Next-day doctor's visits, 24-hour availability of physicians and staff, home delivery of prescription drugs---for $1500 a year.
June 8, 2001 4:19 PM   Subscribe

 
i sympathise with the too-busy doctors, and it makes me wish i lived in canada (sometimes).

with increasing populations and increasing health problems, i just think that socialized medicine must be future.
posted by o2b at 5:22 PM on June 8, 2001


i must say that is great for the doctors and the patients, no one can dispute that, but i just wish it was based on something more than the ability to pay an extra $1500 a year.

Maybe with better healthcare and more time spent with the doctor it would actually be preventative, and actually improve health and reduce costs in the long run?
posted by th3ph17 at 5:30 PM on June 8, 2001


There's something appealing about hiring a doctor who promises to limit his patient load. My father's a doctor, yet I dread seeking any sort of medical treatment because of its high cost and poor service. If this concept gives me an option for better service, I welcome it. Unfortunately, it sounds like Dr. Colton handled the transition to his new business model in a very clumsy way and alienated a lot of patients.
posted by neuroshred at 5:30 PM on June 8, 2001


Neuroshred, he was doing what we engineers refer to as "load shedding". The whole point was to drive patients away. It wasn't possible for him to accomplish his goal without driving patients away.
posted by Steven Den Beste at 5:39 PM on June 8, 2001


I wonder how much these people pay for health insurance (on top of the MDVIP fee). This doesn't deal with the lack of insurance or primary health care that seems to me to be the larger issue either. Personally, some of my worst experiences have been with MDs, while some of the best have been with physicians assistants, nurse practitioners etc. I think this emphasis on a doctor on demand is overrated. But then again, I don't seem to have had some of the experiences mentioned. Both as a poor graduate student (albeit in a university town) and as a less poor person living in a place rural enough that hmos are not an option, I have managed to be seen same day or next day whenever it was important.

This isn't the greatest source but it's not clear that patient visits have gotten shorter since managed care.
posted by noether at 6:23 PM on June 8, 2001


I think it's a good idea. I certainly think there should be a free economy in the health sector.

A free economy uses prices to ration scarce goods and services.. (like this doctor's time). The patients who cannot afford this guy, will simply go to a cheaper doctor. Seems fair.

Do hospitals in the United States charge different amounts for certain things (simple 'emergency' cases - broken leg, etc)? For example, would a hospital in Arizona charge more than one in New York City?

A system in a free economy would benefit all. After all, poorer citizens can save up for crucial operations at 'top' hospitals, but continue to use 'cheap' hospitals for their checkups.

(I'm skint, but if I needed a serious operation, I'd sure find the money to have it straight away, than be added to a 'waiting' list in a cheaper health system.)
posted by wackybrit at 6:51 PM on June 8, 2001


This is hardly surprsing. Supply, demand.
posted by faisal at 7:12 PM on June 8, 2001


Anything that gets us, as a country, closer to a return to a pay-for-service system in health care would be welcome. The divorce of health care and the payment for said care is a major contributor to the spiraling out of control of health care costs.
posted by ljromanoff at 8:08 PM on June 8, 2001


Not only do I think that this a good idea, I think the outright upfrontedness of "you pay, you get treated like a human being" is the wave of the near future, as opposed to the vague pretense that we have now of there being some humanitarian imperative to serve each other.

A glorious future of nothing but pay toilets. Wee-hee.
posted by dong_resin at 8:10 PM on June 8, 2001


Three-thousand patients for one Doctor? Sounds like he's raising the rates so he can get some sleep.
posted by skallas at 8:15 PM on June 8, 2001


A free economy uses prices to ration scarce goods and services.. (like this doctor's time). The patients who cannot afford this guy, will simply go to a cheaper doctor. Seems fair.

Except for a few things. Firstly, if you're to free up the market for physicians, then you logically also have to remove all subsidy from their training costs. And therefore, extend the notion of "you get what you pay for" to medicine degrees. So you get a hierarchy of doctors from day one, ranging from the rich kids who can pay themselves into a better clinical schools to the cheap and nasty ones who follow the "Dr Nick Riviera Learn At Home" course.

Which raises the question of standards, and liability. The notion of a hierarchy of physicians plays into the hands of lawyers who can then sue bargain-basement practitioners for their work. In turn, you'll need the equivalent of a medical Zagat's guide to judge whether your doctor deserves to be charging the amount he or she does.

Which is why I fundamentally disagree with ljromanoff: the ancillary costs that arise from introducing a strict notion of cost-value at the point of delivery undermine the (dubious) economic benefits of saying to patients: "you get what you pay for". Particularly when the specific circumstances of medical treatment -- the emotional pressure for the best treatment, combined with the fact that lives are at stake here -- create a horrifying opportunity for the exploitation of patients and families. "You want to be seen by the doctor? Well, we'll have to swipe your credit card first."

As for this specific example: it's a classic tragedy of the commons that good GPs suffer from their popularity. The local surgery used to have two doctors: one with a good reputation, the other with a less good one. Of course, people wanted to be treated by the good doctor, he worked ridiculously long hours, and eventually retired early, meaning that his patients had to switch, either to his not-well-regarded co-practitioner, or the new GP who took his place. The only solution: maintain and invest in a system whereby the better GPs can make their mark upon the next generation.
posted by holgate at 8:27 PM on June 8, 2001


Actually, 3,000 patients isn't abnormal at all. Many physicians have patient loads of up to 8,000.

I'm working with a group of physicians (6) now that are starting a new practice based on the 24/7 in home service premise. But, they wish to cater more towards the elderly and the adult disabled. Also, there is no subscription service... just straight office call rates ($70-150) and normal rates as they apply to procedures and medicine. They drive Chrysler P.T. Cruisers, have mini labs and cardio gear plus a mini pharmacy.

Also, I'd question the subscription fee... $1500 from 600 patients sounds like someone who wants to work less and not loose money... that's $900,000 a year from subscription fees without a single procedure, per physician. In Boca Raton, you can bet an office call isn't $75.00 That guy is already making $450-500,000 a month straight billing in his clinic.

Anyway, with the boomers getting older... we'll need new ideas. When I really look at it, I don't begrudge the guy making a buck on his annual fee, however I don't feel he'll be able to keep them. This idea isn't new, in fact its moving swiftly across the country. Plus among the many new physicians that can't get into practices, it offers them a new way to earn a living.
posted by Dean_Paxton at 8:31 PM on June 8, 2001


holgate:"Dr Nick Riviera Learn At Home" course

Of course you all remember that Dr. Nick actually graduated from the Hollywood Upstairs Medical College ("King Size Homer" episode - true classic - "look at that blubber fly!"). Compare Dr. Nick to Dr. Hibbert...one mostly good, one mostly "bad." But didja ever notice how Dr. Nick manages to keep his office full? Simple supply-n-demand, just the way we ought to do it. The truth is that the largest factors in sky-high healthcare costs are (1) government regulation & intervention - which inflates costs astronomically, (2) third-party payers - which shields most patients from feeling the effect of utilization, and (3) the heavy hand of "fraternal" organizations such as the AMA and their near-collusion with government to keep costs high, shield doctors' artificially-high incomes, and relegate non-traditional providers to the hinterlands. Please note that this is NOT an attack on the profession of medicine, but rather on the governmental and quasi-official organizations & structures that have crept into the regulation of the business of healthcare. The *true* cost of healthcare is nearly impossible to calculate, as you can't subtract out all of the non-direct costs, such as malpractice insurance, inflated medical school loans to pay for, layer upon layer of regulation (Medicare, JCAHO, state-specific laws, licensing & certification, etc), and so on. I salute the MDVIP folks - they are implemeting a market-based healthcare program, and they are not *forcing* it on anyone. Compare that to the Medicare "we're big, we're bad, we're gonna regulate every nook-n-cranny of your practice or you don't receive Dime One in federal dollars" attitude that nearly all providers cave in to. For more information about *simpler health care*, check this out.
posted by davidmsc at 9:19 PM on June 8, 2001


holgate
Yep, pretty much with you on this one- you're two for two (just read your hee-larious football comment in the Ravens/ Star Wars link! I find a common fallacy among supposed free-market boosters is the inability to recognize hidden costs and subsidies that we take for granted. I think just as big a hindrance is the cart-before-the-horse thinking: becoming so enamored of pure laissez-faire free-market ideology that it becomes the solution to all problems, even when it inconveniently isn't. Or to put it another way: ideally, we seek to find the system, the -ism if you will, that addresses the health care concerns of all citizens as effectively as possible, and if the market or some modified version of it is good, then we go with it. Deciding that a pure free-market is ideal ahead of time, and then considering any failures of that system (such as large numbers of people who remain shut out of basic health care services) as simply collateral damages in pursuit of an ideology is faulty. That is, I believe that certain types of services in a society are too critical to allow for the kind of gaps a purely market-driven model would create, where large segments of society simply lose out. Energy being another one that comes to mind... :)

All that said, I do think there could be something to this, as an inspiration for a smaller scale managed care:
First, scale way down the subscription model, institute some minimal per-visit charge, and this could function to serve some communities that don't have a good health care solution. What I'm envisioning is a group of 4 or 5 doctors that take say 4-5,000 families at around $300-400/yr (about $25-30/ mo.)for a family of 3 or 4, base subscription (additional fees for larger families, of course). These fees would help cover base doctor salaries and the overhead of maintaining a clinic. The doctors then charge a low but meaningful per-visit charge, around $15 for a basic visit, more for house calls (a possible consumer "feature" from this model). In addition, for prescription drugs, more advanced treatment, specialization, or ER visits, the patient's annual subscription could work as insurance, where the doctors would cover some of the costs out of pocket from the subscription fee, and the patient pays some from their own pocket. For extreme expenses, the doctors could get their own insurance to cover life-and-death or other critical expenses that would otherwise swamp them- kinda like malpractice insurance, except a good thing. :) This would hopefully encourage doctors to focus on preventative and attentive care, to keep their out-of-pockets down, while allowing lower and middle income families to get personalized health care at a relatively reasonable cost. In regards to prescription drugs the doctors might not be part owners of pharmacies like they currently are, passing the high drug costs onto patients and/or Medicare- putting the onus on doctors to prescribe needed drugs, but not unnecessarily. Lastly, I'd add in the socialized medicine part and have the guvmint give partial or full assistance to those families who can't afford even the annual fee, as well as regulate for collusion or price gouging by unscrupulous practitioners.

Other thoughts: Presumably, a community would have several of these GP teams in business, so people could swap between them to keep them competitive. If you belonged to a current GP team and seriously wanted a second opinion, you could pay a larger office-visit fee to a different GP team (to keep doctors honest, and hopefully alleviate conflict of interest between good medical advice and profit-making: if the second opinion doctor is better than your own, you can switch, which gives the second opinion doctor reason to diagnose you well).

Basically, I'm envisioning a privatized "Country Doctor" practice combined with government assistance- personalized one-on-one HMOs without the huge corporate bulk and administrative overhead.

Thoughts?
posted by hincandenza at 9:46 PM on June 8, 2001



I don't think that doctors who go to 'lesser' colleges are any worse doctors than the others.

Someone recently flew out to India from the UK to get an operation done cheaper than it'd cost in the UK (or face an 18 month 'waiting list'). It seems that Indian surgeons aren't so bad after all.

Not only that, but the British National Health Service is actually taking recruits fresh out of India and placing them straight into our hospitals. Sure, their education might not be so great, but they're good doctors.
posted by wackybrit at 10:17 PM on June 8, 2001


Hal[1], you've described an HMO. The payment practice is called Capitation, where basically the provider assumes most of the financial risk while the insurer and the insured assume almost none.

Note these two quotes from the article:
--"Not only would I earn zero, I'd have to put money into it," [the doctor] said.
--"When I want to see a doctor, I want to see a doctor," [the patient] said.

While capitation makes a lot of sense from the insurer (and in the case of national healthcare, the state) POV, it's a disaster waiting to happen for those who don't grok the ins-and-outs of actuarial tables (like healthcare providers and patients, and I, as a patient, sure as hell hope my doctor spends more time studying the functionality of the colon than the odds of my getting prostate cancer). When the patient POV is "I have the right to see a doctor when I want to see a doctor, any doctor", but the provider has to assume the cost of that those visits, no policy is ever going to work.

Free market economies aside, a healthy society/state/economy provides for basic healthcare for all. What patients, providers, insurers and policy makers all need to understand, is that someone has to pay, and it isn't gonna be "the other guy" forever.

[1] - I apologize, but I'm assuming you're going with the DFW/Infinite Jest thing with "hincandenza" ;)
posted by dchase at 11:02 PM on June 8, 2001


Even in this age of HMOs and aggressive insurance-driven managed care, money still talks. I had an experience many years ago where one of my kids was given an antibiotic that was not optimal for his condition but was substantially cheaper. Three prescriptions later, he finally prescribed the right one. I talked to him about it, because frankly I was worried that he was incompetent. But noooo. It was the insurance company who demanded that the drugs be prescribed in a certain order A-B-C-D, in order of increasing expense. After all, they were going to foot the bulk of the bill for my filling that prescription. My son was very sick, unnecessarily, for almost three weeks. The doctor knew he needed “D” from the first visit. So I took the doctor aside and we had a little chat. Now, if he thinks there is a better course of treatment for anything than the one recommended by the insurance company, we go “off-the-record.” I pay in full for my office visit, and he doesn’t submit a claim. I use a different pharmacy for those prescriptions (even though there has only been one instance since then), and I pay cash for the medicine so my doctor doesn’t get in trouble with my insurance carrier. For most office visits, we go the regular insurance-company-subsidized route. But I now ask, every time, if there is a better way. Now this is a little silly – that we have to resort to such machinations in order to be assured of getting the best care – but it’s another symptom of the screwed up system we have in place right now. Take this as my helpful hint for the day – have that little chat with your doctor.

My only thought for the guy doing the MDVIP thing is… how sad. Most doctors I know get into that profession because they want to help people get well, fix them when they’re broken. This guy sounds like he doesn’t want to work too hard, but wants to be guaranteed a very high income. Now, if his rationale for doing so was so that he could devote some significant percentage of his time to working with the enormous population of under-served poor, disabled, elderly, mentally ill, etc., then there might be merit to it. That’s probably the role that government regulation needs to play in this equation, to address the concerns raised by holgate and others. Like free speech, free markets are great within established boundaries. Insurance companies probably feel like this is already a free market – they control most aspects of the doctors’ services, and are free to do almost anything to minimize costs. Put that control in the hands of the doctors and costs skyrocket, and no one can afford insurance so people get shut out. Da gubmint’s supposed to find – and administrate – the balance of power in this equation.

Think through the consequences if this tactic becomes widespread. If you want to see a specialist, their office visits are often calendared for months already. Now reduce every doctor’s patient load by 80% (effectively cutting the supply of doctors by 80%) and permit them to discriminate based on ability to pay. So let’s see… you can have an appointment in June 2003 for $25, 6/02 for $150, in 30 days for $500, or we can see you tomorrow for $1200. And by the way, you’re not sick are you? Because we’re only accepting healthy people as clients at this time…
posted by JParker at 11:40 PM on June 8, 2001


Thank you for that.

You've successfully reinforced my gratitude for the NHS hugely.
posted by Grangousier at 12:31 AM on June 9, 2001


Bottom line: do you think doctors should bill in the same way as a plumber? There's certainly a rationale behind it: you pay more for emergency call-outs, treatment at antisocial hours, tricky jobs etc. But: do people respect plumbers on those occasions when they turn a flooded kitchen into a chance to bill a distressed resident for a couple of grand? Not particularly, though we may grudgingly acknowledge that in a free market, they have every right to do so. But do we think that the social function of medical care is different from that of plumbing, just as we expect, say, the police force not to say "can't you get someone else to take a look?" when you call them out? Well, I do.
posted by holgate at 7:32 AM on June 9, 2001


Bottom line: do you think doctors should bill in the same way as a plumber?

If they did, market forces would be restored to health care and costs would go down, so yes.

But do we think that the social function of medical care is different from that of plumbing

No, it's a service like any other. Most medical procedures are not emergencies and one who needs one could certainly shop around to find the best price. It really doesn't matter to me if Doctor A or Doctor B removes my ingrown toenail or gives me my regular eye exam - so if one of them is cheaper he'll get my business.

The idea that 'insurance' should be covering all medical costs is absurd. It's contrary to the entire nature of insurance. Imagine how much a tank of gas or an oil change would be if your auto insurance covered it. You'd make the $5 co-pay, and the auto shop would bill the insurance agency $250 for something we pay $20 for now.
posted by ljromanoff at 8:08 AM on June 9, 2001


Along those lines (ljromanoff - great post) - ever consider how utterly stupid it is to associate "healthcare insurance" with your *employer*?? Why the hell should this occur? I know that it has roots, to a large degree, in the WWII-era price controls that motivated employers to offer non-cash benefits, but this is absolute nonsense. Think about it: if buying your healthcare insurance via your employer is such a great idea, then why not your automobile insurance? What? You say that's preposterous? Exactly. Consider: everyone is free to shop around to their heart's content for auto insurance that provides the level of quality, service, and coverage that they desire. They can change it whenever they want to. They pay reasonable rates and deductibles - or at least you rarely, if ever, hear people bitch & whine to the press, or see the press write front-page articles about, about the outrageousness of sky-high car insurance premiums and deductibles and the byzantine procedures that people must follow to actually use their auto insurance. Why, then, is that not also true of healthcare insurance. I know that some people shop around for other healthcare insurance, and purchase it separately from their employer-based plans, but *in general* that is how society obtains it's healthcare insurance. Ask yourself, and others, WHY.
posted by davidmsc at 9:14 AM on June 9, 2001


you rarely, if ever, hear people bitch & whine to the press, or see the press write front-page articles about, about the outrageousness of sky-high car insurance premiums and deductibles and the byzantine procedures that people must follow to actually use their auto insurance.

Oh, I dunno... Especially when people suffer from the cost of uninsured drivers. (Even when it's a legal requirement.)

Why do people in the US have employer-based plans? Well, both the perceived benefits of collective bargaining (free market economies of scale), and because it provides a measure of certainty that they can pay the premiums, even if that entails a few months' hoping that you won't get sick before the plan at your new job kicks in.
posted by holgate at 9:55 AM on June 9, 2001


Why do people in the US have employer-based plans? Well, both the perceived benefits of collective bargaining (free market economies of scale), and because it provides a measure of certainty that they can pay the premiums, even if that entails a few months' hoping that you won't get sick before the plan at your new job kicks in.

Sorry, holgate, but you're completely wrong. The reason health insurance is so closely tied to employment is federal government meddling in the market during WWII. During WWII, wage and price controls were installed to insure 'stability' but the effect was that employers had to find some way to make their jobs more lucrative than other companies when hiring. Since they couldn't offer more money, they offered 'benefits'. Because the true cost of the insurance was hidden (i.e., a job benefit) and subsequently the true cost of medical care was hidden (due to medical insurance covering the cost), the actual cost-benefit analysis one employs when purchasing services was warped, and this allowed for skyrocketing costs. Furthermore, because the insurance companies were suddenly expect to pay for everything, not just true medical emergencies, individual insurance purchasers were priced out of the market for the most part.

The close relationship between health insurance and employment had nothing to do with a free-market economy of scale choice, but instead resulted from the government attempting to control the economy without (as usual) considering all the dynamic factors involved in the marketplace.

Fortunately, one can still by actual catastrophic health care insurance if one wants, but it is a lot more expensive than it needs to be due to the fact that many fewer people purchase i than would have had we not had several generations of people thinking that health insurance is just something you get with your job.
posted by ljromanoff at 2:37 PM on June 9, 2001


ljromanoff: thanks for the accurate elaboration on the point I was attempting to make. well said.
posted by davidmsc at 9:03 PM on June 9, 2001


ljromanoff: thanks for the accurate elaboration on the point I was attempting to make. well said.

My pleasure. I find this whole health care situation a fascinating and frightening example of unintended consequences of government action.
posted by ljromanoff at 9:11 PM on June 9, 2001


I stand corrected, but note with a certain amount of pride that in precisely the same period, the NHS was created: more or less because there was no functional economy in the post-war period. Same across Europe, and I still think we got the better deal.
posted by holgate at 9:47 PM on June 9, 2001


I had an operation for a cyst. The big bloated hospital overcharged me(post-op recovery was 289$ for 15 minutes) the ana..aneth...the guy who drugged me up overcharged me 110%. Plus a few more 'hidden costs'. I was in-between insurance companies (did not have any). The problem to me is billing. The insurance company usually just pays it, but i had cash. In 20 minutes i saved 1100$. How many times are we overcharged for medical attention. In 1942, my father drove a axe into his leg. The only help was a veterinarian who wanted to take the leg. The women who raised him helped him for 3 months to walk again. My mother got scarlet fever in rural michigan, again the only one around was a Vet who did help her. Medicine has come along ways, regressed in some.
posted by clavdivs at 7:51 AM on June 10, 2001


Medicine has come along ways, regressed in some.

The rate of change across the board in medicine has lagged behind the actual science, and varied massively depending upon the ability of patients to pay. And often, the type of care you receive has little to do with its health benefits, both at the top tier and the bottom: I remember reading of the practices of 18th century doctors in Bath, who offered the equivalent of a celebrity rehab clinic. In this respect, it's possible to argue that medicine is hardly a science at all.

Here's a summary of the 1942 Beveridge Report on "social insurance": the foundation of the welfare state, presented at the time when it was truly needed.
posted by holgate at 9:10 AM on June 10, 2001


Of course, the rationale for paid medical health care is exactly what happens when its not really paid for. Look at the UK.

You can have an axe in your head, yet still have to sit on a trolley in a corridor of a hospital for several hours before a doctor will even see you. Infact, many people have died while waiting.. bit of a national scandal.

In comparison, capitalism makes it a little fairer. Those with 'about to die' injuries would happy hand over their cash so that their lives can be saved. Likewise, those who are impatient, but don't really have any urgent injuries, might come back later and get it sorted out far more cheaply.

If I *desperately* had to see a doctor in ER then I'd sure as heck wanna pay for it to get instant service. However, with the current UK system, I'd probably have to sit around for 6 hours rotting away (all in the interests of 'being fair').
posted by wackybrit at 2:49 PM on June 10, 2001


If I *desperately* had to see a doctor in ER then I'd sure as heck wanna pay for it to get instant service.. However, with the current UK system, I'd probably have to sit around for 6 hours rotting away (all in the
interests of 'being fair').


Know of any private medical providers in the UK that care to handle A&E, wackybrit? There aren't any: it's simply not profitable. (Think about the ancillary costs again: BUPA is quite happy not having to run its own 999 ambulance service.) In fact, if elective surgery in private hospitals goes wrong, the patients will often be shipped to the nearest NHS casualty unit and have to wait their turn -- or rather, be assessed in triage -- like everyone else.
posted by holgate at 3:25 PM on June 10, 2001


In fact, this report (warning: long loading time, oh irony of ironies) suggests just that:

quote:

Hospital Doctor, 20 Aug 98, Dr. E. Walker, A&E doctor, Dewsbury Hospital, W. Yorks., in a piece entitled 'Dangers of Care outside the NHS':- 'There is a private hospital near to where I grew up. Some years ago, when it was staffed by Irish nuns but was taking in seriously and acutely ill patients, a friend did some nursing shifts there. She asked what the cardiac arrest procedure was. With a quizzical expression, the matron removed her chained half-moon spectacles and rested them on her matronly bosom. 'Sure and we just dial 999, dear.' And they did. Anyone who arrested there was taken to the nearest NHS hospital.

: unquote
posted by holgate at 3:32 PM on June 10, 2001


And not wanting to hog the discussion, but this is a choice quotation from that report:

If you were to stagger into any private hospital spilling blood on their carpeted atrium, the receptionist would summon security first and then call you an ambulance.
posted by holgate at 3:40 PM on June 10, 2001


Know of any private medical providers in the UK that care to handle A&E, wackybrit? There aren't any: it's simply not profitable. (Think about the ancillary costs again: BUPA is quite happy not having to run its own 999 ambulance service.) In fact, if elective surgery in private hospitals goes wrong, the patients will often be shipped to the nearest NHS casualty unit and have to wait their turn -- or rather, be assessed in triage -- like everyone else.

I'm not going to pretend to know much about the health care system in Britain (as I am not a UK resident), but dismissing free market health care as unworkable due to the problems with private hospitals is ignoring that the NHS has a huge artificial advantage in that they are supported with taxes. Consequently, private hospitals can not operate in a way that would provide them with sufficient income and provide the public with other services that they would otherwise not make money from - i.e., loss leaders such as emergency care.
posted by ljromanoff at 3:50 PM on June 10, 2001


Except the private sector actually has a huge artificial advantage in that it can rely upon the NHS to take its botch-jobs and emergency cases, and (currently) not have to pay the bill for treatment, nor the cost of any negligence claim that might arise from their own incompetence. 142,000 patients were sent from private hospitals to NHS A&E departments last year, whereas NHS hospitals, with capped budgets and though Blair's corporate "concordat", are now paying to rent bed space in private hospitals rather than make capital investment in their own facilities.

So unless you remove any kind of publically-funded safety net -- or until you give the public facilities the capacity to reclaim costs from private facilities, whether through legislation, insurance or litigation -- private hospitals will always have the chance to call 999 if they can't cope, and finance their facilities accordingly. And that's neither fair nor economically equitable.

Yes, a free market ab ovo might be economically and medically sound; but you can't get there from here.
posted by holgate at 4:32 PM on June 10, 2001


Know of any private medical providers in the UK that care to handle A&E, wackybrit? There aren't any: it's simply not profitable.

It's not as if I disagree with your views. Yes, the private service in this country is poor too. BUPA is certainly not the NHS.

However, I was expressing my view that there should be a private system which can be used, if need be. There are many people in waiting lists with the NHS who have flown to the US or India to get essential operations done.. they probably would have died on the waiting list!

If I broke my leg and wanted it plastered up, I'd rather pay 40 quid an hour on the door to get it sorted by a nurse, than sit around for 5 hours waiting for someone (primarily because I hate waiting and sitting around with people sneezing constantly). And I'm pretty skint!

As to the way a good system could be implemented.. I don't know. We elect people to work out those things. However, the only party with a commitment to private health (Conservatives) didn't get in (I didn't vote for them either though).. this country is too socialist, for the moment.
posted by wackybrit at 4:43 PM on June 10, 2001


Except the private sector actually has a huge artificial advantage in that it can rely upon the NHS to take its botch-jobs

I'm sure the private hospitals would give that up in exchange for the opportunity to have a market where one organization isn't subsidized and gives away service (however shoddy it is) de facto free (certainly not truly free since one must pay for NHS service whether one uses it or not via taxation.)
posted by ljromanoff at 5:09 PM on June 10, 2001


That depends, and I think it's because you're juggling two currencies, as it were, one of which is time. People will pay for that private hip operation, or varicose vein surgery, or to get their cataracts done, because the cost to them in time lost, rescheduled operations etc. outstrips the expense of the procedure. I have no problem with that. The freer the market for elective surgery, the better. Make it tax-deductible. (BUPA already is, I think, being a non-profit organisation.) Similarly, Harley Street thrives on the custom of those who don't want to mingle with the masses at an NHS surgery, just like the people who'll stump up the subs for the doctor mentioned in the story. Fine and dandy.

At the thin end of the wedge, though, the currency is life, and to be quite honest, the free market doesn't function so well in those cases. I recall the report into the Paddington rail crash, where an actuarial decision led to a less robust early warning system being chosen, because the company had factored in a certain number of "acceptable" deaths to their investment.

That's why I don't see emergency treatment -- or even chronic treatment -- as the "giving away" of service; I actually regard it as a social obligation, partly because the people I know who work in those wards see it that way. And there is really no great entrepreneurial "spirit of competition" when it comes to patching up accident victims.

So, will we end up with a public hospital service that is entirely built around last-resort emergency treatment, with a tiered private system creaming off the less gory work? Very possibly: it makes economic sense. But the manner in which it will have to come about... well, it'll be like a slow and nasty death.
posted by holgate at 9:03 PM on June 10, 2001


I think the fundamental problem in the UK is that people demand better services, but aren't prepared to pay for them through taxation. I understand that France spends about 9% of it's GDP on healthcare. In the UK it's about 5%. Are we prepared to see an extra 3p in the pound, if it's ring-fenced for the NHS? Who in their right mind would train to be a nurse, given the hours and pay? It's no wonder we're having to import such staff from India and Spain (which, bizarrely, has a nursing surplus at the moment).

Having said all that, I find the idea of having to pay for private healthcare repugnant. Taxation is based on an ability to pay; medical insurance is not. (And let's not talk about those who can't get or afford insurance.) Healthcare should be for everyone - not just the comfortably well off. The NHS, for all it's faults, does a reasonable job of looking after the people of the UK. Lets not knock it.
posted by salmacis at 3:28 AM on June 11, 2001


"Are we prepared to see an extra 3p in the pound?"
No-one's ever asked me.
I know I am, I know everyone I've ever asked is.
posted by fullerine at 4:11 AM on June 11, 2001


Having said all that, I find the idea of having to pay for private healthcare repugnant. Taxation is based on an ability to pay; medical insurance is not. (And let's not talk about those who can't get or afford insurance.) Healthcare should be for everyone - not just the comfortably well off.

Why do you find the idea of having to pay for health care repugnant? Do you find the idea of having to pay for food repugnant? How about shelter? Clothing? Health care is a service like any other. If one needs the service performed, one should pay for it.
posted by ljromanoff at 5:57 AM on June 11, 2001


The solution to the problems of nationalized healthcare is simple. Tip jars.
posted by kindall at 8:09 AM on June 11, 2001


The NHS, for all it's faults, does a reasonable job of looking after the people of the UK.

When I was last visiting in the UK, there was a story in the press about a young man, rather obese, who had visited an NHS doctor because of severe chest pains. He been having the pains for some time, and they'd been escalating in duration and severity. The morning of his visit, the pains were severe enough to knock him down on his behind and he reported blacking out for a few moments. His father and grandfather before him had both died in their forties of heart disease.

Instead of immediately beginning diagnostic work to determine the severity of this man's heart disease (every factor pointed to him having a major compromise to his heart capacity) he was sent home. A week later, he was found dead in his vestibule. Lying next to him was a letter from the NHS advising him to come in for a cardiac catheterisation some two weeks after that.

The autopsy showed that he had two coronary vessels with more than 90% occlusion. This guy's situation was very grave, and had been for some time. But because he wasn't wheeled into an emergency room with his heart already stopped, he was shunted into the standard NHS system, which, in effect, killed him. He was supposed to wait three weeks for a basic cardiac workup, and the NHS sent him home to die.

Somehow, that doesn't sound reasonable to me at all.
posted by Dreama at 9:23 AM on June 11, 2001


No it isn't, but I'm sure it wouldn't be hard to find an example of someone who died in the USA because the medical system failed him. (No insurance, doctor scared of getting sued etc.) Simply dredging up isolated examples of where the NHS failed doesn't alter the fact that the vast majority of the UK population know that in an emergency, the NHS is there for them.

As to why I find the US system repugnant, I think basic healthcare is a right, not a luxury.
posted by salmacis at 7:07 AM on June 12, 2001


As to why I find the US system repugnant, I think basic healthcare is a right, not a luxury.

Well, that sounds very lovely - but the idea that health care is a right is in fact an argument that health care workers should be comdemned to slavery. Why? Because if health care is a right, not providing me with health care is a denial of my rights regardless of whether or not I provide any sort of payment or compensation to the health care worker. I can demand his labor at any time I wish, without providing him with anything back, because I HAVE A RIGHT to his time and trouble.

I find that repugnant.
posted by ljromanoff at 8:00 AM on June 12, 2001


No it isn't, but I'm sure it wouldn't be hard to find an example of someone who died in the USA because the medical system failed him.

You'd be very hard pressed to find a doctor in the U.S. who would send a patient home to wait three weeks for basic diagnostic work when he presented with very clear signs and a family history of severe cardiac compromise. Even the uninsured don't get sent home when there's a strong likelyhood of heart failure in their near future if they're left without intervention. If there were ever something that shouldn't be treated like its routine, it's cardiac care.

The sad part is that the guy in the UK was supposedly "insured" by the NHS -- and being put off until it was "his turn" was the standard of care offered by the NHS. This is the "right" that you have under the UK system -- to have a life-threatening condition "treated" via a wait list.

Given that, I'll gladly take the "luxury" of having to pay out of pocket health care for my family. At least I know full well that I'm not going to be sent home to die while I wait for a letter that authorises basic care at some time in the future when my number pops up on the roster, as if I'm waiting at the deli counter.
posted by Dreama at 8:30 AM on June 12, 2001


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