Friday, August 14, 2009

British healthcare

Apparently there's been a bunch of ads on TV feeding US populace the horror stories about how horrible NHS is.

This is what real British - you know, the ones actually living there and using British health care (where doctors by and large are government employees and the health care costs are almost entirely paid by the government) - have to say about it:

"Watching these debates is like reading National Geographic. It's just impossible, from a European perspective, to understand what these people are on about. Their political views seem as backwards and removed from the world we live in as a shaman casting magic spells."$1318652.htm

Also, from Investor's Business Daily editorial on 8/3: "People such as scientist Stephen Hawking wouldn't have a chance in the U.K. where the National Health Service would say the quality of life of this brilliant man, because of his physical handicaps, is essentially worthless."

After much ridiculing on the interwebs, they removed the sentence. Pity, it was yet another proof that money != brain.


DzembuGaijin said...

NHC does not have to replace all HC. Just like with schools. There are public and there are privet. NHC sounds like a good idea to me in general, but devil is in details (implementation). NHC will do nothing bad to rich people,but it will do a lot of good to poor. The middle class or upper middle class benefits are a main question here. :-) Most likely that will mean a lower quality of service and/or price increase for a better privet care. This is a simple math. But ... may be it can be done so, quality stay the same or even better, I do not know enough about details to be able to tell.

DzembuGaijin said...

The best HC is French of course :-);contentBody

nathan3700 said...

I'm against NHC, but it doesn't mean I can't acknowledge the good in the British and French systems. They are good in terms of equalizing outcomes. But America isn't about equal outcomes, it is about equal opportunity and *different* outcomes. The primary characteristic of freedom is that it lets people enjoy/suffer the consequences of their free choices.

So freedom would be the casualty if we copied British of French systems. We would also sacrifice the ability to choose really good health care, as the good of the "many" would require we all receive the same watered down government controlled care. So, if you care about optimizing for the average health (such as the WHO), you get once system, but if you care about preserving freedom (which is what America uniquely among nations stands for--in principle if not in practice) then you get a different system.

The question should be, not how well we can copy France, but "how can we improve general health *while* preserving freedom".

Sergey, I'd like to bounce my ideas off you for reforming health care in a way that preserves freedom. I think you'll see I'm not a knee jerk conservative. Check out my vision here

Sergey Solyanik said...

> America isn't about equal outcomes, it is about equal opportunity and *different* outcomes.

So you're telling me that Bill Gates' kids and the black kids from Bronx have the same opportunity?

> which is what America ***uniquely*** among nations stands for

(emphasis mine)

Man, when I lived in Russia, there was a saying there - Russia is the motherland of elephants. This was the folklore response to the party propaganda that Russia is the freest, the richest, and in every way the bestest country. Including, but not limited to it being the motherland of elephants (obviously, NOT).

I can see that party propaganda is not limited to Russia, although unlike Russia, this country seems to have more true believers per unit of population :-)...

Another historical example WRT different outcomes. In Sparta they used to value physical strength, so they threw weak kids from the cliffs. As you know, Sparta ended up NOT being the most powerful of Greek city-states (to put it very mildly). The reason for that is that among the weak kids they were getting rid of kids that are smart and creative. US, by denying its poor citizens health care, essentially follows Sparta's example - by selecting money over everything else. Modern equivalent - Steven Hawking says that he would not have been alive without NHS.

nathan3700 said...

Sergey, I invited you to read my vision of health care. If you would have done so, you'd see that you are talking past me to some some stereotypical view of conservatives. I get this a lot.

When it comes to freedom, you're vision comes closer to the Soviet Union if you think the U.S. needs to be in the business of equalizing outcomes. The goal was to ensure that everyone enjoyed equality in every way. And what they sacrificed to that goal was the freedom to choose and the incentive to be efficient.

As to Gates son versus black in the ghetto. What you are saying is the parents should be denied the freedom to bestow the fruit of their labor onto their children. We're back to the idea of restricting freedom to guarantee equal outcomes. Gate's kids will have a major leg up. But the black kids still have access to one of the most upwardly mobile systems in the world (for those that work hard for it). Equal rights is about equal protection under the law and equal ability to pick your way in life. This is why the U.S. is unique in that people often reinvent themselves with two or more different careers. Anyway, with freedom comes great responsibility, and the U.S. does a lot (Bill Gates is an example) to help the underprivileged. The great thing about it, is that they do it not because the government forced them, but because they freely choose.

Sergey Solyanik said...

You conservatives... One of your problems is that you presume that US is the best country in the world (here's another one: "But the black kids still have access to one of the most upwardly mobile systems in the world") without really ever looking at other countries. The truth is that US is no longer one of the upwardly mobile countries.

Here's the what the real statistical research shows: "Intergenerational mobility in the United States is lower than in France, Germany, Sweden, Canada, Finland, Norway and Denmark. Among high-income countries for which comparable estimates are available, only the United Kingdom had a lower rate of mobility than the United States"

A few other facts that you may find surprising (simple Google search for references):
Among the developed nations US has... of the worst health care systems... of the worst longevity indicators... of the worst education indicators...
...higher level of corruption...
...lower press freedom...
...higher child mortality...

And it will continue to be below average until people recognize that no, awe are not the best in the world, and have to actually work to even compete for the title :-).

Sergey Solyanik said...

BTW, yeah, I read your blog post. I don't get what's the difference between that and what Republican medical-industrial complex proposes... care to summarise?

The root of all Republican problems is best summarised by Michael Moore. Republicans (rank and file, obviously not the leaders of the movement) love their country as a child loves their mother. Mommy could not be wrong. Mommy is the best - by definition.

If you assume that US is the best country by definition, and should "continue to lead" (you have no idea how laughable this phrase is in the context of the healthcare), then sure, why not invent a new "vision", especially that it more or less perpetrates the old system. But we're the best, right? Why not continue to be the best?

If you do look at the facts, you will see a problem. You will see 18k people dying each year because of the lack of health insurance, and hundreds of thousands dying because of medical errors. You will see the whole medical field having degenerated into a huge get-rich-quick scheme, where people are going into this profession because they want to make money, not because they actually like doing this work.

Then of course you might want to actually fix the problem, and the easiest way to do it is to simply look at how other countries did it. Like, for example, France, which has the best medical care in the world (

nathan3700 said...

I understand that the U.S. is not the best country in the world in every respect. It's contribution was in the realm of freedom. Other countries have other important contributions. So can I get credit for conceding that?

If I am guilty of the sin of looking at my country with rose colored glasses, you seem to be doing the opposite: attempting to find nothing but the bad. That I rarely see you pat the U.S. on the back for anything is sad if you are citizen of the country. Don't get me wrong, dissent is good, but looking at the things you typically write about, it tends to be by-and-large negative about people and policies in this country while wearing rose colored glass when looking at Europe. You can find sob stories in both places.

Can you not acknowledge that America has been pretty darn good at a variety of things? Can you not see that some of the statistics you cite are stacked against the U.S. based on cultural and value system bias?

For example:
> of the worst health care systems...

But yet one of the worlds best incubators (and subsidizers) of new treatments and drugs. Doesn't this count for anything?

> of the worst longevity indicators...

Can't genetic factors explain part of this?
And can't even our value of freedom contribute to this? We allow people the *freedom* to pick their lifestyles, trade years off their life for other goals.

> of the worst education indicators...

We have a large ESL population. Illegal immigration and the associated cultural biases that come with it are a factor. Other factors: we don't emphasize trade schools that much, so our indicators are pulled down by those who are event targeted at a college education. More freedom in education delivery such as vouchers would help here.

> ...higher level of corruption...

Agreed. Don't see it as a problem since it isn't drastically worse. We still rank in the top 25

>...lower press freedom...

I wonder what your measuring stick was here.

>...higher child mortality...

We have a higher black populations which have genetically higher child mortality. I suspect that this also relates to different approaches to the use of abortions. Many religious folks will try to carry a baby to full term even when health indicators predict problems. I know my wife would.

So, just because I can google up a study by some progressive organization doesn't automatically mean it can't go unchallenged. It isn't as if I can't find other research that has other findings.

When it comes to my healthcare vision, I think the Patient's Choice Act balances freedom while providing care to the under privileged. It opens up the insurance market to more competition as you aren't beholden to the 3 choices your employer offers you. And it moves us toward high deductibles which means more affordability and more coverage.

Sergey, why are you complaining about people choosing to be doctors to make money? Do we need to adopt communist policies choosing people's professions for them? Do you work as an engineer out of basic altruism? I know somebody who would be happy to take your excess income off your hands :) "From each according to his ability, and to each according to his needs!"

I like your posts. Sorry if I come off too animated. Last word is yours. I welcome your comments on my health care blog.