Yes, it certainly can be a big deal. You are assuming that there is a reliable way to evaluate "minor" and that the bureaucrats in charge will make that decision well in most cases (even though their incentive structure, parallel to an insurance company's, pushes them to trade bounded-but-not-lethal suffering against the bottom line every day).

I speak from personal experience in a country with an NHS-like "free" system. A close relative of mine flew to the US for short-term treatment of what was considered a "minor" eye problem, because he didn't want to spend 2-3 months functionally blind. It's true that the condition didn't threaten his life, but it did threaten his livelihood and personal autonomy on a daily basis; the bureaucratic process assessing priority decided this was a "minor" problem.

It's easy for us as the general population who isn't suffering to decide "minor, non-life-threatening" medical conditions can be comfortably shoved to the side.

*edited to remove language that could be considered inflammatory in the final paragraph, which was not my intent

As I said, it's not ideal, but it doesn't seem nearly on the same level as the US system. I'd rather spend 2-3 months functionally blind than be bankrupted because of a pre-existing condition.

Socialized medicine horror stories all seem to be along the lines of, "I had to wait months, it was very inconvenient," possibly with the addition of "I decided to pay extra to get it taken care of sooner." US medical horror stories are more like, "I couldn't afford to see the doctor, so I just hoped it would go away. When the pain became unbearable, I tried self-surgery. It got infected and now I'm dead."

To be clear: I'm not suggesting the US system is good or that the NHS-style system is bad. But I do think there is a systematic diminuation of the badness of wait times among advocates of NHS-style systems.

I, personally, find descriptions like "it's not ideal" to substantially underplay the human suffering involved. And "it's very inconvenient" is, again in my opinion, a gross understatement of the suffering of losing your vision for a few months.

A couple of years back my son developed an eye infection that didn't respond to the antibiotic drops our GP prescribed. I took him back a couple of days later and we were referred first to a private ophthalmologist (who we didn't have to pay for) and then to the specialist eye department of the local hospital that same day (associated with the medical school of a world top 20 university) where he was regularly seen twice a week until the condition cleared up.

I know the NHS isn't perfect, and I don't really care whether it is #1 or #10 in some ranking. But what I do know that over the last 20+ years of having a family with multiple serious accidents (rugby, climbing etc.), childbirths etc. they've provided excellent and timely care.

Did I have to wait three weeks to get an MRI scan for a sinus infection that was recurring? Yes I did. Did I care if it was being used for properly ill people in the meantime? No I didn't.

It's not perfect, put it is pretty bloody good.

> It's not perfect, put it is pretty bloody good.

Just to round out my thoughts here, I mainly agree! I lived in London for two years and I was always pleased with the NHS overall.

My main point is that, based on my experience in the USA, advocates of moving to an NHS-style system tend to underplay the fact that there is genuinely a different set of costs, and it is not a magical solution.

I spend lots of time in both the USA and in Greece (which has a mostly-NHS-style system), and I have gotten health treatment in both places throughout my life. Both systems have strengths and weaknesses, and I can totally understand someone advocating for an NHS-style system as the best overall set of tradeoffs available. It's just not without some downsides, and I wanted to point out that waiting times can be a real problem.

I find complaints about wait times for minor issues to substantially underplay the incredible waste, suffering, and death which happens in the US system. Yes, the NHS and similar systems are not perfect. But to conclude with "This disabused me of any notion that publicly-provided healthcare is automatically superior" is, to me, trying to put the two on an equal footing which they very much do not deserve.

Maybe I've misunderstood the point they're making, but it sure seems to be saying, well, we could stop bankrupting and killing people for no good reason, but you may want to reconsider, because you might end up waiting several weeks for a non-urgent x-ray.

I realize that even non-urgent conditions can cause great suffering. But how does that suffering compare to dying from an easily treatable condition because you couldn't afford a doctor? If you can fix the latter at the expense of the former, is that not superior?

Especially since the workaround for long wait times seems to be to pay for quicker private care. If you have that option, then is it actually worse at all? You go from "pay to be seen quickly, or die" to "pay to be seen quickly, or wait." Seems like an improvement.

Actually, I never understood this. Is demand and supply matched and this is just the lag in the system (ie 6-8 weeks remains 6-8 weeks forever) or demand is greater than supply and this number will grow. If it is the former then there doesn't seem to be a cost advantage for the wait. A temporary increase in supply could bring this waiting time to zero with just the cost of 6-8 weeks worth of x-rays outsourced. And then you have a steady state system with zero waiting.

x-rays are generally pretty quick in the UK in my personal experience - I'm not sure the 6-8 weeks is representative. x ray technology is widespread and the procedure usually very simple and non-invasive. It's the more exotic scans that take longer to wait for as there are not as many machines, and if you need a gadolinium contrast for example that requires someone to pump the stuff into you during the procedure thus skilled staff requirement, thus bottleneck. I suspect the temporary increase in supply you mention is not realistic for the NHS budget and there simply may not be the skilled staff available to step up resourcing, and there's a fair chance that some of the people requiring the x-ray will recover during the wait! This last point is I think one of the tactics the NHS has been forced to rely on due to lack of budget. It's sad really. Not to grind a political axe but I suspect the NHS's status as provider of healthcare to all migrants free of charge hasn't helped, and may even have been a factor behind Brexit. I have a manageable condition for which I'm seen in a hospital in London every 6 months or so, and every time I vist it's apparent that most of the people at the clinic do not appear to have been born in Britain. I'm guessing this based on their physical appearance, the clothes they wear, and the fact that often they do not appear to have English as their first language. It doesn't seem fair to me that people that have probably paid little into the system are getting some of the finest care in the world out of it (at this particular clinic I mean. It's a world class research centre) free of charge. How am I supposed to feel about this when I have paid in for decades and have to wait months to be seen for things?

I'm hoping the pressure on the NHS budget will eventually force a change to something like the Dutch system, where insurance is compulsory but reasonably priced at the bottom end and everyone is ensured at least a minimum level of treatment, but has scope to buy a better level of treatment within the same system. If that were the case I wouldn't feel so bad about migrants bringing over their grandad for a heart bypass, or pregnant foreign women turning up at British hospitals in labour (there are documented examples).

In terms of efficiency, you're right. However because people get fed up of waiting and having to put up with their health issues and pay to go private instead, this reduces demand and the cost to the NHS. Think of it as a softer way of rationing access to some kinds of NHS healthcare to only those who don't have the money to pay for private care instead.

Or less charitably... they die...

Demand is increasing. Supply is falling.

In a country with decent health care, you should not wait more than the time it takes to get to the relevant clinic. i.e. the fact that you have to wait at all is ridiculous. There should be - and there typically are - enough X-ray machines so that the line is not 6-8 week long, it's 10 minute long.

Some people in UK have very long waits (over 6 months) for treatment that should be relatively easy to provide and for things that are not minor.

One example would be 'community based psychological therapies' - long form talking therapies.

these are an alternative to far more expensive inpatient hospital stays. Without it people are subjected to increased detentions under S136 of the MHA; they use A&E more often; they use crisis teams more often. And those are all more expensive than a talking therapy.

I don't think the gatekeeper GP system helps. What are GPs for? Hugely overpaid generalists supported by a powerful lobby (BMA) that cares little about patients and overwhelmingly about increasing doctors' pay and conditions. I'm hoping technology undermines their position over time.

The trend seems to be towards giving GPs more responsibility. My surgery seems to do a lot more than they did twenty years ago. You are right about the BMA though.