New hip anybody?

[Jacob]

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

 

[selectortone]

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.

 

[Jacob]

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?

 

[Peterm1000]

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).

 

[D_W]

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.

 

[selectortone]

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.

 

[Peterm1000]

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

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

 

[thetyreman]

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!

 

[Peterm1000]

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.

 

[Jacob]

...... 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.

 

[D_W]

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.

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.

 

[Inspector]

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.

 

[Jonm]

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.

 

[TRITON]

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.

 

[Lons]

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.

 

[Lons]

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.

 

[Jacob]

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.

 

[timothyedoran]

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.

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.

 

[Lons]

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.

 

[Reginald]

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