[globetrecker]

I am curious to hear the Americans in New Zealand opinions on the health care issues that are in the media recently. More specifically, why are many Americans so vehemently against having some nationalized health care? I was born and raised in Canada and didn't have problems with the system, and my family who is currently there have not had problems either with supposedly high taxes, lengthy waiting times or poor care. It isn't as the U.S. portrays, from my extended family's experience. I have also lived in the U.S. for 10 years and have seen good things for people with great insurance and also very sad things happen to families there because they didn't have insurance or didn't have enough insurance or had pre-existing conditions. I am now back into a nationalize system here in NZ and work in a hospital, so I've lived on both sides and naturally know that there is no perfect solution. It just doesn't seem "so terrible" as is being portrayed and taught in the U.S. Yet the majority of my American friends are horrified and terrified (exact words) of a system (like Canadian, EU and NZ etc.) They have even brought in communism. The attacks on these systems are quite intense in America right now. I know this is a heated debate and I don't want to start a heated discussion, but I am interested in some more balanced views. Why do Americans have so much fear and disdain for national health care? Any explanations or similar experiences?

[BkyMonster]

Obviously I'm for it, but here are some of my thoughts on why people are against it.
The US lets whaargarbl (Definition here (http://www.urbandictionary.com/define.php?term=wharrgarbl), one of my favorite words to come out of the internet) drive popular opinion. The idea that you might have to wait, or be denied service in a care rationing scheme (here (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=81116) is an article on the Oregon Health Plan, one of the US's socialized health care plans that has been used in media invective to foster incorrect ideas about how rationing doesn't work), is counter to 'popular media opinion' of fairness, when in practice even with privatized (PPO, both Blue Cross and Cigna) health care I routinely had to wait months for appointments. Generally 1 month for routine annuals, 3-6 months for some specialists.
Really there is a lot of worst case scenario scaremongering going on. America has a very vocal minority of media entertainers that many listen to seriously.

The scaremongers choose to highlight the cases in which people are denied care or receive delayed care, and ignore the cases in the current US for-profit system that underhandedly encourages people who develop serious illness to be fired from employment so that the insurer can keep a handle on costs. (Seriously, here are a few examples from googling 'fired for getting sick':http://www.nydailynews.com/news/2009/07/01/2009-07-01_kidney_patient_says_acs_fired_her_for_getting_s ick.html ,http://www.progressivefox.com/?p=721) Or the people who do not have jobs that provide affordable health care (and even those that do) that medical issues bankrupt.


Another article I read stated that the US wants 2009 health care at 1960's prices and would be unwilling to settle for less. As the US is a corporation based country, the for-profit model makes it hard for people to visualize change (look up recision in relation to insurance providers finding ways to deny coverage). Considering people pay quite a bit for insurance as it is, this is a huge fallacy. At my last job my payment for medical/dental/optical was a fully subsidized $7-800/month(state worker), but at OH's last job he paid something like 6-700/month pre-tax. This does not include the co-pays (10-15 at time of visit) and the insurance bills that arrived months after the treatment.


Another thing is that federally funded bodies like the VA hospitals aren't well managed (either through poor funding or corruption) so people fear that a nationwide health care system would be similar to that.
The US form of corruption isn't necessarily in the form of bribes etc. My replacement for my last job(whom I trained) was a Canadian citizen and she commented on how plush our local hospital was. I realized that a lot of the hospital costs went toward maintaining designer carpets, decorations and paint. Not to say environment isn't important in some ways, but (to my view, unnecessary) things were refurbished every few years whether they needed it or not. I could cite a lot of other examples of state/federal money spending the budget to the max every year so it doesn't get cut and similar.

The communist label is dumb IMO as it kind of panders to the aging populations fears of when the Cold War was a scary thing. Most of the scaremongering is aimed at the aging population because they vote more.
In reality, it is fairly routine for people of working age to pay a large portion of one's monthly paycheck (may or may not be subsidized) to company insurance policies that...support everyone you work with. Which is basically the same thing that scaremongers warn against. The aging population is partially serviced by Medicare...which is a social program for medical insurance for people over 65. Again, similar.

[TJH]

I would love to hear the personal medical experiences of American's currently in NZ.

My wife and I have got into numerous arguements with my parents over this topic. They simply refuse to believe that there could be a better way of providing medical care than how the US does it. This is even in face of personal experiences from my cousin who lives in Canada and has spoke about how the system is much better there - and he has some health issues.

I am in complete agreement with BkyMonster in that "America has a very vocal minority of media entertainers that many listen to seriously". I can't even watch mainstream American news anymore as it is more propaganda and entertainment than actual informative news.

The fear of socialized medicine is the result of a small minority voicing their opinion on the matter to such a degree that it has eventually been regarded as fact - even in face of evidence to the contrary. The main problem with the system is that the US system is a "for profit" system for the insurance companies rather than "for the benefit of the people" system who are insured and receive the medical care. These same insurance companies have a lot of money to get their message out that socialized medicine is a horrible idea as it would be horrible for their profits.

Hopefully this thread gets a lot of discussion as I am very interested in this subject.

[BkyMonster]

I can share a few experiences, though nothing serious.
Accidents are covered by ACC and some other people have commented on various experiences with that on this board.

So far here, unless my Dr. is on vacation (which she does from time to time and then I can see someone else in practice for the same fee) I can get an appointment to see her the next day, sometimes the same day. As an adult registered with the practice I pay $32 for the visit. If I want blood tests to be done there I pay an additional $5. No insurance, we decided we don't need it right now, though have looked into it. Before we had PR I paid the non-registered fee of $59 per visit (not sure on blood work).
I had a surgical outpatient day visit a few months before we got PR and that ended up costing me about $2000--something that would have been $6000+ (what the insurer would have paid) in the US (possibly more without insurance, just listing out of pocket costs), and would have been free if we had PR. I was seen within a week of making the appointment, even though they delayed me from a Friday to a Monday for more urgent cases. I got a 10% discount for prompt payment to the hospital. :p
I haven't gone to a specialist yet (though was looking at into it, thankfully ended up not needing it) so maybe someone else can share on that, but there is the option to go private (still not the same level of expense as the US) for faster service. You can have insurance or pay out of pocket as well. There are rules on which medications Drs can prescribe, i.e. some can only be prescribed by specialists.
I'm sure it varies by region and services needed as well, so would also be interested in others experiences.

[globetrecker]

Excellent info so far, and I hope we have more insight from others on here. Keep it coming.

[stellachiara]

Just a few thoughts, because I am deep in a project with a tight deadline. I am not keen to get into an argument, heated or otherwise, and probably will not do so, but I just want to throw in 2 cents from the other side:

-- The US has an enormous population, many times greater than any of the countries you name with government health care, and a far more diverse population than any of the countries you name as well. This makes any kind of overarching government program a far different and more difficult undertaking than it would in, say, New Zealand.

-- The US government is not known as a benevolent, kind entity. I am disgusted by what I see when I read the news every day, and I certainly don't want these liars, cheaters, and robbers controlling what happens or does not happen to my body.

-- Although it may be fair to say opponents of government healthcare in the US "ignore" the downsides of US health care while highlighting the downsides of government health care in other countries, the exact reverse can also be said with a great deal of truth as well.

-- Some of us do not think our choices should be 1) keep everything as it is, it's great or 2) let the government take it over. Some of us think there should be a way where we don't have to ration health care (yes, it is certainly rationed in government health care systems) while at the same time we can provide a safety net and assistance for those who can't afford their health care.

-- Some of us also think that the stated reasons for the health care system not working efficiently (greed, big pharma, doctors ordering too many tests) are NOT the right reasons. There are other reasons, such as the ridiculousness of having to depend on your employer for healthcare, the disallowing of insurance companies to operate across state lines, and other number of government interventions that hurt, not help.

-- I and my family have never had any serious problems with the US health care system, and we are not rich and have not always had coverage. I know more than one person who did not have health insurance who received surgeries for free, birth control for free, and all kinds of other care for free. So, my anecdotal evidence for the goodness of the US health system is as good as your anecdotal evidence for the goodness of the Canadian system.

The bottom line is, some of us prefer not to increase government control over our lives, especially when it is just not necessary and we can get BETTER results by not doing it. I would also like to know where all the magic money is coming from to pay for it. I think the NHS is wishing it had some magic money right about now, and they're not the only ones who can't sustain what they've promised over the long haul.

I just met a lady who lives in the flat above us who has been waiting three years to be scheduled for a surgery for her heart. She has a condition that she could die from at any moment, but, she has to wait. And she tells us she is lucky, because if she were 65 instead of 50, the government might not even think she is worth paying for surgery for. This lady has been a nurse in New Zealand for the last 10 years, so I think she understands the system quite well.

Every system has its positives and negatives, and I am not disparaging either one, really. I just think it's a completely false dichotomy to think the US either has to stick with what it has or let the government take over. Some of us think people have and can do quite well when they are left alone to go about their business and do their jobs, and that that is what should happen. And some of us think that people should be looking to their friends, family, churches, and communities to support and help them, not the government, which possesses too much force and too much power, power and force which can turn on us in a heartbeat.

[Sam B]

The Health system in NZ is not as Nationalised and free as that in Britain, but so far it has worked slightly better for me. I have to pay for my visits to the GP, but I can always get an appointment the same day, and I get to spend more time with my GP as well and don't feel as rushed. For the sake of $30 it is worth it. Prescription medicines are cheaper.

I have had one specialist referral. I waited a month for the letter informing me that I had an appointment, and this appointment took place a month later - so a 2 month wait for a non-urgent condition that was not causing me any discomfort. The specialist doctor was excellent. This appointment was free. The wait was comparable to the NHS in Britain.

So far, no complaints at all. The doctors here seem more relaxed and of a very high quality. I am yet to see a Kiwi doctor however.

[unar]

I am not in NZ yet, but I am an American living in the UK. I love the NHS! I had a minor accident in London, had emergency treatment, then surgery, then physiotherapy all for free, and everything is done efficiently and professionally. The GP system works really well as well.

In contrast to my experience in the US, where I also had an accident which the ER doctor refuse to take a X-ray even though I fell on my face and broke all my teeth. I had insurance, but still had to pay $300 for a bit of saline solution and a bandaid. It is not until I went to dentist the next day where I found out my jaw was broken in three places. And this is with health insurance and an university hospital with a good reputation.

And my husband who had the best insurance money can buy in the US, he almost died in the ER because the nurse refuse to see him without the filled out insurance form. He was having a severe allergic reaction, can't speak and can't write because his face and both hands were so swollen. The doctor who rushed him into treatment, told him another 10mins he would of been dead.

Can't imaging what would be like to be without insurance. I am all for national health. Come Obama, be brave!!!

-Una

[Oregonkiwi]

I would love to hear the personal medical experiences of Americans currently in NZ.

My (American) husband's thoughts - and a lot of discussion in the comments section:

http://spatulaforum.blogspot.com/2009/07/socialized-medicine-good-for-what-ails.html

[sweetpea]

I do think its mostly a few American hypercapitalists and scaremongers who have gotten people riled up over the years. Socialism, until recently, made a good punching bag in the US.

It's been awhile since I've been back, but I get the impression things are changing. My parents (n=2, I know) are pretty staunch Midwest conservatives and they are very strongly for universal health care now. Shocked the hell out of me. I suspect that with the recession and more people losing their jobs and experiencing what having no health coverage feels like, we might find more acceptance of Obama's plans.

[sophiedb]

There's been a lot of discussion about this on the thyroid cancer forum I'm on, some for some against - as usual. Those of us in countries with an NHS-style system all seem in agreement that it works well, and those who want more can pay to go private.

The US-based doctor who runs the forum - expert in his field - is very much FOR a nationalised system. He posted this as his response to the debate:

Dear TCH Members,

The simple answer is given by Dr. Paul Farmer, an amazing role model for any
physician to try to follow: http://www.youtube.com/watch?v=xJpZnUjtorI

Health care is not a privilege of the well-employed or idle rich. It is a human
right.

[72andsunny]

One of my favorite jokes...sums up the US healthcare system:

A famous surgeon presented his patient with a bill. The patient said, “I’m sorry but I cannot pay.”

The doctor then asked, "Can you pay half?” and the patient said, I’m sorry but I cannot pay that either.”

The doctor tried again. “How much can you pay?" ”Nothing" said the patient. The doctor was very upset and exclaimed, “If you couldn’t pay, then why did you choose me, the most renowned surgeon in the country to perform the operation. The patient answered, “ When it comes to my health, money is no object.”

Kidding aside, I am pretty scared about getting sick in New Zealand. In the US, there is no disease I could catch that would be too expensive to treat. We have oncology meds that cost $150,000 (US) and are proven to prolong your life by 3 months. From a societal standpoint, spending that much money to keep someone alive 3 months makes no sense; it even sounds ridiculous from a personal standpoint...but if I only had a few weeks to live, maybe I'd feel differently about stretching things out by a few months.

[JandM]

Then/But if you fear a situation like that, there isn't anything to prevent your taking out health insurance in NZ that would pay for private treatment in such an extreme case, is there? The other side of the coin is a situation such as has been happening with my husband over recent months, where he has been at seven different hospitals for investigations for health concerns (which ultimately turned out to be due to a bad reaction to some new medication for an ongoing condition), and there has been nothing to pay (UK). My son's back was damaged in a small fall while working, and all the investigations, consultations, treatment, medications, and physiotherapy, were paid for, and a chair made specifically to his measurements to support him and help his rehabilitation (he's very tall) for free (NZ).

[DMcG]

A couple of years ago I developed a pain in the side of my chest and lost my appetite. I went to see our local doc who didn't like the sound of it and sent me straight (same day) to the hospital for scans. Three scans/x-rays later and they reckoned I had a perforated diverticulitis (a section of my gut had become infected and ruptured, spreading the infection). I was kept in for three days and treated with high strength antibiotics while they evaluated the necessity of an operation - but in the end, the ABs did their stuff and I walked out intact.
It was followed up with a colonoscopy a couple of months later - which found nothing so I was given a green light.

Total cost - $60 for the visit to the docs - which I could have claimed back under the Southern Cross insurance provided by my work - but never got around to.

100 years ago - I would have "died of a fever"

Dougie

[M-Squared]

Healthcare in the US has many, many similarities to the justice system. It all depends on how much MONEY you have. Nothing else. Thankfully I didn't know how dangerous it could be to be without health insurance in the US when I was without it for 1 year. :eek: Especially when I slipped on some icy steps in my first month there and landed right on my coccyx. Ouch.

When I was employed (then after I was made redundant, when I had subsidised coverage for 6 months, we left the US with 1 month to go before that ran out!) it cost me US$160/month for 3 of us, no complications, no pre-existing conditions, to have good coverage.

It was going to cost me ... US$1,000 a month to have that same coverage after employer subsidy finished!

The US is stuck in a mental rift where the population (those who are apt to be led like sheep) is only too willing to believe in the power of CHOICE above all. Choice is king, and choice even (apparently...) extends to those below the poverty line. I'm sure they could afford US$1,000 a month for 3 of them, right?

The Hippocratic Oath is on display at the ER (A&E) in the local hospital I gave birth in. The ER will give you the bare minimum of care if you're dying, ie. they will stop you dying, then even if you're riddled with disease, need urgent care etc, it will be refused if you can't pay. Lovely.

I intend to never step foot again in the US, and this is one of the reasons. It actually played quite a big part in my wanting to leave there.

[akp713b]

I injured my toe while tramping in New Zealand back in November 2006. It was awfully swollen and I couldn't even get my shoes on. After a week I decided it was more than just a sprain or a bruise and went to a clinic. I was seen in 30 minutes had x-rays done and was given a referral to a podiatrist all covered by ACC. I saw the Podiatrist two days later, no problems getting an appointment, and she had a set of orthotics for my shoes a few days later.

As it was still bothering me when I returned to the States a few months later my mom insisted I see a doctor there. It took weeks to get an appointment and then in order to get an MRI done to check it out, the doctor had to lie on the forms and say I'd had pain for a year. It still took our HMO 2 weeks just to approve the MRI.

People worry about the government rationing care and denying treatment, but that happens every day with HMO's at massive cost. My uncle works at a hospital in New Hampshire and tells me how wonderful the US system is, because they have a whole wing just for Canadians who come south to get better treatment. Yet every one of my Canadian friends had nothing but praise for their health system.

What I think Americans don't seem to understand is that no one is saying private healthcare would no longer be an option. Although Canada did ultimately go that route most nations still have a private option to supplement the National system. Also NZ is helped vastly by having ACC replace the right to sue for medical malpractice.

That being said, the worst medical experience of my life was getting a simple blood test at an NZ clinic, from a Canadian nurse in fact. She collapsed my vein, leaving my arm swollen and immobile for a month. I still have an egg-sized lump on my elbow where she put the needle in 5 months later. The thing that really upset me was that after my arm doubled in size in 5 minutes and I nearly passed out all they did was slap a pressure cuff and some ice on it and told me to drive myself home. I did but was horribly afraid I was still bleeding out and was going to pass out driving over the Harbour Bridge or something. When I showed another doctor my arm a week later she couldn't believe they'd just sent me home.

[M-Squared]

I injured my toe while tramping in New Zealand back in November 2006. It was awfully swollen and I couldn't even get my shoes on. After a week I decided it was more than just a sprain or a bruise and went to a clinic. I was seen in 30 minutes had x-rays done and was given a referral to a podiatrist all covered by ACC. I saw the Podiatrist two days later, no problems getting an appointment, and she had a set of orthotics for my shoes a few days later.

:nice1


As it was still bothering me when I returned to the States a few months later my mom insisted I see a doctor there. It took weeks to get an appointment and then in order to get an MRI done to check it out, the doctor had to lie on the forms and say I'd had pain for a year. It still took our HMO 2 weeks just to approve the MRI.

I can well believe it. Sadly. :(


People worry about the government rationing care and denying treatment, but that happens every day with HMO's at massive cost. My uncle works at a hospital in New Hampshire and tells me how wonderful the US system is, because they have a whole wing just for Canadians who come south to get better treatment. Yet every one of my Canadian friends had nothing but praise for their health system.

What I think Americans don't seem to understand is that no one is saying private healthcare would no longer be an option. Although Canada did ultimately go that route most nations still have a private option to supplement the National system. Also NZ is helped vastly by having ACC replace the right to sue for medical malpractice.

And you can bet your bottom dollar that if/when if comes to a vote, the Old Boys Club of lawyers will come out in extremely strong force on that point. But let's face it, that would never EVER happen in the US! Can you imagine the lack of disturbingly money-grabbing adverts on telly, urging you to sue people???


That being said, the worst medical experience of my life was getting a simple blood test at an NZ clinic, from a Canadian nurse in fact. She collapsed my vein, leaving my arm swollen and immobile for a month. I still have an egg-sized lump on my elbow where she put the needle in 5 months later. The thing that really upset me was that after my arm doubled in size in 5 minutes and I nearly passed out all they did was slap a pressure cuff and some ice on it and told me to drive myself home. I did but was horribly afraid I was still bleeding out and was going to pass out driving over the Harbour Bridge or something. When I showed another doctor my arm a week later she couldn't believe they'd just sent me home.

That's terrible! Do you know if anything came of that?

I had the worst blood-draw of my life from a French nurse who had to draw my blood for my tests for my visa to enter the US. She hit something not quite right, it hurt like **** and left a huge purple-black bruise for a few weeks. Thankfully it was on my left arm, and I'm right-handed. This was after the same nurse had said to me, "I can't find a vein, you'd make a terrible junkie!" Hopefully she was trying to be funny... ;)

[sophiedb]

What I think Americans don't seem to understand is that no one is saying private healthcare would no longer be an option. Although Canada did ultimately go that route most nations still have a private option to supplement the National system.

Exactly. My dad paid for private medical insurance for years, which eventually meant that when he needed a hip replacement it was scheduled more quickly than the NHS could offer. That was the only time he ever used it, and to him it was worth having paid all those premiums to "leap-frog" the queue (though am not sure whether he got as much £treatment as the £premium).

In my case, if you added up all the treatment I've had in the last 3 years - first as a pregnant woman, then as a surgical -> oncology patient (two radioactive treatments and 10+ scans of various types), and two minor dermatology ops, not forgetting my free levothyroxine for life (if I was staying) - I would undoubtedly be considered uninsurable in the US.. or perhaps only for some pretty hefty $$$$.

I'm not even 33. My dad's parents both lived to 90, and my mum's parents are still alive at 89 - as are both of my parents. Chances are that I'll slog on for at least another 50 years, most of them productively (I believe), and am hoping to raise money for the hospital in question by jumping out of a plane before we vanish off to NZ.

(and on that note: how ironic is it that NZIS are 99.9% likely to pass me as medically sound - after sending my notes to the MA - and therefore eligible for their national health system, while living in the US would pretty much force me to return to UK for any future medical needs)

I'm going to climb off my soapbox now..

[Hagabel]

Good thread! I am wondering the same.

I think they are afraid of what they do not know and a little paranoid about the government taking more control over their lives. (which I have to say after the last government who can blame them...)

I say this as someone who grew up in the UK for 24 yrs with the NHS, worked as a nurse in that system and has worked for the past 17 yrs as a nurse in the US health care system. I work in the ER and ICU and see the positive and negative sides of the health care system.

If you have good insurance the system works great. If you have lousy or no insurance it is terrible. Our ER is always full of people who cannot get into to see their PCPs(GPs) as they are not taking there insurance or the wait is too long) or they have no insurance and NOONE will see them. They use the ER as their primary health care as they have no choice or because it is more convenient. That delays care for the people who are real emergecies such as chest pain etc. Don't get me wrong, I am not blaming them, they have no choice.
In the ICU we will keep you 'alive' (as I believe someone already stated) with our fancy machines despite any terminal diagnosis you may have for as long as we can. What happened to quality of life???

The advantage of a nationalised health care system is that everyone gets healthcare as they should do (it is a right, not a privilge) and there is more emphasis on preventative health care than there is over here.

Just my $0.02.

I admire Obama for having the cahunas(?spelling) to actually to try and do something about the health care system...............
:exit

[globetrecker]

Good thread! I am wondering the same.

I think they are afraid of what they do not know and a little paranoid about the government taking more control over their lives. (which I have to say after the last government who can blame them...)

I say this as someone who grew up in the UK for 24 yrs with the NHS, worked as a nurse in that system and has worked for the past 17 yrs as a nurse in the US health care system. I work in the ER and ICU and see the positive and negative sides of the health care system.

Hagabel, thank you for sharing your insight. In your years in the US, do you have any experience with people having their insurance cancelled by their insurance company if they developed a costly disease or lost their job?

[Hagabel]

Hagabel, thank you for sharing your insight. In your years in the US, do you have any experience with people having their insurance cancelled by their insurance company if they developed a costly disease or lost their job?

Yes, if you lose your job then you have to pay Cobra(very expensive) or have no health care coverage. And I have come across people who have had it cancelled or been denied treatment for cancer and such like.
My son(4) has Speech apraxia and our employer (oh's) just changed insurance on us (without us knowing from really good PPO to really crappy HMO) and all of a sudden we went from 100% coverage for Speech therapy to NONE!
Luckily I am starting a new job next week and have the choice to get secondary medical insurance and we can change back to good insurance in January 2010.
And luckily we can afford private ST but many people can not.

[carahafner]

"If you have good insurance the system works great. If you have lousy or no insurance it is terrible. Our ER is always full of people who cannot get into to see their PCPs(GPs) as they are not taking there insurance or the wait is too long) or they have no insurance and NOONE will see them. They use the ER as their primary health care as they have no choice or because it is more convenient. That delays care for the people who are real emergecies such as chest pain etc. Don't get me wrong, I am not blaming them, they have no choice.
In the ICU we will keep you 'alive' (as I believe someone already stated) with our fancy machines despite any terminal diagnosis you may have for as long as we can. What happened to quality of life???

The advantage of a nationalised health care system is that everyone gets healthcare as they should do (it is a right, not a privilge) and there is more emphasis on preventative health care than there is over here."

This is spot on.

I am so tired of people crying "socialism" a la Fox news that I could puke. Who cleans your water people? Who paves your roads? How about that social security check that you are going to collect when you are in your golden years and not working? The US, like many of our fellow developed nations, is a mix of socialism and capitalism already. There are just those of us who think that the capitalism part needs to be tempered a bit when it comes to health care. I 100% agree- health care should be a basic right as a citizen of our nation and not one that is only accessible to those who have the money, the right job, etc.

It does not have to be an either/or choice for health care. What is for damn sure is that the health care system is a mess and is failing a majority of our citizens. Most people are one catastrophic illness away from losing their health care, from filing bankruptcy and many other struggles. This is shameful.

On a professional level, I am very excited to work in NZ as an RN. From what I have heard and read, it will be refreshing to work in a system that does not base so much of its care on a fear of litigation. in the US, evidenced based care, while still practiced in some fashion, is trumped by the "cover your butt" mentality. This is one of the most damaging aspects of US health care and one that I will not miss a bit.

[Hagabel]

I totally agree with the above poster!
I am tired of having to cya!
What speciality are you in? We just moved from WA state. I miss the PNW!
When do you htink you will be in NZ?

:)

[carahafner]

Hi Hagabel,

I have always worked in Women's Health and Maternal-Child health and I will be working as a lactation consultant in NZ.

We are on our way to NZ in a few short weeks (we fly on August 23!). We will end up in Chch after a little road trip down from Auckland.

Where are you? And from where in WA state did you come?

[Familyofmonkeys]

The Health system in NZ is not as Nationalised and free as that in Britain, but so far it has worked slightly better for me. I have to pay for my visits to the GP, but I can always get an appointment the same day, and I get to spend more time with my GP as well and don't feel as rushed. For the sake of $30 it is worth it. Prescription medicines are cheaper.

I have had one specialist referral. I waited a month for the letter informing me that I had an appointment, and this appointment took place a month later - so a 2 month wait for a non-urgent condition that was not causing me any discomfort. The specialist doctor was excellent. This appointment was free. The wait was comparable to the NHS in Britain.

So far, no complaints at all. The doctors here seem more relaxed and of a very high quality. I am yet to see a Kiwi doctor however.


Up until recently we also found the system here better than UK....easy to get GP appointment and more time with Dr etc.

But OH woke up recently in serious pain, which after having emergency stay in hospital and many tests to rule out serious medical problems has been diagnosed with back problem which requires physio. Because this is not the result of an accident, it is not covered on ACC.....so far we have spent the best part of $1000 with many Dr appointments and other tests (which are not free in NZ) so we can't currently afford for him to have the physio we've been told he needs :wah This does make you appreciate the NHS where you can consult your GP as many times as you want without being out of pocket, and even though prescriptions are more expensive, you can still get an annual pre-payment form which caps how much you spend over 12 months so at least it is something you can budget for.

[Hagabel]

Hi Hagabel,

I have always worked in Women's Health and Maternal-Child health and I will be working as a lactation consultant in NZ.

We are on our way to NZ in a few short weeks (we fly on August 23!). We will end up in Chch after a little road trip down from Auckland.

Where are you? And from where in WA state did you come?

How exciting!
We are now in VA having just moved from 1 hr north of Seattle, WA. We are in the final stages of our application with our paperwork being looked at by a CO in London but my older son's medical got referred to a MA so waiting to hear about that.
Good luck with everything..keep me posted!
:exit

[carahafner]

Oh, good luck. I remember some of your posts about your medicals.

Please stay in touch. Best of luck and hope you have those blue bananas soon!

[James 1077]

I'm not an American but have quite "American" views on healthcare. My personal opinion is that governments should not be running health systems. Governments tend towards adding on layers of beurocracy and waste which ends up making systems more and more expensive to run with people receiving less and less for their money.

Add to this the fact that the workers are "public sector" workers it becomes much harder to fire / downgrade bad staff and, conversely, harder to pay more to secure good staff. Competition is also decreased leading to worse and worse service.

Finally I don't like putting my personal medical data into the hands of a government as I, quite simply, do not trust them in the slightest.

This isn't to say that the American system is any good - I don't think that it is at all as too many people are unable to pay (the main reason it is so expensive is, however, down to lawyers rather than healthcare costs as doctors need to perform large numbers of pointless scans, tests etc in order to satisfy their legal liability insurance cover requirements). But it is a better starting point for what, IMHO, would be a better healthcare system.

The first thing that I would do if I were reforming the US's healthcare is to introduce a form of ACC. This would be open to competition with any insurance company entitled to offer ACC to employers, employees and companies. It would be a legal requirement to have cover with the government setting the minimum requirements for that cover. People and companies would then be able to shop around for the best price or offer "enhanced" ACC coverage as a benefit to employees / claimants. There would also be a government appointed review panel that reviewed contested claims. Sueing would no longer be a possibility except in circumstances of extreme negligence.

The effect of this would be to decrease the costs of additional medical tests etc from the cost of the health system.

Next I would have a sliding system of healthcare subsidies. This would be in the form of a government subsidy on your health insurance payments and would be earnings related. So if you earn a small amount an amount equal to 100% of standard "healthy person" costs would be paid by the government and if you earn lots then you are totally responsible for the costs. You can choose to be uninsured but wouldn't get any subsidies. Where employers offer health insurance then there would be some formula for calculate the government subsidy portion. The processing of the subsidies would be done by the insurance companies with a bill sent to the government. This would then be regularly audited in much the same way as tax audits currently occur. The main set-up cost would be that a database would be required to provide the insurance companies with the amount of subsidy an individual should get - so a link to the Inland Revenue's systems that would only provide the amount of subsidy for that individual is all that is needed.

Finally there would be something put in place for the people who would still fall out of the net as being uninsurable or for insurance to be far too expensive (ie terminal illnesses / HIV). These people would be able to apply to a review panel for a larger subsidy or full subsidy - with an application fee that is refundable only for successful applications being put in place to stop everyone from applying!

The important part of this system is that it pushes the costs of an unhealthy lifestyle onto the individual rather than the state. If someone lives an unhealthy lifestyle then they will be charged more for insurance but would only receive a subsidy for a smaller amount - there is therefore financial incentive to be healthier (and these incentives work - I used to have health insurance that subsidised gym membership but only if I went - so I went to the gym at least twice a week!).

This system would take healthcare out of government's hands, decrease the cost to the taxpayer by not funding healthcare for people who can afford it, and allow healthcare providers to compete for patients which would further drive down costs and increase service levels. Furthermore you can decide whether to pay for "top up insurance" that gives you even better service levels or stick with bog standard service.

[Jolie]

I think they are afraid of what they do not know and a little paranoid about the government taking more control over their lives. (which I have to say after the last government who can blame them...)

I would say that this in large part accurate. The Republicans and Big Business (Insurance, Medical, Pharmaceutical) have worked VERY hard to put fear into the average American that with Nationalised Healthcare they will no longer have the option to see the medical provider they choose [false] and that if they become extremely ill or aged, the government will get to decide whether they get the treatment they need to live, or die [false]. In fact, people will still be able to get private health insurance -- as they can here -- which will enable them to "jump the queue" if necessary.

I pay about $105 USD per month for private health insurance here -- WITHOUT employer subsidy. In the US, with my fairly minor pre-existing condistions, the same coverage would likely cost me $1500 USD per month -- assuming that an insurance company would actually be willing to take me on, which is by no means a certainty.



Our ER is always full of people who cannot get into to see their PCPs(GPs) as they are not taking there insurance or the wait is too long) or they have no insurance and NOONE will see them. They use the ER as their primary health care as they have no choice or because it is more convenient. That delays care for the people who are real emergecies such as chest pain etc.

A further VERY negative consequence of that is this: In order to cover the expense of all the health care provided to people who will never be able to pay them, hospitals jack-up their prices for all services to make up the difference. This means that people who can afford to pay for treatment pay much more than they should actually have to. And it means that health insurance companies have to pay much more than they should actually have to -- something for which they compensate by jacking-up astronomically the rates they charge their customers.

Most Americans -- apart from the VERY well-off, who can afford to pay out-of-pocket for their health care without any help from insurance -- would actually benefit from Nationalised Healthcare.

But they've all been filled with scaremongering propaganda to convince them otherwise, so that they will not allow themselves to be dragged kicking and screaming to nationalised healthcare -- and the Insurance, Medical, and Pharmaceutical industries can continue to rake in huge profits.

It's a sad, sad state of affairs. Nationalised healthcare was successfully sabotaged by those industries when Clinton tried to implement it. I truly hope that Obama this time can manage to get it put in place.

[globetrecker]

Excellent post, Jolie. You mentioned $1500 per month for coverage in the U.S. I wanted to reiterate this because it seems like a ridiculous/unbelievable charge for health care per month. Yet it is legitimate. My parents, self employed, moved to the U.S. from Canada and pay just over $1000 a month for health insurance. It is unreal. Yet they say that their taxes in Canada were about 40%. If you do the math, I'd think that the higher taxes in Canada are possibly proportionate to the U.S., when one adds up the actual taxes Americans are paying cummulatively.

The Americans talk about higher taxes if we do a public option, but what about the money most pay for deductibles, bi-weekly health care deductions from the employer, and any other expenses? I look at my paystub in the U.S. and compare it to my one here in NZ-- and the deductions for my salary are slightly LESS in NZ than in the U.S. (Federal, State, FedOASDI/EE, FedMED/EE, Social Security) plus employer's insurance ($173 per month health, $80 for dental) which does not include fees for office visits/co-pays, prescriptions and deductibles. And if you're insurance won't cover or only covers a %age a certain operation, illness, etc. the out of pocket costs skyrocket.

I suspect that the people of the U.S. are getting ripped off and they either don't realize how much is being taken out or they don't want to admit that the taxes and healthcare costs per paycheck are actually substantially higher than people realize.

The health care (or lack thereof) in the U.S. and health care for profit/rescinding benefits once you are sick is the reason my husband (an American) says he will never return. It is too risky for someone who is self employed. If there were insurance reform (i.e. illegal to rescind benefits or deny insurance), that may be a different story. But since it is a multi-billion dollar industry owned by lobbyists and politicians, it will never happen.

Reuter's recently had this article re: rescinding of benefits (California's insurance companies in 2009 so far have reportedly denied or rescinded a huge percentage of claims). I'd like to research this in more depth to see their reporting methodology, but it is very sobering to know that it even occurs at all:

http://digg.com/d31333u
California Blues rejected 28 percent of claims in the first half of 2009. In
2008, six days before RN Kim Kutcher of Dana Point, Calif., was scheduled to
have special back surgery, Blue Cross denied authorization for the procedure
as "investigational" even though the lumbar artificial disc she was to receive
had FDA approval.

At the time of denial, which she calls "insurance hell," Kutcher notes she had
"already gone through pre-op testing, donated a unit of blood, had
appointments with four physicians." Kutcher paid $60,000 out of pocket for the
operation and is still fighting Blue Cross.

Kaiser Permanente, which denied 28 percent of all claims in the first half of
2009, was one of two systems to reject options for radiation and chemotherapy
for 57-year-old Bob Scott of Sacramento after his diagnosis of a brain tumor
in 2005. The reason cited was his age, says wife Cheryl Scott, RN. "He had
been in perfect health all of his life. This was his first problem other than
a sprained ankle. He died six months later."

Rejection of care is a very lucrative business for the insurance giants. The
top 18 insurance giants racked up $15.9 billion in profits last year.

[Jolie]

If you do the math, I'd think that the higher taxes in Canada are possibly proportionate to the U.S., when one adds up the actual taxes Americans are paying cummulatively.

The Americans talk about higher taxes if we do a public option, but what about the money most pay for deductibles, bi-weekly health care deductions from the employer, and any other expenses? I look at my paystub in the U.S. and compare it to my one here in NZ-- and the deductions for my salary are slightly LESS in NZ than in the U.S.

I moved here with my now-ex, and we found that taxes actually worked out about the same between the U.S. and NZ, maybe just slightly higher here.

And given the far greater social programs here (including healthcare) funded by those taxes than in the U.S., I'd say NZ has the better deal going.

Healthcare in the U.S. is SO broken -- but because Insurance, Medical and Pharma businesses have such a huge stake in keeping it that way, and are able to afford HUGE campaign contributions to legislators who will then vote against healthcare reform for them, I'm not optimistic than any meaningful reform will take place anytime soon.

Especially when such a huge percentage of the public has been hornswoggled by those businesses into believing that they've got it good right now -- because they're either too dumb or too lazy to do the research and crunch the numbers themselves, and realise that it isn't so.

Yep. Reason #38 of why I moved to NZ.

[Mamee & Co]

I hope you don't mind a view from a UK resident, but my friend is a US citizen. She has lived in the UK for some time but a year ago was diagnosed with breast cancer. She now cannot go home as she would not get cover for her treatment in her home state. What type of country exiles its ill citizens?

[James 1077]

Interestingly enough the US spends about the same on taxpayer funded healthcare as the UK and New Zealand as a percentage of GDP (8% ish). Total GDP spent on healthcare in the US is around 15% by the time you add in insurance and non-taxpayer funded costs.

Makes you wonder what the US is getting for its money!

[Jolie]

my friend is a US citizen. She has lived in the UK for some time but a year ago was diagnosed with breast cancer. She now cannot go home as she would not get cover for her treatment in her home state. What type of country exiles its ill citizens?

I'm very sorry to hear about your friend. It's not necessarily the country, it's the Health Insurance Industry over there. Once you develop a severe illness or injury, they will do everything they can -- as mentioned by Globetrecker -- to get out of paying for treatment, they will make excuses, they will stall (often until the person dies for lack of treatment). If you've ever seen the movie "The Rainmaker" with Matt Damon, it gives a very accurate portrayal of what goes on behind-the-scenes at health insurance companies.

And even if you do get treatment for a serious illness/injury and get well again, you have now become virtually un-insurable. No company will sell you health insurance -- at any price.

You're right, James, the average U.S. taxpayer does not get health care value for their tax dollar. But most of them don't bother to research the issue and calculate costs. They just repeat what FOX "News" has told them over and over again: that their health care coverage and treatment will get worse if healthcare is nationalised.

You can lead a horse to the trough of knowledge, but you can't make him think.

[BkyMonster]

The amount the US spends on health care for the benefit gotten is actually higher than other countries by a decent margin.
Life expectancy vs health care spending (http://ucatlas.ucsc.edu/spend.php)
They are also enjoying a high amenable mortality (http://blogs.consumerreports.org/health/2009/08/amenable-mortality-us-health-care-system-versus-other-countries-.html) rate.
I really wonder what exactly one gets for taxes paid in the US*. I feel we get a much better benefit for our money here tbh.
I feel ...just sorry for them at this point. And also very annoyed that relatives trust Fox pundits more than they trust us.
*(I know in the US taxes go to things like roads and safety services, but also go to crop subsidies etc.)

[James 1077]

To be honest the problem in the US isn't, IMHO, Fox News saying that a nationalised health system will be worse but the pro-nationalised health service people not getting the message out about how their system will work.

I watch US news and read opinion pieces regularly and have no idea how "Obama-care" is going to be structured. Without any knowledge of how it will be structured anybody who is against a public healthcare system can point out the worst aspects of a chosen system - even if it is nothing like the system that will be put in place.

So you hear that you may not be able to have private insurance if there is a public healthcare system (like Canada). That healthcare will be rationed with waiting lists for all but the most acute conditions (like the NHS). That drugs will be rationed (like NHS / NZ). That there will be no choice etc, etc.

What is needed is for a basic outline of the system being proposed to be aired as then you are limiting the arguments that can be used against it. This will create debate and potentially improve the proposed system.

The system I think that should be put in place is something similar to the Singaporean system (http://en.wikipedia.org/wiki/Health_care_system#Singapore). This would work best with the American psyche and be difficult to argue against. It uses both public and private insurance (government providing insurance for catastrophic healthcare and people who can't afford private insurance) and a mixture of public and private suppliers providing the actual care - which you can choose between. The "Fox News" contingent would have an issue around the price controls but the Singaporean system only costs 3% of GDP (for both public and private monies going into it) so you have a large amount of wiggle room before you hit the 15% that the US is currently paying.

But the big issue with US health is still not being addressed in any of the plans and that is the legal system. Without a reform of the legal system the US is always going to have very expensive care and insurance as doctors have to pay a fortune in insurance and also need to do large numbers of expensive and unnecessary tests and scans in order to comply with their insurance policies. Remove the ability to sue or introduce a legal waiver in return for cheap treatment and health costs in the US will drop dramatically.