In the past I’ve engaged in debates on this site comparing the USA Medical Insurance system of healthcare with the rest of the world, and in particular the NHS (National Health Service in the UK). The NHS being the only true social healthcare in the world e.g. owned and run by the Government, and financed from the taxes so that its free universal healthcare for all at the point of use.
Previously the debates have been largely academic in that I’ve generally been fit and healthy and haven’t needed to see my doctor (GP) often. However, all that changed recently when I had a kidney infection and was hospitalised for three weeks.
Below is a summary of my personal experiences as a comparison, as I am curious to how it might have panned out in the USA; especially as it cost me nothing in the UK, but I can imagine that the costs to someone in the USA would quickly mount?
The hospital I spent my three weeks stay in is Southmead Hospital, Bristol: https://youtu.be/741SRxcCozU
When I became ill, my wife made an appointment for me to see my doctor (GP), and took me to the GP’s surgery a couple of hours later; where upon my doctor then spent the next hour giving me a full examination, and diagnosis; and took blood samples.
My GP (General Practitioner) gave me a prescription which I picked up from the pharmacy next door for free; and arrange for a ‘District Nurse’ to start making weekly home visits, while I recuperate (Part of the NHS ‘Care in the Community’ policy).
The Distracts Nurse arrived mid-afternoon, and checked everything was ok.
The at 8pm we get a phone call from the ‘hospital’ recommending (following my blood test) that I should come into the hospital urgently, and they arranged to send an ambulance for transport.
Two hours later the ambulance arrived (delay as my journey was ‘non-emergency’ and therefore only modest priority).
The ambulance then took me to A&E (Accident and Emergency) at Southmead Hospital (the very same hospital where I was born many decades ago); but no flashing lights as the journey was urgent but not an emergency.
I spent the night in A&E, an open ward with minimal privacy e.g. just a shower curtain when needed.
The following morning, just before breakfast I was moved out of A&E onto a permanent ward for the rest of my stay e.g. my own private room with en-suit bathroom and TV.
The hospitality was excellent: Three square meals a day, a wide choice of good food from a comprehensive menu; and as many hot drinks as you wanted day and night.
On my last day in hospital the hospital organised appointments for me to start seeing my doctor, and for the District Nurse to make home visits; and gave me a bag with all the medication I need to take until I fully recover (about two month’s supply), after which time I’ll need to get a repeat prescription from my doctor if needed. Plus they also gave me a comprehensive diet sheet which will help with recovery.
The hospital did try to arrange for an ambulance to take me home, but after the first two ambulances were diverted for emergency use before they got to me the hospital finally arranged for my wife to pick me up instead.
All being well, after a few short day visits to the hospital over the coming months, I should be fully recovered by the end to summer, and back to normal.
One though that’s crossed my mind quite regularly over the past weeks is that NONE of the above has cost me a single penny; it’s all been 100% free: And I wonder how much it would cost someone in the USA, where costs seem to be added on for everything; especially the ambulance service. My understanding is the in the USA ambulances are prohibitively expensive?
Not only in the US ambulances are expensive. Many years ago my son went to a public event with a flu and fever. He passed out during the event and was rushed to the nearby children hospital (2 km away) by ambulance. We were charged some 800 Euro for that little trip alone.
Now, here in Germany we have a 2 class system. All people are insured by law and are entitled to medical care. Standard is an insurance by law of some 11% of income (50% payed by employer). However high income and self employed people can opt for a "Privatversicherung" private health insurance. Main difference for this VIP treatment: No waiting lines, free choice of services and chief doctors. Very cheap when you are low risk and young. Not quite as cheap when you are older.
For me in my mid 60ties, i pay some 350,- Euro per month and get full coverage of all medical services, including dental, psychiatric, all surgery, no limit hospital stay, all laboratory tests, CT´s, ultrasonic inspections, whatever necessary. The insurance only pays above 1400,- of medical bills per year.
This VIP tariff is also called "self payer", because you get all bills, pay them and then apply for reimbursement from the insurance company.
My medical bills typically are below 1000,- per year. So i don´t even bother to turn in the bills. This is awarded by the insurance with some 500,- Euro payback per year.
I treat my insurance to step in only for really severe and financially impacting cases. 3 years ago i had to undergo major surgery (aneurysma), which cost some 25.000,- Euro. Was fully covered by the insurance without any word. Involved 3 weeks in hospital and another 3 weeks rehabilitation.
The rehabilitation was payed by the pension fund, not by the health insurance. Reason: Pension fund wants to prevent people from having to retire due to health issues. Apparently it is cheaper to pay for a good rehabilitation than to pay early retirement.
So much for the German private insurance system. The standard insurance is not necessarily worse, only limits your choice of treatment, actually you have no choice, you get the treatment that is decided for you.
renewal of recipee: 3,15 Euro
large blood test lab cost: 85,- Euro
personal consultation general practioner: 22,- .. 55,- Euro
yearly checkup general practitioner including ultrasonic inspection: 240,- Euro
yearly checkup special purpose (urologist, vein prothesis check): 180,- 240,- Euro
dental check (incl. professional cleaning and/or minor fillings): 90,- .. 200,-
I consider costs to be reasonable.
Wow, very detailed account of costs and service of German Healthcare. I am surprised that Ambulances are billed in Germany; I’m so used to them being free, and freely available for non-emergency use in the UK (spoilt). In the UK rather than Ambulances and their crew being on standby in Ambulance Stations (which costs money), the NHS Hospitals uses this spare capacity in the service as a ‘taxi’ service to ferry day patients between their homes and the hospital for appointments etc., especially if the patient would have difficulty getting to the hospital for their appointment e.g. the elderly. It costs the NHS no more to use Ambulances as a ‘taxi’ service, when not required for emergency use, than it would to have the same Ambulances standing idle waiting for an emergency. The only proviso being that as such ‘taxi’ service trips are not urgent they take low priority with a risk of the Ambulance being diverted for an emergency before it reaches you; so quite often using the Ambulance as a taxi service for trips to and from hospital may mean waiting a few hours for an Ambulance to be available; but then, as it’s a free service, one can’t grumble.
Apart from Dental, which has its own fixed (nominal) costs, the only cost the patient pays in the UK is through their taxes e.g. no additional costs for seeing your doctor, or blood tests etc. Albeit for people in work, and not suffering long term illness there is a nominal fee for prescriptions of just £9.15 ($13) (regardless to the cost of the drug); for everyone else prescriptions in the UK are free.
FYI: The taxes people pay to the Government in the UK to cover the NHS is as follows:-
• If you earn less than £9,504 ($13,461) per year you pay nothing towards the NHS.
• For everything you earn between £9,504 ($13,461) and £50,000 ($70,810) 12% tax is deducted from your wages by your employer before you get paid, for the welfare costs including the cost of the NHS).
• Above £50,000 ($70,810) earnings you just pay an additional 2% on your wages as tax towards the Welfare State.
The tax you pay towards the Welfare State in the UK is called ‘National Insurance’ and it covers not just of the cost of the NHS, but also pays for the unemployment benefit (if you need it) and you State Pension. To be entitled to full State Pension at State Pension Age you need to have been in employment paying your National Insurance for at least 35 years; albeit, for any years where you were in employment but didn’t earn enough to pay NI, the Government credits you for that year so that you are not penalised when you reach retirement age.
So to sum up, if you are on the national average wage in the UK, which is currently £30,420 ($43,000), then you’d pay £2510 ($3,550) in taxes a year towards the NHS (and other welfare benefits e.g. state pension etc.). And once you’ve retired and paying no taxes, then it’s all free, all the way.
I did not have medical insurance for the first six years of working career. Before that I was a military dependent where everything would be covered by the government.
After '84 I have had private insurance through my working career. Cost to me was very reasonable as my employer split 50/50. And, they switched carriers at times to get the best deal for employees That was all before Obama care, which sent the insurance in a tail spin.
During that period I had to have an emergency lung operation. The cost to me was $500 (354 pounds today dollars), which was the deductible. That covered emergency visit, total room stay for 8 days, operation, and etc. I didn't need after care.
Below, a video I recently put together giving an overview of some of my recent trips to Southmead Hospital.
My Trips to NHS Southmead Hospital, Bristol https://www.youtube.com/watch?v=NB6EnFpi85Y&t=53s
It really all depends on your insurance. My insurance covers everything, and I mean everything. However, in exchange for everything being covered in full (including non-emergency medical air transport) I have to pay three-hundred US per month, per person on my plan. Said plan doesn't even include dental or vision, which I pay for separately.
Back in the day when I had no insurance I would regularly ignore my symptoms in favor of not paying any money, but let's just say that if I had your issue without insurance here In America that first day would've racked up over ten-thousand easily. I've seen phlebotomies that go as high as two-thousand (they were sued for this, but won out in court).
The worst I have ever had happen was getting stuck with around seven-thousand in medical bills after being injured on the job. I was lying to doctors because I didn't want to sue my work, but a doctor refused me treatment for my injury unless I told him how I was injured and the second the news made it to my insurance they revoked all previous payments. I then had to sue my employer, who then forced me to resign utilizing information they sat on for months, and I settled out of that with a substantial payoff to myself, all the while I couldn't be treated because I couldn't afford out-of-pocket at the time.
The American system works well if you have a decent employer, or make a substantial amount of money. Otherwise, well, you're better off waiting until you know whether or not your symptoms are going to kill you. If not, then don't seek medical professionals; if so, you might be better off dead.
Wow, $10,000 costs for my 1st day if it was America; I assume that would be mainly the Ambulance?
If I had to face costs like that I think it would make me ill thinking about the costs of getting ill; especially as I am retired and my only income is my pension and the Government’s Carers Allowance I get for looking after my wife who’s partially disabled.
In mentioning dental, unlike the rest of healthcare in the UK, which is free to all at the point of use, although dental care is still part of the NHS, it is one area where there are fees; as follows.
• Simple check-up: £23.80 ($33) per six monthly visits.
• Minor treatment: £62.20 ($88).
• Full treatment e.g. new dentures: £282.80 ($399).
I’d be interested to know how the NHS fixed fee dental costs (shown above) compare to dental costs in the USA?
Those costs depend on the insurance again. Everything is based on insurance policies here, but if you don't have insurance the running rate on a basic cleaning (excluding specials) is about one-hundred.
As for the ten-thousand, yeah, the biggest hit to your wallet would be the ambulance and the cost of every test performed on you. The first day in the hospital is always the worst for charges because they have to do urine samples, phlebotomies, sometimes fecal samples, etc. I've seen people rack up forty-five-thousand in less than a week while I still worked in a hospital, and the brunt of it was phlebotomies and specialist care.
Perhaps it is my privilege speaking, but even when I was poor and had to suck it up I appreciated our healthcare system. Then again, I don't know anything different and was raised under diehard capitalist ideals. My biggest gripe is that the insurance companies first look for a way not to pay for your treatments, rather than putting their consumer's health first (my work injury escapade).
Wow, it does seem that it can be expensive being ill the USA!
For the three weeks I was in hospital I had blood tests every single day, ECG a couple of times, and an MRI scan, a chest x-ray, and numerous other scans and tests most days; and at times was being fed 2 or 3 litres of saline solution to help support my kidneys while they regained their strength.
It was all free on the NHS in the UK, thankfully; but I’d dread to think how much it would have cost me if I was in the USA?
Basic MRI: ~$500
MRI with lots of dye/extensive: ~$1750
These are the prices for a single one of these, not for multiple. They really begin to add up fast.
I think you can get the idea from these really basic estimates. If you don't have insurance, RIP either physically or financially. According to Business Insider, like my claim I came upon from personal experience, the average
cost of a hospital stay in the USA is 10 grand.
A not-so-funny story: My girlfriend once felt so bloated that she thought her skin was going to rip open, she had no insurance, and despite my insistence that she wait it out she made me take her to the hospital. Whilst there she sat for three hours, as expected because it was non-serious, only to be given an ibuprofen and sent home. This was to the tune of $2500, the most expensive charge in that balance was the pill itself clocking in at ~$800.
Even with my top-tier insurance I still live under the, "never get sick, never go to the hospital," mentality. I diagnose and treat myself now, and it has actually done wonders for my health. I've healed my spine without doctors, losing weight at a healthy pace (from 260 down to 213) and getting shredded again, copious mental deficiencies have been addressed better than any doctor has done so in the past... the medical industry is more a big scary capitalist monster in America than a wellbeing entity.
May these not be my famous last words here soon, lol. *knocks on wood*
WOW – The costs certainly soon rack up when it’s not a free service; it makes me all the more grateful for the NHS. I don’t know what type of MRI I had, no dye but I had to stay still for 20 minutes while it constantly buzzed away doing it thing.
What about the food and drink and basic things like paracetamols? For the three weeks I was in hospital I had three square meals a day, from a menu choice of 5 options for each meal; and allowed up to 7 hot drinks a day, I usually had about 5, sometimes choosing coffee, sometimes hot chocolate made with milk; also given paracetamols on demand when I wanted, up to the daily safety limit. Plus the NHS also supplied me with soap, toothpaste and toothbrush when I ran short, and a free hair comb: - All this was also free on the NHS; do they add these incidentals as costs to the medical bill in the USA?
Food is one of the most expensive necessities in many hospitals, and the quality usually quite low even to an unrefined palate. There was a time when I was little where I needed to stay overnight for an EEG at the hospital, and each plate they served cost around 24 dollars (think two slices of crap pizza). Of course, you are given the option to order from outside of the hospital if you so choose so you can avoid those costs. Drinks were charged to you as well, no freebies except water.
The cost of basic meds depends on which hospital you are using, as it is the distributor who determines the price; I believe only the USA allows the pharmaceutical companies to dictate their prices and I've heard politicians boast that this helps the rest of the world get cheaper meds, but I doubt that it is anything more than feeding the economy. The highest I've seen for a tylenol, though, is ~$275, and that isn't considering anything else tacked on.
As for toothbrushes, etc. I've never been to a hospital that offers any of that, but you are free to bring in your own equipment and establish yourself during an extended stay. Even in wards like Crisis where people stay for a minimum of three days, and sometimes for weeks, they had to be brought their health gear each day. Some people even go without for weeks by choice, but those rare few tend to have severe problems that extend beyond what public hospitals are able to deal with (mental problems usually). I'm sure there are certain hospitals here that hand stuff out, but I'd also bet they charge for it.
From my understanding, as states become more poor they are allowing hospitals to privatize. Take Lawrence Memorial Hospital Health in Kansas, I used to work there and their entire goal was increasing productivity, reducing patient stay times, and lowering hours for their workers. All well and dandy as far as goals go, until you look at the finer details of their budget reports. Their entire goal was to drum up as much repeat patients as possible, while reducing those who don't have insurance, and using as little equipment as possible.
One of the main complaints I would hear from patients is that they did not receive the care they needed, or the care they received resulted in more care being sought elsewhere due to, "incompetence," and many of these individuals were reputable and of a class I wouldn't consider to be just rabble rousers. This was also the same hospital that was accused of unnecessary phlebotomies, and I'd witnessed many unconscious patients receive different treatments they did not consent to while also knowing they had no insurance.
A funny addition to the claims about the hospital in Lawrence, though, was when I got to have a conversation with the CEO. I asked him all kinds of questions, most of which he couldn't answer with any level of meaningful accuracy, and it ultimately led to him being stumped. Upon being stumped he said the most interesting thing I ever heard, mind you he was the first CEO I'd ever really spoken to; he said, "I am not the person to ask about all the technicalities, I only need to know enough to be dangerous."
Apparently the state will eventually pay out what patients cannot under some privatized healthcare agreement, but that's mostly hearsay and speculation on my part. From my perspective the system works for those who work for the system, but if you fall outside of it (most of America) well, good luck to ya. Capitalism is a cruel mistress.
WOW – it certainly does make me feel lucky to be covered by the NHS and not worry about costs and insurance etc.
Another part of the NHS Service which we find invaluable is their 111 Service e.g. just dial 111 (free phone call) and get medical advice over the phone by the NHS if you are worried about anything and don’t think it’s serious enough to see your doctor or visit A&E; if during the course of your phone conversation the staff feel that it is anything serious they will call an ambulance for you, or arrange an appointment for you to see your doctor urgently etc.
Last time we used the 111 Service, when our son had a chest infection, they called an ambulance (which arrived within minutes) to rush him to A&E (Accident & Emergency) just in case it was a heart issue, but it turned out to be a false alarm; but better safe than sorry, and while he was in A&E the hospital gave him a prescription for his chest infection: All’s well that ends well; and all free on the NHS so that it didn’t cost us a penny.
Some interesting Stats on the NHS:
The NHS is the 5th largest employer in the world; employing 1.7 million people
Animation - Primary care and NHS 111 https://youtu.be/-DUd-ZmFSA4
Typically, the insurance companies here offer 24hr nurse lines for that kind of stuff, and you can call any private or public practice (hospitals included) and speak to a nurse for free. How long you have to wait to speak to the nurse depends, though, and you could be waiting for quite some time. Even when you get them on the phone they may get irritated, or seem to be rushing, and many find such behavior to be intimidating and get off the phone feeling worse than before they called.
The last time I called a nurse line for myself was when I swallowed some potatoes whole. Felt like I was going to die, and it incapacitated me for like three days. I was quite young, and the nurse told me it was my choice to see if they would pass, or go to the hospital.
Spent those three days vomiting up whole potatoes (most unpleasant experience of my life), thinking and wishing throughout that time that I would die just to escape the pain.
I called for my son when he was a newborn as well, but once again it boiled down to the same general response I received when I called for myself, "Wait it out, or bring them in," and I only called because my girlfriend was overly worried about a slight fever (100.2 F). It's like the nurses' lines are simply meant to be like a glorified 1-10 pain chart, anything below 9 isn't worth emergency services, while a 9 or 10 is automatically an emergency-like situation.
Wow – It does sound like a rough deal in the USA. Our NHS 111 phone line Service in the UK is friendly and helpful, and very good at giving sound advice and help, and when you phone it someone answers very quickly. It’s all part of the NHS policy of ‘Preventative Medicine’ e.g. if the NHS can help people stay fit and healthy then it puts less strain on the NHS resources later because a lot of needless serious illnesses can be avoided or minimised e.g. the NHS offers lots of free help and advice on good exercise and healthy diets.
Here: One of many NHS Educational Adverts on Healthy Eating: https://youtu.be/b-uX6N4RZjg
However, there’s also the excellent ‘A-Z Health Conditions Index’ on the NHS website which lists just about every illness and treatment imaginable, giving lots of useful information; including for example how, where and when Acupuncture is offered free on the NHS.
The American system, though I'm wary to defend it in any way, is great for our economic structure. If we were to switch without warning, say, to your system overnight it would probably injure much of the world economy for quite some time. Insurance companies account for 3% of our GDP, pharmaceuticals for 2%, and that's a large 5%!
If I lived in an ideal world, we'd all have a universal income, and healthcare would be free except for cosmetic surgery as defined by a board of health authorities in conjunction with lawmakers who do not get to be part of the deliberations, only writing up the documents themselves. Of course, as a method of economic control everyone would be subject to drug tests and would have to hold gainful employment of some sort, barring major accommodations being needed, in order to utilize the free system.
Alas, America is a capitalist country, and that is why we see insurance companies switching to a socialist model of healthcare with, "group policies."
Group policies scare me because the idea behind them is that you stick people of equal risk together (health risks) and balance them with those who are healthier, then they pool what they pay into their policy and share it among one another. All well and dandy, until someone has a major health upset and everyone else is left with an empty, or deficit pool. Much like how banks work.
America is a bit confused, but the profit margins are looking swell!
Yep, ‘Profit Before People’. Up until the late 1940’s Britain was very much the same e.g. just private healthcare, and only those fortunate enough to be in work, where their employer paid for their health insurance, benefited; with the poor and the unemployed dying in their thousands through lack of healthcare.
But in 1945 (in the aftermath of the 2nd world war), to everyone’s surprise Labour won a landslide ‘Victory’ (first time in history that the Labour Party won power); the Labour Party being the political wing of the Trade Unions, and as such a ‘Socialist’ Government.
Labour’s biggest challenge was building a ‘National Health Service’ (free for all at the point of use) from scratch within just six months: The task ahead involved building and opening hospitals that didn’t exist, recruiting and training hundreds of thousands of nurses from scratch, and the most difficult task of all was persuading the Doctors and surgeons to give up their ‘private practices’ and become paid civil servants.
But against all odd the impossible was achieved, and the NHS (built from scratch in just six months) opened on time, and with the support of the doctors who only months earlier was bitterly opposing such changes.
The NHS: A Difficult Beginning (A full documentary) https://youtu.be/-ywP8wjfOx4
So now the British Philosophy is very much “People before Profits”.
The NHS in the UK is one that I think many other countries aspire to. I have no complaints with our health system in Australia, however. Medicare is universal here and entitles everyone to free health cover should they choose that. So, if you happen to fall sick suddenly or are diagnosed with a serious condition, have a major accident etc. there is no stress about racking up huge hospital bills you can’t afford. Ambulances are also free (a portion of the council land rates people pay goes towards funding it.)
Doctors visits may involve a fee, but then you can always choose clinics that bulk bill, and most doctors surgeries bulk bill pensioners so there is no out of pocket cost (subsidised by the government.)
Health insurance is available and encouraged for those who can afford it and they get some tax concessions to encourage it. Insurance allows no waiting time, and the ability to choose your surgeon, and use a private hospital etc. it also covers dental and optical.
Dental care is also free for health concession card holders or those on social security such as the unemployed and pensioners, however for anything other than “urgent” dental work you have to go on a waiting list which can be quite a wait. Glasses can also be obtained free but the choice of opticians and frames are limited.
Most prescriptions are also subsidised by the Government for the above concession holders as well and capped at around $6.50 per prescription. So for a medication with a regular price of say $120 for example you would still only pay $6.50.
It sounds as if Australia’s healthcare is very similar to the NHS; just a few minor differences:-
• In the UK Doctors home visits are free, but to reduce their workload it’s more common to be visited by a District Nurse for routine check-ups.
• In the UK you don’t get to choose your own surgeon or hospital, but you do choose your own doctor (GP), and can change doctors anytime you wish.
• Likewise, in the UK Dental care is free to those on low income e.g. the unemployed. But there is no waiting list; you’re encouraged to see your dentist once every six months, and if treatment is needed, it’s arranged quickly.
• Likewise, prescriptions are capped at £9.15 (for those in work who don’t have long term illness) and the doctor will put all your medication on the one prescription so that you only pay the one fee. If on the other hand you are on a low income, unemployed, under 18, or retired; or have a long term illness, such as diabetes then the prescriptions are free.
• The only area no longer covered by the NHS is ‘optical’; it used to be (very similar to the Australian system); but the Conservative Government abolished that when Margaret Thatcher was in power in the 1980’s; the only thing we can get now are just free eye tests.
My MRI is upwards towards $4,000 with $450.00 for someone to read it
Yes we are very lucky in the uk. Ever since the NHS started back in 1947/8 its been easy to get hospital treatment free.
I had major surgery in 2018 here in the USA and your experience sounds so stress-free compared to mine, and I have insurance. Even with insurance, I ended up with several bills totaling over $5000, and I was thankful it wasn't nore. No in-home nurse's checks and no free rides to and from the hospital. I did have post-surgery complications which required two ER visits and re-admission to the hospital, resulting in another $1,000 in bills. I am not well off but am comfortable and was able to pay my bills. I can imagine how stressful it would be for someone with no insurance or no financial cushion.
It sounds like you have a good system there.
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