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Old 18th May 2018, 12:56 AM   #41
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Originally Posted by 3point14 View Post
Intriguing. Everything I've ever read advises that there's really no preference for whilst over while at any point.
Whilst one doesn't wish to impugn the quality of your research one word is obviously betterer!
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Old 18th May 2018, 12:56 AM   #42
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Originally Posted by Giz View Post
Having lived in both countries... Id say that each system has its strengths and weaknesses.

The US is expensive but far more responsive/quicker than the NHS.
Why should the USA private healthcare be quicker than the UK private healthcare? I've never seen statistics that show that?
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Old 18th May 2018, 12:58 AM   #43
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Originally Posted by Planigale View Post
]So what we have established is that individuals make errors in both the 'socialist' government funded UK NHS and in the capitalist client pays US health care system. That the poorer outcome in terms of maternal and infant mortality in the US are probably attributable to particularly poor outcomes in the 'minority' population who may be economically challenged in accessing antenatal care. That the NHS probably produces better outcomes because there is universal access to maternity services free at the point of care.

It is worth remembering if you want to have your baby delivered in a private hospital in the UK you can do so. Private health care is legal. You just have to pay!
Yep - I really don't see what this is meant to be about apart from a terrible, tragic event that no one would wish had happened.
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Old 18th May 2018, 01:00 AM   #44
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Originally Posted by Information Analyst View Post
"Total costs average $18,329 for a vaginal delivery and $27,866 for a C-section, with the bulk of the bill going to insurers. However, families with insurance still have to pay about $3400 out of pocket."

Ouch!

Is that the final, adjusted bill? Or the US healthcare special where they add a zero and see what they can get away with if the person they're billing doesn't know enough to challenge it?

Also, is there any way to work out how much of the bill goes to pay malpractice insurance?
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Old 18th May 2018, 02:03 AM   #45
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Originally Posted by Darat View Post
Why should the USA private healthcare be quicker than the UK private healthcare? I've never seen statistics that show that?
Giz was comparing US private to UK NHS, UK private is a different matter.
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Old 18th May 2018, 03:36 AM   #46
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Originally Posted by Zambo View Post
Giz was comparing US private to UK NHS, UK private is a different matter.
I think that was Darat's point.
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Old 18th May 2018, 04:43 AM   #47
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Originally Posted by Darat View Post
Why should the USA private healthcare be quicker than the UK private healthcare? I've never seen statistics that show that?
And does that also include the research you first have to do to check if the hospital you intend to go to is in-network, or is reimbursed by your insurer?
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Old 18th May 2018, 04:48 AM   #48
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Originally Posted by ddt View Post
And does that also include the research you first have to do to check if the hospital you intend to go to is in-network, or is reimbursed by your insurer?
Or the time filling in paperwork and dealing with insurance companies?
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Old 18th May 2018, 05:59 AM   #49
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Originally Posted by P.J. Denyer View Post
Or the time filling in paperwork and dealing with insurance companies?
Anecdotal and in the UK not USA.

I switched from NHS to private when I was diagnosed with cancer.

I phoned my insurer, gave them my details, explained what I knew at that point. They then put me through to their oncology division, where I was given my 'guy'. A couple of minutes later I had approval an MRI scheduled for the next day, and plenty of reassurance from Alan (my guy) on how things worked and what would happen next.

My doctors didn't even change, they just put on their private hats, gave me new private secretaries to deal with, and jacked up the bills significantly.

All I do now is call when I have a procedure to get an authorisation number (along with a don't worry if you have to have something done urgently, or miss something minor - we'll sort it out.)
Quite often they have already authorized something before I even call as it's been done by the various doctors' secretaries.
Alan also gives me a ring every month or so to see how I'm doing and whether I need to talk about anything (the department is made up of ex oncology nurses - they know their stuff.)

I get a letter emailed to me whenever they pay something, which I file, and it's all really simple. All accounts go directly to them.

My excess (co payment in the US?) is a massive 200 per year. My company pays the premium (about 100 a month) 100% (I think I might get taxed on that).

So far the total is well over 100,000 in about eight months, and will continue until either the cancer or drugs get me. I've had radiation, chemo, more random scans, consultations and check ups than I can count, and going in for an op next week. Comfy private room, en suite with hot nurses in fishnet stockings.

(That very last bit might be a lie, but they are nice)

Although the condition is a bit ******, the process has been totally stress free.

And as a bonus, I get free prescriptions on the NHS.
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Old 18th May 2018, 06:04 AM   #50
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Originally Posted by fagin View Post
My doctors didn't even change, they just put on their private hats, gave me new private secretaries to deal with, and jacked up the bills significantly.
Mostly, the actual medical care is the same, it has to be, they're clinical decisions.

PMI just lets you jump the queue and gives you the cushions and the nurses of which you speak.
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Old 18th May 2018, 06:07 AM   #51
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Originally Posted by Information Analyst View Post
"Total costs average $18,329 for a vaginal delivery and $27,866 for a C-section, with the bulk of the bill going to insurers. However, families with insurance still have to pay about $3400 out of pocket."

Ouch!
Yeah, it's nuts. I am sooooooo thankful that my wife works for a big, well known hospital and thus our insurance is great. Almost every service we get through that health system is free for us. We didn't see a single bill for our daughter's birth.
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Old 18th May 2018, 06:20 AM   #52
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Originally Posted by fagin View Post
Anecdotal and in the UK not USA.

I switched from NHS to private when I was diagnosed with cancer.

<snip>

Although the condition is a bit ******, the process has been totally stress free.

And as a bonus, I get free prescriptions on the NHS.
Of course, the essential difference is that, in the UK, the private insurers have to compete with the NHS, which offers decent service and is free at the point of care (and which you still pay for through NI). A private insurer which offers crap service would quickly go out of business.

In the US, private insurers only compete with each other. Public insurance (Medicare, Medicaid, VA) is restricted to certain small classes of the population. As long as an insurer doesn't make their service significantly more crap than those of their competitors, they're safe.
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Old 18th May 2018, 06:25 AM   #53
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Correction. NI notionally pays for your state retirement pension. The NHS is paid for from general taxation. Notionally. In reality it's all just "government money".
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Old 18th May 2018, 06:32 AM   #54
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Originally Posted by 3point14 View Post
Mostly, the actual medical care is the same, it has to be, they're clinical decisions.

PMI just lets you jump the queue and gives you the cushions and the nurses of which you speak.
Yep, pretty much. Slicker service, no queueing, although I do get some drugs (specifically the chemo ones) that I wouldn't get on NHS. I know that one of them comes in four variants. Only one is offered by the NHS, and not the one best suited to my condition. The other is a 'smart' immune boosting med that I inject in my tummy after chemo. Mine lies dormant until it 'senses' it's needed. The NHS one is dumb, so you have to inject six over a week.
I also have a Portacath, which you don't get on NHS.

But overall I agree. Although the private coffee is better. Sometimes the private side uses NHS facilities as well, as they have all the gear.
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Old 18th May 2018, 06:45 AM   #55
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Originally Posted by fagin View Post
Yep, pretty much. Slicker service, no queueing, although I do get some drugs (specifically the chemo ones) that I wouldn't get on NHS. I know that one of them comes in four variants. Only one is offered by the NHS, and not the one best suited to my condition. The other is a 'smart' immune boosting med that I inject in my tummy after chemo. Mine lies dormant until it 'senses' it's needed. The NHS one is dumb, so you have to inject six over a week.
I also have a Portacath, which you don't get on NHS.

But overall I agree. Although the private coffee is better. Sometimes the private side uses NHS facilities as well, as they have all the gear.
I've had private medical insurance as a benefit from work for the last several years. I've not used it for myself (apart from health checks the last two years) but have taken advantage of it for members of my family. It was useful for things like elective surgery, and getting some tests done that had a waiting list of several months on the NHS, and, where a hospital stay was needed, the facilities were more like a hotel than a hospital ward.

My experience of NHS service is that for serious conditions, including childbirth, ICU and major surgery, it's excellent. For less serious A&E and general care in post-op wards, there is often room for improvement, at least partly due to lack of funding.

Regarding the title of this thread, the 'while British' seems entirely misleading. It's a tragic situation, but in no way representative of what happens in the UK.
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Old 18th May 2018, 06:59 AM   #56
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Here's the thing.

It's not like in America the whole idea of socialized health care is this foreign concept.

The Veterans Health Administration, a Federal program under the United States Department of Health, has a budget of 65 billion a year, has almost 300,000 employees, and runs thousands of hospitals and clinics to serve the 18.5 million veterans in the United States.

Those are not small numbers and puts the VA Health Care System on par with the socialized health care of a not small country.

And the VA Health Care system is a rolling dumpster fire. It's horrible. It's unusable. It's literally criminally bad. VA Hospitals and Clinics are dystopian nightmares, wait times are measured in how many times Halley's comet comes back before you get treated, and the VA literally had a quasi-official "Solve wait times by pushing back the patients most likely to die so the problem will solve itself" policy. There are still using physical paper records and the backlog got so bad the amount of patient records in one location got so bad it threatened to make the building collapse. I did not make that up.

America's resistance to socialized health care is bad, but I think we're mis-represented as not liking the idea of socialized health care when the fact is while we've never seen universal socialized health care we've seen plenty of smaller (but still massive in their own right) socialized health care programs and they've pretty much all been abject disasters.

I'm not being snarky and sarcastic when the United States government has in no way shown that they are capable of running a health department and frankly I see zero way an American Universal Health Care System wouldn't just become a bigger VA which basically a bigger pile of burning dead people we throw more and more money unto.

And, and again I'm being dead serious, do people in other countries just get better services in general from their government? Anything in American that operates on anything like a consumer level service organization is so bad they are their own metaphors. Do you guys have like super advanced DMV and IRS equivalents that aren't hair pulling hard to deal with? Like I'm trying to imagine a more perfect image of Hell then a hospital run with "government efficiency" and I'm drawing a blank.

How does stuff like bureaucracy and impossible to fire civil servants and just the general fact if you only have one option there's zero reason for that one option to do anything more then the absolute bare minimum not ruin everything for you guys?

Just in general is dealing with your government a lot more pleasant experience in other countries?
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Old 18th May 2018, 07:03 AM   #57
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Originally Posted by JoeMorgue View Post
And the VA Health Care system is a rolling dumpster fire. It's horrible. It's unusable. It's literally criminally bad.
Because it's a flawed concept? Or because it's underfunded and not allowed to throw its wight around for discounts?
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Old 18th May 2018, 07:08 AM   #58
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Originally Posted by 3point14 View Post
Because it's a flawed concept? Or because it's underfunded and not allowed to throw its wight around for discounts?
65 billion to service 18.5 million.

England's NHS has a budget of roughly 166 billion to service a population of 58 million.

Even with adjusting that to account for a veteran population obviously skewing older and with more health concerns than the general population the VA is punching well above its weight budget wise.
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Old 18th May 2018, 07:09 AM   #59
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Originally Posted by JoeMorgue View Post
Here's the thing.

It's not like in America the whole idea of socialized health care is this foreign concept.

The Veterans Health Administration, a Federal program under the United States Department of Health, has a budget of 65 billion a year, has almost 300,000 employees, and runs thousands of hospitals and clinics to serve the 18.5 million veterans in the United States.

Those are not small numbers and puts the VA Health Care System on par with the socialized health care of a not small country.

And the VA Health Care system is a rolling dumpster fire. It's horrible. It's unusable. It's literally criminally bad. VA Hospitals and Clinics are dystopian nightmares, wait times are measured in how many times Halley's comet comes back before you get treated, and the VA literally had a quasi-official "Solve wait times by pushing back the patients most likely to die so the problem will solve itself" policy. There are still using physical paper records and the backlog got so bad the amount of patient records in one location got so bad it threatened to make the building collapse. I did not make that up.

America's resistance to socialized health care is bad, but I think we're mis-represented as not liking the idea of socialized health care when the fact is while we've never seen universal socialized health care we've seen plenty of smaller (but still massive in their own right) socialized health care programs and they've pretty much all been abject disasters.

I'm not being snarky and sarcastic when the United States government has in no way shown that they are capable of running a health department and frankly I see zero way an American Universal Health Care System wouldn't just become a bigger VA which basically a bigger pile of burning dead people we throw more and more money unto.

And, and again I'm being dead serious, do people in other countries just get better services in general from their government? Anything in American that operates on anything like a consumer level service organization is so bad they are their own metaphors. Do you guys have like super advanced DMV and IRS equivalents that aren't hair pulling hard to deal with? Like I'm trying to imagine a more perfect image of Hell then a hospital run with "government efficiency" and I'm drawing a blank.

How does stuff like bureaucracy and impossible to fire civil servants and just the general fact if you only have one option there's zero reason for that one option to do anything more then the absolute bare minimum not ruin everything for you guys?

Just in general is dealing with your government a lot more pleasant experience in other countries?
That isn't the case across the country. Some VA hospital's are actually well run and generally praised by vets. There are some bad ones out there though, that make the news.

https://www.military.com/daily-news/...or-report.html

Although, comparing it to private sector isn't the end all, since our private sector care is vastly overrated. I can see my GP in about oh, 3 weeks if I make an appointment. And now urgent care centers around here require an appointment!!!

ETA: Its still so very strange to me that so many people say "Other countries sure, but America, nope can't be done because reasons".

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Old 18th May 2018, 07:14 AM   #60
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Originally Posted by JoeMorgue View Post
65 billion to service 18.5 million.

England's NHS has a budget of roughly 166 billion to service a population of 58 million.

Even with adjusting that to account for a veteran population obviously skewing older and with more health concerns than the general population the VA is punching well above its weight budget wise.
That comes to only $3500 per person per year. Considering they're treating a lot of elderly veterans that isn't all that much. Thats not all that much more than my insurance premiums and I'm healthy and under 40.
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Old 18th May 2018, 07:18 AM   #61
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Originally Posted by JoeMorgue View Post
65 billion to service 18.5 million.

England's NHS has a budget of roughly 166 billion to service a population of 58 million.
I don't think you can do that sum. Everything just costs more in the US. Well funded by UK standards could be grossly underfunded by US standards. It could free up budget if it could negotiate from a position commensurate with it's buying power but it's specifically prohibited from doing so. I don't think there is any reasonable comparison between the NHS finances (which covers all demographics and is able to use its bulk to leverage) and US healthcare finances (in this instance covering the most expensive patients and not able to use its bulk to apply leverage)


Quote:
Even with adjusting that to account for a veteran population obviously skewing older and with more health concerns than the general population the VA is punching well above its weight budget wise.
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Old 18th May 2018, 07:21 AM   #62
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Originally Posted by 3point14 View Post
I don't think you can do that sum. Everything just costs more in the US. Well funded by UK standards could be grossly underfunded by US standards. It could free up budget if it could negotiate from a position commensurate with it's buying power but it's specifically prohibited to do so. I don't think there is any reasonable comparison between the NHS finances (which covers all demographics and is able to use its bulk to leverage) and US healthcare finances (in this instance covering the most expensive patients and not able to use its bulk to apply leverage)
Its also not fair to compare veteran care with general population care. I mean in the last 20 years I might have cost a government healthcare system, $5,000 (total not per year), a yearly checkup and a couple of visits to urgent care. An 80 year old Korean war veteran could easily be 100 times that.
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Old 18th May 2018, 07:34 AM   #63
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Originally Posted by zooterkin View Post
I think that was Darat's point.
If so, it was a rather silly point.
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Old 18th May 2018, 07:40 AM   #64
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Originally Posted by 3point14 View Post
Is that the final, adjusted bill? Or the US healthcare special where they add a zero and see what they can get away with if the person they're billing doesn't know enough to challenge it?

Also, is there any way to work out how much of the bill goes to pay malpractice insurance?
A new study reveals that the cost of medical malpractice in the United States is running at about $55.6 billion a year - $45.6 billion of which is spent on defensive medicine practiced by physicians seeking to stay clear of lawsuits. The amount comprises 2.4% of the nation's total health care expenditure.

https://www.forbes.com/forbes/welcom...ww.google.com/
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Old 18th May 2018, 07:44 AM   #65
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Originally Posted by lobosrul5 View Post
A new study reveals that the cost of medical malpractice in the United States is running at about $55.6 billion a year - $45.6 billion of which is spent on defensive medicine practiced by physicians seeking to stay clear of lawsuits. The amount comprises 2.4% of the nation's total health care expenditure.

https://www.forbes.com/forbes/welcom...ww.google.com/

Thank you.
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Old 18th May 2018, 07:44 AM   #66
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Originally Posted by JoeMorgue View Post
Here's the thing.

It's not like in America the whole idea of socialized health care is this foreign concept.

The Veterans Health Administration, a Federal program under the United States Department of Health, has a budget of 65 billion a year, has almost 300,000 employees, and runs thousands of hospitals and clinics to serve the 18.5 million veterans in the United States.

Those are not small numbers and puts the VA Health Care System on par with the socialized health care of a not small country.

And the VA Health Care system is a rolling dumpster fire. It's horrible. It's unusable. It's literally criminally bad. VA Hospitals and Clinics are dystopian nightmares, wait times are measured in how many times Halley's comet comes back before you get treated, and the VA literally had a quasi-official "Solve wait times by pushing back the patients most likely to die so the problem will solve itself" policy. There are still using physical paper records and the backlog got so bad the amount of patient records in one location got so bad it threatened to make the building collapse. I did not make that up.

America's resistance to socialized health care is bad, but I think we're mis-represented as not liking the idea of socialized health care when the fact is while we've never seen universal socialized health care we've seen plenty of smaller (but still massive in their own right) socialized health care programs and they've pretty much all been abject disasters.

I'm not being snarky and sarcastic when the United States government has in no way shown that they are capable of running a health department and frankly I see zero way an American Universal Health Care System wouldn't just become a bigger VA which basically a bigger pile of burning dead people we throw more and more money unto.

And, and again I'm being dead serious, do people in other countries just get better services in general from their government? Anything in American that operates on anything like a consumer level service organization is so bad they are their own metaphors. Do you guys have like super advanced DMV and IRS equivalents that aren't hair pulling hard to deal with? Like I'm trying to imagine a more perfect image of Hell then a hospital run with "government efficiency" and I'm drawing a blank.

How does stuff like bureaucracy and impossible to fire civil servants and just the general fact if you only have one option there's zero reason for that one option to do anything more then the absolute bare minimum not ruin everything for you guys?

Just in general is dealing with your government a lot more pleasant experience in other countries?

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Old 18th May 2018, 08:48 AM   #67
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Originally Posted by JoeMorgue View Post
Here's the thing.

It's not like in America the whole idea of socialized health care is this foreign concept.

The Veterans Health Administration, a Federal program under the United States Department of Health, has a budget of 65 billion a year, has almost 300,000 employees, and runs thousands of hospitals and clinics to serve the 18.5 million veterans in the United States.

Those are not small numbers and puts the VA Health Care System on par with the socialized health care of a not small country.

And the VA Health Care system is a rolling dumpster fire. It's horrible. It's unusable. It's literally criminally bad. VA Hospitals and Clinics are dystopian nightmares, wait times are measured in how many times Halley's comet comes back before you get treated, and the VA literally had a quasi-official "Solve wait times by pushing back the patients most likely to die so the problem will solve itself" policy. There are still using physical paper records and the backlog got so bad the amount of patient records in one location got so bad it threatened to make the building collapse. I did not make that up.

America's resistance to socialized health care is bad, but I think we're mis-represented as not liking the idea of socialized health care when the fact is while we've never seen universal socialized health care we've seen plenty of smaller (but still massive in their own right) socialized health care programs and they've pretty much all been abject disasters.

I'm not being snarky and sarcastic when the United States government has in no way shown that they are capable of running a health department and frankly I see zero way an American Universal Health Care System wouldn't just become a bigger VA which basically a bigger pile of burning dead people we throw more and more money unto.

And, and again I'm being dead serious, do people in other countries just get better services in general from their government? Anything in American that operates on anything like a consumer level service organization is so bad they are their own metaphors. Do you guys have like super advanced DMV and IRS equivalents that aren't hair pulling hard to deal with? Like I'm trying to imagine a more perfect image of Hell then a hospital run with "government efficiency" and I'm drawing a blank.

How does stuff like bureaucracy and impossible to fire civil servants and just the general fact if you only have one option there's zero reason for that one option to do anything more then the absolute bare minimum not ruin everything for you guys?

Just in general is dealing with your government a lot more pleasant experience in other countries?
Look at my signature. The US spends a higher proportion of its GDP on public healthcare than the UK does.

Part of it is due to the inefficiencies of the current US system, which is an oligopoly, and where the US government is prevented from using its bulk purchasing power to negotiate lower drug costs.


ETA: And many UK governments aren't exactly renowned for their stellar competence.

One advantage of a universal system - that the current government seems intent on removing in order to be harsh on an imaginary problem, is that generally, it doesn't need to check whether person X is eligible for treatment, or whether they are eligible for a particular treatment.

The bureaucracy is simplified as a result.
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OECD healthcare spending
Expenditure on healthcare
http://www.oecd.org/els/health-systems/health-data.htm
link is 2015 data (2013 Data below):
UK 8.5% of GDP of which 83.3% is public expenditure - 7.1% of GDP is public spending
US 16.4% of GDP of which 48.2% is public expenditure - 7.9% of GDP is public spending

Last edited by jimbob; 18th May 2018 at 08:52 AM.
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Old 19th May 2018, 04:21 PM   #68
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Originally Posted by Giz View Post
If so, it was a rather silly point.
Why?
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Old 19th May 2018, 05:24 PM   #69
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Because one should really compare public maternity care in both countries.
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OECD healthcare spending
Expenditure on healthcare
http://www.oecd.org/els/health-systems/health-data.htm
link is 2015 data (2013 Data below):
UK 8.5% of GDP of which 83.3% is public expenditure - 7.1% of GDP is public spending
US 16.4% of GDP of which 48.2% is public expenditure - 7.9% of GDP is public spending
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Old 19th May 2018, 05:25 PM   #70
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After all, they cost a similar proportion of GDP in both countries.
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OECD healthcare spending
Expenditure on healthcare
http://www.oecd.org/els/health-systems/health-data.htm
link is 2015 data (2013 Data below):
UK 8.5% of GDP of which 83.3% is public expenditure - 7.1% of GDP is public spending
US 16.4% of GDP of which 48.2% is public expenditure - 7.9% of GDP is public spending
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Old 19th May 2018, 05:32 PM   #71
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Originally Posted by MikeG View Post
Whilst British, goddamit.
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Old 19th May 2018, 05:47 PM   #72
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Originally Posted by Darat View Post
Why should the USA private healthcare be quicker than the UK private healthcare? I've never seen statistics that show that?
It's not, it's a myth.

Physician shortages in the US and Canada are similar with not enough specialists in rural areas especially.

There are serious shortages of nurses and physicians in the US.

There may be some longer wait times for certain surgeries in Canada like joint replacement so there is a business in Canadians coming to the US for surgery. Those specific cases are generalized as if that was the norm for all medical care when it isn't true.

And US citizens take surgery holidays to other countries themselves for reasonable cost care.

During flu vaccine shortages here, people went to Canada for flu shots because there was no shortage there.
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Old 19th May 2018, 05:52 PM   #73
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To accept the premise the UK has crappy doctors you'd have to show UK doctors were flocking to the US for better pay. I doubt that's true.

This was a crappy doctor that made a very poor decision to not do a C-section. As for cutting the cervix that wasn't dilated, I'm not an OB nurse but I've never heard of that. Baby's in trouble (especially a premie and a breech to boot) and not progressing into the birth canal, an emergency C-section was absolutely called for.

It has nothing to do with the NHS, it has to do with a bad doctor. We have plenty of them.

What a horrible thing for parents to go through.
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Old Today, 03:24 AM   #74
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Originally Posted by ddt View Post
And does that also include the research you first have to do to check if the hospital you intend to go to is in-network, or is reimbursed by your insurer?
ANd of course the months waits for in network specialists. You can get pretty massive wait times in the US too.
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Old Today, 03:27 AM   #75
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Originally Posted by JoeMorgue View Post
Here's the thing.

It's not like in America the whole idea of socialized health care is this foreign concept.

The Veterans Health Administration, a Federal program under the United States Department of Health, has a budget of 65 billion a year, has almost 300,000 employees, and runs thousands of hospitals and clinics to serve the 18.5 million veterans in the United States.

Those are not small numbers and puts the VA Health Care System on par with the socialized health care of a not small country.

And the VA Health Care system is a rolling dumpster fire. It's horrible. It's unusable. It's literally criminally bad. VA Hospitals and Clinics are dystopian nightmares, wait times are measured in how many times Halley's comet comes back before you get treated, and the VA literally had a quasi-official "Solve wait times by pushing back the patients most likely to die so the problem will solve itself" policy. There are still using physical paper records and the backlog got so bad the amount of patient records in one location got so bad it threatened to make the building collapse. I did not make that up.
This just shows that americans really are uniquely incompetent.
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Old Today, 03:28 AM   #76
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Originally Posted by JoeMorgue View Post
65 billion to service 18.5 million.

England's NHS has a budget of roughly 166 billion to service a population of 58 million.

Even with adjusting that to account for a veteran population obviously skewing older and with more health concerns than the general population the VA is punching well above its weight budget wise.
But it has to interface with the american health care system. Not being allowed to negotiate drug prices by force of law and such really handicaps it. It is truly where americans are exceptional.

Of course when people are getting care in the system it tends to be very highly regarded by those recieving it but that also doesn't fit the narrative so can be ignored.
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