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British NHS May Soon No Longer Offer Free Care
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."
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?)
Faster! Faster! Faster would be better!
Actually, if you follow international news at all, there has been a strong Conservative/Tory assault on the NHS for several years now. The assault comes in the form of privatization and the introduction of the 'free' market to the health care ecosystem. This system, if anything, is attempting to emulate the system put in place with the ACA, and the right in the UK has made it clear that they would like do what the right in America has been arguing for this whole time in terms of health care. Would the Dems have desired to emulate the original NHS, prior to its evisceration? Yes. Now? Not so much. Here's a bit of light reading on the topic, which is anything but hard to find. (Yes, they do tend to be from more leftwing sources, however, they have good information on what has been done to the NHS recently.) http://www.socialistreview.org.uk/article.php?articlenumber=11935 http://www.independent.co.uk/voices/farewell-to-the-nhs-19482013-a-dear-and-trusted-friend-finally-murdered-by-tory-ideologues-8555503.html http://www.medialens.org/index.php?option=com_content&view=article&id=676:people-will-die-the-end-of-the-nhs-part-1-the-corporate-assault-&catid=25:alerts-2012&Itemid=69
"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.
"National Security is the chief cause of national insecurity." - Celine's First Law
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.
"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.
That's pretty misleading. More people die in hospitals in the UK because they can go to the hospitals for free. In the US, they're more likely to die at home, because they can't afford to go to the hospital.
But dead is dead, and the UK's life expectancy is better than America's, while spending less per capita on health care. No amount of spin can change that.
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.
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?
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.
You mean death panels? America already has them - they're called the Insurance Industry
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 ...
Do you jerk off while spreading fud?
Iceland isn't bankrupt, they unlike everyone else, took the healthy choice of defaulting on their loans, restructured and recovered. They are actually fairing better than pretty much anyone else right now.
Why would France want to cover (illegal)immigrants (guess you left that out for your fud)? No-one else are doing so.
Greece is going bankrupt for wholly different things, it's not their public health care that are destroying them.
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.
You clearly haven't been lying on an emergency ward bed on the verge of dying of respitory failure before. Trust me, at that point the negotiating powers are rather poor and frankly one isn't feeling much like a "rational agent".
Excuse the Unicode crap in my posts. That's an apostrophe, and slashdot is busted.
Why ever could that be?
What do you think that graph shows?
Here's what it seems to show. Between 1997 and 2008- the entire Labour term in office before the financial crash- debt dropped to 40% of GDP. This coincides with the highest increase in NHS spending in recent history. Now I'm not trying to argue a causal link- but it clearly wasn't NHS spending which caused our government debt. It spiked in 2008, which correlates with the huge government spending to nationalise and otherwise prop up financial service providers- not spending on a single other thing.
The chart goes on to show that since 2010, the debt to GDP ratio has continued to go up at a faster rate than at any time before the financial crisis. This coincides with the harshest cuts to NHS spending in recent history. So clearly cutting NHS funding hasn't made much of a difference to our government debt either.
Arguing that cutting spending on the NHS or welfare is going to make the blindest bit of difference either way is disingenuous. The only reason the Tories are cutting spending on the NHS is because they always want to cut spending on the NHS, in all circumstances. It's just their basic political modus operandi.
You hear wrongly.
http://euobserver.com/social/121778
http://www.telegraph.co.uk/news/worldnews/europe/eu/10361971/Britain-admits-it-has-no-figures-on-EU-welfare-tourist-numbers.html
Unproductive immigrants are largely a myth. People who can work themselves up enough to emigrate are not usually the sort of people to shy away from work. Statistically, an immigrant is more likely to be in work than a UK native, and is likely to make greater net payments to the state (paying taxes versus using government services) than a native.
Immigration is a knee-jerk right-wing bugbear. You can argue, if you like, that they're taking our jobs. But you can't also argue that they're all work-shy scroungers. Can't both be true.
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.
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.
Weaseling out of things is important to learn. It's what separates us from the animals... except the weasel."
I woke up with a hard pain in my right side. It got worse and worse, until it was clear it wasn't cramp, but something badly wrong.
I called an ambulance. I live in a rural area, so an hour away from the nearest hospital. Ambulance was there in 10 minutes. They assessed me, took me to hospital.
After blood tests, they put me on high dose antibiotics and painkillers, and onto the ward. They suspected a gallstone. A few hours later, I had an ultrasound; no sign of a gallstone, but the gallbladder was clearly inflamed and I had an infection. They decided to see if the antibiotics would tackle the infection, so I could have elective surgery more safely in a couple of weeks to remove the gallbladder.
I got worse over night, with a worsening fever. They booked me in for emergency surgery to investigate, and I was going under anaesthetic inside an hour. Turns out, my gallbladder had turned necrotic and had started to fall apart, and needed removing in a hurry - they had to switch from keyhole to open surgery, took it out on the spot.
I then spent a week in the hospital, recovering from the 6" abdominal hole from the surgery. When I was discharged, my total bill was... £0.
I was treated with huge professionalism and care, survived what could easily have been a fatal infection with rapid treatment, and I didn't spend a second worrying about what it would cost me. Ok, the food was airline quality, but I wasn't exactly hungry anyway.
The NHS is running out of money because there's more people, living longer, wanting the latest, best drugs that cost more, while funding levels are being cut in real terms by the Tory government. That's something that will have to be dealt with, but it's certainly not a reason to kill the NHS. It's one the best things about Britain, and if we have to up our contributions a few percent to pay for it, I for one am glad to do so.
Remember kids, it's all fun and games until someone commits wholesale galactic genocide.
This.
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.
Regards, Phil
The NHS is free at the point of delivery, or in different words, free in at the time of need - which is what the care in healthcare is all about.
No-one said the NHS is free. Someone has to pay for it in the end. The beautiful thing about the NHS is that is you don't have to worry. You don't have to worry money when you are sick, or when you loved ones are sick. You don't have to worry about co-pays, or what this insurance covers and what it doesn't. You don't have to worry about dealing with insurance companies or with your company on healthcare coverage. And on top of that, if you want 'luxuries' like jumping the queue, or private en-suites, you can have that as well, by buying additional private cover.
What you said about NI funding the NHS is not entirely true. Only a very small amount of NI actually ends up in the NHS. The NHS is funded by and large by general taxation. It is budgeted according to need and is relatively efficient - around 8% of GDP is spent on healthcare in the UK, half of what is spent in the US, while covering 100% of the population.
:. Ultimate Control Dedicated/VM Servers
Do you have to worry when your currency is collapsing because of out of control costs? Or when the death panel decides that you aren't worth treating?
There's a fine line between satire and actually being crazy... I want to give you the benefit of the doubt and assume you're being facetious, but given the rhetoric going back and forth in the US lately, I just can't let it go....
In response to your first question -- Canada has had a publicly funded single-payer health care system for nearly 70 years. If it was going to make our economy collapse, it would have done so by now. More than that, in 2008 when *your* economy fell into the shitter, we didn't have *any* banks collapse, and for several years, our dollar was worth more than yours. Your dollar *still* isn't anywhere near recovering to where it was before the 2008 collapse -- 10 years ago, $1 CAD was worth about $0.65 USD. Today it's $0.98. Clearly, a publicly funded health care system will *not* make the currency collapse....
In response to your first question -- "death panels" don't exist. Never have, and never will. The decision on what kind of treatment options to pursue is made by both the patient and the doctor together, and nobody is refused care under any circumstances. Whether that care is palliative or therapeutic will depend on the individual case: just like in the US, sometimes it's better for your quality of life to give you meds so you can breathe easily and not suffer pain than it is to put you through another round of chemotherapy. The sad reality is that medicine *can't* cure everything, and any doctor worth his salt will tell you when the chances are slim/non-existant and give you the choice in how to proceed.