Counter point: the NHS in the UK has more government involvement than the US healthcare system.
The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US.
“Better outcomes” needs more detail:
Medical bankruptcies per year: ~200k in US, ~0 in UK. Caveat: bankruptcies often don’t have one clear root cause, the other ~600k bankruptcies per year in the US may or may not have an aspect of healthcare costs.
Cost of triple bypass heart surgery: US: $110,000, UK: £8,500 (paid by the taxpayer, not by the patient at the point of care - free for them). (P.s. private healthcare is available in the UK too - the procedure costs around £20,000 privately, payable by the patient or their insurance)
Someone told me this a few years back and it stuck with me.
"American healthcare is the best in the world like sportscars- Ferrari, Lamborghini, BMW, Bugatti, etc. are the best cars in the world. Surely they both are the bests in the world- but only for the small percentage of people that can actually afford them."
This is sad.
(Many, including me, wouldn't buy a sportscar even if they could afford one, and sportscars aren't the "best" in their opinion. But this comparison drives the point home.)
I think you're mostly right. Although there are exceptions. Consider to opioid crisis. That's a case where profit motive directly leads to poorer quality care.
Regardless of that, high quality care isn't much good if you can't access it.
The US government is involved in ways that make it inefficient. For example, I don't get to choose my insurance, the government has ensured that instead my company does for me. While I can in theory get insurance elsewhere I lose a large subsidy in doing so, no insurance I can buy can possibly be a better deal for me, even the company insurance is bad.
The incentives for insurance are to ensure that I don't quit, not that it is good healthcare or a good deal.
I don't know what my company pays for my insurance, but if I opt out of that insurance that money is lost. I know I pay $100/month (not the real number but close), and plans on the government health market start at $800/month (after the tax credit), plus by using the company plan they kick in another $100/month in a HSA match, and HSA money is a tax advantaged investment (AFAIK you can only get in an HSA from your employer). So by using my companies insurance it is like getting an additional $800/month in income (some of which is invested!).
I didn't look into details of the insurance market plans, but there were 40 different plans available there for me to choose from (as opposed to the 2 my companies gives me). I suspect that something similar to my work plan is more expensive than the one I listed above. I also suspect that if I was to look at all 40 plans I would choose something that wasn't not similar to the choices I have now. However with the amount of money I'd lose it isn't worth my time to examine my options.
WWII Wage Freezes is where it started, the government regulated that employers could not raise wages so employers started offering services to attract talent, in those days it was having a doctor on site at the factory, or office that employees and there families could see for free.
years later that transitioned to comprehensive benefits packages
> The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US.
It really isn't underfunded. It's grossly inefficient, which is what happens to most if not all publicly funded bodies. It is actually ok to criticise the NHS organization.
They're a monopsony, so actually get absolutely gouged by the pharmaceutical companies. They (currently?) refused to recycle crutches, plastic casts and so on. They'll use their own (hospital pharmacy) drugs if you get admitted, and then discharge you with them, even if you have your own dosette box and refuse to take theirs back. My father was discharged with something in the region of £3-5000 pounds of drugs that we threw away on several occasions.
As a percentage of GDP, it's roughly the same as most other western countries.
Of most interest though is figure 3 in [2] - 80% of UK (NHS) funding came from public money, i.e. tax, and 20% from private money (e.g. insurance). For the US, it's 50% public money (tax), and 50% private money. I'm not sure how much more money the UK general public really thinks the UK government can come up with to keep giving the NHS "more!" money. There's a limit to how much people can be taxed. And compound interest (increase the NHS by 10% per annum!!) means we'd spend all our GDP on the NHS at some point rather quickly.
>They're a monopsony, so actually get absolutely gouged by the pharmaceutical companies.
You've got that exactly back to front. NHS's immense buying power lets them negotiate lower prices for drugs, exactly as medicare used to (before pharma lobbying stripped them of that power).
Pretty much any trade deal negotiations with the US involve the UK being asked to dial down NHS buying power on behalf of pharmas by making hospitals responsible for purchasing.
>As a percentage of GDP, it's roughly the same as most other western countries.
50% of the US - not because the UK is especially efficient but because the US healthcare is essentially legalized extortion.
>I'm not sure how much more money the UK general public really thinks the UK government can come up with to keep giving the NHS "more!" money. There's a limit to how much people can be taxed.
The UK public adores the NHS and is one of the few things polls say that people would be happy to fund with tax raises. It's very very popular. In no small part because we can see how much of a racket the US is.
The ruling party does not like it, however, which is why it has been slowly degrading service over time as preparation for full privatization in 10-15 years. Part of this has been done by handing over chunks of the NHS to be run privately and incompetently by friends and donors of the party. The problems caused by this backdoor privatization will later be "fixed" with privatization. Whatever the problem, privatization will forever be the answer.
The tories argued for an American style healthcare system in 1948 and while they give tacit acknowledgement of the popularity of the NHS their views havent changed (Christopher Chope is a good bellwether of their more unsightly "hidden" views), they still want a US style system.
> You've got that exactly back to front. NHS's immense buying power lets them negotiate lower prices for drugs, exactly as medicare used to (before pharma lobbying stripped them of that power).
In principle, you're correct. In practice the fact that they're the only buyer, means in many cases that they pay at whatever a drugs company sells at since there's no "but company X is only paying Y, why are you charging us Z" as a comparison, particularly in the case of non-generics.
> The UK public adores the NHS and is one of the few things polls say that people would be happy to fund with tax raises.
And that was exactly my point. The UK public might "adore" the NHS, but they have a pretty poor understanding of how it is funded. If the government kept funding the NHS by an extra X percent every year, we run out of public funds.
> The ruling party does not like it, however, which is why it has been slowly degrading service over time as preparation for full privatization in 10-15 years.
The ruling party, being the Tories, that have been "in charge" of the NHS for the majority of its 70 or so years? And who on earth would buy a loss making healthcare system that's funded to the tune of a billion or so a week? Apple?
>> If the government kept funding the NHS by an extra X percent every year, we run out of public funds
Lets say the uk gov allocated 10x to the nhs in the next budget - to be clear, this would put just nhs spending at more than total govt income for the year. If this were a company we’re talking about, they’d be insolvent.
But we’re talking about a govt with a sovereign currency. So what would happen in this scenario? It doesn’t go bankrupt…
How is money created? What is fractional reserve lending? How is money destroyed? Can a country issue a fiat currency without an associated public debt? Or to put that last bit another way - could you settle your tax bill in GBP if there was £0 public debt?
The govt has rules for borrowing from the capital market, and that's (mostly?) for national infrastructure projects. It will never (hopefully) borrow from the capital markets to fund the NHS, and then continually pay it off.
That leaves tax or private money to fund the NHS, and we can't tax people much more. So in your comment "how is the money created?" Answer, tax, and there's a maximum limit to how much we can fund the NHS.
>> The govt has rules for borrowing from the capital market
Yeah it does. The UK govt has had 6 different sets of rules in only the past 10 years.
The current rules followed by Rishi Sunak are actively opposed to what you say - he’s been celebrating beating borrowing forecasts of the OBR by £26bn, and he makes a big song and dance any time he can stating excessive public borrowing is immoral. He found the magic money tree instead…
The scope of quantitative easing has increased massively since it was introduced. On top of this, the bank of england does not publish a report on which govt bonds have matured - but we know some have already without having been sold.
So, the govt borrowed from the govt (bank of england bought out uk govt bonds held by non govt entities) then held them to maturity (so the govt paid the govt back), while remitting the coupon payments back to the govt. All while we can’t see inside the machine - none of this is available via public reporting.
It’s not quite “printing money” but it definitely qualifies as a magic money tree.
It’s how govt’s corona responses are paid for today and it’s the reason NHS funding is constrained not by tax receipts but by policy, political decision.
> It sounds like you are disputing empirical evidence as well as standard economic theory regarding monopsonies.
When there are multiple sellers of generic drugs, you're correct. When there is one seller of a non-generic, life saving drug with no alternative, the NHS is going to pay whatever the one seller, which by definition is a monopoly, is going to charge. [1]
> What is even the point of that sentence?
That we cannot keep increasing NHS funding exponentially. Some people seem to find that fact hard to grasp - there's an upper limit. Another commenter talks about the UK raising debt to fund the NHS. Thank goodness there's a set of rules for government borrowing in the capital markets.
> A) If it is a majority of years it's a fairly slim majority and B) they werent there when it was set up.
Both parties campaigned for the NHS in the 1940s. Labour won. Blair, in power for over a decade promised to "fix the NHS" whatever that meant, but he didn't do it. Thatcher/Cameron/Johnson, all in charge for 2 decades or so, still haven't "sold it off".
> Somebody who knew that they could start charging either customers or government through the nose and make it fantastically profitable.
Except it will never happen. The government would not introduce a commensurate tax cut since they're no longer funding the NHS, so your cost of living would go up, and even in the UK, I think people would get rather upset.
> Branson is one example (Virgin Healthcare sucked £2 billion out of NHS coffers, yay for crony capitalism).
Did he really? Evidence? 2 billion of private money paid by companies into Virgin Healthcare, sure. But did he take £2bn from the NHS?
> They are not so aware of the corruption going on underneath with taxpayer money.
What corruption? Surely the police should be involved if there's true corruption?
I won't defend the NHS. I'll defend the staff that treated my father, but the organization itself needs fixing.
>When there are multiple sellers of generic drugs, you're correct. When there is one seller of a non-generic, life saving drug with no alternative, the NHS is going to pay whatever the one seller, which by definition is a monopoly, is going to charge.
This is incorrect. If the price is too high they refuse, depriving the company of all income. This has been done for certain cancer drugs.
Even if they dont refuse their pricing power lets them beat down prices.
>That we cannot keep increasing NHS funding exponentially
It's barely even increasing in line with inflation.
>Some people seem to find that fact hard
They really dont.
>Both parties campaigned for the NHS in the 1940s.
This is provably false. The tories wanted an insurance based system rather than the system we have modeled on the soviet union.
I think Im gonna leave this discussion here. We clearly dont live in the same plane of reality.
>I'm not sure how much more money the UK general public really thinks the UK government can come up with to keep giving the NHS "more!" money. There's a limit to how much people can be taxed.
To add a little nuance, look at the survival for various cancers in the NHS vs the US. Cancer care for example is measurably better in the US in terms of overall survival, early detection, and access to drugs. You "get what you pay for" when it comes to highly specialized care.
>> look at the survival for various cancers in the NHS vs the US
The figures i can find ignore people who can’t afford to become cancer patients in the US - there’s an unknown, but suspected large, number of people cut out of the figures in the US making that stat unfairly stacked vs UK (where everyone regardless of affordability gets access). The people who can’t afford in the US are typicslly the ones more pre-disposed to adverse outcomes in that statistic.
"better outcomes" when talking about health should be things like 5 year cancer Survival rates, Wait time for Surgery, Wait time for Heart Stints, 5 year heart Attack Survival rates, Wait time for Specialist Care, etc
I am not assuming anything at all, people that attempt to inject affordability into the care debate are doing so for disingenuous reasons.
The question of affordability is different from the question of quality care, we can solve the affordability problem with out having to lower the over all standard of care which is what you are advocating for, the bringing down of the overall quality of care in an attempt to increase accessibility of care. Ironically putting that faith in the US Federal Government will only result in 1 of those happening.
>> people that attempt to inject affordability into the care debate are doing so for disingenuous reasons
What exactly is disingenuous about wanting more people to live longer with higher “quality of life” for less overall spend on healthcare? You can’t achieve this without resolving the affordability issues.
>> which is what you are advocating for, the bringing down of the overall quality of care
With all due respect, you’ve made that up to fit with your world view. It’s certainly not something i’ve advocated for.
Those triple heart bypass operations i started the thread with - the 10x more expensive US procedure results in 3 year shorter life expectency post operation.
It costs more, and it’s not as good a result?
(I am being slightly disingenuous at this point - the reason the US outcomes are poorer despite being 10x more expensive for the same operation are due to differences in the health of the average patient - in the UK because healthcare is free at the point of access, there tend to be earlier interventions, in the US there is a marked difference in severity of presentation - ostensibly people wait longer until they’re really unwell before accessing healthcare)
The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US.
“Better outcomes” needs more detail:
Medical bankruptcies per year: ~200k in US, ~0 in UK. Caveat: bankruptcies often don’t have one clear root cause, the other ~600k bankruptcies per year in the US may or may not have an aspect of healthcare costs.
Cost of triple bypass heart surgery: US: $110,000, UK: £8,500 (paid by the taxpayer, not by the patient at the point of care - free for them). (P.s. private healthcare is available in the UK too - the procedure costs around £20,000 privately, payable by the patient or their insurance)
Life expectancy… you get the idea.