I live in a country with tax-paid medical (and dental, vision, everything necessary, with some minor exclusions) - they basically take 12.92% of your pretax earnigs for medical + ~30eur extra.

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.

My understanding is that post 2008, Dental and eye care in UK has been cut, and going private is the norm.

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.

Dental insurance of any kind is pretty rare in the US. Large employers may offer this to their employees, but even then it’s a situation of very high coinsurance for any procedure of substance, and covered procedures are limited. So however bad your national dental system may be, it at least provides some baseline option for everyone — including the poor, the homeless, the jobless, and employees of small businesses alike.

Let me be more frank, it is a scam and nothing more than prepayment for cleanings and X-rays in the vast majority of cases. The only time I have not paid with cash is when I was on Medicaid.

"they basically take 12.92% of your pretax earnings"

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.

Many European countries have a high health insurance tax rate, but capped to a certain income.

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

> $2,691 per month

per year, I suppose.

> I constantly hear anecdotes about people waiting 6+ months for minor operations in the UK

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...

I grew up in the US, moved to Canada. Saw a friend wait like 6 months to get an ACL replaced. Poor guy could hardly walk for that time. I've known two people who were told to get an MRI for various reasons... the wait on that is 6-9 months too. One good reason to get an MRI: internal bleeding following a concussion can kill you in days, and a CAT scan won't rule it out. But apparently that isn't a good enough reason to skip the line.

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.

> 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 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?

Obviously it would be better to have minor needs met as well. But the point is that when you say “I now have to wait too long for minor things, therefore healthcare for all is bad”, you are implying that you would prefer that you got treatment for a minor condition than someone else got treatment for a major condition.

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!

The problem with minor conditions is, that you still have to pay for them. You pay for dental, but don't get the service.

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.

But thats how taxes work: i pay for schools, and i dont have kids, i dont get a rebate I were to homeschool kids or send them private.

I pay for roads and i dont have a car, i don't get a rebate if i walk. Etc.

Those are not the same.

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.

It's absolutely the same, has COVID taught you nothing about what happens to an economy when an diseases are out of controll?

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!

You cannot transmit your tooth rot to anyone else.

> 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.

They are far more similar than you give them credit for.

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.

I'm definitely for universal healthcare, but one of my worries is the unfairness of an opaque system. Imagine if i'm waiting 3-6 months for an operation as I am for a COVID vaccine (true story!)

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.

A word about waiting for minor surgeries:

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.

As a counterpoint, I have far from "premium" insurance, and can see my doctor for any reason nearly always within a week, and have had multiple "outpatient" surgeries booked/executed within 3 weeks.

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" could be that you have a dark spot on your skin that you'd like to get checked out. If it's cancer, waiting 6 months could mean death for you. Sure, minor could also be getting some help for some mild dermatitis. The problem is when those things are lumped together.

... But it isn't, though.

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.

Why are you arguing waiting for a year or longer for any procedure is ok?

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.