Shocked at how terrible the NHS is nowadays

[ConfusedBoobs]

I had a mammogram a month ago that showed I have calcifications that they don't think are cancer but they won't know for sure until after I've had a biopsy. Today I found out that the biopsy can't be prioritised as urgent and so will still be another month away. AIBU to think it's terrible to leave people in limbo like this?

@julieca

Also the idea that insurance stops people abusing the system is laughable. For people, having to pay £15 co-pay to visit a GP for whom £15 is nothing, they will still go at a drop of a hat with nothing. And if you make A and E free then people will just go there instead and queue for much longer. If you don't make A and E free, then more people will die.

NZ has fees to see the GP (unless very low income/young child) but A&E is free. So yes some people go to A&E instead of the GP to avoid the charge.

@Cameleongirl Yes I agree with that. The problem is we don't have enough GPs to meet healthcare needs, too many vacancies. So it would end up with a high co-pay to ration treatment.
I have just got back from a GP appointment for my teenager booked today. Complex health needs so the appointment took half an hour and the GP has follow up - basically ringing consultant and will phone me tomorrow to confirm medication change. Our insurance premiums would be expensive.

If you increase taxes even more there will be a mass exodus of high earners.

People say this every time there is an election result they don’t like. This exodus never actually happens does it! Because it is a massive undertaking to uproot your whole family.

If you mean “Russian oligarchs might not want to park their money here if we tax them on it” then you may have a point, though I expect their accountants will find loopholes. But no, the average person on £80-150k isn’t going to emigrate to the US because there’s an extra 5p on higher-rate earnings. They more than likely won’t actually notice - I earn within that range, and it would make zero difference to me in practice.

I agree. I genuinely think if England introduces an insurance scheme with co-pays that there will be an exodus of lower-paid workers to Scotland and Wales.
We have been genuinely thinking about moving to Scotland anyway. This would tip the balance. Businesses are already struggling to recruit lower-paid staff.
People don't tend to move just because of things like free prescriptions. But co-pays every time you are worried and take your child or parents to the GP? Absolutely.

And I had exactly the same. Urgent on the day GP appointment yesterday for my teenager. GP said I think we should change medication but I will speak to consultant. GP rang yesterday to say couldn't get hold of consultant as they are in a departmental meeting but will ring today.
I suspect private insurance would just send me straight to the consultant which would cost more and I would pay.

It's not a sustainable model with an ageing population, more expensive treatments and healthcare tourism.

We should move to an insurance model but the UK is nuts over "our" NHS, the new national religion.

@roarfeckingroarr an insurance model is only more sustainable by rationing care through cost ie. poorer people can't afford to pay for their healthcare.
Insurance models cost more because you need a layer of bureaucracy to sell and administer insurance policies.

European countries manage it...

[quote julieca]@roarfeckingroarr an insurance model is only more sustainable by rationing care through cost ie. poorer people can't afford to pay for their healthcare.
Insurance models cost more because you need a layer of bureaucracy to sell and administer insurance policies.[/quote]
I'm sorry julieca, but you continue this line of argument, and it is just not the case. In the majority of the EU insurance based systems cover everyone, there is no rationing. I think you are being very blinkered.

The NHS has layers and layers of bureaucracy, between all the many separate departments, GP's, hospitals, CCG's, NHSE etc etc. They all "administer" our health for us, and bill each other according to the care provided. It's not so different.

@BigWoollyJumpers Yes because there is no way for it not to cost more to provide. You need an extra layer of bureaucracy and management to administer and manage insurance policies and co-pays. Collecting co-pays is expensive. And pursuing people through the courts for debt e.g. from hospital co-pays is expensive.
There is this idea that an insurance scheme will magically get rid of NHS bureaucracy. Just as academies were supposed to get rid of local authority education bureaucracy. Instead, it will just cost more.

The only way we don't all pay more is by rationing. Co-pays are an easy way to do that. The government can then say poorer people are choosing not to undergo GP visits, tests or treatments.
We already have the most disadvantaged people not accessing enough healthcare, it would simply increase.
It would be driven by all the well off people that say £15 to visit a GP is nothing. It is as much as going for coffee and cake with your family. Ignoring that many people do not do those kind of things.

What people want is what happened effectively with academies. Lots of promises, leading to very highly paid managers creaming off money, while the staff delivering get paid less, and those who are expensive to provide a service to get abandoned.

And as I have said, I will just go to A and E every single time, which will cost way more than what my family cost the NHS at the moment. I wont be the only one.

And people will be evicted because they cant pay their healthcare debts. You get knocked down and unconscious and taken to hospital and cant afford your large co-pay? You really think insurance companies are not going to pursue you through the court?

@BigWoollyJumpers I know people who live abroad. Of course not being able to co-pay rations healthcare.

And I am totally against the internal market, Yes it did create more bureaucracy. It was introduced by the Tories so they could privatise some aspects of the NHS. They have already done this. The NHS were far less bureaucratic before the Tories introduced that.

@julieca's assumption is that the Tories would implement something like the old US system (Obama significantly modified the individual market) or private insurance in the UK.

But you can't actually do that. The only reason the US system lasted as long as it did is because most people didn't buy on the individual market. They were on Medicare, Medicaid, or on employer plans, where the premiums are the same for everyone in the company.

There's 3 related pillars of an insurance based system: 1) Mandatory participation; 2) regulated premiums and services; 3) subsidies. Removing any 1 of these 3 will ultimately make it collapse.

If you let people choose whether or not to participate while regulating premiums, healthy people opt out, driving up premiums for those who remain. This can result in what's called a death spiral where only the sickest people remain in the pool. If you do not regulate premiums and services, then you get something like UK private insurance, which works because the NHS does the heavy lifting. This can work in the long term but only if you're prepared to let a lot of people die and the end of funded maternity services--i.e. the health system itself can no longer function. If you don't subsidise the poor, you can't fulfill condition 1.

I don't think the Tories care for the NHS much at all and they're happy to run it down, but the private sector in the UK only works because it has the NHS as a backstop. Privatisation or conversion to an insurance based system is far more difficult than they want to think about.

All systems ration in some way--whether by price or by explicit criteria. The question is how and when.

Yes I agree with all systems ration in some way. I want to ration by medical need, not ability to pay.
NICE was established to ration. So only to approve treatments that were evidence-based and made monetary sense to fund. Health authorities further ration.

And yes where I live, like most of the UK, the private hospitals only provide care for certain conditions. As soon as you need say expensive ICU treatment, off to the NHS you go.

As soon as you need say expensive ICU treatment, off to the NHS you go.

Haha, I can just imagine the furore if a load of highly skilled emergency heart surgeons were twiddling their thumbs at the local private hospital because there were few patients whilst the nearby NHS hospital had patients queueing for beds. That would work!!!!

NICE was established to ration. So only to approve treatments that were evidence-based and made monetary sense to fund. Health authorities further ration.

NICE miserably fail at this though, with their massively illogical short-term thinking that ends up costing a fucking fortune (as small health problems become giant ones when not adequately treated in a lot of chronic illness) but more importantly, with the utter fucking disgraceful blatant disregard for human suffering.

Funding (all kinds of) diabetes properly with CGM and psychological support (continuous glucose monitoring) would save a vast sum of money, and would save people from vision problems and amputations and kidney failure.

It would be FAR more cost effective instead of the firefighting approach. The NHS has huge buying power when it comes to getting drugs/ devices. But no, gotta argue the toss with desperate people and waste time and resources denying them even the basics like extra blood test strips. While everyone acknowledges diabetes complications are a serious economic concern.