A private insurance-based system with suitable protections for the very poorest is the only solution. Anything which is provided free will be abused - plastic carrier bag usage fell 85% when the govt applied just a token 5p charge.
...so we need these companies, run by very very rich and powerful people, to take your money in exchange for your health, as a result of which those people will get even richer and more powerful, and both your wealth and health are increasingly at their mercy...
A properly regulated insurance system would work just fine - I've lived in the US where the health system oddly gets castigated yet it is truly world class for the vast majority of the population but abysmal for the poorest minority only. Correct the latter point and you have the solution.
A private insurance-based system with suitable protections for the very poorest is the only solution. Anything which is provided free will be abused - plastic carrier bag usage fell 85% when the govt applied just a token 5p charge.
I wonder if on the forms it will have, "Any pre-existing conditions?"
That should get the head count down if don't have treat sick people if they can't afford the loaded premiums.
A private insurance-based system with suitable protections for the very poorest is the only solution. Anything which is provided free will be abused - plastic carrier bag usage fell 85% when the govt applied just a token 5p charge.
...so we need these companies, run by very very rich and powerful people, to take your money in exchange for your health, as a result of which those people will get even richer and more powerful, and both your wealth and health are increasingly at their mercy...
A properly regulated insurance system would work just fine - I've lived in the US where the health system oddly gets castigated yet it is truly world class for the vast majority of the population but abysmal for the poorest minority only. Correct the latter point and you have the solution.
It is though, terrifyingly expensive for most, too, right? Which is why most travel insurance has special premiums for those travelling to the US; and why when people lose their jobs they are in terror of not being able to afford healthcare of any kind any more. I will leave others like @SDAddick who is actually there now to challenge your assertion in more detail.
Now if only you had referred to the French or German systems, which are insurance based but under State control, I might have been a bit more supportive.
Oh and when it comes to "proper regulating" a privatised utility, we don't have a great record in that, do we? Gas, electricity, water, railways, telcos. Less savvy consumers ripped off on a daily basis, with only Martyn Lewis to help them.
Yes it's expensive but generally paid by employers as part of a benefits package (which I agree brings other issues) - however it should be expensive because world-class doctors, drugs, medical technology etc. are expensive. In this country frankly not very well-off people would think nothing of spending £400 per month for the HP on a new BMW X5 but would hesitate to spend the same on their family's private health insurance, which personally at least I find odd.
However it's notable that US healthcare inflation has seemingly got out of control whereby the country spends 2x as much as Western Europe for roughly the same outcomes (again I would argue insufficient checks and balances in the relationships between doctors/drug companies, insurers/hospitals etc.).
Yes it's expensive but generally paid by employers as part of a benefits package (which I agree brings other issues) - however it should be expensive because world-class doctors, drugs, medical technology etc. are expensive. In this country frankly not very well-off people would think nothing of spending £400 per month for the HP on a new BMW X5 but would hesitate to spend the same on their family's private health insurance, which personally at least I find odd.
However it's notable that US healthcare inflation has seemingly got out of control whereby the country spends 2x as much as Western Europe for roughly the same outcomes (again I would argue insufficient checks and balances in the relationships between doctors/drug companies, insurers/hospitals etc.).
I've worked for the NHS since 1990 ( retired in October). I have seen the service decline from close up. It is in a dire state. There are huge challenges ahead in healthcare in this country and something drastic does need to be done.
Given all of that the last model of healthcare that needs to be looked at is the one you are espousing. It is more costly per head and leaves many without care at all.
@PragueAddick has mentioned both the French and German models. This will be the way to go.
The NHS as we knew it is on life support. It is systematically being run down ( I really believe that) so that when it fails enough people ( see JohnBoys post above) there will be little will to resist the leeches moving in to turn a profit.
The advice I have given my children and I give it freely to anyone who will listen is to get decent medical insurance.
Yes it's expensive but generally paid by employers as part of a benefits package (which I agree brings other issues) - however it should be expensive because world-class doctors, drugs, medical technology etc. are expensive. In this country frankly not very well-off people would think nothing of spending £400 per month for the HP on a new BMW X5 but would hesitate to spend the same on their family's private health insurance, which personally at least I find odd.
However it's notable that US healthcare inflation has seemingly got out of control whereby the country spends 2x as much as Western Europe for roughly the same outcomes (again I would argue insufficient checks and balances in the relationships between doctors/drug companies, insurers/hospitals etc.).
I've worked for the NHS since 1990 ( retired in October). I have seen the service decline from close up. It is in a dire state. There are huge challenges ahead in healthcare in this country and something drastic does need to be done.
Given all of that the last model of healthcare that needs to be looked at is the one you are espousing. It is more costly per head and leaves many without care at all.
@PragueAddick has mentioned both the French and German models. This will be the way to go.
The NHS as we knew it is on life support. It is systematically being run down ( I really believe that) so that when it fails enough people ( see JohnBoys post above) there will be little will to resist the leeches moving in to turn a profit.
The advice I have given my children and I give it freely to anyone who will listen is to get decent medical insurance.
Ironically perhaps, thanks to the existence of the NHS, private medical insurance in the UK is relatively affordable at least compared to other things people choose to spend their money on.
Again I reiterate that when you remove the market's invisible hand from any goods or services then it will be misallocated. Even introducing a token cost for visiting a GP would at least reintroduce some modicum of a link between the cost of the service at its usage.
To use an analogy we are all familiar with, how often would you use Google search if it cost say 10p each time compared to its current free service? I think usage would fall by 95% yet 'essential' searches would still be conducted.
ps - Apologies if it read that I had suggested adopting the US model in full (which wasn't my intention), but there is so much negative press around their healthcare provision which simply did not resonate at all with my experience of it which was unequivocally positive.
Yes it's expensive but generally paid by employers as part of a benefits package (which I agree brings other issues) - however it should be expensive because world-class doctors, drugs, medical technology etc. are expensive. In this country frankly not very well-off people would think nothing of spending £400 per month for the HP on a new BMW X5 but would hesitate to spend the same on their family's private health insurance, which personally at least I find odd.
However it's notable that US healthcare inflation has seemingly got out of control whereby the country spends 2x as much as Western Europe for roughly the same outcomes (again I would argue insufficient checks and balances in the relationships between doctors/drug companies, insurers/hospitals etc.).
I've worked for the NHS since 1990 ( retired in October). I have seen the service decline from close up. It is in a dire state. There are huge challenges ahead in healthcare in this country and something drastic does need to be done.
Given all of that the last model of healthcare that needs to be looked at is the one you are espousing. It is more costly per head and leaves many without care at all.
@PragueAddick has mentioned both the French and German models. This will be the way to go.
The NHS as we knew it is on life support. It is systematically being run down ( I really believe that) so that when it fails enough people ( see JohnBoys post above) there will be little will to resist the leeches moving in to turn a profit.
The advice I have given my children and I give it freely to anyone who will listen is to get decent medical insurance.
Ironically perhaps, thanks to the existence of the NHS, private medical insurance in the UK is relatively affordable at least compared to other things people choose to spend their money on.
Again I reiterate that when you remove the market's invisible hand from any goods or services then it will be misallocated. Even introducing a token cost for visiting a GP would at least reintroduce some modicum of a link between the cost of the service at its usage.
To use an analogy we are all familiar with, how often would you use Google search if it cost say 10p each time compared to its current free service? I think usage would fall by 95% yet 'essential' searches would still be conducted.
ps - Apologies if it read that I had suggested adopting the US model in full (which wasn't my intention), but there is so much negative press around their healthcare provision which simply did not resonate at all with my experience of it which was unequivocally positive.
Fair points. But as I mentioned earlier, the French system has what you seek. As I understand it, even a visit to the GP needs to be covered by the insurance. You may well be fully reimbursed, but it makes you stop and think whether you really need to go - if it is just a cold, or you just feel lonely and want someone to talk to. But it is not, as I understand it a market based system. The French State has oversight about what all its citizens need from its health service. IMO this was the huge fault line running through the Thatcher privatisations; they told themselves that creating markets is an objective in itself. But fot essential utilities that is nonsense. It should be about whether creating markets is a good strategy to achieve desired objectives.
The problem with all of the comparison between a so-called 'free' system like the NHS and some form of quasi or fully private system is that the former is not free at all, patients simply don't see the cost (and thus misuse it).
Last year 18% of UK govt spending went on healthcare - look at your 2015/16 tax return, multiply the tax you paid by 18% and it will tell you how much you indirectly contributed. For a young couple earning £50k, this implies approx. £1700 which isn't much different from what they might pay in private health insurance - it doesn't strike me as a great allocation of resources.
I'm still not sure why a properly regulated mandatory but fully private health insurance system shouldn't work in the same way as it does for example with car insurance. However unlike car insurance (where one can simply choose not to own a car if they can't afford the premiums), government subsidies should ensure the very poorest are catered for.
It would also introduce (as already obviously exists with car insurance) incentives for people to exercise better life choices for which currently there are none, at least financial ones.
Whilst employers would pick up much of the burden as many do already (and should), the internet and the 'sharing economy' provide massive opportunities for self-employed or otherwise non-covered people to pool their risks and negotiate a better deal from insurers.
The problem with all of the comparison between a so-called 'free' system like the NHS and some form of quasi or fully private system is that the former is not free at all, patients simply don't see the cost (and thus misuse it).
Last year 18% of UK govt spending went on healthcare - look at your 2015/16 tax return, multiply the tax you paid by 18% and it will tell you how much you indirectly contributed. For a young couple earning £50k, this implies approx. £1700 which isn't much different from what they might pay in private health insurance - it doesn't strike me as a great allocation of resources.
I'm still not sure why a properly regulated mandatory but fully private health insurance system shouldn't work in the same way as it does for example with car insurance. However unlike car insurance (where one can simply choose not to own a car if they can't afford the premiums), government subsidies should ensure the very poorest are catered for.
It would also introduce (as already obviously exists with car insurance) incentives for people to exercise better life choices for which currently there are none, at least financial ones.
Whilst employers would pick up much of the burden as many do already (and should), the internet and the 'sharing economy' provide massive opportunities for self-employed or otherwise non-covered people to pool their risks and negotiate a better deal from insurers.
The figure of 18% which you state in almost a negative tone is still less than the Germans and French and certainly the USA pay per head of population for perhaps the most important duty a country has. To look after the health of its people.
As you know took the FIL to Lewisham A&E last night after waiting over 2hrs for an ambulance.
The NHS staff have been absolutely brilliant. However, as of the phone call from my wife at 3:30 the FIL is STILL in A&E as of now, as there are no beds available in the Adult 'majors' ward. He was in the corridor until 2 hours ago when he was moved to a side room.
So coming up to 24hrs when the ambulance was called and still hasnt been admitted properly. Wife/MIL are willing to take him private but cant until he has been admitted and has been properly diagnosed but still waiting for CT/MRI scans.
We left A&E at 6am. Shame the jobsworth parking attendant spoke to my wife so rudely when the ticket machine wouldnt take her £16 of pound coins. I suggest he doesnt ever introduce himself to her at any point as I think she''ll quarely punch him in the face. Absolute arsehole.
This comes 18 months after my 97yo Nan was rushed into hospital with a broken hip and was left lating on the floor for almost 3 hours waiting for an ambulance.
I don't understand why you insist on your desired insurance based system being fully private. (Well, I suppose it is idealogical). All the behavioural advantages you cite, can be obtained where the State - and thus, the citizens - remains the majority "shareholder" . Fully privatised, you know what shenanigans will take place, because as I have said, you need only look to the other utilities and how they run rings round their regulators, of course calling on the most expensive consultancies to assist them, because they can afford it. And the ultimate insult will be, that they will re-locate offshore, avoiding UK corporate tax and directorial accountability. Because that also is the way it goes in the UK.
Why not do it the German way? As with most other comparitive examples (such as the railways), it seems to work better.
A private insurance-based system with suitable protections for the very poorest is the only solution. Anything which is provided free will be abused - plastic carrier bag usage fell 85% when the govt applied just a token 5p charge.
...so we need these companies, run by very very rich and powerful people, to take your money in exchange for your health, as a result of which those people will get even richer and more powerful, and both your wealth and health are increasingly at their mercy...
A properly regulated insurance system would work just fine - I've lived in the US where the health system oddly gets castigated yet it is truly world class for the vast majority of the population but abysmal for the poorest minority only. Correct the latter point and you have the solution.
The problem with all of the comparison between a so-called 'free' system like the NHS and some form of quasi or fully private system is that the former is not free at all, patients simply don't see the cost (and thus misuse it).
Last year 18% of UK govt spending went on healthcare - look at your 2015/16 tax return, multiply the tax you paid by 18% and it will tell you how much you indirectly contributed. For a young couple earning £50k, this implies approx. £v1700 which isn't much different from what they might pay in private health insurance - it doesn't strike me as a great allocation of resources.
I'm still not sure why a properly regulated mandatory but fully private health insurance system shouldn't work in the same way as it does for example with car insurance. However unlike car insurance (where one can simply choose not to own a car if they can't afford the premiums), government subsidies should ensure the very poorest are catered for.
It would also introduce (as already obviously exists with car insurance) incentives for people to exercise better life choices for which currently there are none, at least financial ones.
Whilst employers would pick up much of the burden as many do already (and should), the internet and the 'sharing economy' provide massive opportunities for self-employed or otherwise non-covered people to pool their risks and negotiate a better deal from insurers.
I'm pretty wealthy. It's still pretty bad, particularly if you have chronic conditions (and even moreso if they're mental health conditions) and you need continuity of care. I will pay around $5,200 (£4000ish) in premiums ALONE, that is just the privilege to see doctors and get testing done. That does not include the ridiculously high costs at the point of care, be they co-pays or costs of testing, procedures, medications, etc.
My comments are not just based on personal experience, I've worked in Healthcare IT, my mum has been a physician for almost 30 years currently with Kaiser Permanente (one of the few bright spots in American healthcare), and my dad does consulting for hospitals which have gone bankrupt which exposed just how bad the system was before ObamaCare, and how bad it still is.
To go out another level, our healthcare outcomes are 37th best in the world, and the amount we spend overall and per capita is the highest (I think it's about 15% of GDP). It's a completely unsustainable system, and the largest problem is profit. And that's at every level, starting with insurers and pharmaceuticals, but it trickles down to hospitals, doctors, etc.
If I have time later, I'll find some statistics that aren't particular to me or off the top of my head.
I don't understand why you insist on your desired insurance based system being fully private. (Well, I suppose it is idealogical). All the behavioural advantages you cite, can be obtained where the State - and thus, the citizens - remains the majority "shareholder" . Fully privatised, you know what shenanigans will take place, because as I have said, you need only look to the other utilities and how they run rings round their regulators, of course calling on the most expensive consultancies to assist them, because they can afford it. And the ultimate insult will be, that they will re-locate offshore, avoiding UK corporate tax and directorial accountability. Because that also is the way it goes in the UK.
Why not do it the German way? As with most other comparitive examples (such as the railways), it seems to work better.
I suppose in short I don't agree that privatisation has failed, and in those instances where it could be done better (eg. railways) then it is because the regulations have not been structured appropriately, rather than the privatisation per se. In the case of railways they are a natural monopoly which creates specific issues (not true of the Post Office, airlines, hospitals, utilities etc.).
If one looks at a small but important part of healthcare namely dentistry, then the sector is predominantly privately funded (whether by consumers directly or via insurance) and it seems to work perfectly well with the NHS as a back up for basic treatment.
I don't understand why you insist on your desired insurance based system being fully private. (Well, I suppose it is idealogical). All the behavioural advantages you cite, can be obtained where the State - and thus, the citizens - remains the majority "shareholder" . Fully privatised, you know what shenanigans will take place, because as I have said, you need only look to the other utilities and how they run rings round their regulators, of course calling on the most expensive consultancies to assist them, because they can afford it. And the ultimate insult will be, that they will re-locate offshore, avoiding UK corporate tax and directorial accountability. Because that also is the way it goes in the UK.
Why not do it the German way? As with most other comparitive examples (such as the railways), it seems to work better.
I suppose in short I don't agree that privatisation has failed, and in those instances where it could be done better (eg. railways) then it is because the regulations have not been structured appropriately, rather than the privatisation per se. In the case of railways they are a natural monopoly which creates specific issues (not true of the Post Office, airlines, hospitals, utilities etc.).
Well of the sectors you mention only airlines works for me because it is a global market, and BA did not provide an essential part of the national transport backbone which keeps a country moving. Of the rest, arguably markets potentially exist, but just because they potentially exist does not mean they should be created. They should be created if the outcomes are clearly better for all citizens. Not "customers", and certainly not shareholders. I guess we just fundamentally disagree, and you have a more important post from @SDAddick to respond to.:-)
I don't understand why you insist on your desired insurance based system being fully private. (Well, I suppose it is idealogical). All the behavioural advantages you cite, can be obtained where the State - and thus, the citizens - remains the majority "shareholder" . Fully privatised, you know what shenanigans will take place, because as I have said, you need only look to the other utilities and how they run rings round their regulators, of course calling on the most expensive consultancies to assist them, because they can afford it. And the ultimate insult will be, that they will re-locate offshore, avoiding UK corporate tax and directorial accountability. Because that also is the way it goes in the UK.
Why not do it the German way? As with most other comparitive examples (such as the railways), it seems to work better.
I suppose in short I don't agree that privatisation has failed, and in those instances where it could be done better (eg. railways) then it is because the regulations have not been structured appropriately, rather than the privatisation per se. In the case of railways they are a natural monopoly which creates specific issues (not true of the Post Office, airlines, hospitals, utilities etc.).
Well of the sectors you mention only airlines works for me because it is a global market, and BA did not provide an essential part of the national transport backbone which keeps a country moving. Of the rest, arguably markets potentially exist, but just because they potentially exist does not mean they should be created. They should be created if the outcomes are clearly better for all citizens. Not "customers", and certainly not shareholders. I guess we just fundamentally disagree, and you have a more important post from @SDAddick to respond to.:-)
Well put as always Prague.
NewYorkAddict, the notion of being in favor of privatization in general is one thing. I completely disagree with your assessment of the US system, but that's a separate conversation from the private vs. public sector debate. For me, anything that is part of the "backbone or crucial wellbeing" of a nation should be controlled by the public sector so that profit motive is not a part of it. As I mentioned, the largest problem within US healthcare remains the profit motive. I'll try and look now for some article and statistics to this effect, I don't expect you to respond directly to parts of my earlier post like "why is my premium specifically so high?!?!?!" .
I would also add, as you mentioned, I have had a lot of very positive experiences and genuinely world class doctors and support staff within the US system. The care, particularly in large metropolises, can be excellent. My problems are with the payment structure and lack of oversight, which can make outcomes very poor and costs incredibly high.
You can also look at this from a Capitalistic perspective--healthy people who are healthy workers produce more, which is for the good of the Capitalist society. I believe you can also make a similar argument for transport (at least within a country like the UK), where getting people places is a crucial part of doing business, and without it, you risk the economy slowing down.
A private insurance-based system with suitable protections for the very poorest is the only solution. Anything which is provided free will be abused - plastic carrier bag usage fell 85% when the govt applied just a token 5p charge.
I wonder if on the forms it will have, "Any pre-existing conditions?"
That should get the head count down if don't have treat sick people if they can't afford the loaded premiums.
I suppose ones own experience will inevitably shape ones view - ironically as a frequent visitor to the US, I will still often see my old NY family doctor for advice/prescriptions (which obviously I pay for out of pocket) than mess around with my UK GP who can only see me in two weeks' time when I will no longer be ill. We also had children in both countries and the experience was incomparable.
The US model is extreme of course (we were fortunate to have private insurance through work which cost multiples of your cover) and full of problems which you allude to, but no-one ever receives desperate fundraising requests for sick children to have lifesaving treatment in France or Germany.
....sorry, I'd also note that there are plenty of things in the US which are run by the public sector (eg. airports, passenger trains, mail etc.) which are without fail positively Third World in quality so whilst the healthcare system is flawed, it would be intolerable in govt hands.
Was it on this site that I read a new dad was charged $65 for being allowed to hold his new born child in the USA? Apparently every time an American health worker does anything they put a sticky note on something, or some such system.
....sorry, I'd also note that there are plenty of things in the US which are run by the public sector (eg. airports, passenger trains, mail etc.) which are without fail positively Third World in quality so whilst the healthcare system is flawed, it would be intolerable in govt hands.
And there are a lot of airports and transportation networks that run brilliantly. I would also argue that despite years of under investment and governments led by Republicans who don't believe in Government and thus make Government not working a self-fulfilling prophecy through bad management and under funding, CMS (Center for Medicare and Medicaid) does some things very well. I'm currently working on a proposal for them and for an often maligned and criticized organization, they blend public and private very well.
We are now 35+ years into this notion of "I'm from the Government and I'm here to help" being "the worst thing you can hear," and yet that is patently untrue. There remain many public hospitals that are world class. Our university system is the best in the world. We remain excellent at R&D within that system, all of which is publicly funded, and much of which (particularly in tech and medicine) the private sectors benefits and profits from. The notion that the US government (or governments, at the state level) can't do things well is just simply wrong.
....sorry, I'd also note that there are plenty of things in the US which are run by the public sector (eg. airports, passenger trains, mail etc.) which are without fail positively Third World in quality so whilst the healthcare system is flawed, it would be intolerable in govt hands.
And there are a lot of airports and transportation networks that run brilliantly. I would also argue that despite years of under investment and governments led by Republicans who don't believe in Government and thus make Government not working a self-fulfilling prophecy through bad management and under funding, CMS (Center for Medicare and Medicaid) does some things very well. I'm currently working on a proposal for them and for an often maligned and criticized organization, they blend public and private very well.
We are now 35+ years into this notion of "I'm from the Government and I'm here to help" being "the worst thing you can hear," and yet that is patently untrue. There remain many public hospitals that are world class. Our university system is the best in the world. We remain excellent at R&D within that system, all of which is publicly funded, and much of which (particularly in tech and medicine) the private sectors benefits and profits from. The notion that the US government (or governments, at the state level) can't do things well is just simply wrong.
Don't people have to pay college fees in the US? I only ask as all the TV shows and movies have parents talking about saving up for college.
....sorry, I'd also note that there are plenty of things in the US which are run by the public sector (eg. airports, passenger trains, mail etc.) which are without fail positively Third World in quality so whilst the healthcare system is flawed, it would be intolerable in govt hands.
And there are a lot of airports and transportation networks that run brilliantly. I would also argue that despite years of under investment and governments led by Republicans who don't believe in Government and thus make Government not working a self-fulfilling prophecy through bad management and under funding, CMS (Center for Medicare and Medicaid) does some things very well. I'm currently working on a proposal for them and for an often maligned and criticized organization, they blend public and private very well.
We are now 35+ years into this notion of "I'm from the Government and I'm here to help" being "the worst thing you can hear," and yet that is patently untrue. There remain many public hospitals that are world class. Our university system is the best in the world. We remain excellent at R&D within that system, all of which is publicly funded, and much of which (particularly in tech and medicine) the private sectors benefits and profits from. The notion that the US government (or governments, at the state level) can't do things well is just simply wrong.
Don't people have to pay college fees in the US? I only ask as all the TV shows and movies have parents talking about saving up for college.
Yes they do, and they're very high. But that would pay for simply an undergraduate education, not the R&D arms of a university (by-and-large).
....sorry, I'd also note that there are plenty of things in the US which are run by the public sector (eg. airports, passenger trains, mail etc.) which are without fail positively Third World in quality so whilst the healthcare system is flawed, it would be intolerable in govt hands.
And there are a lot of airports and transportation networks that run brilliantly. I would also argue that despite years of under investment and governments led by Republicans who don't believe in Government and thus make Government not working a self-fulfilling prophecy through bad management and under funding, CMS (Center for Medicare and Medicaid) does some things very well. I'm currently working on a proposal for them and for an often maligned and criticized organization, they blend public and private very well.
We are now 35+ years into this notion of "I'm from the Government and I'm here to help" being "the worst thing you can hear," and yet that is patently untrue. There remain many public hospitals that are world class. Our university system is the best in the world. We remain excellent at R&D within that system, all of which is publicly funded, and much of which (particularly in tech and medicine) the private sectors benefits and profits from. The notion that the US government (or governments, at the state level) can't do things well is just simply wrong.
Don't people have to pay college fees in the US? I only ask as all the TV shows and movies have parents talking about saving up for college.
Yes they do, and they're very high. But that would pay for simply an undergraduate education, not the R&D arms of a university (by-and-large).
My mates lad wanted to study music and luckily got offered a place at a course in Boston. The course was four years and the fees were £35,000 per year, paid up front. He's now studying at Guildford as his mum and dad would have had to remortgage their £175,000 house to send him, which made it unworkable. They place high regard on education as their daughter is doing her doctorate at Cambridge (on the same panel as Stephen Hawking), following on from her mother that went to the same college.
As for hospitals. I work in a busy A & E department. Earlier in the night the department was closed to ambulances as there were no bed spaces in the department (which means trolleys lined up side by side throughout the whole department) or main hospital.
Not sure what the answer is for healthcare in UK. Our department is going through its fourth reorganisation in 10 years. Every time they think it will solve the problem and it never does. The people making the decisions aren't front line staff who see what is happening every day. Not sure who to blame but the country is trying to get a litre out of a pint pot. The system is at capacity almost all of the time.
Mental Health in-patient services are far more squeezed. It is not uncommon to find 26 patients in 20 beds. How come you might ask. Well when an in-patient is given home leave, their bed space is filled in their absence. This results in a problem when the patient relapses during their leave period and needs to return to said hospital, as their space is no longer available. A bed must then be sought in another authority at vastly increased / inflated cost to the trust. This places pressure on the psychiatrists to discharge people or send on leave when they are still unwell, just to free up space. Try juggling 26 balls (lives) and the result will always end with disaster, not if, but when.
If we had not had the bloody olympics in 2012 at a cost of £9 billion and with a new build hospital costing approx £75 million then the NHS would have been in a much better position, but I guess it was more important to have the Olympic legacy (which has not materlised) & to watch synchronised swimming then build hospitals for our ever increasing population.
Mrs TT works for a large (for devon) doctor's surgery with, I think 15 GPs. This is a private company owned by the GPs but all staff are NHS employees.
I am not sure if there could be a better way to run such services as this clearly focuses their minds on efficiency but it also means that the role of the practice manager in a large part is searching NHS rules to maximise income and taking up the latest scheme to quit smoking or fight diabetes.
Just referencing my experiences last year with my mother, as I said, the whole of QM hospital has no doctor at weekends so my mother had to be blue lighted to QE to get emergency treatment.
When a patient in QE she spent a couple of hours waiting for an ambulance to take her to Lewisham to have blood taken! Yes really this is routine. On this particular occasion there were no staff at Lewisham to take the blood.
Mrs TT employs health care assistants in their practice to take blood. Why can't a full scale hospital?
There are constant shake ups of the system but the NHS is clearly in crisis and a complete rethink is required to make it work efficiently rather than yet another excercise to message figures to save money from one budget but ultimately cost lives and money.
Just my tuppence worth - these points may well have been covered already so apologies in advance.
Does the NHS waste money? - Yes, but that is almost inevitable based on its size. The key is minimising wastage.
Is the NHS chronically underfunded? Yes
Should the healthcare provision of the nation be in the public sector? - Yes - health, education and defence are the top priorities of any government.
Should other non-essential government spending be cut back? Yes (HS2 and Trident replacement are two examples).
Should income tax be raised to pay for further NHS funding? Yes for example 20% up to £40k - 40% £40k-£80k - 45% £80k-£120k - 50% above £120k. But we know it won't happen.
Should income tax be raised to pay for further NHS funding? Yes for example 20% up to £40k - 40% £40k-£80k - 45% £80k-£120k - 50% above £120k. But we know it won't happen.
A 50% tax rate on high incomes has been proven to raise less tax not more which is the reason it won't happen.
Should income tax be raised to pay for further NHS funding? Yes for example 20% up to £40k - 40% £40k-£80k - 45% £80k-£120k - 50% above £120k. But we know it won't happen.
A 50% tax rate on high incomes has been proven to raise less tax not more which is the reason it won't happen.
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That should get the head count down if don't have treat sick people if they can't afford the loaded premiums.
Now if only you had referred to the French or German systems, which are insurance based but under State control, I might have been a bit more supportive.
Oh and when it comes to "proper regulating" a privatised utility, we don't have a great record in that, do we? Gas, electricity, water, railways, telcos. Less savvy consumers ripped off on a daily basis, with only Martyn Lewis to help them.
However it's notable that US healthcare inflation has seemingly got out of control whereby the country spends 2x as much as Western Europe for roughly the same outcomes (again I would argue insufficient checks and balances in the relationships between doctors/drug companies, insurers/hospitals etc.).
Given all of that the last model of healthcare that needs to be looked at is the one you are espousing. It is more costly per head and leaves many without care at all.
@PragueAddick has mentioned both the French and German models. This will be the way to go.
The NHS as we knew it is on life support. It is systematically being run down ( I really believe that) so that when it fails enough people ( see JohnBoys post above) there will be little will to resist the leeches moving in to turn a profit.
The advice I have given my children and I give it freely to anyone who will listen is to get decent medical insurance.
Again I reiterate that when you remove the market's invisible hand from any goods or services then it will be misallocated. Even introducing a token cost for visiting a GP would at least reintroduce some modicum of a link between the cost of the service at its usage.
To use an analogy we are all familiar with, how often would you use Google search if it cost say 10p each time compared to its current free service? I think usage would fall by 95% yet 'essential' searches would still be conducted.
ps - Apologies if it read that I had suggested adopting the US model in full (which wasn't my intention), but there is so much negative press around their healthcare provision which simply did not resonate at all with my experience of it which was unequivocally positive.
Last year 18% of UK govt spending went on healthcare - look at your 2015/16 tax return, multiply the tax you paid by 18% and it will tell you how much you indirectly contributed. For a young couple earning £50k, this implies approx. £1700 which isn't much different from what they might pay in private health insurance - it doesn't strike me as a great allocation of resources.
I'm still not sure why a properly regulated mandatory but fully private health insurance system shouldn't work in the same way as it does for example with car insurance. However unlike car insurance (where one can simply choose not to own a car if they can't afford the premiums), government subsidies should ensure the very poorest are catered for.
It would also introduce (as already obviously exists with car insurance) incentives for people to exercise better life choices for which currently there are none, at least financial ones.
Whilst employers would pick up much of the burden as many do already (and should), the internet and the 'sharing economy' provide massive opportunities for self-employed or otherwise non-covered people to pool their risks and negotiate a better deal from insurers.
https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/health-care-spending-compared
As you know took the FIL to Lewisham A&E last night after waiting over 2hrs for an ambulance.
The NHS staff have been absolutely brilliant. However, as of the phone call from my wife at 3:30 the FIL is STILL in A&E as of now, as there are no beds available in the Adult 'majors' ward. He was in the corridor until 2 hours ago when he was moved to a side room.
So coming up to 24hrs when the ambulance was called and still hasnt been admitted properly. Wife/MIL are willing to take him private but cant until he has been admitted and has been properly diagnosed but still waiting for CT/MRI scans.
We left A&E at 6am. Shame the jobsworth parking attendant spoke to my wife so rudely when the ticket machine wouldnt take her £16 of pound coins. I suggest he doesnt ever introduce himself to her at any point as I think she''ll quarely punch him in the face. Absolute arsehole.
This comes 18 months after my 97yo Nan was rushed into hospital with a broken hip and was left lating on the floor for almost 3 hours waiting for an ambulance.
I'm lost for words really.
I don't understand why you insist on your desired insurance based system being fully private. (Well, I suppose it is idealogical). All the behavioural advantages you cite, can be obtained where the State - and thus, the citizens - remains the majority "shareholder" . Fully privatised, you know what shenanigans will take place, because as I have said, you need only look to the other utilities and how they run rings round their regulators, of course calling on the most expensive consultancies to assist them, because they can afford it. And the ultimate insult will be, that they will re-locate offshore, avoiding UK corporate tax and directorial accountability. Because that also is the way it goes in the UK.
Why not do it the German way? As with most other comparitive examples (such as the railways), it seems to work better.
My comments are not just based on personal experience, I've worked in Healthcare IT, my mum has been a physician for almost 30 years currently with Kaiser Permanente (one of the few bright spots in American healthcare), and my dad does consulting for hospitals which have gone bankrupt which exposed just how bad the system was before ObamaCare, and how bad it still is.
To go out another level, our healthcare outcomes are 37th best in the world, and the amount we spend overall and per capita is the highest (I think it's about 15% of GDP). It's a completely unsustainable system, and the largest problem is profit. And that's at every level, starting with insurers and pharmaceuticals, but it trickles down to hospitals, doctors, etc.
If I have time later, I'll find some statistics that aren't particular to me or off the top of my head.
If one looks at a small but important part of healthcare namely dentistry, then the sector is predominantly privately funded (whether by consumers directly or via insurance) and it seems to work perfectly well with the NHS as a back up for basic treatment.
http://www.ukpublicspending.co.uk/current_spending
NewYorkAddict, the notion of being in favor of privatization in general is one thing. I completely disagree with your assessment of the US system, but that's a separate conversation from the private vs. public sector debate. For me, anything that is part of the "backbone or crucial wellbeing" of a nation should be controlled by the public sector so that profit motive is not a part of it. As I mentioned, the largest problem within US healthcare remains the profit motive. I'll try and look now for some article and statistics to this effect, I don't expect you to respond directly to parts of my earlier post like "why is my premium specifically so high?!?!?!"
I would also add, as you mentioned, I have had a lot of very positive experiences and genuinely world class doctors and support staff within the US system. The care, particularly in large metropolises, can be excellent. My problems are with the payment structure and lack of oversight, which can make outcomes very poor and costs incredibly high.
You can also look at this from a Capitalistic perspective--healthy people who are healthy workers produce more, which is for the good of the Capitalist society. I believe you can also make a similar argument for transport (at least within a country like the UK), where getting people places is a crucial part of doing business, and without it, you risk the economy slowing down.
The US model is extreme of course (we were fortunate to have private insurance through work which cost multiples of your cover) and full of problems which you allude to, but no-one ever receives desperate fundraising requests for sick children to have lifesaving treatment in France or Germany.
We are now 35+ years into this notion of "I'm from the Government and I'm here to help" being "the worst thing you can hear," and yet that is patently untrue. There remain many public hospitals that are world class. Our university system is the best in the world. We remain excellent at R&D within that system, all of which is publicly funded, and much of which (particularly in tech and medicine) the private sectors benefits and profits from. The notion that the US government (or governments, at the state level) can't do things well is just simply wrong.
As for hospitals. I work in a busy A & E department. Earlier in the night the department was closed to ambulances as there were no bed spaces in the department (which means trolleys lined up side by side throughout the whole department) or main hospital.
Not sure what the answer is for healthcare in UK. Our department is going through its fourth reorganisation in 10 years. Every time they think it will solve the problem and it never does. The people making the decisions aren't front line staff who see what is happening every day. Not sure who to blame but the country is trying to get a litre out of a pint pot. The system is at capacity almost all of the time.
Mental Health in-patient services are far more squeezed. It is not uncommon to find 26 patients in 20 beds. How come you might ask. Well when an in-patient is given home leave, their bed space is filled in their absence. This results in a problem when the patient relapses during their leave period and needs to return to said hospital, as their space is no longer available. A bed must then be sought in another authority at vastly increased / inflated cost to the trust. This places pressure on the psychiatrists to discharge people or send on leave when they are still unwell, just to free up space. Try juggling 26 balls (lives) and the result will always end with disaster, not if, but when.
I am not sure if there could be a better way to run such services as this clearly focuses their minds on efficiency but it also means that the role of the practice manager in a large part is searching NHS rules to maximise income and taking up the latest scheme to quit smoking or fight diabetes.
Just referencing my experiences last year with my mother, as I said, the whole of QM hospital has no doctor at weekends so my mother had to be blue lighted to QE to get emergency treatment.
When a patient in QE she spent a couple of hours waiting for an ambulance to take her to Lewisham to have blood taken! Yes really this is routine. On this particular occasion there were no staff at Lewisham to take the blood.
Mrs TT employs health care assistants in their practice to take blood. Why can't a full scale hospital?
There are constant shake ups of the system but the NHS is clearly in crisis and a complete rethink is required to make it work efficiently rather than yet another excercise to message figures to save money from one budget but ultimately cost lives and money.
Does the NHS waste money? - Yes, but that is almost inevitable based on its size. The key is minimising wastage.
Is the NHS chronically underfunded? Yes
Should the healthcare provision of the nation be in the public sector? - Yes - health, education and defence are the top priorities of any government.
Should other non-essential government spending be cut back? Yes (HS2 and Trident replacement are two examples).
Should income tax be raised to pay for further NHS funding? Yes for example 20% up to £40k - 40% £40k-£80k - 45% £80k-£120k - 50% above £120k. But we know it won't happen.