robin1234

Isn’t Part C just another name for Medicare Advantage?

Rete

Here is a comparison of the NHS and Kaiser Healthcare in California

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC64512/

SanDiegogirl

Don't these plans come under, what I describe as, Medicare Advantage plans ? i.e you turn over your Medicare premiums to a specific health system which then handles all your medical needs.
In my part of the world Sharp Health, UCSD and Scripps all have their Medicare Advantage plans. Patients can only then go to whichever of these health organisations they have signed up with.

scrubbedexpat091

It's the same in BC for those on disability, technically we have some coverage since we get disability, but the problem is the government hasn't raised the reimbursement rates since 2004 so other than charity dentists who volunteer some time each month, really no dentist who will do any work for the ministry rate, like a basic new patient exam after our disability coverage is still $500-$600 all said and done, and that is before any actual work, that is just x-rays, exam, and such to determine what needs to be done, so functionally the coverage is pretty useless, same with eye glass coverage, $100 max for eye glasses every other year, again really nowhere that you can get your lens, and frames for $100.

I don't miss the monthly premiums of my US policy, but I really do miss being able to access more comprehensive healthcare, a lot of what isn't covered in BC was covered by my US policy, and really my premium for single no kids was only $75 every other week, so it wasn't exactly high, I'd be content paying $75/month premium and $10-$25 co-payments to have a more comprehensive healthcare system here, I am not even asking for free, just a system that includes dental, vision and mental health even if it requires some form of monthly premiums and co-payments.

Shard

All that paperwork and beauracrcy does sound like a Kafka grade nightmare.

robin1234

Yes, and I’d go back to a point I made earlier about the choices every single person is faced with. “Freedom, “ they call it here. It’s a facile rallying cry, to bolster up the “America is the best country in the world!” claim.

Many people do well with choice, for instance, getting the best possible treatment for their medical issues. But I’m guessing that many others end up making really bad choices (just look at the current COVID situation in the US,) and would have been better off with the NHS situation where you respond to calls from your doctor for certain tests, you go to the specialist your GP sends you too, etc. Yes, I know, the NHS is currently badly underfunded, but that’s actually a separate question.

And I’m not even getting into the fact that a proportion of Americans actually have little or no choice, because they have inadequate, or zero, health insurance.

Hiro11

I believe the main reason there's been no change to the healthcare system in the US is that many, many people have good employer-sponsored health insurance that they like. These people also tend to vote more than people who don't have employer-sponsored health insurance. I'm not defending the current system or saying this is true for everyone, clearly it's not. I do think this is a primary reason for the inertia. Shard may call this a tool to keep people "corporate indentured", I'm less cynical as to me it's more of a consideration/trade-off when choosing a career and employer.

Taking myself as an example, I've been employed by companies of all sizes from Fortune 500 to start-up and I've never had to worry about health insurance through ~25 years of employment, it's just a non-factor for me. I currently have an (expensive) BCBS PPO through my very large employer that is totally comprehensive in what it covers and bolstered by various dental, vision care, physical therapy (sports medicine, chiropractic etc), long term care, disability and life insurance coverage. I'm very happy with my healthcare, in fact it's a bit over-the-top whenever I have needed care. There's no "Kafka-esque" nightmare of paperwork for me or my family, we just flash the magic BCBS card and we're in and out. My wife an I both get new glasses every year. I have dental insurance that even covers some optional aesthetic procedures. Of course, this situation isn't true for everyone... but it's also far from rare despite what you may read.

Perhaps you'd look at the above and say that sounds small minded and selfish. Again I'm not defending the current system, I'm just trying to explain why there hasn't been a radical change. Many Europeans read about American healthcare without this context and (like Shard) are baffled why anyone in the US puts up with it. They're not getting the full story. Similarly non-Americans also seem generally unaware that Medicare/Medicaid are already the largest Federal entitlement programs outside of Social Security. The budget for Medicare/Medicaid is already substantially larger than the entire US defense budget and has been for decades. Add in other massive healthcare-related programs like ACA ("Obamacare"), SSDI (Social Security Disability Insurance) and various state programs and US governments are already spending a ridiculous amount of money on healthcare ($1.2T in 2019 alone at the Federal level). Then there's pro bono work, on average each physician in the US does about 150 hours of pro bono work each year. In total it's estimated that physician pro bono work is worth about $200Bn annually in the US, another number that's not widely reported. It's far from perfect (or even good) but the idea that the US healthcare is some sort of social Darwinist / bootstrappers hellscape is more than a little overstated.

Of course, healthcare spending efficiency in terms of outcome is awful in the US, but that's a different topic.

zzrmark

^^^
I'm going to hazard a guess that Hiro's view is, understandably, formed by his/her circumstances and those around him/her. Nice middle class existence (nothing wrong with that) surrounded by other nice employed middle class citizen's means that his beneficial experiences are the norm for him and his colleagues but by no means normal for many Americans.

I'm self employed, I can't afford to take out my own health insurance so jump on my wife's educator's policy. This, as with insurance across most states, varies depending upon your location. Her policy in Florida was absolutely extortionate for me to be added, neither of us had dental or optical, we weren't covered out of state and the co-pays were crippling, hence some reluctance to attend to minor niggles (some of which are now a PITA). Since moving to South Carolina we've seen the premiums fall significantly, despite having dental, optical and out of state coverage, our co pay for doctors office visits has nearly halved and we are now able to use our insurance.

My brother in law is also self employed, long term, but he has no employed wife to rely upon for access to insurance. When he or his family require medical attention they pay for it directly from their pocket. His view is that it is his responsibility to support his family without government interference, inability to have medical attention because he couldn't afford it is nobody but his own fault. This does mean that his 26 year old autistic son has no ID, nor the kind of support that a person familiar with universal healthcare would seek for their son. In his mind, it's his son, his problem. There are projects, few and far between in this area but they are there, for which his son would qualify regardless of income status, especially as he is no longer a minor but that my BIL will not use because 'big government'.
That would not appear to be an uncommon view among poorer Republicans that I have met in FL and SC, they view their failure to secure higher paid employment and the trappings that come with it as their fault and that they don't deserve the trappings that come with financial security if they can't pay for them.

Universal healthcare has it's failings but an inability to pay does not exclude one from access. Here in SC I can only get medicaid if my annual earnings drop to somewhere around $17k, I become disabled, reach 65 or sprog up again (definitely not happening!!). If I am unable to work because of any of those factors then restricted healthcare is going to be the least of my worries. Middle class America is world's apart from a large section of society that has no access to healthcare or those who have no savings to cushion/support them in later life and, I believe, a huge section of the population is blissfully unaware of the daily struggles of their fellow countrymen, to describe conditions for many people in the South West USA as being on par with the third world is no exaggeration.

scrubbedexpat091

My sister and her husband would not have the same view as Hiro, but then while middle class they are on the lower end of middle class, and have insurance company who would rather someone die than cover treatment, so there is also that problem, often its not until something major happens that people realize even their insurance might not be as good as they think it is.

civilservant

Working in healthcare finance, I would associate myself with the comments from zzrmark.

If you can afford it US healthcare is comprehensive. If you have your nose pressed up against the window, then it may kill you. Too many healthcare systems who are 'providers of last resort' lose millions every year to unreimbursed care that would not happen with an NHS style system.

Even those that are not 'of last resort' are required under the law (EMTALA) to assess and stabilize before requiring payment - leading sometimes to huge losses.

ddsrph

Many hospitals are closing each year due to financial losses especially small rural ones. People who look at their bill don’t see the army of support staff that must be paid. Republicans whined for years about people using emergency rooms for primary care. Then when the ACA tried to address that by requiring health insurance or pay a fee the hypocrites couldn’t tolerate any attempts to find a solution. Technology of the future will greatly increase the divide between the haves and have nots or bankrupt us all.

civilservant

I can attest to this personally in NE GA. At least 2 rural hospitals in a 50 mile radius of me have closed this calendar year. It has left 3 major health systems, all in major urban areas, as the only ones left.

If you have a major medical event in the middle of those, if will take you at least 30 minutes to get to a hospital. In a cardiac event, that delay is potentially deadly.

scrubbedexpat091

Sums up most rural areas here in BC, 30 minutes from a hospital is even generous, there are some rural communities 1-2 hours away from the nearest hospital, and even an air ambulance will take up to an hour to arrive.

Granted we also have the problem of having only 5 million people spread over 364,765 sq miles with 50% of the population all living in a relative small area of the province and the other 50% spread out all over the place pretty thinly.

zzrmark

I should clarify, our household and my BIL's are hardly scraping for a crust. I kind of went astray in my earlier diatribe, easy to do when you live in a county where every kid in the county's two state schools is entitled to free school meals. This isn't so much a problem of the poor, unfortunately they are always going to get screwed by the rest of society but thereis a rudimentary safety net if needed, it's the huge swathe of middle earners who run their own businesses that are caught short when it comes to healthcare.

And this wes'country boy just can't get used to saying that he lives in the SE not, as implied earlier, the SW...

Hiro11

A "nice middle class existence"... Thanks for the patronizing and pigeonholing. Also appreciate the lecturing on how "blissfully unaware" I am as a "middle class" person. You know nothing about me or my experience.

If you read my post I address this repeatedly. I'll capitalize it this time so it's clear: I'm NOT DEFENDING THE CURRENT SYSTEM and I'm NOT SAYING MY EXPERIENCE IS TRUE FOR EVERYONE. The point of my post was to provide my opinion on why the American system hasn't changed since WW2, which in my view is caused by a large number of voters who are happy with their current healthcare and don't want change.

Also, I'll point out that your views on this situation are similarly influenced by your perspective as someone who is self-employed... and what serves your best interest. This is 100% reasonable and makes sense but it certainly shouldn't grant you license to act self-righteous and judgmental about people who disagree with you.