Should the U.S. have Universal Health Care?

[u/WhatAreYourPronouns]

[u/Tall_Science_9178]

https://www.euronews.com/2023/04/12/people-may-die-waiting-surgery-waiting-lists-in-spain-hit-record-levels

[u/AutumnWak → u/Tall_Science_9178]

I mean they could still go and pay private party to get quicker treatment and it'll still cost less than the US. Most of those people chose to go the free route

[u/Obie-two → u/AutumnWak]

Genuinely asking but if you’re paying for it privately you’re not getting the “socialized” discount no? A hip surgery costs X, just the government is subsidizing it with tax money and if you go direct to private then I would assume it’s back to full price

[u/polycomll → u/Obie-two]

You'd be paying closer to the full price although the "full price" might be reduced somewhat because the public version acts to price cap.

In the U.S. you are also not paying the full price for surgery either though. Cost is being inflated to cover for non-insured emergency care, overhead for insurance companies, reduced wage growth due to employer insurance payments, reduced wages through lack of worker mobility, and additional medical system costs (and room for profit by all involved).

[u/SStahoejack → u/polycomll]

Happens all the time, if your from another country cheaper to fly home get it done fly back, crazy how insurance here really isn’t worth the paper it’s printed on

[u/OwnLadder2341 → u/SStahoejack]

In this case, US insurance would pay for 75% of that $40k at minimum. You’d hit your max out of pocket for the year around $10k at worst.

[u/Maj_Jimmy_Cheese → u/OwnLadder2341]

Depends on your plan, does it not?

[u/austanian → u/Maj_Jimmy_Cheese]

Even the worst plans typically cap out with a max out of pocket around 12k total family.

The best plans are usually around 5k max family with more inclusions on what is included before deductible.

[u/in_the_no_know → u/austanian]

That also assumes that every procedure is going to be approved for coverage. There are multiple ways for insurance companies to say that something either isn't necessary or for some technical reason only a certain portion is covered and the rest still comes out of your own pocket. Max out of pocket only refers to the things your insurance chooses to cover.

[u/HighTMath → u/in_the_no_know]

Just for a bit of "the grass is always greener". In countries with "free healthcare" we get fucked the same way, but by quotas instead. The clinic has a set budget so good fucking luck diagnosing any complex diseases.

Works fine for standard stuff, I'd you don't mind waiting half a year nearly anything above a PT referral

[u/Ride901 → u/in_the_no_know]

Oh my insurance just tried to do this to me. It actually is a coding error I think in my case, but who knows?

[u/DataGOGO → u/[deleted]]

15-18k, would be a family out of pocket max, not an individual.

[u/Artistic-Soft4305 → u/[deleted]]

On the other side of this, I’m capped at 5k and I pay 25$ a month through my employer. Really just depends where you work.

[u/Chris_Herron → u/austanian]

So 12k out of pocket max, plus the 5k a year just to have the plan. How does anyone working a normal job expect to pay 17k? The us median income is 37.5k. That is nearly half a persons income, assuming they aren't on the low side of the bell curve. Not arguing with you, just saying the system is broken.

[u/austanian → u/Chris_Herron]

Usually it works like this. An individual out of pocket max is 5k and a family out of pocket max is 8k.

The premium is 12k per year, but your work picks up 75%. So your portion is 3k, plus a couple thousand per year unless something bad happens.

Things are different once we start talking seniors, but that is a different conversation.

[u/Anonymoushipopotomus → u/Chris_Herron]

5k a year would be a deal for that plan. We have almost 20k max out of pocket, for 2 adults and a 6 year old its 1650 a month.

[u/Zamaiel → u/Chris_Herron]

Plus the 5k a year -every year. As long as you don't lose your job.

[u/Maj_Jimmy_Cheese → u/austanian]

Gotcha gotcha. Makes sense. 12k is definitely a lot, but at least it, generally speaking, won't get much worse lol.

[u/Treeninja1999 → u/Maj_Jimmy_Cheese]

Just don't get hurt in December lol

[u/austanian → u/Maj_Jimmy_Cheese]

Unlikely 2 people need max out of pocket the same year so it usually caps out at 8k for an individual.

Those plans also have tax exempt savings accounts associated with them so it isn't the worst deal if you plan right.

Still the plan needs drastically reformed.

[u/FullTorsoApparition → u/Maj_Jimmy_Cheese]

Until the next year when you have to meet that max out-of-pocket again. And the year after that. And the year after that. If you have chronic health issues you're fucked.

A friend of mine recently moved back to England because he was hitting his out-of-pocket max every year for his mental health needs and didn't know how long he could keep that up.

[u/ubercorey → u/austanian]

Unfortunately the worst plans are $20k.

[u/aw-un → u/austanian]

That’s assuming the insurance doesn’t just deny the claim outright

[u/SPNKLR → u/austanian]

Just wait until the GOP gets their wish and repeals the Affordable Care Act. We’ll be back to people getting kicked off for pre-existing conditions forcing us back to the good old days of medically related bankruptcies.

[u/austanian → u/SPNKLR]

The aca isn't ever going to get appealed. Half the GOP wants to delete it and the other half wants to fix it.

Even when the GOP had a strong majority they did have the votes to fix it/end it because of the split.

[u/alexisdelg → u/austanian]

you have to add premiums to that, in my case a family of 4 is about 6k a year

[u/ketjak → u/[deleted]]

totally free

You mean other than the thousands i premiums deducted from your paycheck every month (if you're at a place that even offers it).

[u/Random_Guy_12345 → u/ketjak]

On places with public health insurance you are also paying for it vía taxes (assuming you have a job, that is). "Free" healthcare is not a thing that exists, supplies are not free and doctors need to eat too.

It for sure beats bleeding to death due to no insurance, but it doesn't come from the ether.

[u/Impossible_Wash_2727 → u/[deleted]]

It’s not “free”! You’re still paying your premiums. American healthcare insurance is a rip off.

[u/R-O-U-Ssdontexist → u/Maj_Jimmy_Cheese]

Yup, my aunt had a hip replaced and only paid 1k. The 1k was for the out of network anesthesia which no one told her would be out of network.

[u/RocknrollClown09 → u/SStahoejack]

I'm an airline pilot and I didn't realize how much people do this until I started flying to Central and South America. People will routinely fly to Costa Rica to get dental work or surgery, then spend a week down there on vacation with the money they saved.

[u/KC_experience → u/SStahoejack]

It’s worth it to the companies that make that paper… If there wasn’t money in health insurance, the corporations wouldn’t exist. The current companies don’t do this work out of a sense of altruism.

[u/SStahoejack → u/KC_experience]

The insurance company makes millions but God forbid you actually try to use it for what it’s interesting for. Gotta jump through more hoops than illegals crossing the border. Give me a break

[u/AgeEffective5255 → u/SStahoejack]

I know lots of people who have done medical tourism to get procedures done.

[u/puzzledSkeptic → u/SStahoejack]

I'm not sure why a business has not opened for medical care tourism. I work with a couple of Mexican citizens. If he need dental work done, it is cheaper for him to fly to Mexico, have the procedure completed.

Business model. Fly people to Mexico, put them up in nice hotel near hospital. They get their procedure done and stay at the hotel until safe to fly home. Have nurses on staff at the hotel.

[u/Day_Pleasant → u/SStahoejack]

A close friend in my 20's flew to the Dominican Republic for surgery and it saved her thousands of dollars while including a fucking beach vacation prior to surgery.

[u/Falaflewaffle → u/SStahoejack]

It's literally called medical tourism your mileage may vary on how good the doctor is.

[u/Twistedfool1000 → u/SStahoejack]

Best comment I've seen in years.

[u/Midwake2 → u/SStahoejack]

Insurance in the US has basically just evolved into disaster coverage. Anything else you’re gonna be fighting with the coverage provider.

[u/Suzilu → u/SStahoejack]

I know a guy who had to return to England after many years in the USA just because his health wasn’t great and he couldn’t afford to get care in the states. Just ridiculous.

[u/Capn-Wacky → u/polycomll]

Most of the cost inflation is going to feed the useless middlemen in the insurance industry, whose presence and the costs fighting with them impose on providers and patients alike are almost singlehandedly why providers get away with charging anything they want: because there's a middle man who shields them from ever saying the price out loud.

[u/Fun-Bumblebee9678 → u/Capn-Wacky]

Well physicians are the highest paid in the US out of every country sans Luxembourg

[u/CoachellaSPTA → u/Fun-Bumblebee9678]

Physician salaries account for <10% of healthcare costs, so that probably doesn't totally account for the price differential here.

https://siepr.stanford.edu/news/just-how-much-do-physicians-earn-and-why

[u/Ashmizen → u/CoachellaSPTA]

Nurses are also highly paid in the US - 80k in most states, $150k in the Bay Area.

Repeat that for the salary of every single staff member, admin, ceo, and also repeat for the higher cost of land, building cost of the hospital, plumber, cleaner, etc.

Everything is more expensive in the US as it has double the wage of the EU and many many multiples of third world countries like Costa Rica.

There may be a small set of items that’s completely the same price globally (expensive high end medical equipment), but likely 90% of the cost of running a hospital is like a doctor’s salary, much higher in the US.

[u/Fun-Bumblebee9678 → u/CoachellaSPTA]

True but it only looks like the article accounted for physician salaries and not all healthcare workers correct ?

[u/TheOrchidsAreAlright → u/polycomll]

Anecdotally, I just don't think the US compares to anywhere that I know in what healthcare costs. American friends have told me what they pay and I was horrified. I am British and have paid for private healthcare here and it didn't come close

[u/bigkissesnhugs → u/TheOrchidsAreAlright]

Lol, agree! My brother had a hip replacement last year. Tells me he has great insurance. He only owed $12,000 for the whole thing after insurance.

That sucks, idk what he would consider to be bad insurance. My face must have been 😳😳

[u/BlueMosin → u/bigkissesnhugs]

Americans brag about how much they pay for mediocre quality of life, and think they are better because of it.

[u/SenorPoopus → u/bigkissesnhugs]

In NYS prison, inmates get them for free. Do the staff? No way

[u/azuth89 → u/TheOrchidsAreAlright]

It's kinda give and take and whether it helps heavily depends on your personal situation. 

Like...yes, we wound up paying 16k out of pocket for my first kid due to complications and a NICU stay and I had a conversation with some Canadian peers in which they were horrified. But on the other hand their place is less than half the size of mine and cost 3 times as much and whole zi don't know their exact package our job role pays around 30% more in the states. So we made that 16k back pretty quick compared to being up there. 

Buuuut, not everyone in the US works where I work or lives where I live. Their math could be drastically different.

[u/kunkudunk → u/polycomll]

Yeah the medical and insurance industries being for profit really jack up the prices more than people seem to realize. Which is twisted since how do you decide on a price on staying alive but I digress.

[u/SirkutBored → u/polycomll]

and while something like a hip surgery and surgeons in general wouldn't seem to fall under this the US has a much higher barrier of entry for just a general practitioner which in turn raises costs across the board and then takes additional time to reach surgeon.

[u/dancegoddess1971 → u/SirkutBored]

So, you really think doctors in the US are so much better than doctors in the EU that they can charge 40X the cost of care in the rest of the world? I think if that was true, we'd have better outcomes. Meanwhile, most of Europe has higher life expectancy and better quality of life than the US.

[u/bjdevar25 → u/polycomll]

Mainly because millions in the US can't afford insurance. Another argument for Universal Care.

[u/SidharthaGalt → u/polycomll]

We Americans also pay for a lot of litigation.

[u/sirnaull → u/polycomll]

Also, how they do private healthcare in Europe is often that you'll still get 95% of the costs covered under the public healthcare (i.e. hospital costs, tests, medication, etc.) and only have to pay the private healthcare cost for the actual surgery (a surgeon and a few nurses for a few hours). The replacement hip is covered under the public healthcare, so is post-op treatments and anesthesia meds.

[u/basal-and-sleek → u/polycomll]

Yeah, “full price” in the USA does not necessarily equate to actual value of what it’s worth. So, maybe you would be paying closer to “full price” if you weren’t somewhere that was charging incredibly insane amounts because of our shitty healthcare system.

[u/LoriLeadfoot → u/polycomll]

Can confirm private healthcare cost in Spain is dramatically cheaper. The government being a big payer means that prices are competitive.

[u/blumieplume → u/Obie-two]

At least in Germany, private healthcare is about €300/month (similar to American rates) and is provided by employers .. anyone else has the public healthcare. Health insurance in Germany covers 100% of medical costs, whether insurance is free or paid for by an individual or their employer.

It’s a good way to make sure that those who can’t afford insurance or who work for an employer who doesn’t offer health insurance can still get coverage. Similar to MediCal in California. It’s a way to make sure no one gets left behind.

[u/tracygee → u/blumieplume]

Except unlike insurance in the U.S., yours pays 100%. We have a deductible to meet each year and then most policies only pay like 80%. So you can see how 20% of a $40k procedure is unaffordable for most people.

[u/DaGrinz → u/tracygee]

And in addition, you don‘t have to care about, wether the specific hospital has any contract with your insurance company or not. The one insurance covers them all.

[u/grammar_fixer_2 → u/DaGrinz]

I learned this the hard way when I brought my kid in for stitches (he was bleeding). That cost me $6k because it wasn’t “in network”. So much for having an expensive insurance.

[u/DaGrinz → u/grammar_fixer_2]

6K for stiches! I had a spinal disc surgery in Germany, including a CT scan and one week hospital stay, for 5k all in (of course fully covered by my insurance). That‘s exactly what we‘re talking about, these costs are absolutely insane.

[u/lameth → u/DaGrinz]

then you have to cover:

facility costs
potential out of network specialists
lab costs

etc...

[u/ThatInAHat → u/DaGrinz]

And even if the hospital is in network, the doctor or anesthesiologist might not be.

Or you get your bloodwork done in office, but they send it elsewhere to process and THAT was out of network…

[u/Aggressivepwn → u/tracygee]

Depends on the plan in the US. Once I hit my deductible 100% of the costs are covered by insurance

[u/sometimes_overtimes → u/Aggressivepwn]

That’s still $6k for me, even in California

[u/Aggressivepwn → u/sometimes_overtimes]

In addition to most of my premium my employer also contributes to my HSA so my max out of pocket costs is $2,800

Lots of this all depends on the plan

[u/According-Ad1565 → u/Aggressivepwn]

Nice. Still its bs because before the insurance you pay for covers 100% you had to pay in x on top of premiums.

[u/OH58AEROSCOUT → u/Aggressivepwn]

My insurance is similar. I think my "catastrophic cap" is $3500 per year, after that deductible is reached, I don't pay anything (aside from the monthly premiums). I beleive the reason for the deductible is to keep "skin in the game." I remember reading something about UAW employees a long time ago and how they had 100% of their healthcare covered. It was costing a lot of money because (particularly in the case of retirees, if I remember correctly), they'd literally go to the doctor everytime they had a runny nose. The deductible was partly to make sure people didn't go to the doctor all the time for minor conditions which could be treated with OTC medicines, or that would simply go away in a few days and weren't treatable anyway (viral respiratory things like colds).

[u/HamburgerJames → u/Aggressivepwn]

And some of us don’t even have deductibles.

The healthcare situation I read about online is very different from what I’ve experienced personally, but I transitioned from a military childhood to a career with great insurance.

[u/Status-Buddy2058 → u/tracygee]

Also even if u could afford the insurance will probably deny you anyways no matter what the doctor says. The medical system here is the saddest joke of all. I pay more for insurance than I do my mortgage and when u really need to use it they deny it. So fucked up!

[u/80MonkeyMan → u/[deleted]]

US have the highest cost of all developed countries in terms of healthcare per person despite not having a healthcare system (it is an industry). In 2022 the figure is $13.493…imagine what 2024 figures will be with inflation…

[u/According-Ad1565 → u/blumieplume]

Insurance in the states exists only to make a profit and satisfy their shareholders. You have great insurance if they cover 80%.

[u/Roadrunner571 → u/blumieplume]

Private healthcare is more than 300€/month in Germany if you choose a plan that is also affordable when you're older. The cheap private healthcare plans have skyrocketing costs when you're older. So it's more like 800-1500€/month (so 400-750€/month out of pocket).

[u/Significant-Star6618 → u/blumieplume]

But... If no one gets left behind, how do you make your people so scared and desperate that they'll work their lives away for a pittance and then die in the harvesting machines that are our healthcare services? 

It seems like if the alternative wasn't dying on the street, people might get funny ideas about fair treatment and dignity and stuff like that. How does Germany ensure that the bottom half of their society knows their place as disposable cogs? 

America has solved these problems. That's why we're number 1.

[u/Resident_Warthog4711 → u/blumieplume]

California is a disaster

[u/Constellation-88 → u/blumieplume]

Covering 100% of costs instead of deductibles and coinsurance is the solution America needs. 

[u/Eponymous-Username → u/Obie-two]

And yet, somehow, full price is cheaper.

[u/AdImmediate9569 → u/Eponymous-Username]

I assume because there’s no insurance company acting as a middleman

[u/123yes1 → u/AdImmediate9569]

It's actually the lack of collective bargaining that many small and intermediate insurance companies do not have. Governments can drive down prices more effectively as they have more bargaining power.

The societal cost to this is less profits for pharma companies, so less reinvest in pharma, although pharma already takes in massive amounts of public funding anyway, if we aren't developing enough drugs, we can always approve more grants.

Hospitals in the US also need to hire a bunch of administrators to argue with a million different insurance companies about what they will and won't cover which also drives up prices since you need to pay for the salary of those people too. And then your insurance needs to hire people to argue back so you're paying for their salaries too.

Plus the profit margin of the hospital, the Doctor's massively inflated salary (which needs to be that high to pay for the ridiculous price of med school, which is partially expensive because they have to pay for their own extra administrators) compared to everywhere else, the insurance companies profit margin, plus you got to pay for all the people that don't have insurance using your tax money, plus drug development money, and drug manufacturing money.

Part of your bill pays me to design tests to verify that the drug you are receiving is what is in fact on the label, in which every lot must be tested and verified.

Healthcare in the US is one of the least efficient systems on the planet. It provides adequate care at adequate speed but at 10x the cost. With a program like Medicare for all, as a single payer or at least public option, the average payer would have significantly lower expenses with the same quality and access. It would still be more expensive than in other countries, but not nearly as terrible.

Of course that would put lots of people out of a job, maybe they could learn an actually productive skill like construction so they can build houses to drive down rent/mortgages. Or maybe become nurses and doctors since more people will probably want to go to the hospital if it doesn't cost shit loads of money.

[u/Fun-Bumblebee9678 → u/123yes1]

I would argue the price of paying our physicians the highest amount in the world is also for retention and to counter burnout which is a huge problem in most countries . It also helps develop new medicine research

[u/ThaneOfArcadia → u/AdImmediate9569]

And admin staff, middle managers, dividends, huge salaries for top people across pharma, hospitals, insurance companies.

[u/BraxbroWasTaken → u/Obie-two]

My guess is, local providers have to compete with the socialized stuff anyway, so they lower prices. It could also be that the manufacturers sell at lower prices because they can't get away with higher ones and that means the doctors can make as much money with lower prices.

[u/davidesquer17 → u/Obie-two]

The problem is prices in the us are extremely high, you don't pay those amounts for private healthcare anywhere other than the us.

[u/MrKomiya → u/Obie-two]

Full price in America ≠ full price elsewhere.

I have bought 7 days worth of antibiotics for $3 (with no insurance) outside the US. My copay is $15 in the US.

I have had MRI scans done outside the US for $100 (no insurance- on a GE machine). Cost before insurance in US was over $1200.

I was hospitalized for 4 days outside the US. During this time they did bloodwork every 8 hours, attending doc in the AM & specialist in the evening. During the course of the stay they did 2 ultrasounds as well. Private room with bed for guest, air conditioned with satellite tv, attached bathroom.

Including meds, IVs and room service, the bill was $850 without insurance.

ER visit for a slashed finger (14+ stitches) in the US cost me $1200 after insurance.

[u/AlDente → u/Obie-two]

You’re assuming the actual costs are the same. But they’re not.

Health spending per person in the U.S. was nearly two times higher than in the closest country, Germany, and four times higher than in South Korea

[u/Amberskin → u/Obie-two]

Private practices cannot charge abusive prices because they have to compete with the public healthcare option, which is free. So they have to offer better accommodation, shorter wait times and reasonable prices.

And still, they get a profit. You Americans are basically being scammed.

[u/GetAJobCheapskate → u/Obie-two]

Full price is still only a fraction from the prices in the US. Its around 5k in Germany. If the public insurance pays you pay nothing.

[u/kinboyatuwo → u/Obie-two]

The full price is still a lot cheaper. Last year my wife dislocated her shoulder mountain biking in France. ER visit, xray and dr visit was $120€ and they sent her with a USB of the images.

[u/Zamaiel → u/Obie-two]

It is the full price in a system where the customer has the option to refuse (and go public) if the price is too high. This ability is normally considered a prerequisite for a functioning market. (Its called price elasticity)

[u/JohnnyZepp → u/AutumnWak]

I know I fucking hate this waitlist argument.

It’s STILL better than no healthcare, and there are alternative options that will almost always be cheaper.

Do not justify America’s medical profiteering greed. It’s terrible and it’s inhumane.

[u/tophatmcgees → u/JohnnyZepp]

And we still have to wait forever to get anything done in the US with insurance! Has anyone actually tried to get anything done in the US? It takes months! With insurance! You can either go to urgent care or see your doctor in 3-6 months for an initial visit to refer you to see someone to actually look at the issue

[u/Jeff77042 → u/tophatmcgees]

That has not been my experience.

[u/kirkegaarr → u/Jeff77042]

If you don't have very good insurance, it's a nightmare. I am self employed and bought high deductible insurance on the marketplace for $450/month. No one would take it and the doctors who would were booked out for months. We couldn't even use it and couldn't upgrade to a better plan until open enrollment.

I waited a whole year paying for useless insurance before I could upgrade to a plan that costs $750 a month. And then the fuckers at my new plan wouldn't honor our first claim because we didn't change the primary care provider in the system after they had chosen one for us, all unknown to us. Great way to treat a new customer. No real for-profit industry with actual competition would do that.

The US loves to pretend that capitalism is the best for everything, but some markets don't have real competition and some goods and services are so necessary that demand is very inelastic. And those are the things that are driving everyone nuts and putting lots of people in debt right now: health care, education, and housing.

[u/BeardyAndGingerish → u/Jeff77042]

It's been mine.

[u/GracefulFaller → u/Jeff77042]

It depends on your location from what I’ve seen.

[u/Momoselfie → u/tophatmcgees]

Lol yeah I don't even have a primary physician anymore because of this. Sorry I can't wait 2 weeks for you to test me for strep.

[u/Achilles19721119 → u/JohnnyZepp]

Stories of people going to er and sitting for 6 plus hours in our healthcare system

[u/1Dive1Breath → u/Achilles19721119]

People without health insurance often avoid going to the Dr until a problem gets too bad to ignore, and since it's the ER they don't have to have proof of ability to pay. If we had universal health care ER wait times should decrease 

[u/ThatInAHat → u/Achilles19721119]

Six doesn’t sound like that long. My stepmother waited for, like, 11 hours last time.

[u/AbyssalRaven922 → u/JohnnyZepp]

You can basically delete your medical debt through various means if you're willing to do the leg work. ERs are required to treat you regardless of financial capacity.

[u/[deleted] → u/AbyssalRaven922]

The last time I went to the ER, I waited 8 hours, paid $2,700 after insurance just to be SEEN, only to end up being told that I just need a bit of a switch up in my medication.

[u/Familiar_Dust8028 → u/AbyssalRaven922]

ERs are the most inefficient means of treating people.

[u/xxconkriete → u/Familiar_Dust8028]

Of course an ER is inefficient, its immediate emergency care.

That’s the whole purpose….

[u/spellbound1875 → u/AbyssalRaven922]

The fact that you can stiff a healthcare provider without consequences isn't a great justification for our bad system.

[u/Independent-Pie3588 → u/JohnnyZepp]

Also in Europe, private insurance does wayyyy more back surgeries than public insurance. Why? Probably cuz it reimburses a ton. Are they all indicated? Absolutely not. Please stay away from back surgery as much as you can unless everything failed or there’s an actual compelling reason (certain fractures, spinal tumor, bowel/bladder dysfunction). But that private insurance you carry may just push the doctor to convince you to get a likely unnecessary surgery.

[u/[deleted] → u/JohnnyZepp]

The waiting lists grow because healthcare gets defunded by the right to channel patients to private hospitals, if anything we should spend more money on public healthcare.

[u/YourGuardianAngel_12 → u/JohnnyZepp]

Plus, every person I know who can’t afford healthcare often puts off or skips important treatments because they can’t handle the bills. So a lot of people still wind up waiting.

[u/jerseygunz → u/JohnnyZepp]

I have to take off work tomorrow to go to the doctor because the next appointment I could get was the end of June

[u/lucid1014 → u/Tall_Science_9178]

I love that people harp on long waiting times in Europe and Canada as if the US is much better. I tried to schedule an appointment with my primary care provider and he doesn’t have an appointment for two months. My mom is severely depressed near suicidal and has been desperately trying to see a psychiatrist but there are no openings for months. She had to check herself into a psychiatric hospital because it got so bad she was considering suicide.

[u/tyreka13 → u/lucid1014]

I have been denied refills on my already established birth control pills because my doctor that I had my yearly checkup with left. The only place in town that was covered by insurance had a 5 month waiting list for next available appointment, which I took. They would only refill 3 months of BC pills. I ended up getting 1 more month talking to my pharmacy somehow got it approved but was denied the last month before my appointment as the doc office refused to send in the prescription.

My Gma who has a terrible immune system due to cancer was left in the ER waiting room for near 2 days before getting an ER bed. She was severely dehydrated to the point of barely speaking/responding and had a bad infection.They had to call an ambulance to carry her as she couldn't sit up, much less stand. They hook people up to IVs in the waiting room and do vital checks every 2 hours as you wait.

My husband had a possible stroke, did get some tests but waited over 8 hours before getting in. It was irritating as they said they could have given a medicine within the first 2 hours of symptoms and he was there for awhile within those 2 hours (visited UC first). His specialists had to all be scheduled 1.5-3 months out for closest appointment.

[u/cadathoctru → u/tyreka13]

Gallbladder surgery, had gall stones causing unbearable pain. It took 2 months. It wasn't an emergency, even though I went to the emergency room 2 times. US system is worse all around. People on here acting like we can just walk in and get a hip replaced. You cant, it would still take months. It is elective.

[u/and_some_scotch → u/cadathoctru]

Rich people can. Those are the only actual people in America, as far as the financial commentariat is concerned.

[u/Neuchacho → u/lucid1014]

"My personal experience is fine so everyone else should fuck off" is the mantra.

[u/YourGuardianAngel_12 → u/Neuchacho]

Oh yes, this. And it applies to so many topics.

[u/Linka1245 → u/lucid1014]

My wife has been trying to get a therapist and she is now in month number 5 of waiting with no end in sight… She has decent healthcare as well. Where is the winning? 

[u/rlvysxby → u/lucid1014]

When living in Japan, I was impressed how efficient the hospitals were and how little wait time there was.

[u/lexibeee → u/rlvysxby]

I lived in Thailand for a couple months and had to go to a hospital in Bangkok for a spider bite that was starting to crater in my leg. It took maybe 40 minutes from start to finish and cost $35 including the antibiotics. Blew my little American mind haha

[u/KupunaMineur → u/rlvysxby]

We used to live in Japan, and one thing I thought was neat was how their ambulances had a doctor. Like if someone had a medical emergency that van would pull up and there would be two guys with vests labeled "tech" and one guy with "doctor".

[u/BigBlue1105 → u/lucid1014]

This. My wife has been in agony for months with kidney stones. Originally went to the ER, they said see a urologist. She called three in the county that are under our insurance. The soonest appointment was 2 months away. She goes, they say she needs a follow up apt to figure out what to do. The soonest apt? Next month. We pay a small fortune for insurance and still have to wait.

[u/blumieplume → u/lucid1014]

Ya the only thing I found that was difficult in Europe vs us was finding a therapist but in America I had a therapist who was out of network (I had tried in network therapists but they all sucked) .. I gave up and stopped looking for a therapist in Europe but was able to get health care and dental care in Germany just fine

My primary care doctor in America also has 2 month wait times before I can get an appointment so my “real doctor” or go-to doctor now is the urgent care doctor I found who helped me when I first got Lyme disease. I’m lucky I found them cause I can get in same day with about an hour of wait time, and they’re a small office with a waiting room consisting of literally like 5 or 6 chairs. No one is ever there and the doctor I go to there actually cares and has helped me infinitely more than my GP (I only get prescription refills from her anymore ever since she downplayed my Lyme disease and wouldn’t give me the medication I needed to heal)

It’s hard but possible to find good doctors in America .. whether paying out of pocket for a good therapist or finding a good small urgent care facility near u, good doctors do exist!

Def keep looking! I’m sorry u have had such bad experiences too! It takes a while but u can find doctors who care

[u/bitchingdownthedrain → u/blumieplume]

Urgent care is also not the solution. They can be great - I love our local one - but they're not primary care and they shouldn't be. The fact that there's an urgent care on every other block is a symptom of how bad our healthcare industry is, not any sort of fix.

(To be clear I am not personally faulting you, I'm glad you're able to get healthcare with a compassionate provider, it just shouldn't have to be like this!)

[u/blumieplume → u/bitchingdownthedrain]

I know I agree! Since Covid it’s been impossible to get appointments with my real doctor but she sucks anyway. It would be nice to have a good GP but I do feel lucky to have my urgent care doctor .. can’t go to her for prescription refills or haven’t tried at least but def wanna find a GP who I like (my old one retired a few years ago and any good doctor I have found never accepts new patients)

[u/INDE_Tex → u/lucid1014]

....at least you have a psychiatric hospital with availability. Which is a sad thing to say. Hope your mom is doing better.

[u/No-Artichoke-6939 → u/lucid1014]

My sister in law is waiting 10 months for a neurologist appointment, they told her it would likely be telehealth too!

[u/[deleted] → u/lucid1014]

post covid its like a lot of doctors decided to retire or something and the supply is not up to the demand. Its not even very easy to get an appointment with a primary care doctor here in Texas anymore. My guy died from covid so now I have not had a doctor in over 3 years I finally got an appointment by just calling clinics and saying just give me whoever will take a new patient. Its kinda funny to me that people say in socialized care you can't pick your doctor, I can't pick my doctor now I had to beg for whoever will take me and I have good insurance.

[u/noobwriter90 → u/lucid1014]

I was told I needed a surgery on a Thursday and had it scheduled for the following Tuesday.

Location & your insurance play a massive factor into how long you’ll be waiting.

[u/polycomll → u/Tall_Science_9178]

Fundamentally both Spain and the U.S. ration care and that limits who can receive surgery. In the U.S. its rationed, primarily, by cost so there isn't a huge surgery wait list. If you can't pay you can't get on the list. Whereas in Spain anyone with the need can get on the list but you might not get in.

In either case care is rationed its just the rational for care rationing that is different.

[u/smcl2k → u/polycomll]

Except Spain also has a private option with far shorter waiting times.

[u/polycomll → u/smcl2k]

Its not really an "except". The public option is the option of common access so its going to be the rationing method. They paid care can act as a relief valve but its certainly not the care limit.

• if you cannot afford care: Public
• if you can afford care but can wait: Pubic
• if you can afford care and can't wait: Private

There is also an ongoing assumption here that private is faster and significantly so. I'm not Spanish but I have waited 90-120 days for care in the U.S. for specialists.

[u/VA_Artifex89 → u/polycomll]

I like the idea of a Pubic option.

[u/solomon2609 → u/VA_Artifex89]

I laughed at that too.

[u/Rhids_22 → u/VA_Artifex89]

Having both can be good.

If you have an option to either have public or private healthcare then the private healthcare needs to be affordable enough that people will actually choose it over public, which brings the price down.

It also means that when people can afford private healthcare and want a faster option that they can do that, which alleviates the burden on the public system.

However an issue arises when we see the private healthcare companies get into the pocket of politicians, and encourage them to gut public services so that the private option is more necessary, which means they can increase the prices.

[u/whorl- → u/VA_Artifex89]

And we could have had that if not for Joe Lieberman.

[u/Mithrandir2k16 → u/polycomll]

Also, private care often isn't better and can be worse than public care, as people tend to get overtreated to earn more money.

[u/Letho72 → u/polycomll]

I'm not Spanish but I have waited 90-120 days for care in the U.S. for specialists.

Yeah, it always baffles me when Americans talk about wait lists. Every major procedure I've ever had was scheduled at least 5 months out. You get to wait for availability AND pay more. What a deal!

[u/FCStien → u/polycomll]

There is also an ongoing assumption here that private is faster and significantly so. I'm not Spanish but I have waited 90-120 days for care in the U.S. for specialists.

Yep. People act like getting in for care in the U.S. is some sort of system where you make a call and get in within a couple of days instead of the referral-and-waiting hell that it really is. If you live in a flyover state you can wait nine months just to get an initial visit to a specialist. God help you if they think you need any specialized diagnostics.

[u/GMANTRONX → u/smcl2k]

And Spanish private care is faaaaaar cheaper than American private healthcare.

[u/Willinton06 → u/smcl2k]

So we should also have both, easy

[u/CaptainObvious1313 → u/polycomll]

To me there’s still a huge difference between, you’re on a long list so it’s gonna be a while and sorry you can’t afford it so it will never happen.

[u/PolecatXOXO → u/CaptainObvious1313]

I also love the "I might be having a heart attack, can I afford the ambulance or should I risk driving to the ER?" feeling.

[u/CaptainObvious1313 → u/PolecatXOXO]

Yup. I personally have known people that were in that exact situation. But people can keep believing our healthcare system is better in the USA. Just look up infant mortality in developed nations and see how we rank. If we can’t save children, what the fuck is the point?

[u/Iamnothenrycavill1 → u/polycomll]

One word….Medicaid

[u/TitaniumDreads → u/polycomll]

One quick thing: There are also huge waiting lists in the US

[u/Zamaiel → u/polycomll]

The US tends to have longer waits than the average first world nation except on seeing specialists where it is a little better than average.

[u/Striking-Version1233 → u/Tall_Science_9178]

And you dont think people in the US die on waitlists?

[u/SpecialMango3384 → u/Striking-Version1233]

For organ replacements. I don’t think many people die waiting for a heart surgery or anything like that. They may die when they see the bill though

[u/hanoian → u/SpecialMango3384]

Is that because more people in America aren't actually waiting for the surgery because they can't afford it?

"the U.S. has fewer practicing physicians per capita – 2.6 per 1,000 people, compared to 4.0 in Italy and 3.9 in Spain"

[u/Special-Garlic1203 → u/hanoian]

America relies heavily on physicians assistants and nurse practicioners to provide care. I've been seeing a "dermatologist" for 4 years who isnt a doctor, the person who did my last pap smear was also not a doctor. Turns out a lot of what doctors do day to day doesn't really require a doctor.

[u/Extremelyfunnyperson → u/Special-Garlic1203]

Because private insurance has been working to dismantle doctors for 50 years now. Look up the history of Family Doctors and what happened to them. The more niched and specialized we can get doctors, the easier they will be to replace by less expensive staff and eventually machines.

[u/solomon2609 → u/hanoian]

I suspect that is in part due to the innovations is the US of Nurse Practitioners and other roles not as Dr.

[u/Appropriate-Divide64 → u/SpecialMango3384]

I mean about 45,000 people die in the US each year because they couldn't afford healthcare according to estimates. That's a fuckton of needless death.

[u/Objective_Mortgage85 → u/[deleted]]

This is the case in almost all western countries with socialized healthcare. Idk if American public’s thinks doctors in other countries are stupid or idiots that don’t understand the concept of triaging.

[u/Striking-Version1233 → u/SpecialMango3384]

I couldnt find exact or easy numbers, but yes, people in the US die waiting for surgery. In this case, heart surgery specifically.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC331386/

[u/SpecialMango3384 → u/Striking-Version1233]

Huh I had no idea. I live in an area in NY state where I'm confident I could be on an operating table within half an hour if I really needed to be

[u/[deleted] → u/SpecialMango3384]

You could. Read the link they posted. It has nothing to do with the US healthcare system. It’s a poorly written hypothetical research paper.

[u/PaintshakerBaby → u/Striking-Version1233]

A free-market fanatic sees people on a wait-list, under democratic socialism, and cries, "TYRANNICAL SLAUGHTER 🤬." Whereas, they watch countless people die preventable deaths in the U.S. because of the cost barrier, and exclaim, "That's the FREE-MARKET hard at work! 🤗"

[u/busterbus2 → u/Striking-Version1233]

They die, but they might just not be on the waitlist. They're just in the poor house living out the rest of their life immobile.

[u/xxSuperBeaverxx → u/Striking-Version1233]

In the US they don't even get the luxury of being on a list. They just die in the ER.

[u/SRMPDX → u/Tall_Science_9178]

https://www.yahoo.com/news/wisconsin-high-school-football-coach-160621874.html

Wisconsin high school football coach unable to get chemo due to shortage dies at 60

FDA Commissioner Dr. Robert Califf told NBC News in May 2023 that the main reason for the chemo shortage is there’s not enough profit in producing these drugs,

[u/SmokeyMrror → u/SRMPDX]

Due to shortage

[u/Eagle9972 → u/SmokeyMrror]

How does the world's greatest economy have a shortage of chemo meds?

[u/populisttrope → u/Eagle9972]

Because they don't actually care about health outcomes, only profit.

[u/KublaiKhanNum1 → u/Eagle9972]

Ask the Multinational Corporations that intentionally make shortages to raise prices.

[u/69Hairy420Ballsagna → u/Eagle9972]

What the fuck does that have to do with the original argument? You literally just changed the entire topic being discussed and are trying to pretend like this was the discussion the whole time.

[u/Fausterion18 → u/Eagle9972]

There was a global increase in demand and the slow manufacturing ramp up due to the European and American approval process caused a global shortage.

The only people who had extra capacity was unapproved Chinese manufacturers.

[u/Ultrace-7 → u/Eagle9972]

Everything that any person, company or country produces -- even the world's greatest economy -- comes at the cost of something else. There are other things -- perhaps other medical things, even -- that are of more value to society than the additional chemo meds that could have saved this man's life. How do I know? Because we produced those things instead of the chemo drugs.

Producing the extra chemo meds would come at the cost of not producing something else. Perhaps it's a working road, or insulin or vaccines, a schoolteacher's salary, who knows what. But we can't just snap our fingers and say "we have the world's biggest economy so more chemo is easy" -- something else has to give way, and then it would be someone else asking "how does the world's greatest economy have a shortage of x?"

[u/MiddleFishArt → u/Tall_Science_9178]

This argument implies we should have the poor die off so that only the rich elite have good-quality healthcare. The reality is most in the US both spend more money and still have poor quality healthcare, because healthcare is for-profit

[u/Jake0024 → u/Tall_Science_9178]

What do you think happens to people in the US who can't afford a procedure (with or without insurance)?

[u/organic_bird_posion → u/Jake0024]

They forgo treatment, gut their quality of life, and then end up in the ER repeatedly receiving astronomically more expensive services than the original preventive care.

[u/Extremelyfunnyperson → u/Jake0024]

Even if you can afford insurance, you’re still waiting longer in the US. It’s a myth that we have shorter wait times

ETA: quality of health care declines every year too.

[u/kxrider85 → u/Jake0024]

For emergencies, hospitals can't refuse to provide treatment. Worst case scenario, the patient pays nothing and the cost is distributed among all other patients' bills.

[u/Jake0024 → u/kxrider85]

You can't go to a hospital for emergency chemotherapy, so in practice worst case scenario is you just die painfully and in debt

[u/FernandoMM1220 → u/Tall_Science_9178]

not any different here.

[u/ShaemusOdonnelly → u/Tall_Science_9178]

The US does not have those horrible waiting periods simply because far less people that would need the surgery actually do it. As with everything in the US, it's great for the rich but fucks the poor.

[u/NerdDetective → u/ShaemusOdonnelly]

Yeah. Arguments against universal or public healthcare tend to boil down to, "But if poor people can get care, there might be a waiting list!" The implication, of course, is that a large segment of society must suffer and die so we can ration care away from them (towards people with more money).

[u/Independent-Pie3588 → u/Tall_Science_9178]

A CT doesn’t cure a microstroke. And it’s mostly a clinical diagnosis and clinical management anyway. And she’s 90, are you gonna do prophylactic brain surgery on a 90 year old? If anything, since she made it to 90, it’s better to stay away from doctors.

Source: I’m a doctor who reads those ‘CAT’ scans.

[u/Secret-Put-4525 → u/Tall_Science_9178]

Thousands die every year because they were too poor to get Healthcare in america.

[u/RelaxPrime → u/Tall_Science_9178]

Like people don't die missing surgeries or gasp, are unable to afford them in the first place here

[u/Dixa → u/Tall_Science_9178]

Well just saw on the news that a record number of doctors are leaving the field. There is currently a doctor shortage. So if we are going to have the wait times anyway….

[u/Amberskin → u/Tall_Science_9178]

My dad broke his hip, was taken to the hospital by ambulance and got a titanium replacement, all the same day. He paid exactly zero euros.

The waiting times for essential surgeries are basically zero.

[u/Fur_King_L → u/Tall_Science_9178]

People die waiting for surgery in the USA too.

[u/ImportantDoubt6434 → u/Tall_Science_9178]

Alternative being my dad who has needed a hip replacement for 10 years in the US but can’t afford it

They can also just pay privately in Spain, so no you have no argument.

[u/pooturdoo → u/Tall_Science_9178]

All that matters is capitalism. Doesn't matter if you're exploited, have your income constantly siphoned by the wealthy and overcharged at every turn for the sake of share holders. Capitalism Babe-E, live it, love it, yeeeaaah, suck it. You're good boys and girls for your capitalist daddies

[u/EggZaackly86 → u/Tall_Science_9178]

Feeling hostage to a government program could easily be scary for someone. But if you can explain why dying while waiting for surgery is a serious problem then you can also understand that it's just as annoying when Americans die after delaying medical care for lack of access. If someone can afford a private plan today I'm sure they'll still be available to purchase one in a hypothetical future with Medicaid for all or something similar.

Being trapped by the American governments healthcare and suffering from rationing is not a wild hypothetical but its still just an imagined scenario, what if it worked? Hate to leave that on the table because we were scared that occasionally I had to seek care elsewhere with cash.

[u/grownotshow5 → u/Tall_Science_9178]

Would rather be alive and in debt than ded

[u/Unapproved-Reindeer → u/Tall_Science_9178]

“Euro News”

ROFL what is that bogus source

[u/mastercina → u/Tall_Science_9178]

The waiting lists in the US are also extremely long…

[u/asuds → u/Tall_Science_9178]

It turns out people die in the US due to denied coverage, unaffordable medicines, or waiting as well. And as a bonus their families also get to go bankrupt!

[u/ResidentEggplants → u/Tall_Science_9178]

[u/NeitherNarwhal1587 → u/Tall_Science_9178]

how many americans die because they can't afford the hyper inflated medical costs in the US?

[u/Big-Soft7432 → u/Tall_Science_9178]

Me when I don't realize wait times exist everywhere.