Comment by noir_lord | Hacker News Reader

Comment by noir_lord | Hacker News Reader

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The NHS in the UK pays much lower prices for most drugs than the insurers do (there are the odd egregious cases where a company take the piss, the interesting thing is that we do actually fine them in a rare case of consequences been applied) because simply put they are negotiating for 65 million consumers in one go, if the NHS price is high enough for them to make a healthy profit per patient it is a no brainer.

The system requires numerous feedback loops and clinical overview (ours is called NICE - National Institute of Clinical Excellence).

Is it perfect, no, few human things are.

Is it massively preferable to the average healthcare situation for Americans - hell yes it is.

I pay for my prescriptions which is £9 per drug per month (whatever the cost to the NHS of that drug is), I take 3 drugs so that should be £27 per month except they considered that case and I buy a NHS Pre-Payment Card which costs me about £10 a month and covers me for any number of medications. [1]

So for £10 a month I get the routine medications I need to make my life not just bearable but enjoyable which allows me to work.

So if costs controls in government are your concern the elect better people with better systems.

Lest anyone think I'm all sunshine and roses on the NHS, it requires drastic reformation (and they really really need to get rid of their 'internal market' way of running) but the idea is as sound now as it was in 51 years ago (almost to the day, it was founded July 5th 1948).

[1] https://apps.nhsbsa.nhs.uk/ppc-online/patient.do

> Is it massively preferable to the average healthcare situation for Americans - hell yes it is.

Your average American has employer-paid health insurance, which covers most of their costs. According to the OECD, average out-of-pocket healthcare expenditure in the U.S. is $1,370, versus $629 in the U.K. https://data.oecd.org/healthres/health-spending.htm. Keep in mind that median household disposable (post-tax) income in the U.S. is $45,000, versus $29,000 in the U.K.

Sure, but there are obvious cases which turn these averages into really different personal-stories.

One case is the obvious cost of having a child in America, even with insurance some people pay thousands of dollars.

The point is that "some people" is not "average". If we are going to talk about the problems with health care in the US exaggerating the problems is counterproductive.

Does that mean poverty is not a problem worth addressing, because on average we’re a reasonably wealthy country?

Is inequality not a problem, because on average we all have the same opportunities?

"The american system is bad for the poor or unlucky" is a very different argument than "the american system is bad for the average person."

The difference in median disposable income between the U.S. and the U.K. is stunning: almost $17,000. Even after you factor in things like student loan debt (averaging $220/month for the minority of people who have student loans at all) and out-of-pocket healthcare expenses and premiums (a few thousand a year on average, versus maybe a thousand or so in other OECD countries), the median American household is coming out way ahead.

Child mortality rates in the US 5.9 per 1000, In the UK 3.8. [1]

> Two-thirds of people who file for bankruptcy cite medical issues as a key contributor to their financial downfall. [2]

United Kingdom suicide rate per 100,000 7.5, United States 13.8 [3]

United States Murder Rate per 100,000 5.35, United Kingdom 1.2 [4]

More to life than money I guess, also your $17,000 is accounting for income distribution, at first glance that looks good but while our income distribution is pretty bad, the US is positively Dickensian.

No jingoism intended here, we get a lot wrong and other countries straight up kick our arse (Spain's infant mortality rate is half ours at 2.0 for example amongst major European countries) but that just means we should be looking to improve.

[1] https://data.oecd.org/healthstat/infant-mortality-rates.htm

[2] https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most...

[3] https://data.oecd.org/healthstat/suicide-rates.htm#indicator...

[4] https://en.wikipedia.org/wiki/List_of_countries_by_intention...

Guess I hit a nerve.

On infant mortality statistics, at least part of the difference is that the US reports that figure rigorously, while other countries do not necessarily do so: https://www.nationalreview.com/2011/09/infant-mortality-dece....

As to income distribution: that’s the OECD’s estimate of the median household. So it’s not being skewed up by super-rich households.

As to bankruptcies, less than 0.5% of households file for bankruptcy in a given year.

As to homicide or suicide rate: again, that affects a tiny minority. Meanwhile, the much higher income affects 60-70% of the whole population.

The U.K. is a society where you’ve lowered the median to lift up the floor. That’s one way to do it. And I don’t even disagree with you that the US should do more in that regard. But if you support an expanded welfare state (and I do), it’s dishonest to sell that policy to people by pretending that the average person is going to be better off. Unless they place a very high value on security (avoiding low probability outcomes like medical bankruptcy) over material comfort, they’re going to be worse off.

I would dearly love to know what they are including to get an average UK spend of $629. From a brief scan of sources and data set they don't appear break it down any further.

More in the UK get free prescriptions than don't. Even with the most involved care I can't find a way to make it that expensive. So maybe they're including people voluntarily paying some treatment not available on the NHS like homeopathy or unproven experimental treatments, or private insurance generally. Maybe they count dentistry as healthcare.

Prescription charges for some, hospital parking, drinks machine... Unless you include something else it doesn't add up.

dental work maybe.

I have two serious conditions and it costs me a quarter of that.

You would think that the government gains “leverage” by being the only payer. In practice in the US, this is not what happens. Rampant lobbying (i.e. legal bribery) by interested parties causes spending to spiral out of control, since the benefits are focused and the costs are diffuse.

Arguably the NHS model is the only way to get government healthcare to work at all in the US. You would need to gut both private insurance and private hospitals, whose continued political clout would naturally drive up costs if they were allowed to continue existing in their current form.

(In fact, there is already an “NHS-like” example in the US: VA Hospitals for veterans. I’m not sure what we can learn from them, however, as lessons from treating the veteran population may not be able to be extrapolated to the other 300+ million of us.)

One possible lesson: Every veteran I know thinks of the VA as the provider of last resort.

You can’t sue the government unless they decide to allow it, so at least we’ll see the end of malpractice suits. /sarc

The VA had a massive scandal recently. For years, they had chronic problems with timely follow ups and treatment (ergo. Last resort). They were put on notice to improve their patient turnaround times. Miracle ensued -wait times did go down. But as always, bureaucrats played with stats: they achieved the drop by literally IGNORING veterans seeking medical service and appointments. They would simply find a reason to not log the event at all. This went on for the better part of the year when veterans started dying in greater numbers and someone blew the whistle. Claims of reform were made. No one got fired until trump got elected.yet now we start all over again.

VA is not what you want for USA

I am not going to advocate against negotiating lower prices.

However, i should point out that one reason the NHS drug benefit (and that of mostly every country) is not completely broken and obsolete is because USA effectively subsidizes research for drugs that the rest of the world then copies

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