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Counter point: the NHS in the UK has more government involvement than the US healthcare system. The NHS (despite fairly extreme under-funding) has better healt

Counter point: the NHS in the UK has more government involvement than the US healthcare system. The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US. “Better outcomes” needs more detail: Medical bankruptcies per year: ~200k in US, ~0 in UK. Caveat: bankruptcies often don’t have one clear root cause, the other ~600k bankruptcies per year in the US may or may not have an aspect of healthcare costs. Cost of triple bypass heart surgery: US: $110,000, UK: £8,500 (paid by the taxpayer, not by the patient at the point of care - free for them). (P.s. private healthcare is available in the UK too - the procedure costs around £20,000 privately, payable by the patient or their insurance) Life expectancy… you get the idea.

JumpCrisscross 5y ago
> NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US The American system’s problem is exclusion, not quality of care. If you get care in America, your outcomes are among the best in the world.
- CraigJPerry 5y ago
  Yeah you’re right, s/patients/citizens/
- rg111 5y ago
  Someone told me this a few years back and it stuck with me. "American healthcare is the best in the world like sportscars- Ferrari, Lamborghini, BMW, Bugatti, etc. are the best cars in the world. Surely they both are the bests in the world- but only for the small percentage of people that can actually afford them." This is sad. (Many, including me, wouldn't buy a sportscar even if they could afford one, and sportscars aren't the "best" in their opinion. But this comparison drives the point home.)
- SamoyedFurFluff 5y ago
  I would argue a care that is beyond my affordability is bad quality of care.
- nicoburns 5y ago
  I think you're mostly right. Although there are exceptions. Consider to opioid crisis. That's a case where profit motive directly leads to poorer quality care. Regardless of that, high quality care isn't much good if you can't access it.
bluGill 5y ago
The US government is involved in ways that make it inefficient. For example, I don't get to choose my insurance, the government has ensured that instead my company does for me. While I can in theory get insurance elsewhere I lose a large subsidy in doing so, no insurance I can buy can possibly be a better deal for me, even the company insurance is bad. The incentives for insurance are to ensure that I don't quit, not that it is good healthcare or a good deal.
- andrekandre 5y ago
  > I don't get to choose my insurance, the government has ensured that instead my company does for me. how did that happen?
  - bluGill 5y ago
    I don't know what my company pays for my insurance, but if I opt out of that insurance that money is lost. I know I pay $100/month (not the real number but close), and plans on the government health market start at $800/month (after the tax credit), plus by using the company plan they kick in another $100/month in a HSA match, and HSA money is a tax advantaged investment (AFAIK you can only get in an HSA from your employer). So by using my companies insurance it is like getting an additional $800/month in income (some of which is invested!). I didn't look into details of the insurance market plans, but there were 40 different plans available there for me to choose from (as opposed to the 2 my companies gives me). I suspect that something similar to my work plan is more expensive than the one I listed above. I also suspect that if I was to look at all 40 plans I would choose something that wasn't not similar to the choices I have now. However with the amount of money I'd lose it isn't worth my time to examine my options.
  - syshum 5y ago
    WWII Wage Freezes is where it started, the government regulated that employers could not raise wages so employers started offering services to attract talent, in those days it was having a doctor on site at the factory, or office that employees and there families could see for free. years later that transitioned to comprehensive benefits packages
DrBazza 5y ago
> The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US. It really isn't underfunded. It's grossly inefficient, which is what happens to most if not all publicly funded bodies. It is actually ok to criticise the NHS organization. They're a monopsony, so actually get absolutely gouged by the pharmaceutical companies. They (currently?) refused to recycle crutches, plastic casts and so on. They'll use their own (hospital pharmacy) drugs if you get admitted, and then discharge you with them, even if you have your own dosette box and refuse to take theirs back. My father was discharged with something in the region of £3-5000 pounds of drugs that we threw away on several occasions. As a percentage of GDP, it's roughly the same as most other western countries. Of most interest though is figure 3 in [2] - 80% of UK (NHS) funding came from public money, i.e. tax, and 20% from private money (e.g. insurance). For the US, it's 50% public money (tax), and 50% private money. I'm not sure how much more money the UK general public really thinks the UK government can come up with to keep giving the NHS "more!" money. There's a limit to how much people can be taxed. And compound interest (increase the NHS by 10% per annum!!) means we'd spend all our GDP on the NHS at some point rather quickly. [1] https://www.statista.com/statistics/317708/healthcare-expenditure-as-a-share-of-gdp-in-the-united-kingdom/ https://www.statista.com/statistics/317708/healthcare-expend... [2] https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29 https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
- pydry 5y ago
  >They're a monopsony, so actually get absolutely gouged by the pharmaceutical companies. You've got that exactly back to front. NHS's immense buying power lets them negotiate lower prices for drugs, exactly as medicare used to (before pharma lobbying stripped them of that power). Pretty much any trade deal negotiations with the US involve the UK being asked to dial down NHS buying power on behalf of pharmas by making hospitals responsible for purchasing. >As a percentage of GDP, it's roughly the same as most other western countries. 50% of the US - not because the UK is especially efficient but because the US healthcare is essentially legalized extortion. >I'm not sure how much more money the UK general public really thinks the UK government can come up with to keep giving the NHS "more!" money. There's a limit to how much people can be taxed. The UK public adores the NHS and is one of the few things polls say that people would be happy to fund with tax raises. It's very very popular. In no small part because we can see how much of a racket the US is. The ruling party does not like it, however, which is why it has been slowly degrading service over time as preparation for full privatization in 10-15 years. Part of this has been done by handing over chunks of the NHS to be run privately and incompetently by friends and donors of the party. The problems caused by this backdoor privatization will later be "fixed" with privatization. Whatever the problem, privatization will forever be the answer. The tories argued for an American style healthcare system in 1948 and while they give tacit acknowledgement of the popularity of the NHS their views havent changed (Christopher Chope is a good bellwether of their more unsightly "hidden" views), they still want a US style system.
syshum 5y ago
"better outcomes" when talking about health should be things like 5 year cancer Survival rates, Wait time for Surgery, Wait time for Heart Stints, 5 year heart Attack Survival rates, Wait time for Specialist Care, etc Not bankruptcy statics, or costs
- CraigJPerry 5y ago
  You’re assuming universal access to healthcare then, which is not the case. What is the 5 year survival rate for someone who cannot afford cancer care?
  - syshum 5y ago
    I am not assuming anything at all, people that attempt to inject affordability into the care debate are doing so for disingenuous reasons. The question of affordability is different from the question of quality care, we can solve the affordability problem with out having to lower the over all standard of care which is what you are advocating for, the bringing down of the overall quality of care in an attempt to increase accessibility of care. Ironically putting that faith in the US Federal Government will only result in 1 of those happening.
    - CraigJPerry 5y ago
      >> people that attempt to inject affordability into the care debate are doing so for disingenuous reasons What exactly is disingenuous about wanting more people to live longer with higher “quality of life” for less overall spend on healthcare? You can’t achieve this without resolving the affordability issues. >> which is what you are advocating for, the bringing down of the overall quality of care With all due respect, you’ve made that up to fit with your world view. It’s certainly not something i’ve advocated for. Those triple heart bypass operations i started the thread with - the 10x more expensive US procedure results in 3 year shorter life expectency post operation. It costs more, and it’s not as good a result? (I am being slightly disingenuous at this point - the reason the US outcomes are poorer despite being 10x more expensive for the same operation are due to differences in the health of the average patient - in the UK because healthcare is free at the point of access, there tend to be earlier interventions, in the US there is a marked difference in severity of presentation - ostensibly people wait longer until they’re really unwell before accessing healthcare)
sniperjoe360 5y ago
To add a little nuance, look at the survival for various cancers in the NHS vs the US. Cancer care for example is measurably better in the US in terms of overall survival, early detection, and access to drugs. You "get what you pay for" when it comes to highly specialized care.
- CraigJPerry 5y ago
  >> look at the survival for various cancers in the NHS vs the US The figures i can find ignore people who can’t afford to become cancer patients in the US - there’s an unknown, but suspected large, number of people cut out of the figures in the US making that stat unfairly stacked vs UK (where everyone regardless of affordability gets access). The people who can’t afford in the US are typicslly the ones more pre-disposed to adverse outcomes in that statistic.

JumpCrisscross 5y ago

> NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US The American system’s problem is exclusion, not quality of care. If you get care in America, your outcomes are among the best in the world.

CraigJPerry 5y ago
Yeah you’re right, s/patients/citizens/
rg111 5y ago
Someone told me this a few years back and it stuck with me. "American healthcare is the best in the world like sportscars- Ferrari, Lamborghini, BMW, Bugatti, etc. are the best cars in the world. Surely they both are the bests in the world- but only for the small percentage of people that can actually afford them." This is sad. (Many, including me, wouldn't buy a sportscar even if they could afford one, and sportscars aren't the "best" in their opinion. But this comparison drives the point home.)
SamoyedFurFluff 5y ago
I would argue a care that is beyond my affordability is bad quality of care.
nicoburns 5y ago
I think you're mostly right. Although there are exceptions. Consider to opioid crisis. That's a case where profit motive directly leads to poorer quality care. Regardless of that, high quality care isn't much good if you can't access it.

bluGill 5y ago

The US government is involved in ways that make it inefficient. For example, I don't get to choose my insurance, the government has ensured that instead my company does for me. While I can in theory get insurance elsewhere I lose a large subsidy in doing so, no insurance I can buy can possibly be a better deal for me, even the company insurance is bad. The incentives for insurance are to ensure that I don't quit, not that it is good healthcare or a good deal.

andrekandre 5y ago
> I don't get to choose my insurance, the government has ensured that instead my company does for me. how did that happen?
- bluGill 5y ago
  I don't know what my company pays for my insurance, but if I opt out of that insurance that money is lost. I know I pay $100/month (not the real number but close), and plans on the government health market start at $800/month (after the tax credit), plus by using the company plan they kick in another $100/month in a HSA match, and HSA money is a tax advantaged investment (AFAIK you can only get in an HSA from your employer). So by using my companies insurance it is like getting an additional $800/month in income (some of which is invested!). I didn't look into details of the insurance market plans, but there were 40 different plans available there for me to choose from (as opposed to the 2 my companies gives me). I suspect that something similar to my work plan is more expensive than the one I listed above. I also suspect that if I was to look at all 40 plans I would choose something that wasn't not similar to the choices I have now. However with the amount of money I'd lose it isn't worth my time to examine my options.
- syshum 5y ago
  WWII Wage Freezes is where it started, the government regulated that employers could not raise wages so employers started offering services to attract talent, in those days it was having a doctor on site at the factory, or office that employees and there families could see for free. years later that transitioned to comprehensive benefits packages

DrBazza 5y ago

> The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US. It really isn't underfunded. It's grossly inefficient, which is what happens to most if not all publicly funded bodies. It is actually ok to criticise the NHS organization. They're a monopsony, so actually get absolutely gouged by the pharmaceutical companies. They (currently?) refused to recycle crutches, plastic casts and so on. They'll use their own (hospital pharmacy) drugs if you get admitted, and then discharge you with them, even if you have your own dosette box and refuse to take theirs back. My father was discharged with something in the region of £3-5000 pounds of drugs that we threw away on several occasions. As a percentage of GDP, it's roughly the same as most other western countries. Of most interest though is figure 3 in [2] - 80% of UK (NHS) funding came from public money, i.e. tax, and 20% from private money (e.g. insurance). For the US, it's 50% public money (tax), and 50% private money. I'm not sure how much more money the UK general public really thinks the UK government can come up with to keep giving the NHS "more!" money. There's a limit to how much people can be taxed. And compound interest (increase the NHS by 10% per annum!!) means we'd spend all our GDP on the NHS at some point rather quickly. [1] https://www.statista.com/statistics/317708/healthcare-expenditure-as-a-share-of-gdp-in-the-united-kingdom/ https://www.statista.com/statistics/317708/healthcare-expend... [2] https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29 https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

pydry 5y ago
>They're a monopsony, so actually get absolutely gouged by the pharmaceutical companies. You've got that exactly back to front. NHS's immense buying power lets them negotiate lower prices for drugs, exactly as medicare used to (before pharma lobbying stripped them of that power). Pretty much any trade deal negotiations with the US involve the UK being asked to dial down NHS buying power on behalf of pharmas by making hospitals responsible for purchasing. >As a percentage of GDP, it's roughly the same as most other western countries. 50% of the US - not because the UK is especially efficient but because the US healthcare is essentially legalized extortion. >I'm not sure how much more money the UK general public really thinks the UK government can come up with to keep giving the NHS "more!" money. There's a limit to how much people can be taxed. The UK public adores the NHS and is one of the few things polls say that people would be happy to fund with tax raises. It's very very popular. In no small part because we can see how much of a racket the US is. The ruling party does not like it, however, which is why it has been slowly degrading service over time as preparation for full privatization in 10-15 years. Part of this has been done by handing over chunks of the NHS to be run privately and incompetently by friends and donors of the party. The problems caused by this backdoor privatization will later be "fixed" with privatization. Whatever the problem, privatization will forever be the answer. The tories argued for an American style healthcare system in 1948 and while they give tacit acknowledgement of the popularity of the NHS their views havent changed (Christopher Chope is a good bellwether of their more unsightly "hidden" views), they still want a US style system.

syshum 5y ago

"better outcomes" when talking about health should be things like 5 year cancer Survival rates, Wait time for Surgery, Wait time for Heart Stints, 5 year heart Attack Survival rates, Wait time for Specialist Care, etc Not bankruptcy statics, or costs

CraigJPerry 5y ago
You’re assuming universal access to healthcare then, which is not the case. What is the 5 year survival rate for someone who cannot afford cancer care?
- syshum 5y ago
  I am not assuming anything at all, people that attempt to inject affordability into the care debate are doing so for disingenuous reasons. The question of affordability is different from the question of quality care, we can solve the affordability problem with out having to lower the over all standard of care which is what you are advocating for, the bringing down of the overall quality of care in an attempt to increase accessibility of care. Ironically putting that faith in the US Federal Government will only result in 1 of those happening.
  - CraigJPerry 5y ago
    >> people that attempt to inject affordability into the care debate are doing so for disingenuous reasons What exactly is disingenuous about wanting more people to live longer with higher “quality of life” for less overall spend on healthcare? You can’t achieve this without resolving the affordability issues. >> which is what you are advocating for, the bringing down of the overall quality of care With all due respect, you’ve made that up to fit with your world view. It’s certainly not something i’ve advocated for. Those triple heart bypass operations i started the thread with - the 10x more expensive US procedure results in 3 year shorter life expectency post operation. It costs more, and it’s not as good a result? (I am being slightly disingenuous at this point - the reason the US outcomes are poorer despite being 10x more expensive for the same operation are due to differences in the health of the average patient - in the UK because healthcare is free at the point of access, there tend to be earlier interventions, in the US there is a marked difference in severity of presentation - ostensibly people wait longer until they’re really unwell before accessing healthcare)

sniperjoe360 5y ago

To add a little nuance, look at the survival for various cancers in the NHS vs the US. Cancer care for example is measurably better in the US in terms of overall survival, early detection, and access to drugs. You "get what you pay for" when it comes to highly specialized care.

CraigJPerry 5y ago
>> look at the survival for various cancers in the NHS vs the US The figures i can find ignore people who can’t afford to become cancer patients in the US - there’s an unknown, but suspected large, number of people cut out of the figures in the US making that stat unfairly stacked vs UK (where everyone regardless of affordability gets access). The people who can’t afford in the US are typicslly the ones more pre-disposed to adverse outcomes in that statistic.