A fellow traveller wants to know about medical care/elective surgery in your home country--what's the real scoop?
 

I am one who believes that travel involves much more than just being a tourist looking at the sights. Learning more about how other countries function is one of the things I find most fascinating when I travel. One of the things that I most enjoy about travelling to Europe is when I have a chance to talk to people who live other places and thus learn about their lives and their country. This is why I am asking this question here.

We're from the US. When travelling outside the US we've talked with some Canadians, some French citizens and some Germans about health care issues. Recently there was also a thread here about retiring abroad and the issue of health care also surfaced there I think. So many people in the US say that we wouldn't want to go to a Canadian system or British system, for example, because the waits are so long for anything but emergency care. I'd like some comments from those of you who really know firsthand what other countries' healthcare systems are like. Here is my example.

My middle-aged husband hurt his knee and needs arthoscopic surgery. The orthopedist said it needs repair, and while it is not urgent, he shouldn't wait longer than 3 to 5 months. This is what he is looking at as a time schedule. Time from injury to surgery--about six weeks total (2 weeks wait to see the orthopedist, 2 weeks of thinking before deciding to schedule surgery, and 2 weeks wait for the surgery). If this had been your country, how long would he have had to wait? How does your healthcare system operate? I should add that we are lucky that we have good insurance through my employer because in the US this is a huge component to the healthcare picture.

I think that is a good way to get an answer, by a concrete example. I don't know if it's that realistic, though, as I'm an American, and I couldn't get an appointment that quick for nonessential surgery. I know because I just had such an experience (not the knee thing), and had to schedule about two months off.

A lot of people who denigrate other countries health care systems do it for political reasons, and don't have the facts or are deliberately distorting them if they are a politician. It doesn't matter how quickly you can get in to get surgery if you are wealthy. You can always get surgery if you are rich when you want.

A lot of people wouldn't know the answer to your question even in their own country, though, so wouldn't know how long it would take for that or whether it was be considered elective or not.

I have some resources on various country health care systems if you really want to know more about it. There are lots of books and articles written about it. I'm doing some work with McGill U researchers right now on funding of mental health inpatient stay differences by type of payer for use in some Canadian health funding debates. This isn't an easy thing to really describe nor can it be done simply, unfortunately.

oh, sorry, I did not mean to say I wasn't interested in what people would have to say about this question in their country, I am. I have a friend who has German and US citizenship, and she prefers to go to Germany for her health care, and it's not because she doesn't have insurance here.

I have 4 different friends who have their parents here (in the USA)
because they could not get the "help" they needed in Europe. I happen to live near Chicago with many 1st generation Americans who have parents with other citizenship.

Two are from Ireland, one is from Italy and one is from Poland.

One of the Irish citizens was literally "warehoused" because it was deemed her condition was terminal. She was given 6 months at the outside and sent to a 3 person to a room hospice type environment quite far from her home. It was a lymphona.

She was treated for 13 weeks in the USA and it is now 6 years later. She calls her daughter at work every day about 4pm
or so and asks when tea will be.

The others are not as extreme, but the Italian gentleman could not get the knee replacement he needed where he was. He told me that he would have had to wait one more year and it would have been done too far from where he was to get the right kind of physical rehabilitation afterwards.

The Polish Grandpa could not get the medicine he needed in Poland.

I have no political agenda and wish we could have a Universal Health Insurance for hospitalization that would work for 100% of our citizens. My grand-aunts and second cousin in Germany are quite happy with their care, especially their eye care.

But I do know that there are no easy answers, especially when I see people who DO have many free health care perks using the ER as a regular doctor's visit: for colds, sore throat etc.

And so many other things involved are not addressed by this kind of comparison. Especially RX. R& D for RX is only done in so many places. You can't just go by production costs etc. And right now a large percentage of the R&D is being done in the USA.

My daughter is an American citizen from birth and went insurance-less from the time she was 22 to 25. She was still in school or doing jobs without that benefit and could not afford an extra bill. We fought over it and I tried to buy her some.

That is wrong. But so is the fact that at that same exact time, a person I worked with at another library was a new immigrant (as was her husband) with Lupus from Indonesia. She had 4 babies in 5 years when I worked with her and had LUPUS as well. She got top of the line care gratis, including ultrasounds every month or two at U.of C. system. My experience has seen that very costly care can be obtained as long as you have no assets to attach. And if you are very wealthy, it also isn't an issue.

I do think we should cover all our citizens.

In reverse, I have heard of two people going to Canada to have their teeth/ dentures done there.

The answer is actually fairly simple. Each society gets the type/amount of healthcare it is willing to pay for.

In the US most people want to keep taxes very low (versus the rest of the industrialized world) so many people have limited or no healthcare.

Major employers typically provide - or at least support - a resonable quality of healthcare (although some people with HMOS would argue with this). And the indigent have some government support of basic health needs. However a lot of people in the middle (and their children) who have part-time jobs, seasonal jobs or work for small employers that don't provide insurance have little or no care except in major emergencies.

In Canada and many parts of europe it has been decided that everyone is entitled to at least basic healthcare - which is supported by taxation. This may result in delays or sub-optinal care for some people - since taxpayers are not willing to pay the even larger taxes necessary for faster, better care for all.

In both systems there is the possibility of random abuse - but bascially the care offered - and to whom - is directly related to the amount society is willing to pay.

(In every one of these counries the best possible health care is available almost immediately to anyone willing to pay the costs themselves out of pocket.)

Hi J,

>...2 weeks wait to see the orthopedist, 2 weeks of thinking before deciding to schedule surgery, and 2 weeks wait for the surgery...

The middle 2 weeks should not be debited to the health care system.

BTW, I now know 8 people who have had both knees done. They all say they wish that hadn't waited as long as they did.

((I))

Sorry - I left ou my actual example. I work with two MDS - one originally from Germany , the other from England. They both said waiting time for a procedure can vary significantly from one part of the counry to another - depending on resources available.

(Just as in the US there are areas with a plethora of MD in every specialty - and there are ares that are significantly underserved - and those needing specialists may have a significant wait or a long trip.)

Very interesting topic.

I am a Canadian. I am probably not the best spokes person for our system as I am personally young and healthy so I have not personally seen or experienced the horrors claimed to be happening in our system.

My mother-in-law has Crone's disease. She lives in a relatively small town which does not have the highly specialized treatment she needs. She is able to go to facilities within a 45 minute drive for all medical tests. She has had no difficulty with access to specialists. Last fall she had to have a portion of her instines removed. THey brought the specialist surgeon to her town so she could stay at her local hospital and be near her family. When she has been hospitalized in the past she her specialist has come from the neighbouring town.

Another incident - last fall I developed a strange swelling on the side of my nose. Nothing particularly uncomfortable and definitely not life threatening. The only thing was that it looked horrid and people kept staring at my nose. I had to wait for 3 weeks to see a dematologist and then another 2 months to see a plastic surgeon. I dutifully waited my turn to be told that there was nothing to be done. Were the wait times a pain? Yeah, but did it really matter to me? No since I didn't have the look at the thing!

I guess as you can tell - I love our system. I think it works well. Those who need treatment in a timely fashion get it and for elective procedures the rest of us can just wait our turn. Personally I figure if it's elective then you can wait for to let someone who really needs treatment go first. Maybe it's my British heritage, but I think that people whine and complain too much these days. The sense of personal entitlement makes me nauseous. I like how our system treats everyone equally regardless of financial means. I am absolutely willing to pay higher taxes if it means that I can help someone less lucky than I receive the help and treatment they need.

It all depends what type of insurance you have and how you personally take it.

I am happy with HMO, some people can't stand it. Had a tooth filled without even a co-pay with my work insurance.

Eyeglasses are not covered - feel being robbed after paying $195 for new glasses, but the full price was $320, insurance discount.

With my prescriptions practically covered: $10 generic, $20 brand I don't need to go to Canada.

So it all depends on your personal needs.

Boy - this is my hot button issue!

I'm Canadian and have put the system to the test for the last couple of years. 2 years ago I was diagnosed with breast cancer - it was very early so I had minimally invasive surgery and chemo/radiation for extra insurance. My experience has been outstanding - although you do have to be a strong advocate for yourself.

I've become quite involved in the efforts to reform our health care system. There is no question it has problems - particularly orthopedic and diagnostic imaging. I am encouraged, though, by the depth and breadth of the effort now being made by the federal and provincial governments to reform the system; while preserving the basic access. (yes their backs are to wall...but at least there is action).

For example - at a major Toronto hospital the wait time today for a non emergency MRI is less than 4 weeks - I believe that is an acceptable period of time (for non emergencies) if it means everyone has equal access to the technology.....at that same facility I've had MRIs in 12 hours when there was a problem.

I'm not Pollyanna about our system - but I see real efforts to reform it and ensure universal access.

And ladies - early detection is the key!!!! Get that mammogram you've been putting off!

Ira is right. The actual wait time is only 4 weeks.

I'm just curious how all these people JJ5 referred to manage to pay for their healthcare here in the US when they come in from another country where they have been dissatisfied with the care they are getting. Are they independently wealthy or what?

My new daughter-in-law (she married my son who is an American from birth) is from Lithuania and she is working part time jobs now that she finally got work papers. My son doesn't have a job that offers insurance yet. They are paying for their own, and they had a real problem finding a company that would insure her (she's young and healthy) because many companies will not insure someone who has been in the country for less than a year. Also, someone who sponsors an immigrant has to certify that for 10 years he or she will provide support so that the new immigrant is not receiving government services. That's why I can't figure out how these people from other countries come here to get health care. And, yes, my son took care of his dental work in Lithuania because even with his meager salary there it was much more affordable than in would have been in the US.

I had some necessary but not urgent eye surgery last year and my wait was not long. I think my husband and I would both have been willing to wait a bit longer for our surgeries if that is what it would take to ensure that those who are uninsured could have some basic level of health coverage. We too have seen our young college graduate children go uninsured because of the strange system we have here where an employer, rather than the government, is the means by which insurance is obtained.

Your specific example in Belgium:
between 1-2 weeks to see the specialist
between 2-4 weeks to wait for non-urgent surgery.
It doesn't matter whether one has private insurance or not. Every Belgian citizen is entitled to basic (more than basic) healthcare for a very small fee. It even includes free healthcare abroad.

My examples were all paid for by their children, who all have been US citizens for more than 30 or 40 years.

Access for new immigrants is all over the board. And as for US Citizens, if you are on welfare, you get health care but through the county system. It just so happens that Cook County has some very good hospitals. My Lupus patient example was living with a sister and brother in law in a house with 6 other people and was on welfare. She had a CS and high risk pregnancy care for 4 years in a row without any payment.

Julies, I came to USA from the former soviet union. Being on welfare (we came legally) our family got Medi-Cal - the cheapest insurance, not widely acceptable, but the basics are covered.

I was just happy I didn't have to bribe doctors and nurses to have a check-up! Where I lived I could never go to a doctor empty-handed.

And people from different countries come with different statuses. "Refugees" get 100% coverage of all life expenses - rent, foodstamps, medicine, some cash.

Status "Parolee" doesn't give any material support.

But everyone knows the status before coming to USA, so they have time and opportunity to decide to come here or not.

There is also a government "share of cost" FREE insurance for poor families, they pay out of pocket depending on income, and the rest the government picks up. For example, I had a co-worker with one child, her co-pay was $150 a year, and she was extremely happy with it.

Matrexx and Elizabeth_S have posted some positive comments about the Canadian public health system, which I would like to echo.

While this is the experience of only one individual, my father has had several dealings with medical services in Ontario recently. (He's 97, lives by himself in Ontario, and I live in Nova Scotia; I've spent a lot of time with him in doctors' offices and hospitals over the last year.) Contrary to all the horror stories about agonizing wait times and overcrowded facilities, I found the services to have been accessible, prompt, and effective.

One thing that should be pointed out, however, is that delivery of heath services is in the hands of ten provinces; I am not confident that he would have had the same level of care in Nova Scotia.

Anselm

And read why Toyota is by-passing all offers from the US ,to build their new plant in Canada!

US healthcare is great if you are insured with your employer..but if you have to pay for it out of pocket..you better be making mega bucks!

We always had insurance with employers but I decided to retire and though I had COBRA for 3 years at $400.00 a month it ran out 2 years before Medicare kicked in. For those 2 years , it was hell to find something affordable! An HMO for 2- 63 yr olds, in good health was $1700.00 a month! We finally bought a major medical policy with a $5000.00 deductible for $450.00 a month! Even with Medicare , which costs us $120.00 a month we pay and additional $275.00 a month for a supplemental!

We have a friend , who has dual citizenship in the UK and no insurnace here. She needed a hysterectomy(SP) and had to pay out of pocket...she has 5 months to go until Medicare kicks in! The cost in the US was going to be around $35,000.00! She went home to her mother's in London and paid cash>>> $3500.00!

Something is seriously wrong here!

Jody, I agree with you, MediCare is awful, you pay all your life out of your paycheck, then part of your pension goes to pay additional MediCare and still doesn't cover everything! This is the worst treatment of elderly. Speaking of elderly abuse... what is it if not abuse?

You can tell it's hot topic with me as a relative is affected.

Is there a place in the world he can go to get medical help? And if different citizenship comes with it, who cares!

Jody said, "We finally bought a major medical policy with a $5000.00 deductible for $450.00 a month! "

You must have our insurance---our deductible is $4900 per year, and the premium is about $450 per month. We have NO prescription coverage. Last year our son broke his elbow at camp and needed an operation and graft. He was in the hospital one night. Total bill about $3200. The year before, our daughter had her tonsils removed as an outpatient. Total bill $2300. (not including Rx in either case)

I am thankful we are able to pay for care when we need it. My husband is a physician and he, too, advocates some kind of single payer system for the U.S. It just makes sense that the technology is costly enough without third party companies trying to make a profit by insuring only the healthiest individuals.

Our current system could be likened to a patient getting a blood transfusion: blood comes out of one arm and goes back into the other. But between the two arms there is a siphon that takes about 2/3 of the blood out of the line!

Basically, modern medical care is expensive. You can either pay a lot for an on-demand system (like the USA has), or you can ration it like most socialized medicine countries do.

The USA does a big business along its northern border with people who come down from Canada to get care quickly. Canada does a big business with Americans seeking cheaper drugs.

The fact is, you're going to pay one way or another, or a combination of ways. Insurance premiums, out of pocket, or taxes. Pick your poison. Nothing is free in the medical world. Somebody has to pay for it somehow.

We're paying for it all three ways: through insurance premiums, out-of-pocket, and taxes. And we still have a large population of non-and under-insured citizens.

Going to the ER when you don't feel good, having very expensive and unnecessary tests, getting a Rx that isn't filled because it's too expensive, and having no "regular" physician for follow-up care is hardly an admirable system.

Every society is judged in history according to how it treated its most vulnerable citizens.

Poland: Citizens can opt for available services at very low cost but with a time delay. Anyone can buy private services on demand. Private services are inexpensive. Physicians have two or three practices. First, a regular hospital job, next an area clinic position and lastly a private office practice. Total income is very low. The government subsidizes many drugs. Example - PSA test at local clinic, 26 zlotych or $8. No waiting! An office appointment is 100 zlotych/$30.
Health insurance is an oxymoron. Somehow people have decided that they don't have to pay for medical care. Middlemen have created medical insurance as a business not a social service. A rational society could create a universal health care system paid for with taxes. Best advice, build a personal health care fund.

For the NHS in England, you can get all the latest figures at
http://www.performance.doh.gov.uk/wa.../qm08_y00.html

(Scotland, Wales and Northern Ireland all keep their own figures in their own ways).

For the original specific example, access to a hospital specialist would vary, depending on local facilities and the degree of priority given to your particular circumstances, but you could be waiting for a couple of months to begin with. Access to surgery itself could take even longer.

The priorities go, obviously, to life-threatening situations, then to the major public health issues like heart disease and cancer, and only lower down to elective and non-acute conditions. Targetting and new ways of working have driven down waiting times in most areas and the priority areas in particular; but there's a long way to go and a lot depends on both money and managing doctors.

Touch wood, I've had very good treatment from the NHS, but I live in quite a wealthy area. A lot can depend on what we call the "postcode lottery".

I think that the GP system is very good in the UK.

I have an actual example of the difference between the US and UK.
The grandchild of a friend of mine kept getting snuffly colds and running a temperature. The child had a battery of tests including a lumbar pucture, poor mite. After several days of this it was discovered that she had a urinary infection and the parents were told that the condition if undiagnosed in a small girl could lead to kidney failure in later life.

One of our neighbours had a little girl with the same symptoms. The GP, admittedly a very good GP, had seen similar cases before and diagnosed the problem with a urine test. He gave similar warnings.

In both cases, a course of antibiotics solved the problem.

One thing about an insurance based system. If you take a car in for repairs, the garage will usually ask if it is "an insurance job" and no doubt charges appropriately.

I forgot to say that the case with the battery of tests was in the US.

I have private health cover in Germany as I don't pay social security but what I notice is that the doctors appear to constantly overcharge. Calling to make an appointment is considered consulting and the list of things they said they performed during the 10 minute meeting is quite staggering.

I find the standard of doctors in Germany to be very high especially in the field of orthopaedics.

One of the main problems for the govt. in Germany is trying to change the way people seek treatment, normally a person would go straight to the Specialist rather than going to a GP and therefore this costs a lot more for what may be a minor ailment.

I haven't lived in the UK for over 17 years but last March I took my 3 month old son to the UK and during that time he got sick. So I went to a doctor and explained that this was his German insurance but they weren't interested in it, as they said, Germany's in the EU so we have a reciprocal agreemment. I also expected to pay for all of the prescription but the woman in the chemist said that no patient under 16 pays for anything.

So for a family of 4 I pay around $450 per month and this covers us worldwide for 100% prescriptions, consultations, & operations.

Geordie

We've now heard about Belgium, Canada, the US, Britain, Germany & Poland (sorry if I missed anyone). Since I live in the US, I understand that system the best (and think it needs a major overhaul) but still have some questions for those of you who live elsewhere.

As someone mentioned, in the US you can have top of the line coverage with fantastic medical care or be uninsured and taking huge risks because you will be bankrupt for life if something that needs serious medical attention occurs.

For those of you in other countries, do you have people who are uninsured in your country? How is it determined how much you pay per year for health insurance? Do people in your country complain and grumble about your system and think that it needs to be changed? If so, how? In the US, everyone we know discusses our health care system, its flaws, how much it costs and the need for change. But, most people still wouldn't change it because they think they would be giving up their rights to having excellent specialized care in case of a really serious illness.

Well, the whole point of the British - and most other western European, apart from Swiss - system is that it's primarily funded out of tax. There may be some payment at the point of use, for example for medicines or sometimers for doctor visits, there are variations between how different countries provide things free (as opposed to requiring initial payment followed by refunds), and some people choose to top up the state system (a bit) by private insurance. But these are all details.

The central point is that health care is a right, and that people's access to it shouldn't be governed by their ability to pay. And that general principle is, for the most part, honoured - and almost universally accepted even by those of us at the farthest right ofthe political spectrum. And, BTW, almost universally delivered.

Remember that most European countries have higher life expectancies than the US, in spite of spending just over half America's spending per head on health.

Now there are many, many grumbles in Britain - which for the past 30 years has spent less per head on health than almost anywhere in Europe.

But virtually no-one in Britain fundamentally questions the basic principle that healthcare should be free at the point of use, and tax-funded. The debate is entirely about how much the total tax pot should be.

A friend of mine lived in Italy for 15 years and often complained about the health system. She benefited from the state health system, in that she got inexpensive health care. However, it took months for an appointment to check on a possible cancer diagnosis, unforgivable considering her family's medical history.

Recently she told me this sad story: An old boyfriend, age 45, suffered a heart attack at a family dinner. This family cannot afford private healthcare, so they called the public ambulance, informing them of the seeming heart attack. The ambulance arrived in just a few minutes, but it had no equipment of any kind to treat a heart attack. Thirty minutes later another ambulance arrived with the correct equpment, although the poor man was now comatose, a vegetable, and died a few weeks later. If the family was wealthy, they would have called a private ambulance and there's an excellent chance he would be alive today.

This same family is currently experiencing another health care indignity. The boyfriend's father is ailing and has been hospitalized, again under the state system. His wife spends every hour of the day and night at the hosipital because the nurses only visit the patients once a day. The nurses hand over all the medications for the day in the morning and it's up to the patient to take them at the right time. The poor woman is a wreck, mourning her son, worried for her husband, exhausted from the long hospital hours.

US healthcare insurance is expensive, but I'm glad to know that, whatever my means, if an ambulance arrives it will be well equipped, and that I'll receive frequent attention if hospitalized.

I'm a Canadian living in Ontario. In our province, health care comes out of the general taxes. There are continuing mumbles about instituting a "Pay as you go" which is basically a two-tier system.

I absolutely disagree with this. We certainly have problems with our system but I think overall we do very well. I had elective major surgery & got to choose my surgery date (with the admitted proviso that my surgery could be cancelled if the OR was requred for emergency surgery but it wasn't).

There are certain areas - seeing certain specialists where there are too lengthy delays. My mother is waiting 6 months to see an opthamologist but it's for a non-life-threatening issue.

As for Canadians going down to the States for treatment, I suspect that may be for elective surgeries. I personally don't know anyone who has gone this route for any reason, elective or not.

Jody and kswl- $1700 a month??!! What a nightmare!! Yes, if you have insurance with your employer you're okay. We have employer insurance here but it covers things like drugs, semi-private rooms in hospitals, ambulances, dental work etc etc etc.

I do think that healthcare should be a right for all people. We must consider ourselves very lucky, though, even those of us who have to pay high insurance costs etc. We could be in a Third World country and have nothing. Let's count our blessings.

Wow, some of the costs being quoted here are astonishing. The NHS may come in for a lot of criticism in the UK, but at least we're all guaranteed free care (ok, through taxes, but nothing like the cost of what's being quoted here).

Also in the UK, you can opt to join a private health care scheme. Mine costs about £50 a month, and basically allows me to queue jump for treatment, and to stay in a nice posh private hospital. Private health care only kicks in if you want to leap over a waiting list - you get the same doctors. It's regarded as a luxury - by no means a necessity.

I live in Canada.
I saw a vascular surgeon last summer for a varicose vein in my leg. The doctor said it needed to be dealt with. I have to have an ultrasound on the leg. One year later still no appointment booked for the ultrasound. Thinking I must have missed the callfrom the doctor's office to give me the ultrasound date I called back. Nope. I did not miss the call. They were booking appointments for people who saw him in December 2003. I might be apbe to get the ultrasound next July. 23 months after I saw the doctor. Then I will have to wait another couple of months to see the specialist again and then wait for operating room time. We're probably looking at 2 1/2 years from the time I first saw him. But it is FREE, eh?

I'm not a healthy person. I have a number of chronic things my english is not good enough to explain here, in fact, I only know how to say in English that I'm hydrocephalus. I learned it in a forum from Harvard University Hospital with people with the same problem. And I knew there, that even with the hundreds of faults I can tell you about the Spanish Social Security System , I have to be thankful because I had it without a single euro spent.
The surgery I had was about 2 million dollars for the people there. Some of them have good insurances..some of them had lost them because they have children with the illness and children need a surgery almost every year till they left to grow up. The insurances didn't want to cope.
The system here is paid with taxes that can be paid by the employer or by themselves the people who work on their own. It's compulsory to pay and the taxes are both for the health system and the pensions one.
No one is uninsured, never. Not even paperless emigrants, they can go directly to the ER and receive the same attention than anyone else.
You only have to pay a percentage on prescriptions (0 if you are a pensioner).
Yes, there are delays, especially in big cities and in some specialities. Not so many here where I live, its a small one :)
I visit the hospital every month, sometimes for me , sometimes for my parents who are pensioners.
I don't have a private insurance, they don't want me in their files, too much waste they think :) Anyway, the private sector here is not very good, only in the big cities there are valuable private hospitals. Here in Castellón, many people go to a doctor's visit privately..and after that, if they need surgery they go the the Social Security (the doctors are the same ones).
I really think that every system in the world has good things and drawbacks. But if you are on the "health problems" side and not very wealthy..you could have a very rough time in the US system.

I'm not complaining. Our monthly fee (for a family, no matter how large) is 8.50 euro for basic healthcare. Dr visits (at our house) cost 10 euro; 4.70 euro at the drs cabinet. Drugs and hospitalization in private room can cost a lot, though. For all the expenses that are not covered by our legal healthcare we have an insurance plan for which the premium is paid almost in full by my husband's company. I'm not complaining at all!

Agree with Patrick; in the UK it can vary a lot depending on where you live, what you need doing, what time of year it is - all sorts of factors.

I can only offer 2 very minor recent examples. Time from seeing general practioner to seeing consultant - 1) 8 days (I must admit I was surprised), 2) 43 days. Time from seeing consultant to having surgery - 1) 42 days (note that condition was non-incapacitating & had been diagnosed as non-threatening) 2) not required.

Although the NHS isn't what it was, I still believe that when you really need it, the care you need will be there.

Astonished to find myself in agreement with flanneruk for possibly the first time ever !

I'm American, and I actually have two complete health coverages: an HMO paid in large part by the organization I retired from, and a government plan (VA).

While neither provides really quick service, the HMO is much faster than the VA. My wife and I had planned a trip to see the great art of Europe, when I suddenly developed cataracts. After the fairly timely surgery on one eye, my HMO physician left to have a baby, and I sort of fell into a crack, where the other HMO doctors considered me her patient, so they expected me to wait until she returned from maternity leave. I cleverly made an appointment at the VA, but when I went in I was screened and told I could see an opthamologist in eight months, to decide whether I needed surgery, which of course would probably be done in the next life. I went back to the HMO and became demanding, and they finally found someone who would do the second surgery, and I was able to enjoy our trip.

I don't think the government health care is bad, but it is certainly slow, and in my idle moments I looked at how much is appropriated annually for VA health care, and at the number of patients they claim to treat, and it appears to me they could shut down the VA health care system, buy us each the finest private health care plan, and still come out far ahead.

One valid criticism of government coverage for all is that treatment is often available at the start of the fiscal year, but has to be rationed near the end of the fiscal year, so I guess you have to time your illnesses and accidents. I also think there is something to be said for having to bear at least a part of the cost of your own treatment, as it encourages you to take better care of yourself to avoid having to get more medical care; the people who are misusing emergency rooms seem to me to be those people who don't have to cover any of the costs of their care, which of course drives up the costs to the rest of us.

I think both government and insurance programs also drive up the cost of care, even as they try to hold down costs, as they add a whole layer of bureaucracy to the system. Our family dentist is a sole practitioner, with one hygenist who cleans teeth, and a staff of four in the office, who keep track of appointments, and process all the insurance paper!

Caroline:

In case you're worried about the company you're keeping, fear not.

I'm describing the national view (which was julies' request). My own views differ, but julie didn't ask us what we think.

<i>Our family dentist is a sole practitioner, with one hygenist who cleans teeth, and a staff of four in the office, who keep track of appointments, and process all the insurance paper!</i>
Our family dentist is a sole practitioner, hygienist, secretary, ... all in one. Maybe that's why healthcare in Belgium is so affordable.

One way the VA could speed up the process is to let the participants that see other doctor's get their Rxs filled there without having to see a VA doctor first! My husbnad sees a private physican under his Medicare and AARP suppliment, but as we have no drug coverage thru either , he goes to the VA for medicine. But first he has to see one of their doctors and have lab work done..even though he could bring in his lab results from his private DR! BUt it's either that or about $400.00 a month for medicine.

It too 18 months to get hiss first appointment at the VA!

One thing not mentioned in any of this and especially left out of the mention about how our USA costs are so much higher, is the reason why they are higher.

We (USA) do more tests, many more and much oftener. And why? To &quot;rule out&quot; and protect, not only the patient in a more exact (although not needed on numerous occasion as they would improve regardless)manner- but to protect the doctor from being sued.

There is much more to it than the simplification of taxes vs public domain paying. The laws of the lands for retribution in malpractice are not the same.

flanneruk : right ! Well, kudos for getting it right, I reckon :-)