Heavy question, I know. This is not intended to be political, please leave “taxes/government evil” out of it, I’m interested in a pragmatic view.
Infamously the US has mostly private health care, but we also have Medicare and -aid, the ACA, and the VA.
Most other nations have socialized health care in some format. Some of them have the option to have additional care or reject public care and go fully private.
Realistically, what are the experiences with your country’s health care? Not what you heard, not what you saw in a meme, not your “OMG never flying this airline again” story that is the exception while millions successfully complete uneventful and safe journey story. I’m also not interested in “omg so-and-so died waiting for a test/specialist/whatever”. All systems have failures. All systems have waits for specialists unless you’re wealthy, and wealth knows no borders. All systems do their best to make sure serious cases get seen. It doesn’t always work, but as a rule they don’t want people dying while waiting.
Are the costs in taxes, paycheck withholding (because some people pay for social health care out of paychecks but don’t call it a tax), and private insurance costs worth it to you?
I live under singlepayer health care. I like it, but it does have its downsides. For example, let’s say you have something really severe going on, and you’d like to try a hail Mary. Well, you can’t, as the only treatments that are available to you are whatever treatments have been deemed effective and reasonably safe by the regulatory agency. Experimentation, in lack of a better word, is a no-go.
I never experienced this as a problem myself, but I can easily imagine that someone could.
So I think the best is to have single payer available to everyone, but with private for profit doctors available if you need or want something a little more unorthodox and you have the means to pay for it.
EDIT: Seeing as I may have come off as a bit gloomy, I think I should list why I wouldn’t want it any other way.
- My dad had cancer. Chemo and everything covered.
- My kid broke his arm this spring. The only expense was me buying a sandwich while they inserted a titanium rod into his arm.
- Same kid has ADHD. I can show up to any pharmacy in the country and fetch his meds (stock pending) without paying anything.
- His brother also has ADHD and poor eyesight on one eye. Meds and glasses covered.
- All of my kids were born in a hospital at no expense.
- I didn’t learn until last year what the hell “copay” is, and the more I learn about it, the more thankful I am that it’s not something I have to think about.
I also live under single payer healthcare, and I have experience with a much lower stakes “hail mary” type event.
A number of years ago, I developed a growth on my eyelid that no one was sure what it was.
We started with the optometrist, who thought it was a duct blocked by dirt and suggested a medicated cleaning regimen where they assumed it occurred. This didn’t help.
So I got recommended up the scale to my GP, who took one look at it and said, “Yeah, that ain’t right. Here’s a recommendation to an eye specialist at the hospital.” which took ~1 month to get an appointment.
A month later, I have my first appointment with the eye specialist, who isn’t quite sure what it is but knows that it’s an internal problem and not a blocked duct. After the third appointment (3 months after the first) she says that she’s narrowed it down to either a benign tumour or a blood clot, but isn’t confident in her eyelid surgery capabilities and recommends me to an eyelid specialist in a neighbouring province.
6 months after the first optometrist appointment, I have my first appointment with the specialist who identifies it during the appointment as an internal scab that will decompose itself, but the wound isn’t healing. He says that surgery is an option, but there’s a chance I go blind and a smaller chance that I straight up die. He tells me that I’ll come back in 3 months because it’s not life threatening, and if it starts getting much worse, we’ll discuss removing it.
After an appointment with him every 3 months for almost 2 years, it finally cleared up.
The issue itself was relatively low risk, but it wasn’t until 6 months in that it was deemed “not cancer.” At every step, the risk was evaluated, and ‘hail mary’ options were discussed. But they were always discussed as “if it gets worse, we can do this, and the decision is yours”. So (at least where I live) there are hail mary options and you can take them, but only if the risk to your health is significant enough that the rewards outweigh the risk.
I was expecting this to be a story of an issue, but this is actually really encouraging for what single payer could look like. The time scale isn’t great, but it’s pretty comparable to what I’ve experienced and heard about from friends here in the “efficient” private US system.
Part of the time scale was how low risk the issue ended up being. We knew from the first few months that even if it was a tumor, so there was no “rush” to get me in to see people.
One of the ‘mindsets’ of single payer is that more severe/risky issues can get fast tracked over less severe/risky ones. Ultimately, all that was happening to me was that my vision was slightly affected (because my eyelid wouldn’t open fully). But had it been a tumour, I likely would have been on the surgeons table within a month of them finding out.
I’m in the US. For my early adult life, I had no sort of medical insurance, no job that offered any, and not enough money to pay for much. I don’t know if that is typical. Midwife offered sliding scale for delivering the kids, there was a state kidcare plan so they could get the regular doctor visits, eventually I got a better job.
Now I have the most American style plan of all, the high deductible with an HSA.
So, most of my bad experience with our system here relates more to cost than quality. The care I have received has been fine, when I could pay for it, but I do live in a city with a whole lot of medical offices, so many doctors, seven hospitals, I don’t think it’s like that everywhere.
In terms of cost - I get about half of my gross pay as net pay after deductions for tax, (family) benefits, retirement, and the HSA, and with that I do have enough now in the HSA to cover that high deductible (that took years) but not enough to be confident in retirement, I did payroll for our other offices and it looks pretty similar all over, (in terms of amount , not where it goes, most places run most of all through taxes) but other places get more guaranteed benefits for their 50%.
In the US. My partner has health insurance through her job, but she works remotely and the company is based in a different state so the insurance is, too. Partner severed her Achilles tendon about two months ago. Because of confusion about her insurance, every appointment related to the initial injury took an extra hour or more while the office staff tried to get in touch with the insurance company. Her MRI was cancelled because the provider of the MRI thought she was uninsured. She had to reschedule and ended up paying out of pocket for it to ensure it got done. Getting reimbursed out of her HSA took several hours of compiling receipts and filing out forms. After all that, and being insured, she still paid $4000 out of pocket. There’s also a very low limit to the amount of physical therapy sessions insurance will cover plus there’s a copay for every session, so that’s an ongoing cost as well.
We pay about $300 a month in premiums for healthcare policy provided by the employer. We’re limited to 4.2k out of pocket but nothing at all is covered but the annual physician before that (medications are seperate and always have at least a copay).
Good years it’s fine, but a few years ago I had a skin growth they scraped to test for cancer and got billed $2,000 after insurance’s “negotiated” price that took a nice chunk of savings to cover. I’d gladly switch to any other system than the one we have here in the US…
My personal horror story is that I took the time to make sure I went to an in-network hospital before I went to the ER for what ended up being an emergency appendectomy. The surgeon was in-network…for scheduled appendectomies. Emergencies were contracted out to a different organization who he was working for at the time, and that organization was not in network. So I got balance billed for it. I took the payment my insurance company gave me and sent it to him and said “look, I did all this research ahead of time and at no point did anyone ever tell me this would be out of network, so this is all you’re getting out of me.” They left it at that.
In most developed countries, health care is rationed by need. In the US we ration by ability to pay. I would gladly pay more for worse service so long as care was rationed by need.
So stuff works out pretty well in my European country. Personally I never got anything broken, my friend had their hand re-broken because they never realized it was broken in the first place, only noticed that the pain lasted many months. They did not pay a single thing, but had to move to go through all the surgeries (to their parents). That kinda broke them.
Personally, I had a minor health surgery, that kinda left an ugly scar, which I feel like could have been avoided with better surgeon.
Also we have health insurance, and there it gets tricky. Like state owns one, there are more private ones, as some groups try to privatize the healthcare, and then you have to pay the insurance, you can choose which insurance it is, and in some specific cases, some insurers can order different regimes of treatment. Which may not be ideal in every case.
In Malaysia, we have private and public healthcare. We also have public hospital and clinic, where the first one will have specialist and bed and operating theatre and all those equipment, while clinic is a smaller medical center used to give medical attention for smaller issue(flu, vaccination, treat minor wound, pediatric checkup, that sort of thing).
While it’s not free, it’s super cheap and affordable by basically everyone. The downside of it is it’s always full and the waiting list for non-urgent operation is rather long. Last i went for dentist, i paid rm3(rm2 for registration and rm1 for the work, add up to not even a dollar) for both registration and patching my teeth, where private dentist will charge upward of rm80 to rm120 just for a simple tooth filling. That’s at least 26 times more expensive! The downside though, i’m only allowed to do one hole per visit, i got two slightly chipped teeth and one tooth causing me pain, so i have to pick the important one. which is understandable since it will take forever for a single patient if they want to do it at once, making the long line even longer.
I’m always glad public healthcare exists in my developing country, even when it’s underfunded and overcrowded and not the best of experience and i barely use it, but visiting once convinced me that all country need it, it’s a universal basic human right. I’ve heard countless stories that treatment that will normally cost rm10k and above is slashed down to rm1, though i also heard a lot of stories that sometimes it takes an upward of 6 months for simple operation because the doctors just can’t keep up with the amount of works they have to do. It’s a solvable issue though, and one can also use private healthcare for their need if they have the money.
On top of that, in Malaysia the government also have mandatory employees health insurance that employer need to pay for, so if anything happened at work place or when an employees traveling for work and something happened, they are eligible for getting insurance payout on top of free medical treatment.
I don’t live in Costa Rica, but I have family there and they have combined. They complain that the private healthcare systems lobby to underfund the public heathcare system in order to turn people away from public healthcare, and off to their services where they make more money.
So combined systems cannot exist, if you want public healthcare then it should quickly phase our private.
