There are many facets of the United States a foreigner might find baffling.
But ask people from Germany, the United Kingdom, France, Japan, Norway, or even China, what they find strangest about the U.S., and a number will point to Americans buying health insurance through an employee plan that requires thousands of dollars in expenses before coverage even begins. And then, it still might leave a person declaring bankruptcy under medical bills.
That's because many countries provide some sort of universal health coverage through programs funded, or at least supported, by taxpayers. They aren’t cheap, and some say they stifle medical innovation and suppress talent. But the populations of other countries generally like the peace of mind.
James Gibbard, an English immigrant who has lived in Oklahoma since 2000, said U.S. health care is a subject that “gets me very riled up.”
British citizens have access to health care under the United Kingdom’s National Health Service, created in 1946 under the Labour government of Clement Attlee.
Gibbard said British citizens do not live in fear of crippling debt when treated for illnesses or injuries.
“I've lived and experienced both,” he said. “It’s a complete myth about socialized health care not working. Don't listen to the nonsense on talk radio about how bad it is. They haven't lived it; I have. It saved my life and I received quality care with no long waits.”
In contrast, Gibbard is not impressed with U.S. health care. The Yank system may devour the most money and foster innovation, but he believes patients are not treated well.
“I had an emergency here after a hand injury, and my ER experience was terrible,” he said. “While sitting in complete pain and bleeding profusely, I still had to fill out a proof of insurance form. That is completely ridiculous, and I wasn't treated with any urgency.”
England's NHS is not without critics nor scandal-free. New hospital construction under the 1994 Private Finance Initiative was usually over budget by the 2000s, and hospitals were sometimes built with fewer beds than what was replaced, resulting in staff reductions.
Private medical care exists in the U.K. Patients who “queue jump” to private clinics often have the means to afford it. Britons note that such patients “pay twice.” While NHS coverage does not require payment for treatment, it is not free. It is funded with taxes paid by everyone, including those who choose not to use it for certain services.
Britons may complain about the NHS, but there is no stampede of English hooves to the U.S. for its health coverage. Better pay and cheaper property in the U.S. can override exasperation with American health care, as they did for Gibbard.
“Neither country has a perfect system, but if I had to choose one, socialized health care wins every time,” Gibbard said. “My local doctor's practice was excellent – short waits, staff who genuinely cared about their patients, on a first-name basis, the best medicine and treatment, and all without the fear of how much it would all cost. Everybody contributes and pays for it out of their taxes.”
Gibbard said Americans buy “insurance,” then face the dread of paying even more in deductibles if they dare use the insurance. The NHS does not charge deductibles.
“Do they think insurance premiums are free,” he asked. “At the end of the day, the only way to have a fair and balanced system is for everybody to pay into the system. That’s how insurance is supposed to work, and until that happens, health care here will never work.”
In France, per capita health care spending is higher than in most of Europe, but still lower than the U.S. The government handles health insurance by determining premiums charged – based on income – and specifying the refunded prices of medical services. Those dealing with long-term illnesses often have all costs refunded, but for most French citizens in most medical situations, the amount refunded is 70 percent.
In 2000, coverage was extended to all legal French citizens. Private supplemental insurance is available, often through employers. About 62 percent of French hospital bed capacity is handled by public hospitals, while nonprofit and for-profit hospitals and clinics account for the rest. Income for French doctors is only about 60 percent that of American doctors.
Most French citizens must declare the referring doctor when visiting a specialist. Co-pay on a doctor visit is 1 Euro. Prescription coverage is 100 percent if the drug is “irreplaceable,” 65 percent if “important,” 35 percent if “moderate,” and 15 percent if “weak.” Pharmacists are expected to use generics.
Canada calls its plan “Medicare” and operates under the Canada Health Act of 1984. It is publicly funded and offered provincially, but most services are provided by private entities. It is a “single payer” system wherein private doctors offer basic services. Each province negotiates – usually annually – with provincial medical associations for the fee paid to doctors for visits. Public hospitals, most of which are independent, are required to stay within their budgets.
Ann Marie Shackleford, who was an assistant professor of journalism at Bacone College in Muskogee for more than 20 years, became a permanent resident of Canada on Dec. 8, 2016.
“I had to wait 90 days to obtain my Ontario Health Insurance Plan card,” Shackleford said. “This literally enables me to obtain the exact same health insurance as any Canadian. What this means is, I can go see any doctor, go to any walk-in clinic or doctor's office or hospital and pay zero fees.”
Shackleford said she is amazed by the concept of not paying anything after visiting a doctor, and wonders why Americans continue arguing over health care, when “Canada has it figured out.”
“I now have an insurance card that allows me to obtain health care for zero out-of-pocket expenses” she said. “There is no deductible. If you go to a hospital for any surgery, there is no fee. If you have a baby, there is no fee.”
Her employer plan virtually eliminates any expenses the general health care plan does not cover.
“I now have full health care benefits through my employer, the University of Waterloo, as does my spouse, so prescriptions are covered at 80 percent,” she said. “Dental, ditto.”
While awaiting permanent residency for 19 months, Shackleford was without insurance, which she characterized as “a little scary.” She sought residency after marrying a Canadian, and she believes the U.S. can take some lessons from Canada to make health care more accessible and affordable.
“You swipe your OHIP card when you go to the doctor or hospital and the bill is taken care of,” she said. “There is no, ‘Wow, wonder if I can afford to go to the doctor’ because there literally is no charge. I am blown away by what health care is now available to me just because I am now a permanent resident of Canada.”
Canadians have about 70 percent of their health care covered by Medicare. Doctor visits and hospital stays are mostly paid, but pharmacy and dental costs are frequently paid by private or employee policies or out of pocket.
Former Oklahoma Republican Sen. Tom Coburn raised some eyebrows several years ago when he said the U.S. should follow the Swiss example. Switzerland mandates that all citizens purchase health insurance. All insurance vendors must offer the mandatory coverage. Treatment and hospital stays are covered, but the insured pays part of the bill. The percentage is determined by an annual deductible selected by the insured. People are free to purchase private supplemental policies.
A common feature of socialized, or semi-socialized, medicine is that pharmaceutical companies must negotiate price with a government agency for coverage. If a company won’t climb down on the price, the agency may refuse to cover the drug. If not covered, few doctors will prescribe it.