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As someone living in socialized healthcare, and who has lived with socialized healthcare in about a dozen countries, just a reminder:
**Socialized Healthcare is a broken and backwards system**
inb4: No I am not promoting the american healthcare system. It may fix or address the parts that are broken in socialized healthcare, but it has its own problems... There are solutions (though no one talks about it) that doesnt resemble either of these failed systems.
Problems I have repeatidly faced both here and in other socialized health care countries:
* Abusive wait times leading to unnecessary suffering and in my case surgery that wouldnt have been needed if I had prompter care.
* Lack of access to many prescriptions - (I have had at least a dozen medicines I couldnt get because the cost would be too much of a burden to a socialized system).
* Monopolies making unfair and abusive rules to line their pockets at the expense of patients (A good example of this is melatonin being a prescription in Israel due to a pharmecutical monopoly).
* Lack of privacy / anonymity - Since everything is registered through centralized systems (usually) there is no way for you to hide or keep private your medical records. In the USA I would pay cash for prescriptions I dont want on record, not really an option in socialized systems.
@LouisIngenthron Yea that last one has went down hill, but only slightly. They do have databases now,, even if you pay with cash but its limited to 1) only the class of drugs consiered particularly dangerous for abuse (adderall for example), doesnt apply to most low-risk things 2) Even in the case where it is tracked each database is limited to state-wide access, it isnt national.
@freemo Maybe for the government. But I'd bet anything the pharmacy database is (inter)national depending on how big the company is.
@LouisIngenthron Well thats easily mitigated, just go to a small pharmacy. I know the big ones let you opt-out of their system last time iw as there too
@freemo Pretty sure the US banned small business a few years back, lol.
@freemo The big monopoly can be doctors. The Canada system had the toughest time breaking that. Those who weren't happy went to the States. Now the US has a monopoly of doctors and lawyers. Combined, they jack up the price of drugs by a huge amount, to deal with liability claims. The drugs are cheaper in Canada because of the legal system. That said, many clinics for specialized service (colonoscopy) are private and charge the health care system less than hospitals. And you can hop onto the big stick faster....
@hasmis yea monopolies can form in any system, the USA isnt immune. But its a big different when "single payer" by definition means you intentionally create monopolies of one form or another.
@freemo I don't know what you consider "abusive wait times," but as someone dealing with the American health system, I've been trying to get to a couple of different specialists for nearly 6 months and just to see a GP is a 6 week wait. Urgent Care and the ER have become primary care physicians again.
I would welcome a centralized system for medical records, including specialist doctor referrals. It seems that the US healthcare system still depends on faxing, and in my experience, the faxes never are received. Even within our local healthcare system (1 hospital, 1 outpatient location), they fax in-house, and I've recently learned that they use a 3rd party fax provider so even staff calls it the black hole. They have no idea if the request was even sent, much less received.
I totally agree that neither system works and the stresses that COVID put on our healthcare providers has made it even worse.
@Dimestorehalo I cant speak to your specific case, But statistically speaking wait times in the USA are less than almost all other socialized systems.
For example in Australia, canada, france, germany, Netherelands, new zealand, and the UK 20% to 42% of patients with chronic conditions needed to wait more than 2 months to get care.. these are people who are already diagnosed and suffering who need routine care to alleviate that suffering (so its particularly heinous).. In the USA half to a quartyer as many people (10%) have similar wait times.
for comparison In those same countries you have on average about 50% of the people who could get seen in less than 4 weeks, compare that to the USA where 75% of people can be seen in less than 4 weeks.
Specialized doctor referals arent really "centralized" because you dont really "need" it.. just get a ppo and you dont need referals at all. And we already have tons of private systems that are opt-in and centralized for finding doctors (do telehealth and go online and youll get seen super fast as you have a huge centralized database of docotrz)
All that said I do agree with you that there is a LOT of room for improvement and in certain states or regions the problem is likely a lot worse than others.
@freemo Thank you for all the stats and it just may be my state and my semi-rural area but all specialists require a referral from someone and it has to be faxed, even though my private insurance allows me to see anyone within my network. And then there's the issue with hospital requires a referral, the insurance doesn't, and won't pay for the doctor visit to get the referral.
Telehealth is a great idea and I've used it, except for the faxing black hole, I have even brought telehealth orders into a facility and they weren't accepted because they had no way to get them into the system.
Even my GP, thru a telehealth visit last week, says that when the specialists finally receive the referral, it will be sometime in the summer before I'll be able to see anyone. 4-6 months seems to be the average wait time, even with going down to the largest city in the state (150 miles).
I know this is anecdotal evidence (and I know of others with similar experiences), but I'm an experienced consumer of the healthcare system and I see the US system getting worse and worse.
@Dimestorehalo That is very odd that all specialists require a referal. That would be true of course if you have an HMO, but the whole point of a PPO is that you dont need referrals. I'd love to talk to a doctor in your area to know the details on that, its the first time I heard that.
I cabnt imagine why your case is so unusual for the american average but im sorry to hear that, it sounds awful!
I dont think you are wrong about the healthcare system in the USA getting worse, I've seen the same. I certainly wouldnt praise the american system. Like I said while on average it does fix some problems of socialized healthcare it also introduces just as many of its own problems too. So its hardly a system worthy of praise.
@freemo @Dimestorehalo I have roughly the same experience. And all that at 3 times the cost of a comparable system in any other 1st world nation.
Give me Iceland. Although that weird public/private system in Singapore seems to be generating a lot of fans.
@JonKramer @freemo I'm going to have to investigate the Singapore system!
@Dimestorehalo @freemo , to be very fair, I do not fully comprehend it myself, or why it is effective. I tend to view most systems as most efficient with a profit motive, IE a free market system. Libertarian, if you will. Healthcare and education are two counter examples. To me at least. But, the results seem to speak for themselves in the case of Singapore: https://en.wikipedia.org/wiki/Healthcare_in_Singapore
@bot I am not sure I would pick that particular language, but short answer, yes.. I think anyone too poor to afford health insurance should have it provided by the government along with tools to get them out of poverty.
I dont like the word "entitled" here, however and prefer to say that it is in the best interest of society to look after those in society who are struggling.
I don't think the government should be forced to provide folks with healthcare, but a government's competence should be judged on their ability to enhance the economy to the point where healthcare is affordable for everyone.
If health care is too expensive, it gets inaccessible, but if it's too cheap, the quality suffers and the system eventually crumbles.
I just dont think letting people die for being poor, even if they are lazy, is going to give us the best society for all involved.
@freemo @realcaseyrollins @bot
"History will judge societies and governments — and their institutions — not by how big they are or how well they serve the rich and the powerful, but by how effectively they respond to the needs of the poor and the helpless."
~César Chávez
@JonKramer @freemo @bot How's #Canada doing with that?
@realcaseyrollins @JonKramer @freemo @bot Increasing the number of poor and helpless seems to be a key strategy.
@freemo
Interesting video related to the topic (Ik ur not american):
https://youtu.be/U1TaL7OhveM
@freemo I'm not sure I agree with this.
* Healthcare is "free at the point of use" to patients. That's the whole point of the UK system. So there is no cost to the patient to jack up, even if you're going to regard a nationalised monopoly as still a monopoly.
* An effective monopoly on medicine purchase under socialised systems means that pharma companies have to negotiate sensibly on price. Just look at what insulin costs in the US vs. the rest of the developed world: https://worldpopulationreview.com/country-rankings/cost-of-insulin-by-country
* You say that you can't get prescriptions because they're too expensive. Is it that they're too expensive, or that they're regarded as not cost-effective? The UK health system will pay for some very expensive drugs, where the proven benefit is there. Where the benefit is marginal, those resources are used elsewhere. It's all very well saying that you can't get expensive drugs, but that has to be set against the situation in a privatised system, where people who cannot afford [comprehensive] health cover won't be able to access any drugs or treatment at all. Does your right to buy expensive insurance that covers marginal therapies in unlikely situations trump their right to access proven and cost-effective therapies? You can of course still buy that expensive insurance if you want to, nobody's stopping you.
* Waiting times are certainly a problem in the UK at the moment. But that's a feature of a long-term failure to adequately resource the service. When the last Labour government left office in 2010, waiting times for almost everything were short. The Conservative government since then has deliberately under-funded the NHS, with the result that waiting times have soared. If you want healthcare it has to be paid for, and that's as true under a socialised system as under a private one.
* Privacy... I'm not at all convinced that a private system is better at this. At least the public system has to admit what it's doing with your data. Amazon is in the healthcare game in the US now, did you know? https://www.theregister.com/2023/02/23/amazon_one_medical_merger/
Ultimately surely the difference is what it usually is for private vs. public debates: do you think the risks should be borne by the individual (in which case those who are unlucky on the dice roll for both wealth and health are screwed) or that it should be pooled by society (in which case it's a bit harder for the wealthy to get gold-plated-everything and/or they have to make contributions to everyone else's healthcare, but those less well off can get their health looked after too)?
> Healthcare is “free at the point of use” to patients. That’s the whole point of the UK system. So there is no cost to the patient to jack up, even if you’re going to regard a nationalised monopoly as still a monopoly.
Only partly true.. take my example. In israel a pharmecutical companies own pretty pervasive monopolies. Melatonin is a cheap product to produce and means you wont need to buy more expensive drugs to help with sleep problems. So these pham monopolies have a motivation to harm the general public by making melatonin a prescription, preventing competition and requiring you to buy expensive drugs.
To say there is no cost to the patient at point of sale is kinda pointless because there IS a cost to the patient (usually in ones taxes) and that cost is distributed to everyone. So they do exactly that, jack up prices and those prices are just baked into your taxes so it "feels" like you never see it. But you are still paying for it one way or another.
> An effective monopoly on medicine purchase under socialised systems means that pharma companies have to negotiate sensibly on price. Just look at what insulin costs in the US vs. the rest of the developed world: https://worldpopulationreview.com/country-rankings/cost-of-insulin-by-country
We covered this in the last post, on the one hand, yes it can mean more negotiating power to bring prices down. But those same monopolies can negotiate scenarios that line their pockets and harm the individual (as the example with melatonin above).
> You say that you can’t get prescriptions because they’re too expensive. Is it that they’re too expensive, or that they’re regarded as not cost-effective? The UK health system will pay for some very expensive drugs, where the proven benefit is there. Where the benefit is marginal, those resources are used elsewhere. It’s all very well saying that you can’t get expensive drugs, but that has to be set against the situation in a privatised system, where people who cannot afford [comprehensive] health cover won’t be able to access any drugs or treatment at all. Does your right to buy expensive insurance that covers marginal therapies in unlikely situations trump their right to access proven and cost-effective therapies? You can of course still buy that expensive insurance if you want to, nobody’s stopping you.
Its that they are too expensive.. in many cases we are talking drugs with very clear benefits. Take zalepalon vs zolpidem as an example. They are the same class of drugs and very similar. Zalepalon is less common and more expensive so you cant get it in many socialized medicine countries. But its application is vital as it has half the half-life of zolpidem. so for people with sleep disorders that are regulatory (time-shift) zolpidem not long cant treat it but makes symptoms worse where zalepalon can be a very effective treatment, but you cant get it despite the clear medical need due to costs.
> Waiting times are certainly a problem in the UK at the moment. But that’s a feature of a long-term failure to adequately resource the service. When the last Labour government left office in 2010, waiting times for almost everything were short. The Conservative government since then has deliberately under-funded the NHS, with the result that waiting times have soared. If you want healthcare it has to be paid for, and that’s as true under a socialised system as under a private one.
It really isnt though. There is a reason that every single socialized healthcare around the world, with almost no exceptions has significantly longer wait times than non-socialized. If it were limited to mismanagement then we would expect at least a few countries to have wait times on par or better than the USA, but thats just not what we see.
@freemo We've gone off the end of my knowledge of the subject at this point, I just don't have the knowledge of specifics like that. A quick Google turns up lots of references to Zalepalon's marketing authorisation being withdrawn in the UK but little as to why - I would normally assume that's because it was found to be unsafe in some way, because it's not just that the NHS won't buy it, it's that you can't legally sell it here.
On wait times, again I don't have the knowledge to debate it. I do wonder though whether the US having shorter wait times is a function of supply and demand under a privatised health system - the price goes up until enough people have been priced out of the given procedure that the wait time is low. If the wait time is higher the provider might as well jack the price up, because they know that even if they lose a few patients, they'll still be selling as many procedures as they have capacity to perform, and therefore they will make more money.
@VoxDei In most socialized systems ive known enough about to comment (the UK isnt one) if the socialized insurance doesnt want to cover a prescription then it isnt legally allowed at all. I have never personally seen a situation where a prescription drug is legally permitted for prescription but under no circumstances covered by the insurance.
As for wait times in america, despite the reasons, which is speculative at best, the fact is havibg a financial deterrant results in much improved wait times. You can view it in reverse where if you make healthcare practically free then people will seek care for nonissues like mild colds and backlog the system. This is somethibg i see often in socialized systems where jobs often require you to bring in a doctors note to get a day off. Since its so cheap the job doesnt see this as a burden on the employees and you see a huge amount of people seeing doctors for runny noses backlogging the system. In america the idea of requiring a doctors note is just absurd.
@freemo Well that I can speak to in the UK. Here you only need a doctor's note if you're off for seven consecutive days - less than that and you can self-certify that you were ill. Employers are not allowed to require a doctor's note for shorter periods.
In regard to obtaining treatments, there are two things here:
1) The medical marketing authorisation, which process confirms that your drug or treatment is safe and may be sold in the UK. It may require a prescription, but if you can't get it on the NHS for some reason (eg. you want it faster than you can get an NHS prescription) the you can obtain a private prescription that will allow you to buy the drug at full price.
2) The National Institute of health and Care Excellence (NICE) authorisation. NICE look at the cost-effectiveness of any given treatment. If they decide that it is cost-effective then they give permission for doctors to prescribe it on the NHS. If they don't then you cannot obtain that treatment on the NHS, but you can still do so privately.
In regard to Zalepalon, it is the first of these that has been withdrawn. As I understand it normally this would indicate some question mark over safety, but I'm not an expert so I may be wrong.
@VoxDei Yea that doesnt sound like it fixes the problem... Just sounds like there are two broken systems, and you are forced to pay for one (socialized) and have the option to also use the other broken system at an additional cost. I am not really hearing a solution here that addresses the fundemental issue of the two systems, for that we need something that is distinct from either.
@VoxDei Oh and for the record, zalepelon is widely regarded as being **safer** than zolpidem, especially in children.
@freemo Well, there's certainly enough of a debate over here about how broken the NHS is. The thing is though that because the Conservative government have been running the service into the ground for thirteen years (deliberately, some would say - they prefer the private model but they have trouble winning that argument when the NHS is working) it's impossible to disentangle "This isn't working because it hasn't been funded properly" from "This isn't working because the idea is fundamentally flawed". The system worked fine for a long time, whether it still does so in an age where everyone is living longer is another question.
Open to alternatives, just deeply suspicious of anything that involves changing the motivation of the system from "We want to make our people better when they're ill" to "We want to make a small number of people rich, the mechanism for which happens to involve making some people better."
On Zalepalon, following some more Googling, it appears that the marketing authorisation was withdrawn EU-wide in 2015 because the manufacturer didn't want to market it any more. So actually, on the surface (and since you say it's safer) it looks like the manufacturer wanted people to stop taking the one drug (which although safer is presumably either cheaper or was going to go out of patent or something) and instead to take another drug that would make them more money. This doesn't look like a shortcoming of socialised medicine from here, it looks like straight-up corporate greed. If they wanted to sell it they could, but they don't want to, and they don't want anyone else to sell it either.
> Well, there’s certainly enough of a debate over here about how broken the NHS is. The thing is though that because the Conservative government have been running the service into the ground for thirteen years (deliberately, some would say - they prefer the private model but they have trouble winning that argument when the NHS is working) it’s impossible to disentangle “This isn’t working because it hasn’t been funded properly” from “This isn’t working because the idea is fundamentally flawed”. The system worked fine for a long time, whether it still does so in an age where everyone is living longer is another question.
The thing is, people who beleive ins ocialized healthcare will always make excuses, its the conservatives dfault! Its no different than what people who support american-ized healthcare, there is always an excuse.
And ya know, maybe with the NHS there is some (or a lot) of truth to that, maybe the conservatives have made it far worse than it could be. The thing is, the problems we see are fairly universal to the respective types of healthcare. Pure free-market healthcare is consistently expensive, and pure socialized systems are consistently riddled with the sorts of problems I mentioned. If this were isolated to just the UK I thinkt here would be an argument there but its not.
> Open to alternatives, just deeply suspicious of anything that involves changing the motivation of the system from “We want to make our people better when they’re ill” to “We want to make a small number of people rich, the mechanism for which happens to involve making some people better.”
I certainly agree with you there, I never claimed the problem was "we should be trying to make a small number of people rich to improve healthcare". In fact I've pointed out that the american system doesnt work and it is, more or less, just that. So clearly that is not something I'd suggest. The important thing to remember here though is that those two are not your two choices.
The solution to me is simple 1) make healthcare co-op based (which is neither socialized nor capitalist in nature). 2) Ensure anyone too poor to afford the healthcare (which under a co-op system should be far more affordable) has government help and gets it for free
These two things address the major problems. It is no longer centralized, so you avoid the problem of an intentional monopoly or a central authority dictating for eveyone what "affordable healthcare" means. It gives you many options to pick from, none of which are privatized, and ensures the competition between your choices drive quality and not just choices. Finally offering support for the poor means no one will ever be forced to be without health care. It also addresses you concern of lining peoples pockets and making people rich, there is no small group of owners who can profit in such a scenario so greed is eliminate and costs arent driven up.
@freemo I don't know how long it's been since you tried that last one, but I don't think it applies anymore. The prescriptions here are all tracked by computer, so if you need a prescription for it, you're already being tracked whether you pay in cash or not.