What do Americans do if they have no healthcare?

[summeriscomingsoon]

Seeing posts on Reddit about the costs of routine medical visits and the astronomical breakdown of figures charged, but I'm assuming these are all covered by health insurance.

But what if you have no insurance. What happens if you get cancer etc. Are you left to die?

It’s a mess.

America spends more on health care as a share of the economy — nearly twice as much as the average OECD country — yet has the lowest life expectancy and one of the highest suicide rates.
It also has the highest chronic disease burden and an obesity rate that is two times higher than the OECD average.

around 26,000 people a year die due to lack of healthcare.
In 2018 in US there were 38,390 deaths by firearm.

The U.K. spends less than most advanced countries on healthcare.

www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29

@Harrystylesismyjam

Free! They should be free!

It’s free through Medicaid so cost really isn’t the issue.

For PPs worrying about the NHS going the same way, it seems to be the reverse in my city currently.

Over the last decade I know so many people who've been sent to one of two luxury private hospitals we have here for treatment on the NHS.

All I can think is that these hospitals aren't being used enough as no one can afford them, so they get by on NHS contracts.

I just really hope the NHS are paying a reduced rate to them for all this.

Also most people aren’t ‘just left to die’. The US gov spend $613.5 billion per year on Medicaid and $799.4 billion on Medicare.

The new film Nomadland is about the entire social strata of US citizens who've just fallen through the net because of things like this.

Apart from Francis McDormand I think everyone in it is real.

The trailer broke my heart that this sort of thing can happen in the US in 2020.

@LemonRoses

*Just exactly how much is 'fund it properly' going to cost?

More and more money is pumped in hand-over-fist, year on year.

It needs stripping back and rebuilding, or completely scrapping in favour of something like a French style system, or preferably the German type.*

Two completely opposing points and completely inaccurate.

The French and German systems are funded at a far, far higher level than the NHS.
The NHS has had significant reductions in funding over the past two decades. It doesn’t need stripping back. It needs investment.

Where are the promised forty new hospitals? We need a health service that is funded equitably with other developed nations. That remains free at point of delivery for all.

The NHS is about the most efficient healthcare service in the world. Imagine how fantastic it could be if it had the money of other EU countries.

Spending was trebled on the NHS during Labour's time in office, so it hasn't had "significant reductions in funding over the past two decades" - the first decade of that was where Blair/Brown were throwing money at it.

The NHS is an administrative shambles and needs to be properly reformed before we pour any more money into the leaky bucket.

My OH had just had his latest round of chemotherapy cancelled which was due to start of Thursday. He should have had the blood test this morning. Apparently the nurse called in sick so all today's blood tests have been cancelled. He's been on the phone since 8.30 this morning trying to organise another (the person who phoned to cancel at 8.15 apparently couldn't book a replacement test!). He's been passed from pillar to post between the GP surgery, the oncology dept, and a "roaming blood test nurse" system (!) and apparently there's not a single person in the entire NHS who can do a blood test today or tomorrow. The knock on effect of that is that his oncologist appointment on Wednesday has to be cancelled (there are no blood tests to review) and his chemo sessions for the next 3 weeks have to be cancelled as the oncologist can't write the prescription for the chemo on Wednesday without the blood test result! So all that has to be reorganised once he finally manages to get a new date for something so bloody quick/easy a blood test. What a monumental waste of time and effort for some many people (and wasted appointment time), just because the administrators/management won't fit him in for a 5 minute blood test!

@user1497207191

Agreed that the NHS needs some administrative reform, but a US style system is not the way to do it (I realise you don't say that in your post, but it might be implied by the thread title!)

[quote littleloopylou]@user1497207191

Agreed that the NHS needs some administrative reform, but a US style system is not the way to do it (I realise you don't say that in your post, but it might be implied by the thread title!)[/quote]
As I've said upthread, the UK and US systems are at each end of the spectrum. Most developed countries have a model between the two extremes and the US system isn't the only alternative to the UK system and I don't think any "expert" has suggested we adopt a US model. We need to be looking at Canada, Australia, and mainland European models - there are lots of different options. It's not a binary choice.

I do think the NHS should give and an equivalent value calculation to each patient they treat, just so they would know what they would have to pay in the private system. I think it would certainly take away the anger of waiting in A&E.

I have had treatment from the NHS over the last decade for a particular illness. I think with specialised treatment consultations and therapies I would have had over a £100k of treatment. I am very respectful and grateful to the NHS

The NHS is an administrative shambles and needs to be properly reformed before we pour any more money into the leaky bucket.

That’s so untrue. If we fund the NHS at a comparable level to European countries, with same staffing levels, same number of beds per capita, same extent of ITU and diagnostic provision, then perhaps we could compare. At the moment it’s not a reasonable comparison because funding is so much less in U.K.

The NHS is facing severe financial pressures, with trusts across the country spending more than they’re bringing in. The NHS was also asked several years ago to find £22 billion in savings by 2020, in order to keep up with rising demand and an ageing population.

Based on the government’s current spending plans there is likely to be a spending gap of over £20 billion by 2022/23.

One cannot continually cut real spending whilst inflation and increased demand place additional burdens and expect the service to be maintained as people want. Something had to give.

I would very much like a health service with comparable resourcing to European countries. I don’t know that we need to fundamentally change the model of free at point of contact, but the way services are delivered is constantly changing. There is no single NHS operating model. There are numerous commissioning bodies and even more providers- both private and public owned.

*Over the last decade I know so many people who've been sent to one of two luxury private hospitals we have here for treatment on the NHS.

All I can think is that these hospitals aren't being used enough as no one can afford them, so they get by on NHS contracts.*

Most of the private healthcare providers (at least those with hospital provision) would have collapsed over the last year of lockdown had the Govt not chucked them a load of cash in order that they be “available to help.”

As it turned out, almost none of that capacity was used so we, the perpetually shat upon taxpayer, subsidised the fat profit margins of mainly foreign owned private companies.

Those are the same private companies which couldn’t run those ever so expensive elective surgeries without the use of surgeons and nurses that were trained by, and got their experience in, the publicly funded NHS.

Private healthcare in this country is not as expensive as in the States because they don’t do A&E, or anything that might require intensive care facilities or that carries high risk. They don’t have the expense of training their HCPs, they push their mistakes back onto the NHS to fix and they get inflated Govt subsidies to provide cherry-picked services and the “easy” end of elective surgeries.

If we fund the NHS at a comparable level to European countries, with same staffing levels, same number of beds per capita, same extent of ITU and diagnostic provision, then perhaps we could compare. At the moment it’s not a reasonable comparison because funding is so much less in U.K

Yes, this. You wouldn't compare cars by putting poor fuel into one and then concluding it's the cars fault.

Also on admin the NHS is run very efficiently. Obviously always room for improvements. The USA spends a crazy proportion of its costs on admin. I also don't get the idea that admin would be more efficient if you started added in lots of different private organisations into the mix. The admin cost and inefficiency would rise.

@MimiDaisy11

If we fund the NHS at a comparable level to European countries, with same staffing levels, same number of beds per capita, same extent of ITU and diagnostic provision, then perhaps we could compare. At the moment it’s not a reasonable comparison because funding is so much less in U.K

Yes, this. You wouldn't compare cars by putting poor fuel into one and then concluding it's the cars fault.

Also on admin the NHS is run very efficiently. Obviously always room for improvements. The USA spends a crazy proportion of its costs on admin. I also don't get the idea that admin would be more efficient if you started added in lots of different private organisations into the mix. The admin cost and inefficiency would rise.

Also on admin the NHS is run very efficiently.

Funniest thing I've read for weeks!

The idea that when energy is transformed from one form to another, some is lost in the form of heat - I feel that the same is true of money in health services except it's lost as admin - the US system has so much more in the way of transfer of money.

Also on admin the NHS is run very efficiently.

Dont be so utterly ridiculous...

I was a supplier to the NHS for years. The cottage industries, the insistence in not using efficient technology was criminal and the clinging on to the old ways just saw so much money being wasted.

I SO relate to the PP who was talking about a blood test.

When I left my previous company I apply for an NHS admin position. It involved managing 25 people (for £27k per year). I had an interview with three people one of which was a senior manager which lasted over 2 hours. I was told I would hear back within a week, I chased after 10 days, and then once more and am still waiting..... nearly 2 years later. I wasted my time and so did three other people.

I'm a doctor. I've been to the American conference for my specialty a few times.

The Medicine that they practice is pretty terrible. Yes, there are no waiting times but people get a lot of unnecessary investigations - these all carry risks - radiation, finding something unexpected (an incidentaloma) that has no bearing on the condition being investigated and might never affect the patient but now it is known about affects everything - life insurance, driving licences etc.

They are often restricted much more than we are about what drugs to give.

My usual "recipe" of IV Paracetamol/ NSAID and Fentanyl for kids having a tonsillectomy raised huge eyebrows - Fentanyl is frowned upon because of it's addictive potential (and not amongst the kids!) and they can't get IV Paracetamol in the OR as it is "too expensive"...

The NHS has many faults but every time I go I'm mightily glad that I live and work here.

I had an accident last week - I was seen in ED that night, had sutures on my face and my wrist splinted. I got an MRI appt within 36hrs for my wrist followed up my a fracture clinic appt (with a consultant) and then a specialist physio appt. It was all free.

The ED team gave me clear instructions about how to get back in touch with them to initiate an ENT referral if my asymmetric nose wasn't due to swelling as we thought but was because it was actually broken!

All in all the service I received was amazing.

My sister had to wait months for an appointment for a specialist because what she has is quite rare and specialists are few and far between (and the one she did see definitely had a god complex - terminal diagnosis delivered with “well my other patients with XYZ...” and I’m not joking).
I guess it’s not a sexy area or one that brings in the $$$$$.

This was in the states. In the U.K. there is a world leader in its research around the corner from where I work.

Just not (probably) around the corner from most of the 65m people who live on this small island.

@Acovic I'm so glad to hear you say that after my DS' treatment. I hope you agree a catheter for a urine sample in a nappy wearing 2 year old is not just unnecessary but cruel.

There are state hospitals. Not sure about people who don't live in cities.
My son needed emergency care when we were in America and they asked if we had insurance, I said yes (we did) but they didn't ask for any details at the time. They treated him and I could have just lied on the form.

@Moonstone1234

Also on admin the NHS is run very efficiently.

Dont be so utterly ridiculous...

I was a supplier to the NHS for years. The cottage industries, the insistence in not using efficient technology was criminal and the clinging on to the old ways just saw so much money being wasted.

I SO relate to the PP who was talking about a blood test.

When I left my previous company I apply for an NHS admin position. It involved managing 25 people (for £27k per year). I had an interview with three people one of which was a senior manager which lasted over 2 hours. I was told I would hear back within a week, I chased after 10 days, and then once more and am still waiting..... nearly 2 years later. I wasted my time and so did three other people.

bad management exists in private healthcare too. As a system, the NHS is relatively efficient. Just having it free at the point of delivery takes away the army of people employed in the US to determine eligibility and for what, to code, to bill, to follow up on the bills, to deal with appeals etc. Additionally, the NHS is VERY good at negotiating prices compared to more fragmented systems. It's one of the reasons drug prices are so much lower in the UK compared wiht the US. Of course there are examples of inefficiency and wastefulness but you get that in every country.

@wtftodo

You have misunderstood your mil's situation. My husband has Medicare. You do not have to reapply every year. You apply once, 6 months before turning 65.

@Acovic
I'm in the US and had a fainting episode in January. I was taken to the local ER by ambulance as I had a gash on my chin. They did a CT scan to check for signs of stroke or other bleeding in my brain, fractured skull, etc - and discovered I had broken my nose. They also sewed up my chin and administered a saline drip. I was discharged, and felt fine. Went to my doctor for a follow up visit and got a Holter monitor to wear for a month to check for heart abnormalities. I need to get dental work done as I chipped a molar. (All paid for in full by my insurance, including the dental work).

The resistance to investigations is puzzling. I for one would really love to know if I have a heart condition or a carotid problem, or anything else actually, and I am glad to have found out I had broken my nose the day of my accident, not a week later. I can't see what the problem is if other conditions are found in the course of investigations for other problems, especially if those conditions might possibly be treatable if caught early, or need treating because they would cause problems. Waiting until a problem is obvious seems counter intuitive to me, particularly when one reason cited against finding out as much as possible involves life insurance.

IV Acetaminophen for pain management - a news report here:
www.washingtonpost.com/news/wonk/wp/2018/06/19/the-growing-case-against-iv-tylenol-once-seen-as-a-solution-to-the-opioid-crisis/

I live in US. Husband is an architect and was made redundant this time last year at the start of COVID. One of his colleagues did not get made redundant, reason being he has an illness requiring regular medical care so would lose his health insurance if he lost his job. Nice of the employers to take that into consideration, but a bummer for my husband and his colleagues who lost their jobs.