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Comment by lotharbot | Hacker News Reader

> "you can get this public picture that everything is great"

I'm not aware of anyone, from any political background, who thinks the US system is anything above "pretty crappy". I've heard some people express positive sentiments regarding small parts of the system -- the quality of certain types of care, for example -- but never for the system as a whole.

The primary disagreements I'm aware of concern how to fix the current worst-of-both-worlds system. Do we put it entirely in government hands? Do we enact more regulations to try to force down costs? Do we remove or relax regulations that appear to drive up costs? How do we create transparency in pricing? How do we respond to innovative groups like Qliance? How should we balance the role of government, individuals, families, employers, and charity in health care?

Do not mistake disagreement on how to answer those questions as support for the current system.

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You would be surprised. It wasn't long ago when I met an intelligent and otherwise very well informed American who truly believed that the "socialized" Canadian healthcare system was a 3rd rate disaster and feared any change to the precious US system would lead to a similar situation.

Don't get me wrong he acknowledged it wasn't great, but there is more than sufficient doubt and confusion amongst most Americans with regards to what the actual problem is an how to fix it to prevent any kind of attempt and changing things.

I'm from the UK. The NHS is shambles and is spread very, very thin. Doctors are pissed off. Patients are pissed off. The government seems to be too. However I would prefer the 3 hour A&E (ER) waiting times, being spoken to like shit if it isn't as serious as originally thought and epic waiting lists for outpatient services than having companies profit from my health and the massive vulnerability that puts me in (on top of just bad health). Even for all the bad of the NHS, when things really to hit the fan, I can be sure I get seen to ASAP when it is deadly serious.

Just last month my pregnant fiancée was very ill with an infection and she was examined straight away at A&E, bypassing the 3 hour waiting time. It's for cases like here that the 3 hour wait is in place. There was no cost to me for any of that, perhaps except national insurance which is very small payments out of my pay packet each month a d the £7 for the course of anti-biotics

The real problem is how do we adequately reward doctors who spend such a massive amount of effort and time not just in school but in work? The NYS cannot do this, there are targets like "15 mins per patient on ward rounds". Each doctor needs to spend 10 years in the NHS before private practice. How is a system like this sustainable with a massive budget deficit to boot and government that would like to see its end?

"The NHS is shambles"

In 2013 my son received treatment from NHS Scotland for a very serious eye infection and, later on, a nasty shoulder injury - in both cases the care was fantastic and even though I have private health insurance I never thought about using it.

I know lots of people have problems with the NHS (a few years back my wife got some care that was less than "caring" - but that seemed to be a staff problem) but generally the experiences of our family has been excellent.

In my experience the location matters. I sprained my ankle in Edinburgh once, and the hospital visit was almost enjoyable. The staff were great. Where I live in London, it's not so great. They have to deal with a lot of annoying drunks and are overworked, but also the place was just not very clean. Our local A&E is closing down too.

The NHS is not a shambles. Its puts a lot of other countries health care system to shame.

Your moaning about having a 3 hour wait for non urgent cases, when in other countries you'd have to pay a fortune for such treatment.

And who cares how they talk to you, as long as you end up getting the treatment you need that's all that matters.

jwdunne said "I would prefer the 3 hour A&E (ER) waiting times".

As a patient, I'm not really arsed. As a patient, I actively discourage putting strain on the system when unnecessary. I'm really moaning about how doctors are treated, and they are spread thin and are not rewarded by the system fairly by the effort they put in. The targets in place mean they cannot give patients the care they want to give, meaning there is little intrinsic motivation too.

I care, many people care. When you're feeling like shit, you don't want to be made to feel worse. It's simple.

I don't mind a 3 hour wait. The 3 hour wait just shows how thin doctors are spread. Lets face it, a 3 hour wait for any sick person in an uncomfortable chair is NOT going to do them any good.

Your fiancée shouldn't have had to pay for a prescription if she's pregnant.

Looks like you need a form:

http://www.nhs.uk/chq/Pages/941.aspx?CategoryID=68&SubCatego...

Which sounds a bit bureaucratic but it does also mean you get free prescriptions for 12 months after the birth.

Of course, in Scotland, Wales and Northern Ireland there are no prescription charges...

I just had a baby daughter. The care was excellent at a hospital a couple of miles from home. At one point we had 3 midwives helping, then the anaesthetist and for the delivery we had 3 doctors at one point. After-birth care was great too and we were encouraged to stay at the hospital until we felt comfortable going home all the while with adequate food and a private room.

We had to go to A and E with our daughter a couple of weeks ago. We were seen before I even had time to park my car after dropping off the wife and baby! The doctor and nurse were both very supportive and were happy to see us even reassuring us that we were absolutely right to come in even though no treatment was required in the end.

Around 10 years ago I had months of physio on the NHS and a series of consultant appointments. I was very happy with the service.

Yes, the NHS is struggling like all public services, but the media seem keen to trash the NHS and force us into privacy to keep the (mainly conservative) MP's happy and help their friends get the big contracts. It makes mistakes and isn't perfect but in general I've had good experiences.

I've also had surgery and a lengthy hospital stay in California. An excellent standard of service but at a massive cost (fortunately fully paid by my travel insurance).

I'd prefer the service as it is in the UK where everyone is equal insurance or not even if the quality is not quite as high as places where the end user is paying for the service.

My girlfriend just had a major operation on the NHS.

The pre-op preparation was really impressive, the operation itself was astonishingly quick and well-performed (I was not expecting her to be conscious and talking 2 hours after having a non-trivial part of her body replaced), the post-operative care was pretty decent but certainly not terrible, and the physiotherapy support and general aftercare was good to great. They provided the equipment she'd need to get about the house and keep up her normal life whilst she was recovering, and in general, the whole experience was good to excellent.

"The best health care system in the world" is a pretty common refrain among American right wingers. Many of them truly think that we are #1 in this area and that the great tragedy of socialization will be destroying that.

> ""The best health care system in the world" is a pretty common refrain among American right wingers"

In my experience, the right wing perspective is more like "some of the best health care procedures, embedded in a payment/distribution/insurance system that sucks". One of the biggest fears is that the few things American healthcare does well will be sacrificed, and the things that are wrong with the system won't actually be fixed, the costs will just be shuffled around and hidden a bit better.

The two aren't incompatible. I agree with you about the details of the views, but they still generally think it's the best in the world.

Right, but I think "best in the world" is more a negative comment about other systems being terrible than a positive comment about this system being actually good.

My experience is that the system outside of payments and such is seen as superb (when it's actually average), and the rest is seen as OKish (when it's terrifyingly bad).

I was discussing health care reform with one fellow who was under the mistaken impression that outcomes in the US were significantly better. After I explained that people in countries with socialized medicine get care that's just as good as ours, he asked me, "OK, but then why do we need to change anything?" He really thought that the current system, if not great, was still perfectly fine. I've seen that a lot.

There is, no doubt, a wide spectrum of beliefs. But don't underestimate the number of people who think the system is pretty good overall. Really, just look at the total lack of any credible alternative reform put forth by the right wing. They talk big, but they don't seem to come up with anything beyond "leave it alone". They're stuck in kind of a tough position, because they've been advocating government non-interference and free-market solutions for so long, yet they're not in a place where it's acceptable to say that poor people should die in the streets from treatable conditions, even though that's what a free market solution gives you. As a result, there's a huge incentive to convince people that the way things are right now is just fine.

I'm not sure what you base the statement "that's what a free market solution gives you" on, since as far as I know we've never had anything remotely resembling a free market solution. In my experience, one of the most common refrains from that side is "the current solution is bad precisely in the ways that it's not free market". Granted, they're just guessing what will happen, but I don't see that as meaningfully different from your guess about people dying in the streets etc.

Also, I have no doubt that you've talked to people with strange ideas, but your conception of what conservatives advocate (or fail to advocate) is very far from my conception of what conservatives advocate. Your statements make me think you know someone like one of my friends, but you're missing the whole rest of the spectrum of conservative/libertarian/capitalist thoughts, memes, and ideas.

The USA has the best health care money can buy. The problem is that some people only see the first half of that sentence and it's the second half that's so damaging to society.

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