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."
So what? (Score:5, Interesting)
At present, the NHS is still one of the more efficient healthcare systems out there - way more so than the US system, for example.
Healthcare is getting more expensive, and I would imagine that in the next few decades technologies such as synthetic organs will make it even more so. What if every elderly patient wanted a new synthetic heart, lungs, kidneys at a cost of £5,000,000 each? At some point it becomes a logical impossibility to pay for everything that can be done, for everyone. Even now it's not uncommon to find individual patients who've had £2,000,000 spent on their care (small kid with leukaemia) or who needs arthritis drugs at £30,000 pa.
The basic NHS model of prividing medical care is a good one. As a doctor I always ask 'what needs to be done' for my patient. Not 'what can they afford'? I'm frrequently appalled by the unnecessary extra scans etc I see booked in the private system here, or the insurance 'gotchas' (e.g. patient breaks ankle; sent to NHS hospital. Insurance pays for operation in a private hospital but not for the ambulance transfer to it).
The problem with the NHS system isn't that it doesn't work. It's that at present it's being attacked for ideological reasons and that presently we're being forced to do too much with too little. An injection of money would help - and as we spend less than many comparable nations on healthcare it's odd to suggest that this is unaffordable. However at some point we're going to have to accept that we can't do everything for everyone at all times.
Bullshit!!! (Score:5, Interesting)
UK has been getting a flood of immigrants who want nothing more than to live on the UK's generous welfare system.
Sensible arguments are can be made from the right - about NHS, immigration and other stuff, but you wrote flaming nonsense.
No economic migrant anywhere in the world is a leech on the host. They are the most hardworking - generally doing the low wage work the locals are not really keen to do. They pay taxes - may be not income tax - but every other tax when they consume products and services.
Who's the famous immigrant bogeyman in UK? The Polish Plumber. Who's he? A plumber. Someone who unclogs the stupid shit you guys excrete.
This is the same all over the world. Mexicans and Central Americans in US, Bangladeshi's in India (before partition - 60 years back - Bangladesh and India was the same country, calling Bangladeshi's illegal immigrants is stretching matters, still India has 1 billion plus population - so at least in the short term the argument 'we do not need extra heads' may make sense), Sub Saharan Africans in Italy who perish in large numbers when their boats capsize and so on.
The countries taking immigrants - willingly or otherwise - have a brighter future. You need headcount. The native population is not going to procreate in the numbers needed to keep your economy growing and humming. US is a prime example. Japan is on a long term decline for precisely the same reason - they are so insular they have a great derogatory word for non Japanese - GAICHIN. Ask yourself - do you want to live in a Japanese society full of inbred Japanese who all look the same? Parsi's in India - otherwise a very sensible community - is in decline for the same reason. They are so insular if a Parsi marries a non Parsi they are kicked out.
What you - and the type like you - also forget is the cultural and social contribution of the immigrants. Diversity and mixing of gene pool is a good idea. It makes your country stronger.
The new slogan should be "make love to someone of your opposite in gene pool, not war."
comparisons (Score:5, Interesting)
I've lived in three countries, the UK with a full free health service, New Zealand with a partially free health service, and the US, and I've had contact with all of those health services for myself or my family.
The NHS in the UK is the best all round. You see your doctor, you feel that they care about you, they have the backing of a good hospital system to do anything they need to do. It can be slow to get treatment, but you can always go private if you can afford to do so, but when I had problems they were fast enough.
The system in NZ is the second best. The doctors care, and there is a smaller population so it feels more intimate. However, that smaller population means less in the way of economy of scale, so treatment might not be available or you have to travel further. Pharmac negotiates drugs on a national level so that is good for the tax payer, but maybe not for the individual that requires an esoteric cancer treatment. As with the UK you can always go private if the public system is too slow, and I've had an occasion where that was the case.
I don't really know where to begin with the US system. On the positive side its nice and shiny. Individual people do care and help you out, but it doesn't feel like the system as a whole gives a shit. There is a lot of paperwork (absent from the previous examples). There is an abundance of choice and options. When you are sick (or your kid is sick) you don't want choice or options. I was shocked that the health coverage from my company was only subsidised and I still had to pay on top, and I'm utterly confused by the insurance options and savings whatnots (you put money into an account for health stuff?). It is a complex and scary system, but at least if it turns out I have the wrong coverage I can flee home to sanity.
I hope they keep the NHS free. Adding fees will ruin feel of it. I know what they'll do if they charge fees is they'll create a health card for low income people who can't afford the cost. But it is a needless barrier to treatment, if they do that why not just raise tax?
Re:Rose-tinted view indeed (Score:2, Interesting)
By "strong Conservative/Tory assault", you mean the horrors of a competitive tender process to try and find the cheapest provider, so you can offer the most efficient service? Or do you mean they've cut funding? Why ever could that be? [google.com] I know, I know, conservatives just hate poor people, and the fact that the UK's debt is now 90% of it's GDP is irrelevant - they should just keep pouring money into the NHS and hope the problem just goes away.
Margaret Thatcher still applies - the problem with socialism is, eventually you run out of other people's money. Well, the UK has run out. Now it's running out of money it can borrow too.
Or we could (Score:5, Interesting)
Re:Rose-tinted view indeed (Score:2, Interesting)
Privatisation probably works reasonably well for discrete procedures such as hip replacements or cataract surgery, but holistic healthcare is another issue. Patients, particularly older patients, are starting to have more and more medical conditions simultaneously. All the doctors looking after all the separate conditions need to be able to communicate seamlessly and often need access to scans and results requested by other doctors. My experience of private healthcare is that it leaves a lot of 'gaps' in the care.
Sometimes these are literal - e.g. patient needs an operation in another hospital. Both providers refuse to pay for transport between the hospitals because they deny responsibility. At one point I worked in a hospital where porters refused to push patients through a tunnel to another hospital - both sides denied responsibility. It was left to the doctors to push the beds, because nobody else would break the impasse!
Another issue is training. At present, doctors trained on the NHS do private work. But without a public system, how do said doctors get trained? Training is expensive and for that matter increases risks to patients, no matter how much we would like to deny this. This makes private care look much better on paper, but would need to be solved prior to dismantling the NHS.
Re:Rose-tinted view indeed (Score:4, Interesting)
Actually, if you follow international news at all, there has been a strong Conservative/Tory assault on the NHS for several years now.
If you follow the news you realize that Labour might have some involvement since they ran the government for so long.
Labour must bear the blame for the shameful decline of the NHS [telegraph.co.uk]
Up to 1,200 needless deaths, patients abused, staff bullied to meet targets... yet a secret inquiry into failing hospital says no one's to blame [dailymail.co.uk]
- Up to 1,200 patients died unnecessarily because of appalling care
- Labour's obsession with targets and box ticking blamed for scandal
- Patients were 'routinely neglected' at hospital
- Report calls for FOURTH investigation into scandal
I'm sure there is plenty more to find.
Re:My spider sense in tingling.... (Score:5, Interesting)
The free market works for elective surgery because you *can* shop around and take advantage of competition. That isn't where the problems lie. The problems occur in situations where you *cannot* shop around and for which there is no competition, sometimes not even consent (you can't make a deal when you're unconscious). How do you propose to 'let' the free market work in these cases? Why is the care in the US 2.5x as expensive as the "too expensive" NHS (per person per PPP normalized GDP/capita) if the free market system works so well?
Insurance helps, but it comes with a host of its own problems. Very few people are qualified to evaluate a plan (those that are work for insurance companies) which translates into a clueless consumer: if only 1% of people only ever get cancer and require their plan to pay out more than they payed in, then only 1% of people know if they were being ripped off or not. The bandwagon effect and lack of law-of-large-numbers make things worse (risk grows with sqrt(N), risk is cheaper per person for larger plans). And then there is the problem of buying perscription drugs, where even the largest of insurance companies have virtually 0 bargaining power as compared to single payer systems, forcing them to pay 2x for drugs.
We have been 'letting' the market work for the past decade. As a result, our care is 2.5x as expensive. You're nuts if you think that eye surgeries are anything but an outlier.
Re:Rose-tinted view indeed (Score:2, Interesting)
And as a consequence....
Patients facing eight-hour waits in ambulances outside A&E departments [telegraph.co.uk]
Re:Rose-tinted view indeed (Score:4, Interesting)
Yes... Just fine. Those stories of long waits, or unavailable diagnostic care are just rumors, I am sure...
Yes, they are.
Believe me,I lived for 7 years in UK and now I'm in my 6th year in USA and it is incomparable. US system is just massively inferior - and I work for a big national lab and hold the most expensive insurance option.
So yes, I'd go back to NHS any moment.
Incorrect Title is Incorrect (Score:5, Interesting)
Re:Rose-tinted view indeed (Score:5, Interesting)
I woke up with a hard pain in my right side. It got worse and worse, until it was clear it wasn't cramp, but something badly wrong.
I called an ambulance. I live in a rural area, so an hour away from the nearest hospital. Ambulance was there in 10 minutes. They assessed me, took me to hospital.
After blood tests, they put me on high dose antibiotics and painkillers, and onto the ward. They suspected a gallstone. A few hours later, I had an ultrasound; no sign of a gallstone, but the gallbladder was clearly inflamed and I had an infection. They decided to see if the antibiotics would tackle the infection, so I could have elective surgery more safely in a couple of weeks to remove the gallbladder.
I got worse over night, with a worsening fever. They booked me in for emergency surgery to investigate, and I was going under anaesthetic inside an hour. Turns out, my gallbladder had turned necrotic and had started to fall apart, and needed removing in a hurry - they had to switch from keyhole to open surgery, took it out on the spot.
I then spent a week in the hospital, recovering from the 6" abdominal hole from the surgery. When I was discharged, my total bill was... £0.
I was treated with huge professionalism and care, survived what could easily have been a fatal infection with rapid treatment, and I didn't spend a second worrying about what it would cost me. Ok, the food was airline quality, but I wasn't exactly hungry anyway.
The NHS is running out of money because there's more people, living longer, wanting the latest, best drugs that cost more, while funding levels are being cut in real terms by the Tory government. That's something that will have to be dealt with, but it's certainly not a reason to kill the NHS. It's one the best things about Britain, and if we have to up our contributions a few percent to pay for it, I for one am glad to do so.
Re:My spider sense in tingling.... (Score:4, Interesting)
The second point is why socialised health care and insurance companies have advantages over individuals in negotiating for care. An individual probably won't need to go to hospital in any given year, and very few of the ones that will need to can predict what treatment they will need in advance. In contrast, you can statistically work out roughly how many people in a country will need what kinds of treatment, with quite high accuracy. Negotiating to pay for them all together puts you in a much stronger bargaining position.
The big problem with this debate is that it conflates a whole range of choices in a single socialised medicine vs private medicine debate. In reality, there are a lot of points on the spectrum, depending on:
The question of what role the free market plays is complex. Obviously, you can't have people who have just suffered a heart attack shopping around for the best value ambulance to take them to the best value hospital. But you can have, for example, a central government buying medical services for all citizens (which typically counts as socialised medicine in these debates), but having different medical centres competing for the business, especially if they're allowed to take private patients as well so that they can stay in business when they don't have the majority of the government contract.
Re:Rose-tinted view indeed (Score:5, Interesting)
FWIW I work for the NHS. The Labour governement indeed poured billions into the health service during their term but it was almost totally squandered on failed IT projects, an army of midde-managers, non-jobs and grossly overpaid execs.Very little of it was invested in actual patient care.
I do believe the Tories are genuinely trying to fix it, my problem with them is that they're doing their usual carpet-bombing approach instead of carefully targetting the gross inefficiencies that are blighting the NHS.
Re:My spider sense in tingling.... (Score:4, Interesting)
I imagine that there's some limit, like maybe only emergency room visits are covered for visitors or something like that. Still, the process was simple, the staff were helpful, and my daughter got what she needed and she was fine as soon as the antibiotics kicked in.