It is maddening that teeth are so often treated like luxury bones, with their care separated from other medical care...as if the health of our teeth and gums doesn't have any impact on the rest of our bodies. *sigh*
Well, a lot of it is historic, and caught up in class issues. Very early in the run of the PBS program "NOVA", there was an episode (I think it was actually uploaded recently to youtube) called "Strange Sleep" about the dawn of general anesthesia in the 1840s (a docudrama acted it says by medical and dental students and personnel) that gives some of the flavor.
I'm a dual Canadian-US citizen, have used both systems over the years and actively observed family (and visited ER's with them, including my own emergencies) in both places. I can only offer you my personal experience: I would never, ever go to the US for health care again. Period. It isn't that you can't find a good doctor or hospital in the US, you can find them. Its that the billing nightmare is beyond extraordinary, even with a healthy income and insurance. Its too messy, and much more likely to lack access to care because of it. On the other hand, the issues of "quality" I hear about the Canadian system are largely unfounded and untrue. Do we have a family doctor shortage? Yes Canada does, but we still have a higher proportion of people with family docs than the US regardless of having a shortage. And you can still go to a hospital or walk-in clinic any time to receive medical services, regardless of that. Is it a problem? Yes it is. But its a 'better problem' to have, we need to train more family docs. I could offer more experience and stories, but I assume most wouldn't have time to read, so I'll leave it there. I'd never go to the US for health care. Period. I am happy to live in Canada on the basis of health care.
My ex (American) REFUSED to move to the US (I had multiple very good job offers) because of her extended family's experiences with US healthcare and justice. Her mother believed that the US healthcare system stole six-figure amounts from her grandfather (and based on what I know I would agree). It certainly would not have happened in Canada. And yet those who PROFIT from the system - including so-called medical professionals - continue to lie to Congress and the American people (who, courtesy of the myth of American "exceptionalism", buy into it wholeheartedly).
@@capnkirk5528I sympathize with the situation, and likewise I have more than enough personal experience to agree fully with what you're saying. Most people who have lived state-side have experienced the nightmare that is the American health 'system'. Its dysfunctional even when it works. And I don't want to be totally one sided on the topic. Canada does have issues to tackle, it isn't perfect here. There are good and bad docs on BOTH sides of the border. There are good and bad hospitals on both sides. But its far easier to find good doctors and good hospitals and seek medical care in Canada simply because there are no 'networks' for insurance coverage. You are fully covered everywhere in your province. All doctors, all hospitals, all clinics. You make the choice. Despite some of our real and honest problems, like the family doc shortage, its an easier problem to handle here in Canada. In the US, if you don't have the money, you don't have health care at all. That's a reality. Increasingly, it turns out people with insurance often can't afford procedures, especially chronic care. Cystic Fibrosis rings a bell. That requires a lifetime of doctor visits and care to maintain, you can't go without it. You can't skip treatment. Outcomes are much, much, much better in Canada for Cystic Fibrosis patients. Patients here live years longer than the American average, because you can't trust a private insurance company. And that's the common problem: privatization is what doesn't work. These need to be publicly administered rights, not private privileges. Lastly, Canada has world class institutions. You can get very high quality care here. If you have cancer, Princess Margaret Cancer hospital in Toronto is on par with MD Anderson in Houston, one of the best cancer hospitals in the US. I think people forget, private does not equate quality. So, I just can't reiterate enough: never would go to the US for medical care again. Ever.
You doubtless won't be surprised, that my medical life has become so much easier once I transitioned from private health insurance to Medicare. REAL Medicare, not that "advantage" crap.
@@StevenBornfeldI'm not sure how "real Medicare" compares to REAL healthcare like the NHS. But not to worry, the Republicans are going to take it away from you so NOBODY in the US can actually know how badly you're being screwed. And Larry Fink is coming for your retirement. You SHOULD be worried about that!
This! People in America talk about things like long wait times and high taxes like they are so much worse than what we currently have. Not only do we also have long wait times in certain circumstances as well as higher taxes than even some socialized systems, but we have the added problem of a healthcare system that can bankrupt you on a single bad day. Even for minor issues, navigating through the insurance and billing system is a nightmare that no one wants, especially when they aren't feeling well. If the only major problems we had were long wait times and higher taxes, that would be a massive improvement over the problems we currently have. Sure, those are things that need to be improved upon, and no system is perfect, but the US is so far behind when it comes to having a healthcare system that is accessible and efficient.
As an Australian I can tell you that most people I know find the American healthcare system bizarre and needlessly expensive. My brother had a medical emergency soon after moving to Delaware. Because of a mixup with his insurance he ended up tens of thousands of dollars in debt. This absolutely could not have happened in Australia.
What I'm interested in is how all these systems cover long term illnesses (type 1 diabetes, child birth, disabilities, degenerative disease...). In France they're 100% covered regardless of your employment status because just Giving You Insulin (without copay or premiums or deductibles) means you're likely to not go to the ER and cost the community more.
I have dual US/Euro citizenship and moved back to Europe 5 years ago. Healthcare here is like in the UK, zero costs to citizens. The wait times are fine, honestly, similar to regular appointments in the US. I recently became ill and have gone to the ER, specialist visits, tests, treatments, therapy, etc. It would have cost me thousands of dollars in the US even with insurance. I paid nothing here. I was just thinking about this today, how lucky I am to have universal healthcare now!
in england, we have private healthcare as well, you'll just continue to pay the national insurance cost, but there's private hospitals, and private everything as well
surprised Japan wasn’t mentioned. It’s like a better version of France. Same basic concept, but you can go beyond an add on, you can get employer coverage, and get supplemental plans to pay your living expenses while you miss work due to illness, you can get personal cancer plans, personal full plans, multiple insurance to cover gaps, etc. ALSO, vision and dental AND holistic (massage, acupuncture, etc) are included in the basic Shakahouken (spelling?) that every resident gets.
Small correction/update: as of very recently, Canada introduced pharmacare coverage. Currently only contraception and diabetes meds & equipment are covered, but the legislation includes mechanisms for adding more to the plan in the future
It's incredibly frustrating that the American left defaults to a single payer model as the ultimate goal where there are so many other models to choose from. Meanwhile the American right doesn't seem to have any coherent plan on healthcare reform at all. Our public discourse on healthcare reform is incredibly underdeveloped despite having been in the public eye for decades.
The healthcare systems in most other countries also have a much stronger bargaining position when negotiating prices with pharmaceutical and medical services companies. This leads to significantly lower prices on medicine, even when purchased out of pocket. Standardised pricing for blood work etc. also means your freedom of choice is focused on the doctors and hospitals, and not based on comparing wildly varying rates between them.
True. The federal government in Australia negotiates for drug prices and subsidises many of them. Cost of medication here is usually very low. We also have community GPs, pathology and radiology under Medicare, which means subsidises or free exams in those settings (govt pays the private providers). That said there are still gap payments on many services, as the provider is free to set a price, but they must remain competitive so the government price kind of keeps a lid on things. It is getting worse though because government rebates are not keeping up with inflation at all (and in some cases the indexation was frozen for years and years).
I would be so exceptionally happy if we had single payer. Both as someone with no insurance and as a medical provider. Only having to worry about one system to credential with, submit claims to, and trouble shoot with would be incredible. Instead I have a huge spread of reimbursements, requirements, and systems. Oh and to add i'm currently small and not providing insurance to my staff at this time. I want to but it's costly.
I have lived in the US and Canada and interacted with both systems. One note is that depending on the province Canada also has differing degrees of private options similar to Australia. There's a lot said about the Canadian vs American system but one thing I'd like to note is that it seems like the paperwork and registration for things is just easier. In both BC and Quebec the process of getting into the health system and having care paid for just involves a lot less bother than dealing with the US health insurance exchanges and of course it's vastly cheaper. The biggest problem is lack of availability of family doctors. I would love to see an episode of the impact of having a family Dr vs walk in clinics on long term health outcomes and lifetime cost of care. Ie: if it is more expensive to provide a family doctor then is that cost recovered by preventing acute health issues that are more expensive to treat and have other social costs such as time out of work.
Likewise, I'm a dual citizen. Luckily, I've never had a problem finding a doctor. I came to Canada 10 years ago. I found a doc within a few weeks of calling various offices in most locations I've lived in. I just moved back to Toronto and got a new family doc in 2021, so it isn't impossible. But it does take a lot of phone calling and work, sure. But I don't think its any more difficult than having to stick to your US 'network' because here you call any doc office and ask. No limits makes it easier IMO. There is a family doctor shortage, but the truth is, there is one in the US also. More Canadians have a family doc than Americans, its still true in 2024. You always have access to care in Canada by going to a number of health clinics, but its true having a family doc is preferred. We do have problems in Canada, but as I often say, compared to the US we have 'better problems' to tackle. We can train more family docs with an education plan. But in the US, all that private bill pay extravagance hasn't provided for more family docs there. Its telling, it means privatization in health care doesn't work, IMO.
This is also a major thing with the US welfare system. The US actually spends almost as much on welfare per person as Denmark does, they just get far less out of it. A big part is the excessive means testing which eats up a lot of the budget. It's simply more efficient to make welfare services universal and raise taxes on people that don't need them than trying to deny it to those people. The US also has a massive number of programs that are all underfunded and not very effective and have a ton of overlap. Cutting out about half of it's programs and concentrating the funds in the remaining half would let the US get WAY more out of it. Another way to save money is actually to raise the minimum wage and make sure GIG workers are included. After the elderly the two largest recipients of government welfare are children and after that the working poor. Welfare for the working poor is really just a corporate subsidy so that they don't have to pay a livable wage and it shouldn't exist. People who work more than 36 hours per day and have no significant disability or illness should not need any welfare. Increasing people's income also means the welfare spending on children can be less since their parents have more money. This saved money can then be directed towards other welfare like for the homeless or the terminally ill. You can also do a lot with regulations like allowing the government to deal with the pharma companies as a single entity and to ban junk fees, do anti-trust enforcement to clamp down on price gauging. These would all significantly lower people's cost of living without the government needing to give them anything.
I don't think the problem is finding better models or even convincing the American public to try something new. I think the problem is political. The special interests are just too powerful and they won't allow any change.
The UK has been under-funding the NHS and private insurance has become more common among its citizens. I don't know any of the numbers, but I do know that ZombieCleo's dental work was covered under her private insurance with her NHS dentist.
@@rayhuckfield5517 Big number make confirmation bias go brrrrr. Good job. Now look at where it was spent in comparison. Near £20bn was on Non-NHS health care. Over £30bn on procurement of private resources .Less than half was given to the actual healthcare professionals. It's fine to always read headlines but maybe do actual research not just confirmation bias to your own political beliefs. I can't post you links or I would help you. But don't look at newspapers that only source themselves.
@@rayhuckfield5517If you totalled up the cost of any other country's healthcare spending you'd get a similarly dramatic number. It turns out keeping people healthy is pretty expensive, but the social and economic costs of not doing it are worse.
@@rayhuckfield5517 the UK spends around $5000 per person per year on healthcare. Germany spends around $6700. Norway spends $7200. The USA spends $10,000 per person per year. Bloated huh? Before the tories started diverting NHS spending away from efficient public services and giving it to more expensive private contractors and gutting affiliated services like social care the UK had one of the most cost-effective healthcare systems in the world. We got about as much care out per dollar spent as any other country has been able to, and because of that our health outcomes were very creditable considering how little we spent compared to equivalent countries. But cost-effective socialized services don't make dividends for millionaires, so that system had to go
The USA has a health system that works fully as intended: to squeeze out the last cent from people who have no choice but to cough up that last cent if they want to live. Either because with treatment they can continue working, but have to cover insane costs, often putting them into debt. Or they DON'T get care, thus loosing their ability to work, thus loosing their jobs, thus loosing their employer dependent benefits of health insurance; or they simply die from the affliction. Great choices, right? What I don't get is that this video didn't even touch on the oldest continually existing healthcare system, Germany's. It offers both statutory health insurance but also the choice of private health insurance (PHI). However you have to be willing and able to afford the much greater insurance fees for private health insurance. The break-even-point for income is at around 65k€ a year income as a single person. For any person with a spouse and/or kids an SHI will remain viable for much longer, as under SHI non-working spouses and kids are automatically co-insured for free. The German healthcare system includes very basic dental reconstruction, as well as a very basic visual aids (ie the cheapest frames and lenses with absolutely no additional features). Physiotherapy however is covered. Preventative care is part and parcel of the SHI system as the insurers recieve their share from the central pot of ALL SHI fees according to the number of customers they have. This means SHI want to prevent as many illnesses as possible while having the largest number of customers at the same time. PHI allows for doctors and hospitals to charge up to four times the price for SHI coverage, making them incentize PHI patients over SHI. Still over 80% of people in Germany choose SHI over PHI, which includes a large section of people that COULD choose PHI due to their financial situation. In addition to that, the German government has set up rules and regulations for a panel from ALL insurers (both SHI and PHI) to negotiate with pharma companies as well as doctors and hospitals to regulate a standard price list. These include ALL treatments as well as ALL drug prices for generica. Specific brand drugs MAY be included IF the pharma companies agree to reasonable prices with the panel of insurers and doctors. This leads to equal power distribution for the negotiation instead of the horrible negotiation position of individual insurers having to negotiate with individual doctors and hospitals; or worse, even individual citizens trying to negotitate with these conglomerates. As such, the negotiation stance for both major participants, insurers and doctors vs pharma companies and hospitals, is brought to a level playing field. With the price list negotitated among these private sectors without any actual involvement of the government (they just set up the framework of the limits what's possible), reasonable costs will be negotitated that are CONSISTENT across the country. No checking for in-network, coverage, etc. ALL insurers guarantee the coverage of the negotitated prices, and ALL doctors, hospitals, and pharma companies can caluclate with guaranteed prices as well. However the typical red tape of Germany throws a spanner into the works, as far too much regulation is placed on individual doctors, either in practices or in hospitals to provide data on the individual patient to the insurance companies, and vice versa. That's where Germany's system suffers most. There are only a handful of copays there are in Germany. 1. Generic prescription drugs in pharmacies: 5€ (or free), with brand type prescription drugs at 10€. There are however additives you may WANT to buy, which you will have to cover yourself. But even those don't exceed roughly 100€ per month. If they are medically NECESSARY however, you will again drop down to 5 or 10€ per prescription. 2. Dental healthcare: if you go beyond any of the minimal reconstruction into any part of 'beauty improvement' like professional cleaning, bleeching, etc, you have to cover these yourself. There are however supplemental insurances you can get to cover those costs, which usually are worth their low yearly costs. 3. Visual aids: if you want stylish frames and lenses with superior finishes or qualities like auto-darkening, anti-mirroring, etc, you have to cover these yourself. Again, additional supplemental insurances exist for that. 4. Hospital stays: to cover your food you will be charged 10€ per day, up to 240€ per YEAR of continuous hospital stay. That's it. 5. Any elective surgery (especially plastic surgery trying to 'improve' the natural state) that is not strictily medically necessary you will have to pay yourself (duh, obviously). However, reconstructive plastic surgery in case of amputation or damage IS covered 100%. Again, if you want special features on prosthetics, you might have to argue with your insurer what's medically necessary, and what is at best a style feature. With all of that out of the way, Germany provides 100% coverage for ALL citizens in Germany. The government itsself has absolutely NO access to the insurance fees paid by either employers or employees. Thus, these ARE deducted from your pay check/wages automatically, but the government doesn't get their hands on it. Thus, these aren't technically taxes, but insurance fees. But within this system, all SHI fees are collected into one pot, and distributed by a rather complex (and inefficient) system among all SHI companies. PHI goes directly to the respective PHI companies.
Canada is starting to introduce drug coverage. One glaring issue is that the US charges insane rates for health care. In Canada the government pays under $50 for almost any type of X-ray including a mammogram. In the UK, a heart attack may cost the government $10k. How much do these things cost in the US? A public health care system isn’t geared for profit.
Starting this year Canada is phasing dental care. Start for people earning less than $95K/ year it will expand over the next couple of years. Japan which has the highest life expectancy in the world, is also worth a look. It offers national health for everyone and covers 70% of everything including dental. it also caps maximum copays so covers catastrophic care. Private insurance usually through insurance is available. hospitals are a mix of public private and charitable. Note charitable hospitals are really charities, often offering free care, not corporations pretending to be charities while paying CEOs millions in salary and not paying employees enough to use the charitable car. There is even fully private care that is not covered by national health. The only one I know of offers prescription refills over the web, it is so efficient the patients still pay less than the usual 30% copay. Also municipalities will offer free annual checkups on your birth month. I think it would also be worth pointing out that the US spends more of its GDP on health care yet still has the lowest life expectancy in the G7. Even the life expectancies in the richest counties only match other G7 countries' life expectancies.
Just FYI that both drug coverage and dental care in Canada are having regulatory overhauls moving towards single payer for a chunk of coverage. It will be interesting to see how those changes shape up over the next couple years, and it may be worth revisiting the comparisons at that point.
And there are other ways. In Chile, there's a national public system called Fonasa, which everybody can belong to. You pay a percentage of your salary or pension, and you have full access; it is tiered according to your income, but you aren't denied attention if your income is low or nonexistent - you can even get transplants. Yet, it is chronically underfunded and very slow - the dictatorship tried to dismantle it in favor of private healthcare, it failed, but it damaged it. In consequence, there are private health insurance companies, called Isapres. They pretty much work like American companies, with all the good (way faster than Fonasa, more amenities) and the bad (expensive, confuse, they don't cover everything). They are not tied to people's jobs, so, as long as you have the required income level, you keep your plan. Finally, there's purely private healthcare. You go wherever you like and can afford, pay cash, and that's it. That's mostly the way of things like cosmetic plastic surgery. On the other hand, if you have a life-threatening emergency, you go to any public clinic or hospital and get care, even if you are not registered in Fonasa or are an undocumented immigrant. Time for the USA to learn from Chile too?
Medicare in Canada doesn't cover dental care. The government has just recently introduced dental coverage, but it's limited to kids and low-income individuals. Canada's system is very good at preventing bankruptcy, routine scanning for cancer, etc. and for emergencies, but for less-serious care the system is in deep trouble. There's a huge shortage of physicians and wait times are very long.
There is a quite similar setup and situation in Australia. Private insurance tbh isn't so much for additional care, but it's good for skipping the queue for non-urgent care. The downside is the cost is increasingly absurd and so fewer and fewer people are opting for it; putting more pressure on the public system, which is already far behind on elective waitlists, especially after covid.
Frenchie here, I'll add that since 2016, employers are required to provide insurance and employees can only opt out if they prove they have a personal insurance on the side. (The cost is shared between the employer and the employee)
Congress keeps insurance companies from selling insurance across state lines, driving up the cost of insurance because of duplicative administrative costs.
It's not Congress stopping it, per se. It's the health industry lobbyists paying politicians to keep it that way. The system won't ever work for the people while businesses can buy votes
Which I wish would stop. We are the *United* Sates, not the Good Neighbors States. If we're doing private health care, companies should be able to sell nation wide. And if you have health care in one state, it should apply to any state you're in, not just the state you reside in. People travel. They shouldn't have to worry about health coverage if they happen to get sick or injured outside their home state!
@@Tashishi0the problem is a lot of states aren't good neighbors when it comes to public health or supporting their citizens. In CA, having an HSA is actually double taxes instead of being an investment. But our insurance is forced to have the same coverage if you retire here and move to a different state.
Why are dentistry and ophthalmology not part of "medical coverage"? Are eyes and teeth NOT part of the human body? Are you less likely to die or be disabled by a serious untreated eye or tooth problems? If you have an emergency involving your teeth over the weekend, is it ok to just send people home with tylenol and leave them to schedule an appointment days later and hope things are treatable? If it's a problem with a body part, it a MEDICAL issue and should be part of medical coverage and emergency services.
@@Tashishi0People can die from tooth/gum infections because they get sent home from the ER with tylenol instead of getting care. People can go blind unnecessarily because they get sent home and have to wait instead of getting emergency treatment when worrying eye symptoms manifest. All because teeth/gums and eyes are "special" and ERs don't have people for that.
Socialize it all!! I'm poor, so anything that is free at point of entry and likely to cost me nothing afterwards means I will actually go to a doctor before I absolutely have to because I can't stop bleeding or something. Also, I don't know why so many systems separate eye care and dental from the main body of healthcare. Last I checked, all of those things were part of my body, and a big chunk of the money I've had to spend on healthcare over the years has actually been for those two things. My glasses ain't just for style. I need them to actually see. I need my teeth so I can eat. It is all healthcare! No more tiered systems! "Willing to pay more" is just means, in practice, "those who can pay more." In a country with as much poverty and inequality as the US, that cannot be overstated.
In the UK, teeth and eye care are free if you have a sufficiently low income, are a child or pensioner. If your eyesight is bad enough, even as an adult. Dentists are difficult to get hold of though. The NHS has been gutted over the last 15/20 years. It's very sad, infuriating and frightening.
What is stopping the US from using the Japanese system? I loved it when I studied abroad there. Insurance that's universally available if you want it, completely reliable and predictable, and reasonably priced.
To me it's as simple as the cost for US healthcare is double any other developed country for worse outcomes. For what we spend on our premiums in the existing system, we could get substantially better coverage under single payer by eliminating the 20%+ profit margin middleman plus millions of highly paid white collar workers that do nothing but create/manage artificial complexity (at health systems, in the insurance companies, and at every employer in America).
Addendum: Starting last year, Canada (Alberta at least) is already social pay but private clinics/doctors... and moving towards much-more-private clinics. The health care is exactly the same, billing the same to the government - but they operate on a subscription model (several thousand dollars/year/person) for 'member' access to the clinic to keep higher availability to reduce wait times for those willing to pay. Sadly, it doesn't take a math genius to see that a) there is a huge profit margin in that model incongruent with equitable access for the less fortunate, and b) once sufficient clinics move to that model, there won't be enough resources for everyone else. The traditional system clinics will be overwhelmed, burned out, and shut down - leaving only the paid option. Wait times for many procedures/specialists are already in the months-to-years range. Letting people pay to skip that queue will only make it worse for people who can't pay. It's not like it's building entirely new clinics/attracting new specialists - it's converting existing ones.
BC has had two developments in this area: 1. A constitutional case was set aside by the BC court of appeal preventing physicians from operating both for the public and the private systems (the " Cambie clinic" case); and 2. We've moved to paying family physicians a set salary per year instead of a fee for service model. This has helped young GPs go into family medicine instead of becoming hospitalists.
Canada has had history with public ally funded but privately delivered healthcare service. The Doctor strike of 1960s in Saskatchewan can be thanked for this fee for service model. We have today. Most family clinics are privately run but bill a medical service branch of the provincial government for services provided. Now these private clinics like the one in Calgary recently have caused the Alberta government to be threatened the by federal government to withhold money from the Canada health transfer to the province until these private clinics stop charging patients for typical expenses paid for but the government insurance plan. So yes there is a lot of publicly funded and privately delivered healthcare in Canada. Though it hasn’t all well worked out right Alberta? Alberta Health Services has signed a memorandum of understanding with the ownership of Dynalife, which will see the private provider transfer all of its staff, operations and physical locations in the province to Alberta Precision Labs by the end of 2023. So glad to see private labs worked out sooo well for Canada.
This is a quality video that does a good job of explaining overviews. Thanks. I do have concern with the premise, however. As it relates to goals of a healthcare system, quality of care was noticeably absent. What is the logic behind its omission? Anecdotally, most Canadians I know do not have access to reasonable care due to wait times and lack of actual coverage for anything beyond routine. Their best option is typically to purchase traveler's insurance and come to the United States for higher quality care. Thanks.
- **Switzerland**: Utilizes a model of private insurance regulated tightly by the government. Everyone is required to have private insurance, with subsidies available for low-income individuals. Out-of-pocket expenses are relatively high, but catastrophic coverage ensures everyone has some level of coverage. - **Singapore**: Combines government-provided catastrophic coverage with individual responsibility for outpatient care. Mandatory health savings accounts encourage prudent spending, and tiered hospital care allows for choice based on affordability. - **Canada**: Operates under a single-payer system funded mostly by general taxation. Each province or territory manages its own Medicare system, covering medically necessary services provided by hospitals and physicians. However, it does not include coverage for prescription drugs, eye care, or dentistry for adults. - **Australia**: Offers a dual healthcare system where patients can opt for the public system or choose private insurance. The public system, Medicare, covers most costs of hospital and physician services, while private insurance provides access to private hospitals and specialists, as well as additional services not covered by Medicare. - **New Zealand**: Similar to Australia's model but with a stronger focus on community-based care and public health initiatives. The public system provides universal coverage for a range of services, including hospital care, primary care, prescription drugs, mental health care, and disability support services. Private insurance plays a supplementary role, offering faster access to elective surgery and covering services not funded by the public system. - **France**: Offers a system where the public sector sets a baseline for healthcare, but individuals are encouraged to spend more if they desire through supplemental insurance. The public system covers most costs for hospital, physician, and long-term care, while supplemental insurance helps with out-of-pocket costs and covers additional services like dental, hearing, and vision care. - **England (NHS)**: Provides healthcare to all residents without any cost at the point of care through the National Health Service (NHS). The NHS covers hospital, physician, and mental health care, eliminating financial barriers to care. However, there may be trade-offs in terms of wait times and quality of care. Each system has its unique features, including the extent of government involvement, financing mechanisms, coverage of services, and degree of individual responsibility for healthcare costs.
The German healthcare system is characterized by its dual public-private structure and emphasis on universal coverage. Here's how it compares to the systems mentioned in the transcript: - **Dual System**: Germany operates a dual healthcare system consisting of statutory health insurance (SHI) and private health insurance (PHI). SHI covers around 90% of the population, primarily employees below a certain income threshold, while PHI covers higher-income earners and certain professionals. - **Universal Coverage**: The German system achieves nearly universal coverage, with compulsory health insurance for most residents. SHI provides comprehensive coverage for medical treatments, including hospital care, physician visits, prescription drugs, and preventive services. - **Funding Mechanism**: SHI is financed through a combination of contributions from employers and employees based on income, while PHI premiums are risk-adjusted based on individual health risk factors and income. - **Quality and Access**: Germany is known for its high-quality healthcare services and relatively short wait times for non-emergency treatments. Patients typically have access to a wide range of medical specialists and hospitals. - **Choice**: Patients in Germany have the freedom to choose their own physicians and specialists, and they can switch between insurance providers relatively easily. - **Cost Sharing**: While patients may face modest co-payments for certain services under SHI, the overall cost-sharing burden is relatively low compared to some other systems. PHI members may have higher premiums but often enjoy additional benefits and faster access to care. Overall, the German healthcare system combines elements of social insurance with private competition, resulting in comprehensive coverage, high-quality care, and patient choice.
Compared to the healthcare systems mentioned in the transcript, the U.S. healthcare system differs significantly in several key aspects: - **Fragmented System**: Unlike many other countries with universal or near-universal coverage, the U.S. healthcare system is highly fragmented. It lacks a unified system for providing healthcare to all residents. - **Employer-Based Insurance**: A significant portion of Americans receives health insurance through their employers. This system ties coverage to employment status, limiting choice for individuals and potentially leaving those without stable jobs or benefits without coverage. - **Private Insurance Dominance**: The U.S. relies heavily on private health insurance, with multiple private insurers competing in the market. This can lead to variations in coverage, benefits, and costs, resulting in disparities in access to care. - **High Costs and Out-of-Pocket Expenses**: Healthcare costs in the U.S. are among the highest globally. Even with insurance, many Americans face substantial out-of-pocket expenses, including deductibles, co-payments, and co-insurance, which can deter individuals from seeking necessary care. - **Coverage Gaps and Inequities**: Despite the presence of government programs like Medicare and Medicaid, millions of Americans remain uninsured or underinsured, leading to disparities in access to care based on income, employment status, and geography. - **Complexity and Administrative Burden**: The U.S. healthcare system is notorious for its complexity and administrative burden. Patients, providers, and insurers often navigate a maze of regulations, paperwork, and billing processes, which can increase administrative costs and inefficiencies. - **Varied Quality and Outcomes**: While the U.S. boasts world-renowned medical facilities and providers, healthcare quality and outcomes vary widely across the country. Disparities in access to care, socioeconomic factors, and systemic inefficiencies contribute to differences in health outcomes among Americans. Overall, the U.S. healthcare system is characterized by its complexity, high costs, and inequities in access to care, contrasting with the more streamlined and universal approaches adopted by many other countries.
"longer wait times" for countries with socialized health insurance. Uh huh. Haven't been here in the US waiting 6 months to hear back from my allergist.
I'm in my 30s and have realized that it would probably be wise to plan to live in another country for my retirement...now I just need to pick which one!
The preferred systems are *Canada, UK & Taiwan.* Either one of these models will be a game changer for the better for people like myself here in the United States 😉👍💯
When considering replacements I think we need to suit them to the strengths and weaknesses of the American government. We have hyper complicated system overseen by a government that at all levels is demonstrably bad at detailed regulations, every few months there is another story about how providers are ripping off Medicare. I therefore favor single payer or an NHS style system with the simplest possible design.
Feel like Singapore's system would be the easiest sell. It has a fairly strong element of the "bootstraps, personal responsibility, rugged individualism" thing that a lot of Americans get their rocks off to. Though really, the group most opposed to any change are the insurance companies themselves. And since the US government is almost wholly captured by corporate interests, and since Americans are perfectly happy to keep letting bad systems continue forever, uh, I see no change coming. Ever.
Canada has a private health care system... it's called traveling south to the US. You can purchase travellers insurance in Canada and then get the services you want in the US (whatever your travellers insurance covers). Not a great solution but it is a way to get faster services than in Canada if you want to pay a crap ton more to do so.
Yes they do have it right for the most part. The failing lies in that like the United States corporations and wealth aren't taxed to what they should be. The casual observer who's thought about relocating from the US to one of these countries is through US corporate indicrination through the government, see the higher taxes in these countries as too much not realizing they are out of pocket far more when it comes to health-care and other to the public services these countries provide to everyone in residence.
The Medicade system in the US is a mess and at least in my state seems to be designed to keep people in low paying jobs because if you go over a certain amount you get kicked off. I was working 20 hours a week as a library assistant and the moment I went from $16 an hour to $17 I was kicked off. I was lucky in that I was engaged and was able to get married and on my husband's insurance or I wouldn't have been able to afford medical care. I was also living with my parents unable to move out due to my job and the difficulty getting full time librarian work even with a degree and experience.
The NHS in Britain got short shrift here. It does currently have problems, as Conservatives are actively trying to undermine it and are thus under-funding it. Their system is immensely popular and if funded, functions extremely well. BTW, the US could have an extremely well funded NHS for around 60% of what we currently spend on the WORST health care system in the developed world.
Let's not forget the toxic cycle of abuse the US system prompts. If your spouse is abusive, but their job has good benefits, you might stay just to ensure you or your child remains covered. The same goes for abusive employers, or even just regular employers where switching for a better job opportunity can leave you without care, either bc the new job doesn't have as good of care, or you'll need to switch doctors due to the current PCP being out of network. How many people would love to start their own business, but don't bc they can't afford to fund their own private coverage AND the start up costs to make a new business succeed.
The examples presented are all from first world countries but even many third world countries have public health systems where you'd have a better experience than if you were an american of median income. The American health care system is just perverse, all it cares is about profits, not the patients who sees as clients. Healthcare is more than a "service", it is a human right.
Employer provided healthcare is not good in any case I've heard of, outside of the c-suite at least. Plus it chains you to your employer. Can't quit or you lose your health coverage. Plus plus that's only for jobs that charge you for healthcare, I've had a few jobs keep me at 2 hours under the requirement to provide benefits. Plus plus plus it's a barrier to small businesses. Plus PPP it's more expensive overall. All that admin work those HR departments have to do, plus the lobbyists I guess you'd call them who sell the insurance to the companies. Add in the cost to the employee for the overpriced care, then the copays, then the deductibles... it sucks. Pure single payer, or good public option baseline with strongly regulated addons is what we need.
As long as we get the medication and treatments we want. Let's not give up quality of care. Don't pass universal healthcare and just offer low quality medications and dangerous surgeries that are not needed. Give us the same care the wealthy get. Ibprofin and Tylenol ain't going to cut it. We want quality of life.
It’s worth noting that Australia also has tax rebates for people over the age of 31 for basic private hospital cover. Due to issues with poor regulations of what insurance can charge for cover (albeit 100,000 times better regulated than the USA), some people won’t bother even if they could afford it. Personally, I only save about $100 in tax by having private insurance with the scheme. But I do it because then I have backup The major problem is the huge out of pocket costs four private cover in Australia that mean that those who have often don’t use it when they need it because they don’t have a spare $5000 or more (depending on the procedure) out of pocket for the surgeon and anaesthetist fees that are over and above what the insurance company will pay That said, when you do come into a bit of cash it is helpful - I got a lump payment that will probably never happen again and skipped a 3+ year queue for straightening my nose to breathe better (aka septoplasty) It’s got big problems, and our public waitlists can be obscenely long. But the standard of care is high and most people won’t lose their house or fuck their overall credit score for getting sick
Can we also discuss how much these other countries pay in taxes to fund these government sponsored programs? I'd also like to see you go after the companies like United Healthcare that are buying up hospitals and ambulance services so that they control the *entire* healthcare stream, not just insurance, thereby allowing them to charge exorbitant amounts at any stage. (See Dr. Glaucomflecken's series from last October if you don't know about this.) I 100% agree that the US healthcare and insurance system needs reformed, but it is an even more complex issue than indicated in this video.
Couple clarifications for Canada. With Canada provinces(sub national government) have exclusive jurisdiction over health care delivery. The federal governments role is more pharmaceutical manufacturing regulation and control. Medical device and drug reviews(like the US FDA) and health research. Dental care, optical, prescription, physical therapy, Are not typically covered by the provincial health insurance plan. Usually people have work coverage for these or private coverage to access these other primary are services. There is recently the federal government Canada dental plan, which has income requirements in order to access. The federal governments role of setting the standard of healthcare has more to do with the federal government’s financial power than its own intrinsic jurisdiction. The federal government transfers money to each province with the expectation healthcare is publicly delivered. Private clinics, no federal money hence they have the power to set health policy as it typically has more money than provinces because the federal government can directly or indirectly tax individuals while provinces can only conduct direct taxations to residents. To sum up provinces in today’s political climate would rather not have this system and politically would prefer the federal government to step aside when it comes to healthcare system.
In México there is a mixed system where a very slow public hospitals take care for workers with their families plus women and children and while supported by prívate hospitals and services the public hospitals can't or won't provide. Self-employed and jobless adult men have issues with access.
The most annoying myth in these comparisons is the long waiting lists. Sure, in single payer systems you can end up waiting a long time for a low priority operation, but everyone will get hep! In the US system the wait is shorter for those who can afford it, everyone else ends up crippled on welfare, homeless or dead.
one of the problems with us medicare is that the participants are ALL seniors who will require far more medical services than the young and middle aged. this is why it cost so much. obamacare was an attempt to spread the payer base but politically it was a nightmare. the young don't want to pay for something that they generally don't need to use
This is exactly why it should be mandatory. People (especially North Americans) don't want to pay for something they don't need, but paying for someone else's care is exactly how we create a system where people who otherwise can't afford their treatment can still get it. If we wanna be all in this together, you're statistically going to have to put in more than you get out of it.
Not to mention that most single payer or hybrid models use some form of health technology assessment (at least for the single payer component) to establish the cost effectiveness and value of interventions and services (relative to existing options) to ensure care represents value for the invested resources.
What Ithink you miss about Australia (and perhaps other systems) is the significant bias towards prevention/early diagnosis of illnesses. In addition to general health, most diagnostcs (pathology, x-rays, etc.) are free without delay, as a government-pushed screenings for common illnesses such as breast cancer for women and bowel cancer for all at appropriate ages. It's only the more exepsnive/exotic diagnostics (CT, MRI, etc.) that tend to have a - relatively modest - copayment element and even these can be obtained for free if you are willing to wait a bit (or if urgently requrired/done in a public hospital). Our system isn't perfect, but it is pretty well balanced and the focus on prevention/early detecion is one of the reasons that Australians are so long-lived. I would question your number of 33% of Australians having private insurance. Given the tax incetives for having it (or more properly the tax penalties for not having it) which make it effectively free by the time you hit the median salary (and given kids are overed under their parents' plans until 25) I suspect the percentage of people covered is much higher.
It's not higher than 33% I'd guess due to cost. And it's decreasing in recent years. The tax penalties only kick in for singles at $97k and families at $194k. This is far above the median, and even above average, especially for families.
There are healthcare systems, and there are healthcare systems...and then there's what we have, which is pandemonium. I was the beneficiary in the past week of some of the best that U.S. medicine has to offer--a robotic mitral valve repair. And then, for the masses, too often no care at all. When we value the lives of those less fortunate, and health care is considered a right and not a privilege, things may get better.
I’d love to know where you think Indian Health Services in the US lands in this? I’m Native American and part of a federally recognized tribe so I get some benefit from it (it’s a legal patchwork of its own) and wondered how it stacks up to the other systems in the US and the world
Somewhere between absolutely horrible and not great. Talequah has done wonders throughout and since the pandemic and and the new hospital gives me an awful lot of hope and pride. But as a whole it's hey system that at a bare minimum seems disinterested in raising the average lifespan of the people it's supposed to service.
Let’s take a page from Canada, and make it so everyone gets care for free, both preventative, and catastrophic. But you pay for your place in line. So if you only have $400, you wait six months for the ER. But if you have $20,000, then your hemorrhoid surgery takes precedence over a heart attack.
It kind of is the extreme. Healthcare has to be paid for, and the most extreme version ar one end is the government pays for it all. There isn't really anywhere to go further in that direction. It's not extreme ideologically really, but it is in terms of options for systems.
I see videos like this and my heart goes out to all the for-profit insurance CEOs of the world. Why, I bet they're hardly even multimillionaires, and will *never* make a billion. How can they afford yachts, private trips to space, or half-baked transit solutions to avoid interacting with the poor? These other countries could stand to learn a lot from the good old U S of A about how best to treat their wealthiest citizens. 😢
You'd be surprised (or maybe you wouldn't be) how much money private insurers make in Australia even with our system. Of course you are correct that US is on another level 😕
I'm actually quite disappointed in this video. The summery of the English healthcare system is not that accurate. You say "without any cost at the point of care" but that's not strictly true. 1. Dental care comes with an out of pocket charge for most people (subsidised, but can still be 100s of £s for certain procedures). Only dental checkups are free. 2. Prescription medicine is currently £9.65 per item prescribed. Certain medicines are free for certain conditions but most things are not covered. 3. Eye tests are charged in England for most people under 60 y/o. 4. Unlike England, the Scottish, Welsh and Northern Irish NHS provide all prescriptions for free. Some people who are very low income and/or receiving benefits, and those with some chronic health conditions (also pregnancy) can have prescription and dental charges waived. However there are many English people who are not covered who struggle to pay for prescription medicine and sometimes choose to skip taking certain medications. £9.65 for antibiotics may mean they can't afford to eat that week.
Compared to pretty much everywhere else, this is basically free. Of course it's not entirely free, fair enough, but the OOP costs are tiny in comparison to even other socialised systems. The downside is the wait times, risk of escalated emergencies, and driving your healthcare staff into the ground (I'm an aussie healthcare worker who works with several expats, they are glad to get some sleep here!)
"why should we pick one of these other systems" Because every single one of them is better than what we have now. Any one of them would be an improvement.
@@Jay-ho9iono, I want my health care dollars to pay the salaries of lawyers and statisticians whose job it is to make sure that the insurance company avoids footing bills, even by those who pay and thought that they were covered. It’s the American way
Canada is moving in a different direction to privatize the system and restrict access. In Ontario, almost 1/3 of the population no longer has access to doctors.
i love your channel - sadly i belief you are wrong in the assumptions: the goal of the American healthcare industry is to maximise profits, not to provide healthcare services. And this is a cultural and political difference between the US and most of the world. Every country has issues with their healthcare system, costs and efficiency are a problem everywhere. What makes the US unique is the low effectiveness of the system for patients - but it might be the most effective system for the industry to generate revenue. So in order to "fix" the American healthcare system, you need to "fix" the culture first; the core beliefs in the US seems to be closely aligned with the "Rules of Acquisition" from a certain fictional alien culture. Fix the culture and the system will adjust itself. From the outside it seems the most toxic belief is that being poor is a sin against god.
I can't speak for everyone in the US, but the people I know who are the most opposed to government involvement in healthcare are people who are convinced everything the government does is worse than something a private company does and that the fed is much scarier than corporate fat cats. They think that it will make everything even more expensive somehow because it'd be paid for by taxes. When the truth is that the current model of for profit not for patients is driving up costs. I think that a for profit model is the problem, they think that government regulation is the problem.
You kind of glossed over the UK it’s actually more complex. The NHS covers most things however prescriptions are charged at a flat rate per item unless you’re exempt NHS dental car is charged by procedure unless you’re exempt. To be exempt from dental charges you would be well below the poverty line. Eye care is different again. Your eye test is covered by the NHS and is charged unless you’re exempt. NHS glasses are very basic and almost everybody pays for better frames and lenses. This can cost many hundreds of pounds for varyfocal lenses, coatings such as scratch resist and anti glare and frames by supposed designers or big name brands. My sunglasses were pennies shy of £700.00 as I have a condition where I need to block side ingress of light. Many companies include private medical care in their remunerations. This is basically so their staff are off sick for less time. A number of people in the UK pay medical insurance for private health care predominantly so they don’t have to wait. The NHS is a fantastic service and overall the quality of care is excellent. The waiting lists are an issue however for time critical illness such as suspected cancer there is a standard where you are seen within weeks. I hope this gives non UK residents a better idea of the complexities involved in Uk healthcare
This seems well intentioned and it covers a bunch of alternative approaches, but it assumes from the beginning that "insurance" is the right model. I disagree. I want to buy health care the way I buy clothes and cars ... I decide what I need, compare styles and prices and pick what works for me. The insurance industry does everything in its power to make sure that I can't do this.
Another key goal: a system that incentivizes health care providers to constrain the skyrocketing cost of health care. A subscription (prepaid) model with “hospital doctor groups” competing for subscribers (we the people) can accomplish this. Subscribers pay a monthly fee and in return the hospital provides any health care required (minus a small per visit charge to discourage hypochondria). Doctors are paid a salary by their hospital, and don’t work on a fee-for-service basis. Competition between the hospitals in a given region will make hospitals and doctors prioritize efficiency and cost reduction.
This is how a lot of hospital systems already operate and it fosters the exact opposite of quality care. Bottom line padding bureaucrats and bean counters cut costs by overburdening staff, reducing equipment quality to a comical degree, and incentivize doctors to churn through as many patients as possible while maximizing "satisfaction scores" and following asinine "hospital protocols". This means that the hospital turns into a money printing machine where people get to go, order things like it's a menu, and leave "satisfied" with what can only be called shameful medicine. The problem with your idea, ultimately, is that healthcare in the US can't be fixed until administrators are booted from leadership positions.
@@tdawg281 it’s not “how a lot of hospitals already operate.” There are no subscription-model hospitals in the US, and obviously there is also no competition between subscription-model hospitals for subscribers. That competition is the way to constrain skyrocketing costs and maximize quality care. Our current fee-for-service model is what has made the US the world’s most expensive health care system and low quality at the same time.
@@dfs-comedy the wildly escalating cost of healthcare makes it unaffordable for many people (bankrupting many) and it means the government can’t afford to pay for healthcare for as many poor people as it could if the cost wasn’t out of control. Cost is a critical issue for healthcare.
@@tdawg281 Incorrect. There are no hospitals in the US run on a subscription basis. And obviously we aren’t benefiting from competition between multiple subscription based hospitals in one city.
So everything you listed is pretty much Medicare is required in one form or another. Only exception is a required HSA for outpatient care. This is just ACA but original requirements enforced. Medicare is more efficient with its incoming money then private insurance, Medicare for those who want it, and it be the minimum required for people to buy into should be the obvious first step. Pretty sure that's pretty close to Dems current position.
We get taxed- it's just by companies instead of by the government. Your health insurance premium? It's a biweekly or monthly tax. Deductibles mind as well be a tax too. We're paying either way- the primary reason for bankruptcies in the US is medical debt
The tax rate is higher in Canada for sure, but here's the kicker... we spend MUCH less per capita on medical care than the US does, and have better outcomes. One way or another, you're going to pay for it.
I think one of the big obstacles to solving this is how massive the US is. I would like to see states experimenting with a system and improving on it, and then other states seeing what works and then following suit. Trying to convince the entire nation to move in a certain direction and then convince them on what incremental improvements to make is a recipe for the inefficiencies and disastrous compromises that our current system suffers from.
We already have a system for the whole US- Medicare. And? It's the health insurance plan with the highest satisfaction rating so it works better for people than private insurance plans. I would love to have Medicare for all
@@rayzerotI’m not trying to make a judgement on Medicare, but does having the highest satisfaction rating mean it has a high satisfaction rating? I honestly don’t know the statistic but the point I’m trying to make is that if we want systems comparable to other nations we should also be comparing satisfaction and results to those of other nations, not just our own. Now this still comes back to my initial observation about trying to convince the whole nation. Would you rather try to convince the entire US to adopt Medicare for all (convincing will cost time and money) and then get a watered down version for you and the nation to use, or try to convince just your state to adopt it (costing less money and time) and also get something with fewer compromises? And then you can use the success of your state to convince the rest of the nation to adopt it. Not to mention being able to fine tune Medicare for all at a smaller scale while it is still at the state level.
The size of the US is not relevant to this discussion. It's the massive polarization and completely dysfunctional political discourse in the US that leads to gridlock and the impossibility of "trying to convince the whole nation." If there's one thing Americans have become experts at, it's acting against their own best interests.
@@dfs-comedy I want to understand what you are saying. The corollary to your argument is that it is equally difficult for you to get your desired healthcare system for your state as it would be for the entire US. And that the political gridlock in your state is proportional to the country’s. Is that what you are saying? Or do you disagree with that statement?
@@josephnguyen3945 what I'm saying is this: The United States has a completely dysfunctional political system, which is why it's such an outlier amongst advanced countries with respect to its medical system. I do not live in the US, so talking about "my state" is not relevant.
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It is maddening that teeth are so often treated like luxury bones, with their care separated from other medical care...as if the health of our teeth and gums doesn't have any impact on the rest of our bodies. *sigh*
Having messed up teeth is an excellent social class filter. That's the point of separating it.
I know it's not the point of your post, but I'm calling my teeth "luxury bones" forever now.
Also eye care.
@@AkaiAzul Often Hearing too.
Well, a lot of it is historic, and caught up in class issues. Very early in the run of the PBS program "NOVA", there was an episode (I think it was actually uploaded recently to youtube) called "Strange Sleep" about the dawn of general anesthesia in the 1840s (a docudrama acted it says by medical and dental students and personnel) that gives some of the flavor.
I'm a dual Canadian-US citizen, have used both systems over the years and actively observed family (and visited ER's with them, including my own emergencies) in both places. I can only offer you my personal experience: I would never, ever go to the US for health care again. Period. It isn't that you can't find a good doctor or hospital in the US, you can find them. Its that the billing nightmare is beyond extraordinary, even with a healthy income and insurance. Its too messy, and much more likely to lack access to care because of it.
On the other hand, the issues of "quality" I hear about the Canadian system are largely unfounded and untrue. Do we have a family doctor shortage? Yes Canada does, but we still have a higher proportion of people with family docs than the US regardless of having a shortage. And you can still go to a hospital or walk-in clinic any time to receive medical services, regardless of that. Is it a problem? Yes it is. But its a 'better problem' to have, we need to train more family docs.
I could offer more experience and stories, but I assume most wouldn't have time to read, so I'll leave it there. I'd never go to the US for health care. Period. I am happy to live in Canada on the basis of health care.
My ex (American) REFUSED to move to the US (I had multiple very good job offers) because of her extended family's experiences with US healthcare and justice. Her mother believed that the US healthcare system stole six-figure amounts from her grandfather (and based on what I know I would agree). It certainly would not have happened in Canada.
And yet those who PROFIT from the system - including so-called medical professionals - continue to lie to Congress and the American people (who, courtesy of the myth of American "exceptionalism", buy into it wholeheartedly).
@@capnkirk5528I sympathize with the situation, and likewise I have more than enough personal experience to agree fully with what you're saying. Most people who have lived state-side have experienced the nightmare that is the American health 'system'. Its dysfunctional even when it works.
And I don't want to be totally one sided on the topic. Canada does have issues to tackle, it isn't perfect here. There are good and bad docs on BOTH sides of the border. There are good and bad hospitals on both sides. But its far easier to find good doctors and good hospitals and seek medical care in Canada simply because there are no 'networks' for insurance coverage. You are fully covered everywhere in your province. All doctors, all hospitals, all clinics. You make the choice. Despite some of our real and honest problems, like the family doc shortage, its an easier problem to handle here in Canada.
In the US, if you don't have the money, you don't have health care at all. That's a reality. Increasingly, it turns out people with insurance often can't afford procedures, especially chronic care. Cystic Fibrosis rings a bell. That requires a lifetime of doctor visits and care to maintain, you can't go without it. You can't skip treatment. Outcomes are much, much, much better in Canada for Cystic Fibrosis patients. Patients here live years longer than the American average, because you can't trust a private insurance company.
And that's the common problem: privatization is what doesn't work. These need to be publicly administered rights, not private privileges.
Lastly, Canada has world class institutions. You can get very high quality care here. If you have cancer, Princess Margaret Cancer hospital in Toronto is on par with MD Anderson in Houston, one of the best cancer hospitals in the US. I think people forget, private does not equate quality. So, I just can't reiterate enough: never would go to the US for medical care again. Ever.
You doubtless won't be surprised, that my medical life has become so much easier once I transitioned from private health insurance to Medicare. REAL Medicare, not that "advantage" crap.
@@StevenBornfeldI'm not sure how "real Medicare" compares to REAL healthcare like the NHS. But not to worry, the Republicans are going to take it away from you so NOBODY in the US can actually know how badly you're being screwed.
And Larry Fink is coming for your retirement.
You SHOULD be worried about that!
This! People in America talk about things like long wait times and high taxes like they are so much worse than what we currently have. Not only do we also have long wait times in certain circumstances as well as higher taxes than even some socialized systems, but we have the added problem of a healthcare system that can bankrupt you on a single bad day. Even for minor issues, navigating through the insurance and billing system is a nightmare that no one wants, especially when they aren't feeling well. If the only major problems we had were long wait times and higher taxes, that would be a massive improvement over the problems we currently have. Sure, those are things that need to be improved upon, and no system is perfect, but the US is so far behind when it comes to having a healthcare system that is accessible and efficient.
As an Australian I can tell you that most people I know find the American healthcare system bizarre and needlessly expensive.
My brother had a medical emergency soon after moving to Delaware. Because of a mixup with his insurance he ended up tens of thousands of dollars in debt. This absolutely could not have happened in Australia.
Or most anywhere else, for that matter.
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What I'm interested in is how all these systems cover long term illnesses (type 1 diabetes, child birth, disabilities, degenerative disease...). In France they're 100% covered regardless of your employment status because just Giving You Insulin (without copay or premiums or deductibles) means you're likely to not go to the ER and cost the community more.
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.❤😊
I have dual US/Euro citizenship and moved back to Europe 5 years ago. Healthcare here is like in the UK, zero costs to citizens. The wait times are fine, honestly, similar to regular appointments in the US. I recently became ill and have gone to the ER, specialist visits, tests, treatments, therapy, etc. It would have cost me thousands of dollars in the US even with insurance. I paid nothing here. I was just thinking about this today, how lucky I am to have universal healthcare now!
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.😊❤..
As somebody that works in the Singapore healthcare system, that was a very accurate and succint coverage of our healthcare model
in england, we have private healthcare as well, you'll just continue to pay the national insurance cost, but there's private hospitals, and private everything as well
surprised Japan wasn’t mentioned. It’s like a better version of France. Same basic concept, but you can go beyond an add on, you can get employer coverage, and get supplemental plans to pay your living expenses while you miss work due to illness, you can get personal cancer plans, personal full plans, multiple insurance to cover gaps, etc. ALSO, vision and dental AND holistic (massage, acupuncture, etc) are included in the basic Shakahouken (spelling?) that every resident gets.
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.😊❤..
I'll just add that the PBS system in Australia means that you only pay up to to a maxum $30 for prescription drugs
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.❤😊
Small correction/update: as of very recently, Canada introduced pharmacare coverage. Currently only contraception and diabetes meds & equipment are covered, but the legislation includes mechanisms for adding more to the plan in the future
,, plus dental is now covered for children and seniors without other coverage.
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.😊❤..
It's incredibly frustrating that the American left defaults to a single payer model as the ultimate goal where there are so many other models to choose from. Meanwhile the American right doesn't seem to have any coherent plan on healthcare reform at all. Our public discourse on healthcare reform is incredibly underdeveloped despite having been in the public eye for decades.
The healthcare systems in most other countries also have a much stronger bargaining position when negotiating prices with pharmaceutical and medical services companies. This leads to significantly lower prices on medicine, even when purchased out of pocket. Standardised pricing for blood work etc. also means your freedom of choice is focused on the doctors and hospitals, and not based on comparing wildly varying rates between them.
True. The federal government in Australia negotiates for drug prices and subsidises many of them. Cost of medication here is usually very low.
We also have community GPs, pathology and radiology under Medicare, which means subsidises or free exams in those settings (govt pays the private providers). That said there are still gap payments on many services, as the provider is free to set a price, but they must remain competitive so the government price kind of keeps a lid on things. It is getting worse though because government rebates are not keeping up with inflation at all (and in some cases the indexation was frozen for years and years).
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.😊❤..
I would be so exceptionally happy if we had single payer. Both as someone with no insurance and as a medical provider. Only having to worry about one system to credential with, submit claims to, and trouble shoot with would be incredible. Instead I have a huge spread of reimbursements, requirements, and systems.
Oh and to add i'm currently small and not providing insurance to my staff at this time. I want to but it's costly.
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.😊❤..
Should have covered Denmark's system as well -- another hybrid system of mostly govt. but allowing pvt insurance for certain sectors/issues.
I have lived in the US and Canada and interacted with both systems. One note is that depending on the province Canada also has differing degrees of private options similar to Australia. There's a lot said about the Canadian vs American system but one thing I'd like to note is that it seems like the paperwork and registration for things is just easier. In both BC and Quebec the process of getting into the health system and having care paid for just involves a lot less bother than dealing with the US health insurance exchanges and of course it's vastly cheaper. The biggest problem is lack of availability of family doctors. I would love to see an episode of the impact of having a family Dr vs walk in clinics on long term health outcomes and lifetime cost of care. Ie: if it is more expensive to provide a family doctor then is that cost recovered by preventing acute health issues that are more expensive to treat and have other social costs such as time out of work.
Likewise, I'm a dual citizen. Luckily, I've never had a problem finding a doctor. I came to Canada 10 years ago. I found a doc within a few weeks of calling various offices in most locations I've lived in. I just moved back to Toronto and got a new family doc in 2021, so it isn't impossible. But it does take a lot of phone calling and work, sure. But I don't think its any more difficult than having to stick to your US 'network' because here you call any doc office and ask. No limits makes it easier IMO.
There is a family doctor shortage, but the truth is, there is one in the US also. More Canadians have a family doc than Americans, its still true in 2024. You always have access to care in Canada by going to a number of health clinics, but its true having a family doc is preferred.
We do have problems in Canada, but as I often say, compared to the US we have 'better problems' to tackle. We can train more family docs with an education plan. But in the US, all that private bill pay extravagance hasn't provided for more family docs there. Its telling, it means privatization in health care doesn't work, IMO.
There are serious shortages of general practitioner doctors in much of the US
@@BTin416 good points and I really like how you put it: "in Canada we have better problems to tackle." It definitely feels that way.
@@scottabc72And that's for those who can AFFORD one in the first place.
This is also a major thing with the US welfare system. The US actually spends almost as much on welfare per person as Denmark does, they just get far less out of it. A big part is the excessive means testing which eats up a lot of the budget. It's simply more efficient to make welfare services universal and raise taxes on people that don't need them than trying to deny it to those people.
The US also has a massive number of programs that are all underfunded and not very effective and have a ton of overlap. Cutting out about half of it's programs and concentrating the funds in the remaining half would let the US get WAY more out of it.
Another way to save money is actually to raise the minimum wage and make sure GIG workers are included. After the elderly the two largest recipients of government welfare are children and after that the working poor. Welfare for the working poor is really just a corporate subsidy so that they don't have to pay a livable wage and it shouldn't exist. People who work more than 36 hours per day and have no significant disability or illness should not need any welfare. Increasing people's income also means the welfare spending on children can be less since their parents have more money. This saved money can then be directed towards other welfare like for the homeless or the terminally ill.
You can also do a lot with regulations like allowing the government to deal with the pharma companies as a single entity and to ban junk fees, do anti-trust enforcement to clamp down on price gauging. These would all significantly lower people's cost of living without the government needing to give them anything.
I don't think the problem is finding better models or even convincing the American public to try something new. I think the problem is political. The special interests are just too powerful and they won't allow any change.
Correct. People who run the numbers know, before and after running them, that single payer is superior
But are they stronger than my guillotine?
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The UK has been under-funding the NHS and private insurance has become more common among its citizens. I don't know any of the numbers, but I do know that ZombieCleo's dental work was covered under her private insurance with her NHS dentist.
£182 billion in 2022-23 is not under funded it’s over bloated and wasting money
@@rayhuckfield5517Googled numbers-
UK cost per capita- around 3k pounds
US- $14k.
You might want to re-calibrate.
@@rayhuckfield5517 Big number make confirmation bias go brrrrr. Good job.
Now look at where it was spent in comparison. Near £20bn was on Non-NHS health care. Over £30bn on procurement of private resources .Less than half was given to the actual healthcare professionals. It's fine to always read headlines but maybe do actual research not just confirmation bias to your own political beliefs.
I can't post you links or I would help you. But don't look at newspapers that only source themselves.
@@rayhuckfield5517If you totalled up the cost of any other country's healthcare spending you'd get a similarly dramatic number. It turns out keeping people healthy is pretty expensive, but the social and economic costs of not doing it are worse.
@@rayhuckfield5517 the UK spends around $5000 per person per year on healthcare. Germany spends around $6700. Norway spends $7200. The USA spends $10,000 per person per year. Bloated huh?
Before the tories started diverting NHS spending away from efficient public services and giving it to more expensive private contractors and gutting affiliated services like social care the UK had one of the most cost-effective healthcare systems in the world. We got about as much care out per dollar spent as any other country has been able to, and because of that our health outcomes were very creditable considering how little we spent compared to equivalent countries. But cost-effective socialized services don't make dividends for millionaires, so that system had to go
The USA has a health system that works fully as intended: to squeeze out the last cent from people who have no choice but to cough up that last cent if they want to live. Either because with treatment they can continue working, but have to cover insane costs, often putting them into debt. Or they DON'T get care, thus loosing their ability to work, thus loosing their jobs, thus loosing their employer dependent benefits of health insurance; or they simply die from the affliction. Great choices, right?
What I don't get is that this video didn't even touch on the oldest continually existing healthcare system, Germany's. It offers both statutory health insurance but also the choice of private health insurance (PHI). However you have to be willing and able to afford the much greater insurance fees for private health insurance. The break-even-point for income is at around 65k€ a year income as a single person. For any person with a spouse and/or kids an SHI will remain viable for much longer, as under SHI non-working spouses and kids are automatically co-insured for free. The German healthcare system includes very basic dental reconstruction, as well as a very basic visual aids (ie the cheapest frames and lenses with absolutely no additional features). Physiotherapy however is covered. Preventative care is part and parcel of the SHI system as the insurers recieve their share from the central pot of ALL SHI fees according to the number of customers they have. This means SHI want to prevent as many illnesses as possible while having the largest number of customers at the same time. PHI allows for doctors and hospitals to charge up to four times the price for SHI coverage, making them incentize PHI patients over SHI. Still over 80% of people in Germany choose SHI over PHI, which includes a large section of people that COULD choose PHI due to their financial situation.
In addition to that, the German government has set up rules and regulations for a panel from ALL insurers (both SHI and PHI) to negotiate with pharma companies as well as doctors and hospitals to regulate a standard price list. These include ALL treatments as well as ALL drug prices for generica. Specific brand drugs MAY be included IF the pharma companies agree to reasonable prices with the panel of insurers and doctors. This leads to equal power distribution for the negotiation instead of the horrible negotiation position of individual insurers having to negotiate with individual doctors and hospitals; or worse, even individual citizens trying to negotitate with these conglomerates. As such, the negotiation stance for both major participants, insurers and doctors vs pharma companies and hospitals, is brought to a level playing field. With the price list negotitated among these private sectors without any actual involvement of the government (they just set up the framework of the limits what's possible), reasonable costs will be negotitated that are CONSISTENT across the country. No checking for in-network, coverage, etc.
ALL insurers guarantee the coverage of the negotitated prices, and ALL doctors, hospitals, and pharma companies can caluclate with guaranteed prices as well.
However the typical red tape of Germany throws a spanner into the works, as far too much regulation is placed on individual doctors, either in practices or in hospitals to provide data on the individual patient to the insurance companies, and vice versa. That's where Germany's system suffers most.
There are only a handful of copays there are in Germany.
1. Generic prescription drugs in pharmacies: 5€ (or free), with brand type prescription drugs at 10€. There are however additives you may WANT to buy, which you will have to cover yourself. But even those don't exceed roughly 100€ per month. If they are medically NECESSARY however, you will again drop down to 5 or 10€ per prescription.
2. Dental healthcare: if you go beyond any of the minimal reconstruction into any part of 'beauty improvement' like professional cleaning, bleeching, etc, you have to cover these yourself. There are however supplemental insurances you can get to cover those costs, which usually are worth their low yearly costs.
3. Visual aids: if you want stylish frames and lenses with superior finishes or qualities like auto-darkening, anti-mirroring, etc, you have to cover these yourself. Again, additional supplemental insurances exist for that.
4. Hospital stays: to cover your food you will be charged 10€ per day, up to 240€ per YEAR of continuous hospital stay. That's it.
5. Any elective surgery (especially plastic surgery trying to 'improve' the natural state) that is not strictily medically necessary you will have to pay yourself (duh, obviously). However, reconstructive plastic surgery in case of amputation or damage IS covered 100%. Again, if you want special features on prosthetics, you might have to argue with your insurer what's medically necessary, and what is at best a style feature.
With all of that out of the way, Germany provides 100% coverage for ALL citizens in Germany. The government itsself has absolutely NO access to the insurance fees paid by either employers or employees. Thus, these ARE deducted from your pay check/wages automatically, but the government doesn't get their hands on it. Thus, these aren't technically taxes, but insurance fees.
But within this system, all SHI fees are collected into one pot, and distributed by a rather complex (and inefficient) system among all SHI companies. PHI goes directly to the respective PHI companies.
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Canada is starting to introduce drug coverage.
One glaring issue is that the US charges insane rates for health care. In Canada the government pays under $50 for almost any type of X-ray including a mammogram.
In the UK, a heart attack may cost the government $10k.
How much do these things cost in the US?
A public health care system isn’t geared for profit.
Starting this year Canada is phasing dental care. Start for people earning less than $95K/ year it will expand over the next couple of years.
Japan which has the highest life expectancy in the world, is also worth a look. It offers national health for everyone and covers 70% of everything including dental. it also caps maximum copays so covers catastrophic care. Private insurance usually through insurance is available. hospitals are a mix of public private and charitable. Note charitable hospitals are really charities, often offering free care, not corporations pretending to be charities while paying CEOs millions in salary and not paying employees enough to use the charitable car. There is even fully private care that is not covered by national health. The only one I know of offers prescription refills over the web, it is so efficient the patients still pay less than the usual 30% copay. Also municipalities will offer free annual checkups on your birth month.
I think it would also be worth pointing out that the US spends more of its GDP on health care yet still has the lowest life expectancy in the G7. Even the life expectancies in the richest counties only match other G7 countries' life expectancies.
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America should be ashamed of its healthcare system.
It's telling they're PROUD of it.
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Just FYI that both drug coverage and dental care in Canada are having regulatory overhauls moving towards single payer for a chunk of coverage. It will be interesting to see how those changes shape up over the next couple years, and it may be worth revisiting the comparisons at that point.
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And there are other ways. In Chile, there's a national public system called Fonasa, which everybody can belong to. You pay a percentage of your salary or pension, and you have full access; it is tiered according to your income, but you aren't denied attention if your income is low or nonexistent - you can even get transplants. Yet, it is chronically underfunded and very slow - the dictatorship tried to dismantle it in favor of private healthcare, it failed, but it damaged it.
In consequence, there are private health insurance companies, called Isapres. They pretty much work like American companies, with all the good (way faster than Fonasa, more amenities) and the bad (expensive, confuse, they don't cover everything). They are not tied to people's jobs, so, as long as you have the required income level, you keep your plan.
Finally, there's purely private healthcare. You go wherever you like and can afford, pay cash, and that's it. That's mostly the way of things like cosmetic plastic surgery. On the other hand, if you have a life-threatening emergency, you go to any public clinic or hospital and get care, even if you are not registered in Fonasa or are an undocumented immigrant.
Time for the USA to learn from Chile too?
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Medicare in Canada doesn't cover dental care. The government has just recently introduced dental coverage, but it's limited to kids and low-income individuals.
Canada's system is very good at preventing bankruptcy, routine scanning for cancer, etc. and for emergencies, but for less-serious care the system is in deep trouble. There's a huge shortage of physicians and wait times are very long.
There is a quite similar setup and situation in Australia. Private insurance tbh isn't so much for additional care, but it's good for skipping the queue for non-urgent care. The downside is the cost is increasingly absurd and so fewer and fewer people are opting for it; putting more pressure on the public system, which is already far behind on elective waitlists, especially after covid.
Great overview of the different systems. Thank you!
Frenchie here, I'll add that since 2016, employers are required to provide insurance and employees can only opt out if they prove they have a personal insurance on the side. (The cost is shared between the employer and the employee)
Congress keeps insurance companies from selling insurance across state lines, driving up the cost of insurance because of duplicative administrative costs.
Oh its not the congress that drew the line, congress only enforced the line, the companies already marked their fiefdoms long before.
It's not Congress stopping it, per se. It's the health industry lobbyists paying politicians to keep it that way. The system won't ever work for the people while businesses can buy votes
Which I wish would stop. We are the *United* Sates, not the Good Neighbors States. If we're doing private health care, companies should be able to sell nation wide. And if you have health care in one state, it should apply to any state you're in, not just the state you reside in. People travel. They shouldn't have to worry about health coverage if they happen to get sick or injured outside their home state!
State contract provides for regulation. If you get cheated, you have the state to go.
@@Tashishi0the problem is a lot of states aren't good neighbors when it comes to public health or supporting their citizens. In CA, having an HSA is actually double taxes instead of being an investment. But our insurance is forced to have the same coverage if you retire here and move to a different state.
Why are dentistry and ophthalmology not part of "medical coverage"? Are eyes and teeth NOT part of the human body? Are you less likely to die or be disabled by a serious untreated eye or tooth problems? If you have an emergency involving your teeth over the weekend, is it ok to just send people home with tylenol and leave them to schedule an appointment days later and hope things are treatable? If it's a problem with a body part, it a MEDICAL issue and should be part of medical coverage and emergency services.
I've never understood that, either.
@@Tashishi0People can die from tooth/gum infections because they get sent home from the ER with tylenol instead of getting care. People can go blind unnecessarily because they get sent home and have to wait instead of getting emergency treatment when worrying eye symptoms manifest. All because teeth/gums and eyes are "special" and ERs don't have people for that.
I know. I meant I never understood why they are covered separately, outside of general medical coverage. Sorry that wasn't clear.@@void2258
"days later" try MONTHS later...
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Socialize it all!! I'm poor, so anything that is free at point of entry and likely to cost me nothing afterwards means I will actually go to a doctor before I absolutely have to because I can't stop bleeding or something. Also, I don't know why so many systems separate eye care and dental from the main body of healthcare. Last I checked, all of those things were part of my body, and a big chunk of the money I've had to spend on healthcare over the years has actually been for those two things. My glasses ain't just for style. I need them to actually see. I need my teeth so I can eat. It is all healthcare! No more tiered systems! "Willing to pay more" is just means, in practice, "those who can pay more." In a country with as much poverty and inequality as the US, that cannot be overstated.
In the UK, teeth and eye care are free if you have a sufficiently low income, are a child or pensioner. If your eyesight is bad enough, even as an adult.
Dentists are difficult to get hold of though.
The NHS has been gutted over the last 15/20 years. It's very sad, infuriating and frightening.
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What is stopping the US from using the Japanese system? I loved it when I studied abroad there. Insurance that's universally available if you want it, completely reliable and predictable, and reasonably priced.
Corporate lobbyists and delusional right wingers
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As a Scottish resident, it's the UK that has the NHS, not just England! (Although the nations do vary in their provision a tiny bit)
To me it's as simple as the cost for US healthcare is double any other developed country for worse outcomes. For what we spend on our premiums in the existing system, we could get substantially better coverage under single payer by eliminating the 20%+ profit margin middleman plus millions of highly paid white collar workers that do nothing but create/manage artificial complexity (at health systems, in the insurance companies, and at every employer in America).
Medicare is an unofficial designation used to refer to the publicly funded single-payer healthcare system of Canada
Addendum: Starting last year, Canada (Alberta at least) is already social pay but private clinics/doctors... and moving towards much-more-private clinics. The health care is exactly the same, billing the same to the government - but they operate on a subscription model (several thousand dollars/year/person) for 'member' access to the clinic to keep higher availability to reduce wait times for those willing to pay. Sadly, it doesn't take a math genius to see that a) there is a huge profit margin in that model incongruent with equitable access for the less fortunate, and b) once sufficient clinics move to that model, there won't be enough resources for everyone else. The traditional system clinics will be overwhelmed, burned out, and shut down - leaving only the paid option. Wait times for many procedures/specialists are already in the months-to-years range. Letting people pay to skip that queue will only make it worse for people who can't pay. It's not like it's building entirely new clinics/attracting new specialists - it's converting existing ones.
BC has had two developments in this area:
1. A constitutional case was set aside by the BC court of appeal preventing physicians from operating both for the public and the private systems (the " Cambie clinic" case); and
2. We've moved to paying family physicians a set salary per year instead of a fee for service model. This has helped young GPs go into family medicine instead of becoming hospitalists.
Canada has had history with public ally funded but privately delivered healthcare service. The Doctor strike of 1960s in Saskatchewan can be thanked for this fee for service model. We have today. Most family clinics are privately run but bill a medical service branch of the provincial government for services provided. Now these private clinics like the one in Calgary recently have caused the Alberta government to be threatened the by federal government to withhold money from the Canada health transfer to the province until these private clinics stop charging patients for typical expenses paid for but the government insurance plan. So yes there is a lot of publicly funded and privately delivered healthcare in Canada. Though it hasn’t all well worked out right Alberta? Alberta Health Services has signed a memorandum of understanding with the ownership of Dynalife, which will see the private provider transfer all of its staff, operations and physical locations in the province to Alberta Precision Labs by the end of 2023. So glad to see private labs worked out sooo well for Canada.
This is a quality video that does a good job of explaining overviews. Thanks. I do have concern with the premise, however. As it relates to goals of a healthcare system, quality of care was noticeably absent. What is the logic behind its omission? Anecdotally, most Canadians I know do not have access to reasonable care due to wait times and lack of actual coverage for anything beyond routine. Their best option is typically to purchase traveler's insurance and come to the United States for higher quality care. Thanks.
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- **Switzerland**: Utilizes a model of private insurance regulated tightly by the government. Everyone is required to have private insurance, with subsidies available for low-income individuals. Out-of-pocket expenses are relatively high, but catastrophic coverage ensures everyone has some level of coverage.
- **Singapore**: Combines government-provided catastrophic coverage with individual responsibility for outpatient care. Mandatory health savings accounts encourage prudent spending, and tiered hospital care allows for choice based on affordability.
- **Canada**: Operates under a single-payer system funded mostly by general taxation. Each province or territory manages its own Medicare system, covering medically necessary services provided by hospitals and physicians. However, it does not include coverage for prescription drugs, eye care, or dentistry for adults.
- **Australia**: Offers a dual healthcare system where patients can opt for the public system or choose private insurance. The public system, Medicare, covers most costs of hospital and physician services, while private insurance provides access to private hospitals and specialists, as well as additional services not covered by Medicare.
- **New Zealand**: Similar to Australia's model but with a stronger focus on community-based care and public health initiatives. The public system provides universal coverage for a range of services, including hospital care, primary care, prescription drugs, mental health care, and disability support services. Private insurance plays a supplementary role, offering faster access to elective surgery and covering services not funded by the public system.
- **France**: Offers a system where the public sector sets a baseline for healthcare, but individuals are encouraged to spend more if they desire through supplemental insurance. The public system covers most costs for hospital, physician, and long-term care, while supplemental insurance helps with out-of-pocket costs and covers additional services like dental, hearing, and vision care.
- **England (NHS)**: Provides healthcare to all residents without any cost at the point of care through the National Health Service (NHS). The NHS covers hospital, physician, and mental health care, eliminating financial barriers to care. However, there may be trade-offs in terms of wait times and quality of care.
Each system has its unique features, including the extent of government involvement, financing mechanisms, coverage of services, and degree of individual responsibility for healthcare costs.
The German healthcare system is characterized by its dual public-private structure and emphasis on universal coverage. Here's how it compares to the systems mentioned in the transcript:
- **Dual System**: Germany operates a dual healthcare system consisting of statutory health insurance (SHI) and private health insurance (PHI). SHI covers around 90% of the population, primarily employees below a certain income threshold, while PHI covers higher-income earners and certain professionals.
- **Universal Coverage**: The German system achieves nearly universal coverage, with compulsory health insurance for most residents. SHI provides comprehensive coverage for medical treatments, including hospital care, physician visits, prescription drugs, and preventive services.
- **Funding Mechanism**: SHI is financed through a combination of contributions from employers and employees based on income, while PHI premiums are risk-adjusted based on individual health risk factors and income.
- **Quality and Access**: Germany is known for its high-quality healthcare services and relatively short wait times for non-emergency treatments. Patients typically have access to a wide range of medical specialists and hospitals.
- **Choice**: Patients in Germany have the freedom to choose their own physicians and specialists, and they can switch between insurance providers relatively easily.
- **Cost Sharing**: While patients may face modest co-payments for certain services under SHI, the overall cost-sharing burden is relatively low compared to some other systems. PHI members may have higher premiums but often enjoy additional benefits and faster access to care.
Overall, the German healthcare system combines elements of social insurance with private competition, resulting in comprehensive coverage, high-quality care, and patient choice.
Compared to the healthcare systems mentioned in the transcript, the U.S. healthcare system differs significantly in several key aspects:
- **Fragmented System**: Unlike many other countries with universal or near-universal coverage, the U.S. healthcare system is highly fragmented. It lacks a unified system for providing healthcare to all residents.
- **Employer-Based Insurance**: A significant portion of Americans receives health insurance through their employers. This system ties coverage to employment status, limiting choice for individuals and potentially leaving those without stable jobs or benefits without coverage.
- **Private Insurance Dominance**: The U.S. relies heavily on private health insurance, with multiple private insurers competing in the market. This can lead to variations in coverage, benefits, and costs, resulting in disparities in access to care.
- **High Costs and Out-of-Pocket Expenses**: Healthcare costs in the U.S. are among the highest globally. Even with insurance, many Americans face substantial out-of-pocket expenses, including deductibles, co-payments, and co-insurance, which can deter individuals from seeking necessary care.
- **Coverage Gaps and Inequities**: Despite the presence of government programs like Medicare and Medicaid, millions of Americans remain uninsured or underinsured, leading to disparities in access to care based on income, employment status, and geography.
- **Complexity and Administrative Burden**: The U.S. healthcare system is notorious for its complexity and administrative burden. Patients, providers, and insurers often navigate a maze of regulations, paperwork, and billing processes, which can increase administrative costs and inefficiencies.
- **Varied Quality and Outcomes**: While the U.S. boasts world-renowned medical facilities and providers, healthcare quality and outcomes vary widely across the country. Disparities in access to care, socioeconomic factors, and systemic inefficiencies contribute to differences in health outcomes among Americans.
Overall, the U.S. healthcare system is characterized by its complexity, high costs, and inequities in access to care, contrasting with the more streamlined and universal approaches adopted by many other countries.
Thank you for a nuanced discussion
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"Medicare" is repeated so often because it's not exactly a creative name. Literally "Medical Care Insurance" becomes "Medicare Insurance"
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"longer wait times" for countries with socialized health insurance. Uh huh. Haven't been here in the US waiting 6 months to hear back from my allergist.
I fear that your info on Canada is outdated. There are a LOT of private systems and insurances in Canada now. :-(
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I'm in my 30s and have realized that it would probably be wise to plan to live in another country for my retirement...now I just need to pick which one!
The preferred systems are *Canada, UK & Taiwan.* Either one of these models will be a game changer for the better for people like myself here in the United States 😉👍💯
When considering replacements I think we need to suit them to the strengths and weaknesses of the American government. We have hyper complicated system overseen by a government that at all levels is demonstrably bad at detailed regulations, every few months there is another story about how providers are ripping off Medicare. I therefore favor single payer or an NHS style system with the simplest possible design.
Feel like Singapore's system would be the easiest sell. It has a fairly strong element of the "bootstraps, personal responsibility, rugged individualism" thing that a lot of Americans get their rocks off to.
Though really, the group most opposed to any change are the insurance companies themselves. And since the US government is almost wholly captured by corporate interests, and since Americans are perfectly happy to keep letting bad systems continue forever, uh, I see no change coming. Ever.
Canada has a private health care system... it's called traveling south to the US. You can purchase travellers insurance in Canada and then get the services you want in the US (whatever your travellers insurance covers). Not a great solution but it is a way to get faster services than in Canada if you want to pay a crap ton more to do so.
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Yes they do have it right for the most part. The failing lies in that like the United States corporations and wealth aren't taxed to what they should be. The casual observer who's thought about relocating from the US to one of these countries is through US corporate indicrination through the government, see the higher taxes in these countries as too much not realizing they are out of pocket far more when it comes to health-care and other to the public services these countries provide to everyone in residence.
We need to take money out of HEALTHCARE! People should have a RIGHT to FREE and affordable HEALTHCARE!
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The Medicade system in the US is a mess and at least in my state seems to be designed to keep people in low paying jobs because if you go over a certain amount you get kicked off. I was working 20 hours a week as a library assistant and the moment I went from $16 an hour to $17 I was kicked off. I was lucky in that I was engaged and was able to get married and on my husband's insurance or I wouldn't have been able to afford medical care. I was also living with my parents unable to move out due to my job and the difficulty getting full time librarian work even with a degree and experience.
The NHS in Britain got short shrift here. It does currently have problems, as Conservatives are actively trying to undermine it and are thus under-funding it. Their system is immensely popular and if funded, functions extremely well. BTW, the US could have an extremely well funded NHS for around 60% of what we currently spend on the WORST health care system in the developed world.
Let's not forget the toxic cycle of abuse the US system prompts. If your spouse is abusive, but their job has good benefits, you might stay just to ensure you or your child remains covered. The same goes for abusive employers, or even just regular employers where switching for a better job opportunity can leave you without care, either bc the new job doesn't have as good of care, or you'll need to switch doctors due to the current PCP being out of network. How many people would love to start their own business, but don't bc they can't afford to fund their own private coverage AND the start up costs to make a new business succeed.
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The examples presented are all from first world countries but even many third world countries have public health systems where you'd have a better experience than if you were an american of median income. The American health care system is just perverse, all it cares is about profits, not the patients who sees as clients. Healthcare is more than a "service", it is a human right.
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Employer provided healthcare is not good in any case I've heard of, outside of the c-suite at least. Plus it chains you to your employer. Can't quit or you lose your health coverage.
Plus plus that's only for jobs that charge you for healthcare, I've had a few jobs keep me at 2 hours under the requirement to provide benefits.
Plus plus plus it's a barrier to small businesses.
Plus PPP it's more expensive overall. All that admin work those HR departments have to do, plus the lobbyists I guess you'd call them who sell the insurance to the companies. Add in the cost to the employee for the overpriced care, then the copays, then the deductibles... it sucks.
Pure single payer, or good public option baseline with strongly regulated addons is what we need.
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As long as we get the medication and treatments we want. Let's not give up quality of care. Don't pass universal healthcare and just offer low quality medications and dangerous surgeries that are not needed. Give us the same care the wealthy get. Ibprofin and Tylenol ain't going to cut it. We want quality of life.
It’s worth noting that Australia also has tax rebates for people over the age of 31 for basic private hospital cover. Due to issues with poor regulations of what insurance can charge for cover (albeit 100,000 times better regulated than the USA), some people won’t bother even if they could afford it. Personally, I only save about $100 in tax by having private insurance with the scheme. But I do it because then I have backup
The major problem is the huge out of pocket costs four private cover in Australia that mean that those who have often don’t use it when they need it because they don’t have a spare $5000 or more (depending on the procedure) out of pocket for the surgeon and anaesthetist fees that are over and above what the insurance company will pay
That said, when you do come into a bit of cash it is helpful - I got a lump payment that will probably never happen again and skipped a 3+ year queue for straightening my nose to breathe better (aka septoplasty)
It’s got big problems, and our public waitlists can be obscenely long. But the standard of care is high and most people won’t lose their house or fuck their overall credit score for getting sick
Can we also discuss how much these other countries pay in taxes to fund these government sponsored programs?
I'd also like to see you go after the companies like United Healthcare that are buying up hospitals and ambulance services so that they control the *entire* healthcare stream, not just insurance, thereby allowing them to charge exorbitant amounts at any stage. (See Dr. Glaucomflecken's series from last October if you don't know about this.)
I 100% agree that the US healthcare and insurance system needs reformed, but it is an even more complex issue than indicated in this video.
The amount in taxes to fund these services are often not much more or even less than our current taxes combined with our healthcare cost
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.❤😊
Couple clarifications for Canada. With Canada provinces(sub national government) have exclusive jurisdiction over health care delivery. The federal governments role is more pharmaceutical manufacturing regulation and control. Medical device and drug reviews(like the US FDA) and health research. Dental care, optical, prescription, physical therapy, Are not typically covered by the provincial health insurance plan. Usually people have work coverage for these or private coverage to access these other primary are services. There is recently the federal government Canada dental plan, which has income requirements in order to access. The federal governments role of setting the standard of healthcare has more to do with the federal government’s financial power than its own intrinsic jurisdiction. The federal government transfers money to each province with the expectation healthcare is publicly delivered. Private clinics, no federal money hence they have the power to set health policy as it typically has more money than provinces because the federal government can directly or indirectly tax individuals while provinces can only conduct direct taxations to residents. To sum up provinces in today’s political climate would rather not have this system and politically would prefer the federal government to step aside when it comes to healthcare system.
In México there is a mixed system where a very slow public hospitals take care for workers with their families plus women and children and while supported by prívate hospitals and services the public hospitals can't or won't provide. Self-employed and jobless adult men have issues with access.
The most annoying myth in these comparisons is the long waiting lists. Sure, in single payer systems you can end up waiting a long time for a low priority operation, but everyone will get hep! In the US system the wait is shorter for those who can afford it, everyone else ends up crippled on welfare, homeless or dead.
I would appreciate if Congress would be open to a more efficient solution ... but Congress.
one of the problems with us medicare is that the participants are ALL seniors who will require far more medical services than the young and middle aged. this is why it cost so much. obamacare was an attempt to spread the payer base but politically it was a nightmare. the young don't want to pay for something that they generally don't need to use
This is exactly why it should be mandatory. People (especially North Americans) don't want to pay for something they don't need, but paying for someone else's care is exactly how we create a system where people who otherwise can't afford their treatment can still get it. If we wanna be all in this together, you're statistically going to have to put in more than you get out of it.
Not to mention that most single payer or hybrid models use some form of health technology assessment (at least for the single payer component) to establish the cost effectiveness and value of interventions and services (relative to existing options) to ensure care represents value for the invested resources.
What Ithink you miss about Australia (and perhaps other systems) is the significant bias towards prevention/early diagnosis of illnesses. In addition to general health, most diagnostcs (pathology, x-rays, etc.) are free without delay, as a government-pushed screenings for common illnesses such as breast cancer for women and bowel cancer for all at appropriate ages. It's only the more exepsnive/exotic diagnostics (CT, MRI, etc.) that tend to have a - relatively modest - copayment element and even these can be obtained for free if you are willing to wait a bit (or if urgently requrired/done in a public hospital).
Our system isn't perfect, but it is pretty well balanced and the focus on prevention/early detecion is one of the reasons that Australians are so long-lived.
I would question your number of 33% of Australians having private insurance. Given the tax incetives for having it (or more properly the tax penalties for not having it) which make it effectively free by the time you hit the median salary (and given kids are overed under their parents' plans until 25) I suspect the percentage of people covered is much higher.
It's not higher than 33% I'd guess due to cost. And it's decreasing in recent years.
The tax penalties only kick in for singles at $97k and families at $194k. This is far above the median, and even above average, especially for families.
Switzerland is the only one we need to avoid. It's still too expensive
I like Switzerland! I wonder what the Swiss think about it.
It should be noted not all veterans qualify for VA care. You must have a qualified injury.
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.❤😊
No, there are not multiple choices in the US. The only choices we have are the ones that Republicans won't throw a colossal temper tantrum about.
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.❤😊
The problem is always the imminent threat of ... Socialism.
There are healthcare systems, and there are healthcare systems...and then there's what we have, which is pandemonium. I was the beneficiary in the past week of some of the best that U.S. medicine has to offer--a robotic mitral valve repair. And then, for the masses, too often no care at all. When we value the lives of those less fortunate, and health care is considered a right and not a privilege, things may get better.
Germany’s system is a solid option as well.
And that’s the problem right there the word “socialization”. These idiots love to just say ‘oh it’s socialism’.
I’d love to know where you think Indian Health Services in the US lands in this? I’m Native American and part of a federally recognized tribe so I get some benefit from it (it’s a legal patchwork of its own) and wondered how it stacks up to the other systems in the US and the world
Somewhere between absolutely horrible and not great. Talequah has done wonders throughout and since the pandemic and and the new hospital gives me an awful lot of hope and pride.
But as a whole it's hey system that at a bare minimum seems disinterested in raising the average lifespan of the people it's supposed to service.
"What we're willing to trade" lobbies...
We could make a world health organization that keeps all people insured, so all people share the cost of insurance.
healthcare is expensive because insurance exists, as well as government meddling.
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.❤😊
Let’s take a page from Canada, and make it so everyone gets care for free, both preventative, and catastrophic. But you pay for your place in line. So if you only have $400, you wait six months for the ER. But if you have $20,000, then your hemorrhoid surgery takes precedence over a heart attack.
The Singapore system might be the best for Americans, since it destroys the argument of unfairness in paying the bills of an irresponsible person.
Can I interest you in Medicare? Perhaps Medicare? We also have Medicare. If you’re looking for something different, we also have Social Security.
Lol yup it was "non profit base insurance" all the way down. Except for one required HSA for outpatient. We have that it's called Medicare.
Medicare All The Way Down
Medicare has the highest satisfaction rating of any health insurance in the US so...
Where's Japan?
since when is single payer considered an "Extreme"? that's how you know american healthcare is pathetic
Yup
It's one of two extremes. The other extreme is completely unregulated free market. ¯\_(ツ)_/¯
It kind of is the extreme. Healthcare has to be paid for, and the most extreme version ar one end is the government pays for it all. There isn't really anywhere to go further in that direction.
It's not extreme ideologically really, but it is in terms of options for systems.
No to the research on how well these systems work?
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.❤😊
I see videos like this and my heart goes out to all the for-profit insurance CEOs of the world. Why, I bet they're hardly even multimillionaires, and will *never* make a billion. How can they afford yachts, private trips to space, or half-baked transit solutions to avoid interacting with the poor? These other countries could stand to learn a lot from the good old U S of A about how best to treat their wealthiest citizens. 😢
For the denser commenters, the above was sarcasm.
You'd be surprised (or maybe you wouldn't be) how much money private insurers make in Australia even with our system.
Of course you are correct that US is on another level 😕
I'm actually quite disappointed in this video. The summery of the English healthcare system is not that accurate. You say "without any cost at the point of care" but that's not strictly true.
1. Dental care comes with an out of pocket charge for most people (subsidised, but can still be 100s of £s for certain procedures). Only dental checkups are free.
2. Prescription medicine is currently £9.65 per item prescribed. Certain medicines are free for certain conditions but most things are not covered.
3. Eye tests are charged in England for most people under 60 y/o.
4. Unlike England, the Scottish, Welsh and Northern Irish NHS provide all prescriptions for free.
Some people who are very low income and/or receiving benefits, and those with some chronic health conditions (also pregnancy) can have prescription and dental charges waived. However there are many English people who are not covered who struggle to pay for prescription medicine and sometimes choose to skip taking certain medications. £9.65 for antibiotics may mean they can't afford to eat that week.
Im sure you're right about UK health care issues but compared to the disaster that most Americans deal with, it basically can be summarized as 'free'
Compared to pretty much everywhere else, this is basically free. Of course it's not entirely free, fair enough, but the OOP costs are tiny in comparison to even other socialised systems.
The downside is the wait times, risk of escalated emergencies, and driving your healthcare staff into the ground (I'm an aussie healthcare worker who works with several expats, they are glad to get some sleep here!)
Why should we pick _one_ of these other systems? How about looking for the best parts of each one and combining those into our own?
That means less profit. So its not gonna happen.
"why should we pick one of these other systems"
Because every single one of them is better than what we have now. Any one of them would be an improvement.
@@Jay-ho9iono, I want my health care dollars to pay the salaries of lawyers and statisticians whose job it is to make sure that the insurance company avoids footing bills, even by those who pay and thought that they were covered.
It’s the American way
Canada is moving in a different direction to privatize the system and restrict access. In Ontario, almost 1/3 of the population no longer has access to doctors.
And practically every Canadian that works for a living hates it. And wants it to go back to what it was.
i love your channel - sadly i belief you are wrong in the assumptions: the goal of the American healthcare industry is to maximise profits, not to provide healthcare services. And this is a cultural and political difference between the US and most of the world. Every country has issues with their healthcare system, costs and efficiency are a problem everywhere. What makes the US unique is the low effectiveness of the system for patients - but it might be the most effective system for the industry to generate revenue.
So in order to "fix" the American healthcare system, you need to "fix" the culture first; the core beliefs in the US seems to be closely aligned with the "Rules of Acquisition" from a certain fictional alien culture. Fix the culture and the system will adjust itself. From the outside it seems the most toxic belief is that being poor is a sin against god.
I can't speak for everyone in the US, but the people I know who are the most opposed to government involvement in healthcare are people who are convinced everything the government does is worse than something a private company does and that the fed is much scarier than corporate fat cats. They think that it will make everything even more expensive somehow because it'd be paid for by taxes.
When the truth is that the current model of for profit not for patients is driving up costs. I think that a for profit model is the problem, they think that government regulation is the problem.
You kind of glossed over the UK it’s actually more complex.
The NHS covers most things however prescriptions are charged at a flat rate per item unless you’re exempt
NHS dental car is charged by procedure unless you’re exempt. To be exempt from dental charges you would be well below the poverty line.
Eye care is different again. Your eye test is covered by the NHS and is charged unless you’re exempt. NHS glasses are very basic and almost everybody pays for better frames and lenses. This can cost many hundreds of pounds for varyfocal lenses, coatings such as scratch resist and anti glare and frames by supposed designers or big name brands. My sunglasses were pennies shy of £700.00 as I have a condition where I need to block side ingress of light.
Many companies include private medical care in their remunerations. This is basically so their staff are off sick for less time.
A number of people in the UK pay medical insurance for private health care predominantly so they don’t have to wait.
The NHS is a fantastic service and overall the quality of care is excellent. The waiting lists are an issue however for time critical illness such as suspected cancer there is a standard where you are seen within weeks.
I hope this gives non UK residents a better idea of the complexities involved in Uk healthcare
This seems well intentioned and it covers a bunch of alternative approaches, but it assumes from the beginning that "insurance" is the right model. I disagree. I want to buy health care the way I buy clothes and cars ... I decide what I need, compare styles and prices and pick what works for me. The insurance industry does everything in its power to make sure that I can't do this.
Another key goal: a system that incentivizes health care providers to constrain the skyrocketing cost of health care. A subscription (prepaid) model with “hospital doctor groups” competing for subscribers (we the people) can accomplish this. Subscribers pay a monthly fee and in return the hospital provides any health care required (minus a small per visit charge to discourage hypochondria). Doctors are paid a salary by their hospital, and don’t work on a fee-for-service basis. Competition between the hospitals in a given region will make hospitals and doctors prioritize efficiency and cost reduction.
This is how a lot of hospital systems already operate and it fosters the exact opposite of quality care. Bottom line padding bureaucrats and bean counters cut costs by overburdening staff, reducing equipment quality to a comical degree, and incentivize doctors to churn through as many patients as possible while maximizing "satisfaction scores" and following asinine "hospital protocols". This means that the hospital turns into a money printing machine where people get to go, order things like it's a menu, and leave "satisfied" with what can only be called shameful medicine. The problem with your idea, ultimately, is that healthcare in the US can't be fixed until administrators are booted from leadership positions.
@@tdawg281 it’s not “how a lot of hospitals already operate.” There are no subscription-model hospitals in the US, and obviously there is also no competition between subscription-model hospitals for subscribers. That competition is the way to constrain skyrocketing costs and maximize quality care. Our current fee-for-service model is what has made the US the world’s most expensive health care system and low quality at the same time.
Yes, prioritizing efficiency and cost reduction... by de-prioritizing quality of care.
Health care is a human right, not a business.
@@dfs-comedy the wildly escalating cost of healthcare makes it unaffordable for many people (bankrupting many) and it means the government can’t afford to pay for healthcare for as many poor people as it could if the cost wasn’t out of control. Cost is a critical issue for healthcare.
@@tdawg281 Incorrect. There are no hospitals in the US run on a subscription basis. And obviously we aren’t benefiting from competition between multiple subscription based hospitals in one city.
in the united states a rich persons dog is more likely to get cancer treatment than a poor person. sorry jesus. 🤷
So everything you listed is pretty much Medicare is required in one form or another. Only exception is a required HSA for outpatient care. This is just ACA but original requirements enforced. Medicare is more efficient with its incoming money then private insurance, Medicare for those who want it, and it be the minimum required for people to buy into should be the obvious first step. Pretty sure that's pretty close to Dems current position.
"Promosm" 🌟
This is the most obvious and futile content. What abusive lover can learn from healthy relationships! The US is F'ed
Hmm. Sounds like you hate America.... (sarcasm)
No comment or details whatsoever about the tax rate in other countries vs USA?
We get taxed- it's just by companies instead of by the government. Your health insurance premium? It's a biweekly or monthly tax. Deductibles mind as well be a tax too. We're paying either way- the primary reason for bankruptcies in the US is medical debt
The tax rate is higher in Canada for sure, but here's the kicker... we spend MUCH less per capita on medical care than the US does, and have better outcomes. One way or another, you're going to pay for it.
The tax payed for health care in single payer countries is very small compared to health insurance costs in the US
I think one of the big obstacles to solving this is how massive the US is. I would like to see states experimenting with a system and improving on it, and then other states seeing what works and then following suit. Trying to convince the entire nation to move in a certain direction and then convince them on what incremental improvements to make is a recipe for the inefficiencies and disastrous compromises that our current system suffers from.
We already have a system for the whole US- Medicare. And? It's the health insurance plan with the highest satisfaction rating so it works better for people than private insurance plans. I would love to have Medicare for all
@@rayzerotI’m not trying to make a judgement on Medicare, but does having the highest satisfaction rating mean it has a high satisfaction rating? I honestly don’t know the statistic but the point I’m trying to make is that if we want systems comparable to other nations we should also be comparing satisfaction and results to those of other nations, not just our own.
Now this still comes back to my initial observation about trying to convince the whole nation. Would you rather try to convince the entire US to adopt Medicare for all (convincing will cost time and money) and then get a watered down version for you and the nation to use, or try to convince just your state to adopt it (costing less money and time) and also get something with fewer compromises? And then you can use the success of your state to convince the rest of the nation to adopt it. Not to mention being able to fine tune Medicare for all at a smaller scale while it is still at the state level.
The size of the US is not relevant to this discussion. It's the massive polarization and completely dysfunctional political discourse in the US that leads to gridlock and the impossibility of "trying to convince the whole nation."
If there's one thing Americans have become experts at, it's acting against their own best interests.
@@dfs-comedy I want to understand what you are saying. The corollary to your argument is that it is equally difficult for you to get your desired healthcare system for your state as it would be for the entire US. And that the political gridlock in your state is proportional to the country’s. Is that what you are saying? Or do you disagree with that statement?
@@josephnguyen3945 what I'm saying is this: The United States has a completely dysfunctional political system, which is why it's such an outlier amongst advanced countries with respect to its medical system.
I do not live in the US, so talking about "my state" is not relevant.