I have been trying to watch less US news these days (tired of the politics), but I do see some. One of the big topics these days when it comes to news from the USA is healthcare. I think most people agree that Obamacare is not working well. But, there is so much disagreement when it comes to what needs to be done.
I guess one ongoing problem with healthcare in the United States is that the cost is simply affordable. With Obamacare, a lot of people have coverage who did not used to be covered, but the policies are expensive and the biggest problem is that the deductible is often very high. I mean, if you can barely afford the policy in the first place, when you have a major medical need and the deductible is $10,000 or something, well, even if you have the policy, it would seem impossible for a lot of people to use it!
Over the past few years, I have had a few major medical problems. In 2014, I was bitten by an insect and became hospitalized with a major infection in both of my arms. In 2015 I began a major battle against diabetes and the course of that battle caused me to use medical resources a lot. In June of 2016 I had a heart attack, which lead to many uses of the Philippine Healthcare system. I spent a week in the hospital after the heart attack. I started seeing a lot of specialists. I had an Angiogram which caused me to spend 2 days in the hospital. Finally, in November 2016 I had a quadruple bypass. For the bypass operation, through my PhilHealth insurance policy, I was able to use the Z Package which made my surgery quite affordable. So, with my experience using the Philippine healthcare system, I have seen a lot, both good and bad, and I have a good idea of how the system works here.
Thinking about US Healthcare
I got thinking about this over the past few weeks. One of the things that came to my mind was that perhaps the way things work in the Philippines could be a partial solution to US medical cost issues. I mean, I am not so naive to think that the way the Philippines does things is the best and should be adopted in the US or other countries. I don’t think that at all. But, I do feel that there are some things done in the Philippines which could help get US costs under control if adopted and instituted properly in the United States. Because healthcare here is very inexpensive, perhaps the system should be looked at and ways to implement some of this in the United States could help get the system more affordable and working better.
Family “Watchers”
One thing that they use extensively here in the Philippines is the system of “watchers”. This is basically family members or friends who stay at the hospital with you. They take care of things. If you need something, instead of calling a Nurse to your room, one of the watchers goes and takes care of it. You need to take your medicine, the watcher will take care of that, with the assistance of a nurse if needed. Need some supply from the drug store? The watcher will go take care of this. Unless there have been major changes in the time I have been gone from the States, the US has no system like this.
Instead of calling a high paid nurse to take care of minor tasks, it is taken care of a person that is not being paid for the service. A person who has an interest in your health because they are usually family. This would allow the hospital to have fewer nurses, and make the costs less. I actually kine of like this watcher system. It means that you have somebody that loves you around all of the time to help take care of you. The same person does not have to always be there, they take turns. Maybe your wife is there for a while, then she goes home to rest and your son takes over for a while. In my case, Feyma was always there when I was hospitalized, but others, like my kids would take turns there too. Feyma was there all along, though.
If the US adopted something like this, I feel that it would both help the patient (having a loved one around all the time), and also help the hospital reduce the cost of using highly paid people to run errands and such.
Self funding of minor things
In the USA, basically insurance has a role in pretty much every aspect of the healthcare system. If you go to your family doctor, that is an insurance event. If you need blood tests, that is also under the insurance. Of course if you are hospitalized that is something that the insurance gets involved in.
I find that a lot of things where the insurance is involved end up being way overcharged by the hospitals. Ever seen your hospital bill? Even if it was mostly or fully paid by insurance, things like $20 aspirin, $100 boxes of tissues and such. We all know that this stuff does not cost nearly what you are being charged, but hey, the insurance paid it anyway, so who cares? Well, you should care because that is one thing that has vastly pushed up the price of healthcare over the yeas!
In the Philippines, your PhilHealth policy mostly covers hospitalization. There are some outpatient procedures that are covered too. For example, over the past couple of years I have been having some procedures done on my eyes. These are outpatient procedures, but they are partially covered by PhilHealth. For the most part, medical care that is not hospitalization is not covered by PhilHealth.
In the US, your doctor visit, your prescriptions and all are part of your insurance coverage. Here, if you want to go visit your doctor, that is paid for out of pocket. If you have prescriptions, you pay those out of pocket. Need a lab test, get your wallet out!
Now, iI understand, things like doctor visits are a lot more expensive in the US. Here, if I go to my doctor for an office visit, it is usually $10 or less. In the US, I understand it might a couple hundred dollars. But, the very fact that the doctor is working with the Insurance company, billing them, working with the Government (medicare or medicaid), it adds extra cost. If the system were a straight billing to the patient, the cost would be less. That would introduce competition to he process. Does Doctor Smith charge $150? Well, go to Doctor Jones, his is only $100. See what I mean? This kind of direct payment would also make people think twice whether the really need a doctor for the situation they are facing.
In addition to doctor visits, lab tests are paid out of pocket. Prescriptions are paid out of pocket too.
Personally, I like the system here of paying out of pocket for non-hospitalization things.
Government Coverage for major problems
For those who are poor, or for major problems that are very expensive, there is better coverage. For average medical procedures, PhilHealth generally pays about 50% of your bill. The exact amount you are charged depends on your diagnosis and also what hospital you go to. For example, if the insurance will pay P20,000 for hospitalization due to a severe infection, if you go to an expense private hospital and they charge P60k for that kind of care, well, you get P20k from your insurance coverage and you pay P40k. If you choose a mid range hospital that is, soy P30k for that procedure, you will have to pay P10k out of pocket after the insurance pays the P20k that is allowed. But, if you choose to go to an inexpensive government hospital there is a good chance the insurance will cover 100% of the care. It is your choice of what level of hospital you want.
This kind of system would mean competition between hospitals. In the US, the way things are currently, there are amounts that the government imposes on hospitals (especially for billings through Medicare and such), so no matter which hospital the price is the same. If you have 5 or 6 different hospitals in the area competing with each other, you would find costs go down. It’s like Walmart, Target and a couple other stores being within a 5 mile range.. there are sales and such, stores lowering prices to beat the competition. That does not currently happen at hospitals.
Another example of the Government helping more if the problem is major is my own case last year when I had my heart surgery. The cost of open heart surgery like I had is P3 Million at the “best” local private hospital. I had my surgery at the Government hospital. If you do it at the government hospital, then it is possible to get the PhilHealth Z Package. The Z Package is available for very major health issues that are very expensive. Last year, when I was covered under the Z Package, I was the first foreigner ever covered by PhilHealth using the Z Package. It really made a big difference and I could argue that it saved my life. But, this article is about how things like this could be introduced to US Healthcare to try to control costs, so that is a different topic.
The Poor
So, the way PhilHealth is set up and covers only a percentage of the cost, and does not cover non-hospital procedures for the most part, that leaves a gap for the poor, right? Those who are too poor would not be able to use the PhilHealth coverage because they could not afford to pay the half that PhilHealth does not pay, right? Well, not really. When it comes to Healthcare, the Philippine government has other ways that the poor can be covered. For the biggest part, the government hospitals offer huge discounts and even free service for the indigent and very poor. So, this fills the gap.
Additionally, the poor and also senior citizens get free PhilHealth Coverage. Once you turn 60 years old you are a lifetime member of PhilHealth and never have to pay premiums again for continued coverage. For the poor, they can get this kind of free coverage no matter their age.
PhilHealth
Currently, there is a lot of talk, lots of rumors and changes for foreigner coverage under PhilHealth. Let me just say that there are ways that foreigners can get full coverage and even at the old price. Any foreigner can get PhilHealth coverage that does not include the Z Package, and the cost is P17,000 per year. That is for foreigners who are part of the informal economy. If you have a job or employment of another type in the Philippines there are more options available to you.
But, we are not here today to talk about foreigner PhilHealth, that is a topic for another day. I will not allow the comments area to be turned into a discussion of foreigner PhilHealth.
Check out my Health Site!
Since my heart attack I have been working hard about reversing my health. I have eliminated diabetes. I have lost a lot of weight, and my health is actually really good now. I still need to lose more weight, but that just takes time, but I am on that path.
If you have an interest in following what I am doing with my health, you can read my new website about that. The name of the site is 430 To Fit. I hope you will visit!
Didn’t recognized you at first with the beard on, Bob. Obamacare Replacement is currently going fine tuning.
I’ve had a beer and most of the time for the last two plus years, but it’s fairly new i guess.
I heard they have stopped the Z package
That is addressed in the article. I still have the Z Package. They did not stop it, you just have to not be part of the informal economy to qualify.
what is the informal economy??
People who are retired, unemployed, etc.
ok
Also applies to people who take “under the table” payments and such.
You sure about this Bob? The memos from Phil Health have consistently stated that not only is the rate for foreigners much higher than previously (starting July 1) but that the Z package is no longer available to foreigners.
I am completely sure. I already have it in place and have for several months. If you look at the title on the meme you will have confirmation. You are partially right… the Z Package is no longer available to foreigners who are part of the informal economy. I should know.. I am the only foreigner in the history of the Philippines who has received Z Package benefits! 🙂
Bob Martin Thanks for the clarification but the reality is that for most foreigners not only is Phil Health much more expensive (although I will still pay for it at least this year) but some of its benefits are no longer available. I’m happy that you can still use it but that doesn’t do many of us much good.
The cost is no different unless you are part of the informal economy, nothing has changed. Zero difference, unless you are in the informal economy. There is absolutely no reason why you cannot use it the same as I can, you just have to set it up properly. As I said in the article (if you read it) this is not an article about PhilHealth for foreigners, and the discussion will not be on this topic. Good luck to you.
Bob Martin Well I’d love to see an article on how we can qualify. In reality I believe this does relate to the topic since in the US there is a rats nest of rules and exceptions as to what you qualify for, how much it costs, which doctors are and are not covered – the list goes on. So 2 people working for similar companies with similar jobs can have vastly different coverages and costs.
Do a bit of research, it is not hard. I won’t be writing an article about it, I have good reasons for not writing the article, sorry. But, it is easy to figure out if you check a little into what the difference is between the formal economy and the informal economy. I specifically said in the article that this is off topic and not allowed in the comments.After this comment, further discussion will just be deleted. I am sorry about that, I don’t like to do it, but I have good reasons which I can’t go into.
another blog, a mother whose 6 year old had been having chronic heart problems since birth posted two weeks of his medical bills: roughly $100k/week. What to do?
These kinds of problems are worldwide, they happen everywhere. Overall, healthcare here is cheap compared to the USA.
Here’s one for you, Bob. We all know snokers and obese people are much more likely to have health problems than others. Why should my health insurance payments in effect subsidize theirs? As an example, bad drivers – traffic tickets and/or accidents – pay higher rates. Why not the obese and smokers.? Smoking and weight are under our control.
I am not an insurance guy, that is a question for a different person.
But that is essentially what Obamacare or any national health insurance sceme is all about.
Sure, but I am saying I am not the guy to answer that. I am certainly not under any obligation to solve the problem, I just offered a few suggestions.
Why not penalize the pushers of substances that cause these problems in the first place? When you spend tens of billions every week to push products with well researched ads that will psychologically play with peoples heads, confuse the facts, and as often as not downright lie in every meaningful sense of the word is there really any wonder there are so many people facing otherwise preventable problems.
“Why should my health insurance payments in effect subsidize theirs?” One reason is herd immunity. Best if everyone is healthy, and a way to do that is to cover everyone.
That is what insurance is all about, to spread the risk among many people.
Ain’t watching stupid news Bob. Its becoming disaster & my stomach can’t take it that’s it…….
Ha ha… I know the feeling. I try to avoid it as much as possible, although I used to be a news junkie.
Every morning I would do better things like practicing my party DJ skills since I’m a freelance DJ making 7,000 php (138.46 US $) talent fee to be exact. My target clients are the elderly playing throwback music of the 70s, 80s & 90s. I only do this on some weekends & the venues are hotels, country clubs, & restaurants that have ballrooms..
Good luck with that, Brian!
Thanks Bob..
shameful that the wealthiest and reportedly most powerful nation on the planet has children who go to bed hungry and People without medical care.
I totally agree, James. It should not be like that!
Wealthiest nation in the world with 20 trillion debt. Wouldn’t call that wealthy, just a false persona.
The corrupt Obama’s administration put the country downhill
Yeah, I agree.. wealthy it is not, but that is the perception.
Hi Bob,
I completely agree with the part of the article where you talk about people paying for small things. The Philippines actually has much more free market influence than the US system and that does help to keep the cost down. Good article a lot to think about!
Peace
Jay
Hi Jay – I agree, it is very free market here. I am a free market guy, but when it comes to healthcare a lot of people want government intervention. Unfortunately, when the government gets involved you find your choices will be limited.
Always the case when there are too many spoons in the pot and too many cooks for each spoon.
You pretty much hit the nail on the head..l News is all about the bickering about who in the Government, Staes, or Federal, is going to pay, when the question should be how to get it cheaper so people can afford their own.
Absolutely, Tom! They all said it is not affordable, but are doing nothing to address the problem that they see! Good comment.
The biggest thing Americans living in the PI could do for themselves and lower the cost to the system is write their stateside reps to make medicare transportable. This is a huge issue for Filipinos who work their entire careers here in the states and then retire back home. They get to take their social security, but can’t take their medicare with them.
It;s been about a year ago, but I saw that there are some doctors, clinics, and hospitals stateside who are disengaging from the insurance industry. They have gone partly, as much as is possible in the US, into a free market style. If I remember correctly, they don’t take insurance. They have a price list for various treatments and procedures, based on actual labor rates and wholesale costs of drugs, etc. Folks with the high deductible insurance policies are starting to use them for things that fall below their deductible rate.
One of your suggestions that I don’t think would work in the US is the hospital watchers. Most folks I know would have to take time off from work to do that. In the Philippines, every family has a relative, or two, or three, who are not working. Grandma, Auntie, or a cousin are often able to just drop what they’re doing and sit with the patient.
Take care,
Pete
I’ve also heard about doctor’s going for a more free market style of healthcare Pete. Additionally there is a group of doctors, I believe there in Kansas City, who have banded together and started up their own Co-op type system where people pay them a monthly fee and most of their visits and everything are covered. It’s an interesting concept. I believe that the Watcher system could be implemented, it would just require a little bit of work.
I too think the watcher system is a good idea. I had a watcher, a friend in my case, during my hospital stay for a hernia repair. I was in my late sixties, and never had any surgery before, so a bit anxious. It was nice having someone I knew near me. I remember an NPR story about a decade ago reporting on Cuban health care, which I understand to be pretty good. But NPR lambasted the Cuban system because if you wanted clean linen on your hospital bed, someone from your family would have to supply them, or bribe someone. NPR could find nothing about the actual care to criticize. Presently, in the US, if you want heath care you have to “bribe” an insurance company, or pay out of pocket. Involving family and/or friends (I think presently friends would not be allowed) can be only a good thing.
Hi Mitsu thanks for your feedback. I really agree with everything you say. When we first came here, I did not like the watcher system, I thought it was kind of stupid. Now, though, that I have experienced it more I think it is great. You have somebody who actually cares about you assisting in your care.
For those in the USA who don’t have somebody who could help them like that, maybe their loved ones are working or something, they could hire a kid for minimum wage to do it. That could spring a whole new job market for young people! I know a lot of young people have trouble finding jobs in the USA these days, this could kill two birds with one stone!
SOME MAY SAY OBAMACARE DIDNT WORK BOB AND CERTAIN THINGS FOR SURE NEEDED FIXED BUT I PAY 2100.00 WHICH INCLUDES 14 SURGERIES A TITANIUM ELBOW 2 ROTATATOR CUFF SURGERIES THE MOST POWERFUL DRUGS ON THE MARKET . UNDER TRUMPCARE IT WOULD COST ME 23,800.00 A YEAR ACCORDING TO PAUL RYAN, AND IN 2019 AT 67 I WOULD BE INELIGIBLE. SO FIXING OBAMA CARE IS ONE THING. DESTROYING SENIOR CITIZENS IN THE PROCESS THE GOVERNMET SHOULD BE ASHAMED OF. I RECENTLY ENDED UP IN ST LUKES MANILA GBC AND FOR BLOOD WORK IV FOR DEHYDRATION AND NO INSURANCE AND 6 HOURS LATER IT COST 4100P
Strange you’d know what Trumpcare would cost and yet there isn’t a Trumpcare bill right now. So how do you know?
I concur. I disbelieve anything the news tells me on Trump because of their bias and slants.
Obama care was a huge scam. It was my job enforcing it when I completed individual income tax forms. Nobody understood the monthly provisions. Income tax is an annual thing but now in this case it was monthly.
I didn’t learn this occupation to become the insurance police.
Good riddance Obama care.
Sorry to hear that it did not work out well for you Chaz. Hopefully our government can do better in the future.
I just hate Obamercare, before Obamercare a family of 4 we paid $350, with Obamercare we paid $12,000. a year which we rarely use and only for annual checkup. I hate being forced to buy health insurance when the intire family are all healthy and I thank God for it. Obummercare must go away.
Wow, Nilda, that is a huge difference. I see some people saying their cost went down and others saying it skyrocketed.
I hope you are doing well!
I love reading your health care article Bob, I am so happy for you that you are doing good?yes we are also doing great and I thank God for everything ?and yes our tax accountant was shocked to see our annual health insurance bill, we paid over $12,000. and only use for annual checkups., Our son was very healthy and no health issues but forced to buy health insurance with Obummercare ? Obummercare must go away, hope it will happen soon.
Thanks, Nilda. I am glad that you are enjoying my articles on 430ToFit. I am working hard on my health and having great results!
A couple checkups for $12k. Those are expensive checkups! LOL
Take care.
well first off it is part of the FREEDOM OF INORMATION ACT SIR. And wrong twice Paul Ryan brought it to the floor a plan from trump that would demolish rather than chop away the bad parts of ObamaCARE. WHICH IF IT WAS A GOOD PLAN I WOULD BE HAPPY. I could care less either way as to who or what party comes up with a plan. But Paul Ryan himself said the first time it was presented a 64 year. that the plan would cost someone like me 23,000.00 a year making it unaffordable and I don’t remember the year but somewhere around 2023 26 million would lose coverage.. I did not pull this from my backside but it was covered on CNN, Fox, CSPAN , AND MSN. And rightfully so his own party did not back him. The second time PAUL RYAN again regretfully was forced to the floor for a vote. And it was changed very little for an upcoming 3rd vote. BEFORE OPENING AND GUESSING. ABOUT THINGS I KNOW I SAW AND READ I SUGEST RESEARCH..I LIKE A FOOL VOTED FOR TRUMP.. ONE OTHER THING .. RESEARCH KURCHNER’S EMIGRATION LAW TRUMP PASSED THAT ALLOWS EVERY CHINEESE A FREE VISA FOR A 500000.00 INVESTMENT THAT WILL MAKE TRUMPS IN LAWS THE KURCHNER’S MULTI BILLIONAIRES. I GUESS I AM MAKING THAT UP TO..LOL
All valid points Bob my recent 4 day stay for a burst appendix cost me 4k and that’s with a $1000 a month medial insurance through Carefirst.. The problem is that they bill you from 5 different places. Medical billing is an actual profession..too much scamming going on here.
I certainly hear you on that Wally. Here, when hospitalized, we get one bill for everything. It will list the charges separately based on whether it’s for the doctor or the room or whatever, but it’s all on one bill which is nice.
My girlfriend cousin is hospital now from an injury, and the wife stays with him, but many family members bring food and things, I’m paying for his step son school until he can work again, I think it great, he will be better quicker
Good luck, erard. I hope your girlfirend’s cousin recovers nicely.
Salamat
Bob – are you, and perhaps other family members, part of the “formal economy”?
Yes, I am part of the formal economy. I own a business which is fully registered in the Philippines, and I am an employee of the company.
Bob, in glad you are getting well and have taken control of your life.
Part of the attraction to the Philippines is their family values. When I talk about old age or medical issues with my fiance she always says don’t worry we will take care of you. Family is everything.
Would it be okay to share some of your story about Philhealth ? I think you make some really good points and would like to put it out there.
Peace and health to you and your family.
JC
Of course you can share my story and experiences! I would only ask you not to copy what I wrote onto another website. You can just quote a small part and then link to my content. That would be appreciated.
bob, you have to remember before ACA a lot of insurance policies bought by individuals in usa were worthless. you had insurance card and hardly no coverage. remember insurance company do dot provide care; they have a business of making a profit by limiting care. ACA made ibsurance companies have to perform some basic care, which most did not. ACA did not limit there premiums because of there objections to single payer system. we have that in usa already its called Medicaid/medicare, just allow people to purchase and drop all the unnecessary rules. initial cost would be high at first due to getting people healthy but in long run cost would be reduced substantially and far cheaper than private insurance. insurance companies profit margin verses providing decent care is what the problem is. I had private insurance thru blue cross/blue shield and it was not worth the price of paying for. to many deuctibles and co pays. so when people say old system worked good they do not have a clue to insurance cost until you need them to pay for your care. that’s individual policies not group policies payed thru your employer
HC in America is used to control the citizens.
Sad but true.