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There's a strong tendency to criticise the NHS - encouraged by the right as they run it down, employ more wasteful management and sell it off.
But it's still amazingly cost effective and one of the best in the world.
The USA system sounds appalling - unless you have loadsa dosh. Even insurance can catch you out with the small print or if there's a hiccup like late payment or job change
 
Jacob":14luv61y said:
The USA system sounds appalling - unless you have loadsa dosh. Even insurance can catch you out with the small print or if there's a hiccup like late payment or job change

The trouble with most and their insurance is they don't make any effort to know what's in it until after they've already run up charges. It's sort of like buying a citroen 2cv, and then criticizing when you find you don't have something equivalent to a lexus.

In reality, most over here with good work coverage sail through health issues, insurance pays most, we pay the balance, service is fast and more thorough than it probably needs to be and there are a gaggle of customer service or concierge services that go with it. The worst cases of people who don't have things lined up well or where someone makes mistakes and it falls back to the patient are the ones that tend to make TV coverage.

Clickbait. And certainly there are gaps for large groups of people who are under covered or who have no coverage or who make no effort to understand what they have. That's part of the issue with the disparity in our system between the payers and the folks who don't want to pay or who can't pay.

The Canadian president of a health and benefits consulting firm where I used to work always said to us about the US system "best health care in the world if you can pay for the best. If you can't, you're better off in canada or europe". I'm sure most of our specialist physicians are happy here, they can make a ton of money, as well as the folks who sell medical equipment of the complex type (like laser surgery machines, etc). Everyone else is scratching for pennies (rank and file hospital staff, the hospitals themselves, etc). Physicians control the flow of patients so hospitals do whatever they can to keep them happy, and they recruit physicians from each other all the time. The rank and file employees only get attention for a short bit of time if there's an extreme shortage. Many of the lower rank and file are paid abysmally.

I personally ascribe to the notion that I'm not going to live in fear of morbidity or mortality. There's a lot of fear mongering with health care, here and overseas, and too many stories about it are just clickbait to generate ad revenue.
 
We're (the whole family) insured through my wife's employer. Costs us about $800 a month. We can go to any doctor, any time, no need for referrals, waits, etc. I was diagnosed with torn cartilage a few years ago on a Monday and was in surgery on Wednesday. Had is been a sudden injury (it wasn't) like a high school football injury or something like that they would have gone ahead and admitted me and probably operated within 24 hours. They could have done it on Tuesday if I'd wanted to. And this was one of the leading orthopedic surgery groups in the South. Sounds like a lot of money until you get sick then it's peanuts. When my wife had our daughter I think our out-of-pocket expense was $50. She had her at the best all-women's hospital in town (beautiful really), fully private room, just unbelievable care. She had to be induced and there was a point in time that the baby's heart rate dropped and the room filled up with neonatal doctors (three of them; one a neonatal heart surgeon) and two neonatal surgical nurses. Everything turned out fine, but the care we got was just stunning. At that moment, of course, I would have spent any amount of money to have the doctors in the room that needed to be there. When you think about your newborn maybe having to be rushed in for heart surgery I promise you don't begrudge a dollar these guys make. Hell, I hoped the guy was earning $10MM a year (probably not far from it), and not some overworked, bitter quack. Turned out he was a Harvard and Johns Hopkins trained physician and had done his surgical residency at Boston Children's all of which is about as good as it gets over here.

My 88 year old mother who lives with us is on Medicare (with a supplement that costs very little) and her care is as good or better. Her Medicare premiums are less than a $2000 a year and are netted against her Social Security income. It's seamless. Her primary care physician is a board certified Gerontologist and he is just an incredible doctor. She had cataract surgery on both eyes about three years ago, all under the auspices of Medicare, with no copays or any out-of-pocket at all. All done in a top-notch facility by a great doctor.
 
D_W":1ol2w3gt said:
..
In reality, most over here with good work coverage sail through health issues,......
That's what is known as a "self evident truth".
It's the one's who don't have "good work coverage" who test the system.
In the UK and the EU EVERYBODY gets first class health care whether or not they are insured. Insurance or private care buys a few frills but not much else.
It's just so much cheaper and efficient this way - we spend far less on health than the USA and get a much better service.
 
phil.p":2lqatzmc said:
It's OK, Jeremy, you've probably won. You can stop now. :)
I'm flattered by the "Jeremy" :lol: :lol:

But you have to keep banging on - another subject but how do you persuade yanks of another self evident truth: that fewer guns means fewer gun fatalities?
 
Jacob":cbtishy7 said:
D_W":cbtishy7 said:
..
In reality, most over here with good work coverage sail through health issues,......
That's what is known as a "self evident truth".
It's the one's who don't have "good work coverage" who test the system.
In the UK and the EU EVERYBODY gets first class health care whether or not they are insured. Insurance or private care buys a few frills but not much else.
It's just so much cheaper and efficient this way - we spend far less on health than the USA and get a much better service.

I know enough people who moved from England to here to know that the quality and speed of care there isn't quite up to par with first rate care here.

But you're right about the people who don't have coverage here, they're in a bind.

Personally, I'd settle for the English system without complaint, but it's not a choice here.
 
It may surprise some to know that there are more GP's per 100,000 population in the UK than in the US.
You would also expect a certain standard of health care in the US (generally speaking). If a country is spending some 17.5% of it's GDP on health it should have a good standard of health care. It would be ridiculous if it wasn't. You really do have to understand just how much is being spent. There's no comparison. 17.5% is far higher than any other advanced industrialised country. I think Germany comes in at around 11% of GDP iirc. Even a 1 % difference of GDP is an awful lot of money.
 
D_W":3g1ogj4f said:
But you're right about the people who don't have coverage here, they're in a bind.

It's an interesting point. I used to work in the US where I spoke to some very talented and enthusiastic hobbyist woodworkers who said they'd love to make the move to full time, professional furniture maker, but the one thing stopping them was that they'd lose their health cover. I also heard an American musical instrument maker say that the reason there were so many independent instrument makers in the UK was that the safety net of free health care allowed them to take that chance.

Maybe Obamacare will unleash a flood of creative talent by enabling woodworkers to transition to full time makers?
 
custard":39g9ux6x said:
D_W":39g9ux6x said:
But you're right about the people who don't have coverage here, they're in a bind.

It's an interesting point. I used to work in the US where I spoke to some very talented and enthusiastic hobbyist woodworkers who said they'd love to make the move to full time, professional furniture maker, but the one thing stopping them was that they'd lose their health cover. I also heard an American musical instrument maker say that the reason there were so many independent instrument makers in the UK was that the safety net of free health care allowed them to take that chance.

Maybe Obamacare will unleash a flood of creative talent by enabling woodworkers to transition to full time makers?
CStanfords $800 per month would be beyond many one man start-ups.
Is being enslaved by health-care concerns the reason Americans don't take holidays and work longer hours than in the EU? Slavery is not dead yet!
 
custard":mzhg66cd said:
D_W":mzhg66cd said:
But you're right about the people who don't have coverage here, they're in a bind.

It's an interesting point. I used to work in the US where I spoke to some very talented and enthusiastic hobbyist woodworkers who said they'd love to make the move to full time, professional furniture maker, but the one thing stopping them was that they'd lose their health cover. I also heard an American musical instrument maker say that the reason there were so many independent instrument makers in the UK was that the safety net of free health care allowed them to take that chance.

Maybe Obamacare will unleash a flood of creative talent by enabling woodworkers to transition to full time makers?

There aren't many independent instrument makers in the UK. There are a few who can call it a full time occupation, for the rest it's a part time income supplemented by other means. I would go so far to say that the UK and the US has around the same number of full time makers, taking into account population differences. The market in the US is a bit more healthier (cough) for higher end instruments. No different to hand tools. I'll take a guess and say that for Philly the US is one of the better places to sell Planes. I suppose it comes down to disposable income and the US has a certain proportion of it's population that has enough of that disposable income.
 
MIGNAL":2s8mbkox said:
I suppose it comes down to disposable income and the US has a certain proportion of it's population that has enough of that disposable income.

I'm a full time furniture maker, pretty much all of my clients are either very wealthy or it's corporate business. I think it's always been that way, it didn't take the Arts & Crafts movement long to realise that they were only selling to their well-off chums, and the ideal of well-made furniture for the common man was just a pipe dream. In that respect the real winners were the modernist movement who grasped that marrying great design to industrial production was the way forward.

I pretty much accept all that as a given. But what really interests me is that only a tiny fraction of the UK households that can afford hand crafted furniture actually ever commission any. So it's not just money that's restricting the opportunities for designer/makers, there are many other factors at play.

When I was there I did sense (without a shred of quantified evidence!) that in the US there was a slightly greater willingness amongst wealthier households to take a chance on commissioned furniture and original design. I suspect that the real issue is the "original design" part of the equation, and that the moneyed UK client is just that bit more cautious.
 
Jacob":2gm0xle3 said:
custard":2gm0xle3 said:
D_W":2gm0xle3 said:
But you're right about the people who don't have coverage here, they're in a bind.

It's an interesting point. I used to work in the US where I spoke to some very talented and enthusiastic hobbyist woodworkers who said they'd love to make the move to full time, professional furniture maker, but the one thing stopping them was that they'd lose their health cover. I also heard an American musical instrument maker say that the reason there were so many independent instrument makers in the UK was that the safety net of free health care allowed them to take that chance.

Maybe Obamacare will unleash a flood of creative talent by enabling woodworkers to transition to full time makers?
CStanfords $800 per month would be beyond many one man start-ups.
Is being enslaved by health-care concerns the reason Americans don't take holidays and work longer hours than in the EU? Slavery is not dead yet!

Dunno Jacob. My wife is a school teacher and gets tons of time off. I get more than I'd like to have when the work dries up.

Pretty much standard corporate vacation policy (vacation time is in no way a federal mandate) is three weeks after about as many years' service and it goes up from there depending on the company. Otherwise, usually one week in the first year though better companies will go two weeks in the first year. Senior executives will usually negotiate more on the front end when changing jobs. If you job hop a lot you're shooting yourself in the foot with respect to your vacation time. You do have to earn it over here by staying on board with a company (unless you are a very highly placed executive). It isn't given to you except as an award for years of service. Most people I know take their vacation time. And that was my experience in the corporate world as well with FedEx and International Paper.

Private insurance costs are now subsidized under 'ObamaCare' (the Affordable Care Act), your income level determines how much you have to pay out of pocket. Some people pay virtually nothing or a very nominal amount. My family is not eligible for the subsidy. If you are able to afford the coverage you have to pay for it yourself. If you don't carry coverage, you're penalized on your tax return (with a few exceptions). If I were single and just starting out I would likely have to pay nothing for full coverage.

Because of the subsidy, there is theoretically no reason anybody should be without coverage and indeed if you do go without it for some reason you have to pay the aforementioned penalty (essentially a tax) when you file your annual income tax return. Some people, inexplicably, are not taking advantage of the program even when they would have to pay little or nothing at all. There is no logical reason for this other than some sort of social conditioning.

As in all countries that do this or something similar, the actuarial mathematics require essentially full participation, especially by younger insureds. This is especially crucial under the ObamaCare mechanism.
 
MIGNAL":37kz981k said:
It may surprise some to know that there are more GP's per 100,000 population in the UK than in the US.
You would also expect a certain standard of health care in the US (generally speaking). If a country is spending some 17.5% of it's GDP on health it should have a good standard of health care. It would be ridiculous if it wasn't. You really do have to understand just how much is being spent. There's no comparison. 17.5% is far higher than any other advanced industrialised country. I think Germany comes in at around 11% of GDP iirc. Even a 1 % difference of GDP is an awful lot of money.

I don't know how the system works in the UK, but I'd imagine the difference for the supply of GPs has to do with compensation levels being flatter there. It's not unheard of here for a GP to make $200k and a specialist to make closer to $1 million (some make more than that, though it's certainly not the majority).

In the US, you can see a specialist without a reference, so people tend to go to a GP when they have a cold or something, or when they don't know what to do, but not for everything.

I agree it's a horrible amount of money, and it's not a market making an educated decision, and that's part of the problem. The English few that I know that have lived here for a while expect something of the same level of spending when they go back to the UK, and they complain that the care doesn't move as fast as they'd like and facilities and equipment are outdated. (that's compared to here. I doubt I personally would think any of it's outdated).

When I walk into a community hospital here and they literally upgrade everything all the time and the facilities every decade and a half get completely revamped, I think "I'm paying for this remodeling, and i'm only here for a couple of hours. It doesn't need to look like the inside of a brand new high end mall if I have the paying choice". Colleges here have much the same problem, there is a lot of contest spending on status.
 
I don't know. In the last 15 years they have built a huge amount of health infrastructure. Every single one of my old GP centres have gone (3 of them). They have all been replaced with these very new looking medical centres, built from the ground up. Some are like mini hospitals. In fact they do small run of the mill procedures that never existed under the old system. I think it's pretty much the same throughout the whole country. Unfortunately they paid for this through private funding, which has now turned out to be a huge burden. It was all predicted of course.
The only other experience I've had was going through the doughnut. That looked pretty brand spanking new to me. Either that or they had given it a good wash.
 
custard":2ntr82yb said:
Maybe Obamacare will unleash a flood of creative talent by enabling woodworkers to transition to full time makers?

It could, but I doubt it. Not because there isn't maker desire, but because there isn't much desire in the US on a widespread basis for more than house upgrades or remodeling. Furniture and other such stuff here is consumables to most, to be replaced when it gets dented or when a color change is desired. You're absolutely correct that the sentiment of not having basic needs taken care of without being destitute - that drives people to search for jobs that have coverage and not purchase on the individual market. That said, a young individual in the US can still purchase coverage inexpensively on their own, but some of the law's changes shifted older peoples' costs to younger people. Still, insurance for younger healthy folks is much less than the average. Maybe $250 a month or something, which is probably not far off of the tax burden difference between here and there.

The other thing (and maybe it exists there, too) is that as soon as you start a small business, you have to pay both sides of the social security tax here (which is significant) and you have a whole gaggle of payroll and tax related things to overcome. It seems like the lazy (who are more likely to skip doing that and wait to see if they get in trouble) are more likely to go take a shot at a dream.

The established makers usually get hooked up with a museum (either by salary or by business arrangement for reconditioning or repair of museum pieces) or a school, and they probably spend a lot more time repairing and teaching than they do making things from scratch. Charlie would know more about modern furniture, I don't know anything about what the market for that stuff is like, other than to notice that when it does pop up in the artsy fartsy areas around here that have a lot of old money, there still seems to be quite a bit of turnover in makers.

George Wilson, Peter Ross and those types are a good example of the makers here - extremely talented - but worked in a museum environment and did what interested them on the side. I think I can convince George to post here. He is the finest and most capable maker I have ever met.

I do know a few other makers (and I feel impolite to say this) who are not very good, and inevitably move to teaching beginners classes here and they can do so because they have a wife with a professional occupation. At the retail level for a guy like me, I could probably work my planes up a notch or two in finish to sell them but it wouldn't be worth the trouble and I hate trying to convince people they should see value in something I do - because I hate it when other people do it to me. Charlie sells some furniture on etsy, and some other stuff, maybe he can describe the market for it here. Tax work probably pays better and finds a check faster.

What we do have is kitschy craft shows here that are a combination of inexpensive stuff (my mother does those...and very well money-wise), and ridiculously priced things like $40 pens made from kits or very good quality turnings, but with offensive prices. There's just not a good widespread craft segment here.

At any way, the health care thing doesn't help any of that - the idea that you can go out and make yourself an amount of money to get by on food until you get established and live in your maker's space is usually illegal (the latter part) and if it's not, your maker's space will be in a residential area where you have no exposure.
 
MIGNAL":5no1u09h said:
I don't know. In the last 15 years they have built a huge amount of health infrastructure. Every single one of my old GP centres have gone (3 of them). They have all been replaced with these very new looking medical centres, built from the ground up. Some are like mini hospitals. In fact they do small run of the mill procedures that never existed under the old system. I think it's pretty much the same throughout the whole country. Unfortunately they paid for this through private funding, which has now turned out to be a huge burden. It was all predicted of course.
The only other experience I've had was going through the doughnut. That looked pretty brand spanking new to me. Either that or they had given it a good wash.

Trust me, if they did the building they do here, it wouldn't be for 10 or 11% of GDP. It's completely out of control here, and hospital mergers to acquire more cash and do more building and modernizing, even in rural areas, is picking up in order to control patient flow in insurance networks. Completely out of control.
 
Paddy Roxburgh":hcvi9bit said:
Our health care is fine if you cut yourself with old fashioned O1 steel, but cut yourself with PMV11 and you need more advanced care

You have to have provincial canadian care, because what's in it is a secret only known in canada.
 
The market for custom furniture and cabinetry is mostly local so it's difficult to make broad inferences. The notion of a craftsman/artist building whatever he or she pleases and there being an adoring market awaiting each piece is largely mythical though there are some obvious exceptions. If that's the metric then so few meet it that comparisons become meaningless I think. Krenov got to that point but was so deliberate in his work he still couldn't make a living without the woodworking school. I don't think this invalidates his artistic bona fides. It just is what it is. And the market for period reproductions of even the highest quality is essentially gone, again, with the exception of local pockets of activity mostly in the Northeast.

This architect is the older brother of a girl I dated in college:

http://johnjonesarchitect.com/hillstone/

The interior fitments and woodworking were done impeccably by this Memphis firm:

http://www.oldcitymillwork.com/residential.html

Almost every piece of furniture in the home itself excluding fully upholstered items (first link) was custom made by a certain local craftsman (not me unfortunately) though I think the cabinet/joinery firm did do a couple of the standalone pieces. Fairly easy furnituremaking, but a lot of it. I can't imagine somebody not being super happy to have this work though the pieces themselves don't set one's portfolio afire. The ability to handle a large commission, however, speaks to other talents and critical mass of an actual furnituremaking business. These sorts of commissions tend to beget others if the group works together harmoniously -- architect, joinery/cabinet firm, and furnituremaker.
 
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