• Quick note - the problem with Youtube videos not embedding on the forum appears to have been fixed, thanks to ZiprHead. If you do still see problems let me know.

Scotland's healthcare system doesn't suck!

Francesca R said:
According to the prognosis ponderingturtle appears to be alluding to, Obama won't face it, because the blockage to reform is one of executives and legislatures being bought off by coalitions that want to protect the status quo contrary to the public interest. (Isn't that why Hillary Clinton's efforts were skewered?)
Click to expand...

He hasn't, he is bending over backwards to get drug companies, insurance companies and the AMA to sign off on his plans. This is not going to result in cost cutting reforms.
 
Fiona said:
Well it wasn't exactly easy to set up the NHS in the UK either. If the political will is there it must be possible
Click to expand...
There's a less dodgy/flippant response to this than the one I made (sorry).

The problem (and I think I agree it is a problem) is that there isn't enough political will, and that could be the case despite public opinion being highly supportive, though I don't know if it is. Put simply, public opinion which is not well organised and is diverse and diffuse and--at the end of the day--diluted by a lot of other concerns that the non-organised public has, has to work very much harder than the very-well-organised and concentrated special interests of the coalitions that benefit from the present US health system, in order to overcome them and prevail in getting policies that serve the public better than insurance and pharma and the AMA.

According to a brilliant book by political economist Mancur Olson, the efficiency-retarding accumulated influence of special interest groups grows stronger over time the more a country is at peace, democratic, settled and so on. Events that sever these networks of relationships between self-advancing coalitions and government (lost wars, revolutions, state bankruptcy, and I would include Naomi Klein's laundry list of "shock therapies" too), can sometimes restore policies that better reflect public interest not private special interests. I would classify the establishment of the NHS into this situation, though Olson does not mention it but covers many other schisms such as Germany and Japan's post WW2 economic dynamism.

So in all seriousness, I think it is much more difficult for the US to get to UHC than it was for the UK to set up the NHS and the other welfare state institutions that it did post-1945. And that is not because of political will per se.

However, I don't think it can happen without torpedoing some of the financial incentives that drive politics.
 
Last edited:
Francesca R said:
There's a less dodgy/flippant response to this than the one I made (sorry).

The problem (and I think I agree it is a problem) is that there isn't enough political will, and that could be the case despite public opinion being highly supportive, though I don't know if it is. Put simply, public opinion which is not well organised and is diverse and diffuse and--at the end of the day--diluted by a lot of other concerns that the non-organised public has, has to work very much harder than the very-well-organised and concentrated special interests of the coalitions that benefit from the present US health system, in order to overcome them and prevail in getting policies that serve the public better than insurance and pharma and the AMA.
Click to expand...

And lets not forget the TV advertisements with blatant lies in them either.
 
All reasonable points, Francesca R. However I do think that a settled political will on the part of the people is the crux. You are correct in saying that public opinion is seldom united and active: but all that is required is a leadership which wants it enough to do what it takes; and a population which is also in favour.

Special interest groups can do nothing in face of that combination. They are very good at preventing such a consensus emerging: that is what all the lies are about. They aim to confuse people about where their interests lie, amongst other things. And they are quite good at preventing the election of anyone who is ideologically committed to that kind of couse. But politicians want to be elected: if the interest groups are strongly against what the voters really want I know which way I think they will jump. Thus committed leadership and voter recognition of their power is a virtuous circle. I do not think it is more difficult for the reasons you give: I think it is more difficult because american politics is bedevilled by defeatism. That is strange in view of the "can do" attitude they are famous for: but all I seem to hear is "it can't be done"; "no point in trying"; "they won't let us"; and stuff like that. I have been very surprised at that and I am sure it is not as pervasive as it seems on this board. But it seems to be growing in this country too and it may be a feature of the kind of political/economic certainties which are normally put under the "anglo american" label. I do not know. I do know it was managed in the UK when we had no economy to speak of: and it was managed because people wanted it and voted for it. No excuse would have been acceptable so far as I can see.
 
Rolfe said:
Let's face it, and hope Obama will too, getting from where the USA is to anywhere sane is going to be difficult. If the system currently pays out twice what it actually needs to to get the results it's achieving, then 50% of the money is going in unproductive directions. Some people are trousering a lot of cash, which is going to have to be redirected elsewhere if anything constructive is going to be done. They are not going to be very happy with this redirection. And some of these people have enough of said cash already trousered to buy them a great deal of influence.

OK, that's simplistic, but it's the nub of the problem in that respect.

Rolfe.
Click to expand...

True.
But I personally take heart in:

1) "this is not a principled fight"

and the campaign theme that got Obama elected of...

2) Yes We Can!

:cool:
 
Fiona said:
all that is required is a leadership which wants it enough to do what it takes; and a population which is also in favour.
Click to expand...
Yes, though it is not that often that the stars align themselves for this combination for action. Disregarding political colours (and not talking about health policy), let's say it happened with Attlee, Thatcher and Blair in the UK (and Blair did less with his chance) and with <well I dunno> Reagan and <maybe?> Obama in the US. The jury is way out on the last one. So it's rare to get the opportunity for political representation of the public to overcome embedded coalitions of vested interest. Things need to get bad enough I suppose, and people fed up enough of a broken status quo. (And national emergencies "help")
 
News flash. About 3 minutes ago, a front-tooth crown of mine fell out. This is a crown that was put in by the NHS in 1982, by the way.

I will have to wait till tomorrow to phone the dentist, of course. Let's see how long it takes me to get seen and get the crown replaced.

Rolfe.
 
Shocking, isn't it? :D

Based on previous experience, the limiting factor might be me being able to get off work for whichever slot they can fit me in. However, as we're not really pushed at work this week (unless she says Friday afternoon.... :( ) and I don't mind which dentist I see in the practlce, I'd say there's a good chance this will be sorted before the weekend.

She might even grind down a rough filling I have on a wisdom tooth while I'm there. I was keeping that one for my next routine checkup, but that's six weeks away.

Rolfe.
 
Last edited:
In Denmark you pay for your dental work, quite a lot.

My left pinkie and ring finger have been sleeping for the last week.
I suspect I will have to get the hand/wrist sliced up, my problem is not cost as I am not paying, but more with the slicing and recovery part.
 
Toke said:
In Denmark you pay for your dental work, quite a lot.
Click to expand...

It's the same in Germany.

Toke said:
My left pinkie and ring finger have been sleeping for the last week.
I suspect I will have to get the hand/wrist sliced up, my problem is not cost as I am not paying, but more with the slicing and recovery part.
Click to expand...

Just make sure it's no back problem, okay? :)
 
Rolfe said:
Oh, I'll pay for this, but it's a small job. I'll post the price as well. :D

Rolfe.
Click to expand...

Good luck. Is it not covered by the NHS?

Rolfe said:
Does this answer your question?
Click to expand...

Yes thank you.

I can see why ordinary Americans may be fearful of changes to the system - even if they are unhappy with the existing system.


The basic parameters of a system seem to be:
  1. What treatments are covered.
  2. Whether there is a co-payment for those treatments.
  3. Whether enough government money is tipped into the system (this determines where the line between cost-efficient and not cost-efficient is drawn).
  4. How easy is access to a private system for people who want to jump the queue or access treatments not considered cost effective.
  5. Where the government raises the money to pay for the system (if the government has to pay extra than they do currently)
And this is before there is discussion about how efficient the system is run and who gets paid what.

There is also a re-distribution of income. By the sounds of things the wealthy in Britain seem to get the same treatment they would get in the US but seem to pay more taxes (or more of their taxes) to subsidise the health care of the poor.
 
Last edited:
By the sounds of things the wealthy in Britain seem to get the same treatment they would get in the US but seem to pay more taxes (or more of their taxes) to subsidise the health care of the poor.
Click to expand...

Just a small point,gtc. In the UK the wealthy can and do pay for private insurance sometimes. This does give them certain privileges, such as the right to treatment at a time of their choosing, better accommodation etc. It does not generally get them treatment from different doctors (there are some who have a wholly private practice, but not many). More importantly, this cover is generally used for more minor and/or short term conditions. When something goes wrong in a private hospital the patient is usually moved to an NHS facility. When the wealthy are diagnosed with a very serious and/or chronic condition they frequently revert to the NHS as well: because private insurance seldom covers that, just as it does not in the US. There is some redistribution of income, as you say, if the person is treated as a private patient in an NHS hospital. They pay extra but for tangible services and that money is part of the funding of the NHS. But the chances are that they will use NHS service directly at some point in their lives and the amount they have paid in will not cover the cost of that in very many cases. The difference between this and the US system is that they have the right to treatment they cannot afford, just as the poor have
 
Fiona said:
Just a small point,gtc. In the UK the wealthy can and do pay for private insurance sometimes. This does give them certain privileges, such as the right to treatment at a time of their choosing, better accommodation etc. It does not generally get them treatment from different doctors (there are some who have a wholly private practice, but not many). More importantly, this cover is generally used for more minor and/or short term conditions. When something goes wrong in a private hospital the patient is usually moved to an NHS facility. When the wealthy are diagnosed with a very serious and/or chronic condition they frequently revert to the NHS as well: because private insurance seldom covers that, just as it does not in the US. There is some redistribution of income, as you say, if the person is treated as a private patient in an NHS hospital. They pay extra but for tangible services and that money is part of the funding of the NHS. But the chances are that they will use NHS service directly at some point in their lives and the amount they have paid in will not cover the cost of that in very many cases. The difference between this and the US system is that they have the right to treatment they cannot afford, just as the poor have
Click to expand...

My point was a little different.

Given the combination of the government and private health cover, the wealthy should recieve no worse health care under a properly functioning universal health scheme than they would in a purely private system. The poor, however, receive better coverage.
 
I've got to pop into hospital today for a quick investigative op - all routine, nothing serious, I hasten to add. I'm having it done on my wife's work's healthcare cover. As I mentioned before, and as Fiona says above, it's the same doctor I'd get at the local NHS hospital. So why am I doing it? Well, it knocked a few weeks off the waiting time (about 4, I think), and I get to choose the day of the op. Oh, and I get a private room for the hour or two it takes me to recover from the sedatives or local anaesthetic, or whatever.

If it was me paying the cash, out my own pocket, would I bother with private health cover? Heck, no. It's the same treatment, by the same people. NHS is fine.

I like to think of it as a bit like travelling first class on the train. Whether I go standard or first, the train still gets me there in the same time. The only difference is slightly comfier seats and a bit more legroom.

Whereas with the American model, some people are going to be hanging from the outside and at least some will have got left behind at the station.


[I've been fasting for 12 hours now and am grouchy as heck, so apologies if it comes across in the post]
 
gtc said:
Good luck. Is it not covered by the NHS?
Click to expand...


Gaaaaahhhhh!!!!!

It's just as well that I typed that comment about the crown falling out last night. Just after it happened, before I even typed the post, I slipped it back into place. Partly because it felt better, and partly because I know it's important to keep the crown cavity clear and not let it start to "heal up" before the thing is replaced.

It's still there. I ate my supper and it was still there. I slept all night and it was still there. I ate my breakfast and it was still there. I just had my coffee, and it's still there.

I had completely forgotten all about it! And I could well have gone on forgetting all about it until it did it again. Maybe tonight, who knows.

Anyway, I just grabbed the phone and called the dentist, and the receptionist said, it's Karen you usually see, isn't it? I said yes, but I really didn't mind who I saw on this occasion, just anyone who could fit me in.

11 o'clock tomorrow morning, with Karen.

This is on the NHS, but you still have to pay something. Don't know which US term it would be, co-pay or deductible or something. It won't be much.

I could have called up any dentist at all (Karen is actually some distance away, because I didn't change dentists when I moved house two years ago) and they would have done it privately at a rather higher fee, but I chose to travel to my own dentist for continuity of care.

Rolfe.
 
Rolfe said:
This is on the NHS, but you still have to pay something. Don't know which US term it would be, co-pay or deductible or something. It won't be much.
Click to expand...
NHS Dentist Charges Structure
£16.50 - This charge includes an examination, diagnosis and preventive care. If necessary, this includes X-rays, scale and polish, and planning for further treatment. Urgent and out-of-hours care also costs £16.50.
£45.60 - This charge includes all necessary treatment covered by the £16.50 charge PLUS additional treatment such as fillings, root canal treatment or extractions.
£198 -This charge includes all necessary treatment covered by the £16.50 and £45.60 charges PLUS more complex procedures such as crowns, dentures or bridges.

NHS dentist treatment is completely free if you are:

Under 18 years old
18 but in full-time education
Pregnant or have given birth within the last 12 months
Receiving Income Support, Job-seeker's Allowance or 'Guarantee Credit' on your Pension Credit - or your partner is receiving one of these
 
You must log in or register to reply here.

Back
Top Bottom