I worry about my friends, Bob

And I owe it all to Hanz and Franz

Health-wise I've always been pretty lucky.  I've been told I come from a pretty healthy gene pool as very little has ever gone wrong with me....until recently.  I don't smoke, drink only occasionally and in moderation, no drugs, and I was always in pretty good physical shape, even though I never crossed paths with Ah-nold at any gym.  (I did wander into a gym once by mistake, though.)  

I did, however, have several back-to-back detached retinas a dozen years ago, and I came semi-unglued at age 64 when they discovered I had an immune system condition as well as heart arrhythmia (my heart was beating too slowly), necessitating a pacemaker.  Fortunately, thanks to my wonderful wife K, who had a corporate job with insurance (with me added as a dependent), those pesky little boo-boo's cost me surprisingly little out of pocket.  Not everyone is as lucky as me, though.  Here are a few examples of people I know personally who are in truly bad shape, both physically and financially:

My masonry contractor, let's call him Bob, has suffered mightily from kidney stones for many years now.  He's had all the tests, tried multiple doctors....everything....but they haven't yet been able to fix him.  They've given him pain meds and just told him to suck it up.  As his private health insurance carrier eventually jacked his rate up to $1,600 per month he had to let it go.  It was either food for his family or insurance.  

Bob is an American of Mexican heritage and still has relatives back in the old country.  Out of desperation Bob recently became a "medical tourist" (people who travel to another country to have needed surgery because it is so much less expensive than in the US).  He said the doctors and his hospital in Monterrey, Mexico were surprisingly good, but still, his surgery was only partially successful.  He's still hurting and still has no insurance.  I worry about my friend Bob.

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I once had a window washer, let's call him Bob, who came to my house regularly to make sure I could see out.  I didn't mind washing my own windows, but all I ended up doing was rearranging the dirt.  Anyway, Bob was in his early 20's at the time, and in conversation told me he worked 20 hours a week at Kroger's (grocery store) in order to have insurance, and then spent the rest of his time washing windows.

A few years later I visited with him again and he said he had to quit his Kroger job as his window washing job became a 40+ hour a week career he couldn't pass up.  I asked what he did for insurance and he said he was without.  He said if he got sick he was just going to go to the emergency room and hope for the best.  At his age I could tell "getting sick" was the last thing on his mind.  I heard some time later that he was involved in an accident (I believe there was a motorcycle involved) and could no longer work.  I don't know where he is today, but I still think about Bob.

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The foreman at the custom cabinet shop we used, let's call him Bob, was in his 50's when he had a stroke.  Like many small businesses, Bob's boss couldn't afford insurance for his employees.  Bob was airlifted to a hospital in Plano, Tx where they stabilized him, but he was left semi-paralyzed.  After several weeks there (and knowing Bob was going to be a charity write-off) the hospital finally worked with Medicaid to find a rehab facility that would take him.  The last I heard Bob was little improved.  I worry about my friend Bob.

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There are lots of "Bob's" in this country who are hurting and have no insurance.  Sometimes they have no insurance because they couldn't afford it, sometimes because they were foolish.  Notice I said all these people were working.  They weren't lazy bums who were looking for a handout, as many imagine uninsured people to be.  They just didn't have the good fortune of having a smart, hard working wife employed by a large, deep-pocketed corporation to carry them on their health insurance like I did.  Fate is too often fickle like that.

We have a lot of sick people here who compassionate Americans IMO shouldn't turn their backs on.  We're better than that.  But what to do?  I don't know the answer, but I'm confident that the Republican's Ryan/TrumpCare bill now making its way through Congress isn't it, nor is ObamaCare, which they say is now itself on life support.  To those who would rather have the Almighty Tax Cut a slimmed down healthcare bill promises so they can buy another shiny new gadget, I hope they'll think about my friends Bob when they're out toy shopping.

S

NOTE:  These are all absolutely real people I know.  If any of you reading this are actually named Bob, I suggest you stay inside today.  ;)

Decisions, decisions....

Yes, healthcare again.  NO, DON'T HANG UP!  THIS IS ACTUALLY PRETTY INTERESTING.

Congress (the House of Representatives) should be taking a vote this week on whether they'll be adapting Ryan/TrumpCare or sticking with ObamaCare, which it seems all agree will soon be/is on life support.  The Right is hoping for the former, and the Left (Bernie & friends) would prefer something more like the single-payer (universal) healthcare system they've had in the United Kingdom since 1948.

So what exactly is the UK's system (the NHS) like?  I'd heard the doctors and nurses, the technology, and the facilities are all first rate, but the wait time to be seen by a doctor was very long.  To get to the bottom of it all I corresponded with a British friend* and asked him to give me a quick overview.  I trusted him implicitly and knew he would give me the unvarnished truth to the best of his knowledge.  His response:

First, the NHS is a mandatory insurance scheme paid for by National Insurance contributions, a tax for all intents and purposes.  Almost all prescriptions are included for a flat fee of approx $10US each, with exceptions for the young (<16) and the "more mature" (>60), with a few other special exemptions, too.  One option is a Rx pre-payment plan costing roughly $125 per year which covers all your meds, regardless of how many you might have.

All doctor and hospital treatment is included, as are many optical and dental services.  Doctors, dentists, and "opticians" (optometrists) are all self-employed and may be either working entirely for the NHS under contract, entirely private, or a bit of both.  About 8% of the population also has private insurance over and above their NHS coverage, which generally gets them perks like quicker consultations, private hospital rooms, etc.  (He said it really amounts to not having to rub elbows with the common folk in the waiting rooms.)  Almost all feel there is no difference in the care received, although a few would debate that.  If a doctor has a good reputation and a thriving practice serving the 8%, he can probably make more $$$ by going entirely private than with a NHS contract.

The biggest grumble is indeed the wait time to be seen.  Of course all patients are prioritized, just like here, so emergencies get immediate attention while non-emergencies could be in for a fair wait.  Elective surgeries can take (many months) longer to schedule than here, so you might be hobbling around a lot longer on a bum knee, but at least there will be $0 due when you're finally patched up.  

Another common complaint is that the NHS is in places understaffed.  All this varies depending on where you live, just like service in the US varies depending on if you live in a big city or a smaller town.  On the plus side, paperwork there is nil....just show your eligibility card.  That's it!  *take note Aetna!*

My friend pointed out that, essentially, National Insurance and the NHS is a non-profit system that covers everyone.  The nature of the system means that drug manufacturers have to reach agreement with the NHS about what their prices will be, and as a near-monopoly the NHS can haggle for better prices than private hospitals or doctors can here.  This is largely why treatment costs there are so much lower....the non-profit side combined with the fact the NHS dominates the market.  In the US a very large portion of the money we pay goes to the sort of overhead that any privately-run system has....large salaries for health insurance and pharmaceutical company execs, dividends to shareholders, medical billing and the inevitable write-offs, and so on. 

Now for some numbers** :  The United States spends approx 17.1% of its GDP on healthcare (public and private combined), or about $9,403 per person, which still leaves us with about 12% who have the only option of going to an emergency room for care, which they will likely never be able to pay.  The United Kingdom spends approx 8.8% of its GDP on healthcare (public and private combined), or about $3,377 per person, which includes care for every legal resident.  

On a parallel track, the total tax burden on the average American is 26% of his income, and 32.6% for the average UK resident.  Essentially the top income earners here would come out ahead paying a lower tax rate, while the rest of us would probably do better paying higher taxes but receiving all-inclusive healthcare. 

Just as there is considerable political pressure to cut healthcare costs here, the same applies there.  The Republicans here and the Conservatives (Tories) there are looking to reign in costs (ie: coverage).  Both are having some success, taking some services off the table, although incurring the wrath of many voters in the process.  I will say that every single Brit I have ever heard discuss their system said they were overall "satisfied" or "very satisfied" with it.

It seems to me that if you have coverage here in the US (subsidized) by your employer, if you have ample financial liquidity to pay for all your prescriptions, the ever-increasing co-pays, deductibles, and out-of-pocket expenses, and if you believe your job is rock-solid stable (is there such a thing anymore?), you might want to just leave things alone.  But if your situation is anything other than that, the security of a British-style system might look very enticing.  Also be aware, as I understand it, those here over the age of 47 will be especially hard hit by the proposed Ryan/TrumpCare, so be prepared.

Finally, I ran across this article while doing my research comparing the UK and US systems by someone who has used them both.  It's definitely worth a read....very interesting.

Just something for you to think about.

S

* Thank you, Sir, for your invaluable insight.  :)

**  Exact numbers are hard to compare.  US, EU, various research groups, etc, differ slightly.  Some numbers, for example, are from 2015, and some from 2016.  Still, the variations are minor.  Tax liability numbers are as close to "apples-to-apples" as I can find.