Here's an article from 2018 (Pre-COVID) claiming the NHS has 4.3 Million people in it's operation backlog with over half waiting for more than one year[1]. That sounds outrageous, and a massive step backwards from what most in the US have today (even with low tier health insurance plans).
I do not know why this is the reality in nations with Universal Healthcare, but the UK is not alone.
I constantly hear anecdotes about people waiting 6+ months for minor operations in the UK (corroborated by this article and others), and how the wealthy/elites of Canada fly into the US for treatments.
Why is it that Universal Healthcare seems to universally turn into massive backlogs and poorer service?
I'm also not convinced we need some new "Universal" system in the US. Everyone in the US already does have access to healthcare (Medicare/Medicaid/Private). The only difference is above a certain income level you're expected to shop for your own. I much rather prefer that instead of it coming out of my paycheck in another mandatory tax without choice of provider.
[1] https://www.theguardian.com/society/2018/jul/13/nhs-operatio...
I pay a lot of money for those services, but i get really shitty service for some of those - eg. dental. I see a dark caries spot on my tooth, and basically if I'm good enough to eat (not too much pain), my waiting time is ~6months+ (pre-corona time, probably a lot longer now). I can go to a private dentist and get a filling, but I have to pay for the service. There is no way to either opt-out of eg. dental, or to get a part of the service paid by our national insurance (eg same price as the insurer would pay a government assigned dentist, you just pay a difference). We have a bunch of papers with a bunch of words promising <30 day wait times, but in practice, the wait time are huge.
Yes, if you cut your arm off, they will fix you, but the dental (and many other branches) are pretty bad.
Its is bot representative how NHS treats injuries, failing organs, etc.
That being said my experience with Czech system of mandatory insurance has been better.
Could you clarify this? Is the 12.92% your entire tax burden or the extra amount for medical? If the former, I currently pay $92 a month for health and dental insurance. I made nearly 250K last year. 12.92% of 250K is $2,691 per month. That's .. quite the difference.
Eg. Germany has a 14.6% rate for health insurance[1], but capped at 56,250 EUR of income, thus making it capped at 8,212.50 EUR annually, or 684.38 EUR monthly. Still a lot more than your $92 a month :)
[1]https://taxsummaries.pwc.com/germany/individual/other-taxes
per year, I suppose.
Emphasis on the "minor operations". Things are prioritised by need and urgency, so naturally you end up with a long tail of non-urgent, minor operations.
> how the wealthy/elites of Canada fly into the US for treatments
There's a reasonable argument here that the US system has advantages for the wealthy. Generally however this is seen as undesirable.
> Everyone in the US already does have access to healthcare
There's several issues with this statement. The first is that 32.8 million people (12% of the population) were uninsured in 2019[1]. The second is that even if you have health insurance on paper, it's generally prohibitively expensive to use, only kicking in once a deductible is reached that will bankrupt you regardless (40% of Americans can't cover a surprise $400 expense [2] and these deductibles can run into several $1000). The reality for many is that if they're sick, they tough it out because going to a doctor may cause them financial ruin.
> above a certain income level you're expected to shop for your own. I much rather prefer that instead of it coming out of my paycheck in another mandatory tax without choice of provider.
I'm not sure what your experiences have been, but the only context where I've been able to "shop for my own" provider was when an employer happened to offer one of two providers in their available plans, which wasn't always. Functionally I had almost no choice in my health insurance coverage short of specifically finding a job that offered what I wanted, which given my priveliged position as a software engineer would be possible but would be laughable for most professions. Functionally, my health insurance was a mandatory tax without a choice of provider, it just wasn't a tax paid to the government.
I should also note that I now live in Australia, where we have a universal public system where I am still able to choose my doctor and other care providers. In fact, I feel that I have far more choice here than I ever did while living in the US.
[1] https://www.cdc.gov/nchs/fastats/health-insurance.htm [2] https://www.cbsnews.com/news/nearly-40-of-americans-cant-cov...
Like the US, about half of Canadians are strongly opposed to taxes. Our health care system is about as good as it can be, with the budget we have for it.
How long do you wait for eg. a tooth filling? Or if you notice a dark spot on the skin, to get it checked up by a dermatologist? So the minor things, that can get messy real fast if you dont deal with them fast?
If the main argument against nationalized healthcare is that so many more people can get healthcare that your minor condition gets bumped down in priority... well yeah, the point is that many more people can get treatment for major problems!
I pay insurance for my car (it's mandatory here - the mandatory part only covers damages on other peoples cars when you're the guilty one). I also pay (extra) for windshield repair, and when a small rock on the highway breaks my windshield, i go to one of the preaproved service centers (or do the paperwork to do it somewhere else), get the glass replaced, and go home after ~30 minutes.
I also pay for dental in my mandatory government insurance (no way to opt-out), and when i see a dark spot on my tooth, i call the government dentist, and they tell me to come in six months, at 11.30am on a tuesday. I could wait that long, but by that time, my tooth could get worse, and a simple drill-drill-fill-fill might end up as an extraction or worse. So basically, I either have to pay for a private dentist to do it (full price, not just the difference in price compared to a government dentist), or wait six months and risk it. Either way, i pay for dental, that I don't get.
Same for eg. dermatologists... find a spreding dark spot on the skin.. wait six months+ (probably more now, due to the plague), or pay 70eur and get it checked out the next day. Wait six months, and a simple burn-off could be cancer.
I pay for roads and i dont have a car, i don't get a rebate if i walk. Etc.
Bad teeth impacts you and you alone.
On the other hand, your nation, state, city, employer, etc are all run by people who were educated in this country. You directly benefit from roads every time you buy goods from any business, etc.
Do you think disease ridden population carrying ringworms earns well, shows up for work reliably and are good customers?
If healthcare was left to free market completely, we'd see return of The Plague!
> If healthcare was left to free market completely
What evidence of this do you have? Because, in the US, healthcare largely is free market and we do not have the return of any plague or anything similar. In fact, it's free markets that bore out the vaccination the world is using to fight the current pandemic.
Part of the reason healthcare is so expensive in the US is because people cannot afford to get preventative care and so they wait until they are basically dying and then go to the emergency room. If they couldn’t afford $100 to see a doctor before, they can’t afford the $100k the hospital will bill them so they just go bankrupt and the hospital loses it all. The hospital covers these expected delinquent accounts by charging more to people with insurance. The insurance covers these higher costs by charging higher premiums. You are already paying for other people, you’re just doing it the expensive way because there’s so many for-profit organizations in between you and those other people.
Our vaccine deployment differs by state, city, county. 30yos are getting vaccinated in a bordering state while 64yos are not getting vaccinated 20mi away. It depends on who you know, luck, bureaucracy, and how lucky you are with your particular county. I'm in Virginia now and no vaccine opportunity yet. Five miles away in Maryland my friends have received the vaccine.
Imagine this for every dental implant, sprained shoulder, etc.
I'm pretty sure universal healthcare works, but i'm not sure how to get our country to the point where it is at least fair for everyone.
As another has said, these are minor. It's OK to wait.
It isn't like you are going to be out of a job or out of much money: A safety net helps with it. So you are sitting at home or at work on light duty while waiting, depending.
I'm not sure arguing minor surgeries can wait for 6 months-1 year+ is a good thing. If the system cannot handle both minor and major operations within a reasonable amount of time, then something is very wrong.
Minor, in general, is something that plagues you, yet waiting for surgery isn't going to be an issue. Foot surgery, for example, might fall under this. Waiting won't take complications.
For skin cancer checks, though, you can go to your family doctor. (I have to get skin cancer checks due to a medicine I'm on). If they find anything worrysome, sometimes they can remove it in-office or get you to the correct person in a timely manner. You know, because doctors know that some skin cancers spread quickly (others aren't that serious).
Minor actually means minor. It doesn't mean waiting to see if you die.
That doesn't sound ok to me... and objectively is a massive step backwards from what we have in the US today.
In the US today, no matter if you have zero income, little income, or high income - you can see a doctor promptly and have any procedure performed within a month of less.
Otherwise I am pretty sure 100% of people will think that every effort should be made.
I don’t think every effort should be made, at least not in every case. I don’t think every effort should even be offered in many cases.
I don’t know the exact line for me, but if there’s no reasonable prospect for 3 months of out-of-hospital life, maybe palliative care is the most humane thing. In some cases, active intervention should be able to be requested by the patient (with reasonable oversight).
It’s not primarily for money reasons, but a shocking percentage of healthcare dollars are spent in the last 1 month of patients’ lives. Some of that is intensive care for patients after trauma or other acute incident and that care should continue. But a large part of that is spent on futile efforts, what one surgeon friend of mine called “warm autopsies”.
The procedure was scheduled ONE YEAR from the time of appointment, which meant she was blind in one eye for a whole year.
That’s the absurdity of a socialized system.
Everyone already knows the absurdities of this system here so I’ll skip that part of my rant.
This issue is so polarizing, it occurred to me - why don’t we have a medicare-type system (call it m4a) for those who want it, and not for those who don’t? It’s about a 50-50 split anyway.
The catch is, if you don’t pay tax for m4a, you can’t use it.
This way, those who are concerned about “paying for others and receiving inferior service” don’t have to, and those who can’t or don’t want to deal with a privatized system are free to use it.
- If the waiting times are too long, then ultimately it's a supply issue which can be solved by increasing supply (i.e. more funding). Of course, this is obviously easier said than done but it's not really an inherent problem of the system.
- What would your grandmother do in a situation with a privatized system and she couldn't afford surgery? This isn't theoretical: this happens in the US all the time. While I agree that being blind for a year is not acceptable, it's only in certain positions of privilege in the US in the current system where you would even be treated and again is more inherently about funding than it is about an inherent fault of a socialized system.
- I think that if you don't force everyone to pay in the system and allow for private healthcare, people (and politicians!) don't have incentive to improve the system because they can just take private insurance and ignore a languishing public system. The public system doesn't have to be bad, but creating a two-tier public/private system incentivizes people to not care about public healthcare.
What is the incentive of a medical provider to provide The Best Care Possible, when they know for sure there is no competition? You end up with a system whose only raison d’etre is to continue working as little as possible with no real progress.
Yes, not being able to afford it is obviously a bigger issue than being blind for a year. In this case, she had the option to go to a private surgeon and get it taken care of for much more money.
As for your last point, in a socialistic type of service, “progress” serves to elect public officials. In a capitalistic service, “progress” serves to make more money. Both of these approaches have their flaws; however, I would argue that progress is faster and service of higher quality when a government is not involved. The gov’t advantage is that it’s “cheaper” and thus more accessible to everyone.
As a commenter posted below, I think we have a critical mass of folks (half the country, basically) who would be willing to go the public route. I really have to think this through, though, bc it would create some interesting incentives to sign people up to one or the other.
That is, there are plenty of rich Democrats that could bankroll this.
I've been thinking about this a lot myself lately too. It seems like there is critical mass for the people who want universal healthcare, so why can't we make it happen? It doesn't seem that unreasonable to set up a dual system where people who want their taxes to pay for healthcare can get it, and the rest can make their way with the private insurance companies. Win/win.
The difficulty would probably be in keeping the tax pools separate. And deciding at what point someone paying into the single payer system gained permanent eligibility even when unemployed. Things like that.
Having individual discretion over what tax dollars goes to leads to an unmanageable mess for those trying to actually create a budget. Additionally, sometimes a national priority and the hard choices that goes with that means having taxes spent on things that aren't necessarily popular with the entirety of the electorate.
The control over the budget comes (in theory) with voting on a house member who aligns with your goals for the budget. Yes - in theory.
I think a bit of differentiation could be good, but I draw a distinction here. You get to choose among choices available to you. So unless "not paying for the military" was an option written into law by congress, you could not select that option. And it would be unlikely to be offered, for many reasons, not the least of which is that everyone benefits from the military just by virtue of living within the borders of the US.
I don't think it should be a menu where each citizen gets to select from a huge range of options. I think for some things that would work, but there are many things too fundamental to let people opt in and out.
More people who are able to be productive members of the workforce, better mental health from improved financial security, and less cost from preventative rather than responsive treatment.
That also gets to the heart of the problem - not everyone recognizes the benefits that I've suggested from a more universal healthcare system.
I would also contend, that I don't see the benefits from the level of military spending that we have.
The healthcare system is interwoven with rules and regulations. For instance, we already have tax rules depending on your yearly FSA/HSA contributions, tax deductions based on how much money is spent, and most importantly the Obamacare rule that one must have insurance or suffer penalties. Would another exception break the system?
First of all, does the hospital delay care until they can verify that the patient has insurance? What if it's an emergency?
If the hospital doesn't delay care, and afterwards the patient is found to not have insurance, they'd be billed right? What if they can't pay it, and they default? How does the hospital make up for that loss?
Under the current system, I believe the hospital eats the cost, and adjusts their rates accordingly, so the insured end up footing the bill Anyways. A socialized system formalize this, and distribute that cost across everyone instead of just the people who pay for insurance/healthcare.