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?

NHS is unsustainable for EVERYONE no matter their means now.

OK for those below a certain threshold, but not ok if you can afford something to help pay for your health care. And I do realise most will have NI contribs and so on.

It is the way of the world now, unless you pay a contribution through your employment or something like that.

The end is nigh for free NHS for everyone within the next ten years.

A ICU nurse in Texas told me that they charge $5 for a plastic cup for water and $15 for an aspirin. She also told me that by law they have to treat people even if they know they dont have money. She said they often get repeat admissions of homeless people/drug addicts and they treat them each time the same as if it was someone with insurance.

Grew up in US, moved to UK in my 40s. Study health care for a living.

Y'all would be insane to even countenance losing the NHS.

If you work for a big enough company, or have the right kind of job, or are rich, your insurance will be great, relatively low cost, and give you access to a wide array of providers.

You may have still giant co-pays though, and you almost certainly will have trouble if you have a serious illness, especially a chronic illness. You will also spend hours and hours and hours of your life arguing with insurance companies over the phone. Isn't that what you want to spend your time doing when someone in your family has cancer, MS, diabetes, kidney disease?

If you are self-employed, if you own a small business, if you free-lance, if you work in the service industry, if you work for a company too small to have much bargaining power, if you are just getting by and thus earn too much money for subsidised health care but not enough to actually pay for it, if you have a chronic illness that means you lose your job and thus your insurance -- these are just a few of the kinds of people who end up bankrupt because of medical costs. For two-thirds of the people in the US who file for bankruptcy, medical costs are a major contributor. And a LOT of people in the US file for bankruptcy.

velvet, the treatment get DD needed would have been freely available on the NHS. it's not something that would have gone untreated and she would not be up to her eyeballs in debt over here and still have a home.

Don’t forget the old Breaking Bad joke

What would happen if Breaking Bad was set in the U.K.?
Man gets cancer treatment for free. The end.

Given how many people have seen that programme I’m amazed by the lack of knowledge of what it’s really like even for insured people in the US. It may be a highly fictional story but the issues that trigger it are very real.

what's the situation for people who can't afford to pay the $400 per month or the fee up to the $5000 cap? Is it free like it is here?

Of course not it’s not free! If people can’t afford to pay for their healthcare, they don’t get it. It’s really that simple.

If they are unconscious and unable to consent to treatment, they are stabilised and then billed later.

I am so pleased to live in a country where a complex birth, a car accident or cancer won’t bankrupt me or my family with bills worth hundreds of thousands of dollars. The NHS is being sold off, certain services are already privatised and it’s only a matter of time for the rest of it. US spends more on maternity & neonatal care than anywhere in the world, and has some of the worst outcomes despite this.

Healthcare shouldn’t be for profit.

I moan about the tax we as a household pay although obviously not all for healthcare.
BUT I would much rather pay taxes knowing that someone out there in need can receive healthcare. I do not believe that people should die because they can't work/have problems a past etc which does happen in the US.

What I don't agree with is not having to pay a nominal fee maybe £2 for a doctor app. I cannot for the life of me get an appointment my surgery. It seems impossible and people like me and my dh who work long hours can't simply take a whole morning off to go to the doctors and then it's obvious they have no control over who hasn't bothered turning up/is late/is disorganised etc. The nhs really piss me off here on this point. They expect higher earners to bear the brunt of running it via a tax system but we can't even use it half the time. And then there's waiting times. Once a doctor told me if I have private health insurance I just use it or I could die waiting for my 'urgent referral' which she said could leave me waiting up to two weeks for a brain scan. I had the scan the next day on my insurance.
So I'm a fan of a system that works but nhs isn't really working and why oh why is it always the USA system that comes up? Why not Germany or France?

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.

They don't have an exclusive contract with one manufacturer. That's not how it works. If the drug is prescribed by your GP it will be bought and dispense by your chemist shop (who is not part of the NHS) and the NHS will reimburse them. The chemist shop will buy the drug at the lowest price they can. The problem here is that only one manufacturer is selling the drug in the UK and manufacturer have taken advantage of the fact that there is no competition to up their prices.

Big pharma is the epitome of capitalism.

So corrupt its unreal.

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

Virgincare run 400+ services at the moment, including GP services, children's services, social care, adult services, Health visiting and school nursing.

Of my son's care - physio, OT, SALT and community paeds are all under Virgincare. His acute health paeds, orthotics and dietician remain under the NHS (for now). Trying to negotiate the 2 systems to work together to support his complex needs is a fucking shit show.

Agreed. And right now Health Visiting is out to tender in my county. They do so much non-statutory work that simply won’t be done if it’s contracted out.

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

In the UK all contraception is free to everyone.

I work in the Pharma Industry, we work a lot with companies in the States, last lot that came over we were talking about healthcare. These are people in good jobs working for big Pharma with the best healthcare and they still have massive copayments to make, the numbers were scary and suddenly their large salaries (typically double what we earn) didn't sound so great.

@SerendipityJane I have MS. The third drug I had cost £15k a dose. And I had five doses. That's not including steroids, 5 nights in hospital and 3 on day care. Plus the after care. It's bad enough to have it in the first place. Let alone having to worry about getting good treatment.

My mother drove herself to the ER when she had a burst appendix because we couldn't afford an ambulance.

I knew somebody who used duct tape and rubbing alcohol when they gashed open their arm because they were uninsured and couldn't afford stitches in a hospital.

If you can afford it: some states, some insurance policies, some hospitals, some specific doctors will provide excellent care. But it's such a big country and things vary from state to state that there is no one answer here.

The only thing I can say is that you get what you vote for, and from what I've seen, the current government is all too eager to change things for the worse with the NHS.

There are companies in America who refuse to fund contraception under workplace health insurance because it’s against the company’s religious beliefs. And that’s true even if you have a condition like endometriosis for which you require this treatment.

The Supreme Court ruled that companies do not have to fund contraception if it conflicts with their relgious beliefs:
time.com/2941323/supreme-court-contraception-ruling-hobby-lobby/

So you’d have to self fund - roughly $300 per year for the pill or $900 for an IUD. If you have a condition like endometriosis (as 10% of women do) add that to the cost of deductibles / copays for all the other treatment and surgeries you need.

Compare that to the free contraception we are currently fortunate to have.

*I pay $300 a month for health insurance for my family of five through my employer. I pay a $20 copay for a doctor visit, unless it's for preventative care (annual physical, PAP smear, mammogram, etc.), then there's no copay. I've had three babies in the US system, and I've paid nothing out of pocket. Hospital births with private rooms. I pay $75 for an emergency room visit, unless I'm admitted, then there's not out of pocket cost provided the hospital and physician are in my insurance company's network. Which most of them are. I don't need a referral to see specialists, I just go. I've been seeing the same doctor for 15 years, she's always seem me or my kids the same day if we're ill, within the week of we're not. Vaccinations are free. I take Zoloft, a 90-day supply is $1.50. I take diabetes meds (not insulin). They're free.

My dental covers 2 cleanings a year. Anything else is covered 80%.

My vision covers 1 exam a year. I do have to pay out of pocket if I want the digital test instead of the one where they dilate your eyes. Glasses frames are free up to $150, if they're more than that I pay 20% of the difference. Basic lenses are free, for extras like scratch proof coating or transitions lenses, I pay 20%.*

My parents both died of cancer. They received excellent treatment, the out of pocket costs were minimal.

I pay nothing to see a doctor and I usually get an appointment the same day.

I have [aid nothing when I've been to A and E including the ambulance ride. I have been admitted to hospitals in three different parts of the country, I don't need to go to my local hospital.

If I want to see a specialist I can get a GP referral or I can self refer and see the specialist privately, that would be about £100-200. And I can go to anyone, not one linked to a particular network.

I'm on a number of medications, my bill is £0. I also have a CPAP machine on permanent free loan, I get a new mask each year.

My eye tests are free and I get a voucher worth about £70.00 towards glasses and lenses.

Children don't pay for vaccines and my GP doesn't charge for travel jabs, I get a free annual flu jab.

I see my dentist every three months and that includes a scale and polish or a deep clean if I need it. My crown cost me £0. My fillings cost £0.

What I don't agree with is not having to pay a nominal fee maybe £2 for a doctor app.

Then the GP needs a way of charging and collecting the payment, and that would probably cost more than the £2 fee.

What happens when you retire, no employer paid insurance, is it part of pension provision .

What happens when you retire, no employer paid insurance, is it part of pension provision .

I think they get medicare if over 65. I think many treatments are quite limited on this.

What happens when you retire, no employer paid insurance, is it part of pension provision?

At that point you would go on the Medicare programme, which is a state-subsidised insurance policy through a regular insurance company, and rely on a supplemental policy (or have enough saved to deal with the out-of-pocket costs) to fill in the gaps in coverage. These plans work just the same as any other health insurance apart from the premiums being all or part-subsidised, they still have the same excesses and out of pocket maximums to meet.

Medicare is split into 2 main parts -- part A is hospital insurance which covers hospital care and part B, which is medical insurance as we know it and covers doctor's visits, specialists, etc.

If you have never worked, your spouse's work history is taken into consideration. You (or your spouse) have to have work at least 40 quarters to get Part A for free. If you've never worked and not been married to someone who worked, you pay for Part A (so better have some savings ready.) Everyone pays for Part B, it's something you plan for in retirement unfortunately.

Even combining both parts of Medicare leaves significant gaps in care for pensioners, so most people plan on taking a supplemental policy privately to fill it all in, and save for that in retirement too. I have relatives in all three situations -- an aunt receiving great cancer care but she never "worked" (she was a carer for my great grandmother and never married) but she has to pay for Medicare and is doing so through a lien on the family property, my grandparents who have part A & B plus a supplemental policy and a sizeable pension so they don't have to worry about costs, and my own parents who are five years from retirement and attempting to plan for years of care after they stop working but still needing to keep their health needs in mind.

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