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Fellow European (UK) here. From what I understand one argument often given, is that there's a mistrust of the government for anything like this and people prefe

Fellow European (UK) here. From what I understand one argument often given, is that there's a mistrust of the government for anything like this and people prefer to "shop" for it themselves. By making their own choice (even if all that actually means is picking from 1 or 2 options given to them by their employer) - they feel empowered and in control of it. There is a general feeling of "if you want it, pay for it". This StackExchange answer sums up it up succinctly: https://politics.stackexchange.com/a/16372 https://politics.stackexchange.com/a/16372. I find it immensely saddening; the same goes with the general population's attitude to education (in many countries) or providing housing. For what it's worth I know a lot of people with private healthcare in the UK with the attitude that the NHS is complete trash (something I very much disagree with) - I fear this sort of mindset is spreading. "Pull the ladder up jack" as they say.

chimeracoder 9y ago
> From what I understand one argument often given, is that there's a mistrust of the government for anything like this and people prefer to "shop" for it themselves As a data point: the patient satisfaction scores for Original Medicare (government-run) are drastically lower than every single major provider of Medicare Advantage (privately-run). As much as people dislike insurance companies, people in the US are even less happy with the government-run programs, compared to their private counterparts.
- justin66 9y ago
  On the other hand, patient satisfaction correlates with increased rates of hospitalization, higher expenses, and increased mortality. You'd want to dig a little deeper than patient satisfaction before drawing any conclusions regarding medicare vs. medicare advantage, I would think.
  - chimeracoder 9y ago
    > On the other hand, patient satisfaction correlates with increased rates of hospitalization, higher expenses, and increased mortality. You'd want to dig a little deeper than patient satisfaction before drawing any conclusions regarding medicare vs. medicare advantage, I would think. I didn't in my previous comment, because we were talking about the overall public perception, which may or may not be connected to the tangible metrics that we actually want a healthcare system to focus on. As it turns out, though, Medicare Advantage also consistently outperforms Original Medicare on medical outcomes, and it comes in under-budget for identical coverage. Medicaid options vary much more (and they're different in every state, because Medicaid is administered at the state level), but the equivalent private plans for Medicaid coverage also typically perform much better than the public ones. Hacker News readers aren't generally in the demographic for Medicare[0], but for anyone who is: there's really no reason to use Original Medicare. Every jurisdiction should have Medicare Advantage plans that cost you the same amount as Original Medicare does, and your experience (and overall care) will be vastly improved. [0] people over the age of 65, or people of any age who are on dialysis for more than two years, etc.
    - mazelife 9y ago
      > Medicaid options vary much more (and they're different in every state, because Medicaid is administered at the state level), but the equivalent private plans for Medicaid coverage also typically perform much better than the public ones. I'd be interested to see these findings. Do you have links? As far as Medicare Advantage is concerned, it's not the least bit surprising that patient satisfaction is higher. But I wouldn't go treating that as some kind of referendum on Government-run healthcare: "Many private [Medicare] plans require no additional monthly premiums, yet the government pays an average of $849.90 in monthly subsidies to insurance companies for a person on Medicare Advantage, according to the Kaiser Family Foundation. That is about 14 percent more than the government spends on people with standard Medicare, according to the nonpartisan Medicare Payment Advisory Commission." MA was supposed to demonstrate that private insurers could deliver care at lower costs than Medicare, and it hasn't done that. Basically, for every $1.00 the gov spends on a medicare patient, it pays $1.14 in subsidies for an MA patient, with the evidence indicating a lot of that goes straight into the pockets of insurers as profit [2] [1] http://www.washingtonpost.com/wp-dyn/content/article/2009/10/14/AR2009101403953.html?hpid=topnews&sid=ST2009101403963 http://www.washingtonpost.com/wp-dyn/content/article/2009/10... [2] http://theincidentaleconomist.com/medicare-advantage-cuts-once-more-with-feeling/ http://theincidentaleconomist.com/medicare-advantage-cuts-on...
      - chimeracoder 9y ago
        > Many private [Medicare] plans require no additional monthly premiums, yet the government pays an average of $849.90 in monthly subsidies to insurance companies for a person on Medicare Advantage, according to the Kaiser Family Foundation That might be a reasonable comparison if Medicare's claims rates were self-sustaining, but they're not. As I explained in another comment on this thread, private insurers subsidize Original Medicare with their own payouts in claims, and that comes out a few orders of magnitude larger than 14% per Original Medicare patient.
richthegeek 9y ago
Unfortunately the NHS is, in many ways, pretty bad. They're pretty good at dealing with pregnancies, cancers, and emergencies but try getting seen for a chronic pain and you'll follow this rough timeline: - Try see your GP. Wait 2 weeks until your appointment. - GP will give a cursory examination and recommend a dietary change, taking ibuprofen/paracetamol, and to come back if problem persists. - Problem persists. Book in with your GP and wait another 2 weeks. - GP will actually examine you this time. They may then refer you to the local hospital, and so you should await a letter. - about 2 weeks later, the a will arrive saying that you should phone up to make an appointment. - within 8 weeks you should get another letter telling you when your appointment is, which will be within 4 weeks. At this point you have spent 20 weeks just to get seen by a specialist. And that's assuming everything goes ok. Admin may not update your details, so the letters go to an old (or wrong) address. They may just entirely forget to make an appointment for you. Probably if you try phone them they just won't pick up the phone. There's a fetishisation of the NHS in this country that protects it from a lot of criticism. Some will say "well you should put up with that because it's free" or some similar rubbish, ignoring that it costs £2200 per person. None of these issues are restricted to the NHS. Any large organisation will have such issues. But it's utterly frustrating stuff like this that makes me consider going private - I shouldn't have to spend hours on the phone figuring out why I haven't been assigned an appointment despite being referred 3 months ago.
- com2kid 9y ago
  In contrast, to America working for a good employer: 1. Schedule with GP. Say I am in pain. Get in within 2 days. 2. Get a referral to Physical Therapy. Asked if I have any preference where to go. My doctor knows my network and gave me a number of choices that were within network (a number of which were within walking range of where I lived). 3. Call PT office. Schedule an appointment. They apologize that their next opening is a week away. Gladly accept. Physical Therapy is interesting in that it is semi-free market and rather competitive, so it tends to work a bit better than some other scenarios.
  - DanBC 9y ago
    To be fair that's usually how it works in England too, with maybe a bit longer to wait for physiotherapy, and the addition of weight loss programmes.
deleted 9y ago
[deleted]
Shivetya 9y ago
Not that I think the our system (US resident) is all that great but our government runs two of the worst systems that exist in the country, the Veterans Administration which nearly everyone hears about but also the Indian Health Service which sadly flies under the RADAR. so it is a very hard sell to get more Federal involvement when we have constant stories of VA issues and more available just by searching. throw in rules that actively prevented insurers from making multi state offers and the system was bound to be a mess. however one of the problems not discussed is that many receive their health insurance from their employers and while this has been going away slowly, this idea like income taxes, tends to remove the cost component from people's minds. you don't see the cost in whole or in large lump sums so its easy to not think about it. the big hurdle will be convincing people there will be limits of what can be treated. the US infant mortality statistics are one area of exaggeration to the bad simply because to the extent money will be spent to save a newborn that many other system won't

chimeracoder 9y ago

> From what I understand one argument often given, is that there's a mistrust of the government for anything like this and people prefer to "shop" for it themselves As a data point: the patient satisfaction scores for Original Medicare (government-run) are drastically lower than every single major provider of Medicare Advantage (privately-run). As much as people dislike insurance companies, people in the US are even less happy with the government-run programs, compared to their private counterparts.

justin66 9y ago
On the other hand, patient satisfaction correlates with increased rates of hospitalization, higher expenses, and increased mortality. You'd want to dig a little deeper than patient satisfaction before drawing any conclusions regarding medicare vs. medicare advantage, I would think.
- chimeracoder 9y ago
  > On the other hand, patient satisfaction correlates with increased rates of hospitalization, higher expenses, and increased mortality. You'd want to dig a little deeper than patient satisfaction before drawing any conclusions regarding medicare vs. medicare advantage, I would think. I didn't in my previous comment, because we were talking about the overall public perception, which may or may not be connected to the tangible metrics that we actually want a healthcare system to focus on. As it turns out, though, Medicare Advantage also consistently outperforms Original Medicare on medical outcomes, and it comes in under-budget for identical coverage. Medicaid options vary much more (and they're different in every state, because Medicaid is administered at the state level), but the equivalent private plans for Medicaid coverage also typically perform much better than the public ones. Hacker News readers aren't generally in the demographic for Medicare[0], but for anyone who is: there's really no reason to use Original Medicare. Every jurisdiction should have Medicare Advantage plans that cost you the same amount as Original Medicare does, and your experience (and overall care) will be vastly improved. [0] people over the age of 65, or people of any age who are on dialysis for more than two years, etc.
  - mazelife 9y ago
    > Medicaid options vary much more (and they're different in every state, because Medicaid is administered at the state level), but the equivalent private plans for Medicaid coverage also typically perform much better than the public ones. I'd be interested to see these findings. Do you have links? As far as Medicare Advantage is concerned, it's not the least bit surprising that patient satisfaction is higher. But I wouldn't go treating that as some kind of referendum on Government-run healthcare: "Many private [Medicare] plans require no additional monthly premiums, yet the government pays an average of $849.90 in monthly subsidies to insurance companies for a person on Medicare Advantage, according to the Kaiser Family Foundation. That is about 14 percent more than the government spends on people with standard Medicare, according to the nonpartisan Medicare Payment Advisory Commission." MA was supposed to demonstrate that private insurers could deliver care at lower costs than Medicare, and it hasn't done that. Basically, for every $1.00 the gov spends on a medicare patient, it pays $1.14 in subsidies for an MA patient, with the evidence indicating a lot of that goes straight into the pockets of insurers as profit [2] [1] http://www.washingtonpost.com/wp-dyn/content/article/2009/10/14/AR2009101403953.html?hpid=topnews&sid=ST2009101403963 http://www.washingtonpost.com/wp-dyn/content/article/2009/10... [2] http://theincidentaleconomist.com/medicare-advantage-cuts-once-more-with-feeling/ http://theincidentaleconomist.com/medicare-advantage-cuts-on...
    - chimeracoder 9y ago
      > Many private [Medicare] plans require no additional monthly premiums, yet the government pays an average of $849.90 in monthly subsidies to insurance companies for a person on Medicare Advantage, according to the Kaiser Family Foundation That might be a reasonable comparison if Medicare's claims rates were self-sustaining, but they're not. As I explained in another comment on this thread, private insurers subsidize Original Medicare with their own payouts in claims, and that comes out a few orders of magnitude larger than 14% per Original Medicare patient.

richthegeek 9y ago

Unfortunately the NHS is, in many ways, pretty bad. They're pretty good at dealing with pregnancies, cancers, and emergencies but try getting seen for a chronic pain and you'll follow this rough timeline: - Try see your GP. Wait 2 weeks until your appointment. - GP will give a cursory examination and recommend a dietary change, taking ibuprofen/paracetamol, and to come back if problem persists. - Problem persists. Book in with your GP and wait another 2 weeks. - GP will actually examine you this time. They may then refer you to the local hospital, and so you should await a letter. - about 2 weeks later, the a will arrive saying that you should phone up to make an appointment. - within 8 weeks you should get another letter telling you when your appointment is, which will be within 4 weeks. At this point you have spent 20 weeks just to get seen by a specialist. And that's assuming everything goes ok. Admin may not update your details, so the letters go to an old (or wrong) address. They may just entirely forget to make an appointment for you. Probably if you try phone them they just won't pick up the phone. There's a fetishisation of the NHS in this country that protects it from a lot of criticism. Some will say "well you should put up with that because it's free" or some similar rubbish, ignoring that it costs £2200 per person. None of these issues are restricted to the NHS. Any large organisation will have such issues. But it's utterly frustrating stuff like this that makes me consider going private - I shouldn't have to spend hours on the phone figuring out why I haven't been assigned an appointment despite being referred 3 months ago.

com2kid 9y ago
In contrast, to America working for a good employer: 1. Schedule with GP. Say I am in pain. Get in within 2 days. 2. Get a referral to Physical Therapy. Asked if I have any preference where to go. My doctor knows my network and gave me a number of choices that were within network (a number of which were within walking range of where I lived). 3. Call PT office. Schedule an appointment. They apologize that their next opening is a week away. Gladly accept. Physical Therapy is interesting in that it is semi-free market and rather competitive, so it tends to work a bit better than some other scenarios.
- DanBC 9y ago
  To be fair that's usually how it works in England too, with maybe a bit longer to wait for physiotherapy, and the addition of weight loss programmes.

deleted 9y ago

[deleted]

Shivetya 9y ago

Not that I think the our system (US resident) is all that great but our government runs two of the worst systems that exist in the country, the Veterans Administration which nearly everyone hears about but also the Indian Health Service which sadly flies under the RADAR. so it is a very hard sell to get more Federal involvement when we have constant stories of VA issues and more available just by searching. throw in rules that actively prevented insurers from making multi state offers and the system was bound to be a mess. however one of the problems not discussed is that many receive their health insurance from their employers and while this has been going away slowly, this idea like income taxes, tends to remove the cost component from people's minds. you don't see the cost in whole or in large lump sums so its easy to not think about it. the big hurdle will be convincing people there will be limits of what can be treated. the US infant mortality statistics are one area of exaggeration to the bad simply because to the extent money will be spent to save a newborn that many other system won't