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Comment by hvindin | Hacker News Reader

As an Australian I always struggle with the idea that healthcare would cost money above a couple of dollars for things that aren't essential.

But almost every American I've ever spoken to who hasn't experienced decent national healthcare seem to have a bizzare view that "if it's free then obviously it will be abused", not realising that it's just as open to abuse as a system where end customer are also involved because shockingly customers arent usually the ones committing the fraud.

It genuinely feels like theres a view that some people might not "deserve" healthcare, and the way we determine who "deserves" healthcare is not the very humane "well they need it, therefore they deserve it" but rather "capitalism. Definitely the answer."

Makes me a little sad, but I guess when you have nothing else to compare it to...

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There is a massive propaganda machine pushing against any sort of universal health care here. The idea that not everyone deserves care is definitely one of the angles they push. Another angle is that socialized medicine is garbage, a view which tends to confuse people who have lived with it.

Also Australian.

The concept of abuse seems hilarious. What abuse? That people might visit their local doctor more frequently? That's a good thing! Many ailments get more expensive to treat the longer they are left untreated.

Once you come to terms with the fact it's permanently cheap/free, the psychological incentive to be wasteful ("use it or lose it") disappears completely. By comparison the American capitalist health system continually reinforces the notion that healthcare has monetary value, which means failing to take advantage of it feels wasteful.

The concept of abuse seems hilarious. What abuse? That people might visit their local doctor more frequently? That's a good thing!

In the UK A&E is flooded with people with minor ailments that could have been treated at home with a first aid kit, or people who are just drunk. The system is definitely taken for granted. People even call ambulances for a ride to an appointment, not even an emergency.

Source: once spent 5 hours waiting to be seen in A&E, sitting on a plastic chair with a broken leg, while kids with grazed knees and people with minor colds were seen before me. If I needed the bathroom or a glass of water, I had to get up and hobble there on my broken leg. The NHS were great once I actually got seen, but they are swamped with idiots demanding unnecessary medical attention, because it's free.

Also UK. Some 'abuse' of A&E happens because people cannot alway get access to a local surgery as opposed to driving to a nearby hospital, especially at weekends.

This.

I had half of my face stop working and had recently moved (and not yet registered with a new GP.)

I went to my previous GP and they turned me away (no longer in the catchment area) so I eventually ended up in A&E.

It doesn't help that the local ones near me at the time seem to live in the past... No call queuing or online scheduling, have to call within a 1 hour slot for appointments (so that's an hour of busy tones, oh well let's try again tomorrow)

Why does the NHS have catchment areas? Surely you should be allowed to visit any GP anywhere. People do travel after all.

Surely you should be allowed to visit any GP anywhere

A GP practice is a private business, usually all the GPs are partners just as lawyers or accountants would be, and the staff such as receptionists are not NHS employees, they work for the practice. If they can't bill the NHS for their services because you're not on their books, they aren't interested. It is surprising perhaps, but many people in the UK are unaware of this, they think the GPs surgery is directly a branch of the main NHS, and get angry about "privatisation" without realising that GPs have always been private.

Right, but why are private practices artificially limited for whom they can bill the NHS? That seems like pointless, unnecessary bureaucracy that comes back to bite them with more A&E visits.

I'm guessing because each one is only set up to bill a particular NHS Trust? But you're right, it should be possible keyed just off an NI number or something.

There is a hospital in my town but it's A&E was closed in 2007 IIRC, so if you can't see a GP you can't even go there, you have to drive a couple of towns over.

> why are private practices artificially limited for whom they can bill the NHS?

I'm not sure they are. Here's the (admittedly complex) book: https://www.england.nhs.uk/publication/primary-medical-care-...

Note this is only for England. I have no idea about the rest of the UK.

If you're inside the catchment area it's very difficult for the GP to not register you. GPs are expected to provide service to almost anyone living in their region.

If you're outside the catchment area the GP can chose to offer full service; offer limited service; or offer no service.

The full service includes things like home visits, so it's not surprising that GPs seek to limit that to patients who live far away.

For people who are travelling there are temporary registrations, but also GP walk in centres and GP out-of-hours services.

I also recall that a lot of local clinics one would normally go to end up closing thanks to lower funding... so, let's fund more walk-in clinics around?

I once did an experiment: I tried to get an appointment at a local clinic.

(Note: This anecdote was ~15 years ago. Things seem better now.)

Having failed to get an appointment the normal way, because they didn't have any slots available, I decided to test a theory.

I woke before 8pm and continuously dialled during the time slot from 8am-9am when it was, theoretically, possible to book an appointment. I'd wait for the busy tone, then immediately hang up and dial again. For an hour.

I did not get past the busy tone for the first 2 weeks.

After 9am I'd get through, and they told me there we no bookings available and I would need to call back the next day, and they recommended I call between 8am-9am...

In the end I got an appointment but it took 2 weeks and literally hundreds of call attempts to get one.

Apparently this was because the clinics keep statistics on how long people have to wait between making an appointment and attending.

To keep this number down, they set a limit on how far an advance it's possible to book an appointment.

Unfortunately, it had the side effect of preventing people from making appointments when all slots within the limit were filled.

The _true_ waiting time was therefore grossly hidden from reported statistics. And for many, it was enough to make them give up trying to get an appointment at all, further distorting the reported figures.

It took quite a long time before government, which had set the reporting requirements, learned how they were having the opposite of the intended effect.

Sounds like NHS could open more local surgeries and save a lot of money. Or at the very least, add a wing to every A&E to allow stupid stuff to be handled by nurses and trainees.

In Australia, ambulance rides are not free unless you have a membership plan or private insurance.

It is absurd that the UK could not at minimum issue fines against abuse of ambulances. (Not to mention abuse of 999 calls!) The fact that this was an issue for more than five minutes is absurd and cannot be used as an indictment against public systems.

And even if the ambulance issue was unsolvable (ha!) it would still represent a fraction of a percentage of the waste occurring in the American system.

he fact that this was an issue for more than five minutes is absurd and cannot be used as an indictment against public systems.

We also have issues with prescription abuse, such as people getting prescriptions filled who no longer need them, and don't take them anyway. The NHS tried to fix this by printing the real cost of the drug on the label, so people would be aware of the waste. But they had to stop because it was making people who genuinely needed the drugs feel guilty about how much it was costing. No easy answers to this, but something will need to happen because as I say, it is simply taken for granted by so many people.

Unfortunately, the NHS is something of a "sacred cow", any criticism no matter how evidence based of it is seen as a heinous blasphemy. Which means its problems are always brushed under the carpet and will never be fixed. "The envy of the world", we're told, but I doubt the French or the Germans or the Canadians or the Japanese or any number of other nations are envious of it!

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