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Other ways of providing health care

Whenever I have attempted to discuss health care, I am always told about how the US health system fails people. I am sure that this is some combination of untrue (my own experience of US health care was walking in unannounced, paying $100 and being seen and fixed straight away) and unfair. US health care is not wholly private or even very free-market at all, and suffers a high level of regulation. But I do not understand enough about the details.

I occasionally hear good things about other health care systems, such as Australia’s method of having people pay and then possibly having the government refund them. While I can understand that it will be hard to convince people that anarcho-capitalist health care is best, it is interesting in the UK that no changes to the structure of health care at all will be considered. Private companies must not be allowed to make a profit! Such profit can only be gained from killing patients.

However the IEA have recently made an interesting strategic decision to counter-attack the knee-jerk reaction that the only alternative to the NHS is US-style health-care. What if the NHS and the US system are both weird and there are other sane and functional systems in the world? Kate Andrews has appeared on the BBC pointing this out. Guido covered it. Kate Andrews wrote a piece for the Spectator. All this is to publicise the IEA report Universal healthcare without the NHS.

One thing they keep pointing out is that the NHS ranks in the bottom third of the world’s health care systems in terms of outcomes. That will need a lot of repeating if anyone still thinks it is the envy of the world.

It is also, perhaps, a much more effective strategy than attempting to convince people of the benefits of free markets up front. “Let us try to learn something from nice country X” does not require breaking down as many mental barriers as “please abandon a lifetime of carefully cultivated opinions about the unfairness of capitalism”.

27 comments to Other ways of providing health care

  • Runcie Balspune

    Unfortunately the NHS falls into that category of subjects which must not be derided and is pure political suicide to try and address, it has become part of the national consciousness stoked by the establishment.

    The larger problem with the NHS is that it gives the nanny state a Carte Blanche to determine what you must do to “avoid” using NHS resources, thus strict rules on smoking, eating, nutrition, or whatever situation might make you a bit ill, instead of just advising people and then letting them kill themselves (which is, bizarrely, actually far better for the NHS in the long run).

    Left wing authoritarian groups (the “ctrl-left”) see this as a feature not a bug, and that is the main reason they argue against relinquishing any government control.

    Whilst the nasty capitalists are berated for treating their workers like sh*te and paying them a pittance, the same does not seem to apply to the glorious health services in this country, so another angle is to show how this fine establishment is built on the exploitation of the vulnerable (those who are willing to care). With several health care professionals as close acquaintances, I personally don’t feel great when I go for NHS provided treatment knowing the cr*p they have to put up with for little or, in some cases, no pay.

  • pete

    These comparisons are unfair.

    The NHS is a fully nationalised service and therefore its primary aim is the welfare of its employees, not providing a service to the public.

    With its reasonably good wages and excellent terms and conditions it ranks quite highly in this respect. This is why so many foreigners are keen to come to the UK to work for it, and also why NHS staff fiercely oppose any privatisation which might bring their in-work benefits more into line those enjoyed by the people who pay their wages.

  • Mr Ed

    Funnily enough, I was in a pub the other week, and a group of mid-60s fairly well to do people came in, probably ‘risen-managerial’ from what one might call respectable working-class backgrounds, and they started to talk about the NHS and how awful it was, and that it needed to be ripped up and something started in its place. It may be that the current dogma that the NHS is sacred is not as solid as it appears, hence the strident nature of responses to calls to question the Emperor and his new death shroud.

  • Stonyground

    I think that many people are probably terrified of the possibility of contracting the kind of disease that would give rise to colossal and unaffordable medical bills. I suspect that the vast majority of health problems are likely to be in the same league as when your washing machine dies or something unexpectedly goes wrong with your car. These are sudden unexpected expenses that most of us take in our stride, but we can’t seem to consider that moderate medical expenses could be dealt with in this way.

    I am a 59 year old type 2 diabetic and manage my condition by staying fit and exercising a lot. Recently I have had a problem in that while exercising I feel faint, like that feeling that you get if you stand up too quickly and all your blood goes into your feet. I have had an ECG scan done at my GP surgery. This showed up some kind of problem so I was referred to a cardiologist. I was seen by the cardiologist just inside two weeks. He said that the problem is probably caused by a virus and, if this is the case, there is no treatment for it you just have to wait for it to clear up. He said that he would put me down for further tests just to be sure that it was nothing more serious and I now have an appointment about three weeks on from that consultation. I don’t consider that these waiting times are particularly bad compared with people having to wait eighteen months for operations. I do wonder however, are people who use the NHS just used to having to wait for such things and just accept it as normal? If I lived in another country where I paid for my own health care would all this have been sorted the same day?

  • Tedd

    We have the same problem in Canada. The entire debate has become ossifed (along with any chance for improvement) by the false dichotomy of ‘exactly what we have’ versus ‘exactly what (we think) the Americans have.’ Despite our ranking, by various measures, having fallen lower every year for decades, we haven’t changed anything of significance during that decline. It’s been a good ten years since I’ve even had a conversation about it with anyone. It’s simply an off-limits subject in Canada. “Everything’s wonderful, nothing to see here.”

    What’s truly bizarre about it is that nearly every single person I know has, or has someone in their family who has, gone to the U.S. for care they couldn’t get in Canada. But it hasn’t affected their opinion that our system is perfect and “just needs more money.”

  • Stonyground

    I should add that so far, apart from the waits, the service that I have received has been very good, NHS staff have been very professional and I really don’t have any complaints up to now.

  • You might as well go to Saudi Arabia and suggest to the locals they abandon Islam.

  • DOuglas2

    I’ve lived in several places over the years and had occasion to see respective health-care regimes as patient both in A&E and in local practice in countries in Europe and countries in North America. Of course I also have family members who have had their own health crises in different countries — with which I’m unquestionably familiar as I was visiting them/talking to them all the way through.

    Whenever a discussion of US healthcare comes up, it seems inevitable that someone with no experience of said system will say “you don’t know what you are talking about, the XXX is uniformly wonderful!” with XXX being OHIP, NHS, RAMQ, etc; or “you don’t know what you are talking about, Switzerland and Germany have free state provided health care!”; or “If you get injured/critically ill in the US without insurance, your only option is to die!”

    Apparently their parroting of their impressions of ill-informed articles about foreign-places in the Guardian and Huffpo should be more credible to me than my own personal experience of these healthcare systems as resident of the country in question.

    I do think that there are some countries which have better outcomes with lower costs and more freedom for both patients and healthcare-workers, and that these might be great models to follow — because they’ve got incentives working the right way.

    But in the USA any plans for systemic reform always seem end up replicating things that we already know won’t work.

  • JadedLibertarian

    I can’t share too much without breaking a confidence, but the borderline homicidal indifference and narcissism of many NHS doctors makes my blood boil. They’d let you die before they’d admit a mistake.

    “Our NHS” 😡

  • Alisa

    I find the two first comments above contradictory as regards working conditions and wages of NHS employees – is it just me?

  • Eric

    You might as well go to Saudi Arabia and suggest to the locals they abandon Islam.

    This is what’s always struck me when health care conversations come up – the number of people who believe in the NHS with an almost religious fervor.

    I will say when a friend of mine was stricken with lung cancer they did as much as you could expect from modern medicine. But this was a few years back, and from what I can tell things have gone downhill somewhat.

  • JadedLibertarian

    Eric some parts of the NHS are excellent. Some aren’t. That isn’t the problem though.

    We’re told NHS staff are saints and heroes. That’s not true. Some of them are heroes. Some are complete bastards. However it’s only in the NHS that when faced with one of the bastards, you’re actively prevented from being allowed to shop around.

    You only need to look at the Ashya King or Charlie Gard stories to see how out of hand this has gotten. Not only do they not want to treat many patients, they don’t want anyone else to get to either and are willing to use the courts to make it happen.

    In the case of Charlie Gard, the doctors said there was no point treating the child because he was dying. When the parents thought that meant there was nothing to lose by trying a treatment in America, the doctors took them to court and drew things out until the child died anyway.

    From where I was sitting it looked as though the doctors had prophesied this child would die, and were willing to fight to be proved “right”. Doctors (particularly those from Great Ormond Street) seem to using the courts to overrule parents more and more these days. A few decades ago this was unheard of.

    Some of these doctors are honest to goodness sociopaths. In a free market would anyone seriously use a doctor with such a track record?

  • Mr Ed

    You might as well go to Saudi Arabia and suggest to the locals they abandon Islam.

    But isn’t apostasy in Saudi Arabia punishable by death?

    Whereas being a true believer in the NHS is too often, judging by cancer and heart op survival rates, punished by death?

  • fcal

    Over here in Belgium, we have a free choice of the general practitioner and substandard treatment leads immediately to loss of patients. We have a free choice of specialists with the same effect. We have a free choice of the hospital, same story. We pay upfront and get reimbursed by a private healthfund, to which the state subcontracted all this handling. In all cases we have to bear personally a minor part of the incurred expenses. There exist also all kinds of insurances and other provisions in order to alleviate personal costs. It is rather complicated but the monolithic approach type NHS doesn’t exist. In our hospital we frequently encounter British and Dutch customers. They pay the same tariffs and our doctors prosper.

  • R. Dawes

    A side anecdote:

    I took an economics class in uni in the mid 90’s. One of the major assignments was to present a proposal for how government ought organise healthcare.

    We were expressly told it had to be some variant of public and private combined. Arguing for liberty would be a fail.

    Fwiw, being young and dumb, as well as just wanting this crap over and done with, I handed in some awdul thing I did with no enthusiasm and got my pass.

  • R. Dawes

    I should have noted, this was in Australia.

  • Sean

    Anglo countries need a crucifix to bear. The US is guilty of fighting to free slaves. The Canadians, Australians, and Kiwis are guilty of being nice to indigenous people. And the UK is guilty of a belief in public health care. Only one of them is currently killing people however. Pray for a miracle (they do happen).

  • Mr Black

    You can’t win this argument. All people care about is that it is “free”. Quality of care or outcomes are totally irrelevant to them – because they are not currently in a hospital. Those who die get no say, those who are discharged with their complaint resolved are happy. Only a tiny slice of people who have prolonged negative contact with a hospital are going to be dissatisfied. Arguments based on statistics or accounting will move zero votes and zero opinions.

  • Steve borodin

    After extensive experience of the NHS, mainly with grandchildren’s ailments, I suggested that they needed a corporate slogan. “We don’t give a damn” would be appropriate painted on all ambulances.

  • Coming up to 85, I can well remember the times before the NHS was spawned. Contrary to current opinion health care was not a problem. If you were ill you went to your GP, no problems with making appointments, you just turned up at the surgeries, usually one or two doctors, with two surgeries per day each. Too ill to go there, you sent a message and within the day the doctor would arrive on your doorstep. Larger problems, sent to a Specialist, perhaps £5 dependent on your means, but a day or two later. If you needed hospitalisation the Specialist booked you in to the hospital straight away. During the War, my Mother went in for a major operation, no problem despite wartime conditions. Of course, in those days the Matron ran the Hospital, one per Hospital, the Almoner sorted out your means. We were a working class family. Now I have a problem just getting an appointment to see my GP. However, fair play, just recently I have been treated by two particular Departments in my local Hospital who did very good work and were pleasant whilst doing it.

  • the other rob

    I’ve had some slight experience with health care in Canada, the Netherlands and the Ukraine, among other places, but the bulk of my experience has been with the NHS and the US system.

    My experiences with the NHS were mostly negative. It killed my mother, my brother and my grandfather. When I had an appendectomy, it left me to remove the stitches myself, using pliers and a bottle of Scotch, because the nurse couldn’t be bothered to turn up. On the positive side, my then GP wrote me a scripts for a year’s worth of asthma meds, when we moved to the USA, because “it’s very expensive over there”. I’m also old enough to remember small local hospitals, where the quality of care was excellent, though those had mostly gone by the end of my childhood, transformed into nursing homes or apartments.

    The system in the US is no picnic either. While the problems that stem from government are well documented, little is said about the massive private sector bureaucracy that has a vested interest in keeping the cost of health care as high as possible. From medical device manufacturers seeking to bilk Medicare, through insurance companies wanting to maximise the value of their investment pool, to hospital administrators focused on the dollar value of their business, costs are inflated at every turn.

    Where I live, an MRI costs $3000 to $5000. Yet I know of a place that does them for $300 and still turns a profit, by refusing to deal with insurance companies and requiring customers to pay cash. I’ve had dinners that were more expensive. My GP charges $150 for an office visit. Last year, I asked him how much he’d have to charge to make the same profit if he didn’t have the overhead of dealing with insurance companies. He replied “$65”. Get rid of a few bullshit regulations and I bet we could get that down to $50.

    The problem is that we have become addicted to pre-paid health care masquerading as health insurance. You can’t insure against a certainty, yet that’s what current health plans try to do. We pay $12,000 each, per annum (though perhaps that should be “per anum”) and they still can’t get it right. I just received a supplemental bill for $1000 for last year’s cataract surgery – in what other business would that be deemed remotely acceptable?

    In a world of $300 MRIs and $50 office visits, who would put up with this shit? We’d all pay for our own routine health care and carry much cheaper catastrophic insurance, to hedge against events that are not certain to happen.

    The health care system in the USA must be burned to the ground and rebuilt from scratch. Not by any central planner, but by allowing a genuine free market to flourish. FWIW, I think that the way that health insurance is provided for pets would be a useful model to follow.

  • I find the two first comments above contradictory as regards working conditions and wages of NHS employees – is it just me? (Alisa (February 9, 2018 at 8:26 pm)

    In the decade before last, Labour did two things:

    – throw money at the NHS (and I do mean throw)

    – throw regulations at the NHS (and here too, I do mean throw)

    so the staff

    – got serious pay raises around the millennium and shorter working hours (officially, but, due to regulatory form-filling and other effects, often not so much actually)

    – found their daily working experience becoming harder and less satisfying, in part because less productive

    (Some details can be extracted from Natalie’s old post)

    Headlines like “If the NHS were a patient, she’d be on the critical list” began to appear some years after Labour started this. The NHS-in-crisis story has never really gone away since then; it goes quiet then goes loud again, both trends influenced by media political prejudice, but I vividly recall it starting long before Labour lost office in 2010.

  • Alisa

    Thanks Niall, I think I get the idea.

  • Laird

    “The problem is that we have become addicted to pre-paid health care masquerading as health insurance.”

    Bingo! That (third-party payers) is exactly the problem, and it’s entirely due (quelle surprise) to the federal government. Employer-provided health insurance began as simply a workaround from federal wage controls during WW2. The IRS decided to “wink” at it then, and now it is not only an expected employment perk it is a required one (another feature of Obamacare).

    The solution (or the beginnings of one, anyway) would be to: eliminate the preferential tax treatment of employer-provided health “insurance”; repeal any requirement that it be provided (it should simply be a component of the compensation negotiation); permit premiums to be set by honest actuarial computation, not state fiat; and, most importantly, eliminate every single element of mandatory coverage (birth control, maternity benefits, infertility treatments, obesity coverage, psychological counselling, etc., etc.) and thus allow people to decide for themselves exactly what sort of coverage they desire and are willing to pay for. Mandatory coverage of pre-existing conditions should also be abolished; that’s not “insurance”, and if provision must be made for such people it should be done through the welfare system, not off-loaded onto insurance carriers. (I would also eliminate the utter scam of “tax-exempt entities”, but that’s a discussion for another day.)

  • Paul Marks

    The United States is not supposed to have a health “system” – it is supposed (in line with case of Dr Bonham decided by English Chief Justice Sir Edward Coke in 1610) to have freedom. People allowed to work – both charitably and commercially. Unfortunately government regulations (licensing and so on) and subsidies have ruined all that – pushing up costs to an absurd level (although I note Rob’s point that this is not always the case).

    As for Britain – I doubt that any sane discussion of health care is possible here.

  • Paul Marks

    As for other countries – they are all (or almost all) becoming more statist in healthcare, government spending is going up and regulations increasing.

    I suspect the IEA report does not say that.

  • I suspect the IEA report does not say that.

    And why would it? If they are less statist (& they are) then wouldn’t making the UK’s system less like the one we have and more like almost anything that is not a monolithic socialist system be better? So imagine you are IEA, Paul… how would you try and frame your secular heresy (suggesting the NHS is not a good idea) and nudge things in a better direction?

    I doubt that any sane discussion of health care is possible here

    What the IEA is doing seem pretty sane to me.