The US system is very far from a free market.
If a lot of people in the US can’t afford treatment, then why does the US lead the world in several cancer outcomes? If people were just dying for lack of treatment, that would make outcomes far worse.
0: https://www.theguardian.com/us-news/2020/jan/07/americans-he...
The US even had a popular TV show about someone who got cancer and started making and selling meth to be able to afford treatment. Fantasy, sure, but nobody outside the US would even consider that a remotely plausible premise.
Sounds like you've never had a friend or family member die because the NHS found a reason to refuse treatment for their non-terminal cancer. At that point, if you don't want to die, your options are actually more expensive than in the US.
Yes, this happens - a lot more than people on HN like to admit. It's one of the reasons that the UK has one of the worst success rates for cancer treatment out of all of Europe.
Sounds like this is more a problem with NHS-specific bureaucracy or NHS funding rather than universal healthcare in general, though.
For a system designed to heal people, the priority should be to heal people, and to make the cost of doing so as low as possible. In this system, when somehow someone is unable to access healthcare they need, it's a failure of this particular implementation of the system, and something that needs to be fixed. The goal of the system is to take care of everybody.
The US system isn’t designed at all. Many if not most hospitals and insurers are non-profits, while others are operated by varying levels of government. The resulting patchwork is regulated on multiple levels of government with a variety of differing policy outcomes, but “profit” is not generally one of them.
There are, indeed, for-profit producers of drugs and medical equipment, but this is also true in the UK (GlaxoSmithKline is a British drug company).
> For a system designed to heal people, the priority should be to heal people, and to make the cost of doing so as low as possible. In this system, when somehow someone is unable to access healthcare they need, it's a failure of this particular implementation of the system, and something that needs to be fixed.
Minimizing cost and maximizing access are, in fact, competing goals. If a certain medical treatment is inherently costly to provide, you have to make a specific choice between cost and access. If you are unwilling to budget for competitive pay for health care professionals, you directly affect the availability of care by risking shortages of these professionals. Likewise if you don’t build enough hospitals. This fundamental constraint applies to all health care systems.
I would argue that having the government individually operate each hospital and directly employ each doctor and nurse imposes a heavy administrative burden that is fundamentally impossible to optimize for cost-efficacy. “Failures of implementation” are inevitable and systemic in this model; you may have paved a road with good intentions but that doesn’t mean it leads where you want to go. This is why the NHS is relatively unique even among universal systems and was not broadly replicated even in other European or Commonwealth countries, most of which seem to have better health outcomes.
I’m not saying the US system is perfect, or even better for that matter, but countries like Switzerland and a Singapore have systems that are arguably more privatized than the US while providing better outcomes as well. Even most countries with universal health insurance have some private sector involvement. The problems with the US health care system are far more complicated than the oversimplified conspiracy theories people keep spouting (theories that aren’t far off from those of anti-vaxxers or known frauds like Kevin Trudeau).
That isn't what happens in the English NHS. https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-eng...
Current inefficiencies in the NHS are caused by lack of investment in buildings and in staff. The NHS has less management than similarly-sized commercial companies, and none of that management is The Government.
> CCGs buy services from organisations of different shapes and sizes – from NHS trusts that run hospitals and community services, to GPs and others that provide NHS care, including organisations run by charities and the private sector.
Right, so “the government” funds a few public agencies which themselves pass on money to the CCG’s, which also seem to be quasi-autonomous public agencies. The actual care providers are sometimes in the private sector. I’m not sure what distinguishes NHS England or the CCG’s from “the government” other than semantics, but sure.
This is still more administrative overhead than other “universal” systems and does not seem to address the tradeoffs between cost and availability of care. Per Wikipedia:
> A survey of CCGs by the Health Service Journal in April 2015 found that more than a third were planning to save money by restricting access to services, particularly on "procedures of limited effectiveness", podiatry, IVF, and limiting access to procedures based on aspects of a patient's health, for example whether they smoke or are obese, which can affect outcomes.[30] A similar survey by the GP magazine Pulse, in July 2015, found that many CCGs were planning to restrict access to routine care in various ways.[31]
They're not run by a government minister; they're not staffed by civil servants; they're not a government department.
> This is still more administrative overhead than other “universal” systems
It really isn't though. Of course some management exists, it's a budget of over £100bn. But compared to other healthcare systems the NHS is relatively efficient. "The NHS is over-managed" is a persistent myth. See for example chapter 2 of this study: https://www.nuffieldtrust.org.uk/files/2018-06/the-nhs-at-70... (This study does contain a lot of stuff that the NHS is poor at).
>> They found that the NHS spends relatively little on overseeing and planning care, relative to other comparable systems. In 2014, the UK, Portugal and Ireland all devoted 1.5% or less of their government or compulsory health care expenditure to administration. This compares with an average of 3.1%, with 4.1% in France, and 7.9% in the United States.
> "procedures of limited effectiveness"
They're not going to fund things that don't work. Why is that a bad thing?
But, again, I've said that there are problems caused by the choice to de-fund the NHS and that if we had comparable funding as other nations we'd start seeing better outcomes.
It is extremly expensive to run the "insurance industry", much more than inefficiency in goverment run healthcare.
Do you think your insurance agent work without getting paid?
Well, sort of. Some treatments are free. Some other treatments are not covered at all by the NHS, which counterintuitively makes those conditions more expensive to treat in the UK than they would be in the US.
> longer life expectancy
Life expectancy is a horrible way to compare healthcare systems, because there are far too many confounding variables to draw any meaningful conclusions. In reality, factors such as genetics, economic history, and demographics will overpower any effects that healthcare delivery could possibly provide.
> and better health outcomes
Not quite. The UK scores better on some healthcare outcomes, but it scores dramatically worse on others. For cancer treatment, in fact, it's one of the worst in Europe, and far behind the US. (This has been demonstrated by a series of studies that have been replicated multiple times over the past 20 years, the most recent being published only one year ago).
It's only hard to see when you believe what business lobbyists tell you. It's actually easy to see when you look at the numbers.
The real lesson here is: don't believe everything people tell you. Look at the evidence first.
Now there are plenty of government projects that are woefully inefficient, but health insurance seems to be one that governments are actually good at. Maybe not great, but better than an unregulated market.
The US health system is very highly regulated. For what an unregulated market looks like, see the software business. Consumer costs for software have been largely driven to zero.
The software market is a very different market from the health care market. An unregulated software market may not quite be a free market due to monopolies and vendor lock-in, but for consumers, it's quite possible to say no to any software purchase. That's not the case with health care, where often your options are to pay or die. That means that in a profit-driven health care market, prices can be raised indiscriminately, especially in the case of the US where health care prices are often kept hidden, because the people who can afford to, will pay anyway. There's better margins in providing health care to the rich than in providing it to the poor. It's profitable to let the poor go without healthcare.
This makes the healthcare market a very poor market to let be government primarily by a profit motive. Of course health care companies in other systems still make a profit, but they are very limited in how far they can rip off their customers compared to the US.
Sure, private businesses want to charge as much as possible. But they only succeed when they've managed to get the government to limit or eliminate their competition (as goes on in health care).
At the same time most average employees will struggle to buy a house.
And the social security will reimburse well only medical costs (visit to family doctors or medical acts done in hospitals). For other costs, hospital care, glasses, dental or hearing costs, it reimburses very little.
So for me France's SS is actually a kind of mandatory way to channel money towards doctors.
Thus, that money doesn't just go to health care. It also goes to other social security programs and government projects.
It's hard to see how this can be true, since government operations are infamous for excessive cost.