I don’t want debate. I don’t want impassioned pleas to support or oppose Obamacare. I don’t want predictions about what Obamacare will or won’t do.
What I want is the truth about National Health Care or whatever, from people who have lived it. Please tell me your country, whatever specifics you want to give (like how much of your paycheck is taxed to pay for it, or whatever), and just give me the pros and cons. It’s all I ask.
Thanks!
Alberta, Canada. I pay $40 per pay cheque toward my health care, which covers both my husband and I. All our emergency services are direct bill. I have direct bill for prescriptions with my carrier, so just give the pharmacy my card, they run it through, and if there is any balance left (usually a couple of dollars because of the handling charge or something) I pay out of pocket. I can take that amount and submit it to my husband’s carrier and I get it back.
My husband does not have direct bill for prescriptions, so he pays out of pocket, then submits his receipts and gets the money back. If anything of his isn’t covered, he submits to mine, and mine covers it.
There are very few things our health insurance won’t cover. In our case, the only stuff we’ve had to pay for out of pocket is IUI and IVF. My husbands coverage pays for the injections for IVF (around $3000), but not the IVF itself. Everything leading up to these two procedures is covered - blood tests, minor surgeries to take a look inside, ultrasounds, etc.
In the last 12 months, I’ve had an ectopic and required emergency surgery and 24 hours in the hospital, and then I tore my left knee MCL and sprained my ACL, requiring a trip to the hospital, a brace, a visit to a surgeon and physiotherapy. All of this was covered. My husband had a trip in the ambulance and a night’s stay in the hospital a few months ago, and this was covered.
The worst part about our system is trying to find a family doctor. It’s very hard to find a clinic accepting patients and you’re left to walk in clinics, which means hours of waiting. Luckily, my husband and I have great doctors and can get in in a day if needed.
I’ve heard of long waits for surgeries but have never experienced it. My husband has had shoulder reconstructive surgery and I’ve had two laparoscopies (in addition to the ectopic), both would be considered ‘elective’, but neither of us experienced any significant wait. We were both in within weeks.
Oh, my vision coverage is crap. I only get $250 a year for glasses/contacts. Not near enough. But I have a $600 Health Spending Account with my employer, so that covers the rest.
ETA: Hopefully that was what you were looking for? Did you want to know anything specific?
I should clarify, my husband also pays about $40 per pay for health coverage, same set up as me. So we both essentially have dual coverage and use coordination of our benefits to always get 100% back (some things are only covered 80% for some carriers).
…my dad went to his doctor for a routine check up. The doctor suspected something was up and sent him to the hospital where they discovered he had bowel cancer. A few weeks later he was having an operation to have the tumor removed, and now, a couple of years later, my dad is still fitter and healthier than me.
Total cost out of pocket? About forty bucks for the initial doctors appointment, twenty dollars in petrol and ten parks in car parking. My dads age when he had his surgery? 80. My tax burden? I’m a small business owner who currently pays 17.5 cents in the dollar (although that is likely to go up to 33 cents in the dollar in the next financial year.) and 15% on any goods and services purchased for non business purposes. Healthcare spending is apparently about 7% of GDP: but I don’t know how much of my taxes contribute solely to healthcare. I live in New Zealand.
Do you also want facts related to the effects on the economy of national health care? Or just people’s personal experiences?
Our Medicare covers about 85% of most medical expenses. We pay a Medicare Levy of 1.5% of our taxable income, and we pay a Medicare Levy Surcharge of 1% if we earn more than $80,000 as a single or $164,000 as a couple and we don’t have private health insurance. There’s some added complexity - low income earners pay less or are exempted, there’s some differences with older people - but those figures cover most average Australians.
I’ve had two babies under the public system. My pre-natal care all came at no cost to myself, ultrasounds cost me around $210 upfront but Medicare paid me back 85% of that. No cost for my first birth (induced, suction and forceps delivery, five days in a private room in hospital) except for $18 worth of medications that I needed after I left the hospital. No cost for my second birth (induced, emergency caesarian, four days in hospital but a private room for only three and a half of those), except once again for the take-home medications, but I honestly don’t remember how much they cost, (under $50).
I’ve got a pen-pal who is a doctor (a DIPRACOG!) in Australia.
(Doctor in Practice in the Royal Australian College of Obstetrics and Gynecology.) He’s been sending me books and pamphlets and web sites on the Australian system.
He likes it, both as a doc and as a patient. The materials he has sent me have convinced me that it is a good system. In my opinion, the U.S. is sufficiently like Australia that their system would work just fine here. It preserves incentives, which is the only positive feature that a “market driven” system has.
I live in the same city as EmAnJ, and my experience has been similar (well, we’re not trying to get pregnant, so no IVF). Dental isn’t covered, either, so I pay quite a bit each year for dental work, but a large portion of it is covered by my husband’s insurance through his job. My biggest complaint is wait times - wait times to see a doctor, wait times in emergency rooms, wait times to have a procedure done. I want to get an elective surgery done (tubal ligation) - my appointment with the OB/GYN will be two months from the time I talked to my family doctor, and the surgery itself will be sometime before Christmas (probably - I haven’t got a date yet). As far as I know, it will be completely covered by Alberta Healthcare, though.
Pros:
Cons:
I guess for US American libertarians it would be a negative that I pay for healthcare for other people, but the way I look at it, I’m mostly healthy when I’m younger, and I’ll use more healthcare as I get older - I’m paying it forward for myself.
Oh, I just remembered a long wait time we had - the wait to see the infertility specialist. We had to wait six months from referral to first appointment. I called a clinic in the US and was on the phone with the lead doctor in a week for my first consultation. Big difference. But the cost of the US IVF cycles were much, much more than here as well. $20K for two IVF cycles (no meds) vs. $12K here, meds included.
Another Albertan.
I honestly do not know what my personal provincial health care costs. I know it comes out of taxes, but we don’t have a separate line on our tax returns to calculate health care tax. At tax time, I pay the feds a lump, and the province a lump, and that’s that. If I need care, off I go to the doctor, the ER, etc.
I am self-employed, so I have no employer to offer a supplementary private health care plan (e.g. Blue Cross), for such things as dental, vision, prescriptions, etc. I haven’t purchased a supplementary plan, so that costs me nothing. I can buy such a policy on my own, though, and will likely so so at some point soon–I need some dental work done, and probably new glasses.
Pros: A surprising amount is covered by the provincial plan. Major surgery, minor ER things (broken bones, stitches), outpatient procedures, lab procedures, annual physicals–they’re all in there, and more. And it is easy: show your provincial health care card, and the doctor gets started. There is no question whether this doctor or that hospital accepts your insurance–they all accept your insurance. Plus, thanks to reciprocal agreements between provinces, my Alberta insurance is accepted in all provinces and territories of Canada.
Cons: A surprising amount is not covered by the provincial plan. As mentioned, many Canadians have some sort of supplementary plan. It would be nice if such things as dental, vision, and prescriptions were covered by the main provincial plan, but right now, they aren’t.
Question for my fellow Albertans: When you speak of $40/$80 per month, so you mean for a supplementary plan like Blue Cross? We haven’t had separate provincial plan premiums since 2009–it’s all taken from taxes now.
Québec, Canada.
The system:
The government’s health-insurance system (RAMQ) pays for all non-cosmetic medical care, including surgery and hospital stays, and (I think) all drugs during the hospital stay. Generalist doctors (in individual offices and walk-in clinics) are also covered by the RAMQ for non-cosmetic care. It is possible to pay extra for a solo room in the hospital, if available; this may be covered by a private insurance.
Some longer-term care related to vehicle accidents is paid for by the SAAQ, another government department. Similarly, some longer-term care related to work injuries is paid for by the CSST.
Drugs are covered by private group insurance, usually offered by the employer or a professional order. Those who don’t have access to group insurance pay a mandatory special tax (about 800$ a year – 0$ for welfare recipients, I think) and the government then covers drugs up to a certain maximum, with some co-pay.
Dental care is NOT covered by the government (except for welfare recipients) and must be paid by group insurance or out-of-pocket. Similarly with some health-related services such as ambulance transport, psychologists, optometrists, massage therapists, chiropractors. Every group insurance offers different coverage.
Some generalists and specialists choose to work completely outside the system in private clinics, where the customer has to pay directly (and may be covered by group or private insurance). This is often a choice when the public system is too full : last year, I needed to see a dermatologist for a skin tumour and the public system had a 18-month waiting list; I went to a private clinic and got an appointment a month later, for a total outlay of 350$, which my group insurance paid for. The private doctor then referred me to a public hospital where my surgery was paid by the RAMQ.
Also, there are private labs that offer blood tests, radiology, etc. Some are paid by the RAMQ, others are not.
The dollars:
The RAMQ is paid by the government’s consolidated fund and is not billed separately to taxpayers, so it’s hard to put a price tag on it. The entire annual health and human services budget of Québec is about 30000 million dollars, representing about 43% of the provincial budget. The health bill is paid collectively by about 4-5 million taxpayers and by direct payroll taxes. I’m upper-middle class; about 29% of my gross income goes to income taxes: 13% in federal taxes and 16% in provincial taxes. There’s also a 14% combined sales tax on goods and services. I’m not sure how much of my federal taxes eventually pays for health care; if I consider only the provincial taxes, I pay at least 7% of my gross income for health care.
SAAQ (vehicle injuries) has a supposedly separate fund paid by vehicle license fees and (I think) driver’s license fees. A few hundred bucks a year.
CSST (work injuries) has a separate fund covered entirely by payroll fees. I’m not sure how much it costs; the rates vary from employer to employer, as a function of the risk (tree shredding companies pay more than accounting firms).
The group insurance provided by my employer is pretty generous for a private sector employer. It costs my employer the equivalent of about 4000$ a year, covering about 80% of dental care costs, 80% of drugs with a 50$ annual co-pay, some other services as outlined above (up to 500$ a year) for me and my spouse.
IVF costs from this clinic in Melbourne show the dearer ICSI costing nearly $8,500 upfront, but Medicare will rebate $5,100 on the first cycle, more on subsequent cycles. The difference between the value of the US and Australian dollars is negligible at the moment ($US1 = $AU 0.97). It’s been seven years so I don’t remember how long it took exactly, but if I recall correctly we decided to do IVF in May, we saw a fertility specialist in June and we did pre-IVF counselling in July. I was supposed to start my first cycle in August/September but we dropped out at that point. It didn’t seem like a significant delay. We probably could have sped things up if we’d gone to a clinic in the city where the specialists were based instead of waiting for the specialists to make their regular visits to our area, but that’s speculation (for all I know the city clinics had longer waiting lists).
I moved to Japan and got a job with national insurance. I had had a serious tooth problem and couldn’t chew on one side of my mouth for about 9 months. So, I got my health insurance card, went to a dental clinic near the office, and had the initial checkup. IIRC they took an xray and then scheduled a follow up appointment. I went to pay at reception in my beginner Japanese asked how much it was?
The nice young lady said something that made zero sense.
I asked again.
She answered again. Still didn’t make any sense.
Whipped out a calculator and didn’t make sense because the cost was something like 65 yen or well under one US dollar. It turns out that I did actually understand what she said (65 yen) but that made no sense for how could a dental visit in a country as expensive as Japan cost less than a buck?
I forget what the entire root canal process cost. It was well under USD100 with Japanese UHC.
Australian with Medicare and private healthcare, an American expat who moved over the age of 30 so has vast experince with US healthcare to compare.
We have a hybrid system that encourages people who can afford it to get government subsidised private healthcare by means of tax penalties if you don’t have it, plus making it cheaper for life if you get it before age 30. For a family of 3 on a Cadillac plan to cover my kid’s orthodontia in minute detail, that’s about $250 per month - this is going up as the part of this the government pays is becoming means tested, and I am ok with this. Private healthcare works with the public system, it’s not a separate system. I can chose to pay a deductible and use private hospitals.
Pros:
Just…going to the doctor, if that makes sense. If we’re sick/hurt/injured, we go, with no cost/benefit analysis
State healthcare has been fantastic - although I do have private health insurance the time I was sickest I went to a public hospital ER and I got fantastic treatment - my life was saved - and not once was I asked about insurance
Standardisation - mediciations that are covered have a standard payment for them - instead of it being set by a private entity, the government sets the price and deductible for prescriptions.
Affordible medication - as an asthmatic, I never have to worry about being able to afford my asthma medicine. If I were poor, I could get a concession card to get it cheaper than the regular price, which is really very cheap.
Not being tied to my job - I can just quit! My health care never goes away!
Cost - my kid broke his arm, went to the ER in an ambulance (he was out by himself, poor thing), was treated, sent to the bone clinic the next day, had surgery on the arm the following day, had follow up appointments. Total cost to me? Nothing. (Yes, taxes, but no further out of pocket.) I was in the high dependency unit for three days, in hospital for two weeks, with home care to follow up, and total cost to me was $90 ONLY because I asked to see a senior doctor and not the resident on duty.
Cons:
Some things are considered elective surgery (and therefore waitlisted) that are just weird. I don’t mean like cosmetic surgery (which isn’t covered, of course, no face lifts on the public dime), I mean procedures that aren’t life threatening but are still medical. Example: my husband had gall bladder trouble. He was having excrutiating pain in episodes nearly daily. They determined the gall bladder was not infected, which made it ‘elective’ and there would have been a two month wait. Fortunately we had private health insurance and decided to pay the $400 deductible to jump the queue and have it done privately. But still, ugh!
No dental - that’s covered under private health care. If you can’t afford it, there are limited public options that are woeful.
That’s really it. Having been in both systems, I can honestly say that single payer public healthcare one of the major reasons we decided to have my husband turn down a job that would have take us to the US.
Hmm…unless you have a doctor that bulk bills (rare these days) then you don’t really pay anything except for prescritions. But yes, otherwise this is my experience as well (although not the babies - mine flew here!)
A Canadian friend of mine had her sex change paid for by UHC. And the results were fan-fucking-tastic. I don’t know what out of pocket expenses she paid, if any, but the vast majority of the procedure was covered. She’s a single working stiff and managed it without any hardship whatsoever.
An old friend of mine had the same experience–her gender reassignment surgery was paid for by the provincial plan. I don’t recall that she said that she had to pay anything out of pocket for it.
I’ve lived in quasi UHC… pretty close but not quite full UHC. (Basically if you are wealthy but unemployed then you could be without insurance and on the hook to pay out of pocket.)
My insurance is part of a government plan that covers civil servants, veterans, retired mariners, and some disabled. As a civil servant my level of coverage is higher than others covered under the same plan. A bit weird. Persons employed in the private sector typically have private insurance with greter choice of providers.
The insurance is great. The health care provider… anything from great to meh.
Regular doctor visits are covered 100% at government clinics. There are private clinics for those who have private insurance or don’t mind paying out of pocket. Can generally get in to the government clinic within a day or two but might have to go to one further from home. I live in a rural area dnt he local clinic has a doctor only two days a week, for a half day each time.
I have had two times with a several months long wait to see a specialist. 4 months to see a urologist. 6 months of jaw pain and parenthesia in my face and I am still waiting to see an oral surgeon.
I was hospitalized 4 days for a GI bleed. $0 out of pocket expense.
A couple times I have had to pay out of pocket for a prescription which is not on the approved list. Less than $100. Otherwise I just show my card and walk away with the meds with $0 out of pocket. Occasionally the doctor has prescribed non-prescription meds (multi-vitamins, paracetamol) which the pharmacy provides at $0 out of pocket.
Took 8 months to get my first dental appointment scheduled. Teh goernment clinic was particularly understaffed at the time. Since then a cleaning eveny 6 months and dentist evaluation with every second cleaning. $0 out of pocket. Dentures or orthodontics would be covered 50%.
Vision care only covers the exam up to $100 and lenses for glasses every two years, not frames. Contact lenses are covered.
Very advanced care generally must be done overseas. In addition to the medical expenses at the overseas facility the insurance covers air ambulance if needed or commercial airline ticket and hotel for those who have pre-approval.
I have seen outright abuses of the system. People walking out of the waiting room at A&E and calling an ambulance to try to hop the line. Since ambulacne is 100% covered it doesn’t cost them to try.
France : the UHC isn’t run directly by the state but by an organization whose board is made up of representants of employers and unions, for historical reasons. However, changes have to be passed into a law by the state (otherwise, obviously, they couldn’t be mandatory).
For employed people (and unemployed still receiving unemployment benefits) and retired people, it’s deducted from the paycheck or retirement benefit. Self-employed people pay it directly, for indigents, it’s paid for by the government, and for individually wealthy individuals it used to be a voluntary subscription.
In the general case of employed people, it’s a percentage of the salary, capped at some level. Apparently (not something I usually pay much attention to) it’s 9.7% of the salary.
Besides the UHC, many people also have a complementary insurance (more about that later).
The overwhelming majority of large hospitals are public. Private hospitals are typically either little clinics where you’re more pampered but won’t go for something very serious or at the contrary specialized in in a specific activity (say, eye surgery). In public hospital, you pay €15-20 (can’t remember exactly) per day + about the same amount for every medical act (be it a cast or an heart transplant). Most of it is then reimbursed to you by the UHC. So, the out of pocket cost is probably some Euros/day. Private hospitals are free to fix their prices as they see fit.
Doctors not working in hospitals are in their overwhelming majority private practitioners. The UHC fix the cost of a visit (currently €23 for a generalist, maybe €35 or so for a specialist, more for home calls that are still quite common here) and of all specific acts a doctors might have to do. Most of it is reimbursed by the UHC (For a generalist, for instance, €22 if you’re registered with a specific doctor as your primary care provider, €17 if you’ve decided not to). Typically you pay upfront, hand your doctor your UHC card, he fills an online form and the reimbursment is automatically wired to your account.
Doctors aren’t obligated to apply those fixed costs, even though they have some fiscal incentives to do so. Regardless of what was actually charged, the UHC always reimburses the same amount. Most generalists apply the UHC prices. Most specialist overcharge (for instance, I paid yesterday €50 to see a random dermatologist. My mother paid last month something like €120-150 to see a reputed specialist). Finally, dentists charge way, way more than the UHC prices, which are ludicrously low for them.
For prescribed drugs, there are various rates of reimbursment, from 0% to 100% depending on the importance and efficiency of the drug. Typically, you hand over your UHC card to the pharmacist, and pay only whatever isn’t reimbursed if anything. The UHC pays directly the pharmacist for the rest.
People with serious chronic conditions (cancer, AIDS,…) don’t pay anything upfront and are fully covered for all medical expenses.
I would also note that there isn’t to my knowledge any “waiting list” for surgeries or such procedures as it seems to be the case in Canada, for instance.
Finally, about complementary insurances : the majority of people (I think, but it’s probably not the case for the poorest citizens) have one, generally a mutual insurance. A mutual insurance being a non profit organization whose board is elected by the insured. They originated in mutual assistance societies created maybe one century ago by say, steel industry workers, or Paris small business owners, etc…Nowadays, most take in anybody although some are still tied to a specific company or public service (teachers, for instance).
They cover whatever isn’t covered by the UHC, in particular doctors’ overcharges I mentioned above (and they’re invaluable for dental care, glasses, hearing aids… very poorly covered by the UHC), things like an individual bedroom in an hospital and often other somewhat related risks (for instance in case of disability preventing me from working, mine would pay me an income complement. I used to have one that covered burial expenses). The specific conditions, coverage limit, prices, vary a lot. I don’t even remember how much mine costs, but I believe it’s in the € 50 /month range.
You asked about complaints, but frankly I don’t have any. There will always be people grumbling about something or another, but honestly I think we should be very happy of what we have. The main issue, however, is the future funding of this system with a population getting older, and suffering from costly ailments (in particular, the issue of people who can’t take care of themselves anymore, due to major age-related mental of physical disabilities is talked about a lot). I’m 47 but I’m not sure the system will still be anywhere as good when I’ll be (hopefully) 87.
You didn’t mention the country.