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Comment by curt | Hacker News Reader

Where does it work well? A small country with a homogenous population can pull it off but there isn't a single large country where it works. They keep their costs down by rationing coverage with wait-lists. I know a few people from the UK where their family members lived in daily pain and had to wait YEARS for their number to be called. They also limit the availability to the best medications and procedures to keep costs down. Also the quality is also quite poor, hundreds of people in the UK have died of dehydration in the hospital because the staff forgot to give them water.

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> had to wait YEARS for their number to be called.

They could have paid and gone privvate at any time. While wait lists were terrible some time ago they have got a lot better. Since year 2000 wait lists have been consistantly targetted for action by a variety of governments. There are some dodgy actions by some hospitals, but these are called out as dodgy and people take action to prevent it. Patients have maximum wait times listed in national documentation.

> They also limit the availability to the best medications and procedures to keep costs down.

I'm not sure what your point is. Imagine A and B, where A is shown to work effectively and B isn't. Which would you want? In this situation I'm glad that people have a responsibility to evaluate the research to weed out very expensive and inefficient medication and proceedures (and that's really what they're doing. They stop a small number of very expensive and ineffective meds; they don't just allow a small number of cheap meds.)

> Also the quality is also quite poor

How are you measuring quality?

> hundreds of people in the UK have died of dehydration in the hospital because the staff forgot to give them water.

Hundreds sounds too high. Do you have a cite for that please? (Note that the Mirror or the Mail will cause much mirth and laughter and people will then ignore anything else you say.)

While we're talking about deaths from incompetence: Yes, it happens. Yes, it kills distressing many people. It also happens in the US. Medical error is the 3rd biggest cause of death in the US. About 7,000 people die each year in the US because clinicians make a mistake with the medication. About 12,000 people die from unnecessary surgery. About 20,000 die from other errors. Nosocomial (Hospital aquired) infection kills another 80,000 people in the US. About 100,000 people get the right quantity of the right meds, but die from side-effect complications.

There are some things US health care does better. But the UK has better outcomes for some things. We also spend less money on our healthcare than the US.

(http://www.nursingtimes.net/a-comparison-of-british-and-us-m...)

"They could have paid and gone privvate at any time."

Once you have government health care in place, private care costs get so high, only the rich can afford them.

I'm not so sure that's true. I think prices compare pretty well with the US. Here's one website found pseudorandomly via a web search. (http://www.bmihealthcare.co.uk/paying-for-yourself)

Notice that they offer many surgeries "at a fixed price" and that all costs are known before surgery starts. I'm not sure what happens if there are complications; whether those are covered or not.

(I would have called them to get a quote, but they're not open yet.)

The United States has had this situation for a long time, despite healthcare being almost entirely private.

"private care costs get so high, only the rich can afford them"

That is most certainly not the case - private health care is a fairly common perk for senior positions in many companies (I get it and I'm two layers away from a CxO).

Where does it work well? A small country with a homogenous population can pull it off but there isn't a single large country where it works.

The Netherlands has a heterogeneous population (I don't see why size matters) with strongly government regulated sector of private insurance companies and hospitals. The net result is that we pay far less per capita than citizens of the US, yet the healthcare system is judged to be much better:

http://www.reuters.nl/article/2010/06/23/us-usa-healthcare-l... http://www.commonwealthfund.org/Publications/Fund-Reports/20...

I gather the NHS (UK) is similar to Medicare, in Australia, where I live.

Under Medicare, highest priority is given to life threatening conditions. For example, if you have a heart attack, you will be treated without delay and to the highest standard. Non-critical cases, such as a knee reconstruction go on a waiting list and it is relatively common for such operations to be postponed multiple times, as higher precedence emergencies arrive at short notice.

Basically, a person who might die will receive care over an uncomfortable person. It can suck if you have a painful, but not life threatening condition, but it is an attempt to give the best overall service within available resources. The public system will treat you if you're not going to die and normally do so well, but in the worst case (that typically makes the news) it can take a long time.

There is always the option of having an operation done privately, and either paying for it yourself, or having insurance to pay for it. Medicare has broad support within Australia.

It works really well in Germany with about one quarter of the population of the states. You pay about 15% of your salary split roughly 50/50 between the employee and the employer and that's basically it. You have to pay some additional money for different things - drugs (10% of the price, maximum 10,- €), hospital stay (10,- € per day, maximum 28 days) and so on. If you are unemployed, the state will pay for you. Finally you are free to opt out and get private health insurance - this may be cheaper when you earn much and are healthy but it may also turn against you.

The price of this is a very large bureaucracy regulating all this and of course costing quite some money that does not go into actual medical treatment.

> The price of this is a very large bureaucracy regulating all this and of course costing quite some money that does not go into actual medical treatment.

I still think it is smaller than the bureaucracy of the insurance companies in the US. I do not know about Germany specifically but the US has perhaps the largest administrative overhead in the world.

"Also the quality is also quite poor"

If the quality of care is so poor presumably voters here in the UK would be falling over ourselves to get rid of the NHS and replace it with a more efficient and cheaper private system?

The NHS is far from perfect, but in my experience (and I have private health insurane through my employer - which I personally have never used, although my son has) is that the standard of care generally in the NHS is very high - my son was born in an NHS hospital, my wife has been treated for life threatening injuries more than once (e.g. climbing accident) and the standard of care and the attitude of the doctors and nurses was great.

Private health care in the UK is mostly about getting access to non-vital procedures more quickly than others (my son had his tonsils removed) and getting a nicer room.

>I know a few people from the UK where their family members lived in daily pain and had to wait YEARS for their number to be called.

What about people "the market" doesn't find it profitable to treat? I'd rather be on a waiting list for pain medication than told it costs more than I make in a year.

That is certainly not the norm. I lived in the UK for 3 decades, and it's definitely not like that. The level of care is very good, and the vast majority of the population are happy with it.

There are incredibly powerful vested interests in the US who find it useful to convince as many people as possible that socialized medicine is awful and must be avoided at all costs. As a result, there's a huge amount of propaganda floating about, using techniques ranging from cherry-picking (it's bad because of these specific example cases) to outright lies (socialized medicine is why European states are bankrupt). A sadly large number of Americans believe it. Everyone then gets terribly confused when such a person bumps into a European who never noticed that the health care system they used all their life is actually a communist hellhole.

You realize that every single thing you enumerated could easily be applied to for-profit insurance companies in America, right? Just checking.

> there isn't a single large country where it works

The healthcare system in Canada seems to be working a lot better than the one here. Is that large enough?

You mean the one where the Supreme Court of Canada agreed that the delays in the treatment of cancer in combination with a ban on private insurance were violating Canadian citizens' rights?

http://en.wikipedia.org/wiki/Chaoulli_v._Quebec_(Attorney_Ge...

Is the bar "works perfectly" or "works better than what we have in the US"?

The population of Canada is approx 35 million, whereas population of the United States is over 300 million. Canada is not a large country population wise.

And presumably, there are nearly 10 times as many taxpayers in the US to fund such a system. Why do the absolute numbers matter? In fact, shouldn't there be better economies of scale in the larger country?

OK, Japan then. 125 million people, universal health coverage, ranked 10th in the world by WHO (the US is ranked 38).

I hate to say it, but:

owned

Why is this always used as an excuse why the US is different? The US has ten times more people, hence 10 time more tax payers. If anything I would expect things to be easier for the US because of its scale.

Canada has significant costs associated with delivering health care service to remote areas because of its low population density. A US public system should be more efficient, not less.

Nonsense. It works quite well pretty much everywhere in Europe. Better that in the USA, at any rate.

People waiting is better than poor people not getting any health care at all.

> They keep their costs down by rationing coverage with wait-lists. I know a few people from the UK where their family members lived in daily pain and had to wait YEARS for their number to be called. They also limit the availability to the best medications and procedures to keep costs down. Also the quality is also quite poor, hundreds of people in the UK have died of dehydration in the hospital because the staff forgot to give them water.

So we don't have these problems in the U.S. under the current "free market" system?

Before you answer, I already know that the answer is "yes we do".

Wouldn't a free-market system have to ration coverage in some way as well, unless infinite resources were put into medical treatment? The disagreement seems to be over how to ration it, e.g. do you do it based on wait-lists, or do you do it more auction-style, or some hybrid (like France), or something else entirely?

> Wouldn't a free-market system have to ration coverage in some way as well

"Free market" is a rationing system that provides scarce goods/services to those willing and able to pay the most first.

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