4 ms·

> Scandinavia, UK. Public healthcare doesn't need to be bad Here's an article from 2018 (Pre-COVID) claiming the NHS has 4.3 Million people in it's operation b

by Alupis 6y ago

> Scandinavia, UK. Public healthcare doesn't need to be bad Here's an article from 2018 (Pre-COVID) claiming the NHS has 4.3 Million people in it's operation backlog with over half waiting for more than one year[1]. That sounds outrageous, and a massive step backwards from what most in the US have today (even with low tier health insurance plans). I do not know why this is the reality in nations with Universal Healthcare, but the UK is not alone. I constantly hear anecdotes about people waiting 6+ months for minor operations in the UK (corroborated by this article and others), and how the wealthy/elites of Canada fly into the US for treatments. Why is it that Universal Healthcare seems to universally turn into massive backlogs and poorer service? I'm also not convinced we need some new "Universal" system in the US. Everyone in the US already does have access to healthcare (Medicare/Medicaid/Private). The only difference is above a certain income level you're expected to shop for your own. I much rather prefer that instead of it coming out of my paycheck in another mandatory tax without choice of provider. [1] https://www.theguardian.com/society/2018/jul/13/nhs-operation-waiting-lists-reach-10-year-high-at-43m-patients https://www.theguardian.com/society/2018/jul/13/nhs-operatio...

ekimekim 6y ago
> I constantly hear anecdotes about people waiting 6+ months for minor operations in the UK Emphasis on the "minor operations". Things are prioritised by need and urgency, so naturally you end up with a long tail of non-urgent, minor operations. > how the wealthy/elites of Canada fly into the US for treatments There's a reasonable argument here that the US system has advantages for the wealthy. Generally however this is seen as undesirable. > Everyone in the US already does have access to healthcare There's several issues with this statement. The first is that 32.8 million people (12% of the population) were uninsured in 2019[1]. The second is that even if you have health insurance on paper, it's generally prohibitively expensive to use, only kicking in once a deductible is reached that will bankrupt you regardless (40% of Americans can't cover a surprise $400 expense [2] and these deductibles can run into several $1000). The reality for many is that if they're sick, they tough it out because going to a doctor may cause them financial ruin. > above a certain income level you're expected to shop for your own. I much rather prefer that instead of it coming out of my paycheck in another mandatory tax without choice of provider. I'm not sure what your experiences have been, but the only context where I've been able to "shop for my own" provider was when an employer happened to offer one of two providers in their available plans, which wasn't always. Functionally I had almost no choice in my health insurance coverage short of specifically finding a job that offered what I wanted, which given my priveliged position as a software engineer would be possible but would be laughable for most professions. Functionally, my health insurance was a mandatory tax without a choice of provider, it just wasn't a tax paid to the government. I should also note that I now live in Australia, where we have a universal public system where I am still able to choose my doctor and other care providers. In fact, I feel that I have far more choice here than I ever did while living in the US. [1] https://www.cdc.gov/nchs/fastats/health-insurance.htm https://www.cdc.gov/nchs/fastats/health-insurance.htm [2] https://www.cbsnews.com/news/nearly-40-of-americans-cant-cover-a-surprise-400-expense/ https://www.cbsnews.com/news/nearly-40-of-americans-cant-cov...
- ajsnigrutin 6y ago
  > Emphasis on the "minor operations". Things are prioritised by need and urgency, so naturally you end up with a long tail of non-urgent, minor operations. How long do you wait for eg. a tooth filling? Or if you notice a dark spot on the skin, to get it checked up by a dermatologist? So the minor things, that can get messy real fast if you dont deal with them fast?
  - noahtallen 6y ago
    Obviously it would be better to have minor needs met as well. But the point is that when you say “I now have to wait too long for minor things, therefore healthcare for all is bad”, you are implying that you would prefer that you got treatment for a minor condition than someone else got treatment for a major condition. If the main argument against nationalized healthcare is that so many more people can get healthcare that your minor condition gets bumped down in priority... well yeah, the point is that many more people can get treatment for major problems!
    - ajsnigrutin 6y ago
      The problem with minor conditions is, that you still have to pay for them. You pay for dental, but don't get the service. I pay insurance for my car (it's mandatory here - the mandatory part only covers damages on other peoples cars when you're the guilty one). I also pay (extra) for windshield repair, and when a small rock on the highway breaks my windshield, i go to one of the preaproved service centers (or do the paperwork to do it somewhere else), get the glass replaced, and go home after ~30 minutes. I also pay for dental in my mandatory government insurance (no way to opt-out), and when i see a dark spot on my tooth, i call the government dentist, and they tell me to come in six months, at 11.30am on a tuesday. I could wait that long, but by that time, my tooth could get worse, and a simple drill-drill-fill-fill might end up as an extraction or worse. So basically, I either have to pay for a private dentist to do it (full price, not just the difference in price compared to a government dentist), or wait six months and risk it. Either way, i pay for dental, that I don't get. Same for eg. dermatologists... find a spreding dark spot on the skin.. wait six months+ (probably more now, due to the plague), or pay 70eur and get it checked out the next day. Wait six months, and a simple burn-off could be cancer.
ajsnigrutin 6y ago
I live in a country with tax-paid medical (and dental, vision, everything necessary, with some minor exclusions) - they basically take 12.92% of your pretax earnigs for medical + ~30eur extra. I pay a lot of money for those services, but i get really shitty service for some of those - eg. dental. I see a dark caries spot on my tooth, and basically if I'm good enough to eat (not too much pain), my waiting time is ~6months+ (pre-corona time, probably a lot longer now). I can go to a private dentist and get a filling, but I have to pay for the service. There is no way to either opt-out of eg. dental, or to get a part of the service paid by our national insurance (eg same price as the insurer would pay a government assigned dentist, you just pay a difference). We have a bunch of papers with a bunch of words promising <30 day wait times, but in practice, the wait time are huge. Yes, if you cut your arm off, they will fix you, but the dental (and many other branches) are pretty bad.
- redler 6y ago
  Dental insurance of any kind is pretty rare in the US. Large employers may offer this to their employees, but even then it’s a situation of very high coinsurance for any procedure of substance, and covered procedures are limited. So however bad your national dental system may be, it at least provides some baseline option for everyone — including the poor, the homeless, the jobless, and employees of small businesses alike.
  - selimthegrim 6y ago
    Let me be more frank, it is a scam and nothing more than prepayment for cleanings and X-rays in the vast majority of cases. The only time I have not paid with cash is when I was on Medicaid.
- ClumsyPilot 6y ago
  My understanding is that post 2008, Dental and eye care in UK has been cut, and going private is the norm. Its is bot representative how NHS treats injuries, failing organs, etc. That being said my experience with Czech system of mandatory insurance has been better.
- 6y ago
Broken_Hippo 6y ago
A word about waiting for minor surgeries: As another has said, these are minor. It's OK to wait. It isn't like you are going to be out of a job or out of much money: A safety net helps with it. So you are sitting at home or at work on light duty while waiting, depending.
- Alupis 6y ago
  As a counterpoint, I have far from "premium" insurance, and can see my doctor for any reason nearly always within a week, and have had multiple "outpatient" surgeries booked/executed within 3 weeks. I'm not sure arguing minor surgeries can wait for 6 months-1 year+ is a good thing. If the system cannot handle both minor and major operations within a reasonable amount of time, then something is very wrong.
- kelnos 6y ago
  "Minor" could be that you have a dark spot on your skin that you'd like to get checked out. If it's cancer, waiting 6 months could mean death for you. Sure, minor could also be getting some help for some mild dermatitis. The problem is when those things are lumped together.
  - Broken_Hippo 6y ago
    ... But it isn't, though. Minor, in general, is something that plagues you, yet waiting for surgery isn't going to be an issue. Foot surgery, for example, might fall under this. Waiting won't take complications. For skin cancer checks, though, you can go to your family doctor. (I have to get skin cancer checks due to a medicine I'm on). If they find anything worrysome, sometimes they can remove it in-office or get you to the correct person in a timely manner. You know, because doctors know that some skin cancers spread quickly (others aren't that serious). Minor actually means minor. It doesn't mean waiting to see if you die.
    - Alupis 6y ago
      Why are you arguing waiting for a year or longer for any procedure is ok? That doesn't sound ok to me... and objectively is a massive step backwards from what we have in the US today. In the US today, no matter if you have zero income, little income, or high income - you can see a doctor promptly and have any procedure performed within a month of less.

by Alupis 6y ago

ekimekim 6y ago

> I constantly hear anecdotes about people waiting 6+ months for minor operations in the UK Emphasis on the "minor operations". Things are prioritised by need and urgency, so naturally you end up with a long tail of non-urgent, minor operations. > how the wealthy/elites of Canada fly into the US for treatments There's a reasonable argument here that the US system has advantages for the wealthy. Generally however this is seen as undesirable. > Everyone in the US already does have access to healthcare There's several issues with this statement. The first is that 32.8 million people (12% of the population) were uninsured in 2019[1]. The second is that even if you have health insurance on paper, it's generally prohibitively expensive to use, only kicking in once a deductible is reached that will bankrupt you regardless (40% of Americans can't cover a surprise $400 expense [2] and these deductibles can run into several $1000). The reality for many is that if they're sick, they tough it out because going to a doctor may cause them financial ruin. > above a certain income level you're expected to shop for your own. I much rather prefer that instead of it coming out of my paycheck in another mandatory tax without choice of provider. I'm not sure what your experiences have been, but the only context where I've been able to "shop for my own" provider was when an employer happened to offer one of two providers in their available plans, which wasn't always. Functionally I had almost no choice in my health insurance coverage short of specifically finding a job that offered what I wanted, which given my priveliged position as a software engineer would be possible but would be laughable for most professions. Functionally, my health insurance was a mandatory tax without a choice of provider, it just wasn't a tax paid to the government. I should also note that I now live in Australia, where we have a universal public system where I am still able to choose my doctor and other care providers. In fact, I feel that I have far more choice here than I ever did while living in the US. [1] https://www.cdc.gov/nchs/fastats/health-insurance.htm https://www.cdc.gov/nchs/fastats/health-insurance.htm [2] https://www.cbsnews.com/news/nearly-40-of-americans-cant-cover-a-surprise-400-expense/ https://www.cbsnews.com/news/nearly-40-of-americans-cant-cov...

ajsnigrutin 6y ago
> Emphasis on the "minor operations". Things are prioritised by need and urgency, so naturally you end up with a long tail of non-urgent, minor operations. How long do you wait for eg. a tooth filling? Or if you notice a dark spot on the skin, to get it checked up by a dermatologist? So the minor things, that can get messy real fast if you dont deal with them fast?
- noahtallen 6y ago
  Obviously it would be better to have minor needs met as well. But the point is that when you say “I now have to wait too long for minor things, therefore healthcare for all is bad”, you are implying that you would prefer that you got treatment for a minor condition than someone else got treatment for a major condition. If the main argument against nationalized healthcare is that so many more people can get healthcare that your minor condition gets bumped down in priority... well yeah, the point is that many more people can get treatment for major problems!
  - ajsnigrutin 6y ago
    The problem with minor conditions is, that you still have to pay for them. You pay for dental, but don't get the service. I pay insurance for my car (it's mandatory here - the mandatory part only covers damages on other peoples cars when you're the guilty one). I also pay (extra) for windshield repair, and when a small rock on the highway breaks my windshield, i go to one of the preaproved service centers (or do the paperwork to do it somewhere else), get the glass replaced, and go home after ~30 minutes. I also pay for dental in my mandatory government insurance (no way to opt-out), and when i see a dark spot on my tooth, i call the government dentist, and they tell me to come in six months, at 11.30am on a tuesday. I could wait that long, but by that time, my tooth could get worse, and a simple drill-drill-fill-fill might end up as an extraction or worse. So basically, I either have to pay for a private dentist to do it (full price, not just the difference in price compared to a government dentist), or wait six months and risk it. Either way, i pay for dental, that I don't get. Same for eg. dermatologists... find a spreding dark spot on the skin.. wait six months+ (probably more now, due to the plague), or pay 70eur and get it checked out the next day. Wait six months, and a simple burn-off could be cancer.

ajsnigrutin 6y ago

I live in a country with tax-paid medical (and dental, vision, everything necessary, with some minor exclusions) - they basically take 12.92% of your pretax earnigs for medical + ~30eur extra. I pay a lot of money for those services, but i get really shitty service for some of those - eg. dental. I see a dark caries spot on my tooth, and basically if I'm good enough to eat (not too much pain), my waiting time is ~6months+ (pre-corona time, probably a lot longer now). I can go to a private dentist and get a filling, but I have to pay for the service. There is no way to either opt-out of eg. dental, or to get a part of the service paid by our national insurance (eg same price as the insurer would pay a government assigned dentist, you just pay a difference). We have a bunch of papers with a bunch of words promising <30 day wait times, but in practice, the wait time are huge. Yes, if you cut your arm off, they will fix you, but the dental (and many other branches) are pretty bad.

redler 6y ago
Dental insurance of any kind is pretty rare in the US. Large employers may offer this to their employees, but even then it’s a situation of very high coinsurance for any procedure of substance, and covered procedures are limited. So however bad your national dental system may be, it at least provides some baseline option for everyone — including the poor, the homeless, the jobless, and employees of small businesses alike.
- selimthegrim 6y ago
  Let me be more frank, it is a scam and nothing more than prepayment for cleanings and X-rays in the vast majority of cases. The only time I have not paid with cash is when I was on Medicaid.
ClumsyPilot 6y ago
My understanding is that post 2008, Dental and eye care in UK has been cut, and going private is the norm. Its is bot representative how NHS treats injuries, failing organs, etc. That being said my experience with Czech system of mandatory insurance has been better.
6y ago

Broken_Hippo 6y ago

A word about waiting for minor surgeries: As another has said, these are minor. It's OK to wait. It isn't like you are going to be out of a job or out of much money: A safety net helps with it. So you are sitting at home or at work on light duty while waiting, depending.

Alupis 6y ago
As a counterpoint, I have far from "premium" insurance, and can see my doctor for any reason nearly always within a week, and have had multiple "outpatient" surgeries booked/executed within 3 weeks. I'm not sure arguing minor surgeries can wait for 6 months-1 year+ is a good thing. If the system cannot handle both minor and major operations within a reasonable amount of time, then something is very wrong.
kelnos 6y ago
"Minor" could be that you have a dark spot on your skin that you'd like to get checked out. If it's cancer, waiting 6 months could mean death for you. Sure, minor could also be getting some help for some mild dermatitis. The problem is when those things are lumped together.
- Broken_Hippo 6y ago
  ... But it isn't, though. Minor, in general, is something that plagues you, yet waiting for surgery isn't going to be an issue. Foot surgery, for example, might fall under this. Waiting won't take complications. For skin cancer checks, though, you can go to your family doctor. (I have to get skin cancer checks due to a medicine I'm on). If they find anything worrysome, sometimes they can remove it in-office or get you to the correct person in a timely manner. You know, because doctors know that some skin cancers spread quickly (others aren't that serious). Minor actually means minor. It doesn't mean waiting to see if you die.
  - Alupis 6y ago
    Why are you arguing waiting for a year or longer for any procedure is ok? That doesn't sound ok to me... and objectively is a massive step backwards from what we have in the US today. In the US today, no matter if you have zero income, little income, or high income - you can see a doctor promptly and have any procedure performed within a month of less.