A question for anyone regarding healthcare systems...

[Drisque]

So, here in the United States there is currently a big fight over whether we should, or shouldn't adopt a single payer/ federal run healthcare system. A lot of the arguments against this point out the "fact" that a consequence of pursuing this would be long waits and poor healthcare/shotty service. I guess I'd like to know if this is true? And I figured this would be the best forum to ask, as we all have lots of experience with visiting our doctors.

If my question is out of line, I apologize.

[Fishmanpa]

It's an interesting question, not HA related but very interesting nonetheless. My experience and reality with the healthcare system currently in place in the US has not been favorable from the financial standpoint. We have affordable insurance through ACA but its a high deductible. It's basically catastrophe insurance. I've run into a few doctors that have been less than adequate but that can happen anywhere and under any plan so that's not a result of the system.

It's great we can get coverage with pre-existing conditions but the deductible makes it un-affordable to see the doctors we need to see and the tests we need to have. A social worker from the hospital where my wife's neurologist is called me the other day wanting to know why we canceled her appointments. The truth is we can't afford it even with insurance. Her scan alone after insurance was over $5K! I'll be paying last year's off for the next two years! I can't afford to get the testing I need for my heart or get the yearly CT scan on my chest and neck being a survivor. I told this social worker that the sad fact is, those with $$ get the care they need. Those without, take their lives in their hands. That's our reality and the reality of millions here in the United States.

Positive thoughts

[MyNameIsTerry]

If you read enough threads on here you will see a difference between US & UK members. US members can easily access doctors, tests, specialists, etc. UK members can wait months to get to specialists and GP's act as gatekeepers which can also mean targets to reduce unnecessary referrals.

US members have often posted comments such as "go see a dermatologist". We can't do that, it has to be a referral through a GP. Then you go into a queue. My mother has seen them a couple of times and the wait was up to about 8 months. But the NHS has different tracks so any urgent need is pushed through much faster. For instance, possible cancer signs fall under a 2 week target. But this target isn't just for cancer and can be used for issues that are more serious and need treatment more urgently than something that is a more minor nuisance. A nuisance, you may wait a long time for. Urgent stuff will be fast tracked.

It took my elderly mother about 12 months to get a COPD diagnosis. During all but the last month or so she was unmedicated for this. Months of back & forth with a GP trying to work it out to hand off to the hospital. See the consultant, get booked in for tests, wait for the results, wait for a follow up appointment. She was with the hospital process well over 6 months. But those performing tests are expected to look for signs of more urgent issues and flag them which will allow doctors to fast track a patient.

So, it may be slow but we have dedicated tracks for urgent need. We have checks in place to spot something previously not considered urgent, although delays would have been added prior to accessing some tests if there is a queue.

And then there is the money. The NHS is a money pit. It was created to treat physical issues but now mental health has more focus it has had to expand. This was never planned for. But it is said there is a lot in the NHS that is beyond it's original scope. This all means more money.

We can go private too. If we do, we get fast access to much more. You may find some doctors more willing to book you in for every test you want...because it's profit. IT shouldn't be that way but I think we've seen enough of the celebrity doctor cases to know there are plenty of "tame" doctors in the private sector who will prescribe more.

Part of that is just life. If you are rich, you get a better car. And part of the need for social healthcare is to protect those lower down the chain who couldn't afford to pay the bills.

I don't think a direct comparison is possible anyway as we have different economies. We pay higher taxes in some areas where you have lower taxation and doesn't that lower taxation work to pay for the things we get back?

Certainly, one issue with HA I have with your system is the willingness of doctors to book you in tomorrow for testing. That testing is just feeding the beast with many of you. Doctors should refuse what they don't believe is in the best interests of the patient. They seem to do this very well with physical issues but when it comes to mental health they lean towards the quick & easy (that blood test will get them out of the surgery) rather than discuss the elephant in the room, the anxiety fuelling the need. They just kick the can down the road.

There is one argument that this at least calms the patient for now until they can get into therapy and meds start to work. So I respect the fact it's not an easy fix but I do find it alarming so many GP's just book in a test, shout "NEXT", and you're off the books for a couple of weeks. Some, as we see on here, just panic during the waiting anyway. But refusing the test and talking about the anxiety is a longer, time consuming process so there is some motivation for GP's to fob people off this way. And there is the issue of what can a GP really do? They aren't trained or have the time to help.

I would rather social care than private though. Ours is far from perfect but it protects you. The trouble is, we are often selfish. We want a new xbox or that pack of fags. People moan about the NHS but you tell them to pay another £20 a month in tax and they start moaning about their holidays. Not all, but many.

The NHS should face criticism though. There have been culture issues. And any public body has always been a money pit of inefficiency.

[AMomentofClarity]

Certainly, one issue with HA I have with your system is the willingness of doctors to book you in tomorrow for testing. That testing is just feeding the beast with many of you. Doctors should refuse what they don't believe is in the best interests of the patient.

Very good analysis Terry. I would like to add some context to this part though....it’s important to keep in mind also that the US is the most litigious country in the world. Daytime TV is filled with ambulance chasing lawyers who can’t wait to file a lawsuit on someone’s behalf.
I believe this absolutely plays into Drs decisions regarding follow up tests...they don’t want to end up on the wrong side of 1/100 odds and have to deal with the hassle...it’s easier to just provide tests.

[MyNameIsTerry]

Very good analysis Terry. I would like to add some context to this part though....it’s important to keep in mind also that the US is the most litigious country in the world. Daytime TV is filled with ambulance chasing lawyers who can’t wait to file a lawsuit on someone’s behalf.
I believe this absolutely plays into Drs decisions regarding follow up tests...they don’t want to end up on the wrong side of 1/100 odds and have to deal with the hassle...it’s easier to just provide tests.

Yes, that's a very good point. It does happen, doctors mess up and it becomes a big case. It happens over here too but part of the cultural issue with the NHS has been the cover up culture (even the government has admitted it needs tackling) and you end up fighting the whole "system". No lawyers unless you get that far.

So, it's very intimidating to take on such confident professionals for many people. We always had a "doctor knows best" issue in our society (have you had this?) which meant you took what they said as gospel. Now the NHS push more open patient charters stating we should be involved in decision making.

And society has changed as we have become more wealthy & successful. Social mobility has increased and there is less of "they are your betters".

It just seems so detrimental to HAers to be able to access tests more easily. To an extent we do have this problem as low cost tests such as blood testing are excessively used by GP's. I can remember my GP years ago telling me I didn't need certain tests and he explained it would only be telling him what he knew and that they were under pressure to reduce such testing by the local trusts. Surgeries with higher than expected testing levels were monitored.

Our GP's rush to easily to cheap testing. This all takes out of a system that is already in trouble. So, I would criticise ours too for this and we don't have the same legal microscope as I expect you do.

[ErinKC]

There definitely seem to be pros an cons to each. Access is definitely a pro (maybe a con in some cases for people with HA, but generally speaking a pro) in the United States. Cost can be a huge con. I don't necessarily think that single-payer is the way to go, but I have a feeling that our government isn't creative enough (or mature enough perhaps) to work out a more complicated, but potentially better situation.

As an American, to my mind one of the most urgent improvements needed is transparency of cost. I think the major downside of our insurance system is that we have a third party paying our bills for us. Because of this, we don't need to know (or care) what anything costs. So, the healthcare industry can continue to raise prices and you see huge discrepancies from place to place on what different medical services cost. We think we're not paying much, but forget about how high our premiums continue to grow.

I had a very good high deductible plan years ago when I was working for the government and it was the first time I felt at all in control of my healthcare spending. (btw, I did not have health anxiety at this time). I had a plan for setting aside money for healthcare from my paycheck each month and my employer matched a portion of this. It went into my health savings account (HSA), which is like a debit account, and I was able to save a significant portion of money to be used on healthcare. I was living in DC where there is a shortage of doctors and it's almost impossible to get an appointment or even find someone taking new patients, so when I looked for a primary care doctor the only one available sooner than like 8 months didn't accept insurance.

I ended up going to him and at the end of the visit he'd give me an itemized bill that showed exactly how much each part of the appointment costs. Then I paid for it right there with my HSA. No mysterious bills showing up months later with no information except what I owe. No random co-pays, etc...

I even paid for childbirth out of pocket with my HSA. I knew exactly what the cost was and was never surprised after the fact with extra billing or anything. It was amazing. And, there is a significant discount for paying out of pocket. I think I paid about $3500 to give birth and stay 2 nights in the hospital.

It would have to still maintain subsidized healthcare for low income people so they wouldn't incur additional costs they couldn't cover.

I really believe that if we switched to a system more like this, where people paid up front, over time costs would have to go down since people would be directly involved in the exchange. But, this would have a difficult transition period and no politician is going to stand up and say - ok, now you have to pay for your doctor visits. Even if, in the end, it costs people much less than expensive monthly insurance premiums, it would be too complicated to explain and our politicians don't want to lose their jobs.

But, I also don't think we'll ever end up with single payer. The healthcare industry is WAY too entrenched in our country/economy and has way too much swing over politicians. It's almost always the case that the lobbyists are stronger than a politician's principals!

[MyNameIsTerry]

I should also add that my point regarding doctors getting us out of the surgery may be more relevant in our system. They are struggling with patient overload and having 10 minutes per patient makes it very hard to have a meaningful discussion about such complex stuff.

So many of my later appointments were just my GP asking if I was still taking meds, did I feel any worse, am I still in therapy, etc. It was demoralising. I could have emailed it all in.

[ErinKC]

I'll add - the opposite of this was when I had a standard deductible plan and required emergency surgery. It was a niiiiightmare. I went to the ER, had surgery, was in the hospital for 9 days, and then ended up in a different ER a few times during my recovery.

I got dozens of bills over the next several months. For the ER, the surgeon, the anesthesiologist, any doctor who walked in to see me for two seconds, the medication I was on, the room I stayed in, etc... It was madness. Not one of them was itemized so I had no clue what I was actually paying for. I think I paid $6,000-$7000 out of pocket when all was said and done, and I had met my deductible, so I have no idea why to this day.

Also, because there were so many bills and it was such a mess I missed a few and they ended up being sent to collections and the hospital reported this to my credit agencies and my credit score dropped from 780 to 530. This was 8 years ago and I just got back up above 700 last month.

---------- Post added at 00:54 ---------- Previous post was at 00:52 ----------

So many of my later appointments were just my GP asking if I was still taking meds, did I feel any worse, am I still in therapy, etc. It was demoralising. I could have emailed it all in.

We definitely have this issue here. It depends a lot on the doctor, but I've had many doctor that just churn you in and out. Most offices schedule appointments in 15 minute increments... and they get paid hundreds of dollars per appointment. It is demoralizing.

[AMomentofClarity]

our government isn't creative enough (or mature enough perhaps)

Is there a like button for this (particularly the mature part)???

Erin nails this...both parties think in terms of extremes...black/white, all/none for their side. It’s a huge inhibitor.

I saw a poll recently that 70 something % of Americans support a Medicare for all (social) option, but support drops to 30 something % if its the only option/will replace their current healthcare

[MyNameIsTerry]

But, I also don't think we'll ever end up with single payer. The healthcare industry is WAY too entrenched in our country/economy and has way too much swing over politicians. It's almost always the case that the lobbyists are stronger than a politician's principals!

That's the big problem, isn't it? Lack of willingness because of money. Couldn't the same be said for your gun laws?

But something interesting may be smoking. The smoking lobby was big too and eventually smoking was pushed out of public places.

Like you say, pros & cons in each. Our system is underfunded and because of that you can expect delays as there just aren't enough staff to handle us. And the ageing population is going to drive this closer to the point something needs to change.

I have a dog and we always had health insurance for him. It's a niche market and some insurance companies have been shown to up their premiums the following year after a claim by x8. Some stories in the media showed owners having to put their pets down because of this.

We have one insurer who doesn't up the premiums due to past claims. We are with them. We probably pay more than the others because of this guarantee.

Now our dog is over 11 we no longer just pay the excess so we also pay 20% of all claims. He had to spend a week in doggie hospital last year and that was about £3500 with all the treatment in. He's fine now but it took months of treatment and he has to have daily drops to prevent it happening again. So, I can now appreciate a little of what it costs but it's nothing compared to some of the stuff I've seen you guys tell us on here.

If you do change, expect it to take decades and more. The NHS is an ongoing experiment for us.

There are some interesting half & half systems out there too. Australia has one as do Germany. The German one involves a trust.

EDIT: Also, social healthcare becomes a matter for the civil service, which means you have to trust they do what they say. It's not surprise one of the issues the NHS face is drug companies smoozing doctors to get sales. The media have reported before about how drug companies artificially inflate prices. You only have to look at the costs of a generic drug to see the original licence is a licence to extort money. And in our system this has led to drugs being blacklisted.

So, you would want public reporting of where your taxes go.

---------- Post added at 02:59 ---------- Previous post was at 02:57 ----------

Is there a like button for this (particularly the mature part)???

Erin nails this...both parties think in terms of extremes...black/white, all/none for their side. It’s a huge inhibitor.

I saw a poll recently that 70 something % of Americans support a Medicare for all (social) option, but support drops to 30 something % if its the only option/will replace their current healthcare

Yep, Erin's obviously old enough to have voted a few times!

At least give it a different name though, you don't want Trumpcare. A trump is fart over here