How does care provided by U.S. Medicare compare to the British NHS?

Factual Questions
1

I am a British citizen, but a U.S. permanent resident, and I believe I have worked enough in the U.S. to be eligible for Medicare when I reach retirement age (which won’t be for a few years yet). I am thinking of moving back to the U.K. soon anyway, for other reasons, but I wonder which of these medical systems - once I reach the relevant age - would actually provide me with better care and coverage. I get the impression that American retirees on Medicare still often have to pay quite a bit out of pocket for drugs, etc. (and do they still have to pay copayments for their doctor visits, like I have to with my private insurance?). On the other hand, I know the NHS can sometimes be quite stingy about what care it will provide. Is there anyone here who has experienced both, or who has relevant factual knowledge about both?

Please don’t turn this into a political debate. That belongs in another forum.

2

My information is several years old, but I used to do comparative studies of government-provided medical care in several nations.

US MEDICARE
Basically, yes, American retirees on Medicare still have deductibles and copayments, roughly 20% of most costs (it’s quite complicated.) You’d need supplemental medical insurance, you can get a very good policy for around $200 per month in premium (lots of variation here.) Some things are not covered at all: hearing and dental care, and long-term care are the biggest cost areas.

Standard Medicare (Parts A and B) do not cover prescription drugs, but you can buy what’s called “Part D” insurance separately. These are sold by insurance companies, they’re all different and have completely different coverages. It’s a mess, and very confusing to figure out which one is best for you (depends on what medications you’re taking.) Costs are fairly reasonable, but coverage has huge gaps – for example, my 90-year-old mother-in-law has about 80% of her drug costs covered until she hits the maximum (usually around July/August) when she has to pay 100% of medication costs herself until she gets to the “catastrophic limit” and coverage kicks in again, usually around November.

Yes, NHS can be stingy, but so can Medicare and the insurance supplements. I think that the insurance supplements are the worst in terms of withholding payments/treatments, because they’re set up as for-profit organizations (= organisations.)

Remember, in any comparison, that prescription drug prices are way cheaper in the UK than in the US, because there’s huge government subsidies. Actually, most medical expenses (even if you didn’t have NHS coverage) are cheaper in the US, because US care-givers are profit-driven.

3

I guess you meant cheaper in the UK, huh?

Anyway, thanks for the helpful answer.

4

A data point about quality of care is that Americans on Medicare are sicker than the British of a comparable age but live longer. A summary of the study is here
Life expectancy is generally a poor proxy for quality of health care received, but in this case it seems relevant since most of the illnesses suffered by the elderly can be life threatening.

5

I think it must be very difficult to provide any meaningful comparison because the experience is so different. I’m British but I don’t think everything British is necessarily best. However, I think our NHS is an amazing achievement and one that we should be very proud of.

No form-filling. No ‘Can we afford this?’. No ‘How much will these drugs cost us?’. No ‘Is this covered by your insurer?’. No ‘Can you prove this will be covered by your insurer?’.

If you have a problem, you have instant access to a doctor, an emergency room or a hospital, as your right, anywhere in the country. Just walk in and ask for it, or phone and they come for you.

Whatever is the best treatment for your condition, it’s yours as of right (with rare exceptions I’ll mention below). Whatever drugs you need, they are yours, forever, at massively discounted cost, no matter what the cumulative cost of any previous treatment. It’s the same for everyone, and our standards of treatment, medical care, hospital care and surgery are a match for anywhere.

Is it a perfect system? No. Is it open to some abuse? Yes, mainly of political meddling.

In extreme cases of very expensive treatment, there are ‘zipcode lottery’ variations between different health authorities that mean an expensive option might be available in once place but only a cheaper alternative is available where you live. Naturally this gives rise to disputes and quarrels. But these cases are rare.

Overall, it’s a fantastic system, and every time either I or anyone in my immediate circle have had need to use it, I have been strongly reminded of just what an amazing health service we have. And in 95% of cases, the experience is ‘Whatever you need, it’s yours now, just for the asking’.