> Many Americans have decent coverage from their employer. For them, it’s not worth upending the system for what might be moderate gains.
Negative gains I may say. In my experience of the Canadian healthcare and US healthcare systems, the latter, IF you are well insured, feels like a Rolls-Royce whIle the former is like driving a Lada in Pothole City.
I remember the first time I called my provider in the US to book an appointment with a dermatologist. She said "Wednesday", I said "What month?" I couldn't believe it was that same week. I used to wait 2-3 months in Canada. And I had to first get a reference from a ER/generalist doctor.
Also don't forget the US spends on medicare/medicaid/VA about the same % Canada spends on healthcare.
My experience with a dermatologist (in the US) ended up being the same as you anticipated it being. Trying to book a new patient appointment myself I was getting quoted availability 2-3 months out.
I was able to get that sped up a bit by having my primary doctor refer me (which my insurance didn't require) and set up the appointment on my behalf. But even then, it ended up being almost 6 weeks out.
I've also had to book GI appointments in a few different locations, and have had some get me in within a week and others that had a multi-month wait.
And some insurance plans in the use are HMO plans[1], which generally have the requirement of going through your primary care doctor for everything and requiring a referral from them to see other physicians.
The biggest gripe I have about the US healthcare system is how impacted it is by employer decisions. Having decent coverage today doesn't mean the coverage will stay decent, even if you stay with the same employer. I've had awesome insurance unexpected swapped out for crap insurance due to an acquisition, had good plans that I took into account when determining whether to take a job disappear the year after during open enrollment season, had the "same" plan change year to year in subtle but impactful ways (like keeping per-person deductibles the same, but adding a condition to meet a minimum family-level deductible in addition to any individual before you actually hit the threshold).
Right, this is the point that is missed in every hacker news / reddit post that spends hours making fun of how bad the US is and how some people get stuck with $50,000 hospital bills.
If you have good work based coverage, our care is excellent. Fast access, and low out of pocket costs.
I do want to improve it for everyone, but I have 0 complaints about my personal access to health care. I cannot imagine living in Canada and being put on a 8 month wait for something important but not urgent...
> This is the point that is missed in every hacker news / reddit post that spends hours making fun of how bad the US is.
Mostly of the 'making fun' is due to the fact that millions of US citizens have no or little health care and choose not to have treatment because they can't afford it, are limited about what treatments they can have, or have it and are made homeless or live under huge debts.
Just about every country which has some kind of health care system also has private health care/insurance that means you don't have to wait for treatment or have more choice about what, when and where things happen. Because of the competition of the 'free' healthcare systems these policies are usually much, much cheaper that the US.
I work in a company that gives me private medical insurance (which means I might get treated a little early for a non urgent condition, perhaps in a swanky private hospital) but feel good that people that can't afford it won't die, and that I can quit my job and not worry about getting ill.
It's deeper than that though. There is a deep group of rural american's who refuse health care, even when provided by their job at extremely low cost. Doesn't really matter how you change it, the rural american's who don't trust doctors aren't going to do anything different?
“There is a deep group of rural american's who refuse health care, even when provided by their job at extremely low cost.”
Particularly the part about those with insurance not seeking care. The articles cited are concerning vaccine takeup rates, which reasonable people can differ.
Do you not hear how privileged this sounds? You're lucky enough to have employer-provided healthcare. Even more, it's actually good. Many people don't have either. So yeah, the status quo is great for fortunate you and I'm glad you have zero complaints, but it's all the other people who we're really talking about here. I'm sure Musk and Bezos and Gates have no real issue with current tax code, but when we talk about tax reform, they're not the ones who should have much input.
"Worse healthcare for you and your family because you are privileged" is not particularly compelling to the roughly half of Americans you are yelling at.
Sure. Under the private system, health providers are incentivized to suggest more expensive treatments over better treatments. Even your expensive care isnt as good as it could be
Great, that’s an area that could be win win, it could earn my support. What won’t is an attempt to get to a Canada style system (haven’t experienced Canada, but have experienced UK).
You'll reach a lot more people without that kind of language. I for one almost instantly dismiss anyone who talks like that. I didn't even read the rest of your post.
It doesn't take profanity to alienate readers who don't already share your views.
I don't know why you're commenting, since you're not the original commenter, and your very comment shows how you already recognize the generic accusation-of-privilege to be the problem (and how the word privilege is heavily coded with political affiliations and a whole pile of antagonistic/moralizing dogma at this point). You already knew how and why it would be inflammatory.
You recognized the problem, and opted to try to reframe it in more favorable terms to deny the possibility for improvement.
If the original commenter wants to reach across that Red Tribe / Blue Tribe divider and have an actual discussion (or even convince a neutral 3rd party of their views), their first sentence (and general tone) is quite counter-productive, and you know this.
> I don't know why you're commenting, since you're not the original commenter,
This is a multi-user forum not a peer2peer chat client.
> and your very comment shows how you already recognize the generic accusation-of-privilege to be the problem
No, I'm saying the accusation of privilege is correct and it's not a problem to point out to people on here that we are privileged. Because we are.
> You already knew how and why it would be inflammatory.
If you're in the top 10% and can't stand being called privileged then the problem isn't the tone of the accuser, it's the person receiving the comment. The sooner privileged people stop acting like the victims, the sooner we can start fixing the worlds actual problems.
> their first sentence (and general tone) is quite counter-productive, and you know this.
Actually I was arguing that it's not counter-productive. It was the point of their post and a point very much worth making.
I've seen both sides of the social scale and we are definitely not on the side that should be getting offended when people should "privilege" ;)
>I cannot imagine living in Canada and being put on a 8 month wait for something important but not urgent...
We have pretty long wait times in the US for elective surgeries as well. Not as bad as canada, but it can take a bit to get you scheduled for a hip or knee replacement.
Are these waiting times for someone with insurance, or someone on medicare/medicaid? You usually get a better level of service if you are on insurance, as the payment rates are higher.
Kind of? They pay less than say Blue Cross Blue Shield for the same procedure. Many doctors literally limit their medicare patients, i.e. "No more than 20% of my patients can be on medicare"... because doctors like making money too.
Just being insurance doesn't mean much. What the above comment said is true, many doctors don't take Medicaid or severely limit how many patients they have with it. Doctors aren't required to take any/all insurances. Medicaid is avoided because of low reimbursement rate combined with more litigious patients.
I can tell you as someone who was previously on it, it was hands down the best insurance I've ever had. I did not have any issue with getting procedures and drugs covered, which is more than I can say for the private insurance I've had over the years.
Do all doctors take it? No, but I feel like they are in the minority and frankly, if a doctor doesn't take it, I feel they are more motivated by money than caring for their patients.
Yes, the wait times are for insurance. Normally if they care about the medicare vs insurance distinction for payment, they simply don't take medicare at all.
We have a fantastic health plan, and my wife had to wait four months, here, in the US, for an important, but not urgent surgery.
The clinic then fucked up billing, overcharged us, and it took another few months for all of this to get sorted out.
The first part of this story isn't too different from the Canadian[1] system, the second is a pile of unnecessary stress added on top.
Between mine and my employer's share, our 2-adult health insurance costs ~$15,000/year, by the way. And what do we get for it? Months long waitlists and clowns that can't even get billing right the first few times.
This may indeed be the Rolls Royce of healthcare, in the sense that it costs a mountain of money, finds expensive ways to break down all the time, and spends half its time in the shop.
[1] Actually, each province in Canada is responsible for running a provincial healthcare system.
>Months long waitlists and clowns that can't even get billing right the first few times
I've been getting bloodwork done at my physician's office for two years and Labcorp started sending me bills again. Same insurance, but they just randomly stopped filing with them until I spent long enough on the phone for a few of my hairs to grey.
When I was younger, I got a nasty infection after my wisdom teeth were removed. The ER bill, which was close to $5k for a doctor to look at me for roughly 5 minutes and write me a prescription for antibiotics and some pain meds, bounced between health and dental insurance for months, both saying the other should pay for it, before they kicked the can to my parents.
My mom had connections in the hospital's administration, so she was able to get it coded properly for health insurance to pay it. But I am probably the only person in this thread who can say "my mom is on a first-name basis with the people who can get billing issues resolved by the next day." Everyone else gets to sit on the phone for hours trying to sort it out, hoping that insurance will show mercy or that the hospital will bother recoding, or at least give them a bill they can stomach.
> The clinic then fucked up billing, overcharged us, and it took another few months for all of this to get sorted out.
> The first part of this story isn't too different from the Canadian system, the second is a pile of unnecessary stress added on top.
IMO the cost in stress and time of the American system is under-appreciated. We pay way more than other advanced states and have to deal with a whole bunch of companies, all of which seem to be either incredibly incompetent or actively trying to screw us, every time we actually need healthcare, which is precisely when we really don't need more stress or to have extra demands on our time. It's awful.
Are you factoring in premiums? Once you factor premiums from both sides (employer and employee), healthcare in the USA is far from low out-of-pocket. Good family coverage is on the order of $2,000 or so a month.
That's not even getting into the garbage plans offered at some places. I've had plans that covered visits to exactly one region hospital system, any other hospitals needed preauthorization, and even those had the potential for rejected claims.
Which brings up another often missed point. When dealing with the lower cost plans, there's a huge risk of having a claim denied. I know for a fact that at least one major insurance provider has a policy to deny every claim and make the hospital rejustify it. If the hospital fails to justify the claim (to the insurance company standards), either the hospital system has to eat the cost, or they bill the patient instead. This is used to get around those "out-of-pocket maximums" cheap insurance is sold on. So you may only have to pay the first $8,000 of the bill, but that only applies to the first $8,000 of what the insurance company agrees is covered.
My out of pocket + premium for my entire family is MUCH MUCH MUCH less than I save in taxes by being an American over European. Pretend health insurance is a "tax" and add it to your total tax rate. Now compare your total tax rate with someone in Germany/Sweden/Norway making similar pay. For most developer type jobs, I think you are going to find that even a $2,000 a month insurance plan a steal.
If your us jobs are like mine were years back, you’re only paying 20% of the cost of your insurance. Get laid off or quit and use cobra and you’ll learn the real costs.
Let's do the math. So how does public health insurance work in Germany?
* There is a base rate of 14.6% from your gross that split between the employer and employee. The split is not important for our calculation as it will come out of the same budget an employer has for one employee I guess.
* Public insurance providers can demand an additional contribution that was on average additional 1.3 percentage points. The highest I could find is 2.5 percentage points extra.
* There is an upper limit. You only have to pay for your first 58050€ ($67564) a year. For everything you earn above that you do not pay more.
* Family members that do not work or do not earn more than 450€ per month are included for free
So that means from the money your employer has available to pay you a maximum of (14.6 + 2.5) * 58050 / 100 = 9927€ ($11556) a year or 827€ ($963) a month.
I pay almost $1k a month for insurance with a $2500 deductible. Each year my premiums rise another 10-15%. I have to spend hours finding providers that are accepting new patients and usually the wait is long.
This isn't sustainable for me in the long run and I'm definitely considering leaving the US because of it.
The top 50%ish get coverage through jobs that is mostly fine.
The bottom 25% get heavily subsidized plans (often free) from both state and federal programs.
There is a hole there in the middle, but it may be possible to tweak a few programs without throwing out everything. This is basically what ACA tried to do with the backing...
I always find it ironic how quick Silicon Valley is to argue about the need for "disrupting" industries yet how supportive those same individuals are about retaining the current health care system even then they acknowledge it needs to change.
The US health care system is by the far the most complex of any nation state and punishes the losers the worst. It strikes me as something badly in need of disruption. And it's not like we're talking about removing private health care entirely -- if that's what you're scared about?
"Disrupting" health care would involve the federal and state governments massively deregulating health care and insurance so that a private, free market could actually exist. Disruption/competition are quite literally illegal as it stands.
> And it's not like we're talking about removing private health care entirely -- if that's what you're scared about?
I'm personally concerned with the 50 Stalins sort of sentiment surrounding health care. We legislated the current system into existence and its outcomes are perfectly predictable. Why not fix the causes instead of trying to legislative more effects and doubling down on government interference yet again?
> "Disrupting" health care would involve the federal and state governments massively deregulating health care and insurance so that a private, free market could actually exist. Disruption/competition are quite literally illegal as it stands.
The problem isn't regulation. Many other countries are far more regulated in the health care industry and operate a private market just fine. In fact some might even argue that some of the problems with the current US model is a lack of regulation.
The problem I've observed isn't a lack of competition, it's that all of the competition play by the same broken rules. You basically have an industry where people need your service. It's not luxury, it is literally life and death in many cases. People have to use your service, whatever it costs. And you then allow those companies to regulate themselves, companies that will almost always put profit ahead of welfare. That is never going to turn out well. But because libertarianism is very much a core part of the American ideology, whenever the question of how to fix the problem arises you argue that the market needs to be deregulated further. Basically just doing more of the same, as if it will suddenly fix things despite decades of proof that it hasn't already.
Now I'm not going to pretend that other counties have a perfect system. But I do believe the only way you are going to get a health care system that works for everyone is for voters and politicians to want something that is, at least on the surface, very "un-American".
> I'm personally concerned with the 50 Stalins sort of sentiment surrounding health care.
And here lies the problem. People are so brainwashed into thinking any form of social health care is communism and bad. Quite frankly, it's ridiculously misinformed. In fact most of the rest of the developed world has a social health care system AND private health care, capitalism, etc too. On this particular occasion you can actually have your proverbial cake and eat it.
> Why not fix the causes instead of trying to legislative more effects and doubling down on government interference yet again?
Because you're fixing the wrong thing. You're looking at a broken faucet causing water to leak constantly, and instead of fixing that faucet you go and break more faucets thinking that should some how change the behaviour of the first faucet. Then when the flow of water gets too expensive you then start arguing that it's not the leaking faucets at fault, it's the water rates instead. If this weren't a political problem then I'm sure most on here would throw their hands up shouting "learn some basic root cause analysis!"
(I’m assuming Canada is much like NZ)
If you don’t want to be on a waiting list get the 60usd/month health insurance from a private company, or maybe your job will already provide that for you.
Canada is not like NZ. Public health insurance has a monopoly on the things it covers. If you get extended coverage it is for things not covered by your public plan.
There’s no way to pay for better/faster treatment if it’s publicly covered.
EDIT: Edited to clarify I'm speaking specifically about Canada as there is some confusion in the replies.
> There’s no way to pay for better/faster treatment if it’s publicly covered.
This is an outright lie, here in Uruguay and in Chile both with social Healthcare you can enter onto different private plans and that will expedite surgeries, doctor meetings etc
It is something that depends on a country per country basis
A hospital may or may not be for profit but they aren’t allowed to set their own prices or accept anything except OHIP or other provincial insurance. The exception is if you have no public health insurance (e.g. a tourist) or if it’s for a service not covered like cosmetic plastic surgery.
They do let you pay for a private hospital room though oddly enough.
The key thing is that health care is very uneven and unpredictable in the US, in my experience. I have called my primary doctor and gotten a referral the same day to a specialist. I have also waited 3 weeks to get a referral, and another 3 weeks for an actual appointment.
If you want to know what truly excellent health care is like, visit Mayo Clinic. Because of the concentration of doctors in one location, I saw around 12 doctors in a week. That would have taken a year or more through the regular medical system.
"Low out of pocket costs" will depend on a several things: your premium, deductible, co-insurance, out of pocket max and whether or not you are in or out of network. All of these numbers and scenarios are going to be different from person to person. For folks living paycheck to paycheck (or slightly above), a $500 medical bill can be devastating. Furthermore, access to care also depends are where you live. If you happen to live in a more rural area, you won't have the same access as someone in a major metro area. [1]
Work based coverage is variable at best, and for most people if they opt out of work based coverage they are not compensated by their employer for the money that employer would have otherwise put toward their plan. Which intern makes non work based coverage inaccessible which becomes a form indentured servitude if you need coverage.
Even the low out of pocket costs are vanishing with the introduction of the newer high deductible healthcare plans.
I think something a lot of people don't realize is that their care plan is often dictated by the insurer and employer, not their doctor. Your employer and insurer negotiate annually on your coverage with little input from employees. What medicines and treatments are covered is dictated not by the doctor.
> If you have good work based coverage, our care is excellent. Fast access, and low out of pocket costs.
Our care might be excellent but the administrative burden is not.
> Fast access, and low out of pocket costs.
Have you ever had to challenge a bill? or find out that the provider you used sent your labs to another provider that was out of your network and now you owe the other provider full price?
> I cannot imagine living in Canada and being put on a 8 month wait for something important but not urgent...
And you don't need to mimic their process. You can have single payer and privatized medicine. If you're wealthy or a company wants to offer a premium insurance then so be it. There will be a market for those "speed lanes" if you want.
One way to think about it is that there are low wait times on the US because nobody can afford the care. You can skip the queue because all the poor people are kicked out of line.
then you're stuck with your work. Because other work might not provide the same coverage. It's not too bad for programmers because they are spoilt for choice. For many other people it becomes servitude.
Where "excellent" includes shorter length of life, and over-testing, over-diagnosis, and over-treatment (each of which causes harm) because you've got to have something to show for all that insurance spending.
I had an emergency room visit for broken ribs complete with an EKG, x-rays, IV, etc come to a grand total of $75 in the US. I assume this happens frequently, but we don't hear about it because no one cares when everything goes right, or perhaps, it doesn't fit the current narrative.
My default (very good insurance) ER bill is $500 for checking in - I could change my mind and walk out 5 minutes after the intake form and still be responsible for that amount.
You have some outlier coverage if your story is factual.
But like my out of pocket max is 3-5k for my entire family. So a few ER visits or have a baby and you are paying $0 the rest of the year.
The reason a doctors visit is 0-$20 and an ER is $500 is because the insurance company is trying to steer you towards the more cost efficient treatment place.
Yes you can go to the ER for a sprained ankle, but often you can wait until the next day and go to the doctor for better treatment for 1/10 the cost.
Incentivizing you to make more budget friendly choices if capitalism. We like capitalism here right?
Your analogy about ERs is based on situations that aren't emergencies, so I'm not really sure how to square that with reality.
Even following that analogy, you shouldn't delay medical attention to save money, and the insurance company shouldn't be dictating or steering any part of your medical treatment, period.
Incentives only work when you have good information and time to make decisions. When you're in an emergency situation, you can't hop on your phone and shop around for the best deals on trauma surgeons and ambulance rides, and frankly that shouldn't be the expectation.
We hear about patients being stuck with $6000 bill but did said patient actually pay 6k? Absolutely not, even if uninsured.
also they ignore the role of employer healthcare, or how the NHS is paid for by higher taxes, so Americans are effectively paying less for healthcare in this regard.
So much misinformation and misleading info in the healthcare debate, driven by partisan politics.
I have many healthcare issues in my family, so I have a lot of experience with this. It is very dependent on the field. Some are booked out for months, others you can get an appointment the week of, it is very hard to predict. Also, most medical professionals leave some amount of week-space open for emergencies, so if you REALLY need to see someone, you can in less than 24 hours in many cases. But if it's routine or part of a larger "wtf is going on" process, it can take a year to get a diagnosis bouncing between different specialists with 1+ month scheduling runways.
Currently, the industry is also facing a labor shortage, so this is making the scheduling even harder. A family member in high school was diagnosed with obstructive sleep apnea (affecting school performance! You only get 8 semesters to mess up!), and it has been (so far) 8 weeks and we still don't have a formal intake for medical equipment. We have a prescription. We just can't get the equipment supplier to process the prescription and send it to us. I ended up paying out of pocket (and doing some crazy shit) to get a machine and supplies. Note: this is with doing what is basically a part-time job squeaky-wheeling everyone I can to try to get things happening. It is the worst.
Blue collar medical workers are quitting in droves because the work sucks and it has garbage pay, and you see the executives making huge salaries. And you get yelled at by people like me trying to make the system move faster. I try to stay friendly, but... I have lost it a few times. Of the seven people in my family, five of us have chronic medical issues.
I was just talking the other day with a friend wishing there was a medical consultancy I could hire. I give them my health insurance info and family demographics and all of the healthcare shit we need done, and then they find the providers, make appointments, file reimbursements with insurance/hsa/fsa tell me how much to put in fsa/hsa each year, deal with the full time job of having a family that needs to deal with the totally bonkers american medical system. They get some commission of whatever comes back to me, and also just some baseline monthly payment for service. PLEASE GOD LET THIS BECOME A THING. Or, you know, a not insane medical system.
If you've ever been on the scheduling side of these things, you'll see that a lot of these waits come down to inefficient scheduling. If you've waited a month for your appointment, there's a good chance there were multiple cancellations before that you didn't hear about.
I did contracting for a while, I bought insurance with dental in 2010. It cost me about $120 a month and was comparable to my work. I did some contracting around 2015 and i bought insurance, I was paying $400 with barely any coverage. In my 2010 plan i had no concept of co-insurance, in my 2015 i also have co-insurance, also heard from my friend that when his wife had a baby, they had several doctors half in-network and half out to max out his deductible. He said same hospital for his first kid cost him around $400, second kid at 2017 cost him $4500.
When I talk to people about socialized medicine I always force them to address the VA. The VA does some things well, but most things terribly. If you want me to vote for socialized medicine, fix your experiment before you scale it.
I have pretty good insurance, and that's not really my experience. The shortest wait I've ever had (for a non-emergency) was 4 weeks for a therapist as a new patient. My optometrist is booked up for the next 6 months (which I found out when I had to reschedule back in June and ended up with an appointment in November). Physician: 3 months. Dermatologist: 2 months. One of my friends has been on a waiting list for an elective surgery for almost 6 months (because she can't afford to go out of network).
The idea of a same-week appointment, especially as a new patient, seems like fantasy to me.
Bruh, you can walk into lenscrafters and get seen the same day and walk out with a pair of glasses. They accept all the vision insurance plans I've had over the past 20 years.
This is still a pipe dream for some. It’s still very very common to wait months to see a doctor in the states, especially after the pandemic. I routinely wait months to get into my dermatologist, too. YMMV but this is absolutely not the norm.
90% people in the US actually probably couldn't see a dermatologist they don't already have a client doctor relationship with this month and we pay a huge chunk of our money to insurance.
That advantage is going away as health networks are allowed to slurp up all of the doctors.
Where I live, 95% of medical practices belong to 2 networks. Step two after consolidation is reduce costs. Long story short, if you don’t have cancer, you’re looking at 90+ days for an appointment.
Dermatologists are a little different in that they can make money selling bullshit spa services. So you may see more variance by region as being cut out of hospital networks isn’t as big of a deal.
Good points. I ran some numbers and Brits pay more for their healthcare via higher taxes. It's not really free (unless you earn nothing, but the US also has plenty of charity care too). Canada is infamous for long wait times and stuff not being covered (such as dental).
Hopefully you don’t end up with a medical condition that exhausts your PTO and you get kicked off insurance. My neighbor’s go fund me staved off foreclosure for 6 months when his wife had cancer.
1) The conservatives (political right) have eroded public health care any chance they can, such as through cutting budgets to any health-related service over the course of at least the last 20 years. They do this so that they can stand up in front of people and argue that “Wait times are long! If you let us implement private health care you could simply pay for better service!”
2) Even with the reduced budgets and constant attacks by conservatives, if I limp in to emerg with severe pains I’m getting looked at immediately and might be successfully out of surgery by the end of the hour.
On a smaller note, I just had this convo this morning: “Can I book an appt to get my prescription refilled? I know the Dr has to talk to me before writing it” “For sure. I can get you in Nov 28th. Are you completely out?” “Yes I am, I miscalculated and I’m concerned.” “Ok, I’m putting you in for tomorrow afternoon. Does that work for you?”
Negative gains I may say. In my experience of the Canadian healthcare and US healthcare systems, the latter, IF you are well insured, feels like a Rolls-Royce whIle the former is like driving a Lada in Pothole City.
I remember the first time I called my provider in the US to book an appointment with a dermatologist. She said "Wednesday", I said "What month?" I couldn't believe it was that same week. I used to wait 2-3 months in Canada. And I had to first get a reference from a ER/generalist doctor.
Also don't forget the US spends on medicare/medicaid/VA about the same % Canada spends on healthcare.