8 ms·

Even in countries with universal healthcare, people regularly can't afford treatment because expensive treatments aren't included.

spicybright 4y ago
What kind of treatments? How regularly?
- sgjohnson 4y ago
  All kinds, very often. They aren't outright denied, just backlogged for years. Need a hip replacement in the UK, and you're a smoker? Good luck trying to get it within a year. Because it turns out that healthcare is a service, and just making it "free" doesn't magically make it immune to scarcity.
  - amcoastal 4y ago
- ulzeraj 4y ago
  While in Brazil a person very close to me suffered a very destructive paranoid psychotic crisis. We've tried help from the public healthcare but their earliest waiting time was 1 month. I've slept for days at the door because she was convinced there were Russian cameras and radioactive emitters planted at our house and wanted to run away. That person stopped to eat and bath and wasn't thinking rationally. We couldn't wait a month. It was the worst time of my life. I had to pay a private psychiatrist to treat her. A very good one - we plotted together a plan to partake on her fantasy and administer a risperidone injection which was super effective. She is fine now and visits said doctor once in a year only. Sure you can go to a general clinic but the doctor will forward you to the proper specialist queue which might take months or even years.
  - FooBarWidget 4y ago
    In the Netherlands I once sought an eye treatment for my wife. The local hospital only had a waiting time of 2 months. So I called my insurance company who then found another clinic ~45 minutes away by public transport in some small village, which had a waiting time of 2 days. Everything (besides the bus ride) was still covered by the public insurance system.
- Closi 4y ago
  > What kind of treatments? How regularly? In the UK there is a department called NICE which uses health economics to understand how to best utilize the funding for the national health service to best improve health outcomes (generally measured by increasing QALY or Quality-Adjusted Life Years, but there are multiple measures in reality). This means that if there is a £500k treatment that could save the lives of a 70 year old, but there is a £1m treatment that could save the life of a 20 year old, and there is only budget for one, it would go to the £1m treatment because it has the biggest impact on QALY. So the treatments that don't get approval are usually those that have a poor return. Note that it's usually the whole treatment that gets approved / denied rather than particular patient (or it is approved for a particular subset of people). The other issue is capacity - so for instance, if there is only a limited capacity to perform MRI scans, then triage is required.
  - diordiderot 4y ago
    As an American, that's just disgusting. The government shouldn't decide if your parents die. The free market should decide. If you created enough shareholder value then you'll have enough to pay for their treatment like God intended.
    - spicybright 4y ago
      I'm hoping this is sarcasm.
      - diordiderot 4y ago
        It is indeed
    - LadyCailin 4y ago
      I know this is tongue in cheek, but all these countries also have private health options, so it’s not really a genuine argument against it anyways. If you were too poor to afford good coverage in the US, you wouldn’t be able to afford the private coverage in other countries either, but for rich people, private insurance is easily obtainable, for relatively cheap too, since they compete with “free”.
- krzyk 4y ago
  Universal healthcare is well overrated in the US. From a country that had it, it usually means: ugly hospitals, sad faces, long queues for treatments (I mean wait time for "free" treatment can be well over a year). There is no free lunch. On the other hand, I usually can get my kid to doctor same day, while using private healthcare provider (paid by my employer) it is almost impossible, 2-3 days wait. On yet another hand, to get registered to my local doctor I need to use phone and start calling when they open up (8am) - sometimes I can't get to registration. The private healthcare has a normal website where I can look up registrations - so it is less time consuming (and automateable to some degree). Private hospitals are rare here, and most of real work is done by public ones. Because the hospitals don't have enough money, they e.g. don't provide separate meals for people that need them (e.g. you had a digestive tract operation), so it is up for the family. Good thing recently is that if your kid needs to go to hospital, there might beds for parent to stay with the kid (I'm not sure if that is that common in all hospitals)
  - Deritiod 4y ago
    Good for you that your employer pays for it. I think universal healthcare is a social must and we need to fix it instead of talking it down.
  - reacharavindh 4y ago
    I think the right solution is the middle - private primary care and public chronic & advanced care. India does this but loses out on effectiveness because of capacity problems and simply the huge scale it needs to work at. Primary care is provided by private doctors and hospitals, so it is almost like a business. Doctors offices have websites, and get reviews from general public. You choose where you go to. All health insurances cover almost all of them. The doctor's offices are "competing" to provide a good service - being clean, solving problems correctly, not charging too much etc. The government spends what ever money it allocates for healthcare on Public hospitals that focus on expensive medical equipment(labs, diagnostic machines etc), and treating chronically ill patients. In an ideal world, you go to private doctors to figure out what is wrong, and then use the public facility if you can wait, and get the surgery/medicine/treatment for free. Often times, the private doctor refers you to a public doctor with a specific note that says this person needs this particular surgery using this particular medical device. However, this systems leaves a big hole in catering to the poor who cannot afford to go to a private doctor for primary care owing to costs. No system is perfect. I think this model has the most potential for better healthcare.
Deritiod 4y ago
In Germany my aunt gets expensive cancer treatment without extra pay. Any specific you think about?
- trompetenaccoun 4y ago
  Meanwhile people have to pay thousands of Euros to maintain their teeth if they need root canals or prosthetic dentures and such. Maybe you're just not old enough to know? Btw the "free" tier system is a joke in Germany. Waiting months for an appointment is the norm for anything more serious than a cough, unless you're privately insured which all the rich people and interestingly civil servants are. Tells you a lot when those working for the government don't use the public insurance themselves. People may be surprised to hear that someone with a medium income (by EU standards) can get better healthcare in Africa than in a place like Germany. Or at least for now, the ANC is working hard on destroying the private healthcare sector in SA.
  - Deritiod 4y ago
    I have to visit a few low key specialists: Neuro etc. And while waiting is true sometimes calling around helps. The teeth problem I'm aware of and find it quite unfair indeed. Nonetheless cancer doesn't make you poor in comparison to the USA. Still something which has to be fixed in Germany. But you still have the option to go private if you want.
    - trompetenaccoun 4y ago
      Do you have personal experience with fully private heathcare systems in other countries? I ask because reacting to criticism of your system with whataboutism concerning the US is not rational, that's a fallacious argument. As for the US I'm not an expert but my gut feeling is that people compare apples to oranges just like with most of these international comparisons. Cost of living is much higher in the US first of all. Things are simply more expensive in general and American salaries are a lot higher for anyone moderately educated. No one I know who's moved to the US has any problems with insurance, they can simply afford it. Now if you compare a government sponsored system in Germany with private insurance in the US, of course the former will be cheaper (be careful though, some of the real cost is hidden). But like mentioned you also get completely different treatment. Cost in the US could likely be cut by making the service worse. If you want to pay even less, have you looked at the Chinese system? Germans are massively overpaying in comparison to the PRC and it's ruining the middle class. /s Gotta sinophy your healthcare with 10 Yuan TCM pills for cancer treatments. Because cheap is apparently the goal when it comes to healthcare. Btw, here's the kicker if you want to discuss price: With the top notch treatment you get in private South African clinics, people still pay less for their private insurance over there than the government mandated low quality one in Germany. I know because I've used both.
FrenchDevRemote 4y ago
My grandma got a million dollar cancer treatment over a few years, multiple surgeries, chemos, meds, dozens of appointments. We paid for TV and parking(and we could have gotten free taxis to the hospital/doctors appointments but she didn't want to ride with a stranger...) Are you talking about 3rd world countries?
- sacrosancty 4y ago
  I'm thinking of New Zealand. We frequently hear of people who can't get some expensive treatment because it's not funded by the government. Can you say for sure that every medical treatment available in the US is funded by your government? Will they even fly patients to the US for specialist care if it's not available locally?
NoGravitas 4y ago
Like in the UK, teeth are considered luxury bones.
- GaylordTuring 4y ago
  I've never understood this. Not attending to an infected tooth can, for example, spread to other parts of the body, ending up with you having a heart attack or something.

spicybright 4y ago

What kind of treatments? How regularly?

sgjohnson 4y ago
All kinds, very often. They aren't outright denied, just backlogged for years. Need a hip replacement in the UK, and you're a smoker? Good luck trying to get it within a year. Because it turns out that healthcare is a service, and just making it "free" doesn't magically make it immune to scarcity.
- amcoastal 4y ago
ulzeraj 4y ago
While in Brazil a person very close to me suffered a very destructive paranoid psychotic crisis. We've tried help from the public healthcare but their earliest waiting time was 1 month. I've slept for days at the door because she was convinced there were Russian cameras and radioactive emitters planted at our house and wanted to run away. That person stopped to eat and bath and wasn't thinking rationally. We couldn't wait a month. It was the worst time of my life. I had to pay a private psychiatrist to treat her. A very good one - we plotted together a plan to partake on her fantasy and administer a risperidone injection which was super effective. She is fine now and visits said doctor once in a year only. Sure you can go to a general clinic but the doctor will forward you to the proper specialist queue which might take months or even years.
- FooBarWidget 4y ago
  In the Netherlands I once sought an eye treatment for my wife. The local hospital only had a waiting time of 2 months. So I called my insurance company who then found another clinic ~45 minutes away by public transport in some small village, which had a waiting time of 2 days. Everything (besides the bus ride) was still covered by the public insurance system.
Closi 4y ago
> What kind of treatments? How regularly? In the UK there is a department called NICE which uses health economics to understand how to best utilize the funding for the national health service to best improve health outcomes (generally measured by increasing QALY or Quality-Adjusted Life Years, but there are multiple measures in reality). This means that if there is a £500k treatment that could save the lives of a 70 year old, but there is a £1m treatment that could save the life of a 20 year old, and there is only budget for one, it would go to the £1m treatment because it has the biggest impact on QALY. So the treatments that don't get approval are usually those that have a poor return. Note that it's usually the whole treatment that gets approved / denied rather than particular patient (or it is approved for a particular subset of people). The other issue is capacity - so for instance, if there is only a limited capacity to perform MRI scans, then triage is required.
- diordiderot 4y ago
  As an American, that's just disgusting. The government shouldn't decide if your parents die. The free market should decide. If you created enough shareholder value then you'll have enough to pay for their treatment like God intended.
  - spicybright 4y ago
    I'm hoping this is sarcasm.
    - diordiderot 4y ago
      It is indeed
  - LadyCailin 4y ago
    I know this is tongue in cheek, but all these countries also have private health options, so it’s not really a genuine argument against it anyways. If you were too poor to afford good coverage in the US, you wouldn’t be able to afford the private coverage in other countries either, but for rich people, private insurance is easily obtainable, for relatively cheap too, since they compete with “free”.
krzyk 4y ago
Universal healthcare is well overrated in the US. From a country that had it, it usually means: ugly hospitals, sad faces, long queues for treatments (I mean wait time for "free" treatment can be well over a year). There is no free lunch. On the other hand, I usually can get my kid to doctor same day, while using private healthcare provider (paid by my employer) it is almost impossible, 2-3 days wait. On yet another hand, to get registered to my local doctor I need to use phone and start calling when they open up (8am) - sometimes I can't get to registration. The private healthcare has a normal website where I can look up registrations - so it is less time consuming (and automateable to some degree). Private hospitals are rare here, and most of real work is done by public ones. Because the hospitals don't have enough money, they e.g. don't provide separate meals for people that need them (e.g. you had a digestive tract operation), so it is up for the family. Good thing recently is that if your kid needs to go to hospital, there might beds for parent to stay with the kid (I'm not sure if that is that common in all hospitals)
- Deritiod 4y ago
  Good for you that your employer pays for it. I think universal healthcare is a social must and we need to fix it instead of talking it down.
- reacharavindh 4y ago
  I think the right solution is the middle - private primary care and public chronic & advanced care. India does this but loses out on effectiveness because of capacity problems and simply the huge scale it needs to work at. Primary care is provided by private doctors and hospitals, so it is almost like a business. Doctors offices have websites, and get reviews from general public. You choose where you go to. All health insurances cover almost all of them. The doctor's offices are "competing" to provide a good service - being clean, solving problems correctly, not charging too much etc. The government spends what ever money it allocates for healthcare on Public hospitals that focus on expensive medical equipment(labs, diagnostic machines etc), and treating chronically ill patients. In an ideal world, you go to private doctors to figure out what is wrong, and then use the public facility if you can wait, and get the surgery/medicine/treatment for free. Often times, the private doctor refers you to a public doctor with a specific note that says this person needs this particular surgery using this particular medical device. However, this systems leaves a big hole in catering to the poor who cannot afford to go to a private doctor for primary care owing to costs. No system is perfect. I think this model has the most potential for better healthcare.

Deritiod 4y ago

In Germany my aunt gets expensive cancer treatment without extra pay. Any specific you think about?

trompetenaccoun 4y ago
Meanwhile people have to pay thousands of Euros to maintain their teeth if they need root canals or prosthetic dentures and such. Maybe you're just not old enough to know? Btw the "free" tier system is a joke in Germany. Waiting months for an appointment is the norm for anything more serious than a cough, unless you're privately insured which all the rich people and interestingly civil servants are. Tells you a lot when those working for the government don't use the public insurance themselves. People may be surprised to hear that someone with a medium income (by EU standards) can get better healthcare in Africa than in a place like Germany. Or at least for now, the ANC is working hard on destroying the private healthcare sector in SA.
- Deritiod 4y ago
  I have to visit a few low key specialists: Neuro etc. And while waiting is true sometimes calling around helps. The teeth problem I'm aware of and find it quite unfair indeed. Nonetheless cancer doesn't make you poor in comparison to the USA. Still something which has to be fixed in Germany. But you still have the option to go private if you want.
  - trompetenaccoun 4y ago
    Do you have personal experience with fully private heathcare systems in other countries? I ask because reacting to criticism of your system with whataboutism concerning the US is not rational, that's a fallacious argument. As for the US I'm not an expert but my gut feeling is that people compare apples to oranges just like with most of these international comparisons. Cost of living is much higher in the US first of all. Things are simply more expensive in general and American salaries are a lot higher for anyone moderately educated. No one I know who's moved to the US has any problems with insurance, they can simply afford it. Now if you compare a government sponsored system in Germany with private insurance in the US, of course the former will be cheaper (be careful though, some of the real cost is hidden). But like mentioned you also get completely different treatment. Cost in the US could likely be cut by making the service worse. If you want to pay even less, have you looked at the Chinese system? Germans are massively overpaying in comparison to the PRC and it's ruining the middle class. /s Gotta sinophy your healthcare with 10 Yuan TCM pills for cancer treatments. Because cheap is apparently the goal when it comes to healthcare. Btw, here's the kicker if you want to discuss price: With the top notch treatment you get in private South African clinics, people still pay less for their private insurance over there than the government mandated low quality one in Germany. I know because I've used both.

FrenchDevRemote 4y ago

My grandma got a million dollar cancer treatment over a few years, multiple surgeries, chemos, meds, dozens of appointments. We paid for TV and parking(and we could have gotten free taxis to the hospital/doctors appointments but she didn't want to ride with a stranger...) Are you talking about 3rd world countries?

sacrosancty 4y ago
I'm thinking of New Zealand. We frequently hear of people who can't get some expensive treatment because it's not funded by the government. Can you say for sure that every medical treatment available in the US is funded by your government? Will they even fly patients to the US for specialist care if it's not available locally?

NoGravitas 4y ago

Like in the UK, teeth are considered luxury bones.

GaylordTuring 4y ago
I've never understood this. Not attending to an infected tooth can, for example, spread to other parts of the body, ending up with you having a heart attack or something.