As far as I have seen the US system is one of the most expensive but doesn’t , overall, have better results than countries with universal health care. I’d say it’s perhaps better for the rich but then they can still go private in other countries anyway.

There are a range of comparisons around, and they're often not easy to use. The OECD gathers data but I think it's deliberately shy of making comparisons easy. The UK-based Nuffield Trust does a report comparing systems, which I think is based on the OECD data.

I'm sure I've seen some others but don't have time to look them up right now.

COVID 19 has made things more complicated, so I think most comparisons are two or three years old now. Not that I imagine much has changed - though I think the US had a particularly bad experience of COVID, which is not unrelated to the problems in its healthcare system.

As a general rule, compared to other wealthy countries, the US:

• has middling health outcomes

• has some really great healthcare. If you can pay for it, you can get absolutely world-leading healthcare in the US

• but access to healthcare is poor, and the system drives some perverse behaviour - the classic example is putting off dealing with a problem until it requires emergency treatment

• at a country level this is one factor that makes US health spending extremely inefficient in terms of outcomes - focusing a lot of attention on expensive treatment with marginal benefits, as compared to wider availability of lower cost treatment and prevention

• other aspects of US society and the economy contribute to poor outcomes - eg. Americans work longer hours, have fewer holidays, less access to sick pay and less security in their jobs than most rich countries

• it's also worth noting that even the rich can't completely isolate themselves from the effects of the health of others - if your housekeeper comes in to work when they're ill because they can't afford to see a doctor and can't afford a day off, you're at risk of catching whatever they've got

• the US spends far more than any other country as a proportion of GDP. Not only that, but government spending is higher than almost any other OECD country. Put another way: if you could magically transplant the NHS to the US, the US government would spend less on healthcare.

The general rule in international comparisons is that there are a range of ways of funding and providing healthcare and there's debate about which models work better - except for the US model, which nobody wants.

My experience as an American who moved to NZ several years ago is that you can probably get better care in the US if you have a lot of money. (Full disclosure - I have a lot of money and in the US I always had great healthcare through my employer so I had arguably about the best healthcare experience in the US aside from like… “actual” rich people or congressmen.)

But 99% of the time the experience in NZ is superior. Hard to tell how much of that is because of universal healthcare and how much of it is because it’s NZ (way too many confounding factors and variables).

But my experience in the US was… call my doctor.. wait, no first I have to do research to find a doctor on my plan… wait no first I have to figure out which plan I want to get (my employer offered several): do I want a high deductible health plan or the PPO? Catastrophic only? Ok let’s look at my last 5 years health expenses and crack open Excel - how much money would I have spent given my healthcare usage in the past? How about if I get unlucky and break my leg or get cancer? Should I get an HSA? What if I don’t use it? What if I do use it? How do I get the money out of it? What if I want to use it for something besides health?

Ok now find a doctor on my plan.

Call and make an appointment, next available is 2 weeks from now.

Go in, he’s running 30 min late. Receptionist: “are you on the same plan as last time? Have you moved since your last visit? Can I see your card? Blah blah blah”

See doctor. He’s super competent, no doubt, but he’s rushed, wants me out the door. But yes, very good.

On the way out: sometimes I just pay the copay, but for some reason sometimes it’s “put it on your card and here’s the itemized receipt - now go submit that to your insurance company”. Sometimes it’s “insurance company didn’t want to cover this one out of 30 items”. Those last two examples might be for when I saw specialists not on my plan, I forget.

Go to pharmacy. “Are you on the same plan? Can I see your card? Have you moved?” And “come back in an hour or two”. Poor pharmacist has to spend ages calling the insurance company - maybe they only cover the generic? Maybe the doctor prescribed 60 days but the insurance company only wants to cover 30. Who fucking knows. Come back in an hour, perhaps pay a small amount, perhaps pay a lot.

Potentially fight with insurance company.

In NZ it’s like: call and get an appt for that afternoon. Go in and have a pleasant chat with the doctor (I would say so far the quality of the healthcare has been fine, and a much better personal experience in terms of feeling like you can spend some time talking to the dr and having them really listen or explain things without feeling rushed). Pay a moderate amount out the door (or none if it was a result of an accident or for my kid), walk into the pharmacy, pick up the meds, maybe pay $5, done.

So, I dunno, if the expertise and equipment is 5% better, is that worth the stress and headache and time and all that fucking mental overhead? It’s exhausting just writing about it. In NZ if I decide to see the doctor about my funky ankle or cough, the total time expenditure is like an hour. Maybe less.

We also had a kid here. Months of home midwife visits, 3 days of induction in a pretty slick, modern birthing suit with nice recliners and a jacuzzi hot tub thing and gobs of medical equipment all over the place with armies of midwives and nurses and doctors and anaesthetists or whatever, emergency C section with super professional doctors and surgeons and nurses, blood, hearing, vision tests and specialists after that, 3 days recovery in a maternity ward with latching specialists and more help, then home with a few more months of home visits from the midwife… total charge was like $110 in parking. I spent more on food from the hospital cafe than I did on that!

There is a difference in the availability of treatments, but this is difficult to equate to quality. It's just different.

A universal healthcare system should use statistics and costs to find the most effective "package" of treatments to offer to the population. There are plusses and minuses to this. Where it works really well is in screening out dubiously effective treatment and over or unnecessary treatment. For example if someone is old and has cancer, the UK system may steer someone to no treatment:

1. Treatment may be unlikely to actually extend someone's life.

2. Remaining quality of life may be significantly better without chemo.

Where it works less well is sometimes newer treatments take longer to be adopted by the system, and sometimes more customised care is unavailable. It's worth pointing out that private care does exist in the UK if you want it - but most people chose the NHS.