livi the fluffer;)...or any other European M.D.

[Dueller]

As you furners can see, affordable health care is a big issue in the United States, especially with the elections looming. How would you rate the health care system in your country or compare it to ours if you have that insight? I don't want to get too personal, but what kind of lifestyle do doctors lead there?

Our system is so market driven, particularly with respect to pharmaceutical companies (I can buy non-generic meds 60+% cheaper if I go thru internet to Canada. There are generics available in Canada that won't be available for another 5 years here because of the pharmaceutical companies' stranglehold on our legislators.). And while many MD's here earn a decent living, some are just making money like they have a primting press in the backroom. Just curious about your views on your system vs USA's...

I really can only justify catastrophic coverage ($10K deductible) for my wife and myself...we just don't get sick or go to the doctor unless we are on our deathbed. And even at that my private insurance is pushing $1000/month. We "bargain shop" for special offers from clinics for routine stuff like annual physicals, blood work check ups, etc.

[Dueller]

livi...you up?

[livi]

Oui, but working. Completely clogged waiting room. Let me get back to you when I have got rid of all the little brats.

[Dueller]

Well THAT may have just answered my question

Thanks

[MFAFF]

Dueller,

There is no simple answer...

When you talk about a 'health care system' you are covering a vast amount of ground, any or all of which can be used to demonstrate which is better....or worse..

So I'll try to break it down a bit..

1) Emergency Room Care. Having done both I'd say they are broadly equal in the time spent, type and level of care etc etc.. but with private care you do get a bill for it.. and the time spent dealing with that negates any time advantage that you might have over getting treatment...

2) Non Emergency Care ( Like going to see the family doc becuase you are sick).. In the UK the system is creaking and groaning at the seams.. or so it would appear, however recently I had a chest infection and ya know what.. I was able to see the Doc the next morning... a 'walk in service operates at my local surgery from 0830 to 1030 with a first come first served basis...now admittedly there are soemthing like 10 Docs on duty and so a couple take this whilst the others service the appointments. No choice as to who to see. but for the vast majoirty of simple health issues its not a problem. A decent medic can do the simple tests and establish the needs and do the meds.. A specialist would have been unnecessary, in fact I'd argue that a General Practitioner is the right Doc to see...the antiboitics did the trick preventing a worsening of the condition that would have required specialist attention. The experience I had in the Us (lived there for 5 years) was that getting this level of treatment was no easier, possibly more difficult than in the UK. Plus not funding issues to deal with either at the time or later...

3) Specialist Needs.
No question the US model provides quicker access to a wider number of specialists than the U model. Choice of doc, choice of location etc far better. Quality of Docs themselves is essentially the same, but access to the correct one far easier in hteUS.. aclear advantage there.

4) Elective Hospital Treatment.
Elective treatment... ie you make a clear, informed choice to have an operation, be it galls stone or heart transplant. I'd say that as access to the medics is easier in the US getting this is easier...and hence would qualify as better. However breaking this down further you'd have to look at critical elective and non critical elective... if you need a heart transplant is pretty much the same everywhere.. it gets ddone when you get a donor... a bit less clear with cardiac surgery where here the lists are the limiting factor...well aminly the post op critical care facilities but that's another story. For orthopeadic ops the Us win hands down.. far more avaliabiltiy and choice. yet the quality of all the medical treatment is essentially the same.

5) Hospital Care.
The 'hotel aspects' of US hospitals are leagues ahead... food, private rooms et al... but in terms of nursing care there are too many similarities to call a winner.

6) Chronic (Long Term Care)
Such a cancer etc...I'd say the greater access to choice makes this a winner for the US model...the same applies to mental health care.. its there if you want to afford it...in the UK its often not there.

Now factor in your costs.... you state that its costs you (family cover I assume) $1000/ month in premiums per month from taxable income... out of gross that's what $1250? or so....so $15K per year.

As a comparator my tax burden (based on 40% tax rate in the UK...and dual income at $120K plus) gives a rate, (using the published % of GDP ) of $8000 per year for the family cover.

Now granted there are some very big wins with the US system that need to be funded, but for a young family basically in good health (with one exception) this the UK system not only represents a correct level of provision but good value for money (IMO).

To ge tthe same level of access and so forth as the US I would need to spend somehting like.. wait for it $200 per month extra...for the family.. This out of taxable income this totals up to an extra $5000 per year.

So as broadly as we can.. to achieve a similar level of cover it costs you $15K... and it costs me $14K.

So the additional spend it mine to make or not make....nice to have the choice.

[livi]

Right. It is lunch time here now, so I simply declared them all well and threw them out.

Now, traditionally in a semi-socialistic system like Sweden, the money for both the health care and the staff comes from tax money. Doctors make decent money, but not more. At least after reaching consultant level. We can afford a reasonably good living but absolutely no extravagance. I live in a fairly expensive house, but I could never afford for example a brand new Porsche. No way.

We have had a lot of good debates on OT regarding our different health care systems. I like many aspects of a more capitalistic system like yours, but the older I get, the more I appreciate our health care system. The median level of resources and quality is pretty high AND homogeneous. That means, where ever you live in Sweden, you will have access to pretty much equally good care.

Furthermore, as the basic principal is that equal access to equally good health care should apply to everyone, the cost for the patient is virtually nothing. A heart transplant will not cost more than a common cold.

Regarding medications from pharmacies, we have a "cost-roof", so no matter how much or expensive medicine you need you will not have to pay more than a certain sum per year and person. Currently that max sum is approximately $300.

Hence, we do not need any insurances at all in this aspect.

[KFC911]

I don't mean to hijack this thread, but I'm going to exit "corporate america" in a few months, and will be looking for "private insurance" to replace the health benefits that I currently have. I've always been healthy (I'm 47), other than knee surgeries, etc. but this is something that I need to start investigating. I have no problem with a "high deductable", and really just want to protect myself from the BIG $ costs that "can" wipe out a lifetime's worth of effort. Suggestions, etc. would be most appreciated. (I'm single w/ no dependents if that matters). Thanks in advance!

[onewhippedpuppy]

Markus, interesting that there aren't huge financial rewards for doctors in Sweden. I'm sure you realize that this is not the case in the USA, so come on over. Seriously though, without financial incentives, what is the primary motivation to be a doctor in Sweden?

This might sound a bit callous, as I'm sure being a doctor is a very fulfilling career. However, at least in the states, most MDs dedicate at least 8 years and over $100k towards becoming a doctor. On the upside, the years of hard work and big school loans pay off with a $100k+ salary. I assume you have to make the same sacrifices, so where is the payoff?

[Tobra]

Originally Posted by KC911

I don't mean to hijack this thread, but I'm going to exit "corporate america" in a few months, and will be looking for "private insurance" to replace the health benefits that I currently have. I've always been healthy (I'm 47), other than knee surgeries, etc. but this is something that I need to start investigating. I have no problem with a "high deductable", and really just want to protect myself from the BIG $ costs that "can" wipe out a lifetime's worth of effort. Suggestions, etc. would be most appreciated. (I'm single w/ no dependents if that matters). Thanks in advance!

three words for you

Health Savings Account

Bank the money you would spend on premiums. For a 47 yo man, an individual policy would be exorbitant.

[KFC911]

Thanks Tobra! As stated, I've always been healthy, and wouldn't have a problem banking away 10-20K (or whatever is appropriate), but how does that protect oneself from a HUGE (say hundreds of thousands) expenses that can happen in a heartbeat (or lack thereof ). This causes me more concern than almost anything (terrorism, etc.) as I've alway been covered by my employer and sure don't want an "unexpected" to liquidate everything I've worked for all these years.

[onewhippedpuppy]

Isn't there insurance available for major procedures only? Something like that coupled with a health savings account might be perfect.

[Drdogface]

Markus,
Many years ago I had a long term relationship, albeit distant, with a Swedish lady from Goteborg. I visited many times and met many of her colleagues who were MD's. They would work the first four months of the year and then head for Spain to live for the rest of the year on what they'd saved because their taxes were so high it didn't pay them to work...like 90%.. or so I was told.

Is this still the case? Of course Spain is not as cheap as it used to be under Franco but still cheap by comparison I would expect.

[TheMentat]

Originally Posted by onewhippedpuppy

Markus, interesting that there aren't huge financial rewards for doctors in Sweden. I'm sure you realize that this is not the case in the USA, so come on over. Seriously though, without financial incentives, what is the primary motivation to be a doctor in Sweden?

This might sound a bit callous, as I'm sure being a doctor is a very fulfilling career. However, at least in the states, most MDs dedicate at least 8 years and over $100k towards becoming a doctor. On the upside, the years of hard work and big school loans pay off with a $100k+ salary. I assume you have to make the same sacrifices, so where is the payoff?

For one thing, the education is MUCH cheaper in Canada (I'm pretty sure this is the case in Sweden as well). Secondly, when evaluating the monetary rewards for a particular line of work, one has to consider the risks as well. $100,000K per year is pretty darn good for a job that essentially recession-proof.

[Dueller]

Originally Posted by KC911

I don't mean to hijack this thread, but I'm going to exit "corporate america" in a few months, and will be looking for "private insurance" to replace the health benefits that I currently have. I've always been healthy (I'm 47), other than knee surgeries, etc. but this is something that I need to start investigating. I have no problem with a "high deductable", and really just want to protect myself from the BIG $ costs that "can" wipe out a lifetime's worth of effort. Suggestions, etc. would be most appreciated. (I'm single w/ no dependents if that matters). Thanks in advance!

Keith...

First you want to contact your HR dept before you resign as you will be entitled to maintain your current coverage under COBRA for 18 months...at your expense of course. That will give you a baseline as to cost. Usually pretty high.

Keep in mind the Health INSURANCE industry has a lot of different products....catastrophic coverage with an HSA could work for you, but finding a carrier can be a bit of a pain. At your age/good health you're probably looking at $400-550/mo for full coverage with a major carrier and a reasonable deductible but that's a WAG. Also keep in mind that you'll be paying with pre-tax dollars if you're self employed.

[Dueller]

Originally Posted by Tobra

three words for you

Health Savings Account

Bank the money you would spend on premiums. For a 47 yo man, an individual policy would be exorbitant.

Yobra...If I'm not mistaken an HSA must be coupled with a policy albeit with a high deductible.

[notfarnow]

Originally Posted by TheMentat

For one thing, the education is MUCH cheaper in Canada (I'm pretty sure this is the case in Sweden as well). Secondly, when evaluating the monetary rewards for a particular line of work, one has to consider the risks as well. $100,000K per year is pretty darn good for a job that essentially recession-proof.

My sister-in-law is in med school in nova scotia right now, she'll be graduating with ~100k of debt, how does that compare to US med school?

[livi]

Originally Posted by onewhippedpuppy

Markus, interesting that there aren't huge financial rewards for doctors in Sweden. I'm sure you realize that this is not the case in the USA, so come on over. Seriously though, without financial incentives, what is the primary motivation to be a doctor in Sweden?

This might sound a bit callous, as I'm sure being a doctor is a very fulfilling career. However, at least in the states, most MDs dedicate at least 8 years and over $100k towards becoming a doctor. On the upside, the years of hard work and big school loans pay off with a $100k+ salary. I assume you have to make the same sacrifices, so where is the payoff?

Interesting question. I donīt think anyone choose to work in health care for the money. You want to be a doctor/nurse and simply accept that you will not be rich in the process. The incentives lies within the reward of the daily work. But to be honest, it is not that bad money. Everything is relative. I have eight years of training and twelve years working after that. I am a senior consultant and make the equivalent of around $100,000 a year before tax which is roughly 40-50%.

[livi]

Originally Posted by Drdogface

Markus,
Many years ago I had a long term relationship, albeit distant, with a Swedish lady from Goteborg. I visited many times and met many of her colleagues who were MD's. They would work the first four months of the year and then head for Spain to live for the rest of the year on what they'd saved because their taxes were so high it didn't pay them to work...like 90%.. or so I was told.

Is this still the case? Of course Spain is not as cheap as it used to be under Franco but still cheap by comparison I would expect.

'Many years ago' the situation was different. The doctor had a regular monthly salary, but on top of that they were paid directly by the patient for each consultation. My recently retired father is also a pediatrician and he made very good money in his hey days. He also made several working trips to Saudi Arabia, Yemen and other arab countries - making a bundle of cash.

As it happens, my parents have had a nice villa in south of Spain since the early 70īs.

[onewhippedpuppy]

I'm sure most people in health care don't go into it for the money, but many people do a cost/benefit analysis when choosing a career field. I enjoy engineering, but wouldn't suffer through 5 years of hellish classes without knowing that there was good pay and a favorable job outlook waiting for me. With the current demand for doctors and nurses in America, you not only get the satisfaction, but also excellent pay and a guaranteed job.

Are the costs of medical school as high in Sweden? From what I have heard, as well as my pre-med sister-in-law, in the USA it seems to average around $150k by the time you are complete.

[TheMentat]

Originally Posted by notfarnow

My sister-in-law is in med school in nova scotia right now, she'll be graduating with ~100k of debt, how does that compare to US med school?

Perhaps you could ask some of our American compatriots here, but I can assure you that the subsidies that you and I pay for lessen the financial burden on students in our country.