British NHS May Soon No Longer Offer Free Care 634
An anonymous reader writes "Coinciding with challenges in the rollout of the U.S. Affordable Care Act are challenges for NHS. The Independent reports, 'A National Health Service free at the point of use will soon be "unsustainable," if the political parties do not come forward with radical plans for change before the 2015 election, top health officials have warned. Stagnant health spending combined with ever rising costs and demand mean the NHS is facing "the most challenging period in its 65-year existence," the NHS Confederation said ... In a frank assessment of the dangers faced by the health service, senior officials at the confederation say that the two years following the next general election will be pivotal in deciding whether the NHS can continue to provide free health care for all patients. "Treasury funding for the service will be at best level in real terms," they write. "Given that demand continues to rise, drugs cost more, and NHS inflation is higher than general inflation, the NHS is facing a funding gap estimated at up to £30bn by 2020."' From The Guardian: 'Our rose-tinted view of the NHS has to change.' More at the Independent, Mirror, and Telegraph."
My spider sense in tingling.... (Score:4, Insightful)
I sense controversy in the air, a lot of it.
Rose-tinted view indeed (Score:1, Insightful)
Re:Rose-tinted view indeed (Score:3, Insightful)
>And this is the system Democrats want the United States to emulate?
No. Where did you get that idea?
The ACA simply makes it easier to get insurance and requires people to purchase it.
There is nothing free about it.
Oh look, (Score:1, Insightful)
Cameron must have figured out that, if US corporation can make big money out of healthcare, then britfag corps can do the same...and gratefully share some profit with his party...
Re:Rose-tinted view indeed (Score:4, Insightful)
I am sure that some are very good. I also know that others are not. Which one do you bet our government will put out? You know... The government that gave us the TSA...
Re:My spider sense in tingling.... (Score:5, Insightful)
Nah, that's just your allergies kicking in.
No surprise, really. Medical care is something hard to avoid - everyone will get sick / aged / infirm sooner or later and few will opt not to try and at least feel better, if not lengthen or improve their lives. Western medicine is simultaneously very powerful and pretty pathetic. We've gone after much of the low hanging fruit - the newer interventions are going to center on complex molecular biology and that stuff doesn't come cheap. On top of that the population is simultaneously increasing and aging. Not good for controlling medical costs.
We could limit costs. Remember the 80 / 20 rule (actually closer to 90 / 10) - a few patients consume most of the resources. Limit those folks and you've saved quite a bit of money. Of course, that's rather a large change in our social contract and I expect one that would not be palatable to the vast majority of people.
Barring that, there are still some options to reduce costs. Carefully evaluate the cost / benefit ratios of expensive therapies (bye bye dialysis). Basically freeze drug research (it's not like they have come up with any great new therapies) and essentially force generics. Get rid of Big Pharma's advertising budget (bigger than their research budget). Get rid of insurance companies and simplify the byzantine American medical system (one time savings, but a big one, basically kicks the can down the road). Limit reimbursement. Shoot the lawyers. Ration. Ration. Ration.
But people really want good health care which means somebody has to pay for it (preferably someone else). Now, IMHO, in the US at least, we could come up with all the money we needed if we restrained our military from trying to outspend the rest of the world by orders of magnitude. We don't need 11 carrier battle groups. We don't need the F-35. And so on - the money is there, we just have to figure out what our priorities are.
Unfortunately, given the partisan nature of US politics nothing substantive will happen. The ACA was likely the best political compromise available and it sucks big time (basically doesn't change the issues noted above). In the UK, obviously they have fewer levers to pull so they may, again, have to have that difficult 'social contract' conversation.
Just exactly what do you want society and government to do? (And don't give me any free market drivel, even the highly modified 'free market' in the US hasn't worked out so well in terms of patient safety. Just what do you think would happen if the government regulators went on permanent holiday. Do you think any consumer can rationally evaluate treatments? Who has the club in that scenario?)
Re:Rose-tinted view indeed (Score:5, Insightful)
Re:Rose-tinted view indeed (Score:4, Insightful)
Re:My spider sense in tingling.... (Score:5, Insightful)
"And don't give me any free market drivel, even the highly modified 'free market' in the US hasn't worked out so well in terms of patient safety."
There's nothing even approaching a free market in the US. You can't negotiate a price (possibly on some elective things, but not much), you can't bring your own aspirin, hell, they can't/won't even tell you what they're charging for their aspirin until you get your bill.
You can't negotiate a price when you need an ambulance or emergency care. The mystical, magical, almighty free market that you worship won't work there.
Re:Rose-tinted view indeed (Score:2, Insightful)
That's bull shit. What they want is a system like Canada and Mexico where it is a single player system. And free government health care ends up not covering many expensive treatments, so only the rich get care.
In the United States, federal law requires hospitals to provide everyone life saving care whether or not you can afford it.
So what Democrats are pushing for would lead to only the rich getting care. Our current system is fucked up and can use reform, but worst case scenario is a bankruptcy, but your life is saved. I'll take that over dying.
Re:NHS hospital death rates 45% HIGHER than USA. (Score:5, Insightful)
That's pretty misleading. More people die in hospitals in the UK because they can go to the hospitals for free. In the US, they're more likely to die at home, because they can't afford to go to the hospital.
But dead is dead, and the UK's life expectancy is better than America's, while spending less per capita on health care. No amount of spin can change that.
Political will (Score:5, Insightful)
Re:Rose-tinted view indeed (Score:4, Insightful)
Long waits? When was the last time you went to visit your doctor in the US? I'm lucky if I can see him this week.
Same with the emergency room - unless you are bleeding all over the place chances are you'll be waiting for a couple hours.
My one scrape with socialized medicine was in Canada where they fixed a broken arm - put it in a cast. I don't remember waiting at all in the emergency room and to this day I haven't been billed.
Re:My spider sense in tingling.... (Score:1, Insightful)
FTFY
Re:My spider sense in tingling.... (Score:5, Insightful)
Introducing Admin Costs Killed the NHS (Score:5, Insightful)
The UK's NHS has, for most of its life, been neither a single-payer nor an insurance based system ... instead its costs came out of general taxation with no treatment-accounting. By that I mean there was no financial record-keeping related to individual treatments or doctor consultations ..... Family doctors (GP) receive a flat annual sum for each patient they have registered, regardless of how many or how few times the patient visits them. Likewise Hospitals were funded based on the medical needs of the area, with no financial records kept of individual's treatment episodes.
this approach resulted in admin costs of about 5% of expenditure only
Tony Blair started the rot when his Labour government introduced the "internal market", forcing every medical episode to be recorded and costed.. The excuse being that hospitals would compete for patient-referals from family doctors ... as the NHS had gone through a phase when it relocated most district's hospital services onto single sites, most areas of the country have only a single hospital competing against itself. There was no medical advantage to this change BUT it introduced the financial recording system needed for future privatisation
The result was an explosion of admin and financial staff ..... and admin costs that reached 11% of expenditure..
the current government's reforms are predicted to push admin costs over 20% of expenditure.
The other aspect that the Tories hate is that it is paid for out of general taxation not through an insurance premium ... so the rich contribute more than the poor and the unemployed and the less affluent pensioners still receive health-care. with the original funding method, most people paid far less in their taxes for healthcare than in insurance systems such as the US.
In general there are no medical co-pays as in the US ... Drugs are free BUT, unless are exempt (over 60, under 16, etc) you pay $10 for the prescription ... there are small co-pays for a few services such as dentistry and glasses .... things like hearing aids, breathing equipment etc, are provided free .... the NHS used to be the worlds biggest manufacturer of hearing-aids, false-teeth, glasses and artificial limbs ...
Re:My spider sense in tingling.... (Score:5, Insightful)
You clearly haven't been lying on an emergency ward bed on the verge of dying of respitory failure before. Trust me, at that point the negotiating powers are rather poor and frankly one isn't feeling much like a "rational agent".
Re:My spider sense in tingling.... (Score:0, Insightful)
Re:My spider sense in tingling.... (Score:5, Insightful)
At least in a private system, if an insurance company won't cover you, they don't charge you either.
No, they charge you for years and then either deny your claim or cancel your coverage over discrepancies in your medical records.
Re:My spider sense in tingling.... (Score:4, Insightful)
Perhaps the government should provide subsidies to private fire brigades, or private police forces, or private armies.
Oh, wait, they already do that last one.
Re: My spider sense in tingling.... (Score:5, Insightful)
To put it another way, the military is an entitlement programme.
Re:My spider sense in tingling.... (Score:5, Insightful)
OK. Bullshit. I am dying of a heart attack, they are wheeling me into surgery and I shout stop, let's first negotiate how much this is going to cost me or even fucking better, a child is being wheeled into emergency surgery and the parent shouts stop, how much is this going to cost me, hmm, that's to much, sorry sweety you are just going to have to die. See, obvious blatant in your face 'BULLSHIT'.
Re:If wishes were horses we'd all ride (Score:5, Insightful)
Shorter version: they should pay more money for worse care. Other options, like hiking taxes on the rich or slashing military spending to create more revenue, would just be hippie nonsense.
Re:My spider sense in tingling.... (Score:1, Insightful)
You're being silly. The carpenter doesn't build the house, the hammer does.
The coordination that regulation affords is *invaluable* to private industry. To claim that the government does not produce value is so charmingly adorable that it hardly even merits a response. Imagine the giant clusterfuck if companies could not externalize the cost of standardization or international coordination of the frequency spectrum for example.
Sure, the government does not produce sneakers. Nor would private industry if there was no government there to enable them to do so. Nothing exists in a vacuum except our silly libertarian friends.
The Tories have been angling for this for years (Score:4, Insightful)
Publicly they've claimed to want to maintain the NHS, but every single policy has been towards further privatisation, with the ultimate goal being that people "pay their own dues". They are the closest thing you'll find in Britain to the Republicans, but they know they wouldn't get elected if they publicly admitted to this, so they lied and a lot of people have been fooled.
That said. Norway's national health service (and I've just moved back here) is not free at the point of service. Everyone pays approximately $30 per GP consultation and something like $50-100 for a specialist appointment. Unless you're a child (in which case everything is free) or get a "free card" or if it is an emergency (in which case I've never heard anyone get charged).
A free card you get either for being unemployed, on benefits, or if you simply have alread spent more than about $300 on medical bills that year. So a few hundred dollars is the most anyone will spend on health care appointments in a year.
I find this to be a reasonable compromise and it does stop a lot of people from going to their GP "frivolously" and will thus save the health service a considerable amount of money. My only concern is that patients aren't necessarily the greatest judge of what is "frivolous". Men, in particularly, can take a long time going to the GP because they're sure "it's nothing". I'd hate for genuinely ill people to not turn up to the GP because they don't want to waste $30.
Re:Rose-tinted view indeed (Score:5, Insightful)
Why ever could that be?
What do you think that graph shows?
Here's what it seems to show. Between 1997 and 2008- the entire Labour term in office before the financial crash- debt dropped to 40% of GDP. This coincides with the highest increase in NHS spending in recent history. Now I'm not trying to argue a causal link- but it clearly wasn't NHS spending which caused our government debt. It spiked in 2008, which correlates with the huge government spending to nationalise and otherwise prop up financial service providers- not spending on a single other thing.
The chart goes on to show that since 2010, the debt to GDP ratio has continued to go up at a faster rate than at any time before the financial crisis. This coincides with the harshest cuts to NHS spending in recent history. So clearly cutting NHS funding hasn't made much of a difference to our government debt either.
Arguing that cutting spending on the NHS or welfare is going to make the blindest bit of difference either way is disingenuous. The only reason the Tories are cutting spending on the NHS is because they always want to cut spending on the NHS, in all circumstances. It's just their basic political modus operandi.
Re:Could root cause be the UK's immigration system (Score:5, Insightful)
You hear wrongly.
http://euobserver.com/social/121778 [euobserver.com]
http://www.telegraph.co.uk/news/worldnews/europe/eu/10361971/Britain-admits-it-has-no-figures-on-EU-welfare-tourist-numbers.html [telegraph.co.uk]
Unproductive immigrants are largely a myth. People who can work themselves up enough to emigrate are not usually the sort of people to shy away from work. Statistically, an immigrant is more likely to be in work than a UK native, and is likely to make greater net payments to the state (paying taxes versus using government services) than a native.
Immigration is a knee-jerk right-wing bugbear. You can argue, if you like, that they're taking our jobs. But you can't also argue that they're all work-shy scroungers. Can't both be true.
Re: My spider sense in tingling.... (Score:4, Insightful)
And what do you think if those "entitlement systems" as you call it get shut down? Enjoy your life? I sure don't hope you do if you really think that's a good idea.
What do you expect people to do if their services are stopped and they're without a job, without a home, without food, without money, without medical services without ... you name it and they don't have it? You think they'll just go "oh well, what a pity", sit down and die peacefully?
You're living in the country where owning firearms is legal, buddy. You might want to rethink taking people away everything so they end up with nothing to lose.
Re:My spider sense in tingling.... (Score:5, Insightful)
In case you didn't notice, corporations ARE already deciding what we eat.
And no, not even growing your own will avoid that, unless you somehow manage to find some kind of seeds that aren't patented yet.
Re:My spider sense in tingling.... (Score:4, Insightful)
Ahh, yes. As a building estimator contract administrator I was to base all my future medical procedures on the lowest tender, are you absolutely fucking nuts. You got any idea about how often that lowest tender turned out to be a disaster, poor job execution, demands of extra payment, incomplete job et al. Let's reiterate, your in the operating theatre, the surgeon makes his first cut, you scream, surgeon says, oh by the way, aesthetic, that's extra and it ain't cheap.
NHS has been plundered by government (Score:5, Insightful)
The right-wing party hate the NHS because it represents a large slice of the economic pie that their buddies in industry want to get their fork into. They don't care that it's one of the most efficient healthcare systems in the world with excellent outcomes.
The left-wing party just fucked things up by being corrupt and not having the balls to bring the contracts started by the right-wing party to an end.
The biggest crisis facing the NHS is the Public Private Partnership scheme - in which big private companies get the contract to build hospitals and other medical facilities AND a sweetheart contract to run them for 30 years, which typically runs the total cost of ownership up to around 300% of what it actually would have cost.
That was probably the killer blow - you now have hospital trusts struggling to make their buildings payments and keep their clinical services functioning at the same time, which enables the politicians to step in and say "Look, this hospital is struggling! The only thing that can save it is the Invisible Hand of the Market!" ... with no actual coherent explanation of how a private company which by definition will take their cut off the top, can provide a better service than a public institution that has had years of practice at running an operation on a shoestring budget, having had their income cut to the bone so many times that their bones are now rather thin.
The Invisible Hand of the Market of course just wants to reach up the patient's backside and pull the gold fillings out of their back teeth. They don't care about the risky, expensive, uncommon, and difficult procedures, they care about the assembly-line procedures and services that have predictable consumption rates and costs, like hip replacements, haemorrhoids, etc, which they can monetize nicely, ignoring the fact that that surplus on these procedures is what paid for the difficult stuff, like open heart surgery that saves the lives of babies with congenital defects.
The destruction of the NHS is just outright evil, because it will result in less healthcare (because doing less and charging more makes more money), at a greater cost (when the NHS struggles, the private company is brought in. When the private company struggles, it will be bailed out), for less of the people that need it (the lower social demographics require NHS services disproportionately more and are less likely to be able to stump up the co-pay), all to line the pockets of a few Conservative party donors. Doing bad unto others for your own benefit or amusement being the definition of evil.
Re:Rose-tinted view indeed (Score:5, Insightful)
The lowest bidder is propably not what you want.
This outsourcing nonesense has had none of the predicted benefits. Overall costs have not gone down and professionalism has not gone up. It's more of the same with a larger overhead since the outsourcing agency has a beureaucratic overhead as well as the public agency and their respective law departments. To keep the cost roughly the same the people who actually do the work get pathetic wages that in no way shape or form echo their value in the whole system.
Re:My spider sense in tingling.... (Score:4, Insightful)
"In the UK, obviously they have fewer levers to pull so they may, again, have to have that difficult 'social contract' conversation."
I don't think we do. There are plenty of places we could cut first and save a fortune. For example, in the UK if you have a kid and earn less than £50k a year you get a few grand a year for free.
I imagine we'll stop giving free money to people for no other reason than the fact they chose to have kids long before we start denying people healthcare.
Our government wants to spend £50bn (assuming it's even on budget) on a new train line too which seems to have no financial case judging from impartial and non-partisan scrutiny.
Then there's our nuclear submarines we want to replace.
That's before you consider other benefits:
http://www.theguardian.com/news/datablog/2013/jan/08/uk-benefit-welfare-spending [theguardian.com]
We can even stop giving free TV licenses, free bus passes, free money for fuel bills and a state pension to wealthy retired baby boomers also if necessary - yes, that's right, even if you're a millionaire you get money to help pay your fuel bill and a free bus pass past a certain age all paid for by the state.
Really, there's an awful lot that can go before we need to start considering restricting access to healthcare with literally no negative impact on society. As much as they'll still bitch and moan anyway because that's what they do does anyone really think that denying the thousands with even only half a million in assets and a pension access to a free bus pass would have any negative effect on society whatsoever given that they could trivially afford to just pay for the bus with their existing money like anyone else?
Couple that with getting competent people rather than the typical lifelong public sector jobsworths they normally get to pretend to improve the situation (and who inevitable fail) of efficiency in the NHS and I'd wager not only can we deal with that £30bn gap, but we can still have change left over for another carrier group or nuclear submarine or whatever else we fancy.
Free care in the NHS isn't going anywhere at all in at least the next few decades, if ever.
Or if Labour are in at the time (not that I'm a fan of the Tories FWIW) we'll probably just stick it on the national credit card and grow the deficit to pay for it instead, because that's far easier than dealing with the actual problems like free handouts to those who neither need nor deserve them, and major problems of inefficiency largely due to lack of accountability.
Re:Rose-tinted view indeed (Score:2, Insightful)
Problem is neither of those links are credible. The Telegraph is generally known as the Torygraph here because it's pro-Conservative so bound to attack Labour no matter how true, and The Daily Mail is just Fox News with even more lies.
I do really mean lies by the way, The Daily Mail does actually outright lie. I'm all for getting information from multiple sources, but The Daily Mail has so little credibility it's just not worth even using as a competing source because it's not that it simply has a different opinion on things, but that often it's just outright wrong and a wrong source has no merit in providing a balanced opinion because it doesn't provide a different perspective, it just provides wrongness.
Note that I'm not absolving Labour of blame here, but using sources that are known to be untrustworthy decreases the credibility of your argument. I'm pretty sure news outlets that have at least some capability to be objective have also reported on real actual issues without the additional lies the Torygraph and Daily Fail throw in.
Re:My spider sense in tingling.... (Score:5, Insightful)
I salute you. You have quoted an article from a source less reputable than even the Daily Mail. Well trolled.
In any case the NHS 'crisis' is mostly manufactured. The NHS is constantly fighting for budget (as with all other parts of government), while the private sector wants a piece of the action. Everybody's got an agenda, but by and large, the British are very happy with the NHS.