Questions for those living in nations with universal health coverage

[hybrid]

The ACA (Obamacare) and health insurance in general is so politically charged in the US that it feels like we don't get honest input about the things that do and don't work in countries that have implemented it.  Each side is invested in presenting universal health care as either a utopian dream come true or a rationed bureaucratic nightmare with shoddy service. So my questions to the folks who live outside of the US in nations that do have universal coverage are these:  Are you overall satisfied with your health care?  What are your biggest likes?  Biggest dislikes?  What would you change?

Thanks for sharing.

[TGod]

There are a lot of people who complain about our universal health care system in Canada, and it is by no means perfect, but it works for me. It's affordable, about $133/mth for our family of 4, and I believe that is for any family of 3 and up (I actually had to look the cost up on the net b/c I had no idea, my husbands work covers 1/2 and the other 1/2 comes off his paycheck so we don't even see it. That basically covers doctors visits, births, emergency etc.  The big pros, low cost, not worrying about how much an emergency visit is going to cost, or having to worry about going into debt when you have a baby. Things like that, we can definitely take for granted. It used to cover some extras like physio and massage but that was phased out as health care costs really started to rise, most of these can be covered by employer sponsored extended health benefits. It does cover testing (blood work, MRIs, CTs), but the downside is that there can be some crazy wait times for these tests, even though the machines aren't being fully utilized all the time.  You need an MRI...be prepared to wait or pay $1000 to get it done privately. Given that i'm healthy and have never needed surgery I haven't experienced this. But I have friends who did, months waiting for an MRI on their backs when it turns out they have a herniated disk, waiting weeks or months for a PET scan to find out how far the cancer has spread. In those cases it's a sickeningly slow process and often feels like the system is broken. IMO, it will only get worse as the population ages. Resources will be eaten up by a big group of baby boomers who want to maintain mobility and are therefore getting knee and hip surgeries, all of which are covered by UHC.
That said, I'm happy to have the universal coverage, so that at the end of the day I don't have to worry about excessive feels for general medical or emergency situations.

[dadof4]

Its been a while, but I'll share my experience.
Israel has a tax funded universal healthcare system. There are 4 providers which you can choose from, and they compete with each other for membership.  There are supplemental packages that are aggressively marketed, but not really necessary.

Service is generally comparable to an American HMO. Wait times for doctors are pretty minimal. Most drugs are covered in the plan (though there are frequent controversies about a specific drug that isn't included). Most surgeries and expensive medical conditions are covered.

Healthcare expenditures are under 8% of GDP (compared to the US 18%). There are about 50% more doctors per person than the US (3.6 per 1000 vs 2.4 per 1000). Life expectancy is in the top 10 of the world (US is #40).

[Meggslynn]

Living in Alberta Canada we have UHC and we don't pay a monthly fee anymore compared to pp who lives in the province next door. Before it was $44 per person but when times got good awhile back they nixed that.
Our plan works for me and mostly everyone I know. I never have to worry about how much things are going to cost. My son recently had to spend seven days in isolation at a children's hospital and I was thankful that I didn't have to think about how much it was going to cost me. My cousins daughter was airlifted to the children's hospital from five hours away and spent two weeks there in the NICU and never got a bill. Those aspects are awesome.
I have heard about longer wait times but have never experienced them. My mom found out she had breast cancer on December 19th and she was in surgery on December 24th for a double mastectomy. My dad did have to wait two months for specialist ultrasound.
Employer benefits cover things like chiropractors, massage, acupuncture, prescriptions and dental work among other things. I pay $36 per two weeks for that.
I honestly can't think of any negatives except for instances I have heard about on the news where people have had to travel to Europe or the US to get treatment they couldn't get here but that might not be UHC problem but it may be ... I don't know?

[tzxn3]

I live in the UK.

Emergency care is in my experience pretty good, not getting billed thousands of dollars is a plus.

The standards of mental healthcare on the NHS are not so great. General practitioners tend to be reluctant to refer people to psychiatrists in my experience; waiting lists for cognitive behavioural therapy are obscene.

Waiting lists for non-urgent procedures in general tend to be very long. However, for someone who is earning a decent income it is possible to pay privately to side-step the queue.

While not perfect, the NHS at least manages to harness the collective bargaining power of the state to drive healthcare costs down to the extent that private providers have to price competitively. It also provides a safety net which means that a young person with a serious health condition isn't enslaved to their job or bankrupted by medical debt.

The main thing I'd change is to stop all taxpayer funding of fancy sugar pills (also known as homeopathy), because it is obviously idiotic. Outside of that, the system is so large and complicated I'm not where one would start making improvements.

[pachnik]

I am in Canada and we have universal health coverage. 

I am pretty satisfied with it; although I am healthy and don't have much to do with the system (so far).  My father is in his mid-70's and has some chronic health issues.  I am happy with his care.  His family doctor gets him in to see the specialists/tests he needs pretty fast. 

What I dislike is when surgeries are cancelled.   There is also a problem with not enough GPs (family doctors) but my family hasn't been affected by this yet.  As someone up thread said, you do see it on the news once in a while about people going to another province or the States to get some specific medical treatment.

If I could change anything, it would be to have family doctors do more preventative and lifestyle counselling.  I think they just don't have the time for this though my doctor does squeeze it in once in a while for me. 

[drg]

I've lived in 3 countries with "universal health care"--Canada (Ontario), Netherlands and the UK, although I only lived in NL for 5 months.  All of it free at point of access.  Of the three, the UK getting an appointment with a doctor is easiest.  For urgent things, I can be seen by a doctor in the practice that day, or I can get an appointment with my doctor usually within 3-4 days.

However, it's not easy to get specialist care. I could detail the saga, but suffice it to say it took me nearly 2 years to get a diagnosis for symptoms of pressure and ringing in my ear (could have been a tumour), ultimately "eustachian tube dysfunction", which is ENT-speak for "we don't know what's wrong or how to fix it, so go away now".

It was complicated by the fact that I moved countries twice after the symptoms started.  I was prescribed the same treatment three times, despite informing the GP that I'd already tried it.  Too bad, gotta jump through those hoops.  Took 3 months to get a hearing test, 1.5 years to get an ENT appointment and 2 years to get an MRI--lucky for me it was negative.

My family GP (up until I started uni) in Canada was also incompetent.  Didn't diagnose a congenital eye problem I had as a child, so now I have life-long double vision.  Forgot one day while treating me that I wasn't one of his francophone patients.  Misdiagnosed my mom's Crohn's disease as "stomach flu" (hello, it's not even flu) and gave her a contraindicated treatment.  I feel like if people actually had to pay for his services, he'd have been out of business quickly.  But alas, if you have a family doctor in Ontario, it's very difficult to switch to a different one.

[swiper]

I'm generally pleased with Canadian healthcare system. I don't personally know anyone who has had a really long wait for anything very serious nor have I heard friends/family complain but the quality of the care.

 I hold the general belief that by helping (paying for health care of) others I am helping myself.

The biggest gripe I'd have is still not having family doctor(3 years after moving). That said, I can go to any drop in clinic. I’m also confident that should I have a serious issue/accident I will be well taken care by the public system. Our system isn't perfect and here are some things I'd like to see:

+ give more responsibility to nurses and other medical professions to free up doctors for more serious stuff
+ remove caps on medical school class sizes to push through more doctors.
+ more economic planning mentality ie: increasing preventative care, limiting cost of end-of-life care, taxing causes of negative externalities etc.

[drg]

swiper---well I can certainly recommend against one specific francophone family doctor in Ottawa/Gatineau!  (I don't know where he's practicing now, but he did recently close his practice in Vanier.)

[StarswirlTheMustached]

Quite happy in Ontario.

Doctor availability is disgustingly spotty, though. In the GTA? Not bad. In London, I was recruited to a family practice after the doctor saw me twice on clinic duty. Having moved down from Northern Ontario, it didn't even occur to me to look for a regular physician. "I'm only going to be living here for two years. No way I could get to the top of the wait list," I thought. I was flabbergasted.

In any case, the doctor shortage has little or nothing to do with OHIP; it's the College of Physicians keeping medschool quotas too low, so they can keep their fees to the province high, citing supply and demand. We could scrap the 'socialist' health care plan, and if we didn't reform the accreditation system the problem would get no better. Also because everyone in med school is encouraged into one speciality or other. It has always seemed to me like the shortage was in family doctors only. When I needed to see a neurologist, I got one within a couple months. When I needed a cat scan, I was squeezed in quite quickly. When I needed to see a gastroentonologist, I got an appointment within a month.

If anything, I feel our system isn't bloated enough! My biggest complaint is that after learning about the link between gingivitis and heart disease, I think we should cover dental care as a preventative measure. The province could also stand to be more generous with regards to life-saving drugs. (If I go to a clinic and need antibiotics, I must pay. If I cannot pay, and end up in emerge from the same infection, the province is on the hook-- and for a much larger bill.)

[Insanity]

there is a flip side to the tax based care…


What is the insurance like on the doctor's side?  How protected are they from insane lawsuits that can sometimes occur form medical malpractice?

[Richard3]

I've lived in the UK which is the grand daddy of UHC and currently am in NZ which is similar.

In both places I have had moderate medical problems. Specifically a malfunctioning spleen (UK) torn knee cartilage (both), serious head injury (NZ).

In both places I was seen quickly by my doctor (I don't know about the emergency room for the head injury - I just remember waking up in a hospital bed not knowing what month it was, but I assume it was pretty quick as my mother wasn't complaining about me being kept waiting).

In both places I was referred to specialists and or had further tests (including some sort of fancy MRI / CAT scan for my poor brain) done what I assume to be relatively quickly (that night for the head injury).

I did not require further care beyond a prescription and follow up visit for the spleen. The prescription cost me a couple of pounds. Everything else was provided by the state.

I did require surgery for my knee in NZ. Because of the rules I had to have it in the town I was living when I started my claim, not where I had moved to, but this worked out well for me because I got seen quicker and by a better surgeon. I don't think it unreasonable to expect people to remain in the same town for medical care so I didn't mind driving down four or five hours for the surgery.

I did use private medical insurance for my second knee surgery (in the UK) because there were waiting lists and my problem was not very severe (I could walk and even play sport just with moderate pain). I did not need the surgery, but it did improve my life so this seems fair - I would have got it through the NHS but slower.

I know a couple of people who complain abut medical incompetence in the UK. Both are American, one has an unusual combination of diseases and the other knows everything and is a massive hypochondriac (I can't believe the doctor didn't keep you overnight because you had a headache - it could be meningitis!). Everyone else seems pretty happy with the whole thing.


I believe that doctors in the UK and NZ are very well protected against private lawsuits. They still face professional censure / disbarment if they are bad but are unlikely to get lawsuits even filed against them, let alone the massive damages that make it so expensive in the US. I mean maybe if they sexually harassed a patient or whatever, but a mistake, well that's part of the game and we seem to believe the solution is the fence at the top of the cliff (better training and process) not the ambulance (chasing lawyer) at the bottom.

[nrsr]

I live in France.

Seeing a GP is very easy, and you get to pick yours.

I am satisfied with the standard of care in hospitals.

For the rest, many specialists will bill over what Social Security reimburses.

To sum it up, the two ends of the spectrum (basic care and very involved care in hospitals) are well taken care of, the middle is a grey area / more expensive. But not getting ruined by hospital bills and getting to chose your doctor are big pluses.

[LightTripper]

I am in the UK and very happy with the system. I have private insurance through work, but have never needed to use it: most peoples perception here is that private is good for getting a shorter queue for something non urgent (e.g. Orthotics or physio) but for something serious/urgent I trust an NHS hospital more (my local hospital is a teaching hospital, which therefore attracts very good staff). 

There is some luck in the system too.  My GP will always see me always within 2 days and same day if urgent. Where my sister lives it can be much more difficult.  So that is not great.  The system should encourage new GPS to set up in those areas, but it doesn't seem to happen very fast.

My experience of getting access to specialists has been very good - I am often referred without even suggesting it myself.  I may be atypical though, as I had a malignant melanoma at a young age, and I have always wondered if GPs are quicker to refer me because they see that on my record.  But then my sister has had a bad eye infection, and got an appointment with the best eye hospital in the country within 24 hours of seeing her GP, so it's certainly not the case that you need something bad on your "medical CV" to get seen quickly by the best specialists.

Generally what is covered and not seems very sensible.  I trust NICE and their methods, although for really cutting edge stuff (e.g. Proton beam therapy) we are always a couple of years behind the states. Personally I feel that's a price worth paying for a cost effective universal system.

[Cecil]

there is a flip side to the tax based care…


What is the insurance like on the doctor's side?  How protected are they from insane lawsuits that can sometimes occur form medical malpractice?

There are very few medical malpractice lawsuits in Canada. Between 2005 and 2010 there were a total of 4500 lawsuits, 3100 of which were dismissed. Only 116 over 5 years ended with a trial judgement in favor of the plaintiff, and for an average amount of about $100k.

Most doctors get malpractice insurance through the professional organization and the provincial government covers most of the cost of it.

[Insanity]

there is a flip side to the tax based care…


What is the insurance like on the doctor's side?  How protected are they from insane lawsuits that can sometimes occur form medical malpractice?

There are very few medical malpractice lawsuits in Canada. Between 2005 and 2010 there were a total of 4500 lawsuits, 3100 of which were dismissed. Only 116 over 5 years ended with a trial judgement in favor of the plaintiff, and for an average amount of about $100k.

Most doctors get malpractice insurance through the professional organization and the provincial government covers most of the cost of it.

Compare that to:
http://www.beckershospitalreview.com/legal-regulatory-issues/29-statistics-on-medical-malpractice-payouts-and-lawsuits.html

[Financial Threedom]

Nothing but good things to say from my experience here in Canada.  Recently had a baby (free), he had to spend about a week in the intensive care unit after birth (no extra charge).  I couldn't imagine how much more stressful these events would be while worry about how much I would be paying for these services.  Ive also had an optional surgery (free).  The wait times can be a bit long for some things, I'm on 2 at the moment, both elective surgeries, and I've already been waiting 3 months, and will likely be another 6-9 months for each, not a big deal to me though.  I did have about a 3 year wait for a family doctor at one point, but not a big deal for a healthy person in their 20s/30s.  You still need to pay somethings prescriptions/physio unless your employer has a health plan, or you insure yourself for these type of things.

[gooki]

Are you overall satisfied with your health care?  What are your biggest likes?  Biggest dislikes?  What would you change?

We have two systems.
1 - Public health care, hospitals, and subsided specialists (paid for via taxes)
2 - Mandatory accident care compensation (approx 1-2% of your salary)

Overall rating 8/10.

Likes:
- Fantastic level of care for pregnant woman and new mothers, and young children, both at home, and in the hospital.
- Subsided prescriptions.
- High level of care for cancer suffers.
- Free dental for all children up to the age of 18?
- Low cost private health care (because the public system is relatively good, private costs are relatively low, think $2,500 a year for my family of 4, with minimum deductible that coveres everything, or $900 a year for small deductible critical surgery and cancer treatment only)

Dislikes:
- Wait lists for non life treating surgery. Hip replacements etc.
- Accident Care Compensation provider trying to weasels out of their obligations.

What would I change.
There's no need for a waiting list/backlog of surgery. Pay the private sector to clear the backlog, this should be a one off cost and then one should be able to run the public hospitals with minimal backlog (1-2 months for non critical seems acceptable).

Large penalties for when an Accident Care Compensation provider refuses meet their obligations.

[Mumintheburbs]

Australia!
Tax funded system (Medicare)
Higher income earners pay an increased Medicare levy if they do not take out private health insurance, although it is not compulsory to have health insurance.
Similar to the UK, all emergency and urgent care is free, but non urgent procedures can take a while. If you have private health cover, waiting times are vastly reduced for the non urgent stuff (hip replacements)
You can also negotiate to pay private doctors directly (ie not via a health insurer) which I have found very useful.
I have used private, public and self paying options at different times. Personally I find the private health system to be an opportunity for doctors to charge whatever the hell they like and Medicare still pays the same $ amount for each procedure (health funds mainly cover private hospital beds).
I am happy to contribute taxes to fund healthcare. It means that at any moment I could have my children seen by a doctor with less than an hour's notice, babies can be born safely and effectively free, emergencies are dealt with promptly etc etc etc
I find it interesting on these forums when people say "I pay for my healthcare, I don't want to fund others", but they don't actually pay for the care, only the insurance premium

[kms]

I live in Germany and we've had universal health care since 1883. It has obviously been subject to major changes over the last 130 years, the last one being called "Gesundheitsfond" (health fond). The way it works is pretty simple: there are two different ways to get health insurance, universal and private health care. Universal health care is provided by tons of different insurance companies who were able to set their own rates until recently. Now, with the health fond, the federal government sets the rate which is currently at 15.5% of your taxable income, half of which is paid by your employer the other half by yourself. If you have no taxable income the state will cover you. The biggest advantage of this universal health care is that in single income households your spouse as well as all your legal children (biological as well as adopted) up to the age of 25 are covered as well. Pretty much everything is covered - dental, vision, etc.

This type of health care is mandatory for everybody unless you make more than 4.200€/month or are self-employed, in which case you can opt out and chose a so-called private health insurance instead. Rates are usually lower when you're young but tend to explode once you reach a certain age, and your family is not covered by this. Also, there's no easy way back into universal health care once you've left the system. The benefits are usually better (single rooms in hospitals, or shorter waiting periods for non-critical operations). This type of insurance is mostly relevant for the self-employed because they'd have to pay both the employer's and the employee's share of the universal health care rate so most of them opt out.

[kt]

UK and although I have no health care issues myself I think the NHS is great generally from observing experiences for family and friends.
Although I have had an issues with dentists. There is not an NHS dentist within 20 miles of me which is accepting new patients.

[randymarsh]

I find it interesting on these forums when people say "I pay for my healthcare, I don't want to fund others", but they don't actually pay for the care, only the insurance premium

Some people, probably not on this forum, legitimately believe the cost of care is covered by only the premiums they pay. Similarly, some people on Medicare believe they paid into an individual account during their working years and are now just cracking into that piggy bank. In their eyes they're responsible and paying their own way and receive no benefit from other people in the insurance pool or those currently working and paying the Medicare tax.

[hybrid]

Thanks for all the great input so far folks.  Keep it coming, this is a very enlightening thread.

[Rachelocity]

Greetings from Quebec, Canada!  Not only do we have universal health care, but I've worked in the system for ~95% of my work life.  Everyone receives the same level of care and you may have to wait for certain high-demand investigative tests, unless you work in the system and can call a colleague to speed things up ;-)  Waiting lists for elective surgery are long, but emergency care is as good as you'll get anywhere.  My mother was a frequent flier in ERs, CCUs and rehab hospitals for the last 30 years of her life, with cardiac/respiratory/kidney problems, and we never felt that she was neglected in any way.  Even my hypercritical US relatives were impressed with the care she received (there were several "Call the family" moments).  We also have a mandatory prescription plan that caps spending at around $80.00 a month.  This is lowered for certain seniors and people on welfare/disability (covering the largest group of medication users )

As for my work experience, it has been positive, otherwise I'd be working elsewhere.  I love what I do (admin/communications in a major teaching hospital) but in about 5 years, I will retire with a pension that, combined with the government pension, will approximate my full salary.  Even if I hadn't saved a red cent, I'd still be okay. 

[sleepyguy]

Ontario here, I would rate it as pretty good... we haven't had horrible illnesses in my family but for emergencies, births and surgeries, it's been pretty good thus far.  We don't pay out of pocket but be are pretty heavily taxed on everything which of course goes to health care.

[StarryC]

One thing I always wondered about stories of "wait times" and no available doctors is how that actually compared to the US. 

In a large city in the US, say New York, LA, even Denver probably, there are usually plenty of dentists/specialists in a field.  Highly educated professionals (i.e. doctors) want to live there, and therefore there are plenty of GPs. 

However, I grew up in a relatively rural area.  We had to drive 20-30 miles for any doctor.  Dentists were booked out for months, so you made your appointment 6 months in advance.  If you had a cavity, you often had to wait 2 months for a filling appointment.  For specialists you either had to drive to the nearest big city, or wait weeks or months for that specialist to clear.  Young professionals do not want to live there, so there aren't enough.

So, I wonder, if "wait times' in rural Canada/New Zealand are pretty comparable to wait times in the rural US, and people in the urban US think there is no wait time/ doctor problem here, merely because their area isn't experiencing it?

[Ottawa]

Slightly off topic...I think.  But, relevant to ER.  All Canadians have access to the UHC.  Different employers have 'top up' benefits as part of the package.  In particular, as a federal government employee, we have the following for health care:
http://www.tbs-sct.gc.ca/hr-rh/bp-rasp/benefits-avantages/hcp-rss/overview-contexte-eng.asp#Toc532888090

and this for dental care:
http://www.tbs-sct.gc.ca/hr-rh/bp-rasp/benefits-avantages/dcp-rsd/overview-contexte-eng.asp

Under early retirement, I will elect to defer my annuity (probably deferred by 12-14 years).  During this time I will not have access to the above benefits.  The dental care is not reinstated when annuity is collected at 60.  You can, however, elect to buy into the pensioners dental services plan:
http://www.tbs-sct.gc.ca/hr-rh/bp-rasp/benefits-avantages/pdsp-rsdp/overview-contexte-eng.asp

At the age of 60 (or when annuity starts) health care becomes payable as per the following schedule:
http://www.njc-cnm.gc.ca/directive/index.php?sid=87&hl=1&lang=eng

My question is...has anyone retired early and taken out private insurance to replace their 'top up' employer benefits in Canada?  If so, what coverage did you elect for?  If not, why?

Thanks!

[beltim]

One thing I always wondered about stories of "wait times" and no available doctors is how that actually compared to the US. 

In a large city in the US, say New York, LA, even Denver probably, there are usually plenty of dentists/specialists in a field.  Highly educated professionals (i.e. doctors) want to live there, and therefore there are plenty of GPs. 

However, I grew up in a relatively rural area.  We had to drive 20-30 miles for any doctor.  Dentists were booked out for months, so you made your appointment 6 months in advance.  If you had a cavity, you often had to wait 2 months for a filling appointment.  For specialists you either had to drive to the nearest big city, or wait weeks or months for that specialist to clear.  Young professionals do not want to live there, so there aren't enough.

So, I wonder, if "wait times' in rural Canada/New Zealand are pretty comparable to wait times in the rural US, and people in the urban US think there is no wait time/ doctor problem here, merely because their area isn't experiencing it?

Here's some data: http://www.oecd-ilibrary.org/sites/health_glance-2011-en/06/08/index.html?contentType=&itemId=/content/chapter/health_glance-2011-59-en&containerItemId=/content/serial/19991312&accessItemIds=/content/book/health_glance-2011-en&mimeType=text/html
The US rates much better at waiting times (how quickly you can see a specialist) than Canada, France, Australia, New Zealand, and the UK.  It performs similarly to Switzerland and Germany.

[GuitarStv]

My last major experience with our health care happend a couple years ago when I got a very deep cut in my hand in the morning before work.  I cleaned it off, bandaged it up and didn't think much of it.  That night I was woken from my sleep by deep throbbing in the bandaged finger.  I had red streaks going up veins in my arm towards my heart and a fever, so we went to the nearest ER.  Turns out I had developed a case of blood poisoning.  They put me on an IV of some heavy antibiotics and I spent the night in the hospital.  The next day I was feeling a little better, but my finger was still swollen up about three times usual size, and I had to keep the IV in my arm.  The hospital gave me a portable IV pump (it fits in a fanny pack around your waist) and let me go home since I didn't want to stay in the hospital any longer.  They sent a nurse to check on my IV and change the bags once a day for the next week that I was recuperating at home.

Seemed like a pretty decent way of doing things.  (Of course, I didn't have to fork over any money for the health care, the ER visit, or the drugs.)

Overall I've been well served by the Ontario (Canadian) health care system.  Wait times are tolerable because your illness is classified by level of importance . . . so if you're waiting it's because you don't have a life threatening medical NEED to get it done.

[sleepyguy]

Sorry was a bit unclear... we still have to pay pricey prescription drugs and dental.  Most companies have pretty decent plans to cover that or you can buy health/dental/hospital stay coverage.  But very expensive things like surgeries are covered by OHIP.  For example both our kids were C-Section... the procedure is about $10k I think... not including hospital overnight ($200/night).  OHIP covered the procedure and our company benefits covered the 5 night hospital stay.  We went through this twice.

Ontario here, I would rate it as pretty good... we haven't had horrible illnesses in my family but for emergencies, births and surgeries, it's been pretty good thus far.  We don't pay out of pocket but be are pretty heavily taxed on everything which of course goes to health care.

[brycedoula]

I am also a healthy 29-year old living in Canada. I don't see my family doctor much (every 2 years for lady-part stuff), but 2 years ago I had a minor thing (turned out to be nothing). He referred me to a specialist & for 2 diagnostic tests(ultrasounds). I saw the specialist within 5 weeks, and had both ultrasounds done within 3 months. Was actually quite surprised, as had anecdotally heard how awful wait times were everywhere. No cost to me, for any of this.

My dad had a heart attack several years ago. Emergency room visit, $$$ clot-busting drugs, ambulance transfer to a bigger hospital, angioplasty, ICU stay, transfer back to smaller hospital, etc. My parents didn't have to pay a cent for this, BUT the medications he had to take afterwards were quite expensive & he quickly hit the upper limit with their Blue Cross plan.

I am so thankful that living in a place like Canada I wouldn't go bankrupt if something catastrophic happened (heart attack, car accident, etc) & I had medical bills I couldn't pay. Certainly as a result of those things happening my living/social/financial situation might take a nose dive, but not due to in-patient hospital bills.

Having a baby in a hospital, or birth centre, or at home is also all covered by our provincial health plan. Things like physiotherapy in a hospital setting are covered, but if you choose to go to a private clinic you would pay out of your own pocket, and then possibly get re-imbursed if you have private coverage thru work (or thru our provincial auto insurance corporation, or Worker's Compensation)

No complaints so far, but I'm young and healthy. If I was unwell I would likely be singing a different tune

[Trirod]

I live in the US now, but used to live in the UK, and can second most everything the UK people have said so far.  One anecdote:

A couple of years ago we were back in the UK visiting family.  My wife got a really bad stomach bug - vomiting, severe stomach pain etc.  By late in the evening I went out to a pharmacist to see if I could get some medication that would help, but the pharmacist on duty recommended I take her to the ER ("casualty") in UK speak.  We went there, got seen by a Doctor relatively quickly, and got given some medication that helped with the severe stomach cramps.  My wife always says about that visit that it was so great that the first question they ask you is "Where does it hurt?" and not "Who is your insurance carrier?".  No paperwork to fill out, no seeing multiple admin people, just us and the doc.  Technically we weren't even eligible for NHS care since we were no longer residents, but they didn't seem too worried about that.

[Exflyboy]

Same here.. UK expat.

While I love living in the US.. No way could I have saved enough to consider quitting work early next year.. which is what I am going to do.. Yaahoo!

But 8% vs 17%... That pays for a lot of not quite perfectness of the NHS (UK national health care). My Dad sees a cardiologist monthly... You tell me what that would cost here?.. In the UK its free for him.

Frank

[Gerard]

Another Canadian here. I luckily almost never get sick or hurt (last medical interaction was 1999), but I don't mind paying into the system, just for the peace of mind. My mom (who is aging and never took very good care of her health) probably gets her money's worth from the system. She did have to wait a while for one of her knee operations, but it's not like she was left dying by the side of the road.

I do think our system could be improved, partly simply by spending more money, and partly by investing more in keeping/getting people healthy rather than just paying the bills when they get sick. People seem to be bad at considering a 30-year payback window (e.g., for improved post-natal care) when it's tax time.

[TrMama]

Another Canadian here. The thing I think is really being left out of the UHC vs private insurer discussion is the fact that with UHC your health insurance isn't tied in any way to your employer. Yes, some employers offer top up plans to cover the "nice to haves", but when you're looking for a job, the health insurance offered is a very minor consideration. Contrast that with what goes on in the US.

The other big advantage is that I can be certain when my doctor prescribes a treatment, that my insurance will pay for it. There's never any back and forth between me (the sick person who isn't functioning at 100%) and the insurance company over money. This was huge when I was pregnant, extremely sick, and was "spending" $1000+ on prescriptions every month. I just had to submit my expenses and then go home to wait for the money to get direct deposited into my account.

[Christof]

One thing I always wondered about stories of "wait times" and no available doctors is how that actually compared to the US. 

In Germany "wait times" are partly the result of how doctors are paid. With public health insurance they get paid a fixed amount per patient per quarter. There's also an upper limit of how much money is distributed to doctors. One doctor working more takes away from other doctors, because only the distribution changes, not the amount of money.

That has led to many doctors optimizing patients visit by scheduling the second visit in the next quarter and to leave room for private insured patients that do not fall under the upper limit for treatment costs.

[jenstill]

I live in Vermont (USA), very close to the Canadian border and it's extremely common for Canadians to come here to buy medications. I'm wondering if you Canadian folks can tell me why that is, as it seems that your medical needs are covered pretty well at low or no out-of-pocket cost? Is it related to the part of Canada you live in? I see references to the province you live in when talking about coverage. So, we're closest to Quebec (Montreal is less than an hour away); it's just as common to hear the people in line at the checkout speaking French as it is English. I moved here from down south, so that's always fascinated me. :)

[Rachelocity]

jenstill, I may be one of those Montrealers you see!  I buy OTC meds in the US, because there are certain ones that we don't get here, but then again, every time I visit my relatives in the US, I bring Tylenol with Codeine as a hostess gift! 

(Are you in St. Albans?  I've been craving a sub from Pie In The Sky!)

[Heather]

Heather here from Canada.
We're very happy with our health care in our family.  Personally, we haven't had any major issues, but our minor ER issues have been dealt with easily, and extended family members with more serious problems seem to have gotten the care they needed in a timely manner.   
Family doctors seem to be in short supply.  We have in our area no shortage of walk-in clinics, so my friend who used to have no family doctor said is has never been a problem for him even though he would have preferred to have had one.
My main complaint is that family doctor visits are brief, and there doesn't seem to be time for 'how are you' sort of probing, or discussion.  I suspect that the reason naturopaths are popular is that they give people the one-on-one attention that they need to feel "taken care of".  Perhaps there should be a pay for service profession called "health consultant", who is a real doctor, but whose focus is on talking to you and getting your diet and lifestyle optimized, as well as any other issues treated.

 

[Daleth]

I've lived in the UK and France and far prefer the French system--at least, I prefer it to the UK system of 20 years ago; don't know if it's changed since then, but when I lived there you were assigned a clinic based on where you lived, and that just doesn't sit well with me--I like to choose my own doctor, thank you very much. In France you choose your own everything, although you get a discount (that is, a slightly higher reimbursement rate) if you pick one GP and do everything possible through him or her.

I saw some specialists in private practice while in France and never needed a referral. Someone from France please correct me if I'm wrong, but my impression was that if you know you have a problem with X body part, you can just pick up the phone and call a specialist for that body part and make an appointment yourself.

I never had any wait time for anything--maybe it took two weeks to see a specialist for a non-urgent situation, but if, for instance, I was sick right now and needed a doctor I could usually get an appointment that same day, whether or not I'd ever seen the doctor before.

[jenstill]

@Rachelocity: No, I'm not in St. Albans, but pretty close! I LOVE Pie in the Sky; the one in Stowe was on my way to work ... though, since finding MMM, I haven't gone there. :) Now, of course, I'm craving it! It'd be really cool to meet another MMM'er, so if you'd like to, maybe we could meet there next time you come down.

[grantmeaname]

Does anyone else worry about the market inefficiency that comes with the monopsony that is single-payer healthcare? I think we'll see medical innovation plummet if we transition to single-payer in the US as the hurdle rate for new products rises dramatically, but maybe now that we've all but solved the diseases of industrialization that's not as bad a thing as it once was. And perhaps an advantage of the PPACA approach is that it mitigates that somewhat (while reducing costs less, the trade-off).

[Deano]

Does anyone else worry about the market inefficiency that comes with the monopsony that is single-payer healthcare? I think we'll see medical innovation plummet if we transition to single-payer in the US as the hurdle rate for new products rises dramatically, but maybe now that we've all but solved the diseases of industrialization that's not as bad a thing as it once was. And perhaps an advantage of the PPACA approach is that it mitigates that somewhat (while reducing costs less, the trade-off).

I'm not worried. Here's an example, a Canadian one at that. Banting and Best, who figured out the whole insulin situation for diabetics, could have sold their patent or taken royalties for life, making them extraordinarily rich. Instead, they gave it away. Market inefficiency does not apply to university researchers who want to save lives. It may have an effect on the production of new drugs, but as you allude to, there are plenty of those around.

[Abe]

I agree, medical innovation would probably not be hurt by single-payer healthcare.  For example, dialysis was initially so expensive that hospitals would convene panels to determine who should get access to it. Medicaid (founded initially to pay for dialysis) was created because of the cost. Thus, there was a single payer. However, dialysis expense came down dramatically because of funding by the government to decrease the cost. In addition, the NIH sponsored essentially all important transplant research, leading the kidney transplants for dialysis patients.

Big pharma companies get the glory, but most of the research leading to drug developments are done at universities, which have gotten smarter and spin off small companies run with the investigators on the board. These companies are then usually bought by the major companies once all the high-risk work has been done and it's pretty clear the drug or test will be useful. This leads to the university getting some royalties, the investigator getting a (smaller) share, and funding for further research / faculty appointments. My university has done this successfully for several decades now.

The main question now is "what is innovation?" Most medical research results in incremental improvements with a new medication and resulting huge fees for the treatment (there was an article about this in NY Times last week). Is that truly innovative?  Insurance companies and us physicians are getting a bit more savvy about costs for marginal benefit, and a new drug that is slightly better than the current, super-expensive one doesn't get anyone excited anymore.

 The reality of medical innovation is that it is a long, hard slog testing a lot of things and if one is smart + lucky, you will find something truly innovative. If it makes a big difference, insurers/governments will pay for it. We saw this with dialysis, with transplantation, and now with effective chemotherapy. We will probably see fewer of the $50,000 drugs that provide a 3-week survival benefit, giving the perception that innovation has slowed, but I propose that this "innovation" is merely an illusion.

[Christof]

Does anyone else worry about the market inefficiency that comes with the monopsony that is single-payer healthcare? I think we'll see medical innovation plummet if we transition to single-payer in the US as the hurdle rate for new products rises dramatically.

In Germany we have both systems, public (universal) healthcare and private healthcare similar to the one you have in the US. What we have seen is that public healthcare leads to lower prices due to sheer market force and political pressure. Public health insurance companies pay between 20-75% less for the same treatment and medicine than private insurance companies. OTOH, service is a lot better for those with private insurance and coverage is more extensive.

Private healthcare in Germany is kind of affordable because it's only available to self-employed and high-income people which statistically (at least here) are more healthy.

[happy]

The health system works reasonably well here : I think"not quite perfect" is a good description. A major problem is that health is funded via 2 different levels of government - the Commonwealth covers GPs and community type services and the States fund hospitals - which causes some loss of efficiency, but there is no political will to fix this as its  convenient for both sides of govt to keep passing the buck. The ability to purchase above the universal system if you wish is useful but be warned you can only purchase those parts of healthcare that make a profit: profit for shareholders and doctors. The non profitable stuff is all done in the public system.  The govt  allows this to exist: why fund with taxpayer money those bits that can be "self-funding" with a user pays system in the private system.  The balance and cost of private healthcare had been under political debate at times.

There is definitely variation in the quality of public healthcare depending where you live...but thats another issue.

Of course the major determinants of health at this point in the West, have very little to do with the relative provision and quality of healthcare. We are essentially practicing flat of the curve medicine. Education and socioeconomic status and improvement in those are more significant than whether your health service can provide the latest whizz bang soy, latte, double whipped cream, with pumpkin spice, decaffed, fring frang latte of a health intervention. Life style interventions: diet, exercise, stress management, stopping smoking  reducing alcohol  etc etc are more effective than waiting till you need triple bypass surgery. So spending huge amounts on publically funded healthcare without addressing socio-ecomonic determinants of health is like trying to fill a bucket with a hole in it.

[hybrid]

Does anyone else worry about the market inefficiency that comes with the monopsony that is single-payer healthcare? I think we'll see medical innovation plummet if we transition to single-payer in the US as the hurdle rate for new products rises dramatically, but maybe now that we've all but solved the diseases of industrialization that's not as bad a thing as it once was. And perhaps an advantage of the PPACA approach is that it mitigates that somewhat (while reducing costs less, the trade-off).

No more than I worry about the market inefficiencies of Dominion Power.  Which is to say I don't worry too much about that.  In general I prefer competition whenever and wherever practical, but there are a few isolated cases where competition does not make much sense.  The USPS is a great example (I used to work there and the wife still does).  No private company wants to take on the full responsibilities of the USPS (delivery to all addresses for dirt cheap postage rates six days a week requires enormous infrastructure) and yet I can still mail a letter from here across the country for a mere 0.46.

Dominion Power makes a healthy profit and customers pay very reasonable amounts for very reliable electricity.  They may be a monopoly, but all it does is work. 

[grantmeaname]

Lack of electrical transmission innovation is less harmful to society than lack of medical innovation.

[Gerard]

Lack of electrical transmission innovation is less harmful to society than lack of medical innovation.

Grant, I don't fully understand your question or concern. How much of the innovation in medicine happens in situations where single payer healthcare would make a difference? Hospitals still run the same (except they stop spending money on highway billboards convincing shooting victims to drop by). Big pharma still keeps patenting things and spending a shit-ton bribing GPs to prescribe their products. University research still happens, funded by pharma and government. Individual GPs (and many specialists) keep on prescribing whatever they learned about at their last party/convention. Doctors continue to recommend too many tests, except now they do it because government is paying for it, rather than to avoid lawsuits.

[grantmeaname]

How much of the innovation in medicine happens in situations where single payer healthcare would make a difference?

The US currently does substantially all of the world's medical research because it's profitable here and not really profitable anywhere else. As discussed elsewhere, if we introduce a monopsony, that's a market inefficiency just as surely as a monopoly would be. Without an opportunity to profit, why will firms continue to conduct and fund medical research?