Decline

[IdleRich]

was talking to a mate about this the other day so it's in the air at the moment. gut feeling from day to day experience is that this is right and that our collective imagination about the UK being a very rich country is a bit out of date. still a class place and probably overall nicer than the US though.

Yeah and we compare it to the US which is also not as rich as it was and so we don't grasp the full scale of the decline. You've got people with no teeth living in horrible conditions, eating shit and unable to afford to go to a doctor if they get ill - and still completely convinced that every single aspect of their life is better than that of every single person in Sweden or Spain simply cos it's axiomatic that their country is the best in the world (or because God is an Englishman). Maybe it was once but the empire has collapsed from the inside and they haven't even noticed.

 

[vershy versh]

... unable to afford to go to a doctor if they get ill -

You seen Javid floating people having to pay for GP and A&E visits over here?

 

[IdleRich]

Yeah... I was trying to leave that ambiguous so I could be describing US or UK.

 

[Mr. Tea]

Yes, but one important factor is health insurance and medical expenses. Our salaries are higher, but we have to pay monthly health insurance premiums (your company contributes the bulk of it, but the costs are ridiculous if you're self employed)

This, I think, is a neat trick played by the American system, which is to take the money for health insurance out of employees' salaries before it gets to them. That way, people who notionally earn (say) $60k feel that their employer is generously paying their (say) $20k insurance fees. When, in fact, their actual salary is of course $80k - but they might feel very differently about it if this is what they got paid every year, and then they had to write a cheque for $20k to the insurance company.

 

[IdleRich]

I feel that people would be annoyed if they paid tax at that rate but don't mind so much cos it's going to a private company, whereas in many countries people wouldn't mind paying the government but would baulk at giving it to a private company.

Or is it cos when money is taken for health insurance like that it's ok cos it only covers you, but if that money was taken as a tax and used to set up a health system it would benefit everyone?

 

[Mr. Tea]

I feel that people would be annoyed if they paid tax at that rate but don't mind so much cos it's going to a private company, whereas in many countries people wouldn't mind paying the government but would baulk at giving it to a private company.

Or is it cos when money is taken for health insurance like that it's ok cos it only covers you, but if that money was taken as a tax and used to set up a health system it would benefit everyone?

The irony in that latter part being that health insurance doesn't even fully cover you, in that it always has loads of get-out clauses and a massive excess to pay before they actually cough up.

Never mind that, by the very nature of insurance, the people lucky enough to go through life without suffering a serious illness or injury get virtually nothing for their money, whereas people who suffer terrible ill health are, effectively, quids in. Exactly like socialized healthcare systems, in fact, except that with private healthcare you pay far more in total.

 

[Leo]

Here more insurance info than you'll ever want...

For most people in the US (those who work for a company), their health insurance is part of their employment. the company shops around (in theory) and strikes a deal with an insurance firm. the company pays the bulk of the weekly/b-weekly/monthly contribution to the plan, and the employee contributes a smaller portion. it used to be employees would only contribute $20-30 per month, but companies have tried to cut their costs by shifting more of the burden on employees. I've been self employed for 20+years, so not sure what the empire contribution amounts to at this point but wouldn't surprise me if it's in the $100/month range.

all health insurance policies have deductibles and co-pays. you pay a set amount for every doctor visit -- maybe $30-50 for your GP, $75 for a specialist. and then for all tests, hospital visits, procedures, you chip away at the deductible amount. if you have lots of visit and procedures, you eventually reach the deductible amount and the insurance company pays all or most (80%) of all addition costs.

One issue is insurance is regulated by the states, which all have their own regulations and requirements. You buy a policy from an insurance company registered in your state, and the coverage is good for doctors and hospitals within their network, in that state. if I go to a doctors in my network in NY, my insurance covers the visit. if I find a great doctor in Connecticut, that's outside my insurance company's state network, and I'd have to pay 100% of the out-of-network costs. the exception is emergency rooms visits, which get covered regardless of where you are. if I had to go to the emergency room while on a trip to California, my NY insurance would cover the visit even though it's out of state.

 

[Leo]

the costs add up here, but it's not like healthcare if "free" in countries with socialized medicine. it's just paid for out of taxes instead of citizens paying for their own personal healthcare policies and coverage.

 

[IdleRich]

But there is quite a difference in that in one system my payments benefit everyone whereas in the other they only benefit me. Which of those things is better depends on how you think.

 

[shakahislop]

one aspect of the health insurance debate that gets lost sometimes i think: the US system as a whole is impossible to defend obviously, but it has been a revelation for me with my good insurance to see what healthcare can be like when it's well resourced. getting healthcare for me here is approximately bare times better than in the UK. its probably very inefficient but you can just go and see specialists whenever you want, there's no GP acting as a gatekeeper, if you want physio its easy peasy and you get loads of it, if you want therapy its fairly easy to get i think, if you need anything diagnostic its there, if you want to see a nutritionist its there, if you need an MRI for a minor thing you just go and get it within a week, and so on and so on. luckily haven't needed to use it for anything serious but in the uk my experience is mostly trying to get GP's appointments and then being told to go and fuck myself.

this is a very personal experience and i know nothing about how it all works but like a lot of things in the US, there are a lot of people benefitting from how unequal it all is and i think that explains a bit of the reluctance to have universal healthcare here. the people with fancy insurance want to keep things as it is.

there's no doubt though for me, non-UK europe generally has the best healthcare systems, i guess this is blindingly obvious but i don't want to give the impression that i think the US way is good, i'm not defending it

 

[Leo]

That's why the Affordable Care Act (Obamacare) was such big deal: people below a certain income level who previously could never afford to have health insurance were able to qualify for financial subsidies from the government and get covered, a further extension of the Medicare concept, another small step towards a sort of/kind of socialized medicine.

 

[IdleRich]

I think that one of the Republican lawmakers admitted that they had to prevent Obama implementing full undiluted NHS style (but good) healthcare cos when people actually saw it in action it would be so popular that the Republicans would never get in again.

 

[Mr. Tea]

But there is quite a difference in that in one system my payments benefit everyone whereas in the other they only benefit me. Which of those things is better depends on how you think.

Well someone with an insurance policy isn't benefiting someone who doesn't have a policy (with the same provider), it's true. But this is still a kind of fallacious way of thinking, because it ignores the fundamental principle of insurance, which is to collectivize risk, isn't it? Given that, among the set of people who form the customer base of a given insurer, most of those people will never receive care to the value equal to what they've paid in, while a minority will suffer serious illnesses or accidents and will get care worth far more than what they've paid in - effectively subsidized by all the others.

Never mind that, by the very nature of insurance, the people lucky enough to go through life without suffering a serious illness or injury get virtually nothing for their money, whereas people who suffer terrible ill health are, effectively, quids in. Exactly like socialized healthcare systems, in fact, except that with private healthcare you pay far more in total.

 

[IdleRich]

Well someone with an insurance policy isn't benefiting someone who doesn't have a policy (with the same provider), it's true. But this is still a kind of fallacious way of thinking, because it ignores the fundamental principle of insurance, which is to collectivize risk, isn't it? Given that, among the set of people who form the customer base of a given insurer, most of those people will never receive care to the value equal to what they've paid in, while a minority will suffer serious illnesses or accidents and will get care worth far more than what they've paid in - effectively subsidized by all the others.

Yeah but still there is a difference I'd say.
Also of course, the company makes a profit so it's deliberately making unfair bets, whereas in theory a government could use all the health tax money on health - I suppose the argument is that the efficiency savings (ha!) of the private companies will more than compensate for the profits they take.

 

[Murphy]

one aspect of the health insurance debate that gets lost sometimes i think: the US system as a whole is impossible to defend obviously, but it has been a revelation for me with my good insurance to see what healthcare can be like when it's well resourced. getting healthcare for me here is approximately bare times better than in the UK. its probably very inefficient but you can just go and see specialists whenever you want, there's no GP acting as a gatekeeper, if you want physio its easy peasy and you get loads of it, if you want therapy its fairly easy to get i think, if you need anything diagnostic its there, if you want to see a nutritionist its there, if you need an MRI for a minor thing you just go and get it within a week, and so on and so on. luckily haven't needed to use it for anything serious but in the uk my experience is mostly trying to get GP's appointments and then being told to go and fuck myself.

Just imagine being in the opposite position, see, wasn’t so difficult to envisage plus expenditure is less efficient (ie more profitable) than anything here

I paid about 2400$ for an x-ray following a suspected broken leg near DC aeons ago. Part of the 2400 included sutures and about 20mins with a nurse who cleaned and stitched up the wound. ER Dr refused flat out to phone my travel insurance co, said I had to go to another facility (how do you drive with a fucked leg?), which forced a payment plan into effect

US healthcare is a travesty of profit, opportunism and predation

 

[shakahislop]

Just imagine being in the opposite position, see, wasn’t so difficult to envisage plus expenditure is less efficient (ie more profitable) than anything here

I paid about 2400$ for an x-ray following a suspected broken leg near DC aeons ago. Part of the 2400 included sutures and about 20mins with a nurse who cleaned and stitched up the wound. ER Dr refused flat out to phone my travel insurance co, said I had to go to another facility (how do you drive with a fucked leg?), which forced a payment plan into effect

US healthcare is a travesty of profit, opportunism and predation

yeah, i'm not defending it. have been in the same position with travel insurance here and its not great.

 

[Murphy]

It’s among humanity’s more brilliantly conceived profit schemes, operating as social control mechanisms, ever developed

The precision of its wickedness, the universality of applications, the scope of creating deeper systemic pressure points which in turn generate further capital revenues, stunning really and that’s without going off on oxy

 

[Mr. Tea]

Just imagine being in the opposite position, see, wasn’t so difficult to envisage plus expenditure is less efficient (ie more profitable) than anything here

I paid about 2400$ for an x-ray following a suspected broken leg near DC aeons ago. Part of the 2400 included sutures and about 20mins with a nurse who cleaned and stitched up the wound. ER Dr refused flat out to phone my travel insurance co, said I had to go to another facility (how do you drive with a fucked leg?), which forced a payment plan into effect

US healthcare is a travesty of profit, opportunism and predation

there's no doubt though for me, non-UK europe generally has the best healthcare systems, i guess this is blindingly obvious but i don't want to give the impression that i think the US way is good, i'm not defending it

 

[Murphy]

There was a definite “cushy eh” admission previously in the post, you pedantic dick

 

[Mr. Tea]

Yeah but still there is a difference I'd say.
Also of course, the company makes a profit so it's deliberately making unfair bets, whereas in theory a government could use all the health tax money on health - I suppose the argument is that the efficiency savings (ha!) of the private companies will more than compensate for the profits they take.

Sure, I wasn't saying it was exactly the same - but if you wanted to be absolutely hardline in your ethos of "nobody but me should benefit from money that I, personally, have paid", then you'd eschew insurance altogether and simply pay the fees for whatever treatment you needed directly. Of course, this is probably only practical if you're on a seven-figure income even for entirely routine things like having a baby.

Speaking of alleged "efficiency savings", I once got into an online argument with some American guy who was defending the US healthcare system, and his explanation for why bags of saline that cost the hospital roughly a dollar apiece were being charged to patient-customers at literally hundreds of dollars was "government red tape." So, to his mind, "government red tape" in a healthcare system where the government plays a minimal role was responsible for hospitals charging a markup of tens of thousands of percent, whereas in a system like the NHS which is literally run by the government, this doesn't happen, and our one-dollar bag of saline costs the UK taxpayer one dollar, and the patient - at point of use - nothing at all.

I dislike the tendency that many people across the political spectrum have of accusing anyone they disagree with of being "brainwashed", but in cases like this it's very difficult not to take that attitude to someone who is arguing so vociferously against their own interest with such outrageously idiotic anti-logic.