US Healthcare - Finding help and resources

The United States, like other countries provide both private and public health insurance, but there is far more private than public health care. It is the only industrialized country that does not have publicly mandated government-funded coverage for all citizens (apart from South Africa). At the same time however, health care expenditures in the US total over 15% of the GDP, which is greater than any other developed country.

Most people in the US obtain insurance through their employer or on their own. Unfortunately almost 17% of the population are uninsured and have to pay upfront which leads to delay in medical care, missed tests, treatments and follow-up. Almost 20% of the uninsured population is able to afford insurance, almost 25% are eligible for public coverage, and the rest (56%) need financial assistance (8.9% of the US population).

Private Health Insurance:

There are over 1000 private health insurance companies and most offer a fee-for-service insurance plan (with higher premiums) and at usually more than one type of managed care plan (health care delivery system with restrictions on provide choice and referrals, and with lower premiums, eg HMO, PPO, and POS). Some insurance plans cover medications while others do not. Cost-sharing (co-pays and deductibles) is also variable. 60% of the population obtain insurance from employers, while just above 9% buy their own.

Of the many insurance providers, Blue Cross/Blue Shield is a nonprofit carrier that is regulated by insurance agencies in each state. It is an insurance provider for 30 %-50% of working people in the US. Blue Cross caters to hospital costs, while Blue Shield pays for medical tests.

Government-funded Insurance:

Almost 30% of the population is covered by public health care, much lower than other developed nations.

Medicare is provided by the Federal government (through social security) and is for those >65 yo regardless of income and people of any age with chronic disabilities or debilitating illnesses. It covers inpatient hospital costs, home health care, nursing home care for up to 3 months post-hospitalization, hospice care, dialysis, physical therapy, laboratory tests, outpatient care, physician bills, ambulance service and medical equipment. Note that the latter 7 services listed are optional and have a 20% copayment and at least a $100 deductible.

Medicaid is managed by both the federal and state governments. Eligible people include those with very low income (indigent) except childless adults, with 1/3 of the medicaid budget allocated to nursing home care for indigent elderly people. It also provides for inpatient and outpatient hospital costs, physician bills, home health care, hospice care, laboratory tests, dialysis, medication and very importantly long-term nursing care that is not funded by medicare.

In addition, the Department of Veteran Affairs directly provides health care to injured U.S. military veterans and current servicemen and women through a nationwide network of government hospitals (non-injured veterans are often not covered). It basically offers extremely affordable and sometimes free care to veterans

Other public systems include S-CHIP: The State Children's Insurance Program (S-CHIP) covers children whose families make too much income to qualify for Medicaid but have too little to buy private health insurance.

Although many states have discussed an overhaul of the US health system, only a few states have really attempted to provide universal health care coverage, eg Minnesota and Massachusetts (Massachusetts 2006 Health Reform Statute). Other US states (in particular New Jersey) help to cover many people (but not all) by reimbursing hospitals and other health-care providers using what is generally characterized as a charity care scheme.

Charity and Free Clinic facilities:

These centers offer healthcare for free or for a small fee and generally limited to those with lower income and no health insurance, including those not eligible for Medicaid and Medicare. They primarily treat acute, non-emergency conditions and some primary care for prevention and chronic conditions. There are a few that have pharmacies and dental services.

The staff are usually volunteer healthcare professionals and the facilities rely heavily on private donations, foundations, the United Way, and local governments. There have been some student-run clinics (eg Stanford University Arbor Clinic, and San Jose's Pacific Free Clinic) that provide for the underserved community and help provide training for medical students.
The Bureau of Primary Health Care is a site that a will aid in finding a clinic for medical care, even if you are lacking medical insurance or money.

CA: Berkeley Free Clinic , Haight-Ashbury free clinic (SF), Los Angeles free clinic, Rota clinic(SF Bay Area), Free Clinic of Simi Valley


VA: Harrisonburg Rockingham Free Clinic


NY: Free clinics in New York city


NYC: EHHOP - Free Clinic in El Barrio, New York City


OR: North By Northeast Community Health Center