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United Kingdom Government Medicine The Almighty Buck

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."
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British NHS May Soon No Longer Offer Free Care

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  • by cold fjord ( 826450 ) on Thursday October 17, 2013 @11:24PM (#45160665)

    I sense controversy in the air, a lot of it.

    • by ColdWetDog ( 752185 ) on Thursday October 17, 2013 @11:42PM (#45160803) Homepage

      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?)

      • by msauve ( 701917 ) on Thursday October 17, 2013 @11:53PM (#45160877)
        "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.
        • by Anonymous Coward on Friday October 18, 2013 @12:04AM (#45160963)

          "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.

          • by mc6809e ( 214243 )

            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.

            The government doesn't grow food. It gives people money to buy food but relies on the market to respond to the increased demand and provide it.

            The government doesn't provide housing. It give people subsidies to buy housing and relies on the market to provide housing.

            The government doesn't provide medical care (except at the VA). It gives people subsides and

            • by Pseudonym ( 62607 ) on Friday October 18, 2013 @02:25AM (#45161693)

              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.

          • by philipmather ( 864521 ) on Friday October 18, 2013 @05:41AM (#45162571) Homepage Journal

            You want first hand expirience? Go and break/twist something whilst skiing in Austria, I had to ski off a glacier with a broken rib due to certain circumstance but if you have the option of forking out for a ski-do lift off you will, or worse if you need a helicopter out of there you can forget "choices". Obviously it's "choices" that got you there in the first place to an extent but as an illustration of how quickly a fit individual can instantly lose all freedom of choice via nothing but bad luck and random accidents you get the point.
            The care afterwards was epic BTW, I obviously had insurance so walked into one of the private medical clinics, in one hour I'd had a technician do three x-rays, a doctor check me over and then handed over to a nurse for a quick bandage up. Back out to reception and they'd almost instantly burnt my x-rays to a CD complete with program for viewing them, written up my prescription and compiled the bill. Everyone spoke at least passable English as well.
            I've had the flashing blue-light treatment back home via an NHS ambulance as well and whilst it was good and everyone was nice, competent and helpful they were no where near as efficient as the Austrians but there again they were free at the point of need and a general treatment A&E.
            On balance I'll pay my (considerable) taxes all day long to have the NHS there thank you very much.

            • by aclarke ( 307017 ) <.ac.ekralc. .ta. .maps.> on Friday October 18, 2013 @08:54AM (#45163443) Homepage
              We had a similar experience (sort of) in the UK earlier this year. We had a 4 day stopover, and my daughter was sick with a fever and throwing up after getting off the plane. My wife took her to the emergency room, where she received top-knotch care from sympathetic and helpful medical staff. She received prescription antibiotics, and the entire process cost us a total of £0. Healthcare in the UK is free for children, whether they are citizens, residents, or visitors. We were really impressed and appreciative. Thanks, UK taxpayers!

              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.
          • by judoguy ( 534886 )
            The VAST percentage of healthcare in the U.S. isn't emergency. Emergencies happen of course, but most of the time you *can* schedule medical services.

            The discussion is almost exclusively how to make everyone have health insurance. It should be all about how to have as inexpensive healthcare as possible.

            The cheapest possible healthcare is your doctor, her staff and you. Every insurance lamprey, bureaucrat and government added cost, e.g. endless taxes and unneeded regulation added to that list, drives up the

        • by reboot246 ( 623534 ) on Friday October 18, 2013 @12:25AM (#45161089) Homepage
          Actually there is a free market success in the medical field. Laser eye surgery started out expensive and not covered by insurance. Now it's cheap enough to pay for out-of-pocket. I saw an ad just the other day for Lasik eye surgery for just $299.00 per eye. Not bad at all - cheaper than buying glasses in the long run.

          The free market works when you let it.
          • by Anonymous Coward on Friday October 18, 2013 @01:45AM (#45161513)

            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.

            • by TheRaven64 ( 641858 ) on Friday October 18, 2013 @05:46AM (#45162591) Journal
              You (and other posters in this thread) are making several assumptions that are not necessarily warranted:
              • That the person needing the care will negotiate for it at the time when they need it
              • That the person needing the care will negotiate individually, and not via some collective bargaining mechanism

              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:

              • Are hospitals owned and doctors employed by central government, local government, or private enterprise?
              • Are medical services bought individually, as a private collective, at a local government level, or nationally?
              • What mechanism is in place for judging the quality of care and for the payer to select between providers?
              • Is payment by individuals based on need, ability to pay, or something in the middle?

              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.

        • You can't negotiate a price

          You most certainly can. My father-in-law is not a US citizen. He came to New York for a surgery, balked at the initial price estimate, and negotiated it down significantly.

          I have health insurance, so have never needed to do this, but you certainly can negotiate price - they key is to do it BEFORE you receive care.

          I used to go to a dentist that suggested that I pay him a lower fee than I was currently paying in dental insurance premiums. I didn't take him up on it, but it was tempting.

      • Or we could (Score:5, Interesting)

        by rsilvergun ( 571051 ) on Friday October 18, 2013 @12:54AM (#45161241)
        just tax the rich more. Seriously. We put a _lot_ of effort to satisfying their whims and providing them with every creature comfort in the world. The only thing we'd lose is the (false) dream that we can have it ourselves. But then again good luck getting people to give that up...
      • There is much truth in what you say - in my opinion the biggest, single factor in the spiraling health care costs is the pharmaceutical industry; and they are also in a perverse way on of the biggest hindrances to the development of real cures to some of the diseases that cost society so much.

        To understand this, one just have to look at the fact that companies exist primarily to make money. If you find a way to cure, say, cancer, the company that produces the medicine can make money once per patient; but if

      • by Xest ( 935314 ) on Friday October 18, 2013 @06:20AM (#45162731)

        "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: []

        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.

  • by Quinn_Inuit ( 760445 ) < minus poet> on Thursday October 17, 2013 @11:45PM (#45160825)
    And that's assuming no GDP growth during that time. Actual GDP percentage will probably remain constant or rise only slightly. As a resident of a country (the USA) that spends more like 17% of its GDP on health care for outcomes that are no better (and arguably worse), I still think the UK is getting a great deal. Citations:
  • No comparison to ACA (Score:5, Informative)

    by Severus Snape ( 2376318 ) on Thursday October 17, 2013 @11:47PM (#45160839)
    The NHS is currently underfunded, just now the government in charge would love to abolish the NHS purely for ideological reasons. Since the global recession, politics in the UK has been fought over the issues of, public spending cuts, cost of living, the welfare state, immigration; the NHS has been shunned to the side and because of this has allowed funding to minimized. A (phony) promise was made by the government back in 2009 to protect NHS spending, an increase in spending was in fact claimed but the truth is polarising.

    It's privatisation in the back door, under fund it, make it under perform, all of a sudden privatisation becomes an easy argument to make.
  • So what? (Score:5, Interesting)

    by Anonymous Coward on Friday October 18, 2013 @12:02AM (#45160945)

    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.

  • by BlueCoder ( 223005 ) on Friday October 18, 2013 @12:13AM (#45161029)

    For the people on the bottom that physically work and produce nothing really changes. All that people really need is food and shelter and in the western world we can afford to eat a lot less. The people at the bottom already live paycheck to paycheck and they know how to do physical work and how to fix things themselves. The people that will be hurt are the infirm that our modern society supports which includes the elderly, chronically sick and cripples. Most of us will someday at some point join the infirm.

    This is the scenario after a "worldwide bankruptcy" All the land with all the houses and apartments will still exist. All the farmland that produces all the food that overfeeds our country and the rest for the world will still exist. All the fertilizers, chemicals, and natural resources will still exist. At least two thirds of the people, working to produce and distribute the above, will continue doing what they already do. Many of the poorest people of today live in luxury compared to a hundred and two hundred years ago. What will change is the "rich" will be out on the street sort to speak with their bank accounts decimated. There will be a memorable backlash against lawyers, investment bankers, and politicians that support their rackets and games.

    Medical patents will be vacated and health care will go back to being affordable. Doctors will be better protected legally and not need insurance like the do now but will be subject to more public records, reviews and audits. Medicine will go back to being affordable comparable to the 1960. There will be no million dollar procedures unless you have a million dollars. People will die at 85 instead of 90. Doctors pay checks will no longer be quite so big but they will no longer need to support the insurance industry and lawyers. They will become more respectable and esteemed members of society back when children wanted to grow up to be a doctor not because of the paycheck but rather to be a hero of society.

    Higher education will become affordable again but no longer be government subsidized.

  • Political will (Score:5, Insightful)

    by manu0601 ( 2221348 ) on Friday October 18, 2013 @12:23AM (#45161075)
    European countries created socialized healthcare after they had been devastated bu WWII. They had no money for it but they had the political will. Now that they produce more wealth than ever (France GDP gown 700% since 1945, while population only doubled, for instance), European countries have the money but no political will to move it to socialized healthcare instead of shareholders profits.
  • comparisons (Score:5, Interesting)

    by jemmyw ( 624065 ) on Friday October 18, 2013 @12:25AM (#45161087)

    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?

  • by prospector_plus ( 3260823 ) on Friday October 18, 2013 @01:05AM (#45161297)

    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 ...

  • by ErichTheRed ( 39327 ) on Friday October 18, 2013 @01:11AM (#45161329)

    Wow, I knew the UK was becoming more like the US every year, but I had no idea how much. Maybe this is Margaret Thatcher reaching out from beyond the grave to dismantle the remaining state institutions?

    Nobody seems to understand that healthcare (a) has to be treated like a public good (in the economic sense) to be fairly available to everyone, and (b) that requires rationing of care to keep costs reasonable. The ACA we have now does neither of these -- it was a compromise to keep the "free market" insurance companies in on the game while giving them millions more customers.

    If I were king, I would just declare Medicare to be the default universal insurance plan for everyone. That's a good compromise, since it doesn't cover everything and the insurance companies could fight over that market. It does cover catastrophic things, which is the primary failing of our system now. No one thinks the insurance companies would ever deny their claims, but they should try getting very sick sometime and see how fast the friendly relationship changes. People's taxes would go up, but they would be getting a valuable benefit for it.

    The other thing single-payer care could eliminate is the tying of insurance coverage to employment. I personally know a few people whose families have serious health problems and they're literally trapped at their current employer because of the insurance plan they offer.

    I think the ACA will reduce cost by a little bit, but it has flaws:
    - You're still dealing with for-profit insurance companies who are looking for every reason to not cover a claim -- I doubt customer service will improve.
    - The uninsured population that qualifies for subsidies isn't necessarily going to know or care about their ability to get cheap or free health insurance. It's not nice to say that people are stupid, but they are...
    - Same goes for the policies themselves. Even educated people are confused by the language in health insurance policies and it's only gotten more complex with high-deductible plans, MSAs, etc.
    - People who have insurance through work are just going to grumble about their rates going up and get no immediate benefit. Almost everyone vilifying single-payer healthcare has steady, well paying jobs and has never had to worry about going bankrupt if they land in the hospital. Because they don't understand the target population (low income workers with crappy or no insurance from their low-level service job) they think there's no benefit.
    - The current political climate in the US labels anything beneficial that the government provides as socialism and therefore evil.

    I think we should ditch the whole thing and just go single-payer. Doctors would get paid fee-for-service and not have to deal with insurance companies, individuals would be able to use healthcare without worrying about the cost, and things would be better. There's no reason a country like ours with so much wealth can't provide universal healthcare. People complain about government inefficiency, but what's efficient about tons of for profit insurance companies nickel and diming their policyholders and healthcare providers in order to make a buck? I think government would be very efficient at this task (and the NHS is -- the UK has a higher life expectancy than we do and spends less.)

  • by SuperKendall ( 25149 ) on Friday October 18, 2013 @02:03AM (#45161581)

    Something that can't go on forever, won't.

    You cannot possibly tax enough to pay for offering something for free to everyone where a significant percentage of people will abuse the privilege.

    Some free heath care systems work because of cultural insularity, but that will not last forever either without sacrifices...

    • by Xest ( 935314 )

      "You cannot possibly tax enough to pay for offering something for free to everyone where a significant percentage of people will abuse the privilege."

      It's not free, it's paid as tax.

      If it can't work then neither can insurance (health, or any kind) because it's exactly the same - you just have to make sure you charge enough such that your average payment is higher than the average cost of treatment.

      I don't really see how people can "abuse" the NHS, you're either ill or your not, and you're going to be ill or

  • by GauteL ( 29207 ) on Friday October 18, 2013 @03:09AM (#45161897)

    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.

  • by Dr_Barnowl ( 709838 ) on Friday October 18, 2013 @04:49AM (#45162381)

    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.

  • by monktus ( 742861 ) on Friday October 18, 2013 @04:55AM (#45162413)
    There's not such thing as the British NHS in terms of one large health service - there are 4. Healthcare delivered free at point of use was instigated across the whole of the UK in 1946, but the NHS in Scotland and Northern Ireland has always been decentralised with responsibility being with the Scottish Office and Northern Irish government as they were at the time. The Welsh Secretary of State took responsibility for the NHS there in 1969. Nowadays, the Westminster (UK) department of health is only responsible for England. Healthcare (along with many other matters such as justice/policing) is looked after independently by the Scottish Parliament, Northern Ireland Assembly, with the Welsh Senead also governing this (though with fewer other powers than the other two legislatures, which both have their own legal jurisdictions). So whenever reports of privatisation appear, they're normally specific to England, because it's only there that the Tories can carry out their ideological assault on the welfare state so directly.

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