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?

We are in America. Our health insurance is $2300 per month, of which my employer pays $1900 and I pay $400. If I were to lose my job or want to change jobs, it would cost me the full $2300 per month (and for perspective, unemployment in my state is capped at $2700.)

On top of the insurance cost, each family member has a $1,000 deductible, and a $6,000 out of pocket maximum. These reset every year. That means I have to pay $1,000 out of pocket before my insurance even starts covering anything and when they do, they cover 80% of the cost until I hit that out of pocket maximum, at which point they cover 100%.

The problem, of course, is what they cover. Or don't, as the case often is.

For example, right now I am on insulin. The bill is $2,000 per month. That still works out to an astronomical amount even under insurance. I am having a complicated pregnancy and while the insurance company declares "maternity is 100% covered!" they mean what they refer to as "routine" maternity so not the non-stress tests and biophysical profiles which are now twice weekly at over $100 a piece (as my insurance has kicked in.)

That doesn't even take into account that my insurer covers their "preferred" drug list only -- so the medication my doctors WANTED me on, I cannot have via their plan.

This month, I have spent $400 on my insurance, plus another $450 on diagnostic tests at the perinatologist, and then of course the insulin. It is more than my mortgage.

Coverage is limited to the doctors and hospitals in my network. I pay cash for my endocrinologist at $175 per visit because she is the best but not in my network, and then my insurance company won't cover the drug she prescribes and that I prefer because it doesn't make me deathly ill -- at $1,200 per month. It's not their preferred treatment, so they won't pay.

It's a drug that I had free on the NHS, BTW.

This week, my friend who lost her job had to crowdfund her antidepressants and doctor visit, because she's not eligible for Medicaid -- unemployment hasn't kicked in yet and once it does she will make too much to qualify for Medicaid.

This is not a system you want any part of for the NHS, and you certainly don't want the people running it running any part of the NHS, either.

I do quite a lot of work around the US healthcare system and the one thing that stuck with me was a Physician talking about what happened to people in a coma. He referred to sending them to the ‘vegetable patch’, a nursing home where they are basically kept alive.

Other physicians have talked about keeping prem babies on ICU and billing HDU to the family as they can’t afford to pay ICU costs. It’s all about profit, profit, profit. The care varies dramatically between physicians and states. Often patients aren’t offered drugs that would radically change their lives - and allow them to become economically active - as they won’t be covered by Medicare or Medicaid, or insurance without an unavoidable copay.

It’s a hard and profit driven, as opposed to care driven, system.

I’m a resident Brit and moved heaven and earth to get DD to America for treatment when she was diagnosed with a severe neuromuscular disease. There are many differences in the two systems, some good, some bad. What the US does not have is NICE which decided that my daughters quality and length of life wasn’t worth the price of treatment. An NHS which can’t administer utterly transformative treatments is not my idea quality healthcare. Having had many many visits to hospitals both there and here, my experience is the quality of care, compassion, facilities and cleanliness is vastly superior in America.

What the US does not have is NICE which decided that my daughters quality and length of life wasn’t worth the price of treatment.

No, but insurance companies can and do decide that.

Now, I will agree with you on the quality of care, facility, and cleanliness particularly in light of the fact that I am a participant on the thread about terrible NHS birth experiences and that neither DH nor I can deny. But unless you can pay, you get none of those things.

And there are so, so many people who can't pay. We've been there.

We have to pay $3000 a year before our health insurance kicks in and pays anything at all. They can decide not to cover items at all - for example, my son has asthma. The doctor prescribed him an inhaler which insurance decides is not covered so we have a choice to either appeal (we will probably need to have him use the generic version of the inhaler to prove that it doesn't work). We currently pay $200 a month for the inhaler he needs.

If I lose my job, we will have to either pay full cost of my insurance ($1200 a month) or get a policy from the marketplace which will cost similar.

You can access some very good doctors here and never struggle to get the medications and appointments I need, but I'm always conscious of how close people are to medical bankruptcy or serious issues. You are at the mercy of insurance companies as to what is and is not considered medically necessary. A colleague of mine lost her foot due to diabetic complications because the insurance wouldn't approve a treatment she needed.

Didn't Obama try to change the health care system but net resistance?
Also what happens in a blue light emergency. Surely they treat you or do they check you have insurance first

Surely they treat you or do they check you have insurance first.

Assuming you are conscious, they check you have insurance first. Then you have to sign paperwork agreeing to liability for the cost.

If you are not conscious you are given enough treatment to stabilise you and billed for it, as consent to save your life is presumed.

Why would US firms want to be involved if they didn’t see big profits in it?

Why would any firm/anyone be involved? UK firms and individuals in business currently provide all manner of services for profit. Most GP surgeries, dentists, opticians, pharmacies are private businesses. I just don't see any difference whether the pharmacy is British owned or American owned if it provides services to the required standard.

It's not a binary choice between UK and US systems. All other developed countries have their own healthcare systems which are between these two extremes and most provide a comparable or better service, often at relatively low cost.

It's absolutely terrible! Everything is governed by how rich you, how rich your employer is - then their co insurance, co pays, and unless it's routine they send it to panel to decide if you have the treatment. They overtreat, over test because the drs get paid per procedure. Getting sick can mean loosing your house because you pay 10% of the bill typically

It's not a binary choice between UK and US systems. All other developed countries have their own healthcare systems which are between these two extremes and most provide a comparable or better service, often at relatively low cost.

Except it is is a binary choice at the moment, because that's all that's on offer. No matter how many empty baskets a bakery has, if the only bread on sale is white or wholemeal, that's the choice.

If any party is offering up a German, or French, or Canadian style healthcare system, they appear to have hidden it along with Lord Lucans car keys.

The delivery of my dd cost $25k despite not have a single drug and only 24 hours in hospital total ... they charged $25 for disposal gloves! (Even if they used a whole box of 100 that's still only $5 of gloves) thankfully our insurance paid all but $100

LilyBunny, it sounds like you have a great plan, but is it through an employer? And if so what’s the deal if you/your husband can no longer work?

Just for example if you’re diagnosed with cancer in the U.K. you will be offered every available & suitable treatment to give you the best chance in life. However, in the US they will have to choose which treatment that they can afford. If you look on the cancer forums you will see this for yourself, it’s heartbreaking. Some people have sold their homes for this, yet still have massive debts that they’ll leave for their family to pay off after they’ve gone. They still work right up until the end, I know of one man who has his lunch bought for him regularly, he wouldn’t eat otherwise. Watch Breaking Bad.

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.

Except of course that $400 is more than the majority of Brits will pay in tax each month. The median salary is currently £29400 and on that salary you would pay £292.50 in tax each month (assuming no deductions like pension or childcare which aren't taxed).

I don’t live in the US but I do live in a country where healthcare is private. The NHS is truly amazing in a lot of ways and you don’t realize it until you don’t have it.

I pay over £500 per month for my health insurance and still have to contribute to part of the bills. Doctors charge per 5 minutes of their time. I would have to pay about £1000 if I needed an ambulance as it’s not covered. Giving birth would cost over £15,000 if I didn’t have health insurance. Taking my DD to the doctor for a simple checkup always costs over £100 (although I only pay 10% of that).

On the plus side, it’s way easier to see a specialist or to get a scan and quickly. You don’t get prescribed the cheapest medicine. And when you are pregnant and give birth you actually get to see a doctor.

I’ve lived in a lot of different countries and people are always totally shocked to here that in the UK you can go through and entire pregnancy and birth without ever being in contact with a doctor.

It's not a binary choice between UK and US systems. All other developed countries have their own healthcare systems which are between these two extremes and most provide a comparable or better service, often at relatively low cost.

The debate is over we should be worried about US being involved in UK healthcare so obviously it is a binary choice. I doubt people would be worried about a country that has a good healthcare system being involved in the NHS.

On comparable paycheques, DH and I pay far more in tax & healthcare in the US than we ever paid in tax in the UK -- and that's taking into account deductions in the US for pension, flexible spending for childcare, and of course the fact that healthcare isn't taxed.

We had healthcare through my husbands job in the US. We had spent many year paying through the nose and have a high deducible (Excess) So when he got a new job with Health optical and dental coverage we were delighted.
No cost to him (teamsters union) and the whole family was covered, two teens, two adults one child. We got 1st class care it was amazing. We paid the deductible for two people maximum each year and the rest of the year was 100% coverage. Same with medicines, small deducible then $10 per prescription per month. We also got up to 12 Chiropratic visits per year.
The company did let us know what the cost per family was and it cost them $35,000 a year to provide this per family On top of wages. There was talk of the government charging everyone tax on this benefit, not sure if it happened we moved back to UK.
Dh made us of it one year when he got sick, we added up all his bills (the doctors/labs/etc send copies so you know what the insurance had paid)
He cost $40,000 in 10 months in doctor visits, x-rays, blood tests, and medication. Not a single night in hospital or it would have been even higher.
It's only a great system for people with a job with this kind of coverage. If you haven't it sucks and you will be broke in no time.
I used to keep $20,000 in savings in case of medical emergencies where we couldn't work or had to pay for care before Dh got this job.

American healthcare is an absolute nightmare. I’m American and work in a health policy related field. It was probably the main deciding factor in whether dh and I settled in the US or UK.

The thing about a for-profit healthcare system is that it’s designed to generate profit, not to produce optimal health outcomes. In the NHS, cost effectiveness and effectiveness of services (NICE) drive how those decisions are made (in a really general way, not the only deciding factor, but a significant one). In the US, individual hospitals or practices or insurance companies make these decisions based on how profitable services are (so long as the aren’t constrained by government regulations in any way). It sometimes helps if a hospital produces good outcomes (because they attract new customers), but not always. It’s why a c-section can cost $50,000 in Texas and $30,000 in Ohio and then £6000 here. Because in the UK, there is no incentive to charge more to boost executive salaries.

With some exceptions (emerging technologies or certain disease pathways, like cancer, for instance), this doesn’t produce better care. It’s one of the reasons why the US does so dismally in terms of health status relative to expenditures. It spends more on maternity care than anywhere in the world, but comes dead last in maternal and infant mortality.

It also doesn’t get you services faster because you pay for it. I once had a cancer screening come up saying I needed further investigation. I lost my insurance a week later. I couldn’t afford the $2000 for the scan. So I walked around wondering if I had cancer for 2 years until I had insurance again (then the bloody thing still cost me $800 in co-pays!). My mum had stage 3 cancer and had to wait nearly a month to start chemo because her insurance company wouldn’t pre-approve it. It’s a nightmare. A friend from school recently was in hospital due to a pulmonary embolism and then got sepsis and was in for about 6 weeks, probably had 9 operations trying to sort all the various things that started to go wrong. She has insurance, but her bill will still be over $100,000 probably. She’s in a low wage job with 3 dc. She’ll probably lose her house. It’s truly shit. No one who has experienced a system like that would choose it.

The great thing about the UK is that there is excellent private healthcare, if you want it. But we are so fortunate to have the NHS for everyone else who doesn’t it could never afford it.

@JammieCodger yes, absolutely, both of our plans are through our employers. In the (thankfully unlikely) event that my husband was not able to work, that would be considered an event that would allow us to put him on my insurance mid-year. The Affordable Care Act that was passed under Obama would stop my insurance company from deeming his issues “preexisting conditions” that they could refuse to insure. As the law stands now, they would have to insure him if we paid the premium. I am not a fan at all of the American system of tying insurance to jobs. It works great for people like me who have money and good jobs, but it does a great disservice to many, many others. I am an advocate of the single payer system and higher taxes, even though people like me would be bearing the brunt of financing that. I believe the system as-is is morally reprehensible. We are a rich country and how we care for our poorest and most vulnerable citizens says it all.

I’ve lived in a lot of different countries and people are always totally shocked to here that in the UK you can go through and entire pregnancy and birth without ever being in contact with a doctor.

Midwives are perfectly able to decide if everything is going well and if they do decide that you don't need to see a doctor then you don't.

woodchuck liothyronine: www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30334-6/fulltext

"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." No, they don't just buy drugs from UK manufacturers. As I said, in this case they have a contract with one manufacturer in the UK, who has raised the price. It is only otc on the continent, not in the UK, so unless I want to self-fund all my thyroid treatment privately and travel to Turkey or France regularly this isn't an option for me.

It’s very strange when you e been used to free healthcare. Suddenly you have to calculate whether you can afford a scan, a follow up consultation, a procedure. It makes you feel less human, less cared for because it’s not about your health. It’s about how much money they can make.

You do know the NHS already does business with the US right?

Nowhere near the amount that US pharma would like it to.