[Closed] Crudely adjusted over to here. How much would U.S. style health care cost?

Oh,I mean cost by person/family. Not as a country.

Paid by Farage endorsed system. Insurance I mean.

Something tells me it would be a lot more than what youd pay via tax and I'm fairly certain your income tax wouldn't go down the whole way either!

https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/

You can already buy private healthcare over here. Get a quote?

Every time I hear farages name I think of the plane crash that nearly got him.

Some people will be able to afford, some won't.  That's why we should never let the NHS die. Even with its problems it's amazing.

I read that it was double the cost of UK treatment, in part due to it being privatised (and profitable) and also due to the insane amount of litigation that goes on.

I read that it was double the cost of UK treatment, in part due to it being privatised (and profitable) and also due to the insane amount of litigation that goes on.

It's at least 3 times more expensive on average in the US vs the UK

(Source: I do this for a living)

The US system is probably the worst value in the developed world

data

Conversely, the UK system is probably the best value.

Proponents of the US system always use the "more-is-better" argument, which is what patients think they want when it comes to healthcare..... but DEFINITELY what the private healthcare industry wants.

Also, when looking at the US system, you have to consider that only part of the population experiences that level of service. If you are uninsured, or have only very basic coverage, you have a very different experience indeed.

Culturally, a full-on private healthcare model would never work in the UK. I live in Australia at the moment, which has a hybrid public - private system..... it would never work in the UK.

Try as they might, it will never happen.

Even the most right wing, “it’s only bloody common sense” Daily Wail reading Tory voter will reach for the pitchfork.

Anyone stupid enough to try to take over and run the existing infrastructure commercial will be up against 1.5 million saboteurs.

Example (ok, dentistry)... Friend's wife in California went to the dentist for a check up, scale and polish and to have a filling re-done. Her quote was $3600. She's now registered at another dentist.

We already see dentists recommending extractions over fillings because they are cheaper and quicker, so how long before people either do not go to the dentist, or just have no teeth? Mind you, that would be just like back in Victorian times, which would fit the scene.

In Ireland the cost of basic private health insurance for a family of  4 is about €2,500 - €3,000 a year, a lot more if you want to cover certain scenarios.

You can already buy private healthcare over here. Get a quote?

That'll be very vague given it only cover certain care and not such things as acute illness or accidents.

Anyone got any experience of the German system? They're insurance based.

I'm 100% nhs btw

How much does it cost? Enough to financially cripple anyone who needs it?

@belfastflyer, the German system was a bit odd but seemed to work well. They have a public system like the NHS i believe and also private companies with a legal cap on how much they can charge. The private rates were about 10 - 12% of our monthly income if i remember rightly.

I thought health insurance was like most insurance. If you need it once you'll probably be OK, but after that the premiums will go up and/or you'll struggle to find cover.

As someone who has had a fair few health issues over that last few years, both acute and chronic, losing the NHS is one of my biggest fears.

Heard a story of a T1 diabetic lady who moved to the states, her Health insurance would only cover 1 type of insulin (there’s dozens, what works for one may not be good for another), the option was take it and make it work, or leave it.

I have cover via work for me and wife and it costs £1000 per year (from gross salary) and presumably the company is paying a bit on top of that. It is great when required and we have used it for operations quite a few times.
However, it clearly doesn't cover A&E, GPs etc,. so the cost is not a fair comparison.

A work colleague's daughter got an ear infection on holiday in Florida a couple of months back. The walk-in clinics had closed by the time it had got bad enough they figured it needed medical attention so took her to the nearest hospital. They wouldn't even discuss treatment until the insurer (luckily they had some) had faxed them confirmation they'd cover the costs. Ended up at over $2000, for a couple of hours in the hospital and some antibiotics.

How does the US system work in emergencies. Lets say you have a heart attack in the street, an ambulance is called, you get taken to hospital and arrive unconscious. Do they just treat you and worry about the bill later? Or do they try and find out your name and details so they can find the insurance first?

Scroll down the the unexpectedly high vet bill thread to see the effect of insurance on cost.

U.S. style health care

Depends what you mean by that - do you mean a system where those in good jobs for good employers are covered and anyone else is screwed? Do you mean a system where the quality of care is openly and directly linked to your ability to pay? Do you mean a healthcare system driven by reimbursement codes to the extent that people get tests they dont need (because the doc gets paid) and dont get ones that might be useful (because the doc isn't incentivised to even look at them) or that is so influenced by pharma that they have huge opiod addiction problems initially driven through prescribed meds. Or just that there's a 'copayment' so if you get knocked off your bike rather than seeking medical help for your concussion you put it off to save a few hundred pounds and then potentially end up with worse issues?

Oh,I mean cost by person/family. Not as a country.

Thats not really how most US healthcare works. In reality most provision is made by employers. Generally the bigger and better your employer, and possibly the level of job you have, the better your cover. Often this is extended to family members. Those policies are only affordable to "individuals" because they are heavily subsidised by employers, and tax incentivised.

Now, I think I saw figures that said 25% of people in the UK are employed by the state, or by agencies directly providing services to the state. (so Teachers, NHS, Police, G4S doing prison work, SITA doing bin lorries etc). As I understand the US system the state healthcare policies are some of the most coveted (the more people in the policy, the more you can share the risk/cost so the more outliers you can accommodate without pushing up the price per individual too much). Not lets say 33% of the population are effectively state employees or family members of them, who is paying for that?

You can already buy private healthcare over here. Get a quote?

Not "US style" healthcare you can't. What you can buy here is a "luxury top up package" for the NHS that lets you possibly use a nicer hospital, skip some queues, get some tests that might normally be done at that stage etc. Basic keeping you alive, accident, serious illness, chronic disease stuff, even maternity is not included in standard UK private healthcare cover. Is this why people seem to think it would be good? Because its not that expensive?

Let’s face it, the NHS is on borrowed time now.

If it is true, you wouldn't model it on the US system. There are two different parts: how it is funded (the Payer in healthcare speak), and how it is delivered (the hospitals, doctors etc). The US model for both of those is neither fair nor efficient.

How does the US system work in emergencies. Lets say you have a heart attack in the street, an ambulance is called, you get taken to hospital and arrive unconscious. Do they just treat you and worry about the bill later? Or do they try and find out your name and details so they can find the insurance first?

They are worrying about getting paid from the start (and that means from the moment an ambulance is dispatched). They wont delay life saving treatment to obtain payment information (so you'd still get an ambulance, youd still get defibrilated if required, youd still get life saving drugs). What happens next all depends on where you end up, what your cover is etc.
https://www.helpmewithmyhealthcarebills.com/ambulance-coverage/

Thats right - even if you had a heart attack you might be getting a bill for an ambulance ride. That ambulance might have taken you to a hospital that your insurer doesn't have a "network contract with" whilst you were unconscious, and you get the bill for that, and after all of that is taken care of you might still have 20% to pay (if you need a stent that would be a 20% of a $100,000 bill), unless you were financially comfortable enough to pay for the top level of cover (which will still see you paying several hundred).

I was chatting to a couple of US hospital doctors and asked if they were better paid than in the NHS. They claimed they weren't and that the biggest winners were the insurance companies. I read somewhere bureaucracy costs in the NHS are very low.

How does the US system work in emergencies. Lets say you have a heart attack in the street, an ambulance is called, you get taken to hospital and arrive unconscious. Do they just treat you and worry about the bill later? Or do they try and find out your name and details so they can find the insurance first?

They treat you, then you go bankrupt: "A new study from academic researchers found that 66.5 percent of all bankruptcies were tied to medical issues —either because of high costs for care or time out of work. An estimated 530,000 families turn to bankruptcy each year because of medical issues and bills, the research found." - https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most-americans-file-for-bankruptcy.html

You can already buy private healthcare over here. Get a quote?

UK private healthcare is a top-up for certain things, that's why it's so cheap. Everything else is still NHS.

The most important thing to remember about the US system is that even if you have insurance it's still limited. You will be insured up to a certain amount, then you have to pay anyway. People try to keep costs down by not going to the doctor for small issues and as we know, sometimes small issues become big or fatal ones when they aren't caught early.

My in laws were just over, we chatted about this. MiL had an annual checkup mandated by the insurance company (because it's looking after it's insured property) which is fair enough. The doctor asked her about known issues, and then he asked if there was anything else. If she'd talked about a new issue, then that would have led to a new consultation which would have cost something like $500 out of pocket because it's not covered under the existing checkup and consultations cost money.

FiL has a number of issues he wants looked at. Each treatment incurs an excess of a few thousand $, however the total excess you can pay is capped per year, so he's saving up all his issues to get them treated in a single year to save on the excess.

A friend having severe mental health issues was sectioned by the state for a week against the advice of her psychiatrist. Because of this the insurance company wouldn't pay so she had to pay for herself to be sectioned to stop her committing suicide.

It is absolutely shocking how incredibly ****ed up their system is. It's beyond belief. It's not just expensive because it's profit driven, it also has to employ armies of lawyers to argue with people who are being screwed out of treatment to keep costs down. It has to pay for [i]advertising[/i] for ****'s sake.

An estimated 530,000 families turn to bankruptcy each year because of medical issues and bills, the research found.

And that's not counting the ones who can never have family holidays, who can't move house to a safe neighbourhood or closer to a good job etc etc. They are forced into poverty along with all the trouble and stress that goes with it just for being ill.

The UK Private Healthcare business only exists in its current form because we have the NHS.

The Doctors it employs are trained by the NHS and many supplement their NHS income in private clinics rather than exclusively operate as private Doctors.

Also, most private hospital rely on the NHS as to underpin their operations. If you had a severe problem during a private procedure, beyond immediate resus/stabilisation, you would need to be transferred to an NHS Hospital for treatment.

As mentioned, there is no private A&E, critical care etc.

Apparantly, the average Private Healthcare premium is £1,500 in the UK and >$4,000 in the US.

THere are lots of factors affecting why per capita Healthcare spend is higher in the US. However, if you wanted to have an NHS equivelant Health Service in the UK but funded by Private insurance companies I think the annual premiums would eclipse those paid in the US. More like tens of thousands £ per annum.

I don't think anyone would hold up the US system as being a good way to run healthcare compared to any of the European Countries (I like the French system best - it allows you to meaningfully top up.)

However, in their defence, according to the link above the USA *state* spends over 8pc of GPD on Healthcare for elderly, young and disable people (Medicare and Medicaid), in contrast most European countries (including the UK) spend around 10pc. So their state spending isn't far behind us.

Also well paid Medical Staff are a one of the causes of the high prices the USA face. We deal with that problem in the Uk by having a monopoly provider who can really squeeze staff salaries, but that in itself isn't universally popular. (The US pays $100 billion a year in doctor salaries alone - $700 per person and they have the 3rd best paid nurses on the planet - the UK isn't even in the top 10. If we rewarded our medical staff appropriately the NHS wouldn't look so cheap.)

That's my defence of the USA over. Certainly it's pretty dire so if we want to make comparisons we should avoid the USA.

I was chatting to a couple of US hospital doctors and asked if they were better paid than in the NHS. They claimed they weren’t and that the biggest winners were the insurance companies. I read somewhere bureaucracy costs in the NHS are very low.

Don't know about Doctors, but my Wife is a Specialist Nurse, She'll be earning £38k a year when she reaches the top of her banding next year. Equivalent roles in the US pay £52k - £68k, it's not that simple as we currently pay 9.3% for her pension and more income tax her, but equally they only offer 5 days paid holiday a year, which you also need to use for sickness if you want to be paid at least.

Either way, She wouldn't take it, she was offered a big pay hike to work in place they asses people to be 'fit to work', the idea disgusted her.

Have friends in Portland, OR, Their family is made up of 2 adults, 2 kids who are 9 & 11. $1100 per month for the family.

Visiting a GP is a proper ball-ache with appointments booked out months in advance. You get 10 minutes precisely to discuss you ailments. Molgrips comments about only being able to discuss one ailment ring true.

Eldest daughter has had a series of operations in the last couple of years to fix a torn cruciate and then re-fix it again when it failed. There was a tirade of expletives when we discussed what had happened to her premiums after that. She also subsequently ended up with mental health issues as a result of being in pain for nearly two years. That really helped things.

It sounds utterly crap. Almost inhuman.

Anyone got any experience of the German system? They’re insurance based.

Me. Needless to say its expensive and the quality of care/hospital varies greatly (private institutions). Far from perfect.

I can you give you a break down or costs later.

Roughly speaking the U.K. spends 6.5% ish of GDP on healthcare

In the US it’s 13%

The U.K. healthcare budget is approx 120bn, so very roughly we’d need an extra £120bn to run the American model

That’s an extra £2000 from every U.K. citizen, every year.

Disclaimer- above GDP figures are from memory. The Kings fund usually has up to date stats.

When I lived there it was about $500 per month with an 80:20 co-pay (you pay 20%, they pay 80%), a $500 deductible (first bit you pay before they pay) and an annual out of pocket cap of $1500 (max amount my 20% would come to). This was a work subsidised program (so the actual monthly would be higher if you’re and individual) and acknowledged that I had workers comp (hurt at work they cover it). I had good coverage (multi-supplier and out of state allowed). Oh and it was about 15 years ago, so imagine it is more now!
If want cheaper monthly payment then go 70:30 or even 60:40, don’t have a cap and have a large deductible, but accept the risk of big bills if you’re ill. Maternity is more - an add on for 6m before you can get pregnant - friends had a 70:30 policy with no cap, difficult birth with child in nicu, overall cost was $140k, so you do the math on their contribution.
So it is V expensive, far more than tax. Also (as a vet), people need to realise that healthcare is expensive. You want a CT scan it might cost £500-1000 but the scanner cost over a million and it needs to be paid for in a business oriented healthcare model. In veterinary corporatisation further worsens this as profits don’t just provide owner income and future investment, they must satisfy shareholders. Human healthcare in the USA is this on a massive scale, so beware and protect the NHS as it is genuinely the best.

I was chatting to a couple of US hospital doctors and asked if they were better paid than in the NHS. They claimed they weren’t and that the biggest winners were the insurance companies. I read somewhere bureaucracy costs in the NHS are very low.

Nonsense. I suspect they just don't know how little we (UK doctors) get paid by comparison.

In the USA:
Average primary care doctor $223,000
Average physician $329,000
Average cardiologist salary $423,000
Average plastic surgeon salary $501,000

Source: https://www.thestreet.com/personal-finance/how-much-do-doctors-make-14779617

You can Google NHS salaries but an NHS consultant salary starts at £77,000 up to £105,000. It doesn't matter whether you're a plastic surgeon or whatever. However, most consultants currently work extra hours and according to the Telegraph, the average consultant salary is £127,683 which I suppose is the most comparable figure to the numbers above. Crudely adjusted that would be ~ $157,000 US.

Source: https://www.telegraph.co.uk/news/2018/02/16/doctor-earns-740000-year-nhs-gender-gap-revealed/

My sister-in-law is an Emergency Trauma Nurse in Detroit and when I was a student I managed to arrange a placement to work with her over there, so have seen how the costs stack up (and the workload place on staff just accounting for it) in the US. Long story short, the costs vary massively dependant upon reason for admission, if it's an emergency or planned admission, who your HMO is, who the hospital provider is and which state you are in. Overall though it's all significantly more expensive than the UK, shockingly so in some instances.

For instance, if you are unlucky enough to require admission to an ITU (where I work) with Sepsis a rough ballpark figure per day, bed alone, is $4k-$8k. Admission day costs for an ITU pt at the Henry Ford Hospital in Detroit were (back in 2011) approximately $40k, with subsequent days falling to about $24k. If you are unfortunate enough to require CRRT (dialysis) that starts at $2.4k per day, plus the costs of consumables.

To give you an idea of how expensive even seemingly minor item are (after all, you have to pay for everything during your stay) a 'urinary hygiene kit' (urine bottle/bed pan) is about $37.

I did a rough calculation earlier and if the pt I'm looking after today was a pt at the Henry Ford in Detroit they would already have racked up a bill of more than $180k after 6 days. Whilst that may be covered by insurance, as a poorly-controlled Type 2 Diabetic with a history of cardiac problems, they may not be able to afford insurance.

As for the high costs in the US being down to high staff wages, this isn't a given. The average wages of hospital staff vary hugely depending upon which state the staff live in, with wages in Florida, California and the NE states being generally among the highest, with wages in southern states and the midwest being among the lowest. The high cost of healthcare in the US is driven more by excessive amounts of 'middlemen' (HMOs, pharmaceutical companies, specialist services) and liability insurance.

Don't get me wrong though, the US healthcare system if fantastic, but only if you can afford it. The NHS may have its faults but when you turn up in ED we're not bothered about how much money you have. If we were to lose the NHS it would be a travesty and a huge amount of the population would likely find themselves priced out of any alternatives.

Comparing the US to the UK is to compare two extremes and unhelpful. A better comparison is between similar EU countries. The fact is you get what you pay for, and we are not paying enough in the UK for our nation's health.

That’s why we should never let the NHS die. Even with its problems it’s amazing.

I understand the sentiment, but the NHS is not amazing, it is barely adequate, even compared with other EU countries. It is clear that other funding systems are needed, but the hard truth is that we need to pay more for our health and have been unwilling to do so largely since its inception. Whether that is through taxation or compulsory insurance (as in say the Netherlands), society will need to decide.

Simple thing such as access to GPs, oral and eye care, routine health prevention are pretty woeful. We have the lowest ratio of doctors to patients, borrow workers from anywhere and generally make do.

The fact is you get what you pay for, and we are not paying enough in the UK for our nation’s health.

The problem is that it's badly managed and there's no point in throwing endless money at it.

Simple thing such as access to GPs, oral and eye care, routine health prevention are pretty woeful. We have the lowest ratio of doctors to patients, borrow workers from anywhere and generally make do.

Very much agreed.

Edit: can we stop GP practices being businesses, there's nothing fair in being denied healthcare due to Partners treating you as a non-profitable patient.

Don’t get me wrong though, the US healthcare system if fantastic, but only if you can afford it.

I remember a discussion with someone where they were claiming that the US system must be better value, because it was the private sector so it had to be. When they saw the price comparison between the NHS* and the US they maintained that despite being in some cases an order of magnitude more expensive, it was still more efficient and therefore better for the patient because the "market forces" meant that healthcare must be being delivered efficiently and any price difference was due to profit. I tried to point out that most people probably don't care how much profit the hospital or insurance company made on treating their kid's cancer, they probably just wanted them treated, but he wasn't having any of it!

*You can see here: https://improvement.nhs.uk/resources/reference-costs/#rc1718 (in the national schedule of reference costs.xlsx) how much it costs to provide any kind of healthcare in the NHS, on average. e.g. The average cost of an adult critical care day is £1415.
Average cost of an elective "EY08E - Implantation of Single-Chamber Pacemaker" is £2531.

Edit: to compare to this

if you need a stent that would be a 20% of a $100,000 bill

YR15B - Percutaneous Transluminal Angioplasty with Insertion of Single Metal Stent into Peripheral Blood Vessel, with CC Score 3-5
Average NHS cost: £2818

Cinnamon-girl

there’s no point in throwing endless money at it.

We have the lowest ratio of doctors to patients, borrow workers from anywhere and generally make do.

We can either have more doctors (and have to pay them) and not have to 'make do'. Or we can spend less money on the NHS and have fewer doctors and nurses, worse facilities, longer waiting times etc etc.

I agree that there is a workforce crisis in the NHS, but without the money to fix it how is anyone expected to train, recruit and retain clinical staff? You're blaming the NHS for the governments spending choices.

Agree with the GP comment though, individual practices seem to be able to get away with really restrictive rules on getting an appointment.

I understand the sentiment, but the NHS is not amazing, it is barely adequate,

For me that's the key advantage to doing it all privately. My experience of the NHS has been broadly very good so I'm happy with what I'm currently paying. You're not. There's nothing either of us can do about it beyond writing to our MP and whining on the internet.

If it was private I'd be able to stay with my current provider and you'd be able to pay a bit extra for a better package. Nobody complains online that the Apples they buy are crap due to underfunding - they just quietly swap to a better apple provider.

For me that’s the key advantage to doing it all privately...

If it was private I’d be able to stay with my current provider and you’d be able to pay a bit extra for a better package. Nobody complains online that the Apples they buy are crap due to underfunding – they just quietly swap to a better apple provider.

We can either have more doctors (and have to pay them) and not have to ‘make do’. Or we can spend less money on the NHS and have fewer doctors and nurses, worse facilities, longer waiting times etc etc.

I agree that there is a workforce crisis in the NHS, but without the money to fix it how is anyone expected to train, recruit and retain clinical staff? You’re blaming the NHS for the governments spending choices.

The UK is one of the most corrupt countries in the world and without doubt the NHS has been engineered to be in its current state. There's mega bucks to be made from healthcare and it starts with those politicians and those in the House of Lords who are pharma shareholders. Also let's not forget those in the higher echelons of the NHS.

I don't know what is the selection process for doctor training in the UK and how the numbers are decided/forward planning. It seems to me that the UK is not willing to invest in training, instead preferring trainees to saddle themselves with huge debt. But of course there is the most ridiculous situation where other, usually poorer, countries lose their doctors due to the UK being more attractive. All that investment in doctors has been lost, that is a tragedy and, imo, morally reprehensible of the UK to encourage this. This is not racism to be clear, it's stealing doctors from countries who can least afford to lose their investment.

Adding to the mix is the high profile cases of doctors such as Chris Day, Edwin Jusudason etc who've resorted to crowd funding to enable them to defend spurious allegations made by the DHSC etc. Hardly encouraging is it?

To summarise (sorry have gone on a bit and still have more to say!) is first and foremost stop the corruption at the top.

My real point is that we seem to be grateful for the NHS. Despite paying for it. I would be happy with a private system with compulsion - insurers don’t get to choose who they insure. I’m also happy with modest profits in the sector. Health is a commodity, and an important one.

What the US and UK systems have shown is that neither work. The UK probably slide to funding not management. The US due to cost and unwillingness to provide universality.

Other countries have better options that fall in the middle. But the truth is, when Tony Blair announced we would be above the median for EU health spending, he had no idea how much below it we were!

BTW in answer to CG, the NHS has excellent management and probably needs more of it. But the truth is, there isn’t enough resource to manage. I’d want it run by people like Asda who know how to manage resource and logistics, but set a modest profit at say 1% above RPI.