Hacker News Reader

Comment by curo | Hacker News Reader

I've heard this so often yet we left the UK for no other reason than the healthcare. My wife was pregnant and the experience from 0-7 months was so terrible, we flew to the US to have the child.

Post-operative outcomes and survival rates in the US are far better than in the UK and many European countries. Statistics about better birth outcomes or higher longevity is best attributed to healthier lifestyles in Europe/UK and to lower stress (shorter work weeks, etc).

While healthcare in the US can be very expensive, we paid 8k GBP for our NHS immigration surcharge and an additional 5k GBP in NHS-specific taxes (for 2 people, 1 year). A 1k/m health plan in the US (for two of us at the time) gave us 10x better health care.

Yet Americans and Brits alike sing the praises of the NHS vs US healthcare. I chalk it up to shoddy journalism and folklore.

View on HN

I don't think anyone disputes that us healthcare is better if you have the money.

According to GP it’s the same price as the UK.

So then healthcare in the US isn't "worse", it's only worse on average. Why would the people with money ever want to change the status quo?

Because in most democracies the median is what you optimize for, not the extremes, since poor and rich alike only get 1 vote each.

Additionally there are knock-on effects where lack ofgood average healthcare tends to reduce ecconomic efficiency as sick people are bad at working.

then you can understand why those of us with better healthcare and money don't want to take a downgrade to a "universal" system that is better for ppl with no money but worse for others. most middle class ppl in America have decent healthcare as a job benefit so most of us don't want to change. this is why "if you like your doctor you can keep them" was an essential talking point for passing obamacare.

Do you actually like having your health insurance tied to your employment?

To me it would be a huge worry if I lost a job and needed healthcare.

no. but i would rather good healthcare tied to employment then mediocre healthcare that's not. it doesn't seem like other countries have been able to achieve good healthcare not tied to employment so i think it's better to focus on liberalizing the market.

btw it was the ridiculous wage and price controls that led to employers adding healthcare as a benefit... so doesnt seem like more government gonna fix it.

I have both in the UK. There's the NHS when I need it, but I also have private medical insurance to top it up. I don't worry if I lose my job, I just won't have the shiniest hospitals with flowers in reception, and I'll have longer waiting times.

The quality of the medical care itself (once you get it - there are long waiting lists in the NHS now due to Covid) is really about the same.

We looked at Bupa. Is that what you have to supplement? We're earnestly interested in coming back to the UK. But our fear is having more children. It didn't seem like private made a difference in that case.

I had an inexplicable leg I couldn't walk on. I paid for all my x-rays and MRIs after waiting for the NHS for 6 months. If some 500 GBP supplement fixes these problems, that'd be great. As I understand, private health care in the UK is more for bedside manner and responsive GP phone calls than for anything substantial. But I'm selfishly interested in being wrong.

IHS is £624/yr, and what do you mean by NHS-specific tax?

Overall, I probably pay more towards the NHS than I would for healthcare in the US, because I'm a comparatively high earner, and that's the nature of progressive taxation. The NHS seems fairly good value for money, however, although I think that may be due to how much we underpay nurses and doctors.

I'm sorry you had a bad experience. Many people do, and the service's deficiencies are widely publicised domestically. Even at its best, the service has always been a bit rough around the edges - not like the beautiful hospitals with friendly service that you often get by going private.

However, what people like so much about the NHS here is the universality and lack of barriers to access. If you're sick, you just walk in and get treatment - doesn't matter who you are, no charges, no paperwork, no insurance or anything else. Unfortunately, even accessing care is becoming more difficult in recent years. Increasingly people I know are relying on private insurance or self funding to get treatment in a reasonable timeframe.

I assume they mean National Insurance, which gives the impression that it’s a NHS-specific tax, but isn’t.

Yep NI, thanks for clarifying I didn't know NI != NHS

You're very lucky! Where can I find a plan that costs $1k/mo in the US for 2 people and I assume you got kids as well.

Is it paid fully by you or does your employer contribute to it? If your employer contributes, how much would it cost you if you leave the job?

I assume the $1k/mo is only premiums. How much do you pay for deductibles and copays?

Does your insurance cover 100% of your medical bills when you meet your deductibles? Or are you still on the hook for 20% of it?

What happens if one day you lose everything, and you can no longer pay the monthly premiums?

Really it's $1.2k for two of us. $600 a piece. CO. I pull $80k out of a C-Corp and my wife is unemployed so there's a small tax refund. Deductible is $500 for me, $0 for my wife. Our kid has changed that equation.

To answer your last question, if we can no longer pay monthly premiums, then Medicaid exists. The difficulties likely mirror the difficulties with the NHS.

You bring up great points but having experienced both, I'd still go with US healthcare 10 times of 10. It really is *that bad* -- maybe NHS was great back in the day but when we got back stateside US care felt like an oasis in the desert.

Reply on news.ycombinator.com