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American using Britain’s NHS (2015)

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Re: American using Britain’s NHS (2015)

#81

Post by DFHippie »

grecy wrote: post #19
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…

> More interestingly, can the US political system ever enable an evidence-based debate around it? I honestly think the reason the US is slipping so much is because their political system never seems to have evidence-based debates around anything. Worse, they have absolutely no interest what-so-ever in comparing their country and how it's actually functioning to other Developed Countries for the purposes of improvemen…

Funny how you you complain about evidence-based debates proceed to mischaracterize the U.S. based on your impressions.

Americans are not all of the same opinion. They do not all use the same arguments which have the same faults. In this they are like all people everywhere. Also, their political parties do not all employ the same arguments with the same faults. Arguing that everyone has the same faults is both-siderism. It is a counsel of despair. In fact, each party will use facts and international comparisons when doing so supports their preferred policy.

The Democrats have been quite fond of international comparisons in support of their efforts to improve healthcare. I struggle to find a topic on which Republicans prefer facts to mythology but they certainly grab onto a fact when it supports what they want to do. They can recognize and employ a good argument if it presents itself.

If you hear someone making a stupid argument, regarding health care or whatever, nine times out of ten it is not because they desire a worthy thing and are too stupid to get it but because they desire an unworthy thing and are crafty enough to recognize a plausible cover story. You can recognize this happening when someone drives for a constant goal but changes arguments as suits the moment. Republican arguments for lowering taxes fit this pattern as do arguments for not doing anything about climate change.

It isn't the stupidity of politicians, or even their voters, that explain American policy. It's disharmony within the nation mixed with political institutions that expect people to work toward a common purpose.

Re: American using Britain’s NHS (2015)

#82

Post by bane »

Might be of interest to discuss other systems as well. I'm somewhat familiar with the system in South Korea:

- There's a National Insurance System that all citizens are signed up to at birth.

- Premiums are based on income with employers splitting the cost 50:50. Low income/unemployed people go on a slightly different but substantially similar plan with no premiums.

- Prices for procedures are nationally set and fixed.

- Hospitals and Doctors are generally private, but must accept the National Insurance.

- Patients pay a co-pay and doctors bill the National Insurance system for the full price.

- The National Insurance plan only covers a set of elective procedures. Unelective procedures are payed for out of pocket, or by private supplementary insurance (which are also quite popular). e.g. if you have cancer you can go with the prescribed National Insurance treatment and it's covered, or you can go with other treatments which the private hospitals are more than happy to provide.

- Upside: people go to the doctor early and often and as a result South Korea has some of the best medical outcomes in the world (with a few exceptions). The robust private hospital system brings in medical tourists for a wide variety of medical procedures at low prices. If you're in the Hospital and want better care than the National Insurance covers, and you have the money, your class of care options is virtually unlimited. Fewer bankruptcies than the U.S. and - Downside: The system tends to favor simpler problems that can be handled in an assembly-line fashion. Doctors need to see huge numbers of patients to make a living, so bedside chat time is very limited (but in practice it's about as much time as I see my doctor in the U.S.). Doctors over recommend procedures and tests to get the insurance money.

- Paradox: Because doctors are payed per procedure, but the procedures are limited, they tend to oversubscribe labs and imaging. This means that there are about 3x as many hospital beds and imaging machines than the U.S.

- Source: Visit South Korea semi-frequently, been sick there. Even not being insured (thus paying out of pocket) the cost was far lower than my insured care in the U.S.

Re: American using Britain’s NHS (2015)

#83

Post by [deleted] »

Scoundreller wrote: post #56
lavrov wrote: post #14

Earlier quoted context omitted.

The argument that "if the US goes socialized, you will see almost a complete halt to medical innovation over time," and therefore that private funding of research is preferred, is a bad one. It rests on the premise that the profit motive for pharma companies and the imperative to improve health care outcomes for the greatest number of people are aligned, which they are not. Public funding of drug research is a better…

On the other hand, streams of interesting new oral Type-2 diabetes medications have been coming out. E.g. Gliptins and gliflozins Unfortunately, Alzheimer's and Parkinson's treatments have been a black-hole for research funding. Many have tried, most have failed.

[deleted]

Re: American using Britain’s NHS (2015)

#84

Post by foreigner »

I am a lot like the author (dual national, lived in both US and UK). One of my children was born in the US, the other in the UK. I agree with the author 100%. I would emphasize more the peace of mind that in the UK my family's health care is in no way tied to my job (I earn plenty of money and have never had trouble finding employment).

There are also huge societal benefits to socialized healthcare. There are far fewer desperate homeless people in the UK, because many homeless people in the US are stuck in that situation in large part because of some health issue. There's just a fundamental feeling in the UK that we're all going through this life together.

Re: American using Britain’s NHS (2015)

#85

Post by walshemj »

arseraptor wrote: post #25
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…

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.…

And another point in favor of the NHS all my letters arrive very quickly plus a reminder via phone for apointments.

Re: American using Britain’s NHS (2015)

#86

Post by foreigner »

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…

Many Brits are in the same situation and hold the same opinion, because they've never experienced anything else. Having personally experienced the US and UK systems, I assure you that's because you simply can't conceive how bad it is in the US!

Re: American using Britain’s NHS (2015)

#87

Post by PaulRobinson »

jdietrich wrote: post #45
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/fi…

Survival rates for all those things are affected by external factors that are not in the NHS' control.

Smoking, drinking and obesity are all higher in the UK than in many other Western countries, and therefore the types and severity of these issues are likely incomparable.

Compound this with the cultural differences of the NHS (you don't go for a six-month check-up unless you're elderly, you just see a doctor when you're already ill), and the fact spending has been prioritised towards other areas (particularly paediatrics), you start to see a different story.

But there's also the fact the median age of the UK is relatively high. It's so good at keeping alive in younger years they get older and then develop cancer, stroke and heart disease/attacks later in life where they might be less survivable.

We all have to die of something. The NHS can't prevent that. What it can do is stop you having a lot of those issues earlier in life as in other countries and therefore the quality of life is improved.

If you want to see an area where it's proper shit, I would not start there: go with dental work, look at obesity prevention, etc. - that's where it's really lagging behind many other countries.

Re: American using Britain’s NHS (2015)

#88

Post by makomk »

jdietrich wrote: post #35
gaius wrote: post #13

Earlier quoted context omitted.

Aneurin Bevan believed that the cost of the NHS would reduce over time as the population got healthier. The current NHS budget is £125Bn/year. Many people think it is underfunded, but noone is willing to name a figure for fully funded. Is it £150Bn, 200, 500? No progress will be made, by either party, until someone stands up and does this.

>The current NHS budget is £125Bn/year. Many people think it is underfunded, but noone is willing to name a figure for fully funded. Is it £150Bn, 200, 500? It's a moving target, because need continues to grow as the population ages. We're in largely uncharted territory, so it's difficult to make long-term cost forecasts. You could always find ways of spending money to improve a healthcare system, so it just doesn't…

Incidentally, one of the provisions in the ACA over in the US specifically prohibits the use of QALY as a cost-effectiveness threshold. It's just one of many reasons it's so absurd for Americans to point to the NHS as a demonstration of how much more cost-effective healthcare would be if it were nationalised; something like the NHS with its cost-saving measures just wouldn't be politically viable there.

Re: American using Britain’s NHS (2015)

#89

Post by AlphaSite »

cstross wrote: post #76
oldcynic wrote: post #5

As a Brit using the NHS I can only add that I trust, and expect, every government to make the NHS worse whilst they talk of how marvellous it is. I would really like it given to an independent cross-party body, or the civil service, to try distance it from politics and The Treasury. I'd like to see legislation to heavily penalise drug companies seeking 20,000% price increases and the like. Both sides fiddle with it,…

I'd like to see a long-term outcomes-based comparison between NHS England and the Scottish NHS, frankly. The Scottish NHS is a fully devolved issue and has been diverging from the English system for most of a decade now, with a greater emphasis on preventative healthcare and screening programs (not to mention free prescriptions for all). In another couple of years we may even have some hard statistical data on what p…

Scottish NHS also has funding issues, so who knows whats going to happen.
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