AIBU to think healthcare system in US is terrible?

[brasty]

"A few months ago I had a well loved coworker pass away unexpectedly. The day before it happened, she didn't look well, and despite recommendations from many of us to go to the hospital (she had known health problems that were serious but not deadly if properly treated) she insisted she was fine and refused, partly because she didn't want to incur the hospital bills. She would likely still be alive today and for many years (she wasn't old) if she had gone to the hospital. It was unexpected and shocking to everyone. She was vibrant and caring and sassy, and everyone loved her. She has a family. This is the problem with health care in this country. No one should die because of fear of hospital bills."

I just read this about someone in the US. And it is shocking that people can die from easily preventable things, in a rich country. I know in a similar situation, my mum would not have called an ambulance for her suspected heart attack. Women having heart attacks often have much more mild symptoms, and she thought I was making a fuss anyway calling an ambulance. If she had had to pay, she would simply have refused to go, and maybe died.

Things will undoubtedly get worse if the Republicans manage to replace the Affordable Care Act with their plan. The US health care system has been in crisis for decades, and the ACA was a shaky step in the right direction. Getting rid of it now would be a huge mistake which even some Republicans seem aware of so we'll see. A single payer system would be the best option, though God knows when that will ever happen.

I have lived in both the UK and the US. The healthcare I received in the UK was abysmal. And contrary to popular belief, it's not free, you pay for it in your taxes. For the same sort of job in the UK, as I had in the US, I paid way more in taxes. Access to healthcare has improved substantially in the USA since Obamacare.

My ds has a rare genetic disease and severe mental illness. I have the normal crap you get in your 50's when everything is falling apart a bit. Here in the USA I have Medicaid which is the insurance for poor people who don't have insurance through their employer. It costs me nothing and I pay nothing at the point of delivery for any of the services. I purchase an additional policy for my ds to top up what Medicaid doesn't cover. It costs me far less than what I paid in additional taxes in the UK. My ds has been in and out of the hospital, specialist treatment and residential treatment his whole life. All of it has been substantially paid for here in the US. In the UK, I had to fight and wait on waitlists for months to years to even get a specialist to see my ds. And the dire lack of preventative care meant that many of the illnesses that ds had were not diagnosed early enough to minimize his sickness and discomfort. In London, I found the doctor's offices and hospitals to be filthy, in poor repair, and understaffed and the staff to be rude and unhelpful for the most part.

Here in the USA, with Medicaid, over the last 4 years I have had the necessary referrals to rheumatologists, neurologists, dermatologists, OBGYN, gastroenterologists and physical therapy all with at most a month or two waitlist. When I was was in the UK, I developed a problem with a tendon in my foot when I was pregnant with dd that meant I couldn't walk more than a few steps without severe pain. I waited almost 2 years for an operation which when I finally got it was poorly done and caused me troubles with my foot ever since.

Yes, Medicaid isn't as good as a fancy plan provided by a large employer (which means the rich get better care than the poor), but for me it's been way better than anything I experienced in my 7 years in London.

user149
THe NHS is in crisis because Jeremy Hunt is systematically and deliberately underfunding it
see chart here
en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

The US system is in crisis because it is mind numbingly inefficient while not even providing coverage at all to the most expensive patients (the poor and the chronically ill)

A simple comparator on the effectiveness of healthcare systems ....
infant mortality
out of the 34 OECD countries, only Mexico, Turkey, Chile and Slovakia score worse than the USA on infant mortality
en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate
that implies basic weaknesses in the healthcare system in the USA

TalkinPeece the nhs has been in crisis for far longer than JH has been in charge (I'm not a Tory fwiw). There is also great inefficiency in the nhs, eg routine use of hiring temp staff, the woeful situation they've got themselves into with meds contracts etc etc. Even nhs bods say that.

Imo they will struggle to get on top of it. They do not have the funding. Previous governments have not sorted it out (though there is reason to believe it was much better in the 90s/2000s even if they struggled in some areas then).

I'd be happy to pay more tax if I felt confident it would be used well to fund the nhs. There is a lot of firefighting. No disrespect to people who work there, a lot of personal sacrifice is made to make it work, but it is the people who are the least equipped to make changes (ie those at the coal face) who are sacrificing the most.

But I'm not disagreeing that the US system is broken. Look at that, I even said it in an earlier post. Not sure what you would like me to say - ?

SofiaAmes 'And contrary to popular belief, it's not free, you pay for it in your taxes.' Yes, this.

I heard some rubbish on R4 about how hearing aids are 'free', I despair. Ffs make people feel their taxes are worth something, you don't pay for it at the point of delivery because you have already paid for it via tax.

TalkinPeace You forgot the disclaimer that is published next to the statistics you are quoting: Note that due to differences in reporting, these numbers may not be comparable across countries; while the WHO recommendation is that all children who show signs of life should be recorded as live births, in many countries this standard is not followed, artificially lowering their infant mortality rates relative to countries which follow those standards.
Also, the infant mortality rate statistics are not really comparable from country to country as they use different measurements and standards. The USA counts all live births regardless of gestational age while France, for example doesn't count any births before 22 weeks. So a 14 week or 21 week baby that is born alive and then dies a few minutes later would be counted as an infant mortality in the USA, but not in France. If you look carefully at the statistics, most of the USA infant mortality deaths are from pre-term babies.

I live in the USA. I have an 'excellent" insurance plan through my employer. I pay for said plan monthly. All good so far?.

My "excellent" plan has a $4000 annual deductible before it kicks in. That means the first $4000 of any health care we need I have to pay for, EVERY year. I dont have that kind of money.

My Dh was in hospital last year, 5 days. My bill after insurance was $6500.

Dh is 53 and his doctor had been on at him since turning 50 to get his colonoscopy done. He had it done last year cos we had met the deductible for the year so wouldnt have to pay for it.

Im 52 I also need a colonoscopy and a mammogram and blood work. Just cos they want it done after a certain age. I cant afford it so wont be having them done.

Oh and after my $6500 bill, they gave me 3 months to pay it then sent me to collection. I had set up a direct debit to the hospital so I was trying to pay iy but nope couldnt pay it fast enough so off it went. The collection agecny wanted to settle for $4500 but didnt have that either so now I have a direct debit to them.

It sucks.

sofiaames
most of the USA infant mortality deaths are from pre-term babies.
which does not make it any better.
The USA spends more on health than any other country and still has significant numbers of preterm babies (which in India is blamed on poor antenatal care and nutrition)

And you were lucky with your Medicaid. Lack of joined up thinking by them has condemned my relative to a life of illness and then an early death.

user149
You are very right, the underfunding long predated Jeremy H, but he has chosen to carry it on for the last 7 years as health secretary
demanding "efficiency savings" while demanding contradictory "reorganisations"
The NHS has some mind numbing inefficiencies and dire procurement (not helped by the gruesome PFI deals that are bankrupting hospitals)
but with an ageing fattening population, taxes have to rise by about 3% to fund what people want.

theoldtrout01876 but you would almost certainly be saving far more than the $4000 in the taxes you pay compared to the UK. Perhaps you should think about saving that money for your health care since it seems that you need it every year.

Your colonscopy, mammogram and preventative blood work should be free at the point of delivery under Obamacare. I would suggest re-reviewing your health plan to check why you think you would have to pay for these things.

but you would almost certainly be saving far more than the $4000 in the taxes you pay compared to the UK.
Um, you know that only 46% of the UK population pay income tax don't you ....

I'm American, living in the UK for 6 years. I like the NHS, I disliked the system at home. I'm currently 23 weeks pregnant, I've never had to worry about seeing my midwife or doctor for anything because I'd need to pay. I'm not worried about the bill once the baby is delivered. I had an excellent employer paid insurance plan when I was at home. I'm asthmatic, and I paid roughly $70 a month in asthma medication. Asthma meds are some of the only types of medication where there isn't a generic option. I was on birth control, paid $30 a month for that, as I was pre-Obamacare. I was also a student, but worked full time to keep my good health care. Before that I had been on my parents health care insurance plan, but then my dad lost his job during the recession and they couldn't afford Cobra. So I was dropped. At first my employer plan wouldn't cover me because of my pre-existing conditions, but my employer got them to cover me anyway.

These are things I never have to worry about here. Do I see inefficiencies in the system here? Of course. Do I see malpractice and medical mistakes? Of course, we're talking about humans. Do I wish my taxes were lower? Duh, I'm American. But do I ever want to voluntarily go back to a system where there is such an OVERWHELMING inequality? Absolutely not. Having a system that's paid for out of pocket has not removed these inefficiencies or medical mistakes. I'm unsure why people are trying to make that link. Try going to an inner city hospital for an emergency, with Medicaid or without insurance. Try and see how long you're going to wait to be seen. My Aunt is a trauma surgeon in Chicago. The stories she can tell.....

Another example: My sister is trying to get pregnant. They spent $33,000 on IVF, and they've just spent another $15,000 for another round. My trust, York, gives three free rounds, regardless of circumstance. I know where I'd rather be.

theoldtrout has reminded me of another important difference between the US and the UK, which is the focus on preventative screening in the US (our insurance company requires all adults to have an annual physical, including blood work, or pay a further premium of $50 each a month). This, IMO, is the difference between an insurance based approach which uses risk management methods to keep down costs and a population based approach which treats issues as they arise, banking on the fact that most people won't need this intervention.

TalkinPeace luck had nothing to do with the excellent care I am receiving under Medicaid. Choice and accountability do have a lot to do with it. I research every doctor I am referred to and request a change if I am not happy with the referral. I never had that kind of choice and power over my own healthcare in the UK. I recognized that Medicaid probably wouldn't offer the quick and specialized care that my ds needs, so purchased an extra plan for him which was a choice I didn't have in the UK. All said and done it costs me about $8000 a year. So, I have had to cut back on everything to make this work, but my ds is alive. If we lived in the UK, not only would I not have this choice, but I do not believe my ds would still be alive.

One of the basic divisions talking about either system is that a lot of people have only experienced one of them and/or feel strongly that one is superior (morally or qualitatively). And folk who have enjoyed good care in either system don't understand or don't want to understand those who haven't.

As an expat living in the UK I always feel like the NHS is a saved cow and I should never ever dare criticize it! I feel just like SofiaAmes my problem with the NHS has always been the lack of choice.

US medicine is years ahead of ours in many ways, they can easily sort things that the NHS holds basically incurable, scanning technology is widely deployed and readily available, hospitals are often more spacious, clean and well-equipped, staff can work on arguably better terms in terms of pressure/time etc. If you or someone in your family needs a lifesaving operation you can get it in a timely fashion and not cross your fingers and wait for a letter to come before you die, and if you have something chronic and painful that is not life-threatening you are far more likely to be able to get it sorted and return to a good quality of life where the NHS would just leave you in pain until it develops into something life-threatening and that's just that, tough shit live with it (or even give you archaic treatments that were dropped by US medicine years ago because they are proven not to work). Even if you go private in the UK, there aren't the same facilities a lot of the time.

Where the US system fails is, as you identify, provision. Yes most legally working people will have health insurance but it falls massively short. It's little good having great facilities if you are afraid to get things dealt with because your insurer is crap, and no good having access to that operation or cutting edge treatment tomorrow if it will leave your whole family destitute and homeless.

Overall I think the NHS is mostly better from a patient's point of view, but I wouldn't implement it how it is if I was starting from scratch.

US medicine is years ahead of ours in many ways, they can easily sort things that the NHS holds basically incurable

Really? Like what?

The US healthcare system is broken not because it's 'private' but because of an outright lack of competition, owing to a spineless Congress.

It's a good thing for people to feel the weight of their lifestyle choices.

I wonder how many people in the UK suffer longer than they should because it can be so difficult to see a GP: there's the whole rigmarole about booking appointments in advance, or having to play phone lottery on the day; then taking time off work to get to an appointment, or have to take the kids with you. Then there is the likelihood that the doctor will be running late, and when you do get in there you have about 7 minutes to set out your concerns, have any examination necessary, get a diagnosis and any prescription or discuss follow up actions. If you have more than one issue to raise (and often it's the second, embarrassing issue that is more serious, like bleeding every time you poo, rather than the one that was raised first), ideally you would have a double appointment, but that's not always possible.

Compare to the system for seeing a primary care physician in the US, where the appointment is booked for a mutually convenient time and takes basically as long as necessary (I was in with DD for 45 minutes once). No rush, no queue of sick people coughing the waiting room willing you to get out of your consultation as quickly as possible. $30 (ie £20) well spent, if you can afford it.

SofiaAmes Why I THINK I should pay it????? MMMMMM lemme see cos the hospital billed me for it maybe.

I worked in healthcare for 30 years, in the US. I KNOW about health plans and how they work and all the sneaky little ways you are actually getting less than it appears on the surface. I certainly know my own health plan, probably better than you,dont be so fckin condescending

And while Im on the subject of fckin condescending lemme just pull another $350 ish a month out my arse to put aside shall I.

It's a good thing for people to feel the weight of their lifestyle choices

And here we have the internet tough guy in it's natural habitat.

OlennasWimple oh my office visit will be free for a physical but any and all of the stuff they ask for after that, x rays, bloodwork etc is put towards my deductible, so in theory you could say an annual physical is free but in reality its not.

And here we have the internet tough guy in it's natural habitat.

Do you understand how private insurance works?

Risk factors within your control cost more.

It's illegal to charge more for risk factors outside of your control.

Olennas, that is your experience. But for some people with insurance plans that aren't as generous or where they don't have access to a doctor, their experience is not the same.

If anything, this discussion is just highlighting the severe inequality in the system. People in support of the US system who highlight how easily they're able to see a doctor are simply ignoring the millions of Americans who cannot do that so easily because they have no access to insurance because of cost. Furthermore, each state has their own rules on Medicaid, and not every doctor accepts Medicaid. Let's not ignore the problems in the system. This isn't even addressing the issue of a lack of doctors in some communities, i.e. poor inner city and rural areas, areas with high immigrant communities, etc.. There are severe and serious inequalities in the US system. Open your eyes, our system is SHIT for people who don't have money. The stories of people getting kicked off their plans for miniscule bullshit wasn't just an exaggeration of the problem. The stories of people having a hard time finding a doctor to take their type of insurance plan wasn't a lie.

I know you're on Medicaid, but quite frankly, you can afford the $8k to pay for your sons private insurance. Most people on Medicaid cannot afford to do that, as they're on minimum wage or the plan is just way too expensive in their area. Your story on Medicaid is not indicative for the majority. I speak from some experience, my research project for my BSc in Economics and Policy was on health care in light of Obamacare. Furthermore, again, I speak from the experiences of my aunt who works in a deprived area. She said the majority of people who visit her emergency room are either on Medicaid or have no insurance and can never pay their bills. Medicaid also doesn't cover everything. Some states won't allow Medicaid to cover birth control or abortion care. That alone is a severe inequity in the system.

I haven't had a problem getting a GP or midwife appointment in the UK. But even I realise my experience is not indicative of the entire NHS. I did call my US doctor once, with an obvious viral infection. Normally its not a big deal. But, I'm asthmatic so its an emergency appointment. She didn't have any appointments for 2 weeks. I was forced to go to the emergency room for treatment.

My mom told me that she rejected an epidural in three of her labours because she knew her and my dad couldn't afford the additional cost on their bill. WTF is that bullshit. That's the last thing they should be worrying about while trying to give birth.