yellowroom

are you going to actually make a point or just post platitudes and links?

For example, do you think Bevan's vision is still relevant? Achievable? what do you think are the problems the NHS faces? What would be your suggestions for improving delivery of healthcare in the UK?

yellowroom

Yes, I find it hard to disagree with that. Although, I would have said perhaps the weakness is in the "meet the needs of everyone". The NHS is a victim of its own success - many of today's needs would never have been dreamed of 65 years ago. iVF for example.

Could we face a future where the NHS becomes a core service of basic public health and if you want your varicose veins done you pay yourself or have top up insurance?

scrubbedexpat099

I would not call the deaths of 1200 and the misery inflected on countless others a platitude.

I would start with how much of the national wealth you are going to allocate and then where it brings the biggest bang.

As far as control is concerned, well it is pretty clear from both the UK and the US that leaving it to the Man does not work.

There is no perfect solution so I would go with the least worse.

Pulaski

To both of your points, there are medical treatments that are expensive and more medically necessary than IVF, that have become commonplace, but did not exist 75 years ago. An example would be artificial hips, for which there is certainly a need for some but seems in other cases to be used as treatment for a little arthritis which even 20 years ago would be considered "just one of those things", but is now being "cured" by extremely expensive surgery. Until someone is prepared to lay down some guidelines and set up a gate-keeper process to ensure that the payer, whether governmental (UK) or insurance (US), only funds medically necessary treatments, expenditure on healthcare is going to continue to spiral upwards.

The situation we have is that compared to car insurance, it would be like filing an insurance claim for body rust or a new clutch. Things wear out, they don't last forever; good care and maintenance will extend life of your car, exercise and good diet usually helps your body last longer, but neither cars nor bodies last for ever, and expecting either governmental or private insurance to fund an ever expanding range of life enhancing and life extending treatments is unsustainable.

Ozzidoc

The three hour wait in the waiting room to see me or one of my colleagues. Sometimes it's standing room only.

robin1234

OK, thats a bit more useful than your previous comment. Thank you.

Duncan Roberts

There are failures and idiots in every health system in the world. However, being public means that things get published a lot more regarding the NHS than most of the US systems. We have a few of the highest rated hospital systems in the country around me and they are large employers so its impossible to not know a lot of people who work for them. The stuff that happens that never gets reported is amazing. Things like multiple instances in the same hospital where doctors and nurses missed patients with MRSA for days despite family raising questions about it. No precautions were taken by any staff so infection spread. Things like patients being completely ignored for over a day. Doctors who snap at patients and tell them to treat themselves because they have a few printouts from WebMD.

No system is perfect but just look at the size, scale and complexity of what the system is and does.

Mummy in the foothills

As a nurse who worked in UK and US I can assure you that the things reported in the UK as happening, happen in the US too, I've seen and heard of all the same kinds of things happening here. But at least in UK everyone has the same chance at getting seen without breaking the bank.

Lion in Winter

As I said on the other thread on the subject - as you say, there will be mistakes, drawbacks, and unsatisfactory situations in both systems. The huge difference? Access and principles. A society's health care should not be a commercial venture where access is determined and governed by the need to make a profit, because that leaves huge numbers of people either without care, or with inadequate care, or bankrupting themselves to get care. This has been proven in the US. The entire rest of the developed world has a form of socialized medicine. Make it better? Yes. Fund it properly? Yes. Organize it better? Of course. Turn it into a business? No.

yellowroom

yes, that was the point I was trying to make, but you said it better. I foresee an inevitable contraction of services the NHS will offer in order to do those things well rather than spreading resources thinner and thinner, but I dread the prospect of who decides what is covered and and what isn't.

Absolutely. And of course in the light of this thread, it's not just a US vs UK choice - most of the countries in western Europe seem to have efficient health systems with good healthcare/outcomes. I'd hope the NHS learns from them rather than the USA.

This is what I meant by platitude. You're just typing words without actually saying anything meaningful. Again, what would your least worse system look like?

HarryTheSpider

Over a period of probably several decades, a cultural shift could take place where lifestyles change so that the majority of people don't need to go to the doctors so often because they are knowledgeable enough to self medicate for common ailments, and/or realise that the doctor can do little for making a cold go away for example, and people exercise more and/or eat less sh1te.

The 'failure demand' (I invite the reader to investigate that term for themselves ) inherent in the system is reduced. This then frees up resources for dealing with medical 'needs' vs customer/patient 'wants', resulting in a better service for all, a healthier population, and a combination of less/later increases in resources allocated to healthcare.

I can see in the US the very powerful business and other interests will fight tooth & nail against it - a fat, unhealthy, uneducated population is exactly what these industries need in order to continue to make money...

Bob

But is that actually true? I don't know.

Plenty of people with gold plated cover in the US are at the doctors at the first sign of a sniffle here, so it happens regardless of co-pays or not.

I also don't know that many people that bothered with the doctors in the UK unless things were really bad because they couldn't be bothered wasting the time, but here it seems they want to get the value for their money.

Then on the other hand, how much of this going when you can leads to things being found earlier than leaving things till they are to late?

Bob

Looking at it, then the NHS would be it then wouldn't it.

AmerLisa

I don't think people anywhere run off to the doctor's office unless it's necessary in some fashion, unless you're a hypochondriac. If there's something bothering you, or you feel it's necessary to go and see a doctor, then you should go, but who goes just to get "their money's worth"?

Bob

Japan has a pretty good system too and it's all insurance based.

The government pays for people who are under x years, kids, students for example, also those unemployed/disabled.

The rate can only be determined by your height/weight range and if you're a smoker or not, so no pre-existings or age. You pick the deductible you are comfortable for before cover kicks in. Employers usually just pay this or the government does, not sure.

There's no co-pays for anything and no cost at point of service allowed. It's the cost of doing business.

Prescriptions are picked up by the government I think....part of the reason they want older people to hurry up and die

So a cross between this, France, Switzerland, Germany....there are plenty of options for insurance based systems to work, which would probably be more popular here than an entirely government run system.