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Comment by k-mcgrady | Hacker News Reader

>> "The reason the EU model works is that doctors (and other medical professionals) get paid less. A quick google search suggests a US ER doctor or radiologist gets paid more than 3x what a British one does, a family practitioner 2x."

I'm not sure if you were posing this as a problem or not but as long as doctors want to work for the NHS it isn't one.

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I'm not posing it as a problem. I'm simply pointing out the real reason things work in the UK is that people pay less for the same thing.

Tangentially, if anyone proposes UK-style solutions to health care problems in the US without proposing 50-66% wage cuts for doctors/nurses, they are lying to you.

Well, the NHS is socialism so as far as I can see an approach like that wouldn't be ideologically acceptable in the US.

NB Regarding the "socialism" part, from NHS founder Aneurin Bevan:

"A free health service is pure Socialism and as such it is opposed to the hedonism of capitalist society."

I always think it is worth noting that the title of Bevan's book on the NHS was "In Place of Fear" - which I think sums it up nicely.

https://en.wikipedia.org/wiki/Aneurin_Bevan

I have no problem, in theory, with socialized medicine that we drastically underfund. It's probably a great way to waste fewer resources on medicine.

In practice that's just not politically feasible in the US. An illustrative example: a few years ago, a major study found that mammograms before age 50 are financially wasteful and medically harmful. Congress passed a law requiring insurance companies to pay for them anyway.

https://www.bloomberg.com/view/articles/2012-07-31/in-mammog...

http://www.uspreventiveservicestaskforce.org/Page/Document/U...

So I have read through the US Preventative Service Task Force Recommendation about 10 times in conjunction with Obamacare and preventative services, as well as been involved in some of the politics behind the data sets.

The US government actually tracks mammograms in the US through the Breast Cancer Surveillance Consortium. http://www.bcsc-research.org/

Their research basically has it come down to a massive case of Simpson's Paradox among many important subgroups needing early screening (black women, ashkenazi women, previous radiation to the chest) that suddenly disappears when they are added together en masses.

The US Preventative Service Task Force, however, is not in the business of explaining stats: it is basically a guidebook of what insurance will or will not cover, and they went with the rating they did as a compromise over the simpson paradox over the fear that these subgroups would lose coverage in high deductable plans

In exchange, they actually did cause problems by not doing comprehensive DNA testing and ONLY covering BRCA testing - which is bad science.

Medicare, Medicaid and the must stabilize mandate for ERs are underfunded.

It's one of the reasons that out of pocket costs are so high.

> Medicare, Medicaid and the must stabilize mandate for ERs are underfunded. It's one of the reasons that out of pocket costs are so high.

Exactly. This is the hidden secret about US healthcare that very few people are aware of. Even providers usually don't see this anymore, because they're so removed from the billing process (especially now that most providers are salaried and not running their own practices).

Medicare and Medicaid are the reasons that sticker prices for treatment in the US are absurdly high. Incidentally - and most people don't know this - if you're uninsured and self-paying, you almost never have to pay the sticker price. Hospitals really don't care, and if you just tell them that you're self-paying and can only afford (say) 10% of what they billed you for, they'll almost always immediately agree to a 90% discount. The only reason they're showing you that bill is that they need to present high bills to private insurers (to make up for the loss on Medicare/Medicaid reimbursements) and they're not legally allowed to present differently-priced initial bills to patients based on their insurance status.

No, they aren't underfunding. US government health care spending was $4,034/person. UK total health expenditures per person was $3,935.

http://data.worldbank.org/indicator/SH.XPD.PCAP

http://www.usgovernmentspending.com/year_spending_2014USbn_1...

For us to underfund it to UK levels, we'd have to expand medicare or medicaid to every single person while simultaneously cutting the total government budget for health care by 2.5%.

The UK system isn't competing with private US consumers for a limited pool of services. The comparison perhaps illustrates the poor value/dollar achieved in the US, it isn't instructive as to whether US government funded healthcare meets the costs of providing the services it mandates (a perfectly reasonable definition of underfunded).

To clarify, when I said I'd favor socialized medicine that we drastically underfund, the goal was to stop wasting resources on medicine. I.e., we should bring our health care utilization/spending down to UK levels, since evidently that doesn't significantly harm health.

Using a definition like "meets the costs of providing the services it mandates" inherently contradicts this philosophy since in the US, all sorts of crazy services will be mandated. E.g., mammograms for women under 50.

Except that the per-capita spend on health in the US is approximately three times what it is in the UK, which seems to corresponds quite nicely to what you're saying is the difference in salaries.

So, actually, yeah, you probably could move to a UK style solution, with the same per-capita spend as in the US while still preserving the seemingly very high wages for doctors and nurses.

as said above - almost all jobs are Nx paid in the US. Doesnt necessary mean you have more money NET in the end

Going by the standards required to get into medical school in the UK from high school I don't think there is any lack of applicants!

Might also be worth comparing the cost of qualifying as a medic in the UK and the US!

> but as long as doctors want to work for the NHS

Current under-funding of the NHS means there's a shortage of consultants (especially in A&E and mental health) and a shortage of nurses.

Some A&E units are being downgraded and closed at night because of these shortages of staff.

It's possible the problem is that we don't have enough qualified staff. Any source showing is that's the issue or it's that a huge number of people are going abroad?

I'm not claiming staff are going abroad.

Some, although I don't know how many, definitely are, though, especially after the junior doctors contract change.

I agree. I have several friends who have went abroad because they get paid more, work is less stressful and the weather is nice. I'd like to see a proper breakdown. From what I can see the problem is more of an increase in total jobs that was not met by the number of people qualifying which could just be poor planning.

It's always possible to get someone to be a doctor. Since there are many other jobs paying competitive salaries for smart folks, paying doctors less necessarily means they will be lower quality all other things equal.

They don't. Doctors in the NHS work longer hours than their U.S counterparts, and those who go through the system tend to move to either private practice, Australia, or the U.S after their residencies. For now, the system is still working, but it's clear that medicine is a much less lucrative/desirable job in the U.K than, for example the U.S. (And maybe that's a good thing – I don't know).

> k longer hours than their U.S counterparts, and those who go through the system tend to move to either private practice, Australia, or the U.S

The figures suggest you are wrong. The substantial majority stay in the NHS

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