Advanced Conversation with Jennifer on Health Care in the U.S. 🩺 (1)

Hi! I'm Jennifer from English with Jennifer, and I'm ready to share another current issue.

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In this video, I'm going to share vocabulary and information related to health care in the U.S.

I'll do my best to give a balanced presentation. It's not my goal to promote a political agenda.

As an English language teacher, I'm here to offer the language support

that learners will need to follow and participate in discussions about health care.

So are you ready? Let's get started.

Health care refers to the services you get to prevent and treat medical problems.

When we talk about our health, we're referring to our physical and mental well-being.

In the U.S., we have many medical professionals and, in general, health care professionals

who provide services for our physical and mental health.

A health care provider isn't necessarily a doctor or a nurse.

Health care providers include therapists, counselors, and various technicians.

Note that "health care" can be written as one word or two. Just be consistent in your own writing.

The health care system in the U.S. can be confusing.

There are different ways you can get medical treatment, and basically any visit to any medical center

involves paperwork and some form of payment by someone.

Hospitals, clinics, and private practices need to get paid. Even after you get

treatment, you may have to worry about completing more paperwork and making additional payments.

Let's start with a fundamental question.

Is health care a basic human right or a privilege?

A human right is something everyone should have.

A privilege is a benefit -- something good and useful -- but not everyone receives it.

If we talk about getting a basic education, for example, every child in the

U.S. has access to public schools. It's their right to get an education from

kindergarten through 12th grade. Our public schools are paid for with tax

dollars. If you're a U.S. citizen or resident, you pay local, state, and federal taxes,

whether you have school-aged children or not. Tax money funds the

public school system. Families don't pay tuition at public schools.

Now with health care, we don't really have a free health care system for everyone.

You'll hear terms like "national health care system" or "universal health care."

We don't have that kind of program where services are free for everyone. However,

tax dollars are used to pay for federal and state medical programs that some people

participate in. I'll explain more a bit later.

I'd say the majority of Americans have health insurance, and most often it's

employer-based insurance. That means that people have health insurance policies

through their employers.

The policy is the agreement and terms. Health insurance

is a benefit employers can give. Employers pay most of the cost of the policy,

and then the remaining money is deducted or taken out of your paycheck.

A health insurance policy for one employee can cover that individual or an entire family.

For example, my husband has a full-time job with a company.

Health insurance is one of his benefits. He's the policyholder. As his spouse, I'm

insured. And our children are eligible dependents. "Eligible" means they meet all

the requirements to be considered dependents, so they're insured too.

We can talk about being insured or covered. It's the same thing.

Our family has insurance. We have coverage. Those are the nouns.

Even as a benefit, health insurance is expensive. I read that the average company

contributes 70 to 80 percent towards health insurance. The employee pays the

rest. If you have a family plan, more is deducted from your paycheck. Even after

those deductions, you still have copays and deductibles.

Getting confused by all the terminology? We can get confused, too, sometimes.

The premium is the total cost. It's the amount you pay in order to have a health insurance policy.

When you hear people talk about high premiums or premiums going up, they're talking about

high costs or costs going up. As I said, the employer usually covers most of the premium.

The rest you have to contribute as the employee. It's taken out of your paycheck.

"Copay" is short for copayment. This is the amount of money

that you have to pay when you visit a health care provider and receive some kind of service.

A copay is in addition to your premium. For example,

it may be 10 to 25 dollars when you visit your regular doctor, who we

call your primary care physician or your primary care provider.

But your copay to see a specialist will be even higher. Maybe 30 or 50 dollars.

And if you have to go to the emergency room, your copay may be as much as one, two, or even three hundred dollars.

Some argue that copays serve at least one purpose, and that's to reduce the use of services.

If you know you have a copay, then you're not so quick to seek medical attention for every little problem.

We also have copays for medicine at the pharmacy.

Your health insurance policy will usually cover a larger percentage

of the cost. Some of my copays are as low as $7, others $70.

Then there are things that you need, but they're not covered by insurance, like a back brace

or vitamins. You have to pay out-of-pocket. These things are an out-of-pocket expense.

For example, there's a little bottle of vitamins that I need. It lasts

for about three months. Each bottle is over a hundred dollars. That's not covered by my insurance.

Deductibles aren't to be confused with premiums.

The premium is the total cost of your plan. A deductible is the amount you have to pay

before your insurance will start covering your medical expenses.

Maybe you have a $500 deductible. That means you have to spend

$500 before the insurance company starts covering expenses.

You might have a high premium with a low deductible or a low premium

with a high deductible. In short, health insurance companies are running a

business, and they have to make money.

With premiums, deductibles, co-pays, and out-of-pocket expenses, you don't want to

get sick. It's expensive. Well, the good news is that many preventive health care

services are covered under a plan. For example, we don't have copays when we

get our flu shot, and we don't pay extra when we go for our yearly eye exam or

when we go for dental cleanings twice a year.

Keeping people healthy avoids bigger costs, right? But everyone gets sick now and then.

Injuries happen. Health problems arise, especially as you get older.

What do you do if you don't have private health insurance? We have one federal

program called Medicare. It's mainly for the elderly, so if you're over 65, you're

entitled to Medicare. And if you have some kind of disability, you can get

coverage from Medicare. Those over 65 likely contributed earlier when they

were younger and paid taxes, so coverage in retirement makes sense. Most everyone agrees.

Even on Medicare you'll have premiums, deductibles, and co-pays. At least, that's what I understand.

If you can't afford those additional expenses,

then there's Medicaid. Medicaid is another government program. It's a

federal and state program that offers financial assistance to low-income patients.

In the U.S., we have a law that allows everyone to get medical treatment in an

emergency situation, regardless of their ability to pay.

EMTALA stands for Emergency Medical Treatment and Labor Act. It's a law that says you have to

give a patient, any patient, access to emergency services.

So here's how I understand the law. Under EMTALA, Medicare-participating hospitals with emergency

services must screen all patients coming to the emergency room, the ER.

Then if there is an emergency condition, the hospital must treat and stabilize the patient.

So there should be no "patient dumping," but EMTALA does not necessarily

require ongoing care. Once a hospital has met its EMTALA obligations, it's no

longer obligated to provide services to that patient.

The challenge with this kind of law is funding. Costs and charges are two

different things. A hospital may not charge a patient for a service, but

there's still a cost to the hospital. How much can be given for free before a

hospital doesn't have enough money to cover its expenses and pay its employees?

The government has a set amount of money for health care. How should that money be managed?

The EMTALA law ties into the issue of ethics. Ethics has to do with

what is morally right and wrong. Health care is a business, and any business

faces the challenge of managing finances while still being ethical.

But can a health care facility stay in business if too many services are given for free?

Health care almost always makes the news headlines. There are often new policies,

new proposals, and new controversial cases that make us question how we can

improve our current health care system. Some believe the current system has some

good aspects, and it simply needs to be improved and fixed in certain areas.

Others say the current system doesn't work. It needs to be replaced with

universal healthcare for all residents in the U.S.

You'll hear these people talk about the need for a complete overhaul. That's a complete change.

Many of the 2020 U.S. Democratic presidential candidates have very progressive proposals.

A number of them want Medicare for All, a government-run program.

This would mean no more private insurance companies. Americans would pay taxes,

and taxes would cover medical services for everyone. Under Medicare for all,

hospitals, clinics, and pharmacies would receive payment from one payer: the government.

So you'll hear the term "single-payer health care."

Some candidates are proposing more moderate versions of this reform so that Americans could keep

their health insurance coverage through their employers and still work with

private insurance companies. So some are proposing Medicare for all who want it.

You'd still have the option to work with a private insurer. You'd still have the

option to keep insurance through your employer. The public option allows people

to buy in if they want to. At least that's how I understand it. Again, health care

is confusing, so I apologize for any inaccuracies. I'm explaining the concepts as I understand them.

We had a degree of reform under President Obama when the

Affordable Care Act was created. That was back in 2010.

And it was created to expand coverage to those who were without any.

One of the controversial ideas has been to require or mandate that everyone has to have insurance.

If you don't buy in, you have to pay a penalty. The logic is that

everyone has to buy in or pay the penalty, so there should be enough money

to cover the treatment of those who need it.

But this is one point that causes arguments.

The young and healthy have less need for health insurance and

medical services in general, so they may wish to live without insurance and avoid

unnecessary costs. Is it right to create a universal health care system and

require everyone to participate?

So I've mentioned the Medicare for All plan. It's a universal healthcare system,

and there are at least two ways of looking at it.

On the one hand, everyone gets coverage. Those who need medical services receive

those services. On the other hand, everyone is required to buy in --

to contribute tax dollars. So essentially, it also means that healthy people are

paying for others' medical expenses.