Everything You Ever Wanted to Know about National Health Plans ….and maybe more - United Kingdom

United Kingdom

Britain’s public provider of health care is known as the National Health Services (NHS). Services provided by the NHS include hospitals, family doctors, specialists, dentists, chemists, opticians and the ambulance service.

Not all services provided by the NHS are free of charge. Unless exempt, patients pay (subsidised) fixed costs for prescriptions, sight tests, NHS glasses and dental treatment. Hospital treatment, the ambulance service and medical consultations remain free.

The UK’s NHS was the first state organisation in the world to provide free universal healthcare. Today, it is an organisation with some severe structural problems which means:

  1. Waiting lists for treatments even for urgent operations have grown
  2. Standard of treatment in some hospitals has deteriorated.
  3. Many Britons in the higher income bracket purchase private health insurance and there is a growing number of employers providing private cover as standard to their employees

Private Health Care

Private medical treatment in Britain is amongst the best in the world, with London having some of world’s most skilled specialists. Within the country, most people go private to avoid NHS waiting lists for non-emergency specialist appointments and non-urgent treatment. About 25% of all operations are performed privately.

No Difference between Private or Public Doctors

There is almost always no difference in quality between private and NHS doctors. Indeed, you will often end up seeing the same specialist privately as you would have seen through the NHS. The difference will be

  • When you get the appointment
  • How quickly you are treated, i.e. a heart bypass operation may be diagnosed for and completed in a couple of weeks with private treatment, but through the NHS this could take two or three months

Many employers also provide their workers with private health insurance, which is definitely worth finding out about if interviewing for different positions or negotiating a package.

NHS to allow 'private' drugs for cancer

Patients may soon be allowed to pay for "top up" drugs on top of their NHS care under a major reform to Britain's healthcare system.

Approval of top-up payments for cancer and certain other treatments is being widely anticipated from the review being conducted by Professor Mike Richards, the Government's national cancer adviser, despite fears that it could introduce a two-tier NHS.  Medical organisations have accepted that the change is inevitable in a health service that champions patient choice and is increasingly driven by consumer demand. But there is little enthusiasm for the move, which is seen as difficult to implement and would pose a long-term threat to a comprehensive NHS.

The review was ordered by Alan Johnson, the Health Secretary, in June after protests from NHS cancer patients who were told they could not pay privately for cancer drugs that had been rejected, or not yet assessed, by the National Institute for Clinical Excellence.

Life prolonging cancer drugs to be banned because they cost too much

Thousands of patients with terminal cancer were dealt a blow last night after a decision was made to deny them life prolonging drugs.
They are too expensive for the NHS and the Government's rationing body picked out two drugs for:

  1. Advanced breast cancer
  2. A rare form of stomach cancer
  3. The National Institute for Health and Clinical Excellence is expected to confirm guidance in the next few weeks that will effectively ban their use.

The move comes despite a pledge by Nice to be more flexible in giving life-extending drugs to terminally-ill cancer patients after a public outcry last year over 'death sentence' decisions. Leading campaigners last night said Nice had failed the 'acid test' of whether it really intended to give new priority to people with just a few months to live.

Cost Containment has created problems in the NHS

Filthy hospitals in Kent have led to the death of 90 patients.
Appalling hygiene at Kent and Sussex Hospital, Pembury Hospital and Maidstone Hospital saw the killer Clostridium difficile bug C.diff directly linked to 90 deaths.  Almost every hospital in England has suffered C.diff outbreaks and MRSA scares.

Hard-up hospital orders staff, don't wash sheets - turn them over

Cleaners at an NHS hospital with a poor record on superbugs have been told to turn over dirty sheets instead of using fresh ones between patients to save money.

Housekeeping staff at Good Hope Hospital in Sutton Coldfield, have been asked to re-use sheets and pillowcases wherever possible to cut a £500,000 laundry bill.

Posters in the hospital's linen cupboards and on doors into the A&E department remind workers that each item costs 0.275 pence to wash. Good Hope reported a deficit of £6million last year and was subject to a report by the Audit Commission because of its poor financial standing.

It recorded 36 cases of MRSA from April last year to January, while cases of clostridium difficile have more than doubled in less than a year to 327. A Government hit squad was drafted in to solve the infection problems last year but the trust is still failing to hit MRSA targets.

Tony Field, chairman of Birmingham-based MRSA Support, said: 'Is that all the safety of a patient's life is worth? 0.275 pence? 'It is utterly disgraceful and tantamount to murder because hygiene like changing sheets is essential to protect patients.  "It proves beyond all doubt that cost- cutting is directly contributing to hospital acquired infections." The scheme is one of many ways that cash- strapped trusts are trying to save money.
Staff at West Hertfordshire NHS

Trust were amazed to receive a memo urging them to save £2.50 a day by:

  1. Prescribing cheaper medicines,
  2. Reducing the number of sterile packs used,
  3. Cutting hospital tests and
  4. Asking patients to bring drugs in from home.
  5. Epsom and St Helier Trust in South London has removed every third light bulb from corridors.

The NHS cost containment can be deadly "Dying woman refused chemotherapy by the NHS Tuesday 3rd June 2008"

A widower has demanded a change in the law after his wife was denied chemotherapy for bowel cancer on the NHS because she paid privately for life-extending drugs.

Linda O'Boyle, 64, and husband Brian, 74, both retired NHS workers, decided to pay for drug cetuximab in addition to NHS treatment after her consultant said it might prolong her life.
The decision meant she was considered a private patient and had to pay for her NHS treatment as well, because the Government has banned patients mixing public and private care. Mrs O'Boyle died on March 26 this year. Mr. O'Boyle, who was a health manager for 30 years before his retirement, blames the Government and South West Essex Primary Care trust for the system which saw them paying out £11,000 for private treatment, including cetuximab and chemotherapy.    Mr O'Boyle said he and Linda, who was an assistant occupational therapist, were angry at the decision.  He blames Health Secretary Alan Johnson, who last year issued guidance to NHS trusts telling them not to permit patients to pay or additional medicines. Mr. Johnson claims co-payment would create a two-tier NHS, with preferential treatment for patients who buy extra drugs.

"Linda told me they just did not think she was worth helping and had put her on the dump and sent her to die. "That was her initial reaction. It was a huge shock."  He added: "I still think it extended her life by three months, so don't regret doing it, but the system needs to be changed."

Comments on a United Kingdom blog from citizens...

Mrs. K., Southend on Sea says  8:36am Tue 3 Jun 08

  • "In 1997 when it was discovered that my Dad had lung cancer, he wasn't offered any sort of chemotherapy or radiotherapy at all.  Maybe it was because it was too far gone to do anything, or maybe it was because he was 80 years old, although he only looked about 65 and was still full of life. He died six months later."

Tony Winchester, Wos says  1:15pm Tue 3 Jun 08

  • "A tragic decission from the PCT but then again they wont even give school kids the TB vaccine (not British ones anyway)so therefore this case don't surprise me unfortunately. My heartfelt wishes go out to her family."

Cost Containment – waiting times Friday 8 June 2007 - One in eight NHS hospital patients still has to wait more than a year for treatment


The government acknowledged yesterday in its first attempt to tell the full truth about health service queues in England.

A Department of Health analysis of 208,000 people admitted to hospital in March showed:

  • 48% were wheeled into the operating theatre within 18 weeks of a GP sending them for hospital diagnosis
  • 30% waited more than 30 weeks
  • 2.4% more than a year

The inpatient clock started when the consultant decided hospital treatment was needed and stopped when the patient was treated. The maximum inpatient delay is six months. Until now, the NHS did not measure the time patients waited after the first outpatient appointment before going on the inpatient list. This "hidden" delay could last months.

Some primary care trusts ordered hospitals to go slow to avoid overspending. The analysis measured the waits of people who were treated during the month without estimating the extra waiting experienced by those still in the queue.

Norman Lamb, the Liberal Democrat health spokesman, said: "Behind the statistics, thousands of sick people are still waiting more than a year for hospital treatment. This is a daily tragedy."

Operations cancelled as NHS runs out of money - January 4, 2007

Patients are being denied basic operations, including treatments for varicose veins, wisdom teeth and bad backs, as hospitals try frantically to balance the books by the end of the financial year.
NHS trusts throughout the country are making sweeping cuts to services and delaying appointments in an attempt to address their debts before the end of March.

Other cost cutting requests
  1. Family doctors have been told to send fewer patients to hospital
  2. A&E departments have been instructed to turn people away
  3. A wide range of routine procedures has been suspended

In one example of the cash-saving strategies, seen by The Times, a primary care trust in Yorkshire ordered:

  1. Hospitals that they will not be paid for some non-essential operations,
  2. Patients will not be given a hospital appointment in under eight weeks

Similar tactics have emerged at hospitals in Norfolk and Surrey, while dozens of trusts have resorted to closing beds and offering voluntary redundancy in recent months. Devon Primary Care Trust has offered voluntary redundancy to all 5,000 staff.

The cuts are widespread, although there are no central records to provide definitive figures. Among the most comprehensive plans are those from North Yorkshire and York Primary Care Trust, which faces a deficit of £24 million this year.

A letter from its chief executive, Janet Soo-Chung, says that all non-urgent admissions must be approved by an assessment team or they will not be paid for.

A&E departments in Harrogate, Scarborough, South Tees and York have been told that they will not be paid for treating patients with minor ailments who could go elsewhere.

No patients will be given a hospital appointment in less than eight weeks, and none admitted for elective surgery unless they have waited a minimum of 12 to 16 weeks. Those treated quicker will not be paid for.

The trust also announced the immediate suspension of treatments for:

  1. Varicose veins
  2. Wisdom teeth
  3. X-rays of the back
  4. Operations for carpal tunnel syndrome
  5. Bunions
  6. Arthroscopy of the knee
  7. And grommets for the ear, among others

“We fully appreciate the difficulties that the introduction of these measures entail," Dr Soo-Chung's letter says. "However, the financial position of the PCT is such that there is absolutely no alternative to this programme if we are to avoid even more difficult decisions in the near future."

Norfolk PCT has issued similar instructions, telling hospitals not to treat patients who have waited less than 17 weeksexpected to rise to 18 weeks by February. Hilary Daniels, the interim chief executive, told hospitals to work out how many patients could be deferred until next financial year, and said that the trust would not pay for elective operations on smokers until they had attended smoking clinics.

In a report published this week, the think-tank Reform said that NHS deficits were deepening. It called for a one-off repayment of debt followed by a more rigorous financial regime and immediate administration for failing trusts. But the idea was rejected by the Department of Health.

Last year the NHS returned a net deficit of £512 million, a fraction of the total budget. But the scale of the problems was concealed by strategic health authorities saving large amounts of money largely by cutting education and training budgets.

Just Landed - National Health Service Public health care in the UK

Just Landed - Private Health Care in Britain

Dying Cancer Sufferer Wins High Court battle to get Life Prolonging Drugs - Daily Mail UK

Dying woman refused chemotherapy by the NHS - Echo News UK

Sarah Perez, who died in June aged 40 was also denied drugs - Telegraph UK

Life prolonging cancer drugs to be banned because they cost too much Daily Mail - UK

NHS to allow Private Drugs for Cancer - Independent UK

Hard-up hospital orders staff: Don't wash sheets - turn them over - Daily Mail UK

Filthy Hospitals in Kent - The Sun UK

Map for hospitals with MRSA and C'Diff

One in eight patients waiting over a year for treatment, admits minister - UK Guardian

Operations Cancelled as NHS runs out of money - Times UK

Tomorrow the last two countries - Brazil and Taiwan




About got it pegged

The big however comes for people like pregnant women, sick kids, and swine flu preparedness. The UK has antivirals for 50% of the population and it will be covered under NHS. I have neighbors who require dialysis and some who have seizures who are taken care of, no questions asked. This is a good thing.
I do wish some of the more enthusiastic proponents of national healthcare could become familiar with the actual results. Those who think that their best friend would have survived their breast cancer if they had lived in the UK should think twice. An American would be appalled at the conditions I have encountered at various clinics and hospitals here.
There are trade offs when the taxpayer is supporting the medical system and the taxpayer goes broke. Even so, I think the NHS is a fairer system on the whole.

I Grew Up in the UK


I have an alternative view - I grew up in he UK and I had access to health care and as a kid my life was saved (no massive insurance bills, etc) and I have lived in New Zealand and now Australia. Granted a universal health service is not great across the board but it appeals to my inner humanity as it does many other people. Basic health care is of universal benefit to society. The US suffers from all the 'tiers' of service that add no value but takes a 'clip' in terms of profit - in the end each dollar delivers less health care across society unless you are wealthy and you can afford insurance.

I guess we all have our experiences but I would chose the health care systems of France, UK, Canada, NZ, Australia, etc, before the US.

Nexus read this

I see you posting comments and hope you will create an account and join in with both feet. When you create an account the letters to prove you're a human go away and a tracking feature shows up so you can see who replied to your comments. Plus you can also write Instapopulists and if you dare to tackle it, a blog post.

I think there is a lot of misinformation, confusion going on here because I 100% agree with you and also lived abroad where I was almost shocked at how health care was a right instead of a privilege. But point was it was way cheaper AND in a foreign language no less, the Doctors listened to me. Now I just got some sort of bacterial lung infection so no major anything but these details he is putting in his blog....I just never heard anything like this in the UK, France, Sweden, Finland, Norway, Italy or Germany. In the UK, I just remember people talking about how incredible the system was.

Come join in the party for real, create an account and let's discuss.

Robert I guess nothing will change a mind once

a mind is made up. People can tell you forever that your girlfriend is treating you badly but you are in love and will never acknowledge it.

I have pointed to 98% of international sites, to Japanese papers, to German papers, to UK papers and because of anecdotal evidence, all those papers are deemed incorrect. Anecdotal stuff can go on forever. I knew a horse jockey that grew up in Canada. He swore that the Canadian system killed his mother. He was a bit high strung and if you wanted to get him ranting....bring up Canada's health care system. Truth be known....sometimes I did it for fun, to watch that horse jockey sized man puff up. Bad me.

I don't think I said our health plan doesn't need help, it does. I have also pointed (this will be part of a coming blog) that all (BIG LETTER ALL) the other plans of the world have MAJOR, long term, financial problems. Problems, that in some countries are at hand.

I've never said that other countries don't get the job done. They do.

From a humanitarian point of view nobody should be denied health care. Nobody should be denied food, clothing or shelter.

At what point does Progressive government stop? Maybe we should all just go back to sharing the same communal soup pot, give it all to the government and they will give us our soup. IF that is the case, I will no longer work and spend time on, my love of playing guitar. It would be heaven, I could spend all day playing and no longer worry about health care, food, clothing or shelter. Yep....that would be heaven. Or would it be hell in waiting?

I am glad that I have reached an age that I can see an end. Because I see the future as the worst sci-fi, no freedom, government obsessed life and to me...that would be a living hell on earth. Arnie's movie, Total Recall comes to mind. To top it off would be the movie Minority report.

You could call me an ex-sixties blue collar hippy. In the sixties I could never have, could never have dreamed that America in 2009 would have so much government control or so many people that aren't willing to take care of their own problems. Sigh.

Now they are talking about kids going to college without a need to pay for it. Hell there are too many people with college degrees that are worth the paper they are written on and we are going to get more of them.

OECD, references

May I point out that maybe someone else here needs to shift that paradigm, open one's brain and start looking at the statistics, the details and that is from much more objective resources.

Health care is not "one's own problems". Everyone gets ill just as much as everyone dies and everyone needs to eat. Food, clothing, shelter....health care.

Now you cannot fill in the blank blog posts to justify your own beliefs and conclusions....

Now I haven't gone through every details but I read enough of the references to note the above and also note you are posting biased horror stories that simply are not the case in comparison to the United Sates.

50% of all bankrupties in the U.S. are due to health care costs. There has been statistics as well as testimony of insurance companies literally killing patients by denying life saving treatment. People are now medical tourists, traveling to India, Mexico, all over....just to get health care and affordable prescriptions. The horror stories of the United States pale, absolutely pale to any of these anecdotal stories you have found.

So, you've got some philosophy it appears which is clouding your objectivity. EP is about objectivity, stats. facts, objective thorough analysis....getting to the bottom line.

Yes Canada had problems.....10 years ago!

Robert I have looked at your OECD stuff but it never ever

tells the particulars to how the plans work or problems with the plans. All that I have been able to find are strict numbers. Stuff like this... http://stats.oecd.org/WBOS/index.aspx

It doesn't tell you what the copay is in Japan or the coinsurance in France or that Germany complains about its two tiered system. I would never have known about the complaints if it were not for the German news.

If you can point the way to OECD sites that tell the pros and cons of the different plans, if you can point to OECD sites that show copays, how prescription plans work in a certain country.....I am ALL for it. OECD does good database management but that is about all I have found, good database numbers management. Help me.

My sister runs a business and have people working with her from Romania and Germany. They aren't too keen on either of their places of origin nor happy to hear about universal care but that is of course anecdotal.

I get a bit cranky when people point out the USA problems because I am alrady aware of them. If people point to OECD stuff that shows that Canada doesn't have copay or coinsurance for drugs, that France isn't running a large health spending deficit, etc. Cool, that is a debate!

Even NPR says, " Day to Day, July 11, 2008 · France, like all countries, faces rising costs for health care. In a country that's so generous, it's even harder to get those expenses under control. Last year, the national health system ran nearly $9 billion in debt. Although it is a smaller deficit than in previous years, it forced the government of President Nicolas Sarkozy to start charging patients more for some drugs, ambulance costs and other services. Debates over cost-cutting have become an expected part of the national dialogue on health care. Related NPR Stories"

The French system sounds good but I do not pay any wher near 21 percent of my wages. From the NPR article: "To fund universal health care in France, workers are required to pay about 21 percent of their income into the national health care system." I could not pay 21% for the healthcare, 15% for Federal taxes, 15% Social Security, 3% for State taxes, 1% for City taxes and then also pay the high property tax (10% of pre- tax income). That comes to 65% of income to taxes. My 87 year old parents didn't need to pay such taxes, my grandparents didn't need to pay such taxes and I'll be damned if I am going to pay such taxes. Oh I forgot the 6.5% State Sales tax. Hm....with such figures maybe we are almost to the point of giving everything to the government and they will give us back our slice of daily bread.

Now I think the French people in general are more healthy and not just because of their health system. They eat high fat cheese but don't get the heart problems like the USA. I think this is correct: "Even with high-fat diets, obesity rates are lower—is it the wine?" Good wine yum yum.

One thing the OECD site did give was obesity. That to me is a lagging indicator of health problems and costs. The USA is the biggest (France 9.4 - the USA 32.2)  OCED Stats

  When my wife hurt her knee and needed an operation I talked with the surgeon. The surgeon said he does so many more knee operation on people in their 30's and 40's. His reason was not like my wife hurting hers from a sports injury. His reason was obesity and how the knees of a 35 year old now look like a 60 year old knee of the 1950's.

I will make a wager. In 15 years most all of the universal plans will be bankrupt or will have massively increased patient participation (co-pays, co-insurance, etc) to a point that only the elite will be getting good care. It has to happen. They are in deep debt voodoo and we all know it can't last forever.

Seriously ....if you can post an OECD site that gives all the information about how the different plans work, I would appreciate it. Even EconoSpeak today addresses the Social Security problem. "Cut benefits! Raise taxes! This is your last chance to save Social Security!"

This was a good article about Cancer. Cancer is something so many of my family and friends have had and France does have it together. This was a funny part and shows how people look at other systems, "Many British expatriates say they live in France, in part, because they don't trust the British health care system." Coote isn't one of them, but he does appreciate the health care he has received since his surgery in France. It allows him to continue to live the life of his choice in this stunning corner of the world — even as he battles a difficult cancer."

As an ex-pat the poor guy almost lost his French coverage. "Last fall, just as Coote began his treatment, the government announced it no longer would pay for foreign retirees' health care. They would have to buy their own private insurance. But Coote knew that with cancer, he wouldn't find anyone to insure him." "Some 200,000 British expatriates live in France, according to the British Embassy there. Their numbers give them power. They petitioned and protested. In January, the government reversed itself."

France At Forefront Of Free, Innovative Cancer Care

Now I am off to play some tennis.

well, it's a Medusa, as mentioned

Here are some papers I found useful. But this is a Medusa topic, so organizing the stats into something manageable as an overview to even comparison contrast is a bitch to be frank. Fortunately blog databases hold lots of info!

The biggest issue I find via OECD data is how the U.S. is 8x more costly than any other system, with the worst overall health statistics. That alone should raise your eyebrows.

On EP are meta tags and the search engine. Here are the posts about health care which have various studies, references in them.

you can click on those meta tags (they are linked) and pop up all posts with the same tags too.

Here is the H.R. 676 "promo" site. It has a lot of good stats and is promoting this bill. Now bear in mind, all special interests have squeezed out these groups (primarily physicians, medical people) from the negotiating table. Also bear in mind, Ms. Pelosi is one hell of a corporate/special interest House leader so ya know, who knows what's going to pop out but we need to be diligent on what comes out of Congress....could be we get all of the illegals getting full coverage with the entire middle class footing the bill and left out of the picture (wouldn't surprise me!)

Frontline Sick around the world has a lot of links that back up their documentary.

Here is a WHO 2000 study comparing international systems.

Overall, I think you are focusing in on exceptions and horror stories and that is a huge mistake. You are focused on things like copays, instead of the overall average costs, out of pocket, taxes for citizens of Japan, Sweden, France, etc. and then the extremes of those costs, say for the ultimate healthy person to the ones will genetic disorders which have beyond belief daily costs (as an example). You cannot focus on some exceptions and minor details to see the big picture when it comes to system analysis/comparison/contrast. That's only good for the "tails" of the system, i.e. the problems with each one versus the overall effect on a society. I think it's making you forget about the U.S. horror stories. I'd say homelessness, or being dumped out onto the streets while being seriously ill is one hell of a horror story....let's look at those or people who plain die because they could not afford the preventative and early detection tests or treatment that would have saved their lives....

Also, and I agree with this one....with such lack of representation in D.C. plus their continual refusal to tackle the big issues in the national interest, the middle class interest....the idea of them coming up with a good health care reform is beyond frightening.

But in terms of France....while "your" money "disappears"
ya gotta realize so do your costs which is disappearing now anyway via insurance premiums, deductibles and copays and still if you get seriously ill, you're still screwed...you will not be able to work and then the entire house of cards come crashing down and you are almost guaranteed bankrupt with a major illness today.

Not unless you have a personal support system.

So my thing is costs. Right now the U.S., the entire system is so FUBAR, even in terms of getting real preventative check ups.

Crap like people being too fat...well, they also will not do anything about these overloaded calorie foods either...
in France they suck down the pastries but still the calories don't add up to a big mac....i.e. the food industry is loading up empty calories across the board in our foods! There are other issues too....it's not enough of a "walking" culture in that one fears for one's safety say in LA to go walking...very common in a lot of areas.

So, bottom line for me at elast is costs and no I do not want IBM or GE getting (they already did) medical technologies contracts. I want U.S. companies using U.S. workers, even if they have to do startups....to bring efficiencies. Online databases of medical records really is obvious but even pharmacies, they are completely inefficient with some seriously bad database designs, in flexible. Billing is beyond belief inefficient and all of those absurd insurance codes and people trying to work with them, plus get around them....that's another area.

Having to redo your medical records continuously and some of the technologies themselves, esp. labs/blood work, are beyond belief antiquated.

Then they bureaucratic costs are well documented and increase overall costs...legions of people in insurance companies trying to deny your claim in so many words. Medical practices spending more money, resources and their time dealing with insurance requirements that providing the actual care....list goes on and on.

Yeah I remember that dumped on the street thing in LA

what a bone headed decision.

But seriously Robert, where did you get this idea (The biggest issue I find via OECD data is how the U.S. is 8x more costly than any other system)?

The OCED database says:

Total expenditure on health, % GDP

France 11

USA 15.2

Canada 9.8

UK 8

Switzerland 11.4

Total expenditure on health, Per capita US$ PPP

France 3117.0

USA 6014.0

Canada 3218.0

UK 2509.0

Switzerland 3990.0

The USA is more expensive but 8 times...you were just kidding?

I present the problems of the plans because there are many, many people that think there is not one darn problem going on with any universal plan.  It is just not true and quite poly-anna to think so.

I have a client who has a son working in Japan as a translator. Great job BTW.  But apparently Japan has ER problems and will send ambulances away, she e-mailed me some info that her son sent to her." if you call an ambulance, they then in turn have to call around to neighboring hospitals to see if the doctors in the emergency room have time to see another patient. As it goes, emergency rooms are often pretty busy and a lot of them say no."

More than 14,000 emergency patients were rejected from hospitals three or more times in 2007.

"my wife is (was) an ER doctor in Japan. She has "escaped" to the US due to the issues facing Japanese doctors.

There are several problems - firstly, Japan does not have a good samaritan law. In the US, if a doctor sees a person on the street needing help, the doctor can help that person, and will not be held liable if something bad happens (*as long as no payment is accepted by the doctor). In Japan, the doctor who helps the person on the street can then be sued (as a criminal and for a civil suit for money). This has happened.

Secondly, as far as the ER goes, apparently, if the patient in the ambulance is accepted by the ER of a hospital, and that ER then turns out to not be fully equipped to care for the patient, the accepting doctor can be (and have been) held liable in a criminal suit. Most ER's in Japan are small, and have only 1-3 doctors present at a time. Therefore, if you want to accept a patient, you have to be sure that you can take care of anything that might crop up, or else you may be dragged to jail. Example (true story): An opthamologist working in the ER accepted a guy punched in the face, took care of his face, then told him to come back the next day; the patient was sent to the police station, and ended up dying shortly after (allegedly of a "lung injury"). The doctor was arrested 12 hours after the patient died, and the guy who beat the patient was not."

Maybe there are just too many people because it seems there are so many insurmountable problems?


You're right.

We get it. There is no solution that will satisfy everyone (anyone?). So, fuck it, let's go kidnap some medical professionals and start pimping them.

you don't get it

just telling these horror stories, many at this point not verified, isn't the issue here on aggregate analysis.

One can point to 10 horror stories in the United States for each one you come up with...so that means nothing in terms of systems and analysis.

I made a mistake, I don't know where I got that 8x. Original post is here. It's PPP and that is very different from GDP but more in tune with true cost of living. Note PPP ratios are off the charts and they have increased dramatically. This is 2006 data.

You know what

How can you proof your statement? (One can point to 10 horror stories in the United States for each one you come up with...so that means nothing in terms of systems and analysis.)

I point out the negative because nobody else does it. When analyzing something is it good to only point out the positives. Hey invest in the stock market, people have made good money. Yeah....don't talk about the down side.

Most of my links are EU newspapers or EU sites that help you with information when moving to another country. 

A link to the Japanese ER problem? Here you go. I am sure it will be one more horror story that will mean nothing. But it is a system problem in Japan not just an anecdotal once in a while story.  "For more than an hour the ambulance crew tried to find a hospital to accept her. Eight refused."  The problem is there are neither enough doctors in Japan, nor emergency facilities.

The number of obstetricians has declined - medical students are said to be put off by the long hours of training needed to qualify and a rise in the number of malpractice suits.

The health minister has promised to try to improve the situation. But measures already in place - like scholarships for doctors willing to work in rural areas - have not made much of a difference.

Japan's health minister has pledged to address the shortage of doctors in the country after a woman in labour was turned away by eight hospitals.

I would guess that with the USA being the combined size and population of the UK/France/Germany and a bit more, something like above has probably happened.  Probably in the urban areas.  But it I doubt if it is systemic.  My neighbor is an EMT...I'll see what he knows.

I would lay $1,000 on the table that if you give Docs, nurses, hospitals immunity to law suits like Medicare has and you would see a great savings by the doctors.  Why did the government provide people that adjudicate Medicare immunity under the Official Immunity" and the "Medicare Preclusion Law.Under the "Medicare Preclusion Law," 42 U.S.C. Sec 405 (h), no lawsuit can be brought against a Medicare contractor or employee.

Ooooo this is dicey.  Mortality rates for NHS hospitals will be posted.

Gee one more notable incident.  Let's run to this system and not think about the problems.  Almost two thirds of nurses in Northern Ireland have raised concerns about patient safety with their employers, new research indicated today.

Maybe this has become more of an issue because of wage stagnation.  Once upon a time we in the USA made real money and we could pay our way.  Now because of wage stagnation people look to the government for help.

last time

I am not going to swim through more anecdotal horror stories instead of a correct analysis. If you do not understand my point, read the EP rules.

If you do not realize that the world is already full of these stories, many debunked and that the source of many is the corporate lobbyists, the vested interests, that the health care sector is expected to grow, in the trillions of market share and there are a host of MNCs who have a vested interest in protecting those profit margins and "growth" rates....I don't know what to tell you.

Fairer manner would be an interesting adverb to use

If by fairer manner you mean that you don't need to worry about your own health coverage, I will agree. It is nice when someone else is at the wheel taking care of things. I don't think it was a fairer manner for the people denied cancer treatment by the UK government mandates, that isn't fair.

We've all heard that old saying, "you live under my roof, you follow my rules." Most kids can't wait to get out from under the "roof." With the freedom comes responsibilities and they need to learn to take care of themselves. I read that it is not uncommon these days for kids in their thirties are still living with their parents. Is there a generation that likes to be taken care of?

Here is something I was think about...a plan. The government sets up its own health plan and it would be a base plan everyone can buy into. They must invoice (no using other services like the IRS to collect payments), they must adjudicate claims, they must have their own administration (paid out of collected premiums NOT taxes), they must pay for all meetings, they will set payment schedules. They must run it as a business because the deep pockets of the taxpayer would not be available to them.

Private plans already work under the above model. Private plans would have the mandated base plan. They could also have plans for sale that have added benefits. Private plans would be non-profit or profit. To make everything on par with the Feds, they would not be subject to property taxes, State gross premium taxes, local taxes, etc. Don't force anyone through taxation to buy the government plan but (like many countries) everyone must purchase an insurance plan.

When I get to my final blog it will address the shadow administration stats given my the government. When you hear their low admin costs, well just like CPI; the unemployment stats; you aren't given the rest of the story. When I read the blogs like the Kozkids and HoffPo, I really think they are expecting that a single payer plan is going to do more than any other single payer in the world. So many, many of them on the above blogs have no idea that other countries are having funding problems, have coinsurance, etc. They sound like they WANT something for nothing.

I just found this today. Apparently the Canadian Act doesn't cover prescriptions and leave it up to Provinces to provide as a supplement.

Health care services include insured primary health care (such as the services of physicians and other health professionals) and care in hospitals, which account for the majority of provincial and territorial health expenditures.

The provinces and territories also provide some groups with supplementary health benefits not covered by the Act, such as prescription drug coverage. The level and scope of coverage for supplementary benefits varies between jurisdictions.


Benefits not covered by the Act, such as prescription drug coverage

Under the Canada Health Act, all necessary drug therapy administered within a Canadian hospital setting is insured and publicly funded. Outside of the hospital setting, provincial and territorial governments are responsible for the administration of their own publicly-funded prescription drug benefit programs.

Most Canadians have access to insurance coverage for prescription medicines through public and/or private insurance plans. The federal, provincial and territorial governments offer varying levels of coverage, with different eligibility requirements, premiums and deductibles. The publicly-funded drug programs generally provide insurance coverage for those most in need, based on age, income, and medical condition.


Outside of the hospital setting, provincial and territorial governments are responsible

Fair?  Yes it is nice when someone else drives, pays my bills, etc. The question becomes, how far are we willing to go in allowing the government to pay our bills?  Do I or we want to have the rule, "when you live under my roof you will follow my rules" or do we want freedom.

Freedom? Where is this coming from?

Seriously. Do you honestly believe you have freedom or choice right at the moment in health care? Or with any private health care? No, the insurance company is completely dictating your choice. You also have MDs who are dictating choice to the point of absurdity.

It's a cartel, half of the MDs just think they are right, no matter how absurd their diagnosis, recs. are and one must then whip out more money, find another Doctor, assuming one can do that...to even get the right prescription, never mind the right tests and diagnosis....

Honestly I think you need to physically go to the UK, go to Sweden, etc. and see their health care system, in action.

and on administrative costs, I've really looked into it so you need to cite those objective studies.

The only problem I have in the U.S. single payer health is our government is so riddled with special interests, corporate agenda....getting any efficient system running is tough. But the reality is they do have some experience with Medicare/Medicaid and if anyone has done anything with billing and insurance companies....I strongly doubt anything can be as inefficient as private insurers in the U.S. right at this moment. You get 4 pieces of paper for one procedure, all mailed. Just that alone you can tell and there is also a huge reason so many Medical Professionals are arguing for single payer health care and it is not to line their own pockets.

Ok I'll give you a shot to show me

Is CMS labor or CMS building management included in Medicare administration calculations and what is the cost of IRS to collect and distribute Medicare premiums?

Robert, I'm headed to 57 years old and have had dealings with medical insurance. I will agree that the "this is not a bill" paper is redundant. We must talk to our State about that one, they make the laws and I think they are mandated to send that "this is not a bill."

I know a guy that is a medical miracle. He tells me he has had $200,000 of cancer treatment. They even pay for him to go to John's Hopkins an out of State hospital. He has paid very little toward that $200,000 bill.

Funny you should mention duplicate papers. Today I received a paper from my son's high school. At the bottom it said:

White copy - Student
Yellow copy - division principal
Gold - guidance
Green - teacher

I didn't think such paperwork existed outside of the military.

BTW if I (at age 57 / son 15) can buy an insurance policy for @$240, it doesn't mean you need to be rich to get insured. For the $240 I get $8 million of coverage for me and $8 million for my son. All I care about is cancer, heart attacks and the like. So by freedom I mean allow me to worry about my own plan, my own financial plan. Why is that so hard to understand?

Create a health safety net and be done with it. I have no problem with a safety net.

Notice how I say our health plan has problems, give kudos to other plans but also point out the problems of other plans are real.

I have yet to see someone say, "yes their plans do have problems." It is almost like I step on toes when I point out the problems.

Once again

BTW if I (at age 57 / son 15) can buy an insurance policy for @$240, it doesn't mean you need to be rich to get insured. For the $240 I get $8 million of coverage for me and $8 million for my son. All I care about is cancer, heart attacks and the like. So by freedom I mean allow me to worry about my own plan, my own financial plan. Why is that so hard to understand?

Once again, what state do you live in and who is your provider? I'd LOVE to get that kind of coverage at that price- I keep getting rejected for it.

Executive compensation is inversely proportional to morality and ethics.

Maximum jobs, not maximum profits.

get sick and speak to us

firstly where is your plan, what does it cover and what is your deductible and what state are you in? I suspect you have no major condition or had any health problems with this kind of story.....


The IRS isn't going to collect any premiums, I have no idea what you are talking about....they have systems already in place today, i.e. Medicare/Medicaid/VA and then the entire Federal Employee insurance system (this is the Senators/Congress system).

There is no huge overhead in comparison to private. and it's still inefficient as hell but much lower overhead in comparison to private.

I agree on this one

still inefficient as hell but much lower overhead in comparison to private.

I didn't mean IRS collection oops on my part. When you pay your medicare tax, how does it get to be part of medicare? Where does that cost show up in the administration?

When seniors pay their Medicare premium, who collects it and does that show up in the administration?

Just because admin costs are hidden does not mean they don't exist.

I'm going to talk to my Congressman and see if I can find out the entire poop.

I have Health Assurant, I have an HSA but I don't like giving out my State....its the internet ya know. I am on the east coast. If you are in CA, California rates.....forget about it, they are higher. Each month I put money into my HSA account, it is my money not owned by the insurance company.

The guy that turned me on to the company dis have a heart bypass. The insurance company paid what they were to pay and nobody had any problems. After hearing ...I looked into the ins company.

HSA is not insurance

That's just a tax exempt account which means you pay out of pocket and should be just to cover deductibles. I just checked their rates and they cover less and are more expensive than Blue Cross out here.

So, even with max. individual insurance, believe me if something happens, it can bankrupt you anyway.

This is explaining a lot to me for it sounds like you're running on the denial and prayer plan. That's "oh nothing will happen to us" and when it does people get down on their knees and pray they survive (only to be bankrupt, wiped out by medical bills).

But my main point I keep going back to over and over is one cannot do by anecdote any comparative analysis. That's like me doing a mathematical proof by using examples. The answer is infinity, an "F" on the test, and one cannot run through all exemptions to in the aggregate compare.

HSA is an account with a high deductible

I have a deductible of $3200. It is a 100% plan...meaning after I pay my deductible everything is covered at 100%. I have had this plan for several years and have over $4,000 in the HSA account. So if I need to use the insurance, the money is there to pay. I now have a first dollar health plan.

My wife worked for a CPA firm that was number 9 (back when there was the big 8) , they used to ask me in to give financial management talks to their CPA's, I've taught part time Risk Management classes at our local college. I think...just maybe....maybe, I know a bit about managing financial affairs.

An HSA is a good way to go. Silly me, thinking that people can manage their own affairs. I could have given an extra $300 a month to an insurance company for a low deductible but why? Why not put that $300 into my own HSA account?

But hey, we are in a new world, a world that people can't manage their credit, can't buy a house that is within their financial grasp and now they clamor for the government bail out.

Tell me Mr Oak. How is my plan going to bankrupt me? I really, really want to hear you explanation in numbers. Tell me how I am going to go through the max of $8 million dollars.

When I looked into them they had many different plans. They did have some plans that I would never have touched. Plans that had limits on chemo and other stuff like it. Those are sucker plans. Which plan did you look at?

OK...you made me pull out my policy and read it. It is 23 pages and in my State an insurance contract can not be a contract of adhesion.
Inpatient/outpatient/surgical/reconstructive surgery/x-ray and labs/prescription drugs/anesthesia is covered up to lifetime maximum ($8 million). It is a PPO with the Physicians Health Care Services.
What I was taught about contracts, if it is not excluded by contract it is included. I looked for any cancer exclusions or reduced benefits....there was not any.

But I got around to opening yesterdays mail and my health insurance
renewal was in the mail. I am going from $247.36 a month to $272.36.

Caveat here.......I live in an area of my State that is not anyplace near an urban area, prices of houses, hospital stays so my insurance is lower.

I don't know your age but I'm old enough to have watched friends die, people I know having strokes, and other nasty stuff. They all had insurance and had no problem with their insurance paying.

I asked my EMT friend in for coffee this morning to ask about the ambulance thing said, he has heard of the problem in big cities but never in our two hospital area. I told him why I asked and said about my insurance company. I showed him my insurance card. He recognized it. Turns out that 15 years ago (it was called Fort insurance or something like it back then) he was between jobs and had a short term policy with the company. A week after taking out the policy he was playing volley ball and took one to the nose. Broke it. The insurance company paid (after $250 deductible) for the broken nose....no questions asked.

I think that a certain sector of our society does what I've been accused of doing......presenting only negatives. Why do I get the feeling that you choose the lowest denominator when saying my plan doesn't cover enough?

Just did an online quote with the Blues ($3500 deductible/90% plan) so my maximum out of pocket would be higher. The premium is $375.00.

So clearly our views are different because of the areas of the country we live in. Actually I was surprised that the Blue Shield plan was so low because usually they are the high cost people.

Sometimes freedom is only "freedom for the rich"

And I'd certainly say that's the case with health care in the United States- it's only freedom if you can afford it.

I'd rather have both available- "when you live under my roof you will follow my rules", but "if you can afford private insurance, go for it".

Instead, when we have only one available, there is no real freedom, no real choice. An excellent example (sorry Robert, go ahead and delete if you think the example is inappropriate, but it's the one that comes to mind) is the so called freedom to terminate a pregnancy. There is no freedom for the poor single woman with no health care- $600 in debt is better than $6000 in debt either way you look at it, and thus, abortion becomes the *only* choice, regardless of the mother's wishes.

Executive compensation is inversely proportional to morality and ethics.

Maximum jobs, not maximum profits.


In the U.S. Freedom means private insurance companies have the freedom to continue their outrageous profits, acting like the credit card companies, denying health care the minute someone actually needs it....

The minute I hear words like "freedom" and "socialist"...
folks, come on, both sides has their propaganda and one thing I really hope EP enables is to allow people to cut through the bullshit and get to the real truth of the matter through stats, theory, facts, details....

There is huge money on health care pushing so much misinformation, propaganda because...oopsy, you might just be cutting into their profit margins.

Health insurance companies backing off of $2 trillion in savings

If you all recall earlier this week there was headline after headline claiming the Obama administration got all private health insurers and others to promise to reduce medical costs by $2 trillion dollars.

So, after we get this massive press sweep, the truth is they are all back peddling....in other words, they have no intention of doing that...

it cuts into the profits.

and last i heard, grassroots groups, those for universal single payer, the MDs and the Nurses are still let out of the negotiating table creating legislation.

Even worse, I have not heard at all, anything about regular patients being at the bargaining table.