# Why is healthcare cheaper in nations with UHC? **URL:** \ **Category:** Great Debates\ **Created:** [October 25, 2012, 4:46pm UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840 "2012-10-25T16:46:39Z")\ **Posts on this page:** 20\ **Page:** 4
**Author:** ![Lobohan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lobohan/32/79_2.png) [@Lobohan](https://boards.straightdope.com/u/Lobohan)\ **Post date:** [October 29, 2012, 10:34pm UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/61 "2012-10-29T22:34:38Z")
> [@amarone](#): > > No - he will get it done privately. He may well have private insurance (many professional people do, not just superstars), or may just pay for the treatment out of (his club’s) pocket. I expect that someone who needs treatment for work would be put ahead of someone who needs treatment but has a sedentary job. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [October 29, 2012, 10:49pm UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/62 "2012-10-29T22:49:11Z")
> [@Sam\_Stone](#): > > In Canada, our emergency rooms are so over-crowded that people have been known to die after sitting for hours waiting to be seen. In my city a couple of years ago, there was a scandal because a boy with a broken arm waited all night in an emergency ward, then was sent away without treatment because they couldn’t find a slot for him. He went to another hospital and waited another long period of time. By the time he was seen, his arm had knit together and had to be re-broken to be set properly. Also happens in the USA. > [@](#): > > Will Americans accept a half-year wait for heart surgery? Will they accept a multi-year wait for joint replacements? As the population ages, these surgeries will become more in demand, and therefore the lists will grow longer. The poor will. I think what you’re saying is that you want the ability to use your money to jump the line or buy better care. But you don’t live in the USA, where a third of health insurance is for-profit and we spend great numbers of man-hours just arguing over who and what is insured. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [October 29, 2012, 10:51pm UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/63 "2012-10-29T22:51:40Z")
> [@Sam\_Stone](#): > > Private orthopedic surgery is allowed in the UK? In Canada it isn’t. So normal people who want it done quickly go to the States. Somehow, sports stars get instant access. The UK uses public hospitals, and permits private practice and private insurance. Canada uses single-payer insurance, and outlaws private insurance. The UK is both more socialized and more libertarian. ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [October 29, 2012, 11:27pm UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/64 "2012-10-29T23:27:05Z")
Of course health care is rationed in places with UHC. It’s rationed _everywhere_. And yes, that includes the US. > [@](#): > > Quoth **Bill Door** : > > Direct costs are tiny, but indirect costs can be huge. How many MRI’s are performed for a simple headache because the physician is afraid of having to sit in the witness box and explain it was really unlikely that it was a tumor and it was a one in a million chance that it turned out to be one? Juries end up punishing bad outcomes rather than bad medicine. Wait, if it’s only a one in a million chance, why is the doctor even worried about ending up in the witness box? Surely, if the chance is large enough that the doctor ought to be worried about it, the patient (whose life is on the line, after all) is even more justified in worrying about it? > [@](#): > > Quoth **drew870mitchell** : > > **Unhealthy transit** - Europeans walk and bicycle more than twice as much as Americans. Well, you know what they say: Sick transit is the glory of the world. (Oh, come on, how often do you get a chance to use a line like that?) ---
**Author:** ![njtt](https://avatars.discourse-cdn.com/v4/letter/n/ecd19e/32.png) [@njtt](https://boards.straightdope.com/u/njtt)\ **Post date:** [October 29, 2012, 11:48pm UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/65 "2012-10-29T23:48:29Z")
> [@Sam\_Stone](#): > > The last few posts are dancing around one of the major reasons health care costs are lower in countries with UHC, but no one wants to come right out and say it. So I will: > > Health care costs are lower in some of these countries because health care is _rationed_. So it is in America, by the insurance companies, and for the express purpose of limiting their costs. The problem is that the system is so chaotic that despite all the rationing, sometimes stricter than in UHC countries, the costs still get out of control. When I was in the US my doctor wanted to prescribe me Lunesta for sleep problems, but it was not covered by my insurance company. I got zolpidem (generic Ambien) instead, but the doctor thought it was not so good. Now I am in the UK and I get generic Lunesta (zopiclone, not available in the US because of how it would cut into big pharma’s profits) for free. All healthcare systems except cash on the nail, but certainly including the US insurance system, ration healthcare. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [October 30, 2012, 5:42am UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/66 "2012-10-30T05:42:25Z")
Again it seems that “the USA” in Sam Stone’s mind is “post-scarcity Libertopia.” I come from the middle of the USA, where the free market is supposed to fix everything. The people in my hometown are poor and slipping further behind, but at least they can choose whether to listen to the GOP and blame themselves like good little Objectivists or to listen to the preachers and say it’s a fallen world and blame Eve or the Devil or something. Either way, it’s not Paradise. Post-scarcity _anything_ is adolescent bad sci-fi; it’s not possible. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [October 30, 2012, 6:28am UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/67 "2012-10-30T06:28:44Z")
> [@Mdcastleman](#): > > The US is a lot more generous with certain types of care too. My friends from the UK keep whining about how there’s a 6 month waiting list for psychotherapy and then they get sent to the curb after a year. When I decided I wanted therapy in the US I had an appointment the next week and have been seeing therapists for several years. The Spanish protocols for public-system psychotherapy are similar to those of the UK. The Spanish protocols for private psychotherapy are similar to those of the US. Are you familiar with UK protocols for private psychotherapy? My bet is, they slide you in ASAP and keep you in for as long as you’re willing to pay - same as in the US and Spain’s private systems. Allow me to reframe the key word: pay ---
**Author:** ![Sam\_Stone](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)\ **Post date:** [October 30, 2012, 7:18am UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/68 "2012-10-30T07:18:10Z")
Of course health care is a scarce resource. No one is arguing otherwise. The question is, what is the most efficient way to provide health care services to the public? One side argues that the free market is, overall, the best way to ensure that health care resources are utilized optimally. The other side believes that the industry must be ‘managed’ by a bureaucracy and the resources doled out by technocrats, who can be trusted to be fairer than the market in determining who should have access. That’s the debate. No one is promising a utopia. ---
**Author:** ![Lynn\_Bodoni](https://avatars.discourse-cdn.com/v4/letter/l/e47c2d/32.png) [@Lynn\_Bodoni](https://boards.straightdope.com/u/Lynn_Bodoni)\ **Post date:** [October 30, 2012, 7:47am UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/69 "2012-10-30T07:47:45Z")
> [@njtt](#): > > So it is in America, by the insurance companies, and for the express purpose of limiting their costs. The problem is that the system is so chaotic that despite all the rationing, sometimes stricter than in UHC countries, the costs still get out of control. > > When I was in the US my doctor wanted to prescribe me Lunesta for sleep problems, but it was not covered by my insurance company. I got zolpidem (generic Ambien) instead, but the doctor thought it was not so good. Now I am in the UK and I get generic Lunesta (zopiclone, not available in the US because of how it would cut into big pharma’s profits) for free. > > All healthcare systems except cash on the nail, but certainly including the US insurance system, ration healthcare. I needed some procedures done to check out a heart problem. I had to get them pre-approved by my insurance. The doctor submitted the paperwork. Several times. I kept calling the insurance company. Nope, they’ve never even seen this paperwork. Two years after the doctor asked for pre-approval, the insurance company approved it. Of course, I’d already switched insurance, and the second company approved it. But the doctor dropped this company, too, as she said that she’d gotten the run-around from them too many times. Were they actively putting requests into the round file as a way of keeping costs down? Or were they merely incompetent? Apparently it wasn’t just requests from my doctor that they were dropping the ball on, as she said that she’d heard about them from other doctors, too. ---
**Author:** ![Gukumatz](https://avatars.discourse-cdn.com/v4/letter/g/74df32/32.png) [@Gukumatz](https://boards.straightdope.com/u/Gukumatz)\ **Post date:** [October 30, 2012, 7:52am UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/70 "2012-10-30T07:52:53Z")
> [@Sam\_Stone](#): > > Of course health care is a scarce resource. No one is arguing otherwise. The question is, what is the most efficient way to provide health care services to the public? One side argues that the free market is, overall, the best way to ensure that health care resources are utilized optimally. The other side believes that the industry must be ‘managed’ by a bureaucracy and the resources doled out by technocrats, who can be trusted to be fairer than the market in determining who should have access. > > That’s the debate. No one is promising a utopia. So you can choose to have faith in the profit motive or well understood triage principles. Seems like an easy choice. ---
**Author:** ![Novelty\_Bobble](https://avatars.discourse-cdn.com/v4/letter/n/a3d4f5/32.png) [@Novelty\_Bobble](https://boards.straightdope.com/u/Novelty_Bobble)\ **Post date:** [October 30, 2012, 7:57am UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/71 "2012-10-30T07:57:58Z")
> [@Sam\_Stone](#): > > Yeah, you’d think that’s how it would work. But it really doesn’t. It really, really does.trust me. > [@](#): > > Tell me - if a sports star blows out a knee, do you really think he’s going to go on an NHS waiting list behind grandma? Here in Canada, granny can be on a waiting list for a knee for five years, but if an NHL player needs reconstructive knee surgery, he’ll be in the hospital within a few days getting the work done. In the UK he would wait his turn unless he wanted to pay and go private. Medical need trumps all. > [@](#): > > And when doctors are put in charge of deciding the order of people on a waiting list, do you honestly think they are going to put a construction worker ahead of a major politician? Or a homeless man on the street ahead of a captain of industry? The fastest way to political suicide would be to jump an NHS waiting list. > [@](#): > > I’ve seen first hand how Doctor’s discretion works. If you go into a doctor’s office looking like a biker with a long beard and leathers, you’re going to get a completely different assignment to a waiting list than you will if you go in wearing a business suit. It’s just human nature. The doctor knows both of you can’t be treated in a timely fashion, so he’s going to make a judgment call. Low-lifes and people living on the edge of society won’t fare well in that judgment call. asserted without evidence. The UK judgment is based on medical need. I’ve seen or heard nothing to suggest otherwise. You seem to hold a very binary expectation of the health care services. Either US or Canadian style. The reality is that myriad intermediate systems exist that ensure good care for those without money and permit the rich to use their wealth to go private. I suggest you read up more on other methods of UHC delivery and compare those to the US. ---
**Author:** ![njtt](https://avatars.discourse-cdn.com/v4/letter/n/ecd19e/32.png) [@njtt](https://boards.straightdope.com/u/njtt)\ **Post date:** [October 30, 2012, 9:05am UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/72 "2012-10-30T09:05:40Z")
> [@Sam\_Stone](#): > > Of course health care is a scarce resource. No one is arguing otherwise. The question is, what is the most efficient way to provide health care services to the public? One side argues that the free market is, overall, the best way to ensure that health care resources are utilized optimally. The other side believes that the industry must be ‘managed’ by a bureaucracy and the resources doled out by technocrats, who can be trusted to be fairer than the market in determining who should have access. > > That’s the debate. No one is promising a utopia. And the facts are very clear. Every country that has UHC has a much, much less wasteful system than the USA, spending a fraction of the money for results, in terms of health outcomes for the population as a whole, that are better. So yes, the evidence clearly shows that healthcare is more efficient, and much fairer, if managed by a bureaucracy than if left to “the market”. Of course, the US system is not a real free market, and might perhaps be more efficient _economically_ if it were, but then there is a good reason why it is not a free market. Even Americans are not that dumb or that callous, and know that economic efficiency does not trump all other values. A real free market in healthcare, as did exist in the bad old days, leads to horrible, horrible results, with huge numbers of people dying and suffering unnecessarily. ---
**Author:** ![amanset](https://avatars.discourse-cdn.com/v4/letter/a/8dc957/32.png) [@amanset](https://boards.straightdope.com/u/amanset)\ **Post date:** [October 30, 2012, 10:17am UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/73 "2012-10-30T10:17:53Z")
> [@Sam\_Stone](#): > > Private orthopedic surgery is allowed in the UK? In Canada it isn’t. So normal people who want it done quickly go to the States. Somehow, sports stars get instant access. Disclaimer: I am not an expert on Canadian healthcare. But, these people: > **[asc-vancouver.ca](http://www.asc-vancouver.ca/payment.html)** > > This domain may be for sale! say this: > [@](#): > > Orthopaedic, Reconstructive Plastic Surgery, General, Gynecology, Urology and Neurosurgery > > ASCV is committed to the principles of the Canada Health Act and Medicare Protection Act, and requires that surgical services are paid by third party payers, not patients. This may include an employer, a disability insurer, or another third party (WCB, RCMP, ICBC). Now if an Employer can pay for surgery on a private basis, surely these “sports stars” are getting their surgery paid for by their employer, ie. the team/franchise. This is an effect of how Canada limits payment (to employers and other third parties) rather than preferential treatment. ---
**Author:** ![elbows](https://avatars.discourse-cdn.com/v4/letter/e/b3f665/32.png) [@elbows](https://boards.straightdope.com/u/elbows)\ **Post date:** [October 30, 2012, 11:44am UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/74 "2012-10-30T11:44:15Z")
> [@](#): > > One side argues that the free market is, overall, the best way to ensure that health care resources are utilized optimally. The other side believes that the industry must be ‘managed’ by a bureaucracy and the resources doled out by technocrats, who can be trusted to be fairer than the market in determining who should have access. Such a disingenuous argument, implying that the ‘free market’ version is something other than ‘bureaucrats’ and ‘technocrats’ denying you access, or isn’t being ‘managed’. One system means: bean counting insurance hacks determine your access, the other: the doctor directing your care does. Who do you believe _really_ has your interests at heart? ---
**Author:** ![Zeriel](https://avatars.discourse-cdn.com/v4/letter/z/58956e/32.png) [@Zeriel](https://boards.straightdope.com/u/Zeriel)\ **Post date:** [October 30, 2012, 4:13pm UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/75 "2012-10-30T16:13:59Z")
I expect \*\*Sam’s \*\*experience may vary on a per-province level, or someone’s playing silly buggers. I had a co-worker at my last job (which had, from my perspective, excellent health insurance coverage) who was a recent immigrant from Canada, and we got to talking about it since this was 2008 and it was an election issue. His commentary was that the only thing he DIDN’T like about moving to the US was…our health care. According to him, he paid more out of pocket and got worse care, and he perceived the wait times for everything from emergency care to scheduling routine doctor’s checkups to be significantly longer here than there. ---
**Author:** ![drew870mitchell](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/drew870mitchell/32/3946_2.png) [@drew870mitchell](https://boards.straightdope.com/u/drew870mitchell)\ **Post date:** [October 30, 2012, 4:14pm UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/76 "2012-10-30T16:14:27Z")
> [@Sam\_Stone](#): > > Of course health care is a scarce resource. No one is arguing otherwise. The question is, what is the most efficient way to provide health care services to the public? One side argues that the free market is, overall, the best way to ensure that health care resources are utilized optimally. The other side believes that the industry must be ‘managed’ by a bureaucracy and the resources doled out by technocrats, who can be trusted to be fairer than the market in determining who should have access. I think you have your terms mixed up. There is no shortage of bureaucracy and technocrats and “managing” in the US system. For every hour of care I’ve actually gotten from a doctor I’ve probably spent another two just _dealing_ with insurance paperwork, phone calls to figure out benefits or where to go, and billing disputes. It’s like the US has managed to cobble together a system that is the worst of both worlds: expensive and difficult. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [October 30, 2012, 4:25pm UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/77 "2012-10-30T16:25:17Z")
> [@Chronos](#): > > Well, you know what they say: Sick transit is the glory of the world. > (Oh, come on, how often do you get a chance to use a line like that?) You almost have it. Actually, sick transit is the glory of the first day of the work week, probably because you can stay home if it is sick enough. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [October 30, 2012, 4:29pm UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/78 "2012-10-30T16:29:00Z")
> [@Sam\_Stone](#): > > Of course health care is a scarce resource. No one is arguing otherwise. The question is, what is the most efficient way to provide health care services to the public? One side argues that the free market is, overall, the best way to ensure that health care resources are utilized optimally. The other side believes that the industry must be ‘managed’ by a bureaucracy and the resources doled out by technocrats, who can be trusted to be fairer than the market in determining who should have access. > > That’s the debate. No one is promising a utopia. No Sam, the question is how we should allocate scarce resources. In UHC systems, it is done on the basis of need. In the US it is done more or less on the basis of ability to pay, with lots of paperwork to determine who is poor enough to get service from the government and who isn’t. I have no idea what the optimal choice is, but I suspect the wait times for Canadian and European UHC systems would be a lot lower if they paid anywhere close to the percentage of GNP that the US does for it. ---
**Author:** ![amarone](https://avatars.discourse-cdn.com/v4/letter/a/e0b2c6/32.png) [@amarone](https://boards.straightdope.com/u/amarone)\ **Post date:** [October 30, 2012, 4:30pm UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/79 "2012-10-30T16:30:07Z")
> [@Lynn\_Bodoni](#): > > I needed some procedures done to check out a heart problem. I had to get them pre-approved by my insurance. The doctor submitted the paperwork. Several times. I kept calling the insurance company. Nope, they’ve never even seen this paperwork. > > Two years after the doctor asked for pre-approval, the insurance company approved it. Of course, I’d already switched insurance, and the second company approved it. But the doctor dropped this company, too, as she said that she’d gotten the run-around from them too many times. > > Were they actively putting requests into the round file as a way of keeping costs down? Or were they merely incompetent? Apparently it wasn’t just requests from my doctor that they were dropping the ball on, as she said that she’d heard about them from other doctors, too. I will not be shy about naming names; your experience is very similar to mine with United Healthcare (were they taking the piss when they chose to abbreviate their name to UHC?). My wife (before we were married) had similar issues with them. By talking to colleagues we discovered that they routinely rejected the first claim each year on the grounds that the customer “might have other insurance”. When I first came to the US I had some claims for treatment that went unresolved for 2 years, largely because I ignored them (hey, I wasn’t used to having to pay for healthcare and assumed that because I had insurance, I still would not). The biggest issue was that the insurance company (Aetna, this time) rejected the treatments as not having been approved by the primary care physician. When I pointed out that the treatment was by the primary care physician, they finally relented. In a similar thread some time ago I asked people who had lived under both the US system and in a UHC country which they preferred. Only one preferred the US - someone from Mexico. ---
**Author:** ![Sitnam](https://avatars.discourse-cdn.com/v4/letter/s/6a8cbe/32.png) [@Sitnam](https://boards.straightdope.com/u/Sitnam)\ **Post date:** [October 30, 2012, 4:54pm UTC](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840/80 "2012-10-30T16:54:14Z")
> [@sweeteviljesus](#): > > Assuming that this is an established fact (I think it is), why is this the case? If it isn’t the result of an employer plan Healthcare providers get to screen it’s customers so larger profits come from a better selected pool, not more efficient service. If it is an employer plan than healthcare is a perk whose pay structure mostly doesn’t affect the customer directly. The thinking is: I pay every month into the plan my employer provides so I should get the best care they have available. The actual cost of everything (band aids, catheters etc) is irrelevant, and unknown, because it doesn’t directly affect me. Even if it did I have a preexisting condition and/or employer provided insurance so I can’t change my provider. [Previous page](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840.md?page=3) [Next page](https://boards.straightdope.com/t/why-is-healthcare-cheaper-in-nations-with-uhc/638840.md?page=5)