I am curious as to what operation – particularly an orthopaedic operation (?) – might cost $500K. I can equally understand this might not be the venue to discuss this.
Europeans in the US tend to fall into two groups, IME: those that can adapt and those that can’t. In 40+ years of exposure to European expats (my background is a bit complex) I’ve seen a fair number of both. The least able that I can recall was a Danish woman I dated, simply unable to act beyond I what I saw as a blinkered view of life and ineffective in managing it in the US, including her health care. I ended up with a very strong willed and independent thinking German, God help me. 
She’s not highly educated etc but loves it, moved here in middle age and tells me she doesn’t miss Germany at all, only family. Most of the Mexicans that are our major immigrant group now wouldn’t leave either, if their life depended on it.
@kwlf, in brief the cost of the operation started with the preparation, they were understandably reluctant to do major surgery on somebody close to 90. When she’d done every kind of other possible treatment over six months there were a lot of pre-surgical tests. Then the surgery which involved insertion of a long spinal rod over 7 or 8 hours, something you would understand better than I. Then a month in a very nice hospital that involved at least one reversal due to infection, culminating in a period in an area of the hospital mostly utilized by stroke and accident victims, to get her walking. Then a lot of outpatient hospital and home based physical therapy. The total cost as @Peter points out is not easy to calculate, the hospitals and insurance companies play a game with costs, but regardless her out of pocket cost was comparatively minimal. She’s now at what I would say is 90%, pretty much pain free and based on what I see good to go for quite a while.
Another more flying oriented US medical situation occurred recently to a 76 year old friend who has flown everything there is since age 19. He was initially diagnosed with heart failure, after months of treatment and tests including a very interesting to me real time cardiovascular MRI to check heart function, they figured out that it was a heart virus and that he is now fine. The initial written diagnosis was updated. With that in hand he and his wife put together a big package of supporting data and his AME submitted it to FAA in support of a special issuance medical. We’re hoping it will arrive soon, the AME is a straight shooter and says its very likely. Once that is in hand, he’ll wait a few months then get Basic Med certification that’s good for 4 years – i.e. nothing more required until he is 80, at which point he claims he will quit flying… we’ll see 
Total cost to him for all of that was a few hundred dollars, to the AME.
He’s wealthy, smart and resourceful
Me too, not private-jet wealthy, but certainly not poor. And both the others too. Still, every encounter with the US system leaves me terrified that one day I might need it for something serious.
As far as Covid… lots of people avoided going to a doctor because they were afraid of the cost. I remember one story of someone who did, end ended up with a bill for $5000 for a bunch of unnecessary tests, which he had no chance of being able to pay. 20+% of Americans have NO insurance, because they can’t afford it or would be denied. A friend of mine had a bad case and still his insurance refused to pay $30K+ of hospital treatment because they deemed it “unnecessary” even though the doctor wouldn’t even let him leave his office. He is “smart and resourceful” and will probably figure it out, but even so it’s a nightmare at a time when you least need it, and for many people just impossible to deal with.
It seems every country loves its healthcare system, no matter how bad, perhaps because they’re terrified of something even worse. Brits love their NHS, which imo is mid-way between the abyss of the US system and something that actually works like France or Germany.
Having had two uncles who died unnecessarily under (and I do mean under) the UK NHS, I wouldn’t choose it.
Thanks. I had been very curious when you mentioned such an expensive operation as to what it might be. The truth is that I have no idea what that sort of surgery would cost in the UK. I wish your mother well.
I’ve seen successful elective hip replacements done on patients in their mid 90s. It’s amazing what can be achieved for the right patients.
Thank you
The truth is that I have no idea what that sort of surgery would cost in the UK. I wish your mother well.
There’s about a 10x difference in procedure cost between Europe and the US. A few years back I had a shoulder prosthesis fitted. I was living in the US (and had excellent insurance) but chose to have it done by the surgeon in Nice, France who had fixed up the original injury. Just in case no insurance would cover that, I asked what it could cost: about $8K, including everything: theater, surgeon, hospital stay, etc.
I asked my US insurer whether they would cover it, and they were delighted to say yes – it would have been over $100K in the US. (In the end it was still covered by my French Social Security from when I lived there).
johnh wrote:
A few years back I had a shoulder prosthesis fitted. I was living in the US (and had excellent insurance) but chose to have it done by the surgeon in Nice, France who had fixed up the original injury. Just in case no insurance would cover that, I asked what it could cost: about $8K, including everything: theater, surgeon, hospital stay, etc. I asked my US insurer whether they would cover it, and they were delighted to say yes – it would have been over $100K in the US. (In the end it was still covered by my French Social Security from when I lived there)
Just like with aircraft, there are direct costs and indirect costs. The French taxpayer did you a nice favor, and would even have done your US insurer a nice favor. More fool him.
My US health insurance is also valid across national borders – I do not need to buy additional coverage when out of the US, although people I know do buy Medjet coverage to get them back to the in the event of injury: one friend ended up in a Romanian hospital for a while after an accident, before transferring Germany where the damage of Romanian hospital care was undone, then eventually he got back to the US. A punctured lung was part of the transportation delay.
No, even privately a procedure like that would probably cost a similar amount in the UK. I suppose the public sector provides some subsidy for the costs of training the staff involved, but all the direct costs will be included in the price and even if you took the training costs into consideration the figure would be considerably but not massively greater.
A relative recently had a hip replacement. She’s relatively young so it took an hour and a half of theatre time, three outpatient appointments with the surgeon, three X rays and a few nights in hospital. It’s when things go wrong and you need a week or two of intensive care, months of antibiotics and perhaps some revision surgery that the costs really mount up. The private sector tries very hard to avoid treating these patients.
kwlf wrote:
I suppose the public sector provides some subsidy for the costs of training the staff involved, but all the direct costs will be included in the price and even if you took the training costs into consideration the figure would be considerably but not massively greater.
Who pays the mortgage or rent on the facility land and building? Who buys the advanced medical equipment, who pays for drug and biotech R&D given caps on drug prices that remove all but a small profit? Who pays when things go wrong and have to be redone? Who pays the benefits and retirement costs for the employees? Who paid to educate the doctors and nurses? Who pays to treat foreigners who leave without paying? Who pays every employee of the system who is not billing directly?
