BBC One tonight: Poor America

Ilya_Ilyich

..on nowhere near the same scale. Trivially any healthcare system can't spend infinity dollars on every patient so there's always going to be scope for further treatment. A system designed to maximise the cost efficiency of care is probably going to provide better service overall than one designed to maximise profits, though.

Generali

Ilya_Ilyich wrote: »

A system designed to maximise the cost efficiency of care is probably going to provide better service overall than one designed to maximise profits, though.

Do you know of a country with this sort of system? I can think of a couple but it ain't the NHS.

No 'free' system of healthcare can deliver care efficiently as if everything is priced at zero there is no difference between spending hundreds of thousands on a treatment and spending tens of pounds on a different treatment, perhaps on a different patient.

A system that imposes some costs on patients will always be more efficient. The Aussie system is a particularly fine example although there are others I believe. The NHS is expensive and inefficient and can never be anything else.

Australians and British spend broadly the same amount overall on heath care, whether provided by the state, privately or via a charity (8.5% of GDP vs 8.4% of GDP - link) despite Australia facing great difficulties providing health cover to a part of her population because of their geographical spread.

The life expectancy at birth for an Aussie is 16 months higher than for a Briton; infant mortality rates are 16% higher in the UK than Aus; mortality 'amenable to health care' (that is deaths that could have been prevented by better treatment) are 47% higher in the UK than in Aus.

Rather than compare the UK's system to another failing one, it would be better to compare it to one that is succeeding!

pqrdef

ILW wrote: »

USA was built on self sufficiency and survival of the fittest.

Right-wing mythology. The homesteaders struggled self-sufficiently for decades and were still dirt poor.

Haven't you heard what Adam Smith said? The productive guy was the guy on Henry Ford's assembly line, tightening the third nut from the left all day. He could live the American Dream, until there was a downturn, and then he was jobless and homeless. All his own fault, he should have been out there being self-sufficient and making America great.

ILW wrote: »

Many there see it as a good thing.

The point of the mythology is to allow the well-off to turn a blind eye to what's going on. Similar ideas were popular in this country 200 years ago. They led to most of the population of the richest country in the world being crammed like sardines into the filthiest slums.

vivatifosi

It was an interesting programme. I'd hate to be poor or sick in America. I don't think that an ideology where you look after yourself and save up is a bad thing, but the lack of an effective safety net is. It is a great shame that many people who achieve the first can't understand why some people still need the second.

I spend a lot of time in the US and have seen with my own eyes children sleeping on the streets (in Los Angeles downtown area). I've gone back to my rented accommodation after checking out because I'd accidentally left something in my room to see the poorly paid housekeepers going through my food leftovers to see what could be kept and taken home (in Florida). I also have a friend in Michigan whose Multiple Sclerosis has progressively worsened to the point that they lost their job (we met through work) and has now used up all of their medical insurance entitlement.

However the programme was I feel also flawed in that it spent too little time on the numbers: for example it said something along the lines of "half of all of the families living in poverty earn £7000 per year for a family of four". Now that's a big statement and I would have wanted to see a lot more unpacking of that and a better understanding of how they got to that number, why that happens and what can be done about it.

pqrdef

vivatifosi wrote: »

why that happens and what can be done about it.

It's the natural condition of people who don't have any capital, because even if they're fit to work, labour alone doesn't get people out of poverty, not when there's a massive oversupply.

Their only hope is that capitalists will hire them or the government will hire them.

VfM4meplse

PasturesNew wrote: »

There are many drugs out there that might fix people, but the NHS says "nope".

The NHS cannot commission on a "might": decisions are made on the cost-benefit vs risk. Drug companies over-state the benefits of drugs vs the actual trial evidence, and the risks are hidden in the small print. The US allows direct to patient advertising - where there is a gullible population just waiting for the next miracle and doctors need no encouragement to make more money through consultations.

Generali

VfM4meplse wrote: »

The NHS cannot commission on a "might": decisions are made on the cost-benefit vs risk.

Apart from in cases where the decision is driven by the front pages of the newspapers of course.

Ilya_Ilyich

Generali wrote: »

No 'free' system of healthcare can deliver care efficiently as if everything is priced at zero there is no difference between spending hundreds of thousands on a treatment and spending tens of pounds on a different treatment, perhaps on a different patient.

I'm not sure what you mean by this. Can you elaborate? No difference to whom? The specific complaint I was responding to was that the NHS doesn't fund every possible treatment. I believe that the NHS aims to ration care primarily based on cost-effectiveness whereas the American system aims to ration care primarily based on the wealth of the recipient, which necessarily leads to a lower quantity of care overall.

I don't think the UK/Australia comparison is relevant to this thread as it's intended to discuss the USA. An Australia/US comparison might be fairly appropriate though and help overcome some of the "but America is big and sparsely populated" arguments. From your source Australia has less than half the healthcare spending per person of the US but significantly better outcomes; again indicative of a much more cost effective system.

vivatifosi

VfM4meplse wrote: »

The NHS cannot commission on a "might": decisions are made on the cost-benefit vs risk. Drug companies over-state the benefits of drugs vs the actual trial evidence, and the risks are hidden in the small print. The US allows direct to patient advertising - where there is a gullible population just waiting for the next miracle and doctors need no encouragement to make more money through consultations.

On the subject of drug companies - though not the US so apologies for going off on a tangent - there's an interesting article being run on Sky News this morning about the generics manufacturers in India. AIUI (and I'm a bit doped up at the moment) in order for India to trade more freely with the EU, the EU has demanded a clampdown on these generic companies because they are basically bootlegging the patented drugs invented by Western Companies. However the argument is that there is a massive human cost in doing this as these drugs are helping people stay alive.

The commission argues that life saving drugs aren't affected, but those on the street and protesting are arguing that retrovirals are included. It would probably be worth digging deeper into to find out where the truth lies. It's also a great shame that big drug companies aren't doing more to ensure access within the developing world for those who need it as there is clearly a need.

Generali

Ilya_Ilyich wrote: »

I'm not sure what you mean by this. Can you elaborate? No difference to whom? The specific complaint I was responding to was that the NHS doesn't fund every possible treatment. I believe that the NHS aims to ration care primarily based on cost-effectiveness whereas the American system aims to ration care primarily based on the wealth of the recipient, which necessarily leads to a lower quantity of care overall.

I don't think the UK/Australia comparison is relevant to this thread as it's intended to discuss the USA. An Australia/US comparison might be fairly appropriate though and help overcome some of the "but America is big and sparsely populated" arguments. From your source Australia has less than half the healthcare spending per person of the US but significantly better outcomes; again indicative of a much more cost effective system.

No difference to the patient.

The point is that the NHS basically doesn't charge except for prescriptions. From the patient's point of view, having ingrown toenails removed, pointlessly seeing a doctor when they have a cold and having cancer cured cost exactly the same, i.e. nothing. That actively encourages frivolous use of the medical system.

If I get a prescription filled I have a choice between the generic and the branded version (where both are available). I can have the branded one but only if I want to pay more. I pay $30 each time I visit the GP. As a result I can get a same-day appointment rather than wait for 2 weeks as I used to have to do in London in winter. Rationing in that case was being done by time rather than by price to the patient.

If you compare the NHS against the failing US system the NHS is clearly better. If you compare the NHS against all systems the NHS comes up as mediocre.