Can I ask why the U.S. don't want an NHS?

[Fizzielove]

Why don't Americans want an NHS? I just don't get it? Can someone lease explain to this to me?

My DD needed an X-ray after visiting the Drs. We were sent to the local hospital with letter provided by GP. She was back at school within an hour of leaving the GP.

I don't think any one country has got it 100% right and I suspect a lot of that is to do with patients (sometimes unrealistic) expectations. You can chuck all the money in the world at some conditions but it doesn't change the fact there's a fair few things that can't be cured or in some cases even treated.

I've heard of Germany being held up as a good example but have still heard horror stories and grumbles about their system.

Our nhs does need an overhaul. The basic ethos and accessibility should be protected but it does need to be streamlined massively. I suspect the guidelines that seperate private and nhs work prevent that though. Offering certain procedures/medications 'at cost' rather than completely free or private rates along with raising NI contributions and actually spending the money on healthcare, and renegotiating pfi agreements would go a long way I reckon. Personally I would also make routine investigations (blood tests, ct scans etc) subject to prescription charges and criteria. It wouldn't save billions but it would work towards making the service affordable and available.

What I don't want to see is a set up like America where people are reliant on a private organisation making decisions about their clinical needs. I firmly believe that Americans who support the status quo just haven't been stung by it yet. There's plenty of accounts of insurance companies withdrawing funding of life saving treatments on seemingly baseless whims.

YoungGirl but you do have a choice - you are free to use private healthcare in the UK. Lots of Americans are under the impression that it's banned, for some reason.

The NHS saves the lives of millions of people who would die under the American system. Yes, the NHS can be improved, but it doesn't require poor people to exhaust themselves working three jobs just to afford basic healthcare. The 'I'm alright Jack' attitude of anti-NHS Americans stinks.

My child was ill recently in America. One call to the local paeds office she was seen within the hour, given the best drugs needed regardless of cost and a follow up every few days until she was better. It was excellent although expensive.

Compare that to her recent sleep apnea/ tonsiladenoidectomy care in the UK which was bloody awful until we paid privately.

I know what system I would choose.

Plus I don't want to see my local bumbling GP who looks everything up on google thank you very much. I want to go to the excellent GP in the next village...but I can't because nowhere near use accepts out of catchment patients (crap policy that was when they can choose to opt out) and our nearest private GP is an hour away.

The US system is nothing to aspire to. That said, I would love to see people paying for health care according to risk factors within their control.

The obesity and alcohol epidemic in the UK means that we're paying for health care in the UK through national insurance and then again privately if we're not interested in waiting 3 months for a specialist referral.

Their system isn't perfect but we need to stop looking at ours through rose tinted glasses as ours is a long way from acceptable too.

It was excellent although expensive. I know what system I would choose. - I think pretty much everybody agrees that if you have enough money, the health care you can get in the US is indeed excellent. The question is what happens if you don't.

The US healthcare system is big big business and the insurers and medical providers are there to make a profit. My experience is that they over medicalise for max profit e.g straightforward pregnancy involving obstetrician rather than midwife.

They also live in fear of being sued so are over cautious and again involve consultants, procedures and tests to cover their backsides and boost profit at the same time.

My DD needed an X-ray after visiting the Drs. We were sent to the local hospital with letter provided by GP. She was back at school within an hour of leaving the GP.

My son had persistent ear infections through his entire early childhood. We were referred to an ENT specialist after maybe 2 years and 15 infections.

He actually outgrew ear infections before he had a chance to get grommets on the NHS, enduring scores of sleepless nights, courses of antibiotics, and of course pain.

Now we pay £300/month for private insurance. When he had a perforated ear drum recently after years of dormancy, he saw an ENT surgeon about 48 hours after we became aware of the hole.

I should think any private insurance is going to attract better reviews than a national service. The point is that there is a choice in the uk and if you can't afford to go private you will still get the treatment you need. Albeit you will have your need weighted against the needs of many others and prioritised accordingly, but you will still be cared for. You wouldn't be left with a diagnosis of something like diabetes and left with a month choosing between rent and insulin.

Whether private insurance would be sustainable from cradle to grave in its entirety is very different from choosing to go private for specific issues. It would be an interesting excercise to see how much insurance would have cost for your lifetimes worth of medical needs and if it still represented such a great service and whether it's one you'd still be able to afford. Taking into account the times you wouldn't have been earning for example whilst in education.

If I recall correctly it's only recently through obamacare that children can stay on their parents insurance until 25. I know when I was 18 and living away from the family home an a&e bill for thousands when had a burst ovarian cyst would have set me back years financially. A like-for-like job I had at the time in the usa certainly wouldn't have covered much.

American healthcare paid for a relative to get a Kidney transplant.
But will not pay for the anti rejection drugs that will allow that person to ever be well enough to work.
So they live on social security, dying slowly of secondary kidney failure.

The NHS would have given free healthcare and the EPO injections so the kidney would not have failed.

Pre Obamacare
The US system did not cover you if your employer goes bust
The US system did not cover you if you were between jobs
THe US system did not cover you if you lost your job due to being off sick too much (eg having cancer treatment)

THe USA has low unemployment because Americans cope with shitty employment situations, just to get employer healthcare.

US Healthcare covers less of the population for twice the cost of the NHS
and the rich ARE subsidising the poor
because companies deduct their healthcare costs from their pre tax profits

Senpai's response is pretty typical of what you'll get if you try to discuss this with an American.

"How do we expect us to pay for it?" Well, the answer to that is "with the huge amount of money you spend on an inefficient healthcare system already".

UK healthcare spending as a % of GDP: 9%
US healthcare spending as a % of GDP: 17%

The Americans spend roughly twice as much on healthcare for a system that leaves substantial numbers of people uninsured.

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You're cute. Us poor Murican's just have no clue what we're talking about. This is the typical response you'll get if you try to explain it to a Brit who has no fucking clue how our economy works.

That's all true on the percentage of money spent per person. But you're leaving out the fact that our medical procedures cost much more than yours, the fact that we regularly provide medical care to people who are illegal and uninsured, and the fact that what we cover per person is the people who are uninsured.

Right now we spend 17% on people who are uninsured. That's only 15% of the population, everyone else pays for themselves. Most insurance is subsidized by the company, meaning they pay less because the company purchases large group packages. Some pay more, some pay less depending on overall health.

So let me break it down for you again.

We are currently paying 17% on 15% of the population. Tell me, then. How do propose we keep those pesky tax numbers numbers down when:

• We would have an extra 85% of the population to pay for.
• We no longer have companies helping to subsidize insurance rates.
• Our medical companies are not going to budge on prices.
• We're all on the same package and can't choose the less expensive option
• Our hospitals are already declaring bankruptcy as it is because our gov isn't reimbursing them for the uninsured they treat like they're suppose to.

Taxes will go up for everyone to cover the cost, and the people that will be hit the hardest is the middle class who already are taxed the higher than any other income bracket in relation to their salary as it is. It's just going to effectively shrink our already shrinking middle class.

Your idea is great in theory. The only good thing this program has done is keep the scummy insurance companies honest and prices down so people go to them instead of gov. insurance.

senpai
We are currently paying 17% on 15% of the population
Stats is clearly not your strong point.

THe total cost of healthcare in the USA is 17% of GDP to cover everybody in the country.

THe total cost of healthcare in the UK to cover everybody is around half that

our operations cost less because there is less profiteering by insurance companies

Math isn't my strong point.

Regardless, companies subsidize a good chunk of insurance. You can't suddenly say that all medical care is now government funded and expect taxes to stay at the same rate. Again, where is this extra money needed per person now coming from?

Medical companies are not going to lower prices, so that's also going to come out of our pockets. The gov. insurance offered with no company picking up the slack is more expensive than company insurance.

It's all well and good to say medical companies need to lower costs, but they'll do that by sacrificing quality and hiring less medical staff. not trimming a little off their own paychecks up top.

We have valid reasons to be against it.

Happily it won't exist for much longer - but as long as healthcare is still delivered free at point of need, I don't care

You're right younggirl the NHS won't exist for much longer, but you're delusional if you think that means your healthcare will remain free at the point of delivery.

We have an ageing population with a crisis in social care, a government which refuses to have a proper conversation about healthcare funding and provision.

The total health spend per capita and as a proportion of GDP in the UK is less than most of our European neighbours and is half of what the US spends. If you want a system comparable to France or Germany you are going to have to pay for it through either more taxes, insurance or co-payments.

I'd prefer to pay for it through taxes and for my taxes to provide healthcare rather than profit for shareholders, but your view may vary.

But what we are all going to have to do is pay more.

Or find ourselves increasingly without care, as is already happening.

You can't suddenly say that all medical care is now government funded and expect taxes to stay at the same rate. Again, where is this extra money needed per person now coming from?

The money the employers and individuals give to insurance companies together with the existing taxes adds up to a whopping 17% of your GDP. This is twice what we have available in the UK.

Imagine what an amazing service there could be for everyone if this could all be spent on healthcare and none of it siphoned off by shareholders.

What I find flabberghasting about US healthcare is how bloody cavalier so many Americans with poor health insurance are about their health.

If I was having to pay to visit the doctor every time I went (because don't most insurance schemes have an excess?) I'd sure as hell not want to be weighing 35 stone and unable to walk more than a few hundred yards.

One in three adults is obese.

Two in three adults are overweight.

And paying a lot towards their healthcare.

[shocked]

At least over here we can overeat, smoke and lead sedentary lifestyles knowing that someone else is going to have to pay for the health fall-out.

"Right now we spend 17% on people who are uninsured."

Not sure that's what that figure means.

I think the 17% as a percentage of gross domestic product spent on health in the US refers to ALL health spending, not just that by the government.

However, 20% of the US total budget is spent on healthcare. The figure for the UK is 16.2. That's for nearly 100% of the population....

American health care doesn't look like very good value for money.

senpai
You have clearly read very little about how the US healthcare system is funded
and understand little about the changes that are happening in both Private/ employer insurance as well as Medicare/Medicaid and Obamacare.

The fact is that Breast Cancer treatment in the UK is exactly the same as in the USA (same number of radio / chemo appointments, same drugs, same doses) but in the UK it costs less than any of the private insurers
and the fact that some insurers charge three times as much for the same treatment is purely down to the opacity of the system and profiteering.

American health providers LOATHE the transparency of pricing and the removal of rent seeking that big data analysis is providing
and showing up that most American employers are paying far more than they need to for the services they want their employees to have.

I think it's probably worth thinking about why the NHS came into being. Without the new social compact following WWII it probably wouldn't exist. WWI also brought about significant changes (too many conscripts weren't fit enough to fight). I doubt very much that something like the NHS would be introducable in the UK now.

I used to work for the NHS before I emigrated (in public health and quality assurance) so am aware that there are plenty of things wrong with it, and the recent excessive political reorganisations have done a lot of subsequent damage. But I've also lived in the States and now in Canada and there is plenty wrong with those systems too.

The fact is that healthcare is only going to become more and more expensive. Populations are aging, the tax base is shrinking and the cost of care is escalating. All public healthcare systems are pretty much in crisis. Private systems much less so because they can pick and choose who they treat and how they treat them. They are also very inefficient. The (very justified) fear of litigation in the States is a huge factor in over treatment and the pharmaceutical companies are way to involved.

When we were in the States dh got an ear infection (pre existing issue). He went to a doctor on the list from the insurance company (only so much picking and choosing possible) got seen very quickly (good) and his ear cleaned with some high tech kit (good, but very similar to the kit in the teaching hospital he'd been to before). He then got given some samples and a prescription. It cost I think about $80 to be filled (this is with full and very expensive insurance coverage). I asked a pharmacist friend of mine about the prescription. She said it was completely inappropriate for his condition, likely prescribed because he had the samples in his office. A practice that is illegal in the UK. the US is massively corporately influenced.

elly I think you'll find grommets don't always work. In fact another of my DDs had grommets fairly quickly as was the protocol then, but continued to have repeated ear infections.

Just recently another DD has had an urgent ear op, we were able to schedule the date best for us, excellent care, consultant on ward the following day at 7am to check her progress. Outpatients follow up again at a time date to suit.

I think you need to go to a better hospital!

An American I went to uni with couldn't believe the treatment he got here when he broke his leg on a boozy night out

"They didn't ask me for money! Or even where I lived!"

He was v impressed.

I think the healthcare looks good, but there's too much money to be made for it to be a great system.

*healthcare in thr US