[ein0p]

Lately I can’t even get a doctor - both the specialist and primary care doctors are booked months in advance. And I have one of the best insurance coverages currently available. Remember how we laughed at Canadians and Brits waiting for months to see their free/cheap doctors? Well we’re at a point where we have to wait _and_ pay through the nose. And then they can’t really do anything or fuck you up even worse.

[vidarh]

Not that I'm trying to make you feel worse about it: In the UK we pay less per capita in taxes toward healthcare than you do in the US (or at least did last I added up the numbers - Medicare and Medicaid alone added up to a higher per capita cost than the NHS), and if we do want private health insurance, which here is basically "queue skip insurance", it costs a fraction of in the US because they only need to provide the "extras" - you'll normally try your NHS GP first, call your insurer if you can't get an appointment, or ask them to refer you privately for things there are queues to get done on the NHS.

For a lot of elective procedures, the price is even low enough that it'd pay you to fly to the UK and stay in a hotel to get things done here if the recovery isn't too long.

[ein0p]

The US is so corrupt that I’m afraid any attempt at universal healthcare would make it even more expensive. Obamacare was basically a trillion dollar giveaway to Big Pharma and Big Healthcare. The only positive thing I can see in it for me personally is that it became possible to buy (extremely expensive) healthcare privately rather than through an employer, and you could not be denied due to pre-existing condition. Don’t get me wrong, that’s significant, but the insurance is now three times the price it was before Obamacare and the actual care is much worse. And both the cost and quality/availability seem to be trending in the wrong direction.

I guess what I wanted to say is, lucky you. Hold onto that NHS for dear life and resist any attempt to privatize it. It’s very much a one way street.

[netsharc]

Obama himself has said to that Obamacare (well ACA) is like (to use my own analogy) a "patch" on a a system that can't just be reimplemented (most of it due to political reasons). It's not terrific but it's what was able to be done.

Whereas e.g. single payer was an unachievable pipe dream from where they were standing in 2008/09. And he'd rather have something a bit better rather than go for the excellent system and fail and be left with the bad system.

[shiroiushi]

And why was it "an unachievable pipe dream"? As I remember it, the Democrats had control of both houses of Congress, as well as the White House, for about 2 years. They could have passed anything they wanted.

[netsharc]

A others have replied, some Dems were quite red, a lot of politicians are more eager to preserve their jobs than burn political capital...

The excerpt from his book: https://archive.is/V5TVM . He also talks about "political capital" and whether it'd be more wise to spend them on e.g. recession recovery. Ctrl-F for "More than forty-three million Americans were now uninsured" to skip the introduction about how the system got to the way it got.

[triceratops]

You're remembering wrong. They had a super-majority for only about 6 months. After that Republicans could hold up legislation via filibustering.

https://en.wikipedia.org/wiki/2010_United_States_Senate_spec...

[ein0p]

Because they’re owned by Big Pharma and Big Healthcare. Same as Republicans. Also because we'd much rather fund wars than solve such problems.

[netsharc]

I was complaining about the state of discourse on HN the other day. Your comment is example number... I don't know what number, I've lost count.

[tstrimple]

Joe Lieberman sabotaged the public option.

[chgs]

If one person has such power you aren’t really in a democracy

[gregjor]

Matches my experience. As a self-employed person health insurance in the US costs more under ACA, and then many doctors, hospitals, and labs won’t accept the ACA coverage.

My parents in America have Medicare plus a private “advantage” add-on they can barely afford. Right now they are waiting — for months — to find out if a necessary surgery will get approved or not.

I live in Thailand now, where I can afford insurance and get top quality care with no waiting, referrals, or uncertainty, and costs at the best hospitals still a fraction of US prices.

[simonbarker87]

> For a lot of elective procedures, the price is even low enough that it'd pay you to fly to the UK and stay in a hotel to get things done here if the recovery isn't too long.

But please don’t do this. Our system is better than the US but private is now starting to struggle along with the NHS wait times as more people use their private coverage where they wouldn’t have done before.

[Trhoe3849]

Flying to UK for cheap healthcare is a sick joke.

There are much better countries for medical tourism: Thailand, Malaysia, Greece...

[vidarh]

If you want it as cheap as possible, sure. The point was not that it's the cheapest option but that even a high cost country like the UK is still cheap enough to be viable destination.

But the UK does attract a significant amount of medical tourism, and has hospitals specifically targeting an international clientele who clearly considers it a good balance of cost and quality.

[xvector]

In the UK you also pay insane taxes and your _median_ citizen in the UK has far less disposable income after all expenses including healthcare, according to OECD metrics. In software engineering specifically, I'd make a third of my current income in the UK.

I'd much rather make 3x as much in the US and still get free healthcare through my employer, with shorter waiting lists and better treatment outcomes than the NHS.

And we also have "skip the line" services here as well.

My family have worked as doctors both in the UK (NHS and private), and the US, and they vastly prefer the US system from an outcomes and efficiency perspective.

---

Commonwealth Fund studies like the one in the article tend to be quite biased and pushing a very specific agenda.

But in reality, we have far better mortality rates (1) for serious diseases: 48% better outcomes for cancer, as an example.

When people with serious problems want treatment, they come to our system if they can afford it, because we actually do have better outcomes regardless of what these highly biased studies say.

1: https://www.politico.eu/article/cancer-europe-america-compar...

---

Edit: People calling my argument a "strawman" should really try living in both systems for a year with a chronic, serious health condition.

They will very quickly find that the US system is far better than the NHS. We get seen more quickly, our doctors can afford to actually spend time on us, more effort goes into root-causing a problem, we have more treatment options, etc.

It's easy to theorycraft online and look at the "on paper" metrics from highly biased studies and come to the wrong conclusions.

[Rinzler89]

> your software engineers make a third of what they make here

Is this topic for discussing health care systems or the SW engineering salary dick measuring Olympics? Because those are two different unrelated topics.

Which country pays its software engineers the most is not some yardstick for measuring national quality of life of its average citizens, and whether SW engineers get paid a lot is totally irelevant to the people who are not working or aspiring to be SW engineers.

I bet the disabled US vets, homeless people or McDonalds workers in the states also don't give a fuck that their SW engineers are the best paid in the world but would probably feel a bit cheated learning that despite living and paying taxes in the richest country in the world, their peers in poorer EU countries get much more benefits and better quality of life.

[happiness_idx]

>I bet the disabled US vets, homeless people or McDonalds workers in the states

Those two groups share interesecting means by which their healthcare is provided. Surprise! Its the government. So when people have doubts about an implementation of "Universal Healthcare" you shouldn't be surprised when you can acknowledge that as you said " but would probably feel a bit cheated learning that despite living and paying taxes in the richest country in the world, their peers in poorer EU countries get much more benefits and better quality of life."

Irrelevent but homeless people don't really pay taxes in any meaningful sense.

[vidarh]

It's always fun how the strawmen appears instantly when you discuss this subject.

We pay marginally more in tax, sure. How that is relevant to healthcare, however, is a mystery, given we spend less tax money per capita on healthcare than the US does. It's not healthcare that is the reason our taxes are higher, but other services.

I'm sure doctors prefer the US system. That's unsurprising - the US system pays doctors vastly large amounts. It also costs patients vastly larger amounts. So speaking of bias...

[evgen]

> In the UK you also pay insane taxes and your software engineers make a third of what they make here. At my big tech, as an IC5 I was making more than our UK Directors.

How strange. When I moved from US to UK within a FAANG I took a fractional pay drop and got an RSU topper. After leaving and working as a UK employee in an international org I make more than a lot of US directors. Perhaps the difference comes from the value you brought to the company?

One thing that is objectively true though is that, outside of the whinging from software devs in the 1% that no one really cares about, the outcomes and efficiency of the US system sucks compared to every other western nation.

[vidarh]

> They will very quickly find that the US system is far better than the NHS. We get seen more quickly, our doctors can afford to actually spend time on us, more effort goes into root-causing a problem, we have more treatment options, etc.

Nothing stops you from choosing extra insurance in the UK too if you believe you need that level of cover.

The only reason you're comparing it to the NHS instead of an equivalently expensive UK private healthcare plan is that the NHS provides good enough universal coverage that most people don't feel the need for more.

But the US equivalent would be to compare it with Medicare and Medicaid.

[xvector]

In the UK, not only would I pay massive taxes for healthcare, but then I'd also have to purchase private healthcare anyways.

The US is far cheaper, even according to OECD metrics (disposable income after all expenses incl. healthcare.)

[sensanaty]

Okay, and what about all the other people who aren't blessed enough to be SWEs? They should just rot and go into medical debt for the rest of their lives for daring to get sick?

[usr1106]

You forgot to mention what country you are talking about. That seems to be American.

Difficulties to get an appointment is also common in at least some areas of the EU countries I am familiar with.

[suslik]

Indeed. My girlfriend is waiting for ADHD appointment in Sweden - 2 years and counting.

[ein0p]

United States.

[fire_lake]

The UK isn’t functioning well at the moment. Cancer treatments keep getting delayed and people are dying as a a result, to give one example. I don’t know which countries are doing a good job on health, but it’s not the UK.

[gregjor]

Same. Forced to get insurance through state exchange, premiums over $1,000/mo for two people. Very hard to find a doctor that accepted the insurance. And that was in a major US city. Every test and procedure requires a referral to a specialist, and the game of “do you take this insurance?” repeats. Then you get referred to diagnostic labs with long wait times (sometimes months) and they want payment up front and may not accept your insurance.

That process seems worse in every respect compared to my experience in SE Asia, and the US does not have better outcomes to justify the much higher costs.

[DavidPeiffer]

There are a ton of benefits to having continuity of care, but also access to care. Do any out-of-network providers have appointments available? If so, and you can't find one in-network, you may be able to get an out-of-network provider covered as in-network due to an inadequate network.

I've heard of people calling their insurance company and keeping them on the line while they call a handful of offices and get turned down for appointments to get this approved.

[inferiorhuman]

To be clear that's been true in the United States for the better part of two decades.

[Simon_ORourke]

Same here - and I'm always left wondering what manner of trivial/cosmetic cases are taking up these bookings and leaving more urgent medical cases to wait.