[WordSkill]

I lived in Scotland for a decade or so. On the surface, the provision of healthcare seemed good, and the media constantly tells you it is, but it tended to fall apart once you needed it for anything serious.

I heard of the experiences from countless others and, sadly, encountered it myself. As the patient, even though you are paying for the service through high taxes, you are not seen as the customer. This leads to a certain sense, when you do need a medical service, that they are doing you a favor, that you are somehow the recipient of charity and should be grateful for what you get.

Decisions about what medicines or treatments are available are often political, with certain high-profile conditions sucking up scarce resources at the expense of others. The focus is very much on managing public opinion.

There are many situations in which cost considerations have a horrific impact on lives. For instance, if there is a medicine which can prevent you losing your sight, but it is expensive, you will be offered it only for your second eye after you have lost sight in your first - the reasoning being that it is only worth spending that much money to prevent total blindness, but sight in one eye is enough.

If you think that your high taxes mean that your healthcare needs are covered, think again.

There is also a deep-rooted coverup culture that circles the wagons around bad doctors and poor processes. In my case, a ridiculous misdiagnosis had a real impact on my life for over a year. The other healthcare professional only came clean about it after the lead doctor had retired.

Again, you are not seen as the customer, as the one paying all their wages, so, you should just shut up and be grateful for what you get.

I often laugh when I hear inexperienced American talk about how much better the health system is in the UK. Sure, health insurance is expensive, but the actual healthcare is leagues ahead of anything available via any sort of national health service. Being recognized as the customer, with real rights, is of pivotal importance in receiving the care you need, when you need it.

In fact, you often come across UK citizens with a rose-tinted view of the National Health Service, but such opinions tend to change rapidly once you actually need something more than an occasional General Practitioners appointment. The whole thing is a cruel joke.

[acallaghan]

> Being recognized as the customer, with real rights, is of pivotal importance in receiving the care you need, when you need it.

Except if your poor though right? Isn't that really the case?

In the UK we don't tend to ignore kids broken bones if they have poor parents. No one goes bankrupt and ends up homeless for contracting an illness, or having an accident at work.

We also spend less on our taxes towards the NHS than Americans spend on their Medicare - and then you have to pay for private 'health care' insurance on top, including all of the 'co pays' and whatever. It's a system that's rigged against you. For the rich, by the rich, to make the rich richer.

Even if the top 1% of private healthcare is better in the USA, you're ignoring the 99% of healthcare that isn't.

Most Americans just can't see the simple fact - many many other countries are better at this than you are. This is a solved problem in many other developed countries.

Universal healthcare simply benefits everyone in society, and does so purley for the common good.

[WordSkill]

> In the UK we don't tend to ignore kids broken bones if they have poor parents. No one goes bankrupt and ends up homeless for contracting an illness, or having an accident at work.

Kids with broken bones are at the easy end of the scale. Most people, before they have experienced serious, complicated, expensive health issues, have a series of relatively positive experiences with the NHS in which they present with a minor issue that is dealt with by in a satisfactory manner. The system is optimized for that. This maintains the illusion that, through your taxes, your health requirements are "covered".

This falls apart once you present with something more complicated. You might be surprised at the extent to which people in the UK are pretty much abandoned when they hit a certain point. I know of many cases in which people had to find the money, somewhere, to buy vital treatment that the NHS was not willing to allocate. This is no less brutal than what happens to the uninsured in the US ... but ... the big difference is that UK residents are under the delusion that they do not need to worry.

Again, my argument is not that the NHS is bad, or evil, or that it does not sometimes do a good job. What I am saying is that, over your lifetime as a whole, it costs more than good health insurance would while letting you down badly when, inevitably, you encounter more serious problems.

The best way to help the poor is to improve the economy. A massive, complicated tax system makes it particularly hard to hire people at the low-end of the skill range. It is simply not worth it, and this will become increasingly evident as workers continue to be replaced by technology.

The UK has ended up with a multi-generational unemployed class who are under the illusion that everything will be taken care of "from cradle to grave". Their personal agency has been almost entirely removed. Alcoholism, obesity, diabetes and depression are at epidemic levels among the unemployed. We have created the perfect storm and it is the poor who will bear the brunt of that.

[DanBC]

> I often laugh when I hear inexperienced American talk about how much better the health system is in the UK. Sure, health insurance is expensive, but the actual healthcare is leagues ahead of anything available via any sort of national health service

Exactly the same private healthcare is available to you in Scotland, if you chose to pay for it.

[WordSkill]

Yes, it is available, but the high levels of taxation - not just income tax but, also, a 20% tax on purchases - means that most families simply cannot afford that.

My argument is that people are _already_ paying but in a mandatory, indirect way, that removes their power as consumers and creates a situation in which the health services' prerogatives often differ from those of the patients.