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In 2018, age 31 I emigrated from the UK to the USA. I'd spent my entire life under the NHS and taken it for granted. In Jan 21 my first child arrived, 8 weeks

In 2018, age 31 I emigrated from the UK to the USA. I'd spent my entire life under the NHS and taken it for granted. In Jan 21 my first child arrived, 8 weeks early. This led to a lengthy 49 day NICU stay spread across two hospitals. Ask me to put a price on the work those doctors did to save my families lives (8hrs in the OR and both nearly died several times) and I'd give you all I could. In the end, the bills we've received so far exceed $350k. For the joy and relief that they both made it out the otherside healthy, it's worth every penny. And this speaks to perhaps why Americans rationalise exorbitant healthcare costs - because we're tied up in the emotion of it all. I'm lucky to work for a company who provide a high deductible plan which means my max annual out of pocket cost is $6k. On the face of it, $6k sounds like a lot - but the level of care we received far exceeded anything I've ever experienced in the NHS. Private rooms, appointments with my GP without doing the 8am phone purgatory British Drs surgeries require, world class NICU care at a world renowned facility (Chapel Hill). But we must also factor in that in the UK I pay for healthcare whether I use it or not via taxes. Indeed my take home in the UK was about 15-20% less than here after the government had taken their share. However here, I have the choice to contribute to my HSA up to $7,200 annually. In the end, I feel like I end up paying about the same despite the high sticker price. But the key difference is that in the UK model I look after my neighbour without any choice in the matter. Whereas here, it speaks to the underlying American pysche of individualism. My conclusion is that as an individual, with a good tech job, the system works - for me. But there is a nagging sense of guilt about how the experience I've had is not available to all. A bit like the suburban sprawl discussion I fear that this way of doing things is so deeply ingrained in so many people that they can't even imagine changing the system to work better for all for fear of what might come to pass. I'm very happy in the US on a day to day level, but it truly is a very weird place. Simultaneously a forward looking tech hub, leading the way in the world in many ways. And yet, it's an incredible backwards, self-preserving, individualistic society where dramatic social change is probably impossible.

rakmos 5y ago
Interesting perspective from someone who can legitimately compare the experience… I disagree with how it is characterized that Americans are rationalizing healthcare costs as a result of being wrapped up in emotions. While emotions certainly influenced most decisions being made at the time, the costs didn’t feel even remotely in the realm of something that can be controlled. The nature of emergencies (such as the birth of a child in this context), the fact that the costs aren’t even communicated until months go by, and the fact that healthcare coverage is tethered to your employer (resulting in a spectrum of experiences) are all aspects that I believe serve to maintain the status quo. For instance, with this pandemic… I was laid off, and while I was incredibly fortunate to be able to have multiple options for new employment, it caused unnecessary stress on ensuring health care coverage was continuous. It also played a role in how I ultimately chose which company I decided to work for despite the difficulty I have generally experienced in getting prospective employers to be forthcoming about their health insurance options. And some things just literally aren’t available such as whether your current doctors / specialists are considered “in-network” —- which really matters when in the context of a helping a premature child get “caught up” in life. Oh, and I don’t want to forget pointing out that changing employers also resets those deductibles and max out-of-pockets… In any case, thanks for sharing the perspective.

rakmos 5y ago

Interesting perspective from someone who can legitimately compare the experience… I disagree with how it is characterized that Americans are rationalizing healthcare costs as a result of being wrapped up in emotions. While emotions certainly influenced most decisions being made at the time, the costs didn’t feel even remotely in the realm of something that can be controlled. The nature of emergencies (such as the birth of a child in this context), the fact that the costs aren’t even communicated until months go by, and the fact that healthcare coverage is tethered to your employer (resulting in a spectrum of experiences) are all aspects that I believe serve to maintain the status quo. For instance, with this pandemic… I was laid off, and while I was incredibly fortunate to be able to have multiple options for new employment, it caused unnecessary stress on ensuring health care coverage was continuous. It also played a role in how I ultimately chose which company I decided to work for despite the difficulty I have generally experienced in getting prospective employers to be forthcoming about their health insurance options. And some things just literally aren’t available such as whether your current doctors / specialists are considered “in-network” —- which really matters when in the context of a helping a premature child get “caught up” in life. Oh, and I don’t want to forget pointing out that changing employers also resets those deductibles and max out-of-pockets… In any case, thanks for sharing the perspective.