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!

Most countries ration by need. The US rations by wealth. The former is obviously morally and ethically right.

And usually in countries with universal healthcare you still have the option of buying private insurance on top, which is usually super cheap (because universal healthcare takes care of almost everything anyway) but gets you faster care if you need it.

I was going to say William Fitchner.