Brits, Canadians, and others: tell me about socialized medicine

I’m not sure whether this technically belongs in GQ, GD, or IMHO, but I have a feeling that GD is where it will end up in any case, so it may as well start here. Obviously, Americans are welcome to post, but I’d really like to hear from people who have personal experiences with socialized health care.

The American media often describe socialized medicine in Britain and Canada as a “failure” but seldom offer any details or explanations. Do you agree with this characterization? Why or why not? What do you see as the biggest strength(s) and weakness(es) of your country’s health care system? If there were a movement to privatize health care in your country, would you support it? Why or why not? (Yeah, I know, sorry about the essay-question-ish phrasing. Please feel free to skip some or all of the questions, and to go off on tangents.)

There are a number of points.

I think our system is ok, but there are queues for treatment, waiting lists and there are hospitals which are under staffed and stretched. On the other hand, everyone has access to medical treatment, no matter what their income.

I do not know exactly how the American system works, but I would not be in favour of completely privatising healthcare. I think it is a right of every individual to have access to healthcare. If others want to pay for private care or insurance, it is their choice. Private healthcare running alongside public healthcare means people can avoid long waiting lists if they arw willing to pay for it, but people who cannot afford that can still get the treatment.

I have friends in the US who have been ill and have not been able to afford to go to the doctors, I think this is a bad thing.


Sorry, should have mentioned I live in the UK :stuck_out_tongue:

Oh my ! – I hope this isn’t going to be a ‘us vs. them’ shouting match……….

<-----deep, deep breathe---->

OK, first thing: ‘Socialised’ is a term designed and promoted (one assumes) by insurance companies to turn Americans off the concept. It’s ‘socialised’ in the same sense as universal education is ‘socialised’ or taxation or death – ‘socialised’ is successful Agitprop b / s that must make the propagandist NRA green with envy. I believe Euro’s think universal free medical care on demand is a birth right that any civilised society should aspire to – a basic human right, a principle to be proud of and it’s an integral part of the value system of the kind of society in which we wish to live. I know of no debate anywhere in Europe – or elsewhere - that questions the fundamental value of this system.

Nor is it anywhere near as expensive as Americans are led to believe – it is, in fact, cheaper than the American system. I will search for exact figures (give me a little slack, this flu is driving me nuts at the moment) but last time I looked Americans spent approx 14% of GNP on a health care system that covered no more than 65% of the population while the average Euro country spent a little less (12% ish) and covered the whole population. The absence of stockholders appears to help achieve better value for money.

Health is also not a subject appropriate for charity. Respect for personal dignity requires that members of a society are not dependent on goodwill and handouts that might, if they are lucky, help them get through. Charity in this regard only creates division and undermines an individuals’ worth – but it makes the rich folk feel all warm.

With commitment, vision and long term planning, it works and, frankly, I feel happier living in a country where I know no one – at least in theory – does not get (eventually) the treatment they need. I should also add that, over the years, the UK has probably been the least effective country practicing this system. But health care – along with education – is the leading political issue and medium term funding has been allocated to try and correct a shortfall in services. If the present Government fails to get re-elected, health care will probably be the reason why.

I also believe the US is truly and radically out of step with every other developed nation in this regard – IMHO, to Euro’s it makes no sense that owning a firearm is seemingly a birth right but health care is not.

Now, this is a huge, huge subject and there are endless problems with running a system like this…what do you do with an increasingly elderly population, how to view and apply more advanced (and expensive) treatments and medication, what is to be deemed an “acceptable” level of health care, what should be included and excluded……it’s very big and there is always something wrong somewhere. But, ultimately, if viewed in the same light as education, perhaps it can make more sense to those who have been led to believe it to be ‘socialised’.


I’ve had experience of socialised medicine in NZ and Australia. There are waiting lists in both countries which really suck. But there is a safety net in place which is a Good Thing. That’s what appears to be missing in the US.

What seems to be often overlooked is that with socialised medicine, you still have the choice to go privately and to be privately insured. I’ve actually found recently that some of the health care practitioners I am seeing privately for my son just take the public fee so I end up paying nothing. The public waiting lists are scary but when it costs AUD 30 to see a paediatrician privately, it is not that big a deal.

Both Australia and NZ are moving to privately funded health care which I find scary.

Not in Canada, at least. So, if there are 100 people waiting for a test, and you are number 50 and are willing to pay privately for it to be done elsewhere, at your expense, and even though it would move persons number 51 to 100 up a position and shorten their wait, you can’t. It is illegal.

Still, as has been said, there is a safety net. Everybody gets equal, and, I think, generally good, care. The downside is waiting, queuing, biding your time, and then more waiting.

Actually, not everyone waits. If you are connected, you get expedited services, operations, etc. This has been documented in the medical literature (for example see this paper).

Work for the goverment if you have govermental health care.:slight_smile:

Does anyone have a good idea of what doctors in Canada or the UK make compared to those in the US? I’ve always heard that they make less than we do, but I don’t know how much less. I’ve also always heard that the difference is bigger for specialists than for primary care docs.

This is the most common criticism of universal health care that my classmates come up with. How quickly we lose our idealism. :frowning:

Dr. J

Israeli (living abroad) speaking:

Three years ago, my mother-in-law (-to-be, at the time) had a nasty fall, breaking her knee and shattering her hip. She needed extensive surgery, bone replacement and any number of platinum screws. She spent two weeks in the hospital, two month in recovery and to this day has a physiotherapist come by every three days. She needed a wheelchair, a walker and constant pain medications and antibiotics. She’s had to go into surgery three more times.

To this date, her single largest expenditure has been to hire some guy to build a 3-foot ramp so they could get her wheelchair up on the porch.

I don’t know how the government managed to pay for all that. Perhaps Israeli doctors make more money, perhaps taxes are higher. Whatever the reason - it’s worth it.

I can understand why they’d see that as a valid criticism. To become a licensed physician requires years of expensive and difficult training. If you want to specialize you can tack on a few more years of training. Then over your career as medicine makes advances you’ll have to learn new skills and medicines. On top of that every single time you practice medicine your license is on the line. Personally I believe doctors deserve to be well compensated for the job they do.

I had surgery many years ago and the doctors bill alone was thousands of dollars. I didn’t feel as though his fee was unreasonable in any way, shape, or form. Of course I was insured. Had I not been insured I would have paid out of pocket because it still would have been worth it.


Difficult obviously, but not necessarily expensive. I don’t know about the UK or Canada but in Sweden, another country with public health care, we also have public education.

Public funding doesn’t mean free or cheap.


Canadian doctors don’t make as much money as American doctors because we have limits to how much they can charge the government for any given procedure (that’s a basic fee; I believe equipment, etc, is extra).

As Eggs a la Ted said, we also have publicly funded education, so paying off your student loans isn’t so painful.

The most common comment I’ve heard from Americans about Canadian medical issues:

“But you can’t choose what doctors you want to go to!”

What? When I lived in Ontario I could go to any doctor in any city I wanted. I could see a specialist anytime I wanted. Here, with *!@#&% Blue Shield, I can only go to certain doctors at certain times, and I still have to pay for the privilege.

I love universal health care. Sure there are waiting lists for non-emergency surgery (I’ve never experienced it, though), and the hospitals are underfunded and the nurses overworked (ask my MIL), but I hated having to trade it for privatised care.

I paid $15,000 for my five-year degree. Tell me that’s not cheap compared to what Americans pay. And my parents’ taxes weren’t any higher than the US average.

Not “free” in the greater scale, but it is without cost to the individual student. So IMO high cost of education would not be a valid argument for higher salaries if the doctor didn’t have to pay for it personally.

Not “free” in the greater scale, but it is without cost to the individual student. So IMO high cost of education would not be a valid argument for higher salaries if the doctor didn’t have to pay for it personally.

I’m glad you started this topic, Freftul. I’d been thinking lately that there sure are a lot of Americans here posting about how awful socialised medicine (in general) and the NHS (in particular) are - and they never seem struck by the fact that those who actually use them don’t tend to think they’re that bad, and certainly don’t want to switch to an American-style system.

Anyway, in Ireland’s system you also have the option of taking out private coverage if you want. If you do, you will be seeing the same doctors that the folks on the public system use (and yes, you can choose your own doctor). The main difference if you don’t have private insurance is that if it’s a non-urgent procedure you may have to wait longer, and if you require surgery you won’t get a private room in the hospital. IMHO these differences are a small price to pay to ensure everyone has access to health care.

The waiting lists are a problem to be sure, and there are concerns that they will drive more people into private insurance and thereby drive the system toward the US model, where there is one standard of care for the better-off and one standard for the poorer. This is just about universally regarded as a Bad Thing. At the risk of repeating myself, whatever the problems are with national health care virtually nobody wants to get rid of it and send everyone private, and I think those who constantly harp about how bad we have it over here should consider that we still think we have it better than the US.

Can I inject a little dull economic theory into this thread? In order to understand the policy issues involved in this area it is useful to get to grips with the workings and problems of markets. A number of factors interact, so bear with me for a little.

First off the health market is dominated by insurance. Almost everyone is willing to pay to limit the potential spread of outcomes in the health market. A perfect insurance market would insure everyone who was willing to pay the actuarially fair premium (the expected cost of health care). The two limitations to the working of insurance markets are moral hazard and adverse selection. Moral hazard is fancy term meaning people change their behaviour once they are insured. They do this in a number of ways: [ul][li]they will use more health services[/li][li]they will take less care about their health[/li][li]they will not monitor service providers for value for money.[/ul]In other words being insured completely takes away the incentive for consumers to do the things they ordinarily do in normal market transactions. People are more likely to go to the doctor for trivial things; more likely to go skiing; and less likely to care whether they are being ripped off -all for the simple reason that insurance company (public or private) is paying.[/li]
Adverse selection means that insurance companies are unable to effectively control their risk pool because the market mechanism works adversely to them due to asymmetric information. An example: suppose a car insurance company found out that the average risk of all Dopers meant that a $100 premium would cover their costs. So they offer that premium here. Those who would accept the policy would on average be worse risks than $100, because those who were better risks than average would decline the policy. Now suppose the company did a serious assessment of each Doper individually an offered its best guess as to risk. It is still the case that there is some information that they do not and cannot know. For some people they will have slightly overestimated the risk, for some slightly underestimated. The people who take up the offer will systematically be the latter. Adverse selection means that a proportion of the population willing to pay a premium based on risk will be uninsured or underinsured in a private market.

Next feature: the government (at least in a rich country) will inevitably end up being the insurer of last resort. Governments cannot credibly say “those who fail or refuse to insure and who get in serious medical trouble can go without treatment.” Note that this will exacerbate the tendency under adverse selection for people (particularly the poor, the healthy young and the medically indigent) for people to drop out of private health insurance.

Now doctors and hospitals. Unless constrained by insurers, these people have a pretty clear incentive to push up costs. One reason is that there is a buck in it, the other is that they want to give the best available treatment to their patients regardless of costs. Given that there is new and expensive technology constantly coming on to the market, this is likely to be a problem. There are also strong anti-competitive element in the behaviour of medical professionals.

So after all that, how will a fairly crude market function? [ul][li]First, due to adverse selection, many people will not have health insurance. This is a really big deal - without coverage at least for the catastrophic risks it is hard to make much of life. []Secondly, assuming that the government takes up its role as insurer of last resort there will be substantial government expenditure on the poor, the uninsurable elderly and the otherwise medically indigent. []Private insurers will spend a great deal of money trying to improve their risk profile, further exacerbating adverse selection. []Insurance companies will try to control expenditure by using expenditure caps, and coinsurance. These are demand-side attempts to deal with moral hazard. There are two concerns about this:[list][]it reduces the extent to which they are doing their job, which is reducing risk[/li][li]it doesn’t work very well, because patients are ill equipped to monitor doctors’ behaviour regardless of the incentives and because empirical studies show that the demand for health care is not very responsive to price (in economists’ terms it is highly inelastically demanded)[/ul]Insurance companies will be fairly poor at controlling the behaviour of doctors and hospitals, since in a fairly competitive health insurance market they lack bargaining power.[/list][/li]Okay, that’s the setup. In countries like Australia (and almost all of the developed world except for the US) policies of universal compulsory health insurance funded by taxpayers have been established. They do provide a partial solution to these problems. There is no adverse selection problem, because everyone is in the pool. This means two things: First, everyone is covered. Nobody has to worry that they or their children will be denied access to basic health care. Secondly, all the costs incurred by private health insurers trying to maintain the quality of their risk pool by trying to attract good risks and exclude bad risks are saved. Thirdly, the government has bargaining power and can clamp down on costs.

If you look at the literature from, say 15 years ago, the general conclusion was this: with a national health insurance system you get better health care (in terms of mortality and morbidity statistics) that covers more people for less money. This is not to say that there aren’t serious problems. Whilst acute and trauma care are typically good, chronic and non-urgent matters tend to get stuck in queues due to the difficulty in effectively managing hospital budgets. Costs in Europe, Canada and Australia remain much lower than the US, but they may merely be catching up rather than permanently lower.

The big change has been the emergence in the US of managed care, which shows real promise in controlling private sector health expenditures.

The real problem in both systems is that the payer of the bill is not in the room. More sophisticated private insurers like HMOs show an increasing capacity to deal with this problem, and in the near future will probably surpass compulsory government-funded systems in this regard. Once this is the case, targeted provision of insurance services by the government can probably deal with the casualties of adverse selection. But there is no general presumption that private insurers will deal with the problems, since there are significant failures in the insurance market whose effects spill over and indeed dominate the medical marketplace. I’m very glad we have the universal system in Australia as a starting place for reform.

Sorry, this ended up a bit long.

The starting salary for a Junior House Officer, aged at least 23, with a minimum of five years’ higher education, working 70 or 80 hours per week, is less than £20,000 (~$30,000).

A Specialist Registrar (3-4 years post-qualification, aged about 29) makes about £30,000 (~$45,000), working roughly the same hours.

The maximum salary for a hospital Consultant is about £60,000 (~$90,000), but their contracts usually allow them some time to practice privately. With private practice, many of them make more than £100,000 (~$150,00) and some might make as much as £300,000, depending on the amount of private practice they do.

Hospital doctors are paid on the basis of a fixed salary for a 40-hour working week and hourly payments for additional duty hours (ADHs) between the hours of 5.00 p.m. and 9.00 a.m. The real gripe of most doctors is that the ADHs are paid at a stupidly low rate, often less than the cleaners and porters earn.

And I’ll second everything that ruadh says.

Many of you mention that waiting for services as one of the biggest problem with ‘socialized’ medicine. Well, as someone suffering under the American health insurance system (I have, to date, payed far more in premiums than I have collected in benefits, in spite of the fact that my employer pays part of my premiums), I can say that there is waiting here as well. However, not much is made of this here. You go to the doctor, they schedule you for a procedure, and no mention is made of why they scheduled it when they did. Now, granted I’ve never known anyone to have to wait what seemed like an unusual amount of time to me. A few years ago, my wife was diagnosed and scheduled for gall bladder surgery, and the whole process took less than a month (maybe as little as two weeks, I don’t recall exactly).

I wonder, though, if anyone has any numbers to compare how much longer people wait for health services in different countries. Is this difference being exaggerated?