Reply to How would you feel about losing your company-provided health insurance for "medicare for all"?

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[quote=Anonymous][quote=Anonymous]I've lived in Australia, the UK and the US and have a few observations given I've experienced their different healthcare systems.  I'll probably be pilloried for offering anecdotal observations but I'll go ahead anyway.  I should add that my experiences reflect the fact I lived in those countries at different stages of life.

At the outset, I'll also say no system is perfect and each brought their own frustrations, costs and trade-offs.  Unfortunately, the debate here seems to be simplistic and ideological.  If you favour universal coverage, you must be a socialist.  If you value private insurance, you're an unabashed capitalist.

Previous posters are correct that in many countries which offer universal healthcare coverage, people have the choice to also take out private insurance or it may be offered by their employer.  This is the case in both Australia and the UK.  So, it's not an either/or decision.

In the UK, my company provided private insurance.  So, when I had both my children I used the public system (in fact, childbirth is not covered by private insurance in UK - the system must have been designed by a man!).  Great outcomes - the NHS uses a midwife and GP-led approach with referrals to obstetricians where needed.  When I was diagnosed with a frozen shoulder, I opted to use my private insurance to access immediate treatment and the following physical therapy. If I had not used private insurance, I would have had to wait longer.  When I developed chronic eczema during a period of unemployment, the waiting time for a good dermatologist was 2 years on the NHS.  So I paid privately for a consultation and he then wrote a referral so he could see me as a public patient.

Medical services in the US are undeniably expensive.  A few years ago, I visited a GP in all three countries in the same 12 month period (I travelled a lot).  I paid privately for each visit.  I can't remember the precise costs but the visit to my Bethesda doctor cost almost 100% more than a GP in a posh Sydney suburb.  The GP in the UK was about 50% less than in Bethesda.  I know it's just one service and it's dangerous to extrapolate.

The gravy train.  There is definitely overservicing in the US system or at least no disincentive to access expensive services and facilities which may not be necessary if you have good insurance with low deductibles.  The cynic in me says that doctors know they are perpetrating overservicing but figure it lines everyone's pockets.  At my more generous times, I think they just figure they will give out unnecessary referrals as they know insurance covers most of the costs and to protect themselves from any potential criticisms.  In countries with government-provided health systems, resources are more limited so this is not an issue.  It's more likely to be the opposite of overservicing and an inability to access treatment in a timely manner.

One of my children was diagnosed with a medical condition on being born.  He was referred to a top pediatric specialist in London who advised that, in his and general experience, the issue could resolve within the first 2 years of life and so he recommended we administer daily prophylactic antibiotics for 2 years and then reassess.  He warned that, since we were moving to the US within a couple of months, we might encounter a more 'proactive' approach to treatment with doctors want to do tests to identify the precise cause of the problem.  Sure enough, once we moved here, my 6 month old was put through many traumatic tests and endured many visits as the doctors wanted to identify the cause.  We were bombarded with charges from hospitals, radiologists, pediatricians, urologists, etc.  The end result was the lead specialist recommended the best approach would be to administer daily antibiotics and then reassess in 2 years!!!  This is an example where the outcome was exactly the same but the costs of arriving at it were vastly different.

I think a combination of universal coverage and private insurance might offer the best general outcomes.  However, this is still going to be expensive unless overservicing and the high comparative costs can be addressed.

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Yes this overservicing (good term) is a HUGE part of the problem. My son was born with one kidney- diagnosed prenatally. He’s 11 and totally fine. Needs no ongoing care and never has. But the TESTING they did in his first 18mos was just insane- I can’t even imagine what it all cost. The conclusion? Nothing- the kid has one well functioning kidney and can expect to live a normal life. Which seems to be the conclusion the vast majority of the time. Wed never have even known without them seeing this on the prenatal ultrasound. My insurance was probably charged 100K+ (who knows- probably far more) for all of these tests, specialist appointments, etc etc etc. There has to be a better way. [/quote]

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