This concerns me enough that I oppose nationalized health insurance. I think the status quo ante of the ACA was intolerable, and that the system needs dramatic improvements (high on my list would be price transparency regulations), but that the core problem we have in the US is not that health care isn't universal, but that we pay too much for it, and baking that quietly into our taxes is an alarming proposition.
Why didn't the republicans do that over the past two years in the US? It seems like it would be great for the free market, and also encourage competition. Or do they believe in large company profit "protectionism"?
I know that this take is likely to be viewed as extremely uncharitable to Republicans, but there really is no other logical way I can see to explain the party's anti-ACA plank.
(I think it's actually quite counterproductive to the conservative movement, because by abandoning ideology in favor of naked partisanship the GOP has guaranteed that Democrats will never give them a seat at the table when health care reform comes up again while Dems are in power. As a liberal, I couldn't care less, of course, but I can't help but note the irony...)
Here's one: tax cuts to insurance companies based upon the number of people they insure over time, to help offset the cost of insuring sick people.
This seems like a no-brainer republican solution, which probably would have gotten a fair number of democrats on board.
2.) If you want private healthcare in the UK, you can still get it: https://en.wikipedia.org/wiki/Private_medicine_in_the_United... Public healthcare doesn't mean private healthcare is illegal - why would you think that?
> This is simply untrue.
> There's too much wrong with your link to debunk it. It's almost entirely wrong. Mostly, there is a different QALY threshold applied when drugs are used for people with life expectancy of under 24 months, and also they're using an unsourced value for QALYs.
"There's too much wrong with your link to debunk it" isn't much for me to go on to change my assessment of the story.
Moreover, I don't think any of your assertions can change the result, for several reasons:
1) The BBC article I linked to says: "NICE aims to spend less than £20,000 to £30,000 per Qaly. That is not a hard limit; it will go almost twice as high for end-of-life drugs."
You say that "there is a different QALY threshold applied when drugs are used for people with life expectancy of under 24 months."
But if life expectancy is under 24 months, the total amount NHS spends is correspondingly limited, even if the per-year threshold is higher. Even if NHS would pay 60,000 pounds per QALY for end-of-life care, with a 2-year life expectancy, you're not coming close to the $500,000 the U.S. insurance company paid.
2) My estimate is conservative to begin with. The course of treatment actually cost more than $500,000 (the lady paid hundreds of thousands of dollars during the two-year period after exceeding the lifetime limit). I also estimated British costs at half of U.S. costs. But if most of the costs in this situation were due to drugs subject to a higher QALY limit, the that would be an overly conservative assumption, since cutting-edge cancer drugs aren't half the price in the U.K. as in U.S. (while services may be).
In this particular case, probably over 500,000 pounds was spent to extend this person's life by maybe a year if that. I don't think anything you've provided suggests that NHS would have spent that much, or even the 400,000 pounds the U.S. insurance company actually spent.
I also don't understand your point about my "assumptions." I'm not assuming expensive treatment is good treatment. I'm saying expensive treatment is what people want, and U.S. insurance companies are willing to pay for it, and NHS is much less willing to pay for it. That's my point. Here in the U.S., the outrage is why the insurance company didn't pick up the tab for the other couple of hundred thousand dollars. Nobody is willing to suggest that maybe we do what the NHS would have done, and deny such expensive treatment for someone with such a bad prognosis.
There was an article on HN the other day that talked about how much debt a woman had incurred for her husband’s cancer treatment after she hit her insurer’s lifetime limit. But it turns out that in the UK, the expensive of that course of treatment compared to prospects would have been far above what NHS would have been willing to pay.
If you have socialized care, you need to ration it, ideally focusing on maximizing QALYs for younger individuals with years of productive life left. I fear our political system in the US wouldn’t let us do that.
EDIT: Here is the article: https://www.npr.org/sections/health-shots/2017/08/10/5425892.... The insurance policy's lifetime limit was $500,000, or about 400,000 pounds. Even if we assume British healthcare costs half as much, under NHS's policies, the expected benefit of treatment would have to be 6 QALYs for NHS to have paid even as much as the U.S. insurance company paid. But it was a rare, aggressive cancer and the lady's husband died in less than two.