Health Care, Disease Control, Crime and Safety in The United StatesIf you’re planning on visiting the United States, either for an extended visit or permanent move, you should definitely familiarize yourself with the country’s health and safety systems, policies and practices, along with the various organizations that deliver these services. To help you do that, below we go over, in some detail, the heath care and law enforcement systems in the United States, and provide you with some basic tips to help you preserve and protect your health and safety while visiting this beautiful country.
United States Health and Safety: U.S. Health Care SystemWhen it comes to the health care system of the United States, there can be no debate about its quality and efficacy. America has one of the finest systems of health care in the world, with state-of-the-art facilities boasting the finest and most recent medical technology. There are some people who would argue, however, that the lack of access to health care for some of the country’s neediest citizens makes the health care system inherently flawed, especially when you consider that the United States spends more on health care each year than any other country in the world.
Recently the United States Congress passed the Affordable Care Act; a law that will essentially put into a place a national system of health care that somewhat mirrors that of Canada and some European nations. This ACT is designed to provide affordable health insurance for all Americans. However, the basic provisions of this law do not go into effect until 2014.
Understanding the debate when it comes to the American health care system requires an elementary understanding of its structure. In the following section we will explain the organization and financing of the United States health care system.
Structure of the United States Health Care System
As with most other developed countries, medical insurance in the United States is broken down into private insurers and public insurers. What makes the United States’ system unique, however, is the dominance of private insurers as compared to the public element. Last year, nearly 68 percent of all Americans under the age of 65 were privately insured. Most of these people received their benefits through employer-sponsored health insurance and the remainder through private insurance purchased on the open market. 15 percent were enrolled in public insurance programs (like Medicaid), and another 17 percent were uninsured. Elderly individuals over the age of 65 are almost all insured by Medicare.
Public insurance in the United States can be broken down into three general categories: Medicare, Medicaid and other smaller programs.
Medicare is a national health insurance program that covers all individuals aged 65 and older, whether they are working or not, as well as some disabled individuals receiving social security benefits. A single-payer program, Medicare is administered solely by the federal government, which reimburses doctors and hospitals for the services they perform. The program is financed by federal income taxes, a payroll tax shared by employees and their employers, and individual enrollee premiums.
Medicare is broken down into four parts: Medicare Parts A, B, C, and D. Medicare Part A covers all services performed in a hospital setting; Medicare Part B covers physician services; Medicare Part C refers to “Medicare Advantage,” HMO’s that administer Medicare benefits; and Medicare Part D offers a prescription drug benefit.
Although Medicare is a very valuable program for seniors and disabled individuals, the coverage has many gaps. Medicare Part B, for example, only covers 80 percent of the overall cost of seeing a physician, and the remainder must be paid by the patient. There is also no coverage whatsoever under this plan for dental, hearing and vision concerns, and incomplete coverage for care provided in a skilled nursing facility.
Medicaid is a program designed for low-income and disabled individuals. By law, each state must cover certain individuals that fall below a predetermined income level, including pregnant women, children, the elderly, disabled and parents. Individuals without children are generally not covered (unless they are disabled), and many poor people make too much to qualify for the program. Because Medicaid is administered by the state, each state has the option of expanding eligibility if they so choose, but they cannot limit the basic coverage outlined by the federal government.
Medicaid is financed jointly by the states and federal government through taxes. For every dollar spent by the state, the federal government matches it 100 percent. In poorer states, the federal government may spend more than its equal match share, which is why currently the federal government pays for 57 percent of all Medicaid programs. Coverage through Medicaid is fairly comprehensive, but because of the poor rate of reimbursement, many Medicaid beneficiaries may find it difficult to find a provider that accepts this insurance.
Other Public Insurance Programs
There are a few other insurance programs in the United States that fit the category “public health insurance.” The State Children’s Health Insurance Program (S-CHIP), for example, which was enacted in 1997, is designed to cover children whose families make too much money to qualify for Medicaid, yet not enough to purchase private health insurance. Also in this category is the Veterans Administration (VA), a program through which veterans of America’s armed services can receive health care through government-owned hospitals and medical facilities. The VA is paid for through tax dollars and the care it offers to veterans is fairly comprehensive.
Private Health Insurance
Private health insurance in the United States can be divided into two categories: employer-sponsored health insurance and private non-group medical insurance.
Employer-Sponsored Health Insurance
The most popular type of health insurance for Americans under the age of 65 is employer-sponsored health insurance. This is usually part of the benefit package people receive from the company or organization for which they work. This type of insurance coverage is administered by private companies, both profit and non-profit. The majority of the costs for this type of insurance are typically paid by the employer, with the employee making up the remainder of the costs not paid by their employer. In 2012, the average annual premium in the United States was roughly $5,000 for individuals and over $10,000 for a family of four. Benefits vary widely under these plans. For example, some employer-sponsored health plans cover the costs of prescriptions, while some do not.
Private Non-Group Insurance
Private non-group insurance, bought on the individual market, covers the portion of the American population that is self-employed, retired or those who are unable to obtain health insurance coverage through their employer. In contrast to the group insurance market, the individual market (currently) allows health insurance companies to deny people coverage based on pre-existing conditions (When it fully goes into effect, the Affordable Care Act will prohibit health insurance companies from denying insurance to those with pre-existing conditions). Like the group policies, these plans are administered by private insurance companies and the costs of the premiums are absorbed completely by the purchaser.
The United States Health Care System as Compared to Other Countries
The United States currently spends nearly 18 percent of its Gross Domestic Product on health care, the highest percentage in the OECD (an organization of industrialized countries). This is nearly double the 8.6 percent average spent on health care by other OECD countries. In addition, the U.S. spends more on health care per capita than any other OECD country. Last year, total health spending in the United States per capita was $8,200, a figure that is more than double the OECD average of $3,900 (when adjusted for U.S. dollars). Studies show that health care spending in the United States increases by approximately 4.5% a year, which is comparable to the OECD average of 4.4% a year.
The public sector is the main source of health funding in all OECD countries, except the United States, Mexico and Korea. In the United States, 46% of health spending is funded by government revenues, well below the average of 75% in all OECD countries.
Health Care and Visitors to the United States
Each year, the United States hosts millions of foreign visitors from all over the world. While the United States healthcare system is recognized as one of the best in the world, many visitors are concerned about the potential out-of-pocket expenses that could result from an injury or sickness during their visit to the country. Healthcare costs are much different in the United States than they are in most other countries, which is why foreign nationals who intend to visit the United States for an extended period of time should always consider purchasing “visitor’s” Medical Insurance to protect themselves and their families in case of an injury or accident while visiting the country.
United States Health and Safety: Law Enforcement in the United StatesIn 2012 there were approximately 1.2 million full-time, sworn law enforcement officers in the United States and nearly 18,000 state and local law enforcement agencies. There are basically three levels of law enforcement in America: Federal Police, State Police and Local Police. These three branches of law enforcement have much in common, but their duties can vary widely. All sworn officers, however, are alike in that they take an oath to enforce the laws of the United States
Most police officers at the federal level work under the leadership of the national Department of Justice (DOJ). There are several DOJ agencies involved in federal policing, including the Federal Bureau of Investigation (FBI), the Drug Enforcement Administration (DEA), the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF), the United States Marshals Service, the Federal Bureau of Prisons and others.
The Department of Homeland Security is another branch of federal police with numerous federal law enforcement agencies reporting to it. These include U.S. Customs and Border Protection (CBP), U.S. Immigration and Customs Enforcement (ICE), United States Secret Service (USSS), United States Coast Guard (in peace time), and the Transportation Security Administration.
All of these agencies have specific duties and jurisdictions. For example, the most well-known agency of federal police, the FBI, performs certain duties that are outside the purview of local and state agencies. The FBI is responsible for gathering domestic intelligence, and works to thwart threats to the federal government and the United States as a whole. As the premier law enforcement agency in the United States, the FBI also assists local police in handling major criminal cases, and has a sophisticated lab for examining forensic evidence. Law enforcement agencies across the country can send material for analysis to the FBI if their local labs are not equipped to handle it. High profile cases, such as murder; crimes which cross state boundaries; and kidnappings are all under the jurisdiction of the FBI. FBI officers are distributed throughout the United States in special “field offices” to assist state and local agencies in enforcing the laws of the U.S. and neutralizing threats to American security.
In most states, there are a variety of state-run government law enforcement agencies, performing tasks that include investigations and statewide patrols. Depending on the state, these agencies can be known by many different titles, including State Police, State Patrol or Highway Patrol, and are normally part of the state Department of Public Safety. In addition to these safety patrol officers, the state Attorneys General’s offices also have their own state bureaus of investigation. One of the most well-known state law enforcement agencies of this kind is the Texas Rangers.
State patrol officers can be seen on the roads and highways in every state in America, ensuring motorists are following the traffic laws of that specific state. They are tasked with the responsibility of ticketing or citing motorists for unsafe driving behavior—speeding, drunk driving, etc.—and they respond to highway accidents to render assistance and perform investigations.
Certain state government departments may also have their own law enforcement divisions. State-run universities, for example, usually have a campus police division, as do many large hospitals. The Department of Corrections is in charge of running each state’s prison system, and the state game wardens patrol natural areas and state parks.
Local police can be divided into two categories: County Police and City Police
The Sheriff’s Department is the primary law enforcement agency at the county level. These officers provide all the traditional law enforcement functions, including countywide patrols and investigations, irrespective of city or municipal boundaries. The Sheriff’s Office is often the sole law enforcement agency in unincorporated areas. The Sheriff’s department is also responsible for operating and staffing county jails.
At the city level, the size of the police department depends largely on the population. Smaller towns may have a department staffed by just one or two officers, while larger United States cities, such as New York, Los Angeles, Chicago and Houston, employ officers in the tens of thousands (New York has 40,000 + sworn officers). The duties afforded these local city police officers are vast, including patrolling within the city, issuing traffic citations, investigating crimes, testifying in court cases, writing reports and just generally keeping the city safe from a wide range of crime. Most local police departments have both uniformed officers, responsible for daily 24/7 patrols throughout the city, and plain-clothed officers or detectives, responsible for investigating more serious crimes such as burglary, rape and murder.
Private Law Enforcement Agencies
While most law enforcement duties are conducted by public employees at the federal, state and local level, there are also a number of private protective agencies and private investigation agencies scattered throughout the United States. Many businesses, for example, employ a private security firm to watch over their company both during and after hours. Large shopping centers usually have private guards on hand who are paid to monitor suspicious individuals and detain criminals, such as shoplifters, until local or county law enforcement can arrive. Private investigators are also plentiful around the country. These professionals are typically hired by an individual for a wide range of investigative reasons, including the disappearance of someone who the client wants located. Some, but not all of these private officers are permitted to carry a firearm in the course of their duties.
Health and Safety Tips for Visitors to the United StatesFor the most part, the United States is a very safe country to visit, but like any country it does have its share of unsavory areas and individuals. To help ensure your safety during your visit, so you can happily enjoy all the United States has to offer, below we have compiled a few basic health and safety tips you should always keep in mind.
During your excursion to the United States, the last thing you want is to become ill or injured, but in the event you do, it literally pays to be protected. Today there are literally hundreds of companies that offer health insurance for travelers. These simple insurance policies will enable you to seek the medical attention you need in the event of an emergency and help you avoid the high costs associated with the American health care system.
If you plan to be in the United States for an extended period of time, you may want to see your doctor, even your dentist for a checkup prior to leaving. Remember to fill any prescriptions you currently take and make sure you bring enough to cover your entire trip and then some, just in case your return trip somehow gets delayed. These simple preventative steps can often be the difference between a fun and healthy United States vacation and one that is less than enjoyable.
As we mentioned above, the United States is a highly developed and very safe place to visit. However, just to ensure you don’t encounter any trouble along the way, try and keep the following tips in mind:
- Prepare Your Documents. Before departing for your trip, make sure you have in your possession all the required travel documents you will need to legally enter the country—Including your valid passport (with the ESTA authorization) and a valid, unexpired multiple-entry visa.
- Ask for Directions. If you plan to partake in some sightseeing (which you should) while visiting the United States, always ask for directions before you depart. Looking lost can often make you look like an easy target for crime. If you do get lost along the way, stop into a local business to ask for directions.
- Watch for Pickpockets. Visitors to attractions that tend to draw large crowds can be susceptible to pickpockets and other criminals. For that reason, it is imperative that you stay alert in your surroundings, keep your personal belongings close to your body, and be vigilant when standing or walking among lots of other people.
- Buddy Up. There is safety in numbers. Whenever possible, try not to travel alone. Also, avoid driving on some of the more desolate U.S. roadways at night. If you happen to break down in these areas, help can often be very far away.
- Avoid Cash. When traveling to the various destinations you want to see while visiting the United States, avoid carrying large amounts of cash. Instead, use traveler’s checks or a credit card to pay for your purchases, preferably one from a reputable company that will reimburse you in the event of theft.
The keys to a healthy and safe trip to the United States are preparation and vigilance. Plan carefully for your trip by preparing all the documents and other items you will need to enter the country and enjoy your trip. While in the country, stay vigilant with regards to your surroundings and never put yourself in a vulnerable position. Like you, most people in the United States are upstanding law-abiding people, but it only takes one bad apple to ruin your trip.