zlacker

> but suggesting the NHS isn't perfect is against the religion here

I don't know anyone that doesn't complain about the state of the NHS. The only time I've heard anyone defending it would be when compared to countries without national healthcare (e.g. America).

>>mijoha+(OP)
That's different. Yes, everyone complains about the state of the NHS but the "religion" is that the NHS may not be criticised itself. So it is in a bad state because it does not receive enough money, that's it, nothing else. Any suggestion that the organisation itself might be improved or, god forbid, that patients might pay is indeed usually seen as "blasphemy".

>>mytail+r2
> god forbid, that patients might pay is indeed usually seen as "blasphemy".

There are policies that are wildly popular. Free public healthcare is one of such policies in many countries, and perhaps for a good reason.

>>mytail+r2
> So it is in a bad state because it does not receive enough money, that's it

In real terms the budget is the largest it's ever been, it's a relic of the time when people worked and died shortly (a decade) after retiring, not when they live for 30+ years longer.

>>mijoha+(OP)
I'm an American living in London and I'd gladly return to the US just for the healthcare.

Granted I'm in tech so that's steady employment with benefits, but there you go.

>>mytail+r2
The UK spends about 18% less per capita on the NHS than the EU14 countries do on their health systems.

A lot of that money has gone on stealth privatisation through inefficient outsourcing of contract staff and PFI of infrastructure.

So the actual standard of care is far lower than the funding suggests. And it has been deliberately run down so a US-style system can be implemented.

So yes, the organisation should be improved, but in the exact opposite direction to the one you're suggesting.

The UK's real problem is that it's run by an out-of-touch inbred aristocracy with vast inherited wealth, working through a political system which prioritises stealth corruption over public service.

They don't see why they should contribute anything to the welfare of the peasants. The obligation is all one way - from the peasants to the gentry.

And there's a layer of middle class professionals who have convinced themselves they're the gentry, even though they can't afford to pay their school fees, never mind maintain a huge estate.

So - private ownership good, public spending bad. More sensible countries don't have this attitude problem, and are proud their public services actually benefit the public.

>>TheOth+R7
If you go to, say, France, you'll find that healthcare isn't free at the point of use and that the system is much more private than in the UK. I believe this is so in many other European countries, too.

So public/NHS vs private/US system is a false dichotomy, and "free at the point of use" is a red herring.

Looking at the reactions, this whole threads does exemplifies what the OP said about the NHS being a "religion".

>>mijoha+(OP)
The one country whose healthcare I’ve studied in depth aside from the US is Costa Rica. Our Plan B is to establish permanent residence there and starting next year we will be spending a couple of months there every winter and maybe in July.

Costa Rica has an affordable all inclusive public health care system (Caja). But you can also pay for extra for private healthcare. Is it the same in the UK?

>>mytail+h9
Same with Canada, they have public health insurance run by provinces which private hospitals bill to. While the UK has a giant national public hospital system run across an entire country (NHS England, NHS Scotland etc).

>>scarfa+o9
> But you can also pay for extra for private healthcare. Is it the same in the UK?

Yes

>>scarfa+o9
The main criticism of two tier healthcare systems (public+private) is that it creates an unstable system. The private system steals all the talent, the rich don’t care if the public system is good since they don’t use it, and thus the public system dies a slow death of 1,000 cuts.

In canada we’re in a phase where this is just starting. Private clinics (e.g. telus health) have started to pull doctors out of the public system and put them behind subscription paywalls. We’re still paying the majority of their salary, but they can only be accessed if you pay their private overlords a monthly fee.

>>riv991+C4
> In real terms the budget is the largest it's ever been

Which it needs to be given the demographic changes you note. It's about 15% smaller per capita than comparable countries spend. That would suggest that we need to increase the budget if we want comparable service.

>>ap99+X4
Nothing stops you from getting private healthcare here and still end up paying a fraction of the average per capita cost for Americans - the NHS costs about the same per capita as Medicare + Medicaid, and private health insurance is overall cheaper in the UK, because they "fall back" on using the NHS as a first line.

>>riv991+C4
It's still one of the cheapest healthcare systems among similarly wealthy countries per capita - it's seriously underfunded.

To bring it to a comparable level to similarly wealthy countries would take an increase in funding of 20%-30%.

>>dmix+ma
The UK has NHS trusts that run hospitals etc. For a limited period of time - just a few years -, the trusts in England were reporting to NHS England. NHS England is being abolished.

These ca. 200 trusts operate with a great degree of operational independence, though they are public entties.

The distinction is important because they are what makes the scale manageable, and it also provides resilience.

>>kennyw+zc
We certainly have this issue in the UK right now. In dentistry in particular there is a problem that basically everyone agrees on which is that the NHS dental contract makes little sense for the dentists providing the care. In many cases they would literally lose money by performing routine treatments on NHS patients and then claiming what allowances they can back from the government. So of course many don't do that and in large areas of the country it is now literally impossible for someone moving there to register with a local NHS dentist because 100% of the surgeries within a reasonable distance are only accepting new private patients. Meanwhile I can register with a private dentist based just a few minutes from my home who offers a full range of treatments and excellent service with near instantaneous responsiveness - at a price that many people in normal jobs can't afford to pay.

>>vidarh+9h
The distinction is important because they are what makes the scale manageable, and it also provides resilience.

Though it also leads to inconsistency and the "postcode lottery" problem where the quality of treatment a patient receives for a specific condition can be extremely variable depending on where they live.

>>kennyw+zc
The issue is the same in the US. A lot of specialist say they aren’t taking new Medicaid patients and a few who don’t accept Medicare.

>>mytail+h9
I guess you're talking about healthcare for the unemployed or non-residents or non-French people, because if you're employed there is additionnal and mandatory healthcare. There's still basic free healthcare if you don't yet fit well in the system but it's like for example to remove a tooth instead of clean it and reconstruct it.

>>domini+uj
No, I am talking about everyone.

> because if you're employed there is additionnal and mandatory healthcare

Yes, if you are employed in the private sector there is now mandatory additional private health insurance to cover what public healthcare does not.

Healthcare isn't free at the point of use in any case. Things may be automatically paid/reimbursed as the case may be. Private sector is much more involved than in the UK, too, starting from GPs who are all private practices.

The point is that it's not because you have to pay at point of use or because things are more private that you end up like in the US. This is an FUD argument against change.

>>Silhou+gi
That's true, but now mitigated at least to some extent by the right to choose (though people are woefully unaware of this, and GP's in my experience never ask so you need to bring it up if you have issues with your local hospital - the NHS could do better at requiring this; in some cases I've been given links to pick treatment provider after being referred, and it'd be nice if that was the norm).

But it's better to have management failings contained to individual trusts, that are monitored, than to have these failing affect the system as a whole. Not least because it does allow patients going elsewhere as a last resorts.

>>mytail+h9
It's not a "religion" to have people disagree with you on philosophical points.

In addition, I'd say most of this thread is a bunch of people debating what issues there are with the NHS (I don't see anyone claiming there aren't any) with some people for it, and some against it.

A fair few people believe that it is the duty of the state to care for individuals, and that one right that people have is free access to healthcare.

If someone expresses that viewpoint I don't think it's fair to say that they're being religious or dogmatic about it, just like it wouldn't be fair for people to argue that your view (which I assume is for a more privatised healthcare system) is religious or dogmatic, it's a simple disagreement.

>>scarfa+o9
Yes. Like no matter what someone thinks about the NHS, it's always affordable, and it's entirely inclusive. And if you want private healthcare, you can absolutely get it. I've had private health insurance at every post-university job I've had, it's a standard offering in tech.

>>nicobu+te
That has changed in recent years. Now greater than in France in absolute spend per capita, would need a 7.5% increase to match in terms of GDP. It would still require a 15% increase to match Germany in absolute per capita, but only 8.5% in percentage of GDP.

https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locat... https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?end=2...

>>ap99+X4
I haven't lived in another country, but I have never had an issue with healthcare in the USA. It does seem like you can step on a landmine if you are negligent, but I have employer paid healthcare now and it works great. When I was low income (during my early 20s) medicaid would legitimately hound me to keep me on it. I actually had an issue because they kept enrolling me after I got I job that no longer required them.

I imagine medicaid funding is directly tied to the enrollment count so they are very aggressive about getting people on it. Granted it was trash insurance and most specialists wouldn't take it, but it covered basic care fully.

>>TheOth+R7
I like the cut of your jib. I see the class system in much the same way but with different analogies. The middle class professionals are like the 'house n-gro' described by Malcolm X and the minimum wage workers are like the 'field n-gro' (not sure we can use that word even in academic discussions given where the UK free speech laws are going!).

There is also a lack of a respected teaching class. With the changes to universities and schools, there is no longer any respect for those with an education and able to teach.

>>ericmc+Qs
This isn’t the story we generally hear - what we hear about us healthcare is that you need a well paid job and even then medicines are ridiculously expensive - like thousands of dollars a month for something that is tens of pounds in the uk.

>>ed_ell+GA
My medication is billed as "thousands per month" but the insurance company pays a different rate than the 'billing' rate and all I pay is $20/month for my biologic infusions. If I didn't have insurance I could enroll in the drug program and get it nearly free. I think its really very rare for the case you mention.

>>ericmc+Qs
If you have a kid that landmine can be larger than you think if you’re at the wrong hospital.

>>mytail+Un
All the GP practices in England are private businesses working under contract to the NHS. Most people don't notice since the majority of services are covered under that contract.

https://www.kingsfund.org.uk/insight-and-analysis/long-reads...

>>ed_ell+GA
The opposite of survivorship bias I guess.

>>ed_ell+GA
Healthcare coverage generally comes with any fulltime job. It's cheap for individuals (I pay about $150/month) but gets more expensive with families, which is a real problem. Most medications are cheap. The only medications I've heard of that are expensive are new ones not yet approved by the insurer. I pay less than $10/month for my medications.

>>harvey+yI
Yes they are but they are indeed service providers as you mention.

That's quite different from a private practice (like a solicitor here) that you pay directly and/or that seeks payment from health insurance.

>>ap99+X4
That’s the entire point of the NHS

>>mytail+h9
I moved to Finland from the UK and found exactly the same thing you mentioned in France. Plus extra layers of beauracracy (there's no national health service, there are public hospitals that send a bill to the public insurer and you get a bill for an excess unless you are absolutely down-and-out. Either way, a nice job program for public administrators). Prescriptions are far more expensive than the UK (your co-pay on them is something like €600 a year)

One nice perk though is that [private, corporate] jobs offer cushy health insurance as part of the deal as standard really so you can go and see one of the many private doctors in their offices at your choice and leisure.

>>ed_ell+GA
That's generally all true. My family's monthly healthcare premiums are about $6000 per month for a family of 6, for a "platinum plan" paid for by my employer. I had my gallbladder out earlier this month, and my out-of-pocket cost (i.e. what I had to pay myself after insurance paid its part) was about $2500 for the same-day surgery without complications where I went home an hour after it was over.

Yes, after paying approximately $70,000 per year in premiums, I still have to pay a couple thousand dollars for routine, non-emergency, common healthcare procedures.

Technology wise, I think we have the greatest healthcare system in the world. Finance wise, it feels like the worst parts of Cyberpunk 2077.

>>vidarh+mf
So now he has to pay for the incompetent NHS and healthcare that actually works?

>>mytail+QT
There are a great many things that the NHS pays practices for on a unit basis which is very much like them seeking payment from an insurer. The system has a far lower administrative cost than the USA model but the contract management process still looks more like a plate of spaghetti and not a circuit diagram.

>>xvecto+q72
Just like in the US, where the taxes per capita to pay for Medicare and Medicaid are about the same as for the NHS. Only in the UK this actually provides for universal healthcare, and is far from incompetent.

The irony of you replying like this to a comment that replied to an American is stark, as unlike in the US, in the UK the care you get if you opt to go without private care is very viable, and private insurance costs far less than in the US.

If anyone should be upset over paying twice, it should be Americans.