Health care - administrative incompetence

[Agatha]

Well, a similar thing occurs now in the UK, now, but they don't call it the same thing. If you pay extra for private insurance you get a private room.

If you pay extra for private you are guaranteed a private room, you are quite likely to get one even if you don't pay extra. Most NHS hospital 'wards' are a mixture of 4-6 bed bays and private rooms.

 

[Matthew Best]

Are they free? Or are they taxing the Hell out of you through your income and VAT?

I don't know how many times this has to be explained - they are free at the point of delivery. I don't have to stump up $160 out of my spare cash to get them.

As for whether they are "taxing the Hell out of me", personally I don't think so. Are they taxing the Hell out of you?

 

[xjx388]

I don't know how many times this has to be explained - they are free at the point of delivery. I don't have to stump up $160 out of my spare cash to get them.

As for whether they are "taxing the Hell out of me", personally I don't think so. Are they taxing the Hell out of you?

You don't have to pay at point of care because you are already paying through your taxes. You understand this, right? Maybe if you had more of your own money in your own pockets you'd get it.

My effective tax rate, even at the upper end, is lower than yours when you consider the higher effective income tax rate + VAT.

 

[Agatha]

You realise VAT isn't on every purchase, right? And that there are different rates on various items, right?

And no doubt you just forgot to mention that you'd included sales tax and heath insurance when calculating your effective tax rate, for comparison purposes. You did include those, right?

 

[Matthew Best]

My effective tax rate, even at the upper end, is lower than yours when you consider the higher effective income tax rate + VAT.

That may well be true (I don't know and you haven't demonstrated it, just asserted it), but as has already been pointed out to you, this is not because of the health service. We pay less in taxes for the NHS than you do for Medicare and Medicaid.

 

[Wildy]

I don't think liver transplants should be considered basic medical care. It's funny how in the UK, a simple and inexpensive procedure to correct a person's vision (Lasik) and improve their QOL is NOT considered "basic medical care" but a complex, risky and scarce treatment like liver transplants are?

And now that I've got Lasik in your minds, isn't it amazing how the free market has whittled the cost of this procedure to a mere £395 per eye? It used to be much more expensive than that but competition drove it down. How can you argue that other procedures, even transplants, wouldn't be the same?

Have you ever considered that in the case of Lasik it's because there is a cheaper and just as effective way to correct a person's vision. It's called glasses, or contact lenses if you don't like glasses.

Now the last time I checked there isn't a cheaper and effective way to fix a broken liver.

Health care in the US is not a free market, it is a monopoly of the insurance companies and pharmaceutical companies, and I find it so sad that there are people who have been brainwashed into thinking that this is the best way to deliver health care.

But that monopoly isn't a government one so apparently it's ok.

We should let people choose which is more important. If they want to spend money on football instead of their health, bully for them. Go for it; it's a free country. But don't expect me to pick up the bill because they spent their income on something relatively trivial.

And if I understand it correctly you would be picking up the bill if those people ended up in an ER with say a gunshot wound or a heart attack.

Personally, I would support a complete ban on tobacco products; we ban much less harmful substances.

Bit strange to see this statement from someone who just said "it's a free country".

Oh sure, except the one that extended Nikki Blunden's life by a year.

If it was an insurance company that had denied those drugs to her would you be complaining?

Another straw man. I never said private insurance is the best way to deliver healthcare. And right you are, the US is not a free market. It should be, IMHO.

But how would you be able to apply free market principles to healthcare?

Herehttp://www.aafp.org/afp/2004/0315/p1465.html are the Evidence Based Guidelines we use here. If rapid strep is positive we give penicillin unless they are allergic in which case we give erythromycin. Every positive case unless they are chronic. Then we consider other measures. UK and France, no antibiotics. Wonder why socialized medicine would be so different?

Because over prescription of antibiotics can cause problems?

I don't see sources for funding cited. Not sure what you are getting at there. You are the ones who say health care is a basic right. If you truly believe that, how can your society justify expenditures on footballers, etc when so many people are denied treatments based on cost-effectiveness?

I never knew that the Government paid for footballers.

In a free market, lower costs = lower price. We don't have a free market, so those prices haven't come down. It's simple economics.

Not necessarily.

Advice on improvement <> Health Care.

Can someone explain what the "<>" is supposed to mean?

A nationalized catastrophic insurance plan, 6% of your salary taken out of your salary like a tax to be used to fund your routine healthcare needs, and government enforced price controls to keep things affordable?

I'd be fine with that.

But would such an insurance scheme work outside of a city state?

Yes, the gov is always going to take taxes. In Singapore, they take 6-9% as forced savings which is used for your own healthcare and is supplemented by employers. Of course, there is also an income tax in Singapore (much lower rates than the US) and this tax money is used to pay subsidies for lower income people. Not so bad.

So you don't believe that people should be free to spend their money as they like? Why is it ok for the government to take your money as "forced savings" but it's not ok for them to take it as taxes to fund a national healthcare programme?

Well, you are saving for your own care. You make all the decisions. You are paying for your catastrophic insurance. The government pays only through the subsidies.

The government only controls pricing, not what doctors can and can't do health care wise. Patients can see any doctor and go to any hospital in the country. I don't like the price controls but I do like giving patients the freedom to choose.

That would suck if your treatment fell outside of what the government covers. Then it would fall into the realm of the private insurance company.

The government is your doctor and all guidelines are created by the government. If they say you don't get care, you don't get care unless you are rich.

That's wrong but if it was:

"The insurance provider is your doctor and all guidelines are created by the insurance provider. If they say you don't get care, you don't get care unless you are rich."

That's ok for some reason?

 

[xjx388]

You realise VAT isn't on every purchase, right? And that there are different rates on various items, right?

And no doubt you just forgot to mention that you'd included sales tax and heath insurance when calculating your effective tax rate, for comparison purposes. You did include those, right?

Not every purchase. Just the fun ones! I understand how VAT works; pretty much like sales tax in Texas except double (UK) or triple the rate (Sweden). So you have a higher effective tax rate for my income (income +NI) plus the VAT. My insurance is about 2% of income and I voluntarily save about 15% of my income for a variety of purposes including health expenses. So yes, effectively I pay less taxes. Guess what the kicker is, though? I get to choose where and when to spend my money!

Every time I start complaining about my taxes, I think of Europe and cheer up!

 

[Uncayimmy]

Can someone explain what the "<>" is supposed to mean?

Not equal to.

 

[xjx388]

Have you ever considered that in the case of Lasik it's because there is a cheaper and just as effective way to correct a person's vision. It's called glasses, or contact lenses if you don't like glasses.

Now the last time I checked there isn't a cheaper and effective way to fix a broken liver.

No, but if we had a free market, doctors and hospitals would have to compete against each other to provide the service. Prices would have to come down. Let's find a free market solution to the organ donation problem. Why not offer me an incentive to donate my organs? It would vastly increase the number of organs available. Simple, simple solutions to the liver transplant cost problem.

But that monopoly isn't a government one so apparently it's ok.

Do you guys know what a monopoly even is? The NHS is a monopoly. I have a choice between insurers. If I don't like the coverage or the way they treat me, I can move. Or I can go without. My choice.

Bit strange to see this statement from someone who just said "it's a free country".

It is. But we restrict marijuana and other less harmful drugs, so might as well lump the killer tobacco in there too. I personally hate cigarettes, so I was speaking from a personal standpoint, not society.

If it was an insurance company that had denied those drugs to her would you be complaining?

Nope. The point of that illustration was this: the UKers were trying to say that the NHS takes care of everyone's needs better than the US. Guess what? Most US insurers cover lapatinib! Here's Cigna's policy and they are usually one of the worst ones. Imagine that . . . a greedy US profit monster covers a drug that the altruistic and beneficent NHS does not! "Everyone's needs are covered," my hairy toe.

But how would you be able to apply free market principles to healthcare?

By eliminating the government as an insurer.

Because over prescription of antibiotics can cause problems?

Sure, if you give them to someone with a virus. If you give them to a person with a bacterial infection, they reduce the risks of transmission and
complication.

I never knew that the Government paid for footballers.

They don't, who said that? I said that 1)The UK has said that healthcare is so important that the government must provide it. 2)There are not enough resources to go around so people are denied drugs like lapatinib. 3)Yet there are, somehow, enough resources to go around to pay footballers, pop stars, etc. ridiculous sums of money.

Can someone explain what the "<>" is supposed to mean?

Less than or greater than; not equal.

So you don't believe that people should be free to spend their money as they like? Why is it ok for the government to take your money as "forced savings" but it's not ok for them to take it as taxes to fund a national healthcare programme?

Savings for your own needs <> taxation

That's wrong but if it was:

"The insurance provider is your doctor and all guidelines are created by the insurance provider. If they say you don't get care, you don't get care unless you are rich."

That's ok for some reason?

I can choose my insurance provider within a few months. Government policies take years and $$$ (or £££ in this case) to change.

 

[Agatha]

Not every purchase. Just the fun ones!

Not quite, food is almost entirely exempt or zero rated.

I understand how VAT works; pretty much like sales tax in Texas except double (UK) or triple the rate (Sweden). So you have a higher effective tax rate for my income (income +NI) plus the VAT. My insurance is about 2% of income and I voluntarily save about 15% of my income for a variety of purposes including health expenses. So yes, effectively I pay less taxes. Guess what the kicker is, though? I get to choose where and when to spend my money!

Guess what? So do we! Because we don't have to worry about the medical bills if we get a rare cancer, or if we happen to have a lifelong chronic disease!

I don't know if your assertion on effective tax rates is likely to correct, but just glancing at the Wiki page on US tax rates I'm not sure it is. Are you including the tax free payments many UK taxpayers receive, such as Working Tax Credit, Child Tax Credit or Child Benefit when calculating our effective rate of tax - whereas I think you have deductions for dependants made from your gross income when calculating tax? It may be that higher earners have a lower effective rate in the US but lower earners have a lower effective rate in the UK, but I really don't think it would be sensible to derail this discussion into the nitty-gritty of individual tax computations because there are so many variables - not least in terms of how one chooses to spend/save which affects the effective rate if one is including VAT or sales taxes in any computation. In any case, you are unlikely to have a lower effective rate of tax than I do, so where would that leave us?

As Matthew Best points out (and as several people have previously), we pay less in taxes to fund the whole of the NHS which everyone can use, than you do to fund Medicare/Medicaid, which not everyone can use. So any discussion on tax really needs to be limited to healthcare taxes- otherwise we'll be derailed into other areas of government spending.

Are you ever going to address my points about lifelong chronic illness? It's starting to look as though you are deliberately avoiding this.

 

[Darat]

...snip...

Do you guys know what a monopoly even is? The NHS is a monopoly. I have a choice between insurers. If I don't like the coverage or the way they treat me, I can move. Or I can go without. My choice.

...snip...

From the above I don't think you know what a monopoly is, from Encarta:

1. control of market supply: a situation in which one company controls an industry or is the only provider of a product or service

As you can see that definition does not apply to the NHSs in the UK.

 

[Agatha]

Nope. The point of that illustration was this: the UKers were trying to say that the NHS takes care of everyone's needs better than the US. Guess what? Most US insurers cover lapatinib! Here's Cigna's policy and they are usually one of the worst ones. Imagine that . . . a greedy US profit monster covers a drug that the altruistic and beneficent NHS does not! "Everyone's needs are covered," my hairy toe.

This implication that people are denied life-saving drugs is getting really, really tiresome. Lapatinib isn't offered on the NHS because clinical trials (you know, evidence) have shown that it is no better than existing treatments at extending life. However trials are continuing and if new evidence comes out of those trials which shows that the drug is better than existing treatments, it will be offered. I am surprised that someone who apparently works in a medical field has so little regard for evidence-based medicine.

 

[Jocce]

Every time I start complaining about my taxes, I think of Europe and cheer up!

I pay just under 30% income tax and get all the medical help I need when I need it without hazzle. I get education up to any level I personally choose. I get 480 days paied maternal leave and excellent child care for $180/month (max amount in progressive scale), etc. You sound like the stereotypical image we have of americans as completely clueless about the world outside their borders.

In any representative democracy the politicians tell you "this is what we're gonna charge you and this is what we gonna spend it on. If you like that, vote for us". Your side obviously lost but there has to be a limit to loosers whining no?

 

[Jocce]

Sure, if you give them to someone with a virus. If you give them to a person with a bacterial infection, they reduce the risks of transmission and complication.

Maybe you should check up antibiotics resistance? It's one of the major global threats.

 

[xjx388]

From the above I don't think you know what a monopoly is, from Encarta:



As you can see that definition does not apply to the NHSs in the UK.

So the NHSs don't control the medical care market in the UK? I understood from this thread that private insurance was for things like better accommodations, etc. I also understood that doctors were employed by the NHS and that was the free care you were entitled to.

What is the extent of the private system in the UK?

 

[Rolfe]

You don't have to pay at point of care because you are already paying through your taxes. You understand this, right? Maybe if you had more of your own money in your own pockets you'd get it.

My effective tax rate, even at the upper end, is lower than yours when you consider the higher effective income tax rate + VAT.

For about the twentieth time, when it comes to healthcare,

WE HAVE MORE OF OUR OWN MONEY IN OUR OWN POCKETS THAN YOU DO.

We pay slightly less in tax to fund the NHS than you do to fund the government provided healthcare in the USA.

Then, get this, we don't have to pay any more.

You have to pay all over again to fund your own healthcare because you can't access the healthcare your taxes are paying for.

If you add the amount you are spending on health insurance (don't forget to include your employer's contribution if there is one, because that's indirectly coming off your wages anyway) to your taxes, you're massively worse off than we are.

We have the freedom to access the healthcare our taxes pay for, and the freedom to choose not to spend any more of our money on healthcare unless we want to. (And the freedom to spend more on healthcare if we do want to.)

We have the freedom to make any choice of employment or not to be employed, without having to consider how this might affect our healthcare coverage.

We have the freedom to choose any doctor or hospital we like, without having to find out if it's covered by our particular insurance provider.

I could go on but that will do for now. Wouldn't have xjx388's life on a bet.

Rolfe.

 

[Rolfe]

So the NHSs don't control the medical care market in the UK? I understood from this thread that private insurance was for things like better accommodations, etc. I also understood that doctors were employed by the NHS and that was the free care you were entitled to.

What is the extent of the private system in the UK?

With private insurance the only gain you're getting over the NHS service is better accommodation and so on, but you are paying for the treatment, surgery, whatever. The point is that the treatment won't be any superior to the NHS provision, being as the NHS provision is pretty much state of the art.

If the NHS provision was wanting in any way, then the private sector is right there to sell it to you.

So, not a monopoly. Just an offer you'd be a bloody idiot to refuse.

Rolfe.

 

[Darat]

So the NHSs don't control the medical care market in the UK? I understood from this thread that private insurance was for things like better accommodations, etc. I also understood that doctors were employed by the NHS and that was the free care you were entitled to.

Sorry to say but it seems like you came into this discussion with no knowledge of what the NHS does or does not do and you've been trying to find fault ever since?

To try and help you out:

You can not pay any extra "to the NHS" to get a private room or for some other type of care, it does not have a "top up" system. However if you wish to take out health insurance there are many companies that offer such insurance. Some of them (such as Bupa) have their own hospitals and will offer treatment in those hospitals, some even lease unused resources from the NHS and so on.

And what is even more ironic is that because we have a right to timely care at times the NHS will buy procedures from the private hospitals and then you'll have NHS patients getting the benefits of the newer* "hotel style" hospitals. This right to treatment has even seen people on the NHS being treated in countries such as France when the NHS did not have the resources at that moment in time. All because we have a right to health care.

What is the extent of the private system in the UK?

From a patient's perspective: http://www.privatehealth.co.uk/


*In the UK we have hospital buildings going back a hundred or so years but new hospitals are built pretty much the same as a new hospital in most countries.

 

[xjx388]

I pay just under 30% income tax and get all the medical help I need when I need it without hazzle.

Don't forget 25% VAT on most purchases!

I get education up to any level I personally choose. I get 480 days paied maternal leave and excellent child care for $180/month (max amount in progressive scale), etc. You sound like the stereotypical image we have of americans as completely clueless about the world outside their borders.

All those benefits are wonderful. But you pay through the nose for them with taxes. And that's OK. That's a decision that you as a nation decided to make. Americans will not make that choice.

In any representative democracy the politicians tell you "this is what we're gonna charge you and this is what we gonna spend it on. If you like that, vote for us". Your side obviously lost but there has to be a limit to loosers whining no?

What are you talking about? Did you see the results of the last election? We can keep "whining" until we get the changes we want. And to be clear, I'm not on any "side." My views do not fit in neatly to any party I'm aware of and I don't dogmatically support one party over another.

You sound like the stereotypical image of Europeans we have -"Americans are stupid! They don't do things the way we do!"

 

[Rolfe]

Sorry to say but it seems like you came into this discussion with no knowledge of what the NHS does or does not do and you've been trying to find fault ever since?

To try and help you out:

You can not pay any extra "to the NHS" to get a private room or for some other type of care, it does not have a "top up" system. However if you wish to take out health insurance there are many companies that offer such insurance. Some of them (such as Bupa) have their own hospitals and will offer treatment in those hospitals, some even lease unused resources from the NHS and so on.

And what is even more ironic is that because we have a right to timely care at times the NHS will buy procedures from the private hospitals and then you'll have NHS patients getting the benefits of the newer* "hotel style" hospitals. This right to treatment has even seen people on the NHS being treated in countries such as France when the NHS did not have the resources at that moment in time. All because we have a right to health care.

From a patient's perspective: http://www.privatehealth.co.uk/

*In the UK we have hospital buildings going back a hundred or so years but new hospitals are built pretty much the same as a new hospital in most countries.

Darat, we should maybe point out that all these "featured consultants" also work for the NHS so you won't be getting any sort of "Top Man" you couldn't get on the NHS. In fact, the way to check that your private surgeon is good is to find out what his NHS appointment is. Since the very best guys have the top consultancy posts at the top NHS teaching hospitals, they can be identified very easily that way.

Rolfe.