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This is from my country, Norway.
I wouldn't, despite all the flaws our healthcare system in germany has. (one of it is that it "accidently" gives apothecaries incentives to give you an as expensive as possible medication instead of generic drugs, this got a bit better since people have to pay a share of the medicine and force their apothecary to give them a cheaper medication though)
And at the aspect of forcing people to pay for insurance, richer people over here in germany don't have to be insured as unlike for poorer people there is a very high chance that he can pay the bill. (Insurances, both private and governmental are forced since 2007 to accept anyone in their insurance though as their have been many cases of "statistical discrimination").
We also don't pay taxes for the health, pension and unemployment insurances but duties, that means they are capped, so someone earning 100 Million only has to pay something ~5000 Euro for his healthcare insurance.
This "If you are rich and have a serious disease, the US health care system is the best in the world" argument might be true but it has one flaw: Nobody prevents rich people of any other country to get treatment in the USA (unless they are seen as Terrorists or Criminals maybe)
Mandatory Insurance is not really "socialist" though in every case , it can also prevent that the society has to pay for damages done by individuals who didn't contribute anything. Mandatory Insurances are not for the good of the individual but to reduce the risks the society has to burden.Take a look at a mandatory car liability insurance - imagine if you collide with a petroleum truck, it explodes so a tunnel collapes. Without Insurance who pays the damage, you obviously can't as it could be a few dozen million it costs to repair it? The whole society (aka socialism). With a mandatory insurance only the statistical group of car drivers (those who are at risk causing the damage) pay the damage not the people who don't use cars.
Like I mentioned earlier I pay $16,800 a year for medical insurance and that doesn't include another $1400 a year for very poor dental insurance. And of course that number is rising every year. For this I get a plan with a $20 copay for doctor visits, $100 ER visits, $10/20/30 drug copays along with a $100 per year drug deductible and a $1000 per year procedure deductible. This is not atypical family coverage costs which in my case is just for me and my wife, although some people in a larger group insurance plan might get 2 to 3 thousand off of that price.
So how does that $16,800 compare to the other major expenses of a person's life; taxes and housing? Well for me anyway I do still pay more in both taxes and housing but it's geting awful close. That's why it's laughable when people say we can't go from a $4000 or $6000 or whatever it is per capita to a plan that's basically half that without crushing taxes. We *already* have crushing taxes, they're called medical insurance premiums. So If I'm paying $16,800 a year and the per capita cost is $6000 (or whatever) then clearly there are slackers out there not carrying their share of the load. If this is what you mean that the choices of "responsible individuals" are to let others carry their burden then I'd say in this case we need less choice.
Hmmm... Liposuction isn't really the right example. Let's take an example that a doctor diagnoses that someone needs a conorary atery bypass surgery. While someone needing it is in a somewhat dangerous condition, he is not in a life-threathening condition. Here in .nl someone needs to wait for his turn for that. Typicial is 2-4 weeks.
While this is almost always reasonable (no doctor will let someone wait if his condition doesn't allow it), it cannot be denied that every day of delay introduces a small risk and some rich person in .us would be able to get his treatment quicker, thus has a lower risk.
One has to realise at what cost, because in .us, the ones that do get treatment get it at a many times higher cost, and many would not get any treatment at all.
The idea is that for about half the cost of a procedure in the US someone can book travel to India that includes travel, the procedure performed by US educated doctors, a week's hospital stay along with an additional week's stay at a luxury hotel for "rest and recuperation". And one of the examples of procedures performed mentioned on 60 minutes included coronary bypass surgery that someone without insurance could previously not afford to get treated and so faced a virtual death peanalty. The downside is that if something goes wrong you can't sue for malpractice like you can here.
So the rich of the world use the US to get the "best care in the world" while the US middle class are encouraged to go to India to get their medical treatment. Please move to the back of the bus.
[edit] Here's the link to the 60 minutes piece for those interested. It was originally broadcast in 2005 but it was recently re-broadcast with some updated material although I haven't found any link to that.
http://www.cbsnews.com/stories/2005/04/21/60minutes/main689998.shtml
[/edit]
Let me anticipate your response and say, "I didn't think so".
[edit] BTW how do .nl medical insurance premiums compare to the $16,800 I pay or for that matter how do your total taxes compare to the $16,800 I pay in medical insurance *on top of* the $29,000 I pay in taxes (actually that's just federal taxes, I have another $6000 in state taxes as well plus god knows what I pay in sales taxes). [/edit]
Yes, but you're missing my point. If we could magically and immediately switch over to one of the better healthcare systems currently employed somewhere in the world, we would see a huge short-term improvement in our overall healthcare (with some localized declines). But in another decade we'll be right back where we are now. But the reality is that in the US any major change to the healthcare system will have to be phased in over many years, which means that by the time the new system is firmly in place it will already or shortly be in need of another major overhaul.
That is why I don't want to just copy someone else's system. I want a better one.
The accessibility of our healthcare system and the individual's superior ability to spend their money are unconnected. The problem isn't that people are making poor spending choices, the problem is that the privatized healthcare system has resulted in unpalatable costs for many people. Giving the government control over our healthcare choices without doing anything about the fundamental problem will just result in an even less efficient system than what we have now. It's probably the case that people will have to give up complete freedom of choice when it comes to healthcare if they want good universal healthcare, but that's because universal anything requires major government control, not because government can spend the same money more efficiently, all else being equal.
It's well proven that the government is less financially efficient than private individuals and companies. Private companies require fractions of what NASA spends to achieve the same results. Companies like Blackwater train mercenaries that are just as effective as and better equipped than US soldiers for a fraction of the cost. Private schools in general can make the same amount of money go a much longer distance than public schools. If the government were really more efficient than private companies and individuals then we'd all be better off giving all of our money to the government and have it decide what to do with it all. But it's not, so we only pay the government to do the things no private company could do, would want to do, or should do.
I agree 100%. That's essentially why the privatized healthcare system isn't working to our standards. There are things the government can do that no individual can - not because of monetary cost, but because of power and control.
One of our problems is that many people in similar situations as yours are either in favor of inaction or just indifferent. It won't affect them, so why should they care? The result is a much tougher job for people who are trying to effect change.
I don't see the problem with that, though. If they can afford it, and the American system can handle the small extra load of foreign patients, then it doesn't really hurt anyone. Maybe it slightly raises certain healthcare costs across the board but I doubt it's big effect. The number of foreign patients vs. domestic patients is negligible.
Untrue. Yes there are waiting times but these occur on a triage basis. Those with true life threatening conditions are dealt with on a very timely basis. However if you want Liposuction, a face lift or boob job then you're right, you probably *will* have to wait a bit.
Completely true, actually. Yeah if someone getting a face lift and someone suffering from a life-threatening condition are in line for the same thing, the one with the serious condition will get through first. But the fact is in every socialist healthcare system around the world waiting lines for tests and serious treatments can be dangerously long. The fact that Canada doesn't have enough MRIs to adequately handle their patient load is the classic example, and still true after all these years (In the early 90's there were more MRI machines in Manhattan than in all of Canada). There can be similarly long waits for serious surgical procedures and intense treatment procedures like chemo and radiation therapy for cancer.
My uncle actually died due to Canada's long waiting lists. He had a minor heart attack and was admitted to the hospital. They couldn't get him scheduled for an MRI for two months. My parents offered to bring him to the US to have it done immediately but he didn't want to leave home. One month later he died, and the autopsy showed that a relatively simple surgical procedure would've saved his life. If he were living in the US (or even agreed to just be treated here) he would have survived; even if he couldn't afford his treatment he still would've gotten it - hospitals can't refuse to perform life-saving surgery in the ER, even if the patient can't afford it. The result is that people who cannot afford life-saving treatment are left with huge medical bills that they have to struggle to pay off afterwards - and these bills often haunt people for the rest of their lives. This is despicable and is a major part of the problem of the US system, but they at least have their lives.
A related problem with the US system, which I think is even worse, is that hospitals can and will refuse treatment that isn't urgent if a patient can't afford it.
yep exactly it isn't a problem but some people here claimed that the health system for the USA is superior for the rich people compared to other nations but then those rich people can move everywhere to get the care (except for emergencies obviously)
Yeah, "expletive deleted liberal" is definitely not the right term for the type of person you're describing. The correct word would be "anarchist."
That problem exists just as much in universal healthcare models. The difference is that in most universal healthcare models the taxes are done more progressively than here in the states. In fact that's essentially the definition. Universal healthcare means that everybody gets more or less the same care, whether you could afford it or not. The only way this can be done is to force the wealthy to pay healthcare costs for the people who can't afford it. It is entirely possible that if you lived in Frace doing the same job you have in the states that you'd be paying an equally disproportionate sum in healthcare taxes (it'd likely be lower in absolute value because the per capita costs are lower, but you'd still be carrying the burden of others).
Also, one of the reasons why we Americans have to pay so much in order to cover the costs for those who can't afford them is because the poor often go to the ER for everything, because that's the one place they'll be treated whether they can afford it or not. And the problem is that ER visits cost much more than a regular doctor or hospital visit.
I also have another question. Has anybody looked into healthcare costs compared to median household income and cost of living? I'm sure the US is still worse off, but it'd be interesting to see.
However it seems that you think if this was considered that would tend to reduce the spread between what the US pays and what the rest of the world pays. I would argue that based on the cost of living on the East Coast where I live that may even make the comparison *worse*. But whatever.
I have no issue with people that make more money carrying a disproportionate part of the load, I'm simply arguing that the total cost is about double that of any other industrialized country on this planet and that is simply too high and needs to be significantly reduced. I can't see how any reasonable person can argue to the contrary.
It doesn't seem to me that anyone is really arguing that US healthcare costs shouldn't be significantly reduced but it does seem like people are willing to argue that every example of a system that does work in many was better than our own will somehow *not* work here.
The primary difference between the US system and the rest of the world is the health insurance industry and the fact that health insurance has historically been included as part of an employees's compensation package. Pretty much everywhere else in the world healthcare is funded by the government either directly from taxes or as has been pointed out some national windfall source of income. Again I point out that having a national windfall source of income really doesn't matter because if that were not spent on healthcare it could be spent on any number of other things like perhaps tax reduction.
Anyway when our costs are double that of every other developed country in the world and we're the only ones with a health insurance industry along with health insurance costs forced to be a part of employee compensation then it's reasonable to assume some cause and effect here.
As an aside, yes, other countries have *some* health insurance but it's not anywhere near a 400 *billion dollar* a year industry as it is in the US.
Our costs are unique because our system is unique, if our system were similar to any of the other developed countries then our costs would be similar. I keep saying it, throw a fracking dart, we couldn't possibly do worse than what we have now.
We have a insurance based system in germany as well and have much lower costs than in the USA (both absolute and as share of GDP), but higher costs then many with a universal health care system. The magic reason why a universal health care system is often cheaper than restrictive ones is that prevention is often many times cheaper than treating diseases.
I have no clue why the healthcare system is so expensive in the USA but that it is insuranced based can't be the sole or primary reason especially as when you look at the costs back in 1970 and 1980 where it wasn't really more expansive than in many other developed countries.
As I've said before, there is no simple solution. Socialzing the US medical system exactly as it stands won't magically make things cheaper; there is no "adopt a new plan" and suddenly things cost half as much.
It'd make a heck of a lot more sense to examine and address the costs *first*, then see where we need to go from there; it's not something we can learn just by looking at every other country out there, but rather it will require a significant amount of introspection.
A variety of things we could stand to lose come to mind (drug companies spending billions on advertising *prescription* drugs, for one), but I couldn't pretend to know where all the extra costs truly lie.
The following are exerpts from http://www.howtogermany.com/pages/insurance.html.
"Health Insurance Options in Germany - 2008
Germany has one of the best health care systems in the world, providing its residents with comprehensive health insurance coverage. The health insurance reform 2007 requires everyone living in Germany to be insured for at least hospital and out-patient medical treatment.
The options available to you for health insurance while living in Germany are the government-regulated public health insurance system, private health insurance from a German or international insurance company or a combination of the two.
Government Health System
Most German residents are members of the government health system (Gesetzliche Krankenversicherung or GKV). If your gross annual salary is below 48,150 Euros per year or 4,013 Euros per month, membership in the GKV is mandatory. The total cost of government health insurance is currently approx. 15% of your gross salary up to a maximum monthly income of 3,600 Euros. If you earn more than this amount your insurance premium remains constant. Your employer will normally pay slightly less than half of the monthly premium."
The key points being that it's government-regulated health insurance with required particiaption (you must be in either the government program or a private program) and it's effectively paid for by a tax since it's proportionate to your income with an income cap of 3600 euros per month. I'm not sure how much a euro is these days but I suspect that 6480 euros (15% of 3600/month times 12 months) is significantly less than my $16,800 yearly health insurance bill. How about this, I'd glady give you 6480 euros for 16,800 US dollars, are you interested in this trade?
Like I said, throw a dart. Sight unseen I'd take the German system over ours in a heartbeat.
You've already mentioned that you wouldn't be wiling to swap healthcare systems with US.
I also did not say that the solution is in any way simple. All I've said is that there are 10 to 20 examples of working systems out there each of which is better than ours. Picking one and using it as a model is far better in my mind than trying to reinvent the wheel by committee negotiation between the AMA, the Insurance industry and PhARM.
[edit] Oh yeah, the other thing I would eliminate is the fact that the US market for non generic drups apparently has a 100% premium with respect to the prices anywhere else in the world. It seems that other countires can negotiate drug prices down to per unit production costs plus nominal profit while the double cost that the US consumer pays is what is used to fund future development. Clearly future drug development is a necessary cost but not one the US should support entirely by itself, the rest of the world getting a free ride has got to end. This occurs because the cost of drugs is simply part of the insurance and most people see their $20 copay instead of the $250 that is charged to insurance however this is a significant part of what drives up the cost of insurance in this country. [/edit]
Actually if you could make the changes I proposed above without socializing healthcare then I'd be fine with that as well but I can't see how you get rid of a 400 billion dollar a year industry or control healthcare proffessional incomes without socialization. But certainly the malpractice limits and drug cost penalty that the US consumer face could be addressed without a socialized plan.
As far as the malpractice suits my stance is that no one should become obsenely rich just because a doctor made a mistake. I do believe that if a doctor makes a mistake that causess someone to require care for the rest of their lives that *does* need to be paid for, but no one should get 10 million dollars for "pain and suffering" of which the lawyers take 5 million off the top. I do think that there should be more criminal prosecution of doctors for gross negligence and incompetance but obviously not for an honest mistake.
Now, how do we overhaul the health care system so the pharma companies stop puttong up all these lame commercials with the pretty music playing in the background, scenes of nature, serenity, and some guy's voice saying, "Please take Propecia. Side effects are heart failure, kidney failure, and brain seizures. You might die from taking it, or wish you were dead. Other studies have shown you might sprout three arms or explode from prolonged exposure to Propecia. Please see your doctor and ask about Propecia. See if it's right for you."
Cost of living. Not standard of living. Big difference. And yeah, much of the east and west coasts have high costs of living, but there are also places with extremely low costs of living. Like Pittsburgh, Cleveland, and the middle of the country in general. And I know its hard to find data adjusted to things like cost of living and GDP, otherwise I'd have found it already. I was just asking if anyone has seen any such data, or analysis of said data anywhere...
I'm getting really tired of repeating myself. I've said this in every single one of my numerous posts. I'm not saying that, say, France's system blatantly won't work here. I'm saying that it's a silly idea to replace our failing system with another failing system, even if it's not failing as quickly. If we go through the massive undertaking of overhauling our healthcare system, I'm of the opinion that we should try fix it, not temporarily patch it up. If somebody is diagnosed with a serious risk of massive heart attack that could be fixed with open heart surgery, do you proscribe a daily dose of advil, or do you do the surgery?
Why should we settle for throwing a dart? Yeah wherever it lands it'll be better, but we can do better than that. Throwing a dart is the lazy and irresponsible way of going about this. Especially when you consider kryo's point. No two countries are alike - and the US in particular has plenty of its own idiosyncracies. You can't just lift something as major as healthcare policy from one country and place it in another. I could go through this again, but instead I'll just ask you to reread kryo's latest post.
I actually don't think placing wage controls on healthcare professionals is necessarily the right way to go about things. A lot of people are surprised to learn that the number of how many physicians can be accepted for training every year is limited by the US government. Somewhere along the way the government (congress, really) made a major miscalculation and the result is an ever-growing shortage of physicians - largely due to bad advice by the Council on Graduate Medical Education and the AMA. Fixing the shortage would go a long way towards bringing healthcare professionals' wages down from their lofty heights. Now, some sort of wage control might also be a good idea, but government-imposed wage control does kind of make me cringe...
And lol tetleytea - that was a great impression of those damn commercials.
I refer you back to the global warming discussion and in that scenario there really is *no* credible difference of opinion and yet look at what we have to wade through and even then we can't get a sizeable segment of the population to even *admit* there's a problem. With healthcare there are far more different power bases (AMA, Insurance, PhARM) to deal with and far more credible choices.
If you look back on Hillary's attempt at health care reform it was basically derailed by the big three (AMA, Insurance, PhARM) putting out ads that harped on socialized medicine. It's so much easier to shoot something down than it is to propose something positive.
I can tell you already what is going to happen and basically it will not even come close to having a system as good as one selected by that proverbial dart.
The only thing on the table really is a national group that everyone can belong to that provides everyone group access to insurance instead of individual access. For example my $16,800 per year insurance bill is $1400 per month which is pretty much the best I can get for an individual plan. However a decent sized group plan with the same benefit level is only $1100 so this could save approximately 15%. Sure I'll take a 15% discount but that's *not* a very significant change.
There are no plans to change the employer as the primary source of insurance and there are also no plans to allow US consumers to pay the the same price for drugs that the rest of the world pays. There is *some* possibility for reducing the huge values of malpractice settlements but you'll have the American Bar Association fighting *that* one tooth an nail.
In all reality the best we'll get is lip service to healthcare reform and if anything we'll just be adding additional layers of regulation that will actually drive the costs up even further than they actually are.
I did read kryo's post and yeah it's a nice, measured way to proceed but it's doubtful that such a process will be completed before the end of my lifetime.
But yes, *if* you're right that we *will* come up with something better than the rest of the world in a reasonable period of time then I'll be first in line to support it. Personally I won't be holding my breath.
Those ads are a direct result of the lobbying power of PhRMA, among others. They used to be illegal, and IMO they still should be. Tobacco companies can't advertise their self-identified hazardous products on TV, and those swine can? I'm mystified. But then I'm one of those weirdos who does not believe that spending money is directly equal to 'speech' in First Amendment terms. I want Buckley v. Valeo overturned, not continually used to defend the corrupting influence that large campaign contributions have on our political system (inlcuding Mr. Obama's success, and I voted for him).
Folks trying to scare the U.S. away from a civilized health care system often put up a red herring along the lines of "You'll Lose Your Choice of Doctor." HMOs already do that, but they have no public accountability. The profit-maddened actions of PhRMA members make the problem worse because even if you manage to keep a relationship with a given physician, you always need to question their judgement about prescriptions unless you have evidence that they've consistently rejected all the drug-branded office supplies, free meals, and fancy 'educational' events that Big Pharm provides. New drugs come out faster than most busy docs can seriously follow, and 'opinion leadership' in this area is at least as distorted by marketing budgets as our legislative process is distorted by campaign spending.
You are fully correct. I think I would be insured if I lived in the U.S., but I'm not sure of it. However, an academically educated computer scientist like me should be able to find a job where he can afford a health insurance. But even then, I am not convinced I would get better healthcare than I have here. This is because while our healthcare system, like everywhere else in the world has some flaws and cost issues, there is absolutely no lack of skilled specialists and facilities here.
Further, it doesn't make sense to switch to a system where the good doctors and nice equipment remain completely out of reach for a significant part of the population. Considering, getting medical help is a human right, it would even be immoral.
I pay EUR 114 a month for the base health insurance (which covers all normal healthcare costs) and a plus package (which covers dentist costs and gives me rights for some extra aids/tools in of periods of hospital stay and recovery). The health insurance has an uninsured part of a maximum EUR 229 per year. That means that if I get a EUR 15000 hospital bill, I pay 229 euros of it, and the health insurance the rest. If I get a second one within the same year, the health insurance covers everything. Simple medical care like doctor visits and drugs are not affected by this, they are fully insured and don't cost me anything.
Regarding taxes, you pay 33.5% over your income until EUR 17878, 42% over your income until EUR 54776 and 52% over the rest. The resulting tax bill is reduced by EUR 2072. My income is a bit variable because of commissions I get on deals that I bring in, but let's say it is EUR 40000 a year, the tax would be 0.335 * 17878 + 0.42 * (40000-17878) - 2072 = EUR 13208. It's a bit more complicated than this, because there are costs that you can subtract from your income and a situations (like when you own multiple houses) when you pay higher taxes.
Then I pay about EUR 3500 each year on social premiums, like for the case you become unemployed. Then there are communal taxes on waste and your house. VAT is 19%, but several things are taxed extra, mainly energy is taxed a lot, a litre of petrol costs EUR 1.16 at the moment, of which about 75% are taxes. Also electricity and natural gas is taxed extra.
Cars are taxed too, depending on how energy friendly they are, I pay EUR 24 a month for my license plate. Further, new cars are taxed depending on CO2 emissions. This can be between 15% to 40% of the price of a car.
Well, capitalism?
There has been a heavy battle here recently between insurance companies and pharma companies about this issue. Basically pharma companies were targetting doctors to prescribe their expensive branded drugs. Insurance companies were not happy with this and wanted to stop insuring branded drugs that serve no purpose compared to cheaper alternatives. Government allowed them to do so if there is no medical reason for the more expensive drug.
This is quite an issue, because a doctor has a higher authority than an insurance company, because only he knows the exact medical condition of the patient and could, using his medical authority, prescribe any drug, including the expensive ones.
So, they went to court, did battle for many few years, and recently this came a conclusion. The verdict was basically very expected: if an alternative is available with exactly the same composition, there cannot be a medical reason to prescribe the expensive drug and thus a health insurance company is not required to pay for the higher priced drug.
The result has been that during 2008 there has been a price war between pharma companies, because they all want their drugs being covered, in which case insurance companies want the prices to drop. Many drugs have more than halved in price. The government says it has saved about EUR 400 million last year just because of this (because of the partially private, partially socialized system, many costs are indirectly paid by the government).
IMNSHO, the problem is corruption, pure and simple. If the government is corrupt, I would say privatize health care. If the companies are corrupt, I would say socialize health care. The problem is, what do you do when they're both corrupt? You can't win. Our doctors are by-and-large okay, but you still have a system where the big money is in surgeries, and not in office visits. So let's just fatten America and give everyone bypass surgery at $100k a pop. Even our insurance companies are often okay (NOT including AIG...), but you have corrupt claimants, resulting in all kinds of problems. So what do you do...regulate everything? The FDA's in bed with the pharma companies. When you boil it all down, the devil's not in the system--systems are only made up of people. At the root of it all: integrity. Pure and simple. Clean up the people's act, you clean up the system.
I hate to say it, but maybe the American people just aren't doing as well on the integrity front as some other countries. Ouch. That hurts. (although, I'm thinking of a certain country south of us...they aren't doing any better...)
I meant more "quality of life" care, not cosmetic. My father recently needed heart surgery; not life threatening, but without it his current active lifestyle would have come to an end. Most European countries would have had him wait listed, as they lack the number of specialists we have. Same with back surgery: it's not a life threatening problem, but if you need it, you want it NOW. Not after being on a waiting list for months. As for dental care, ever see a British smile? They're not much into orthodontics because it's way too low on the priority list (I happen to agree in most cases, but apparently I'm in the minority here).
If I may ask some people from outside the states, how long does it take to schedule an MRI or other tests common in the US? I heard an average 4-6 week wait list for an MRI in Canada, but haven't been able to confirm. Wait, I see this was addressed in a post I hadn't read yet.
No offense intended, I do not believe all liberals are that stupid. Alternatively, there is also large groups I would call (explitive deleted) conservatives. Your stance places you squarely in the rather mundane "sane" category of liberal. I personally know liberals who fall in the (explitive deleted) category, and *insane* is probably the kindest thing I could say about them - or the aforementioned conservatives. Believe it or not, I once had a discussion with some twit who considered it a Second Amendment violation to ban guns in courthouses, because all the government had to do was supoena you to disarm you.
I agree completely, but it won't happen.
That, and reform of the prescription system which you've mentioned, are much my opinion as well. Advertising prescriptions, even indirectly (Ask your doctor about treatments for...) should be illegal.
Another massive expense is insurance and legal fees defending against drug lawsuits. Get rid of the billion-dollar class action lawsuits - if something got through the FDA approval policy, the company making it should not be held liable if something is eventually found wrong with it. The usual exceptions for illegal activities getting it through the process and blatant quality control issues, of course.
I had an MRI scan once in my right knee, and the waiting time for it was 5 days.
I think you are too much afraik that wait times of many months would become normal. They are not, it's not accepted. It can happen that hospitals get too far behind with their schedules, they need to readjust their budgets in such case. If a hospital is unable to fix it in a reasonable time, it is consired malfuntioning. A malfunctioning hospital will get press attention and can result in a parliament asking the government to intervene.
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