Having spent the first 20-some years of my life in the US system and the last 13 in the UK, and having had operations in both countries, I have to say that while the facilities in the US tend to be shinier and newer (the outpatient center where I had my US surgery looked like a shopping mall), the overall level of care has been roughly equivalent. I’ve had excellent care and crap care in both countries, but this has always been down to the individual doctors involved and not the systems.
When my wife was pregnant last year, she was considered high risk for a number of reasons. Throughout the pregnancy she had regular scans and checkups. Following the birth she and the baby spent a week in the hospital due to medical complications. When they came home, a midwife paid a few visits to make sure that everything was okay and to answer any questions, followed by regular visits from a health visitor to do baby checkups. When my daughter developed a bad reaction to the formula she saw several specialists who found the problem and prescribed a special formula powder which she has been taking for several months now (well, she’s weaning now, but…). She has follow-up appointments with the allergist and dietitian next month, as well as her next set of inoculations.
Cost to us at point of delivery? Nothing. And that includes the prescriptions (which are free for children). Had we been in the US, we would have had to make some very hard choices about seeing doctors, and would have been spending a lot of time on the phone with our insurance company.
So yes, our taxes are a bit higher than they would be otherwise, and for many years we were paying in more than we were getting out of the system. But when we needed the NHS, they came through for us.
@ Quartz: The main reason for the “2” is the cleaning. The outsourced cleaners at the hospitals we’ve been to have been noticeably crap. Just sayin’.
Anyway, Gyrate, about our taxes being higher: I’m sure someone will be able to tell me I’m wrong, and admittedly I did have trouble finding any useful information, but I was looking to see how much higher they are than Americans’ taxes, and from what I could find they seemed to be roughly equivalent. Certainly inputting my salary (which is in the most common tax band), I found that I would be no better off in the States than I am here. We have National Insurance as well, but that pays for different things.
OK, for more info (though no-one asked!): if I lived in the USA, I’d be paying 15.6% tax, as far as I can tell on a calculator where I only entered my salary, no other details (deductions, exemptions, adjustments - things I wot not of). According to my payslip and my maths, I’m currently paying 12.12% tax. That’s not more. With National Insurance, my total deductions are 20.18% of my salary, but as I say, NI pays for other things.
Hmmm, I must be remembering incorrectly. It’s been a while since I was on the pill, but now that you mention it, I can see you’re right. Although I think I did have to pay for it when it wasn’t for birth control purposes. This was over 10 years ago, though, so that may be different (or my memory has failed yet again failed).
Anyway, my point stands. Prescriptions which would cost a significant amount stateside are pretty damn cheap over here. Sorry if my example was misleading.
Teacake, I don’t know how you worked out those figures, but they aren’t completely comparable in the way that you’ve expressed it. You’re considering income tax only, but here we also have non-income related Council Tax which pays for stuff like schools, whereas in the US local tax also paid on income: they have Federal income tax but also State income tax (which differs from state to state - some have none at all). Then we have VAT on purchases, and their sales tax is calculated differently per state too.
Former USAian here, five years in the UK and now in Canada.
In the USA I had employer health insurance (via husband) for most of my life. It sucked. Yeah, it took care of most of the costs (after deductibles and 80% coverage for random things) of various health issues, but the paperwork was enough to drive me batshit insane, not to mention the challenge of finding a doctor that accepted the insurance. At one point, none of the local hospitals even accepted it, so it was out of pocket payment with reams of paperwork to get reimbursed time (and with the all the attendant “discussions” regarding itemized coverage)
When I didn’t have health insurance (before and after marriage) it sucked even more and cost a fortune for the slightest little problem.
Because of the cost and/or the hassle of seeing a doctor in the USA, I more often than not opted not to.
Getting insurance after divorce (and when I was self-employed) was incredibly expensive (COBRA was $560/month for a limited time and private was somewhere in the neighborhood of $700-900/month - and that was before telling them about a pre-existing condition - add that to your tax burden, eh )
And it’s getting worse. My daughter, with the same pre-existing condition, (which incidentally is a no treatment/no cure condition so I don’t know why it would impact insurance) pays extra on her company offered health insurance.
5 years in the UK. All health care issues taken care of without quibble, including an appointment with a specialist the day after I arrived to deal with a problem that started in the US shortly before I emigrated and would have cost me thousands of dollars if taken care of there (no insurance at that point - see above cost problem) Admittedly, I married an NHS GP and had a bit of an inside track, but still… Any other issues I had went through normal channels and were quickly and efficiently taken care of. GP appointments given the day I called unless it wasn’t convenient for me and any follow-up scheduled with-in a week for non-emergency stuff. ER care for tachycardia was instant walk-in.
I’m now experiencing Canadian health care and so far, no complaints. The only difference I’ve noticed from the NHS is the cost of medications, which are not covered unless you have additional private insurance and which can be quite expensive for a chronic condition (or so I’ve been told by others)
So… rate the NHS 1/2 and only 2 because there’s always room for improvement, and because I have (second hand) insiders knowledge of some of the issues that NHS employees face.
True, but the USA also has Property tax (comparable to council tax and covers roughly the same stuff). Sales tax (as well as State income tax) in the USA is very variable depending on your location.
One of the interesting and rarely mentioned consequences of Bush’s tax cuts is that lots of federal funding for local programs dried up, which caused local sales tax, property tax and State income taxes to raise. Not only did they raise but they impacted lower income people at a much higher proportion than the cuts in Federal income tax benefited them. The true impact of those tax cuts was that lower income people actually paid more in the end. Cute, huh?
(I don’t have a cite but I remember reading a breakdown on one of the citizen taxation web-sites back when)
I’ve got a lot of experience with the NHS. My parents practiced medicine in NHS facilities for a combined 50-odd years, and I was a very sickly child- serious asthma and chronic bronchitis that put me in the hospital for weeks and even months at a time.
I think the basic system is sound, it just needs tweaking here and there.
Option 2: times change, options and possibilities as to what is the most efficacious mix of public and private provision change. The principle of free-at-point-of-delivery for all is what counts.
This is tangential to the NHS discussion but the government (and this goes back at least to the Major government, when I first came to the UK) are notorious for handing out contracts that are difficult to break, and in fact disincentivise replacement of contractors by making the cost and effort of replacement greater than that of cleaning up the mess caused by an incompetent, lazy or corrupt contractor.
As best I can figure, anyone capable of negotiating a proper contract has long since gone to the private sector where they can make more money, hence the overall ongoing cluelessness in government procurement.
If they are your own employees you can set proper standards and enforce them like any other job performance issue. It worked fine for decades, with specialised ward staff.
Private companies are cheaper because they do not do the same good job. They have untrained over-worked unmotivated staff and value is leeched out in the form of profit.
Makes no sense and this has belated been realised.
While emergency treatment is very speedy - the ex had quite a few medical problems which resulted in surgery and hospital stays - chronic conditions can take an absolute age to get sorted. You get there in the end, but it can be frustrating waiting for surgery.
The ex was also a diabetic, which leads me to something I think needs a bit of a shake up: Medical exemption certificates, giving free prescriptions for people with certain long term health problems.
Diabetes is a condition covered by such a certificate, but the exemption covers all medication not just those needed to treat the condition. While (during the time we were married) it would have meant us spending more money, I always thought that only diabetes treatments should have been free and the money saved by having to pay for other medicines would’ve been better spent by adding something like asthma to the list of conditions that qualify for an exemption certificate. It’s fair silly that a diabetic can get medicine for a non-diabetes related bellyache for no fee, while an asthmatic has to pay for an inhaler.
On the tangent about cleaning, my mother was a domestic supervisor in a NHS hospital for years. Man, does she bloody rant about the state of the hospitals now.
I worked them out using an online US income tax calculator and my payslip. I thought comparing just our basic income tax with just their basic income tax, no other taxes taken into consideration on either side, would have to be fairly comparable. Is council tax relevant when it doesn’t pay for the NHS? As I said though, I was sure someone would come in and point out the flaw in my reasoning!
But then as Slumtrimpet pointed out, the US has property tax. Not knowing how all the different taxes drain down into their little holes, I thought I’d stick with just the big, central government one. Both countries have a whole lot of different taxes and duties; if I tried to do all of them, it’s impossible to compare how much tax I pay here in London with how much tax someone pays over there, really. What’s the fuel duty at the moment? Do you live alone? How much do you eat? Are you small enough to wear children’s shoes, and does that make a difference to the level of sales tax you pay? Do you drink much? Specifically what do you drink? because that makes a difference to the duty as well. Smoke? Pay customs duty on imported goods? The only solid thing I could compare is how much income tax I pay on a stated amount of salary, and how much someone in the States declaring as a single person would pay.