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Comment by stefanfisk | Hacker News Reader

As a swede I’m confused, how does it work where you are from?

You'll call 911, gets transported to the hectic emergency room by ambulance and then you'll be triaged and whatever things that needs to be done will be done.

Few weeks later, you'll receive a financially-crippling bill in the mailbox because the insurers refuse to reimburse your treatment/you were sent out to a out-of-network hospital/because you don't have health insurance in the first place. Oh, don't forget to pay for the ambulance!

Ooh, you get ambulances? Fancy. In the U.K., you dial 999, and then you die on the kitchen floor.

Seriously. Excess deaths due to failure to treat are off the charts.

Isn't that a problem of Brexit? As I read here https://eand.co/britains-finally-figuring-out-brexit-really-...

Yeah, Brexit is a factor, but it's also one of many and it's important we tackle all of them. The private finance initiative (PFI) in the early 00s, is another[0]. Our government's lack of funding is also another ("The UK has spent around 20 per cent less per person on health each year than similar European countries over the past decade")[1]. Privatisation has been linked to not treating otherwise treatable deaths[2], so that's likely another. Then there's unwillingness and delay in many areas, to tackling air quality by reducing local pollution from car wheel breakage (linked to bad health)[3] by building more cycling infrastructure so that people don't have to be afraid of getting hit by a car[4] (and actually end up cycling). And disincentivising unhealthy diets[5] that are linked to hospital admissions, and amusingly urban planning like more cycling lanes can help people exercise without even really thinking about it like people already do in the Netherlands.

[0] https://www.theguardian.com/politics/2019/sep/12/nhs-hospita...

[1] https://archive.ph/UDtZo/again?url=https://www.ft.com/conten...

[2] https://www.opendemocracy.net/en/nhs-privatisation-health-so...

[3] https://www.gov.uk/government/publications/health-matters-ai...

[4] https://usa.streetsblog.org/2019/05/29/protect-yourself-sepa...

[5] https://digital.nhs.uk/news/2021/one-million-admissions-link...

Well, only in as much as Brexit has restricted the availability of people prepared to do social care work for minimum wage from outside the UK. But that’s not the main cause of the current problems the NHS is facing.

The problems in the NHS are mostly structural & have been building ever since George Osborne chose austerity in the aftermath of the 2008 financial crash. NHS spending was ringfenced in real terms, but social care wasn’t as that was funded out of local authority expenditure. Social care is now difficult to access & in short supply nearly everywhere as a result. Care homes are closing under the pressure of the difficulties in employing staff & inflation in fuel costs running headlong into the squeeze on LA funding meaning that LAs have been forced to eliminate any/all discretionary expenditures.

For the NHS this has led to two issues that have got progressively worse over time: 1) the UK population is aging & old people need more healthcare, meaning that freezing NHS funding in real terms would inevitably result in a steady increase in healthcare need that couldn’t be met and 2) for those people the NHS did manage to treat the collapse in social care has made it impossible to discharge them from hospital safely in a timely manner.

Some estimates suggest that currently a third of NHS beds are occupied by people who could go home if a care plan was in place for them, but that care is either unavailable due to LA funding cuts (forced on them by a government which cut LA funding to the bone) and can take weeks to arrange as the staff doing the assessments are themselves in extremely short supply.

This bed shortage then has knock on effects that ripple through the rest of the system. Combine with the regular winter flu epidemic & Covid wave spiking demand & you end up with A&E full to the brim with patients dying on the floor whilst every single available ambulance sat queueing outside A&E with patients that cannot be left alone & with no-where for them to go.

All of this has been aggravated by Brexit, but we would still have ended up here without Brexit: the root cause is the intersection of the steady decline in healthcare & social care funding with the increase in demand caused by an aging population & two concurrent epidemics.

All this has been predicted for years, it was obvious from the data that the system was persistently overloaded: waiting times for NHS treatment were steadily increasing at every level, including A&E. The current collapse was entirely predictable, but our current government was either unwilling or incapable of doing anything about it.

Chunks of the left believe that this is a planned collapse - that at least part of the government intended to force the NHS into a state of collapse in order to drive through a US-style privatisation that would enable them to line their own pockets. We know that government ministers have met with representatives of US medical companies numerous times within the last few years, so this isn’t an entirely baseless conspiracy theory sadly.

I’m not personally against private companies being part of a national healthcare service - most of the EU provides healthcare on some kind of partially private basis, with many differences in the details. However the US system is the worst of all possible worlds - it’s extremely expensive whilst giving very poor coverage of the population. It’s impossible not to suspect that US healthcare companies are hoping for an opportunity to carve up the UK healthcare market along similar lines in order to line their own pockets - the cost of bribing government ministers with a few well placed post-government directorships would be a small price to pay.

I'm not a Brexiter but I really dislike this trend of "everything is a Brexit" problem. Can we dismiss all US problems as a "Trump" problem because it suits our own narrative?

It's a shallow perspective on a complex problem and I'd encourage you to read something with more depth.

A significant fraction of US and UK problems come from the same root of people refusing to have a good faith look at what's actually happening, or deal with the large amount of overtly misleading media output and unmeetable promises.

Any time someone uses the phrase “good faith” you can discount everything they say, fyi. It’s a bad faith statement about a strawman of the opposition. Kind of ironic.

But once you run through all the complexity, you are usually left with “elections have consequences.” None of these problems are unfixable, but solutions do require leadership and competence.

If by "off the charts" you mean about the same as the EU then sure. (Germany is particularly badly affected - which is interesting because the British press has been pointing to their higher levels of healthcare funding and larger number of hospital beds as proof our healthcare system has been catastrophically underfunded. Eurostat doesn't have the December figures, but Germany had a 23% excess mortality rate in October, the most recent month, when England was still at 10%. If it was the other way around the headlines here would be yelling about a catastrophic failure... It looks like other EU members experienced similar spikes earlier in 2022 too.)

BTW, there are apparently two main concepts for ambulances:

“Scoop and Run” (just get the patient into the ambulance and then the hospital as quickly as possible) vs

“Stay and Play” (emergency doctor starts treatment on site, then transportation to the hospital).

Apparently the former is more associated with the UK and US, the latter with the European continent.

That's a false dichotomy.

Scoop & Run vs Stay & Play is just a way of describing whether to treat on scene or not. It's used everywhere (at least everywhere that has a modern ambulance service with paramedics) and the boundaries shift depending on scene, patient, skill level on the ground, distance to definitive care, transport options, etc.

The whole world has been migrating over the last ~50 years from a purely Scoop & Run model where ambulance drivers were just that - barely first-aid trained - to a model where more and more care is delivered on-scene, Stay & Play.

In the US, how much treatment you get depends on how EMS triages you over the phone. AEMTs and paramedics, especially in bigger cities, are authorized to perform some crazy shit, vs EMTs who can just give you aspirin.

So you're arguing there should be more up front blockers between a person and their attempts to get health care, European-style?

I simply answered GP's question:

> As a swede I’m confused, how does it work where you are from?

I simply described it as how would an ordinary American would experience a potential emergency. Between the "designated doctor" versus "let's be cautious", I'm not sure which is the objectively superior one (although unlike your presumption, I actually like this cautious approach), however I cannot underestimate the fact that your insurance company can just declare your situation as not emergency, despite multiple administrations trying to close loopholes (and even some arguing that the liberalness of insurance companies are not enough). Except for the (rather bitter, I'll be honest) tirade about health insurance, I have tried to not evaluate which system is better, and I'm not sure where did you get the impression that I despise the Anglo-American procedure.

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