Health Care Reform: Chapter 1: Gruber

Gruber begins his journey through the US health care system by looking at four Americans who
are about to have a heart attack: Anthony, Betty, Carlos, and Dinah.
Fortunately, because emergency care is good in the US, each person is treated and has
recovered. However, the cost of this identical emergency care is very different for each of
them.
1. Anthonyworks for a big company that has a comprehensive health plan. So, no
problem; his emergency medical expenses are paid by the company insurance plan, for
which he and his employer contribute a combined monthly premium.

2. Bettyis going to be okay financially because she is over 65 so is eligible for Medicare.
Shell be responsible for only about $1000 for her emergency care; hospital, doctors,
drugs, etc.

3. Carlosis feeling pretty down because his employer doesnt cover him and he has had
to buy an insurance plan in the private insurance market. This plan costs a lot and has a
very high deductible and less than full coverage. Carlos will have to pay about $2500 just
for his hospital stay. Moreover, if he had suffered a previous heart attack, the plan
would not have covered him andhis insurance company will now probably withdraw
coverage (too much risk).

4. Dinahis in real trouble. She works at a low-paying full-time job, but she is not eligible
for government supported Medicaid which is reserved for the poorest Americans. She is
among the working poorpeople with jobs who have no health insurance.
So Dinah will have to her emergency costs out-of-pocket, which she cannot do.
She simply does not have that kind of money. Dinah is essentially forced into
bankruptcy.
The National Business Group on Health estimated the cost of a severe heart attack at one
million USD. (Thats about 182,000,000 Tenge.) This includes hospital, doctors, pharmaceuticals,
and loss of work. A less severe attack would cost only $760,000thats about 38,000 dollars
a year over 20 year versus $50,000 for a severe heart attack.