I would be happy with a private system with compulsion – insurers don’t get to choose who they insure.
But high risk patients attract higher premiums, and as there is a correlation between poverty and poor health those high premiums become a means to 'choose' who they insure, ie; the poor and ill get excluded by circumstances.
If it was private I’d be able to stay with my current provider and you’d be able to pay a bit extra for a better package.
Or the opposite is true: you are a bit hard up so you choose worse cover cos it's cheaper. Then you get worse or more limited treatment cos you're poor.
The UK is one of the most corrupt countries in the world
That's a very first-world thing to say!
But high risk patients attract higher premiums, and as there is a correlation between poverty and poor health those high premiums become a means to ‘choose’ who they insure, ie; the poor and ill get excluded by circumstances.
The key downside of course being that poor people die because they can’t afford insulin.
Even the USA which we all agree is the worst health system in the developed world the poor, disabled, old and young are covered by the state. (To the tune of 8pc of GDP whereas the UK pay ~10pc for the entire population.)
...but it has to change. So many people complain about the way the state funds the NHS and the problem's going to get worse because health inflation is higher than 'normal' inflation so sooner or later to keep pace you have to pay 100pc of GDP on healthcare. That's not workable.
None of us complain that on social media that the state doesn't invest enough in food because we don't let the state fund and manage our food. We deal with it ourselves and we get the food we want. Health care is every bit as important as food.
We have this mental situation where people don't like the way the government run and fund healthcare, but are also adamant the government must to run and fund healthcare. If Matt Hancock and Boris set up a car insurance company I wonder how well it would be run? And yet these people are deemed the perfect people to be organising healthcare?
I'd go for the French system. The state pays out a flat rate and people top up according to their own preference. Stops all complaining over night.
Or the opposite is true: you are a bit hard up so you choose worse cover cos it’s cheaper. Then you get worse or more limited treatment cos you’re poor.
Whereas currently *everyone* gets crap treatment. (Or says they do - my treatment has been great.)
Or the opposite is true: you are a bit hard up so you choose worse cover cos it’s cheaper.
Which isn't an option I'd have if my healthcare money is being taken out of my taxes. I think I know more about my priorities than Sanjiv David.
The problem is that it’s badly managed
No, the problem is mostly that it's under managed. In that it hasn't got nearly enough decent management and of course people's illness are changing and it takes a while to adapt to that, The NHS is very good (one of the best) at acute care, and pretty good (in Europe) of treating disease. What it's bad at (and it's not alone in that) is treating people who have multiple issues that make them poorly but not "seriously" ill. Like overweight, diabetes, and the issues arising from those problems. We treat many folk like that but we don't often cure them. In some of my practices 50% of our pts appts are with folk who are diabetic or low/depressed (often they're the same people)
Agree with the GP comment though, individual practices seem to be able to get away with really restrictive rules on getting an appointment.
There is a huge shortage of GPs, and in the short term due to retirement and immigration restrictions it will only get worse. I don't know any GP practice that wouldn't give more appts if they had the clinicians to staff the sessions.
Which isn’t an option I’d have if my healthcare money is being taken out of my taxes. I think I know more about my priorities than Sanjiv David.
In the US model you can choose worse cover, if it's a low priority for you, but it's so much more complicated than this. If you are under pressure you cut your cover and simply hope that nothing goes wrong. Often this is family cover, so the fact that a parent can't make enough money means the children go without cover.
But it's not as simple as cover or not. You may have insurance, but it still costs you to go to the doctor. So, when you are struggling to pay your bills, you don't go to the doctor to check out that stomach pain, then six months later you're dying of bowel cancer and your family is now single parent without support.
Healthcare should not be down to your personal choice because you should always have whatever healthcare you need. And taxation isn't the same as insurance in practice or principle. We fund the government, and the government funds the country. So yes, my tax money goes to pay benefits for people out of work, and healthcare for people who've never paid more than a few hundred quid in tax, and that's good.
Tomhoward
Subscriber
Heard a story of a T1 diabetic lady who moved to the states, her Health insurance would only cover 1 type of insulin (there’s dozens, what works for one may not be good for another), the option was take it and make it work, or leave it.
Another one I heard- another diabetic was recommended to do a blood test with each meal, and before driving- pretty standard advice. Their insurers said that's ridiculous, you only need to do one test per day, and refused to pay out for any more.
The really disgusting thing about that, is that mistreatment of diabetes today, causes massively more health issues in the long term. Spending money on blood testing strips is cheaper than spending money on retinopathy, kidney damage, heart disease... But it's not in a healthcare provider's interest to do the cheap thing. It's in their interest to do the thing that means you have to pay more for longer to not die.
And after the new orleans flooding, there were a load of stories about diabetics left without medication. That was entirely because the cheap insulins are less stable and durable, so they get damaged quickly by heat. The insulin I use, which is about twice as expensive but way better, doesn't fail as quickly. So it was the poorest people who got screwed twice.
When I got my fractured hip replaced, they used a technique that's expensive, and that requires a lot of physio to make it worthwhile, because you can regain almost full function of the leg. If I'd been in teh states on standard health insurance, they'd have done a half-hip replacement, which is cheaper to do and way way cheaper to do the recovery for, because there's no point in spending dozens of hours on rehab.
And so on. Replacing the NHS with US-style private healthcare would kill people, more people than any serial killer or mass shooter could dream of. We should treat people who try to do it like we would any other attempted killer, and stop them by any means necessary in self defence and to protect other people who can't do it themselves.
How does the US system work in emergencies. Lets say you have a heart attack in the street, an ambulance is called, you get taken to hospital and arrive unconscious. Do they just treat you and worry about the bill later? Or do they try and find out your name and details so they can find the insurance first?
https://www.theatlantic.com/health/archive/2019/08/medical-bill-debt-collection/596914/
Also the US, folk aren't blind to the fact they can see how healthcare is run in Europe and many states (remember that in reality it is State provision, there isn't really a US-wide program) are changing the way that people can access healthcare. with programs like Medicaid/care and CHIP being given wider and wider enrolment access. In reality the US is coming towards a mixed (state with private top up) provision rather than further towards a more heavily biased Insurance provision.
Most Americans realise that their system; while providing world beating care for those who can afford it, is otherwise broken and not fit for purpose, the US healthcare corporates that I've dealt with who operate in the UK are v keen NOT to have to replicate that in the UK.
There is a huge shortage of GPs, and in the short term due to retirement and immigration restrictions it will only get worse. I don’t know any GP practice that wouldn’t give more appts if they had the clinicians to staff the sessions.
I worked with someone who had a 1:30-2 hour commute (drive to station-two trains-walk to the office). Her GP surgery near home wouldn't give any appointments in advance. The only way for her to see a GP was to phone the surgery at 8:30 when it opened and try to get a same day slot. If she didn't then she'd then be anywhere from 2-3 hours late for work (due to the trains only running once or twice per hour). If she did get an appointment it might not be until the afternoon, but a 3pm appointment would mean that by the time she finally got to work (leaving at 9 rather than 6:30 as usual) she'd have to pretty much turn straight back round.
She really should have been able to just book something for a couple of weeks in advance.
Both the NHS and private sector in the UK are in trouble due to a chronic lack of staff. The impact on safety and waiting times is substantial and many hospital and community providers are really struggling. Social care staffing is even worse with no care available in people’s homes in some places. This is a result of over optimistic workforce planning for the capacity needed despite an ageing and increasingly complex population with high expectations. It’s only just being addressed. Whichever funding and delivery model you’d choose won’t solve this.
The NHS is independently recognised to be one of the most efficient healthcare models and performs very well for most outcomes. It’s certainly not perfect but we should be very wary of wholesale deconstruction based on over-simplified analysis of other countries funding systems or worse, political ideology - all of which have caused mayhem for staff and patients in the NHS over the years and rarely achieved what was promised eg the internal market.
However, something does need to be done to help manage demand and funding. My view, which is reasonably well informed having spent 30 years as a clinician, an Executive and currently acting CEO of an NHS trust, is there is an argument for testing a targeted and gradual expansion of small charges to eg GP appointments and A&E attendances (for minor not major conditions) which would help manage demand, subsequent unnecessary investigations and interventions for minor and self-limiting conditions, free up capacity to improve access when really needed and a help with bit of additional resource. It’s not a politically popular option so I’m not optimistic we will ever see it; politicians tend to prefer grand schemes with populist appeal.
Meanwhile, do spare a thought for NHS staff at present; from cleaner to surgeon we are working unbelievably hard to keep a very, very short-staffed system going.
small charges to eg GP appointments and A&E attendances (for minor not major conditions) which would help manage demand,
I’ve been of this opinion for some time. You could call it a ‘national insurance excess charge’. Let’s face it, if contents insurance paid out without question no matter how small or petty the claim, and no matter how the insured property was lost or damaged, no one would be able to afford the premiums after a while. The charge needs to be just enough to make people feel invested in the process; not an onerous amount. For an ambulance for example, double the cost of an Uber would be more than enough...
I worked with someone...
perhaps your friend needed to change her GP to one nearer her work? but yeah any GP that can't give you an appt. in a couple weeks time is pretty rubbish.
there is an argument for testing a targeted and gradual expansion of small charges to eg GP appointments and A&E attendances
While I sort of agree with you about charging for this sort of appt, 2 issues; 1. who will administer the charging/collection of fees..? And 2 It may put off people attending.
perhaps your friend needed to change her GP to one nearer her work? but yeah any GP that can’t give you an appt. in a couple weeks time is pretty rubbish.
Not an option. You take the GP that you live in the catchment area for. I moved to Leeds but still worked in Harrogate, didn’t tell the gp I’d moved as it was more convenient to see them whilst at work. I accidentally let slip that I’d moved during a trip to a minor injuries unit, within 30 mins of doing so the gp had rung to say I had 30 days to find a new one...
is there is an argument for testing a targeted and gradual expansion of small charges to eg GP appointments and A&E attendances
Not bloody likely. As someone who has no alternative but to fund and manage two health conditions (one life-long) I strongly object to being asked to pay as the NHS continues its dereliction of duty with my health. Additionally, I've been blocked by my GP Practice from accessing any NHS consultants and this is clear discrimination.
I think the best value is the yearly NHS card prescription card. Amazing value for my regular meds. I had to buy a private prescription once and it was about 60 pounds for 1 item for a month.
A lot of this seems to be based on the current situation. Maybe we need to think what if...
What happens in five or ten years time when genetic screening starts to make insurance unaffordable to some? What would people feel if their health care insurer starts dictating what you can or can't do with your life? Be a strange world where mountain bikers are seen as a risk and so have to pay more. Or you have to pay more because you live in a certain area.
We just need to start investing in the NHS; accepting that the good times have rolled and we really need to start see taxation as an investment. Spreading the burden across society. On the other side there is an onus on the public sector to work as efficiently as possible whilst maintaining social responsibility. Not here to make a profit but not here to squander the money - it's a finite resources thing.
It may put off people attending.
Some people NEED to be put off; at least until they’ve engaged their brain. A bit of personal responsibility for their health would do some people a lot of good.
Not an option. You take the GP that you live in the catchment area for.
There's nothing in any of the the GP contracts that prevents any GP registering any patient from any address. They may restrict it to certain postcodes for things like home visits, but they don't need to necessarily. The CCG may have a policy about it if you fall out of their catchment area, but there are even reciprocal agreements to deal with that
v8ninety
...Some people NEED to be put off; at least until they’ve engaged their brain....
I read that as you saying the NHS should discriminate against thick people.
Surely not?
Some people NEED to be put off
Yep probably, but Sod's law will say that those folk will manage to pay up, and granny who's maybe very poorly will be put off. I think in general, any system that gets in the way of, or is designed to prevent people accessing healthcare is probably not a good idea. Personal I think Heathcare (in general) needs to get a bit more interventionist.
I read that as you saying the NHS should discriminate against thick people.
I don’t think ‘thick’ is a protected characteristic, and obviously there could be exemptions for certain categories of people.
Seriously; People should have some personal investment in their health care. A good analogy would be a national car insurance scheme; you’d need a significant excess and strict terms and conditions to stop people upping the national premiums by claiming for every little scuff repaired from the nations purse. And car mechanics are a LOT cheaper than GPs.
Seeing your GP, visiting ED, calling an ambulance. It’s all just making a claim on your national insurance. Why shouldn’t there be a fair use excess payable? It’s a lot more palatable and socially just than the private sector model, that’s for sure.
and granny who’s maybe very poorly will be put off.
This is a much trotted our trope, that could be avoided by waiving the charge for anyone who claims a state pension, and also, It happens anyway. In my sphere of experience, I’ve lost count of the number of old dears who ‘didn’t want to bother you dear’ with their stonking MI (heart attack), whilst simultaneously ambulances are attending 20 and 30 something people who’s RIGHT it is to have a free ride to hospital with their sniffles because ‘I pay your wages innit!?!’
Something has GOT to give.
Charging distances those that can not pay from the healthcare they need. Entitled ****s will just behave more like entitled ****s if they have paid a small (in relation to the actual costs or provision) fee for the ride or consultation.
This is a much trotted our trope
And are amongst the most vulnerable folk in the community, I think that you're right, there would need to be waivers
Whilst simultaneously ambulances are attending 20 and 30 something people who’s RIGHT it is to have a free ride to hospital with their sniffles because ‘I pay your wages innit!?!’
Touche...This is a much trotted out Sun headline that's about as accurate as most Sun headlines... 🙂
This is a much trotted out Sun headline that’s about as accurate as most Sun headlines
You know what though; a broken clock is right twice a day. And this one happens. Lots. I’ve got the T-shirt.
Charging distances those that can not pay from the healthcare they need.
You know, I’d generally agree (and I cannot BELIEVE that I’m actually advocating point of care charging, given my political persuasions) but honestly, societally, many peoples attitudes have changed. No longer is universal access to healthcare seen as the massive and amazing privilege that it really is by many, rather it’s a right to be squandered without a thought. It would be interesting to hear from the GPs who frequent this place about how many appointments would be freed up if we could just persuade people to engage their brain and maybe seek more appropriate help than they currently do. The NHS is creaking at the seams At the point of access and it’s because it is massively taken for granted, and chronically (ideologically) underfunded.
Saw an article somewhere recently that a certain tablet that costs 3 quid here, costs something like 900 dollars EACH in the States. Thats a pretty massive jump.
Thats the problem. Becuase US healthcare is so lucrative there's 10 hospitals per city, as opposed to maybe a couple here. I can't see our hospital numbers going up drastically, so the profit comes in the costs of the treatments.
Many people in the US get it with their job. However.... Say you're diagnosed with diabetes. You want to get a new job but Your potential new employer may not cover your condition.
Your now potentially stuck in that job for life and your employer knows it....
