Getting the NHS established was not an easy task, especially in 1948 when the UK virtually bankrupt after the war. The GPs were dead against the idea, fearful that they would lose their professional independence and become state employees. However, the Minister of Health was former miner and committed socialist and determined to create a national health service.
It was a fascinating period of British political history and it ended in a compromise with the doctors. The NHS was established but the doctors held onto their ‘clinical and professional independence’. Their status remains as private contractors and they are allowed to ply their trade privately when they get to hospital consultant level and tend to the seriously wealthy in Harley St.
The argument was that the health of the nation was far too important to be left to a profession charging fees. It could only be financed properly if the government raised a tax on everyone to pay for it. That part resonated with the surgeons who ran under-financed hospitals and they managed to persuade the GPs. To the general public and particularly the working classes and the poor, the NHS was payback time after a long, hard war. The sense of entitlement remains very strong and politicians have to tread very carefully. Sadly that is also true of the doctors who seem to have been able to hang onto their professional privileges.
This financial arrangement, that it is single payer, is very efficient. No need for the huge bureaucracy that encumbers other systems that involve insurance companies shifting liability and costs between patient, hospital and doctors.
The state model of socialised medicine was appropriate for the UK, which had a highly centralised economy at that time, just after the war. But that does not mean that single payer cannot be used as a model elsewhere, it does not have to run by a government. The key is simplicity.
Changing any system that is entrenched and has powerful vested interests is very a difficult political challenge.
One comment : I think the resurgence of interest in single payer is for one simple reason.
Numbers matter. It’s one thing to stick to your ideological position when you can afford it. But medical care has been steadily inflating in cost, year after year, and now costs so much in inflation adjusted dollars that only the 1% can really pay out of pocket. The majority of voters, as we all know, if they can’t get the primo insurance from their employer, end up with 10k a year premium/6k+ a year deductible style plans. Basically, pay an insane amount of income each year for a policy that most years will pay nothing.
And the cost to employers has risen to the point that only the most valuable employees are actually worth the cost. That’s why salaried jobs with employer paid health insurance are getting harder to come by. It’s probably also a contributing factor to age discrimination from certain famous employers.
Anyways, in just a few years at the current rate, medical care and insurance will just be completely unaffordable. Nobody will be able to pay it (except a tiny percentage of millionaires). I’m not sure how costs can continue to inflate past the levels they are at now.
And, yeah, as everyone points out. It’s one thing to worry about death panels when you could plausibly pay out of pocket or get an insurance plan that covered things the state death panel didn’t want to cover. But if the out of pocket cost for the treatment you need is $500,000, who can pay that? Very few.
If you’re elderly, and dying from several causes, it doesn’t matter if you get your cancer treated with million dollar biologic therapy if your kidney problems kill you the month after. So death panels make a certain amount of sense, as distasteful as they are. (and I think they are flat out evil for other reasons but that’s another topic)
I think people often regard government benefits as socialism. I never have. While recognizing that people can have legitimate differences of opinion about what socialism is, to me socialism didn’t become a coherent philosophy until Marx, so therefore any idea that predates Marx cannot in itself be socialist. Government benefits predate Marx, so government benefits are not socialist. The idea that Marx proffered that was genuinely new was government ownership of the means of production. IMO, THAT’s socialism, and the NHS is quite socialist. But no other country outside of totalitarian states is dumb enough to choose such an obsolete model. Except for our VA, but that’s for a very specific purpose, to provide something we believe the private sector cannot. Although I really do think we should be utilizing the private sector more in veterans’ care, especially for non-combat related conditions.
But no, single payer is not socialism IMO. It’s just nonoptimal. But given the nature of our Constitution, it might be the only legal way to deliver UHC. We can’t force people to buy health insurance.
It’s more inertia than an active choice. ACA has many problems, but one thing I’ve never accused it of is not being a modern solution. Single payer on the other hand is straight out of the 1940s and it sounds simple. Until you realize what the transition will involve. It was actually much easier to implement 50-70 years ago than it would be today.
That’s not what the so-called “death panels” (as originally proposed with the ACA) were, or what they are anywhere. It was just a scary term invented by the insurance lobby and the right-wing opposition to the ACA in their unceasing campaign to associate universal health care with socialism and death and anything else they could think of that would scare people. What the draft ACA had actually proposed was funding end-of-life counseling for the elderly, dealing with things like understanding about living wills and DNR (Do Not Resuscitate) directives, the kind of counseling that modern medicine is increasingly recognizing as an important part of medical practice as people live longer and medicine becomes capable of ever more heroic and drastic life-saving measures that may often be counterproductive from the standpoint of net benefits to the patient.
The only country in the world that actually has real death panels is the United States, where insurance bureaucrats can legally sentence an innocent patient to death by declining to pay for critical life-saving procedures if they can find a policy loophole for doing so. Example: Health Insurer to Be Charged With Teen’s Murder
Wendell Potter was a former senior VP at the health insurer in question here, Cigna, and it was one of the reasons he felt morally obliged to resign and become a whistleblower and activist for health care reform. Another reason was RAM. RAM stands for Remote Area Medical and was originally established to provide critical medical services in backwards, underserved third-world countries. Today, as Potter notes, much of their activity is devoted to the US, particularly poor rural areas. Such is the state of health care when it’s not universal and the whole system is geared to profits and “free markets” – i.e.- ability to pay.
There’s nothing “modern” about any health care system that relies almost entirely on private insurers or direct out-of-pocket payment. That is, in fact, precisely what all other countries had at various times in the distant past that they would sooner forget about. The modernization was moving to true universal health care which in most cases is either single-payer or a highly regulated system that works pretty much the same way.
From what I’ve read of your legislators, it does rather look as though they can be prone to use legislation to micro-manage public professional services in a way that, on the whole, ours generally haven’t*. So this may not be too unrealistic a fear, in the US context, where it would be in ours.
*Though I grant there has been a worrying trend over the last few decades for politicians to imagine they know all about education, they don’t, on the whole, attempt to use law to second-guess the professionals on clinical medical policy, let alone clinical judgments in individual cases.
Single payer is actually pretty rare. It’s popular in the English-speaking world, but continental Europe and the advanced Asian economies tend to do things differently.
Single payer without private competition for basic health services is very rare indeed.
France, the #1 system in the world, is multi-payer. Italy, #2, is single payer but the private sector competes directly with it. Despite the dreams of progressives in the US, introducing single payer does not kill the insurance industry. It just lets it cherry pick richer and healthier people. And that’s not a bad thing.
Where we’re seeing that go way overboard is with painkillers. The same people who whine endlessly that we should never get between a woman and her doctor for private medical decisions are, well, getting between a woman and her doctor on private medical decisions.
Of course they do. Those pointy-headed poindexters in That Man’s adminstration have only one goal. To establish full-blown communism over every aspect of every red-blooded American’s life.
Actually, there is a very strong contingent amongst the Republican conservatives to do exactly that, for exactly that reason. When the time came to deal with the rather obvious and long standing shortcomings in the VA system, the GOP wanted to substitute private insurance for the entire thing, rather than properly fund it and manage it.
What is more intriguing to key on, is that until the ACA was passed, Congress did get free health care coverage. I haven’t seen a mention yet as to whether the repeal and replace efforts would return to them getting it free again, or continuing as they are now, having to get coverage the same way we do.
Since the VA is a very large institution it will do us well to compare its perfomance with the private-sector insurance-based system. This is an experiment in the finest tradition of reality-based economic conservatism.
And, when that comparison is made … SPOILER ALERT! … the VA is seen to win the comparison by a substantial margin.* Yes, the VA does have some problems, as does private-sector healthcare, but much of its inefficiency derives from Reagan-Ryan ‘starve the beast’ budget cuts. (We’re not in the Pit; can I mention that much of the government sabotage orchestrated by Republicans is deliberately intended as sabotage?)
Google hits strongly show VA as better and cheaper. I chose the hit written by the guy who is NOT a Nobel Prize winner.
@ adaher — So, do you still want VA privatised? Why?
We’re not calling to privatize it, just allow vets to seek care in the private sector when the VA can’t treat them. That’s the whole reason most countries have private and public insurance: so that you can jump the line.
So do you want your veterans getting extra treatment from the private sector, paid for by themselves, supplementing the VA treatment they are entitled to ? Or do you want them getting private sector treatment paid for by the tax-payer ?
I would imagine the first is legal, and the second is socialism. With a dash of cronyism on the side.
They did that, and that’s how the opioid crisis got started. Still, it does seem that the medical profession realized its mistake and is probably in far better a position to fix it than the government.
The private sector is almost always in the best position to correct internal problems…much like the fox is in the best position to stop the raiding of the chicken coops.
Except for the pill mills, this isn’t a profit issue though. Doctors got into this faddish thinking that pain was to be eliminated to the largest extent possible, and that only patients could tell you how much pain they were in and deserved to be believed. It was feel good stuff, but it turned out badly. But it had nothing to do with profits for 99% of individual doctors.
And so far the government’s solutions have done nothing but deny pain meds to patients who actually need them. Letting the medical profession self correct on this is the best policy.
It’s not like the pill-pushers have any influence whatsoever over what and/or how often pills get prescribed, right? Gifts, trips and straight out bribes would be the first thing docs would ban if they were allowed to self-regulate! :rolleyes:
