Healthcare in the UK

[Protect Trans Hoosiers]

So British mum Karen Knott, who couldn't bear to see her 14-year-old son, Elliot, in pain has decided to fly him to India for an operation.

Don't they have private doctors in the UK, or is everyone forced to work for the NHS?

I think a lot of Americans would be fine with the idea of socialized medicine if it meant you could choose your own doctor, and you could purchase private insurance to cover those ailments that a nationalized system almost certainly would fail to cover.

I have two brothers-in-law suffering from Chronic Fatigue.  Illnesses like that typically fall through the cracks when healthcare bureaucrats with no accountability to anything other than their budget get to decide what is and isn't covered.  In a free-market system, there is an incentive to provide the best care possible.  In a competition-free socialized world, that incentive is gone.

[Platypus]

socialised medecine isn't the problem; at best (for your case) the problem is the NHS.

[Filuwaúrdjan]

Don't they have private doctors in the UK, or is everyone forced to work for the NHS?

There are private doctors here, yep. A lot of doctors do most of their work for the NHS and a bit of private stuff on the side.

[Protect Trans Hoosiers]

Don't they have private doctors in the UK, or is everyone forced to work for the NHS?

There are private doctors here, yep. A lot of doctors do most of their work for the NHS and a bit of private stuff on the side.

Ok, it's not as restrictive as I thought it might be.

Besides freedom of choice issues, there are a lot other issues that Americans are greatly concerned over.  The cost in terms of tax is one thing.  How much of our income would be taxed just to pay for a national system?  Also, the bureaucratic inefficiencies of operating a centralized system for a nation the size of the US are potentially huge.  Just simply the overhead in the huge amount of administration that would have to be created... Private enterprise has built-in checks on administrative waste.  When the government operates something, there is actually a disincentive to be efficient.  As someone who has worked in the public sector, I know this to be true.  Government jobs are wonderful, but productivity isn't exactly the number one priority.

Anyway, the problem with US health care is that doctors and insurance companies have become so powerful through the whole "managed care" movement that they control the whole game.  They've priced millions of Americans out of their health, and are bankrupting people left and right.  Something is going to come to a head, and very soon.  Of course, all socialization will do is redistribute the cost.  So any battle for nationalization is going to turn into an ugly class war.  Try convincing someone making $150K that he has to pay $30K/year more in taxes to pay for other people's medical care.  Good luck.

[John Dibble]

Anyway, the problem with US health care is that doctors and insurance companies have become so powerful through the whole "managed care" movement that they control the whole game.  They've priced millions of Americans out of their health, and are bankrupting people left and right.  Something is going to come to a head, and very soon.

Has a ring of truth to it. I also think part of the problem is that Medicare and Medicaid stop people from shopping around for their medicines - they can get their stuff free or at little direct cost, so they'll go for the first place that can provide it instead of looking for somewhere that can get them their medicine cheaper. People have an incentive to shop around for any good the government doesn't pay for - in the healthcare industry, look at laser eye surgery. It's relatively new, but the price has consistently gone down, and suprise suprise the government will not cover it.

[○∙◄☻¥tπ[╪AV┼cVê└]

Our system isn't perfect, but I would never abolish the right to free basic healthcare.

Then why do you support the Democrats moving to the right, and mindlessly attack Boxer?

[Filuwaúrdjan]

How much of our income would be taxed just to pay for a national system?

Surreally enough, less than the amount you pay towards various government healthcare schemes etc. already...

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True (although it's hard to think of anything that could be more inefficient than the existing U.S healthcare system...) but then the NHS isn't especially centralized these days (most of the adminstration is done by the local NHS trust, the Local Health Authority or whatever) and if an attempt was made to export the idea to the U.S it would likely be even less centralised; LHA's might be elected for one thing.

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True (in theory) but in practice healthcare can't be delivered effeciently by the private sector to the bulk of the population (because there is no incentive for the private sector to do so).

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Which is where things like independent audits, targets and all that come in

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True

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Well the amount of money needed to run a US NHS would actually be significantly *less* than the amount of money needed to fund the existing setup... (the U.S healthcare system is astonishingly inefficient for some reason; any idea why? I'd guess something to do with so many different administrative bodies admistrating things or summet) but yes, there'd be losers. There always are; to get the doctors to agree to the NHS, Nye Bevan "stuffed their mouths with gold" (ie: let them continue with private practice if they wished to).

[TheresNoMoney]

The cost in terms of tax is one thing.  How much of our income would be taxed just to pay for a national system?

It would be less for the vast majority of Americans than they pay now. I've seen a few proposals were there would be a payroll tax of 2% on the employee and 6% or 7% on the employer (which is less than most employers pay now).  Universal health care would be much cheaper than the current system.

Also, the bureaucratic inefficiencies of operating a centralized system for a nation the size of the US are potentially huge.  Just simply the overhead in the huge amount of administration that would have to be created...

Actually, just the opposite is true. That's why universal health care would be cheaper. Overhead on private health insurance is something like 20%-25% while overhead on Medicare/Medicaid is something like 3% or 4%. Doctors would have less paperwork to fill out and billing would be 100X easier than it is now, since they would have standard forms and only one payor.

Anyway, the problem with US health care is that doctors and insurance companies have become so powerful through the whole "managed care" movement that they control the whole game.  They've priced millions of Americans out of their health, and are bankrupting people left and right.  Something is going to come to a head, and very soon.

I agree with that. With 45 million uninsured and our current health care system making our economy less and less competitive, something has to be done. 

[TheresNoMoney]

Of course, all socialization will do is redistribute the cost.

No, it would cut the cost by eliminating huge amounts of overhead. We could also put price ceilings on prescription drugs (like Canada does) which would save billions.

Try convincing someone making $150K that he has to pay $30K/year more in taxes to pay for other people's medical care.  Good luck.

Somone making $150K a year would only pay about $3,000, most likely less than they are paying now.

[A18]

http://www.cato.org/pubs/pas/pa532.pdf

Wherever national health insurance has been tried, rationing by waiting is pervasive, putting patients at risk and keeping them in pain. Single-payer systems tend to leave rationing choices up to local bureaucracies that, for example, fill hospital beds with chronic patients, while acute patients wait for care. Access to health care in single-payer systems is far from equitable; in fact, it often correlates with income—with rich and well-connected citizens jumping the queue for treatment. Democratic political pressures (i.e., the need for votes) dictate the redistribution of health care dollars from the few to the many. In particular, the elderly, racial minorities, and those in rural areas are discriminated against when it comes to expensive treatments. And patients in countries with national health insurance usually have less access to critical medical procedures, modern medical technology, and lifesaving drugs than patients in the United States.

Details>>>

Pretty terrible stuff.

[TheresNoMoney]

Yay for the ever-reliable Cato Institute (will you use the Heritage Foundation next?)

[A18]

Somone making $150K a year would only pay about $3,000, most likely less than they are paying now.

You said 2% paid by the employee. And 6-7% paid by the employer. That comes out to between $12,000 and $13,500.

Social Security taxes are about 12% already, and you want to remove the cap on that. So someone making $150,000 a year would pay a top marginal rate of 53%.

[TheresNoMoney]

Social Security taxes are about 12% already, and you want to remove the cap on that. So someone making $150,000 a year would pay a top marginal rate of 53%.

No, for a single individual with $150,000 in taxable income, they would pay a top marginal rate of 36.2% (28% tax bracket + 6.2% social security tax + 2% health insurance tax).

You're only 17% off, though.

The employer would pay 13.2% on wages (6.2% social Security + 7% health insurance).

Both parties would be paying less than they currently do in the vast majority of cases.

[A18]

http://taxes.yahoo.com/rates.html

33% bracket + 12% Social Security tax + 7-8% health insurance

The employer 'pays' the tax on your behalf, out of your earnings. And payroll taxes are not deductible.

[TheresNoMoney]

You're using the 2004 table, I used the 2005 table.

http://www.fairmark.com/refrence/index.htm

Employee would pay 36.2%.

Costwise, the vast majority of the population gets a break from what they pay now. Most people don't realize that.

[A18]

You mean the 2006 table?

Even if we go with the 28% bracket, it's 48-49%. The employer half has just as big an impact on your pay check as the part you pay. You might as well just have the employer collect the whole thing and pretend it's all 'free.'

[TheresNoMoney]

I used the table for 2005 income, not sure why that's so hard to understand.

Either way, the vast majority of Americans would pay less under single-payer health insurance (public/private partnership) than they are now. Health insurance for every American at a lower cost. Sounds like a damn good deal to me.

[A18]

Well, it's the table used for taxable income due in 2006.

I doubt many people making $150,000 a year think a top marginal rate of 50% is a 'damn good deal,' especially when the health care sucks.

[TheresNoMoney]

I doubt many people making $150,000 a year think a top marginal rate of 50% is a 'damn good deal,' especially when the health care sucks.

It would be less than they pay now. The only change is that it would go to the government instead of an HMO.

And again, the individual would be paying a top marginal rate of 36.2%, not 50%.

[A18]

Uh, no. It's all your money. Who pays is irrelevant.

You might as well say a sales tax of 6% is not a tax on consumers, but rather on retailers.

[Protect Trans Hoosiers]

Of course, all socialization will do is redistribute the cost.

No, it would cut the cost by eliminating huge amounts of overhead. We could also put price ceilings on prescription drugs (like Canada does) which would save billions.

The only reason we have new drugs on the market is that US consumers foot the R&D bill (to which nations like Canada directly benefit).  Someone has to pay up.  What do you suggest, that the government subsidize drug research, or that we simply let the pharmaceutical industry die/move to China?