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How to Make The American Health Care System Work for You



Health care is a deeply political issue in the U.S. But, it is more than just the bickering and rhetoric of wealthy individuals (most of whom have their health care provided by the state), it is a genuine concern for millions of Americans that could profoundly affect their futures. There are effectively two extremes: Universal or State-provided health care, the likes of which you’ll find in Canada and much of the democratic world. This is considered the liberal position and uses government funds collected through taxes to pay for the health care of the entire population.

Then, there’s Free-Market health care. Free-Market health care exists when private insurance institutions compete for the business of individual citizens who pay for whatever health care they choose.

In America, we use a combination of both of these philosophies. There is, effectively, a free market available for those who can afford it, and state assistance for those who cannot.

The virtue of a free marketplace is supposed to be that competition will work in favor of the consumer. The actual mileage the consumer has seen thus far when it comes to the health industry has been spotty at best. Regardless, unless you fall into certain categories, it is pretty much the only option you have.

If you are in one of those categories, you may qualify for what is known as Medicaid. There is a lot of misinformation about all federal assistance programs, but it seems to be Medicaid in particular that is the most mischaracterized. There is a stigma attached to it that suggests that those who make use of its services are greedy, lazy leeches who could otherwise pay for the care they need.

It would disingenuous to suggest that there aren’t people who abuse the system, but the previous description of Medicaid users is as offensive as it is inaccurate.

Fact: Medicaid covers 74 million people, making it the largest health care program in the country.

Fact: The majority of those 74 million are elderly or disabled members of the middle class.

Fact: Half of all Medicaid enrollees are kids.

Fact: Medicaid has been under siege for about a year and a half.

Proposed changes

Currently, Medicaid is paid for by the federal government and the respective states. The federal government picks up the bulk of the tab and in many cases, helps the states with some of their responsibilities too.

The current Administration has been trying to reform this arrangement into what is known as ‘block grants.’ These block grants would be a predetermined amount of money that would be entirely at the discretion states to use as they please. This would allow the states to use the money more freely – great (ostensibly). The problem with a fixed number is that prices aren’t fixed. As costs rise and the grants stagnate, a deficit emerges – much less great.

Should these changes go into effect, it will cut funding to Medicaid by about a 1/3 by 2026 (which is much closer than it seems). If you’re on Medicaid, you can see why this is a problem. If you’re not, here’s why you should care.

Medicaid covers at least half of the births in America, it covers the bulk of the care for the elderly and disabled. Without it, (or with less of it, more accurately) those are all more costs that private insurance institutions will have to cover. The more stuff they have to cover, the more money they are going to need. Where do you think they get that money from?

So, the choice becomes funding Medicaid at its current level, not getting a tax cut and potentially even seeing tax increases? Or, getting a tax cut you probably won’t even feel, and an insurance rate increase that you almost certainly will?



What Can You Do?

When it comes to the law, all you can really do is vote and contact your local representatives. When it comes to dealing with these currently still hypothetical changes, you can either look for low cost (typically low quality) private insurance or roll the dice uninsured.

You don’t technically need insurance for medical treatment. However, the way the health care system is designed, everything is dramatically marked up with the expectation of insurance companies footing the bill (or most of the bill). Without insurance, you have to eat those costs yourself. If you have a low income, the whole point is that it’s harder for you to pay. It’s a vicious catch 22. Hopefully, you can find a free clinic in your area.

Moreover, with the individual mandate still in place, you will have to pay a penalty every year you go without insurance. Either 2.5% of your yearly household income or $695 per adult and $347.50 per child under 18 years old, up to $2,085. If these fees are not paid, they will be taken from your tax refund. That said, you don’t have to worry about any criminal penalties or liens being taken out against you for failure to pay.

Urgent Care Centers Vs Emergency Rooms

No matter what your income, if you are injured or sick, you will need some kind of medical attention. Emergency rooms are pretty self-explanatory; you have a medical emergency, you go to an emergency room. Urgent care centers serve a similar purpose but are not quite as ubiquitous (though that is quickly changing). Urgent care centers are more like treatment stores than hospitals. If you sprain your foot, go to an urgent care center. If you get hit by a car, go to the emergency room.

Capability-wise an emergency room is almost certainly going to beat an urgent care facility because most ERs are in hospitals. That said, UCCs can handle pretty much all non-life-threatening medical issues you may come across.

The major difference is payment. Without insurance, the ER is expensive…extremely expensive. UCCs are generally less expensive. The twist is that an ER MUST treat you (even if you can’t pay) a UCC is under no such obligation. Don’t misunderstand, the ER will still bill you, and if you don’t pay it you’ll still be in debt, but they won’t turn you away – UCCs will.

 

Whether you have private insurance, Medicaid, or no insurance at all, make sure you have some kind of plan in case of medical emergency. If you feel passionately enough, become vocal about how you want your country to be run; regardless of where you fall on the spectrum.

Let us know how you meet your medical needs in a time when health care is so politically charged!

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