#413

I would not say this. A lot are government insured healthcare where the healthcare itself is private. In the UK the NHS is arguably government run although primary care are almost all private and there are lots of private contractors.

4 Likes
#414

Yes, European systems are not all the same. The UK is probably the worst as it is Soviet-style: doctors are effectively civil servants. France is paid by the gov, but the majority of the system is private (in the same way that in some countries you can use a school voucher paid by the gov to get private education services for your kids). Other systems are a mix. And in all European countries there are also out-of-pocket expenses and private insurers on top of the public system.

Likewise, the US is not fully private either. The MAJORITY of healthcare is paid by the GOVERNMENT in the US (yes, you read that well). This is from 2015:

image

Latest sources show this: How has U.S. spending on healthcare changed over time? - Peterson-KFF Health System Tracker

image
image2264×890 129 KB

The issue is system design rather than “who pays?”.

3 Likes
#415

OK, we said no politics, but… European countries pay for their security, directly or indirectly:

  1. They spend ~2% of their GDP on defense vs 3% for the US. It’s less, but it’s not zero.
  2. They host US military bases.
  3. They follow US foreign policy and sanctions even if not in their financial interests (Europeans would love to trade with Iran, for instance).
  4. They buy US debt, funding US deficits (including military spending).
  5. The dollar is the world’s currency, so the US can print money and the inflation tax is paid by the world, so mostly by non-US-citizens.

Last but not least, the US actively discouraged European rearmament:

  • Prevented German militarization after WWII (for arguably good reasons but it’s weird to blame the Germans decades later for not spending on defense :joy: )
  • Offered extended nuclear deterrence to the whole of Europe
  • Stationed troops

So the deal was: don’t spend too much on defense, we’ll protect you, in exchange you buy our military equipment (“Military–industrial complex”) and you focus on economic growth and you buy our goods and services. An excellent deal from the point of view of the US. Rather stupid to try to stop it.

That being said, Western healthcare systems (including the US one) are not financially sustainable.

6 Likes
#416

This is, however, substantially a healthspan issue. What happens to limit expenditure in the UK is a form of queuing system and some rationing and refusal of certain treatments based upon the concept of QALY (Quality Adjusted Life Years).

There is also a continuing tension between health costs (mainly paid by the state) and social care costs (mainly paid privately)

3 Likes
#417

The idea of gatekeeping healthcare behind employment or wealth requirements is so bizarre if you think about this.

If you believe, as current evidence suggests, that your genetics and upbringing are a huge component of your future attainment, this becomes extremely arbitrary. For example, if getting health insurance depended on being able to dunk a basketball rather than being able to do math homework, it would be perceived as deeply unfair. Instead, we lock healthcare behind a college degree and certain types of job. In other words, if you can’t do your math homework or were born to the wrong parents, you’re mostly condemned to never have good insurance. Weird, right?

This is something which is essential and also beneficial for the country. It’s common sense that you don’t want to have a population which is unhealthy, which ends up harming productivity and costing even more money. The economic impacts of poor health are massive. Imagine someone who has a stroke at 55, then they can’t work, family members cut down on work to take care of them, the family becomes poorer, they buy less stuff etc).

The idea of “insurance” makes total sense, because NONE of us knows what our healthcare costs are going to be. You could never interact with the system for decades, then suddenly need a $1M surgery or complex treatment. Or you could be cursed with some chronic health condition when you’ll need lifelong assistance, through no fault of your own.

Other posts have made ideological arguments for private or public systems. To be honest, I think we know that either can work, looking at other countries. However, one huge problem in the USA system is simply the massive amount of greed at every level. Everybody everywhere is trying to maximize profits, and a few people are getting filthy rich while the majority end up with worse outcomes.

What we’re also seeing now is a bizarre battle between these mega corporations, all profiting, but at your expense. You have companies like Mondelēz (Kraft), Coca Cola, Unilever etc, making shitloads of money selling you terrible food which destroys your health. Then you have the big tech companies purposefully getting you addicted to their products, leading you into bad decisions, exposing you to misinformation - all in the name of more attention, clicks and driving your spending decisions, making profit for themselves. Then you have supplement, pharma and medical services making shitloads of money offering to “fix” the terrible health resulting from the terrible lifestyle. And don’t forget the mega advertising agencies and media who profit from food, tech and pharma advertising. You have a world where someone is scrolling brain rot content on social media, getting adverts for Uber Eats and Macdonalds, gets up-sold into ordering nuggets too, has a Big Mac delivered, and also paying $500/month for an injection to lost weight. If you step back and look at it, it’s absolutely crazy that this exists where everybody is profiting at this persons expense.

a-chart-showing-what-companies-own-which-brands-v0-7ipjy9ml6wka1.jpg
a-chart-showing-what-companies-own-which-brands-v0-7ipjy9ml6wka1.jpg2400×1507 454 KB

3 Likes
#418

On NHS.

It was just yesterday I was listening to the skincare guru Caroline Hirons (a London resident) talk about her health. She said everything she does it private pay because she has never had any reasonable care provided by NHS.

I went to a doctor and then the hospital there many decades ago… after spending all day to be seen, and when the doctor refused to do anything for me after condescendingly saying “we aren’t like you Americans who treat everything”, I may or may not have snapped back… well, no wonder your healthcare is free, you don’t do anything!

I was uncontrollably throwing up for days (turns out it was shockingly the water)

2 Likes
#419

My Brit friends describe it as you have in your message. You want treated go outside of the government care and pay for it. Always thought it strange that doctors have two practices… one for government. Then after hours for private pay. They make their living off their private pay patients.

3 Likes
#420

Interesting to know. And on that note, it reminds me that in the Hirons facebook group, a lot of UK girls will ask for advice on what to do what some gosh awful thing on their face… I once chimed in, go to the dermatologist for crying out loud… they all shared with me it’s almost impossible to be seen by a derm there… CRAZY

2 Likes
#421

When the majority of health care is paid for by the state people will also be resistant to paying privately.

4 Likes
#422

You can’t just “see a dermatologist” without going through a general practitioner (GP) first. The GP is the gatekeeper to any and all specialists. And even then, in many areas of the country you’ll struggle to get a GP appointment, and then you might have to persuade the GP to actually refer you to a specialist. Then you’ll wait likely weeks to months to get an appointment date for the specialist, and that appointment date may be months or years in the future.

And yes, the system is broken, in that anybody who has money will simply go private and there are tons of nice dermatology and cosmetic/aesthetic clinics in big cities. Of course, that means those doctors likely left the NHS or work half NHS, half private, to earn more money. What’s even “funnier” is that often it’s the same doctor you would have seen through a referral - but you’re just paying to skip the queue. So this attempt at having “everything free healthcare for everybody” literally creates a worse situation where you have a two tiered system where the good doctors go, and the wealthy patients go, leaving the worse service to the people with least means to do anything about it.

4 Likes
#423

That hurts my heart…

And to your point, the snowball effect of allowing private means the people who can’t easily afford that option now have even worse care that takes longer to get due to private appointments being available to the more wealthy. Sigh…

My only experience with the needing a referral bs was decades ago when it was the insurance option at work. In the US, at least for me, it was still a simple and fast and free process, but I was indignant I had to jump through a hoop to go see who I wanted to see. We also have many plans where you have to see docs in that system, but I wanna see who I wanna see. Private plans in CA are awful as far as choice goes if stuff hits the fan. There are two main options… one means you can’t go to UCSF and the other means you can’t go out of state to places like MD Anderson if you should get cancer. That sounds like a champagne problem if you are in the UK, but it just shows even if you pay through the nose, it’s still not perfect.

And yes, @John_Hemming I definitely get delaying important treatment because if you wait, you can get it for free… that is too tempting to be safe.

1 Like
#424

Its not just delaying it to get it for free, but an unwillingness to pay at all.

1 Like
#425

It’s the unwillingness to renounce to what you already paid for (with your taxes), and are entitled to, to instead pay a second time.

3 Likes
#426

Haha yep… check out this recent article for example of the attitude:

The NHS won’t give you a [DEXA] scan just because you ask for one. Even if you go to a private clinic, it will need to be signed off by a qualified medical practitioner. “You have to have a clinical risk factor or two before you can have a scan,” says Prof David Reid, an osteoporosis specialist and fundraising ambassador for the ROS.

Meanwhile, a Dexa costs what, 100 bucks, in the USA, and you can do it in multiple locations in any major city? But the UK you need actual permission from a doctor to do a completely harmless scan of your own body. No autonomy at all.

As another example, look at PCSK9i drugs. The NHS does allow them to be prescribed in some restricted, limited situations (if you’ve already had an MI, on maximum tolerated statin, still have LDL-C over some stupid high threshold). However, my friend runs a massive pharmacy in the UK, dispensing more than 20,000 prescriptions per month and he has never dispensed a single PCSK9i drug. That’s because doctors simply don’t bother prescribing them. It’s crazy to think how many extra heart attacks must happen because of things like this.

2 Likes
#427

Reading about how my bones might snap if I cough freaks me out :slight_smile:

Yesterday we were on a little hike and I stepped in a little hole while going downhill. You should have seen me hopping around trying to catch myself to avoid the fall… I probably looked like I was on fire! As a proper geek, afterwards, I said, thank goodness I’ve been working on my fast twitch fibers!

So, the US has an incredibly flawed healthcare system, and now I’ve learned healthcare in the UK is called minimum inept slow care.

Who has the best model and what is the secret sauce? I’ve heard Australia is good, but that was just from someone who does health policy here. DeStrider makes it sound like Hong Kong has their act together. Is there a place where those who can’t pay get the same care as those who can? I mean, healthcare here is great for those who can afford it, but that is a small group of people.

More on cost… me, with a private plan the two of us pay over $2500 a month for, when I went to the hospital for chest pain a couple years ago just to make sure it was not a heart attack, cost me aprox 6-8k (I don’t really remember) … when you pay that much, it makes you think twice before going again! I even sat with the pain for probably 6 hours before my doc said you have to go.

Fyi, in the US, to the best of my knowledge, the dexas we can all do for about $65 and request ourselves are mostly just to check out our body fat/ muscle.

The dexas that check out bone density do require an order from a doc… but yeah, we just ask the doc and then it’s done. It’s standard once you turn 50. I requested one at 40 and did have to argue with my doc to get her to write the order. Most would have caved, but I’m me, so….

My last one in Oct probably cost me aprox $600 out of pocket. Perhaps they are less elsewhere. My out of pocket max for in network is aprox 8k is for the year.

It’s a different ball of wax if you are working and have employer coverage. It varies wildly, but I had only worked for very large companies and paid almost nothing out of pocket for most of my care. It was only after I stopped working that I started to pay these huge amounts… and yes, when you are not earning money, the gift is paying more.

And yes @adssx
“ It’s the unwillingness to renounce to what you already paid for (with your taxes), and are entitled to, to instead pay a second time.”
Exactly that. I immediately understood John Hemming’s comment because my mom would have been one of those people. She would have happily let herself die before she paid a second time out of principle. And then I think about how the people feel who can barely afford their rent. I absolutely get it.

1 Like
#428

This is drifting off topic, but there are a couple of misunderstandings here. First, all NATO members are fully paying into NATO: funds that literally go into NATO are very minimal, and cover their administration, infrastructure, etc.

The thing that US Presidents have been complaining for a generation about, and that Trump mischaracterizes as “paying into NATO,” is that until recently most NATO members were not investing enough into their own militaries. The concern was that they were too weak to either defend themselves in case of an invasion, or to commit forces to defend other members if those other members were invaded.

In the only real test of this we’ve ever had, which is 9/11, NATO members did step up to support US action in Afghanistan: the Brits and Canadians in particular took large and dangerous assignments and lost a lot of troops.

Hoje , however, most NATO members are making their agreed-upon investments into their militaries. Some of the ones that aren’t are fairly poor countries (though there are relatively poor countries in NATO that are meeting the target too), but the Canadians, Italians, and Spaniards have no such excuse.

So most EU NATO members are already both preserving a generous safety net and meeting their NATO obligations — and the laggards could meet their obligations with about a 0.7% of GDP top-up. As @RapAdmin points out, part of this is because their healthcare costs are much lower than in the US to begin with.

As far as tarriffs go: contrary to what some politicians are saying, average EU tariffs on US goods are only modestly higher than pre-2025 US tariffs on EU goods:

While most countries have a range of tariff rates covering different goods imports, they also report an average external tariff to the WTO, which reflects the overall average tariff rate applied to all imports.

The US had an average external tariff of 3.3% in 2023.

That was slightly lower than the UK’s average tariff of 3.8%.

It was also below the European Union’s average tariff of 5% and China’s average tariff of 7.5%.

America’s average tariff was considerably lower than the average tariff of some of its other trading partners.

For instance, India’s average tariff was 17%, while South Korea’s was 13.4%.

America’s average tariff was lower than Mexico’s (6.8%) and Canada’s (3.8%), though trade agreements between the US and these countries mean that American exports to them are not subject to tariffs. The same is true for South Korea, with which the US has a free trade agreement.

There are certainly individual tariffs on individual goods that are much higher than the average — but that goes both ways. The EU has high tariffs on US cars, but the US has high tariffs on trucks from anywhere in the world. Canada has low tariffs on dairy, but has a supply management system and rapidly escalate tariffs when imports exceed the limits defined in the system. Meanwhile the US subsidizes US dairy up the yin-yang for water and feed. Etc.

That would be a choice US voters and politicians make: it won’t be dictated by anyone’s tariffs.

5 Likes
#429

I am a Jungian, a Yeatsian, and a Platonist. We are partly determined by biophysics, partly by the environment, and partly by the womb. These are conscious and unconscious forces. Buried beneath this layer are the archetypes of the collective unconscious, the ghosts in the machine.

#430

This just isn’t true. I’ve had 3 Dexa scans in London over the last 4 years and didn’t need to get any sort of referral from a GP. Just booked it on line and turned up.

4 Likes
#431

In the UK blood tests don’t need permission from a Doctor. In theory the rules in the USA are more restrictive even if they are not really enforced when it comes to importing medicine.

#432

image
image866×641 85.6 KB

This isn’t helping.

1 Like