The British Health Care System

Aug 2019
Warwickshire UK
A little bit about health care, UK style.

There’s a lot of talk at the moment about doing UK/US trade deals when we leave the European Union. Boris Johnson, the Prime Minister, has quite rightly said that deals involving the British National Health Service (NHS) and letting in US companies to privatize (plunder) the service are not up for negotiation. He’s quite right. Any political party that allowed that would be out of office overnight and there wouldn’t be thousands, but millions out in the streets. It’s not an exaggeration to say there would be a near revolution. The NHS is not just a health care provider, it’s a national institution. It’s called National Insurance because it’s an insurance scheme run by the government, not a freebie.

Here’s how it works. Every week you work the government take a compulsory sum out of your salary, depending on how much you earn. Average would be around £40 ($48.79 a week at the current exchange rate). For that you get healthcare free at the point of delivery. In other words, you’ve already paid for your health insurance so no money is involved. You simply walk into any hospital and get seen to at the same level of care as everyone else. That often means standing in a queue, but if it’s an emergency, say a car accident, or you’ve collapsed in the street, you automatically go to the front of the queue. Medication is free if you’re in hospital, but you have to pay a small charge if you’re an outpatient, currently I think about £9 ($11) per prescription, or drugs given for use outside the hospital. If you don’t work it’s free. We don’t do deductibles; from injury to treatment everything has already been paid for and crowd funding for medical treatment is unheard of.

For your money you also get eye care and dental treatment, plus a pension when you retire, currently £168 ($204) a week. There is also statutory sick pay (SSP) that the employer has to pay if you’re off sick for a period of a few weeks. If you’re injured at work you’ll probably be able to claim compensation. Your employer can’t just fire you or abandon you because they feel like it.

I recently had a full eye test with all the electronic gadgets that took an hour and the frames for the lenses cost £26 ($31). For $31 I now have 20/20 driving vision – the tests and diagnosis was free. The pension is based on how many years you’ve worked. If memory serves me right 30 years of work gives you the full pension and if you haven’t done 30 years you get a percentage of what you’ve paid in. So 15 years would give you $102 a week pension. So healthcare (NHS) is only part of an overall National Insurance Scheme (NIS).

It’s not all plain sailing and there are many things wrong with the NHS and it all centers around funding. The drive to equality means that those not working and not paying in get the same level of healthcare as those that do and that makes it expensive for the payers. The idea behind the NHS is to get you well as soon as possible because you’re costing the health service money. I don’t fully understand how the US system works, but it sounds complicated. In the US it’s in the interests of healthcare to keep people as unhealthy as possible because it brings in ‘customers’ for the insurance companies, hospitals and drug companies, but at the same time the insurance companies are trying to find ways to increase their profits through deductibles. So there’s this conflict of interests going on and privatization was never anything other than making a profit for the shareholders. In the UK the NHS users are the shareholders.

In the first-world we take some things for granted. You turn on a tap and water comes out. Press a switch and the light comes on. These sort of things are necessities of life and in the UK we also look at health as being for non-profit, not strictly as a right, but as one of the necessities of life. In the UK we simply couldn’t live in a healthcare system where if we’re sick or injured we’re asked have we got private insurance, or how much money we have on our credit card.

If I were to walk out of my house now and collapse, within minutes there would be an ambulance arriving to take me to the nearest hospital, front of the queue, best medical treatment available. No money, no insurance card … If it’s not serious or life threatening we wait. We simply wouldn’t have it any other way.
Jul 2014
The American Health Care system is a product of Wage and Price Controls, it was developed in an economy where the government rationed most products and set wages and prices for almost everything. Because it was created as a sort of black market, it has little to do with market forces, although much lip service is paid to market forces, they are largely absent, and it is primarily a mechanism to transfer wealth from the middle class to the top 1%.

In the UK, people actually sat down and thought about how to provide a nation with good health care for a reasonable cost, that never happened in America.
Our system is profit based, whatever generates the most profits is what is pursued, recently we have seen huge profits generated by getting people addicted to opioids under the umbrella of "Health Care". The market system is based on greed and fear, the two balance each other in a functioning market.
In the US healthcare system, there is no functioning market, there is unbridled greed, hence we have a system that does not provide quality and quantity of care that the National Health Service provides, even though it costs 2 1/2 times as much.

This is because the system is maintained by lobbying the congress, and making considerable "contributions" to political candidates to maintain the current system.
The problem with health care is that it works, and a health care system that works, costs more every year, tacking the extra profits onto a small slice of the economy is innocuous and can persist for decades, but as that slice becomes larger, the added "premium" becomes a substantial burden, even as the profits become enormous.

In the US we have three systems now, a "private" system, a single payer system and a government run system.
As you would expect, they each deliver roughly the same quality of service, the single payer system costs substantially less per person, the government run system costs even less.
Change will come, it will be forced as the system becomes unsustainable.
Aug 2019
Warwickshire UK
Yes, the UK system was thought out, but mass unemployment was never envisaged. A situation developed where millions don’t pay in but everyone is entitled to take out. Having said that though, it struggles along and is a system based on need. Its peace of mind really knowing you will never be refused equal quality care and a bit like car insurance. You pay in for ten years and don’t have a car accident and its money wasted, but come the day you do you’re glad you have it. We also have private health insurance if you can afford it, as well as the compulsory national health contributions for those who choose to spend their money on paying extra to avoid the queues.

Our economic system is moving to that of a ‘gig economy’ (a free labour market organized around short-term contracts), but we won’t let our health service go the same way. Some of the National Health Service is privatized, I think food is one such area, but not the care itself. I have bad news for Mr. Trump. There’s no chance of British health care becoming Americanized. :)

It’s not socialist, it’s an insurance scheme. The government simply fund it from contributions.

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