Heavy question, I know. This is not intended to be political, please leave “taxes/government evil” out of it, I’m interested in a pragmatic view.
Infamously the US has mostly private health care, but we also have Medicare and -aid, the ACA, and the VA.
Most other nations have socialized health care in some format. Some of them have the option to have additional care or reject public care and go fully private.
Realistically, what are the experiences with your country’s health care? Not what you heard, not what you saw in a meme, not your “OMG never flying this airline again” story that is the exception while millions successfully complete uneventful and safe journey story. I’m also not interested in “omg so-and-so died waiting for a test/specialist/whatever”. All systems have failures. All systems have waits for specialists unless you’re wealthy, and wealth knows no borders. All systems do their best to make sure serious cases get seen. It doesn’t always work, but as a rule they don’t want people dying while waiting.
Are the costs in taxes, paycheck withholding (because some people pay for social health care out of paychecks but don’t call it a tax), and private insurance costs worth it to you?
As someone doing systemic healthcare management for a living (and for research purposes) I might be a bit biased, but basically there is no other way than socialized healthcare. Healthcare is not a market that is open - a patient that needs healthcare is in almost all cases not able to shop freely - unlike a regular economic market you are unable to hold back your healthcare needs (normally).
Additionally society pays massively when healthcare needs are not met - crime goes up, long term healthcare costs rise, the pressure on emergency services increases.
I live in the US and was born here. This is true of my wife as well.
I hate to say it because I know how bad many people have it here, but our health care experiences have been excellent. IVF? We paid a few grand by the end of everything, but that’s it - most of the cost was one hormone in particular. My cancer that almost killed me? We paid $15 co-pays for doctor appointments and physical therapy appointments, nothing for any treatments (radiation, chemo, surgeries, hydration, etc.), and about $15 co-pays for each prescription medication. My upcoming rotator cuff surgery? I’ll pay similar to the cancer. Regular in-home therapy services for our children with special needs? Free.
This was not by accident or dumb luck. My wife and I have always chosen jobs in large part based on benefits in general and health insurance in particular. We may not make as much money on paper as job hoppers and those who chase the highest number on their paychecks. Do you know what we do have? No medical debt. Great parental leave. More vacation time than most. A legal plan that paid to set us up with every estate planning and life management document one could need.
So it’s hard. Our system is fucking broken - too many people cannot get the care they need, or they go into debt to get it. It needs to be fixed. That said, I also have friends who just made shitty choices. They actively chose direct income over benefits. They gambled and some of them lost.
We need to fix US healthcare in or much every way. In the meantime? My wife and I choose to play the game by the rules as they are currently written, and we play with intent to win.
How much are your monthly premiums?
Just because you aren’t paying when you go to the doctor doesn’t mean you aren’t paying every month for it.
That is a good point. We are not paying monthly premiums. Again, over the years we have chosen our employers very carefully. To be clear, we are lucky to have been in the place to do so.
That said, we also did very well when I was a public high school teacher. The pay was awful, but the health insurance we had was better than my wife could get at most corporate jobs at the time. We now use my wife’s corporate benefits because my family’s needs have placed me as a stay-at-home dad for several years. Once she got in with a company that actually values its employees, we made the decision to stick it out.
So you just don’t care about the people who chose differently? What about the people who just had to take whatever job they could get?
Our system is fucking broken - too many people cannot get the care they need, or they go into debt to get it. It needs to be fixed.
Reading comprehension
I care very much. Please read everything I wrote. The system is broken, and we need to fix it. In the meantime, since we must live within the broken system, it is wise to do a thorough cost/benefit analysis before accepting any job. Not everyone can do that, but some can.
We play pretty conservative baseball when it comes to personal finances. We have a smaller house further from the city than my wife’s peers at work. We buy cars that meet our needs, but our wants are frequently compromised in search of the lowest total cost of ownership. We make no major purchases without real research first. Our kids have not been to Disney, but they will hopefully be able to go to the college of their choice without a mountain of debt when the time comes.
We are very lucky, but most people that merch our income are not actually in as stable a place as we are. That stability comes from good decisions.
I care very much
I have friends who made shitty choices
In the US. My partner has health insurance through her job, but she works remotely and the company is based in a different state so the insurance is, too. Partner severed her Achilles tendon about two months ago. Because of confusion about her insurance, every appointment related to the initial injury took an extra hour or more while the office staff tried to get in touch with the insurance company. Her MRI was cancelled because the provider of the MRI thought she was uninsured. She had to reschedule and ended up paying out of pocket for it to ensure it got done. Getting reimbursed out of her HSA took several hours of compiling receipts and filing out forms. After all that, and being insured, she still paid $4000 out of pocket. There’s also a very low limit to the amount of physical therapy sessions insurance will cover plus there’s a copay for every session, so that’s an ongoing cost as well.
In Malaysia, we have private and public healthcare. We also have public hospital and clinic, where the first one will have specialist and bed and operating theatre and all those equipment, while clinic is a smaller medical center used to give medical attention for smaller issue(flu, vaccination, treat minor wound, pediatric checkup, that sort of thing).
While it’s not free, it’s super cheap and affordable by basically everyone. The downside of it is it’s always full and the waiting list for non-urgent operation is rather long. Last i went for dentist, i paid rm3(rm2 for registration and rm1 for the work, add up to not even a dollar) for both registration and patching my teeth, where private dentist will charge upward of rm80 to rm120 just for a simple tooth filling. That’s at least 26 times more expensive! The downside though, i’m only allowed to do one hole per visit, i got two slightly chipped teeth and one tooth causing me pain, so i have to pick the important one. which is understandable since it will take forever for a single patient if they want to do it at once, making the long line even longer.
I’m always glad public healthcare exists in my developing country, even when it’s underfunded and overcrowded and not the best of experience and i barely use it, but visiting once convinced me that all country need it, it’s a universal basic human right. I’ve heard countless stories that treatment that will normally cost rm10k and above is slashed down to rm1, though i also heard a lot of stories that sometimes it takes an upward of 6 months for simple operation because the doctors just can’t keep up with the amount of works they have to do. It’s a solvable issue though, and one can also use private healthcare for their need if they have the money.
On top of that, in Malaysia the government also have mandatory employees health insurance that employer need to pay for, so if anything happened at work place or when an employees traveling for work and something happened, they are eligible for getting insurance payout on top of free medical treatment.
We pay about $300 a month in premiums for healthcare policy provided by the employer. We’re limited to 4.2k out of pocket but nothing at all is covered but the annual physician before that (medications are seperate and always have at least a copay).
Good years it’s fine, but a few years ago I had a skin growth they scraped to test for cancer and got billed $2,000 after insurance’s “negotiated” price that took a nice chunk of savings to cover. I’d gladly switch to any other system than the one we have here in the US…
I have a life threatening chronic illness. Imagine every year is a bad year.
That is my biggest fear health wise. Losing $7,800 in premiums and out of pocket plus copays for medicine and office visits would be painful to say the least
Just recently filled some prescriptions: was told they’d be $100 each if using insurance, $50 and $75 if not using insurance. Our system is deranged. In the US.
My personal horror story is that I took the time to make sure I went to an in-network hospital before I went to the ER for what ended up being an emergency appendectomy. The surgeon was in-network…for scheduled appendectomies. Emergencies were contracted out to a different organization who he was working for at the time, and that organization was not in network. So I got balance billed for it. I took the payment my insurance company gave me and sent it to him and said “look, I did all this research ahead of time and at no point did anyone ever tell me this would be out of network, so this is all you’re getting out of me.” They left it at that.
In most developed countries, health care is rationed by need. In the US we ration by ability to pay. I would gladly pay more for worse service so long as care was rationed by need.
I don’t live in Costa Rica, but I have family there and they have combined. They complain that the private healthcare systems lobby to underfund the public heathcare system in order to turn people away from public healthcare, and off to their services where they make more money.
So combined systems cannot exist, if you want public healthcare then it should quickly phase our private.
EXACTLY!
I like to think of this way: If society has two boats (one private for profit one and the other public) wealthy people will always seek to pay extra to ride in and fund the upgrades of the private boat rather than the public one. By simply offering a paid alternative, they prevent the public boat from being improved upon for the good of everyone. Offering a paid choice effectively torpedoes the free standard for others.
If we’re all in the same boat, society as a whole will unite and work towards improvements to that communal boat.
I live under singlepayer health care. I like it, but it does have its downsides. For example, let’s say you have something really severe going on, and you’d like to try a hail Mary. Well, you can’t, as the only treatments that are available to you are whatever treatments have been deemed effective and reasonably safe by the regulatory agency. Experimentation, in lack of a better word, is a no-go.
I never experienced this as a problem myself, but I can easily imagine that someone could.
So I think the best is to have single payer available to everyone, but with private for profit doctors available if you need or want something a little more unorthodox and you have the means to pay for it.
EDIT: Seeing as I may have come off as a bit gloomy, I think I should list why I wouldn’t want it any other way.
- My dad had cancer. Chemo and everything covered.
- My kid broke his arm this spring. The only expense was me buying a sandwich while they inserted a titanium rod into his arm.
- Same kid has ADHD. I can show up to any pharmacy in the country and fetch his meds (stock pending) without paying anything.
- His brother also has ADHD and poor eyesight on one eye. Meds and glasses covered.
- All of my kids were born in a hospital at no expense.
- I didn’t learn until last year what the hell “copay” is, and the more I learn about it, the more thankful I am that it’s not something I have to think about.
That’s why I feel like there should be both systems. Possibly public and private healthcare, but with the additional requirement that everyone has to have health insurance. Otherwise there’s going to be too much of a problem with young people not getting insurance and not paying in. You’ll also have NEETs and neckbeards who work 12 hour weeks and aren’t paying anything in to the system.
And where is this amazing place, so that we may move there?
I also live under single payer healthcare, and I have experience with a much lower stakes “hail mary” type event.
A number of years ago, I developed a growth on my eyelid that no one was sure what it was.
We started with the optometrist, who thought it was a duct blocked by dirt and suggested a medicated cleaning regimen where they assumed it occurred. This didn’t help.
So I got recommended up the scale to my GP, who took one look at it and said, “Yeah, that ain’t right. Here’s a recommendation to an eye specialist at the hospital.” which took ~1 month to get an appointment.
A month later, I have my first appointment with the eye specialist, who isn’t quite sure what it is but knows that it’s an internal problem and not a blocked duct. After the third appointment (3 months after the first) she says that she’s narrowed it down to either a benign tumour or a blood clot, but isn’t confident in her eyelid surgery capabilities and recommends me to an eyelid specialist in a neighbouring province.
6 months after the first optometrist appointment, I have my first appointment with the specialist who identifies it during the appointment as an internal scab that will decompose itself, but the wound isn’t healing. He says that surgery is an option, but there’s a chance I go blind and a smaller chance that I straight up die. He tells me that I’ll come back in 3 months because it’s not life threatening, and if it starts getting much worse, we’ll discuss removing it.
After an appointment with him every 3 months for almost 2 years, it finally cleared up.
The issue itself was relatively low risk, but it wasn’t until 6 months in that it was deemed “not cancer.” At every step, the risk was evaluated, and ‘hail mary’ options were discussed. But they were always discussed as “if it gets worse, we can do this, and the decision is yours”. So (at least where I live) there are hail mary options and you can take them, but only if the risk to your health is significant enough that the rewards outweigh the risk.
If it means anything, my parents have been going to a lot of specialists lately as they age and have had issues, and it’s pretty much the same story:
- set appointment with a doc - soonest you can get is in a few weeks or a month
- go see a doc, get a recommendation another doc
- they’re full, wait 3 weeks
- huh, maybe this other doc?, etc
I was expecting this to be a story of an issue, but this is actually really encouraging for what single payer could look like. The time scale isn’t great, but it’s pretty comparable to what I’ve experienced and heard about from friends here in the “efficient” private US system.
Part of the time scale was how low risk the issue ended up being. We knew from the first few months that even if it was a tumor, so there was no “rush” to get me in to see people.
One of the ‘mindsets’ of single payer is that more severe/risky issues can get fast tracked over less severe/risky ones. Ultimately, all that was happening to me was that my vision was slightly affected (because my eyelid wouldn’t open fully). But had it been a tumour, I likely would have been on the surgeons table within a month of them finding out.
I’m in the US. For my early adult life, I had no sort of medical insurance, no job that offered any, and not enough money to pay for much. I don’t know if that is typical. Midwife offered sliding scale for delivering the kids, there was a state kidcare plan so they could get the regular doctor visits, eventually I got a better job.
Now I have the most American style plan of all, the high deductible with an HSA.
So, most of my bad experience with our system here relates more to cost than quality. The care I have received has been fine, when I could pay for it, but I do live in a city with a whole lot of medical offices, so many doctors, seven hospitals, I don’t think it’s like that everywhere.
In terms of cost - I get about half of my gross pay as net pay after deductions for tax, (family) benefits, retirement, and the HSA, and with that I do have enough now in the HSA to cover that high deductible (that took years) but not enough to be confident in retirement, I did payroll for our other offices and it looks pretty similar all over, (in terms of amount , not where it goes, most places run most of all through taxes) but other places get more guaranteed benefits for their 50%.
So stuff works out pretty well in my European country. Personally I never got anything broken, my friend had their hand re-broken because they never realized it was broken in the first place, only noticed that the pain lasted many months. They did not pay a single thing, but had to move to go through all the surgeries (to their parents). That kinda broke them.
Personally, I had a minor health surgery, that kinda left an ugly scar, which I feel like could have been avoided with better surgeon.
Also we have health insurance, and there it gets tricky. Like state owns one, there are more private ones, as some groups try to privatize the healthcare, and then you have to pay the insurance, you can choose which insurance it is, and in some specific cases, some insurers can order different regimes of treatment. Which may not be ideal in every case.
In Australia we have fully socialised medical care, but you can have private health care if you want.
I paid $0 for my kidney transplant and cancer treatment.
We also get no-interest loans that only increase with CPI from the government to go to university, which is paid back via a percentage of our income once we earn over a certain threshold.
This allows people to actually raise their social status, such as our current Prime Minister, who grew up working class in a single parent family in a poor part of Sydney, before going to university and succeeding.
If I was in the US I would definitely be bankrupt and most likely dead already.
I also earn more (as a teacher) and pay less tax overall than in most US states.
