National health care

Depending on the outcome of the up coming election in the US we may find ourselves under what many countries call National Health Care. I don't want to get into the politics of it.

This will be a big change for us and we hear stories good and bad on both sides.

My question is to those of you who are currently under this type of program.

How do you like it?

How do you rate the care you are getting?

What per cent of your income goes to provide this service?

And finally to cover anything else not mentioned what are the pro's and con's of your plan.

How do you like it?

How do you rate the care you are getting?

What per cent of your income goes to provide this service?

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If not for the national health care system in Belgium, my wife and I would have been (medically) bankrupt many times over, all our properties sold and my wife most likely passed away in the meantime.

Health coverage is however not 100% free. A certain percentage based on which procedures need to be carried out, is paid by the recipient as out of pocket expense. But it is seldom very high. For instance a doctor's consult costs 25 euros of which the patient is required to pay 6 or 7 euros himself. The rest is reimbursed. On a yearly average, medical costs above 1000 euros (more or less) per individual or per family are also reimbursed providing they are considered necessary costs.

Choice of physicians is completely free in Belgium. You are not assigned a doctor as in some other countries in Europe where medical costs are sometimes completely free (such as Spain for instance). Here, you may go to any doctor that strikes your fancy and still be reimbursed, even if he has a practice on the other side of the country, 300km away.

If you choose to stay with one and the same family physician, a higher percentage of your medical costs are reimbursed since all your dossiers are centralized and easier to locate.

The care is first rate and once again choice of hospitals is free as well - though if you wish a certain doctor you will have to go where he is accredited. Hospitals are never located far away, nor are there waiting lists for operations of any significant length.

I am certain that in other countries, with free health care systems, the overall price is cheaper, but the minimum amount you must pay here in Belgium ensures a wide range of choice re doctors and hospitals. Most 100% free systems require registration with a local doctor. No exceptions permitted unless you wish to pay full non-insured prices.

My wife and I will be moving to Spain within the year where the costs are lower, but free choice of doctors is limited if you go with the free national health coverage system. I am curious how that will turn out, since living in Belgium guarantees free choice of doctors.

That said, I have had a very serious operation here and the care was first rate and very successful as well (lung cancer - non malignant). The same for my wife (but for other serious maladies). Since doctors can be chosen freely, obviously we tend to go to a doctor who fits into our personalities and perceptions and with whom we are comfortable. There is abundant choice.

The amount of income spent on medical care per year for medically necessary procedures is never higher than around 1000 euros a year for both of us together. Anything higher is reimbursed anyway. All medical out of pocket payments are added up and if higher than 1000 euros, then the higher part is reimbursed. Non necessary things like non prescription medicines probably run up to more or less the same amount, perhaps somewhat less. Things like nose sprays and other non essentials are probably not included in the sum, though it's hard to say what is or is not essential sometimes. Like Prep H? Lots of suffering without it .. ha ha.

Though I must say that in neighboring countries like the Netherlands, prices for over the counter medicine are much lower. Which means that for things like aspirins, prep H and other similar things, we stock up when across the border.

So overall as a family of 2 we do not spend more than around 1500 - 2000 euros a year all told on necessary medical expenses. Health insurance premiums are included in salaries and pensions but if you wish for extra privileges for single hospital rooms for instance, you can take out a supplementary hospital costs insurance for a sum of around 150-200 euros a year per person.

Everyone in part of Belgium (the region of Flanders) is also required to pay a supplementary 50 euros a year medical insurance for the care of invalids and the long term ill. This health tax is then used to finance home care for the disabled and invalids, the elderly and such. It is a mandatory tax and of course youngsters fresh out of school do not see the wisdom of such a tax, so they do tend to grumble and moan about it - insignificant amount though it is.

So the Belgian health care system is not entirely free. People here like to say it is a good compromise between being cheap, affordable and high on quality, while still allowing for a large amount of free choice regarding choice of doctors and hospitals.

I cannot see any average American being fearful of such a health care being implemented. Overall average Gross National Product spending in Belgium on health related matters stands at 8% versus 16-18% in the US. And in Belgium for universal and virtually free coverage. That makes it more efficient and cheaper by half than in the US per ratio of GNP spending.

Nothing to fear for regular people on this account should a similar system be implemented in the US. The only losers in the US would be Big Health Insurance Companies ... and just watch my heart bleed for them.

Well, since my initial coverage by the Ontario Health Insurance Plan, administered by the province and paid for by tax revenue, I've seen doctors countless dozens of times, received hospital care for elective major and minor surgery, including dental surgery, biopsies, radiation treatment, and a bone scan, all without ever being required to pay a cent from my pocket. It's a good feeling to know an unforseen emergency or cancer won't bankrupt me and cause me to lose my home and property.

How important is life, liberty, and the pursuit of happiness if you don't have Number One - health?!

In the U.S., the medical industry is big business. So, as we know, is the insurance industry. Neither want to have their apple carts upset, so they do everything at their disposal to lobby politicians and influence voters through slanted TV ads, showing the purported downside of change that will cause them to lose their outrageous money-grabbing ability to fleece the public. I am always amazed by your ads that show (supposed) Canadian stooges bad-mouthing our system, though realize they are being paid to do so for their obvious lies. Regarding my own health care, I've always had every option open to me, including choice of doctor. Our docs are tops! My surgery for cancer was performed at the hospital where F. Banting discovered and first used insulin. That hospital et al remain on the cutting edge of medical knowhow and innovation.

A sister in the U.S., having worked many years as an RN, was fully covered with top insurance and "the best of healthcare." She developed cancer and, following surgery, continued to work even while undergoing chemo treatment on most days. With her second round of chemo, she eventually missed enough working days to become a part-time employee at her hospital, resulting in a downgrade of her insurance, until she had little or no insurance. By the time of her death, she and her husband were losing their shirts financially and were sliding into deep debt and their second daughter had to leave her expensive college and (luckily) enrol in a lesser one.

Our Canadian income taxes are generally on close par with those in the U.S. (I've been a taxpayer on both sides); however, ours are much higher on tobacco and alcohol products, which probably isn't a bad thing. Our economy isn't suffering - our dollar currently being worth $1.03 USD. I believe we have much more to show for our Canadian tax dollars in infrastructure. Our roads and bridges are constantly being built and repaired. A bridge in PA near an uncle's farm, meanwhile, has been condemned and closed to traffic for decades.

Finally, for those who would label our government health coverage as socialist, that's as much baloney as saying so are your public schools and social security.

P.S.: I might add that, as a senior, my prescription medication is now free for life. My last "purchase" of a three-month supply of BP and cholesterol meds rang up as $0.00.

Here is the bad of US health care. 25 years ago, I went through hell to fight for the care my wife needed. I experienced death panel by insurance company. I had to fight for her rights while they were giving free concerts in the park. We had paid our insurance for 20 years and were treated like dirt. I was left with $100,000 in debts. It destroyed me and my career. I have ptsd from the fight.

Please keep the discussion on the topic of what you like/dislike about YOUR national healthcare program rather than discussing a political party, as per zity's rules: - Religious, political, and other “prone to huge arguments” threads [are not allowed].

Here in the UK we have the National Health Service (NHS). A very big organisation, the third largest employer in the world I believe, behind the Indian State Railways and the Chinese Army which is out of sight!

Started in 1948 it's older than me so I've never known any different.

1. I like it a lot...if one person needs an operation to remove their toe nail and another needs a triple heart bypass, they pay exactly the same...nothing.

2. The care is generally excellent and the NHS includes world renowned centres of excellence such as Moorfields Eye Hospital and Great Ormond Street Childrens Hospital to name but two.

On the other hand because it is such a large organisation you can sometimes get post code lotteries.

3. It is paid for out of central taxation so I have no idea what percentage of my income goes towards it. I expect the rule of thumb is the more you earn the more you contribute. People on lower incomes don't pay anything directly towards general health care, but might pay a little towards dental care.

4. People moan about the NHS we all do from time to time, but the reality of the situation is that you don't have to worry about the cost of being ill or your kids being ill, no matter what your financial situation is, and that is a big plus.

There are cons of course...You will probably wait longer for an operation than if you are prepared to pay cash privately, but waiting lists have been reduced in recent years so it's not too bad.And you will most probably see the same doctor/surgeon if you pay or if you don't pay. Urgent cases like cancer are treated urgently whatever.

Dr Philip - The UK Play Doctor.

Interesting and thank you for your replys.

One other thing; it is my understanding that the pay Dr recieve is limited by the NHS.

How do they afford going to med school and residencys ect.

Currently in the Us medical school is very expensive and most Dr are in serious debt when they get out.

How do they afford going to med school and residencys ect.

Currently in the Us medical school is very expensive and most

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There was an interesting article in the Belgian papers a few days ago about the cost of tuition for university here compared with the Netherlands. The cost for a year university tuition fees here - for any university major or 'faculty' as it is called here, the tuition fee is some 570 euros a year. This is the same for medical or law school, journalism or whatever you choose ... all tuition is the same (though expenses for textbooks for instance will vary considerably)

In the Netherlands it is around 1700 euros a year, but there is a numerus clausus system in the Netherlands which mean only a fixed number of students per year is allowed in any one faculty. Which results in many Dutch students coming to Belgium to study medicine and get other university degrees, since here there is no above the board numerus clausus system ...

Of course, a student has many other expenses besides simply paying tuition, but the actual cost for that alone still remains around 570 euros a year in Belgium. Not a hardship amount by any standards.

Of course, since medical school does last 7 years, it is not always easy for students coming from low income households to be able to afford getting through this period without financial hardship. In Belgium there are various types of government scholarships, but the conditions are not that easy to fulfill. Family income must be quite low in order to qualify and scholastic achievements successful. Failing grades and scholarships are discontinued.

For medical students, it is possible to get private loans from banks at a special rate, provided the student has already completed the first 4 or 5 years successfully - it being taken for granted that the last remaining years will be no problem to complete for a med student so far along in his studies. A friend ours did this (in the 1970's), but did not experience any problems repaying the loan, as the amount of interest is fixed and constant. Nor is the borrowed sum high to begin with.

Sometimes medical students can also get funding for their medical studies by applying to to a public health insurance mutuality or labor union and agreeing to work a fixed number of days/hours per week at fixed wages for the benefit of that organization. It is sort of similar as US aviators agreeing to a set number of years in military service as repayment for getting a college degree paid by the government/military.

All in all though, there are no real outrageously expensive tuition fees such as one reads about in the US - $20 00.00 dollars a year or more or whatever ... not in Belgium.

This is mainly because all universities are virtually exclusively government funded. They are private and independent institutions of learning, but their funding comes from government subsidies per student along with subsidies for buildings and equipment. They have no profit motive (though they will all accept commissions from private industry according to certain restrictions) and yet they are still influential and respected institutions of learning and science.

So simply put, because the profit element is eliminated, and government invests in education, costs for students are significantly lower than in the US, allowing for a more diverse and less privileged student body to start university studies. Merit and good scholastic scores are the main criteria for entrance to a medical school - not family income.

Well said Dr Philip

I am in the UK and have benefited from the NHS

Type 2 diabetes - monitoring and care

Treatment for heart attack with catheter check of the heart and a stent

A 7 hour operation to remove my cancerous bladder with regular follow up checks and supplies for my urostomy

All for free!!

And I am still alive!!!

Radian

In Canada, a university education is heavily subsidized by the government, making such education much less expensive than in the U.S. The downside is that many of our graduating docs and nurses are in high demand in the U.S. and are attracted by the much higher salaries they receive there. (Pay scales here are regulated.) That sucks for taxpayers.

A cousin my age decided at age 29 (!) to study medicine and went through medical school in Britain to become a GP, thanks to U.K. taxpayers. I never asked him, though suspect he worked many years as a doc in Northern Ireland to repay through service.

Less expensive than in the U.S. The downside is that many of our graduating docs and nurses are in high demand in the U.S. and are attracted by the much higher salaries they receive there. (Pay scales here are regulated.) That sucks for taxpayers.

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That's one of the complaints one often hears about Dutch university students who come to get their degree in Belgium - namely that they are getting their degree on Belgium's dime.

However, many Dutch graduates do ultimately stay in Belgium - housing, taxes are lower, there are less regulations in setting up a private practice and let's say that life in general in Belgium is considered less stressful and more enjoyable. This is the 'sunny South' for the Dutch already anyway, a rather exotic place compared to their cold, crowded and over-regulated country ... and the same language is spoken, so the affinity is stronger than one would think at first.

Anyway, these things are not really a significant drain upon national budgets in any perceptible manner. It is rather the simple thought of another nationality profiting from your own national education system (or whatever) that seems to grate with some people. But you can't have a Union without freedom of choice for study and residence (and many other things naturally).

Trying to stay on topic here but the question I keep coming back to is: "Name one thing the US government does that is more cost effective and higher quality than the private sector?"

Trying to stay on topic here but the question I keep coming back to is: "Name one thing the US government does that is more cost effective and higher quality than the private sector?"

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The topic is the comparison of costs and quality for medical services between the US and OTHER countries. The US government as a stand-alone entity versus private interests should not be brought into this discussion for that reason alone.

Besides, private interests and large health insurance companies so dominate the medical landscape in the US, along with very specifically particular American ideas about free markets and how services should be provided to the populace, that there is no way the government there could even begin to provide the same type of health care as in other countries. Too few Americans can get beyond the idea that private corporations do everything better. It's an almost axiomatic part of the cultural make-up.

But: to answer your question at least partly - a government does not need to ensure the profit levels that a private corporation will expect to earn by virtue of its simple existence, since a government run service is by definition non-profit. No mega bonuses paid to managers, no dividends to stock-holders.

Every statistic of comparisons between percentage of GNP spending on medical costs per country will show that the US has an inordinately higher cost per GNP percentage than other Western nations. Medical spending per GNP in the US stands at between 16-18%. In countries such as Belgium, the percentage stands at 8% of the GNP. Which is half cheaper.

But private interests and lobbygroups will fight to the death to ever prevent the possibility of having a true government-run health service in the US as in other (European) countries. There is too much money at stake.

MikeLittoris, a truly responsible government COULD regulate costs and keep them from getting out of hand. Trouble is, people with huge sums of wealth, their various associations, and related industry can afford to lobby congressmen and senators and pay for misleading ads.

On an Amsterdam to Toronto flight, I overheard a conversation between two doctors seated behind me. One was trying to convince the other that by not practicing medicine as an MD or whatever and by moving into research, he could multiply his earnings many times over with minimal actual work and with bankers hours. Moreover, he'd enjoy more free time for five-star vacations. Apparently, even a doctor's pay isn't enough for some.

Was mentioned as example to MikeLittoris in regard to "Name one thing the US government does that is more cost effective and higher quality than the private sector?" and why government sometimes fails.

Bingo! Another responder correctly mentioned that the NHS in the U.K. is the WORLD'S THIRD LARGEST EMPLOYER. Remember, this is a fairly small country and health care is a small sector of the economy. This is all anyone needs to know to understand that we do not want this system in the United States. People in countries with nationalized health care like it because they have been institutionalized. They have no idea what is possible with free enterprise. They accept long waits for surgery because they know nothing different.

People in countries with nationalized health care like it because they have been institutionalized. They have no idea what is possible with free enterprise. They accept long waits for surgery because they know nothing different.

Just as people in the US have been conditioned (which is the word I hope you actually meant to use - not institutionalized as in committed to the care of an institution for mental disorders) to totally freak out when they in turn hear the word nationalized health care?

One of the great things possible with free enterprise is for instance medical bankruptcy - losing all property and assets because of disease or illness. Truly a comforting thought. One doesn't however see people in any country in the world clamoring to have this introduced into their country as an indication of how far they are on the road to progress.

As for the 'long waiting list for surgery' meme ... it is rather lame and time-worn and moreover untrue. If it were true, death rates would rise due to fatally delayed surgeries and this would be reflected in various statistics - among others in average life-expectancy. And besides, the worst kind of 'waiting list' to be on for surgery or any kind of medical treatment at all, is the waiting list of being able to afford paying for treatment at all. Free enterprise simply guarantees that wealth and affluence trumps all other considerations. You only get treated if you pay through the nose.

Another interesting thought about what is called free enterprise in the US is the fact that medication is most often far cheaper in neighboring countries and that moreover US citizens are not really allowed to buy and import these back into the country. That does not sound like free enterprise, but more like a staged racket. Just about the same as the US health care insurance provided for by the free enterprise system in which it is possible to deny insurance coverage to people because of unsuspected pre-existing medical conditions as one of the most glaring examples. The concept alone implies that people should be either clairvoyant to the future or all-knowing about the condition of their body.

Bingo! Another responder correctly mentioned that the NHS in the U.K. is the WORLD'S THIRD LARGEST EMPLOYER. Remember, this is a fairly small country and health care is a small sector of the economy.

Health care spending in most European countries is usually around 7-9% of the Gross National Product. Which means that health care spending is not a small sector of the economy, but a fairly substantial one, especially if it is organized nationally and not segmented into umpteen independent companies.

Health care spending in the US factored by GNP comes to around 16-18%. Which translates into roughly double the costs. Hardly a better result by any standards. So if this is what can be accomplished by free enterprise, doubling the price for worse or even similar results, then it sounds like a big failure by any standards. And that is not even including the fact that this free enterprise system manages to exclude several tens of millions of fellow citizens. Which does not happen with national health care systems as they are all inclusive systems of health coverage for all inhabitants of these countries.

And besides, say that health care in the US were organized as in the UK with a theoretical single employer, then that would probably be the largest employer in the world. And if it were, then so what?

Bingo! Another responder correctly mentioned that the NHS in the U.K. is the WORLD'S THIRD LARGEST EMPLOYER. Remember, this is a fairly small country and health care is a small sector of the economy. This is all anyone needs to know to understand that we do not want this system in the United States. People in countries with nationalized health care like it because they have been institutionalized. They have no idea what is possible with free enterprise. They accept long waits for surgery because they know nothing different.

Yes that was me and no we are not institutionalised,that's what happens when you get put in prison!

And no here in the UK we don't accept anything we question things, and because of that politicians change things. Long waits for surgery are a thing of the past.

If I want to see a doctor I can get to see one the same day, I ring up in the morning and I get the appointment, that's the rules no waiting. We have more doctors per head of population than the US... 27.43 per 10k to 24.22 and more nurses and midwives 101 to 98 per 10k population. Healthcare is excellent in the UK and we have a higher life expectancy than the US, yet we only spend $3480- per person on healthcare against the US which spends a massive $8362- per person.

So I fail to see what extra benefits for patients are possible with free enterprise. The only benefit I can see is maximum profits for shareholders.

Don't you guys ever question why healthcare is so very expensive in the US? Why you are paying way over the odds compared to the rest of the world, I would seriously.

What happens if you lose your job and can't pay your health insurance premiums?

Dr Philip - The UK Play Doctor.

You see no problem with the NHS being the world's third largest employer?

I had surgery to repair an acromioclavicular joint separation provided by the NHS. The procedure was carried out 5 days from the initial consultation. It should be noted the damage to my shoulder was not an emergency and non urgent. The dedicated people who provide this exemplary service cannot be praised enough. and they do this for considerably less reward than in the private sector.

No system is perfect I'm sure private sector health care has it's failings.

Please do not criticize those who are dedicated to helping others.

We have more doctors per head of population than the US... 27.43 per 10k to 24.22 and more nurses and midwives 101 to 98 per 10k population.

And that's not even taking into account the regional differences in the US which can vary from state to state by as much as 200%. States like Mississippi, Oklahoma, Arkansas, Wyoming, Texas have about half the number of doctors per head of the population than states such as New Jersey, New Hampshire, Hawaii, Vermont ...

For a more detailed listing and info on trends and such: http://www.usatoday.com/story/money/business/2012/10/20/doctors-shortage-least-most/1644837/

In a national health care system, as far as possible, a more equitable spread of medical personnel can be achieved since regional shortages are eliminated by assignment. In a free enterprise system doctors and medical personnel gravitate towards money. That's a natural and understandable phenomena when considered on a personal scale, but a huge failing when considered on a national scale.

If we are "conditioned" to the NHS then what about the so called "Health tourists" coming to the UK specifically to make inappropriate use of the NHS because health care costs in their own country are prohibitive? These people although creating an additional burden on an already stretched service must feel the service is good!

My daughter is a pharmacist in a hospital in Wisconsin. She informed me they are seeing a lot of women from Canada for problem pregnancies. Note this is done at the expense of the province. So I guess that works both directions.

I also know a lot of people who go to Canada for medications that are a lot less expensive.

Actually the NHS is the envy of the world... it's not perfect nothing ever is in life, but it doesn't discriminate between rich or poor that's the beauty of it.

Actually the NHS is the envy of the world

Boy is that a loaded statement!

It may be true in England but holds little weight here in the US.

I do thank you for the facts you have presented though.

In further research I did find this web site that lends a lot of insite into the differences between the two health systems'

http://scienceblog.cancerresearchuk.org/2009/08/17/we-need-to-be-careful-when-comparing-us-and-uk-cancer-care/

I'm still not sure this is the way to go for the US

Actually the NHS is the envy of the world

Boy is that a loaded statement!

It may be true in England but holds little weight here in the US.

One statement that can certainly be said to be virtually universally held - no one envies the US health system. Why? Because it always boils down to the ability of an individual to pay. And moreover paying vastly more on average than citizens of other countries pay.

It is such a bewildering thing to see Americans arguing for their right to pay through the nose, be denied coverage on a whim and be threatened by bankruptcy because of a possible illness. There is no rationality behind it. And moreover, the excessive amounts paid out for medical care goes to line the pockets of private individuals, CEO's, shareholders and heavens knows what other kinds of investment sharks. It is not even spread out equitably to help others less fortunate.

The only people who envy the US health system are choose who systematically abuse it - bankers who charge excessive rates to (medical) students for student loans, health insurance companies who make a profit on a service that should be universally available out of simple human dignity (not only to those who luckily have a job or can afford to privately pay for it) and naturally the accompanying investors and financial operators who see everything in terms of possible profit.

As a personal opinion, and one that I am certain is held by an overwhelming majority of other citizens around the world, I can only say that for a country so otherwise affluent it is shameful to think that the present situation is morally acceptable. You don't have to be and act concerned on an individual basis, but that so many Americans do not even wish their government should attempt to address the situation is simply beyond me. It does sometimes seem that Ayn Rand has become the de facto philosopher for so many.

I know that the citizens of other countries would be up in an uproar if their national health care systems were ever to be dismantled and turned into something even remotely resembling the US health care system, new or previous. Not even the most conservative European government would dare try to pull a stunt like that. Nor do the most conservative citizens wish anything like that either. If there is one certain thing that there is an almost unanimous national consensus on, it is that everyone wishes to preserve national health care systems as they now exist. No one is clamoring to adopt a US system.

Maybe there is a subtle kind of clue in that ...

Agracier said:

. . . . That said, I have had a very serious operation here and the care was first rate and very successful as well (lung cancer - non malignant). . . . .

I'd like to know how someone can have non-malignant lung cancer.

agracier said:

I'd like to know how someone can have non-malignant lung cancer.

Well, you can have it if you are very lucky with the bad luck, so to speak. There are many types and varieties and sorts of cancer of course. If you look up 'teratoma' you'll know what I am talking about.

I should however have been a bit more specific and said I had a non-malignant cancer IN the lung. But when i say that to friends or acquaintances then most people have no idea what that means and it ends up with a lot explaining that most do not understand anyway. But the end result was losing a lung due to the inability of removing the tumor from the lung tissue in which it had been growing since birth as is often the case with a teratoma type tumor. I'm not certain it was ever explained to me just which subtype it was, or if I would have been interested in it at the time anyway. I am still here after 31 years and quite pleased about it too.