WASHINGTON: Health care in the United States is private, complex and expensive. Ahead of a Supreme Court hearing into President Barack Obama's effort to reform the health care system, here's a snapshot of how it works.
THE BASICS
There is no national mandatory health insurance system in the United States, due to the unique history of the country and its outlook. Free choice and individual responsibility are fiercely defended notions.
Everybody or every family except the elderly or the very poor who wants health coverage must do so through a private insurer. In 55 percent of cases, such coverage is provided through an employer who shares the cost with the employee.
The system hinges on market factors. Premiums, types of care reimbursed, levels of reimbursement, cost-sharing between employer and employee all this depends on a variety of variables, from how big the employer is to where the employee lives. Women pay more than men, large people more than thin ones, the elderly more than young people.
For the elderly and the poor, there are two government programs. One is Medicare for over-65s and the handicapped; it covers 48 million people by paying for basic hospital care, with options available at extra cost for doctor's visits and prescriptions. The other is Medicaid, which provides free care for the neediest, subject to their resources.
Civil servants and military veterans have their own health insurance.
In 2010, 49 million Americans under the age of 65, or 18 percent of the population, had no health insurance.
HOW IT WORKS
Health insurance may pay for the whole cost of a medical bill, but more often, it covers only part of the cost, leaving the patient to "co-pay" the remainder of the bill. Patients can go to designated hospitals or doctors with whom the insurer had negotiated discounts; if they go outside that list, they have to check first if the insurer will pay.
Those without insurance, most often the poorest, pay higher, non-negotiated fees out of their own pockets.
Fees are very high in general because doctors must pay back the high cost of their medical studies and insure themselves against malpractice suits, which are common in the United States and which explain why American doctors carry out so many detailed examinations. All this weighs on the cost of premiums.
A doctor can refuse a Medicare or Medicaid patient.
Paperwork generated by the complexity of the system requires the hiring of many administrative employees, adding further to the costs. In case of a life-or-death emergency, by law, the patient must be treated.
THE COSTS
For the government, despite the private-sector way in which the sector works, 47.7 percent of overall health costs are public expenditures, due to direct or indirect assistance, such as tax deductions.
The US health care system is the most expensive in the world in terms of percentage of gross domestic product (17.4 percent). Per capita, it costs $8,000 twice the figure for France, for example.
Some $2.6 trillion dollars went towards health care in 2010, 10 times more than more than 30 years ago.
For individuals, premium costs vary widely, due to the many parameters involved. Last year, coverage for an employee and family, through an employer, typically cost $15,000, with 30 percent paid by the employee and the rest by the employer. That premium was nine percent greater than a year earlier, and represents a 113 percent increase over 10 years.
Individuals can open non-taxable health savings accounts to squirrel away money in the event of a future medical need.
US HEALTH CARE IN THE WORLD
Life expectancy in the United States is 78.2 years. In that regard, it ranks 50th on a world scale, and 28th among rich nations in the Organization for Economic Co-operation and Development Reuters
The United States rank 32nd among OECD member states for infant mortality (seven per 1,000) and first for medical costs imposed on patients.
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