The Unbiased Truth About UHC, Single-Payer, Whatever

In My Humble Opinion
21

Australia. All of the day-to-day stuff has been covered - medicare (my doctor bulk-bills, so I walk in and don’t pay a dollar), complementary health insurance to cover elective/private procedures and things like dental, chiropractic and so on.

But for all that some odd things are classified as “elective” and there are some waiting periods, if there’s a true emergency you don’t have to wait for anything.

My ex-husband developed a duodenal ulcer in the beginning of 2008. He lost several units of blood on my kitchen floor. He was taken to hospital in an ambulance, spent a week in ICU, was given several units of whole blood. He then had ongoing health issues that required abdominal surgery, CT scans, Xrays, multiple hospital stays of anywhere from a day to a week, a remote abdominal scan (posted cost $1000), pain clinic referrals and treatment for a double pulmonary embolism. This has gone on for the last four years and so far his total out-of-pocket cost has been… about $10 a month for his medications.

The second situation involves my Stepdad. He has HepC. A couple of years ago, my mum had a car crash and his leg was broken. While he was in hospital they did some standard blood tests and found his liver function was impaired. They did further testing and found that the HepC had finally progressed enough to start damaging his liver. For about a year and a half he was under the care of the liver specialist at our local hospital. Regular appointments, blood tests, abdominal scans… $0. His disease has now progressed to the point that he needs a liver transplant. He has been put on the transplant list and his care has been taken over by the liver transplant unit at the major hospital in this city. His blood tests, appointments and scans have carried on. He occasionally needs fluid build-up from his abdominal cavity, and can’t have saline because his kidneys are shot so he requires albumen fluid replacement at $400 a unit. When the liver becomes available all the testing, the surgery and the aftercare will be done without costing him a dollar.

We worked out his symptoms were starting to show at about the time of the car crash because he’d been talking about going to the doctor about a few things a few days earlier. Because the damage was picked up at the time, treatment was able to be started promptly. When he lived in the US, he was uninsured because he’d lost his job as a long-haul driver and was working shit shifts as a taxi driver and a short-order cook in a grill. So he probably wouldn’t have gone to see the doctor regarding his lower-level symptoms. Which means he wouldn’t have sought medical attention until his liver damage had progressed to full cirrhosis. Which means at best he probably would have ended up in the ER to be told “You’re in late-stage liver failure. Sorry” and that would be that.

22

I live in the UK, and most of these apply:

I’m not entirely sure how to factor individual cost for care since it’s part of my taxes, but it’s not particularly onerous especially considering the pros above.

In general, if I need to see a GP urgently I can call first thing in the morning and get an appointment that day, or if it is less urgent I can get an appointment later in the week. There are out-of-hours helplines (if you just need advice) or clinics (if you need to see a doctor). I took my daughter to see a doctor on Easter Sunday when she developed stomach pains during the night - no charge and actually very little waiting. (Also, did I mention that medications for children and pregnant women are free?). When she was injured on a previous occasion, the nearest hospital had a dedicated children’s ER and a “play therapist” to help distract her while her head wound was treated.

There is virtually no paperwork to fill out once you’re registered with a GP the first time, and even checking into the ER for a minor injury just involves standing at the front desk to give the receptionist (or whatever s/he is) your name, address, age and doctor’s office details.

As for cons and waiting, I did once get “bumped” a month when I came in to have my deviated septum fixed and the operating rooms got filled with emergency cases that day. But annoying as it was, I wasn’t there for a lifethreatening problem. And you do have to take charge of your own health - if you don’t like the answer a doctor gives you, you occasionally have to push to get what you feel you need - a second opinion, a test, etc. But that’s often true in the US too. And bear in mind that private insurance and medical care is still available as a second tier if you want to “jump the queue” (although bear in mind that you’ll still probably get an NHS doctor and may even be in a private wing of an NHS hospital).

I’ve been through both the US system and the UK system, including surgeries in both, and while the quality of the facilities in the US is generally better the fact that you have to pay thousands for it has a lot to do with it. There are things the NHS could do better but the freedom from having to decide whether I can afford to send my daughter to a doctor when she’s in pain is worth a lot to me, and the healthcare system is one of the reasons I’m not keen to move back to the US.

23

The best way to put it, is that I don’t think of healthcare at all (Netherlands btw). For my whole life it has been ‘normal’ that you go to a hospital or GP when something is wrong and no other factors play a role in this decision. It is just something that is there and doesn’t need a second of thought. Fairly recently things have changed and become a bit more expensive (about 100 euros a month), but I just pay this (I’m too lazy to actually compare the rates of different insurance companies) automatically and whenever I have a doctors (or dentist) bill, I send it to my insurance company and the money is put on my account in a matter of days. I can’t stress enough how much healthcare doesn’t play a role in day to day life… let alone worrying about it.

I remember a thread here a few days ago, where someone talked about (hypthetically) quitting their well paying job, because healthcare would be taken care of now. This reasoning left me dumbfounded, people have jobs just because of healthcare?

24

This pretty much reflects my father’s experience, except he was around 40 and it was a compressed disc.

Also in New Zealand. He also got some sort of benefit while he recovered.

Following a brain haemorrage for my mother, and intensive care for the night I don’t think we ever got a bill for any part of the treatment or the Ambulance transfer of 80- odd km.

25

This is really the best summary for me. I don’t worry about roads, or water service, or police/fire, or health care - they all are public services that are available as needed, not tied to one’s job or level of income. Health care is simply part of the public services that we all pay for with our taxes.

My personal experience is much like the other Canadians who have posted. We have universal health care coupled with a single-payer system for each province and territory. When I or anyone in my family needs to see a doctor, we set up an appointment with our GP. It usually takes a few days to get an appointment, so that’s for routine things like regular check-ups, or things that need attention but aren’t pressing. If it’s something that we’d like to see a doctor immediately for (e.g. the Cub having a fever), we can just walk into the clinic and be seen that day by whichever doctor is seeing the walk-ins; no guarantee in that case it will be our own GP. And if it’s an emergency, we go straight to the ER at the hospital.

I recently posted a thread about the health care line, where you can call in and get immediate advice from a nurse, which can include whether or not to go to the ER. Several other Canadians posted that their provinces had the same service, and some Americans posted that they do not have that service, because of liability issues: I am a big fan of the Saskatchewan Health Line! Triage by phone spares trip to ER!

26

NHS story.

I had a killer headache and some loss of mobility on my right side, so booked in for a same-day appointment with my GP. She didn’t diagnose automatically (the headache and mobility loss were on the same side, so it was a bit weird), but booked me in for a specialist consultation a few months later after confirming that it wasn’t life-threatening. I got two brain scans (MRI and CAT, I think) and a clean bill of health.

Total cost: £0.

27

Under single-payer, in Spain:

You need a GP or NP and don’t wanna go to a private one, call your healthcare center (HCC) if you’re home, or the nearest one if not. Get an appointment, usually for the same day or the next working day (in most regions; Andalusia has a reputation for sometimes giving you day-after-tomorrow appointments, which I can attest to as it happened to me… my relatives thought it was a black legend until it did). Go. Get scrips, referrals, sent for analytics or a pat as needed.

For specialists which work out of your HCC, same; they don’t require a referral (for me this has included, depending on where I was and my age: pediatrician, dentist, traumatologist and obgyn). If you’re being sent by your GP, the GP gives you the appointment when he sends you over (generally for within the next five working days; they may even give you same-day if it’s both possible and what you prefer).

For specialists in another center, you get contacted giving you your appointment; this used to be by mail but nowadays it may be via SMS or email. Waiting times depend on triage: a thrown back gets to trauma now, someone with vague symptoms who’s getting to see every specialist in hopes that someone will figure out what the problem is will do best to ask for a date in a vacation period (there tend to be lots of open spots then); routine checks for a known issue don’t need a referral, they get an appointment set up periodically (if you think it’s taking too long, you can call and ask about it, or prod via your GP).
Direct expense for my brothers’ births: zero. For my grandmother’s gallblader surgery: zero. Expected bill for my mother’s hysterectomy next September: zero (she could have scheduled it for June but chose to have it after the summer).
Under not-so-single-payer: we now have a system where each region manages its own healthcare system and some of them are being total bitches about it. I’ve had problems with this, but note that the problem is not due to UHC/SP… it’s due to the opposite!

28

I think you have to take into account all taxes, not just those that appear on the paycheck. For example, in the UK there several other major sources of tax such as VAT and fuel duty. So the question of cost should be how much of one’s gross pay goes towards the NHS? I’d guess it’s about 8% of a typical person’s income, based on quick back-of-an-envelope calculations.

29

(UK)

Experience: Healthcare is free at the point of delivery. As a kid I had a condition that required lots of hospital stays and no-one ever asked my parents for their credit card or to see their latest tax return or whatever. When they found the exact cause of my condition and there was the possibility of an op to correct it once and for all, I had to wait a few months when perhaps I would not have had to on private healthcare – but it wasn’t critical to have the op immediately.

Cost: NHS costs aren’t clearly differentiated in our taxes (we have “national insurance” but I think that it is not strictly true that all NHS funding comes out of NI contributions).
I earn a basically middle-class salary: a few thousand dollars over the mean. My total tax paid is 25% of my salary (10% NI and 15% PAYE).

30

We live in Japan. There are two UHC systems. The most common one is for people who work in companies larger than 10 employees, and it is 4% of the wage, also matched by the company. There is a cap at about $90k salary. This covers the whole family unless the spouse is working and then he or she pays for their own coverage.

The other system is for people who work for smaller companies or independently and premiums are based on income with a maximum premium of about $6k per year.

There is a copayment of 30%, but because it’s single payer system the fees are set and much lower than the US. (When China Guy would have been here, the copayment was 10% for the primary holder and 30% for the dependents. This has changed to 30% for everyone.) There is a cap on the copayment, so catastrophic insurance isn’t necessary.

You can purchase additional insurance which pays if you are hospitalized, get cancer or have surgery, depending on the policy. When Beta-chan was born, we had to have an emergency c-section, which was covered because it was an emergency.

There are certain expenses if you are hospitalized which are not covered, (such as private or semi-private rooms) which is one reason most people have additional insurance. It’s not that expensive, though. Mine is about $60 a month.

The wait is much less for us than what my mother has in the States even with good insurance. We have gotten into specialists within a week.

The city pays for the copayment for our children for almost all of the procedures.

Some things such as therapy are not covered, though. I have no idea about sex change operations, but I suspect they are not. IVF treatments are not, but we didn’t have any issues with that.
Overall, I really like the health insurance system.

31

I’m an American who lived in Australia for a few years, had a baby there. He had respiratory issues as an infant and required several hospitalizations, testing, etc. My experiences were all positive and they line up with the other posts about the Australian system.

Because my in-laws are Australian, I’ve also witnessed how the medical system has been for them. My father-in-law had pancreatic cancer and passed away while we were living there. Toward the end of his life, they were able to have daily home visits by nurses who helped bathe him, monitor medications, etc. Toward the very end, he was placed in a very nice hospice care place. This was all covered by Medicare. My in-laws are lower middle class pensioners, living on a fixed income. There’s no way people in a similar situation here in the U.S. would be able to afford the level of care they received.

32

Which is about what my family pays for my husband’s fairly crappy employer-provided insurance (his company pays 100% of his premium, so it’s just for the rest of us). I just paid almost $200 out of pocket for a quick trip to an urgent care for a ear/sinus infection. Our insurance covered the remaining $35.

33

Yes, for separate private insurance. I guess I didn’t make that clear. To be honest, I never consider the provincial health we pay for in taxes. I mean, I don’t ever recognize it as a line item or anything when it’s tax time. I have no idea how much I pay in that reagard.

34

Canada - Ontario

I pay so little attention to the cost of healthcare that I just checked my husbands paystub because I remember long long ago having to pay a small monthly cost for OHIP (Ontario Health Insurance Plan) but I have no idea when that went away. So now it’s all tax based.

We have supplementary insurance from his employer that covers eyeglasses, prescriptons and dental.

Friday my daughter had an allergic reaction to something while at work and was rushed to the hospital by her coworkers. They monitored her for a couple of hours, gave her meds to reduce the swelling and recommended a followup with an allergist since up til this point she’d never had a reaction like that. Cost - $0

A longer term issue was the medical mystery I dealt with a few years ago. Initial incident was abdominal pain which caused me to be removed from work at midnight via ambulance. They treated the pain and sent me to my GP to discover the cause. Cost - $60 for the ambulance ride.

Over the next several months I saw a new specialist every month as we tried to figure out what was wrong before we finally resorted to scheduling exploratory surgery since tests were all coming back normal. Turns out a surgical staple from a 15 year old tubal ligation had come loose and done some damage to my bladder and uterus and the resulting scar tissue had cause them to attach. The initial incident was caused by the abrupt detatchment of the two organs from each other. So, surgery, 5 specialists over 6 months, multiple tests and many visits to my GP. Cost - $25 for the TV in my hospital room.

When we moved from east of Toronto to north west side of Toronto we had some difficulty finding a GP who was taking new patients but we were able to call the Health department and they had our old doctor fax them a confirmation that he was removing us from his patient list and then provided us with a reference to 4 doctors locally who would see us. We chose our doctor from that list.

We’ve never experienced a wait that caused discomfort or deterioration and for quick things like strep tests if your GP has a long wait there are walk in clinics all over the city who can deal with one off situations. Most hospitals now have a walk in clinic on site to ease the burden on the emergency room. They can triage and direct you to the appropriate location.

In general I’m satisfied with our health care. I think that the system could do somethings better and having lived in multiple provinces I think we should actually consider nationalizing health care and doing a better job of providing the same service level across the country. I’m sad that Alberta has seen such a lack of investment and subsequent deterioration in the last 15 years.

35

I’d seriously like to know where this number comes from. In Ontario I pay a health tax premium (thanks Dalton!) of about $75 a month on top of all my other income, sales, and property taxes.

If I were to guess, I would say that I might contribute a thousand dollars a month that directly supports the health care system in Canada. I have no idea how to calculate this but there’s no way you only pay $40 a month to support health care.

36

For a senior, let me share my experience with caring for my mother-in-law after she survived a devastating stroke that left her entirely bedridden, etc.

Firstly her drugs were covered under the provincial senior drug benefit plan. So she paid out the first $150, in any 12 month period, and everything else was covered. And she paid only a highly discounted dispensing fee. Since she was on 17 pills a day, and the medications were always being adjusted and changed, especially near the end, this is a substantial amount of savings.

Because she was entirely bedridden, and we were keeping her in our home, she was entitled to 2hrs of home care assistance, 7 days a week. You get to shift it as it suits your needs, 3 times a week/everyday, and you get to apply them to the tasks that you need help with, bathing, laundry, prepare, serve, feed, clear a meal, dust her room, it’s a very flexible program. No cost to the senior.

Whatever she needed among the services of; a nurse, blood drawn, occupational therapist, physical therapist, Dr, all came to our home at no cost.

She was also entitled to 90days respite care stay (short term stay, in a long term care facility, so caregivers can take a holiday or redo the floors, etc.), at a cost of only $39 a day! We never used our 90days in a year, but when we needed it we had it. And it was a life saver for us!

Now this level of service requires paperwork, of course. And seniors, staying in homes, present special issues, as their conditions are ever changing, usually on a downward trajectory. That means case managers coming for visits, (they need to see everybody is okay and doing well), but it’s annoying to find yourself swamped with caregiving and then being expected to jump through hoops or answer the same questions for the 10th time.

From a distance it’s clearer that these controls are required and unavoidable. And the system could certainly stand some improvements, and, of course, people rightly complain when they get caught in the more confusing spots. But for the 6 years we cared for her in our home, we were nothing but grateful for the support, always aware that without it, we wouldn’t be able to do what we did for her.

And for all it must have cost them, to provide all of that to us, over a six year period, the truth is it was by a large, large margin extremely cost effective for them. The cost of 6 yrs in a long term care facility is huge.

Oh, and I live in Ontario, Canada.

37

You know, I just checked my last pay stub and I no longer have the $40 fee on there. I guess my company pays all my private care premiums now. I know my husband for sure pays about $40/month for his Blue Cross.

38

You do know how federal taxes and transfer payments work, right?

39

Another Ontarian here.

I am in the same position as polar bear. Healthcare costs are just something I don’t think about.

If I get sick or injured, I make an appointment with my doctor. If it is an emergency, I go to the ER. If it isn’t an emergency but can’t wait, I go to the walkin (which is often staffed by my doctor).

The worst experiences I have had have been in the ER. I went there when I was having one of my miscarriages. They had given me misoprostol (the abortion pill) to speed things along and I was in the worst pain of my life. I waited an hour and a half before they gave me the blessed relief of drugs. Similarly, I had to wait an hour when I passed a kidney stone to receive the same.

The best experiences have been with my doctor (who I love, she gets my jokes) and with the walkin clinic. My husband had a fever that wouldn’t go down and cough once and we went into the walkin, got an xray got a scrip for antibiotics and were out the door in 20 minutes. Or when I sliced my finger open and they said not to use it and I burst out in tears (since I didn’t have time not to use my hand, dammit). The nurses comforted me and got me to realizing that it would be okay.

Or UHC does not cover dental and prescriptions (also some other stuff like psychologists and out-of-hospital physiotherapy) but I have a plan that covers these things 100% through my employer. It would never be enough to keep me at my job if I didn’t like it, though. I get about 3500 dollars out of that a year (that’s for my family of four).

40

I guess not. What do you mean by this?