American using Britain’s NHS (2015) • Hacker News Board

Re: American using Britain’s NHS (2015)

#41

Post by Scoundreller » Sat, Mar 03, 2018, 4:49 PM UTC

vixen99 wrote: post #26

arseraptor wrote: post #25

Earlier quoted context omitted.

Funny how your anecdotal point is just that, anecdotal. Here's another anecdotal point for you -- Pancreatic cancer (stage 2). Diagnosed on the first visit even though a private doctor had missed it previously. Surgery in less than 5 days, excellent follow-up and post-surgery care including the surgeon having a set of non-mandatory procedures approved in record time (10mins) as a preventative step towards recurrence.…

So instead look at the statistics. In many sectors they are dire.

UK residents have the 20th highest life expectancy in the world. 21st for health-adjusted life expectancy. The Japanese take the top spot and live +2 years. The average American lives -2 years.

There's a lot more to health than the health care system, and this doesn't say much about how painful the process can be, but the stats look pretty good for the UK.

https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...

Re: American using Britain’s NHS (2015)

#42

Post by jdietrich » Sat, Mar 03, 2018, 4:51 PM UTC

tomalpha wrote: post #2

So how does the US improve its healthcare system? More interestingly, can the US political system ever enable an evidence-based debate around it? From the other side of the pond, it feels like debates end up being emotional rather than scientific. (I’m a Brit and love the NHS with a passion but would not claim that it’s without flaw. Neither would I claim that we necessarily have more reasoned debates about issues he…

>So how does the US improve its healthcare system?

On both sides of the pond, we need to break the false dichotomy of UK vs US. Our systems are almost diametrically opposed, but they get vastly disproportionate mindshare and airtime. In any debate about NHS reforms, people will inevitably hold up the US as a cautionary tale and vice-versa, but hardly anyone raises Germany or Australia as a workable middle ground. This false dichotomy also dominates the debate over gun control.

Healthcare Triage did an excellent series of videos summarising the strengths and weaknesses of various international healthcare systems. I can highly recommend it to anyone on either side of the pond who is thinking about how their healthcare system could be reformed.

https://www.youtube.com/watch?v=ylsO0VVy29U&list=PLkfBg8ML-g...

Re: American using Britain’s NHS (2015)

#43

Post by oldcynic » Sat, Mar 03, 2018, 4:55 PM UTC

blibble wrote: post #40

simonbarker87 wrote: post #38

By comparative metrics to the rest of the world the NHS comes out either top or pretty damn good. By comparison to whatever the metrics of whatever government is in power at the time the NHS always looks terrible. Budgets can be set arbitrarily by the government so it’s easy to make the NHS look like it is over budget (in fact all you need to do is increase the budget by less than inflation and talk about absolute nu…

> The whole “4 hour” thing is mad - you should be seen in a reasonable time frame for the ailment you have. Severed hand? Go right ahead. it's already like this, A&E is run on triage, "4 hours" is a target not an instruction and if you go to A&E with something like a cold you'll be given a stern talking to and sent home

Here's some background on the pros and cons of clinical targets. They can distort priorities

https://www.kingsfund.org.uk/projects/general-election-2010/...

Re: American using Britain’s NHS (2015)

#44

Post by Scoundreller » Sat, Mar 03, 2018, 5:03 PM UTC

lucideer wrote: post #29

sambe wrote: post #24

I have never seen such a bureaucratic/inefficiently operated institution - and there are plenty to choose from in the UK. My electricity company replaced all Vs with Ks in letters to us for 7 months. The NHS is much worse (try even getting a letter to arrive within a month - to the right address - let alone receive any medical treatment). I have not dealt with US healthcare but having experienced other countries' I'd…

> I have not dealt with US healthcare Since we're detailing anecdata, I went on a working holiday to the US and had an accident in work. I was fully covered under my travel insurance, and doubly covered under my employer's insurance. I broke several bones in my hand and needed a costly operation to insert pins. The payment approval time from insurers took longer than the minimum wait for the operation before bones fu…

> I'm living in Ireland and would love to have a system as good as the NHS over here

Why? Ireland has longer lifespans and better health-adjusted life expectancies than the UK.

Re: American using Britain’s NHS (2015)

#45

Post by jdietrich » Sat, Mar 03, 2018, 5:07 PM UTC

simonbarker87 wrote: post #38

By comparative metrics to the rest of the world the NHS comes out either top or pretty damn good. By comparison to whatever the metrics of whatever government is in power at the time the NHS always looks terrible. Budgets can be set arbitrarily by the government so it’s easy to make the NHS look like it is over budget (in fact all you need to do is increase the budget by less than inflation and talk about absolute nu…

>By comparative metrics to the rest of the world the NHS comes out either top or pretty damn good.

Ish. The NHS is remarkably cost-effective, but has relatively poor survival rates for cancer, stroke and myocardial infarction. International comparisons seem to damn the NHS with faint praise - it's cheap and the patients are happy, but it's not very good at keeping people alive.

http://www.qualitywatch.org.uk/sites/files/qualitywatch/fiel...

Re: American using Britain’s NHS (2015)

#46

Post by lucideer » Sat, Mar 03, 2018, 5:11 PM UTC

Scoundreller wrote: post #44

lucideer wrote: post #29

Earlier quoted context omitted.

> I have not dealt with US healthcare Since we're detailing anecdata, I went on a working holiday to the US and had an accident in work. I was fully covered under my travel insurance, and doubly covered under my employer's insurance. I broke several bones in my hand and needed a costly operation to insert pins. The payment approval time from insurers took longer than the minimum wait for the operation before bones fu…

> I'm living in Ireland and would love to have a system as good as the NHS over here Why? Ireland has longer lifespans and better health-adjusted life expectancies than the UK.

Only marginally. The difference is negligible and even if it weren't, there's certainly far more contributing factors than the quality of healthcare provision.

Playing devil's advocate, I guess one could speculatively argue that Ireland's private system* brings up the overall average while the public system only caters to the poor and deprived, but I don't think this would be enough to bring the averages up on its own. I'm sure it's more likely lifestyle factors.

* for those unfamiliar, Ireland has a two-tier health system with extremely poor, underresouced single-payer free healthcare coupled with privately-run hospitals for those with the means to pay.

Re: American using Britain’s NHS (2015)

#47

Post by decasia » Sat, Mar 03, 2018, 5:12 PM UTC

As a point of anecdata, my dad, an American, lived in Wales the last ten years of his life. His arthritis got too bad for him to work, and the NHS took excellent care of him for years. Then he had cardiac issues and although his NHS doctor recommended heart surgery, they didn't schedule the procedure for several months and he died of a heart attack in the meantime (age 62).

Public healthcare took great care of him and then it killed him. Hard not to be ambivalent about that (though n.b. this is not an endorsement of the US system by any means).

Re: American using Britain’s NHS (2015)

#48

Post by Scoundreller » Sat, Mar 03, 2018, 5:12 PM UTC

Mvandenbergh wrote: post #12

triviatise wrote: post #4

one of the meta challenges with socialized medicine is that there is virtually no innovation due to price controls (please no anecdotes). The US essentially funds medical innovation for the entire rest of the world. If the US goes socialized you will see almost a complete halt to medical innovation over time. Here are 3 (not evidence based) reasons why medical care costs more in the US: 1) more administration (too ma…

>one of the meta challenges with socialized medicine is that there is virtually no innovation due to price controls (please no anecdotes). Thanks for parenthetically instructing us not to share anecdotes at the end of a statement which isn't even that. https://www.statista.com/statistics/266141/pharmaceutical-sp... That's per capital spending on pharmaceuticals. Two things to note from that: 1) The highest by far is…

> That's $450k/yr, treatment required for life. I suspect that many American insurance companies wouldn't fund that.

The question is, how did NICE arrive at the decision to fund it when it doesn't meet their CBA threshold?

Isn't the whole point of a CBA threshold to say: "We should defund really expensive treatments so we can pay for more cheaper treatments and improve aggregate outcomes per GBP"?

Re: American using Britain’s NHS (2015)

#49

Post by Havoc » Sat, Mar 03, 2018, 5:14 PM UTC

>In the US, having sat in many an ER waiting room for hours at a stretch, the idea of a hospital seeing nearly 9 out of 10 patients in four hours would be regarded as a miracle.

That is so bizarre. I'd be concerned if it takes and hour. Seriously it's called emergency room because it's an emergency, not a "it can totally wait" room.

Re: American using Britain’s NHS (2015)

#50

Post by Scoundreller » Sat, Mar 03, 2018, 5:17 PM UTC

UseStrict wrote: post #11

triviatise wrote: post #4

one of the meta challenges with socialized medicine is that there is virtually no innovation due to price controls (please no anecdotes). The US essentially funds medical innovation for the entire rest of the world. If the US goes socialized you will see almost a complete halt to medical innovation over time. Here are 3 (not evidence based) reasons why medical care costs more in the US: 1) more administration (too ma…

I strongly disagree with your first statement. The US definitely has a high rate of innovation in medical procedures, but by no means is it Atlas, carrying the world on its shoulders. Canada which is just a single socialized healthcare system has systematically produced fantastic innovations in drugs and therapy over the last 100 years. We have dozens of research hospitals who innovate regularly. I don't have the tim…

> Canada which is just a single socialized healthcare system

I wouldn't say single. Each province runs its own system. Each province can't decide how many sub health regions it wants (SK just merged theirs, ON collapsed their community care regions into their health integration regions). GP practices are basically private for-profit companies. Hospitals operate like independent charities with wildly different processes, costs and outcomes.