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Subject: Health Care
Jimme    10/23/2007 2:51:42 AM
I was reading the "required defense spending" thread and I read some of the figures for the UK's health Care spending and I have to tell you it seams a bit excessive. At $180 Billion for a population of 60 million, that comes to around $3,000 per person. Or around the same exact price as private health insurance cost for an Individual. This really caught my attention because as a small business owner who has always believed in nothing but the best health care coverage for my employees(I even splurge for full dental) I was recently shopping around for a new plan. I noticed there are great deals with good coverage to be had if you only look and bargain a little. With this in mind I was thinking might not UK's interest be better served if it switched to a private health care system and just paid the private insurance premiums for all but the rich? I think you could save at least 30% Since a family can be grouped together for around $8,000 instead of $3k per person. Even a family of 3 would save $1,000 and a family of 5 $7k. Now I really don't know exactly how your system works but I have heard of long wait times for basic care and even longer for dental. Maybe a move to privatization would move things to more of a US type system where I can basically see my doctor tomorrow if I really had to, or by the end of the week if it could wait. So what do you guys think, now I may be ignorant and might have things all wrong so please excuse me if that is the case. I would be interested to know exactly how you Health Care system does work in any case. Do you have PCPs, if not who administers your primary care. If you wanted to see your doctor or a doctor, what would it involve to schedule an appointment. How is dental care handled. How are prescriptions handled?
 
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Council34c       10/23/2007 6:51:00 AM
Yes it would be better but that isn't the point, the point is to have a huge monolith sucking up all the otherwise useless underemployed and make it look like they have jobs. As a side note it also helps to suck the money out of hard working people as if we can't all be rich the government thinks we should all be poor.
On a serious and far more liberal note however breaking up the NHS would be almost impossible, it is tied together by an impossible weave of bureaucracy, and even if you could privitise would you, I get the feeling that somehow the poor would left by the wayside in terms of quality as hospitals strove to get people to change from poor paying state insurance to generous private heath insurance. Besides the idea of people being kicked out of a hospital for not having insurance is capitalism taken too far.
 
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interestedamateur       10/23/2007 8:26:49 AM
I have just worked for a healthcare charity, so although I'm no expert I do know a fair amount about the NHS.
 
It isn't perfect, yes you do have to wait for doctors, we have problems with dirty wards etc. However it is fair, and that is something I suspect that the US system is not. It is also generally very good for acute problems (i.e major surgery etc) and those people needing serious support will receive a very professional service. One thing I will say is that I think that it gets a very bad press - it could be better for sure but it isn't as bad as is made out and has massively improved over the past 5 years.
 
The problem is that as the NHS improves health, people live longer - average life span in the UK is rising by one year per year. As people grow older, they need more healthcare! This basic fact means that the NHS will never have all of the resources it needs because it is playing continual catch-up with an ever increasing number of elderly ill people.
 
To answer your questions; NHS structure is routinely changed by the government, but primary care is managed locally by "Primary Care Trusts" which are usually groups of hospitals which will organise the levels of services needed for their community (i.e number of acute wards for instance). In Hertfordshire where I live (population c. 750,000 people) there are 2 PCT's. Doctors and other services (such as counselling, complementary therapy, mental health units etc) contract to the PCT's.
 
For a medical emergency, you would go to the local hospital  A & E (accidents and emergency) unit - I did so recently for chest pains (turned out to be muscle strain only thank god). For a doctors appointment ring your local surgery which you have registered with. Seeing a doctor can take a couple of weeks depending upon the problem - I usually see mine within about 3 days. Dentistry is a real problem - much of this is now conducted outside of the NHS - it is one of those areas which has suffered as their simply isn't enough money to go around. Prescriptions are generally written by doctors and picked up from a pharmacy - there is usually a charge.
 
So there you go Jimme - a bit of good and a bit of bad. The NHS is undoubtedly expensive, very bureaucratic, and imperfect, but the poorest people in society will get a top class service. It's hard to change - it's the largest employer in Europe, but you basically get what you pay for and I don't think there's any real appetite in UK to move too far to the US system. Would the UK be better off if we saved the money and gave it back to people to use it in an insurance scheme - well wealthy people would! That of course is the rub - I hope you've got a sense from my email about the fairness of the system - it's expensive but is something we in the UK can be proud of.
 
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Jimme       10/24/2007 12:45:42 AM

Yes it would be better but that isn't the point, the point is to have a huge monolith sucking up all the otherwise useless underemployed and make it look like they have jobs. As a side note it also helps to suck the money out of hard working people as if we can't all be rich the government thinks we should all be poor.
On a serious and far more liberal note however breaking up the NHS would be almost impossible, it is tied together by an impossible weave of bureaucracy, and even if you could privitise would you, I get the feeling that somehow the poor would left by the wayside in terms of quality as hospitals strove to get people to change from poor paying state insurance to generous private heath insurance. Besides the idea of people being kicked out of a hospital for not having insurance is capitalism taken too far.

I understand the importance the NHS represents as an employment vehicle. I also understand all the political aspects keeping the status quo, I deal with endless red tape myself doing business in what i sometimes think is the union capitol of the universe (NYC). Such large organizations are great for political gain. What I am suggesting however is not a dismantling of the NHS but rather a reformation. Much the same way Medicaid was reformed not so long ago. Instead of underwriting the health costs it now covers the insurance premiums at a discount, allowing recipients to choose between competing private companies for the best deal.

Despite what many may believe, the poor are not left out in the cold when it comes to health care in the US and no one  is kicked out of the hospital because you have no insurance. If you are in stable condition a private hospital may transfer you to a public one but thats not a bad thing necessarily. Some of the best doctors are at Public or University Hospitals. There can be horror stories nothing is perfect. The big problem is for people who don't qualify because they make too much but don't really make enough to afford good coverage. Or in cases where ones medical problems are severe and treatments are extensive and expensive.  In this aspect is where i think the UK could do much better then in the US with a privatized system.

It is the law of marketing that when companies compete the only real winners are the consumers. Competition breeds innovation and brings down prices. The biggest problem with any form of socialization is stagnation. No need for improvement when your the only game in town.

I think if you created a hybrid model in where you had the open market of the US system backed by the guaranteed coverage of the UK system, you would have as close to a perfect system as can be. Your concern about loss of quality induced by hospitals vying for "generous " private insurers couldn't be further from the truth. There is nothing generous about these private companies and they bean count every cent unlike government agencies which usually get taken to the cleaners. Mandatory coverage would keep the companies from trying to get too cheap with its policy holders too.

All in all It would save you guys money and improve you health care while providing at least the same amount of coverage you currently have if not more.
 
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Claymore       10/24/2007 3:20:25 AM
The Us system does not benefit the wealthy, it benefits the healthy. The biggest health problem facing the American Lower Class is Obesity. That shows more of a lack of self discipline than lack of resources. If they are able to afford to fatten themselves up they should be able to cut down on intake and save for insurance.

If people were more fiscally responsible everyone would be ok.

 
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Heorot    Long term care.   10/24/2007 2:53:28 PM

What happens in the US if a person has a chronic illness that incapacitates them for years and their health insurance hits the limit? Conditions such as paraplegia or even severe arthritis?

 

In the NHS, that person will still be treated and even the drugs required will be free if the person has a low or no income.

 
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Armchair Private    Jimme reply   10/24/2007 3:00:52 PM
I'd say that your suggestion holds water and there have been bodged moves from both Conservative and New Labour Governments to move in the direction you point to.

In the UK the NHS is a Shibboleth, major changes especially to funding ("free at the point of service" is the phrase) would risk damage that no party or political movement could ever recover from.

It's the third rail, except no one touches it over here.

 
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Claymore       10/24/2007 7:10:15 PM

What happens in the US if a person has a chronic illness
that incapacitates them for years and their health insurance hits the limit?
Conditions such as paraplegia or even severe arthritis?


 


In the NHS, that person will still be treated and even the
drugs required will be free if the person has a low or no income.

Yep so someone who puts nothing into the system gets everything out of it. It is not sustainable and unfair to people who are productive and work. You cannot opt out of this system you are FORCED to pay for people who don't pay for themselves.

 
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rb_martin       10/24/2007 8:18:40 PM




What happens in the US if a person has a chronic illness

that incapacitates them for years and their health insurance hits the limit?

Conditions such as paraplegia or even severe arthritis?




 




In the NHS, that person will still be treated and even the

drugs required will be free if the person has a low or no income.



Yep so someone who puts nothing into the system gets everything out of it. It is not sustainable and unfair to people who are productive and work. You cannot opt out of this system you are FORCED to pay for people who don't pay for themselves.

On the opposite side of the spectrum, there are those who simply can not afford health care insurance; myself being one of them. Last time I was given a quote through the business group plan, basic health care insurance would have been a little over a quarter of what I make in a month.

Now that I am a full-time student, forget it. I can not afford to be sick. If I do get sick, going to a doctor is out of the question. If a major medical crisis occurs, I can go to a county hospital and receive treatment, but that will ruin me. Health care is available if it is absolutely necessary, but it is not going to be the best available compared to someone who's insurance is going to pay the bill...

I refuse to get sick...the best option.

 
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rb_martin       10/24/2007 8:32:17 PM

What happens in the US if a person has a chronic illness
that incapacitates them for years and their health insurance hits the limit?
Conditions such as paraplegia or even severe arthritis?


In the NHS, that person will still be treated and even the

drugs required will be free if the person has a low or no income.

It depends. There are county hospitals that treat people who can't afford insurance. For the most part, at least in this area, they are good hospitals that are staffed with competent doctors and nurses. The other option is the Veterans Administration hospitals if you are lucky enough to live close to one. The last time I was in a VA hospital, the staffing was a major issue. This may have improved since my visit; I don't know. I won't go back.

Drugs are free if  you want to sign up for whatever services they offer the poor I would imagine. I never tried, so I am ignorant of those programs. For the rest that don't qualify, you either pay for the medication or you do without...

There are three main problems in the US in regards to health care as I see it. The first, is that it is extremely expensive and time consuming to obtain a medical degree. I don't really fault the doctors and nurses, because they do have to re-pay their student loans. The second problem is the amount of lawsuits filed against the medical profession, which drives up malpractice insurance rates.  We seriously need torte reform to address this issue. The third problem is insurance rates for the average or below average person.  Insurance rates are beyond the means of a lot of people here.  I understand that this sector is a business, and the goal of a business is to make money.  To do it by price gouging is just unacceptable, and should be regulated.  Of course, I am not an expert in any of this.  I am on the bottom of the scale,  and currently I am priced out of the market.

 
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Jimme       10/26/2007 2:53:48 AM

What happens in the US if a person has a chronic illness
that incapacitates them for years and their health insurance hits the limit?
Conditions such as paraplegia or even severe arthritis?


 


In the NHS, that person will still be treated and even the
drugs required will be free if the person has a low or no income.

That is one of the bigger problems in the US. Many people with long term illnesses can run out of coverage. There are options many of these people have though that ranged from government sponsored programs to private not for profit organizations. Even pharmaceutical companies have programs to help those that can't afford their medicines. It could be a lot better though. This is one of the perks of the UK system that would make the hybrid model i suggested a great one.

 
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