Topic: Free/universal healthcare (non Americans)

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Posted on: Feb 8, 2021 03:57PM

Posted on: Feb 8, 2021 03:57PM

illimae wrote:

This is not a political debate post but as the US considers future healthcare options, I have questions for those of you from countries that already provide it.

1. What country are you from?

2. Are you able to choose your doctor and hospital or are you assigned to one?

3. Are tests and results scheduled in a timely manner, like two weeks?

4. Do people generally agree that the higher income tax rates are a fair trade for the medical benefits? (I only ask this because I can’t see how it would be possible to provide it without raising taxes)

5. What’s the best/worst things about your healthcare system?

Thanks for sharing your experiences :)

Diagnosed at 41 Stage IV De Novo Dx 11/16/2016, IDC, Left, 5cm, Stage IV, metastasized to bone, Grade 3, 3/13 nodes, ER+/PR-, HER2+ Chemotherapy 1/2/2017 Abraxane (albumin-bound or nab-paclitaxel) Targeted Therapy 1/2/2017 Herceptin (trastuzumab) Targeted Therapy 1/2/2017 Perjeta (pertuzumab) Surgery 6/26/2017 Lumpectomy; Lumpectomy (Left); Lymph node removal Radiation Therapy 8/10/2017 Breast, Lymph nodes Dx 10/5/2017, IDC, Left, 5cm, Stage IV, metastasized to brain, Grade 3, 3/13 nodes, ER+, HER2+ Radiation Therapy 10/20/2017 External Local Metastases 10/20/2017 Brain Radiation Therapy 4/18/2018 External Local Metastases 4/18/2018 Brain Radiation Therapy 5/23/2019 External Local Metastases 5/23/2019 Brain Surgery 1/22/2020 Radiation Therapy 2/17/2020 External Local Metastases 2/17/2020 Brain Radiation Therapy 7/20/2020 External Local Metastases 7/20/2020 Radiation therapy: Bone Radiation Therapy 12/4/2020 External Local Metastases 12/4/2020 Brain Targeted Therapy Tukysa (tucatinib) Chemotherapy Xeloda (capecitabine) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Feb 11, 2021 11:50AM beesie.is.out-of-office wrote:

The thing that you have to keep in mind is that even if there was a perfect system out there in some other country, the U.S. would not be able to replicate it.

Any system that already exists somewhere else has decades of history behind it. In Canada, for example, our healthcare act passed in 1968 and we've had universal health care implemented in all provinces since 1971. What this means is that during the early decades baby boomers were barely using the system but they have been paying into this system through their taxes for all of their working lives. Starting a new single payer system now, when baby boomers are older, many retired, and many heavily using the healthcare system, would be a completely different dynamic with very different financial and coverage implications.

You also have to consider that the U.S. has a huge medical infrastructure and millions of people in the medical and medical insurance industries. The U.S. system is completely different than what any other country has. Whatever changes the U.S. makes will have to be built up from the existing system which obviously means that what results will be different than what's in other countries.

Lastly, every system is dependent on decisions made by politicians and bureaucrats and medical interest groups. Even with identical systems, the decisions of the politicians in one area will be different than the decisions of the politicians in another area. We see that in Canada in how our healthcare systems differ by province. Here in Canada we are able to pick our own doctor (I think this is true in all provinces). Doctors may be full and not taking new patients, but no doctor can refuse a universal healthcare patient (since every patient in Canada is a universal healthcare patient). Would the same decision be made in the States? To my understanding, you already allow doctors to not take patients on Medicare (I think; my info is old on this, from my parents lived in the U.S. 10+ years ago and my Dad complained that fewer and fewer doctors were accepting Medicare patients) and patients with insurance are restricted to doctors within their network. Doesn't seem like a stretch then to think that with a single payer system, the U.S. might implement restrictions on which doctors patients can see.

The U.S. should have acted decades ago. Hillary-care. Don't know how you implement something now without drastic harm (financial, employment) to some industry or interest group.


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Feb 11, 2021 02:10PM illimae wrote:

All good points Bessie. It’s much more complicated than most realize, myself included.

Diagnosed at 41 Stage IV De Novo Dx 11/16/2016, IDC, Left, 5cm, Stage IV, metastasized to bone, Grade 3, 3/13 nodes, ER+/PR-, HER2+ Chemotherapy 1/2/2017 Abraxane (albumin-bound or nab-paclitaxel) Targeted Therapy 1/2/2017 Herceptin (trastuzumab) Targeted Therapy 1/2/2017 Perjeta (pertuzumab) Surgery 6/26/2017 Lumpectomy; Lumpectomy (Left); Lymph node removal Radiation Therapy 8/10/2017 Breast, Lymph nodes Dx 10/5/2017, IDC, Left, 5cm, Stage IV, metastasized to brain, Grade 3, 3/13 nodes, ER+, HER2+ Radiation Therapy 10/20/2017 External Local Metastases 10/20/2017 Brain Radiation Therapy 4/18/2018 External Local Metastases 4/18/2018 Brain Radiation Therapy 5/23/2019 External Local Metastases 5/23/2019 Brain Surgery 1/22/2020 Radiation Therapy 2/17/2020 External Local Metastases 2/17/2020 Brain Radiation Therapy 7/20/2020 External Local Metastases 7/20/2020 Radiation therapy: Bone Radiation Therapy 12/4/2020 External Local Metastases 12/4/2020 Brain Targeted Therapy Tukysa (tucatinib) Chemotherapy Xeloda (capecitabine) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Feb 11, 2021 02:44PM flashlight wrote:

Most doctors/hospitals in the US accept Medicare patients. Doctors/hospitals/nursing homes can limit their Medicaid patients because they don't receive any financial benefit. Usually they will lose money. Hospitals are able to make money off of private insurances that helps to balance out the reduced cost that Medicare offers. Yes, its so confusing.

Dx 11/15/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR-, HER2- Dx DCIS, Left, <1cm, Stage 0, Grade 1, 0/1 nodes Radiation Therapy Whole breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lumpectomy: Left
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Feb 11, 2021 02:59PM exbrnxgrl wrote:

Remember too that most who belong to unions bargain for health care so it is treated as a contractual negotiating point. That makes things even more complex!
Dx IDC, Left, 4cm, Stage IV, Grade 1, ER+/PR+, HER2-
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Feb 11, 2021 03:08PM summerangel wrote:

My parents are 81 and 83 and they have difficulty finding doctors who accept Medicare, so I wouldn't say "most" accept Medicare.

Healthcare has been an interest of mine for many years. I think it started when I was 22 and working in retail and a middle-aged man I worked with told me he would never retire and never have any money because he would be paying off his wife's cervical cancer treatments. She died from the cancer. I was so shocked and sad for him it triggered my interest.

When I was working as a consultant I traveled to Germany a few times. I specifically spent time asking the people around me how they felt about their healthcare system and what it was like. Those I worked with were very happy with it and said they would never trade what they had for what we have in the US. Granted, I have no idea if any of them had ever experienced a serious health issue or not, but that's what they said.

Age at dx: 45. Oncotype, left-side tumor: 9. Right side had multifocal IDC and "extensive" LCIS. Isolated tumor cells in 1 right-side node. Dx 3/27/2015, IDC, Left, 2cm, Stage IIA, Grade 1, 0/3 nodes, ER+/PR+, HER2- Dx 4/27/2015, IDC, Right, 1cm, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 6/1/2015 Lymph node removal; Mastectomy; Mastectomy (Left); Mastectomy (Right) Surgery 6/1/2015 Reconstruction (Left): Tissue Expander; Reconstruction (Right): Tissue Expander Surgery 8/28/2015 Reconstruction (Left): Fat grafting, Silicone implant; Reconstruction (Right): Fat grafting, Silicone implant Surgery 12/4/2015 Reconstruction (Left): Fat grafting, Nipple reconstruction; Reconstruction (Right): Fat grafting, Nipple reconstruction
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Feb 11, 2021 03:14PM olma61 wrote:

illimae, I learned a lot about healthcare around the world in a couple of Facebook groups about health care policy, which have since gone dark, unfortunately. They were not specifically focused on cancer care, either, but still incredibly informative.

Kaiser Health News (khn.org) is a good source if you really want to dive in deep to US health policy news.

I would love to hear more from people here about cancertreatment in other countries, especially Germany and Switzerland. Even though, in the end, it is true, whatever continues to develop here is going to be unique to the USA, building on our current health care system and within the bounds of what is possible politically.

10/30/2017 Xgeva for bone mets 5/31/2018 Taxol finished! "If one just keeps on walking, everything will be all right” - Kierkegaard Dx 8/3/2017, IDC, Right, 2cm, Stage IV, metastasized to bone, Grade 2, ER+/PR+, HER2+, IHC Targeted Therapy 10/28/2017 Perjeta (pertuzumab) Targeted Therapy 10/28/2017 Herceptin (trastuzumab) Chemotherapy 10/30/2017 Taxol (paclitaxel) Hormonal Therapy 5/14/2018 Arimidex (anastrozole) Radiation Therapy 5/30/2019 External Local Metastases 5/30/2019 Radiation therapy: Bone
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Feb 11, 2021 03:16PM exbrnxgrl wrote:

SummerAngel, I agree that, increasingly, people are finding fewer and fewer doctors who will accept Medicare. This will be a big problem going forward

Dx IDC, Left, 4cm, Stage IV, Grade 1, ER+/PR+, HER2-
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Feb 11, 2021 04:40PM mightlybird01 wrote:

I am German, but have lived in the US for some 15 years now, and when I was still living and working in Germany (I left Germany when I was 35) I hardly ever was sick. So my experience is limited, yet I have 2 80 year old parents and my sister and her family still live in Germany and I know what they experience.

In Germany, we have 2 types of health insurance, one is "universal" and one is privat. Every person has to have one or the other. If your job is well paying you can choose the private insurance otherwise you have to have the universal. Even within the universal, there are several policies but they are rather similar. If you don't have a job and no means to pay for the health insurance via savings or pension the "Bundesversicherungsanstalt für Arbeit" (a governmental organization) will pay it for you.

I calculated the costs for universal health care based on a 3,000.- EUR salary before tax (see below). The employee pays 1/2 and the employer the second half. In total, the monthly cost is 290.25 EUR (and the same amount is paid by the employer). The price is calculated based on income. The more you earn the more you pay (currently 15% of your income before tax). There are no deductibles and the patient never sees any bill. One can go and see any Dr. at any time. There are no in "in network" or "out of network Drs". Also as far as I know you don't need a referral for a specialist. However, it sometimes can be a wait times for specialized Drs. That's were the private insurance comes in a bit better, Drs. usually prefer private patients because they can charge more for their services. When I was still working in Germany, I had a well paying job so I chose the private insurance, which has a slightly higher monthly premium and a deductible (which I could choose on my own). The higher the deductible, the lower the monthly cost. When I needed an appointment and I was told the next available would be in 3 weeks, I said I was a private patient and so my next appointment was usually available within 1 week. Usually one can get an appointment within 3-4 weeks for any sort of Dr. even as a universal health patient. If it is an emergency, one can get it much quicker, or obviously can go straight to the hospital.

My mother has universal health insurance, but she has a private "supplement", which allows her a few extra perks, such as single rooms in the hospital and extended sick pay, and for her, because we live at the Swiss border, she can also go to Switzerland for treatment if she wishes to do so.

From what my parents tell me, in recent years there are fewer and fewer small local practices and more and more large centers, which means longer travel for them and navigating new places. For example, she told me that in our home town of 30,000 people no longer has a local gynecologist. Local family Dr. getting rarer and rarer too, many also prefer to work in Switzerland where salaries are higher. Opticians the same thing. My mom's optician retired recently and none of the other close-by opticians would take on any new patients when she called. In this case, one can call the insurance and they have to find a Dr. for you. They will then make the appointment. Drs. cannot refuse a patient, at least in theory.

I guess the biggest thing right now in Germany is the tendency that the small local offices disappear. But on the other hand, large new modern centers arise, but they require more travel and maybe for the elderly not as convenient. Germans like to do things local :-)!


But overall, Germans are very satisfied with their health care, I have never met anyone who had any dept from paying of medical bills, no matter what sickness they had. Also the premiums are universally accepted. The more you earn the more you pay seems fair to everyone. It has always been that way, so noone really questions it.






Ihr voraussichtlicher monatlicher Beitrag zur Kranken- und Pflegeversicherung 219,00 EUR Krankenversicherung (7,3 %)

Sie und Ihr Arbeitgeber teilen sich den Beitrag zur Krankenversicherung. Jeder von Ihnen zahlt 7,3 %, berechnet auf Ihre Bruttoeinnahmen.

18,00 EUR TK-Zusatzbeitrag (0,6 %)

53,25 EUR Pflegeversicherung für kinderlose Mitglieder ab 23 Jahren (1,775 %)

290,25 EUR Gesamtbeitrag


Dx 4/12/2019, IDC/IDC: Medullary, Right, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2- Chemotherapy 5/21/2019 AC + T (Taxol) Surgery 11/8/2019 Mastectomy; Mastectomy (Right)
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Feb 11, 2021 05:46PM hapa wrote:

Great topic Mae! I'm just starting the process of qualifying for Portuguese citizenship and I am wondering how their healthcare system compares to ours. My impression is that if you are poor, young, and/or have a chronic condition, you are probably better off with universal healthcare. If you are wealthy or have something really weird or rare, the care you get with an employer-funded health plan in the US is really hard to beat. This is because most large employers are actually self-insured -- your company foots the bill, the insurance company on your card is just an administrator. So they'll approve everything because they're not paying. But if you have a standard, marketplace plan with the same insurance company getting things covered is a whole different story.

My plan is to retire in Europe and if my cancer comes back to go through treatment there. When things get sticky and I've run through several treatment options, I may want to come back to the US because as far as I can tell we get access to the newest treatments first.

Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2- Targeted Therapy 3/28/2018 Herceptin (trastuzumab) Targeted Therapy 3/28/2018 Perjeta (pertuzumab) Chemotherapy 3/28/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 8/22/2018 Lymph node removal; Lymph node removal (Right): Underarm/Axillary; Mastectomy; Mastectomy (Right); Prophylactic mastectomy; Prophylactic mastectomy (Left); Reconstruction (Left): Silicone implant; Reconstruction (Right): Silicone implant Radiation Therapy 10/22/2018 Whole breast: Lymph nodes, Chest wall Hormonal Therapy 12/21/2018 Arimidex (anastrozole), Zoladex (goserelin) Targeted Therapy Nerlynx
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Feb 11, 2021 08:37PM - edited Feb 11, 2021 08:38PM by minustwo

Yes, Mae - great topic. I am on Medicare and chose to stay with the traditional (original) plan rather than move to an "advantage" plan when they were developed.

With traditional Medicare, I also pay for a Medigap policy that covers the 20% Medicare doesn't pay. Between the two policies, I have not paid anything else except the yearly deductible that was $183 last year. That said, there are several Medigap policies you can choose with different rules. Example - some require a $20 deductible for each visit. But there are no "gatekeepers" and I don't need a referral for any kind of specialist.

In 11 years I have never found ANY docs who wouldn't accept Medicare. The only exception was my old PCP who converted to be a "concierge" doctor. You paid something like $1500 each year (in addition to regular costs) and were guaranteed a personal answer or appointment immediately. Needless to say, I found a new PCP. I live in a big city so finding docs who accept Medicare may be different in a rural area.

The Advantage plans cover more services for less money, but usually requires you to be part a specific network. If the doc you like isn't in that network, its not covered. And you have to have a referral from a primary care physician before you see a specialist. Hopefully I'll be able to continue with my current plan and have treatment wherever I want.

Not mentioned yet is Long Term Care. When those insurance policies were instituted, I was unable to afford the premiums. And premiums have continued to increase exponentially, which most of us didn't understand to be part of the original deal. Many people have dropped out as premiums increased. I'm still unable to afford Long Term Care insurance. Medicare does NOT pay for nursing homes for very long - 90 days maybe now?? And it does not pay for home care. I have no idea what I'll do when I can no longer take care of myself. I just keep sticking my head in the sand.

Sorry - didn't mean this to be so long. One last note - I have some 50 year old friends who took early retirement and moved to Panama. They love the health care set up there. Of course neither has ever been sick yet.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014

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