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This is par for the course in the UK. Not saying it's good enough, but it's truly par for the course.

NHS budget in 2021 was about £135B or ~$180B in USD, which is offered to the entire UK population ~67M.

Medicaid budget was $458B in 2020, offered to part of the US population (~84M).

So we have UK: $180B for 67M people US: $458B for 84M people

The only difference is that $458B is provided solely by the 270M Americans who, in exchange for their medicaid funding, are banned from using it.

So basically, we have an NHS in America but it's only for the people who don't pay for it. Then we have an entire secondary subsidization going on with health insurance which some comments above have pointed out is often tens of thousands per year.

One of the most crooked things I've ever seen.

May be relevant to this, that money probably goes a lot further in the NHS than in US system. Staff are paid less, hospitals run on lower budgets, less unnecessary tests, no billing systems, less beaurocracy (NHS has its serious IT issues, but not probably to the level of US healthcare) etc . The NHS is badly under-funded at this point, and more and more Brits resorting to private healthcare to jump waiting lists, and wards in hospitals are not exactly posh, and getting appointments is harder, and you can see things creaking. But I think I'd still rather be treated by the UK's system than USA, unless I was extremely lucky with the right kind of US healthcare insurance, lived near a particularly good hospital etc... If the US would simply adopt our system that everyone deserves treatment no Qs asked, I think that would make life in the US a lot better, for everyone actually, not just low income people.

I live in Romania and often wonder why there isn't more medical tourism...a good way to have a holiday and get a diagnosis.. I've had surgery done here, maybe I was lucky because it was dirt cheap but the hospital stay was beyond basic but then again I didn't stay long... I stayed the winter in Egypt and heard the same thing, cheap prices, good service... wierd not many seem to be taking advantage of combining travel and doctors...

> I can't stress enough how uneven and cruel the US healthcare system is.

Yes, and there is no doubt healthcare is expensive. I won't rehash the reasons it's particularly expensive in the USA; they're well-known, though there isn't strong consensus. But:

> I feel the only way to survive long-term is to have a career that enables access to jobs (or unions) that offer health care as a benefit. Without it, paying for family-level premiums is similar to a mortgage.

"Obamacare" tried to remedy this by capping healthcare costs at 8.5% of income. Yes, there are holes (in particular, before 2021 this only applied to those earning under 400% of the federal poverty line FPL) and healthcare is even more egregiously expensive in those special cities where 400% of the FPL is below the local poverty line.

But whether you get subsidized by the state, a union, or your employer, the thing to keep in mind is that the costs of healthcare are ultimately still borne by "you": really, we, collectively, employees, union-members, taxpayers -- yes some of us are privileged enough to work for companies that are not financially constrained, but for most employers an extra $1000-3000/mo going to healthcare (you did say "family-level premiums") just feeds in to their total cost of employing you. Offering that benefit to employees means the pay they can offer you as an employee is constrained by its cost as well.

If having employer-based care is the only way to survive, then what that really means -- since money is fungible, really -- is that having the privilege of being well-compensated is the only way to have effective healthcare.

I think that's worse, honestly.

>> If having employer-based care is the only way to survive, then what that really means -- since money is fungible, really -- is that having the privilege of being well-compensated is the only way to have effective healthcare.

Anecdotally, it seems to be the current and foreseeable future.

I had a co-worker a couple years ago that had an undiagnosed condition (lupus) for many years because he couldn't afford healthcare. Once he had insurance, he was able to pursue various doctors for help. This is the pattern I've seen.

>> the costs of healthcare are ultimately still borne by "you"

Yes, and always will be, but costs have ben obfuscated for years. For-profit health insurance is one of the big issues, in my opinion [1]. Profit-making is largely apathetic to patient outcomes. I have no idea how to realistically change this current structure.

[1]: https://stanmed.stanford.edu/2017spring/how-health-insurance...

> Yes, and always will be, but costs have ben obfuscated for years. For-profit health insurance is one of the big issues, in my opinion [1].

I have no kind words for for-profit health insurance, having been burned by the industry myself. Being for-profit definitely doesn't help, but the non-profit insurers in the US are not much better. The truth is, the incentives are terrible all around, including -- and you won't read this in Stanford Medicine's quarterly magazine -- the fact that we train far too few doctors, nurses, and other medical staff, work them far too hard while not using their time well, and pay them very, very generously.

Then again, the cost of higher education has grown tremendously too, without (that many) for-profits taking a cut, and that's an industry where we face no shortage of qualified professors, work them harder (oddly) the less they get paid, and pay the ones teaching the most classes, well, let's just say it's not "very generously".

Perhaps the major commonality is that the people getting the service are often not the ones paying (at least, up front) -- either insurers or lenders are? That and also these are both highly human-capital-intensive industries.

> Now, my sister is currently struggling with a serious issue, and as a Medicare patient (being under the poverty level), she wasn't able to be seen for months, and even now they are unable to diagnose properly due to delays in getting her referrals or tests (CT scans, etc).

This sucks, and I’m genuinely really sorry that you and your sister are having to go through this. I hope she gets the care she needs soon and that the delays don’t cause any irreparable harm.

Unfortunately, the current issues with access probably have more to do with the way the pandemic has crushed the health care system than with whatever insurance your sister is using. My experience has been that getting access to services right now is much harder than it was in 2019. I’ve had referrals take 3 weeks just to get a scheduler on the phone (plus 1–4 month wait times), physicians wasting their time chasing people up and doing their own scheduling because their support staff no longer exist or aren’t doing their jobs, labs that don’t return phone messages. I even had a clinic outright ghost me last year. It’s an absolute shitshow out there right now.

(Also, pedantically: Medicare and Medicaid are two confusingly similarly named but distinct things. Medicare is federally managed for old and disabled people; Medicaid is state managed federally assisted for low income people. You can be on both Medicare and Medicaid at the same time because Medicaid will pay costs that Medicare doesn’t, but they aren’t the same thing.)

> I feel the only way to survive long-term is to have a career that enables access to jobs (or unions) that offer health care as a benefit. Without it, paying for family-level premiums is similar to a mortgage.

I’m not sure even this is a long-term solution. A friend of mine who works for a very large financial institution as a software architect has had their premiums increase by 200%, OOP by 300%, and deductible by 400% over the past three or four years. They had to figure out how to absorb almost $10000 in new health care costs this year after the company eliminated everything except for some high-premium high-deductible plans.

Thanks, I get the two confused. it's Medicaid.

We are currently hosting Ukrainian refugees and one of them was suddenly struggling to breathe. We brought her to the hospital two days ago and they made her sign a single sheet that says "you can request the social services on my behalf". Since then she's been transferred to another hospital, has been CT scanned and they did at least a dozen different tests on heart, lungs, etc. all it took was a few hours of waiting and the power of Google translate to make her be understood. We expect that she will not have to pay a single Euro.

Honestly I don't even need to tell you which country that is as that's what I would expect in any western or northern European country (except maybe Switzerland, which is its own capitalist hellscape).

The US is still the richest country in the world. That you are suffering is not needed. It is not a necessary feature of the system. It's a policy choice.

If your poor and in certain US states, Medicaid is pretty comprehensive.

Medication including PrEP, Metformin (for diabetics), sleeping meds and such are free, and you won't pay a single dollar for going to the emergency room or going to see your doctor. Dental coverage even exists too!

That being said it is a fragmentary system where those that do not qualify for Medicaid in states with good coverage essentially only have more expensive and varying quality options available. The quality of said options can be difficult to evaluate as an outsider to the medical industry as well.

I think Switzerland is not bad in this respect. There are several health insurance companies, but the basic plan's coverage and price is set by the government and it's quite comprehensive. Those who can't afford it get it through social services.

Switzerland locks you into obligatory health insurance, starting at around 200$ a month but with 2k franchise which you pay before you get covered or more like 400$ a month and then you're still liable for 10%of the bill...it's a capitalistic hellscape allright...sure you can get government subsidies...not sure what each cantons requirements are... the irony imo is that under the guise of competition people pay multiple management organizations of different health care companies a good cut ... they tried 7? times to vote by referendum to amalgamate them all but ¯\_(ツ)_/¯... Also I've been through their "Urgences" triage in Lausanne with a menisque problem and they were incredibly inefficient and then had the gall to charge me 100chf and bill me for painkillers I didn't want...