This StackExchange answer sums up it up succinctly: https://politics.stackexchange.com/a/16372. I find it immensely saddening; the same goes with the general population's attitude to education (in many countries) or providing housing.
For what it's worth I know a lot of people with private healthcare in the UK with the attitude that the NHS is complete trash (something I very much disagree with) - I fear this sort of mindset is spreading. "Pull the ladder up jack" as they say.
As a data point: the patient satisfaction scores for Original Medicare (government-run) are drastically lower than every single major provider of Medicare Advantage (privately-run).
As much as people dislike insurance companies, people in the US are even less happy with the government-run programs, compared to their private counterparts.
I didn't in my previous comment, because we were talking about the overall public perception, which may or may not be connected to the tangible metrics that we actually want a healthcare system to focus on.
As it turns out, though, Medicare Advantage also consistently outperforms Original Medicare on medical outcomes, and it comes in under-budget for identical coverage. Medicaid options vary much more (and they're different in every state, because Medicaid is administered at the state level), but the equivalent private plans for Medicaid coverage also typically perform much better than the public ones.
Hacker News readers aren't generally in the demographic for Medicare[0], but for anyone who is: there's really no reason to use Original Medicare. Every jurisdiction should have Medicare Advantage plans that cost you the same amount as Original Medicare does, and your experience (and overall care) will be vastly improved.
[0] people over the age of 65, or people of any age who are on dialysis for more than two years, etc.
I'd be interested to see these findings. Do you have links?
As far as Medicare Advantage is concerned, it's not the least bit surprising that patient satisfaction is higher. But I wouldn't go treating that as some kind of referendum on Government-run healthcare:
"Many private [Medicare] plans require no additional monthly premiums, yet the government pays an average of $849.90 in monthly subsidies to insurance companies for a person on Medicare Advantage, according to the Kaiser Family Foundation. That is about 14 percent more than the government spends on people with standard Medicare, according to the nonpartisan Medicare Payment Advisory Commission."
MA was supposed to demonstrate that private insurers could deliver care at lower costs than Medicare, and it hasn't done that. Basically, for every $1.00 the gov spends on a medicare patient, it pays $1.14 in subsidies for an MA patient, with the evidence indicating a lot of that goes straight into the pockets of insurers as profit [2]
[1] http://www.washingtonpost.com/wp-dyn/content/article/2009/10... [2] http://theincidentaleconomist.com/medicare-advantage-cuts-on...
That might be a reasonable comparison if Medicare's claims rates were self-sustaining, but they're not. As I explained in another comment on this thread, private insurers subsidize Original Medicare with their own payouts in claims, and that comes out a few orders of magnitude larger than 14% per Original Medicare patient.
- Try see your GP. Wait 2 weeks until your appointment.
- GP will give a cursory examination and recommend a dietary change, taking ibuprofen/paracetamol, and to come back if problem persists.
- Problem persists. Book in with your GP and wait another 2 weeks.
- GP will actually examine you this time. They may then refer you to the local hospital, and so you should await a letter.
- about 2 weeks later, the a will arrive saying that you should phone up to make an appointment.
- within 8 weeks you should get another letter telling you when your appointment is, which will be within 4 weeks.
At this point you have spent 20 weeks just to get seen by a specialist. And that's assuming everything goes ok. Admin may not update your details, so the letters go to an old (or wrong) address. They may just entirely forget to make an appointment for you. Probably if you try phone them they just won't pick up the phone.
There's a fetishisation of the NHS in this country that protects it from a lot of criticism. Some will say "well you should put up with that because it's free" or some similar rubbish, ignoring that it costs £2200 per person.
None of these issues are restricted to the NHS. Any large organisation will have such issues. But it's utterly frustrating stuff like this that makes me consider going private - I shouldn't have to spend hours on the phone figuring out why I haven't been assigned an appointment despite being referred 3 months ago.
1. Schedule with GP. Say I am in pain. Get in within 2 days.
2. Get a referral to Physical Therapy. Asked if I have any preference where to go. My doctor knows my network and gave me a number of choices that were within network (a number of which were within walking range of where I lived).
3. Call PT office. Schedule an appointment. They apologize that their next opening is a week away. Gladly accept.
Physical Therapy is interesting in that it is semi-free market and rather competitive, so it tends to work a bit better than some other scenarios.
> 1. Schedule with GP. Say I am in pain. Get in within 2 days.
> 2. Get a referral to Physical Therapy. Asked if I have any preference where to go. My doctor knows my network and gave me a number > of choices that were within network (a number of which were within walking range of where I lived).
> 3. Call PT office. Schedule an appointment. They apologize that their next opening is a week away. Gladly accept.
> Physical Therapy is interesting in that it is semi-free market and rather competitive, so it tends to work a bit better than some > other scenarios.
Speaking from recent experience, on Obamacare:
1. Live with pain for 6 months because you know you're not getting out of a specialist's office for less than $750.
2. Cave in when the pain becomes unbearable and see a specialist.
3. Make an appointment for PT with a provider who doesn't take insurance at all, because the transparent pricing means no surprises.
4. Pay out of pocket for PT appointments.
5. Spend the next 4 months getting bills for your one specialist visit. Half of these are coded wrong so insurance won't pay. Spend 2h every week on the phone trying to get it sorted out.
If you talk to whoever does the specialist's billing at any point, you'll find that they're totally unable to estimate the cost of services. You might as well not even try to figure out how much it costs in advance.
1. Schedule with GP, get appointment very quickly.
2. GP has no idea who is "in network" for you and doesn't seem to care very much. They also don't understand the different insurance plans so have no idea if you're covered for certain types of referral.
3. Schedule appointment with a specialist. Ask for up front cost estimate for consultation/procedure given your insurance plan. Unable to answer.
4. Go to appointment anyway as you don't have many other choices.
5. Receive astronomical bill for some obscure billing code that is not covered by your health plan.
6. Spend time calling doctors office and insurer to figure out the situation and try to avoid or reduce bill.
I've experienced the NHS too - for all its flaws, the peace of mind living in the UK from a health standpoint is worth every penny of the associated taxes IMO.
Chronic pain is an extremely tricky phenomena. A lot of US health care been "dealing" with it by handing out opioids and we can see the devastating effect of that. Even a given physical therapist may not be able to help a given patient (assuming some body of some sort could at all).
Similarly, a smart consumer may be able to find a massage therapist with skills in a bodywork subdiscipline that happens to really help them (I favor trigger point and Shiatsu massage after sample a bunch in my area). This is cost effective compared to just about everything and something I imagine someone in UK could find in the larger cities.
Tests are all same day.
It feels to me that we in the West are going ever faster backwards over fairness in issues like education, health and housing. I'm lucky to be well off & healthy enough to not (yet) be affected by a poor performing NHS but I wish we, as a country, would pull together on this - from top to bottom. Unfortunately, I just don't see it happening anytime soon, we seem to be increasingly more divided - religiously, economically, politically - than ever before.
Society feels increasingly like a "Mad Max" movie in operation. This is only going to end badly for everyone. There is way too much "me me me" from all levels. I find it emotionally exhausting to think about.
I don't begrudge anyone who has the means to get private health care from doing so (my girlfriend and many friends do) - so please don't think I am saying nobody should - I just wish there was a more proactive and pragmatic desire to fix the root issues. Of course, I realise I am living in cloud cuckoo land on that.
I should add that I can certainly empathise and can agree with your comment about chronic pain. My father is suffering from sciatica and it has been over a year to get an operation scheduled. This will involve him travelling from Northern Ireland to the Midlands because there is an even longer (multi year) wait to be seen in NI.
I agree with everything you say, except the part about cancer.
Even by European standards, the NHS is actually quite terrible at dealing with cancers - even "routine" cancers (like breast cancer and prostate cancer), let alone rare cancers. The five-year survival rate for prostate cancer in the UK is 55%, whereas in the US it's upwards of 90%. (Prostate cancer is an incredibly treatable form of cancer; for most people, as long as it's detected early and managed appropriately, they will die with prostate cancer as opposed to from it).
Of developed countries, only Japan, Portugal, and Denmark have worse five-year survival rates for prostate cancer.
Prostate cancer may be something of an outlier given the hesitation people have in discussing it. This is something that has only really recently been attempted to be addressed in the UK. Campaigns fronted by comics like Bill Bailey have tried to make it normal to talk about. The British as a society are still so reserved that I imagine thousands die of preventable cancers and diseases simply out of embarrassment.
Edit - I've just had a look at Cancer Research's figures[1], [2] and, using data from 2010/11 - prostate cancer had a UK survival rate of ~84% or so - i.e. nearly the same as the US.
[1] http://www.cancerresearchuk.org/health-professional/cancer-s...
[2] http://www.cancerresearchuk.org/health-professional/cancer-s...
It's looking at people with prostate cancer, regardless of insurance status.
> Prostate cancer may be something of an outlier given the hesitation people have in discussing it.
It's not limited to prostate cancer; for survival rates, the NHS does pretty terribly on almost every form of cancer compared to the US. I picked prostate cancer because it's something that's very treatable - the upper limit is close to 100% for five-year survival, which makes the UK's outcomes that much more unacceptable. But the story is the same for all other common cancers (let alone rare cancers, which the NHS is not optimized as a system to treat).
It's survival rate from point of diagnosis. Obviously, insurance and access will affect whether and when diagnosis occurs, but the effects aren't as simple as just limiting the scope to the insured or not.
https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...
I don't understand the point you're trying to make. [Treatable] cancer isn't the leading cause of death in any country[0], so no matter how good (or bad) a country is at treating cancer, you wouldn't expect that to be visible in the overall life expectancy rates.
[0] Ordinally, cancer is #2, but that includes untreatable cancers, and the tail is very long, so getting better at improving five-year survival rates for cancers won't budge your life expectancy at all, outside of the margin-of-error.
Such survival rates are from date of diagnosis; IIRC, because prostate cancer detected early usually doesn't have interventions that are less harmful than the cancer is likely to be, there's considerable debate about the utility of screening; there has been considerable argument that the US tends to overscreen and over-intervene for prostate cancer.
If the UK doesn't do that and tends to screen in a way that tends to catch less of the less-imminently-dangerous prostate cancers, it would have a lower 5-year survival rate simply by not diagnosing prostate cancer where the diagnosis isn't usefully actionable; this doesn't mean they are actually worse at dealing with it.
> Prostate cancer is an incredibly treatable form of cancer; for most people, as long as it's detected early and managed appropriately, they will die with prostate cancer as opposed to from it
Prostate cancer is very often an extremely non-aggressive cancer with interventions that can have significant negative impacts, which is why, even when it's diagnosed “watchful waiting” or “active surveillance” are often the preferred management approaches; quite a lot of people will die with, rather than from, prostate cancer with no active intervention.
Population-wide 5-year survival rates from diagnosis are probably not a good metric for comparing countries with different screening practices; mortality rates are a better comparison metric, but also don't tell the whole story.
Over-intervention and over-screening are two different problems, particularly for prostate cancer, where screening is low-cost and low-risk. In the US, most cases of prostate cancer do not require invasive intervention if detected early, but they will begin treatment, as well as more regular monitoring of the cancer. When screening costs are low, overscreening is not particularly problematic as long as it doesn't result in overtreatment (which is demonstrably true for prostate cancer in the US)
Again, this is not limited to prostate cancer. The difference is the most stark there because the screening costs and risks are both low, but the UK still does a much worse job at treating breast cancer, colorectal cancer, lymphoma and leukemia, which are the other deadly common cancers.
For all cancers, not just prostate cancer, the US over-screens a small amount, but the UK underscreens by a massive amount, resulting in many people detecting cancer when the window of optimal treatment has long passed. That's the reason that the UK is close to last place among developed countries for five-year cancer survival across all common forms of cancer, not just prostate cancer.
They are distinct but not unrelated, particularly in a system where treatment decisions are highly patient driven, especially for patients with financial means.
But my point is less about over screening than that differences in screening practices naturally produce difference in five-year survival statistics even in cases when they have no meaningful outcone in terms of disease progression, mortality, and quality of life, because more screening will detect more cases of disease earlier, even cases for which intervention would never be clinically indicated. If you do a lot better job at diagnosing cases for which there would never be intervention, you get a better 5-yesr survival rate but haven't done any better at dealing with the disease.
Note that I'm not arguing about whether the UK does deal with prostate cancer well, in fact what I've seen using mortality rates suggest they are a bit worse than the US, though much less bad then you'd think from 5-year survival rates. I'm just staying there 5-year survival rates aren't great metrics for systems that are different in conditions that lead to diagnosis.
I agree. That's why looking at all common cancers as well is important. Leukemia and lung cancer are the opposite end of the spectrum - early intervention is critical for leukemia and most lung cancers. And the UK does a much worse job at treating those than almost all other developed countries, and particularly the US.
So yes, some portion of the difference can be attributed to differences in screening practices, but screening practices are a relevant aspect of the entire system, and screening practices alone can't explain the UK's abysmal record for treating the more aggressive cancers which they do detect.
First: no, the England branch of the NHS is still larger than Original Medicare (~53 million in England compared to 46 million on Original Medicare).
And that might be a reasonable way to interpret the data, except that two-fifths of Medicare patients (and growing) are not on Original Medicare - they use Medicare Advantage, which is privately run. Coincidentally, Medicare Advantage outperforms Original Medicare on medical outcomes across the board, including cancer treatment.
So no, the fact that the US is drastically better at keeping prostate cancer patients alive cannot be explained by the claim that Original Medicare is so phenomenally better that it accounts for the difference.
It's very easy to draw conclusions from statistics. It's much harder to draw correct conclusions from them.
So... less than 1/3rd of what the US pays on a per capita basis? I'd be cool with that...
- Book a GP appointment. Generally get in the same day (costs $20-$80 depending on your GP. I have private insurance that pays up to $38) - GP orders blood tests, these are free. Clinic is on-demand, just show up. Wait times are around 30 minutes. Also prescribes ibuprofen ($5 for 100 tablets) and paracetamol (non-subsidised. $10 for 100 tablets). - GP will assess you and refer to a public or private specialist depending on your preference. In my case a public rheumatologist would have taken around a month to see, so I chose private. This cost $180 for the consultation and $120 for follow-up (insurance paid 80%). - Specialist refers more tests. For me this was an MRI. Public wait times were around 3 months because the machine needed replacement and they'd only pay for serious cases to go to the private clinic. I went private, this cost $1400 (insurance paid 80%). - Specialist orders more blood tests, still free.
And they still didn't find anything conclusive.
Personally I'd like GP visits to be free. They can be for people under a certain income level with the right GP. The public system also needs more funding, but in NZ we spend less per capita on socialised healthcare than the US, and the US has to add private insurance on top of that.
so it is a very hard sell to get more Federal involvement when we have constant stories of VA issues and more available just by searching. throw in rules that actively prevented insurers from making multi state offers and the system was bound to be a mess.
however one of the problems not discussed is that many receive their health insurance from their employers and while this has been going away slowly, this idea like income taxes, tends to remove the cost component from people's minds. you don't see the cost in whole or in large lump sums so its easy to not think about it.
the big hurdle will be convincing people there will be limits of what can be treated. the US infant mortality statistics are one area of exaggeration to the bad simply because to the extent money will be spent to save a newborn that many other system won't
Once you have you'll quickly realise that the 'long wait times' narrative is complete propaganda FUD.
Anecdote time: My sister is anaphylactic, when she goes to the ER she is admitted, hooked up, and given epi almost immediately. When my aunt couldn't move her arm one day, she got an MRI, diagnosed brain cancer, and had brain surgery in the same week.
I'm glad to have a system that when you are waiting it's because there are people with more urgent needs, rather than because there are people who paid more.
> Once you have you'll quickly realise that the 'long wait times' narrative is complete propaganda FUD.
This is a decent example of the typical Canadian attitude I was referring to, blind refusal to even acknowledge any issues, such as the well documented long waiting times for non-emergency procedures, as well as the outright refusal to treat ailments deemed "not important enough" by your doctor.
Say I'm sitting around and I finally decide to get pain in my wrist looked at that I've had since I broke it ten years ago. I could see a specialist in less than a week. However, I probably would have had it looked at 7 or 8 years ago if I was in a single-payer system. Maybe I would have had to wait 6 months to see a doctor, but that still puts me about 7.5 years ahead of where I am now.
I know a lot of people who have bones that never healed right because an emergency room visit is going to cost you a fortune whether or not you are insured, so they don't go to the ER because it doesn't hurt 'that bad'. I imagine that is somewhat less prevalent in places with socialized healthcare.
It reminds me of an old joke about things that don't have a listed price: "If you have to ask, you can't afford it." I think that mentality is really prevalent in the US when it comes to healthcare, regardless of how expensive the procedure would actually be.
1. A friend of mine had severe back pains, all what he got from a family doctor was some painkillers and some stories that his back pain due to to weak muscles and he has to exercise more and wait a bit (3-6 months) before he can get some tests done. Anyways he moved to the US and week later made some tests to find that he has cancer in some serious stage. He started treatment but it was too late.
2. Another friend had spend 6 hours in ER with his eyelid cut in half (he got a branch into his eye while hiking).
3. I had some troubles with my daughter in Canada as well, don't want to go into details.
I eventually moved to the US and while healthcare here is outrageously and ridiculously expensive it is still years ahead of Canadian when you have a good insurance.
Anecdotes don't really do anything for us besides give us pointless things to argue about. You need to look at statistics like life expectancy, quality of life, average wait times, unnecessary deaths, etc.
The fact that you have to qualify your final statement with "when you have good insurance" is the whole problem. Before the ACA, that was far from a given, and even if you had good insurance it was too easy to lose. If Republicans have their way, we'll be back in that situation again.
I don't get it when people bring up situations like your #2. I'm sure it really, really sucked to wait six hours in the ER with an injury like that, but is it worse than staying home and trying to treat it yourself because you can't afford to visit the ER? Is it worse than dying from a simple condition because you can't afford to see a doctor?
Your doctor in Canada refusing to give you a referral to a specialist makes comparing these numbers not terribly useful.
> I don't get it when people bring up situations like your #2. I'm sure it really, really sucked to wait six hours in the ER with an injury like that, but is it worse than staying home and trying to treat it yourself because you can't afford to visit the ER? Is it worse than dying from a simple condition because you can't afford to see a doctor?
A system that allowed consumers to inject additional money into the system would increase the budget and managed properly(!), allow more total health care services to be provided to everyone.
Of course, "this will never work, all doctors will just move to the private sector" will be the refrain. Under our current society and so-called legal system perhaps, but put me in charge, I will put mandatory guidelines and levels of service in place, and then when doctors knowingly break the rules because based on history they well know they can do it without punishment, put a few of them in prison for 10 years, and watch compliance magically improve.
Surely even in the actual best in the world, waiting for something that is no urgent simply makes sense and is the only way it can function. Do you expect a hospital to have 5x as many beds and staff as is often required so you can have instant surgery on your non-urgent problem? (i.e. knee replacement)
Of course you wait a little bit while they schedule it in, otherwise it would cost an insane amount of money to have all those resources waiting around for your non-urgent problem.
My experience with "urgent" problems has always been instant in Canada - my broken nose, my brother's separated shoulder and broken legs. Even when I went in a week after being hit by a car I waited all of 5 minutes before a doctor saw me.
And those in the lower echelon of society economically are those least able to have the time or money to march or lobby for change.
With copays and out of network stuff a lot of people will go bankrupt in case of a serious illness.
By law, those are capped for people with insurance. The maximum that you will have to pay out-of-pocket can be no more than about $7,000, and many private plans set the cap at a lot less.
$7,000 is a non-trivial amount, but it's not a large number of people that both are insured and can't afford their out-of-pocket maximum without bankruptcy.
This is the equivalent of a car payment for the rest of my working life.
It doesn't matter, because that's still capped.
The bills themselves aren't capped. The amount they are obligated to pay is. Insurers make up some of the difference, and the rest is forgotten about. (It's not written down in the accounting sense, because the hospital doesn't necessarily actually treat the entire billed amount as receivable.)
I explained in a top-level comment how this works and why it works this way.
Also worth mentioning, it's been broken for a while (e.g.: ACA is not even broken in yet).
Even with a vanishing middle class, the middle and upper class that remains still have largely great healthcare and healthcare plans, it's the poor who are largely being screwed. Even then, they don't support universal healthcare (it's mostly us hipsters or whatever) because they are still weary of the government and we're still dealing with post-mccarthyism where any sort of government service for the public benefit is socialism.
This is absolutely not true [1]
That's only saying that you'll have bills you can't pay, not that you'll go bankrupt from it. Most (if not all) insurance plans have a maximum out-of-pocket expense amount that's like $10k. Yes, that's more than some middle-class Americans can afford to pay in a year, but it's not enough to go bankrupt over. They just defer paying it until they can afford to.
It's more like $6800 for 2016 and $7100 for 2017. That's the federally-mandated cap; many private plans set their cap even lower.
This is one of the things Obama-care addressed, because before that most bankruptcy's in America where caused by medical bills. I'll see if I can find the article. [1] But with Obama-care going away/being changed this might be a thing again.
[1] "A study done at Harvard University indicates that this is the biggest cause of bankruptcy, representing 62% of all personal bankruptcies. One of the interesting caveats of this study shows that 78% of filers had some form of health insurance, thus bucking the myth that medical bills affect only the uninsured.
Rare or serious diseases or injuries can easily result in hundreds of thousands of dollars in medical bills - bills that can quickly wipe out savings and retirement accounts, college education funds and home equity. Once these have been exhausted, bankruptcy may be the only shelter left, regardless of whether the patient or his or her family was able to apply health coverage to a portion of the bill or not. (Find out what you can do to avoid a financial meltdown when there's a medical emergency. " http://www.investopedia.com/slide-show/top-5-reasons-why-peo...
If I didn't have a comfy software engineer salary, and instead lived paycheck to paycheck, this would've been devastating, even with insurance.
You're right. Of course the private insurance premiums have a negative expected value. Aside from insurance always having a negative expected cash value by definition, private insurance premiums are literally used to subsidize care of Medicare, Medicaid, and uninsured patients.
Insurance was billed ~10k, with coinsurance I had to pay $1,400. This is after the hospital billing in multiple rounds and forgetting to bill insurance on one of them and also forgetting to send the bill to me (which if I hadn't been proactive about following up with would have led to it getting sent over to collections).
I'm assuming I have better health insurance than a decent percentage of the population and I can afford the bill but how the hell can most people? What a terrible, terrible choice for someone to have to make between getting care when they're at their most desperate and avoiding financial ruin
I see USA as a country where, if the car crash didn't kill you, the medical bills certainly will.
The idea that life is unfair and random is not accepted by america.
Black americans oppose any kind of social service that might benefit anybody but themselves including other black americans.
People are people and ignorance doesn't have a color. It has always been like this. Blaming one or the other doesn't actually fix anything and it is also why nobody brings it up any longer not because they are afraid to mention it.
We don't necessarily need socialized medicine. If we just went back to the way things were done in 1970 everything would be solved. The money the government currently spends on healthcare subsidies could buy free healthcare for everyone at 1970 prices.
Life expectancy was a bit shorter in 1970, but not by that much. And most of the increase is due to other factors than healthcare (e.g. the smoking rate has dropped a lot, cars are much safer, air pollution is reduced, etc.) And there have been studies done that show increased spending on health care doesn't really correlate with increased life expectancy.
http://time.com/4829103/mitch-mcconnell-protest-senate-healt...
This last Saturday, there was a peaceful protest of around 200 people held in DC in front of Congress. One of my friends attended this protest. Around 150 of them were arrested, and then given bullshit charges, like crowding, obstructing, incommoding, or resisting arrest (of what charge were they being arrested for, angering Trump...).*
When you try to "peacably protest", and "redress the government for a redress of grievances" and are arrested, detained for 6 hours, and then given a $25 citation of 'crowding' - what else do you do? Molotov Cocktails? AR-15's?
The answer, unfortunately, is nothing. You keep your job, eat decent food, and live a life under whomever the current 'king' is. And hope to the gods that nothing knocks you down to a lower socioeconomic ladder rung.
* https://www.washingtonpost.com/local/public-safety/police-ar...
If you are unable to enact the change you want from within the system it's because not enough people agree with the change you are proposing.
Welcome to the complexities of Society.
If you don't want to participate you don't have to. Abandon the laws of man and return to the laws of nature. Just remember the law of nature demands conflict be resolved in the favor of the more powerful will. I doubt very much you would fair well.
Because that's some bullshit.
Most of the great social and political progress in western nations has come from mass civil disobedience. You take that away and you begin to stagnate.
I don't think that anybody really believes that the mess we've made of billing/paying-for services via insurance + government + hospital/doctor is a good idea. At least nobody who has dealt with it for more than 5 minutes, which is most people over 25.
The problem is that nobody can agree on how to fix it. One side wants to socialize the whole thing, the other side wants to do... something else, I guess. Regardless, neither side has enough power to just do what they want, so we're stuck with this bizarre Frankenstein's monster instead.
Meanwhile it's almost impossible to escape from the mess. You can't just have no insurance and pay for yourself, because they've made the prices for most things ludicrously high and then basically rebated them to the insurance companies.
Actually, it reminds me just a bit of that paraphrase of the Laws of Thermodynamics: you can't win, you can't break even, and you can't get out of the game.
We have the resources to fix many of these problems. But we won't. The powers that be would prefer lower taxes.
http://www.econtalk.org/archives/2017/06/christy_ford_ch.htm...
The guest is an economic historian who details the historical forces which led us to where we are right now. She also describes a few different, more effective and rational models (not just single payer) which could potentially have existed, but which sadly are, for all practical purposes, impossible to get to now.
Media outlets like to publish horror stories because it attracts eyeballs.
Yes they can happen and there are bad actors in the system. But most ER patients either don't pay a dime because they don't have a dime, or their insurance picks up the tab subject to deductible. "In Network" rules specifically don't apply in true emergencies under most plans. Of course if you go to the ER for a runny nose, there may be some pushback.
It's primarily lots of Byzantine rules in small print buried in long policies that few people read and even fewer memorize. If you are lucky and are conscious when you need to use a policy to visit a health care provider, you can bring your policy with you to ensure you follow it, but it's not always that easy. The health insurance company claims they told you how to follow the policy, but they don't make it any easier than they legally have to.
If you skip a rule (like calling your health insurance company before you visit an emergency room), that might violate your policy. If you visit an "out of network" hospital when you should have visited an "in network" hospital, you may be liable for the difference in cost (which is huge due to health insurance distortions in the medical market). If you try to go to a medical specialist without first going to your primary provider (as defined by your health insurance company), they likely won't cover it. There are usually dozens or hundreds of pages of these rules in booklets that you get when you join an insurance policy. If you don't know about / forget about a rule, you are responsible for the costs associated with the violation.
It's easy to unwittingly ask a health insurance question about your policy to the office manager at a doctor's office (who isn't qualified to speak about specific health insurance policies) and getting bad information that you then assume is good.
> Why aren't people marching in the streets?
I think most people see this as a "free market" problem (since 60%+ are covered by their employer-sponsored health insurance), not a political one. ~20% of Americans are covered by Medicare (the retirement-aged national health coverage) or have military veteran benefits, which are generally considered pretty good (unless you listen to political arguments). How would "marching in the street" fix a problem that people have with the "free market"?
The remaining 20% are among the most politically apathetic. We are lucky to get 50% participation of the voting-eligible electorate, even in presidential elections (which have higher turnout than other elections).
I think lots of Americans pride themselves on being stubborn and pretending like painful things aren't painful, then trying to ignore them.
Lastly, I think most Americans simply don't think that marching works. Rural America doesn't march. Urban America only seems to march for generic social justice causes, not for specific policy improvements.
The UK cried and moaned when the NHS was introduced but now (aside from Conservative efforts to "starve the beast" on it) most wouldn't go back for the world (though it could be improved, obviously).
The US has a mentality that it's the best in the world for everything. Even when it's objectively not true (like in healthcare) this colors the debate.
Fundamentalism, basically.
Or maybe fanaticism is a better word.
For the rest who aren't, there's a simple reason: services operated by the government tend to suck (or are at least perceived to be so). It is an American tradition to stand in long lines at the Department of Motor Vehicles to renew your driver's license, or to get your vehicle inspected. The TSA exists to inconvenience travelers. Public schools are perceived to be failing (they are in some places; I was lucky enough to get a very good education in public schools) even if they are not necessarily. The Postal Service is not profitable (even if it doesn't need to be...) and there are always lines at post offices. And so on. (typing on mobile, could give more examples but I'm sure others have their own)
Whether these problems are real or not is irrelevant. Americans distrust the government, especially the federal one. You could call it indoctrination, to a degree. Those who benefit from the system are allowed to persuade the populace, even from birth, and are supported by both major parties. (Drug and other healthcare advertising is legal.)
It is also part of our history. The tradition of the US is a distrust of big government. Before the US Constitution was written, we had a federal government under the Articles of Confederation. It was meant to be permanent. The federal government was extremely weak, gave too much power to the states, and ultimately did not work. So the Founders had to go back and try a second time and gave the federal government more power. And that's where we are today...but that feeling of distrust has persisted through the centuries.
So to sum it up: many like the idea of private healthcare not because they have a choice, but because they believe that the government(s) will screw it up worse.
Americans seem to have always preferred so-called "freedom" to social solidarity. It's every man for himself over there in the land of the free.