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You guys have the most bonkers health system anyone could imagine. 1/6 of your economy goes on "health care", but most of that doesn't actually contribute to yo

by PaulAJ 9y ago

You guys have the most bonkers health system anyone could imagine. 1/6 of your economy goes on "health care", but most of that doesn't actually contribute to your health, it gets skimmed off by insurers, drug companies, individual practitioners, hospitals and lawyers. Sooner or later you are going to wake up and realise that a government-run single payer scheme is the only way to go.

dandare 9y ago
I totally agree with everything up to the last sentence. State can be a horrible manager too, trust me I am from Europe. Is the problem not about lack of competition and all kinds of barriers?
- EADGBE 9y ago
  States can be horrible managers too, trust me I am from the US.
folli 9y ago
I've yet to come across a health insurance scheme that I'd approve without any reservation. The British NHS that you obviously praise as the single solution is also not without its flaws regarding quality and waiting lists. An acquainted Iranian surgeon who works in England under the NHS remarked that he'd rather fly to Iran in case he should ever get a surgery because the infrastructure is more up to date and the surgeons equally well trained. The Swiss healthcare system, which I'm more familiar with (universal healthcare, with health insurance being compulsory, while the insurance companies are still private), is also not devoid of flaws. The assumed competition among the insurance companies is not working at all, resulting in rising costs since years.
- throwawaymanbot 9y ago
  There is NO perfect healthcare system. But I feel, its fairer to consumers in Switzerland and the UK. Its kind of turned in to a sick (excuse the pun) joke here in the US.
- marcindobry 9y ago
  A very recent example from me, I had my first appointment at an NHS physio scheduled 4 months after my shoulder dislocation, which is a full month after I already finished recovering by going to a private physiotherapy clinic.
  - EADGBE 9y ago
    after I already finished recovering by going to a private physiotherapy clinic. So, you're saying the method generally used in the US worked for you, and treated you faster. Unfortunately, at a cost. But I'm pretty sure that's the way it works. A same-day appointment to a family clinic (Of which you'd already have an association with - I only say it like that because I don't know of a similar practice in other countries) would get you in and out within an hour. Cost is dependent on your insurance, but probably a $30 or less (even $0) visit.
- simonh 9y ago
  Is being devoid of flaws really the standard a system should be held to? Is approval without reservation the only threshold for approval? The NHS and Swiss systems aren't flawless, they have problems and mistakes get made, but the US system is just appalling by comparison. Things that would be considered utterly unacceptable aberrations and be immediately fixed in those systems are routine occurrences in the US with no sign of them ever being addressed and in fact entrenched interests actively working to ensure that they aren't.
  - bluGill 9y ago
    All systems have flaws. You hear about flaws in the US system, but they are not nearly as common as you think they are, at least not in my experience.
    - cptskippy 9y ago
      > at least not in my experience. I'm glad you're here to speak for us all. I hope you never have to deal with anyone in your family being admitted to inpatient or residential treatment. As if severe illnesses weren't enough stress on the family, having to immediately come up with your insurance's out of pocket maximum deductible and then spending all of your free time on the phone trying to find ways to keep up the coverage can just push you to the limits. There's nothing worse than the look on a doctor's face when he's trying to be optimistic while telling you that your kid must be discharged because the insurance company's doctor has deemed them better and is denying claims and you can't afford the $2400 a day it costs to keep them there.
  - folli 9y ago
    Oh no, being devoid of all flaws is definitely not a realistic requirement for approval. I was merely disagreeing with the original comment, which made a very absolutist claim ("a government-run single payer scheme is the only way to go").
- Spoom 9y ago
  Curious about your reservations about Canadian-style single payer, where hospitals and doctors get reimbursed by the government but are otherwise independent. IMHO it's the best solution, but I acknowledge my own bias since I grew up there.
  - strictnein 9y ago
    The wait times seem insane. For things like seeing specialists or having an MRI, the wait time seems to be 30-40x that of the US. Maybe more.
strictnein 9y ago
> " it gets skimmed off by insurers, drug companies, individual practitioners, hospitals" 7% goes to the insurers and it's not like there aren't equivalent workers doing much of the same work in your healthcare system for similar costs. Maybe it's slightly more efficient, but not by much. As for being "skimmed" by practitioners and hospitals... that's a weird word to use, since they're just being paid for their services. You also have to understand that, since you don't experience the US healthcare system directly, the only thing you're going to read is people complaining. The wait times for many services in the US are vastly shorter than they are in government run systems. For an example, same day MRIs are available in some cases or with a day or two wait in most cases.
- Others 9y ago
  The short wait times are because of the higher costs/smaller number of people having access to MRIs. It's a tradeoff, and honestly I don't think it's worth it.
  - strictnein 9y ago
    The point is that we pay more and actually get things for it. I think a lot of the people commenting from outside the US think we pay more and have a lower level of service than they do, which is incorrect.
    - bspn 9y ago
      That is true, but we also get a lot of things we don't need because the provider knows that insurance will reimburse it. My wife spent some time in the hospital recently and the number of tests they performed was truly staggering. When I asked the technician performing one of the scans what it would show, his response was "probably nothing, but we just do it because we can." I contrast that with my experience in my home country when I ruptured my ACL and required surgery. I visited the specialist who immediately diagnosed the problem after a quick exam and told me that we could do an MRI but that would be a waste of time as it wouldn't reveal anything we didn't already know. I was booked in for surgery the next day with a minimum of fuss.
skrause 9y ago
> Sooner or later you are going to wake up and realise that a government-run single payer scheme is the only way to go. But it's not. Just look at Germany, we have universal and not too expensive healthcare without a government-run single payer scheme, but instead a mix of well-regulated public and private health insurance companies. That's also a path the US could take instead going all the way to the other extreme of a single player system.

by PaulAJ 9y ago

dandare 9y ago

I totally agree with everything up to the last sentence. State can be a horrible manager too, trust me I am from Europe. Is the problem not about lack of competition and all kinds of barriers?

EADGBE 9y ago
States can be horrible managers too, trust me I am from the US.

folli 9y ago

I've yet to come across a health insurance scheme that I'd approve without any reservation. The British NHS that you obviously praise as the single solution is also not without its flaws regarding quality and waiting lists. An acquainted Iranian surgeon who works in England under the NHS remarked that he'd rather fly to Iran in case he should ever get a surgery because the infrastructure is more up to date and the surgeons equally well trained. The Swiss healthcare system, which I'm more familiar with (universal healthcare, with health insurance being compulsory, while the insurance companies are still private), is also not devoid of flaws. The assumed competition among the insurance companies is not working at all, resulting in rising costs since years.

throwawaymanbot 9y ago
There is NO perfect healthcare system. But I feel, its fairer to consumers in Switzerland and the UK. Its kind of turned in to a sick (excuse the pun) joke here in the US.
marcindobry 9y ago
A very recent example from me, I had my first appointment at an NHS physio scheduled 4 months after my shoulder dislocation, which is a full month after I already finished recovering by going to a private physiotherapy clinic.
- EADGBE 9y ago
  after I already finished recovering by going to a private physiotherapy clinic. So, you're saying the method generally used in the US worked for you, and treated you faster. Unfortunately, at a cost. But I'm pretty sure that's the way it works. A same-day appointment to a family clinic (Of which you'd already have an association with - I only say it like that because I don't know of a similar practice in other countries) would get you in and out within an hour. Cost is dependent on your insurance, but probably a $30 or less (even $0) visit.
simonh 9y ago
Is being devoid of flaws really the standard a system should be held to? Is approval without reservation the only threshold for approval? The NHS and Swiss systems aren't flawless, they have problems and mistakes get made, but the US system is just appalling by comparison. Things that would be considered utterly unacceptable aberrations and be immediately fixed in those systems are routine occurrences in the US with no sign of them ever being addressed and in fact entrenched interests actively working to ensure that they aren't.
- bluGill 9y ago
  All systems have flaws. You hear about flaws in the US system, but they are not nearly as common as you think they are, at least not in my experience.
  - cptskippy 9y ago
    > at least not in my experience. I'm glad you're here to speak for us all. I hope you never have to deal with anyone in your family being admitted to inpatient or residential treatment. As if severe illnesses weren't enough stress on the family, having to immediately come up with your insurance's out of pocket maximum deductible and then spending all of your free time on the phone trying to find ways to keep up the coverage can just push you to the limits. There's nothing worse than the look on a doctor's face when he's trying to be optimistic while telling you that your kid must be discharged because the insurance company's doctor has deemed them better and is denying claims and you can't afford the $2400 a day it costs to keep them there.
- folli 9y ago
  Oh no, being devoid of all flaws is definitely not a realistic requirement for approval. I was merely disagreeing with the original comment, which made a very absolutist claim ("a government-run single payer scheme is the only way to go").
Spoom 9y ago
Curious about your reservations about Canadian-style single payer, where hospitals and doctors get reimbursed by the government but are otherwise independent. IMHO it's the best solution, but I acknowledge my own bias since I grew up there.
- strictnein 9y ago
  The wait times seem insane. For things like seeing specialists or having an MRI, the wait time seems to be 30-40x that of the US. Maybe more.

strictnein 9y ago

> " it gets skimmed off by insurers, drug companies, individual practitioners, hospitals" 7% goes to the insurers and it's not like there aren't equivalent workers doing much of the same work in your healthcare system for similar costs. Maybe it's slightly more efficient, but not by much. As for being "skimmed" by practitioners and hospitals... that's a weird word to use, since they're just being paid for their services. You also have to understand that, since you don't experience the US healthcare system directly, the only thing you're going to read is people complaining. The wait times for many services in the US are vastly shorter than they are in government run systems. For an example, same day MRIs are available in some cases or with a day or two wait in most cases.

Others 9y ago
The short wait times are because of the higher costs/smaller number of people having access to MRIs. It's a tradeoff, and honestly I don't think it's worth it.
- strictnein 9y ago
  The point is that we pay more and actually get things for it. I think a lot of the people commenting from outside the US think we pay more and have a lower level of service than they do, which is incorrect.
  - bspn 9y ago
    That is true, but we also get a lot of things we don't need because the provider knows that insurance will reimburse it. My wife spent some time in the hospital recently and the number of tests they performed was truly staggering. When I asked the technician performing one of the scans what it would show, his response was "probably nothing, but we just do it because we can." I contrast that with my experience in my home country when I ruptured my ACL and required surgery. I visited the specialist who immediately diagnosed the problem after a quick exam and told me that we could do an MRI but that would be a waste of time as it wouldn't reveal anything we didn't already know. I was booked in for surgery the next day with a minimum of fuss.

skrause 9y ago

> Sooner or later you are going to wake up and realise that a government-run single payer scheme is the only way to go. But it's not. Just look at Germany, we have universal and not too expensive healthcare without a government-run single payer scheme, but instead a mix of well-regulated public and private health insurance companies. That's also a path the US could take instead going all the way to the other extreme of a single player system.