31 votes

American asking - how does your country's healthcare system perform for you?

So I've almost (March 29) quit an IT role in a U.S. company that functions with the private healthcare market. It's been long evident to me that most industrialized nations have much more sensible systems, and my employer's business model would be nonexistent outside the U.S.

There's a current political trend towards "Medicare for All", basically a single-payer system for existing health services. The prevailing resistance comes from insurers, whose business models will cease to exist, and those whose compensation might be cut (physicians and hospitals) up to 50% under the current scheme for U.S. Medicare. That's leaving aside pharmaceutical companies.

I'm trying to decide where my political time should be spent - the "Medicare for All" slogan is great for bumper stickers, but are there other models that work better?

Please talk about your nation's policies - the good, the bad, and the ugly. Tildes is mostly a young crowd that might not have direct experience of major medical need, but any commentary on what has worked and what doesn't is welcome.

30 comments

  1. [3]
    Sahasrahla (edited ) Link
    Canadian: I like universal healthcare and wish it went further. I mostly don't have to worry about medical problems financially ruining me (at least to pay for treatment; being medically unable to...

    Canadian: I like universal healthcare and wish it went further. I mostly don't have to worry about medical problems financially ruining me (at least to pay for treatment; being medically unable to work would be a different matter). I've known people who had weeks of cancer treatment and over a year of almost daily in-home nurse visits for follow up and they had to pay for nothing but subsidized hospital parking. Like I said, my complaints are mostly about what isn't covered: prescription drugs (outside of the hospital), dental care, vision, etc. Pharmacare might be an election issue this year so it would be nice if we could get that.

    As for the bugbear of wait times that are often brought up in American media when talking about Canadian healthcare, I don't really know if it's worse in Canada than in the US. I'm sure unbiased statistics and comparisons could be found if one looks hard enough. One thing I'd keep in mind though: Canadian healthcare covers everyone but American healthcare doesn't, so, when talking about wait times we're comparing the entire Canadian system to only those top X% in the US who get any treatment at all. It's a bit apples to oranges.

    Edit: Thought of something else I like. Healthcare is covered by the provinces but to ensure equal access to healthcare across the country the federal government mandates transfer payments between the provinces. So, whether you live in an economic backwater or somewhere with a booming economy you should still get equal care. This leads to some bitterness and divisive rhetoric about "have and have-not provinces" but really, we'd find other ways to complain about each other even if we didn't have this.

    15 votes
    1. patience_limited Link Parent
      I spent my young adult life close enough to the Canadian border that I had several friends there, and they'd tell stories that made me gasp in amazement. Even though we were all students and/or...

      I spent my young adult life close enough to the Canadian border that I had several friends there, and they'd tell stories that made me gasp in amazement. Even though we were all students and/or worked low-level jobs, I felt much poorer than them.

      If I went to the doctor or urgent care, I'd miss a day of work and wait for hours - general practitioners, internists, and OB/Gyns are in short supply, because other specialties are so much better reimbursed. Professional care meant being $50 - 100+ poorer, even before the trip to the drugstore. I'd use over-the-counter drugs to try to control asthma and allergies, because the proper medicines were unaffordable. Every now and then, I'd scoot across the border and pick up cheap Canadian versions of prescription drugs that cost far more in the U.S. (e.g. a $15 CAD albuterol inhaler, which would otherwise cost $60 USD.)

      Generally, I'd wait until I was in frightening distress. I would arrive at the doctor to find what started as a couple of weeks of scratchy throat or cough had turned into secondary infections, usually pneumonia - add in the cost of chest x-rays. [My brother went through the same thing, only he almost died from meningitis.] Emergency treatment for an infected animal bite left me several thousand dollars in debt not covered by high-deductible student insurance. [This was before insured parents could keep kids on their plans up to age 26.]

      Mostly, I went to Planned Parenthood for routine medical care, because they at least indexed cost by income - that place literally saved my life. It wasn't until I was working a regular full-time job that I had decent insurance, but still the out-of-pocket deductibles and prescription costs ($50/mo. for birth control!) were burdensome.

      Canadian friends reported zero cost, medical care the instant they had sniffles, and hardly ever a missed day of work or school. On an anecdotal basis, I can say I probably missed up to two weeks of work per year due to untreated illness or delayed treatment, where my Canadian friends might have missed a day or two.

      The only case I know of where a Canadian acquaintance had to wait for treatment, it was a retiree waiting for a hip replacement, still ambulatory, and they were only delayed by about four months.

      I haven't found good data yet on the relative loss of economic productivity from untreated disease. We do know, though, that the U.S. spends nearly twice as much on healthcare as Canada, on a per-capita basis, for a smaller proportion of the populace.

      6 votes
    2. parenthesis Link Parent
      Another Canadian here! Overall I also really like our system, and I generally don't worry too much about my health costs. I live in Quebec, and we do have government provided prescription drug...

      Another Canadian here! Overall I also really like our system, and I generally don't worry too much about my health costs.

      I live in Quebec, and we do have government provided prescription drug insurance here. It's only open to people who don't have private drug insurance through work/school. We pay a copay for drugs, but it maxes out at around $90 per month, so if you're on an expensive treatment, it's still reasonably affordable. The premium cost comes out of your taxes, so it varies depending on your income. People under 18 and people on social assistance don't pay for drugs. It's fairly good system, and I like knowing that if I do ever need expensive medications, it won't bankrupt me.

      Lots of people in Quebec don't have a family doctor, and the wait lists for one are absurdly long. I'm honestly not sure if it's worse here than other places, but we do like to complain about it. However, there are lots of walk-in clinics, including some that will give you an appointment so you don't have to wait around for hours, so routine care is fairly accessible.

      I wish things like dental and vision were covered by the government. Lots of people get coverage for them through their employer, but my workplace doesn't offer health insurance, so I find myself limiting how much I access those things.

      2 votes
  2. [3]
    Badger28 Link
    British: we have universal health care. It is open to anyone and there is no payment at all to see a doctor, visit a hospital or receive any treatment. The only costs which we have to personally...

    British: we have universal health care. It is open to anyone and there is no payment at all to see a doctor, visit a hospital or receive any treatment.

    The only costs which we have to personally cover are prescriptions and car parking. If you are unemployed or have certain illnesses you don't have to pay for prescriptions. If you have to pay it is possible to get a prepayment card for about £15 per month which covers all prescriptions.

    Car parking is often expensive.

    The NHS is amazing, if you have a life threatening illness or accident then you will be treated and rushed to the front of the queue. However there are waiting times for non-emergency treatments.

    In recent years with funding being squeezed a lot of services have been stripped back. Mental health services have been cut to the bone in some areas, and complimentary services are less well funded now.

    Nurses / doctors are also underpaid and over worked but are largely brilliant at what they do.

    I am personally proud of the NHS in the UK. We pay national insurance to fund it and although I thankfully dont use it often, I am more than happy to help fund it. I know if I am ill then I will be helped without a financial cost. Those less fortunate than myself can seek treatment without worrying about cost.

    In my opinion this is an essential part of a caring / responsible society. It isnt perfect, but is far superior to the majority of health services across the world.

    The American system is quite alien to me. I would genuinely be scared of being ill, or seeking treatment because of all the costs involved. It could be ruinous.

    14 votes
    1. Gibdeck Link Parent
      In my opinion, this system should be worldwide. One can dream...

      In my opinion, this system should be worldwide. One can dream...

      1 vote
    2. appa Link Parent
      Pretty much this. I am deeply saddened by efforts made in the recent years, to get rid of the NHS.

      Pretty much this. I am deeply saddened by efforts made in the recent years, to get rid of the NHS.

      1 vote
  3. [6]
    kfwyre (edited ) Link
    Am I allowed to answer as an American? I'm going to anyway, only because I'm pretty fed up. I don't have a great understanding of our healthcare system, but I know a problem when I see one, and...

    Am I allowed to answer as an American? I'm going to anyway, only because I'm pretty fed up.

    I don't have a great understanding of our healthcare system, but I know a problem when I see one, and we've definitely got one.

    At present, my husband and I have two choices for our insurance:

    Option 1: We can go through my employer, where I would pay $350+ dollars a week for us to have coverage. I'm a public school teacher, so that is a significant percentage of my salary.

    Option 2: We can go through my husband's employer, which is $140 a week for the both of us. Much more manageable, right? Well, not exactly, because that plan has a $6000 deductible. I remember when $1000 was considered a high deductible! Those were the days--and they weren't even that long ago!

    We chose my husband's, but it's not a good option--it's simply the lesser of two evils. The amount we've spent on healthcare has risen every year since probably somewhere around 2012, and the level of care I receive isn't commensurate with how much I'm paying. I have undiagnosed fatigue issues that we've been trying to address for nearly a year. When I call to see my primary care physician, I'm usually told that the first available appointment is one to two months out. I can get in earlier by seeing their physician's assistant, but that's trading down the chain--swapping out expertise for expediency.

    Many of the tests I've had done haven't been considered "medically necessary," so I end up paying for them out of pocket. I paid for a $700 night guard that wasn't covered by my insurance, despite the fact that I have "severe" grinding issues with my teeth that has already caused "irreversible damage" (quotes are direct from my dentist). When my severe grinding destroyed that night guard within a month, my insurance was again not willing to pay for a replacement. If breaking through the piece of acrylic specifically designed to protect my teeth from harm isn't enough to warrant coverage, I don't know what is. Thankfully my doctor covered the replacement free of charge and gave me a more heavy-duty one, but I can't help but feel that the thousands of dollars I spend on health care should cover basic preventative methods and I shouldn't have to rely on the quixotic kindness of any particular medical professional.

    If my husband or I were to ever get diagnosed with something significant, I feel like we would have to decide between leaving the country or bankruptcy. The saddest part of this isn't even that choice, but the idea that we are significantly more well off than most! We are both gainfully employed at modest, albeit above median-income jobs. We also do not have children, nor do we plan to. Financially speaking, we are in a better position than many in this country, and we still live with the looming specter of future healthcare costs.

    Something has got to give. If we're feeling the pinch this much with our situation, I have to imagine there are many out there that have it far worse.

    9 votes
    1. [5]
      vektor Link Parent
      This sounds like you're stuck in that awkward gap of "too rich to die, too poor to live" - I've heard the US healthcare market is a nasty place for people just a bit wealthier than what would be...

      This sounds like you're stuck in that awkward gap of "too rich to die, too poor to live" - I've heard the US healthcare market is a nasty place for people just a bit wealthier than what would be needed to qualify for medic...are? aid?... one of the two.

      I'm not sure if waiting for a significant diagnosis is the best course of action tbh. Sounds like a terrible time immigrate to another country, get insurance and jobs there lined up, etc., but what do I know.

      5 votes
      1. [5]
        Comment deleted by author
        Link Parent
        1. Sahasrahla Link Parent
          This is something that I think a lot of people forget. To access many benefit programs you have to navigate a hostile bureaucracy that exists to try to keep you from getting those benefits. For...

          it's made into an even nastier experience than navigating through the private healthcare market by legislators who emphatically do not want you to have it

          This is something that I think a lot of people forget. To access many benefit programs you have to navigate a hostile bureaucracy that exists to try to keep you from getting those benefits. For many people in need that's not really an option even if they do qualify.

          3 votes
        2. [2]
          bike Link Parent
          I agree with 90% of what you've said, and your overall message. But I disagree with your mention that Medicaid is a program for extreme poverty or is too difficult to use. 72,000,000+ Americans...

          I agree with 90% of what you've said, and your overall message. But I disagree with your mention that Medicaid is a program for extreme poverty or is too difficult to use.

          72,000,000+ Americans receive Medicaid [1] . This is over 22% of the population.

          It is twice the entirety of Canada.

          I agree with you that the program needs to be expanded and made easier to use, and it is in no way perfect. But I think, from time to time, it is worth celebrating that we can assist 72,000,000 real people, and take that positive message to do even more.

          [1] https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html

          3 votes
          1. patience_limited Link Parent
            There's another difficult piece to this though, and it's the limited number of healthcare providers who accept (or are permitted to accept) Medicaid or CHIP payments. This is part of the territory...

            There's another difficult piece to this though, and it's the limited number of healthcare providers who accept (or are permitted to accept) Medicaid or CHIP payments. This is part of the territory I work in, and the process physicians have to go through to qualify for participation in these payment programs is atrocious. It can take 6 months to a year for a provider to qualify, particularly for CHIP.

            At that point, there's such a scarcity of enrolled healthcare providers that it's an additional layer of rationing on top of the low reimbursement rates and blocks to participation. However many participants there may be in Medicaid and CHIP, it's very difficult for them to find doctors who will actually accept the plans.

        3. vektor Link Parent
          I was not aware that was a myth, thanks. Truth be told, germany has similar BS when it comes to unemployment benefits it seems, but I don't know for sure. Stuff like that you have to write...

          I was not aware that was a myth, thanks. Truth be told, germany has similar BS when it comes to unemployment benefits it seems, but I don't know for sure. Stuff like that you have to write ridiculous amounts of job applications to keep your benefits, and they'll force you to take on jobs you are ridiculously overqualified for, any job at all basically. And then the benefits aren't even that high. At the same time, exactly these benefits are at the center of the freeloader rethoric 'round here. Apparently everyone who receives the benefits does fuck all to improve their own situation, drug problems, child abuse, shitty taste in daytime TV programs, the works. I dunno man. Why don't we just give that kind of money away to any citizen, no strings attached, and then provide opportunities and incentives to get them employed? Low, but sufficient UBI, negative tax rate for your first few € of earnings, something like that. Lets you remove a lot of benefit programs completely and yields less administrative overhead too.

          2 votes
  4. quinns Link
    One thing that I always bring up as an American supporter of universal healthcare is that there are so many countries that have already proven that it works, we really have no excuse not to...

    One thing that I always bring up as an American supporter of universal healthcare is that there are so many countries that have already proven that it works, we really have no excuse not to implement such a solution.

    We don’t have to make ours a carbon copy of any other system, rather we should learn from each country’s system to implement one tailored to our own country’s needs.

    The main obstacle is the lobbying and propaganda put forth by insurance and pharmaceutical companies. They pose the main obstacle to America pursuing universal healthcare. That and the portion of the population that sees it as America becoming a socialist country. But the reality is that having some socialist programs within capatilsm is the ideal, and in my opinion actually would aid the economy in general. When people aren’t concerned about their healthcare breaking them financially, when they are healthy because they actually can go to the doctor rather than avoiding it altogether, they are more financially sound and robust, and more productive within the capatilist system.

    8 votes
  5. [3]
    vektor Link
    German: I don't fully understand our system wrt. all the details. We have a two-caste system. Goverment mandates everyone be insured in heavily regulated insurance (statutory health insurance)....

    German: I don't fully understand our system wrt. all the details. We have a two-caste system. Goverment mandates everyone be insured in heavily regulated insurance (statutory health insurance). Your dependants (uninsured spouse, children and young adults still in education - this still applies to me) are automatically insured, and apparently free of charge, but maybe not at any income, not sure. Your dues are based on income, but are capped if you're modestly wealthy and paid by govt if you're unemployed.(I can't tell you how this matter would be handled for an unemployed, non-EU migrant.)

    However, you can be liberated from that statutory duty to become part of private health insurance. This is mostly available to high-income people and Beamte (see below). Switching back is hard. Your dues are then based on age and health, so that could be cheaper. Beyond that, Doctors are usually much happier to take on private insured patients, apparently because they're more lucrative. This leads to the aforementioned two-caste system, where private insured get quicker treatment with less hassle when it comes to specialist doctors. Your GP generally won't mind, but I've even had trouble timely finding a eye doc in a 50k people town previously. As a rule, the statutory coverage is sufficient, but not luxurious, and there's certainly spots where it could be better. Rural areas are lacking specialist and emergency service coverage for example, and some procedures aren't covered.

    This all however plays into the role of Beamten (civil servants) in germany in interesting ways: In germany, some jobs commonly go with Beamtenstatus (teachers, policemen, etc). Beamte can't go on strike, need any side gigs signed off on and are generally held to a higher standard (may not follow illegal orders, need not follow orders that are not relevant to the service(maybe part of why german police works so well compared to the US, generally speaking - compare the stats on shots fired in anger, deaths among police and death to police to get a taste)). In return, they receive good pay, excellent job security (save for fuckups of stellar proportions, you basically can't lose your job) and their pensions are paid directly by the govt, not by a statutory pension insurance. The difference is that the insurance works as a generational contract, i.e. they "take what they can get" and pay everyone who depends on them. The problem comes with demographic change and a smaller portion of working-age people: Their dues go up, while their pension prospects go down. Meanwhile, the Beamter is looking on from the sidelines, in his lawn chair, watching the shit show. Because he'll get paid anyway.

    I'd be much happier if Beamten pensions would be handled as everyone else's, and if you couldn't leave statutory health insurance at all. Also, scratch the part where we cap people's dues. You earn a few million euros, you can afford to pay more for everyone's health than someone who earns 55k€/a. That's essentially degressive taxation. Where are we, in America?

    I would leave Beamtenstatus intact though; it models what I would consider to be a ideal employment relation. In fact, I would want everyone to receive those benefits and be held to those standards... just... don't stiff everyone else on the way there.

    6 votes
    1. [2]
      Artrax Link Parent
      I honestly don't think charging people progressively makes a lot of sense. It's an insurance after all which, in opposition to social security which pays based on your previous income, threats...

      I honestly don't think charging people progressively makes a lot of sense.
      It's an insurance after all which, in opposition to social security which pays based on your previous income, threats everyone the same.
      Since the statutory insurance is heavily subsidized by the federal government anyway, it just makes much more sense to increase income tax (or other kind of taxes) and subsidize it more.

      Also, private insurance is waaaaaay more expensive. They offer things just some people definitely want, but many other wouldn't want to pay an extra for. Abolishing private insurances would have multiple draw-backs:

      1. Remove any incentive to master something very specific, since the GKV would just assign the patients (or incentivize those heavily specialized ones to go abroad, creating a shortage of those specialists which makes everything more expensive for people stuck in the statutory insurance)
      2. Instead of having a regulated official way of getting a "luxury" treatment, people with the sufficient funds would use semi-illegal methods.
      3. As you said, it's luxury treatment. Nearly everything, that is needed to care for your health is provided by the GKV, and what is not, is still attainable via other option. Being able to select you surgeon is something nice, but not something that is feasible when everyone has the absolute same priority. If there is only exactly one specialist that is able to perform the needed surgery and there is no other possible treatment, than the GKV will pay for it. Also not having to wait for a month for something not-urgent, is again, luxury. If it is urgent, than you will get a quicker appointment, if not, then because there are truly no appointments left.
      1. vektor Link Parent
        Well, the fact that GKV is mandatory makes me think of it in terms of taxes. And -subsidies aside- the way this is funded right now is basically a proportional tax for the poor-ish and a flat tax...

        Well, the fact that GKV is mandatory makes me think of it in terms of taxes. And -subsidies aside- the way this is funded right now is basically a proportional tax for the poor-ish and a flat tax for the wealthy. That's regressive taxation in my book. I consider healthcare a fundamental right, so I mentally frame it not as paying for it but as paying my taxes so the state can pay for it for everyone. Tomato Tomäto. I can see your point too though, just as valid. But at the end of the day, healthcare cuts a big chunk out of poor people's paychecks and I don't really like that.

  6. Happy_Shredder Link
    Much the same story here in Australia, as in EU & UK. If you're sick, you call up your GP for an appointment in the next few days. If it's an emergency, call the ambulance, and you'll be in the...

    Much the same story here in Australia, as in EU & UK. If you're sick, you call up your GP for an appointment in the next few days. If it's an emergency, call the ambulance, and you'll be in the hospital as fast as possible. In both cases treatment costs nothing, and pharmaceuticals are cheap and sometimes free. It's liberating.

    There are private hospitals and GPs that may offer 'better' or more 'personal' services. Dental and optical typically aren't covered, which sucks. Private insurance exists, but it's a little hard to justify having it. It can cover dental and optical, and private health service providers. Actually, the public service, Medicare, is run technically as a health insurer. Service providers charge Medicare in much the same way as they do private insurers. However, the government mandates how much Medicare can be charged --- there's a big book of prices for every possible medical service.

    I never worry about health. Of course I don't want to be sick or hurt, but if I am treatment is available and won't bankrupt me.

    6 votes
  7. [2]
    Pilgrim Link
    It's terrible. I never feel like I can go to the doctor without thinking about whether or not I can afford it. When I do go, I often have no idea what I'll be charged. If I ask at the doctor about...

    It's terrible. I never feel like I can go to the doctor without thinking about whether or not I can afford it.

    When I do go, I often have no idea what I'll be charged. If I ask at the doctor about price they treat me like some sort of poor pariah, or worse, like some greedy miser. They'll give me some arcane medical codes rather than a price and then I have to call my insurance company and then they'll go back and forth often without giving me a firm idea of what the final price will be.

    When my daughter broke her arm I left work early to meet my wife and daughter - not because I wanted to be with them in her hour of need, I did, but because I wanted to see if it was really broken or just sprained. I knew that a trip to the hospital would set us back $1,000. I was wrong - it was $1,400 for a small fracture. She only needed a cast for six weeks.

    You may say "what a monster!" but you'd feel differently knowing that at that time my family had worked hard over the past four years to save up for a new house in a nice neighborhood in a nice school system and a medical bill could have jeopardized all of that work - because I didn't know it it'd be $1K or $5K or $20K - no one will tell you for sure.

    "Preventative care" is an almost complete joke and is not as free as it's touted as being. If I go for a routine physical the doctor basically takes my blood pressure, listens to my heart, and if I so much as ask a question about anything that might be going on with me, then I get billed for a "long visit" that runs $120 or so.

    Basically, our health system is training me to never go to the doctor until it's too late.

    I live in the United States of America.

    4 votes
    1. patience_limited Link Parent
      I'm definitely not saying "what a monster!" As I mentioned elsewhere, I know exactly how badly I treated myself for fear of those massive, unknown costs. My life would be very different (I'd be a...

      I'm definitely not saying "what a monster!"

      As I mentioned elsewhere, I know exactly how badly I treated myself for fear of those massive, unknown costs. My life would be very different (I'd be a doctor), if $20k in healthcare debt hadn't intervened.

      Right now, I'm insured through my spouse's work, at a cost of around $5,000/year, and still paying about $350/month in out-of-pocket medical expenses.

      I suppose the insurance did pay for itself, if one can accept that the spouse's shoulder reconstruction surgery cost nearly $250,000, by the hospital's reckoning, and only about $3,000 in out-of-pocket expenses. [The devastating thing about this is that people who have insurance pay a heavily discounted cost, while those who have no insurance would be on the hook for the entire amount, assuming they'd been allowed the care in the first place.]

      I haven't gone for basic preventive care in a few years, because the in-network primary care doctors in my area are either awful or booked months in advance. I know what my employer charges for family plans that can still leave thousands of dollars in deductibles uncovered.

      This is an insane, Kafka-esque nightmare of a system, and again, I'm planning to devote considerable time in the coming year to political action.

      1 vote
  8. [5]
    DyslexicStoner240 Link
    Italian here: as much as Italians usually like to shit on how we handle our country, very few are ever going to complain about our healthcare. It's universal, generally speaking our professionals...

    Italian here: as much as Italians usually like to shit on how we handle our country, very few are ever going to complain about our healthcare. It's universal, generally speaking our professionals are of reliably high quality and considering the ever increasing budget cuts across the board i never had (or directly heard) of any major issueand the system's been holding up great.

    Basically how it works is that if you are an Italian or European citizen and you find yourself in a serious injury you'll be transported, taken care of and healed free of charge if not for negligible tickets (magnitude of hundred of euros tops).

    Of course waiting time and fees ensue (in the range of 100€ in the worst case scenario) when you show up in an hospital in a non life threatening condition or without a serious injury.

    Exams are also usually taken care of by a generic personal doctor that will usually send you to specialised professionals if something's coming up.

    I've been stitched up quite some times, my parents have had heart attacks and ligament tears respectively, and each time we were taken care of without questioning, swiftly and with no fallouts.

    Having said this I'd like to chime in with my experience with the US healthcare system.
    The one time i came to the US i managed to fall into an internet connection manhole thing that was left open and somewhat hidden in the grass right beside the sidewalk while in Charlotte (i really should have sued that one time - that was dumb of me not to); i had a rebar beam pierce right in my knee by like a full cm and something. It was painful and gory, but thankfully it didn't get to the bone. I had to go to the hospital and was scared shitless of the fees having read many times horror stories online.

    I was treated fairly, though i was questioned before getting any help by some medical staff.
    Thankfully i had made a travel insurance before leaving (something like 200€), after hearing that (and having it proven) they had my wound cleaned and patched up and a tetanus shot administered. The fee was substantial, something like $1500, i know for fact that if this happened in italy i probably wouldn't have had to pay more than 50€ in the worst case scenario.
    Nevertheless they did a good job; wound has since healed well. I basically just left it all to the insurance company to deal with and never heard from them or the hospital since. I ain't complaining, everything went well in the end, but I'm sure things could have turned sour if i hadn't had insurance, which is kinda fucked up...

    3 votes
    1. [4]
      patience_limited (edited ) Link Parent
      I'm increasingly aware that I don't live in a civilized nation, but rather a collection of more or less feudal states. The worst parts of the U.S. engage in medical serfdom - if you're not...

      I'm increasingly aware that I don't live in a civilized nation, but rather a collection of more or less feudal states.

      The worst parts of the U.S. engage in medical serfdom - if you're not employed in a company in a position high enough to merit decent insurance, you're SOL. Even children aren't fully ensured everywhere. Elderly people can participate in a decent federal insurance program (Medicare), but they're still subjected to substantial out-of-pocket costs, particularly for prescription drugs.

      Our campaign financing system has left ample room for corrupt influence - medical associations, private hospitals and insurers, pharmaceutical companies, and medical device manufacturers are writing the laws and blocking public coverage. There are consolidated professional guilds, care oligopolies, and patent-protected drug monopolies with complete price control.

      Many states' legislators perpetuate barbaric beliefs that the poor deserve to suffer, or just need to work harder (regardless of sickness and need for caregiving), or that charity can serve in place of state services. States which try to provide care for citizens are dealing with budget-busting costs because of the medical oligopolies.

      I have some personal animus in this area - I dropped out of medical school thanks to a mis-treated antibiotic-resistant infection, side effects from the treatment, and thousands of dollars in costs not adequately covered by insurance. That was twenty years ago, and things have gotten unbelievably worse since.

      1 vote
      1. [3]
        DyslexicStoner240 Link Parent
        Yikes about that last part, but it sounds it was quite some time ago so i'll assume you managed to get over it, props for it. I'm very weary at openly criticising any country as usually what it...

        Yikes about that last part, but it sounds it was quite some time ago so i'll assume you managed to get over it, props for it.

        I'm very weary at openly criticising any country as usually what it has or hasn't developed up to this point is the result of many years of history and are like it or not very circumstancial.

        That being said and stating the obvious, how the concept of meritocracy is brought up in the American society as a whole and stretched across all the various organisations (be it healthcare or prison to name the two obvious offenders) is rather unethical to say the least.

        Trust me though on this earth there is yet no 'Garden of Eden' of a country, sure the US may have its flaws and sure they might have weighted you down considerably, but it also has its advantages - in the same way Italy still currently functions great in its healthcare system but is headed towards a really explosive shitshow if we don't manage to get this populist regime out of our government.

        It's not a competition for what country is better or worse for there is really no end or prize to the game; the good of comparing ourselves to others is that it is the one and only way we can find our flaws, change and improve ourselves - a way to highlight the injustices.

        2 votes
        1. Badger28 Link Parent
          100% this. No country on earth has it completely right yet. I honestly believe some are better than others, but no system is perfect. Healthcare which is genuinely available to all, and well...

          100% this.

          No country on earth has it completely right yet. I honestly believe some are better than others, but no system is perfect. Healthcare which is genuinely available to all, and well funded across the board is the dream.

          I would like to hear more from people from Scandinavian countries. The general opinion in the UK of these countries is that cost of living there is high, as are taxes but a lot of the money goes into education, health care etc and so quality of life is generally very good.

          3 votes
        2. patience_limited (edited ) Link Parent
          There are U.S. advantages which are mainly accidents of geography and epidemiology; the early European settlers just happened to inherit a vast, thinly populated territory thanks to the diseases...

          There are U.S. advantages which are mainly accidents of geography and epidemiology; the early European settlers just happened to inherit a vast, thinly populated territory thanks to the diseases they brought along. The U.S. could easily have remained a fractious collection of more disparate feudal states, with "democracy" restricted to landholders. Many of our political problems are due to a reactionary faction trying to return to that situation (with updates to include corporate sovereigns). The meritocratic myth, and its deliberate erasure of inherited advantage, is just a reinvented propaganda version of the divine right of royalty.

          I know Italy has its own reasons for political division - the long North/South wealth and culture divide, corrupt influences of old religious and criminal institutions, its own toxic media ownership problems (Cf. Silvio Berlusconi and Rupert Murdoch's political puppet shows).

          I'm not telling my story as an "oh, poor me", but rather as a typical example of systemic democratic failure in the U.S.

          Public healthcare isn't necessarily a populist undertaking; it ought to be a system which both the general populace and elites can support for nationalist reasons (let alone compassionate concerns). Prosperity, productivity, political/economic stability, and other general benefits arise from a healthy citizenry. Most modern nations have a good grasp of this concept.

          I'm terrified that democratic political experiments globally won't withstand climate change, resource shortages, the easy corruptions of dark money, unmanageable false information, and the general breakdown of social trust.

          1 vote
  9. lazer (edited ) Link
    Sweden: When I moved here on a working holiday visa in 2012 and got sick I went to a "walk-in clinic" and paid 200sek (~21 USD). I am now a permanent resident and when I go to the doctor this is...

    Sweden:

    When I moved here on a working holiday visa in 2012 and got sick I went to a "walk-in clinic" and paid 200sek (~21 USD). I am now a permanent resident and when I go to the doctor this is still what I pay. Sometimes the doctor refers you to specialists (for example I had to get a couple of heart related tests). Most of the time I don't pay anything for the specialists, but I did have to pay for a 2-day EKG where I had to walk around with electrodes stuck to my chest for a couple of days, that was also 200 SEK. My skin checkup with a skin specialist cost nothing, and blood tests and such have cost nothing so far. Reproductive health costs nothing in my limited experience. Medicine like antibiotics when I needed them have cost within the < 200 SEK range as far as I remember.

    There have been complaints about waiting times. Indeed, when I wanted to check my heart my appointment was booked a month in advance. Personally I didn't find this to be a problem as this was clearly more a nagging "just in case" check than an emergency. I'd been living with a rapid heart rate for years and finally decided to get it checked out. My ex partner had a heart scare a few years back and went to the emergency room, where he was seen within 10 minutes (he ended up being totally fine, it was just anxiety). When I got bitten by a cat volunteering at a shelter on a weekend I walked into a clinic and got a tetanus shot and antibiotics within an hour. For me those are reasonable times when I weigh up condition-vs-urgency. On the other hand, I've also been fortunate enough to be relatively healthy with no chronic issues or anything of the sort, so maybe the system timing would feel less efficient for me if I had to use it more.

    One thing I do not like is that I think dental is not fully covered...I think there are some public/government funded dental procedures or clinics, but everyone I know just pays for private dentist visits.

    3 votes
  10. mftrhu Link
    Italy is so-so, it depends on where you live. My experience, living in the south, has not been good. GP visits are free, and most meds that you have a prescription for cost a flat rate (€1 for the...

    Please talk about your nation's policies - the good, the bad, and the ugly. Tildes is mostly a young crowd that might not have direct experience of major medical need, but any commentary on what has worked and what doesn't is welcome.

    Italy is so-so, it depends on where you live.

    My experience, living in the south, has not been good.

    GP visits are free, and most meds that you have a prescription for cost a flat rate (€1 for the prescription, €2 for each box), or nothing if you are exempt from paying for them.

    But the infrastructure leaves a lot to be desired. My brother died because of it. There is often not enough beds, or meds, or supplies for the patients they are supposed to serve. Hospitals are understaffed, and it's probably only going to get worse.

    For anything less than emergency treatment (and that needs more than a GP visit), you'll have to deal with long waiting lists and a somewhat byzantine... interface (read: "who do I need to call? what do I need to say? what documents do I need to bring?"). A lot of people go down the private route as a result.

    This has been a problem especially when having to get blood tests. Apparently, according to my GP, he can't prescribe me most of them - despite the fact that they are needed to monitor my levels - because a law passed recently to stop "defensive" medicine and over-prescription of tests (which has always been a problem, but the limits given are fairly ridiculous - like cholesterol being allowed once every five years), so I have to pay for them out of pocket.

    Luckily, even paying out of pocket most things won't be really expensive - in the €50-€100 range - and sometimes even cheaper than going through the NHS (rate based on the exams/meds you need vs flat), but it's not exactly peanuts.

    Abortion is technically guaranteed by law, but up to 90% of the doctors in any given hospital/area might be consciousness objectors.

    Trans care is just ridiculous, no matter where (with maybe the exception of Genova). Next to no info available, doctors are untrained and follow outdated or homebrewed (and outdated) protocols in a shitty, paternalistic manner.

    It can be good. It can be very good if you do not live in a rural area. But it still needs more funding, and more importantly - more staff.

    3 votes
  11. Grand0rbiter Link
    Geez, even Brazil is better than US. We have free healthcare for everyone. The waiting lines are gigantic depending on the case, the staff is underpaid and not the best, but treatment and...

    Geez, even Brazil is better than US. We have free healthcare for everyone. The waiting lines are gigantic depending on the case, the staff is underpaid and not the best, but treatment and medication are all free.

    That said, having insurance is best because the emergency care here (called UPA) is full of young underpaid doctors who graduated because dad afforded and wanted them to continue the doctor heritage.

    Being a doctor here is a garantee of status and being rich (even if underpaid). So there's a lot of expensive but not so good schools with not so good students. In a country in financial crisis like this, everyone wants to be a doctor.

    2 votes
  12. [3]
    Algernon_Asimov Link
    A few years back, I fell and fractured my elbow. The pain was intense. And I was unemployed at the time. A friend drove me to a nearby hospital immediately. He chose it mostly on the basis of its...

    how does your country's healthcare system perform for you?

    A few years back, I fell and fractured my elbow. The pain was intense. And I was unemployed at the time.

    A friend drove me to a nearby hospital immediately. He chose it mostly on the basis of its proximity to my accident. He just picked the nearest public hospital and drove there.

    We went into the emergency room that evening. We filled out some paperwork, including giving them my Medicare number. Every time my arm moved the wrong way, the pain caused me to nearly collapse on the floor, so a nurse gave me some painkillers while I waited.

    I had to wait about 4-6 hours (my memory's a bit vague!) to be attended to. They took X-rays and MRI scans of my arm that night. I was assessed and diagnosed by a doctor some time after midnight. I was admitted to the hospital immediately afterward.

    I was operated on 2 days later. Coincidentally, a surgeon who specialises in injuries like mine was scheduled to work in this hospital that same week.

    I was released from hospital on the 3rd day after my accident, with my arm in a sling and all the medical procedures finished.

    The total cost me to all of that was ZERO. I never once had to worry about money or payment. I knew it would all be covered by Medicare.

    The only thing I had to pay for was the post-operative physiotherapy - but, that's what private health insurance is for. Private health insurance is useful for treatment in private hospitals, rather than public hospitals, and for any ancillary medical costs one incurs, such as dentistry, physiotherapy, psychology, and so on. But all actual medical costs, like hospitals and doctors and operations, are covered by Medicare.

    I'm in Australia. I love Medicare.

    2 votes
    1. [2]
      patience_limited Link Parent
      Curiously, I had a related experience at the time I had the best health insurance I'm likely to ever have again. I worked for a university hospital system, in a school with a fantastic student...

      Curiously, I had a related experience at the time I had the best health insurance I'm likely to ever have again. I worked for a university hospital system, in a school with a fantastic student health service.

      Bike crash, showed up in the ER with what sure as heck felt like a broken elbow, hip, wrist, and some other things. The hospital ER was an 8 hour wait, with a bunch of student doctors parading through, giving my arm a shake and saying "That's not broken!". The X-ray developer was having problems, so it took three passes through to be told nothing was wrong.

      Follow up at the student health clinic a few days later - broken elbow, torn knee ligament, and an assortment of other diagnoses.

      The great health insurance through the university paid for nearly everything, including a couple of rounds of physical therapy, but the quality of care was wildly uneven.

      1. Algernon_Asimov Link Parent
        Now, imagine going through the same process without health insurance - like I did. I was unemployed and had no insurance whatsoever. My quality of care was uniformly competent.

        Curiously, I had a related experience at the time I had the best health insurance I'm likely to ever have again.

        The great health insurance through the university paid for nearly everything

        Now, imagine going through the same process without health insurance - like I did. I was unemployed and had no insurance whatsoever.

        but the quality of care was wildly uneven.

        My quality of care was uniformly competent.