# Health-insurance for everyone in USA



## Dutch-EMT (Nov 17, 2009)

Following the plans of Obama on the news, I was a little bit shocked about the selfish opinion told by a few residents from a small town in the middle of the USA (Canton).
A Dutch tv-programma makes a report out of this town to follow the economic crisis and the changes with Obama as president.

A woman has to sell her house because she wasn't insured and had a heart-attack. The hospital bills she has to pay are about $50.000
With her husband unemployed they are bankrupted.
In the next report the tv-crew asked a woman on the street about the health insurance for everyone, as Obama wants to introduce.
The case of the first woman was explaned and her reaction was:"When they don't wanna pay for an insurance, then it's their own problem...
She didn't even think about the fact, that some people can't afford an insurance. I was realy surprised by this woman. 

In the Netherlands we already have a health-insurance wich is for everyone the same and also an obligation. The people who don't earn enough get an addition from the government. This is an basic insurance. Hospital and ambulance-care, physician care, medicins are all included.
For dental care, maternity nursing, physiotherapy and other paramedic consults we can choose if we want to pay for it.
The health-insurance (basic) costs about €100,= ($145,=) a month.
With extra dental care it's about €110,= ($160,=)
The Dutch people think Obama has great plans!

How do paramedics and EMT's think about the plans of Obama?
You must see a lot of people without insurance who refuse to go to the hospital?


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## Dutch-EMT (Nov 17, 2009)

The movie of the report
http://usa2.eenvandaag.nl/canton/35304/terug_naar_canton


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## Shishkabob (Nov 17, 2009)

Hey, I'm all for everyone having insurance, but it is NOT the federal govts job to pay for it. 

People should NOT be forced to have insurance and should NOT be fined for opting to not have it. 

Employers should NOT be forced to provide it, and NOT be fined for not providing it. 


Imagine the good that would happen if the $1trillion for the healthcare was instead put in to our education system.


I'm all for insurance reforms and reigning in the companies and making it more fair


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## Dutch-EMT (Nov 17, 2009)

Linuss said:


> People should NOT be forced to have insurance and should NOT be fined for opting to not have it.



Well, in the Netherlands it works perfect! Everybody pays tax. But the heightof the tax depends on the income. The addition depends also on the income. Everybody has insurance. And nobody feels less free. It doesn't feel like it is forced. When somebody doesn't have insurance, the tax-authorities will be on you in max. 6 months. Those people get an addition for insurance and use it for other things. They will be forced to take a health-insurance.

In the USA are 50.000.000 people without insurance. Only one sickness bring people (who mostly don't have a lot to spend or are unemployed) to bankruptcy. When I should be in a position of unemployement and I couldn't insure my family because i'm broke... It should be terrible.


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## akflightmedic (Nov 17, 2009)

Linuss said:


> Hey, I'm all for everyone having insurance, but it is NOT the federal govts job to pay for it.
> 
> People should NOT be forced to have insurance and should NOT be fined for opting to not have it.
> 
> ...



So should we not be forced to have car insurance and not be fined when we don't?

You are ok with someone totaling your car, possibly injuring you and not having insurance?

I mean after all, it is a forced insurance, no?

Or is it just medical you care about...or don't care? Doctor's should not be forced to carry mal practice insurance. Home insurance, forget about it...why do we force it?

Just asking...


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## Sasha (Nov 17, 2009)

Linuss said:


> Hey, I'm all for everyone having insurance, but it is NOT the federal govts job to pay for it.
> 
> People should NOT be forced to have insurance and should NOT be fined for opting to not have it.
> 
> ...



Aren't you the one who was toting that people should get employed by employers that offer insurance if they could not afford it for themselves?

Sooo.. what if they have a pre-exsisting condition that makes their premiums per month unaffordable? Since employers don't have to offer it she should just languish and die? I think I've said this before, but my obese, diabetic, hep c mother would have to pay more than $500 a month in insurance, plus any copay, if she had insurance. That is more than half her rent. If she didn't work for an employer who offered insurance she'd probably still be uninsured, unmedicated, and very sick. What are people like her supposed to do, since you don't approve of universal health care, but don't think employers should offer insurance, which was your master plan for insuring the masses?


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## 46Young (Nov 17, 2009)

Many that have private insurance, good private insurance, feel like they're already paying enough, and are doing what they're supposed to by having a job that features that plan. Money is tight in many working households. It's necessary for the breadwinner to do OT or side work, or have the spouse go to work, at the expense of time with the children among other things. Now the gov't is potentially asking these households to surrender more of their disposable income to the uninsured.

If you've become unemployed legitimately, not just on paper (I mean working off the books while receiving public assisance, thus misrepresetnting your true income, and failing to contribute taxes as such), become recently divorced or widowed with no income streams, suffered a disabling accident, or for other LEGITIMATE reasons, I'm all for providing health coverage for those populations. 

It's those individuals that game the system, who take whatever handouts that they can get, and basically get a free ride from the gov't, that I have a problem with carrying financially. I'm referring to those individuals who never intend to work, ever, since their needs are taken care of for free. Welfare, Section 8 housing and other programs of the like were originally intended to help individuals/families provide for basic necessities while they WORK towards financial independence. If you're looking for a revenue stream to help pay for universal healthcare, then the gov't ought to require these individuals to find legal work within a certain time frame, or at least devote a certain amount of time each week to community volunteer activities, so they benefit society in some fashion. Look there first before asking me to surrender more of my disposable income.

I'm working OT and a side job, at the expense of family time, to be able to buy a home, invest for my childrens' education, and for retirement. Asking me to surrender that income to individuals who refuse to work (not unable to, but refuse to, there's a difference) and those in this country illegally (as opposed to our ancestors that went about it the proper, legal route), is fundamentally wrong. We're working, saving, investing, and doing without certain things while someone down the block receives free food, medical, cheap housing and such while refusing to work, or worse - working off the books, making good money, while they get most of their basic needs free of charge from the gov't. I've personally witnessed this many times over. This is where much of the opposition and outrage towards universal healthcare coverage likely originates.

My current coverage is better than average. I pay about $350 pre tax monthly, and everything is covered 100%, (PPO), my MD copay is $10, ED $50 unless admitted, then free, scripts are $10 generic, and $35 otherwise. All prenatal care is 100% covered after initial visit. Vision is included. I'm waiting to see two things - first, how will my coverage change? Everything is basically covered 100%. Will that remain intact? Second, how will the cost of that coverage change? Will my premium increase by making it post tax, an increase in the Federal tax rate, deductibles (which I'm not currently required to pay) or via some other discreet method of taxation (or "fees" or whatever)? 

So, we may be asked to surrender much more of our (maybe) disposable income, and possibly not enjoy the same level/accessability of care. Given that in addition to the above reasons, why would I be in favor of universal healthcare? 

Also, no one really knows what universal healthcare will entail. There's absolutely no way our Reps and Senators could possibly read the entire bill in the time frame alloted before the vote. It's impossible. So, congress is again voting on bills that they could have not possibly have reviewed adequately.


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## firecoins (Nov 17, 2009)

I do not believe in a single payer system.   I think that that a single payer government run service will decide what medical care you receive and will not receive simply because resources are limited.  I am against that.  

There are ways to make insurance cheaper for people in the USA without a massive spending and taxes.  I support government programs for people who need assistance just not a single payer system.  The public option is going to eventually become the single payer system. 

I do not believe in forcing people to have insurance as is the current plan.  People are not forced to have cars.  I didn't have health insurance by choice for 3 years. I was healthy and didn't want to spend the money.  I see no reason why this freedom should be lost.


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## bunkie (Nov 17, 2009)

OP, in your country everyone pays the same percentage of tax right?

That's the problem in the US. We do not have set universal tax. So we can not maintain the kinds of programs that _much smaller_ countries in Europe provide their citizens. That said, I firmly believe our entire tax/health care/public assistance systems need to be overhauled. But each of those problems will take decades to tackle.


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## 46Young (Nov 17, 2009)

Also, think about all of the small businesses that wil go bankrupt if they are required to provide health coverage. Profit margins are razor thin as it is for many of these businesses. That would put them over the edge.


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## medicdan (Nov 17, 2009)

This topic is the center of my major course of study in college. I have many, many complicated opinions. What I think we need to do, before enacting any significant change, is to closely examine the resources we put into healthcare. We need to learn how to cut costs on "high technology", resource utilization, etc.

Look at what "universal healthcare" has done for Massachusetts....


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## Seaglass (Nov 17, 2009)

emt.dan said:


> This topic is the center of my major course of study in college. I have many, many complicated opinions. What I think we need to do, before enacting any significant change, is to closely examine the resources we put into healthcare. We need to learn how to cut costs on "high technology", resource utilization, etc.



I agree. I think we need tort reform and some redirection of the budget (how about taking subsidies away from corn and putting them towards pharmaceutical research, for instance?) before we try for universal healthcare.


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## 46Young (Nov 17, 2009)

Seaglass said:


> I agree. I think we need tort reform and some redirection of the budget (how about taking subsidies away from corn and putting them towards pharmaceutical research, for instance?) before we try for universal healthcare.



That sounds like a good plan, but it's ultimately up to which industry has the more effective lobby.


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## Seaglass (Nov 17, 2009)

46Young said:


> That sounds like a good plan, but it's ultimately up to which industry has the more effective lobby.



Of course. I'm only talking about what I'd do as Supreme World Dictator.


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## Hal9000 (Nov 17, 2009)

The current plan is a horrendous mess of such epic proportions that it's nigh unimaginable. Emotional reasons based on the fact that many people do not have health insurance are illogical and prone to premature decisions.


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## rescue99 (Nov 17, 2009)

I'm a Medic and I'm in Canton! I am also the mom of 3 (2 now) medically involved children and the wife of a 2x cancer survivor. We've sold a house for the purpose of using equity to pay off medical costs on at least 2 occasions. Our coverage is respectable but, our medical expenses are huge compared to the average household. Medical costs are just another bill we find a way to pay. 

I wish to heaven illegals would learn the same concept! I am more than willing to help our own but, I do have issues with paying one red cent toward the care of anyone, man, woman or child, who lives here illegally. Even those who come here legally but are already too old or sick to work...let the families pay...just like we have to. May sound harsh but, oh well. I'ts time we took a special interest in what's best for our own citizens first.


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## 46Young (Nov 17, 2009)

rescue99 said:


> I'm a Medic and I'm in Canton! I am also the mom of 3 (2 now) medically involved children and the wife of a 2x cancer survivor. We've sold a house for the purpose of using equity to pay off medical costs on at least 2 occasions. Our coverage is respectable but, our medical expenses are huge compared to the average household. Medical costs are just another bill we find a way to pay.
> 
> I wish to heaven illegals would learn the same concept! I am more than willing to help our own but, I do have issues with paying one red cent toward the care of anyone, man, woman or child, who lives here illegally. Even those who come here legally but are already too old or sick to work...let the families pay...just like we have to. May sound harsh but, oh well. I'ts time we took a special interest in what's best for our own citizens first.



+1,000,000.

Sorry about your loss. no one should ever have to experience that.

I don't know the validity of this, but I've been told that you should never commit to a concrete payment plan with a hospital for medical bills, only to tell them that you don't know how much you can afford to pay towards the bill, only that you'll give something (be vague as to an actual dollar amount) each month. Give 5 bucks or something each month. It's almost like what the illegals do, which is not pay anything. consult an attorney, of course. No one should have to go broke over medical bills, especially when others are given the world.


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## 46Young (Nov 17, 2009)

The only plausible reason as to why illegals and the leeches of society are catered to is for increased chances of re-election. The illegals may have legal residents and sympathizers here, and they will have children, who will vote someday. The populations that would benefit from handouts and free rides (I'm entitled!) are legion. They'll elect politicians that serve their agendas. And so it goes on.......


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## Shishkabob (Nov 17, 2009)

Sasha said:


> Aren't you the one who was toting that people should get employed by employers that offer insurance if they could not afford it for themselves?



Yup.  Where are you getting confused?  If you want health insurance, go to a place that offers it, but don't force places to offer it.  




akflightmedic said:


> So should we not be forced to have car insurance and not be fined when we don't?
> 
> You are ok with someone totaling your car, possibly injuring you and not having insurance?



First, car insurance isn't federally government mandated, and as such, is not applicable to this debate.  

Second, not all states require auto insurance.

Thirdly, just as I believe with all types of insurance, you should have it, but if you opt not to (and it's legal to not have it), then it's your choice, and it's up to you to deal with the financial consequences of doing so.  (And I'll reiterate: If it's legal)






Again: I'm all for people to have insurance, but it should not be federally government funded / mandated.    On top of that, if you don't pay your share of taxes, you should not expect / get any share of government benefits.    This is a topic that should be left up to the individual states to decide what they want to do.



Put the $1trillion towards education.  I don't know why anyone would be against that.


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## rescue99 (Nov 17, 2009)

46Young said:


> +1,000,000.
> 
> Sorry about your loss. no one should ever have to experience that.
> 
> I don't know the validity of this, but I've been told that you should never commit to a concrete payment plan with a hospital for medical bills, only to tell them that you don't know how much you can afford to pay towards the bill, only that you'll give something (be vague as to an actual dollar amount) each month. Give 5 bucks or something each month. It's almost like what the illegals do, which is not pay anything. consult an attorney, of course. No one should have to go broke over medical bills, especially when others are given the world.



You're correct. Hospital payment plans can be in bits and pieces. We work hard to get everything paid because it's the right thing to do. Nothing should come free to those who can pay. If I pay mine, the cost to everyone is lower. Medical costs go way, way beyond a hospital visit though. Those off lable meds for example, they're a killer! It's those additional costs that can add up and really squash a budget! Slows down being able to pay outstanding hospital bills as quickly as one would like. We've taken up to 4 years to pay some in full. 

I for one am concerned with a national health care plan. Not for my kids because they can only be treated by specialists not available at corner hospitals. I'm more concerned for the average family who could wind up standing in line for years for routine medical care and procedures. I am concerned that budgets, politics and policies will leave hard working citizens in poor health due to delays in provider care. The list of concerns goes on.


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## 46Young (Nov 17, 2009)

rescue99 said:


> You're correct. Hospital payment plans can be in bits and pieces. We work hard to get everything paid because it's the right thing to do. Nothing should come free to those who can pay. If I pay mine, the cost to everyone is lower. Medical costs go way, way beyond a hospital visit though. Those off lable meds for example, they're a killer! It's those additional costs that can add up and really squash a budget! Slows down being able to pay outstanding hospital bills as quickly as one would like. We've taken up to 4 years to pay some in full.
> 
> I for one am concerned with a national health care plan. Not for my kids because they can only be treated by specialists not available at corner hospitals. I'm more concerned for the average family who could wind up standing in line for years for routine medical care and procedures. I am concerned that budgets, politics and policies will leave hard working citizens in poor health due to delays in provider care. The list of concerns goes on.



I understand your moral obligation to do the right thing. However, if it comes down to losing my house, I think I'll choose to keep my home. It'll hurt the hospital system a lot less than it'll hurt your family to pay slowly.

 Think about it. Your healthcare bills are/were so high due to uncompensated cases. These individuals aren't losing anything, aren't being asked to give up the roof over their heads, so why should you? Our lawmakers feel no obligation to go after freeloaders, so don't feel bad about wanting to keep your posessions, which you and your husband have worked so hard for, doing the right thing and all.


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## rescue99 (Nov 18, 2009)

46, I didn't lose a house..just spent a lot of the equity. For some it is the heavy burden of having those outstanding bills hanging over our heads that is more distressing. I see where you're coming from though and I agree.


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## 46Young (Nov 18, 2009)

rescue99 said:


> 46, I didn't lose a house..just spent a lot of the equity. For some it is the heavy burden of having those outstanding bills hanging over our heads that is more distressing. I see where you're coming from though and I agree.



It'll be OK. Here's why: It's not beneficial to keep more than 20% equity in your house, anyway. Once your bills are paid, or if you can cry poverty and pay signifcantly less toward them, you can start investing. Interest rates are around 5% currently. Don't fall into the ruse of prepaying principal. Funds that would otherwise go into paying down the principal ought to be invested, earning a greater return than that 5%. Mortgage interest is tax deductible, payments to principal are not. Your investment account will compound at a quicker rate than you would save in interest by prepaying. Down the line, you can still pay off your house early if you wish, but I would refinance with an 80% mortgage and invest the proceeds with the rest. 

This account is accessible if you sustain any further financial insults. The account can pay you interest, which will later provide interest to help pay your mortgage for you, hopefully in full. Why pay toward the principal and then borrow it later? Let your money work for you. If you pay off your house, you'll be house rich and cash poor. You wouldn't keep 250k under your mattress, would you? Why would you keep it in the walls of your house? You still have your house, let it help provide for your financial security. Big, long mortgages can be financially beneficial for you, provided the monthly payments are reasonable, and the disposable income is invested.


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## HuiNeng (Nov 18, 2009)

*Reading the legislation*

The various arguments posted so far show some common themes. Unfortunately, some of those themes are old, tired, and wrong. The usual scapegoats have been trotted out. 

Malpractice reform is a good idea. The Department of Health and Human Services is taking action on the problem outside the scope of current health insurance legislation.

You can find the text of four versions of current US health insurance legislation on www.thomas.gov. The bill numbers are HR3200, HR3962, S1679 and S1796.

HHS held meetings with US citizens across the country to find out what concerns people the most. Some of those concerns are reflected in prior posts in this thread. Check out some of the meeting reports.

I don't have links at hand for the following points. The quotes below are copy-n-pasted from the text of HR3962.

Those of you who have ever been self-employed already know that we pay both sides of the FICA (Social Security) tax. A requirement for carrying some sort of health insurance is consistent with the idea of paying into Social Security even though you're 18 and invincible. Young adults become sick and injured too. I skipped health insurance when I was young and poor. I was lucky. 

For those who don't like our hard working, entrepreneurial illegal aliens, "Nothing in this title shall change current prohibitions against Federal Medicaid and CHIP payments under titles XIX and XXI of the Social Security Act on behalf of individuals who are not lawfully present in the United States."

Some here might be interested in (the caps are in the original): "SEC. 2554. ASSISTING VETERANS WITH MILITARY EMERGENCY MEDICAL TRAINING TO BECOME STATE-LICENSED OR CERTIFIED EMERGENCY MEDICAL TECHNICIANS (EMTS)." Cool. That would employ veterans and bring bleeding-edge trauma knowledge to the folks back home.

Others here might be interested, pro or con, in : "SEC. 1737. CONTINUING REQUIREMENT OF MEDICAID COVERAGE OF NONEMERGENCY TRANSPORTATION TO MEDICALLY NECESSARY SERVICES." Taaaxi!

These bills are huge. There's a lot to like or dislike about them. Might I suggest that it would be more useful to debate the actual content of the legislation, rather than dredge up tired old tropes?


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## Dutch-EMT (Nov 18, 2009)

But how much costs an health-insurance in the US?
And what is the average middle-income?

In the netherlands the middle-income is about €2300 bruto a month.
That's Netto €1500,= / €1600,= a month
Average mortgage is abou €500/€600 a month.

Depending on wich insurance-company you choose, the costs are for a bisc insurance €85,=.
Addition of the tax-authorities is about €20,= a month.
So in fact I pay €65 for a basic insurance.


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## firecoins (Nov 18, 2009)

Dutch-EMT said:


> But how much costs an health-insurance in the US?
> And what is the average middle-income?
> 
> In the netherlands the middle-income is about €2300 bruto a month.
> ...



The US is broken down into 50 states.  Health Insurance has different cost in different states due to different regulations.  In NY state, a health insurance plan is about $1100 a month.


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## Dutch-EMT (Nov 19, 2009)

firecoins said:


> The US is broken down into 50 states.  Health Insurance has different cost in different states due to different regulations.  In NY state, a health insurance plan is about $1100 a month.



Well... can you imagine that there are Dutch people think the insuranceprice is to high in the NLD? When i read this, $1100, that's absolutely absurd.

Now i can tell that the dutch government tries everything to bring down the costs of health-care. No longer the expensive brandmarked medication will be compensated, but only the cheaper unmarked medication. 
For example: Lasix can be replaced by the unmarked furosemide. 

I think the health-care providers can also do something to keep the costs as low as possible... But only making profit seems to be important.


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## 46Young (Nov 19, 2009)

Dutch-EMT said:


> Well... can you imagine that there are Dutch people think the insuranceprice is to high in the NLD? When i read this, $1100, that's absolutely absurd.
> 
> Now i can tell that the dutch government tries everything to bring down the costs of health-care. No longer the expensive brandmarked medication will be compensated, but only the cheaper unmarked medication.
> For example: Lasix can be replaced by the unmarked furosemide.
> ...



The $1,100 is somewhat accurate, but misleading. My plan costs $1,289 monthly. My employer pays $966/month, and I pay $322/month. This is for a family plan. So, I'm paying only 25% of the premium. A single person pays $66 for a $443  monthly policy. A two party plan costs $216 for a $866 monthly policy.


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## medicdan (Nov 19, 2009)

Not all employers contribute as much as your's does to your insurance. The premium says little about the quality of your plan. Is it an HMO? PPO? HSA? How does it reimburse for hospital stays? DRG? Outpatient MD visits? Does it require referrals? Utilization Review? Pre-Approval? Are physicals paid for? How about outpatient lab studies? How much does an ER visit cost? Catastrophic condition?


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## 46Young (Nov 19, 2009)

emt.dan said:


> Not all employers contribute as much as your's does to your insurance. The premium says little about the quality of your plan. Is it an HMO? PPO? HSA? How does it reimburse for hospital stays? DRG? Outpatient MD visits? Does it require referrals? Utilization Review? Pre-Approval? Are physicals paid for? How about outpatient lab studies? How much does an ER visit cost? Catastrophic condition?



Cigna OAP (Open Access Plan). 
-Sripts - 10 for generic, 20 for brand formulary, 40 for brand non-formulary
-Maternity - paid in full after $10 visit copay
-Labs/x-ray - covered in full after $10 copay
-office visits $10 copay, same for well child and outpatient psych
-ER tx $50 copay unless admitted, then free
-inpatient hosp care - covered in full
-everything else not mentioned covered 100%
-vision through Davis vision, too lengthy to post here
-No deductible or out of pocket yearly limit
-Out of network most everything is covered 70%. A true emercency at the ED will still be covered 100%
-No PCP required

Also, our Occupation Health Center gives us comprehensive yearly physicals (free, and our time at the center is compensated for financially) including TB tests, blood work, traeadmill stress tests, pulmonary function, vision/hearing, hemoccult, plus a general physical.


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## rescue99 (Nov 19, 2009)

Dutch-EMT said:


> Well... can you imagine that there are Dutch people think the insuranceprice is to high in the NLD? When i read this, $1100, that's absolutely absurd.
> 
> Now i can tell that the dutch government tries everything to bring down the costs of health-care. No longer the expensive brandmarked medication will be compensated, but only the cheaper unmarked medication.
> For example: Lasix can be replaced by the unmarked furosemide.
> ...



I think you're misinformed about some things. Freedom to choose comes with a price in some respects. Generic drugs are more common than trade names and the average prescription for most of the common medications is only 4 dollars. To families of children, free. Off lable use can get expensive mainly because so many are newer medications.


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