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Caucasiafro t1_je7wq1a wrote

The specifies of exactly how the system works varies a lot from country to country.

But it means that basically because you are a citizen of a country you just...have health insurance. That's basically the long and short of it.

This is different from the US where most people get their health insurance thru their employers. So if you are unemployed or don't have a job that gives you health insurance and you have to go to the doctor you are going to get a (massive) bill after you do so. But if you are insured and your insurance covers it you either wont get a bill, or you will get much smaller bill.

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> it seems to be in other countries rather than the United States

Indeed, the US is only developed country doesn't have something that could be considered universal health care.

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TheBananaKing t1_je81wsg wrote

It's not health insurance. It's healthcare.

I'm Australian. If I get sick, I can go to a GP and pay nothing for the consultation, then go to the pharmacist and pick up my prescription for a few bucks.

If I have a medical emergency, I can go to an ER and pay nothing for the consultation, medication, procedures, stay, even surgery and rehab.

If a woman gets pregnant, it's all paid for: prenatal care, birthing, hospital stay, lactation consultant, the works.

There are some out of pocket costs scattered through the system. You pay for ambulance trips for some reason, you pay for dentists (though there are some hospital-run clinics for low-income people, bit of a waitlist for these though), you pay for some scans and MRIs from external provider, you have some out of pocket costs from private specialist consults (generally on the order of a few hundred dollars), and a proportion of GPs are starting to charge out-of-pocket costs, because a decade of conservative governments have done their level best to starve the system out of existence.

And all of this is funded by a 1.5% income tax levy, which is waived for disadvantaged or low-income people.

It's not insurance, becasue there's no business front-ending it and trying to screw you out of payment. You don't have to submit a claim and hope it's accepted. The medical provider simply bills the government for service. An insurance model is designed around contingencies you assume never happen. The healthcare model assumes that there's an ongoing need, and simply pays for it straight up.

There's no insane million-dollar bills being issued, because hospitals know they're getting paid and don't have to high-ball in the hope of getting some of it. Nobody goes bankrupt or loses their home because they get sick. Nobody is strong-armed into staying at a shitty job in horrible conditions by the threat of losing access to healthcare.

It just works - better and cheaper for everyone.

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Antman013 t1_je83uok wrote

To expand on this . . . universal healthcare is funded by tax revenues. And the idea is to provide every citizen with the same level of ACCESS to treatment, regardless of income level, or other personal details.

That said, while ACCESS is universal, there is a certain level of "rationing" that will occur.

I am Canadian and, whether that rationing takes the form of certain treatments and/or procedures NOT being covered by the system, or having to wait an exceptionally long time for a procedure that IS covered, it does exist.

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For example, it was determined my sister needed a knee replacement, as her joint was bone on bone. After a referral and consultation, her surgery was scheduled . . . almost a year later. So, she had to wait 11 months, while her knee was shot, and causing her no small amount of discomfort, in order to have the situation dealt with.

Now, granted, it WAS dealt with . . . but some feel these wait times aren't acceptable.

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RibsNGibs t1_je8zwfa wrote

Most countries ration by need. The US rations by wealth. The former is obviously morally and ethically right.

And usually in countries with universal healthcare you still have the option of buying private insurance on top, which is usually super cheap (because universal healthcare takes care of almost everything anyway) but gets you faster care if you need it.

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BigBearSpecialFish t1_je93u71 wrote

I think rationing is a bit of a dubious word to describe it. In both public and private healthcare you have limited healthcare resources split across the public so "rationing" occurs either way. The real difference is that in public healthcare it's rationed by the severity of your condition while on private it's rationed by the size of your wallet.

If a private system would've allowed your sister to get treated faster, then it would likely mean that whoever was ahead of her in the queue for public health treatment (and thus had a more severe condition), is now losing out on treatment instead

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Antman013 t1_je96h5m wrote

It's rationed by the funding, too. Lack of funding is why ORs sit unused while patients wait. Restrictions on entry to med schools is why too.

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BlackEyedSceva t1_je8h0iz wrote

I know someone who recently said that if healthcare gets socialized (I assume she means universal health care) that the quality of care will be worse than it already is. But my reasoning is if healthcare was universal I could just go see a rheumatologist and get evaluated instead of waiting for my GP to care. Do you know of any resources that show quality of care in other countries with universal health care?

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Mkwdr t1_je8t5ii wrote

As far as I have seen the US system is one of the most expensive but doesn’t , overall, have better results than countries with universal health care. I’d say it’s perhaps better for the rich but then they can still go private in other countries anyway.

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tiredstars t1_je914ac wrote

There are a range of comparisons around, and they're often not easy to use. The OECD gathers data but I think it's deliberately shy of making comparisons easy. The UK-based Nuffield Trust does a report comparing systems, which I think is based on the OECD data.

I'm sure I've seen some others but don't have time to look them up right now.

COVID 19 has made things more complicated, so I think most comparisons are two or three years old now. Not that I imagine much has changed - though I think the US had a particularly bad experience of COVID, which is not unrelated to the problems in its healthcare system.

As a general rule, compared to other wealthy countries, the US:

  • has middling health outcomes

  • has some really great healthcare. If you can pay for it, you can get absolutely world-leading healthcare in the US

  • but access to healthcare is poor, and the system drives some perverse behaviour - the classic example is putting off dealing with a problem until it requires emergency treatment

  • at a country level this is one factor that makes US health spending extremely inefficient in terms of outcomes - focusing a lot of attention on expensive treatment with marginal benefits, as compared to wider availability of lower cost treatment and prevention

  • other aspects of US society and the economy contribute to poor outcomes - eg. Americans work longer hours, have fewer holidays, less access to sick pay and less security in their jobs than most rich countries

  • it's also worth noting that even the rich can't completely isolate themselves from the effects of the health of others - if your housekeeper comes in to work when they're ill because they can't afford to see a doctor and can't afford a day off, you're at risk of catching whatever they've got

  • the US spends far more than any other country as a proportion of GDP. Not only that, but government spending is higher than almost any other OECD country. Put another way: if you could magically transplant the NHS to the US, the US government would spend less on healthcare.

The general rule in international comparisons is that there are a range of ways of funding and providing healthcare and there's debate about which models work better - except for the US model, which nobody wants.

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RibsNGibs t1_je91mys wrote

My experience as an American who moved to NZ several years ago is that you can probably get better care in the US if you have a lot of money. (Full disclosure - I have a lot of money and in the US I always had great healthcare through my employer so I had arguably about the best healthcare experience in the US aside from like… “actual” rich people or congressmen.)

But 99% of the time the experience in NZ is superior. Hard to tell how much of that is because of universal healthcare and how much of it is because it’s NZ (way too many confounding factors and variables).

But my experience in the US was… call my doctor.. wait, no first I have to do research to find a doctor on my plan… wait no first I have to figure out which plan I want to get (my employer offered several): do I want a high deductible health plan or the PPO? Catastrophic only? Ok let’s look at my last 5 years health expenses and crack open Excel - how much money would I have spent given my healthcare usage in the past? How about if I get unlucky and break my leg or get cancer? Should I get an HSA? What if I don’t use it? What if I do use it? How do I get the money out of it? What if I want to use it for something besides health?

Ok now find a doctor on my plan.

Call and make an appointment, next available is 2 weeks from now.

Go in, he’s running 30 min late. Receptionist: “are you on the same plan as last time? Have you moved since your last visit? Can I see your card? Blah blah blah”

See doctor. He’s super competent, no doubt, but he’s rushed, wants me out the door. But yes, very good.

On the way out: sometimes I just pay the copay, but for some reason sometimes it’s “put it on your card and here’s the itemized receipt - now go submit that to your insurance company”. Sometimes it’s “insurance company didn’t want to cover this one out of 30 items”. Those last two examples might be for when I saw specialists not on my plan, I forget.

Go to pharmacy. “Are you on the same plan? Can I see your card? Have you moved?” And “come back in an hour or two”. Poor pharmacist has to spend ages calling the insurance company - maybe they only cover the generic? Maybe the doctor prescribed 60 days but the insurance company only wants to cover 30. Who fucking knows. Come back in an hour, perhaps pay a small amount, perhaps pay a lot.

Potentially fight with insurance company.

In NZ it’s like: call and get an appt for that afternoon. Go in and have a pleasant chat with the doctor (I would say so far the quality of the healthcare has been fine, and a much better personal experience in terms of feeling like you can spend some time talking to the dr and having them really listen or explain things without feeling rushed). Pay a moderate amount out the door (or none if it was a result of an accident or for my kid), walk into the pharmacy, pick up the meds, maybe pay $5, done.

So, I dunno, if the expertise and equipment is 5% better, is that worth the stress and headache and time and all that fucking mental overhead? It’s exhausting just writing about it. In NZ if I decide to see the doctor about my funky ankle or cough, the total time expenditure is like an hour. Maybe less.

We also had a kid here. Months of home midwife visits, 3 days of induction in a pretty slick, modern birthing suit with nice recliners and a jacuzzi hot tub thing and gobs of medical equipment all over the place with armies of midwives and nurses and doctors and anaesthetists or whatever, emergency C section with super professional doctors and surgeons and nurses, blood, hearing, vision tests and specialists after that, 3 days recovery in a maternity ward with latching specialists and more help, then home with a few more months of home visits from the midwife… total charge was like $110 in parking. I spent more on food from the hospital cafe than I did on that!

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konwiddak t1_je8s0o5 wrote

There is a difference in the availability of treatments, but this is difficult to equate to quality. It's just different.

A universal healthcare system should use statistics and costs to find the most effective "package" of treatments to offer to the population. There are plusses and minuses to this. Where it works really well is in screening out dubiously effective treatment and over or unnecessary treatment. For example if someone is old and has cancer, the UK system may steer someone to no treatment:

  1. Treatment may be unlikely to actually extend someone's life.

  2. Remaining quality of life may be significantly better without chemo.

Where it works less well is sometimes newer treatments take longer to be adopted by the system, and sometimes more customised care is unavailable. It's worth pointing out that private care does exist in the UK if you want it - but most people chose the NHS.

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usernamenailed_it t1_je8zmjg wrote

FYI - no charge for an ambulance in Qld. Qld govt fully funds it so it's free for everyone. There used to be a levy but that finished in 2011.

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figmentPez t1_je8204e wrote

One small note, health insurance is not the same thing as health care. Having health insurance does not ensure that someone can get health care. Insurance usually makes it easier to get health care, but ideally universal health care goes beyond just what insurance provides.

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