UK v USA – the basic healthcare facts


8:38 am - August 14th 2009

by J Clive Matthews    


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It’s worth noting in this US vs the NHS row is that the US has just about the highest healthcare spending in the world – 2nd highest by percentage of GDP, first by overall cost – largely because it’s among the most expensive. Time for some numbers – all freely available via Google.

I hold no brief for the NHS (and unlike most LibCon contributors tend to lean towards part-privatisation of its services), I’m just interested in the facts, so feel free to correct me if I’ve got some of the maths or figures wrong.

Of the c.15% of GDP the US spends on healthcare annually (that’s about $2.2 trillion*), around 50% is spent by the government (around $1.1 trillion). By contrast, the UK spends around 8% of its GDP on healthcare, with the Department of Health’s budget for the NHS (England**) in 2008/9 around £94 billion (about $155 billion).

The English NHS cares for 49 million people (100% of the population of England); US public healthcare currently covers about 83 million (around 28% of the US population).

For a direct comparison, that means that in England the government spends around $3,200 per capita on healthcare and covers the entire population whereas in the US the federal government spends around $3,700 per capita and yet covers less than a third of the population.

Take away those 80 million covered by the US’s state healthcare (which doesn’t cover all uninsured Americans, so this is being generous) from the States’ 300 million population, we’re left with 220 million Americans to account for the other $1.1 trillion spent in the US each year on private healthcare.

If I’ve got my maths right, that works out as $5000 for every American in the private system – almost $2,000 a year more than the NHS costs.***

Yep, that’s right capitalism fans – the US free market system for healthcare provision is significantly less efficient than a “socialised” one.

This no doubt explains the Republican fear of universal US healthcare – if providing government healthcare funding for less than a third of the population costs $1.1 trillion, they no doubt imagine it would involve a bit more than a threefold increase in public healthcare spending to cover the entire population. (If they’re being really cynical, they’d no doubt point out that the US government’s $1.1 trillion healthcare spend divided by 83 million works out as a cost of $13,250 per person per annum – and therefore the annual cost to cover all Americans at that rate could be as high as $4 trillion a year.)

Of course, what they’re failing to do is take into account the ability a public healthcare system would have to drive down costs, and in their attacks on the NHS are choosing to ignore the simple fact that the NHS (even with all its problems and wastage) works out as far, far better value for money than even the current US system.

Were you to be more of a lefty than me, you might be tempted at this point to suggest that it is precisely this ability of a national health service to drive down costs that the Republicans are opposed to, as it’d leave the rich pharmaceutical companies out of pocket.

But this in turn would ignore the fact that the US’s over-spending on medicine thanks to its piss-poor health system helps to subsidise the cheaper medicine available in other parts of the world by offsetting pharmaceutical R&D costs, etc. – in other words, a US version of the NHS would almost certainly decrease the cost of US healthcare, but may well end up raising it elsewhere…

——————————-
(Figures sometimes rounded up/down to the nearest round number for convenience’s sake, and taking the most recent figures I could find wherever possible (normally from the last three years, mostly via the OECD)).

* Assuming a trillion to be the common usage of a one followed by 12 zeros (a million million), rather than the alternate definition of a one followed by 18 zeros (a million million million)

** Governance of the NHS across the UK has been subject to devolution – I could have done an overall UK figure, but it would have involved more maths. Sorry.

*** $2.2 trillion divided by 300 million, for the *overall* per capita annual cost of US healthcare, works out as $7,000 per person – though a direct comparison with the English NHS’s per capita cost of $3,200 is unfair – because despite what some American right-wingers (and Tory MEP Daniel Hannan in his Fox News interview) like to imply, there is also a private healthcare system in the UK. I don’t have annual private healthcare cost figures for England or the UK to hand (my private health insurance sets me back around £500 a year, but I don’t know if that’s representative or what percentage of the UK population has private health insurance). Either way, it’s more or less irrelevant – in the UK, going for private healthcare is a matter of personal choice (mostly for the very rich who want a waiting room with leather armchairs); in the US, it can be a matter of life or death.

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About the author
This is a guest post. Jc Clive Matthews has written about European affairs for years at: Nosemonkey's EUtopia
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Story Filed Under: Blog ,Equality ,Foreign affairs ,Health ,United States

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Reader comments


Just wondering whether or not the US figures are skewed by pseudo medicine; eg, to what extent is plastic surgery included in these figures? If so, does it distort them; if so, how?

Right, so let me get this straight – you think that it is only valid to compare HOW MUCH is spent on each healthcare system without asking WHAT they spend it on.

Sounds like you’re suffering from a severe case of ‘Brown-itis’.

Yeah, except Obama is not proposing a US version of the NHS. Are you a dolt? He just wants to introduce a public health insurance option to compete with the private insurers. He isn’t talking about an NHS.

4. Chris Baldwin

“in other words, a US version of the NHS would almost certainly decrease the cost of US healthcare, but may well end up raising it elsewhere…”

Fine!

5. the a&e charge nurse

Thanks for the stats, JCM – certainly food for thought.

Personally, I think the American health system is (by and large) a matter for them, although I admire the line taken by Obama.

What does interest me though is the near hysteria from some quarters in America whenever the NHS is mentioned.

Obviously Hannan is pandering to this audience and has clearly done his best to reinforce certain misconceptions and half-truths about our system.

The NHS certainly has faults but as you point out it is BOTH cheaper than the US and universal – qualities that should not be lightly dismissed, in my opinion.

Some graphs in New Scientist a couple of weeks ago suggest that in the USA the costs of health care are higher than other industrialised countries and the outcomes are worse. The USA system skews spending to expensive treatments that have litle impact on life expectancy and away from cheaper treatments that have a higher impact.

Good stuff, thanks. I tend to agree that this scrap is essentially a matter for the Americans but the fact that about 200 creepy, freaky, perfect clones of Daniel Hannan are going to roll up in the next House of Commons as newbie MPs and start trying to compete for jobs to rule over us is very much a problem for us.

Meanwhile, on the basis of your piece, how do you justify this?

“I hold no brief for the NHS (and unlike most LibCon contributors tend to lean towards part-privatisation of its services).”

We all know that part privatisation is being already pushed through, badly, with the financial interests of the contractors totally in the driving seat. All that’s happening is that systems are being designed to leach out as much taxpayers money as possible directly into the coffers of the private health companies, many of which are Texan and at the very heart of the crooked practice rife in USA, and through into dividends for the monied who like high profits at no risk. The interests of the patient are below nowhere.

9. the a&e charge nurse

[2] Right, so let me get this straight – you think that it is only valid to compare HOW MUCH is spent on each healthcare system without asking WHAT they spend it on.

No, I don’t think JCM makes any such claims, LFAT, and well you know it, but the numbers are very interesting – specifically the fact the US spends more than every other country in the world on health.
Why is that do you think?

There is a superb article (below) that discusses the broader aims of any health system, particularly the importance of prevention (something the Americans are less good at) verses expensive late stage intervention (for which the US are probably world beaters).
http://www.um.edu.mt/umms/mmj/showpdf.php?article=197

Comparing health is always tricky because the system itself is only one part, albeit a very important part, of the overall equation.

For example, one or two commentators have picked up on Singapore’s relatively low spend on health (less than half that of the USA) yet this country still seem to have very favourable outcomes – but it may be that the average citizen of Singapore simply looks after their health more conscientiously than your typical obese, beer swilling, smoking Yank or Brit?

By the way its not just Brown who is defending the NHS – Cameron is as well maybe due to the kindness he received from NHS staff following the untimely death of his own child

10. the a&e charge nurse

Yes, LFAT, this from Haslams article;
The high tech world of hospitals always looks more glamorous, but the work of Barbara Starfield from Johns Hopkins in Baltimore shows remarkable benefits from having a focus on primary care. Her work demonstrates that countries whose health systems are more oriented towards primary care achieve;
• better health levels
• higher life expectancy
• better health outcomes
• higher satisfaction with health care among their populations
• lower overall health care costs
• lower medication use

Secondary care is not health care in the UK or anywhere else in the world. Far from it. In the United Kingdom approximately 90% of the work of the Health Service is carried out in primary care. In one recent year there were 268 million consultations with general practitioners , and satisfaction rates with general practitioners are high This under-valuing of primary care is puzzling.

More food for thought if you find the numbers too upsetting.

It is very odd to see the fuss being made over some very modest plans for reform. In the 1940s Bevan was treated in the same way when he tried to bring in the NHS. He was called a Little Hitler, Stalin etc. etc. but when the dust settled most people realised it was fuss about nothing.

We have a healthcare system that covers everyone. Also, I believe, the single biggest cost to the NHS is expensive new drugs, so take those out and it’s actually pretty cheap considering what it does.
I personally think having a medical system based on ability to pay above need is disgusting and very wrong.

Contribution by Ed Hoskins on French health sysem -well worth a read.

http://www.spectator.co.uk/coffeehouse/5261858/the-nhs-isnt-free.thtml

Letters From A Tory – No, I’m asking what it’s spent on as well. 100% of the population in the UK system vs. 28% of the population in the US system – yet the UK system costs less. Surely by any standard that makes the UK system better value for money?

(Not sure what Brownitis is, but for the record I’ve never voted Labour in a general election – and am already on record as saying that I voted for Boris for mayor. Sorry chum, I’m not your regular LibCon contributor, so the standard assumptions are leading you astray. I genuinely am just interested in what the best system is. I don’t think it’s the NHS, but I’m pretty damn certain that the NHS beats the US system hands-down.)

F Klug – are you a dolt? Did I at any point even mention the Democrats, let alone Obama? This is about Republican NHS-bashing, and whether it has any grounds in reality. I couldn’t care less what Obama does to the US health service.

Strategist – that’s the sometime Tory-voter in me, I suspect. I do, however, think that insurance-based systems can work well (cf. Japan, for example), and that the NHS has a lot of wastage and offers a lot of unnecessary treatments. Using the US as an example of an insurance-based health service is rather like using someone who catches MRSA, has a scalpel left in their guts during surgery, and then is left to die on a trolley in a corridor as an example of an NHS patient – pretty much the worst case scenario.

Bearded Socialist – I agree with your last sentence pretty much entirely. But that’s no doubt because I’ve been brainwashed by the evil socialist bastards who set up the NHS (which included my grandfather, who turned down the offer of a plush Harley Street practice and a life of luxury – having helped pioneer techniques that would go on to become the basis of modern plastic surgery during the war – to join the new health service on its launch) with their communist temerity to think it might be nice if fewer people died.

I mean – how DARE anyone want to both help keep people alive and lessen their suffering? (To this point I’ve tried to avoid any direct comment on the US policy debate as it’s none of my business, but that attitude truly does sicken me.)

“Yep, that’s right capitalism fans – the US free market system for healthcare provision is significantly less efficient than a “socialised” one.”

Weeeell….no. To make that statement you have to assume that what is being provided is equal. Which it very much isn’t.

The US system provides access to higher tech and newer treatment which NICE won’t fund (vide Herceptin and Alzheimer’s drugs rows) (and that’s the Medicare part, the govt, let alone private insurance). It also, as you note, subsidizes huge amounts of medical research and innovation which the rest of the world then enjoys the benefits of (no, really, JCM is correct there).

What the US system, whether Medicare or private insurance really provides though is no waiting. Or at least, compared to the NHS it does.

Now of course, we can go on and say that the latest high tech treatments aren’t worth the money, that we’d be better off rationing them (although that does lead to a slowing of innovation, new things do tend to start out expensive and then become cheaper: mobile phones anyone?). You can also say that the huge amount Americans spend on end of life treatments isn’t worth it.
You can even say that the US should not be subsidising medical research for us….although that wouldn’t be a very progressive thing to say, for the rich are supposed to subsidize the poor aren’t they?

I’d also drop in my favourite little argument here: deadweight costs of taxation. As a rule of thumb these costs are 20% of the money raised (others think, at current tax rates, it’s more like one third). These costs are not, of course, included in the above calculations of the costs of tax paid systems. But they should be of course.

This doesn’t explain the cost differences between Medicare and the NHS…..but that Medicare is only for the old who tend to cost more in health care (fancy that!) and the NHS is for everyone helps explain that.

But there’s one further point which should be made, question to be asked.

What is the “right” amount to spend on health care? As a portion of income, as a portion of taxes, as a portion of national production?

Anyone actually know? Anyone even got an idea of how we can work it out?

From disgusting free markets people like me I would sorta assume that the “right” amount is whatever people actually want to pay for it. No, leave aside the efficiency of delivery for a moment. We know that as incomes change then so do the portions of those incomes spent on various items change (and the same is true for personal as for national incomes). We all spend vastly less as a portion of income on food than we did in 1900 (err, as our forefathers did) and vastly more as a portion on transport, just to take two examples. Vastly more on leisure than they did.

So, as incomes rise, what portion of total income (or even of that extra income) is the “right” amount to be spending upon health care. And as technology marches on and more is possible to do with health care, what is the right portion?

As I say above, free marketeers like myself would respond that it’s whatever people decide that they want to spend is the “right” portion. So if we look around the world and see that the most free market system (which isn’t very but it is more so than most others) has a higher portion, then perhaps that is the right portion, not the artificially depressed levels where politics makes the decision?

Maybe the rational planner thinks that taking delay out of the system isn’t worth it, that end of life treatments aren’t worth it, that the latest treatments aren’t worth it. And the general public, in their willingness to pay for these things, proves the rational planner wrong?

Note, as I say, that this isn’t an argument about the delivery syste, it’s one about the general level of expenditure, what people are willing to pay for.

“Also, I believe, the single biggest cost to the NHS is expensive new drugs,”

No, total drugs bill is in the 10-20% range. The biggest cost, unsurprisingly, is wages. 70% of that drugs bill is in primary care (GPs etc) and the balance in secondary care (hospitals). At a guess (and yours is as good as mine here) “expensive new drugs” would be secondary care, consultants prescribing from hospitals.

And remember, NICE doesn’t approve the really expensive ones, those that cost more than £40k or so per QUALY. Or even those that cost £2.50 a day for the onset of Alzheimer’s.

15. EvilEuropean

Nice piece, nice to get some numbers down and you raised some valid points.

One that I would question would be the impact of the price of medicine around the world. US and Western pharamcutical companies have a habit of focusing on ‘rich world’ diseases brought about by poor lifestyle which in turn is not really very relevant for the rest of the world.

I’m sorry to say that as soon as I saw Mr Worstall had put his pennies in I was turned off this discussion.
We just won’t agree, will we?

Fair play on correcting me about spend on wages and drugs, I hold my hand up there.
I would also agree with you (shock horror) that the right amount is what people want to spend. Now I want the country to spend lots and through a nationalised, socialised, possibly reformed, health service. I want that level to be decided by the public in an election. If they disagree, well i’ll have to dismantle democracy and FORCE people to be nice to each other.

Joking aside I think that Mr Worstall misses one major point which is access. The NHS is great because anyone can get treatment regardless of their ability to pay, which was the point (of the NHS) all along. To me, this is the most important thing which over-rides all other concerns.

On NICE, i actually think too much is spent on the drugs that come through that. I’m not for artificially extending life a little through expensive drugs. It’s harsh but that’s my two pennies on it.

It is unnecessary to invoke anecdotal accounts and impressions of the NHS.

As a matter of public record:

“The NHS has seen a year-on-year fall in productivity despite the billions of pounds of investment in the service, latest figures show. The data from the Office for National Statistics showed a fall of 2% a year from 2001 to 2005 across the UK.”
http://news.bbc.co.uk/1/hi/health/7610103.stm

As for how the NHS compares with healthcare systems in other west European countries, the regular annual review of European healthcare systems continues to find the NHS rates as fairly mediocre:
http://www.healthpowerhouse.com/files/canadaIndex03.pdf

The particular characteristic of Britain’s NHS is that it combines a social insurance scheme for personal healthcare costs with a verging-on state monopoly provider of healthcare services. Healthcare systems in other west European countries have avoided that combination and concentrate instead on social insurance schemes. The NHS was created at a time when state-owned industry monopolies were highly fashionable in Britain and where the prospect of “competition” between service or product suppliers was considered threatening. Governments in other west European countries didn’t start out with that mindset. Whether by coincidence or not, in European comparisons the NHS comes out fairly well down the performance league table.

Try: What Obama can lean from European healthcare, by Steven Hill
http://www.huffingtonpost.com/steven-hill/what-obama-can-learn-from_b_173154.html

The French Health Care System
http://www.medicalnewstoday.com/articles/9994.php

It may come as a terrible cultural shock to many but credit for first implementing a national insurance scheme for healthcare goes not to Britain for creating the NHS in 1948 but to Count Otto von Bismarck, first Chancellor of the German Emprire.

“The Health Insurance bill . . was passed in 1883. The program was considered the least important from Bismarck’s point of view, and the least politically troublesome. The program was established to provide health care for the largest segment of the German workers. The health service was established on a local basis, with the cost divided between employers and the employed. The employers contributed 1/3rd, while the workers contributed 2/3rds . The minimum payments for medical treatment and Sick Pay for up to 13 weeks were legally fixed.”
http://en.wikipedia.org/wiki/Otto_von_Bismarck

Whatever else, Bismarck was no socialist.

Readers may like to know: a seminal paper on the economic rationale for national social insurance schemes for healthcare costs is now available online with kind permission of the American Economic Association:

Kenneth Arrow: Uncertainty and the welfare economics of medical care (AER 1963)
http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf

See also these relating “Reading notes”
http://hadm.sph.sc.edu/COURSES/Econ/Classes/Arrow.html

18. the a&e charge nurse

[14] And remember, NICE doesn’t approve the really expensive ones, those that cost more than £40k or so per QUALY. Or even those that cost £2.50 a day for the onset of Alzheimer’s.

No, that’s not strictly true, for example NICE approved Revlimid – it costs over £4,000 a month per patient for the first 26 cycles that a patient remains on treatment. After 26 cycles it then becomes free to the NHS.
http://www.myeloma.org.uk/Page.aspx?pid=1500

Adam Wishart produced a fine documentary on this very topic – I would highly recommend it.
http://www.adamwishart.info/2009/06/the-price-of-life-bbc-documentary.html

Question is do you prefer to have a system of health care based on EVIDENCE or one driven by desperation or various pressure groups?
For example you allude to the drug aricept but meta-analysis suggests;
“The debate of the efficacy of Aricept continues as the treatment effects are small and not always apparent in clinical practice”.

And ………..
“Aricept was associated with significantly more adverse events than placebo, particularly so for 10 mg of Aricept per day”.
http://www.library.nhs.uk/mentalhealth/ViewResource.aspx?resID=114048

Anyway, if aricept is such an effective drug why to YOU think it is being denied when it costs so little – perhaps we should ask Danny Hannan for his considered opinion?

Americans – do you know just how ignorant you are about the NHS? http://bit.ly/16muK

Tim – On the equality of service thing, agreed. It’s not equal:

US life expectancy is 78.1 years; in the UK it’s 78.7.

The US has a 30.6% obesity rate; the UK’s is 23%.

The US has an infant mortality rate of 6.3/1000, and an under-fives mortality rate of 7.8/1000; the UK’s are 4.8/1000 and 6/1000 respectively.

It all depends on what you look at really. Me? I’m a bit of a utilitarian most of the time – so the UK system strikes me as better, thanks to people living longer, fewer children dying, and everyone having access to healthcare no matter what their bank balance. If you don’t count those as being as important as having the option of buying unproven, experimental drugs, then we’ll (as so often) have to agree to disagree.

(As an aside, it’s worth remembering that if someone British is really *that* keen on those drugs, they still have the option of going to the States and getting them there – after all, as only the rich can afford them in the US system, if we had the same deal here the same would be true, and what difference is the cost of a transatlantic flight really going to make if it’s a matter of life or death?)

“US life expectancy is 78.1 years; in the UK it’s 78.7.”

Now look it up again for life expectancy at 65. Situation reverses.

Presumably because the US system (Medicare, yes, govt run) spends much more on those end of life treatments than we do.

No, I’m not trying to indicate my preferences here, simply to point out that there’s more to your numbers than you’ve so far assumed.

The US system provides access to higher tech and newer treatment which NICE won’t fund (vide Herceptin and Alzheimer’s drugs rows) (and that’s the Medicare part, the govt, let alone private insurance).

This is a myth, as pretty much everything that is proven effective is approved by NICE.

The things you can get in the US that you can’t get in the UK are the ones which haven’t been NICE-approved because there isn’t any real evidence that they work better than the previous gold standard treatments.

How does that work? Well, to get a drug approved, you need to show in large, controlled trials that it’s better than placebo. You don’t need to show it’s better than the current most popular treatment.

You can, however, produce small-scale, cherry-picked studies against other drugs, which are much less rigorous than the criteria for approval, and use them as a basis for intensive marketing to doctors (combined with intensive freebies, advertising, DTC marketing aimed at patients, massive PR campaigns directed at medically ignorant journalists, etc).

NICE insists on seeing large-scale trials showing that a drug is more effective than its current gold-standard treatment before it approves its distribution on the NHS. This is a Good Thing.

It also, as you note, subsidizes huge amounts of medical research and innovation which the rest of the world then enjoys the benefits of

Similarly, rail privatisation led to huge profits for management consultants. “Creates enormous benefits for people who the scheme isn’t supposed to benefit” is normally viewed as Bug Not Feature.

Tim – Oh, no doubt – this is a short post knocked up quickly last night as I tried to work out my position on the whole thing. I blatantly haven’t done a total systems analysis, and I’d be the first to admit that my statistical knowledge is minimal, so I’ve no doubt got things wrong somewhere here.

The figures I came up with just surprised me, is all. Enough that I quintuple-checked them before finalising this post. I’m quite happy to be convinced that I’ve got this wrong – that’s why I decided to go for this as a LibCon post, to tap into a wider audience that may know more about this than I do – but nothing much is convincing me so far.

Similarly, what A&ECN says about Aricept. There’s no evidence it works, so there’s little point in spending money on it.

Obviously, people in the early stages of Alzheimer’s will grasp at any straw to avoid that horrible fate – but I’m not sure the role of a healthcare system should be to help appalling charlatans to steal money from the terminally ill under the pretence that their completely ineffective drug will ease their suffering.

Come on, I don’t think there would be many prizes for guessing what the right’s reaction would be if NICE suddenly approved a load of expensive, ineffective drugs. We’re well into the realm of ‘criticise by any means necessary’ by now.

The stupidity of this argument is that we are focusing on a big row about whether the right model is the US or UK when there is a continent-full of healthcare systems just over the Channel that (appear to my non-specialist eye) to churn out better outcomes than either eg Netherlands, Germany, whatever. On that I agree with J. Clive Matthews Esquire.

My key point to J. Clive is not that the NHS is perfect and needs no improvement, it obviously does; it is that we are sorely mistaken if we think the reform we need is to follow the advice of a load of eyewateringly expensive, public school wanker management consultants to bring in a load of crooked Texan shysters to fill their cowboy boots with British taxpayer dollars and fuck off back to Dallas.

NHS privatisation is the biggest scam of our times, it’s a daylight robbery being perpetrated right under our noses, and we just can’t afford the luxury of wasting our money on this kind of shit any more.

there is a continent-full of healthcare systems just over the Channel that (appear to my non-specialist eye) to churn out better outcomes than either eg Netherlands, Germany, whatever.

Per £ spent, they’re no better.

Americans – do you know just how ignorant you are about the NHS? http://bit.ly/16muK #welovethenhs

I would sorta assume that the “right” amount is whatever people actually want to pay for it.

As expressed through their voting preference at elections?

As expressed through their voting preference at elections?

seems like a good idea

I would sorta assume that the “right” amount is whatever people actually want to pay for it.

As expressed through their voting preference at elections?

No, because elections are never solely about healthcare – it is one of the five most important issues, but not the most important.

Hence the policy, I guess, of bringing £ per head spent up to the EU average. Fair enough. (“you stole my fucking budget” was the quote, I seem to recall)

The problem is that the City of London, looking for easy money as always, couldn’t see a way of turning a buck on a big cash injection to the existing system, so the consultancy & lobbying machine went into overdrive to rubbish the existing system and push systems of turning as much as possible of the much needed investment in health care in this country into easy money for them.

Good facts, pair that with the outcomes data I put up in another thread on this debacle and you have a picture of how well the NHS bests US healthcare.

Not that Obama’s plan is the NHS, as others have pointed out, not that this is really about the NHS at all, it is just that with the conservative nobs in the States using it as a whipping boy, it is nice to whip back.

RT @libcon: : UK v USA – the basic healthcare facts http://bit.ly/DXjXC [interesting analysis]

“As expressed through their voting preference at elections?”

Contributes to it, certainly. But economists tend to prefer “revealed preferences”. Not what do people say they’ll do (I’ll pay more tax for the NHS….or perhaps more accurately, the rich should pay more for the NHS) but what do people actually do given the choice?

Which is part of the argument I make above. As the US system allows you more choice (in terms of insurance, what will be covered, what are out of pocket expenses, what are the copays , deductibles etc) then we can, by analysing what people actually do, get a better handle upon their desires than by their voting habits.

This isn’t an idea restricted to health care of course.

Any number of people say they’d be happy to pay more tax. Yet very few indeed actually do so: last time I checked with The Treasury it was something like 5 people in the year had voluntarily sent a cheque and four of them were dead.

What people do seems to be a better guide to behaviour than what people say.

But Tim – if my figures are roughly accurate and public healthcare currently costs the US $3,700 per capita per annum, where in the UK it costs $3,200 per annum, then the point is that an NHS-style system in the US* could lower taxes.

(Plus, a point I didn’t make in the article, the introduction of the competition of cheap universal state-funded healthcare should also drive down private-sector healthcare costs – so everyone’s a winner, surely?)

* I know that’s not the kind of system that Obama’s proposing, but still – the Republicans brought it up, not me…

Of course not everyone’s a winner, the state would be involved. State = communism therefore the end of the world. I don’t think it’s going too far, the logic is obvious.

Sorry, couldn’t resist.

Obama seems as scared of the state as most Republicans, though i don’t know if that represents his true feelings or just political manouvering

Re: Tim Worstall with
“”As expressed through their voting preference at elections?”

Contributes to it, certainly. But economists tend to prefer “revealed preferences”. Not what do people say they’ll do (I’ll pay more tax for the NHS….or perhaps more accurately, the rich should pay more for the NHS) but what do people actually do given the choice?

Which is part of the argument I make above. As the US system allows you more choice (in terms of insurance, what will be covered, what are out of pocket expenses, what are the copays , deductibles etc) then we can, by analysing what people actually do, get a better handle upon their desires than by their voting habits.

This isn’t an idea restricted to health care of course.

Any number of people say they’d be happy to pay more tax. Yet very few indeed actually do so: last time I checked with The Treasury it was something like 5 people in the year had voluntarily sent a cheque and four of them were dead.

What people do seems to be a better guide to behaviour than what people say.”

I never fail to be amazed. My boss is one of you Tory lot, free markets and all that. Apparently, they look at the big picture while us silly lefties only look at the small picture.
It seems the other way round. CHOICE?! Nice if you can get it. But only a few get that choice, which righties miss time and time and time again. It’s the ‘right to starve’ thesis

“I never fail to be amazed. My boss is one of you Tory lot, free markets and all that. Apparently, they look at the big picture while us silly lefties only look at the small picture.”

Err, revealed preferences comes from Paul Samuelson. He’s a lefty.

What I found most interesting about the OECD figures was the public spending per head on health. The USA pays out more public money per head than the UK does, that’s before you’ve even started with the private money.

As for the US spending on research; it’s not as if the rest of the world gets that for free. American pharma and medical technology companies charge for their products.

For a comparison, have a look at Finland. Better outcomes than us but for less money.

http://flipchartfairytales.wordpress.com/2009/08/14/the-nhs-as-good-as-us-heathcare-but-much-much-cheaper/

RT @silentypewriter: NHS vs US heathcare numbers laid bare – http://bit.ly/4g73nN – by @nosemonkey (via @libcon) #welovetheNHS

RT @silentypewriter: NHS vs US heathcare numbers laid bare – http://bit.ly/4g73nN – by @nosemonkey (via @libcon) #welovetheNHS

No, I’m not trying to indicate my preferences here, simply to point out that there’s more to your numbers than you’ve so far assumed.

Of course not Tim, of course not…. it’s just that even when the FACTS show how good a socialist system is you’ll still try and find some objections just to say that isn’t the whole picture.

Of course it bloody well isn’t that – that would take entire terabytes.

This is from the blog-article linked above:

Expenditure is about the only area in which the USA tops the table. Its number of nurses per head of population is around the OECD average and its number of doctors significantly below the average. In both cases, the numbers are similar to those in the UK, despite the huge difference in spending. Its life expectancy rate is below that of the UK and the OECD average.

Its infant mortality rate is worse than the UK’s, slightly worse than Poland’s and on a par with that of Slovakia. The USA scores better on flashy machines like MRI and CT scanners but that’s about it. It’s as if the British have bought a VW Golf and the Americans have bought an Audi A3 but paid the price of a Mercedes S-Class.

Take that in your pipe and smoke it.

‘UK v USA – the basic healthcare facts’ – (by @nosekonkey ) showing how NHS is better and cheaper- http://bit.ly/15VfPZ #welovetheNHS

So, fairly good evidence that it isn’t just about the (public) money spent?

I found some UN figures from 2004. UK spending on healthcare 7% gdp (public) 1.1% gdp (private). US spending 6.9% gdp (public) 8.5% gdp (private). Per capita US $ 6,096 UK $2,560. source: http://hdrstats.undp.org/en/indicators/16.html

48. Sallysuesimpleton

Gee, have you even considered how much less the US would spend if we stopped paying for all the medical care of the illegals that have flooded into our country? They fill the ERs and hospital beds and the hospitals and doctors don’t get paid a dime for their services! These charges are passed on to the rest of us! Or how about the millions upon millions of dollars doctors and hospitals have to pay for malpractice insurance. This is passed onto the patients as well. Health care reform cannot do anything unless these two problems are addressed. You cannot compare our two systems at all. They are vastly different!

Sallysue – The NHS treats any number of foreign nationals, illegal or otherwise, free of charge – because it’s *free at the point of use*, with no need to prove that you’re a British taxpayer or even resident.

In addition, the NHS is also hit by the occasional lawsuit, and so also has to fork out for insurance against such things, as well as payouts when it/its employees are found guilty of malpractice.

In other words, on those two fronts the systems aren’t so different after all – and yet the NHS is *still* cheaper.

Bob – I don’t think anyone here’s trying to argue that the NHS is the *best* healthcare system in the world, are they?

And I’m certainly not arguing that it’s the *most* efficient (in fact I’d say it’s anything but – hence my mention of “all its problems and wastage”).

The whole point is that, compared to the US healthcare system, the NHS would appear to be better and more efficient (covering a greater proportion of the population at a lower cost per head, resulting in a longer average life expectancy).

Compare the NHS to, I dunno, Finland or Japan or something and I have no idea how it would stack up – but those comparisons aren’t relevant in this instance. The Republicans are slating the NHS as significantly worse than the US healthcare system; this post is simply trying to see if this assertion is supported by any evidence. If a bunch of Japanese politicians start slagging off the NHS as well, I’ll do a similar post comparing those two systems – how’s that?

Just following up the “but the US pays for new drug development” point:

Total global pharma R&D spending was US$53bn for 2004 (it won’t have order-of-magnitude changed since then).

US healthcare spending was $2.4 trillion for 2007 (and likewise).

So even if you assume the US does literally pay *every penny* associated with global pharma R&D, that’s just 2% of total US healthcare spending.

Next spurious right-wing argument?

UK $3,200/capita & covers the entire population vs. US$3,700/capita & covers less than 1/3 of the population http://bit.ly/3RSZPN

UK $3,200/capita & covers the entire population vs. US$3,700/capita & covers less than 1/3 of the population http://bit.ly/3RSZPN

At this point, although the debate and spin continue, this bill is essentially dead from an emotional and mandate perspective, even if some version gets passed. Whether it ultimately proves to be of any benefit to society, or a detriment, will take years, if not decades, to appreciate.

This bill, and virtually anything that might be done to improve our healthcare system, involves too much complexity with which we are emotionally motivated to deal.

There’s been too much arguing about the details. People can not describe in 2 or 3 sentences the conceptual parameters of the effort and what it is supposed to accomplish. Unfortunately, people can describe how they feel about it in 1 or 2 words, and that’s not good.

If either side of the debate has to work this hard arguing about something which theoretically should improve the lives of the masses of people, there’s a big problem.

Even more so than how something is done, people are interested in results, not the details. And once again, as is frequently the case with much of human processing, the facts don’t really matter. How people view the world, what they value, and what they want, matters.

And there is nothing collaborative in nature about that. Factor in the strong individualistic American DNA, and this effort is emotionally toast.

Bob Briant @ 18

Lloyd George also implemented the National Insurance Act (1911), he was a Liberal. It was found to be unhelpful for most poorer families as it acted like private insurance, eg you were expected to pay for medical services and then claim back the cost on your insurance. The NHS Act addressed this problem with the ‘free at the point of delivery’ rule. BTW – the author of the welfare state, William Beveridge, was also a Liberal, too long to debate the politics here, but Churchill, a Conservative and also a free-marketeer, agreed its’ inception.

Errr. per capita health spending doesn’t equal efficiency. America spends $5,000 per head, the UK $3,000 per head. But what is each side getting for that money?

If I spent £100 and you spent £200 on similar product, have you necessarily been less efficient? Perhaps I’ve bought an awful product because it’s cheap and yours is the quality. Simply comparing how much is spent doesn’t make things more inefficient.

Again, in the 1998 Budget, Health spending was £34.7bn. This year it’s going to be near £100bn. Not even the Tories are saying that ALL of that extra money is wasted.

The point about nationalised healthcare in America is that it completely goes against their founding principles, namely that the large collection of power by the state is to be avoided. Ideally this should be something voted on by individual states. Such is the beauty of America that they can try 50 different system and see which works the best, while we’re still wedded to the idea that a service dreamt up 60 years ago is still suited to the modern world.

Don’t get me wrong, I believe in providing a level of service to the poorest in society but I also believe that holding a great proportion of the population in a health system that they could afford to leave if only we would let them is wrong. Perhaps people would choose the NHS given the choice – but the point that would drive efficiency is that people need to be given that choice.

Mark M: you don’t seem to have read the post.

DHG

Your modus operandi seems to be to confront anyone with whom you disagree- not with a counter argument but with calculated insolence.

This is becoming tedious.

Unless you have something constructive to add to the debate my suggestion would be to say nothing at all.

I’ve looked at this for two days and I don’t undersatnd your figures. Yet lots of clever people have read this post and haven’t picked it up, which makes me think I’ve got the wrong end of the stick, unless I’m the one-eyed man in the country of the blind. So what haven’t I understood ?

“Of the c.15% of GDP the US spends on healthcare annually (that’s about $2.2 trillion*), around 50% is spent by the government (around $1.1 trillion)…. US public healthcare currently covers about 83 million (around 28% of the US population) …in the US the federal government spends around $3,700 per capita and yet covers less than a third of the population.

Take away those 80 million covered by the US’s state healthcare (which doesn’t cover all uninsured Americans, so this is being generous) from the States’ 300 million population, we’re left with 220 million Americans to account for the other $1.1 trillion spent in the US each year on private healthcare…if I’ve got my maths right, that works out as $5000 for every American in the private system”

I see these calcs as saying :

1.1 trillion (US govt spend) divided by 83 million = $3,700
1.1 trillion (private spend) divided by 220 million = $5,000

whereas I was taught that if you divide by a larger number, the answer is smaller. I

What have I missed ? Or are you saying that the US govt spend is $3,700 per head of the entire US population – even though according to you “public healthcare currently covers about 83 million” ?

Surely if only 83 million people benefit from this 1.1 trillion spend, they’re getting about 13.2K of treatment each – at which point I wonder why anyone uses private healthcare when the state is so spectacularly generous !

Laban – I’m so shit at maths I re-checked this several times – and so I can understand your confusion (it did my head in no end).

The $3,700 figure is if you divide the *total* spending on US healthcare by 83 million (to get the cost per head of those whose healthcare comes from the government) – so $2.2 trillion divided by 83 million, not $1.1 million.

As noted down the bottom, the cost per capita for those whose healthcare comes from the state if you do it just by the amount the state spends ($1.1 trillion divided by 83 million) is around $13,250. So the point remains – overall American expenditure on health is more expensive than in the UK; both the US public and private healthcare systems are, on a simple cost basis, less efficient than in the UK.

‘As the US system allows you more choice’

That argument really doesn’t make any sense when you poke at it. The only additional choice people have in the US is to pay for less health care. (Not quite zero – there is always the minimal (but expensive to the taxpayer) care you get from turning up at A&E and coughing over the nurses).

In the UK, government stormtroopers really won’t come and knock down your door if you sign up for BUPA. But not many (8%) do, and even few of those sign up for a plan that is justifiably called ‘more healthcare’ rather than ‘nicer rooms’.

You could, I suppose, argue in principle that that extra choice is a good thing, and there probably are a few people who genuinely would voluntarily make that choice. But that’s not the argument you are making.

The ‘revealed preference’ in the US is not for cheaper care, it’s for _more expensive_ care. That can’t be directly caused by the extra choice of paying for _less_ care, it has to be some other factor.

The simplest is that the uninsured and under-insured act as unpaid marketeers for the high-end care. Create a worry that you will die in agony because you can’t afford a doctor, or that the 400 dollar a month plan will lead to your children bankrupting themselves to pay for the exclusions, and you can sell more 800 dollar a month plans.

If every cheap car had a good chance of exploding Hollywood-style if it got into the smallest of bumps, you would sell a lot of high-end cars.

‘Chicago-style economics’ is not supposed to mean making the claim that small businessmen have a ‘revealed preference’ for handing over 10% of their takings to Al Capone.

@53:

I say that Pagar because clearly the person in question hadn’t, the efficency they were banging on about had already been proven, in that post and in previous comment threads regarding comparitive outcomes and accepted measures of healthcare.

Chill your boots.

Been looking aroud the back of the statistics (for another piece elsewhere) and I’ve found that the US is, according to WHO, number 1 for “responsiveness”.

http://www.photius.com/rankings/world_health_systems.html

As I said above “What the US system, whether Medicare or private insurance really provides though is no waiting. Or at least, compared to the NHS it does.”

I’m sticking with my thought that this is what makes it all so expensive.

That’s about the only thing that it is number one at.

And was it you or Nick that didn’t like using WHO stats? Must have been Nick?

I don’t like the WHO stats although I’ve not said so here I don’t think.

No, it must have been Nick then.

@51

“Don’t get me wrong, I believe in providing a level of service to the poorest in society but I also believe that holding a great proportion of the population in a health system that they could afford to leave if only we would let them is wrong. Perhaps people would choose the NHS given the choice – but the point that would drive efficiency is that people need to be given that choice.”

Ok, but ………. leaving aside the definition of what actually constitutes “efficiency”, for this argument to be valid it would require all “consumers” of healthcare to have complete (or at least adequate) information about alternative interventions and then to act rationally in deciding which intervention to choose. Rationality, at least in this context, means that they should act in such a way as to maximise the utility they derive from the intervention which is, in itself, a completely subjective notion but let’s assume that it means that they will choose the intervention which is most likely to lead to a positive outcome, eg recovery, faster recovery, greater life expectancy. There’s a big problem with both of these requirements:

a. Most people do not have the academic background, knowledge base or even time to make sense of the available data. To compound this problem, data can be presented in a number of ways and, in a market based system, this is likely to be in such a way as to show the intervention that a particular provider is promoting in the best possible light. Just look at the arguments in this thread for examples of looking at data in different ways in order to support different arguments.

b. Because of the difficulties many people will encounter in making sense of the available data, they will simply not be in a position to act in a truly rational manner – their decisions may appear rational based on a particular interpretation of the information they have but, if this interpretation is flawed (or, more likely, the information is presented in a partial or otherwise flawed manner) then their decision will not be trully rational.

Examples of large numbers of people making irrational choices about health, based on flawed presentation of information, abound – MMR, Homeopathy, Chiropractic etc. If you want an example of how information can be presented in such a way as to deliberately mislead people (for comic effect in this case) visit this site:

http://www.dhmo.org/

Sorry for the long rambling post and apologies if this has already been said (I didn’t read the whole thread). Basically, what I’m saying is that markets, choice etc are a great way of maximising things. The problem is that they don’t always (in my opinion, ever) maximise anything worth maximising. The NHS may be flawed but it delivers medical care to everyone, regardless of wealth, and that, for me, is the most important point.

@57

the efficency they were banging on about had already been proven

Mark started his post. per capita health spending doesn’t equal efficiency.

He was making a different argument. To respond to a five paragraph post by telling him he hadn’t read the original article is not, in my view terribly constructive.

Anyway I’m chilled now.

Good Pagar and as I’ve said, in virtually all measures of ‘bang for buck’ the NHS beats the US healthcare system.

Not that that matters really, as the US system is a bit of a bloody shambles.

I am a US citizen living in the UK with my British husband. I pay my taxes in both countries and have worked and accrued benefits in both countries. I have been on the waiting list for surgery since 2007 with the NHS. They will use any excuse not to put you on the the list for surgery. The paid is so bad I am going to the states.

I am booked in the states to see a Dr, 4 days later surgery is tentativley schedule becuase my NHS records have been sent to the states. After a short physio then fly home. The flight is going to cost more than the surgery.

I wish both countries would just think of the person, their health, get rid of those who abuse the system and help those in need.

That’s lovely Foppiano but one personal anecdote does not a health service make or is reflective of.

RT @libcon Liberal Conspiracy » UK v USA – the basic healthcare facts http://bit.ly/4B1c11

I’m an American. Many of us get scared when we see stats like this…

(my source is the BBC — http://news.bbc.co.uk/2/hi/health/7510121.stm )

article contains these stats (among others)…

The US had the highest five-year survival rates for breast cancer at 83.9%
and prostate cancer at 91.9%.

The UK had 69.7% survival for breast cancer,
and 51.1% for prostate cancer.

Question is — how do you explain the differences (quite significant differences)?
Can anyone here account for or explain those differences?

Oh, and as for the “But Obama is not wanting NHS style health care, only a gov’t OPTION,” please take a look at this video…

http://www.youtube.com/watch?v=p-bY92mcOdk

People over here are beginning to see the Emperor has no clothes.

One thought – no idea if this has any basis in reality or not, but seems plausible. Could the US have a lower cancer detection rate than the UK?

If cancer screenings cost you money (a mammogram appears to cost $50-150, a cervical cancer screening c.$330 – not sure about prostate cancer screening), you’re less likely to have them – especially if you’re on a low income.

That means that the US could be detecting fewer cancers (especially among the poor – which may explain the lower cancer survival rate among African Americans), but treating the ones they do find (among people who can afford the screenings and treatment) effectively.

As I say, just a thought. What’s more interesting is why the French and Japanese have got better survival rates, when they – like us Brits – have universal healthcare. (Then again, the figures for Britain in that report were apparently a good decade out of date.)

Huh?

The answer to how to have *higher* cancer survival rate, is to have *fewer* screening tests?!?

You lost me there.

Fairly obvious, surely? The survival rate may seem higher due to a bunch of people dying of cancer without seeking treatment. If there are 200 people with cancer, but only 100 people have that cancer identified and treated – yet all those survive – then it would go down on official records as a 100% success rate, when actually only 50% of those with cancer have been treated.

No idea, and I don’t really care, to be honest. Healthcare success rates are entirely subjective, and are always affected by far wider factors than just the type of healthcare system in use.

Tim Worstall @ 58:

As I said above “What the US system, whether Medicare or private insurance really provides though is no waiting. Or at least, compared to the NHS it does.”

Yeah, and don’t forget to include the 80 million uninsured. They don’t wait either. Quibble, eh?

80 million uninsured? In the US?

Even the most zealous proponents of gov’t health care don’t use THAT figure. The TOP figure used is 48 million. And many believe even that figure is deceptive (overstated) — here’s why… http://nrinstitute.org/mediamalpractice/?p=134

So, I’m not sure where you’re getting that 80 million figure.

As for the cancer survival rates — I’ve never heard that idea. Hmmm. Lower the stats by letting people die of cancer “off the books.” I’m pretty sure most doctors would tell you that notion is absurd. That’s like the old Henny Youngman joke… He’s a good doctor — if you can’t afford the surgery, he’ll just touch up the x-rays.

Are you saying the UK’s *lower* survival rates is actually a sign of superiority? Yeah — if only the UK could figure out how to let people die of cancer more “secretly,” their stats would improve. We’ve got to be more like the Americans in that respect! Try publishing that in a medical journal + see how far you get.

I’m saying that if you have to pay for it, or it might hit your insurance premiums, then you’re less likely to get yourself checked out – just as if you drive a car into a tree and dent it a bit, you’ll probably leave it as it is or try to fix it yourself, but if someone drives into you you’ll get it fixed properly because it’s their insurance paying for it, not yours.

Fewer people getting checked => fewer cancers found => statistics that don’t give an accurate picture of the number of cancers.

It’s not a political point – it’s a logical one.

So, if one DIES of prostate cancer, but was never TREATED for prostate cancer, one dosen’t get COUNTED as having had prostate cancer?

That’s how you are telling us America’s (much) *higher* survival rates are actually an indication *lower* survival rates. Black is white and white is black. I see.

I’m sure WHO and/or any other keeper of cancer survival stats would be fascinated by that analysis.

Also, where did you get your 80-million-uninsured idea?

Erm… You mentioned “five-year survival rates” – that would tend to imply that the cancer had been diagnosed *before death*, not afterwards, surely?

On the 80 million figure (actually rounded down from 82 million), I can’t recall precisely where that came from originally. This CNN report states 86.7 uninsured at some point in the last two years, however, while this MSNBC article states the figure to be 82 million.

You see – that’s the problem with the lack of universal healthcare coverage. You can’t even tell how many people are uninsured – let alone get accurate figures on how many have/die of cancer.

There are three aspects to the prostate cancer point:

1) uninsured men in the US are likely to never have their prostate cancer diagnosed, as they only get emergency healthcare. So that artificially improves the US survival picture.

2) insured older men in the US have regular prostate cancer screening. This means that prostate cancer is detected at a much earlier stage than in Europe, which artificially inflates 5-year survival rates: if John Bull and Sam Adams both develop a cancer that will kill them after seven years, and neither healthcare system does anything to save them, but John Bull’s cancer is detected after three years and Sam’s is picked up straight away, then even though they’ve had exactly the same experience Sam will show up as a five-year survivor and John will show up as a five-year fatality.

3) Finally, US early detection does allow life-saving and life-prolonging treatment to be administered.

The impacts of 1 and 2 are highly significant, but 3 does also exist. Against it, you’ve got the worry and suffering provided by diagnosis. Nearly all men who die of old age have prostate cancer at the time of their death, in most cases in the UK it’s undetected and never does them any harm. In the US, you’re subjecting someone near the end of their life *certainly* to all the worries of the Big C Word *and* often surgery or chemotherapy that reduces their quality of life, in exchange for a slightly improved statistical chance of beating one of the many things that will soon kill them.

“I’m saying that if you have to pay for it, or it might hit your insurance premiums, then you’re less likely to get yourself checked out”

Which leads us to one of the great paradoxes of heath care. Prevention usually is not cheaper than ignorance. For those who die young consume less health care overall.

A grisly way of looking at it, yes, but when people are claiming that US health care can be made cheaper be increasing the number being checked out so that disease can be prevented…..

Even the politicians who want to make the MOST out of the ‘problem,’ don’t dare use a figure as bogus as 82 million. The generally accepted figure is 48 million (google it). But, as I say, (even) that figure is a gross exaggeration due to factors listed in the article I showed.

A growing # of Americans are wondering why Obama wants to overhaul the entire system instead of just fixing what’s wrong with it. The answer many are coming up with is: Power Grab.

The polls are slipping on the whole issue because many are seeing that Obama is just-plain lying about what is in the bill(s) — and they can see that he wants to use this as a stepping stone to (eventually — sooner, not later) end up with the gov’t completely taking over ALL health care. The slippery slope we Americans commonly call, “boiling the frog.” See for yourself — http://www.youtube.com/watch?v=p-bY92mcOdk

(flat out lies such as (but not limited to) “you’ll be able to keep the health insurance you have now.” and “I welcome healthy debate on this issue” when everyone knows he wanted to RAM this through before the August recess, WITHOUT any debate on it at all.)

America was formed SPECIFICALLY to make sure gov’t stays SMALL. That is the very definition of America — literally + figuratively. When things start slipping towards the nanny state end of the spectrum, people wake up + start fighting it. Thank goodness.

Yes, TW, but US government spending on health care hasn’t stayed small, has it?

The US government spends more tax money per head than the UK does but it gets a lot less for it.

#47: “The whole point is that, compared to the US healthcare system, the NHS would appear to be better and more efficient (covering a greater proportion of the population at a lower cost per head, resulting in a longer average life expectancy).”

So what? For decades – to my personal knowledge – the Labour Party and its supporters have been trading on the (totally irrelevant, if true) claim that the NHS is a better deal than the American system of healthcare.

That claim has made us all complacent about the NHS – as it was probably intended to – when the NHS is sorely in need of reform to bring it up to the performance standards of healthcare systems in other west European countries, which is surely what matters more to NHS patients.

The distinctive characteristic of the NHS is that it combines a system of universal social insurance for healthcare costs with a verging-on state monopoly in the provision of centrally managed healthcare services. Other west European countries have avoided that combination and have focused instead on social insurance schemes without the state monopolies. On the evidence, that latter structure has yielded better healthcare performance according to independent assessments, the comparison which matters.

For illuminating comparisons of the relative performance of the NHS from a perspective of 2000 – the beginning of the big spending spluge on the NHS – try this:
http://www.economist.com/world/britain/displaystory.cfm?story_id=E1_PQTNND

We are surely entitled to ask whether the extra spending has rectified the NHS deficits in 5 year cancer survivial rates and the numbers of physicians per head of population. We might also research on the important question of why the NHS developed those performance deficits compared with healthcare systems in other large west European countries.

Bob B:

“So what?”

Well considering that is the point of this thread…just a thought.

88. Andrew Duffin

“the US free market system for healthcare provision is significantly less efficient than a “socialised” one”

Ahem.

Only if the outcomes are the same.

Which clearly they are not. I have experience of the US free market system (maybe you have too?) and believe me it is fantastically good. Expensive, as you’ve pointed out quite rightly, but there is no comparison in the quality and timeliness of the service you get. No comparison whatever.

Andrew – quick summary of the efficiency point:

USA => excellent health coverage *for those that can afford it* (at a very high cost per capita)

UK => adequate health coverage *for everyone* (at a much lower cost per capita, and with the option to pay more for better-quality private treatment for those that want it)

In my books, that still makes the UK far more efficient. See also the life expectancy and child mortality points above – the US healthcare system is one of the few in the developed world that the NHS can beat hands down in most areas. Cost and coverage, however, remain the most important indicators of its efficiency as far as I’m concerned.

In America — if/when we’re forced to choose — we tend to favor freedom over equality. Especially freedom from big gov’t. That’s the very spirit that made us kick you guys to the curb, way back when! And we swore, in writing, we’d never let gov’t get too big again. That’s why Oboama’s attempted policies are seen by many as being fundamentally un-American. As Regan said, gov’t is the problem, not the solution.

85
It’s a pity the same ideological expression was not given to the first Americans, I wonder what they would have done if they had been forced to choose.

Yes there are plenty of “flaws” in the system. Native Americans (“Indians”), slaves, etc. etc. We are not without our upheavals. But the current polls show Obama’s “Chicago Way” takeover is losing support (as The People wake up to it). More and more are seeing it as the power grab that it is. It’s becoming clear his MO is to create chaos + crisis, then ride in as the nanny state to “fix” the problem — the only “price” is the giving up of one’s soul/freedom.

The cure is the disease.

Just look at the biz’s + industries the gov’t has “bailed out” — and what happens to them afterwards (become gov’t controlled). If you read the health care bills proposed, you see the underlying effect (goal?) is to control the people — in an irreversible way. In America, that’s just not how we “roll.”

TW – I still don’t see why it’s so hard for you to understand how universal healthcare can *increase* the very right to choose that you profess to love so much.

In an insurance-based system those who can afford insurance may have the ability to opt out, for sure – but those who *can’t* afford insurance don’t have the ability to opt in.

In my books, that means *less* choice, not more.

As for the founding principles of the United States, how about “life, liberty and the pursuit of happiness”? The first of these is life, not liberty – for without life, how can you have liberty?

The details of Obama’s healthcare plans may well have their faults, but the basic version is that he’s trying to enable greater access to life-extending healthcare to his fellow Americans. That sounds entirely within the spirit of the founding fathers to me – your take on it, by comparison, is more reminiscent of the aristocratic/oligarchic world view that the American Revolutionaries rose to shake off.

Not so. The gov’t “option” is a trojan horse deliberatley designed to phase out all other “options.” Read the bill(s), and see the videos of Obama (+ his ilk) saying this is merely a STEPPING STONE to the “single payer” plan — aka NO choice at all. See the vids for yourself. I think I posted the links above. If not, let me know + I’ll post them again.

This is a thinly-veiled one-way (ratcheted) path to total gov’t control. The people are wise to the ruse, and that’s why the polls are showing dwindling support for it. “We’re from the gov’t — and we’re here to help you.” That’s an immediate red flag.

Nosemonkey, you’re being very patient with the TW idiot and doing a fine job refuting his or her nonsense, seriously, the extrem right have their idiots well trained to perpetuate these terrible myths that have no basis in reality.

They are fighting a fictional war.

HW – So you seriously reckon that Obama’s trying to turn America more communist than China?

Daniel – It’s a different political culture over there. The language is more extreme and the rhetoric tends to hyperbole, to be sure, but the basic worries usually tend to have some basis in reality. I still don’t know where, in this case, though – that’s what I’m trying to find out.

Nosey: American exceptionalism’s to blame, I reckon. American is the best country in the world, therefore if it tries to copy other countries’ health care systems, well, things will be worse than they are now, won’t they? Stands to reason.

I don’t think people are consciously thinking this way. But I do think it’s at work.

DHG — you say I’m an idiot.

1) Is that because I just-plain don’t know what’s good for me? In other words, I’m an idiot because I don’t want an eventual total gov’t takeover of health care (“universal health”)?

2) Or is it because I’m believing in some kind of myth(s) about the bills under consideration?

If it’s #1, then I’m in good company because the polls are slipping sharply re: Obama care. And, as you know, The People (supposedly) still run the country over here. The senators, etc. are public servants. he people decide what happens, even if they “just-plain don’t know what’s good for them.” Are you suggesting that’s a bad arrangement?

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/20/AR2009082004305.html

And today…
http://www.examiner.com/x-20271-Fresno-Political-Buzz-Examiner~y2009m8d27-New-poll-less-support-Obamas-healthcare-plan-now-than-Clintons-1994-plan

If it’s #2, please tell us what are the myths I am operating under? — specifically.

No matter what the debate over health care here, one thing is CERTAIN — almost NO ONE (***%-wise***) is in favor of “single payer” (NO options, all-gov’t run) Yet, that is exactly what Obama IS in favor of (as are many of his cohorts)… eventually.

Click here… http://www.youtube.com/watch?v=p-bY92mcOdk

He can’t pass the bill because if he makes it too gov’t heavy, moderate democrats won’t vote for it (because they will LOSE their jobs in 2010 if they vote for it — see all the Town Hall meetings w/angry voters!). If he makes the bill NOT gov’t heavy ENOUGH, the liberal loon wing of the democrats won’t vote for it because it doesn’t go far enough.

TW:

You’re an idiot because you’ve swallowed lies about the Obama healthcare plan.

Hope that’s clearer for you.

So-called death panels? A myth, right?…

Obama’s chief advisor on health care is Dr. Ezekiel Emanuel (brother of his chief of staff, Rahm). Here’s his philosophy on health care (+ how to control costs)…

an article in the radical publication “The Wall Street Journal” (yes, I realize it’s on the opinion page)…

http://online.wsj.com/article/SB10001424052970203706604574374463280098676.html

This is just one of the reasons Americans are speaking out (angrily) against Obama care.

Again, this is not how America “rolls” … even if it “should,” according to people who “know better” (like you?)

Again DHG… did you view the video clip? what lies am I believing about Obama care? — specifically.

TW:

Death panels operate now TW, although the name is crude and idiotic, the GIOP myth on what they will be under the Obama healthcare plan is just that. A myth.

The American people, or at least those that are falling for these lies, get the crappy healthcare they deserve, why anyone who any decency would oppose a plan that will help so many people is beyond me but that is America for you.

You’re falling for myths as well (ex: how many people the bill(s) will “help” — how many people are currently uninsured). People have read the bill(s). They are opposed to them. Obama has made his case several times. The people are still against it. The non-partisan CBO has said Obama’s figures are inaccurate. Obama’s figures about the CURRENT budget (WITHOUT healthcare) were seen to be off by 2-trillion $’s the other day. People know gov’t estimates about how much things will cost are always off by miles. They also know the new health care bill(s) will be paid for on the backs of seniors (50-billion in cuts to medicaid over 10 years), and these cuts are in spite of the raw number of seniors increasing greatly (baby boomers getting older).

Obama has had plenty of opportunity to set the record “straight” about what he wants to accomplish — and none of it sticks for many reasons — including the truth! It’s not selling ’cause people smell a rat. A rat that’s coming on the heels of an historic, gargantuan gov’t spending spree ($787 billion +++).

Also remember, he WANTED to pass all this WITHOUT ANY debate at all. Now we are seeing why!

Are YOU in favor of “single payer” (ALL gov’t controlled)?
If so, it is you who is the radical here (from the US people’s perspective) — no one (*%-wise*) wants THAT here — there’s no debate about that.

No, afraid not but keep destroying a perfectly good healthcare plan based on fiction, it makes you look great.

Myths? I asked 2 or 3 times for you to be specific — and every time, you wouldn’t (couldn’t?). You’re like Obama — he can’t be specific either. Hence the distrust + backlash.

Obama’s been more than specific, an 8 point plan, followed by by 8 point rebuttal of all the lies, followed by another 8 point plan about why the change is needed.

I could put them all up here as I have done in other US healthcare threads but no point, your views are based on facts, they are based on prejudice and lies.

Otherwise why else would you have a problem with a healthcare reform that helps more people than the current terrible system.

UK spends $3,200 per capita on HC & covers entire population. US spends $3,700 & covers <33% of the population. #hcr http://bit.ly/9JW7c


Reactions: Twitter, blogs
  1. J Clive Matthews

    I’ve done a NHS vs US cost/benefit analysis for LibCon: http://bit.ly/BPHdO #welovethenhs (I don’t, actually, but it’s better than many)

  2. Poorold America

    Americans – do you know just how ignorant you are about the NHS? http://bit.ly/16muK

  3. Poorold America

    Americans – do you know just how ignorant you are about the NHS? http://bit.ly/16muK #welovethenhs

  4. Ian Duncan

    RT @libcon: : UK v USA – the basic healthcare facts http://bit.ly/DXjXC [interesting analysis]

  5. Hermione Crease

    RT @silentypewriter: NHS vs US heathcare numbers laid bare – http://bit.ly/4g73nN – by @nosemonkey (via @libcon) #welovetheNHS

  6. Poorold America

    RT @silentypewriter: NHS vs US heathcare numbers laid bare – http://bit.ly/4g73nN – by @nosemonkey (via @libcon) #welovetheNHS

  7. Liberal Conspiracy

    ‘UK v USA – the basic healthcare facts’ – (by @nosekonkey ) showing how NHS is better and cheaper- http://bit.ly/15VfPZ #welovetheNHS

  8. valia lestou

    UK $3,200/capita & covers the entire population vs. US$3,700/capita & covers less than 1/3 of the population http://bit.ly/3RSZPN

  9. The NHS under attack | Nosemonkey’s EUtopia

    [...] So, over at Liberal Conspiracy, I’ve done a post in the only language right-wingers seem to understand: a US healthcare vs UK NHS cost/benefit analysis. [...]

  10. BMJ Group blogs: Journal of Medical Ethics blog » Blog Archive » Healthcare costs: NHS vs US.

    [...] Do these numbers, and what’s done with them, look plausible?  They do to me, but then I’m statistically hopeless.  Thoughts? [...]

  11. The NHS – as good as US heathcare but much much cheaper « Flip Chart Fairy Tales

    [...] My comments about bloggers not picking this up were, perhaps, a little unfair. Liberal Conspiracy’s Nosemonkey is on the case too. Possibly related posts: (automatically generated)Dress Code GuideIt’s [...]

  12. Jason Thomas

    RT @libcon Liberal Conspiracy » UK v USA – the basic healthcare facts http://bit.ly/4B1c11

  13. One for NHS Workers. - Page 3 - YD Scuba Diving Forums

    [...] [...]

  14. Hugh Jaz

    UK spends $3,200 per capita on HC & covers entire population. US spends $3,700 & covers <33% of the population. #hcr http://bit.ly/9JW7c

  15. Allan Siegel

    Health care debate redux; in case you missed this; the American taxpayer pays more for health care and gets less; http://bit.ly/7N4mIF

  16. Siobhán

    Useful dissection of UK vs. US healthcare spending. Rick's an idiot – NHS for the win! http://t.co/ATfgD3Xr @_Ms_R @dlknowles #santorum

  17. tweetreader

    @mrjamesob We spend less than the US per head. Why do we need a cheaper NHS?
    http://t.co/ECp6uWm5

  18. Sam Beavan

    US VS UK healthcare system http://t.co/KcrGuSdt #in

  19. paul ursell

    Interesting article comparing the NHS to the is healthcare systems. http://t.co/KIwwu3Tp

  20. Divney Mathers

    @theanthonydavis http://t.co/k1iNn1rw





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