Uneasy Neighbo(u)rs by David T. Jones David Kilgour

Author:David T. Jones, David Kilgour
Language: eng
Format: epub
Published: 2018-09-20T16:00:00+00:00

THE U.S. MEDICAL SYSTEM

There are as many U.S. medical systems as there are legs in a nest of millipedes. That is, every American has a “medical care program,” but it is personally selected (even if by default); however, there is nothing akin to a national health services system. One could conclude that the U.S. system is a total mishmash of options—including having no formal medical care at all for many individuals. And that judgment would be accurate to a degree, although perhaps not relevant.

There are, to be sure, huge public medical systems that are virtually ignored in the discussion of U.S. health care. The entire cadre of the U.S. Armed Forces and their dependents are covered by a government-financed and -run medical system with military health personnel providing the care (or reimbursing civilians when military medical services are not available). Likewise, there is an extended system of hospitals for veterans (162 in 2004), run by a cabinet-level secretary for veterans’ affairs, which provides for those (and their dependents) who have completed a career of professional military service.

Additionally, government medical services are provided for a number of special groups, for example, Indians on reservations, and diplomats assigned outside the United States. Furthermore, extensive medical assistance is given to the elderly and a number of disadvantaged and/or low-income groups under Medicare and Medicaid.

Many private companies provide health insurance plans to their employees; often these non-salary benefits are the consequence of detailed union bargaining over decades with major industries, such as the auto workers. Some are paid partly by the employer and partly by the employee. In any event, they are significant expenses: General Motors, for example, contends that health-related costs, at $1,525 per car, are a greater percentage of the cost of each vehicle than steel, and that these costs are bankrupting the company. 23 Indeed, one observer suggested that GM was a medical care service (for its retired employees and their dependents) that sold cars as a sideline. Other major manufacturing companies argue vigorously that the United States is becoming uncompetitive because the national health care systems of other countries relieve their industries of health costs that U.S. firms must absorb.

Nevertheless, the bulk of medical care comes through systems of private (or government-sponsored) insurance. Again, while the U.S. system offers almost infinite choice in such private medical care, the basic point is straightforward. The individual selects a system of insurance coverage and pays a fee for this coverage.

Then it becomes complicated. Coverage can be for self and/or family. Conditions and degrees of care vary. Qualification for insurance coverage may exclude pre-existing conditions; that is, insurance companies may not accept (or accept only at increased fee) an individual who already has a medical condition requiring extensive continuing expense. Most coverage includes a deductible (an annual initial amount of medical expense—usually several hundred dollars—that the individual pays in full) and requires the individual to pay a percentage of the total cost (usually 20 percent). Many insurance companies have a “catastrophic” clause wherein the company assumes all expense at a certain point.

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