Cost of healthcare - UK vs US
Discussion
Split from the 47 thread. Because complicated.
Question was – how does the cost & performance of the US (private, insurance driven) and UK (Universal Healthcare) systems compare?
(yes, I’ve experienced and lived with both)
The US famously spends the highest percentage of GDP of any developed nation on healthcare. In $ terms ~$15k per head vs our ~$5.5kWhen comparisons usually come up comparing the two, it falls foul of the effects of averages. US Healthcare, when looked through the lens of averages, looks to have pretty average/poor outcomes, especially when the costs are looked at. However, there’s a world of difference between “with insurance” and “without insurance”. Currently 8% of the US has no insurance. Used to be 16% pre-Obama.
My costs (which are very typical) as an example:
Insurance (negotiated by employer, and the same for all employees) $190 per month per person
FSA (tax free “savings” account for healthcare out of pocket spending) $2500 per year
So $4780 per year. Pre tax, so $3824 net.
Out of pocket costs are on top of insurance. However, there is a maximum of $4000 per year (of which the $2500 FSA contributes), so an extra maximum possible of another $1500 on top of the $3824 for a total (PP) of $5324. Almost 4k sterling on the nose.
If we compare that to NHS & private top up coverage in the UK (or Ireland, for example), google suggests average for an adult in the UK is 80 sterling per month, or 960 per year.
But of course, the NHS isn’t free (but free at point of use). The difference in marginal tax rates between the UK and US means I’m spending the same or less in the US. So the “extra” 3k sterling US healthcare costs is easily covered by the lower tax.
Yes, the NHS is absolutely brilliant in some areas. But you have to get into the system first. I have experienced zero delays in getting diagnostics or treatment in the US. Some specialists may take a week or two for a “new patient” visit (rheumatologists seem thin on the ground where we are). But for example, if the doc reckons an xray is needed (for example) it’s done at that visit.
They’re different systems, and if you can’t afford general insurance the US isn’t the system you want to be relying on. But if you can afford/access insurance, your access to top notch healthcare is vastly better in the US. If you can’t afford/access it your life expectancy just dropped.
Conversely, in the UK, you need to hope you don't have anything that needs catching/treating quickly.
But costs wise, it’s not the headline costs you see on twitter/facebook/tik tok.
Nobody pays the “pre-negotiation” price. Not even close. My wife had a bold test with a “sticker price” of $8,000. Actual cost was $40.
M.
Question was – how does the cost & performance of the US (private, insurance driven) and UK (Universal Healthcare) systems compare?
(yes, I’ve experienced and lived with both)
DJC76 said:
Mortarboard said:
And to be honest, the cost of decent healthcare insurance & copays in the US costs roughly the same as NHS plus private coverage in the uk. But facilities in the US are vastly more widespread, with bugger all waiting.
M.
I’m curious about this statement. The NHS costs about £3k per person per year. Private insurance is the U.K. is dirt cheap, I pay more for my Sky subscription than I do my private healthcare!M.
The US famously spends the highest percentage of GDP of any developed nation on healthcare. In $ terms ~$15k per head vs our ~$5.5k
My costs (which are very typical) as an example:
Insurance (negotiated by employer, and the same for all employees) $190 per month per person
FSA (tax free “savings” account for healthcare out of pocket spending) $2500 per year
So $4780 per year. Pre tax, so $3824 net.
Out of pocket costs are on top of insurance. However, there is a maximum of $4000 per year (of which the $2500 FSA contributes), so an extra maximum possible of another $1500 on top of the $3824 for a total (PP) of $5324. Almost 4k sterling on the nose.
If we compare that to NHS & private top up coverage in the UK (or Ireland, for example), google suggests average for an adult in the UK is 80 sterling per month, or 960 per year.
But of course, the NHS isn’t free (but free at point of use). The difference in marginal tax rates between the UK and US means I’m spending the same or less in the US. So the “extra” 3k sterling US healthcare costs is easily covered by the lower tax.
Yes, the NHS is absolutely brilliant in some areas. But you have to get into the system first. I have experienced zero delays in getting diagnostics or treatment in the US. Some specialists may take a week or two for a “new patient” visit (rheumatologists seem thin on the ground where we are). But for example, if the doc reckons an xray is needed (for example) it’s done at that visit.
They’re different systems, and if you can’t afford general insurance the US isn’t the system you want to be relying on. But if you can afford/access insurance, your access to top notch healthcare is vastly better in the US. If you can’t afford/access it your life expectancy just dropped.
Conversely, in the UK, you need to hope you don't have anything that needs catching/treating quickly.
But costs wise, it’s not the headline costs you see on twitter/facebook/tik tok.
Nobody pays the “pre-negotiation” price. Not even close. My wife had a bold test with a “sticker price” of $8,000. Actual cost was $40.
M.
NHS doesnt typically bin your claim off as it will dent profits though, so theres that.
You are earning, how does the US work for folk that arent earning ? I keep seeing all the idiots getting mashed up at these "Takeover" events, compound fractures, knocked out cold (dead ?) but how would a kid with no money be treated if a Hellcats just done a burnout over him ?
You are earning, how does the US work for folk that arent earning ? I keep seeing all the idiots getting mashed up at these "Takeover" events, compound fractures, knocked out cold (dead ?) but how would a kid with no money be treated if a Hellcats just done a burnout over him ?
h0b0 said:
Mortarboard said:
My costs (which are very typical) as an example:
FSA (tax free “savings” account for healthcare out of pocket spending) $2500 per year
Putting money into a tax efficient savings account is not a cost.FSA (tax free “savings” account for healthcare out of pocket spending) $2500 per year
M.
Mortarboard said:
h0b0 said:
Mortarboard said:
My costs (which are very typical) as an example:
FSA (tax free “savings” account for healthcare out of pocket spending) $2500 per year
Putting money into a tax efficient savings account is not a cost.FSA (tax free “savings” account for healthcare out of pocket spending) $2500 per year
M.
J4CKO said:
NHS doesnt typically bin your claim off as it will dent profits though, so theres that.
Never had, nor heard any actual anecdotal evidence of "normal" medical treatment being refused.But it's moot- any treatment I get, if insurance later declines to cover it, isn't my responsibility. It's on the treatment provider, if in network.
J4CKO said:
You are earning, how does the US work for folk that arent earning ? I keep seeing all the idiots getting mashed up at these "Takeover" events, compound fractures, knocked out cold (dead ?) but how would a kid with no money be treated if a Hellcats just done a burnout over him ?
Emergency treatment cannot be refused. If you cannot afford to pay the treatment, tough tittay for the provider (medical debts are almost impossible to pursue now)For folk that aren't earning/poor, there's Medicaid available. Until the repiblicans burn that too.
M.
Drawweight said:
You can’t argue with the number of bankruptcies due to medical bills or the amount of debt due to medical companies no matter how much you spin your personal circumstances.
Yes you might be okay and able to afford it but the numbers say a hell of a lot of folk can’t.
True. But averages (per the start of the post) are as equally unusable comparison. Yes you might be okay and able to afford it but the numbers say a hell of a lot of folk can’t.
Note- bankruptcy is very, very different in the US.
M.
h0b0 said:
Ahh, it may be better to say "use it or lose it". I have an HSA account which is also an investment account.
Used to illustrate "max cost" for the purposes of comparison. On the other hand in the uk, if you don't use the NHS, it's very expensive in terns of tax 
Folks often see the social media posts with huge medical bills, not knowing the actual cost is a percentage of it, usually small.
For example, wife had spinal neurosurgery by a Harvard trained doctor a few months back:
Hospital "sticker price" $21,000
Actual bill insurance got $15,200
Our out of pocket $1,644
M.
Mr Penguin said:
J4CKO said:
NHS doesnt typically bin your claim off as it will dent profits though, so theres that.
No, it just fobs you off instead.Let's say you find a suspicious mole:
You've got to get to your doctor first
Then get a referral for dermatologist
Then appointment for biopsy
Then follow up appointment
Then treatment, if warranted
In the US, your doc would have it biopsied amd you'd have the results the same day, typically
M.
Mortarboard said:
h0b0 said:
Ahh, it may be better to say "use it or lose it". I have an HSA account which is also an investment account.
Used to illustrate "max cost" for the purposes of comparison. On the other hand in the uk, if you don't use the NHS, it's very expensive in terns of tax Folks often see the social media posts with huge medical bills, not knowing the actual cost is a percentage of it, usually small.
For example, wife had spinal neurosurgery by a Harvard trained doctor a few months back:
Hospital "sticker price" $21,000
Actual bill insurance got $15,200
Our out of pocket $1,644
M.
There is a law capping profits.
ChatGPT said:
Medical Loss Ratio (MLR) Rule
Under the Affordable Care Act (ACA):
Insurance companies must spend:
At least 80% of premium dollars on health care and quality improvement for individual and small group plans.
At least 85% for large group plans (usually big employers).
That means they can only keep:
20% (or 15%) of the money for administrative costs, marketing, and profit.
If they under spend, they have to give the money back... soUnder the Affordable Care Act (ACA):
Insurance companies must spend:
At least 80% of premium dollars on health care and quality improvement for individual and small group plans.
At least 85% for large group plans (usually big employers).
That means they can only keep:
20% (or 15%) of the money for administrative costs, marketing, and profit.
ChatGPT said:
Tactics They Use to Hit MLR
Increase provider reimbursements
They may approve more expensive procedures, push claims through faster, or raise what they pay out to hospitals/doctors.
Loosen prior authorizations
Things that usually require more red tape to get approved (like specialty treatments or expensive scans) might suddenly get green-lit more easily.
Boost “quality improvement” spending
This is a key MLR loophole. Insurers are allowed to count spending on things like:
Health education
Preventive services
Case management programs
Near year-end, they might invest more here to pad their MLR-compliant spending.
Delay administrative expenses
They might hold off on bonuses, marketing, or certain overhead costs so it doesn’t eat into the MLR percentage.
I do not know how accurate ChatGPT is on the MLR loophole but I did get a voucher for a free flu shot. Flu shots are already free.Increase provider reimbursements
They may approve more expensive procedures, push claims through faster, or raise what they pay out to hospitals/doctors.
Loosen prior authorizations
Things that usually require more red tape to get approved (like specialty treatments or expensive scans) might suddenly get green-lit more easily.
Boost “quality improvement” spending
This is a key MLR loophole. Insurers are allowed to count spending on things like:
Health education
Preventive services
Case management programs
Near year-end, they might invest more here to pad their MLR-compliant spending.
Delay administrative expenses
They might hold off on bonuses, marketing, or certain overhead costs so it doesn’t eat into the MLR percentage.
Its not exactly a loophole- anyone can get the "negotiated rates" simply by asking, in most cases.
One local prov8der, on all their invoices, has the line "if you do not have insurance, you're entitled to an automatic 25% discount!"
Or put another way, "if you do have insurance, we're automatically charging you 33% more!"
There so much invoice padding, discounts are "easy:
But now medical debts don't count agai st credit scoring in the US. So chances of small bills getting paid are almost zero. Big bills just mean a quick bankuptcy...
M.
One local prov8der, on all their invoices, has the line "if you do not have insurance, you're entitled to an automatic 25% discount!"
Or put another way, "if you do have insurance, we're automatically charging you 33% more!"
There so much invoice padding, discounts are "easy:
But now medical debts don't count agai st credit scoring in the US. So chances of small bills getting paid are almost zero. Big bills just mean a quick bankuptcy...
M.
OutInTheShed said:
Always worth realising there are more than two countries in the world, options beyond the two broken extremes?
I'm not familiar with it, but the French system is supposed to be a kind of "half-way" house.Not free, but low cost, capped treatment costs.
So you don't have a system clogged up with frivolous s
te, but still affordable.M.
I can only speak from my own experience, but the last two times I needed to use the NHS, I was seen within a few hours. Even with regards to an NHS dentist, I got an appointment the next day. I appreciate that's not the case for many, and is merely anecdotal.
That said, one can't simply compare the bare costs of insurance at the outset. Those may be fine, but change dramatically once you start using the system and fall into the position of having a pre existing condition. So yeah, for healthy people, the costs might be comparable but, apparently 60% of Americans suffer from at least one chronic illness, and 40% suffer from multiple.
https://www.rand.org/pubs/articles/2017/chronic-co...
Equally, as you get older, your healthcare requirements increase, as do the insurance costs.
Regardless, I know from friends and relatives in the US that the cost of healthcare is something that it is ever present in their minds, whereas it's not really something we give much thought to here.
My own view is that healthcare shoud be treated no differently to the police, fire service or national security. It's an essential part of any civilised society, which should be paid for centrally, and provided equally to all who need it.
That said, one can't simply compare the bare costs of insurance at the outset. Those may be fine, but change dramatically once you start using the system and fall into the position of having a pre existing condition. So yeah, for healthy people, the costs might be comparable but, apparently 60% of Americans suffer from at least one chronic illness, and 40% suffer from multiple.
https://www.rand.org/pubs/articles/2017/chronic-co...
Equally, as you get older, your healthcare requirements increase, as do the insurance costs.
Regardless, I know from friends and relatives in the US that the cost of healthcare is something that it is ever present in their minds, whereas it's not really something we give much thought to here.
My own view is that healthcare shoud be treated no differently to the police, fire service or national security. It's an essential part of any civilised society, which should be paid for centrally, and provided equally to all who need it.
Ive have used health care in both countries.
Had an emergency operation due to a work injury in the us, the treatment was outstanding, i was in and out the same day, required surgery and a pin or two. Nice hospital, no waiting at all, very impressed, but at a cost, luckily i was insured, i did see the bill and it was eye watering.
In the uk ive also had a similar injury, and it took six months to be fully treated, for instance i had to wait 2 months for an operation.
So no comparison there,
The treatment was free at the point of use for me in the uk tho, although i had been paying all my taxes for 30 years prior, so not free.
The experience in the us was almost nice, ignoring the pain, the experience in the uk was horrendous and frustrating. And cost me almost a year of not being able to work.
However in the us insurance doesnt cover everything.
I did hear that Christopher Reeve, the old superman actor, died broke after he broke his neck, and im sure he wasnt a poor man.
So there are pros and cons to both.
I do think that alot of the problems in the uk are caused by the misconception that health care is free, so people over use the service for things that really the nhs shouldnt be funding.
I know of a few cases like this, a lady i used to work with managed to get a boob job on the nhs, another got IVF on the nhs,
Just two instances that in my opinion they should have had to go private for.
But some might argue that me having a work injury treated on the NHS should have been private aswell, so its a fine line.
Had an emergency operation due to a work injury in the us, the treatment was outstanding, i was in and out the same day, required surgery and a pin or two. Nice hospital, no waiting at all, very impressed, but at a cost, luckily i was insured, i did see the bill and it was eye watering.
In the uk ive also had a similar injury, and it took six months to be fully treated, for instance i had to wait 2 months for an operation.
So no comparison there,
The treatment was free at the point of use for me in the uk tho, although i had been paying all my taxes for 30 years prior, so not free.
The experience in the us was almost nice, ignoring the pain, the experience in the uk was horrendous and frustrating. And cost me almost a year of not being able to work.
However in the us insurance doesnt cover everything.
I did hear that Christopher Reeve, the old superman actor, died broke after he broke his neck, and im sure he wasnt a poor man.
So there are pros and cons to both.
I do think that alot of the problems in the uk are caused by the misconception that health care is free, so people over use the service for things that really the nhs shouldnt be funding.
I know of a few cases like this, a lady i used to work with managed to get a boob job on the nhs, another got IVF on the nhs,
Just two instances that in my opinion they should have had to go private for.
But some might argue that me having a work injury treated on the NHS should have been private aswell, so its a fine line.
QJumper said:
My own view is that healthcare shoud be treated no differently to the police, fire service or national security. It's an essential part of any civilised society, which should be paid for centrally, and provided equally to all who need it.
That's filthy commie radical lefty talk. M.
richhead said:
But some might argue that me having a work injury treated on the NHS should have been private aswell, so its a fine line.
Interestingly, in Ireland it's now commonplace that a&e will ask if the injury was caused in an insurable incident, such as workplace or traffic accident, with a view to billing the responsible party.Its an understandable approach. Why should the taxpayers subsidize the negligent actions of third parties...
M.
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