The topic at hand is the impact of universal health care on the costs of ostomy supplies in the U.S. A retiree in the U.S. is curious about how universal health care systems in countries like Canada and the UK work, especially in terms of ostomy supplies, and what changes might occur in the U.S. as health care reforms are implemented.

Here are some insights and advice shared by people from the UK and Canada:

1. In the United Kingdom, under the National Health Service (NHS):
- People with permanent stomas do not have to pay prescription fees for their supplies, which include ostomy pouches and wafers.
- Those with temporary stomas usually pay a standard prescription charge, which is about £7.20 per item. A box of 30 pouches is considered one item.
- Supplies are ordered through a general practitioner (GP) and can be picked up at the pharmacy or mailed by the supplier.
- GP visits and most hospital care are free, funded by National Insurance contributions. However, non-urgent care can have long wait times, and private insurance is available for quicker access.
- Dental work and some prescriptions are not universally free, though there are exemptions for pensioners, those under 18, and people with certain medical conditions.

2. In Canada, specifically Manitoba:
- Ostomy supplies are fully covered now, but before 2002, patients had to pay out-of-pocket.

3. Anticipated effects of U.S. health care reform:
- Some people believe that insurance premiums for those with ostomies might decrease once coverage becomes mandatory and pre-existing condition exclusions are removed.
- Others worry that premiums could increase, and small employers or self-insured rural hospitals might drop coverage, opting to pay federal fines instead. This could push employees into public exchanges or put financial strain on facilities.
- There are concerns that Medicare funding cuts and mandatory coverage requirements could strain budgets, especially for those on fixed incomes.

4. Current experiences shared by U.S. members:
- A self-employed person with an ostomy pays $150–200 per month for supplies out-of-pocket, in addition to a $460 monthly health insurance premium and a $500 annual deductible. Their insurance only covers generic items and excludes ostomy supplies.
- A hospital employee at a self-insured facility currently receives supplies and medications for free but is worried about losing this benefit if the hospital decides to drop its plan.