Naively I would assume as a non-American that if you're in the top 20% by income in the US you end up much better off than the top 20% income Brit, for example.
Or is it just actually worse for everyone? It feels intuitively obvious that the average will be worse because, well, the average person is skint and the US is less socialist.
I'm sure that if you're rich enough, you have fantastic care available in the US, but from what I've seen of prices for pretty basic stuff, I'm not so convinced most of the top 20% in the US have healthcare I'd consider tolerable.
Here's an NHS case.
Case 1. My friend's wife had her body going numb, like, completely senseless. They didn't have a private insurance back then. It was maddening hard to get past the GP. And then there were numerous tests, and queues, and... She had a viral brain infection that was, luckily, easy to fix. Could go horribly wrong should they wait for a couple more months.
The problem is that GPs are afraid to assign tests other than the most simple blood tests (unless it's an obviously broken bone).
Case 2. My wife fainted in the middle of a family dinner. It looked serious, and I recognized the sympthoms thanks to dr. ChatGPT. Our car was at service that day. I was trying to get an ambulance but calling all the publicly available NHS numbers but all we got were endless questioneers. We had to force the situation by taking a taxi right to the hospital door. She had an urgent surgery the same evening, quite serious.
Again, there's just TOO MUCH backpressure from NHS at the entrance. Once you get past these filters, it actually it decent.
OTOH, with my highest tier private insurance I had an MRI scans, kidney checks, blood tests all done within a week or two, mostly because of how I had to coordinate things between various private clinics. Not fast, sure, but acceptable.
As for tests, one of the reasons they "are afraid" has nothing to do with being afraid, but what is medically indicated. A lot of private services will do everything "just in case", the NHS won't. That means you often get people wondering why they've not been sent to an MRI for example (as one of the most common examples), because it's only actually affecting outcomes for a very small set of diagnoses. But some GPs certainly do get it wrong, and people need to be more aggressive about changing GPs if they feel they're not being heard.
So how it works, unfortunately, is that GPs get a lot of pressure to not do things "just in case". But "just in case" is the only way you can notice things that are wrong on a deeper level.
What, for example, is "back pain"? In 90% of the cases this can be fixed by, say, 10 sessions with a physio. But sometimes it can mean something serious, like a spinal disk injury.
Or sleepiness. 98% of that can be fixed with lifestyle and diet changes. But sometimes this can a sympthom of something scary.
Or my wife's example: didn't feel quite right for 3-4 weeks then fainted. Turned out to be serious. The full GP discussion would have taken weeks.
Or my friend's example: increasing numbness, nothing serious at first. Major brain infection. The GP actively tried to downplay things.
I don't know if there is a solution to this. Right now it feels that without chatgpt-assisted self-diagnoses and being aggressive with getting over the GP wall the system tries to avoid helping out.
Waiting times are not only for non-essential things. The only thing with no waiting time is A&E if you are in immediate danger of death.
The NHS is some "safety net" that does the bare minimum at this point, or no longer anything at all (eg. dentistry).
Interestingly, nowadays if you have a good job and private insurance in China you get better routine checks than in Europe/UK. Even Chinese hospitals are extremely thorough and quick compared to British ones (at least the main Chinese cities)
There's an inflection point, sure, where you start spending enough privately that the insurance is worth it, but so many of these things are so cheap here anyway that the gap from between where it starts to pay off until you're ill enough to get reasonably fast treatment with the NHS is quite narrow.
Sometimes people think it is wider than it really is because people want and push for treatments that are not medically indicated. E.g. patients pushing for pointless MRIs is common enough that same-day MRIs is a huge industry here even though they only make an impact on outcomes for very specific symptoms.
For instance the UK have very bad outcomes for cancer because things tend to be caught late and treatment delayed thereafter. Frankly, for anything potentially serious or time-sensitive I would go straight private (and in fact the NHS tells you to do that when they ask you if you have private insurance).
The NHS has much bigger problems than funding. Even the new, left-wing government has indicated that they won't increase funding without reforms.
It's always very convenient to starve something of funding for years when you want to insist something needs to be reformed before you can spend as much as it costs to provide service at an adequate quality.
Reform or no reform, outcomes won't improve without increasing the funding, as no other system in a comparable country manages to deliver more at the NHS cost level.
Another issue is that the NHS is a religion. It is blasphemous to suggest departing from free-of-charge delivery or private involvement (although that's already what we have). Even suggesting "reform" is badly received.
I'm from the US so excuse any oversimplifications, but over the past couple decades I've noticed a trend of US-ification in British politics. I would be careful with looking to greener pastures.
The French system is based on a mandatory health insurance, now with mandatory private health insurance in addition to that.
GPs and most health professionals are private practices that set up shop like a, say, lawyer would and there is big private sector involvement up to hospital level.
I think there are many similar examples throughout the world.
This is partly why I find this focus on the US system in the UK puzzling. My best guess is that it is used as a scarecrow by those opposed to any changes to the NHS.
- USA: $819k (2021)
- UK: £187k = $247k (2024)
- FR: €111k = $123k (2023)
Or are you just talking specific tech jobs.
The 95th percentile US taxpayer earns as much as the 99th percentile Brit. Huge, huge difference.
A billion is just three Manhattan skyscrapers, so it can't change a city. Depending on where you live, you might well experience the exhaust, dust and noise of these environments, no matter how luxurious your individual dwelling.
But I did double-take when walking past Russell T Davis (or a lookalike) in Sheffield a decade and a half ago, and Richard Osman in Cambridge train station some other time.
I'm fairly sure most of those can go out for dinner or drinks and no one would know who they were.
In all cases treatment is required by law, regardless of payment.
No, it's not. This is a myth. The only thing that's required is to stabilize the patient. If you need surgery to repair your shattered leg bone so you don't get an infection and need an amputation, you're not going to get that surgery without payment. But once you get a bad infection and need the leg amputated so you don't die, they'll do that for free.
As best I can tell, the medical community and education system would reject a doctor in the US from licensure for any other attitude towards health care.
That would delay treatment, sadly, same as it would everywhere else in the world. Filling out forms is a barrier to healthcare no matter where you go. That barrier does seem to be bigger in the US. No doubt.
But healthcare is available, it is partly socialized, and given enough effort, it does work for a large majority of cases, as is evidenced by life expectancy.
I think what's unique about the US is that the burden of cost for the average American is put on their employer, which for many is a rich cooperation.
It's a tax on the rich. It's not perfect. But it's far from bad when compared with most other countries. Maybe even all others. Not sure.
* Hospitals must treat or stabilize regardless of payment, but only for emergencies - they just have to try to keep you from dying on the spot
* The ACA (or Medicaid) subsidizes insurance for the unemployed, if your household income for the calendar year is low enough
* Employers are required to offer coverage to their employees, provided they work more than 30 hours a week at that company and it has at least 50 full time employees (this extends to dependent children but not spouses or other dependents)
This is better than nothing, don't get me wrong, but it could be a lot better still. We have the technology.
Screening for and stabilization of emergency medical conditions is required at all emergency departments by law, regardless of ability to pay, but that's much more limited than "in all cases, treatment is required by law, regardless of payment", and even then, hospitals skirt the rules.
To contrast, my sister lives in Europe and needs shoulder surgery and unless she pays for a private treatment (by the same doctor) she will not be treated for 12 months. Guess what I paid for. Is that any better?
Many employers do not provide coverage. They skirt the law by employing people part-time (Walmart, Amazon) or as gig workers.
Even if the law reads as you claim that doesn’t mean you can get care in the US.
>Many employers do not provide coverage
For under 50 employees, making less than 50k, Healthcare.gov covers those cases. You can visit there now to confirm my claim.
And yes, it means you can get care in the US. I brought my Euro girlfriend here and she got care under a bullshit name. And they treated her, the same as any other patient. And she never paid anything. It was non emergency and we went to an emergency room anyway.
Do you have a counter example? If so please share.
I'm not sure what point you were making, or refuting, but I didn't catch it.
https://journalofethics.ama-assn.org/article/obligation-prov...
It wouldn't make sense to risk your license or insurability. It's a bad business decision both for the doctor and for the hospital to send you home without care and discover later that a more serious condition was underlying the symptoms presented as non-emergent. It makes sense to at least check, and in so doing, treat. And if treating to provide the best care possible to avoid liability.
If you have examples of hospitals doing otherwise as a matter of practice I'll be interested to understand how that business model is possible.
As far as I've researched, I've only found cases where the hospital was sued and lost. Doctors fired or jailed. Etc.
The situation is that by requiring emergency care (which is subjective) the law creates enough risk that the de facto mode of operation is to treat all cases where risk is a factor, which is very nearly all cases.
Personally I have experienced wait times approaching infinity, the hospital not denying care, but not providing it either, because people with insurance or cash get to the front of the queue unless an indigent person bleeds out in the ER.
If you go to an ER and need diagnostic tests for a real but non-emergency condition you will likely get referred to a diagnostic clinic, a place that only does tests and does not provide medical care, and that’s where your journey will end if you don’t have insurance or cash up front.
Try to get prenatal care in the US without insurance or cash. Possible to find programs for low-income uninsured people in some cities, but not everywhere by any stretch, and getting worse every year.
Talk to homeless people and advocates about people who cannot get treatment or medications because they have no insurance or money. Hospitals won’t dispense things like insulin until you go into shock in the ER, assuming you can get to one.
Yes, you're required to fill out forms and participate in the system. And therein lies the rub. The people that don't have care are those who are not capable of filling out and keeping up with all the forms. Or are otherwise unwilling to do so. And that's exactly how it goes in Europe too. You don't just get to walk into any hospital with no ID and no registration (aka insurance) and get non emergency care. That's pretty comparable. And even with their "free" care they still have to pay for private treatment from the same doctor anyway so they won't have to wait a year for non emergency surgery.
At worst you can say our forms are longer, and more complicated. But you can't say it's not socialized. If you fill out all the forms you get the same care at the same price as Europe (if you count taxation) and at least in my state, there's no line for the hospital and I can see a doctor in a few days, usually, for specialty stuff.
And objectively, we have more broke people entering this country and still living long enough that our life expectancy is on par with countries that have a tenth of the immigration rate and a lesser poverty rate. So medically speaking, we're pretty miraculous, all things considered. So says the data.
That statement doesn't match actual data about ER wait times, for example [1], [2], [3]. It seems anecdotal (one lucky visit) at best, and just made up at worst. As the father of three with multiple ER visits of varying severity in my own set of anecdotes, 8 minutes seems extremely unlikely unless you required resuscitation, or the ER had no other patients.
While a hospital employee (health care professional) may talk to you within a few minutes to ascertain your condition and severity, and insurance/payment method, that doesn't equal time to get care, nor does it mean you will leave the ER with satisfactory treatment, referral to a clinic, or medications. Because American hospitals very often don't have diagnostic equipment, or only want to use it when absolutely necessary (and payment looks likely), you may get "treated" with pain killers and antibiotics and referred to a diagnostic clinic for further tests, scans, etc. Those clinics do not treat anyone who walks in, they require payment in advance of treatment, so they create a chokepoint on people receiving actual needed care.
One relative waiting over six months for a non-emergency MRI in Oregon. Another has waited for over three months for her insurer to "approve" diagnostic imaging for a foot surgery her (required by insurance) primary care provider already prescribed. That kind of thing happens in other countries too, but I have walked in to hospitals in Taiwan, Thailand, and Malaysia and received immediate care, including diagnostic imaging, at prices a fraction of what I've paid for the same thing in the USA.
Without getting into the possible reasons, health care in the US consistently (during most of my lifetime anyway) ranks very high for cost, very high for corruption and profiteering, and increasingly worse in terms of outcomes. And the US has a large and growing population of uninsured and underinsured citizens, even compared to other countries with similar demographics and immigration (Canada, Australia).
> our life expectancy is on par with countries that have a tenth of the immigration rate and a lesser poverty rate
Actually the US ranks rather poorly in terms of life expectancy, even compared to countries with similar immigration rates and poverty [4]. You can slice the numbers all kinds of ways, and interpret them according to your own biases, of course. But given that the USA stands as the richest country and the biggest spender on health care per capita, by wide margins, one has to wonder why it ranks below, for example, Thailand and Panama on at least some measures of medical outcomes and life expectancy.
As you seem to allude to, the truly indigent and uninsured may receive some minimal care faster, and for free, compared to the working class or middle class people who appear to have the means to pay. Hospitals and the US health care system at large factor treating the uninsured as a cost of business, passed on to those who can pay-- similar to how Americans who pay for car insurance subsidize those who don't. As a middle-class person with some form of insurance (often useless or inadequate, but that's a different topic) I know my first interaction at a hospital or emergency room will amount to establishing how I will pay, the wallet-dectomy.
America also leads the world in medical debt [5], the aftermath of inadequate insurance and inflated costs for treatment and medications. Medical debt usually ranks at the top of the list of reasons for personal bankruptcy in the US.
[1] https://worldpopulationreview.com/state-rankings/er-wait-tim...
[2] https://www.beckershospitalreview.com/rankings-and-ratings/e...
[3] https://www.statista.com/statistics/1475298/average-wait-tim...
[4] https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...
Outside my window is a line of billboards with digital displays that show the ER wait time at the hospitals beneath them (there are 7 within a 5 mile radius). I can see them without having to actually go to the ER. Maybe I could post a photograph for you somewhere. When I go (I've been over 47 times in my life, or at least that's what I have records for) in this state I've never waited more than 30 minutes, and there's rarely more than 4 or 5 people in the lobby. If you are really having a hard time getting care for your children that's a good reason to move to another state.
All that being said, I can agree with you in some cases. In Los Angeles I waited far longer and I don't blame people living there for believing it's bad everywhere. But in fact, it's common here to have no wait at all. The last time I took my elderly mother in for care (three times in the last week) the wait was for the front counter clerk to get back from the bathroom. The lobby was completely empty of patients. Her circulatory system was imaged. We were in and out within 2 hours.
Most of the hospitals here are owned by an insurance provider, and maybe that helps. I'm not sure, really.
>Actually the US ranks rather poorly in terms of life expectancy
Again, check that you are using reliable sources for your claims. Life expectancy is right around 80 in most civilized countries and the US is right there with Europe.
Keep in mind that large corporations don't like paying for their employees' health care and they don't want you to like the health care system that they are forced to pay for. They want you to get online and rally efforts to vote against it so that it will be as bad as it is in Europe.
I live in both places, and I can say with confidence, you will absolutely pay more (in taxes) for health care in Europe, and the wait for care is often so long that you'll pay for private care anyway. Same doctors, you just skip the long wait if you pay. I'm literally paying for it today for a family member.
I'm not saying the US is perfect, I'm just saying that it's partly socialized, and that if you fill out the forms you can get care, same as in Europe, and at least in some states, it's better.
The overarching reality is that even socialized care requires filling out forms and registering in some system. And the rich still get to go to the front of the line. It's no different in Europe.
When I last lived in the USA my ACA premium (self-employed, two adults) started at $1,150/mo with $12,000 combined annual deductible, plus a co-pay. I struggled to find doctors who would accept the insurance, and in the US you need a primary care physician to refer to specialists, get diagnostics, etc. After two years of that my premium got raised to $1,450/mo with $14k deductible — prohibitive for me and I will guess most middle-class people. Quality of care fairly poor — doctors and labs missed a critical cardiac condition twice.
I live in Thailand now, where I can walk in to a hospital without a referral, get the tests I need immediately, and pay out of pocket because prices come to 1/5th or less than US prices. Thai hospitals found two urgent conditions missed in the US. I have a catastrophic policy that costs $210/mo for me and my wife, with $500/yr deductible. In a poor developing country that, incidentally, has a lot of immigrants, legal and illegal.
Thailand has socialized health care for citizens. Very cheap but not the best quality of care. If you remove automobile and motorbike collisions (bad in Thailand) the medical outcomes and life expectancies match the US, on average.
Your mileage varies. In the US you can get treatment for some things in the ER. You cannot walk in and get a colonoscopy, or cardiac imaging, which may not seem urgent in the moment but can save your life nevertheless. I prefer not to wait for the heart attack or tumor I may survive if I can get to an ER in time. My father had the same largely genetic conditions and died without insurance, unable to get diagnostic care where he lived.