[Resolved] National Health Service

[yrwyddfa]

I wondered what people who do not live in the UK think of a National Health Service.

The idea, in case you didn't know, is that any and every citizen of the UK is entitled to health care on the basis of criticality and need. That service is free. Furthermore, the UK government will pay the costs of health care provided by any other country in the world providing you carry a UK passport.

Do you think it's a good idea?

[Wally Pipp]

wish it was, our hospitals have been flooded by British patients because of the shorter waiting times...

[Pino]

its a good idea, there are no reasons to say it isnt.

- Just to add the service isnt free, to everyone who works we pay tax

[yrwyddfa]

Yes, the near continent complains of the same thing.

I was thinking less pragmaically, and more about the concept, though.

[yrwyddfa]

Just to add the service isnt free, to everyone who works we pay tax

It depends on how you measure 'free'. If I walk into a hospital with a broken leg, they're gonna fix it right. They will not question whether or not my NI contributions are up to date. I may be self employed, and avoided NI contributions all my life (not the case, I might add)

It is, for all intents and purposes, free at the point of need. But yes, you are quite right, it is paid for out the UK tax system

[Pino]

Agreed I'm still a student, so apart from stealing all my tution fee's next year, I dont pay tax at the mo.

[yrwyddfa]

Agreed I'm still a student, so apart from stealing all my tution fee's next year, I dont pay tax at the mo.

Student=Sponger

[Pino]

lol not next year student = in massive debt.

Because of my parents income I will be having to pay the full amount, 3000 a year plus my living and expensise, works out 22k best case scienario.

[grilkip]

I wondered what people who do not live in the UK think of a National Health Service.

The idea, in case you didn't know, is that any and every citizen of the UK is entitled to health care on the basis of criticality and need. That service is free. Furthermore, the UK government will pay the costs of health care provided by any other country in the world providing you carry a UK passport.

Do you think it's a good idea?

It's a lovely idea(l) but unsustainable over the long term.

[yrwyddfa]

Why do you think it's not sustainable? The UK have been at this now for nearly 60 years.

[grilkip]

Because you face the same demographics as all the western nations, in 20 years time you will have a huge number of retired people who require a lot of attention.

Ofcourse you could sustain it if you cut it down untill its almost nothing.


Edit: No disrespect but the UK health system has a terrible reputation.

[MasterBlaster]

National Health care is crap. There is no accountability. In a private Healthcare system a doctor can be sued out of house and home if he does shoddy work. An Example. My Aunt in England was gettin an injection in her spine. The doctor flinched and paralized her from the neck down. She's screwed for the rest of her life. In the US she would have had a malpractice case and would have been financially compensated for the rest of her life by the doctor. Instead my uncle has to work two jobs for the rest of his. Threaten a doctors pocket book and he will be a better doctor. That's my theory any way.

[Shaggy Hiker]

Not a bad theory in theory, but does it work in practice?

My cousin went in to the hospital (in the US) for a simple procedure near her eye. The doctors took a wrong turn, cut some of the muscles controling the eye, then nicked the nerves (perhaps the optical nerve, I forget). At that point, they decided they might have taken a wrong turn, and stopped, but sufficient damage was done.

With follow-up surgery, my cousin can now move her eye some, and has some vision, but she will never be the same. The hospital took full responsibility, and have taken care of her well, but the damage was done....and in the accountable US.

Your aunt might prefer compensation over nothing, but I'd bet she'd rather walk.

[szlamany]

Nationalized health care is not a good idea.

I actually work in the health insurance industry in the US - and although it is a royal mess right now - it functions well in our capitalist society, and will self-correct in the next decade.

Whenever anything is nationized, it is dumb'd down to the lowest common denominator.

BTW - your system of nationalized health care is not free - it's a "share the cost among everyone". That's called "insurance" in the USA.

There are more then enough ways for the poor to get health care in the US - but those who can afford it should buy insurance according to their means.

[MasterBlaster]

Your aunt might prefer compensation over nothing, but I'd bet she'd rather walk.

I'm sure she would like to walk. Problem is there aren't too many jobs that a paralized person can do. The bills need to be paid somehow.

I'm sure there are plenty of potential malpractice cases in the US every day. I'd be interested to see numbers and how they compare to those with national heatlh services.

[Shaggy Hiker]

True enough. That seems like it would be a good metric.

[yrwyddfa]

I actually work in the health insurance industry in the US - and although it is a royal mess right now - it functions well in our capitalist society, and will self-correct in the next decade.

Whenever anything is nationized, it is dumb'd down to the lowest common denominator.

BTW - your system of nationalized health care is not free - it's a "share the cost among everyone". That's called "insurance" in the USA.

There are more then enough ways for the poor to get health care in the US - but those who can afford it should buy insurance according to their means.

(i) The free market (the capitalist economy you are talking about) in the US is not just about the self-correct.

(ii) I don't see 'dumbing' down. There might be problems, but I certainly cannot see any reduction in knowledge, or research inside nationalised health care in the UK.

(iii) Reread other posts. This point has already been covered.

(iv) I see where you're coming from, now. Healthcare and more importantly quality healthcare should be based on the ability to pay, not on need? I think this is appalling. One presumes that you can 'shop around' for insurance? Different levels, different cover? Market forces at their very very best? The poorest and most vunerable people of our society are the ones we should be looking our for, and caring for.

The premise that if you've got money you should pay for it is exactly what happens in the UK tax system - mainly through National 'Insurance' contributions.

[yrwyddfa]

Not a bad theory in theory, but does it work in practice?

My cousin went in to the hospital (in the US) for a simple procedure near her eye. The doctors took a wrong turn, cut some of the muscles controling the eye, then nicked the nerves (perhaps the optical nerve, I forget). At that point, they decided they might have taken a wrong turn, and stopped, but sufficient damage was done.

With follow-up surgery, my cousin can now move her eye some, and has some vision, but she will never be the same. The hospital took full responsibility, and have taken care of her well, but the damage was done....and in the accountable US.

Your aunt might prefer compensation over nothing, but I'd bet she'd rather walk.

I think that you'll find that doctors (etc) inside the NHS are just as accountable as those in the US

What you are talking about is the 'sue culture' If I trip on a crack in the pavement and break a bone, then in the US there is reason to sue. Most people in the UK wouldn't dream of it. They would've been looking where they were going.

The ability for legal action is not a metric for superior quality, nor is it some sort of measure of accountability.

Accountability is not hurting someone where it hurts (their pockets) it's finding out what went wrong through a transparent process, and ensuring that it doesn't happen again. I do NOT believe that this is achievable in a private business - which is what ensured healthcare is all about.

As an aside do you believe that profits should be made from people at the most vulnerable time of their lives?

[szlamany]

(i) The free market (the capitalist economy you are talking about) in the US is not just about the self-correct.

(ii) I don't see 'dumbing' down. There might be problems, but I certainly cannot see any reduction in knowledge, or research inside nationalised health care in the UK.

(iii) Reread other posts. This point has already been covered.

(iv) I see where you're coming from, now. Healthcare and more importantly quality healthcare should be based on the ability to pay, not on need? I think this is appalling. One presumes that you can 'shop around' for insurance? Different levels, different cover? Market forces at their very very best? The poorest and most vunerable people of our society are the ones we should be looking our for, and caring for.

The premise that if you've got money you should pay for it is exactly what happens in the UK tax system - mainly through National 'Insurance' contributions.

I am sad for your inability to understand

(i) Your opinion on this point is meaningless to me - and obvious to me. I would expect you to have that point of view and limited understanding of our "health care economy" - which was the "economy" I was tallking about.

(ii) Dumb'ing down was certainly not meant as an indication of "intelligence" - it's a general term I use to indicate when something becomes less then what it could be. I should try to avoid local idioms when talking to an international crowd.

(iii) And from reading your posts, in particular, I saw a flagrant use of the word FREE as if that LABEL made it special, when in reality FREE doesn't fit the BILL at all - you are misinformed about social government if you use the word FREE to describe a SOCIAL service!

(iv) Now you are simply being sarcastic - if you got all those ideas from my one simple post, then you are editorializing for your own benefit. In order to build a strong health-care/provider institution, the individuals involved must be compensated according to education, desire to work, effort put forth - that's capitalism.

When you are offered insurance options at your place of employment, there are levels you can chose from. The single-guy, doing drugs at home, choses more money in his pocket and less coverage. The married guy, with big responsibilities and strong ethics choses more coverage, and drinks less beer every night.

In a social-insurance world, the herion addict gets in line before you for elective surgery to remove a wart. Your's turns cancerous before it's looked at. [oops - sarcasm - sorry - strike this paragraph]

Seriously though - our poor and needy are cared for in regular hospitals just like the rest of us. They don't usually go to doctors, but use the emergency room. But that's part of the social-strata they are stuck in. There are many free-for-use clinics in poor areas of our country for treating people. The "state governments" pay for this with federal and state funds, just like your social health care system. It's not a whole lot different.

But we also have a free-market health care system that is used by the other 80% (I'm guessing) of the country.

Personally, I get my coverage from a well organized labor union - 100% of most fees are paid by that insurance. But I also pay into that particular "arena" of insurance - and I want to pay into that group - at the level I can afford for the 100% coverage I get for it. That's what life here in the USA is all about. I work extremely hard, can buy something special for my family (full coverage) and enjoy the fruits of my labor.

[Shaggy Hiker]

I think that you'll find that doctors (etc) inside the NHS are just as accountable as those in the US

What you are talking about is the 'sue culture' If I trip on a crack in the pavement and break a bone, then in the US there is reason to sue. Most people in the UK wouldn't dream of it. They would've been looking where they were going.

The ability for legal action is not a metric for superior quality, nor is it some sort of measure of accountability.

Accountability is not hurting someone where it hurts (their pockets) it's finding out what went wrong through a transparent process, and ensuring that it doesn't happen again. I do NOT believe that this is achievable in a private business - which is what ensured healthcare is all about.

As an aside do you believe that profits should be made from people at the most vulnerable time of their lives?

Actually, I think that was my point. I was making an ironic statement.

szlamany, I think your last few paragraphs are based more on wishful thinking than reality. If you make good money, you have lots of choices. I have alot of friends who are just entering the work force, and make well below the national median income (which is 40k, I believe). For them, their choices on insurance can truly be grim. One gal I know just left here to work for an insurance company. You might think that she could get good insurance, but it isn't the case. The employee policy they offered her has a deductible that is several thousand dollars, and the coverage is mediocre.

Of course, that is not her only option, she could shop around for herself. I did that once about 10 years ago. The cost of insurance was higher than the cost of housing, food, or transportation, and would have amounted to over a quarter of my net income. Costs have risen dramatically since then. For a young, healthy, woman, I would not be at all surprised if the cost of mediocre private insurance wasn't half of her net income. At those costs, you aren't choosing between drinking and health insurance, you are choosing between EATING and health insurance. That's why there are so many uninsured people in this country.

I ran a crew of fish markers for several years. We paid them pretty much squat, so we were drawing from the uneducated pool in economically depressed areas, where even job just over minimum wage was better than nothing. These folks could not afford health insurance, and could not afford to get injured. Yes, they could go to the emergency room, and hospitals cannot turn people away, but the cost is not $0, and the health care is not average.

[szlamany]

But those costs you talk about are real regardless of a social health system or a "insured" system.

The UK isn't getting anything for free - it's costing the same 25% of net income (I'm using that percentage as an example - I have no clue).

Here in CT about 6 years ago we enacted a "free to poverty level" insurance coverage for people. That was funded by state taxes. I worked on the software to enable the insurance companies to cover these individuals.

Social health coverage exists in the USA - just as in the UK. It just isn't the only option here.

15 years ago I also purchased my own coverage - and can relate to the excessive fees if you are not in a "group policy". Insurance is a tricky business, but I still would never trade that for the UK social system.

Clinton and his wife promised us that 10 ago - see where that got

[Shaggy Hiker]

But those costs you talk about are real regardless of a social health system or a "insured" system.

The UK isn't getting anything for free - it's costing the same 25% of net income (I'm using that percentage as an example - I have no clue).

Here in CT about 6 years ago we enacted a "free to poverty level" insurance coverage for people. That was funded by state taxes. I worked on the software to enable the insurance companies to cover these individuals.

Social health coverage exists in the USA - just as in the UK. It just isn't the only option here.

15 years ago I also purchased my own coverage - and can relate to the excessive fees if you are not in a "group policy". Insurance is a tricky business, but I still would never trade that for the UK social system.

Clinton and his wife promised us that 10 ago - see where that got

I wouldn't disagree with any point you made there, especially the last one. Anybody who tries to fix the insurance issue in the US has one heck of a fight on their hands. Too many people are making money off the status quo.

Free to the poverty line is a good thing, but the poverty line is far below the affordability line, so there is still a big chunk that can't afford the hit of private insurance. Interesting, but unsurprising, to note that it is individual states that are leading the way at trying to find solutions.

Medical coverage, of the quality we have available in this country, is going to be SERIOUSLY expensive, no matter who pays for it. I do believe a nationalized system could be cheaper overall, but there are certainly plenty of examples of this type of a system not working.

One thing we would have to consider when looking at any such system is what the true cost would be to the individual. Consider this: I make x dollars an hour. This means that my gross pay is x times 80. However, the gross pay is neither the amount of money I receive each paycheck (that would be my net), nor is it the amount my employer pays to keep me here, because the gross pay does not include the employers contribution to health insurance and SSI. In fact, I currently have no idea what my employers contribution is.

If we were to nationalize health insurance, what would that do to the amount my employer pays to keep me here. If what they pay now for health insurance was turned back to me in the form of a raise, it would probably more than ofset the increase in taxes that I would expect to occur to cover the insurance cost. However, that is based solely on a wild-ass guess at what they are paying, coupled with an understanding of what I am currently paying in taxes. Basically, if my taxes were doubled, I expect that would be less than what my employer currently pays for health insurance.

Because of the high cost of insurance, even for large entities (I'm in state government), there is room to consider other options. A zero-sum change could mean a net gain for me, I just don't know for sure.

[szlamany]

One of the customers I have is a self-insured employer group. They collect per hour to cover the cost of coverage they give out to the group.

About 4000 members, 15000 or so covered lives.

The contribution that keeps them afloat is a little over $4 per hour worked - around $700 a month.

Could you afford to give $700 a month to a nationalized insurance system? The transistion, as you said before, would be painful to say the least.

People in other countries fail to realize the vast geographical area that the US covers - the incredible difference in population densities. From the 15 million (or more) that live within 50 miles of NYC to the 15 people that live in North Dakota.

They also fail to realize that we are 50 states - the federal government is not the equivalent of the UK government. The UK government is more the equivalent of the New York or Pennsylvania state governments.

[MasterBlaster]

I think that you'll find that doctors (etc) inside the NHS are just as accountable as those in the US

What you are talking about is the 'sue culture' If I trip on a crack in the pavement and break a bone, then in the US there is reason to sue. Most people in the UK wouldn't dream of it. They would've been looking where they were going.

The ability for legal action is not a metric for superior quality, nor is it some sort of measure of accountability.

What are you basing this on? How do you know that the ability for legal action is not a metric for superior quality? Show me the numbers and I'll buy that. What I do know that the united states private healthcare system produces the best doctors in the world. That could be mostly attributed to the highly funded education and research system here but I would also bet that doctor accountability factors in somewhere. Of course there are no concrete studies on this so all either of us can do is speculate.

Yes we have a sue happy system in the us. On thing though, the majority of these cases are thrown out of court before any money exchanges hands or they are settled out of court. I'm talking about doctors really screwing up royally and being held accountable.

Accountability is not hurting someone where it hurts (their pockets) it's finding out what went wrong through a transparent process, and ensuring that it doesn't happen again. I do NOT believe that this is achievable in a private business - which is what ensured healthcare is all about.

Yes, of course you need to figure out what whent wrong and what to do to ensure it never happens again. Of course this is acheiveable in a private business. Ever been to a wrap up meeting for an application you or your company built? You know the meeting where you go over exactly that. The doctors are supplying a product. The patients are buying it. To make more money by expanding customer base and to avoid loosing money in lawsuits, constantly reveiwing procedures is necessary. Remember when a kidney transplant or lasic eye sugery was a big deal? Now doctors can do it with blindfolds on because they reworked and reworked and rewoked the process to make it safer, faster and cheaper. I'm betting that the existing threat of lawsuits helps drive the "safer" part.

[Shaggy Hiker]

One of the customers I have is a self-insured employer group. They collect per hour to cover the cost of coverage they give out to the group.

About 4000 members, 15000 or so covered lives.

The contribution that keeps them afloat is a little over $4 per hour worked - around $700 a month.

Could you afford to give $700 a month to a nationalized insurance system? The transistion, as you said before, would be painful to say the least.

People in other countries fail to realize the vast geographical area that the US covers - the incredible difference in population densities. From the 15 million (or more) that live within 50 miles of NYC to the 15 people that live in North Dakota.

They also fail to realize that we are 50 states - the federal government is not the equivalent of the UK government. The UK government is more the equivalent of the New York or Pennsylvania state governments.

My point is that my employer may already be paying $700/month or more to give me health insurance (I have no idea, and expect that it might be a bit lower, but not much). While this is not deducted from the gross pay that I see on a paycheck, it IS part of the cost of employing me. If that cost went away, the employer could give me that money as a raise, the government could then take that money in taxes, and use it for a health insurance plan.

Under that system, the cost to my employer would remain the same, my net pay would remain the same, but the uninsured would be insured. That would have no net effect on my paycheck, no net effect on my employers cost, but a huge positive effect on the general decency of society.

However, having said that, I ought to note that $700/month is far more than I am currently paying in taxes and social security combined. I seriously doubt that the actual cost would be that high, but if it is, then so be it.

[yrwyddfa]

What are you basing this on? How do you know that the ability for legal action is not a metric for superior quality? Show me the numbers and I'll buy that. What I do know that the united states private healthcare system produces the best doctors in the world.

(i) I think that the ability to take someone to court is self-evident in all progressive nations. I do not therefore think that private healthcare adds any more 'transparency'. I do not think you need numbers - nor am I able to provide them for this.

(ii) How do you define 'best'? Those who get sued the least? What function is there that defines what 'care' is? Do you accept that this is subjective?

[yrwyddfa]

(iii) And from reading your posts, in particular, I saw a flagrant use of the word FREE as if that LABEL made it special, when in reality FREE doesn't fit the BILL at all - you are misinformed about social government if you use the word FREE to describe a SOCIAL service!

Read post #5

[yrwyddfa]

I am sad for your inability to understand

I guess I should say thank you?

[yrwyddfa]

(iv) Now you are simply being sarcastic - if you got all those ideas from my one simple post, then you are editorializing for your own benefit. In order to build a strong health-care/provider institution, the individuals involved must be compensated according to education, desire to work, effort put forth - that's capitalism.

That's not capitalism; that's greed. I recommend you read a little of John Smith's work . . .

[yrwyddfa]

Seriously though - our poor and needy are cared for in regular hospitals just like the rest of us. They don't usually go to doctors, but use the emergency room. But that's part of the social-strata they are stuck in. There are many free-for-use clinics in poor areas of our country for treating people. The "state governments" pay for this with federal and state funds, just like your social health care system.

Right then:

(i) Do you gain further benefits from subscribing to an insurance scheme? That is do the people who don't subscribe get a worse service. If this is the case then even you should admit that care is about who has the most money. Is this acceptable?

(ii) Do you accept that if people are in their 'social-strata' position that they are 'stuck; there? I find this idea abhorrent (however impractical any solution may be) in any advanced nation in the world.

[yrwyddfa]

Social health coverage exists in the USA - just as in the UK. It just isn't the only option here.

You are talking about a free market economy here. Which, I am presuming, you are a champion of.

My point, whoever ineloquently put, is that the idea of care should not be subject to free market conditions.

I believe that there are somethings that we accept as given. One of those is 'life' Everyone should have the right to life regardless of social position or wealth.

If you gain better treatment through wealth (your insurance system) then you are part of a system that does not put human care first. It puts money first.

Therefore if money is a key indicator you cannot believe that everyone is born equal.

[szlamany]

Right then:

(i) Do you gain further benefits from subscribing to an insurance scheme? That is do the people who don't subscribe get a worse service. If this is the case then even you should admit that care is about who has the most money. Is this acceptable?

(ii) Do you accept that if people are in their 'social-strata' position that they are 'stuck; there? I find this idea abhorrent (however impractical any solution may be) in any advanced nation in the world.

(i) In the UK system is there any kind of cost sharing (co-pay) or deductible involved? Do you have 100% of your bill covered with no out-of-pocket expense?

(ii) Why people get 'stuck' in a social-strata position is an age-old question. Education? Entitlement? Drug-abuse? I could go on and list these forever... I live in a densly populated area and have seen (and know) of homeless people, and drug-abusers and again - the list goes on. How far are you willing to help the underacheivers in all parts of your country? Going to pay more taxes to raise them up? Are you willing to have less so those who don't try hard can have more?

[yrwyddfa]

One of the customers I have is a self-insured employer group. They collect per hour to cover the cost of coverage they give out to the group.

About 4000 members, 15000 or so covered lives.

The contribution that keeps them afloat is a little over $4 per hour worked - around $700 a month.

Could you afford to give $700 a month to a nationalized insurance system? The transistion, as you said before, would be painful to say the least.

People in other countries fail to realize the vast geographical area that the US covers - the incredible difference in population densities. From the 15 million (or more) that live within 50 miles of NYC to the 15 people that live in North Dakota.

They also fail to realize that we are 50 states - the federal government is not the equivalent of the UK government. The UK government is more the equivalent of the New York or Pennsylvania state governments.

Hmmmm? Where did this come from?

[szlamany]

Hmmmm? Where did this come from?

What part do you not understand - the real information about cost, or the absurdity I see when people compare the US to their own country?

[yrwyddfa]

(i) In the UK system is there any kind of cost sharing (co-pay) or deductible involved? Do you have 100% of your bill covered with no out-of-pocket expense?

(ii) Why people get 'stuck' in a social-strata position is an age-old question. Education? Entitlement? Drug-abuse? I could go on and list these forever... I live in a densly populated area and have seen (and know) of homeless people, and drug-abusers and again - the list goes on. How far are you willing to help the underacheivers in all parts of your country? Going to pay more taxes to raise them up? Are you willing to have less so those who don't try hard can have more?

(i) In terms of deductible with have a system called National Insurance. This is deducted as part of your tax. It is deducted on the basis of if you earn more you pay more. If you earn less than £4716/yr then you don't pay at all.

(ii) The argument is not about how to help people out of their social position. The argument is about healthcare. Why do you assume that you can only have good healthcare if you have enough money? If you need it in the UK you get it (there will be, I'm sure, some appalling example of where this hasn't happened, but in the majority of cases it holds true)

[yrwyddfa]

What part do you not understand - the real information about cost, or the absurdity I see when people compare the US to their own country?

I wouldn't compare the US to the UK - ever. As you say it's not worth the comparison.

[davebat]

Therefore if money is a key indicator you cannot believe that everyone is born equal.

Do you? Because clearly their not.

[yrwyddfa]

(i) In the UK system is there any kind of cost sharing (co-pay) or deductible involved? Do you have 100% of your bill covered with no out-of-pocket expense?

I forgot to say. If you need treatment in the UK you turn up at the hospital, or you ring for an ambulance. The healthcare from thereon in is on the basis of need. You do not have to pay for anything (it's already been taken care of in the form of taxes)

[yrwyddfa]

Do you? Because clearly their not.

Although it's straying from the debate a little . . .

I believe - like the American constitution - that everyone is born equal. That includes equal rights to life, and the care of such life.

So YES, I do.

I have to wonder why you think that 'clearly' they're not? By this statement you are indicating that some humans are inferior to others.

That does not make me comfortable. At all.

[szlamany]

That's not capitalism; that's greed. I recommend you read a little of John Smith's work . . .

Compensation based on participation is a good thing in my opinion. I have employees - if they don't participate they get fired. I don't have a clue how you got "greed" out of my description of building a solid health care/provider institution.