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I'm a Brit and America, your health care system is torturing me
- tomc1985 8y agoThe HMO system is misery. PPOs are better but costly :/
- jschwartzi 8y agoHMOs are great if you're healthy and plan to remain that way for a while. I have the same deductible and co-pays as a PPO but pay about $200 less per month. The level of care is adequate for my needs, and I actually go to the doctor now because the HMO is integrated with the provider network, so I can book appointments online. Since the HMO also owns the lab and other facilities at the clinic everything that they do to me is covered. They even have an optometrist in case I need an eye exam. Their pharmacy is also really quick compared to most places.
- vivism 8y agoPeople don't plan to remain healthy?
- lotsofpulp 8y agoBased on most people's actions, it would appear not. Excessive eating, drinking, smoking, and insufficient exercise and sleep seem to apply to most people.
- pkaye 8y agoI'm in kidney failures (due to an auto-immune disease.) I have to do dialysis every day. I'm super careful with diet and lifestyle. But many people are not. My dietitian tells me stories of dialysis patients that go out for massive fast food meals before coming in for dialysis. Dialysis functions maybe at 10-20% of a normal kidney. Its meant to keep you alive not pull out wastes products from your excesses. It doesn't do a perfect job. These people are slowly just killing themselves.
- taurath 8y agoHMOs fail most often on mental health from anecdotes of friends on them. They force you through only one provider who may be qualified or not, and you get a "permanent record" which can actually really hurt your care in the future. If Jill the ARNP says you were awful and maybe faking a sympton, and she has lunch with a bunch of other doctors in the cafeteria, you're gonna get treated like crap.
- jschwartzi 8y agoYeah, I can see how that would be an issue. The HMO I'm on actually specifically covers private practitioners because their in-house practitioners are totally full for months. And it was pretty damn easy to get an appointment. I just had to call in and get a preapproval.
- virusduck 8y agoAre you in an area where Kaiser Permenente operates? It has been, on the whole, a great healthcare provider. The level of integration of their centers is great--I can walk downstairs for an MRI or Xray or lab test (no waiting for one doctor's office to phone in authorization/orders). Electronic records are fully and usefully integrated. Costs are relatively low, and there are several options of locations in my area--small, neighborhood office; a larger, integrated facility; and a 24-hour hostpital-like facility. They also have partnerships with other hospitals in my area, so I can go to other hospitals and be treated fully under KP insurance. There are so many advantages, I've kept my KP plan over several employers (including a stint on the Healthcare marketplace).
- pkaye 8y agoI'm using the KP health system. Its pretty awesome. Everything in integrated. I can use the website or phone app to check any of my test results. I can message my doctor for a e-consult at no extra cost. They usually reply within half day. I can book most appointments online. If I went to a specialist, I can continue messaging them in the future. And since the doctor is gate keeper, you just need them to approve a procedure and it will happen.
- tomc1985 8y agoI had Kaiser years ago and while the quality of care was high I remember eight- to ten-week waits to see certain specialists for non-critical issues. The HMO approach concerns me more as someone with special medical needs -- I would strongly prefer the flexibility to see a specialist that is experienced with my specific condition as I've had problems with doctors whose only experience with my condition is in a textbook
- ConfusedDog 8y ago"Rather like when the British rail system ground to a halt because of the wrong type of snow, the American health care system apparently is beset by the wrong type of patients: ill ones." That is so true. I'm not sure if the betterment of health insurance industry would be the solution, or the health insurance industry itself is actually the problem.
- deogeo 8y agoRelated: https://en.wikipedia.org/wiki/Health_system#International_comparisons https://en.wikipedia.org/wiki/Health_system#International_co...
- taurath 8y agoThats a good quick chart I can use to pull up when arguing for a single payer system. I think the biggest problem with single payer in the US is cultural, not even political - people simply don't trust the national government to do anything at an acceptable level (except when it comes to defense, the post office (74% approval rating), and the CDC).
- tptacek 8y agoHow does this chart address the question of how we should fund our health care system? The problem is how much we're paying, not whether we pay for it in payroll taxes or out of pocket.
- deogeo 8y agoThe chart shows a strong correlation between government funded healthcare, cost-efficiency, and effectiveness - that's how.
- tptacek 8y agoCorrelation isn't causation. Switzerland's health spending is in line with that of Canada, France, and Germany, has roughly the same (better in some cases) life expectancy outcome, and is an entirely private system. Life expectancy is also a poor way to compare health care systems, because major factors decreasing life expectancy have nothing to do with quality or access to care --- for instance, one of the most significant hits we take to life expectancy in the US is the prevalence of traffic fatalities.
- sethev 8y ago
- growlist 8y agoMeanwhile, here in the UK the NHS - weaponised by the left and virtually above criticism/reform as a consequence - tortures people by making them wait months/years for treatment due to rationing of care, this rationing in no small part being due to the fact that care is free at the point of delivery, which leads some people to abuse the service. Even a token £10 charge for GP visits, for example (subsidised for the genuinely incapable of paying) - similar to the Netherlands - would likely deter many of the unnecessary visits, and raise desperately needed revenue. I would gladly pay. But any/all genuine reform is blocked by the left raising the spectre of privatisation. So let's not pretend we have the all the answers here in the UK.
- aequitas 8y agoHere in the Netherlands we are not charged for visiting the GP (thanks Theme Hospital for learning me this term). Only for specialist treatments or medicine after diagnose you pay either a deductible if it falls within base insurance or 'normal' prices if you're not additionally insured. This is so nobody is discouraged from visiting the doctor for help.
- tbunt 8y agoComplete nonsense.
- amaccuish 8y ago> But any/all genuine reform is blocked by the left raising the spectre of privatisation I don't know if you didn't notice, but the Conservatives have been in power since 2010, and until recently have had majorities. They could have introduced the charge you suggest, but haven't. This isn't a left/right issue. Please don't turn this into some left v right brawl.
- multjoy 8y ago>weaponised by the left Flying your flag there, champ.
- flossball 8y agoIt is stupid to blame Obama or Trump even for the current state of Obamacare. The parties involved right now are resulting in a much worse than medicare solution as it is similar to the three wolves one sheep version of democracy (which is the whole premise of libertarian concerns about democratic socialism). It is an attempt to obfuscate the otherwise obvious corruption and theft that is healthcare. Here the wolves are the AMA(doctors), insurers, pharma, and the politicians claiming to want to solve healthcare. The AMA and insurers have insane billing policies based on assuming inept doctors and corrupt patients. Most insurance today is just passing on the discounted (actual) price on to the insured co-pay or deductible. They cover very little normal costs of medicine nor do they provide any actual services for their premium. The main reason we don't have universal medicaid/medicare is similar to why the IRS doesn't do electronic filing themselves. Billions of dollars of middleman and tens of thousands of otherwise worthless jobs are on the line. We need a private/public system. It will initially look costly and it will suck (differently) for doctors and hospitals. However, in five to ten years the costs will stabilize and insurance and other services will be more honest as they will have real competition. Also, he should try to just fly back to the UK for non-emergency issues. Most foreign friends I have just keep insurance in their home countries as it costs usually 100-200 a year. A $1k flight back to see your family is cheaper than any surgery in the US.
- rayiner 8y agoI favor nationalized health insurance, but I worry American idealism would screw up implementation. The British are aggressive about rationing care. They aim to pay around 20-30,000 pounds per quality adjusted life year: https://www.bbc.com/news/health-28983924 https://www.bbc.com/news/health-28983924 There was an article on HN the other day that talked about how much debt a woman had incurred for her husband’s cancer treatment after she hit her insurer’s lifetime limit. But it turns out that in the UK, the expensive of that course of treatment compared to prospects would have been far above what NHS would have been willing to pay. If you have socialized care, you need to ration it, ideally focusing on maximizing QALYs for younger individuals with years of productive life left. I fear our political system in the US wouldn’t let us do that. EDIT: Here is the article: https://www.npr.org/sections/health-shots/2017/08/10/542589232/widowed-early-a-cancer-doctor-writes-about-the-harm-of-medical-debt https://www.npr.org/sections/health-shots/2017/08/10/5425892.... The insurance policy's lifetime limit was $500,000, or about 400,000 pounds. Even if we assume British healthcare costs half as much, under NHS's policies, the expected benefit of treatment would have to be 6 QALYs for NHS to have paid even as much as the U.S. insurance company paid. But it was a rare, aggressive cancer and the lady's husband died in less than two.
- tptacek 8y agoAnother problem is that for a variety of reasons, some of them structural, Americans consume significantly more medical services (diagnostics, procedures, visits) than Europeans do, without improved outcomes. There are fundamental inefficiencies in our system --- for instance, incentives have led to the creation of lots of small hospitals that see poor utilization --- that lead to this, and will be baked into any single-payer system we devise. This concerns me enough that I oppose nationalized health insurance. I think the status quo ante of the ACA was intolerable, and that the system needs dramatic improvements (high on my list would be price transparency regulations), but that the core problem we have in the US is not that health care isn't universal, but that we pay too much for it, and baking that quietly into our taxes is an alarming proposition.
- bb88 8y ago> (high on my list would be price transparency regulations) Why didn't the republicans do that over the past two years in the US? It seems like it would be great for the free market, and also encourage competition. Or do they believe in large company profit "protectionism"?
- Simulacra 8y agoI think universal single payer healthcare would be wonderful, but the issue of healthcare is politicized enough as it is. With a private company I can fight. I might lose, I might have to go elsewhere, but I have a choice. With the government I have no choice, and I have no recourse. When has that ever led to better outcomes?
- tbunt 8y ago> When has that ever led to better outcomes? Every day in every other developed nation in the world
- multjoy 8y agoYou can still pay for private healthcare if you want to skip waiting lists. In terms of choice, the NHS allows you to shop around for your specialist, and they're also the same doctors you'll see privately.
- DanBC 8y agoFor England: You can usually chose your doctors in the NHS. Here's the patient facing info: https://www.nhs.uk/using-the-nhs/nhs-services/hospitals/nhs-e-referral-service/ https://www.nhs.uk/using-the-nhs/nhs-services/hospitals/nhs-... Here's the bureaucratic document for commissioners of general practice (primary care doctors) (sorry you need to ctrlF for "choice".) This document also tells you where in law patient choice is detailed: https://www.england.nhs.uk/publication/primary-medical-care-policy-and-guidance-manual-pgm/ https://www.england.nhs.uk/publication/primary-medical-care-... > and I have no recourse. If the treatment is negligent and causes harm you can sue. There are cultural and legal differences, but suing the NHS is possible.
- jjeaff 8y agoThis is more of a sidenote, but after having way, way more experience in healthcare system over the past few years, I thought I would share my experience. The Affordable Care act made some big changes in health insurance. Unfortunately, making it "affordable" was not one of the things. But, if you do have money, you have the option now to have absolutely great health care. For about $1300 a month, you can cover a family of 3 in california. That amount is less if you qualify for subsidies. And that is not a budget option. This is a premium silver PPO from a large provider. All your normal medical needs are covered with copays. $40 for doctor visits. $80 for specialists and $350 for an E.R. visit. Your max out of pocket is $7500 per person or $15k total. So $30,600 a year is your absolute worst case maximum that you would have to pay if everyone in the family had serious medical issues in one year. Now, I agree, that's expensive. But we are on a plan like this and it is very good coverage (and it's likely not much more than companies pay for their employee plans). While sometimes navigating everything has been a beurocratic nightmare, it has never denied us coverage and almost every doctor we have come across is in network. It also pays about $600 a month (after $80 in copays) for our regular, ongoing prescriptions. It also covered the $600 a month eyedrop Rx I needed for about a year for dry eyes. The quality of care is top notch and we have never had to choose anything less than the absolute best when it comes to treatment. Anyway, my point is, American quality of care is some of the best in the world. If not the best... If you have money.
- zaarn 8y agoIn 2017, the median income of households in the US was 61'000 $. Meaning half the population has to pay half their income (maximum) into this healthcare plan. And 61'000$ income isn't being dirt poor either. In some economic models this is the lower middle class in terms of income. For people who only graduate high school and no college, this is 80% of their income. If they go to some college about 70% (14'000$ left of the income). This group makes up about 30 to 40% of the US population. In my own country, I would pay 350€ a month for a 60'000€ yearly income. The equivalent of an ER visit copay for you and it covers all my medical needs for a month.
- tptacek 8y agoThe key idea in the ACA that addresses this problem is subsidies: you get tax credits and (ostensibly) CSRs to offset the cost of health insurance if you're within some multiple of the Federal poverty line. Unfortunately, this is exactly the part of the system Congressional opponents of the ACA have taken direct aim at.
- tptacek 8y agoThis is a weird article that starts out with a customer service problem and ends up extrapolating an entire new health system out of it. The problem this person has is that they signed up for an HMO instead of a PPO, which is what most people in the US have. HMOs subject you to additional red tape in exchange for lower premiums; PPOs allow you to walk in to a specialist (though most Americans will see their GP first anyways). Whether you get an HMO or a PPO, it is far easier to see a specialist in the US than it is in the UK. In fact, most health care economists would argue that it is in fact too easy to get specialist care in the US, and we as a result overconsume services without obtaining better outcomes.