I have first hand experience of the healthcare system in five countries including India. Success Stories and Horror Stories abound everywhere.

Here’s my quick summary of the comparison of public healthcare between these countries:

  • Germany: Pay Lot Get Lot
  • UK: Pay Little Pray Lot
  • USA: Pay Nothing Get Nothing, Pay Lot Get Lot
  • India: Pay Nothing Get Something, Pay Lot Get Lot

Let’s dig in.

Germany – Pay Lot Get Lot

Health Insurance is mandatory and very expensive. Premium is a percentage of salary. Higher income person pays more premium than lower income person. But they both get the same treatment, which is widely believed to be very good.

High earner does not complain that he’s subsidizing low earner’s healthcare. Everyone is proud that their country is rich enough to be able to afford fairly expensive mandatory health insurance premiums.

During my stay in Germany, I incurred a total cost of INR 36 Lakhs equivalent in health insurance premium @ EUR 1200 / month. I barely utilized INR 5 Lakhs in healthcare benefit (all of which were OPD clinic visits for self and family).

UK – Pay Little Pray Lot

Health Insurance is mandatory. It’s not as expensive as in Germany but treatment is uncertain.

Employer deducts National Insurance from payroll. It’s not widely known that a part of NI goes to NHS. Even doctors with decade-long experience in NHS don’t know this and think NHS is fully funded by taxes.

 

In theory, you get free treatment. In practice, the “system” decides whom to treat, when to treat, what to treat, how much to treat, and so on.

When I signed up for NHS, the first step was to enroll with a Primary Health Center in the neighborhood of my home address (E14 9FF). All three PHCs in my neighborhood said they were full and refused to enroll me. For everything, I had to therefore take a bus or taxi to go to the nearest NHS hospital, which was in Whitechapel Road, a different neighborhood. Three hour waiting time was standard.

If you go with degenerative problems, NHS will tell you to live with them, and turn you away without burdening the system with even the cost of painkiller or physiotherapy or whatever. When I had knee pain, I went to an NHS clinic. Doctor showed me a fancy flipchart, and told me it’s early onset of osteoarthritis, incurable, nothing can be done about it, go live with it. He did not even prescribe a painkiller or physiotherapy.

(When I had the same pain a few years later, in Pune, India, the doctor said early onset of osteoarthritis, but he didn’t say nothing can be done about it – presumably because he could make money off of me for doing something about it. He prescribed physiotherapy and painkiller for SOS. I have been doing those physiotherapy exercises. Knock on wood, there’s no pain for many years therafter, and I have never taken that SOS painkiller tablet.)

There are long waiting lists for virtually every type of treatment.

6 weeks for cough.

 

 

3 months for interpretation of CT scan.

6-9 months for elective surgery.

A cardiac surgeon who once practised in NHS told me that, if a 35 year old person went to hospital with chest pain, s/he’d be admitted directly to Cardiac ICU and given the whole nine yards of treatment. OTOH, if a 70 year old person went with the same chest pain, s/he’d be sent to General Ward and given painkillers till whatever happened happened.

Cue to the present day. NHS now tells people not to come into the hospital.

USA – Pay Nothing Get Nothing, Pay Lot Get Lot

I have no first hand experience but, based on the personal experience of close family members and friends, the feedback on healthcare system in USA is mixed:

  1. Atheist relative said the only time he beseeched God in his whole life was during his 10 years stay in USA when he prayed that he’d never fall ill and would need to encounter the US healthcare system
  2. Customer had kidney stone. Woke up in the middle of the night with severe pain. Ambulance came in five minutes. Surgery done in four hours. Mission accomplished!
  3. Friend had a bad fall during mountain climbing trek. Airlifted by helicopter and taken to ER. Received immediate treatment.
  4. Relative’s coworker had to wait for seven hours to be attended at ER
  5. Somebody on Twitter faced a 20 minute waiting time when they called 911.

It’s not only my network.

Horror Story:

 

Everybody rants against the high cost of healthcare in USA. As an outsider, the one factor that detractors miss about the system is medical malpractice tort law. Nowhere else in the world do aggrieved patients get millions of dollars in damages. While malpractice should be prevented, $hit happens in life, including healthcare industry, and protecting patients from it has a cost to it.

India – Pay Nothing Get Something, Pay Lot Get Lot

Mother of household help in my house in Pune, India, had chest pain. Went for checkup to government hospital. Long story short, she got bypass surgery done and was back home in 12 days. Doubt if she paid anything.

Everytime I have done ICU Attendant Duty in Jehangir Hospital for a hospitalized family member, I have seen several fellow attendants. They appear poor but are still able to get their people admitted in Jehangir Hospital, which is a leading private hospital in Pune.

People get fairly good treatment if they’re willing and able to pay for it. Common man may crib that it’s too expensive, daylight robbery, healthcare mafia, and things like that but cost is definitely not as high as in USA (even after adjusting for PPP), as the illustration in the following tweet shows:

Some people recommend UK NHS style healthcare system for India. Based on my experience with NHS described earlier, I vehemently disagree.

Austria

Europe

 

 

Key Difference in Health Insurance

Indians can get treatment at government hospitals for zero / negligible cost without paying for any health insurance. This is true for both tax payers and non-tax payers.

OTOH, treatment at private sector hospitals could cost a lot and warrants health insurance.

Under the present health insurance system in India, the premium for a given level of coverage is fixed. The rich and the poor both pay the same amount of premium to get the same level of treatment. This creates a situation where people with greater financial resources can get more treatment because they can shell out more premium and buy costlier insurance. Whereas people with lower financial resources can’t. In other words, treatment depends on bank balance, if health insurance is involved.

To me, that sounds fine since, as noted above, every Indian has the option to get virtually-free treatment at government hospital without any health insurance.

But, if that sounds unfair to others, then the government can adopt the “Universal Healthcare” system prevalent in Western Europe, where the premium is a fixed percentage of income and the coverage is the same for everyone. The rich pay more, the poor pay less, but both get the same treatment. No longer will human life be measured by bank balance. As an aside and contrary to popular misconception, Europeans don’t get free healthcare along with income tax. They get it but because they pay health insurance premium separately.

Universal Healthcare is widely seen as a system that ensures fairness to both private citizens (i.e. common public) and corporate citizens (i.e. healthcare companies). Going by my personal experience with the system in Germany and UK, the “haves” will have many reservations with it. But I’m still willing to go ahead with it since it’s a good starting point in the pursuit of improving healthcare for everyone without too much government intervention.

While on the subject, it’s worth preserving free market principles, even in the healthcare industry, since I strongly believe that “Capitalism is the worst system except for all the others”, to paraphrase Winston Churchill’s quote about democracy.

Why US Healthcare Is In Ruins

On X (fka Twitter), @Gautaamm shares his take on what has ruined the healthcare system in USA.

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3 things ruined American Health Care: Insurance, Corporate Ownership and Pharma companies being allowed to advertise their medicines. 2 stories to illustrate these points: Friend went to a Corporate Dental Practice in New Jersey. Needed a few fillings. He repeatedly asked to check the insurance portion and hence his share of the cost. Was told it will be approx $100-125. Gets work done and is handed a bill of $700. When he asked why, he was told “Oh you were supposed to see a dentist who is in network but he was not available so we scheduled you with someone else but he is out of network so the insurance does not cover it as much as for the in network dentist. He had no choice but to pay the $700. I remarked how that is a perfect example of what is wrong with the American Health care model. He added “Gautam that is minor. My brother in law had a slip disc issue so he consulted a spine specialist and was advised surgery. The operating surgeon was different from the consulting one. He never met the operating surgeon. He was taken into the OT, administered GA and the surgeon came and did the surgery and left. The residents covered the post op and the consulting doctor took it up from there. But he NEVER interacted with the surgeon who actually operated on him!!!!!!” I can’t even imagine that.. So glad we have a far better healthcare model …… TILL NOW at least!

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After talking to my friends in USA, I totally agree that US healthcare system is in ruins e.g. In many parts of USA, it takes 5-12 hours for a doctor to attend to an emergency in ER! However, I ascribe the pathetic state of affairs to a different set of underlying reasons:

  1. Malpractice / very high tort damages, which creates the practice of “Defensive Medicine”. Doctors avoid the patients as far as possible (e.g. 3 months to get cardiologist appointment). When it’s no longer possible to procrastinate, they see patients but they refuse to use their experience to arrive at a diagnosis immediately. Instead, they prescribe a battery of tests e.g. Blood Test.
  2. This creates need for expensive equipment (e.g. MRI). Individual hospitals can’t afford them. Ergo corporate ownership of hospitals happens because only large companies can afford to incur the high capex required to buy, install and maintain such equipment
  3. All of this pumps up the cost of healthcare, which can only be covered via Insurance (and not direct payment by patient on per-incident basis)
  4. Deep subsidy for medicines developed in USA for second and third world countries, which pushes up the cost of drugs in USA, which has to be obscured by pharma advertising.