I think all the countries with "free" healthcare end up with having absurd waiting times
This is such a common trope that the USA tradeoff is that we pay to get higher quality expedited care, but it's just not true
It’s not health-care, it’s health-don’t-care.
US healthcare is easy to access. I've used it at every economic tier and it has never been difficult to get access to proper care. It is obnoxiously expensive.
> This is why average longevity in US is declining while it is growing in other developed countries.
It's growing in most, not all of course. Britain as one example is seeing something between stagnation and decline in its life expectancy, despite their vaunted NHS. And for seven decades it has lagged increasingly behind its peers, being ahead of only the US in its peer group. Universal healthcare will only take you so far.
"Life expectancy in the UK has grown at a slower rate than comparable countries over the past seven decades, according to researchers, who say this is the result of widening inequality.
"The UK lags behind all other countries in the group of G7 advanced economies except the US, according to a new analysis of global life expectancy rankings published in the Journal of the Royal Society of Medicine.
"While life expectancy has increased in absolute terms, similar countries have experienced larger increases, they wrote. In the 1950s, the UK had one of the longest life expectancies in the world, ranking seventh globally behind countries such as Denmark, Norway and Sweden, but in 2021 the UK was ranked 29th." [0]
---
"A new analysis of global rankings of life expectancy over seven decades shows the UK has done worse than all G7 countries except the USA." [1]
[0] https://www.theguardian.com/society/2023/mar/16/life-expecta...
[1] https://www.lshtm.ac.uk/newsevents/news/2023/uk-drops-new-gl...
Emergency care is typically easy to access. Non-emergency care is pretty easy to access in some places and quite inconvenient in others.
On top of that (and in conjunction with Medical Levy Surcharge) the government pushes everyone to have private health insurance, and it makes a huge difference in terms of wait times for "elective" hospital procedures (i.e. anything that won't kill you very soon).
All in all, last year I paid some AUD16k getting no medical services at all.
Paying all that you're still out of pocket for anything serious, as specialists (anesthetists, urologists, gynos, you name it) are typically charging way above Medicare standard fees and private insurance doesn't cover that completely.
[1] Sorry: 30% of Federal outlays are spent on healthcare, only some of that is part of the "budget"
There are people in the US who say "I cannot afford to go to the doctor" when they are sick; this does not happen in Australia.
That doesn't mean to say that it's as bad as in the US, but it does exist.
I'd also go out on a limb and say that there are more poor people in the USA than in Australia per capita, which might factor into how many people can't afford healthcare.
Pretty sure there are a LOT of hospitals in the US where that's an expected or short time in the ER waiting room, and once you're taken in (into a room and charges accruing) you may well wait a another hour or more before being seen by a doctor.
Note that all of these places should prioritize you if you come in with heart attack or stroke symptoms.
If you're lucky, for certain situations, the system is set up VERY well.
Other situations, not so much.
I'm happy to live in Canada, where I just don't worry about the cost of things.
Problem is most hospitals are setup to be overloaded aka "every day is a bad day" - god forbid you have some staff sitting around twiddling their thumbs! Better to just have just enough staff that the place doesn't fail.
TLDR; The US system isn’t “free” and it is still shit.
And the clarification comment says only ~8h were wasted waiting to be seen. The rest of the 3 days was probably justified (might be surprising if you are expected to be at work unless you die).
For me, I would pay $100 for the ER and then schedule outpatient that day or later some other time and pay up to $350 for the surgery.
The tax rates seem similar though with Australia being 23.6% and US 22.6% [0] (average for single worker no kids, of course there are variations).
[0] https://www.oecd.org/tax/tax-policy/taxing-wages-australia.p...
To your point, rich people in the west have prime access to world class care, and if it's not an emergency they'll fly to wherever they need to get the best clinics they can afford. People flying to Korea for plastic surgery is a thing.
Even at upper middle class you can go through non subsidized clinics if you want prioritized and/or special care.
Being even mildly rich will always help.
About a third of American households make 100k a year. Median household is about 70k a year:
But I suspect the person making the claim was just picking an arbitrary number where most people in that salary band will have decent benefits, and can usually afford the out of pocket portion also
I think you're reading too much into the OP's off-hand guesstimate. At every company I've worked for, the engineers earning $200K are on the same health insurance as the high school graduate in the warehouse earning $40K/year. The higher compensation makes it easier to clear the deductible/out of pocket maximum hurdles, obviously, but there wasn't a secret insurance plan that got unlocked at higher compensation.
I feel like a lot of such medical tourism has more to do with cost than quality of care.
Mental healthcare is a different story, but it's not any better with private insurance. Every therapist or psychiatrist in the insurance racketeer's provider directory is either dead, moved out of state, or not taking patients. "Ghost networks," they're called...
The worst insurance I've ever had was at a FANG, via United Healthcare. It covered nothing. Hardly anyone accepted it, apart from the on-site health clinic. It was worse than a university health plan, for god's sake. As to quality, you say it's the best in the world, but the fact that the US now has a life expectancy lower than China, Cuba, and Albania determines that this is a lie.
Unpopular truth on this forum: the healthcare system in this country is owned and operated by organized crime entities. It is completely illegitimate. It consumes 19% of GDP of the richest country on the planet, and Americans are some of the least healthy people outside of active war zones. Unless you're using your doctor as your Xanax dealer (John Mulaney explains how that hustle works: https://www.tiktok.com/@funkytownmc/video/722624028419819447...), this system sucks for you too.
I would be shocked if the Mexican cartels weren't deeply involved with United Healthcare and all these other corporate gangsters. This industry is the greatest crime of all time.
The sad truth about those stats is that if you split them by social class, you get two distinct groups: disenfranchised people with some of the worst health outcomes in the world, and privileged people with some of the best.
The childibrth related mortality rate for black american women is 3x higher than for white women, for example.
Geography is a greater determinant of health than race. People die a full 7 years earlier on average in Mississippi than California or Massachusetts, and 6 years earlier in West Virginia.
There's a clear correlation with income here, but one can easily argue that both income and life expectancy are downstream of policy. Red state policies are simply bad for your health and your wallet.
It's really just mental healthcare and dentistry that are basically impossible, but again, not much better with a private health plan.
Take the blinders off, stop pretending you're not getting robbed, and maybe we can fix it. There is no silver lining to private healthcare. You're not getting better care. Social determinants of health are very real, but they're driven by those 9 states without Medicaid expansion dragging the averages way down, a lifetime of bad care before the ACA, and also that medicine can't solve the many problems caused by poverty.
We would all be better off in literally any other system. Everyone thinks they're an above average driver. Everyone thinks they'll live longer than average. The truth is, you're just not that special. Unless you're a politician that gets to go to Walter Reed, or you have a wing in the hospital named after you, you're getting the abysmal standard of care that everyone gets.
At the same time, I was looking for a new dentist for myself and for this kid. There are a half dozen dentists who would see me within ten minutes walk. I finally found her a dentist some 20 minutes drive away (bonus: she can't drive).
And the mental health provider we found who would take Medicaid did intake for new patients on Friday mornings between 9am and 12 noon, no appointments, recommend you arrive early in order to be seen.
This is in WA.
For whatever bloody reason they just don't exist in anything near enough quantity.
Conversely, I'm surprised you found a dentist and a mental health provider that takes any insurance at all, and didn't have a months-long wait list. I've almost always had to self pay for both...
Do you for example have data showing that life expectancy in this group is higher than, e.g., the life expectancy of an average citizen of France?
Add up what a person making $100k pays in insurance premiums, plus what the employer kicks in on those same premiums, plus the deductibles and co-pays for every procedure, plus drug costs even with insurance and it's not even in the same ballpark. Even if you are healthy and don't go to the hospital the premiums are huge for even basic health plans.
This is a hard lesson for many later in life and why social safety nets are so important for everyone.
Minor mistakes and games can also create odd billing situations that are opaque and difficult to fight.
It’s a huge range of negative feedback loops that drive US medical costs into insane territory.
My recent ER visits have all resulted in $1K-$2K or more (don’t remember exact numbers). A stupid sling costs about $100 in the ER. All due to deductible, Co-insurance and other provisions.
Also $350 for surgery?
You must have a really nice plan.
It is $100 for just the co-pay. Depending on your state, there are the balance bills, mystery bills, lab bills, xray bills, random radiologist bills from affiliated practices, and a host of other things that come in the mail ~6wks later.
Worst thing, the ER doctors, and radiologists in many cases as you noted, seem to always be subcontracted to some other agency which bills separately from the main hospital.
Wife said “no no no I’m not a citizen” and they said “yeah we’re so sorry about the cost” and she laughed.
Counting premiums, we paid $48k out-of-pocket for healthcare here in the US last year.
Australian public hospitals have first class surgeons. In this case they recommended surgery. They're not doing it for financial gain, why not trust their advice?
Your alternative is to go to another surgeon for a second opinion but you can only do that in the private health system, and that will take months or maybe longer and cost you alot of money.
Also, because people heal naturally at a variable rate. Not every tear or break needs invasive treatment.
Obviously I don't know what happened there, but as an example having a broken bone in their hand which is badly set would fit. It would cause you to have "pain in your hand" and it would require immediate surgery to avoid further damage.
On top of that (and in conjunction with Medical Levy Surcharge) the government pushes everyone to have private health insurance, and it makes a huge difference in terms of wait times for "elective" hospital procedures (i.e. anything that won't kill you very soon).
All in all, last year I paid some AUD16k getting no medical services at all.
Paying all that you're still out of pocket for anything serious, as specialists (anesthetists, urologists, gynos, you name it) are typically charging way above Medicare standard fees and private insurance doesn't cover that completely.
A minimum wage worker pays more like 1k in taxes per year towards healthcare, still somehow "$1000 for a couple of stitches" strikes people more than "$1000 for nothing at all", and somehow people seem to be grateful to the "free healthcare" for getting a 4-man 10-hour surgery "for free" rather than their neighbours. Go figure.
I wasn't poor even before I moved to Australia, and I would go to a store, buy some crap for a week (far from everything I needed) for $X, then see a notice saying "hiring cashiers, $2X a month". I'm probably speaking for a lot of Australians - I want none of that working poverty here, and high minimum wages and Medicare always were big parts of that.
I think AUD < USD though, so spending power is probably a lot different. Don't think you can do a real thorough comparison in an HN post.
We here in the US also pay "tax" for healthcare, it just inst called tax. It is called {co-pay, co-insurance, deductible, balance bill, annual employee premium, annual employer premium}
Lets not kid ourselves, we pay dearly in the US.
It comes at a lower cost than what people in the US already pay.
That's right... if we converted to public health care in the US, you would actually pay LESS money than you do now for health care.
The booked him in to stay the night and did surgery the next day and he stayed for two more days then went home.
Without a bill.
Thank goodness for Australia's healthcare system. It's far from perfect, but when it works, it really works well.