
An American Doctor Experiences the NHS Again - petepete
https://drjengunter.wordpress.com/2016/08/20/an-american-doctor-experiences-the-nhs-again/
======
codegeek
The article is nice but a specific comment caught my attention which was "I
honestly live in fear of having an accident or getting sick here in America."

This. No matter what we claim about American healthcare, this points resonates
so well with most of us in America. It absolutely is scary to imagine being
sick even with insurance. Without insurance, forget about it. Then comes the
maze of crazy terms like co-pay, co-insurance, deductible, pre-authorization,
in-network, out-network, Specialist referral and god knows what else.

Now may I rant about the Insurance companies if I may ? Obamacare was supposed
to fix healthcare but it added to the red tape further. No real solutions.
Insurance companies still have too much power and they call the shots, not the
doctors/hospitals. Good luck fighting a denied claim unless you can shell good
amount of lawyer money.

I don't know the solution though. America still has one of the best facilities
in the world and even though the process is too bureaucratic and downright
idiotic in many cases, the care that is actually provided is still pretty
good. And I say this as someone who is aware of medical tourism and countries
such as India.

One solution could be to get rid of insurance scam (yes I call it a scam) and
then lets hospitals/doctors compete with transparent pricing in a free market.
For catastrophic events, let insurance companies exist. I hate it that to even
get an X-Ray, I need insurance and without it, they will look at you as if you
came from some strange land. And if you do end up getting a service without
insurance, good luck looking at the bill when it finally comes. You can be a
crypto expert but won't be able to figure that one out.

~~~
pascalmemories
> One solution could be to get rid of insurance scam (yes I call it a scam)
> and then lets hospitals/doctors compete with transparent pricing in a free
> market.

I don't understand the American (and it is American) obsession with having a
free market in healthcare.

Why do Americans not look at public provision, paid for via your tax system?
Canada does it, so it demonstrably does work in North America, Europe does it,
with varying degrees of efficiency, but it basically works.

No-one in Europe or Canada lives "in fear having an accident or getting sick"
because they know healthcare is provided by the state in the same way as
education, fire services and police service are all provided as a public
service, for the general good of society, via taxation.

Americans are happy to send their children to school, to be able to call the
fire department or the police (we'll set aside the clear problems of US
policing - you generally still call the police when you see a bank robbery, so
there is a degree of confidence in them still).

So why is healthcare the exception? What sort of mentality says I am to blame
for getting sick and told if I cannot afford medical treatment, I should not
have become ill?

~~~
rdtsc
Reasons are historic and idelogical. A free market is considered sort of a
religion here. In other words we don't usually evaluate and consider things
based on their own merit (what is the best way to provide healthcare, what is
the best way to fix infrastructure, like bridges, etc), but rather how will
this make free market happy. We treat it as sort of a deity and if we don't
abide by its likes we'll be severely punished.

~~~
_superposition_
The healthcare "market" is anything but free. From insurance companies,
negotiated prices, all the way down to the AMA limiting the supply of doctors
and all the other things they do to keep prices high. It seems the only thing
free about it is the freedom to get screwed over. So in those terms, I'm not
sure what sort of diety it is that we're worshipping.

~~~
maxxxxx
If you want a market make it transparent not "free". Patients have no chance
participating in the US health care market because they have insufficient
information.

~~~
mikepurvis
And it's impossible to get "sufficient information" or negotiate anything when
you're being loaded into an ambulance. The whole idea of negotiating
healthcare at the personal level is patently absurd.

------
grecy
> _To receive this care all my cousin had to do was provide her name and
> birthdate. No copayments, no preauthorizations, no concerns about the
> radiologist or orthopedic surgeon being out of network_

For the vast majority of people in the developed world, that's how heath care
works.

~~~
Inthenameofmine
Frankly a lot of the developing world too.

------
brightshiny
I've worked in the NHS, for several different organisations at different
levels of the hierarchy (PCTs, SHAs, CCGs etc), as a contractor, over several
years.

I would privatise it tomorrow. The amount of waste in terms of time and money
were eye-watering, _every time_. The amount of politicking was immense. A
project that should take a few weeks could easily expand into a couple of
years. I resigned from my last contract because it actually felt immoral to be
taking a large amount of cash to either sit around twiddling my thumbs, fight
with people, or do work at the slowest possible pace in the most ineffective
way. I'd rather do something else. Basically, I've never worked for a private
company that was anything like that, even the worst ones, and I find it hard
to believe any private company would survive very long working that way.

I'll add, my Japanese girlfriend and her friends are utterly unimpressed with
the level of service. As was my Spanish girlfriend, who also worked on a
hospital's grounds as a medical researcher.

I'm not saying we should copy the Americans, no way, but the Japanese system
is private, the German system is private, the Dutch and French systems are
also private. Going private does not mean chucking the idea of universal
healthcare on the fire, it means _properly_ separating the regulator from the
provider and removing the kind of conflict of interest that led to the cover
up of high mortality rates, among other things. There is more than one way to
skin a cat.

And no, I'm not a Tory. Try picking up a copy of Private Eye if you want to
divest yourself of the notion that the NHS is a saintly institution. Or work
there.

~~~
majewsky
> The amount of waste in terms of time and money were eye-watering, every
> time. The amount of politicking was immense.

Have you ever worked at a reasonably large private organization? It's exactly
the same there. It's a complete fairy tale that large private organizations
are somehow more efficient than large state-run ones.

~~~
marcoperaza
The difference is that private organizations that don't perform eventually
fail to turn a profit and go out of business.

~~~
duncanawoods
I think this is usually because their profit engine breaks rather than being
overwhelmed by waste. All big orgs seem to have one part of the business
printing money while the rest tries to burn it. So long long as the printer
prints, the bonfires burn.

~~~
marcoperaza
If your competitor can produce the same output with less waste, they can lower
prices and take your customers.

This is especially true of health care where there's not much salient
differentiation or other dynamics that would naturally produce monopolies.

~~~
acdha
That's a very simplistic view: it assumes that the product in question is an
easily-compared commodity, the business has low barriers to entry, and that
there aren't other factors (long-term contracts, regulatory requirements,
natural monopolies, etc.) which would make switching hard.

In the case of healthcare, consider the cost of entering a competed space:
nobody is better at everything so you won't have a clear advantage for many
patients, the startup costs (time, money, permits, staff, etc.) are massive,
people like to keep their existing doctor and won't change without cause, and
the complexity of the problem defies simple solutions. You can't save on staff
costs without losing in-demand professionals, things like billing are both
intrinsically complex and disastrous if you get them wrong, and so are all of
the safety and other regulatory compliance issues. You might be able to shave
bits here and there but it'll take time, have indirect costs, and it's going
to be a modest percentage over time.

------
Normal_gaussian
> Maybe teach kids in school how to use the health care system (hey, why not
> NHS ed alongside drivers ed or sex ed?).

We should probably break the news to her that there is no "drivers ed" in the
UK.

But she is right. The NHS can be great, but the way the government is fucking
with it at the moment will prove disastrous. It is education, not
privatisation, those are the answers to the problems of the NHS.

~~~
arethuza
I suspect that some of the meddling with the NHS is _intended_ to be
disastrous so that public opinion is more likely to accept profit-generating
private schemes.

NB Some schools (at least here in Scotland) do offer classes on the theory
part of the driving test as "interest" courses.

Edit: I eventually found the quote that sums up the approach that is being
taken with the NHS:

 _" Only a crisis - actual or perceived - produces real change. When that
crisis occurs, the actions that are taken depend on the ideas that are lying
around. That, I believe, is our basic function: to develop alternatives to
existing policies, to keep them alive and available until the politically
impossible becomes the politically inevitable.”_

Milton Friedman

Of course, the crisis that created the NHS was WW2 - I remember my father (who
served in the RAF in WW2) being pretty clear that returning to the pre-war
status-quo was not an option that anyone was interested in, which is why there
was such a resounding defeat of Churchill at the polls when the war ended.

~~~
digi_owl
That quite can be applied to the whole neoliberal process that has been
ongoing since the 80s.

First laden the public services with excessive regulations and budgetary
constraints to make it crack, loudly publicizes the resulting failures, claim
TINA on privatization/deregulation of the market, laugh all the way to the
(offshore) bank.

~~~
dTal
This is indeed a classic tactic, but I'm surprised you refer to it as
"neoliberal". Deregulation, privatization, and "Starve the beast" have been
conservative platforms since Reagan.

~~~
oriolid
Neoliberal is effectively conservative with less guns and religion.

~~~
dragonwriter
"Neoliberal" is a particular economic approach within the broad umbrella of
political conservatism. (In the US this is somewhat confused because lots of
the Democratic Party is neoliberal, but the Democratic Party is basically a
coalition of moderate left to center-right, leaning more to latter.)

------
privateersman
She had two options: go through the GP-based system where treatment can take
anything from days to months, or take the initiative by jumping the line and
go to A&E.

Going to A&E is like having your tech support handled by engineers. Going
through the GP system is like calling a support line. She got a positive
outcome because she went with the option that costs the most.

I'm pointing this out as someone who has gone through both methods. Don't
believe the hype that you read about the NHS. It's good to have, but it's not
amazing and if everyone went through A&E, the system would probably collapse.

~~~
have_faith
Struggling to understand your point of view.

It's not really a case of GP or A&E. They are two different things with
different purposes. The A&E is designed for problems that shouldn't wait. Your
GP is for ongoing issues that aren't crucial to be sorted right away. It's
called Accident and Emergency for a reason.

The NHS is far from perfect but I don't know what a better system would be.

~~~
privateersman
Just pointing out that what people experience from A&E is vastly different
from what people experience from the GP system.

This article highlights the best part of the NHS, whereas the GP system is
like being caught in limbo. If you are rich enough and plan in advance, it can
be avoided by going private, otherwise it can mean months, even years of
suffering through long waits.

------
lanestp
This kind of article is a nonsense puff piece. Giving an example of receiving
good or bad care in a health system is of no value. I have had incredibly
positive and negative experiences with US hospitals and doctors but my
experience is simply a data point.

As for the NHS the mother of a friend died due to negligence while being
transported home. So it's not all good, which is why the system cannot be
judged this way.

~~~
Angostura
luckily, there are statistics on patient satisfaction available for individual
hospitals and the NHS as a whole which shows a good degree of satisfaction.

Of course no system is perfect and their are a number of hospitals in 'special
measures' which means their management is replaced and they are in turnaround.
I'm very sorry to hear about your friends mother. I assume it triggered a full
investigation?

~~~
refurb
How do you compare satisfaction rates across countries? It's not easy.

As someone who has sxperienced the US and Canadian healthcare systems, I can
confidently say most Americans would be deeply unsatisfied with aspects of the
Canadian system. Yet Canadians love their system.

The waiting times for certain procedures in Canada, the lack of provider
choice and the lack of access to the latest drugs/tech are just accepted in
Canada. One reason why the US system is so expensive is the expectation of a
lot of Americans that they get the absolute best healthcare out there, costs
be damned

And yes, I'm generalizng with the comments. No need to call that out.

------
andreasklinger
As an european now living in America:

The reason the EU model works is that people treat their problems early.

You have a concern - you go to the doctor.

NHS - with all it's short comes - has the same principle

~~~
yummyfajitas
The reason the EU model works is that doctors (and other medical
professionals) get paid less. A quick google search suggests a US ER doctor or
radiologist gets paid more than 3x what a British one does, a family
practitioner 2x.

[http://www.payscale.com/research/UK/People_with_Jobs_as_Phys...](http://www.payscale.com/research/UK/People_with_Jobs_as_Physicians_%2F_Doctors/Salary)

[http://www.payscale.com/research/US/People_with_Jobs_as_Phys...](http://www.payscale.com/research/US/People_with_Jobs_as_Physicians_%2F_Doctors/Salary)

"You have a concern - you go to the doctor" is a waste of money. We've done
randomized controlled trials to study this question and the result is more
money spent with no increase in health.

[https://www.nber.org/oregon/](https://www.nber.org/oregon/)

[http://www.rand.org/health/projects/hie.html](http://www.rand.org/health/projects/hie.html)

~~~
k-mcgrady
>> "The reason the EU model works is that doctors (and other medical
professionals) get paid less. A quick google search suggests a US ER doctor or
radiologist gets paid more than 3x what a British one does, a family
practitioner 2x."

I'm not sure if you were posing this as a problem or not but as long as
doctors want to work for the NHS it isn't one.

~~~
yummyfajitas
I'm not posing it as a problem. I'm simply pointing out the real reason things
work in the UK is that people pay less for the same thing.

Tangentially, if anyone proposes UK-style solutions to health care problems in
the US without proposing 50-66% wage cuts for doctors/nurses, they are lying
to you.

~~~
arethuza
Well, the NHS is socialism so as far as I can see an approach like that
wouldn't be ideologically acceptable in the US.

NB Regarding the "socialism" part, from NHS founder Aneurin Bevan:

 _" A free health service is pure Socialism and as such it is opposed to the
hedonism of capitalist society."_

I always think it is worth noting that the title of Bevan's book on the NHS
was "In Place of Fear" \- which I think sums it up nicely.

[https://en.wikipedia.org/wiki/Aneurin_Bevan](https://en.wikipedia.org/wiki/Aneurin_Bevan)

~~~
yummyfajitas
I have no problem, in theory, with socialized medicine that we drastically
underfund. It's probably a great way to waste fewer resources on medicine.

In practice that's just not politically feasible in the US. An illustrative
example: a few years ago, a major study found that mammograms before age 50
are financially wasteful and medically harmful. Congress passed a law
_requiring_ insurance companies to pay for them anyway.

[https://www.bloomberg.com/view/articles/2012-07-31/in-
mammog...](https://www.bloomberg.com/view/articles/2012-07-31/in-mammogram-
debate-politics-trounces-science)

[http://www.uspreventiveservicestaskforce.org/Page/Document/U...](http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-
cancer-screening)

~~~
maxerickson
Medicare, Medicaid and the must stabilize mandate for ERs _are_ underfunded.

It's one of the reasons that out of pocket costs are so high.

~~~
yummyfajitas
No, they aren't underfunding. US _government_ health care spending was
$4,034/person. UK _total_ health expenditures per person was $3,935.

[http://data.worldbank.org/indicator/SH.XPD.PCAP](http://data.worldbank.org/indicator/SH.XPD.PCAP)

[http://www.usgovernmentspending.com/year_spending_2014USbn_1...](http://www.usgovernmentspending.com/year_spending_2014USbn_17bs2n_10#usgs302)

For us to underfund it to UK levels, we'd have to expand medicare or medicaid
to every single person while simultaneously cutting the total government
budget for health care by 2.5%.

~~~
maxerickson
The UK system isn't competing with private US consumers for a limited pool of
services. The comparison perhaps illustrates the poor value/dollar achieved in
the US, it isn't instructive as to whether US government funded healthcare
meets the costs of providing the services it mandates (a perfectly reasonable
definition of underfunded).

~~~
yummyfajitas
To clarify, when I said I'd favor socialized medicine that we drastically
underfund, the goal was to stop wasting resources on medicine. I.e., we should
bring our health care utilization/spending down to UK levels, since evidently
that doesn't significantly harm health.

Using a definition like "meets the costs of providing the services it
mandates" inherently contradicts this philosophy since in the US, all sorts of
crazy services will be mandated. E.g., mammograms for women under 50.

------
ZenoArrow
Many of the problems with the NHS derive from the UK government's attempts to
privatise it. If you're short on time but want to understand more, look at the
mess with PFI used to fund the building of new hospitals.

EDIT: If you've got more time/interest I'd recommend the documentary Sell-Off:

[https://m.youtube.com/watch?v=ultKvnw2h3Q](https://m.youtube.com/watch?v=ultKvnw2h3Q)

~~~
hansjorg
You seem to be interested in this subject. As an outsider, I've been wondering
why there hasn't been more of a ruckus after the Royal Mail privatisation.

As I understood it, the shares turned out to be underpriced by about 80% and
were primarily sold to a secret list of short time investors that made bank.

Have I misunderstood what went down? If not, how is this possible in the UK
without any political repercussions?

~~~
ZenoArrow
I'm not overly familiar with what happened with the Royal Mail privatisation,
but thank you for suggesting it as a subject, it sounds like something worth
investigating further.

I'm also not overly familiar with mainstream news media in other countries,
but if you had to point the finger at any one group in terms of why there
hasn't been more resistance in the UK to the dismantling of public
institutions, a large portion of the blame lies with our crap mainstream news
media. The public aren't kept informed about matters of substance, they're
distracted by misinformation and personality politics. It may be a problem we
share with other countries (from the outside, the US mainstream news media
seems similar/worse), but it doesn't have to be this way. We could have
mainstream news outlets that gave people a chance to get better informed about
the issues being faced in their country/community. It's an essential part of
society that is sadly missing, I don't think you can have an effective
democracy (effective in the sense of standing up for public interest) without
a well-informed public.

------
Waterluvian
I wish Canada's system was that good. I've been to the ER twice. 6-8 hour wait
for things that weren't life threatening but definitely required an ER visit.
Ever waited in an ER for 8 hours while sick as a dog? It's awful.

But then I think about how often I intend on being at the hospital and will
gladly pay 8 hours every time if it means nobody has to find a co-pay to learn
if their cancer is back.

~~~
andreasklinger
I waited 6 hours in an US emergency room. Compared to EU ER rooms an horrible
experience. All kinds of people with unfixed long term problems that
apparently only the ER is obliged to handle.

Btw the reason was even more frustrating:

A us doctor (turned out nurse/practitioner) told my GF that all the obvious
reasons are not the cause of her short breathness. So it might be a deadly one
- we needed an xray to make sure - we had an xray with us but she wasnt
comfortable looking at it because of missing education. She offered us an
ambulance to the ER. We had no issues whatsoever - she just tried to cover her
ass in case of.

~~~
jseliger
_I waited 6 hours in an US emergency room. Compared to EU ER rooms an horrible
experience. All kinds of people with unfixed long term problems that
apparently only the ER is obliged to handle._

I live with an ER doctor, and the problem with US ERs is EMTALA:
[https://www.verywell.com/emtala-the-emergency-medical-
treatm...](https://www.verywell.com/emtala-the-emergency-medical-treatment-
and-labor-act-2615167). If you want a better ER experience you must fight that
first (or get a concierge doc, which is another route).

If it makes you feel better many doctors are themselves disillusioned with the
system: [http://jakeseliger.com/2012/10/20/why-you-should-become-a-
nu...](http://jakeseliger.com/2012/10/20/why-you-should-become-a-nurse-or-
physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-
school/) and I have heard many ER docs complain about how they don't have
enough time to adequately see, understand, and diagnose each patient. And the
rants against EMRs are epic. One friend said that he chose a hospital because
they still use T-sheets.

~~~
andreasklinger
> If it makes you feel better

Not really ;)

------
madaxe_again
The NHS is great at emergency care. I came down with a severe infection a few
months ago and landed in Glan Clwyd. I was practically grabbed as I staggered
through the door, and spent a few days in a private room (!!!) white they
figured out whether what I had was infectious. Then a few days on a general
ward, then discharged, well enough to finish sorting myself out at home. The
staff were lovely, friendly, genuinely caring people - although I worry for
their futures, given that most were EU nationals, and the only UK natives were
agency staff. In my less delirious moments we chatted about the impending
brexit vote - very worried faces.

When it comes to long term or weird and wonderful stuff - not so great. I've
been bouncing around referrals for five years, and the lack of digital records
means that they have to mail 30lbs of paper to each other before I show up. If
the records didn't arrive, I have to dictate my case. Again, and again, and
again. Still undiagnosed. One particularly spectacular SNAFU ended up with me
having unnecessary surgery, because someone read the wrong notes.

Their core infrastructure is in dire need of modernisation. The government
seem to think the answer is creeping privatisation. If they hadn't wasted
£14bn on lining their chums pockets, the NHS would probably be pretty
unassailably brilliant by now.
[https://en.m.wikipedia.org/wiki/NHS_Connecting_for_Health](https://en.m.wikipedia.org/wiki/NHS_Connecting_for_Health)

~~~
retbull
It isn't like that doesn't happen here in the US. That sounds like part
bureaucratic problem and part difficulty of diagnosis. I know plenty of people
who ended up in similar situations or got the wrong diagnosis for years
despite having pretty good medical insurance. You'd still have to get your
medical records transferred around.

------
DanBC
Those hospital wheelchairs are difficult to use, but it's possible to safely
push them.

> The only real issue was people who show up for care that is clearly not even
> semi urgent never mind emergent.

People do love the NHS. And they trust A&E. Companies would kill to get that
kind of brand loyalty. So the answer is to co-locate walk-in doctors and minor
injuries with A&E departments, and have fierce triage on entry to divert the
people who don't need it away from A&E.

------
UK-AL
I find the NHS is good for the little things, gets worse as you go for the
more complicated things.

My dad had pancreatic cancer and went to the doctors, did every sort of cheap
test they could. They didn't believe him, and said it was psychological and
sent him to a psychiatric hospital instead. Again nothing worked

After constant complaining, eventually they went for the expensive scan, and
found that it was pancreatic cancer wasting several months.

Awful.

------
Ericson2314
I know rhis isn't the main impediment to policy change, but I kinda want to
require that all doctors and nurses study/be a resident abroad, just so most
people in any US hospital know what we're missing.

------
greggman
Well... Sadly I've had bad experiences

I was in London last summer. Got sick. Waited about 9 days for it to get
better. No signs of change so went to NHS. Wait one hour. Was led into
consultation room and was told I could wait another 90 minutes if I wanted but
that I could only see a nurse and regardless of what the nurse found she could
not prescribe any medicine. Or, I was told by the same NHS person I could go
about a 10 minute walk to a private clinic and see a doctor probably
immediately and as a doctor they could prescribe medicine if needed.

So ... Yea, wasn't a good first impression of NHS.

Not saying USA's system is better.

In Japan it's easy to see a doctor but at least in my experience about 30% of
them are quacks.

Also if you need surgery and you want a good doctor you need to bribe them.
This is so common it's a normal part of most medical dramas.

I'm scared of getting the giant bill in the USA. But I'm scared of getting
hurt by the doctor in Japan if I need any surgery. I don't know the solution.

------
anexprogrammer
We get a lot for the money, compared to the cost of other systems. I
absolutely don't want to see more privatisation of the system despite most
governments nudging towards this. All is not perfect though. Every government
wants to be seen to be "doing something", so fiddles. Constantly. Staff is
overworked and mostly underpaid.

Emergency and cancer care seems to be very good. I'd recommend not needing a
non-emergency or mental health treatment in some of the poorer regions of the
country though.

For instance. If you need Aspergers help for your child, or referral to some
CBT for depression in some places you can wait 12 months. Sometimes more.

Even so I prefer it to anything like the US system as you can;t fall through
the gaps entirely for being broke. I'm glad to pay more tax as a result,
rather than an insurance premium or in-work benefit.

------
WoodenChair
The problem with socialized medicine is not with regards to the routine
(broken ankle, high cholesterol) but instead with regards to the even slightly
unusual. The economic incentive is not there for highly trained specialists.

Nothing about this article is surprising, despite the author's tone. Any
modern industrialized country should be able to quickly treat a routine broken
ankle. Where that's not possible in the US it's a travesty. Now compare the
care of extremely rare diseases in the US and UK and you have something more
interesting to talk about.

~~~
aleksei
I have to disagree with this. If there were no private hospitals this might
hold true, but as it is the better off will continue to pay for their
expensive treatment, keeping the economic incentive for doctors, while the
poor will at least have basic treatment available (at no cost, no less).

As for comparing rare disease treatment, I can't say but would like to see
some more information.

------
neom
Grew up in the UK, went to college In Canada, US for the last 6 years.

NHS was excellent growing up. OHIP/Ontario Health Care was excellent. The US
is contrived and awful.

~~~
falsestprophet
> "NHS was excellent growing up. OHIP/Ontario Health Care was excellent. The
> US is contrived and awful."

 _contrived_. having an unnatural or false appearance or quality

What?

~~~
neom
What do you mean by what? I presume by the italics it means you're unable to
comprehend the word contrived? Would you like me to define it for you?

------
shanacarp
I actually watch this.

I'm in a private group for what is collequally called previvors (specifically
Young previvors - though some people have had/current do have breast/ovarian
cancer, including a few who are dying of it). I need specialized DNA testing
for complicated reasons in my family history for risk assessment. It isn't
covered. We have UK and European Members. I see who their doctors ares, what
research they publish. I know what they pay. ($0) I know that for patients
like me, European doctors are way more proactive, even for joining studies,
because they can afford to be.

I know factually that if I were in europe that test would have been done LAST
YEAR. Instead I'm still looking around for one doctor outside of my regular
provider to do this one DNA test under research protocols.

Doing this one test could potentially save the medical system thousands of
dollars. That's what baffles me the most: The insurance companies wants me to
use a certain amont of services, but only so much, in the US

It is like they actually don't want me to be healthy - and I am not sure why.

------
dzhiurgis
Had 3 visits so far in London hospitals, regarding recurring pain around heart
area. Doctor solution was making me keep pain diary as NHS has no money for
diagnostics...

I did get some basic blood checks though.

~~~
DanBC
Were they emergency visits, or GP arranged visits? What did the GP say when
you asked him/her about it?

~~~
dzhiurgis
GP visits, that's GP. NHS has no money.

I think they thought I am eastern european freeloader. The pain is manageable
and tends to disappear when I stop drinking, which suggests liver swelling.
But then my arms sometimes feel numb.

I've moved from UK since. To a place where immigrants pay just as much tax,
but do not get free healthcare like citizens do.

------
cja
The NHS is massively overstretched. I'd be terrified of having to go to A&E at
Worcester hospital, where I live, but the system we have doesn't allow for me
to take my business elsewhere so there's no competition.

------
jkot
My friend had diabetes, her GP could not even diagnose that from basic
symptoms, several visits and blood test.

I strongly recommend to anyone with 'mysterious' long term illness to visit
doctor in other country.

~~~
vertex-four
Some doctors suck, no matter what country you're in. I've heard similar
stories from people in the US, India, everywhere. You have a right to a second
opinion in the UK - use it if you're unsure.

~~~
jkot
Yes, but in UK you have to go through GP for everything. It can take months
before seeing specialist for trivial stuff.

~~~
Angostura
What kind of trivial are we talking about? i went with concerns about changes
to my bowel habits and the GP had me to a specialist with a camera up my arse
within two weeks.

~~~
jkot
Blood tests, to get second opinion. GP disagreed with patient suggestion, and
had loundry list of treatments to try first (including shrink and
accupuncture).

Three months is reasonable number if you have no GP (have to register first),
bad english and live in poor neighbourhood.

Visiting foreign doctors is cheaper and faster.

~~~
vertex-four
You can get a second opinion from another GP. You can ask to see anyone in
your practice without issue - you're registered to the practice, not a
specific doctor. If your entire practice is filled with awful doctors...
there's an issue, but I've yet to see that. (You can also register with
another practice if you have issues with your nearest one.)

------
maxerickson
For lots of Americans, the copay on that CT scan is 100%.

I guess if they are getting over cancer they might be lucky enough to have met
their out of pocket maximum for the year.

edit: Why is this controversial? I literally paid out of pocket for 2 CT scans
last year. They both applied against my deductible (so they were 'medically
justified' or whatever, not done at my insistence or something). Is being
sarcastic about the high cost of healthcare in the US so absurd?

~~~
refurb
That's how high deductible plans are supposed to work! In exchange for much
lower premiums, you pay the first few thousands of dollars out of your own
pocket. If you have a severe illness, the insurance covers the rest.

Usually high deductible plans come with a tax free savings account. You sock a
little money away each month so when something happens you have a cushion to
fall back on.

They certainly aren't for everyone, but if i was young and in good health I'd
probably go that route.

~~~
maxerickson
Sort of. The premiums aren't all that low (they are intentionally high to
subsidize care for other patient groups) and the fees have only a vague
connection to the costs of providing the services.

We have an insane system where mandated government care is underfunded and
then the hospital is expected to make up the difference by charging the people
that need medical care. People that are having a bad day pay for the people
that are having a bad year.

Of course I have no way of giving any weight to such a statement, but I'm
pretty sure I would have paid 1/3 to 1/5 as much in a reasonably competitive
marketplace...

~~~
refurb
The last time I looked, a low deductible plan might cost $500-700/month for an
individual. A high deductible plan can be under $200/month depending on the
state. That's a pretty reasonable decrease.

Otherwise, yes, I agree that the private system is subsidizing the public
system, particularly Medicaid.

