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Comment by springogeek | Hacker News Reader

The actual phrase for describing the NHS is meant to be "Free at the point of use", but people are likely shortening for convenience. People are paying for it, but not in a tangible way.

The main thing is knowing that if you need any procedures, services, an ambulance, critical or emergency care, etc, you'll not be asked up front to pay for it, you'll just be treated. Seeing that principle erode over time is heartbreaking and terrifying.

(rant) Healthcare as an industry doesn't function properly under a capitalist model, which expects that competition and consumer choice will encourage innovation and further competition, leading to a better outcome for the consumer. If you need healthcare, you don't really have a choice in it, or your choices are artificially restricted by circumstance, so you can't benefit from a competitive marketplace. It's a broken system, as far as I am concerned.

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I'd say the health insurance industry specifically doesn't function and that's because in the United States you will not be turned away from life saving treatment regardless of the cost [1]. Other aspects range from working very well to working marginally and could be improved. Public-private relationships generally seem to do well but we need to capture more of the profits when the funding is subsidized by the public, but that doesn't mean that private entities who do heavy lifting shouldn't also profit. It seems like we have some clear win-wins if we want to take them. On the whole the government is far better at cutting checks than it is at innovating.

I agree with your statement that "Free" is likely short-hand but I personally still don't like it because I prefer to think of items like that less so as entitlements because entitlements are easy to attack and dismantle. On the other hand when someone feels like they paid for something they are more likely to defend it. Social Security in the US is IMO a good example of this.

[1] Price discovery is impossible in a free market where you can't be denied service. Since society is (in my view correctly) not willing to let people die on the street if they can't pay for treatment the health insurance industry can't function except as a parasite with the aim to extract as much as it can and redistribute it to employees and shareholders. I do think healthcare costs would be cheaper under a "pure" free market where we let people die on the streets, though, but again I just don't find that acceptable.

Ambulance service might be free at point of use but that hardly matters if the ambulance never arrives.

https://www.bbc.com/news/health-64243044

You're right, but it isn't a helpful comment for the discussion at hand. The story in that article, and many like it, are symptoms of a larger problem, but it's not because of public vs private healthcare.

The system works, assuming it's adequately funded, which it hasn't been for a while. Salaries aren't high enough to live on (thanks to the conservative government and creeping privatisation), and then brexit and other immigration policies have caused a shortage of trained professionals and no one willing to fill the vacancies.

There's a whole heap of issues (I've left out quite a few) stacked up against the NHS, and yet it powers on, doing its best.

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