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Comment by petesergeant | Hacker News Reader

It is, although it disproportionately affects people who are poor but not broke. If you’re truly broke, there’s Medicaid, if you’re old there’s Medicare, 4% by some form of military healthcare, many people covered by their employers, and so on. 90% of Americans are insured.

As a Britisher, obviously I’m in favour of universal healthcare, and I think the US system would benefit from it. But let’s not pretend it’s perfect there either

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> 90% of Americans are insured

I'm one of those 90%. My health insurance (family of 4) costs more than my house payment, and the annual deductible is over $6000 (for one person). Either the premiums or my deductible goes up every year. In terms of total cost (monthly premiums plus annual deductible) it's also pretty much the least expensive plan that I can get.

It's not that health care here is bad, it's that it's ridiculously expensive compared to most other places in the world.

> It's not that health care here is bad, it's that it's ridiculously expensive compared to most other places in the world.

Sure, but the average American also gets paid $20k more than the average Brit, on average.

That doesn't matter for this discussion, because the average American spends way more on healthcare as a percentage of their income than the average European.

~25% of the federal budget goes to medicare and medicaid, i.e. healthcare for other people. On top of that, you're paying for your own medical insurance as an implicit deduction on your salary for your employer-sponsored healthcare plan, or you just pay for your plan directly if you're self-employed.

Those percentages add up.

Whereas in the UK, or in Sweden where I'm from, you only pay once through your taxes for healthcare for everyone, including yourself.

On top of that, copays are higher in the US, annual deductibles are much higher, procedures are much more expensive, medication is much more expensive. Healthcare in the US is simply disproportionally more expensive than in the rest of the world, as a percentage of people's income, and as a percentage of GDP. It's got nothing to do with salary levels.

We spend over $30k annually just on premiums. On top of that, we pay for most doctor visits, tests, prescriptions and procedures out of pocket.

Edit: everything we pay out of pocket we can deduct from our taxable income (it's an HSA plan), but still.

The medium income is about $48k vs £38k which is much more realistic than averages when a select few make millions per year. Healthcare costs can easily exceed this difference.

> f you’re truly broke, there’s Medicaid

Which you still might not qualify for, and may not get even if you do qualify for it (https://www.theguardian.com/tv-and-radio/2024/apr/15/john-ol...)

> 90% of Americans are insured.

Which doesn't prevent nearly 40% of americans from being forced to put off needed medical care because of the expense they're still subjected to. (https://www.cnbc.com/2023/01/20/americans-put-off-health-car...) Medical debt is the leading cause of bankruptcy.

Again, with the caveat that I much prefer the British system...

> nearly 40% of americans from being forced to put off needed medical care

Hard to interpret UK NHS waiting-time figures, especially given the political weight given to them, but these[0][1] paint a picture of 6 month to >1 year waiting times.

0: https://www.boa.ac.uk/resource/boa-statement-on-nhs-app-show...

1: https://www.rcseng.ac.uk/news-and-events/media-centre/press-...

> Medical debt is the leading cause of bankruptcy

Medical debt for non-elective treatment feels barbaric, although digging into the figures (2m personal bankruptcies a year, 60% medical) gives 0.3% of the US population declaring medical bankruptcy a year, possibly going up to 1% if you do fancier maths involving households vs people.

It might be worth stressing for US audiences that the UK NHS waiting times quoted are for elective non life threatening procedures; osteoarthritis surgeries that decrease pain for people already with a degenerative joint disease, hip and knee replacements, etc.

The long wait times, 22 weeks mean average, > 63 week in 8% of extreme waits, are regrettable but not indicitive of waiting for urgent emergency life threatening required non elective procedures which are relatively prompt and immediate for the most part.

I don't think your portrayal captures the reality of this well. Again, generalizing about numbers when it's such a hot political issue is difficult, and it's super-easy to cherry-pick, but take three NHS trusts in the South East, which for non-Brits is the rich part of the country -- I've chosen these three because I'm somewhat familiar with the hospitals themselves, and they're all big enough to have multiple specialties. I suspect if anything they understate rather than overstate the problem.

0: https://www.myplannedcare.nhs.uk/seast/royal-surrey/

1: https://www.myplannedcare.nhs.uk/seast/oxford/

2: https://www.myplannedcare.nhs.uk/seast/buckinghamshire/

For each specialty, there's a waiting time, which is the time between you seeing your local doctor and then seeing a specialist, and then there's a waiting time given from when the specialist refers you for a treatment -- they need to be added together. Cardiology is 17+21 weeks, 10+12 weeks, and 25+28 weeks, urology is 12+18 weeks, 18+23 weeks, and 25+20 weeks. Orthopedics (for your osteoarthritis example) is at 17+24 weeks, 22+46 weeks, and 20+25 weeks.

> not indicative of waiting for urgent emergency life threatening

Hospitals in the US can't turn you away if you show up presenting urgent, emergency, life-threatening symptoms either, and I suspect those are not the types of medical care that people in the US are generally putting off for cost reasons (although I'm sure there are a few cases where they are).

> I don't think your portrayal captures the reality of this well.

"My" portrayal is a summary of the information in the links that you provided.

I’ve used emergency care in the US and U.K. waiting in the U.K. was half an hour, in the US was 4 hours. The U.K. was of course free, the US was $2k

Same problem, same prescription.

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