While I do think our health care system is top notch, I doubt that it is that much better than Southern Californias
Hmm. I guess you haven’t experienced the US healthcare system. It’s one of the principal factors motivating our move back to France. For sure excellent health care exists in the US. That’s probably true of say Vietnam or Russia or Mongolia too. The question is, can you access it? Something like 20% of people have NO health insurance, and given that these are typically the poorest people, they can’t afford to pay for it if they get sick. As one minimum wage worker said when I asked him how he dealt with this, “I just don’t get sick.”
Even if you do have insurance, healthcare quality is very mixed and mostly not very good. The system is primarily focussed on (a) making money (b) not getting sued (c-z) making money. The only good doctor I have had in the US was French (sadly moved away now), and worked outside the insurance system. $200 for a visit, but luckily we can afford that. I have Medicare now (mandatory for over 65), and I have yet to have it actually pay for anything.
Going back to Covid itself… it’s interesting that here in the US, I don’t think I know or even know of anyone who has had it, in my own small circle of friends etc (apart from myself, before it became known – caught prob99 on a flight from HKG). But in England, I think everyone I know has at least been in contact with someone who has shown convincing symptoms. Almost nobody has been tested though.
Peter wrote:
The word “pikey” is also likely to get you beaten up. The correct one is “traveller community”. The most correct one is to avoid all discussion of it (but sms the local farmers when you see the vehicle train heading for your village)
I think you will find the Romanies get upset about the Gypsies, and the Gypsies think they are better than the Didicoys, they all think they are better than the travellers and they all refuse to acknowledge the Pikeys. 
Do you remember this;
johnh wrote:
I guess you haven’t experienced the US healthcare system. It’s one of the principal factors motivating our move back to France.
Ho Hum. US healthcare, in my experience, provides truly outstanding healthcare to those who are competent and proactive in engaging with it. My mother is a good example of care over 65, at age 88 she had major back surgery paid by Medicare, several weeks in hospital, unbelievable thoroughness in my view in every stage of the year long preparation and treatment, now with very satisfactory end results. Basically they installed a long rod to support a completely worn out spine that was causing immobility and pain. I have never been so impressed with the thoroughness of any healthcare procedure, or any healthcare providers.
FWIW, every European resident I know personally in the US feels the same way, including for example my wife’s German ‘girlfriend’ who has had an unusual form of cancer for fifteen years, with endless treatment including experimental stuff at places all over the country, plus surgeries, paid for by insurance after max. annual out of pocket expenses were exceeded. It’ll get her in the end, but the efforts put forth and paid on her behalf have been truly outstanding.
Coincidentally this was hashed out at our house recently with a Danish couple we know, who agreed that the main issue with Europeans on the receiving end of US healthcare is their passive disengagement.
johnh wrote:
While I do think our health care system is top notch, I doubt that it is that much better than Southern CaliforniasHmm. I guess you haven’t experienced the US healthcare system. It’s one of the principal factors motivating our move back to France. For sure excellent health care exists in the US. That’s probably true of say Vietnam or Russia or Mongolia too. The question is, can you access it? Something like 20% of people have NO health insurance, and given that these are typically the poorest people, they can’t afford to pay for it if they get sick. As one minimum wage worker said when I asked him how he dealt with this, “I just don’t get sick.”
Even if you do have insurance, healthcare quality is very mixed and mostly not very good. The system is primarily focussed on (a) making money (b) not getting sued (c-z) making money. The only good doctor I have had in the US was French (sadly moved away now), and worked outside the insurance system. $200 for a visit, but luckily we can afford that. I have Medicare now (mandatory for over 65), and I have yet to have it actually pay for anything.
Everyone I know in the States had very good health care cover, and it is very costly.
I never entirely understand for those that dont, exactly what happens? Lets say you have zero inusrance and become a) ill, and b) serioulsy and life threatenignly ill, what truly are your options? And what happens in retirement for those whos savings gradually ebb away and they can no longer afford health insurance cover?
I knew a chap who had a company that helped recover healthcare costs from the government. He stated that the government spending on healthcare was tremendous. He made a lot of money going to hospitals and improving money recovery from the government for a small percentage.
Basic healthcare as I understand it is provided free (i.e. they’ll keep you alive)
In terms of difficult stuff and high end care America seems to lead the way, especially for 5 year cancer survival figures (or at least it did when I had a look at them)
Fuji_Abound wrote:
Let’s say you have zero insurance and become a) ill, and b) seriously and life threatening ill, what truly are your options? And what happens in retirement for those whose savings gradually ebb away and they can no longer afford health insurance cover?
Lots of parallel solutions, most requiring engagement. I’ll do my best:
People over age 65 are covered by Medicare, Federally paid medical insurance, with the exception of illegal aliens. Retired military and government workers have their own parallel systems, often available regardless of age.
For low or zero income people under 65 who are not covered by a family member’s insurance, there are multiple overlaying systems. The first stop is highly (actually progressively) state (with a small s) government subsidized commercial health insurance for which those having higher income don’t qualify. In parallel different state run systems pay for low income people who have not properly taken advantage of that option – an acquaintance of mine received $1M of treatment by that method after letting his insurance lapse and falling off his motorcycle while under the influence. He was actually a better person after they finished, in many ways, and was rehabilitated. Then he did it again, and they paid again but the results were never going to be satisfactory. Eventually he fell down the stairs at his house while drunk and died.
Again in parallel, hospitals individually cannot deny basic treatment (including for those who are illegally resident in the country) with treatment written off against their taxes so that government ends up paying for it.
Fuji_Abound wrote:
Everyone I know in the States had very good health care cover, and it is very costly.
Might say more about the people you know than about the US health system ;-)
Seriously: US health system is one of the best in the world on average but also one with the largest spread on quality and access. US private pilots in general and such US private pilots that network with European pilots in particular might typically not be at the lower end of health system experience.
Fuji_Abound wrote:
I never entirely understand for those that dont, exactly what happens? Lets say you have zero inusrance and become a) ill,
Most likely you will get no treatment and hence get more ill until your illness starts to affect your capability to earn your living resulting in social decline and getting even more ill
and b) serioulsy and life threatenignly ill, what truly are your options?
You die.
And what happens in retirement for those whos savings gradually ebb away and they can no longer afford health insurance cover?
Medicare helps in some cases – however it still requires significant CoPay. If you have eaten up all of your funds (so are really poor!) Medicaid can help as well. But as Silverair put it very positively: you need to be “competent and proactive”. It’s quite hard to be “competent and proactive” on health insurance if you are amongst the 10% of the population that can’t read or the further 15% that can read only so badly that they would never understand a Medicaid enrollment form.
Malibuflyer wrote:
It’s quite hard to be “competent and proactive” on health insurance if you are amongst the 10% of the population that can’t read or the further 15% that can read only so badly that they would never understand a Medicaid enrollment form.
There are other people, some paid for that function, who know how to read English. The main issue there is that the US is much more diverse than e.g. most European countries, so its not at all abnormal for service providers to face a person who is illiterate in English. They are often quite helpful.
My wife took her US state written drivers license test in German, believe it or not, but had some issues with translation between the material she had studied so earnestly in English (with a little of my help) and the German words used on the written test. She still passed first time, and I was very proud of her.
Fundamentally people in the US do not, and do want to, rely on a single system to solve their problems, without their own initiative, without interaction with other people, without individual control or options.
Might say more about the people you know than about the US health system ;-)
Exactly. While my wife and I both worked for major US companies, we had no worries about health care (not that we needed anything significant, luckily). People who can afford to fly probably have decent insurance through their employer. But even that is extremely fragile – lose your job and you are instantly uninsured. Example: one startup I was with was shut down instantly by the investors. It was the 28th of the month. Three days later, everyone lost their health insurance. (There is something called CORBA that provides limited cover, at great expense, if you are laid off, but not if the company ceases to exist or if you are fired).
Medicare is hideously expensive – between us we pay over $1000/month. And as I said, I have yet to have it agree to pay for anything. Example: I have prescription insurance, which costs nearly $100/month, and is mandatory. Recently I had a prescription. Price with no insurance: $86. Price (“co-pay”) with insurance: $85. Yep, my $100/month insurance paid one whole dollar.
Getting private (non-employer) insurance is possible, now, thanks to Obamacare, but that has been steadily dismantled and weakened over the last 4 years. Previously any “pre-existing condition” would make it impossible or unaffordable. And it is still very expensive and not very good.
If you are uninsured, tough luck. If you are injured or seriously ill you can go to a hospital ER. You will get minimal treatment, and certainly no follow up or preventative care. We know of someone who died of cancer, in great pain for several months because she couldn’t afford the painkillers she was prescribed.
