[Baader-Meinhof]

Sure, the NHS does provide excellent care, but it's not free. The fact that the British won't come to terms with this is causing its collapse:

"In December, as many as 500 patients per week were dying in Britain because of E.R. waits, according to the Royal College of Emergency Medicine, a figure rivaling (and perhaps surpassing) the death toll from Covid-19. On average, English ambulances were taking an hour and a half to respond to stroke and heart-attack calls, compared with a target time of 18 minutes; nationwide, 10 times as many patients spent more than four hours waiting in emergency rooms as did in 2011. The waiting list for scheduled treatments recently passed seven million — more than 10 percent of the country — prompting nurses to strike. The National Health Service has been in crisis for years, but over the holidays, as wait times spiked, the crisis moved to the very center of a narrative of national decline."

https://www.nytimes.com/2023/01/25/opinion/uk-economic-decli...

[petercooper]

Sure, the NHS does provide excellent care, but it's not free.

Correct, but the US has the rather odd status of spending even more per capita in public funds towards healthcare before they even get to the privately funded portion. The NHS has a lot of problems, but at least it's not (outside of dentistry) making us pay both ways at once.

[ericmay]

The US healthcare industry is easier to understand once you equate insurance companies with the government and realize that they are jobs programs.

But that also makes it easier to understand the need to get rid of them and have the government fund healthcare.

My mom passed away recently (Monday) and it would have been impossible for her (because it was impossible for me) to try and navigate insurance claims (and subsequent denials lol), hospital billing, Medicaid, Medicare, Ohio Medicaid, and other programs. It's just level after level of waste and all of this could be combined into just one god damn program that does the same work and we would save money. But jobs. Oh and also let's not forget the now 3-6 spam calls I get daily from official sounding scam artists who try to "help" with your medical problems (steal money) in your darkest hours and most vulnerable. Does nobody seriously care? Why does the United States of America allow its citizens to be robbed?

When we were clearing out her things we probably had an entire trash bag worth of prescription medication.- Waste Maybe you should be required to return the empty? All those pills had to be safely disposed of.

Equipment - thankfully we could donate this to a local charity but many hospitals and healthcare facilities won't accept things like wound bandages even if they are brand new and sealed in a box.

Transportation - It's unreliable. Companies like Caresource contract with the government to provide rides to get patients to appointments, but they then further subcontract these rides to the most obviously shitty companies imaginable and then those companies contract the rides out to random people who will go pick people up for money. It works sometimes, but ultimately things happen. We had multiple no-call, no-shows and my mom who needed lifesaving cancer treatment had a hard time getting to scheduled appointments. More waste.

I could go on and on.

The thing that pisses me off the most is that we're explicitly opting in to spend more money. It's just a tax that goes to the health insurance industry instead of the government. Health insurance companies are just parasitic entities and do not innovate or provide market efficiencies - they just work to find how they can deny claims and try to "innovate" on billing complication. Unlike pharmaceutical companies and healthcare equipment companies. There are still efficiencies to be had there with licensing, drug patents, trials, etc. but health insurance is a complete scam. If we just did single-payer then we could see some actual innovating on the insurance side from whatever business was remaining that the "wealthy" could afford - which I'm fine with.

I do dislike the usage of "free" to describe the NHS or any government run healthcare program since it's inaccurate (nothing is free) but as another user pointed out the US system is like double cost because you pay taxes, you don't get any of the benefit, and then you have to pay too. Philosophically I prefer people to say "hey we should fund this" versus "I need my free thing from the government" because the former is indicative of a society coming together to support itself and the other is indicative of social collapse. People don't call Social Security free very often, but instead support it because "I paid for it".

[springogeek]

The actual phrase for describing the NHS is meant to be "Free at the point of use", but people are likely shortening for convenience. People are paying for it, but not in a tangible way.

The main thing is knowing that if you need any procedures, services, an ambulance, critical or emergency care, etc, you'll not be asked up front to pay for it, you'll just be treated. Seeing that principle erode over time is heartbreaking and terrifying.

(rant) Healthcare as an industry doesn't function properly under a capitalist model, which expects that competition and consumer choice will encourage innovation and further competition, leading to a better outcome for the consumer. If you need healthcare, you don't really have a choice in it, or your choices are artificially restricted by circumstance, so you can't benefit from a competitive marketplace. It's a broken system, as far as I am concerned.

[ericmay]

I'd say the health insurance industry specifically doesn't function and that's because in the United States you will not be turned away from life saving treatment regardless of the cost [1]. Other aspects range from working very well to working marginally and could be improved. Public-private relationships generally seem to do well but we need to capture more of the profits when the funding is subsidized by the public, but that doesn't mean that private entities who do heavy lifting shouldn't also profit. It seems like we have some clear win-wins if we want to take them. On the whole the government is far better at cutting checks than it is at innovating.

I agree with your statement that "Free" is likely short-hand but I personally still don't like it because I prefer to think of items like that less so as entitlements because entitlements are easy to attack and dismantle. On the other hand when someone feels like they paid for something they are more likely to defend it. Social Security in the US is IMO a good example of this.

[1] Price discovery is impossible in a free market where you can't be denied service. Since society is (in my view correctly) not willing to let people die on the street if they can't pay for treatment the health insurance industry can't function except as a parasite with the aim to extract as much as it can and redistribute it to employees and shareholders. I do think healthcare costs would be cheaper under a "pure" free market where we let people die on the streets, though, but again I just don't find that acceptable.

[nradov]

Ambulance service might be free at point of use but that hardly matters if the ambulance never arrives.

https://www.bbc.com/news/health-64243044

[springogeek]

You're right, but it isn't a helpful comment for the discussion at hand. The story in that article, and many like it, are symptoms of a larger problem, but it's not because of public vs private healthcare.

The system works, assuming it's adequately funded, which it hasn't been for a while. Salaries aren't high enough to live on (thanks to the conservative government and creeping privatisation), and then brexit and other immigration policies have caused a shortage of trained professionals and no one willing to fill the vacancies.

There's a whole heap of issues (I've left out quite a few) stacked up against the NHS, and yet it powers on, doing its best.

[arethuza]

"Free" in the case of the NHS means "Free at the point of delivery",

We know perfectly well that we pay for it through taxes.

[mrtranscendence]

I don't know why people have such a problem with this. Nobody in the UK with an IQ above 70 thinks the NHS is literally free in the sense that no money ever changes hands. "It's not really free!" is a stupid gotcha that doesn't even make sense.

[mrguyorama]

It's a thought terminating cliche that weird people use to imply that making american healthcare would require raising taxes.

[fennecfoxy]

As we should be if we want a utopian society. Better than paying corrupted, monopolistic, lobbying US medical companies over-inflated prices for everything because people have no other choice.

The only issue with public healthcare is the government corruption that tries to kill or diminish public healthcare, but it's still a hell of a lot better for society than private.

[IOT_Apprentice]

Isn't that because the Tory governments have been squeezing NHS to death in terms of funding to try and privatize it?

[MSFT_Edging]

People love to starve the beast then point to the starving beast and say "Look its dying, this was always going to happen".

[theironhammer]

In the USA a big proportion of health care costs is hospital administrators. Also, the cost of administrating all the different private insurance plans. I wonder how much of the NHS budget is eaten up by administrators and how much that cost has increased with all privatization by stealth under the Tories?

The bulk of the budget should go to front line workers not administrators.

[automatic6131]

>because the Tory governments have been squeezing NHS to death in terms of funding to try and privatize it?

No. Often repeated, never true. The NHS has had at or above inflation budget increases every year of Tory government[1]

https://ichef.bbci.co.uk/news/976/cpsprodpb/166A5/production...

Look! Real terms money on the Y-axis, it only goes up!

"Squeezing in terms of funding", "Try and privatise it" are common myths repeated by the Labour party to get elected, and NHS bosses to increase the pie even further.

[rwmj]

(1) It needs more than real terms increases because of a growing, ageing population.

(2) The government is destroying it in other ways, such as not having a proper recruitment pipeline, outsourcing the lucrative parts to the private sector, and failing to pay staff adequately (literally - nurses going to food banks).

[automatic6131]

The mean salary for an NHS nurse is £33k, if you need to go to a foodbank on that salary, you'll need to go to a foodbank on £36k or £40k.

Yes, there has been mismanagement with the recruitment pipeline, because every government prefers to pillage poorer nations for their healthcare staff since it's quicker than training them.

But remember, that's not the original claim is it - I didn't say the Conservatives are doing a perfect (or even good) job, I said they're not "squeezing it dry of funding" and not "trying to privatise it", which are both, still, false.

Also "outsourcing the lucrative parts" - give source for your claim please. They do cross subsidize, allowing private patients to pay for treatment in NHS hospitals, but that's not the same thing.

[r00fus]

> Also "outsourcing the lucrative parts" - give source for your claim please.

This one indicates "unfunded mandates" - a trick the GOP in the US has done for decades (notably so-called Medicare Advantage which created a crisis that didn't exist): https://www.theguardian.com/commentisfree/2022/apr/05/tories...

Another specific tactic is privatizing things that didn't need privatization (or the result is less efficient than what existed before, but it happened to make some corporations and ministers/secretaries a lot of money) - see "failed efficiency savings and privatization" here:

https://www.opendemocracy.net/en/nhs-crisis-rishi-sunak-cons...

Of course, Brexit (another Tory gift to their owners) really messed up things for NHS and caused a number of challenges (see above).

[yunwal]

> £33k

That seems… incredibly low for a licensed profession

[MrJohz]

Bear in mind that that's apparently the mean salary, which one would expect to be somewhat higher than the median (as it's more affected by high salary outliers in upper bands).

The people in the NHS that I talk to say it's running on goodwill and sticking plasters right now.

[zarzavat]

Mean is meaningless. What's the minimum?

[tpoacher]

> Sure, the NHS does provide excellent care, but it's not free. The fact that the British won't come to terms with this is causing its collapse.

In the words of Luke Skywalker: Amazing. Everything you said in that sentence is false.

But focusing on the "it's not free" part; perhaps a distinction should be made in terms of "background passive costs paid regularly (e.g. taxes)" vs "additional costs once you're ill".

What is "not" free in the NHS is the first, but the latter is generally free.

This distinction becomes very meaningful when you realise that, in the US, things like the £145k quoted in the article fall in the latter category, while still paying for the former (in terms of regular insurance or whatnot).

This "dishonest" comparison made when the "NHS is not free" argument is thrown to justify why in the US things cost money, is to ignore the fact that you are also paying the background stuff in the US too, even in the absence of illness, but this is rarely counted in these discussions.

I would love it if someone armed with more numbers than I could give a breakdown of what it costs annually a person to passively contribute to the NHS through taxes vs an average US medical insurance scheme (assuming the US does not have other healthcare related taxes which I do not know about).

[yunwal]

> assuming the US does not have other healthcare related taxes which I do not know about

The U.S. government pays about the same amount per capita (1.2 trillion for ~400 million people or $3000/person) on healthcare as the UK gov. That’s before private insurance costs. Some of this is on things like Medicare, Medicaid, and the VA, which are nationalized health systems for specific portions of the population, but the point still stands that we’re not avoiding taxes going the private route.

[SideburnsOfDoom]

> the NHS does provide excellent care, but it's not free. The fact that the British won't come to terms with this is causing its collapse:

This is complete nonsense. The British public knows very well that the HNS is (or was) and should be "free at point of use", and also paid for via tax. The public want it and want it well funded. The current British political establishment does not like this state of things and seeks to privatise it, but due to the popularity of the NHS, cannot just come out and and say it.

"That's the standard technique of privatization: defund, make sure things don't work, people get angry, you hand it over to private capital."

[BerislavLopac]

> The fact that the British won't come to terms with this is causing its collapse

No, the collapse is caused by the government which has been methodically dismantling it for a couple of decades now, replacing it with private health insurance and moving the ownership of NHS trusts and GP offices to private companies.