Hello everyone, welcome to America under the Microscope advanced, James here.
And Lulu here, so we're gonna continue with going to doctors, right?
If we must … So we left off talking about getting medicine at the drug store in the difference between name brand and generic medication. Now we're gonna start with this advanced episode by talking about: what if you need to see a specialist, like… let's say, you have a heart problem or a brain problem?
Like the cardiologist.
Yeah, cardiologist, neurologist or any of these other -ologist that exist in medicine.
Can't you just go directly and see a specialist?
No, you can't. In America what you have to do is you have to go to the family doctor first. They act as basically the gatekeepers.
Why do they need gatekeepers? Can't I just say I know something is wrong with my heart? I can, I want to see a specialist, I want to see a cardiologist.
The problem with that is things that might seem like problem with a part of your body, so like your heart, let's say your heart hurts. It can turn out that's actually a stomach problem like acid heartburn which is an acid going up your esophagus burning that area feels like heart pain.
So what you're saying is stop self-diagnosing.
Right.
So you see the family practice doctor first and they'll see if the problem is more basic routine or something simple that they can treat with just regular medication or other treatments. If the family doctor says: you know what, you need a specialist they will write you a referral which you will then give to the specialists, clinic or receptionist or whoever needs to be given to and then he can make an appointment at that specialist and see the specialist.
I suppose it makes sense. It kind of saves medical resources.
So this specialist only sees the patients who truly need the specialist instead of people who have maybe more simple problems or mundane problems with these parts of your body
I suppose that makes sense. Then seeing a specialist, if you get a referral, actually you do need to see a specialist and then you need to make an appointment, right?
Yeah. And then you make an appointment and it's more or less you go through the same procedures as we talked about in the previous episode.
Now here is the question. Last time you said the family doctors or for pediatricians it's very easy for you to get an appointment. You usually get to see them the next day. Specialist, I'm assuming you'll have to wait for longer.
In most cases, yes, there are a few exceptions like for pregnancy, you don't tend to wait that long. But for things like cardiologist, neurologist or oncologists who are cancer doctors, sometimes you do have to wait because demand. So an American tends to run in a more of a 'first come first served' basis. They'll take whoever makes the appointment first.
It's not based on how serious your conditions are?
Not usually, if it's life threatening, yes, you'll be seen right away. But if you can wait then they will just put you…
They will just make you wait.
They will just make you wait for the next available appointment.
Okay, and talking about all these specialists, I'm always a bit curious. You have all these specialism right? Which doctors in what areas do they make the most money?
Well, number one is plastic surgery, especially ones who do cosmetic plastic surgery.
Of course.
Because that's not covered by insurance, so the doctors can charge lots of money and they get to keep it, so plastic surgeons make lots money.
And also dentist?
Yeah surprisingly dentist or orthodontist specifically who do braces; they make lots of money because a lot of that stuff is considered cosmetic. They get paid without insurance. Also dentists pay much lower insurance rates because doctors have to pay insurance in case they make a mistake; and a dentist's mistakes aren't going to kill you or at most cases they won't kill you, whereas a heart doctor make a mistake, you might die. They pay much lower insurance so they could keep more money.
Okay but I'm assuming like, doctors like cardiologist or neural surgeons and urologists, they also make a lot of money.
Yeah. In terms of more traditional doctors like cardiologists and neurologist are at the top of the pay scale. They make a lot of money.
They should, they worked very hard for it.
I want the person cutting into my brain to make a lot of money.
Great, now let's look at the cost of medicine.
That will make you cry.
You know if you watch again, if you watch all these TV series and movies, they constantly talk about how it is better in Canada where you get free medical care because they are welfare state and how United States is not. You have to pay a lot for medicine, for medical treatments.
Well okay. So the TV shows are right that Canadians have a welfare state, so they don't have to pay for it. Sadly Americans cannot go into Canada and use that system for free; that only affects Canadian residents. For Americans, this is where TV shows are fairly accurate. The cost of medicine in the United States is really high and I've met lots of Chinese in China say, "Oh China is really expensive!" and I, as an American is like, ah … you haven't seen expensive.
The other thing you constantly hear is "Obama Care".
Yeah, so Obama Care which is not the official name, official name is the Affordable Care Act and this is a law that was passed almost ten years ago now, which basically states that Americans are required to have medical insurance. For most Americans this insurance is provided by your employer. So it's part of your benefits package for a job.
Your employer is ordered by law to give him insurance.
Yes, but that doesn't cover everyone because some people are farmers or some people are business owners themselves, so who pays for their insurance? The other part of the law are also set up market places to allow these individuals to buy their own insurance at competitive rates or if they are low income, at reduced rates. And in some case if your income is really low, it's free.

Ok, essentially you have to have insurance.
Yes. In fact, there's a fine if you don't now.
There is a fine if you don't have insurance. Okay? So that is Affordable Care Act. You also constantly hear Medicare and Medicaid.
These are government programs. Medicare is our retirement insurance. So when you retire and reach sixty, I think sixty or sixty five years old I don't remember you can get this medical plan from the government because you're retired, you don't have a job; no company can give it to you. And any American who has worked for ten years in America qualifies for it.
And you don't have to pay for anything. This is all covered.
This is discovered yep. Medicaid is similar, but Medicaid is for low income groups. So Medicare is for retirement. Medicaid is for people who live in poverty.
Okay. That sounds like it covers pretty much everyone, but you know I think like in a lot of the countries, health care reform is always one of those topics that keeps popping up.
Right, so if you follow American news specifically political debates, this is one of the big ones is healthcare reform. Right now in the United States, they are talking about expanding Medicare, the retirement one we just talked about to cover everyone in the country. And there are studies that have been done that shows that it would actually be cheaper to do this than what the government currently pays for all these different programs and grants and all these. That's really complicated, but with anything political in the United States government, there's always two sides and seldom do they agree.
We'll just keep and stay as cool.
Probably for now.
So all of these, you know like Affordable Care Act, all the insurance all that, I assume people complain about health care being expensive is because these programs they don't really pay for everything, they are just partially?
Right, well in the past, it was much worse and things were really expensive. Uh the Affordable Care Act just made it less worse. Yes, your insurance will pay for most of it, but not everything. You might still be on the hook for thousands of dollars in medical care if you have a serious condition. For most, if you're a healthy American, you probably won't even notice because you're not going to the doctor that much. This is mostly designed to help people who have serious conditions who wouldn't normally be able to have insurance before.
It does sound very complex.
A lot of Americans themselves don't understand it.
But what about people who are visiting the USA, for example, you know for Chinese travelers who are traveling in USA, what would you recommend?
I would highly recommend travelers insurance, which is really inexpensive. There's no reason not to have it. I think you can buy travelers insurance in China for…
A few hundred…
A couple of hundred RMB,
But it does cover a lot.
Yeah, basically covers all your emergency problems if you need to get an ambulance to the hospital, if you have an emergency surgery, they might even, it may even pay for your ticket back home if it's serious enough.
The thing is one of the things that I keep hearing is for people who are in United States sometimes, especially for students. You heard these stories about them getting really sick and their friends are like, I'll call you an ambulance. And this really sick student was saying: please don't and just throw me in a car and drive me to hospital because apparently ambulance is very very expensive. They will save you at all cost and then bill you later send you to bill later. Is that true?
Yes. Although your insurance will pay for ambulance fees but it can be really expensive. And so yes some people will just do that put you in a car and drive you to the hospital themselves. But this is way more complicated because if you're from where I am in the country, ambulance means helicopter.
Oh, that will be astronomical price.
Yeah. But for some people in the country that's their only option because the hospital could be pretty far away, so there will be an air ambulance.
So we talked about travelers, in the end, what about students? For international students when they are applying for a university or a school in United States, do they have to get insurance?
If any of our listeners have experience with this, they should be able to tell you that having medical insurance is a requirement for US student visa. So most of the times you can buy the insurance itself through these universities, so universities will have special student plans which tend to be inexpensive. It's not the best insurance. It's basically… well we termed it as emergency insurance, so it'll protect you if you know get hit by a car or a serious illness just happens.
But generally when you're applying for universities, the university when they accept you, they can give you certain information on what kind of insurance to get.
Yeah university would definitely know, you can in fact contact the universities uh international students' office and they'll most likely tell you exactly what you need.
That's certainly very useful tips for anyone who wants to travel or wants to study in United States.
If any of you have any comments or experiences with this, please let us know in the comments below.
And if you have any further questions, also leave us a comment. We'll see you next time.
Bye everyone.
Bye.

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