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?

I wish everyone would read Lionel Shriver's book "So Much For That", and get back to me re US health costs for a family member who is seriously ill and the impact it has on everyone around them.

Shudder. It had an effect on me anyway to be honest.

Have you seen the Michael Moore documentary Sicko?

Sure it’s very one-sided but all of the people in that documentary had insurance - the man who lost his home and had to move i with his daughter because he suffered multiple heart attacks, the people whose loved ones died because insurance companies found any excuse to get out of funding a treatment, the woman whose asthmatic daughter died because her insurance company refused to fund care in the hospital she was taken to and she was moved while unstable.

We should absolutely care.

The US government spends more on healthcare per person than the U.K. does and still people die for lack of insurance, and people go bankrupt due to dodgy insurance companies.

The reason the government pay so much? A privatised system is much more expensive to run, and drugs typically cost many times more than we pay.

You should absolutely be worried.

But putting aside costs, ask yourself the question, if you had a life threatening condition, would you prefer to be in the average US hospital or the average NHS hospital?

That depends on how much money you have surely? Have you seen the discrepancy in US cancer survival rates for insured vs uninsured people?

Many Americans on low incomes with poor or no insurance simply don’t seek medical advice when needed. I was reading an article recently which unfortunately I can’t find now but it showed the percentage of ER visits which were down to lack of primary care before Obamacare came in and it was not far off half. These people had nowhere else to go.

US healthcare tends to be more risk averse than the UK. Doctors need [malpractice] insurance as well, and that can be impossible to renew if you've got some "questionable" decisions under your belt.

It's why they're so hot on scans and tests - they are intended to drive the patient to make the decision and ensure there's no danger of being sued.

So not only are you paying an eye watering amount in your insurance+excess. You're also being asked (quite sneakily in some cases) to effectively set out your own treatment.

But putting aside costs, ask yourself the question, if you had a life threatening condition, would you prefer to be in the average US hospital or the average NHS hospital?

Absolutely the NHS hospital. Because then when I woke up and started on the path to recovery I wouldn't be worried about the amount of debt I was about to be in and how to handle insurance.

I had a very complicated and traumatic birth experience in the UK but the one thing I never had to worry about was the cost. Here, I am terrified of what would happen to my family if the same thing happened again.

What would be so bad about it? For a start:

• My insurance company, not my child's doctor, would decide what treatments she gets, based on what they cover. The doctor may or may not be able to negotiate this, but that takes time and in the case of life-saving care that is the one thing we would not have. And in that situation who would not agree to anything to save their child's (or indeed their own) life?
• I would have to cross my fingers and hope that all treating professionals at the hospital were covered. For example, on my last A&E visit in the US, all but one of the doctors were in-network and covered. The one that was not -- and I can't remember even who that was, or seeing them, was not and cost me an additional $500 (on top of my $500 co-pay for emergency treatment, which doesn't apply to the deductible.)
• I would be spending recovery time negotiating care costs with the insurance company, finding in-network and covered doctors.
• I will be paying to the deductible & out of pocket maximum for any follow up care, meds, physical therapy, etc.

And then at 12 weeks, I'd be back to work. Maybe. Assuming I didn't need/my child didn't need additional care, which at that point could cost me my job because we're outside of the scope of the Family Medical Leave Act.

The NHS is being dismantled.

I have two kids with additional needs.

In the last year my boy has been told they no longer offer the physio he needs, the enuresis nurse he saw retired and was not replaced as was his paediatrician. He has Speech and Language difficulties that will affect him in the future but there is no help as there are worse cases. He has been waiting 2 years and 3 months for an assessment to see if he has autism.

My dd has lost her physio and gas ended up in hospital in a mental health crisis at the age of 10. She's not bad enough for any help though! Unless they are trying to top themselves, they're not bad enough to be seen. If she does get help, she'll be seen urgently. The urgent waiting list is 6 months.

That's how underfunded the NHS is by this government. It's only going to get worse under them. They are breaking it up, brick by brick.....

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 isn't to do with NHS "negotiation skills" or because they have chosen to buy from only one supplier though. The NHS doesn't approve prices for generic medicines and they would buy from a cheaper supplier if they could! The company have taken advantage of the fact that noone else is supplying the UK and there is no competition as usually happens with generic medicines. They are being investigated by the competitions and markets authority about it,

I get the impression the US medical system is dominated by an effective monopoly of health insurance companies, private hospitals and drug companies. Because health care is (by necessity) heavily regulated, there can't be true free competition, so there are no incentives to reduce costs, and every incentive to keep raising them.

To give an example, I read how ventolin (asthma puffers) cost maybe $5 over the counter throughout the worlds. In America they cost something like $50 or more, due to drug companies abusing patent laws.

Those who are fortunate enough to have decent health insurance may have semi-affordable health care (still with a lot of out of pocket expenses). Everyone else has to take their chances.

Popped up via FB ... yet another

My experience in a US hospital was awful. They are no different from nhs hospitals, busy, crap food, etc.
Whereas here my dh had one of the top specialist surgeons in the country for his nhs treatment.

One thing I will say about what my US insurance covered was that I could go to fancy dermatologist clinics to get moles checked etc. But haven't really compared that to nhs equivalent.

If the cost doesn't put you off, remember it's an INSURANCE COMPANY you'll be dealing with. Exactly like other insurance co's in terms of cocking things up, putting wrong things on forms, trying to get out of paying, loads of small print so you never quite know if you're covered it if they will agree that the treatment you got was necessary so they will/won't pay.

At least with the current uk system, ppl with enough money can choose to go private if the nhs service isn't quick / comprehensive enough etc

Healthcare coverage in the US has changed/improved significantly since the Affordable Care Act was passed. Everyone is entitled to insurance of some sort, but you do have to be proactive and sign up for it (not a complicated process).

Some years ago, I had to stop working full time because of a sick child. Because of my low income I was then eligible for Medicaid (coverage for the poor and/or low income). Under Medicaid I have ALL my medical care covered with zero cost to me. If you are disabled then you are eligible for Medicare and/or Medicaid. And for the most part there are excellent doctors available in every field. Mental health and dental care is sparse, but light years ahead of anything I encountered in England.

When I lived in the UK (1995-2005) I had to wait months and sometimes years for any sort of specialist appointment. When I couldn't walk because of a torn ligament/bone spur, it was 2 years before I was able to finally get a an operation which allowed me to walk again. I had no choice in doctors (the operation was poorly done and I have been in pain ever since) I was given NO aftercare and no assistance in getting around. Both my dc's were born in well respected hospitals in London and they and I almost died because of the poor and extremely understaffed medical care.

Here in the USA, when I had a unusual numbness in my face...(turned out to be TMJ), I was referred to specialists and multiple MRI's within days until it was determined that it wasn't life threatening and then it took only a few weeks to be referred to a PT to treat the TMJ. In the UK when my ds has some neurological issues as a toddler, it took almost a year for him to be referred.

I also what to reiterate what a PP said. For someone who is earning enough that they have to pay premiums and co-pays, the cost of healthcare at the point of delivery is more in the USA, but my experience was that I paid an equivalent amount (about $10,000) less in taxes than in the UK.

You will always hear a story about someone who went broke or had absurd bills in the USA. I suspect that most of those cases are either someone who had an illness before the Affordable Care Act (this was a game changer in the USA), or someone who had not bothered to obtain health insurance (just like buying car insurance, this is legally required in the the USA), or someone who got a incorrect bill and instead of questioning it, just ignored it (This happens all the time....everywhere....not just in healthcare).

I believe the phrase ‘selling the NHS’ is somewhat simplistic.

What I fear may happen is that services within the NHS may be put out to tender. ie cancer screening, a+e, heart surgery etc.

Some services are already run by private companies for the NHS - food, linen etc. But not many that directly affect the actual patient.

The worry is that companies will submit tenders that may initially appear advantageous to the NHS but soon turn out not to be. The costs may spiral upwards and whilst we, as patients, won’t be asked for cash we will as taxpayers.

The NHS has a lot of bargaining power over the price of drugs. Americans pay far for their drugs, be it privately or through their insurance.

American healthcare is brilliant - if you are wealthy or have decent insurance but many 3rd world counties offer better care that what poor/uninsured Americans can expect.

If theses Tories get in they WILL sell the NHS. They privatised everything else (with horrific consequences). They'll see it as yet another to make a few (more) million each.

I'm not very good at links OP, but suggest you watch Rob Delaney on You tube talking about our wonderful NHS

woodchuck yes, are we not saying the same thing - ? I didn't mention skills, I stated that they have an exclusive contract with one manufacturer, who has raised the price. I can buy it for a fraction of the price in the US and otc outside the UK.
I understand this is not the usual way of things and I have no argument here except to say I've had good, affordable care in both the US and UK - ?

You can get great healthcare in the USA, if you have the cash. They do not have a healthcare system to ensure all citizens get access to healthcare according to their need in a fair, affordable and equitable manner .

I’ve lived in the USA. In addition to the points already raised, I will note that my dental surgery had more billing clerks than dentists, because exact billing clerk has to specialise in just one or two insurance companies and their policies.

US healthcare is so expensive because everyone has to have their cut and make a profit. I had a bad back while I was there - there were “doc in a box” clinics where I could just turn up and have xrays - great, I could afford it, many can’t. Then the referral to the specialist and first I saw the physician assistant, explain everything to them, while the doctor joked about with the receptionist. Then the PA went to relay our conversation to the doc, then the doc came in to me to have the same conversation, only this time it was longer while I corrected what the PA got wrong.

Same scenario with dental nurse, hygienist; nurse & gynaecologist. Massive job creation & money making scheme.

US healthcare is so expensive because everyone has to have their cut and make a profit.

My US friend had to be £1500 for a very minor op for her child. He was 9. They have good insurance, this was the excess.
Another thing is that healthcare systems that work in this way tend to over-medicalise as there is an incentive (someone will pay). So, you may be offered plenty of ultrasounds during pregnancy. Maybe they are even included in your insurance package, but ultimately, you are paying for them. The NHS bases everything on medical need. It's not perfect and things do go wrong, but people here donor have to worry whether they will get treatment or whether their treatment will be inferior because they have less money.

I don't understand how it works in detail but I have a friend over there who had last year a DD with down syndrome. she needed heart surgery twice which was not covered by her insurance and she is currently selling the family home to pay the $250k back. It has ruined her and her family completely.

I am so glad we have the NHS here. Such a thing would never happen.

Also health insurance providers have the right to drop you if your health conditions become too costly, then you really are up the shit creek

Not true. Obamacare fixed that. Thank you Mr. Obama!

@NannyR are you a fellow TPWKY fan? I absolutely love it!

A film like Erin Brokovich might help you understand some of the human factors involved, or there are some other suggestions at www.thewrap.com/9-movies-health-care-america/.

Or if you'd like something a little more recent, then Lost Transmissions - vancouversun.com/entertainment/movies/simon-pegg-delivers-strong-dramatic-turn-in-2019-whistler-film-festival-opener

Just be rich and don't get sick or have an accident. You'll be fine.

Oh and lots of plans don't cover mental health care, you'll have the privilege of paying extra for that luxury

Wrong. We have unlimited visits, $30 a visit and no waiting lists. In the UK I was told it was a 2-year waiting list through the NHS. I had to pay 75 quid a visit instead, otherwise I would have more than likely been dead by the time my name reached the top of the list.

Contraceptive pill - you only get the exact number you're allowed under the plan. If you're going away and need to get an extra pack you have to go through a few hoops

Wrong again. No hoops to jump through, just order a second pack and pay $25.

The quality of healthcare is America is far better but it’s more expensive. It’s actually more expensive than it should be because it’s syndicated. There was an article in last weeks economist on the issue in the American healthcare system. Worth a read.

@losingthepl0t the NHS is increasingly not treating or has such long waiting lists that it might as well not treat. If things don’t improve very very soon it could happen. There are already many people who compelled to pay to go private instead of risking a long waiting list.