Hellobee Boards

High taxes, high gov involvement. My family may lie in relative health and security, but that is not the case for MANY, MANY Anericans. I'd prefer to pay more if it meant a level of security and care for ALL citizens regardless of the circumstances they find themselves in.

I'd take high-tax, high-service any day. I think a big problem the US has is what @Littlebit7 mentioned - the programs run by government currently aren't the greatest, like USPS (dingy storefronts, misdelivered mail, with no real recourse). Unfortunately some of the government programs we already have are woefully underfunded and/or mismanaged, so we're understandably skeptical of putting even more responsibility in the government's hands.

I think we need to start from scratch and rebuild the healthcare system in the model of Canada/UK, instead of this cobbled-together mess we have now.

@Applesandbananas: You can see in places with universal healthcare that there's significant incentive to control costs to stay within the tax revenue (which does lead to some rationing, for better or worse). Compare that to private healthcare companies in the US who can basically price-gouge people who need services/medications to live (just look at poster-boy Martin Shkreli's company, or cancer drugs that cost $10k+ per month in the US but much less in other countries).

#feelthebern

@yoursilverlining: regarding your first paragraph, it's a great point--but it still gives me the shivers to hand over absolute control to the government. on the other hand, our big insurers were sitting at the table with dollar signs in their eyes when Obamacare was being discussed, so maybe I'm living in a fantasy world here asking for choice.

@Applesandbananas: the VA has a lot of downfalls and has plenty that needs to be fixed, though that depends somewhat on where you go, but it also has advantages. Most insurance currently reimburse based on studies where on average one treatment is better than another but patients are more complex than most of these studies account for. At the VA physicians have a lot more flexibility to try treatments that work for the patient and that aren't just based on some average based patient and it's all covered, so it usually does take longer but if you go to a good VA you can get better solutions if you aren't an average patient.

@Astro Bee: I think you can find bad scenarios no matter which argument you go for. I would rather have for profit where it provides you with more options. But I do achknowledge that it doesn't have to be an all or nothing system. However, I wouldn't want to pay higher taxes and then be subject to private premiums if I wanted to go that route for better care. I admit that I am not as familiar with the Canadian and European models, but my health insurance is relatively inexpensive and I have low deductibles. I don't really think I'm very quick to say sure raise my taxes.

@Applesandbananas: It's great that you had that option. I work for a small non-profit and we got one option, which is not super great. I chose to stay on my husband's plan through his employer because it has better maternity coverage and benefits. Now we are being charged $150 extra every month because his company decided that they didn't want to continue to cover spouses/dependents who have access to other coverage and chose not to take it.

I'm also grateful for the ACA because it means my diabetic husband can never be denied coverage by insurance companies for his pre-existing condition. Before, we had to jump through hoops to get him coverage and there were years that we would have to pay full price for his insulin and doctors visits because the insurance company refused to cover him. Nobody should have to go through that. Everyone deserves affordable coverage.

I think Americans tend to forget some practical things when we start thinking our system is so great. We have had to wait months and months to see a specialist, can only see certain doctors on our plan, have spent hours and hours haggling with our insurance. Even pre-ACA, I have had at least 8 different insurance plans due to changing jobs, work switching plans on us. I've spent 18 months trying to get my insurance and hospital to agree on how to bill an ER visit for my son. Meanwhile the hospital sent it to collections while forgetting to send me a bill. The idea that our system is efficient is truly laughable, and a complete myth.

The idea that government is inefficient is a myth created by people who want to pay less in taxes. Let's envision a world where everything is privatized. My state wouldn't have schools because it wouldn't be affordable for any business to invest in such a rural area. Roads would be a nightmare. What about a private military? Would it only protect places of commercial interest?

@yoursilverlining: @avivoca: Even when there's only one option through your employer, the insurance companies have a huge incentive to compete to pick up your employer as a customer, so even if you're not the one they're directly trying to appeal to, your employer is and they also have a big incentive to try to get you the most benefits for the least cost. That attracts and helps retain employees!

We pay roughly 10% in taxes when you divide our tax liability over our total income. I'm not sure what it is if you divide tax liability over taxable income (it would be higher, but that isn't a true picture of the percentage of money earned vs money paid in taxes). I'd hate for that to be 50% given the inefficiencies of our government.

@Truth Bombs: and how many low income people in the US have pediatricians or access to basic health care?

We are in Canada and also have access to private services. DH would have had to wait 6 months before getting an MRI but opted to use his health spending account through his employer and had it covered.

If you earn a healthy income, then yes, it is better for you to live in the US. But I think about how lucky I am that I don't have to worry about getting into a good school district since the schools in Canada aren't dependent on the wealth of the neighbourhood the school resides in. I have had low-income family members survive cancer and not be bankrupted by high medical costs.

No system is perfect, but I choose to live in a country/society that puts the common good ahead of the individual.

@Eko: You are completely right that you can find scenarios to support either argument. Such is the nature of healthy debate, and why I love threads like this. It's interesting to hear other people's experiences and viewpoints.

I do think that the experience of @YourSilverLining 's parents is more common than not. In a single payer system or single with the option of private insurance, you won't die because you have to wait to see a specialist, as @Ree723 pointed out, or have to pay out more than most people make in a year, and deal with creditors and bankruptcy.

@SSLM: A year does seem like a long time to wait for a vasectomy, however, friends of ours have gotten the same procedure within a few months. Keep in mind, however, if your BIL had required life-threatening surgery, he wouldn't have to wait very long to see the urologist. Yeah, it's an annoyance, but there are other short-term options for birth control in the meantime.

@sunny: that's awful!!

@sunny: So sorry to hear that. I hope you get it straightened out.

@sslm: Yeah, I know you know that. I just wanted to correct any misconceptions that there might be about our healthcare system for those that are less familiar with it, and who might be thinking that that was the norm. Thanks for being a good sport!

@MoonMoon: I know that's a factor but it starts even before that, and there seems to be little self accountability. Also lack of education for people to lead a healthier lifestyle (and I wonder how many primary providers have those hard conversations!). It's sort of a domino effect. There's also a heavy utilization of expensive emergency services for not even remotely serious issues (and by people who have insurance). Oh and lack of primary care providers.....so many problems in the system

@MoonMoon: @blackbird: In regards to preventative measures. Most insurance plans now cover preventative visits. Yet how many of those insured actually use it. I admit there are some I do (ob visits) and some I don't (physicals).

Why the negative attitude towards Tricare? At least half of my employee group (12,000+) within my employer (large national company) is comprised of veterans and many are still in the Guard/Reserves. Almost everyone in that group still serving chooses Tricare Reserve Select over our civilian insurance, myself included. Within Tricare there are different plans, not all of them require you to have a primary care manager for referrals. Also, I have worked for multiple employers in my adult life and have never had a choice of insurance companies, only the plan within a specific company.

@mamag: my OOP max on my new family plan is 40% of my take-home salary.... not exactly what I would call low Most companies are shifting to high-deductible, high OOP-max HSA plans because they are lower on premiums and put the onus on employees to pay for the bulk of their care via the HSAs. Between my dad, mom, husband, and I, all 4 of our employers have shifted to only offering these types of plans at a realistic premium cost.

@Freckles: that's crazy that he had to wait 6 months for an MRI. Within 6 months last year I had AT LEAST four that I can remember and I probably had 7 or 8 since last January.

of course, I had a CVST, live in a major city, and opted for their midnight appointments to be seen faster. but still. I've never waited 6 months for anything, whatever the issue was.
and my RnY was done OOC & fully funded.

@looch: I'm not sure if perhaps you meant that Swiss insurers can't deny claims or maybe have to pay everything above a set limit, but if they simply can't deny coverage to anyone, then the US law is the same. If you've got/had cancer or a preexisting condition, for example, insurers in the States still have to accept you.

@honeybear: They can deny coverage to non citizens, but if you can pay for it, you're welcome to be treated in their system.
The most basic plans would include full coverage for cancer care, at no cost beyond the monthly amount. So we're looking at $150 per month, versus say, at least $270,000 on my current plan with co-insurance (using my above quoted $1.8 million bill), where I also have the pleasure of paying almost $1000 a month in premiums for a family of 3.

We've got savings, but I'd have to wipe out my retirement accounts, pay a hefty penalty, possibly get a second mortgage on my house, etc etc where in Switzerland, I wouldn't even have to think about any of that.

So even if you can get a health plan, it doesn't mean that it's going to be at no or low cost for catastrophic health issues. Which means that I worry about making decisions based on finances versus science.

eta: NOTHING is free, everything comes at a cost. It's just a matter of when you pay.

@Ms. RV: but isn't that state-funded insurance covered by taxes?