All have limited periods before the patent on the technology expires, all have to make back their money in a limited period. I don’t think that capping drug prices is a good solution just allow big purchasers to negotiate discounts that their buying power warrants as happens in any normal free market.

The fact that the US government specifically prohibits this to its public buyers is interference in the working of the market. If I want to buy 100 planes from Boeing, I will likely get a lower price than if I want to buy 1.

By artificially keeping the price of drugs high, this encourages too much money to be put into r&d leading to misallocation of resources, too much money spent on researching drugs that benefit too little. As with most things, diminishing marginal returns apply, each extra $m put into research yields less benefit. It could therefore be quite reasonably argued that the money could be better used in other areas of healthcare or put to better non-healthcare uses if the artificially high prices were not mandated.

European countries with ‘socialised’ healthcare seem to do ok when it comes to drug research, Glaxosmithkline, Bayer, Sanofi-Avensis, Astrazeneca etc etc don’t just sit there twiddling their thumbs all year long.

NOthing is going wrong with the free market, it’s bearing the burden of cost that the socialized market won’t pay. Unfair to us, yes.

1) In all countries, I was treated by well trained, compassionate and very competent professionals.

2) Each system had ‘quirks’ and horror stories, but overall the standards seemed high and those treating me seemed to do a magnificent job.

3) The US system had a few more ‘niggles’ than the others. I was covered by my employer’s “Blue Cross” health insurance system. Despite this, I had to pay extra for a couple of X-Rays, and for some lab analysis. Both these extras involved phone calls and then forms that required filling, and then finally cheques to be written and sent. In other words, the US system seemed to take a bit more time and effort.

4) The cost of medication in the US should be a national scandal! A very basic inhaler that I know costs approx $25 in the UK and a similar price in France cost nearly $115 in the US – something is going very wrong with the free market!

5) Finally some facts:

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678

I suspect that some measure of health care reform is inevitable in the United States.

“You brought up several interesting points that should be clarified.First “patients make demands of GP’s to see x or y specialist for a or b treatment”That is one of the basic differences between the US private system and the NHS.I suppose that the GP’s in the UK are what is here called the “gatekeepers”.They are somewhat reluctant to refer a patient to a “specialist” unless repeated demands are voiced.That is what I heard.I presume the NHS demands it as they can not cope with the demand (long waiting lists)and the GP’s pocket part of the money saved. The exact opposite happens here.Firstly a good insurance plan has a long list of participating MD’s of all specialities and the patients can visit their MD’s -GP,gynecologists,internist,orthopedic surgeon etc ditectly by making an appointment.The physician then advises on the best course of treatment done in the fastest and most efficient way.The insurance will pay for the tests after approval,minus deductable.There is no waiting list for specialized exams in general as we do the required test immediately on the latest available equipment-day and night according the patient needs.At least in our town and its hospitals.”

Yes, the gatekeeper system does help to cut costs but also means that there is an incentive not to provide treatments. The alternative of a ‘fee for service’ arrangement might go too far the other way though and provide an incentive for unnecessary procedures and thus the costs of the system get out of control.

You can have universal healthcare systems that limit the role of gatekeepers though and allow patients to self-refer to specialists, the French system for example.

“The second point brought up “Americans die younger,infant mortality is higher”.Reading the statistics, that may be true.It all depends how you count.If a newborn is delivered here he/she gets treatment regardless of the maturity of the infants.These are then counted as part of statistics.In Europe ,I believe the definition of infant mortality is different.In Switzerland ,I believe, the living infant is defined as living over 24 hrs ,must have certain weight etc,this of course makes for far better results.”

I don’t know about Switzerland but in the UK infant mortality is measured as a proportion of live births and live births are defined as all births showing signs of life delivered after 24 weeks. Now I can see that this can cause a grey area regarding births at less than 24 weeks but as a proportion of the total these births are minute, 1,300 per year born at less than 26 weeks (half of whom survive) out of a total of 700,000, not enough to make a large difference to the overall statistics. I would also wonder how much difference other countries definitions actually make to the overall picture.

“The other point-Americans die younger.Again this may staistically appear to be correct.However the US is a vast country with extremely inhomgeneous population and huge range of socioeconomic structure.Even though bilions of $ were spent on socioeconomic improvements that can go only so far.To really compare the statistics,I believe that one would have to compare fairly homogeneous population of the UK with similar group of Americans.”

The population of the UK and many other European countries is not that homogenous these days, we have rich people and poor people, black, white and brown people, urban and rural people, legal and illegal immigrants and we also have a problem of ‘health tourism’ whereby ill people come from other countries to access our ‘free’ healthcare which naturally has an effect on the statistics.

“By the way we do not refuse treatment to anybody in acute condition,they are stabilized and sent to the local city-University Hospital for further treatment.This is supported by the taxpayers.”

Yes I know, so tax and insurance premium payers are already paying for the healthcare of others. Opposition to this is one of the main arguments used by those who don’t want universal healthcare but it already happens under the current US system. In fact, under the current system, US citizens pay more tax dollars per head for government provided healthcare than Europeans do, compared to some European countries significantly more.

Would it not be cheaper to allow access to preventative healthcare rather than wait until a person presents at the emergency room with acute symptoms before treating them?

I wouldn’t model any health system on the UK system but I think that you can get the advantages of universal healthcare combined with the efficiencies of the private sector, the best of both worlds.

Give us the numbers of how many people in countries with socialized medicine, pay more and go to private hospitals.

If we didn’t have the private option we’d be dying. We keep the socialized system alive for the people who are too lazy to go to work basically. People who live on welfare.

A large chunck of the population “go private” anyway.”

Susan, obviously the numbers vary between countries, not all ‘socialised’ systems are the same.

Regarding the UK specifically though as this is what the article was discussing, 12.8% of the population were covered by private medical insurance in 2002 so it’s probably still somewhere in the 10-15% range.

http://www.privatehealth.co.uk/aboutus/industry/industry-marketdata/private-medical-insurance/

The private healthcare market is expanding largely as a result of NHS outsourcing to the private sector. For example, early last year my partner needed an operation on her foot, the local NHS could only provide the operation after 5 weeks but a local private hospital had availability in just a few days so she chose to go there and the NHS picked up the bill. This type of funded publicly, carried out privately arrangement is becoming more and more common as part of the largely succesful drive to significantly reduce waiting times.

One of my previous employers, a US company, offered private medical insurance to its workers but many people in my workplace decided to forego this and take a cash alternative instead.

So yes, some people do have private cover but the vast majority do not. They still might get private treatment funded by the NHS though if they need a procedure done and the NHS can’t do it quickly enough.

I agree with much of the questions raised by the commenters about the behaviors of Carol Gould and incongruence of her story. I could argue that what she saw is pretty common practice in any hospital worth its name, even in Naples.

My first point is: wait to see if your friend will receive rehabilitation, how fast and how much.
I know, for example, that the doctor in chief of the ER had to battle with the Pharmacy to obtain botulin antidotes to keep at hand because they cost so much and expire so fast. But, without, if a botulin poison happen the antidote will be hours away when minute matter. The Neonatal Ward usually went often asking other Neonatal Wards in other hospitals for surfactant (other costly drug used for pre term babies – without they are unable to breath).

For an ecography I needed 30 days (they had a max 30 day waiting list – so they stopped to take appointment when they reached the limits in public hospitals), for the treatment I needed other 30 days (and paid with my wallet money). The SSN would not cover for the Shock Wave treatment to my shoulder; it was surgery (when it will become much worst) or nothing. So I was force to take a (paid) sick leave for two week (I treated the first shoulder but the second worsened first) take an awful quantity of FANS, didn’t was able to sleep for one week and force to sleep seated. It cost me 1.000 €, it cost the SSN for a replacement nurse to do my job, it cost the job insurance (state owned) pay for my sick leave and it cost me two very painful weeks.

The problem is socialism is inefficient. But also that premium health care is not affordable to all. They pay is low (well some private jobs pay less, but not so much), so the best abd the brightest don’t think to become nurse or doctor. We are understaffed because people don’t enroll, we are importing nurses and doctors from abroad (Romania, Perù and others).

The NHS attract people from all the world because is a stepping stone to go in the USA (many englishman and women already went in the USA). The NHS pay more than other European health services so it attract many health workers there. It is a market where who pay more obtain the best people and enough people and who pay less keep what he is able to keep. The Finland nurses did a strike and by law were forced to work (the same is in Italy – you can not go on strike as the law mandate a minimum number of nurses and doctors); after years they were forced to sending their letter of termination en mass to force the state to give them a raise.

Another point about socialized health care is that in Italy you could find an awesome doctor and nurse that care you or an awful doctor and nurse that care you. It is like the ticket of the lottery. Being evaluated for what they accomplished? A minister (Brunetta) is trying to do this. He is submerged by critics from unions, professional orders. God help him.

“She says she keeps thinking about how she might have died had she been on holiday to the USA and someone might have dithered over her insurance coverage as she lay dying.”

That is rubbish, if she had wound up in any good hospital in the US, one that is ranked as highly in our system as St. Mary’s is in the UK, she would have received treatment as good, or better than, she received in the UK. Payment would not have been discussed with her until after she had recovered. Of course she needn’t discuss payment in the UK, there is nothing to discuss, she will pay her taxes or go to jail.

Second: Ms. Gould has not explained why after the call from Mil on the third day of her illness, Ms. Gould did not take further steps such as calling one of Mil’s other friends, relatives or neighbors, or even the Police. No rule of ethics could have required Ms. Gould to further endanger her own health (remember she had a strep infection) or that of Mil or even strangers on the street, by leaving Ms. Gould’s sickbed, but she needs to tell us why she could not have made a few further phone calls.