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Old 12-08-2012, 02:28 PM   #61
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Thanks Alan, although I was generally aware of how the system works in the UK.

One disagreement I have with the UK system is that folks can purchase, either through insurance or direct pay, private health care. It seems like if some rich folks can afford to buy private supplemental insurance or private pay for extra services, they could be taxed to obtain more revenue in order to provide enhanced services for all.
Private health insurance has always existed in the UK. It's usually a top up and used for elective surgery or to get quicker treatment. Most people don't have it or need it.

The UK does not stop you from spending money on health care outside of the NHS if you want. However, the UK tax system is more progressive than in the US with a higher tax free income threshold (but fewer deductions) and a top rate of 50% so those with higher incomes pay more in tax than in the US.
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Old 12-08-2012, 02:44 PM   #62
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Congrats on having "beat the system!"

Hopefully our reforms will level the playing field so everyone has access to the same healthcare with no exceptions. No denials based on health or finances. No access to "extras" based on ability to pay. Folks such as yourself might give up a few small features while folks with no coverage will certainly gain. But, in the end, best for all.
I'm grateful to have such good healthcare. I would certainly like to see better care available to all US residents, but given the current cost of US healthcare that seems unlikely. I would compromise my current plan, or pay more tax, if it would mean better care for others, but I'd also like to see the systemic cost and efficiency issues addressed which I think are the real issues.

The care I receive is world class, but the insurance coverage and cost is worse that I'd have in the UK. So I'd actually like to see my current MA plan improved and for every US resident to have access to similar coverage. The UK system is very far from perfect. It has big funding issues and problems, some people are unsatisifed with it and it performs poorly in relation to other EU systems for the treatment of some conditions like prostate cancer etc, but it does deliver coverage to 100% of UK residents and generally provides excellent care at half the cost of the US system.

I don't think the US should be so far behind the UK and the rest of the world when it comes to healthcare provision. It leads the world in medical treatment, it's just way behind in paying for and delivering that care.
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Old 12-08-2012, 03:20 PM   #63
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One disagreement I have with the UK system is that folks can purchase, either through insurance or direct pay, private health care. It seems like if some rich folks can afford to buy private supplemental insurance or private pay for extra services, they could be taxed to obtain more revenue in order to provide enhanced services for all.
I'm very surprised to hear that you are opposed to private care in parallel with public care. There are a great many private clinics and hospitals available to those that can afford to have, mostly elective, surgery. For example, sport is a very big industry in the UK, particularly soccer. If private clinics were not available for scans, surgeries and treatments then the whole sports industry would suffer and clubs would not be able to attract the best players in the world.

So, since a large private health system exists already, why not let people get that cartilage or hernia repaired this week instead of waiting 1-2 months. (e.g. in 2008 my father had to wait 6 weeks to get a hernia in his groin repaired).

I had a quick look for private hernia operations, and you can get one done at a specialist hernia clinic for ~$4,000 including all fees.

London Hernia Clinic :: Hernia Repair Surgery Cost

Quote:
Hernia Repair
Laparoscopic repair of Inguinal hernia (one side) (Keyhole surgery) - £ 2488.00
Open repair of Inguinal hernia (one side) - £2130.00
Open repair of umbilical hernia – £2569.00
If you're paying for your surgery yourself we want to ensure your costs don’t escalate; that’s why all our prices are inclusive of an intensive after-care programme. There are no hidden extras. Our price includes:
  • Surgeon Consultation – You will meet with the consultant who will perform the procedure
  • Hospital Fees – includes a day case stay at the hospital
  • Surgeon Fees – the cost of the operation performed by a Specialist Surgeon.
  • Anaesthetist Fees – the cost of anaesthetic assessment and the specialist anaesthetic care throughout the operation.
  • The cost of the specialist equipment used during your operation.
  • Antibiotics and Pain Medicine during your hospital stay and immediate recovery (first 5 days at home).
  • Follow-up consultation 4 – 6 weeks following surgery
For other areas of the country you can shop around through sites like this one.

Hernia Repair Surgery / Operation : Costs for private treatment in the UK
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Old 12-08-2012, 03:34 PM   #64
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Medicare costs and coverages are at the Government website here:

Medicare costs at a glance | Medicare.gov

Basic costs:
Quote:
Medicare monthly premiums

Part A (Hospital Insurance) monthly premium (for people who pay a premium): If you buy Part A, you'll pay up to $451 each month in 2012. In 2013, you'll pay up to $441 each month. Higher-income consumers may pay more.
Part A late enrollment penalty: If you don't buy it when you're first eligible, your monthly premium may go up 10%. (You'll have to pay the higher premium for twice the number of years you could have had Part A, but didn't sign up.)
Part B (Medical Insurance) monthly premium: Most people pay the Part B premium of $99.90 each month in 2012 ($104.90 in 2013).
Part B late enrollment penalty: If you don't sign up for Part B when you're first eligible, you may have to pay a late enrollment penalty for as long as you have Medicare. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it.
Part C (Medicare Advantage) monthly premium: The Part C monthly premium varies by plan.
Part D (Medicare prescription drug coverage) monthly premium: The Part D monthly premium varies by plan (higher-income consumers may pay more).
Part D late enrollment penalty: The cost of the late enrollment penalty depends on how long you went without creditable prescription drug coverage.
The rest of the page covers the deductible, exclusions, co-pays and coverage.
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Old 12-08-2012, 03:37 PM   #65
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The stars indicate the number of times others have benefited from advice you gave in your posts, minus the number of times others have been annoyed by something you said. As long as the net star quantity remains positive, you will continue to have posting privileges here. If it ever dips into negative territory, you will be banned from the community.
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It reflects the number of posts you have submitted. You'll get more stars after a while, and then you won't care either.
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Old 12-08-2012, 04:25 PM   #66
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I'm very surprised to hear that you are opposed to private care in parallel with public care.
The poorest should have the same access to health care as the richest, no? It sounds kind of draconian that someone without the money to private pay will wait up to 2 months (in your example) for surgery while the privileged rich guy gets taken care of right away.

It sounds like Obamacare, at least in the direction it seems to be headed now, will be more progressive than the UK NHS. People will have subsidized medical insurance that allows them to get in line for services anywhere, not just at the public facilities with long waiting times. I hope I'm correct on that.

I have no issue with private care in parallel with public care as long as there are gov't programs in place to pay for the private care for those who can't afford it. Oh wait...... maybe that would make it public care?
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Old 12-08-2012, 04:31 PM   #67
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Medicare costs and coverages are at the Government website here:

Medicare costs at a glance | Medicare.gov

Basic costs:

The rest of the page covers the deductible, exclusions, co-pays and coverage.
It's strange that the info concerning penalties for being "rich" is omitted. There is a penalty for Part B and Part D for having an annual MAGI of $170k or greater for a couple filing jointly. I'm sure it doesn't impact many folks, but for someone retiring with SS, a pension, some bonus pay, a portfolio kicking off some serious interest, divs and cap gains, Roth conversions, and the like, it can come up.
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Old 12-08-2012, 04:42 PM   #68
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And don't forget eye color and length of the second toe are also factored in.
I thought it had to do with your height, or your endowment and for females the prowess of her rack.
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Old 12-08-2012, 04:56 PM   #69
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I don't think the US should be so far behind the UK and the rest of the world when it comes to healthcare provision. It leads the world in medical treatment, it's just way behind in paying for and delivering that care.
No doubt. And I think once we have a way to have all our citizens provided with health care, we need to look at the Canadians and Australians for tips on how to exclude folks who aren't citizens and for fully sharing the cost of development of medical technology and drugs.

For example, I have a very close friend whose daughter met an Australian who was here to attend university. They married and moved back to Australia. With her technical vocational skills, she was welcomed, except for health care. To become part of the Australian health care system, she needed to provide extensive background information concerning some spinal surgery she had as a child. They just didn't rubber stamp her into the system. I also know that fleeing across the border into Canada won't get uninsured Americans ongoing free medical care up there. I do believe we won't be able to afford to act differently than either Australia or Canada in this regard. They, and other countries, have been at this for a while and we need to learn from their experience.

Ditto with medical research and drug development. We absolutely must find ways to fully share the cost with everyone benefitting, within and without the USA.
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Old 12-08-2012, 04:59 PM   #70
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I thought it had to do with your height, or your endowment and for females the prowess of her rack.
Yikes. The only endowments I talk about are financial, the only racks are for wine, and the only prowess is investing, and in all three I could stand to improve.
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Old 12-08-2012, 05:03 PM   #71
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The poorest should have the same access to health care as the richest, no? It sounds kind of draconian that someone without the money to private pay will wait up to 2 months (in your example) for surgery while the privileged rich guy gets taken care of right away.
The way it works with the NHS is that critically required treatment is given right away. For less urgent procedures you may well have to wait a while. This is still a lot better than not getting treated at all, which is what happens in the US if you don't have good insurance.
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Old 12-08-2012, 05:05 PM   #72
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Jus another note on how Medicare and the NHS are funded. Medicare FICA taxes stop at around $100k income whereas because the NHS is funded from general taxation everyone contributes to it from all their income, so the rich pay more for it than the poor and there's no cap on what they pay. Obviously the NHS also covers all UK residents Shea's Medicare only covers US retirees.

The NHS is one of the few truly socialized healthcare systems in the world and was set up to deliver healthcare to UK residents no matter their ability to pay and free at the point of service. The private system that existed before the NHS continues and many NHS doctors also take private patients. The NHS can well be described as a socialist system, but the UK is not a socialist country so the private system is free to compete and finds patients in those areas where the patient is not satisfied with the treatment offered by the NHS. Most people in the UK don't have private insurance though.
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Old 12-08-2012, 05:12 PM   #73
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The way it works with the NHS is that critically required treatment is given right away. For less urgent procedures you may well have to wait a while. This is still a lot better than not getting treated at all, which is what happens in the US if you don't have good insurance.
The UK NHS may indeed be better than the current USA system. But why should the goal of developing a better system in the USA be to make those unable to private pay for non-critical surgery wait longer than the wealthy? That's unacceptable to me. Certainly you're not satisfied with such a draconian system?
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Old 12-08-2012, 05:14 PM   #74
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Jus another note on how Medicare and the NHS are funded. Medicare FICA taxes stop at around $100k income whereas because the NHS is funded from general taxation everyone contributes to it from all their income, so the rich pay more for it than the poor and there's no cap on what they pay. Obviously the NHS also covers all UK residents Shea's Medicare only covers US retirees.

The NHS is one of the few truly socialized healthcare systems in the world and was set up to deliver healthcare to UK residents no matter their ability to pay and free at the point of service. The private system that existed before the NHS continues and many NHS doctors also take private patients. The NHS can well be described as a socialist system, but the UK is not a socialist country so the private system is free to compete and finds patients in those areas where the patient is not satisfied with the treatment offered by the NHS. Most people in the UK don't have private insurance though.
There is an upper limit on income subject to Social Security tax but not on the 1.45% x 2 Medicare tax.
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Old 12-08-2012, 05:15 PM   #75
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Jus another note on how Medicare and the NHS are funded. Medicare FICA taxes stop at around $100k income whereas because the NHS is funded from general taxation everyone contributes to it from all their income, so the rich pay more for it than the poor and there's no cap on what they pay.
Uhhhhh........ I don't think you're correct there nun. Wow......... that's quite a misunderstanding........ We seems to have been talking past each other on this subject and I think I understand why now.

From the SS site:

Quote:
There is no limitation on taxable earnings for Medicare's Hospital Insurance (HI) taxes.

The Medicare tax rate is 1.45 percent for employees and employers.

The Medicare tax rate is 2.9 percent for self-employed.
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Old 12-08-2012, 05:23 PM   #76
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No doubt. And I think once we have a way to have all our citizens provided with health care, we need to look at the Canadians and Australians for tips on how to exclude folks who aren't citizens and for fully sharing the cost of development of medical technology and drugs.

For example, I have a very close friend whose daughter met an Australian who was here to attend university. They married and moved back to Australia. With her technical vocational skills, she was welcomed, except for health care. To become part of the Australian health care system, she needed to provide extensive background information concerning some spinal surgery she had as a child. They just didn't rubber stamp her into the system. I also know that fleeing across the border into Canada won't get uninsured Americans ongoing free medical care up there. I do believe we won't be able to afford to act differently than either Australia or Canada in this regard. They, and other countries, have been at this for a while and we need to learn from their experience.

Ditto with medical research and drug development. We absolutely must find ways to fully share the cost with everyone benefitting, within and without the USA.
Have you ever lived outside the US?

There are poor Americans crossing the Canadian border for free health care. Uninsured Americans even use their Irish ancestry to get free health care in poor little Ireland! Can you blame the Aussies?

But in EU they already have reciprocal agreements where they treat each other’s citizens just as if they were at home.

BTW, Canada’s universal healthcare system has its roots in western Canada during the great depression of the 1930s, soon that system will be 100 years old! So to Americans waiting for healthcare reform to kick-in, I say welcome to the 20th century.
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Old 12-08-2012, 05:29 PM   #77
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There are poor Americans crossing the Canadian border for free health care.
I don't think there are a significant number of poor Americans crossing the border to receive free, ongoing Canadian health care. I don't think the Canadians have provisions for providing free, ongoing care for non-citizens and I think they know how to handle those issues better than the USA. Do you have something, an article or whatever, you can point me to?

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Can you blame the Aussies?
I don't blame the Aussies a bit. I said that we will need to learn from them and implement the same kind of screening as they do. We won't be able to accept all comers and meet the need for substantial per capita cost reductions. We'll need to follow the lead of countries like Australia and Canada regarding screening who's in and who's out. You really misunderstood what I was saying.
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But in EU they already have reciprocal agreements where they treat each other’s citizens just as if they were at home.
I suppose that it might be possible for the USA, after full implementation of some new health care program, to have reciprocal agreements with some other countries. But I doubt very seriously that we'll be able to afford those kind of arrangements if they cost us more than we receive. As everyone seems to be pointing out, we already pay too much and can not afford to continue doing so.
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BTW, Canada’s universal healthcare system has its roots in western Canada during the great depression of the 1930s, soon that system will be 100 years old! So to Americans waiting for healthcare reform to kick-in, I say welcome to the 20th century.
Yep, and I'd be relatively happy to go to a Canadian-like system with some modifications. I especially like the way that Canada limits it's exposure to whom it provides services and for how long. An important lesson for us to learn as we move through adopting a more progressive system for providing health care. We're not the big brother capable of doing everything for everybody. As the numbers show, we're not even doing a good job for ourselves.
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Old 12-08-2012, 07:46 PM   #78
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I have some that are different. Folks we sit with in the dining hall at fishing camp "Up Nort" every summer are from Canada and Australia and go on and on about their health care system being "free," that they don't have any claim forms or paperwork to do since there are no charges, etc. They pooh pooh any mention that somehow, somewhere, someone is paying for it.
.
They probably know how talk like that gets the Yanks all stirred up. ;-)

The fact is, though, that our collection of ad hoc processes and procedures that we've cobbled together for healthcare is more expensive per person than just about anywhere else in the world. Many of the rent seekers that have their fingers in the healthcare pie feel entitled to their cut, and won't want to let go. This makes any reform attempts messy, for hundreds of millions of lobbying dollars worth of messy.

http://en.wikipedia.org/wiki/List_of...PP)_per_capita
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Old 12-08-2012, 10:02 PM   #79
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Uhhhhh........ I don't think you're correct there nun. Wow......... that's quite a misunderstanding........ We seems to have been talking past each other on this subject and I think I understand why now.

From the SS site:
Thanks for the correction, I didn't know about the Medicare exception to the FICA/SS income limit. That actually makes the deal the US retiree gets a lot worse. You'd think Medicare could do more with all that funding.
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Old 12-08-2012, 10:20 PM   #80
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I suppose that it might be possible for the USA, after full implementation of some new health care program, to have reciprocal agreements with some other countries. But I doubt very seriously that we'll be able to afford those kind of arrangements if they cost us more than we receive. As everyone seems to be pointing out, we already pay too much and can not afford to continue doing so.
I can't see a reciprocal health care agreement being implemented between the US and EU countries because the organizing philosophies and implementations are so radically different. The freedom of movement and employment within the EU also requires reciprocal health care agreements.

Interestingly the US does have reciprocal social security agreements with may countries.
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