Comment by Latty | Hacker News Reader

Comment by Latty | Hacker News Reader

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The NHS is crumbling under a decade and a half of underfunding and intentional mismanagement to designed to prove it doesn't work by the Tories, and even then, it isn't as bad as you make out. There are 100% unacceptable wait times for some things and some procedures, but I'd take having an annoyingly long wait to see my GP over people I care about not having healthcare at all, and realistically it isn't as bad as you are making out.

In 2022, the British government spent £3.5k ($4.4k) per person per year on healthcare. The US spent $13k per person per year in 2022, of which $6.2k was government (national+state+local)[2]. The UK government spends less per person than the US government on healthcare, even before the amount paid privately.

Even if you think the UK's healthcare is worse than the US (which I fundamentally disagree with), you have an extra $2k to play with and do better than the UK before it costs more than the current system to the government, and then another $6k of extra tax before people would be more out of pocket than with private healthcare.

Healthcare is complicated, all systems have flaws and all are vulnerable to being manipulated. None of that changes that the US has the worst system, run in the worst way, with the least efficiency. And that's without even getting to the obvious point that a country where people are healthier is worth paying for: my friends and family, colleagues, people I interact with being well, living longer, and not having diseases is very worth paying for and I want to be taxed to achieve that.

[1]: https://www.ons.gov.uk/peoplepopulationandcommunity/healthan... [2]: https://www.cms.gov/data-research/statistics-trends-and-repo...

>"In 2022, the British government spent £3.5k ($4.4k) per person per year on healthcare. The US spent $13k per person per year in 2022, of which $6.2k was government (national+state+local)[2]. The UK government spends less per person than the US government on healthcare, even before the amount paid privately."

The difference in medical spending is largely due to wage costs being much higher in the USA than the UK; healthcare insurance companies are not as profitable as it may seem (they're about as profitable as other insurance businesses). Pharmaceutical prices don't explain much of the difference either, because they’re only a single-digit percentage of healthcare spending (in the USA).

It isn't about the profit margin of the insurance companies it's about their purpose. What value do they add to the healthcare industry?

Aren't healthcare insurance companies intrinsically an inefficiency that could be outright eliminated?

If there is to be some control on healthcare spending, and/or policing of fraud, someone must approve and decline payment for services. This is the function currently fulfilled by the insurance companies. You can eliminate the companies, but anyone performing the service will consume some amount of overhead.

Well whatever is going on in America[0] it just isn't working.

https://en.m.wikipedia.org/wiki/File:Life_expectancy_vs_heal...

It isn't intrinsic. In any modern healthcare system, someone has to manage resource allocation and risk pooling. Some countries have government perform those functions, which can be more efficient but isn't necessarily so. In the USA, even the government run Medicare health plan outsources much of the administrative work to for-profit companies.

@nickff shouldn't that be a not-for-profit watchdog capability then? Not a massive money making middleman?

(Can't reply that deep)

Even if that is true, how does that change anything about what I said? The government can evidently do this more effectively, fairly, and efficiently.

That may be true; what are you basing this view on? How do you evaluate those three criteria?

> what are you basing this view on?

Every other developed nation?

It seems that it's not as clear to me, so could you please explain how one should evaluate those criteria?

The most obvious criteria is cost per citizen. The US has, by far, the highest cost per citizen. And also the lowest quality care.

I explained in my original post. The fact the UK government spends less than the US government on healthcare per-capita, despite the fact it gives everyone healthcare rather than just a subset of the population is pretty damning. How can anyone possibly argue the US system is working more efficiently given that?

The UK has private health insurance available for purchase too, right? I'd be curious to see what that per capita amount is. Does UK private insurance mean you opt out of the public system, or does it provide coverage for more things on top of the public system?

Yes, it's not opt-out, just additional coverage or the use of private facilities. Apparently about £1k per capita[1], I'd suspect a lot of that is probably dental due to a huge shortage of NHS dentists.

Historically private healthcare here was just about fancier rooms, better food, etc... Now it's often "the NHS said I need to wait 6 months to get this procedure, if I pay I can get it next week". A lot of the time with the same doctors and same facilities as if you went NHS.

In general, if you weren't waiting a long time for NHS healthcare, people were happy with it: five or so years back I worked for an American company that offered private healthcare as standard, even in the UK, and the healthcare company offered you £50 a day while you got NHS treatment rather than actually using their services while you had coverage, as it was obviously much cheaper for them, and everyone I knew took that deal every time.

Increasingly this is less true though, a decade and a half of being slowly throttled, then Covid, and you can feel that everyone is rushed and stretched to breaking point.

[1]: https://www.statista.com/statistics/283221/per-capita-health...

Thanks! So even including the folks who get private insurance on top of NHS, the healthcare spending difference between the UK and US is massive.

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