Question about US healthcare (coming from a Brit)

On basic coverage available - besides the emergency room via getting care in the ER and then not paying the bill (ER's are mostly hand-tied in pursuing people) there's no basic level of care available with no means to pay. And that's really just a back door that can be abused not really "available".

On disability and the like, we do supply Medicare (and Medicaid) to needy folks if they request it and can prove the need for it. Which almost every childhood disability will get proven pretty easily. And depending on the circumstances of the condition only needs review rarely. (7/10/20 years for most, some like blindness never need review)

Disabled kids can usually qualify for certain programs (Federal and State). There are also places like Shriners Hospitals for Children which work on a "pay what you can pay" system and they rely very heavily on donations to help subsidize care. My nephew has a severe case of spinal bifida and Shriners has been a huge help to his parents, since their medical insurance will refuse to pay for certain rehab-type activities/materials.

Its not THAT scary if you're really poor - under $11k in most states, under $7k in a few - because Medicaid is basically a NHS type thing for the ultrapoor - the problem comes about in that tier right on the upper edges of poverty and into the lower tiers outside of it where employers aren't offering healthcare frequently. Fundamentally this is what the ACA was working on fixing - because overall the system works in it's bizarre fashion compared to a NHS for the lowest tier and tiers 4+ or so just tier 2 and 3 have a really hard time with bizarre "plans" that used to pop up that were more exploitative than an actual health benefit. [Or them feeling that gambling on nothing happening to save the $$ made sense...]

It's hard to just say ours was "bad" but there certainly are drastic differences in quality between the middle tiers and the upper and lower - honestly in some regards it's better to be ultrapoor for healthcare here, for the few that qualify for it one of the most comprehensive and cheapest copay plans around is for the poor disabled where they get the benefits of both Medicaid and Medicare. [I'm actually crossing my fingers that when they allow the buy-in for Medicaid next year for secondary insurance that investment income won't count so we can switch our secondary plan from my current costly plan that bounces alot of stuff being a large hassle (great coverage though, but seriously sometimes 3-4 times of bouncing a claim) because the combo was a dream for my wife before we got married]

That's the truly bizarre thing about our system pre-ACA and the ACA only seems to be mending partially - is that the lower middle class was getting the worst coverage while paying the bulk of the cost but the poor got pretty damn good coverage at a fraction of the cost and the wealthy got amazing coverage barely paying anything extra considering.

We still have government based coverage but it isn't for everyone. Medicare is from the Federal level and is intended for retired persons and also often covers your congenitally disabled children like with spina bifida or severe mental retardation.

Medicaid is from the State level and varies by state. Usually though it is intended for the poor. People who work shit jobs that don't provide coverage or even enough money to buy your own coverage can often get Medicaid coverage. Single moms and their children are also often covered by Medicaid.

Emergency medical providers are not allowed to refuse people for lack of funds or insurance. In other words, ambulances and emergency departments can only ask for paymentafterthey treat you.

That said, each level gives you different levels of care. A good private insurance will pay for anything. The premiums are steep but the level of care they are willing to pay for is usually much higher. Medicare's standards aren't too bad. You'll get a room and a long stay if needed and rehab at a decent place and follow up coverage and prescription coverage for many things. It's not perfect but it's really not that bad either. Medicaid on the other hand has a much lower standard of care. You'll get the cheapest room for as short as possible. You might get a short stint at rehab but it'll be at a complete shit hole facility. There is no follow ups, no private doctor, no prescriptions. You have to visit an Urgent Care or a Doc-In-The-Box for primary treatment. Or, as often happens, you have to use the ER at the hospital as your primary care because they can't turn you away. Medicaid is real bottom-of-the-barrel stuff.

The other option is for veterans of the armed forces through the VA coverage. They are covered for life no matter what but it is more akin to Medicaid levels of treatment (at least in my experience).

To answer your question, the Federal government usually steps in for disabled children using Medicare.

you're better off being poor than making 60k a year if you have more than one kid in the U.S.

I know my boss is only able to report 30 hours a week to keep some kind of special insurance she has to cover her sons constant medical issues from having child arthritis. I'm not sure of the specifics there though, and it may not be true any more with Obamacare.

With Obamacare now in civilized areas of the country populated by "liberal book-learning" types you get government health insurance if you are below the starvation level income line. But it's hard for these people to find a doctor because the government pays them less than normal health insurance, and doctors are apparently only in it for the money and don't give a fuck about any of the things you normally associate with someone who dedicates their life to medicine. Fuck you, pay me. For people above the poverty line, Obama pays part of your monthly premium and deductibles and the amount scales with income. The level of care these people can expect to get varies by state. (because money)

See, what you need to understand is that it's different in every state. The medical insurance for the poor part above doesn't apply to redneck states that opted out of certain pats of Obamacare because socialism + can't take orders from the uppity negro. In backwards hillbilly land (30 out of 50 states) it is still possible to not be able to qualify for any sort of government aid at all if you are below the poverty line. You can literally be too poor to get any help paying for insurance. Note that by doing this, these states actually LOSE MONEY.

Here in VA, for example, it's pretty much Fuck You, Go Die in a Ditch. The only way you get medicaid (free-ish) here is if you have children and you work or are disabled and you make less than $5000 a year. No kids? Then you wait until you are dying/injured and you can get emergency room care that you will be billed for but can go just not pay (bye bye credit for 15? years. So you'll never own a home and will waste everything you earn paying rent and will basically be poor for the rest of your life, even if you get a decent job. Better hope someone will co-sign for you!)


EDIT x50: Tried to rearrange the post to make less it confusing but.. yeah, welcome to insurance in the USA.

Now you can imagine a situation where someone who has kids can get caught in a bubble where it is actually worse for them to work more hours/get a better job because they will lose aid but still cannot possibly afford to survive on their wages. It is not, however, some retarded hyperbolic figure like "60k a year" unless you are single with about 30 kids. This bubble has actually been greatly mitigated in not-fucktarded states that fully implemented Obamacare, because you can now get help paying for insurance without having to be dumpster-diving levels of poor. It now scales, instead of the absurdly low income cap states like mine have which actually promote welfare queens. Of course, there are fuckwits out there who don't understand or simply won't admit that Obamacare is actually a good thing in that regard.

BubbySoup_sl said:

Ok, well things didn't seem too bad until Kreugen entered the thread, Jesus that sounds awful in some of those states :/

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That's pretty much how it was everywhere before Obamacare. Starvation level of poor with kids? You can get help. Everyone else? You pay full price, so you better hope you can bypass "shitty job just to have a job" and go straight to "good salary with benefits." Good luck.

Kreugen_sl said:

That's pretty much how it was everywhere before Obamacare. Starvation level of poor with kids? You can get help. Everyone else? You pay full price. Good luck.

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Even better, I live in MA where we actually were the first state where you got penalized on your taxes if you didn't have coverage for any part of the year.

Fucked up system.

Noodleface_sl said:

Even better, I live in MA where we actually were the first state where you got penalized on your taxes if you didn't have coverage for any part of the year.

Fucked up system.

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Getting a conservative to admit that Obamacare actually helps to solve the welfare queen problem rather than worsen it (as they'd likely argue) would be like winning the goddamn Super Bowl.

Hey go out and get a crappy job and immediately make your situation worse because your medicaid goes away! Vs, go out and get a job and you still get a level of aid that scales until you can support yourself. And with Obamacare you don't even FUCKING NEED KIDS to get help. Unfortunately, this is still limited to just health insurance.

I'll never understand why we have a system that actually encourages poor people to spawn future $31,000 a year inmates. Everyone should be able to get aid in the richest goddamn country on Earth. Because that winds up being money not spent keeping them in prison. That'd be an interesting cost analysis project right there. Food, medical and housing assistance extended to the non-parent and able bodied poor. Would it lower crime and incarceration costs and therefore pay for itself? Fuck if I know, this is starry-eyed liberal territory. I'm guessing no, but it sounds nice. Poor people will still be pooping out kids because they are dumb poors and the welfare queen problem is mostly a myth.

This is way the hell outside of the scope of the thread. Sorry, I had two cups of coffee today.

Hell Kreugen, imagine if snips and tube ties were offered free to those that are supposedly "welfare queens" and the like how much that would cost for a relatively cheap (under $10k pretty sure average support check is close to that in just a year or two, no?) fix for those that want to be responsible but can't afford to be.

[Note: Not that "welfare queens" exist in any real number - but wouldn't it be a wonderful option to make available to them - hell maybe even give them a small bonus for going through with it - like an extra couple bucks on their check (still less than a full extra person) - and of course no kids in the household or the existing kids eventually aging out with no more new kids means the childcare issues to not working would be resolved for those stuck at home because of kids, etc. etc.]

Vaclav_sl said:

Hell Kreugen, imagine if snips and tube ties were offered free to those that are supposedly "welfare queens" and the like how much that would cost for a relatively cheap (under $10k pretty sure average support check is close to that in just a year or two, no?) fix for those that want to be responsible but can't afford to be.

[Note: Not that "welfare queens" exist in any real number - but wouldn't it be a wonderful option to make available to them - hell maybe even give them a small bonus for going through with it - like an extra couple bucks on their check (still less than a full extra person) - and of course no kids in the household or the existing kids eventually aging out with no more new kids means the childcare issues to not working would be resolved for those stuck at home because of kids, etc. etc.]

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nb4 garglechimp throws a fit about birth rates

BurnemWizfyre_sl said:

nb4 garglechimp throws a fit about birth rates

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You barely slid in under that one.

Skanda_sl said:

You barely slid in under that one.

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Like a dead fetus sliding up a vacuum.

fanaskin_sl said:

there's like 50 million more americans that should be alive today

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