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> That's not really different from care outside of insurance coverage that exists today, e.g., elective plastic surgery. It is different, because in most count

> That's not really different from care outside of insurance coverage that exists today, e.g., elective plastic surgery. It is different, because in most countries where there is universal healthcare you can still cover that "private" care with a health insurance plan if you choose (e.g. BUPA or Nuffield in the UK) And then you can do the extra electives on top of that. So there are three tiers, rather than two. (In the UK there are a few situations where we effectively almost have only the US two tiers; opticians, dentistry, nutrition, physiotherapy all have much less NHS provision coverage, largely because the elective stuff is so easily upsold; professionals can leave the public sector for the private money. The worst being opticians; the idea that the market can provide that more cheaply has been proved wrong.)

sidlls 5y ago
It isn't different: you can get insurance for those things in the US or pay for them directly (no employer or government subsidy). That's exactly the same as what the GP suggests. Plenty of companies even provide tiered insurance for executives and their families. So whether insurance is all employer-provided, private, government provided, or a mix, in the US one is almost certain to be able to buy something above and beyond the basics out-of-pocket.
- unfocussed_mike 5y ago
  > It isn't different: you can get insurance for those things in the US or pay for them directly (no employer or government subsidy). That's exactly the same as what the GP suggests. I'm not saying that none of those things are impossible in the USA -- obviously, surely!? Nor is your GP. You replied to: > You know even if there is universal healthcare, you can pay private doctors yourself if you would like. By saying: > That's not really different from care outside of insurance coverage that exists today, e.g., elective plastic surgery. But it is different. Because it happens on a third rung, not the second. The difference is that you do not need private health insurance for the provision of basic things. In the UK (and in countries with even better healthcare) you have three tiers providing substantially the same services. (Even in the case of elective plastic surgery.) (And the second rung is more affordable as a result.) In the USA, there is no bottom rung for the majority of healthcare; if there was, there would not be an opioid epidemic. Medicare and Medicaid do not provide a universal bottom rung.

sidlls 5y ago

It isn't different: you can get insurance for those things in the US or pay for them directly (no employer or government subsidy). That's exactly the same as what the GP suggests. Plenty of companies even provide tiered insurance for executives and their families. So whether insurance is all employer-provided, private, government provided, or a mix, in the US one is almost certain to be able to buy something above and beyond the basics out-of-pocket.

unfocussed_mike 5y ago
> It isn't different: you can get insurance for those things in the US or pay for them directly (no employer or government subsidy). That's exactly the same as what the GP suggests. I'm not saying that none of those things are impossible in the USA -- obviously, surely!? Nor is your GP. You replied to: > You know even if there is universal healthcare, you can pay private doctors yourself if you would like. By saying: > That's not really different from care outside of insurance coverage that exists today, e.g., elective plastic surgery. But it is different. Because it happens on a third rung, not the second. The difference is that you do not need private health insurance for the provision of basic things. In the UK (and in countries with even better healthcare) you have three tiers providing substantially the same services. (Even in the case of elective plastic surgery.) (And the second rung is more affordable as a result.) In the USA, there is no bottom rung for the majority of healthcare; if there was, there would not be an opioid epidemic. Medicare and Medicaid do not provide a universal bottom rung.