It's a bit of a worry: US hooks into the NHS

[echt]

The idea of the US getting involved in the NHS is horrifying:

www.theguardian.com/politics/2019/jun/02/us-wants-access-to-nhs-in-post-brexit-deal-ambassador-to-uk-says

I'm really concerned about this, people with my disability are losing access to treatment as Medicaid wont cover it any more. Its a lifelong treatment we need at regular intervals.

This is a harsh reality and should be a wake up call to those who support a no deal Brexit.

As part of a trade deal Trump would also insist on flooding the UK with factory farmed products; and UK farmers will be out of business in no time as they would not be able to compete.

Bit of a worry? Its fucking terrifying!

So, no different to now then given there is already private healthcare provision in the NHS, and some elements of our NHS service sell their services overseas. That's what happens in global trade.

I’m worried about this too. NHS needs protection. We are so very lucky to have it.

So, no different to now then given there is already private healthcare provision in the NHS, and some elements of our NHS service sell their services overseas. That's what happens in global trade

But the NHS is not a global trade. That's sort of the point.

If Brexit actually happens, I think we'll end up as effectively the 51st state. We'll be right under his side stubby little thumb.

Dunno where that rogue 'side' came from

Why we are welcoming this assault on us with red carpets and uber-schmoozing instead of with pitchforks and burning brands I don't know. Asset Strippers R Us.

It’s terrifying. I don’t know how many would pass an insurance medical or afford the health insurance fees.

It’s more than a little worrying. The leave voting areas are full of people who cannot afford American style insurance premiums but there’s no telling them.

I wonder if we’ll also be flooded with their addictive drugs such as OxyContin too?

I don't understand why some people think it comes down to a binary choice of the NHS or the U.S. system.

If the NHS was so wonderful, then the entire planet would have followed that model. They haven't, so what does that tell you?

Many countries in Europe have a co pay system, which works well. Where I live, physios, radiographers, radiologists, cardiologists are in clinics, or their own practices, away from the hospitals, and you are referred by your GP and can make your own appointments.

We need a grown up conversation about the structure of the NHS; what it does, how it can be more efficient, and how we fund it. Until that is done, and a system emerges that is fit for purpose, we are going nowhere with it.

@echt

But the NHS is not a global trade. That's sort of the point

But it is. The NHS sells services as well as buys them in. It sells in Europe, in China, in India plus the US - and the Life Sciences Organisation promotes other UK Health and life science expertise, in many cases where the UK is preeminent. Having a trade deal doesnt 'force' anything to happen unless our politicians enable it.

It worries me more that people talk about 'flooding' our market with substandard goods as if we don't live in a market economy and can make choices.

The NHS is hardly a perfect system.

How does the NHS sell services abroad?

www.gov.uk/government/news/government-export-support-to-help-nhs-profit-by-sharing-expertise

It sells expertise, research and in some cases has set up commercial entities to secure contracts.

It can't make a profit and can only generate surplus to be reinvested in the NHS.

It’s terrifying. I don’t know how many would pass an insurance medical or afford the health insurance fees.

You are completely misunderstanding what is being talked about. This has nothing to do with changing the way the NHS looks to patients.

Currently some private providers provide services to the NHS. A trade deal would mean that if those providers were American, they couldn't be treated worse than UK businesses who supply the NHS.

If anything, it would mean the NHS gets better value for money because there are more companies competing to supply them.

One of the risks is that US trade negotiators and politicians arguably have a track record for seeing trade negotiations as a zero sum game. I think the UK won't have much leverage and that's not being defeatist.

I think that the same people who seem to think the UK has negotiating leverage with the EU (EU export more to the UK than the UK does to the EU and 'Do you really think the German car manufacturers will let Frau Merkel not give the UK what we're asking for') seem to think the UK would have leverage and hence would get a much better deal with the US than it has at the moment within the EU.

I expect agriculture and health services will be of interest to US negotiators and politicians.

@unhomme

I totally agree, I’m in France with exactly this system. I can’t understand why this alternative never even gets an airing in the UK.

However, it would be a massive cultural shift to adopt a «pay up front / get reimbursed» system in the UK. The idea of paying up front for medical care would put people off, even if it’s all reimbursed. Plus, some form of medical ID card would need to be introduced: there’s a lot of resistance to that in the UK.

You only have to read on here about people being outraged that they have to pay for HRT, for example, to see that paying upfront is a long way off from being acceptable.

I don’t see US companies competing to provide something at a lower cost; it will be for higher profit instead.

At some point, because of the disgraceful way some patients treat the NHS, they will have to introduce a system of charging for missed appointments etc unless the patient has been taken into hospital.

Once they do that, I think we will see a move towards paying a nominal fee for some services with no charges along the same criteria as prescriptions.

Depending on what services they are, I don't think this will be a bad thing and might stop some people abusing a system that is struggling with sheer demand.

@AngelicInnocent The cost of administering a charge for missed appointments outweighs any revenue it brings it. Added to which, it punishes those who have chaotic lifestyles due to chronic health conditions. It's only a good idea if you put zero thought into the practicalities of it.

Charging a nominal fee is an equally stupid idea for the same reasons. It's a disproportionate burden on those who need it most and can afford it least.

And the NHS is on its knees because of continuous cuts to its funding. Yes, demand is high, but the vast majority of patients do not abuse it and you don't punish everyone for the actions of a tiny minority.

There's a cultural shift needed but that’s not enough. 90% of prescriptions are already dispensed free of charge. Can you imagine anyone paying for 3-10 medications monthly? I also wouldn’t lay it all on patients. A lot of the NHS woes are due to underfunding. Competition with cut-throat US companies would not help this. Plus, UK has shown itself unable to organise a piss up in a brewery, I don’t fancy the chances in any meaningful negotiations.

I haven’t had to buy long-term meds here in France. Most pharmacies are linked directly to the govt system so that the state reimbursement is deducted from the charge at the till, so you only pay for the top up - and that’s reimbursed within a week by the mutuelle. Often, it’s all reimbursed straight away and we pay nothing at the pharmacie. But we’ve had to get used to always having a bit of money available for up-front charges.

If you miss an appointment without cancelling here, you get maybe two chances then yr taken off the drs list and refused any more appointments.

And yr right about the admin: French state health bureaucracy is massive.

The other cultural shift would be within the health service. Here, the first thing that’s established is what your rights are regarding use if the state health service - you need the right papers, whether that’s an EHIC card for visitors or a Carte Vitale for residents or a specific card that’s available for people in a very low income or refugees. You wing be left to die in an emergency, but for everything vaguely routine you need to prove your status and eligibility to receive certain services.