Comment by mijoharas
8 days ago
> 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).
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.
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.
So now he has to pay for the incompetent NHS and healthcare that actually works?
1 reply →
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.
This isn’t the story we generally hear - what we hear about us healthcare is that you need a well paid job and even then medicines are ridiculously expensive - like thousands of dollars a month for something that is tens of pounds in the uk.
4 replies →
If you have a kid that landmine can be larger than you think if you’re at the wrong hospital.
That’s the entire point of the NHS
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".
> 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.
> 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.
> 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.
1 reply →
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%.
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.
I like the cut of your jib. I see the class system in much the same way but with different analogies. The middle class professionals are like the 'house n-gro' described by Malcolm X and the minimum wage workers are like the 'field n-gro' (not sure we can use that word even in academic discussions given where the UK free speech laws are going!).
There is also a lack of a respected teaching class. With the changes to universities and schools, there is no longer any respect for those with an education and able to teach.
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".
11 replies →
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?
Yes. Like no matter what someone thinks about the NHS, it's always affordable, and it's entirely inclusive. And if you want private healthcare, you can absolutely get it. I've had private health insurance at every post-university job I've had, it's a standard offering in tech.
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.
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.
The issue is the same in the US. A lot of specialist say they aren’t taking new Medicaid patients and a few who don’t accept Medicare.
> But you can also pay for extra for private healthcare. Is it the same in the UK?
Yes