> as if other countries with universal healthcare have people dying while waiting in line for care

This absolutely does happen in the UK, although I'd pick our health over the US's any day of the week.

It's also worth mentioning that private health care and insurance both exist in the UK.

Individuals still get the choice to go to any private doctor they want, they'll just have to pay for it themselves. Just like the US, except the NHS provides an excellent safety net for everyone without private insurance or the means to pay for private care.

In most cases its the same doctors working in private hospitals and for the NHS.

And in some cases it involves NHS facilities too. There are definitely some questionable aspects of our public/private healthcare. But again, this isn't always how it works, and the ethics involved are also complicated.

I know someone whose condition rapidly deteriorated while receiving treatment in a private hospital and when things were looking really bad they got transferred to an NHS hospital.

I hope the person you know was OK. That transfer is actually not surprising. Emergency/intensive care is almost always NHS here.

Private options tend to be better in situations like having multiple treatments available where one is significantly more effective or more reliable but also costs a lot more. Sometimes the NHS will only offer a cheaper but inferior alternative, which sounds horrible until you think that there is a huge but ultimately pooled budget and any time policy allows more spending on one treatment there is always someone losing out somewhere else.

The US has safety nets as well, they're just not as generous as the UK's.

Agreed on both points. The UK system is far from perfect but for balance we should also say that it is not normal or expected for something as bad as that to happen here. Even in recent times, with the extra pressures of COVID, critical care has mostly kept up and the emergency overflow facilities that were built very quickly in case of overwhelming demand mostly went unused.

Obviously there will always be limits and the available resources will run out if one of them is reached. In the aftermath of a major incident or an unusually busy period it can happen. I expect a lot of us from the UK might agree that the limits need to be raised further by investing more into the NHS. But I would still choose this type of system over a US-style one every time. I've never heard of anyone here dying because they couldn't afford tens of thousands for routine medication to treat a common condition.

I'm a big fan of universal healthcare, and have made great use of both public and private hospitals in Europe and the US.

Everywhere I've lived (except the US) has had a totally free public system, and every time I've still paid for private insurance. I'm not rich by any means, and I don't have any particularly special requirements. I'm not even looking for better doctors or machines, since they are mostly shared or equivalent between public and private care.

The only reason it's worth it for me to spend money on private insurance is waiting times. On the private system, I can see a consultant in one month instead of six, or get a surgery in three months instead of three years. This is all for non-emergency care of course.

There are lots of elderly people waiting on operations like hip replacement on the public system, and it's expected that some will die before their turn comes up. It's a compromise that's built into the way the government operates their national health system. It not obviously the wrong way to do things, since carrying out all these operations would be very expensive and have limited benefit in terms of quality and quantity of life. It also sucks for the people waiting, especially since others who can afford to skip the line by paying (usually through private insurance) may even be seen by the same surgeon in the same OR.

I don't mean to argue for or against this system, but just to point out that people often die waiting for (non-emergency) care in at least several large public healthcare systems in highly-developed countries in Europe.

> On the private system, I can see a consultant in one month instead of six, or get a surgery in three months instead of three years. This is all for non-emergency care of course.

Have you considered that you are essentially jumping in line just because you have a larger wallet than other people?

Yes. I find it difficult to deal with morally. Fwiw, I'm not particularly well-off, and I only spend about two weeks' worth of take-home pay a year on my insurance.

My intention was not to flame you individually, but to emphasize that the argument "well, the lines are shorter" is pretty shallow without some background information on what that means in practice.

The countries I have direct experience with, France and Germany, don't have any issues with people dying while waiting for procedures. Experts are usually readily available, so there are exceptions.

I don't know of any public health care system in developed countries that have really these issues. I do know so, that a lot of that comes from a PR campaign run by US insurances against the Canadian system.

When you say they don't have any issues, do you mean it doesn't happen?

I'm more familiar with the Spanish, Irish and UK systems. I tried to find a nice document giving numbers for what I was describing, but most of what I can find is anecdotal, and the official reports are weren't quantitative.

Here's an article from an Irish newspaper last year that gives a rough guess (though of course there are other factors): https://www.irishtimes.com/news/health/are-patient-waiting-l...

I'm certainly open to US insurance companies paying me to shill on hn against Canadian healthcare, but right now I'm only saying these things out of the goodness of my heart.

Waiting times do happen, usually end of quarters when the quarterly budget runs out. No issues in so far as these waiting times don't affect emergency procedures.

And no, I don't see a direct link between public health care and wait times. The German issues are mostly caused by a bloated bureaucracy.

I think we're pretty much in agreement then. Emergency procedures don't have long waiting times in any of these nice European countries. (Of course, even in the US they will give some urgent life-saving care to someone who can't pay.)

I also think that these (some several year) wait times aren't unavoidable. Management of these national public health systems is fabulously complicated and difficult and expensive, but it could certainly be done much better. In the end I think a country that really wanted to, and was willing to pay, could have a public system at least as good as what a 1%er in the US gets.

Absolutely in agreement. IMHO in Germany the main reason is budget, defined quarterly. So of course a Doctor might push out appointments to the next quarter if he can when he ran out of budget already. And the ratio by which doctors practices are assigned and planned. That leads to an abundance in cities and a shortage elsewhere. And that imbalances cam, and do, drive wait times up. Going from experience so, it got better.

Theoretically I could switch to Germany's private insurance scheme. I have no willingness to do so.