I hope this is the correct sub, if not, please direct me somewhere.
Let me preface this – I do not live in USA.
I’m an interpreter from Poland, currently during training. Since we’re going to help Poles living in USA with, for example, health insurance, we’re being taught how it works.
But in theory it’s all nice and dandy, while in reality it seems horrible. I can’t find the middle ground and how it’s applied to real life situations. Trainer denied explanations, claiming interpreters are not allowed to have opinions (or at least express them), but I think this knowledge would allow me to better understand the context of the situation.
If there are deductibles and then copay and then out of pocket maximum (that apparently nobody ever reaches anyway), then why people have such high med bills even though they’re insured? If out of pocket maximum is for people with serious medical issues ending up with hospitalisation, why insurance companies suggest setting up gofunmes? If insurance or M4A work, then why people can’t afford their insulin, or don’t go to therapy? Why do I see people complaining about “insurance don’t cover my basic meds and I have to pay full price” if there are these… PPOs? I think that’s what they’re called. Insurance should direct them to where they can get a price at least partially covered by the insurance.
I don’t understand, but since I don’t live over there, I probably miss something that is obvious to people who do.
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The main explanation is that the US health care system is awful for a country as wealthy as ours and is at the mercy of the Health Insurance Industry
Insurance companies are profit driven. Their goal is to make money for investors, so the less they have to pay out the better. So things like deductions and out of pocket cost allow more of the burden to be put on the policy holder, thereby increasing profit margins.
Also, there are no standards for medical costs in the US, you can actually shop around to find varying costs for procedures. I am self employed and have negotiated fees for procedures by explaining to the accounting department of the hospital that my insurance would not pay. In addition, hospitals often charge very high amounts for standard procedures and medicines to help offset costs, this then drives up insurance policy premiums.
So short answer, our insurance system works very poorly in terms of providing health care at reasonable costs.
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