American healthcare vs U.K. Healthcare

[maglil55]

My Daughter in law is American and is constantly raving about how wonderful the NHS is and has frequent disagreements with some of her family members in the USA who were dead set against Obama Care which she reckoned was a step in the right direction. NHS have always come through with my family when it is something serious. I think my DIL summed it up nicely when she said it is not a question of who is best but rather getting a great standard of treatment without worrying about whether you'll need sell your house to pay for it.

 

[psignathus]

Generally speaking I am happy with the NHS. Clearly there is work to be done regarding dietary advice for certain patients which currently is an umbrella approach that leaves a lot of people inadequately catered for. However if and I mean if your are able to take some control/ responsibility for your own health care then you can get by just fine. I accept this is not the case for all.

 

[GrantGam]

Again, another very reasonable question. Obviously, it depends on what bracket your income places you in each country.

I was actually curious about this myself so I used some of the income tax estimators. I'd pay about $36k (roughly 29kgbp) more in taxes if I lived in the UK than if I lived here in the USA. Now, I live in Texas where we don't have state or city income taxes. If I lived in New York city, I'd likely pay about the same (or possibly even more) in taxes than if I lived in the UK.

You're missing quite a huge point with respect to UK taxes @TorqPenderloin, not all of our taxes goes towards funding the NHS - which is how I read your post.

Our taxes are basically split into two categories; income tax and NI (national insurance). Some of our income tax funds the NHS and also some of our NI too. However, from NI tax we also pay towards "the kitty" for:

-Disability benefit
-Unemployment benefit
-Job seekers allowance
-State pension
-Child benefit

Our income tax also contributes towards things such as:

-Education
-NHS
-Welfare system
-Public projects (road, rail, airports, housing, etc)

So your point of paying £29k more in taxes if you were a UK resident would be entirely valid, providing that your £29k went entirely towards the NHS. But the fact is, it doesn't. Further, I don't know if as a Texan US citizen if you are entitled to many of the benefits which we have here at home? So it's really impossible to answer the question that @Bluetit1802 put forward. Whether we do or do not pay more in taxes between all the aforementioned countries doesn't actually matter. The reason it doesn't matter is because all the countries offer their citizens very different systems, benefits and care. Unlike the US, we here in the UK can't truly know how much the NHS "costs" us, because it comes from a very large "kitty" with lots of different people contributing various amounts of money.

One thing I will add, as it's kind of a personal grievance of mine. Is that the NHS is in absolutely no way a "free service". To some it may cost them nothing, but to others it can potentially cost a lot of money in paid taxes.

I love the concept of the NHS, but I'd also prefer aspects from the privatised system such as you have in the US @TorqPenderloin. Although it has many flaws, the NHS is a critical system to the UK and one that I think works pretty well considering we've a wee overpopulated island with a relatively high rate of unemployment

Btw, I wouldn't say you've offended anyone!

 

[tim2000s]

If you wanted a view on the cost of the NHS you can slice and dice the numbers in many ways.

The 2015/2016 Income Tax, Capital Gains Tax, National Insurance contributions and Bank Payroll Tax, i.e. personal taxation, take made up 56% of the overall tax income for the country. This amounts to about £299bn. Total tax receipts were £533.7bn.

The spend on the NHS in the same period was about £140bn, or about 26% of the total tax take.

If you look at the taxes you currently pay, you could fairly assess that at whatever level you are, 26% of the tax you pay can be attributed to the NHS.

So rather than a system where healthcare has an absolute cost of £x per month and you choose what x means in terms of the cover you get, we have a relative system where you get the same cover, regardless of what you contribute to the countries overall healthcare based on the amount of money you earn, and can therefore afford. And if you want to go private, then you can pay for that.

What does this mean in reality? It means that the majority of the population get very good healthcare that is much better than they would afford if they had to pay insurance, whilst those at the top end of the income bracket have the option to get better healthcare if they want to pay to top it up.

 

[TorqPenderloin]

You're missing quite a huge point with respect to UK taxes @TorqPenderloin, not all of our taxes goes towards funding the NHS - which is how I read your post.

We do agree on that. I wasn't suggesting that the difference in taxes would be entirely allocated towards the NHS. When I say "Income tax" I am speaking to the entire amount of money that is taken from my paycheck by the government. I am not separating between "Income tax" and "National Insurance" in this particular case and lumping both together.

To be fair, what I pay towards FICA (Medicare and Social Security) is almost exactly the same as what I would pay towards National Insurance. The main difference is that I don't personally benefit from medicare (basically, healthcare for the disabled and elderly) and our Social Security (government-run retirement benefits) system is so broken that I likely won't see a dime from it when I retire.

I think you said it best in that the biggest difference is the public vs. privatized nature between the two countries. I just strongly favor privatized healthcare, retirement, etc.

 

[dbr10]

Have a watch of Micheal Moore's documentary movie called Sicko, he shows who has the better health services.

You will be surprised who is best.

I prefer the service we have in Australia, you can either pay into a health insurance fund and get treated quickly in a private hospital. Or you can go into the public system and wait for anything up to two years for non urgent surgery.

Members of Congress I believe. They deny other people the benefits they enjoy themselves.

 

[GrantGam]

We do agree on that. I wasn't suggesting that the difference in taxes would be entirely allocated towards the NHS. When I say "Income tax" I am speaking to the entire amount of money that is taken from my paycheck by the government. I am not separating between "Income tax" and "National Insurance" in this particular case and lumping both together.

To be fair, what I pay towards FICA (Medicare and Social Security) is almost exactly the same as what I would pay towards National Insurance. The main difference is that I don't personally benefit from medicare (basically, healthcare for the disabled and elderly) and our Social Security (government-run retirement benefits) system is so broken that I likely won't see a dime from it when I retire.

I think you said it best in that the biggest difference is the public vs. privatized nature between the two countries. I just strongly favor privatized healthcare, retirement, etc.

I agree a lot with what you've said wrt retirement. We pay into the "state pension" which come the time I (and others my age) retire, will probably be claimable from 75 vs 65 as it currently is. Will I live 10 years longer to justify that differential, probably not.

I'd love to put my finances towards private health care, simply because I could afford to. If that meant me having the ability to allocate part of my premium for things such as pump therapy and CGM then it's a no brainer.

On the other side of the coin, I'd be pretty upset if my standard of health care suffered due to my financial predicament being ropey.

Wrt benefits for the disabled and elderly, you never know, one day we all may need it... There is no right and wrong here, as what is right for someone - may not be for someone else.

The unfortunate truth is that the majority of systems in operation in the States are financially driven. If you have money, you're sound. If you don't, then you're not so sound. I guess at least in the UK (although we can't pick and choose what cover we get in terms of health care) everyone gets the same benefits regardless...

 

[MikeTurin]

I think you said it best in that the biggest difference is the public vs. privatized nature between the two countries. I just strongly favor privatized healthcare, retirement, etc.

You're missing a big point in Uk after Margate Thatcher both parties started to adhere at the neoliberist ideology. This has undermined the public service just because the neoliberists likes the minimal state idea instead of the social welfare state idea. (I stop here because I have difficulties to explain in depth the concept in Italian, translating in English is almost impossible).

The biggest problem I see anyway is that unregulated corporation are going to the profit anyway, eventually arriving to destroy themselves an remain as a finance-only entities, and in too many cases a bribing machine to continue to have specific helping laws enacted.

By the way Italian SSN is similar to NHS and works reasonably, at least in northern Italy and when private clinics and corporations aren't too involved, or worse the mobsters ...

 

[Dark Horse]

In the UK we also have private health care schemes, and many employers and unions offer schemes. We can also chose to pay to see a Consultant if we want to jump the queue and then continue with any necessary treatment on the NHS . Prescription medicines are free to the over 60s, the under 18s still in education, diabetics on medication, and people on benefits. There may be more categories eligible for this that I don't know about. Ambulances, first response medics - all free. Dental treatment is free to under 18s still in education and there are NHS dentists around if you can find one where treatment is subsidised. GPs and Health Centres are free, hospital treatment is free, maternity is free.

I say "free" but we do pay for all this through our taxes. Do we pay more in taxes than the USA or Australia? I have no idea.

The USA government pays more than double what the UK pays on healthcare per capita, for no better outcomes. Government expenditure comes from taxes so ... the UK citizens pay less than half in healthcare-related taxes, on average. One of the advantages of the NHS is that it is huge and can negotiate much better discounts on prices than lots of independent insurers can.

 

[JenniB]

Which do you think is better and what would you change about them

Hi all
I think UK at the moment but believe the long term plan is for privatisation. If you have a few minutes could you complete the online form to save my local hospital in Telford please? The site is www.prh4me.co.uk they are closing our a & e/out of hours emergency and women and children's unit (only 2 years old) and keeping the one at a hospital in Shrewsbury. Very difficult to get to by bus (3 buses and a long walk) and I fear for people in Telford. There are rumors that the screening facilities will also be moved in 2 years time and I am a pensioner and would find it very difficult/impossible to get to the hospital at Shrewsbury - which is over the other side of Shrewsbury. Please sign the PRH (Princess Royal Hospital) petition on line.

 

[Daibell]

Hi. I lived in the USA for 2 years in the 70s. The experience was both good and bad. I had superb free emergency treatment from San Fran General hospital with a kidney stone. On the other hand my wife had a miscarriage and went to a private hospital in Dallas (with insurance cover) as an emergency and she would have bled to death if I hadn't ranted at the stupid staff who didn't want to intervene. The good thing about the USA is you can elect to go straight to a consultant (and pay of course) or a GP. In the UK you have to go via a GP which introduces extra cost to the NHS, delay and possibly an incorrect diagnosis as GPs are generalists. So, both the UK and USA can be very good and very poor.

 

[britishpub]

In 1996 in the U.K. my eldest son (aged 2) fell off a swing and had a "green stick" fracture of his arm. We took him to A&E, which was heaving, but as he was a child we were seen immediately, and then again on all the follow ups we were seen without ever waiting.

In 1998 when we were living in Florida (Tampa) my younger son also then aged 2 suffered a similar injury. At the local ER which didn't appear busy, we waited over 3 hours to be seen, and on all the follow up appointments we always had to wait 30 minutes or more to be seen, and at the end of it all were presented with a bill for many hundreds of $.

As an anecdote it probably says that the NHS is better, but luckily other than the ludicrously expensive but necessary kids "jabs" it was our only encounter with healthcare in the US over our 5 1/2 years there, so probably isn't conclusive

 

[Mep]

I say "free" but we do pay for all this through our taxes. Do we pay more in taxes than the USA or Australia? I have no idea.

Here in Australia we have numerous taxes which include the hidden ones that people don't even think about like the tax on fuel, etc. But our income tax is an average of 28-30% (the highest bracket is 49% I think). We also have goods and services tax (GST) of 10% on everything we buy which is considered non essential items (funnily enough they think ladies sanitary products are non essential). But if you need a plumber or something you are charged GST for the call out. It's quite subjective really what they consider non essentials. Then we have the state taxes people have to pay for e.g.. payroll tax, vehicle licences & registration, financial transactions, property taxes, etc. They also tax all the resources including petrol. The commonwealth here taxes petrol too (fuel excise tax).

I guess if you speak to an average Australian they will say they feel they're taxed to the hilt for everything. The only people that don't pay taxes are the low income earners under the tax threshold (but technically they still pay tax for purchases). As far as medical is concerned a lot of people here can no longer afford private health cover either even though they've all been told it's compulsory for aged 30+.

 

[chalup]

Other than we do not have compulsory private health insurance it sounds almost exactly like Canada. I am in British Columbia which seems to be the only province that charges a monthly premium, based on income, for government medical coverage, and it is compulsory. Low income people or families pay nothing. A single person making an average skilled wage will pay about $65 per month. Dental coverage for anyone over 18 years of age is private or nothing as well as opthamologists. Prescriptions are only free if you have reached your deductable, which is based on income and can be quite high, or if you have very good third party insurance through work. You still have to have government coverage even with third party insurance.

 

[zand]

I have heard stories that in USA some people have been given expensive treatment that they don't need and which could even be harmful to the patient....all paid for by the patient or their medical insurance. At least we know that is less likely to happen in UK with our cash strapped NHS. To suffer because you don't have the treatment you need is awful, but to suffer because you have unnecessary treatment has to be just as bad, if not worse?

 

[TorqPenderloin]

I have heard stories that in USA some people have been given expensive treatment that they don't need and which could even be harmful to the patient....all paid for by the patient or their medical insurance. At least we know that is less likely to happen in UK with our cash strapped NHS. To suffer because you don't have the treatment you need is awful, but to suffer because you have unnecessary treatment has to be just as bad, if not worse?

I know what you're speaking to, and there are many stories much worse, but I do have one of my own. It's actually how I was diagnosed with T1D.

I had developed a severe rash on my back (that likely wouldn't clear because my blood sugar was 25+). I went to see a dermatologist (without speaking to my GP) who prescribed me 4-weeks worth of prednisolone and some topical steroids. As many of us know, those are known to increase our blood sugar, and I felt absolutely horrible during those 4-weeks. I cringe at the likely possibility that my blood sugar was >30.

After that didn't work, she began recommending I use her fancy UV machine in her office. It was basically a medical tanning bed, and I had to pay $25 three times a week to use it for 3-6 minutes. It sounds a big ludicrous now, but keep in mind that I was miserable with my rash and willing to do anything to get it to clear up.

After about three months, it looked exactly the same. At that point, my parents were afraid I had cancer or something life-threatening (and T1D certainly can be). On the last day I saw her, I gave her a typed list of all the symptoms I had and told her that I was going to get blood work done.

I actually have the list somewhere, but it looked basically like this:
-drink 3 gallons of water a day
-unexplained weight loss 35-40lbs
-frequent urination
-irritability
-excessive hunger

I probably spent over $1000usd going to see that woman who was so incompetent that she saw me for three months and never even considered that I might have diabetes even when I essentially handed her a list of nearly every telltale symptom of the disease.

Long story short, the next day I went to see me GP, handed him the exact same list of my symptoms, and it literally took him less than 30 seconds of looking at the list before he suspected I had diabetes...I did, blood sugar 500+, ended up in emergency care, and the rest of is history.

The point of my story is that this doctor was getting paid something ridiculous like $150-200 (by my insurance) every time I went to use that stupid machine. I had continuously expressed my concern that it wasn't working and her most common response was that it takes time to work (basically, spent more money to use it more often and it will work better).

 

[zand]

@TorqPenderloin that must have been so worrying for you and your family. Thanks for sharing.

 

[JohnEGreen]

I know this is from two weeks ago but was listening to an interview with Stan Brock the other day and it made me think of this thread.

 

[BrianTheElder]

Hi. I lived in the USA for 2 years in the 70s. The experience was both good and bad. I had superb free emergency treatment from San Fran General hospital with a kidney stone. On the other hand my wife had a miscarriage and went to a private hospital in Dallas (with insurance cover) as an emergency and she would have bled to death if I hadn't ranted at the stupid staff who didn't want to intervene. The good thing about the USA is you can elect to go straight to a consultant (and pay of course) or a GP. In the UK you have to go via a GP which introduces extra cost to the NHS, delay and possibly an incorrect diagnosis as GPs are generalists. So, both the UK and USA can be very good and very poor.

I used to have private insurance via BUPA, but left when they put the cost up to £6000 a year because of my medical history (God knows what it would be now). So I decided to use the NHS and pay for private treatment when I needed it (and save an awful lot of cash). I have found that if you make your GP aware of that, they will not faff around with tests etc, but refer you to a consultant straight away. This saves the NHS money and gets me better treatment. I do feel guilty that I may be queue jumping, but all the treatment I have had has been in private, not NHS hospitals. I also understand that not everyone can afford this, but at my age, I think it's a good use of my savings.

 

[Bluetit1802]

I used to have private insurance via BUPA, but left when they put the cost up to £6000 a year because of my medical history (God knows what it would be now). So I decided to use the NHS and pay for private treatment when I needed it (and save an awful lot of cash). I have found that if you make your GP aware of that, they will not faff around with tests etc, but refer you to a consultant straight away. This saves the NHS money and gets me better treatment. I do feel guilty that I may be queue jumping, but all the treatment I have had has been in private, not NHS hospitals. I also understand that not everyone can afford this, but at my age, I think it's a good use of my savings.

Never regard it as queue jumping. By going private you are giving your NHS place to someone else who would have had to stay in the queue a bit longer. I couldn't afford fully private, but if I ever found myself in a queue I would be grateful to those who can and do.