Hacker News Reader

Comment by ahi | Hacker News Reader

The problem with the TANSTAAFL argument in this case is that the NHS is far cheaper than the American alternative. It is also far superior at providing preventative care than the American alternative.

View on HN

As an example of preventive care offered by the NHS. I am registered with a local GP who I hardly ever see (because I don't need to). Two years ago I received an SMS message from them because of my age (over 40) to come in for the NHS Health Check (http://www.nhs.uk/Planners/NHSHealthCheck/Pages/NHSHealthChe...).

The test involved a bunch of basics (weight, exercise, blood pressure, etc.) and two blood tests (for cholesterol and blood sugar level). They will repeat this every five years.

I do not think the NHS is the greatest possible system (in fact, I preferred the French system when I lived there), but by many measures it is good.

Indeed. The US private sector and the US federal government EACH spend more per capita on health care than the UK does. And yet we rank behind the UK on virtually every health statistic that they bother to track.

In 1993 Republicans did an interesting analysis. They found that Clinton's health care plan would work, and would be popular. If it passed, they believed that Republicans would be losing national elections for a generation. But they also figured out that if they derailed it, then they could turn fears about it into a potent election issue. They did, and it was. They tried the same thing with Obama's plan. Whether the other half of their prediction comes true is yet to be decided.

For the actual Republican analysis from 1993, see http://delong.typepad.com/egregious_moderation/2009/03/willi....

> "They found that Clinton's health care plan would work..."

They found nothing of the sort. Did you even bother to read their analysis at your link? You can disagree with someone without misrepresenting their motives.

You are exactly right and often times the ability to derail a reform plan in the legislature costs it support not only by seemingly discrediting it in the political process but also forcing reform advocates to support a concrete bill that has real consequences while opponents don't need to offer anything and can attack consequences of the bill passing out of context. No one is sure it will pass, so invariably some members waver and the bill is watered down to guarantee support, at which point it becomes compromised and rather ineffective which once again discredits reform.

Its interesting in the post-1945 election in the UK very few voters strongly supported the NHS but once it passed it developed bipartisan support. The chances of a party taking every house of congress a supermajority in the senate and the presidency to have the ability to move legislation is incredibly small in our system as compared to a parliamentary one. I'm not suggesting that our system is always worse but in this instance it certainly is.

Not only that, but as Dean Baker never tires of pointing out, if the US only spent as much as other rich countries do on health care (countries that get better health outcomes), it would have huge budget surpluses rather than deficits.

Of course it's cheaper - the NHS is actively controlling prices. That of course means that doctors get paid less, patients wait longer for certain types of treatments or are denied other types outright, and people do are not granted unlimited resources to fight death at their end of life as they are in our system. You can't just say it's cheaper as a blanket endorsement without analyzing exactly why it's cheaper.

Is private insurance still available if I want more exotic options? Sounds like the best of both worlds to me.

Yup. You can happily pay for private insurance, or pay out of pocket for private care, and you'll be able to get all the drugs that the NHS thinks are too expensive for the benefits they bring, or surgical procedures that are considered experimental.

So why all the hate for socialized medicine? If the rich(er) folks want to have access to the most exotic care, they can still have it. Meanwhile, people who can't afford basic care today will get it. Come on, America.

Because it involves force to implement and removes my control. At least that's my reason for hating socialized anything.

Yep. You can go private if you want and if you have the money.

My father in law in the UK got a cataract done privately.

If you have the money, you can get what you want.

US patients are not granted unlimited resources to fight death. They are limited by how much money they have.

The UK also allows you go privately and pay yourself and choose your won doctor and hospital and treatment if you want and have the money.

Just for the record, I'm not saying NHS is worse than American healthcare. I'm just stating that its possible, in a hypothetical system, in which an efficient and fair allocation of resources will bring about end-of-life care scenarios that are less ideal than what the OP describes. And that its also possible that ideal end-of-life care will end up hurting others (through a disproportionate allocation of resources) and doing so in a way that is hard to dramatize (until it's too late).

This is a tension that keeps effective health care reform from moving forward, but it's still a tension that should weigh as heavily in a debate as an emotional appeal.

Reply on news.ycombinator.com