[Closed] Crudely adjusted over to here. How much would U.S. style health care cost?

Oh,I mean cost by person/family. Not as a country.

Paid by Farage endorsed system. Insurance I mean.

Something tells me it would be a lot more than what youd pay via tax and I'm fairly certain your income tax wouldn't go down the whole way either!

https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/

You can already buy private healthcare over here. Get a quote?

Every time I hear farages name I think of the plane crash that nearly got him.

Some people will be able to afford, some won't.  That's why we should never let the NHS die. Even with its problems it's amazing.

I read that it was double the cost of UK treatment, in part due to it being privatised (and profitable) and also due to the insane amount of litigation that goes on.

I read that it was double the cost of UK treatment, in part due to it being privatised (and profitable) and also due to the insane amount of litigation that goes on.

It's at least 3 times more expensive on average in the US vs the UK

(Source: I do this for a living)

The US system is probably the worst value in the developed world

data

Conversely, the UK system is probably the best value.

Proponents of the US system always use the "more-is-better" argument, which is what patients think they want when it comes to healthcare..... but DEFINITELY what the private healthcare industry wants.

Also, when looking at the US system, you have to consider that only part of the population experiences that level of service. If you are uninsured, or have only very basic coverage, you have a very different experience indeed.

Culturally, a full-on private healthcare model would never work in the UK. I live in Australia at the moment, which has a hybrid public - private system..... it would never work in the UK.

Try as they might, it will never happen.

Even the most right wing, “it’s only bloody common sense” Daily Wail reading Tory voter will reach for the pitchfork.

Anyone stupid enough to try to take over and run the existing infrastructure commercial will be up against 1.5 million saboteurs.

Example (ok, dentistry)... Friend's wife in California went to the dentist for a check up, scale and polish and to have a filling re-done. Her quote was $3600. She's now registered at another dentist.

We already see dentists recommending extractions over fillings because they are cheaper and quicker, so how long before people either do not go to the dentist, or just have no teeth? Mind you, that would be just like back in Victorian times, which would fit the scene.

In Ireland the cost of basic private health insurance for a family of  4 is about €2,500 - €3,000 a year, a lot more if you want to cover certain scenarios.

You can already buy private healthcare over here. Get a quote?

That'll be very vague given it only cover certain care and not such things as acute illness or accidents.

Anyone got any experience of the German system? They're insurance based.

I'm 100% nhs btw

How much does it cost? Enough to financially cripple anyone who needs it?

@belfastflyer, the German system was a bit odd but seemed to work well. They have a public system like the NHS i believe and also private companies with a legal cap on how much they can charge. The private rates were about 10 - 12% of our monthly income if i remember rightly.

I thought health insurance was like most insurance. If you need it once you'll probably be OK, but after that the premiums will go up and/or you'll struggle to find cover.

As someone who has had a fair few health issues over that last few years, both acute and chronic, losing the NHS is one of my biggest fears.

Heard a story of a T1 diabetic lady who moved to the states, her Health insurance would only cover 1 type of insulin (there’s dozens, what works for one may not be good for another), the option was take it and make it work, or leave it.

I have cover via work for me and wife and it costs £1000 per year (from gross salary) and presumably the company is paying a bit on top of that. It is great when required and we have used it for operations quite a few times.
However, it clearly doesn't cover A&E, GPs etc,. so the cost is not a fair comparison.

A work colleague's daughter got an ear infection on holiday in Florida a couple of months back. The walk-in clinics had closed by the time it had got bad enough they figured it needed medical attention so took her to the nearest hospital. They wouldn't even discuss treatment until the insurer (luckily they had some) had faxed them confirmation they'd cover the costs. Ended up at over $2000, for a couple of hours in the hospital and some antibiotics.

How does the US system work in emergencies. Lets say you have a heart attack in the street, an ambulance is called, you get taken to hospital and arrive unconscious. Do they just treat you and worry about the bill later? Or do they try and find out your name and details so they can find the insurance first?

Scroll down the the unexpectedly high vet bill thread to see the effect of insurance on cost.

U.S. style health care

Depends what you mean by that - do you mean a system where those in good jobs for good employers are covered and anyone else is screwed? Do you mean a system where the quality of care is openly and directly linked to your ability to pay? Do you mean a healthcare system driven by reimbursement codes to the extent that people get tests they dont need (because the doc gets paid) and dont get ones that might be useful (because the doc isn't incentivised to even look at them) or that is so influenced by pharma that they have huge opiod addiction problems initially driven through prescribed meds. Or just that there's a 'copayment' so if you get knocked off your bike rather than seeking medical help for your concussion you put it off to save a few hundred pounds and then potentially end up with worse issues?

Oh,I mean cost by person/family. Not as a country.

Thats not really how most US healthcare works. In reality most provision is made by employers. Generally the bigger and better your employer, and possibly the level of job you have, the better your cover. Often this is extended to family members. Those policies are only affordable to "individuals" because they are heavily subsidised by employers, and tax incentivised.

Now, I think I saw figures that said 25% of people in the UK are employed by the state, or by agencies directly providing services to the state. (so Teachers, NHS, Police, G4S doing prison work, SITA doing bin lorries etc). As I understand the US system the state healthcare policies are some of the most coveted (the more people in the policy, the more you can share the risk/cost so the more outliers you can accommodate without pushing up the price per individual too much). Not lets say 33% of the population are effectively state employees or family members of them, who is paying for that?

You can already buy private healthcare over here. Get a quote?

Not "US style" healthcare you can't. What you can buy here is a "luxury top up package" for the NHS that lets you possibly use a nicer hospital, skip some queues, get some tests that might normally be done at that stage etc. Basic keeping you alive, accident, serious illness, chronic disease stuff, even maternity is not included in standard UK private healthcare cover. Is this why people seem to think it would be good? Because its not that expensive?

Let’s face it, the NHS is on borrowed time now.

If it is true, you wouldn't model it on the US system. There are two different parts: how it is funded (the Payer in healthcare speak), and how it is delivered (the hospitals, doctors etc). The US model for both of those is neither fair nor efficient.

How does the US system work in emergencies. Lets say you have a heart attack in the street, an ambulance is called, you get taken to hospital and arrive unconscious. Do they just treat you and worry about the bill later? Or do they try and find out your name and details so they can find the insurance first?

They are worrying about getting paid from the start (and that means from the moment an ambulance is dispatched). They wont delay life saving treatment to obtain payment information (so you'd still get an ambulance, youd still get defibrilated if required, youd still get life saving drugs). What happens next all depends on where you end up, what your cover is etc.
https://www.helpmewithmyhealthcarebills.com/ambulance-coverage/

Thats right - even if you had a heart attack you might be getting a bill for an ambulance ride. That ambulance might have taken you to a hospital that your insurer doesn't have a "network contract with" whilst you were unconscious, and you get the bill for that, and after all of that is taken care of you might still have 20% to pay (if you need a stent that would be a 20% of a $100,000 bill), unless you were financially comfortable enough to pay for the top level of cover (which will still see you paying several hundred).

I was chatting to a couple of US hospital doctors and asked if they were better paid than in the NHS. They claimed they weren't and that the biggest winners were the insurance companies. I read somewhere bureaucracy costs in the NHS are very low.

How does the US system work in emergencies. Lets say you have a heart attack in the street, an ambulance is called, you get taken to hospital and arrive unconscious. Do they just treat you and worry about the bill later? Or do they try and find out your name and details so they can find the insurance first?

They treat you, then you go bankrupt: "A new study from academic researchers found that 66.5 percent of all bankruptcies were tied to medical issues —either because of high costs for care or time out of work. An estimated 530,000 families turn to bankruptcy each year because of medical issues and bills, the research found." - https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most-americans-file-for-bankruptcy.html

You can already buy private healthcare over here. Get a quote?

UK private healthcare is a top-up for certain things, that's why it's so cheap. Everything else is still NHS.

The most important thing to remember about the US system is that even if you have insurance it's still limited. You will be insured up to a certain amount, then you have to pay anyway. People try to keep costs down by not going to the doctor for small issues and as we know, sometimes small issues become big or fatal ones when they aren't caught early.

My in laws were just over, we chatted about this. MiL had an annual checkup mandated by the insurance company (because it's looking after it's insured property) which is fair enough. The doctor asked her about known issues, and then he asked if there was anything else. If she'd talked about a new issue, then that would have led to a new consultation which would have cost something like $500 out of pocket because it's not covered under the existing checkup and consultations cost money.

FiL has a number of issues he wants looked at. Each treatment incurs an excess of a few thousand $, however the total excess you can pay is capped per year, so he's saving up all his issues to get them treated in a single year to save on the excess.

A friend having severe mental health issues was sectioned by the state for a week against the advice of her psychiatrist. Because of this the insurance company wouldn't pay so she had to pay for herself to be sectioned to stop her committing suicide.

It is absolutely shocking how incredibly ****ed up their system is. It's beyond belief. It's not just expensive because it's profit driven, it also has to employ armies of lawyers to argue with people who are being screwed out of treatment to keep costs down. It has to pay for [i]advertising[/i] for ****'s sake.

An estimated 530,000 families turn to bankruptcy each year because of medical issues and bills, the research found.

And that's not counting the ones who can never have family holidays, who can't move house to a safe neighbourhood or closer to a good job etc etc. They are forced into poverty along with all the trouble and stress that goes with it just for being ill.

The UK Private Healthcare business only exists in its current form because we have the NHS.

The Doctors it employs are trained by the NHS and many supplement their NHS income in private clinics rather than exclusively operate as private Doctors.

Also, most private hospital rely on the NHS as to underpin their operations. If you had a severe problem during a private procedure, beyond immediate resus/stabilisation, you would need to be transferred to an NHS Hospital for treatment.

As mentioned, there is no private A&E, critical care etc.

Apparantly, the average Private Healthcare premium is £1,500 in the UK and >$4,000 in the US.

THere are lots of factors affecting why per capita Healthcare spend is higher in the US. However, if you wanted to have an NHS equivelant Health Service in the UK but funded by Private insurance companies I think the annual premiums would eclipse those paid in the US. More like tens of thousands £ per annum.

I don't think anyone would hold up the US system as being a good way to run healthcare compared to any of the European Countries (I like the French system best - it allows you to meaningfully top up.)

However, in their defence, according to the link above the USA *state* spends over 8pc of GPD on Healthcare for elderly, young and disable people (Medicare and Medicaid), in contrast most European countries (including the UK) spend around 10pc. So their state spending isn't far behind us.

Also well paid Medical Staff are a one of the causes of the high prices the USA face. We deal with that problem in the Uk by having a monopoly provider who can really squeeze staff salaries, but that in itself isn't universally popular. (The US pays $100 billion a year in doctor salaries alone - $700 per person and they have the 3rd best paid nurses on the planet - the UK isn't even in the top 10. If we rewarded our medical staff appropriately the NHS wouldn't look so cheap.)

That's my defence of the USA over. Certainly it's pretty dire so if we want to make comparisons we should avoid the USA.

I was chatting to a couple of US hospital doctors and asked if they were better paid than in the NHS. They claimed they weren’t and that the biggest winners were the insurance companies. I read somewhere bureaucracy costs in the NHS are very low.

Don't know about Doctors, but my Wife is a Specialist Nurse, She'll be earning £38k a year when she reaches the top of her banding next year. Equivalent roles in the US pay £52k - £68k, it's not that simple as we currently pay 9.3% for her pension and more income tax her, but equally they only offer 5 days paid holiday a year, which you also need to use for sickness if you want to be paid at least.

Either way, She wouldn't take it, she was offered a big pay hike to work in place they asses people to be 'fit to work', the idea disgusted her.

Have friends in Portland, OR, Their family is made up of 2 adults, 2 kids who are 9 & 11. $1100 per month for the family.

Visiting a GP is a proper ball-ache with appointments booked out months in advance. You get 10 minutes precisely to discuss you ailments. Molgrips comments about only being able to discuss one ailment ring true.

Eldest daughter has had a series of operations in the last couple of years to fix a torn cruciate and then re-fix it again when it failed. There was a tirade of expletives when we discussed what had happened to her premiums after that. She also subsequently ended up with mental health issues as a result of being in pain for nearly two years. That really helped things.

It sounds utterly crap. Almost inhuman.

Anyone got any experience of the German system? They’re insurance based.

Me. Needless to say its expensive and the quality of care/hospital varies greatly (private institutions). Far from perfect.

I can you give you a break down or costs later.

Roughly speaking the U.K. spends 6.5% ish of GDP on healthcare

In the US it’s 13%

The U.K. healthcare budget is approx 120bn, so very roughly we’d need an extra £120bn to run the American model

That’s an extra £2000 from every U.K. citizen, every year.

Disclaimer- above GDP figures are from memory. The Kings fund usually has up to date stats.

When I lived there it was about $500 per month with an 80:20 co-pay (you pay 20%, they pay 80%), a $500 deductible (first bit you pay before they pay) and an annual out of pocket cap of $1500 (max amount my 20% would come to). This was a work subsidised program (so the actual monthly would be higher if you’re and individual) and acknowledged that I had workers comp (hurt at work they cover it). I had good coverage (multi-supplier and out of state allowed). Oh and it was about 15 years ago, so imagine it is more now!
If want cheaper monthly payment then go 70:30 or even 60:40, don’t have a cap and have a large deductible, but accept the risk of big bills if you’re ill. Maternity is more - an add on for 6m before you can get pregnant - friends had a 70:30 policy with no cap, difficult birth with child in nicu, overall cost was $140k, so you do the math on their contribution.
So it is V expensive, far more than tax. Also (as a vet), people need to realise that healthcare is expensive. You want a CT scan it might cost £500-1000 but the scanner cost over a million and it needs to be paid for in a business oriented healthcare model. In veterinary corporatisation further worsens this as profits don’t just provide owner income and future investment, they must satisfy shareholders. Human healthcare in the USA is this on a massive scale, so beware and protect the NHS as it is genuinely the best.

I was chatting to a couple of US hospital doctors and asked if they were better paid than in the NHS. They claimed they weren’t and that the biggest winners were the insurance companies. I read somewhere bureaucracy costs in the NHS are very low.

Nonsense. I suspect they just don't know how little we (UK doctors) get paid by comparison.

In the USA:
Average primary care doctor $223,000
Average physician $329,000
Average cardiologist salary $423,000
Average plastic surgeon salary $501,000

Source: https://www.thestreet.com/personal-finance/how-much-do-doctors-make-14779617

You can Google NHS salaries but an NHS consultant salary starts at £77,000 up to £105,000. It doesn't matter whether you're a plastic surgeon or whatever. However, most consultants currently work extra hours and according to the Telegraph, the average consultant salary is £127,683 which I suppose is the most comparable figure to the numbers above. Crudely adjusted that would be ~ $157,000 US.

Source: https://www.telegraph.co.uk/news/2018/02/16/doctor-earns-740000-year-nhs-gender-gap-revealed/

My sister-in-law is an Emergency Trauma Nurse in Detroit and when I was a student I managed to arrange a placement to work with her over there, so have seen how the costs stack up (and the workload place on staff just accounting for it) in the US. Long story short, the costs vary massively dependant upon reason for admission, if it's an emergency or planned admission, who your HMO is, who the hospital provider is and which state you are in. Overall though it's all significantly more expensive than the UK, shockingly so in some instances.

For instance, if you are unlucky enough to require admission to an ITU (where I work) with Sepsis a rough ballpark figure per day, bed alone, is $4k-$8k. Admission day costs for an ITU pt at the Henry Ford Hospital in Detroit were (back in 2011) approximately $40k, with subsequent days falling to about $24k. If you are unfortunate enough to require CRRT (dialysis) that starts at $2.4k per day, plus the costs of consumables.

To give you an idea of how expensive even seemingly minor item are (after all, you have to pay for everything during your stay) a 'urinary hygiene kit' (urine bottle/bed pan) is about $37.

I did a rough calculation earlier and if the pt I'm looking after today was a pt at the Henry Ford in Detroit they would already have racked up a bill of more than $180k after 6 days. Whilst that may be covered by insurance, as a poorly-controlled Type 2 Diabetic with a history of cardiac problems, they may not be able to afford insurance.

As for the high costs in the US being down to high staff wages, this isn't a given. The average wages of hospital staff vary hugely depending upon which state the staff live in, with wages in Florida, California and the NE states being generally among the highest, with wages in southern states and the midwest being among the lowest. The high cost of healthcare in the US is driven more by excessive amounts of 'middlemen' (HMOs, pharmaceutical companies, specialist services) and liability insurance.

Don't get me wrong though, the US healthcare system if fantastic, but only if you can afford it. The NHS may have its faults but when you turn up in ED we're not bothered about how much money you have. If we were to lose the NHS it would be a travesty and a huge amount of the population would likely find themselves priced out of any alternatives.

Comparing the US to the UK is to compare two extremes and unhelpful. A better comparison is between similar EU countries. The fact is you get what you pay for, and we are not paying enough in the UK for our nation's health.

That’s why we should never let the NHS die. Even with its problems it’s amazing.

I understand the sentiment, but the NHS is not amazing, it is barely adequate, even compared with other EU countries. It is clear that other funding systems are needed, but the hard truth is that we need to pay more for our health and have been unwilling to do so largely since its inception. Whether that is through taxation or compulsory insurance (as in say the Netherlands), society will need to decide.

Simple thing such as access to GPs, oral and eye care, routine health prevention are pretty woeful. We have the lowest ratio of doctors to patients, borrow workers from anywhere and generally make do.

The fact is you get what you pay for, and we are not paying enough in the UK for our nation’s health.

The problem is that it's badly managed and there's no point in throwing endless money at it.

Simple thing such as access to GPs, oral and eye care, routine health prevention are pretty woeful. We have the lowest ratio of doctors to patients, borrow workers from anywhere and generally make do.

Very much agreed.

Edit: can we stop GP practices being businesses, there's nothing fair in being denied healthcare due to Partners treating you as a non-profitable patient.

Don’t get me wrong though, the US healthcare system if fantastic, but only if you can afford it.

I remember a discussion with someone where they were claiming that the US system must be better value, because it was the private sector so it had to be. When they saw the price comparison between the NHS* and the US they maintained that despite being in some cases an order of magnitude more expensive, it was still more efficient and therefore better for the patient because the "market forces" meant that healthcare must be being delivered efficiently and any price difference was due to profit. I tried to point out that most people probably don't care how much profit the hospital or insurance company made on treating their kid's cancer, they probably just wanted them treated, but he wasn't having any of it!

*You can see here: https://improvement.nhs.uk/resources/reference-costs/#rc1718 (in the national schedule of reference costs.xlsx) how much it costs to provide any kind of healthcare in the NHS, on average. e.g. The average cost of an adult critical care day is £1415.
Average cost of an elective "EY08E - Implantation of Single-Chamber Pacemaker" is £2531.

Edit: to compare to this

if you need a stent that would be a 20% of a $100,000 bill

YR15B - Percutaneous Transluminal Angioplasty with Insertion of Single Metal Stent into Peripheral Blood Vessel, with CC Score 3-5
Average NHS cost: £2818

Cinnamon-girl

there’s no point in throwing endless money at it.

We have the lowest ratio of doctors to patients, borrow workers from anywhere and generally make do.

We can either have more doctors (and have to pay them) and not have to 'make do'. Or we can spend less money on the NHS and have fewer doctors and nurses, worse facilities, longer waiting times etc etc.

I agree that there is a workforce crisis in the NHS, but without the money to fix it how is anyone expected to train, recruit and retain clinical staff? You're blaming the NHS for the governments spending choices.

Agree with the GP comment though, individual practices seem to be able to get away with really restrictive rules on getting an appointment.

I understand the sentiment, but the NHS is not amazing, it is barely adequate,

For me that's the key advantage to doing it all privately. My experience of the NHS has been broadly very good so I'm happy with what I'm currently paying. You're not. There's nothing either of us can do about it beyond writing to our MP and whining on the internet.

If it was private I'd be able to stay with my current provider and you'd be able to pay a bit extra for a better package. Nobody complains online that the Apples they buy are crap due to underfunding - they just quietly swap to a better apple provider.

For me that’s the key advantage to doing it all privately...

If it was private I’d be able to stay with my current provider and you’d be able to pay a bit extra for a better package. Nobody complains online that the Apples they buy are crap due to underfunding – they just quietly swap to a better apple provider.

We can either have more doctors (and have to pay them) and not have to ‘make do’. Or we can spend less money on the NHS and have fewer doctors and nurses, worse facilities, longer waiting times etc etc.

I agree that there is a workforce crisis in the NHS, but without the money to fix it how is anyone expected to train, recruit and retain clinical staff? You’re blaming the NHS for the governments spending choices.

The UK is one of the most corrupt countries in the world and without doubt the NHS has been engineered to be in its current state. There's mega bucks to be made from healthcare and it starts with those politicians and those in the House of Lords who are pharma shareholders. Also let's not forget those in the higher echelons of the NHS.

I don't know what is the selection process for doctor training in the UK and how the numbers are decided/forward planning. It seems to me that the UK is not willing to invest in training, instead preferring trainees to saddle themselves with huge debt. But of course there is the most ridiculous situation where other, usually poorer, countries lose their doctors due to the UK being more attractive. All that investment in doctors has been lost, that is a tragedy and, imo, morally reprehensible of the UK to encourage this. This is not racism to be clear, it's stealing doctors from countries who can least afford to lose their investment.

Adding to the mix is the high profile cases of doctors such as Chris Day, Edwin Jusudason etc who've resorted to crowd funding to enable them to defend spurious allegations made by the DHSC etc. Hardly encouraging is it?

To summarise (sorry have gone on a bit and still have more to say!) is first and foremost stop the corruption at the top.

My real point is that we seem to be grateful for the NHS. Despite paying for it. I would be happy with a private system with compulsion - insurers don’t get to choose who they insure. I’m also happy with modest profits in the sector. Health is a commodity, and an important one.

What the US and UK systems have shown is that neither work. The UK probably slide to funding not management. The US due to cost and unwillingness to provide universality.

Other countries have better options that fall in the middle. But the truth is, when Tony Blair announced we would be above the median for EU health spending, he had no idea how much below it we were!

BTW in answer to CG, the NHS has excellent management and probably needs more of it. But the truth is, there isn’t enough resource to manage. I’d want it run by people like Asda who know how to manage resource and logistics, but set a modest profit at say 1% above RPI.

I would be happy with a private system with compulsion – insurers don’t get to choose who they insure.

But high risk patients attract higher premiums, and as there is a correlation between poverty and poor health those high premiums become a means to 'choose' who they insure, ie; the poor and ill get excluded by circumstances.

If it was private I’d be able to stay with my current provider and you’d be able to pay a bit extra for a better package.

Or the opposite is true: you are a bit hard up so you choose worse cover cos it's cheaper. Then you get worse or more limited treatment cos you're poor.

The UK is one of the most corrupt countries in the world

That's a very first-world thing to say!

But high risk patients attract higher premiums, and as there is a correlation between poverty and poor health those high premiums become a means to ‘choose’ who they insure, ie; the poor and ill get excluded by circumstances.

The key downside of course being that poor people die because they can’t afford insulin.

Even the USA which we all agree is the worst health system in the developed world the poor, disabled, old and young are covered by the state. (To the tune of 8pc of GDP whereas the UK pay ~10pc for the entire population.)

...but it has to change. So many people complain about the way the state funds the NHS and the problem's going to get worse because health inflation is higher than 'normal' inflation so sooner or later to keep pace you have to pay 100pc of GDP on healthcare. That's not workable.

None of us complain that on social media that the state doesn't invest enough in food because we don't let the state fund and manage our food. We deal with it ourselves and we get the food we want. Health care is every bit as important as food.

We have this mental situation where people don't like the way the government run and fund healthcare, but are also adamant the government must to run and fund healthcare. If Matt Hancock and Boris set up a car insurance company I wonder how well it would be run? And yet these people are deemed the perfect people to be organising healthcare?

I'd go for the French system. The state pays out a flat rate and people top up according to their own preference. Stops all complaining over night.

Or the opposite is true: you are a bit hard up so you choose worse cover cos it’s cheaper. Then you get worse or more limited treatment cos you’re poor.

Whereas currently *everyone* gets crap treatment. (Or says they do - my treatment has been great.)

Or the opposite is true: you are a bit hard up so you choose worse cover cos it’s cheaper.

Which isn't an option I'd have if my healthcare money is being taken out of my taxes. I think I know more about my priorities than Sanjiv David.

The problem is that it’s badly managed

No, the problem is mostly that it's under managed. In that it hasn't got nearly enough decent management and of course people's illness are changing and it takes a while to adapt to that, The NHS is very good (one of the best) at acute care, and pretty good (in Europe) of treating disease. What it's bad at (and it's not alone in that) is treating people who have multiple issues that make them poorly but not "seriously" ill. Like overweight, diabetes, and the issues arising from those problems. We treat many folk like that but we don't often cure them. In some of my practices 50% of our pts appts are with folk who are diabetic or low/depressed (often they're the same people)

Agree with the GP comment though, individual practices seem to be able to get away with really restrictive rules on getting an appointment.

There is a huge shortage of GPs, and in the short term due to retirement and immigration restrictions it will only get worse. I don't know any GP practice that wouldn't give more appts if they had the clinicians to staff the sessions.

Which isn’t an option I’d have if my healthcare money is being taken out of my taxes. I think I know more about my priorities than Sanjiv David.

In the US model you can choose worse cover, if it's a low priority for you, but it's so much more complicated than this. If you are under pressure you cut your cover and simply hope that nothing goes wrong. Often this is family cover, so the fact that a parent can't make enough money means the children go without cover.

But it's not as simple as cover or not. You may have insurance, but it still costs you to go to the doctor. So, when you are struggling to pay your bills, you don't go to the doctor to check out that stomach pain, then six months later you're dying of bowel cancer and your family is now single parent without support.

Healthcare should not be down to your personal choice because you should always have whatever healthcare you need. And taxation isn't the same as insurance in practice or principle. We fund the government, and the government funds the country. So yes, my tax money goes to pay benefits for people out of work, and healthcare for people who've never paid more than a few hundred quid in tax, and that's good.

Tomhoward

Subscriber

Heard a story of a T1 diabetic lady who moved to the states, her Health insurance would only cover 1 type of insulin (there’s dozens, what works for one may not be good for another), the option was take it and make it work, or leave it.

Another one I heard- another diabetic was recommended to do a blood test with each meal, and before driving- pretty standard advice. Their insurers said that's ridiculous, you only need to do one test per day, and refused to pay out for any more.

The really disgusting thing about that, is that mistreatment of diabetes today, causes massively more health issues in the long term. Spending money on blood testing strips is cheaper than spending money on retinopathy, kidney damage, heart disease... But it's not in a healthcare provider's interest to do the cheap thing. It's in their interest to do the thing that means you have to pay more for longer to not die.

And after the new orleans flooding, there were a load of stories about diabetics left without medication. That was entirely because the cheap insulins are less stable and durable, so they get damaged quickly by heat. The insulin I use, which is about twice as expensive but way better, doesn't fail as quickly. So it was the poorest people who got screwed twice.

When I got my fractured hip replaced, they used a technique that's expensive, and that requires a lot of physio to make it worthwhile, because you can regain almost full function of the leg. If I'd been in teh states on standard health insurance, they'd have done a half-hip replacement, which is cheaper to do and way way cheaper to do the recovery for, because there's no point in spending dozens of hours on rehab.

And so on. Replacing the NHS with US-style private healthcare would kill people, more people than any serial killer or mass shooter could dream of. We should treat people who try to do it like we would any other attempted killer, and stop them by any means necessary in self defence and to protect other people who can't do it themselves.

How does the US system work in emergencies. Lets say you have a heart attack in the street, an ambulance is called, you get taken to hospital and arrive unconscious. Do they just treat you and worry about the bill later? Or do they try and find out your name and details so they can find the insurance first?

https://www.theatlantic.com/health/archive/2019/08/medical-bill-debt-collection/596914/

Also the US, folk aren't blind to the fact they can see how healthcare is run in Europe and many states (remember that in reality it is State provision, there isn't really a US-wide program) are changing the way that people can access healthcare. with programs like Medicaid/care and CHIP being given wider and wider enrolment access. In reality the US is coming towards a mixed (state with private top up) provision rather than further towards a more heavily biased Insurance provision.

Most Americans realise that their system; while providing world beating care for those who can afford it, is otherwise broken and not fit for purpose, the US healthcare corporates that I've dealt with who operate in the UK are v keen NOT to have to replicate that in the UK.

There is a huge shortage of GPs, and in the short term due to retirement and immigration restrictions it will only get worse. I don’t know any GP practice that wouldn’t give more appts if they had the clinicians to staff the sessions.

Both the NHS and private sector in the UK are in trouble due to a chronic lack of staff. The impact on safety and waiting times is substantial and many hospital and community providers are really struggling. Social care staffing is even worse with no care available in people’s homes in some places. This is a result of over optimistic workforce planning for the capacity needed despite an ageing and increasingly complex population with high expectations. It’s only just being addressed. Whichever funding and delivery model you’d choose won’t solve this.

The NHS is independently recognised to be one of the most efficient healthcare models and performs very well for most outcomes. It’s certainly not perfect but we should be very wary of wholesale deconstruction based on over-simplified analysis of other countries funding systems or worse, political ideology - all of which have caused mayhem for staff and patients in the NHS over the years and rarely achieved what was promised eg the internal market.

However, something does need to be done to help manage demand and funding. My view, which is reasonably well informed having spent 30 years as a clinician, an Executive and currently acting CEO of an NHS trust, is there is an argument for testing a targeted and gradual expansion of small charges to eg GP appointments and A&E attendances (for minor not major conditions) which would help manage demand, subsequent unnecessary investigations and interventions for minor and self-limiting conditions, free up capacity to improve access when really needed and a help with bit of additional resource. It’s not a politically popular option so I’m not optimistic we will ever see it; politicians tend to prefer grand schemes with populist appeal.

Meanwhile, do spare a thought for NHS staff at present; from cleaner to surgeon we are working unbelievably hard to keep a very, very short-staffed system going.

small charges to eg GP appointments and A&E attendances (for minor not major conditions) which would help manage demand,

I’ve been of this opinion for some time. You could call it a ‘national insurance excess charge’. Let’s face it, if contents insurance paid out without question no matter how small or petty the claim, and no matter how the insured property was lost or damaged, no one would be able to afford the premiums after a while. The charge needs to be just enough to make people feel invested in the process; not an onerous amount. For an ambulance for example, double the cost of an Uber would be more than enough...

I worked with someone...

perhaps your friend needed to change her GP to one nearer her work? but yeah any GP that can't give you an appt. in a couple weeks time is pretty rubbish.

there is an argument for testing a targeted and gradual expansion of small charges to eg GP appointments and A&E attendances

While I sort of agree with you about charging for this sort of appt, 2 issues; 1. who will administer the charging/collection of fees..? And 2 It may put off people attending.

perhaps your friend needed to change her GP to one nearer her work? but yeah any GP that can’t give you an appt. in a couple weeks time is pretty rubbish.

Not an option. You take the GP that you live in the catchment area for. I moved to Leeds but still worked in Harrogate, didn’t tell the gp I’d moved as it was more convenient to see them whilst at work. I accidentally let slip that I’d moved during a trip to a minor injuries unit, within 30 mins of doing so the gp had rung to say I had 30 days to find a new one...

is there is an argument for testing a targeted and gradual expansion of small charges to eg GP appointments and A&E attendances

Not bloody likely. As someone who has no alternative but to fund and manage two health conditions (one life-long) I strongly object to being asked to pay as the NHS continues its dereliction of duty with my health. Additionally, I've been blocked by my GP Practice from accessing any NHS consultants and this is clear discrimination.

I think the best value is the yearly NHS card prescription card. Amazing value for my regular meds. I had to buy a private prescription once and it was about 60 pounds for 1 item for a month.

A lot of this seems to be based on the current situation. Maybe we need to think what if...

What happens in five or ten years time when genetic screening starts to make insurance unaffordable to some? What would people feel if their health care insurer starts dictating what you can or can't do with your life? Be a strange world where mountain bikers are seen as a risk and so have to pay more. Or you have to pay more because you live in a certain area.

We just need to start investing in the NHS; accepting that the good times have rolled and we really need to start see taxation as an investment. Spreading the burden across society. On the other side there is an onus on the public sector to work as efficiently as possible whilst maintaining social responsibility. Not here to make a profit but not here to squander the money - it's a finite resources thing.

It may put off people attending.

Some people NEED to be put off; at least until they’ve engaged their brain. A bit of personal responsibility for their health would do some people a lot of good.

Not an option. You take the GP that you live in the catchment area for.

There's nothing in any of the the GP contracts that prevents any GP registering any patient from any address. They may restrict it to certain postcodes for things like home visits, but they don't need to necessarily. The CCG may have a policy about it if you fall out of their catchment area, but there are even reciprocal agreements to deal with that

v8ninety

...Some people NEED to be put off; at least until they’ve engaged their brain....

I read that as you saying the NHS should discriminate against thick people.

Surely not?

Some people NEED to be put off

Yep probably, but Sod's law will say that those folk will manage to pay up, and granny who's maybe very poorly will be put off. I think in general, any system that gets in the way of, or is designed to prevent people accessing healthcare is probably not a good idea. Personal I think Heathcare (in general) needs to get a bit more interventionist.

I read that as you saying the NHS should discriminate against thick people.

I don’t think ‘thick’ is a protected characteristic, and obviously there could be exemptions for certain categories of people.

Seriously; People should have some personal investment in their health care. A good analogy would be a national car insurance scheme; you’d need a significant excess and strict terms and conditions to stop people upping the national premiums by claiming for every little scuff repaired from the nations purse. And car mechanics are a LOT cheaper than GPs.

Seeing your GP, visiting ED, calling an ambulance. It’s all just making a claim on your national insurance. Why shouldn’t there be a fair use excess payable? It’s a lot more palatable and socially just than the private sector model, that’s for sure.

and granny who’s maybe very poorly will be put off.

This is a much trotted our trope, that could be avoided by waiving the charge for anyone who claims a state pension, and also, It happens anyway. In my sphere of experience, I’ve lost count of the number of old dears who ‘didn’t want to bother you dear’ with their stonking MI (heart attack), whilst simultaneously ambulances are attending 20 and 30 something people who’s RIGHT it is to have a free ride to hospital with their sniffles because ‘I pay your wages innit!?!’

Something has GOT to give.

Charging distances those that can not pay from the healthcare they need. Entitled ****s will just behave more like entitled ****s if they have paid a small (in relation to the actual costs or provision) fee for the ride or consultation.

This is a much trotted our trope

And are  amongst the most vulnerable folk in the community, I think that you're right, there would need to be waivers

Whilst simultaneously ambulances are attending 20 and 30 something people who’s RIGHT it is to have a free ride to hospital with their sniffles because ‘I pay your wages innit!?!’

Touche...This is a much trotted out Sun headline that's about as accurate as most Sun headlines... 🙂

This is a much trotted out Sun headline that’s about as accurate as most Sun headlines

You know what though; a broken clock is right twice a day. And this one happens. Lots. I’ve got the T-shirt.

Charging distances those that can not pay from the healthcare they need.

You know, I’d generally agree (and I cannot BELIEVE that I’m actually advocating point of care charging, given my political persuasions) but honestly, societally, many peoples attitudes have changed. No longer is universal access to healthcare seen as the massive and amazing privilege that it really is by many, rather it’s a right to be squandered without a thought. It would be interesting to hear from the GPs who frequent this place about how many appointments would be freed up if we could just persuade people to engage their brain and maybe seek more appropriate help than they currently do. The NHS is creaking at the seams At the point of access and it’s because it is massively taken for granted, and chronically (ideologically) underfunded.

Saw an article somewhere recently that a certain tablet that costs 3 quid here, costs something like 900 dollars EACH in the States. Thats a pretty massive jump.

Thats the problem. Becuase US healthcare is so lucrative there's 10 hospitals per city, as opposed to maybe a couple here. I can't see our hospital numbers going up drastically, so the profit comes in the costs of the treatments.

Many people in the US get it with their job. However.... Say you're diagnosed with diabetes. You want to get a new job but Your potential new employer may not cover your condition.

Your now potentially stuck in that job for life and your employer knows it....