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Petition the government no NHS negotiations

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servodude
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Re: Petition the government no NHS negotiations

#228820

Postby servodude » June 12th, 2019, 2:46 am

Slarti wrote:
servodude wrote:
Slarti wrote:
And the insurance adds another layer of cost and administration onto the healthcare system, reducing efficiency.

Slarti


This with bells on! The insurers are not there for the benefit of the patients.

Among other projects, I am involved in the design of CPAP machines (for the treatment of Sleep Apnoea).
The majority worldwide are bought through medical insurance. At face value this means a patient only "pays" half the listed price when they receive the machine; the listed price is above the private RRP.

The real stickler though is that once they commence treatment the "compliance" data belongs to the insurer.
This should be used by their doctor to tune their treatment. In effect though their recorded use, or not, of the machine is directly used to obviate the insurer from future claims.

Not very nice
- sd


Prices paid vary wildly.

A chap I know on twitter is a fellow CPAP machine user, but in the USA and he is not happy with the machine provided by his insurance and so looked at buying his own. Unfortunately the cost appeared to be over $1,000! I pointed out that here we can get perfectly good ones for less than half that, if not provided by the NHS and started a thread about how American medical insurance cause prices of meds and equipment to be artificially inflated.

Slarti


There are some aspects of medical insurance that do make sense, but the way these machines are used is nonsense.
It goes beyond well beyond reduced efficiency, in to a business plan of exploitation and invasion of privacy.

At the risk of going too far off topic though one man's perfectly good CPAP is another's hairdryer; everyone's prescription is different and CPAPs vary greatly in capability, smarts and performance. All of them do cost more in the US if you buy them through insurance though ;-)

Have fun (& sleep well)
- sd

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Re: Petition the government no NHS negotiations

#228874

Postby dspp » June 12th, 2019, 10:11 am

UncleIan wrote:
Lootman wrote:I have experienced healthcare in both the UK and the US. The US experience was much better.


I've got an anecdote and I'm gonna use it. ;)


I have a child who was born in the USA, on mostly-employer-funded-insurance, and in a very affluent up-market location. From a technical & comfort perspective the healthcare package was roughly comparable with the NHS.

What was different is that medical bills for the birth just kept on coming. Literally for about 3-4 years afterwards.

Fortunately we were able to absorb the co-pay element of them, and middle-class enough to play email ping pong and bounce the insured element of them back to the insurer. However these were not cheap and one could never be sure when the billing system would magic up another one from the depths. And then one had to understand them, check them against (many !) others that had already appeared and been paid / challenged, challenge them, pay them, etc. All in all this is a terrible experience which I would not wish on anyone. And in practice the fear of it is quite enough to keep the poor well away from the US healthcare system except in emergency situations, or for fixed fee situations.

So, whatever you do, don't pretend that all is sweetness and light in the USA medical system. It is legalised extortion imho. I'm not saying the NHS is perfect, but it can hold its head up high against the USA.

- dspp

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Re: Petition the government no NHS negotiations

#228962

Postby Lootman » June 12th, 2019, 3:35 pm

dspp wrote:don't pretend that all is sweetness and light in the USA medical system. It is legalised extortion imho. I'm not saying the NHS is perfect, but it can hold its head up high against the USA.

I don't pretend that. The US system is inferior if you are poor and/or don't have insurance. My point is more that IF you have insurance and/or can afford it, THEN it is superior.

How much an individual with employer insurance has to co-pay varies depending on the insurance. They do vary from employer to employer as they are negotiated individually. There is no set standard. So if you have a policy with holes in it then you can be out of pocket by a fair bit. Other policies are excellent and the co-pays are modest and manageable.

So where the US system is better it is precisely because it is more expensive. You can get the very best that is possible, which is why UK patients sometimes go to the US for treatments that the NHS won't do.

My comment was about excellence rather than whether it is better for everyone. And I am arguing for some level of co-pay in the UK to enable the NHS to be more financially sustainable, along with a bigger, better private sector to relieve the load on the NHS.

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Re: Petition the government no NHS negotiations

#228969

Postby paullidd » June 12th, 2019, 3:48 pm

Lootman wrote:
dspp wrote:don't pretend that all is sweetness and light in the USA medical system. It is legalised extortion imho. I'm not saying the NHS is perfect, but it can hold its head up high against the USA.

I don't pretend that. The US system is inferior if you are poor and/or don't have insurance. My point is more that IF you have insurance and/or can afford it, THEN it is superior.

How much an individual with employer insurance has to co-pay varies depending on the insurance. They do vary from employer to employer as they are negotiated individually. There is no set standard. So if you have a policy with holes in it then you can be out of pocket by a fair bit. Other policies are excellent and the co-pays are modest and manageable.

So where the US system is better it is precisely because it is more expensive. You can get the very best that is possible, which is why UK patients sometimes go to the US for treatments that the NHS won't do.

My comment was about excellence rather than whether it is better for everyone. And I am arguing for some level of co-pay in the UK to enable the NHS to be more financially sustainable, along with a bigger, better private sector to relieve the load on the NHS.


I can pick up a second hand violin for £20 but it's not going to sound very good, I can pick up a stradivarius for up to £27,000,000 - so yes if you have lots of money you can afford the best of anything - I could have a string of highly acclaimed specialist doctors following me around day and night to keep me at optimum health with a mobile surgery - I just can't afford it.

just googled this for 'fun'.

"A new study from academic researchers found that 66.5 percent of all bankruptcies were tied to medical issues —either because of high costs for care or time out of work. An estimated 530,000 families turn to bankruptcy each year because of medical issues and bills, the research found.11 Feb 2019"

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Re: Petition the government no NHS negotiations

#229044

Postby Lootman » June 12th, 2019, 9:14 pm

paullidd wrote:
Lootman wrote:
dspp wrote:don't pretend that all is sweetness and light in the USA medical system. It is legalised extortion imho. I'm not saying the NHS is perfect, but it can hold its head up high against the USA.

I don't pretend that. The US system is inferior if you are poor and/or don't have insurance. My point is more that IF you have insurance and/or can afford it, THEN it is superior.

How much an individual with employer insurance has to co-pay varies depending on the insurance. They do vary from employer to employer as they are negotiated individually. There is no set standard. So if you have a policy with holes in it then you can be out of pocket by a fair bit. Other policies are excellent and the co-pays are modest and manageable.

So where the US system is better it is precisely because it is more expensive. You can get the very best that is possible, which is why UK patients sometimes go to the US for treatments that the NHS won't do.

My comment was about excellence rather than whether it is better for everyone. And I am arguing for some level of co-pay in the UK to enable the NHS to be more financially sustainable, along with a bigger, better private sector to relieve the load on the NHS.

I can pick up a second hand violin for £20 but it's not going to sound very good, I can pick up a stradivarius for up to £27,000,000 - so yes if you have lots of money you can afford the best of anything - I could have a string of highly acclaimed specialist doctors following me around day and night to keep me at optimum health with a mobile surgery - I just can't afford it.

just googled this for 'fun'.

"A new study from academic researchers found that 66.5 percent of all bankruptcies were tied to medical issues —either because of high costs for care or time out of work. An estimated 530,000 families turn to bankruptcy each year because of medical issues and bills, the research found.11 Feb 2019"

I think we are arguing at cross purposes. I never said the US system is better if you cannot afford it. But given that our audience here is fairly affluent older men, I was talking about their outcomes rather than the indigent.

Moderator Message:
RS: The comment about our audience here is conjecture rather than fact and we have no reason to limit our appeal to the widest of audiences irrespective of gender or financial means


The NHS does better for poor people but not for the non-poor. The NHS is a virtual monopoly and I'd prefer more choice and competition. I also think we cannot ultimately afford the NHS as originally conceived, and therefore it needs to change.

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Re: Petition the government no NHS negotiations

#229051

Postby dspp » June 12th, 2019, 9:47 pm

I perfectly accept that there are issue with the NHS, including capture by some special interest groups. These are most notably the medical unions - both doctors & nurses - and they do it by a process of regulatory capture, media capture, and political capture.

However what I cannot see is how to expose health care in the UK, the majority of which is NHS-funded, to a beneficial mixed market in a way that is both likely to have positive effects, and to be politically acceptable over sufficient time period as to deliver those outcomes.

It may be that we have to settle for the NHS being one player in the mixed market that is the greater global system, i.e. we should examine the problem about how to deliver cheaper/better/faster/lighter healthcare at a global level. The NHS certainly benefits from the rest of the world so maybe a UK-specific view is too narrow.

Simply kicking the NHS is unlikely to get good responses.

regards, dspp

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Re: Petition the government no NHS negotiations

#229071

Postby servodude » June 12th, 2019, 11:02 pm

Back in my day fairly affluent older men would have decried the blatant waste of resources, funds and effort caused by US medical insurance. They did not get to be fairly affluent older men by putting up with that sort of nonsense.
They don't make them they used to.

sd

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Re: Petition the government no NHS negotiations

#229076

Postby Lootman » June 12th, 2019, 11:15 pm

dspp wrote:I perfectly accept that there are issue with the NHS, including capture by some special interest groups. These are most notably the medical unions - both doctors & nurses - and they do it by a process of regulatory capture, media capture, and political capture.

However what I cannot see is how to expose health care in the UK, the majority of which is NHS-funded, to a beneficial mixed market in a way that is both likely to have positive effects, and to be politically acceptable over sufficient time period as to deliver those outcomes.

As best I know, the rest of Europe offers more of a mixed private/public model. Only the UK went as far as having only a public model where everyone involved in delivering healthcare is a government employee.

A more balanced mix with genuine competition would be more sustainable.

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Re: Petition the government no NHS negotiations

#229097

Postby paullidd » June 13th, 2019, 7:09 am

Lootman wrote:
paullidd wrote:
Lootman wrote:I don't pretend that. The US system is inferior if you are poor and/or don't have insurance. My point is more that IF you have insurance and/or can afford it, THEN it is superior.

How much an individual with employer insurance has to co-pay varies depending on the insurance. They do vary from employer to employer as they are negotiated individually. There is no set standard. So if you have a policy with holes in it then you can be out of pocket by a fair bit. Other policies are excellent and the co-pays are modest and manageable.

So where the US system is better it is precisely because it is more expensive. You can get the very best that is possible, which is why UK patients sometimes go to the US for treatments that the NHS won't do.

My comment was about excellence rather than whether it is better for everyone. And I am arguing for some level of co-pay in the UK to enable the NHS to be more financially sustainable, along with a bigger, better private sector to relieve the load on the NHS.

I can pick up a second hand violin for £20 but it's not going to sound very good, I can pick up a stradivarius for up to £27,000,000 - so yes if you have lots of money you can afford the best of anything - I could have a string of highly acclaimed specialist doctors following me around day and night to keep me at optimum health with a mobile surgery - I just can't afford it.

just googled this for 'fun'.

"A new study from academic researchers found that 66.5 percent of all bankruptcies were tied to medical issues —either because of high costs for care or time out of work. An estimated 530,000 families turn to bankruptcy each year because of medical issues and bills, the research found.11 Feb 2019"

I think we are arguing at cross purposes. I never said the US system is better if you cannot afford it. But given that our audience here is fairly affluent older men, I was talking about their outcomes rather than the indigent.

The NHS does better for poor people but not for the non-poor. The NHS is a virtual monopoly and I'd prefer more choice and competition. I also think we cannot ultimately afford the NHS as originally conceived, and therefore it needs to change.


So let's see if I can get this straight - The NHS is a virtual monopoly; the cost of medical care is cheaper in the UK than the US, but it's not better for rich people who can afford to go private anyway. So do away with the virtual monopoly, increase the price make it less efficient, let the poorest die or become bankrupt, pay a whole load of insurance companies for medical care, but make it a nicer experience for the rich who can afford private care.

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Re: Petition the government no NHS negotiations

#229100

Postby redsturgeon » June 13th, 2019, 7:15 am

Last time I looked there was no prohibition in the UK against health insurance or private healthcare.

My family are relatively healthy and practise lifestyle choices to keep that way. We therefore do not feel the need to spend on health insurance. However we are quite happy to pay privately for things if we feel there is a benefit. For potentially life threatening or emergency situations it is very useful to know that the NHS will provide without the danger of bankruptcy .

On most measurements of healthcare provision for its people the UK ranks higher than the US.

Here for instance UK 19th, USA 37th

https://www.who.int/healthinfo/paper30.pdf

or here

https://www.businessinsider.com/the-hea ... rapidly-16

In fact I can't find any survey which backs up your assertion of the US as having the best healthcare. Can you provide a link please.

John

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Re: Petition the government no NHS negotiations

#229186

Postby sunnyjoe » June 13th, 2019, 12:26 pm

Lootman wrote:
paullidd wrote:
Lootman wrote:I don't pretend that. The US system is inferior if you are poor and/or don't have insurance. My point is more that IF you have insurance and/or can afford it, THEN it is superior.

How much an individual with employer insurance has to co-pay varies depending on the insurance. They do vary from employer to employer as they are negotiated individually. There is no set standard. So if you have a policy with holes in it then you can be out of pocket by a fair bit. Other policies are excellent and the co-pays are modest and manageable.

So where the US system is better it is precisely because it is more expensive. You can get the very best that is possible, which is why UK patients sometimes go to the US for treatments that the NHS won't do.

My comment was about excellence rather than whether it is better for everyone. And I am arguing for some level of co-pay in the UK to enable the NHS to be more financially sustainable, along with a bigger, better private sector to relieve the load on the NHS.

I can pick up a second hand violin for £20 but it's not going to sound very good, I can pick up a stradivarius for up to £27,000,000 - so yes if you have lots of money you can afford the best of anything - I could have a string of highly acclaimed specialist doctors following me around day and night to keep me at optimum health with a mobile surgery - I just can't afford it.

just googled this for 'fun'.

"A new study from academic researchers found that 66.5 percent of all bankruptcies were tied to medical issues —either because of high costs for care or time out of work. An estimated 530,000 families turn to bankruptcy each year because of medical issues and bills, the research found.11 Feb 2019"

I think we are arguing at cross purposes. I never said the US system is better if you cannot afford it. But given that our audience here is fairly affluent older men, I was talking about their outcomes rather than the indigent.

The NHS does better for poor people but not for the non-poor. The NHS is a virtual monopoly and I'd prefer more choice and competition. I also think we cannot ultimately afford the NHS as originally conceived, and therefore it needs to change.


As a fairly affluent older man resident in UK, I do pay for private health insurance so that if the need arises I can avoid the unfortunate NHS queue. I would much rather that the NHS was better funded so that the queues were minimised.

It should be noted that private healthcare in GB is only good for a limited range of conditions / procedures and if they cock it up they ship you out for emergency care in the NHS toot sweet.

On Tuesday night the excellent BBC future dystopian drama "Years and Years" showed someone getting their cataracts done immediately by paying for NHS+ <shudders>

Throwing in my own anecdote, this year I witnessed NHS end of life care for two dear relatives and I was highly impressed with the standard of care, the compassion of the staff and the dignity that this afforded.

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Re: Petition the government no NHS negotiations

#229213

Postby Lootman » June 13th, 2019, 1:50 pm

sunnyjoe wrote:It should be noted that private healthcare in GB is only good for a limited range of conditions / procedures and if they cock it up they ship you out for emergency care in the NHS toot sweet.

On Tuesday night the excellent BBC future dystopian drama "Years and Years" showed someone getting their cataracts done immediately by paying for NHS+ <shudders>

Yes, that is the problem, private care at the moment is limited in the UK. We really do not have two parallel systems at all, because the NHS consumes all the resources. Private hospitals are few and far between, for instance.

I see no problem with paying more for a better service. Why do you?

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Re: Petition the government no NHS negotiations

#229262

Postby paullidd » June 13th, 2019, 3:31 pm

Lootman wrote:
sunnyjoe wrote:It should be noted that private healthcare in GB is only good for a limited range of conditions / procedures and if they cock it up they ship you out for emergency care in the NHS toot sweet.

On Tuesday night the excellent BBC future dystopian drama "Years and Years" showed someone getting their cataracts done immediately by paying for NHS+ <shudders>

Yes, that is the problem, private care at the moment is limited in the UK. We really do not have two parallel systems at all, because the NHS consumes all the resources. Private hospitals are few and far between, for instance.

I see no problem with paying more for a better service. Why do you?


Then presumably the private medical companies should build some private hospitals or do you suggest they asset strip the NHS to provide their overpriced offerings?

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Re: Petition the government no NHS negotiations

#229288

Postby Lootman » June 13th, 2019, 4:51 pm

paullidd wrote:
Lootman wrote:
sunnyjoe wrote:It should be noted that private healthcare in GB is only good for a limited range of conditions / procedures and if they cock it up they ship you out for emergency care in the NHS toot sweet.

On Tuesday night the excellent BBC future dystopian drama "Years and Years" showed someone getting their cataracts done immediately by paying for NHS+ <shudders>

Yes, that is the problem, private care at the moment is limited in the UK. We really do not have two parallel systems at all, because the NHS consumes all the resources. Private hospitals are few and far between, for instance.

I see no problem with paying more for a better service. Why do you?

Then presumably the private medical companies should build some private hospitals or do you suggest they asset strip the NHS to provide their overpriced offerings?

If it was economic to do so then they would. But outside of some locations and specialties it is not, because they would be competing with the NHS which effectively offers its services for free. There is not a level playing field.

How we get from here to there is a reasonable question. But most other European countries have a more balanced mix of public and private, and make greater use of insurance to ensure funding. Just because we want too offer free healthcare to certain demographics does not imply that everyone who works in healthcre has to be a government employee.

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Re: Petition the government no NHS negotiations

#229386

Postby servodude » June 14th, 2019, 1:32 am

Lootman wrote:How we get from here to there is a reasonable question. But most other European countries have a more balanced mix of public and private, and make greater use of insurance to ensure funding. Just because we want too offer free healthcare to certain demographics does not imply that everyone who works in healthcre has to be a government employee.


what would you consider a "balanced mix of public / private"?
- at present there are 4million private policies in the UK (https://www.laingbuisson.com/wp-content ... _FLYER.pdf)
- 19% of the population in spain have one (https://www.expatica.com/es/healthcare/ ... em-101467/)
- 10% in sweden (https://transferwise.com/au/blog/health ... nce-sweden)

is there a difference between manditory public health insurance and paying extra tax?

if you really want to get USA style treatment their hospitals are open to taking in any patient who can pay; there is nothing stopping anyone from travelling
- it certainly does not mean their system offers greater value, or is more efficient, or is "better"
- just have a look at last year's bloomberg review: https://www.bloomberg.com/news/articles ... ore-at-top

"want to offer free healthcare to certain demographics":
In the UK healthcare, paid from general taxation, is offered to everyone regardless of demographic
- that might mean that fairly affluent older men have to mix with the hoi polloi but that surely can't be a problem?
- and if you want exclusivity Harley St is still there

there's plenty that can be improved with the NHS
- but as a system it trounces that of the US by most measures

- sd

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Re: Petition the government no NHS negotiations

#229404

Postby UncleEbenezer » June 14th, 2019, 8:57 am

servodude wrote:is there a difference between manditory public health insurance and paying extra tax?
- sd

I would say, yes.

If you've paid an insurer, they are then under an obligation to you (enforceable by fierce lawyers) in your hour of need. Whereas under the UK system, it's the NHS lottery, and there's commonly no comeback for those whose needs are simply not met.

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Re: Petition the government no NHS negotiations

#229417

Postby vrdiver » June 14th, 2019, 9:55 am

gal
UncleEbenezer wrote:If you've paid an insurer, they are then under an obligation to you (enforceable by fierce lawyers) in your hour of need. Whereas under the UK system, it's the NHS lottery, and there's commonly no comeback for those whose needs are simply not met.

However, an insurance contract can be very specific on what is and is not included. A tax contribution to the NHS is flexible to meet changing needs.

The other advantage of taxation is that the layer of insurers is removed, allowing more of the original money to arrive intact at its planned destination.

VRD

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Re: Petition the government no NHS negotiations

#229458

Postby bionichamster » June 14th, 2019, 12:03 pm

UncleEbenezer wrote:
servodude wrote:is there a difference between manditory public health insurance and paying extra tax?
- sd

I would say, yes.

If you've paid an insurer, they are then under an obligation to you (enforceable by fierce lawyers) in your hour of need. Whereas under the UK system, it's the NHS lottery, and there's commonly no comeback for those whose needs are simply not met.



Just what one needs in one's "hour of need", lots of dealings with lawyers and some long drawn out proceedings while said insurer stalls and waits for you to die.....


BH

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Re: Petition the government no NHS negotiations

#229476

Postby UncleEbenezer » June 14th, 2019, 1:28 pm

bionichamster wrote:
UncleEbenezer wrote:
servodude wrote:is there a difference between manditory public health insurance and paying extra tax?
- sd

I would say, yes.

If you've paid an insurer, they are then under an obligation to you (enforceable by fierce lawyers) in your hour of need. Whereas under the UK system, it's the NHS lottery, and there's commonly no comeback for those whose needs are simply not met.



Just what one needs in one's "hour of need", lots of dealings with lawyers and some long drawn out proceedings while said insurer stalls and waits for you to die.....
BH

Most victims will suffer in silence. How does the insurer know in advance who has the tenacious relatives or other support group who won't let it go?

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Re: Petition the government no NHS negotiations

#229487

Postby Lootman » June 14th, 2019, 2:12 pm

servodude wrote:In the UK healthcare, paid from general taxation, is offered to everyone regardless of demographic
- that might mean that fairly affluent older men have to mix with the hoi polloi but that surely can't be a problem?

Correct, that is not the problem, although going to a private clinic is generally more pleasant than going to a NHS clinic.

The problem is more to do with the financial sustainability of the NHS model. And the fact that millions of people could afford to pay but instead get healthcare "free" means that there is a lost opportunity to put the NHS on a firmer financial footing.

I never argued to do away with the NHS. Only that the private sector should be encouraged to become a fully-fleged competitor rather then a niche provider, and therefore relieve the burden on the NHS.


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