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?

I am on a forum with lots of American people who have the same health condition as me. I am shocked by the over-medicalisation of those who are well insured. The amount of scans and x-rays they have is really rather worrying. Some people sing the praises of the private system because they get everything they want. I'd argue that it's not medically necessary in many cases and detrimental overall.

I live here and from what I can see, the USA, the only for-profit healthcare system in the developed world will not go to a non-profit system anytime soon. There is simply too much money involved, the healthcare industry spends about $6 million in lobbying efforts annually, considering that almost every member of congress is a millionaire and needs campaign funding where do you think the lobbying money goes?

As for the general public here, many of my friends are very much in favour of a NHS type system but others (my conservative inlaws for example) buy into the notion that the USA has the best quality healthcare and that NHS is not as good. They also have this "personal responsibility" philosophy, where everyone is responsible for their own good health (ridiculous I know but anything that smacks of a safety net is socialism in many people's eyes here that means communism!

Then you have the medical professionals, my BIL and SIL are doctors and they make a lot of money (approximately $300-$500 a year), something they wouldn't be able to do if they worked for the NHS. You won't find a doctor here in favour of making less money, especially as medical school costs approximately $250k or more.

At the end of day, the for-profit system is what everyone is used to and while it would be wonderful to go to a NHS type system the odds are stacked against getting the political will to make a change, the exact same problem facing gun safety advocates - regular people are sensible and want change but the politics are controlled by lobbying money and right wing conservative types (my inlaws again...) I sometimes think to be a right-wing, religious conservative in this country means to take a position against your own self interest on everything!

I have excellent healthcare in Thailand but that is because I had travel medical insurance to cover me

If I needed to see a doctor in the states I have my travel medical insurance to cover me (have used yes good quick treatment) it does not work the same way for those who live there and are insured

rainbunny
ridiculous I know but anything that smacks of a safety net is socialism in many people's eyes here that means communism
and yet the USA has "non recourse mortgages" which are about as safety net as it gets and much too socialist for the EU

Yes. I understand what you're all saying. It costs less in the UK for treatment. Your medical providers charge less.

Ours do not. They charge twice as much, so to put that on taxes would give us a tax increase. I agree that our medical and pharmaceutical providers over charge and do unnecessary tests. There is no disagreement on any of these points.

If we could do it on the NHS and lower overall cost at the same time and simply reallocate our budget while keeping the same quality of care, I'd be fine with it. Most people here would be.

However, our medical companies are not going to lower costs, and to foot the bill on taxes would raise our taxes. We cannot afford that. People are already losing out on prescriptions they need and were previously working because insurance companies are refusing to cover expensive medication due to mandated coverage laws, and gov insurance only covers generic brands. The medical community is not going to suddenly sprout halos over night and decide to work for the greater good of man kind.

I don't know how else to explain to you that your ideal system you guys have in mind for America would end up a train wreck due to the reality of how our congress refuses to just get their head out of their asses and cooperate. Our bureaucracy would screw it up, and everyone already knows that. Our taxes would go up, we'd still be paying deductibles out of pocket and then if we wanted private insurance we'd have to pay more. It's great it works in the UK, but that's now how it would end up going down in the US. You're asking for a complete overhaul of our entire government to make this work and realistically, that's not happening anytime soon.

Obamacare as it was proposed was great, but then there were so many push backs and revisions that it ended up a mess that we're still mopping up. The main benefits that it has really brought is that it has put down strict rules on insurance companies which has been needed for a long time. They were dropping people due to loop holes any chance they got. It has also provided competition to insurance companies so they no longer have the monopoly and are forced to offer better care and lower prices to compete. These are all great things that came of it.

But as for the gov. insurance itself, it's a joke. The deductibles you still have to pay out of pocket are still restricting people from seeing a doctor. If you're not making much than have to pay $2k before insurance will cover you, you're only going to use it as catastrophe insurance where it only saves you money if you get in a car accident or something.

You also have to remember, we have a very large aging dying population. Dying people cost money. The way as I understand it works now, is that everyone puts in the same pot. The healthy people cost less because they're healthy and fund the sick. That's fine. But when the sick and old outnumber the young and healthy, it's going to be more expensive for everyone to make up for it.

Perhaps when the older population dies off and we have more balance it could work. But right now, it's a nice idea.

France pays 11.7% of GDP in healthcare costs. People supplement socialised emergency care where about 85% of your costs will be reimbursed with complementary insurance which can cover a huge range of things depending on levels of cost and cover. Average cost of the additional insurance is about £500, and kids would normally be covered by their parents' insurance.

Critically, a lot of the providers of the complementary insurance are mutuals - as not for profits they are almost an extension of the social model where you pay in and it helps others if you don't need to claim.

I truly believe something like this is the only way to save the NHS.

I reckon it'll be a generational battle Senpai, the effects of a top heavy elderly society on western society is going to be noteworthy on many levels and I agree that the time in history has passed in America to be able to implement a full on national health service like Britain did after ww2. We were at a point with very little left to lose, less capitalist influence and a greater need for a population in decent health. All of those factors have changed now.

Little wins like obamacare will be built on in time, my personal feeling is that will be down to greater awareness and personal connections through the Internet. It allows people from so many different backgrounds to voice their opinion and experiences. Obviously there is a great deal of complete guff but the reality of other people's lives is a lot harder to ignore the more contact you have.

The way care is provided is very different here in the US. There is much more emphasis on preventative care here. I have annual smear tests and they do a HPV test as standard and these tests start at 18. Annual check ups are performed and they check your bloods.

I also love that if I want to see a specialist it's quite easy to do so. In the UK your are assigned to someone. Also the continuity of care I have received during my pregnancies is amazing. I'm on my 3rd pregnancy and all have been managed by the same two doctors with the same doctor (my primary obn) delivering both babies. I ended up needing an EMCS and it was performed by someone who had managed my pregnancy. How many people in the UK have an EMCS performed by a doctor who had examined them before admittance let alone from 8 weeks through to delivery?

It has been shown in several benchmarking exercises that the NHS is one of the most efficient health services in the world. The US one of the most expensive.ow
The point is that whilst the NHS is not perfect and probably not be designed the way it was if it was starting now, it delivers and delivers to everyone regardless of financial status.

Like so many others I owe my life and the life of my children to the NHS. I was grateful to them when I had cancer and I was grateful to them last year when the DC and I were in a major car accident. I dread to think how much it would have cost us if we'd had to pay for all the treatment following that accident.
The NHS is an emotive subject and a source of national pride for good reason - it is unique and holds a precious place in all of our hearts - because it does save lives, every single day.
A few years ago I had a routine operation at a private hospital (was referred there by the NHS to cut the waiting lists) and I was appalled at the care I received: the wrong size cuff for my blood pressure, the fact that I was discharged a few hours after my op despite being obviously ill and subsequently ended up in the local A&E within an hour of being discharged.

I see how the NHS is moving towards the US model and it worries me. As someone who has needed significant amounts of healthcare and as someone who works with the health service in conduct research into how to make it better. If we lose it now, we will never get it back and, like so much else, we won't truely appreciate it until it is gone forever.

Also obamacare is a shit show. They needed to sort out lawyers and pharmaceuticals and didn't. Instead illegal immigrants are excluded from requirements yet a poor american is subject to a fine if they present themselves to ER needing care and don't have insurance. Additonally the obamacare policies have plenty of exclusions regarding care. My old neighbour has cancer and her policy no longer covers the facility who has managed her care. Closest facility is in Philly and she can't change policy for another 6 months. We are in Northern NJ so quite a fair distance from Philly and what I would call an extremely long distance for someone with cancer.

Also the NHS doesn't work but rather than look at the U.S. the government should be looking at Canada, France and Germany.

Oh yes, the NHS doesn't work

Most Americans who have truly experienced the NHS beyond a GP visit are horrified.

Not this American. I've been here over 10 years, and I can honestly say I love the NHS.

My sister (and quite a few other people I know in the states) is very much anti-Obamacare, and very vocal about "if the poor people need health insurance, tell them to get off their ass and get a job!" Try explaining to them that the people that are struggling are those that make just enough that they don't qualify for free medical care, but don't make enough to pay for the copays or whatever their shitty employer provided medical insurance covers. It's the "get up and deal with it yourself - why should I pay to help those worse off when they can do it themselves?" attitude that I find so utterly appalling. No understanding at all that it's just not always that easy.

And I've had one baby in the states and two in the UK. The UK births were by far the better experience. All 3 were similar circumstances for the delivery, but I was much happier with the way the delivery was handled in the UK.

My relative cannot get a job because they have kidney failure and require regular dialysis
AFTER a transplant
because the US medical system is too short sighted to realise that giving the right anti rejection drugs would turn that person into a taxpayer

They think the NHS doesn't work. They are wrong.

I keep telling friends and family that it works as well as insurance for our family, and costs us the same as insurance in the US would. With the added benefit that you don't loose it if you become redundant. And the added benefit that you know everyone's children are being cared for, not just your own. Lots of little children in the US are sent to school routinely with earaches etc. because a doctor's visit and penicillin is at least $200 plus a day off work.

The NHS is much more efficient than the private health system in the USA where insurance have to take their cut. The US spends 3 times as much as the UK collectively on healthcare with much worse health outcomes across the population.

NHS = 6.5% GDP
US health care spending =17.4%

No contest

My children had to have an annual check up in the States. It was a complete waste of time, a pointless use of scarce resources. We had to do it so they could go to a summer camp, but most of our American friends thought it was totally essential. When I said my son hadn't been to see a doctor for several years they were horrified - he's not seen a doctor in the seven years since either as he is a healthy kid (dd on the other hand has regular appointments for a variety of reasons).

Smears every year and below the age of 25 have been shown to be ineffective. It's not a sign of good practice to not follow evidence based research but the opposite! Likely to lead to excess tests, over treatment and unneeded anxiety.

NHS = 6.5% GDP
US health care spending =17.4%

No contest

It's not a contest between the US and the UK. Neither are good.

health care spend, you say?

Now here's a funny thing.

Spend more, get worse.

Though the high spend does mean there are plenty of vested interests who can afford to lobby to keep things that way

It's not a contest between the US and the UK. Neither are good.

Having experienced both. I judge the UK to be the better of the two which we are discussing.

Spot on Piglet.

There are lots of us here who do want an NHS-style system, actually. And the Veterans' Affairs system of healthcare here, which serves military veterans, is remarkably similar to the NHS. I know because I am employed by it, and I have an aunt and a cousin in England.

Polls have shown that the majority of US physicians (including myself) are in favor of a single-payer healthcare system. There is an organization dedicated to this goal which has loads of members.

One of our current presidential candidates has made single-payer healthcare an important part of his platform and he is doing well. (Bernie Sanders.)

There are several bills, to nationalize our public health insurance system to cover everyone in the country. Socialized, single-payer, government run healthcare will come to the US eventually, but it will probably spread state by state, just like the system in Canada evolved, province by province, rather than all across the country at once. Vermont will likely be the first state to accomplish this.

Trying to do anything big nationally in the US is like trying to get all of Eastern and Western Europe to do something all at once.

I live in the Mid-Atlantic region, and when someone talks to me about something going on in South Carolina, I often cannot relate to it because there is such a difference among states here. This is why change occurs regionally, not nationally, here, as in the case of gay marriage, or, even more currently, health insurance coverage for the health care needs of transgender people (which is progressing beautifully, thank goodness).

pitiless
interesting point about the VA system : which is probably as big as the NHS due to the massive size of the US military

the other big "socialised" medical system is that linked to the penal system because the USA has 25% of the world's prisoners (despite having only 5% of its prisoners)

the integrated approach works for both of them - because the lobbyists are kept out
which bodes well for the rest of the system when Romneycare finishes rolling out

Americans will buy into the anything makes them feel superior to their fellow man and boosts their ego. They are slaves to large corporations and blinded by the 'dream' they are being sold.

There are also bills being floated about to allow Americans to buy into Medicare coverage, instead of buying private insurance. This is another way in which single-payer activists are attempting to consolidate the payment and provision of care into a single, governmental umbrella.

Believe it or not, even my husband, who is also a specialist physician, and is quite right-wing in general, is now in favor of single-payer, socialized medicine. The young people coming up in our country seem to get it, on a very fundamental level, and they seem much more socially-minded than my generation. I have great hopes for them to push for change but in the meantime lots of us middle-aged people are agitating as well.

Also, someone up-thread talked about drug company reps giving out free samples of the most expensive medications in an attempt to influence physician prescribing here. When I was in medical school 22 years ago we had lectures about that phenomenon, and nowadays, drug company reps are banned from most hospitals and clinics here. And most insurance companies, HMOs, and the VA, where I work, have formularies from which we have to choose medications.

Of course, this all breaks down when it comes to uninsured people. That is a disaster. However, most of the states in the US have increased the income threshold for public insurance so many previously uninsured people are now eligible for care. It is not an ideal situation, and I look forward to a complete overhaul of the system.

I think the NHS is a far superior system to what we have here, although I don't think I would trade our system of higher-education preparation/admissions for yours. Yours is very intense and stressful and a bit rigid. Also, if you live in a certain town here, you are guaranteed that your kids will have a spot in the local school. I think the way it works in Britain is very stressful. But that is a whole other thread!

Overall I think the NHS is terrific and wish we had it here. Lots of us do.