Woa, that much?

Yeah. A lot of that has to do with malpractice insurance and such, but for every appointment the doctor has to review notes and chart the results.

Whenever I go to the doctor, the health insurance company pays $180 for the 15 minutes or so of actual time I get with the doctor.

American health care is the best in the world in a few niche areas, unfortunately, they aren't ones that most people need. They tend to be health care for the elderly and trauma care. But, the care that makes the most impact we tend not to do well with.

If you think about it, most European countries that don't have a UK NHS-style system but use a mandate for insurance are quite similar to the US, where you are forced to buy health insurance, whether it be through your paycheque into a non-profit provider or as an individual. The problem with the US is that insurance companies aren't regulated as tightly as they would be in Europe.

Are the healthcare services provided by the employer considered "public" or "private"? I guess the latter, yet one of my friend's latent heart condition went unnoticed by the employer's doctor, because the doctor didn't want to send him to further examinations, possibly because he'd have to explain the employer why he orders such high-cost tests.

Public healthcare may have similar problems when there is lack of resources (tax money), but at least every citizen (even without a wallet) can vote for decision-makers who channel more, or less, tax money to public health care. So everyone fit to vote has some say on it.

My feeble understanding about the US insurance-based health care system is that doctors would willingly send people to all kinds of costly tests, but insurance companies are the watchdogs who try to prevent that. So, vote with your wallet (providing you are wealthy enough to have one), trying to find an insurance company who doesn't block too many tests from you?


That said, I always feel these "US vs Europe" comparisons are unfair, usually towards US, because US is one big country, Europe is not. As many said, there is no European wide healthcare system. Luckily so, I just don't feel like paying high taxes to take care of people in other parts of the Europe. There's quite a lot of argument here now that should e.g. the gypsies that come from Romania, Bulgaria etc. every summer receive Finnish healthcare, almost as if they were Finnish citizens (they are actually considered tourists).

And partly due to the size, maybe it is indeed too costly for US to provide public healthcare to all of its citizens, I don't know. In smaller countries in is easier to think "We take care of all our citizens, free education and healthcare to all etc.", while in a much bigger country with much much more immigrants that is just not plausible.

It's rather more complicated than that. Doctors tend to order up a number of pointless cover my ass type of tests to ensure that they don't get sued if something is missed. The insurance companies don't want to pay for anything if they can at all help it and do get sued from time to time for not providing all the services that the law requires.

Ultimately, no service is perfect, but in truth there's far less choice in the US system than it might appear as most insurance companies tend to cherry pick the lowest risk patients and try to cancel more expensive patients whenever possible.
That's definitely a problem, but it does vary somewhat state to state presently. In 2014 there will be an individual mandate that will cover basically everybody, assuming that SCrOTUmS doesn't stick its nose in where it doesn't belong and over turn that aspect of the law.

In the near future you're likely to see for profit insurance companies going effectively out of busines as they're not able to make more than 15% profit on the patients in group policies and 20% on the individual market. Most of the time they'll be making less.

I've always found it baffling that companies make a profit out of something like someone else's healthcare. I suspect that most problems people get with their HMOs would be solved if all insurance providers were co-ops or nonprofits, which is how some healthcare systems work in Europe.

I really can't argue with that. My health insurance back home is through a non-profit and the insurance commissioner gets to approve premium increases. But, it just seems really wrong to me the amount of profit that's taken by various people in the course of providing health care.

I don't think that people should be barred from profiting, but I do think that there needs to be appropriate checks to prevent outright profiteering.

But, in all honesty the bigger problems are the pay for service, lack of preventative care and the people getting charity care because they didn't feel like paying for insurance before they got sick,
Honestly, anybody who claims that any healthcare system is free is ignorant on the issue. The question really ought to be do we pay individually or do we pay via taxation.

On a side note, please don't use the term ObamaCare, it's one that conservatives use to undermine the credibility of the measure and neglects the fact that he wanted something considerably more liberal and this was the best the congress would give him to sign.

About healthcare in Spain:

http://www.spanish-town-guides.com/Healthcare_Spain.htm

there is a noticeable private healthcare system, but it's mainly used when you have a not really severe condition and want to benefit from a more "hotel-like" treatment. When it comes to the quality of the medical treatment itself, public healthcare is usually better.

Just one example (me): I went to the (public) hospital to have the doctor check a pain I had on the sole of my foot; after about 1 hour waiting, she did a quick inspection and sent me to x-rays in another wing of the hospital. about half an hour afterwards I was again at the doctor's office with an x-ray scan of my foot. She filled a prescription for orthopedic insoles, 100% free of course. Pretty amazing if you ask me; I don't have really any issues in paying high taxes in exchange of such a terrific service.

It is interesting to note, however, that the current government is currently trying to severely cut the healthcare spending because of the crisis (or at least that's what they say). I suspect it may have more to do with the relentless pressure from private insurance companies to get the big share of the pie.

You pay a coin each month, and if you need a health potion, you get it. If you get sliced in half by a werewolf, you even get priority resurrection. But you can forget abut mana potions, and you get only subsidies for strength potions.

Here in Germany we have quite a weird system.

Most people are insured by so-called "statutory health insurance companies". In principle they're no different than your average private health insurance, but there are a few key differences:

* They are not permitted to turn people down on the basis of health or income.
* Insurance contributions are calculated on the basis of your income on a government-approved scale.
* They are required to insure most medical treatment.

Obviously the precise contribution rate and the additional services each company provides vary slightly, so there is some competition, but it ensures a healthy balance between the benefits of private and state healthcare. In fact, while the US' biggest problem is the state's abstinence from healthcare regulation, Germany's biggest problem has been the government's interference in it.

I think that HMOs should only be allowed to profit from non-essentials, like cosmetic surgery or non-emergency dental work, etc. It is ridiculous how people are saddled with loans because they have cancer.

There is a lot of history behind the healthcare systems in Europe. During the world wars most countries involved provided universal healthcare to their citizens and after the war many people wanted to keep that coverage. So Western Europe has a very positive experience with it and that is reflected in the very high approval of government run healthcare even when the government is very unpopular. The devastation of the wars wasn't felt in the US on the same scale, so there was never a necessity to provide full coverage to the civilian population and the distrust of the government has overrode its acceptance.

The main argument against is that it goes against free-market liberal ideas, which in the US are enshrined with the same status as free access to firearms. Unfortunately, healthcare is one sector that does not follow the economic laws for two reasons. One, those who are in most need are also the least able to pay. The majority of healthcare expenses happen in the last 5 years of a person's life and there is no profit in giving care to a terminally ill patient. Even if a elderly patient is successfully treated the probability that they will generate enough income through pensions to repay their medical costs are negligible. Two, for most of a healthy person's life there is very little to no demand, however the capacity to pay for healthcare is at it's highest. Demand and capacity to pay and chances of success are at opposite ends of the spectrum.

This leads to very high costs because the majority of healthcare expenses cannot be paid. The best way around this is through blanket healthcare insurance, where everyone is covered and the costs are spread out over a long period of time and divided amongst more people. The reason the per capita healthcare spending is astronomically high in the US is because there is no such system. So in the UK, for instance, everyone is covered on NHS and everyone has to pay into it. In the US individuals have to pay both private insurance and Medicare/Medicaid taxes while up to 10% are covered by neither and many more are under-insured and unable to pay medical costs at all. The main cause of private bankruptcy in the US is medical bills and in those situations portions of those bills go unpaid, so the costs are passed on to the next consumer.

What's going on in the US at the moment? The Supreme Court is going to decided if it is legal for the government to require a citizen to buy insurance and whether it is constitutional to force employers to offer their employees insurance. Should they overturn those points then Obama's healthcare reform, which was weak to begin with, would be almost worthless. Keep an on the news in early June when the decision will be announced.

So, how is healthcare in the UK? Very good actually. Everyone (even tourists and illegal immigrants) have free access to all necessary services and insurance is available for those who want private care or elective procedures. We are even compensated if we go to Europe and have to pay for services there! The per capita healthcare costs is less than half of the US and are even low when compared to other EEA countries. We have both a longer life and longer healthy life expectancy, though this might be more because of differences in diet and physical activity, for instance we eat 25% less red meat than our American counterparts. My favourite feature of the NHS is that they have a centralised on-line site for all my lifestyle questions or basic medical needs. The US does have this service but it is less centralised and not as easily navigable. My biggest criticism is dental coverage is not included though many Britons desperately need it.

Edit: typo

This is probably one of the most insightful comments I've seen on the health care system in quite awhile.

There is a bit more to it as in that in the US we don't have universal care until one ages into the medicare system. And that we allow people to freeload in the ER or hold off on paying until they get sick.

But, basically you're completely right as far as I can tell.

You beat the US in happiness and several other "well being" metrics as well.

But, FUCK YEAH! USA IS THE BEST!