Government-run Health Care

[GlennD]

A couple of threads recently have taken a tangent towards discussions about health care, particularly about health care provided by the government. One of the cool things about mobileread is that we have so many people from so many nations represented.

So I'd like to ask -

What are people's personal experiences with health care in various countries? I'd like to step aside from the political/moral debate about whether governments should be in the business of providing health care (although this is Mobileread, I'm sure we'll have some of that ), I'm more interested in the reality of living under different health care systems. What kind of waits are there, for different kinds of care? What kinds of procedures are taken care of, or not? Who makes the decision about what is necessary - i.e., are doctors ever in the position of wanting to provide a certain kind of care but they can't because it will not be covered? How proactive are doctors about different kinds of testing (MRIs are expensive for example, so a doctor might try to avoid one unless they have very concrete indications that one is needed. Or they might prescribe one just to rule out possibilities)?

[Sparrow]

My recent experiences with the UK's National Health Service (NHS).

Recently my mother has needed a hearing aid. Audiology service was excellent, took six weeks from diagnostic appointment to fitting. No charge - replacement batteries are free. The quality of the device seems extremely good - we were told it costs £1800 if brought privately. My mother is delighted with the service she received.

A few years ago my father was stricken with a mental illness. The treatment the NHS provided was appalling. He was given different diagnoses over several years, none of the treatments helped, his condition deteriorated and he was placed in residential care. His life savings were used to pay the cost, he didn't get any help beyond basic care (feeding, washing etc.) He was eventually hospitalised, they tried to discharge him when he was in no fit state to go because they needed the bed. When we saw the condition he was in the departure room, we were shocked they thought he was well enough to leave. A nurse agreed and got him readmitted. He died in hospital a few weeks later.
To be honest, if I was in the same position as my father at the start of his illness, with the prospect of the same level of NHS treatment, I think I'd opt to take matters into my own hands rather than endure it.

[rhadin]

I live in the U.S. and do not have national health care, but I do have insurance (through my small business). To see the orthopedist for my back, I had to wait 6 weeks and to see the neurologist, I had to wait 7.5 weeks. To see my primary care, I only need to wait 1 to 1.5 weeks.

Sparrow talks about appalling treatment, but I wonder whether that is the result of the NHS or simply the quality of the doctors. Even in the U.S., where care is fee-for-service based, the quality of care ranges from dismal to exceptionally great. Its the luck of the draw on the physician.

Also worth noting: One of the arguments in U.S. against national health care is that patients will lack choice. But for those of us who do have health insurance, what choice do we really have? To afford the insurance for my wife and I, I had to choose HMO or EPO care. In both cases, we can only go to doctors preapproved by the insurance carrier, which means doctors who have agreed to accept the amount of money the insurer is willing to pay for a service. It is true that we could abandon insurance altogether and simply pay everything out of pocket, but that's not realistic. So although we don't have national health care limitations, we have the same limitations, just ones imposed by an insurance company and we don't get immediate access to doctors.

[Sparrow]

Originally Posted by rhadin

Sparrow talks about appalling treatment, but I wonder whether that is the result of the NHS or simply the quality of the doctors. Even in the U.S., where care is fee-for-service based, the quality of care ranges from dismal to exceptionally great. Its the luck of the draw on the physician.

I got the impression it was more the nature of the illness. Different professionals were involved at different times, but the quality of the care was dismal throughout. I wonder if mental illnesses are beyond the ability of the NHS to deal with at the moment - we saw lots of other patients in a similar plight.

[Ham88]

My experiences here in the state o' Maine aren't really that bad. But I have health insurance which covers all of my doctors, and I don't have to wait to see any special doctors (optometrist) all I need is a referral from my primary care physician and insurance will pay for it, though I'm not sure if they will pay if the referred to doctor is out of network, because mine was in network anyway. But I am aware of the plight of those who don't have insurance because health care is expensive, so people wait until they have to go to the emergency room, which leads to the overly crowded ERs here in the states.

[Alisa]

Originally Posted by Sparrow

I got the impression it was more the nature of the illness. Different professionals were involved at different times, but the quality of the care was dismal throughout. I wonder if mental illnesses are beyond the ability of the NHS to deal with at the moment - we saw lots of other patients in a similar plight.

There is very little coverage for mental illness under our private insurance here in the US and the state-run programs were gutted decades ago. Besides, if he were too ill to work, he likely wouldn't have private insurance. If he didn't have family to take care of him he would more likely end up homeless on the streets than in a mental hospital. Of course, even with family it can be difficult to hospitalize an adult. One of my cousins is schizophrenic but not considered ill enough to commit. She went of her meds and ended up homeless despite the fact that her parents had ample money and she had a trust fund. She couldn't keep it together to go pick up her check and her parents had no right to control her. But it's not like there would have necessarily been treatment available for her even if she'd been willing to take it if her parent's weren't wealthy. The city of San Francisco has more homeless than the country of France even though it's only 7 miles on a side and has fewer than a million people. Many of them are mentally ill folks that aren't cared for. I wonder if we can find an example of a system that cares well for its mentally ill.

[RCR]

GlennD didn't want political/moral debate on health care, so I'll avoid that, though I do have strong opinions. GlennD just wanted personal experiences, so here's mine:

In Australia we have both government provided health care and, if you want to pay for it, private health care.

I choose not to pay for private health care. I've been hospitalized twice.

Once, I lost a lot of skin in a chemical burn. I was through ER and in a hospital ward within minutes. After about three weeks in hospital, I had recovered sufficiently to go home. I was given "meals on wheels" (someone brings prepared food around to your home) until I had regained sufficient mobility to feed myself. There was no cost to me at all.

On the second occasion, a badly set broken nose started to give me breathing problems. The doctor told me I would have to go on a waiting list for about 18 months. Two weeks later I was in hospital, getting my nose reset. About a week in hospital and cost me nothing.

On my infrequent visits to doctors, I go to a local medical centre where I'm allowed to choose a particular doctor, but I never bother. A consult costs $55.00 up front but then I get a government refund of $32.10.

I had laser nuking of one eye that had severe astigmatism. A perfect job which cost me $2500 up front. I got a tax rebate of about $500 on that.

The dentist: The last time I had a clean in Melbourne was in 2005 and it cost me $135. Now I have it done a couple of times per year in Pattaya, Thailand. The cost is about $30. They do a far better job than Melbourne and the staff are sooooo cute!

(Prices in Australian dollars).

[LazyScot]

My direct experience is somewhat limited. I had an emergency appendectomy, that went fine without having to worry about anything. Only in for a few days, and no problems.

I've had family members have a range of heart and cancer surgery operations and procedures, all of which seem to have been exemplary (though I little bit of chasing up is required). But I've also had some where the results have been far from perfect. On balance, my experience of the NHS has been very good, but it does depend on where you are in the country.

We do have private health care in the UK. I've never really felt a need for it, or that it is really good value for money. That said there are a few services that we have paid for privately, such as physio treatments, but the prices of those are very reasonable, and you can get that through the NHS.

[rhadin]

Originally Posted by Ham88

. . . all I need is a referral from my primary care physician and insurance will pay for it, though I'm not sure if they will pay if the referred to doctor is out of network . . .

At least in my plan, referrals have to be approved by the insurance carrier and they have to be to in-plan doctors unless you can demonstrate that no in-plan doctor has the expertise/knowledge to deal with your problem. Then, if the insurance company agrees, you can go out-of-plan but have to pay the difference between what the insurance carrier would pay an in-plan doctor and what the out-of-plan doctor charges.

Even for tests, the insurance carrier has to preapprove (some don't require preapproval, they are on the preapproved list already). I have had the insurance carrier deny coverage for a test because some doctor or nurse that I have never met or spoken to in the insurance company's office decided I didn't need the test. One can appeal the decision, but that is a nightmare in itself.

Similarly, prescription coverage is up to the insurance company. My doctor can prescribe medication but if it is not on the preapproved list, it isn't covered by the insurance.

So I don't see how the insurance company bureaucracy is any different from any other bureaucracy that might come about from national health care.

[Ham88]

Originally Posted by rhadin

So I don't see how the insurance company bureaucracy is any different from any other bureaucracy that might come about from national health care.

They're different in the regard that the government bureaucracy will lose money unlike the health insurance companies of today.

(Is that being cynical?)

[Gideon]

In the US I've had insurance off and on over the past decade. The insurance I have currently is through my university. It is, to put it mildy, terrible. One of my doctors is great, but the others aren't - most of my visits end with "Eh, I don't know." I had a problem with depression a couple of years ago - it was a very severe case (the barely make it out of bed type, and normally I'm a tornado on legs), lasted about 8 months. I had access to one part time psychiatrist who, if I wasn't depressed (and the inability to do anything that entails) I would have pursued to the best of my ability to get fired. She was absolutely dreadful and actually spent most of our first meeting insulting me (went on about my weight because she consulted a stupid BMI chart and decided I was obese.. until I stood up and she realized I was just built like a tank. But you don't spend a half hour telling a VERY depressed person how fat they are, even if they are which I wasn't) and letting me know her personal politics.

So, I had to spend 110 dollars every week seeing a private doctor for meds/therapy. I didn't have a choice because my options was that beast or talk to the grad students who were less than worthless ("so you're saying your depressed." "Yes, you're so helpful how you repeat everything I say without offering anything at all useful.")

My parents who had insurance lost their coverage that they have had for over 20 years, never missed a payment, etc. after my dad was diagnosed with diabetes. They just canceled the coverage with some sort of obscene technicality (it was some sort of paperwork issue that was extremely minor but they go looking for that sort of thing when you really get sick.) So they lost their insurance and had to find another plan that is over a 1000 dollars a month because of their age and dad's health and their meds are STILL hundreds of dollars a month (and my mom is perfectly healthy and dad is in decent shape besides the diabetes/blood pressure). And fortunately, my parents can afford this... but not easily. They had money at the time, and this happened to them. So this insurance crap doesn't just effect the poor.

Yay private insurance. It sure does entail excellence.

[GeoffC]

NHS experiences generally good; though I draw the line at an urgent appointment being 18 months in the future !!!

[desertgrandma]

It seems that we in the US soon won't have a choice. Right now, you can choose to have insurance, or not. Here's an interesting article I read last night.

http://www.azcentral.com/news/articl...hcare0702.html

Just like car insurance, health insurance will soon be "mandatory".

[pshrynk]

I was in the AIr Force Medical Corps for eight years. Closest thing I've ever been to NH. The VAMC also has similar set-up. If a military member or dependent needed to be seen, they called the clinic and got an appointment. They were seen. If they needed a procedure, they got it. If they wanted elective stuff, they could eventually get it unlees there was a contra-indication. It worked pretty well, except for having to wear goofy uniforms every day.

Personally, I want the US to have a National Health program so that we can stop throwing away all our resources to hideously expensive "health care" that does little to prevent illness. We spend about 60% of our health care budget in two areas: Preventing lawsuits and prolonging life of those who no longer have any quality of life becasue they no longer are actually able to be cognitively aware of their world.

Yes, there are bad doctors who need to be punished for bad care, but there are other ways of doing it than driving the cost of everyone else's care through the roof. And, yes, there are people who are loved and who need care to get back to their loved ones. But those are not the peopel whom I am referencing.

They current system is severely broken and we need to fix the broken bits.

[LazyScot]

Originally Posted by desertgrandma

It seems that we in the US soon won't have a choice. Right now, you can choose to have insurance, or not. Here's an interesting article I read last night.

http://www.azcentral.com/news/articl...hcare0702.html

Just like car insurance, health insurance will soon be "mandatory".

Interesting article. Thanks.

In the UK, the NHS started (together with some other things) being funded by "National Insurance" contributions (NI) which an individual pays at something like 10% of income, and the employer adds to that (slightly more 12%?). Apologies if these figures are wrong -- I'm sure Google will correct me! If memory serves, they were a lot lower when the NHS started.

Practically today, the NI contributions just go into a big pot that, once the bankers have removed their bonuses and guaranteed pensions, is then used to pay for the NHS and everything else the government pays for (no, it doesn't do everything it *pays* people to do it).

So it is possible to argue that we in the UK have compulsorary insurance, however it doesn't suffer from companies trying to save money by excluding people or charging more to some. Whether that is good or bad is the subject for a completely different debate that will get so heated I don't want to have anything to do with it.

(If you're interested in the history of the NHS, probably the Beveridge Report is as good a place to start as any.)

However, I'm not happy with the car insurance analogy. I only need car insurance if I am going to drive. Health insurance, it can be argued, is needed if I intent to live... Next the reason car insurance is mandatory, at least in the UK, is the direct impact (pun unintended) that a driver can have on others.