Skip to content
No Excuses not to talk about healthcare

So Many Questions

PUBLISHED 2017-06-05
how does health insurance actually work?

You get a health insurance plan in one of many through your job, a government-run exchange, Medicare if you're older, or Medicaid if you're very poor. Every month, you pay your insurance company a certain amount to have your plan. That's called a premium. The insurance company keeps that cash on hand to pay all or some of the bill when customers get sick. Since these companies have all the customers, they can negotiate prices with doctors and hospital systems. The ones they have deals with are “in-network,” so the patient will end up with a smaller tab at the end of it. All the others are “out-of-network” aka you're basically on the hook for most or all of the bill. Once you've hit your deductible – the $$$ you have to pay toward medical costs before your insurance picks up part of the tab – your insurance will cover some or all the costs of prescription drugs, hospital stays, lab tests...whatever you need.

How much does insurance cost?

HA. Nothing is easy. First, there's the monthly premium that you have to pay, which is basically a fixed bill just to have your health care plan. Then, there's your deductible, which is what you have to spend before your insurance company pays for anything. Breathe. For preventive appointments (like your general physician or your gynecologist) you usually just have to fork over a co-pay. That's the payment you make every time you get care. The actual bottom line totally depends on where you live, how old you are, and what kind of plan you have. But to give you an idea, last year the average total for covering a single person was $6,435. That's just what you and your company pay for you to have a health insurance plan – it doesn't include your medical bills after that.

What is COBRA?

COBRA is the service that lets you keep your health care benefits for a certain period of time after you quit a job or get fired. Congress put it in place in the ‘80s to make sure people had a safety net if they suddenly lost their jobs. But since your old company isn't required to pay into your health care anymore, it's gonna cost you. As in the full cost of your health care plan – meaning what you've been taking out of your paycheck plus what your employer has been chipping in. Not so fun.

What's the difference bewteen the US Uk and EU healthcare systems?

The US has a private healthcare system. The Brits have a socialized system called the National Health Service provided by the government. Pretty much all of their health care – appointments, treatments, prescription drugs, etc – is paid for ahead of time through taxes. The UK spends a lot less on health care than the US does – as in thousands of dollars per person per year. To help this happen, Britain has a board that decides what kinds of treatments the gov will pay for and which it won't. Sometimes that means potentially life-saving new drugs get the axe because they're too much cash money.

how's america doing healthcare0wise comapred with the rest of the world?

Not so great. Bad news: the US has the most expensive healthcare system in the world. More bad news: it also has some of the worst health care in the developed world. Stacked up against Canada, the UK, Europe, and Scandinavia, the US comes last. That's in terms of quality of care, access to doctors, and outcomes. Bitter pill.

What does "In network" vs "out of network" means?

This is insurance speak. Basically, in-network refers to the doctors groups and hospitals that your insurance company has deals with to make the bottom line less expensive for them and you. Out-of-network are the ones your insurance doesn't have a deal with. Cue the flying money emoji. You might have to pay for your costs our of pocket if you see an out-of-network doctor. Depending on your provider, you might get reimbursed up to a point. Maybe.

What's happening with drug prices?

They're going up, up, and away. Prescription drug prices are due to increase by double digits this year – just like they did last year. They're going up faster than wages and the cost of living. Problem. Lawmakers have been looking into it, and they're pointing their fingers at drug companies trying to scoop up more and more in profits. This issue got put in the spotlight last year when it was discovered that Mylan – the company that owns EpiPen – hiked up the price of a two-pack to more than $600. Not exactly affordable for those who need them handy in case of a run-in with a peanut. It didn't look great that Mylan execs were giving themselves some serious raises at the same time. Thanks to public shaming, Mylan agreed to start selling a lower-cost version. Other companies like Valeant and Turing Pharmaceuticals were also put on blast for similar reasons. President Trump has promised to tackle the issue.

how does a drug get approved?

Everything has to get a green light from the Food and Drug Administration. Here's how that happens...

First comes the pre-clinical phase. Once a drug company cooks up something new in the lab, it has to test it out on animals. Sorry Mickey. Then, the company sends a text to the FDA that they've got a new drug in the works and want to test it on humans.

Now comes the clinical phase. Anywhere from 20-80 healthy people volunteer to test the drug. This is to figure out what the side effects are. Then another slightly larger group of people test whether the drug actually works. This group has the disease or condition that the drug is trying to fight off. Some of them get the drug, and others get a placebo. Then ANOTHER, even bigger group tests the drug and different doses of it.

Next up: the FDA gets more involved. It checks how the drug is being labeled, where it's made, and meets with the drug company to ask any Qs. If all goes well, a drug gets the stamp of approval.

Then comes post-game. It's not over yet. The drug company submits regular updates to the FDA on how things are going with the new drug. Is it doing what it's supposed to? Are there any new side effects? Sometimes a drug has to be yanked off the shelves. But usually, it's free and clear.

What's the difference between a drug and its generic version?

Think of the generic version as the brand-name drug in a different outfit. Brand-name drugs are protected from copycats by patents for about twenty years. After that, generic copies – which are basically the exact same drug, only cheaper – can go on the market.

What's Obamacare? Why don't republicans like it?

Think of Obamacare as a kitchen stool. There are three legs that keep it up and running. Lose one of them and you fall on your peach emoji.

1) Everyone can get health insurance. Including people with pre-existing conditions like asthma or diabetes

2) Everyone HAS TO get health insurance. Either through your employer, Medicare or Medicaid, or state or federal-run government exchanges set up under the law

3) The US government helps foot the bill for people who don't make enough to pay for coverage on their own.

Republicans don't like Obamacare for lots of reasons. Some say it's another super-expensive entitlement program like Medicare and Medicaid that the taxpayers have to pay for. Others say the federal government has no business getting involved in the free market.

Why would I pay for healthcare if Obamacare is free?

Ooooh...bad news. Obamacare isn't free. At least not for most people. The law helps some people cover their insurance costs, depending on their income. Some services are free – like birth control and your annual checkup. It's also paid for using your tax dollars. So, not free. Sorry.

Does the federal gov fund abortion procedures?

Not in almost all cases. There's this thing called the Hyde Amendment. It blocks federal funding for abortion services (except in cases of rape, incest, or when the mom's life is in danger). Planned Parenthood provides abortion services, along with lots of other reproductive care like birth control, breast exams, and STD screenings. Last year, the nonprofit said that abortion services made up just 3% of the services that it provided. The feds reimburse Planned Parenthood for preventive services it gives to people on Medicaid – but not abortion services. Pro-life advocates say this indirectly supports abortion, since the reimbursement money helps keep Planned Parenthood's doors open.

What are birth control options? What's most popular?

About a quarter of women on birth control take a pill. Another quarter have had ‘tubal sterilization' aka got their tubes tied. About 15% just use condoms. Another 10% have an IUD – or an intrauterine device – that's basically a small piece of flexible plastic shaped like a T that acts like a semi-permanent bouncer for sperm. There are other, less common, methods, too.

How long has birth control pill been around? is it safe?

In 1960, the FDA OK'd the pill for contraceptive use. It was hugely popular right away. Just three years later, more than two million ladies were using it. This was a game-changer for women, who gained more control than ever over how many kids they had. In 1960, the typical American woman had three or more children. Twenty years later, it was two or less. Today, there are way more options, but about a quarter of those on birth control take the pill. That's about 9.7 million women.

Is it healthcare or health care?

Nobody really knows. It used to be health care always, but healthcare has become a thing in recent years. Generally, healthcare refers to the industry. Health care two words refers to services you get from your doc.

Sign up for theSkimm