4 ms·

That still sounds like a terrible deal to me. In the UK, I pay around 10% of my salary for national health care and get free care for any problem I might have (

by lucian1900 14y ago

That still sounds like a terrible deal to me. In the UK, I pay around 10% of my salary for national health care and get free care for any problem I might have (and so does my girlfriend, of course). Medication is always exactly £7 (or similar, it might have changed slightly recently) regardless of what it's for.

rdl 14y ago
So my coverage is maximum out of pocket per year $5-7k. It's very reasonable to assume HN readers make more than $50-70k/yr, so that's better than 10% of income for the same coverage. (I also think the top US care, if you are in the right place, is better than the top NHS care, but only for cancer or very rare diseases; for everything common they're comparable, but NHS covers everyone, so the average quality of care in the UK is better than the average in the US (rather, the 25th percentile care in the US is horrible, whereas the 25th percentile in the NHS is pretty comparable to any NHS care) (and, with an HSA, if I spend less than $3-5k/yr, I get to put that money pre-tax into a Roth IRA equivalent retirement account. I generally spend $200-1000/yr on medical care, so this tends to work out well for me; I don't think I've ever spent more than $1500 in a year. A lot of employers will just give you that money (and pay your premium) if you pick an HSA plan vs. a PPO plan, since it saves them approximately that much in premium) I'd be willing to pay some premium to cover everyone in the country vs. just myself, and to ensure I would have full coverage regardless of income. I don't think I'd want to pay a flat 10% on all of my income without limit for that, on top of taxes, though. (although, between medicare and 3.8% obamacare surcharge on income and capital gains, it's already nearly 10% up to 100k) In addition to HSA, what I'd really like is truly universal minimum standard of care -- not quite where the NHS is, but maybe 20% of that -- to cover preventive and "very cost effective" treatments. The problem is while the NHS is able to use QALYs in making decisions, I don't think the US government would be so rational; we'd end up over-covering dramatic diseases and under-covering less dramatic diseases. I don't believe a $500k intervention for an indigent old person with limited benefit should be paid by taxes, since that same $500k could cover childhood immunizations or preventive care for 5-10k people.
- SEMW 14y ago
  > my coverage is maximum out of pocket per year $5-7k. It's very reasonable to assume HN readers make more than $50-70k/yr, so that's better than 10% of income for the same coverage You're not comparing like with like. Comparing a figure (presumably) calculated by taking the GP's effective tax contributions and multiplying by the proportion of UK public spending that goes to health (~19%)[1], with a figure of the direct cost of insurance, is not an accurate way of comparing healthcare costs between countries. Most actual comparisons I can find between effective cost of healthcare between the US and UK, e.g. [2], seem to conclude that the US pays just over twice as much as the UK per capita (~$7k vs ~3k). (Also, it's not a "flat 10% on all your income", you misunderstand the GP. Our income tax system is progressive, just like the US's. The NHS is funded from general taxation (including NI payments)). [1] http://www.guardian.co.uk/news/datablog/2013/mar/20/budget-2013-tax-spending-visualised http://www.guardian.co.uk/news/datablog/2013/mar/20/budget-2... [2] http://www.forbes.com/sites/toddhixon/2012/03/01/why-are-u-s-health-care-costs-so-high/ http://www.forbes.com/sites/toddhixon/2012/03/01/why-are-u-s...
  - rdl 14y ago
    This is an interesting link from the Forbes article: http://www.nejm.org/doi/full/10.1056/NEJMp0907172#t=article http://www.nejm.org/doi/full/10.1056/NEJMp0907172#t=article Apparently the variation across regions in the US (controlled for all other factors like race, income, etc.) almost half as much as the variation between the US and UK, even though the entire US has the same financial structure.
- lucian1900 14y ago
  I make £32k/year, which is certainly less than $70k.
smcl 14y ago
> Medication is always exactly £7 Except in Scotland, Northern Ireland and Wales where since 2011 it is always exactly £0 http://www.bbc.co.uk/news/uk-12928485 http://www.bbc.co.uk/news/uk-12928485
- lucian1900 14y ago
  Yes, it can get even better of course :)
greedo 14y ago
And that leads to perverse incentives; If you have no incentive to help control costs, then it falls upon the NHS to control costs through delays and denial of service.
- epistasis 14y ago
  Empirically, this is false. Perverse incentives and perverse pricing pervades the US system. Whereas the UK system provides equivalent health at half the cost. Certainly your thought is a common one, the idea that individuals can be incentivized to cut costs was the motivation behind high-deductible plans. High-deductible plans were initially priced much lower than they are now, because the insurance companies thought that individuals on those plans would control their costs much better. However, that was not observed, and the insurance companies have raised rates faster than with other plan types, and HDHPs are now not nearly as good deal as they once were. (At least in my area.)
  - rdl 14y ago
    Didn't exactly that also happen with HMOs from 1973 onward (once they had a federal regulatory framework)? It seems like an underlying problem is that whenever a "cover somewhat less, save money, charge a huge amount less" plan is put in place, there are incentives in individual cases (through lobbying or whatever) to add coverage, killing the cost savings.

rdl 14y ago

So my coverage is maximum out of pocket per year $5-7k. It's very reasonable to assume HN readers make more than $50-70k/yr, so that's better than 10% of income for the same coverage. (I also think the top US care, if you are in the right place, is better than the top NHS care, but only for cancer or very rare diseases; for everything common they're comparable, but NHS covers everyone, so the average quality of care in the UK is better than the average in the US (rather, the 25th percentile care in the US is horrible, whereas the 25th percentile in the NHS is pretty comparable to any NHS care) (and, with an HSA, if I spend less than $3-5k/yr, I get to put that money pre-tax into a Roth IRA equivalent retirement account. I generally spend $200-1000/yr on medical care, so this tends to work out well for me; I don't think I've ever spent more than $1500 in a year. A lot of employers will just give you that money (and pay your premium) if you pick an HSA plan vs. a PPO plan, since it saves them approximately that much in premium) I'd be willing to pay some premium to cover everyone in the country vs. just myself, and to ensure I would have full coverage regardless of income. I don't think I'd want to pay a flat 10% on all of my income without limit for that, on top of taxes, though. (although, between medicare and 3.8% obamacare surcharge on income and capital gains, it's already nearly 10% up to 100k) In addition to HSA, what I'd really like is truly universal minimum standard of care -- not quite where the NHS is, but maybe 20% of that -- to cover preventive and "very cost effective" treatments. The problem is while the NHS is able to use QALYs in making decisions, I don't think the US government would be so rational; we'd end up over-covering dramatic diseases and under-covering less dramatic diseases. I don't believe a $500k intervention for an indigent old person with limited benefit should be paid by taxes, since that same $500k could cover childhood immunizations or preventive care for 5-10k people.

SEMW 14y ago
> my coverage is maximum out of pocket per year $5-7k. It's very reasonable to assume HN readers make more than $50-70k/yr, so that's better than 10% of income for the same coverage You're not comparing like with like. Comparing a figure (presumably) calculated by taking the GP's effective tax contributions and multiplying by the proportion of UK public spending that goes to health (~19%)[1], with a figure of the direct cost of insurance, is not an accurate way of comparing healthcare costs between countries. Most actual comparisons I can find between effective cost of healthcare between the US and UK, e.g. [2], seem to conclude that the US pays just over twice as much as the UK per capita (~$7k vs ~3k). (Also, it's not a "flat 10% on all your income", you misunderstand the GP. Our income tax system is progressive, just like the US's. The NHS is funded from general taxation (including NI payments)). [1] http://www.guardian.co.uk/news/datablog/2013/mar/20/budget-2013-tax-spending-visualised http://www.guardian.co.uk/news/datablog/2013/mar/20/budget-2... [2] http://www.forbes.com/sites/toddhixon/2012/03/01/why-are-u-s-health-care-costs-so-high/ http://www.forbes.com/sites/toddhixon/2012/03/01/why-are-u-s...
- rdl 14y ago
  This is an interesting link from the Forbes article: http://www.nejm.org/doi/full/10.1056/NEJMp0907172#t=article http://www.nejm.org/doi/full/10.1056/NEJMp0907172#t=article Apparently the variation across regions in the US (controlled for all other factors like race, income, etc.) almost half as much as the variation between the US and UK, even though the entire US has the same financial structure.
lucian1900 14y ago
I make £32k/year, which is certainly less than $70k.

smcl 14y ago

> Medication is always exactly £7 Except in Scotland, Northern Ireland and Wales where since 2011 it is always exactly £0 http://www.bbc.co.uk/news/uk-12928485 http://www.bbc.co.uk/news/uk-12928485

lucian1900 14y ago
Yes, it can get even better of course :)

greedo 14y ago

And that leads to perverse incentives; If you have no incentive to help control costs, then it falls upon the NHS to control costs through delays and denial of service.

epistasis 14y ago
Empirically, this is false. Perverse incentives and perverse pricing pervades the US system. Whereas the UK system provides equivalent health at half the cost. Certainly your thought is a common one, the idea that individuals can be incentivized to cut costs was the motivation behind high-deductible plans. High-deductible plans were initially priced much lower than they are now, because the insurance companies thought that individuals on those plans would control their costs much better. However, that was not observed, and the insurance companies have raised rates faster than with other plan types, and HDHPs are now not nearly as good deal as they once were. (At least in my area.)
- rdl 14y ago
  Didn't exactly that also happen with HMOs from 1973 onward (once they had a federal regulatory framework)? It seems like an underlying problem is that whenever a "cover somewhat less, save money, charge a huge amount less" plan is put in place, there are incentives in individual cases (through lobbying or whatever) to add coverage, killing the cost savings.