This is the Government that You Want to Run Health-care?

[Rolfe]

Oh, and if he hates anecdote so much, would he care to show validated statistics to demonstrate what percentage of the British (jeez, Architect, how can you so blithely type the UK bit? - my typing fingers seize up!) population has ever experienced a wait of six months or more for any item of healthcare? Being as 100% of the population has utilised the NHS at some point in their lives.

And mother and her 13-month waiting list for the cataracts doesn't count. Because see, she didn't actually wait that long. Because see, the system in Britain doesn't just consist of the NHS you know.

No doubt somebody waited the 13 months, somebody either less affluent than an 80-year-old clergyman's widow on a pension, or somebody who wasn't bothered enough by their condition to shell out. However, how long would a clergyman's widow on a pension wait in the USA for such treatment?

The fact is that when the dreaded waiting list strikes, those who are stuck on it are either of the socio-economic group that would probably be unable to access any decent healthcare in the USA, or not actually worried by waiting. But we never got that far in the discussion because of the Gnome's choice to use dismissive one-liners and nasty insults instead of debate.

So in case he comes back, let's make this a recurring question.

Gnome, please post links to statistics showing the percentage of the population of Britain who have ever had to wait six months or more for an item of healthcare.

And how is it working out for you, paying out more of your income to fund state medical services you can't access personally, than we pay out for universal healthcare we can all access?

Because that's the nub of it. Because we can all access the NHS, most people don't even feel the need to purchase extra health insurance. And those who do find it quite affordable, because the insurers know that their clients will still be covered by the excellent NHS urgent and emergency care (and even rescued by the NHS from serious complications of privately-performed surgery).

I can't see a single point on which Jerome's precious system can possibly be described as winning.

Rolfe.

 

[balrog666]

Let me sum up the situation here this way:

If you think health care is expensive now, wait until you see what it costs when it's free. - P J O'Rourke

 

[Architect]

Let me sum up the situation here this way:

If you think health care is expensive now, wait until you see what it costs when it's free. - P J O'Rourke

I don't care whether healthcare is expensive for the affluent. I do care whether it is available universally, in particular to those with the greatest need.

If you want to progress your point beyond a soundbite then, as a skeptic, you'd want to look to data on the relative costs in the various different systems/countries and draw a meaningful conclusion.

Feel free.

 

[Francesca R]

Let me sum up the situation here this way:

If you think health care is expensive now, wait until you see what it costs when it's free. - P J O'Rourke

It seems that you keep reverting to some "it will never work, free market forces deliver better goods cheaper, government intervention messes it up" mantra, in the face of evidence that it already has worked to an extent many people profess some satisfaction with.

 

[Rolfe]

Let me sum up the situation here this way:

If you think health care is expensive now, wait until you see what it costs when it's free. - P J O'Rourke

I don't care whether healthcare is expensive for the affluent. I do care whether it is available universally, in particular to those with the greatest need.

If you want to progress your point beyond a soundbite then, as a skeptic, you'd want to look to data on the relative costs in the various different systems/countries and draw a meaningful conclusion.

Feel free.

Two points. First, I don't really believe the affluent should be hammered for healthcare costs. Look at the Abigail Hall case again. Her father is an architect, as it happens. How could even an affluent family be expected to find the money for that sort of treatment? And then to rub salt in the wound, have to realise that if they'd been poor their daughter would have been treated free? If the taxation system is properly designed, an affluent family will be paying proportionately more tax into the common good, and should be equally as free to access that common good as the poor family.

To get back to what G'Kar said, ".... the situation here...."

This is what's really been coming out for me in this thread. Because the US has so far proved itself incapable of running an efficient and good-quality healthcare system, two assumptions are made. First, Jerome's false assumption, that therefore all state-funded healthcare systems must be of low quality. I think we've adequately dealt with that, just get your head out of your own backyard, look around and smell the coffee. But second, that therefore the US as a country is incapable of achieving a good-quality state-funded (or other universal) heathcare system in the future.

That's what G'Kar is assuming. "If you think it's expensive now, wait till you see what it costs when it's free." Why so? That's an entirely baseless assumption, predicated only on past US poor performance in that area. We have it "free" (at the point of need), and it costs us rather less than the current US poor-quality system which nobody but the poor can access is costing.

Is the USA really in such a parlous state, has so few gifted administrators or dedicated politicians or exerienced economists, that it can't even think about achieving what pretty much all other developed first world countries have achieved in so many different ways?

Come on, G'Kar, you surely think better of your own country than that!

Rolfe.

 

[Architect]

Two points. First, I don't really believe the affluent should be hammered for healthcare costs. Look at the Abigail Hall case again. Her father is an architect, as it happens. How could even an affluent family be expected to find the money for that sort of treatment? And then to rub salt in the wound, have to realise that if they'd been poor their daughter would have been treated free? If the taxation system is properly designed, an affluent family will be paying proportionately more tax into the common good, and should be equally as free to access that common good as the poor family.

Agreed; if that means that the affluent are paying more per head than the poor, then I consider it fair and equitable in order to ensure universal healthcare.

 

[WildCat]

Is the USA really in such a parlous state, has so few gifted administrators or dedicated politicians or exerienced economists, that it can't even think about achieving what pretty much all other developed first world countries have achieved in so many different ways?

Come on, G'Kar, you surely think better of your own country than that!

Rolfe.

Sadly, we do know our own country well. It's easy to say that what should happen is that Medicare and Medicaid should be scrapped entirely, and a completely new system built from the ground up that will cover health care for all. It's quite another in real life to abolish a giant government bureaucracy that have so many deeply entrenched political interests involved. There are union issues, there are issues as to which states will get the plum parts of the new bureaucracy, which states will lose the plum bureaucracies they have now, who loses their job, who gets the new jobs...

Not an easy thing to do in practice.

 

[balrog666]

Sadly, we do know our own country well. It's easy to say that what should happen is that Medicare and Medicaid should be scrapped entirely, and a completely new system built from the ground up that will cover health care for all. It's quite another in real life to abolish a giant government bureaucracy that have so many deeply entrenched political interests involved. There are union issues, there are issues as to which states will get the plum parts of the new bureaucracy, which states will lose the plum bureaucracies they have now, who loses their job, who gets the new jobs...

Not an easy thing to do in practice.

The devil is in the detail.

 

[jimbob]

There were quite a few when the NHS was founded,

Attributed to Nye Bevan:

I stuffed their mouths with gold.
Around 1948, Nye Bevan engineered a notorious "bribe" to win the support of hospital consultants. The father of the NHS made his famous declaration after he brokered a deal in which consultants were paid handsomely for their NHS work while allowing them to maintain private practices.

 

[Architect]

There were quite a few when the NHS was founded,

Attributed to Nye Bevan:

FYI, you foreign johnnie types, Nye Bevan was arguably the main driving force behind the creation of the NHS and was the Minister responsible for its implementation. This, in turn, draws on a much wider labour/social responsibility movement in South Wales which included (amongst other things) a community-led healthcare support system.

 

[Rolfe]

Oh, I gather it was hell on wheels when Nye Bevan steamrollered it through. I used to be opposed to the idea that NHS employees (the consultants) could also moonlight in their lucrative private practices, but having seen how it all works out in practice (in particular in keeping the best and the brghtest working in the NHS) I've come to the conclusion that whether Bevan meant it or not, it worked out pretty well.

The details were enormously complicated, vested interests and hidden agendas, the works. And political dynamite.

Just as well he didn't sit on his hands and wail about how impossible it all was.

Rolfe.

 

[Darat]

Just because I find it very cool I'll declare an interest - Nye Bevan was a relative of my partner (mother's cousin to be exact), and can you imagine this: they were slightly embarrassed by him! (Him being a raving socialist and all that.)

The NHS was and is a truly remarkable achievement - certainly many members of my family and friends would not be alive today if the NHS hadn't been created and we'd continued with the "no-government-interference-free-market" health system we had prior to the NHS.

Of course it ain't perfect and terrible mistakes do happen but nothing in this thread has persuaded me that my society would be better in terms of health care without some form of "socialized" health care.

 

[Darat]

As for the quips about dental treatment - I'll share an anecdote.

My mother has been being treated for cancer of the larynx for the last about 14 months, she has received first class and very prompt care all along the way. As part of the treatment she has had to undergo her teeth have been damaged (radiotherapy side effect) and they have literally been rotting away in her mouth and they cannot be saved. In February she started dental treatment that will remove all her remaining teeth, see her have 6 to 8 bone implants in her jaw and have a complete set of permanent dentures fitted. (Whilst this is happening she will also for a couple of months have a set of temporary dentures.) The total cost of this is in the region of thirty to forty thousand pounds. She will pay nothing for this as this is considered reconstructive dental work not cosmetic. My mother is almost 67 and a retired factory worker, I would like to understand how she would have paid for this out of her very small pension....

(Oh and one of the things one of the dentist said to her was "You'll have a Hollywood smile." To which my mother said "I don't want that - I want teeth that look right in a 60 year old woman, not white artificial tombstones blinding everyone when I open my mouth!")

 

[Rolfe]

The NHS was and is a truly remarkable achievement - certainly many members of my family and friends would not be alive today if the NHS hadn't been created and we'd continued with the "no-government-interference-free-market" health system we had prior to the NHS.

I was talking to my mother about this. She was already over 30 before the NHS was founded.

Her family was reasonably prosperous, and in fact she hadn't even thought about the cost of the surgery that saved her life when she was 15, and developed osteomyelitis in her arm. During our conversation she got a bit pensive about the whole thing, re-evaluating her early experiences of her parents bringing up a family of eight. How would a poor family have afforded that sort of treatment? She didn't know. However, the sheer paucity of complex medical interventions available at that time made the inequalities significantly less marked.

The incident that really struck us however happened in about 1944. The war was on, and her older sister had returned to the family home with her newborn baby because her husband was in the army. The baby wasn't thriving. To me, it seems quite clear that my aunt had postnatal depression, and knowing her mental health history from later years just strengthens that conclusion. For some reason my grandparents didn't realise how serious the problem was, and it fell to my mother, then an unmarried 27-year-old, to call the doctor. The doctor was horrified, and started an intensive nutritional programme, which my grandfather mainly carried out. My cousin survived, long enough to have her type 2 diabetes treated on the NHS, and a hip replacement last year.

My mother recounted all this, and I remarked to her how different this was compared to my own infancy, ten years later. She had told me how she was visited frequently by a health visitor, how my weight was constantly monitored, and she was bombarded with free vitamins and so on. And yet there was nothing wrong with me!

What was the difference? The NHS, started in, I think, 1947.

I've heard so many stories of people benefiting at about that time. People who had had chronic problems they simply put up with, because they knew they couldn't possibly afford surgery or whatever was needed, whose lives were transformed.

Of course it will be different nowadays. I imagine the USA has some form of neonatal care system that doesn't require poor parents to be constantly paying a doctor to monitor their infants. And one of Nye Bevan's predictions turned out to be hopelessly wrong. He thought that once universal preventative medicine was functioning properly, the NHS would cost less, as people's problems could be treated before they became intractable. Of course he didn't foresee the huge expansion in new cutting-edge treatments, open-heart surgery and transplants and expensive cancer treatments and so on. Or the increasing cost of end-of-life care. For these reasons the NHS has continued to require more investment than he predicted. However, we're still getting extraordinarily good value for our money, and by and large the NHS has indeed managed to keep up and offer people the latest interventions even though Nye Bevan didn't plan that.

Slightly changing the subject, would the US posters in this thread like to comment on how they feel about the whole concept of the "common good". The idea that we are not individual islands, but part of the continent, and that looking after others benefits us by benefiting society as a whole?

Rolfe.

 

[Architect]

The NHS ensures that everyone, regardless of income or social standing, has access to medical attention as required. Everyone. Whether they've paid NI stamps or not. In fact the poorest sectors of the community will clearly not have paid any NI, nor would one have expected them to be able to afford it.

I have pigmented villonodular synovitis of the right knee - a rare condition. It requires an athroscopic synovectomy every 10 years or so, which is an expensive operation. It's followed by around 3-6 months of physiotherapy. I couldn't afford that treatment privately, and most insurance policies wouldn't cover it (as a pre-existing condition, etc.).

Likewise after my last knee op, I was hospitalised with what turned out to be severe pneumonia but had all the symptoms initially of a thrombosis (breathing problems, muscle aches, etc). The on-call doctor was contacted at 11am on Xmas day. At 11.30 I was seen by the doctor. At 11.45 I was admitted to casualty. I received one-on-one nursing and full monitoring during a wheen of tests over the next 2-3 hours, followed by a week under observation (in a ward, unfortunately) then extensive ultrasound tests just to make sure I wasn't going to keel over. The surgeon and consultant both saw me daily whilst an in-patient and weekly thereafter. All absolutely free, all top-notch treatment.

My next door neighbour just had a double heart bypass (only 48, fit as a fiddle, appears to be genetic). Problem diagnosed on the Monday afternoon, operation on the Wednesday, intensive care for a week, now back home. Getting fed up with the doctor coming to visit him, apparently. Absolutely delighted with his treatment, although the Scots here may be as surprised as me to learn that it was done at Ross Hall.

I've another close friend with fairly chronic Crohns. In hospital for around 2-3 weeks every year, heavy drugs to control it and so on. Couldn't speak more highly of his treatment.

In my experience many of those who talk most loudly about private treatment regimes are those who have most to benefit from it - typically on grounds of age or good health, which naturally result in lower premiums. There is usually scant regard for those vulnerable marginal groups, or those with chronic illness.

If we accept that the mark of a civilised society is how it treats the most vulnerable, then surely a robust and all-encompassing healthcare system as to be the way. The NHS has traditionally led the way in relation to other countries, although I will happilly admit that the French have produced a more expensive model which provides excellent care.

 

[jimbob]

Architect,

Acuity did ask that question in a slightly more oblique fashion:

I disagree with anything being nationalized. Government interfering in the free market is never a good idea.

What is your position on public goods? Do they exist to you?

Of course her point* was simply that "public goods" provide private benefit, so doesn't begin to address the whole moral issue...


*Acuity, please elaborate if this is too simplistic...

ETA: Private affluence, and public squalor.

 

[Architect]

Oh noes, Acuity is invoking Adam Smith.

See, we Scots have been running your country for centuries......

 

[Darat]

Our country....

 

[Architect]

Our country....

We just let you think that.

 

[Francesca R]

Acuity did ask that question in a slightly more oblique fashion:

Of course her point* was simply that "public goods" provide private benefit, so doesn't begin to address the whole moral issue...

*Acuity, please elaborate if this is too simplistic...

The NHS system has created a public good which is free-healthcare-at-delivery. This does not have to be a public good, in that it could be both excludable and rival. (Healthcare is actually rival but, for most purposes, has been made to be as non-rival as is practially achieveable under the NHS. But roads are, in a strict sense rival goods too, so are police, etc).

Public goods need not be supplied or acknowledged. If they are acknowledged as a worthwhile part of the social contract then governments can deliver them. Private capitalist agents can not do so. What we have with some posters seems to be a desire to treat healthcare as a private good and I think that's what the argument boils down to. What is invalid to me is any suggestion that a private good can ever be ubiquitous, nonexclusive and nonrival. If that's what you want, then universal state healthcare of some sort is necessary and sufficient. If it's not what you want, fess up to it.