Demographics and shrinking labor forces alone will bring the system to its knees regardless of money. It's absolutely baffling in the face of this trend that preventative, systemic policies are practically never discussed and everything centers around individual care.
Countries like Singapore show how you can tackle this, strong interventions to prevent entire populations from being obese, a regulated medical sector to bring costs down and private savings funds to encourage personal responsibilty.
The UK does have a sugar tax that was implemented 5 years ago that seems to have some good effects
https://www.wcrf.org/looking-back-at-5-years-of-the-uk-soft-...
The problem is any regulation is an opportunity for those who don't like the government to attack the other side.
I’m surprised that countries with socialized health care doesn’t already enforce preventive care. Yes, it’s draconian but otherwise the entire system will fall apart faster. Maybe they will with the advent of CBDCs?
If you build more hospitals, you need more staff, if you need more staff, you need to make it more attractive, but even if you do you need several years before the first doctors/nurses from the wave with renewed interest in the position finishes university.
And that’s only if there is any political will to do so.
(It’s universal with 70% of costs paid by the government)
https://www.imf.org/en/Publications/fandd/issues/Series/Anal...
> And that’s only if there is any political will to do so.
More taxes can only do so much if that was what you were implying. Middle class families can barely support themselves now let alone subsidize the little income they have left. Case in point, in the US for a family to have the same economic power as families in the past; they must make $240,000 - $300,000 depending on the metro
"defunded"? Maybe if you're comparing post pandemic budgets to pandemic budgets, but spending is still way up compared to pre-pandemic levels.
If we adjust the data for age and demographic changes, then we can see spending was reduced between 2010 and 2021.
https://www.nuffieldtrust.org.uk/news-item/the-past-present-...
Blair’s Labour—for all their faults—at least stopped the bleeding, but there wasn’t enough political & popular support for significantly increased spending.
Then Cameron & his bs “austerity measures” cropped it
https://www.epbmacroresearch.com/blog/the-global-demographic...
This has major implications for many social safety net programs and entitlements ie there aren’t enough working adults paying into the system, which is also exacerbated by recent anti immigration movements which was a major cause for the UK leaving the EU.
This story is now common in many developed countries that offer socialized healthcare.
There's also the issue where people believe that everyone, regardless of age, should be treated to the maximum level possible (or what they can afford in the case of the US).
If you publicity suggested that someone who is 99 years old and in poor health shouldn't receive some treatment that costs a massive amount of money/resources you would be looked at in disgust. No politican would even dare. Combine that with the selfish nature of most people (of course to be fair the instinctual desire to avoid death) and an aging population (as you mentioned) and it seems like a few generations are going to be weighed down to extended the lives of the least productive members of society.
Assuming most disease based hospital stays (heart attacks strokes, cancers) are biased towards older folk it makes sense that resources to younger folk be prioritised.
It makes -sense-, but asking a decent human to turf an "old person" out of bed because a "young person" has arrived (with a survivable, but urgent condition) is tough.
In war triage is a thing. Save the ones who can be saved, more-or-less ignore the ones you can't. We cannot, and should not, expect civilian medical staff to triage ambulances, A&E, ward beds. But health services are being drowned in the meantime.
Why is it? It is because medical care is more "personalized" and less of a commodity? Because it's heavily controlled by government? Is it the liability (medical people can get sued for a lot more than a bad haircut)? Due to much higher expectations of what is acceptable medical care compared to, say, food?
It doesn't seem obvious to me why the economics of medical care should be so different than everything else we use and depend on.
The only countries which can totally avoid this problem, are those that are so small that the whole country is a single major urban area, and "remote rural areas" either don't exist at all, or are such a minuscule percentage of the population as to be a statistical rounding error – so basically city-states such as Singapore, Monaco or Vatican City
I ask from the perspective of an American, with access to great health care but it’s expensive. If we were going to reinvent health care here, who should we copy?
There are multiple unnecessary levels of bureaucracy being paid, leaving little room for people who do actual work. This also results in those people being stifled by busy work.
Source: Doctors I'm friends with, and personal experience (with family members dying or permanently and seriously damaged).
[1] https://www.doctr.ca/private-healthcare-in-canada/ [2] https://en.m.wikipedia.org/wiki/Private_healthcare_in_the_Un...
For comparison look at cosmetic surgery in the USA. It isn't covered by insurance so patients pay out of pocket. Only the affluent can afford it but the business is highly competitive and most procedures are available with little or no waiting and high quality.
Liability is only a minor factor. Some US states have severely limited non-economic damages in medical malpractice cases but that only brought costs down slightly.
Compared to other essential professions, doctors need 8 years of schooling and another 4 years for apprenticeship. As for nurses, they are both abused and underpaid. Maybe AI and subsidizing medical schooling can help? Raising the retirement age should also help. A large portion of the population does not pay into the healthcare system.
The full Social Security retirement age is already 67. There isn't much room to push it higher. By that age many workers, especially those who have done manual labor, are disabled to an extent. It's just not realistic to expect them to continue working.
> The analysis assessed how quickly patients can access health care in each of England’s 533 constituencies — the British term for electoral districts — and found that nearly every single area is failing to meet even half of eight key indicators tracked by the government, from hospital bed availability to ambulance waiting times. A fifth are meeting none.
Australia has pretty terrible health care in many of its rural areas, and Australia's governments (both state/territory and federal) are clearly guilty of major policy failures in rural/remote healthcare provision.
But even supposing they did a much better job, even supposing they did the best job humanly possible – you are still going to get higher mortality and morbidity somewhere like Ivanhoe [0] – a town of less than 300 people, 800 km by road west of Sydney – than in the Sydney metro area. It is just the inevitable tyranny of distance. Far Western NSW simply doesn't have the necessary population to sustain the most advanced health care facilities (tertiary/quaternary), and the inescapable physical delays in getting to them (even using air evacuation) is going to cause deaths and clinically inferior outcomes.
Now of course, England is geographically a much smaller country than Australia – England has over twice Australia's population in less than 2% of the area. However, even in England, I would be surprised if the impact of geography on mortality and morbidity completely disappeared – inevitably, even if the NHS were the best health system humanly possible (and it obviously isn't), someone who lives in central London is going to have faster access to the most advanced healthcare than someone who lives in Penzance, [1] – and there are going to be times when that difference makes a real impact to mortality and morbidity.
My spouse, who lives in the same house, but has a different employer, gets much quicker treatment from the same clinics.
There’s too many factors to go into but the most pressing issue is that there aren’t enough care home beds available to discharge elderly patients so there’s not enough beds available in hospitals. Ambulances often have to wait long times before they can unload a patient at the hospital which ties them up - at one point ambulances had to wait over an hour on one out of ten trips nationally (thats just the stat the NHS keeps, they often wait for much longer than an hour).
Combined with population growth significantly outpacing growth in NHS budget and staffing, it’s created a perfect storm of shite.
Beyond general disorganization the UK system shoots itself in the foot regularly. Care homes are bottlenecked by labor cost, so their solution was:
1. Raise the minimum wage, thus increasing care prices and ensuring more people can't afford to pay for it even though there's lots of available labor.
2. Fire huge numbers of carers because they didn't want to get vaccinated, even though the vaccines weren't reducing transmission and their elderly tenants were multiple-vaccinated anyway.
(2) was especially damaging because care homes were one of the few sectors that had vaccine mandates in the UK, so people have now learned that if they go to work at care homes then they will be forced to take experimental medical things even if they don't want to or if it doesn't seem to make sense. That's a big downside to a job that already had few upsides.
Here's the lowdown:
- If you can't afford it, the government pays for your insurance
- If you can, you pay for it (nearly everyone can)
- Prices are regulated by the government
- You can not be turned away, and can not be charged more than the regulated amount for your insurance, no matter what
That last one is the killer feature. You could have cancer, and the insurance company still has to take you, and for a monthly price not higher than the maximum the government's put in place.
The Netherlands had a free system like the NHS, but once the quality started going downhill, they looked at reality in the face and built a better system. The standard of healthcare here is amazing!
This isn't a popular narrative in the UK, because it shows how there are more choices than just "completely free" or "U.S.A. style dystopia", which is the argument used there to promote the idea that the NHS can work.
What I can recommend is a great book that compares all the systems, through the lens of an American with the same question you have, called The Healing of America by T.R. Reid. Highly recommended.
Price counts though right? If you can't afford healthcare in the US then for you it's the worst system
The UK had the lowest healthcare expenditure per capita relative to our comparator countries (UK, $3825 (£2972; €3392); study average, $5700), although this was roughly in line with the average healthcare expenditure of the OECD member states ($3854) and the EU member states
So the UK spends about the same as other EU and OECD countries. It only spends less compared to a set of hand-picked "comparator countries" which are: Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland, and the USA.
That's a remarkably cherry-picked list. If you average such a small list then the mean will be dominated by healthcare spending in the USA. To get better and less cherry-picked data you can turn to the ONS. See Figure 1 (2017) here:
https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
The UK is around the same level as Finland, New Zealand and other developed countries.
This chart really makes it obvious how they picked their "comparator countries": all the countries that spend the most on healthcare. That isn't surprising. It's hard to get a more biased source on British medical spending than the British Medical Journal. Of course academics specializing in healthcare will claim the UK doesn't spend enough on healthcare.
Source: work in practice management and billing software, and personal experience
In practice what happens is you go to your G.P. and literally say; "can you write a referral so I can go and see my private doctor", and they do so on the spot without batting an eyelid.
> on top of destroying people financially?
I'm not sure where that's coming from either? Mine was paid for, but it wasn't exactly extortionate. I could have afforded it myself at the time.
I don't understand why it's such an emotionally charged issue for some people. If it's a poor/class thing, does it help that I grew up in a piss poor council estate, and thank god I don't have to rely on the NHS ever again.
And don’t worry. Student physicians these days are working as a nurse before even the second year in many places. Of course, this is effectively used as a way to save money, not to have sufficient personnel, and that means these students are often standing there alone, not learning much, making mistakes.
The government’s idea seems to be to just allow more immigrant doctors… except immigrant doctors largely go to 2 countries, and even there it’s not enough. And, as per usual, policy fails, government doubles down on failed policy. Meanwhile, professors in medical faculties are keenly aware that they can’t let more people in and failing a student is more 72h shifts for everyone… so the quality of doctors, or at least the bottom level, is going downhill fast too.
The scary bit is that if the system fails beyond a certain point, it’ll require large investment for a decade before you even see the first improvements. And, of course, it will make a lot of victims. We don’t even really know how far that point is.
https://www.economist.com/img/b/400/436/90/media-assets/imag...
As you can see, it's below pandemic levels (as I previously said), but still way above pre-pandemic trends.
It's pretty blatant dishonesty to say that healthcare hasn't been defunded, and then only focus on NHS provision of healthcare while ignoring public health, social care, nursing care, etc.
Oh? Do what, fund the health system at almost record levels?
> It's pretty blatant dishonesty to say that healthcare hasn't been defunded, and then only focus on NHS provision of healthcare while ignoring public health, social care, nursing care, etc.
It would be if someone had done that. Incidentally, are you saying that NHS has not been defunded? You wouldn't be very popular with said ideologues either then.
Stopped the figurative bleeding and started the literal...
But by stopped the bleeding, do you mean kept at levels comparable to those set by the previous conservative government? I.e., agreeing with the level of funding set by the conservative government.
I find it weird how governments are given a pass in that way. Setting funding from X to Y is a horrific crime, but leaving it at Y when you have the power to change it to X is somehow okay.
Looks like there has been no slashing going on, even adjusted for inflation and demographics. And the conservative governments after 2010 kept funding at about the same levels as the Labour governments set it at. Fancy that.
I wonder what governments have had to show for this massive 2x increase in adjusted healthcare spending. Vast improvements to the system, surely.
For example no lockdowns, that sacrificed young people over old. I still have bad health from that. My daughter has developmental issues.
And overweight people should not have publicly founded insurance. We should respect their wish to die!
And no publicly founded health insurance for non-citizens. That even has strong political support!
"And overweight people should not have publicly founded insurance. We should respect their wish to die!"
Overweight people don't want to die. Obviously you know this but were trying to make some point, one I don't understand.
So no overweight people. Hmm. I'm not sure what the cut-off for overweight is...
I guess, if we're going to police lifestyles from a health point of view, we should exclude smokers, vapers and drinkers from the list as well? Apparently no amount if alcohol is good for you...so....?
While we're at it what about red meat consumption? Thats not great in excess.
Oh, and motor-bikes. There's no good reason for those, and they're like accident magnets.
I guess what I'm saying is that once you start down the path of determining non-qualifying behaviors, it's hard to stop. Surely all of us would be disqualified sooner or later.
I suggested selective care based on cost and quality of life. That's the logical way to do it even if you think it's immoral. You believe non-citizens shouldn't be helped? Why? "Because they don't contribute with taxes". There are many people who are citizens who don't contribute. Illegal aliens also provide a workforce for vital food production and other jobs that help the economy (regardless of if you think it's wrong).
You also had a issue with fat people because it's their fault. What about people who speed and crash? Skiers who fall, horse riders, any optional activity that carries risk falls into the same category.
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"For example no lockdowns, that sacrificed young people over old"
Young people were thankfully much more resilient to Covid but was this wasn't known initially when the strictest lockdowns were put in place. Health officials were being cautious. What were to happen if there were no lockdowns? Certainly more deaths of old people but also adults in their 40s, 50s, 60s to a lesser extent.
As for the mental toll on young children- the total lockdowns didn't last long, you could go out and meet in small groups even during the initial phase. Many people didn't even care or follow the advice after the first few weeks. However, kids were remote learning for much longer but if that causes development issues what about home schooling? What about kids in remote areas?
What is the specific situation and time frame that cause your child's development issues?
I'm admitting there was a not insignificant mental toll on children, as this study shows[1]. You need to weigh this against the alternative of less or even not having any lockdowns and lack of information when these decisions were made. This means that using data you have now about the affect on children and how Covid 19 affected different age groups as a criticism, which I don't think is valid
And again, most of the metrics here (bed availability, for example) should not be geographically bound at all.
Is that true though? A less densely populated area would have a lower baseline number of hospital beds, which I'd expect would make it more sensitive to unexpected volatility in demand. Major hospitals often have empty wards which are kept available as contingencies for unexpected events such as terrorist attacks or natural disasters – I've seen one in person before, all these beds and medical equipment with the lights turned off gives me goosebumps for some reason – less major hospitals are less likely to have such facilities – but obviously they give hospital management greater leeway (at least in theory) to manage unexpected bursts in demand. And of course, less densely populated areas are likely to have fewer major hospitals and a greater number of minor ones. Similarly, larger hospitals have larger staffs, so greater likelihood they can ask extra staff to come in to meet unexpected demand bursts.
So, in the abstract, I would not be surprised if less densely populated areas of England had worse bed availability than more densely populated areas. And indeed, the least dense area of England, the South West, scored the worst in hospital bed availability in their analysis–as I would have expected.
I think that is a flaw in the methodology of this article, they display no evidence of having considered factors like that, or having attempted to control for them.
This means you can run with fewer free beds than in a low population area.
For example, if you have 3.8 beds/1000 people, that's 4 beds in a town of 1000 people.
A single additional person is 25% of the beds in the small town. A car crash? You won't be able to fit them in.
In a city of 50,000 people, that's 190 beds, and random events fit in the slack much more easily.
Also, since the baseline is larger, it's easier to scale. The minimum addition in the small town is a whole bed, or a 25% increase in costs.
In the city, it's also 1 bed, but that's ~0.5%.
The demographic explanation simply does not hold water when routine healthcare is not available.
And dentistry is why people in England are scared of changing the model for NHS healthcare, because we see that dentistry is fucking awful for huge numbers of people.
The problem with the NHS is not the model, it's the funding.
In the US dental is considered a seperate insurance for most. So there's a separation for whatever reason meaning using it to disprove the demographic theory for "regular" healthcare might be valid
There are still big sources of error in these numbers. It's not obvious, but spending on IT systems and hospitals (capital investment) isn't included in these numbers, yet these have sucked up a lot of NHS spending over time especially in the form of large failed IT projects, and capital expenditure on hospital buildings has often been done "off the books" in the UK using PFI schemes.
Unfortunately the ideological basis of the NHS means that many people feel a nearly moral obligation to argue its failings are always about money, especially Brits who work in the healthcare world themselves. It's a risk free strategy. To criticize the way the NHS is actually structured or operates would come dangerously close to wrongthink.
We are also used to people who would rather we had a more US-like health system pretending that they care about it while actually trying to make it fail, effectively to privatise health care by the back door.
So it's a hard subject to debate rationally here for sure.
Japan put in place many strategic constraints on their system to achieve this result. Hard decisions most countries would revolt at, doctors unions would strict at, and westerns would call broken.
But at least the system does it's job and is not projected to collapse. You can win votes, or you can design a functional system. You cannot do both.
That’s why I questioned the idea that demographic issues are going to prevent the West from solving this problem. A little bit of political will and some signatures is all it takes.
See for example Japan having very few public trash cans but also very low amounts of litter, or even very low wage workers taking pride in their jobs, or Japan having both extremely low unemployment and also low/no wage inflation for very long periods of time. Japanese business culture is one of seeing a duty to the public/consumer in a way that most other capitalist countries do not. They have a cultural aversion to screwing people over and ripping them off, and in working very many extra unbilled hours because it’s expected of them - they’d never have the same healthcare failure modes as in other countries
Some time ago I read 2 different books on healthcare systems, both very detailed, the authors having compared in-depth the many styles of healthcare systems in existence in addition to having relocated for some time to some of the locations to get a personal look. And despite all the complexities involved in such comparisons, both came to the same very basic conclusion: Healthcare systems are a reflection of the mindset of the country's citizens; Americans won't get universal healthcare until the average American believes that other Americans deserve it.
The USA is weird in comparison: you get immediate healthcare even if you can’t afford it, with everyone else just paying for those who can’t or don’t want insurance. If Americans don’t want universal healthcare because they don’t think some Americans don’t deserve healthcare, they are doing that really wrong.
These examples heavily downplay the public health, safety, and behavior progress the West has made. In the US, litter, graffiti[1], and smoking were all greatly reduced over the past half century. The male smoking rate in America is half of the male smoking rate in Japan.
I think the idea that the Japanese form of capitalism is more benevolent than the rest is also a bit rosy-eyed. Statistics on hours worked aren’t great for Japan. It’s arguably not a good thing that low wage workers are prioritizing work. You say that there’s an aversion to screwing people over but in the same sentence you’re saying that low wage workers are being exploited and convinced to work unbilled hours.
[1] Jusr do an image search for “New York Subway 80s”
In case you're wondering why having to foot the bill for all those uninsured hospital visits doesn't make the "taking responsibility" thing super obvious, it's because most people aren't aware of how much they are paying for it. Like many things here, uncompensated medical care is ultimately paid out of a combination of many different local, state, and federal sources. While we are all paying for it somehow, it is not obvious to an individual how many of their dollars went to it. Therefore, while unfortunate, many believe that an increase in monthly healthcare premiums (they know exactly how many of their dollars go to that) means they will be paying more overall, not the same or less, because they are either unclear on how much of their money is going to the uncompensated costs now, or they don't trust that their tax bills will actually decrease.
We're once again at a place where most Americans believe healthcare coverage should be guaranteed, but are miles apart on who they trust to actually handle it. [1]
[1] https://news.gallup.com/poll/468401/majority-say-gov-ensure-...
Now add inflation, that it was underfunded in the first place, and that the charts used start right after a major recession & the beginning of Thatcher…
Not increasing funding to match inflation is defunding. If you disagree then you’ll be fine working for the sane salary you’d have had in the mid 90s, right?
No. You would not. So either you’re being deliberately obtuse or now you understand
Also, completely-free or U.S.A.-style-nightmare are not the only two options. There's a whole rainbow in between, those are extremes! I'm now in a country that's got the balance right; everyone has healthcare, and everyone who can afford it (most) pay affordable insurance for it. The standard of care is _amazing_!
I also really doubt there are many in government or politics who want a US style system. The US has a strange system replicated nowhere else (much like the UK). The way healthcare is tied to the employer there is a legacy of socialist economics during WW2. To try and stop inflation wage controls were implemented so companies started to compete via non-wage benefits, like bundled health insurance. Then for reasons I don't know it was made tax-exempt, so the tax system incentivized workers to demand healthcare through their employer instead of paying it themselves. And then legal changes and union campaigns cemented that system. Part of why US healthcare is so expensive is the sheer number of layers between the people who use it and the act of paying for it. It's very much an accident of history born in the war, and not a model to obviously replicate.
The UK system is likewise rather dysfunctional thanks to WW2. Years of wartime propaganda followed by a victory convinced Brits that the government must be very good at things, and of course this was an era in which socialist economics was taken seriously across society. So on victory the UK immediately voted in a Labor government that nationalized many industries including the entire healthcare system, with Bevan famously dividing and buying off doctors who realized it'd be a bad idea by "stuffing their mouths with gold". Governments have attempted to use the same strategy to solve its problems ever since, yet have never been able to predict or control costs in the way a business would need to. Even in its very first year, costs were double what was predicted. This is very far from the original belief that GDP improvements from the NHS would be so great it would effectively pay for itself.
> I also really doubt there are many in government or politics who want a US style system.
You might want to read "Britania Unchained" which very much says that they want to dismantle the NHS. There's a bunch of current Conservative politicians who want to effectively dismantle the NHS and implement a US style system. They're very clear about this.
The book doesn't say they want to replace the NHS with a US style system. Have you read it? I haven't but according to the Guardian - the least friendly and neutral reviewers imaginable - they argue for a French style system instead:
https://www.theguardian.com/politics/2012/aug/22/britannia-u...
Sometimes these are less fearsome than you might expect – Raab likes the French healthcare system; Truss admires the German economy – but often the foreign models cited are Asian
Observe: no mention of the USA. But it seems that the book must hardly mention health, given that healthcare isn't even mentioned on the Wikipedia summary of the book and the Guardian review mentions it only in passing.
The idea that the Tories hate the NHS for ideological reasons and want the US system is a common idea on the British left, but that's not what they really think. What they really think is that the NHS is a lost cause and a European health insurance model would work better. They also think a US style economy would be beneficial. Given that the US is now a lot richer than the UK and their economy is motoring ahead, it seems the book's prediction of a "slide into mediocrity" has come true. The ultimate determinant is wealth - given enough of a gap, a poor Britain will always have worse outcomes than a rich USA regardless of how healthcare costs are paid.
