Honest thoughts on US Healthcare system.

Hi everyone,

As you may all know, we the Canucks of Canadia, have benefitted greatly (in most cases) from having a universal healthcare system. I know that our single payer health care system has its inefficiencies as it relates to wait times for procedures, organ donations, and high costs of providing care in some areas, but through regular discussions with fellow citizens I find that nobody is opposed to the system we currently have as a whole. While we may disagree on logistics, funding and operations, I think us Canadians all agree that we wouldn't want any other system.

Ever since I moved to this country as a child, I always loved the fact that the government would always be there to protect us if we were to ever need it. This really resonated with me because it shows the Canadian government truly sees everybody as worthy of care. Coming from India where the playing field is ridiculously uneven between rich and poor, it was a great sight to see that you would be cared for no matter what. It doesn't matter if you are an investment banker with a 6 figure salary, or if you are a janitor cleaning the investment bank. You will receive the same type of medical attention without having to get a 2nd mortgage on your home.

I know the healthcare system is the cause of huge, nasty debates in the USA. I find it really sad that such a critical topic is so politicized with both sides of the political spectrum pushing their own crazy agendas. Maybe I am a little crazy, but I firmly believe that healthcare should be an inalienable right in such an advanced country like the USA. It is a sign of a highly developed nation and shows true empathy for its citizens.

I would love to hear any thoughts from fellow USA based WSO peeps on what they think about the healthcare system in the USA at the moment? What do you think it can do better? What is it doing well right now? How do you think it can be improved?

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Comments (76)

Jul 21, 2020 - 8:12pm

Everyone thinks they want universal healthcare and a single payer system but fat, lazy, entitled Americans would shit brick houses if they were to actually get what they're vehemently demanding. In no other country are drugs available the moment they're marketed or specialists seen within days, and sometimes even hours (thanks ZocDoc), that they are "needed".

Imagine asking my countrymen to wait 4 months for a psych appointment or 24 months for that expensive cancer med that they want (if at all). They would flip their shit, tweeting at everyone from their pharmacy to the HHS to the NYT, etc and throwing tantrums in the waiting area of their local hospital, just like how they react to "unacceptable" service at the Apple store when they stroll in 2 days after the latest iPhone was released and there are none in stock.

Universal healthcare = Medicaid-level service. Do you hear how little shit Medicaid covers and how much red tape is involved to get to a simple doctor's appointment? Americans can't even figure out the dental insurance that they currently have, so imagine how inept they'd be at navigating something similar for all of their healthcare needs. Shit would be an absolute mess

Jul 21, 2020 - 8:30pm

This is a great take. In a previous life I lent to SNF/skilled nursing operators and talked a bit about the operations/regulatory environment, especially the intricacies of the payer system (Medicare [changed last year with the PDPM], Medicaid, commercial insurance, etc.). It was wild how inefficient it can be... and this is only for a small portion of the overall market!

Quant (ˈkwänt) n: An expert, someone who knows more and more about less and less until they know everything about nothing.

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Jul 21, 2020 - 9:03pm

Seeing a specialist takes 6-8 months, and bloodwork is 10x more than getting it done through a private service.

My thoughts on US Healthcare? Garbage in my experience.

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Jul 21, 2020 - 9:06pm

Honestly, I haven't heard a single good thing about the VA. I don't believe government is at all efficient and I'd much rather pay a premium for the best service in the world.

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Jul 22, 2020 - 9:39am
Intern in IB-M&A:

Honestly, I haven't heard a single good thing about the VA. I don't believe government is at all efficient and I'd much rather pay a premium for the best service in the world.

Yes, and the crucial statement here is "pay". Most Americans can't pay.

In fact, all the arguments about long wait times to see specialists, etc, are all kind of missing the point. I can't access the underlying research (so it could be dog shit) but this CNN article says that half a million American families go into bankruptcy every year due to medical bills. Which honestly sounds about right. The point being, imagine the number of people who aren't getting semi-regular check ups, who are ignoring early stage indicators of illness, because they cannot afford to go to a doctor? If the alternatives for poor folks are "wait 6 months to see a doctor" or "don't go at all until the situation is genuinely life threatening" then waiting 6 months doesn't sound so bad.

And, of course, if we could orient our healthcare system to be preventative rather than curative, we'd cut costs drastically.

Jul 22, 2020 - 12:06pm

You're missing the point. The whole argument is about the access of healthcare to **society **as a whole, not the select few who can afford premium service.

I honestly do not mind paying higher taxes in Canada because I know if anything were to ever happen to me medically (i.e. Cancer) or financially (i.e. Job Loss), I'd be taken care of very well until I am able to get back on my feet. Do I get frustrated at certain aspects of how healthcare systems are operated in Canada? yes, totally, but in my overall experience it has been a great safety net.

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Jul 21, 2020 - 9:22pm

The argument is we prefer to have a system that consumers and physicians abhor. We also want to keep the insurance company executives fat and happy.

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Jul 22, 2020 - 12:13am

Single payer healthcare is risky on 2 grounds.

1) If the supply side restrictions are too stringent, then yoi get terrible waiting periods and shortages like in Canada. Everyone can afford healthcare, but no one receives it on time.

2) Let's say that the supply side issues are resolved as well, meaning there are enough doctors, enough nurses, enough drugs, enough equipment, enough hospital beds, etc... How do you maintain this? Continuing to have enough supply entirely depends on enough people going into medicine, professionals working extra hours, and constant technological innovation. Without the proper incentive systems and an innovation friendly environment, things would fall apart and revert back to scenario 1.

Not to mention the government inefficiency that would kick in, meaning you would get less cents on a dollar you spend than what you would get from a private insurance provider.

Better alternative would be to have a public option for the most marginalized and privayeboptions for who can afford them while loosening up the supply side restrictions. This would make healthcafe generally cheaper (with or without insurance) and increase insurance coverage to almost everyone.

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Jul 21, 2020 - 9:16pm

Our healthcare system sucks. Millions of people can't afford healthcare. What good is a system of great hospitals and doctors when only the wealthy can afford to pay for services.

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Jul 22, 2020 - 11:14pm

I mean... this is overly broad and just flat wrong.

The U.S. has de facto access to care in the form of mandatory ER admission law as well as social programs like Medicare and Medicaid. There are reasonable conversations to be had around pop. health measures that would enable better preventive care measures / channel vulnerable populations away from ER's, but to just say "the system sucks" is pretty ridiculous.

For example, U.S. has the best cancer treatment outcomes in the world and has the fastest access to (and is largely the source of) most new pharmaceutical developments. If you control for things like obesity, violence, tobacco use, and other very American lifestyle choices then the U.S. has some of the best healthcare outcomes in the world. That's not just the rich benefitting.

Jul 22, 2020 - 11:14pm
bostongrowthequityguy:

If you control for things like obesity, violence, tobacco use, and other very American lifestyle choices

Bingo, the U.S. Healthcare system literally and metaphorically gets crushed by the "weight" of the lifestyle choices of every day American citizens.

Jul 21, 2020 - 10:28pm

US healthcare has 2 main problems.

1) Supply side problem: Ridiculous restrictions, regulations, and what not that make healthcare expensive in the first place.

2) Coverage problem: You know, insurance is expensive... So not everyone can afford it.

In many places with universal healthcare, including Canada, coverage problem is removed. However, supply side problems still remain large. That's why you have to wait so long in Canada.

There are couple places that were able to take care of supply side problems, mainly Korea. They have a legally mandated single-payer healthcare system. Yet most major surgeries, operations, drugs, other healthcare services are not in short supply. Why? 3 things - 1) Huge pressure to "trim the fat" in medical administration. If you ever go to a hospital in Korea, small or big, service and operational efficiency is top notch. They figured out all sorts of crazy techniques and built crazy efficient software to increase the average productivity of doctors and nurses. 2) Doctors work longer hours. 3) Looser restrictions (compared to the US) on what drugs, operations, medical equipment, etc... can be used. Combination of these 3 have allowed Korea to be one of the best places for healthcare, top notch doctors for affordable price. Admittedly, going to Korea for medical needs is like going to Dartmouth instead of HYPS.

The biggest problem in the US is that the supply side restrictions are one of the most stringent in the world. Drug patents last 20 years compared to 10~15 years in most other countries (way too expensive drugs), FDA has some unrealistic expectations (not enough drugs), bureaucratic costs of even opening up a hospital is too high (not enough hospitals), and unions that restrict the number of doctors and nurses. Quite obviously, if everyone wants something and there isn't enough of it, the seller can name the price. Which in turn makes insurance expensive.

All in all, Korean healthcare works at the expense of the doctors. The system only works because enough people want to be doctors. If people started realizing that they could make more money doing other things, the system would fall apart.

Single-payer healthcare is just too risky and difficult to maintain. That's why people need choices, btw public and private options. Public option could be there for the most marginalized of the society. While the rest can buy into a private option.

TL;DR: Supply side restrictions make healthcare expensive. Insurance coverage problem obviously doesn't allow everyone to buy insurance. Fixing just the coverage problem is problematic because you have to wait forever to get treated. Fixing the supply side issue, through loosening certain restrictions, getting rid of unnecessary regulations (focus should be smart regulations. not less or more regulations), encouraging technological advances resolve supply side issues. Most robust type of healthcare is a mix of private and public insurance option with smart supply side regulations + environment for biotech/healthcare innovation that allows healthcare to be accessible to everyone at fast enough speed (no waiting for months and what not).

Jul 22, 2020 - 1:25am

Since you believe one of the main reasons the system works in Korea is that there are enough people that wish to be doctors, what is your opinion on the American Medical Association? Which according to Milton Friedman is a government sanctioned trade cartel that raises costs and diminishes quality. As far as I know we have many people that want to be doctors (and are probably entirely capable, despite taking a B or 3 in college) but the supply is kept artificially low. I'm not saying we should be letting anyone become a doctor but it takes very little research to understand that some of the practices of the AMA are quite concerning if we truly want to apply free market principles to the industry.

Jul 22, 2020 - 2:08am

Not Milton Friedman, nor Fried Chicken Man, but the USA could easily import excellent doctors from around the world and offer them citizenship. We could have A+ grade doctors from other countries before having to dig into the C-grade U.S. students.

Be excellent to each other, and party on, dudes.
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Jul 22, 2020 - 3:54pm

The strongest and the most harmful unions are unions if high skill laborers. AMA is no exception.

Getting into medical school risiculously tough. Getting a prestigious internship program is even tougher. Too much of the healthcare is provided by the elite of the elite and this is part of what drives the prices so high.

You don't need to visit a Harvard MD to get diagnosed with a flu.

There are also a lot of things that doctors do that could easily be done by technicians.
1) doctors don't need to be the ones operating imaging machines, let the technicians do that, 2) doctors don't need to be the ones giving you shots, simple procedures, etc...We are better at the division of labor than we used to be, but still an important thing to look into.

Jul 22, 2020 - 12:00pm

These are interesting arguments which I never really looked into. I will do some research into the Korean system. Thanks for taking the time to post that!

This topic really peaked my interest since the pandemic started. Gosh, do I ever regret not taking Economics of Health during my undergrad!

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Jul 22, 2020 - 1:14pm
Milton Friedchickenman:

Admittedly, going to Korea for medical needs is like going to Dartmouth instead of HYPS.

I love how you put this in a perspective people on this forum can relate to.

Quant (ˈkwänt) n: An expert, someone who knows more and more about less and less until they know everything about nothing.

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Jul 22, 2020 - 4:16am

I have lived in Canada, America, and the UK so I have some comparison experiences. If you are in the upper middle class in the US and have insurance, the US is top-notch for speed of service on non-essential items. For the other 80% of society, the Canadian system and UK NHS are 10x better than what the US has to offer.

Even with insurance, US prices are ridiculous. For example, what I paid out of pocket for glasses/dental care in the UK was cheaper than the deductible I paid in the US with premium insurance coverage.

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Jul 22, 2020 - 12:10pm

I've lived in the Nordics and I'd say I've gotten appointments way faster and better than when I was in the US and I had no problems with money in the US. I had a longer waiting time in the US than in Denmark or Sweden for my Crohn's exams and blood work. It could've just been me, but waayy better than the US.

Jul 22, 2020 - 9:39am

Single payer may work if Americans gave an ounce of effort when it comes to taking care of themselves. Americans can't beg for single payer and then continue to shove ho-ho's and ding-dongs in their fat fucking faces. Other than that, idk, I like my healthcare as it is but I'm not gonna die on this hill.

Jul 22, 2020 - 1:53pm

You lost the argument by demanding it as an inalienable right. There are no rights without duties. The left's habit of making whatever they want a ''human right'' is an unimitigated cancer in society, a primary lecture towards personal irresponsibility, social parasytism and inability to take care of yourself when facing life's challenges.

And I'd even support your cause on other grounds.

Never discuss with idiots, first they drag you at their level, then they beat you with experience.

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Jul 22, 2020 - 3:31pm

I stated my belief that it should be in a highly advanced society that actually prioritizes things other than maximization of profit. If you don't agree, that's fine. I like to think I have empathy for my fellow man and maybe Canada is significantly different from the USA in how we actually view our fellow countrymen. The vast majority of us do not mind the higher taxes we pay because it means we'd have our medical bills covered if we'd ever need it. There are no rights without duties? Yea dude, I know. My duty is to pay taxes and that's how our system is funded. You have a way larger tax base with many more wealthy people, but yet you choose to spend ungodly sums on military instead of addressing domestic medical system issues? Lol
Why is congress always in deadlock and can't agree on any health care solutions? When you allow lobbyists and corporations pour billions into swaying political decisions that affect peoples lives... that's messed up. In my opinion this isn't a Liberal or Conservative issue... it's a basic societal issue.

I agree with you that demanding too much (i.e. entitlements) leads to a total disaster with people refusing to take personal responsibility, but that's not what we're fucking talking about. We're talking about basic fucking healthcare. You can't predict if you are going to get a rare form of cancer or some other disease that requires you to break the bank. I'm saying the system in the USA as a whole is so corrupted and oh so skewed towards favoring those with means that it makes me sad.

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Jul 22, 2020 - 4:17pm

I highly recommend reading Ferguson's Cash Nexus. Until basically WW1,the overwhelming majority of state expenditure was dedicated to war related issues, very much like the overwhelming majority of tax revenue came from the wealthy. Whatyou call ''basic fucking healthcare'' is actually a privilege of post war generations, who also enjoy the privilege of not facing coscription and being sent to war to die in flocks.

Again, I don't think you guys understand how lucky you are and yes, I do think healthcare in the US is insanely expensive.

Never discuss with idiots, first they drag you at their level, then they beat you with experience.

Jul 22, 2020 - 4:26pm

No

Never discuss with idiots, first they drag you at their level, then they beat you with experience.

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Jul 22, 2020 - 1:56pm

in any complex system with competing interests, individuality, and a massive diverse population, you will have issues. the USA has clearly prioritized profit maximization and innovation as opposed to access and lowering costs. I'm not saying I agree with our priorities, just saying that until those change, you will get what you get.

I've yet to see another country with 350mm people that has a better healthcare system, for whatever that's worth. I think the solutions for an in-shape, ethnically and culturally homogeneous culture with

Jul 22, 2020 - 3:53pm

As brofessor pointed out, Scandinavian and East Asian societies are highly homogenous, which is correlated to a stronger preference towards redistributive policies and social cohesion (see the solidarity vs diversity condundrum, David Goodhart). Widespread high education is a very recent phenomenon that comes after the development of healthcare system, it does not preceed them nor is the cause, although it could be convenient for someone to argue ''if only we had enough educated people, we'd have healthcare''. The US has a comparable, if not higher % of educated people than many countries with healthcare. Also, higher % of highly educated is actually correlated to social instability, which is the opposite of the social cohesion you need for what you want.

Never discuss with idiots, first they drag you at their level, then they beat you with experience.

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Jul 22, 2020 - 2:20pm

To be fair, there are not other countries with 350MM people. I'm interested in why you think scale matters here though. What part of either Canada, or the UK, or Germany's healthcare system makes it not scale-able? Certainly America has more people, but we also have more doctors, a larger tax base, etc.

Commercial Real Estate Developer

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Jul 22, 2020 - 2:28pm

I don't know that it matters, I'm just posing the question. maybe the same solutions that work for Denmark would translate well to our culture and size doesn't matter. maybe Japan having less immigrants doesn't matter and their model will work. maybe the only thing that matters is how healthy the society is generally, and obviously we have a lot of work to do as a society, and no healthcare system (single payer or not) will work until we solve the obesity problem, I don't know.

I know that same leadership lessons work in teams of 4 as they do for armies of hundred thousands, so scale doesn't matter in that realm. at the same time, it doesn't work the same in a business dealing with customers. some business like mine would simply not work if I had 5,000 clients instead of just a few hundred, so scale matters here. I'm not saying that scale always matters, I'm saying I don't know if it does with healthcare but I'd like to see that explored.

Jul 22, 2020 - 4:48pm

A diverse population has absolutely nothing to do with how a particular health mare system works or not, unless different groups prefer/need vastly different medical needs (which I don't think is true).

I think the real issue is that there are simply too many conflicting views, hence the political cost of change toward any direction is extremely high.

Only if people focused on what's considered effective problem solving (we're so good at this in the private sector, so it puzzles me why the public sector and politicians can't figure shit out), then we wouldn't have problems.... this is why I hate the government.

Jul 22, 2020 - 2:32pm

Correct. Positive rights vs negative rights

Money can purchase freedom, if you have the guts to buy it

Jul 22, 2020 - 3:33pm

Yea, I am sure the 38 million other Canadians who benefit from healthcare as an inalienable right totally agree with you

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Jul 22, 2020 - 2:23pm

The US Healthcare system has a problem from the very beginning:

a) Education

Most people don't know how to eat from a very early age and the status quo surely doesn't teach by example. Most Americans are obese and don't know how to change. They are indebted to quick calories and quick fixes to medical help through bypass surgeons at the worst to pharmaceutical fixes at the least. The whole US medical system trains doctors to assist those with heart problems. Nutrition in US med school is lacking, so from the lack of education from our youth to seeing the way those around them live (society, parents) and how their doctors just treat them and then the medical companies get paid and big pharma gets paid, its all a big system and cycle in place.

There are a lot of lobbyists to keep these systems in place. To keep milk on the recommended menu that the government provides. But, is milk necessary? No. Do I like milk personally? Yes. But, the diet that elementary to high school teachers teach is mandated by shoddy information from the government. Nutrition seems like a soft science to Americans and its no wonder that heart disease is such an issue here.

We have to change the way kids are exposed to proper eating and living. Heart disease is the killer in America today and if we just keep living the same nothing is going to change.

"If you always put limits on everything you do, physical or anything else, it will spread into your work and into your life. There are no limits. There are only plateaus, and you must not stay there, you must go beyond them." - Bruce Lee

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Jul 22, 2020 - 3:05pm

Healthcare is not an inalienable right, matter of fact it is not a right at all. Why should taxpayers have to pay for the oftentimes obese, ignorant people who spent their lives eating poorly? Why should I have to pay for someone else's medicine at all? I am sure there are private, non-profits that could address the proletariat's healthcare needs.

Jul 22, 2020 - 5:06pm
NYCBoyAbroad:

Why should taxpayers have to pay for the oftentimes obese, ignorant people who spent their lives eating poorly?

I agree to this, mainly for the fact that I spend a lot of time and effort to be 'fast' or as others call it 'healthy'.

"If you always put limits on everything you do, physical or anything else, it will spread into your work and into your life. There are no limits. There are only plateaus, and you must not stay there, you must go beyond them." - Bruce Lee

Jul 22, 2020 - 3:51pm

At the end of the day Americans are perfectly okay with cancer being the biggest cause of bankruptcy in this country.

My friend's mom got cancer. She is a small business owner and they're a lower middle class family. Between COVID and cancer... well it's a struggle. The family had to start a gofundme to cover some of the costs. That's the country we live in.

People are here opining about speed/quality of care but I have never run across someone from a country with universal healthcare that says "man I prefer the U.S. healthcare system". A fair amount of ppl have been tricked into believing the trade-off (if one really exists) is worth it by the powers that be. From all indications, it's not.

Meanwhile, those with the money are perfectly fine with the current system as they can afford it.

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Jul 22, 2020 - 5:44pm

Yeah the US definitely pushes excellence in medicine.

"If you always put limits on everything you do, physical or anything else, it will spread into your work and into your life. There are no limits. There are only plateaus, and you must not stay there, you must go beyond them." - Bruce Lee

Jul 22, 2020 - 4:47pm

As a Canadian who has had the chance to live long-term in the US, UK and Japan, I definitely have some views on the whole situation. Part of what make this issue so difficult to discuss is that generally speaking, Americans don't understand that there are different systems (well 4) throughout the world and choice is not limited to a single payer vs. completely private. So:

Canada: Beveridge model = government finance and provide care. Care is mostly provided in government run clinics and hospitals
Japan: Bismarck model = government provide a certain level of care (in Japan they pay for 70% of costs). everything else is covered by private insurance, but having insurance is MANDATORY. Care is mostly provided in privately own clinics / hospital, but rates are set.
UK: National insurance model: Beveridge and Bismarck operate side-by-side.
US: Out-of-pocket model = everything is private and providers can charge whatever they want (and don't even have a legal obligation to provide you with prices before performing care)

While there are slight difference in the application of the Bismarck model, there's a practically unanimous consensus that is delivers the best outcome for most at the lowest costs. It covers everyone, but forces people to contribute to their health care costs (ie. have skin in the game) while ensuring that there is adequate supply. Preset rates significantly reduces the admin burden while encouraging care provider to be efficient. It also gives people choices with regards to insurance.

It's unfortunate that the debate hardly every mention that option. the NYT (which I normally don't think is a great source of information, but whatever) did a very interesting interactive piece on what is the best healthcare system in the world and Switzerland and France came on top. Having quite a lot of friends and family in both countries, i can concur that they are very happy with the care they are receiving. I recommend all of you to have a look

https://www.nytimes.com/interactive/2017/09/18/upshot/best-health-care-…

Jul 22, 2020 - 5:33pm

I've only read half of this thread, but I'm going to assume this hasn't been said in the other half. my thoughts:

From reading the book "Death by Regulation" (highly recommend), I've come to the conclusion that the reason why healthcare is so expensive and BS-y in the US is over regulation. My short term solution while we seek out a longer term fix (that is not government-run healthcare) is to privatize the FDA. Much in the way that the Big 4 and other accounting firms compete to certify audits, there should be drug certification companies that compete to approve the safety of medicines.

I think the elimination of the FDA monopolization of drug approval alone would make great strides in fixing our system without resorting to socialized medicine.

Jul 22, 2020 - 6:28pm

Playing devil's advocate here, do you not think even more privatization in healthcare could do more harm than good? The Big 4 (+ Big 3 ratings agencies) aren't exactly without their faults - there's tons of examples of incentive problems - look no further than Wirecard / EY - and in fact you could argue the privatization of 'certification' in credit markets is what caused the biggest financial meltdown in recent history.

It's one thing when the party being harmed by such behavior is the abstract shareholder sitting in a boardroom (yes I understand pensions, life insurance etc. are at stake but it remains a couple of steps removed). It's a whole different ballgame when pharma companies start playing these games with human lives on the line.

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Jul 22, 2020 - 6:14pm

Another UK/US person checking in.
I think the NHS system works really well. People here always talk about "preferring paying a premium for the best care".

Well, in the UK, those with good jobs (like those in finance), can get private insurance and see private doctors + hospitals.

For everyone else, there is a "Medicaid" style system via the NHS which is free. This ensures everyone can get their diabetes treated etc.

They do have a funding problem with the NHS, but I think the flaw they have here is that they do not charge copays. Studies show that charging people on the order of 10$ for a doctors visit makes them use health services more frugally.

The point that always gets missed, is there is also a large distributional question. Doctors in the UK get paid way less than US doctors.

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