[nvm0n1]

Your study doesn't actually say that. You'd expect their comparison to be with other developed countries given how it's worded, but in reality:

The UK had the lowest healthcare expenditure per capita relative to our comparator countries (UK, $3825 (£2972; €3392); study average, $5700), although this was roughly in line with the average healthcare expenditure of the OECD member states ($3854) and the EU member states

So the UK spends about the same as other EU and OECD countries. It only spends less compared to a set of hand-picked "comparator countries" which are: Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland, and the USA.

That's a remarkably cherry-picked list. If you average such a small list then the mean will be dominated by healthcare spending in the USA. To get better and less cherry-picked data you can turn to the ONS. See Figure 1 (2017) here:

https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

The UK is around the same level as Finland, New Zealand and other developed countries.

This chart really makes it obvious how they picked their "comparator countries": all the countries that spend the most on healthcare. That isn't surprising. It's hard to get a more biased source on British medical spending than the British Medical Journal. Of course academics specializing in healthcare will claim the UK doesn't spend enough on healthcare.

[MattPalmer1086]

Thanks, must read my sources more carefully! Still second lowest in G7 though.

[nvm0n1]

Maybe. There's a lot of noise in these measurements. A lack of error bars doesn't mean a lack of errors. For many years activist orgs and newspapers liked to claim the UK was at the rock bottom of EU healthcare spending, that it spent far below other nations. When new accounting standards came in that tried to unify the way healthcare spending was measured between nations, overnight the UK went up to be about the middle of healthcare spending. The reason was, social care spending hadn't previously been reported as healthcare spending in the UK whereas in other places it was. Standardizing that fixed the disparity.

There are still big sources of error in these numbers. It's not obvious, but spending on IT systems and hospitals (capital investment) isn't included in these numbers, yet these have sucked up a lot of NHS spending over time especially in the form of large failed IT projects, and capital expenditure on hospital buildings has often been done "off the books" in the UK using PFI schemes.

Unfortunately the ideological basis of the NHS means that many people feel a nearly moral obligation to argue its failings are always about money, especially Brits who work in the healthcare world themselves. It's a risk free strategy. To criticize the way the NHS is actually structured or operates would come dangerously close to wrongthink.

[MattPalmer1086]

The NHS is pretty much like a religion in the UK, it is true. Most of us are very wedded to the idea that health care that is free at the point of use for all is a very good thing.

We are also used to people who would rather we had a more US-like health system pretending that they care about it while actually trying to make it fail, effectively to privatise health care by the back door.

So it's a hard subject to debate rationally here for sure.

[ghusto]

It's crazy how weird people get about it, but I think it's a class-shame thing. I grew up in a poor council block, and have _no_ qualms calling it out for what it is.

Also, completely-free or U.S.A.-style-nightmare are not the only two options. There's a whole rainbow in between, those are extremes! I'm now in a country that's got the balance right; everyone has healthcare, and everyone who can afford it (most) pay affordable insurance for it. The standard of care is _amazing_!

[nvm0n1]

I don't think the UK has ever had a government that actually wanted the NHS to fail. Even the most right wing conservatives realize they're stuck with it and that voters will be happier if it works better. They have very few levers to achieve that. Private sector involvement is one but not a very powerful one given that the NHS killed off the private health sector in the UK and ensures it can't regrow to any kind of meaningful capacity. To the extent it grew in the last few years that's only because the NHS is now in the stages of advanced collapse, failing to provide even the most basic services you'd expect and therefore for some paying twice is the only way to get healthcare at all.

I also really doubt there are many in government or politics who want a US style system. The US has a strange system replicated nowhere else (much like the UK). The way healthcare is tied to the employer there is a legacy of socialist economics during WW2. To try and stop inflation wage controls were implemented so companies started to compete via non-wage benefits, like bundled health insurance. Then for reasons I don't know it was made tax-exempt, so the tax system incentivized workers to demand healthcare through their employer instead of paying it themselves. And then legal changes and union campaigns cemented that system. Part of why US healthcare is so expensive is the sheer number of layers between the people who use it and the act of paying for it. It's very much an accident of history born in the war, and not a model to obviously replicate.

The UK system is likewise rather dysfunctional thanks to WW2. Years of wartime propaganda followed by a victory convinced Brits that the government must be very good at things, and of course this was an era in which socialist economics was taken seriously across society. So on victory the UK immediately voted in a Labor government that nationalized many industries including the entire healthcare system, with Bevan famously dividing and buying off doctors who realized it'd be a bad idea by "stuffing their mouths with gold". Governments have attempted to use the same strategy to solve its problems ever since, yet have never been able to predict or control costs in the way a business would need to. Even in its very first year, costs were double what was predicted. This is very far from the original belief that GDP improvements from the NHS would be so great it would effectively pay for itself.

[DanBC]

> I don't think the UK has ever had a government that actually wanted the NHS to fail.

> I also really doubt there are many in government or politics who want a US style system.

You might want to read "Britania Unchained" which very much says that they want to dismantle the NHS. There's a bunch of current Conservative politicians who want to effectively dismantle the NHS and implement a US style system. They're very clear about this.

[nvm0n1]

Indeed that's so, but it's not what I said. Those politicians want to dismantle the NHS because they believe that it will inevitably fail regardless of what they do, indeed that it already is failing, and that there's just no way to make that structure work, no more than the USSR could be made to work. That's not the same as wanting it to fail. Clearly life would be easier for them if it weren't the case as then they could avoid being blamed by voters for it.

The book doesn't say they want to replace the NHS with a US style system. Have you read it? I haven't but according to the Guardian - the least friendly and neutral reviewers imaginable - they argue for a French style system instead:

https://www.theguardian.com/politics/2012/aug/22/britannia-u...

Sometimes these are less fearsome than you might expect – Raab likes the French healthcare system; Truss admires the German economy – but often the foreign models cited are Asian

Observe: no mention of the USA. But it seems that the book must hardly mention health, given that healthcare isn't even mentioned on the Wikipedia summary of the book and the Guardian review mentions it only in passing.

The idea that the Tories hate the NHS for ideological reasons and want the US system is a common idea on the British left, but that's not what they really think. What they really think is that the NHS is a lost cause and a European health insurance model would work better. They also think a US style economy would be beneficial. Given that the US is now a lot richer than the UK and their economy is motoring ahead, it seems the book's prediction of a "slide into mediocrity" has come true. The ultimate determinant is wealth - given enough of a gap, a poor Britain will always have worse outcomes than a rich USA regardless of how healthcare costs are paid.