Privatisation of the NHS discussion

[Howardh]

I think the NHS deserves it's own thread, but on the Brexit theme, I wonder if any leave voters would change their minds if, down the line, in order to get trade deals with the US it meant our NHS becoming partially, or wholly privatised meaning the majority of us would require costly insurance, which could be astronomical if you have conditions??

Personally if anyone touched our NHS I think the voters would be aghast and it would bring down any government trying to privatise it. But that's just a feeling; does anyone think the only way to save/improve the NHS IS to privatise it, and if so how would pensioners, or those with pre-existing conditions pay for it?

 

[coppercapped]

I think the NHS deserves it's own thread, but on the Brexit theme, I wonder if any leave voters would change their minds if, down the line, in order to get trade deals with the US it meant our NHS becoming partially, or wholly privatised meaning the majority of us would require costly insurance, which could be astronomical if you have conditions??

Personally if anyone touched our NHS I think the voters would be aghast and it would bring down any government trying to privatise it. But that's just a feeling; does anyone think the only way to save/improve the NHS IS to privatise it, and if so how would pensioners, or those with pre-existing conditions pay for it?

I agree about the NHS having its own thread, but just to make a quick observation. The NHS versus insurance debate always takes the situation in the USA as the only alternative. This is not true - closer to home there are many variations in ways health cover can be provided without the State being the provider. In the three countries on the continent where I have worked and lived (Germany, Belgium and France) health insurance is provided by non-state bodies - these can be insurance companies but in most cases are a form of not-for-dividend co-op ('mutuelle'). These bodies are however closely regulated by the Land, Federal or State governments as appropriate. It is a legal requirement for individuals to have health insurance but one does have a choice of providers - the quid-pro-quo is that the insurers are obliged to insure all comers.

In Germany the local town council has to provide the hospital buildings, the number of beds being aligned to the size of the local population, but the medical and running costs are carried by the Krankenkassen. In France many routine examinations - blood tests, X-rays and so on are supplied by medical test centres in the high street on the production of a prescription from one's doctor, it is not necessary to schlepp to a hospital which could be some way away. In Germany no money changes hands at the doctor's surgery - and one can change one's doctor at fixed intervals if one wants to with no complications; in Belgium and France one pays the doctor or service at the point of use and then claim the expenses back from the Mutuelle. For socially disadvantaged people in Belgium and France special arrangements are in force whereby no cash - or only a nominal amount - changes hands.

Insurance rates in all three countries are on a par with the payments individuals make to the NHS (NI plus a part of income tax) in the UK. The USA is NOT a good example of the alternative to the NHS.

 

[Howardh]

I agree about the NHS having its own thread, but just to make a quick observation. The NHS versus insurance debate always takes the situation in the USA as the only alternative. This is not true - closer to home there are many variations in ways health cover can be provided without the State being the provider. In the three countries on the continent where I have worked and lived (Germany, Belgium and France) health insurance is provided by non-state bodies - these can be insurance companies but in most cases are a form of not-for-dividend co-op ('mutuelle'). These bodies are however closely regulated by the Land, Federal or State governments as appropriate. It is a legal requirement for individuals to have health insurance but one does have a choice of providers - the quid-pro-quo is that the insurers are obliged to insure all comers.

In Germany the local town council has to provide the hospital buildings, the number of beds being aligned to the size of the local population, but the medical and running costs are carried by the Krankenkassen. In France many routine examinations - blood tests, X-rays and so on are supplied by medical test centres in the high street on the production of a prescription from one's doctor, it is not necessary to schlepp to a hospital which could be some way away. In Germany no money changes hands at the doctor's surgery - and one can change one's doctor at fixed intervals if one wants to with no complications; in Belgium and France one pays the doctor or service at the point of use and then claim the expenses back from the Mutuelle. For socially disadvantaged people in Belgium and France special arrangements are in force whereby no cash - or only a nominal amount - changes hands.

Insurance rates in all three countries are on a par with the payments individuals make to the NHS (NI plus a part of income tax) in the UK. The USA is NOT a good example of the alternative to the NHS.

All that's fine, and shows excellent knowledge, but likely to be irrelevant as we are leaving the EU and it's clear the americans want to get their hands on our NHS in return for a deal. https://www.theguardian.com/us-news/2019/jun/04/trump-says-he-turned-down-corbyn-request-to-meet

Donald Trump has declared he wants the NHS to be on the table in any US-UK trade deal and refused to meet the “negative” Labour leader, Jeremy Corbyn, who pledged to oppose US corporations taking over the health service with every breath in his body.

However further down the article those comments have been "rown back" although I take whatever Trump says with a dose of salt the size of Kent.
If we could end up with a German system (for example) and no US input whatsoever that may be far more palatable.

 

[takno]

I agree about the NHS having its own thread, but just to make a quick observation. The NHS versus insurance debate always takes the situation in the USA as the only alternative. This is not true - closer to home there are many variations in ways health cover can be provided without the State being the provider. In the three countries on the continent where I have worked and lived (Germany, Belgium and France) health insurance is provided by non-state bodies - these can be insurance companies but in most cases are a form of not-for-dividend co-op ('mutuelle'). These bodies are however closely regulated by the Land, Federal or State governments as appropriate. It is a legal requirement for individuals to have health insurance but one does have a choice of providers - the quid-pro-quo is that the insurers are obliged to insure all comers.

In Germany the local town council has to provide the hospital buildings, the number of beds being aligned to the size of the local population, but the medical and running costs are carried by the Krankenkassen. In France many routine examinations - blood tests, X-rays and so on are supplied by medical test centres in the high street on the production of a prescription from one's doctor, it is not necessary to schlepp to a hospital which could be some way away. In Germany no money changes hands at the doctor's surgery - and one can change one's doctor at fixed intervals if one wants to with no complications; in Belgium and France one pays the doctor or service at the point of use and then claim the expenses back from the Mutuelle. For socially disadvantaged people in Belgium and France special arrangements are in force whereby no cash - or only a nominal amount - changes hands.

Insurance rates in all three countries are on a par with the payments individuals make to the NHS (NI plus a part of income tax) in the UK. The USA is NOT a good example of the alternative to the NHS.

The systems allowed in Europe would potentially not be acceptable under a US trade deal. You would potentially have rules requiring mutuals to compete with American health providers on terms which were largely set by the US health providers. More importantly, the ability of the NHS (or mutuals) to act as a syndicate buyer and tame the excesses of the US drug industry would be hobbled, and we may even struggle to make safety-grounds arguments for not allowing some of the drugs which we currently ban or severely limit. Irrespective of the actual form of the health system, we could end up with something that costs everybody a significant multiple of the NHS, and can't protect us from idiocy like the current US opioid crisis

 

[edwin_m]

There are graphs kicking around that show health spend per person along the bottom and outcomes up the side, and the USA is generally an isolated point down in the bottom right hand corner. For people who can get the relevant insurance the tendency is to over-treat, and of course many people don't have any provision at all. So the track record of American companies in delivering cost-effective healthcare is pretty poor. Even the private companies involved in the NHS today game the system by only taking the simpler cases within a particular treatment category, leaving the local NHS to do the more complicated ones with both receiving the same payment per treatment. And guess who provides the emergency care if something goes wrong...

Somebody's obviously taken Trump aside and explained to him that threatening the NHS damages the chances of the Brexit and the potential leaders he so favours. He tends to think whatever someone last whispered in his ear so on this occasion I would guess his first utterances were closer to his actual belief.

 

[fowler9]

I agree about the NHS having its own thread, but just to make a quick observation. The NHS versus insurance debate always takes the situation in the USA as the only alternative. This is not true - closer to home there are many variations in ways health cover can be provided without the State being the provider. In the three countries on the continent where I have worked and lived (Germany, Belgium and France) health insurance is provided by non-state bodies - these can be insurance companies but in most cases are a form of not-for-dividend co-op ('mutuelle'). These bodies are however closely regulated by the Land, Federal or State governments as appropriate. It is a legal requirement for individuals to have health insurance but one does have a choice of providers - the quid-pro-quo is that the insurers are obliged to insure all comers.

In Germany the local town council has to provide the hospital buildings, the number of beds being aligned to the size of the local population, but the medical and running costs are carried by the Krankenkassen. In France many routine examinations - blood tests, X-rays and so on are supplied by medical test centres in the high street on the production of a prescription from one's doctor, it is not necessary to schlepp to a hospital which could be some way away. In Germany no money changes hands at the doctor's surgery - and one can change one's doctor at fixed intervals if one wants to with no complications; in Belgium and France one pays the doctor or service at the point of use and then claim the expenses back from the Mutuelle. For socially disadvantaged people in Belgium and France special arrangements are in force whereby no cash - or only a nominal amount - changes hands.

Insurance rates in all three countries are on a par with the payments individuals make to the NHS (NI plus a part of income tax) in the UK. The USA is NOT a good example of the alternative to the NHS.

Yeah but we are leaving the EU.

 

[edwin_m]

Yeah but we are leaving the EU.

Which doesn't make any difference to whether we could, if we wanted, adopt the systems used in countries that are remaining in the EU. It does make it possible for our government to go after a trade deal with the USA - which would be almost totally on their terms possibly including allowing American firms to take over parts of the NHS.

 

[Howardh]

Perhaps the mods could split this into a separate NHS thread - and other non-Brexit NHS issues cou

Which doesn't make any difference to whether we could, if we wanted, adopt the systems used in countries that are remaining in the EU. It does make it possible for our government to go after a trade deal with the USA - which would be almost totally on their terms possibly including allowing American firms to take over parts of the NHS.

One difference in leaving the EU could be the sourcing and cost of drugs and medicines that come into this country. If there's no deal I would expect tariffs to be placed on EU imports, thus increasing the cost burden on the NHS, pharmacies and individuals.

I suppose they won't be able to stop us travelling to Bulgaria for cheap dental treatment which costs a bomb here even under NHS charges (ie a bridge or crown)!

 

[fowler9]

Which doesn't make any difference to whether we could, if we wanted, adopt the systems used in countries that are remaining in the EU. It does make it possible for our government to go after a trade deal with the USA - which would be almost totally on their terms possibly including allowing American firms to take over parts of the NHS.

Well there you go. We can get a deal with the EU which we are currently part of anyway or go to the US and see what they are willing to offer, ha ha.

 

[krus_aragon]

Well there you go. We can get a deal with the EU which we are currently part of anyway or go to the US and see what they are willing to offer, ha ha.

I don't think you've quite understood @edwin_m 's point. If the UK wishes to reform it's healthcare system, it could copy the system used in another EU country whether we're still part of the EU or not.

(And if no EU country looks inspiring, and neither does the US's approach, there are plenty of other countries we could study and take pointers from.)

 

[fowler9]

I don't think you've quite understood @edwin_m 's point. If the UK wishes to reform it's healthcare system, it could copy the system used in another EU country whether we're still part of the EU or not.

(And if no EU country looks inspiring, and neither does the US's approach, there are plenty of other countries we could study and take pointers from.)

I think I did and I think if we want a trade deal with the US outside of the EU they will be pretty insistent on the health care side. Medical care is big money in the US. I think maybe you don't understand my point.

 

[dgl]

I think I did and I think if we want a trade deal with the US outside of the EU they will be pretty insistent on the health care side. Medical care is big money in the US. I think maybe you don't understand my point.

yes, any country that allows TV adverts for PRESCRIPTION medication is not exactly one I want to have access to the NHS.

 

[krus_aragon]

I think I did and I think if we want a trade deal with the US outside of the EU they will be pretty insistent on the health care side. Medical care is big money in the US. I think maybe you don't understand my point.

Indeed, I had misunderstood. I thought you were emphasising that we had to stay in the EU in order to emulate a European healthcare model. Now I understand that you were focusing on the opposite scenario of seeking closer relations with the US instead, and that we may end up opening the "private competition" aspect of the NHS* to US healthcare providers as a result.

I did indeed catch the wrong end of your stick. Sorry.

*This "competition and choice" thing is England-only so far, as I understand it. I certainly haven't come across it in the Welsh NHS yet.

 

[SteveP29]

If anyone needs a heads up about what a privatised healthcare system looks like, then have a read of this.....

https://twitter.com/Iwantcurlyhair2/status/1135928793409843200

 

[DarloRich]

Bad idea for normal people. Close thread.

 

[SteveP29]

yes, any country that allows TV adverts for PRESCRIPTION medication is not exactly one I want to have access to the NHS.

Indeed, when I was over there, the disclaimers for the drugs they were advertising went on longer than most UK adverts.
The only things that got advertised on TV in Florida were medicines and cars

 

[Aictos]

The only reason why the US wants more access to the NHS is because at the moment, said organisation is the bar for 25% of all transactions made by the US drug companies so of course they want more access so they can charge even more for vital life saving drugs which is wrong.

They just want a one way trade deal that only benefits the US which should never happen!

 

[Typhoon]

If anyone needs a heads up about what a privatised healthcare system looks like, then have a read of this.....

https://twitter.com/Iwantcurlyhair2/status/1135928793409843200

Please do read it. Please don't lets sleepwalk into some sort of medical hell. (Thanks for the post - it is worse than I thought.)

 

[DarloRich]

Please don't lets sleepwalk into some sort of medical hell. (Thanks for the post - it is worse than I thought.)

We will. Brexit will deliver this. The country is falling apart and most people don't care.

 

[thejuggler]

I don't have to read it. My wife works for a US company and hears the stories regularly.

 

[fowler9]

Indeed, I had misunderstood. I thought you were emphasising that we had to stay in the EU in order to emulate a European healthcare model. Now I understand that you were focusing on the opposite scenario of seeking closer relations with the US instead, and that we may end up opening the "private competition" aspect of the NHS* to US healthcare providers as a result.

I did indeed catch the wrong end of your stick. Sorry.

*This "competition and choice" thing is England-only so far, as I understand it. I certainly haven't come across it in the Welsh NHS yet.

No worries mate. The thought of having a health care system like the US terrified me. The vocalist of a band I like died of treatable cancer when the families money ran out. The was a massive whip around in the music community but the insurance companies wouldn't take him on because he already had cancer.

 

[Typhoon]

It almost reminds me of the Neil Kinnock speech of almost 36 years ago which starts

If Margaret Thatcher is re-elected as prime minister on Thursday, I warn you.
I warn you that you will have pain–when healing and relief depend upon payment.

Not Margaret Thatcher of course, but doubtless that are one or two of the candidates who would happily take us down this route (although they won't admit to it) and a few more who could be convinced if only because it may be made a requirement for a trade deal with the US. Ironically the Kinnock speech was made in Bridgend. The speech also includes

I warn you that you must not expect work–when many cannot spend, more will not be able to earn. When they don’t earn, they don’t spend. When they don’t spend, work dies.

 

[krus_aragon]

And to throw out another scare story, there's the caravan of people who travelled north to Canada to buy affordable insulin, as reported a month ago. Here's the Independent's article, and a more in-depth analysis from north of the border by CBC.

Long story short: incremental improvements to insulin formulations have kept it under patent in the US, so it's not available in a generic form from third party manufacturers. Older varieties are not licensed in the US. Healthcare insurance often expects the patient to pay the first X of the cost, like our car insurance excesses. That excess, or deductible, can be on the order of $1000-$10,000 a month.

So when a 10ml vial of insulin costs $300 in the US, and the Canadian equivalent costs $30, a lot of people will drive for hours to another country instead.

 

[AlterEgo]

Many privatised healthcare systems are far better than what we have here, but not America's. The US healthcare system only works for you if you're reasonably wealthy and get REALLY sick.

We should continue to keep our options open when it comes to suggesting a different healthcare model, but I don't want the US involved with our system at all. I don't see any appreciable benefits.

 

[hexagon789]

I think the NHS deserves it's own thread, but on the Brexit theme, I wonder if any leave voters would change their minds if, down the line, in order to get trade deals with the US it meant our NHS becoming partially, or wholly privatised meaning the majority of us would require costly insurance, which could be astronomical if you have conditions??

Personally if anyone touched our NHS I think the voters would be aghast and it would bring down any government trying to privatise it. But that's just a feeling; does anyone think the only way to save/improve the NHS IS to privatise it, and if so how would pensioners, or those with pre-existing conditions pay for it?

I support using private companies to provide some NHS services, but I will not support privatising the NHS for any reason. One of the things I think we can be rightly proud of is our NHS and if we need to raise taxes to ensure its continuance I think that's something the overwhelming majority of people would accept.

And yes, he who touches the NHS commits political suicide, no doubt about that!

 

[Bletchleyite]

We should continue to keep our options open when it comes to suggesting a different healthcare model, but I don't want the US involved with our system at all. I don't see any appreciable benefits.

I don't want the US involved in anything in the UK, really. I can't think of a single thing it does better than us either politically or commercially. I see only disadvantages.

 

[Howardh]

I don't want the US involved in anything in the UK, really. I can't think of a single thing it does better than us either politically or commercially. I see only disadvantages.

(we really need a "like" button!)

 

[krus_aragon]

I don't want the US involved in anything in the UK, really. I can't think of a single thing it does better than us either politically or commercially. I see only disadvantages.

Their federalised structure of government is better than our federalised structure, but we've only really been doing it for a few decades. After that, though, I'm drawing a blank.

 

[Howardh]

I think privatisation will creep in by the back door; such as making us pay for food and board when in hospital. After all, it could be argued, we have to feed ourselves at home, keep the gas on etc; so why should the NHS pay when we're not there?
Then pay for the bedding and washing. After all, we would at home...
Etc etc.
So we have to be very wary. However, how many think we should pay for board and lodgings (an insure ourselves for the cost if necessary)?

 

[433N]

It almost reminds me of the Neil Kinnock speech of almost 36 years ago which starts
Not Margaret Thatcher of course, but doubtless that are one or two of the candidates who would happily take us down this route (although they won't admit to it) and a few more who could be convinced if only because it may be made a requirement for a trade deal with the US. Ironically the Kinnock speech was made in Bridgend. The speech also includes

"I warn you that you must not expect work–when many cannot spend, more will not be able to earn. When they don’t earn, they don’t spend. When they don’t spend, work dies."

Nice words. It's a wonder he couldn't bring himself to support the Miner's Strike if that's what he believed ?