This was in the US, just outside Washington, DC.

That's true but as always the difference between left vs right (populism) is not what is being said but what the proposed solution is. This goes for many things: healthcare, immigration, poverty, etc. The issues are hot button topics but the proposed or implied solutions vary drastically. Alas of course the left in countries like the UK and Germany have become very centrist and instead of proposing different solutions from the right often join the moderate conservatives in suggesting what the right says "but less". This results in aimless reformism, means testing and bureaucracy which further feeds into far right populism by demonstrating "the left" as incompetent.

For what it's worth (don't let the politicians tell you otherwise) the US is the exact same way.

Here, because it's all about profit and margins are so thin, there's no slack in the system. It takes literally months to book an appointment with my primary care doctor. If you aren't already "established" it might take even longer.

Tests for not-immediately-life-threatening things are the same way. You get the next available slot which could be weeks or months out.

There aren't free slots floating around because they want all the staff busy all the time.

And you might think "well can't you pay extra to get to the front of the line?" The answer is well... I can't. Maybe there's some income level that this is possible or secret handshake, but it's not accessible to middle class people.

But in reality there is a vast continuum between "free" and prohibitively expensive. There is also of course the option that some categories get "free" care in any case (like prescriptions now, which in England are £9.90 in general but 0 for children and people on specific benefits).

"Free at the point of use" is totemic of the NHS and any suggestions of change are rejected as a matter of quasi-religion (which can be seen in a few comments here to some extent)

But for the majority, it isn't great. You go with pain in stomach and it happens to be cancer, you die waiting. I personally have seen so many of these and it's heartbreaking.

> In Estonia, health information is gathered to the Health Information System, where your prescriptions and medical records are accessible to the health care professionals that provide services to you. The Health Portal enables you to view your data in the Health Information System, submit additional information, and change your personal data. You may restrict your health data if you wish. In that case, health care professionals no longer have access to your health information and the quality of medical care may be impaired, especially in emergency situations.

We take privacy very seriously. We can also see exactly who looked at our data, as there is a log of every person or institute who has done so. A little more is written here: https://e-estonia.com/i-spy-with-my-little-eyeprivacy/

This I know is a very unpopular opinion, but for my specific case, I've got plenty of medical record that may be considered "shameful"? Got several colonoscopies, endoscopies, I lost a finger, I had a LIS (anal operation) , etc, etc, etc haha. Yet, I kind of don't really care if people knew about it.

Maybe I have never truly suffered discrimination (I'm what we call "whitexican" here in Mexico, so I'm privileged. And that's why I think like this.

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?

There are much better countries for medical tourism: Thailand, Malaysia, Greece...

Ok. Didn't know that. But you are talking about public services aren't you? I would assume a rather small fraction of the huge US health expenses are publicly financed. The bigger part is completely private businesses, both service production and insurances for those who have one.

That's the opposite in most EU countries and UK. A large fraction is either produced publicly or if produced privately then paid for by a publicly organized health insurance.

The beat of the drum has long been "repeal the ACA" for a political party. It rallies people to undo a sweeping change the other party put in place, but it has never materialized. So many parts of the ACA poll very popular, a complete repeal without a really good alternative (which has also never materialized beyond "a concept of a plan") would be a surefire way to immediately lose political standing.

And perhaps most sad of all of this is ACA didn't even remove health insurance from its tie to employers. There are still massive inefficiencies for people who hit a deductible or max out pocket early in the year. They'll either need to pay through the nose for COBRA through the year end, or switch jobs and start over with the deductible and max out of pocket, which for large swaths of the population is simply not a reasonable option. Switching near the start of the plan year is optimal, but definitely less efficient overall.

In 2020 I learned health insurance premiums from your paycheck are taken pre-tax, however you cannot deduct COBRA premiums. It really rubs salt in the wound for people who have been laid off.

To get to the specialist doctors is also hard in EU, compared to the Ukraine. Here I had to wait between 1 to 3 months to a lot of specialists. And if any mistake in the referral is made, then wait need to be repeated.

Example - I got a referral for the retinal diag. But to do it 15 mins before the test eye drops are administered (atropine) to dilate pupils. Apparently I have needed to have two referrals - one for the drops, and another for the diag itself, and I got only the second one (made by an eye doctor in the same clinic, so regular staff). So I have waited months, and was denied the procedure, then a spend a week on a phone and visiting clinics in person to sort this out. Then I got proper referral (haha, actually not even then, they simply caved and allowed me to do it with what I had) and had to wait a month again to do a simple check which would take me a hour at any arbitrary day in Ukraine.

I believe that things in the UK and Germany might be a lot slower and much more restrictive.

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.

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.

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.

Whereas e.g. single payer was an unachievable pipe dream from where they were standing in 2008/09. And he'd rather have something a bit better rather than go for the excellent system and fail and be left with the bad system.

My parents in America have Medicare plus a private “advantage” add-on they can barely afford. Right now they are waiting — for months — to find out if a necessary surgery will get approved or not.

I live in Thailand now, where I can afford insurance and get top quality care with no waiting, referrals, or uncertainty, and costs at the best hospitals still a fraction of US prices.

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.

Is this topic for discussing health care systems or the SW engineering salary dick measuring Olympics? Because those are two different unrelated topics.

Which country pays its software engineers the most is not some yardstick for measuring national quality of life of its average citizens, and whether SW engineers get paid a lot is totally irelevant to the people who are not working or aspiring to be SW engineers.

I bet the disabled US vets, homeless people or McDonalds workers in the states also don't give a fuck that their SW engineers are the best paid in the world but would probably feel a bit cheated learning that despite living and paying taxes in the richest country in the world, their peers in poorer EU countries get much more benefits and better quality of life.

We pay marginally more in tax, sure. How that is relevant to healthcare, however, is a mystery, given we spend less tax money per capita on healthcare than the US does. It's not healthcare that is the reason our taxes are higher, but other services.

I'm sure doctors prefer the US system. That's unsurprising - the US system pays doctors vastly large amounts. It also costs patients vastly larger amounts. So speaking of bias...

How strange. When I moved from US to UK within a FAANG I took a fractional pay drop and got an RSU topper. After leaving and working as a UK employee in an international org I make more than a lot of US directors. Perhaps the difference comes from the value you brought to the company?

One thing that is objectively true though is that, outside of the whinging from software devs in the 1% that no one really cares about, the outcomes and efficiency of the US system sucks compared to every other western nation.

Nothing stops you from choosing extra insurance in the UK too if you believe you need that level of cover.

The only reason you're comparing it to the NHS instead of an equivalently expensive UK private healthcare plan is that the NHS provides good enough universal coverage that most people don't feel the need for more.

But the US equivalent would be to compare it with Medicare and Medicaid.

And Why can't you just walk in to a clinic to get x-rays and tests done like it is in done elsewhere. Have clinics compete for price.

The other part no one mentions is the utter cheating that goes on in statistics to show that the health care system is doing good. Things like counting the patients who were admitted but not counting the rest 90% who died just waiting for months.

>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.

It's just not paid for by your health insurance.

And no, you are wrong, overtreatment is a huge problem.

For an average citizen the system is terrible and getting worse by the day. The examples are too numerous to mention.

I'm also not sure if you think that I'm somehow against private clinics. I'm not. They of course won't compete on medications with public services as that's pointless. What I do find apalling is that doctors are working in both public and private clinics completely legally. Moreover, that practice makes the public services worse by removing the availability of the doctors and makes taxpayers being double charged for the same service.

There would be riots with pitchforks if most needed some non-basic ("take these pills") medical help. When you're young you probably don't need much. But as you get older you actually might need some procedure or a treatment. But by that time you are actually older, sicker, and there aren't too many of you to actually riot. And many jump the lines by having friends (of friends) working in hospitals. It's bleak and grim and I don't see it getting better.

If there is one EU region where digital security must be taken as a life-and-death matter, it is the Baltics. In case of weakening of NATO, they are the foremost candidates for the next Special Military Operation.

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.

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.

https://journalofethics.ama-assn.org/article/obligation-prov...

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.

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.