Why do Americans fear nationalised healthcare so much?

I read somewhere (but I can't remember where) that despite not having nationalised healthcare the US spends more money per head on healthcare than the UK does with the NHS.

Was talking about this on Saturday night with a friend who has just returned from a trip to the States for medical treatment.

The Doctor he saw there predicted literal rioting in the streets over some of the alleged current plans.

One of my favourite ever real-life quotes "How the fuck can you guys have a Queen and still be Commies?" from an American businessman on having NI & the NHS explained to him (a concept which he could never quite grasp).

ETA:- In the multimillionaire bracket, he told me frankly, and I believe he was sincere, that he'd walk away from it and live on the streets before he'd pay for a random stranger to be sick

Why? Im not entirely sure, but honestly, if one more person over here *blames* me for it, or makes me justify the UK health system, Im going to hurt them..badly!

Unfortunatly, stuff like this brings out the worst in some people, and being from the UK and living in the ever accepting "Deep South", we seem to be getting the rough end of the stick..(admittedly, not everyone is being knobish, just most..)

Quick question. If you're in an accident in the US and go to hospital do you still have to pay? Is it really everything you have to pay for?

Just had this reply from someone

"The "free" drugs and innovation come from the US. Britain's idea of innovation? The abortion pill. In the US, 80% of men with prostate cancer are cured, in the UK, it's only 40%. Thank goodness the UK doesn't have to produce anything and can rely on a private system in the US to supply the world with medical technology, and, apparently, start-up money."

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Yip, including the ambulance!

I do wonder whether that bit is true. After my son was diagnosed with Fragile X Syndrome, I found that there's loads of research into finding a treatment in the US, I asked my geneticist what research into treatments was going on in the UK, her answer? As far as she knew, none. In fact, the US government has a scheme going to try and encourage pharma companies to research drugs for rarer diseases by offering them financial and marketing incentives because money motivates them to research (for the most part, not everyone of course). The experimental drugs for FX are financed partly because they could lead to a treatment for autism too, and therefore riches beyond imagining.

I don;t understand why people in the US are annoyed with us for having a free healthcare system though. Can you shed any light Ethel?

I've not heard the annoyance personally but I think it's fear. "They" think that Obama sees that the UK has free healthcare and therefore the US should have, ie if no one had it then Obama wouldnt have seen it to want it. Does that make sense?

The way healthcare is over here means you get what you want when you want, even if its not 100% necessary. If a doctor said you didn't need a CT scan when you had a headache it would be because they were trying to save money, not that it wasn't necessary. The vast majority of Americans see Socialism as a dirty word.

Yes, I see what you mean GW. I'm very happy that we have the NHS in the UK though, but I guess if you're brought up here, you see free healthcare as a 'given', so it's hard to understand why people wouldn't want it, especially since you can get private health insurance if you want it anyway. I wince at the idea that it's unacceptable to contribute towards the health care of someone else when you can get exactly the same yourself, but given the McCarthy US hysteria over communism in the past, I suppose it does sound a bit Marxist doesn't it? From each according to their ability to each according to their need (probably a horrible misquote, but giving the gist I hope). I assume those attitudes are still alive and well in the Deep South where Ethel is.

In Australia, we have a mixed healthcare- private and public- which seems to work reasonably well, and seems a good model. I would have thought this would be the basis for US new model.

It does seem that having extra money helps with research, as all the new innovations (cervical cancer jab, bionic ear for example) come from 'Australian" scientists with suspicously strong Scottish/English accents.

We are encouraged (via extra tax burden) to have private cover if we earn over x dollars. For emergencies, you go public (free). For elective you can chose. For pregnancy you can chose. In- hospital care is a choice, out-patient is public. Waiting times are reasonable and some things are much easier- see a physio..look them up in yellow pages and go....none of this referral stuff.

I guess at some point in the future, this might be the way UK NHS has to go.

The thing is. if you are a rich American with good health insurance, in the short term those concerns are probably completely justifed.

(Ignore the fact that a healthy population, inc its poorer members, is a good thing for everyone, inc the rich, because few people think in terms of indirect consequences in issues like this.)

In lots of ways healthcare in America is much better, if you can afford it, than what the NHS provides here- more choice, a more pleasant experience, no waiting lists (except in rare circs or for transplants etc), more innovation in areas where innovation brings remuneration...I have absolutely no doubt that my American equivalent receives better healthcare than I do, and that she probably pays less for it.

Of course none of this addresses the scandal of the most successful country in the world failing to be able to care for its poorest members or the harm that is done (personal and financial) through people not having healthcare. But it does explain why so many Americans are against the proposals.

While I love the principle on which the NHS was founded and am absolutely in favour of free healthcare for all at the point of use, I think the NHS is struggling to keep going, TBH, and can well see why other nations would reject our particular model. The best healthcare I have seen is in Belgium which has a system whereby doctors and hospitals work privately but their charges are reimbursed by the state. Patients can then choose to top up this care through their own resources or through insurance in order to get "luxuries" like a private hospital room instead of a 4-bed one. The care is brilliant, patients get a meaningful choice, there are no waiting lists. However it's incredibly expensive- Belgium has higher rate tax of 50% flat rate (ie on all your income) and 21% VAT, plus they spend a much higher proportion of their tax revenues on health. There is no way Americans would stand taxes anything like that (nor Brits, I imagine).

Knownowt is spot on, as usual [schoolgirl crush icon]

I suppose we've had 60 years to get used to the idea that we all pay for the NHS for everyone, for the greater good. So it's not perfect, but then we also accept that if a homeless alcoholic falls over in the street they can be picked up and taken to casualty just the same as if I fall over on my way out of a posh restaurant. I think to most of us the idea that people who are long term sick or have disabled children would have to bankrupt themselves or just go without health care is repugnant, whereas the opposite seems to pertain in some quarters of the US.

I suppose the only part of health care I know anything about really is around pregnancy and birth. The NHS is a long way off being perfect in that respect, but we at least don't have a higher maternal death rate and neonatal death rate than some 3rd world countries, unlike the US. If a mother dies in the UK there is an automatic confidential enquiry to make sure that nothing was missed and it shouldn't happen again (that's how rare maternal death is here, by the way) - in the US, they don't get reported to anyone beyond the hospital. We don't generally have babies dying just because they're born into poverty, at least not in the numbers that happens in the US system. We don't generally coerce women into unnecessary major surgery because an obstetrician gets paid more for a caesarean birth than a straightforward one. Yay for the NHS, with all its flaws and even its strange smell of school dinners, disinfectant and wee ?

I don'tknow but I'm loving the Daily Show's take on the Neo-Cons view of this - panels of people to decide whether the elderly or disabled should live or die based on costs, apparently this is how the NHS works.

There was also a fab article yesterday when someone ranted in a right-wing paper about how if Stephen Hawking had been in the UK the NHS would have said he wasn't worth the money and let him die. Of course, they've since had to remove that part and admit that Hawking is not only British but lives in the UK ?

The right wingers don't even understand how their current system works - I've seen comments about how state treatment doens't work and then complimented the MEDICAID scheme which is, you guessed it, a state-organised scheme. And they rave about the treatment of the VA hospitals, which are state-funded too (free healthcare to all Vets).

If you're rich, US healthcare is probably the best in the world - but God help you if you have average insurance and a long-term disease because then you won't get insurance.

Re. prostate cancer - the USA is very very keen on prostate cancer screening and have pushed it on their patients much more than the UK but they did so without stopping to see whether diagnosing prostate cancer would actually improve quality of life or longevity of life in men. Studies show it doesn't in many cases; it's not as clear cut as diagnosing/treating prostate cancer = improved healthcare...

And Zebra's also right [more schoolgirl crush icon]

I'm loving the fact that the Graun has an article on its website today in which Stephen Hawking is quoted as saying that it's the NHS that's kept him alive...

Where does this idea that the elderly and disabled would be left to die on the NHS come from? Surely it's the diametric opposite? It's not here that it happens. Or are they only talking about US elderly and disabled with massive savings and good insurance, and be buggered to everyone else dying in corridors?

But they do have Dr gregory House, which is a plus point for US medicine [swooooon]

What do you mean he's not real?!

? Flowery. And Hugh Laurie is probably also a product of the NHS...

(and, just so I don't get too carried away lauding the NHS, I imagine that if you want unreasonable, pig-headed doctors who are convinced that they are always right you could throw a stone and hit quite a few on the NHS, though they probably don't get so many shiny acolytes as Dr House does)

Thanks for the reply. Luckily here we don't have to pay if we get injured, however you have to pay for the doctor (£34 a time now I think) and the ambulance unless you have health insurance.

In terms of costs / efficiency the NHS spends approx 4% of budget on admin (which includes IT infrastructure etc). The US hospitals and insurance companies spend 25%. The US also do a lot of unnecessary interventions - because it's a money-making exercise primarily - and do not have significantly better mortality or morbidity rates than the UK.

Trying to remember the stats of 20 years ago when I did my social policy degree and I seem to remember that the US spent something like twice as much per capita on healthcare, but had worse mortality / morbidity. Things have changed over time but they are certainly not getting value for money in terms of healthcare. What they do get are small clinics, no wating times, and lots of tests - all of which make them feel they're getting a great service even if most of what they go through is unnecessary.

LOML wrote a veery funny post about the Stephen Hawking thing on his blog yesterday, actually

http://hopisen.wordpress.com/2009/08/11/stephen-hawking-not-killed-by-nhs-yet/#comments

I agree with the hitcher who said nationalised healthcare is very poorly understood in the US. Its thought of as connumist, basically, and anything communist is of course, terrible.

As it stands in the US now many small towns do not have doctors because the cost of personal neglience insurance is prohibitive for those who practise. ina free markert people will never invest their expertise in areas where there is no money to be made. A massive proprotion of the US population live in towns and backwaters (that said, I have been to hospital in new York and was horrified by it- much like I'd imagine hospitals in India to be)

Sicko is an absolutly fantastic film if you're interested in this. After it had finished I swore I'd never leave europe. I think the massive problem is there is no obligation for companies to insure- there is no safety net. so if you get cancer, thats it, no more insuarcne for you. Then you join the very large number of people for whom a broken leg could equal bankrupcy.

On the communist thing, in sicko they expressed disbelief at the amount drs in the UK earned- they thougth in a "communist" system they'd be very poorly paid (hence not attracting the best students) in fact, the doctor they spoke to earned more than the average US doctor.

Another two things I think are issues:

1. I think the average American probably overestimates how good his insurance is. Underinsurance is a huge problem, and I think many people either don't read the small print or discount certain risks entirely. There are plenty of people who would probably be net recipients from nationalised healthcare who believe that they would most likely be net contributors (the same phenomenon exists in Britain- people underestimate the income level at which one is likely to switch from net recipient to net contributor of the state).

2. I think it's also partly the flip-side of living in a country that prides itself on being extremely meritocratic. There are lots of good things about meritocracies- the reward of genuine hard work and talent, so that success is seen as deserved- but the corollary is that people who are not rewarded, who do poorly paid jobs or struggle to get on at all, are seen as deserving their failure. Poverty is therefore seen not as misfortune but as a sign of being intrinsically less good. Add to that the fact that the US is of course not entirely meritocratic, far from it, and you have a situation in which it is extremely easy for rich right-wingers to convince themselves that poor people have inevitably brought their problems on themselves because they are lazy, stupid etc. "Your momma works in McDonalds" is a very American sort of insult- the idea that lack of personal success is in itself a sign of lack of worth. We have the same thing in Britain but to a lesser extent- there is more recognition here across the political spectrum that we don't live in a meritocracy.

I think the meritocracy thing is key. Is the "there but for the grace of god..." assumption that a lot of us have about ill health and disability more of a British attitude, I wonder? You see someone who, say, becomes disabled in their 30s and has to give up work and think "you poor ***, could happen to anybody" whereas if one comes from the more meritocratic model, would you think they'd somehow brought it on themselves/should try harder/hadn't taken enough care of themselves?

I also wonder if the timing of the introduction of the NHS is important; at a time when everyone remembered lots of previously fit young men coming home in need of medical care, coupled with a determination to rebuild a better society in which no one was seen as intrinsically less worthy. I remember speaking to my grandparents about the NHS, and both sets recalled the sense of relief that an illness wouldn't necessarily mean financial hardship any more. ( In later life, one set of them got private insurance and were then spat straight out again by BUPA when grandpa got something that was actually an illness and would actually cost money to manage - so ended up back in the NHS safety net anyway.)

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Yes, that's the article I was referring to, the correction made me laugh too.

Hyacinth, you're right of course, the NHS is a socialist thing and obviously all socialists are communists and reds live under the beds and sneak out only to kill the old and disabled. I think that's roughly how the Neo Cons think. ?

Having just used yet another NHS service today with my son I'm very glad I don't have to worry about whether or not I can afford to have his hearing tested, his speech development monitored and his squint examined. I can't imagine how worrying it must be for anyone in the USA who can't afford health insurance (staggering proportion IIRC) and can't afford to pay for individual tests.

PL - my gran's first pregnancy went to 44 weeks because her son was breech. It was a good case for a c-section but of course, it was just before the NHS was funded and my Grandparents didn't have the money to see a doctor let alone have an op.

Amazingly enough the experience didn't stop my Gran having another seven children but there's something not quite right about my uncle, p1ss poor hearing and eyesight, and just a bit odd - I wouldn't be surprised if he had birth brain injury of some kind.

Erm..... because the healthcare industry makes so much money that the big players in the game can fund political campaigns?

My theory on healthcare reform is to take all the money that is paid to the healthcare companies (in insurance) by employers and employees (think $400-$500 per person per month, PLUS what we have to pay for those who don't pay their own because they are working under the table or not working) and use this to set up a state funded system.

There would be no reason to alter medical personnel salaries, but if it was administrated by the government rather than a for-profit, they could refuse much of the non-necessary treatment requested by hypochondriacs, people that insist on 2nd, 3rd, 4th referrals, etc. The amount of waste in the medical industry over here is ridiculous. I don;t think they would need to raise taxes to do this.

And the other reason American's fear it.... same reason that communists fear capitalism. It is just not in line with their comprehension of how a country works.

Oh, and I'm sick of hearing them bang on about all the Americans who can't afford healthcare getting a raw deal, when my friend, a single parent in her 50's who has not been out of work for a day since she was 21, and has paid health insurance every single day of her working life, is preparing to declare bankrupcy after re-mortgaging her house twice to pay for cancer treatment because the health insurance (a reputable plan with the biggest health insurer in the country) didn't cover all the costs. She is the sole provider for her two teenage children. I can't believe that the system puts someone like this in that situation.

Terrible, utterly terrible, your poor friend - I think that's the problem, too many loop holes in the insurance plans that you only find out when you get the hospital bill...

Don't you have to pay that here to if you have a road traffic accident e.g. on the motorway? Unless it's some kind of fine perhaps (trying to recall what friend did)

God Boston Girl thats absolutly awful. Your poor friend. what a heartbreaking scenario.

That is also a big problem I think with privatised health care- people only make money when you are ill. In the UK GPs are often incentivised to keep their patients healthy- bonus for patients giving up smoking for example, or losing weight- prevantative medicine. In the US no one makes any money until you're sick, so why plough money into preventing illness? I've read shocking statistics about infant mortality, life spans, rates of disability and so on in parts of the states- often worse than many 3rd world countries- its shameful.

As Boop says, there's a lot more testing in the USA, so it's not always true that they don't work towards preventing disease.

There's big business in preventive medicine - hence why USA pushes screening to the point they screen for diseases patients don't necessarily benefit from treatment for, eg, prostate cancer.

And the USA is very pro-vaccination.

Where the USA probably falls down hardest is reaching enough of the population - healthcare is just not available to everyone and the poorest have the poorest healthcare and due to other lifestyle factors like education have the highest risk for diseases. Esp among African Americans and Hispanics.

Dentists are all private in Australia too, except for the very poor who can go to the dental hospital.

My friend's little boy (living in Aus) has CF and his consultant is British. He said he moved to Australia because they were free to try more experimental treatments and weren't shackled like they were in the NHS and that's where the cutting edge research into CF was happening. I guess that could translate to more money making research more viable.

This sounds like a hideously contrived and blatantly made-up example, but it's entirely true: two of my exes have multiple sclerosis, but one's based in London while the other's in small-town America. Both earn a pittance, at least partly because it's next to impossible for them to work reliably. Have a guess which one currently enjoys a better quality of life.

When Stephen Hawking says that the NHS literally saved his life, I can think of an exact equivalent scenario amongst my own social circle, and it's not something I take lightly.