# New hip anybody?



## Jacob (19 Apr 2021)

They are talking about it over there TheWoodHaven2 • View topic - Has anyone here had a new hip?
I'm on the list - waiting for telephone triage.
Gotta keep fit - can't get on/off bike, running is OK except for long recovery, now reduced to squats!
Bound to be some decrepit old woodworkers on here who've gone though it! How was it for you?


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## Keith 66 (19 Apr 2021)

Not me but my wife has had both hips replaced. The best advice she can give you is that the surgeon will give you a bunch of exercises to do before the operation. DO them religously as they will strengthen your muscles & increase muscle tone. This will increase recovery time post op by a huge amount. My wife was up out of bed the day after the op. & made a first class recovery.
A lady who she knows who had the same op the next day did not do the exercises & her recovery took far longer.


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## Spectric (19 Apr 2021)

I know a couple of people who have had them done and watched one being done on Tv, would not advise you to watch until afterwards but these days it is almost just like going to the dentist but a lot cheaper. I find it odd that they don't knock you out completely, I would want to be knocked out and wake up all done, see, hear & feel nought.


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## AJB Temple (19 Apr 2021)

Oh no. Jacob peruses the other place.


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## Jacob (19 Apr 2021)

AJB Temple said:


> Oh no. Jacob peruses the other place.


Well you never know - could miss something interesting. 
Hasn't happened so far except for geriatric health problems. I hope somebody is looking after them.


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## doctor Bob (19 Apr 2021)

Best of luck with it Jacob, big op but the results are fantastic. 10 years ago we had a fitter who really struggled with dodgy hips, had the op and he was like a new man.
Sounds like your physically fit, which will help with recovery. 
Any hint of infection call GP immediately, father in law got infection in bionic knee and messed up recovery big time.


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## TheUnicorn (19 Apr 2021)

I was in a ward with several people having hip and knee ops, they seem to have it down to an absolute art, I couldn't get over how quickly people were going home.


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## paulm (19 Apr 2021)

Had to have one of mine done at a relatively young age, early forties, legacy of a motorbike accident as a teenager !

Twenty years on and still going well, touch wood ! Transformed daily life for me, just the rest of me is struggling to keep up now !


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## Spectric (19 Apr 2021)

It will be nice when they can replace vertebrae and fit new antifriction disc, that will help a lot of people and a lot better than just fusing them together.


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## Inspector (19 Apr 2021)

Sign me up! I could use a new neck.

Pete


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## thetyreman (19 Apr 2021)

my mother had hers done a couple of years ago, worst part of it is the injections to prevent blood clots that you have to stab yourself with daily right in to the stomach area, and it was tough getting up for a good few weeks, doing the excercises post op are a must, makes a big difference.


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## Jester129 (20 Apr 2021)

Not a new hip but a new knee. Weird seeing my foot at an angle that didn't look right over the small sheet they put up to stop me seeing, then they put up a BIG sheet up and I started to get worried! All was okay and I was up later in the day walking on crutches. Sent home 3 days later with exercises to do and did them religiously. 5 weeks later walked back in to see the surgeon for a review and he could tell that I'd done the exercises. Handed my crutches back to physiotherapy and haven't looked back. It was just great to walk without pain, and my dogs appreciated it as well, they got far longer walks. 
Whatever you have done, please do the exercises, you won't regret it. HTH.


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## Keith 66 (20 Apr 2021)

Re anasthetics, my wife had her first hip replacement under a general anasthetic, she does not take anasthetics well & was quite poorly for the following couple of days. Second time she had an epidural with sedation & her recovery time was far quicker. 5 years & three years on respectively her hips are as good as new.


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## Woody Alan (20 Apr 2021)

I had my right hip done at 59. I was struggling to walk on uneven suface, cock my leg over the bike, had to throw knee out at top of the stroke etc. My anaethetist recommended being totally out (still with epidural but just under with sedation or general not sure of the specifics) and I was happy to go with that. I remember waking up and asking the nurse if she was an Angel, she laughed and said "definitely not", I said "I know I'm back in the right place then" . It was stiff and sore for a while and for the last few years has been brilliant, The odd thing is my foot is now straight which always stuck out since being a child. Guess that's why it failed early. The regained mobility is just fantastic.
Oh and I had pills for the anticlot no injections.


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## Argee (20 Apr 2021)

50% of men who have the epidural have difficulty passing urine during the early hours of recovery. A catheter will prevent any discomfort, inserted post anaesthetic, as I know from personal experience - one hip without, the second with.


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## Peterm1000 (20 Apr 2021)

From experience... 3 hip ops myself after breaking it aged 35 and my wife 2 replacement hips at 40... We had general anaesthetic each time. I have no idea why you wouldn't have that. The op is pretty brutal (they start by dislocating your hip and then throw the leg out at an unnatural angle to get at the joint I believe). Just be careful of the painkillers they give you afterwards. Anything with codeine is likely to block you up and trying to pass something with a major injury in the hip area is beyond agonising. The surgeon told my wife that how you use your new hip is a bit like running a car engine - you can run on it and abuse it any way you like, but it is going to wear out quicker if you do. Likewise, the heavier you are, the quicker it will wear out. Then you have to be careful with certain movements (such as reaching down to the side to put on shoes and turning your knee in) as some of those are likely to dislocate the new hip which is very bad news. However, all pain disappears and you can get back to everyday life... I know people that sail dinghies with replacement hips so you can be pretty flexible afterwards. Good luck, I am sure you will do just fine!


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## Jacob (20 Apr 2021)

Thanks for replies - very re-assuring - I'm looking forward to it now!


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## AJB Temple (20 Apr 2021)

Hip, Hip .....hooray. 

Hope it all works out. I might have to look a bionic knees one day.


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## TominDales (20 Apr 2021)

Jacob said:


> Thanks for replies - very re-assuring - I'm looking forward to it now!


Hi Jacob, I had mine done aged 55, I didn't realise it was my hip that needed fixing, despite friends saying I was limping for the previous 10 years, I thought it was my back. 
I can talk you through the early stages from my experience (good) and that of my mother (no so good) , here are the first 4 or so:

1. GET ON THE LIST FOR THE OP ASAP: Get on a list to get it done asap, there is so much pressure on NHS etc that you may have to wait and every day waiting your leg muscles waste away. Typical waiting time is 1yr to 18months My bad leg was half the size of the good one and it tool about 18 months to get it to full strength again. I thought I was ok limping along, only bad thing was the lack of sleep. But with hind sight seeing the x-rays I should have had it done years before.

You have to constantly nag the NHS and highlight you are in great pain. There is a huge waiting list. I was too polite and the surgeon told me to wait as I was young (he did his best to put me off the op, by talking up the number of dislocations, reversions, and deaths on the operating theatre (ca 1% or less). COVID is making matters worse.

2. Do the exercises that Keith66 indicates - you will find your leg muscles waste away which makes everything take longer. Also lose some weight, if you can, as that has a big bearing pain and op successes etc. I was a lot lighter than my boss, so was in much less pain than him - downside was i had to wait a lot longer for the op. Try to do exercises that don't jolt the hip. So running is not good. Swimming is etc. I think cycling is, but I didn't have the strength to get on a bike. If found I had to walk with ski sticks with the family. The more you do that the longer you can wait.

3. Once you have a surgeon (who you trust) lined up - go with his/her recommendations - there is a lot out their on the type of hip, (ceramic, steel etc), type of anaesthetic. But statistics show that the most success is when a surgeon sticks to their way of doing things, if you persuade them to do it your way or differently, things can go wrong. If you really don't like the proposal from the surgeon, then find a different one. (that may mean going privately or waiting longer). They will ask for your preferences within their envelope, but they will be experienced in doing things a certain way. Try to find a surgeon who just does hips. The more they specialise in hips the better. Generalists who do hips, Knees, and other ops are ok but the specialist hip folk have an edge - you may not have that choice.

4. That's its for now, I'm sure you will have more questions. Worth saying it is one of the operations with the highest benefits, hips and cataracts give an immediate/ full recovery in most patients. Simply amazing. There is a lot about pre and post operative things to do, but that can wait.

Final cautionary comment. There is a down side you may have to reluctantly consider. If the waiting list is so long that you get chair of bed bound, you may have to bite the bullet and pay to go privately. From how you described things, you are still quite mobile so this is a long way off. But the waiting lists at the moment are a lottery as to the state of your local NHS system. I was ok, I waited about 18 months for my op from first diagnosis to operation I probably had another 12 months in me before the bone started to chip badly.
My mum on the other hand would have died is we did not pay to get her hip replaced last year. Aged 86, she had waited too long, she was fit rushing about person and coped with her arthritis in her feet, hands etc, but she endured the pain in her hip for too long until suddenly she could not walk or sleep - months of near zero sleep and had to move into a separate room as her screams woke my dad. With Covid, there were just no operations happening. She would have died if she waited any longer. As it was, we later found she had a blood clot that developed while awaiting for the operation. Its was not cheap, it cost my brother and I about £7k. We also had no idea how to go about it. But all the healthcare staff were wonderful, both GPs/NHS and the private ones (actaully the same people??) Politically - we told ourselves that this allowed someone to go up the waiting list? Not an easy choice but it may come to that eventually. It all depends if you can keep moving. Once you get chair or bed bound the risk of thrombosis rises. So best to get on the list right away to avoid complications later. As I and others have said, it is a wonder operation.
I give you this cautionary message now, as although it does not seem a life threatening condition, it can become so and you may have to start to think of desperate measures.
Good luck Tom


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## Peterm1000 (20 Apr 2021)

My daughter works in the local hospital... 2 things:

1. Covid is causing less delays for some ops now because a) a lot of people are afraid of being admitted and b) morbidly, a lot of the people who would have had hip ops have died from covid.
2. £7k for the hip op is very cheap. Bupa does a £10k all in package - surgery, physio, stays in hospital, everything...


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## Jacob (20 Apr 2021)

Peterm1000 said:


> My daughter works in the local hospital... 2 things:
> 
> 1. Covid is causing less delays for some ops now because a) a lot of people are afraid of being admitted and b) morbidly, a lot of the people who would have had hip ops have died from covid.
> 2. £7k for the hip op is very cheap. Bupa does a £10k all in package - surgery, physio, stays in hospital, everything...


NHS for me. Cost zero (for attn. of our American friends!).


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## Phil Pascoe (20 Apr 2021)

NHS spending in England was around £129 billion in 2018/19 and is expected to rise to nearly £134 billion by 2019/20, taking inflation into account.

Cost to the Country. Rather a lot. Zero cost it is not.


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## doctor Bob (20 Apr 2021)

Seeing as how I haven't really hit the NHS for a lot, I'd like to think I'm paying for your hip over the last few years Jacob ..................


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## Ozi (20 Apr 2021)

Good luck Jacob, I'm sure it's a daunting prospect but the results will be worth it.


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## nickds1 (20 Apr 2021)

After a lifetime of sport - rugby, judo, skiing, cycling, running, long distance swimming etc. my left knee just collapsed a couple of months ago whilst I was jogging on the treadmill...

After an MRI, turns out that the knee is completely shot - bone on bone now, bits everywhere - it just seems to have gone *bang*. Really frustrating as I had a load of half-marathons, couple of marathons and potentially my first triathlon this year, plus all the club cycling and distance swimming...

I was 63 this week. Now waiting on triage...


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## Jacob (20 Apr 2021)

Phil Pascoe said:


> NHS spending in England was around £129 billion in 2018/19 and is expected to rise to nearly £134 billion by 2019/20, taking inflation into account.
> 
> Cost to the Country. Rather a lot. Zero cost it is not.


Explainer for Phil; zero cost it is, to me that is.
I do not need to cheque my bank balance, insurances, raise a mortgage, sell my house, face bankruptcy, like some unfortunates in other countries.
Support the NHS. I'm happy to pay my taxes. And I'm happy for my taxes to pay for the expensive care of people much more needy than me.
The net cost per individual is very much lower than private health care and is much more efficient.
Oddly it'll probably be done by a privatised operation payed by the NHS as they have farmed out the profitable routine ops, leaving the NHS with everything else. It's being sold off bit by bit. Not good news.


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## TominDales (20 Apr 2021)

Peterm1000 said:


> My daughter works in the local hospital... 2 things:
> 
> 1. Covid is causing less delays for some ops now because a) a lot of people are afraid of being admitted and b) morbidly, a lot of the people who would have had hip ops have died from covid.
> 2. £7k for the hip op is very cheap. Bupa does a £10k all in package - surgery, physio, stays in hospital, everything...


That makes sense, probably uneven picture around the country. Either way, I recommend Jacob get on the waiting list as soon as possible, hips only deteriorate. There comes a point where the synovial fluid starts to soften the bone and it chips and it become difficult to walk. An x-ray should show how bad it is. 

I have to say my visit to the local hip ward was like visiting gods waiting room. I was the youngest by far so not that surprised by your daughters comment, its an operation dominated by the elderly - and a successful one at that. In no time we were walking up and down the corridors.

Maybe we have some more bills flowing in for mum. it was all done in a terrible rush over so I could be in for a another bill from the family, my brother just handed them his CC, it was bit like talking to the undertaker, you just hand over the money in an emotional state.


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## Jacob (20 Apr 2021)

TominDales said:


> That makes sense, probably uneven picture around the country. Either way, I recommend Jacob get on the waiting list as soon as possible, hips only deteriorate. There comes a point where the synovial fluid starts to soften the bone and it chips and it become difficult to walk. An x-ray should show how bad it is.
> 
> I have to say my visit to the local hip ward was like visiting gods waiting room. I was the youngest by far so not that surprised by your daughters comment, its an operation dominated by the elderly - and a successful one at that. In no time we were walking up and down the corridors.
> 
> Maybe we have some more bills flowing in for mum. it was all done in a terrible rush over so I could be in for a another bill from the family, my brother just handed them his CC, it was bit like talking to the undertaker, you just hand over the money in an emotional state.


I'm on it, thanks for the tip. Had the X rays now waiting for triage phone call. I note the deterioration comment. Seems like it happens slowly over years (7 or 8 for me) but you pass various points of no return e.g. from difficulty getting leg over bike, to impossibility. Hard to get a sock on foot etc.


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## Peterm1000 (20 Apr 2021)

TominDales said:


> That makes sense, probably uneven picture around the country. Either way, I recommend Jacob get on the waiting list as soon as possible, hips only deteriorate. There comes a point where the synovial fluid starts to soften the bone and it chips and it become difficult to walk. An x-ray should show how bad it is.
> 
> I have to say my visit to the local hip ward was like visiting gods waiting room. I was the youngest by far so not that surprised by your daughters comment, its an operation dominated by the elderly - and a successful one at that. In no time we were walking up and down the corridors.
> 
> Maybe we have some more bills flowing in for mum. it was all done in a terrible rush over so I could be in for a another bill from the family, my brother just handed them his CC, it was bit like talking to the undertaker, you just hand over the money in an emotional state.


Are you in Ripon? If so, I hope that is it from a cost standpoint... I am just outside London so maybe it costs more here. After the op, all that was left was a follow up with the consultant 6-8 weeks later and weekly physio sessions for about 8-10 weeks.

I do think it might be worth paying for the physio privately, even if you get the op done on the NHS (which is probably better than private anyway - bigger hospital = bigger toolkit and more facilities if there is a problem). It's only about £40 a session and you can go at your convenience.


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## Lons (20 Apr 2021)

That's incredibly cheap by today's standards. £7k is almost exactly half the price my son's MiL paid for her bog standard hip replacement early last December at the Nuffield Newcastle., We're having to pay over £9k for my wife's heel operation and that's after managing a discount of more than £1k. Most are hospital and physio costs but consultations are minimum £200 a go and an MRI is £550, I've just paid the invoices!

My wife had both hips replaced in 2016 with just a 7 week gap between operations and the results were excellent.


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## Phil Pascoe (20 Apr 2021)

Jacob said:


> Explainer for Phil; zero cost it is, to me that is.



I'm not about to get into a political argument about the NHS, I just get get peed off with people saying it's free. It's not.


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## Jacob (20 Apr 2021)

Bills, bills! 
I guess two thirds of the population could not afford anything like these quoted. 
I certainly couldn't - I would be bankrupt by now, on top of earlier treatments of self and family.
This is why we need the NHS, which, interestingly, is highly efficient but costs far less per capita than the inefficient USA public sector. We do it a lot cheaper with a much smaller call on taxation.


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## TominDales (20 Apr 2021)

Lons said:


> That's incredibly cheap by today's standards. £7k is almost exactly half the price my son's MiL paid for her bog standard hip replacement early last December at the Nuffield Newcastle., We're having to pay over £9k for my wife's heel operation and that's after managing a discount of more than £1k. Most are hospital and physio costs but consultations are minimum £200 a go and an MRI is £550, I've just paid the invoices!
> 
> My wife had both hips replaced in 2016 with just a 7 week gap between operations and the results were excellent.


I wonder if my mum paid the rest. She shouldn't have but probably has. They live in Rutland/Leicestershire, but she had to go to Nottingham as Peterborough and Leicester hospitals were full to the brim with Covid patients - that second wave was in full swing. My brother organised it as he lives nearby and I went to stay to looked after my dad who has early onset dementia. What should have been a four day trip, I stayed 3 weeks. She was only in hospital for a couple of days and got discharged because of the Covid fears even though she could not walk, it took her nearly 3 months to re-learn to walk due to two painful clots and she had a bleed - that made the surgeon swear at me at 11pm at night - he apologised - but I didn't mind as it showed he cared. It was all touch and go as she was on treble strength heparin for the blood thinning and had a bleed. We did one physio session with the hospital by zoom. Fortunately a neighbour is a retired physio and he popped round every day and got her going and eventually driving again.

My hip was no problem, I wast out of hospital in a couple of days and walking with a stick within a couple of weeks and back at work driving at 6 weeks. So for Jacob's sanity, most hips go smoothly. In my mums case, it was left too long and complications started to set in even before the operation.


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## Jacob (20 Apr 2021)

Phil Pascoe said:


> I'm not about to get into a political argument about the NHS, I just get get peed off with people saying it's free. It's not.


Oh yes it is free, and _*you*_ are kicking off a political argument!
I get peed off with people saying it isn't, as though we are deluded and don't realise that it's paid for by taxation.
Free means free. If someone gives you a pint of beer it's a free pint of beer, unless you have a different technical meaning for "free".
If you pay for something it is not free. If someone else does, then it is free.


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## Lons (20 Apr 2021)

Jacob said:


> Bills, bills!
> I guess two thirds of the population could not afford anything like these quoted.
> I certainly couldn't - I would be bankrupt by now, on top of earlier treatments of self and family.
> This is why we need the NHS, which, interestingly, is highly efficient but costs far less per capita than the inefficient USA public sector. We do it a lot cheaper with a much smaller call on taxation.


Absolutely agree but it's the best part of a 2 year waiting list and she'll be in a wheelchair in under 6 months if we don't do it, sometimes you just have to find the money even if it meant borrowing for those who can it's hobsons choice. Just think, if working for yourself and the choice was totally unable to work withing a few months then maybe 18 months no income it's not much of a choice.

In my wife's case we know for certain the outcome as her other heel had to be done in 2018 and because of delays in the system it became a much more difficult and complicated operation that it should have been.


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## TominDales (20 Apr 2021)

Jacob said:


> I note the deterioration comment. Seems like it happens slowly over years (7 or 8 for me) but you pass various points of no return e.g. from difficulty getting leg over bike, to impossibility. Hard to get a sock on foot etc.


Yes that was my experience, gradually catches up with you, but then tips over into chronic all consuming pain. The membrane protecting the bone gets rubbed away (no technical speak) and so the bone gets exposed to the synovial fluid and starts to soften -think of damp wood swelling and splintering. These splinters become agonising. I caught it in time, hence why I suggest there is some urgency to it. The NHS consultant kept playing for time - they give you an Oxford pain scale test and I was a bit too brave about it. I was not sleeping well and my boss who had just had his hip done gave me less than 12 months before the pain/immobility set in. (Its this that drives people to the private sector - the pain is unbearable - I'm sure from the description of my grandparents, its what their parents died of). You read of war heroes like Noel Mason McFarlane dyeing of arthritis before the hip replacement came in.
In my case I limped along for nearly 10 years with an increasingly bad back and got stiff to the point I could not touch my feet let alone toes.


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## JobandKnock (20 Apr 2021)

Jacob said:


> Oh yes it is free, and you are kicking off a political argument!
> I get peed off with people saying it isn't, as though we are deluded and don't realise that it's paid for by taxation.
> Free means free.


How about "free at the point of delivery", then? Or is that too pedantic?


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## Jacob (20 Apr 2021)

JobandKnock said:


> How about "free at the point of delivery", then? Or is that too pedantic?


It'd suit the Jeremiahs but yes, is fairly pedantic! What things are free, but _not_ at the point of delivery?


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## RobinBHM (21 Apr 2021)

Phil Pascoe said:


> NHS spending in England was around £129 billion in 2018/19 and is expected to rise to nearly £134 billion by 2019/20, taking inflation into account.
> 
> Cost to the Country. Rather a lot. Zero cost it is not.



The NHS is free at the point of use, which I imagine is what Jacob meant.

That means every person in this country can get treated without having to worry whether they can afford it.

I would not like that principal to be changed.


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## Jacob (21 Apr 2021)

RobinBHM said:


> The NHS is free at the point of use, which I imagine is what Jacob meant.
> 
> That means every person in this country can get treated without having to worry whether they can afford it.
> 
> I would not like that principal to be changed.


No, I meant it is simply free.
Any thing "free" is "free at point of use", however it came to be provided.
It's a redundant right wing "trope" which pleases our gloomy Jeremiahs, or Eeyores.

Maybe Phil mutters to himself "oh no it isn't" every time he sees a sign saying, for instance, "free parking"?  Or what about things offered "FTAGH" - some confusion there?

On the other hand if anybody needed a reminder you could say "provided free by the community", but that's horribly close to the dreaded "communism" and could make some sad people uneasy.


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## Austin Branson (21 Apr 2021)

Hello Jacob, I’ve had two hips replaced, and my right knee. The first was my right hip that I had done aged 54 in Birmingham, the other two were done were here in France. In France I had epidural injections, which I found incredibly painful. The knee required 9 injections. Recovery from the knee took a lot longer than the hips, but fine now. Go for it.


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## Lons (21 Apr 2021)

TominDales said:


> The NHS consultant kept playing for time - they give you an Oxford pain scale test and I was a bit too brave about it. I was not sleeping well and my boss who had just had his hip done gave me less than 12 months before the pain/immobility set in. (Its this that drives people to the private sector - the pain is unbearable ..........In my case I limped along for nearly 10 years with an increasingly bad back and got stiff to the point I could not touch my feet let alone toes.



That's what happened to my wife when she needed her hips replaced, the consultant kept saying "pain must be coming from your back" by then she couldn't walk 50 yards and it got to the point where she was given a disabled blue badge and I had to buy a mobility scooter. The consultant sent her for injections, another 2 month wait then the guy administering them said it was a waste of time and would only relieve pain for a very short time so we switched to a different NHS area and got the operations within a month. The new consultant had to repair bone damage he said was caused by the delays and had it gone much longer one of her hips would have had much less chance of being repaired successfully. He was shocked to say the least but we just put it down to the original consultant being cr*p and were thankful she was fully mobile again.

When the delaying tactics happened again with her heel 2 years later we were forced into paying for a private consultation to short circuit the system and yet again this time with her other heel when they refused to refer to a consultant until she's been through the mill for months, initially via the muskuloskeletal system and then eventually go on the waiting list, currently nearly 24 months we are left with no options but to go private. It's money we can ill afford to spend but my wife's health and wellbeing comes first.


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## Jacob (21 Apr 2021)

Lons said:


> That's what happened to my wife when she needed her hips replaced, the consultant kept saying "pain must be coming from your back" by then she couldn't walk 50 yards and it got to the point where she was given a disabled blue badge and I had to buy a mobility scooter. The consultant sent her for injections, another 2 month wait then the guy administering them said it was a waste of time and would only relieve pain for a very short time so we switched to a different NHS area and got the operations within a month. The new consultant had to repair bone damage he said was caused by the delays and had it gone much longer one of her hips would have had much less chance of being repaired successfully. He was shocked to say the least but we just put it down to the original consultant being cr*p and were thankful she was fully mobile again.
> 
> When the delaying tactics happened again with her heel 2 years later we were forced into paying for a private consultation to short circuit the system and yet again this time with her other heel when they refused to refer to a consultant until she's been through the mill for months, initially via the muskuloskeletal system and then eventually go on the waiting list, currently nearly 24 months we are left with no options but to go private. It's money we can ill afford to spend but my wife's health and wellbeing comes first.


That sounds appalling - I reckon you have grounds for a complaint/compensation and should see a solicitor.
My recent NHS treatment has been fast and efficient - hernia op few years ago, cataract recently, fairly positive progress so far with hip op.
PS and knee accident op 9 years ago - broken quad tendons urgently needing operation within 24 hours for a good recovery.
Steadily falling apart!
PPS and hearing aids - top quality - would have cost several £k if done privately.


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## Jacob (21 Apr 2021)

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## Spectric (21 Apr 2021)

This thread is not good for the younger members, they are fit and healthy like we once were and don't really need to look into their future and see what could be waiting.


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## Sandyn (21 Apr 2021)

Jacob said:


> Bound to be some decrepit old woodworkers on here


Yes, very decrepit old woodworker here, but touch wood hips and knees still reasonably functional. I have two friends who had hip operations. One had it donee just a couple of weeks ago, the other, about 5 years ago. I saw him got from a hobbling guy in constant pain to walking and cycling perfectly normally. It absolutely transformed his life. I was also cycling with a guy a couple of weeks ago, who had one hip done and waiting for the other to be done. It certainly didn't hold him back, 18-20+ mph. Good luck. I'm sure it will all go well and you will soon be getting your leg over the bike again! You should ask if you can get a grease nipple fitted for maintenance!


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## Peterm1000 (21 Apr 2021)

Of course, NHS treatment is free - as is any other service provided by taxation such as going to school or any use of the roads (anyone who says road tax pays that is wrong - road tax raises £6.5bn but the roads cost £31bn). If you even take a step out of your house onto the pavement you are benefitting from the public purse for free. The cost of installing that pavement, cleaning it, maintaining it, lighting it are all borne by the public.


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## Jacob (21 Apr 2021)

Peterm1000 said:


> Of course, NHS treatment is free - as is any other service provided by taxation such as going to school or any use of the roads (anyone who says road tax pays that is wrong - road tax raises £6.5bn but the roads cost £31bn). If you even take a step out of your house onto the pavement you are benefitting from the public purse for free. The cost of installing that pavement, cleaning it, maintaining it, lighting it are all borne by the public.


Have to tell Phil! Remind him that every time he strolls "freely" along a path to not kid himself; it may not be _absolutely_ free at all!


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## TominDales (21 Apr 2021)

Lons said:


> That's what happened to my wife when she needed her hips replaced, the consultant kept saying "pain must be coming from your back" by then she couldn't walk 50 yards and it got to the point where she was given a disabled blue badge and I had to buy a mobility scooter. The consultant sent her for injections, another 2 month wait then the guy administering them said it was a waste of time and would only relieve pain for a very short time so we switched to a different NHS area and got the operations within a month. The new consultant had to repair bone damage he said was caused by the delays and had it gone much longer one of her hips would have had much less chance of being repaired successfully. He was shocked to say the least but we just put it down to the original consultant being cr*p and were thankful she was fully mobile again.
> 
> When the delaying tactics happened again with her heel 2 years later we were forced into paying for a private consultation to short circuit the system and yet again this time with her other heel when they refused to refer to a consultant until she's been through the mill for months, initially via the muskuloskeletal system and then eventually go on the waiting list, currently nearly 24 months we are left with no options but to go private. It's money we can ill afford to spend but my wife's health and wellbeing comes first.


I'm no expert, but from my observations, our local NHS system applies a rationing/recycling of patients based on local supply demand, its probably quite informal as they probably don't like publishing waiting lists. Somethings happen fast and efficient, others you get into a recycling coil like a plane waiting to land at an airport. My kids teeth - instantly - strait to consultant in Leeds/Harrogate - seemed to have a department to ourselves, very empty waiting area, consultants keen to investigate stuff, (some quite questionable xrays, MRIs and examinations) . Whereas sons hole in ear drum has had 5 years of toeing and throwing to see differing doctors and consultants in York, Harrogate, Leeds etc then covid and now back to GP with lots of 10 minute appointments but back into a 3 month que, consultant called into AE so start again, needing antibiotics so that they can see in so back to GP and round again, - busy waiting areas with a lot of through traffic - I assume that department is full up whereas the teeth dept was quite slack.

My hip experience was of a busy department. The consultant had us lined up in cubicles and he went for one to the next with his very full clip board finding ways to get us off the list and onto something else, 5 minutes a person. It was only after the 3rd time of this that I realised I needed to push for action or go private. I was offered physio but still waiting 5 years later for the appointment - I'm now better so don't need it. It strikes me that the people in the system have these various ways of delaying when they are full-up - and you can tell by how full the waiting room is that some are busier than others. I felt the original consultant was being a it cr*p but with hind sight, he was managing demand, he had too many people to treat. Once in another trust area things speeded up.


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## selectortone (21 Apr 2021)

Jacob said:


> Have to tell Phil! Remind him that every time he strolls "freely" along a path to not kid himself; it may not be _absolutely_ free at all!


I don't get it Jacob. I would have thought a dyed-in-the-wool socialist would be proud to say he pays for the NHS. Or do you have some magic way of avoiding income tax, VAT, and all the other taxes the rest of us pay that fund it?


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## Jacob (21 Apr 2021)

selectortone said:


> I don't get it Jacob. I would have thought a dyed-in-the-wool socialist would be proud to say he pays for the NHS. Or do you have some magic way of avoiding income tax, VAT, and all the other taxes the rest of us pay that fund it?


It's free to anybody who needs it and I am happy to be part of the community who pays for it. I realise this causes a bit of head scratching on the right!


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## selectortone (21 Apr 2021)

So you DO pay for it. Thanks for clearing that up.


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## Jacob (21 Apr 2021)

selectortone said:


> So you DO pay for it. Thanks for clearing that up.


No I don't pay for it. It's free. 
I do pay taxes however. But don't worry about it if you can't quite get it.


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## selectortone (21 Apr 2021)

Hee hee. The very definition of 'weasel words'. 

Presumably you have a hotline to the chancellor as to where your tax is spent.


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## Peterm1000 (21 Apr 2021)

I see the Jacob baiting is now well an truly underway. He said it was free. If anyone other than Jacob had said that, no one would have said a word. Instead, an opportunity was taken to attempt to drag him into a political argument - and if he engages, he would no doubt be complained about. The same happens every time Jacob posts on anything vaguely related to anything political. To me - that's very boring and takes away from an other interesting thread,

Everyone knows someone pays for the NHS as they pay for all the other "free" services you get. Point made. We get it. I don't think we need another 10 posts to say the same.


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## selectortone (21 Apr 2021)

Peterm1000 said:


> I see the Jacob baiting is now well an truly underway. He said it was free. If anyone other than Jacob had said that, no one would have said a word. Instead, an opportunity was taken to attempt to drag him into a political argument - and if he engages, he would no doubt be complained about. The same happens every time Jacob posts on anything vaguely related to anything political. To me - that's very boring and takes away from an other interesting thread,
> 
> Everyone knows someone pays for the NHS as they pay for all the other "free" services you get. Point made. We get it. I don't think we need another 10 posts to say the same.


So I'm a 'Jacob baiter' because I disagree with something I read on this forum?


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## selectortone (21 Apr 2021)

Peterm1000 said:


> Everyone knows someone pays for the NHS as they pay for all the other "free" services you get. Point made. We get it. I don't think we need another 10 posts to say the same.


My grandfather was a coal miner before WWI, was wounded in France, came back to the grinding poverty and inequality he left in 1914 and though "_What have I been fighting for for the last four years?_" He became a union official and along with his communist brother got his skull cracked a few times fighting for a better life. My great uncle got thrown in prison. My Dad, along with the majority of his WWII servicemen bretheren, voted Churchill out on his return in favour of a Labour government that brought in the NHS, (along with old age pensions nationalising water, electricity, gas, the railways ...) and generally gave them all the level playing field they deserved.

Jacob doesn't have a monoply on socialism here. I'm fiercely proud of the NHS. I don't need lecturing on the subject, thanks.


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## Jacob (21 Apr 2021)

selectortone said:


> My grandfather was a coal miner before WWI, was wounded in France, came back to the grinding poverty and inequality he left in 1914 and though "_What have I been fighting for for the last four years?_" He became a union official and along with his communist brother got his skull cracked a few times fighting for a better life. My great uncle got thrown in prison. My Dad, along with the majority of his WWII servicemen bretheren, voted Churchill out on his return in favour of a Labour government that brought in the NHS, (along with old age pensions nationalising water, electricity, gas, the railways ...) and generally gave them all the level playing field they deserved.
> 
> Jacob doesn't have a monoply on socialism here. I'm fiercely proud of the NHS. I don't need lecturing on the subject, thanks.


So why do you need an explanation of the meaning of a _*free*_ health service?


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## selectortone (21 Apr 2021)

Jacob said:


> So why do you need an explanation of the meaning of a _*free*_ health service?


Well, if I might be permitted to answer:

When I'm talking to Americans and they talk about our 'free health service', I always say it isn't free, we all pay for it.


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## Peterm1000 (21 Apr 2021)

selectortone said:


> So I'm a 'Jacob baiter' because I disagree with something I read on this forum?


I wasn't aiming the comment specifically at you, but seeing as you responded.... He had already clarified what he meant and accepted the point that public services are publicly funded. You then sent 3 messages that did not bring new information and looked to me like they were designed to provoke a response rather than add to the debate (including accusing him of weasel words). If that isn't baiting, I don't know what is.

By the way, the NHS describes their services as "free" for residents of the UK (which I think Jacob is). From the NHS website - "Hospital treatment is free to people who are "ordinarily resident" in the UK.". They don't talk anywhere about it being free at the point of use or how they are funded. Hopefully this clarifies and we don't need to go over this again.









How to access NHS services in England if you are visiting from abroad


How to access NHS services in England if you're visiting from abroad.




www.nhs.uk


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## Jacob (21 Apr 2021)

selectortone said:


> Well, if I might be permitted to answer:
> 
> When I'm talking to Americans and they talk about our 'free health service', I always say it isn't free, we all pay for it.


But that isn't true.
Even people who pay no tax and have no insurance get it, without question as long as they are "ordinarily resident".
Next time you talk to an American maybe you could explain better to them what they are missing - some seem to think NHS is a sort of communist plot and hopelessly inadequate. It is neither, and is extremely cost effective


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## selectortone (21 Apr 2021)

Jacob said:


> But that isn't true.
> Even people who pay no tax and have no insurance get it, without question as long as they are "ordinarily resident".
> Next time you talk to an American maybe you could explain better to them what they are missing - some seem to think NHS is a sort of communist plot and hopelessly inadequate. It is neither, and is extremely cost effective


Well, I could argue that just about everybody pays VAT.


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## Jacob (21 Apr 2021)

selectortone said:


> Well, I could argue that just about everybody pays VAT.


Oh all right then. Why don't you go and have a little lie down?


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## Peterm1000 (21 Apr 2021)

selectortone said:


> Well, I could argue that just about everybody pays VAT.


I am sure you could...

But the NHS will still describe themselves as free and numbers 1 & 2 of the 7 principles that guide the NHS are based on the idea that care is available to all and not based on the ability to pay (the definition of free).


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## D_W (21 Apr 2021)

Jacob said:


> But that isn't true.
> Even people who pay no tax and have no insurance get it, without question as long as they are "ordinarily resident".
> Next time you talk to an American maybe you could explain better to them what they are missing - some seem to think NHS is a sort of communist plot and hopelessly inadequate. It is neither, and is extremely cost effective



How many people in the UK don't ever pay any VAT?

It's true that the burden of the cost is placed more in the higher income there. To some extent, it is here, too.

As far as what we're missing - if you're truly poor here, you don't pay for health care. We've had this discussion. I would prefer a basic health care system like the NHS, but most of the prissy and demanding people here would have a cow briefly at the outset when they couldn't get instant service any time for any reason, at least in urban and suburban areas. The private system cost here funds the availability of the same instant service for the folks who are riding the free care (which includes many who would otherwise be able but who have been able to find their way into SS disability - probably about 25% of disability recipients are awarded as a matter of navigating the legal process rather than having a disabling condition that meets the intent of the laws - it's a bit of an entitlement, I guess. But it does take care of the people who are truly disabled.

The bigger issue in the states is folks not understanding health care in general, and boasting that they are so healthy that they haven't needed to see a doctor for 20 years. I think that will be gone in another generation.

If you said here in the states that you could add a 10% VAT and remove the need to pay for or obtain private insurance, I'd call that a good trade. Most people would balk at it - the system here has too many payers which dilutes decisions and sensibility.


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## selectortone (21 Apr 2021)

Jacob said:


> Oh all right then. Why don't you go and have a little lie down?


We'll, if we can't have a civil discussion, count me out.


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## Peterm1000 (21 Apr 2021)

selectortone said:


> We'll, if we can't have a civil discussion, count me out.


You are the one who suggested Jacob was using "weasel words"


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## thetyreman (21 Apr 2021)

I am very thankful the NHS is free, no way I would cough up 10 grand for an operation in my situation, the NHS did a great job with my mum, nurses were great and they followed up and checked up on her to make sure she was doing all the exercises, we are very lucky that we don't have to pay for it!


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## Peterm1000 (21 Apr 2021)

D_W said:


> How many people in the UK don't ever pay any VAT?


DW - for consumers, think of VAT like US sales taxes. It's a tax you pay on goods or services that you can't get back. For businesses, it's different.

If you buy almost anything in the UK in any store you will pay VAT. Anyone who spends any money in the UK has paid it. So we all pay it unless we live life as a hermit living off the land. But it's less than 20% of total taxation and income taxes make up the majority of tax revenues. Half of adults in the UK pay no income taxes.

And as you point out, the US does have a free (at the point of use - for the pedants) healthcare service. It doesn't provide as much for free as the UK. The UK's health service doesn't provide all health services for free either. For example, dentistry is not free - although perhaps it should be so we can avoid Americans threatening their kids with "English teeth"!  Emergency stuff such as broken limbs is covered in full. Major surgery is also covered. If you have cancer, some drugs are covered and others aren't. Lots of people have private medical insurance to supplement the NHS. Great examples of why you might do that in this thread.

This is the age old debate - how much should society pay for and how much should be paid for by individuals.


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## Jacob (21 Apr 2021)

Peterm1000 said:


> ...... For example, dentistry is not free - ......


Partly free in a messy sort of compromise. 
You can chose between NHS scales of charge for most routine stuff, no means test or anything, e.g. 
"Band 3: £282.80 Covers all treatment included in Bands 1 and 2, plus more complex procedures, such as crowns, dentures and bridges." , 
Or very much higher charges for private treatment and a higher standard.
Or if you qualify due to low income etc you can get NHS service completely free.


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## D_W (21 Apr 2021)

Peterm1000 said:


> DW - for consumers, think of VAT like US sales taxes. It's a tax you pay on goods or services that you can't get back. For businesses, it's different.
> 
> If you buy almost anything in the UK in any store you will pay VAT. Anyone who spends any money in the UK has paid it. So we all pay it unless we live life as a hermit living off the land. But it's less than 20% of total taxation and income taxes make up the majority of tax revenues. Half of adults in the UK pay no income taxes.
> 
> ...



the trifecta here is dental, vision and health - of course (in insurances). Because of the multi-payer system and negotiations, you don't want to take on any of the three on a cash basis unless you're really poor (in that case, the providers will negotiate because they figure they're not getting paid in the first place). 

If I were to go get a root canal and crown at my dentist and pay cash, it would be $3k. My insurance's negotiated rate is $900 for both and I have to pay half. To me, this is morally wrong. Dentists tend to be in business entirely to make money, so they breathe nothing of it to patients. An older friend of mine had a spouse who needed some dental surgery, and she was quoted a price of $7k out of pocket (10% difference for cash). He was retired and paid out of pocket for routine visits. I told him the price was way out of line and to go find the cheapest dental coverage he could locate and go back to the dentist (he was pondering how to save for the procedure for his spouse). Dental insurance is *really* cheap here if it has limited benefits, but you get the negotiated rates even if you pay most of the costs. The same procedure went to less than $3k even though his insurance didn't cover it - he had to pay out of pocket. He was irate (many folks here -especially older - consider someone they go to for decades as sort of a friend, and of course, the providers don't do anything to say "well, be careful, i'm a business"). 

To his credit, Trump attempted to make health systems post prices for routine procedures so that individuals who have high deductible coverages or catastrophic only could price shop. 

I had vestibular issues last year, this is another comparison. I went to a well regarded vestibular center here and pretty much had my eyes tracked, did tests with an audiologist, and had various things stuck in my ears to test my balance, etc. At the end of the procedure, I saw a doctor for about 15 minutes. The whole adventure was unrewarding because they told me I should take a benzo to deal with dizziness and ear pressure because they couldn't see anything causing. No thanks big time on the benzo!!

The statement for services came and the pre-negotiated cost was $5500!!!!!!!!!!!!!!!!!!!

The actual cost after insurance was accounted for was $1100 and my insurance paid all but $25. If I'd have known what they would charge to put some things in my ears, a couple of spinning chairs and special glasses and TVs that track your eyes, and a short stint with a doc suggesting a highly addictive medication, I wouldn't have gone. It was a waste of time. But to be paying $5500 for it would've been appalling, even if the health system offered a "cash discount". 

This all makes it important to navigate costs on your own. In my opinion, the average person would be served by a flat system with no options, even though everyone here thinks they're special and too good for that. 

Obviously, when a health system charges $5500, and then is reimbursed $2000 by one insurance, $1100 by the next and offers a 10% discount for cash (there would be more than two carriers), they're going to balk at posting a flat price. If they post $5500, nobody comes. If they post something else, it violates their agreement with insurers who are told by contract that they get a certain % discount (usually an enormous made up number like this situation). Attempting to call and get a quote ahead of time would be a minefield. I applauded trump for getting the ball rolling and saying "I hear your concerns, I hear you say it's complex - figure it out, anyway". I can't applaud trump for a whole lot other than a few things like that and not getting us stuck in wars. 

I suspect that initiative will go away. 

In terms of just how much someone will get for free if they're truly indigent, there's often three layers of safety net - the federal government, then states, and for folks especially living in urban areas, county/local programs. This is dizzying. If you're really poor in the US, here's what you'll get:

* supplemental income
* free food (not unlimited choices, of course)
* free health coverage
* if you're not poor enough for free health insurance for yourself, CHIP (state program for kids) will kick in and at least cover your kids
* rental or house purchase assistance
* free phone
* potentially subsidized internet
* assistance with utility bills

In some places (probably most now), you'll get a public advocate who will help you search for benefits that you can get, and there are private foundations who do the same (especially for single mothers) who may make odd suggestions like "you should get divorced but live under the same roof as your eligibility for benefits will be determined separately, then one of you can work and the other can collect benefits for you and the kids")

The three layers of payment is a huge problem -nobody knows what they're paying, there's no system set up to allow anyone to make an informed decision without a lot of work, and when nobody knows what they're paying, the providers will charge more. It's not a matter of someone deciding not to get care so much as that there's nobody at the gate checking the flow, so to speak, and making sure that it's not stinky.


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## Inspector (21 Apr 2021)

Although my dental is covered by my wife's work insurance there are limits so I go to the local university and get the 3rd and 4th year dental students to do the work. The charge is about half as much which means the insurance is stretched farther and the student get the experience and practice before they set out on their own. The only downside is they are slower because they are more thorough and careful but the instructors follow on double checking and in part duplicating some of the work. This fall I will see if I am a candidate for a couple implants and the crowns on them. It'll be about $7,000 instead of $14,000. We'll see how much the insurance covers.


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## Jonm (21 Apr 2021)

Many years ago my father had both knee joints replaced (not at the same time). He could get about fine without a stick but found that in crowds people did not give him enough space and time. He found that by using a hospital type walking stick people would realise he had some mobility problems and give him a bit of space. An ordinary walking stick was not as effective.

It was a long time ago and the joints have got much better, his were more simple hinges so stepping sideways was not so easy.

At the time the number of tv channels were far more restricted than now. During his convalescence he watched more TV. His comment about the soaps is that he found them “addictive” started looking forward to finding out what happened next. So beware of becoming addicted to tv programmes you would not normally watch.


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## TRITON (21 Apr 2021)

selectortone said:


> Well, I could argue that just about everybody pays VAT.


Its not just vat, its not just tax from wages, its not this tax or that specific tax its an accumulated amount. So there is no single source the same manner that road tax doesnt pay for the roads.

We have nuclear subs. Cant remember ever hearing of nuke sub tax or anything such. As a country we pay for things from the total income.

Everyone gets paid one way or the other, and theres money already in your accounts, from this accumulated amount you pay your bills, you buy your beer(or weed or whatever) you buy your food etc etc. Its much the same.


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## Lons (22 Apr 2021)

Jacob said:


> That sounds appalling - I reckon you have grounds for a complaint/compensation and should see a solicitor.
> My recent NHS treatment has been fast and efficient - hernia op few years ago, cataract recently, fairly positive progress so far with hip op.
> PS and knee accident op 9 years ago - broken quad tendons urgently needing operation within 24 hours for a good recovery.
> Steadily falling apart!
> PPS and hearing aids - top quality - would have cost several £k if done privately.


We won't be doing that Jacob, I detest the claim for everything culture (though I'm still considering whether to add my name to the MB diesel claim as that's against a private company) and I would find it very difficult to claim against the NHS because of the incompetence of one specific consultant as as I believe in general the service is excellent. We have a lot of family and contacts and can use that in certain cases to get some results and it's worked out ok in the end. 
The NHS delays are for non urgent issues and purely to save money but when it comes to urgent serious issues like cancer they excel and we have experience of that as well recently so you have to be understanding and take the bad with the good sometimes.


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## Lons (22 Apr 2021)

TominDales said:


> I'm no expert, but from my observations, our local NHS system applies a rationing/recycling of patients based on local supply demand, its probably quite informal as they probably don't like publishing waiting lists.



GP practices don't all operate in the same way but they all can receive payment for delaying consultant and hospital referrals so certainly in the larger practices they have specific meetings to decide who gets the ok and who doesn't. The national Muskuloskeletal system was set up to weed out those with issues that can be managed for longer until surgery becomes essential which is why pain management and physio is part of their procedure, I understand the need for this but it's a blunt instrument and causes months of unnecessary suffering and damage to those caught up in the system or forces them to find the money somehow which takes them out altogether.

In the case of my wife's heel operation it was very obvious what the issue is because it's exactly the same as her other one fixed 2 years ago so a call to the GP resulted in an ultrasound scan, GP phoned to confirm results and said "you need to go to physio", wife says "no didn't work last time and makes it worse, I want to be referred to the same consultant as last time", GP says "OK I understand will do", but a week later rings back and says " can't refer you unless you've been through the Muskuloskeletal system" or in other words you've been rejected, that's when I made the appointment for a private consultation and he was not at all impressed.
Have a cancer scare or something that needs urgent action and they're all over it usually.


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## Jacob (22 Apr 2021)

Lons said:


> GP practices don't all operate in the same way but they all can receive payment for delaying consultant and hospital referrals so certainly in the larger practices they have specific meetings to decide who gets the ok and who doesn't. The national Muskuloskeletal system was set up to weed out those with issues that can be managed for longer until surgery becomes essential which is why pain management and physio is part of their procedure, I understand the need for this but it's a blunt instrument and causes months of unnecessary suffering and damage to those caught up in the system or forces them to find the money somehow which takes them out altogether.
> 
> In the case of my wife's heel operation it was very obvious what the issue is because it's exactly the same as her other one fixed 2 years ago so a call to the GP resulted in an ultrasound scan, GP phoned to confirm results and said "you need to go to physio", wife says "no didn't work last time and makes it worse, I want to be referred to the same consultant as last time", GP says "OK I understand will do", but a week later rings back and says " can't refer you unless you've been through the Muskuloskeletal system" or in other words you've been rejected, that's when I made the appointment for a private consultation and he was not at all impressed.
> Have a cancer scare or something that needs urgent action and they're all over it usually.


I'm expecting triage conversation and it seems pain relief and physio will be first options, which makes sense on the face of it but not if its a delaying tactic. Run the risk then of getting the op later on, in much worse health in terms of recovery. Oh well will wait and see.


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## timothyedoran (22 Apr 2021)

D_W said:


> the trifecta here is dental, vision and health - of course (in insurances). Because of the multi-payer system and negotiations, you don't want to take on any of the three on a cash basis unless you're really poor (in that case, the providers will negotiate because they figure they're not getting paid in the first place).
> 
> If I were to go get a root canal and crown at my dentist and pay cash, it would be $3k. My insurance's negotiated rate is $900 for both and I have to pay half. To me, this is morally wrong. Dentists tend to be in business entirely to make money, so they breathe nothing of it to patients. An older friend of mine had a spouse who needed some dental surgery, and she was quoted a price of $7k out of pocket (10% difference for cash). He was retired and paid out of pocket for routine visits. I told him the price was way out of line and to go find the cheapest dental coverage he could locate and go back to the dentist (he was pondering how to save for the procedure for his spouse). Dental insurance is *really* cheap here if it has limited benefits, but you get the negotiated rates even if you pay most of the costs. The same procedure went to less than $3k even though his insurance didn't cover it - he had to pay out of pocket. He was irate (many folks here -especially older - consider someone they go to for decades as sort of a friend, and of course, the providers don't do anything to say "well, be careful, i'm a business").
> 
> ...


Im from the UK and from my perspective which may well be one of ignorance; the US land of the free always seems to be the land of the free if you can afford it. If you can't afford it then the alternative seems less good than the UK welfare and health system. 
In the UK the class system still exists and is a barrier to prosperity, but the free* NHS for everyone is not to be sniffed at. The welfare system as you describe it sounds bamboozling.
Not picking a fight, and really appreciate the perspective you have shown. The usual message in the UK is that there is no healthcare in the US.


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## Lons (22 Apr 2021)

Jacob said:


> I'm expecting triage conversation and it seems pain relief and physio will be first options, which makes sense on the face of it but not if its a delaying tactic. Run the risk then of getting the op later on, in much worse health in terms of recovery. Oh well will wait and see.


You need to keep pushing don't let them think the pain management or physio is working or you'll be pushed aside, you won't get on to the waiting list whatever they tell you until they agree you need surgery, assuming of course they are at that stage. Knees don't get better when they're worn out they just get worse.


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## Reginald (23 Apr 2021)

god bless the NHS they are all angels and make the lives of many people good again


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## AlanY (23 Apr 2021)

I had a knee injury playing football some 40 years ago. It never really healed and I gave up playing at the age of 24. Since then, the knee has deteriorated to the point that I cannot do much with it. Osteoarthritis set in some years ago and I have been back and forwards to consultants within our beloved NHS. The concensus seems to be that I need a new knee, but I cannot have one because I have not reached the pain threshold where an operation will be approved. Hints have been dropped to me by doctors and nurses (not from my local practice, I hasten to add) that I need to lie about the pain, but I refuse to do that and because nothing changes I have simply accepted that I will never exercise again and will have to rely on a walking stick for support. I love the staff, but the NHS as an organisation needs reform (although I have no idea how such a dinosaur could be reformed).

(I thought about my original content of the last sentence and decided it was unfair to compare the NHS to our corrupt political system. Edited accordingly)


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## Jacob (23 Apr 2021)

AlanY said:


> I had a knee injury playing football some 40 years ago. It never really healed and I gave up playing at the age of 24. Since then, the knee has deteriorated to the point that I cannot do much with it. Osteoarthritis set in some years ago and I have been back and forwards to consultants within our beloved NHS. The concensus seems to be that I need a new knee, but I cannot have one because I have not reached the pain threshold where an operation will be approved. Hints have been dropped to me by doctors and nurses (not from my local practice, I hasten to add) that I need to lie about the pain, but I refuse to do that and because nothing changes I have simply accepted that I will never exercise again and will have to rely on a walking stick for support. I love the staff, but the NHS as an organisation is as corrupt as our politicians. It needs reform (but I have no idea how such a dinosaur could be reformed).


Hardly "corruption"! The reform it needs is greater expenditure, as is widely known, widely repeated, promised by current government. Not a dinosaur either - recognised worldwide as highly efficient and cost effective, but underfunded. Has been subject to extensive reform in recent years but not all to the good
You do have a point though - maybe make more fuss rather carry on putting up with the pain.


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## Lons (23 Apr 2021)

Jacob said:


> Hardly "corruption"! The reform it needs is greater expenditure, as is widely known, widely repeated, promised by current government. Not a dinosaur either - recognised worldwide as highly efficient and cost effective, but underfunded. Has been subject to extensive reform in recent years but not all to the good
> You do have a point though - maybe make more fuss rather carry on putting up with the pain.


Jacob, I'm in agreement with all you said above but it's not as simple as just throwing money at it, governments of all parties have been doing that for years to varying degrees and my comment has nothing to do with the politics of which party does what so I'm not going there with you or anyone else. The real issue is that that although I agree they need much more funding it needs to be spent in the right areas and not as has happened over decades just been used to swell the hierarchy rather than at the sharp end where it's most needed. More managers, computer systems and software that don't work and huge wastage of materials and resources won't get the waiting lists down.


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## Jacob (23 Apr 2021)

Lons said:


> ....... I agree they need much more funding it needs to be spent in the right areas and not as has happened over decades just been used to swell the hierarchy rather than at the sharp end where it's most needed. .....


Agree. The theory was that the NHS needed more management and separation to be more efficient. Big mistake. Big step towards privatisation - which is now well under way and not a coincidence


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## Peterm1000 (23 Apr 2021)

Being careful not to steer into party politics...

The problem I believe is that there are always new cures for the incurable and improvements to previous treatments being found. These generally require new medicines or new machinery - both of which are expensive. Just compare the equipment in a hospital today to the equipment of 70 years ago.

The cost to the country of the NHS in 1950 was 3.5% of GDP and today it's about 7%. Taking inflation into account, the NHS costs 10 times what it did 70 years ago. The scope of what the NHS treated in 1950 and the scope today are radically different. There are value decisions that need to be made as to which treatments the country will pay for and which they won't - so a tried and tested hip replacement that has a certain outcome and costs about £7-10k? Yes, we'll pay for that. An experimental cancer treatment that might have a 5% chance of success and cost the same? We won't pay for that.

The service we get for free (at the point of use for the pedants) is not as comprehensive or as good quality as people get in other countries under their self-paid / insured system. However, historically, although lots of people have suggested someone else should pay more, no one has volunteered to pay more themselves (you have the ability to overpay tax in the UK if you want - almost no one does). I think this is the challenge we are all facing...


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## D_W (23 Apr 2021)

AlanY said:


> I had a knee injury playing football some 40 years ago. It never really healed and I gave up playing at the age of 24. Since then, the knee has deteriorated to the point that I cannot do much with it. Osteoarthritis set in some years ago and I have been back and forwards to consultants within our beloved NHS. The concensus seems to be that I need a new knee, but I cannot have one because I have not reached the pain threshold where an operation will be approved. Hints have been dropped to me by doctors and nurses (not from my local practice, I hasten to add) that I need to lie about the pain, but I refuse to do that and because nothing changes I have simply accepted that I will never exercise again and will have to rely on a walking stick for support. I love the staff, but the NHS as an organisation needs reform (although I have no idea how such a dinosaur could be reformed).
> 
> (I thought about my original content of the last sentence and decided it was unfair to compare the NHS to our corrupt political system. Edited accordingly)



This is one case where in the states, if you had solid insurance from an employer, the providers would be falling all over you to replace your knee. The cost would be around $0-100 out of pocket, I would guess, depending on your coverage, and then possibly a little bit more for copays on physical therapy (though they may be covered for some under the original fee). 

The flip side is if you have high deductible coverage, you may pay the entire deductible, but you wouldn't have to express much other than that you have discomfort that would be solved. It wouldn't have to be "bad" discomfort.


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## D_W (23 Apr 2021)

Peterm1000 said:


> Being careful not to steer into party politics...
> 
> The problem I believe is that there are always new cures for the incurable and improvements to previous treatments being found. These generally require new medicines or new machinery - both of which are expensive. Just compare the equipment in a hospital today to the equipment of 70 years ago.
> 
> ...



No real solution here from the US standpoint as our cost is probably $6k more per individual per year in the US - that's a LOT. But wonder of the NHS would be better served by some scaling or cost sharing, so that the mention above re: the knee would be "your pain is ____ so you are not eligible for full cost replacement, but you are eligible for 50% cost sharing on it". 

This kind of thing creates complication, reporting, red tape and more fibbing, though. Everyone would overstate their pain. I'd still choose the NHS system as a base here just due to cost. The insurance system is so large that supplemental policies covering things like this would show up immediately.


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## Jacob (23 Apr 2021)

Peterm1000 said:


> ....The service we get for free (at the point of use for the pedants) is not as comprehensive or as good quality as people get in other countries under their self-paid / insured system.


Comparing like with like? How does our free service compare to other nations' free services for the non payers or non insured.


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## Peterm1000 (23 Apr 2021)

Jacob said:


> Comparing like with like? How does our free service compare to other nations' free services for the non payers or non insured.



I think where countries do have any kind of free health service (go to Sudan or Gabon and try getting free healthcare...), they tend to be less comprehensive than what we get in the UK - note, I think. Which is why you see the scandalous situation of some of the world's wealthiest countries with people wandering around with some very fixable diseases.


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## AlanY (23 Apr 2021)

Jacob said:


> Comparing like with like? How does our free service compare to other nations' free services for the non payers or non insured.



Since when was the NHS free? It is only free to those who do not pay tax or who use the service when visiting the UK. For the rest of us a big chunk of the tax/NI we pay goes to funding the NHS. This is the problem I have with reforming the NHS: how could it be done without removing that essential 'free at the point of use' element? I suspect an even bigger problem is that I probably am not qualified to speak on the subject but, Hell, it is still an almost-free country.


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## Inspector (23 Apr 2021)

Canada also has universal health care. Each province is in charge of theirs with the Federal Government sharing in the costs. Some provinces have no subscription fees, this one for example, where others charge an annual fee of up to $200 per family. If you can't afford that care is still provided. Ambulance fees may or may not be included in the coverage. Everything is covered except cosmetic operations, eg; breast enhancements, nose jobs, but medically needed ones like breast reductions for back pain are covered as are reconstructive work from accidents. Heart operations, cancers, joint replacements illnesses, child birth etc are all provided although some have long waits. Dental for the most part is not covered. Yearly eye exams for kids until they come of age is covered, the prescriptions for glasses I don't know. Drug prescriptions are not covered until retirement. Private insurance is available for the extras like dental, glasses and drug prescriptions and many employers provide it. You can also find private medical centres if you want to pay for an operation and don't want to wait. Workman's Compensation often use private services because it can be cheaper to get an injured worker back to work rather than pay for them to stay at home until fixed up. First Nations peoples have coverage for everything by treaty. Refugees get all their medical needs taken care of for at least a year until they transition into society. I've probably missed a lot but it appears our systems are similar.

Pete


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## Jacob (23 Apr 2021)

AlanY said:


> Since when was the NHS free? .


Since 1947


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## TominDales (24 Apr 2021)

Jacob said:


> Comparing like with like? How does our free service compare to other nations' free services for the non payers or non insured.


Most Northern European countries provide excellent universal healthcare to all their citizens regardless of income. However its very hard to compare like healthcare (HC) systems with like as every country has its own culture and doing it their way. One thing that strikes me as odd about debates on the NHS, is that its generally only compared to the US system and those comparisons are usually rather crude. Whats is surprising is universal HC that is essentially free in Europe that gives good outcomes are not talked about in the UK. This is especially odd as on some metrics they give better outcomes than the NHS. Not to say that the NHS isn't superb and something to be immensely proud off.

Newspapers and UK politicians very rarely look at Northern European HC and don't do analysis of where those countries are delivering better national outcomes to the NHS in some areas- metrics like cancer survival rates, waiting times and overall mortality rates. Its probably because the ones with the best outcomes operate in a very different cultural and historical context to ours, and maybe innovations would be hard to implement, and impossible politically as NHS is a highly politicised issue in the UK. 

Most European HC systems have a mixture of private, charity and church based hospitals, these are either paid for by the patents insurance or by the state. In most countries its not free at the point of use, but reimbursed through insurance schemes, although countries such as France issue citizens with a national credit card to pay. The Bismarkian insurance type schemes (Germany's comprehensive insurance based national healthcare dates back to 1880) enable these countries to raise more funding for their H/C system than the UKs tax based system - from 1% to 2% of gdp more and in a less politicised environment than the UK. There is a market element that enables them to charge the rich more, which helps raise significantly more money. 

Free for the poor.
Citizens in most Northern European states (states with similar standard of living to the UK) are compelled to take out health insurance from an approved provider, a bit like UK car insurance is compulsory. In several countries there is a choice of provider offering different levels of cover. For all patents, the basics are the same ie good safe H/C, but those that pay more get slightly quicker service and slightly posher hospitals. The unemployed and poor have theirs paid for by the state and get the basic service (of a standard as good as the UK). The trick is for those in paid employment, pay about 13% of their salary into the insurance on top of other taxes. The way I liken it is an analogy with taking a plane flight, the state pays for an economy flight whereas the private insurance pays for business class. They pay 13% plus and get a slightly faster and more comfortable service, but both passengers get the same safe flight that takes them from a to b. This extra 1% to 2% of extra finance enables continental countries to employ more doctors per 1000 people than the UK. I think its this two tier structure that makes the European systems less political than in the UK. The rich pay up because they see they get a better service (even if its only cosmetically different), the poor like it because they get excellent healthcare for free. Because of the duel funding structure there is less funding from general taxation so its not such a hole at the treasury.

To my mind, the other huge benefit of these HC systems is how un-politicized they are. They are not associated with one political party as the founding of the NHS is, but a consensus that goes back to Bismark with subsequent improvements as social modernisation and innovation in social democracy developed in Europe. Originally the schemes were only available to those who could afford insurance, but since WW2 the state has covered those whose incomes are low or the unemployed.

In terms of delivery, the different private hospitals groups compete for patients, which means they need to provide an excess of resources such as beds and doctors (an in-efficiency cf the NHS) but means they have extra capacity available for winter flu, patients have more choice, and lower waiting times. Its probably the main reason COVID death rates in Northern European countries are lower than the UK, they have a bit more critical care capacity than us.

These schemes are not much discussed in the UK. I think its largely that they are so different to the , tax payer financed NHS and universal monolithic offer. They are probably impossible for us to copy without politically impossible changes. Its could be seen as privatising the NHS and we don't trust our governments sufficiently to allow for such reforms and we are terrified that we would adopt a US model so its just not discussed. For the right of centre politically the continental systems is paid for disproportionately by the well off. So I can see that politically it does not appeal to either the left or the right.
Every EU country is different to a degree, there finance and paying structures reflect their history and culture, but they have broadly similar Bismarkien insurance based schemes with government top up for the unemployed, disabled, this makes comparisons across Europe really quite hard as not country is the same.
I heard a Professor of H/C policy from Imperial college give a talk to us at work on improvement schemes in the NHS and I asked him to rank other countries, he said that although France appears fantastic, especially to British tourists, there are discrepancies in provision between wealthy areas (that tourists visit) and the depressed mining communities, so overall he didn't think the French got so much better treatment than we do through the NHS, even though they spend more gdp on HC than us. He said its difficult to compare data sets, however he held up examples of clearly more effective systems, the Netherlands, Finland, Nordics, Germany, Belgium as leading lights. He commented that the Netherlands and Finland spend about the same as us on HC but get better outcomes. Another fact of European H/C is they train more doctors and nurses per head than we do and they pay there doctors, consultants a lot less than their equivalent in the UK. This has the upside that it helps the NHS recruit from the EU, when desperate, but it means on the downside, on the whole we have less doctors and consultants than our pears overseas, and we expect them to be more productive.

I hope that answered your question, I've tried to keep it factual. But one observation on these various systems is one of how easy is it to convince a population to fund its HC.
I think that as long as we solely rely on taxation to fund the NHS, we will have to accept there are limits to what taxpayers will reasonably put up with. Healthcare is predominantly consumed by the old, (although we all use it, something like 85% of operations are on the over 65s) but paid for my the young fit and healthy, so there is only so much that politicians of all colours can persuade people to transfer through taxation. That is the one obvious benefit from the continental way of doing things.

The other comparison is value for money.
Its hard to compare things like efficiency and productivity as the boundaries of what is NHS and the rest of the state are so different. So with that caveat, there have been studies, one fact that differentiates the NHS is that is by an large a nationalised monopoly, it does not need to compete and so runs to keep its assets full through central/regional planning and has very high utilisation of its assets ie bed use, ration of staff to general population, whereas European hospitals are private or charitable entities that compete in a market for patients so need to have extra capacity. the NHS scores well on efficiency measure based on asset and people utilisation. However the NHS sufferer from structural inefficiency through its regionals and hierarchical structures, consultant fiefdoms and silos that are prevalent in a large employment structure. The more atomised continental systems are efficient at delivery and efficient with patents time. In many (but not all) European countries, the primary care center - cf our GP practice, often has a healthcare centers equipped with laboratories and scanners so that the doctor can get scans etc done while you visit. Cutting down on a lot of waste which we don't measure in the UK. One sad trend, is the UK system seems to have got less efficient over the past 10 years - not sure if this is just the way we measure it, its got more sophisticated, or the effect of the Landsley reforms
One benefit of having a national systems is in a global emergency, such as responding to a pandemic can be centrally planned and rolled out, we saw that this year where patients were transferred up and down the country during the hight of the pandemic, whereas Italy struggled with its excellent, but regionally organised H/C. In terms of value for money the NHS is up in the top tier (US is way down) but the Netherlands, Finland, Belgium Nordics seem to offer better value for money.

Most comparisons of H/C tend to focus on money - costs of this and than. But the other dimension is trust, brand image and care and feel. Here the NHS is outstanding in this regard. We trust the staff, we trust the motivation and care. Scandals in the NHS are usually due to incompetence, the odd murderous of competent professional hiding in the system, but the people, there motivation and the organisation is trusted and loved. However when I speak to work colleagues from Northern European visiting or resident in the UK, they prefer to go home to get treatment as they don't trust the NHS to the extent we do. And avoid British dentists at all costs has been something I've read about all my life, which I think is unfair as dental practice has improved during my lifetime.

Although these systems work well in Northern Europe, they are just so complety different to the UK that its hard to see how we can learn from them. If over time their healthcare massively outperform ours, then maybe there would be a case for a re-think.

So Jacob, to try and answer your questions - and I hope I've not introduced politics into this as its a genuinely interesting topic, out biggest national institution and the second biggest area of government expenditure - also my company is being paid by the tax payer to develop vaccines so I have a personal interest. There are HC systems every bit as good and free as the NHS, but we just don't discuss them in the UK. unfortunately they are so different that its hard for us to lean from them and vice versa. We can only look on enviously at the HC available to a Finn, a Dane, a German a Dutchperson, that does not have the same political interference as this country, they tend to leave it to the professionals, civil service, contracted, regulated insurance companies, private hospitals etc, to just get on with it. I do wish for that.


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## Peterm1000 (24 Apr 2021)

AlanY said:


> Since when was the NHS free? It is only free to those who do not pay tax or who use the service when visiting the UK. For the rest of us a big chunk of the tax/NI we pay goes to funding the NHS. This is the problem I have with reforming the NHS: how could it be done without removing that essential 'free at the point of use' element? I suspect an even bigger problem is that I probably am not qualified to speak on the subject but, Hell, it is still an almost-free country.


Go back a few pages - this discussion has been comprehensively had already. The NHS describes itself as "free" and has it as the first 2 of their guiding principles. Obviously it gets paid for by taxes as do every other public item in the UK which everyone still posting on this thread has acknowledged. If you park in the town centre on a Sunday and don't pay, that's not "free" as you paid for the tarmac and parking attendant through your taxes - the sign will still describe it as "free".


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## Peterm1000 (24 Apr 2021)

TominDales said:


> Most Northern European countries provide excellent universal healthcare to all their citizens regardless of income. However its very hard to compare like healthcare (HC) systems with like as every country has its own culture and doing it their way. One thing that strikes me as odd about debates on the NHS, is that its generally only compared to the US system and those comparisons are usually rather crude. Whats is surprising is universal HC that is essentially free in Europe that gives good outcomes are not talked about in the UK. This is especially odd as on some metrics they give better outcomes than the NHS. Not to say that the NHS isn't superb and something to be immensely proud off.
> 
> Newspapers and UK politicians very rarely look at Northern European HC and don't do analysis of where those countries are delivering better national outcomes to the NHS in some areas- metrics like cancer survival rates, waiting times and overall mortality rates. Its probably because the ones with the best outcomes operate in a very different cultural and historical context to ours, and maybe innovations would be hard to implement, and impossible politically as NHS is a highly politicised issue in the UK.
> 
> ...


Interesting post - thank you.

So most individuals do pay more...


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## AlanY (24 Apr 2021)

TominDales said:


> Most Northern European countries provide excellent universal healthcare...


What a good read! Thank you for taking the time to post this.


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