British Health Service: A National Disgrace
A recent PJM article painted a rosy picture of socialized medicine in Britain. Here's the real story.
I must say, as a British citizen familiar with the National Health Service, I found Carol Gould’s recent PJM article praising the NHS quite fascinating.
From an emotional point of view, I could see why she praised them because they saved her friend’s life. (However, surely this is the job of an intensive care unit.)
But when I read further and realized that a major part of her praise came because the health care was “free,” it enraged me. Gould is an American who has lived in Great Britain for many years; my family and I have used the NHS system on a regular basis for over 40 years.
First and foremost, NHS health care is not free: every working person in the UK pays National Insurance whether they use the system or not. In addition, recently the British government has imposed measures to penalize those who choose to opt for private medical care, despite the fact that in many areas, NHS waiting lists for operations are too long.
The NHS has garnered very poor reviews where cancer treatment is concerned. Many of my parents’ friends have died because the NHS has failed to diagnose cancer early enough to be successfully treated.
The NHS is a particularly expensive beast to run and “cost” determines the treatment it offers.
My experience with NHS care, or what one of my friends referred to as “torture,” is utterly different from the almost fairytale description of Carol’s friend’s treatment. I broke my ankle and was rushed to “accident and emergency” at Guy’s and St. Thomas’s Hospital in London (also a teaching hospital) at around 9:30 p.m. I was left waiting for about an hour and a half, in a cold corridor on a hard wood chair. Finally I was sent for an x-ray. Only when they saw the x-ray did they realize I had actually broken my ankle on both sides, whereby my foot was actually dislocated from my leg. Then they asked me if I wanted painkillers. They proceeded to set my foot into a temporary cast. At 3:00 a.m., I was finally admitted to the Nightingale Ward — before being taken for another x-ray to see if my ankle was correctly set in the temporary plaster. It was not and it was painfully re-set again. I can only describe the nursing care in this ward as the worst I have ever encountered. Indifferent, they left me lying helpless, without the cover of so much as a sheet, naked on the hospital bed, with the door wide open for all to see for almost half an hour. Someone did bring me a robe. This was thrown onto a chair, out of my reach. This was a common pattern: putting things out of my reach. This included bowls of water to wash myself with and food to eat. Their attitude was callous. I was thankful that I had family and friends to sit with me and help me.
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Kim Dodge writes plays, novels, lyrics, and blogs at ktdodge.com. She resides with her husband Andrew Ian Dodge on the coast of Maine.
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75 Comments
1. Marc Malone:Horror stories abound. They do here, too, but the difference is degree. No one is allowed to starve to death in our hospitals, although at times, it feels like it….
Jan 25, 2009 - 12:57 am 2. Rather Read:I enjoy reading the British newspapers (except for al-Guardian) and the stories I have read there, more than corroborate what you have said.
If you have friends and family, they are the ones who mostly take care of you.
My supervisor thinks that national health care is a wonderful idea. A couple of years ago, she had to have a knee replaced and it was done quickly and with excellent results. If we had national health care, I am sure she would still be waiting.
Jan 25, 2009 - 3:11 am 3. formwiz:It’s the same in Canada, apparently; the other model for socialized medicine for the Left. My wife and I met a Canadian couple on vacation and they were surprisingly quick to tick off the problems they encountered (the wife has multiple health problems), even though they described themselves as “Leftists” and were both university professors. According to them, it started out well, but the bureaucracy quickly sent it downhill.
Jan 25, 2009 - 4:54 am 4. Michael O'Brien:Even Madonna wouldn’t give birth to her second child in the British hospital system. She said they were “old and Victorian”. Although she later praised that at least everyone in Britain had access to them, even if they aren’t good enough for her.
http://news.bbc.co.uk/1/hi/entertainment/875895.stm
Jan 25, 2009 - 5:44 am 5. BC:Yeah, well most of my relatives have lived in Ireland and England for all their lives, and as some have become elderly, one thing has become very obvious: if you are old and get injured or sick, you are laughably better off in England. Even in the better medical areas of this country, the treatment of the elderly sucks compared to England’s. My mom actually broke her wrist one time here, and not only was getting treated in the emergency room a now cliche nightmare, they never set the wrist correctly. Luckily (?!?) she was traveling in London a few years later and tripped while walking around some sidewalk construction and rebroke the same wrist: not only was she treated and released there with a wave of the hand, but her wrist was properly set and it healed correctly. Also, for that London trip, she brought her many meds, and the English doctors didn’t think too much of that — the elderly are way overmedicated here.
I’ve heard almost nothing but nightmarish stories from friends here with elderly parents or grandparents in regards to medical treatment.
One time I flew to England to visit an elderly relative close to death, and it was like stepping into an old Hollywood movie: it was an old hospital, but well upkept and the staff acted in a way you usually only see in old movies and less cynical TV shows — with maturity and genuine kindness & thoughtfulness. When was the last time you saw that kind of behavior in any medical facility in this country? (Sometimes the TV show “Scrubs” comes off more like a reality TV show than a comedy.)
Jan 25, 2009 - 6:02 am 6. The Cat Herder:Unfortunately, a nationalized heath care system won’t start out in such disarray – it takes time for the bureaucracy to take a hold. There was a time when the NHS was a wonderful thing, dispensing timely care to those in need. Now? Not so much. Medical decisions are made as much (if not more) by accountants and “managers” than by doctors or surgeons. It probably took 30 years for the NHS to descend from a shining beacon of hope to an inefficient, costly nightmare.
Jan 25, 2009 - 6:06 am 7. Big Red:My son’s job takes him to Canada frequently. He gets a kick out of the people calling talk radio complaining of National health care and wishing for a U.S.-style private health system.
Jan 25, 2009 - 6:16 am 8. Byron Dickens:This spring, I had to take my wife to the emergency room here. To make a long story short, it progressed from uterine cysts to discovery of a level one cancer to surgery. Total time from 1st visit to going home after surgery, 5 weeks. I wonder if a National Health system would do the same. We have about $4,000 in co-pays to come up with, but we’ll manage. before I get the usual “winner of life’s lottery” crap, until the Democrats tanked the economy my company had trucks sitting in the yard we couldn’t find drivers for. Any one who could drive out of the yard without hitting anything could get the same health insurance I have. But, I guess “free” is easier than earning a living.
This is what we have to look forward to if Obama gets his way.
Jan 25, 2009 - 6:26 am 9. Carol Gould:My friend is now in a specialist NHS hospital for neurological care to help with her paralysis. It is nine weeks since she collapsed and was on Life Support, but she is already writing and reading. This latest NHS hospital — I have visited her every day for nine weeks and therefore see a lot) cannot do enough for her and their motto seems to be, ‘No one leaves here unable to stand on their won two feet.’
What I find interesting is how many Britons have written in ‘enraged’ that I am praising the NHS. American expats can’t win: I have suffered eight years of verbal diarrheoa about Guantanamo, Abu Ghraib, Rumsfled, Bush and the Zionost neocons destroying the world, but when I write something about one of the many thinsg that put the Great into Britain I am pilloried. I am quite sure that had I written a piece lambasting the health service there would have been heaps of letters ‘enraged’ that a bloody American should ‘dare criticise our beloved NHS.’ !!
I would like it made clear onace and for all, as I have written here several times to British bloggers ‘enraged’ by my observation that ‘no money changes hands’ when one is ill in the UK, that this is a truly blessed system that looks after anyone and everyone in medical need. the fatc that one does not need to provide insurance cards and write cheques before someone is admitted is a virtue of the NHS that is of Biblical porportions. The Torah, the Koran and the New Tetsament teach us, each in its own way, that healing the sick and visiting the infirm are both a blessing and a duty. Jesus said the Temple had been turned into a den of thieves; the American health system and pharmaceutical monopoly is just that and has bankrupted millions of Americans.
I have been a taxpayer since 1979 and though I keep BUPA ( since 1981, for those of you ‘enraged’ that an American dare use the NHS, nowithstanding the millions of visitors from abroad who use and abuse it every year) and have gone private for many issues, I consider the NHS one of the greatest inventions of the past century. I have worked tirelessly as a volunteer on patient panels to improve the NHS and the private sector.the fatc that the Hospital of St John and St Elizabeth, which as a charitable Trust lies between private and NHS, has now combined forces with the NHS practice at Brampton House and is a step forward in primary care. The NHS is not perfect but it is a darned sight better than the sorry system in the United States, where hardworking taxpayers end up with Hospital Liens over their homes.
Jan 25, 2009 - 6:27 am 10. don:At the end of the day my London friend is a medical marvel due to the utter brilliance of St Mary’s Hospital and my friends in the USA keep saying ‘had this happened here, by the time they sorted out her eligibility for treatment she would have died.’
Miss Gould is so addicted to a Socialist ideology that she can’t see any forest for the small buds that will one day become trees (or weeds). She goes on a petty rant about Zionists, and etc. before getting back to her core argument.
Socialism is a lie, in economics and in medicine. In medicine (in all examples one can name) It always turns into a system of marginal care for all (save the lucky) and heroic care for the few (the nomenclatura whatever their composition). From the Sovstate to Norway, UK to Canada it’s a great system long as you are not really ill.
Her attacks on the system here? Start by reading the 1st two sentences . End with this; our system of healthcare is compromised by two conflicting (yet synergizing) groups, medical mercenaries (”to cut is to cure”, you need this procedure/medication/hospital stay to . . . (so I can bill you)”, and the mercenaries of the “Legal” profession (remember “Ambulance chasers”?) who’s overarching concern is not the patient or families health, but to maximize fees/billable hours/settlement numbers. The two groups independently/synergistically have created a bloat in costs that punishes those of us who pay our taxes AND our insurance premiums. The third leg of the problem is a “blame” culture, encouraging patients to sue (to cash in?) for any reason (however petty).
There are many medical professionals who look at what they do as “serving a greater good” and take the Hypocratic oath seriously here and across the world, there are also those who work within systems where “close enough for government work” is the cardinal mantra and woe betide those who put extra effort in (you make everyone else look bad!). The shame is both are very typical of Socialist societies (and socialized medicine in general), with the “gubment work” mantra being the catchphrase of the majority.
Jan 25, 2009 - 7:09 am 11. Oldguy:If socalized medicine is implemented in the U.S., and doctors become government employees; will they demand fourty-hour work-weeks? Can you see the obvious delay for treatment this will cause?
Jan 25, 2009 - 7:22 am 12. TexEd:I believe what happened in the former Soviet union was the majority of doctors were really nurses. We better carefully read the directions before we take this medicine.
Fortunately, when our health care is nationalized, stories like this will be unheard of! It will be considered hate speech to tell such a story and those who do will be required to volunteer to work in a health care facility for a number of years. Confidence in the system will be far more important than the quality of the work performed by the system!
Jan 25, 2009 - 7:26 am 13. Battlecat:National health care works very well in Germany and France. It’s a disaster in Britain. So it can work, depending on how well it is administered.
Jan 25, 2009 - 7:34 am 14. Craig:In all fairness, and I am not a proponent of a NHS, I have had similar experiences in Americam hospitals.
Jan 25, 2009 - 7:35 am 15. cedarford:Big Red – before I get the usual “winner of life’s lottery” crap, until the Democrats tanked the economy my company had trucks sitting in the yard we couldn’t find drivers for. Any one who could drive out of the yard without hitting anything could get the same health insurance I have. But, I guess “free” is easier than earning a living.
Apocryphal tales of one company with temporarily open “good jobs” simply driving a truck..does not mean anything – you have to look at the economy and health insurance prospects of the nation as a whole.
1. Business and manufacturing associations have warned that exploding health care costs are unsustainable. They have said that they are seeing a sharply rising number of employers opting for contractors, part-timers, and outsourcing services to India because of health care expenses. Most have gone on record as saying it is essential to remove the health care cost added to employers goods and services in order for America to become globally competitive again and reduce our trillion-dollar trade deficit.
2. 1/7th of working Americans lacking health insurance has become 1/6th under Bush and is headed to 1/5th.
3. Lack of health insurance is blamed on causing 18,000 extra deaths each year in America, which drives how we have a lower life expectancy than most nations with universal healthcare. In addition, the AMA and the Dental Association warn that cutting dental coverage or private insurance omitting it altogether is resulting in declining dental health for the average American and possible secondary cardiovascular conditions caused from untreated dental deacy, infections.
4. Private health insurance for those not working because of medical conditions or in areas of high unemployment like the Rustbelt, working independently, in small business, small business employers themselves – doubled in cost in the Bush years. Many families and small business owners report that the monthly cost for a single family policy exceeds the average cost of mortgages in the USA.
We have 1 million medical expenses caused bankruptcies a year. No other advanced nation has this problem. Credit reporting agencies now list 3 of 7 categories of bankruptcy as medical care -generated, and have two of those categories reserved for “no fault of credit candidate”.
5. Opponents of universal health care love to point to NHS or Canada – and ignore far better systems in German, Japan, France, Scandanavia, Singapore.
Jan 25, 2009 - 7:48 am 16. Tom:We pay Israel 5 billion a year, which helps them provide universal health care. In Iraq, one of the 1st things Iraqis and Americans agreed on was that oil revenues would be used to provide universal health coverage – where no one would be turned away or bankrupted by being injured in war or accidents or by happenstance of disease. To do otherwise was termed “unconscionable” and one of Saddam’s big shortcomings..
What we need is less restrictions, more competition, and portability so people can cut the link of insurance from their employer if they so choose.
Also, insurance now gives little incentive to take better care of yourself since if you do get it, you don’t pay as much.
A nationalized plan for a population of 300 million will destroy the US economy within 5 to 10 years after implementing. It would be a disaster. Something like that might be feasible in a country of say 3 million, but not in a huge country like the USA.
Portability, competition, incentives for people to become doctors and nurses, and tax credit up to a certain amount are a good start. Nationalization just doesn’t work in the USA in other areas where it is tried.
Jan 25, 2009 - 8:47 am 17. David H:NO No No No, Carol Gould wrote of what she saw, there are areas of excellence in the NHS, but I have to say emergency care of a normal nature is not one of them, my sister in law had a similar tale to tell as Mr Dodge, the service was just terrible in that they actually forgot she was there… I had a good experience when I was ill in 1997 however.
France has a good system, but it is expensive, Europe has a mixture of Government and insurance type cover, so you cannot call it as being like the NHS in France and Germany, and they seem to work well in most cases.
Jan 25, 2009 - 8:56 am 18. Joe Bison:One of the problems in the universal system is
the mentality is that it is “free”. People abuse
the system with needless visits.
Also in the Canadian system for example
whacks of old parents were brought into the
country by their immigrant children from the
third world. These old people never worked or
paid taxes in Canada but cost a lot in medical
terms. Whoops, politically incorrect topic.
Over time more and more procedures get cut
Jan 25, 2009 - 8:57 am 19. fred:or restricted. Eye exams in the province
of Ontario for example. Others had no or
limited coverage from the start. Dental and
drugs for example except for certain groups
or circumstances(HIV+) for example.
If Tom Daschle thinks that the British system is the model for what ours is to be, we are in trouble. Big trouble. What Obama and Daschle are proposing is so ghastly that it is unethical in the extreme. People are going to die under this system who would not have under what we have right now. There will be more medical mistakes. Lack of timely treatment will results in ailments and traumatic injuries becoming ever more complicated. The NHS will also make access to clinical trails difficult, at best.
Only socialists could pervert something that is governed by the Hippocratic Oath.
Jan 25, 2009 - 9:21 am 20. Big Red:cedarford: actually, driver shortage has been industry-wide for over a decade, but the recent economic slowdown has resulted in far less freight to haul, so that problem has been “solved” for now. I do not claim there is not problem in health insurance, but to take the money from a different pocket doesn’t really solve the problem. How many of the 1/7 to 1/6 heading to 1/5 aren’t even supposed to be here? How much is the legal profession responsible for the increased cost? The other countries you mentioned have also experienced increases in cost. The UK is on the verge of bankruptcy. And i just saw the video of Charles Rangle and Robt. Reich agreeing that stimulus money must not go to white male construction workers, only unskilled minority and women. These are not the people I want in charge of my health care. I do like the point you made about Iraq’s oil revenues going for health care. Guess we won’t be doing that here in the near future.
Jan 25, 2009 - 9:55 am 21. John Moore:Neither system is very good.
We need to stop using ideology as the only measure of a system and look at how it works.
The US system is great for those who have decent health insurance or good health, but a financial disaster otherwise. If you’ve been covered by employer insurance all your life, try buying private insurance when not covered. Only the very healthy can get it. If you cannot buy it, the cost of procedures to you can be up to 10 times the cost if an insurance company was paying.
The idea of having your health insurance provided by your employer is probably more idiotic than having it provided by the government. It is an artifact of wage controls in World War II.
The US spends far more per capita on health care than other countries.
On the good side, US health care is excellent. Those who compare mortality statistics with European countries fail to account for confounding factors that the US has far more than Europe – factors unrelated to the system itself.
Canadians routinely come here for superior, more available care. Our local Mayo Clinic has a full time staff of translators for foreigners.
The US system, because it does not have a monopoly buyer for medical care, is a major driving force in medical innovation. Create a monopoly buyer and where are the drug companies (for example) going to make enough profit to pay for their costs of developing new medications?
Anyone who thinks the US system is a free market one is fooling themselves. Anyone who thinks the free market will take care of the following problems is likewise wrong:
1) The displaced cost of those who choose not to buy insurance and then use expensive resources
2) The fate of those who cannot buy insurance due to finanical reasons, but need care
3) The FACT that many cannot buy insurance due to extreme pre-existing conditions limitations; and the fact that insurance companies must impose pre-existing conditions limitations or fail due to free-riders (you don’t buy insurance until you get cancer, for example).
3) The (required) provision of care to all comers, with the problem of who pays.
3) The pathetically low state of automation of the US medical system, due to the lack of mandatory standards
4) The power of big insurance monopsony buying, which forces hospitals (and other providers) to shift the real cost to those without those policies. The cost to the uninsured can be more than 10 times the cost to the insured (in my case, my insurance payed $480 on a bill that would have cost me, without insurance, $5000).
Jan 25, 2009 - 10:16 am 22. Mary Grabar:Yup, government workers. Imagine the person behind the desk of DMV operating on you.
Jan 25, 2009 - 10:21 am 23. ed t:An example from the UK which my family relayed to me yesterday- an elderly family friend was called into hospital for a gall bladder operation. She’s 86, a widow. She was called in early in the morning and kept waiting without food or water for 8 hrs. At some stage she had to go to the toilet, unaided by nurses. While there she suffered a stroke and is now stuck in a carehome. This kind of thing is normal in the UK NHS.
Jan 25, 2009 - 10:25 am 24. AlexinCT:As long as so many people feel they are entitled to healthcare we will be forced to deal with those that see this as a perfect vehicle to give government an even larger influence on the average citizen’s life. I for one agree with the poster that pointed out nationalized healthcare means you have to go through people you would meet at the DMV to get care, and I would prefer to avoid that at all costs. Not to mention that there are many people lobbying for healthcare to be another government handout so they can truly have a real good reason to go permanently on the dole. I had a colleague once tell me the only reason he worked was that his wife needed healthcare. He pointed out that as soon as it was free – meaning other people paid for it – he would quit the rat race and live off the dole. “Work is for idiots” was his basic life philosophy.
The solution to this issue is not too hard. Mandate catastrophic coverage for everyone through a pooling system, and make everyone responsible for their own health care gap coverage otherwise. With catastrophic medical bills covered by some state or nationwide pool (and definitely not controlled or ran by government unless you want it to fail) buying gap coverage suddenly becomes much less expensive. Especially if you allow menu plans where the user picks and chooses what they want covered while also limiting how much of the buffet style coverage for super expensive and specialized care mandated by states that often drive the costs sky high.
Get insurance from your employer or on your own, or not at all. But no insurance should mean you pay for your own coverage, out of pocket, or you get no medical treatment, period. Sounds harsh, or even barbaric, but I know some very well off people that tell me, without any shame or remorse, they feel no obligation to insure themselves at all. This is because when they show up at a hospital emergency room they get care anyway. And afterwards they can manipulate the state to pay for their bills by claiming some kind of financial duress they do not really have.
Of course we will never get anything like this because the battle is between those that want to give government control of healthcare, and thus of people’s lives, and whom will not compromise with anyone on that final solution, and everyone else. These people will never allow, or even contemplate, any kind of change that does not give government control, and them more power, in the end. Just like they will not allow any change to Social Security because of the power it gives them. And yet they are winning the day because they pretend they are doing this to help those the system is not helping. The road to hell is paved with good intentions. Do not let these people claiming to want to do good fool you.
Jan 25, 2009 - 11:21 am 25. Pope Linus:My wife and I were in an American emergency room last year for 22 hours before she was admitted–in a hospital where she is an employee. She ended up needing major abdominal surgery.
Why the long wait? Not enough beds. While in triage, she had to compete with the homeless coming in off of benders or those with stomach aches, the elderly and confused, etc. Everyone is guaranteed emergency care in America.
Waiting was a terrible experience, but her care by the doctors, nurses, techs, surgeons, was absolutely fantastic. It completely made up for the initial problems. Her surgery went perfectly, done by absolute professionals.
Is the American system perfect? Of course not. But its problems won’t be solved by more government intervention. We were told that, in her condition in England or Canada, she could have waited for days for her surgery–which could have made her septic. And, as others have already stated, the levels of professionalism among doctors and nurses in other countries aren’t close to those in America.
I hesitate to think about what would have happened had we been in England or France, or anywhere else other than the U.S., frankly. If you want healthcare to be run like Social Security, or Amtrak, or Medicaid, headed by elected lawyers intent on staying in office, trumpet the cause of socialized medicine. Sorry, but even with its flaws, I trust free market solutions every day of the week, even with my own health.
Jan 25, 2009 - 11:55 am 26. Ian Thorpe:Like any large organisation the British NHS resembles the curate’s egg; it is good in parts.
The worst part of the NHS is its A & E function. But that is the same anywhere, remember ER, the last season of which was not so long ago? (I’ll miss the show but at least we get back the gorgeous Parminder Nagra) Acciden and Emergency services are impossible to manage efficiently anywhere, there is no way the workload can be planned. On the other hand the NHS does excel at intensive care functions. I wouldn’t be here if they didn’t.
As for cancer, there is a big problem in that area but it is not due to inefficiency. Successive corrurpt and self serving governments have cut deals with big pharma that do not serve cancer patients but do pull in big financial contributions for political parties.
Jan 25, 2009 - 12:12 pm 27. Ian Thorpe:@ #9 Carol Gould
If your friend is using a computer I can put her in touch with a couple of very good support groups that will be able to help her when she is ready to leave special care.
I had nine months in a neuro rehab unit after a massive brain haemorrhage, learning to walk again and other basic stuff. If you can’t prise my e-mail out of Pajama Media visit my blog:
Jan 25, 2009 - 12:48 pm 28. Larry J:http://greenteeth.blog.co.uk/
if you want to get in touch.
The US government already runs vast segments of health care including the VA, Medicare, Medicaid, and treatment for active duty military members. None of these systems are effective, efficient, or offer high quality health care on a consistent basis. On the basis of that, we’re talking about letting the government run all health care?
As an analogy, suppose you hired a handyman to do some projects around your home. One after another, he botches the projects. The work quality is poor, the prices are grossly inflated over the estimates, and the handyman is surly. Who in his right mind would then hire the guy to built his next home?
Jan 25, 2009 - 1:02 pm 29. John Moore:Medicare offers high quality health care on a consistent basis. I think this is because the same practitioners and facilities are also in the private market. However, Medicare’s compensation system has been copied by the insurance companies, resulting in poor practices such as compensating surgeons far more than the front-line diagnosticians.
Jan 25, 2009 - 1:16 pm 30. Andrew Ian Dodge:As we have found out from friends. In the UK once they know you got cancer they are pretty good. However they are bloody awful at finding it. More often than not they are too late by the time they find it. I mean, for instance, you have to request a colonoscopy and more often than not they just settle for scans.
NB: This was written by K T Dodge and not me.
Jan 25, 2009 - 2:33 pm 31. davod:“Medicare offers high quality health care on a consistent basis.” This is a misleading statement.
Medicare does no provide medical care. It reimburses medical providors who provide care to those covered by Medicare. So in the general scheme of things the care provided is good because it is the general medical community which provides the care.
However, Medicare keeps costs down by minimizing the amount paid to providors. If the payments do not cover costs and allow a reasonabale profit then providors opt out.
Jan 25, 2009 - 4:20 pm 32. Squirmn:Improvements can always be made. My wife had a kidney transplant, and while I did not have insurance at the time, Medicare covered it (they cover all transplants regardless of income). Because of the plethora of pills required during the first 3 years of recovery, they will also cover prescriptions. I personally did not desire this so I financially burdened my small business with group insurance. Until the time the new policy went into effect, about 6 months, I paid for the pills myself. This is no small feat, and I found that a little conversation goes a long way. All those who claim uninsured or under insured have no relief are patently wrong. By talking to the hospitals, clinics, pharmacy’s and pharmaceutical companies I was able to reduce the costs significantly to a point where it was not a financial hardship on a monthly basis. Like I said, improvements can be made. Red-tape could be reduced if not eliminated by simple cross referencing and maybe digi-chart technology. All things considered I would never have taken my wife to another country to get this procedure, or any of the myriad follow-up procedures performed.
On the other hand-
My mother has a friend who lives in Canada. In October he was scheduled for a bone scan due to the possibility of prostate cancer, which metastasizes to bone frequently. On January 4th he got his bone scan. The cancer is now so advanced he has no hope of survival. That health system ostensibly handed him a death warrant. In America scheduling a bone scan might take 2 days.
Now I know these are only 2 examples, and I of course hand-picked them, but they ring true. This IS the modus operandi of these separate systems and this IS what makes them different. The American health system is not perfect, but it is certainly not broken to the point of needing to socialize it.
Jan 25, 2009 - 4:27 pm 33. cedarford:John Moore – Appreciate your balanced comments. In my own post about the great flaws of the US system, I omitted the archaic, byzantine paperwork that adds cost and inefficiencies other advanced nations have moved past – and the screwing of those denied or without insurance having to pay 5 to 10 times more.
In another discussion in a different forum, the latter topic was brought up. This practice of charging uninsured “top price” while saying big insurers and government wards (welfare mommas, prisoners, illegals, seniors on Medicare) get huge discounts was defended as fine and proper by certain free market ideologues.
Their rationale is that if individual citizens denied insurance by the jobs they do or a pre-existing condition are “too lazy” to negotiate their own discount schedule for a range of maladies they might one day have in the future – well, then they deserve to pay 5-10 times more and be bankrupted. I thought that stance was ludicrous, the idea that an individual is responsible to visit hospital billing dept and personally negotiate and argue with an employee and the lawyer from Hospital Legal for “best rates”. Spend a few days there, getting prices for 500 diseases, all possible hospital charges,600 possible tests, and prices on 3800 possible drugs or disposable med devices used?
Then hit all the doctors offices to negotiate deals for anything you might, but likely not, possibly come down with?
I called the hospital in my medium-sized city – the only hospital within 45 miles – to ask how many uninsured individuals have attempted to negotiate their possible future prices down to less than 5-10 times more than insured and gov’t wards get. They referred me to legal…which explained that they had institutional contracts agreeing to rates, but absolutely no provision for individuals to negotiate..
*******************
On the matter of only the US system avoids “socialism” while “innovating”…thus is better even if 50% more in cost and leading to lower life expectancy in part because 1/6th of workers do not get employee benefits –than those “inferior foreigner ways”…..
Jan 25, 2009 - 4:55 pm 34. robin4est:A Japanese associate who also had worked in Singapore and the Netherlands which were roughly similar explained that their health care system is universal insurance but private sector care. 6-7 large insurance companies are obligated to to cover all (no cherry-picking, no denial for pre-existing conditions), workers are obligated to be covered by payroll deduction, people who can’t work or are unemployed have gov’t pay the premiums if they cannot afford to.
He said that the private companies have to compete for people nationally, insurance is not crazy-quilted by differing prefecture law and regs (A Prefecture is like a US State). QA is built into the process and quality of patient care is examined by independent gov’t inspectors and benchmarked against how foreign nations do. Goals are set, and those private medical providers that are the most efficient and innovative get more profit.
He also said that he believed (his brother is a MD) that Japan does as much R&D as the US does per capita into drugs (All the big pharma outfits have R&D facilities in Japan and India), basic cancer research,develop new drugs, and as much or more med research papers and drug patents, per capita.
Cedarford:
“He also said that he believed (his brother is a MD) that Japan does as much R&D as the US does per capita into drugs (All the big pharma outfits have R&D facilities in Japan and India), basic cancer research,develop new drugs, and as much or more med research papers and drug patents, per capita.”
Probably true, but most, if not all worldwide medical R&D is undertaken with the U.S. market in mind. Many innovations, drugs, and treatments used worldwide were financed with profits from our health care system. Like it or not, profits from the American market drive many worldwide medical advances. A socialized system will save a lot of money initially, but the future will be bleak. The only advances that will get into distribution will be those with political connections.
Jan 25, 2009 - 6:48 pm 35. cthulhu:That there is a constant catfight over healthcare costs and methods for getting them paid completely ignores the fact that there are two factors that influence the cost point where the market clears — supply and demand.
We are paying monopoly rates for health care, and people continue to argue whether it should be individuals, insurance companies, or government that should pay them. How about just making the rates lower? Start a project to graduate twice as many MDs five years from now, and twice again in 10…lower medical school costs drastically…shorten patent protection on medications…lower costly FDA barriers to new treatments. Change the Supply side.
The cure for monopoly is not monopsony, except in the very shortest of terms. The cure for monopoly is market competition.
Jan 25, 2009 - 7:42 pm 36. Eric:The NHS has resulted in fewer and fewer native Brits becoming physicians so Britain has to import more and more doctors from the Muslim Middle East (remember the airport incident in Scotland? All docs). The Brits won’t work under the NHS bureaucracy or for reduced wages. In time, if we implement the same type of socialist plan fewer Americans will want to enter medicine and we too will have ti import 3rd world doctors to make up the shortfall.
Jan 25, 2009 - 8:59 pm 37. John Moore:Something like this is perhaps a good approach for the US, although it has failed where tried (not sure why). It ties together the most important issue: must issue rules and must buy insurance rules.
It’s not where the research is done – it’s where the profit is made, which is in the countries where the governments do not drive the prices down by monopsony buying. One socialized system in the US – The VA System – deals with this by simply not paying for a whole lot of important drugs – hence denying profits to the pharma companies.
Jan 25, 2009 - 9:12 pm 38. Matthew:Something that baffles me: Why, when discussing universal health care, does nobody ever mention australia? I think we’ve got it as close to right as anyone ever has. We have price controlled, subsidized pharmaceuticals, a working public hospital system, we can still buy private health insurance as competitive rates (I do – and it’s a heck of a lot cheaper than the figures bandied about during the US election) and when it comes down to brass tacks people get the health care they need. It doesn’t cost us anything like the NHS’s disastrous figures, and we spent a fraction on health care (per capita) of the US for the same outcomes. We have problems, yes, but they’re more to do with individual bad decisions (like the baffling decision to cut medical school places in the 90’s) than the overall approach.
I also get a giggle from the breathless claims that this is all a drain on the poor pharmaceutical companies – for a bunch of parasitic socialists, I think we punch pretty well as a country for medical research, most of which benefit (in dollar terms) those very companies. For the west wing fans out there – you know that comment that arnold vinnick made in the debate about private research producing a pill to fix stomache ulcers? That was actually discovered and developed entirely by two guys in western australia on public research grants. They got a nobel prize for it. Part of me wonders if that was a deliberate mistake by the script writers to undermine the argument – they must have known that, surely?
On the other hand, maybe it’s for the best that nobody pays attention. Maybe that’s all that stops washington from applying the sort of diplomatic pressure it does over drug policies in order to bust it.
It is actually possible to get it right, IMHO.
Jan 25, 2009 - 9:18 pm 39. rk:Here’s a note from the UK NHS. From BBC NEWS Jan,25th
The NHS hospital building programme in England could be badly disrupted by the recession, a health service memo seen by the BBC suggests.
According to the memo, PFI schemes were always plan A, and that now none of the banks have any money the absence of a plan B is going to cause a real problem.
It also predicts that NHS funds will be hit hard by the credit crunch and that 2010/11 “is going to get really tight”.
looks like tought times in the Uk
Jan 26, 2009 - 12:21 am 40. Jonesy55:“It doesn’t cost us anything like the NHS’s disastrous figures”
Just out of interest, how much does Australia spend on healthcare? It must be very little by developed world standards if it is significantly less than the UK.
Jan 26, 2009 - 12:38 am 41. Jonesy55:“The NHS has resulted in fewer and fewer native Brits becoming physicians so Britain has to import more and more doctors from the Muslim Middle East (remember the airport incident in Scotland? All docs). The Brits won’t work under the NHS bureaucracy or for reduced wages.”
Are wages in the NHS ‘reduced’? As far as I can see the pay is not too bad at all. Of course there are doctors from overseas, not just the middle east but Africa, Eastern Europe, India etc plus nurses from the phillipines, the carribean and elsewhere. Is this not the case in the US?
Jan 26, 2009 - 12:42 am 42. KansasGirl:No government enities should run healthcare, none, never.
Jan 26, 2009 - 1:35 am 43. Henry Scowcroft:It is regrettable that KT Dodge links to our post as evidence of the NHS garnering “very poor reviews”. The post in question is a report of a talk given by Professor Michel Coleman on variance of cancer rates across the European Union. From a UK perspective, this is a picture that has been improving steadily as the effects of the NHS Cancer Plan and the Cancer Reform Strategy kick in.
Admittedly, there are still areas of concern for the UK cancer community – and the variance of cancer outcomes according to socioeconomic status is one such area. However, this variance is certainly not unique to the UK, and hard to see how this can be laid at the door of ’socialised medicine’ per se – the US has similar health inequalities after all.
Jan 26, 2009 - 3:26 am 44. deguello:I can’t wait for OBAMACARE:how about you? The Brits voted themselves this montrosity,and now it’s killing them.
Jan 26, 2009 - 6:46 am 45. Michael:No one seems to place the blame where it squarely belongs. Lawyers and the civil court system. Fix that and the problems of US health care will drop 10 fold.
Awards for malpractice should be for actual losses and the attorneys fees should be capped at a resonable rate. Malpractice is a tragedy, not winning lifes lottery for the patient or his relatives. If there is a true problem then the doctor, hospital health care provider,should face sanctions more appropriate than having his insurance rates increased.
That alone would bring the cost of health care to a reasonable price.
Jan 26, 2009 - 7:41 am 46. edk:I lived there and actually NURSED there.
Jan 26, 2009 - 8:01 am 47. cedarford:Awful, just look at the huge problem with MRSA infections in the NHS.
Michael:
No one seems to place the blame where it squarely belongs. Lawyers and the civil court system. Fix that and the problems of US health care will drop 10 fold.
Hardly.
The hard right conservatives that extoll the “free market!!” theory glommed on to “evil trial lawyers” as the reason why US healthcare costs exploded, 1/7th and now 1/6th of working Americans were uninsured.
Until people both in the right wing and people seriously began looking at costs and what factors make US healthcare 40-60% more expensive per capita than other advanced nations. Tremendously wasteful paperwork, administration, lack of IT in records and work between insurers, employers, gov’t, – was the biggest cause, followed by excessive services and drug fees compared to Europe and Asia. Lack of preventative health care in the USA. Then Medical misadventures and lack of quality.
The damn evil trial lawyers and excessive defensive medicine came to 5-7% of excess costs. Something that surprised folks like Gingrich who started off thinking “F*-ing lawyers” must have a bigger part. What they found – study groups, CBO – was that malpractice insurance reflected in large part each doctor paying for the actual costs of actual doctor and careprovider screwups. And the cost of the “middlemen” to resolve claims that universal healthcare cuts out, considerably….meaning suing to pay for future services not already provided involves tons of payouts for administrators, lawyers, courts attempting to adjudicate lawsuits to establish fault and future payers. Something largely avoided in other countries. When a doctor screws up in another country, regulators establish fault and award pain & suffering damages according to law. There is no need, as in America – to make the huge awards that are estimated to be needed to fund all future healthcare and making pain&suffering whatever a manipulated jury feels it should be.
Jan 26, 2009 - 8:32 am 48. Richard:I hate to ask this but were the nursing staff from overseas?
Jan 26, 2009 - 9:04 am 49. Scott:At our public hospital in Memphis,US citizens have to line up behind Mexicans who have the sniffles…
Jan 26, 2009 - 9:11 am 50. Blackwell:Michael: lawyers have been around forever: hospitals drowning in debt are relatively recent.
California limited pain and suffering recoveries 20 plus years ago and the amount has never been increased. It limits recoveries in most med mal cases but trauma wards keep closing and hospitals keep losing money. Because of the number of uninsured people using emergency wards and hospitals for everything from birth to death. Hospitals have to treat them by law till they are stabilized. Guess where most of those people are from? Good guess.
The US also allows and provides great “high end” health care for cancer, heart attacks and prolongs life where other countries do not. It also devotes staggering sums on preemie babies where other countries do not.
Jan 26, 2009 - 9:48 am 51. Michael:I think you underestimate what that 7% (and I think this is low) does. I know that insurence premiums can pass $100,000 per year for a good doctor with a good record. That is also reflected in all parts of the health care community.
Being regulary attacked in the court system is not just part of buisness. It is a personal thing. It is an attack on their abilities and their character.
You think you have a problem now just wait. A recent survey with family practitioners, the first line medical personel, about 60% said they seriously wanted out of the profession.
Are the suits the only problem? No. But they have a snowball effect that makes the avalanche that is crushing the health care system.
Jan 26, 2009 - 9:48 am 52. momof3:I agree we need tort reform in many areas. Lowering costs 5% or so would be a start, no, even if that’s all legal reform brought? I feel little pity for the uninsured here in the US. They talk about the expense like it’s a choice between being homeless or covered, when it’s not. It’s a choice between the lifestyle they want, and a slightly lower one that includes healthcare. Maybe you need an 1800 sq ft house instead of a 3000 sq ft one. Maybe one car instead of 2. Maybe a $10K car instead of a $30k one. Life is choices, including what we find important enough to spend our money on. if healthcare isn’t that important to you, that you’re willing to pay for it, then why on earth should I help pay for it for you?
We also need more drs and nurses. More supply, the wages go down. Pretty simple. I understand why med schools try to stay so competitive-to keep the best quality people only entering-but they need to loosen up. We also need a LOT more nurse practitioner programs. A nurse practitioner can handle all routine care, and costs about half an MD in salary. India has an amazing rural village health program (not a government-run function!) where illiterates are taught basic hygeine and healthy lifestyle changes, then sent back to their village to teach the others, and send people to the program’s hospital when necessary. How much healthcare costs could we save by teaching the poor to eat better and exercise? It deosn’t take an MD for that. This program alone has lowered maternal/fetal deaths by 80%.
Jan 26, 2009 - 10:10 am 53. cedarford:Michael – Are the suits the only problem? No. But they have a snowball effect that makes the avalanche that is crushing the health care system.
No, Michael. They were only a bogey man erected to explain why US healthcare and drugs were priced far higher than other nations. Now even serious conservative Republican healthcare reformers like Gingrich, Romney, Tommy Thompson admit that lawyers have little to do with the systemic problems that undelie the slow failing of US healthcare.
There is no snowball, there is no avalanche from lawyers “being the root of present problems”.
If we look at core problems we see that globalism has made employer-provided health insurance obsolete if we are to compete. We cannot give free medical care to indigents and pass on those costs endlessly. Unlike other portions of our society, technology and innovation have not provided better solutions at lower cost but solutions, sometimes marginally better, at far higher cost.
Jan 26, 2009 - 10:20 am 54. John Moore:Lawyers are only a manifestation of the systemic dysfunctions we have that bring the lawyers to do some resolutions the system cannot presently achieve.
You hardly refute the fact that your price controlled pharmaceuticals are free-loading on the pharmaceutical companies. In fact, when you say “price controlled” you are admitting that your government is preventing free market prices from being achieved.
That can have only one effect: reducing the income of those companies in Australia relative to, say, the US.
You are free-loading, not off the pharma companies, but US pharma consumers, who pay the difference to keep those companies afloat.
As for the research, lots of countries do basic research, as do drug companies. But the specific research necessary to get a drug from the speculative stage to acceptable for use by humans is very expensive and is borne by the companies. In the US, this is the cost of getting FDA approval – which is a (not very efficient) mechanism for determining efficacy and safety of medications.
Which medication are you referring to? An Australian doctor discovered that, contrary to decades of medical belief, most stomach ulcers were caused by the bacterium H. Pylori, rather than stress. The “pill” for that is common, pre-existing antibiotics.
Jan 26, 2009 - 10:22 am 55. CrumbleKid:Hate to disappoint you, guys, but I live in England and for all its faults the National Health Service is IMMENSELY popular. We wouldn’t go over to the system you have in the States for all the tea in China.
Seriously.
Come over here [it's very cheap these days!] and ask some real British people.
Jan 26, 2009 - 10:24 am 56. Andrew Ian Dodge:Well it won’t be all the ones that are killed by incompetence now is it? You can sue but it takes a long time and get rather little.
And British opinion is just a tad skewed by the bashing the US system gets repeatedly by the BBC et al.
And as far as “real” remark goes. The author of this piece is British and very real. And she is not the only British person I know who is very down on the NHS.
Jan 26, 2009 - 11:04 am 57. mohammed:40 million Americans have NO health insurance and can only get emergency treatment. The NHS I understand covers everyone that is legally resident in Britain. STOP comparing apples to oranges. It took katrina to open the world’s eyes to the worlds richest country hidden backyard. My foot.
Jan 26, 2009 - 11:33 am 58. CrumbleKid:One thing that I think Americans fail often to grasp is that you can go private if you want to. And many people do for minor things. If you’ve an ingrowing toenail or whatever and you want to ‘jump the queue’ you can. But when it comes to the big stuff, cancer, stroke, heart trouble, it’s the NHS every time. Cos when it comes to the big stuff, it’s the best.
Jan 26, 2009 - 1:48 pm 59. Mary Jackson:Relatives’ and friends’ experience has been generally good but mixed. Both my parents have had cancer, and the care could not have been better, nor that of a friend who had a heart attack. But those with less urgent/life-threatening problems tell of long waits and rude/indifferent staff.
I don’t think you can generalise. The NHS is a good idea, but the practice doesn’t always live up to it. Even if the US adopted some kind of socialised health care – arguably it already does – it wouldn’t be, and shouldn’t be, along the lines of the UK, not least because the US is so much bigger.
Jan 26, 2009 - 3:28 pm 60. John Moore:This is purely and simply false. Every American can get routine care and emergency care.
Jan 26, 2009 - 4:39 pm 61. cedarford:John Moore:
40 million Americans have NO health insurance and can only get emergency treatment.
This is purely and simply false. Every American can get routine care and emergency care.
With the following caveat: routine and emergency care is free to illegals, welfare mommas, and even the richest elderly, and the insured get 70-80% discounts and a 20 dollar copay. The uninsured, which “can get” care, pay 3.3-7 times as much for the same medical service “package”.
Imagine if we sold 4X3′ plasma TVs. Free to the poor, 80 bucks copay to the rich with no deductable in the “exec only” premium med acre deal, and 1200 dollars for the middle class, expected to shoulder not just the costs of direct purchase , but subsidizing as much “free indigent care” inc. plasma TV purchases, as possible foisted on them.
Yes, and get ready for the bankruptcy proceedings if they are uninsured and are stupid enough to have any liquid assets for creditors to seize.
Unless you are an illegal, a prisoner, or an elderly person with huge net wealth eligable for free care, discounted but non-means tested taxpayer drug subsidies for seniors.
Even if you are fully insured, beware of health providers that quit arguing with insurance agents foot-dragging and decide to turn accounts over to bill collectors. Collectors who subsequently report to credit agencies that you are a paid debt risk, even if insurers then agree to the billing code or negotiate a deal with the health care provider.
I found I paid about 520 extra for car insurance over 3 years, and 2200 in home refinance because of two med laboratory bills that were paid by insurance, but creditors never removed the “account not paid” adverse credit info from two bills under 100 dollars from minor “wellcare” blood tests my wife did that were not paid by insurers within 1 month. The 2720 in extra payouts was termed “non-recoverable” by my counsel..who I payed 100 bucks to learn that only in America will even the insured get screwed on credit for mistakes.
I learned in America that bill collectors will only call once or not at all, and insurance premiums and mortgage underwriters will charge extra and not inform the purchaser they have poor credit which is the basis of hundreds, thousands extra charged.
Jan 26, 2009 - 6:48 pm 62. John Moore:Actually, it’s worse than that – see above where I had a personal example of a ration of 10x.
You must have come across some pretty incompetent bill collectors! They make their money by collecting the bill – they buy it at a discount form the hospital or whomever, and then try to collect it form you. If they only tried once, they were hardly the norm.
Jan 26, 2009 - 8:15 pm 63. Jonesy55:“I lived there and actually NURSED there.
Awful, just look at the huge problem with MRSA infections in the NHS.”
Not just in the British NHS, believe it or not you can even get ill from MRSA in the USA where apparently fewer than half of staff properly disinfect their hands. It seems that even private employees can be lax sometimes, who’d have thought it?
http://www.courier-journal.com/article/20090111/NEWS01/90110018/1008
Jan 27, 2009 - 2:16 am 64. Andrew Ian Dodge:Yes, but when they screw up you can sue them. You can’t, or its very hard and you get bugger all in the UK. There is very little accountability in the UK for incompetence.
Jan 27, 2009 - 5:27 am 65. Mirco:National health care works very well in Germany and France. It’s a disaster in Britain. So it can work, depending on how well it is administered.
Jan 27, 2009 - 6:57 am 66. Mirco:I would say not so good, when old tourists in Barcelona game the system so they are able to return Germany with the drugs they need. Strangely they always forget their needed drugs at home.
And immigrants are an huge burden in all Europe.
But you will never know, until the system start falling apart.
Someone wrote about Japan and Singapore and compared them with Great Britain and the USA.
The great difference with Singapore is that Singapore is small so it is difficult to game the system and easy to keep under control.
Japan, the other side, is big, but homogeneous. They are all ethnic Japaneses, with the same culture, same behaviors, etc. The peer pressure keep them honest.
The italian system is spotty, good and bad professionals, good and bad hospitals, thieves and very honest people. It work, usually, in the North, and work not so good in the South where the (public) hospitals staff is swollen of people.
Nationalizing the system in the USA will not work because there is too much variety of people, with different ethics, too much immigrants, it is too big to enable a strict control.
But mainly, after you have it in place, it will be too big to fail. But it will fail the people paying for it.
Jan 27, 2009 - 7:14 am 67. Jonesy55:“Yes, but when they screw up you can sue them. You can’t, or its very hard and you get bugger all in the UK. There is very little accountability in the UK for incompetence.”
The figures don’t reach the wild sums paid out in the US but that’s not a bad thing in my opinion.
However the NHS does pay out a lot of money
http://www.nhsla.com/home.htm
“In 2006-07, 5,426 claims of clinical negligence …against NHS bodies were received by the NHSLA.
£579.3 million was paid out in connection with clinical negligence claims in 2006-07.”
£579.3m paid out in 5,426 clinical negligence claims is an average of £106,000 ($150,000) per claim.
Jan 27, 2009 - 7:23 am 68. Jonesy55:“Nationalizing the system in the USA will not work because there is too much variety of people, with different ethics, too much immigrants, it is too big to enable a strict control.”
But you wouldn’t need to nationalise the system or have government running hospitals to provide universal care.
Why not a system along these lines?:
Each legally resident individual has a healthcare account.
The government pays an annual sum into that account equivalent to the price of an average full service insurance policy for a person of that age, gender, genetic make-up, pre-existing conditions etc, basically the factors that the individual can’t choose to alter.
The individual then uses that money to either buy a full service insurance plan in the open market or alternatively a cheaper casualty-only policy in which case they can use the remaining funds to pay for routine healthcare costs.
If the individual has extra ‘lifestyle risks’ such as being a smoker, driving a lot, living in a dangerous area, being obese and so on that make their premium more expensive, they can either take a cheaper and less comprehensive policy, accept a bigger deductible, pay the extra from their own pocket or change their lifestyle.
Individuals could put extra money tax-free into their accounts to pay for plans that go beyond the average and they could take money out for other non-mediacal purposes once they were covered by at least casualty insurance (in which case the money would become taxable).
I would suggest that this provides universal coverage while keeping the government out of the business of running hospitals and deciding healthcare priorities for individuals who are better placed to make those decisions themselves. It also avoids the ‘poverty trap’ problem of means tested systems which provide subsidy for the poor only and take that coverage away when they get work or start to earn more money.
Jan 27, 2009 - 7:45 am 69. Mirco:The government pays an annual sum into that account for a person of that age, gender, genetic make-up, pre-existing conditions etc, basically the factors that the individual can’t choose to alter.
The problem is the equivalent to the price of an average full service insurance policy. If you cover all people legally residing in the USA, you will not be able to compute the price. Because there will be no market for the “average full service”. And it is never clear what is a “full service”.
The sum paid will become the minimum for all the services, because the prices will grow up given the increased demand. It is like a market with a minimum subside given to the buyers for unit of good bought. The prices will grow (usually fast) to meet this minimum.
The system could be working if you have a two tiers system, where (few) destitute people would obtain a subside to buy an insurance in the free market and all the working majority would obtain a bigger (much more bigger) deducible for their actual health insurance.
The problem, as usual, is that politicos will hear the complains that the minimum level is too low (it must be, else the system will never work) and will be asked to raise it a bit now and then or enlarge the number of people entitled. After a few years, the difference with the second tier will be negligible, the price will be raised and all people will fall in the “entitled” first tiers.
The real solution is 1) full private and personally funded personal healthcare (tax exempt); 2) full private donation funded charity healthcare (tax exempt).
Jan 27, 2009 - 8:19 am 70. Anonymous:“The problem is the equivalent to the price of an average full service insurance policy. If you cover all people legally residing in the USA, you will not be able to compute the price. Because there will be no market for the “average full service”. And it is never clear what is a “full service”.
The sum paid will become the minimum for all the services, because the prices will grow up given the increased demand. It is like a market with a minimum subside given to the buyers for unit of good bought. The prices will grow (usually fast) to meet this minimum.”
I’m not sure that this would be the case because buyers will have the option of choosing cheaper policies and withdrawing the rest of the money in their account to spend on other things. Some will choose to do this so there will be a market for cheaper than average policies.
If the money was ‘either to be spent on healthcare or you lose it’ then I would tend to agree with you, prices would drift upwards so that the level of funding given became the minimum price.
Obviously the definition of ‘full service’ would be subjective but something that provides the sort of care that typical employer-paid plans do now with a low deductible would be a reasonable standard.
Jan 27, 2009 - 8:39 am 71. Andrew Ian Dodge:As if on cue…the BBC shows up with its latest trash American health care piece.
Jan 27, 2009 - 9:41 am 72. deguello:The USA electing a laundered street thug to create a bad version of the NHS,that’s the REAL national disgrace!
Jan 27, 2009 - 3:15 pm 73. cedarford:#68,69 Jonesy55 and Mirco – The good news is that America does not have to reinvent the wheel to get universal health care, increase American life expectancy, and restore us to a globally competitive position again (healthcare costs now added to all goods and services we try exporting when no other nation sticks those costs on is absolutely killing us on trade)
We have 60 years of expertise in Asia and Europe (over a century in Germany thanks to Bismarck) to look at what works and forms the basis of successful systems – Germany, France, Japan, Singapore, Netherlands, Scandanavian countries have the best systems.
Jonesy55 – The problem with your healthcare plan is that you want people penalized for risk factors which the Euros and Asians rejected because it would mean a police state to monitor people’s weight, miles driven…inspectors coming in to evaluate your home and what your “risks” were in employment and diet…and so on.
You also want to allow people to divert money out of healthcare accounts for whatever they wish to spend it on.
The Euros and Asians have found that unworkable. The risk must be spread around. Otherwise, you end up with wildly different rates for the same coverage and just repeat two great flaws in the American system (1)Younger and healthier people “opting out”, greatly increasing premium costs of families with medical problems or the aged. (2) You would just recreate the awful American problem of denying insurance and healthcare to those with a significant pre-existing condition until they bankrupt themselves on expenses then the state must give them care free……
Mirco – The real solution is 1) full private and personally funded personal healthcare (tax exempt); 2) full private donation funded charity healthcare (tax exempt).
Unfortunately, the problem is not with the very rich who would love the new tax exemptions and could fully fund deluxe elective medical care on top of their already plush employer insurance plans. The problem is the working poor, who cannot afford private insurance, would get no tax deduction, and who are now 1/6th of Americans.
That is why Bush and the wealthy’s push for privatizing social security and healthcare were DOA. Only the well-off got significant benefit – it did nothing for presently uninsured Americans.
We already make charity donation for healthcare tax deductable. And other countries have gone away from that because of the great disparities that exist in charitable giving to fund all needed “charity-based” health solutions. Meaning some “pet maladies” involving cute kids or a great celebrity cast of endorsers gets lavishly funded – sometimes overfunded so much that the money is more than is needed for care and R&D and has to, just has to, go to the non-profit execs compensation, and into more advertising to get more charity dollars and away from “competing diseases” after the same dollar.
Jan 27, 2009 - 7:20 pm 74. D. Mullan:More charity dollars go to R&D and care of an exotic genetic disease that may kill 700 kids a year than go to diabetes or lung, prostate cancer that kill 100 times as many people…..
This link is way out of date (year 2000) but it’s a a British Medical Journal article re international ranking of Health Systems, so is worth a look.
France number 1, Uk 18th, USA 37th….out of 191 WHO member states. All ranked according to certain set criteria and provided by the World Health Organisation. Of course, the WHO could have an agenda of its own, I suppose. Who knows?, ho hum.
So I’m not claiming it’s gospel or anything but it’s interesting. Especially since some replies here from Americans assume their system to be top dog.
Personally, I don’t have a clue as I’m not that knowledgable when it comes to other Health systems. I’ve only ever used the British NHS but not that often as ( touch wood) I’ve never really had a nasty accident or been ill enough to require medical treatment. Soemtimes you hear good stuff regarding the NHS and sometimes ” nightmare” stuff.
Anyway, heres’s the link :
http://tinyurl.com/bh9jhr
Jan 27, 2009 - 11:31 pm 75. Jonesy55:“Jonesy55 – The problem with your healthcare plan is that you want people penalized for risk factors which the Euros and Asians rejected because it would mean a police state to monitor people’s weight, miles driven…inspectors coming in to evaluate your home and what your “risks” were in employment and diet…and so on.
You also want to allow people to divert money out of healthcare accounts for whatever they wish to spend it on.”
No, it would mean that insurers asked questions about these factors when quoting for cover, the government wouldn’t need to be involved in this. It’s no more a ‘police state’ than when car insurers or life assurers ask similar questions.
As for letting people divert money to other things, yes why not? As long as they are covered by casualty insurance for major health problems, they can choose how much risk to take on for minor healthcare costs.
I would mandate casualty insurance (maybe with a prescribed maximum deductible) though otherwise you would get the problem of people choosing not to get insured and saving themselves the money then getting free treatment when they get seriously ill anyway because civilised society won’t just let them die.
“The Euros and Asians have found that unworkable. The risk must be spread around. Otherwise, you end up with wildly different rates for the same coverage and just repeat two great flaws in the American system (1)Younger and healthier people “opting out”, greatly increasing premium costs of families with medical problems or the aged. (2) You would just recreate the awful American problem of denying insurance and healthcare to those with a significant pre-existing condition until they bankrupt themselves on expenses then the state must give them care free……”
Well, I said that the amount paid by the government into an individuals health account would be adjusted for their age, gender and other risk factors not chosen by the individual, so a 65 year old with a family history of heart disease would get more than a 25 year old with no genetic risk factors. This would address your first point. I would let individuals take on the cost of chosen ‘lifestyle’ factors as this provides an incentive for individuals to reduce their own health risks.
Insurers and government could work together to come up with a list of pre-existing conditions that the market is unwilling to insure and individuals with those conditions could have an extra amount paid into their account to be spent on treating those conditions based on the cost of current treatments. This would keep the coverage universal while retaining the efficiency and choice of the market for the vast majority of cases.
Interestingly the British NHS is introducing ‘personal health budgets’ along these lines for people with chronic conditions, so a person with diabetes might get £x per year to buy NHS or private healthcare products and services with rather than just being passive recipients.
http://www.guardian.co.uk/society/2009/jan/16/nhs-health-personal-budgets
Jan 28, 2009 - 1:52 am