NHS / US healthcare compared

by Richard on August 15, 2009

Tony has already turned up this very worthwile and balanced contribution to the debate in the comments, but it bears repeating I think: This American’s Experience of Britain’s Healthcare System

I can sum up my experience of the British and American healthcare systems in one simple sentence: given a choice between the two systems, I’d choose the NHS in a heartbeat. And though this is the experience of only one single person out of millions, unlike so much of the propaganda and hysteria surrounding the current healthcare debate, it is the absolute Gospel truth.

{ 22 comments… read them below or add one }

1

Kim 08.15.09 at 5:09 pm

Preach it, brother!

2

steph 08.15.09 at 6:02 pm

I love the NHS. Meanwhile Fox news poison the american public with lies and propaganda - the NHS has to recruit more doctors and recruits terrorists (is Muslim = terrorist) as doctors. Doug Chaplin has a video link
http://clayboy.co.uk/2009/08/all-go-mad-on-health-care/

And my doctor might be Muslim. She’s great. I love the NHS - I’d die without it …

3

Beth 08.15.09 at 8:28 pm

Oh. My. Goodness.

I hadn’t realised that Fox News was that bad. Surely this report borders on inciting racial hatred? I’ve honestly never heard such a lot of hateful crap being spoken on national television.

4

PamBG 08.15.09 at 8:42 pm

It’s worth reading this post by the same author: http://tinyurl.com/mq2d9r entitled ‘And Our Insurance Premiums Rose by 350%’

I’d really like to see Earl and DH go on this woman’s blog and give her their ‘Well, them’s the breaks and tough shit’ speeches. I just don’t get it when people fail to be cynical about the motives of insurance companies and when we act like healthcare is not a human right but primarily something from which companies first and foremost have the right to make money.

5

Steve 08.15.09 at 9:53 pm

Personally, I wish we in the US weren’t so scared of the “socialism” bogeyman that we could adopt a true single-payer plan, but given the level of irrationality with regard to anything government sponsored, the current proposal is better than nothing. Personally, I am terrified by the though of losing my job not so much because of the lost income as because of the lost health insurance. And there is no way I would ever start a business unless my wife could bring good health insurance from another job to the table. Not only does our existing nonsensical system harm those without insurance, but it’s a terrible drag on risk taking which is central to a healthy economy.

6

Beth 08.16.09 at 10:29 am

Seems to me that one of the things about the British system that’s being missed out in the discussion in the US is this - if you want health insurance, you can have it. You can pay your premiums and have a private service in return. Those who can afford health insurance in the US could just keep paying for it. A British-style system wouldn’t change that, it would just provide guaranteed healthcare to those who can’t afford to pay.

7

dh 08.17.09 at 1:51 am

Beth and others there are ways to cover the 5 million people who can’t afford healthcare, who are not illegals, or are not part of people who could be covered under medicare or medicaide but who have not filled out the paperwork. It is by tax breaks and tax credits. John McCain came up with a great plan and other have too. Why the need for single payer or socialized plans?

8

Beth 08.17.09 at 9:51 am

Let me ask a different question - why should insurance companies be making huge profits out of healthcare, when it’s possible to have a system that bypasses them altogether? In the UK, personal money goes to tax, which goes to the healthcare providers. In the US, personal money goes to an insurer, and may or may not be paid to a healthcare provider, depending on what kind of care is needed and whether the company decides to pay up. If you never need medical care, the insurer just keeps your money. These are not philanthropic organisations. They’re in it for the profit. Seems like a no-brainer to me that that kind of system isn’t going to be a responsible or ethical one.

9

DH 08.20.09 at 4:27 pm

…and the Government is a “philanthropic organization”? I like “J’s” comment on the “Cost of Healthcare” thread. He gives a BIG analysis into why such a system you prefer is a bad one.

The issue with private vs. public is one of where the question is “Who holds the risk?” I personally don’t want my tax dollars to be “at risk” by having government pay for something that all economists says about healthcare is “inelastic demand”.

For people to wait for services for healthcare seems to me to be “irresponsibile”. For know facts of people loosing sight in Canada due to a proccedure not considered an emergency seems also to be unethical and irresponsibile. No one should have to wait longer than two weeks to get a surgery or for any healthcare service no matter what the proceedure is. Under a government sponsered plan the potential for this now or in the future is greater. I want those things to be an impossibility and having a private health care system makes those things an impossibility.

Does the US system need to be improved? Absolutely All of the goals that Richard and others look to for improvement can be addressed within a tax credit healthcare system where no government employee dictates to the public anything regarding services, payment, etc.

10

PamBG 08.21.09 at 2:04 am

OK so you and your partner get a job at $7.50/hour, part time at 0 hours per week with no group health. A family member needs a $60,000 operation - twice your combined annual gross income. How do tax breaks help?

11

J 08.21.09 at 1:23 pm

“why should insurance companies be making huge profits out of healthcare, when it’s possible to have a system that bypasses them altogether?”

Mainly allocation of resources. Your question appears to assume getting rid of profits would result in a net overall cost reduction, but that hasn’t been the case in the US. Medicare spends a little over $8000/yr per recipient, and is generally regarded as inferior to care provided by for profit insurance companies . Overall expense for those not eligible for medicare averages about $7400/yr per person, and medicare has an older client base, so they’re not necessarily spending more on an age adjusted basis, but they certainly aren’t spending less and are no more efficient than a for profit provider.

“I just don’t get it when people fail to be cynical about the motives of insurance companies”

If you talk to many people in the US, you’ll find they’re plenty cynical about the motives of their insurance company; they’re just more cynical about the motives and competence of the government.

“How do tax breaks help?”

They don’t, but tax credits would help plenty. In this case though, the fastest solution would be medicaid, under the income or medically needy provisions.

12

DH 08.21.09 at 3:39 pm

Pam the individual you present is covered by the individual state Medicaid so really there is no need for there to be a “federal socialized plan”. With regard to tax breaks or also something I mentioned that you didn’t recognize was “tax credits”. My proposal and what many people within my “camp” prefer is a “tax credit” for individuals to purchase private healthcare insurance. A “tax credit” is money from the government that is added to the amount one gets as a refund. I have heard proposals (don’t quote me on it but it is close to the amount) that the “tax credit” proposed for those who make under a certain minimum was between $5000.00 to $7,500.00 a yr. This amount would more than pay for some of the best private healthcare plans. With the competition between insurance companies across state lines the premiums will decrease.

Tax breaks would help those in the lower middle class but like myself and J are saying one would need to include tax credits to really address the concerns you, Richard and others identify with regard to health care reform. As you can see a “socialized, public option” is not needed to address the concerns and praxis of the current system.

J, great answers. If you have any further insight into what I wrote feel free to respond. I’m always trying to “fine tune” my delivery. :)

13

DH 08.21.09 at 3:53 pm

“With the competition between insurance companies across state lines the premiums will decrease.”

To clarify: We would also need to allow individuals to purchase private healthcare insurance across state lines so that the overal premiums could go down.

Speaking for those who happen to be within the group that agree with me, we believe that the federal government is too big and has too much power. I the US we were founded with a “balance of power” or “balance of responsibility” between the federal government and state government. For many outside of the US that could be a concept that is understandably hard to understand. With a big county geographically and in population state government should have this “power” because they are closer to the people and better respond to the needs of its constituents.

aka: The needs, concerns, policies,etc. of Hawaiian citizens are dramatically different that the ones for Floridian citizens. It is hard for us who favor the “states” to see how Washington DC dictate something that may be looked at favorably to such a few states onto all of the rest of the statesl. What is good for NY is not good for Wyoming. What is good for California is not good for Colorado. However, what is good is if people in Florida who might have higher private insurance premiums to have the ability to purchase private insurance in Wyoming where private health insurance premiums might be way lower. Currently priavate health insurance cannot cross state lines unless a person works in one state and lives in another. To this is totally ridiculous and arbitrary. Private health insurance should be interstate not intrastate.

14

Tony Buglass 08.21.09 at 4:32 pm

“we were founded with a “balance of power” or “balance of responsibility” between the federal government and state government.” “Private health insurance should be interstate not intrastate.”

I suspect part of our disagreement is due to the difference in patterns of government, which is also affected by the sheer difference in size of the two nations. Most Brits have little sense of the sheer size of the US - the longest train journey you would normally expect to make in the UK would be about 12 hours, while in the US it could be about a week. (OK, there are some trains in the UK which feel as if they take a week to get here, but that’s a different set of problems…). The result is that our national goverment feels closer to us than your federal government.

However, the healthcare issue which you describe (comparing Hawaii with Florida) is somethign we have met in this country: we call it the postcode lottery. (The postcode is the same as the US ZIP code.) The problem is that in a supposedly unified and national health service, clincial decisions are limited by budgets set by regional health trusts. The result is that treatment which would be available to a patient in one region could be refused to a patient in another, simply because the health trust will not budget for it. This generally applies to expensive drugs, so the medication which the doctor wishes to prescribe would be permitted in one region, while in another he will not be allowed to prescribe it but would be advised to substitute something different.

Not surprisingly this has caused a great deal of controversy, and many have argued loudly and cogently that in a national health service there should be no postcode lottery. Granted that there may be medications which a health service budget simply cannot afford, there should be no differences between the regions: so health care should be inter-regional not intra-regional.

From our perspective, that is why we argue for a national health service. I can see how that sounds different in the US, but if there are differences between what is provided in the different States, then some form of federal oversight would be necessary to guarantee fairness of access to care.

15

PamBG 08.21.09 at 7:54 pm

Your question appears to assume getting rid of profits would result in a net overall cost reduction,

Insurance companies are accountable to their shareholders and they have committed to their shareholders that the reason for their existence is to maximize profits.

Why would any sensible person put their healthcare in the hands of someone who told them “My first commitment regarding your healthcare is to make money for those guys over there. My second commitment is to give you healthcare that fits with those guys’ profit-making expectations. Therefore I will raise my prices as much as the market will bear and I will cut my costs as much as the market will bear.’ Why would any sane patient put their healthcare in the hands of someone who promised to give them the least care possible at the greatest possible expense?

What it comes down to, I think, at the bottom line is whether one thinks business or government is more accountable to the people. I’m cynical about both but I feel absolutely certain that business is accountable only to shareholders and owners and not to society at large.

Others seem convinced that the government is ‘out to get them’ and I think that’s really what’s at the core of the issue. Unless, of course someone really does believe it’s perfectly OK for business to screw the American public, in which case that’s just plain evil.

16

DH 08.21.09 at 8:27 pm

Tony, thanks for “understanding” what I was saying how the geographics can play a part in the differences. I still believe that the issues you say that can be solved with a federal plan can still be resolved under the plan as I have described with tax credits and tax breaks (depending on what income level you are in). Also, the interstate portability of healthcare insurance can be addressed without a “federal plan” by saying that all “socialized state healthcare” should be private. Some things can be address by mandates from the federal government regarding insurance regulations in light of “pre-existing conditions”,etc. but only on a limited basis. Then you wouldn’t have some states doing healthcare rationing line they are doing (aka rejecting service due , everyone would be able to afford healthcare insurance

Pam, I don’t believe it is OK for business to “mess up” the American public. However, I believe in a super majority sense, that business doesn’t “mess up” the American public. Without business you have no jobs and without jobs you have poor people (period).

With that said, the survivability and longevity of people with healthcare proceedures in the US cannot be denied as being very good.

17

Tony Buglass 08.21.09 at 8:58 pm

“With that said, the survivability and longevity of people with healthcare proceedures in the US cannot be denied as being very good.”

Given the amount you spend, so it should be. But didn’t someone quote stats a few days ago showing that the NHS performs rather better?

18

DH 08.21.09 at 9:13 pm

Tony, at least we don’t wait in line for some proceedures or have any form of “rationing”.
With regard to “performance”, How realiable is the source of the so called “stats”?
Irregardless I never said that the US healthcare system is “perfect” or doesn’t need reform. It is matter of how that takes place and what is done that is the issue. We mustn’t do something that will result in thousands of billions of added debt which hurts an entire nation and makes more people poor than otherwise.

Tony, what are your thoughts on my first paragraph from my previous response?

19

PamBG 08.21.09 at 9:30 pm

Tony, at least we don’t wait in line for some proceedures or have any form of “rationing”.

This is untrue and naive.

And I suspect that waiting times in the UK are nothing like what the American Right think they are.

20

J 08.22.09 at 12:02 am

“What it comes down to, I think, at the bottom line is whether one thinks business or government is more accountable to the people”

It does; in the US, I would argue our tort system makes private insurers far more accountable than the government. I don’t think the government is “out to get” me or anyone else; I think it’s indifferent to the needs of players other than itself, and enjoys sovereign immunity. I can complain to elected representatives, but they are so far removed from individual decisions that they are effectively insulated from an accountability. By contrast, 8 and 9 figure settlements tend to focus a business on doing the right thing, no matter how greedy it’s owners are ( http://www.msnj.org/advocacy/insurance/ClassActionLawsuits.aspx ).

Tony’s remarks on the “lottery” are interesting. I’m pretty sure that wouldn’t pass legal muster in the states, as in our legal system an insurance contract either covers treatment or it doesn’t; the financial condition of the insurer would be irrelevant up to the point of insolvency. Whether the government could get this sort of provision waived is unclear.

21

PamBG 08.22.09 at 10:58 pm

Yea, the US tort system is great. When Ohio refused to cap awards my mothers’s doctor, who was excellent, was forced to leave the State because his annual insurance premium became unaffordable and he moved to California. Closer to home, our auto insurance here is going to cost us 3x what it did in the UK because of personal liability insurance.

Believe me, the money-grubbing adversarial approach of American culture is pretty evident in all aspects of resettling here. And I have genuinely never considered myself ashamed to be American. Just at the moment, I’d rather be back in the UK.

22

PamBG 08.22.09 at 11:03 pm

J, I’ve had friends with serious long term health issues and I’ve watched insurance companies try and succeed to unindure them. I’ve watched hard-working middle class people with good jobs and good education reduced to financial hardship. Postcode lottery or no, if you are going to battle cancer for ten years, make sure your spouse is a partner at Goldman Sachs or become eligible for the NHS.

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