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OK, you're sort of shining a spotlight on my ignorance here, but a few thoughts: 1. Maybe "fully nationalized" isn't technically true, but my understanding was

OK, you're sort of shining a spotlight on my ignorance here, but a few thoughts: 1. Maybe "fully nationalized" isn't technically true, but my understanding was that the UK was widely regarded to have a nationalized healthcare system. Not really interested in whether that's technically true at the margins unless there's some major policy impact. 2. "Cost-effective" is an interesting term, because it assumes we agree on what "effective" means. I want choice, innovation, better health outcomes, more convenience, shorter wait times, etc., and I'm willing to pay some premium (but not 4x or something) for them. For these reasons, I don't want want the NHS system here (nor do I think it'd work here), despite it being better for some values of "cost-effectiveness". 3. If by "cost-effectiveness", you just mean per-capita spending on healthcare, are you sure the NHS is the most cost-effective of any developed country? Doesn't seem to be the case here: https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... -- maybe you're using some more complicated measure of spending per health outcomes?

deleted 9y ago
[deleted]
vidarh 9y ago
> 1. Maybe "fully nationalized" isn't technically true, but my understanding was that the UK was widely regarded to have a nationalized healthcare system. Not really interested in whether that's technically true at the margins unless there's some major policy impact. Which countries do you consider not to have a nationalized healthcare system, then we can make a comparison? Note that even in the US, the government covers roughly half of all healthcare expenditure. The UK government covers about 79%. > 2. "Cost-effective" is an interesting term, because it assumes we agree on what "effective" means. I want choice, innovation, better health outcomes, more convenience, shorter wait times, etc., and I'm willing to pay some premium (but not 4x or something) for them. For these reasons, I don't want want the NHS system here (nor do I think it'd work here), despite it being better for some values of "cost-effectiveness". Even if you for some reason believe you don't get this with the NHS (meanwhile most people here considers the US system to be terrifying), you have all of that by combining the NHS with private top-up insurance. The average cost of combining NHS and private insurance in the UK is far lower than the average cost of healthcare in the US. So you can get the benefits that socializing services have in ensuring universal coverage and ensuring nobody drives up overall costs by waiting until things get more expensive to treat, with the ability to pay for whatever extra services you want. Fewer people go without coverage, and you get cheaper coverage and more choice since you can still pick and choose from private providers but also get a public option if you prefer that. In fact, because of the ability of the NHS to rent out resources, even privately paying for operations etc. tends to be so much cheaper even at top end London specialists that if you're in the US and need elective care it is worth checking the cost of flying to London, having it done, and staying in a nice hotel while recovering. For a lot of conditions that'll be cheaper. Personally I find it telling that it is almost impossible to find people holding your positions in places where people have experienced these socialized systems unless they have the money to pay far more for care that is out of reach of most people. For 3., note that you're referring to PPP adjusted numbers. The UK costs have also increased more the last few years than I realized. Even so, while the PPP adjusted data does not have the UK stand out as much as it used to, the gap between the UK and e.g. the US still illustrates the most important point.
- ryanwaggoner 9y ago
  By "nationalized", I mean where the state owns and employs a significant portion of the healthcare resources and personnel, as opposed to just paying for it. Personally I find it telling that it is almost impossible to find people holding your positions in places where people have experienced these socialized systems unless they have the money to pay far more for care that is out of reach of most people. Really? Then I think you've misunderstood my positions and you might want to try another read through my original comment. Unless you think that every other developed country in the world is clamoring for the exact NHS system? Because my point is that I'd prefer single payer or a robust public option to nationalized systems, not that I want the current US system. note that you're referring to PPP adjusted numbers Yes, because that's what makes sense. Why wouldn't you use PPP-adjusted numbers? the gap between the UK and e.g. the US still illustrates the most important point As I suspected, you're just defending the UK system as being superior to the US system. On this we agree, but it's irrelevant to my broader point. Side note: why are Europeans so freaking defensive about their systems of governance? I swear that you can't have a reasonable discussion online about healthcare, taxes, employment law, etc, etc. without a mob of people from Europe jumping in to assure everyone that their system is the best and the US system for everything is horrible and we all unknowingly live in a terrifying dystopia. We get it, you love the way you do things. I tend to agree on a number of issues, but I'm so tired of the condescending chatter about it. It just comes off as really insecure. I've lived in Europe, I'd do it again, I LOVE Europe, but I don't think you've got it all figured out, or that your systems will always work everywhere. What are you trying so hard to prove?
  - vidarh 9y ago
    > By "nationalized", I mean where the state owns and employs a significant portion of the healthcare resources and personnel, as opposed to just paying for it. In that case the NHS is a lot less nationalized than you might think: a huge proportion of NHS services are provided by private firms under NHS contracts. > Really? Then I think you've misunderstood my positions and you might want to try another read through my original comment. Unless you think that every other developed country in the world is clamoring for the exact NHS system? Because my point is that I'd prefer single payer or a robust public option to nationalized systems, not that I want the current US system. The vast majority of developed countries have systems very similar to the UK, with a mix of public and private service provisions. The exact mix of public and private varies, but then again even in the US about half all healthcare expenditure is through the government. > As I suspected, you're just defending the UK system as being superior to the US system. On this we agree, but it's irrelevant to my broader point. That wasn't anything to "suspect" - it was there in plain sight. But that was also just as an example. Pretty much every developed country have socialized healthcare that is both cheaper and providing proper care for a large proportion of the population than the US system. > Side note: why are Europeans so freaking defensive about their systems of governance? Because the prospect of "US conditions" is terrifying, to the point that "US conditions" is actually a term used in politics in some European countries used to scare voters with the thought of what happens if you let the right wing run rampant over public services. >I swear that you can't have a reasonable discussion online about healthcare, taxes, employment law, etc, etc. without a mob of people from Europe jumping in to assure everyone that their system is the best and the US system for everything is horrible and we all unknowingly live in a terrifying dystopia. Equally, you can't have such a discussion without a bunch of Americans trying to push the kind of deregulation that led to the festering mess that is the US healthcare system. > What are you trying so hard to prove? It's not that we're trying so hard to prove anything. It's that we find it offensive that you let people die on the streets to avoid applying known working solutions out of fear they're too left wing. You don't need to pick the UK solution. Any solution from any of the wealthier developed countries is superior to the US system. And they span the range from almost totally socialized (Norway) to mostly private healthcare with a mix of private and public insurance (Germany, France for example). What they all have in common is that they provide universal coverage and a regulatory system that put people first. Most of them are cheaper than the US. Most of them are

deleted 9y ago

[deleted]

vidarh 9y ago

> 1. Maybe "fully nationalized" isn't technically true, but my understanding was that the UK was widely regarded to have a nationalized healthcare system. Not really interested in whether that's technically true at the margins unless there's some major policy impact. Which countries do you consider not to have a nationalized healthcare system, then we can make a comparison? Note that even in the US, the government covers roughly half of all healthcare expenditure. The UK government covers about 79%. > 2. "Cost-effective" is an interesting term, because it assumes we agree on what "effective" means. I want choice, innovation, better health outcomes, more convenience, shorter wait times, etc., and I'm willing to pay some premium (but not 4x or something) for them. For these reasons, I don't want want the NHS system here (nor do I think it'd work here), despite it being better for some values of "cost-effectiveness". Even if you for some reason believe you don't get this with the NHS (meanwhile most people here considers the US system to be terrifying), you have all of that by combining the NHS with private top-up insurance. The average cost of combining NHS and private insurance in the UK is far lower than the average cost of healthcare in the US. So you can get the benefits that socializing services have in ensuring universal coverage and ensuring nobody drives up overall costs by waiting until things get more expensive to treat, with the ability to pay for whatever extra services you want. Fewer people go without coverage, and you get cheaper coverage and more choice since you can still pick and choose from private providers but also get a public option if you prefer that. In fact, because of the ability of the NHS to rent out resources, even privately paying for operations etc. tends to be so much cheaper even at top end London specialists that if you're in the US and need elective care it is worth checking the cost of flying to London, having it done, and staying in a nice hotel while recovering. For a lot of conditions that'll be cheaper. Personally I find it telling that it is almost impossible to find people holding your positions in places where people have experienced these socialized systems unless they have the money to pay far more for care that is out of reach of most people. For 3., note that you're referring to PPP adjusted numbers. The UK costs have also increased more the last few years than I realized. Even so, while the PPP adjusted data does not have the UK stand out as much as it used to, the gap between the UK and e.g. the US still illustrates the most important point.

ryanwaggoner 9y ago
By "nationalized", I mean where the state owns and employs a significant portion of the healthcare resources and personnel, as opposed to just paying for it. Personally I find it telling that it is almost impossible to find people holding your positions in places where people have experienced these socialized systems unless they have the money to pay far more for care that is out of reach of most people. Really? Then I think you've misunderstood my positions and you might want to try another read through my original comment. Unless you think that every other developed country in the world is clamoring for the exact NHS system? Because my point is that I'd prefer single payer or a robust public option to nationalized systems, not that I want the current US system. note that you're referring to PPP adjusted numbers Yes, because that's what makes sense. Why wouldn't you use PPP-adjusted numbers? the gap between the UK and e.g. the US still illustrates the most important point As I suspected, you're just defending the UK system as being superior to the US system. On this we agree, but it's irrelevant to my broader point. Side note: why are Europeans so freaking defensive about their systems of governance? I swear that you can't have a reasonable discussion online about healthcare, taxes, employment law, etc, etc. without a mob of people from Europe jumping in to assure everyone that their system is the best and the US system for everything is horrible and we all unknowingly live in a terrifying dystopia. We get it, you love the way you do things. I tend to agree on a number of issues, but I'm so tired of the condescending chatter about it. It just comes off as really insecure. I've lived in Europe, I'd do it again, I LOVE Europe, but I don't think you've got it all figured out, or that your systems will always work everywhere. What are you trying so hard to prove?
- vidarh 9y ago
  > By "nationalized", I mean where the state owns and employs a significant portion of the healthcare resources and personnel, as opposed to just paying for it. In that case the NHS is a lot less nationalized than you might think: a huge proportion of NHS services are provided by private firms under NHS contracts. > Really? Then I think you've misunderstood my positions and you might want to try another read through my original comment. Unless you think that every other developed country in the world is clamoring for the exact NHS system? Because my point is that I'd prefer single payer or a robust public option to nationalized systems, not that I want the current US system. The vast majority of developed countries have systems very similar to the UK, with a mix of public and private service provisions. The exact mix of public and private varies, but then again even in the US about half all healthcare expenditure is through the government. > As I suspected, you're just defending the UK system as being superior to the US system. On this we agree, but it's irrelevant to my broader point. That wasn't anything to "suspect" - it was there in plain sight. But that was also just as an example. Pretty much every developed country have socialized healthcare that is both cheaper and providing proper care for a large proportion of the population than the US system. > Side note: why are Europeans so freaking defensive about their systems of governance? Because the prospect of "US conditions" is terrifying, to the point that "US conditions" is actually a term used in politics in some European countries used to scare voters with the thought of what happens if you let the right wing run rampant over public services. >I swear that you can't have a reasonable discussion online about healthcare, taxes, employment law, etc, etc. without a mob of people from Europe jumping in to assure everyone that their system is the best and the US system for everything is horrible and we all unknowingly live in a terrifying dystopia. Equally, you can't have such a discussion without a bunch of Americans trying to push the kind of deregulation that led to the festering mess that is the US healthcare system. > What are you trying so hard to prove? It's not that we're trying so hard to prove anything. It's that we find it offensive that you let people die on the streets to avoid applying known working solutions out of fear they're too left wing. You don't need to pick the UK solution. Any solution from any of the wealthier developed countries is superior to the US system. And they span the range from almost totally socialized (Norway) to mostly private healthcare with a mix of private and public insurance (Germany, France for example). What they all have in common is that they provide universal coverage and a regulatory system that put people first. Most of them are cheaper than the US. Most of them are