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Comment by xyzzyz | Hacker News Reader

Just for context, here is what it would have looked like in socialized medicine system, the UK’s NHS:

so we went to an ophthalmologist's office, to get it looked at

In UK, you can’t just go to ophthalmologist’s office. You’d first need to schedule an appointment with your GP, who then would (or would not) give you a referral to a specialist. You then need to wait for something between 6-12 months (sometimes more, depending on your location) for an ophthalmologist appointment. You wouldn’t need to pay for it out of pocket, but you’d wish you had an option to pay the damn 500 quid so that you can start the treatment sooner.

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I had to wait almost six months to get her treatment here as well because I couldn't afford it. At least in the UK I wouldn't have been out the cash.

Also, I hear lots of horror stories about wait-times in universal healthcare systems, but that always seems have smuggled in the premise of "you don't have wait times like this in the US", which has certainly not been my experience.

I wanted to see an allergist in 2022, so I went to my health insurance portal, and called a few in the area, and the earliest appointment that I could find was almost four months out. My wife had to wait for months even from our good insurance to get approved for proper medication for her eye problem. What insurance do you have where you're not stuck with long bureaucratic waiting lists?

I would agree. The irony is the much maligned HMO's now seem to beat PPOs, maybe because at least they have a more structured referral system and predictable rules, vs. PPOs always try and fight you.

Double irony is the govt healthcare programs seem to be paying/performing better than the privates (Medicare is like the perfect PPO and no wait, managed medicaid/medical used to be sloooooow but now seem to be improving as the in-network provider availability is improving)

> In UK, you can’t just go to ophthalmologist’s office. You’d first need to schedule an appointment with your GP, who then would (or would not) give you a referral to a specialist

I literally cannot see a specialist in the US without a referral or else insurance will deny it. And this is on a good healthcare plan.

> You then need to wait for something between 6-12 months (sometimes more, depending on your location) for an ophthalmologist appointment.

It took me around 2-3 months to see my doctor, and then talking to them it would take another few months to even talk with a sleep clinic.

> You wouldn’t need to pay for it out of pocket, but you’d wish you had an option to pay the damn 500 quid so that you can start the treatment sooner.

I cannot pay out of pocket to start treatment sooner because it would cost an insane amount of money and waste the large amount I pay on health insurance coverage.

Wait time is a function of supply not insurance regime. And in OPs case, he was still referred. Where I live in the US, dermatologists are in high demand. It can take a year to get a routine appointment. My wife recently had a dermatologist cancel (dr was going on leave). The office provided a list of other dr’s to call for an opening (who may or may not be in our insurance provider network.).

Wait times are not exclusive to social insurance at all and insurance networks only further complicate matching supply and demand.

> You then need to wait for something between 6-12 months (sometimes more, depending on your location) for an ophthalmologist appointment.

I needed a specialty ophthalmologist (for dry eye treatment) and the wait time in Seattle was 4 months. Another time, I needed a cardiologist appointment and the earliest one available within my insurance network's coverage was 5 months away. And I had literally the best insurance plan we could get.

Both appointments were at least several hundred dollars out-of-pocket.

Counter point, when things are urgent, it gets done for free pretty fast in countries where I lived with such healthcare. Speaking from personal experience.

Agreed. My parents in Canada both had cancer treatments without delay, they both recovered, etc. With $0 out of pocket. I'd at minimum have to pay the Kaiser max co-pay here for a similar problem.

I remember having this same conversation with a family friend in another country when I was younger. I had read so much on the internet about how American healthcare is bad in every way and EU/UK/Canadian socialized medicine had it all figured out.

The family friend patiently explained all of the things I take for granted in America, such as being able to choose my own specialists, getting a long list of treatments that were very difficult to get approved in their country (ADHD medications, for example), and the ability to shop around for shorter wait times.

Really opened my eyes to the tradeoffs that come with different systems, whereas the Reddits of the world would make you think America is the worst in every dimension and there are no downsides in other countries.

The more I read these conversations, it becomes clear that Americans don't actually want the healthcare systems and rules of other countries. They want most features of American healthcare, but without the pricetag.

There's a lot of room to work on improving how things get paid for, but I worry that anything that involves compromise or tradeoffs is DOA, politically. We want it all, we want it now, and we don't want to have to pay for it.

I am in complete agreement with you. Fortunately, there is a good way to make solid incremental improvement here, which would be easy to sell to the American public on both sides of the political spectrum: increase supply of medical services. Educate or import more doctors, make it easier to open new practices and hospitals, and reduce overhead required to operate them. Do that, and prices will go down.

My acquaintance who moved to the US a few years before I did (both from Canada) said it this way: if you have a good job / are wealthy, US healthcare is miles ahead of Canada. If you are poor, it is much, much worse.

you can pay for a same day private GP appointment (~£150)

they can refer in the same way an NHS GP can, and you can normally get a same week appointment

(obviously you pay for it)

Yes, the free market medicine solves some of the socialized medicine problems.

having the NHS there puts a cap on the price the private sector can charge

generally the NHS is fantastic once you've been placed on the correct conveyor in the factory

however getting to that point can be an absolutely dreadful experience

I don't know how you fix this problem

And socialized medicine solves many of the employment-dependent privatized medicine problems! Funny world.

I don't live in the UK, and I've never experienced anything "medical" in the UK outside of buying aspirin at an ASDA, so I'm kind of speaking out of my ass here.

That said, it seems like having "free" competition would make it so that the private costs don't get crazy?

It probably helps although private medicine is fairly expensive here. Like a hip replacement is ~£14k. Some people save money by going abroad to say Lithuania or Thailand where the costs are like 1/3.

You can go to A&E at Moorefields. At least that's what I did for a macular hole. I got offered an operation within a couple of months.

You can also get referred from an optometrist, found in many high st opticians to a ophthalmologist. GPs are not very keen to deal with eye issues as they don't have the specialist training and equipment. Like the optometrist will likely have an OCT scanner but not your GP.

Kinda depends on if you have the 500 quid to begin with. If it's between having a roof over your head and food in your belly, and your kids', and seeing an ophthalmologist who's just gonna make a referral to another specialist which you have to wait another month for, it's a shit question no matter how you juggle it. The question though is how do you want to pay for the £2,500 laser surgery (per eye) that comes out of meeting with the ophthalmologist? Say, instead, you've got a kidney something or other and need dialysis. A single £500 session to get things tip top shape doesn't sound too bad. It'll hurt but I can get £500 together for an emergency treatment if I hit up everybody I know including rich uncle Joey. But let's say now it's a chronic condition and you need that dialysis three times a week for the rest of your life. Uncle Joey better be real rich and feeling really generous.

I love the silent omission in all these "waiting time" arguments... the majority of America doesn't regularly get healthcare and delays diagnostics and treatment because they can't afford it. So those "wait times" are low because The Poors don't burden the system by actually being taken care of.

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