After Experiencing British And U.S. Health Care, This Family Says Single-Payer Is Abominable

[CaliCat 3,957]

7 hours ago, IDWAF said:

Large number of uninsured?  Only 28 million were uninsured last year, vs. 48 million in 2010.  I thought that number was a move in the right direction? That's less than 9% uninsured in the US.

 

Which is really why we need universal coverage. No American should go without health care. 

[Roper-Harrison 19]

9 hours ago, Bill & Katya said:

This is what amazes me, 66 million in the UK and the NHS is the fifth largest employer in the world.  I wonder how large a similar system would be in the US?  Personally, I am fine with socialized medicine in theory, yes, wait times for anything beyond a GP visit may grow exponentially, and we will now have a government agency instead of an insurance carrier make the decision to proceed with care, but I often wonder if it is sustainable economically?  Sure, sustainability shouldn't matter when it comes to people's healthcare, but it is a fact of life that services have to be paid for regardless of the service.  The other thing that interested me about the OP article is the differences in the NHS services depending on one's location.  How does this get reported in the UK?  I am honestly curious if there is any discussion of the variation in the quality of care across the country?  My other question is if the NHS says to an individual that a treatment is not warranted, does the patient have an appeal, or is there a private medical industry they could turn to without having to travel to another country?

 

I don't know that I or anyone else has an answer to the question of sustainability other than to say that it's a standard that seems to get applied by free market supporters who have difficulty understanding the morality of the various issues they oppose. If you believe as does The Federalist and the author of this particular article that free markets exists and that they eventually solve all human problems, socialized medicine is and always will be anathema. If on the other hand you embrace the concept of certain inalienable human rights and class accessible and affordable healthcare among those rights - as do I - and, further, understand that free markets simply do not exist in the current global economy  - if indeed they ever did - then universal healthcare is an existential necessity. People do seem to find ways of making existential necessities sustainable. Clean air and water might be an example. And there are certainly others all of which would be, and in fact are, roundly condemned in every issue of The Federalist. Sometimes the first step in considering the sustainable nature of something is in considering the source of the arguments being proffered. And I understand that I too am a source.

 

That said - the NHS is not just the fifth largest employer in the world it is also the single largest employer in the UK (England/Scotland/Wales) with about 1.6 million employees. That truly is amazing. And on the face of it I'd say should be subjected to a major amount of scrutiny. But big numbers in and of themselves are not the bottom line. The Federalist article attempts to condemn the idea of universal healthcare on the basis of a couple of anecdotal situations using those particular situations in an attempt to tar the entire system. Poor form; very poor form. 

 

When considering policy to deliver the greatest good to the greatest number it helps to set the anecdotes aside-  good and bad - and consider something a bit more evidentiary. A 2014 study by the US-based Commonwealth Fund is illuminating. You can find it here. And this chart comes from that study:

 

 

As you can see UK ranks 1 or 2 in all but one category - and that one is a bit hard to explain - and as far as cost per person goes is second only to NZ. Every system shown here is universal care except one - the US. You can see where it stands in the rankings. I believe this chart also provides an answer to your question about quality of care. As for a patient's right of appeal - yes, they have a right to second and third opinions and these rights are exercised. Additionally there is a private healthcare market in UK if one cares to available themselves of it. There is certainly no need to travel outside the country to gain access to healthcare that is non-NHS provided. Having said that people do travel abroad for elective healthcare for he simple reason that it's much less expensive. US citizens do the same. If you live in SoCal and need a dental implant you can pay from 3-5k USD for it in US or you can also drive to Tijuana and get first class treatment  - including expedited border crossing in BOTH directions for a fifth that amount. And no, you  won't get mugged.

 

 

[bcking 3,157]

18 hours ago, Roper-Harrison said:

 

I don't know that I or anyone else has an answer to the question of sustainability other than to say that it's a standard that seems to get applied by free market supporters who have difficulty understanding the morality of the various issues they oppose. If you believe as does The Federalist and the author of this particular article that free markets exists and that they eventually solve all human problems, socialized medicine is and always will be anathema. If on the other hand you embrace the concept of certain inalienable human rights and class accessible and affordable healthcare among those rights - as do I - and, further, understand that free markets simply do not exist in the current global economy  - if indeed they ever did - then universal healthcare is an existential necessity. People do seem to find ways of making existential necessities sustainable. Clean air and water might be an example. And there are certainly others all of which would be, and in fact are, roundly condemned in every issue of The Federalist. Sometimes the first step in considering the sustainable nature of something is in considering the source of the arguments being proffered. And I understand that I too am a source.

 

That said - the NHS is not just the fifth largest employer in the world it is also the single largest employer in the UK (England/Scotland/Wales) with about 1.6 million employees. That truly is amazing. And on the face of it I'd say should be subjected to a major amount of scrutiny. But big numbers in and of themselves are not the bottom line. The Federalist article attempts to condemn the idea of universal healthcare on the basis of a couple of anecdotal situations using those particular situations in an attempt to tar the entire system. Poor form; very poor form. 

 

When considering policy to deliver the greatest good to the greatest number it helps to set the anecdotes aside-  good and bad - and consider something a bit more evidentiary. A 2014 study by the US-based Commonwealth Fund is illuminating. You can find it here. And this chart comes from that study:

 

 

As you can see UK ranks 1 or 2 in all but one category - and that one is a bit hard to explain - and as far as cost per person goes is second only to NZ. Every system shown here is universal care except one - the US. You can see where it stands in the rankings. I believe this chart also provides an answer to your question about quality of care. As for a patient's right of appeal - yes, they have a right to second and third opinions and these rights are exercised. Additionally there is a private healthcare market in UK if one cares to available themselves of it. There is certainly no need to travel outside the country to gain access to healthcare that is non-NHS provided. Having said that people do travel abroad for elective healthcare for he simple reason that it's much less expensive. US citizens do the same. If you live in SoCal and need a dental implant you can pay from 3-5k USD for it in US or you can also drive to Tijuana and get first class treatment  - including expedited border crossing in BOTH directions for a fifth that amount. And no, you  won't get mugged.

 

 

Commonwealth Fund is a great organization that produces a lot of really good studies on quality in medicine. Good reference.

 

A couple of points on this topic:

 

1. The fact that the NHS is such a large employer is not really a big deal. Yes it seems crazy how big they are, but if you compared it to the number of people employed in the private health insurance industry PLUS medicare/medicaid in the USA it wouldn't look quite so impressive. Private insurance industry alone employees over 2.5 million people, which doesn't include a lot of hospital system employees, doctors or the public health system we do have in the USA. 

 

The growth of "Non-clinica" support staff in US healthcare has been staggering, and honestly leads to a lot of wasteful spending.

 

 

2. Having a "Public Health System" doesn't automatically create need for medical care that didn't exist prior to the system existing. A common complaint/worry with Obamacare was how inundated doctors and resources would be when suddenly more people would have insurance. The act of obtaining insurance doesn't generate the need for healthcare. That need existed before those people had insurance. The only thing a public health system does is make that need more transparent, and establishes a responsibility to respond to the need instead of just ignore it.

 

Our queues for many procedures in the USA may be shorter, but that is unlikely because we magically better able to get through the same number of cases. Because our care is fragment we have many people who have a need but can't even get into queue for a procedure. That means the queues tend to be shorter, but not because we have handled it better. We just ignore those who can't get in line.

 

Unfortunately studying the "true need" (prevalence) of any particular disorder/disease requiring therapy has a hard time including those who don't present for care, and those who have no insurance are less likely to present for care.

[Tahoma 2,291]

Trump: "I was for universal health care before I wasn't.  Now I have a GREAT plan: throw 20 million people off of  their insurance!!!"

[Amica Nostra 4,803]

31 minutes ago, Tahoma said:

Trump: "I was for universal health care before I wasn't.  Now I have a GREAT plan: throw 20 million people off of  their insurance!!!"

At the end of the day, history will read that Trumps presidency triggered a shift in public opinion that enabled Universal health care.  Not saying it should be that way but we actually have attention on the absurdity of  the situation.  We are paying more and getting less. 

Edited September 8, 2017 by Il Mango Dulce

[Dashinka 23,242]

1 hour ago, bcking said:

Commonwealth Fund is a great organization that produces a lot of really good studies on quality in medicine. Good reference.

 

A couple of points on this topic:

 

1. The fact that the NHS is such a large employer is not really a big deal. Yes it seems crazy how big they are, but if you compared it to the number of people employed in the private health insurance industry PLUS medicare/medicaid in the USA it wouldn't look quite so impressive. Private insurance industry alone employees over 2.5 million people, which doesn't include a lot of hospital system employees, doctors or the public health system we do have in the USA. 

 

The growth of "Non-clinica" support staff in US healthcare has been staggering, and honestly leads to a lot of wasteful spending.

 

 

2. Having a "Public Health System" doesn't automatically create need for medical care that didn't exist prior to the system existing. A common complaint/worry with Obamacare was how inundated doctors and resources would be when suddenly more people would have insurance. The act of obtaining insurance doesn't generate the need for healthcare. That need existed before those people had insurance. The only thing a public health system does is make that need more transparent, and establishes a responsibility to respond to the need instead of just ignore it.

 

Our queues for many procedures in the USA may be shorter, but that is unlikely because we magically better able to get through the same number of cases. Because our care is fragment we have many people who have a need but can't even get into queue for a procedure. That means the queues tend to be shorter, but not because we have handled it better. We just ignore those who can't get in line.

 

Unfortunately studying the "true need" (prevalence) of any particular disorder/disease requiring therapy has a hard time including those who don't present for care, and those who have no insurance are less likely to present for care.

Total curiosity per your point 1.  In the NHS what is the percentage split between clinical and non-clinical employees?

[Dashinka 23,242]

36 minutes ago, Tahoma said:

Trump: "I was for universal health care before I wasn't.  Now I have a GREAT plan: throw 20 million people off of  their insurance!!!"

Actually, I am not sure Trump ever said he was ever against single payer.  Sure he did say Obamacare was bad, but I think he would sign single payer if it were sent to him.  If you have a quote to the contrary I would love to hear it.

[bcking 3,157]

3 minutes ago, Bill & Katya said:

Total curiosity per your point 1.  In the NHS what is the percentage split between clinical and non-clinical employees?

Not sure off the top of my head. I'll look around and get back to you. 

[Dashinka 23,242]

18 minutes ago, bcking said:

Not sure off the top of my head. I'll look around and get back to you. 

Thanks.

[Tahoma 2,291]

13 minutes ago, Bill & Katya said:

Actually, I am not sure Trump ever said he was ever against single payer.  Sure he did say Obamacare was bad, but I think he would sign single payer if it were sent to him.  If you have a quote to the contrary I would love to hear it.

Trump: "I used to support single-payer health care.  Didn't you read the book my ghost writer wrote?  It's called 'The America We Deserve.'  I sang the praises of Canada's and Scotland's health care systems.  Now that I'm in charge, the truth has come out: I support the failed Darwinian market approach."

[bcking 3,157]

5 minutes ago, Bill & Katya said:

Thanks.

For NHS England it's about 50-50 regarding some clinical training (doctors, nurses, EMTs etc all in one group, no clinical training in the other).

 

The chart I linked from US data compares growth of just doctors vs. administrators, so it isn't a direct comparison. We've also seen a huge growth in mid-level providers (PAs/NPs).

[Roper-Harrison 19]

2 hours ago, bcking said:

Our queues for many procedures in the USA may be shorter, but that is unlikely because we magically better able to get through the same number of cases. Because our care is fragment we have many people who have a need but can't even get into queue for a procedure. That means the queues tend to be shorter, but not because we have handled it better. We just ignore those who can't get in line.

This is where the "Equity" point hits in the Commonwealth Study. Queues can always be shortened if the number of eligibles is parsed to a fraction of the population. 

 

And good point on considering the employment levels in the US healthcare system as a whole. Too, if the sustainability of anything can be questioned then the growth of non clinical personnel certainly should rise right to the top of the list.

[bcking 3,157]

Just now, Roper-Harrison said:

This is where the "Equity" point hits in the Commonwealth Study. Queues can always be shortened if the number of eligibles is parsed to a fraction of the population. 

 

And good point on considering the employment levels in the US healthcare system as a whole. Too, if the sustainability of anything can be questioned then the growth of non clinical personnel certainly should rise right to the top of the list.

I find it funny how people find the employment at the NHS surprising without considering how instead of a single organization, we have an entire business sector that has grown to deliver healthcare. The sector here in the USA has millions of people working in it. Insurance companies, CMS, VA, hospital systems, private practices, chronic care facilities. Those are all separated, fragmented and therefore have insane reduncies.

 

While I have no doubt the US-version of an "NHS" would be quite a bit larger than the UK version, it would pale in comparison to what we have now if you were to add everything up.

[Roper-Harrison 19]

1 hour ago, Il Mango Dulce said:

At the end of the day, history will read that Trumps presidency triggered a shift in public opinion that enabled Universal health care.  Not saying it should be that way but we actually have attention on the absurdity of  the situation.

As perverse as it sounds I suspect you're correct. The one thing that trump seems to be expert at is creating chaos. Mainstream pols hate chaos. Predictability is the name of the game. When the center is constantly failing there is no where to hide. Taking action is the only real defense. It will if nothing else be an interesting battle.

[Roper-Harrison 19]

1 hour ago, Bill & Katya said:

Total curiosity per your point 1.  In the NHS what is the percentage split between clinical and non-clinical employees?

Based on a real quick search about 500,000 people make up the non-clinical staff - a little less than one-third of the workforce, which to my mind is not out of line when you stop to take into account the vast infrastructure the NHS incorporates into its operations.