172driver wrote:
While living in the UK (+/- 20 years) I always considered the NHS pretty much a sub-Sahara African system that kept people alive, but in relatively bad health generally
You must have lived in a different UK to me.
I found the NHS excellent. In 1987, I had an accident with a glass door that cut my wrist to the bone, severing all the nerves, arteries and tendons. The NHS put it all back together with 6.5 hours of microsurgery (which at the time was advanced work – the techniques they used were new at the time). The follow up treatment was top notch – 3 hours of physiotherapy 5 days a week for two months, weekly followup visits with the consultant every Friday.
The American aeromedical doctor who did my first medical said “they did an excellent job” when he examined it, as this was something declared on my medical form. I have absolutely no reduction in function in that hand, just a really impressive set of scars and a story to go with it.
This was more than just “keeping people alive in relatively bad health”. I was on a ward of people (mostly victims of industrial accidents) who were all receiving the same level of care.
have no idea about procedures to avoid cross-contamination, e.g. using your phone with gloves and then using it without gloves.
Even education only gets you so far. If one considers all the ways in which you can spread contamination, work grinds to a halt and your hands will fall apart from being continuously bathed in alcohol gel.
A lot of it is down to how workplaces are designed as much as individual agency. Is there a separate pen by every bedside so that people can jot down observations without carrying a biro from patient to patient? Does air flow from the patients to the corridor, or from the corridor to the patients? Which option would actually be correct? And is it better to have a door to stop the airflow or no door so that there’s no handle to contaminate.
I’m seriously surprised more people haven’t gone off sick with OCD.
dublinpilot wrote:
Yes indeed. That was my sarcastic comment. Obviously many health systems don’t operate at 100% over the weekends, even in the middle of a pandemic.
As someone deep within the German health system, I must say the population is extremely lucky that we don’t operate like we do on weekends on all days. The level of care we provide on weekends is extraordinary and probably superior to what most countries provide on weekdays.
What we do extra on weekdays is probably the reason why you don’t have to wait two years for a hip replacement here. Lots of easily postponable operations are performed on weekdays, I’d say about 70% of the procedures could be postponed for weeks with little to no long-term damage to the patients. This was very apparent during early April when our department regularly had dozens of anaesthetists sitting around or even sent home (on full pay, of course, we’re not in the US…), including yours truly, because all those postponable operations were actually postponed for once.
A great health system is one were people are sometimes seen doing nothing, because only then do you have the necessary spare capacity to treat everyone properly when the proverbial hits the fan.
That is also why capitalism has no place in a proper health sector, same with fire services or police actually.
That is also why capitalism has no place in a proper health sector
However, if Germany wasn’t capitalist and wasn’t making so much money (remember DDR, where a Trabant was a status symbol?) Germans could not afford to pay the relatively huge insurance premiums which fund all that spare health sector capacity 
I have a part family in Germany so this is not off twitter.
Ultimately it makes little difference how one does it. It’s a matter of what presentation Joe Public is looking for. If people want a cheap “NHS” then it is presented as “free” but you pay a lot of tax for it; this is what we have in the UK because, ever since 1947, Brits want stuff cheap and preferably free. In Germany most working people are prepared to pay more for “quality” and are mostly happily forced to pay quite a lot in insurance, but it is at least labelled as health insurance. In the US, they go a bit further and fund relatively little health provision out of general taxation (mainly non-recoverable emergency / patient unable to pay work) and people pay as and when needed, but most have insurance… hmmm just like Germany actually In the UK there is a lot of insuring going on too, for those who have a bit of £££ and want a faster (if not better; often it’s the same people) service, and a lot of people (myself included) just pay when needed. Many years ago I was paying BUPA premiums and for the cost of a family you could have a major operation every few years. A few years ago somebody I know (not me) smashed his uretha in a mountain bike accident, walked around for a few months with a bottle strapped to his leg while it healed up, and then had it reconstructed by the absolute very best dick surgeon that anybody could recommend. Cost, privately done, was £8k. Less than a Kia! I would never pay insurance now; you should never insure what you can afford to pay directly, and even a heart bypass is about 30k i.e. similar to an engine overhaul which I don’t insure either Also it is a whole lot easier to be sure to avoid a bypass (eat veg, etc) than to avoid an overhaul.
I am sure German hospital car parks look just like British ones (lots of Aston Martins here, parked in “reserved” rows)
You only ever get what you pay for. The State is merely spending your tax money.
Lots of things in life are about presentation. Even forums. In some countries you can’t have a moderated forum because of “censorship” connotations. So their forums are run to appear unmoderated, and the mods (you still need mods, to remove illegal content) are covert.
Peter wrote:
However, if Germany wasn’t capitalist and wasn’t making so much money (remember DDR, where a Trabant was a status symbol?) Germans could not afford to pay the relatively huge insurance premiums which fund all that spare health sector capacity I have a part family in Germany so this is not off twitter.
I fully agree with you but it’s not what I meant. What I meant is that within the sector itself, hospitals/surgeries should not be forced to compete as in a free market economy, nor should personnel and medical equipment be paid for under the capitalist idea of cutting cost to increase profit margins.
What I mean is that a good health system needs more personnel and equipment and ultimately capacity than an MBA would calculate necessary with his/her training.
A lot of things in the health sector are done purely for the sake of cost cutting or increasing profit margins, even in Germany with its universal and mandatory health insurance system. But there is no reason why a hospital should turn a profit. Instead of the economic outcomes, the medical outcomes must take centre stage.
In fact, often the ultimate total cost of providing medicine is – paradoxically for many MBAs, who are not used to this kind of long term thinking – lower if you pay more upfront for good treatment, because the complications that occur more often from using cheap equipment, cheap therapies and fewer, badly paid and thus less motivated personnel, will outweigh the initial cost savings generated from this initial cost cutting approach.
All this non-withstanding, a thriving social market economy does of course help to pay for all this.
Peter wrote:
Ultimately it makes little difference how one does it. It’s a matter of what presentation Joe Public is looking for. If people want a cheap “NHS” then it is presented as “free” but you pay a lot of tax for it; this is what we have in the UK because, ever since 1947, Brits want stuff cheap and preferably free. In Germany most working people are prepared to pay more for “quality” and are mostly happily forced to pay quite a lot in insurance, but it is at least labelled as health insurance. In the US, they go a bit further and fund relatively little health provision out of general taxation (mainly non-recoverable emergency / patient unable to pay work) and people pay as and when needed, but most have insurance
The main difference is the US is that the facilities and equipment are much better, particularly in terms of quantity and availability, and the medical professionals are paid two to three to times more. Why? because we pay for it, and I for one am happy to do so. I’m also glad the pharmaceutical industry has solid research funding, mainly sourced from profit on US sales. There’s just more money in the system, and it’s a good thing.
One point you did overlook is that US healthcare is government funded for people 65 and older, and of course today with the boomer generation aging that’s a big fraction of the population. Within the last year my mother had a roughly $500K operation on that system, in her case paid by an insurance company but due to her age her insurance company premium is highly subsidized. Anyway (regardless of who paid that big bill) thanks to a very well paid and skilled surgeon, a month of excellent care in hospital, and more months of incredibly attentive physical therapy she is now pain free and walking again at age 89, driven by pure determination and happy. It’s awesome.
Silvaire wrote:
Within the last year my mother had a roughly $500K operation on that system
It’s a $500k operation in the US (on the basis that that’s what it’d cost you if it wasn’t for insurance or state provision) because performing it is contributing to making someone, or some people, extremely rich.
It wouldn’t be considered a $500k operation in Europe because it simply doesn’t cost that much to deliver it.
It comes down to whether you view healthcare as a free market commodity or not. Some people think that in a modern civilised society access to healthcare should not depend almost exclusively on one’s ability to pay. Others think that it should be left to the market. Both are valid points of view.
I’m happy my mothers nurses were paid over $100-$150K a year during her procedure, her surgeon probably $300-400K a year. Those are conservative numbers and it adds up quickly, no doubt. Good things cost money and good people should be well paid, also including those developing the tools, drugs and technology.
Silvaire wrote:
I’m happy my mothers nurses were paid over $100K a year during her procedure, her surgeon probably $300K a year. Those are conservative numbers and it adds up quickly, no doubt. Good things cost money.
A quick Google suggests the average salary for a registered nurse in the US is about $75k.
Obviously I don’t know how much your mothers nurses are paid, but that’s not the point – you said that $100k was a conservative number.
In any case I’m not talking about what individuals are paid. It’s not like a surgeon and two nurses on those salaries devoted an entire year of their time to her care in order to reach that $500k estimate.
It is model, for sure, and it works very well for those who are able to pay or are otherwise covered. But try being seriously unwell in the US and being broke.
