And that is another thing to address. By lower the costs of schooling, we could get more doctors, and they have less debt/investment for their education, so they could charge less.
Add to that the amount of time that doctors spend dealing with insurance paperwork, which takes away from time to see patients, and that means they have to charge even more per patient in order to get what they feel they need to make to be an equitable return on their investment.
To be successful, an MD in the US has to be a part of a larger practice.
Such organizations have a back office which does the incredibly complex insurance paperwork.
A Medical Office Manager is worth, almost literally, for her (almost always “her”) weight in gold.
The days when a doctor could “hang out his shingle” and run a one-man operation disappeared about the time Baby Boomers came into adulthood and employer-financed health insurance started finding ways to NOT pay for the new burden. Bizarre adjudication rules were one part of the scheme. This was when entire books were printed with names of covered illness/injury, and you had better use the right name for THIS insurer.
I suspect that the medical back office workers are among those most opposed to National Health Insurance - their reason for being would disappear.
The rule in the US: Never get both sick and poor.
Until age 43, I never had health insurance, but did have above-average income.
I had a cancer scare and bought insurance. Two months later, I ended up in an ER followed by ICU (wherein I was asked the "Is there anyone you wish to have present?*).
I was there for about 15 hours.
I saw the bill: $54K
The insurance company hated me, I’m sure. They told me I had a lifetime max of $6 Mil.
When that insurance went from $500/mo to $700/mo and I was disabled by Osteoarthritis and on SSDI, I finally accepted Medicare.
My old PCP is happy I moved away - that practice is one of many which will not take Medicare.
But, by medical ethics, he WAS my doctor and would be required to continue treating me.
One of my friends from the UK is on a trip to the USA. She’s not a rich person; she’s doing this because she needs to rub shoulders with more influential people in her industry, and because much of it is paid for. In fact, she really doesn’t have much cash to spare.
And today she was bitten by a dog. She’s bleeding, the wound is showing signs of infection, and she’s not going to go to a doctor, because she knows full well she cannot afford to. In Britain it would be no problem - she’s already getting treatment for fibromyalgia, she’s got healthcare, because the Brits recognize that there’s no fucking reason why, in a modern society, you can’t care for your people. Here? If this gets infected, she’s going to be one of those people you see on GoFundMe begging for funds to pay for a major doctor’s bill she cannot possibly afford.
I agree with you, of course, but I think a clarification is necessary. The policies of all civilized countries – and the aspect in which they differ so markedly from the US – is that they provide universal health care for their own citizens, not for visitors. An American in Britain or in Canada wouldn’t be covered, either, and would be expected to have some form of supplemental travel insurance or be covered by their own plans.
Canadians visiting the US will generally have limited coverage under their home province’s plans for unexpected medical emergencies, but generally in amounts much less than what a typical US hospital ER would charge. From what I can find, the British NHS will provide such coverage only for countries with which it has reciprocal agreements, of which the US is unfortunately NOT one, according to what I could Google.
IANAD but if it looks like the infection is spreading – hopefully it isn’t but it’s vital to keep an eye on it – this is not something to fool with. If this is the case I would urge that she go to an ER at the first opportunity. I had that happen to me once and when the infection increased the next day the doctor sent me straight to the ER where I got a strong antibiotic administered by IV, and IIRC I had to come back next day for a second round of IV treatment before I was deemed safe. This can be serious business leading to a systemic infection.
The student debt in the UK is a very different beast.
It is actually more of a graduate tax in that you aren’t liable to pay it back until you are earning above a certain level and the amount of repayments are very small until you are earning a substantial amount. Nor is it counted as “debt” when applying for mortgages etc
as an example, you will only be asked to repay 9% of your salary above £20k. Below that you pay nothing and the debt is written off after 30 years.
If you were earning 60k then your monthly repayment (regardless of debt size) would be £300 a month.
Of course student doctors can rack-up a scary-sounding amount of debt but the repayments are never going to be ruinous.
Well, it’s not all beer and skittles. I’m lucky enough not to have needed a doctor more than about 6 times since I left school, and twice that was for a broken ankle, so have little direct experience; but apparently as one ages they get… somewhat intrusive. They offer a free bowel cancer check every two years after hitting 60, by post, and the directions shown by my neighbour were some of the most humiliating instructions I have ever read. Involving sticks touching excreta. Considering our 19th century ancestresses around the world preferred to be physically examined through 17 layers of clothing, I can only think we have lost something of that old-world delicacy.
Dunno how much that would cost in the USA; it doesn’t seem a dream job.
And still, Germany yet beats us all: reading Wiki on Spas, I saw:
Taking a cure’ (Kur) at a spa is covered 100% by both public and private health care insurance, as mandated by federal legislation. Typically, a doctor prescribes a few weeks, no less than two weeks, but generally four to six weeks, stay at a mineral spring or other natural setting where a patient’s condition will be treated with healing spring waters and natural therapies. In addition to the treatment and accommodations even all meals and drinks as well as entertainment is paid for by the insurance. Most Germans are eligible every two to six years, depending on the severity of the condition. Germans get paid their regular salary during this time away from their job which is not taken out of their vacation days.
Not only Yanks, but Brits also would like this.
In practice this is rarely the case. A US citizen in the same situation would be treated in A&E and they are highly unlikely to be billed at all, and if they were it would be small. If you are interested you can dig into the excel sheets here and they will show, in theory, what a US citizen could be charged. I suspect our US friends will think that there are a few zeros missing but no, the costs are that low.
In any case the range of treatments free to everyone is pretty wide, from the NHS website
So certainly an infected dog bite shouldn’t attract a bill for a US citizen in the UK.
I don’t want to seem insensitive, but could she not have bought travel health insurance in Britain to cover her time in the US? Or shouldn’t her employer have bought it, as part of the expenses of the trip?
I don’t set foot in the US without having bought travel health insurance.
I was under the impression that a UK visitor’s visa for anyone from outside the EU included the condition “no work or access to public funds” stamped right in the passport, which I took to include health services, and indeed the NHS exclusion appears to be the case (please correct me if I’m totally wrong on this):
People who live outside the EEA [European Economic Area], including former UK residents, should now make sure they are covered by personal health insurance, unless an exemption applies to them. Anyone who does not have insurance will be charged at 150% of the NHS national tariff for any care they receive.
Also, this is the list of the countries with which the UK has reciprocal health agreements. It does not include the US (nor Canada) but includes Australia and New Zealand.
A corollary to the OPs original rant:
“I can’t afford these insane rates!”
“Oh yeah where do you live?..oh YOU live in one of those states that refuse the Medicaid expansion!!..Fuck you for living there!! You probably voted in those bastards anyway so you deserve what you get!”
That’s true, and of course it would be sensible to make sure you were covered but for the situation described if you showed up at A&E with a dog bite they’d sort you out for free. In the event that you had to be admitted then yes you’d be charged but the costs would be in the realm of hundreds rather than thousands.
There has been a bigger push from 2016 onwards to register more foreign users of the NHS and seek to recover more funds but to be honest it is a probably still more hassle to do this than it is worth.
That holds for everybody who’s only ever lived with NHS or similar. We take it for granted, like breathing.
For Spain the cost is viewed more in terms of time than cost. If you’re the god of healing himself, you’ll take 10 years vs 4 for someone getting a normal degree; that’s 6 years of medical school followed by being one of those few people who pass the MIR exam on first try followed by 4 years in specialist training. During training you get paid the same salary as any other doctor; you simply don’t get the seniority bonuses etc. that people working for longer will already have.
Apologies, I realized it was unclear: the pay is during specialist training.