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Comment by philjohn | Hacker News Reader

So - in the UK you pay national insurance, which ostensibly pays for the NHS and retirement benefits.

If you earn £150k a year (top 2% of salaries in the UK) you pay £6,964.16 a year. That's an astounding deal. There are no deductibles, no co pays for hospital stays, GP visits are free, as are any tests and investigations.

You do pay £9 for each item on a prescription, but if you get more than 3 items a month you can pay a flat rate of £104 a year for a prepayment certificate.

Private health insurance is still a thing - it just gets you a nicer room in a private hospital and quicker treatment for non life-threatening conditions.

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You pay around 40% effective tax rate at £150k. It doesn't really matter exactly where the money goes, at the end of the day the budget has to made by the chancellor and they'll funnel money from NI to other areas and vice versa if they need to.

Still a good deal though.

Except for the fact that the NHS is utter garbage and anyone here making 150k is on private health insurance.

Except that's not the case at all.

The NHS is underfunded, sure, but in an emergency situation (you know, the kind that will bankrupt you in the US) you won't get treated privately, it will be done on the NHS. Sure, if you have cancer your Chemo will be given in nicer surroundings, but it's the same drugs administered under the same protocol.

All private insurance in the UK gives you is that - a nicer environment and quicker access to treatment for non life-threatening conditions.

Yes, emergency treatment is on the NHS but so what? That doesn't mean it's good! Emergency care is better in the US( even if it later bankrupts you). You can routinely wait for 6-12 hours in an emergency room in the UK (admittedly not for truly life-threatening situations). By most metrics, healthcare outcomes in the US are much better than in the NHS, quick google found this: https://qz.com/397419/the-british-seem-less-likely-to-get-ca...

"All private insurance in the UK gives you is that - a nicer environment and quicker access to treatment for non life-threatening conditions."

I don't think you would consider this a small thing if you were one of the 500k people waiting > 6 months for basic treatment on the nhs: https://www.telegraph.co.uk/news/2018/08/11/numbers-going-pr...

Citation needed.

I dont think that the NHS is utter garbage - sure there is room for improvement, but it seems that it is not "garbage" at all according to recent research: https://www.kingsfund.org.uk/sites/default/files/2018-06/NHS...

That report has some very interesting charts. E.g. Figure 9 shows that almost 25% of people in USA skipped going to the doctors due to cost, or almost 20% of people in USA skipped prescription medicine due to cost. For comparison on the NHS it was 5% and 2% respectively. Mind-boggling.

I'd agree though that anyone on 150K plus (and probably anyone in a job from the 40K range upward (if not lower)) would have private medical cover. As others have noted, private cover basically just means you get seen quicker/at a more convienient time and the waiting room is nicer - the care is no better or worse than the NHS IME (although I dont have any data on that - just a personal anecdote)

A good citation can be found in the one you provided:

Under Key findings:

Its main weakness is health care outcomes. The UK appears to perform less well than similar countries on the overall rate at which people die when successful medical care could have saved their lives.

Among its strengths, the NHS does better than health systems in comparable countries at protecting people from heavy financial costs when they are ill. People in the UK are also less likely than in other countries to be put off from seeking medical help due to costs.

So: main strength - cheap, main weakness - health care outcomes!

It's no surprise that fewer people in the UK skip medical care due to costs when it's (close to) free. The problem is that the health care is bad when you get it (according to your own provided document)!

Nowhere in that report does it say it is "garbage", as you suggest it is.

Yes it is not as good as some other wealthy countries, but it is by no means "garbage", e.g. on page 35: "The results show that although the UK does well by global standards, it performs poorly compared with the other developed countries in our comparison group". "..does well by global standards.." completely contradicts the idea that it is "garbage".

There are some interesting comments in the document suggesting that some of the health outcomes might actually be social which was news to me an quite interesting - e.g. the british "stiff upper lip"/"keep calm and carry on" might be causing people to defer medical help, or that the large income disparity could be skewing it. Interesting & worrying stuff.

Does well by global standards?! Yes, we should definitely be comparing our healthcare system to those found in places like the Congo. It has bad healthcare outcomes and costs a lot for them, that is bad, don't get hung up on the single word 'garbage', it's called hyperbole.

Same personal anecdote - have excellent BUPA coverage, just allows you to skip the lines for non serious things, if you have a heart attack you'll be going to an NHS A&E whether you have private insurance or not.

Utter garbage is a bit strong but yes a lot of people on that income will have additional private health insurance. Insurance which is cheap as chips because it only covers additional things. Even if you're buying privately (not as a company benefit) you're paying £900ish a year per person.

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