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It’s weird how the argument in America is always socialised healthcare VS private healthcare. Rather than people just demanding non-insane private healthcare. I

It’s weird how the argument in America is always socialised healthcare VS private healthcare. Rather than people just demanding non-insane private healthcare. I have private healthcare here in the UK through work and it costs £150 a month to add my wife too, for one of the best plans around.

tux1968 7y ago
Could it be because it has to compete with the public option, or at least stand up to comparison with it?
- jonplackett 7y ago
  Exactly! Competition is what makes capitalism work, otherwise you just have a monopoly and then everything turns to crap real quick. We have a similar problem in a way with our trains. They’ve all been ‘privatised’ but if only one train company runs your route there can’t be any competition, so our trains suck big time and are really expensive.
  - lordnacho 7y ago
    Not only that, there's also only one Network Rail doing the maintenance. So the local monopoly on passengers relies on another monopoly. End result is it costs upwards of £4k for an annual pass for a half hour train journey. Add to that the fact that nobody would ever allow the trains to cease operating, and you have a really big question mark over what the point of privatizing was?
    - hogFeast 7y ago
      Do you understand what they were like when they were public? Costs have fallen dramatically, prices are actually way down, the govt subsidy is down (although will rise again with HS2), and service quality/output is up. We know this doesn't work because we tried it and it didn't work.
      - lordnacho 7y ago
        I'm willing to entertain that thought, given a source.
        hogFeast 7y ago
        Simple: https://en.wikipedia.org/wiki/Impact_of_the_privatisation_of_British_Rail#/media/File:GBR_rail_passengers_by_year_1830-2015.png https://en.wikipedia.org/wiki/Impact_of_the_privatisation_of... - you can find other information/sources on the same page (not all of it is accurate but that will start you off).
      - jonplackett 7y ago
        This is the usual argument. But it doesn’t hold water. France, Germany, Spain all have cheap, really good government-owned trains - in fact they also operate some of our trains in the UK and use the profit to fund their own trains. Prices have gone up by the maximum operators are allowed to increase them every year (there’s a 1 year exception where I think they were frozen for political reasons) https://www.bbc.co.uk/news/business-49331238 https://www.bbc.co.uk/news/business-49331238 Just because we tried something before and did it badly doesn’t mean it won’t work in future if done well. Execution is everything, right?
        hogFeast 7y ago
        Left out is the specific reason why you think it will work well in the future. Define really good? They are less safe, the prices charged to consumers may be lower but what is the overall subsidy (I understand that you want other people to subsidise your commute...other people tend not to be happy about this), and it is fair to say that UK trains are less punctual but the difference is not massive (and we do come ahead of the nations you mention some years too). The discussion on this in the UK is pathetically weak, and largely a function of trade union lobbying (if you didn't know, the TUC pours money into this cause like nothing else...presumably they just really really care about commuters).
    - jonplackett 7y ago
      The even worse part is that the government funds network rail. So we have privatised the parts that make money and kept public the bit that costs money.
  - matthewmacleod 7y ago
    Competition in the UK railway system isn’t about competition for consumers, but competition for the long-term contracts for operating services. This is a totally valid form of competition and does not mean that a monopoly exists in the sense you seem to think it does.
    - jonplackett 7y ago
      I disagree completely. For a business to be good for customers it needs to be accountable to those customers. These businesses are only accountable to governments and even then only ever X years when the contract comes up for review. Their motivation is therefore to service the government not the customer and the customer suffers.
      - matthewmacleod 7y ago
        Governments are the customers.
- spzb 7y ago
  Possibly, but there's also the fact that private providers in the UK don't usually cover emergency, ICU, primary care or maternity care. It's more of a top-up service to avoid waiting times on the NHS. They also have a tendency to drop their patients who suffer complications after surgery back into the NHS
  - 1PlayerOne 7y ago
    It seems like it is not health insurance, but more of a health scam, if you can be dropped when if they find out you really need the money to pay for "complications."
mprev 7y ago
Private healthcare here (the UK) is subsidised by the NHS, so it’s not a fair comparison. Swiss private healthcare might be closer.
- lordnacho 7y ago
  I've used the Swiss system as well as the NHS and private UK systems. The Swiss seem to have something right. They have actual competition between insurers, though you are restricted to changing supplier at the annual window. Everyone is obliged to buy basic coverage from somewhere, but you can choose. And the obligatory level is fairly cheap, maybe a few hundred CHF per adult per month (kids cost fractions of an adult, basically nothing). You can then add on perks like guaranteed single rooms and such, costing as much as they can get you to pay. In return you get a service that seems magical. My colleague crashed his bike and needed stiches. He was at work in the morning only slightly later than the normal time. The time I needed the emergency room I wondered how on earth that could be room, it was empty. When my wife gave birth it was like a hotel stay, they even fed me (the father) three meals a day for the best part of a week. The NHS these days is super stressed. Everyone seems busy, the halls seem very old and crowded. If you're not bringing in a kid, be prepared to wait. And there's plenty of articles about waiting times and busy staff, which seem believable given I know some of those staff. UK private seems to work nicely if you can pay for it. I had a couple of knee operations, and everything was very comfortable. Barely even saw another patient, and there were lots of people attending to me.
  - hogFeast 7y ago
    I regularly use NHS ER (not personally, fortunately) and it is a joke. The hospital local to me is notorious for fudging waiting time numbers, the longest wait I have had is 36 hours, and even when it is literally deserted it will still be 6-8 hours...I have no idea why or how (there are tons of staff, quite what they are doing is unclear). Also, I live in Scotland where the NHS has been getting more money for a while...still awful. The NHS drop massive wedges of cash on vanity projects (always over budget, usually issues because of poor project management) but never hit waiting time targets. Definitely, there is an issue with care and old people having to stay in hospital...but there is also something far deeper (my area is rural, total population of 30-40k...the NHS just dropped £75m on a ten-ward hospital...I go there four or five times a week, 75-80% of the people you see walking around are staff). I don't know what the solution is, I just know that other countries do it better and they have larger private sectors.
xenospn 7y ago
In Israel, I had mandatory healthcare that I paid taxes for (about $100 a month) and additional private coverage for about $5 or $20/month (can't remember how much) and thats all you'd ever spend on anything. Even hospital parking was reimbursed. People in the US act like it's either/or, but why can't it be like USPS and UPS? USPS works fine for 99.9% of all deliveries and you can pay extra for UPS if you want to. Healthcare should be the same - Why would I go to a private doctor for a simple throat culture? Makes absolutely no sense.
- jonplackett 7y ago
  It’s a good comparison and thanks for the info on Israel system.
OnlineCourage 7y ago
One third of our healthcare by cost is socialized in the US, and yet people seem to not understand that basic fact. There is no anti-socialism debate, it already is one third socialism.
- hogFeast 7y ago
  It is also a little bit more complex than that because, of course, by cost means you underweight the size of the public sector which typically pays far lower prices. As an outside observer, charging the private sector more is a smart way of subsidising the public sector. (No-one seems to have actually read the article, it says that her insurer would have paid ~$650 if the lab wasn't one owned by the doctor she saw...and, if I understood correctly, the doctor also did a whole bunch of totally unnecessary testing...this looks a bit like plain ol corruption).
lend000 7y ago
People regularly oversimplify this problem as socialized vs private healthcare without considering why American healthcare is so broken. If you look carefully at the problems, you see that they won't go away if the government replaces private insurance and expands Medicare for everyone. These problems include a tremendous shortage of doctors [0]. Even Canada and the UK have more doctors per capita, and they are known for extremely high wait times (the jokes of the socialized medicine countries, so to speak). There are a number of possible reasons for this, most notably the hassle of occupational licensing (12-14 years of expensive college + 'indentured servitude' residency in the US). Nonetheless, American healthcare science is still ahead of the curve and subsidizes socialized countries -- ~60% of all new drugs between 2001-2010 were invented in the US, and foreign dignitaries of socialized medicine countries often still get important procedures done in the US [1]. It would be interesting to see how the R&D dynamic plays out if America loses its market incentive to innovate in the space, and no other developed countries have the financial incentive left. [0] https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?end=2018&most_recent_value_desc=true&start=1986 https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?end=2018... [1] https://xconomy.com/seattle/2014/09/02/which-countries-excel-in-creating-new-drugs-its-complicated/ https://xconomy.com/seattle/2014/09/02/which-countries-excel...
- keenmaster 7y ago
  Our medical licensing system isn’t “indentured servitude” in the long run. It is convoluted precisely to benefit medical practitioners by artificially decreasing the supply of labor and reducing competition. Medical organizations largely want our med school and residency status quo to remain. Only recently, after bizarrely warning of an impending doctor surplus in the 90’s, have they stopped lobbying against increases in the number of residency positions.
BookmarkSaver 7y ago
>Rather than people just demanding non-insane private healthcare There is no such thing. A free market for healthcare will end up with people being trapped or simply lacking access. The entire concept of insurance is just a middle-man on a necessary service, one which should be considered a right for a society as rich as ours. You either massively regulate private companies to force them to cover sick poor people at a big loss and compensate by making healthy people pay more, or you just get rid of the middleman and cover everyone directly (single payer). Seriously, what value do insurance companies provide? How is it not just rent-seeking on people's health?
matthewmacleod 7y ago
Private health insurance in the UK is not comparable to a fully private health system, and you can’t draw any conclusions from the cost of your coverage. Private insurance here mostly covers some specialist referrals, faster access to scans and treatment, and private hospital access. Acute services and long-term conditions are still handled by the NHS.

tux1968 7y ago

Could it be because it has to compete with the public option, or at least stand up to comparison with it?

jonplackett 7y ago
Exactly! Competition is what makes capitalism work, otherwise you just have a monopoly and then everything turns to crap real quick. We have a similar problem in a way with our trains. They’ve all been ‘privatised’ but if only one train company runs your route there can’t be any competition, so our trains suck big time and are really expensive.
- lordnacho 7y ago
  Not only that, there's also only one Network Rail doing the maintenance. So the local monopoly on passengers relies on another monopoly. End result is it costs upwards of £4k for an annual pass for a half hour train journey. Add to that the fact that nobody would ever allow the trains to cease operating, and you have a really big question mark over what the point of privatizing was?
  - hogFeast 7y ago
    Do you understand what they were like when they were public? Costs have fallen dramatically, prices are actually way down, the govt subsidy is down (although will rise again with HS2), and service quality/output is up. We know this doesn't work because we tried it and it didn't work.
    - lordnacho 7y ago
      I'm willing to entertain that thought, given a source.
      - hogFeast 7y ago
        Simple: https://en.wikipedia.org/wiki/Impact_of_the_privatisation_of_British_Rail#/media/File:GBR_rail_passengers_by_year_1830-2015.png https://en.wikipedia.org/wiki/Impact_of_the_privatisation_of... - you can find other information/sources on the same page (not all of it is accurate but that will start you off).
    - jonplackett 7y ago
      This is the usual argument. But it doesn’t hold water. France, Germany, Spain all have cheap, really good government-owned trains - in fact they also operate some of our trains in the UK and use the profit to fund their own trains. Prices have gone up by the maximum operators are allowed to increase them every year (there’s a 1 year exception where I think they were frozen for political reasons) https://www.bbc.co.uk/news/business-49331238 https://www.bbc.co.uk/news/business-49331238 Just because we tried something before and did it badly doesn’t mean it won’t work in future if done well. Execution is everything, right?
      - hogFeast 7y ago
        Left out is the specific reason why you think it will work well in the future. Define really good? They are less safe, the prices charged to consumers may be lower but what is the overall subsidy (I understand that you want other people to subsidise your commute...other people tend not to be happy about this), and it is fair to say that UK trains are less punctual but the difference is not massive (and we do come ahead of the nations you mention some years too). The discussion on this in the UK is pathetically weak, and largely a function of trade union lobbying (if you didn't know, the TUC pours money into this cause like nothing else...presumably they just really really care about commuters).
  - jonplackett 7y ago
    The even worse part is that the government funds network rail. So we have privatised the parts that make money and kept public the bit that costs money.
- matthewmacleod 7y ago
  Competition in the UK railway system isn’t about competition for consumers, but competition for the long-term contracts for operating services. This is a totally valid form of competition and does not mean that a monopoly exists in the sense you seem to think it does.
  - jonplackett 7y ago
    I disagree completely. For a business to be good for customers it needs to be accountable to those customers. These businesses are only accountable to governments and even then only ever X years when the contract comes up for review. Their motivation is therefore to service the government not the customer and the customer suffers.
    - matthewmacleod 7y ago
      Governments are the customers.
spzb 7y ago
Possibly, but there's also the fact that private providers in the UK don't usually cover emergency, ICU, primary care or maternity care. It's more of a top-up service to avoid waiting times on the NHS. They also have a tendency to drop their patients who suffer complications after surgery back into the NHS
- 1PlayerOne 7y ago
  It seems like it is not health insurance, but more of a health scam, if you can be dropped when if they find out you really need the money to pay for "complications."

mprev 7y ago

Private healthcare here (the UK) is subsidised by the NHS, so it’s not a fair comparison. Swiss private healthcare might be closer.

lordnacho 7y ago
I've used the Swiss system as well as the NHS and private UK systems. The Swiss seem to have something right. They have actual competition between insurers, though you are restricted to changing supplier at the annual window. Everyone is obliged to buy basic coverage from somewhere, but you can choose. And the obligatory level is fairly cheap, maybe a few hundred CHF per adult per month (kids cost fractions of an adult, basically nothing). You can then add on perks like guaranteed single rooms and such, costing as much as they can get you to pay. In return you get a service that seems magical. My colleague crashed his bike and needed stiches. He was at work in the morning only slightly later than the normal time. The time I needed the emergency room I wondered how on earth that could be room, it was empty. When my wife gave birth it was like a hotel stay, they even fed me (the father) three meals a day for the best part of a week. The NHS these days is super stressed. Everyone seems busy, the halls seem very old and crowded. If you're not bringing in a kid, be prepared to wait. And there's plenty of articles about waiting times and busy staff, which seem believable given I know some of those staff. UK private seems to work nicely if you can pay for it. I had a couple of knee operations, and everything was very comfortable. Barely even saw another patient, and there were lots of people attending to me.
- hogFeast 7y ago
  I regularly use NHS ER (not personally, fortunately) and it is a joke. The hospital local to me is notorious for fudging waiting time numbers, the longest wait I have had is 36 hours, and even when it is literally deserted it will still be 6-8 hours...I have no idea why or how (there are tons of staff, quite what they are doing is unclear). Also, I live in Scotland where the NHS has been getting more money for a while...still awful. The NHS drop massive wedges of cash on vanity projects (always over budget, usually issues because of poor project management) but never hit waiting time targets. Definitely, there is an issue with care and old people having to stay in hospital...but there is also something far deeper (my area is rural, total population of 30-40k...the NHS just dropped £75m on a ten-ward hospital...I go there four or five times a week, 75-80% of the people you see walking around are staff). I don't know what the solution is, I just know that other countries do it better and they have larger private sectors.

xenospn 7y ago

In Israel, I had mandatory healthcare that I paid taxes for (about $100 a month) and additional private coverage for about $5 or $20/month (can't remember how much) and thats all you'd ever spend on anything. Even hospital parking was reimbursed. People in the US act like it's either/or, but why can't it be like USPS and UPS? USPS works fine for 99.9% of all deliveries and you can pay extra for UPS if you want to. Healthcare should be the same - Why would I go to a private doctor for a simple throat culture? Makes absolutely no sense.

jonplackett 7y ago
It’s a good comparison and thanks for the info on Israel system.

OnlineCourage 7y ago

One third of our healthcare by cost is socialized in the US, and yet people seem to not understand that basic fact. There is no anti-socialism debate, it already is one third socialism.

hogFeast 7y ago
It is also a little bit more complex than that because, of course, by cost means you underweight the size of the public sector which typically pays far lower prices. As an outside observer, charging the private sector more is a smart way of subsidising the public sector. (No-one seems to have actually read the article, it says that her insurer would have paid ~$650 if the lab wasn't one owned by the doctor she saw...and, if I understood correctly, the doctor also did a whole bunch of totally unnecessary testing...this looks a bit like plain ol corruption).

lend000 7y ago

People regularly oversimplify this problem as socialized vs private healthcare without considering why American healthcare is so broken. If you look carefully at the problems, you see that they won't go away if the government replaces private insurance and expands Medicare for everyone. These problems include a tremendous shortage of doctors [0]. Even Canada and the UK have more doctors per capita, and they are known for extremely high wait times (the jokes of the socialized medicine countries, so to speak). There are a number of possible reasons for this, most notably the hassle of occupational licensing (12-14 years of expensive college + 'indentured servitude' residency in the US). Nonetheless, American healthcare science is still ahead of the curve and subsidizes socialized countries -- ~60% of all new drugs between 2001-2010 were invented in the US, and foreign dignitaries of socialized medicine countries often still get important procedures done in the US [1]. It would be interesting to see how the R&D dynamic plays out if America loses its market incentive to innovate in the space, and no other developed countries have the financial incentive left. [0] https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?end=2018&most_recent_value_desc=true&start=1986 https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?end=2018... [1] https://xconomy.com/seattle/2014/09/02/which-countries-excel-in-creating-new-drugs-its-complicated/ https://xconomy.com/seattle/2014/09/02/which-countries-excel...

keenmaster 7y ago
Our medical licensing system isn’t “indentured servitude” in the long run. It is convoluted precisely to benefit medical practitioners by artificially decreasing the supply of labor and reducing competition. Medical organizations largely want our med school and residency status quo to remain. Only recently, after bizarrely warning of an impending doctor surplus in the 90’s, have they stopped lobbying against increases in the number of residency positions.

BookmarkSaver 7y ago

>Rather than people just demanding non-insane private healthcare There is no such thing. A free market for healthcare will end up with people being trapped or simply lacking access. The entire concept of insurance is just a middle-man on a necessary service, one which should be considered a right for a society as rich as ours. You either massively regulate private companies to force them to cover sick poor people at a big loss and compensate by making healthy people pay more, or you just get rid of the middleman and cover everyone directly (single payer). Seriously, what value do insurance companies provide? How is it not just rent-seeking on people's health?

matthewmacleod 7y ago

Private health insurance in the UK is not comparable to a fully private health system, and you can’t draw any conclusions from the cost of your coverage. Private insurance here mostly covers some specialist referrals, faster access to scans and treatment, and private hospital access. Acute services and long-term conditions are still handled by the NHS.