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The envy of the world

Every time there is even a semi-serious debate in this country about the provision of health care and reform of the NHS, the reactionaries cry ‘Do we want to be like America?’. It is the British equivalent of ‘Do you want Farmer Jones back?’.

Well, do want to be like America?

Patients who have major operations on the National Health Service are four times more likely to die than Americans undergoing such surgery, according to a new study.

The difference in mortality rates was blamed on long NHS waiting lists, a shortage of specialists and competition for intensive care beds.

One of these fine days, that plaintive, theatrical and bogus rhetorical bleat is going to result in a resounding ‘yes’.

49 comments to The envy of the world

  • Cydonia

    “plaintiff” ?

    You’ve been a lawyer for too long 🙂

  • Ted Schuerzinger

    Could you explain the Farmer Jones reference for those of us on the wrong side of the pond?

  • John Thacker

    I assume it’s a reference to George Orwell’s Animal Farm.

  • Dave O'Neill

    Interestingly I was out for dinner with a bunch of Americans, in America last night who don’t have medical cover and were terrified about it.

    I keep hearing from some people online that everybody can be looked after in the US and then I meet people out here who say the complete opposite.

  • Sandy P.

    Why don’t they have med coverage?

    How old were they? what do they do?

    Need more specs before can theorize, thanks!

  • Vicky

    Everyone can go to the hospital and be treated for emergencies. I work for a OB/GYN dept at a big university and we see quite a few people without any coverage (mainly illegals immigrants). So those people may not be able to go to the dermatologist to take care of their acne but they can receive emergency care if they needed it.

  • Susan

    Dave: Please explain something to me. What’s the difference between:

    1.) Having guaranteed medical care on paper, but which you can’t use because it is being rationed by the state (long waiting lists, “non-essential” operations denied, etc.)?

    2.) Not having medical care because you can’t afford medical insurance??

    In both cases the patient is not really covered by medical insurance. It’s just that 1) doesn’t admit it.

  • Texas

    In the US, individuals who have no insurance coverage can and will be treated by the county hospitals. These hospitals handle the indigent and non-insured who can’t afford treatment. For serious injuries or trauma, they are some of the best hospitals one can go to. The care is generally excellent. For general preventative or on-going health problems, not so great because of the large numbers of people needing care but they do receive treatment and medicines at minimal cost. Comparable or less than what those with insurance pay. For the average middle or working class person who may have found themselves without insurance for whatever reason, these hospitals can seem overwhelming and a bit frightening because of the underclass population and illegals that utilize them. They essentially are the safety net. All hospitals however, are not allowed to turn away critical patients. They can and will be sued if the patient dies because of it.

  • ernest young


    What do you mean, ‘one of these fine days’, here and now the answer is, ‘yes, yes, yes.’

    First, let me make my claim to being in a position to offer an opinion on this very subject, no I am not a doctor, but a patient.

    I have had treatment on both the NHS, the Private sector in UK, and in the US. Everything from minor stuff like a hernia (3), to kidney stones (5), hip replacements (2), and a five-way open heart by-pass procedure. For some, I had insurance and for some I had to pay.

    The best treatment; private in the UK, but fifteen years ago, and the fees paid by PPP. The worst treatment; the NHS in 2001, with a ‘bribe’ paid to the consultant to get on the NHS list, else an eighteen month wait to get treatment for a kidney stone. Degree of pain was immaterial, and of no consequence.

    Treatment at Guy’s was the most primitive, basic, and uncivilised that I have ever received anywhere in the world, and that includes a spell in a Greek hospital in the 1970’s. During the six months treatment I had two ‘near death’ moments, due entirely to nursing errors. All this for a simple kidney stone dispersal…and in one of the more modern NHS facilities.

    Fortunately for me I was in the US when I needed the by-pass. at that time in the UK there was only two, – yes, two emergency cardiac beds in the UK system, patients who needed cardiac care at that time were being stabilised in the ER (if there was one open), and then put in an ambulance to go in search of a vacant cardiac bed, sometimes involving trips of several hundreds of miles..

    Treatment in the US was excellent, timely and state-of-the-art, the only reason it was not top of my list, was that I had to pay for it personally. Writing the cheque was the most painful part!.

    When I complained about having to pay, my Wife would ask me what I would rather have spent the money on. I know, a trite riposte, but very appropriate. It was also very nice to be treated as an adult.

    The differences between the various systems – not difficult to itemise. Private UK fifteen years ago, good, civilised, timely and professional, good nursing. Private UK now, not so good as in the past, less timely, less personal, more pressurised, but still much better than the NHS at any time.

    The NHS fifteen years ago, adequate, impersonal, timely, generally inexperienced doctors and nurses, getting uncivilised re cleanliness and hygiene facilities.

    The NHS now (2001-2), BARBARIC, seriously ill people being put on ever lengthening waiting lists, being shunted around with interminal appointments, which are quite likely to be cancelled, and all done to take pressure off the system. Consultants treating interns as serfs, probably rightly so, as they seemed to be very badly trained, nurses who – to give them their due, were very willing, but the lack of quality training was painfully obvious. Total lack of ward cleaning, and just two washbasins for thirty patients!, shower facilities were nonexistent, and this in a urology ward, where urine was the ‘aroma of the day’. All in all, totally uncivilised, humiliating, and very inefficient – the infection rate was at an all time high. All this in return for paying substantial premiums through NI contibutions for over fifty years.

    Guy’s is a modern facility, built and designed in the last ten years, with an atrium which costs mega money to heat, light and maintain, but which can not afford to have the wards cleaned on a daily basis.

    The US, over the past ten years, two hip replacements, done at my convenience, i.e. when the pain level became intolerable. excellent treatment by doctors who were specialists, by nurses who cared, in an environment that was clean and comfortable. Treated as an adult who had a choice of doctors and hospitals. A phrase that sticks in my mind, said when the surgeon was examining me, ‘Sir, I am sure that you will be pleased with the result.’ Can you imagine a doctor saying that to a patient in the NHS?. After care – excellent, with the surgeon taking part, not being left just to an intern and a nurse. A caring experience.

    The way to pay in the US is via an insurance plan, either self-funded, or employment funded, only problem is that as you get older the premiums get higher, till you reach a point where you can not afford the premiums nor the treatment. However, even with no insurance, or other means to pay, no-one who needs treatment is turned away. The treatment might be basic, but better than nothing. There are public funds to meet the cost. The level of this treatment is roughly equivalent, or slightly better, than that available in the NHS.

    My knee-jerk opinion of the NHS, is that the bureaucracy was to blame for the mess, however, I think that the doctors and surgeons are as much at fault. They seem to aquiesce to every stupid rule laid down by the politicians, when with very little pressure they could have a very workable system – if they really wanted it!.

    Either they have such low morale as a body, they cant resist the relentless bad management, or, and I think that this is more realistic, they are hoping that the system will collapse under the weight of it’s own mendacious stupidity, when they will still be required and in a position to make the rules, and of course, the profits. I do have reason for this cycnical attitude, but this is not the place to discuss it.

    At present they condone practices that they know are detrimental to their patients, yet they persist in playing the politicians game.

    Medicine, as practiced in the NHS is hardly the altruistic, caring profession that the BMA would like us to believe. For example, the lack of care and respect for older patients, shows a very cynical attitude by them, for us…imagine seeing your file marked ‘CTD’, or with the dreaded red mark, or some other smart-assed acronym for ‘don’t bother’. I’m sorry, but the medical profession is guilty of collusion in the collapse of the NHS.

    Just wait until I have the time – I’ll tell you what I really think!!.

    p.s. Dave – funny how you always seem to meet Americans with a negative or different opinion – must be the crowd you mix with.. West Coast?

  • Dave O'Neill

    Sandy, Vicky,

    One of the people I met was a male, late 30’s recently lost his job but has a chronic but non-life threatening respiratory problem which requires in the region of $300 a month in meds. Or so he said. This would, in those circumstances, not be a problem on the NHS – my wife has severe asthma and hayfever the medication for which has cost £39.60 for the summer (a bulk buy) and for which she has seen the doctor twice and had two visits the local hospital for an x-ray and a session with a specialist.

    IO’ll not personally defend the NHS, the UK health service needs extensive reworking. But I’ve worked in the US and fortunately I wasn’t ill but none of the local doctor’s offices would take my companies medical insurance, so I only had emergency cover or I had to pay for myself.

  • Dave O'Neill


    There is a difference, its subtle but there. The problem isn’t the emergencies. The NHS is, in my and my families experience pretty good at those. My father had cancer a few years back and had excellent treatment, I needed an appendectomy and was seen and operated on within 12 hours on a Sunday.

    Both of the cases you cite are forms of economic rationing, the issue is how you deal with non-life threatening chronic illness. Respratory illness is a good example where you can get into a vicious circle of not being able to work.

  • Dave O'Neill

    Dave – funny how you always seem to meet Americans with a negative or different opinion – must be the crowd you mix with.. West Coast?


    Pacific North West this trip, but you seem to act as if that automatically makes their opinion invalid? I’m just pointing out that the public view in the US is not uniform.

    According to this mornings Seattle Times the Washington Post has a survey that says 70% of Americans think Saddam had something to do with 9-11… Should I believe that too? 😉

  • As an American who works in the health insurance industry, and who works there (rather than as a consultant) primarily in order to qualify for health insurance, I have a few comments…

    First, everyone in the US can get care, and it is pretty good to outstanding.

    The only caveat is that if you are not covered by insurance, you may end up becoming destitute paying for your care. Furthermore, you will pay FAR more than insurance companies would for the same services.

    Insurance is often not available to individuals, especially as they get older, because of what is called “medical underwriting” – the practice of exclusing coverage for anything you are already sick with, or worse, simply refusing to sell you insurance at all because of your medical history. This is extremely common. This happened to me at age 33 when I had nothing particularly serious in my medical history, and has happened again since then. The fact that one has had insurance since the time they were young and healthy does no good in this situation… because the system is rigidly partitioned between employer-purchased (group) insurance and individual insurance, and the latter system simply does not work at all (see reference below).

    The opposite side of medical underwriting, and the cause for it, is free riders. If you did not have to buy insurance, but could get it at a reasonable price as soon as you needed it, the insurance would not work in a business sense. Imagine people delaying buying insurance until they were wheeled into a hospital for a heart transplant, or when they discovered that they were HIV positive!

    Insurance works best when risk is spread out across a pool of people. This is why people with the larger employers can get insurance – because the employers make it mandatory and the insurance companies then have a reasonable risk pool to work with. The better an insurance company can judge the risk to an individual, the worse for the individual!

    I think the current situation needs some serious work, however. In fact, I think it needs (gasp) government intervention. I would make it *mandatory* to purchase health insurance, and make it illegal to price based on risk. I would also make it illegal for employers to purchase health insurance on behalf of their employees, but they could give money to employees to spend only on insurance. I would also provide ways for the poor to acquire insurance (they have it now anyway), but with financial incentives for them to use it wisely (rather than getting routine care at emergency rooms like they do now).

    There are many subtleties here, but the system right now favors those who don’t work, those who are old, and those who have jobs at larger companies. It discriminates against small business in a way that has to be damaging to the economy, and it is a counterincentive to individual savings, since the odds of having your savings wiped out, as you get older, unemployed but too young for Medicare (federal insurance) are growing rapidly. Furthermore, it is a major cause of “age discrimination,” since an employer with an older work force will pay more for health insurance. Thus those over 50 find it difficult to find work, and they don’t qualify for government insurance until they reach age 65 or go broke along the way.

    To personalize this, a friend of mine became ill, ended up having his private insurance cancelled, and lots his quite considerable assets paying his medical bills ($500,000). He is now completely broke, and the government picks up the tab for his living via Social Security disability.

    See here for more details on US health care issues.

    In summary, the US system has flaws (basically, cracks in the *financial* protection that people can fall through) but I wouldn’t trade it for Canada’s or UK’s at all!

  • Dave O'Neill

    John, thanks for that overview it explains the stories I was being told last night.

    Personally, I like the principle of the UK/Canadian/ROTIW systems, plus, of course, people are always free to pay extra if they want to.

  • Cydonia,

    Quite right. My second blooper in as many days. A third, and I have to attend a Samizdata Re-education camp where I must confess my guilt and be reconstructed.

  • Jonathan L

    The cost of medical care in the US distorts a comparison of the two systems. That excessive cost is due mainly to the cost of Tort lawyers rather than medical care.

    My guess is that take away the greedy Lawyers and the US system would look a lot better.

  • Guy Herbert

    All this is very interesting, but for the “the US is system is terrible” legend to disappear, might take longer than the “the NHS is the envy of the world” legend, since direct personal comparison is harder to come by.

  • Verity

    I have long said that if the NHS is the envy of the world, why has no envious country ever copied it? It was always a repulsive idea, making taxpayers into supplicants for that most precious resource, their health, and its development into the sleazy public sector empire it is today was perfectly predictable. More bureaucrats than beds! It’s a joke. It says a lot for the passive nature of the British that they didn’t drive a stake through its heart decades ago.

    I believe Britain is the only successful economy with this statist system – although some Canadians may write in to correct me!

  • Andrew Duffin

    Dave O’Neill wrote:

    “I like the principle of the UK/Canadian/ROTIW systems, plus, of course, people are always free to pay extra if they want to.”

    Actually I believe in the case of Canada this is NOT true. There is no private sector there at all iirc. Hence so many Canadians come to the UK if they need treatment, where it is, of course, totally free to anyone who turns up from anywhere in the world, no questions asked, and no limits.

  • Verity

    I see just now that the Institute of Food Research, whatever that is, has “urged the government to make nutrition a priority” after “figures” (doesn’t tell us where the figures came from) showed that bad eating habits are costing the health service £15bn a year.

    Having a nationalised health service hands the government a key to interfere in the lives of every private citizen under the guise of saving taxpayer money. It is the lynchpin of the Britain’s socialist society. Pull the rug of the NHS out from under the government’s feet and you take away one of its most powerful weapons. You also free up hundreds of billions of pounds for the private sector.

  • Thanks for the explanation, John, but it invites what I think is a natural question. You say: “Insurance works best when risk is spread out across a pool of people. This is why people with the larger employers can get insurance – because the employers make it mandatory and the insurance companies then have a reasonable risk pool to work with.” If so, why do not those who have to rely on individual insurance (you’re talking about Blue Cross/Shield-type insurance, as I understand?) — e.g., small entrepreneurs — pool their resources into some sort of fund and buy group insurance? Or, if there is a coordination problem involved, why wouldn’t someone come forward and offer to help set up and manage to set up such a fund, and buy group insurance for the ‘investors’ as if he were their employer?

  • S. Weasel

    One wonders what the difference is between a national health service and private insurance that everyone is required by law to buy.

  • damaged justice

    Mandatory health insurance? So what are you (the hypothetical you in charge of the law) going to do to me (the citizen, subject, serf) if I decline to participate?

    I’m sure such a plan will have exactly the same effects on individual health that “mandatory car insurance” has brought to our system of roads: A road straight to Hell, but paved with only the best intentions.

  • out there

    Alex(ei), that sounds like a great idea, my guess is that somehow it is not allowed under current practices.

    When BlueCrossBlueSheild turned me down for insurance- though they agreed to insure the rest of my family members- I was able to get a groupish policy through a private insurance agency, where I joined a group (a consumer organization) and became eligble to buy a particular insurance. It’s more expensive than what my family pays. The premiums keep going up on all our insurances. We take the highest possible deductibles, to keep the premiums down, and so pay for all our health care on top of the insurance payments, each year.

    We are paying for peace of mind, in the event of a major illness or accident.

    We could get insurance through my partner’s place of employment, but as it is a small business that is not big enough to qualify as a group, the plan they offer is just as expensive and has worse coverage than we currently have, plus jumping through all the hoops of applying for insurance only to find out that we would be denied coverage on anything we have been treated for in the past X years- well, there just doesn’t seem to be any point in that. Better to pay the climbing premiums and hope for the best.

    I am old enough, in the US, to recall when health insurance did not cover a person for all their medical costs, every time they walked in a doctor’s door. People paid for their routine care, and insurance was for the big stuff.

    That’s the kind of insurance I want. That is, mainly, the sort of coverage we have. It’s expensive. I guess we are paying so that others who can’t pay can get care, in some convoluted way, through our premiums and our taxes. There must be a more efficient way to do this.

    There is a clinic in a nearby town, that will treat anyone and people pay according to a sliding scale based upon their income.

  • Sandy P.

    –One of the people I met was a male, late 30’s recently lost his job but has a chronic but non-life threatening respiratory problem which requires in the region of $300 a month in meds. Or so he said.–

    He has chosen not to take the insurance. All people terminated have the option of COBRA, 18 months of insurance thru the company, but you must pay the premiums.

    Of course, he could work part time to cover the cost of those meds, bartending, sales on the weekends, etc. He’s just not at that point yet.

    Americans are a mobile society. Maybe another part of the country would ease his breathing problem. And his job problem. He can also buy it on his own.

  • Sandy P.

    Don’t forget tort reform, John, I would think that that’s 50% of the problems.

    Andrew, the Canuck aren’t just going to England.

    Detroit does quite a business.

    –e.g., small entrepreneurs — pool their resources into some sort of fund and buy group insurance?

    My husband’s an SBO and pays all the premiums, at least 700/m per emp. And for years small businesses did not get to write it off like the big boys.

  • Dave O'Neill


    The issue there is for things like that the NHS is pretty good. Its the bypass surgery you need the real insurance for.

    One of the worst problems with the UK is the private sector is a poor relation of the NHS. Personally I’d like to see the private sector invigorated and the tax system changed to encourage it.

  • R.C. Dean

    “If so, why do not those who have to rely on individual insurance (you’re talking about Blue Cross/Shield-type insurance, as I understand?) — e.g., small entrepreneurs — pool their resources into some sort of fund and buy group insurance?”

    Sometimes they can, and do, pool up and buy group insurance for several companies as one group. However, the individual states regulate what constitutes a proper group for these purposes, and in many states, the regulators have determined that you cannot put two unaffiliated companies in one group.

    Does this break down potential bargaining power in the small business sector? You bet it does. Why do you think the insurance companies like these rules so much?

  • Rob Read

    A nice link 4uall


    There is a lot of appetite for governments to try fundamental reform of the National Illness Incentive System (NHS) the funny thing is no political party is prepared to give people what they want.


  • Ron

    “Hence so many Canadians come to the UK if they need treatment, where it is, of course, totally free to anyone who turns up from anywhere in the world, no questions asked, and no limits.”

    Given that air fares from London to New York, etc, are so low these days, why aren’t there more Americans with medical insurance problems hopping on planes to get their work done in the UK?

    Even if it meant flying over once to get on the waiting list, then flying over another time 6 months later to get the work done, surely a few hundred dollars air fares are a lot cheaper than the x hundred dollars a month quoted above?

  • Kit Taylor

    I am old enough, in the US, to recall when health insurance did not cover a person for all their medical costs, every time they walked in a doctor’s door. People paid for their routine care, and insurance was for the big stuff.

    There is a plan called SimpleCare seeking to reduce the cost of modest “cash in hand” doctor visits, freeing up money for highly deductible insurance against catastrophic health problems.

    Adam Sparks also has an article on cheaper US healthcare that you might be interested in.

  • R.C. Dean


    That may be true, but I understand that in Scotland the sheep are still pretty nervous.

  • ernest young


    It just isn’t that easy, first you have to get onto the waiting list, which may take at least three visits to see the Consultant, all nicely spaced out every two weeks. If you are lucky, he may, and I emphasize may, put you on a waiing list. This list is more than likely a waiting list for the waiting list. You could wait three months, or more before actually getting on THE LIST.

    Still with me?, in between times you will be required to attend for x-rays, blood tests, etc. These will be spaced out at one test every two or three weeks, miss an appointment, and it is back to
    square one.

    This has a double effect, it keeps your hopes up, that you are getting nearer to receiving treatment, and it relieves the pressure on the hospital to actually do something for you. Don’t hold your breathe!

    Your degree of pain will have little effect on the Consultants decision, as to when he will deign to perform his ‘magic’ on you. I know of peole who have been reduced from being fully ambulatory, to wheelchair bound wrecks, while waiting for His Lordship to forgo his lucrative ‘private’ practice, to perform his statutory duties as a NHS Consultant.

    So you see- it isn’t as simple as ‘just hopping on a plane’.

    Most Consultants, have a minor commitment to the NHS, while maintaining lucrative private practices. I believe this gives them a ‘free’ pass to use NHS facilities for their private practice.

    Easy to see why the majority of them will vehemently defend the NHS, and why they are quite happy with the status quo.

    If you really want the ‘low-down’ on the NHS, ask a senior, they are the ones who are, more than likely to have need of an efficient NHS. Younger folk usually only have need in an emergency, which as has been mentioned, is not too bad.

    Jam today, and jam tomorrow!!

  • ernest young


    No, you are thinking of Wales….:-)

  • Julian Morrison

    I think a big part of the problem is people not taking responsibility for their own health. NHS and health insurance are both dodges to do this. Both of them encourage an attitude of freebie-seeking and “go to the hospital for a grazed knee”. Both of them end up treating patients as a burden and a loss, not as a valued client.

    Back in the day, people used to self-fix, buy medicines at the chemists, keep their own first-aid supplies, only calling out the (expensive but helpful) doctor if the injury/illness was grave. Sick people were treated at home, rather than aggregated into huge socialist buildings full of other (infectious, depressing) ill people, overworked staff, and bacteria trained to an SAS-like peak of ferocity by surviving repeated doses of antibiotics and bleach.

  • Doug Collins

    Back in the days of the ‘Contract with America’ or maybe even back in the Reagan administration, there was an oscure law passed that set up ‘Medical IRA’s’ in which a person could deduct a sum of money from their taxable income and put it into an account with which they paid for insurance and built up a savings for major medical expenses.

    If they got to about 70 years old and didn’t need to use the money, they could cash out at a low tax rate.

    It sounded great to me, but my accountant said it was a poor investment – group insurance was a lot cheaper. (By the way, he also said if you need to get into a good group with good insurance, check out your university alumni association. Some associations will let you join if you are just a ‘friend’ of the school, you needn’t have studied there.)

    Anybody know what happened to the idea? What was really wrong with it?

  • ernest young

    Julian Morrison,

    For those of us who have been around since the start of the NHS your last comment seems very offensive.

    It isn’t as though we even had a choice, there was no alternative, there were no health insurances available, and there were certainly no private facilities for treatment. It was the NHS or nothing.

    It was not until the late 60’s or early 70’s that saw the start of insurance schemes such as BUPA and PPP, people, such as the self employed joined them with enthusiasm. To the employed the premium seemed a luxury, and deemed such schemes as for executives and ‘toffs’. In reality they were a lifesaver for people whose time was of some importance. and certainly weren’t regarded as ‘freebies’, nor used frivolously. Even at that time the NHS treaated patients like cattle.

    Going private meant that you were treated as an adult, with a degree of common respect that civilised folk have for each other. In other words, you were treated as a valued customer, and not as a burden, as you suggest. It is only in the NHS that the patient is a burden and an impediment to the tranquility of the administration.

    You talk of the days when people used to ‘self-fix’. What a strange expression!. Julian, most people still do their own first aid, even you probably have a sticking plaster in a drawer somewhere!. The long wait in emergency rooms is enough to deter even the most hardened hypochondriac.

    So you sneer at the NHS and private health insurance, as being for the feeble-minded, so what is your answer?, – to have a personal fund ready to pay for that emergency heart attack resuscitation, or for that much needed chemotherapy!. Let me tell you that you wouldn’t be able to afford the cost of an appendectomy, let alone anything more serious if it wasn’t for the subsidised facilities capitalised by the health insurers, and yes, the NHS. from all of our taxes.

    The fact that the whole medical system has been politicised and badly managed for decades, doesn’t mean that the basic idea of health insurance is not a good one. The seeds of the NHS’s destruction were sown on the day it was born, seeds sown by an impractible socialist ideal of free care for all.

    At that time there was furious debate over whether the care provided should be ‘means tested’, that is that is was only free to the poorest and most needy, with fees being on a sliding scale. The other side of the debate was over whether some sort of qualification for treatment was needed. ended up with the most unsustainable system of all – free care for all…..

    Julian, your comment was not only thoughtlessly rude, but showed your total lack of understanding of the history of the problem. Your cliche riddden, knee-jerk scenario of days gone by, shows how little thought you gave the matter. While, to you it may be just another political scoring point, to others this is a matter of some import. So if you having nothing other than cheap juvenile rhetoric to add, I suggest you keep quiet, read and you may learn something.

  • Steve D

    Even if I did want to nationalise healthcare, I probably still wouldn’t support it. The US government’s track record at running similar programs SUCKS. Look at Social Security…totally bankrupt.

    In my mind, it would be like having to go to the Post Office for healthcare…I hate even going for stamps!

  • Julian Morrison

    ernest young: you’ve misinterpreted what I meant. I didn’t mean “people who relied upon the NHS were being negligent”. I know the NHS was a full monopoly. I know that as things stand, the NHS is still enough of one that it warps the market and drives private medicine into the high price bracket, out of many people’s reach.

    My point was rather: the NHS and private health care are both products of the same (IMO mistaken) idea, that health care ought to be free (to the patient, at the time of use). The NHS pushes the burden onto taxes; insurance pushes it onto the company, and behind them, the healthy premium-payers. This is IMO symptomatic of a more general underlying social trend, of adults not wanting an adult’s responsibility. This is the trend that’s at the root of nanny statism, and the NHS is a form of nanny statism. Insurance isn’t (necessarily**) statism, but it’s still nannying.

    (**except where some idiot has made it mandatory, giving providers a defacto tax subsidy.)

    A symptom of this pushing responsibility for payment onto other people, is that both systems produce perverse incentives. That insurance provider which is most profitable is the one which is the least useful to its subscribers. The patient seeks overtreatment, the provider seeks undertreatment, and they meet in the middle as opponents, not allies. Contrast this with the cash-on-the-nail approach, where the patient’s incentive is to make minimal but effective use of doctors, the doctor’s incentive is to keep patients happy.

    It’s possible some insurance may be useful in case you need an extremely-high-cost procedure. But thing is, the market as it stands is everywhere warped. Need prices be so high?

    In the UK, there’s the NHS. In the USA, the health industry is regulated ’til it squeaks, and as usual the regulations favor the politically savvy big providers. If I recall also, employers are forced by law to offer health insurance to employes. As a result, the health industry in both places is steeped in “deep pockets” assumptions. The insurers or the NHS may prefer not to pay, but once they agree to, they have an awful lot of cash to throw about. All medical gadgets are n-tuply redundant, tested and certified, and bloody expensive. Drug companies are forced to jump through regulatory hoops, and given patents as a sop; no wonder drugs cost so much! Doctors have legislated monopolies, nobody is given the choice to trust their health to a less-but-adequately qualified alternative.

    In an unregulated, freebie-less market, all the above mess would be avoided. Surely some entrepreneur would see the profit in making a “Ryanair” style “good enough and far cheaper” health care alternative? Stuff like this might well push private health into the range where everybody (no longer drained by the exhorbitant NHS taxes) could afford to pay up front.

  • Sandy P.

    We have Medical Savings accounts but Congress was worried that too many healthy people would use them and leave the system so they limited it. It’s getting back to the front burner again, tho.

    And some companies also offer Flexible Spending Accounts (FSA). Money taken off the top to use for medical/dental/eye that insurance doesn’t cover. Believe it or not, that included saline solution for contact lenses. A mix of FSA/Catastrophic w/tort reform could be interesting.

    Whatever’s not used up by the end of the year, you get.

  • Sandy P.

    And I’ll never forget the story of the poor guy from Kiwiville who cut off his gangrened finger w/scissors after he received a letter from the NHS saying it would be another six months before they could see him.

    After his story made the news, of course the wrong letter was sent.

  • ernest young

    Julian Morrison,

    It seems that your general understanding of the way in which health insurances schemes work, is at fault. If your experience is limited to the use and abuse of the NHS, then your remarks have some validity. As I mentioned, the credo of ‘free care’ for all, is the maggot at the core of the NHS. with a large percentage of patients never having contributed anything to the system. This is part of the bad management referred to and on which we both agree.

    The case of private health schemes is different, where most in the UK are operated by ‘non-profit’ organisations, and as such are not driven by the profit motive. To say that such insurance encourages ‘nannyism’, and a rejection of self-responsibility, is utter poppycock. By your definition, any insurance, for whatever purpose, represents a desire to be ‘nannied’.

    It is highly responsible to have insurance for unseen circumstances. With health insurance you select the type of cover you need, and you pay your premium. If you want the deluxe version, you pay a higher premium. If you abuse the system, your premiums will increase, simple cause and effect, (also known as ‘market forces’). Note, such increase will be in your premium, not the in the premiums of your fellow insured!. In addition we all know that we will make more use of the insurance as we get older, hence, we expect our premiums to increase as we get older.

    I suspect that when you complain of people using such plans at the expense of the healthy, what you really mean is ‘us healthy young people are paying for an insurance we dont use, to benefit all the old farts who need all that expensive care’. As mentioned – the older you get the more you pay, your contention that costs are born just by the healthy is disingenuous, we are all healthy to start with, and we all get sick, at some time or other!. You should be pleased when you don’t have to make a claim…..

    When we are healthy, it is nice to have the peace of mind to know that we have decent medical care available, should we ever need it. That is why it’s called insurance…..

    Private medical care expensive in the UK?, I don’t think so!, most of the facilities used are subsidised by the NHS anyway. The same goes for the most of Europe, where government subsidies are the norm.
    Drugs are expensive because of the R&D. Doctors are expensive because they are highly skilled. Good facilities are expensive because they have to be the best. Nursing is expensive, because nurses are highly skilled. Equipment is expensive because it isn’t mass produced, like cars. Yes you do have a choice of treatments, the private health sector is expanding all the time, and provides everything from a basic service in a NHS hospital,(Ryanair), to a deluxe service at the London CLinic. (Private Lear jet).

    Sounds as though you believe more in the socialist concept of ‘ give what you can, take what you need’, than in any free market concept.

    I am still of the opinion that your remarks are of the ‘knee-jerk’ variety, and show little understanding of the reality known as ‘life’. If you are trying to make a political statement, then good luck to you, – if so, then you need to brush up your rhetoric a bit…

    I am still wondering what these ‘freebies’ are that you talk about.

  • lars

    ernest young wrote:

    “If you abuse the system, your premiums will increase, simple cause and effect, (also known as ‘market forces’).”

    Seems to be more like, if you use the system, your premiums will increase. Oh, wait- even if you don’t use the system, your premiums will increase!

    “Note, such increase will be in your premium, not the in the premiums of your fellow insured!. ”

    Hmmm. In my experience, this is more true of automobile insurance than health insurance.

    “In addition we all know that we will make more use of the insurance as we get older, hence, we expect our premiums to increase as we get older.”

    All health insurance premiums go up, year after year, for everyone in a family, from infant to old fart. True, we are all getting older… but all of us, even those who do not use their insurance at all, are paying more.

    The answer seems to lie in the direction of people taking responsibility for their own bloody health. Preventive measures, decisions about what to do in the event of this illness or that chronic condition, what experts to consult for information with which to make these decisions in the course of educating one’s self- a person’s health is their own responsibility.

  • J S Allison

    When I worked overseas we had a physician’s assistant that worked for the company staffing the company aid station who took care of routine matters and jobsite emergencies. I wonder how large a company would have to be for a corporate medical office to make sense and result in health insurance coverage savings. Not a full service facility of course, but rather something that could handle routine care for the employees and their families, an in-house G.P., as it were.

  • ernest young

    Lars ,

    There is a difference between ‘use’, and ‘abuse’.

    In the US where the insurers are ‘for profit’ organisations, you experience may be true. In the case of UK health plans, normal use of an insurance plan does not, of itself, increase your premium.

    Once again, the bleat, ‘Everyone should take responsibility for their own health,’ sounds OK in theory, but what about the big ticket items such as chemotherapy, or treatment for AIDS?. not all health insurance is for surgery, and a lot of it is justifiably pricey.

    Price increases are for other reasons than corporate profit, ever heard of inflation?. and dont tell me that there is very little of that at this time. If you believe that then you are very naive.

    Seems any discussion on this topic falls into a battle between old and young. First they are the first to discover sex, now they are the ones to discover perpetual health, give me a break!…

    (Yes, then I can have it fixed at your expense!, the break that is!).

  • Dave O'Neill

    Back in the day

    Many of the conditions we for granted as treatable were deadly.

    Myocardial Infraction is a good case in point. When a good friend of mine entered nursing in the early 60’s if you arrived with a heart attack, they’d make you comfortable but there wasn’t a huge amount they could do.

    They certainly couldn’t pull your blood pressure down with beta-blockers, stabalise your condition, reduce the likelyhood of further clotting and, if necessary arrange for a triple bypass.

    I’m not convinced I want to return to those good old days myself.

  • The debate on health care system is not a problems in America I think this is a hot issue in all over the world.

  • max

    Certainly it is specially in india this issue would really be controversial unlike as it is.

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