بیمه سلامتی در ایالات متحده

Health Care in the U.S.

Hi! I’m Jennifer from English with Jennifer, and I’m ready to share another current issue. If you’d like to communicate more confidently and effectively in English, be sure to subscribe and get all my lessons. And if you want to get the very most you can out of your studies here on YouTube, then consider becoming a member of my channel. There are three different levels.

Click to view all the perks. In this video, I’m going to share vocabulary and information related to health care in the U.S. I’ll do my best to give a balanced presentation. It’s not my goal to promote a political agenda. As an English language teacher, I’m here to offer the language support that learners will need to follow and participate in discussions about health care. So are you ready?

Let’s get started. Health care refers to the services you get to prevent and treat medical problems. When we talk about our health, we’re referring to our physical and mental well-being. In the U.S., we have many medical professionals and, in general, health care professionals who provide services for our physical and mental health.

A health care provider isn’t necessarily a doctor or a nurse. Health care providers include therapists, counselors, and various technicians. Note that “health care” can be written as one word or two. Just be consistent in your own writing. The health care system in the U.S. can be confusing.

There are different ways you can get medical treatment, and basically any visit to any medical center involves paperwork and some form of payment by someone. Hospitals, clinics, and private practices need to get paid. Even after you get treatment, you may have to worry about completing more paperwork and making additional payments. Let’s start with a fundamental question.

Is health care a basic human right or a privilege? A human right is something everyone should have. A privilege is a benefit – something good and useful – but not everyone receives it. If we talk about getting a basic education, for example, every child in the U.S. has access to public schools.

It’s their right to get an education from kindergarten through 12th grade. Our public schools are paid for with tax dollars. If you’re a U.S. citizen or resident, you pay local, state, and federal taxes, whether you have school-aged children or not. Tax money funds the public school system.

Families don’t pay tuition at public schools. Now with health care, we don’t really have a free health care system for everyone. You’ll hear terms like “national health care system” or “universal health care.” We don’t have that kind of program where services are free for everyone.

However, tax dollars are used to pay for federal and state medical programs that some people participate in. I’ll explain more a bit later. I’d say the majority of Americans have health insurance, and most often it’s employer-based insurance. That means that people have health insurance policies through their employers. The policy is the agreement and terms.

Health insurance is a benefit employers can give. Employers pay most of the cost of the policy, and then the remaining money is deducted or taken out of your paycheck. A health insurance policy for one employee can cover that individual or an entire family. For example, my husband has a full-time job with a company.

Health insurance is one of his benefits. He’s the policyholder. As his spouse, I’m insured. And our children are eligible dependents. “Eligible” means they meet all the requirements to be considered dependents, so they’re insured too. We can talk about being insured or covered. It’s the same thing.

Our family has insurance. We have coverage. Those are the nouns. Even as a benefit, health insurance is expensive. I read that the average company contributes 70 to 80 percent towards health insurance. The employee pays the rest. If you have a family plan, more is deducted from your paycheck. Even after those deductions, you still have copays and deductibles.

Getting confused by all the terminology? We can get confused, too, sometimes. The premium is the total cost. It’s the amount you pay in order to have a health insurance policy. When you hear people talk about high premiums or premiums going up, they’re talking about high costs or costs going up.

As I said, the employer usually covers most of the premium. The rest you have to contribute as the employee. It’s taken out of your paycheck. “Copay” is short for copayment.

This is the amount of money that you have to pay when you visit a health care provider and receive some kind of service. A copay is in addition to your premium. For example, it may be 10 to 25 dollars when you visit your regular doctor, who we call your primary care physician or your primary care provider.

But your copay to see a specialist will be even higher. Maybe 30 or 50 dollars. And if you have to go to the emergency room, your copay may be as much as one, two, or even three hundred dollars. Some argue that copays serve at least one purpose, and that’s to reduce the use of services.

If you know you have a copay, then you’re not so quick to seek medical attention for every little problem. We also have copays for medicine at the pharmacy. Your health insurance policy will usually cover a larger percentage of the cost. Some of my copays are as low as $7, others $70.

Then there are things that you need, but they’re not covered by insurance, like a back brace or vitamins. You have to pay out-of-pocket. These things are an out-of-pocket expense. For example, there’s a little bottle of vitamins that I need. It lasts for about three months.

Each bottle is over a hundred dollars. That’s not covered by my insurance. Deductibles aren’t to be confused with premiums. The premium is the total cost of your plan. A deductible is the amount you have to pay before your insurance will start covering your medical expenses. Maybe you have a $500 deductible.

That means you have to spend $500 before the insurance company starts covering expenses. You might have a high premium with a low deductible or a low premium with a high deductible. In short, health insurance companies are running a business, and they have to make money.

With premiums, deductibles, co-pays, and out-of-pocket expenses, you don’t want to get sick. It’s expensive. Well, the good news is that many preventive health care services are covered under a plan. For example, we don’t have copays when we get our flu shot, and we don’t pay extra when we go for our yearly eye exam or when we go for dental cleanings twice a year.

Keeping people healthy avoids bigger costs, right? But everyone gets sick now and then. Injuries happen. Health problems arise, especially as you get older. What do you do if you don’t have private health insurance? We have one federal program called Medicare. It’s mainly for the elderly, so if you’re over 65, you’re entitled to Medicare. And if you have some kind of disability, you can get coverage from Medicare.

Those over 65 likely contributed earlier when they were younger and paid taxes, so coverage in retirement makes sense. Most everyone agrees. Even on Medicare you’ll have premiums, deductibles, and co-pays. At least, that’s what I understand. If you can’t afford those additional expenses, then there’s Medicaid.

Medicaid is another government program. It’s a federal and state program that offers financial assistance to low-income patients. In the U.S., we have a law that allows everyone to get medical treatment in an emergency situation, regardless of their ability to pay. EMTALA stands for Emergency Medical Treatment and Labor Act.

It’s a law that says you have to give a patient, any patient, access to emergency services. So here’s how I understand the law. Under EMTALA, Medicare-participating hospitals with emergency services must screen all patients coming to the emergency room, the ER. Then if there is an emergency condition, the hospital must treat and stabilize the patient.

So there should be no “patient dumping,” but EMTALA does not necessarily require ongoing care. Once a hospital has met its EMTALA obligations, it’s no longer obligated to provide services to that patient.

The challenge with this kind of law is funding. Costs and charges are two different things. A hospital may not charge a patient for a service, but there’s still a cost to the hospital. How much can be given for free before a hospital doesn’t have enough money to cover its expenses and pay its employees?

The government has a set amount of money for health care. How should that money be managed? The EMTALA law ties into the issue of ethics. Ethics has to do with what is morally right and wrong. Health care is a business, and any business faces the challenge of managing finances while still being ethical.

But can a health care facility stay in business if too many services are given for free? Health care almost always makes the news headlines. There are often new policies, new proposals, and new controversial cases that make us question how we can improve our current health care system.

Some believe the current system has some good aspects, and it simply needs to be improved and fixed in certain areas. Others say the current system doesn’t work. It needs to be replaced with universal healthcare for all residents in the U.S.

You’ll hear these people talk about the need for a complete overhaul. That’s a complete change. Many of the 2020 U.S. Democratic presidential candidates have very progressive proposals. A number of them want Medicare for All, a government-run program. This would mean no more private insurance companies.

Americans would pay taxes, and taxes would cover medical services for everyone. Under Medicare for all, hospitals, clinics, and pharmacies would receive payment from one payer: the government.

So you’ll hear the term “single-payer health care.” Some candidates are proposing more moderate versions of this reform so that Americans could keep their health insurance coverage through their employers and still work with private insurance companies.

So some are proposing Medicare for all who want it. You’d still have the option to work with a private insurer. You’d still have the option to keep insurance through your employer. The public option allows people to buy in if they want to.

At least that’s how I understand it. Again, health care is confusing, so I apologize for any inaccuracies. I’m explaining the concepts as I understand them. We had a degree of reform under President Obama when the Affordable Care Act was created. That was back in 2010. And it was created to expand coverage to those who were without any.

One of the controversial ideas has been to require or mandate that everyone has to have insurance. If you don’t buy in, you have to pay a penalty. The logic is that everyone has to buy in or pay the penalty, so there should be enough money to cover the treatment of those who need it.

But this is one point that causes arguments. The young and healthy have less need for health insurance and medical services in general, so they may wish to live without insurance and avoid unnecessary costs. Is it right to create a universal health care system and require everyone to participate?

So I’ve mentioned the Medicare for All plan. It’s a universal healthcare system, and there are at least two ways of looking at it. On the one hand, everyone gets coverage. Those who need medical services receive those services. On the other hand, everyone is required to buy in – to contribute tax dollars.

So essentially, it also means that healthy people are paying for others’ medical expenses. Arguments arise over how much each person should contribute. Should people with higher incomes pay more?

How much more? What’s fair? Low-income households aren’t able to contribute as much, yet households with a higher income might argue that they’re being asked to shoulder too much of the burden. This is especially true of the middle or upper-middle class. Some politicians argue that although people would be paying higher taxes, their health care costs would be lower.

Would things balance out in the end? Would they be better? Would they be worse? Plenty of residents and citizens have come from other countries – countries with state-run healthcare systems, and there are mixed opinions.

On the one hand, countries with universal health care systems don’t have to deal with all the paperwork and billing issues that we Americans do because of our private insurance companies. On the other hand, there are stories of longer wait times at the doctor’s office or just to schedule appointments and services.

There’s a question of quality care. Would a government-run health care system be able to pay medical professionals well? If doctors and nurses and other health care professionals aren’t paid well, will they have enough incentive to perform well every day and with every patient? I’ll end here. There’s a lot to think about.