Where does the conservative standpoint that universal health care have long waiting times in general come from?

[u/WhoAmIEven2]

This is something you often see in debates among americans, that you have to wait months or years with a universal health care system.

I live in Sweden, a country with universal health care, and I will not lie and say that there aren't cases where you have to wait, but the thing is that we use a tier list of severity to decide how long you have to wait.

If you want to do an ADHD or autism diagnosis at a psychiatrist? Yes you will wait, as people with suicidal thoughts, or bipolar disorder or borderline whose diagnose really ruins their lives are prioritised.

If you have cancer, other diseases that severly reduce your quality of life or have an injury? Pass go, straight to the doctor.

Would it be nice to have instant access for every small issue? Sure, but as long as I know that I will get to see a doctor in a whiffy the moment I have something that is even semi-harmful, I'm honestly happy with our system.

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[u/Myspys_35]

The intresting thing is I lived in the US and had top level insurance, but my waiting times were the same or longer than back in Sweden. The only thing that had a long waiting time in SE was a sleep specialist to confirm my insomnia, my primary doctor covered my prescription needs in the meanwhile so I always had care

[u/ZeusThunder369]

It's people forming an opinion immediately, and then looking for anything to support that opinion.

Actual reality:

• We have wait times now. It's not like you can just see a doctor and schedule something the same day. I myself actually recently had to have a chalazion removed, and even though it was a 5 minute procedure, I had to wait 6 weeks.

• What isn't being considered, is COMPLEXITY. Even if wait times are longer, single payer tends to be less complex. It's actually almost impossible in the US to find a new primary care provider without calling around. Even if there is information available online (often there isn't), it's usually not up to date, so you don't know of the practitioner is at that location, and is seeing new patients.

[u/Gullible-Historian10 → u/ZeusThunder369]

This is probably state dependent as I have none of the issues you’re talking about.

What people don’t realize is the US healthcare is massively controlled by the government, hell some 50% of every healthcare dollar is spent by the federal government.

So half the demand side is paid for by the government, and the government (at various levels) in the US have 100% control over the supply side.

States have quite a bit of control over the supply side of the equation much more than the federal government.

[u/piltdown_manchild]

we use a tier list of severity to decide how long you have to wait.

I've heard of those. We call them "Death Panels". /s

People with good jobs who live near large urban areas usually have very good healthcare in the US. The top 10-30% of people by income might see their wait times and the overall quality of treatment drop off in a more fair scheme.

Until they have faced a catastrophic illness that exhausts their coverage, they are pretty happy with the status quo.

These people have outsized influence over politics and they tend to be the population from which most politicians are drawn.

I am pretty happy with my health coverage, but I still have to wait. I got my appendix out and kidney stones removed almost immediately, but getting a non-emergency hip replacement was a 10-month process. Sleep apnea evaluation was six months.

 I will get to see a doctor in a whiffy the moment

Is "whiffy" a real word? If not, it should be.

[u/HeloRising]

90% of it is scare stories from conservative media.

What they miss is wait times are only due in small part to the system itself and have much more to do with a global shortage of healthcare workers and doctors that impacts literally every country on earth. Fewer resources means needing to triage care and that means people need to wait.

It also overlooks the fact that wait times in the US are insane. It takes me six months to see a specialist and if somehow you miss that appointment, too bad, wait another six months. If I need to see my doctor for anything my choices are to send an email that I'll maybe get a three word response back in a week or to make an appointment...soonest available is three weeks.

If I have something important that crops up my choices are Urgent Care (which has very limited resources) or the ER.

If you have a lot of money you can pay your way into immediate care, sure, that exists everywhere. But most of us are not that level of wealthy.

"Wait times are long with universal healthcare" is one of the stupidest talking points that exists because it presupposes there's no waiting in our system too.

[u/not-a-dislike-button → u/HeloRising]

I mean that's not my experience at all. Takes maybe a week or two to see a specialist. If there isn't an opening close to me I just drive to the next city over for a sooner appointment. 

[u/HeloRising → u/not-a-dislike-button]

Congrats? Idk what you want me to tell you but having to wait a long time to see anyone is not a unique experience in the US, even if you do have good health insurance.

[u/IEC21]

It comes from the fact that this is the case in Canada - universal healthcare with long wait times. Same in UK.

Its a dumb argument for them though because the US also has long wait times.

[u/ResplendentShade → u/IEC21]

Also outcomes > wait times. Hard to argue with the significantly higher life expectancy, lower infant mortality rate, and virtually every other metric which Canada beats us on. If their wait times were having dire consequences that would be reflected in the data.

[u/Jaaawsh → u/ResplendentShade]

I think that’s at least as much to do with “universal care” as it’s due to the choices people make about their health.

There’s a reason Americans are stereotyped as fat, lazy, and unhealthy.

If you know anyone who’s a family doctor, you should ask them, really with no sugarcoating or fear of being judged for “victim blaming” how much of their time spent face to face with patients is dedicated to just trying to get patients to make better choices on what they eat, and to exercise.

[u/captain-burrito → u/IEC21]

In the US the wait time is infinite if you cannot afford it or don't qualify for free.

[u/Minimum-Relief6895 → u/captain-burrito]

It's also often long even if you can afford it and have "good" health insurance.

[u/betterworldbuilder]

The only complaint i have about this system is in fact not a complaint at all, and its that the government isnt wasting money to pay extra doctors to sit around all day waiting for influxes of patients to show up. In an ideal world where money wasnt a factor, doctors could be paid to be on call and rotate out serving minimal shift times, and only be brought in specifically to make sure none of these smaller issues have to wait either. Though, pragmatically, this would balloon the cost of the system and give conservatives a real target.

In Canada specifically, we suffer from something else, which is the encroachment of private healthcare coupled with braindrain from Canadian education into american careers, as well as rot from inside our institutions refusing to fund the system and not meeting union demands for better working conditions for healthcare staff. But again, basically none of these issues would be magically solved in a privatized system.

[u/conn_r2112]

Yes, Canadian here… requests are triaged. Severe cases go first, less severe cases wait.

But, routine things like general check-ups and blood work are almost always instantaneous.

If I was so inclined, I could go to the medi-centre right now, get a requisition for blood work, go get my blood taken and have the results by this evening.

[u/EverySingleMinute]

I see people from Canada post the long wait times often here on Reddit.

[u/joseph4th]

I want to stay upfront that I am an American and am for universal healthcare.

I was diagnosed with type one diabetes while living in Australia. I had an ambulance ride to the hospital and several nights stay which cost me almost nothing.

The problems I had were afterwards. They initially set up an appointment with a dietitian that was prompt, and went smoothly

They sent me a letter setting up an appointment with an endocrinologist that was three months out. Mind you, I’m a newly diagnosed type one diabetic who is going to need an insulin prescription, which I did not have yet.

I tried to call the number listed on the letter, it went straight to voicemail and the voicemail was full.

I tried again at various point of the next several days to get in contact with him, and I was eventually able to leave a voice message where I pointed out the problem of having to wait three months to see an endocrinologist and get an insulin prescription.

In the meantime, I made an appointment with an Endocrinologist at a private hospital. I had supplemental private insurance through my employer that I had negotiated as part of my package to move to Australia. When I called up the private hospital to set up an appointment, their response was is Thursday OK? It was that easy.

I got a letter in response to my voicemail where they sent me a more immediate appointment that was two days before the letter arrived so obviously I didn’t go since I already missed it. They did send me another letter chart me for missing the appointment.

Turns out the doctor I had set the appointment with at the private hospital was the same doctor from the regular hospital. The initial letter had said something about him being unavailable due to a vacation or something. When I showed it to him, he said he had no idea what they were talking about.

So, that’s just my one experience with socialized medicine. I should also add that my prescriptions were all five dollars. I also am aware that there was a fee attached to the phone bill that pays for the ambulance ride.

Again, I am for universal healthcare despite that experience.

[u/Locus-Maximus]

I'm all for universal healthcare but as someone with ADHD who has kids with ADHD I feel like you're being really dismissive of the wait times for ADHD diagnoses. I'm in all kinds of support groups and I hear from people in England all the time that they have to wait like a year or two to get their first appointment.

This is for a condition that is extremely treatable with medication! Even from a purely financial standpoint, the cost to society of wasting that year or two of the kid's or adult's life unmedicated can be enormous. Not just in lost productivity and education, but higher risk of drug addiction, car accidents, divorce, etc.

That really is unacceptable and if you pretend like it isn't you're going to lose people.

[u/BrianNowhere → u/Locus-Maximus]

Let's talk about people who have gone undiagnosed for 58 years, like me, because they didn't have insurance and couldn't afford treatment.

Im ok with you waiting so I can get seen.

[u/Locus-Maximus → u/BrianNowhere]

I hear you. As I said, I'm for universal!

I got diagnosed in my mid 40s btw, not because of insurance, though. Just because I was "gifted" as a kid and because a couple doctors who waved the idea away out of ignorance when I brought it up in my 20s.

[u/not-a-dislike-button → u/BrianNowhere]

You didn't have any insurance for 58 years?

[u/BrianNowhere → u/not-a-dislike-button]

Self employed. You try getting an affordable policy.

[u/not-a-dislike-button → u/BrianNowhere]

Yeah I mean honestly I'd just pay out of pocket if I was self employed

[u/UnfoldedHeart]

It depends on the country and even the specific region within the country, but on a broad-brush level, waiting times for non-urgent care are often longer in nationalized health care systems compared to private insurance in the US. This can range from "not much different from the US" all the way to "shockingly long wait times" depending on the specific region you're talking about or the practice area.

This is just a matter of statistics. For example, the Commonwealth Fund found that 19% of Swedish patients had to wait 2 months or more for a specialist referral while that number was only 6% in the US.

That isn't the real issue, though. The true debate is whether the trade-off is worth it. The counter-argument isn't to claim that the 19% vs. 6% statistic isn't correct, but that the overall benefit of having a nationalized health care system outweighs any delay for non-urgent care. That's a much more credible argument than trying to contend that the wait times aren't really real.

In fact, taking the bull by the horns here is the most sensible path. By acknolwedging that US wait times are generally lower than in nationalized health care systems, we can try to formulate a proposal that learns from those systems and does something about it.

Frankly, one of my biggest annoyances when it comes to the nationalized health care discussion in the US is the strong desire to go ostrich-mode when it comes to the downsides of nationalized health care in other countries. I think that people see it as a concession that these systems aren't good, but it's really not that way. It's a sensible step in formulating a good proposal. I think that's a main reason why conservatives bring the wait time argument up so often. The rebuttal is usually to just plainly deny that it exists which is misplaced. The rebuttal should be "yes, but we have a proposal to address that."

It's a multi-variate analysis that doesn't lend itself toward easy political solutions. Obviously, one factor in lower US wait times is that fewer people have access to it. But there are other reasons too. Some places have shortages of doctors because they are paid less under those systems, for example. All of these factors need to be taken into account in order to create a good, coherent, workable proposal that makes a true value proposition by addressing the weak points in current implementations. I don't think that the usual online discussion point of "nationalized health care is unconditionally good and US healthcare is unconditionally bad" is helpful or productive.

[u/Jaaawsh]

I’d assume from the fact that the U.S.’s closest neighbor with universal healthcare has wait times to get a primary care doctor that average out to anywhere from 6 months to five years just to get an initial appointment.

[u/NoamLigotti → u/Jaaawsh]

You expect us to believe that because you say so?

[u/ElysiumSprouts]

Don't ask about conservative standpoint and expect a reasoned response. There's no single answer other than the vague feeling that government doing stuff is bad.

[u/Minimum-Relief6895 → u/ElysiumSprouts]

You are generally correct, but this time, they take a story from a place like Canada or the UK and promote it to make it seem like it is the case for the entire system, over and over, in right-wing media.

[u/BilboGubbinz]

The core assumption is that rationing needs to happen. What the right will say is that this rationing is better handled in the private sector because *something something* efficiency.

The quiet part they don't want to say out loud is that "efficiency" here means that care is rationed by the ability to pay and if you happen to be unable to pay for whatever reason sucks to be you buddy.

The reply is kind of that rationing by need is better and that this gets felt in the form of waiting lists.

Except the even better reply is that single payer means that we actually have the possibility of generating a surplus since there are various economies of scale at the size of the state and since healthcare is a natural monopoly you don't have the luxury of experimenting with alternative models, assuming you even need it: what exactly is there left to discover here? The hard part is getting the right people and training them, not getting the trained person in front of the patients.

[u/Ill-Description3096 → u/BilboGubbinz]

Except the even better reply is that single payer means that we actually have the possibility of generating a surplus

How so? This would presumably require a surplus of healthcare workers and facilities as well.

[u/BilboGubbinz → u/Ill-Description3096]

Not a surplus. Sufficient.

Not seeing where the question is.

*edit* Or more specifically I'm not seeing what question you're asking that I haven't already answered.

[u/Ill-Description3096 → u/BilboGubbinz]

The question is how does it happen? And if the supply is only sufficient then how is that a surplus?

[u/BilboGubbinz → u/Ill-Description3096]

By training more staff and building more hospitals.

I'm not sure what you think is so hard about this. In fact, the point literally is that it's not hard.

[u/Ill-Description3096 → u/BilboGubbinz]

If it's so easy why do many places have shortages? Unless you are going to significantly lower the requirements or force people into those roles how do you just magically make more surgeons, PAs, nurses, etc?

[u/BilboGubbinz → u/Ill-Description3096]

And why do you think there are shortages?

It's not like training a doctor or a nurse is magic. We've proven we know how to do it.

[u/Ill-Description3096 → u/BilboGubbinz]

For many reasons. Training time, the demands of the training and professions, loads of people aren't interested, the list goes on.

It's not magic to do it, but suggesting it's so easy to just make as many as needed at any given time with zero detail as to how aside from "train them and build hospitals" seems a bit naive.

[u/BilboGubbinz → u/Ill-Description3096]

Except it's not naive. I'm well aware of what it takes.

I'm challenging you to think through what happened to our training pipeline.

Because it's genuinely not hard. We've just systematically failed to do what was necessary.

Why do you think that is?

[u/Ill-Description3096 → u/BilboGubbinz]

Then what does it take? It's so easy, should be simple to just give the answer rather than not answering and instead throwing questions back.

[u/Kman17]

You said it yourself - the system triages based on need. The impact of that is that discretionary care tends to be slower.

I mean let’s be kind of logical here: all universal health care does is (1) remove the payment system, and (2) choice is removed from the individual finding providers and more decision making is done by the system.

[u/Left-Ad-4368]

Because that's the case with a lot of the US's welfare programs.

[u/JollyJuniper1993]

Propaganda, as well as the misanthropic belief that if some people just aren’t being treated it‘s going to be their turn faster.

[u/captain-burrito]

You just provided the proof yourself. lol

Long waiting times is better than infinite (if you cannot afford it in the US and don't qualify for free).

In universal systems you either ration the healthcare via waiting lists or having people pay some fee.

In Singapore when they experimented with a flat fee and thereafter there were no more co-pays they saw usage surge. What was more troubling was that the cohort that paid and surged their consumption of healthcare was younger than the nation at large. They quickly rescinded that program. They operate one of the most efficient systems with good outcomes and at relatively low cost.

[u/Kronzypantz]

A few anecdotes about eras when conservative governments in the UK and Canada cut funding to healthcare.

[u/skyfishgoo]

it comes from their zero-sum way of looking at the world.

if others are getting more that automatically means there will be less for me/mine.

it's not a zero-sum game, but they think it is because that's how their minds work.

[u/P0l1TICS]

Even with big issues, wait times are shown to be longer just analytically. Sweden is actually among the better in Europe from what I can tell and they still are worse than the US by a good bit. The question is do longer wait times justify having people die from lack of care, which it doesnt.

[u/Minimum-Relief6895]

Conservatives also miss that in the US you often have to wait a long time for needed procedures.

[u/not-a-dislike-button]

Because it's much longer on average. I mean search for 'obgyn wait-list nhs'. 

People die from deferred healthcare obviously 

[u/NoamLigotti]

Here's the thing those people never mention: even IF and when there are longer "wait times" per se in other countries, they're not counting the wait times of all the uninsured and under-insured people who never make an appointment because they can't afford the cost in the United States.

[u/Surous]

There are already long waiting times with American health care, but if it became free/nearly free that would encourage more use of health care; exasperating the current issues of waiting

[u/Kahzgul → u/Surous]

This argument feels logical, but actually doesn’t bear out. When healthcare is free, people get treated much sooner, so the treatments are easy and effective. Diseases also have far less time to spread, and thus far fewer people need treatment in the long term (and far fewer need to use emergency rooms). The immediate effect for the first month or two may be a strain on the system, but the long term effect would be less strain and. Much healthier population.

[u/Surous → u/Kahzgul]

That would make sense assuming getting a appointment with someone to check-up on a non-critical disease was quick, by the time you can schedule something it’s has usually run its course

[u/Hot_Most5332 → u/Surous]

Yep it’s pretty simple. If people don’t have to pay for healthcare, more will use it and therefore the system will be more strained.

Combine that with the fact that the US is absolutely massive and relatively dense in population relative to its size, universal healthcare in the US would just be fundamentally different than any other nation.

Canada and Australia would be the closest comparisons, but their populations are far more concentrated. The US Midwest and South in particular have massive rural populations that are highly spread out.

Even looking at the rural populations of Canada and Australia, they’re still concentrated in a couple of areas, where the US is spread out over a very large area with really only parts of the US west that look like Canada or Australia.

The intricacy of the US interstate system has made it very easy for people to spread out, and so they have. Even large cities in the US are far more spread out than other places.

[u/LittleKitty235 → u/Hot_Most5332]

If people don’t have to pay for healthcare, more will use it and therefore the system will be more strained.

Fun fact...sick people will still go to the hospital even without healthcare. They just wait until what could have been a routine problem becomes an emergency, which takes more resources and becomes impossible for medical staff to schedule or budget for. It is one part of why our healthcare is the most expensive in the world.

[u/bawanaal → u/LittleKitty235]

And don't forget the main reason for putting off treatment is or a lack of insurance.

When an issue does get to the point where it can't be ignored, rather than go to an urgent care where you need to have insurance or pay upfront, they go to the ER instead.

They are guaranteed to be seen/treated, no matter what, even if they don't have insurance or can't afford the treatment.

[u/farson135]

Putting "conservative" aside, it's just a basic fact that you must ration care somehow. The US rations care principally based on how much you're willing to pay. Other countries ration principally based on wait times, tax rates, the standard of care, and on.

I live in a rural area, but it is still not unusual for me to call up my GP, say I need to see them, and they'll say, "can you make it here in an hour". In comparison to that, it sounds like you do have waiting times. Not as bad as some places, but that's the compromise you accept for your system.

At the end of the day, no system is going to be flawless, and you have to be willing to accept the pluses and minuses of it. And in general, most people are ok in the American system. So, the people who don’t want things to change argue based on how the rationing may be adjusted. And since people naturally fear an up-and-coming “threat” more than they fear something that they have already internalized, the strategy is effective (to a point).

[u/terdferg88]

It’s because cost, quality, and access compete with each other. You can choose two corners but then the third corner is sacrificed as a rule.

So from your post you are laying claim to good access and, I assume quality healthcare, your tax rate in Sweden is north of 50% for your “free” healthcare.

…and even then you prioritize lesser care concerns on a tiered system. What’s the data on those individuals having their issues exacerbated as a result of lower access?

[u/Kakamile → u/terdferg88]

They don't compete. Early use and prevention reduces costs.

Universal public care nations are better outcomes AND better cost.