Health Care for Everyone

[FoolKiller]

The use of the word lottery is just a media hype tool. Basically the different geographical NHS trusts are given a annual fund based on population etc and it's up to them how they spend that money while meeting various targets therefore if you live in one post code area you may have the best cancer treatment with access to the latest and most expensive cancer treatment drugs but if you live in another part of the country the cancer treatment may not be as good and you may not be given the latest and most expensive drugs to treat it. Another example is the criteria required to receive fertility treatment and how many goes you get if they aren't successful.

But can I go to another post code to get the better treatment?

 

[Danoff]

The use of the word lottery is just a media hype tool. Basically the different geographical NHS trusts are given a annual fund based on population etc and it's up to them how they spend that money while meeting various targets therefore if you live in one post code area you may have the best cancer treatment with access to the latest and most expensive cancer treatment drugs but if you live in another part of the country the cancer treatment may not be as good and you may not be given the latest and most expensive drugs to treat it. Another example is the criteria required to receive fertility treatment and how many goes you get if they aren't successful.

Also The Independent is credible so assume the story to be true.

Keep talking. That sounds friggin awful.

 

[Neal]

But can I go to another post code to get the better treatment?

I'm not 100% sure but I don't think you can go to another NHS trust that has different selection criteria to receive treatment for less essential conditions but there is meant to be freedom of patient choice and competition within the NHS. It should also noted that if you have a serious condition and need the best specialist care then you can be transferred to the hospital that provides that where ever that is in the country, when my wife was at Liverpool Women's Hospital there was a woman there with epilepsy from Birmingham who had been transferred there as it was the best place for her to receive the care she needed.

Keep talking. That sounds friggin awful.

The NHS receives a lot of criticism but whilst it doesn't have a bottomless pit money to provide the absolute best care and treatment to everyone regardless the seriousness of their condition it does provide care when you really need it regardless of who you are, how much money you have or where you live. I'm fully in support of the NHS but I do think everyone across the country should receive the same level of care regardless of where they live. Also for the people who aren't happy with the level of care who have the money can always go private which has the knock on effect of freeing up resources within the NHS.

 

[FoolKiller]

I'm not 100% sure but I don't think you can go to another NHS trust that has different selection criteria to receive treatment for less essential conditions but there is meant to be freedom of patient choice and competition within the NHS. It should also noted that if you have a serious condition and need the best specialist care then you can be transferred to the hospital that provides that where ever that is in the country, when my wife was at Liverpool Women's Hospital there was a woman there with epilepsy from Birmingham who had been transferred there as it was the best place for her to receive the care she needed.

Let's say, for example, this was me when I started seeing my current cardiologist and there was no talk of transplants or surgeries, just annual monitoring. I live two postal codes, 50 miles, away from my cardiologist, who is in Louisville. Sure, Frankfort has a pediatric cardiologist but the ones in Louisville were innovating new techniques and were some of the highest rated in the country. Would anything have stop me from being able to use them for just basic cardiology care?

Or my my wife became overly paranoid about my daughter because she didn't gain weight for three months (same period when she was learning to walk, thus burning more calories) and we decided to get her checked by a cardiologist. Without a physicians referral or anything we just called up the pediatric cardiologist in Louisville and asked when we could get a diagnostic exam done. Would anything have prevented us from doing that?

 

[Danoff]

The NHS receives a lot of criticism but whilst it doesn't have a bottomless pit money to provide the absolute best care and treatment to everyone regardless the seriousness of their condition it does provide care when you really need it regardless of who you are, how much money you have or where you live. I'm fully in support of the NHS but I do think everyone across the country should receive the same level of care regardless of where they live. Also for the people who aren't happy with the level of care who have the money can always go private which has the knock on effect of freeing up resources within the NHS.

Not in Canada you can't.

Over here if you need a hip and you're working or have provided a good retirement for yourself, you get a hip because you're paying for it (insurance). You don't get put on a waiting list not being able to walk because your case isn't as serious as the guy who got stabbed in the gang fight.

Now, I'm aware that I'm picking extremes. But the point is that I don't want to subsidize the lifestyles of everyone I'm around, and I'd rather that my money went toward the care I actually need than to provide a line for me to wait in with the promise that if I start dying I'll get moved ahead.

 

[Neal]

Let's say, for example, this was me when I started seeing my current cardiologist and there was no talk of transplants or surgeries, just annual monitoring. I live two postal codes, 50 miles, away from my cardiologist, who is in Louisville. Sure, Frankfort has a paediatric cardiologist but the ones in Louisville were innovating new techniques and were some of the highest rated in the country. Would anything have stopped me from being able to use them for just basic cardiology care?

I’ve looked into this a bit more and the short answer is no, you can choose where you want to go.

” If you need to go to hospital to see a specialist, you have the right to choose which hospital you're referred to by your GP. This legal right, which was introduced in April 2009, lets you choose from any hospital offering a suitable treatment that meets NHS standards and costs.”

I’ve just done a search on the NHS website for recommended hospitals for heart conditions and the results are for hospitals up to 50 miles away, I also assume that if you wanted to go to one further away that wouldn’t be an issue.

Or my my wife became overly paranoid about my daughter because she didn't gain weight for three months (same period when she was learning to walk, thus burning more calories) and we decided to get her checked by a cardiologist. Without a physicians referral or anything we just called up the paediatric cardiologist in Louisville and asked when we could get a diagnostic exam done. Would anything have prevented us from doing that?

You wouldn’t be able to call the paediatric cardiologist direct to book an appointment yourself, you would need to be referred by your GP/physician but then you could choose where you wanted to go. This shouldn’t really be an issue though as your GP should help you get the best and most appropriate treatment and if you’re not happy with them then you can change which GP Practice you go to.

As an example my mum recently became concerned that she was developing a heart condition which based on family history isn’t that unlikely. She went to her GP and was referred for cardiothoracic tests at a local private hospital (which the NHS pays for) and was then sent for further tests (MRI scan, echocardiogram etc) at the main NHS hospital, non of the waiting times for any of these were more than a few weeks. It turns out she is mostly ok and needed a change of blood pressure medication and to lose weight and improve her fitness.

Not in Canada you can't.

Over here if you need a hip and you're working or have provided a good retirement for yourself, you get a hip because you're paying for it (insurance). You don't get put on a waiting list not being able to walk because your case isn't as serious as the guy who got stabbed in the gang fight.

Now, I'm aware that I'm picking extremes. But the point is that I don't want to subsidize the lifestyles of everyone I'm around, and I'd rather that my money went toward the care I actually need than to provide a line for me to wait in with the promise that if I start dying I'll get moved ahead.

I see your point although it’s extremely unlikely someone admitted through A&E with a stab wound would affect anyone waiting for a scheduled hip replacement, perhaps someone admitted with a serious bone injury requiring orthopedic surgery could bump you down the queue but in reality all that would happen in that situation is you’d have to wait a few hours longer to go into theatre but you’d already be in hospital and they wouldn’t send you home.

I’m very far from being a tree hugging hippy that thinks property is theft and everyone should have the same lifestyle regardless of how hard they work but when it comes to healthcare I fully agree with the welfare state. If you’re working or have a good retirement and have good medical insurance then I can understand why you wouldn’t want to subsidize anyone else’s healthcare but what if you’re out of work through no fault of your own so have lapsed on your insurance or downgraded it (I’m assuming there are different levels) and you or your family get seriously ill but you can’t get the treatment you need because you’re not covered. In the UK everyone who is working pays at least 22% of their salary in Income Tax & National Insurance contribution of approximately 12% of their salary and everyone in the UK is entitled to healthcare regardless of what it costs, obviously this means that many some people contribute more than they receive back in care but it means you don’t have to worry if the worst happens. Some examples...my dad had a very severe stroke when he was 45 and spent 10 months in hospital followed by many years of therapy, if he had been paying for his own insurance he may not have had sufficient cover to allow him to receive the same level of care. My Nan had angina and a triple heart valve replacement, I’m certain she would not have had sufficient insurance to cover this so would have died at a much younger age. My mum brought 2 children up on her own and struggled for many years not to lose our house, it would have been very difficult if not impossible for her to do this and pay for health insurance for the three of us. She later returned to work for 15 years before retiring so this in addition to the NI contributions she made in the 15 years she was working before she had kids would very likely cover her life time healthcare.

As I’ve said the NHS does get a lot of criticism, and with regards to hospital food this is very much deserved, but when you are properly ill you will receive some of the best care in the world, fair enough you may need to wait a few months to receive it for non life threatening conditions but you will get it. Many people in the UK take it for granted which to a certain extent is the way it should be but that shouldn’t detract from how lucky we are to have it.

 

[Mr. S]

The NHS receives a lot of criticism but whilst it doesn't have a bottomless pit money to provide the absolute best care and treatment to everyone regardless the seriousness of their condition it does provide care when you really need it regardless of who you are, how much money you have or where you live. I'm fully in support of the NHS but I do think everyone across the country should receive the same level of care regardless of where they live. Also for the people who aren't happy with the level of care who have the money can always go private which has the knock on effect of freeing up resources within the NHS.

I don't know how much it's in the UK but I'm paying 10 Euros a month for a "mutuelle" - that's some sort of additional insurance. They're paying for all drugs, 90% for glasses and so on. I doubt it's as cheap in the US, tho.

 

[Vince_Fiero]

I don't know how much it's in the UK but I'm paying 10 Euros a month for a "mutuelle" - that's some sort of additional insurance. They're paying for all drugs, 90% for glasses and so on. I doubt it's as cheap in the US, tho.

But this is on top of national health care, check what your employer and you pay for that and add it to your 10 Euros. In total it is not that cheap.
Here in Europe we like that system, in US a lot of people want to choose to pay or not.

A part of the reason there is currently no government in Belgium is based on that the Flemish contribute to the Walloon health care and do not agree how it is used (a lot more spending per head then in Flanders). It is not a simple thing.

Now that you put me on the French, these is this girl that has an extremely rare decease (leucodystrophie), who was taking an experimental (Danish) medication that was stopped in test. A lot of people were revolting against this stop of producing the mediation. I admit it is very sad for the girl and her family, however the health care needs to take difficult decisions similar like this. There is a limit, not all can be helped, not even with a good healthcare.

 

[Encyclopedia]

Because I have never heard of such a thing in the US in relation to health care.

Explain how it works to me, and what its purpose is before I weigh in on it any more, because I will admit I am unsure of what it is. But it sounds like you are basically holding a lottery to see who gets certain health care procedures.

Heh I think I missunderstood what you meant. We have something called the postcode lottery here in Sweden which is just a lottery. Nothing to do with healthcare.

 

[FoolKiller]

I’ve looked into this a bit more and the short answer is no, you can choose where you want to go.

” If you need to go to hospital to see a specialist, you have the right to choose which hospital you're referred to by your GP. This legal right, which was introduced in April 2009, lets you choose from any hospital offering a suitable treatment that meets NHS standards and costs.”

I’ve just done a search on the NHS website for recommended hospitals for heart conditions and the results are for hospitals up to 50 miles away, I also assume that if you wanted to go to one further away that wouldn’t be an issue.

So, under a similar system nothing would prevent me from getting on the organ donors waiting lists in Louisville, Lexington, Cleveland, Minneapolis, Indianapolis, Nashville, and Houston?

You wouldn’t be able to call the paediatric cardiologist direct to book an appointment yourself, you would need to be referred by your GP/physician but then you could choose where you wanted to go. This shouldn’t really be an issue though as your GP should help you get the best and most appropriate treatment and if you’re not happy with them then you can change which GP Practice you go to.

This sounds eerily like how HMO's work in the US, the same HMOs that our politicians like to claim are the problem with our system. When I was younger we used an HMO and even for scheduled checkups with the cardiologist there had to be referrals. It was the most convoluted and inefficient system I had ever seen. What I have seen done, that I think works better, is that some specialists will not see you in the US without a referral.

As an example my mum recently became concerned that she was developing a heart condition which based on family history isn’t that unlikely. She went to her GP and was referred for cardiothoracic tests at a local private hospital (which the NHS pays for) and was then sent for further tests (MRI scan, echocardiogram etc) at the main NHS hospital, non of the waiting times for any of these were more than a few weeks.

That doesn't sound too bad to...FEW WEEKS!!!! I have been in my doctor's office for just a six month checkup and had him say something along the lines of, "everything is looking stable. There's been no change since your last visit, but an echo can see more accurately so let's go ahead and get one of those before you leave today." The machines are in the office. That is usually followed by his RN saying she will go check with the tech to see if they are ready and then coming back and saying the tech will come get me in about 15 minutes, when she finishes getting setup. They also have the ability to do an EKG in under five minutes and read, test, and reprogram my pacemaker/ICD.

For other diagnostic tests, such as MRI, CAT Scan, bloodwork, etc I will be given an order (or they call it in if they are affiliated with the hospital) and I cross the street/walk over the pedway to the hospital and register in outpatient registration. I had some vasculitis over the winter due to a medicine reaction and the blood specialist I went to in order to track down the cause had a blood lab off the waiting room so that while you waited for the doctor they got your blood test done. And if they wanted more after the exam, you just walked into the lab and handed them the doctor's note.

My grandmother started going into congenital heart failure, although all we knew was that she was tired a lot more easily. After she met with her cardiologist he wanted similar tests done because he suspected some CHF and she got it done the next day. The only reason why it was next day was because she is 96 and was too tired to do anything else that day.

Then there is the time last year where I got a heart catheterization done next day. I had a choice for same day but opted to do it the next morning and was given a choice of 8:00 or 10:00.

I almost forgot my monthly blood thinner check. I have a standing order on file for PT/INR bloodowork, so I just walk in whenever I can get away from work for an hour to get it done.

What sounds reasonable to wait a few weeks for you sounds absolutely ridiculous to me. I complain if I wait a few hours.

It turns out she is mostly ok and needed a change of blood pressure medication and to lose weight and improve her fitness.

That is very good to hear. Sounds like she is just like every other human who is getting older.

I don't mean to make an example of your mother's minor health scare by pointing out the waiting times, but I have a college buddy that had an aortal tear fixed before it killed him because he walked in to the hospital outpatinet registration and asked for an MRI because he felt weird and had a family history of something similar. He was basically told that if he had waited two hours he would have died. My uncle had an emergency quadruple bypass surgery because my dad had some minor heart stuff pop up and they use the same doctor, so the doctor called my uncle in just to check him.

For many medical things waiting a few weeks could be a death sentence because an issue can be undiagnosed as anything other than minor without more comprehensive testing.

In the UK everyone who is working pays a National Insurance contribution of approximately 12% of their salary

It is pay day so I have my pay stub in front of me right now and just did the math. I pay less than 10% of my paycheck to insurance (medical, dental, and vision), before taxes. That dollar figure is the same for everyone on my plan whether they are starting out or CEO of the company, so some people pay a higher percentage, others pay less. But we all pay the same amount for the same service.

As I’ve said the NHS does get a lot of criticism, and with regards to hospital food this is very much deserved,

That is universal the world over. They have to cook healthy food low in sodium and cholesterol for hundreds of people. And it is probably some minimum wage school cafeteria reject, not a real cook, so there is very little going on in the way of proper, healthy seasoning.

I don't know how much it's in the UK but I'm paying 10 Euros a month for a "mutuelle" - that's some sort of additional insurance. They're paying for all drugs, 90% for glasses and so on. I doubt it's as cheap in the US, tho.

I pay approximately $260 a month for my insurance. That covers 100% dental, 100% glasses lenses and up to $120 on frames, and 100% of medical so long as it is a doctor who accepts my insurance plan, which is everyone because I use Blue Cross Blue Shield. There are some copays, but they are very minimal. As you can see on a previous post, I paid $0 for a $175,000 procedure. Prescription medications are on a tiered system based on type of drug, how new it is, and if it is generic or not. Some cost me as little as $4 for 90 days while others can be as much as $60 for 90 days. Considering I paid $60 once for a drug that cost my insurance $1500 I think I am getting a good deal. And yes, there are tiered insurance plans.

There are also supplemental insurances I can add on like short-term disability, accident insurance, cancer insurance, etc. My wife used Aflac for $17 a month, which handed her $1500 for a six week maternity leave.

And just to show how much of my income that equates to, on taxes they take out $564 a month. That is Federal, State, County, City, Social Security, and Medicare taxes. And that does not cover things like sales taxes, school taxes, gas taxes, telecommunications taxes, and so on. Simply put, my government takes more money from me than my medical expenses.

 

[Neal]

So, under a similar system nothing would prevent me from getting on the organ donors waiting lists in Louisville, Lexington, Cleveland, Minneapolis, Indianapolis, Nashville, and Houston?

The organ donation service in the UK is national so I assume it is irrelevant where you are from and where the donor organ comes from. I couldn’t find anything on this but I did find a news story about a liver being saved and transplanted from a Cessna plane crash so they are transported over fairly large distances.

This sounds eerily like how HMO's work in the US, the same HMOs that our politicians like to claim are the problem with our system. When I was younger we used an HMO and even for scheduled checkups with the cardiologist there had to be referrals. It was the most convoluted and inefficient system I had ever seen. What I have seen done, that I think works better, is that some specialists will not see you in the US without a referral.

I think with our slightly more stretched resources there needs to be the filter of the doctor (GP) referrals to avoid potentially unnecessary appoints with people who should have been seen by someone else.

That doesn't sound too bad to...FEW WEEKS!!!! I have been in my doctor's office for just a six month checkup and had him say something along the lines of, "everything is looking stable. There's been no change since your last visit, but an echo can see more accurately so let's go ahead and get one of those before you leave today." The machines are in the office. That is usually followed by his RN saying she will go check with the tech to see if they are ready and then coming back and saying the tech will come get me in about 15 minutes, when she finishes getting setup. They also have the ability to do an EKG in under five minutes and read, test, and reprogram my pacemaker/ICD.

For other diagnostic tests, such as MRI, CAT Scan, bloodwork, etc I will be given an order (or they call it in if they are affiliated with the hospital) and I cross the street/walk over the pedway to the hospital and register in outpatient registration. I had some vasculitis over the winter due to a medicine reaction and the blood specialist I went to in order to track down the cause had a blood lab off the waiting room so that while you waited for the doctor they got your blood test done. And if they wanted more after the exam, you just walked into the lab and handed them the doctor's note.

My grandmother started going into congenital heart failure, although all we knew was that she was tired a lot more easily. After she met with her cardiologist he wanted similar tests done because he suspected some CHF and she got it done the next day. The only reason why it was next day was because she is 96 and was too tired to do anything else that day.

Then there is the time last year where I got a heart catheterization done next day. I had a choice for same day but opted to do it the next morning and was given a choice of 8:00 or 10:00.

I almost forgot my monthly blood thinner check. I have a standing order on file for PT/INR bloodowork, so I just walk in whenever I can get away from work for an hour to get it done.

What sounds reasonable to wait a few weeks for you sounds absolutely ridiculous to me. I complain if I wait a few hours.

Comparing waiting times in that way I can see why they shock you and I’d like for our service to be run more efficiently so that we had a similar service but NHS waiting times have been an issue as long as I can remember so I don’t see that changing anytime soon.

That is very good to hear. Sounds like she is just like every other human who is getting older.

I don't mean to make an example of your mother's minor health scare by pointing out the waiting times, but I have a college buddy that had an aortal tear fixed before it killed him because he walked in to the hospital outpatinet registration and asked for an MRI because he felt weird and had a family history of something similar. He was basically told that if he had waited two hours he would have died. My uncle had an emergency quadruple bypass surgery because my dad had some minor heart stuff pop up and they use the same doctor, so the doctor called my uncle in just to check him.

For many medical things waiting a few weeks could be a death sentence because an issue can be undiagnosed as anything other than minor without more comprehensive testing.

Thanks and you are right, I did tell her she would be helping herself hugely by losing weight but she wasn’t too impressed hearing it from me!

I’m sure there are cases where speedier action could have saved lives over here but if someone is genuinely feeling rough then they go to A&E and will then be in a hospital where they can get the treatment they need.

It is pay day so I have my pay stub in front of me right now and just did the math. I pay less than 10% of my paycheck to insurance (medical, dental, and vision), before taxes. That dollar figure is the same for everyone on my plan whether they are starting out or CEO of the company, so some people pay a higher percentage, others pay less. But we all pay the same amount for the same service.

Although we are paying a proportion of our salaries similar amount towards healthcare the money I pay goes into the pot for everyone even if they don’t earn a salary due to being too young, too old or out of work due to disability or bad luck/laziness whereas yours is just for you. I’m happy to do this and think it is fair so also have to accept that the services will be stretched further.

That is universal the world over. They have to cook healthy food low in sodium and cholesterol for hundreds of people. And it is probably some minimum wage school cafeteria reject, not a real cook, so there is very little going on in the way of proper, healthy seasoning.

Apparently there are hospitals in the UK that have awarded catering contracts to the same companies that cater for our prisons, some of it really is dire and not what I would want if I needed to recuperate

 

[Danoff]

I’m very far from being a tree hugging hippy that thinks property is theft and everyone should have the same lifestyle regardless of how hard they work but when it comes to healthcare I fully agree with the welfare state. If you’re working or have a good retirement and have good medical insurance then I can understand why you wouldn’t want to subsidize anyone else’s healthcare but what if you’re out of work through no fault of your own so have lapsed on your insurance or downgraded it (I’m assuming there are different levels) and you or your family get seriously ill but you can’t get the treatment you need because you’re not covered.

We have a strange plan in place in the US that covers losing your job (for some time period that I don't know... it's not terribly short). So it's not like someone who is fired here immediately loses all heath coverage. There is a huge problem in the US whereby our government treats you to a massive reward if you get your health insurance through your employer. As a result, almost everyone does, and as a result, almost everyone who loses their job worries about health care. You can, of course, pay for health insurance outside of your employer, but the government doesn't give you a massive tax break for that. You could also simply pay out of pocket for health care, but doing so puts you at risk if you develop a serious condition, and it goes against our healthcare system in a huge way. It's like trying to swim upstream (I've tried it).

The very first change I would make to the US healthcare system is to either remove the tax credit for health insurance through your employer, or to add a tax credit for health insurance outside of your employer. That way there would no longer be any incentive to do so through your employer. If you lose your job, you'd simply need to be able to keep paying your health insurance until you find another job. At my current insurance rates, this would entail saving up few grand to float for a year. My current job would contractually have to hand me more than that in cash in order to fire me. This is something that everyone and anyone who is providing for themselves should take pride in saving.

In the UK everyone who is working pays a National Insurance contribution of approximately 12% of their salary and everyone in the UK is entitled to healthcare regardless of what it costs,

I pay 3%. My wife pays 1.5%, and we have good insurance.

 

[FoolKiller]

Although we are paying a similar amount towards healthcare the money I pay goes into the pot for everyone even if they don’t earn a salary due to being too young, too old or out of work due to disability or bad luck/laziness whereas yours is just for you. I’m happy to do this and think it is fair so also have to accept that the services will be streached further.

Did you notice one of my taxes I paid was Medicare? Guess what that is. No one with a life threatening condition in the US will go uncared for, by law. If someone with no money walks into an ER (A&E) having a heart attack they will be taken care of. It is not a heartless system, as some have made it out to be, but it does allow those who are paying more into it to get an equivalent quality of care.

Apparently there are hospitals in the UK that have awarded catering contracts to the same companies that cater for our prisons, some of it really is dire and not what I would want if I needed to recuperate

OK, ours is not that bad, but when I go to the hospital I do take my own seasonings.

We have a strange plan in place in the US that covers losing your job (for some time period that I don't know... it's not terribly short).

COBRA

If your former employer has 20 or more employees, the company is required by a 1986 federal law to offer you the option to pay for an extension of your health insurance coverage for at least 18 months. This law is known as COBRA, which stands for Consolidated Omnibus Budget Reconciliation Act.

I am well-versed in COBRA as state law requires anyone who has not had a lapse in insurance to have their pre-existing conditions covered by a new employment group health plan.

The very first change I would make to the US healthcare system is to either remove the tax credit for health insurance through your employer, or to add a tax credit for health insurance outside of your employer. That way there would no longer be any incentive to do so through your employer. If you lose your job, you'd simply need to be able to keep paying your health insurance until you find another job.

I always felt that untying the group health insurance benefits from employment was an option. Then you could get group health through AAA or your apartment building or any other group of people you are involved with. Heck, you could even get 20 people together and form a group health insurance co-op. Insurance companies would give you group cost benefits because you are buying in bulk, essentially, which is the key to making insurance work.

 

[Danoff]

I always felt that untying the group health insurance benefits from employment was an option. Then you could get group health through AAA or your apartment building or any other group of people you are involved with. Heck, you could even get 20 people together and form a group health insurance co-op. Insurance companies would give you group cost benefits because you are buying in bulk, essentially, which is the key to making insurance work.

..or not. Buying in bulk really isn't required. I buy my car insurance from state farm without a group. I buy life insurance from metlife without a group. Insurance companies can offer health insurance in the exact same way with the exact same model.

Imagine "we give you a discount when you buy your home, auto, life, and health insurance from us". It would be especially interesting if the life insurance guys were also doing the health insurance. They'd have a built-in incentive to keep you healthy.

 

[Neal]

I totally cocked up on how much we pay towards the NHS, it comes out of income tax not national insurance I'll try and find out the figures and come back...this is why I shouldn't be allowed in the opinions forum without adult supervision!

 

[FoolKiller]

..or not. Buying in bulk really isn't required. I buy my car insurance from state farm without a group. I buy life insurance from metlife without a group. Insurance companies can offer health insurance in the exact same way with the exact same model.

Imagine "we give you a discount when you buy your home, auto, life, and health insurance from us". It would be especially interesting if the life insurance guys were also doing the health insurance. They'd have a built-in incentive to keep you healthy.

My comment is based on the assumption that the companies themselves work the same way. If we break down all other barriers too, then yes buying in bulk groups is replaced by bundling by individuals.

But so long as health insurance companies are tied down to state borders and the rest of the current regulations then the only way someone like me can get any kind of health insurance is through a group plan.

All that said: Vanishing deductibles, healthy living discounts, no-hospitalization bonus. It sounds like a wonderful world.

 

[Neal]

I totally cocked up on how much we pay towards the NHS, it comes out of income tax not national insurance I'll try and find out the figures and come back...this is why I shouldn't be allowed in the opinions forum without adult supervision!

Approx 18% of the UK total tax budget is spent on healthcare, if this total tax budget were just income tax and national insurance that would equate to approx 4% of you salary going on the NHS but as we pay tax on pretty much everything we buy then the correct figure is going to be between 1% and 2%...ish

I pay 3%. My wife pays 1.5%, and we have good insurance.

Similar to what you're paying then.

Did you notice one of my taxes I paid was Medicare? Guess what that is. No one with a life threatening condition in the US will go uncared for, by law. If someone with no money walks into an ER (A&E) having a heart attack they will be taken care of. It is not a heartless system, as some have made it out to be, but it does allow those who are paying more into it to get an equivalent quality of care.

I did notice and I know people aren't left to die in the street over there although I have heard people coming out with crap like that in the past!

 

[Danoff]

Approx 18% of the UK total tax budget is spent on healthcare, if this total tax budget were just income tax and national insurance that would equate to approx 4% of you salary going on the NHS but as we pay tax on pretty much everything we buy then the correct figure is going to be between 1% and 2%...ish

Similar to what you're paying then.

The percentage I listed is the total amount I pay toward health insurance (does not include anything I pay toward socialized care in the US). You should include any sales tax that goes toward healthcare as well.

Currently our federal government pays 23% of its budget to healthcare (medicare, medicaid). So it seems we have more of a socialized healthcare system than you do.

 

[Neal]

/thread

 

[MikeTheHockeyFan]

The percentage I listed is the total amount I pay toward health insurance (does not include anything I pay toward socialized care in the US). You should include any sales tax that goes toward healthcare as well.

Currently our federal government pays 23% of its budget to healthcare (medicare, medicaid). So it seems we have more of a socialized healthcare system than you do.

That is actually very ironic

There's no doubt Medicare and Medicaid need some kind of long term reforming. Unfortunately the political issue is so touchy that politicians who go near it get buried (just look at the dismissal of the Paul Ryan deficit plan by both parties).

 

[Sureboss]

On Hospital food in the UK, a former chef lecturer of mine used to work in the local hospital. The budget was insane, so tight.

It's been a while since I've had the need for hospital food (er, about 8-9, so 15 years ago or so) but I've always found the NHS in general to be good to me and others. I love the principle behind it, it's something I'm proud of, of course it's not the most efficient, but then can something like that ever be as efficient as a private trust/hospital?

If you look at all of our nationalised/public systems, are any of them that efficient?

 

[Danisfast]

This issue boils down to one question as far as I am concerned...

If policing and fire services are necessary expenses of society, should healthcare also come under this banner of 'essential services for the effective maintenance and protection of society and its public'?

I think it does and therefore should be provided for. Private healthcare should still be an option (and there are many factors that may complicate the issue of public healthcare in the future - as we are finding out now!). But we have our NHS, and it is a source of national pride because it is a simple, fair and decent system that is surprisingly rare among the big economic players in the world.

It shocks me that America's libertarian attitude is so strong that, in my opinion, it overrules the decency to band together to help your fellow man (and possibly yourself one day). Alas, I guess it's about finding the appropriate balance between the rights and responsibilities of the individual for themselves and for the society in which they exist (perhaps something that we Britons have gone too far the other way in doing in recent times - still, not many people die at the hands of our approach).

 

[Sam48]

If policing and fire services are necessary expenses of society, should healthcare also come under this banner of 'essential services for the effective maintenance and protection of society and its public'?

There's a massive gap you've failed to notice. Fire services and policing are run by local people who practically devote their life to protecting the people at little to no money at all. A healthcare system for an entire nation is run directly by the government. Now, when has the government EVER run anything properly? Let alone better than the private sector?

Private healthcare should still be an option (and there are many factors that may complicate the issue of public healthcare in the future - as we are finding out now!). But we have our NHS, and it is a source of national pride because it is a simple, fair and decent system that is surprisingly rare among the big economic players in the world.

Surprisingly rare? Did you once think there might be a fairly good reason for that?

- still, not many people die at the hands of our approach).

Did you count those who are left to die?

 

[FoolKiller]

It shocks me that America's libertarian attitude is so strong that, in my opinion, it overrules the decency to band together to help your fellow man (and possibly yourself one day).

This is such a gross misrepresentation that it isn't even funny. The libertarian ideal is to protect the rights of every individual equally. I know few libertarians who wouldn't volunteer to help those who legitimately need it. I've done it myself. Libertarians are banded together to fight for everyone to be treated equally. In that is that you cannot charge one group of people to pay for the healthcare of another group of people.

To go even further, as we were founded as a Republic of united independent states the Constitution has guaranteed that anything not explicitly given as a power of the Federal Government in the Constitution is to be handled by individual states. That is why I don't get into the Massachusetts health care plan, because I do not know enough about Massachusetts law to rule on it and it is an exercise in state's rights. I think it is a bad plan on the surface, but from a legal standpoint I have no clue.

Emergency services are a different thing altogether, which is why you will find that even some libertarians are willing to discuss emergency medical being covered in some way. But even then you leave a question of why should we be paying for a guy who ate fried chicken and french fries his whole life and had a heart attack at 35. And that opens a whole new can of worms. Under our private system we already try to regulate what we can eat because of the health care cost burden. If we give government actual control over health care where the cost burden is 100% on the government/public then how much further will that trend go? Some places are taxing sodas or banning them from certain areas, laying new regulations on fast food chains, and so forth. The next trend appears to be going after salt. Now, I am on a low sodium diet. I can vouch for the existence and labeling of low sodium products. But they want to enforce it on the mainstream foods. I can also vouch that certain foods are absolute crap without the salt. Crackers turn into a gummy mush when you attempt to eat them, no matter how much seasoning you use in soups they taste bland after being canned without salt, and there is no such thing as a low sodium sharp cheese.

still, not many people die at the hands of our approach.

The same goes for our approach, and most people would agree our current system is screwed up.

 

[Keef]

This issue boils down to one question as far as I am concerned...

You're not taking a deep enough look at the situation, because...

If policing and fire services are necessary expenses of society

...my question is this: Are police and fire services necessary [public] expenses of society? Obviously they're necessary - your wording is a bit vague - but should these functions be handled by a government or a private entity?

 

[KSaiyu]

It's a system that has to be changed, and I'm grateful that the NHS was founded the time it was. I don't understand the fear of government interference, is it still a perceived threat of socialised medicine or just a general mistrust of politicians? It's indisputable costs have to come down, surely you're at the stage where this can only be achieved collectively by national controls, or am I oversimplifying here....

 

[Danoff]

It's a system that has to be changed, and I'm grateful that the NHS was founded the time it was. I don't understand the fear of government interference, is it still a perceived threat of socialised medicine or just a general mistrust of politicians? It's indisputable costs have to come down, surely you're at the stage where this can only be achieved collectively by national controls, or am I oversimplifying here....

Not at all. All analysis of the situation suggests that the problem with our system is attempting to divorce customer from cost. "National controls" would further this process and require rationing. This is essentially economics 101. There is no way to look at this situation and come to the conclusion that nationalizing the program is the cost-effective solution.

 

[FoolKiller]

It's a system that has to be changed, and I'm grateful that the NHS was founded the time it was. I don't understand the fear of government interference, is it still a perceived threat of socialised medicine or just a general mistrust of politicians? It's indisputable costs have to come down, surely you're at the stage where this can only be achieved collectively by national controls, or am I oversimplifying here....

There are so many changes that could be done to our system to help lower costs without government intervention (in fact, some of the costs are there because of government intervention) that it could easily be fixed. And with that I look at all the things that government does run and they are wasteful, incompetent, and fail to produce decent results. As someone who needs a heart transplant I have seen two organ transplants denied by Medicare/Medicaid at the last minute as medically unnecessary. At least one of them died within six months. You can override a ruling if you get multiple doctors' opinions, however a transplant has a window of a few hours and the testing is too extensive for doctors to rule on in time. When they denied those transplants they knew they were doing it in a way that couldn't have been overridden.

When I read stories like this and this I just tend to worry about what happens when I have no choice but to use a system run by these same people.

 

[KSaiyu]

Not at all. All analysis of the situation suggests that the problem with our system is attempting to divorce customer from cost. "National controls" would further this process and require rationing. This is essentially economics 101. There is no way to look at this situation and come to the conclusion that nationalizing the program is the cost-effective solution.

So it's about maintaining choice, while creating a more efficient system for the people in a position less able to have such a choice (the uninsured, or those with not-so-good plans)? Rationing seems a strong word in this context, especially when the opposite can almost be proven to do more harm than good sometimes. This article looks at the most expensive city in the US in terms of healthcare, and the page I've linked to shows the apparent disconnect between expenditure on procedures and tests and patient care. It's really worth reading the rest though.

There are so many changes that could be done to our system to help lower costs without government intervention (in fact, some of the costs are there because of government intervention) that it could easily be fixed. And with that I look at all the things that government does run and they are wasteful, incompetent, and fail to produce decent results. As someone who needs a heart transplant I have seen two organ transplants denied by Medicare/Medicaid at the last minute as medically unnecessary. At least one of them died within six months. You can override a ruling if you get multiple doctors' opinions, however a transplant has a window of a few hours and the testing is too extensive for doctors to rule on in time. When they denied those transplants they knew they were doing it in a way that couldn't have been overridden.

When I read stories like this and this I just tend to worry about what happens when I have no choice but to use a system run by these same people.

It really is another world of Pantomime villains and Gotham super corporations over there. And I thought it was bad when Panorama uncovered Surgical Scissors were being made in Pakistan instead of Germany....

 

[Owen.C93]

I love the principle behind it, it's something I'm proud of, of course it's not the most efficient, but then can something like that ever be as efficient as a private trust/hospital?

If you look at all of our nationalised/public systems, are any of them that efficient?

Wasn't there a study a few days ago that showed the NHS was the most efficient. It wouldn't surprise me.