To ask about the American healthcare system?

[ZortNarf]

There's a lot of talk about the NHS being sold off to the Americans. From what I can see it's just about American companies getting higher prices from the NHS - so not 'selling it off'.

But if they were allowing American companies in to run the NHS would that be a bad thing? I've no real idea what healthcare's like in America except from TV. Is it bad? Don't we keep raising money to send sick kids there when we can't treat them here?

Genuine question. Surely doctors are doctors and hospitals are hospitals? Should I care who runs them, owns them, or whatever?

The US healthcare system is an absolute hellscape, of that there is no doubt, but it's also even more bizarre than many people claim, and many of the list prices you see being posted, are not actually the prices people end up paying,

There are very strange incentives at work, where the hospital will vastly over-inflate the list price (i.e. the price the hospital quotes the insurance company ultimately paying the cost), because it gets to claim revenue from the government by claiming that a proportion of the difference between the total list price, and the actual monies collected (i.e. the true price it collects from the insurer), were used to fund "free" care for the poor.

Meanwhile, the insurer gets to claim that the difference between the pretend "list price" and the "true price", shows its ability to negotiate the price down.

So you have a double perverse incentive which leads to it being basically impossible to understand true healthcare pricing in the US.

I listened to an economics podcast recently about a straight up private healthcare provider in Kansas City, which only accepts cash and refuses to take insurance. It offers many of the services at a fraction of the mainstream US healthcare cost, their prices have not risen since the 90s (so have gone down in real terms), and their business is booming, priced cheap enough for lower middle class Americans to just directly pay for certain treatments.

The true indictment of the US healthcare system that this straight-up paid for healthcare is actually less of a nightmare than their unholy fuck up of a model!

It is genuinely, horrifyingly complex, and actually way worse than even its detractors claim. It would actually be better if it was a straight up raw capitalist private system where hospitals competed for patients.

There's a lot of talk about the NHS being sold off to the Americans

Oh no there isn't.

@koloh we never pay at the hospital. The bill is first sent to the insurance company for them to settle their portion (how is the hospital even to know what insurance plan you are on and what your deductible is? That’s between you are the insurance company). After that is settled, the insurance company sends a statement and the hospital bill follows. This usually takes several weeks. My husband is American, lived here all his life, I’ve lived here many years. Never paid anything whilst at the hospital. Ever. Or are you not insured? If so, how can you expect to avail of a service for which you have made no contribution through taxation or insurance without paying? I’m British but don’t have NHS eligibility anymore so if I fall ill whilst visiting family I would also have to pay. Isn’t that the same thing?

I didn't expect that. I had UK insurance. There seemed not to be a process for dealing with this.

But tbh I was more talking about the state of the place. It was dilapidated.

@ZortNarf 72.5 million people here are covered by MedicAid - that’s for low income and disabled people. Over-65s are covered by Medicare. MedicAid is funded by taxation. Children are covered by CHIP - also funded by taxation.

Our is $400 a month for our household. As I mentioned, our taxes are much lower. The $400 is deducted from my pay check each month so I don’t physically hand over money to pay it, I just see it as a kind of tax.

I’m American. I pay $500/month in premiums on my very good healthcare plan for myself and the children (my husband is on his own plan through his employee). My employer pays the rest of our premium. I pay copays ($10-50) for every doctor visit. I pay a copay on prescriptions (usually $10-20). I have to meet a deductible of $1800 before my plan starts paying (copays do not count towards that). It can get really complicated very quickly. My husband was just diagnosed with a condition that will require brain surgery, and we are going to hit the out of pocket maximum on his plan. Thankfully, he “only“ has a $5,000 out of pocket maximum and we can afford that. His plan should pay the remaining $150,000 for his surgery.

The real issues arise if the Affordable Care Act is repealed, as the Republicans would like to do. That would allow insurers to call my husband’s issues a “pre-existing condition” and refuse to insure him. We could also go back to the world of lifetime maximums, where a plan could put a cap on healthcare expenses over your lifetime and refuse to insure beyond that. For someone like my husband, who is in his 30s with a major medical diagnosis, that could be crippling. And keep in mind we are wealthy by any definition. For those living on minimum wage or just trying to get by, the system is not sustainable.

@koloh - it was New York, say no more! Where we live the hospitals are very well managed, very clean, always have a private room and bathroom, the food is of a very high standard.

My comment was aimed at the fact that you were implying that NO ONE leaves a hospital without paying over here and its simply not true.

@SerendipityJane is she here in the US? If so, disabled people are covered by Medicaid, which is financed by taxation.

Not in the US and never going to go (because ... yup, insurance).

Putting aside the clunky "disabled", when she was diagnosed (aged 17) it was practically unheard of for someone that young to be diagnosed with MS which (in 1987) used to be considered a disease of middle age. It was only a once in a lifetime chance that the neurologist she first saw had literally just graduated and the last thing he'd studied was MS. He had a right old ding-dong with his boss who refused to accept the diagnosis (so there's your first hurdle - being believed). Only when a lumbar puncture proved it, was it accepted.

Of course not all MS is as nice and fluffy as the inspirational videos would have you believe. She could walk until aged 20 and then it was pretty quickly crutches and a wheelchair. Oh, and "might as well get sterilised, we don't want you having kids, do we ?" (verbatim quote from doctor).

Of course at that stage it was impossible to work (I imagine the US is a paradise of accessibility ...) and that's been life these past 32 years. In the past 5 years her legs started "jamming up", but in a rare break, it turned out she would benefit from a treatment where a pump trickles baclofen into the spinal column and prevents them seizing.

www.medtronic.com/us-en/patients/treatments-therapies/drug-pump-severe-spasticity/getting-therapy/insurance-coverage.html

If the cost of treatment is an issue, don't hesitate to explore alternative options and look for assistance. A social worker may be able to provide help or information (your doctor can provide a referral). Or ask the hospital finance or billing office about special financial programs and options.

The day, a UK NHS doctor has to talk about payment plans before treatment will be a dark, dark day indeed.

To tag onto my previous post, which is quite doom and gloom, I should add that it is nice in crisis situations to have quite a bit of freedom of choice and the ability to move quickly if you can pay for it. In the three weeks since my husband was diagnosed with a brain tumor, we have traveled the country to meet with eight of the most world renowned specialists and get their opinions on treatment. We are likely going to travel 2,000 miles across the country and have his surgery done there because that is where the best doctors are. We have a very good plan, so most doctors in the country are “in network” and we can just call them and schedule an appointment (no need for a referral or anything like that).

I don't know what to tell you. Perhaps read what I wrote again.

I wonder how both healthcare systems would cope with shutting down potential epidemics? I don't know enough about the American healthcare system to make any bold claims on the matter but surely there would be an acceleration in transmission when there are whole sections of society that don't have easy access to medical attention and then surely it puts everyone else at risk?

*You're suggesting that a deal with a US pharmaceuticals, which we already have, incidentally, would open the door for them to pass through unrelated charges?

You do know that there would be a contract, and there would be lawyers reading it before signing off?*

Currently the NHS has strict controls on drug pricing. If that ceases to be the case under a UK US trade deal then that opens the door for the kind of price gouging and profiteering there is in the US.

It sounds as though you are suggesting that what is legal is somehow unchangeable. Parliament legislates. A trade deal would include/require legislation, wouldn’t it? Apologies if I misunderstood your point.

Another American here, though I'm now in the UK and have been for some time. I have a lot of experience with both systems. It sounds like you’re one of the lucky ones as far as your insurance policy goes, BritWifeinUSA.

For all its faults, there's no way I'd trade in the NHS for a US-style system.

Poor people who lose their children have to deal with grieving whilst juggling a fuckton of medical bills and avoiding homelessness.

That's all I need to know to know that it's a shit system.

Look up how many private bankruptcies there are every year in the States and why they are caused.

I wonder how both healthcare systems would cope with shutting down potential epidemics?

depends on the politics. The response to HIV/AIDS was pretty woeful compared to the UK which is acknowledged as being the boldest and quickest, with a corresponding low rate of infection.

Like a few pp I've had a good experience in the US but we always had good insurance. Just five years ago my mum (long retired teacher) was treated for breast cancer at a top teaching hospital for minimal copays.

I take an expensive drug that costs pennies to make and is available otc for next to nothing on the continent but costs the NHS hundreds of pounds a month because they failed to negotiate a decent contract so the sole UK manufacturer raised the price on a whim. Costs $100 for three months supply in the US without insurance. I feel dreadful getting it on the NHS but that's the only way I can have it monitored.

I was able to get a blood test from my mum's GP in the US for $40 (didn't bother claiming it on insurance). Sometimes if they know you're uninsured they charge you their costs and no more, but I accept this comes under the banner of 'who you know' and everyone doesn't have access to that.

My (US) cousin is on a low income and her kids have always had access to decent health and dental care. I think it's a real problem if you have preexisting conditions and/or expensive/inadequate insurance and an income that is just above the cutoff point for Medicaid.

I do however think the NHS isn't perfect as it's abused so much........I'd like to see charges brought in for missed appointment and those that abuse A&E.

Won't happen tho as it will just lead to more vulnerable people being too scared to go.

A US friend with MS. She pays thousands for MRI's, and her and her husband have good heathcare. It's insane. She told me it will cost them $300 just to walk in to an ER, they charge for everything, even individual band aids. Their son is under orders to be bloody careful because the cost of an ER visit is insane.

Currently the NHS has strict controls on drug pricing. If that ceases to be the case under a UK US trade deal then that opens the door for the kind of price gouging and profiteering there is in the US.

There's also the very real situation where a UK-US trade deal prohibits the UK (and it's citizens) from purchasing from anywhere but the US. So no importing medicines for personal use from (say) the EU or China ....

@BritWifeinUSAThey don't fund expensive medication for MS for example though. I think people can apply for assistance but they don't always get it certainly not like here. Healthcare costs are much much higher in the US and they are here and if you aren't paying that much it is because your employer is paying for it.

and they are here than they are here

Dental care, eye exams, hearing aids, etc. are not covered by basic Medicare. You can pay more for supplementary Medicare plans to cover things like that.

Long-term care is not covered by any Medicare. If an American needs long-term care, they need deep pockets and/or a good private insurance policy.

I take an expensive drug that costs pennies to make and is available otc for next to nothing on the continent but costs the NHS hundreds of pounds a month because they failed to negotiate a decent contract so the sole UK manufacturer raised the price on a whim. Costs $100 for three months supply in the US without insurance. I feel dreadful getting it on the NHS but that's the only way I can have it monitored.

What drug is this? Your anecdote sounds very odd as the NHS doesn't just buy drugs from UK manufacturers and if it is something you can buy over-the-counter then the price they negotiate as irrelevant anyway.