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I've always thought that the most damning part of the UK-US comparison is this: The United States government spends substantially more per capita on healthcare

by scarmig 14y ago

I've always thought that the most damning part of the UK-US comparison is this: The United States government spends substantially more per capita on healthcare than the UK (a number which, to be clear, excludes people's private spending and if anything understates things because it doesn't include the cost of tax breaks for employer plans), but fails to guarantee healthcare to everyone and has developed an underclass of people who have substantially worse healthcare than many second world countries. The UK system is, in many ways, unique, in that it's severely underfunded but gets outstanding bang for buck. I wouldn't recommend it here, because I'd be pretty skeptical we could transplant the necessary consensus political support and willingness to say no to stupid treatments.

pacaro 14y ago
Here's my take on the UK health care system - these are just anecdotes, but they are illuminating in their own way. I broke my collarbone (clavicle, whatever) snowboarding - I go to see an orthopedic surgeon, or rather I go to the local hospital's orthopedic department and see somebody who I assume is a surgeon (he was in fact an MRCS) who tells me, "Collarbones heal on their own just fine in about 95% of cases" - my response - "According to this very out of focus x-ray I was given in France, my collarbone is in a gazillion pieces - maybe I'm in the 5%" - to which he replies - "Collarbones heal on their own just fine in about 95% of cases, I can write you a sick note". My nephew, my brother's child, was born with what at the time was assumed to be a hole in the heart but which later turned out to be a particularly obnoxious genetic disorder (CHARGE), my brother and his partner lived in a central London hospital for six months while their son lived on life support and underwent open heart surgery. He will need a fairly high level of medical support his entire life, the cost to his parents $0 - in the US this could bankrupt an extended family.
- scarmig 14y ago
  Lines up well with my impressions of the system. Perhaps my point about not doing stupid treatments was badly phrased, though: your collarbone example is one such treatment, and stupid isn't exactly the right word. Humans seem to have this inborn tendency to always overestimate the effects of medical care. The USA healthcare system thrives on that impulse: if there's any procedure at all that could conceivably do something and you can afford health insurance, you get it, from a full array of pointless tests to highly invasive surgery. In the UK, the system seems to work on the opposite assumption: because every cent spent on healthcare is a cent that the government doesn't have access to, it vigorously refuses treatments if at all possible. Hence, your collarbone example: most collarbones (apparently) heal easily enough on their own, so it's cheaper to assume it will and treat it later than it is to treat all of them to the maximum extent possible. "Death panel" is fairly histrionic, but it does have some validity to it. The issue is that if we want to get the American system's spiraling costs out of control, we need to recognize it doesn't have enough death panels (i.e. a willingness to say, no, it's better to give half-assed or no treatment here and perhaps sacrifice some level of well-being in order to save a couple bucks). I personally believe that people place way too much faith in the ability of medical science to perfect outcomes, and that much of what we do amounts to modern voodoo. So I tend toward thinking that doing the minimum treatment that can be justified is the better way to go.
- thematt 14y ago
  Nonsense, the cost wasn't $0, the price was. Doctor's don't work for free and that money came from somewhere, in that case taxpaying citizens of the UK, of which I assume your brother was one of. It cost him, he just got the bill from the gov't instead of the hospital. I know it may sound pedantic to argue over little words like that, but I think people's lack of understanding around basic economics contributes to the problems we have. Promoting the notion that healthcare can somehow be "free" does little to fix the problems we see in our current system here in the US.

by scarmig 14y ago

pacaro 14y ago

Here's my take on the UK health care system - these are just anecdotes, but they are illuminating in their own way. I broke my collarbone (clavicle, whatever) snowboarding - I go to see an orthopedic surgeon, or rather I go to the local hospital's orthopedic department and see somebody who I assume is a surgeon (he was in fact an MRCS) who tells me, "Collarbones heal on their own just fine in about 95% of cases" - my response - "According to this very out of focus x-ray I was given in France, my collarbone is in a gazillion pieces - maybe I'm in the 5%" - to which he replies - "Collarbones heal on their own just fine in about 95% of cases, I can write you a sick note". My nephew, my brother's child, was born with what at the time was assumed to be a hole in the heart but which later turned out to be a particularly obnoxious genetic disorder (CHARGE), my brother and his partner lived in a central London hospital for six months while their son lived on life support and underwent open heart surgery. He will need a fairly high level of medical support his entire life, the cost to his parents $0 - in the US this could bankrupt an extended family.

scarmig 14y ago
Lines up well with my impressions of the system. Perhaps my point about not doing stupid treatments was badly phrased, though: your collarbone example is one such treatment, and stupid isn't exactly the right word. Humans seem to have this inborn tendency to always overestimate the effects of medical care. The USA healthcare system thrives on that impulse: if there's any procedure at all that could conceivably do something and you can afford health insurance, you get it, from a full array of pointless tests to highly invasive surgery. In the UK, the system seems to work on the opposite assumption: because every cent spent on healthcare is a cent that the government doesn't have access to, it vigorously refuses treatments if at all possible. Hence, your collarbone example: most collarbones (apparently) heal easily enough on their own, so it's cheaper to assume it will and treat it later than it is to treat all of them to the maximum extent possible. "Death panel" is fairly histrionic, but it does have some validity to it. The issue is that if we want to get the American system's spiraling costs out of control, we need to recognize it doesn't have enough death panels (i.e. a willingness to say, no, it's better to give half-assed or no treatment here and perhaps sacrifice some level of well-being in order to save a couple bucks). I personally believe that people place way too much faith in the ability of medical science to perfect outcomes, and that much of what we do amounts to modern voodoo. So I tend toward thinking that doing the minimum treatment that can be justified is the better way to go.
thematt 14y ago
Nonsense, the cost wasn't $0, the price was. Doctor's don't work for free and that money came from somewhere, in that case taxpaying citizens of the UK, of which I assume your brother was one of. It cost him, he just got the bill from the gov't instead of the hospital. I know it may sound pedantic to argue over little words like that, but I think people's lack of understanding around basic economics contributes to the problems we have. Promoting the notion that healthcare can somehow be "free" does little to fix the problems we see in our current system here in the US.