The Phileas Club 89 – Special: Healthcare (in Europe)


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  1. Having grown up in the UK, lived in the US and currently living in Singapore, my experience is that the UK has the worst system, US next worst with Singapore being far and away the best.

    I didn’t recognise a lot of the description of the NHS from Brian and some of what he mentioned highlighted the issues with the system, although they were presented as benefits of the system from his vantage point.

    All in all, another good episode providing an important alternate view for me to listen to.

    • patrick says:

      Hey Hayden, I’m not sure what you mean when you say that issues are presented as benefits… Could you expand on that by any chance?

      • Hayden,

        I think one thing i alluded to that might not have come across in the episode is that one of the problems that the current system might have now is that there can be variation across Health Boards and I know for a fact that the Scottish NHS which is currently more supported by the devolved Scottish Parliament is in a better state than NHS England. I am interested as to where in the UK you lived and what services you used when there?

        And for the record, as much as I will defend the NHS and its staff to my deathbed I will be the first to admit there are problems and it is highly likely that there are better ways of doing things, I just don’t advocate the american system of individual health insurance and charging people for keeping them alive or well.

      • Bruce

        That is a big issue with the NHS, it is a lottery based on where you live. You may live near a good hospital or if unlucky a poor one. And for most people they have very little choice.

        I lived in Greater London and had family and friends treated in Hospitals in and around that area.

        The American System, from my experience, had numerous issues (mostly in the way US insurance companies were isolated from competition IMHO) but the treatment i received (and Friends of mine received) was of a much higher quality. I also experienced the case with an uninsured Friend having a life threatening condition be saved by the US healthcare system, when the NHS had missed the issue for approximately 6 months . He was not charged a penny.

  2. Before I say this I want to say I do not want to come across as being critical of Brian’s decisions but as the podcast was a very personal explanation of his experiences I feel I have to address some of his experiences and my view towards them. Brian, I hope this does not come across as a personal attack. Patrick, feel free to not allow this through if you deem this is too personal.

    One benefit as issue that i saw was where the ‘free’ healthcare can be a pull for people who have not necessarily paid into the system before hand. As Brian mentioned when he moved to the UK in 2002 he had previously lived in Zimbabwe so had not paid anything into the system beforehand. I am aware he will have paid National Insurance for a number of years once in the UK but after leaving (and presumably stopping paying NI whilst in Zimbabwe) the ‘free’ healthcare in the UK was a reason for returning. If National Insurance was indeed insurance (as Brian mentioned it is really a tax that is ring-fenced by the Government for certain things) he would not have been covered as he had stopped paying into the system during that time. The ‘Benefit’ of being able to walk into a healthcare system with no prior contribution is grossly unfair to those who have paid toward it previously.

    I also thought that the choice not to take up Insurance as he did not feel it was worth it was a decision that he had every right to take but with this decision comes a personal responsibility to deal with the consequences of that decision. If that means greater cost later (presumably to be paid with the money saved from not having insurance previously) then that is the consequence of that decision.

    • Sorry, I said Brian 🙂 1.30 am here and very tied.

      I of course meant Bruce.

      • Hayden, no worries. I must sound like a Brian because i have been mistaken for one many times in my life.

        Thank you for your points, I don’t disagree with your assessment on the surface and there was a time when i would have wholeheartedly been on your side. I feel there are a number of issues surrounding this and there is no easy answer here.

        The only thing i can say is look at it this way. Even if i had not spent 10 years paying into the NI system in the UK before I left (without ever using it), coming back for the “free” healthcare was a benefit that not many people would have had (I have a british passport due to having a British father and according to the current rules that entitles me to those benefits), I came back into this country and have for the past 5 years paid into the NI system and feel a sense of responsibility to my community and the NHS that i never had before.

        Is it greatly unfair for those who have not paid into the system top pull resources out? Possibly yes, but I would always argue that a child of 5 years old who was born in the UK (by chance of birth) has given as much as a person from Somalia who is 45 and who needs the help, but cannot due to where he was born by chance. Is there a simple answer to this? Should we just care for our own? AS someone who was born in Zimbabwe to British/Italian parents who grew up knowing people from all over the world I would argue that we are all the same and we need to do what we can to help humanity as a whole. IF that means i will end up paying £10 a month more with no direct benefit to myself… i consider that a win. This is where ideology comes into it and I think we could argue each side till we are blue in the face.

        One point you do have, however, is the post code lottery, this is something that is not exclusive to health care in the UK. Schooling also has this problem too. The council i live in is having a major shortage of teachers and it is a big problem here. It brings the value of the property in the area down etc etc. The same can be said for anything that is in any way devolved, the road condition, availability of good restaurants, parking charges, exposure to noise/light and other pollution… anything. Big companies experience this problem, KFC in Elgin is different from KFC in Inverness (40 minutes drive away)… a different person serves me, a different manager oversees the cleaning of the place, a different clientele will have slightly different demands.

        I dont think it is easy to get a uniform service and I have no doubt whatsoever that you have had bad experiences with the NHS that were outweighed by those in the USA, I dont pretend it is perfect in any way… this is where I have to be dispassionate and look at the figures. People in Europe and the UK live longer and cost themselves and the state less for healthcare than they do in the USA, where people have a lower life expectancy. I could tell you about how my brother was misdiagnosed by a privately paid doctor and almost died and how he was only saved by another privately paid doctor catching the issue in hospital… or how my son was saved by a series of NHS doctors being cautious and ignoring a progressively irate father. Mistakes happen anywhere, no matter how the service is paid for.

        Believe me, I am well aware that locally things can vary, in fact there is a concerted effort in Scotland right now where Health and Social Care Partnerships are being directed to provide services according to much more local needs. Even different nations with the same system can have variances that have nothing to do with the system used and everything to do with the ecosystem and culture they are being used in. It could very well be that an NHS type system could never work in America, but that thought really saddens me.

        I hope that kind of makes some sense as to where I am coming from. As I said on the podcast my views have changed very slowly over the past 20 odd years, and I am not trying to convince, I just feel it is important to always look at every angle… and to quote Donald Trump “Nobody knew it could be so complicated”… 😛

      • patrick says:

        Hey both, just wanted to say I really appreciate this conversation. Hayden is making good points, which aren’t so far from the conservative HC idea that “you should get what you pay for, not what others have paid for”, and in the end that’s the ideological stance which is core to this debate. But I think Bria… Bruce is making even better points (as a bleeding heart liberal, I would), especially when it comes to the dispassionate “looking at the numbers” part. When the population as a whole lives longer and benefits that much, it’s hard to argue against the system, however imperfect it is.
        But even more than that, I’m really thankful for the calm conversation happening here, when we see how inflammatory everyone else is. We must be doing something right. 🙂

  3. I really enjoyed the show. It was great to hear more of how the European healthcare system works from people who have experienced it. I’m an American with liberal leanings so I naturally tended to favor the health care systems that were described in the show. I think one of the inaccurate statements that Patrick and Bruce kept using was that the service they and their loved ones received was free. While you didn’t need to pay any co-pays or deductibles like US private insurance tends to require, I know your costs are all wrapped up in your taxes. So this brings me to my question: approximately how much are the tax rates and what is taxed to cover the cost of the healthcare system? These details tend to get left out from anyone who reports on the subject of healthcare. You’re claiming it’s cheaper overall for both the state and its citizens, but I’d like to see how so.

    Keep up the good work Patrick.

    • patrick says:

      Hey Chis, and thanks for the kind words! I honestly have no idea how much it costs per person… The thing is, it depends on your salary and many other things, so even an average amount wouldn’t be very significant I think. That being said, I wonder how much it costs in the US, too! 🙂

    • Chris, apologies for the late reply. I think your question is great, I personally laugh at people who pay for First Class and claim that their champagne is ‘free’. The way National Insurance works is not quite the same though.

      In the UK, when you are in work National Insurance contributions are 12% of your salary as a base measure. There are caveats to that in that if you are below a certain threshold you don’t pay anything and higher earners pay at a slightly higher rate.

      For me, as a Father of two and husband of a wife who is currently not in work that works out to just over £200 a month. Keep in mind though that at no point am i asked for any money when I go to a doctor, no excess, no existing condition charges, no exceptions and in fact, in Scotland all prescriptions are ‘free’ too. This compares directly to charges of over $150 my wife and I had to pay each ($300 in total) in Zimbabwe with additional excesses and some services not included. My sister in law’s father had one of the most comprehensive insurances in the country (i know it was over $250 a month) and was taken seriously ill a few years ago, was in hospital for months, and because of loopholes in the insurance his family ended up having to plead for extra funds from gofundme and other fund raising events to pay for the hospital bills they were still charged.

      I dont know what the charges are in the US, a quick google search gives me quite a few variations and while individually i might get something cheaper, I am not sure it would be as inclusive as the NHS service wise. You also have to keep in mind that I can access the service if i lose my job, and my children and wife can access it too for no extra charge. (Family coverage seems to start at $500 a month)

      In essence… just like any other service, it is paid for by a tax and you only pay that tax if you work. This is, on top of the normal tax which is currently set at the following rates in the UK:

      Personal Allowance Up to £11,500 0%
      Basic rate £11,501 to £45,000 20%
      Higher rate £45,001 to £150,000 40%
      Additional rate over £150,000 45%

      A recent survey also found that 70% of respondent tax payers were willing to pay an extra penny on the pound if it was to be ringfenced for the NHS so I would add that most people do not find the tax rates excessive.

      • To say the NHS is funded by National Insurance is not wholly accurate as 80% is funded from general taxation and 20% from NI. To this end it is not a straight comparison with the Zimbabwe fees as a proportion of your income tax is also used for health.

        NI cannot really be viewed as Insurance as it is, as you state, just another tax.

        I know when I worked in the UK, the amount I paid to the NHS was multiples of what I was charged for private health care and for me and my family (2 children, Wife not working) worked out as a very bad deal especially as I did not use the NHS. Had I had the freedom to opt out I certainly would have done so (which is of course why the government would never allow it 🙂 )

        I will also admit that whilst leading a healthy life (never smoked, don’t drink, do not take drugs and regularly exercise) I deeply resented having to pay multiples of what I paid for private insurance to subsidise those who made less healthy life choices.

      • Hayden, correct, but that is what we pay as a nominal fee.

        I would draw your attention to the data in the link above though. The US government still pays more per head for health in the USA even with the individual people having to pay their premiums on top of that. So, in essence, your tax dollar in the USA is paying to support health care infrastructure and then you are having to pay private insurance again on top of that:

        “Despite less than half of the USA’s total healthcare expenditure coming from government expenditure or compulsory insurance schemes, it still spends more per person on these financing schemes than the UK- £3,111 in the USA in 2014, compared with £2,210 in the UK. In the USA spending on privately-funded healthcare is over five times more per person than in the UK.”

        I would also add that there are many people who suffer long term illness and injury that has nothing to do with their life choices. A huge amount of money and resource is used supporting the elderly and the disabled; I might also add that because the state feels the impact of bad life choices more it is much more invested in preventing bad health choices and schemes to educate people and help them make positive life choices are on the whole pretty well funded.

        Whatever the figures say though, I think there is a fundamental difference in ideologies, and the one behind the NHS is a lot more to the left than a lot of people are comfortable with. I would argue though, even if there is dispute over the figures and discomfort over individual payments, the cost to the society as a whole is less.

      • All in all we generally seem to agree about what the NHS is (which in t as fun as a good argument. It can’t have everything 🙂 )and, as you say, it all comes down to ideologies, a utilitatarian view of doing things for the greater good vs an individual rights.

        I am sure you can Guess where I am 😉

        I think a lot of disagreements come down to this fundamental difference especially in the US which values individual rights over the social “good” that Europe and, to a lesser extent, the UK do.

      • Thanks for the response, sorry I didn’t have a chance to chime in again until now. So if I’m understanding correctly, this is an additional tax on wages of on average 12% and is paid through income taxes.

        I think one of the biggest challenges in adopting a government sponsored health service in the US is because of how people get covered by health insurance. A lot of people get covered by health insurance through their employers so they don’t see just how much the monthly premiums are. People don’t realize that they’re actually paying for this in lower wages because they never see it in the first place. I’ll use myself as an example, I get my personal health coverage through my employer, but I have to pay extra to cover my wife and son. We actually bought a separate plan through a different provider because the premiums through my employer were too expensive each month. However, on top of these monthly premiums, we still have to pay some specified amount when we visit a hospital or see a doctor. These plans also cover some things but they don’t cover other things. For example, chiropractors can be covered, but dentists and optometrists usually are not. The worst part, in my experience, is it still depends on whether the doctor even accepts the health plan. If the doctor doesn’t, you might as well not be insured as you’ll have to pay most of the bill anyway.

        Still, that’s all stuff you knew and I wanted to look at the costs anyway. Just looking at my situation and using 12% of my wages as an estimate it would be cheaper. 12% of my wages comes up to about what I’m paying monthly for premiums for my wife and son, so I would be paying that amount, but I could also get a higher salary since my employer isn’t having to pay that amount for insurance for me, and by the sound of it, I wouldn’t have to worry about the co-pays as well. Seems to work out for individuals from a cost perspective. The question would be whether I can see the general practitioner I want to or if my options on who I see for care become limited in anyway, which it doesn’t sound like it based on what I heard on the show.

        Just an aside, I live in the state of California which is currently discussing creating what they’re calling a single-payer health system. I’ve not read anything on how it would work just yet, but with the Democrats having a super majority in the California legislature, it’s certainly a possibility for it to get pushed through. We’ll see what the future holds.

  4. Average Random Joe says:

    Hey Patrick

    One thing that is being missed in your episodes is that the US already has both a single payer AND state controlled system. Medicare and Medicaid are single payer while the VA system is state controlled, doctors, nurses, techs, and administrators are all government employees. And that is why the US is sceptical about the implementation of said systems.

    My wife’s aunt had ovarian/uterine cancer and was on medicaid. She was told that she would need to wait a month to start treatment because that would sterilize her (she was postmenopausal, so nature had already done it). She and my mother-in-law called everyday for a few days and convinced them to accelerate the treatment. Not because you shouldn’t worry about sterilizing a postmenopausal woman but it was something about my mother in law already had a plane ticket to help her sister. And that is the only person I know on either of those systems. So when I hear that private doesn’t cover something and that is terrible, the government doesn’t seem much better.

    And then you have the VA, the lies to cover up incompetence (like legionnaires disease outbreak being covered up for a year with people dying) or wait times that are out of control (and people dying because of those wait times).

    And comparing different countries health stats isn’t all that great of evidence. I mean all I ever hear from Europeans is how fat America is, that we have a serious obesity problem. So in the health argument, we say that life choices affecting health across nations (which you have to assume to compare effectiveness in health care, just like comparing a doctor’s mortality performance in the ER vs a the mortality performance of a physical therapist would be rare the same while the US has a health crisis because they aren’t making proper nutrition and/or physical activity choices.

    And this all ignores, if the state pays for your health care, would it be allow to dictate the health choices you make? Smoking banned? Drinking? Compulsory exercise? Compulsory aborted fetuses with defects, like Iceland does with downs syndrome? Every right has a responsibility attached to it, you have the right to make your own choices to health but you are responsible for the outcome.

    And all of this finger wagging at the US says the US has a free market system of health care and health insurance. It doesn’t, not as completely as you socialist frenchies 🙂 seem to think. And that is part of the problem, it is incredibly overweight with government regulation. Healthcare is provided by your employer because they get a tax deduction for it, so people don’t get to choose their insurance plans outside of what their employer has chosen for them. And then employees aren’t seeing the bills, they don’t pay the real cost so they go to the doctor for every sniffle, every ache, every headache. The system is starting to correct getting non-doctors that specialize in these lesser things to handle diagnoses and treatment. Like there are PAs or NPs that do earaches instead of taking a doctor away from more complex things to do this simple and routine thing.

    One simple question, does France have a pharmaceutical company? Honest question, I was just curious if you guys develop medicine or do you guys wait until the US companies release the drug? Because that is the impression we here in the US always hear, that you guys can’t develop it, which is expensive so we have to pay for it.

    • patrick says:

      Hey Random Joe, I won’t dive into the entire comment, but I will answer your direct question: France does have a significant Pharmaceutical lab at least: Sanofi, which is one of the biggest in the world. But there is also a lot of fundamental research (including medical) being done in the country, as we have historically (and in recent years) been one of the leading countries in that field. The Pasteur Institute having done great work as I’m sure you know. I’ll add that I’m not convinced the two are necessarily related, but that would be a discussion for another time. 🙂

    • I’ve certainly seen instances of state interference in the UK being justified as”it costs the NHS too much”. The Public Smoking ban and Sugar Taxes being 2 instances. It’s a common government tactic as they know the NHS is akin to a religion in the UK.

      • Hayden… again, you are not wrong here. One of the problems with the NHS which i think i said on the podcast was the over-politicisation of it and that happens at all levels. When you have politicians, with no medical experience making decisions based purely on populism it can often lead to inefficient results.

        (As someone who works in Health and Social Care, who has to write reports to politicians, I have felt issues get completely misrepresented for the wrong reasons.) I think it is a small price to pay for the benefits though.

  5. Thought I’d drop this here as it seems pertinent to the conversation:

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