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And Germany is one of the countries with relatively good public coverage. I am in the UK, we don't get medicine for some things because it is too expensive: HR

And Germany is one of the countries with relatively good public coverage. I am in the UK, we don't get medicine for some things because it is too expensive: HRT has been in shortage for years, we don't get most newer cancer drugs (it is unrelated to efficacy, it is just too expensive to treat people), epilepsy drugs are the same. Because drug prices here are so low, pharmacies get drugs, and then ship them to Europe to flip. I have relatives who are sick and don't get treated because it is NHS policy not to treat conditions properly (the most well-known one is CFS, the UK's approach to CFS/ME is...unique, and governed heavily by cost). And ofc, lots of money thrown into "cheaper interventions" like public health advertising (coincidentally, the people who run these campaigns are friends with people in the NHS...which is nice for them). Mental health is another area: too expensive, massive underinvestment, even today most of the mental health system is nurses who get a couple of weeks training from psychologists, psychologists are too expensive (somehow, almost no-one who studies psychology in the UK ends up doing clinical work). There is no trade-off. Someone has to pay because doctors don't work for free. The US has a relatively optimal system with targeted universal healthcare that is heavily subsidised by the wealthy. Germany is a derivative of that system with a relatively large private component that subsidises the rest of the system. It is far better to overproduce healthcare for the wealthy, then underproduce it for everyone else. Ofc, "free healthcare" sounds very nice (unless doctors start working for free, the cost of a US public health system would largely be what it is already...Medicare and Medicaid is cheaper...but not by much because doctor and nurses, for one, are relatively well paid...in the UK, nurses make the equivalent of $25k, again no trade-offs).

pasabagi 5y ago
The UK per-capita expenditure on medicine is very low. It's also hamstrung by the choice a few years back to balkanize the NHS (stopping financially successful hospitals from subsidizing unsuccessful ones). My feeling is the NHS is a good institution in an unfortunate political culture. The UK is an essentially conservative state (they have been the ruling party for the vast majority of the last century) which is a poor fit for a pretty radical socialist healthcare system.
- hogFeast 5y ago
  Right, but there is no concept of "financially successful" hospitals because no-one is paying for anything (success is measured in terms of input/output...the UK also does poorly here because we overpay massively for doctors, and underpay everyone else). The reason why medicine expenditure is low is because the system is managed for cost. Systems like Germany, US, Netherlands, Australia are more effective because there is a huge element of subsidy...the UK is about giving everyone the same defective product. Also, the NHS is one of the only things on which there is almost no real political debate in the UK. The BMA is probably the most powerful lobbying group in British politics (and this isn't good, they are one of the more sources of stasis, they have opposed every change in health policy...they also opposed the introduction of the NHS). So the problem is the opposite: if anyone tries to reform the NHS is any way then the political opposition is instant (and the only way someone like Blair did reform at the edges, was to pay off doctors...which ended up costing massive amounts of money and leaving the system in a bigger hole). The main conservative force is the NHS itself...it isn't really radical, it is just a system that doesn't really work but Brits have this weird tribalism built up by tabloids telling people that someone is trying to privatize it (and btw, this is the conclusion of anyone with a brain...the NHS doesn't work well, the wealthy and middle-class need to subsidise the system more heavily but people want a Nordic size state with US taxes...and btw, what people don't understand is that we have US taxes with a public health system that is half the size of the US public health system...so we don't even do that properly). I also wouldn't call it "socialist" either, there is no real subsidy, US healthcare is way more redistributive, it is universal but lots of other healthcare systems in Europe achieve universality with large private systems...so universality really isn't the dealbreaker that people in the US think it is. But most people are die-hard NHS supporters, so it clearly isn't "socialist".
  - pasabagi 5y ago
    Do you seriously think there is a single health secretary or government in the last fifty years that wouldn't privatize the NHS if they thought they could? Sajid Javid literally reads The Fountainhead twice a year - and he's not much more neoliberal than his predecessors. My feeling is it's hard to succeed as an organization when your boss really would like your organization to fail so the free market can step in. And that's been the NHS's situation for most of its history. Nonetheless, there are inherent inefficiencies of private healthcare, even subsidized private healthcare, in that it results in horrific paperwork multiplication and information siloing. In germany, where I live, the amount of paperwork you need to get insurance is insane. There are literally offices full of people in every city doing basically senseless work just to make sure people don't get more healthcare than what they paid for. It's also a strong reason why the UK had such an easy time doing a vaccine rollout - the NHS could just send everybody who was in x age a letter. They also pay far less for medication, because the negotiating position is much stronger. Sure, you can't get a homeopathic suppository from your heilpraktiker, or give birth in a giant bath that's shaped like a vagina, but it delivers a good service for a low price.

pasabagi 5y ago

The UK per-capita expenditure on medicine is very low. It's also hamstrung by the choice a few years back to balkanize the NHS (stopping financially successful hospitals from subsidizing unsuccessful ones). My feeling is the NHS is a good institution in an unfortunate political culture. The UK is an essentially conservative state (they have been the ruling party for the vast majority of the last century) which is a poor fit for a pretty radical socialist healthcare system.

hogFeast 5y ago
Right, but there is no concept of "financially successful" hospitals because no-one is paying for anything (success is measured in terms of input/output...the UK also does poorly here because we overpay massively for doctors, and underpay everyone else). The reason why medicine expenditure is low is because the system is managed for cost. Systems like Germany, US, Netherlands, Australia are more effective because there is a huge element of subsidy...the UK is about giving everyone the same defective product. Also, the NHS is one of the only things on which there is almost no real political debate in the UK. The BMA is probably the most powerful lobbying group in British politics (and this isn't good, they are one of the more sources of stasis, they have opposed every change in health policy...they also opposed the introduction of the NHS). So the problem is the opposite: if anyone tries to reform the NHS is any way then the political opposition is instant (and the only way someone like Blair did reform at the edges, was to pay off doctors...which ended up costing massive amounts of money and leaving the system in a bigger hole). The main conservative force is the NHS itself...it isn't really radical, it is just a system that doesn't really work but Brits have this weird tribalism built up by tabloids telling people that someone is trying to privatize it (and btw, this is the conclusion of anyone with a brain...the NHS doesn't work well, the wealthy and middle-class need to subsidise the system more heavily but people want a Nordic size state with US taxes...and btw, what people don't understand is that we have US taxes with a public health system that is half the size of the US public health system...so we don't even do that properly). I also wouldn't call it "socialist" either, there is no real subsidy, US healthcare is way more redistributive, it is universal but lots of other healthcare systems in Europe achieve universality with large private systems...so universality really isn't the dealbreaker that people in the US think it is. But most people are die-hard NHS supporters, so it clearly isn't "socialist".
- pasabagi 5y ago
  Do you seriously think there is a single health secretary or government in the last fifty years that wouldn't privatize the NHS if they thought they could? Sajid Javid literally reads The Fountainhead twice a year - and he's not much more neoliberal than his predecessors. My feeling is it's hard to succeed as an organization when your boss really would like your organization to fail so the free market can step in. And that's been the NHS's situation for most of its history. Nonetheless, there are inherent inefficiencies of private healthcare, even subsidized private healthcare, in that it results in horrific paperwork multiplication and information siloing. In germany, where I live, the amount of paperwork you need to get insurance is insane. There are literally offices full of people in every city doing basically senseless work just to make sure people don't get more healthcare than what they paid for. It's also a strong reason why the UK had such an easy time doing a vaccine rollout - the NHS could just send everybody who was in x age a letter. They also pay far less for medication, because the negotiating position is much stronger. Sure, you can't get a homeopathic suppository from your heilpraktiker, or give birth in a giant bath that's shaped like a vagina, but it delivers a good service for a low price.