> 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

> 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.