Law Offices of Chris M. Ingram

American Dream – Medical and Dental Insurance v.s A National Health Service

Medical and Dental Insurance vs. A National Health Service

Many Brits know that there is no National Health Service in the US. The bulk of medical services are privately funded although there are some state funded facilities. Local General Practitioners (GPs):Every local community will have GPs. These GPs should be regarded as corner shops. The GP is self-employed and makes his money directly from each patient the GP sees. Each type of service he provides is priced and listed on a special chart. Either you will pay for the treatment yourself or if you have private medical insurance you will pay a contribution to your medical costs while your insurance carrier will take up the rest. All medical insurance plans require that the patient pick up some of the bill at all times.American GPs are generally very thorough, because if they mis-diagnose you and you suffer further as a result they can be sued. GPs are routinely sued for the merest mishap. GPs are sued not because they are particularly negligent, but over the years a litigation culture against anyone and everyone has developed. GPs who cover themselves will carry a whole array of testing on the simplest of conditions to make sure they spot everything. Whilst this is great for the patient in that on occasion latent conditions may be spotted early, it is not good on the patient’s pocket since every single test and treatment is billed. This means that on occasion a seemingly routine trip to the doctors could leave you or your insurance company with a bill for several thousand dollars.

You might think that if this is the case then getting insurance should not be a problem. You’d be half right. Getting insurance is generally not a problem, after all, the insurance companies are happy to take on new clients. However, you may find that any previous conditions might be excluded from your coverage. This having been said, the biggest difficulty is not getting insured, but staying insured.

Insurance premiums escalate all the time. You don’t get such a thing as ‘no claims bonus’. Instead you could find your insurance premiums increasing at a rate of 30-60% per year. This is due, so they say, to the higher costs in medical treatment. Today only a third of the US population can afford private health. This is not surprising when premiums for a family of four can easily exceed $500 per month. This would cover around 80% of GP and hospital costs. In some types of insurance plans the policyholder has to pay the first $3,500 on claims duri ng the year before the insurance policy will start to cover the cost of the treatment. These are called ‘deductibles’, and your insurance agent will explain these to you.

As a result of these high prices many people try to live a much healthier lifestyle. You will often see many people walking or jogging, which is not a fashion statement; they do this to keep from going to the GP or hospital! Also, many people will rely heavily on their chemists (pharmacists) for medical advice and assistance. Also, alternative medicines are far more popular in American culture.

GPs and Hospitals: Due to the above outlined reasons, you will find, in part, that if there is any doubt as to your diagnosis your GP will refer you to a specialist for a second opinion. In this way the GP will limit his exposure to liability, and secondly, it’s how the medical community works-by referral. It’s not uncommon to be referred several times to get to the root cause of your trouble. Remember, each time you get referred more fees will be incurred. As mentioned above, this ensures excellent medical care if you can afford it, but it can also lead to a lot of unnecessary treatments and medicines which some would argue could have been avoided altogether if there was not an overriding fear of being sued. Employers Sharing the Cost of Medical Insurance:Until recently many larger firms would provide medical insurance as part of their overall remuneration package. However, companies are finding these costs becoming prohibitively expensive. In many cases new employees are not being offered the same medical package as longer serving employees and longer serving employees are having their existing medical coverage modified downward. This has resulted in a number of high profile strike cases with the end result being that more people than ever are finding their medical coverage being eroded and they have to make up the shortfall or do without or with less. Dealing With Pre-existing Conditions:If you have a pre-existing condition many insurance companies will not include further treatment of that condition under their policy. However, where a company covers the employee’s insurance the insurance companies are not allowed to discriminate against the employees or their family members under the same policy. This provides at least some method of getting otherwise uninsurable coverage. In fact, even small family run businesses can set up company insurance plans for this very reason. The only downside with this approach is that company insurance plans are charged at a higher rate than personal medical insurance plans. Dental Practices:

In the US, dental practices are privately owned, operated and funded. US dentists are also fearful of being sued for any form of mal-practice and as a result tend to only use the best materials for their work. Therefore, for example, very few dentists would ever use amalgam-based fillings due to the mercury content in them, even though these are routinely used in the UK.

Also, remember that dentists are in business to make a profit, so route canal treatments are very common instead of routine fillings. If in doubt always seek a second opinion before spending $1,000 on one root canal treatment where a $150 filling might have done the trick, at least for a while.

As with medical insurance, you can obtain dental insurance, but in both cases you will have to pay a part of the costs in all cases. With dental insurance your contribution to the cost of the treatment will generally be higher than that paid by your insurance company.

It does make one wonder why pay all these insurance premiums, when you have to pay anyway. You would not be alone in thinking that and as a result many people simply decide to pay as they go. Obviously if you can afford to set up your own private fund for these things then take out insurance policies that will cover only the most serious of conditions, and then you would be well on your way to thinking like an American.

Overall there are only a few major downsides to living in America if you come from a land of socialized medicine, and medical and dental insurance is perhaps the major one. Once you’re past this issue you’re pretty much over the worst of it. It’s gets much better. Besides, if you need an expensive but non-emergency operation you may just as well have it in your home country on the house.