A question for anyone regarding healthcare systems...

[ErinKC]

At least give it a different name though, you don't want Trumpcare. A trump is fart over here

I wouldn't be surprised if Trump pushed through single-payer just to spite his opponents. It's been a weird few years over here!

I'm only 35 but I'm cynical beyond my years.

But smoking is a good example. I remember in college every bar was full of smoke and no one thought anything of it. Today I would be horrified if someone lit a cigarette inside a building. But, I think even the most liberal Americans still have a natural, cultural aversion to government mandates and top-down solutions. Things go over much better when they happen as gradual cultural changes (see: gay marriage and pot legalization). There are, of course, times when incremental change is too slow - like the civil rights amendment - but in many cases waiting for the cultural pendulum to swing makes policy changes easier.

I think we're definitely swinging in a direction away from our current healthcare system. Where it leads is still uncertain. Same with guns, I think. That one even more than others has to come from the bottom up because of the constitutional issue.

[Drisque]

I really appreciate the time everyone took to explain their countries healthcare system, your personal experiences and opinions. That is exactly what I was hoping for. Over here in the States it's a really difficult issue, because as Amomentofclarity put it, our two party system only gives you two options and both exist on the wings of our political spectrum. It's kind of odd how most American fit somewhere in the middle of that spectrum, while the parties themselves keep wandering further and further away.

I, myself, feel that we need to pursue something other than what we have now. The insurance we're given is essentially useless. For example, my deductible is so high that I pay out of pocket for everything. I never reach my deductible, which means my insurance "benefits" never kick in. It cost my wife and I over $7k to bring our son into this world. That simply will not do lol. I hope we can get someone in office in 2020 that will be willing to go for some of these issues, because it's only getting worse.

Again, I really appreciate your responses. I now have a frame of reference based on actual accounts as opposed to the biased opinions of Dems and Reps who haven't experienced it. Thank you to everyone

[ErinKC]

our two party system only gives you two options and both exist on the wings of our political spectrum. It's kind of odd how most American fit somewhere in the middle of that spectrum, while the parties themselves keep wandering further and further away.

1000% this.

[MyNameIsTerry]

I really appreciate the time everyone took to explain their countries healthcare system, your personal experiences and opinions. That is exactly what I was hoping for. Over here in the States it's a really difficult issue, because as Amomentofclarity put it, our two party system only gives you two options and both exist on the wings of our political spectrum. It's kind of odd how most American fit somewhere in the middle of that spectrum, while the parties themselves keep wandering further and further away.

I, myself, feel that we need to pursue something other than what we have now. The insurance we're given is essentially useless. For example, my deductible is so high that I pay out of pocket for everything. I never reach my deductible, which means my insurance "benefits" never kick in. It cost my wife and I over $7k to bring our son into this world. That simply will not do lol. I hope we can get someone in office in 2020 that will be willing to go for some of these issues, because it's only getting worse.

Again, I really appreciate your responses. I now have a frame of reference based on actual accounts as opposed to the biased opinions of Dems and Reps who haven't experienced it. Thank you to everyone

Our politics seem to have become more entrenched and further away from each other too. The make up of the leadership of the parties has swung further left in one and further right in another leaving the swing voters & moderates a bit stuck.

I think you have it worse in this respect because we don't have the complications of race as much, amongst other things. It feels like that anyway, we certainly have those battles but you guys seem more mini civil war. But then it's always hard to tell with the media peddling so much nonsense overinflating stuff.

We always have debates about the NHS here. It has been a political football like many other areas. One party gets in, messes it up and the main other party moans about their incompetence. They get in, the role switches. We are pretty much a two party system so it just goes back & forth with the opposition moaning when part of their moan was created by them in a previous government. Is it the way for you guys?

Some want the NHS removed from this by having ringfenced money from taxes so it can't be easily touched or played with. Some want a compromise closer to systems like Germany, Australia, etc where you pay some but it's reasonable and social care is still very much there. But any debate about it and you can bet it will all be about the US system and the emotional stuff starts.

We outwardly project an image that the NHS is the jewel in our crown. Try living here and reading that. It's brilliant for anything serious. There are some issues with expensive treatments and funding but overall they will be all over you to help with anything serious. But when it comes to the elective stuff or the less serious illnesses you see a big change in things like waiting times. The staff, on the whole, are great and doing a very difficult job under very difficult circumstances with not much government support.

Imagine if we had a great big panel of people tasked with making things better. No egos, no self serving interests, just altruism. But then that would wreck politics as most of it seems to be about BS and feathering your nest.

---------- Post added at 04:53 ---------- Previous post was at 04:50 ----------

I wouldn't be surprised if Trump pushed through single-payer just to spite his opponents. It's been a weird few years over here!

I'm only 35 but I'm cynical beyond my years.

But smoking is a good example. I remember in college every bar was full of smoke and no one thought anything of it. Today I would be horrified if someone lit a cigarette inside a building. But, I think even the most liberal Americans still have a natural, cultural aversion to government mandates and top-down solutions. Things go over much better when they happen as gradual cultural changes (see: gay marriage and pot legalization). There are, of course, times when incremental change is too slow - like the civil rights amendment - but in many cases waiting for the cultural pendulum to swing makes policy changes easier.

I think we're definitely swinging in a direction away from our current healthcare system. Where it leads is still uncertain. Same with guns, I think. That one even more than others has to come from the bottom up because of the constitutional issue.

You are not alone, Erin. By my thirties I had change my mindset about voting to one of choosing the least worst who will do the least damage.

Yes, steady change is best. You get more time to educate people and let them change. Generational change breeds certain attitudes out, for the most part.

I think it comes down to you, the people. The trouble is you just vote in politicians and they are to afraid of upsetting the applecart and their salaries. You can go round & round over guns with no one budging whilst the deaths continue or you can have a vote and let the people decide.

[ErinKC]

We are pretty much a two party system so it just goes back & forth with the opposition moaning when part of their moan was created by them in a previous government. Is it the way for you guys?

Yes. This is how it is exactly. There's no institutional memory and there's so much hatred, especially at the moment, that automatically anything that "their side" does must be bad and anything that "my side" does must be good... even when you have both sides doing the exact same things at different times. So, we get nowhere. Immigration reform is a great example, too. No one is willing to say - hey maybe that guy has a point, or hmm, maybe we could compromise here. It's all - you're evil, I'm good. And, once you've pegged your opponents as evil you can justify never compromising with them again, because who makes deals with the devil?

You are not alone, Erin. By my thirties I had change my mindset about voting to one of choosing the least worst who will do the least damage.

This is our only option, or vote third party, which I've done in the past even though they have no shot at winning. It's depressing! I was a political science major and used to really love this stuff. I even worked in immigration for our State Department for 6 years... but now I just want nothing to do with it. I'm starting law school in the fall so I can help people who get screwed by our system!

---------- Post added at 03:19 ---------- Previous post was at 03:03 ----------

Also - this has been such a nice chat. It's so hard to talk about politics without things getting really intense and mean. I had to get off facebook because I couldn't take all the hate all the time... and the worst offender was my OWN MOTHER who would start fights on every single thing I posted.

[MyNameIsTerry]

Yes. This is how it is exactly. There's no institutional memory and there's so much hatred, especially at the moment, that automatically anything that "their side" does must be bad and anything that "my side" does must be good... even when you have both sides doing the exact same things at different times. So, we get nowhere. Immigration reform is a great example, too. No one is willing to say - hey maybe that guy has a point, or hmm, maybe we could compromise here. It's all - you're evil, I'm good. And, once you've pegged your opponents as evil you can justify never compromising with them again, because who makes deals with the devil?

Yes, things have got very binary. Social media is bad for that. I think you find it is worse with people who wouldn't necessarily be considered, to me at least, as worth listening too. More moderate people are willing to listen and understand both sides but those towards the fringes just want to throw their toys out of the pram. It stupid really as we are all hypocrites in some way, being human.

I wonder of things drift more back to the centre whether parties will be less vitriolic and willing to work together? It should be about the good of the nation rather than party politics, but now I'm sounding like I was born yesterday

This is our only option, or vote third party, which I've done in the past even though they have no shot at winning. It's depressing! I was a political science major and used to really love this stuff. I even worked in immigration for our State Department for 6 years... but now I just want nothing to do with it. I'm starting law school in the fall so I can help people who get screwed by our system!

It's the same here. We have more parties but there are typically 3, unless you vote Green. Scotland & Wales have another party (although it's really Scotland that matters for) and NI is completely different although is even more intrenched.

If you vote for the Liberal Democrats you take a vote away from the main parties, Labour and Conservatives. But this can be useful if done the right way as proven by the rise of the UKIP party (mainly about anti EU, anti immigration but have now gone further to the right as an anti-Islam party, but they are busted now the EU debate has changed and voters have returned to their roots) which started taking votes from Labour and Conservative candidates to the point they worried about the marginal seats. They did end up forcing the EU referendum. But yes, outside of that a minor 3rd party has proven pretty pointless.

With things lurching further apart it makes it even harder to vote now. Neither party is attractive if you class yourself a moderate. And we're back to voting for the least worst or the "anybody but xyz candidate" which I expect you know plenty about given your last election was heavily dominated by that on both sides!

I think it's great you are training to defend people. It must very intimidating taking government depts on. We have plenty of that here over the benefits system for one but also the mess that is immigration. Some have suggested it's not immigration incompetence but intended. This is interesting as that's how the benefits system has gone, they try to boot everybody off hoping you don't appeal so they end up saving money (the success rate for appeals is huge, which should indicate a major problem).

---------- Post added at 05:42 ---------- Previous post was at 05:23 ----------

Also - this has been such a nice chat. It's so hard to talk about politics without things getting really intense and mean. I had to get off facebook because I couldn't take all the hate all the time... and the worst offender was my OWN MOTHER who would start fights on every single thing I posted.

Yes, I think it helps that by & large we get on here. And obviously we have empathy for each other because of the mental health struggles.

I've always liked this place being international as you learn a lot about other people's lives.

But I wouldn't go near politics forums, they are horrible! Not as bad the comments sections of some media outlets but the arguing, name calling, etc would just make my anxiety worse. They are a useful way to keep an eye on the news and views as you can see different points of view but they can be so depressing due to the negativity. I don't mind talking about it on here, and do on Misc, but it's much nicer and we can have a laugh too.

Luckily my family are of a similar opinion about politics. If we argue in general it's all done with and we move onto something else quickly anyway. Mine are classic working class so believe all politicians share a common stripe of BS running through them

Facebook, Twitter, etc I stay away from. I struggle with just this place so I doubt I could keep up with all that! My GAD came due to work overload and much of it was email, meetings, calls, etc so it's been an uphill struggle to do any of that again.

You are probably better for being off it anyway, there have been some interesting articles about unplugging being better for our mental health.

Our NHS recently set up a cyber mental health dept to look at the detrimental side. Well worth it! I wonder how anxiety will look, as a community, in future generations and whether social media will be a much larger root cause they spend time dealing with in therapy.

Earlier you mentioned about the disparity between costs based on location. What drives this? I'm guessing it's partly about regional wealth/earnings as well as just the companies themselves? Is there any control over pricing or is it completely free market?

[lofwyr]

In the US, I will add it can depend a lot on which state you are from. Some states have extensive social assistance, and provide excellent subsidized insurance to those who cannot afford it. My home state of Minnesota has much higher state income taxes, but also has among the highest rates of longevity and access to good Medical care. It is so good that in order to retain my coverage in Minnesota to monitor my aortic aneurysm, I am living there six months a year and the other half near my aging parents in New Mexco. New Mexico has a much tougher situation, lower taxes, less money, smaller social saftey nets etc. There are vast regional disparities in part because of wealth, and along with that education, lifestyle choices, access to medical care, decisions by state governments, and influence by the federal government. There are layers of issues at work, all interconnected to the previously mentioned issues, a very complicated morass to tackle, to be sure. I am literally a medical migrant, knowing I will need open heart surgery and needing a CT scan every eight to twelve months means I have no choice but to keep my Minnesota residency, as I know I will not get the same level of care in New Mexico and I would Minnesota. I am fortunate to be able to do so, many do not get that choice.

[MyNameIsTerry]

In the US, I will add it can depend a lot on which state you are from. Some states have extensive social assistance, and provide excellent subsidized insurance to those who cannot afford it. My home state of Minnesota has much higher state income taxes, but also has among the highest rates of longevity and access to good Medical care. It is so good that in order to retain my coverage in Minnesota to monitor my aortic aneurysm, I am living there six months a year and the other half near my aging parents in New Mexco. New Mexico has a much tougher situation, lower taxes, less money, smaller social saftey nets etc. There are vast regional disparities in part because of wealth, and along with that education, lifestyle choices, access to medical care, decisions by state governments, and influence by the federal government. There are layers of issues at work, all interconnected to the previously mentioned issues, a very complicated morass to tackle, to be sure. I am literally a medical migrant, knowing I will need open heart surgery and needing a CT scan every eight to twelve months means I have no choice but to keep my Minnesota residency, as I know I will not get the same level of care in New Mexico and I would Minnesota. I am fortunate to be able to do so, many do not get that choice.

Thanks for the explanation. We have issues between different regions of the UK and it is much the same as you say, the wealth of a region does dictate not only the cover but the social attitudes to an extent.

What is it like for mental health care? I'm guessing that is worse in terms of parity between states?

[RadioGaGa]

MyNameIsTerry has posted some excellent points on the NHS.

Although this post of mine is going against my better judgement, I can't help but add some of my own 'issues' with our current health service.

Emergency Department

Far, far, far too many people abuse this pivotal part of the NHS. I've personally encountered prescriptions for people attending with the following:
* Rx for plasters for a RAG NAIL
* Rx for paracetamol for a sore wrist
* Rx for Chlorhexidine mouthwash for gum disease
* Rx for bisacodyl for constipation
* Rx for ibuprofen for a tension headache.

Anyone reading this who has even an ounce of logic (you wouldn't need ANY medical training at all) would (or should) know these are NOT matters for A&E. And no, these are not isolated or unusual presentations. Many people attend with these idiotic complaints every day. And a few of them are 'frequent flyers', that is, they regularly go to the ED for these, frankly, stupid complaints.

Why do doctors treat them, you ask? They have to. If you attend the ED, you HAVE TO BE SEEN AND TREATED, regardless of your complaint. You'll just wait longer if its not serious.

How could this be improved? We need a more aggressive public awareness campaign, that A&E/ED is for LIFE-THREATENING EMERGENCIES ONLY. Also, would it be unethical to introduce a payment process? All people self-presenting (e.g. not ambulance arrivals) to A&E should be made to pay a deposit (say £20), and if their complaint is deemed non-urgent by the treating doctor, they should lose their deposit. But then, of course, this raises ethical issues.

I could go on and on for all day, but it'll just put me in a bad mood.

The Minor Ailments Scheme

This scheme was introduced to allow pharmacists to issue a prescription for a drug to people with 'minor ailments'. For example, you complain of toenail fungus, your pharmacist can give you Terbinafine cream for it without you having to pay for it. Although this sounds great, should we really be expecting the NHS to pay for this? The system is also prone to abuse by some unscrupulous pharmacists, who will issue Rx for anything they can.

(Forgive me for sounding as if I have preconceived misconceptions here, because I don't, I'm just telling you of the typical case).

A young single mother with four children comes in, complaining that her child has a cold. She asks the pharmacist for Calpol on the "minor elements" (as a lot of them call it) and when this is refused, and she is told she needs to pay £3.50 for it, she becomes outraged and then says "I'll just wait and see the GP for a prescription".

It is that mindset, up above, which is downright costly, ignorant and costing our health service a small fortune. Again, this is not an isolated or unique case, this happens every day, all across the country. And, naturally, the GPs issue the prescription. So instead of the mother paying £3.50 for the Calpol, it ends up costing the health service 10x that, once everything is taken into account.

A lot of people think the NHS is great, because its free at the point of use. Yes, it is free, BUT nothing in life is free. It is costing the taxpayer. We don't have an endless supply of money and it is those points above that honestly cost us a fortune.

Then, there's another thing which makes my blood boil.

HIV 'Pre'-Exposure Prophylaxis

(I am a gay man myself, so don't shout homophobia at me here!)

The wonderfully moral drug companies in America realised they could increase their profits when they realised HAART (Highly Active Antiretroviral Therapy) could be used to prevent HIV. To 'dumb this down', HIV negative patients take HAART, sleep with an HIV positive person, and the treatment prevents infection.

What is wrong with condoms? This is making an HIV diagnosis far too trivial. "I can just take a pill" is the mindset. ALL HAART drugs are heavy duty drugs. They come with potentially serious side effects, but those in 'high places' have convinced our Government this is a really good idea.

Essentially this is giving the OK to promiscuity, with serious disregard to the potential for a virulent drug resistant strain emerging. I don't say this to scare people, but there were isolated cases of virulent, refractory and rapidly progressive HIV in New York a few years ago. This could potentially happen with PrEP if it is not used EXACTLY as prescribed.

All antimicrobials are prone to resistance. Just like bacteria become resistant to antibiotics, viruses will become resistant to antivirals. HIV, a retrovirus, uses the hosts DNA to replicate.
It's a very, very 'intelligent' virus, and resistance is out there already.

And the cost! The BNF states the first line treatment for PrEP is Emtricitabine with Tenofovir. This costs just under £400 for a 30-day supply per person!. That's nearly £5000 per year for just ONE patient receiving PrEP!!!. It's an eyewatering, sobering figure, considering this is equally preventable through condoms, at a fraction of the cost. And through this, other areas of the NHS suffer, for example mental health, oncology etc.

£5000 per year, per person, just so they can sleep around without a condom? Craziness. Absurd. I'm surprised the DailyMail hasn't been all over this.

As you can see, I could go on all day about it.

The bottom line

America should stay how it is. We need serious reforms to our NHS, because at this rate, there won't be an NHS in 20 years.

My father and mother have private healthcare, and I have since availed of it myself. The difference between NHS treatment and private treatment is night and day.


Rant over.


(Goes off to make himself a coffee)

[Drisque]

They get in, the role switches. We are pretty much a two party system so it just goes back & forth with the opposition moaning when part of their moan was created by them in a previous government. Is it the way for you guys?

This is definitely how it is here. I can't really put it better than Erinkc did. There's a lot of passing the buck between the former and current presidents/ parties and then there's also a lot of luck in the game, as well. For example, the economy might be slowly entering a downturn at the end of president A's term and won't be really noticeable until president B takes office, thus president B takes the blame.

Another thing I can't stand is how the two parties play chess with our lives via shut downs. Government shut downs are awful and selfish political tactics and every president partakes. The shutdown becomes a game of"No! You first" and the "winner" thinks they'll be perceived as strong and that they will ride that perception into the next election. Meanwhile, the real loser is both the federal workers who work without being paid and the economy. It's ridiculous. Does this happen in your system?

I think social media has a lot to do with our parties splitting from its more moderate constituents. I hate to be the guy who blames tech and or new things, but I've just noticed how people are on Facebook, Twitter and the others. I think social media has given people with far left or far right ideologies a HUUUGE platform and the person with the most outrageous things to say is the one who gets the spotlight. And I think that is in part because they say it so often and with such an intensity that it's impossible to ignore. So, I think our parties are misreading where the public actually sits politically because of this. That's my opinion anyway.

I agree, this has been a breath of fresh air. Usually when politics are brought up it gets pretty ugly. I cant seem to wrap my head around the childish antics. The name calling, the blame game and the violence. It seems like maturity is tossed to the wind the second politics rears its ugly head. I suppose that's human nature?