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This isn't correct in the UK under NHS. There's a set amount NHS is willing to pay for drugs and treatment, and beyond that, it's refused altogether. You'd have

This isn't correct in the UK under NHS. There's a set amount NHS is willing to pay for drugs and treatment, and beyond that, it's refused altogether. You'd have to go elsewhere and on your own dime for expensive treatments. Here's a link from the BBC I quickly found but it's widely documented: https://www.bbc.com/news/health-28983924 https://www.bbc.com/news/health-28983924

arcticbull 6y ago
The QALY metric they mention is exactly what I had in mind, actually, very cool. Wealth won't get you better care, or faster care, or different in the NHS. That's the point I was making, and your article supports that position. > "You'd have to go elsewhere and on your own dime for expensive treatments." [In a single payer system there's nowhere else to go.] (retracted)
- grey-area 6y ago
  The majority of single payer systems don't outlaw private care. There are private hospitals in the UK for example. Single payer is about removing insurance companies from the process (saving money), standardising care (saving money, improving outcomes), collective bargaining for drugs (saving money), providing a base level of care to all (saving money and improving QOL). But it doesn't usually forbid spending money on private care. As a result single payer results in similar outcomes for vastly less public money, and almost zero private money spent on healthcare.
  - arcticbull 6y ago
    Indeed, and I retract my final sentence.
    - fraggle_sock 6y ago
      Ideally though, all private healthcare would be banned. Aside from ideological concerns about not giving the wealthy an unfair advantage, this has pragmatic benefit in ensuring that the public healthcare system is up to standard. That is, if the wealthy and powerful are forced to use it too, it means they have skin in the game and won't just use their power to run it into the ground in pursuit of profit or from lack of concern for others.
      - arcticbull 6y ago
        Interestingly, private healthcare isn't banned in Canada but in in reality, there's virtually none of it. The system is designed so that the public sector doesn't subsidize a potential private sector, and without those subsidies, nobody's interested. Personally, I agree with you. Private healthcare should be abolished entirely.
        chordalkeyboard 6y ago
        > Private healthcare should be abolished entirely. Wouldn't this mean using the police to arrest people if, e.g. a person got a doctor to look at them or suggest a treatment for a condition and it wasn't something that had gone through government channels?
        lazyasciiart 6y ago
        Perhaps at an extreme point, but most white collar crime is dealt with by fines and licensing rather than arrests and jail. E.g minimum wage laws.
        chordalkeyboard 6y ago
        But if you refuse to pay the fine on the grounds that you consider it unethical to withhold medical care from someone who requests it, you’d still be subject to incarceration?
        arcticbull 6y ago
        This situation exists today. Let's say I'm a physician, with experience from a foreign country and a years-long unimpeachable track record. What I don't have is a US degree or residency. I'm 100% going to prison if I perform a surgery in my van. Licensing and various other requirements are imposed on physicians in order to practice lawfully. One of those requirements would be not to accept direct payment for services outside the public system. If you do, then you are practicing without a license, and whatever comes of that comes of it. Likely a fine, or license suspension or if you continue to defy the law, prison. Your argument that "you consider it unethical to withhold medical care from someone who requests it" is not a defense today for practicing medicine without a license, and in my scenario, that would not change.
  - varjag 6y ago
    Thing is a good public option decimates the market for advanced private care of the level you have in the US. Here in Norway the private health providers that do exist mostly deal with low-investment, low-asset, high-return cases. They will look into your psoriasis but ain't going to treat your cancer. Fortunately the advanced care in public system is great. Still it's not unheard for patients that can afford it to go to the USA for specific treatments.
    - DanBC 6y ago
      > decimates the market for advanced private care of the level you have in the US. > Still it's not unheard for patients that can afford it to go to the USA for specific treatments. They're often getting very expensive, but not very good, treatment that do not lengthen life nor improve quality of life. Sometimes these treatments reduce length of life or quality of life.
      - varjag 6y ago
        No, I'm talking specifically about things like bleeding edge treatments for late cancer stages accessible only in top U.S. hospitals. Treatments that are still in trials or just approved and not available in Norway yet. Sometimes they would work and sometimes they wouldn't, but in Norway your option then is basically arranging your own funerals.
    - kritiko 6y ago
      https://www.aleris.no/en/cancer-center/cancer/ https://www.aleris.no/en/cancer-center/cancer/ "Aleris’s Cancer Centre (Aleris Kreftsenter) provides a complete range of diagnostic tests and therapies for most types of cancer. We offer the latest cancer drugs and innovative treatments, such as immunotherapy, before they are available in public hospitals."
  - simonh 6y ago
    In fact a single payer system alongside private insurance works really well to keep the private insurance providers honest. Up against a single payer one of their primary value add for most people isn't even better health care per se but better customer service, faster appointments, clear and helpful advice, etc. This is a good deal for the NHS as well because they still get your tax contributions but the private system takes some of the load off them. In theory I'm mostly a Friedmanite. I think he has good reasons for preferring private enterprise for most thing. In theory private enterprise should be able to provide better health care than a public system as well. The problem is politics, lobbying and market distortions always introduce complications and obstacles. Health care is one of those markets where the resources and incentives on the provider side just overwhelm the ability for private individuals to get a fair deal. I'm very glad we have the NHS over here, yes it has inefficiencies and weaknesses but compared to the horror show in the US I think it's far preferable.
- onion2k 6y ago
  In a single payer system there's nowhere else to go. We have private health care in the UK in addition to the national health service (eg https://www.bupa.co.uk/ https://www.bupa.co.uk/). It's insurance-based, and it pays for treatment in hospitals both inside and outside of the NHS. It's even offered as a perk by some employers. Specifically relevant to this HN story, there's access to cancer treatments before they're approved by the NHS and NICE (https://www.bupa.co.uk/health/health-insurance/bupa-cancer-promise https://www.bupa.co.uk/health/health-insurance/bupa-cancer-p...). I realise that some people are politically averse to single payer healthcare, but please read up a bit about how the UK's healthcare system works before posting about it. You're only spreading misinformation if you don't. For clarity - the UK's NHS is a single payer taxation funded, free-at-the-point-of-use healthcare system, but we also have companies that offer parallel private health insurance funded healthcare for anyone who chooses to pay (and yes, that does mean they're paying for the government service and their own private service, but that's just how taxation works).
  - arcticbull 6y ago
    I wasn't commenting on the NHS there, I was making my comments with reference to the Canadian system. I retracted my comment because I made it overly board. If you'd like to learn more about the legality of private cover within the Canadian system you can do so here. [1] In Canada, while in general private cover is not illegal, for covered health services, it roughly speaking does not exist and my statement that you "have nowhere else to go" holds. I can see that my statement was unclear, hence my edit. With respect to the other statement I made, that money won't buy you better care within the NHS is true to the best of my knowledge. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/
    - beagle3 6y ago
      > In Canada, while in general private cover is not illegal, for covered health services, it roughly speaking does not exist and my statement that you "have nowhere else to go" holds. The key is “covered health services”. E.g. a friend who broke his arm in Israel (which has an NHS like medical system) needed to have it cast; a standard plaster cast was covered, but for an extra $150 or so, he was able to pay and get a super-lightweight composite cast material (which he had to buy at a pharmacy down the road himself, but the doctors at the public hospital happily applied). This was about 20 years ago - I suspect the ultra lightweight cast is covered by now as well - but there will always be treatments which may make sense for an individual to pay for, but not for the system. Similarly to the NHS, more money doesn’t buy you better care within the system in Israel; but there is a complementary private system which occasionally can get you better care (and can often get you the same non urgent care faster). The general rule for coverage inclusion in the Israeli system is: if it’s life saving, it is covered. If it’s life extending or quality improving, then a QALYs analysis and budget constraints set the priorities (most proven reasonable cost treatment are indeed covered)
- nr2x 6y ago
  As somebody who paid significant fees out of pocket to see NHS physician in private capacity that is very, very false.
foldr 6y ago
To clarify, the NHS evaluates the cost effectiveness of treatments. It does not set any kind of cap on expenditure per individual (nor is this number even tracked AFAIK). I don't know of any healthcare system that doesn't make some kind of evaluation of cost effectiveness. Insurance companies do this too!
DanBC 6y ago
Your article mentions the cancer drugs fund. In the US companies will happily exploit dying people to extract as much money from them, and their families, as possible. In the UK we recognise that dying people are vulnerable to this form of harm and we put protections in place. The cancer drugs fund was a way to allow the NHS to use newer cancer drugs by reducing the amount of testing needed, and by increasing the amount of money we were will to pay for these meds. After several years we realised that these drugs, while being very expensive, provided no meaningful benefit and often caused harm. Sometimes they degraded quality of life and shortened length of life. https://www.bmj.com/content/357/bmj.j2097 https://www.bmj.com/content/357/bmj.j2097

arcticbull 6y ago

The QALY metric they mention is exactly what I had in mind, actually, very cool. Wealth won't get you better care, or faster care, or different in the NHS. That's the point I was making, and your article supports that position. > "You'd have to go elsewhere and on your own dime for expensive treatments." [In a single payer system there's nowhere else to go.] (retracted)

grey-area 6y ago
The majority of single payer systems don't outlaw private care. There are private hospitals in the UK for example. Single payer is about removing insurance companies from the process (saving money), standardising care (saving money, improving outcomes), collective bargaining for drugs (saving money), providing a base level of care to all (saving money and improving QOL). But it doesn't usually forbid spending money on private care. As a result single payer results in similar outcomes for vastly less public money, and almost zero private money spent on healthcare.
- arcticbull 6y ago
  Indeed, and I retract my final sentence.
  - fraggle_sock 6y ago
    Ideally though, all private healthcare would be banned. Aside from ideological concerns about not giving the wealthy an unfair advantage, this has pragmatic benefit in ensuring that the public healthcare system is up to standard. That is, if the wealthy and powerful are forced to use it too, it means they have skin in the game and won't just use their power to run it into the ground in pursuit of profit or from lack of concern for others.
    - arcticbull 6y ago
      Interestingly, private healthcare isn't banned in Canada but in in reality, there's virtually none of it. The system is designed so that the public sector doesn't subsidize a potential private sector, and without those subsidies, nobody's interested. Personally, I agree with you. Private healthcare should be abolished entirely.
      - chordalkeyboard 6y ago
        > Private healthcare should be abolished entirely. Wouldn't this mean using the police to arrest people if, e.g. a person got a doctor to look at them or suggest a treatment for a condition and it wasn't something that had gone through government channels?
        lazyasciiart 6y ago
        Perhaps at an extreme point, but most white collar crime is dealt with by fines and licensing rather than arrests and jail. E.g minimum wage laws.
        chordalkeyboard 6y ago
        But if you refuse to pay the fine on the grounds that you consider it unethical to withhold medical care from someone who requests it, you’d still be subject to incarceration?
        arcticbull 6y ago
        This situation exists today. Let's say I'm a physician, with experience from a foreign country and a years-long unimpeachable track record. What I don't have is a US degree or residency. I'm 100% going to prison if I perform a surgery in my van. Licensing and various other requirements are imposed on physicians in order to practice lawfully. One of those requirements would be not to accept direct payment for services outside the public system. If you do, then you are practicing without a license, and whatever comes of that comes of it. Likely a fine, or license suspension or if you continue to defy the law, prison. Your argument that "you consider it unethical to withhold medical care from someone who requests it" is not a defense today for practicing medicine without a license, and in my scenario, that would not change.
- varjag 6y ago
  Thing is a good public option decimates the market for advanced private care of the level you have in the US. Here in Norway the private health providers that do exist mostly deal with low-investment, low-asset, high-return cases. They will look into your psoriasis but ain't going to treat your cancer. Fortunately the advanced care in public system is great. Still it's not unheard for patients that can afford it to go to the USA for specific treatments.
  - DanBC 6y ago
    > decimates the market for advanced private care of the level you have in the US. > Still it's not unheard for patients that can afford it to go to the USA for specific treatments. They're often getting very expensive, but not very good, treatment that do not lengthen life nor improve quality of life. Sometimes these treatments reduce length of life or quality of life.
    - varjag 6y ago
      No, I'm talking specifically about things like bleeding edge treatments for late cancer stages accessible only in top U.S. hospitals. Treatments that are still in trials or just approved and not available in Norway yet. Sometimes they would work and sometimes they wouldn't, but in Norway your option then is basically arranging your own funerals.
  - kritiko 6y ago
    https://www.aleris.no/en/cancer-center/cancer/ https://www.aleris.no/en/cancer-center/cancer/ "Aleris’s Cancer Centre (Aleris Kreftsenter) provides a complete range of diagnostic tests and therapies for most types of cancer. We offer the latest cancer drugs and innovative treatments, such as immunotherapy, before they are available in public hospitals."
- simonh 6y ago
  In fact a single payer system alongside private insurance works really well to keep the private insurance providers honest. Up against a single payer one of their primary value add for most people isn't even better health care per se but better customer service, faster appointments, clear and helpful advice, etc. This is a good deal for the NHS as well because they still get your tax contributions but the private system takes some of the load off them. In theory I'm mostly a Friedmanite. I think he has good reasons for preferring private enterprise for most thing. In theory private enterprise should be able to provide better health care than a public system as well. The problem is politics, lobbying and market distortions always introduce complications and obstacles. Health care is one of those markets where the resources and incentives on the provider side just overwhelm the ability for private individuals to get a fair deal. I'm very glad we have the NHS over here, yes it has inefficiencies and weaknesses but compared to the horror show in the US I think it's far preferable.
onion2k 6y ago
In a single payer system there's nowhere else to go. We have private health care in the UK in addition to the national health service (eg https://www.bupa.co.uk/ https://www.bupa.co.uk/). It's insurance-based, and it pays for treatment in hospitals both inside and outside of the NHS. It's even offered as a perk by some employers. Specifically relevant to this HN story, there's access to cancer treatments before they're approved by the NHS and NICE (https://www.bupa.co.uk/health/health-insurance/bupa-cancer-promise https://www.bupa.co.uk/health/health-insurance/bupa-cancer-p...). I realise that some people are politically averse to single payer healthcare, but please read up a bit about how the UK's healthcare system works before posting about it. You're only spreading misinformation if you don't. For clarity - the UK's NHS is a single payer taxation funded, free-at-the-point-of-use healthcare system, but we also have companies that offer parallel private health insurance funded healthcare for anyone who chooses to pay (and yes, that does mean they're paying for the government service and their own private service, but that's just how taxation works).
- arcticbull 6y ago
  I wasn't commenting on the NHS there, I was making my comments with reference to the Canadian system. I retracted my comment because I made it overly board. If you'd like to learn more about the legality of private cover within the Canadian system you can do so here. [1] In Canada, while in general private cover is not illegal, for covered health services, it roughly speaking does not exist and my statement that you "have nowhere else to go" holds. I can see that my statement was unclear, hence my edit. With respect to the other statement I made, that money won't buy you better care within the NHS is true to the best of my knowledge. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/
  - beagle3 6y ago
    > In Canada, while in general private cover is not illegal, for covered health services, it roughly speaking does not exist and my statement that you "have nowhere else to go" holds. The key is “covered health services”. E.g. a friend who broke his arm in Israel (which has an NHS like medical system) needed to have it cast; a standard plaster cast was covered, but for an extra $150 or so, he was able to pay and get a super-lightweight composite cast material (which he had to buy at a pharmacy down the road himself, but the doctors at the public hospital happily applied). This was about 20 years ago - I suspect the ultra lightweight cast is covered by now as well - but there will always be treatments which may make sense for an individual to pay for, but not for the system. Similarly to the NHS, more money doesn’t buy you better care within the system in Israel; but there is a complementary private system which occasionally can get you better care (and can often get you the same non urgent care faster). The general rule for coverage inclusion in the Israeli system is: if it’s life saving, it is covered. If it’s life extending or quality improving, then a QALYs analysis and budget constraints set the priorities (most proven reasonable cost treatment are indeed covered)
nr2x 6y ago
As somebody who paid significant fees out of pocket to see NHS physician in private capacity that is very, very false.

foldr 6y ago

To clarify, the NHS evaluates the cost effectiveness of treatments. It does not set any kind of cap on expenditure per individual (nor is this number even tracked AFAIK). I don't know of any healthcare system that doesn't make some kind of evaluation of cost effectiveness. Insurance companies do this too!

DanBC 6y ago

Your article mentions the cancer drugs fund. In the US companies will happily exploit dying people to extract as much money from them, and their families, as possible. In the UK we recognise that dying people are vulnerable to this form of harm and we put protections in place. The cancer drugs fund was a way to allow the NHS to use newer cancer drugs by reducing the amount of testing needed, and by increasing the amount of money we were will to pay for these meds. After several years we realised that these drugs, while being very expensive, provided no meaningful benefit and often caused harm. Sometimes they degraded quality of life and shortened length of life. https://www.bmj.com/content/357/bmj.j2097 https://www.bmj.com/content/357/bmj.j2097