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You still pay for it. The costs don't disappear into the ether (although it is definitely true that your exposure to extreme financial risk is substantially red

You still pay for it. The costs don't disappear into the ether (although it is definitely true that your exposure to extreme financial risk is substantially reduced). However, there are downsides. If you have something very wrong with you, and it is somewhat rare (i.e. the medicine is expensive) or not well understood...you are done. The NHS provides universal care but not universal treatment. You go to the doctor, they go shrug can't help you. That is it and there is no "second opinion" (unless you go privately but that doesn't work either in many cases...you are usually seeing the exact same doctor, just paying for it upfront). It is important to recognise that there are trade-offs in every situation. The UK system is, despite the cult-like following, not particularly effective. In terms of outcomes, it is below average by most measurements. It is very cost-effective...but that isn't the only thing that matters.

arethuza 7y ago
I think that's a bit harsh on the NHS - a more reasonable view would perhaps be: “Compared to the other 18 countries the UK has middling funding and middling performance overall. We can be proud of the fact that the UK is a standout nation where people are not put off from seeking care due to cost, and the NHS is cheap to run. But austerity has bitten hard, and the lag of investment shows. If we want to hold our head up high next to our European neighbours we can and must do better.” https://www.nuffieldtrust.org.uk/news-item/nhs-receives-mixed-scorecard-in-major-analysis-of-international-health-systems https://www.nuffieldtrust.org.uk/news-item/nhs-receives-mixe... I don't think anyone thinks that the NHS provides the best healthcare, that's unlikely given the amount we pay for it, but as a country I guess we do have "cult-like" obsession with making sure everyone has access to healthcare.
- hogFeast 7y ago
  I don't think that conclusion is one that follows naturally from the data. And what the report misses out is that in many other countries patients are not put off from seeking care due to cost either...and they achieve better outcomes. They do this through a mix of private and public healthcare which is naturally intolerable to the NHS. Btw, this should be plainly obvious if you actually look at what the data is...it is based on a population sample. If someone sick does not have access to care then that shows in the data. It is a great trick to change the question and say it is about access, it is not one that follows from the data. As a lot of the Nuffield Trust get their staff from the NHS, I am not surprised that they self-importantly included that their work has led to the UK being a "standout nation". The stuff about austerity is utter bullshit. Health spending per person has been growing after inflation at ~2%/year, and as a percentage of GDP health spending is up two points since 2010. Yes, attempts at cuts were made in 2017 (the rate of growth in spending was only ~1%) but that is because the govt had cut literally every other department to the bone first. A reasonable person would question whether that was worthwhile given that it involved large % cuts for the income of vulnerable people (in other departments, and in care budgets) rather than asking doctors to just accept an unchanged or small % drop in salary. Wasn't the recent negotiation for junior doctors a double-digit increase (which they wouldn't even accept and striked multiple times)? The willingness of Brits to not think rationally on this topic (and not realise how much lobbying goes into the maintenance of these views) is baffling.
  - louthy 7y ago
    > And what the report misses out is that in many other countries patients are not put off from seeking care due to cost either...and they achieve better outcomes. They do this through a mix of private and public healthcare which is naturally intolerable to the NHS. It's "naturally intolerable to the NHS" because of its key tenets, which are: * Free at the point of delivery * Equality of care for all i.e. There shouldn't be a tiered system where rich people get more. That leads to distortions and incentives to provide more for rich people and less for the poor. There would also be incentives for governments to start shrinking the pot of cash available to the NHS to make individuals pay more. The ideals I think are correct, and if I don't like them then I can get private healthcare for a significantly lower price than if the NHS didn't exist (because the NHS does all the difficult expensive stuff, like A&E): that means the private providers are protected from some of the worst costs of providing healthcare.
louthy 7y ago
> The NHS provides universal care but not universal treatment. You go to the doctor, they go shrug can't help you. That isn't actually the case. There are certain treatments and drugs that NICE (National Institute for Clinical Excellence) [1] won't sanction due to them either being ineffective or too expensive for the returns, but mostly you will get coverage for pretty much everything. The main issue with the NHS is waiting times, but that can easily be avoided by topping up with private healthcare for about £80pm. So, because of the NHS private healthcare is also cheap. [1] https://www.nice.org.uk/about/what-we-do https://www.nice.org.uk/about/what-we-do
- hogFeast 7y ago
  It is the case. You have just explained part of how that operates (you appear to be incredibly casual about a bureaucrat deciding whether your life will generate a sufficient "return"...is that because you think it can never happen to you?). But, in addition, the NHS has a fixed policy on whether they will treat certain conditions or not (I know this because I look after a relative with one of these conditions). In the US, you can seek a second opinion (from someone who is very specialist). That doesn't and cannot occur in the UK. You can seek a private opinion but you will be seeing the same doctor (who will likely not know anything beyond NHS policy). The only solution in these cases is (usually) to go to a system that has an active private healthcare market (Germany, the US, Netherlands, etc.).
  - louthy 7y ago
    > (you appear to be incredibly casual about a bureaucrat deciding whether your life will generate a sufficient "return"...is that because you think it can never happen to you?). Not at all. I understand that there's a pot of cash and unless we have a government that is going to expand that pot of cash by either raising taxes (which I would be all for) or increasing borrowing that then we need NICE to make some decisions. Their mandate is to consider what's best for the population as a whole, not what's best for the government. It may have let you down, and I really do feel for you and your situation, but the extreme negativity with which you portray the NHS is unwarranted in my opinion. I don't know what condition you're referring to, but if it's chronic then I assume it would likely bankrupt you if you tried treating it in the US. Other aspects of our system that work very well is that NICE can negotiate with the pharmacutical companies for lower rates, because we have the buying power of 65 million people. US hospitals are often negotiating individually and so their costs sprial. > You can seek a private opinion but you will be seeing the same doctor (who will likely not know anything beyond NHS policy) That is far too sweeping a statement, this is the truth map: * There are private only specialists * There are NHS only specialists * There are private only specialists who may do NHS overspil work that a private hospital has tendered for * There are NHS hospitals with 'private wings' where you'll be treated by an NHS specialist Depending on the specialism a specialist may be 'attached' to a private hospital group (like HCA) and you can call up HCA [1] and get a quote for anything you like (that they provide). If you have private insurance then you can get that private work covered if the insurance company is willing to pay for it - just like all insurance healthcare models around the world, or you can pay for it yourself. I have spent the past 15 years building a healthcare software company and work with the biggest private healthcare companies in the UK (and recently with the NHS). [1] https://www.hcahealthcare.co.uk https://www.hcahealthcare.co.uk

arethuza 7y ago

I think that's a bit harsh on the NHS - a more reasonable view would perhaps be: “Compared to the other 18 countries the UK has middling funding and middling performance overall. We can be proud of the fact that the UK is a standout nation where people are not put off from seeking care due to cost, and the NHS is cheap to run. But austerity has bitten hard, and the lag of investment shows. If we want to hold our head up high next to our European neighbours we can and must do better.” https://www.nuffieldtrust.org.uk/news-item/nhs-receives-mixed-scorecard-in-major-analysis-of-international-health-systems https://www.nuffieldtrust.org.uk/news-item/nhs-receives-mixe... I don't think anyone thinks that the NHS provides the best healthcare, that's unlikely given the amount we pay for it, but as a country I guess we do have "cult-like" obsession with making sure everyone has access to healthcare.

hogFeast 7y ago
I don't think that conclusion is one that follows naturally from the data. And what the report misses out is that in many other countries patients are not put off from seeking care due to cost either...and they achieve better outcomes. They do this through a mix of private and public healthcare which is naturally intolerable to the NHS. Btw, this should be plainly obvious if you actually look at what the data is...it is based on a population sample. If someone sick does not have access to care then that shows in the data. It is a great trick to change the question and say it is about access, it is not one that follows from the data. As a lot of the Nuffield Trust get their staff from the NHS, I am not surprised that they self-importantly included that their work has led to the UK being a "standout nation". The stuff about austerity is utter bullshit. Health spending per person has been growing after inflation at ~2%/year, and as a percentage of GDP health spending is up two points since 2010. Yes, attempts at cuts were made in 2017 (the rate of growth in spending was only ~1%) but that is because the govt had cut literally every other department to the bone first. A reasonable person would question whether that was worthwhile given that it involved large % cuts for the income of vulnerable people (in other departments, and in care budgets) rather than asking doctors to just accept an unchanged or small % drop in salary. Wasn't the recent negotiation for junior doctors a double-digit increase (which they wouldn't even accept and striked multiple times)? The willingness of Brits to not think rationally on this topic (and not realise how much lobbying goes into the maintenance of these views) is baffling.
- louthy 7y ago
  > And what the report misses out is that in many other countries patients are not put off from seeking care due to cost either...and they achieve better outcomes. They do this through a mix of private and public healthcare which is naturally intolerable to the NHS. It's "naturally intolerable to the NHS" because of its key tenets, which are: * Free at the point of delivery * Equality of care for all i.e. There shouldn't be a tiered system where rich people get more. That leads to distortions and incentives to provide more for rich people and less for the poor. There would also be incentives for governments to start shrinking the pot of cash available to the NHS to make individuals pay more. The ideals I think are correct, and if I don't like them then I can get private healthcare for a significantly lower price than if the NHS didn't exist (because the NHS does all the difficult expensive stuff, like A&E): that means the private providers are protected from some of the worst costs of providing healthcare.

louthy 7y ago

> The NHS provides universal care but not universal treatment. You go to the doctor, they go shrug can't help you. That isn't actually the case. There are certain treatments and drugs that NICE (National Institute for Clinical Excellence) [1] won't sanction due to them either being ineffective or too expensive for the returns, but mostly you will get coverage for pretty much everything. The main issue with the NHS is waiting times, but that can easily be avoided by topping up with private healthcare for about £80pm. So, because of the NHS private healthcare is also cheap. [1] https://www.nice.org.uk/about/what-we-do https://www.nice.org.uk/about/what-we-do

hogFeast 7y ago
It is the case. You have just explained part of how that operates (you appear to be incredibly casual about a bureaucrat deciding whether your life will generate a sufficient "return"...is that because you think it can never happen to you?). But, in addition, the NHS has a fixed policy on whether they will treat certain conditions or not (I know this because I look after a relative with one of these conditions). In the US, you can seek a second opinion (from someone who is very specialist). That doesn't and cannot occur in the UK. You can seek a private opinion but you will be seeing the same doctor (who will likely not know anything beyond NHS policy). The only solution in these cases is (usually) to go to a system that has an active private healthcare market (Germany, the US, Netherlands, etc.).
- louthy 7y ago
  > (you appear to be incredibly casual about a bureaucrat deciding whether your life will generate a sufficient "return"...is that because you think it can never happen to you?). Not at all. I understand that there's a pot of cash and unless we have a government that is going to expand that pot of cash by either raising taxes (which I would be all for) or increasing borrowing that then we need NICE to make some decisions. Their mandate is to consider what's best for the population as a whole, not what's best for the government. It may have let you down, and I really do feel for you and your situation, but the extreme negativity with which you portray the NHS is unwarranted in my opinion. I don't know what condition you're referring to, but if it's chronic then I assume it would likely bankrupt you if you tried treating it in the US. Other aspects of our system that work very well is that NICE can negotiate with the pharmacutical companies for lower rates, because we have the buying power of 65 million people. US hospitals are often negotiating individually and so their costs sprial. > You can seek a private opinion but you will be seeing the same doctor (who will likely not know anything beyond NHS policy) That is far too sweeping a statement, this is the truth map: * There are private only specialists * There are NHS only specialists * There are private only specialists who may do NHS overspil work that a private hospital has tendered for * There are NHS hospitals with 'private wings' where you'll be treated by an NHS specialist Depending on the specialism a specialist may be 'attached' to a private hospital group (like HCA) and you can call up HCA [1] and get a quote for anything you like (that they provide). If you have private insurance then you can get that private work covered if the insurance company is willing to pay for it - just like all insurance healthcare models around the world, or you can pay for it yourself. I have spent the past 15 years building a healthcare software company and work with the biggest private healthcare companies in the UK (and recently with the NHS). [1] https://www.hcahealthcare.co.uk https://www.hcahealthcare.co.uk