Your statements about the USA are completely false. I was given a clear choice as to valve type. I was encouraged to home test. When I requested I was allowed to home dose. I live in the US.
Your problem is you see the USA through Australian eyes and a with a negative bias. For example, you talk about the US "health system". Australia, Great Britain, etc. have systems. There is not a US unified health system. It varies by state, by city, by urban vs. rural, by insurance group and then there is Medicare and Medicaid, which vary by program and can vary by state.
You damn the US system but unlike those who live in national health system countries I got my valve replaced within 2 months of need and on the date of my first surgical appointment. I had a choice of 2 world class hospitals in my city. After I chose mechanical, my surgeon recommended the St. Jude because they have a good track record and were stocked but would have installed an Onyx, however he'd have to order them.
Hello – I am a US citizen and agree more with Pellicle’s view on our system. I’m guessing that you most likely have a good job with good insurance, and probably have had such, your entire working life. Before that, your parents took care of your needs. When you have top tier insurance especially when working for large Corporations, the patient can usually get whatever they want.
As an aside, this situation causes some people to stay in jobs they hate because of the great insurance. That causes other issues impacting our economy.
But when you become unemployed (after ridiculously expensive COBRA coverage runs out) the resulting options are very poor. The premiums are based upon your most recent tax year, not your current zero income, so if you were making good income previously, the premiums with even very high deductibles, are insane like $25k / year with $10k annual deductibles.
The affordable care act was a good idea, but it really only works well for the poor who are paying next to nothing, and as you said it varies widely by State. The middleclass gets screwed.
Then when you hit 65 and retire and go on Medicare, your choices will be limited by what is covered. You will not have the luxury of choosing whatever you want and get it for free.
The recent handling of Covid in the US is a good example of how medicine works in other countries. You need a test, go in, get it done, free. You need a vaccine, go in, get it, and it’s free. You need monoclonal antibodies, (first try to get them as they are allocated) but say you are fortunate enough to get, they are free to you. This is how the system should work. We are all paying for it thru different means either way, but our friends in Washington will never change it as they personally benefit from the current system.
Home testing in my (limited) experience, is not well known nor encouraged. My PCP who is close to 60 years old and has been practicing medicine for at least 30 years with a very successful practice, has zero patients home testing. I had to educate his office on how it’s done. Again, our system encourages patients to use more expensive methods such a Coumadin Clinics, Quest diagnostics etc. to bill more and keep that system humming along. They do not believe in efficiencies.
Look at drug pricing. I worked in the pharmaceutical industry for over 20 years. See what manufacturers charge for the exact same drugs across different countries. We are getting screwed and helping subsidize the other countries lower prices, and all of the nice direct to consumer drug advertising you see on TV every night.
There is so much room for improvement! I’m just scratching the surface.
Sorry, but that’s my opinion.
This reminds me of that great Jeff Daniels clip. No, we are not the greatest. But could be…….
that warrant that reaction. It’s rude. Feel free to disagree and have a conversation, but the face isn’t needed. 
