Anonymous wrote: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.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:We are self employed and buy a policy on the exchange for full price. Our policy is absolutely terrible, overpriced, and limits our access to care for that reason. We hate it.

That said: I have a feeling we’d be even worse off with a M4A type plan. We are UMC (gross 275-300) and I’m guessing we would pay through the nose for it, and need to buy a supplemental policy on top of that.

M4A would be a huge win for those of more modest incomes, however.

Costs needs to be brought down- significantly. I’m skeptical that any scheme can do that at this point. I really am.

I’m completely disheartened by the costs of health care and see no viable solution and no real political will to make changes, either.

What would you do if Republicans succeeded in repealing the ACA with no replacement?

People with employer-sponsored health insurance don’t seem to realize some people are self-employed. They seem to think they themselves will always have good employer coverage. They don’t seem to realize they too might face a coverage gap between employment and Medicare.

Purchase on the open market- which is what we did before. However we have no pre existing conditions- though now we are over a decade over since the last time we purchased. We were overall happier with our pre-Obamacare plan. Alternatively one of us would have to get a job at a large employer (probably me). The whole system makes little sense. The roadblock to change is employer-sponsored health care but I don’t begrudge those who don’t want to lose it, either. What a mess healthcare is.

Thank you for your reply. It is a mess! So is there no longer an open market? Is Obamacare the only option you have at present?

Right. We could purchase from a broker but it would be the same plans and pricing. Our only option is to buy on the exchange and we are getting hosed.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:We are self employed and buy a policy on the exchange for full price. Our policy is absolutely terrible, overpriced, and limits our access to care for that reason. We hate it.

That said: I have a feeling we’d be even worse off with a M4A type plan. We are UMC (gross 275-300) and I’m guessing we would pay through the nose for it, and need to buy a supplemental policy on top of that.

M4A would be a huge win for those of more modest incomes, however.

Costs needs to be brought down- significantly. I’m skeptical that any scheme can do that at this point. I really am.

I’m completely disheartened by the costs of health care and see no viable solution and no real political will to make changes, either.

What would you do if Republicans succeeded in repealing the ACA with no replacement?

People with employer-sponsored health insurance don’t seem to realize some people are self-employed. They seem to think they themselves will always have good employer coverage. They don’t seem to realize they too might face a coverage gap between employment and Medicare.

Purchase on the open market- which is what we did before. However we have no pre existing conditions- though now we are over a decade over since the last time we purchased. We were overall happier with our pre-Obamacare plan. Alternatively one of us would have to get a job at a large employer (probably me). The whole system makes little sense. The roadblock to change is employer-sponsored health care but I don’t begrudge those who don’t want to lose it, either. What a mess healthcare is.

Thank you for your reply. It is a mess! So is there no longer an open market? Is Obamacare the only option you have at present?

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:We are self employed and buy a policy on the exchange for full price. Our policy is absolutely terrible, overpriced, and limits our access to care for that reason. We hate it.

That said: I have a feeling we’d be even worse off with a M4A type plan. We are UMC (gross 275-300) and I’m guessing we would pay through the nose for it, and need to buy a supplemental policy on top of that.

M4A would be a huge win for those of more modest incomes, however.

Costs needs to be brought down- significantly. I’m skeptical that any scheme can do that at this point. I really am.

I’m completely disheartened by the costs of health care and see no viable solution and no real political will to make changes, either.

What would you do if Republicans succeeded in repealing the ACA with no replacement?

People with employer-sponsored health insurance don’t seem to realize some people are self-employed. They seem to think they themselves will always have good employer coverage. They don’t seem to realize they too might face a coverage gap between employment and Medicare.

Purchase on the open market- which is what we did before. However we have no pre existing conditions- though now we are over a decade over since the last time we purchased. We were overall happier with our pre-Obamacare plan. Alternatively one of us would have to get a job at a large employer (probably me). The whole system makes little sense. The roadblock to change is employer-sponsored health care but I don’t begrudge those who don’t want to lose it, either. What a mess healthcare is.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Depends on whether I get Canada's outcomes measures with that. Or Germany's, or New Zealand's.

This is an excellent point, one ignored by anybody advocating for any of this. Let's take Japan, as an example. They have health care for all. They also have a system where if you have cancer with a low percentage of success in curing, you get a kiss on the forehead and you go home to die. Dental care is another basket of insanity over there. And, yes, I know. I have lived there and work with Japanese companies all the time.

Of course, our system would never work that way. Only the best of palliative care, regardless of condition! That won't work, and is unsustainable. You want BASIC health care for all, that could only work if it is limited. Want something better, get yourself into a position to have health care provided as part of your compensation. Its not that hard, despite what everybody wants to say about how horrible america is, particularly now with millions of jobs unfilled, all of which provide health insurance, because people won't show up sober for more than a few days in a row.

Yeah, I'm talking outcomes data for specific countries, not whatever unsourced story you want to tell (true or not) about a totally different country.

Try to keep up.

I've had similar experiences with the Japanese medical system. Also you want a US educated doctor in Japan. Their training programs aren't as rigorous as US medical schools and they're backwards in many ways. Go hang around gaijinpot if you want all the stories of interactions with that shitty shitty system that messed up a buddys back, and another friends intestines.

The Japanese have long lifespans due to diet and exercise despite rampant smoking. There is almost no obesity over there compared to the USA.

Anonymous wrote: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.