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Comment by sambe | Hacker News Reader

I have never seen such a bureaucratic/inefficiently operated institution - and there are plenty to choose from in the UK. My electricity company replaced all Vs with Ks in letters to us for 7 months. The NHS is much worse (try even getting a letter to arrive within a month - to the right address - let alone receive any medical treatment).

I have not dealt with US healthcare but having experienced other countries' I'd strongly suggest not following the UK system - other European countries certainly come to mind as working substantially better. Of course, there's a huge "Save Our NHS" push due to the number of people it employs, unions, misplaced national pride etc.

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Funny how your anecdotal point is just that, anecdotal. Here's another anecdotal point for you -- Pancreatic cancer (stage 2). Diagnosed on the first visit even though a private doctor had missed it previously. Surgery in less than 5 days, excellent follow-up and post-surgery care including the surgeon having a set of non-mandatory procedures approved in record time (10mins) as a preventative step towards recurrence. Two years later, cancer free with excellent reminders and follow-ups on periodic checkups.

Your experience does not dictate the system, as doesn't mine.

So instead look at the statistics. In many sectors they are dire.

UK residents have the 20th highest life expectancy in the world. 21st for health-adjusted life expectancy. The Japanese take the top spot and live +2 years. The average American lives -2 years.

There's a lot more to health than the health care system, and this doesn't say much about how painful the process can be, but the stats look pretty good for the UK.

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

But how much of life expectancy can be attributed to the healthcare system? Maybe Brits spend more time outside, and are less stressed, etc etc. how have the rankings changed over time and what changes in the healthcare systems correlate to those trends?

I didn't claim otherwise - is there a need for that tone? What have private GPs got to do with it?

I don't doubt that the NHS would treat me reasonably quickly and probably quite well if I had stage 2 cancer. People in the UK have been trained to herald such as a result as heroics from the NHS, as if the alternative was third-world level service. I do expect - based on a lifetime of anecdotal data from myself, friends and family - that the whole process would reveal repeated mistakes, bureaucracy and time and money wasted. False dichotomy often prevails in NHS discussions.

And another point in favor of the NHS all my letters arrive very quickly plus a reminder via phone for apointments.

It's a myth to suggest the NHS is heavy on bureacracy. The NHS has less management than most UK business, and often those managers are dual role clinicians / managers.

https://www.kingsfund.org.uk/projects/health-and-social-care...

> The NHS Information Centre shows that there were about 43,000 NHS managers in 2009 (about 3.7 per cent of the total workforce), although this figure does not include many clinical managers. How does this compare to other sectors?

> According to the Office for National Statistics, the proportion of managers in the UK workforce as a whole in June 2010 was 15.4 per cent. These statistics also show that there were 77,000 hospital and health service managers across the United Kingdom, or 4.8 per cent of the NHS workforce. In other words, the NHS has a managerial workforce that is one-third the size of that across the economy as a whole.

Your letter taking a month to arrive is something that you can complain about. Did you make a complaint about it to the relevant trust?

> I have not dealt with US healthcare

Since we're detailing anecdata, I went on a working holiday to the US and had an accident in work. I was fully covered under my travel insurance, and doubly covered under my employer's insurance. I broke several bones in my hand and needed a costly operation to insert pins. The payment approval time from insurers took longer than the minimum wait for the operation before bones fused. I did not have the operation and have had problems in my right hand since.

I take your point about other European countries doing it better, I'm sure that's true. But the article is using the US system as a metric. I'm living in Ireland and would love to have a system as good as the NHS over here. Everything's relative but when you're comparing the NHS to clearly inferior systems there's not much point playing devil's advocate. There are enough individuals with a vested interest in the disassembly of the NHS as it is.

> I'm living in Ireland and would love to have a system as good as the NHS over here

Why? Ireland has longer lifespans and better health-adjusted life expectancies than the UK.

Only marginally. The difference is negligible and even if it weren't, there's certainly far more contributing factors than the quality of healthcare provision.

Playing devil's advocate, I guess one could speculatively argue that Ireland's private system* brings up the overall average while the public system only caters to the poor and deprived, but I don't think this would be enough to bring the averages up on its own. I'm sure it's more likely lifestyle factors.

* for those unfamiliar, Ireland has a two-tier health system with extremely poor, underresouced single-payer free healthcare coupled with privately-run hospitals for those with the means to pay.

Granted it's from wiki, but 79% of 2010 Irish health care spending was by government. And part of that 21% will be from public system co-pays and levies that have nothing to do with private-run hospital visits.

Sounds like the public system provides the majority of care.

Any "public" system still has a private-tier available to anyone that can afford a plane ticket.

Yeah, this is what I would've expected (hence the devil's advocate qualifier), which is why I think our life expectancy has other causal factors.

Although, one thing to note is the the government does invest in private hospitals as well, so that 79% figure won't be exclusively public healthcare. This is due to public-private-partnerships whereby a single site will accommodate both a public and private hospital with the entire project being funded by a combination of public and private funds, usually with an extremely favourable arrangement for the private side.

It's actually one of the best value health care systems.. Sadly it is being made inefficient by the current government.

If we are going by anecdotal evidence, the NHS has been absolutely brilliant for me.

https://www.theguardian.com/society/2017/jul/14/nhs-holds-on...

Oh come on, it's always fashionable to blame the current government. The Guardian's view (which has shifted further left and become more "us vs them" divisive in the last couple of years) of an already unpopular Conservative government is not the first source I'd used.

Personally, I've seen these reports come up from time to time, and having experienced some of the other countries listed find it very hard to believe. It sounds like a lot of the data is collected from patient surveys. My claim that citizens have a positive-skewed view of the system is relevant (I recently read a survey result where UK citizens considered the NHS a greater achievement than defeating the Nazis and the abolition of slavery).

Many Brits are in the same situation and hold the same opinion, because they've never experienced anything else. Having personally experienced the US and UK systems, I assure you that's because you simply can't conceive how bad it is in the US!

> My electricity company replaced all Vs with Ks in letters to us for 7 months

What does that mean?

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