Submitted by Thegreatcornholio459 t3_1267104 in explainlikeimfive
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Comments
bluecatcollege t1_je8nxrg wrote
I'm now thinking about a crazy world where insurance companies have their hooks in every public service.
Operator: 911, what's your emergency?
Person: I'm locked in my bathroom! My husband's gone crazy and says he's going to kill me!
Operator: Ok, I'll need your address and insurance information and we'll send an officer over right away.
Person: Ok here it is!
Operator: Hmm...It seems your insurance plan doesn't cover domestic violence so you'll have to pay $787 out of pocket. Do you still want us to send an officer over?
Unkindlake t1_je8oeil wrote
This is completely unrealistic. You know they would charge a lot more than that
taisui t1_je8tygi wrote
and there is no way they can give you a quote over the phone, the bill will arrive in a month and be 10X of what you expected but with a 70% insurance "discount"
USS_Barack_Obama t1_je8x2mz wrote
and the officer would still be late
taisui t1_je8yc2s wrote
and one month later you get another bill for the fee of the police cruiser.
bluecatcollege t1_je93dn8 wrote
Officer response ($787 x 2 officers)..................................................$1,574
Use of mace on suspect......................................................................$50
Use of taser on suspect.......................................................................$150
Handcuff arrest.....................................................................................$45
Cruiser ride to jail..................................................................................$200
Overnight stay in jail ($300 x 2 nights)...............................................$600
Emergency response call ($1.50/per minute x 32 minutes).............$48
TOTAL.....................................................................................................$2,667
ExistingUnderground t1_je94s2d wrote
Convenience fee: $383.90
Befuddled_Cultist t1_je8za94 wrote
It's a Republicans wet dream!
Unkindlake t1_jebb9zs wrote
Well that happens anyway
MmmNotSureBoutThat t1_je8r6na wrote
I'm giving them 6-8 years to get to that. Sorry, the time it takes to build 3 football fields.
Blasphemous666 t1_je8xsjg wrote
Don’t give them any more ideas. We’re already being nickel and dimed by corporations.
Schuhey117 t1_je92ht2 wrote
Yeah this was actually the case in London at one point. If you weren’t insured you had lower priority for your house being put out if it was on fire.
DTux5249 t1_je8gxnj wrote
>Imagine if firefighters would only save your home if you had insurance provided through your current employer...
Wasn't that actually the case in early US history?
BillyCloneasaurus t1_je8ol31 wrote
Mostly an urban legend that has since been debunked
USS_Barack_Obama t1_je8xbxv wrote
Don't know about US history but, apparently, in Ancient Rome Marcus Crassus used to do this:
> Once a house caught fire, Crassus would send his slaves to fight the fire. Once they arrived at the house, they would only put out the fire if the owner of the house sold the building to Crassus. Crassus would then sell the house back to the original owner at a marked up price.
[deleted] t1_je91thm wrote
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[deleted] t1_je95guu wrote
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PavelPod t1_je98908 wrote
That is incorrect information. Firefighters, police, road maintenance and public schools are regulated and maintained by local governments- state and primarily town. Military is shared between federal and state.
There are many towns in US without police departments. There are many towns in US that have only volunteered firefighters or no firefighters at all. There are US towns with worlds worst schools, with worlds best schools and without schools at all- and kids go to schools in nearby towns.
Truly universal services would mean- no matter how much you pay you get approx the same public service quality. In case of US- you live in poor town - you get poor service.
throwawaydanc3rrr t1_je8a3et wrote
Ever notice that universal road maintenance still has lots of roads with potholes?
Well, the road maintenance crew cannot get to all of the roads, there is a limit to how many manhours of labor they have, and also of the necessary materials (asphalt, tar, etc.) and equipment they have available.
And just like they have to decide which roads get fixed and which ones have to wait, universal healthcare has this exact same issue.
Irbricksceo t1_je8m5tj wrote
That’s a matter of funding, there is no reason we couldn’t fund it enough to get rid of all waits. But, for the record, people DO wait years for healthcare here too. I’ve been doing it. The difference is we wait because we can’t afford it. They triage based on need, we triage based on income.
throwawaydanc3rrr t1_je9hygo wrote
>That’s a matter of funding, there is no reason we couldn’t fund it enough to get rid of all waits.
Yes there is. A country only has so much money, and they have to decide how to spend it. Canada has a population of 39 million and it has as many MRI machines in the entire country as there are in the state of Tennessee with a population of 7 million.
Do you think that Canada would like to have as many MRI machines per capita as Tennessee? Sure they would! Why do they not? They cannot afford it.
Canadian healthcare does triage based on need, but they also triage based upon availability of resources. Hip replacements generally impact older people, and in some Canadian provinces the wait time for hip replacement is greater than 80 weeks. Statistically speaking that means there are people dying before they can get the hip replacement.
Irbricksceo t1_je9rrqp wrote
That sounds like an issue that they should probably get working on then. If govs spent money in a way better suited to helping the people, and with a more logical tax structure, they absolutely could do it. I'm not saying canada's Healthcare system is some perfect model right now, it absolutely isn't, with many a flaw, But I'd still take it over the system here, where every life choice I ever make is built around minimizing the number of doses I'm likely to miss anyway. And I fully believe, with all my heart, that it is easier to fix a system that, at least in theory, exists to provide healthcare to all, than it is to fix one that is supposed to be profitable. I view profiting off healthcare as a moral failure.
Colmarr t1_je8bcsh wrote
Universal healthcare is usually supplemented by a private health system.
If it will take too long to get the surgery you want, you have the option to pay for it with a private provider or to wait for a public provider to do it for free.
throwawaydanc3rrr t1_je8cfhh wrote
First off, thank you for the reply.
Second off, I am not saying you are wrong.
But what I would like to point out is that without doing any deep searching I found three different news stories about Canada, Britain, and Ireland where there are prolonged wait times for diagnostic procedures, like MRIs. And diagnotic procedures are required to diagnose (or confirm diagnosis) so that treatment can be identified. Waiting three months for an MRI means you have to wait an extra three months before you get that knee operation.
"In March, the Saskatchewan Ministry of Health reported patients waited an average of 105 days for an MRI."
"Before the pandemic, Canadians were waiting an average of 89 days for MRI imaging, according to CAR’s 2022 pre-budget consultations report. This is far longer than the 30-day wait time recommended by the Canadian Wait Time Alliance, an organization focused on identifying the longest medically acceptable amount of time a patient should wait before receiving treatment.
Come 2022, the Conference Board of Canada estimates the average wait time for an MRI will rise to 133 days. "
"NHS patients are waiting more than three months for tests including MRIs, colonoscopies and heart scans, with overall waiting lists doubling in some parts of England."
"The average wait for a brain MRI through the public system is 126 days, the report points out, while private patients wait just six days."
DTux5249 t1_je8h37h wrote
All I will say is that it's better to have slow healthcare than none at all; given many Americans just never go in for routine medical check ups due to the cost.
modern_messiah43 t1_je8or77 wrote
Yep. I haven't been to a doctor in almost 15 years. I'm sure there are plenty of things I should get checked out and maybe even things a doctor would find. But it's not like I could afford to do anything about those things anyway.
giantroboticcat t1_je8m439 wrote
> But what I would like to point out is that without doing any deep searching I found three different news stories about Canada, Britain, and Ireland where there are prolonged wait times for diagnostic procedures, like MRIs.
Do people think that healthcare is instant with private US insurance? It's fucking not...
My wife had chronic back pain and went to see an Orthopedist. Our insurance required her to do 12 weeks of physical therapy before she could get an MRI. The physical therapy did nothing for her and often times she came home feeling worse from her PT appointments than before she went in. The Physical Therapist said that if she had the MRI they'd at least know what they were dealing with and could maybe target exercises better to address the pain, but still insurance wanted to wait things out and see if things improved on their own.
After the 12 weeks were up, she got the MRI, it was a herniated disc as she suspected because she had a similar issue with her back when she was a teenager. So great, PT was never going to fix that. She needed back surgery. She made an appointment, had to schedule that out another 6 weeks before she could get a slot. A spot opened up after 1 week and they called her and asked if she wanted it. She of course said yes, she was in so much pain for so long she would have literally crawled over nails to get there. She called me so happy and excited, and then 30 minutes later called me back again in tears because the doctors said they couldn't give her the appointment because our insurance wouldn't be able to process the paperwork that quickly...
My wife works for the state of NJ. Our insurance isn't "bad", it's essentially the best available in our state, and since it's almost 100% covered by the state, we have the absolute best plan her job offers her.
And still my wife had to wait 18 weeks before she could have the surgery she needed to fix her back pain. She had a baby in September... Her back pain began in December and she didn't have surgery until May. She literally felt pain every time she lifted our infant child... Could you imagine how torturous that was for her? Can you imagine how difficult it is to comfort someone crying about not being able to care for her own baby?
But yeah go ahead and tell me how bad other countries have it with their scary socialized medicine...
The only people who get healthcare instantly are people rich enough to pay out of pocket for it. That is true in countries with and without socialized medicine. So let's fucking stop using it as an argument as to why the US system is better...
My anecdote is not an exception. US wait times are comparable to other countries with socialized medicine and if you think otherwise it's because of the propaganda we are fed to think such things.
https://worldpopulationreview.com/country-rankings/health-care-wait-times-by-country
GeorgeJacksonEnjoyer t1_je8fplm wrote
Canada, US, and England all have privatized services working for them even though it's universal. What's the wait time on something that is completely socialist such as Cuba? Cuba has a much better healthcare system than the US and better doctors. They also have way more primary care doctors and help people prevent diseases rather than helping people cope with them. Seems it's smarter to prevent something before it occurs rather than to wait for something to happen to actually do something about it
Colmarr t1_je8fwa7 wrote
You seem to be pointing to problems with universal healthcare as though we are arguing about its merits.
I wasn't (although I do believe it is a far better system than my understanding of the the US' user-pays model). I was simply pointing out that universal healthcare is commonly supplemented by a user-pays model.
throwawaydanc3rrr t1_je9j0xq wrote
I am not "arguing" at least not on purpose.
the person that posted the "other universal services" that Americans receive (and it was a pretty good analogy) gave an opportunity to expand that analogy.
Just like every road cannot be patched because of limited resources in universal healthcare not every patient can be treated. This is not meant to be a statement of merit, merely one of fact.
Ishidan01 t1_je8vs08 wrote
As opposed to private healthcare like in America?
Engineer: this road is in bad shape. Here is what materials and actions we need to fix it.
Insurance: denied, your customer's insurance plan does not cover that.
Engineer: what? Excuse me, may I see your engineering degree that says you can tell me how to do my job?
Insurance: don't need it. We're just telling you, it's not structurally necessary.
Engineer: by what do you base that?
Insurance: because it would not be profitable for us.
Edit round 2!
Engineer: we were unsure if there are underground utilities where I want to dig. Ignoring this possibility could be disastrous, so I ordered a consult with a specialist to look for underground utilities. The dig site is clear.
Insurance: so they found no utilities?
Engineer: correct.
Insurance: so the test was not necessary. Coverage denied.
blipsman t1_je7wy71 wrote
It means heath insurance that covers every citizen. No matter their employer or whether they even have a job. Everybody has health insurance coverage.
HarryHacker42 t1_je844j9 wrote
Having health insurance not tied to your job means you can quit your job if they screw you over and still have healthcare. In the USA, many people are stuck at their job for their healthcare. Also, the average country similar to the USA pays HALF of what the USA pays per person for healthcare. It would save us trillions of dollars per year to switch to Canada's system, or Australia, or UK, or Europe, or pretty much anything.
djamp42 t1_je86b33 wrote
It would be one thing if the current system actually worked well. But it's fucking horrible. I'm disputing a charge right now.
Insurance is saying the doctor needed prior authorization. My wife is actively having a heart attack in the ER on vacation at Disney world with my 2 kids. The insurance company couldn't even pronounce the name of the procedure that needed authorization. Like I'm not going to know that, I don't know if the Dr knows that, and it's against the law to deny me coverage for prior authorization in an emergency.. but they still did it.
HarryHacker42 t1_je86tqp wrote
The whole USA system is designed to make it hard and charge you more, that's why we need to discard it and start over with another country's model as the goal.
They've found numerous insurance companies that had the policy of "reject every [nth] claim" such as "toss every 5th claim" so you get a rejection and either pay it or go complain, and if you complain, they'll usually pay it, but it is just to hassle you. And hospitals *LOVE* to have an out-of-network doctor visit and charge everybody huge rates the insurance doesn't cover. Its so bad they're making it illegal. There is nothing to fix, it needs to be replaced.
And worse, Christian hospital chains are buying up as many hospitals as they can get so they can deny abortions and contraception and anything they feel like.
djamp42 t1_je877fn wrote
You might have something on that nth claim thing, because I had a bunch of other bills from that same event and they were all covered, even ones from the same doctor, but for whatever reason this one was denied.
HarryHacker42 t1_je887ow wrote
20% error rate on claim processing:
https://www.carecloud.com/continuum/health-insurance-claim-errors-waste-17-billion-annually/
Aetna admits they never looked at some patients medical records before marking the claims denied:
https://www.cnn.com/2019/04/26/health/aetna-settlement-california-investigation/index.html
Superspudmonkey t1_je93wd4 wrote
Was that not what Obamacare was before it had to compromise to pass?
roseumbra t1_je8xoan wrote
Sorry you have to deal with this. Honestly do what you can to tell the doctors office you Cannot pay them a dime before the claim is approved by insurance. They have staff designed to deal with this in ways you don’t have the years of training to. If you force them to tackle insurance with hard stops before they see a dime they will find a way…
It’s all about how the fucked up the coding when sending it. And this is why I hate the healthcare system.
djamp42 t1_je97acq wrote
Yeah that coding shit is a disaster. The entire thing is a disaster.
Unkindlake t1_je8olyp wrote
Why would anyone want the current system? Who could possibly have something to gain from tying healthcare to an employer?
markroth69 t1_je8uf4x wrote
Employers who don't want to provide anything more than the lowest possible pay and some level of health insurance.
People who make money because of the current system.
And both groups can afford to buy Congressmen.
Unkindlake t1_jebbn5l wrote
Of course they don't, but it is more sinister than that. They want healthcare to be tied to employment to limit your options in shopping for a better job and to leverage it to exploit their workers
BlackEyedSceva t1_je8gb82 wrote
Do you know any sources I can look up and show people? I'm not sure where to look.
HarryHacker42 t1_jeaa78s wrote
USA: 51st in life expectancy
https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy
(Wikipedia has all the sources for the data at the bottom of the page)
​
Per capita healthcare spending by country from 2021:
1l536 t1_je98v0n wrote
The downside to that is I can see many hospitals closing because it would be regulated by the government and they would choose what hospitals could remain open.
You can not say it wouldn't happen because since when has the government ever walked away from an opportunity to screw the public over. I mean they are now trying to screw over veterans just like Canada.
They (elected officials) should have been forced to give up their healthcare when Obamacare passed, I think that they should be exempt from any laws they pass to us the citizens.
HarryHacker42 t1_jea9glc wrote
I strongly agree that Congress should be in the muck with the rest of us, and their pensions and healthcare should be based on what the upper 50% of government workers get, so they have to lift up at least a huge chunk of people to elevate themselves.
The government has created the EPA, which helps the average American pretty often. The CFPB fights for citizens against banks every day. FEMA responds to disasters and does a pretty decent job of improving people's lives in hard situations. NOAA is so good at weather forecasting that private companies want to block it from publishing the data that they give away freely so those companies can publish it. California is guaranteeing school kids will have food. There is a lot of good government does. They're currently taking care of everybody over 65 years old for medical care, so extending that down to 55 or 45 would be a good test pattern, but in the end, insurance companies need to go away because they are what inflates the numbers, and we need to buy our drugs from countries who don't allow shameless profiting on drugs like the USA does.
skawm t1_je8frf4 wrote
Don't forget about the lack of dealing with insurance networks, so you're covered regardless of where you go instead of having to utilize specific providers to utilize the coverage.
Thegreatcornholio459 OP t1_je7ym03 wrote
Ahh thank you and here in the US, it's different, usually there are requirements and is often separate depending on income and much expensive?
horrifyingthought t1_je80zip wrote
No. The healthcare isn't more expensive. The fact it is both for profit and has absurd administrative costs is what drives prices up.
YellsAtGoats t1_je8fsvt wrote
That, and outright bizarro hospital / private insurance markups. In your everyday life, you can go to any pharmacy and get basic cough lozenges at like $10 for a pack of 20 or more. But under hospital billing, those exact same lozenges can be $10 apiece.
SilverSageVII t1_je85jo5 wrote
Yep this^ if anyone is interested, look up sticky ceiling in the medical industry. It is an economic theory explaining part of why cost is so high.
Edit: as I was searching for a link it seems that “sticky ceiling” was a term coined by NPR to refer to “price stickiness” that was tending toward highest prices in the medical field.
darkmooink t1_je8w5qz wrote
You realise that you just said “healthcare isn’t more expensive. The prices are just higher.”
roseumbra t1_je8xzvt wrote
I think they mean the actual cost to provide the healthcare isn’t higher, rather they just inflate the price to the consumer.
horrifyingthought t1_jec3nnq wrote
... and? That would be correct. The cost to provide services isn't different when compared with comparable nations, but the structure and incentives of US healthcare are set up in a way that increases the price astronomically compared to other nations.
DeHackEd t1_je80ygv wrote
Health Insurance is something you have to get like any other type of insurance, paying a monthly fee (or getting someone like your employer to pay it for you) and all the fun of shopping around and discovering what is and isn't covered, and what other catches might exist.
By contrast, for example, I had my appendix removed. I'm a Canadian citizen. Was in and out of the hospital, never even discussed a bill or price. Procedure was basically paid for by my (and everyone else's) taxes. Everyone is covered for life-saving procedures for sure at any hospital.
YellsAtGoats t1_je8ffmx wrote
It gets interesting at the level of nonessential care and procedures.
I too am a Canadian citizen. If I suffer a serious trauma like a gunshot wound or severely broken bone or severed appendage, I'm well taken care of on taxpayers' money. But it's not so nice for illnesses like Cancer or for less-than-urgent needs like eye care and dental care. There, I could be on a waiting list for an MRI or CAT scan for months or years, or left to pay mostly out-of-pocket for things like eyeglasses and dental surgery.
Case in point, in the Canadian system, if you don't have private insurance to cover dental care and you have gum disease, you're left to pay tens of thousands of dollars to keep your teeth from falling out of your head. If you need vision correction for poor eyesight, too bad, if you don't have private insurance for that, you're paying out of pocket for glasses/contacts/LASIK just like any American schlub. I say case in point because that's all me.
Irbricksceo t1_je8lyxw wrote
Good news, here in America dental care is also tens of thousands. I’m looking at another 32k soon, and I’ve already spent double that. And I have what is considered good dental
concentrated-amazing t1_je8bk66 wrote
It's interesting to note that spending on healthcare is lower per capita in Canada, for example, vs. the US, with health outcomes such as infant mortality and life expectancy being better.
anentropic t1_je93vwa wrote
Or healthcare that's not even framed in terms of insurance. Just provided free to whoever needs it.
[deleted] t1_je8fc14 wrote
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Caucasiafro t1_je7wq1a wrote
The specifies of exactly how the system works varies a lot from country to country.
But it means that basically because you are a citizen of a country you just...have health insurance. That's basically the long and short of it.
This is different from the US where most people get their health insurance thru their employers. So if you are unemployed or don't have a job that gives you health insurance and you have to go to the doctor you are going to get a (massive) bill after you do so. But if you are insured and your insurance covers it you either wont get a bill, or you will get much smaller bill.
​
> it seems to be in other countries rather than the United States
Indeed, the US is only developed country doesn't have something that could be considered universal health care.
TheBananaKing t1_je81wsg wrote
It's not health insurance. It's healthcare.
I'm Australian. If I get sick, I can go to a GP and pay nothing for the consultation, then go to the pharmacist and pick up my prescription for a few bucks.
If I have a medical emergency, I can go to an ER and pay nothing for the consultation, medication, procedures, stay, even surgery and rehab.
If a woman gets pregnant, it's all paid for: prenatal care, birthing, hospital stay, lactation consultant, the works.
There are some out of pocket costs scattered through the system. You pay for ambulance trips for some reason, you pay for dentists (though there are some hospital-run clinics for low-income people, bit of a waitlist for these though), you pay for some scans and MRIs from external provider, you have some out of pocket costs from private specialist consults (generally on the order of a few hundred dollars), and a proportion of GPs are starting to charge out-of-pocket costs, because a decade of conservative governments have done their level best to starve the system out of existence.
And all of this is funded by a 1.5% income tax levy, which is waived for disadvantaged or low-income people.
It's not insurance, becasue there's no business front-ending it and trying to screw you out of payment. You don't have to submit a claim and hope it's accepted. The medical provider simply bills the government for service. An insurance model is designed around contingencies you assume never happen. The healthcare model assumes that there's an ongoing need, and simply pays for it straight up.
There's no insane million-dollar bills being issued, because hospitals know they're getting paid and don't have to high-ball in the hope of getting some of it. Nobody goes bankrupt or loses their home because they get sick. Nobody is strong-armed into staying at a shitty job in horrible conditions by the threat of losing access to healthcare.
It just works - better and cheaper for everyone.
Antman013 t1_je83uok wrote
To expand on this . . . universal healthcare is funded by tax revenues. And the idea is to provide every citizen with the same level of ACCESS to treatment, regardless of income level, or other personal details.
That said, while ACCESS is universal, there is a certain level of "rationing" that will occur.
I am Canadian and, whether that rationing takes the form of certain treatments and/or procedures NOT being covered by the system, or having to wait an exceptionally long time for a procedure that IS covered, it does exist.
​
For example, it was determined my sister needed a knee replacement, as her joint was bone on bone. After a referral and consultation, her surgery was scheduled . . . almost a year later. So, she had to wait 11 months, while her knee was shot, and causing her no small amount of discomfort, in order to have the situation dealt with.
Now, granted, it WAS dealt with . . . but some feel these wait times aren't acceptable.
RibsNGibs t1_je8zwfa wrote
Most countries ration by need. The US rations by wealth. The former is obviously morally and ethically right.
And usually in countries with universal healthcare you still have the option of buying private insurance on top, which is usually super cheap (because universal healthcare takes care of almost everything anyway) but gets you faster care if you need it.
Antman013 t1_je96nlf wrote
I wish that were possible in mine.
BigBearSpecialFish t1_je93u71 wrote
I think rationing is a bit of a dubious word to describe it. In both public and private healthcare you have limited healthcare resources split across the public so "rationing" occurs either way. The real difference is that in public healthcare it's rationed by the severity of your condition while on private it's rationed by the size of your wallet.
If a private system would've allowed your sister to get treated faster, then it would likely mean that whoever was ahead of her in the queue for public health treatment (and thus had a more severe condition), is now losing out on treatment instead
Antman013 t1_je96h5m wrote
It's rationed by the funding, too. Lack of funding is why ORs sit unused while patients wait. Restrictions on entry to med schools is why too.
BlackEyedSceva t1_je8h0iz wrote
I know someone who recently said that if healthcare gets socialized (I assume she means universal health care) that the quality of care will be worse than it already is. But my reasoning is if healthcare was universal I could just go see a rheumatologist and get evaluated instead of waiting for my GP to care. Do you know of any resources that show quality of care in other countries with universal health care?
Mkwdr t1_je8t5ii wrote
As far as I have seen the US system is one of the most expensive but doesn’t , overall, have better results than countries with universal health care. I’d say it’s perhaps better for the rich but then they can still go private in other countries anyway.
tiredstars t1_je914ac wrote
There are a range of comparisons around, and they're often not easy to use. The OECD gathers data but I think it's deliberately shy of making comparisons easy. The UK-based Nuffield Trust does a report comparing systems, which I think is based on the OECD data.
I'm sure I've seen some others but don't have time to look them up right now.
COVID 19 has made things more complicated, so I think most comparisons are two or three years old now. Not that I imagine much has changed - though I think the US had a particularly bad experience of COVID, which is not unrelated to the problems in its healthcare system.
As a general rule, compared to other wealthy countries, the US:
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has middling health outcomes
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has some really great healthcare. If you can pay for it, you can get absolutely world-leading healthcare in the US
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but access to healthcare is poor, and the system drives some perverse behaviour - the classic example is putting off dealing with a problem until it requires emergency treatment
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at a country level this is one factor that makes US health spending extremely inefficient in terms of outcomes - focusing a lot of attention on expensive treatment with marginal benefits, as compared to wider availability of lower cost treatment and prevention
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other aspects of US society and the economy contribute to poor outcomes - eg. Americans work longer hours, have fewer holidays, less access to sick pay and less security in their jobs than most rich countries
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it's also worth noting that even the rich can't completely isolate themselves from the effects of the health of others - if your housekeeper comes in to work when they're ill because they can't afford to see a doctor and can't afford a day off, you're at risk of catching whatever they've got
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the US spends far more than any other country as a proportion of GDP. Not only that, but government spending is higher than almost any other OECD country. Put another way: if you could magically transplant the NHS to the US, the US government would spend less on healthcare.
The general rule in international comparisons is that there are a range of ways of funding and providing healthcare and there's debate about which models work better - except for the US model, which nobody wants.
RibsNGibs t1_je91mys wrote
My experience as an American who moved to NZ several years ago is that you can probably get better care in the US if you have a lot of money. (Full disclosure - I have a lot of money and in the US I always had great healthcare through my employer so I had arguably about the best healthcare experience in the US aside from like… “actual” rich people or congressmen.)
But 99% of the time the experience in NZ is superior. Hard to tell how much of that is because of universal healthcare and how much of it is because it’s NZ (way too many confounding factors and variables).
But my experience in the US was… call my doctor.. wait, no first I have to do research to find a doctor on my plan… wait no first I have to figure out which plan I want to get (my employer offered several): do I want a high deductible health plan or the PPO? Catastrophic only? Ok let’s look at my last 5 years health expenses and crack open Excel - how much money would I have spent given my healthcare usage in the past? How about if I get unlucky and break my leg or get cancer? Should I get an HSA? What if I don’t use it? What if I do use it? How do I get the money out of it? What if I want to use it for something besides health?
Ok now find a doctor on my plan.
Call and make an appointment, next available is 2 weeks from now.
Go in, he’s running 30 min late. Receptionist: “are you on the same plan as last time? Have you moved since your last visit? Can I see your card? Blah blah blah”
See doctor. He’s super competent, no doubt, but he’s rushed, wants me out the door. But yes, very good.
On the way out: sometimes I just pay the copay, but for some reason sometimes it’s “put it on your card and here’s the itemized receipt - now go submit that to your insurance company”. Sometimes it’s “insurance company didn’t want to cover this one out of 30 items”. Those last two examples might be for when I saw specialists not on my plan, I forget.
Go to pharmacy. “Are you on the same plan? Can I see your card? Have you moved?” And “come back in an hour or two”. Poor pharmacist has to spend ages calling the insurance company - maybe they only cover the generic? Maybe the doctor prescribed 60 days but the insurance company only wants to cover 30. Who fucking knows. Come back in an hour, perhaps pay a small amount, perhaps pay a lot.
Potentially fight with insurance company.
In NZ it’s like: call and get an appt for that afternoon. Go in and have a pleasant chat with the doctor (I would say so far the quality of the healthcare has been fine, and a much better personal experience in terms of feeling like you can spend some time talking to the dr and having them really listen or explain things without feeling rushed). Pay a moderate amount out the door (or none if it was a result of an accident or for my kid), walk into the pharmacy, pick up the meds, maybe pay $5, done.
So, I dunno, if the expertise and equipment is 5% better, is that worth the stress and headache and time and all that fucking mental overhead? It’s exhausting just writing about it. In NZ if I decide to see the doctor about my funky ankle or cough, the total time expenditure is like an hour. Maybe less.
We also had a kid here. Months of home midwife visits, 3 days of induction in a pretty slick, modern birthing suit with nice recliners and a jacuzzi hot tub thing and gobs of medical equipment all over the place with armies of midwives and nurses and doctors and anaesthetists or whatever, emergency C section with super professional doctors and surgeons and nurses, blood, hearing, vision tests and specialists after that, 3 days recovery in a maternity ward with latching specialists and more help, then home with a few more months of home visits from the midwife… total charge was like $110 in parking. I spent more on food from the hospital cafe than I did on that!
konwiddak t1_je8s0o5 wrote
There is a difference in the availability of treatments, but this is difficult to equate to quality. It's just different.
A universal healthcare system should use statistics and costs to find the most effective "package" of treatments to offer to the population. There are plusses and minuses to this. Where it works really well is in screening out dubiously effective treatment and over or unnecessary treatment. For example if someone is old and has cancer, the UK system may steer someone to no treatment:
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Treatment may be unlikely to actually extend someone's life.
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Remaining quality of life may be significantly better without chemo.
Where it works less well is sometimes newer treatments take longer to be adopted by the system, and sometimes more customised care is unavailable. It's worth pointing out that private care does exist in the UK if you want it - but most people chose the NHS.
usernamenailed_it t1_je8zmjg wrote
FYI - no charge for an ambulance in Qld. Qld govt fully funds it so it's free for everyone. There used to be a levy but that finished in 2011.
TheBananaKing t1_je91l7h wrote
Oh, nice :)
Still pay for it in nsw :(
figmentPez t1_je8204e wrote
One small note, health insurance is not the same thing as health care. Having health insurance does not ensure that someone can get health care. Insurance usually makes it easier to get health care, but ideally universal health care goes beyond just what insurance provides.
TurboThrobber t1_je7vrkl wrote
In it's simplest form, universal healthcare is a free at the point of use, taxpayer funded healthcare system that provides and equal level of care to everyone.
Caucasiafro t1_je7xzng wrote
Universal healthcare does not mean it is free at the point of use. It almost always is, but it does not need to be.
The swiss actually have universal healthcare that is not free.
contactspring t1_je8c7y0 wrote
You know how the government spends trillions for the military to "protect" you? Imagine that also included medical care for you.
PavelPod t1_je98mon wrote
The Biggest portion of US budget is spent on healthcare- more than 30%.
Government doesn’t spend trillions on military. Count goes in billions which is thousand times less than trillions.
contactspring t1_je9e5sf wrote
I believe that the cost of the Iraq war was 1.1 trillion.
CapnLazerz t1_je8cid4 wrote
Universal Healthcare ideally means that everyone who lives in a particular place has guaranteed access to healthcare regardless of their ability to pay for it. The government might provide it directly (The UK, Canada) it might be provided by private providers paid for through tax money and/or mandatory health savings(Singapore), it might be mandatory health insurance with government paying for lower income coverage (Germany, Switzerland and the intent of the US ACA). In these programs the government or related entities usually set prices for care and meds to keep it affordable so that money is not a barrier to access.
A non Universal Healthcare system means that access to healthcare is not guaranteed. For example, in the current US system, only very low income people or people 65 and over have guaranteed access to healthcare through Medicaid and Medicare, which are funded by the government by money taken in the form of taxes. Everyone else either needs to get health insurance through an employer, get insurance on their own (the Feds do offer financial help if you use their marketplace) or pay cash whenever they need to use healthcare services. We can argue that everyone has “access” to healthcare in the US, but in reality, access is dependent on ability to pay -even if one has a health insurance plan. High premiums, deductibles, copays, co-insurance and the lack of price limits on services and medicine means that many people simply can’t use healthcare services because they don’t have the money to pay.
Skalion t1_je8x6sd wrote
Just to add for Germany, as universal healthcare is always confused with free. Depending on income you pay a certain percentage of your income, which is automatically deducted from your pay by your employer. I pay around 370 per month and my employer pays an additional 340 per month for my health insurance, and that's with slightly above average income..
But my family (wife and kid) are completely covered as well.
roseumbra t1_je8y9fn wrote
In the us for basic coverage that is employer sponsored is still closer to $1000 a month. At least that’s the bill I got when I got laid off.
bobbobbobbobbob2020 t1_je7vwfu wrote
Universal Healthcare is like having a dog park that's open and welcoming to all doggos, no matter their breed, size, or age. In this dog park, every pup can receive the care and attention they need, like getting their fur brushed, nails trimmed, and receiving check-ups from a friendly veterinarian.
The idea behind Universal Healthcare is that all humans, regardless of their income or social status, have access to medical care when they need it. Just like the dog park that's open to all pups, Universal Healthcare means everyone can get the treatments, check-ups, and medicine they need to stay healthy and happy.
Some countries, like the United States, don't have Universal Healthcare, so not all humans can easily access medical care. It's like having a dog park where only certain dog breeds or sizes are allowed, leaving some doggos without a place to play and receive care.
In other countries that have Universal Healthcare, everyone has the opportunity to get the medical care they need, just like a dog park that's open and welcoming to all our furry friends.
Red__M_M t1_je8eh03 wrote
Basically universal healthcare means that it is paid for by the government rather than private insurance companies. Medicare is a form of universal healthcare for the elderly. Blue Cross, United Healthcare, and Humana are all forms of commercial / private insurance.
To be clear, the citizens fund the government, so the citizens pay the bill for universal healthcare. However, being government funded means that the “insurer” is not profit driven. They are not fighting to deny claims or to exclude high cost members, etc.
Government funded care is cheaper than commercial insurance because it is a single large entity rather than many small entities.
Universal healthcare is probably 90% a benefit and 10% a detriment. The argument against it is that money drives innovation and superior care. there is an ounce of truth to that and a pound of lies.
Universal care will likely never happen because there is an absurd amount of money in the health care industry so there are billions of dollars in lobbying / related spending / corruption to keep insurance private.
Nooneofsignificance2 t1_je8lcj6 wrote
There’s like two dozen things it could mean based on each country. But there are really 3 major possibilities.
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Private Hospital, Public funding. Public funds a major portion of patient bills, private enterprise provides care. Aka Medicare for all style. How most nations do it.
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Public Hospital, Public Funding. All hospitals are government ran, payment is through taxation. Healthcare is completely a government enterprise. This is like NHS in the UK
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Private Hospital, Private Funding, but extreme regulation. The best example are the Swiss, everyone is mandated to get insurance and things are tightly regulated. This is the model the Obama administration was trying to move us to, trying to get everyone covered.
Note Universal Healthcare is really about ensuring everyone has some basic level of coverage. Healthcare systems can still very a lot in what that coverage entails. In the U.S the term has become synonymous with Medicare for all, the first option. However it should be noted this is not the only way to ensure everyone gets healthcare coverage. It’s just an extremely popular one since private health insurance seems to be such a train wreck in the United Sates.
gramoun-kal t1_je8xlff wrote
If you get sick, you just go to the doctor.
At no point you worry whether you can afford it.
The doctor looks at you and makes a list of what they think you need. At no point they ask you what you can afford. You just get what you need. It might be going through a multi-million dollar machine, operated by a very well paid specialist. No matter. You get sick, you get the machine. The CEO of some bank gets the same sickness, they gets the exact same prescription.
Depending on the details of the implementation, when it's all over, you're free to go, there's nothing to pay. In some implementations, there's a bill. But, you usually have enough change on you to pay it. It's very cheap, and doesn't actually cover the costs at all. Some implementation require people to pay a symbolic amount to avoid stuff like lonely people pretending to be sick just to have someone to talk to.
So, who pays? Taxes. It's not cheap either. Billions upon billions. But that's a choice societies make, and pretty much all societies that have the cash make the Universal Healthcare choice. I know of only one exception.
Muricka.
Frednotbob t1_je8xn3a wrote
There are a lot of good explanations, but I think I can be more concise:
Universal health care is a healthcare system that's available to all, regardless of financial status. In Canada, our health system is administered by the Federal government (via the Canada Health Act), and funded through tax revenues.
Any Canadian (or more broadly, anyone that meets the residency requirements) is automatically covered, at no cost, for most (but not all) medical services.
Certain categories aren't included under the services outlined in the Canada Heath Act (dental and vision care, and prescription medications), but there are supplementary health plans available for those that ease the financial 'sting' a little.
Bisjoux t1_je93vm0 wrote
It means never having to worry about what would happen when you get sick. An example is my blood cancer treatment. Tests in local hospital including various scans and procedures.
In patient treatment in local hospital. Out patient and in patient treatment in London hospital which is designated an international centre of excellence. Life long monitoring. Taxis sent by hospital to collect me when I’ve needed to be admitted. Completely free drugs all the time. Even some really expensive ones (over £1,000 per week for one and I was on multiple different drugs).
Never having to worry about my care at any stage. Even now I’m in remission I still have regular check ups. Recently I had a routine orthopaedic operation. Due to my medical history the anaesthetist wanted to discuss some blood test results with my haematology consultant. Different hospitals in different parts of the country. All resolved the same day.
Same for pregnancy. Son born premature and very ill. Never a question of cost for treatment and monthly appointments with a consultant for first 5 years of his life. All completely free.
horrifyingthought t1_je81gxu wrote
US Healthcare - every job offers some form of healthcare. No one has any leverage. The healthcare is shitty. It's a million stitched together independent hospitals, non-profits, doctors, etc.
Everywhere else - the government is the ONLY provider of healthcare, and it covers EVERYONE.
Therefore, the government sets the price points, there is no worrying about what plan you have or if your provider is "in network," you simply... have affordable healthcare covered for the most part by taxes.
The side benefit of this is that jobs become more competitive - in the US, you can't leave your job if you need the healthcare it provides, AND jobs have to provide good healthcare to lure good workers. Everywhere else, if you could find a better job, you can go take it without interrupting your healthcare plan, making the job market for employees better through increased competition.
Colmarr t1_je8btwb wrote
It’s not that simple.
In Australia, for example, there are many private providers but we have a system called Medicare under which those private providers service the general public at agreed rates that will be paid by the government.
The private providers can also provide other services at private rates, but people have the choice whether to use “public” providers or private providers.
horrifyingthought t1_je8c8qw wrote
It's "explain it like I am five," not "provide me with the various national blueprints that the US could adopt."
I am aware not every other nation adopts a single payer system, or adopts a single payer that outlaws private healthcare at the same time. But for someone who has no fucking clue what any of that means, I feel I provided I decent starting point.
Colmarr t1_je8f3jp wrote
Your comment seems unduly heated.
ELI5 requests simple explanations but that doesn't mean the answers should be outright wrong like this comment you made:
>Everywhere else - the government is the ONLY provider of healthcare, and it covers EVERYONE.
horrifyingthought t1_jec35d5 wrote
It's an excellent baseline understanding of what other rich countries do to have successful healthcare. For the purposes of talking to a 5 year old, it is correct.
[deleted] t1_je867zb wrote
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DTux5249 t1_je8gpw9 wrote
It means that the government insures you for non-cosmetic medical expenses if you're a citizen
If you break your leg, you have don't have to pay millions of dollars out of pocket if you don't have a job
supercalifragiwhat t1_je8jyk1 wrote
There are three main types of healthcare coverage. The simpler one is the “out of pocket” model (think USA), in this system you get what you pay for. In nations where this type of model is used people usually can’t afford to get private health insurances and there is no universal healthcare. The second one, Bismarck Model, originated in Germany in 1883, healthcare was seen as an universal right, but the coverage wasn’t universal, since it was based on employment and subsequent taxation (later laws and regulations were made for those who couldn’t work, for example people affected by disabilities). The third one, and the one considered truly universal, is the Beveridge Model, installed in the UK in 1948, and in which universal coverage is provided by the government, this coverage comes from income tax payments, but every citizen receives it, regardless of employment status. (This is just a résumé, but the main points are there)
shruggedbeware t1_je8n1u9 wrote
It is a vague term, but usually involves some sort of initiative toward state subsidies for healthcare programs for all workers in all industrial sectors.
[deleted] t1_je8nzio wrote
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[deleted] t1_je8r6gz wrote
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Due_Signature_5497 t1_je91boc wrote
Not being mentioned here and honestly want some non- propaganda answers from people living on socialized medicine. 1) I constantly hear about ridiculous wait times for non emergency treatment. In fact, I have many friends that have traveled from the UK and Canada to get treatment in the U.S. Can someone that has experienced this please weigh in? Someone has to pay for it so how does this affect your tax burden? I keep reading that the NHS is failing people in a big way? UK, what do you think of them? There is a huge industry on bot the Northern and Southern borders of the US of hospitals and Medical care where people from our neighboring countries come for medical care. Why would you pay these prices if you socialized medicine is working for you? Hoping for honest thoughts, not people subscribing to an idea without actual knowledge. Thank you.
[deleted] t1_je91kob wrote
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Flair_Helper t1_je96chk wrote
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Jf2611 t1_je7vwjl wrote
Universal healthcare is publicly provided and funded healthcare. Free and accessible to everyone.
The critics of this type of system argue that the quality of the care is subpar because there is no profit in it for the provider to give good care only the basic level.
Proponents of it argue that other countries that have it do not have any issues with the level of care they receive.
It would be a difficult thing to implement in the US because the insurance and healthcare industries are so large at the present time. A lot of large companies would suddenly not be needed, which would cause a very large number of people to be suddenly unemployed.
Chromotron t1_je80s6w wrote
> A lot of large companies would suddenly not be needed, which would cause a very large number of people to be suddenly unemployed.
This is the worst reason ever. The true reason why the US cannot change is that those huge companies lobby the sh*t out of politicians and spend billions on spreading propaganda such as that.
Jf2611 t1_je81w0h wrote
I didn't say that it was the right system, only that this is one of the realities of doing away with healthcare for profit.
If the US government suddenly banned privatized communications, and everyone had to use a new national internet and cell phone network - wouldn't a lot of people doing redundant jobs at ATT, Verizon, TMobile and other telcoms be suddenly out of work?
Not acknowledging that aspect of making a change over to universal healthcare is to only see the forest for the trees.
Manofchalk t1_je81iit wrote
> Universal healthcare is publicly provided ... healthcare
Not necessarily.
Australia's healthcare system incorporates a lot of private healthcare providers, on the lower level (GP's, dentists, etc) to my knowledge it is mostly private.
Private providers negotiate with the public insurer, Medicare, for how much they are paid per medical procedure and any extra they charge to the patient or any supplemental private insurance they might have. Some aim to charge entirely within what Medicare provides (called Bulk Billing services) while others charge more.
Jf2611 t1_je8297v wrote
Very good point. There is a lot of complexity to the issue, but this is ELI5, so I thought it best to keep it simple.
Fortressa- t1_je958iy wrote
Just to clarify, private providers do not negotiate with Medicare. The Medicare Benefits Schedule is set and the provider can take it or leave it. There are tweaks and new items and occasional indexations, but the rate is the rate. Docs can charge whatever they want, and the patient will only get back what the MBS says.
Spinaccio t1_je7x4tv wrote
But, wouldn’t the new administrator need most of the same people to manage the system?
Jf2611 t1_je7yn4n wrote
Not even close. There is a whole industry within the industry. Insurance companies have sales teams who are responsible for bringing in new hospitals to be "in network" as well as bringing in new employers and private citizens to use their insurance over someone else's. Then think about every insurance company and the amount of people in leadership roles that would no longer be needed - thousands of C level and VP level executives who "run" the various companies that wouldn't be needed anymore.
Then you have all of the customer service agents who answer questions about coverage to customers. Then you have a whole bunch of folks, like my wife, whose sole job is to verify that your insurance will cover the procedure you just scheduled for yourself.
Then you have all of the various ancillary jobs associated with those roles, admin, IT, etc. Not to mention all of the people that work for drug and equipment companies who "lobby" the insurance companies to cover certain drugs and what the costs would be.
Then you look at how many companies are in the industry to make a profit - drug companies for example. You start dictating to them at the government level how much they can charge for a drug or piece of equipment, suddenly they don't have an incentive to innovate and so people are laid off.
Medicine is a big business machine in the US.
Look up largest employers by state, so many of them are hospital networks. A lot of those jobs are admin related to dealing with the insurance companies.
Spinaccio t1_je804j3 wrote
That is a lot I didn’t know, thanks for answering. Do the countries with single payer insurance have similar networks?
Jf2611 t1_je8129c wrote
Not even close to the same scale. Single payer is a type of universal healthcare. In a nutshell, it means that a single entity is contracted to provide healthcare. They would need some admin, but nothing to the scale that the US system has. With a single payer system, there wouldn't be the need to verify insurance coverage, determine costs, etc. It is what it is.
Spinaccio t1_je81x7r wrote
So, would switching to a single payer system require a whole set of other programs to employ all these talented people? Like a New Deal? Seems like our gornment would have to do a lot of work to plan and administrate something so massive. Like, do their job.
Jf2611 t1_je82sky wrote
There would be a need for jobs, for sure. But there would be a lot of redundancy if your goal was to give everyone a job in the new system.
Let's say there are 10 insurance companies and we suddenly had to get down to one organization. So that's 10 CEOs down to 1 - what jobs do the other 9 get? The further down the chain of command the more redundancy you get. You could probably run the new administration with the headcount from two of those 10 companies, maybe even less since one system would allow for streamlined optimizations of policy and admin work.
Manofchalk t1_je8321u wrote
Would it require, no.
Would it be a good political move to do so, probably. Though attempting to cut down the US for-profit health insurance industry with its massive lobbying arm is already unhealthy for a political career so maybe the ire of thousands of unemployed middle managers and cubicle workers wont matter.
GermaneRiposte101 t1_je84ib3 wrote
A major advantage of Universal Health is that the they can use their size to reduce the cost of medicine, sometimes by several orders of magnitude
throwawaydanc3rrr t1_je89o91 wrote
Often this is done with rationing the care by wait lists.
In the United States it is (mostly) rationed by price.
nagmay t1_je82k91 wrote
A lot of good answers here, but perhaps some examples of "universal" services that Americans already enjoy would help:
These are all services that are paid through taxes. They are then "freely" available to all citizens of the US, regardless of income or current employer.
Imagine if firefighters would only save your home if you had insurance provided through your current employer... otherwise, your house would burn down (or, more like the current healthcare situation, you would go bankrupt paying them back).