American family medical insurance costs

How bad is the American medical insurance system? Just look at China's medical system. Because the original blueprint of domestic medical reform is to copy the United States. The director who made Fahrenheit 9 1 1 released another documentary, sicko, last year, which severely criticized the chronic diseases in the American medical system. Once released, it became the most popular documentary in American history. At the end of the movie, an old American woman who was middle-class before her illness sobbed and said that she had struggled all her life and looked down on doctors, but in Cuba, all these were free. In the United States, the medical insurance system is a big "stubborn disease" and has become the most criticized problem of the American people in recent years. The main problem is that the medical expenses are too high and soaring year after year, which leads to the increasing burden of personal medical insurance. At the same time, the government has invested more and more, but the effect is not proportional. Under the impetus of the Bush administration, the US Congress will discuss the reform of the medical insurance system from next month. Health care reform and immigration reform will be the two hot spots of domestic reform in the United States this year. Massachusetts passed the universal health insurance bill recently, the Massachusetts legislature passed a bill to reform the health insurance system by almost a unanimous vote, becoming the first state in the United States to try to establish a universal health insurance system. This bill requires employers and employees to bear the responsibility of purchasing medical insurance: employers with more than 10 employees will accept a fine of $295 per employee every year if they do not provide medical insurance for all employees; Residents who have the ability to buy medical insurance but don't buy it will face the tax penalty of 1 from 2007; Meanwhile, the government will provide subsidies for low-income residents to purchase medical insurance. Massachusetts lawmakers said that after the implementation of this bill, it is estimated that by 2009, more than 95% of the state's existing 500,000 residents without medical insurance will have medical insurance. This bill caused great repercussions in the United States. Unlike most western countries, the United States has no universal medical insurance system. After World War II, several presidents, from Truman and Johnson to Nixon and Clinton, tried to establish a universal medical insurance system, but all ended in failure. Domestic comments in the United States have mixed opinions on this bill in Massachusetts. Supporters believe that more and more people in the United States now have no medical insurance, and this bill is the first bold attempt to solve the medical insurance problem; Opponents believe that forcing individuals to buy certain insurance products violates the principles of personal choice and free economy, and may lead to excessive expansion of government power. The reporter once talked with an official who works in the welfare department of a local government in the United States. Even he admits that America's health care system is getting worse and worse. He said that 20 years ago, no one needed to pay for medical treatment or purchase medical insurance. In the past 20 years, repeated reforms have made the burden of personal medical insurance heavier and heavier. Statistics show that employers in the United States are increasingly reluctant to buy medical insurance for their employees. Since 200 1, the share of medical insurance expenses borne by American employees has increased sharply: family medical insurance, the share borne by employees has increased by 58%; Personal medical insurance, employee share increased by 63%. At present, only 6 1.9% people enjoy the medical insurance provided by their employers, while in 1987, the proportion was 7 1%. It is estimated that there are still 46 million people without any medical insurance. High medical expenses have pushed premiums soaring. Dr Meng Yingying, a senior researcher at the Center for Health Policy Research at UCLA, has been engaged in public health policy research for a long time. She briefed the reporter on the background of the reform of American medical insurance system. American medical insurance system is based on marketization and privatization. In this system, the government is only a buyer, buying services from private insurance companies and medical institutions, and the government itself has limited intervention ability in insurance companies and medical institutions. In this respect, the United States and Canada are different. Canada has established a national welfare medical insurance system, and the government has huge market resources, so it can negotiate with insurance companies, hospitals and pharmaceutical companies to reduce prices. The US government has only two social welfare medical insurance plans, one is the "medical care plan" for the elderly, and the other is the "medical assistance plan" for the low-income or unemployed. These two schemes involve a limited number of people, which limits the government's negotiating ability. At the same time, influenced by political culture, it is difficult for the United States to establish a universal health insurance system. Any universal health insurance system will limit the individual's right to choose. In the United States, a society that advocates personal choice, if some citizens sacrifice a little freedom, it will cause great social repercussions. In order not to sacrifice anyone's right to choose, the only way is to maintain the current mechanism of marketization and privatization. However, this mechanism is now experiencing more and more serious failures. The most obvious problem is that more and more money is invested, but the result is not proportional. The annual medical expenses in the United States are the highest among developed countries, and have increased rapidly in recent years. According to a survey conducted by the American Public Welfare Foundation in March this year, from 1993 to 2003, the medical expenditure in the United States increased from $900 billion to170 billion, and the per capita expenditure increased from $3,354 to $5,670 per year. These two indicators are high in western countries, but the quality of medical services is not the highest. According to the comprehensive comparison of medical institutions in Germany, Canada, New Zealand, Australia, Britain and the United States, the overall quality of medical services in the United States ranks last. The key problem that causes this situation is that the medical expenses are too high, which drives the premium of medical insurance to soar year by year. The lack of drug prices restricts the limited welfare coverage, so why doesn't the government take action to curb the skyrocketing medical expenses? The reason for the increase in medical expenses is that medical technology and equipment are constantly updated, and new drugs are constantly coming out, especially the medical expenses are greatly increased. The price of medical expenses in the United States is mainly the result of checks and balances between insurance companies and medical institutions, but it lacks constraints on pharmaceutical companies and medical device companies. Hospitals don't overcharge, but pharmaceutical companies and medical device companies overcharge. There is no direct economic relationship between insurance companies, pharmaceutical companies and medical device companies, and this part of the price increase factor cannot be suppressed through negotiation. As a purchaser of services from insurance companies and medical institutions, the government has no direct economic leverage to intervene in pharmaceutical companies and medical equipment companies. Pharmaceutical companies and medical equipment companies are the biggest donors in American bipartisan politics, and they have strong out-of-hospital activities. Any move to suppress prices is bound to encounter unimaginable resistance. This has caused an interesting phenomenon: the drugs produced by American companies are very expensive in the United States, but they are sold in Canada, but they are suppressed by the Canadian government. So countless Americans flocked to Canada to buy medicine. In addition to the cost, the coverage of medical insurance is also a key issue. Dr. Meng Yingying explained that because there is no universal health insurance in the United States, the whole system is based on marketization and privatization, resulting in the characteristics of fragmentation and disorder of the medical insurance system. The welfare of the government and enterprises can't cover everyone, and quite a few people are in an awkward position. Dr Meng Yingying, who once worked in the Shanghai Municipal Health Bureau, believes that the American medical insurance system is market-oriented and lacks social co-ordination, which has indeed caused certain problems. But this system also has advantages, that is, insurance companies and medical institutions contain each other under the market mechanism, insurance companies should control costs and ensure service quality, and medical institutions should strive for customers and provide good services at the same time. The most ideal medical insurance system is the organic combination of marketization and social overall planning, but it is not easy to do, and there are certain contradictions between them. It is difficult to touch the roots of President Bush's reform methods or free market and privatization ideas. The core of his "personal health account" plan recently is that individuals deposit part of their pre-tax wages into a tax-free "personal health account", which can be transferred every year, and individuals use the money in this account to pay medical expenses and purchase "high deduction" insurance plans. "High deduction" means that the insurance company will pay the medical expenses only when the medical expenses reach a fairly high amount. Of course, the premium will be quite cheap. The advantage of this plan is that individuals will be more cautious when spending money on medical treatment. At the same time, due to the tax reduction policy that treats everyone equally, some people who have not purchased medical insurance will join this plan, and the problem of no medical insurance is expected to be partially solved. But the disadvantage is that it is beneficial to young people with good health and stable income. For people who often need to see a doctor, this plan is not worth the loss, and low-income people simply don't have enough money to deposit in a "personal health account". Therefore, critics say that the consequence of this plan is that all healthy people have joined the "individual health account" plan, leaving the elderly, patients and low-income people in the government welfare system. The income of government medical accounts has decreased, but the expenditure has increased, and the welfare system will collapse faster. Many States in the United States have considered bypassing the Federation and acting alone. Massachusetts's reform plan is the first. More than 20 States, including Maryland, are considering legislation to force large enterprises to buy insurance for their employees. Kansas, Maine, Minnesota and other states want to design an insurance plan for employees for small businesses. Florida began to convert medical benefits into cash and distribute them to individuals last year. South Carolina wants to privatize Medicaid. It can be seen that the current direction of medical reform in the United States, from the federal level, is further marketization and privatization, and from the local government level, it is bent on its own way, which is bound to deepen the segmentation trend of the American medical system. Moreover, all the reforms have not touched on the most fundamental problems, that is, stabilizing drug prices and controlling medical expenses, so it is difficult to expect to completely solve the existing problems. Our correspondent in America has many questions about the medical insurance system. The Los Angeles Times published a special report on April 3, illustrating the dilemma faced by some Americans because of medical insurance problems: some people want to divorce, but in order to pay for medical insurance, they can't go through divorce procedures for more than ten years; Some people struggle all their lives, enter the middle class from the poor class, fall back to the poor class after a serious illness, and can only live on the government's welfare medical insurance; Some people immigrated to the United States from Mexico and worked for more than 20 years, but they still can't afford family medical insurance in the United States. They can only buy Mexican medical insurance and go back to Mexico to see a doctor. The government's medical insurance is in trouble, and the medical expenses are rising, which is difficult for the government to support. The American government's medical insurance plans are facing financial crisis. The "medical care plan" is mainly aimed at retirees. After 20 1 1 year, a group of baby boomers will gradually retire, which will bring great pressure to the plan. In addition, in June 5438+10, President Bush launched the prescription drug insurance plan for retirees as a performance project. It is predicted that by 20 13, the prescription drug plan alone will cost 558 billion dollars, and the account of "medical care plan" may go bankrupt at that time. The "medical assistance program" provides medical assistance to low-income and unemployed people, and the number of recipients has increased by more than 8 million in the past three years. A considerable part of the annual foreign debt of the US Treasury is used to fill the gap in this plan. In addition, the US government has to pay the emergency expenses of all public hospitals. According to American law, all emergency patients in public hospitals must be treated unconditionally and immediately, regardless of whether the patient has insurance or not, or even whether he is a legal resident of the United States. The medical expenses are finally hung on the government bill. This expenditure is also very powerful every year. A few years ago, the public hospital system in the United States had to be greatly reduced, with dozens of hospitals closed and tens of thousands of people laid off. In the face of various contradictions, the insurance industry in the United States is also constantly reforming, but all it can do is to negotiate with medical institutions to reduce costs. For example, in the "managed medical plan", insurance companies sign contracts with medical institutions, which contract a certain amount of medical services, and the insurance companies pay a fixed monthly fee according to the number of people, regardless of whether these people have seen a doctor or not and how sick they are. This can effectively control medical expenses and make medical institutions pay more attention to disease prevention. This scheme is becoming more and more popular now, but it can't solve the fundamental problem of increasing medical expenses. Medical expenses in the United States have been rising year after year, and treatment has become more and more expensive.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.