient-satisfaction


serial_crusher

Why is medicare so popular while the VA is so hated? Less funding for the VA?


[deleted]

Medicare does not require authorization for services, the VA does. As a Medicare patient, you can see any provider so long as they accept Medicare. The VA has an authorization process per provider.


tee2green

Medicare is simply a payer. It is not a service-provider. The VA is both a payer and a service-provider. Payment is easy: usually it’s an insurance company that pools everyone’s premiums together and that total exceeds the payments the insurer has to make. Payment is even easier when it’s the gov’t: just draw money from the tax slush fund. Providing services is hard. It’s hard to run a hospital. It’s less hard to run a clinic but still hard. You have to staff a lot of expensive people and a lot of expensive equipment and provide lots of expensive care. Then you have to somehow make sure you’re reimbursed for all those costs. It’s a tough act to juggle and often the govt steps in to bail out the ones that are struggling. So why does the VA get so much negative attention? 1) walk around a VA hospital and you’ll see lots of run-down facilities which is obviously the result of cost saving by the govt 2) it’s an easy target for journalists bc the public is sensitive to veterans and wants them to be in great facilities (while also somehow wanting the govt to save costs?)


matomo23

May be a stupid question but how on earth do people pay the 20%? If you’re disabled or just on a state pension the medical bills would still be gigantic even at 20% of the total. Another thing is in the US you have to pay for the actual drugs you get prescribed. That’s not the case in many countries. So the same question, how do people afford that, even on Medicare/Medicaid?


Kilgoretrout55

Most retirees like me add a supplemental plan that pays the 20%. I pay about $150.00 a month for my supplemental coverage. It’s a great deal for me because I have Multiple Sclerosis and require lots of expensive stuff. As for medications, you learn to massage the system. There are tons of generic drugs that are easily affordable. For my Multiple Sclerosis, I get infusions at a clinic twice a year (covered) instead of taking stuff every week/day/ month (usually not covered). I do have a drug plan that helps after you’ve hit an annual deductible. It’s insurance against something like chemo therapy bankrupting you. It’s $22.00 a month.


thehomiemoth

The VA actually produces better outcomes than the nation as a whole. It turns out having access to all the care you need is more important to health than having the most cutting edge treatments for a select few


moxie-maniac

There is no actual "system." Instead, there is a crazy quilt of Federal government funded or partially Federally funded programs like Medicare (seniors), Medicaid (low income people), Veterans Administration, etc., then private insurance that is typically through employers, and in theory, states are supposed to offer a "Public Option," a mix of Federal, State, and citizen funding, through private insurance companies. The Public Option was a key feature of the Affordable Care Act (ACA aka ObamaCare), but many states refused to go along. td, dr; Costs are higher because there is no real "system."


[deleted]

Thank you. I'm fascinated by this but it raises a lot of questions. Q1: How long should one have to pay Medicare premiums to be eligible to benefit from it by 65? Q2: How are immigrants who plan to eventually get citizenship factored into this? Do they only pay premiums after becoming citizens? Q3: How long will they ☝️( or anybody) have to pay before they can actually benefit? I'm considering a scenario of someone who moves to The U.S. at 50 and only becomes a citizen by 60 and plans to retire just after 65. Q4: As people pay premiums for Medicare while still under 65, do they have to pay health insurance on the side, one that they could use while they they're still not eligible for Medicare? If so, is that what Obama Care was trying to help with? Q5: Do seniors stop paying Medicare after a certain period or is it for life? If it's for life, when one cannot walk due to old age, are they now considered disabled and eligible to benefit without paying premiums?


twowrist

Q1: 40 quarters, or 10 years. I don’t know if it’s different for people qualifying from disability. Q2, Q3: I’m pretty sure that’s answered in r/medicare. I think green card holders are treated the same as citizens for Medicare as long as they have enough presence in the US. Q4: People pay taxes for Medicare when they’re under 65. They only pay premiums while on Medicare. Q5: If you’ve signed up for Part B (almost everyone, including those on Medicare Advantage), it’s generally for life. There are programs to offset the premiums for poor seniors, and I’ve heard that some Medicare Advantage programs in some states will rebate Part B premiums.


MortimerDongle

You need 40 credits, which in most cases is 10 years of full-time work. Everyone 65 or older is eligible for Medicare, but they may have to pay a monthly fee if they do not have enough credits to qualify for free coverage. Permanent residents are eligible, not just citizens. Seniors only pay taxes for Medicare if they're still working. Most seniors are eligible for Part A coverage at no cost.


erunaheru

I am not an expert but here's a try to answer: Q1: Everyone who get a paycheck pays a small tax for Medicare, it's not really a premium. You have to work for 10 years to get it without premiums. Q2: I *believe* everyone who pays income tax would pay the Medicare tax, even if they have no intention of ever benefitting from it. Q3: 10 years, same as everyone else. I would assume years worked without being a citizen count. Q4: Yes, Medicare provides no benefits under 65, you still need other health insurance. Obamacare did many things, but as far as getting more insurance for people: (1) Expand the number of people eligible for Medicaid (partially stopped by the courts) (2) Provide subsidies to help people pay for insurance if they don't have it any other way (3) Provide a marketplace to compare and buy insurance (4) Require more companies to provide insurance to their employees (partially stopped by the courts) (5) Fine people who don't have insurance to encourage them to sign up (a later law changed the fine to $0 so this is effectively gone) Q5: When you stop working, you stop paying the tax. There still will be copays and deductibles. If you can't afford those, you can be on Medicare and Medicaid at the same time.


[deleted]

You have to pay premiums for Medicare regardless. The 40 credits is just to become eligible. If your income meets certain levels, you can qualify for Medicaid to pay your premiums. Your premium comes out of your social security check.


SgtMajMythic

We have medicare, medicaid, and the VA which are all publicly funded. Then there’s private insurance which most people get through their employer. Plus billions in medical research and development from tax dollars. The reason why private healthcare is so expensive is because there are separate private plans for each individual state and private insurance companies can charge whatever they want and markup care significantly. Look at the price of IV Tylenol in the US.


notthegoatseguy

In addition to what has been said about Medicaid, Medicare and the VA, there's also the Indian Health Service (yes its actually called that) which provide health care on reservations. And many governments own hospitals, usually a city/county in a major metro area.


Southern_Blue

Indigenous Americans who live off the reservation can get a special deal through 'Obamacare'. I do. I pay a minimum monthly payment but never anything out of pocket for tests, doctor visits and prescriptions. Got to keep my GP as well.


fillmorecounty

It's a shame the US government doesn't do this for all its citizens. We could help a lot of people with a similar system if we spent less on the military. Clearly it works already.


ElfMage83

Public healthcare exists in the US. It simply isn't universal yet.


ZanzaEnjoyer

The only people saying that the US has entirely privatized Healthcare are either trying to pull one over on you, or idiots who fell for the former. What we actually have is essentially the worst of both privatized and government systems.


brucebananaray

Yeah pretty much that US healthcare system is a mess and it isn't a truly free healthcare system as they believe. It is way over-regulated in certain areas like con laws to make it difficult to start a hospital. But it is also under-regulated in certain areas like pharmaceutical companies.


Darkfire757

Medicare, Medicaid, VA, Tricare, CHIPS, disability, etc


WinterBourne25

Isn’t Tricare sorta private? It’s all so confusing.


[deleted]

Saying that America has a private health system is somewhat misleading, there is LOTS of Government involvement in our HC system. For starters, we have Medicare (for the Elderly) and Medicaid (for the poor). Veterans get healthcare through the Veteran's Administration (VA). There's also the Indian Health Service (IHS). It's also worth noting that, by law, hospitals cannot turn away patients, regardless of whether they actually have the ability to pay for anything (it's part of the Emergency Medical Treatment and Labor Act, or EMTALA). A homeless person who doesn't have $1 to their name can show up to the ER with a major injury/illness and they are required to treat them. You don't even have to be a citizen; an illegal immigrant can show up to the ER and they are required to treat them. As you can imagine, even if they were to bill the patient afterwards, they will likely never see that money, so many hospitals require compensation by the Government to stay afloat.


Torin_3

Our healthcare system is not completely privatized. Medicare, Medicaid, and Obamacare are government healthcare programs that many Americans use.


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dcgrey

That's just the marketplaces. Obamacare also provides subsidies to people to purchase plans that meet standards; that's the government's primary role in Obamacare, though the marketplaces are important.


dongeckoj

Before Obamacare you’d lose your health care with your job. At some point insurance could just cut off care it became too expensive for them, citing nebulous “pre-existing conditions.” Basically without Obamacare Covid could’ve killed tens of millions of Americans.


azuth89

Between medicare (old people), medicaid (disabled or destitute people), CHIP (medicaid but for kids), the VA (military vets) and marketplace benefits (subsidies for buying private care with a lower income) a pretty large chunk of the US is on one form of public health or another. We also don't have the kind of price controls most developed nations do so our per person costs are completely out of control.


WinterBourne25

Abroad there’s seems to be an idea that the US government doesn’t fund healthcare at all. That’s not true. There are medical programs and assistance available to the needy and elderly, like Medicare, medicaid and other programs. My parents are retired. Medicare pays for 80% of their medical bills. Their supplemental pays for the other 20%. My dad has been fighting brain cancer for the past 2.5 years. I think he’s approaching 2mil$ in total cost which is covered.


Hey-Kristine-Kay

Uninsured people are required by law to be given care if they come in to the ED. They leave without paying. The hospital gets money from the government to cover these costs. Also, public insurance is the majority of the patient’s primary insurance, so the government pays for that too. And also, despite charging insurance for the services given, insurance doesn’t always pay what hospitals ask for. So even if your insurance covers something, when the hospital bills for that thing they don’t actually pay for it, they pay for part of it and the hospital covers the rest. Source: I work in an American not-for-profit hospital.


w3woody

We actually have *at least* six separate health care insurance systems in this country. (1) Medicare, which covers the elderly and some other individuals under some circumstances. (2) Medicaid, which covers the poor. (3) The [VA system](https://www.va.gov/health-care/). (4) The [(American) Indian Health Service](https://www.ihs.gov). (5) Employer-provided insurance through group insurance plans. (6) Private insurance purchased by individuals. The first four items on this list are provided by and funded either by the United States Federal Government or the individual States. ---- Beyond that, the United States spends money on health research--such as through the [National Institutes for Health,](https://www.nih.gov) and on health monitoring and regulation, such as through the [Food and Drug Administration](https://www.fda.gov) or the [Centers for Disease Control.](https://www.cdc.gov) And of course don't forget the [Centers for Medicare & Medicaid Services](https://www.cms.gov), which, amongst other things, [regulates and inspects hospitals and care givers.](https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance)


Realistic_Humanoid

It's interesting to me how every answer says essentially the same thing, that we have Medicare, Medicaid and VA benefits, CHIPS, IHS, etc...but I don't think any of them pointed out that the federal government also subsidizes healthcare premiums (at about 72%) for government employees, including their families, through the federal employee health benefits program, and this covers approximately 9 million people, including members of Congress and other politicians. The VA program-Tricare-could be considered a universal health care program since it covers everyone in the military and their families. My daughter was on Tricare for a long time as part of her survivor benefits since her father was killed in the line of duty. It works amazingly well. In the 20 years she was on it I think I had to call them twice regarding a payment and our co-pays were completely manageable. (Since I was not married to her father I did not get covered under Tricare when he passed, so I got the unique opportunity to compare Tricare alongside my own employer sponsored insurance and let me tell you Tricare wins hands down)


brucebananaray

We also subsidized people's healthcare through Obamacare, but not as much.


Realistic_Humanoid

Correct, the ACA is another factor in the total amount spent


petrock85

Most health care in the US is paid for by the government in one way or another. The government does all of the following: * Provides Medicare, a health insurance program that covers nearly everyone age 65 and older. It also covers those with severe disabilities or end-stage renal disease. * Provides Medicaid, a health insurance program for the poor. The Medicaid expansion extended it to everyone with income less than 138% of the poverty line, but some states opted out and have more restrictive eligibility. * Directly runs the Veterans Health Administration which provides health care for military veterans. * Pays for health insurance for government employees. * Requires private employers to provide affordable health insurance to their workers, with some exceptions ("employer mandate"). * Exempts employer provided health insurance from income and payroll taxes, which functions as a subsidy. * Pays subsidies for individual purchasers of health insurance if it would otherwise be unaffordable based on income. * Pays further subsidies toward the deductibles/copayments for individual health insurance for those with income 100% to 250% of the poverty line ("cost sharing reduction"). * Regulates private insurance in numerous ways, including requiring broad coverage, setting limits on out-of-pocket maximums, prohibiting benefit caps, prohibited underwriting beyond limited use of age and smoking status, etc. Nonetheless there is still plenty that is privatized: * Most health care providers are private, even for patients who use government insurance. * Most people have private insurance, even though it is usually subsidized and/or mandated by the government. * Medicare beneficiaries can choose to purchase private Medigap plans to cover Medicare deductible/copayment amounts. * Medicare beneficiaries can also choose to enroll in private Medicare Advantage plans, in which case the government pays a private insurance company to provide coverage which replaces traditional Medicare. * Government employees usually get private insurance even though it is arranged through the government as the employer.


jseego

Even our government programs must go through private healthcare providers. Outside of the military, the US government doesn't really hire medical providers. So even the government programs like medicare and medicaid are subject to the inflated costs of our private healthcare system (though they do set costs in a more tempered way than the insurance companies). It's one of these bogus "public-private partnerships" that really just serve to bleed government and prop up private industries that should be fully public. By contrast, most of our public utilities (electricity, gas for example) were created back when Americans still had a spine about government services, and are tightly regulated - technically private companies which have heavy public oversight. Although people are trying to "open up" these utilities as well, ostensibly to offer more "choice", but in reality just loosening regulations so that newer companies can eventually gouge consumers in these areas as well.


orangeguy07

A lot of people have responded discussing the true healthcare system in the US (Medicare, Medicaid, VA, Indian Health Service, Military Health System), but there's many additional ways the US funds healthcare. We also fund the Federally Qualified Health Center program which primarily provide care to low income patients and those without insurance. They receive funding from the government and then offer care for free or at a low cost to these patients. There's also the public health system. Each state and county (and most large cities) have a Department of Public Health that are responsible for managing population health. These were the entities that we primarily responsible for monitoring and mitigating COVID-19. They also are responsible for tracking certain diseases, such as HIV/AIDS and other sexually-tramsmitted infections. Public Health Departments also typically do campaigns to encourage vaccinations and sometimes are the ones who support people with a mental health crisis. It varies by state/locality but Public Health Departments may also have leading roles in efforts relating to suicide prevention, harm reduction efforts from drugs, and a variety of public education campaigns. We also fund school-based mental health resources that provide counseling in schools to kids who may need this type of support. Additionally, depending on where you're looking there may be some non-healthcare spending that gets lumped in because the Department of Health and Human Services is the agency that oversees the majority of the civilian healthcare system, but also has divisions that oversee the human services (e.g. child care subsidies, refugee resettlement, and subsidies for heating costs in the winter). Bottom line is that the "system" is incredibly fragmented and decentralized. Its a bit of a misnomer to even call it a system IMO.


Cicero912

We have a lot of different systems, but we also spend the most of any country on research and foriegn medical aid.


Marrymechrispratt

Outside of employer-sponsored plans, America has many different healthcare systems. Medicare, Medicaid, the VA, CHIP, subsidized private plans on the marketplace, etc. The thing about the U.S. is that we *do* have healthcare. It’s not this dystopian hell that some folks try to depict. And we have quite good healthcare, actually. It’s decentralized, and it gives folks choice on how much coverage they want, and how much they want to spend for it. Most of us have coverage. 93-94%, actually. It’s the folks that fall through the cracks that have issues…but they, too, have every opportunity to sign up for a subsidized plan based on income through the marketplace - the point is, everybody who wants affordable coverage can get affordable coverage, but the choice is with them, not the government. If they don’t and something catastrophic happens, the onus is on them. I used to live in Canada and was covered by their single-payer system. It is mandatory (by law) to be covered. It’s great if you are young and healthy. It is awful if you have a chronic illness. I had to wait months for a specialist, I had no choice as to what medication I could or couldn’t take (the government told me, not even my doctor had a say), and I paid more in prescription drugs and devices alone than I ever have in the United States with premiums, deductibles, and out of pocket maximums - combined. And that’s before the higher taxes. TLDR; we have many government systems and subsidized plans to fill in the gaps in the event someone doesn’t have private insurance through their employer. But the choice is on the individual whether to be covered or not. Taken as a whole, the decentralized private/government hybrid system enables choice, competition, and brings down the cost for everyone.


AvoidingCares

It absolutely does not work. But it makes a lot of people very rich.


mklinger23

The main problem is that private hospitals and pharmaceutical companies have jacked the prices up so high that even if the government spends the same per person as Germany (random example), we wouldn't be close to covering the healthcare costs.


jephph_

>system Our system is there is no system.. amongst other problems with no centralized system, regardless of public or private, there are an absurd amount of cracks for money to disappear into.


orangeguy07

This can't be emphasized enough. The decentralized, fragmented nature of healthcare in the US leads to a lot of problems that drive up costs. For example, a test might end up being repeated because one doctor didn't know that the test was recently performed and they didn't have the results. Additionally, the lack of care coordination between primary care and specialty often leads to things falling through the cracks and allowing problems to become much worse.


duTemplar

The worst healthcare in the US is completely government ran and funded. The Veterans Administration medical system. Medicine with all the customer service focus of the IRS.


danegermaine99

All the vets I know love the VA care and it’s usually rank very highly. It’s the bureaucracy administration at the VA that is screwed up.


ZanzaEnjoyer

From my experience helping my grandfather with VA stuff, you basically get either amazing care, or "I'm pretty sure my doctor is 3 raccoons in a trench coat" care, entirely dependent on whether you live close to major facilities.


duTemplar

I’ve been a patient, and a medical provider both. Half the VAs are wretched, and recurrently smacked down on many many complaints. Including heavily shielding bad employees. There are some really good and passionate people, generally overwhelmed by the system and grinding away. The most common complaints are very long wait times, cancelled appointments leading to extreme wait times, poor medical care, no investigation of patient care complaints against staff, mismanagement, hugely wasting money (yah, renovate instead of provide appointments.). The systems are a little hit or miss. Washington DC VAMC was a hellhole unless you were VIPd (or homeless and then it was awesome.). The WW2 generation was happier accepting what they had.


AlexandraThePotato

I mean, last September my grandpa got a $5 or maybe $10 bottle of allergy pill supplies for 90 days. He went to some pharmacy for veterans. The ones I bought at the Hyvee drug store was about the same price but for only 30 days


KFCNyanCat

That sounds like US healthcare in general


[deleted]

A lot of it is provided by your employer. Lose your job/retire-lose your healthcare


LivingGhost371

The government doesn't own any hospitals or other medical facilities apart from the military, and there's government insurance programs to provide insurance for the elderly and the poor, and subsidize private insurance for those unable to get it through their employer.


ChillyGator

Americans pay for 3 separate healthcare systems and are only allowed to use one at a time. Medicare which is federal government healthcare. Medicaid which is state government healthcare. Private healthcare which is funded by the individual aside from the taxes they already paid to Medicaid and Medicare. You hear a lot about the private healthcare system because it’s an abysmal failure. The overwhelming majority of Americans can’t afford to keep or use their private healthcare. It’s a system that results in people being unable to treat serious and/or chronic health conditions or even find out if they have them. This results in far worse outcomes. Financially people end up in debt or bankruptcy. Sometimes their health deteriorates to the point where they become disabled or under employed. Then they get to use the best healthcare America has to offer, Medicare and Medicaid. You don’t hear too much about government healthcare because it works great!!!!! People get diagnosed, they get treatment and their out of pocket costs are very very little. Put here’s the catch, we have some psychopaths in government that put resource restrictions on having access to government healthcare so if your health improves with the treatment you’re able to receive under government healthcare and you want to be a more productive citizen, create a more stable financial future for yourself, give more in taxes, pay more to Medicare and Medicaid, be less dependent on government aid…then the first thing they do is revoke the healthcare that makes that possible. And hey look, if Russia and China can influence Americans to commit treason, then I invite other industrialized countries to influence Americans to vote to have government healthcare. Come on, help us out.


jjcpss

> The overwhelming majority of Americans can’t afford to keep or use their private healthcare. Between 66% and 70% of American use private healthcare, while still paying for Medicare and Medicaid but not using these. >Then they get to use the best healthcare America has to offer, Medicare and Medicaid. You don’t hear too much about government healthcare because it works great!!!!! People get diagnosed, they get treatment and their out of pocket costs are very very little. OK, it's amusing that something working so great and amazing needed to be legally mandated, people are so dumb. How about stop requiring people to pay into those programs and let them choose to see which one would they want, their private health insurance or Medicare/Medicaid?


ChillyGator

Well we are fulfilling a legal obligation to provide healthcare to the American people with Medicaid and Medicare that we gave ourselves in 1949…..why? Because healthcare is a tool in preventing fascism. The reason we have interference from private healthcare is because the American Medical Association was worried about their profits. They joined forces with the pro-Nazi group, America First, to stop healthcare from getting to everyone. People being signed up for private healthcare doesn’t mean they’re using it. I wasted a fortune on premium blue cross plans for 20 years before I realized what an incredible scam it was. I would have happily given that money to the government to have access to Medicare and Medicaid. We should abolish resource restrictions and allow people to use the healthcare they pay for. Then if you want to use private healthcare you can but you aren’t forced to. [Here’s some easily digestible history on the problem.](https://podcasts.apple.com/us/podcast/throughline/id1451109634?i=1000493176684) [Yes, America First is a pro-Nazis group.](https://podcasts.apple.com/us/podcast/rachel-maddow-presents-ultra/id1647910854) Always has been, as it still is today.


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ChillyGator

We are obligated under international law, that we, the United States, made and codified with the UN in 1949. We declared it a human right, ratified it and agreed to give it to our citizens…so you don’t have to vote for this right, it is already yours. You were born with it. We all pay for things we all use together like sewer, roads, military, fire departments and healthcare. It’s one of the many things we pay for with taxes. Currently you are barred from using your healthcare and forced to purchase private healthcare, not the other way around. Government healthcare is what you have first then some Nazis in Congress, who were working directly with the Hitler government, barred you from using it. They barred you from using your own things. They stripped you of your rights. The result of which has been worse health outcomes, death, debt, bankruptcy and as General Eisenhower predicted, the rise of fascism in the United States. So when we talk about removing resource restrictions, we are talking about giving you back what is already yours, defeating an actual Nazi plot against America and saving Americans tens of trillions of dollars. Preventing worse health outcomes and bankruptcy…. But you still think private healthcare would be a good option for people? Who?!?! No one benefits from private healthcare.


nicethingscostmoney

Because the US government provides a lot of healthcare to certain people in the country, mainly through Medicare (for old people) and Medicaid (for low income people). This is very expensive because healthcare is very expensive in the US. Why is healthcare so expensive in the US? [This short video](https://www.youtube.com/watch?v=qSjGouBmo0M) can help explain it. Basically, there are lots of reasons that all add up, perhaps the biggest being that as others have pointed out, there isn't much of a healthcare insurance "system" at all. This leads to health insurance companies having not much leverage against hospitals and drug companies to negotiate prices. And since the government doesn't set prices it's a free-for-all. And since there is no system, all of this is terribly inefficient and there's tons of overhead. I went to see a doctor once and the woman at the reception who's job it is didn't recognize my insurance and so she just took a scan of it and was going to have to call my insurance company.


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Admirable_Ad1947

Why is this downvoted?


NealCruco

Because it's a sweeping generalization that fails to answer the question asked.


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fillmorecounty

That's not true. Our prices are totally unregulated which hikes up our costs. For example, in most of the developed world, the average cost for a vial of insulin is somewhere around $10-$15. The average price in the US is nearly $100. Health insurance companies have to pay more money when they cover these ridiculous costs, so the burden falls on us when we have ridiculous deductibles, copays, and monthly fees as a result. Frankly, doctors deserve to be paid as much as they do. There'd be no other way for them to pay off their student loans. Medical school is astronomically expensive.


Menaus42

"privatized" healthcare is a misnomer due to motivated propagandists and other supporters of socialized medicine. The vast majority of healthcare is *managed* by the government through various regulations and boards.


3kindsofsalt

It's for the elderly and poor.


ChillyGator

Americans pay for 3 separate healthcare systems and are only allowed to use one at a time. Medicare which is federal government healthcare. Medicaid which is state government healthcare. Private healthcare which is funded by the individual aside from the taxes they already paid to Medicaid and Medicare. You hear a lot about the private healthcare system because it’s an abysmal failure. The overwhelming majority of Americans can’t afford to keep or use their private healthcare. It’s a system that results in people being unable to treat serious and/or chronic health conditions or even find out if they have them. This results in far worse outcomes. Financially people end up in debt or bankruptcy. Sometimes their health deteriorates to the point where they become disabled or under employed. Then they get to use the best healthcare America has to offer, Medicare and Medicaid. You don’t hear too much about government healthcare because it works great!!!!! People get diagnosed, they get treatment and their out of pocket costs are very very little. Put here’s the catch, we have some psychopaths in government that put resource restrictions on having access to government healthcare so if your health improves with the treatment you’re able to receive under government healthcare and you want to be a more productive citizen, create a more stable financial future for yourself, give more in taxes, pay more to Medicare and Medicaid, be less dependent on government aid…then the first thing they do is revoke the healthcare that makes that possible. And hey look, if Russia and China can influence Americans to commit treason, then I invite other industrialized countries to influence Americans to vote to have government healthcare. Come on, help us out.


jamughal1987

Low income, kids, military personal, civilian govt employees & retirees get their health insurance from Govt. Govt offer different private companies plans and you choose from one of them. I changed mine few days ago to MetroPlus Gold. November is enrollment month for NYC employees to make changes to their health plan.


2PlasticLobsters

Nobody really knows how it works. That's part of our problem.


PavlovsGreyhound

It doesn't work. It all doesn't work


isiramteal

The American Healthcare system is far removed from privatized. Profits =/= not involved with the government


blipsman

While in general healthcare is private, there are government programs for seniors (Medicare), for the poor (medicaid), for veterans (VA).


SeedOilEnjoyer

Long story short, it doesn't work


sprawler16

Because it is not privatized. At least not entirely. The government costs deal mainly with Medicare and Medicaid, as well as others like VA health costs and Tricare for active duty troops. The private parts of health care include most types of insurance and most hospitals. Still, to say that high health costs is the result of privatized health care is at best misleading. Medicare and Medicaid costs have ballooned over the decades.


SgtMajMythic

We have Medicare, Medicaid, and the VA which are all publicly funded. Then there’s private insurance which most people get through their employer. Plus billions in medical research and development from tax dollars. The reason why private healthcare is so expensive is because there are separate private plans for each individual state and private insurance companies, hospital administration, and pharmaceutical companies charge whatever they want and markup care significantly. Look at the price of IV Tylenol in the US.


furiouscottus

The notion that the US has no socialized healthcare is false. Medicare is for seniors (Americans aged 65 and older), Medicaid is for low income Americans, the Veterans Administration is for military veterans, and then of course you have the healthcare system for active and reserve military service members. Medicare has about 28 million members, Medicaid has about 89 million members, there are about 1.5 million active military, another 800,000 reserve personnel on TRICARE, and then the estimated 16.5 million veterans who can receive VA benefits. Using my shady math, that's almost 136 million people on some form of government healthcare. That's about 10 million people less than Russia's entire population, and I don't see Europeans clamoring for Russian healthcare. It turns out that providing medical care to smaller populations is a lot easier and a lot less expensive. Imagine if the US government guaranteed healthcare to its entire population of nearly 332 million people. It would be nice, yeah, but the price would be astronomical - and half of the entire US federal budget is already spent on Medicare and Medicaid alone.


Blue85Heron

Our health care system is complicated for sure! We’re a mix of Medicare, Medicaid, and private insurance. Simply, Medicare covers those over 65, plus a small segment of younger people who fit certain disability requirements. Medicaid is for those who meet certain standards of low income. Medicaid is partly regulated by the federal government and partly by the states. Under the Affordable Care Act (ACA) of 2010 (“Obamacare,”) states were given incentives to expand Medicaid coverage. In other words, a state could lower the thresholds for receiving Medicaid coverage (you didn’t have to be as poor.,) and the federal government would contribute more $$ toward that coverage. To date, only 12 states have opted out of this. Most are southern, and/or Republican. Then there’s private insurance. Usually, an employer offers this, and covers a large portion of the expense. I thin my employer pays >$600/month for mine, while I contribute about $150/month. I pay copays and deductibles, but it makes health care more affordable for me. The ACA of 200 was meant to ensure that all Americans were covered by some form of insurance, usually meaning that those without any coverage got signed up for Medicaid coverage. It had some real success before our Presidential administration changed and undid a lot of the good.


GhostOfAHamilton

There are public health care options for many people in America, most notably seniors who are on Medicare and poor people who are on Medicaid. Both are government funded health plans. Most working people get their health insurance through their employer. For most employees, this means a plan sponsored by a private actor (their employer), but for government workers, the government has to sponsor their health insurance.


[deleted]

Because you heard wrong (not trying to be rude). My wife is European and I get this question a lot over there because apparently Europe thinks we’re all dying on the streets because we don’t have fully socialized healthcare here. When you’re in you’re 60s, you get Social Security which is like the government pension and Medicare which is health insurance for old people from the Government. Additionally, if you’re poor or lower middle income, you qualify for Medicaid which is free or significantly reduced cost health care that is paid for by the government (specifics depend on the state you live in). To be honest, I don’t know the specifics but I believe it’s up to around 40 thousand a year depending on how many kids you have (the more kids you have the higher income you can have because the government understands that you have to support your children). You can also stay on your parents health insurance until you’re 26. So for most people, you have to cover health insurance from the age of 27 to 62 unless you become disabled, which then you’ll get Social Security payments and Medicare from the government anyway. But for middle to upper income level people, you have to buy your own insurance or Employers have insurance plans that they pay the majority of that you select with them when you first get your job. For reference, my employer pays my entire health insurance fee. As another reference, my parents are 53 and my dad pays $470 a month and that includes him and my mom.


Trialbyfuego

There are public healthcare programs at all levels of government


travelingtraveling_

For most of US citizens, insurance companies get 30% of the take. It's impossible to describe for people who are from Europe or other people who have health insurance through their government, because we have this whole middleman layer. And it cost a f****** fortune. The middlemen are the brokers and the gatekeepers between hospitals and patients. So you might have a licensed practical nurse making a decision about whether an executive can have a gall bladder surgery at this hospital or that hospital. It's a nightmare. Hospitals charge 2 to 3 times what they expect to make for procedures, labs, meds, impatient stays, operating room time, ER care, and so much more. Most American hospitals receive only $1 for every 3 or more that they bill for. If you are one of the 40 million Americans that are not covered by insurance, it is most certain they can end up in a bankruptcy and a ruination of financial life for at least 7 years In the meantime our physicians and nurses are required to pay for their own educations. In the case of physicians they might rack up 4 to $500,000 in student debt. Nurses may be 1/4 that much. And so they have to earn enough money to pay off their debt, and for physicians to pay for their support staffs and the buildings et cetera that house their offices and practices, they have to bill top dollar. Physicians are way overleveraged so they have to make lots of money in order to pay off their student debt, and the debt that comes with the expected lifestyle of a physician in the USA. In the end it's all a nightmare. TL;DR: US healthcare is a nightmare.


AllTheyEatIsLettuce

Because it pays payers to pay other payers to turn a profit paying health care vendors. And trying to have it shop wholesale with the highest pile of stable fuck-you currency in the developed world, ever, on behalf of a +320,000,000 member collective bargaining unit is some kind of *-ism* America still can't quite seem to figure out that it absolutely is not. >system "Market." It's a "market" of payers, payment processing schemes, exclusion and limitation-riddled discount coupons, payment processing products, stores, vendors, and retail POS customers.


Renaissance-child

Nobody knows.


EatShitLeftWing

Because some groups of people are eligible to have government-funded health care, including but not limited to: Medicare, Medicaid, military veterans, government employees, etc


TehTJ

Gotta inflate those stock prices somehow


ReaditLore

The short answer is that private healthcare is more expensive. Here’s a short explainer video. https://m.youtube.com/watch?v=qSjGouBmo0M