What is Health Insurance, and Why Do You Need It?: Health Care Triage #2
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- เผยแพร่เมื่อ 12 มิ.ย. 2024
- In this episode of Healthcare Triage, Dr. Aaron Carroll gets some surprised questions from "friend of Obama" John Green who is still waiting for his big government giveaway . Unfortunately, insurance still costs money, and it's still really complicated. Aaron explains how the insurance system we have today came to be, and why most of us get coverage through our jobs. He talks about why we need insurance, which basically boils down to the fact that health care is really, really, really expansive. More importantly, he explains why you need to know what premiums, networks, deductibles, co-pays, and co-insurance are, and how they have to be considered in the true cost of insurance. Also, ground unicorn horn.
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Read more on Aaron's blog: theincidentaleconomist.com/
John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen - Graphics
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Yep. I am soon to be 32 years old, and not one mandatory course in all my years of schooling taught me any of these basic fundamental concepts. I realize one can't expect to be handed life on a silver platter, but it still baffles me that children and young adults aren't taught this stuff before they are sent out into "REAL" life and expected to work full-time and function as proper adults.
In a country that extols personal freedom and market forces, the only way to promote health care socialism and insurance is to keep citizens like you as dumb as possible. Even Aaron Carrol has no clue, since he maintains that insurance is needed to pay for health care because health care is so expensive, without acknowledging that paying for health care coverage of medical expenses through insurance in general and Obamacare in particular adds some 25% to the cost of any procedure or drug. That's what the "loss-ratio" limits written into Obamacare lilterally imply! Carrol must have had the same schooling as you.
@@jimkirby9959 You can't push all the blame onto government and insurance. Providers often over utilize services to prevent malpractice litigation which increases cost, hospitals buy extremely expensive facilities and state-of-the-art medical technology to be competitive in the market and push that investment back onto patients, and physicians have to be paid extremely high salaries to pay off medical school which is also a cost pushed back onto patients.
So its an all around scam? Idk
Here's an idea: maybe it shouldn't cost 6,000 dollars to have an ultrasound and a prescription for an antibiotic. How in the world are people justifying 30,000 dollars for an uncomplicated delivery?!
I agree. Looking at lower costs in other countries, healthcare is expensive, but it's possible to be not that expensive.
There must be some point in the healthcare industry where the market doesn't seem to work.
Someone is getting filthy rich for no good reason.
Also, those 30.000 are average, not uncomplicated. But that's still too high.
insurance in case something go wrong i know the nhs spends £482m which is A fifth of maternity services funding. or £700 a birth.
May as well head to the bath tub at that point smh
I heard if you have a baby in the US and don't pay your bill, they just cram the baby right back up in there.
**hocks loogie**
I seen it done. It was on that there Teen Mom.
**spits**
its true, happened to me 😪
I really appreciate these explanations, although I might have to watch it a couple times to memorize how co-insurance works.
Growing up poor and continuing to be relatively poor I have such a negative outlook in life. After going to therapy for a year and continuing to practice mindfulness I continue to see the world more for how it actually is. Which isn't horrifically horrible and out to get me. Your videos really help me a lot and I want to thank you.
This sounds very different to what we have in Australia. then again all I know is I flash my shiny medicare card and it's all free :P
Thank God I'm a Canadian. Here in British Columbia, I paid $65 a month in premiums but now that I'm married I will pay $120 a month for my wife and I. That's it -- no copay, no deductibles, etc. We even get most prescriptions drugs covered by the government health care plan!
And Canada teaches you to say "for my wife and I" in public school with other people's money, too.
Jim Kirby the CEO are still laughing on how u defend their system
I live in Canada and had bronchiolar pneumonia a couple of years ago. I dropped about 20 pounds over 3 weeks (from not eating because I wasn't hungry). When I went to the doctors I got three x-rays and a host of antibiotics. I didn't pay for the doctor's visit, nor the x-rays which were two floors below my doc. And insurance mostly covered the drugs through my Mom's work. Universal Healthcare still has private insurance and they work incredibly well together in our hybrid system. I don't get why Americans don't want universal healthcare now...
Well over here universal healthcare is associated with socialism--as are most social programs--and unfortunately many Americans have been convinced that socialism is a very bad thing. In fact the word "socialist" is often used as an insult over here.
it seems to me, only rich people are complaining about it.
Some people don't like it because they're afraid of government involvement in things they don't like or understand. Remember, the "Red Scare" stuff wasn't all that long ago for us. There is also an American attitude of everyone for themselves, and the hell with the rest. Sadly, many (most?) Americans are simply ignorant and don't research much.
Also, Canada's system isn't perfect. While you don't pay much for care at time of care, you do pay for it with taxes instead. Also, the services can take a very, very long time to get to. "Free" care for everyone means very long lines.
avoisin what takes a long time to get in the canadian services? Our wait room times are a fraction of Americans and our spending on healthcare is substantially lower than the American system as well. Not sure where you get the 'very long lines' from but when I needed an x-ray it was a mere matter of going down an elevator and waiting 30 minutes. E-room vists for 86% of people are under 6 minutes before they see a doc, and walk in clinics, are well, walk in and you will probably be able to see someone.
avoisin I hope you know that Americans and Canadians pay almost the same for taxes, with maybe a 1 - 2% difference, so wrong there.
Also wait times vary, in both Canada and the US, but ours are not that long. I had to go to the hospital one evening because I had burnt my had and was not sure if it was a second or third degree. I literally went in, my mom signed me in and I saw a doctor right away, much like the two times I went to get my blood tested. Then I lived in a small town and it was not busy.
My friend went in several months ago after getting a piece of glass stuck in her foot. We live in one of the larger cities. It took maybe 30/40 mins to see the doctor. AFTER that is when it took a decent amount of waiting, because she had to get an X-ray and then the glass removed. And she paid nothing.
Circumstances are a big factor. Really, there is not a big difference between Canadian and American hospitals or taxes. Generally Canadians just don't have to pay as much, simple as that.
This is awesome. Clear, concise explanations that don't oversimplify or over-complicate the issue. And it's nice to hear someone discussing this without BSing or screaming bloody murder to make a point, like one might find in a network newsroom or in DC. Keep these coming!
You'll have to trust me that an ultrasound was necessary. He was sent there from the primary care doc's office (where he was seen first).
This series is fantastic. The production value is top notch, and the information is dearly needed, especially right now in the U.S. Thank you, Dr. Aaron!
This channel is so important, thank you for this video and all of the information. I am 20 and know like no real person adult stuff so this is really.
I manage the health care benefits for my company of about 1000 employees, and I find myself explaining these concepts regularly. Thanks for making them easier to understand! I'd love to see you talk about the impacts to employer sponsored plans and the tough decisions employees are facing as a result.
Thanks so much for doing this channel. I look forward to future episodes. You people with a passion for education make my world go round.
This was a really useful video! Recently I've been having to deal with my insurance A LOT because I'm in the process of getting my first wheelchair, and just the vocab words alone are really helpful in allowing me to follow along with everything that's happening. Thanks for the info! It's like a crash course for immediately relevant life things.
OMG I never knew how BAD it was in the USA. and it still is.
This is very helpful for getting the gist of how health care works because, as I am a teenager, I have never had anyone take the time to explain it to me so thank you.
I thank you for your effort to give educated advice & inform people about health insurance; It's a shame that we lost so many people because they were not gifted the insurance needed.
Really great job explaining everything and pacing out the explanations so I could actually process them! I'm looking forward to more!
I'm so glad you created this channel! This is really helpful for me because I'm currently taking an American Government class, and we've been talking about stuff like this recently. Thanks for the awesome videos - I can't wait for next week's episode!
This video was very informative for me in regards to health insurance and healthcare. The fun fact that caught me by surprise is how health insurance came about because of competition. Jobs had to find an advantage to get workers, and health insurance benefits were the answer!
People get mad that they're paying health insurance for the sick. Just like the video said, they're missing the point. I believe that this part of insurance, everyone paying less but it benefits the sick more is good. The ones that are healthy can complain about paying for insurance when it doesn't apply to them... until they get sick! Then they're in the same boat as the people they're complaining about. Nice informative video Healthcare Triage!
NOPE
Well done, Dr. Carroll! Love hearing you on Pete's show, I've learned so much!
Thanks for making these videos (and this whole channel). Keep it up!
Excellent summary of how health insurance actually works. I appreciate the candor and factual accuracy, as a college student studying actuarial science. If I had a complaint, it would be the pace of the videos and the information density, but I suppose that's not for everyone. I would favor a CGPGrey-style vid with more history, but this is still excellent. Looking forward to more.
I enjoyed watching the video, it explains everything in detail, the video is very interesting and effective. Thank you and good luck with the upcoming videos.
First of all, I really want to thank you for providing USEFUL and CONCISE information about such an important topic. It's really frustrating entering the healthcare world as a college student and only hearing ridiculous propaganda on major news networks. Could you perhaps explain in a separate video or comment how medical costs are low in other countries? I've heard an explanation involving a government subsidy of actual medical supplies and equipment, but I didn't fully understand it. I was under the impression that healthcare reform would lead to lower costs similar to that of European countries.
There is a video on the vlogbrothers channel regarding why US healthcare costs are so high. Healthcare reform could (in theory) lower costs, simply from competition. If insurance companies start picking and choosing hospitals and doctors with lower care costs, then the others will have to drop too, to compete. That's just an idea though, I don't know if that would actually happen or not because healthcare is so vital to survival. Thats how they've been able to get away with $6000 for an ultrasound and small doctors visit at the ER.
This is the best video about this topic ever
It's not just the delivery. It's prenatal care, ultrasounds, infant care, etc.
This video makes me feel proud to be a Canadian. Thank you Tommy Douglas!
Thank you for making this series. Navigating all of this is terribly confusing, especially when my state's exchange site rarely works.
Well, yeah, babies used to all be delivered at home before. But infant mortality was way higher. People don't want increased risks. Plus, it's not just the delivery. It's prenatal care, ultrasounds, infant care, etc.
This is why I'm so glad we have the NHS in the UK
I absolutely love love love this channel. So glad to be able to get this information from a source I can trust - I know I can trust you because John Green said so. Also him saying INsurance and wearing that jacket = so much lol.
Great video! They're very informative and I make sure to pass them on.
Awesome video! I'm glad that i found this channel!
Thank you for this video, very informative!
Just shift to the system we have in Denmark - everybody is automaticly covered no mater what the costs may be.
Thank you this was very helpful and informative 👍👍
Wow. This was really interesting and made me thing a lot about our health care system in Canada and what we pay for, what we don't, and how it could be improved.
I was fortunate in that my family had private health-insurance before my cardiac arrest when I was 12, also that I live in Australia where health-care costs are lower. But yeah insurance is good and I would recommend it for everyone, and this video does a very good job of outlining all the basics you need to know :)
Glad you liked it!
Those tough decisions are also the for employers - pay more, drop coverage, reduce plan levels to bronze, etc. thanks again!
One of the things I'm doing in my spare time is writing about labor and manufacturing policy in the mid century. It's becoming clear that a lot of the "good ol' days" was in fact the product of a historical accidents, emerging as an industrial leader in WWII for example. Outside of these historical accidents, employee based healthcare was always unsustainable. Trying to maintain it will be impossible going forward. It destroys the price system by which we can make decisions.
Wow. I love these rather short informative videos!
After a really bad injury, I spent a month at Children's and had 4 MRI's and a TON of physical therapy. I was always super healthy before, but I'm so glad my parents had solid insurance or else we would have been stuck.
Terrific, tight summary. One bit you left out is Health Savings Accounts, which are a way for consumers to create what amounts to a 401(k) for healthcare. You then pay copays + deductibles using money that comes off the top of your reported income. There are annual limits ($3,250 single, $6,450 family), but I bet those numbers will rise as more people buy their own insurance + start pushing to raise the annual limits to match annual max deductibles - the $6,350/$12,700 mentioned in the clip.
Much appreciated! Spread the word!
We appreciate the feedback!
Thank you for this awesome information. I'm sharing it to Facebook!
I always seem to forget how insurance works. This made it make sense again. :)
Thank you!!! Insurance actually makes a little bit of sense now...
This was so helpful.
In Canada we have a mixed system. For me, the Ontario government covers things like ER visits, medical tests, walk in clinics, cancer screenings, immunizations, even some preventative surgeries. We co-pay for things like ambulance use (if necessary), and they provide subsidies for seniors care. Dental care, prescriptions, eye care those kinds of less life threatening things, private insurance covers, up to a set amount.
Thanks for this informative video, real helpful
hey, i like this guy! Where has he been all this time? Go Carroll!!!
It should have really been mentioned early in the video that this kind of health insurance is unique to America. While a lot of the terminology is similar, people outside of the states can get confused quickly as government and private insurance programs and institutions differ widely from country to country.
I live in one of those countries with general healthcare, but I do get the bill and have to forward it to my insurance. My question is: Why is everything in the US like 5 times as expensive?
Because our government is run by corporations and coporations love money.
Its a long story. The short version is that its expensive because it costs a lot to provide medical coverage, and not everyone can afford that but we provide it to them anyway.
But that's also a very cold-hearted version, so here's four to five paragraphs of explanation in long form:
Basically, Hospitals are required by law to provide treatment. Everyone can be treated by going to the emergency rooms... but there is a small problem with that when they can't pay due to both not being able to pay out of pocket/bank account and not having insurance.
The cost of their healthcare has to be paid for the hospital to keep running, and the hospital has to make a profit in order to expand its setup or improve its equipment (to say nothing of paying its shareholders).
Suing those people wouldn't do any good, because even if you managed to get a court-order for them to pay you they might not have the resources at home to sell off to pay you, and as such they would probably go bankrupt and still fail to pay you everything you need to turn a profit. Meanwhile, you would be hit with the legal fees and the cost of your attorneys.
Its pretty realistic to assume that you would be likely to *lose* money in this situation rather than gain any due to the costs of the lawsuit. So in order to cover the cost of covering people who can't pay, the prices across the board have to be increased.
The ACA should in part deal with this problem... after the initial price-hike in insurance caused by the backlog of preexisting conditions that now have to be paid for by insurance companies. I commented on someone else's thread on how that works though, and you should be able to find it pretty easily.
I recently fell off my bike, bruised my tailbone and got a 4cm deep puncture wound. Over the month it took me to heal I received 2 prescriptions (antibiotics and painkiller), one x-ray, 5-6 visits with a doctor, and daily wound irrigation and dressing changes by nurses. Total cost to me? $2. I should mention I'm Canadian. Our system is amazing!
I have lived in several countries and the Canadian health system if by far the best. In certain countries with socialized health care, the quality is terrible, but not in Canada. In Canada the quality of health care is on par with the USA while being cheaper for everyone since Canada from a percentage point of view spends less money on health care compared to the USA.
I'm here purely by curiosity and the more I here about your healthcare system the more I'm like 'wow that really sucks.. I feel so lucky now'
Thank you very much, will be waiting for the next video.
I suspect that I will be frequenting this channel heavily...
I'm from Portugal, our government didn't handle public spending well, but now we have sustainable health care again. I pay like 4€ for a doctor visit, sometimes I have tonsillitis and I have to spend a night or a day at the hospital with intravenous antibiotics and it's like 15 to 20€, I'm unemployed and pay no premiums, nothing. Usually exams like cat scans and xrays if not on the ER, people go to private companies, 3 heart related exams were like 25€ some years ago when I needed them.
I love this guy, keep the videos rolling :)
Wow I could have really used this video about a year ago when my class of English learners asked me to explain what their health insurance was and why they had to have it. I was able to make a lesson on it, but it took a lot of research on my part.
Very informative video about having health insurance. Whether it's ObamaCare or from a private insurance, everyone should have health insurance to have peace of mind and live life more freely.
As far as I know, the debtor decides if he/she will default, not the debtholder. A debtor defaults if he/she shows that she will not be repaying the debt or if some contractual clause is triggered, e.g., missing a number of payments may be considered a default. You're partly right about the bankruptcy issue. In some cases, debts can be wiped clean if the debtor qualifies, otherwise the debtor will go on a payment plan, but there's no guarantee the payments will be made.
Great opening graphic!
I like how he has The Fault in our Stars in the lower left cabinet!
The bare minimums--family physician appointment, referral to a specialist through family physician, hospital visits and diagnostics deemed necessary by those groups, are 100% covered by government via higher taxes and (in some provinces) healthcare premiums paid by users to the government. Extended health coverage (e.g. dentists, chiropractors & optometrists) and prescription coverage are privately run (and non mandatory), usually included in workplace benefits.
COOL!!! YES NEW ONE EVERY WEEK!!!
As someone who works answering phone calls for a Medicare Plan, I wish that all sales agents showed this video to the customer. It would help with so much confusion. Can you please do a video on the Coverage Gap?
I surgeon had to remove 3 teeth because I had a maxillary sinus surgery. Does my insurance cover the teeth replacement.
Why are your views so low? These videos are amazing.
thanks for your answer.
We'll get to that in future episodes!
Thanks for uploading this. I'm from the UK and I'm trying to understand the inner workings of the US health system. Can you do a comparison between the US and UK/Canadian free health care model.
So much... makes my head hurt. I've worked in Rx, MD & DDS practices; have done everything from receptionist to pharm tech to med records keeper. Today I'm just an American managing life w/ chronic illnesses. But, while at those past jobs, something I always tried to do, especially while training new hires, was give a thorough, detailed picture of "a day in the life of" what their job entailed. I'd like to see videos that show what it takes to process claims, authorizations, Rx refills, etc.
Really interesting topic, I will be avid subscriber.
This is something that I wish they would taught in high schools along with tax law to help people understand some of the things you will have to deal with in life. Maybe even understand 1-2 sentences out of a 80 page document that seem to be common.
I think one thing you didn't mention is out of network sometimes means you pay everything. We ran into this with my daughter and one of the doctors was out of network. We didn't know till after.
Great, great video as someone who has worked a bit in billing for a private primary care office. :)
I might have mentioned this on the last video, but, just in case -- nice graphics, Mark! I like the intro sequence.
Where I live, in the NJ/NY area, gas is 10 cents more expensive per gallon if you pay by credit card. If there is not a lower cash than credit price, then the cash customers are subsidizing the credit customers because the station pays credit card processing fees and is distributing the cost amongst all of the customers.
Almost all private plans come with prescription coverage these days. Check out your options!
Awesome video!
I think we need more channels like this. Another channel describing how the American system of government works for example... hint hint Hank/John
It's a serious suggestion because you have a serious decision to make. You can wait around until you're thoroughly screwed financially by a system that is fundamentally broken, potentially being a burden on your family (which I'm sure you don't want to do), or you can move and gain access to a system that will treat you well.
I understand that it's expensive and difficult to make such a major change but it is an option you should at least consider and in the longer term it could be the best.
I really appreciate this series. Being a Canadian trying to understand the American system has been very difficult, and even harder to understand the opposition to "Obamacare" when it is still far from the way universal health care works here.
@@nickarjoma5350 Very true, but it is still described by most as "universal health care".
Even the Canadian Government describes it that way: www.canada.ca/en/immigration-refugees-citizenship/services/new-immigrants/new-life-canada/health-care-card.html#system
Is there a plan to make some sort of comparision how universal health care (like the uk and germany have) compares to the us system? b/c right now I am just confused and feel sorry for people in the us...
Can you please explain why, when my brother got extremely sick overseas and had to get surgery, the insurance company sent us a bill saying that we paid too much, even though it cost 1/25 what the procedure would have cost here in the states?
I can vouch for the concept: I had an appendectomy without health insurance about 13 years ago, and successfully plead my case to the various hospitals and doctors who treated me. I ended up paying just over $1,000 of $13,000 in bills.
While I'm smart enough to know that it's a rare case and that I was very, very lucky, there are likely lots of Americans that would assume that if it works once, it'll work forever.
What about prescription plans? Are those typically a completely separate policy from the medical plans?
Or, do prescription drug costs from copays contribute to the deductible and out-of-pocket maximum?
Oh my god... guys, guys there hasn't been any comment saying what number they are or on the number of views seen so far. Guys... this must be a first! PS this was really interesting, and I can't wait till next Sunday!
Thank you!
I just noticed The Fault In Our Stars on the shelf. :)
We sure hope so!
Can someone explain to me why:
1) The USA can't have universally free healthcare for citizens like other countries, where healthcare is paid through taxes?
2) Healthcare in the USA is so expensive? We have the same services and, in some cases, better, in Europe, but it's much much cheaper. . .
I'm very confused. . .
In other countries,government negotiations drive prices down. Watch the vlogbrothers video on 'Why are American healthcare costs so high'.
*****
in the UK its not free we pay for it in National Insurance, but it is free at ther point of use.
Thanks for clearing this up, I'd really like if u had a video about paying for obamacare and like how much you'd have to pay if you are a company, or a family whom parents smoke or whatnot. And about the subsidies, im really confused about that
I am for the ACA for sure, but my biggest problem is those of us who have healthcare offered through our employer, so we don't qualify for the market and subsidies, but STILL can't afford to buy health insurance. I've been gearing up to get a third job just to pay for the insurance when I, luckily, got a promotion at work. But had it not worked out that way, I would have been screwed.
I got a Blue Cross and Blue Shield ad for this. XD
Great show Doctor! I have a question perhaps you could do a video on. Supplements is a huge market for bodybuilding and fitness programs. Claims like "1 gram of protein for 1 pound of body mass," "eat 5 meals." Is this a bunch of nonsense? Are protein supplements healthy? I've read nitrogen balance is important in building muscle and simply counting caloric intake. Though what is the healthy approach and is protein supplementation effective and safe? I know that's sort of a lot and a bit scattered, but fitness is very important to me and I want to do and educate it correctly! Plus I'm curious what research you find.
>Are those typically a completely separate policy from the medical plans?
Not typically, some companies will offer supplementary prescription plans though.
>do prescription drug costs from copays contribute to the deductible and out-of-pocket maximum?
Only if the plan specifically says it does, from what I've been told/seen while shopping myself they generally do not and are counted as a separate deductible from other medical care.