An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

The allowance is the amount an insurer has agreed to pay for a particular treatment or medication. This number is determined after negotiations with a hospital or drug manufacturer. A lack of transparency around negotiation processes contributes to the high costs that patients are expected to shoulder.

An ancillary service is any additional treatment a patient receives after receiving bare bones care. This definition has grown over the years, and now includes tests, physical therapy, imaging, and ambulances. Since the classification for an ancillary service has grown significantly, it is easy for doctors and insurers to exploit.

A conglomerate is any collection of healthcare organizations that work together to provide coordinated care. These differ from HMO plans because patients often join them because they are what is available in their area, and not because of any genuine desire to be in their network. Conglomerates can leverage their size and power to demand more money from insurance companies and patients and charge arbitrarily high prices for an average standard of care. Conglomerates were one of the first medical entities to accept and use EMRs (electronic medical records).

This is the money a patient is expected to contribute directly after receiving a particular treatment or medication. Copays are not standardized across insurance plans, meaning that patients with different providers may shoulder radically different costs for similar treatments.

This is the amount a patient needs to spend on medical care before insurance policies will kick in. If a patient does not meet this amount, they will be required to pay the remainder on their yearly bill. It is important that patients clarify the exact terms of their deductible so that they are not blindsided when they receive their bill.

The FDA is the main governmental body tasked with approving new medical treatments. An American Sickness largely focuses on how drug manufacturers exploit loopholes in its approval process to generate profits.

HMOs are one of two types of insurance programs. They are highly centralized networks of doctors, specialists, and hospitals that operate under the same umbrella. This makes communication between doctors, specialists, and patients incredibly efficient. Any health professional in the HMO will automatically know what other care their patient has received. However, some people dislike HMOs due to their lack of choice.

Medicaid is a government-funded state and federal insurance program available to people in low-income communities. While it functions similarly to Medicare, it also provides coverage for additional treatments, such as nursing homes. 

Medicare is a publicly funded government insurance program available to any American over the age of 65. Hospitals and doctors have mixed feelings towards it: its highly regulated nature can make it difficult for them to profit. Medicare is the only insurance plan in America that is a government-subsidized single-payer system, which places it squarely at the center of debates about the future of America’s healthcare.

These are medical professionals, like technicians, who conduct work on behalf of a physician. Doctors can bill patients for any work done by these extenders.