Who should pay the healthcare costs of the uninsured?

[CaptainQuasar]

I must agree with mheslep that nationalized healthcare would be socialism. But it's socialism in the same way that a nationalized military or a publicly-funded firefighting or police force is socialism. Whether that's “real” socialism or not, I don't particularly care personally.

⚛​

 

[vanesch]

I must agree with mheslep that nationalized healthcare would be socialism. But it's socialism in the same way that a nationalized military or a publicly-funded firefighting or police force is socialism. Whether that's “real” socialism or not, I don't particularly care personally.

⚛​

Haha, it seems that "socialism" is a scare-word in the US, in as much as "capitalism" is in France

In fact, nationalized health care is a kind of imposed health insurance with some solidarity. That is, with taxes you take the 'insurance fee' and the solidarity mechanism is then such that the fee is somehow more or less proportional to your income.

 

[Schrodinger's Dog]

Haha, it seems that "socialism" is a scare-word in the US, in as much as "capitalism" is in France

In fact, nationalized health care is a kind of imposed health insurance with some solidarity. That is, with taxes you take the 'insurance fee' and the solidarity mechanism is then such that the fee is somehow more or less proportional to your income.

In the UK the amount we pay in National insurance, is in almost all cases never more than we get out. The rest is made up from taxes, a small amount of which will come from the tax payer. Of course though when your system only costs 7% GDP, that is a lot cheaper than otherwise it would be.

It's not imposed health insurance, you can opt out in some systems and go private if you like, that's the point of running both systems, everyone is covered to the standard they would want?

This is what I find really bemusing, it's not the fact that there are any problems with the system, after all I believe 3 states employ it rather successfully already, so on a state by state basis, where is the issue? It's the notion of having to pay an average that covers everyone. That somehow you're paying for the poor's health care too? Instead of getting what is essentially nationalised and subsidised health care whenever you need it, and for all but cosmetic reasons.

Don't get me wrong there are problems with nationalised/private health care, even in France. But they don't even begin to approach the problems with a purely privates system, that shoots itself in the foot.

Is supplying every person with lighting, heating, education, pensions subsidies, socialism? Yes technically I suppose it is. But what is wrong with socialism when it actually is less costly than the alternative? The only people who suffer here are the insurance companies and the lawyers. And to be frank, if they had all their eggs in one basket, then there looking at a serious profit cut, not a very sensible idea anyway.

Do you know that you actually pay between 3 and 4 times more GDP towards health than towards your military budget? That's quite ironic don't you think?

Socialism like Democracy has it's positives and its flaws, it's about time people realized that, instead of imagining the "socialist" boogeyman as an evil spectre lurking under the bed.

EDIT: it's actually $\simeq$ 3.58 times as expensive.

 

[ShawnD]

I think I see a trend. Americans in this thread seem to be under the impression that they're wealthier than they really are. Given that the top 10% of incomes pay something like 90% of total taxes, people need to admit that they are already leeches on the system with their respectable $50,000 income. You leech when you use the roads, you leech when you send your kids to school, and you leech when you call the police. Those are all paid for by people much wealthier than yourself. To think that using money from progressive taxation would cost more out of pocket than using a flat cost (pay for your own) is ignorant at best. The only exception would be if you truly are in the top 10% of incomes, which starts somewhere in the ballpark of $250,000.

 

[mheslep]

...Do you know that you actually pay between 3 and 4 times more GDP towards health than towards your military budget? That's quite ironic don't you think?...

Didn't use to be that way as pointed out in https://www.physicsforums.com/showpost.php?p=1608851&postcount=32". I suggest its due to the employer based tax exemption US federal law passed just after WWII. Before that health care was much cheaper.

 

[mheslep]

...But what is wrong with socialism when it actually is less costly than the alternative?...

Again this assumes that the nationalized systems are providing the same service; I think its clear they do not. Its suggested the wide spread adoption of auxiliary private care in previously all state run systems is evidence that nationalized + private is the way to go. Another possible view of those facts is that the nationalized health care system is failing badly and is being propped up by the private system. As I've stated in this thread there are several problems w/ the existing US system (which btw is anything but all private, to the tune of $600B/yr govt. monies spent) including cost/service and those that can't access the system. I don't see evidence that nationalizing the system is the remedy.

 

[Schrodinger's Dog]

Again this assumes that the nationalized systems are providing the same service; I think its clear they do not. Its suggested the wide spread adoption of auxiliary private care in previously all state run systems is evidence that nationalized + private is the way to go. Another possible view of those facts is that the nationalized health care system is failing badly and is being propped up by the private system. As I've stated in this thread there are several problems w/ the existing US system

That's what I said, that's what we have in the UK. And that is indeed what many countries have.

It's not imposed health insurance, you can opt out in some systems and go private if you like, that's the point of running both systems, everyone is covered to the standard they would want?

There you go.

(which btw is anything but all private, to the tune of $600B/yr govt. monies spent) including cost/service and those that can't access the system. I don't see evidence that nationalizing the system is the remedy.

So why are nearly 1 in 6 not covered? nearly 50 million Americans without health cover? It's because the poorest are covered, the wealthy are insured and those somewhere in between? Well it depends if they can afford it.

Like I say since out of that list I gave you virtually all the top 30 healthcare providers are a mix of national and private, or have a generally higher social mobility that allows full nationalisation. Then it's quite obvious to me, that the situation in the US, isn't exactly functioning very well. Most medically advanced country in the world at number 38, we know the reasons, but what are the solutions. Like I said some sort of state by state partial nationalisation. Seems the only losers will be insurance companies and lawyers.

 

[mheslep]

Man you're up late in the UK

...So why are nearly 1 in 6 not covered? nearly 50 million Americans without health cover? It's because the poorest are covered, the wealthy are insured and those somewhere in between? Well it depends if they can afford it.

That number is the uninsured which is not the same as saying they don't can't get get health care. Twenty percent off the top qualify by lack of means for medicaid but don't use it or don't know about it. (Mass. Romney care found this out). Another very big chunk are the 20 somethings that believe they're invincible and don't want to cut into pub money for some cheap insurance (little less than the cost of food in their case). They walk into clinics or emergency rooms all the time. This group is big in the news here lately as Sen Clintons health plan will force the 20 somethings to pay and play where as under Sen. Obama's plan its optional. The remainder include the chronically ill with some means but no employer* coverage. Note that for all these cases you can still go into an emergency room most places even w/ out insurance though that's a lousy option - big debts, not preventative, etc. - its discussed way up thread. Again this situation needs to be fixed but I don't think the mantra of 50m no insurance leads to a good outcome.

*thats the problem. Fix by eliminating the dang employer tax exemption.

 

[Schrodinger's Dog]

Actually it was only 20:58 when I posted that. Now it's 22:48 and you're right that is late, but a bit of free time atm.

Anyway I'll take a look at how universal healthcare works in the few states where it happens and get back to you. I'm sure that would provide an insight into possible solutions, being we know they can work.

Well there's also the problem of people saying, well it'll cost me if I get it sorted out so I'll leave it until it's really bad. Where as over here, you can contact web sites or phone services, if your concern is minor and get live access to qualified medical staff. GP service is free, so if you have a genuinely serious or even not so serious problem you don't have to worry. Plus of course all your prescription are at a blanket charge of about $13, or free if you are unemployed. So no matter how expensive your medication, you still pay the same. Leaving people less likely to forgo expensive treatment because of cost. These are all things that would be improved if people felt they could get access to medical care regardless of financial concerns.

 

[mheslep]

Anyway I'll take a look at how universal healthcare works in the few states where it happens and get back to you. I'm sure that would provide an insight into possible solutions, being we know they can work.

I'm fairly sure there's no universal health care offered at the US State level; I expect you've heard of instead Massachusett's Romney plan which mandates everyone buy insurance. The insurance is still private but it has a single state level clearing house that works out the terms of the policy w/ the companies; the theory being the state keep costs down by pooling large groups of people. (https://www.physicsforums.com/showpost.php?p=1616495&postcount=117") A couple other states have been closing watching the Mass plan, esp. California's Govenator who proposed something similar but was shot down by his legislature for costs. So far the Mass program is having difficulty as they're base plan is still very expensive, but yes it certainly bears watching.

Well there's also the problem of people saying, well it'll cost me if I get it sorted out so I'll leave it until it's really bad.

Exactly

Where as over here, you can contact web sites or phone services, if your concern is minor and get live access to qualified medical staff. GP service is free, so if you have a genuinely serious or even not so serious problem you don't have to worry. Plus of course all your prescription are at a blanket charge of about $13, or free if you are unemployed. So no matter how expensive your medication, you still pay the same. Leaving people less likely to forgo expensive treatment because of cost. These are all things that would be improved if people felt they could get access to medical care regardless of financial concerns.

Here's where we part company. I don't think it should be free, I think it should and can be much cheaper than it is in the US. I'm skeptical that its no worry in the UK even if its free at the point of service (obviously someone pays for it in VAT or whatever over there). Anything that's free eventually has to be rationed because of pressure from both patients and the providers. The patients, since its free, overuse the service:
o UK: "A Hypochondriac's Paradise", New Statesman, Sept 18, 1998, pg 28
o UK: "Girl, 12, to get Breast Implant", Guardian, Nov. 9, 1998, pg 6.

and the providers cut back on the quality and quantity because the price/pay is fixed:
o http://www.oecd.org/dataoecd/5/27/26781192.pdf"
o 10,000 people in UK waited 15 mos for surgery. Economist magazine of London, pg 55, April 13, 02
o UK woman whose cancer surgery was postponed until it had to be canceled because it became inoperable during delays. Economist, Nov 24, 2001, pg 52.
o http://www.theaustralian.news.com.au/story/0,25197,23178213-2703,00.html" - "Among the 277,000 doctors registered in Britain, roughly half are from Commonwealth nations"

 

[mheslep]

The issue of malpractice costs has been raised. Direct costs 2% or ~$29B. Another issue was the cost of defensive medicine brought on by these suits which is hard to quantify. Found this http://www.tigerdroppings.com/rant/MessageTopic.asp?p=6969549&Pg=5" for what its worth:

Just a note about defensive medicine from a MD...

It sure does exist. Here is an example that many of us have been faced with over and over. A male in his late 30's/early fortys comes to the ER complaining of chest pain. He has a cough or some other reason to have some chest pain (nothing points to cardiac disease) but since he said the magic words "chest pain", we now feel obliged to order the full workup to protect us from the 0.001% chance that this may represent heart disease.

He gets an EKG X 2 (probably $100)
He gets cardiac enzymes drawn X 3 (probably $150)
He gets other routine labs (maybe $150 total)
He gets a chest X-ray ($100)
He gets admitted to a medical/cardiac telemetry floor 24 hour observation ($1200)
He may get a stress test if he had any risk factor at all ($750)
He gets discharged with a follow up appointment with his PCP ($75)

So, about $2500 is spent when the only thing needed was $2 worth of Motrin. Happens every day unfortunately.

 

[ShawnD]

I've experienced that preventative medicine problem in Canada too.

I regularly have chest pain, right around where the heart is. I've always had this problem, so I don't really see it as a big deal. I've been tested in every way you can think of, including the stuff about heart tracing, EKG, normal blood testing, arterial blood testing, urine testing, breathing tests, hearing and vision testing, etc. Nothing has ever been found, so it's probably not a big deal. Even after all of that has been done, people still tell me I should see a doctor every time I groan and grab my chest. I don't even want to think about all the money those people waste. In Canada they waste tax money, and in the US they waste insurance money, which means everyone pays higher premiums.

Hypochondriacs are a problem for all of us.

 

[Schrodinger's Dog]

I'm fairly sure there's no universal health care offered at the US State level; I expect you've heard of instead Massachusett's Romney plan which mandates everyone buy insurance. The insurance is still private but it has a single state level clearing house that works out the terms of the policy w/ the companies; the theory being the state keep costs down by pooling large groups of people. (https://www.physicsforums.com/showpost.php?p=1616495&postcount=117") A couple other states have been closing watching the Mass plan, esp. California's Govenator who proposed something similar but was shot down by his legislature for costs. So far the Mass program is having difficulty as they're base plan is still very expensive, but yes it certainly bears watching.

Did you know that the US is the only wealthy Western country without some form of nationalised health care. That's the trouble with primarily being concerned with profits, although you can make a system work, it would be seen as limiting drug companies profits (although obviously if the government is paying for it, then that is not the case) and lawyers, and health insurance companies. And heaven forbid they lost money. AFAIK drug companies in this country make substantial profits, despite the NHS, so I'm not entirely sure why people think this.

Here's where we part company. I don't think it should be free, I think it should and can be much cheaper than it is in the US. I'm skeptical that its no worry in the UK even if its free at the point of service (obviously someone pays for it in VAT or whatever over there). Anything that's free eventually has to be rationed because of pressure from both patients and the providers. The patients, since its free, overuse the service:
o UK: "A Hypochondriac's Paradise", New Statesman, Sept 18, 1998, pg 28
o UK: "Girl, 12, to get Breast Implant", Guardian, Nov. 9, 1998, pg 6.

Rationed? I don't think so, nothing like that happens here, there are some extreme cases where health authorities have had to make the choice to deny certain treatments because the cost was prohibitive, and the outlay would mean denying funding elsewhere (so the patients had to resort to funding it themselves) This was on Avastin btw, the drug that got repackaged and went up 1000% in price after they discovered it was being used to treat things other than were covered by the research. I'm not sure what you are referring to here. National insurance and tax pays for it. But then with a GDP of 7% that would work out less anyway. The government of course pays for the treatment, whatever that happens to be. Cosmetic surgery is not covered under the NHS normally, unless it's reconstructive surgery for burns etc. NHS Direct, means instead of burdening health services with minor complaints people can now contact trained professionals of any level 24/7, this has had the result of reducing the problem of hypochondriacs.

and the providers cut back on the quality and quantity because the price/pay is fixed:
o http://www.oecd.org/dataoecd/5/27/26781192.pdf"

Old statistics, waiting times have improved in most hospitals. It does vary from place to place though, which means under a new incentive, patients are free to chose healthcare at a place that will treat them sooner, or even in some circumstances another country. The hospital where I worked, waiting times for consultant oncologist was much less. As were the waiting times for most operations.

o 10,000 people in UK waited 15 mos for surgery. Economist magazine of London, pg 55, April 13, 02

Not any more, I believe these are also falling in most places.

o UK woman whose cancer surgery was postponed until it had to be canceled because it became inoperable during delays. Economist, Nov 24, 2001, pg 52.

Anecdotal but obviously dreadful, this is far from the norm.

o http://www.theaustralian.news.com.au/story/0,25197,23178213-2703,00.html" - "Among the 277,000 doctors registered in Britain, roughly half are from Commonwealth nations"

Yeah we have a Dr shortage, this is because of a long term problem with Dr's working too many hours and pay issues, this has now been rectified, but atm we are importing quite a few Dr's. We had the same problem with nurses at one point until we bought in a total restructuring of pay schemes, under the Agenda for Change (meant to tackle the issues with employee retention and other work issues) This appears to be helping.

Like I say there are problems with nationalised health care, but it's better than the alternative. And let's face it if you want I can put up more than a few horror stories about the US, patients being asked what fingers they can afford to save and so on. Or you could watch that film Sicko, although I've not seen it.

By the way the US GDP is now 15.4%. See http://www.who.int/whosis/database/core/core_select_process.cfm?countries=all&indicators=nha" statistics for details.

Your table placings have improved though. After they removed certain cases which weren't necessarily treatable or self inflicted such as smoking, diet, accidents and suicides (not sure I entirely agree with this but still) Sweden is now top.

http://www.guardian.co.uk/society/2003/nov/14/politics.medicineandhealth

Since we've slipped down from 18th place to 18th place, I'm not sure that news report is very accurate to be frank. Although the table is correct.

1)Sweden
2)Norway
3)Australia
4)Canada
5)France
6)Germany
7)Spain
8)Finland
9)Italy
10)Denmark
11)Netherlands
12)Greece
13)Japan
14)Austria
15)New Zealand
16)United States
17)Ireland
18)United Kingdom
19)Portugal

EDIT: To be honest I'm also a bit dubious about you saying 1 in 6 not receiving health cover is not significant either. Whatever the cause having 50 million people not receiving treatment is abysmal to be honest.

 

[vanesch]

Again this assumes that the nationalized systems are providing the same service; I think its clear they do not. Its suggested the wide spread adoption of auxiliary private care in previously all state run systems is evidence that nationalized + private is the way to go.

This is the way it is in many European countries (again, with some having the pointer more on one side, and others more on the other). You have a nationalized health care and imposed "taxation" (part of your social security contributions), and then, if you want (and many people do) you can take an extra private insurance. You can go to a public hospital, or you can go and see a private clinic. In the last case, you will have to see how much they charge, and how much you are covered for this by the public insurance, and by your supplementary private insurance.
So if you want the "minimum", you just pay your social security, and get (almost) free care in public hospital. You can get more, if you want to, in the private sector, but this minimum is imposed to everybody.

 

[mheslep]

EDIT: To be honest I'm also a bit dubious about you saying 1 in 6 not receiving health cover is not significant either. Whatever the cause having 50 million people not receiving treatment is abysmal to be honest.

I didn't say it wasn't significant, just the opposite: 'lousy'. What the 50m either can't afford or choose not to afford is insurance. Again, that doesn't necessarily mean they necessarily don't 'receive treatment', most everyone can get treatment, though at the last minute and inefficiently.

 

[mheslep]

Rationed? I don't think so, nothing like that happens here, there are some extreme cases where health authorities have had to make the choice to deny certain treatments because the cost was prohibitive, and the outlay would mean denying funding elsewhere (so the patients had to resort to funding it themselves).

Cutting out here so that you don't have to cut back there is rationing. The most notable examples are the wait times referenced below.

o http://www.oecd.org/dataoecd/5/27/26781192.pdf"

Old statistics, waiting times have improved in most hospitals.

That OECD chart (fig 3.9) is from a 2004 survey.

Like I say there are problems with nationalised health care, but it's better than the alternative. And let's face it if you want I can put up more than a few horror stories about the US, patients being asked what fingers they can afford to save and so on. Or you could watch that film Sicko, although I've not seen it.

By the way the US GDP is now 15.4%. See http://www.who.int/whosis/database/core/core_select_process.cfm?countries=all&indicators=nha" statistics for details.

I see two problems under discussion that have very different compositions: (1) the quality of health care for the majority in the country (those that can afford it), and (2) getting care to all the hard cases (chronically ill, limited means, etc). These two problems are often muddled together at the expense of clarity. The WHO report is a good example. To determine the ranking it mixes the life expectancy metric with others like "inequality", "fairness", "dignity", and "Distribution of Financing". The latter are important but they're not good for measuring top flight medical treatment. If I am looking around the world for top flight medical care - cardio work, cancer - I don't look at the WHO list and jet off to Sweden or France. I stay right here and go to Johns Hopkins or the Mayo clinic. Same w/ Sicko type comparisons. People falling through the cracks are the ugly side of the US system but that is a different problem from the quality of the care of the US insured, of whom ~70% say they're very happy w/ the their care. (They also say its far too expensive). I see some role for government in covering (2), the hard cases. I don't see evidence that nationalized heath is the best way to do that given the problems list above. Note that for that 15% of GDP figure cited, nearly half of that is government spending now. No, I'm more inclined to fix the current private system so that is affordable to everyone. We do it with food.

 

[Schrodinger's Dog]

Cutting out here so that you don't have to cut back there is rationing. The most notable examples are the wait times referenced below.
That OECD chart (fig 3.9) is from a 2004 survey.

Nonsense. You are suggesting that all hospitals have to cut back? That is simply not true. And I have already said that patients are free to seek treatment in another hospital or even if none is available are funded to do so in another country. So yes there are a small amount of cases where treatment is denied because of the extraordinary costs (usually the fault of the pharmaceutical companies) but these are hardly the norm. And I'm not sure why after I gave those explanations above you seem keen on pursuing this, given that your assumptions are faulty, and based on small amounts of cases, mostly anecdotal.

I see two problems under discussion that have very different compositions: (1) the quality of health care for the majority in the country (those that can afford it), and (2) getting care to all the hard cases (chronically ill, limited means, etc). These two problems are often muddled together at the expense of clarity. The WHO report is a good example. To determine the ranking it mixes the life expectancy metric with others like "inequality", "fairness", "dignity", and "Distribution of Financing". The latter are important but they're not good for measuring top flight medical treatment. If I am looking around the world for top flight medical care - cardio work, cancer - I don't look at the WHO list and jet off to Sweden or France. I stay right here and go to Johns Hopkins or the Mayo clinic. Same w/ Sicko type comparisons. People falling through the cracks are the ugly side of the US system but that is a different problem from the quality of the care of the US insured, of whom ~70% say they're very happy w/ the their care. (They also say its far too expensive). I see some role for government in covering (2), the hard cases. I don't see evidence that nationalized heath is the best way to do that given the problems list above. Note that for that 15% of GDP figure cited, nearly half of that is government spending now. No, I'm more inclined to fix the current private system so that is affordable to everyone. We do it with food.

Of course you don't see evidence, after all it's not like the centralising of beaureaucracy works elsewhere, that the termination of need for huge arrays of insurance companies, and the reduction of legal costs work anywhere else do they?

I'm not saying nationalisation doesn't face its own problems, what I am saying is that it seems to work more efficiently, without sacrificing efficacy (ie it covers more people not less) given the vast amount of evidence from other countries (which you conveniently don't trust) that says so. That is all I am saying. The only real problem with implementing it on a state by state basis, is the damage to profits of certain companies (not pharmaceuticals, demand is still the same, the bill merely passes to the government). Insurance companies and lawyers - who frankly I'm not that bothered about, if they have all their eggs in one basket then that's their problem - which can still provide insurance to those who want to go private anyway, as for the lawyers? Well I'm sure they'll survive, even with a reduction in frivolous law suits.

 

[Schrodinger's Dog]

1)Sweden
2)Norway
3)Australia
4)Canada
5)France
6)Germany
7)Spain
8)Finland
9)Italy
10)Denmark
11)Netherlands
12)Greece
13)Japan
14)Austria
15)New Zealand
16)United States
17)Ireland
18)United Kingdom
19)Portugal

EDIT: To be honest I'm also a bit dubious about you saying 1 in 6 not receiving health cover is not significant either. Whatever the cause having 50 million people not receiving treatment is abysmal to be honest.

EDIT 2: Actually this table only included Western industrialised nations. Thus the statistics are only meant to be indicative of health care in the Western wealthy nations.

Sorry that's kind of misleading. This is an independent study removing the factors the US considered biased the WHO tables (mortality statistics). Such as smoking, obesity, suicides, homicides, etc.

They say that diebetes is preventable and treatable, but what they don't say that is obesity is one of the biggest risk factors associated with diabetes, and heart disease and cirrhosis of the liver interestingly enough. So I hope they took account of that too.

 

[mheslep]

Nonsense. You are suggesting that all hospitals have to cut back?

Again, I didn't say that. I'm saying its fair to call the description you provided above about 'cut backs' to save money, in a word, as rationing.

And I have already said that patients are free to seek treatment in another hospital or even if none is available are funded to do so in another country. So yes there are a small amount of cases where treatment is denied because of the extraordinary costs (usually the fault of the pharmaceutical companies) but these are hardly the norm. And I'm not sure why after I gave those explanations above you seem keen on pursuing this, given that your assumptions are faulty, and based on small amounts of cases, mostly anecdotal.

Hardly. The OECD 2004 data of 220 days is hardly anecdotal nor is it based on my assumptions. The average wait for surgery in the UK in 2004 was 220 days, period.

Of course you don't see evidence, after all it's not like the centralising of beaureaucracy works

Says who? Where's the evidence that says nationalized part of EU systems 'works'. Why is it not more plausible that the recent addition of private carriers to these system is responsible for any success?

I'm not saying nationalisation doesn't face its own problems, what I am saying is that it seems to work more efficiently, without sacrificing efficacy (ie it covers more people not less)

I see little evidence of that. I see again and again national + private systems grouped together offered as proof that the national part is great.

given the vast amount of evidence from other countries(which you conveniently don't trust) that says so.

Which mixes together many unrelated numbers and makes some relatively meaningless ranking. Sweden is number one in what? I doubt any clear statement can be formed from the numbers WHO aggregates.

 

[Schrodinger's Dog]

Why are the WHO's statistics inaccurate, I presume they ask countries for relevant information, and proceed from there. Also this is an independent study, so I presume they are working from the best available information. If the US statistics are erroneous, then that no doubt is because the US has supplied erroneous statistics when asked for them, I presume though they do some checking into any data supplied by a particular country.

I also think you have to take into account that some non serious medical operations, are not considered to be priority, and so the statistics don't take into account serious medical problems. For example, the bench mark for cancer is a consultant appointment in 3 months maximum, something that is usually achieved. Such a blanket statistic is misleading. And tends to infer that even serious cases are likely to warrant 7 or so month waits. As I said before if you wish you can ask to be treated in a place which could see you sooner. So again if the problem is serious, there is provision for you to be seen sooner, something that your statistic misses, and which is also a recent proviso that came in after 2004.

As for evidence it works, try the top performers, who have partial private and nationalised, without the limiting factors previously mentioned, such as diet and suicides and smoking and so on - which of course tends to rule out a vast swathe of the population where you can't look at the treatment for such cases because they are not accountable - so that in itself raises issues. If independent studies aren't going to convince you, then nothing is, it's obviously some sort of conspiracy.

Again note I'm not saying we don't have our share of problems, or indeed going on that table that we are doing better. For years the NHS was underfunded, staff underpaid and there was a serious brain drain to other countries such as the US because of this. The labour government has introduced a rather short sighted policy of jumping through hoops, but it at least is better than it was in the early 90's when the conservatives almost ran the NHS into a crisis. The NHS is now looking at more private options to help with the nationalised side of its operations, it's also gone from the insular mentality of the 90's to a more business like approach. Hopefully this will have favourable results. Of course it's not going to go fully private though, that would be even worse, and no doubt we'd end up with the same problems you have.