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> but suggesting the NHS isn't perfect is against the religion here I don't know anyone that doesn't complain about the state of the NHS. The only time I've he

> but suggesting the NHS isn't perfect is against the religion here I don't know anyone that doesn't complain about the state of the NHS. The only time I've heard anyone defending it would be when compared to countries without national healthcare (e.g. America).

mytailorisrich 1y ago
That's different. Yes, everyone complains about the state of the NHS but the "religion" is that the NHS may not be criticised itself. So it is in a bad state because it does not receive enough money, that's it, nothing else. Any suggestion that the organisation itself might be improved or, god forbid, that patients might pay is indeed usually seen as "blasphemy".
- jampekka 1y ago
  > god forbid, that patients might pay is indeed usually seen as "blasphemy". There are policies that are wildly popular. Free public healthcare is one of such policies in many countries, and perhaps for a good reason.
  - deleted 1y ago
    [deleted]
- riv991 1y ago
  > So it is in a bad state because it does not receive enough money, that's it In real terms the budget is the largest it's ever been, it's a relic of the time when people worked and died shortly (a decade) after retiring, not when they live for 30+ years longer.
  - vidarh 1y ago
    It's still one of the cheapest healthcare systems among similarly wealthy countries per capita - it's seriously underfunded. To bring it to a comparable level to similarly wealthy countries would take an increase in funding of 20%-30%.
  - nicoburns 1y ago
    > In real terms the budget is the largest it's ever been Which it needs to be given the demographic changes you note. It's about 15% smaller per capita than comparable countries spend. That would suggest that we need to increase the budget if we want comparable service.
    - graemep 1y ago
      That has changed in recent years. Now greater than in France in absolute spend per capita, would need a 7.5% increase to match in terms of GDP. It would still require a 15% increase to match Germany in absolute per capita, but only 8.5% in percentage of GDP. https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locations=FR-DE-GB https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locat... https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?end=2023&locations=FR-DE-GB&start=2000&view=chart https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?end=2...
- TheOtherHobbes 1y ago
  The UK spends about 18% less per capita on the NHS than the EU14 countries do on their health systems. A lot of that money has gone on stealth privatisation through inefficient outsourcing of contract staff and PFI of infrastructure. So the actual standard of care is far lower than the funding suggests. And it has been deliberately run down so a US-style system can be implemented. So yes, the organisation should be improved, but in the exact opposite direction to the one you're suggesting. The UK's real problem is that it's run by an out-of-touch inbred aristocracy with vast inherited wealth, working through a political system which prioritises stealth corruption over public service. They don't see why they should contribute anything to the welfare of the peasants. The obligation is all one way - from the peasants to the gentry. And there's a layer of middle class professionals who have convinced themselves they're the gentry, even though they can't afford to pay their school fees, never mind maintain a huge estate. So - private ownership good, public spending bad. More sensible countries don't have this attitude problem, and are proud their public services actually benefit the public.
  - mytailorisrich 1y ago
    If you go to, say, France, you'll find that healthcare isn't free at the point of use and that the system is much more private than in the UK. I believe this is so in many other European countries, too. So public/NHS vs private/US system is a false dichotomy, and "free at the point of use" is a red herring. Looking at the reactions, this whole threads does exemplifies what the OP said about the NHS being a "religion".
    - dmix 1y ago
      Same with Canada, they have public health insurance run by provinces which private hospitals bill to. While the UK has a giant national public hospital system run across an entire country (NHS England, NHS Scotland etc).
      - vidarh 1y ago
        The UK has NHS trusts that run hospitals etc. For a limited period of time - just a few years -, the trusts in England were reporting to NHS England. NHS England is being abolished. These ca. 200 trusts operate with a great degree of operational independence, though they are public entties. The distinction is important because they are what makes the scale manageable, and it also provides resilience.
ap99 1y ago
I'm an American living in London and I'd gladly return to the US just for the healthcare. Granted I'm in tech so that's steady employment with benefits, but there you go.
- vidarh 1y ago
  Nothing stops you from getting private healthcare here and still end up paying a fraction of the average per capita cost for Americans - the NHS costs about the same per capita as Medicare + Medicaid, and private health insurance is overall cheaper in the UK, because they "fall back" on using the NHS as a first line.
  - xvector 1y ago
    So now he has to pay for the incompetent NHS and healthcare that actually works?
    - vidarh 1y ago
      Just like in the US, where the taxes per capita to pay for Medicare and Medicaid are about the same as for the NHS. Only in the UK this actually provides for universal healthcare, and is far from incompetent. The irony of you replying like this to a comment that replied to an American is stark, as unlike in the US, in the UK the care you get if you opt to go without private care is very viable, and private insurance costs far less than in the US. If anyone should be upset over paying twice, it should be Americans.
- ericmcer 1y ago
  I haven't lived in another country, but I have never had an issue with healthcare in the USA. It does seem like you can step on a landmine if you are negligent, but I have employer paid healthcare now and it works great. When I was low income (during my early 20s) medicaid would legitimately hound me to keep me on it. I actually had an issue because they kept enrolling me after I got I job that no longer required them. I imagine medicaid funding is directly tied to the enrollment count so they are very aggressive about getting people on it. Granted it was trash insurance and most specialists wouldn't take it, but it covered basic care fully.
scarface_74 1y ago
The one country whose healthcare I’ve studied in depth aside from the US is Costa Rica. Our Plan B is to establish permanent residence there and starting next year we will be spending a couple of months there every winter and maybe in July. Costa Rica has an affordable all inclusive public health care system (Caja). But you can also pay for extra for private healthcare. Is it the same in the UK?
- monkey_monkey 1y ago
  > But you can also pay for extra for private healthcare. Is it the same in the UK? Yes
- kennywinker 1y ago
  The main criticism of two tier healthcare systems (public+private) is that it creates an unstable system. The private system steals all the talent, the rich don’t care if the public system is good since they don’t use it, and thus the public system dies a slow death of 1,000 cuts. In canada we’re in a phase where this is just starting. Private clinics (e.g. telus health) have started to pull doctors out of the public system and put them behind subscription paywalls. We’re still paying the majority of their salary, but they can only be accessed if you pay their private overlords a monthly fee.
  - Silhouette 1y ago
    We certainly have this issue in the UK right now. In dentistry in particular there is a problem that basically everyone agrees on which is that the NHS dental contract makes little sense for the dentists providing the care. In many cases they would literally lose money by performing routine treatments on NHS patients and then claiming what allowances they can back from the government. So of course many don't do that and in large areas of the country it is now literally impossible for someone moving there to register with a local NHS dentist because 100% of the surgeries within a reasonable distance are only accepting new private patients. Meanwhile I can register with a private dentist based just a few minutes from my home who offers a full range of treatments and excellent service with near instantaneous responsiveness - at a price that many people in normal jobs can't afford to pay.

mytailorisrich 1y ago

That's different. Yes, everyone complains about the state of the NHS but the "religion" is that the NHS may not be criticised itself. So it is in a bad state because it does not receive enough money, that's it, nothing else. Any suggestion that the organisation itself might be improved or, god forbid, that patients might pay is indeed usually seen as "blasphemy".

jampekka 1y ago
> god forbid, that patients might pay is indeed usually seen as "blasphemy". There are policies that are wildly popular. Free public healthcare is one of such policies in many countries, and perhaps for a good reason.
- deleted 1y ago
  [deleted]
riv991 1y ago
> So it is in a bad state because it does not receive enough money, that's it In real terms the budget is the largest it's ever been, it's a relic of the time when people worked and died shortly (a decade) after retiring, not when they live for 30+ years longer.
- vidarh 1y ago
  It's still one of the cheapest healthcare systems among similarly wealthy countries per capita - it's seriously underfunded. To bring it to a comparable level to similarly wealthy countries would take an increase in funding of 20%-30%.
- nicoburns 1y ago
  > In real terms the budget is the largest it's ever been Which it needs to be given the demographic changes you note. It's about 15% smaller per capita than comparable countries spend. That would suggest that we need to increase the budget if we want comparable service.
  - graemep 1y ago
    That has changed in recent years. Now greater than in France in absolute spend per capita, would need a 7.5% increase to match in terms of GDP. It would still require a 15% increase to match Germany in absolute per capita, but only 8.5% in percentage of GDP. https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locations=FR-DE-GB https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locat... https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?end=2023&locations=FR-DE-GB&start=2000&view=chart https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?end=2...
TheOtherHobbes 1y ago
The UK spends about 18% less per capita on the NHS than the EU14 countries do on their health systems. A lot of that money has gone on stealth privatisation through inefficient outsourcing of contract staff and PFI of infrastructure. So the actual standard of care is far lower than the funding suggests. And it has been deliberately run down so a US-style system can be implemented. So yes, the organisation should be improved, but in the exact opposite direction to the one you're suggesting. The UK's real problem is that it's run by an out-of-touch inbred aristocracy with vast inherited wealth, working through a political system which prioritises stealth corruption over public service. They don't see why they should contribute anything to the welfare of the peasants. The obligation is all one way - from the peasants to the gentry. And there's a layer of middle class professionals who have convinced themselves they're the gentry, even though they can't afford to pay their school fees, never mind maintain a huge estate. So - private ownership good, public spending bad. More sensible countries don't have this attitude problem, and are proud their public services actually benefit the public.
- mytailorisrich 1y ago
  If you go to, say, France, you'll find that healthcare isn't free at the point of use and that the system is much more private than in the UK. I believe this is so in many other European countries, too. So public/NHS vs private/US system is a false dichotomy, and "free at the point of use" is a red herring. Looking at the reactions, this whole threads does exemplifies what the OP said about the NHS being a "religion".
  - dmix 1y ago
    Same with Canada, they have public health insurance run by provinces which private hospitals bill to. While the UK has a giant national public hospital system run across an entire country (NHS England, NHS Scotland etc).
    - vidarh 1y ago
      The UK has NHS trusts that run hospitals etc. For a limited period of time - just a few years -, the trusts in England were reporting to NHS England. NHS England is being abolished. These ca. 200 trusts operate with a great degree of operational independence, though they are public entties. The distinction is important because they are what makes the scale manageable, and it also provides resilience.

ap99 1y ago

I'm an American living in London and I'd gladly return to the US just for the healthcare. Granted I'm in tech so that's steady employment with benefits, but there you go.

vidarh 1y ago
Nothing stops you from getting private healthcare here and still end up paying a fraction of the average per capita cost for Americans - the NHS costs about the same per capita as Medicare + Medicaid, and private health insurance is overall cheaper in the UK, because they "fall back" on using the NHS as a first line.
- xvector 1y ago
  So now he has to pay for the incompetent NHS and healthcare that actually works?
  - vidarh 1y ago
    Just like in the US, where the taxes per capita to pay for Medicare and Medicaid are about the same as for the NHS. Only in the UK this actually provides for universal healthcare, and is far from incompetent. The irony of you replying like this to a comment that replied to an American is stark, as unlike in the US, in the UK the care you get if you opt to go without private care is very viable, and private insurance costs far less than in the US. If anyone should be upset over paying twice, it should be Americans.
ericmcer 1y ago
I haven't lived in another country, but I have never had an issue with healthcare in the USA. It does seem like you can step on a landmine if you are negligent, but I have employer paid healthcare now and it works great. When I was low income (during my early 20s) medicaid would legitimately hound me to keep me on it. I actually had an issue because they kept enrolling me after I got I job that no longer required them. I imagine medicaid funding is directly tied to the enrollment count so they are very aggressive about getting people on it. Granted it was trash insurance and most specialists wouldn't take it, but it covered basic care fully.

scarface_74 1y ago

The one country whose healthcare I’ve studied in depth aside from the US is Costa Rica. Our Plan B is to establish permanent residence there and starting next year we will be spending a couple of months there every winter and maybe in July. Costa Rica has an affordable all inclusive public health care system (Caja). But you can also pay for extra for private healthcare. Is it the same in the UK?

monkey_monkey 1y ago
> But you can also pay for extra for private healthcare. Is it the same in the UK? Yes
kennywinker 1y ago
The main criticism of two tier healthcare systems (public+private) is that it creates an unstable system. The private system steals all the talent, the rich don’t care if the public system is good since they don’t use it, and thus the public system dies a slow death of 1,000 cuts. In canada we’re in a phase where this is just starting. Private clinics (e.g. telus health) have started to pull doctors out of the public system and put them behind subscription paywalls. We’re still paying the majority of their salary, but they can only be accessed if you pay their private overlords a monthly fee.
- Silhouette 1y ago
  We certainly have this issue in the UK right now. In dentistry in particular there is a problem that basically everyone agrees on which is that the NHS dental contract makes little sense for the dentists providing the care. In many cases they would literally lose money by performing routine treatments on NHS patients and then claiming what allowances they can back from the government. So of course many don't do that and in large areas of the country it is now literally impossible for someone moving there to register with a local NHS dentist because 100% of the surgeries within a reasonable distance are only accepting new private patients. Meanwhile I can register with a private dentist based just a few minutes from my home who offers a full range of treatments and excellent service with near instantaneous responsiveness - at a price that many people in normal jobs can't afford to pay.