National Health Insurance
Only some populations have the opportunity to benefit from government health insurance in the United States. At the state level, there are these three programs:
Medicare
Created as part of the Social Security Act, Medicare is designed to provide medical care for elderly and seriously pre-disabled citizens. Any American 65 years of age or older is eligible for Medicare benefits. Citizens with a recognized disability or acute kidney failure are also protected by Medicare.
Medicaid
Medicaid stands for “Medical Assistance” and is a welfare program designed to assist primarily children and low-income individuals. Because it is a welfare-type benefit, a means test takes place before Medicaid can be received.
Tricare & Veterans Administration
Tricare is a health insurance program for members of the U.S. military. Tricare-eligible individuals include military members and their families, National Guard members and their families, survivors, some former spouses, and Medal of Honor recipients and their families.
Private Health Insurance
The majority of the U.S. population does not qualify for government benefits and, accordingly, must arrange their own coverage through a private provider.
Private insurance through the employer
Most U.S. citizens have private health insurance through their employer. Often, group health insurance is purchased for the entire company, with employer and employee sharing the cost.
However, employees often have to pay extra for the benefits they use or purchase additional private insurance. In addition, since the employer is the contracting party for the insurance coverage, if the employee loses his or her job, the health insurance usually ends as well.
Own private insurance & Marketplace
Since the enactment of “Obamacare”, anyone who needs to find private health insurance on their own – without the support of an employer – has the option of finding and purchasing suitable insurance coverage through the U.S. government’s Marketplace.
Depending on one’s region of residence, there are different types of insurance tailored to different needs. When purchasing health insurance, there is usually a choice between the following three types:
Traditional “fee-for-service” health insurance: usually the most expensive option, but offers the most flexibility in choosing providers (free choice of doctors).
Health Maintenance Organizations (HMO): network that employs its own physicians as contractors; members pay a fixed monthly fee and can only see physicians in the network
Preferred Provider Organizations (PPO): network of physicians and hospitals; members can also go to physicians outside the network if they contribute to the costs themselves
Cost of health insurance in the U.S.
In general, medical care in the U.S. is of a high standard. There are a number of private clinics with modern facilities and state-of-the-art technology. However, health care costs in the U.S. are among the highest in the world.
Why are the costs so high?
Several factors are driving health care costs in the U.S. higher and higher:
Unhealthy diet
Burgers, soft drinks, sweets: Many Americans eat an unhealthy diet. The U.S. Centers for Disease Control and Prevention (CDC) states that over 42% of American adults are obese. The associated health risks increase costs to the healthcare system.
Deferred treatments
Many uninsured or underinsured Americans avoid nonessential doctor visits. As a result, illnesses often go undiagnosed or are not treated in a timely manner, which in turn leads to high treatment costs in the long run.
High drug prices
Drug prices in the United States are extremely high. For prescription drugs, Americans pay more than twice as much as citizens of other industrialized nations.
Potential lawsuits
American clinics factor potential lawsuits for compensation into their pricing. Since each clinic can set its own prices, it sometimes happens that simple tissues or plastic cups become a “luxury item.”
Consequences of high costs
Due to the high cost of healthcare, insurance premiums in the USA are also very expensive. As a result, part of the population cannot afford health insurance, or can afford it only with difficulty.
