Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Ill in England? Your Location Can Determine If You Live or Die

bloomberg.com

Post reply on HN
Print view View original

61–70 of 96 posts

Re: Ill in England? Your Location Can Determine If You Live or Die

#61

Post by ghusto »

Counterpoint to all the "it's because it's underfunded" arguments: The money's there, it's just misspent, as with all government lead bureaucracies, resulting in service that could and does kill.

There are multiple unnecessary levels of bureaucracy being paid, leaving little room for people who do actual work. This also results in those people being stifled by busy work.

Source: Doctors I'm friends with, and personal experience (with family members dying or permanently and seriously damaged).

Re: Ill in England? Your Location Can Determine If You Live or Die

#62

Post by dkh »

seanmcdirmid wrote: post #55
dkh wrote: post #54

Earlier quoted context omitted.

This. You see this effect to some extent in Switzerland as well. Switzerland, many seem to feel, is "similar enough" to the United States that the existence of its universal healthcare system "seems" like a goal should be similarly within our reach. But this is to discount cultural differences, among other things, and the mindset of the average Swiss is I think quite different than that of the average American. Some…

The Swiss are big into responsibility: you must buy health insurance because we don’t want to pay for your healthcare when you need it (and lots of other mandatory insurance, eg bike and gun insurance, things that hardly exist in the USA ). They will give subsidies to those that can’t afford premiums, but otherwise you must buy it or else you are being a burden to your neighbors. It isn’t about people “deserving” hea…

Interestingly, despite the burden of uninsured/unpaid medical costs, many in America view universal health coverage as antithetical to "forcing people to take responsibility." Given how many people are provided insurance by having (or being married to someone who has) a full-time job (half the population), there are many who feel that not being covered means you don't have a proper job, and perhaps you should, and why should I pay into a system so that you can get coverage easier? This is, of course, completely absurd, but you'll have no trouble finding people who think this way.

In case you're wondering why having to foot the bill for all those uninsured hospital visits doesn't make the "taking responsibility" thing super obvious, it's because most people aren't aware of how much they are paying for it. Like many things here, uncompensated medical care is ultimately paid out of a combination of many different local, state, and federal sources. While we are all paying for it somehow, it is not obvious to an individual how many of their dollars went to it. Therefore, while unfortunate, many believe that an increase in monthly healthcare premiums (they know exactly how many of their dollars go to that) means they will be paying more overall, not the same or less, because they are either unclear on how much of their money is going to the uncompensated costs now, or they don't trust that their tax bills will actually decrease.

We're once again at a place where most Americans believe healthcare coverage should be guaranteed, but are miles apart on who they trust to actually handle it. [1]

[1] https://news.gallup.com/poll/468401/majority-say-gov-ensure-...

Re: Ill in England? Your Location Can Determine If You Live or Die

#63

Post by moribvndvs »

ghusto wrote: post #61

Counterpoint to all the "it's because it's underfunded" arguments: The money's there, it's just misspent, as with all government lead bureaucracies, resulting in service that could and does kill. There are multiple unnecessary levels of bureaucracy being paid, leaving little room for people who do actual work. This also results in those people being stifled by busy work. Source: Doctors I'm friends with, and personal…

Am I supposed to feel better or worse, considering private healthcare also has bureaucracies that could and does kill, on top of destroying people financially?

Source: work in practice management and billing software, and personal experience

Re: Ill in England? Your Location Can Determine If You Live or Die

#64

Post by loosescrews »

petermcneeley wrote: post #29

Canada doesnt have these kinds of issues with its universal healthcare. We have pioneered new processes to reduce the burden to our medical system [1]. [1] https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html

I know you are joking, but the problem is potentially worse in Canada. Private healthcare is illegal in Canada [1]. At least in the UK you can get private health care [2]. You could argue that this is only an option for the wealthy, but my point of comparison is the US, which is similar minus the public option.

[1] https://www.doctr.ca/private-healthcare-in-canada/ [2] https://en.m.wikipedia.org/wiki/Private_healthcare_in_the_Un...

Re: Ill in England? Your Location Can Determine If You Live or Die

#65

Post by nvm0n1 »

chaostheory wrote: post #52
computator wrote: post #49

It's intriguing that medical care is always the worst kind of service, by far, in every country in the developed world, compared to every other kind of product or service we depend on. Compare it to food, electricity, gasoline, clothing, water, cell service, haircuts, transportation, movies. If you're not in a rural location, you can buy food or a restaurant meal 24-hours a day in less than an hour. There's complex i…

> Compare it to food, electricity, gasoline, clothing, water, cell service, haircuts, transportation, movies Compared to other essential professions, doctors need 8 years of schooling and another 4 years for apprenticeship. As for nurses, they are both abused and underpaid. Maybe AI and subsidizing medical schooling can help? Raising the retirement age should also help. A large portion of the population does not pay…

Do all doctors need that much or is it just the homogenizing effect of licensing? You could argue that programmers need many years of schooling and apprenticeship to become useful if you set the bar of utility at the same place Google used to, but in reality most people can be useful way before that. Also self-learning makes a big difference but isn't recognized by the medical licensing system.

Re: Ill in England? Your Location Can Determine If You Live or Die

#66

Post by MattPalmer1086 »

ghusto wrote: post #61

Counterpoint to all the "it's because it's underfunded" arguments: The money's there, it's just misspent, as with all government lead bureaucracies, resulting in service that could and does kill. There are multiple unnecessary levels of bureaucracy being paid, leaving little room for people who do actual work. This also results in those people being stifled by busy work. Source: Doctors I'm friends with, and personal…

Well, it is underfunded [1]. The UK spends a lot less per capita than any other developed nation.

[1] https://www.bmj.com/content/367/bmj.l6326

Re: Ill in England? Your Location Can Determine If You Live or Die

#67

Post by glomph »

throwawaylinux wrote: post #60
photonerd wrote: post #43

Earlier quoted context omitted.

The NHS has been underfunded for about 40 years, but especially under Conservative government. Blair’s Labour—for all their faults—at least stopped the bleeding, but there wasn’t enough political & popular support for significantly increased spending. Then Cameron & his bs “austerity measures” cropped it

> Blair’s Labour—for all their faults—at least stopped the bleeding, Stopped the figurative bleeding and started the literal... But by stopped the bleeding, do you mean kept at levels comparable to those set by the previous conservative government? I.e., agreeing with the level of funding set by the conservative government. I find it weird how governments are given a pass in that way. Setting funding from X to Y is a…

Labour under Blair significantly increased the spending on the NHS compared to the conservative government before them.

Re: Ill in England? Your Location Can Determine If You Live or Die

#68

Post by nvm0n1 »

civilitty wrote: post #17
skissane wrote: post #9

Isn't this true just about everywhere? Someone who lives in a major urban area is going to have more prompt access to advanced emergency healthcare than someone who lives in a remote rural area, simply due to factors such as travel time, and the clinical need to physically concentrate specialist medical resources (specialist clinical teams need a certain minimum case volume to properly maintain their skills, and if y…

In the UK it’s much worse than normal for rural areas due to chronic underfunding of social services and healthcare. There’s too many factors to go into but the most pressing issue is that there aren’t enough care home beds available to discharge elderly patients so there’s not enough beds available in hospitals. Ambulances often have to wait long times before they can unload a patient at the hospital which ties them…

Integrated healthcare systems in other countries like Kaiser can balance patient flows between hospitals and care homes. This is something that in theory the UK should be good at given it's also an integrated system, but the dysfunction caused by trying to have the government centrally plan everything means it doesn't work in practice. The issue isn't under-funding, the UK social/healthcare system has plenty of money relative to peers.

Beyond general disorganization the UK system shoots itself in the foot regularly. Care homes are bottlenecked by labor cost, so their solution was:

1. Raise the minimum wage, thus increasing care prices and ensuring more people can't afford to pay for it even though there's lots of available labor.

2. Fire huge numbers of carers because they didn't want to get vaccinated, even though the vaccines weren't reducing transmission and their elderly tenants were multiple-vaccinated anyway.

(2) was especially damaging because care homes were one of the few sectors that had vaccine mandates in the UK, so people have now learned that if they go to work at care homes then they will be forced to take experimental medical things even if they don't want to or if it doesn't seem to make sense. That's a big downside to a job that already had few upsides.

Re: Ill in England? Your Location Can Determine If You Live or Die

#69

Post by nvm0n1 »

MattPalmer1086 wrote: post #66
ghusto wrote: post #61

Counterpoint to all the "it's because it's underfunded" arguments: The money's there, it's just misspent, as with all government lead bureaucracies, resulting in service that could and does kill. There are multiple unnecessary levels of bureaucracy being paid, leaving little room for people who do actual work. This also results in those people being stifled by busy work. Source: Doctors I'm friends with, and personal…

Well, it is underfunded [1]. The UK spends a lot less per capita than any other developed nation. [1] https://www.bmj.com/content/367/bmj.l6326

Your study doesn't actually say that. You'd expect their comparison to be with other developed countries given how it's worded, but in reality:

The UK had the lowest healthcare expenditure per capita relative to our comparator countries (UK, $3825 (£2972; €3392); study average, $5700), although this was roughly in line with the average healthcare expenditure of the OECD member states ($3854) and the EU member states

So the UK spends about the same as other EU and OECD countries. It only spends less compared to a set of hand-picked "comparator countries" which are: Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland, and the USA.

That's a remarkably cherry-picked list. If you average such a small list then the mean will be dominated by healthcare spending in the USA. To get better and less cherry-picked data you can turn to the ONS. See Figure 1 (2017) here:

https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

The UK is around the same level as Finland, New Zealand and other developed countries.

This chart really makes it obvious how they picked their "comparator countries": all the countries that spend the most on healthcare. That isn't surprising. It's hard to get a more biased source on British medical spending than the British Medical Journal. Of course academics specializing in healthcare will claim the UK doesn't spend enough on healthcare.

Re: Ill in England? Your Location Can Determine If You Live or Die

#70

Post by candiodari »

nvm0n1 wrote: post #65
chaostheory wrote: post #52

Earlier quoted context omitted.

> Compare it to food, electricity, gasoline, clothing, water, cell service, haircuts, transportation, movies Compared to other essential professions, doctors need 8 years of schooling and another 4 years for apprenticeship. As for nurses, they are both abused and underpaid. Maybe AI and subsidizing medical schooling can help? Raising the retirement age should also help. A large portion of the population does not pay…

Do all doctors need that much or is it just the homogenizing effect of licensing? You could argue that programmers need many years of schooling and apprenticeship to become useful if you set the bar of utility at the same place Google used to, but in reality most people can be useful way before that. Also self-learning makes a big difference but isn't recognized by the medical licensing system.

You need X doctors per 100000 people. Point. That means the budget for training physicians needs to expand with population, 8 years ahead of time. Instead it’s been dropping and dropping, while the government also made the job of physician much less attractive. And there’s still a Numerus clausus. The idea that remote communities have a local physician is already a romantic idea from the past.

And don’t worry. Student physicians these days are working as a nurse before even the second year in many places. Of course, this is effectively used as a way to save money, not to have sufficient personnel, and that means these students are often standing there alone, not learning much, making mistakes.

The government’s idea seems to be to just allow more immigrant doctors… except immigrant doctors largely go to 2 countries, and even there it’s not enough. And, as per usual, policy fails, government doubles down on failed policy. Meanwhile, professors in medical faculties are keenly aware that they can’t let more people in and failing a student is more 72h shifts for everyone… so the quality of doctors, or at least the bottom level, is going downhill fast too.

The scary bit is that if the system fails beyond a certain point, it’ll require large investment for a decade before you even see the first improvements. And, of course, it will make a lot of victims. We don’t even really know how far that point is.

Post reply on HN