I thought this tweet by Clive Peedell worth sharing:
Clive is Co-founder of the NHAparty. He is an NHS consultant clinical oncologist with interest in lung & prostate cancer and other related issues. He also has a pretty good brain for economics.
This critical slide he was sharing was, perhaps, this one:
I haven't done the weighted averages on the data, although it would be easy to do. The simple facts stand out. After five years most people who have cancer in the USA are alive. In fact, overall it looks like there might be a near nine in ten chance of that.
And the associated cost is a 40% chance of bankruptcy.
That is no way to run a health service.
And yet this is the model those in office in the UK aspire to.
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To put this in context, there are about 1 million bankruptcies each year in the US, for about 330 million people. So, over 5 years, about 1.5%. In the UK it is about 100,000 for 60 million people, or about 0.8% in 5 years. Even in the UK, I suspect the percentage will go up somewhat for those with serious long term health issues.
I saw reporting of research on the “Medicare for all” proposal, suggesting it would save nearly 70,000 deaths a year, and cost $450 billion less than the existing system. Why is this controversial? Some people seem to think saving lives and money is a bad thing.
Why do we have to debate this nonsense? Over 33 million Americans have no healthcare at all and rely on the benevolence of charitable organisations, endure chronic conditions to save money or just die untreated. It is quite obvious that a plethora of insurance companies in the US, with their individual overheads, are going to add to the cost of provision whereas the NHS benefits from the economies scale and the direct transfer of money from the treasury which eliminates the need for insurance companies and therefore reducing the administrative burden.
I thought the Tories were about efficiency and so where a service costs about half of a comparator and also provides universal coverage it is a no brainer.
BUT NO.
The Tories aren’t in favour of saving money as much as they are in favour of lining the pockets of their sponsors, their donors and themselves.
Heh, so high US cancer survival rates are a result of diagnosing early cases of breast or prostrate cancer that probably won’t kill you until something else does first, hence US stats aren’t that great and shouldn’t be regarded as such. Yeah, that builds my confidence in the UK system.
The simple fact is that most Americans have access to what is probably the best medical care in the world. When I go into Stanford I certainly don’t feel that “jeez, wouldn’t I be better off in Cuba”. There are some horror stories about insurance, but that affects a small number of people. Also, medical research spending per capita is much higher than in Europe, which might have a role in higher cancer survival rates.
The argument about American healthcare basically boils down to “the 85-90% of Americans who have ready access to the best healthcare in the world should be willing to accept something inferior so that the last 10-15% are also included without risk of financial distress”. That may be a fair and equitable argument but be honest about what it is. “The accepting less” part is what makes it so controversial.
Can I point out that 10-15% is very hard to reconcile with 40% bankruptcy rates
Shall we stay evidence-based here?
stve pesenti
“jeez, wouldn’t I be better off in Cuba”.
Word on the street is yes, you might be, actually.
Cuba’s medical services are rated as amongst the best in the world.
American health services are only comparably good for the people who can afford to pay for them.
Yeah, just ignore healthcare costs rising above inflation, the fact that most health insurance plans are kafkaesque nightmares with high deductibles, narrow networks, and balance billing. And if you don’t know what any of those mean you have no business praising our ‘turn the bones of the poor into profits for oligarchs’ system. We pay TWICE as much per capita as the UK on healthcare for much worse results on literally every measure that doesn’t even cover everyone. Even just our government outlay is on par with what the UK spends per capita, except they don’t have profit sucking leeches at every conceivable turn.
‘Geeze wouldn’t I be better off in Cuba?’ as far as healthcare goes, yes you would be better of in just about any other country in the world. In the progressive bastion of Utah the state government SAVES thousands of dollars buy Paying to put state employee’s on a round trip flight to Mexico to pick up prescriptions. https://abcnews.go.com/Health/wireStory/utah-sends-employees-mexico-lower-prescription-prices-68861516
It’s much cheaper to pay for a round trip flight to Paris if you need dental work too.
Staying with evidence based thinking, overall US health costs are double (roughly) those in Europe and overall health outcomes are worse. So we do not need further evidence on bankruptcy rates to know that the U.S. system is not fit for purpose.
Just to add some anecdote to the data – my family has experienced both the US and U.K. systems in the last 3 months. Daughter in law and grand-daughter in 2 hospitals in the smarter part of Detroit, and daughter in 2 large, heavily loaded hospitals in N London.
No contest whatsoever in terms of both the technical quality of healthcare, and the personal care and concern shown by staff. The NHS were miles ahead. After the second experience in the US, involving a 4 year old with a broken arm, they even spoke to a lawyer but needless to say, that’s a monster can of worms in the US, even where the care has been very poor.
The only criteria on which the US is ahead is in making money for the players – insurance companies, lawyers, pharma companies and surgeons. None of that represents investment in healthcare. Today’s Tory party puts the interests of those parasites (their mates and sponsors) ahead of the nation’s health.
(PS All the the family are fine after their experiences)
I’m pleased they’re OK
I was interested to hear an obviously US national on a train recently
She’s working in the UK and has no intention of going home
She could never afford the healthcare
The statistics for almost anything American in terms of health, wellbeing, earnings and prisons are all pretty appalling.
On prisons – the USA has over 4% of the world population and 20% of world prison population – go figure as they say. Netherlands has prison spaces as they look at why people get locked up and see if they can intervene with e.g. mental health issues and only lock up the dangerous.
Priti Patel will build more prisons.
I bookmarked this article about The Oligarch Takeover of US Pharma and Healthcare ! This is where the UK is heading under Johnson, if he gets his way.
https://thesaker.is/the-oligarch-takeover-of-us-pharma-and-healthcare-and-the-resulting-human-crisis/
@ affa nae weel
Thanks for posting that link. It makes for fascinating reading. I had known something of the state of affairs regarding healthcare costs in the US but not in such detail. It’s terrifying. My fear for the UK population is that so much of what the NHS does is taken for granted and by default, perhaps, not truly appreciated. If the general public do not get behind it I think we’ll lose it under this Government.
I suppose I should put this out there: the US healthcare model is clearly a nightmare, but perhaps it might it be possible to have a sensible debate about what other options could be viable for improving healthcare in the UK, apart from sticking with the present UK system.
For example, might there be something to learn from the healthcare models in places such as, for example, France, Germany, Spain, Switzerland, etc?
What is their advantage?
“What is their advantage?”
There probably isn’t one, or wouldn’t be if our government would keep the funding up to date instead of constantly looking to make ‘savings’.
I’d guess that anyone who has experienced a continental hospital (while on holiday for example) will come home with glowing tales of how marvellous it was. Rather as they speak very highly of the NHS when they have actually needed it rather than pay attention to what they read in the papers. (?)
I only know about Spanish hospitals. They are, of course, ‘superb’ because they solved the problems at the time and averted a crisis. It’s almost as if we expect them to be somehow inadequate as if only the British could possibly do anything so clever as provide medical services. And then there was EHIC so money didn’t come into the reckoning. Will that survive Brexit ? Hmmmm….?
Its a huge and complex subject so at the risk of generalising…
Having a French side to the family and having spent several weeks in a small French hospital some years ago, it’s a topic that’s interested me. I came back to a UK hospital and there were some distinct differences which subsequently I went back to the hospitals general manager to share – being at the time a management consultant… it was a very interesting – and friendly – discussion. There were some classic organisational, cultural and technological factors.
In the U.K. the debate only seems to be between U.K./public and USA/privatised models and there is little or no consideration of what are clearly successfull (no-ones perfect) models in Europe that are ‘hybrids’. I’m a big fan of the NHS but that does not mean there are not positive ideas or lessons to take from elsewhere. The developed European countries spend more on health but that’s not the whole story. They also have many more doctors, nurses and beds available, perhaps reflecting U.K. politicians (and bean counters) obsession with ‘efficiency’, whilst failing to understand that 100% utilisation of a health service is a very bad sign.
Some aspects of the NHS go back to its foundation in terms of the role of GPs as independents, and the marked hierarchies in hospitals from consultants down to cleaning staff. Both of those are rather different in France. The baronies of the different consultants in hospitals can be a real barrier to change and sharing data. The shortage of GPs in the UK means they can become blockages in getting people quickly through to consultants.
The NHS certainly struggles with technology and has been slower to take it up. The consultant baronies can be part of that problem. There seems to be limited appetite for piloting or experimenting On the private front, my understanding is that in France at least, the sector has a lot of mutuals and not for profits which perhaps accounts for the reasonable health costs there, rather than the obscene profit taking in the USA.
So yes, I would argue that there are useful ideas to take from European health systems. One might also argue that there is good learning to take from the best of the NHS and transfer to the less good. That kind of learning has not been common in the sector (as good mates at senior levels in the sector confirm), though there are some great examples. Having people like Hancock in charge who think the answer to everything is an App does not help.
It’s got to be the case that the sector keeps an eye on what others are doing and adopts good ideas from elsewhere. That ought to be from generally successful health sectors like Germany or France (good outcomes for the whole population at reasonable costs)rather than dismally bad ones like the US. But it’s not about simplistic silver bullets
There are aspects of these systems that appeal
But there is a reason why they cost 2% more of GDP and that is GPs do not triage out those who do not need to see a consultant at all
There is then over investigation and waste
Do we want that?
France, Germany, Spain and Switzerland all have higher cancer survival rates than the UK in breast cancer, stomach cancer, lung cancer and prostate cancer.
In a 2019 worldwide country comparison for survival, the UK came 28th in Breast cancer, 42nd in stomach cancer, 47th in lung cancer and 28th in prostate cancer. (source – Concord Programme run by the London School of Hygiene and Tropical Medicine)
Do you not think we should try and find out why?
Terribly selective of you
Cancer is the only thing we do worse at
We were discussing systems
You don’ understand that.
“Terribly selective of you
Cancer is the only thing we do worse at”
In 2018 the Nuffield Trust compared the NHS with healthcare systems in 18 similarly developed countries. From the report:
The UK’s NHS performs worse than the average in the treatment of eight out of the 12 most common causes of death, including deaths within 30 days of having a heart attack.
The UK was 16th of the 18 countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’)
The UK has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): seven in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries.
“We were discussing systems
You don’ understand that.”
No, I obviously didn’t understand that we were discussing ‘systems’. I thought we were discussing saving lives.
No doubt you will dismiss this comment, claiming I am a ‘troll’ or that I have an ‘agenda’, when all I am doing is reporting the results of surveys by experts and asking again, is there nothing we can learn from other countries that seem better at keeping their citizens alive?
Since you dismiss cancer survival rates as ‘terribly selective’ when it’s the single most common form of early death and since you have clearly done no research if you make a demonstrably incorrect comment like “cancer is the only thing we are worse at”, I wonder if it is you that has an agenda.
You claim this is a forum for education and discussion. I wonder if it really is when you seem unwilling to learn and when you patronise and sneer at any opinion different from your own, even when your opinion is not supported by the facts.
I have nit checked your evidence
I accept U.K. death rates are rising
As Danny Dorling has shown, much of that is directly down to austerity – in other words these are the direct result of government choice
But you did not look at the Commonwealth Foundation the USA data
I will say you are being decidedly selective
And unquestioning
Im certainly well aware of the triage role of GPs – and how that triage role can become a bottle neck when it takes weeks to get an appointment, as GPs are so overloaded. Also that being a pharmacist in France is a good business!
However I suspect that that their better ratios of doctors/nurses and beds per head of population might be a rather better explanation of the extra 2% of GDP that they spend. And that the UK ought to be spending that too, to get back to the kind of figures of the New Labour years
I don’t dispute that it would help
But we need more GPs then as well