Americans Want More Health Care Investment by Government

[David S]

We know some people who illustrate some of the problems with government funded health care. Names have been changed to protect the innocent (or maybe its the guilty.)  Lets start with Joe. He's in his early twentys and until a couple of years ago he lived in an apartment with his mother, his sister and  a live-in girlfriend. The sister who was not married became pregnant and had a baby. Medicaid picked up the bills. I don't know what the cost was but lets use Angus' figure of $16,000.

After the birth the sister moved out and Joe brought in live-in girlfriend #2. Yes he had two girlfriends living with him and his mother at the same time. Girlfriend #2 became pregnant and had a baby also on Medicaid's dime. Then she moved out.

Joe and girlfriend #1 moved into a house trailer he inherited. Joe's brother then showed up needing a place to stay. Joe's brother has been in prison in at least one state and possibly two. He  brought his girlfriend who was, ...you guessed it... pregnant. Now who do you think paid for that pregnancy? If you said Medicaid you're starting to get the idea. BTW Joe's brother's girlfriend gets food stamps. And of the four people living in the trailer Joe is the only one who works.

Now on one hand no one wants to see a pregnant woman without medical care, but on the other hand its unfair as hell to make the taxpayers pay for so much irresponsible behavior. This kind of thing really creates some resentment among middle class people who pay the taxes for Medicaid and at the same time see their own health insurance bills becomming unaffordable.

[dazzleman]

One thing that we don't talk about much is that the term 'insurance' is really a misnomer for medical coverage.

The term 'insurance' implies that there is a pretty low likelihood that it will ever be used to a major degree.  I own a home and have fire insurance, but the theory there is that a lot of people pay a small amount of money to protect them against something that is highly unlikely.

In the case of health 'insurance,' it is not insurance at all, really.  It's a plan by which we pay a steady (if ever increasing) amount of money on an ongoing basis, rather than paying when we need the service.

I suspect some combination of medical savings accounts for routine issues and catastrophic insurance for major issues might be better than the system we have now.

The catastrophic insurance would be a lot closer to the true insurance concept -- there is a low likelihood that it will be needed at any given time, though like life insurance, it will probably be needed eventually.

And with medical savings accounts, the consumer will be directly in touch with what he/she is actually paying for medical care, making the market more efficient.

There will never be the necessary legal reform until enough people wake up and realize how badly we are all being raped by these lawyers and frivolous lawsuits, and demand legal reform.  That has a better chance of happening if people see the effect directly, and can't just blame 'greedy' insurance companies.

[Nym90]

angus, you're very right to point out the legal angle to this problem.

Our ailing and dysfunctional legal system is being used as a means of legalized extortion to milk the health care system of huge amounts of money that go into the pockets of ambulance-chasing lawyers.

A health care system with the government as the sole payer will not change this.  Taxpayers will simply assume billions of dollars of illegitimate legal liabilities directly, rather than indirectly as is currently the case.

Until the legal system is fixed, there is no point in putting through any type of real reform, because the current legal system is a dealbreaker as far as the success of any reform is concerned.

I agree that the lawyers are a big part of the problem. Not nearly as much as the HMOs though.

Medical malpractice reform is a double edged sword. How do we cut out the frivolous lawsuits, while keeping the many legitimate ones? For example, my father is currently involved in a case in which misdiagnosis and mistreatment (actually, no treatment at all) cost him the use of both of his legs. What is that worth to a person? If someone were willing to pay you 10 million dollars but the condition was that you'd be paralyzed from the middle of the chest down for the rest of your life, would you take the deal? If the answer is no, then it can't really be argued that it's an exorbinantly high amount of money.

In our case, there weren't any ambulance chasing lawyers coming to my father, he went to them. Obviously there are always leeches who are looking to make a quick buck, but lawyers are part of the adversarial part of the legal system. They make the case, and juries decide the ultimate outcome. It seems as though the juries should be blamed just as much as anyone else, if not more, if malpractice awards are too high.

[dazzleman]

I do blame the juries.  But the system seems to pre-ordain that bad juries will be chosen.  And that the same case heard in different jurisdictions will yield completely different results.

Your dad's story is a very sad one, and not the only one I am sure.  Still, the legal system has to find a better way, other than relying on pools of people in which anyone who shows any sign of brain wave activity is automatically eliminated, in order to separate the legitimate from the illegitimate cases.

In the meantime, more government 'investment' in health care (whatever that means) can only serve to further enrich people who are illegitimately manipulating the legal system to the detriment of the rest of us.

[Nym90]

I do blame the juries.  But the system seems to pre-ordain that bad juries will be chosen.  And that the same case heard in different jurisdictions will yield completely different results.

Your dad's story is a very sad one, and not the only one I am sure.  Still, the legal system has to find a better way, other than relying on pools of people in which anyone who shows any sign of brain wave activity is automatically eliminated, in order to separate the legitimate from the illegitimate cases.

Agreed. There is no simple solution. My point was simply that blaming only lawyers is simplistic at best and deceptive at worst.

The reality is that anyone with a highly marketable and rare skill is going to charge an arm and a leg for their services, whether it be a doctor, a lawyer, or a professional athlete, or any other profession. Someone always has to pay the bill, and whether it's through the private sector or the public sector, it still all comes back to the consumer in the end.

[angus]

I suspect some combination of medical savings accounts for routine issues and catastrophic insurance for major issues might be better than the system we have now.

oh, we do that as well.  I do a tax-sheltered hundred per month for '05 and 06, but will probably nix that in '07, since the boy will be in his third year and will not need quarterly visits, vaccinations, etc. 

good point about the use of the word insurance.  although technically we do have some mention of incurable cancer, HIV, leukemia and the like in my policy.  I figure if I'm ever diagnosed with AIDS I'm fukked anyway, and no amount of money will make it go away.  So far so good.  Been with the same chick for over six years and I'm not getting thin and sneezing all of the sudden.  I did have a friend who died slowly over many month from AIDS, though, and it's not something I'd wish on anyone.  In his case his family was fairly well off (though technically the were "poor" by the forum standard since even though the family income was in the several hundred thousand per year range, the parents worked for a living) and they had excellent coverage.  No amount of coverage would help this guy.  Hell of a way to go too, man.  He was great fun to be with.  Slept around with nasty chicks though, and shared IV needles with his druggie buddies.  Not smart.  It was sad watching the life drain slowly from him.  I also knew a guy who was HIV positive and gay and gave HIV to his partner, a close personal friend of mine.  But last I heard none of them had AIDS.  Man, I don't think any amount of insurance makes you feel any better about yourself when you know that you're immunodeficient.  Maybe they can freeze you, like on Futurama, till a cure is discovered.  That seems a little futile as well.  You know how meat and vegetables that have been frozen just aren't as fresh or tasty.  I think it just wouldn't be the same.

Anyway, I don't think fighting this fire with more fire is the solution to the soaring costs.  Sometimes, it's actually best to fight the fire with water.

[dazzleman]

I do blame the juries.  But the system seems to pre-ordain that bad juries will be chosen.  And that the same case heard in different jurisdictions will yield completely different results.

Your dad's story is a very sad one, and not the only one I am sure.  Still, the legal system has to find a better way, other than relying on pools of people in which anyone who shows any sign of brain wave activity is automatically eliminated, in order to separate the legitimate from the illegitimate cases.

Agreed. There is no simple solution. My point was simply that blaming only lawyers is simplistic at best and deceptive at worst.

The reality is that anyone with a highly marketable and rare skill is going to charge an arm and a leg for their services, whether it be a doctor, a lawyer, or a professional athlete, or any other profession. Someone always has to pay the bill, and whether it's through the private sector or the public sector, it still all comes back to the consumer in the end.

It's not right to blame only lawyers.  That is true.

But it's also true that lawyers have a lot to do with what is wrong with the legal system.

Still, lawyers are like out of control children.  While they are bad and responsible for their own behavior, it is still a failure of the parents who allow that behavior to continue.  We have to find some type of mechanism to get rid of the frivolous lawsuits to the greatest extent possible, other than taking up years of time in the system to put them in front of brain-damaged juries who are incapable of comprehending the decisions they are making.

[Nym90]

I do blame the juries.  But the system seems to pre-ordain that bad juries will be chosen.  And that the same case heard in different jurisdictions will yield completely different results.

Your dad's story is a very sad one, and not the only one I am sure.  Still, the legal system has to find a better way, other than relying on pools of people in which anyone who shows any sign of brain wave activity is automatically eliminated, in order to separate the legitimate from the illegitimate cases.

Agreed. There is no simple solution. My point was simply that blaming only lawyers is simplistic at best and deceptive at worst.

The reality is that anyone with a highly marketable and rare skill is going to charge an arm and a leg for their services, whether it be a doctor, a lawyer, or a professional athlete, or any other profession. Someone always has to pay the bill, and whether it's through the private sector or the public sector, it still all comes back to the consumer in the end.

It's not right to blame only lawyers.  That is true.

But it's also true that lawyers have a lot to do with what is wrong with the legal system.

Still, lawyers are like out of control children.  While they are bad and responsible for their own behavior, it is still a failure of the parents who allow that behavior to continue.  We have to find some type of mechanism to get rid of the frivolous lawsuits to the greatest extent possible, other than taking up years of time in the system to put them in front of brain-damaged juries who are incapable of comprehending the decisions they are making.

Agreed. Maybe something akin to the grand jury system for criminal cases? I don't know if that would work effectively but some sort of a preliminary screening process would be helpful.

I know that in my dad's case, the suit is going to be reviewed by a panel of 3 attorneys (I don't really know anything about their backgrounds or how they are chosen) and they recommend a settlement amount. If one of the parties agrees to the amount but the other doesn't, and the case goes to trial and the one who didn't accept the recommended amount doesn't get at least a 10 percent improvement upon the recommended amount, they have to pay the legal fees of the other side.

In addition, the lawyer in his case is paid strictly on a commission basis. He gets a third of the total final amount. That would seem to be a deterrent to the most frivilous cases, as a case that is lost ends up earning the lawyer nothing. In addition, I know that the insurance company has to be reimbursed for any and all expenses they have paid so far out of the final settlement amount. So that ends up reducing the amount that the person actually gets from what otherwise might be a more impressive total.

[dazzleman]

The big problem with the legal system is that even an innocent person has to spend huge sums of money to defend himself.

This acts as an incentive for unscrupulous lawyers to go after soft targets like insurance companies who have deep pockets.

Many companies will settle even when they know they're right because (a) it would cost more to mount a good defense, and (b) with the way juries are selected, there is no guarantee that a reasonable determination will be reached.

The effect of all this is subtle, and goes beyond the medical realm.  So many business decisions that are often not the best thing overall are made based upon the assumption that the legal system cannot be trusted to reach reasonable conclusions, and that involvement with it must be avoided at all costs.

I like your grand jury idea for civil cases.

[TheresNoMoney]

The right loves to demonize lawyers, but the reality is that lawsuits/legal costs account for less than 1% of health insurance costs.

[opebo]

We know some people who illustrate some of the problems with government funded health care. Names have been changed to protect the innocent (or maybe its the guilty.)  Lets start with Joe. He's in his early twentys and until a couple of years ago he lived in an apartment with his mother, his sister and  a live-in girlfriend. The sister who was not married became pregnant and had a baby. Medicaid picked up the bills. I don't know what the cost was but lets use Angus' figure of $16,000.

After the birth the sister moved out and Joe brought in live-in girlfriend #2. Yes he had two girlfriends living with him and his mother at the same time. Girlfriend #2 became pregnant and had a baby also on Medicaid's dime. Then she moved out.

Joe and girlfriend #1 moved into a house trailer he inherited. Joe's brother then showed up needing a place to stay. Joe's brother has been in prison in at least one state and possibly two. He  brought his girlfriend who was, ...you guessed it... pregnant. Now who do you think paid for that pregnancy? If you said Medicaid you're starting to get the idea. BTW Joe's brother's girlfriend gets food stamps. And of the four people living in the trailer Joe is the only one who works.

Now on one hand no one wants to see a pregnant woman without medical care, but on the other hand its unfair as hell to make the taxpayers pay for so much irresponsible behavior. This kind of thing really creates some resentment among middle class people who pay the taxes for Medicaid and at the same time see their own health insurance bills becomming unaffordable.

The behaviour you mentioned above was not 'irresponsible', David S, it was caused by the position of the participants in the social heirarchy.  They are powerless poors, and therefore are oppressed, lack resources and options, and therefore live in the fashion described.  The 'blame', as always, lies with the powerful who made it happen that way, not the powerless who were mere victims.

[dazzleman]

The right loves to demonize lawyers, but the reality is that lawsuits/legal costs account for less than 1% of health insurance costs.

Do you have a source for that Scoonie?

[John Dibble]

The behaviour you mentioned above was not 'irresponsible', David S, it was caused by the position of the participants in the social heirarchy.  They are powerless poors, and therefore are oppressed, lack resources and options, and therefore live in the fashion described.  The 'blame', as always, lies with the powerful who made it happen that way, not the powerless who were mere victims.

Yes, the poor have absolutely no control over their own behavior. They're incapable of making personal choices. If one is poor, one can't control whether or not one only has one girlfriend or not, or whether one commits a crime.

Reality is that poor people are just as capable of making good decisions as everyone else. Maybe you need to consider the reason that many people like the ones David described are poor because they make bad decisions, not the other way around.

[dazzleman]

The behaviour you mentioned above was not 'irresponsible', David S, it was caused by the position of the participants in the social heirarchy.  They are powerless poors, and therefore are oppressed, lack resources and options, and therefore live in the fashion described.  The 'blame', as always, lies with the powerful who made it happen that way, not the powerless who were mere victims.

Yes, the poor have absolutely no control over their own behavior. They're incapable of making personal choices. If one is poor, one can't control whether or not one only has one girlfriend or not, or whether one commits a crime.

Reality is that poor people are just as capable of making good decisions as everyone else. Maybe you need to consider the reason that many people like the ones David described are poor because they make bad decisions, not the other way around.

I agree with you completely Dibble.  But why waste your time talking common sense to that guy?

[angus]

The right loves to demonize lawyers, but the reality is that lawsuits/legal costs account for less than 1% of health insurance costs.

Do you have a source for that Scoonie?

I do not, but according to a report given to me by an obstetrician recently, during the period from 1995 to 2004 the severity, or size, of medical malpractice claims remains on the rise.  They were growing at a trend rate of 7.5 percent annually.  And show no signs of slowing.  This also means that the profitability for insurance companies on medical malpractice policies was getting pretty weak.  I don't have it in front of me, but something like:  for every dollar of premium they collected near the end of that period, they were paying out 1.09 dollars in claims.  And this report was just an AMA sponsored malpractice study, and didn't even take into account the money paid by groups to lobbyists to get laws passed in the first place.  So I have a very hard time believing that it's one percent.  My guess would be that  mandated health benefits and excessive health services regulation at the state and federal levels account for maybe twenty to thirty percent, depending on how you count it.  but that's just a guess.  And it doesn't include peripherals.  You could probably count it in a way that it's more than fifty percent.  Whatever the figure is, the legal expenses contribute to the level of Americans who cannot afford to purchase private health insurance.  So it's easy to see why so many want a Nationalized system.  My only point here is that further government might not be the best way to go.  We always talkabout more government involvement, but no one talks about less.  That's a fresh idea that ought to be further examined before deciding it's a bad one.

[John Dibble]

I agree with you completely Dibble.  But why waste your time talking common sense to that guy?

There's this little voice in my head, my conscience perhaps, that tells me that I have this duty to speak up against idiocy. Even if the idiots don't listen, which they rarely do since they're idiots, it might make people less prone to listening to them.

[Beet]

We always talkabout more government involvement, but no one talks about less.  That's a fresh idea that ought to be further examined before deciding it's a bad one.

People have been talking about 'less' government for a long time, in this context and others. The only problem is that once you actually vote the bastards in, they tend to have a hard time implementing it...

[dazzleman]

The right loves to demonize lawyers, but the reality is that lawsuits/legal costs account for less than 1% of health insurance costs.

Do you have a source for that Scoonie?

I do not, but according to a report given to me by an obstetrician recently, during the period from 1995 to 2004 the severity, or size, of medical malpractice claims remains on the rise.  They were growing at a trend rate of 7.5 percent annually.  And show no signs of slowing.  This also means that the profitability for insurance companies on medical malpractice policies was getting pretty weak.  I don't have it in front of me, but something like:  for every dollar of premium they collected near the end of that period, they were paying out 1.09 dollars in claims.  And this report was just an AMA sponsored malpractice study, and didn't even take into account the money paid by groups to lobbyists to get laws passed in the first place.  So I have a very hard time believing that it's one percent.  My guess would be that  mandated health benefits and excessive health services regulation at the state and federal levels account for maybe twenty to thirty percent, depending on how you count it.  but that's just a guess.  And it doesn't include peripherals.  You could probably count it in a way that it's more than fifty percent.  Whatever the figure is, the legal expenses contribute to the level of Americans who cannot afford to purchase private health insurance.  So it's easy to see why so many want a Nationalized system.  My only point here is that further government might not be the best way to go.  We always talkabout more government involvement, but no one talks about less.  That's a fresh idea that ought to be further examined before deciding it's a bad one.

A nationalized system, without legal reform, is not going to lower costs, and we'll choke on the taxes to pay for it.

I'll go on record as saying I flat out don't believe the 1% number, in any way, shape or form.  It can only be a gross distortion.  Many untrue 'facts' are put out there by interest groups, and this sounds like one of them.

Under the current political and legal constraints, I would expect a nationalized system to work as well as, say, inner city school systems, in many areas.  The same effect of dragging the middle class down to the level of the poor, or alternatively, forcing them to pay twice for the same service, would take over.

[Nym90]

I would think, in assessing the effects of a universal system, one would have to study how well it has (or hasn't, as the case may be) worked in other countries that have it. The United States is one of the few first world countries to not have some system of unviersal coverage. What have the effects been in places like Canada or the UK? What are some of the key differences in those countries that might make a universal coverage system work better or worse there than it does here?

[dazzleman]

I would think, in assessing the effects of a universal system, one would have to study how well it has (or hasn't, as the case may be) worked in other countries that have it. The United States is one of the few first world countries to not have some system of unviersal coverage. What have the effects been in places like Canada or the UK? What are some of the key differences in those countries that might make a universal coverage system work better or worse there than it does here?

Well, we know that people in Canada who really need serious medical care and can afford to pay for it come to the US for it.  That should tell you something.

And the Canadians, for various reasons [smaller population, less diversity], have generally gotten BETTER results from government programs than we have.

[David S]

We know some people who illustrate some of the problems with government funded health care. Names have been changed to protect the innocent (or maybe its the guilty.)  Lets start with Joe. He's in his early twentys and until a couple of years ago he lived in an apartment with his mother, his sister and  a live-in girlfriend. The sister who was not married became pregnant and had a baby. Medicaid picked up the bills. I don't know what the cost was but lets use Angus' figure of $16,000.

After the birth the sister moved out and Joe brought in live-in girlfriend #2. Yes he had two girlfriends living with him and his mother at the same time. Girlfriend #2 became pregnant and had a baby also on Medicaid's dime. Then she moved out.

Joe and girlfriend #1 moved into a house trailer he inherited. Joe's brother then showed up needing a place to stay. Joe's brother has been in prison in at least one state and possibly two. He  brought his girlfriend who was, ...you guessed it... pregnant. Now who do you think paid for that pregnancy? If you said Medicaid you're starting to get the idea. BTW Joe's brother's girlfriend gets food stamps. And of the four people living in the trailer Joe is the only one who works.

Now on one hand no one wants to see a pregnant woman without medical care, but on the other hand its unfair as hell to make the taxpayers pay for so much irresponsible behavior. This kind of thing really creates some resentment among middle class people who pay the taxes for Medicaid and at the same time see their own health insurance bills becomming unaffordable.

The behaviour you mentioned above was not 'irresponsible', David S, it was caused by the position of the participants in the social heirarchy.  They are powerless poors, and therefore are oppressed, lack resources and options, and therefore live in the fashion described.  The 'blame', as always, lies with the powerful who made it happen that way, not the powerless who were mere victims.

Their behaviour is absolutely irresponsible and is not the result of any action by anyone else.

Your comments illustrate once again your "Poors" vs the "owning class" mentality. It is essentially communist ideology. I suspect that you envision yourself being among the ruling elite in your communist society. But you are forgetting the 8th plank of the communist manifesto "Equal obligation of all to work." Given that, and your work ethic, I think the more likely place for you to end up would be at the end of a rope. 

[Filuwaúrdjan]

The United States is one of the few first world countries to not have some system of unviersal coverage. What have the effects been in places like Canada or the UK?

I can't speak for the Canadian system, but the NHS has become something of a national institution since it was founded in 1948. To say that healthcare for the overwhelming majority of the population has got better since the founding of the NHS is something of an understatement. The main problem with the NHS these days (now that it's become a lot more decentralised) is the habit of some NHS Trusts to overspend, rather than anything serious, or even close to being serious.
The quality of healthcare is good, especially from the point of view of working class people, and what private hospitals there are, are on the whole no better (even though the people that use them like to imagine that they are). Private practice was kept legal as a way of stopping a doctors strike when the NHS was founded (it was basically a bribe, and Nye Bevan had no problem admitting it and said that he "stuffed their mouths with gold") and these days is used by the NHS as a sort of dumping ground for minor/vanity operations.
Interestingly the average taxpayer in the U.K pays less into Government healthcare stuff than the average American taxpayer and the NHS takes up a suprisingly small size of the budget.

Will post more if anyone wants.

[Nym90]

I would think, in assessing the effects of a universal system, one would have to study how well it has (or hasn't, as the case may be) worked in other countries that have it. The United States is one of the few first world countries to not have some system of unviersal coverage. What have the effects been in places like Canada or the UK? What are some of the key differences in those countries that might make a universal coverage system work better or worse there than it does here?

Well, we know that people in Canada who really need serious medical care and can afford to pay for it come to the US for it.  That should tell you something.

And the Canadians, for various reasons [smaller population, less diversity], have generally gotten BETTER results from government programs than we have.

I agree that the US has the best health care in the world for those who can afford it.

Americans frequently go to Canada to buy prescription drugs due to their cheaper cost. Both systems have their pros and cons.

[dazzleman]

I would think, in assessing the effects of a universal system, one would have to study how well it has (or hasn't, as the case may be) worked in other countries that have it. The United States is one of the few first world countries to not have some system of unviersal coverage. What have the effects been in places like Canada or the UK? What are some of the key differences in those countries that might make a universal coverage system work better or worse there than it does here?

Well, we know that people in Canada who really need serious medical care and can afford to pay for it come to the US for it.  That should tell you something.

And the Canadians, for various reasons [smaller population, less diversity], have generally gotten BETTER results from government programs than we have.

I agree that the US has the best health care in the world for those who can afford it.

Americans frequently go to Canada to buy prescription drugs due to their cheaper cost. Both systems have their pros and cons.

True.

My big fear with respect to federal control of the health care system is that they will do to it what they did to urban education when they effectively took control of that in the 1970s.

With respect to urban education, the feds effectively said, "We have to make everybody equal, and since there are certain people we can't pull up, we will pull everybody else down."

What they did was bad, and they did it in an illegitimate and undemocratic fashion.

The highly localized nature of education made it possible for those who weren't satisfied with this scenario to escape it by moving, if they had the economic means.  Or they could effectively pay for the service twice, by sending their kids to private school.

I deeply fear the same result with health care -- that the vast majority of people will end up paying more than they are currently, and will see a degredation in the quality of care they receive, in order that a smaller number of people can receive care that is modestly improved over what they get now, with heavy subsidies.

Once again, people will have to submit to something they find unsatisfactory, or they will have to pay for the service twice by opting out.

[angus]

Interestingly the average taxpayer in the U.K pays less into Government healthcare stuff than the average American taxpayer.

This is true, according to the statistic I have seen.   The U.S. spends about 14 percent of its GDP on health care.  Canada spends about ten percent and the UK spends about nine percent.  Put another way, we spend about 4200 dollars per capita on health care (of which 1700 is public money), while Canada and UK spend about 2300 and 1500 dollars, respectively.  (The numbers vary depending on whom you ask and their spin and motivation)  I think OECD countries spend, on average, about 2000 dollars per capita on health care.  Despite our spending, we usually rank about tenth or so out of the 30 OECD countries on fairly objective aggregate standards comparisons.  I'm not sure why.  But I don't think the data suggests, a priori, the need for greater centralization or government involvement in the US.  Anyway most folks who are serious about healthcare use Canada or Britain only as cautionary tales.  Taking a look at national healthcare systems that work, Sweden is one of the most centralized, France is somewhere in the middle, and Germany or the Netherlands at the least centralized end.  These healthcare systems all have their advantages and disadvantages.  The Arabians have an interesting system as well.  Bear in mind that what works for a small, ethnologically homogenous country may not work for a big, diverse one.

Interestingly, according to the 33-page report, titled Joint Canada-U.S. Survey of Health, 42 per cent of Americans and 39 per cent of Canadians describe the quality of care in their respective countries as "excellent." At the other end of the spectrum, 12 per cent of Americans and 15 per cent of Canadians rate health care as "fair" or "poor." (The rest, 46 per cent in both countries, ranked services as "good.")  So just looking at the USA versus Canada (which is different from UK system), we see only a minor difference in customer satisfaction for a HUGE difference in cost.  That's the frustration here.  It turns out yankees have only a slight advantage over canadians in terms of rates of disease, treatment and recovery.  But there is rationing of health care in both places.  In Canada the rationing is done by time: if you need surgery, you may have to wait up to six months or more it is not an emergency.  In the US, the rationing is done according to ability to pay.  Thus wait times for those who can afford it are tremendously shorter than in Canada.   Lots has been written on the subject.  Not as much on UK though.  At least not here.  Would be interesting to read anything you post in terms of wait times, customer satisfaction, and the like.