My husband, an English teacher, also wanted to get the facts from someone who has experience with national health care. He asked a former student (who is now working as a MD in England) what he thinks of this whole conundrum and whether an 85 year old person can have a necessary operation under the UK health system. The reply was very interesting, and is reproduced below.
"As usual the debate on healthcare
reform is being reduced ad absurdum. There is not rule that says an 85 year
old person cannot have an operation. It all depends on the medical status of
the person and the benefit that the operation will have to a patient.
Medical care in the UK is given free at the point of delivery based on
medical need, not the ability to pay. If an 85 year old person has a need it
needs to be balanced with the risk of the operation to the individual and
the needs of others for the same intensive care bed after the operation. If
the 85 year old person does not need an intensive care bed they are likely
to get their operation, even if they do they are likely to get their
operation but it may be delayed if a 25 year old person has a car accident
and jumps the que (line) into the ICU bed.
The point that the scare mongering congressman made is that all 85 year old
patients in the UK have the right to be considered for an operation and they
have had that right all their life where as the 85 year old patient in the
USA will have to deal with co-pays and deductibles and bureaucracy and bills
and may not feel empowered to even attend the doctor because until they were
65 years old they did not have medical care at all.
When you come to see a doctor here in the UK you don't pay, you don't sign
anything no one is counting how often you came or looking at what conditions
you have -- you simply get the care you need -- that may be different from
the care that you want. Much of the care for people who have insurance in
the states is care that scientifically they don't need or is of marginal
benefit.
The best example is the yearly pap smear. Medically a low risk patient probably needs
one every 5 years. The pick up rate for a screen every 5 years is 87% when
you increase the frequency to every 3 years it jumps to 96%. The increase
to every year jumps to 97%. In the USA women are told to go every year. The
false positive rate is about 20% Therefore, 20% of the women who are being
screened are being told they may have cancer when they really don't -- this
leads to a lot more tests and a lot more potential harm in the USA because
you are screening 3 times as often with only a very marginal benefit. And
who makes all the money from that -- doctors who should know better. It will
and does lead to women having unnecessary surgery and even death from
complications. The major point is though that all Women in the UK get their
pap smears because it is free where many American women wont because it is
not.
There is truth in that we do not spend as much on the elderly but that is
more a national attitude than a government policy. Here there is a more
straightforward expectation that you have to die of something sometime and
when people of an elderly disposition get their fatal illness -- which
necessity dictates they must get, the British are more reserved and resigned
to the fact that they will die someday. There is none of this heroic
fighting against the odds that goes on in the USA. That is not to say we
don't try to do the best for people but at the same time they aren't
throwing good money after bad trying to save the life that just can't be
saved. We also care better for people. We have a hospice network and our
terminally ill mostly die at home with a nurse and sometimes me by their
side, not in a hospital hooked up to machines which is what happens in the
USA.
The NHS has its problems and is wasteful but its waste provides a peace of
mind that no American will ever imagine. It is coupled with a Welfare State
that ensures you will not starve. Everyone has a right to be housed and
everyone has a right to subsistence. It isn't great for some but it allows
most to feel that they are not alone in the world.
The longer I live over here the less I am proud of the USA. My cousin in
Ohio is currently being treated for Leukemia. She waited 30 days of feeling
deathly ill because she had to wait for her workplace based insurance to
start before she would go to the doctor. Then she missed too much work and
she lost her job, Ohio Medicaid picked up the tab but now she has no money
and she had to be unemployed for 60 days before she can claim disability.
That is not a moral society and the richest country in the world should know
how to deliver health care and basic welfare to its poorest without making
them into criminals. My cousin is a nurse and she has been treated badly by
the system. It would have never happened here.
Basically, the example that the congressman brought up would never happen
because we would never have gotten to the point that an 85 year old woman
would need an operation. We would have taken care of the problem years
before because that woman would have had health care - free healthcare --
her entire life!
The UK wants the NHS to be better but it would never and will never trade
its system for something like the US or even Germany. The NHS and the BBC
are 2 institutions of which the British Public are incredibly proud and they
have given the BBC to the world. We are going to keep the NHS for ourselves."
reform is being reduced ad absurdum. There is not rule that says an 85 year
old person cannot have an operation. It all depends on the medical status of
the person and the benefit that the operation will have to a patient.
Medical care in the UK is given free at the point of delivery based on
medical need, not the ability to pay. If an 85 year old person has a need it
needs to be balanced with the risk of the operation to the individual and
the needs of others for the same intensive care bed after the operation. If
the 85 year old person does not need an intensive care bed they are likely
to get their operation, even if they do they are likely to get their
operation but it may be delayed if a 25 year old person has a car accident
and jumps the que (line) into the ICU bed.
The point that the scare mongering congressman made is that all 85 year old
patients in the UK have the right to be considered for an operation and they
have had that right all their life where as the 85 year old patient in the
USA will have to deal with co-pays and deductibles and bureaucracy and bills
and may not feel empowered to even attend the doctor because until they were
65 years old they did not have medical care at all.
When you come to see a doctor here in the UK you don't pay, you don't sign
anything no one is counting how often you came or looking at what conditions
you have -- you simply get the care you need -- that may be different from
the care that you want. Much of the care for people who have insurance in
the states is care that scientifically they don't need or is of marginal
benefit.
The best example is the yearly pap smear. Medically a low risk patient probably needs
one every 5 years. The pick up rate for a screen every 5 years is 87% when
you increase the frequency to every 3 years it jumps to 96%. The increase
to every year jumps to 97%. In the USA women are told to go every year. The
false positive rate is about 20% Therefore, 20% of the women who are being
screened are being told they may have cancer when they really don't -- this
leads to a lot more tests and a lot more potential harm in the USA because
you are screening 3 times as often with only a very marginal benefit. And
who makes all the money from that -- doctors who should know better. It will
and does lead to women having unnecessary surgery and even death from
complications. The major point is though that all Women in the UK get their
pap smears because it is free where many American women wont because it is
not.
There is truth in that we do not spend as much on the elderly but that is
more a national attitude than a government policy. Here there is a more
straightforward expectation that you have to die of something sometime and
when people of an elderly disposition get their fatal illness -- which
necessity dictates they must get, the British are more reserved and resigned
to the fact that they will die someday. There is none of this heroic
fighting against the odds that goes on in the USA. That is not to say we
don't try to do the best for people but at the same time they aren't
throwing good money after bad trying to save the life that just can't be
saved. We also care better for people. We have a hospice network and our
terminally ill mostly die at home with a nurse and sometimes me by their
side, not in a hospital hooked up to machines which is what happens in the
USA.
The NHS has its problems and is wasteful but its waste provides a peace of
mind that no American will ever imagine. It is coupled with a Welfare State
that ensures you will not starve. Everyone has a right to be housed and
everyone has a right to subsistence. It isn't great for some but it allows
most to feel that they are not alone in the world.
The longer I live over here the less I am proud of the USA. My cousin in
Ohio is currently being treated for Leukemia. She waited 30 days of feeling
deathly ill because she had to wait for her workplace based insurance to
start before she would go to the doctor. Then she missed too much work and
she lost her job, Ohio Medicaid picked up the tab but now she has no money
and she had to be unemployed for 60 days before she can claim disability.
That is not a moral society and the richest country in the world should know
how to deliver health care and basic welfare to its poorest without making
them into criminals. My cousin is a nurse and she has been treated badly by
the system. It would have never happened here.
Basically, the example that the congressman brought up would never happen
because we would never have gotten to the point that an 85 year old woman
would need an operation. We would have taken care of the problem years
before because that woman would have had health care - free healthcare --
her entire life!
The UK wants the NHS to be better but it would never and will never trade
its system for something like the US or even Germany. The NHS and the BBC
are 2 institutions of which the British Public are incredibly proud and they
have given the BBC to the world. We are going to keep the NHS for ourselves."
