truthiness_aura: Gray birdwing. (Default)
[personal profile] truthiness_aura
So flist!

Some of you may have heard about the debate going on right now in the US over universal health care. As WIkipedia states, "Universal health care is implemented in all industrialized countries, with the exception of the United States." What we have here are a number of private health insurance companies and plans (and a smaller number of providers) that give health care to those who can afford it. Health care plans are generally offered as part of your job benefits. If you're like me and work at a large organization, you generally have access to good providers and don't pay a great deal for services. If, on the other hand, you work for a smaller company, or a company that for whatever reason doesn't have a good plan, you can spend a lot of money on health care, and/or be denied coverage for procedures or doctors you'd prefer. And if you or your spouse don't have a job (and don't qualify for the plans for low-income citizens (Medicaid), elderly citizens (Medicare), or citizens who served in the armed forces (the Veterans Administration)), you generally won't have health care benefits, will be charged hundreds or thousands of dollars for your care, and are just all-over screwed. It's a big messy system with some public participation, but it's mostly overseen by large health insurers.

President Obama is supporting a bill that has provisions for universal publically-funded health care in it. Liberals (Democrats) generally support the idea of universal health care, while conservatives (Republicans) generally oppose it. Wikipedia has an excellent rundown of the arguments on both sides that I won't bother to replicate. But for whatever reason, this issue has really brought out the crazies over here. People (okay, far right conservatives) are arguing that, among other things, adopting universal health care means that the elderly and persistently ill will get poor quality care. (They're also shrieking something about forced euthanasia, but my brain gave out under the sheer bullshit present.) Basically the fear seems to be twofold- first, that the overall quality of care will diminish; and second, that those most at risk will not get the care they need.

So I thought I'd ask people about their healthcare experiences in their countries. I'm particularly interested in seeing the differences in access to care, quality of care, and cost of care between American citizens and citizens of other nations. What do you like about your healthcare? What don't you like? I know my flist has folks from all over. Tell me about your experiences!

I'll start by saying that I live in the US; I have a few chronic illnesses (depression and a kidney transplant) that require regular doctor's appointments and medical tests; and that I have what is considered high-quality health insurance through my job. I would say that my annual expenses on healthcare are about USD $650 a year (about 2% of my gross salary). Much of this cost is from medication. I take five medications daily; I save money by ordering them online through a company that has a deal with my insurer. I like the fact that my health plan offers me some choice in the doctors I'm permitted to see; I don't like the amount of paperwork I have to deal with and the fact that my coverage hinges on being employed. What if I'm fired, or I lose my job because I'm sick?

Fire away, friends! I'd like to hear more than what's being screeched about on CNN.

I'm a Brit

Date: 2009-08-18 07:41 am (UTC)
ext_18328: (Default)
From: [identity profile]
My healthcare is provided by the National Health Service, established after WWII by a conservative, Winston Churchill. I suffer from the odd case of eczema, and my partner has the odd health issue.

I am so mad at the GOP for misrepresenting our system (oh okay, lying). Ugh, and the Conservatives over here want to go for an American style system, say what? No.

Basically, we tend to be registered with a local Practice (where you have doctors and nurses who work in little clusters in local health care clinics) and you are registered to a particular doctor (it doesn't mean that you can only see this doctor, you can see others). When you first register at a clinic, they take samples: blood, urine, etc, to check for diabetes or any other anomalies, because we believe in preventative medicine here, not diagnostic. So, if you just register and something is wrong, they will have it on flag. Your records are connected to your place of registration, but if you move, you can have it transferred to your new nearest local clinic.

If you have a problem, you have to book in to the doctor on the same day (which is a hassle but still), go to the doctor and you get checked. The great thing is, I don't have to walk with money in my purse for copayment or whatever (because my taxes already pay for this), and if I'm not working, I'll get my medication free. If I'm working (and I am), for my eczema, I can pay for steroids and cream, but its still subdized and doesn't cost me over £10 pounds in certain instances. If you're diabetic or have chronic illness, the NHS has a duty of care to see that you're taken care of, and that is free.

The only drawback with the NHS is that it's very good for life threatening stuff, the basic stuff, but for other things that aren't considered life threatening (like IVF) you do get a lottery. Some local NHS services might pay for IVF up to three times (the NHS' limit), some once, or some not at all. If you're considered too old, they will dismiss you out of hand. Same thing for breast reductions (there has to be a weight minimum before the NHS gets involved). Or if you want to see a specialist in some instances, you have to be on a waiting list for weeks.

This is where private health insurance comes in (like BUPA), say, if you don't want to wait on a specialist to see you (be it strokes, or just general surgery), you can then opt out of the NHS and just go straight to a specialist, or you can juggle both.

I knew a friend who had cancer, and she lived in Nottingham, but the nearest treatment was in Leicester, which was a county away. The NHS gave her the option of transport, but her family would just drive her there on a Friday, she'd get treatment, and stay in the hospital until Monday.

As much as the NHS has its drawbacks with being a government organisation (it can be argued that for all the funding that's been pumped into it, it should be in rude health, but it's not as efficient as it could be), I'd rather have that than the US style of insurance, where the insurance companies can decide if you live or die just because the treatment will affect their bottom line. That is eugenics, right there.

Re: I'm a Brit

Date: 2009-08-19 04:54 am (UTC)
From: [identity profile]
Ahh...very interesting, Mr. Bond. Much of what you talk about (preventative medicine, having a primary care doctor) is basically the same over here, at least if you're insured. The quality of your insurance is what really affects the flexibility of your care; better insurers will allow you access to more doctors, and they often cover (or at least partially cover) things like IVF or laser eye surgery. We usually have to wait a while to see specialists over here too, unless it's urgent; seeing a dermatologist can take months, they're just so busy.
The tricky part comes with people who aren't insured for whatever reason. I'm insured through my job, but if I lost that, I'd have to apply for stopgap coverage through the government while I looked for a new job. US hospitals are bound to treat any individual who comes through their doors with a threat to life, limb, or eyesight, insurance or no; they will just charge you directly for your care, which is much more expensive. However, uninsured people tend to lack the preventative medicine and early detection; they put off nonessential tests and going to a doctor because they can't afford the insane prices. So instead of getting someone who presents at a yearly physical with elevated blood sugar and is prescribed an inexpensive daily pill and goes about his or her life, you get someone who presents in the local ER with severe symptoms of the disease and has to be admitted for a week and have gobs of tests run which they can't afford. That's really where things break down here, it's with folks with no coverage who don't get continuing care. And it not only tends to make diseases more severe and harder to treat, it incidentally costs more money(!).
I have to say, though, insurers over here don't decide who lives or who dies any more than the NHS has euthanization panels. This is not to say that I particularly like health insurance, or think nothing about it needs to change- there's a lot of slippery fuckers out there who want to save their company money. But the vast majority of the cases you see and hear about (Nataline Sarkisyan, for one) have to do with treatments that are deemed experimental, and not standard-of-care cases. It's a difficult fuzzy area, and I don't know if it becomes any less difficult if the state is paying for it.


Date: 2009-08-19 04:58 am (UTC)
From: [identity profile]
Wow, look at that wall o' text. TEXT CRIT GOOOOOOOOOOOO

I've gotten horror stories from my relatives

Date: 2009-08-19 07:08 am (UTC)
ext_18328: (Default)
From: [identity profile]
Who speak about things like copayment, and the fact that they get quoted a bill for X only for it to be twice that size when done. Or the insurance company after you pay all the premiums decide that certain things are 'pre existing conditions' like babies born in distress, etc. So your insurance sounds grand, but I've heard too many stories from American relatives and friends (those who have health insurance and those who don't) and have been scared.
From: [identity profile]
I was thinking about what you said, and the fact that if I'm not careful, an insurer could call my kidney transplant a "preexisting condition" (part of the reason I would get extended gov't health care coverage). God, I wonder if I've just got so used to how bad things are over here that I don't see it anymore. What happens when I go to graduate school and get insured through there? :(

It seems so

Date: 2009-08-19 02:20 pm (UTC)
ext_18328: (Default)
From: [identity profile]
God, I wonder if I've just got so used to how bad things are over here that I don't see it anymore.

I know I'm horrified by certain things that I've heard about the US and its insurance system that makes me go, "WHAT?" and my relatives go silent, because it probably just hits them, you know?

Which is why Obama has to just tell the Rethugs to go eff themselves and go full out for single payer healthcare. Withdraw the troops, call off the wars, and pump all that money into state healthcare, for real.

Eff the lobbyists. Sod the Tories too because they want that BS over here.

Re: It seems so

Date: 2009-08-19 02:43 pm (UTC)
From: [identity profile]
It's very difficult to look up and see how bad your situation is or could be over here and realize how little can be done about it. Going to start looking into demonstrating for the public plan...fuckin' Republicans.

If you don't have ONTD_P on your flist

Date: 2009-08-19 02:48 pm (UTC)
ext_18328: (Default)
From: [identity profile]
You should. If nothing else, they have things you can do to contact your senators. Just write, and protest and get the message out. For real.

The only thing I can do is just dispel the LIES the GOP is telling about healthcare in the EU. I remember when the queue for hip replacements was so backed up, the NHS had to pay for people to go overseas (to France and Spain) to get them done because their quality of life was deteriorating due to waiting on replacements for so long. The government and the NHS have a duty of care to its citizens, in a way that insurance companies don't. They only have a duty of care to their stockholders, not the people that they are supposed to serve.

Sorry, it's touched a nerve, and I don't think I'll ever stop railing. Tim Wise has a good article on public health care and racism. I swear, people are showing me their asses. True fax.

Re: If you don't have ONTD_P on your flist

Date: 2009-08-19 02:58 pm (UTC)
From: [identity profile]
I shall add it this very day.


Date: 2009-08-21 03:34 pm (UTC)
velithya: (perth)
From: [personal profile] velithya
I made this post specifically for this sort of question! (and also for all the dumb aussies who don't know how it works - MORE THAN YOU'D THINK *facepalm*)

Australian Healthcare 101

If you have any questions feel free to ask! :)

Re: Australian

Date: 2009-08-21 03:41 pm (UTC)
velithya: (Hospital)
From: [personal profile] velithya
hmm, personal stories? well in 2006 I got a DVT and was admitted to hospital twice, firstly for four days and then for a week. My care both times was absolutely free. My subsequent clinic followups were also free, and my medication cost either $30 for my month (or two months; I can't actually remember) of needles, or when I had a healthcare card briefly, $5 for the same amount.

When I started seeing a private specialist instead, I paid something like $150-$200 for my appointment, but I got at least half of that back from the public health system rebate.

At the end of the day, if I'd been hospitalised in the US, my hospital bills would have run up into the thousands of dollars, and I probably would have been paying a lot more for my medication that I needed to live. That I still need, every time I want to get on an aeroplane. ANYWAY I WILL STOP WHINING. This is basically why I don't travel without medical travel insurance.

Re: Australian

Date: 2009-08-27 03:24 am (UTC)
From: [identity profile]
Eeeek. I hope you're doing well (from your posts, it seems so! yay!).

My care both times was absolutely free. My subsequent clinic followups were also free, and my medication cost either $30 for my month (or two months; I can't actually remember) of needles, or when I had a healthcare card briefly, $5 for the same amount.

This, right here, is what completely gobsmacks me; when I went into the hospital throughout high school (kidney failure and subsequent transplant, with lots of additional hijinks along the way), I was covered through my father's health insurance. (Many insurers here extend coverage to their clients' kids throughout college.) Nevertheless, my folks got hit with some fairly substantial bills. We had a fun experience with a collection agency that insisted that I'd been on hemodialysis for two years, instead of two months- took some yelling to straighten that out. My dad had to buy my first month's worth of meds post-transplant, and it cost him something around USD $1400. Even now, it would cost me about $7000 a year to buy my necessary meds if I didn't have some kind of drug plan.

I guess what I'm realizing is that costs are manageable for me, and I was able to make it through a major health crisis with few insurance-related bumps, but this is only because my dad was lucky enough to have good insurance through his job, like I have good insurance now. I'd like to go back to grad school sometime soon, but when I think about trying to get insurance as a grad student, I start to have a minor freakout.

Re: Australian

Date: 2009-08-27 08:59 am (UTC)
velithya: (Default)
From: [personal profile] velithya
Yeah I'm doing okay on the DVT front. It's something I'm pretty much used to by now, anyway. *shrug*

!! transplant? Woah, I hope you're doing well!

I think the main difference with hospitals in the US and here is that over there every hospital appears to be a private hospital - even if you present to the ED you end up with a bill. But over here there is a pretty even distribution of public and private hospitals, and if you are in a public hospital your care doesn't cost you.

Woah med costs. :| Yeah, that would cost you a lot less over here. And you'd be insurable with no penalty over here as well :|

Re health insurance for client's kids, I don't know about other health funds but for mine, quoting from the website:

Your children can remain on your family policy up until the end of the year they turn 18, unless they're married or in a de facto relationship. Cover may then be continued up to the age of 25, provided they are not married or in a de facto relationship and either:

1. are a full-time student; or
2. do not earn a taxable income of more than $19,500 pa.
(about USD $16,150)

Bear in mind that a "family policy" is generally about twice as expensive as an individual policy, and covers every member of the family including children. For the one price.

I'd like to go back to grad school sometime soon, but when I think about trying to get insurance as a grad student, I start to have a minor freakout.

Is it possible you can work out some sort of part-time job/part-time grad student thing that will let you keep your insurance cover and still study? :| Otherwise, maybe the colleges you apply to can help you investigate insurance options, or something.

I guess at the end of the day, here in Australia health insurance is something that is very affordable and available to all citizens without individual penalties; from what I understand of the current US system, health insurance is not at all affordable and penalises citizens for medical conditions they have. :|
Edited Date: 2009-08-27 08:59 am (UTC)

Re: Australian

Date: 2009-08-27 03:11 am (UTC)
From: [identity profile]
Thank you madam! Very comprehensive indeed. Right now I'm really pulling for some PBS-style benefits over here in the States, but it would be nice to have comprehensive coverage, so that if I lose my job and fall under a bus, I'm not f*cked six ways from Sunday with an insurance bill I can't afford. That's all I really want (and probably won't get, if the right-wingers have their way). D:
Here's a question- do you know if there's certain drugs that aren't on the PBS list, like, say, birth control? That's another perennial hot topic round these parts. The fact that some insurance plans will cover Viagra but NOT birth control is one of the few things that makes my mother reliably froth at the mouth.

Re: Australian

Date: 2009-08-27 08:27 am (UTC)
velithya: (Default)
From: [personal profile] velithya
Yeah, the PBS is pretty good value for money - helps keep all those drug companies in check re medication pricing.

I can tell you for sure that not all drugs are on the PBS - they have to be approved first. But the vast majority of drugs are - and since, back when I used to be on the pill, it didn't cost me more than $30 for my three months supply I'm pretty sure that birth control is one of those.

My understanding is that every commonly prescribed drug for medical conditions is on the PBS; the only time you'd get a drug that wasn't on the PBS would be when it was new-ish or a really rare medical condition.


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