Essay

Health care in America

By David Yenches

音声ダウンロード

Health care in America is complicated. One thing a lot of people in countries like Japan might not know is that the quality of care you have depends on the state you live in.

My wife and I have now experienced health care in Washington state and California. In Washington, our provider charged us over $200 (¥22,400) a month, but in California, it is under $5 (¥560).

In Washington, she broke some bones in her ankle and had to go to a hospital. But she couldn't go to just any hospital. She had to go to one that was in her insurance plan. Her X-ray cost about $10 (¥1,120). Not bad! But for her follow-up visit to a doctor, where she had a consultation and got a small brace for her leg, the charge was over $500 (¥56,000). She phoned the hospital when she got the bill and they offered her a 15 percent discount.

At least she had insurance. Around 28 million Americans have no insurance at all. They have to pay the full price of any medical procedure. A one-day hospital stay costs on average $5,220 (¥586,000).

In Japan, private insurance is an option on top of national health care. But in the U.S., almost all insurance is private insurance. And if you don't have insurance, you have to pay the full sticker price.

How do Americans buy insurance? Health plans are either bronze, silver, gold or platinum, with bronze having the cheapest premiums and highest deductibles, and platinum the highest premiums but the lowest deductibles. When you choose a plan, you have to consider how often you will see a doctor or need medical attention.

For Americans, getting the right plan is a bit of a gamble, based on their health and budget. If you choose a cheap bronze plan, you'll have low premiums but you better hope you stay healthy, because your deductible will be high. If you become seriously ill, you might have to pay thousands of dollars out of pocket before the insurer starts paying for your treatment. Do you have a special medical condition that needs special treatment? Then you'll also need to compare plans and providers in detail, to make sure your plan covers your condition.

If you are fortunate enough to have employer-provided health insurance (like my son), the employer will pick up all or part of the premium. If you don't have a plan through your employer, you have to buy one yourself.

Currently, the Affordable Care Act, or "Obamacare," is the law of the land. It isn't perfect, but it's lowered the number of Americans without insurance. But it might not survive.

The Republican-controlled Congress wants to get rid of Obamacare. Will they succeed? My wife and I are crossing our fingers.

アメリカの医療制度

全ての人が医療保険に入っている日本と違い、アメリカの医療保険制度は非常に複雑だ。国民皆保険制度がなく、およそ2800万人もの人が無保険状態という深刻な問題を抱えている。

The Japan Times ST: July 28, 2017