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ObamaCare: UK Style

by C1ay / April 6, 2011 1:27 AM PDT

Surgeons say patients in some parts of England have spent months waiting in pain because of delayed operations or new restrictions on who qualifies for treatment.

In several areas routine surgery was put on hold for months, while in many others new thresholds for hip and knee replacements have been introduced.

The moves are part of the NHS drive to find

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Britain has a two tier health care system. The basic tier
by Ziks511 / April 6, 2011 4:23 AM PDT
In reply to: ObamaCare: UK Style

is the NHS which is fully paid for by taxes, but has restrictions as noted above. The second tier is Private Insurance which is usually paid at least in part by an employer. If you've got a decent job odds are you will have Private Insurance as part of the package, and you can go to a Private Hospital and the restrictions above don't apply. I really don't know what the statistics are of percents covered by Basic vs Private insurance. Perhaps Mark might know. Regardless of that issue, life expectancy is a couple of years longer in the UK than it is in the US, and that's entirely due to the availability of Health Care. The same is true with every Single Payer system in the world, better outcomes and longer life expectancies than those in the US, despite the inconveniences.

The thing is that Health Care in the US prior to Congress's Health Care (it's not what Obama was talking about during the campaign, it was messed about ferociously) was rationed through the large number of people without insurance, or with insufficient insurance, or those people whose insurance was cut off in mid treatment by their insurance companies. There are significant waits for various surgeries at Public Hospitals, which means the US already has the same problems you are remarking upon as applying to Britain. When I see people talking about the US Health Care system, they just skip over the people who don't have generous Health Insurance Plans as if they don't exist. They have always existed in the US.

People may have to wait for treatment, but they get it eventually. Additionally this is as I understand it, a move put in place by the Conservative government requiring the NHS to save 20 billion by 2015. Allocation of funds in this case is a political decision, and the average Conservative voter probably already has a private plan anyway. However I would like to hear what Mark Flax has to say on the issue.

My personal experience working for the NHS was extremely positive, and the services offered were far greater than those in either the US or Canada in both of whose Health Care Systems I have worked.


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Heres a graph of 2010 figures comparing 8 advanced nations
by Ziks511 / April 8, 2011 3:10 AM PDT
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And those in the US
by MarkFlax Forum moderator / April 6, 2011 4:35 AM PDT
In reply to: ObamaCare: UK Style

that don't have health care insurance?

I saw a TV report a few years ago, (no links), A team of dentists visited various places in the southern US states offering free dental treatment for those without insurance. They were over-subscribed by thousands and couldn't treat them all. The queues were hundreds of yards down the streets for those who had never been able to afford dental treatment in their lives.

Is forced capitalist {lack of} treatment on such uninsured really moral?

To Rob. No, most businesses do not offer private health insurance. The private industry has tried for decades to get a foothold into the UK with little success.


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The difference is
by Mike_Hanks / April 6, 2011 6:42 AM PDT
In reply to: And those in the US

That if an uninsured American went to the dentist and wanted to pay for it themselves, they can get treatment. Is that allowed where you live?

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(NT) Yep
by MarkFlax Forum moderator / April 6, 2011 6:44 AM PDT
In reply to: The difference is
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Is the above story wrong?
by Mike_Hanks / April 6, 2011 8:07 AM PDT
In reply to: Yep

Why are people waiting for medical care?

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I see, a different tack
by MarkFlax Forum moderator / April 6, 2011 9:36 PM PDT

It happens.

I've never said our NHS system is perfect.

Seems you think yours is?


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Are you a follower of Coronation Street?
by JP Bill / April 6, 2011 10:15 PM PDT

Blanche went to Poland to get a "Polish Hip" Happy

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Of course it's not perfect
by Mike_Hanks / April 7, 2011 7:35 AM PDT

But it is the best

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But it is the best
by JP Bill / April 7, 2011 12:12 PM PDT
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I'd have to wonder what the rank could quickly be
by Steven Haninger / April 7, 2011 6:50 PM PDT
In reply to: But it is the best

if the spin-off industry from it...that being litigation...could be dealt with before creating a money pot to cover it. The money pot is going to have other hands than medical providers reaching for it.

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I doubt it would make much difference ...
by Bill Osler / April 7, 2011 7:54 PM PDT

I don't mean to minimize the impact of the US legal system but I think that the cost impact of the legal system has been somewhat exaggerated.

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Don't you think there is more than a financial cost?
by Steven Haninger / April 7, 2011 8:47 PM PDT

It would seem to me that fear of being sued is just as, if not more-so, involved in both the $$$ cost of treatment as well as medical innovation. Don't we read that US health providers are more procedure driven than those in other countries? I don't know how true this is or what the impact might be but, since we're talking about health care in general, the impact may be more than what we see on the billing statement and may not be easily measurable.

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Well, it does drive doctors into the arms of the Insurance
by Ziks511 / April 8, 2011 3:52 AM PDT

Industry who seem to be a law unto themselves. You ever had a clean driving record and find your insurance has nearly doubled the next year? Happened to me up here in Ontario. One year it was $600, the next it was $1000, all because the insurance industry "claimed" that the accident rate had gone up, even though their payouts had gone down that year. The Province had to step in and create a Province wide No Fault Insurance system to force the Private Insurers to back away from their cash grab.


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There is also the point that insurance
by Roger NC / April 8, 2011 7:39 AM PDT

pays by procedure and test. A doctor talks to you, listens to your heart/lungs, decides you're ok.

He, or rather his clinic/employer, gets paid for an office visit.

He orders testing to verify what he thinks (perhaps to cover himself in case of a lawsuit also) and his employer has it's own testing, there is more fees.

I'm not saying the doctors are ordering unneeded tests. I'm saying there are pressures from the way the systems works, both financially and liability wise, to run two test instead on one.

The payment scheme for advising you on what to eat and what exercise you need isn't very rewarding. That is unless you're referred to a clinical dietitian and a rehabilitation expert.

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It's nowhere near that simple ...
by Bill Osler / April 7, 2011 7:53 PM PDT
In reply to: But it is the best

The WHO rankings depend on a certain set of criteria that are partly arbitrary.

I can't speak for the other countries on the list, but the US has multiple health care systems that all end up lumped together in that list. We 'benefit' from: the VA/military system that does a fair/poor job, the indigent care system that offers abysmal care, Medicaid that varies from state to state but is probably fair/poor overall, commercial insurance that mostly offers good (if expensive) care, and care for the wealthy that is completely unrestricted that offers excellent but very expensive care.

Some critics look only at the low end of that care spectrum. Some enthusiasts look only at the high end of the spectrum. I don't think either of those approaches is very meaningful.

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RE: It's nowhere near that simple
by JP Bill / April 7, 2011 8:24 PM PDT

I it states in my link.

The World Health Organization's ranking of the world's health systems was last produced in 2000, and the WHO no longer produces such a ranking table, because of the complexity of the task.

Best for one person may not be good enough for their fellow countryman.

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What evidence do you have to back the "it's the best"
by Ziks511 / April 8, 2011 3:44 AM PDT

assertion. Even when I lived in the US for the first half of my life, I couldn't understand why we thought US health care was the best. The cure for Diabetes was found in Canada. The first heart transplants took place in South Africa, Cancer treatments come from all over the globe including but not restricted to the US, Heart Pacemakers were pioneered at Toronto General Hospital in the late 1940's and early 1950's. Johns Hopkins and Alfred Blalock pioneered "blue baby" operations but so did the Hospital for Sick Children and Robert Mustard in Toronto, and a Hospital in Christ Church New Zealand, all around the same time, and each with a slight difference. The surgery now is a combination of the approaches.

An odd thing from my experience and unfamiliar to most of you save Dr. Bill, Total Parenteral Nutrition, for people whose stomach and intestines have been removed for any of a number of reasons, was pioneered in Sweden, and the lipid solution is still made there, though perhaps there are now US manufacturers (there weren't when I first encountered it in the US).

TPN must be kept fresh in a Hospital grade refrigerator, and supplied about every two weeks to the patients (i.e. a two week supply is delivered). Not only does the NHS supply these I.V. solutions, but it supplies the rather expensive fridge to store them. I used to deliver them once a week to two lists of patients on alternate weeks, meaning the Hospital must have a delivery van too. I don't know how it's done in Canada, though I have encountered it here, but I don't know that it's available for home use as it is in the UK.

So why is the Health Care delivered in the US "the best". Do you have the lowest infant mortality? No. Do you have the longest average life spans? No. Do you have the cheapest Health Care? No, US Health Care is the most expensive in the world while leaving 50 million uninsured and probably another 100 million under-insured.

I came up here somewhat reluctantly, unhappy to leave all that was familiar behind. It took me 10 years to get to the point where I could see that the Canadian system was not merely better but far better, and far fairer, and when I went to Britain 7 years after that, I was astonished at how much more comprehensive the British system was than the Canadian.

I still think the solution to underfunding in the UK and Canada is to funnel all the taxes on liquor and cigarettes directly into the health care budget. Those are the two things that cause the most health problems. That would likely end all the problems, but of course government has been spending those revenues on just about everything else but Health Care. But that wouldn't help in the US where "sin taxes" aren't much in evidence.


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(NT) For those that can afford it
by Diana Forum moderator / April 21, 2011 4:53 AM PDT
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By the way, Mike. British Health Care includes Dental care.
by Ziks511 / April 8, 2011 3:12 AM PDT
In reply to: The difference is

I had a crown done there for about a quarter of what it costs in Canada.


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So say you....
by C1ay / April 9, 2011 5:03 AM PDT
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US dental care?
by Roger NC / April 9, 2011 5:12 AM PDT
In reply to: So say you....
Despite the overall improvement in oral health status, gaps in the provision of care remain. Over the 20-year period 1977-96, the gap in the use of services between low-income people (those with incomes under 200 percent of the Federal poverty level) and higher income people (those with incomes over 400 percent of the Federal poverty level) increased.2 The number of preventive visits is below recommended levels, and access to dental care remains problematic for minorities, the elderly, children on Medicaid, and other low-income children. For example:
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by Mike_Hanks / April 9, 2011 6:45 AM PDT
In reply to: US dental care?

That has NOTHING to do with UK dental care

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Oh, I though the idea was to discuss problems with systems,
by Roger NC / April 9, 2011 10:54 AM PDT
In reply to: So?

not just a discussion of one system's defects while forbidding the mention of another. You're technically correct, what is done here and what is done there are separate issues...But you also seem a bit touchy about it.

Actually, there's a lot about government medical or government insurance I don't think I like. But when I look around sometimes, I wonder which list of deficiencies is worse.

So far I've been lucky, I've only had a few periods since I entered the work force full time I wasn't working. And they were all less than 3 months so I could carry COBRA. Expensive, but I managed it. If it had been more than 3 months, I'd probably have been without insurance.

I had a couple of crowns before I had any dental insurance. Even with a steady fair paying job for the time, covering them was a hassle. It helped a lot my dentist was willing to spread part of it out over a few paychecks.

But if I had had an abscess without insurance or a job, I would have had to lose the tooth. Root canals and crowns have never been inexpensive.

While some people are out of work because they won't put forth enough effort, I know some personally that are out in spite of what they're willing to do. I know some working part-time with no insurance because they can't afford it. In the last year, I barely kept my job. The cutoff was actually above me, but three older workers volunteered for layoff to collect their severance, draw unemployment or work part-time for a few months until they officially retired.

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Why stop there
by C1ay / April 6, 2011 4:26 PM PDT
In reply to: And those in the US

If you're going to suggest those without private insurance deserve it at the expense of those that do have it then you might as well advocate that everyone in the world deserves it. Borders shouldn't even matter.

FWIW, Medicare does cover hip replacement in the U.S...

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Yep, that would be a good cause
by MarkFlax Forum moderator / April 6, 2011 9:39 PM PDT
In reply to: Why stop there

Health Care for everyone.

Who do you believe 'doesn't' deserve health care?


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I'd have to respectfully say that your questions is
by Steven Haninger / April 6, 2011 10:22 PM PDT

a bit too broad. We'd need to find a proper definition for the term "health care" and especially as opposed to "medical treatment". I'd consider health care to include such as routine diagnostics, preventive care, consultations and advice by professionals, etc. These are such covered by insurance or "wellness" plans. Medical treatment is another matter. I don't think we do or should deny an accident or heart attack victim some sort of emergency service and there are plenty of free clinics that will offer such as immunizations, some outpatient treatments, etc. But a full fledged health care plan is another matter.

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Perhaps that is where we differ then
by MarkFlax Forum moderator / April 6, 2011 10:36 PM PDT

In Europe we see Health Care as all-encompassing, from birth onwards.

I have no difficulty with that definition and I see no moral reason to refuse anyone health care simply because they are poor and cannot afford it or cannot afford private insurance.

Big differences there.


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I don't know how you feel but I have a problem with
by Steven Haninger / April 7, 2011 10:22 AM PDT

paying for other people's health issues that are due to poor lifestyle choices and I don't expect the same in return if I don't live responsibly. I believe that type of health care is a major bone of contention as we consider blanket (cradle to grave) overage for all.

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Health Care is care provided by or at the direction of a
by Ziks511 / April 8, 2011 2:50 AM PDT

physician. It is Hospital Care, it is Diagnostic Tests, it is rehabilitation or physio therapy (except here in Ontario, the idiots), it is surgery, it is psychiatric care in and out of hospital. It is preventive medicine like seeing your doctor and being prescribed asthma drugs, or blood pressure medication or all the other things that a GP does, and that Specialists do, and that Nurses and Technicians do at the Doctor's request. It includes blood tests and tests of less attractive fluids or substances.

The more you restrict services and the people entitled to them, the more inequality you have in society, and the more they cost per capita.

Obama was profoundly wrong to retreat from a single payer system without a fight, that's the only way to fairly distribute Health Care and to keep costs down.


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