Interesting debate (and one of the most civilised I've seen online about healthcare
).
I have a somewhat unique perspective on this: I'm English and lived there most of my life, then lived in Switzerland for 4 years, then moved to the US. I've therefore personally experienced all that is good and bad about the three systems: single payer/ government controlled; a not-for-profit marketplace; (until recently) a largely unregulated marketplace.
First up, the UK: the cost isn't 11% as someone mentioned earlier (that's the percentage for a thing called National Insurance, which also goes towards the equivalent of Social Security; in fact, the whole UK tax/ NI thing is a huge fudge of pointless naming, it's all taxes). It's funded on a sliding scale of income - earn around $28k, you'll pay about 2% of your income; someone on $45k is paying about 4%; someone on $150 is paying about 6%). Figures are from here:
Revealed: how much you pay towards benefit bill - Telegraph (a dollar is approximately 1.5 pounds, for mental conversion).
Everything that most people are likely to get in their lives is covered, no questions asked, no copays, just get the treatment and walk out the door. The only extra cost is for prescriptions, and this is capped at about $10 per item (item=type of med, so if you get a scrip for 3 asthma inhalers, that's one charge).
The potential downsides are that you might need to wait for things that aren't urgent in the eyes of the system, even though they might be urgent in the eyes of you - if your knee injury is causing discomfort, or you're having to take time off work, that doesn't get you to the front of the queue. An old person requiring a hip replacement; again, they might have to make do and hobble around for a couple more months, but they'll get there eventually.
You might also not have total say over which hospital you get sent to, although I believe there is more choice than when I last lived there (I've seen online league tables encouraging patients to 'ask' for X hospital for their procedure). And yes, there will be some procedures or drugs that you won't get access to - the 'it's new and experimental, and costs $100,000 a year to prescribe, and it's not yet clear whether it actually works in more than 1% of cases'... sorry, it's bad luck you've got X condition, but unfortunately the rest of society isn't willing to pay out vast amounts more tax on a slim-to-nothing chance.
If the basic service isn't sufficient for someone, and they have the means to do so, they can take out private top-up insurance with a private company (you may have heard of BUPA, who I believe are the largest). This gets you much quicker access to your operation, and a hospital that's more like a hotel - lavish private room, excellent food, lots of attentive staff, fresh flowers and fish swimming in a tank in reception, etc. Or you can skip the private insurance, but then just pay for the individual treatment you require, again at a private hospital.
Now Switzerland: this is closer to the forthcoming US model, where it's compulsory for everyone to have medical insurance, with subsidies for the poor. When you move to a new town/ area in Switzerland, you have to register with the town authorities within a week; within 3 months you have to provide them with proof of your medical insurance. If you don't, they will purchase a policy for you, and they don't worry overmuch if it's the cheapest.
Like in the UK, the Swiss medical insurance is designed to cover 98% of what regular people might encounter during their lives. There's a deductible that the person can choose based on their personal health needs, from $300 to $3k dollars, but everything after that is 100% funded. (Children have to have the $300 deductible, presumably to avoid sick kids not being taken to the hospital to save money.) I suppose this is similar to the point made above about how knowing you have diabetes or similar ongoing condition requiring medication and treatment is not for 'insurance' as such, more a budgeting issue. The premiums for the $300 deductible worked out at about $3k more than having the high deductible, so if you know you're going to be claiming, you sign up for that additional $3k and pay it monthly. Otherwise, like us, you hope you don't get sick or knocked down by a bus, have the $3k in the bank to cover it if you do, and cross your fingers.
You buy this basic cover from any of the several dozen or so providers, who all have to offer it on a non-profit basis. What they can then sell you for profit is a supplementary policy to cover being able to choose an out-of-network (area) hospital, or having a private room, or complementary therapies.
As a healthy couple in our late 30s with two kids, we were paying about $550 a month for policy with the kids covered after the first $300, and the adults covered after the first $3k. Payment is between you and the medical provider - the doctor would send you the bill, with enough time to then forward it on to the insurance company who'd send you the money early enough to have it in place before the doctor's bill was due. This all took days and perhaps weeks, rather than months.
There's a system in place where you can't have to pay out more than X percent of your income in medical costs, including premiums. I think it was about 10%, but didn't really pay that much attention at the time.
Here in the US, we're covered via hubby's work - the high deductible plan covers the 4 of us for a monthly contribution of about $500, including dental and vision. The deductible is $3k per person, $6k for the 4 of us; preventative is free, of course. The premium comes out pretax and we use a HSA to further offset the cost, but it probably equals out about the same as we paid in Switzerland in real 'money lost' terms, as the salary there was higher.
It amuses me no end when people in the US say they don't want 'socialised medicine' where they're funding other people's choices and misfortunes, and can't choose what treatments to have. I don't know if hubby's employer (a large multinational) is unique, but the scheme charges 3 different employee contribution levels based solely on salary (adjusted for family situation, of course). He's paying the top rate, so our very healthy family with a random kiddie doctor visit of about $1-200 a year and never once hitting the insurance, is clearly subsidising someone on a basic factory wage (and possibly with many more kids than us, or health issues caused solely by their lifestyle choices). Coming from the UK, I don't have a particular problem with this - it suits even higher earners to have society tick gently along, and not have people fuelled by desperation running rampant in the streets - but I don't see ANY difference between this being a large pool of employees and paying for other people's costs, and being in a large pool of everyone in the UK, and paying for their costs. And I also see no difference at all as an end user in having a government tell me they're not going to pay for X, and an insurance company telling me they're not going to pay for X.
As a user, there is no real difference in quality of care between the three systems. I think the US one has a nicer 'customer feel' to it - I'm more likely to be visiting a swishly decorated office with fresh paint and plants dotted about, and the staff apologise profusely if the appointment is running more than 5-10 mins late. But I had both my kids in the UK, with post c-section hospital stays in moderately pleasant surroundings with caring staff. One time I also needed a CT scan of my head. The process for this was swift and efficient, with an appointment within days and the results immediately. In Switzerland, my daughter needed day surgery to have some teeth issues sorted out under a GA; the hospital was a bit functional and painted throughout in 'institutional mushroom', but again, the medical care was excellent.
Pretty offices and knee jerk instant service aren't terribly important to me - if I had the option to use a basic, no-frills service that treated me but I had to wait a bit, or they might be running an hour late for my appointment, or I'd be sharing a room in the hospital... but it's half the cost - fine, I'd take that deal. The choice here though, seems to be between fully insured for lavish opulence along with your medical treatment, or not covered at all.
The one thing I would LOVE to change about here is knowing what my medical treatment was going to cost. I recently had to take my son to the children's hospital for an evaluation for a chest issue - I was told it would be an initial exam (look, prod, listen to heart) and chat with the doctor, lasting about 30-45 mins. 'And can you give me idea of how much that's going to cost - I'm still in my deductible, so will be paying this all out of pocket'. 'I'm afraid not', says the receptionist cheerily down the phone, 'the doctor will decide... it'll be somewhere between $100 and $500'. I can't even express how ridiculous this is - they can tell me exactly what the consult will involve and how long it will last, but can't tell me how much it will cost me upfront, within an accuracy ratio of 5:1? The notion of having people being interested parties to their own healthcare, paying out of the pocket of their deductible and questioning the need for XYZ test or treatment, is damned before it's even started if they can't find out costs in advance.
(Sorry it's so long - less debate, and more just a huge sounding off on my part! - but I thought others might be interested in personal experience of the 3 different systems that seem to be being compared.)
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