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One thing I've heard (correct me if I'm wrong) is that European health systems like the NHS are more than capable of saying no to unnecessary treatment.
The worry is that we lack that ability in the U.S. As a result, we'd end up with all the monstrosities of our current system with even fewer checks on costs. That was certainly the system that Bernie Sanders was proposing during his campaigns.
The necessary increase in taxes could cripple the US economy as well, making us like Britain in more ways than one.
As usually, it comes down to government effectiveness. When the government is effective, it unlocks all sorts of wonderful societal gains: high speed rail, nuclear power, great health care, etc... But when our government is broken and corrupt, more money just equals more waste.
The last few decades have seen government services in the U.S. erode, not due to lack of money but due to lack of competence. In theory, a single-payer system could reduce costs. In practice, it won't. Not with our current government.
In a way, this is part of the problem. A lot of conservative and libertarian criticism of nationalized healthcare is about people being “denied treatment” - almost always terminally ill children who have no hope of survival, brain dead people who will probably never come out of a coma or be non-vegetative, and other cases where the US spends millions of dollars on someone unnecessarily. See the furore about QALYs and death panels. With insurance, premiums can just go up next year, and employers and individuals will just have to pay. Insurers have no real incentive to even negotiate drug costs downward.
The British government is no less easily persuaded by public mawkishness about grandma needing care than the American government is. It is cost pressure and cost pressure alone that forces this kind of pragmatism on the NHS because managers know what the budget for next year is going to be for the entire healthcare system, and increases have to be directed approved by Parliament, the same way defense spending has to be approved by Congress. There’s limited obfuscation, if the industry needs 10% more money next year congressmen have to put their name to that increase. If they don’t, then the system has to cut costs whether it wants to or not.
Do you think that the British cult-of-NHS stuff sometimes mocked by contrarians is about government trying to "pay in appreciation" to make up for things that can't be paid for in real money due to constant cost control?
I think the US system allows the public to dump blame for high costs on insurance executives who are (as we see now) pressured into approving treatments. The UK system seems healthier, in that there’s less anger around healthcare and most people support stuff like QALY-based decisions because the fact that it’s “our” money is more obvious, such that even the median person understands it.
I'm not sure how well the QALY stuff works in practice. I heard stuff about the public being able to pressure the NHS into funding treatments that didn't pass QALY tests. Puberty blockers were also funded by the NHS at some point. Though, I think this treatment seems to be around £1000/year so maybe if your QALY bar is £20,000/QALY then you can make the numbers work if you are able to find some marginal net improvement across the cohort. But I'm very suspicious of these mental health treatments. What if some dude claims if he spends £1000/year on good quality alcohol that passes the QALY bar? At what point does it morph between healthcare and funding utility monster lifestyle choices?
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I don't think this is true, insurers do have a real incentive to negotiate on costs. Here is a basic insurance model, this is about where the money is going from premiums.
Payouts for care (by law an insurer must pay out 80% of premiums collected, the 80/20 rule): 83%
Overhead: 11%
Profit: 6%
I am justifying this model with the below link. You can quibble with the percentages I have assigned, I just guessed at them but they are approximately true.
Now take 2 insurance companies, Company X & Company Y. X negotiates it's drug prices, it gets its drugs for say ~70% of the cost that company Y gets its drugs. This reduces the amount company X needs to spend to provide the same amount of care, now X can either pocket that savings as profit or increase their market share by reducing their premiums. Company X is more effective at giving care, that money goes somewhere. I don't think this is a perfect model, negotiating will likely mean that X has comparatively more overhead vs Y. But I am assuming that companies act in their best interest and wouldn't spend eg $2 to save $1, which is a pretty good assumption.
I think that your model ("With insurance, premiums can just go up next year") really only makes sense when there is only one player in a market and they can do whatever they want, or when the costs of switching insurers are huge. Which I don't think is the case at all.
https://www.oliverwyman.com/our-expertise/insights/2024/jan/health-insurer-financial-insights-volume-12.html
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Maybe you know, but how much chronic illness does the UK wrestle with compared to the US? About the same?
A while ago I went down this rabbit hole about how to combat childhood obesity, and the scourge of associated diseases it causes, assorted advocates are recommending Ozempic as a first line of defense instead of diet and exercise. Because psychopaths are employing HAAS or woke -ISM language to imply diet and exercise is unfair, but Ozempic for toddlers is "equity".
So I sit and I ask myself, does a NHS in the American context make this worse or better? My gut reaction is worse. These people have wormed their way into every level of government policy crafting in a way that has proven (as yet) impossible to uproot. I can't shake the feeling that if we had an American NHS they'd be reporting parents to child services for feeding their kids vegetables instead of pills.
Or take trans kids, an issue I am 1000% against. By and large it's fiat accompli as medical licensing boards have been weaponized, and if even ideologically critical doctors don't toe the "affirm affirm affirm" party line, they lose the livelihood they went into massive college debt and sacrificed over a decade of their life to achieve. All the same, does this get better or worse with an American NHS? My gut is it gets worse. Which is paradoxical as the UK NHS effectively banned the practice of transing kids. But my read on the beliefs of the PMC that would be in charge of an American NHS say the outcome would be the complete opposite.
Because it actually matters what people make up an institution. And presently, I wouldn't trust the federally employed PMC to manage my health. As the groundswell of support for RFK Jr shows, they've done a shit job in their already limited capacity the last 50 years.
Maybe in 4 years, or however long it takes to restore trust in institutions and non-partisan science, my thoughts on this will change. I want to believe things will be different this time around. But I am also prepared for disappointment.
Just a minor nitpick, but since I see this so often:
It's "fait accompli," (French for "accomplished fact") not "fiat accompli" — a "fiat" is an authoritative command or order, and is from the Latin fīat "let it be, let their be, may it become, may it happen" (probably best known from the phrase in the Latin version of Genesis 1:3: fīat lūx, "let there be light").
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Puberty blockers for under-18s banned indefinitely, published just three hours ago. Strange to see a country as culturally close to the US as the UK, to deviate so greatly from the policies of the Metropolis. Maybe Arjin is right, and that transexualism, unlike other minority sexual ideologies, will not achieve permanent victory.
Wes Streeting is an openly gay man and has (like a lot of the Labour cabinet) a fairly consistent record of being pro-LGB and trans sceptic. This is often framed as a matter of "they want to make gay kids trans instead of letting them be gay". Trans activists often frame this anti-trans attitude, the one area of an agenda which the country has otherwise enthusiastically embraced, as being due to the tabloid press. I have to say I agree, the media which has been broadly pro-refugee, gay rights etc. (with the only dissent coming sporadically from the Sun and Express) has been in near lockstep over the trans issue, at least since the Tavistock scandal. Even the Guardian publishes regular TERF-y op eds. Why? Honestly no idea, I mean the outrage stuff clearly sells, but it isn't as if the politicans are all anti-woke, just specifically on this issue.
Far out speculation: there might be a link to the fact that the Conservative party activist wing and MPs are incredibly homosexual from top to bottom, as is Fleet Street. They legalised gay marriage so have their credentials with the LGB crowd already, rather than in the US where it tends to be either LGBT rights OR anti-LGBT. Something there..?
It's interesting speculation, but generally the LGB organisations have taken up the T mantle, and this is no different in the UK (with Stonewall being a strong proponent of trans issues).
Two plausible-ish reasons I've seen come up to explain it are:
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