5 ms·

> Fantasy, sure, but nobody outside the US would even consider that a remotely plausible premise. Sounds like you've never had a friend or family member die be

> Fantasy, sure, but nobody outside the US would even consider that a remotely plausible premise. Sounds like you've never had a friend or family member die because the NHS found a reason to refuse treatment for their non-terminal cancer. At that point, if you don't want to die, your options are actually more expensive than in the US. Yes, this happens - a lot more than people on HN like to admit. It's one of the reasons that the UK has one of the worst success rates for cancer treatment out of all of Europe.

mcv 7y ago
That is terrible. Why would they refuse treatment for non-terminal cancer? Sounds like this is more a problem with NHS-specific bureaucracy or NHS funding rather than universal healthcare in general, though.
- philwelch 7y ago
  Why is it a random and specific coincidence when a system you like fails but an inherent flaw of the system when a system you dislike fails?
  - mcv 7y ago
    The difference is that one system is designed to heal people, while the other is designed to profit from it. In a system designed for profit, poor people have little or no access to medical care, and anyone who's not filthy rich is at risk of bankruptcy when they're struck by an expensive medical condition. There's a drive to make healing people as expensive as possible, because that means more profit. In this system, people being unable to afford healthcare is by design. If you want better care, it's the system itself that needs to be replaced, because not taking care of people who cannot afford it, is part of the system. For a system designed to heal people, the priority should be to heal people, and to make the cost of doing so as low as possible. In this system, when somehow someone is unable to access healthcare they need, it's a failure of this particular implementation of the system, and something that needs to be fixed. The goal of the system is to take care of everybody.
    - philwelch 7y ago
      > The difference is that one system is designed to heal people, while the other is designed to profit from it. The US system isn’t designed at all. Many if not most hospitals and insurers are non-profits, while others are operated by varying levels of government. The resulting patchwork is regulated on multiple levels of government with a variety of differing policy outcomes, but “profit” is not generally one of them. There are, indeed, for-profit producers of drugs and medical equipment, but this is also true in the UK (GlaxoSmithKline is a British drug company). > For a system designed to heal people, the priority should be to heal people, and to make the cost of doing so as low as possible. In this system, when somehow someone is unable to access healthcare they need, it's a failure of this particular implementation of the system, and something that needs to be fixed. Minimizing cost and maximizing access are, in fact, competing goals. If a certain medical treatment is inherently costly to provide, you have to make a specific choice between cost and access. If you are unwilling to budget for competitive pay for health care professionals, you directly affect the availability of care by risking shortages of these professionals. Likewise if you don’t build enough hospitals. This fundamental constraint applies to all health care systems. I would argue that having the government individually operate each hospital and directly employ each doctor and nurse imposes a heavy administrative burden that is fundamentally impossible to optimize for cost-efficacy. “Failures of implementation” are inevitable and systemic in this model; you may have paved a road with good intentions but that doesn’t mean it leads where you want to go. This is why the NHS is relatively unique even among universal systems and was not broadly replicated even in other European or Commonwealth countries, most of which seem to have better health outcomes. I’m not saying the US system is perfect, or even better for that matter, but countries like Switzerland and a Singapore have systems that are arguably more privatized than the US while providing better outcomes as well. Even most countries with universal health insurance have some private sector involvement. The problems with the US health care system are far more complicated than the oversimplified conspiracy theories people keep spouting (theories that aren’t far off from those of anti-vaxxers or known frauds like Kevin Trudeau).
      - DanBC 7y ago
        > I would argue that having the government individually operate each hospital and directly employ each doctor and nurse imposes a heavy administrative burden That isn't what happens in the English NHS. https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-england-work https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-eng... Current inefficiencies in the NHS are caused by lack of investment in buildings and in staff. The NHS has less management than similarly-sized commercial companies, and none of that management is The Government.

mcv 7y ago

That is terrible. Why would they refuse treatment for non-terminal cancer? Sounds like this is more a problem with NHS-specific bureaucracy or NHS funding rather than universal healthcare in general, though.

philwelch 7y ago
Why is it a random and specific coincidence when a system you like fails but an inherent flaw of the system when a system you dislike fails?
- mcv 7y ago
  The difference is that one system is designed to heal people, while the other is designed to profit from it. In a system designed for profit, poor people have little or no access to medical care, and anyone who's not filthy rich is at risk of bankruptcy when they're struck by an expensive medical condition. There's a drive to make healing people as expensive as possible, because that means more profit. In this system, people being unable to afford healthcare is by design. If you want better care, it's the system itself that needs to be replaced, because not taking care of people who cannot afford it, is part of the system. For a system designed to heal people, the priority should be to heal people, and to make the cost of doing so as low as possible. In this system, when somehow someone is unable to access healthcare they need, it's a failure of this particular implementation of the system, and something that needs to be fixed. The goal of the system is to take care of everybody.
  - philwelch 7y ago
    > The difference is that one system is designed to heal people, while the other is designed to profit from it. The US system isn’t designed at all. Many if not most hospitals and insurers are non-profits, while others are operated by varying levels of government. The resulting patchwork is regulated on multiple levels of government with a variety of differing policy outcomes, but “profit” is not generally one of them. There are, indeed, for-profit producers of drugs and medical equipment, but this is also true in the UK (GlaxoSmithKline is a British drug company). > For a system designed to heal people, the priority should be to heal people, and to make the cost of doing so as low as possible. In this system, when somehow someone is unable to access healthcare they need, it's a failure of this particular implementation of the system, and something that needs to be fixed. Minimizing cost and maximizing access are, in fact, competing goals. If a certain medical treatment is inherently costly to provide, you have to make a specific choice between cost and access. If you are unwilling to budget for competitive pay for health care professionals, you directly affect the availability of care by risking shortages of these professionals. Likewise if you don’t build enough hospitals. This fundamental constraint applies to all health care systems. I would argue that having the government individually operate each hospital and directly employ each doctor and nurse imposes a heavy administrative burden that is fundamentally impossible to optimize for cost-efficacy. “Failures of implementation” are inevitable and systemic in this model; you may have paved a road with good intentions but that doesn’t mean it leads where you want to go. This is why the NHS is relatively unique even among universal systems and was not broadly replicated even in other European or Commonwealth countries, most of which seem to have better health outcomes. I’m not saying the US system is perfect, or even better for that matter, but countries like Switzerland and a Singapore have systems that are arguably more privatized than the US while providing better outcomes as well. Even most countries with universal health insurance have some private sector involvement. The problems with the US health care system are far more complicated than the oversimplified conspiracy theories people keep spouting (theories that aren’t far off from those of anti-vaxxers or known frauds like Kevin Trudeau).
    - DanBC 7y ago
      > I would argue that having the government individually operate each hospital and directly employ each doctor and nurse imposes a heavy administrative burden That isn't what happens in the English NHS. https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-england-work https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-eng... Current inefficiencies in the NHS are caused by lack of investment in buildings and in staff. The NHS has less management than similarly-sized commercial companies, and none of that management is The Government.