Saturday, August 15, 2009

Its healthcare, newlyeducated person!

Well thank you so much all of you who bothered to leave such lengthy comments on my query about the US health care debate. I do feel I understand a lot better now. but of course with understanding comes that desire to comment. Not on the US system per se - as all I know about that is what you told me yourselves. But on our system, as I understand it has been dragged into the debate.

The NHS is funded by national insurance which to all intents and purposes is another name for income tax. This means that you get treated irrespective of income. Everyone is entitled to the same. This ideal - with which I can have no argument in principle - does not work perfectly.

It was set up in the post war years when the available treatments were a lot less in number and a lot less costly. Plastic surgery was experimental, transplants did not exist. This was in the Pre-AIDS, pre IVF days. I venture to suggest that the general populace were also a lot more grateful and a lot less of the view that if something exists they are 'entitled to it' irrespective of cost. So, now the system is struggling to fund every new and very expensive treatment which drug companies patent. Unless we all want to pay more into the system we have to accept that there will be some judgement calls on what can be afforded. This is particularly difficult when there is a drug which will extend life for a very short period but will not cure and it of great cost in that short period compared to another treatment which could, for the same cost, give benefit to many more people.

The NHS is now dealing with a larger population who are living longer. There are waiting times. There have been relatively few, but nonetheless horrendous examples of ill treatment of elderly people and of negligence cases. But every system which is staffed by people will suffer from misjudgments and bad attitudes.

Over all it is a great system. No one need worry in this country that if they get cancer, have a stroke or slice their finger with a rotary cutter ( guess who!) that they will get no treatment at all. It is free at the point of use, which can cause annoyance when it is misused by those who have never paid taxes into the system. But I for one would rather have to carry the drunken unemployed yobs who require A&E care at 3am on a weekend than see decent folk go without healthcare they need. I do think that we have to accept that some treatments are beyond our collective capacity to afford at current taxation rates.

That said, I also have private health insurance. Dennis and I have both had surgeries on the NHS and privately. I would make the following observations:

1. The surgical care is no different.
The surgeons work for both systems and their skills are no different on a Tuesday in the NHS to a Wednesday in BUPA hospital. However, you get a much longer consultation pre operation in the private system.

2. In our experience the nursing care was far better in BUPA.
However, I believe that to have been a matter of which individuals you got and of their attitude rather than of qualification levels. I do think that the working environment for nurses in the BUPA hospital is calmer and more pleasant. I think they are treated better by their patients and so their attitude is much nicer and more caring. In the NHS the night staff ignored the surgeons pre-op instructions for Dennis. They yelled to each other down the ward in the middle of the night. He was perfectly cared for in the BUPA hospital.

3. The private system allows for convenience.
When I needed to see a consultant I was told I would have to turn up at a day clinic. All patients are called at the same time and you sit and wait. It was considerably cheaper for me to pay ( this was before we took out insurance) to see the consultant in a private hospital close to my home at 6pm in the evening than it was for me to take that day off work. This despite the fact that the consulation time allowed was much longer. X rays were taken instantly in the room next door and looked at at once.
When my sister in law needed an MRI - she was in Northern Ireland - the waiting lists were so long that at one point they were considering sending her to Scotland. I had mine done four miles from home on a day of my choosing. That said my sister in law did in fact have it done in Ireland after her treating surgeon intervened.

4. The private system is quicker.
There is no doubt about this - Dennis got appointments within days not weeks or months as in the NHS. Again, this is cost effective for me. If I have a condition which means I cannot work, my income protection insurance only kicks in after 6 months. (Although I could pay more and have a shorter period of course). I might wait that time on the NHS. With BUPA I can minimise the costs of unpaid time off work which is cost effective. Even when Dennis was working this benefits the state. By us paying to go private we minimised the sick pay the state had to pay him. There is no flexibility in the NHS. Once, he needed a blood test. He asked could he be seen first in the day because then the school would not need ( at tax payers expense) to pay for a sub while he sat the day in hospital. He was told in no uncertain terms that he would not get 'privilege'. So the state paid for him to sit there while retired people went in front of him.

5. The private system is nicer.
Nothing whatsoever to do with health care or how quickly I recover. But I did not enjoy recovering from an operation in a communal ward,open to a corridor when I could hear every word of every vistor's conversation and they mine. Give me a private room anytime and I will pay for it. It is not essential at all to health care that room service is available for visitors and that there is a choice of menu for patients. But is makes being ill that little less stressful. It did not kill me that the NHS bed I was put into to recover from my day operation was marked 'for paediatric ward use only' and had holes in the blankets, But if its all the same I'd rather pay and have a nicer surroundings.

On a more serious note when ward rounds were done in the NHS ward I was required to leave to give the patients privacy - because the only thing that separates you from the next bed whilst the doctor is examining you is a curtain. So families are not present when these consultations take place. (It admittedly might be different with an operation that was more serious). Not so in the BUPA hospital. In BUPA I could visit at anytime which was very helpful when Dennis was in inpatient and I had work commitments some distance from home.

6. Private patients subsidise the NHS over and above their national insurance payments.
Lets say I need surgery that costs £3000 on the NHS. I will get that for free at the point of use. I will either have overpaid or underpaid for it depending on how much tax I have paid by the time I die! But to go privately it costs much more - say £7,500. I have to pay for that either in cash or via my private insurance. However, I do not then get my £3000 worth from the NHS. I do think that sum should be transferred to BUPA (less admin costs) to defray the private costs. But you cannot 'top up' in that way. So the NHS gets an additional bonus saving.

7. I still get benefit from the NHS because although you can see a private GP here few do. We use NHS GP's and the insurance then kicks in from the time you are referred to the appropriate consultant. Plus the NHS trains the surgeons who then operate part time at BUPA hospitals. So there is no problem in my view of paying for both systems because I do benefit from both but also people who have a low income also need me to chip into provide for the health care of others. That seems to me like a basic human thing to do for your fellow citizens.

8. I suspect that - for reasons which I do not understand but probably relate to profit - US insurance will be more costly than here. For me for a system which kicks in at the point of referral to to a consultant and which has a deductible of £500 per year ( I had a choice of what to set that at) it costs me £ 36.35 per month. That's US $60.28 per month for unlimited treatment. The same plan for Dennis costs £71 as he is older and had some pre-existing conditions when we took it out. Whether that is affordable or not depends of course on what you earn and what you decide to prioritise in your budget. We made a conscious decision not to buy a SKY TV sport package at £35.50 per month but to have health insurance at £36.35 for example. Or if you want a comparison on buying power terms my plan costs 3.63 metres of full price quilting cotton a month. I don't think, for the benefits you get that can be objectively termed expensive. My taxes on another hand I do consider high at 41% at the top level. (That's tax and NI combined). I do think that if we want the NHS to spend more the cost has to come at the basic rate of tax (currently 20%) so almost everyone will contribute not at the top rate where the few are carrying the many. That may well mean families have less discretionary income but essentials should come first.

So, my conclusions. I would tinker with the NHS but I would not want my country without it. I do not want my sister, my parents, my friends, my neighbours, my clients to be worried that they may have cancer but not be able to afford treatment. Would I give up my private insurance? It would be one of the very last payments to go if I was in financial trouble. But that is not because I need it for treatment. I need it for speed which does make financial sense for me. And I need it because I choose to be ill in an environment closer to a hotel or the standards of my own home than a waiting room - a probably snobbish attitude which I, not all tax payers should pay for.

So ,anyway that is my view. I think that might be that topic dealt with!


Margeeth said...

Your NHS system sounds great to me. We had a system like that in the Netherlands, but it has been abandoned for a system in which everyone pays a set premium (which is about 100 pounds), regardles of income and if you have more money you can also pay for extra coverage.

By the way, there was an item at the dutch news about the health care debate in America. One woman, her face contorted (with hate /rage /fear?) was screaming that "healthcare is not a right, it is a privilige".

Feather on a Wire said...

Well said. You might find your insurance for private treatment goes up exponentially when you hit sixty. (Though it would still be the very last thing I would give up)

Kristin L said...

Thanks for the insight.

Anonymous said...

the English system sounds similar to the Australian (or vice versa probably!). I always had private health insurance too - until we had to use it.

after the first baby we received 'gap' bills in excess of $1000 for stuff i didnt really need - blankets without holes, a semi private ensuite room and my 'own' ob-gyn, who just happened to be playing golf - i kid you not - so i had one of his mates who id never met with his hand up me - so much for paying for your 'own' doctor! . So we decided private insurance was a rip-off. now we just save the money, go public, and if necessary (mammograms in private hosptial so i am only sitting around waiting for my appointment for 4 hours not 12, and dentists, optical etc)we just pay the full amount. And very pleased we did too when i had a complicated birth for the third child and we were both in hosptial for three weeks (admittedly with a charming selection of crack whores in the bed next to me)- we'd still be paying off the 'gap' bills! the australian public system is ok (some tweaking required as you said) but the private insurance system is a crock - insurance is just a money making venture. id rather pay more tax for a better public system than fork out huge insurance premiums - and then only get a portion of the costs back .

Beverly said...

Thank you for that explanation of the British system- all I've ever heard is from my British-born BIL, and the experiences of his older relatives he talked about were decidedly less favorable.

You are right that health insurance here costs more. My son, who is 30, pays over $400 per month to cover himself and his wife. Have no idea what it will go up to when their baby is born next month. And, it is not a gold-plated plan like all Washington politicians have- for free, I believe.

Would that every American citizen could understand, as you seem to, that providing healthcare for all can actually benefit all of us. But the attitude expressed at some of the town meetings, that it is a privilege, is distressingly common in some parts of this country.

Judy said...


A most interesting read, we have a continuing debate here in Tasmania, and our Federal Gov. is going to look at changing who owns hospital OZ wide. It is difficult to provide for all to have good health care, but it seems such a huge systems always seem to break down somewhere. Thanks for a well written observaation of the British system gives one food for thought.

Jude said...

Having worked for the NHS and BUPA, I do take your observations slightly to heart. I am the same person..doing the same job...treating the, hmm? same patients. I didn't treat anybody differently..must add I was treated differently by the non NHS patients, who seemed to think I was being paid personally by them so could treat me like a personal maid.
Did you take into consideration that you lived so close to MRI was the reason you were seen quicker, what was the distance from your relative's? Also, the amount of people needing the service?
On the whole (apart from a couple of years in A and E)I worked on wards where the staff treated the patients with care and consideration. The families were catered for as much as possible within the limitations of a six bedded bay.Most people can visit between 10 am. and 8 pm.After all, patients in hospital are ill or recovering, so, need as much rest as possible where the thought of entertaining visitors is rather tiring to say the least! There were also several single bedded rooms for privacy.
Very interesting..

Carol said...

Thanks for the great info on your system. It has really increased my understanding. Don't know which way the US will go but some sort of change is needed.