BoyOhBoy, you sure ask complicated questions!  (Didn't I just hear you
say "Explain the U.S. health insurance system."?)  What follows is an
oversimplified answer from a non-expert.  (Don't ask me; I just live here!)

First, not all employers offer health insurance.  It's a "fringe
benefit" that employers may offer along with wages to attract good
employees and induce them to stay.  Usually, only full time employees
get full fringe benefits, but who gets what depends on the employer.

Some employers offer a group health insurance plan (cheaper than the
plans that could be purchased by individuals on their own) but require
the employee to pay for part or all of the insurance, or require
"co-pays" (e.g., I pay a $10 per doctors' office visit).

There are also other employer-offered programs that help with health
care costs, such as "health care spending accounts".  These allow you to
set aside money from your paycheck to pay for health care costs (such as
co-pays or non-covered expenses), without having to pay income tax on
that part of your income.  Not all employers offer these, either.

Ironically, higher-paying employers typically offer better fringe
benefits, so lower-paid or part-time employees are probably more likely
to be subject to out-of-pocket health care costs.  *If* an employer
offers health insurance, there are various regulatory provisions about
how they must handle it, basically so that it's non-discriminatory, has
"tide me over" provisions for people who leave employment, etc.

If you don't have an employer, or your employer doesn't give you health
insurance, perhaps:

1.  You're independently wealthy (lucky you), or self-employed,or
otherwise can scrape up the bucks, and buy your health insurance on your
own, either an individual plan or through some affiliated group plan.
It's expensive, with costs varying depending on where you live, who you
are (demographically), etc.  Think several hundred dollars per month,
potentially.

or

2.  You're very poor and are eligible for some kind of governmental
program that helps with health care costs, such as Medicaid.

or

3.  You're retired or disabled, and eligible for a governmental program
that helps with health care costs, such as Medicare (not the same as
Medicaid).  You may or may not have "medicare supplemental insurance"
through your (former) employer, or that you purchase on your own, to
help with things not covered by Medicare.

or

4.  You're in the armed forces or are in the immediate family of someone
in the armed forces, and get some benefits from their health care system.

or

5.  You're screwed.

The things that make people criticize the U.S. system are scenario #5,
and/or the various points where you can have co-pays, out-of-pocket
costs, or coverage limitations that could potentially cost you more
money than you have.  There are a host of gap-filler compassionate
programs, charities, etc., but finding them and qualifying can be
majorly bureaucratic just when you least need it.

In 2003 (most recent year for which government stats are available),
15.6% of people weren't covered by health insurance.  According to
census bureau stats, 60.4% were covered by employment-based health
insurance, 68.6% by some type of private health insurance
(employment-based, self-purchased, etc.), 26.6% by government programs
(12.4% Medicaid, 13.7% Medicare).

I've read (but can't find census stats that relate to it) that there's
economic behavior afoot in the uninsured group, that is, some portion of
the un-insured who technically could afford insurance, but decide
(perhaps because they're young/healthy) to bet on the proposition that
they won't have catastrophic illness, and elect to spend their money
elsewhere.

Let the corrections (and complaints) begin . . . .

Ann T.
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